key: cord-0005235-av1gk318 authors: nan title: Abstracts from the 39th Congress of the Société Internationale d’Urologie, Athens, Greece, October 17-20, 2019 date: 2019-10-16 journal: World J Urol DOI: 10.1007/s00345-019-02955-9 sha: 40cc562681d4a838bfe5c246086646ab29563a34 doc_id: 5235 cord_uid: av1gk318 nan There are several molecular diagnostic markers of OAB, however clinical diagnosis of OAB is still symptom-based. The urothelium directly contacts with urine, secreted proteins from the urothelium could be released into urine. In previously study, we demonstrated that urothelial protein expression is dynamically altered by OAB. These altered proteins in OAB urothelium could be used as potential diagnostic markers. In this study we tried to compare the profile of proteins secreted by OAB urothelium with those secreted by normal bladder urothelium to identify molecular diagnostic markers for OAB. The study was conducted using male Sprague-Dawley rats, subdivided into sham control (n= 40) and partial BOO groups (n= 60). Partial BOO was induced for 2 weeks and DO was confirmed with measuring cystometry. The urothelium was carefully removed from the smooth muscle layer under a dissecting microscope and its protein expression was analyzed by LTQ-Velos mass spectrometer. The identified proteins were analyzed to discover upstream molecules, and potential biomarkers that are associated with OAB by using Ingenuity Pathway Analysis (IPA) tool. The analysis was done against the Ingenuity Knowledge Base. The results of this analysis identified 17 putative upstream regulators. Complement component 3b/4b receptor 1-like, huntingtin, and inhibin α act as upstream regulators of Cryab, Aldoa, Tpm2, Myl9, Cnn1, Myh1, and C3, and may cause activation of muscle contraction. Six of the upstream regulators, huntingtin, inhibin α, integrin α2, complement component 3b/4b receptor 1-like, HNF1 homeobox B, and platelet derived growth factor family, may also affect positively the cell movement of leukocytes and neutrophils as well as cellular infiltration by leukocytes through the regulation of many other proteins identified in the urothelium. These regulators are involved primarily in inflammation and cytoskeletal organization. Conclusion: Extracellular proteins expressed by urothelium that are released into the urine could also be used as non-invasive OAB diagnostic markers. These potential markers are closely related to the pathophysiological changes that occur in OAB. In addition, expression of the up-regulated proteins was verified by real-time PCR experiment. Detecting these proteins or their peptide fragments in urine may be a useful tool for the diagnosis. Verification of these proteins in the urine of OAB patients may be useful non-invasive diagnostic markers for OAB. Safety and Efficacy According to Median OS, months (95% CI) 7.9 (6.8-9.1) 11.6 (8. 8-18.8) 9.0 (7. 8-10.4) 14.5 (9.5-18.8) 8.5 (7.5-10.9) 8.3 Overall response rate, % (95% CI) Introduction and Objective: Filarial or idiopathic chyluria is a debilitating and recurrent disease. Here we present our experience and outcomes of laparoscopic pyelolymphatic disconnection for refractory chyluria. In 26 patients (>15 years of age) with filarial or idiopathic refractory chyluria (after failure of Medical treatment + 2 courses of instillation sclerotherapy), laparoscopic pyelolymphatic disconnection procedure was performed between March 2010 and Feb 2018 at 2 tertiary care institutions. Preoperative assessment included clinical examination, ultrasonography, intravenous urography, cystoscopy and retrograde pyelography ± CT scan, serum albumin, urine test for chyle, cholesterol, triglycerides and albumin. Of these, 25 patients underwent unilateral procedure and 1 underwent bilateral procedure. Transperitoneoscopic procedure included skeletonization of renal artery and vein, nephrolympholysis and upper ureteral lympholysis using 3 or 4 ports. Postoperative assessment included clinical examination, serum albumin, urine test for chyle, cholesterol, triglycerides and albumin at 3, 6 and 12 months follow up. Thereafter patients were followed up clinically. Results: Urine became clear in all patients immediately after surgery. In postoperative period, 4 patients had high (>1 liter/day) and/or prolonged (> 5 days) chylous drain output which settled in 3 weeks in all. Absence of urinary chyle, a significant (p < 0.05) increase in mean serum albumin and a significant (p < 0.05) decrease in mean urinary albumin, triglycerides and cholesterol was noted at 3 months follow up after the procedure. In follow up period, chyluria recurred in 3 patients; in one from ureter at 4 months on operated side, in another at 5 months from unknown site on operated side and in third at 12months from contralateral unoperated kidney. All these 3 recurrences responded to povidine-iodine instillation sclerotherapy. Thus, laparoscopic pyelolymphatic disconnection alone was curative in 23/26 (88.4%) patients and 25/27(92.6%) renal units at a mean follow up of 74.6 months. Conclusion: For refractory chyluria, laparoscopic pyelolymphatic disconnection is an effective surgical treatment with low morbidity and offers an early full dietary freedom to these patients. MP-00.03, Figure 1 . A and B: Each ureter was spatulated for 2.5 -3 cm and initial suture was placed at the apex of both ureters, through all layers; thereafter, further muco-mucosal running suture of everted posterior medial ureteral wall edges was placed; C: Lateral edges of the newly formed ureteral plate and the everted ileal mucosa (from the proximal end of conduit segment) were anastomosed in a running fashion; Introduction and Objective: A novel liposomal formulation of bupivacaine is available as a 96-hour delayed release formulation. Given that patient reported pain from the Buccal Mucosal Graft (BMG) harvest site is worst in the first 1-2 days following surgery, infiltration of this medication has the potential to dramatically reduce post-operative pain in these patients. We aim to assess the efficacy and safety of liposomal bupivacaine infiltration on the BMG harvest site in alleviating pain by evaluating the post-operative pain score, narcotic requirement and associated morbidities. After IRB approval, a single-blinded randomized controlled trial was conducted among adult patients with urethral stricture, that were evaluated suitable for substitution urethroplasty using BMG. Patients were randomized using computer generated allocation scheme to group 1 (liposomal bupivacaine) and group 2 (control). Patient demographic and peri-operative data were collected. Outcome assessed were: post-operative day 1 -2 narcotic use, converted as cumulative morphine equivalents on a 24-hour basis. A validated survey with 10-point visual analogue scale for evaluation of patient reported oral pain score, associated oral morbidities, and oral conditions on post-procedural day 1-3 and 1-month follow-up. Fisher-exact test and independent T-test was used to analyze the data with statistical significance set at 0.05 level. (Clinicaltrials.gov registration NCT03720223) Results: A total of 50 eligible patients were enrolled, 7 were excluded according to predefined exclusion criteria (Group 1: 21, Group 2: 22). No significant baseline characteristics difference was noted between the treatment groups. Compared to group 2, a significantly lesser narcotic requirement was noted among the patients in group 1 on post-op day 1 (IV Morphine equivalent mean difference 8.58; 95%CI 1. 59, 15.56, p=0.017) . No significant between group difference was noted for narcotic requirements on post-op day 2. Likewise, no between group difference was noted for post-procedural oral pain score, and oral morbidities on post-op day 1 to 3, and at 1-month follow-up. For post-procedural oral conditions, a significantly higher number of patients in group 1 have reported oral numbness at post-op day 2 (14 (87.5%) vs 8 (44.4%); p=0.013), which was not sustained and equivalent to group 2 at 1-month follow-up. Our study showed that Liposomal bupivacaine infiltration to the BMG harvest site is safe and may adequately address the postprocedural oral pain, with noted significantly fewer narcotic requirements at post-op day 1. Although, higher incidence of oral numbness can be reported among these patients on post-op day 2, which was not long-lasting. Future studies may consider evaluating the cost-effectiveness to determine suitability for routine use. MP-00.14 Introduction and Objective: To describe the effect the size of prostate lesions found using multiparametric magnetic resonance (mpMRI) has on the detection rate of (clinically significant) prostate cancer (CSPCa) using MRI/US fusion biopsy. A total of 536 patients scheduled for prostate biopsy for elevated total PSA were analysed. All patients underwent multiparametric MRI (evaluated by PIRADS v1 system) prior to biopsy. MRI/US fusion guided biopsy was followed by systematic 12 core biopsy in all patients. We evaluated the sizes of mpMRI detected lesions and detection rates of PCa and CSPCa in targeted biopsies with lesions smaller than 5 mm, 5 -10 mm, 10 -15 mm, and larger than 15 mm. The mean patient age was 63 (31-80) years. Mean PSA was 8.94ng/mL. Mean prostate volume and volume of transitional zone was 62.3 mL and 34.5 mL respectively. In 107 patients with benign or low-risk lesion (PIRADS 0-2), targeted biopsy was not performed and they were excluded from subsequent evaluation, leaving 429 patients with PIRADS 3-5 lesions for assessment. We found 392 PIRADS 3 lesions with an average volume of 0.33 cm³, 271 PIRADS 4 lesions with an average volume of 0.99 cm³, and 66 PIRADS 5 lesions with an average volume of 3.9 cm³. The results of the detection of overall prostate cancer and CSPCa for defined lesion diameters in individual PIRADS groups are presented in the following table. Introduction and Objective: The relationship between bone mineral density (BMD) and estimated glomerular filtration rate (eGFR) in medical renal disease is still controversial; in chronic obstructive uropathy this is largely unknown. This study was done to investigate relationship between eGFR and BMD levels in chronic obstructive uropathy with renal insufficiency. This prospective study in a tertiary care institution from December 2016 to September 2018 recruited 100 adult patients with obstructive uropathy and deranged renal function. Surgical/medical renal optimization was done to achieve a nadir serum creatinine before assessing eGFR by EC renal scan. BMD (at lumbar vertebrae L 2 -L4, by DXA Scan) was compared between patients with eGFR 2 (Group A, n= 50) and patients with eGFR >60ml/min/1.73m 2 ( Group B, n= 50) . Vitamin D levels were also assessed in group A patients. Chi-square, independent t-test/Mann Whitney test, spearman rank correlation coefficient, univariate/ multivariate linear regression tests were applied and SPSS ver21.0 was used for statistical analysis. ROC curves were used to define cut off levels of eGFR for osteoporosis and osteopenia. Introduction and Objective: The therapeutic potential of low intensity extracorporeal shock wave therapy (LI-ESWT) in erectile dysfunction is being increasingly recognized, with supporting evidence from animal and human studies. However, there is a scarcity of data on the impact of LI-ESWT on the bladder. We used an experimental model of diabetic rats to investigate the molecular effect of LI-ESWT on the diabetic bladder. Wistar rats were randomized into 3 groups. A control group (Control bladder CB; n= 5), a group of diabetic rats without treatment (DM, n= 5) and a group of diabetic rats treated with LI-ESWT (DM-ESWT; n= 5). Diabetes mellitus type II was induced by a single intraperitoneal dose of streptozotocin (60 mg/ kg). Twenty days after the induction of DM, each rat in the DM-ESWT group received 300 shockwaves with an energy flux density of 0.09 mJ/mm2 at 2 Hz (Medispec ED 1000). Sessions were repeated three times/week for two weeks, followed by a two-week washout period. The bladder was then harvested and quantitative Real Time Polymerase Chain Reaction (qRT-PCR) was performed to analyze the expression pattern of the Transient Receptor Potential Vanilloid 1 (TRPV1), interleukin 1β (IL1b) as well as the muscarinic acetylcholine receptorts M1, M2 and M3 (MAChR1, MAChR2 and MAChR3) in the bladder tissue. Results: The expression of TRPV1, IL1b, and MAChR2 genes was significantly different between the three groups (p= 0.002, 0.000 and 0.011, respectively). The expression of all genes appeared to be increased in the DM group when compared to CB group, but was statistically significant only for the TRPV1 and IL1b genes (p= 0.002 and 0.000, respectively). Treatment with LI-ESWT significantly reduced the expression of the IL1b and MAChR2 genes (p= 0.001 and 0.011, respectively). A tendency for reduced expression was noted for TRPV1 (p= 0.069) as well. Conclusion: In this rat model, induction of diabetes was associated with increased expression of bladder receptors related to mechanosensation (TRPV1), inflammation/ischemia (IL1b), and bladder contraction (MAChR2). Treatment of the diabetic rat bladder with LI-ESWT partly restored the expression of TRPV1, IL1b and MAChR2 receptor genes, indicating a possible therapeutic potential of this treatment modality in diabetic cystopathy. Introduction and Objective: Transrectal ultrasound guided biopsy of the prostate (TRUBP) remains the gold standard for the diagnosis of prostate cancer. Urosepsis is a serious potential complication of TRUBP associated with high morbidity. We performed a retrospective analysis of urosepsis admission rates following TRUBP in a single tertiary centre; where a targeted antibiotic regime is performed based on a pre-biopsy rectal swab screening for ciprofloxacin resistance. Eight hundred and fifty-four TURBPs were performed (systematic TRUBP and/ or MRI/US fused) in Hamilton from January 2015 to December 2017. Urosepsis was defined as hospital admission within 14 days of biopsy with confirmed infection on blood culture or MSU and with at least two of the systemic inflammatory response syndrome (SIRS) criteria. Antibiotic prophylaxis was ciprofloxacin 1 g 2 hours pre-biopsy and 500 mg BD post procedure orally; unless resistance was detected. If resistance was detected, then ceftriaxone 1 g or ertapenem 1 g I.V. was administered instead as appropriate. Results: Ciprofloxacin resistance was detected in 92 (10.8%) of rectal swabs. 62 (7.2%) were ceftriaxone sensitive, and 30 were Extended Spectrum Beta-Lactamase (ESBL) positive. 4 patients (0.47%) presented with urosepsis, all had a prior negative screen, but 2/4 grew resistant E. coli in the blood culture. Only 1 patient required admission to the High Dependency Unit. There were no deaths nor Intensive Care Unit admission. Mean length of stay in hospital was 4.5 days. Introduction and Objective: Interstitial Cystitis/Painful bladder Syndrome (IC/PBS) is a complex urological disorder that significantly affects the quality of life of its sufferers. Patient reported quality of life is emerging as an important concept in overall treatment regime in many disease areas and IC/PBS is no exception. This study was aimed at evaluating patient perception of IC/PBS amongst members of the Bladder Health UK support group. This was an online cross sectional study where a hyperlink containing Brief Illness Perception Questionnaire (B-IPQ) was sent to members of the group with a diagnosis of IC/PBS aged 18-80. Results: A total of 165 respondents completed the 10-point scale domain of the questionnaire, whilst 175 completed the aetiology domain out of 601 members who were approached. 95% of the respondents felt that their condition would continue indefinitely; 75% believed that they were well informed about their condition and are seriously concerned about it. In the aetiology domain, perceived causes of IC/PBS were: no idea (19.4%), infection and inflammation (29.1%), lifestyle (22.3%), pelvic surgery/procedure (6.3%), diet and medication side effects (4.6% each), child-Introduction and Objective: Surgical options are limited when treating large (>80 cc) prostates for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH); there is a need for novel surgical approaches with shorter learning curves and effective treatment. Aquablation (AquaBeam System, PROCEPT BioRobotics, Inc., USA), an ultrasound-guided, robotically executed waterjet ablative procedure, could be this novel tool. This analysis compares the outcomes of Aquablation in 30 cc to 80 cc prostates with the outcomes in 80 cc to 150 cc prostates. is a prospective, double-blind, multicenter, international clinical trial comparing the safety and efficacy of Aquablation and TURP in the treatment of LUTS/ BPH in men 45 to 80 years old with a prostate between 30 cc and 80 cc. WATER II (NCT03123250) is a prospective, multicenter, single-arm international clinical trial of Aquablation in men with a prostate between 80 cc and 150 cc. We herein report baseline parameters and 6-month outcomes in 116 WATER MP-03.01, Figure 1 . TEAEs leading to study drug discontinuation 3 (0.8) 6 (1.7) Drug-related TEAEs leading to study drug discontinuation 2 (0.6) 5 (1.4) Introduction and Objective: To systematically investigate the effects of combination therapy consisted of an α-blocker and a phosphodiesterase-5 inhibi-tor (PDE5I) for the treatment of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). To investigate the effect of baseline urodynamic detrusor contractility on postoperative patient satisfaction after HoLEP in patients with BPH. Database of the patients who underwent HoLEP between May 2012 and December 2016 for BPH was drawn from the prospective Seoul National University Hospital BPH Database Registry. The patients underwent preoperative evaluation including LUTS questionnaires (IPSS, OABSS), uroflowmetry and PVR measurement, TRUS and urodynamic study. Responses to Treatment Satisfaction Question (TSQ), Global Response Assessment (GRA) and Willingness to Undergo the Same Surgery Question (WUSSQ) were obtained at postoperative sixth months. Patients were divided into normal detrusor activity (NDA) group and detrusor underactivity (DUA) group according to the baseline urodynamic results. Introduction and Objective: Vesicoureteric reflux (VUR) is a complication of neurogenic lower urinary tract dysfunction. It is secondary to high bladder pressures and differs aetiologically from primary VUR. There is data to confirm that Macroplastique is effective in the treatment of secondary VUR in spinal cord injury (SCI) patients. Also, botulinum toxin (Botox) alone is effective in improving VUR. The aim of this study is to assess the efficacy of Macroplastique alone or in combination with Botox, in managing VUR in SCI population with presumed healthy bladders. The OABq showed progressive degrading, with sensations worsening slower than other parameters. The association between these two drug classes led to a statistically significant increase in the time between retreatments. Botulinum toxin made solifenacin effective in those cases where it didn't show enough efficacy when used alone. Antimuscarinics apparently decreased the sensation, and that might be the main reason behind longer efficacy. Even when combined with botulinum toxin, antimuscarinics did not cause acute urinary retention. The increased cost of treatment might be balanced by a longer period of efficacy. Therapeutic Effects of PDE9 Inhibitor on Lower Urinary Tract Dysfunction (LUTD) Following Spinal Cord Injury (SCI) Introduction and Objective: Evaluate clinical outcome and patient satisfaction of periurethral bulking as a treatment for stress urinary incontinence (SUI). Review of all patients having undergone periurethral bulking procedures (PBP) at a single institution between January 2014 and January 2019. Results: Fifty-four patients had a PBP by 3 Urological surgeons. Mean first follow-up was 3.6 months and mean latest follow-up was 18 months. Mean age was 58 years and mean BMI was 29.5. Mean pre-operative pad use was 3.6/24 hours and mean UISF score was 14.8. At first follow-up, 22 patients (40.7%) had a successful outcome (one or less pad use) with mean pad use of 1.5/24 hours. Mean UISF score at latest follow-up was 9.9. Twenty-eight (71%) reported duration of treatment effect being between <1 month and 6 months, with 5 (10%) patients reporting benefit beyond 6 months. Mean Likert scale for patient satisfaction with the procedure was 1, on a scale -3 (completely dissatisfied) to +3 (completely satisfied). Those with a higher BMI were less likely to be dry at the first follow-up with 38%, 33% and 20% being dry in BMI groups of normal, overweight and class I obesity, respectively. Those with no SUI on CMG (n= 17) were more likely to be dry at the first follow-up (43.8%) compared to those with SUI (38.9%). Amongst those with previous anti-SUI procedures (n=13), 46.2% were dry at first follow-up, compared to 38.5% with no previous continence procedures. Ten patients (19%) had further anti-SUI treatment (repeat PBP, transvaginal tape, colposuspension). The complication rate was low, with 1.9% risk of urinary tract infection. Conclusion: Whilst transurethral synthetic tapes remain suspended in the UK, periurethral bulking has become a popular treatment for SUI. This retrospective study provides medium-term outcomes following PBP. Improvements were noted in UISF score and pad use post-operatively. Factors determining post-operative success may include a lower BMI and lower pad use. Periurethral bulking was shown to be safe and acceptable as a treatment to patients. Duration of effect was short-lived, with only 5.6% reporting effect lasting beyond 6 months. We would advocate larger, prospective studies to further evaluate this treatment and its durability. A systemic immune-inflammation index (SII) based on neutrophil (N), lymphocyte (L), and platelet (P) counts has shown a prognostic impact in several solid tumors. The aim of this study is to evaluate the prognostic role of SII in metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone and enzalutamide. We retrospectively reviewed consecutive mCRPC patients treated with abiraterone and enzalutamide in our Institutions. X-tile 3.6.1 software, cut-off values of SII, neutrophil-to-lymphocyte ratio (NLR) defined as N/L and platelets-to-lymphocyte ratio (PLR) as P/L. Overall survival (OS) and their 95% Confidence Intervals (95% CI) was estimated by the Kaplan-Meier method and compared with the logrank test. The impact of SII, PLR, and NLR on overall survival (OS) was evaluated by Cox regression analyses and on prostate-specific antigen (PSA) response rates were evaluated by binary logistic regression. Conclusion: SII and NLR might represent an early and easy prognostic marker in mCRPC patients treated with abiraterone and enzalutamide. Further studies are needed to better define their impact and role in these patients. Introduction and Objective: Prostate cancer diagnostics and surveillance has evolved. Pre-biopsy multiparametric MRI with Prostate Imaging Reporting and Data System (PIRADS) scoring is standard practice. The use of PIRADS in conjunction with risk calculators such as the Rotterdam Prostate Cancer Risk Calculator are widely used to avoid unnecessary over investigation of men with suspected prostate cancer. We aim to assess these systems further by correlation with transperineal prostate biopsy results that carry lower complication rates and higher diagnostic accuracy. A prospective review of all template biopsies performed at our institution was carried out from January 2017 to December 2018. Demographic data, histology and complications post-biopsy were obtained. Histology results were correlated with pre-biopsy MRI to assess robustness of PIRADS reporting at predicting clinically significant prostate cancer. Rotterdam Prostate Cancer Risk Calculator scores were applied retrospectively to assess its accuracy. Results: 190 template biopsies were performed during the study period. Mean age was 65 (44-79) and theater mean PSA 9.86 (0.5-40.0 ug/L). Clavien 1/2 complications occurred in 8(42%) patients and no patients developed post-procedure sepsis or infection. Prostate cancer was found in 99 patients with 67% (n=66) of these being clinically significant. The percentage of significant prostate cancer detected by PIRADS scores were: PIRADS-2 (33%), PIRADS-3 (30%), PI-RADS-4 (38%) and PIRADS-5 (55%). 32% of all scans reporting PIRADS 2&3 lesions had significant cancer detected. Treatment escalations, where radical treatment was given to 46 patients. For patients with significant prostate cancer at transperineal biopsy mean Rotterdam Prostate Cancer Risk Calculator scores for risk of prostate cancer detection and risk of significant cancer were higher. Our results illustrate that Trans-perineal template prostate biopsy is a safe procedure and superior at detecting significant prostate cancer when compared to multiparametric MRI and cognitive targeted Transrectal biopsy. In addition, correlation of tranperineal prostate biopsy results with use of the Rotterdam Prostate Cancer Risk Calculator adds further accuracy. Our work indicates further improvement can be made to make pre-biopsy disease prediction more accurate and help to tailor patient selection for prostate biopsy. Diagnostic Accuracy of 68Ga-PSMA PET and mpMRI to Detect Intra-Prostatic Clinically Significant Prostate Cancer Using Whole-Mount Pathology. Impact of the Addition of 68Ga-PSMA PET to mpMRI? Introduction and Objective: Multiparametric magnetic resonance imaging (mpMRI) fusion biopsy has been demonstrated to detect clinically significant PCa as compared to standard transrectal ultrasound (TRUS) guided biopsy but an optimal PSA threshold for its use is unclear. We evaluated the clinically significant cancer detection rate of MRI fusion biopsy stratified across PSA cutoffs. We reviewed 670 men undergoing MRI-fusion and standard TRUS guided prostate biopsy from January 2016 to June 2018. Patients were divided into 3 groups by PSA: <4, 4-10 and >10 ng/mL. The greatest grade form either MRI-fusion or standard biopsy was compared, clinically-significant (CS) PCa defined as Gleason-score 3+4 or greater. Results: A total of 348/670 (52%) men were diagnosed with PCa by either biopsy method. Overall CSPCa detection rate was 131/337 (38.9%) in MRI-fusion biopsy and 134/333 (40.2%) in standard biopsy (p= 0.38). By PSA groups, significantly more patients with PSA 4-10 ng/mL had CSPCa found by MRI-fusion vs standard biopsy (63/337 (18.6%) vs 44/333 (13.2%), p= 0.03). However, patients with PSA <4 ng/mL had CSPCa found by MRI-fusion vs standard biopsy (9/110 vs 6/110, p= 0.36), patients with PSA >10 ng/mL had CSPCa found by MRI-fusion vs standard biopsy (70/172 vs 62/172, p= 0.38). The assessment of tumor aggressiveness is crucial in prostate cancer treatment, but the established prognostic parameters have limitations and new markers are needed. Checkpoint kinase 2 (CHK2) is a serine-threonine kinase with a role in DNA repair, cell cycle arrest and apoptosis in response to DNA damage. Both reduced and increased CHK2 expression have been described in different tumor types with impact on patient prognosis. As a potential new marker, we evaluated CHK2 for diagnostic and prognostic relevance. To evaluate prevalence and significance of altered CHK2 expression in prostate cancer, a tissue microarray containing 9.733 evaluable tumors was analyzed by immunohistochemistry. For prognostic evaluation of the findings, clinical follow up data was taken into account. Results: Nuclear CHK2 immunostaining was absent or weak in normal prostate epithelium, but 82.9% of the prostate cancers we evaluated had a positive CHK2 immunostaining (weak in 36.7%, moderate in 34.5% and strong in 11.7% of prostate cancers). High levels of CHK2 staining were associated with advanced tumor stage, high Gleason grade, positive nodal status, positive surgical margin, high preoperative PSA, and early PSA recurrence (p <0.0001 each). High CHK2 expression was also associated with TM-PRSS2:ERG fusions (p <0.0001). Subgroup analysis of ERG positive and negative cancers revealed that the impact of CHK2 expression on unfavorable tumor phenotype and poor prognosis was largely driven by the ERG negative cancers. In this subgroup, high CHK2 expression was an independent predictor of patient prognosis. High CHK2 expression was also linked to presence of chromosomal deletions, high level of androgen receptor expression, positive p53 immunostaining, and high Ki67 labeling index. Conclusion: High CHK2 expression is linked to adverse tumor features and independently predicts early biochemical recurrence in ERG negative prostate cancer. CHK2 measurement, either alone or in combina-Introduction and Objective: The estimated risk of tumor progression is crucial for the treatment of prostate cancer, but common prognostic markers have limitations. To improve risk stratification, new observer-independent markers are needed. Claudin-1 is a membrane tight junction protein and important for the sealing of the paracellular cleft in epithelial and endothelial cells. Differential expression of Claudin-1 is linked to disease outcome in various cancers. In this study we evaluate the diagnostic and prognostic relevance of Claudin-1 expression in prostate cancer. A tissue microarray containing samples of 13.464 tumors with annotated clinico-pathological and molecular data was immunohistochemically analyzed for Claudin-1 expression. To evaluate the prognostic relevance, clinical follow up data was taken into account. Results: In normal prostate, glandular cells were always Claudin-1 negative while there was a strong staining of gland-surrounding basal cells. In contrast to normal prostatic glands, a positive Claudin-1 immunostaining was found in 38.7% of the interpretable cancers (weak in 12.7%, moderate in 13.2%, and strong in 12.8% of cases). Positive Claudin-1 immunostaining was associated with favorable tumor features like low pT (p= 0.0212), low Gleason grade (p <0.0001), low preoperative PSA (p <0.0001) and was associated with a reduced risk of PSA recurrence (p= 0.0005). A positive Claudin-1 staining was markedly more frequent in ERG positive (63%) than in ERG negative cancers (22.8%; p <0.0001). Subset analyses revealed that all associations of Claudin-1 expression and favorable phenotype and prognosis were driven by ERG positive cancers. In multivariate analyses it became apparent, that even in ERG positive cancers, the prognostic impact of high Claudin1 expression was not independent of established clinico-pathological parameters. Conclusion: Claudin1 is a promising diagnostic and prognostic marker in prostate cancer. The protein is overexpressed in a fraction of prostate cancers and increased Claudin-1 expression levels predict a favorable prognosis in ERG positive cancer. Introduction and Objective: There has been much publicity in Australia regarding the role of mid-urethral slings (MUS) in the treatment of stress urinary incontinence (SUI). Previous research from Canada has suggested no significant change in MUS procedures after relevant Government advisories (see Welk and Winick-Ng, 2015 and Carlson et al, 2017) .We sought to quantify the behaviour of surgeons in England and Australia around important policy releases, including: 1) United States Food and Drug Administration ( Results: Data from Australia and England demonstrate similar patterns of declining MUS procedures in the past decade ( Figure 1 ). Significant change in rates of procedures is evident in both countries from 2014. Australia has also seen a further steep decline in procedures performed since the TGA ban on transvaginal mesh for POP. Conclusion: Recent controversy and subsequent legislative changes in relation to the safety of use of mesh has caused significant impact on the use of MUS in Australia and England. This has important implications for the management of SUI in these countries, highlighting the need for surgeons to address con-cerns and educate patients in relation to appropriate treatment options to ensure adequate treatment continues to occur. To describe the perception and management of urinary incontinence in Ancient Greece with particular emphasis in the Hippocratic era. A meticulous literature review of articles found on PubMed and on Google Scholar related to urinary incontinence as that is depicted through medical history. Results: Ancient Greece has played an important role in laying the foundations of clinical medicine. Its principles have been embraced by people of different cultures across the centuries and helped shape modern day medicine. Hippocrates (c.460-c.370 BC), a prominent figure in Ancient Greek medicine and founder of the Kos medical school, has written extensively about different ailments including that pertaining to the urinary tract. He systematically assessed his patients with medical history and physical examination. Hippocrates introduced uroscopy (macroscopic urine examination) as an additional tool for patient evaluation and he believed that uroscopy has an important role not only for diagnosis but also for prognostic purposes. According to Hippocratic references, urinary disorders were classified in the following four categories: difficult urination or dysuria, dropwise urine or strangury, urinary retention and urinary incontinence. Severe disorders of urination appear frequently in descriptions by the Kos medical school implying the impact that such symptoms had on patients. Urinary incontinence was perceived as MP-05.02, Figure 1 . SIU 2019 ABSTRACT BOOK -39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE 31 unconscious discharge of urine and was distinguished into two main types, namely copious and drop urine wise urinary incontinence. The main principle of treatment was treating the underlying cause and focused around the use of herbal remedies. It was not until the 17 th -19 th Centuries that medical therapies began to emerge and surgical techniques were formally introduced in the 19 th century. Conclusion: It is of note, that even from the Hippocratic era, people were concerned about urinary symptoms as those had an impact on human lives. Although there was lack of scientific knowledge and technology, preliminary efforts were made to classify urinary disorders including urinary incontinence and initial approaches were made to manage those conditions. With regards to urinary incontinence, it is unsurprising that such a complex disease process took a long time to be understood better and for medical and surgical treatment modalities to be initiated. Bladder Stone Surgery: History of the High Operation Siriwardena L, Devarajan R, Kumar P Introduction and Objective: Bladder stone surgery has been synonymous from antiquity with perineal lithotomy. For various reasons, novel approaches to bladder stone surgery were met with resistance. We explore the history of the suprapubic lithotomy otherwise known as the 'high operation' . A comprehensive literature search was performed using Medline, PubMed, Google Scholar and historical texts using the terms 'bladder stone' , 'high operation' , 'suprapubic' , 'lithotomy' and 'cystolithotomy' . Results: The first high operation reportedly took place during the Renaissance. Colot performed a suprapubic lithotomy on a criminal in 1475, however the surgery was largely forgotten until the first recorded case by Pierre Franco a century later. Following failed perineal lithotomy, Franco performed a suprapubic lithotomy to successfully remove a bladder stone in a child. Despite his success, the high operation once again fell into obscurity for many decades. In 1719 it was re-introduced by John Douglas who realised that a distended bladder could be entered extraperitoneally. This was described by Cheselden in 1722 although he would favour perineal lithotomy for his further practice. In 1758 Frere Come developed an approach to suprapubic lithotomy with the 'sonde-a-dard' device that avoided painful bladder distension. A century later the Victorian era saw the advent of anaesthesia which facilitated the suprapubic approach and wider acceptance. Conclusion: From antiquity to 150 years ago the perineal approach to lithotomy was considered the gold standard. From stuttering starts the high operation found its place with the era of anaesthetic and displaced perineal lithotomy. Even in the era of transurethral lithotripsy we still have occasion to call upon suprapubic lithotomy to this day. Fessenden Introduction and Objective: Otis is survived in urology by the Otis urethrotome, an instrument used for internal urethrotomies in the management of distal urethral strictures. Otis' surgical engineering has been used for over 100 years since its inception in 1870, replaced by the Sachse method of direct vision internal urethrotomy in 1970. A non-systematic search of online resources, electronic journals, and archived e-books was performed. Results: F. N. Otis was born on 5th May 1825 in Saratoga, NY, United States. His family emigrated from England to Massachusetts in the late seventeenth century and his father was also a doctor. Otis gained his diploma of medicine in 1852 from New York Medical School, where he excelled and received a gold medal for his thesis. He completed his internship at the Charity Hospital, a penitentiary hospital which served both prisoners and the poor. In 1853, Otis became a surgeon in the Pacific Mail and Steamship Company and later joined the Panama and Pacific Railroad Company in 1859. His artistic works earned him honorary membership to the "Artists' Fund Society", New York. In 1867, he authored "Isthmus of Panama: History of the Panama Railroad…", a richly illustrated book on the Panama transcontinental rail project. He later lectured at the College of Physicians and Surgeons, Columbia University, and became Professor of Genito-urinary and Venereal Diseases in 1871. Otis disproved the accepted theory of the time that the male urethra was limited to 27Fr, and his research into post-gonorrhoeal strictures developed a number of instruments such as dilating urethral sounds (adopted by Clutton, but invented by Otis), the urethrometer, and the urethrotome. He performed hundreds of urethrotomies, pioneering techniques and instruments which deserve recognition. The Role of FDG PET/CT in Evaluation of Response to Systemic Therapy for Metastatic Renal Cell Carcinoma: Dissenting View and Evidence Madhavan SK, Madhavan K, Jain S, Kumar N, Banathia R Introduction and Objective: The application of FDG PET/CT has been limited in renal cell carcinoma (RCC), mainly due to physiological excretion of the isotope by the kidney. We evaluated the role of FDG PET/CT in the evaluation of response to systemic therapy in patients with metastatic RCC. We also compared its utility with CECT (the present standard of care) in this setting. We prospectively observed 24 patients from June 2016 to January 2018 with met-astatic RCC on systemic therapy after having undergone cytoreductive nephrectomy. A baseline study (both FDG-PET-CT and CECT) was done after cytoreductive nephrectomy and repeated after 3months of systemic therapy. Response evaluation was done as per the PERCIST and updated RECIST criteria separately on each patient. Introduction and Objective: Although DJ stents are an integral part of endourological management, they are associated with stent related symptoms which impair quality of life. Many drugs and stent material have been studied and used to decrease stent related symptoms. We did a comparative study of four different drugs used for this purpose. After institutional ethical and scientific committee approval, the study was conducted at our institute from January 2018 to January 2019. Fifty patients between 18 to 60 years of age were enrolled in each group. Patients with prior LUTS, DM, B/L stent, pregnant mothers and patients who were on trial drugs for other indications or contraindication of trial drugs were excluded. Same material (Teflon) DJ stent was used and patients having distal coil of stent crossing midline on post procedure xray were excluded. All the patients were randomised by computer generated numbers into 5 groups. Patients received 21 days course of Alfuzosin 10 mg, mirabegron 50 mg, solifenacin 10 mg, tadalafil 5 mg (single dose night time) as per their group after catheter removal. Folic acid tablets were given as placebo. 1st follow up visit was conducted between 7th to 10th day after discharge and second visit at 21st day after discharge. Patients were evaluated by various parameters like urinary symptoms score( voiding and storage) by IPSS, QOL measures, pain score, sexual function, general measures realeted to absent from work and any additional measures like unplanned consultation, adverse reactions and early stent removal. Results: Demographic data were comparable in all the groups. Urinary symptoms, work performance, QOL and body pain were significantly improved with alpha blockers. B3 agonist and anticholinergics were significantly improve storage and body pain symptoms. PD5I was the only group which improved sexual performance. All drugs were tolerated by patients. Three patients in PD5I group and 4 in placebo group unplanned visit and 2 of them needed early stent removal in either group. Conclusion: Usage of various medicines improves stent symptoms and QOL but none of them improves them in all the aspects. All drugs are safe and tolerable by patients. Large multicentric trial is required. Improvement of Blood Pressure in Hypogonadal Men Receiving Long-Term Treatment with Testosterone Compared to a Hypogonadal Control Group: 6471 Patient-Years of Clinical Experience Introduction and Objective: Hypogonadism was added to the 2018 AUA Guidelines with 31 Statements, 3 of which mention cardiovascular related factors. In an ongoing registry study in a single urology practice, we monitored cardiovascular related parameters for up to 12 years. We report data from 805 men with symptomatic hypogonadism participating in a registry study started in 2004. 412 men received testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group), 393 opted against TTh and served as controls (CTRL). Changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction and adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and quality of life to account for baseline differences between groups. Results: Mean (median) follow-up: T-group 8±3 (8), CTRL 8±2 (9) years. Total observation time: T-group 3309, CTRL 3162 years. Baseline age was 58±7 in T-group and 64±5 years in CTRL.Antihypertensives were used by 52.7% in T-group and 46.7% in CTRL, Statins by 43.6% in T-group and 55.7% in CTRL. All patients were encouraged to change lifestyle at baseline.T-group: Systolic blood pressure (SBP) decreased by 23.6±0.7mmHg in year 10. CTRL: SBP increased by 7.7±0.8mmHg. Estimated adjusted difference between groups: -31.3mmHg.T-group: BMI decreased by 6.0±0.1kg/m2 in year 10. CTRL: BMI increased by 1.1±0.2kg/m2. Estimated adjusted difference between groups: -7.0kg/m2.Over the whole observation time no MI or stroke occurred in T-group, 59 MI and 52 strokes were observed in CTRL. Conclusion: Long-term TTh in hypogonadal men improved blood pressure despite advancing age. In an untreated control group, blood pressure worsened. BMI and waist circumference both increased in untreated controls while decreasing in the treated patients. Alfa Blockers Dosage for BPH and Quality of Life of The Patient -Does It Affect Our Decision? Introduction and Objective: For the last 45 years, alfa blockers drugs have played a crucial role in the treatment of BPH patients. However, while many of those patients dropped out from the daily treatment, no general effort from the urologic community was made to evaluate the reason for the noncompliance or the need of the daily use of these drugs. : 320 patients entered the study. The patients were divided into two groups. The first group (n=165) were patients who received alpha blockers but wished to discontinue with the drug. The second group (n=155) were patients who were recently diagnosed with BPH. Patient's baseline entrance in FLOWMETRY was QMAX less than 12 and or urine more than 60 mL. Baseline IPSS was more than 15 points. Patients from the first group and the second group were instructed to change their daily usage of Tamsulosin and to upgrade or degrade the daily usage of the drug according to the flow and their own quality of life. The tailored usage of the drugs was carefully monitored by IPSS and periodical FLOWMETRY. The average max flow rate in the first group was 13.1 and 10.5 in the second. Mean IPSS score was 16 in the first group at the start and 22 at the second group. A third of the patients from the first group were unable to change their habits. A fifth of the patients of that group could keep an alternating daily usage of Tamsulosin, and half continued and could change their daily usage of Tamsulosin to twice a week. Immediate improvement was reported among 118 out of the 155 patients from the second group, while no change in quality of life was reported in 5 percent. The FLOWMETRY and IPSS among the first group of patients kept with a small range of 3 points on the IPSS score. In the second group the IPSS improved dramatically to 15 and remained so. We discuss an unusual presentation, a vulval-urethral mass, of a rare condition, primary bladder lymphoma. We discuss the history, the investigations (with images) and the treatment. We then review this rare disease. A 78-year-old lady (with mild dementia) was investigated for non-visible haematuria. On flexible cystoscopy a large soft irregular mass was seen extruding from the urethra. It was continuous with a mass involving the neck and trigone with a diffusely reddened bladder. Urine cytology revealed hyperchromatic nuclei but no obvious malignant cells. She underwent TURBT of the internal component and a biopsy of the external component. Both specimens showed diffuse infiltration by large malignant lymphoid cells with frequent mitotic figures and apoptotic bodies. High Ki67 95%. These features were consistent with diffuse large B cell lymphoma.On CT urogram, there was a lobulated lesion at the level of the trigone measuring approximately 3 x 2 cm in size. It appears to further extend superiorly along the posterior wall to the level of the left VUJ. A right inguinal node measured 27mm. She was referred after TURBT, to the haematology team who commenced prednisolone 40mg and 4 cycles of multi-agent low dose chemotherapy R-Pmit CEBO in 6-week cycles. There was shrinkage of the tumour. She then received 30 grays of external beam radiotherapy over 15 sessions. She achieved an excellent response. The lymphoma arises in the sub-mucosal follicles. Peak age is 40-60 with women being affected more commonly. It more usually forms part of a systemic picture. There is a spectrum of variants, with T cell, Burkitts, diffuse large B and Hodgkins. The most frequent variant is the low-grade mucosa associated lymphoid tissue variant. Diagnosis is by microscopy and appropriate immunohistochemistry staining. These are done to exclude lympho-epithelial carcinoma and small cell neuro-endocrine carcinoma which can mimic this. Knowledge Attitude and Practice (K.A.P.) Gap for the Stone Disease Management in Patients with Recurrent Stone Disease: Survey Based Analysis of Tertiary Care Centre at High Stone Burden Area and Its Implementations. Shah P 1 , Jha A 2 , Panwar G 1 1 B.T. Savani Kidney Institute, Rajkot, India; 2 Sterling Hospitals, Rajkot, India Introduction and Objective: Person who had renal stone once has 50% chances of having renal stone within 10 years. Being in tertiary care centre of high stone belt area we are dealing with huge number of patients facing consequences of recurrent stone disease. We have noticed a wide gap in knowledge, attitude and practice of these patients regarding their problem. After institutional ethical and scientific committee approval we have prospectively collected data of patients who were presented to our hospital with history of any form of stone surgery or documented lithuria. Children less than 14 years, mentally retarded patients and socially dependant old age patients were excluded as they are under the influence of their care taker. We have collected a data of 500 patients having recurrent stone disease. Among them only 24% of patients were under regular follow up and detected stone on their follow up. 80% among them are male and highly educated. In the rest 76% of cases, 70% were of female patients. Education status is below par in that group. 25% had history of spontaneous lithuria. In this group 16% were feared for surgery, 21% were waiting for medical management, 18% were consulted quacks, 15% had economical problems, 8% didn't have any symptoms and detected accidently and 25% were waiting for spontaneous passage of stone with local home-made remedies. 5% were required nephrectomy in that group and 15% had some form of complications due to delaying the management. Mean delay time was 11 months in that group and more in case of female patients. Introducing new skills in the setting of minimally-invasive surgery (MIS) can have long and variable learning curves. This study was undertaken to evaluate the impact of age on the ability of learning novel surgical techniques in the MIS setting. Materials and Methods: Thirty-two subjects were recruited into the study representing a wide range of ages and educational levels. Trainees were divided into four groups with eight individuals in each group. Group one (GRP #1) was composed of eight senior high schools. Group two (GRP #2) was comprised of eight senior undergraduate college students. The third group (GRP #3) were medical students in the third or fourth year of medical school. The fourth group (GRP #4) was constituted of eight PGY1 or PGY2 residents. Trainees were asked to perform nine successive, novel tasks in a standardized laparoscopic training box. Each series of nine tasks were repeated for five trials in order to assess the maximum efficiency of carrying out the assigned novel skills. Results: High school students exhibited the longest average trial time to completion during the first repetition of the nine serial tasks. However, by the end of five repetitions, high school students were demonstrating the fastest average time to complete the nine assigned tasks. These were followed by undergraduate students and medical students. Interestingly, residents constituted the slowest group after five repetitions of the nine tasks. Conclusion: These preliminary results suggest that younger individuals acquire novel laparoscopic skills with greater efficiency than do senior students and surgical residents. These results raise the larger question of how we may need to change surgical education and the selection of future surgical candidates based in part on psychomotor information and skills acquisition. MP-05.14 Introduction and Objective: We present a new portable, low-cost mobile based surgical simulator and compare to a commercially available simulator. We validated it for its face, content, construct and concurrent validity. The new surgical simulator uses any mobile smartphone as camera, light source and display. It is homemade with manufacturing cost <11 USD (Rs 750/-), dimensions of 18" ×5" ×10", weighing around 500 gm. 18 urological surgeons (12 residents and 6 consultants) were included in the study. They were asked to perform some exercises on both simulators. Their performance was scored on the basis of time and penalty by an independent observer. Accordingly, their total score was calculated. Lower scores were better. Every surgeon rated both the simulators subjectively on the Likert scale 1-5 based on questionnaire. Results: The simulator experience was rated positively by novice and experts with mean score of 2.8 to 5 and 3.5 to 5 respectively, establishing its face and content validity. They all thought the new simulator is portable, performs warm-up exercises, records and maintains log of one's performance and helps distant coaching. The mean scores of the tasks on new simulator were less or equal to the old simulator but was not statistically significant. This showed the similar performance on both the simulators, proving non-inferiority of the new simulator and its concurrent validity. The mean scores of the expert group were significantly less than the novice in all the tasks performed on new simulator except the circle cutting task. Thus, the new simulator could differentiate between novice and the expert surgeon, thus establishing its construct validity. Conclusion: This new portable, home-made, low-cost mobile based surgical simulator has all four validity to be used as a surgical simulator. This new simulator may prove boon in developing countries where cost is a concern. Introduction and Objective: Transurethral resection of the prostate (TUR-P) remained as gold-standard treatment in treating Benign prostatic hyperplasia (BPH), thus its mandatory for all urology residents to develop surgical and technical skills for TUR-P. However, current dry lab training for TUR-P is either still expensive or inadequate to emulate prostate resection on human. This study would like to develop a novel 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK model similar to human prostate in terms of its texture profile and anatomy. Materials and Methods: Ten designs of prostate model were proposed. Objective measurement, subjective measurement, and anatomical design development were done in this study. For objective measurement, texture profile parameters were measured comparing the designs with human prostate, using Lloyd Texture Analyzer TA-XT2i (Llyoid Instruments, Ametek Inc). Four texture parameters were included, namely hardness, elasticity, cohesiveness/consistency, and adhesiveness/stickiness. Most similar model to human prostate were selected for subjective measurement by urologist review using satisfactory questionnaire, and comparison with a control model was done. Feedbacks from the questionnaire were used as reference in developing a 3D design to mold the model. In objective measurement, each designs and prostate underwent two successive compression cycles using Texture Profile Analyzer. Mean Hardness, elasticity, cohesiveness/consistency, and adhesiveness/stickiness of human prostate were 3753.4±673.4, 85±1.9, 0.7±0.03, and 0 respectively. Design number IX were objectively more similar to human prostate with results of 3660.7±465.6, 87.0±2.5, 0.6±0.05, 0 respectively. Subjective measurement from urologists (n=22) by comparing the prostate model with control resulted in mean score of 16.95±1.36 and 8.86±3.10 respectively (P=0.001). Most of the respondents agreed that the texture, consistency, and phantom ability to mimic human prostate upon resection were similar to human prostate. Most of the feedback were to add anatomical hallmarks of prostate, e.g. verom-ontanum, medial, and lateral lobes. We used these feedbacks to develop a mold designed to produce these important hallmarks. Introduction and Objective: Several robotic simulators have been shown to improve basic robotic skills. But there are no studies showing that basic robotic skills could be transferred to the operating room. The aim of this study was to assess the transferability of basic robotic skills from the daVinci Surgical Skills Simulator to the operating room. Fourteen robotic-naïve urology residents were randomized to 2 groups: Group A were required to practice 3 sessions on the simulator whereas Group B was required to practice until reaching competency as defined by the Norm-referenced method with 5 experts. All experts and residents performed were recorded while performing 9 exercises on the simulator. After completion of the simulation training, both groups performed bladder mobilization and urethro-vesical anastomosis during robotic prostatectomy. Recordings were assessed blindly using the validated GEARS tool using C-SATS. Wilcoxon rank-sum test was used to assess differences between groups. Spearman's correlation coefficient (rho) was used to assess correlation between the GEARS scores obtained on the simulator and in the operating room. Introduction and Objective: The U.K has seen a 42% increase in emergency admissions over the last twelve years. This has translated to the increasing difficulty for hospitals to reliably deliver elective care, often with patients being cancelled. We noticed a concerning number of patients being unnecessarily admitted out of hours. The aim of this quality improvement project was to assess and improve the current status of Urology out of hours admissions. We used the Plan-Do-Study-Act (PDSA) quality improvement methodology. Questionnaire surveys were distributed to the Surgical SHO for urology patients admitted out of hours over a 2-week period pre-(n=32) and post-intervention (n=34). Various parameters were evaluated. Clinical notes, imaging and laboratory tests were reviewed. Patients admitted for less than 24 hours were further assessed to evaluate whether their admission was avoidable. Our intervention consisted of an emergency urology lecture delivered to trainees (FY1-CT2). Furthermore, we introduced a new policy where all admissions were required to be discussed with the Urology Registrar. Results: Pre and post intervention audits revealed improved rates of escalation to the urology registrar (41%vs87% p=0.04), and avoidable admissions (35%vs90% P=0.02). We also demonstrated a reduced length of admission, patients that were not clerked and those that were incorrectly worked up and had a change in their diagnosis/management. There was a significant improvement in rate of escalation as well as avoidable admissions through our interventions. The implementation of which led to improved patient safety, an essential part of good clinical governance. Introduction and Objective: It is very difficult to distinguish the retractile testis from the gliding testis in the clinic. We want to find the rate and size of gliding testis compared to retractile testis. We evaluated 71 consecutive boys who performed unilateral or bilateral scrotal orchiopexy for retractile or gliding testis under 2 years old. We included 114 (83.2%) retractile testes and 23 (16.8%) gliding testes and excluded 7 inguinal testes in these patients. We distinguish retractile testis and gliding testis as two anatomical findings of the gliding testis: the abnormal attachment of the gubernaculum and a patent processes vaginalis. Additionally, we compared with 21 hydrocele testes for the control group. Testis volume was calculated using the Lambert formula, length * width * height * 0.71. The mean age was 17.1 ± 4.2 moths (8-24 months). The gliding testes were more frequently unilateral than the retractile testis. The bilaterality was 64.8% in the retractile group and 2.8% in the gliding group, and 23.9% in retractile and gliding group in each laterality. Volume of testis was 1.05 ± 0.41, 0.88 ± 0.27 and 1.12 ± 0.24 cc in retractile testis, gliding testes and testis with hydrocele in each. (P=0.018) There was significant different in volume only between gliding testis and testis with hydrocele. However, there was no significant between gliding testis and retractile testis, and retractile testis and testis with hydrocele. The epididymal abnormality was found 12.3% and 52.2% in retractile and gliding group in each. The patients were classified as follows according to the clinical characteristics (cystic dense, reducible), internal inguinal ring (IR) types (hole with communicating, hole with tapering, closed) and treatment methods (Group 1: laparoscopic assisted high ligation only, Group 2: high ligation + scrotal aspiration, Group 3: hydrocelectomy). We compared the success rate and complications. The patients with reducible hydrocele were performed only high ligation, with cystic dense hydrocele were added aspiration. When the hydrocele had closed IR, hydrocelectomy was performed. Results: The mean age of the patients was 30.4 (19-105) months. The mean follow-up duration was 28 (4-52) months. There were two clinical features; cystic dense in 71, reducible in 115. There were three types of IR; hole with communicating in 121, hole with tapering in 61, closed in 4. The size of the testis had hydrocele was smaller than contralateral side. There were 124 units in group 1, 50 units in group 2 and 12 units in group 3. The success rate was 97.6% (121/124) for group 1, 98% (49/50) for group 2 and 100% (12/12) for group 3. The size of testes with hydrocele was smaller than the other side. Laparoscopy for classification is necessary for accurate diagnosis and treatment, which may reduce unnecessary scrotal surgery. Introduction and Objective: In recent years, disposable circumcision sutures are widely used in clinical practice. It has the advantages of no suturing, short operation time, less bleeding, low infection rate and beautiful appearance. However, the disposable circumcision suture device does not ligature large blood vessels when cutting the foreskin. It is more likely to occur subcutaneous hematoma. In our study, we try to preoperatively suture the visible, thicker superficial penile veins at the far-end of cut point to avoid subcutaneous hematoma or edema. A total of 100 patients, aged 20 to 33 (25 ± 2) years old, were enrolled in the outpatient clinic in our hospital from January to June 2018 because of prepuce or circumcision. Group A: the visible, thicker superficial penile vein was first sutured at end-far of the stapler suture. Group B: direct suture circumcision. The hematoma is a dark purple swollen area with subcutaneous confinement. According to the hematoma diameter, it is divided into small hematoma (< 5 mm), middle hematoma (5 ~ 10 mm), and large hematoma (> 10 mm). Results: There were 32 cases of penile hematoma after operation,6 cases in group A and 26 cases in group B. The smaller hematoma is wrapped with gauze pressure. In group B, there were 5 cases of large hematoma immediately after operation. There was only a small amount of oozing in the margin of the group A, and the amount of bleeding was 1 to 3 (1.6 ± 0.3) mL. The amount of bleeding was 2 to 15 (2.5 ± 0.6) mL of the group B, and the difference was statistically significant (P < 0.01). Introduction and Objective: Assessment of urethral stricture (US) management seems important to evaluate the quality of attention and plan educational interventions. We aim to investigate the patterns on diagnostic and therapeutic approaches to adult male anterior US among urologists in Spain. Materials and Methods: Invitation to participate was sent to all members of AEU (Spanish Urological Association) by email. Non-validated, anonymous, 23-questions online survey was linked to each invitation. Demography data and information about prac-tices on evaluation and treatment of anterior US were included. In total, 1737 invitation letters were sent by email, with 21.7% response rate. Data was prospectively collected during 8 months (February-September 2016), sending reminder emails every 2 months. Descriptive analysis and univariate comparisons were conducted using X 2 test. Statistical significance considered when P ≤0.05. Results: Responders were mainly from Tertiary (63.6%) and Teaching University Hospitals (70.2%). Age distribution was uniform. 63.2% treated ≥ 10 patients/year with US. Retrograde urethrogram (RUG) was the commonest diagnostic tool (99.5%) followed by uroflowmetry (UF). Internal urethrotomy under direct vision (DVIU) was the most frequent treatment (95.7%) along with urethral dilatation. 84.4% limited DVIU for US ≤1.5 cm. 62.3% performed ≤5 urethroplasties/year. Anastomotic urethroplasties were performed by 75.7% and graft repairs by 68.9%. Dorsal grafting was preferred rather than ventral. Non-transecting techniques were used by 23.9%. UF was the most common follow-up tool (94.7%). Up to 23.9% of responders would refer a patient with a 3.5 cm bulbar stricture, while only 17.6% if the stricture had measured just 1 cm. Half of the urologists rated their training on US treatment as adequate, and 88.4% stated that referral units are required. Tertiary hospitals used Patient Reported Outcome Measure (PROM) questionnaires more frequently than secondary centres (P= 0.016). High-volume urologists were more likely to use non-transecting techniques (P <0.001) and to choose urethroplasty as first choice procedure (P= 0.002). Conclusion: Male anterior US in Spain are treated by many urologists, mainly using endoscopic procedures. RUG is preferred for diagnosis, and UF for follow-up. A high percentage of urologists perform urethroplasties, mainly anastomotic repairs, but in low volume. Referral centres are felt as necessary and educational activities required. Introduction and Objective: Split-thickness skin graft is typically used in neoglans reconstruction following glansectomy or distal corporectomy. A sheet graft (SGr) is harvested from anterior thigh and secured over the tip of the penis both with quilt and secure stitches. Sheet grafts provide excellent cosmetic result, but they carry a theoretical risk of graft failure due to subgraft hematoma. In contrast, meshed grafts (MGr) are considered safe in term of graft take, but they are aesthetically inferior. The aim of this study was to compare the surgical outcomes in sheet grafts with 1.5:1 meshed grafts. This was a retrospective comparative study of patients who undertook penile-preserving surgery for penile cancer or lichen sclerosus with at least 6 months follow up. We included those who underwent sheet grafts or 1.5:1 meshed graft neoglans reconstruction. Patients with disease MP-06.08, Figure 1 . The relationships between AGEs and the ED severity in the diabetic ED group. recurrence were excluded. Primary endpoint was the percentage of graft loss while secondary outcomes were any intervention to prevent graft slough, patient reported aesthetic result (scale 0-10) and sexual performance (IIEF Questionnaire). Pearson test was used for correlations and t-test to assess intra-group variability. Introduction and Objective: Testis sparing surgery (TSS) is applied in selected patients with testicular masses. We herein analyzed the oncological and functional safety of this method. In this multicentric study we reviewed the outcomes of 65 patients who underwent 66 TSS for different indications. Results: Mean patient age was 31.0±10.8 years. In 47 patients TSS was performed as an elective procedure (normal contralateral testis). 13 patients had previous unilateral orchiectomy (10 radical orchiectomies (RO) for germ cell tumors). 5 patients had bilateral synchronous testis tumors where 4 underwent unilateral RO and TSS on the contralateral side, 1 had bilateral synchronous TSS. Overall, 47 masses were benign and 19 were testicular cancers (seminoma n= 12, nonseminoma n= 7). Mean tumor size of the benign and malignant tumors was 16.1±10.8 mm and 16.7±7.6 mm, respectively (p= 0.85). All patients with germ cell tumors had Stage 1 disease. Mean pathologic tumor size was 15.5±8.0 mm. Intraoperative frozen section evaluation of the mass was performed in 45 patients (all benign pathology). Tumor bed biopsies were taken in 18 patients with malignant TSS pathology and intratubular germ cell neoplasia (ITGCN) was detected in 4 (22.2%), 3 of them had concurrent cancers ≥2 cm. During 25.5±22.7 months follow-up, no patient developed systemic disease, local recurrence was detected in 4 patients who metachronously needed RO (3 with ITGCN in frozen section). Of the 16 patients with malignant pathology, 13 patients had normal preoperative testosterone levels, that remained at normal level following TSS in 10 patients. Erectile dysfunction (ED) was present in the remaining with testosterone deficiency needing hormonal replacement. No ED was reported in the 45 patients with benign lesions. Conclusion: TSS seems to be a safe and feasible approach with adequate cancer control and preservation of sexual function in 2/3 of patients harbouring malignancy. Introduction and Objective: Penile cancer is a rare malignancy in the developed world. The management guidelines are mainly derived from retrospective studies and currently there are no randomised trials. The primary objective of this study was to assess patterns of practice and outcomes of penile squamous cell carcinoma across several tertiary hospitals in Melbourne, Australia. A retrospective, multicentre database of patients undergoing treatment for penile cancer was created between January 1999 and August 2018. Patient demographics, presentation, clinical status of inguinal node, cancer stage, recurrence patterns and clinical outcomes were reviewed. All data was de-identified and analyzed using IBM SPSS version 22 and Microsoft Excel. Continuous variables were expressed as medians with ranges. Categorical variables were expressed as numbers with percentages. Kaplan-Meier survival analysis was performed to calculate overall survival (OS) and relapse free survival (RFS). Overall survival was calculated from time of detection of penile cancer to last follow up. Relapse free survival was calculated from time of surgery to last follow up. Log rank test was used to assess statistical significance. Factors affecting survival were iden-tified using univariate analysis. Multivariate logistic regression analysis was performed to identify factors independently affecting overall survival. Results: A total of 96 patients with histologically proven squamous cell carcinoma of the penis were included in the analysis with a median patient age of 67.7 (32-92.5) and median follow up of 14 months (0-142). Human papilloma virus (HPV) status was known in 49 patients, with HPV positive patients having a longer overall survival than HPV negative patients. Organ preserving surgery was the most common operative management for primary tumour (n=79, 82.3%), followed by radical surgery (n=15, 15.6%). Histopathological staging of the primary tumours demonstrated pT1 (37.4%), pT2 (44%), pT3 Introduction and Objective: There is an absence of evidence confirming the oncological superiority of one treatment strategy directly compared to another for localised penile cancer, and treatment decisions depend largely on experience of the treating clinician. Surgical decision making and data set comparisons would be significantly enhanced by a consistent, reproducible system that quantitates the pertinent characteristics of localised penile tumours. Currently, there is no system to characterise penile tumours. We present a structured, reproduceable, quantitative scoring system to describe and classify the most surgically relevant features of localised penile cancer. A consecutive sample of men undergoing surgery for penile cancer from January 2000 to August 2018 from 8 institutions were included. We defined complex tumours as those that underwent radical penectomy. Multivariable logistic regression analysis was used to identify predictive factors for complex penile tumours. We then used the beta coefficients from this model to develop a complexity score akin to nephrometry score. Receiver operating curves were created to assess predictive performance. Results: A total of 90 patients were eligible for analysis of which 15 (16.7%) underwent radical penectomy. Lesion location and cystoscopy results were found to be predictors of undergoing radical surgery. Lesions located in areas other than the glans were significantly more likely to be complex and undergo radical penectomy [OR 10.02, ]. Patients with a lesion observed on cystoscopy were also more likely to require radical treatment [OR 52.94, 95%CI 3.67-1691.04]. The PEN13 score allocated points for the Introduction and Objective: To validate the prognostic value of the 8 th TNM staging system and assess a modified N stage by incorporating high-risk human papillomavirus (hrHPV) status in a multi-center cohort. The entire cohort consisted of 292 patients with M0 penile squamous cell carcinoma from 6 referral centers and hrHPV status was examined. The Chinese multi-center cohort (n=230) was used to validate the 8 th TNM staging system and propose a modified N classification. The modified N classification was further validated in an independent cohort (n=62) from Moffitt Cancer Center (MCC). Results: The median follow-up was 48.9 months. 42.1% of patients had node-positive disease with a 5-year overall survival (OS) of 47.5%. In the primary cohort, the 8 th edition achieved better discriminative ability compared with the 7thedition with a C-index of 0.769 versus 0.751 (p=0.029). The 8 th N category could better stratify survival between pN1 and pN2 (HRs compared to N0 from pN1 to pN3: 2.47, 5.30 and 8.50, p<0.001) and reclassify 14.82% of the node-positive disease into pN1 with a 5-year OS of 63.87%. HrHPV status could further stratify pN2-3 disease (p=0.040) and pN2-3/hrHPV-disease had a dismal 5-year survival of 32.48%. The newly-proposed 3-tier classification (pN1, pN2-3/hrHPV+, pN2-3/hrHPV-) significantly increased the C-index from 0.627 to 0.659 compared to the 8 th N classification (pN1, pN2-3) (p=0.04). Results of significant improvement (C-index from 0.575 to 0.663, p=0.027) were observed in the external validation of the modified N classification with MCC. The 8 th edition of the AJCC staging system for penile cancer, especially the N category, showed better discriminative ability in prognostic stratification. The addition of hrHPV status would further improve the prognostic stratification in node-positive disease. Jiang S, Jackson S, Calvert C, Pruett T, Warlick C Introduction and Objective: The management of prostate, renal, bladder, testicular, and penile cancer in transplant recipients is challenging and remains controversial. Currently there is no consensus regarding screening and management, with much of the clinical decision-making based on historical practices that fail to take into account recent progress in both genitourinary (GU) cancer diagnosis and management, as well as the immunosuppression protocols used by modern transplant teams. The University of Minnesota Solid Organ Transplant database, curated based on UNOS data collected from 1984 -2017, was queried for renal transplant recipients in whom development of subsequent urologic malignancies (prostate, bladder, renal, penile, and testicular cancer) was found. Results: In total, 4983 renal transplants were performed from 1984 to 2017 at the University of Minnesota. Among patients who underwent renal transplantation, genitourinary tumors were detected in 197 subjects (3.9%). The predominant genitourinary cancer was renal cell cancer, both of the native and of the transplanted kidney (n = 83), follow by prostate cancer (n = 59), bladder cancer (n = 44). Cumulative incidence of all cancers of a genitourinary etiology are presented, with each of the respective GU malignancies demonstrating respective 20-year incidence rates from the time of transplant of less than 4%. Conclusion: This study presents analysis of the Minnesota experience with regard to the incidence of GU malignancy in the immunosuppressed transplant patient. We demonstrate that despite heavy screening, there is no increased risk of developing GU malignancy in this population of renal transplant recipients. El Kaddouri H 1 , Doerfler A 2 , Broeders N 1 , Quackels T 1 , Lemoine A 1 , Nortier J 1 , Roumeguère T 1 MP-06.14, Figure 1 . The association between malignancies and immunosuppression in KT is well recognized. The aim of this study was to analyze the incidence, treatments and outcomes of bladder cancer (BC) in kidney transplant recipients (KTR). We conducted a retrospective analysis of all KTR in our institution between January 1993 and December 2018. We analyzed patient's demographic characteristics, past medical history including the initial nephropathy, and bladder cancer's treatments with outcomes. Results: During this period, 1720 KT were performed in 1586 patients and 27 patients (1.7%) were diagnosed with a BC. The mean delay between KT and diagnosis of BC was 8.9 years. Fifteen patients (55%) had been previously exposed to aristolochic acids and 7 were smokers. BC was non-muscle invasive (NMIBC) in 17 patients (63%), muscle invasive in 10 cases (37%) and metastatic in 4 cases (14.8%). All cases have been managed in accordance with current urological guidelines after transurethral bladder resection. In NMIBC patients, 6 relapsed after mitomycin C and were successfully treated with BCG. Immunosuppression doses were adjusted, and prophylactic anti-tuberculous treatment given to reduce risks of graft rejection and infection. One patient underwent a radical cystectomy for local recurrence and non-eligibility for BCG-therapy. Overall mortality of muscle-invasive and metastatic disease was high with 85% mortality rate. Conclusion: In our series, BC incidence is high in recipients for end-stage aristolochic acid nephropathy. Management of BC in KTR is similar to the non-transplanted population. Under standardized conditions, immunotherapy based on intravesical BCG is feasible, effective, and well tolerated in renal transplantation. A close follow-up of KTR suffering from a Chinese herbs nephropathy is mandatory to avoid progression as prognosis of muscle invasive BC remains very poor. Introduction and Objective: Kidney transplantation (KT) is the optimal treatment for end stage renal disease. The association between malignancies and immunosuppression (IS) in KT is well recognized. The aim of this study was to analyze the incidence, treatments and outcomes of urological malignancies in kidney transplant recipients (KTR). We conducted a retrospective analysis of all KTR in our institution between January 1993 and December 2018. We analyzed patient's demographic characteristics, past medical history including the initial nephropathy, and all diagnosed urological malignancies with treatments and outcomes. Results: During this period, 1720 KT were performed in 1586 patients and 62 urological malignancies were diagnosed in KTR. The most frequent were 38 urothelial malignancies (27 bladder cancers including NMIBC and MIBC and 11 upper tract urothelial carcinomas) -related to the large number of recipients for end-stage aristolochic acid nephropathy -followed by native kidney cancers (14 patients), prostate cancers (9 patients) and testicular cancer (1 patient). No graft cancer was reported. The majority of the malignancies were diagnosed at a localized stage and could be treated with a curative intent, in accordance with current oncological guidelines. Modification of IS was not always mandatory and no graft-nephrectomy was performed. Introduction and Objective: Robotic Assisted Kidney Transplant (RAKT) is being increasingly utilized in adult patients. Its application in paediatric population is still evolving. Equipment size, learning curve and small working space are major issues. Herein, we compared outcomes of children who underwent RAKT with open kidney transplant (OKT) at our centre. Materials and Methods: Five children (M:3, F:2) aged between 7-16 years underwent RAKT and 14 (M:8, F:6) aged between 11-17 years underwent OKT between April 2016 to March 2019. Grafts were laparoscopically harvested from adult donors. Kidney was introduced inside the peritoneal cavity through Pfannenstiel incision in three child and Gelpoint ® in two. Anastomosis was performed with common iliac vessels (end to side) in all the three cases of RAKT while in open cases depending upon the size of children, anastomosis was done with common, internal or external iliac vessels. Modified Lich-Gregoirureteroneocystotomy was performed in all cases over DJ stent. between the two groups. Mean operative time was longer in RAKT but was not statistically significant. Diuresis was immediate in all patients. Mean estimated blood loss (EBL), need for analgesia, length of scar and incidence of wound infection significantly favoured RAKT. Conclusion: Well performed RAKT is technically feasible and safe in children with similar functional outcomes. RAKT is cosmetically superior than open procedure especially in girls. More cases of RAKT are required to established better comparative results. To compare the perioperative, functional and oncological outcomes of robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for completely endophytic renal tumors. After reviewed patients who underwent either RAPN or LPN between 2013 and 2016, 61 RAPN and 51 LPN cases for completely en-dophytic renal tumors were included. Baseline characteristics, perioperative, functional, and oncological outcomes were compared. Outcome also included pentafecta achievement [negative margin, no 30-day complication, ischemia time <= 25 min, return of glomerular filtration rate (eGFR) to >90% from baseline, and no chronic kidney disease upstaging]. Univariable and multivariable analyses were performed to determine the independent variables associated with pentafecta achievement. Results: Compared to LPN, the RAPN were performed more recently (p < 0.001). No significant differences between RAPN and LPN were noted for operating time (105 vs. 108 min, p= 0.916), estimated blood loss (50 vs. 50 ml, p= 0.130), renal artery clamping time (20 vs. 20 min, p= 0.695), rate of positive margins (3.3 vs. 2.0%, p= 1.000), postoperative complication rates (Grade I-V, 18.0 vs. 21.6%, p= 0.639; Grade I-II, 14.8 vs. 21.6%, p= 0.348; Grade III-V, 3.3 vs. 0.0%, p= 0.500), postoperative hospital stay (6 vs. 6 days, p= 0.114). RAPN was associated with a higher direct cost ($11240 vs $5053, p <0.001). There were no statistically significant differences in pathologic variables. Also, there was no difference in rate of eGFR decline between groups for postoperative 1-day (RAPN 13.6 vs. LPN 22.4%, p= 0.244) and 12-month (RAPN 9.8 vs. LPN 10.6%, p= 0.901). During the follow-up, no local recurrences and distant metastasis occurred in both two groups. Pentafecta rates were not significantly different (RAPN 42.6 vs. LPN 37.3%, p= 0.564). Multivariate analysis identified that only RENAL score (OR 0.684, 95% CI 0.492-0.952, p= 0.024) was independently associated with the pentafecta achievement. Conclusion: For completely endophytic renal tumors, both RAPN and LPN have excellent and similar results in terms of perioperative, functional and oncological outcomes. Selection of surgery should depend on surgeon experience and comfort with either approach. Introduction and Objective: This study aimed to explore the security and feasibility of three-dimensional(3D) printing technology assisted laparoscopic cryoablation to treat renal tumors. April 2016 to August 2017 in our hospital underwent this operation. Three-dimensional reconstruction technology was used to mimic cryoablation treatment before operations in terms of how many needles this process needed and the depth and angle required to insert the needles into the tumor to precisely reserve nephrons. CT scan was used to assess the effect of the treatment after operation in regular follow-up. Results: All cases were performed in this operation successfully and recovered without major complications. The mean operation time was 111 minutes; the 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK mean blood loss was 66.7mL; the mean post-operation serum creatinine was 76.5 umol/L. The follow-up time was between 16-8 months, and the mean time was 13.3 months. Follow-up survey was conducted regularly based on a standard protocol in outpatient. The results showed no abnormal reinforcing signals in cryoablation treated areas. Introduction and Objective: Laparoscopic excision of urachal remnant usually needs three to five ports. Recently there have appeared new methods for resection of the urachal remnant by reduced port surgery (RPS). We had performed 13 RPSs and found that resecting the remnant in an antegrade way was sometimes stressful because proximal portion of the remnant was out of sight by camera port in the Lap-protector. We, therefore, developed retrograde approach for remnant resection. The antegrade procedure was followed; we first resected umbilici and urachal ligament as far as possible (2 cm approximately) and then inserted lap protector with 2 port channel into the umbilici defect. Then we resected umbilical ligament (UL) from proximal part towards bladder. This antegrade approach was stressful because dissection of the proximal part of the UL from the small wound of umbilici was physically challenging. We, thus, invented a new method for dissection of umbilical remnant: inserting multichannel port before dissecting umbilici from upper part of the umbilici, and then dissecting median UL and urachal remnant from distant part in a retrograde manner. This new method makes us easily dissect the urachal remnant. Here we describe this new method and compare its surgical result with antegrade approach. Introduction and Objective: We present for the first time a modification of the Endoscopic Combined Intrarenal Surgery (ECIRS) technique "the Athenian version". It consists of a modified position of the patient which ensures combined easy access both lumbar and from the urethra. Materials and Methods: 16 patients were treated with ECIRS from April 2017 to June 2018 in 2 centers for kidney stones with an average maximum diameter of 2,6 cm (1,8-3,1 cm). Their age ranged from 16 to 77 years and they had a BMI from 25 to 31 and an ASA score of 2-3. 9 of the cases were catheterized with a double j stent at least 10 days earlier. The Fiber optic STORZ Flex2s ureteroscope and the Flexible urethrocystoscope were used for the retrograde part of the operation. The STORZ and the Olympus nephroscopes were used with a maximum diameter of 26 Fr. The dilatation of the percutaneous access was achieved with Amplatz dilators with a maximum diameter of 28 Fr, while 10-12 Fr Rocamed ureteral access sheaths were used in the ureter. The corresponding side of the operation is risen by 30 degrees. The legs of the patient are in a straight position on the operating table unlike other modifications of the supine position. Access of the bladder and the ureteric orifice is achieved by the flexible cystoscope. A hydrophilic guide wire is inserted in the ureter. An access sheath is placed over the wire. Access of the pelvicalyceal system is achieved with the flexible ureteroscope. Introduction and Objective: We use the safest techniques and methods to prevent colonic, vascular and internal organ injury in PCNL in a single surgeon series. Materials and Methods: Between July 2011 and February 2019, a total of 620 patients underwent a free hand ultrasound guided PCNL. Mean patient age was 39 years (range 2 to 85) and male to female ratio was 1.3: 1. In all patients we used only ultrasound to complete the procedure (zero radiation). A database was kept prospectively for all patients. Results: Mean operative time was 79.1 minutes (range 15 to 300). Average stone size is 36.4 cubic mm (range 5 to 200). Patients with multiple stones are 71 and 549 with solitary stone. Patients with solitary kidney are 7, 1 pregnant patient, 1 transplanted kidney, 5 with endopyeletomy, 2 malrotated kidneys, 3 horseshoe kidneys, 2 pelvic kidneys, and 1 with percutaneous pyeloplasty. We did PCNL under general anesthesia in 498 patients, 87 under epidural anesthesia, 32 under spinal anesthesia and 3 patients under local anesthesia. Only 3 patients received blood transfusion 0.48% (500 to 1000 mL). One case failed entry due to hypermobile kidney. One percutaneous tract used in 514 patients (82.9%), 2 tracts in 71 patients (11.4%), 3 tracts in 27 patients (4.3%), 4 tracts in 6 patients (0.96%), 5 tracts in 1 patient (0.16%) and 6 tracts in 1 patient (0.19%). No colonic injury , no renal arterial-venous fistula, no urine fistula and no internal organ injury occur in this study because the use of Doppler ultrasound-guided PCNL with hydro dissection and optical-hydro dissection with induced hydronephrosis by ureter stent insertion with saline inflation of the bladder which leads to refluxing hydronephrosis that leads to easy pelvic collecting system needle penetration and tract formation, to prevent colonic and vascular injury with multiple positioning (prone, lateral, semi-lateral and supine). Conclusion: PCNL carry some serious complications and need safest techniques to prevent these complications, use Doppler ultrasound instead of fluoroscopy, hydro dissection and optical hydro dissection with specific patient position; all are collective leads to decrease these complications. Oncological and Functional Outcomes of Robot-Assisted Radical Cystectomy: Is it Acceptable During the Learning Curve? Tae JH, No TI, Kim HK, Shim JS, Kang SH Introduction and Objective: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC at the Korea University Medical Center. These were divided into three groups of 40 cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 patients who underwent RARC, 42, 73 and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD Age (year), mean ± SD 63.3 ± 9.8 65.7 ± 11.2 64.4 ± 11.6 64.5 ± 11.0 0.628 c T any, N1 1 (2.5) 5 (12.5) 5 (12.5) 11 (9.2) T any, N2 3 (7.5) 4 (10.0) 4 (10.0) 11 (9.2) T any, N3 0 (0.0) 1 (2.5) 3 (7.5) 4 (3.3) Positive Margin, n (%) 0 (0.0) 0 (0.0) 1*(2.5) 1* (0.8) LN during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection (PLND) was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 78.4%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n= 8) with or without PDE5-I at 1 year and 33.3% without PDE5-I (n= 4). Conclusion: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome. Introduction and Objective: To assess the impact on bleeding and complications due to the perioperative continuation of antithrombotic agents during undergoing robot-assisted radical prostatectomy (RARP), we prospectively investigated surgical outcomes of patients whose are all continuing antithrombotic therapies. From January 2014 to September 2018, a total of 445 patients who underwent RARP with prostate cancer were included in this prospective clinical trial. All patients continued taking antithrombotic agents in overall perioperative phase. We evaluated outcomes including intraoperative blood loss, transfusion rate, and bleeding complications in patients with continuous administration of antithrombotic agents (AA group: n= 65) and compared with patients without history of taking antithrombotic agents (NA group: n= 380). Multivariable analysis was used to identify independent risk factors for increased bleeding. Results: Among patients in AA group, 53 (82%) patients used antiplatelet (aspirin: 45, clopidogrel: 6, others: 4, combination: 2), 16 patients (24%) used anticoagulant (warfarin: 10, dabigatran etexilate: 2, others: 4), and 4 patients used both of them (aspirin + warfarin). As comparison of both group patients (AA vs NA group; median (min-max)), patients in AA group were older (72 (51-79) vs 68 (45-82) years, p < 0.0001) and had more severe comorbidity (charlson-comorbidity index; 2 (0-8) vs 2 (0-5), p < 0.0001) than NA group. Nevertheless, there was no significant difference between both groups in intraoperative blood loss (200 (0-1338) vs 189 (0-2055) mL, p= 0.63), hemoglobin deficit (2.3 (0.6-4,7) vs 2.2 (0.2-6.4) mg/ dL, p= 0.61), rate of intraoperative transfusion (0 vs 0.3%, p= 0.85), and rate of any high-grade complications (Clavien-Dindo Grade III; 4.6 vs 1.8%, p= 0.17). There was no patient who needed secondary procedure for postoperative hemorrhage in both groups. In multivatiate logistic regression analysis, predictors of intraoperative bleeding > 400 mL (upper 75% tile of overall patients) were charlson-comorbidity index 3 (OR= 3.0, IC95%: 1.4-6.2, p= 0.0037), BMI 25 (OR= 2.4, IC95%: 1.5-3.9, p= 0.0003), and not expert surgeon (OR= 2.2, IC95%: 1.2-4.0, p= 0.0093). The history of continuing antithrombotic therapies (OR= 0.9, IC95%: 0.5-2.0, p= 0.89) was not a significant risk factor of high-volume bleeding. These results indicate that perioperative continuing use of antithrombotic agents is not a factor of increased bleeding, and considered safe in RARP. Therefore, patients who have a risk of fatal throm-boembolism should continue administrating their antithrombotic therapies during perioperative phase in RARP. Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy: Experiences from 101 Consecutive Cases in a Single Center Du S, Gu L, Wang B, Shi T, Huang Q, Ma X, Zhang X The PLA General Hospital, Beijing, China Introduction and Objective: Robotic surgery has been increasingly applied in the management of renal tumors with inferior vena cava (IVC) thrombi. However, only anecdotal reports and small case series were published with short-term outcome. We report the largest single center series to date with regard to perioperative results, pathological outcomes and surgical complications. A total of 101 consecutive patients (69 male and 32 female) with level I-IV IVC tumor thrombus undergone robotic nephrectomy with IVC tumor thrombectomy from May 2013 to June 2018 were retrospectively analyzed. Level 0 thrombi (renal vein only) was excluded from the study. Data of patient demographics, perioperative results, complication rate, pathological and oncologic outcomes were collected. Results: The IVC tumor thrombus originated from the renal, adrenal and retroperitoneal malignancy were 96, 2 and 3 cases, respectively. Fifteen were level I, sixty-nine were level II, nine were level III, and eight were level IV thrombi. Mean patient age was 55yrs (21-86yrs) with mean BMI of 24.4kg/m 2 (13.2-33.7kg/ m 2 ) and mean maximal tumor diameter of 7.7cm (2-21cm). The mean length of IVC tumor thrombi was 5.7cm (1-14.2cm). There were 6 and 13 cases with preoperative lymph node and distant metastasis, respectively. Mean operative time was 266min (76-723min) with blood loss of 1152ml (50-12000ml). There were no conversions to open surgery. Mean postoperative hospital stay was 9d (1-32d). On surgical pathology, eight cases were pT4, eighteen cases were pT3C and seventy-five cases were pT3B. No positive surgical margin was reported. At a mean follow up of 16 months 25 patients had disease progression and 12 died of disease. We report a relatively large experience of robotic nephrectomy with IVC tumor thrombectomy. This technique was feasible for selected patients with acceptable surgical and pathological outcomes. Efforts should be continually paid to further refine the minimally invasive surgical management of such high-risk procedure. Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is recommended for patients with benign prostatic hyperplasia with large prostates. The aim of the study was to assess the functional outcomes in men undergoing HoLEP with huge prostates (>150cc) and compare these two men with smaller prostates (<150cc). We retrospectively evaluated all patients undergoing HoLEP in a UK single tertiary hospital between August 2017 and December 2018. Data on pre-operative and post-operative International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), post void residual (PVR) and prostate specific antigen (PSA) was evaluated for patients with huge prostates and compared to those with smaller prostates. Results: In total, HoLEP was performed on 196 patients with a preoperatively measured prostate size of20-450cc.Of these patients, 62 had a huge prostate (>150cc) with a mean volume (measured by MP-MRI) of 193cc (range: 150-450cc). The mean total operative time was 109.8 mins (range: 30-225 mins) with a mean morcellated prostate volume of 126.5g (range: 60-270g). With regard to functional outcomes, patients with huge prostates undergoing HoLEP had significant improvements in IPSS (from 21.4 ± 9.3 to 7.9 ± 6.0), Qmax (from 10.0 ± 4.3mL/s to 34.9 ± 17.5mL/s), PVR (from 144 ± 117mL to 76 ± 60mL) and PSA (from 13.2 ± 11.1ng/mL to 4.9 ± 14.5ng/ mL). Four patients (6.5%) with huge prostates had significant stress urinary incontinence following surgery at 3-6 months follow-up. These were all managed non-operatively with intensive physiotherapy. All patients were catheter-free following surgery.Comparison of IPSS, PSA, PVR and continence rates between patients with huge and smaller prostates showed no statistically significant differences. Qmax showed a greater improvement in the huge prostate group, which was significant (29.34mL/s vs 12.91mL/s; p=0.0235). Conclusion: Our study shows that HoLEP is a safe and effective operation for treatment of BPH in patients with huge prostates (>150cc) with excellent functional outcomes and a low complication rate. Introduction and Objective: Salvage cystectomy post pelvic irradiation (RT) is technically challenging and carries higher peri-operative morbidity and mortality. However, all previous literature is from open surgery era. We present our experience of robotic salvage cystectomy. We retrospectively reviewed records of all patients who underwent salvage robotic cystectomy [whether anterior exenteration (Ant-Ex) or radical cystoprostatectomy (RCP)] post radiother-apy for either carcinoma cervix or carcinoma urinary bladder from 2011-2018. Peri-operative complications and post-operative oncological outcomes were analyzed. Results: Thirty-five patients were indentified. RCP and Ant-Ex were performed in 17 and 18 patients respectively. Indication for surgery was recurrence and residual disease in 22 and 13 patients respectively. Mean operative time was 5 hours (+/-62 minutes) and blood loss was 362 ml (+/-165 ml). 9 patients needed peri-operative blood transfusion. Urinary diversion was performed extra-corporeally in all. 1/3rd patients experienced complications however none experienced a Clavien-Dindo class IV or V event. 2 patients with ileal neobladder developed urinary leak, 4 patients developed abdominal wall dehiscence, 4 patients had prolonged paralytic ileus and 1 patient developed rectovaginal fistula (treated by repair of fistula and diversion colostomy). Median hospital stay was 7 days (inter quartile range 6-9 days). Only 4 (11%) patients had positive surgical margins on final histopathology all of which had pT3b or pT4 disease. Mean follow up duration was 19 (+/-18.97) months 24 (69%) patients were disease free on follow up. 6 (17%) patients had early recurrence (within < 6 months) while 4 (11.4%) patients had delayed recurrence. Conclusion: Post-radiotherapy salvage robotic cystectomy is feasible with acceptable peri-operative and oncological outcomes. Preoperative Planning and Intraoperative Navigarion Based on 3D Modenling During Procedures in the Retroperitoneal Space Introduction and Objective: We used a medical 3D visualization computer program ("Volga-M", Russia) for a better understanding by the surgeon of the individual anatomy of the organs, allows for preoperative planning and helps with orientation in retroperitoneal space during the surgical procedure. The surgeon studied the 3D model of the organ and performed the training removal of the tumor, discussed it with the patient before the operation. During the procedure, the virtual model was combined with the image of a real organ on an additional surgical monitor in a semi-automatic mode. The method of 3D modeling was performed on 65 patients with various diseases, preoperative planning and intraoperative navigation was applied in 21 patients, among them 9 patients with adrenal tumors underwent LA, the mean age was 42.4 (32-58), 4 men (44,4%) and 5 women (55,6%), size tumors 3,5 (2,8 -5,1) cm and 12 patients with small renal tumors, who needed in surgical treatment LPN, mean age was 42,5 (36 -54) years, men -5 (41,7%), women -7 (58,3%). Size of the tumors were 3,2 (2,0 -4,0) cm. The average operation time LA performed using 3D modeling was 75.4 (40.0 -95.5) minutes. The average operation time LPN performed using 3D modeling was 95,5 (80-155) minutes. Warm ischemia time was 20,5 (18 -28) min. There were no cases of positive surgical margins. There were no complications during the operation and in the post-operative period. The virtual modeling and preoperative planning helps the surgeon to better understand the patient's individual anatomy, perform the training procedure on the retroperitoneal organs and explain its features to the patient. Intraoperative navigation based on the combination of images of organs makes the procedure more secure. Further application of the method is required to evaluate its results. Introduction and Objective: To evaluate the preventive effect of silodosin on ureteral injury resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. In this randomized controlled trial, 100 patients who underwent retrograde intrarenal surgery for kidney and upper ureter stone were prospectively enrolled from May 2018 to March 2019. The experimental groups received silodosin 8 mg for 7 days preoperatively. Ureteral injuries after insertion of 11-13Fr UAS were assessed with endoscopic classification. The primary outcome was rate and severity of ureteral injury. The second outcomes were surgical outcomes, such as the stone-free rate, complications, and pain score. Results: Of the patients, 44 and 43 were randomly assigned to the control and experimental groups, respectively. Silodosin prevented from severe ureteral injury involving the smooth muscle layer than control group (16.3% vs. 38.6%; p= 0.018). There are no significant difference in overall complication (p= 0.626) followed by modified Clavien classification system and computed tomography scan stone-free rate (76.7% vs. 77.3%). Patient who received silodosin before the RIRS had lower pain score and less likely to seek medical assistance for pain the control group (14.0% vs. 38.6%; p= 0.008). Conclusion: Our data suggest that preoperative silodosin medication prevent from severe ureteral injury related to insertion of UAS during the RIRS. Also, silodosin seems to decrease postoperative pain. Patients might be received for preoperative silodosin if they were not presented before retro-grade intrarenal surgery. In-vitro spermatogenesis in mammalian species is considered an important topic in reproductive biology. New strategies for achieving a complete version of spermatogenesis ex vivo have been conducted using an organ culture method or culture of testicular cells in a three-dimensional soft agar culture system (SACS). The aim of this study was to develop a new method that supports spermatogenesis to the meiotic phase and morphologically mature spermatozoa through the culture of testicular cells and seminiferous tubules (STs) in a modified SACS, respectively. First, enzymatically dissociated testicular cells and mechanically dissociated STs of neonatal mice were separately embedded in agarose and then placed on the flat surface of agarose gel half-soaked in the medium to continue culture with a gas-liquid interphase method. Results: Following 40 days of culture, the meiotic (Scp3) and post-meiotic (Acr) gene expression in aggregates and STs was confirmed by real-time polymerase chain reaction. These results were complemented by immunohistochemistry. The presence of morphologically mature spermatozoa in the frozen sections of STs was demonstrated with hematoxylin and eosin staining. We observed Plzf-or Integrin α6-positive spermatogonia in both cultures after 40 days, indicating the potency of the culture system for both self-renewal and differentiation. Conclusion: This technique can be used as a valuable approach for performing research on spermatogenesis and translating it into the human clinical setting. Post-Fertilization Effect of Paternal Exposure to Nicotine Treatment on Offspring Development in a Rat Model Introduction and Objective: Cigarette smoking has been proved to detrimentally affect the sperm motility, morphology as well as the sperm fertilizing capacity. We selected nicotine as major addictive substance of cigarette smoke and investigated the post-fertilization effects of paternal exposure to nicotine and its abstinence on the development of the offspring. Adult male rats were treated with nicotine orally for 10 weeks (100 μg/ml, Nico group; n=20). Another group was treated with nicotine for 7 weeks (100μg/ml) followed by 3 weeks of abstinence (Abst group; n=20). Control group had free access to drinking water (n=20). Five days before completing the period of 10 weeks, mating studies were performed, and each male rat was placed in the same cage with two female rats. After the five days, female rats were placed in separate cages and the male rats were sacrificed. Oxidative stress (OS) was evaluated in the testis and epididymis. Additionally, immunohistochemistry (IHC) was performed in the epididymal cauda for OS markers. The development of the offspring was recorded at postnatal days 2, 3, 5, 14 and 28. Results: Nicotine induced a significant increase in the levels of malondialdehyde (MDA) in the testis and epididymis of Nico group compared to Control or Abst group. IHC revealed increased expression of MDA, 4-hydroxynonenal and 8-oxo-2'-deoxyguanosine in the epididymal cauda of the Nico group compared to Control or Abst group. Pups delivered from female rats that mated with male rats from Nico group had significantly lower body weight at all recorded postnatal days compared to the Control. Three weeks of abstinence resulted in pups with significantly higher body weights compared to Nico group in all postnatal points recorded, but significantly lower compared to the Control. Our data provide evidence that paternal exposure to nicotine results into high levels of OS in the testis and epididymis and finally affects negatively the body weight and development of the offspring. Therefore, it is a necessity to inform the male smokers who wish to become fathers, that their habit will have an impact on their child's development during the first stages of its life and encourage them to follow a cigarette cessation program. Introduction and Objective: Urethroplasty is the gold standard treatment for patients who have recurrent strictures after urethral dilatation or urethrotomy. Success is typically described in the literature as "no need for further intervention" but how and when that decision is made has never been described. This review of our prospective database aims to address those questions. Complete follow-up is available for 297 patients who had a bulbar urethroplasty performed between January 2011 and December 2015. All patients were assessed by symptoms, a urinary flow rate study and an ascending urethrogram and micturating cystogram. All patients were followed-up for a minimum of 24 months and up to 82.5 months. Results: Failure rates and timing of the various types of urethroplasty were as follows: 5 of 25 (20%) of transecting anastomotic bulbar urethroplasties at a mean of 12.6 (range 0.8-32.3) months postoperatively; 4 of 83 (4.8%) non-transecting anastomotic bulbar urethroplasties occurring at a mean of 9.37 (range 3.9-16) months postoperatively; 4 of 145 (2.8%) augmentation urethroplasties using oral mucosal grafts occurring at a mean of 11.6 (range 4.6-16.1) months. The overall failure rate of bulbar urethroplasty was 13 of 253 procedures (5.1%) occurring at a mean of 11.13 (range 0-32.3) months postoperatively.Failure was associated with symptoms, a reduced flow rate and a radiological stricture, all together, excepting a few elderly patients who had developed prostatic obstruction. It was not always possible to determine whether the patient had a recurrent stricture at the same site as the original stricture or a new stricture (usually more proximal). Conclusion: By and large, recurrent strictures after bulbar urethroplasty tend to become apparent within the first year or so after surgery and symptoms of a reduced flowrate and a radiologically demonstrable stricture (and the presence of residual urine) all tend to be equally reliable. Invasive investigation is therefore not always necessary albeit useful if further treatment if planned. Indeed, outside of specialist academic reconstructive units, it is reasonable to simply tell patients who have had a bulbar urethroplasty to return for further assessment if they develop recurrent symptoms. It is rare to see coexisting anterior urethral stricture and a posterior stricture due to pelvic fracture urethral distraction defect (PFUDD). This is a systematic demonstration of how to synchronously repair these two strictures of completely different aetiology and also make it affordable. Three patients with age of 49, 24 and 51 presented with concomitant anterior stricture and PFUDD. In addition to PFUDD stricture, two patients had a penobulbar stricture and the third one had a proximal bulbar stricture. The first patient had a failed PFUDD repair in 2014. The urethrograms showed anterior urethral stricture and PFUDD stricture. At the synchronous single-stage repair proximal stricture at the prostato-membranous urethra was addressed first. It was localized with a soft catheter that could pass easily through the distal stricture but was blocked at the proximal stricture. The proximal urethra was dissected, transected and stricture was excised. Fibrous tissue around the proximal segment was excised till healthy, pink, mobile prostato-membranous urethra was well defined. The distal segment was trimmed and spatulated. A well-approximated end to end anastomosis between the two segments was then done with eight 4-0 vicryl sutures. The distal stricture was then localized with a bigger soft catheter. Two patients with penobulbar stricture underwent a dorsal onlay and the one with a proximal bulbar stricture underwent a ventral onlay BMG repair. A 14-F silicon catheter was placed. Results: Urethrogram was done at 4 weeks. After confirming the absence of any extravasation catheter was removed. Out of the three patients, one with a long anterior stricture required calibration at 3 months. The other two patients had an uneventful recovery and were voiding well at 15 and 17 months respectively. As both the surgeries were combined together overall expenditure was substantially low. Conclusion: Concomitant presentation of anterior urethral stricture along with PFUDD is rare. It is fea-sible to repair both as a single stage. PFUDD repair should be done first followed by anterior urethroplasty. A combined approach to repair two strictures of different aetiology and different location, simultaneously makes this technique most suitable and affordable. Outcomes of Penile Fasciocutaneous Island Flap in One Stage Reconstruction of Complex Anterior Urethral Strictures in the Komfo Anokye Teaching Hospital, Kumasi-Ghana Introduction and Objective: In developing countries, the problem of complex anterior urethral strictures presents a major challenge to the urologist. The causes include poor quality catheters and poorly managed STI's. Staged urethroplasty for long and multiple anterior strictures may be fraught with infections between the stages that may impact the outcome. To evaluate the stricture characteristics of patients undergoing one stage penile fasciocutaneous island flap ventral onlay urethroplasty and the outcomes of the surgery in Kumasi, Ghana. and December 2018, a total of 47 penile fasciocutaneous island flap ventral onlay urethroplasties were performed for long and multiple partial anterior urethral strictures by one surgeon at the Komfo Anokye Teaching Hospital. The distal penile circular fasciocutaneous flap was mostly used in this study. A database which included patient's age, aetiology, location, length and number of strictures as well as the duration of surgery and follow up, post-operative complications and final outcome of repair were kept prospectively for all 47 patients. Patients were reviewed at 3, 6, 12 months postoperatively and yearly thereafter. Data were entered into SPSS 17.0 for statistical analysis. Results: Forty-seven patients met the criteria for the study over the period. The mean age was 45.3 years with a mean stricture length of 6.3 cm (1-15 cm) with a mean follow up period of 46.6 months (6-96 months). Twenty-nine (61.7%) had 2 or more strictures. There were more patients with strictures involving both the penile and bulbar urethra than either location alone 25 (53.2%). Catheterization was responsible for 76.6% of the causes of these strictures with urethritis accounting for 19.1%. Complications included SSI in 6, urethrocutaneous fistula in 2, urethral diverticulum in 2 and one patient had both penile shortening and chordee which required correction at a later date. The overall success rate at first surgery was 85.1%. This rose to 93.6% after secondary repairs in 4 out of 7 patients whose repair failed at first attempt. Conclusion: Single stage penile fasciocutaneous ventral onlay flap urethroplasty for long and multiple partial anterior urethral strictures is a versatile technique with a good medium to long term outcomes even in resource poor countries. Modified Introduction and Objective: Management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) poses a unique challenge in patients with a history pelvic fracture urethral injury (PFUI) reconstruction. Patients who are refractory to medical therapy may require a surgical intervention; however, experts recommend against performing a transurethral resection of the prostate (TURP), as these patients often have a compromised external sphincter and rely on their internal sphincter at the bladder neck for continence. We seek to evaluate the utility and efficacy of a modified TURP in patients with a history of PFUI reconstruction who have failed medical therapy. α Value derived from ROS from patient note § Patient presented in retention Q-max -Maximal flow on uroflowmetry PVR -Post-void residual IPSS -International prostate symptom score Introduction and Objective: Elaborated perineal approach is merited in patients with long gap for anastomotic urethroplasty after PFUDD. There is paucity of literature to predict the need for inferior pubectomy in patients with PFUDD. The only available suggestion is by Koratiam who described the bulbourethral index, by measuring the length of bulbar urethra and the length of the gap. We share out experience in predicting the need for pubectomy. This manuscript is based on the experience of more than 1307 cases of PFUDD done over 2 decades. This includes various Live urethroplasty workshop done across 30 countries in the world. Most important factor is to have a good retrograde urethrogram and micturating cystourethrogram. The angle at which the patients is positioned in the Urethrogram is very important to understand the anatomy. Some patients in our experience with complex urethral issues will need MRI as imaging. We have modified our protocol with full bladder (which acts as natural contrast) and injecting lignocaine jelly in urethra. We study the relationship of the inferior margin of pubic bone to the lower margin of posterior urethra. In complex cases we have performed 3 d printing using CT Images of Urethrogram and this is a very useful tool. Results: Based on conventional imaging it is possible to predict the need for pubectomy. However, there are lot of fallacies as the imaging is 2 dimensional. Koratim's bulbo urethral index is based on the length of gap. However truly, the gap can be small but posterior urethra if above and behind the pubic bone, the patient will still need pubectomy. So Koratim's index is not universally true. The only factor which predicts the need for pubectomy is the relationship of posterior urethra to the inferior margin of pubic bone. This can be achieved by MRI using our modified technique and we suggest use of 3 D printing model as an educational tool The relationship of posterior urethra to pubic bone decides the need for pubectomy which most accurately can be predicted by MRI which is a 3-Dimensional imaging.3 D printing is the new technology on the cards. Introduction and Objective: Implementation of new surgical approaches, including endourologic and laparoscopic, leads to increase in number of iatrogenic ureteral injuries. From the other side there are different ureteral diseases for which a reconstructive procedure is necessary, because of reasons like fibrosis, stenosis or even tumor and an ileal ureteric replacement is used as the last resort in complex reconstruction of the urinary tract.The aim of the study is to review indications, improve surgical technique and evaluate the results in patients who underwent different variants of intestinal plasty of the ureter. Retrospective analysis of 178 patients that were surgically treated from 1982 to 2018 with intestinal plastics of the ureter. Mean age was 56,5 + 8,2 years. All patients underwent complex investigation prior to surgery. Patients follow up ranged from 6 months to 26 years. Results: Indications to bowel substitution of the ureter were: 58 (32,6 %) -traumatic ureteral injuries; 109 (61,2 %) -cases of retroperitoneal fibrosis (radiation, idiopathic); 8 (4,5 %) -patients had ureteral cancer; 3 (1,7 %) -ureteral obstruction due to tuberculosis. 29 (16,3 %) patients underwent segmental ureteral plastics, 39 (21,9 %) -subtotal, 57 (32 %) -total, 53 (29,8 %) -bilateral ureteral substitution. Substitution of one or both ureters was performed with isoperistaltic graft. Ileo-vesical anastomoses were formed with antireflux mechanisms: in 109 (61,2 %) patients distal part of ileum was everted forming an intravesical cuff; in 69 (38,8 %) -the mucous membrane of a new orifice was incised longitudinally at 12 and 6 o' clock (1-2cm), the suture was placed on the line of the incision. This suture divided the orifice into two parts.In addition to antireflux protection, in 21 (11,8 %) patients, we used plication stitches on contra mesenteric margin of the intestinal segment. This technique straightens the graft and prevents reflux development.Long-term complications included: stenosis of uretero-ileal anastomosis in 3 (1,7 %) patients, stenosis of ileo-vesical anastomosis -6 (3,4 %), loss of kidney function -5 (2,8 %), metabolic acidosis -4 (2,2 %). Vesico-ureteral reflux with intravesical cuff was seen in 41 (36,6 %) patients, with intravesical cuff and divided orifice -8 (13,3 %) (X2 = 13; p<0,01). Two independent reviewers assessed and selected citations, extracted data, and assessed the risk of bias using a standardised form. We included cohort, case-control and cross-sectional studies enrolling at least five adults with TBI in whom at least testosterone was assessed. We excluded case studies and studies in which other neurological conditions were indistinguishable from TBI. The online search found 840 papers, from which 45 cohort studies which met the inclusion criteria were identified. Most studies measured all anterior pituitary hormones and the tools used to measure endocrine outcomes including testosterone didn't vary significantly between studies. Across the studies, hypogonadism was shown to impact on QOL including sexual dysfunction. There was little evidence of the benefits of testosterone Replacement Therapy (TRT) as TRT was rarely used to treat low testosterone levels in patients. The studies also found correlation across secondary outcomes, particularly TBI severity positively correlated to hypogonadism incidence. Conclusion: Patients with TBI may have hypogonadism although this seems to be transient, with studies identifying resolution without intervention at follow-up several months later. Older age and TBI severity as identified by GCS predict anterior pituitary disorders including hypogonadism. Further high-quality studies are needed to better define the burden of hypogonadism and to assess the impact of TRT. Is There any Difference of Safety Between an Acellular Dermal Matrix (Allograft vs. Xenograft) Used for Penile Augmentation Surgery During the Early Period? Introduction and Objective: To assess the incidence of penile skin infection of an acellular collagen matrix (ACM; allograft vs. xenograft), we investigate two substances used for penile girth enlargement. From January 2018 to January 2019, a total of 554 penile augmentation surgeries using allograft and xenograft were analyzed for this article. Post-op evaluations on the safety an acellular collagen matrix was conducted at the 2-week and 2-month follow-up visits after operation. We assessed the penile skin infection or necrosis caused by insertion of ACM and compared a difference between the two substances. Results: Of the patients, xenograft was used in 472 cases (85.2%), and 82 (14.8%) used allograft. 96% of all patients reported great satisfaction with penile augmentation surgery with ACM. Infection, that required medical and surgical treatment, developed in 6 (1.3%) of these patients used xenograft and 1 (1.2%) of one used allograft, respectively. There was no statistical difference between the two groups. Of the patients with skin problems, 6 had no previous medical history, but 1 had a history of penile augmentation surgery seven years ago. All patients were cured of infection after graft removal and 2 weeks of continuous treatment with broad-spectrum antibiotics. Conclusion: In the present study, there was no difference in the incidence of penile skin infection between the two groups. The study reported a high satisfaction rate with these two types of ACM for penile augmentation. Therefore, when the patients decide on penile augmentation surgery, we can choose any of these products comfortably. Impact of Pulmonary Rehabilitation on Sexual Activity in Patients with Chronic Obstructive Pulmonary Disease Introduction and Objective: Chronic Obstructive Pulmonary Disease (COPD) impairs quality of life, affecting also sexual function. Pulmonary rehabilitation (PR) is a helpful treatment in COPD patients. The aim of this study is to assess sexual activity on COPD male patients and evaluate the impact of a PR program over sexual function in COPD patients. We conducted a single cohort prospective study over male COPD patients that are candidates to a PR program. Clinical, respiratory and biochemical (T, LH, FSH, progesterone) assessment were performed before enrolment. Patients were asked to fill a baseline IIEF questionnaire before PR program, and 6 months after completing it. Descriptive initial analysis was performed. Statistical comparison of respiratory values between patients with and without sexual activity at baseline was conducted using Pearson's X 2 , Student's T test for independent samples, and non-parametrical tests when required. Evaluation of changes in IIEF results after PR compared with baseline values was performed using paired samples T-test. Satisfaction with treatment was assessed using EDITS at the last visit. Zhu W, Zeng G Introduction and Objective: Epidemiological evidence suggests that daily intake of vinegar whose principle bioactive component is acetic acid is associated with a reduced risk of nephrolithiasis. The underlying mechanism, however, remains largely unknown. Here we prove that impact of dietary vinegar on calcium oxalate (CaOx) crystals formation and its mechanism. We used an animal model in rat fed with ethylene glycol (EG)-containing water. Results: We found that oral administration of vinegar or 5% acetic acid reduced EG-induced CaOx crystal formation likely through increased citrate and reduced calcium in urinary excretion, two critical molecules for CaOx crystal formation. Mechanism dissection suggested that acetate enhanced acetylation of Histone H3 in renal tubular cells and promoted expression of microRNAs-130a-3p, -148b-3p and -374b-5p by increasing H3K9, H3K27 acetylation at their promoter regions. These miRNAs can suppress the expression of Nadc1 and Cldn14, thus enhancing urinary citrate excretion and reducing urinary calcium excretion. Furthermore, systemic delivery of antagomiRs against these miRNAs abolished protection from vinegar through derepression of Nadc1 and Cldn14. Consistent with this, systemic agomiRs could silence Nadc1 and Cldn14 expression, mimicking the effect of vinegar consumption in reducing renal CaOx crystals deposition. Significantly these mechanistic findings were confirmed in human kidney tissues, suggesting similar mechanistic relationships exist in humans among vinegar, Histone H3 acetylation, NADC1 and CLDN14 expression as well as expression of miR-130a-3p, miR148b-3p and miR-374b-5p. Results from a pilot clinical study indicated that daily intake of vinegar increased citrate and reduced calcium in urinary excretion in CaOx stone formers without adverse side effects. Results: During the study period, 142 stones were evaluated in 142 patients in whom biochemical stone analysis was performed. We put the mean HU 900 as a cutoff value. A value of 900 HU or more was noted is 62 patients. Of the latter, 50 patients (80.6%) had the biochemical stone composition of calcium oxalate monohydrate mainly (70-100%), 9 (14.5%) had mainly calcium oxalate dihydrate (60-80% of stone composition), and 3 (4.8%) had mixed composition (calcium carbonate phosphate, brushite stones). CT density of less than 900 was found in 80 patients. In this group, calcium oxalate stone were noted in 53 patients (66.3%), uric acid stone in 10 (12.5%), cystine in 6 (7.5%), ammonium hydrogen urate in 4 (5%), struvite stone in 1 (1.3%) and mixed stones in 6 (7.5%). Conclusion: Hounsfield units (HU) above 900 is highly predictive of calcium oxalate stones. However, HU below 900 indicates variable stone compositions. Therefore, we recommend stone analysis only to those patients with HU less than 900. Comparative Study on Anatomical Parameters of Renal Lower Pole Between Normal Population and Patients with Lower Pole Calculi Introduction and Objective: To explore whether there is difference in anatomy of lower pole between normal population and patients with lower pole calculi. The anatomic parameters of lower calyx, including infundibulopelvic angle (IPA), infundibular length (IL), infundibular width (IW), and Caliceal pelvic height (CPH ) were prospectively collected and measured in patients with lower pole calculi, and compared with normal population. Results: A total of 172 patients with lower pole calculi and 203 normal subjects were collected. The anatomical parameters of IPA, L, IW, CPH were analyzed by single-factor statistical analysis in normal people and patients with lower pole calculi. There was significant difference in IPA (P <0.0001), IL (P <0.0001), IW (P <0.0001) and CPH (P <0.0001) between the two groups. Multi-factor Logistic regression analysis showed that there were three factors with P <0. 1 corresponding to the estimated coefficients: IL, IW, CPH. According to the Logistic regression analysis, a line chart was created to visualize the prediction. The sensitivity was 71.51% and the specificity was 82.27%. The anatomical parameters of renal lower pole in normal population are different from those in patients with lower pole stone. It is necessary to fully recognize the possible anatomical variation of lower pole in operation. Pelvic Fracture-Related Injuries of the Bladder Neck and Prostate Introduction and Objective: Injuries to the prostate and bladder neck (BN) as a consequence of traumatic disruption of the pelvic ring are a well-recognised but uncommon entity. The aim of this study is to describe the nature, cause, and management of this type of injury. Over a 10-year period, 15 men with pelvic-fracture related injuries of the BN were treated in a single tertiary reconstructive urology unit. They were referred between 3 months to 5 years after injury with intractable incontinence, recurrent infections or hematuria. 12 had a longitudinal rupture of the bladder neck and prostate at or close to the anterior midline and associated with lateral compression or 'open book' fractures. 5 were confined to the BN and prostatic urethra; the other 7 extended into the subprostatic urethra. All were associated with cavitation into the pubic symphysis when this was disrupted or otherwise involving pubic bone fragments where these had been fractured. 2 of the injuries were simultaneous transection of the BN and the membranous urethra with a sequestered prostate in between. In another, the anterior aspect of the prostate was avulsed. 14 patients underwent reconstruction by resection of any involved bone fragments and excision of the cavity, layered repair of the prostate and BN with an omental wrap in 13. The last patient had a Mitrofanoff diversion. The primary injury appeared to be to the prostate and prostatic urethra with secondary extension into the BN or subprostatic urethra. Of those reconstructed, the one without an omental wrap broke down and was salvaged by revision surgery. 4 patients who had an associated typical posterior urethral injury had a simultaneous bulbo-prostatic anastomotic urethroplasty. 6 patients had an acceptable continence after reconstruction; the other 8 underwent subsequent implantation of an AUS. Conclusion: These injuries usually occur primarily to the prostate with the BN being involved by secondary extension. They have a particular cause and particular location with a predictable outcome. A high index of suspicion is needed to identify them and treat them promptly to avoid significant morbidity. Genitourinary Trauma in Sport: Analysis of 10-year data from a Tertiary Centre Introduction and Objective: Injury whilst playing high impact sports is quite common. Most of the data concentrates on musculoskeletal injury given the incidence far outweighs solid organ injury. Nonethless, solid organ injury can be severe, and the damage caused to patients can be devastating. We aim to analyse the admission rates of trauma related to sport causing genitourinary injury at our centre to further ascertain the disease burden. We highlight any changes to sports that may reduce this incidence and improve patient outcomes. Ethics approval was acquired from the Austin Health Ethics committee. Patients who were admitted to Austin Health from 2007-2017 with genitourinary trauma were included. Those pa-tients who were injured due to sport were highlighted. The demographics, management and outcomes were studied. Twelve patients were identified to have suffered from genitourinary injuries caused by sports related trauma. Five cases presented with varying degrees of kidney injury and two cases of ureteric injury. Scrotal injuries accounted for five cases. The longest length of stay in hospital was six days and the average age of admission was twenty years of age. Of the twelve cases, four were cricket related, two were pole vault related and three were related to Australian Rules Football. One case was related to basketball, bike riding, horse riding and rugby respectively. Of the twelve cases, five needed surgical management. Of the sports involved, only cricket mandated protective sports equipment for the injuries involved. Of the two cricket related injuries which received surgical intervention, one patient was wearing the protective gear recommended and the other was unspecified. Iatrogenic Urinary Tract Injuries During Obstetric and Gynecological Procedures: Single Center 7-Years' Experience Introduction and Objective: Urologic injuries during obstetric and gynecologic procedures are not uncommon. Studies revealed an incidence of 0.18% and 0.49% bladder injuries and 0.01% and 0.24% ureteric injuries in obstetric and gynecologic surgeries respectively. These complications can result in morbidity and even mortality for affected patient. Our aim is to retrospectively analyze the frequency and management of urological injuries in obstetric and gyne-cological procedures in our tertiary referral hospital over the last 7 years. Of 12910 obstetrical and gynecological surgeries performed in our hospital from January 2012 to August 2018, medical records of all patients who sustained urological injuries were reviewed. Type and indication of surgery, site of urologic injury, type of urologic management and outcome were reported and analysed. Results: During the study period 1356 patients had underwent gynecological surgery and 11554 patients underwent obstetric surgery (Caesarean Section "CS" in 11533; of them 3661 were recurrent or caesarean hysterectomy in 21 cases (12 with placenta Accrete, 5 with placenta Increta, 2 with placenta Percreta, and 2 for postpartum haemorrhage) .Urological injuries were sustained in 42 (0.33%) patients. Bladder injury was reported in 8 (0.56%) gynecological surgeries and 28 (0.24%) obstetric surgeries (1 with primary CS, 22 with recurrent CS, 3 with placenta Increta and 2 with placenta Percreta). Ureteric injury was seen in 4 (0.29%) gynecological surgeries and 2 (0.017%) obstetric surgeries; the injuries included ligation in 2 (0.015%) cases, transection in 2 (0.015%) cases and contusion in 2 (0.015) cases. All injuries were diagnosed intraoperatively. Cases of bladder injury were treated by formal surgical repair and bladder drainage, while patients with ureteric injury were treated by surgical repair and/or ureteral stenting. Conclusion: Urological injuries were more common among gynecologic than obstetric surgeries. Difficult surgeries due to recurrent CS or abnormal placenta were the commonest causes for urologic injuries in obstetric cases. Key factors to ensure good outcome are keeping high index of suspicion in difficult and risky cases with early recognition and immediate repair of injuries. To evaluate the feasibility and safety of the application of robot-assisted laparoscopic partial adrenalectomy (RALPA) for patients with adrenal mass. The study retrospectively reviewed 13 patients who underwent RALPA in Shanghai Changhai Hospital. 8 were women and 5 were men, with an average age of 48 years old (range 32 to 68). The median nodule size was 3.3 cm (range 2.3 to 6.5). RALPA was performed with a standard procedure using Da Vinci robotic system. Multivariate analysis was used to identify predictors of operative time, warm ischemia time, estimated blood loss, major perioperative complications, and postoperative functional outcomes. Results: All robot-assisted partial adrenalectomies were successfully completed without conversion to a hand-assisted or an open approach. The final pathologic examination revealed that 5 patients were non-functional adrenal adenomas, 4 patients were primary hyperaldosteronism and 4 were pheochromocytomas. The mean operative time was 75 minutes (range 60 to 95), with a mean warm ischemia time of 12 minutes (range 8 to 17). The estimated blood loss was 20 mL (range 10 to 50). No intraoperative complications occurred. At a median follow-up period of 12 months (range 9-15), all patients are steroid independent without any disease recurrence. As an alternative procedure for several adrenal masses, RALPA represents a safe and effective approach with promising perioperative and functional outcomes, which merit an increasing adoption for this technique. The Adrenal Vein Sampling Algorithm Should be Applied Before Adrenalectomy Chang CH, Yeh SD, Liu MC Introduction and Objective: Primary aldosteronism has become a common cause of hypertension. The screening guideline was promoted by measuring the plasma aldosterone-to-renin (PAC/PRA) ratio. However, the data were affected by various factors. The Mayo Clinic developed an algorithm that uses adrenal computed tomography (CT) and adrenal vein sampling (AVS), in order to diagnose aldosterone-producing adenomas (APAs). Since the AVS algorithm was introduced 4 years ago in our center, we aimed to review the applications in clinical practice. from PN to SAE was 12 days. The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up computed tomography of 7 asymptomatic patients revealed iatrogenic vascular complications. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula and contrast extravasation. Technical and clinical success was achieved in all patients. There were no episodes of bleeding during the follow-up period. The embolization and control groups showed 94.9% and 94.3% estimated glomerular filtration rate (eGFR) preservation after PN, respectively, with no statistical difference between the two groups (p= 0.649). There was no statistically significant difference in surgical methods or baseline characteristics between the two groups in the entire data analysis and PSM. Conversely, there was statistically significant difference in ischemic time in the entire data analysis and PSM. In the embolization group, renal tumors were endophytic (28/41) and posterior (25/41) and showed statistically significant difference in the PSM. Introduction and Objective: Pre-stenting of the ureter causes passive ureteric dilatation and better access to the urinary system during subsequent procedures. However, the pathophysiology of ureteral stenting is currently unknown. In this study, we aim to elucidate the mechanistic pathway that leads to the involvement of multiple tissue layers in ureteric dilatation. Materials and Methods: Three pigs were stented unilaterally for 14 days and sacrificed. Both stented and non-stented ureters were harvested; histological analysis was performed to determine the tissue layers affected by stent placement. The protein expression of transcription factor Gli-1 (effectors of Hedgehog signaling) was assessed via immunohistochemistry scored independently by 3 different pathologists who were blinded to the laterality of ureteric stenting. Results: Microscopic examination of transverse cut sections of the ureters demonstrated luminal dilatation of both stented and non-stented ureters in Pigs 1 and 2. Pig 3 showed luminal dilatation of the stented ureter with no significant histological changes on the contralateral non-stented ureter. The ureters were not uniformly dilated along its entire length; proximal segments of the ureters showed a significantly greater degree of dilatation compared to the distal segments. The mucosa showed diffuse reactive changes with intestinal metaplasia. The stented ureter displayed focal mucosal ulceration associated with acute inflammation and granulation. In the submucosal layers, chronic inflammatory changes were seen in 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK both the stented and non-stented ureters. The muscularis propria layer in both stented and non-stented ureters showed smooth muscle thinning and hyperplasia with increased luminal diameter. Gli-1 protein was expressed in the smooth muscle cells of the muscularis propria in all three pigs. The intensity of staining increased with increasing luminal diameter. These findings were similar in both the stented and non-stented ureters. Conclusion: Our findings suggest that ureteral stenting induces a systemic response causing dilatation in the contralateral non-stented ureter and the Gli-1 protein may potentially be involved in this dilatation cascade. The Conclusion: In early-onset UTUC patients, germline genetic testing identified 1/4 cases carried pathogenic germline mutations in DDR genes. This emphasized the importance of screening these early-onset patients, especially cases with higher T or N stage. Germline DDR mutation screening represents an achievable aspect of personalized medicine that can help genetic counseling and guide patient management. To investigate the relationship between sunitinib-induced hypertension and efficacy in patients with metastatic renal cell carcinoma. The clinical data of 65 patients with metastatic renal cell carcinoma treated with sunitinib were collected retrospectively from January 2009 to June 2016. All patients received the standard dosing schedule of sunitinib: 50 mg daily for 4 weeks on and 2 weeks off. The efficacy was assessed by CT examination every 2 cycles and blood pressure was measured on days 1 and 28 of each cycle of treatment. Results: Patients were divided into hypertension group (n = 30) and normal blood pressure group (n = 35) according to adverse events of hypertension during patients treated with sunitinib. There was no significant difference in baseline characteristics between the two groups. Sunitinib-induced hypertension often occurred during the first or second cycle of treatment. It was occurred earlier in the increasing of systolic blood pressure (median time: cycle 1, range: 1 to 9 cycle) compared with the increasing of diastolic blood pressure (median time: cycle 2, range: 1 to 11 cycle). At 12-month follow-up, the objective response rate was significantly higher in the hypertensive group (17 patients, 56.7%) than that in the normal blood pressure group (10 patients, 28.6%) (P= 0.016). Through subgroup analysis, there was significant statistical difference between systolic hypertension group or diastolic hypertension group and normal blood pressure group (systolic pressure comparison: P= 0.039; diastolic pressure comparison: P= 0.038). During long-term follow-up, the mean progression-free survival time in the hypertensive group was significantly longer than in the normal blood pressure group (13.4 vs. 8.7 months, P= 0.002). Conclusion: Patients with sunitinib-induced hypertension achieve better tumor control and longer progression-free survival, which is suitable for predicting the efficacy of treatment. Neoadjuvant Targeted Introduction and Objective: Targeted therapy is an option for locally advanced and metastatic RCC, but the usage of the indicated treatment in patients with local disease in the neoadjuvant regimen is still controversial and poor studied. The basic principles of neoadjuvant targeted therapy for RCC is the concept of improving the safety of the procedure and improve outcomes. The aim of the study was to evaluate the factors that influence adverse events rate in adjuvant and neoadjuvant regimens of targeted therapy in patients with RCC. In 8 cases the upper end of the thrombus was located between the mouths of the major hepatic veins and the diaphragm. All patients underwent piggy-back liver mobilization, surgical access to the supradiaphragmatic IVC from the abdominal cavity, and manual repositioning of the thrombus apex below the diaphragm (milking maneuver). Extracorporeal circulation was performed in none of the cases. The extrapericardial approach was sufficient for the tumor thrombus apex control in 22 of 24 patients, including 3 cases of the atrial thrombi. The isolation of the supradiaphragmatic IVC and cavoatrial junction most easily and safely was performed through T-shaped diaphragmotomy. The transpericardial access was necessary only in 2 patients with large atrial thrombi (intra-atrial part up to 3.5 cm). During the access stage, intraoperative complications in the entire series were registered in 22.4% cases. They included damage to phrenic veins (45.8%), major hepatic veins (20.8%), IVC (12.5%) and the liver (12.5%). However, the average volume of blood loss due to the trauma of these structures did not exceed 100 ml. Specific complications associated with the access to the supradiaphragmatic IVC and the right atrium were detected in none of the cases. Conclusion: In our opinion, surgical approaches to the supradiaphragmatic IVC and the right atrium from the abdominal cavity, with or without opening the pericardium, are safe and easy-to-perform. In situations when the atrial part of a thrombus exceeds 1.5 cm, it is necessary to use the extrapericardial access with complete mobilization of the IVC at the level of the diaphragm. The association between inflammation and carcinogenesis has long been studied, and inflammatory markers including the Lymphocyte-Monocyte ratio (LMR) have been shown to predict oncological outcomes in several solid malignancies. We aimed to critically evaluate the utility of LMR in the prognostication of oncologic outcomes for localized post-nephrectomy renal cell carcinoma (RCC), for both clear cell and papillary subtypes. A total of 780 binephric patients from Singapore General Hospital with localized unilateral RCC treated with partial/radical nephrectomy from the years 2000 to 2015 were retrospectively analysed. Haematological values were collected prior to nephrectomy for calculation of LMR, and the optimal cut-off for LMR was determined using X-tile 3.6.1 software (Yale University, New Haven, CT, USA). In order to analyse the prognostic significance of LMR, both univariate and multivariate Cox regression models were evaluated, with primary outcomes of overall survival (OS) and cancer-specific survival (CSS). Conclusion: For localized post-nephrectomy RCC patients, LMR is a useful predictor for 5-year oncologic outcomes of OS and CSS, but its use is mainly limited to the clear cell subtype. The available data in urological literature regarding the role of n-3 PU-FAs in the field of BC chemo-prevention are scarce and conflicting. The present work aims to test the chemo-preventative effects of n-3 PUFAs against BC induction in a rat model and the potential antineoplastic mechanisms of the drug. Ninety male Fisher rats were divided into 3 groups during a 22-week protocol: group 1 (control), group 2 (Placebo+ N-butyl-N-4hydroxybutyl nitrosamine (BBN) for induction of BC) and group 3 received n-3 PUFAs at a daily dose of 1200 mg/kg/day + BBN. At the end, blood samples and bladder tissues were collected and checked for the presence of malignancy, markers of angiogenesis (CD34 expression and VEGF relative gene expression), inflammation (IL-6), proliferation (KI-67 expressions), redox status (serum MDA) and epigenetic control (miRNA-145 level).Results: Survival was [30/30 rats (100%) ,18/30 (60%) and 26/30(86.6%)] for groups 1, 2 and 3 respectively. There was significant weight loss among rats in group 2 (carcinogen) when compared with n-3PUFAs rats (group 3; P <0.001). The frequency of neoplastic and paraneoplastic lesions was less in group 3 when compared with group 2. Staining for CD34 expression and KI-67 were less in group 3 when compared with group 2. Moreover, there were significant up regulation of miRNA-145 expression (tumor suppressor) in group 3 when compared with group 2. Finally, there were significant lower VEGF, IL-6 and serum MDA levels in group 3 when compared with the group 2 (Table 1) . We also managed to prove that our modification of the dose was not harmful and tolerated by rats. Introduction and Objective: A combined diagnostic (white light cystoscopy-WLC and narrow band imaging-NBI) and treatment (bipolar plasma vaporization-BPV) approach were compared to the standard protocol (WLC and monopolar transurethral resection of bladder tumors-TURBT) in large non-muscle invasive bladder tumors (NMIBT). A matched-paired, index-control, cohort study included 260 patients with at least 1 bladder tumor over 3 cm. Index patients (n=130) were prospectively enrolled and underwent standard and NBI cystoscopy, followed by BPV (tumor staging and complete removal confirmation by using bipolar resection). In the retrospectively selected control cases (n=130), WLC and TURBT were solely applied. The matched pairs were determined based on the similar recurrence and progression risk categories according to the EORTC risk classification. Standard Re-TUR was performed, followed by 1 year BCG immunotherapy. The follow-up protocol included urinary cytology and WLC, performed every 3 months for a period of 2 years and every 6 months for the next 3 years. Introduction and Objective: Bladder cancer (BC), generally urothelial carcinoma, is a clinically and molecularly heterogeneous disease. Patients with BC have poor outcomes due to lack of effective molecular targets for therapy. Activity-dependent neuroprotective protein (ADNP), which is involved in embryo formation and neurodevelopment, has been shown to be overexpressed in several human cancer types. Nevertheless, the role of ADNP in the progression of bladder cancer (BC) remains unknown. The present study aimed to identify ADNP as a novel mitochondrial target in BC cells, suggesting a potential role for AKT-MDM2-p53 signaling in human bladder cancer. The effects of ADNP in human bladder cancer identified by bioinformatic analysis based on TCGA database. ADNP expression in tumor samples was examined by qRT-PCR, immunoblotting and immunohistochemistry. The patients' clinical data were downloaded from electronic medical records (system). The effects of cell proliferation on ADNP knock-down as well as overexpression were assessed by CCK-8 assays and colony formation assay. Cell cycle distribution tested by FACS and immunoblotting. The tumorigenic effect(s) of ADNP knockdown was assessed using a mouse orthotopic xenograft model. ADNP-related downstream pathways confirmed by immunoblotting. Results: ADNP expression was higher in tumor tissue compared to it in adjacent normal tissue in patients with BC. Immunohistochemical analysis of 221 paraffin-embedded archived BC tissues showed that high ADNP expression was significantly associated with nuclear grade, pathological T stage and pathological N stage. Univariate and multivariate analysis indicated that high ADNP expression was an independent prognostic factor for poorer overall survival and progression-free survival in the entire cohort. ADNP overexpressing significantly promoted cell proliferation in vitro, as well as tumor growth in vivo. Conversely, ADNP knockdown exhibited the opposite effects. The flow Cytometry assays showed that ADNP fostered cell cycle progression at G1-S transition. Moreover, we also demonstrated that ADNP-induced the promotion of G1-S cell cycle transition was me-diated by activation of AKT-MDM2-p53 signaling at the molecular level. Introduction and Objective: UroVysion (Abbott Molecular, Inc., Illinois, USA) is based on multicolor fluorescence in situ hybridization (FISH). It has been used successfully in the USA following its Food and Drug Administration approval in 2001. However, the technology was not approved for use in Japan until 2017. Cystoscopy and urine cytology are the most frequently used examinations to detect bladder cancer in Japan, and there are only a few reports regarding the performance of UroVysion. Therefore, the aim of this study is to examine the diagnostic accuracy of UroVysion FISH in Japanese patients whose tumors are detected by cystoscopy before transurethral resection of bladder tumor (TURBT). From April 2018 to July 2018, a total of 40 patients who were diagnosed as having bladder tumors by cystoscopy, and therefore underwent TURBT were registered in this study. One day before TURBT, urine cytology and UroVysion FISH were used in order to compare the accuracy with which they could detect bladder carcinoma, as confirmed by pathological results of TURBT. Introduction and Objective: Current standard methods used to detect and monitor bladder cancer are invasive or have low sensitivity. We developed a non-invasive, fast molecular diagnostic test, based on the gene expression patterns of urine, for bladder cancer detection with better sensitivity than NMP22 and urine cytology while maintaining adequate specificity. We performed bioinformatics analysis on the gene chip information and clinical pathology information contained in the data set GSE31189 in the comprehensive database of gene expression (GEO DATABASE), and performed gene transcriptome on the urine of 52 bladder cancer patients and 40 control subjects. We further enrolled 63 bladder cancer patients and 44 controls into a training set to construct a classification model. Thirty-two genes were screened out from 75 genes as a group of bladder cancer urine molecular markers. Finally, 214 voided urine samples including 121 cases of bladder cancer, 93 cases of control were obtained to verify this multigene panel. The sensitivity and specificity were compared to cytology and the NMP22 assays using cystoscopy as the reference. Introduction and Objective: Involving patients in diagnostic minimally invasive procedures as colonoscopy has been reported to ease pain and anxiety; involving patients in cystoscopy may give similar results. The objective is to compare during cystoscopy the effects of real-time visualisation with appropriate explanation with explanation alone on pain in patients who underwent ambulatory cystoscopy. From January 2015 to March 2019, male patients, undergoing ambulatory rigid cystoscopy for the first time and accepting to watch the monitor during the procedure, were included in this study. They were randomized in two groups: Group A -they watch monitor during procedure and receive explanations; Group B -they receive explanations alone. All patients were operated for bladder carcinoma and underwent cystoscopy under local anesthesia (uretral instillation of 5 mL of Xylocain). They receive detailed explanations during the procedure. They are asked to record the pain they had experienced during the procedure on a scale of 1-10 with a visual analogue scales (VAS). Pain was significant if VAS >4. Results: Only 67 patients were included in the study. They were 35 in group A and 32 in group B. There was no statistically epidemiological difference between the two groups. Men who were allowed to watch their rigid cystoscopy experienced significantly less pain, than those who did not (p=?0.033). Age and education level had no effect on the results. There were no complications. Conclusion: According to the present observational study, watching the monitor during rigid cystoscopy decreases significantly pain in patients receiving explanations. Thus, men who undergo rigid cystoscopy should be offered to watch their procedure in real-time on a video screen to make it less painful. IDENTIFY provides contemporary cancer detection rates and patient variables in a global population alongside diagnostic test performance for each cancer type. The detailed data will allow a personalised approach to haematuria investigations and improve shared decision-making by developing predictive models to optimise cancer detection. These patient-specific pathways will reduce patient and healthcare resource burdens. Introduction and Objective: CD155, serving as a ligand for co-stimulatory and co-inhibitory receptors of lymphocytes, is associated with tumor immune regulation. In this study, we evaluated the expression pattern and clinical relevance of CD155 in bladder cancer. Conclusion: In a Canadian setting, inclusion of IOs for treatment of metastatic bladder cancer in first or second-line will increase treatment cost by approximately $50,000 for an incremental survival of 3 to 6 months. The development of minimally-invasive techniques that allow improved 3D visualization of the surgical field, as well as modern instruments, represent a step towards the broadening of the indication of partial nephrectomy to more complex tumors. Furthermore, the enucleation of renal masses has been proven to be an oncologically safe procedure, with the possibility to avoid renal ischemia. The objective of our video was to evaluate the feasibility of the 3D laparoscopic approach for the enucleation of complex renal tumors. We present the case of a 63-year-old female patient, who was referred to our department for the incidental ultrasonographic diagnosis of a right kidney tumor. The contrast-enhanced CT identified a 40/38/31 mm right renal tumor, located in the mid-kidney, on the anterior valve, almost completely endophitic, PADUA score 10, cT1aN0M0. The patient had no significant comorbidities and the pre-operative GFR was within normal range. We proposed a 3D laparoscopic partial nephrectomy. We performed a transperitoneal approach using 4 trocars. The procedure started with the medial mobilization of the ascending colon and duodenum. The right ureter was identified, and the dissection continued cranially up to the renal pedicle. The renal artery and vein were identified and isolated with vessel loops. The Gerota fascia was incised, followed by the identification of the tumor and incision of the renal capsule circumferentially. Zero-ischemia enucleation of the tumor was performed. Renorraphy was performed in a single layer using the sliding clip technique, resorbable suture and hemostatic material. The operative time was 150 minutes and the blood loss was minimal. The lumbar drainage was removed in the first post-operative day and the patient was discharged on day 4. The pathological examination revealed the diagnosis of renal cell carcinoma, Fuhrman grade 1/ ISUP 1, with negative surgical margins. The laparoscopic approach for the enucleation of highly complex renal tumors is feasible and safe in experienced centers. The enhanced 3D visualization offers the possibility to develop the avascular plane between the renal parenchyma and the tumor, while avoiding renal ischemia with the highest chance of renal function preservation. Clampless (0%) . The statistical incidence of this complication in transurethral endoscopy is comprised in scientific literature from 3.4 to 9.8% -a significantly lower incidence of sclerosing cicatricial stenosis of the bladder neck. In the light of these results, laparoscopy is a safe alternative technique that can be offered to patients who need to undergo surgery for medium or large obstructive pros-Introduction and Objective: We present a video of a new endoscopic technique for the recanalization of the complete obstruction of the uretero-pelvic junction (UPJ), using endoscopic blunt dissection of the proximal ureter through the renal-pelvic wall, using the biprong forceps through the nephroscope. The ureter is localized using cut-for-the-vibration technique. Then, an endoscopic uretero-pelvic anastomosis is performed. 56-year-old female presented with a right flank pain. 3 months ago, she had the history of open surgery for a right renal stone. Ultrasound and CT-scan showed a large right hydronephrosis, and a pyelonephritic left kidney with stones. Retrograde uretero-pyelography showed a complete obstruction of the UPJ. A nephrostomy was performed. The patient wass placed in the split leg modified lateral position. A 24 Fr percutaneous access was performed through a middle calyx. At exploration, the nephroscope did not find the UPJ nor its scar. A dye was injected through the ureteral catheter and it does not pass into the renal pelvis. Retrograde ureteroscopy and trying to cut for the light technique failed. The ureteroscope light was not seen by the nephroscope. An endoscopic incision was performed in the pelvic wall, using an electrode. The biprong forceps were used through the nephroscope to perform an endoscopic blunt dissection of the dense fibrotic tissue outside the pelvic wall. In order to find the ureter, a cut-for-the-vibration technique was used. The ureteral catheter was vigorously rattled. Dissection was orientated following the catheter vibrations. The ureter was found and opened. A 3.5 needle-holder was inserted in the nephroscope and using a 13 mm needle suture, 2 sutures were placed between the pelvic and the ureteral wall. Then, double-J-stent was placed. Results: Endoscopic blunt dissection of the proximal ureter was possible. The cut-for-the-vibration technique had oriented the dissection, had allowed to find the ureter and recanalization. The suturing was difficult due to fibrosis and the tissue edges were fixed far apart. The mean operative time was 154 minutes. The postoperative hospital stay was 3 days. Retrograde pyelography showed a medium passage of contrast media through the UPJ, and a new JJ-stent was placed, with a follow up of respectively 36 months. Introduction and Objective: To present our initial experience performing percutaneous transvesical single-port robotic simple-prostatectomy (pSP-RSP) using the novel da Vinci SP® Robot Platform. Two consecutive patients were submitted to pSP-RSP between January 2019 and February 2019. On the percutaneous transvesical approach, the patient is positioned in the supine position, a 3 cm infra-umbilical incision is made after percutaneous needle identification of the bladder dome, a GelPOINT Mini advanced access platform is inserted directly into the bladder and the da Vinci SP ® robot is docked. The bladder is then insufflated with CO 2 at 12 mmHg Pneumovesicum pressure and the prostate adenoma is enucleated and hemostasis is achieved. Finally, a mucosal advancement flap is sutured to the urethra to cover the resected area. Results: Mean total operative time was 168.5 minutes, mean estimated blood loss was 75 mL and the mean postoperative Hgb deficit was 1.7 mg/dL. The mean length of stay after the end of surgery was 17 hours and 11 minutes. All patients came out of surgery with a 2-way foley catheter and no bladder irrigation. No patient received drains. There was no need for additional ports. No intraoperative complications were reported, and no surgeries were converted to open approach. There was no blood transfusion during or following the procedures. The pSP-RSP is an option regarding minimally invasive techniques for treating benign prostatic obstruction with substantially enlarged glands. Our initial experience revealed that this procedure led to minimal bleeding, no need for additional ports, no need for bladder irrigation, minimal usage of postoperative opioids, and thus favoring a shorter hospital stay and opening the possibility of outpatient management in the future. Further studies need to be completed with a larger sample and long-term follow-up to confirm our findings and after comparing it to the other available large prostate surgical options. Introduction and Objective: We present our novel technique of vaginal flap incorporation during robot assisted vesicovaginal fistula (VVF) repair. This avoids ureteric reimplantation in cases where the ureter is opening in the margin of VVF. A 55-year-old lady presented with continuous leak of urine following total abdominal hysterectomy performed for fibroid uterus, at a private hospital. There is a history of repair for bladder injury at the time of surgery. During the immediate postoperative period, she developed acute kidney injury and underwent right percutaneous nephrostomy placement. On pelvic and cystoscopic examination, a VVF of 2x2 cm was found located in the posterior wall. The left ureter was not visualized during cystoscopic examination. She was planned for robot assisted VVF repair with left ureteric reimplantation. However, during surgery, the left ureteric orifice was identified with an opening into the vagina by the colored efflux of phenazopyridine. A ureteric catheter was placed in the ureter and another ureteric catheter was placed across the fistula. During the fistula repair, a flap of vagina was incorporated into the bladder and the ureteric reimplantation was avoided. The operative time was 150 minutes. Results: Post-operative period was uneventful, and she was discharged on post-operative day 5. The urethral catheter was removed 3 weeks after the surgery. The patient is continent at 4 months post-surgery and on ultrasound examination showed normal upper tracts. Cystoscopic examination revealed efflux from both ureteric orifice and no fistula. In complex fistulas with ureter opening at the fistula margin, our technique can avoid ureteric reimplantation. It shortens operative time and consequent inadvertent ischemia to the bladder. Introduction and Objective: Augmentation gastrocystoplasty has been the technique of choice for patients with a contracted urinary bladder and impaired renal function. This video demonstrates the execution of this procedure in a total robotic approach. A 27-year-old lady suffered from a fibrotic and contracted urinary bladder secondary to ketamine abuse. Her impaired renal function rendered her unfit for ileo-cystoplasty. Robotic augmentation gastrocystoplasty was performed, be-ginning with the stomach part in a head-up position. Ten-centimetre wedge of stomach was used as the patch to augment the bladder, preserving the right gastro-epiploic vessel as its blood supply. The bladder part was completed with redocking of the robot and putting the patient in the slight Trendelenburg position. Upon completion of the procedure, the patient had a urethral Foley catheter and a pelvic drain in place. Results: Operation time was 275 min. Blood loss was 100 mL. Nasogastric tube was taken off on postop day 2. The patient was discharged on post-op day 6. Foley was taken off on post-op day 14. Recovery course was smooth without complication. Functional bladder capacity at post-op 3 months was 300 mL. Conclusion: Total robotic augmentation gastrocystoplasty is a safe alternative to the conventional open approach. Long term outcome assessment is necessary to determine if this minimal invasive approach can be recommended as one of the standard options in this setting. Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is a safe and effective procedure for benign prostatic hyperplasia (BPH) treatment. Incontinence following HoLEP can be encountered, although it is often temporary. To avoid incontinence, the sphincter, located in the urethra as an omega shape, must be protected. In particular, many techniques have been reported concerning enucleation step in HoLEP. With this video presentation, we would like to share our experience and technique on HoLEP with respect to the external urethral sphincter and its omega shape configuration. Materials and Methods: All HoLEP procedures were performed using a 120-W holmium: YAG (yttrium aluminum garnet) laser (Versapulse, Lumenis Inc., Santa Clara, CA, USA); and a 550-nm end-firing fiber (SlimLineTM 550, Lumenis Inc.). Continuous flow 26 F resectoscope (Karl Storz, Tubingen, Germany), a rigid nephroscope with a 5-mm working channel (Karl Storz), and a Versacut tissue morcellator (Lumenis Inc.) were also used. Power settings were 37.5 Watt (1.5J energy, 25 Hz frequency) in the right pedal and 100 Watt (2 J energy, 50 Hz frequency, and short-500 µs pulse width combination) in the left pedal. After the cystoscopy, the median lobe was incised from both sides, from the urethral orifice line to verumontanum. This groove is deepened to the level of the surgical capsule. After both lateral lobe apex border markings, median lobe enucleation was completed. In next step, midline incision from verumontanum to bladder neck in 12 o' clock region of the prostatic fossa. Mucosal incisions were performed from down to up in both lobes. These incisions were connected at 12 o' clock in behind of the urethral sphincter. This image looked like an Omega Sign. Following this step, left and right prostate lobes were enucleated, respectively. This procedure was completed with morcellation. Results: 229 patients with BPH were treated by this technique. All procedures were performed using the same mucosal incisions as the procedure preparation and the landmarks. No incontinence was reported. Step 1 -It started with enucleation of left lobe of prostate. Step 2 -Enucleation of right lobe of prostate was completed. Step 3 -Small suprapubic mid-line laparotomy was done after complete enucleation of prostate. Step 4 -Small cystostomy was opened after 2 stay stitches via bladder wall. Step 5 -Retrieval of all bladder stones and enucleated prostate were performed simultaneously. Step 6 -2-layer closure of urinary bladder defect was done. Step 7 -Negative leak test of repaired urinary bladder was confirmed before closure of small laparotomy wound. Results: Total operation time was 1 hour. 3 large bladder stones with a total diameter of more than 10 cm were retrieved and enucleated prostate was sent for pathology, which came back to benign pathology. There was no drop of haemoglobin. Patient was discharged on day 2 postoperatively. He was readmitted to trial off Foley catheter and removal of stitches on day 7 postoperatively. Conclusion: Simultaneous bipolar enucleation of prostate and open cystolithotomy with two teams' approach is safe, a one-off procedure and has short operation time. It is one of the surgical options for benign enlarged prostatic obstruction with large bladder stones. Early Introduction and Objective: Aquablation is a novel and minimally invasive alternative to transurethral resection of the prostate for treating lower urinary tract symptoms (LUTS), secondary to benign prostatic hyperplasia (BPH). It's an image-guided robot-assisted water-jet ablation of the prostate that combines an integrated cystoscope with intra-operative transrectal ultrasound (TRUS) images. The aim of this video is to share our experience and offer a step-by-step guide to perform the Aquablation technique. The surgery was performed with the AquaBeam® system (PROCEPT BioRobotics, Redwood Shores, CA, USA) under spinal anesthesia. A biplanar TRUS probe was used. A 24-F handpiece was inserted transurethrally. Both the handpiece and the TRUS were fixed to articulating arms attached to the operating table. Real-time ultrasound imaging outlines the surgeon-planned prostatic fossa and a robotically guided handpiece containing a side-firing nozzle shoots a high-velocity water-jet from bladder neck to verumontanum in a single pass (in most cases). This precise and fast (± 5 min) ablation is able to preserve anterograde ejaculation by sparing the ejaculatory function anatomical landmarks and protecting the urinary sphincter. Hemostasis was achieved by a Foley catheter balloon tamponade. There are various methods of post-Aquablation hemostasis, however the most adequate is still evolving. Results: This video demonstrates how to perform Aquablation, a procedure that has been proven to be safe, efficient and easy to learn, regardless of prostate size (up to 150 mL). Conclusion: This video serves as a step-by-step visual guide to perform Aquablation. It has been demonstrated previously in the literature that the combination of robotics and image guidance increases reliability and significantly reduces the operative/resection time and improves anterograde ejaculation preservation. These promising results warrant further studies to assess long-term outcomes. Green Introduction and Objective: Given the hemostatic benefits of the Greenlight laser wavelength, there has been an increased interest and application with endoscopic enucleation of the prostate (EEP) in recent years for the treatment of benign prostatic obstruction (BPO). The aim of this video is to offer tips and tricks to perform anatomic EEP with the greenlight laser and to share our experience and practical advice in order to improve the overall results of this procedure. We used the Green laser enucleation of the prostate (GreenLEP) "enbloc" technique followed by mechanical morcellation in all the cases with a 532-nm lithium triborate laser (GreenLight® XPS 180W device; Boston Scientific, Boston, MA), 2090 side-fire laser fiber and the Pira-nha® morcellation system (Richard Wolf GmbH, Germany). We merged multiple surgical videos from our own daily experience with the technique to provide tips and tricks for GreenLEP, as well as recommendations and troubleshooting to ensure proper technique. We have demonstrated herein some technical tips and tricks that surgeons may find beneficial in carrying out the GreenLEP technique, improving patient safety and outcomes and avoiding the most common intraoperative complications in this procedure. More specifically, details for fibre handling/direction, power setting, anatomic landmarks for capsular recognition, manual mechanical endoscope details and systematic approach for EEP are reviewed to facilitate dissection and optimize patient outcomes. Conclusion: GreenLEP previously demonstrated its feasibility, safety and similar short to mid-term functional outcomes compared to surgical gold standards in the literature. This video offers a step-by-step practical guide to learn the technique and perform GreenLEP en-bloc procedure safely, effectively and efficiently. Laparoscopic Introduction and Objective: Perforation of the bladder or urethra and erosion of the mesh after cystocele repair surgery, are not uncommon and have potentially serious complications. Traditionally, surgical management of such complications has involved excision of the mesh using either a transurethral approach or open surgery. In this video, we present our experience of laparoscopic transvesical surgery for exposed mesh and stone. The patient was placed in the lithotomy position under general anesthesia and a 30° operating cystoscope was inserted under direct vision. After filling the bladder with 300 mL normal saline, a 5 -mm VersaStep™ bladeless trocar was placed 2 cm above the pubic symphysis. Two more 5 mm trocars were placed bilaterally at 3 cm intervals from the initial trocar site. The pneumovesicum state was maintained at 8 -12 mmHg and a 5 mm telescope was introduced. Using a curved dissector and curved Mayo scissors, the exposed mesh was mobilized and removed. Interrupted 4 -0 Vicryl sutures were used to close the defect. To localize the ureteral orifice, intravenous Indigo Carmine was used. The bladder stones were removed through the urethra using a stone basket, guided using a ureteral stent pusher. Results: Total operation time was 55 min and the Foley catheter was removed at post-operative day 5, after post-operative cystography. Conclusion: Excellent visualization of mesh exposure and ureteral orifice was possible under aparoscopic transvesical surgery and reconstruction, including the mucosa and muscle layer, was able to be achieved. This method is useful and feasible, with minimal invasiveness and an early post-operative recovery. Robotic A section of small bowel is isolated, and the remaining bowel restored using a covidien stapling device. A transverse incision is made into the bladder and the de-tabularised section of bowel sutured into position. The cuff is then placed through the 5 mm port and positioned around the bladder neck. Following this, the reservoir is placed into the pelvis beside the bladder and inflated with an iodine-based solution. Next, the tubings are trimmed, capped and secured under the skin. The patient underwent a procedure to insert the pump in the scrotum and connect all of the tubings 3 weeks later to ensure no infection. However, this is something to review for future procedures. Results: Total hospital stay was 6 days. The catheter was removed at 3 weeks following cystogram. Urodynamic studies 10 months following the procedure showed a functioning AUS, with normal bladder compliance but persistent neurogenic detrusor over activity which improved with tolterodine. Patient pad usage decreased from 5 to 2 daily. Herein we present a successful outcome of concomitant robotic ileocystoplasty and AUS insertion to treat a patient with severe urinary incontinence due to neurogenic detrusor over activity, small bladder capacity, and neurogenic sphincter weakness. an artificial urinary sphincter in males suffering from persistent stress urinary incontinence with history of failure of male sling placement after radical prostatectomy. Materials and Methods: AMS 800 artificial urinary sphincter was placed in two males, 64 and 65 years old, who firstly underwent male sling placement. The first patient underwent radical prostatectomy 7 years ago and salvage radiotherapy post-operatively. Because of severe stress incontinence, he underwent adjustable male sling Atoms ® 4 years ago. On the 3 rd post-operative month, the symptoms reappeared. Via a vertical perineal incision, the adjustable sling was recognized and removed. The bublo-spongiosum muscle and the urethra were recognized in excellent condition and the simultaneous placement of artificial urinary sphincter was decided. The peri-urethral cuff was placed at the height of the bulbar urethra. During the access to the paravesical region, a traumatic injury of the external iliac vein was recognized which treated with vein ligation. The second patient underwent male 4-arm sling Virtue ® because of moderate postoperative stress urinary incontinence, without improvement, so the artificial urinary sphincter was decided. The sling was recognized, prepared and removed. The bulbo-spongiosum muscle was atrophic. The urethra was recognized in good condition, followed by the placement of periurethral cuff, of the handling pump and of the reservoir. The surgical procedures were uncomplicated. The artificial urinary sphincter was activated on the 6 th postoperative week successfully. The patients were re-examined after 1 month and every 3 months afterward. Results: During the 3-month follow-up, the patients remained continent without the need of pad. They have fully returned to daily activities. The stress urinary incontinence consists one of the most common complications of the radical prostatectomy. The placement of a male sling presupposes the existence of a functional sphincter mechanism, but it has a failure rate of up to 30%. The placement of an artificial urinary sphincter is the only alternative solution for the incontinence restoration. Despite the potential intraoperative difficulties, it is a feasible and viable solution with excellent functional results and a high degree of acceptance and satisfaction. Introduction and Objective: Radical external beam radiotherapy has been an indispensable treatment modality for prostate cancer. Recent advancement in radiotherapy techniques calls for more accurate targeting of radiotherapy to diseased tissues. Fiducial markers (FM) have emerged as a potential solution to localizing prostate cancer during radiotherapy. To avoid septic complication of transrectal insertion of fiducial markers, we have performed 4 cases of transperineal insertion of fiducial markers in March 2019. We composed a video report which depicted how transperineal insertion of fiducial markers could be performed under ultrasound guidance. Firstly, the perineal region was disinfected. Then local anesthetic was injected to the periprostatic plane. Under ultrasound guidance, two trocars were inserted to guide implantation of FM to the right base, right apex and left middle gland. This triangular arrangement of markers held true for tumors in any part of the prostate. Results: Among the 4 cases, the average age was 69 years, the mean PSA was 7.97 ng/dL, and 3 cases were T1C disease, while the last case was stage IV disease with oligo-progression at prostate after hormonal therapy. One case with aspirin 80 mg daily was not stopped before the procedure. Average procedure time was 7 min. The average pain scores of ultrasound probe insertion, local anesthetic injection and fiducial markers insertion were all 1 only. There was no admission due to fever, sepsis, haematuria, per rectal bleeding or other complication after the procedure. Conclusion: For patients with prostate cancer, transperineal insertion of fiducial markers is safe and effective in deploying full advantages of image-guided radiotherapy in modern era. Robotic Our technique of extra-peritoneal robotic radical prostatectomy includes 2 previous steps. Extra-peritoneal space: a 3 cm infra-umbilical incision is used to reach the extra-peritoneal space and then a kidney shape balloon is introduced until the pubic bone and deployed to create the working space which is then verified using a laparoscopic endoscope. Single port device placement: a mini gel point advance platform is inserted through the incision with the previously attached 25 mm robotic single port cannula and multichannel guide and a 12 mm laparoscopic port. After that the radical prostatectomy can be performed following the steps used with other platforms -the opening of endopelvic fascia, bladder neck dissection, pedicles and neuromuscular bundle management, dorsal vein complex transection and ligation, posterior reconstruction and urethro vesical anastomosis. We demonstrate an uncommon, combined approach to the surgical management of an intractable, recurrent Vesico-Urethral Anastomotic Stenosis (VUAS) in the setting of prior pelvic radiation therapy. We retrospectively reviewed 5 patients who underwent SP robot-assisted laparoscopic posterior urethroplasty (SPRALPU) by a single surgeon from October 2018-January 2019. Compared to multi-port robotics, the SP robot allows for improved exposure and less instrument clashing in the deep pelvis. Variables included patient demographics, diagnosis and etiology, prior interventions, intraoperative variables, functional outcomes, and complications. Success was defined as passage of a 17 Fr. flexible cystoscope or absence of urinary symptoms. The operative technique involves SP port placement at a periumbilical location for transabdominal mobilization of the bladder neck and urethra. Cystoscopy is used to identify the level of the urethral stenosis. The stenotic segment is excised and the anastomosis is completed using either excision and primary anastomosis or Y-V plasty. Combined abdomino-perineal approach may be used for distal urethral mobilization to reduce tension. Introduction and Objective: The use of buccal mucosal graft (BMG) during urologic reconstructive surgery is common practice. Graft fixation can be difficult in poorly accessible surgical areas. We developed and implemented a surgical "sewing device" to improve the effectiveness of graft quilting and suturing in these challenging spaces. Our objective is to demonstrate the ease of adopting this technique as well as its applicability to a variety of reconstructive surgeries. We conducted a retrospective chart review of all patients where the improvised surgical "sewing machine" was utilized for graft fixation due to limited exposure and accessibility. Pre-operatively, all patients were confirmed to have strictures. Intraoperatively, after harvesting BMG, the device was assembled using materials readily available in the operating room. An absorbable barbed suture was loaded into a hollow needle and then deployed into the tissue with application of gentle pressure. The barbs secured the suture in place to allow for easy removal, forward advancement and reintroduction into the tissue to create a continuous running suture. Postoperatively, patients were seen within a couple weeks and then followed at 4-month intervals to assess graft survival, suture resorption and stricture recurrence. Results: Between January 2017 and November 2018, a total of 8 patients underwent BMG quilting utilizing the novel device. This included 6 men, 1 woman and 1 transgender female. The mean patient age was 57 years (range 29-79). The types of surgeries performed included 4 posterior urethroplasties, 1 transvesical bladder neck reconstruction, 1 augmented urethrostomy, 1 female dorsal onlay BMG urethroplasty and 1 revision neo-vaginoplasty. Average follow-up was 31 weeks (range 6-68). Graft survival was demonstrated in all patients with suture resorption occurring between 12-16 weeks postoperatively. There were no recurrent strictures within the time period studied. The novel surgical "sewing machine" can be used in a variety of surgeries where graft quilting or suturing is technically challenging. It creates a solution to the problem without compromising surgical outcomes. In addition, it has the potential for future applications in endoscopic and laparoscopic surgery. New Adjustable Artificial Urethral Sphincter (AUS) with an Additional Stress Balloon to Further Improve Treatment Outcome in Male Stress Urinary Incontinence (SUI) Sievert KD 1 , Huebner W 2 , Gunnemann A 1 , Ameli G 2 Introduction and Objective: The artificial urinary sphincter (AUS) became the gold standard to treat stress urinary incontinence (SUI) in the male. The reported success rate varied between 50 to 96%. Still, certain issues seem not to be solved. The recently released AUS Victo+ from Promedon® has been developed to solve these issues: faster reaction to stress-less episodes of urine loss; adjustable cuff to ensure the critical urethral closing pressure-avoidance of corpora spongiosum atrophy. We demonstrate the Victo+ surgical procedure and show its safety and efficacy. We retrospectively reviewed data stored in a multi-center prospective database for 46 (average age: 70 ± SD 7.5 years old) male patients with severe SUI. The causes of SUI were related to previous TURP, radical prostatectomy and/or radiation related to prostate cancer. In the lithotomy position through a midline perineal and inguinal incision, the one-piece Victo+AUS was implanted. Patients were now followed from 16 (5.9-25.9) months. The essential features of operation are described. Primary successful operative measurements were defined as no complications and patient satisfaction. Successful treatment outcome was defined as no pad usage or reduction of pad usage > 50%. Results: No intraoperative complications occurred. Operative time was 63 (55-78) min. After 6 weeks, the patient returned for activation. 18/36 patients became continent with the initial filling and the other patients needed additional fluid to reach a satisfactory outcome. The need for pads reduced from 6.4 ± 3.6 to 1.8 ± 1.8 pads/day. Overall patient satisfaction was reported in 84%. The patients were also investigated with regard to their leakage while coughing. Related to the stress balloon, the leakage while coughing was not seen in any of the patients. The number of implants and the follow-up is still small to make a final conclusion. The initial results of the Victo+AUS demonstrates that it can be safely and effectively performed with promising results. There was no clinical evidence of mycotic aneurysm. Pre-operative planning dictated a midline transperitoneal approach to provide direct access to the anteriorly positioned TRAA, the iliac vessels and allograft hilum without mobilizing the allograft. The iliac vessels were first secured proximal and distal to the single arterial anastomosis. TRAA was then dissected down to the aneurysmal neck with its connected branches. Renal vein was dissected too. Right saphenous vein graft was harvested and prepared by anastomosing it to right common iliac artery. Based on segmental clamping partial nephrectomy principles, in vivo excision of the TRAA was performed after suture ligation of anterior segmental arterial origin and clamping of the distal branches. With renal vein and posterior segmental branch unclamped, the rest of the kidney remained perfused. The prepared saphenous vein graft was then anastomosed to the distal divided end of the anterior segmental arterial branch. Results: Total operative time was 148 minutes. Estimated blood loss was 500 mL. Hospital stay was 5 days. Total warm ischemic time was 20 min. Post-operative renal function was normal and after 6 months. Follow up scans showed no TRAA recurrence. Conclusion: Careful pre-operative planning enabled a direct approach to the aneurysm, with its excision under segmental arterial clamping and repair with vein grafting. This in turn helped to achieve a rapid and complete allograft function recovery. Ganpule A, Patil A, Singh A, Sabnis R, Desai M Introduction and Objective: Robotic Assisted Kidney Transplantation (RAKT) is a new and challenging technique in urology. The robotic approach is especially useful when the operative field is deep and narrow and requires fine dissection and micro suturing. We present various risk reduction strategies for good outcome of RAKT. We analyzed 25 patients who underwent RAKT at a single institute from 2014-2019. We analyzed the challenges in RAKT patients. Appropriate strategies were formulated for the risk reduction and improve the outcomes of the procedure. Results: Creation of graft jacket with ice is required for maintaining cold ischemia of the graft. Pfannenstiel incision for engraftment has advantage of being cheap and prompt access in case of emergency bleeding. Adequate mobilization of bladder is required to prevent inadvertent bladder injury while engraftment. The orientation of graft is very important to prevent tospy-turvy graft, which can be salvaged by endto-end anastomoses of graft ureter to native ureter. Bench preparation can be done in case of dual donor renal arteries by anastomosing small artery to large donor renal artery in end-to-side fashion. Internal iliac artery can be utilized in case of significant plaque in external iliac artery. Less significant plaque in external iliac artery can be stabilized by 6-point fixation by Prolene sutures. Meticulous bench preparation with ligation of all possible tissue is essential to avoid post-clamp release graft surface bleeding. Adequate Retroperitonealization of the graft is essential to prevent graft torsion and access for graft biopsy. Retroperitonealization should be with good peritoneal windows to prevent lymphocele formation. Conclusion: RAKT is safe and feasible if risk reduction strategies are followed at appropriate steps. The Use of Smart Phone Thermal Imaging for Temperature Monitoring During Renal Transplant Vlok A, Cassim F, Van der Merwe A Introduction and Objective: Thermal imaging is a well-known technology with a wide spectrum of clinical uses. Recent introduction of devices able to connect with a smartphone have opened up the possibility for non-invasive temperature monitoring during surgery including renal transplant. A Flir one thermal camera was connected to a I-Phone and used during a renal transplant to monitor the temperature of the renal graft. Real time video was done with the camera during the preparation of the graft on the bench and also during the transplant. Results: Thermal imaging use prior to surgery allowed us to assess if the graft preservation fluid was of adequately cooled. During graft cooling, the non-invasive and real-time temperature monitoring allowed us to see if the graft was being cooled sufficiently and if the whole kidney, or only one area of the kidney, was being cooled. During this stage it is difficult for the surgeon to assess the temperature of the graft as his fingers are also in the iced saline bath. During the transplant, the temperature could be monitored from a distance and the surgeons could be made aware when the graft's temperature is rising and prompted to cool it with cold saline. The findings of this study changed our institutions protocols for temperature monitoring during renal transplants. Fluids and working area temperatures are now adequately assessed and, if required, cooled before surgery. Doctors are now more aware of the temperature of the graft and more effort is taken to assure adequate cooling of it during the surgery. Automated Needle Targeting (ANT) Device Assisted Renal Access in Percutaneous Nephrolithotripsy (PCNL) Puncture. A Novel Technique in University Malaya Medical Centre (UMMC) Introduction and Objective: PCNL is the treatment of choice for large renal stones. However, PCNL can be challenging for new urologists as accurate puncture for renal access is vital for success. The ANT device is an intraoperative navigation system developed to provide needle guidance in renal access during PCNL. It uses a software-controlled automated electromechanical arm with 2-D fluoroscopy images to calibrate needle puncture, aiming to reduce surgery time and radiation exposure. This video presentation demonstrates use of the ANT device to achieve successful PCNL puncture. This is an ongoing open label, single surgeon phase II clinical trial in subjects undergoing PCNL, using the ANT device. Ethical approval was obtained from UMMC ethics review board (Ref No 20118105-6740) . Consenting patients diagnosed with kidney stones and suitable for prone PCNL, would undergo surgery using the ANT percutaneous access technique. After initial motor calibration, the ANT is assembled, and image calibration is done with the patient's fluoroscopy image. Then, ANT software-oriented calculation will be made to achieve bullseye alignment before percutaneous puncture. Accurate renal access is confirmed by efflux of urine in the chiba needle as well as imaging with the C-Arm positioned at different angles. Our primary endpoints are time taken to successful renal access and assessment of adverse events. Open versus retroperitoneoscopic surgery for urinary stone treatment is not usually indicated. Nevertheless, they represent valid options in presence of anatomical abnormalities, big ureteral stones or failure after endoscopic or extracorporeal shock wave lithotripsy (ESWL). We present the case of a 67-year-old man with a past history of right hemicolectomy due to a colon adenocarcinoma. A 16 x 20 x 28 mm right renal pelvis and right pyeloureteral junction's urinary stone was diagnosed during a routine urological examination. ESWL was not indicated due to stone volume and localization. Retroperitoneoscopic pyelolithotomy and transurethral ureteral stent placement was performed. Results: Surgical time: 80 min. Hospital stay: 3 days. No post-operative complications. Ureteral stent was removed after one month. Crystallographic Stone analysis: magnesium ammonium phosphate. Retroperitoneoscopic access represents a valid alternative for complex renal stones treatment in experienced hands. To describe our technique of "Percutaneous calyceal flush manoeuvre" for clearance of residual stones/stone fragments in inaccessible calyces in horse shoe kidney (HSK) during percutaneous nephrolithotomy (PNL). A 77-year-old woman was found to have HSK and multiple renal stones in right moiety during evaluation for hematuria. Her urine for malignant cytology was negative and her serum creatinine was normal. Percutaneous access for PNL was achieved through superior calyceal puncture. Initially stone in the renal pelvis was fragmented and retrieved. An accessible lower calyceal stone was also cleared. One small stone (5 mm) was still seen located in an inaccessible posterior calyx medially under fluoroscopy. Initially a retrograde pyelogram was performed after blocking the previously placed amplatz sheath with a gauze piece. The location of the residual stone bearing inaccessible calyx was noted and it is punctured fluoroscopically using 18G two-part PNL puncture needle. Subsequently, under fluoroscopy the needle tip was positioned just on the surface of the stone and the inner trocar of the two-part PNL puncture needle was removed. Free flow of saline was seen through the cannula confirming the location of the tip of the needle in the pelvic calyceal system. Twenty-mL saline loaded syringe was connected to the cannula and with pressure the saline was flushed after removing the previous packed gauze piece in the amplatz sheath. The water jet pushed the stone from the calyx to the pelvis and it was subsequently retrieved through the already placed amplatz sheath. Complete stone clearance was confirmed, and 18 Fr nephrostomy was placed. Total operative time was 50 minutes. Post-operative course was uneventful. Next day perurethral catheter with ureteral catheter was removed and nephrostomy was clamped which was after 48 hours. Patient was discharged on third post-operative day. Conclusion: "Percutaneous calyceal flush manoeuvre" is a simple minimally invasive intraoperative adjunct during PNL for clearance of residual stones or fragments in inaccessible calyces of horse shoe kidney. Introduction and Objective: Percutaneous nephrolithotomy (PCNL) is the standard technique to manage large renal calculi. Second look PCNL is usually performed under intravenous (IV) sedation or spinal/ general anesthesia for removal of remnant stone. This leads to additional pre-anesthesia assessment and close monitoring. To simplify this procedure, the authors investigated feasibility and safety of second look PCNL without anesthesia and sheath, after maturation of nephrostomy tract. Results: Seven patients had their records reviewed. Mean age was 54 years (range 36 -68 years). All were males. In final histopathology report, 6 were transitional cell and one was adenocarcinoma. Of them, three were T1G3, two were T2N0, one with T3aN1 and last was T3bN2. The intraumbilical incision for specimen retraction and extracorporeal ileal conduit creation was 9 cm. Mean estimated blood loss was 400ml (range 300-700ml). Mean duration of surgery was 6 hours (range 5-8 hours). All of the patients spent 36 hours in intensive care unit. Orally sips allowed on post-operative day (POD) 2 and complete orals by POD 4. Per urethral catheter drain was removed on POD 3. Mean time of abdominal drain removal was 8 days, although in 1 patient, it was kept for 15 days because of urine leak, which was managed conservatively. All patients were discharged on POD14, except one who had urinary leak and was discharged on POD 28. Wound infection occurred in one patient and was managed conservatively. There was no operative mortality. Conclusion: 3D-Radical cystectomy has made dissection easier in radical cystectomy, due to its better vision and depth perception. What is BT-ESD? It's an enbloc resection of bladder cancer using Hybridknife. The electrode firstly marks the 5 mm clear margin circumferentially, then submucosal injection of saline to elevate the tumour, and it is followed by cutting the mucosa of the previous markings circumferentially. During en-bloc dissection of the tumour, cauterisation of the bleeding vessel is done at the same time, and finally the tumour is resected completely. Studies have shown that BT-ESD has high rate of detrusor muscle inclusion with no significant difference of perioperative morbidity and recurrence rates as compared with TURBT. Results: 70-year-old gentleman presented with gross hematuria, flexible cystoscopy and showed 4 cm bladder tumor over left posterolateral wall and 1.5 cm bladder tumor over right lateral wall. Multi-parametric MRI confirmed clearance of upper tract and organ confined bladder tumors. MRI VIRADS system from grade 1 to 5 signifies different degree of invasiveness of the bladder cancer. VIRADS grade 3 means non-suspicious of muscle invasion of both tumors of the patient. The duration of the whole procedure was less than one hour. Foley was removed and patient was discharged on post-op day one. Pathology of these two tumors was high-grade non muscle invasive bladder cancers. Conclusion: MRI VIRADS system guides us the invasiveness of the bladder cancer before BT-ESD, which is a safe en-bloc resection of bladder cancer with high detrusor muscle inclusion rate. Endoscopic visualization of these tumors will nearly be the same and resembling urothelial tumors, trans-urethral resection and histological analysis needed to identify the cell of origin. Introduction and Objective: To introduce a modified ileal conduit (MIC) intracorporeally performed following laparoscopic radical cystectomy (LRC) and dissection of lymph nodes for bladder cancer (BC). Using linear anastomosis stapler (LAS) 15 cm terminal ileum was isolated with mesentery transilluminator to preserve the blood supply. The continuity of the ileum was restored by endto-end ileoileal anastomosis, using LAS. The isolated loops were flushed with normal saline containing gentamycin, two single-J stents were pulled through the lumen of the loops. At stoma site a circular incision was made, and an extra-peritoneal tunnel was bluntly created with index finger. Through the tunnel, the loop and stents were pulled out of the incision. The left ureter was brought over the great vessels to the right side. The posterior wall of spatulated ureters were sutured to the loop in running suture, the anterior wall was closed after stents were inserted into ureters respectively. Finally, the conduit and the ureterointestinal anastomosis was totally re-peritonealized by closing the rent of retroperitoneum. Results: Twenty-six patients of BC were included. Male/female 20/6, age 63.57 ± 9.96 years old, BMI 23.91 ± 2.957 kg/m 2 , operation time 329.08 ± 96.91mins, estimated blood loss 232 ± 222.62 mL, ambulation 2 (1-4) days, flatus 3 (1-5) days, hospital stay 11 (6-25) days. Peri-operative complications (Clavien-Dindo) within 90 days included minor (I-II) 11 (44%) cases and major (III-V) 1 (4%) cases. Hydronephrosis was found in 3 cases (mild, 1; moderate, 1; severe, 1) and compromised renal function in 9 cases (mild, 7; moderate, 1; severe 1). The MIC was intracorporeally accomplished with maximally preserved blood supply of involved intestine and end-to-end reflux ureterointestinal anastomosis with conduit anchored in the extra-peritoneal tunnel. The ureterointestinal anastomosis was totally retroperitonealized, thus obviating any chance of herniating small bowel lateral to the conduit, reducing the incidence of urinary intestinal leak and secondary infection, and facilitating to handle subsequent complications. MIC is feasible and safe although technique challenging, which preserves satisfying renal function while not increasing peri-operative complications. Introduction and Objective: Ligation-free technique is firstly proposed and used in laparoscopic radical prostatectomy. In long-term clinical practice, it has been found equally applicable for bladder cancer. We herein reported the 2-year follow-up results of Ligation-free technique (suture-free dorsal vascular complex) used in laparoscopic radical cystectomy. From January 2015 to October 2016, 49 males less than 60 years old with Ta-T3a bladder cancer underwent laparoscopic radical cystectomy and orthotropic detail sigmoid neo-bladder. Prostate malignancy was excluded based on pathological examination. During the operation, the dorsal vascular complex was treated with ligation-free technique. The operation time and intraoperative blood loss were recorded. Oncologic (cancer specific mortality and recurrence) and functional outcomes (voiding, continence and erectile function) were evaluated as followed up. No patient had severe intraoperative complications. The operation time was 205.6 ± 32.4 min, and the intraoperative blood loss was 187.5 ± 42.6 mL. No patient had a positive apical surgical margin. The average catheterization time was 12.6 ± 4.57 days, and 7 patients achieved daytime control two weeks after removal of the catheter. Median follow-up was 22 ± 6.8 months. During follow-up, daytime continence was achieved in 42 patients while nighttime continence was achieved in 22 patients, respectively. In 19 patients who had normal erectile dysfunction before surgery, 7 patients recovered erectile function in 2 years of follow-up. 2 patients were found to have unilateral pyelo-carcinoma and underwent surgical resection. The rest of the patients had no localized recurrence and distant metastasis of prostate tumor and bladder tumor. The integrity of the dorsal vascular complex plays an important role in urinary control. Ligation-free technique can clearly expose the apex of the prostate and reserve the functional support structure as much as possible, which not only reduces the operation time but also promotes post-operative functional recovery without compromise of oncologic effectiveness. Introduction and Objective: Radical cystectomy with lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. We herein describe our technique and outcomes of capsule-preserving cystoprostatectomy and orthotopic detail sigmoid neobladder in selected patients with bladder cancer. We retrospectively analyzed the clinical data of 26 patients who underwent transurethral anatomical enucleation and resection of the prostate and radical cystoprostatectomy in the single center from April 2015 to January 2018. Inclusion criteria were less than 60 years of age with pathological diagnosed as bladder invasive urothelial carcinoma, and pre-operative pathology confirmation that the urethral mucosa did not invade. All patients had received an elaborate evaluation to rule out prostate cancer pre-operatively, which included initial value of prostate-specific antigen, multiparametric pelvic MRI, prostate biopsies when necessary. Results: All operations were successfully completed. The mean transurethral endoscopic surgery time was 27.8 ± 4.3 minutes, and the laparoscopic surgery time was 115.2 ± 26.5 minutes, detail sigmoid neobladder was reconstructed extracorporeally. Post-operative pathological staging T carcinoma in situ in 2 patients, T1 multiple grade 3 N0M0 in 6, T2 grade 3 N0M0 in 15, T2 grade 3 N1M0 in 1 and T3 grade 3 N1M0 in 2. No severe intraoperative complications occurred, and the mean PSA level was 0.45 ug/L three-month post-operative. During follow-up, complete daytime and nighttime continence is 88.5% and 61.5%, respectively. In 14 patients who had normal erectile function before surgery, 7 patients recovered erectile function in 1 year of follow-up. The IIEF-5 score increased from 7.7 three months postoperative to 16.7 in the first half of the year and 19.5 in 1 year after surgery. During the follow-up period, one patient developed local tumor recurrence and was receiving further chemotherapy and radiotherapy. Conclusion: Transurethral enucleation of the prostate preserves the surgical capsule is technically feasible and does not increase the risk of post-operative tumor recurrence. For young patients, it can significantly improve post-operative erectile function recovery and accelerate early recovery of urinary continence. It is worth noting that this group of cases needs to be strictly screened, and preoperative routine prostate biopsy and intraoperative frozen examination are recommended. Long-term functional and oncologic outcomes of this procedure still require a large randomized control trial to verify. Introduction and Objective: The main aim of this communication is to show that robotic surgery facilitates the approach of complex lymphadenectomies, even in large metastatic nodes after chemotherapy. We present the clinical case of an 18-year-old patient who was initially diagnosed with left testicular cancer and treated by orchiectomy. The pathological examination showed an embryonal carcinoma, pT1aN0M0. In the second control, 6 months later, a CT scan showed the appearance of lymph node metastasis, located in left para-aortic position. In consequence, a treatment by 3 cycles of BEP based chemotherapy was administered. Despite chemotherapy treatment, the lymph nodes continued growing. Three months later, these lymph nodes have increased to twice their size but fortunately, they did not show pathological activity in the PET scan. The uro-oncological committee decided to perform a surgical rescue and we carried it out by a robotic approach for a safer surgery. The robotic approach, thanks to its precision and maneuverability, allowed us to perform a complex surgery with the highest degree of safety and accuracy, removing all the affected lymph nodes and preserving the adjacent structures. Conclusion: In complex lymphadenectomies, especially after chemotherapy treatments, we must select the safest and most precise techniques. The robotic approach allows us to perform this kind of complex surgery, in order to remove all the affected nodes, without damaging the surrounding structures. Indocyanine Green ( We report the first case of bilateral VEIL in Singapore, aided also by indocyanine green (ICG) for deeper tissue penetration and visualization of nodal and vascular structures in a foreign operative field. A 63-year-old with pT1aN3M0 squamous cell carcinoma of the penis, underwent bilateral VEIL following partial glansectomy and 4 cycles of neoadjuvant chemotherapy. Port placement comprised the camera port 4 centimetres distal to the apex of the femoral triangle, with 2 working ports sited 6 centimetres laterally on either side. A plane was developed deep to Scarpa's fascia via a combination of digital dissection and introduction of the endoscope, and operative pneumoperitoneum was established at 8 mmHg. ICG-assisted nodal dissection was then performed abiding by the boundaries of the femoral triangle as the operative limits of dissection. Results: Staged VEIL was performed. Operative time for right VEIL was 255 minutes, with the patient discharged on post-operative day 3, and a brief readmission on day 25 for a right thigh seroma, treated initially with oral antibiotics. Left VEIL and concurrent ultrasound guided aspiration of the right thigh collection were then performed on day 35, with a total operative time of 170 minutes. The patient was discharged 5 days thereafter, with bilateral drain removal on day 17 in clinic and no significant complications following. Nodal yield was 11 and 8 nodes respectively, for right and left VEIL, with a total of 5 metastatic nodes overall. . After mobilization of colon, adrenal gland was dissected free from neighboring organs. Adrenal tumor was exposed and enucleated in conn's adenoma, and tumorectomy was done in the other cases (partial adrenalectomy). All patients were followed by lab data, imaging and clinical outcome. The mean age was 39.6 years (6 months to 83 years). Mean tumor size was 5.1 cm (range 1 to 18 cm). Tumor pathologies were 11 cases of pheochromocytoma, 6 cases of conn's adenoma, 2 cases of cushing adenoma, 2 cases of myelolipoma, 1 case of hydatid cyst, 16 cases of simple cyst and 4 cases of incidental adenoma. 14 patients from the total adrenalectomy group and 3 patients from the adrenal sparing group underwent bilateral surgery. No Clavien grade 3, 4 or 5 or any major complication due to surgery occurred. Hematocrit change and hospital stay were similar in these 48 cases and other patients. In the follow up period, imaging and hormonal tests were normal for all patients and signs and symptoms, such as blood pressure, became normal post-operatively. Laparoscopic Treatment of Giant Hydatid Renal Cyst Introduction and Objective: Hydatid cysts are caused by Echinococcus granulosus and are rarely present in the kidneys, whereas isolated kidney occurrence is estimated to be as low as 2-4% of all cases. We present a case of a large isolated renal hydatid cyst that was treated laparoscopically. Laparoscopic excision of the renal hydatid cyst roof with removal of contents was done and depicted in the video. All the clips were edited by a video editing program and all images were obtained after obtaining written consent from the patient. Results: A four-minute video was compiled and uploaded with commentary about the case. The mainstay of treatment of large renal hydatid is surgery. Minimally invasive surgery is preferable to conventional surgery and kidney preserving surgery is optimal if applicable. In our case, we were successful in treating the large cyst with clearing of all the contents and unroofing of the external cyst wall laparoscopically. Blue Spritz Technique -A Simple Way to Identify the Elusive Calyceal Diverticulum Ostium Introduction and Objective: Calyceal diverticuli are hypothesised to be congenital outpouchings of the renal parenchyma lined with non-secretory urothelium; acquired diverticuli have been proposed to be the sequelae of calyceal obstruction, secondary to calculi or a localised cortical abscess draining into a calyx. Urinary stasis within the diverticuli promotes stone formation resulting in renal colic or recurrent infections. When indicated, the treatment of calyceal calculi can be challenging when getting endoscopic access to the stone-bearing calyceal diverticuli, especially if the ostium/neck of the diverticuli is narrowed. In this video, we showcase the endoscopic treatment of a 53-year-old male patient who presented with recurring left flank ache. The KUB X-ray showed a cluster of calculi in the upper pole of the left kidney. An intravenous program was subsequently performed which demonstrated a dilated left upper pole calyx with multiple small clustered calculi. After thorough discussion regarding ureteroscopic and percutaneous approaches, he elected to proceed with the ureteroscopic approach. In the first procedure, it was noted that the distal ureter was tight, hence decision was made to proceed with staged pre-stenting. Subsequently, in the second procedure, there was difficulty identifying the ostium of the stone-bearing calyx. The ostium became apparent only after utilising the "blue spritz" technique -methylene blue was instilled into the collecting system via the flexible ureteroscope and then suctioned out; normal saline irrigation fluid was then introduced into the collecting system, with the residual blue dye seen escaping from the ostium of the stone-bearing calyx. A guidewire was then inserted into the calyx with subsequent laser infundibulotomy. The cluster of multiple calyceal calculi was visualised and extracted with a zero-tip basket. Results: A total of 105 small calculi were extracted from the calyceal diverticulum, each measuring about 1-3mm in size. The patient was rendered stone-free at the end of the procedure with the placement of a ureteral stent. At 1-week post-procedure, he was reviewed in the clinic; KUB X-ray showed no residual calculi and the ureteral stent was removed successfully. The "blue spritz" technique is an effective way to identify the elusive ostium of the renal calyceal diverticulum, saving the patient the need for percutaneous nephrostomy access. Since the initial description of open pyeloplasty by Anderson-Hynes, laparoscopic pyeloplasty (LP) has been considered to be the gold standard technique. However, this is increasingly being challenged by the robotic approach. Laparoscopic intracorporeal suturing is technically challenging and thus, to facilitate adherence to the principles of good anastomoses, barbed sutures have been employed in LP. However, results have been conflicting, there are reports of high failure rates that may be due to ischaemia and fibrosis. Conversely, others have reported favourable results. The suture used in their LP is the V-Loc (4/0); this has more barbs/cm compared with the bi-directional spiral anchor suture, Stratafix (4/0). We describe our technique and present our results using the less abrasive Stratafix. We prospectively reviewed 41 LP performed at our institution between 2015 and 2018. All patients underwent a CT Urogram and MAG III renograms. All patients underwent a transperitoneal LP with antegrade JJ stent insertion. Post-operatively, urethral catheters were removed between 3-5 days, JJ stent removed at 4-6 weeks and MAG III renograms performed at 3 and 12 months post-operatively. Patient demographics and perioperative complications were recorded. Pre-and post-operative reflux grades were evaluated by voiding cystourethrography at 6 months after surgery (VCUG). Surgery is the gold-standard for correction of Peyronie's curvature. Recently, there have been reports on partial plaque excision and grafting with collagen fleece technique regarding long term efficacy. However, there is still concern regarding post-operative bleeding complications and worsening of erectile function. Here, we introduce a less invasive technique by various plaque incisions instead of plaque excisions to minimize complications. From May 2018 and Jan 2019, 7 patients with stable Peyronie's disease (PD) were included. Surgical technique was composed of 3 major steps; 1) plaque thinning, 2) various plaque incisions and 3) sealing with collagen fleece (TachoSil ® ). We assessed the stretched penile length (SPL), total straightness and International Index of Erectile Function (IIEF-5) pre-operatively and 12 weeks post-operatively. Results: Mean patient age was 62.1 years (range: 52-72); 57.1% of patients had dorsal deviation, 42.1% lateral or ventral deviation. Mean operative time was 80.7 min (range: 60-120). All patients achieved total straightness. Mean penile length of preoperative and postoperative 12 weeks were 10.3 cm (range: 9-12) and 11.3 cm (range: 10-12), respectively. None of patients had hematoma post-operatively and erectile function was preserved 12 weeks post-operatively. Conclusion: Our initial experience with this technical modification of various plaque incisions shows that one can achieve a sufficient surgical effect without making defect of carvernosum. However, long-term clinical outcomes are necessary to confirm these encouraging findings. Oral Grafts for Urethral Augmentation or Substitution. Harvesting Technique from Inner Cheek and Sublingual Area Introduction and Objective: Oral mucosa is the tissue of choice nowadays for urethral augmentation or substitution due to its adequate features and availability. It could be harvested from several locations within the oral cavity. The aim of this video is to demonstrate the detailed technique of harvesting and preparation of oral mucosa grafts for their use in urethral surgery, from two of the most common locations -inner cheek and sublingual area. In our video, we show the standardized harvesting technique of oral mucosa to be used in urethroplasty surgeries, through several clips from patients from our series. We expose some urethral repairs with indication for multiple oral mucosa grafts in order to enlarge or substitute damaged segments. We explain in detail the main steps for harvesting and preparing oral grafts from inner part of the cheek and sublingual area. Anatomical landmarks and surgical keypoints are highlighted. Results: After cleansing the oral cavity and placing adequate retractors, we show how to identify and mark the limits for safe mucosal harvesting in each location. The grafts are designed, measuring and tailoring them according to the damaged urethral segment. Submucosal injection of local anesthetic and adrenaline prior to incising the mucosa helps with dissection and haemostasis. We incise the graft limits, and rise the mucosal segment, coagulating the bleeding spots with bipolar forceps. Donor sites are closed using absorbable sutures and grafts are prepared, removing muscle fibres, in order to get ready for their placement in the perineal or penile urethral segment. Conclusion: Oral mucosa is a suitable material for urethral augmentation or substitution. Graft harvesting from inner part of cheek or sublingual area is a safe procedure. A detailed knowledge of oral cavity anatomy and a standardized technique of harvesting and preparation of grafts are paramount to achieve good outcomes and prevent complications. Robotic Posterior Urethroplasty After Complete Urethral Transection During Abdominal Perineal Resection Baumgarten A, Heinsimer K, Wiegand L, Patel T Introduction and Objective: Urethral trauma after colorectal surgery is rare, and therefore, there is paucity of literature on their management in the current era. Additionally, there is a lack cases describing robotic posterior urethral repair without a simultane-ous perineal dissection or history of prostate cancer treatment. Description of a robotic transabdominal posterior urethroplasty in a 39-yearold male with complete urethral transection after laparoscopic abdominal perineal resection (APR). The patient sustained complete urethral disruption while undergoing an APR. Imaging was consistent with urologic trauma limited to a urethral transection proximal to the membranous urethra. Three days after the APR, the patient was taken to the OR for repair. Prior port sites were utilized for our robotic port placement, the retropubic space was developed and dorsal venous complex divided similar to a prostatectomy. After identifying the urethra with the aid of a cystoscope, the prostatic urethra was anastomosed to the membranous using a 3-0 barbed monofilament. At post-operative week four, a voiding cystourethrogram showed a small leak, therefore the urethral catheter was left for a total of six weeks. At last follow-up, the patient was voiding per urethra without fistula, incontinence, or stricture. Conclusion: Immediate robotic repair of an iatrogenic posterior urethral disruption is feasible with successful short-term outcomes. This is a select and rare complication of colorectal surgery and therefore, long-term stricture free rates are yet to be determined. Materials and Methods: Forty-nine patients with flat bladder lesions diagnosed by white light cystoscopy + narrow-band imaging followed by transurethral resection were included. The diagnostic value of narrow-band imaging was compared with post-operative pathological results. Results: A total of 59 flat lesions were identified, in which 8 were normal urothelium, 3 were chronic inflammation, 1 was papillary urothelial neoplasm of low malignant potential, 2 were mild dysplasia, 1 was moderate dysplasia, 1 was severe dysplasia, 3 were carcinoma in situ, 16 were low-grade papillary urothelial carcinoma, 16 were high-grade papillary urothelial carcinoma, and 8 were invasive papillary urothelial carcinoma. For narrow-band imaging, the sensitivity was 86.7% (39/45), specificity was 57.1% (8/14), diagnostic accuracy was 79.7% (47/59), false-positive rate was 42.9% (6/14), positive predictive value was 86.7% (39/45), negative predictive value was 57.1% (8/14), and area under ROC curve was 0.719. Among these lesions, the sensitivity and specificity for post-operative recurrent lesions were 100% (3/3) and 40% (2/5), respectively, and those for erythematous patch-like lesions were 90% (9/10) and 100% (4/4), respectively. -QoL) . The aim of the current study is to compare HR-QoL outcomes between ileal orthotopic neobladder (IONB) and standard bilateral cutaneous ureterostomy (CU), using validated diversion-specific QoL questionnaire. The study utilized retrospective cohort design, including all patients who underwent radical cystectomy with either orthotopic neobladder or bilateral cutaneous ureterostomy from January 2010 till December 2017. In total, 69 and 57 patients were included in each group respectively, after applying the following exclusion criteria: female, pre-and post-operative radio and chemotherapy, palliative surgery. HR-QoL was calculated for patients with a minimum of 12 months of follow-up. HR-QoL was evaluated using Functional Assessment of Cancer Therapy (FACT) questionnaire for patients undergoing cystectomy (Bl-cys). No statistically significant differences were observed in any of the scores when comparing modified CU arm to standard CU and IC arms. In contrast, in multivariable regression mean scores of functional health (11.5 vs 14.5, p-0.003) and additional concern (35.5 vs 39.7, p-0.039) domains, current erection status (0.2 vs 0.9, p-0.004) and satisfaction from urinary diversion (1.5 vs 2.1, p-0.009) scores were statistically significantly inferior in standard CU arm compared to IC arm. Conclusion: Modified CU is associated with lower early post-operative complication rate while HR-QoL is not statistically significantly different between CU and IC arms. Therefore, modified CU could be offered to selected patients requiring IC. Clinical Practice Patterns of Immediate Intravesical Chemotherapy Following Transurethral Resection of Bladder Tumor The Ottawa Hospital, Ottawa, Canada Introduction and Objective: Current evidence supports the use of a single post-operative dose of intravesical chemotherapy following bladder tumor resection for non-muscle invasive bladder cancer (NMIBC). However, several studies have demonstrated a wide variation in the utilization of post-operative intravesical chemotherapy in various health jurisdictions around the globe. Our goal was to assess current practice patterns among urologists in the Canadian healthcare system with regard to post-operative chemotherapy instillation. Institutional review board approved our study. An electronic questionnaire was distributed to Canadian urologists via email in June 2018. An initial invitation to participate was followed by two reminder emails. Statistical analyses were performed on the collected data. is an uncommon yet difficult scenario for which various procedures have been described and yet, there is no clear consensus on the optimal procedure. We report our experience with dorsal buccal mucosal graft urethroplasty in these patients. After ethics board approval, we performed urethroplasty in 15 patients from August 2016 to 2018 for urethra with a caliber <12F and severe voiding LUTS, significant PVR on ultrasonography and high detrusor pressures on urodynamic study (>40 cm H20 in voiding phase). Patients underwent a uroflowmetry, urodynamic study, cystoscopy pre-operatively and were assessed using AUA symptom score, uroflowmetry post-operatively. The mean age of the patients was 38.4 years and the median AUASS was 22. In 12 out of 15 patients, stricture was idiopathic, two patients had his-tory of urethral caruncle surgery and one patient had history of prolonged catheterization at the time of obstetric trauma. Nine out of 15 had multiple urethral dilatations/urethrotomy previously. The mean urethral caliber was 9.6F, and all patients had a flat graph with a mean Q max of 9.1 ml/sec on uroflowmetry. In voiding phase, the mean detrusor pressure at maximum flow was 71.06 cmH 2 0. The mean length of the stricture segment was 2.9cm. The mean operative time was 38.2 minutes. Post-operative urethral calibration >18F in all patients. The median AUASS at 1 month, 3 months and 6 months of follow-up after trial without catheter was 5, 6 and 5 respectively. The pre-operative mean Q max of 9.1 mL/s increased to 22.8 mL/s, 24.6 mL/s and 24.2 mL/s with normal flow rate curves at the 1-, 3-and 6-month follow-up, respectively. Two of the patients complained of persistent symptoms, one of whom required regular self-calibration and the other followed up for monthly office dilatation. None of the patients complained of neurosensory complications or urinary incontinence. Instead of undergoing repeated, overzealous dilatations for urethral strictures, patients should be given an option of upfront urethroplasty. Dorsal buccal mucosal graft urethroplasty offers an easy, less morbid approach, with excellent results and minimal complications. Long-Term Functional Outcomes after Radical and Partial Nephrectomy RF-01.07, Figure 1 . Mean estimated glomerular filtration rate as a function of time by assigned treatment. Conclusion: Partial nephrectomy is feasible in patients with localized kidney tumors and size larger than 4 cm, providing better functional outcomes over radical nephrectomy. Taking to account equal oncological outcomes of both surgery types, organ-sparing management seems more favorable in terms of reducing comorbidity development risks. Retrospective Introduction and Objective: Chronic nephrolithiasis predisposes to squamous metaplasia and squamous cell carcinoma (SCC), which is a rare malignancy of the upper urinary tract. It is often unsuspected clinically due to its rarity and ambiguous clinical and radiological features, and hence patients present at advanced stages, resulting in poor prognosis. The clinic-pathological characteristics, surgical outcomes and survival of renal pelvic SCC associated with renal stones were retrospectively analyzed. A retrospective analysis of data from Jan 1995 till Feb 2017, who had undergone nephrectomy for non-functioning kidney due to renal calculi and incidentally detected to have SCC of the pelvis at MPUH, Nadiad was done. 18(n) cases of malignancies associated with stone disease were analysed. Results: M: F = 11:7; Age: 50.80 ± 9.6 years. Right: Left side tumors = 10:8. The mean operative time: 100.5 ± 40.5 min, mean blood loss: 120 ± 20ml, mean hospital stay: 6 ± 2.5 days. 1 patient had duodenal injury. Final histopathology revealed T4 in 6, T3 in 10 and T2 in 2 patients. 3 received post-op radiotherapy and 5 received platinum-based chemotherapy. One patient had evidence of lung metastasis in post-op chest CT. Infectious and systemic symptoms were noted in the majority of patients. Pre-operative imaging: suspicious tumor in 2 cases. Both underwent radical nephrectomy and median follow-up was: 15 months, later lost to follow-up. In the other 16 patients, mean follow-up was 4.5 months. Conclusion: Malignancies associated with stone disease have insidious onset of clinical symptoms in patients with prolonged history of stone disease. The grave prognosis associated with it, mandates one to have a high index of suspicion. This emphasises the necessity of prompt treatment of renal stones and assessment for renal tumors in patients with long-standing staghorn calculi. The incidence of SCC in hydronephrotic kidneys in our series also highlights the need for ureteroscopy biopsy of the pelvis and meticulous sampling of the renal pelvis by the pathologist in such specimens. Outcome Since conventional grey scale ultrasound has limited sensitivity and specificity in the detection on prostate cancer, Micro-Ultrasound was developed using high frequency (up tp 29MHz) and high-resolution ultrasound images. We evaluated the diagnosis performance of Micro-Ultrasound in the detection of prostate cancer index lesion and compared its performance relative to mpMRI, using pathological whole mount sections as the reference. Materials and Methods: 32 prostate cancer patients scheduled for radical prostatectomy underwent Micro-Ultrasound before surgery, where still images and cineloops were recorded. 16 patients had mp-MRI images with acceptable quality and complete sequences available. Each prostate was partitioned into 12 sectors for a total of 192 sectors evaluated. Micro-Ultrasound images were scored according to the Prostate Risk Identification using Micro-Ultrasound (PR-IMUS) and mpMRI images were scored according to PI-RADS v2. A score of up to or equal to 3 was considered to be suspicious for both scores. The index lesion, which was the biggest lesion visible, was identified and filed depending on the localization. Prostatectomy specimens were processed according to the Stanford protocol. Pre-operative and post-operative results regarding the identification of the index lesion were compared and sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated. Conclusion: Sonourethrography has a high accuracy in the determination of extent of spongiofibrosis which correlates excellently with intraoperative findings. It also has a higher sensitivity specificity, PPV and NPV in the determination of length of stricture than retrograde urethrography. Both tools are valuable in management of urethral stricture. Reintroducing Augmented Urethroplasty as Anterior Urethral Stricture Management in Tertiary Referral Hospital in East Java Lanang Andi Suharibawa IG, Satyagraha P, Nur Budaya T Introduction and Objective: Urethral stricture disease is challenging condition to treat. Augmented urethroplasty represents a reliable therapeutic option for anterior urethral stricture patient with high success rate. We report our experience in reintroducing augmented urethroplasty as anterior urethral stricture management in a tertiary referral hospital in East Java. Between January 2012 -December 2017, we found 306 urethral stricture patients. There were 136 patients that underwent urethroplasty and 58 of them underwent augmented urethroplasty. The data of urethral stricture patients were collected from medical record in Saiful Anwar General Hospital. Treatment outcome was evaluated based on post-operative clinical symptoms, uroflowmetry, the additional procedure needed, and the correlation was analyzed by T-Test and Chi-Square. Results: There were 58 patients with urethral stricture had augmented urethroplasty in our institution from January 2012 until December 2017, with an average age of 50.8 + 15.3 years old. The most common site of stricture was panurethral (29/50%). The minimal, maximal and average length of anterior urethral stricture was 2 cm, 18 cm and 7.72 cm. Infection was the main cause of urethral stricture (29/50%). One side dissection dorsal onlay was the most common procedure with 47 patients (81%). Buccal mucosal graft were used in most patient with only two patients (3.4%) use lingual graft. The overall success rate of the procedure was 86.2% with the average length of follow-up was 108 weeks. The most common complication was recurrent stricture (6/75%). Introduction and Objective: The use of oral mucosa grafts in urethral reconstruction involves transplantation of non-keratinized oral mucosa for the repair of a variety of urethral defects and in the last two decades, this has emerged as the most widely used substitute tissue in urethral reconstruction. The common sites of oral mucosa grafts for urethroplasty include the inner cheek (buccal), the lips (labial) and the anterolateral aspect of the tongue (lingual). However, harvesting of oral mucosal grafts has certain complications. This study evaluated the donor site complications that may result from oral mucosa graft harvest for anterior urethral reconstruction for stricture. This was a prospective study of 28 consecutive patients who presented at the Urology Unit of a University Teaching Hospital with long segment urethral stricture, who had oral mucosa graft harvest and substitution urethroplasty. The donor sites were evaluated at 48 hours, at discharge, 1 month and at 3 months post-operatively. Variables evaluated included pain using the Verbal Descriptive Scale (VDS); haematoma due to bleeding; difficulty in opening the mouth; ability to drink and eat food, and numbness in the mouth. Results: The mean age of the patients in this study was 45.4 (+ 13.2) years with a range of 14-69 years. The mean length of graft was 5.25 cm (+ 2.00), range of 1.5 cm -11.0 cm. Location of strictures was bulbar urethra in fourteen patients (50%), in twelve patients (43%) it was present in the peno-bulbar urethra. Graft donor sites were buccal in 25 patients (89.3%); in 2 patients (7.0%), they were obtained from both the cheek and lip; and in 1 patient (3.5%), the graft was harvested from the tongue. Oral mucosa donor site complications included pain (32%), bleeding (14%) and peri-oral numbness (3.5%). No patient had difficulty in opening the mouth and all were able to eat and drink within 48 h post-operatively. All donor site complications resolved at discharge and there were no events at follow-up. Harvesting of oral mucosa graft for substitution urethroplasty is safe but may be associated with minimal short-term donor site complications. F-fluciclovine PET/CT scans increased with higher pre-PET PSA levels ( Figure 1 ). Significant differences in positivity after BCR in the prostate bed were noted between radical prostatectomy (14.2%), radiotherapy (65.3%) and cryotherapy (87.5%) patients (p <0.001). Following 18 F-fluciclovine PET/CT, planned management was revised in 31 of 48 patients (64.5%) and were associated with a positive PET/CT in 24 of 31 cases (77.4%). The most frequent change was from salvage or noncurative systemic therapy in favor of watchful waiting (10 of 31 patients; 32.2%), from noncurative systemic therapy to salvage therapy (7 of 31 patients; 22.6%), and from salvage therapy to noncurative systemic therapy (5 of 31 patients; 16.1%) ( Figure 2 ). Conclusion: 18 F-fluciclovine PET/CT detected recurrent sites in most men with BCR PCa, often resulting in management changes. Saouli A, Karmouni T, Elkhader K, Koutani A, Iben Attya Andalousi A Introduction and Objective: The aim of this study is to evaluate the prevalence of urinary colonization in patients with the JJ stent, to define the predictive factors associated with this colonization. This is a monocentric prospective study (Between January 2013 and April 2017), conducted in the Urology B department of Ibn Sina Hospital in Rabat. 145 double ureteral catheters carried by 120 patients were examined. The bacteriological profile of the urine of our patients was followed by the completion of an initial urine exam and another at the time of the removal of the JJ. The rate of colonization in patient's holder JJ was 35.8% (43 out of 120). The urinary colonization rate was 31.7% (38 out of 120). The rate of urinary colonization in patients with colonized JJ was 81.6%, where as it was only 18.4% for non-colonized probes. On double ureteral stent culture, we identified Escherichia Coli as the most predominant colonizing pathogen (47.3% of probes) followed by Enterococcus feacalis and Klebsiella pneumoniae (18.4%, 15.8% respectively). 11.5% of colonized patients developed infectious complications (5 out of 43) and have been treated successfully except a patient who died from septic shock. In multivariate analysis, three factors were statistically associated with this risk; diabetes mellitus (p = 0.005, OR = 0.23, CI = 0.08-0.64), the urgent establishment of JJ (p = 0.05, OR = 0.26, CI = 0, RF-02.02, Figure 1 : 18F-fluciclovine PET/CT detection rate by PSA. The prevalence of urinary colonization in patients with the double J stent was 31.7%. Diabetes mellitus, duration of implantation of the JJ more than 30 days, and urgent JJ establishment are associated with a higher risk of these urinary colonization. Bacteriology and Antibiotic Sensitivity Pattern of Isolates in Patients Who Underwent Percutaneous Nephrolithotripsy (PCNL) at the Philippine General Hospital (PGH) Introduction and Objective: Despite being a clean contaminated procedure, PCNL is associated with significant infectious complications, such as pyrexia and post-operative bacteremia. We determined the prevalence of post-PCNL infectious complications and distribution, and antibiotic sensitivity of microorganisms isolated from patients admitted for PCNL. Risk factors associated with the occurrence of positive culture results and development of post-operative fever and bacteremia were also analyzed. A cohort of 102 adult patients who underwent PCNL from January to December 2018 under the PCNL Urinary Tract Infection Surveillance Protocol at a tertiary government hospital was studied retrospectively. The susceptibility patterns of isolated bacteria from urine, stone and blood cultures were evaluated against the most common antibiotics in the hospital. Chi-square and Student's T-test were used to determine differences in the frequencies and means for different risk factors for those who developed fever and urosepsis and those who did not. Results: Ten isolates were recovered from the preadmission urine culture study (CS), seven from intraoperative urine CS, forty-seven from stone CS, none from febrile urine CS and 4 from febrile blood CS. The most common organism isolated on the urine specimens was Escherichia coli, which showed high sensitivity to aminoglycosides. This organism is also among the most common isolate found in stone CS but a significant number of Pseudomonas aeruginosa and Stenotrophomonas maltophilia were also cultured, which showed higher sensitivities to fluoroquinolones. Twenty-five percent (26/102) and 3.9% (4/102) of PCNL-treated patients developed post-operative fever and urosepsis, respectively, despite receiving antibiotic prophylaxis. No significant associations were found between the different clinical variables studied and the occurrence of post-operative fever and urosepsis. The current antibiogram formulated showed higher sensitivity to aminoglycoside and fluoroquinolones. Despite nearly consistent resistance to ceftriaxone of the isolates in our cases, it does not warrant a change in the antibiotic prophylaxis utilized in the surveillance protocol, given the lower rates of the post-PCNL infectious complications compared to published literature. Further surveillance is required to justify a shift in prophylactic antibiotics and identify significant risk factors for the development of fever and urosepsis post-PCNL. Antibiotic Susceptibility Trends of UTI Causative Bacteria in Indonesia: A Four-Years Surveillance Study Yuri P 1 , Zulfiqqar A 1 , Shigemura K 2 , Kitagawa K 2 1 Universitas Gadjah Mada, Yogyakarta, Indonesia; Dr. Sardjito General Hospital, Yogyakarta, Indonesia; 2 Kobe University Graduate School of Medicine, Kobe, Japan Introduction and Objective: The emergence and spread of antibiotic resistance has become a global challenge. Urinary tract infection (UTI), one of the most common infections, has also become more challenging to treat. Increases in uropathogen resistance to antibiotics has caused higher morbidity, mortality, and cost in UTI cases. This study addressed trends in antibiotic resistance and uropathogen demographics in Indonesia over four-years period. A retrospective cross-sectional study was conducted from January 2015 through January 2019. Urine samples were collected and cultured from patients with UTI hospitalized in the Dr. Sardjito Hospital. The isolates from 2171 urine samples were cultured. Escherichia coli (E. coli) (20.6%), Enterococcus faecalis (20.5%), and Klebsiella pneumoniae (K. pneumoniae) (10.4%) were identified as the most common bacteria found on culture. E. coli (23.0%) was the most common uropathogen in pediatric patients, with E. faecalis (14.9%) and K. pneumoniae (9.96%) following as the second and third most dominant uropathogen. Antimicrobial susceptibility tests showed that E. coli is sensitive to amikacin (AMI) (95.35%), ertapenem (ERT) (88.3%), meropenem (MER) (86.1%), and nitrofurantoin (NIT) (75.7%). Extended-spectrum beta-lactamase (ESBL)-producing E. coli showed a similar pattern. E. coli and K. pneumoniae infections were more common from 2015-2016 and significantly declined in both adult and pediatric patients thereafter (p< 0.05). However, the percentage of ESBL-E. coli significantly increased in adult patients (p < 0.05), as did ESBL-K. pneumoniae in pediatric patients. Antibiotic susceptibility tests showed that AMI and carbapenems (MER and ERT) had no change in susceptibility over time. Ciprofloxacin showed lower susceptibility for all bacteria, but susceptibility did not significantly change over the study period (p > 0.05). Pseudomonas aeruginosa was sensitive to MER, but not to other antibiotics. The susceptibility tests on this study showed the proportion of ESBL-producing bacteria increases significantly, trend of resistance changed over time and results were different with current national guideline. Our study confirms that antibiotic cycling reasonable as current strategy on management UTI. We propose AMI as the first line antibiotic for UTI in Yogyakarta, with carbapenems considered for severe UTI, and MER are recommended for suspected Pseudomonas eruginosa infection. The Fate and the Natural History of Small Angiomyolipomas in a Contemporary Series Alsunbul A 1 , El-Tholoth HS 1 , Aldughiman A 1 , Alakrash H 1 , Al-Afraa T 1 , Ali-El-Dein B 2 , Alzahrani T 1 , Alzahrani A 1 , Obied A 1 Introduction and Objective: Angiomyolipomas are common benign tumor of the kidney and the most common fat containing tumor in the kidney. Retroperitoneal hemorrhage is its most serious complication. The long-term outcome of renal angiomyolipoma has rarely been reported. The aim of this study is to review the fate and the natural history of ultrasound diagnosed small renal angiomyliopmas. Retrospective review of our radiological data base was performed searching for all cases who underwent ultrasound study and were radiologically diagnosed (first time diagnosis) to have angiomyolipoma of a size less than 4 cm. Age at diagnosis, presentation, duration of follow-up, confirmation by computed tomography, progression and time and reason for intervention were stated. Analysis of data and the growth rate over a year were reported. Results: A total of 232 patients were included in our study with a mean age of 52 years. The mean size of the tumor at diagnosis was 1.9 cm. The diagnosis needed was confirmed by CT scan in 97 (41.8%) of cases. During follow-up (mean 54; range 12-108 months), 90 patients (38.8%) showed no change in size at all, while in the remaining patients the rate of increase in size was less than 1 mm per year. In only 8 patients (3.4%) the tumor became more than 4 cm. Three of these 8 patients were symptomatic needed and accepted interventions by angioembolization. Patients whose tumors became more than 4 cm in size had tumors more than 3 cm from the start. Conclusion: Small angiomyolipomas, at initial diagnosis, are slowly growing or static tumors. However, meticulous follow-up is mandated to discover any increase in size and/or possible complications. Abdominal Phalloplasty in Three Patients with Penile Agenesis Introduction and Objective: Aphallia is an extremely rare congenital anomaly and its' treatment is still controversial, even regarding gender assignment. Type of surgery and age for surgery are debated, due to quite insufficient literature data. We present our results in the treatment of three patients with penile agenesis. From June 2016 until February 2018, 3 patients, aged 2, 3.5 and 5 years, underwent phalloplasty due to penile agenesis. They were all evaluated and diagnosed soon after birth. All three boys presented with descended testicles and perineal urethral opening. Phalloplasty was performed using lower abdominal wall skin flap, in all three cases. Skin flaps were designed and harvested to create an appropriately shaped and sized neophallus, in a good position. The tip of the neophallus was fixed to the abdominal wall skin to keep it elevated for the first three days after surgery. In that way, the tension was reduced, as well as the risk of flap necrosis. Donor site was closed by direct approximation in all cases. Results: Follow-up ranged from 14 to 32 months (mean 21 months). There were no complications related to the flap or the donor site. Satisfying aesthetic outcome was achieved in all cases, defined as a wellshaped and sized neophallus, and properly positioned as well. All parents reported happiness with the final outcome. Conclusion: Creation of the neophallus in boys with aphallia is very important for their psychological and psychosexual development. An adequate age for surgery should be discussed with psychologists and parents. A lower abdominal wall skin flap presents a good and safe option for these patients in childhood, as a temporary phallus. However, creation of an adultsized neophallus in adolescence is the next step. That is why a lifetime follow-up of these patients is necessary. Introduction and Objective: Worldwide and over the years, reconstruction of the urethra has continued to present formidable and enormous challenges for urologists as diverse opinions have been expressed on the quality and type of ideal substitution material. The most common graft material used for substitution urethroplasty are buccal mucosa and a preputial skin graft. The aim of this study was to evaluate the outcome of dorsal onlay substitution urethroplasty in bulbar urethra and pan-urethral, performed either with preputial skin flap or buccal mucosa, in terms of functional results and the post-operative complications in a prospective study. From January 2015 to August 2016, 53 patients with bulbar urethral strictures underwent urethroplasty using inner preputial skin flap (27 patients) and buccal mucosa graft (26 patients) with follow-up at 3, 6 and 12 months with IPSS and uroflowmetry. Success was defined as improvement of IPSS and Q max >20 mL/s. Further instrumentation was considered a failure. Results: With the mean age of 41.24 years and mean stricture length of 5.9 cm, 50 and 3 patients belonged to inflammatory and post-traumatic etiology respectively. Mean graft size was 5.6 cm and 5.4 cm in preputial skin and buccal mucosa respectively, with overall success rate of 87% (preputial skin flap 85.2% and buccal mucosa graft 88.5%). At 1 year, all patients had Q max >20 mL/sec in both the groups, except 7 fail-ure cases (13%) out of which 4 patients (57%) were in inner preputial skin group and 3 patients in buccal mucosa group. Complications included postvoid dribbling (3 patients), penile skin necrosis and fistula formation (1 patient each) in inner preputial skin group and altered sensation in cheek (5 patients), post void dribbling (2 patients) and infection (2 patients) in buccal mucosa group. Conclusion: Inner preputial skin flap and buccal mucosal free graft can be used as a reasonable material in substitution urethroplasty. On comparing the rate of success and complications, the difference was insignificant with an added advantage of buccal mucosa graft where preputial skin was unavailable. However, longer follow-up with a greater number of patients is needed to judge the long-term efficacy. To Bleed or Not to Bleed? Dayof-Procedure Blood Tests for Transurethral Prostatectomy Patients Introduction and Objective: Transurethral prostatectomy (TURP) is a common urological procedure used to improve urinary symptoms in men with prostatic hypertrophy. Despite being routine, it is not without risk, including haemorrhage and development of TUR syndrome. As a result, it has been customary in our trust to test haemoglobin, sodium and also group and save (G&S) at both pre-assessment clinic and on the day-of-procedure. Few patients appeared to develop these post-operative complications and so we wanted to assess the clinical need compared with the actual incidence and cost-analysis. Having been identified on a surgical database, the clinical records of all patients who were listed for TURP at Kingston Hospital over an eight-month period were retrospectively reviewed. Data including demographics, pre-operative blood results, blood transfusions required, and development of TUR syndrome were recorded. Cost-analysis was performed using local values from the processing of FBC, U&E and G&S. Results: In total, 94 patients were eligible for inclusion during the period August 2018 to March 2019. The mean age was 72. No patients required intraoperative transfusion and only 2% required post-operative transfusion at 12 and 26 hours from procedure. In the patients requiring transfusion, one had clear operation notes detailing the likely risk of bleeding. 1/94 developed post-operative confusion and was found to have hyponatraemia which quickly resolved on the ward without ITU admission. Cost-analysis revealed that £2014.89 would be spent per year for the processing of the day-of-procedure bloods along with 36 hours of operator time. In this study, pre-assessment and day-of-procedure haemoglobin and sodium results rarely gave an indication of who may be at risk of developing post-operative complications and there were significant associated costs. In light of these results, patients attending Kingston Hospital NHS Foundation Trust for TURP will no longer have day-of-pro-cedure bloods unless there are specific indications. This will lead to savings in operator time, equipment and lab processing fees and reduces the number of venepunctures that the patient has to endure. A Materials and Methods: A total of 75 male SD rats were randomly divided into five groups: group A received sham operation, group B received bilateral cavernous nerve injury, group C received PLGA membrane system only, group D received OECs only, group E received PLGA membrane system combined with olfactory ensheathing cells. Then, the maximum intracavernous pressure (mICP) of the rats were calculated by electrical stimulation of the major pelvic ganglions, the proportion of nNOS-positive nerve fibers in the total area of penile dorsal nerves, and a-SMA-positive corporal smooth muscle and nissl staining determined by immunohistochemical staining, the levels of endothelial cell marker nNOS, PKG, sGC, VASP, p-VASP and b-Actin detected by Western blot. Results: After 28 days of treatment, the rats in the group E, as compared with those in the group B, group C and group D, showed significant increases in the mICP (P<0.001), the proportions of nNOS-positive nerve fibers in the total area of penile dorsal nerves (P<0.001), the a-SMA-positive corporal smooth muscle (P<0.001), the number of nissl bodies in cavernous nerves (P<0.001), but no remarkable decrease with group A (P>0.05). Conclusion: PLGA membrane system combined with olfactory ensheathing cells can protect the erectile function of the rat with cavernous nerve injury by protecting the nerves, improving the alleviating fibrosis and inhibiting cell apoptosis in the cavernous tissue. El-Khoury J 1,2 , Brookes J 1 , Shahbaz S 1 , McCahy P 1 1 Monash Health, Melbourne, Australia; 2 Northern Health, Melbourne, Australia; Introduction and Objective: Modern handheld media players (iPads, Mobile phones, etc.) are being increasingly adopted to help manage patient comfort across a range of medical procedures. This study sought to assess whether the use of visual media or music improves the patient experience and reduces analgesic requirements in patients undergoing ESWL. A randomised double blinded control study was undertaken, at a single centre over 10 weeks. The only inclusion criteria were patients suitable for undergoing ESWL. 95 patients undergoing ESWL at our centre were randomised to either a control group (current standard of care) or modern media distraction, either visual or audio. Post-procedure patients completed a short questionnaire using the Visual Analogue Scale (VAS) to assess peri-procedural pain and patient satisfaction. Any additional analgesic requirements. ESWL settings and stone/patient factors were also recorded. Results: Patients in the control group reported an average pain score of 6/10. The average score for patients in the music distraction group was 3.5/10, and for patients in the video distraction group 3.6/10. Both interventions improved patient satisfaction by 50% (3/10 in the control group, compared to 8/10 in both the music and video distraction groups). Conclusion: Modern media devices allow ESWL to be better tolerated without general anaesthesia. Both video and music distraction improve patient experience of the procedure and markedly decrease reported levels of pain, while decreasing analgesia requirements. Single-Stage Bilateral Retrograde Intrarenal Surgery (RIRS): Safety and Outcomes Fang Z 1 , Peng Y 1 , Li L 1 , Lu C 1 , Gao X 1 , Sun Y 1 , Chen R 2 Introduction and Objective: This study aimed to assess the effectiveness and safety of single-stage bilateral unilateral retrograde intrarenal surgery (RIRS) for treatment of patients with renal stones. Patients undergoing single-stage bilateral RIRS for renal stones between January 2014 and January 2019, were retrospectively reviewed and matched to patients undergoing unilateral RIRS at a 1:1 ratio, by the propensity score based on age, sex, body mass index, American Society of Anesthesiologists classification, stone burden, and stone location (involvement of the lower calix or not). Main outcome measures were stone-free rate per patient and per renal unit and RIRS-associated morbidity. Results: Of 123 patients treated by single-stage bilateral RIRS, 84 patients were matched with patients treated by unilateral RIRS. Stone-free rates per patient for bilateral RIRS and unilateral RIRS were 89% and 92%, respectively (P= 0.25). Median operative time (105 vs 68 min, P <0.001) and post-operative hospitalization (2 vs 1d, P= 0.01) was significantly longer for bilateral RIRS than unilateral RIRS. Median changes in hematocrit (1.3% vs 1.0%, P= 0.56) and serum creatinine level (3 vs 2 mol/L, P= 0.54) were similar between bilateral and unilateral RIRS. The overall complication rate was slightly higher with bilateral RIRS (9% vs 8.5%, P= 0.45). No serious RIRS-associated morbidities occurred in either group. Conclusion: Bilateral ureteroscopy can be performed safely with short-term complications, consistent with published literature. We found no long-term complications and high stone-free rates. Bilateral ureteroscopy in a single procedure represents a viable standard of care for patients with bilateral stone disease. Urolithiasis and Water Intake in Saudi Arabia: Is it a Matter of Quality or Quantity? Al-Gonaim A 1 , El-Tholoth HS 1 , Bin Joher A 1 , Alotaibi M 1 , Ali-El-Dein B 2 , Al-Afraa T 1 , Alzahrani A 1 , Obied A 1 Introduction and Objective: Urolithiasis is a significant problem with increasing incidence and preva-lence worldwide. Multiple factors such as water intake, climate change, dietary habit and genetic factors can affect stone formation. Our aim is to clarify the relationship between water intake and urolithiasis in Saudi Arabia as a hot climate area. This cross-sectional internet-based survey was conducted in November 2017. Our study was performed using a standard web-based questionnaire using social media open to all internet users. We excluded the incomplete responses. Analysis of the data was then carried out using the chisquare test and SPSS package version 20. Results: We found a great response to our survey, where 9100 participants responded. Among the participants, 76.6% were females and 23.4% were males. The largest age group was between 18-30 years (60.8%). Of the participants, 842 (9.3%) had a history of urinary tract stones. About 74.3% of the participants with a history of urinary tract stones were drinking less than 1 L per day of water in comparison with those who had no history of urinary tract stones who were drinking a minimum of 1.25 L per day in 55.1%. Regarding the type of water intake, there was no significant relationship between the type of water and the incidence of stones formation (p= 0.096). The amount of water was significantly correlated with urolithiasis (p= 0.000). We concluded that the amount of water intake per day significantly correlated with urolithiasis and the minimally accepted intake was ≥ 1.25 liter/ day. However, the type of water consumed has no statistically significant impact on stone formation. Ureteric lithiasis is among the most common acute urological presentations in Australia. With the number of stone procedures increasing, the decision for intervention versus conservative management remains controversial. MIMIC is the largest international retrospective cohort study evaluating the management decisions and outcomes for patients presenting to hospital with confirmed stone disease. This study is an analysis of data contributed to the collaboration from health networks across Australia. This study is a multicentre international cohort coordinated by the Australian Young Urology Researchers Organisation (YURO) and British Urology Researchers in Surgical Training (BURST). Retrospective analysis of electronic medical records was performed at participating Australian sites from 1/5/17-1/1/18. Inclusion criteria were patients presenting with acute renal colic and computed tomography (CT) evidence of single obstructing ureteric calculus who were discharged with non-operative management. The primary outcome of stone passage was confirmed with repeat CT imaging after a minimum of 6 months. Patients with multiple stones or who had a subsequent presentation were excluded from the study. Data were entered into a centralised REDcap database and multivariate analysis was performed on patient age, sex, previous history, location of presentation, and stone size and position. Results: Data was collected from 400 patients entered from 6 health networks across Australia. Most patients (72%) were discharged with conservative management and of those, over two thirds had a confirmed outcome of being stone-free or had another admission for intervention with the remainder being lost to follow-up. Three-quarters of Australian patients experienced spontaneous passage with the remainder requiring surgical intervention. Spontaneous resolution of ureteric lithiasis was dependant on calculus size, with 79% of stones under 6 mm and one-third of stones larger than 6 mm passing spontaneously. Clearance was affected by anatomical location with proximal, mid and lower/distal ureteric stones passing with increasing rates respectively. Conclusion: This study represents the most comprehensive data set for the contemporary management of ureteric colic both within Australia and internationally. The dataset collected from the Australian hospitals largely reflected the international cohort. Associations between stone size, stone position and need for intervention were identified. The results of this study can be used to inform management practice both within Australia and internationally. Predicting the Natural History of Moderate to Severe Incontinence After Prostatectomy Based on Early Post-Operative Factors Introduction and Objective: The natural history of moderate to severe post-prostatectomy incontinence (PPI) has not been adequately studied. Our aim was to predict which patients may benefit from prompt surgical interventions for incontinence. We hypothesized that men using > 3 pads after surgery with high bother symptoms would be least likely to regain continence. The study population included men with localized prostate cancer treated with radical prostatectomy at a single center from December 1999 to April 2018. EPIC-26 and UCLA quality of life surveys were completed at multiple time points post-op, up to 60-months follow-up. Associa-tions between health outcomes and pad use were assessed using Pearson's chi square tests. Post-surgery improvement in urinary control and quality of life were modeled using multinomial logistic regression. The interaction of pad use post-surgery and bother score on achieving continence was considered in the forward selection multinomial logistic model. In total, 1,568 patients were assessed at 30 months and 689 at 60 months. At one month following surgery, 1,034 reported using < 3 pads and 534 reported > 3 pads. Patients using < 3 pads were 7.17 times more likely to become continent (defined as using 0-1 pads) by month 30 compared to patients using > 3 pads (95% CI 5.151-9.991). Patients using < 3 pads had a 0.87 probability of regaining continence by month 60, while patients using > 3 pads had a 0.13 probability. High bother score at any time post-surgery was significantly associated with using > 3 pads (3 pads at one month had a lower probability of recovering continence than patients without these characteristics (p < 0.0001). Conclusion: Patients who require > 3 pads and are highly bothered are less likely to recover continence or improve in their subjective quality of life. This cohort should be appropriately counseled as these men may benefit from early surgical interventions for PPI at six months post-operatively. Introduction and Objective: Prostatic urethral lift surgery (PUL) is an established minimally invasive technique proven to be effective in the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, BPH with obstructive median lobe (trilobar prostatomegaly) present a challenge in delivering PUL in the standard technique to provide an effective disobstruction. Therefore, we have embraced the 4D urolift technique placements (P. Chin, Australia) to achieve good urine outflow outcomes (similar to MEDLIFT study) with no serious adverse events or sexual dysfunction. Seventeen patients with symptomatic LUTS were assessed with flexible cystoscopy where enlarged lateral and median lobes were noted. They were counselled about the 4D urolift procedure and informed consents gained. 4 urolift implants were placed adjacent to bladder neck region in 4 different directions to maximally widen the bladder neck. All patients were discharged on same day, 12 patients without catheter while 5 patients discharged with catheter with a trial without catheter (TWOC) on post-op day 3. Retrospective clinical data were collected from patients including International Prostate Symptoms Score (IPSS) and urine flow rates. Results: Reduction of 9.7 in mean IPSS was noted (pre-op mean 24.3; post-op mean 14.6). QoL scores reduced from 4.7 (pre-op) to 2.4 (post-op). Urine flow rate improved with mean Q max from 9.8 mL/sec (pre-op) to 13.5 mL/sec (post-op) and reduction of post void residual volume of 103.9 mL (mean). There were no reports of ejaculatory dysfunction in any of the men post-operatively. All patients had successful TWOC at the planned schedule post-op. One patient had haematuria which settled with bladder irrigation overnight. There were no significant adverse events noted. Conclusion: BPH with obstructive median lobes can be effectively treated with this novel technique of 4D prostatic urethral lift surgery. Our early encouraging results of this 4D technique will pave the way for larger future studies to further evaluate the effectiveness of this new approach in treatment of BPH with median lobes. Thulium Laser Enucleation of the Prostate: Top or Down Technique Adopting During the Early Learning Curve? Introduction and Objective: Since 2010, Herrmann and colleagues introduced Thulium laser enucleation of the prostate (ThuLEP) as a versatile minimally invasive enucleation procedure; followed by a number of studies that have confirmed its feasibility and efficacy, such as HoLEP. Our aim was to present the feasibility of adopting both top and down techniques during a self-taught, ThuLEP, learning curve for a single surgeon with no previous HoLEP experience. and March 2019, a well-trained endourologist; who did not perform laser enucleation of the prostate before, started reviewing the available literature, attended more than 15 procedures at another hospital and participated in 3 laser enucleations of prostate workshops. 29 patients with a prostate size between 80 and 120 grams underwent ThuLEP without tutoring or mentor supervision. We used Revolix DUO TM machine with a 40-watt setting for both cutting and coagulation with a 550-mic fiber for all cases. Results: In the first 4 cases, the surgeon was unable to completely enucleate the 1 st lobe and ended with an open prostatectomy. In the following 4 cases, one lobe was completely enucleated and morcellated while the other lobe was finished by bipolar resection. The following 10 cases the down technique was the primary strategy for a successful enucleation. Then the last 11 cases were successfully completed by a combination of down and top techniques. All patients had a satisfactory voiding outcome with a mean Q max of 24.5 after surgery. Conclusion: ThuLEP extraordinary hemostatic effect and the limited penetration depth may allow it to be the standard step for beginner surgeon, while adopting both top and down techniques may be the easiest way for accelerating the learning curve for surgeons performing ThuLEP. Laparoscopic Partial Nephrectomy with Superselective Clamping Viegas Madrid VN, Albers Acosta E, San José Manso L, Brime Menendez R, Costal M, Celada Luis G, Olivier Gomez C Introduction and Objective: Renal carcinoma represents 2-3% of all cancers. The main approach is the surgical one. In selected cases of accessible and well-defined tumors, partial nephrectomy is the technique of choice; however, this type of procedure can compromise the oncological safety and perioperative results of the patient. The main advantages of nephron-sparing surgery are the best conservation of renal function, being comparable in terms of overall survival to the radical approach. Our objective is to show the results of the complex renal surgery within the program of complex surgery training of the urology residents in our center. We present the case of a 77-year-old man with benign prostate hyperplasia and diabetes mellitus type 2 with grade III renal failure. During the follow-up, there was an incidental finding of renal mass due to lower urinary tract symptoms. Results: We performed a laparoscopic partial nephrectomy (LPN) without complications, with optimal post-operative recovery. The anatomopathological report confirms a Fuhrman II clear cell carcinoma, with negative margins. The patient presents a maintained renal function without needing hemodialysis, despite his renal failure of base. The LPN is a safe and effective procedure for the treatment of small and well-defined renal tumors, with good oncological and functional results. This technique requires a high learning curve, which can be initiated during residency, within a program of progressive acquisition of competences. Making Partial Nephrectomy a Simple Task Using Veriset TM -Outcomes and Lessons Learnt Durai P 1 , Biligere S 2 , Lie KY 2 , Tiong HY 1 , Heng CT 2 , Gauhar V 2 1 National University Hospital, Singapore; 2 Ng Teng Fong General Hospital, Singapore Introduction and Objective: In Nephron sparing surgery (NSS), two keys are prompt hemostasis and proper closure of pelvicalyceal system (PCS). We present our experience with Veriset TM hemostatic patch (Covidien, Mansfield, MA, USA). Primary aim: feasibility and safety of Veriset™ as a hemostatic agent during NSS. Secondary objective: to assess its efficacy and the need for additional measures to secure haemostasis, post-op complications/dogmas in follow up imaging, and lessons learnt. June 2016 -October 2018 had NSS. After tumour excision, closure of PCS and securing bleeding points in the resection bed, Veriset TM was directly applied as per instructions. Patient demographics, tumour characteristics and intra-operative events were recorded. Follow-up imaging at 3 months was discussed at a dedicated uro-radiology meeting. Results: 73% male and 27% were female (range 35-78 years). The median tumour size was 3.5 cm (range 1.2-6.2). 14/15 cases were done with open approach. Application of Veriset TM was easy in all patients. In 1 patient, wrong side of patch was applied and required reapplication of a second patch. Hemostasis was achieved within 5 minutes and none of the cases required renorrhaphy/bolster/additional hemostatic manoeuvres. One patient required post-operative blood transfusion. The median length of stay was 6 days (range 4 -9). Only the case of reapplication of patch required selective polar angio-embolization. Follow up imaging did not pose any disparities. Our initial experience with Veriset TM is promising and its use in NSS is feasible and safe. Easy application, rapid onset of hemostasis and safe profile aids in reducing ischemia time, any need for additional hemostatic manoeuvres and reduces surgeon's anxiety. Nephrometry score had no impact on its application and no issues were noted on follow-up imaging. Crucial steps for best outcomes with Veriset TM were: water-tight PCS closure, adequate point suturing of bleeding vessels, trimming Veriset TM to appropriate shape of the renal cortical defect, avoiding removal and reapplication of the patch. Is Cortical Renorrhaphy and Approximation of Parenchyma Essential in Partial Nephrectomy? Kumar A, Gaur P, Maheshwari R, Chaturvedi S, Desai P, Panwar P, Singh V Introduction and Objective: Cortical Renorrhaphy is a standard method to achieve hemostasis and closure of parenchyma in partial nephrectomy (PN). However, it has a potential to compress/damage vessels in cases of large renal tumors extending up to renal hilum. There is also potential of devascularization of the parenchyma compressed by cortical sutures, leading to loss of nephrons. Herein, we are presenting a case of robot assisted partial nephrectomy (RAPN) without cortical renorrhaphy, without compromising the trifecta outcome of partial nephrectomy. A 48-year-old male presented with 7x6 cm mid-polar heterogeneously enhancing mass in left kidney, with R.E.N.A.L. nephrometry score of 10x. Renal vein and IVC were free. Metastatic workup was negative. He underwent RAPN on using da Vinci ® surgical platform (Intuitive Surgical, USA). After reflecting the descending colon, hilar dissection was done, and renal vessels were looped with vascular loops. Tumor was visualized, its margins precisely scored with the help of intra-operative USG (Flex focus 800 ® , BK Medicals Inc., USA). Renal artery was clamped with bulldog clamp. Tumor dissected with scissor while prospectively identifying the vessels and applying Hem-o-lok ® clips (Teleflex Inc., USA). Tumor bed was sutured using 4-0 Stratafix ® (Ethicon Surgical, USA). Renal artery was de-clamped, and hemostasis achieved using sutures and Floseal ® (Baxter Inc., USA) while cortical renorraphy was completely avoided. Results: Total duration of surgery was 2 hours 34 minutes. Console time was 1 hour 48 minutes. Esti-mated blood loss was 185 mL. Warm ischemia time was 16 minutes. There was no pelvicalyceal system injury. Post-operative period was uneventful. Post-operative hemoglobin decreased by 0.8 gm/dL while there was no significant change in serum creatinine (0.08 mg/dL). Per-urethral catheter was removed on post-operative day (POD) 1, patient was orally allowed on POD 1. Abdominal drain was removed, and he was discharged on second POD. Histopathology examination confirmed clear cell RCC with all surgical margins free. Conclusion: PN without cortical renorrhaphy for large tumors extending up to renal hilum can decrease the risk of parenchymal loss, vascular compression and warm ischemia time without compromising the trifecta outcomes. Robot Assisted Nephron Sparing Surgery: Expanding Indications Beyond the Conventional Sharma AP, Mandal AK, Mavuduru RS, Bora GS, Devana SK, Singh SK Introduction and Objective: Robotic nephron sparing surgery (NSS) is now established approach for small renal masses (SRM) with low and intermediate renal nephrometry score (RNS < 7). The use of a robot has been expanded to renal tumors with high RNS (?10) and the data is emerging. We have further expanded its use in simultaneously managing multiple tumors, concomitant pathologies such as stone disease and adrenal tumor. We present our experience of managing such complex cases in this video. Prospectively maintained data of all robot assisted NSS was reviewed and those with RNS of ≥ 10 were identified. 46 out of 280 cases met the above criteria. Two patients with stone and one patient with adrenal tumor tackled simultaneously were also noted. One patient had tumor in polycystic kidney. Results: RANSS was performed in 280 patients. 46 patients had RNS > 9. Mean age -50.78 ± 13.42 years. Median follow up was 23 months (4-48 months). Mean operative time was 156.41 ± 46.93 minutes. Mean warm ischemia time was 26.79 ± 5.85 minutes. Median estimated blood loss (EBL) was 175 (IQR-100-262.5) mL. Pelvicalyceal (PC) violation was seen in 32 (69.5%) of the tumors. Trifecta outcomes were achieved in 65% of the patients. When compared with low and intermediate RNS, only EBL and PC violation was significantly higher in high RNS group. Post-operative complications, renal function preservation and oncological outcomes at 3 months were comparable to low and intermediate RNS groups. Two cases had simultaneous stone retrieval, one case had multiple tumors and one case of RANSS in polycystic kidney disease has also been highlighted. Conclusion: Our data shows the feasibility of RANSS in achieving reasonable perioperative outcomes in higher nephrometry score tumors via adequate functional preservation with minimal complications and negative margin. Concomitant pathologies are also tackled well with use of robotic assistance. A 33-year-old female presented to the emergency department of our hospital with urosepsis and hematuria with clot retention secondary to a complicated pyelolithotomy for left-sided pelvic calculus. A percutaneous nephrostomy was placed for drainage as a DJ stent could not be traversed into the left renal pelvis with retrograde pyelography demonstrating complete cut-off at L4-L5 level. After stabilization, she was found to have uretero-pelvic junction obstruction (UPJO) in left solitary functioning kidney with long-segment upper ureteric stricture and nadir serum creatinine 1.5 mg/dL. Nephrostogram and CT scan revealed an intra-renal pelvis with no passage of contrast into the ureter. Primary hyperparathyroidism secondary to parathyroid adenoma was also detected and she underwent excision of the same. The long-segment ureteric stricture and need for a wide drainage ruled out pyeloplasty and ureterocalicostomy as treatment options. Results: A wide-bore communication between the lower calyx and bladder was necessary and robot assisted ileocalicostomy was performed in this case. A 20-cm-long segment of ileum was used to replace the ureter with a suprapubic 16 Fr Foley's catheter as splint. Post-operative course was uneventful with all tubes removed by third post-operative week. Nephrostogram demonstrated gravity-dependent drainage into the bladder with no leak or anastomotic narrowing. The patient is doing well at 6 months of follow-up with a stable renal function. Conclusion: Robot assisted ileocalicostomy is a safe and effective technique, which provides wide gravity-dependent drainage in complex UPJO with long-segment ureteric stricture and intra-renal pelvis. Lezrek M 1 , Tazi UVID-04, Table 1 . scope is advanced until reaching the uretero-pelvic junction (UPJ). It is mandatory that the ureteroscope pass beyond the UPJ. The endopyelotomy incision has to be performed from above the UPJ down the ureter; not the other way around. A strict lateral endopyelotomy is performed with a 2.5 Fr electrode or a 4 Fr ureteral catheter with its metallic stylet. The whole pelvic, UPJ and ureteral wall is incised, until reaching the peri-ureteral fat. Then, an endopyelotomy double-J stent or 2 double-J stents are inserted. Results: 13 patients, 5 males and 8 females, aged from 11 to 56 years old, underwent retrograde endopyelotomy using a rigid ureteroscope, save for one patient in which endopyelotomy was performed with a flexible ureteroscope. One patient had a pelvic kidney. The UPJ obstruction was primary in 2 cases and secondary in 11 cases. The mean operative time was 35 min. No complications were noted in the peri-operative period. The double-J stents were removed between 4 to 6 months. Ten patients had good symptomatic and radiologic results. One patient had non-satisfactory radiologic result and had a successful second retrograde endopyelotomy. Two patients had complete failure with aggravation of hydronephrosis and had successful open pyeloplasty, which found a crossing vessel in both cases. The mean follow-up was 35 months. Conclusion: Retrograde endopyelotomy with electro-cautery with an electrode through the ureteroscope has provided acceptable results in this small series. Its main advantage is the short operating time. How to Remove a Double J Stent Without Forceps: The Hook Lezrek M Introduction and Objective: When the proper forceps are not available, in order to remove the double J stent with a basket, the J end of the stent has to enter between the loops of the basket. So, it may need some time to find the J tip, and more time to catch it into the basket. It is impossible to remove the stent, attracting it by the body. For this purpose, we use a hook. The metallic stylet of a ureteral catheter is used. Its tip is curved like a hook. The hook is introduced or backloaded through the working channel of the endoscope. It is tried in our glove model. An amplatz sheath is inserted into a glove, and it is fixed with ligations. The glove is filled with water. The endoscope is introduced through the amplatz sheath. At exploration, the stent is found. The hook is advanced and ensnares the stent. The endoscope is retrieved extracting the stent. The hook is back loaded into the rigid ureteroscope or mini-nephroscope, since it cannot pass through the working channel. Conversely, the hook can pass through the working channel of the cystoscope and the medium or standard nephroscope. The hook easily and quickly catches the stent by the body and attracts it. During the procedure and especially when retrieving the endoscope, the tip of the hook has to be monitored closely, to avoid mucosal injury. Also, the tip of the scope has to be elevated toward the urethral roof far from mucosa. The hook allows to perform a rigid ureteroscopy, with insertion of the guidewire and removal of the stent in the same time. The hook is backloaded into the ureteroscope. The guide wire is passed through the ureteroscope beside the hook. Which is impossible beside the forceps. The hook seems to be a quick way to extract a double J stent. However, its tip has to be monitored closely, to avoid mucosal injury. Moreover, the shape of the hook might be upgraded for more safety. Homemade Plastic Tri-Prong Forceps For PCNL We present a video of how to make plastic tri-prong forceps using available equipment in the operating room. Then, it is tried on our endoscopic glove model. For the prongs, a 6 Fr double J stent pusher is used. Beginning from the tip, 3 parallel and equidistant longitudinal incision of 3 to 4 cm are performed, to have three equal prongs. The tips of the three prongs are incurved. For the forceps sheath, a 12 French guidewire dispenser coils is used. A segment longer than the pusher, by 15 cm, is selected and severed. Then, a point in the dispenser is selected 5 cm shorter from the tail of the pusher. A lateral incision is performed to accommodate the exit of the pusher. The pusher is backloaded through the dispenser, until exiting through this lateral hole. The remaining length of the dispenser is curved to make the handle. Both ends of the pusher and the dispenser are fixed with a plastic clamp. The three-prongs forceps is tried through the nephroscope in our endoscopic glove model. The three prongs forceps are easy and quick to make. The inner catheter is sliding easily within the outer one. Pushing it opens the three prongs and withdrawing it closes the three prongs. It is tried with a ball of paper. The three prongs easily catch and release the ball. When used in a glove model, it passes through the nephroscope operating channel. It was effective to catch and extract the stones. However, the stone grasping is not very strong. Because the pusher is little flexible; thus the 3 prongs are flexible. It is better to have a more rigid one, to have a good grip. Conclusion: This plastic tri-prong forceps are feasible. It might solve a difficult situation if the metallic one broke during the procedure. However, it needs to be upgraded. Extra Urological Application of Endourology Introduction and Objective: The endourological procedures have been an advancement in minimally invasive surgery, offering an optimal resolution of complex cases with minimally invasive approaches and short hospital stays. Its applications and uses can be extrapolated to other specialties with the support of highly experienced teams. In this video, we present some of the applications of endourological surgery by using the flexible ureteroscope in the laparoscopic approach of the bile duct as well as the nephroscope for retroperitoneal approach in cases of pancreatic necrosis. We present the case of a patient with suspected obstruction of the bile duct, who required a choledochoscopy by introducing a flexible ureteroscope during a laparoscopic approach. The second case shows a patient with pancreatitis and the presence of an abscess and pancreatic necrosis. A percutaneous approach is performed through the use of minimally invasive renal surgery techniques. The endoscopic procedures of urological surgery are explorable and applicable to other disciplines, achieving the resolution of complex pathology with minimally invasive approaches through multidisciplinary collaboration. Introduction and Objective: Ureteroileal anastomosis stricture is the most frequent complication after radical cystectomy. It is diagnosed between 3-11% of cases according to the series, and most of them are diagnosed during the first year after surgery. A 64-year-old man with a laparoscopic radical cystoprostatectomy due to muscle invasive bladder cancer and ileal conduit, presented bilateral obstructive pyelonephritis 2 months after surgery due to ureteroileal anastomosis stricture. The uretero-ileal anastomosis was type Wallece II. A bilateral nephrostomy tube was placed. Nephrostomy pyelography revealed bilateral stenosis in the distal ureteral section with filiform contrast to ileal conduit. Results: The surgical time was 5 hours; the hospital stay was 4 days and there were no complications in the post-operative period. The pathological anatomy reported a chronic inflammation without evidence of neoplasm. At 15 months after surgery, the patient remains asymptomatic, without catheters, and with creatinine levels of 1.3 mg/dL. The CT scan performed rule out stenosis relapse and leakage. The laparoscopic approach in patients with ureteral strictures after ileal conduit, is feasible and safe with good results and without long-term complications. Self-Insertion of Urethral Foreign Body: A Simple Endoscopic Technique for Removal of a Metal Forceps from Male Urethra Introduction and Objective: Foreign bodies of the urethra and bladder are seldom seen in clinical urologic practice with iatrogenic injury, self-insertion, and rarely migration from adjacent sites. Treatment is focused on foreign body extraction, diagnosing complications, and avoiding compromise of erectile function. In this case, we present our endoscopic technique for removal of a metal forceps from male urethra. A 22-year-old male presented with history of inserting a metal foreign body into his urethra 4 years ago. His physical examination showed a non-distended bladder, normal external urethral meatus, and a palpable long foreign body from the mid-shaft of the penis to beyond the penoscrotal junction. X-rays of the pelvis and ascending urethrogram showed a metal forceps in the anterior urethra. Cystoscopy demonstrated the metal forceps with its closed end embedded in a false passage at the proximal end of the bulbous urethra. Our endoscopic technique was accomplished by asking the assistant to close the open end of the forceps by external pressure on the palpable sides of the forceps through the penile shaft, then an endoscopic foreign body forceps was introduced, and the distal closed end of the metal forceps was held under vision and pulled out. No urethral catheter was inserted, the patient voided well and went home post procedure. Results: This case is interesting, as the insertion of a metal forceps in male urethra hasn't been mentioned in literature except only once. The open thumb metal forceps poses more technical difficulties during endoscopic extraction, and this is because of its sharp open distal ends, which can injure the urethra during removal. This technique warrants safe endoscopic removal of metal forceps and avoids open surgery. Conclusion: Urethral foreign body extraction can be achieved endoscopically. However, a more holistic approach to management is crucial, which includes, prevention of complications or further urethral injury. In the case of open metal forceps, we recommend the use of external pressure technique to aid extraction without injuring the urethra any further. Psychiatric consultation is recommended to prevent further attempts at insertion of other foreign bodies in the urinary tract. Oita University, Yufu, Japan Introduction and Objective: MRI target biopsy has a higher detection rate of clinically significant cancer than standard systematic biopsy, and as a method, MRI-TRUS fusion prostate biopsy is gradually spreading in Japan. To examine the usefulness of cancer localization diagnosed by MRI-TRUS fusion biopsy in robot-assisted radical prostatectomy (RARP), we analyzed the resected specimen of cases in which RARP was performed after MRI-TRUS fusion biopsy. We examined the clinical outcomes of 15 patients who underwent RARP after MRI-TRUS fusion biopsy at our hospital from February to September 2018. MRI was performed prior to biopsy, and we conducted target biopsy of about 3 per lesion, in addition to systematic 12 cores biopsy for cases with PI-RADS category 3 or higher lesions using the MRI-TRUS fusion biopsy system (KOELIS TRIN-ITY). The 3D cancer mapping image by MRI-TRUS fusion biopsy was used as an index for determining the resection range during RARP. The average age and PSA at biopsy were 70 years old and 10.9 ng/ml. PI-RADS category 3, 4 and 5 were 2, 12 and 1 cases, respectively. Gleason score in biopsy was 2 cases of 6, 8 cases of 7, 4 cases of 8 and 1 case of 9. The detection rate of significant cancer (SC; GS ≥ 7) was 13/15 (87%) by target biopsy, and 9/15 (60%) by systematic biopsy. In the RARP, nerve preservation was performed in 9 cases (6 patients on both sides, 3 cases on one side). The pathology of extracted specimen was 3 cases of pT2a, 10 cases of pT2c and 2 cases of pT3a, and positive resection margin was observed in 1 case of pT3. Gleason score in RARP was 10 cases of 7, 2 cases of 8 and 3 cases of 9. The 3D cancer mapping image was almost consistent with the localization of significant cancer in the resected specimen. The urinary continence (0-1 pad/day) rates 1, 2 and 3 months after RARP were 54%, 71% and 86%, respectively. Conclusion: MRI-TRUS fusion biopsy is useful for the detection of clinically significant cancer and diagnosis of cancer localization, suggesting that it may be useful for determination of nerve preservation adaptation and resection range in RARP. Completely Intracorporeally Laparoscopic Radical Cystectomy and Orthotopic Detaenial Sigmoid Neobladder: The Initial Experience Introduction and Objective: Radical cystectomy with lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. We herein illustrate the operative technique of completely intra-corporeally laparoscopic orthotropic detail sigmoid neo-bladder and perioperative outcome of the initial 10 cases. The procedure was performed in ten consecutive bladder cancer patients. Conventional bilateral pelvic lymphadenectomy and radical cystectomy were completed with the urethral sphincter preserved. The specimen was retrieved and manipulated in a homemade tissue morcellate appliance. For the creation of the detail sigmoid neo-bladder, a 20 cm segment of sigmoid was mobilized and the detail procedure under the laparoscope is done with a water injection design which simulated procedures of open surgery. By using the inherent gap between muscular and mucosa of the sigmoid, and the pressure of the pneumoperitoneum, seromuscular layer between omental taenia and free taenia were removed continuously. Approximately 2 square centimeters of the seromuscular layer was preserved at the central portion and two ends of the isolated sigmoid to strengthen the urethral and ureterointestinal anastomosis respectively. Each ureterointestinal anastomosis was done in a continuous manner using 2 separate 4-0 polyglactin sutures. Before the anastomosis, the single J stent was advanced up to the renal pelvis. All suturing was done exclusively using free-hand laparoscopic techniques. Demographic, peri-operative, pathological and functional data were collected. Results: All operations were going on well without severe complications or conversion to open surgery. Mean operative time was 392 ± 26.79 min, with 358 ± 55.4 cc mean blood loss, only one patient underwent intraoperative blood transfusion. Surgical margins and the pelvic lymph nodes were all negative, confirmed by histopathology. The patients resumed ambulation on post-operative day 3, and oral liquids were resumed on day 4. Hospital stay was 12.3 days. Catheterization time was 2 weeks post-operative with a cystogram confirmed watertight healing. The single J stents were removed 4 weeks post-operative Clavien-Dindo grade I, II complications within 30 days were 20%, and 20%, respectively. No grade III or above complications. Completely intra-corporeally laparoscopic radical cystectomy and orthotropic detail sigmoid neo-bladder is technically feasibility. This is an initial experience including a limited number of patients with a restricted follow-up time, the long term functional and oncologic outcomes of this procedure require longer term follow-up data to verify. Ventral Inlay Buccal Mucosal Graft Urethroplasty (VI-BMGU) in Female Urethral Stricture Disease (USD), Our Initial Experience Kumar G, Aggarwal S Introduction and Objective: To present our initial experience with ventral inlay buccal mucosal graft urethroplasty (VI-BMGU) in female urethral stricture disease (USD). Between May 2016 to June 2018, twelve women with USD underwent VI-BMGU. All women were evaluated pre-operatively with the American Urological Association (AUA) symptom score, uroflowmetry, calibration with 12 Fr catheter and ultrasonography with post void residual (PVR) urine measurement. Micturating cystourethrography was performed in select cases. Intra-operative confirmation of stricture was done with 6 Fr cystoscope. Post-operatively, the women were followed at 3, 6 and 12 months after surgery with AUA symptom score, uroflowmetry, and PVR estimation. Increase in AUA symptom score, maximum flow rate (Q max ) < 12 ml/s, and failure to calibrate with 18 Fr catheters were considered as recurrence of the disease. The mean age of the patients was 41 years. The mean follow-up period was 18 months. All women voided successfully after catheter removal. There was an improvement in AUA symptom score, Q max and reduction in PVR at 3, 6 and 12 months. One woman had recurrence of stricture at 6 months and was treated by urethral dilatation followed by institution of self-dilatation regimen. Success rate was 92%. Conclusion: VI-BMGU is a simple and safe method of urethroplasty in women. Studies with larger sample size and a longer follow-up are required to document the long-term success of this procedure. Multiple Renal Arteries in Laparoscopic Donor Nephrectomy Introduction and Objective: Multiple renal artery kidneys represent a special challenge for surgeons, during both donor nephrectomy and renal transplantation. This video aims to show our center's experience in a laparoscopically procedure in either single early branching or dual renal artery kidneys. Laparoscopic donor nephrectomy was limited to the left kidney with single renal vessels but nowadays, criteria to accept donated arteries are markedly extended due to emerging of laparoscopic living donor nephrectomy. Laparoscopic donor nephrectomy is of great advantage for donor recovery and length of stay. In this video presentation, we are presenting a sample of three videos (laparoscopic donor nephrectomy: for a single artery and vein, early branching arteries and dual renal arteries). All of them were left-sided kidneys, with usage of stapler to control arteries and veins, hemlocks used to control ureters, and endo-bags used to gain the kidneys. Results: From a total of 450 laparoscopic donor nephrectomies, 77 (17.1%) were on kidneys having dual renal arteries (DRA). The mean duration of the surgery was 225 min and 240 min in single and dual renal artery groups; the mean warm and cold ischemia times were statistically similar in both groups. There were no complications or conversion to open among donors in both groups. There were no statistically significant differences in hospital stay of the donors and immediate allograft function among the two groups. Conclusion: Laparoscopic donor nephrectomy was found to be safe in the donors with multiple renal arteries in our experienced surgical teams, as much as in donors with single arteries. A Laparoscopic Approach in a Rare Cause of Bladder Stone The intrauterine device (IUD) is a contraceptive method which has been used for many years. Uterine perforation with migration of IUD into the pelvic cavity, including the bladder is a rare complication. Laparoscopic surgery can be used for the removal of IUD. We review a case of IUD perforation with migration into the bladder and subsequent stone formation, treated with laparoscopic approach. Results: A 55-year-old woman with history of cervical carcinoma treated with radio-chemotherapy, presents 9 years after, with recurrent urinary tract infection and urinary incontinence. CT scan showed a large bladder calculus (maximum diameter 4.5 cm) with severe bilateral hydronephrosis. Furthermore, vesicovaginal fistula was identified. The patient underwent general anaesthesia, a bilateral ureteral stents placement and cystolithotomy by laparoscopic approach. After incision of a markedly thickened bladder wall, calculus fragmentation with IUD extraction was laboriously achieved. The fragments of the calculus were removed with use of Endobag®. A mobilization of an omental flap was performed. Due to difficult access, uncertain identification of fistula tract and high risk of infection, vesicovaginal fistula correction was postponed. Conclusion: IUD is usually a safe contraceptive method. However, IUD perforation is rare but serious complication, which may present with bladder migration and secondary stone formation. Laparoscopic surgery can be used safely for stone fragmentation and removal of IUD. Viewing Daily from Wednesday, October 16 -Sunday, October 20 0800-1600 Laparoscopic Surgery for Adrenal Tumors: A Single Surgeon's Experience from 52 Cases Ichikawa T, Hayashi A, Doi K, Kusumi N, Tsushima T Introduction and Objective: We evaluated the outcomes of 52 laparoscopic adrenalectomies performed by a single surgeon. Materials and Methods: Data from 52 patients who underwent laparoscopic adrenalectomy between 1999 and 2018 were retrospectively reviewed. The parameters were approach (transperitoneal or retroperitoneal), operating time, estimated blood loss, surgical complications, and learning curve. Data were expressed as median. The study group included 27 males and 25 females, with a median age of 58 years (28-86 years). The tumor was located on the right side in 23 patients and on the left in 29. Pathologies included aldosteronoma in 20 patients, non-functioning adenoma in 10, pheochromocytoma in 9, malignant tumor in 5, Cushing's syndrome in 4, myelolipoma in 3, and ganglioneuroma in 1. Median tumor size across all patients was 26.5 mm (8-105 mm). In total, 29 patients were treated using the transperitoneal approach, while 23 were treated using the retroperitoneal approach. No major complications were recorded in any of the cases. One case presenting with a malignant tumor required conversion to open surgery due to severe adhesion. Excluding this unique case, median operating time was 149 min (88-286 min) and estimated blood loss was 50 ml (5-400 ml). No significant differences were observed in the operating time (155 min on the right side and 142 min on the left) and in estimated blood loss (57.5 ml on the right and 50 ml on the left) when patients were divided into two groups with respect to the tumor location. Furthermore, no significant differences were observed between the transperitoneal and retroperitoneal approaches with respect to the operating time (153 and 142 min, respectively) and estimated blood loss (30 and 60 ml, respectively). Regarding the learning curve, the operating time and estimated blood loss significantly decreased in the remaining 26 cases when compared with the first 25 cases (p = 0.0001). Conclusion: Regardless of the approach, laparoscopy is a safe and feasible treatment option for adrenal tumors. (8), Retro-mesenteric PG (1), concomitant procedures (3), and conversion from laparoscopy (2). Mean operative time was 220 minutes (120-360), blood loss was 868 mL (100-2800), 11 patients required a blood transfusion, and hospital stay was 6.44 days (3-13). All these parameters were higher than for minimally invasive surgery in this cohort. Three patients suffered a post-operative complication. Conclusion: Open surgery is most often indicated for large tumors especially with central necrosis or those located in the inter-aortocaval region. Most such procedures require large incisions and possible hepatic mobilization on the right side. The procedures can be safely completed with few complications. Laparoscopic Simultaneous Bilateral Adrenalectomy -Indications and Outcomes from a Retrospective Cohort Prakash P, Ramachandran R, Tandon N, Kumar R Introduction and Objective: To report our experience of indications, feasibility and outcomes of laparoscopic simultaneous bilateral adrenalectomy (LSBA) at a tertiary care center and compare with open simultaneous bilateral adrenalectomy (OSBA). Data of patients undergoing simultaneous bilateral adrenalectomy (SBA) between July 2008 and March 2019 was retrieved from our prospectively maintained electronic database and hospital records. Tumor characteristics, operative and recovery parameters, and complications were evaluated for indications and outcomes of LSBA vs OSBA. Results: During the study period, 37 patients (mean age 31.1 years, range 13-62) underwent SBA, out of which 31 underwent LSBA and 6 underwent OSBA. The various indications for SBA were bilateral pheochromocytomas (25, LSBA-20, OSBA-5), Cushing syndrome (11, all LSBA) and ACC (1, OSBA). Mean tumor size in LSBA and OSBA group was 3.7 cm (1.7-5.5) and 8.6 cm (4-13) respectively. Mean operative time for LSBA group was 185 minutes (120-300) including repositioning and reprepping time, as compared to 197 minutes (165-240) for OSBA group. Mean blood loss was 163 ml (50-1000) in LSBA group and 666 ml (400-1000) in OSBA group. Only one patient required blood transfusion in LSBA group while four patients in OSBA group required transfusion. Mean hospital stay in LSBA and OSBA groups were 3.64 days (1-12) and 7.66 days (3-11) respectively. Two patients in LSBA group (6.45%) and one in OSBA group (16.6%) suffered post-operative complication in the form of intra-abdominal collection requiring pigtail drainage. Conclusion: LSBA is feasible and safe in patients requiring bilateral adrenalectomy, e.g. bilateral pheochromocytomas and refractory Cushing syndrome, and associated with low morbidity and earlier recovery compared to OSBA. The better convalescence and cosmetic outcomes associated with LSBA may especially encourage endocrinologists to consider bilateral adrenalectomy earlier in the management of Cushing syndrome after failed attempt to control primary source. Impacts We studied the effect of cerebrolysin on neurogenic bladder in spinal cord injured Wistar rats. A total of sixty female Wistar rats randomly divided into 10 groups (n=6). All of the rats were separated into 10 groups (n=6 in per group) as follows: control, sham-operated, SCI animals received saline normal daily for 1 week or 4 weeks, three acute and chronic treatment groups including SCI animals received 1, 2.5 and 5 mL/kg CL for 1 week and 4 weeks. Drug intervention began just after complete transection at the T9-T10 level of rat spinal cord. In acute groups, intraperitoneal injection of cerebrolysin performed for 7 days (1 week) and in chronic groups continued for 28 days (4 weeks). At the end of drug intervention, spinal cord and bladder tissue were harvested for immunohistological and western blotting process. Results: Immunohistochemical evaluation of GAP43 (growth associated protein 43), a marker of axonal sprouting, in spinal cord tissue showed that in the chronic phase, there was a significant difference among sham and SCI+saline (4 weeks) groups (p <0.01), but in acute group, there were no significant differences among sham and SCI+saline (1 week) groups (p= 0.064). Also, a significant difference was observed between intervention and SCI+saline groups in all three groups received 1, 2.5, and 5 mL/ kg cerebrolysin (p <0.001), in the both of acute and chronic phase. Immunoblotting analysis of ERK1/2 expression in spinal cord showed that in the both of acute and chronic phases, ERK1/2 expression in the spinal cord in groups received cerebrolysin in 2.5, and 5 mL/kg in compare to SCI+saline groups significantly increased (p <0.01), (p <0.001), respectively. Immunoblotting analysis of ERK1/2 expression in bladder showed that in both acute and chronic phase there was a significant difference between intervention and SCI+saline groups and among all intervention groups (p <0.001). No significant differences were observed among SCI-saline and sham groups in both acute (p= 0.95) and chronic phase (p= 0.97). Our results show that Cerebrolysin as a mixed growth factor have a potential role in the improvement of neural pathways and neurogenesis in the spinal cord and bladder. This new finding of the effect of Cerebrolysin in the improvement of neurogenic bladder disorder could be useful in SCI patients. The Immunservice GmbH, Hamburg, Germany Introduction and Objective: Intravesical instillation of Interleukin-2 (IL-2) has been shown to be very well tolerated and promising in patients with bladder malignancies. This study aims to confirm the use of a new IL-2 based immunotherapy candidate as safe for intravesical application. IL-2, produced in mammalian cells, is glycosylated and therefore due to unique solubility and stability optimised for intravesical use. Urothelial cells and fibroblasts were generated out of porcine bladder and cultured until they reached second passage. Afterwards they were cultivated in REM and DMEM with four different types of human Interleukin-2 immunotherapy products (IMS-Research, IMS-Pure, Natural IL-2, Aldesleukin) in four different concentrations (100, 250, 500, 1000 IU) and compared to negative control. Cell proliferation was analysed by WST proliferation assay after 0, 3 and 6 days for single cell culture and co-culture. Results: Proliferation Assays showed that all IL-2 products induced very similar cultivation results and none of the IL-2 variants had a negative or positive impact on proliferation of urothelial cells and fibroblast in neither concentration. Conclusion: Human recombinant glycosylated IL-2 has no negative or positive influence on tissue cell proliferation of urothelial cells and fibroblast, and represents a safe and promising innovative potential intravesical therapy candidate for patients in high need. The Effects of a High Sodium Diet on Lithogenesis in an Experimental Rat Model of Renal Calcium Oxalate Stone Formation Hong Y, Xu Q, Huang X, Xiong L, Zhang F, An L Introduction and Objective: The aim of this study was to investigate the effects of a high and low sodium diet on lithogenesis in a rat experimental model of calcium oxalate stone formation. Twenty male Wistar rats were randomly divided into the following four groups: group A-4% NaCl+1% ethylene glycol (EG); group B-8% NaCl+1% EG; group C-8% NaCl+normal drinking-water; and group D-1% EG+ normal diet. The rats were fed in metabolic cages, and their urine volume was recorded every day. All rats were sacrificed four weeks later, and blood samples were collected via cardiac puncture. Kidney samples were collected for Von Kossa staining to evaluate the formation of calcium-containing crystals. The final 24 h urine samples were also gathered for metabolic analysis. Results: Von Kossa staining demonstrated that rats in both groups A and B had significantly more renal calcium crystals than those in group D. In addition, the final 24 h urinary volume of group B was significantly increased (142.26±20.91 mL) compared to group A (100.52±28.23 mL), group C (107.35±14.23 mL), and group D (40.78±8.71 mL) (P= 0.004, 0.012, and 0.000, respectively). Levels of urine sodium (Na), potassium (K), chlorine (Cl), calcium (Ca), and urea nitrogen of group B were significantly higher than group D. The levels of urine phosphorus, oxalate, creatinine and the urine specific gravity and urine pH between group B and group D were similar. The concentration of serum sodium of group B (151.26±4.06 mmol/L) was higher than that of group D (145.56±1.12 mmol/L) (P= 0.002). Conclusion: A high salt diet increased urine volume and resulted in urine metabolism changes and promoted stone formation in this rat calcium oxalate lithogenesis model. A lower salt diet may suppress the development of urinary stones. Renal Zinc Accumulation is Critical for the Protection of Exogenous Zinc Preconditioning Against Renal Ischaemia-Reperfusion Injury Ischia J, O›Kane D, Patel O, Baldwin G, Bolton D Introduction and Objective: Annual costs associated with in-hospital acute kidney injury (AKI) in the US alone exceed $10 billion. Renal ischaemia reperfusion injury (IRI) is the leading cause of AKI in these patients. Despite extensive research, there is no way to protect against renal IRI. Our group has demonstrated that zinc (Zn) preconditioning (PC) protects against renal IRI in rat and sheep models. However, the mechanisms of Zn PC remain unknown. Dysfunctional cellular metal homeostasis has been suggested as a pivotal mechanism of cellular death in IRI. The effect of Zn PC on renal concentrations of Zn and other metals in the context of IRI is not known. Furthermore, other key putative mechanisms of renal IRI include inflammatory, apoptotic, and oxidative stress pathways. Interleukin-6 (IL-6), Bax & Bak, and glutathione peroxidase-1 (GpX1) are proteins centrally involved in these respective pathways. The role of Zn in these key pathways, and the relationship of Zn PC to these pivotal mediators in IRI, is not known. Eight-to-twelve-week-old wild-type C57BL/6 mice were preconditioned with intraperitoneal injection of ZnCl 2 (10mg/kg) or control, 24 hrs and 4 hrs prior to right nephrectomy and 30 mins of left renal ischaemia. Serum creatinine and urea were measured after 48 hours of reperfusion. Renal histology and tissue metal analyses were performed. The same protocol was applied to three separate C57BL/6 mouse strains, with genetic KO of IL-6, Bax & Bak, or GpX1. Results: Significant differences were observed in renal concentrations of Na + , Mg 2+ , Ca 2+ , & Fe 2+ as a result of renal IR. Zn PC had no effect on the concentrations of these metals. Renal Zn was 1.46-fold greater in Zn-treated animals compared with control (p= <0.01). Zn-treated mice in all strains had significantly improved renal parameters compared with saline-treated controls. However, protection with Zn was attenuated by KO of IL-6. Conclusion: Protection with Zn PC is associated with elevated renal Zn. Protection is not affected by KO of Bax & Bak, or GpX1. Protection with Zn is attenuated by IL-6 KO, which may be a result of reduced IL-6-mediated cellular Zn uptake, or inhibition of metallothionein induction, which is also mediated by IL-6. Introduction and Objective: Calcium oxalate stone is the most common type of nephrolithiasis, however the etiology is still unclear. Short-chain fatty acids (SCFA) are major products of gut microbial fermentation and profoundly affect host health and disease, which can regulate immune system and have protective effects on epithelial cells. This study aims to investigate renal crystal formation and deposition, in mice after orally administered with SCFAs, and analyze the change of gut microbiome in mice with renal crystal deposition after orally administered SCFAs. Glyoxylate was administrated intraperitoneally to C57BL/6J mice for five consecutive days to establish a mouse model of kidney calcium oxalate crystal formation and deposition with or without orally administered SCFAs. Kidney, serum and cecum content were collected from mice. 16S ribosomal RNA (rRNA) sequencing was performed to analyze the microbiome composition. Serum creatinine, BUN, urea and uric acid were detected, and renal crystal formation and deposition was detected by Von Kossa staining. Results: After intraperitoneally administrated glyoxylate, mice had large amounts of renal calcium oxalate crystal deposition with fibrosis and infiltrated inflammatory cell in kidney. Renal calcium oxalate crystal deposition was significantly decreased in mice with orally administered SCFAs. Also, the serum creatinine, BUN and urea were significantly decreased in mice with orally administered SCFAs. The gut community compositions were difference among control mice, glyoxylate induced model mice and glyoxylate induced mice with SCFAs. Interestingly, we found Lactobacillus was increased significantly in glyoxylate induced mice with SCFAs than control mice and glyoxylate induced mice. Functional prediction of 16S rRNA showed increased glutathione metabolism, ion channel, cytochrome P450 and vitamin A metabolism pathway abundance after the administration of SC-FAs, suggesting that these metabolism pathways were correlation with anti-inflammatory. Conclusion: SCFAs may prevent renal crystal formation and deposition by regulating gut microbiome composition and anti-inflammatory pathway. Introduction and Objective: Platelet rich plasma (PRP) has shown to prevent the atrophy of corporal smooth muscle cell and enhance the regeneration of nerve fiber in cavernous nerve injury rat model. We investigate the effects of PRP on the recovery of erectile dysfunction in streptozotocin (STZ)-induced diabetic rats. Six-week-old SD male rats received intraperitoneal (IP) injection of STZ (65 mg/ kg) or vehicle injection after a 16 hour fast. Twelve weeks later, the erectile function in the entire rat was assessed by measuring intracavernosal pressure (ICP) and other functional parameters of erectile function. Diabetics with erectile dysfunction (ED) rats were di-vided into two groups: the intracavernosal injection vehicle-only or PRP treatment. The control without STZ injection and diabetic rat without ED were as a control. Four weeks after treatment, erectile function was assessed by measuring ICP. Penile tissues were collected to undergoing the histomorphometrically analyzed and further perform ultrastructural analysis of the corpus cavernosum. Results: Intracavernosal injection of PRP increased all erectile function parameters at 28-day post-treatment. Ultrastructural analysis revealed the tissue protection of PRP is through maintaining the structure of adherens junctions to keep the integrity of the corpus cavernosum. Conclusion: Intracavernosal injection of PRP treatment improved erectile function in STZ-induced diabetic rats through the protection of corpus cavernosum. PRP may have the potential for clinical use of diabetes with ED in the future. The Effect of Irrigation Power and Ureteral Access Sheath Diameter on the Maximal Inra-Pelvic Pressure During Ureteroscopy: In-Vivo Experimental Study in a Porcine Model Noureldin Y 1 , Kallidonis P 2 , Ntasiotis P 2 , Adamou C 2 , Zaki Z 2 , Evangelos Z 2 , Liatsikos E 3 Introduction and Objective: To assess the effect of irrigation settings and the size of ureteral access sheath (UAS) on the maximal inra-pelvic pressure (IPPmax) during ureteroscopy. In supine position, 3 anesthetized female pigs underwent cystoscopy to insert a 6F ureteral catheter in each ureter. Pigs were then turned to prone position to establish a percutaneous access, insert a 10F nephrostomy tube in the kidney, and connect it to the (P-ves) side of a Urodynamic device. Irrigation was connected to the 8F semi-rigid Ureteroscope or the Flex-X2 Flexible Ureteroscope and two irrigation settings; gravity flow and manual pumping were used. Ureteroscopy was performed without UAS and with the UAS 9.5/11, 12/14, 14/16 at the uretero-pelvic junction and the IPPmax was recorded. Results: Under gravity irrigation, the recorded IP-Pmax during semi-rigid URS in the distal ureter and the renal-pelvis was 0, 30 cmH2O, respectively. Furthermore, the IPPmax during flexible URS in the renal-pelvis without UAS, with UAS 9.5/11.5, with UAS 12/14, with UAS 14/16 was 23, 6, 2, 1 cmH2O, respectively. Under manual pumping, the IPPmax during semi-rigid URs in the distal ureter and the renal-pelvis was 84, 105 cmH2O, respectively. Furthermore, the IPPmax during flexible URS in the renal-pelvis without UAS, with UAS 9.5/11.5, with UAS 12/14, with UAS 14/16 was 45, 46, 18, 1 cmH2O, respectively ( Figure 1 ). UP.008, Figure 1 . Serum level of creatinine, BUN, urea and uric acid (B) . Partial Least Squares Discriminant Analysis (C) and (D) the differences of microbiome composition among control mice, glyoxylate induced mice and glyoxylate induced mice with SCFAs. Introduction and Objective: Urethral strictures are a common urological problem which could require complex reconstructive procedures. Urethral dilation is a frequent intervention associated with high recurrence rates. Drug-coated balloons with cytostatic drugs have been successfully used for the prevention of vascular restenosis after balloon dilation. These balloons could be used in the urethra to reduce the restenosis rates of urethral dilation. Nevertheless, the urothelium is different from the vascular endothelium and these drugs may not be distributed to the outer layers of the urethra. Therefore, we performed this experiment to evaluate the distribution of paclitaxel (PTX) in the rabbit urethra after the inflation of a PTX-coated balloon (PCB). Eleven rabbits underwent dilation of the posterior urethra with common endoscopic balloons after urethrography. Nine of these rabbits were additionally undergone dilation with PCB. The urethras of the 2 control animals were removed along with 3 more dilated with PCB urethras immediately after the dilation. The remaining of the urethras were removed after 24 (n= 3) and 48 hours (n= 3). The posterior segments of the urethras were evaluated with Hematoxylin and Eosin staining, as well as with immunohistochemistry (IHC) with polyclonal anti-paclitaxel antibody. The two control specimens showed denudation of the urothelium after balloon dilations and no PTX was observed. All urethral specimens from those dilated with PCB showed distribution of PTX to all layers of the urethra. The specimens which were immediately removed exhibited denudation of the urothelium without any inflammation. The specimens removed at 24 and 48 hours showed mild acute inflammation. Conclusion: PTX is distributed to all layers of the rabbit urethra after PCB inflation. Thus, PTX could exert its activity to the smooth muscle cells which are responsible for the production of collagen and restenosis of the urethra. Peritoneal fibrosis remains a serious complication of long-term peritoneal dialysis. Stem cell therapy is an innovative field of scientific investigation with potential for clinical application. Here, we systematically reviewed the studies to determine whether stem cell-based therapy could improve the peritoneal fibrosis in experimental models of peritoneal fibrosis. Our systematic search of PubMed, Scopus, Web of Science, and Cochrane Library yield 5219 article. After screening for eligibility, in vivo, experimental, interventional studies using stem cells in animal models of peritoneal fibrosis; 11 articles were included. The studies underwent comprehensive review, quality assessment, and data extraction. Results: Mesenchymal stem cells were the most used type (90.9%) originated either from bone marrow (70%), adipose tissue (20%), or umbilical cord (10%). In 90.9% of studies, stem cells were injected after peritoneal insult and 63.6% of studies used the intraperitoneal injection route. Eight studies met the ≥ 50% of criteria indicated by ARRIVE recommendation. Information regarding the nature of ethical review permissions, species, strain and gender, dose, route and duration of treatment, was stated by all studies; 81.8% of the studies reported the number of animals in each group. Adverse events were reported in one study. Improvement in histological parameters including attenuation of submesothelial thickness (100%), inflammation (62.5%), angiogenesis (60%), and fibrosis (85.7%) was reported after stem cell therapy. Peritoneal permeability function by assessing the ultrafiltration, glucose transport and solute permeability was improved in all studies. Stem cell treatment resulted in mesothelial recovery in 100% of studies. In preclinical studies, the use of stem cells is associated with improved peritoneal fibrosis. This may provide an important foundation to support future translational clinical research using stem cell therapy to repair the injured peritoneum and modulate immune responses in PD patients. Qian S, Yu Y, Ding Y, Qi J Introduction and Objective: Renal function protection during partial nephrectomy and renal transplantation has been highly focused and demands a prompt solution. Ischemia-reperfusion injury (IRI) is one of the most vital pathogenesis leading to kidney injury during perioperative periods. Previous studies have confirmed that kidney injury molecule-1 (KIM-1) mediated autophagy plays an important role in the process of kidney injury and epithelia renovation. This study was conducted to investigate the regulatory role of MHC class II of proximal tubular cells (PTCs) in the process of KIM-1 mediated autophagy during renal IRI. Nephron MHC class II conditional knockout (cKO) mice (Six2-Cre + / -; MHCII flox / flox ) were performed to establish the bilateral IRI model (30 minutes of ischemic duration or sham operation). That age-and sex-matched littermates from the Six2-Cre -/ -; MHCII flox / flox colony were chosen as control mice. Both acute phase (48 hours after surgery) and chronic phase (6 weeks after surgery) of renal IRI were evaluated to investigate the underlying mechanisms. Results: MHC class II cKO mice suffered more deteriorative kidney function after renal IRI. Compared with control mice, MHC class II cKO mice manifested higher KIM-1 expression in both acute and chronic phase of renal IRI (24.76±2.34 % vs. 16.47±1.27 % and UP.010, Figure 1. 109 2.21±0.41 % vs.1.03±0.27 %, correspondingly; both p<0.05). In the chronic phase, the severity of kidney fibrosis and collagen I deposition were dramatically greater in the cKO mice (12.85±3.34 % vs. 9.78±2.62 % and 20.08±5.77 % vs. 17.40±3.36 %, respectively; both p<0.05). In addition, MHC II cKO mice showed a significantly less kidney-infiltrating CD4+ CD25+ Foxp3+ T cells (regulatory T Cells, Tregs) during the process of renal IRI (p<0.05), indicating Tregs were the most essential lymphocytes in the KIM-1 mediated autophagy pathway during renal IRI. Conclusion: MHC class II of PTCs plays a protective role in the kidney injury caused by bilateral IRI. After the process of KIM-1 mediated phagocytosis and autophagy, antigen could be further presented to MHC class II of PTCs, thus regulating the renal immune response. Among all the infiltrating immunocytes, Tregs are the most vital in the KIM-1 mediated autophagy pathway during renal IRI. The Introduction and Objective: Laparoscopic surgery is clearly different from open surgery and therefore requires a different training setup. Laparoscopy training has evolved in recent years. We describe a simplified training program using the pelvitrainer to improve the basic laparoscopic skills of the junior urologists and visceral surgeons. This is an analytical prospective study focusing on the skills progress of 20 residents in surgical specialties and with different levels of training. Our program started with 4 inanimate tasks that included peg transfer, disc cut-out, needle guidance and intracorporal knot tying. Each task was practiced for one-hour training session with an objective evaluation (time necessary to achieve every task and quality criteria in the 2 first tasks) at the initial attempt and at the end of the training session. Results: Residents were 28 years old (26-31). The sex ratio was 4/1. Two specialties were represented: visceral surgery (12 residents) and urology (8 residents). The continuous evaluation of these trainees showed that there was a significant decrease in the time required to perform each of the 4 tasks at the end of their corresponding sessions compared to the base line values. Task 1: the average time decreased from 4 min 25 sec to 2 min 30 sec (p = 0.00). The average number of dropped objects decreased from 0.8 to 0 (p = 0.037). Task 2: the average time decreased from 4 min 44 sec to 3 min 19 sec (p = 0.019). The average length of cutting beyond the lines decreased from 2.1 cm to 0.6 cm (p = 0.005).Task 3: the average time decreased from 8 min 36 sec to 4 min 43 sec (p = 0.004). Task 4: the average time decreased from 4 min 7 sec 2 min 12 sec (p = 0.001). The results of this study confirm that such a model allows training surgeons to progress significantly. The Pelvitrainer is a powerful and inexpensive tool that can help in the improvement and in the retention of the basic laparoscopic skills of the junior residents. We investigated the effects of in utero exposure to di-n-butyl phthalate (DBP) on testicular cell apoptosis in pubertal cryptorchid male rat offspring and the regulation of miRNAs in this process. Twenty pregnant SD rats were divided into two groups. During gestation day 12 to 19, control group was given 1ml/d of olive oil, and experimental group was given DBP 500mg/kg/d by gavage. On postnatal day (PND) 45, the testes of male rat offspring were removed. Transmission electron microscope and HE staining were done for morphological analysis. Apoptosis was detected by TUNEL. The expression of Bcl-2, Bax and p53 was presented by immunohistochemistry and Western blotting. RNA sequencing was performed to screen the differentially expressed miRNAs and bioinformatic analysis was used to predict the target genes. Quantitative PCR was performed to validate the apoptosis related miRNA expression. Data of the two groups were compared using t-test by SPSS 20.0. The incidence of cryptorchidism in the offspring of DBP-exposed group was 65.6%. In PND45 cryptorchid rat testes, increased apoptosis was observed and spermatogenetic cells were significantly decreased. The apoptosis index of germ cells in cryptorchid testes was significantly higher than that of the controls (P < 0.01). Immunohistochemistry and Western blotting revealed significant overexpression of Bax and p53 in cryptorchid testis after DBP exposure (P < 0.05). 237 differentially expressed miRNAs were obtained. The KEGG pathway analysis revealed 15 apoptosis-related miRNAs, with 13 up-regulated miRNAs and 2 down-regulated miRNAs. Quantitative PCR revealed that the expression of miR-204-3p in the cryptorchid testes was significantly higher than that in the control group (P<0.05). Conclusion: Maternal exposure of DBP may lead to severe DNA damage in the cryptorchid testis of rat offspring, which may increase the expression of p53 by up-regulating miR-204-3p, and promote the release of Bax from mitochondria by cytochrome C, resulting in increased apoptosis of germ cells, testicular spermatogenesis dysfunction and infertility. The Role of Type 1 Angiotensin II Receptor (At1) on the Levels of Transforming Growth Factor b1 (TGF-b1), Matrix Metalloproteinase 9 (Mmp-9) and Type III Collagen Wistar Rat Bladder Wall with Partial Infravesika Obstruction Sihombing A 1 , Adi S 1 , Noegroho BS 2 , Setiawan S 1 1 Padjadjaran University, Bandung, Indonesia; 2 Hasan Sadikin Hospital, Bandung, Indonesia Introduction and Objective: Excessive strain on the bladder wall caused by bladder outlet obstruction results in changes in bladder wall type III collagen, smooth muscle hypertrophy, and disruption of smooth muscle function. These changes were also found in the condition where the local bladder's renin-angiotensin system (RAAS) and TGF-b1 increased excessively. The objective was to compare AT1 receptor expression between angiotensin receptor blocker treated group and angiotensin-converting enzyme inhibitor treated group Materials and Methods: This study was an experimental study that used 30 adult male wistar rats. These Wistar rats were divided into 3 groups of rat models BOO and 1 group sham operated. Group I (positive control group) consisted of 9 rats with artificial bladder outlet obstruction (BOO) without any treatment, group II consisted of 9 mice with artificial BOO treated with ramipril, group III consisted of 9 mice with artificial BOO treated with telmisartan. Group IV (sham group) consists of 3 mice with sham procedure. Observation on day 1, day 7 and day 14 was done at the expense of rats from each group to take bladder tissue. The bladder tissue from each group was processed and examined for AT1, MMP9, TGF-b1 and type III collagen receptors using the ELI-SA method. Data were analyzed using one-way ANO-VA and Spearman correlation. Statistical analysis using SPSS version 20.0. Results: AT1 receptor level group III on the 14th day was lower than the group II AT1 receptor level (p 0.013). Group III showed a tendency of decreasing AT1 receptor levels on the 14th day while group II tended to increase. There is a positive correlation between the levels of AT1 and MMP-9 receptors and a positive correlation between MMP-9 and TGF-b1 levels in BOO model mice. The level of MMP-9 group III on the 14th day is lower than group II but was not statistically significant. Levels of TGF-b1 group III on day 1 were lower than group II with p 0.015. Expression of AT1 receptor level ARB treated group is lower than AT1 receptor level of ACE inhibitor treated group. There is a strong correlation between AT1 receptor and MMP-9 and MMP-9 with TGF-b1. Urine Introduction and Objective: Bacterial biofilm is the key pathogenic factor for CAUTI; the study intends to explore the impact of bladder urine flow hydrodynamics on E. coli biofilm formation on the surface medical silicone membrane. The authors firstly put forward a new point: bladder urinary flow pattern is turbulent flow, then designed the artificial urine turbulent shear stress loading system based on bacterial biofilm reactor of in vitro bionic human bladder. The experimental grouping included hydrostatic pressure (SAU), constant shear stress (DAU1), physiological and pathological shear stresses (DAU2, DAU3) and the test time-points were 24 h, 72 h, 120 h, and 168 h. Biofilm bacteria suspension smear colony count, optical density value, CLSM, and SEM techniques were used to characterize biofilms. The inter-group and intra-group differences were quantitatively compared by Image J and Comstat software. The repeated measure data were analyzed by RM-ANOVA with SAS software. Results: (1) The colony counts were significantly different between time points (P=0.0029). (2) The OD values were significantly different between groups or time points (all P<0.0001); the interaction effect existed between stress and time point (P<0.0001). (3) The biofilm biomass on CLSM images were significantly different between groups or time points (P=0.0004, <0.0001), the interaction effect existed (P<0.0001). The surface areas were significantly different between groups or time points (all P<0.0001); the interaction effect existed (P<0.0001). The average diffusion distances were significantly different between groups or time points (all P<0.0001); the interaction effect existed (P<0.0001). (4) The biofilm surface areas on SEM images were significantly different between groups or time points (all P<0.0001); the interaction effect existed (P<0.0001). A new urine turbulent shear stress loading system based on bacterial biofilm reactor of in vitro bionic human bladder was successfully constructed, and bladder urine turbulent shear stress significantly stimulated E. coli biofilm formation. Urine Turbulent Shear Stress of Bionic Human Bladder Based on a New Bacterial Biofilm Reactor Stimulated the Expression Differences of E. coli Biofilm Lectins: An In Vitro Preliminary Study Introduction and Objective: In chronic infections, lectins play key roles in establishing biofilms. We have proved the bladder urine turbulent shear stress could promote E. coli biofilm formation based on in vitro bacterial biofilm reactor. This study intends to explore the impact of bladder urine turbulent shear stress on the expression differences of biofilm lectins. The E. coli biofilm was constructed based on a new bacterial biofilm reactor with artificial urine turbulent shear stress. The experimental grouping included hydrostatic pressure (SAU), constant shear stress (DAU1), physiological and pathological shear stresses (DAU2, DAU3) and the test time-points were 24 h, 72 h, 120 h, and 168 h. The specialized lectin microarray was used to detect the differential expression of 26 lectins ( (1) In SAU and DAU1 groups: the glycosylation degrees gradually increased from 12 h to 168 h and three lectins of AAL, RCA-I, and HPA were mainly bound. (2) At 24 h, 72 h, 168 h of DAU2, the glycosylation degrees were similar, poorer at 120 h, but HPA expression was stronger than AAL. (3) At 24 h, 72 h of DAU3, the glycosylation degrees were similar, poor at 20 h but stronger at 168 h. The AAL expression was stronger than HPA at 24 h and 72 h but was the inverse of the two lectins expressions at 120 h, the Galactose degrees was quite high at 168 h. The in vitro urine turbulent shear stress based on bacterial biofilm reactor of in vitro bionic human bladder could lead to the expression differences of E. coli biofilm lectins. The lectins AAL, RCA-I and HPA were mainly expressed on the E. coli biofilms, and the time and stress differences were also observed. Renal Denervation Ameliorates Renal Ischemia-Reperfusion Injury and Modulate Micro-RNA Expression in Injured Kidneys in Rats Zou X, Zhong L, Sun J Introduction and Objective: Ischemia-reperfusion injury (IRI) is a main clinical cause of acute renal injury, which can lead to renal failure. Renal denervation (RD) was used in renal injury repair, but the mechanism is still unclear. Micro-RNA was regarded as an important media in renal injury repair, which may involve in the therapeutic effect of RD in renal IRI. So, the purpose of this study was to investigate the therapeutic effect of RD on renal IRI and to further explore the changes of micro-RNA in injured kidneys. Materials and Methods: Renal IRI animal model was established with right nephrectomy and left renal ischemia for 45 minutes in rats. Left renal arteries were separated and treated with 10% phenol solution for 2 minutes in RD experiment. IRI, IRI + RD and sham operated groups were involved in this study. Kidney UP.017, Figure 1 : The left figure shows the biofilm bacteria suspension smear colony count comparison. The right figure shows the optical density value comparison and blood samples were obtained 24 hours and 3 weeks after the intervention, respectively. Tyrosine hydroxylase (TH) and calcitonin gene-related peptide (CGRP) were stained in injured kidneys to assess the denervation effect. Renal pathology score was tested with Periodic Acid-Schiff (PAS) staining and renal fibrosis were reflected with Masson trichromatic staining. Serum urea nitrogen and creatinine were used to detect renal functions. Moreover, the different expressions of miRNAs in kidneys were determined by micro-array analysis, and gene ontology (GO) was used to analyze the functions of their target genes. Results: RD reduced the expression of TH and CGRP significantly in injured kidneys. Meanwhile, RD can alleviate the damage of tubule cells in the early stage of IRI (24 hours), abrogate renal fibrosis in the later stage (3 weeks) and improve renal functions. Through micro-array analysis, RD changed the micro-RNA contents in injured kidneys, and the up-regulated micro-RNAs mainly targeted in mitochondria dynamic and angiogenesis pathways. Conclusion: RD could ameliorate renal IRI both in the acute and chronic stage, and the modulation of mitochondria dynamic and angiogenesis related micro-RNAs may be a potential mechanism. This study establishes a substantial foundation for future research and treatment. Human Urinary RNA Exosome: Optimizing Methods of Isolations and Sample Preparation for Transcriptome Danarto R 1 , Prasetyo AD 1 , Kristanto J 1 , Hugo R 1 , Putra SP 1 , Wardana T 1 , Astuti I 1 , Haryana SM 1 , Zulfiqqar A 2 1 Universitas Gadjah Mada, Yogyakarta, Indonesia; 2 Universitas Gadjah Mada, Yogyakarta, Indonesia; Dr. Sardjito General Hospital, Yogyakarta, Indonesia Introduction and Objective: Human urine is a potential bio-fluid to study as a diagnostic biomarker method. There are substances secreted from metabolism residue and damaged cell, including genetic substances that cast away through urine and RNA (Ribonucleic Acid). Recently, RNA (coding-ncRNAs) UP.018, Figure 1 : The upper-left of figure shows the expression differences of E. coli biofilm lectins in SAU stress group. The upperright of figure shows the expression differences of E. coli biofilm lectins in DAU1 stress group. The lower-left of figure shows the expression differences of E. coli biofilm lectins in DAU2 stress group. The lower-left of figure shows the expression differences of E. coli biofilm lectins in DAU3 stress group has been developed for diagnostic methods because it could represent profile expression in the cell. Furthermore, RNA urinary isolation methods are important to be established in order to get reliable non-invasive biomarkers compared to tissue biopsy. In fact, the optimization method for isolation RNA from urine is not clear. So that, the optimization and stability storage study are needed to be used as a reference standard protocol. This study was performed to determine the optimization methods of RNA isolation from urine samples and RNA concentration stability storage for transcriptomic (non-coding RNA) analysis. Each sample was collected as many 15 mL in the morning and treated with lysis solution from different manufacturers (Qiagen, Ambion, Geneid, control without buffer). ANOVA statistical analysis was performed to determine the significant difference between the methods used. Results: RNA stability measuring of RNA and DNA observed on days 1, 3, 5, 7, 9, 11, and 13 had a p-value > 0.01. At the same time, RNA stability storage is known to decrease consistently by 0.1-1 ng each day. Quantification mRNA could be done from urine samples. There are no significant differences between all the methods used. Introduction and Objective: To prospectively evaluate the incidence of transitional cell carcinoma (TCC) in the prostatic urethra in patients with bladder tumors and investigate characteristics of bladder tumors in relation to the risk of involvement of the prostatic urethra. A prospective study of 100 patients with bladder masses presented in the period between October 2015 and November 2016. Patients underwent transurethral resection of the bladder tumor (TUR-BT), with biopsies from the prostatic urethra at 5 and 7 o' clock just distal to the bladder neck and proximal to the verumontanum. We excluded patients with visible tumor invading the prostatic urethra on cystoscopy. Results: Mean age was 60 years. Prostatic urethral biopsies were positive in 25 patients (25 %), only one of them was with carcinoma in situ (1%). We found 52 patients with a mass near to bladder neck (<2 cm from bladder neck), while 48 patients had it away (> 2 cm from bladder neck). 61 patients had a single mass, while 39 had multiple bladder masses. We found that invasive bladder cancer (mass felt by DRE, associated with Hydronephrosis by CT, solid in appearance, muscle invasive masses) is the most important factor that increases the risk of prostatic urethral invasion. Conclusion: Prostatic urethral sample should be considered in all patients suspected to have an invasive tumor, which may affect further management of these patients. Albers Acosta E, Celada Luis G, San José Manso L, Brime Menéndez R, Casado Varela J, Cogorno Wasylkowski L, Costal M, Viegas Madrid V, Olivier Gómez C Introduction and Objective: Second transurethral resection of bladder tumors (TURB) in pTa high grade (HG) patients is recommended in cases without muscular tissue in the initial pathological report. It has demonstrated outcomes in recurrence-free survival and overall survival (EAU guidelines). Primary objective: to analyze TURB usefulness after BCG induction cycle in pTa HG tumors (high risk according to EO-RTC) in order to identify an early relapse. Secondary objective: to analyze early relapse prognostic factors in these patients. It was a retrospective and descriptive study. We enrolled 59 patients with pTa HG bladder urothelial carcinoma (high risk according to EORTC), from July 2010 to September 2016, submitted to induction with BCG instillations (81 mg -six-weekly schedule) and TURB after a six-week cycle. We compared the early relapse in evaluative TURB against late relapses (more than 6 months) and the number of tumors, multicentricity and tumor size at first TURB as prognostic factors. We stratified the recurrence and progression risks according to EO-RTC at the time of the evaluative TURB. Results: The mean follow up was 42.9 months. 19 patients showed recurrence (32.2% [IC95%: 20.6 -45.6%]) with a mean of 12 months (3-60 months). 7 patients (11.9% [IC95%: 4.9 -22.9%]) showed recurrence at evaluative TURB. Recurrence risk was higher in multifocal tumors with an OR 3.184 (IC95%: 1.022 -9.917) and OR 9.600 (IC95%: 1.075 -85.733) both in early recurrence patients and globally. According to the risk stratification, 94.7% of relapses showed an intermediate recurrence risk and 84.2% showed a high progression risk. 88.1% of all TURB were negative. Conclusion: Patients with multifocal pTa HG tumors in first TURB benefit from an evaluative TURB after BCG prophylaxis induction cycle. Blue Light Cystoscopy with Hexaminolevulinate has a High Negative Predictive Value for Ruling Out Urothelial Malignancies Amin A 1 , Blazevski A 2,3 , Macrae C 1 , Yuen C 1,3 Introduction and Objective: Studies have demonstrated that blue light cystoscopy with hexaminolevulinate improves detection of non-muscle invasive bladder cancer (NMIBC) compared with white light cystoscopy. We report our Australian experience to test the efficacy of ruling out urothelial malignancies with blue light cystoscopy. We retrospectively identified 41 consecutive patients who underwent blue light cystoscopy and biopsies, following instillation of hexaminolevulinate between 2016 and 2018. Intraoperative biopsy specimens were prospectively labelled "blue light positive" or "blue light negative". "Blue light positive" indicated a specimen taken from an area that illuminated red, whilst a "blue light negative" specimen was one from an area that did not illuminate red as part of systematic bladder biopsy. All samples underwent histopathological analysis and the results compared. Results: 41 patients (Median age 74, 88% male and 12% female) underwent bladder biopsies, which yielded a total of 254 specimens. There were 131 blue light positive samples and 123 blue light negative biopsies. Of the 131 blue light positive samples, 71 (54%) demonstrated urothelial malignancy (including CIS), whilst 60 (46%) had no evidence of malignancy. Of the 123 blue light negative samples, 117 (95%) samples were negative for malignancy, whilst only 6 were positive for malignancy (all of which were CIS). There was a high detection rate of CIS at 86%, whilst low and high-grade urothelial malignancies had a 100% detection rate. Blue light cystoscopy conferred a high sensitivity of 92% and negative predictive value of 95% in ruling out urothelial tumours in a population with a high prevalence of tumour. Specificity and positive predictive value were lower, at 66% and 54% respectively, owing largely to a significant amount of false positive results from bladder inflammation. A negative blue light cystoscopy is reassuring in ruling out malignancy based on our data. There is a high detection rate of CIS. Inflammation in the bladder is a large contributor to our high false positive rate and low positive predictive value. Robotic Assisted Radical Cystectomy -An Analysis of Safety and Oncological Outcomes from an Australian Case Series Amin A, Blazevski A, Cole-Clark D, Yuen C Introduction and Objective: Robot assistance is increasingly being used for radical cystectomy. Numerous international studies have demonstrated equivalence or superiority of oncological and safety outcomes of robotic assisted radical cystectomy (RARC) compared to open cystectomy. The aim of this presentation is to describe an early Australian experience of RARC with intracorporeal urinary diversion and compare oncological and safety outcomes with the international published literature. There were 21 male and five female patients who underwent RARC between 2013 and 2018. Median age was 70 (range 56-84). 5 patients underwent neo-adjuvant chemotherapy. All 26 patients underwent intracorporeal ileal conduit urinary diversion. There were no conversions from RARC to an open cystectomy. Median blood loss was 300 mL (range 50-600 mL). There was a 73% overall complication rate in 90 days, with the most common complications being urinary tract infection and ileus, whilst the major complication (Clavien-Dindo > 3) rate was 12%. The positive surgical margin rate was 8%. Median lymph node yield was 13 (8-20) and me-39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK dian positive lymph nodes were 1 (0-2). Two patients (8%) had a readmission to the hospital within 30 days of discharge. There were no deaths within 90 days of operation. Results: There were 21 male and five female patients who underwent RARC between 2013 and 2018. Median age was 70 (range 56-84). 5 patients underwent neo-adjuvant chemotherapy. All 26 patients underwent intracorporeal ileal conduit urinary diversion. There were no conversions from RARC to an open cystectomy. Median blood loss was 300 mL (range 50-600 mL). There was a 73% overall complication rate in 90 days, with the most common complications being urinary tract infection and ileus, whilst the major complication (Clavien-Dindo > 3) rate was 12%. The positive surgical margin rate was 8%. Median lymph node yield was 13 (8-20) and median positive lymph nodes were 1 (0-2). Two patients (8%) had a readmission to the hospital within 30 days of discharge. There were no deaths within 90 days of operation. Our results are comparable with much of the international published literature in safety and oncological outcomes in robotic cystectomy. Further prospective trials in the Australian setting need to be conducted to compare RARC to open radical cystectomy. Could DNA Methylation in the Urine be a Future Biomarker for Risk Stratification and Screening of Patients with Neurogenic Lower Urinary Tract Dysfunction (NLUTD) for Bladder Cancer? Koukourikis P 1,2 , Papaioannou M 1 , Chakim Z 1 , Apostolidis I 1,2 , Georgopoulos P 1,2 , Apostolidis A 1,2 1 Aristotle University of Thessaloniki; 2 Papageorgiou General Hospital, Thessaloniki, Greece Introduction and Objective: Literature on the prevalence of bladder cancer (BCa) in NLUTD patients is conflicting and an established screening protocol does not exist. The development of urine biomarkers for BCa is an attractive non-invasive method of screening in this patient population, as opposed to cystoscopy, urine cytology and bladder biopsies. DNA methylation, an epigenetic modification resulting in transcriptional silencing of tumor suppression genes, is found in 50-90% of BCa cases. In urine samples of patients with NLUTD, we explored DNA hypermethylation of a panel of five genes' promoters previously associated with a higher risk of BCa, and in comparison, with reported results from normal individuals. Eligible participants for this pilot, prospective study were patients with a history of NLUTD of at least five years. DNA was extracted and DNA methylation was assessed for the RASSF1, RARb, DAPK, hTERT and APC genes' promoters by the quantitative Methylation Specific PCR in a urine sample. The sample was collected via clean intermittent catheterization (CIC), indwelling catheter of free flow, depending on patients' voiding habits. Results: Thirty-three patients with a mean age of 48.39 years and a mixed etiology of NLUTD were enrolled. Most patients (57.6%) were male. The majority of patients (81.8%) emptied their bladders with CIC and the median duration of catheter use was 6 years and median NLUTD duration was 12 years. DNA was detected in 28 of 33 urine samples. DNA was found to be hypermethylated in at least one of five gene promoters in 11 urine samples (39.29%). RASSF1 was hypermethylated in 6/11 samples (54.55%), APC in 5/11 samples (45.45%), DAPK in 3/11 samples (27.59%), RAR-b2 in 1/11 sample (9.09%) and hTERT in no sample. The NLUTD group demonstrated higher prevalence of DNA hypermethylation in comparison to the control group (39.29% vs.13.64%, p= 0.045). Conclusion: In our cohort of NLUTD patients, DNA hypermethylation of a panel of five genes associated with BCa was found in at least 1/3 of patients, a higher prevalence when compared to normal controls. Whether this suggests a higher BCa risk in NLUTD patients' needs to be confirmed in large, controlled longitudinal studies. Pathological Significance of Thrombospondin-5 in Patients with Bladder Cancer: Did its Expression Correlate to Blood Supply of Cancer-Related Microvessels? Introduction and Objective: Among of thrombospondins (TSPs), pathological roles of TSP-1 and -2 in malignancies have been previously studied in vivo and in vitro. On the other hand, there is little information on the relationship between other members and clinicopathological features in bladder cancer tissues. In this study, we paid attention to TSP-5 expression because it is associated with vascular homeostasis including blood coagulation. That is, we hypothesis that TSP-5 plays important roles for tumor growth and cell dissemination via securing blood supply of cancer-related microvessel in cancer tissues. The main aim of this study is clarifying this hypothesis in patients with bladder cancer. Materials and Methods: Expression of TSP-5 was evaluated in 206 patients, with 150 non-muscle, invasive bladder cancer (NMIBC) and with 56 MIBC patients. TSP-5 immunoreactivity, proliferation index (PI, measured by using anti-Ki67 antibody), and microvessel density (MVD, measured by using anti-CD34 antibody) were evaluated in formalin-fix specimens by immunohistochemical technique. By using computer imaging analysis system, ratio of blood cells and an area of microvessel within the tumor is analysed. Results: TSP-5 immunostaining in cancer cells was observed in mainly cytoplasm and cell membrane. One-hundred nineteen patients (57.8%) were judged as positively expressing TSP-5, and it was significantly associated with grade (P < 0.001), T stage (P < 0.001), and presence of metastasis (P < 0.001). In addition, it is useful predictor for cause-specific survival (log rank P=0.023) in Kaplan-Meier survival curves. On the other hand, TSP-5 expression was correlated with PI (P < 0.001), but not with MVD (P = 0.427). With regard to ratio of blood cells and an area of microvessel, mean / SD ratio in TSP-5-positive tissue (45.7 / 14.7 %) was significantly higher (P < 0.001) than that in -negative tissues (29.8 / 11.9 %). Our results showed that TSP-5 expression was significantly associated with pathological features and survival in bladder cancer patients. We speculated that increasing of cancer cell proliferation may play an important role, and TSP-5 may secure the blood supply of cancer-related microvessel. The main limitation of this study is that ratio of blood cells and an area of microvessel does not always reflect the blood supply. However, I believe that there is a possibility that TSP-5 is positively associated with malignant aggressiveness via securing blood supply and pathway for cancer cell dissemination in bladder cancer. Kumamoto University, Kumamoto, Japan Introduction and Objective: CD169 + macrophages play a pivotal role in establishing anti-tumor immunity. In mice, they capture dead tumor cells in the draining lymph and activate tumor-antigen-specific CD8 + T cells, which is important for tumor suppression. It was reported that a greater frequency of CD169 macrophages is associated with a better cancer prognosis in cancer patients. The goal of this study was to determine the prognostic significance of CD169 + macrophages residing in the tumor-draining lymph nodes of bladder cancer. Materials and Methods: 64 bladder cancer patients who received radical cystectomy were retrospectively examined. The abundance of CD169 + macrophages in the regional lymph nodes and CD8 + T cells in the tumor were investigated by immunohistochemistry. The CD169 score was determined as the proportion of CD169 + macrophage among CD68 + cells in the lymph node. Results: Bivariate comparisons of clinicopathological features of patients using the chi-square tests showed that the CD169 score positively correlates with an abundance of CD8 + T cells in the tumor. The high CD169 score group showed significantly higher cancer-specific survival rate than the low CD169 score group (5-year cancer-specific survival rate: 80.4% versus 25.1%, p = 0.0005). A multivariate analysis identified the CD169 score as the strongest and independent favorable prognostic factor for cancer-specific survival. Conclusion: These results suggest that CD169 + macrophages in the lymph nodes enhance anti-tumor immunity by expanding CD8 + T cells in the bladder cancer. We propose that the CD169 score can be used for predicting cancer-specific survival rate in the bladder cancer patients. Introduction and Objective: Bladder exstrophy is a rare congenital anomaly. Malignant transformation of the native mucosa is an uncommon complication. Adenocarcinoma comprises the vast majority (95%) while squamous cell carcinoma accounts for less than 5%. Malignant transformation of bladder exstrophy is known to occur after primary surgery in childhood as well as in untreated adults. We describe three cases of bladder exstrophy with malignant transformation presenting in adulthood. This series demonstrates a spectrum of malignancy and highlights the need for awareness of this potentially fatal complication. A retrospective search of patient records in our computerized database over a 15-year period. We identified three cases of malignant transformation in untreated adult bladder exstrophy. Two of these were squamous cell carcinoma and one was adenocarcinoma. Malignancy was evident in two of the cases where tumor was visible within the exposed bladder mucosa. In one case, the diagnosis of malignancy was ascertained post-operatively as a histological surprise. Conclusion: Bladder exstrophy is a known predisposing factor for malignancy after reconstruction as well as in untreated cases. Adenocarcinoma is, by far, the commonest histology. Squamous cell carcinoma is much rarer, with the majority of reported cases having occurred in untreated adult exstrophy. Given the risk of malignant change, we recommend biopsy of the exstrophied bladder in all adult cases before complex reconstruction is performed. Autophagy Inhibition Enhances Leflunomide-Induced Cytotoxicity in Human Bladder Cancer Cells Introduction and Objective: Dihydroorotate dehydrogenase (DHODH) is one of the essential enzymes in the de novo biosynthesis of pyrimidine and might be a potential therapeutic target for cancer suppress. The anti-proliferative and apoptosis-inducing effects of leflunomide, a potent DHODH blocker, have been demonstrated in multiple human cancers. This study aims to investigate the cytostatic effects of leflunomide on bladder cancer and the involved mechanism. Materials and Methods: Two human bladder cancer cell lines, T24 and 5637 were used in this study. After incubation with varied doses of leflunomide, the cell viability, apoptosis and cell cycle assay were determined with MTS, cell colony assay and flow cytometry. Western blot was used to evaluate the expression changes of cleaved-PARP, proteins involved in Akt/ mTOR/P70S6K signaling pathway and cell autophagy pathway. AVO stain assay was performed to detect the autophagosome. Moreover, the cytostatic effects of leflunomide were further investigated after the modulation of cell autophagy with autophagy agonist rapamycin and inhibitor chloroquine. Results: Our data demonstrated that leflunomide markedly inhibited the growth of both bladder cancer cells via inducing cell apoptosis and cell cycle arrest in S phase in a time-and dose-dependent manner. After leflunomide treatment, the phosphorylation levels of Akt, mTOR and p70S6K proteins in both cells were significantly down-regulated. Furthermore, AVO stain assay revealed the decline of autophagosome under the incubation of leflunomide. Modulation of autophagy with rapamycin and chloroquine observably attenuated and enhanced the cytostatic effects of leflunomide, respectively. Leflunomide significantly reduced the cell viability of bladder cancer cells via Akt/mTOR/ P70S6K signaling pathway. In addition, cell autophagy was demonstrated to be involved, combination leflunomide with autophagy modifier exerted enhanced antitumor effects in bladder cancer, which offered novel ideas for bladder cancer treatment. Introduction and Objective: Metastases to the urinary bladder are rare, accounting for up to 4.5% of all bladder neoplasms. These are often due to the direct extension from another pelvic neoplasm, such as cervical, prostate and colon cancer. Metastases from distant organs are exceptionally rare and have been described sporadically, the most common being stomach, lung and skin. We retrospectively studied the surgical and oncological management of patients with secondary neoplasms of the bladder. ). Twenty patients underwent surgical intervention (80%), whilst 1 patient received chemotherapy alone (4%) and 1 patient received radiotherapy alone (4%). Four patients received either a combination of surgery and chemotherapy (16%), 3 patients received Surgery and chemo-radiotherapy (12%), 1 patient received chemotherapy alone (4%) and 1 patient received radiotherapy alone (4%). Chemotherapy regimens varied but most commonly involved Oxaliplatin, Gemcitabine, and Carboplatin. Transurethral Resection of Bladder Tumour (17 patients, 68%) and Radical Cystectomy (3 patients, 12%) were the most frequently performed surgical procedures amongst our patients, whilst 5 patients (20%) did not receive any surgical intervention. The median survival for our patients was Renal (1528 days), Ovarian (552 days), Prostate (555 days) Colorectal (518 days), Lymphoma (404 days), Breast (241 days), and Cervical (125 days). In survival analysis, younger patients presented the best prognosis, whilst older patients had the worst overall survival. Conclusion: Prostate adenocarcinoma is the most common secondary neoplasm affecting the bladder closely followed by colorectal adenocarcinoma and lymphoma. Prognosis and treatment depend upon the primary neoplasm. When it is performed in older patients it is associated with higher complication rates but same mortality rates as in younger patients. The aim of our study is to evaluate the safety of open radical cystectomy for high stage disease (T4) in frail patients with severe comorbidities. In this prospective single center study we collected data from patients who underwent radical cystectomy in our department for high stage disease during the year 2018. We included only patients with severe comorbidities such as severe coronary disease, arrhythmias requiring antithrombotic agents, metal aortic or mitral heart valves or severe respiratory disease. Perioperative results as well as postoperative complications and 30 days mortality rate were recorded. Results: At total 11 patients with severe comorbidities underwent radical cystectomy in our department during 2018. All patients were males. Median age was 71 years (61 -86). All patients presented with severe comorbidities. Preoperative hemoglobin was 9.7 g/100ml. In 2 patients cystectomy was salvage (after trimodality treatment failure) and in one patient was palliative due to severe hemorrhage. Duration of operation was 120 minutes. As far as it concerns urine diversion, in all cases ureterostomies were performed in order to reduce morbidity. Estimated blood loss was 580 ml. Regarding transfusion rates, 6 patients underwent transfusion perioperatively or postoperatively. Concerning postoperative complications, 2 patients presented with ileus which was treated conservatively. One patient suffered wound dehiscence which required reoperation. One patient suffered acute coronary disease and was treated also conservatively in the cardiology department. In terms of oncologic results, bladder removal was performed in all patients and all pr esented with T4 stage disease. In terms of 30 days postoperative morbidity, one patient died due to deep vein thrombosis and pulmonary embolism. Conclusion: Radical cystectomy in frail patients with severe comorbidities presenting with T4 stage disease is quite demanding but it may be performed with accepted rates of complications and low mortality. Muscle We did survey based analytic study for BCG practice among urologist from western India. A set of questions regarding indications, protocol and understanding of clinical guidelines for administration were asked to fill by the consultants. Any urologist with more than 10 years of practise was considered as senior and rest were considered as junior urologist. Results: All consultants are agreed for BCG in t1 high grade tumor. 60% of seniors used for intermediate risk compare to 80% of junior consultants. All gave induction course of 6 weeks with one-week gap in between but 70% seniors started it by 2 weeks and 90% of juniors started after 4 weeks of surgery. There was no consensus for second induction course among senior urologist while 60% of juniors were in favour of second induction course. Wide variety of dosage from 80 to 120mg among both the groups. 90% of juniors were instilled BCG their self with 8 or 10 FR catheter while 70% of seniors rely on trained staff and using feeding tube. Wide variety was noted for maintenance protocol. 45% of juniors follow maintenance protocols up to 1 year while 70% of seniors had their maintenance protocol but they varied it widely. Storage LUTS was the most common complication noted. Wide variety was seen in prescribing antibiotics among senior and juniors. 27% of seniors were prescribing anticholinergics along with BCG. Conclusion: Despite the guideline recommendations and awareness for the same, consultant practise widely varies among the senior and junior practitioners. An understanding of the utilisation of BCG therapy must be made universal for the all urologist for betterment of patients. Use Conclusion: Immediate post-treatment FISH results may be able to identify patients who are at risk for tumor recurrence following intravesical chemotherapy for BCG refractory NMIBC. This may have implications for directing early cystectomy in this high-risk population. These findings require validation in a larger, prospective cohort. Gene Amplification and Potential Overexpression of CYP2A6 in an Invasive Phenotype of Bladder Cancer Introduction and Objective: We observed genomic instability in common with rodent experimental models and human bladder cancers. Based on the findings we used immunohistochemistry to identify specific biomarkers in early-stage invasive cancers. In a candidate gene of Cy-p2a5, we performed immunohistochemistry including a precancerous lesion in tissues of rodent. The protocol was approved by the Committee on the Ethics of Animal Experiments. To analyze the role of the human ortholog gene in tumor progression, CYP2A6 expression was examined by immunohistochemistry in 18 incipient and 27 recurrent TUR-treated cases of human superficial papillary tumor. Furthermore, to identify a new biomarker, we analyzed the immunohistochemical scores in superficial papillary and invasive scattered lesions in eight same patients. This study was approved by the Ethics Committee and was performed in accordance with the Declaration of Helsinki, 1995. All patients gave their written informed consent prior to their inclusion in this study. Results: Immunostaining of the rodent bladder tumor revealed that CYP2A expression was not particularly higher in the superficial papillary lesions of the rat but was slightly higher in the dysplastic and significantly higher in the early invasive lesions of the mouse. Differences in CYP2A6 expression were not statistically significant among the incipient and recurrent cases of human superficial papillary tumors (P = 0.196). However, a significant difference in CYP2A6 expression, estimated based on the immunohistochemical score and cell number ratio, was noted between the superficial papillary and invasive scattered lesions in the eight same patients (P = 0.0162). The overexpression of Cyp2a5 was specific in mouse invasive bladder cancer, moreover, the immunohistochemistry findings suggested that the overexpression was prominent in the precancerous lesion. The amplification and potential overexpression of CYP2A6 was significantly associated with invasive cancers. Our results indicate that CYP2A6 can be considered as a useful biomarker for early detection of transformation to invasive phenotypes in bladder cancer. Conclusion: UBC antigen test has acceptable sensitivity and lower specificity in patients with non-muscle invasive bladder cancer compared to voided urine cytology. Introduction and Objective: Management of the highest risk subtype of High-grade T1 (HGT1), represents one of the most difficult challenges for urologists and patients alike. Our objective is to evaluate the characteristics and oncological outcomes of patients with HGT1 of non-muscle-invasive bladder cancer (NMIBC) treated with immediate radical Cystectomy (RC). We collected a pooled database of 173 patients who underwent radical cystectomy between 2012 and 2015 in the urology department of the EHU Oran in Algeria; 46 of these patients had highest risk subtype of High-grade T1 (HGT1). Survival data were analyzed using Kaplan-Meier method. Results: The median age of patients was 69 years with a mean follow-up time of 35 months. The 3-year overall, disease-specific and disease-free survival was 81%, 87%, and 69%, respectively. 12% of patients were given adjuvant chemotherapy. Pathologic stage distribution was p0: 5 (10.8%), pTa: 3 (6.5%), pT1: 12 (26.08%), pT2: 13 (28.2%), pT3: 9 (19.5%), pT4: 4 (8.6%), pN0: 34 (73.9%) and pN1-3: 12 (26.02%). On multivariate analysis, only pN stage and histological variant were independently associated with overall, disease-specific and disease-free survival. Conclusion: There is an understanding of the HGT1 with more than half of the highest risk tumors are muscle-invasive bladder cancer. Immediate radical cystectomy in HGT1 offers excellent overall and specific survival. Only PN stage and histological variant were independently associated with different survival. Our study has limitations with short-term survival (This is not a comparative study). permanently discontinue the BCG installations. 1 patient developed a urethral stricture after the revision TURBT, which was treated with intermittent dilatation with Tiemann catheters. 1 case of polyarthritis was treated with NSAIDs and discontinuation of the BCG treatment. 1 patient presented with epididymis abscess and underwent epididymectomy, while another had a serious allergic shock and discontinued the BCG treatment. No deaths were reported. We present our department's initial results after 5 years of follow up in patients who underwent TURBT with T1 stage histology. The intensive follow up schedule after initial tumor treatment, results in excellent oncological outcomes, with a very good safety profile. Follow up cystoscopies were less frequent than suggested by most guidelines which results in lower costs for the patients without compromising oncological outcomes. Residency of CD103+ CD8+ Conclusion: There is a high percentage of patients with residual tumour, especially in T1 tumours. If the most valuable reason for re-look is to identify those who need radical treatment, then the risk of finding MIBC is extremely low for Ta tumours. Therefore, for the majority of patients, we are delaying BCG therapy unnecessarily. Does the Presence of Histological Variants in Urothelial Carcinoma of the Bladder Predict Worse Clinical Outcomes After Radical Cystectomy? Introduction and Objective: The effect of histological variants (HV) in urothelial carcinoma (UC) on clinical outcomes is unknown. This study was conducted to investigate the impact of presence of HV on prognosis of patients with muscle-invasive bladder cancer (MIBC). We reviewed consecutive patients with MIBC (clinical T2-4aN0M0) who were treated with radical cystectomy at a single academic center between 2003 and 2017. All specimens were re-reviewed by dedicated pathologists. Disease-free survival (DFS) and overall survival (OS) were evaluated using Kaplan-Meier, log-rank, and Cox regression analyses. Results: We identified 43 (32.1%) and 91 (67.9%) patients with HV and pure UC, respectively. HV group was associated with higher pathologic T stage (≥ pT3) (58.1% vs 27.5%, p = 0.001). Patients with HV had poorer DFS (p = 0.008) and OS (p = 0.015, Fig.1 ) than those with pure UC. In cases with neoadjuvant chemotherapy (NAC), the 5-year OS rate of the HV and UP.045, Fig. 1 Kaplan-Meier curve shows OS stratified by histology. Introduction and Objective: Thrombospondin (TSP)-1 and -2 are recognized as inhibitors of angiogenesis under various pathological conditions including cancers. Many investigators showed that TSP-1 has anti-carcinogenic and anti-angiogenic activities. However, TSP-1 has also been shown to play the opposite role, in stimulating the malignant aggressiveness of several cancers. As such, it is still uncertain whether TSP-1 has pro-or anti-cancer effects. In contrast to TSP-1, fewer studies have evaluated pathological roles of TSP-2 and 4N1K-peptide (KRFYVVMWKK) derived from TSP-1 and -2 in bladder cancer. The study clarified whether the expression of TSP-1, TSP-2, and 4N1K-peptide is correlated with malignant aggressiveness and prognosis in these patients. Two-hundred six bladder cancer tissues were examined for the expressions of TSP-1, TSP-2, and 4N1K-peptide by immunohistochemical technique. Cancer cell proliferation measured with anti-Ki-67 antibody, apoptosis measured with cleaved caspase-3, angiogenesis measured with anti-CD34 antibody, and matrix metalloproteinase (MMP)-9 immunoreactivity were also examined. Relationships between expressions of TSP-1, TSP-2, and 4N1K-peptide and malignant aggressiveness, pathological features, and survival are analyzed. Results: TSP-2 expression was negatively associated with T stage (P < 0.001), metastasis (P = 0.021), and grade (P = 0.018). Similar negative relationships were also detected with respect to 4N1K-peptide expression (P < 0.001, 0.025, and 0.002, respectively). On the other hand, such significant relationship was not found in TSP-1 expression in all variables. TSP-2 expression was negatively associated with the cell proliferation (P = 0.005) and MMP-9 expression (P < 0.001), whereas 4N1K-peptide was significantly associated with apoptosis (P < 0.001), angiogenesis (P = 0.024), and MMP-9 expression (P = 0.005). Multivariate analyses showed 4N1K-peptide expression was a significant predictor for subsequent metastasis (hazard ratio = 3.90, P = 0.002) and overall survival (hazard ratio = 2.43, P = 0.012). TSP-1 expression was not associated with these 2 parameters on survival. Conclusion: TSP-2 and 4N1K peptide play important roles in the malignant aggressiveness and progression of bladder cancer via complex mechanisms involving cell proliferation, apoptosis, angiogenesis, and MMP-9 expression. We suggest that 4N1K-peptide would be a more useful predictive marker and potential therapeutic target in these patients. High Diagnostic Efficacy of 5-Aminolevulinic Acid-Induced Fluorescent Urine Cytology for Urothelial Carcinoma Nakata W, Yamamichi G, Tsujimura G, Tsujimoto Y, Nin M, Mimura A, Miwa H, Tsujihata M Introduction and Objective: Generally, urine cytology is often problematic because of its low sensitivity, especially for low-grade urothelial carcinoma (UC) in clinical practice. To improve the sensitivity, we focused on 5-aminolevulinic acid (5-ALA) because recent studies suggested that 5-ALA-induced urine cytology can be used for photodynamic diagnosis. In this study, we evaluated the diagnostic efficacy of 5-ALA-induced fluorescent urine cytology for urothelial carcinoma. We included in this study 318 patients comprising 158 non-cancer patients, 84 bladder tumor (BT) patients, and 76 upper urinary tract urothelial carcinoma (UUT-UC) patients treated in our institution from March 2013 to September 2018. Using the same voided urine sample, we compared sensitivity and specificity between conventional urine cytology and 5-ALA-induced fluorescent urine cytology. Results: Overall, the sensitivity of 5-ALA-induced fluorescent urine cytology was significantly higher than that of conventional urine cytology (86.9% vs. 69.4%; p= 0.0002), and the specificity was equivalently high (96.2% vs. 95.6%; p= 1.0). In subgroup analysis, the high sensitivity of 5-ALA-induced fluorescent urine cytology was also detected regardless of age, sex, and tumor type. However, in terms of stage and grade, differences were only detected in patients with less than pTa stage (89.2% vs. 52.1%; p= 0.0001) and lowgrade tumor (91.5% vs. 51.1%; p <0.0001). Conclusion: 5-ALA-induced fluorescent urine cytology was significantly more effective for UC diagnosis when compared with conventional cytology, especially in patients with low-stage and low-grade tumors. These findings indicate that 5-ALA-induced fluorescent urine cytology may potentially be a very useful tool for clinical use. En-block Resection of Bladder Tumors -Our Initial Experience Nayak P, Mandal S, Das M, Kumar G, Agrawal S, Mishra A Introduction and Objective: The initial experience of using en-bloc resection of bladder tumors using bipolar button device is being reviewed here. Materials and Methods: Twenty consecutive patients with pedunculated bladder tumors underwent en-bloc resection using a bipolar button between 01-01-2019 and 30-03-2019. A single surgeon at AIIMS, Bhubaneswar, performed all the surgeries. The mean age of the patients was 62 years (46 to 69) and the male to female ratio was 4:1. Fourteen patients underwent surgery under general anesthesia and the remaining six under spinal anesthesia. A unilateral obturator block was used in 3 patients and a bilateral block in 1 patient. A Karl Storz morcellator was used in 9 patients for evacuation of the resected specimen while an Ellik's evacuator was able to remove the specimen in the remaining. Results: Twelve patients had a single tumor with mean size of 2.5 cm (largest dimension on CECT scan). The rest had multiple tumors (median of 4 lesions, range 2 to 18). Mean operative time was 7 minutes for single tumors (range 5 to 19 minutes) and 23 minutes for multiple tumors (range 9 to 53 minutes, median 13 minutes). The bleeding was minimal in all cases and none of the patients required post-operative blood transfusion. A total of 5 obturator jerks were recorded in 2 patients on obturator block. Perivesical fat was not seen after any jerk. A loop deep muscle biopsy was taken from the tumor base after en-bloc resection and removal of all tumors. All patients except one (with 18 tumors) received post-operative mitomycin 40 mg intravesical instillation within one hour post-operatively. Catheter was removed as a matter of routine on post-operative day 2, and patients were discharged the next day (except in the patient with 18 tumors, when it was removed on day 7). Histopathology revealed low-grade Ta lesion in 15 patients and high-grade T2 disease in the rest. Conclusion: En-bloc resection of bladder tumors is feasible and safe in pedunculated bladder tumors. This was our initial experience and we are designing a randomized trial comparing it with standard Trans-Urethral resection of Bladder Tumor (TURBT). Small Cell Bladder Cancer: Experience from a Tertiary Care Center Nayak B, Singh P, Gurnani N, Kaushal S Introduction and Objective: Small cell cancer (SCC) of bladder comprise of only 0.35% -0.7% of all bladder tumors. It is associated with a median survival of 19.6 months for all stages in view of its aggressive course, presentation at later stages and with larger tumors. SCC of bladder has no standard treatment and current management is based on SCC lung protocols. We report here a retrospective analysis of the management of SCC bladder at our institute. Between the period of 2014 to 2018, 12 patients with histopathological diagnosis of SCC bladder were identified and data was available for 10 patients. Data regarding patient demographics, smoking history, performance status, stage (limited/ extensive), treatment received, and outcome was obtained. Survival was estimated as the time from diagnosis of SCC bladder to death or the last follow up. Survival curves were generated using the Kaplan Meier curves. Results: Data was available for 10 patients. Most of the patients were males (9/10) and smokers (8/10) with a median age of 59 years. Most patients had good ECOG performance status of 0-1 (8/10) and presented with limited stage disease (9/10). The only patient with extensive disease was a non-smoker female presenting with involvement of cervix and vagina. All patients presented with hematuria and underwent TURBT. Post TURBT, treatment was at surgeon's discretion. One patient received chemoradiotherapy without undergoing radical cystectomy, three received chemotherapy only. Three patients received neoadjuvant chemotherapy followed by radical cystectomy and one patient underwent upfront cystectomy. Two patients underwent TURBT only. The mean follow up period was 20.6 months. Four patients were alive till the last follow up amongst which two had received neoadjuvant chemotherapy followed by cystectomy, one only completion TURBT and one only chemotherapy. The overall median survival was 14 months. Conclusion: SCC of bladder is a rare aggressive tumor affecting the elderly smokers. The prognosis is influenced by performance status, extent of disease and use of chemotherapy either in neoadjuvant or adjuvant setting. For young patients, cystectomy with chemotherapy offers better survival as compared to chemoradiation alone. Initial , there was no documented reason for not administering IVT. However, the most common reasons provided for not instilling chemotherapy were that malignancy was not suspected (11.9%), BCG treatment was recently administered or planned (11.5%) and deep resection (10.7%). Conclusion: Across the different parts of the world, rate of adherence to use of post-operative intravesical chemotherapy was 41.7% with mitomycin and epirubicin being the preferred choices. Our multicentre audit highlights the need for better adherence to inter-national guideline be across the world to reduce rates of recurrence in NMIBC. In the period of August 2017-August 2018, a total of 70 patients were included in this study. The inclusion criteria were recurrent NMIBC <10 mm; negative cystoscopy and positive cytology; cancer suspected findings on white light cystoscopy, control of selected T1HG and patient treated using BCG instillations. All patients received Hexvix and intra-vesical application of 20 ml Xylocain 1% one hour prior to the procedure. White cystoscopy, PDD, tumor biopsy and tumor destruction with diode lasers were performed as outpatient procedure. Pain experiences were assessed using visual analogue scale (VAS, range: 0-10). Results: A total of 74 procedures were performed on 70 patients. 16 patients with earlier Ta LG were treated only with diode lasers without biopsy. Tumor biopsy and diode laser was done in 54 patients. CIS findings were confirmed in 8 patients (15%). Pain experiences were 3 for biopsy and 5 for laser coagulation. Conclusion: Non muscle invasive bladder cancer can be diagnosed and treated in outpatient clinic using local anesthesia, flexible cystoscopy, PDD and diode laser. The efficacy of this treatment should be prospectively evaluated. Conclusion: Using population-based data and different analytic methods to control for imbalance between study groups, we found that trimodal therapy was associated with decreased overall and cancer-specific survival at increased costs compared to radical cystectomy. Proximity Introduction and Objective: Exposure to aromatic amines is a risk factor for bladder cancer. Incidence rates according to proximity to oil refineries are largely unknown. We sought to determine proximity of oil refineries and bladder cancer incidence in the State of Texas which is home to the largest number of oil refineries in the United States. The Texas Cancer Registry database was used to identify patients diagnosed with bladder cancer from January 1, 2001 to December 31, 2014. The U.S. census data from 2010 was used to ascertain overall population size, age and sex distributions. Heat maps of the 28 active oil refineries in Texas were developed. Incidence of bladder cancer were compared according to proximity (<10 vs. ≥ 10 miles) to an oil refinery. Risk ratios were adjusted using a Poisson regression model. A total of 45,517 incident bladder cancer cases were identified of which 5,501 cases were within 10 miles of an oil refinery. In adjusted analyses, bladder cancer risk was significantly greater among males vs. females (Relative Risk (RR) 3.41, 95% Confidence Interval (CI), 3.33-3.50), and greater among people living within 10 miles from an oil refinery than those living outside a 10-mile radius from an oil refinery (RR 1.19, 95% CI, 1.08-1.31). Conclusion: People living within 10 miles from oil refineries were at greater risk for bladder cancer. Further research into exposure to oil refineries and bladder cancer incidence is warranted. We retrospectively measured the parameters of length and width of tumour post radical cystectomy. We had a total of 236 cases. We estimated tumour volume by assuming the 3 rd dimension to be 50% of the width. We then used the ellipsoid tumour calculator LxHxWxpi/6 to give an approximation to the volume. Pathologists do not ordinarily estimate tumour volume on cystectomy specimens. They will record the two largest diameters, the length and width. The tumours are irregular in shape and can be multifocal. We included TURBT chippings. Regression analysis to determine significant predictors of mortality. Results: Attached. The mean tumour volume of transitional cell cancer is 15 cc. There was no significant difference between neuroendocrine, sarcomatous, adenocarcinoma and metastatic subtypes. There was a significant difference in the size of sarcomatous variants with a mean volume of 36 cc and the enormous size of squamous tumours with a mean volume of 106 cc. We note that half of the squamous tumours were of low or medium grade which may have a bearing on how they can reach this size. Regression analysis shows the known predictors of mortality plus, significantly, the amount of tumour volume using this model. TV is significant. Tumour volume should be included as a prognostic risk factor to advise decisions making post TURBT and further management post cystectomy. UP.055, Figure 1 There is a worse prognosis for SCC. This is probably due to a higher incidence of severe comorbidities accounting for the worse all cause mortality. Features specific to SCC account for the higher disease specific mortality. , overall self-perception and body satisfaction in ostomized patients due to bladder cancer and determine any relationship that may exist between them. Multi-institutional retrospective review was performed on patients with blad-der cancer and who underwent radical cystectomy with urinary diversion via the ileal loop (Bricker's operation). We included adult patients who didn't receive chemo-or radiotherapy with no evidence of metastasis or recurrence and followed at least for 3 years. They were asked about all aspect of their SE according to Rosenberg's self-esteem scale. The present study accounts 36 patients. They were 20 men and 16 women with an average age of 60.4 years (24-75). They were single in only 7 cases. Results: SE was very weak to weak in 23 patients and strong to very strong in 4 of them. Overall perception of self was negative in 13 patients of which strong to very strong in one case only. Overall perception of self was positive in 23 patients of which strong to very strong in 9. Body satisfaction was negative in 10 patients (strong to very strong in one case) and positive in 26 patients (strong to very strong in 4 cases). Strong and significant positive correlations were found between body satisfaction and overall perception (r = 0.77, p <0.001), body satisfaction and SE (r = 0.59, p <0.001), and overall perception and SE (r = 0.769, p <0.001). Suicide attempt was reported by two patients. Conclusion: Self-esteem, overall self-perception and body satisfaction in ostomized patients due to bladder cancer are low with strong relationship between them. Schnöller TJ, Hirning C, Riefler T Introduction and Objective: 95% of all tumors of the bladder are urothelial carcinomas. 80% of these carcinomas are non-invasive at initial diagnosis. 92% are located in the bladder, 6% in the ureter and 2% in the renal pelvis. Often the localization is multicentric, 10 to 15% of these tumors develop a muscle-invasive growth. Because of the high risk of recurrence, intravesical prophylaxis, for example, mitomycin or BCG are established and anchored in the guidelines. We analyzed what measures patients take for themselves to reduce their risk of recurrence. In the time between January 2017 and December 2018, we interviewed a total of 97 patients as part of the tumor follow-up in our uro-oncological consultation -with a diagnosis of maximum pTa urothelial carcinoma -with regard to educational status, prevention, smoking habits, nutrition and drinking habits, aftercare, instillation therapy. 52 patients had received at least one intravesical recurrence prophylaxis. 67% of patients said the disease had little or no change in their lives, developed recurrences; 68% of patients who reported a very strong or complete change in their lives, stayed relapse-free. All but 3 were in follow-up care. 52 patients had received at least one intravesical recurrence prophylaxis (10A, 18MR, 24HS). 14 patients took vitamin supplements (N = 5A, 4MR, 5HS), 12 patients mistletoe extracts (N = 3A, 3MR, 6HS) intermittently. Of the initial 56 smokers, 6 did not change their smoking habits (n = 1A, 1MR, 4HS), 40 gave up smoking (n = 10A, 12MR, 18HS), 7 reduced the nicotine dose (n = 0A, 4MR, 3HS). 25 patients reported a change in diet (n = 6A, 8MR, 11HS): mainly reduction of meat consumption, more fruits and vegetables. The water intake was increased by 49 patients (n = 14A, 15MR, 20HS). Two patients completely changed their profession due to the diagnosis (both high school graduates), although they were not in professional high-risk groups. Twenty-four secondary malignancies were discovered due to improved screening behavior (n = 7A, 4MR, HS). The self-taken measures are manifold and mainly refer to nicotine consumption, drinking and eating habits. Although in the supposed higher educational level and presumably with better access to information, it is not high school graduates changing crucial habits or seeking secondary prevention. It is the secondary school graduates. Place Results: Surgery duration in group without LN was 132 ± 23 min vs. 154 ± 27 min for group with standard LN. Mean blood loss was 400 vs. 375cc. There was no statistically significant difference between the groups in terms of postoperative hospital stay, blood transfusion rate and in perioperative complications rates, with only one significant intraoperative complication -external iliac vein trauma that needed vascular reconstruction. Late postoperative complications rate were equal with 2 (1 in each group) complications that needed reoperation within 30 days after surgery. Survival analysis showed no difference in overall survival rates at 2 and 3 years with 58% vs. 59% and 49% vs.49% respectively for both groups (Fig. 1 ). Our study revealed that in symptomatic patients with advanced and metastatic bladder cancer cystectomy may be performed without standard LN. Such approach may improve surgical outcomes decreasing overall operative time and intraoperative complications associated with LN without impact on overall survival. Such approach need further evaluation in larger patient cohorts. The Induction scheme of six-weekly and three fortnightly instillations started two weeks after the initial TUR or re-TUR. Maintenance instillations were then be offered in a scheme of ten monthly instillations. During treatment, patients were offered cystoscopy and cytology every three months, while CT and chest radiographs were reviewed every 6-12 months. All 161 patients were followed up. Univariate and multivariate regression analyses were used to predict risk factors for failure of BCG instillation in bladder cancer. The data of seven patients were excluded because of drug discontinuance for severe adverse events and 154 patients were followed up. Median (interquartile range) follow-up of 25 (3-57) months. The overall recurrence rate was 28.6% and the 2-year recurrence-free survival was 72.5%. On univariate analysis, recurrence status, use of instillation chemotherapy before and re-staging transurethral resection influenced the recurrence. Multivariate regression analysis showed recurrence status was an independent prognostic factor for recurrence-free survival. The incidence of adverse events in all 161 instillation patients was 40.4%. Grade I, grade II and grade III adverse events accounted for 53.8%, 40.0% and 6.2% respectively. The data of seven patients were excluded because of drug discontinuance for severe adverse events, and 154 patients were followed up. Median (interquartile range) follow-up was of 25 (3-57) months. The overall recurrence rate was 28.6% and the 2-year recurrence-free survival was 72.5%. On univariate analysis, recurrence status, use of instillation chemotherapy before and re-staging transurethral resection influenced the recurrence. Multivariate regression analysis showed recurrence status was an independent prognostic factor for recurrence-free survival. The incidence of adverse events in all 161 instillation patients was 40.4%. Grade I, grade II and grade III adverse events accounted for 53.8%, 40.0% and 6.2% respectively. We report a urine excrement shunt surgery and investigate its validity in the treatment of severe metabolic disorders after Sigma rectum pouch for bladder cancer. Six male patients who received radical cystectomy and Sigma rectum pouch due to bladder cancer two to five years ago generated hyperchloremic metabolic acidosis, hypokalemia and renal dysfunction. They received urine excrement shunt surgery (the pouch was isolated from intestinal tract and abdomen ostomy was made; the sigmoid colon and rectum were reconnected), and the parameters of blood gas analysis, electrolytes and renal function after surgery were compared with those before surgery. Data were analyzed by SPSS 20.0, using ANOVA of single factor repeated measurement data. Results: Blood hydrocarbonate significantly improved three months after surgery compared to pre-operatively. Six months later, blood pH and potassium significantly improved and remained normal. UP.062, Figure 1 : Survival curves for patients with or without LN. Over the past few years, several studies have reported that the clinical value of serum prostate specific antigen (PSA) increase in up to 40% of intravesical immunotherapy patients for non-muscle invasive bladder cancer (NMIBC) and return to baseline by 3~12 months. Aim of this prospective multicenter study was to evaluate PSA changes induced by intravesical chemotherapy. Moreover, the differences between clinical parameters and PSA changes induced by chemotherapy and immunotherapy were also investigated. The clinical value of serum PSA was prospectively assessed in 102 male patients who had undergone intravesical immunotherapy (78 cases) or chemotherapy (24 cases) after transurethral resection of NMIBC from 2015 to 2018. Serum PSA, digital rectal examination (DRE), urinalysis, urine culture, International Prostate Symptom Score (IPSS) and quality of life (QoL) were performed before and at 3, 6, and 12 months during the maintenance course. Immunotherapy (Oncotice, 12.5 mg in a volume of 50 mL normal saline) and chemotherapy (50 mg of epirubicin) protocols were the same for all cases. Patients were instructed to refrain from bladder voiding until 2 hours after BCG and 1 hour after epirubicin instillation. A prostate biopsy was performed when serum PSA was persistently greater than 4 ng/mL in 2 or more samples or an abnormal nodule was palpated on the DRE. Results: PSA elevations were detected in 48 patients (62%)/16 (67%) during BCG and epirubicin, respectively. Overall average PSA statistically increased from 1.79/2.52 ng/mL before treatment to 2.56/3.43 ng/mL and 2.27/3.31 ng/mL at 3 and 6 months from the beginning of the treatment with BCG and epirubicin, respectively (p <0.001/ p= 0.001 at 3 months and p= 0.012/ p= 0.004 at 6 months) and returned to baseline levels within 12 months. Although there was a tendency for the irritative symptom scores of IPSS and QoL scores to be worsen in the patients with intravesical chemotherapy, there was no statistically significant correlation. PSA persistently greater than 4 ng/mL in 2 or more samples was detected in 2 (2.6%) and 1 (4.2%) patients after BCG and eprirubicin instillations, respectively, but was no more evident at 12 months. Prostate biopsies, performed in 3 patients (2 during BCG and 1 during epirubicin), showed granulomatous prostatitis, nonspecific inflammation and benign prostatic hyperplasia, of whom none had prostate cancer. Our results show that a statistically significant PSA increase is identified during immunotherapy and chemotherapy. However, PSA elevation in patients treated with intravesical BCG or epirubicin is self-limited and prostate biopsies are not mandatory in such patients and could be withheld at 12 months, while monitoring PSA. Urachal Cysts: A Single Centre Retrospective Analysis of Management UP.064, Table 1 . The results of arterial blood gas analysis, serum electrolytes and renal function one-week pre-operation and three months to three years post-operation (mean ± SE). UP.064, Figure 1 . Schematic of the pouch ostomy on the abdominal wall and sigmoid-rectal anastomosis. (A) Schematic of the Sigma rectal pouch. The dotted lines were cut lines between the pouch and sigmoid colon and rectum. (B) The pouch was isolated from intestinal tract and abdomen ostomy was made; the sigmoid colon and rectum were re-coincided to recover the intestinal continuity. chal anomalies, principally cysts. Patient presentations varied from incidental diagnoses on imaging, to peritonism with sepsis. The mean age was 29 (range 4 months -66 years). Ten had imaging defined urachal cysts, and 4 had sinuses. Six patients had bladder findings on cystoscopy. Of the 14, 4 were treated laparoscopically and 7 with open surgery, the 3 remaining patients chose active surveillance with imaging. All 11 operative patients had benign histology with normal tissue or active inflammation. Our case series demonstrates that urachal cysts in adults may not be as rare or have the incidence of malignancy as other case series suggest. The different modalities of management of these patients was surgeon dependant but had no impact on the long-term outcome. Laparoscopic surgery has been our team's preference for uncomplicated cases, which has led to equivalent patient outcomes with grossly reduced length of stay (4 days vs 8). Our findings of no signs of malignancy on histology in any of our cases is at odds with other published work suggesting as many as 50% of urachal abnormalities are malignant. In our unit the indications for surgical intervention are to relieve symptoms or if the patient is immunocompromised or has anxieties about the possibility of cancer. The Introduction and Objective: Radical cystoprostatectomy is the gold standard for muscle invasive bladder cancer. Prostate adenocarcinoma is often found incidentally in the cystoprostatectomy specimen. Its clinical significance has not been well characterized. We review a cohort of 238 male patients who underwent cystoprostatectomy for primary muscle invasive urothelial carcinoma of bladder between 1998 and 2017 at our institution. The baseline patient characteristics and prostate cancer clinical, biochemical and pathological characteristics were reviewed. Results: Over a median follow up of 13 years, 238 Chinese male patients, aged 44 to 88 (median age 69) received cystoprostatectomy. 31 (13%) had incidental prostate adenocarcinoma found in the pathology specimen. All of them had organ confined disease (≤T2a )and ≤ Gleason Score 3+3 (Gleason Grade Group 1). All of them attained undetectable PSA level post-operatively. None of them had biochemical recurrence nor received androgen deprivation therapy. None died of prostate cancer. Incidental prostate adenocarcinoma is reported in one third of radical cystoprostatectomy patients. Our Chinese cohort has less clinically significant prostate cancer as compared to commonly quoted figure from western population. Low risk prostate cancer is commonly managed with active surveillance in this era. Since prostate-sparing cystectomy may confer better preserved erectile function and continence, we may consider prostate-sparing cystectomy in highly selected patients without compromising oncological outcomes, e.g. young male patients. Further studies are paramount in determining the oncological and functional outcomes and long-term efficiency. Choice Here, we mimicked the tumor microenvironment to explore the interaction between CAFs and BCa cells using a co-culture system. Autophagy in CAFs was induced and inhibited by rapamycin and siRNA, respectively. After co-culture with CAFs, proliferation, invasion, and aerobic glycolysis in BCa cells was measured in vitro. Results: Autophagy in CAFs was induced and inhibited by rapamycin and siAtg5, respectively. Enhanced autophagy in CAFs promoted cell proliferation and invasion in BCa cells in vitro, whereas there was no significant difference between the autophagy-inhibited group and controls. Lactate concentration was elevated in the rapamycin-treated and siAtg5-treated versus control group. In addition, the levels of MCT1, HK2, GLUT1, and MMP-9 increased in the autophagy-enhanced group. Our results indicate that fibroblasts regulate BCa invasion and metabolic phenotypes through autophagy, providing us with new alternative treatment approaches for BCa. We evaluated the outcome of transurethral resection of the prostate (TUR-P) in men with benign prostatic hyperplasia (BPH) and urodynamically diagnosed weak detrusor contractility. A prospective study of 33 male patients presented to our department in the period from October 2015 to January 2017. All patients had BPH candidate for TUR-P with impaired detrusor contractility by preoperative urodynamic study. We studied the postoperative outcome of these patients after TUR-P regarding international prostate symptoms score (IPSS), maximum flow rate (Qmax), post voiding residual urine (PVR), the patients need for catheter, and urodynamic pressure flow study (PFS) parameters (maximum detrusor contractility, bladder contractility index (BCI), maximum bladder capacity and compliance) in six months follow up. Conclusion: There were significant improvements in IPSS, detrusor contractility, and urine flow after TUR-P in patients with BPH and weak bladder contractility. We excluded patients with other urological or neurological diseases. Full history, urological and neurological examination, MRI brain and spinal cord with contrast, abdomen-pelvic ultrasound and urodynamic study were done to all patients. We followed up all the patients for at least one year to detect the progression of urinary symptoms by American Urological Association (AUA) symptoms score and urodynamic study. The study included 120 patients, 38 males (31.7%) with mean age 35.2 ± 10 years. The mean duration of MS was 6.1 ± 4.9 years and the mean number of relapses was 4.1 ± 2.3. The most common presentation was paraparesis (40%) and least common presentation was depression (1.7%). All patients were suffering from urinary symptoms, but cognitive functions were the least to be affected (1.7%). The most common MRI finding was periventricular lesion (85%). Ninety percent of patients suffered from irritative symptoms, and 51.7% suffered from Obstructive symptoms. The most common urodynamic finding was detrusor overactivity (61.7%) and the 2 nd common was detrusor sphincter dyssynergia (26.7%) and 10% had normal urodynamic study. All patients received the same neurological treatment protocol and symptomatic treatment for voiding dysfunction. Follow up showed significant improvement of AUA symptoms score and urodynamic criteria in 108 pa-tients (90%). The site of brain lesion was the most significantly affecting factor on the urological symptoms and their improvement as juxtacortical lesion was the most common lesion associated with detrusor overactivity and pericallosal lesion is significantly associated with poor prognosis of urinary symptoms. There was no significant effect of age, duration of the disease, number of relapses, first presentation, or type of MS on urinary symptoms or their progression. Conclusion: Urinary symptoms are prevalent in patients with multiple sclerosis. Site of the lesion is the most predictor factor for urinary symptoms progression with no effect of age, duration of the disease, number of relapses, first presentation, or type of MS on urinary symptoms progression. Real World Study of the Prostatic Urethral Lift Introduction and Objective: Like many BPH technologies when they are first introduced, the prostatic urethral lift (PUL) has been well-studied in controlled trials with excellent results demonstrating rapid, significant, and lasting improvement in symptoms and quality of life. The next step is to determine how these results compare with those in the real world. To this end, a retrospective study within a large set of commercial PUL cases was conducted. A retrospective analysis of 1,413 consecutive PUL patients in North America and Australia was performed. Baseline demographics and symptom outcomes of real-world registry (RWR) subjects were compared to subjects in the L.I.F.T. study. IPSS, QoL and Qmax were evaluated at 1, 3, 6, 12, and 24 months post-procedure for all non-urinary retention subjects (Group A), and retention subjects (Group B). Within Group A, outcomes were analyzed using paired t-tests and 95% mean confidence intervals for the following parameters: IPSS baseline ≥ 13, age, prostate size, site of service, prostate cancer treatment, and diabetic status. Surgical interventions, rates of adverse events and catheterization were analyzed. Results: Compared to those in the L.I.F.T. study, RWR subjects were older, had lower baseline IPSS and QoL and higher Qmax. Following PUL, mean IPSS for Group A improved significantly from baseline by ≥ 8.1 points throughout follow up and 84% of subjects required no catheter. No significant differences were observed between Group A and B absolute symptom scores. Within Group A, subjects with an IPSS baseline ≥ 13 behaved similarly to L.I.F.T. Age, prostate volume, site of service, prior cancer treatment and diabetic status did not significantly affect PUL effectiveness outcomes. Previous prostate cancer treatment did not elevate adverse events of high concern. Of all sites of service, the office had the lowest incidence of side-effects and catheterization. Conclusion: This is the first and largest study to assess PUL effectiveness in the real-world setting. PUL performs well in the real-world in terms of symptom relief, morbidity and patient experience for all examined patient cohorts, and confirms pivotal clinical study results. Change Introduction and Objective: Nitric oxide system in the urothelium is one of the factors affecting bladder function. However, differences in the expressions of nitric oxide synthase (NOS) isoforms in the urothelium depending bladder function have not yet been clarified. We investigated the correlation between nitric oxide and urodynamic in men with bladder outlet obstruction (BOO) using analysis of NOS in the urothelium. We prospectively enrolled 25 men who planned to undergo surgical treatment for benign prostatic hyperplasia and identified as BOO in the preoperative urodynamic study. Bladder mucosal specimens were collected during surgical prostate resection. Expressions of endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and neuronal nitric oxide synthase (nNOS) in the urothelium were analyzed using immunofluorescence staining and enzyme-linked immunosorbent assay. The correlation of urodynamic parameters with expressions of eNOS, iNOS, and nNOS in all patients was assessed. We also compared the expressions of eNOS, iNOS, and nNOS between BOO with detrusor underactivity (DU) group and BOO without DU group. The Results: A total of 323 cases were identified. The first 50 cases were excluded to account for the initial learning curve and a further 7 for meeting the exclusion criteria leaving a total of 276 cases. These cases were divided into 5 cohorts (Group A: 1-50, Group B:51-100, Group C: 101-150, Group D:151-200 and Group E 201-276). Mean patient age was 70.41 (± 8.43). As the series progressed there was a statistically significant improvement in both median EE: 0.95g/ min Group A -1.45g/min Group D (p=0.001), and median L/PR: 3.79kJ/g Group A -1.87kJ/g Group D (p=0.016). There was improvement in Efficiency of 0.125g/min per 50 cases and L/P-ratio of 0.48kJ/g per 50 cases. There was no plateauing in either EE or L/P ratio in the last cohort. No statistical difference was found in secondary outcomes. Our study suggests that performance continues to improve beyond 50 cases and did not plateau. The reported learning curve may be an underestimate which may have implications for performance, mentoring programs and theatre utilisation. The Metabolic disorder has recently been recognized as an important factor in prostate progression. However, the role of hyperglycemia in prostate growth is unclear. The aim of the present study was to assess the relationship between glycaemic status and prostate growth during aging. The medical records of BPH patients who referred to surgery in our department were reviewed. Prostate morphology data were measured by transrectal ultrasound. According to the American Diabetes Association (ADA) criteria, the patients were categorised as normoglycemic, pre-diabetic, or diabetic. Glycaemic status and other variables were considered as being independent variables in an effort to evaluate any potential correlations using non-adjusted and multivariate-adjusted regression models. Results: A total of 659 individuals were included in our study. The prevalence of pre-diabetes and diabetes in this population were 37.2% (245/659) and 23.8% (157/659) respectively. Different from men with normoglycemic, the growth rate of prostate in men with pre-diabetes and diabetes was significantly faster before the age of 70 than after the age of 70 (P <0.05). Further multiple logistic regression analysis revealed that abnormal glucose homeostasis was positively correlated with the prostate size in the non-adjusted or adjusted models. Before the age of 70 years old, compared with men of normal glucose, the adjusted odds ratio (OR) for total prostate and transitional zone enlargement for men with pre-diabetes was 2.24 (95%CI, 1.29-3.89) and 3.11 (95%CI, 1.76-5.47) respectively; for men with diabetes was 4.67 (95%CI, 2.24-9.74) and 6.41 (95%CI, 2.92-14.07) respectively. However, there was no significant difference when the age was greater than 70 years old. In normoglycemic state BPH patients, the prostate growth rate is relatively stable, and the prostate volume reaches a higher level after the age of 70. However, the annual prostate volume changes are faster in BPH population combined with prediabetes and diabetes, and the prostate grows to a larger volume before the age of 70, after which prostate growth is significantly slower. To investigate the impact of adding one prostatic biopsy for tissue culture, during TRUS-guided biopsy, on subsequent treatment and improvement of IPSS score. We prospectively reviewed all cases of TRUS-guided prostatic biopsy from February to November 2018 at the Urology Department, PSMMC. The indications for biopsy were either high PSA or suspicious DRE. All patients have negative urine culture, received pre-biopsy (ciprofloxacin 500 mg twice a day started one day before biopsy then continued for five days after and at night rectal enema before biopsy. Evaluation consisted of prostate tissue culture, pre-biopsy LUTS (IPSS) and effectiveness of antibiotic treatment for those with positive tissue culture. Results: In 25 of the 50 patients studied, a biopsy for tissue culture was taken during the procedure. The tissue culture was positive in 14 patients (28%). Out of these 14, two patients with prostate cancer were excluded. In the remaining 12, ten had LUTS with IPSS score ranging from 18 -32, while two were not complaining of LUTS. All patients with positive culture were treated with 4-week course of antibiotics according to the bacterial sensitivity. In nine of the ten patients with LUTS, the IPSS score improved to (5-12), while one patient showed no improvement. The latter was found to have a urethral stricture and treated by VIU. Histopathological assessment of the biopsy in these patients showed evidence of BPH with or without focal prostatitis. We retrospectively analyzed the cases of 118 BPH patients who underwent transurethral prostatic surgery. Their smoking history was confirmed. We assessed the relationship between smoking history and clinical parameters: International Prostatic Symptom Score (IPSS), uroflowmetry, pressure-flow study results and the magnitude of prostatic inflammation. We evaluated the relationships between the clinical parameters and the patients' smoking duration, smoking-cessation duration and Brinkman index. We used prostatic tissue obtained from the patients' surgery to quantify the magnitude of prostatic inflammation histologically, based on the abundance ratio of high endothelial venule (HEV)like vessels. HEV-like vessels can be detected by immunostaining with MECA-79. At the same time, we detected all vessels in the tissue by immunostaining with CD34. We then counted the number of MECA-79+ vessels and that of CD34+ vessels and calculated the MECA-79+/CD34+ vessel ratio. We previously demonstrated that the MECA-79+/CD34+ vessel ratio is a reliable marker of chronic inflammation. The IPSS straining scores of the non-smokers were significantly lower than those of the smokers (1.710 vs. 2.600, p= 0.029). In the pressure-flow study, there were negative correlations between smoking duration and strong desire to void (SDV), and between urgency and bladder volume at the initial detrusor overactivity (DO) (SDV: correlation coefficient -0.314, p= 0.013; urgency: correlation coefficient -0.349, p= 0.008; bladder volume at initial DO: correlation coefficient -0.417, p= 0.021). We next focused on the former smokers and examined the relationship between smoking cessation and clinical parameters. The smoking-cessation duration was significantly negatively correlated with the magnitude of chronic prostatic inflammation (correlation coefficient -0.253, p= 0.027). In the pressure-flow study, the smoking-cessation duration was positively correlated with urgency and MCC (urgency: correlation coefficient 0.286, p= 0.030, MCC: correlation coefficient 0.241, p= 0.050). We demonstrate that smoking exacerbated LUTS and chronic prostatic inflammation and observed the effectiveness of smoking cessation on LUTS. Introduction and Objective: The aim of this study was to assess the clinical outcomes of prostatic urethral lift in Korean patients with bothersome lower urinary tract system due to benign prostatic hyperplasia (BPH). A total of 32 men with symptomatic BPH were consecutively treated at a tertiary care center in Korea. To be included in the present analysis, patients had to meet the following criteria: age ≥ 50; International Prostatic Symptom Score (IPSS) > 12; and prostate volume between 30 mL and 80 mL. Patients were evaluated up to a median follow-up of 1-year post procedure. The primary outcomes included symptom relief, improvement of quality of life (QOL), and preservation of sexual function. Results: All procedures were completed successfully with a mean of 2.2 implants without serious complication. The number of patients diagnosed with diabetes mellitus, hypertension, and ischemic heart disease were 16 (50%), 24 (75%), and 9 (28.1%), respectively. Patients experienced symptom relief by 1 week that was sustained to 12 months. Mean IPSS, QOL, and maximum flow rate (Qmax) improved 43%, 70%, and 25% by 1 week, and 41%, 60%, and 32% by 12 months (p<0.001), respectively (Table 1 ). There were no occurrences of early urge incontinence, retrograde ejaculation, or erectile dysfunction. Adverse events were mild and transient. Prostatic urethral lift is a safe and effective treatment for BPH in Asian population. This treatment is minimally invasive, can be done under local anesthesia, and may be an appropriate method for fragile patients. irrigation resectoscope was employed, using normal saline as irritant. A two or three lobe technique was used, taking care to safeguard the sphincteric zone. Morcellation was performed using Maurmayer stone punch in smaller prostates, and Storz TM morcellator in prostates over 60 g. Intraoperative fall of hematocrit, lasing time as well as duration of surgery were recorded in all patients. Complications were recorded in the perioperative period, at 6 weeks post-op and at one year and two-year follow-up. Results: Mean operative time was 92 min, and average fall of haemoglobin was 0.6 g (0.4 to 1.0), average Lasing time was 46 min (4 to 141 min). Average Postoperative catheterisation time was 60 h. There was no instance of conversion to TURP or any reactionary or secondary haemorrhage; or clot retention. Re-catheterisation was necessary in 43 patients (9%), due to postoperative edema, or obstruction by necrotic tissue, sometimes due to unrecognised detrusor underactivity. 3 patients developed significant extravasation requiring extraperitoneal drainage. 65 patients (14%) had significant urge incontinence, requiring antimuscarinic medication. The incidence of stricture was 5.7%, and another 3.2% developed bladder neck contracture, these were managed endoscopically. Reoperation for resection of obstructing apical or necrotic tissue was necessary in 3 patients, and urethroplasty required in 2 patients. Conclusion: Diode laser enucleation has high intraoperative safety with regard to hemorrhagic complications but carries a significant risk of catheterisation and urge incontinence in the short-term follow-up and of stricture and bladder neck fibrosis in the longterm. Efficacy Introduction and Objective: This study was undertaken to investigate the efficacy of mirabegron addition after alpha-adrenergic blockade with respect to storage symptoms and overactive bladder symptom scores (OABSS) in patients with benign prostatic hyperplasia (BPH). Fifty-eight patients that had been taking alpha-adrenergic blockade for more than 8 weeks but had an OABSS (Overactive Bladder Symptom Score) especially Q3 of greater than 3 points, were enrolled. After 1-week washout period, patients were divided into two groups. Group 1 was alpha-adrenergic blockade only (n=18), group 2 was alpha-adrenergic blockade with mirabegron (n=38) for 8 weeks. After 8 weeks treatment period, International Prostate Symptom Score (IPSS), IPSS storage symptom score, OABSS score, OABSS Q3 and Q4, maximal flow rates (Qmax), and post-void residual volumes (PVR) were checked. Results: Mean patient ages in alpha-adrenergic blockade only group and alpha-adrenergic blockade with mirabegron group were 71.7 ± 7.1 and 69.8 ± 7.0 year old, respectively. Mean prostate volume was 30.5 ± 14.0 cc and 30.3 ± 8.7 cc in each group. Baseline characteristics were not significantly different in 2 groups. In group 1, IPSS decreased from 15.7 to 13.1 (p= 0.298), and in group 2, IPSS decreased from 19.4 to 16.5 (p= 0.024). Mean storage symptom score reduced in group 1 and group 2 from 6.3 to 5.5 (p= 0.584) and from 8.8 to 7.3 (p <0.005), respectively. Mean OABSS score reduced from 8.3 to 7.2 (p= 0.173) and from 8.8 to 7.3, respectively (p <0.005). Mean OABSS Q3 score reduced from 3.6 to 2.9 (p= 0.073) and from 3.5 to 2.7 (p= 0.002), respectively. Mean OABSS Q4 score reduced from 2.4 to 2.0 (p= 0.306) and from 2.7 to 2.0 (p= 0.016), respectively. Mean Qmax and PVR was not significantly changed in 2 groups. Conclusion: IPSS total score, storage symptom score, OABSS, Q3 and Q4 and QoL were improved in group 2. We recommend alpha-adrenergic blockade with mirabegron in persist urgency symptom. Prostate Symptom Score (IPSS) voiding-to-storage subscore ratio (IPSS-V/S) before transurethral resection of the prostate (TURP) can help to predict postoperative outcomes. We reviewed medical records of 152 patients who underwent TURP by a single urologist from July 2008 to June 2017. The TURP of men who had previous prostate surgery or procedure, palliative TURP of prostate cancer patients, and simultaneous TURP with transurethral resection of bladder tumor were excluded. The IPSS, quality-of-life score (QoL), uroflowmetry, and postvoid residual volume before TURP were compared with those of 12-16 weeks after surgery. The value obtained by dividing the IPSS voiding subscore (IP-SS-V) by the storage subscore (IPSS-S) was defined as IPSS-V/S. Surgical outcomes according to this ratio were analyzed. gold standard, for the treatment of post prostatectomy incontinence (PPI). Variable success rates have been reported for the male sling. The likelihood of success is not well understood and the predictors of outcome poorly documented. We review the pre-operative parameters that might facilitate patient selection. All men with PPI across two supra-regional urology centres had data collected in a prospective database. Data included previous intervention, radiotherapy, 24h pad weights and urodynamic parameters including retrograde leak point pressure. Results: 100 men were treated with the Advance male sling system between 2012 and 2018. Mean patient age was 67 (range 47 to 88). Mean follow up time was 66 weeks (range 3 weeks to 5.5 years). 73 patients were cured of their urinary incontinence (1 or less pads for reassurance) whilst 27 patients remained significantly wet (more than 1 pad per day). The table shows preoperative parameters in those who were dry versus those remaining wet. Differences were assessed using paired T-tests, Mann-Whitney U Test and Fisher's Exact Test as appropriate. A p<0.05 is considered significant. Male sling was successful in 73% of patients, of which 46% did not use any pads postoperatively. 27% of patients had ongoing residual leakage. The only significant predictors were number of pads, detrusor overactivity and bladder capacity; which were associated with poorer outcomes. Male sling was a successful treatment in the majority of patients irrespective of pre-operative parameters. The only predictors of significance were number of pads, detrusor overactivity and bladder capacity on preoperative video urodynamics. Patients should be carefully counselled but not be excluded from male sling treatment on pre-operative parameters alone. Nocturia May be a Predictive Factor for Restart of Dutasteride Masuda H, Sekine K, Mikami K, Ootsuka K, Hou K, Kato T, Suyama T, Araki K, Kojima S, Naya Y Teikyo University Chiba Medical Center, Chiba, Japan Introduction and Objective: It was reported that if dutasteride was discontinued, 60% of patients were restarted within one year and baseline intraprostatic architecture was associated with restart of dutasteride. The aim of this study was to clarify the predictive factors for restart of dutasteride for long follow up. and December 2016 at a single center, 39 patients in who were treated with dutasteride (0.5mg/d) by the diagnosis of benign prostatic hypertrophy and discontinued dutasteride were included in this retrospective study. In the groups of restarting and discontinuing dutasteride, patient's age, body mass index (BMI), International Prostate Symptom Score (IPSS), QOL score, Overactive Bladder Symptom Score (OABSS), the duration of medication, prostate volume, the reduction rate of prostate volume, post-void residual urine volume (PVR) using transabdominal ultrasound, concomitant medication and comorbidities were evaluated. Although patients were followed for 24 months after cessation, patients were allowed to restart dutasteride during the follow-up period by their desire and judgement of the attending physician. Statistical analysis was carried out to identify clinical covariates significantly between restarting group and discontinuing group. Results: Overall, 35 patients were analyzed at 24 months and 12 patients (12/35, 34%) restarted dutasteride. The mean nocturnal event before discontinuation of dutasteride (2.8 vs 1.8; p= 0.005) was more in restarting group than discontinuing group. The mean duration of medication before discontinuation of dutasteride (37 vs 25; p= 0.0261) was longer in restarting group than discontinuing group. No significant differences in the patient characteristics were observed between restarting group and discontinuing group in other factors. Multivariate analysis revealed that nocturia and duration of medication before discontinuation of dutasteride were independent predictive factors for restart of dutasteride. Conclusion: Our study clarified that nocturia and longer medication might prompt restart of dutasteride. Therefore, the possibility of the discontinuation or intermittent medication of dutasteride was suggested in the patients that were recognized nocturnal voiding frequency < 2. Prospective Multicenter Open Label Trial Investigating a Neutraceutical Complex Novex ® in LUTS/BPH Nemr E, El Helou E, Semaan A, Abi Chebel J, Mjaess G Introduction and Objective: The aim was to assess the efficacy of "Novex®" (a neutraceutical complex made of Pumpkin Seed Extract 550mg, Soy Germ Isoflavonoids 50 mg and Cranberry 50mg) in the management of male patients suffering from mild to moderate LUTS/BPH. This is a prospective multicenter open-label trial with a duration of 6 months. Male patients aged between 40 and 80 years, who had had mild to moderate LUTS for > 6 months at screening, with an International Prostate Symptom Score IPSS <18, with no previous therapy or who are still symptomatic despite alpha-blockers, were recruited. "Novex" was administered orally, daily, for 3 months. After obtaining local ethics approval, a total of 100 consecutive patients with Benign Prostatic Obstruction (BPO) and normal sexual activity were enrolled from June 2015 to June 2016. These patients were selectively randomized into two groups; 50 patients in each group. Group (1) underwent ejaculation preserving transurethral bipolar enucleation of prostate (ep-TUBEP) and group (2) underwent ejaculation preserving transurethral bipolar resection of prostate (ep-TUBRP). All patients were evaluated pre-and post-operatively using the maximum flow rate (Q-max), post-void residual urine (PVR), international prostate symptom score (IPSS) and the International Index of Erectile Function (IIEF-5) including two additional questions evaluating ejaculation and orgasm. All patients were followed-up at 1, 3, and 6 months. Results: Overall, 100, 98 and 97 patients were evaluated at 1, 3 and 6 months, respectively. All pre-operative parameters were comparable between the two groups (Table 1) . At 1-month follow-up, antegrade ejaculation was preserved in 88 of 100 (88%) (45 patients in group (1) and 43 patients in group (2)). In addition, there was significant improvements in the Q-max (from 6.54 ± 1.72 mL/sec to 15.38 ± 3.02 mL/sec), and PVR (from 94.4 ± 41.85 mL to 25.04 ± 32.72 mL), and IPSS (from 21.7 ± 6.6 to 11.72 ± 2.39) compared with the preoperative measurements. Moreover, these improvements were maintained at 3-and 6-months follow-up visits (all p-values were <0.001). No serious adverse events were reported. The ep-TUBP seems safe and effective for preservation of antegrade ejaculation with either the resection or the enucleation technique. UP.090, Figure 1 . Introduction and Objective: Muscle mass and strength, and physical performance are well-known indicators of age-related vulnerabilities in elderly adults. However, evidence for the associations of these with overactive bladder (OAB) is scarce, especially in healthy subjects. This study aimed to assess the associations of muscle mass, grip strength, and gait speed with OAB in community-dwelling elderly adults. patients (53%) make at least one mistake to correctly answer Conclusion: Although IPSS is a useful tool to evaluate TUTS severity and decide management, it is often misunderstood and time-consuming test. We need really more than just asking old patients. We really need feedback. We have to be sure that they fully understand the question and give us the right answers. Urodynamic We analyzed the urodynamic characteristics of bladder detrusor hyperactivity with impaired contractility (DHIC) and evaluated the efficacy of medical and surgical treatment. Sixty-eight cases of male patients were diagnosed as DHIC by urodynamic examination. Patients with BOO were treated by TURP, and non-BOO patients were given medication according to the symptoms. IPSS and QoL scores, Q max and PVR were used as prognostic indicators to evaluate the therapeutic efficacy for 3 months of follow-up. The overall efficacy of combined therapy with a-blockers and anticholinergics was better than that of the single drug group. The average IPSS and QoL scores were significantly improved after treatment in each group. In addition to the anticholinergic group, Q max increased significantly in all groups after treatment, and PVR reduced significantly in the combined pharmacologic and surgical group. Conclusion: It was safe and effective for male patients with DHIC to receive combined pharmacologic therapy using a-blockers and anticholinergics, but the anticholinergics should be used carefully for patients with detrusor contraction coefficient (DECO) less than 0.5. Surgical treatment of BPH could be chosen for patients with obstruction coefficient (OCO) greater than 1.5. We identified the correlation between post-void residual (PVR) and severity of bladder outlet obstruction (BOO) and detrusor contractility decreased in benign prostatic hyperplasia (BPH) patients. Misunderstanding patients' answer Include urination before sleeping (n=53), at morning (n=68) and when they weak up not really for urination but for "Fajr prayer" (n=77). Night workers (n=9). Sleeping trouble (n=21) UP.099, Materials and Methods: 152 cases of BPH underwent ultrasound and urodynamic examination to measure the volume of prostate, PVR, free Q max , bladder outlet obstruction index (BOOI) and bladder contractility index (BCI). The correlations between ultrasound and urodynamic parameters were analyzed by SPSS 20.0. Result: There is positive correlation between prostate volume and BOOI and BCI (r = 0.432 and r = 0.343, P < 0.01). Qmax was correlated negative with BOOI, but there is no significant correlation with BCI (r = 0.123, P > 0.05). When PVR?150 mL, there is no significant correlation between PVR and BCI (r = 0.041, P > 0.05). When PVR> 150 mL, PVR and BCI have significantly negative correlation (r = -0.490, P < 0.01). When PVR > 300 mL, this correlation is particularly noticeable (r = -0.717, P < 0.01). Conclusion: PVR could somehow predict the detrusor function. We should pay attention to evaluate of detrusor function for PVR > 150 mL cases, especially when PVR > 300 mL, it is suggested to perform urodynamic examination to exactly evaluate BOO severity and detrusor contractility. Introduction and Objective: Many patients with benign prostatic hyperplasia need treatment for remaining storage symptoms after transurethral resection of prostate surgery, even if the obstruction was successfully relieved. But there is no consensus on the cause of detrusor instability after relief of bladder outlet obstruction (BOO). We investigated the alteration of bladder a1-adrenoceptor subtype after relief of partial bladder outlet obstruction in a rat urothelium and detrusor muscle. A total of 60 female Sprague-Dawley rats were randomly divided into three groups: the sham-operated group (Sham, n= 20), the partial BOO group (BOO, n= 20) and the partial BOO relief group (BOO+R, n= 20). PBOO rats were induced for 2 weeks, the obstruction around the urethra has relived by removal of ligation after 2 weeks. The bladder tissue was carefully separated into urothelium and detrusor muscle layer under a dissecting microscope by cutting in through the lamina propria. The expression of a1-adrenoceptor subtype (a1A, a1B, a1D) in the urothelium and smooth muscle tissues was examined by Western blot assay. In the urothelium of the BOO group, the expression of a1D-adrenoceptor was significantly higher than the sham operated group. The expression of a1D-adrenoceptor was also significantly higher in the BOO group in the muscle. After relief of partial BOO, a1D-adrenoceptor expression was significantly decreased as compared to the partial BOO group but was still significantly increased than sham operated group. Alpha1D-adrenoceptor predominated over other subtypes in both urothelium and bladder muscle. In addition, a1A-adrenoceptor was predominant in the sham operated group but was significantly decreased in the urothelium in the partial BOO group, and there was no statistical difference in muscle and total bladder. The expression of a1B-adrenoceptor was not statistically significant among the three groups in muscle and urothelium. Our findings indicate a remarkable increase in bladder a1D-adrenoceptor expression after relief of partial bladder outlet obstruction. This finding suggest that urothelial a1D-adrenoceptor plays an important role in the persistence of storage symptoms in the partial BOO relief group. These results may also imply that selective a1D-adrenoceptor antagonists such as naftopidil may be effective in persistent post-operative storage symptoms of BPH patients. Introduction and Objective: Retrograde ejaculation has been accepted as a common but harmless side-effect after transurethral resection of the prostate (TURP). The objective of this study was to determine the level of bother in benign prostatic hyperplasia (BPH) patients who experienced de novo anejaculation after TURP. Materials and Methods: 80 subjects (45 prostatic urethral lift, PUL; 35 TURP) were enrolled in a prospective, randomized trial (BPH6 study). Male Sexual Health Questionnaire for Ejaculatory Function (MSHQ-EjD) outcomes was assessed through 12 months. TURP cohort data were analyzed to evaluate bother from de novo anejaculation. Subjects who answered 1-5 to the MSHQ-EjD function question 3 were defined as having ejaculatory volume while those who answered 0 were defined as having anejaculation. At the earliest report of anejaculation, the corresponding response to the MSHQ-EjD bother question was assessed and results were compared to subjects with volume. To determine if bother was sustained, the same assessment and comparison were performed at the last report of anejaculation. Introduction and Objective: Little has been known about possible relationships between peri-prostatic anatomical structure and severity of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) as well as effectiveness of medical treatment for BPH. We investigated whether periprostatic vascularity was related with pre-treatment LUTS severity, and if so, whether it could predict efficacy of dutasteride treatment in BPH patients. Subjects of this retrospective analysis were 97 men with BPH that had underwent baseline prostatic magnetic resonance imaging (MRI) and treatment with dutasteride 0.5 mg daily for at least 6 months at our institution between 2009 and 2015. Sixty-seven of the subjects (69%) also received a1-blockers concomitantly. Peri-prostatic vascular area (PPVA) was measured on axial T1-weighted MRI images at the level of prostatic base by tracing the outer circumference of the bilateral vascular bundles. Baseline characteristics including age, prostate-specific antigen (PSA) level, prostate volume, intravesical prostatic protrusion (IPP), PPVA along with International Prostate Symptom Score (IPSS) before, 12, and 24 months after dutasteride treatment were recorded. Results: Median (range) values of age, total IPSS, PSA, prostate volume, IPP and PPVA were 71 (59-94) years, 15 (8-32), 7.08 (2.57-44.5) ng/mL, 54 (22-145) mL, 8.7 (0-30.5) mm and 615 (89-1353) mm 2 , respectively. Median (range) follow-up duration was 33 (6 -74) months. After 12 and 24 months of dutasteride treatment, median (range) change in total IPSS were -6 (-23 to 10) and -6 (-20 to 6) respectively. Logistic regression analyses revealed that PPVA was most strongly associated with pre-treatment total IPSS (r = 0.213, p = 0.045) among the factors analyzed. We also confirmed that PPVA was the sole significant predictor of percent total IPSS change in both 12 and 24 months after dutasteride administration (r = -0.295, p = 0.038, and r = -0.368, p = 0.046, respectively). Conclusion: Peri-prostatic vascular dilatation was associated with severe LUTS and better subjective improvement under dutasteride therapy in BPH patients. Further prospective studies are warranted to clarify possible mechanisms underlying between peri-prostatic blood congestion and LUTS as well as relief of LUTS by dutasteride. Qmax and/or UVol that were extremely different (i.e., a UVol much higher than maximum UVol at home); no tendency towards systematically higher/lower values of Qmax/UVol during hospital flowmetry was apparent. 16% of patients classified as "obstructed" (Qmax <10 ml/s) based on hospital flowmetry were classified as "equivocal" or even "unobstructed" based on ambulatory values, all of whom received surgical treatment. The questionnaire showed 75% of patients preferred ambulatory flowmetry and all patients considered this modality "more representative" of his normal urine flow. Conclusion: Hospital uroflowmetry, based on limited number of measurements in an artificial environment, added to the normal fluctuation of Qmax, may not always reflect the patient's average urine flow and does not express nocturia. This may have important interference with treatment decisions. Ambulatory uroflowmetry may be useful in equivocal cases, when patients are unable/unwilling to perform the exam at the hospital or when a bladder diary is deemed necessary. Open Prostatectomy for Large Benign Prostates: Assessing Benefit of Post-Operative Epidural Analgesia on Outcomes Introduction and Objective: There is convincing body of evidence that epidural anaesthesia and analgesia improves post-operative recovery and outcomes following major surgery. Thus, this study aims to assess benefits of postoperative epidural analgesia on some postoperative parameters commonly encountered following open prostatectomy for large prostates. Results: The age incidence of the patients in both groups were similar. There were no reports of bladder spasms or blocked urethral catheter amongst group A patients, whereas this was constantly reported among group B patients. Post-operative blood loss as estimated by need for transfusions and total volume of irrigation fluid was significantly higher for group B than A patients (P <0.001). Post-operative pain scores were also significantly higher for B patients. Average weight of enucleated adenoma for both groups was 119 g (range 70-300) and 128 g (range 70-280) respectively. There was no significant difference in hospital stay for both groups. Conclusion: Post-operative epidural analgesia is highly beneficial for open prostatectomy patients as it has abolished the pain, the spasm, the bleed, the blockage and the flush commonly encountered in the post-operative period following this procedure. The non-high-density lipoprotein-cholesterol (HDL-c) to HDL-c ratio is reportedly associated with metabolic syndrome and insulin resistance. Benign prostate hyperplasia (BPH) and testosterone deficiency (TD) are common in aging male. More and more evidence has supported these two conditions are related to metabolic factors. In this paper, we performed a retrospective study and discussed the possible relationship between non-HDL-c to HDL-c ratio and TD in aging Chinese men with BPH. The medical records of 795 BPH patients who referred to surgery were evaluated. We reviewed the clinical data by age, body mass index (BMI), medical history, serum prostate-specific antigen (PSA) levels, serum total testosterone (TT) levels, biochemical analysis and transrectal ultrasound. TD was defined as a serum value of TT less than 10.4 nmol/L (300 ng/dL). Conclusion: Nearly one-third of aging Chinese BPH patients we studied had TD. Clinicians should be aware of the high prevalence of low testosterone in these patients. Non-HDL-c to HDL-c ratio has a positive correlation with TD. It may be a good index that could well reflect the status of TD. Materials and Methods: Among Patients who were consulted for voiding problems during hospitalization from 2016 to 2017, female were collected ret-rospectively. Patients who received brain and spinal and colorectal surgery, who expired during hospitalization, and who received radiation therapy on pelvic area were excluded. And in this study, we analyzed the patients over 60 years old. Patients were divided into two groups by the presence of constipation. Current voiding problems including retention, lower urinary tract symptoms (LUTS; e.g. frequency, straining, incomplete emptying sense), urinary flow rates, post void residuals (PVR). Almost patients who were underwent retention or voiding difficulty received alpha blocker for symptom relief. Patients who showed Furthermore, the recovery from the retention was investigated. Results: Fifty-five patients were analyzed to this study. Patients mean age was 68.3 (± 5.6, SD). Eighteen patients showed constipation and received anti-constipation medication (oral, rectal, or enema). Retention patients were 7 (38.8%) in constipation group (C group) and 12 (30%) in non-constipation group (N-C group) (p = 0.56). Mean periods of recovery from retention were 8.4 days (± 7.7) and 5.8 days (± 4.3) (p < 0.05). Except retention patients, patients with LUTS showed like this. Frequency was shown in 8 (44.4%) of C group and 14 (35%) of N-C group with p >0.05, urgency in 5 (27.7%) and 8 (20%) with p > 0.05, nocturia over 2 times in 6 (33.3%) and 6 (15%) with p <0.05, straining in 6 (33.3%) and 5 (12.5%). Among non-retention patients, peak flow rates were 19.7 mL/s (± 15.5) in C group and 24.8 mL/s (± 21.9) with p > 0.05. PVR were 53 mL (± 118) and 30 mL (± 76) with p < 0.05. Patients in hospital showed various voiding dysfunction. Patients with defecation dysfunction also show the trend of voiding dysfunction. Recovery from retention tends to be more rapid in patient without constipation. Voiding symptoms rather than stor-age symptoms are shown in more frequently in constipation patients. However, larger population should be investigated. Results: A total of 1,446,465 patients were enrolled in this study. 7955 patients visited the emergency room when the daily temperature difference was below 4 degrees and 38985 patients visited the emergency room when the daily temperature difference was more than 10 degrees. When the daily temperature difference was more than 10 degrees, about 4.9 times more patients visited the emergency room than when the daily temperature difference was below 4 degrees. After visiting the emergency room, there were 3,309 patients who inserted the catheter at the daily temperature difference below 4 degrees. When the daily UP.114, Figure 1 . 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK temperature difference was more than 10 degrees, the number of catheter insertion cases was 16,303, which was 4.9 times higher than that of below 4 degrees. The greater the daily temperature difference, the greater the number of patients undergoing BPH surgery after visiting the emergency room. By time, surgery was most frequently performed within three months after visiting the emergency room. The deterioration of LUTS symptoms in patients with BPH is associated with daily temperature differences. Conclusion: Our study demonstrated slightly greater objective success rate compering to the subjective success rate. We demonstrated that TOT procedure improves in great measure symptoms of urgency voiding, coital incontinence and generally the quality of life. We also found improvement in general health and lower depression rate after the procedure. Open were combined fistulae while 12 (10%) had more than one opening on pan-endoscopy; 7 (5.8%) cases were recurrent. Mean size of fistula was 2 cm (range 1.5 to 5 cm). Ureteral stent was placed in 17 (14.1%) patients, which were removed after 6 weeks. Mean hospital stay was 12 days (range 10 to 14). 111 (96.5%) patients were completely dry at 6 and 12 weeks follow up; 2 (1.7%) had urge incontinence while 2 (1.7%) had persistent leakage. Five patients were lost to follow up, though they were dry at the time of discharge from hospital. Open transvesical repair of vesicovaginal fistula is the tried, easy and tested method of VVF repair with less complications and more than 95% success rate especially if there is no previous intervention, do the best procedure first. the fistula with minimal burden to the patient. The literature has previously described use of fibrin sealants to close urological fistulas and furthermore synthetic glues have been widely used in vascular surgery as an embolic agent. Such Synthetic glues like Glubran2, work by rapidly polymerizing when in contact with living tissues. This study describes a cases series using a minimally invasive cystoscopic approach to treat small uncomplicated vesicovaginal fistulas through injection of a synthetic glue into the fistula tract. Retrospective review of patients who were symptomatic of VVF and had small but persisting fistulas confirmed on cross sectional imaging. Following failed conservative management with IDC, these patients underwent repair of the VVF through injection of Glubran2 directly into the fistula tract via cystoscopic approach. A 16Fr IDC was left in situ post operatively for 2 weeks. Patient symptoms were reviewed in outpatient clinic to assess leakage and a retrograde cystogram was performed to confirm closure of fistula tract. Results: A total of 6 patients were treated with cystoscopically with injection of synthetic glue. One case of this method has failed with patent fistula on cystogram and associated symptomatology. The remaining 5 patients had successful treatment of fistula via Glubran2 injection with complete resolution of symptoms. We describe a novel method of treating repair of VVF via minimally invasive method. Injection of synthetic glue into the fistula tract has been proven effective with nephrocutaneous fistulas and this study postulates that its use could be extended to treat small fistula tracts successfully. Failure associated with this technique has been associated with larger fistula size and poor patient healing factors. In this small series, it suggest this new method of minimally invasive repair may adequately treat fistulas with minimal patient burden. Further randomised studies would be required to further assess long term efficacy of this method. and perioperative data were collected and summarized. All patients had an office cystourethroscopy performed at 6 to 7 months post-operatively then yearly to asses urethral lumen size and patency. Successful outcome was defined as absence of need for further instrumentation (including self-catheterization, dilation, urethrotomy or further surgical repairs) at last recorded clinic follow-up. Post-operative complications were also reviewed. Results: A total of three patients with a median 33-month (range 7-45) follow-up period were identified and reviewed for peri-operative characteristics and intermediate-term surgical outcomes. Median patient age at time of surgery was 61 years old (range 50-62), and median body mass index was 34 (range 32-34.1). All patients had at least one failed urethral dilation prior to definitive reconstruction. Other intraoperative variables included: median BMG surface area harvested of 12 cm 2 (range 10-12.5), median estimated blood loss of 150 mL (range 150-200), and median total procedure time of 152 minutes (range 145-165. Length of stay was 48 to 72 hours, and an indwelling urethral catheter was left in place for 3 weeks. All patients were found to have a patent urethral lumen -able to accommodate an 18 to 20 Fr caliber -and no patient required further urethral instrumentation by their last clinic follow-up visit. The only reported morbidity was BMG harvest site tightness, which did not require further intervention. We present a case series of successful intermediate-term outcomes for female panurethral stricture disease managed with novel approach of dorsal and ventral dual buccal mucosal graft onlay urethroplasty. Considering results are promising and complication rates are low. Larger studies must be performed to confirm efficacy of this procedure. Anterior and Apical Prolapse Treatment with a Novel Uterine-Sparing Transvaginal Mesh Procedure Gonzalez-Lopez R 1,2 , Garde-Garcia H 1 , Garcia-Fernandez E 1 , Mahillo-Fernandez I 1 , Gonzalez-Enguita C 1 , 2 Introduction and Objective: The aim of this study is to evaluate efficacy and safety, using a novel uterine-sparing transvaginal mesh for treatment of anterior and apical prolapse (POP). Results: There were 163 patients (mean age of 43 years (20 -85)) included; 78% were female and patients had experienced symptoms for an average of 6 years (1 -30). 83% of patients had pelvic imaging -44% ultrasound, 42% MRI and 14% CT. Imaging was abnormal in 5 patients (4%). 14% had Hunner's lesions and 55% were moderately/markedly improved after laser ablation with a mean duration of effect of 10 months. ESSIC findings and outcomes of laser ablation are summarised in Table 1 . The presence of Hunner's lesions in patients with BPS/IC is not uncommon. Pelvic imaging rarely identifies any cause for pain and so cystoscopy under anaesthesia is essential for accurate phenotyping. Phenotype-directed management with Holmium laser ablation to Hunner's lesions has good short-term efficacy in improving pain, but patients often require repeat treatments. Long Term Urinary Continence and Sexual Outcomes Following Successful Vesicovaginal Fistula (VVF) Repair Panaiyadiyan S, Nayyar R, Seth A, Kumar R, Singh P, Nayak B Introduction and Objective: Various repairs have been described for vesicovaginal fistula (VVF); however, there is a paucity of information on long term continence and sexual function outcomes following successful VVF repair. We set out to analyse the longterm urinary continence and sexual outcomes in patients with successful VVF repair at our institute. We retrospectively analyzed women who underwent VVF repair between 2011 and 2018. Preoperative, operative and postoperative details were recorded from electronic data software. The individual couple were called in person for the follow-up. Sexual satisfaction score was assessed using a verbal rating scale (Score: 0-not satisfied; 1-partially satisfied; 2-satisfied and 3-very satisfied). Outcomes Limitations include retrospective design and data from single institute. The elderly patients had more residual urine before surgery, but the rate of postoperative dysuria did not differ from those under the age of 75. Mid-urethral sling is also indicated for elderly patients with stress urinary incontinence. Review The optimal management of patients with ureteric obstruction in advanced malignancy is unclear. The treatment is associated with complications and frequent readmissions. How the patients' quality of life is affected by a nephrostomy and how many of these patients undergo further oncological treatment remains uncertain. The objective of this retrospective multicentre study was to look at the outcomes of patients who had percutaneous nephrostomy for malignancy. We identified patients who had a nephrostomy inserted for ureteric obstruction due to malignancy at our institution from Jan 2015 to Dec 2018. We obtained data retrospectively from our electronic patient record system. Patients who had nephrostomy insertion for other causes such as ureteric calculi or injury were excluded from the study. an average life expectancy of 139 days, in those who died following nephrostomy. Interestingly after nephrostomy insertion only 30.47% (n=32) patients underwent further oncological treatment as the rest were too frail to undergo any chemotherapy. Conclusion: In our series most patients who had nephrostomy insertion for ureteric obstruction due to malignancy had no further oncological treatment following insertion. Percutaneous nephrostomy is a procedure not without associated morbidity and does not always prolong survival. Given the associated poor prognosis in cases of advanced malignancy, we advocate multi-disciplinary approaches to decision-making in terms of nephrostomy insertion. Introduction and Objective: Most district general hospitals (DGHs) in the UK have MRI facilities; fewer have a nuclear medicine department that can perform bone scans (BS). On a background of several recent meta-analyses that have shown whole-body MRI (WB-MRI) performs better than BS in the detection of metastatic prostate cancer (PCa), we examine whether an advantage exists in performing (WB-MRI) instead of (BS) for staging PCa in a DGH. We conducted a retrospective review of patients that had both a BS and WB-MRI between for the purpose of detecting prostate cancer metastases. The metastatic disease detection rate for each modality was compared and the impact of the WB-MRI on clinical management was assessed. The cost and time taken to perform the different scans was also evaluated. We do not know of any other UK data that has been obtained in this setting. Introduction and Objective: The use of prostate-specific membrane antigen (PSMA) radiotracer in positron emission tomography (PET) has been successfully incorporated into the clinical management of prostate cancer. However, PSMA tracer uptake is not limited to prostate cancer tissue. We present studies exploring PSMA expression beyond the prostate gland using techniques of 68 Ga-PSMA PET imaging. These studies demonstrate potential utility for uptake of PSMA tracer in patients with non-prostatic cancers. Results: PSMA has been detected in other normal and neoplastic organs, as well as the vasculature associated with many other solid tumours. Its expression has been found on normal cells in varying concentrations, for example in benign fractures. Immunohistochemistry studies have shown PSMA to be expressed in the kidney, testis, ovary, brain, salivary gland, small intestine, colon, liver, spleen, breast and skeletal muscle, as well as malignancies of these tissues. Conclusion: These findings are important for the surgical oncologist assessing a patients 68 Ga-PSMA PET imaging for metastatic prostate cancer. Scrotal Ultrasonography in the Management of Male Infertility -The Experience in a South-Western Nigerian Hospital Fasola O, Ogbole G, Osobu B Introduction and Objective: Male factor infertility accounts for 40% of the causes of infertility of a couple. Due to its accessibility and superficial location of its contents, the scrotum lends itself to splendid ultrasonographic evaluation. Scrotal ultrasound (USS) may be useful in the evaluation of male factor infertility. We present a one-year review of the scrotal ultrasound scans performed at the tertiary center in Ibadan, Southwestern region of Nigeria. All scrotal ultrasound scan reports between April 2017 and May 2018 were retrieved from the electronic records of the institution. The data was analyzed and presented with simple percentages and means. Results: One hundred and seventy (68%) of 248 scans performed in the period were available for review. The mean age of 35.9 ± 14.1 years, the most frequent indication for a scrotal ultrasound scan was infertility (59%). The testicular sizes showed small volume testes in 35% and 41% of the adults (n=151) on the right and left respectively. The mean peri-testicular vein diameters on the right were 2.597±0.92mm pre-Valsalva and 2.936±1.03mm post-Valsalva; while on the left, they were 2.797±0.92mm and 3.142±1.02mm pre-and post-Valsalva respectively. There was a diagnostic rate of 49% of varicoceles. There was no consensus cut-off diameter for the diagnosis of varicoceles. Conclusion: Scrotal ultrasonography may play a central role in the evaluation of male factor infertility. We recommend that a consensus cut-off vein diameter of 3.0mm for diagnosing varicoceles to avoid over-diagnosis. However, this should be done in collaboration with the urologists. Initial Experience of Tc-PSMA SPECT in Prostate Cancer Holmes M, Alan B, Devcich G, Lanka L Introduction and Objective: PSMA-PET has rapidly emerged as a critical element in the assessment of prostate cancer. Tc-PSMA-SPECT offers a lower cost, more readily available alternative to PSMA-PET, given that SPECT scanners are widely available, while PET scanners may not be. In New Zealand PSMA-PET is not funded by the public health system and is beyond the financial reach of many patients. SPECT scanners are available within the public funded system, but despite this Tc-PSMA SPECT is not yet widely utilised. In addition, Tc-PSMA offers the opportunity for radio-isotope guided salvage surgery. We sought to review our units experience of Tc-PSMA-SPECT, including indications for and impact of the study on patient treatment pathway. Data was collected prospectively as part of an ongoing audit into the effectiveness of PSMA-SPECT between June 2018 and April 2019. Indications varied but broadly fell into assessment prior to A) Definitive curative therapy in high risk localised prostate cancer B) Recurrence after definitive therapy C) Recurrence after salvage radiotherapy D) Atypical cases and E) Radio-guided salvage nodal dissection. Results: Nineteen patients underwent a 99Tc-PSMA-SPECT. PSA at study varied from 0.1 to 200. A) Prior to definitive curative therapy n =8. PSA 4.5-27. Nodal metastatic disease was identified in 5/8 including in the patient with PSA =4.5. In 1/8 a false positive node was identified. Subsequent Radical Prostatectomy was node negative and patient is biochemically cured. B and C) Post-therapy n= 6. PSA ranged from 0.1-21. The lowest PSA with a positive scan was at PSA=0.1 with local recurrence in the prostatic bed. 5/6 results of SPECT affected therapy decisions. D) 4 atypical cases were evaluated. These included patients with indeterminate radiology (MRI, bone scan and CT) in whom SPECT clearly identified metastatic disease and allowed appropriate therapy choices (stereotactic salvage radiotherapy). One patient presented with a P.E, PSA of 80 and only osteolytic lesions on CT. His Tc-PSMA-SPECT was extremely positive, clarifying diagnosis and treatment choices. E) radio-guided salvage nodal dissection was performed on n=1 patient using Tc-99-PSMA ligand to direct surgery using intraoperative Geiger counter; 1-year post surgery patient remains biochemically cured. Conclusion: Tc-PSMA -SPECT is a valid, extremely useful tool to guide rational treatment in men with high risk prostate cancer, who can harbour unexpect-ed nodal disease, in men with recurrent disease and in atypical presentations. It was successfully used in radio-guided salvage nodal surgery and provides an affordable alternative to PSMA-PET. Uptake of PS-MA-SPECT should be encouraged. Reproducibility tor. Surgical excision of the tumors was used as the standard of reference. The interobserver variability for each of the RENAL-NS parameters, respectively, a hilar location, and the total score was 96%, 81%, 97%, 85%, 82%, 83%, and 91% of patients, corresponding to kappa values of 0.92, 0.64, 0.98, 0.74, 0.71, 0.75, and 0.84, respectively. The Nearness, Radius, and total score had shown the best agreement. For the cases that were discordant in terms of the final score, no major implications were seen in surgical planning. The RENAL-NS is a useful systematic tool for assessment of the anatomical features of the renal tumors. It is easily reproducible and applicable by different radiologists of different durations of experience. Which The highest PSA at the time of negative DWIBS was 2.4 ng/mL, while DWIBS depicted progressive sites even in patients with undetectable PSA. When limited to PSA 2 ng/mL or above, DWIBS was positive in 41 of 42 (98%) studies. Among the patients with 5 or less progressive sites, progressive site-directed therapy was given to 13 of the 34 DWIBS-depicted progressive sites, and clinical response was achieved in 8 sites. In the presence of suspicion of disease progression regardless of PSA level, DWIBS can be used to detect oligoprogression in some asymptomatic PCa patients undergoing ADT. Further studies are warranted to reveal organ-specific diagnostic performance of DWIBS in these patients. Spontaneous Resolution of Renal Pseudo Aneurysm Following Percutaneous Nephrolithotomy Omar M, El Waraky M Introduction and Objective: Latrogenic renal pseudoaneurysm is one of the rarest and most serious complications following percutaneous nephrolithotomy. We report a case of lower polar pseudoaneurysm that leads to one episode of severe hematuria following the surgery and resolved spontaneously. A 55 years old gentleman, with multiple lower pole calyceal stones; underwent uneventful prone percutaneous nephrolithotomy, through a lower posterior calyceal puncture. Patients were discharged on the next day of surgery following removal of the nephrostomy tube. Ten days later, the patient was readmitted for severe gross hematuria that was conservatively managed. A CT angiography revealed a 9 mm pseudoaneurysm at the site of the puncture. We decided to perform angio-embolization but was postponed due to technical difficulty due to severe tortious Aorta that necessitates a special angiography catheter. Results: On the 20 th day, angiography was done, that showed resolution of the pseudo-aneurysm and embolization were aborted. 6 months following surgery, the patient didn't manifest any other attack of hematuria. Conclusion: Although iatrogenic pseudo-aneurysms after PCNL are managed by angio-embolization, still, some cases may resolve spontaneously. A careful follow-up and a ready angiography facility may allow for a save conservative trial. Twenty patients were randomly selected from an overactive bladder patient cohort. The primary endpoint was to identify the range of false BWT measurements outside, which significant changes in UEBW calculation occur. We used the Kojima method and a semi-automatic 3-D model that is based on Chalana's principle. Measurements were performed using the correct BWT and a series of faulty calculations from +0.5mm to -0.5mm using steps of 0.05mm from true BWT. The effect of a fixed 0.5mm BWT error was checked in bladder volumes above and below 250mL and in three UEBW groups (< 35 gr, 36-50 gr, > 51 gr). Results: BWT measurement errors above 0.25mm cause statistically significant changes in UEWB calculation when a 3-D model is used and errors above 0.15mm when Kojima's method is used. At a fixed BWT error of 0.5mm and bladder volume < 250mL, there is a 23.76% deviation from true UEBW, while at volumes > 250 mL the deviation is 32.72%. The deviation is inversely proportional to the UEBW result, and heavier bladders deviate less. Conclusion: UEBW is a promising diagnostic tool, but small errors in BWT measurement might cause significant deviation from the true values. A 3-D calculation model appears to minimize such risks. Urologists Awareness of the Microbiome of the Ileum, is it Actually Sterile? Attwell-Heap A 1 , Duncan C 1 , Teh J 1 , Tang V 2 , Bolton D 1 , Lawrentschuck N 1 1 Austin Health, Heidelberg, Australia; 2 Stockport NHS Trust Foundation, Stockport, United Kingdom Introduction and Objective: Urinary diversion using distal ileum has come with the assumption that the contents of the terminal ileum are sterile and consequently bowel preparation is not routinely used preoperatively. Due to this assumption, spillage of ileal contents into the abdominal cavity is no perceived to be a major issue intraoperatively nor is the washout of the conduit perceived as a required step prior to urinary anastomosis. However, if the content of the ileum is not truly sterile, do urologist need to be more cautious about handling the content of the small bowel to prevent post-operative complications? The purpose of this study was twofold; firstly, to establish as microbiome of terminal ileum in cystectomy patients and then to cross reference the microbiome of any post-operative infections to ascertain a causal route. A retrospective review was performed on 23 cystectomy patients. These patients who, at the time of operating the distal ileum was divided and a bacterial swab was taken and sent to the laboratory for culture. A retrospective review of the patient notes was performed to identify any evidence of sepsis. The respective septic screens were reviewed and compared with the intraoperative terminal ileum swab. Results: The terminal ileum microbiome was consistent with the literatures. Swabs from 3 out of 23 patients grew pathogens. One out of the 23 patients developed post-operative sepsis, which it was identified as urinary source and culture of the urine and swab correlated suggesting the primary source originating in the terminal ileum. No signs of sepsis was identified in the remaining 22 patients. This study largely supports the concept that the gastrointestinal contents of the terminal ileum are sterile. However, in a small percentage of patients that harbour pathogens in the ileum there are associated negative clinical outcomes. These pathogens were identified on swab after 72 hours, which also correlates with development of many UTIs as described in the literature. This study postulates that swabs taken intraoperatively would allow early identification of pathogens and thus targeted rather than empirical antibiotic therapy. Conclusion: AABP patients with LS seem to behave somewhat differently than their non-LS counterparts. They experience more hygiene issues at baseline and are more likely to require skin graft during surgical treatment. Though overall surgical success and complications rates are similar, they do experience a higher rate of late post-operative complications, mostly related to impaired wound healing. Work on improving wound healing in this population -such as post-operative use of corticosteroid creams -should be pursued. Epididymo-Orchitis as the First Presentation of Brucellosis in an Endemic Area Introduction and Objective: Brucellosis, which is also called Mediterranean or Malta fever, is an endemic enzootic disease and can involve various organ systems. It is commonly endemic in the Mediterranean countries and the Middle East. Epididymo-orchitis is a focal form of human brucellosis. Brucella species cause granulomatous orchitis usually presenting as an acute or chronic unilateral swelling of the testis. Patients rarely present to the clinicians with acute scrotum due to Brucellosis Epididymo-Orchitis (BEO) as an initial finding. Our aim is to estimate the prevalence of the BEO among the cases diagnosed with Epididymo-orchitis in our hospital over the last four years. Retrospective study from 2015-2018 involving all cases diagnosed with Epididymo-orchitis in our hospital. A total of 92 cases of Epididymo-orchitis were diagnosed during this period. These cases presented to ER complaining of severe unilateral scrotal pain, swelling, fever and sweating. Local examination showed swollen enlarged testis and epididymis with marked tenderness. Brucella serologic test for both B abortus and B melitensis were requested routinely for all cases of epididymo-orchitis. Scrotal Doppler ultrasonographic examination was requested at initial diagnosis and after 2 weeks to exclude abscess formation. Results: Out of 92 cases, 8 were diagnosed to have brucellosis (8.7%). The median age of patients was 32 years (range, 18-41 years). All patients had positive history of consuming unpasteurized dairy products, which is a risk factor for brucellosis. The diagnosis of brucellosis was made via positive serological testing results (Brucella abortus and melitensis). One case showed testicular abscess formation. All cases were given combination of tetracycline and rifampicin for 6-12 weeks. Two cases required prolonged hospital stay due to testicular abscess formation in one and development of Brucellosis spondylitis in the other. Gentamycin was added for one week in such cases. ried out a systematic review with meta-analysis of the available case-control studies in order to verify possible differences in the occurrence of HPV infection in urine samples in patients with BlCa and normal subjects. PubMed was used to search for articles published from January 1965 to August 2018 using the key words "bladder cancer" and "HPV". No restrictions to date, language, or article type were applied. Case-control studies reporting Odds Ratio (OR) for HPV infection in urine samples in patients with BlCa and normal subjects were analyzed. The quality of the studies was evaluated by the New Castle Ottawa scale. Data were combined using random effect models. The Cochrane Chi-square (Cochrane Q) statistic and the I-square test were used to analyze heterogeneity. The publication bias was graphically explored through funnel plot, and Duval and Tweedie's "trim-and-fill" test was used to correct possible publication bias. The selection process yielded only three studies with eligibility criteria for analysis, that gave information on 278 patients with HPV infection in urine and 903 patients without HPV infection in urine. The pooled OR estimated showed that patients with HPV infection in urine exhibit a significantly higher prevalence in BlCa than patients without HPV infection (OR= 2.602, 95%CI: 1.484, 4.56; P= 0.001). We obtained a heterogeneity chi-squared value Q exp= 1.573 (p= 0.456) (I-square= 0%). Funnel plot non suggested a possible publication bias in the analysis. Only one study compared the incidence of HPV infection in urine with HPV infection at the tissue level. A higher incidence of HPV infection was observed in the urine of patients with bladder cancer than in tumor tissue. The pooled OR value showed a moderate relationship between urinary HPV infection and BlCa. HPV infection in the urine may have a role in carcinogenesis of the bladder tumor. Further well-conducted studies could be useful to confirm this conclusion, and thus be able to identify if the determination of HPV in urine can be considered useful in clinical practice for its use in the diagnosis and follow-up of patients with BlCa. Introduction and Objective: Transrectal ultrasound (TRUS) guided prostate biopsy remains the most common method of prostate cancer diagnosis. Current Australian therapeutic guidelines recommend a single dose of oral ciprofloxacin 1 hour prior to biopsy, however, there still remains a significant risk of post-TRUS sepsis, ICU admission, and death. We aimed to analyse the bloodstream infections following TRUS prostate biopsy in the Australian Capital Terri-tory (ACT) with a focus on bacteriology and antibiotic sensitivities. Analysis of a prospective database of bloodstream infections following TRUS biopsy in the ACT, Australia from 1998 to 2018 was performed. Australian MBS (Medicare Benefit Schedule) database was used to calculate the number of TRUS biopsies performed in the ACT during this period. Data were analysed using SPSS 24.0. Results: There were 6728 TRUS biopsies performed in the ACT, with 58 culture proven bloodstream infections following biopsy resulting in a 0.08% sepsis rate. The bacteria cultured were E. coli (89%), Klebsiella pneumoniae (5%), Pseudomonas aeruginosa (2%), Morganella morganii (2%) and S. aureus (2%). Bacterial multi-resistance saw an increasing trend in the last 20 years, with 100% of bloodstream pathogens displaying multi-resistance. Cephazolin and gentamicin resistance was 22% and 26% respectively. Ciprofloxacin resistance was present in 36% of cases. There were 3 patients that required ICU care and no resultant mortality. Conclusion: Bloodstream infections post TRUS biopsy remains low in our Australian centre, however, multi-resistance blood organisms are becoming more prevalent. To adequately account for the emergence of resistance, additional antibiotics administration on top of ciprofloxacin may provide better coverage for prophylaxis. Despite these, our experience suggests that TRUS biopsy could be a safe method for prostate biopsy if done in the controlled hospital setting. Does Conclusion: Usage of pre TRUS-Bx intrarectal povidone iodine suppository together with standard antibiotic prophylaxis with ciprofloxacin helps decrease post procedure infectious complications and proved to decrease incidence of infection among patients having ciprofloxacin resistant rectal organisms. Calmette-Guerin (BCG) is a live attenuated vaccine produced from Mycobacterium bovis that is effectively used for the treatment of high-grade non-invasive urothelial carcinoma (UCC). A very rare complication of BCG instillation includes disseminated disease. We report a case of delayed "BCGosis" in a form of renal tuberculosis. A case study of a 75-yearold man was undertaken and relevant background history, examination, and investigative results were reviewed. Results: A 75-year-old man presented with recurrent fevers up to 39.7°C after maintenance BCG therapy 2 years ago for recurrent high-grade stage T1 UCC. His blood showed acute on chronic renal failure, elevated inflammatory markers with a high C-reactive protein of 140-150, leukocyturia without isolated pathogen and negative blood cultures. Initial CT intravenous pyelogram showed subtle hypoperfusion of left renal cortex suggestive of pyelonephritis. However, despite multiple antibiotic agents, his fevers continued, and further investigations were organised to exclude occult infection. A gallium scan was performed that showed intense focal activity in left renal parenchyma with positive cultures for acid-fast bacilli confirmed renal BCGosis. He was commenced on triple therapy and was discharged home on day 50 of admission. He is being planned for nephroureterectomy as a definitive treatment. Conclusion: Renal tuberculosis is a rare complication of BCG therapy. This case highlights rare but potential systemic complication of BCG in a patient presenting with pyrexia of unknown origin. A low index of suspicion is required in patients with prior exposure to intravesical BCG to prevent delayed diagnosis and to initiate prompt treatment. Introduction and Objective: As per institution protocol, CAUTI and ' Adult Urethral Catheterisation for Acute Care Settings' guidelines were implemented where saline was used as skin preparation agent for flexible cystoscopy. Therefore, we tested for an association between surgical site preparation agents and post cystoscopy infection rates. All patients who underwent flexible cystoscopy in a single institution between January 2017 and July 2018 were classified by skin preparation agents used (saline vs chlorhexidine). Patients who were re-admitted within 7 days following procedure with urinary infection with a pathogen were identified. Contingency tables were analysed using the chi-squared statistic and p < 0.05 was considered statistically significant. Results: A total of 719 patients underwent flexible cystoscopy during the study period; Saline preparation was used in 355 patients (49.4%). There was no difference in mean age (68.6 years vs 68.0 years, p= 0.66) and gender (p= 0.12) in chlorhexidine and saline groups. Post-procedure infection was observed in 8 patients (1.1%); 6 were urosepsis as defined by Sepsis-23 criteria and 2 were urinary tract infection (UTI). Significantly more post-procedure infections occurred in the saline group than the chlorhexidine group (7 vs 1, p= 0.03). There was an increased trend towards urosepsis in saline group (5 vs 1), but this was not significant (p= 0.09). There was no difference in infection rate by operators (p= 0.51) or if stent removal was performed during flexible cystoscopy (p= 0.21). Conclusion: Post-flexible cystoscopy infection was more common when saline skin preparation was used. A larger randomised study is needed to validate these findings. Introduction and Objective: Acute cystitis is a common infectious disease in women. Acute cystitis with extended-spectrum beta-lactamase pathogen (ESBL) causes an increase of medical cost, an increase of treatment period, changing antibiotics regimen and aggravating of infection to acute pyelonephritis which needs admission treatment. Unlike ESBL in acute pyelonephritis, only a few studies have focused on the prevalence and clinical outcomes of acute cystitis with ESBL. We investigated the prevalence and clinical characteristics of acute cystitis with ESBL in women for out-patients department (OPD). Efficacy of Intravesical Botulinum Toxin A as a Treatment to Relieve Symptoms in Adult Patients with Interstitial Cystitis: A Systematic Review Introduction and Objective: Interstitial cystitis/ bladder pain syndrome (IC/BPS) is an inflammatory condition of unknown aetiology associated with supra-pubic pain and other urological symptoms. Many treatments have shown limited efficacy in this difficult to treat condition. However, botulinum toxin A (BTX-A) given by intravesical sub-mucosal injection has been used as an unlicensed treatment for IC/PBS. It has been suggested that BTX-A has an effect on afferent neurons in addition to its well-known effects on the neuromuscular junction thereby improving both the urinary symptoms and pain seen in IC/PBS. The aim is to review the published data relating to the efficacy of BTX-A used in IC/PBS with respect to pain and symptom relief and to assess whether the pattern of intravesical injection (bladder wall vs. trigonal injection) impacts outcomes. Analysis of the RCTs suggests BTX-A improves pain control as well other symptoms compared to either placebo or alternative treatments such as hydrodistension and pentosan polysulfate (PPS). One paper compared trigonal and non-trigonal injections and found no significant difference between the two groups but both improved symptoms compared to baseline. Analysis of cohort studies found that BTX-A improved pain and other symptoms when compared to patient's baseline readings. Conclusion: BTX-A injection in the bladder has shown to be a safe and relatively effective treatment for patients with IC/BPS who have failed other conventional therapies. However, more detailed research is needed to determine the efficacy of BTX-A in IC/ BPS especially when considering doses used, outcomes measured, and injection protocols. Should Nephrectomy Be Done for Non-Functioning Kidneys due to Genitourinary Tuberculosis After Receiving Anti-Tubercular Therapy? Prakash P, Singh P, Seth A Introduction and Objective: To evaluate the role of nephrectomy for non-functioning kidney (NFK) due to genitourinary tuberculosis (GUTB) after receiving anti-tubercular therapy (ATT) by demonstrating whether live tubercle bacilli persists in nephrectomy specimens after treatment or not. Symptomatic patients with tubercular NFK who underwent nephrectomy after completion of at least 6 months of ATT, were included in this study. We sent tissue from the nephrectomy specimen and pus, wherever present, for acid fast bacilli (AFB) staining, polymerase chain reaction (PCR) and culture to look for live bacilli. Bacilli were considered alive only if AFB culture was positive. Only those patients were included for final analysis where histopathology of nephrectomy specimen was consis- Results: Twenty-seven patients underwent nephrectomy for NFK due to GUTB within 30 months duration. Nine of them had microbiological evidence of tuberculosis (either urine or pus for AFB positive or urine GeneXpert positive) before starting ATT. Remaining 18 patients were treated on clinical and radiological basis alone in absence of microbiologic evidence. Three of them were excluded because histopathology of nephrectomy specimen was not consistent with tuberculosis. The remaining 24 patients (18 females and 6 males) were included for analysis. Two patients showed persistent live bacilli in pus obtained from nephrectomy specimen, while one patient with concomitant renal and epididymal involvement, showed persistent AFB positivity in epididymal aspirate even after completion of ATT. Drug sensitivity testing showed multi-drug resistant (MDR) strain in all three patients and they were treated with second line ATT for 18 months. All of them improved significantly after therapy and showed no evidence of recurrence after one year of follow up. Conclusion: Nephrectomy in tubercular NFK may not be required in all cases, but symptomatic patients with hydronephrotic or pyonephrotic kidneys should undergo nephrectomy as they are more likely to harbour live bacilli. AFB culture from operated specimen must be done to identify drug resistant cases so that they may be treated with second line therapy if required. Introduction and Objective: Granulomatous prostatitis is a rare and benign inflammatory process. But in the absence of specific clinical signs and given the great similarity with a malignant tumor process, this diagnosis remains based on the anatomopathological examination. Our study focuses on the anatomopathological profile and aims to highlight its clinical character and treatment specificities. Our work includes 12 patients aged between 47 and 91 years followed in Sfax Urology Department, including 8 cases of xanthogranulomatous prostatitis and 4 cases of non-specific granulomatous prostatitis. Results: The average age of our patients was 66 years old. The most common reasons for consultation are dominated by voiding disorders including dysuria, pollakiuria, and acute urine retention with renal failure in one case. The digital rectal examination revealed an indurated hypertrophy of the pseudotumor-like deceitful prostate in 2 cases and a homogeneous hypertrophy not suspected in 10 cases. The PSA assays performed in 6 patients were >4 ng / mL in 4 cases. Hyperleukocytosis is observed in 6 cases. Cytobacteriological urine examination was positive in 3 cases. Ultrasonography performed in 8 patients visualized adenomatous prostatic hypertrophy in all cases. One of our patients underwent a prostate biopsy to make the diagnosis of xanthogranulomatous prostatitis, and then treated medically. In other cases, diagnosis was made after histological examination of the prostate resection. Conclusion: Xanthogranulomatous prostatitis is a rather rare benign inflammatory condition that often confuses with a malignant prostatic process. In view of the non-specificity of the clinical, radiological and biological signs, the diagnosis remains histological. Prostatic biopsies contribute to earlier diagnosis and more appropriate conservative treatment. Retroperitoneal Ascariasis: A Case Report Introduction and Objective: Infection with adult Ascaris primarily include the gastrointestinal system, but physical migration has been reported in a number of case reports. To date, only a small number of cases are available which involve the urinary system and no report of Ascariasis migration to the retroperitoneal space. This is a case of a 38-yearold female admitted as a case of right flank pain secondary to perinephric abscess, renal mass right, initially managed conservatively with IV antibiotics and percutaneous drainage. However, patient did not improve hence an emergency exploratory laparotomy, with retroperitoneal exploration done. During exploration, no colonic fistula was noted and upon opening the retroperitoneum, a 1 cm opening at the mid lateral pole associated with purulent discharge was noted. Interestingly, a 16x1 cm wax-like, moving structure was found in the retroperitoneal space. The object was removed with Debakey forceps and was sent to pathology for review. Histopathology revealed to be Ascaris Lumbricoides. The patient then had an uneventful recovery. Fecal analysis was negative for Ascaris. She was then discharged from the hospital with an improved condition. Results: This report is a unique and extremely rare case of Ascaris Lumbricoides presenting as perinephric abscess that has caused fistulation from the urinary tract to the retroperitoneal space Conclusion: Ascariasis of the genitourinary tract is a rare condition. This is the first reported case of ascariasis in the retroperitoneum. What is the Factor Influencing Erectile Dysfunction After Acute Myocardial Infarction? Song PH, Park JS, Choi JY, Kim YU, Ko YH, Moon KH, Jung HC Introduction and Objective: Erectile dysfunction (ED) is a common problem whose relation to cardiovascular diseases has been scientifically proven, but it has not been studied sufficiently in patients recovering from acute myocardial infarction (AMI). We evaluated the prevalence of ED and the predictive risk factors affecting erectile function after AMI. Materials and Methods: Seventy men (mean age, 60.8 ± 10.2 years) with AMI, who underwent coronary angiography, were evaluated for ED using a 5-item version of the international index of erectile function (IIEF-5) questionnaire. All examinees filled up the questionnaire twice at the beginning of the treatment and at least 6 months after the initial erectile function assessment. Risk factors for AMI were also reviewed. The correlation between ED and the number of involved coronary vessels, age, the number of accompanying cardiovascular risk factors and their current antihypertensive medications were analyzed, prospectively. Results: Among patients who recovered from AMI, 75% suffered from ED, of which were mild in 22%, moderate in 25% and severe ED in 53%. The prevalence of severe ED was significantly higher than other ED types (P<0.021). Risk factors of patients with AMI for ED were hypertension (48%), smoking (67%), coronary artery disease (55%), and diabetes (19%). On multivariate analysis, age and the number of involved coronary vessels were independent risk factors associated with prevalence of ED (P=0.034; Odds ratio=0.912, P=0.044; Odds ratio=0.281, respectively). None of the antihypertensive drugs were independently associated with the presence of ED. Self-reported reasons for decreased frequency of sexual activity were experiences of ED (40%), decreased libido (31%) and fear of recurrent heart attack (29%). This study provides data on the prevalence of ED and the significant correlation of ED with old age and the number of involved coronary vessels in patients with AMI. Although it is a well-known fact that AMI is associated with ED, most physicians do not inquire about ED, and most patients are too embarrassed to discuss it. Therefore, routine ED workup should be recommended for every patient included in the program of cardiac rehabilitation. Risk We performed a retrospective cohort study over a 2-year period at our tertiary centre. All patients with infection from upper urinary tract obstruction were included. Primary outcome was all-cause in-hospital major morbidity (Clavien-Dindo Classification III-V). Patients were assessed for SIRS criteria from presentation until the time of interventional procedures for urinary drainage. We evaluated the test characteristics of Sepsis-1 as a predictor of major morbidity. We identified 104 patients with infected and obstructed upper urinary tracts. 65 met the Sepsis-1 definition of at least 2 SIRS criteria, while 39 had 1 or 0 SIRS criteria. The overall major morbidity rate was 11.5% (0% Clavien III, 10.6% Clavien IV and 0.96% Clavien V morbidities). The major morbidity rate for patients who fulfilled the Sepsis-1 criteria was 18.5%, with a sensitivity of 100% (95% CI: 73.54-100%) and specificity of 32.4% (95% CI: 32.2-53.1%) to predict morbidity. The positive predictive value of the Sepsis-1 criteria to predict major morbidity was 18.46% (95% CI: 16.0-21.2%) and negative predictive value of 100%. There were no major morbidities among all 39 patients with 1 or 0 SIRS criteria. The Sepsis-1 definition performed well in risk stratification of patients with infected and obstructed upper urinary tracts. The high sensitivity and negative predictive value of Sepsis-1 demonstrated its clinical effectiveness as a screening assessment for patients at higher risk of major morbidity. Fungal Scrotal Abscess in the Immunocompromised Diabetic Introduction and Objective: We review a case of the rare complication of a fungal scrotal abscess in immunocompromised patient following multiple Urological procedures. Retrospective case report of a patient's journey through initial investigation, treatment and adjuvant therapies and review of the literature surrounding these rare abscesses and their risk factors. We present a case if a 71-year-old man with multiple presentations to our service with progressive urological pathologies over a 3-month period, likely as a consequence of his poorly controlled type 2 diabetes. He initially presented with proteus mirrabilis prostatitis, which transformed into an abscess, which was de roofed. He represented with unilateral epididymo-orchitis and what appeared to be a radiolucent stone on that side for which he received antibiotics and a stent. After settling he was discharged on antibiotics, but further represented with bilateral epididymo-orchitis which transformed into a right scrotal abscess. Scrotal ultrasound defined a likely right testicular abscess and concurrent CT abdomen ruled out any other focus of infection for his ongoing fevers. Urine microscopy showed budding yeast forms on gram stain and he was commenced on fluconazole in addition to meropenem. Scrotal exploration proceeded and resulted in a right orchiectomy for a necrotic focus and a multiloculated abscess. Intraoperative microscopy demonstrated a candida albicans for which he received antifungals. Histology was benign, revealing epididymal necrosis and disseminated abscess formation. His repeat CT also did not demonstrate the radiolucent stone for which he was previously stented, and his stent was removed 2 days following. Conclusion: This case highlights the need to consider implications of poorly controlled diabetes and its secondary immunosuppression in recurrent urological infection. A review of the literature found only limited reports of fungal scrotal abscess, but consistently within the immunosuppressed and poorly controlled diabetic patient. Incidence of urinary candidiasis has a widely reported range of incidence dependant on multiple factors. In the outpatient setting incidence is reported as low (under 3.3%) versus inpatient incidence ranging between 11 to > 40%. Treatment recommendations continue to be antifungals and surgical source control. Emphysematous Pyelonephritis: Trujillo Santamaria H Introduction and Objective: To determine morbidity and mortality in patients with emphysematous pyelonephritis subjected to urinary derivation versus nephrectomy with associated risk factors. A multicentre, observational, retrospective and comparative study was conducted in a period from June 2013 to December 2018 in 12 hospital centers in patients with tomographic diagnosis of emphysematous pyelonephritis according to the HUANG classification and were divided based on the treatment offered in two groups: early nephrectomy versus urinary diversion (JJ catheter, open or percutaneous nephrostomy). Results: A total of 182 patients were included, in whom the age of greatest incidence was between 50 and 59 years, with a greater predominance of females (73.53%), where more than 55% of the patients had a history of DM2 and CKD, as well as renal lithiasis, occurred in more than 60% of the population studied. Clinical and biochemical conditions were evaluated at hospital admission and 48 hours after performing a surgical intervention (urinary diversion versus early nephrectomy) and the response to it was evaluated. Morbidity and mortality were evaluated at 30 days according to the treatment offered. The main risk factors were identified during their illness, which was: Dm2, CKD, Renal lithiasis, Leukocytosis, neutrophilia, medial arterial pressure. In addition, a sub analysis was performed on early nephrectomy versus delayed nephrectomy (previously treated with urinary derivation), finding an advantage in survival in early nephrectomy. Ulrich CM, Götz M, Krah X Introduction and Objective: Calciphylaxis is a very rare disease with limited therapeutic options. There are only 24 to 35 documented cases/year. Due to a sclerosis of the media of small arteries and arterioles it comes to wound healing disorders. If superinfections occur, mortality increases by up to 80%. In June 2017, a 53-year-old man presented with necrosis on the foreskin and scrotum. The patient suffered also from dialysis-dependent diabetic nephropathy as well as a PAOD. Following initial cystofix placement, necrectomy, circumcision, and repeated wound revision, a secondary suture was performed on inconspicuous wound conditions. A little later, the patient again presented with necrosis and putrid secretion. In addition to largescale debridement of the wound to treat the histologically proved Fournier's gangrene, resection of the penis and scrotum followed by vacuum therapy. Because of persistent wound problems, we performed a penile amputation and colostomy. In total, 48 operative interventions were required in 3 months. The cause of the extremely poor wound healing was a medicinal not controllable Calciphylaxis. In the further course, the patient suffered apoplexy. A little later there was readmission with progressive deterioration. Finally, the patient suffered a hemodynamically effective pericardial effusion and died. The simultaneous occurrence of calciphylaxis and Fournier´s gangrene carries a high risk of mortality (about 60%) and thus represents a special medical challenge. Dialysis-dependent patients with wound healing disorders should, therefore, be carefully examined regarding an underlying Calciphylaxis. Introduction and Objective: Microdissection Testicular Sperm Extraction (micro-TESE) is a surgical method used for obtaining sperm for men with non-obstructive azoospermia. Success rate for this procedure ranges between 25% to 60%. Clomiphene citrate stimulates LH and FSH production. Its use currently is still off label in men. It has been found that using CC prior to micro-TESE gave a better chance of sperm retrieval. We usually prescribe CC by in 50 mg doses once daily for 6 months prior to micro-TESE. This retrospective study included all patients who underwent Micro-TESE between August 2015 to November 2018. Data on preop hormonal levels, testicular volume, and associated genetic abnormalities were collected. Results: 122 patients were included in this study mean age was 37 ± 8.84 years, mean LH was 8.32 ± 6.08, mean FSH was 15.83 ± 11.64, mean testosterone level was 15.84 ± 9.50. Thirty-seven (30.32%) of patients were taking CC. Karyotyping was done showing that 11 (9%) patients had Kleinfelder syndrome and two of them were taking CC and 3 (2.5%) patients had Y chromosome micro deletion and none of them were on CC. The overall sperm retrieval rate was (44.3%) and (50%) in the normal karyotype group. Micro-TESE results were not found to be statistically affected by age, testosterone levels, Kleinfelder syndrome, and CC. However, higher testicular volumes and Lower LH and FSH levels were found more in positive micro-TESE this was statistically significant. Furthermore, Taking CC was associated with higher levels of LH and FSH levels, this was not statistically significant. Conclusion: Micro-TESE results were found to be unaffected by CC, age and testicular volumes. This is contrary to the belief that it holds a positive impact on micro-TESE outcome. We recommend for this finding to be further explored on a larger sample size and different study design. Nine patients (32.14%) had significant improvement in sperm parameters and the remaining portion either had no change in SA or became azoospermic this difference was not found to be statistically significant (p >0.05), on short-term follow-up. The magnitude of improvement after microsurgical varicocelectomy for severely oligospermic pts is lower than reported in mild male factor infertility. Future studies are needed on larger scale to include also impact on IVF results. Using new molecular and morphological approaches, monomorphic teratozoospermia are currently being better-known with the recognition of numerous subtypes and the description of some recurrent mutations. Here, we present the genetic aspects and clinical characteristics of 24 Tunisian infertile men with monomorphic teratozoospermia. A monocentric study, about a serial of 24 Tunisian patients with monomorphic teratozoospermia and for who clinical, morphologic and genetic explorations have been done, was conducted. Data was collected from the medical and genetic records of the Histology Department of the Medical University of Sfax. Results: Macrocephalic sperm head syndrome (SMP) was noted in 14 cases and globozoospermia or round-headed sperm syndrome (STR) in 10 cases. The average age was 39 years old. The mean duration of primary infertility ranged from 5.6 years (SMP) to 7.6 years (STR). Oligo-astheno-teratozoospermia was noted in 80% of patients. 43% of SMP patients who were involved in assisted reproduction treatment (ART) failed to conceive in all cases, whereas among 70% of STR patients who were conducted into ART cycles, only one couple gave birth to a healthy twin using oocyte activation protocol. 71.4% of SMP patients were molecularly explored for the c.144delC microdeletion of exon 3 of the AURK C gene. Five SMP (type 1 form) patients were found to be positive and homozygous for the microdeletion whereas five patients (SMP type 2 form) were negative. 70% of STR patients were explored for the c.848G> A mutation of exon 4 of the SPATA 16 gene and only four STR patients for DPY19L2 gene rearrangements. No mutations were detected. The karyotype was normal for 23 patients with 46, XY formula whereas a reciprocal translocation involving chromosomes 4 and 16, was detected in one SMP patient (type 1 form). Our study demonstrated the impact of the implementation of genetic and morphological techniques as well as new ART techniques and procedures in order to precise the diagnosis and the fertility prognosis of monomorphic teratozoospermia. Introduction and Objective: The nature and magnitude of reproductive toxicities are often dependent on exposure levels, but these factors are difficult to assess in an occupational setting. The aim of our study was to investigate the association between occupational exposures and alteration of sperm parameters as well as the cumulative effects of exposures. A cross-sectional descriptive study was conducted at the Department of Histology, Embryology and Genetics of the Medical University of Sfax (Tunisia) involving 250 infertile men who were attending the genetic counseling for diagnostic purposes to their infertility during a period of two years. All participants were interviewed and provided a se- UP.161, Table 2 : The association between taking CC and sperm retrieval. men sample and a blood sample. A detailed questionnaire about the exposure to occupational factors was performed. According to job-exposure matrix, men were classified as either occupationally exposed or non-exposed. Semen as well as chromosomal analysis was performed. Statistical analysis and correlations were conducted using SPSS IBM 20 for Windows. The significance in the differences was evaluated by using Student and ANOVA tests. Results: Of 250 infertile men, 119 (47.6%) were exposed and occupational exposures were to solvents (54.6%), endocrine disruptors (30.3%), metals (29.4%), high temperatures (20.2%), UV radiations (14.3%), and pesticides (12.6%). Thirteen exposed patients had a single identified exposure (25.21%), 51 were exposed to two factors (42.85%), 32 to three (26.89%), and 4 for four agents (3.36%). Secondary infertility has most often observed in patients with two recorded occupational exposures. Severe changes in sperm parameters had been frequently observed in men exposed to two or three reprotoxic agents. Even though, using one-way ANOVA analysis of variance, no significant positive association between the number of occupational exposures and the spermatic profiles was found. Moreover, eight of twelve exposed men recorded as having cytogenetic abnormalities (66.7%) were exposed to at least 2 or 3 toxic agents. Although, multiple exposure was not statistically associated with an altered karyotype (p = 0.05). Conclusion: Our findings suggest that occupational exposure may affect male fertility and semen quality. However, no statistical association between the number of exposures and the degree of semen alterations was demonstrated. The magnitude of reproductive toxicities is often dependent on exposure levels, but their assessment is difficult in an occupational setting. Further studies are needed to evaluate the association between combined occupational exposures, altered sperm parameters and genomic alterations. Preventive measures must be established and could be completed by the use of biomarkers to a better characterization of combined exposures to chemicals and non-chemicals factors and their commutative spermiotoxic effects. Introduction and Objective: Bardet-Biedl syndrome (BBS) is a ciliopathy causing multivesicular abnormalities. It is a rare and heterogeneous genetic condition characterized by obesity, mental retardation, dysphoric extremities, retinal dystrophy, hypogonadism and genitor-renal anomalies. To date, mutations in 18 different loci are responsible for BBS phenotype. We report two Tunisian patients who attended our genetic counselling because of ambiguous genitalia for the first patient and primary infertility for the second and for who the diagnosis of BBS was done clinically. Results: The first patient was a 24-year-old male who was referred because of aspermia. Patient history reveals parental consanguinity, familial cases of polydactyly and bilateral orchiopexy one year ago. Physical examination showed poor visual acuity, strabismus and gaze nystagmus (with retinal degeneration at ophthalmologic examination), obesity, tetramelic postaxial polydactyly, superficial dilatation of veinules, dental problems, short neck, low hairline at the nape of the neck, impaired coordination and ataxia and moderate mental deficiency. At sexual level, the patient had severe disorder of sex development (DSD) without renal abnormalities, a female voice, small empty scrotums that look like labia majora with a severe microphallus. Cytogenetic evaluation reveals a 46, XY male formula. The second patient was a 34-year-old man who was referred because of a primary male infertility with cryptozoospermia and failure of two ICSI attempts. He had the same specific signs of BBS syndrome but at the sexual level, he had unilateral right cryptorchidia, normal penile and normal sexual activity. Cytogenetic evaluation reveals a 46, XY male formula. He failed to conceive by intracytoplasmic sperm injection using intra-testicular spermatozoa. Conclusion: BBS is a rare autosomal recessive genetic disorder. It is characterized in males by heterogeneous genital phenotype with a large spectrum of genital abnormalities varying from sexual infantilism to subnormal male phenotype associated or not to hypogonadotropic hypogonadism but with invariable infertile phenotype. Here, we describe an exceptional case of BBS carrying a low amount of spermatogenesis. A genetic testing will be mandatory before other attempts of medically assisted procreation. Varicocele is present in 15% of the general population, and in 35% of primary infertility and 70-81% of secondary infertility cases. Its correction improves semen parameters and pregnancy rates. However, it is still controversial if varicocelectomy has the same efficacy in older males. We retrospectively analyzed all cases of varicocelectomy due to infertility between 2012 and 2018, evaluating its efficacy in sperm parameters and pregnancy rates improvements, and verifying if there were any differences between two age groups. Results: In this period, 42 patients underwent varicocelectomy, with a mean age of 33.3 ± 5.1. Overall, there was an improvement in sperm concentration (p<0.001), progressive motility (p=0.001) and morphology (p=0.001), although in the last there was a higher number of males without any change (n=20, 48%). There were no differences related to sperm volume (p=0.1). Dividing the patients in two different groups, using as cut-off the mean age (< 33 vs ≥ 33 years), we observed no differences regarding the number of patients who presented any kind of improvement in semen parameters (67% vs 58%, p=0.582). However, there was a more pronounced improvement in the sperm concentration in the younger group (increase of 203%, p=0.02 vs 94%, p=0.004), and this was also the only group who presented an improvement in motility (increase of 33%, p=0.001). Overall, the patients' spouses' pregnancy rate was 35%, the majority of them (71%) from males who have had improvement in sperm parameters. The younger patient group presented a statistically significant higher rate of deliveries (60% vs 20%, p=0.006), that remained even after adjusting for the spouse age (OR= 5.55, p=0.035). Varicocelectomy is an effective technique in the improvement of sperm parameters, with the younger males being the ones who benefit the most. Surgical correction in a younger age is associated with a better success in pregnancy rate, and so it should be employed early. Enhancement (13%) and normal spermatogenesis in 7 (7.4%) of patients. Conclusion: In our hands and in the absence of Micro-TESE facilities, applying this standardized technique with pre-operative hormonal manipulation yielded accepted rate of sperm retrieval. This approach saved our patients with positive sperm unnecessary extra-biopsies. Randomized study for pre-TESE hormonal stimulation is warranted to justify its routine use. Prevalence of Chromosomal Abnormalities Among Non-Obstructive Azoospermic Patients, Tabuk Experience Introduction and Objective: Chromosomal or genetic abnormalities account for around 10% of male infertility. The prevalence among non-azoospermia patients is much lower while in azoospermia patients is higher. Our aim is to define the prevalence of chromosomal anomalies among our azoospermia patients in Tabuk area. All non-obstructive azoospermia patients evaluated in our hospital from 2010 until 2018 were subjected to chromosomal analysis after full clinical, laboratory and radiologic work up. Analysis included karyotyping and study of Y-chromosome micro-deletions. Patients with iatrogenic causes of azoospermia as those post-chemotherapy or vasectomy as well as cases of obstructive azoospermia were excluded. Results: Out of 115 non-obstructive azoospermia patients evaluated in our hospital, 14 (12.17%) showed abnormal chromosomal pattern. Klinefelter syndrome (47XXY) was detected in 9 of them (7.82%) where it accounted for 64.3% of our patients' chromosomal anomalies. Y-chromosome microdeletions were detected in 3 (2.6%) of our cases. One case of abnormal chromosome 16 and another case of Balanced Robertsonian translocation between chromosome 13 and 14 were diagnosed. All those patients were referred for higher center for pre-implantation genetic diagnosis in conjunction with micro-TESE Conclusion: Chromosomal abnormalities were detected in significant number of our non-obstructive azoospermia patients. All these patients need genetic counseling and discussion of the significantly lower sperm retrieval rate during TESE among them and possible transmission of the abnormality to their children. The Experience of Vassal Sperm Aspiration on Patients with An-Ejaculation or Retrograde Ejaculation Introduction and Objective: To update the feasibility and outcomes of loupe-assisted vasal sperm aspiration for sperm retrieval of male infertility due to anejaculation and retrograde ejaculation. We retrospectively reviewed vasal sperm aspirations on 10 patients with an-ejaculation or retrograde ejaculation during the recent 3 years from 2015 to 2017. We collected pre-operative serum hormonal data (testosterone, follicle-stimulating hormone, luteinizing hormone and prolactin) and comorbidities of each patient. Every patient received standard procedure of vasal sperm aspiration by single surgeon with immediately specimens interpreting and then was follow-up at clinics. Results: Of all, 4 patients with retrograde ejaculation and 6 patients with an-ejaculation. There were 7 patients with controlled diabetes mellitus, one with ejaculating duct stone and one with unilateral testicular cancer status post orchiectomy and adjuvant chemotherapy, only one without any comorbidity. Aspirations were performed for use with assisted reproductive techniques in 9 cases and for cryopreservation alone in one. The average total sperm count was 178 × 106, with the motility between 9% and 66.7%. Three of the population had received open testis biopsy or microsurgical epididymal sperm aspiration (MESA) before vasal aspiration but prior result of semen analysis was poor quality for use in vitro fertilization (IVF). No complications have been observed to date. Vasal sperm aspiration is a simple and effective method as alternative to sperm retrieval, considering its advantage of high success rate while less invasive and destructive for reproductive system, it could be performed prior to retrieval from epididymis or testis. The Results: According to the results, 30 patients (60%) from the 50 who underwent surgery, had a semen improvement 3 months after surgery and half of them 15 (30%) infertility treatment with pregnancy. These percentages are comparable to those referred in international bibliography. Conclusion: Varicocele is considered as a cause of male infertility, that can be treated either incisional, laparoscopic or radiologic, which depends of the experience of the medical practitioner. Treatment of varicocele should be considered from the urologists in patients with pathologic spermogram where other causes of infertility excluded, as it seems to improve spermogram in many cases and can also lead to pregnancy. Clinical effect of phosphodiesterase 5 (PDE5) inhibitors has been less addressed on fertility. Regarding this, in this clinical study, we investigated whether oral sildenafil administration modifies seminal parameters. In a double-blind, randomized, placebo-controlled, cross-over, from October to March 2016, we enrolled 79 infertile patients. Patients were assigned to two groups A and B. In group A, patients initially received 50 mg sildenafil citrate and then received placebo after the washout period; in group B, patients initially received placebo and then received 50 mg sildenafil citrate after the washout period. People were asked not to ejaculate 3 days before administration and avoid smoking and caffeine. Then the two groups listed above replaced each other, so that the group receiving sildenafil received placebo on this occasion after the washout period and the appropriate time to test the next semen analysis which was considered one week. Meanwhile, all studied patients did a single semen analysis one week before receiving the first dose of drug or placebo in the same lab. The mean age of patients was 34.5 years. There was no significant difference in the mean sperm count before receiving the drug in all groups. Sperm count, motility, morphology, pH, viscosity, and liquefaction time of semen did not significantly change after receiving sildenafil in comparison to placebo group (P > 0.05). These results indicate that sildenafil did not change sperm parameters in treating infertile patients; it also had no positive effect on semen parameters. Nano Curcumin Effect in Nuclear Factor Kappa B (NFkB), Tumor Necrosis Factor-a (TNF-a) and Interleukin-10 (IL-10) in Preventing Antisperm Antibody Introduction and Objective: Antisperm antibodies (ASA), one of the causes of immunological factors. ASA occurs due to damage to blood testes barrier (BTB). Inflammation can release of pro-inflammatory cytokines TNF-a, so that activation occurs NFkB transduction pathway through IKK. Nano curcumin which is the active ingredient of ginger in nano size that can inhibit the activation of NFkB. Randomized experimental design, carried out to determine the role NFkB, pro-inflammatory cytokines TNF-a, anti-inflammatory cytokine IL-10 level in the ASA artificial on adult male Wistar rats aged 10-12 weeks by administering 80 mg of curcumin nano/kg body weight There are 3 treatment groups, the group given nano curcumin 7 days, the group given dexamethasone tablets, and a placebo. Before treatment of blood taken for examination TNF-a, and IL-10 NFkB with ELISA method, and performed a biopsy on the left testicle to be examined immunohistochemistry. After the examination the same treatment as before with left orchidectomy. Results: TNF-a, IL-10 and NFkB level on nano curcumin group showed significant differences (p <0.05) before and after treatment. Comparison of the percentage change in the variable from before to after treatment obtained a significant decrease in the percentage of TNF-a (p= 0.001) in the amount of 20.3% (p=0.001) and the percentage decrease in NFkB is 22.53% (p= 0.043) in the group given nano curcumin. There is a significant correlation between the study variables in the percentage decrease of TNF-a and increase in IL-10 in the group given curcumin nano r= 0.90 with p= 0.037 and the percentage decrease of TNF-a and the percentage decrease of NFkB with r= 0.06 and p= 0.04. The results of immunohistochemistry, nano curcumin can prevent the occurrence of ASA by 57%. Conclusion: Nano curcumin shows anti-inflammatory effects by inhibiting TNF-a, NFkB and increased levels of IL-10 to prevent the ASA. Role Twenty-four Wistar strain rats are grouped into 4 groups. The control group performed only an orchidectomy, ligation without release ligation group, ligation with release ligation of vas deferens group, and EPO group that got injection with dose of 1000 iu/kg BW intraperitoneally for a week after release ligation of vas deferens. Spermatogonium, Sertoli and Leydig cells counted by the number on the 5 cross sections of the seminiferous tubules using a 400x light magnification microscope with Haematoxylin Eosin staining. The number of apoptosis observed using TUNEL staining assay. Eosin-stained slides were prepared to assess the motility of sperm cells. Results: Ligation release action affect spermatogonium cell count and EPO group have higher spermatogonium cell counts significant difference in number compared to other three groups (p<0,05). EPO group not only shows higher cell count of spermatogonium but also higher Sertoli and Leydig cell count compared to other groups (p<0,05). The number of apoptosis shows a lowest in EPO group compared to three other groups (p<0,05). There is a sig-nificant difference in the motility of sperm cells in the control group compared with the vasectomy group (p <0.05). The individual movement percentage of sperm cells in ligation group were fewer in number than the vasectomy group (p< 0.05). Administration of EPO after releasing the ligation of vas deferens had a best percentage of the motility than the vasectomy group and the ligation release group (p<0,05). Erythropoietin improved the amount of spermatogonium, Sertoli cell, Leydig cell, sperm motility and decrease apoptotic number in Wistar rat after releasing the ligation of vas deferens. Effect of Tyrosine Kinase Inhibitors on Spermatogenesis Introduction and Objective: With marked improvement of cancer treatment, fertility issues are one of the greatest concerns for cancer survivors. Spermatogenic impairment, such as irreversible azoospermia, occurs after classical chemotherapy (i.e., platinum containing drug, alkylating agents and anti-metabolites), whereas information regarding to the effect of molecular target drugs, such as tyrosine kinase inhibitors (TKIs), on the spermatogenic function is limited. March 2017, a total of 12 patients with TKIs were included, and testicular volume, semen examination, and endocrine findings were evaluated. Results: Mean patient age was 34.6 years (range 22 to 53). Seven patients were CML, three were renal cancer, one is AML or GIST, respectively. TKIs prescribed on these patients were dasatinib, imatinib, nilotinib, sorafenib and sunitinib. Average semen volume was 2.04 mL (range 1.5 to 3.5 mL), sperm concentration was 42.41 x 10 6 /mL (range 3 x 10 6 to 130 x 10 6 /mL), sperm motility was 39.8% (range 5 to 70%), FSH was 5.6 mU/mL (range 3.8 to 8.9 mU/mL), testosterone was 4.28 ng/mL (range 2.9 to 5.5 ng/mL), and testicular volume was 17.7 mL (range 14 to 22 mL). Potentially TKI may cause spermatogenic dysfunction although it is milder than those of classical anticancer agents. Ali R Introduction and Objective: The incidence of stone disease in pregnant women is same as of non-pregnant women, but the management is big challenge during pregnancy. There are various negative consequences of symptomatic stone disease on both mother and baby. The objective is to evaluate possible outcomes of stone disease during pregnancy. We are recruiting patients prospectively, presenting in our clinics or seen on floor. Data is collected for age, gestational age, clinical presentation, findings of ultrasound, any radiological or surgical intervention and follow up. Results: In our initial 35 patients, the mean age is 30 years, most common presentation is with right flank pain in 2 nd trimester, all patients had ultrasound scan as initial investigation. Most of them treated conservatively, three patients had right PCN insertion and one had two patient had JJ stent insertion. One patient with solitary kidney had miscarriage. Conclusion: Conservative approach is main stay in treatment of stone disease during pregnancy. Surgical or radiological intervention is option for complicated cases. Staghorn Calculi Due to Uric Acid Introduction and Objective: Staghorn calculus means infective stone is known fact. But many staghorn calculi are caused by uric acid. We want to share this changing trend of staghorn calculi and how to suspect them at time of surgery. Stone occupying major part of pelvis and extending in one or more calyces is taken as staghorn calculus. No differentiation made whether partial or complete. Results: Out of 210 staghorn calculi, 49 (23.3%) patients were found to have uric acid as major contributor for stone composition. Rest were infective (Triple phosphate and calcium oxalate). Uric acid stones are golden yellow in colour, smooth surface, soft in consistency and easily fragmented with pneumatic lithoclast or shock-pulse lithotripsy system where suction is used. Conclusion: Incidence of staghorn calculus due to uric acid is increasing and this changing trend needs attention. Uric acid calculi can be suspected due to its appearance and softness at time of stone fragmentation and can be confirmed by stone analysis, so that specific treatment for prevention of recurrence can be advised. Our Experience of Combined Energy Source with Suction Device Through PCNL for Staghorn Calculi Introduction and Objective: Stone fragmentation and retrieval in staghorn calculus is tedious, time consuming and causes blood loss. There are many energy sources for stone fragmentation (Pneumatic, Ultrasonic, Laser, etc.) and each has its own advantages as well as limitations. A new device consisting of mechanical and ultrasonic energy with suction for stone retrieval was evaluated for its efficacy and benefits as well as its limitations, at time of PCNL for staghorn calculi. Material and Methods: Retrospective data of last 3 years from March 2016 to March 2019 was studied, 161 cases of staghorn calculi treated by PCNL as a mono-therapy by single surgeon. Stone hardness was evaluated by KUB X-ray and CT Scan. On CT stone more than 1000 houns field units were taken as hard stone. In 81 patients with hard stone, pneumatic lithoclast used for fragmentation and fragments removed by stone grasping forceps. In 80 patients with soft and moderately hard stone, shock pulse lithotripsy system was used for fragmentation and retrieval. This new device (from Olympus) consists of mechanical and ultrasonic energy combined together and large bore 3 mm suction channel is incorporated in hand piece only for stone retrieval. Stone fragmentation and retrieval time, blood loss, clarity of endo-vision and subjective comfort level of surgeon were compared in both groups of patients. Results: Stone fragmentation and retrieval time and blood loss was less in shock pulse device was used. There was excellent endo-vision. Stone migration and mucosal injury was less. Device was very comfortable for surgeon, though hand piece is heavy. Conclusion: New shock pulse lithotripsy system is very useful for soft to moderate hard density staghorn calculi during PCNL. Introduction and Objective: The use of ureteric stenting post ureterorenoscopy (URS) remains controversial, with stent symptoms causing significant morbidity. The objective of this study is to determine the indications for stent use in large series. A prospective database of 1418 URS performed at our institution was retrospectively analyzed. UP.179, Figure 1 . In uncomplicated cases, ureteric stenting post URS for diagnosis, ablation of small tumors, and fragmentation of stones under 10 mm or < 1000 HU can be avoided. The highest stenting rates were for stones in renal pelvis and proximal ureter. Results: The series accounts 13 males and 7 females, with a median age of 44,7 years (19-72). Renal ectopia was an incidental finding in 6 patients. Otherwise, pain was the main presenting symptom (n= 13) followed by lower urinary tract symptoms (n= 3) and hematuria (n= 1). Physical examination revealed a tender abdominal mass in only one patient. Excretory urography had made the diagnosis in 17 cases and CT scan in 3. In 8 patients both kidneys were on the left and in twelve both were on the right side. CRE was with fusion in 13 cases: S-shaped kidney in 7 cases, L-shaped in 4 cases and disc kidney in one case. Additional congenital anomalies were especially of the skeletal system. It was complicated with renal stones in 5 patients and hydronephrosis in one patient. Treatment was conservative in 15 patients, pyelolithotomy in 3 patients, ESWL in one case and nephrectomy in one patient. With a median follow-up of 41 months, we didn't detect any complication. Conclusion: CRE is a rare entity in adults. Diagnosis is more and more fortuitous. Symptoms are often due to complication or associated abnormalities. Treatment should be conservative as possible as we can. The objective of the study is to point-on and to analyze medico-legal aspects of conventional nephrectomy overuse for benign conditions in adults. We retrospectively reviewed the records of all patients who had conventional nephrectomy within the 20-year period between January 1994 and December 2014 at Mohamed Tahar Maamouri University Teaching Hospital in Nabeul, the Rabta University Teaching Hospital and Security Forces Hospital in Tunis. The entire data of each patient was reviewed by two senior urologists without reference to the original readings to decide if nephrectomy was objectively the only therapeutic option and if there was any neglect or suspicion of medical malpractice leading to this procedure. In 14 patients, we didn't find in the medical documentation sufficient data to justify nephrectomy. The age of the patients ranged from 23 to 67 years (Mean age 41.4 years). Most of them were female (n=8). Most nephrectomy was on the right side (n=9). They have history of PCNL for pelvic stone (n=1), ureteroscopy for lumbar ureteral stone (n=1) and ureteroscopy for ureteral Stein Strasse post-ESWL (n=2). Nephrectomy was performed in PUJO (n=4), staghorn stone (n=3), pelvic stone (n=4) and lumbar ureteral stone without real evidence of non or poor functioning kidney. Nephrectomy was an easy solution for complicated cases in eight cases. Ablative surgery was indicated on the IVU data in 5 patients, in whom renal parenchyma was normal in three. Histopathology studies concluded to chronic pyelonephritis without sign of malignancy in all cases. Three patients continue to complain of back pain, and one had developed UP.179, Figure 2 . So, the aims of this study were to investigate the effect of hypoxia on generation of MSC-EV, and further to verify its protective role in renal IRI. Human umbilical cord MSC was isolated and cultured in vitro. The cells were cultured under normal oxygen (21%) and hypoxia (3%) conditions for 24 hours respectively, and the proliferation rate was tested. Meanwhile, cell conditioned medium was collected, and EV was isolated for quantitative analysis. Further, the expression of EV generation related Hif-1a/PRAS40/RAB27A pathways were detected. In vivo study, normoxic and hypoxic MSC-derived EV were used to treat rat renal IRI (right nephrectomy and left renal ischemia 45 minutes) model for 24 hours. Renal pathology score and functions were tested to evaluate the therapeutic effects. Results: The proliferation of MSC was not affected by hypoxia culture (3%), but hypoxia could promote EV production significantly. Meanwhile, Hif-1a/ PRAS40/RAB27A pathways were activated under hypoxia conditions. In vivo, MSC-EV reached the injured kidneys after 24 hours. Further, compared with normal oxygen MSC-EV, hypoxic MSC-EV treatment rats showed lower renal tubular injury and serum creatinine levels. Conclusion: Hypoxia could promote the generation of MSC-EV and enhance its therapeutic effect on renal IRI, and the regulation of Hif-1a/PRAS40/ RAB27A pathways may play an important role. The results will provide a new research idea for the efficient acquisition and utilization of MSC-EV in renal IRI treatment. Open Results: The two groups of patients were statistically comparable in terms of epidemiological characteristics (age, sex, weight, body mass index, antecedents, etc.), in terms of current medical history, physical examination data, and kidney to remove. The average size of the kidneys removed by laparoscopy was significantly lower than that of the kidneys removed by open sky (7.51 cm versus 10.69 cm) and the difference was significant (p < 0.001). Lithiasic pathology was the main cause. At nearly equal intraoperative complication rates, laparoscopic simple nephrectomy was superior to open nephrectomy in terms of blood loss and transfusion, type of analgesia, dose of paracetamol received, early postoperative complications, early and late postoperative pain, duration of hospital stay, and duration of convalescence. In the laparoscopic nephrectomy group: The size of the kidneys removed was the predictive factor for increased intraoperative complications; surgeon experience was the predictive factor in decreased postoperative analgesia, decreased early postoperative complications, and decreased length of hospital stay. Laparoscopy is currently a well-coded first safe pathway; it is a technique of choice in the treatment of upper urinary-tract pathologies including nephrectomy. Comparison of Acute Phase Response in Patients Undergoing Open Versus Laparoscopic Nephrectomy Introduction and Objective: Laparoscopic nephrectomy is greatly increasing and become the standard of care in candida patients, but there remains little evidence on the stress response following the procedure. The aim of this study was to evaluate the inflammatory response to laparoscopic nephrectomy and compare it with the response generated by open surgery. This was a prospective randomized comparative study involving 60 patients divided into 2 main groups (open and laparoscopic) each of them containing 30 patients. Blood samples were obtained from all patients preoperatively, 24 h and 48 h postoperatively and examined for: differential white blood cells (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and interleukin 6 (IL-6). Also, data regarding operative time, intraoperative blood loss, postoperative fasting period, hospital stay period and time needed till return to work were collected and compared. Results: There was no significant statistical difference between both study groups preoperatively. WBCs count, CRP and IL-6 were increased postoperatively in both groups, but the increase was more in open than in the laparoscopy group. The difference was highly significant in CRP and IL-6. There was no significant difference between the increases in the ESR in the 1 st day postoperative in both groups, while the increase was higher in open group at 2 nd day postoperative. There was no difference between both groups regarding operative time. The amount of intraoperative blood loss, postoperative fasting period, hospital stay period and days till return to work were higher in the open group. Conclusion: This study shows that when compared with open surgery, laparoscopic nephrectomy results in a less pronounced inflammatory response and more pronounced anti-inflammatory action. So, the laparoscopic nephrectomy is less stressful than open surgery. Prevalence of Histopathological Subtypes of RCC in a Middle Eastern Population: A High Prevalence of Chromophobe RCC Introduction and Objective: The incidence of RCC is on the rise in the Western hemisphere and is reported to vary widely amongst different populations. The histopathological subtypes also vary based on genetic and geographic factors. There is paucity of data on the subtype distribution and prognosis in the Middle East region and minimal reporting on disease recurrence and progression. We herein examine the incidence and relative frequency of pathological subtypes of RCC in a tertiary Middle Eastern referral center. Validation of the RENAL Nephrometry Score for Tumor Complexity and its Concordance with the Surgical Approach Performed and Application of Nephron Sparing Surgery Introduction and Objective: The RENAL nephrometry score (NS) was introduced by 10 years ago and is based on five critical and reproducible anatomic features of solid renal masses. We evaluated the correlation of tumor complexity using RENAL-NS and the type of renal surgery performed in a tertiary referral center in the Middle East, during the introduction of the Da'Vinci Robotic system. 5, 6 and 7, 8, 9) , and radical nephrectomy was applied to 20% of these patients. By contrast, radical nephrectomy was applied the majority of patients (79%) with high complexity tumors (RENAL-NS=10, 11, 12). 9/48 patients (19 %) who underwent Radical Nephrectomy group, had low complexity tumors, and majority of this subgroup had LRN (Table 3 ). In NSS cohort, minimally invasive approach (LPN/RAPN) was utilized in 59 and 69% for tumors with low and moderate complexity, respectively and in 50% for high complexity tumors ( Table 2) . Tumor complexity is not the only factor influencing the decision for adopting NSS versus radical nephrectomy. RENAL-NS standardizes and effectively stratifies renal masses facilitating the decision for NSS and the application of minimally invasive approaches such as RAPN. We recommend prospective and meticulous recording of the RENAL-NS for all patients presenting with renal tumors and its inclusion in tumor registries. Quantitative We aimed to conduct an extensive quantitative proteomic analysis of renal cell carcinoma (RCC) and detect the proteins and biological processes which may play a role in the critical steps of oncogenesis and tumor progression. Proteins were isolated from the tumor and adjacent normal tissues of 13 patients who underwent nephrectomy due to RCC. Obtained peptides were chemically labelled with different dimethyl isotopes. Liquid chromatography-coupled tandem mass spectrometry (LC-MS/MS) was used to distinguish cancer/normal peptides. The mix samples were fractionated by Strong Cation Exchange chromatography prior to LC-MS/MS analysis for a comprehensive proteome coverage. Only the proteins that had tumor/normal ratios in a minimum of 70% of the 13 patients were used for data analysis. In order to identify significantly UP-and downregulated proteins in the cancer tissue compared to adjacent normal tissue, a two-tailed Wilcoxon signed rank test was employed. Gene Ontology enrichment analysis of significantly regulated proteins was conducted using the PANTHER v13.1 webtool to reveal predominant biological processes. years. All of the excised RCCs were of clear cell subtype. ISUP grade and pathological T stage distributions were as follows: grade 2 (n= 4), 3 (n= 4), 4 (n= 5) and pT1a (n= 2), pT1b (n= 3), pT3a (n= 8). Two patients had metastatic disease at the time of surgery, while the others had localized/locally advanced disease. A total of 10,160 RCC-associated proteins were identified. The most commonly upregulated and downregulated biological processes in tumor samples were antigen processing-presentation, glycolysis, RNA splicing and ferredoxin metabolic process, oxidative phosphorylation, tricarboxylic acid cycle, respectively. Regarding the comparison between RCC grades, fatty acid beta-oxidation and cell-matrix adhesion were the most significantly upregulated and downregulated processes, respectively in grade 4 vs. grade 3 RCCs. Proteins that were involved in RNA splicing were found to be significantly downregulated in grade 4 vs. grade 2 RCCs. Conclusion: To our knowledge, results of this study represent the largest proteome of RCC. A Warburg-like protein profile, which is characterised by elevated glycolysis and glycogen metabolism and reduced mitochondrial energy metabolism, have been detected in RCC samples. Biological processes that exhibit significant difference between RCC and normal tissue may shed light to discovery of biomarkers. Differences in RCC grades in terms of their proteomic profile and up/downregulated biological processes might be useful to generate novel therapeutic targets to slow down disease progression. Is In this technique, a ureteral catheter is placed before nephrectomy with cystoscopy. After nephrectomy, the ureter is released as far distally as possible to the bladder whether an open or laparoscopic approach and the catheter is secured to the distal portion of the ureter. The patient is moved to the lithotomy position, and the ureter is intussuscepted into the female urethra with retrograde traction. The distal ureter and bladder cuff is removed from the urethra and surrounding the cuff marked with a few stitches and cut off and the remaining ad- Introduction and Objective: The overexpression of hypoxia induced factor 1a/2a in ccRCC leads to up-regulation of vascular endothelial growth factor (VEGF), resulting in increased angiogenesis, tumor metastasis, and treatment resistance. Using several preclinical xenograft models, we demonstrated that therapeutic doses and schedules of the selenium-containing molecules, seleno-L-methionine (SLM), and methyl selenocysteine (MSC) caused enhanced degradation of HIF1a/2a, down-regulation of oncogenic miRNA-210 and 155, up-regulation tumor suppressor miRNA-664 and LET-7b, and stabilization of tumor vasculature, yielding higher tumor drug uptake and protection from toxic side effects when combined with chemotherapeutic and VEGF-targeted agents. We report a phase I (3+3 design) dose finding trial of SLM (2500, 3000 or 4000 µg) given orally twice daily for 14 days, followed by once a day in combination with standard dose axitinib to patients with metastatic RCC. Primary endpoint was safety, secondary endpoint is efficacy including overall response rate (ORR), progression free survival (PFS) and overall survival (OS). Results: Twelve patients with metastatic RCC who progressed on one or more prior lines of treatment were enrolled. Six patients were treated at 4000 µg, 3 patients at 3000 µg, and three patients at 2500 µg. No dose limiting toxicity (DLT) was seen. Most common adverse events (AEs) included fatigue, diarrhea, hypertension, nausea, anorexia, cough, proteinuria and weight loss. Four of the 6 patients in the 4000 µg cohort have been assessed. Two (50%) patients achieved complete response (CR) with ongoing responses at 31 and 29 months, one patient (25%) had partial response (PR) for 24 months, and one (25%) had progressive disease (PD) at 3 months. Of the 3000 µg cohort, one (33%) patient had ongoing PR for 12 months, a second (33%) lasting 10 months, and the third (33%) had stable disease (SD) for 4 months. Of the 2500 µg cohort, one patient (33%) had ongoing PR for 21 months, one (33%) for 6 months, and one (33%) at 2 months. High dose SLM is safe in combination with axitinib, with promising efficacy. Biomarker assessment is currently ongoing, and further evaluation of SLM in the treatment of ccRCC is warranted. Introduction and Objective: The purpose of this study was to assess the prognostic value of preoperative prognostic nutritional index (PNI) on survival in patients with non-metastatic renal cell carcinoma (RCC) treated with partial or radical nephrectomy. We retrospectively reviewed medical records of 480 patients with RCC who underwent partial or radical nephrectomy at two institutions between June 1994 and July 2017. Among these patients, 21 patients with lymph node or distant metastasis were excluded. Thus, the remaining 459 patients with non-metastatic RCC (307 men and 152 women, mean age of 55.8 years) were included in this study. The PNI was calculated using a selective combination of serum albumin level and lymphocyte count in the peripheral blood as previously described. The prognostic significance of various clinicopathological variables including PNI was analyzed using univariate and multivariate analysis. Discrimination was measured with the C-index. The median follow-up duration was 72 months (range 4 to 272 months). Of the total 459 patients, 49 patients (10.7%) developed local recurrence or distant metastasis and 27 patients (5.9%) died of disease during the follow-up period. In the univariate analysis, anemia, PNI, tumor size, T stage, Fuhrman's nuclear grade, sarcomatoid differentiation, and lymphovascular invasion were significant prognostic factors of recurrence-free and cancer-specific survival. The multivariate analysis identified that PNI (p=0.024), tumor size (p=0.001), T stage (p=0.001), Fuhrman's nuclear grade (p=0.002), sarcomatoid differentiation (p=0.001), and lymphovascular invasion (p=0.006) were independent prognostic factors for recurrence-free survival, whereas PNI (p=0.035), tumor size (p=0.002), T stage (p=0.004), Fuhrman's nuclear grade (p=0.025), and sarcomatoid differentiation (p=0.006) were independent prognostic factors for cancer-specific survival. Conclusion: PNI is an independent prognostic factor for recurrence-free and cancer-specific survival in patients with non-metastatic RCC treated with partial or radical nephrectomy. These findings indicate that PNI may be a useful tool for predicting recurrence or survival in patients undergoing nephrectomy for non-metastatic RCC. 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK try, Three-Dimensional (3D) printing is only starting to become adopted in Medicine and Surgery. Using medical image data acquired as part of gold standard clinical care, 3D anatomical models can be created, which can be 3D printed as an adjunct to surgical planning, simulation, and patient education. In the field of Uro-Oncology, researchers and clinicians have recognised the potential of this exciting new technology and have started integrating it into Urological practice. We review current literature regarding 3D printing and other 3D technologies in the field of Urology. As per PRISMA guidelines, we performed a literature search including: Web of Science, EMBASE and Cochrane databases. Publications included in this study were limited only to English-language articles, published between 1980 and 2018. The search terms used were "3D printing", "urology", "surgery". This resulted in 41 articles, which were independently read in full to identify relevant studies. Suitable articles were incorporated for their merit and relevance with preference given for articles with high impact, original research and recent advances. Results: 41 publications were included for analysis and discussion. Conclusion: 3D printing is a promising technology with much promise in the field of Urology. However, the field is still very much in its infancy, and further research into the optimisation of the medical imaging to 3D printed anatomical model workflow is required before 3D printing is ready for widespread adoption. The variable cost of this technology was a recurrent theme in publications, and cost reductions must continue to make 3D printing a feasible adjunct in Urology. As patents expire, costs decline and the diversity of materials continues to expand, the uses of 3D printing in Urology will continue to grow. A cohort of 1.809 cancers was analyzed by dual labeling fluorescence in situ hybridization (FISH) with probes for 8p and centromere 8 in a tissue microarray (TMA) format. The results were correlated with histopathologic features and with clinical follow up data. The analysis provided interpretable FISH data in 1.474 tumors and showed substantial differences between renal cancer subtypes. The fact that an 8p deletion was only seen in 1 of 216 (0.48%) papillary carcinomas identifies this tumor as one of the very few malignant tumors where 8p deletions hardly occur. This underscores the biologic uniqueness of papillary kidney cancer, which is also defined by a highly distinct morphology. 8p deletions were found in 13.2% of 976 clear cell carcinoma, 7.8% of 77 chromophobe carcinoma, 0.84% of 119 oncocytoma, but also in several rare tumor entities including 1 of 4 collecting duct cancers, 1 of 3 multilocular cystic renal neoplasm of low malignant potential, 2 of 10 Xp11.2 translocation cancers, 3 of 18 not otherwise specified carcinoma, and in the only analyzed medullary carcinoma. In clear cell carcinoma 8p deletions were significantly associated with higher ISUP (p = 0.0014), Fuhrmann (p = 0.0003) and Thoenes grade (p = 0.0033) and linked to advanced tumor stage (p = 0.0006), large tumor diameter (p = 0.0019), distant metastases (p= 0.0183), overall survival (p = 0.0158) and progression free survival (p ≤ 0.0001). In multivariate analysis, the prognostic role of 8p deletions was not independent of established clinic-pathological parameters. Conclusion: 8p deletions are strongly linked to tumor aggressiveness in clear cell kidney cancer. Because 8p deletions are easy to measure by FISH, 8p deletion assessment may have a role in future prognosis assessment in clear cell kidney cancer, most likely in combination with other parameters. Introduction and Objective: Partial nephrectomy is nowadays considered to be the gold standard in T1 stage renal cell carcinoma. It may be performed in an open approach, laparoscopic or robot assisted. Regardless the method, the aim of the surgeon is to achieve a trifecta including no positive surgical margins, low rate of complications and as less as possible renal ischemia. As experience grows in partial nephrectomy, totally of-clamp partial nephrectomy may be performed in high volume centers. The aim of this study is to evaluate the safety of off-clamp partial nephrectomy in patients with T1b renal tumors. This is a prospective single center study including 29 patients who underwent off-clamp open partial nephrectomy during the years 2017-2018 for T1b stage renal tumors. Median age was 57 years (21 males, 8 females). Median tumor size was 5.5 cm (4.1 -7cm). Perioperative results including duration of surgery, blood loss, transfusion rates, use of hemostatic agents and postoperative complications using the Clavien Dindo system were recorded. Results: Out of 29 patients, 25 completed the operation in a total off-clamp approach. In 4 patients we had to apply warm ischemia due to either hemorrhage or inability to be certain that the tumor was removed with negative surgical margins. In the 4 cases where warm ischemia was applied, the mean duration was 7 minutes. Only one patient in the ischemia group underwent radical nephrectomy due to damage of the renal vein. No patient in the off-clamp group underwent radical nephrectomy. Total blood loss was 340 ml and duration of surgery 117 minutes. No patient was transfused intraoperatively. As far as it concerns postoperative complications, 3 patients presented arteriovenous fistula and were treated successfully by arterial embolization. Moreover 4 patients presented with large hematoma requiring blood transfusion. All were treated conservatively, and no reoperation or arterial embolization was needed. In addition, 3 patients presented with urine leak during the first postoperative day but in all cases, it stopped the second postoperative day without need for intervention. Regarding oncologic results, only one patient had positive surgical margins. Conclusion: Nephron sparing surgery without use of warm ischemia is a safe choice in patients suffering from stage T1b renal tumors in experienced high-volume centers. Outcomes Introduction and Objective: Nephron sparing surgery is an effective treatment for RCC. Oncological outcome is equivalent to radical nephrectomy, with the added functional advantage. It is underutilized, especially in tumors in anatomically challenging positions like central and hilar positions. Nephron Sparing Surgery and Renorrhaphy -Outcomes from a Modification of Technique Introduction and Objective: Nephron sparing surgery is an effective treatment for RCC. Oncological outcome is equivalent to radical nephrectomy, with the added functional advantage. The renorrhaphy closure of the defect usually involves closure with a superficial and deep layer of sutures to close the collecting system. We report outcomes from a modification of technique for renorrhaphy. Hospital case notes and electronic records of 101 consecutive cases of partial nephrectomies, conducted at a single center over the last 8 years were analysed. The method of renorrhaphy involves use of a deep layer of suture (liver suture), plus Evicel and an oxidized cellulose bolster with superficial sutures to hold the bolster in place. Data was assessed on the peri-operative complications, length of stay, transfusion rate and return to theatre. Results: 26 cases were in the mid zone, 33 were lower and 42 were upper zone. 57 were elective and 2 cases were absolute, 4 were imperative, 1 case was a relative indication for nephron sparing-surgery. 8 had bilateral tumours. Cold ischemia was used in 1 (28 mins), warm ischemia in 20 cases (average 15.3 min) and no arterial clamping in 87 cases (zero ischemia). The preoperative TC is an independent prognostic marker for recurrence-free, cancer-specific and overall survival after curative surgery for non-metastatic clear cell renal cell carcinoma of ≤ 7cm on preoperative imaging. Hernando Arteche A, Navarro Serrato JC, Amaruch García N, Gonzalez Enguita C Introduction and Objective: Kidney cancer incidence rates vary substantially worldwide. It ranks 13 th in incidence, 16 th in mortality and its prevalence is near 3%. The objective was to analyze the survival of kidney cancer in disseminated stage according to the treatment administered in the public hospitals of the Autonomous Community of Madrid (CAM). Comparisons of "Surgery" versus "Systemic" and "Surgery" versus "Surgery + Systemic" also did not obtain statistical significance (p= 0.76 and p= 0.24, respectively). Patients with transitional cell carcinoma histology show differences between "systemic" versus "surgery" (in favour of the first, p= 0.03). However, "Surgery + Systemic" versus "Surgery" and "Surgery + Systemic" versus "systemic" did not reach significance (p= 0.06 and p= 0.51, respectively). Long Conclusion: Partial nephrectomy of single kidney is an effective method of treatment of RCC with good long-term functional and oncological results. Recently there is a trend towards higher rates of incidence of non-clear cell renal cell carcinomas (RCC). The aim of our study was to evaluate prognostic factors that influence on the probability of recurrence and progression of disease, to assess progression-free (PFS) and cancer-specific survival (CSS). Conclusion: Percutaneous renal mass biopsy is useful in managing both localised and metastatic renal mass with high a positive predictive value. We recommend this procedure to get a histological sample for the metastatic renal cancer that require targeted therapy and localised masses that require curative treatment. Especially, increasing pRBC units in transfused patients may be a concern in light of worse OS and CSS. Therefore, in case of patients with risk factors of PBT need, such as symptomatic, older age, and lower preoperative Hb, efforts to limit the overuse of PBT should be continued for the improvement of postoperative survival. Experience Matters More Than Renal Nephrometry Score in Robotic Partial Nephrectomy Maheshwari R, Chaturvedi S, Gaur P, L. R. R, Banerjee K, Qadri Y, Kumar A Introduction and Objective: Partial nephrectomy is established as standard of care of renal tumors. With increasing surgical expertise, more and more complex renal tumors are being managed by minimal invasive technique using robotic platform. The aim of this study was to compare oncological and functional outcomes in patients with high and low renal nephrometric scores after robot assisted partial nephrectomy. From October 2015 to January 2019, eighty-three robotic partial nephrectomies were done using da Vinci Xi surgical robotic platform by a single experienced robotic surgeon. The patients were evaluated in detail including multiphasic CT scan. Nephrometric scoring was done for all cases. Arterial control was taken in all cases and Venous control was taken selectively. Intra-operative USG was used in all cases for delineation of tumor. Renography was done using barbed 3-0 suture and cortical approximation done using Vicryl 1-0 and sliding hem-o-lock technique. Hemostatic agent (flow-seal) was used selectively. Pre-operative variables including patient age, BMI, pre-operative Hb and creatinine, tumor characteristics, post op Hb, creatinine, HPE and all complications were recorded prospectively and analyzed. Results: Eighty-three patients (52 males, 31 females) with mean age of 56.7 (28 -77) years were operated by single surgeon (AK). Mean BMI was 26 + 3.8 kg/ m2. Mean pre-op Hb and creatinine were 11.9 and 0.9 and post op Hb and creatinine were 10.8 and 1.02 respectively. 23 were diabetic, 27 were hypertensive, 5 had COPD and 8 had history of CAD. Classifying on basis of nephrometric score, 37 had low score, 29 had moderate score and 17 had high score. In the hands of an experienced robotic surgeon, oncological and functional outcomes of renal tumors with high and low nephrometric score treated with robotic partial nephrectomy remains comparable except for higher warm ischemia time and pelvic-calyceal system injury. Feasiblity of Omission of Cortical Renorrhaphy in Robotic Assisted Partial Nephrectomy Introduction and Objective: Cortical Renorrhaphy is a standard method to achieve hemostasis and closure of parenchyma in partial nephrectomy (PN). However, cortical renorrhaphy without damaging or compressing vessels in cases of large renal tumors extend- ing up to renal hilum is not always possible. It also has potential of devascularisation of the parenchyma compressed by sutures while doing renorrhaphy, which in turn leads to loss of nephrons. This study was done to assess the safety of omitting cortical renorrhaphy during robot-assisted partial nephrectomy and measure preliminary functional outcomes. Eleven robot-assisted partial nephrectomies were performed with a running, base-layer suture for the collecting system and vessels however cortical renorrhaphy and approximation of parenchyma was completely avoided. Hemostatic agent (Flowseal) was used to achieve complete hemostasis. The non-renorrhaphy group was matched 1:2 R.E.N.A.L. nephrometry score to a sliding-clip cortical renorrhaphy group retrospectively. Intraoperative blood loss, urine leaks, postoperative bleeds, and functional outcomes were evaluated. Results: Statistically significant differences were not found between both groups in sex, age, tumor diameter, nephrometry score, preoperative glomerular filtration rate, Charlson score or the amount of resected healthy kidney margin. Operative time, Console time, amount of blood loss, post-operative analgesia requirement, drain output and duration of hospital stay was not found to be significantly different in renorrhaphy and non-renorrhaphy group. There was a single case of re-bleeding, requiring re-exploration in renorrhaphy group and none in non-renorrhaphy group. Warm ischemia time was less for the non-renorrhaphy group. The median % GFR loss was 18.3% for renorrhaphy and 12.6% for non-renorrhaphy at a median follow-up of 6.2 months. In a multivariable model, both cortical renorrhaphy (P= 0.009) and tumor diameter (P= 0.004) were predictors of GFR loss. Cortical renorrhaphy and approximation of parenchyma does not appear to be essential in partial nephrectomy. The percent GFR loss was improved by omission of cortical renorrhaphy. Hyaline Casts in Renal Tubular Ducts is Useful Predictor for the Residual Renal Function after Nephrectomy in Patient with Renal Cell Carcinoma Kusano S, Nanri M, Nagase K, Noguchi M Introduction and Objective: The surgical methods for the treatment of renal cell carcinoma (RCC) have changed significantly. Recently, partial nephrectomy has contributed to the preservation of the renal function. However, the standard surgical method for ≥cT1b renal cell carcinoma is nephrectomy. Thus, the control for CKD after the nephrectomy in patients with RCC will be needed. Therefore, the purpose of this study is finding out the predictor of renal function after the nephrectomy for the intervention in CKD. Patients who underwent nephrectomy with a diagnosis of renal cell carcinoma (≥cT1b) from 2011 to 2015 were enrolled in this study. We examined the histopathological findings in normal region of extracted kidney. By using univariate and multiple regression analysis, relationships were determined between the histopathological factors, patient characteristics and the alteration of the eGFR for 3 years after the operation. In histopathological analysis, the glomerulosclerosis rate (2.5×5 field of view), the number of hyaline casts in renal tubular duct (2.5×5 field of view), inflammatory cell infiltration (2.5×5 field of view) were examined. Results: Thirty-one patients were analyzed. They were 20 males and 11 females; their age is 45-85 years old (median: 65 years old). In their renal function, median eGFR before surgery: 71.0 ±3.62 mL/min/1.73m². The median decreasing rate of eGFR after surgery was 38.6 ± 1.86%, 43.14 ± 2.8% at one and three years after operations, respectively. The decreasing rate of eGFR was significantly difference between preoperative CKD 1,2 at 40% vs CKD 3,4 at 44 % (P <0.05). In a multivariate analysis, only the number of hyaline casts in renal tubular duct was significantly associated with the eGFR decrease after 3 years (P= 0.001). The decline of residual renal function after the nephrectomy was associated with preoperative renal function. Furthermore, the evaluation of hyaline casts in renal tubular duct in normal region of extracted kidney was considered a useful predictor of the decline in the residual renal function. This histopathological evaluation is easy and simple, it will contribute to the postoperative renal management. Lebastchi A Introduction and Objective: Patients with bilateral or multifocal renal tumors benefit from maximal renal parenchymal preservation. Completely endophytic renal tumors represent a unique challenge as they can require sacrificing normal renal parenchyma overlying the renal tumor. We propose XCITE -a novel technique to enucleate endophytic renal tumors while preserving the overlying renal parenchyma. We reviewed 10 consecutive patients with a history of bilateral or multifocal renal tumors who presented to our institution with complete endophytic renal masse(s). All patients underwent XCITE. In each case, after intraoperative localization of the mass using ultrasonography, an X-shaped incision was made in the renal capsule. The overlying renal parenchyma was split until the tumor pseudo capsule was reached. The tumor was subsequently enucleated, and the overlying renal parenchymal flaps were closed. Patient demographics, tumor characteristics and perioperative outcomes were recorded. Results: Ten consecutive patients with completely endophytic renal tumors undergoing the X-CITE technique were included in our study. Median follow up was 12.2 months (interquartile range 10.6 -14.9 months). Most patients also had additional exophytic tumors and on average, 5 renal tumors were removed per operation with a median largest renal tumor size of 3.2cm. There were no intraoperative or post-operative complications recorded. There was no decline in renal function after surgery when comparing pre-and post-operative eGFR (70.0 vs 75.1; p=0.31) or creatinine (1.06 vs 1.03; p=0.28). Furthermore, postoperative nuclear MAG-3 renal scans demonstrated equal differential kidney function after surgery. The X-CITE technique is feasible, safe and effective with minimal collateral damage in the treatment of completely endophytic renal masses. This approach spares the overlying parenchyma while allowing removal of deep, completely endophytic renal tumors. Further investigation is needed to identify which patients may benefit from this procedure as well as to explore intermediate and long-term outcomes. The optimal cut-offs of pre-operative inflammatory indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR) and red-cell distribution width (RDW) were determined using X-tile 3.6.1 software (Yale University, New Haven, CT, USA). Cox regression models were created to evaluate the proportional hazards of these hematological indices for overall survival (OS) and cancer-specific survival (CSS). We further evaluated the utility of these markers against established prognostic models such as the Mayo Clinic Leibovich score and UCLA Integrated Staging System (UISS) using Harrell's c-index. To Investigate the Relationship Between the Duration of Initial Diagnosis and Urothelial Carcinoma/Renal Cancer with Dialysis Patients in Taiwan Introduction and Objective: The cohort study declared the duration of initial diagnosis for urothelial carcinoma/renal cancer in those dialysis patients in Taiwan. Introduction and Objective: Anemia was reported to be associated with poor prognosis after cytokine therapy in patients with metastatic renal cell carcinoma (mRCC). However, it was still unknown in tyrosine kinase inhibitors (TKIs) era. This systematic review and meta-analysis was to assess the significance of anemia and increase of hemoglobin in predicting the outcomes of mRCC patients with TKIs treatment. We searched Pubmed, Web of Science and EMBASE databases until January 6, 2019 for studies comparing outcomes of mRCC patients who had different hemoglobin level before or after TKIs therapy. The hazard ratios (HRs) and its 95% confidence interval (CI) of progression-free survival (PFS) and overall survival (OS) were extracted for evaluating the predictive value of hemoglobin. Trifecta success rate: 72.7 vs. 92.9% in retro-and transperitoneal groups. Paralytic ileus developed after surgery in only one patient in the transperitoneal approach group, and surgery was not converted to nephrectomy or laparotomy in any patient in either group. Preoperative eGFR (mL/min/1.73m 2 ) was 88.5 and the median eGFR changes (%) at 1, 3, and 6 months after surgery were -11.2%, -11.3%, and -13.7%, respectively, showing no significant difference from that after surgery through the transperitoneal approach. Conclusion: No significant difference was noted in any of the surgical items and the postoperative eGFR after retroperitoneal RAPN, being comparable to those after transperitoneal RAPN. Since the retroperitoneal approach may take time for resection and suture in patients with a high RNS, it should be kept in mind that the ischemia time extends. By securing a space as wide as possible and setting trocars, it may be possible to perform retroperitoneal RAPN minimizing interference with the arm, similarly to transperitoneal RAPN. Conservative The economic burden of mRCC is increasing with the severity of the disease. The results given in the present work are preliminary and constitute a groundwork for future studies that need to be done integrating newer treatment option in the management of RCC. Inferior is among the most challenging of uro-oncological procedures. RCC has a biological predisposition for direct vascular invasion, with intravascular tumour thrombus occurring in 4 -10% of cases. Aggressive surgical resection has been demonstrated to provide a survival advantage; however, this approach is associated with high peri-operative morbidity and mortality. Often an experienced multi-disciplinary surgical team is required. We aimed to examine the surgical management and outcomes of patients who underwent radical nephrectomy involving IVC thrombectomy at a single tertiary centre. Electronic medical records at a single centre was interrogated to extract a list of all patients who had had a nephrectomy between March 2009 and March 2019 using ICD-10 codes. The criteria for inclusion were patients who had undergone a radical nephrectomy with IVC thrombectomy for renal cell carcinoma. Data such as patient demographics, operative details, histology, post-operative complications and survival outcomes was kept prospectively for all patients. The study identified 27 patients, 20 males (74%), with median age of 63 (range 28 -84). There were 12 level IV, 4 level III, 10 level II and 1 level I tumour thrombi. 88.9% of cases were performed using a multi-disciplinary surgical team, incorporating cardiac, vascular or hepatobiliary units. 30-day post-operative mortality was 14%, including two intra-operative deaths, all were patients with level IV tumour thrombi. Two patients required return to theatre, both for haemorrhage control. Mean hospital length of stay was 14.2 days (range 6-30). Overall survival was 48% at a median survival time of 20 months. Conclusion: Radical nephrectomy with IVC thrombectomy is a technically demanding surgery requiring an experienced multi-disciplinary team in majority of cases. High peri-operative mortality is reflected in the most advanced cases despite extensive pre-operative work-up and planning. Conclusion: IVR occurred in nearly half of our patients and was more common in patients who had previous BCa and/or had a diagnostic URS. No survival loss was seen in the IVR group, but patients with previous BCa have a higher rate of DSM. IVR in our unit can potentially be reduced by limiting the use of URS and introducing post-RNU bladder instillation. Introduction and Objective: Kidney resection in patients with urothelial tumors is a rare type of surgery and can be performed only in cases of localized small tumors of the calyx when renal function is preserved. The aim of our study was to evaluate short and long term functional and oncological outcomes of patients that underwent kidney resection due to urothelial tumors. Retrospective analysis of 107 patients with upper urinary tract cancer that were treated in our department from 2008 to 2019. Average age was 64.2 + 5.2 years. Men\women ratio -77/30. Conservative surgery was conducted in 35 cases, among which 10 underwent partial nephrectomy and became the object of our study. All tumors were highrisk. Results: Average observation period was 28.4 + 18.2 months. All patients had localized urothelial tumors of the kidney with lesion area that did not exceed 50% of pelvicalyceal system. Preoperative planning included CT imaging analysis with measurement of expected remaining functioning parenchyma volume. Tumors located in the lower segment calyces in 6 patients, in middle segment in 2 case and in upper segment -in 2. According to dynamic renal scintigraphy average unilateral kidney GFR prior to surgery was 19.6 + 5.2 ml/min, serum creatinine level -1.16 + 0.26 mg/dl. All patients underwent resection of the affected calyx with the segment where it was located. Perioperative flexible pyeloscopy was conducted through the incision hole in the pyeloureteral segment that additional helped to margin the lesion. In cases of upper pole resection renal cavities were sutured, but when tumor located in the middle or lower segment are construction of pelvicalyceal system was used. All surgical procedures were conducted without ischemia. Average blood loss -564 + 178 ml. There were 2 surgical complications Cl-Dindo II after surgery that were managed conservatively. According to dynamic renal scintigraphy average unilateral kidney GFR 3 months after surgery was 15.8 + 4.8ml\min (p = 0,68), serum creatinine level -1.21 + 0.21 mg/dl (p = 0.43). There was 1 case of local relapse that was managed with nephroureterectomy. In 1 patient there was diagnosed a decrease of unilateral GFR below 10 ml\min. Conclusion: Although kidney resection in patients with pelvicalyceal urothelial tumors is a complex surgical procedure it preserves unilateral and total glomerular filtration rate. Early diagnosed ureteral tumors of the renal cavities can lead to conservative surgery and affect functional outcomes of the treatment. Efficacy Oncological In all cases open partial resection of the kidney was performed, in 51 (37.1%) was supplemented with adrenalectomy due to tumor placement in the upper pole of the kidney and high risk of invasion. The main indication for its implementation was RFPV over 56 % and tumor polar or 99 (70.7%) and lateral location -41 (29.3%). In 56 (40%) cases central ischemia was used, with time ranging from 4 to 25 minutes (13.1 ± 4.5). Blood loss ranging from 100 to 2500 mL (680 ± 380) with 10 (7.1%) patients who underwent hemo-transfusion. Postoperatively, there were 8 (5.7%) complications: In 5 (3.6%) cases -urinary fistula, which was managed with kidney stenting, in 3 (2.1%) cases -bleeding with the formation of retroperitoneal hematoma, requiring re-operation and elimination of the bleeding causes. Observation period ranged from 1 -109 months (26.4 ± 25.9). Local recurrence occurred in 4 (2.8%) patients: 3 (2.1%) patients underwent radical nephrectomy, one required systemic therapy due to metastatic disease. There were found no statistically significant difference between preoperative and postoperative total GFR (p > 0.07), mostly associated with compensatory mechanisms. There was found statistically significant decrease in GFR on the affected side 3 months and 1 year after surgery, although kidney function was retained. The main indication for resection of the kidney in large tumors is not the size of the tumor, but its location and the presence RFPV over 56%, which gives the opportunity to get good oncological and functional results, with low rates of intra-and postoperative complications. We review a case of an 83-year-old patient with a tumor seeding that occurred 5 months after a laparoscopic nephroureterectomy for a urothelial carcinoma of the upper urinary tract. Results: An 83-year-old female patient underwent a left laparoscopic nephroureterectomy for a urothelial Carcinoma of the Upper Urinary Tract. Surgery was performed without any complications, the specimen was removed without manipulation or accidental rupture, using a Endo Bag. Histological examination revealed a high-grade transitional cell carcinoma with lamina propria involvement (stage T1G3) and negative surgical margins. The patient was evaluated 5 months after surgery with an increasing abdominal mass at a laparoscopic port site. Abdominal and pelvic CT scan showed an 8 cm, solid lesion of the abdominal wall with heterogeneous density but no evidence of visceral metastasis. Surgical enucleation of the abdominal wall mass was performed with a safety margin of 2 cm. A primary closure of the peritoneum was performed, and the abdominal wall was reconstructed with a permanent mesh with a bioresorbable coating. Skin closure was achieved with an abdominoplasty-like approach. Histological examination confirmed the diagnosis of poorly differentiated tumor consistent with transitional cell carcinoma infiltrating the fibromuscular adipose tissue; the surgical margins were negative. The patient will start systemic chemotherapy (gemcitabine and cisplatinum). Conclusion: Tumor seeding after laparoscopic surgery is uncommon. However, it can be managed in multimodal approach, surgical ablation with reconstruction of the abdominal wall and chemotherapy. Doege-Potter Syndrome -A Case Report UP.236, Table 3 . Prognosis UP.237, Figure 1 . peripheral nerve sheath tumor. Mean age of presentation was 62 years and male predominance. Flank pain was present in all cases and 4 cases had palpable flank mass. Hematuria was present only in one patient. Routine blood investigations of all patients were normal. Radiological investigations were suggestive of large heterogenous enhancing mass compressing surrounding structure in all the cases. Mean size of mass was around 15 cm. 4 cases had enlarged lymph nodes on imagine. Radical nephrectomy with lymph node sampling was performed in all cases. Histopathology report was suggestive of spindle cell tumor and confirmation was done by IHC. After follow-up of at least 3 years, 5 patients were disease-free, and 1 patient has died within 18 months of surgery and others died within 3 years. Conclusion: Large heterogeneity in the behaviour of mesenchymal renal tumors. Majority of mesenchymal tumors are large and seems to be aggressive in nature, but prognosis and survival are depending on final histopathology. Immunohistopathology is an integral part for the diagnosis of mesenchymal renal tumors. Shah P, Mehta A, Shah C, Jadeja P, Joshi V, Kalaria J Introduction and Objective: Horse shoe kidney is an abnormality of kidney that poses difficulty in renal surgery. Urothelial carcinoma in horse shoe kidney is very rare condition and difficult to operate. A 50-year diabetic and hypertensive male presented with acute clot retention with history of gross painless hematuria with clots for 10 days. All routine investigations were normal. USG was suggestive of bladder full of clots and Right side moderate HN with 5 cm sized mass lesion filling pelvicalyceal system in horse shoe kidney. CECT abdomen was suggestive 4*5 cm size heterogeneously enhancing mass of in right renal pelvis extending in mid and lower pole calyces in horse shoe kidney with 7*8 cm size clot in bladder. We did emergency Cystoscopy and clot evacuation. Results: There was normal bladder mucosa and hemorrhagic efflux from right orifice. After stabilizing the patient, we did Right radical nephroureterectomy with isthemectomy with bladder cuff excision and template lymph node dissection. There were multiple aberrant vessels that we have to ligate with blood loss of approx. 1.5 litre. Histopathology was in suggestive of high-grade urothelial carcinoma involving renal parenchyma. No lymph nodes were positive. Patient is asymptomatic with 2 months of follow up. Conclusion: Incidence of urothelial carcinoma in a horseshoe kidney is 2.1 cases/10,000,000. But the incidence of urothelial carcinoma in a horseshoe kidney is approximately 3 to 4 times more compare to normal kidney, possibly due to chronic obstruction, lithiasis and infection. Vascular supply of Horse shoe kidney is anomalous which leads to difficulty in surgery. Primitive Neuro-Ectodermal Tumor of Kidney; A Case Report and Review of Literature Shah P, Dholaria P, Shah C, Jadeeja P, Kalaria J Introduction and Objective: Neuroectodermal tumors are a heterogeneous group of neoplasm that differs in biological behaviour, histologic pattern and response to treatment. Well differentiated NET are indolent in nature and mostly arise from GIT, pancreas and lung. In GUT (very rare) kidney is most common to involved. Poorly differentiated NET are aggressive and arise from bladder and prostate. Only 65 cases of PNET of kidney are reported so far in literature. Introduction and Objective: Primitive neuroectodermal tumor (PNET) of the kidney is unusual in adults. These tumors are diagnosed mainly on histopathology and that too sometimes has limitations. Immunohistochemical staining can be of help in establishing the diagnosis. In this retrospective study, we reviewed our institutional database from January 2006 to July 2018 to include all the cases of primary PNET of the kidney. Descriptive statistics was used to analyze the data. The immunohistochemistry of all cases were done, and clinical outcomes of all cases were evaluated. Results: During the above-mentioned period a total of 420 patients with renal masses were managed at our centre of which 12 cases of primary renal PNET were managed. Of these 12 patients, 5 were males and 7 females. Clinical follow up was available for 7 patients whereas histopathological data of all the 12 patients were available. Out of these 7 patients, 2 patients had metastasis at diagnosis, one had locally advanced disease, 6 underwent radical nephrectomy, 5 patients received adjuvant chemotherapy (two currently receiving) and only 1 patient received adjuvant radiotherapy. Renal vein and IVC involvement by tumor thrombus was seen in 3 cases. On Immunohistochemistry (IHC), CD99 and FLI1 were positive in all the cases. Median survival was 10 months with range of 3 to 125 months. Conclusion: PNET of kidney is a rare disease with incidence around 1%. PNET remains a pathological diagnosis and IHC has important place in diagnosis of PNET. Poor prognosis is due to delayed presentation and lack of definitive management guidelines. Multimodality approach seems the best possible strategy. Despite the availability of multiple scoring systems for the evaluation of renal masses, none address the difference between right and left sided mass. Right radical nephrectomy has an inherently higher level of difficulty due to anatomic differences. We devised a scoring system (SGPGI score) based on pre-operative CT angiography to predict the level of difficulty and outcomes of right radical nephrectomy. In a prospective observational study on 64 patients from January 2014 to July 2018, we calculated a score based on CT angiographic imaging as per table 1. The initial scoring was done by a senior uro-radiologist at our institute. To evaluate internal consistency and interrater agreement, it was repeated by a radiology and urology resident independently. The data analysis was done using IBM SPSS statistics for mac version 23 using Shapiro-Wick test, paired t-test, Kruskal-Wallis, ANOVA, logistic regression, Cronbach's alpha and interclass correlation coefficient (ICC). Higher score was associated with higher operating time (p < 0.001), bloodloss (p = 0.008), post op stay (p < 0.001) and Clavein Dindo score (p < 0.001). We evaluated the internal consistency by using Cronbach's alpha and this was 0.744. ICC was used to evaluate the inter-rater agreement among the 3 raters (0.678 -1 for different components of the score). The SGPGI score evaluates right renal masses based on pre-operative CT angiography and is able to predict surgical outcomes effectively. The (Fig. 1a) . But the mRNA expression showed no obvious change (Figure 1c ). It showed both increase expression of PPARγ on protein and mRNA when KLF2 over expression ( Fig. 1b and 1d) . IHC stain of MKRN1 and KLF2 on EAML specimens showed statistically significant lower in tumor site than normal site both in nuclear and cytoplasm ( Fig. 2a and 2b ). identify the metastatic potential of SRMs. It is evident some SRMs harbour aggressive potential, which necessitates a complete metastatic workup, aggressive curative therapy and stringent follow-up to ensure favourable prognosis. Evaluation of Postoperative Renal Function in Off-Clamping and Non-Renorrhapy Laparoscopic Partial Nephrectomy Tomisaki I, Onishi R, Minato A, Fujimoto N Introduction and Objective: Although partial nephrectomy is the standard treatment for small renal tumor, temporary clamping of renal artery and renorrhapy were adverse factors for the post-operative renal function. The objective of this study was to evaluate the influence of off-clamping and non-renorrhaphy laparoscopic partial nephrectomy using soft coagulation on the renal function. . In comparison of perioperative renal function, though the median eGFR significantly decreased only on the day after the operation and improved after 3-5 days in patients of complete group, the significant decline in eGFR continued until one year after the operation in patients with conventional and incomplete groups. The decline rate of eGFR on the day after the operation was significantly higher in patients of conventional and incomplete groups. Conclusion: Off-clamping and non-renorrhapy laparoscopic partial nephrectomy using soft coagulation was a favorable surgical technique for preservation of the post-operative renal function. Tyrosine kinase inhibitors (TKIs) combining with immunotherapy can improve the objective response rate (ORR) of patients with renal cancer, but markedly increase the incidence of adverse events (AEs). We develop a new method of neoadjuvant therapy to treat patients with absolute or relative indications of partial nephrectomy (PN) but in high surgical risk, trying to shrink the tumor, reduce AEs and surgical difficulty. We present 3 cases of renal cell carcinoma with indications of PN but moderate or severe surgical difficulties. Pazopanib was taken 800 mg once a day, and low dose (20mg) pembrolizumab incubated autologous peripheral blood lymphocytes were administrated once a week in the first 4 weeks and then once every two weeks thereafter. The therapeutic course will last no longer than 3 months. Results: Computed tomography (CT) evaluations had taken after 1.5 month of starting treatment. The therapeutic evaluation of case one was stable disease (SD) (table 1). AEs were grade 2 skin reaction of hands and feet, oral mucositis and elevated alanine aminotransferase (ALT). Case two was evaluated as partial remission (PR), and AEs were grade 2 vomiting and grade 1 thrombocytopenia. Case three was evaluated as SD. AEs were grade 3 elevated ALT and grade 2 skin reactions and hypertension. The AEs had relieved after symptomatic treatment and PN were performed successfully in 3 cases. Conclusion: Neoadjuvant therapy with pazopanib plus peripheral blood lymphocytes incubated with pembrolizumab in renal cell carcinoma that having indication of PN but in high surgical risk, may shrink the tumor and reduce AEs meanwhile, then PN may be implemented successfully. However, further clinical study is still needed to verify this conclusion. To explore the effectiveness of three-dimensional printing physical model assist laparoscopic partial nephrectomy (3D-LPN) in patients with renal tumors. This was a retrospective analysis of data collected from all patients who underwent LPN with or without 3D physical model assisted from January 2016 and February 2018. Demographic characteristics, operative data and clinical outcomes from the procedure were collected and compared. Results: Data were available from 127 patients of whom 69 were operated on using 3D-LPN and 58 were operated on using traditional LPN. The 3D model assisted, and laparoscopic partial nephrectomy groups were equivalent in terms of age, gender, body mass index, anesthesiologist's status, R.E.N.A.L score and surgical approach, respectively. Comparison of clinical metrics indicated that no difference between groups in operative time, estimated intra-/postoperative blood losses, increased creatinine level and complications, respectively (P>0.05). Warm ischemia time was statistically significantly shorter in 3D-LPN (P<0.05), while surgery waiting time was long for 3D-LPN vs LPN (P<0.05). Subgroup analysis based on complexity indicated that for complex tumor 3D-LPN significantly shorter warm ischemic time and lesser intraoperative blood loss than traditional LPN. Intra-and postoperative hospital complication rates were similar for 3D-LPN and traditional LPN (8.7% vs 13.7%). Conclusion: 3D physical model is a technically safe and efficient tool to assist laparoscopic partial nephrectomy, offering the advantages of shorter warm ischemia time and less intraoperative blood loss, especially for complex renal tumor. Clamping the segmental renal artery instead of the main renal artery during nephron-sparing surgery is a promising technique to decrease warm ischemia injury, which impacts renal function outcomes following partial nephrectomy. Our objective was to explore the effectiveness and safety of three-dimensional (3D) printing model on preoperative planning and intraoperative guidance for segmental renal artery clamping in laparoscopic partial nephrectomy. Materials and Methods: 8 patients who qualified for laparoscopic partial nephrectomy with clamping the segmental renal artery were selected. 3D physical models were designed based on these patients' contrast enhanced computed tomography (CT) images data. The target segmental arteries, clamping position, and a different hilar approach accessing target segmental arteries were planned preoperatively. The operations carried out under the intraoperative guidance of the physical model. Patients' demographic, intraoperative parameters and surgical outcome, including operative time, warm ischemia time, intraoperative and postoperative blood losses, increased creatinine level as well as complications, were collected and analyzed. Results: All patients successfully underwent partial nephrectomy with segmental renal artery clamping and all margins were negative. The mean operative time was 140.5 mins, warm ischemia time was 23.5 mins, intraoperative and postoperative blood losses were 90.7 mL and 140.7 mL, respectively. And the mean increased creatinine level was 16.8 mg/dL. Anecdotally, no delayed complication occurred during the follow-up period. Conclusion: 3D physical models provide effective orientation for segmental renal artery clamping technique and lead to satisfactory surgical outcomes. The Application of Early Sequential Unclamping Method in Laparoscopic Partial Nephrectomy for Patients with T1b Renal Tumor Xingang C, Xi L, Xiuwu P, Fajun Q Introduction and Objective: To analyze the value of early sequential unclamping method in laparoscopic partial nephrectomy. From April 2017 to October 2017, a total of 8 cases of renal tumor patients by early sequential unclamping method of laparoscopic nephrectomy (LPN) were reviewed. The early sequential unclamping method was used as follow: The branches of renal artery and the main renal artery were sequentially blocked. After removal of the tumor, the first layer of bare kidney wound blood vessels and collection system were sutured and repaired. Then released the main renal artery occlusion clamp, restored most of the blood supply to the kidney, but kept the tumor-specific segmental renal artery blocked. Continuous suture of the kidney created a rough combination of the renal wound. After second layers of suture completed, unclamped the segmental renal artery and sutured the renal wound again, made the third layers of suture intersecting with the second seam suture to strengthen the hemostatic effect. Results: All the 8 patients were performed LPN with early sequential unclamping method successfully. The average operative time was 132.5 (90 -180) min, the intraoperative blood loss was 142.5 (100 -200) mL, the completely warm ischemia time was 15.5 (12.0 -20.0) min, and no blood transfusion was performed intraoperatively and postoperatively. Postoperative complications such as urinary leakage, incision infection and fever were not found. The time of postoperative hospitalization was 4.8 (4-6) days. At 1 month after operation, the GFR level of one side kidney with tumor was 52.3 (43.2 -59.6) mL/min. Early sequential unclamping method could shorten the warm ischemia time and reduce the risk of bleeding during the operation. Preoperative Results: The median (range) follow-up period after nephrectomy was 55 (3-106) months. The median (range) values of NLR, hemoglobin, platelet count, and serum calcium were 3.4 (1.4-11.3), 11.0 (8.9-16.6) g/dL, 187 (72-352) x10 3 /µL, and 9.9 (7.5-11.3) mg/dL, respectively. Prognostic values of NLR (cutoff 4.8), hemoglobin (cut-off 11.0 g/dL), platelet count (cut-off 228 x10 3 /µL), serum calcium (cut-off 9.4 mg/dL) were evaluated dichotomously. Multivariate analysis revealed that NLR was the sole independent prognosticator for recurrence among the preoperative blood-based markers (hazard ratio, 15.7; 95% CI, 1.5 to 167.3; P= 0.023). Kaplan-Meier estimates demonstrated that the higher NLR was significantly associated with shorter RFS (P= 0.005). The current results indicate that preoperative NLR level can be a prognosticator for dialysis patients with nonmetastatic renal cell carcinoma. Fur-UP.259, Figure 1 . Recurrence-free survival curves according to NLR levels. The effect of metabolic characteristics on the prognosis of patients with metastatic renal cell carcinoma remains controversial. We investigated the associations between metabolic features of each individual and disease prognosis in patients with metastatic renal cell carcinoma. Materials and Methods: Data of 1,584 patients with metastatic renal cell carcinoma from a multi-institutional database were retrospectively analyzed. The entire cohort was stratified into three subgroups according to how many patients had abnormal metabolic features (hypertension, diabetes mellitus, and low body mass index). The Kaplan-Meier and Cox proportional analyses were performed to investigate the associations between abnormal metabolic features and disease prognosis. Results: There were 465 subjects without any metabolic features, 995 with one or two, and 124 with three. When the survival outcomes were compared according to the number of metabolic features, patients with higher numbers of metabolic features had significantly shorter overall and cancer-specific survival than those with fewer metabolic features (all p values < 0.05). The multivariate Cox analysis showed that the number of metabolic features was an independent predictor for shorter cancer-specific and overall survival (all p values < 0.05). When performing subgroup analysis according to the cellular type, significant results were only obtained among the clear cell subtype subgroup, with the association not being significant in the non-clear cell subtype cohort. Conclusion: Patients with more metabolic features had significantly worse survival outcomes than those with fewer metabolic features. However, the association was only statistically significant in patients with clear cell-type metastatic renal cell carcinoma. Results: LncRNA APOC1P1 expression was increased in ccRCC tissues compared with normal kidney tissues (P< 0.001). Its expression was higher in the Fuhrman grade III and IV group than in the Fuhrman grade I and II group (P < 0.05), and significantly upregulated in the advanced stage group (P < 0.05). Kaplan-Meier analyses revealed that elevated LncRNA APOC1P1 expression was significantly associated with poor overall survival (P < 0.05) but may not be an independent prognostic factor. Knockdown of Ln-cRNA APOC1P1 inhibited cell proliferation, induced apoptosis, and arrested cells at G1/S phase (P < 0.05). Silencing of LncRNA APOC1P1 also led to decreased cell migration and invasion (P < 0.05). Conclusion: LncRNA APOC1P1 acts as an oncogene, plays an important role in ccRCC development, and can be considered a prognostic biomarker and therapeutic target in ccRCC patients. Prospective Evaluation of Bilateral Same Session Ureteroscopy, is it a Valid Option? Introduction and Objective: Saudi Arabia has one of the highest upper urinary tract stone rates all over the world. Bilateral renal stone management is controversial; we sought whether bilateral same session FURS was properly evaluated. Thereby, it could be adapted as a practice that potentially reduces costs, hospital stay and the need for second intervention. This was a prospective study, with patients from January 2015 -May 2017; we collected data of patients with bilateral renal stones who went for same session FURS, and these data were reviewed and analyzed. Patients' characteristics as well as operative data were recorded. Outcomes were determined at 6 weeks on renal ultrasound or Non-contrast CT scan (NCCT). Success rate was defined as stone free (SF) or remaining fragments (RF) less than 3 mm. Ureteroscopic Stone Lithotripsy: Complications Introduction and Objective: Ureteral stone disease is a common affliction of human beings worldwide. Ureteroscopic stone lithotripsy is the most efficacious minimally invasive treatment option. The aim of this study is to evaluate ureteroscopic stone lithotripsy complications and to compare between the stone-related factors associated with the occurrence of these complications. Full medical and surgical history, routine laboratory investigations and imaging study were done preoperatively. After taking informed consent, preoperative antibiotic was given, procedure done under general or regional anesthesia using (8 or 9.5) ureteroscopy and pneumatic or laser lithotripsy, and DJ stent inserted in most of the patients. Stone free status was reached when all the stones were destructed and extracted while gravels and fragments less than 2 mm left for spontaneous passage. The patient was discharged home after 24 hours unless complications occurred. Results: Stone free status was achieved in 85% of patients. Regarding intraoperative complications: perforation occurred in 10.1%, of them 8.6% were minor and 1.5% were major, mucosal abrasions occurred in 10%, false passage in 2.25%, stone retropulsion in 7%, and intraoperative bleeding in 1.8%. Postoperative complication include fever (10 %), and ureteral obstruction (6 %). Conclusion: Ureteroscopy has gained wide acceptance worldwide for managing ureteral stones with low rate of intra and postoperative complications. Most of the complications are minor and can be managed conservatively. Although most of the patients required stent insertion, still some of them were left without in certain situations. A We present real-life data on the efficacy of intravesical BoNT/A in patients with refractory neurogenic incontinence. This is a prospective observational study of patients with drug-resistant neurogenic incontinence who received intravesical treatment with 200U of BOTOX in the specialized Neuro-urology outpatient Clinic of a public teaching hospital. Patients were subjected to urodynamic investigation before and 6 and 24 weeks after treatment, while recording the presence of urinary tract infection (UTI) before each treatment. The primary outcome was the patient-reported complete cure of incontinence. Secondary outcomes were the post-treatment changes in recorded urodynamic parameters and the associations between pre-treatment UTIs and response to treatment. Results: Forty-nine (49) patients (28 males and 21 females) received at least one BOTOX injection, 15 re-ceived a 2 nd treatment, 10 a 3 rd , 6 had a 4 th , and one had a 5 th and 6 th session, respectively. Median patient age was 47.04 years (SD: 14.16); 18 (36.7%) suffered from spinal cord injury, 12 (24.54%) from multiple sclerosis and the rest from other neurological conditions. After the first treatment, incontinence was cured in 73.7% of the patients. Incontinence cure rates were sustained after the 2 nd , 3 rd and 4 th injections (66%, 60% and 66%, respectively). There was no significant correlation between gender or neurological background and the persistence of incontinence. The median relapse time after first treatment was 6 months (IQR = 5) and 10.5 months after the second (p = 0.31). An increase in maximum cystometric capacity (MCC) was noted after each treatment compared to baseline (p < 0.001), while a reduction in Pdetmax only after the first session (p <0.05). Changes in MCC, filling and voiding Pdetmax were no different between the sessions. Fourteen patients (28.6%) were diagnosed with a urinary tract infection (UTI) before the first treatment. The presence of UTI was not associated with post-BOTOX persistence of incontinence and did not affect relapse times or the changes in MCC and Pdetmax after initial treatment. In this mixed neurogenic etiology cohort, intravesical injection of 200U BOTOX achieved complete cure of drug-resistant incontinence in a significant proportion of patients, with sustained clinical and urodynamic improvements after up to 4 injections. The presence of pre-treatment UTI was not found to affect treatment outcomes, at least after the 1 st injection. In patients with iatrogenic ureteric strictures due to pelvic surgeries and endoscopic procedures, the use of minimally access approach could improve the outcomes. However, pure laparoscopic surgery for ureteric reconstruction is still technically demanding and having a steep learning curve. The employment of robot-assisted approach could be the solution of this complicated condition. The aim of this study is to compare the outcomes of robot-assisted vs open ureteric reimplantation with psoas hitch for distal ureteric stricture. Between 2013 and 2018, 21 consecutive patients with unilateral iatrogenic ureteric strictures underwent ureteric reimplantation with psoas hitch in a single center were retrospectively reviewed. In the middle of the study period, i.e. 2016, there was a shift from open to robot-assisted approach. Thus, 10 robot-assisted and 11 open ureteric reimplantation were evaluated. Results: There were no demographic differences between robot-assisted and open groups in terms of age (51 vs 51, p=0.48), Charlson Comorbidity Index (score ≥ 3: 30% vs 36%, p=0.76), and the mean number of prior abdominal surgeries (1.30 vs 1.27, p=0.50). For the perioperative outcomes, the mean operative times were the same (robot-assisted: 168 minutes vs open: 169 minutes, p=0.48). Robot-assisted group was associated with less estimated blood loss (10ml vs 154ml, p=0.002) and shorter mean postoperative hospital stay (6.9 days vs 11.9 days, p=0.023). The complications (Clavien-Dindo classification III-V) were similar between the two groups, 1 in robot-assisted group (ureteric stent migration) and 2 in open group (pelvic collection and sepsis). The mean Follow-up period of robot-assisted and open groups were 17 and 26 months respectively, no stricture recurrence observed in robot-assisted group, while one recurrence in open group. The estimated cost of disposables of the robot system was USD $2390 per case, and it was well compensated by the cost saved due to the average 5 days' reduction in hospital stay in the robot-assisted cohort (USD $3182 per patient). Conclusion: Robot-assisted ureteric reimplantation and psoas hitch has the benefit of less blood loss and shorter hospital stay, while it does not cause significant extra financial burden to the health care system. Changes of Voiding Functions in the Patients with Robot-Assisted Bladder Diverticulectomy or Partial Cystectomy Introduction and Objective: Bladder diverticula in adults might be incidentally discovered with low urinary tract symptoms (LUTS), hematuria, bladder outlet obstruction (BOO), or urinary tract infection. Comparing various management options, robot-assisted bladder diverticulectomy presented the greatest magnification, least invasive, and most efficient technique since 2006. Similarly, robot-assisted partial cystectomy was indicated for malignancy (ex: urothelial carcinoma, colon/ovary cancer with bladder invasion) or non-malignancy conditions. Voiding dysfunction can be found during the perioperative period in both procedures. Therefore, we aimed to review the urinary function of patients with these applications. In this retrospective study, all patients who underwent robot-assisted transperitoneal bladder diverticulectomy or partial cystectomy were enrolled. The patients with upper tract urothelial cancer and had bladder cuff excision were excluded. Complete data, including initial symptoms, imaging studies, urodynamic studies, surgical outcome, and follow-up duration, were obtained and analyzed using SPSS. Results: From Oct. 2011 to Feb. 2019, 33 patients underwent diverticulectomy or partial cystectomy; 4 were for the indication of LUTS (2 men and 2 women, with ages of 70.50 ± 15.26 years). All patients underwent CT or sonography for evaluation. The number of the diverticulum was 1.6 ± 0.89, which showed 4.68 ± 2.65 cm in diameter (range 2.40 -9.35). All patients had recurrent urinary tract infections, but only 1 had Foley before the operation. Twenty-nine patients had partial cystectomy (7 for urothelial carcinoma, 6 for colon cancer, 6 for gynecological cancer, 4 for sarcoma, 5 for endometriosis) with ages of 56.89 ± 14.49 years. Post-voiding residual urine was 20.64 ± 24.12mL post-operatively (range 0 to 70.74). Four had urge incontinence but no post-operative urine reten-tion were noticed. The follow-up duration was 35.99 Introduction and Objective: Obstruction of the lower ureter by pelvic cancer requires a palliative treatment. Percutaneous derivation is often performed in emergency context. If obstruction is limited to the peri-meatic area; Percutaneous antegrade recanalization can be performed and may require a resection of the ureteral orifice. We evaluate the results of percutaneous antegrade recanalization associated with possible bladder resection in the treatment of pelvic neoplastic ureteral stenosis. A retrospective, descriptive study from September 2015 to January 2019; included all patients with complicated pelvic tumor with ureteric-hydronéphrosis; patients with advanced bladder tumor were excluded. Under general anesthesia, in Valdivia modified position; A guide-wire is passed via the nephrostomy, and retrieved from the bladder to the urethral meat, followed by descent of ureteral-catheter under X-ray control; We might need a resection over the presumed uretric-meat as it will help open the lower extremity of the ureter, so it can be easily catheterized with a double J. Results: In our study 58 patients, including 23 men and 35 women, with an average age of 65 years (52-78 years). The Karnofsky index was ?80% in 92% and between 80-60% in 8% of patients. The average extent of ureteral stenosis was 2.25 cm (1-3.5 cm). The aetiologies of obstruction were dominated by cervix cancer 60.34%, followed by prostate cancer 39.6%. The recanalization is carried out 40% on the left, 60% on the right, bilaterally in 30% of the cases. The improvement of renal function in 82%, however 18% progressed to chronicity. The disappearance of the dilatation was present in 85%, whereas 15% of the cases presented a residual dilation without alteration of the renal function. The resection of ureteral meat in 75% of the cases. A few rare complications were noted: pyelonephritis (7%), isolated lumbago (10%), and bladder irritative syndrome (13%). The average survival of these patients depended essentially on the pelvic cancer responsible for the obstruction; ranging from 11 months to 45 months. Conclusion: Percutaneous repermeabilization associated with bladder resection is an attractive, reproducible and well-tolerated technique. Very few complications are reported. It provides a good quality of life to patients. Bilateral Adrenalectomy for Refractory Hypercortisolism Tan Tock Seng Hospital, Singapore, Singapore Introduction and Objective: Cushing's disease refractory to conventional medical and surgical treatment has an impact on patient's mortality, morbidity as well as quality of life. We aim to evaluate the role of bilateral adrenalectomy as a treatment for refractory Cushing's disease/syndrome and its safety, efficacy and surgical outcomes. We reviewed 32 cases of laparoscopic adrenalectomies from Jan 2016 to Jan 2019, of which 3 cases are bilateral adrenalectomies. Surgical outcomes and subsequent follow up results are evaluated. A literature review was conducted to compare outcomes with international studies. Results: All 3 patients were female of the ages of 39, 42 and 70. 2 of which have persistent CD after transsphenoidal operation and 1 has ectopic Cushing's syndrome. All 3 have undergone laparoscopic bilateral adrenalectomies via transperitoneal approach. Mean operative time is 374 minutes (SD 41.8), with a mean estimated blood loss of 200mL intraoperatively (SD 0). The mean length of stay is 21 days (SD 25.2, 5-50). None were converted to open. No intra-operative complications were noted. Out of the 3 patients, only 1 had post-operative complications more severe than Clavien Dindo I (Clavien Dindo IV). All patients have experienced symptomatic improvement post-operatively. No return to OT or re-admissions required. Conclusion: Bilateral adrenalectomy is a safe and effective treatment for refractory Cushing's Disease/ syndrome, especially in patients who have consequences of hypercortisolism. Success requires working closely with our Endocrinologist colleagues both pre-and post-operatively to ensure medical optimisation and an uncomplicated recovery. Various surgical approaches have been described, our case series has shown transperitoneal approach is safe and produces good surgical outcomes. Patient's quality of life and disease burden have improved post-operatively. Introduction and Objective: The Da Vinci surgical system has been adopted by urological surgeons due to its superior visualisation, greater degrees of motion, and precise movements. However, during complex procedures it may be necessary to disengage from the Surgeon Console in order to reference patient imaging. 3D reconstructions allow for the visualisation of complex anatomy with unprecedented ease. Combining the two technologies, we utilised the existing Da Vinci TilePro TM function with the aim of improving operative efficiency by providing a real-time, surgeon-controlled tool to aid in orientation of the displayed robotic surgical anatomical field. Using a laptop and the current Da Vinci models, the TilePro TM input port is accessed at the back of the Surgeon's Console. The laptop is connected via an HDMI output to DVI input cable to the TilePro TM DVI input port. Manipulation of the 3D model is controlled by the surgeon via wireless mouse. The surgeon is able to manipulate the 3D model as an intraoperative reference without needing to disengage from the Surgeon Console. The models are used to orient structures at times of anatomical ambiguity and used to identify target sites during resection. Our qualitative survey revealed that the interface was easy to use; improved understanding of visualised anatomy and that ongoing use of the application would be preferred in future complex cases. Conclusion: This innovative approach highlights 3D modelling as an invaluable adjunct in the preoperative planning of technically challenging cases in robotic surgery. This may be crucial to the success of oncological resection and functional outcomes of difficult operations. Given the ease this is achieved, the benefits of its use and the low cost of implementation, we suggest that all robotic surgeons consider this as part of standard operative setup. Introduction and Objective: Retroperitoneal lymph node dissection (RPLND) is technically challenging, with overall morbidity of 17-33%, and often involving the conversion of laparoscopic approaches to open. Robotic surgery lends itself to RPLND with its superior visualisation, greater degrees of motion, and precise movements. However, visualising complex relationships of tumour to aorta remains challenging. Our group has pioneered the fusion of robotic surgery and 3D modelling in preoperative planning and in intraoperative integration of these models to aid precision dissection. We describe the world's first fully robotic malignant RPLND aided by live intraoperative reference to a 3D model. Using the open source medical image processing software 3D Slicer (version 4.10; Harvard, US, 2019), standard patient CT imaging was 3D reconstructed. The node and aorta to its bifurcation were further highlighted and superimposed on the 3D reconstruction. Using the Da Vinci (Intuitive Surgical, CA, USA) Xi model, the TilePro input port was accessed via HDMI output to DVI input cable. This workflow adds no additional costs to the standard robotic setup. Results: Informed consent was obtained, and the patient positioned in modified lithotomy. Ureteric stents were inserted for better delineation. Four robotic ports and one assistant port were inserted. The robot was docked to the patient's left. Following adhesiolysis, small bowel loops were reflected superiorly. The parietal peritoneum over the right common iliac artery (CIA) was dissected up to the aortic bifurcation using the monopolar energy device. The left CIA and both ureters were identified and preserved. True to the 3D reconstruction, this revealed the malignant node at the bifurcation, which was sharply dissected, aided by live intraoperative referencing to the 3D reconstruction which could be manipulated live by wireless mouse through the Surgeon Console. This was particularly useful in establishing a plane between the node and anterior aortic wall where dense fibrosis was encountered. The specimen was removed in an endocatch. Operative time was 150 min and estimated blood loss <50 mL. Conclusion: This innovative case highlights cutting-edge 3D modelling as an invaluable preoperative planning tool and intraoperative reference in technically challenging robotic RPLND. Practice of Percutaneous Nephrolithotripsy (PCNL) and Outcomes at the Philippine General Hospital (PGH) Introduction and Objective: There have been refinements on the technique of PCNL over the years, but the Philippine General Hospital has just recently acquired the equipment and materials for this complex procedure. The outcomes and practice of PCNL at a tertiary hospital was analyzed. Medical records of 57 patients who were treated with PCNL from July to December 2018 were retrospectively scrutinized. Results: Fifty-seven patients underwent percutaneous nephrolithotripsy in the Philippine General Hospital, with a mean age of 48 years (range 21-78 years). Stone burden significantly predicts length of operative time (mean 103 minutes), lithotripsy time (mean 638 seconds), nephoscopy time (mean 43 minutes), fluoroscopy time (mean 10 minutes) and major complications (sepsis and bleeding requiring blood transfusion) but no association was found with the amount of irrigation fluid utilized which ranged from 200 ml to 50 liters (mean of 6.61 liters). Complete stone clearance was achieved in 44/57 (77%) patients. Three patients (5.26%) succumb to urosepsis and one (1.75%) had delayed hematuria. The average length of hospital stay, and postoperative length of stay was 8.6 and 5.2 days, respectively. The morbidity rate was 5.3%, mortality rate was 0%, reoperation rate was 3.5%, and readmission rate was 8.8%. As a tertiary hospital that caters to about 120 patients for PCNL per year, PGH can be a considered a high-volume center for this procedure. Stone clearance rate is acceptable which can be improved with time as residents achieve maximum learning curves with the techniques of the operation. Practice and outcomes need to be monitored to deliver the best quality of care tailored to the patient characteristics and stone demographics. The figures presented in this study may be quoted in counseling patients who will undergo PCNL. Ureteral Access Sheath -To Use or Not to Use? That is the Question Introduction and Objective: The ureteral access sheath (UAS) revolutionized the management of urinary pathology by providing quick access to the ureter and kidney. Several studies questioning the use of UAS against non UAS for intrarenal surgery (RIRS) demonstrates highly contradictory results and a debate rage on. The objective is to analyze the results after RIRS for kidney stones using single use flexible ureteroscope without UAS. Materials and Methods: RIRS procedures were performed in 51 renal units and treated 65 kidney stones for period of 5 months (Oct 2018 -March 2019). All cases were done using PUSEN digital single use flexible ureteroscope -270 degrees of deflection up and down, 3.6 Fr working channel, 9 Fr diameter of distal tip inserted over a 0.35-inch hydrophilic guidewire. The irrigation fluid was at 35-40 cm height and when needed irrigation with a 50-cc syringe at a low pressure were applied manually. Rhapsody Holmium laser with two long and short pulse modes with ingle use laser fibers were used in all patients. All procedures were started with energy 20 Hz, 05 J to test the stone at long pulse mode and modified during the procedure if needed. The treatment policy is always to dust the stone and do not use any basketing. In all patient we inserted a 5 Fr J stent for two to four weeks. We analyzed: patient's age and gender; size, number and location of the stone; preoperative CT measurement of HE; pre and postoperative urine culture, duration of surgery, hospital stay, complications including ureteral injuries, bleeding, fever, postoperative pain. Follow up was at month 1 and 3. In all 51 patients we were able to access the kidney without using UAS. The location of the stones was: 29 (57%) in renal pelvis, 18 (35%) in the lower pole and 4 (8%) in other calices. Combination of lower pole stone and a stone in the pelvis were found in 14 (27%) patients. Mean stone size was 17±9 cm, mean operative time 41±30 min, mean hospital stay 3±2 days. We did not encounter any ureteral injuries; hematuria was observed in 11(21%) of cases. Fever was documented in 13 (25%) patients and all of them were obstructed before the procedure. Bacteremia or sepsis were not observed. Stone free rate (SFR) defined as fragment less than 3 mm was achieved in 41 (81%) of the cases. A redo procedure was done in 5 (6%) of all cases. There are controversies about UAS and in which cases is it more feasible to use traditional technique and in whom is not necessary to apply access sheath. Based on data from different studies, development in lasers and our limited experience we believe that urologists will move to dusting techniques and RIRS without UAS. Introduction and Objective: Laparoendoscopic single-site surgery (LESS) reduces the limited invasiveness of conventional laparoscopy, while providing superior cosmetic results. However, LESS remains a challenging surgical technique even in robotic surgery primarily due to the lack of triangulation and limited instrument movement. The da Vinci SP® system was recently introduced to overcome these limitations. We describe our initial experience with pure single-site robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction (UPJO) using the SP system. There are many benefits to minimally invasive surgery (MIS), including less blood loss and faster recovery. On the other hand, long-term performance and symptoms have not been evaluated sufficiently. We present long-term symptom scores of patients who underwent MIS compared to open nephrectomy (Nx). At every visit to the clinic, all kidney patients in our center fill out the Edmonton Symptom Assessment Scale (ESAS) questionnaire evaluating pain, tiredness, nausea depression, anxiety, drowsiness, appetite, well-being, and shortness of breath using a scale 0-10, 0 being the absence of a symptom and 10 being the worst level of it. We used our Institutional Databases to compare this information between patients who underwent open and MIS Nx, considering each of the ESAS domains. Results: The mean operative time was 80.7 min (range, 35-210 min). The mean nephrotomy tube removed was 3.7 days. The postoperative hospital stay was 7.2 days. The postoperative hemoglobin concentration decreased in 34 patients, and the mean hemoglobin decrease was 12.0 g/L (Range, 0.7-26.8 g/L). The stone-free rate at hospital discharge is 80% (40/50). Postoperative complications occurred in 3 patients including fever (>38.5°C) in 3 (7.0%) cases. There were no patients who received blood transfusion in our study. No sepsis, kidney loss, and adjacent organ injury were observed. Conclusion: Despite the abnormal anatomy of the kidney, PCNL also has an acceptable stone-free rate and complications in the treatment of horseshoe kidney stones. Comparison To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for treating ureteric stones and compares the results between children, adults and elderly age group. From January 2015 to July 2018, ESWL was performed for treatment of ureteric stones in 46 children (age less than 17 years), 77 adults (age more than 17 years and less than 60 years) and 68 elder patients (age above 60 years). We used Modulith SL X lithotripter 3rd generation Storz medical equipment (Electromagnetic) for ESWL. The stone free rates, number of ESWL sessions required, com-plication rates and auxiliary procedures used were evaluated in a comparative manner. Results: Mean Stone size was 0.91 ± 0.20 cm in pediatric age group, 1.09 ± 0.39 cm in adults and 1.18 ± 0.39 cm in elderly age group. Post ESWL stone free rate was 89% for children, 89.6% for the adults and 64.7% in elderly age group respectively (p value=0.04). In children group second session was required in 3 (6.52%) patients, in adults second session was done in 10 (13.3%) patients and 3 sessions in 4 patients, while in elderly age group second session was done in 12 (36%) and third session was required in 6 (15%) patients. Hematuria was seen in 4 (8.69%) children, 5 (6.49%) adults and 6(8.8%) elderly patients. Stein Strasse in 0/46 children, 1 (1.3%) adult and 1 (1.45%) elderly patients. Fever was seen in 2/46 (4.34%) children, 1 (1.3%) adult and 0% elder age group. Post procedure severe Flank pain was seen in 4/46 (8.69%) children, 2 (2.6%) adults and 4 (5.8%) elderly patients. The results of ESWL for ureteric stones in adults remain similar to that of children. While stone free rate of elderly age group was inferior to that of the adult age group. Complication rates were almost similar in each of the children, adult and elderly age ESWL groups in our study. Adopting the Novel Concept for Reporting Outcomes of a Successful Treatment in Ureteroscopy and RIRS for Stones: The SToNE-FECTA. A Single Center Experience. Introduction and Objective: To adopt a new method for reporting outcomes during URS/RIRS for stones, the SToNE-FECTA (Successful Treatment in Endourology) concept at our center. It's said in recent literature that endourological procedures outcomes should be seen as composite in terms of stone free status and the absence or presence of minor/major complications. It's helpful in providing patients with counselling regarding the composite outcomes. Materials and Methods: From April 2018 till September 2018, total of 210 consecutive patients underwent URS/RIRS by 2 well experienced endourologists at hospital. These patients were prospectively analyzed. Those patients who achieved simultaneously a stone free rate in single procedure, absence of urinary infections and having no urological complications were considered to have achieved the SToNE-FECTA. Continuous and categorical variables were showed as mean, standard deviation (SD) and frequencies, percentages (%) respectively. For the statistical univariate analysis Kruskal-Wallis, chi-squared and Fisher exact tests, were used to compare continuous and categorical variables as needed. A multivariable logistic regression model was prepared to assess independent factors responsible for achieving SToNE-FECTA. A p value < 0.05 was considered statistically significant. All statistical analyses were performed using SPSS v.16.0 (SPSS Inc, Chicago, IL, USA). Results: Single-procedure stone free rate was seen in 186/210 (89%), absence of UTI in 206/210 (98.10%), and no procedural urological complications rates in 198/210 (94.3%) at a median follow-up of 2 months. SToNE-FECTA rate at 2 months was 87.4%. On multivariable logistic regression analysis, Stone length and width, prior urinary tract infection and impacted nature of stones were independently related with the SToNE-FECTA. We concluded that adopting SToNE-FECTA outcomes helps manage patients' and surgeon expectations post URS/RIRS procedures. This new predictive model may be useful tool for a composite counseling of patients and can be considered for the improvement of standardized quality assessment during the residents training as well. Interobserver Variability Among Senior and Fresh Graduates Surgeons in Assessment of Guy's Stone Score and S.T.O.N.E. Nephrolithometric Score: A Prospective Evaluation Iqbal N 1 , Alam U 2 , Hasan A 1 , Bhatty T 1 , Akhter S 1 1 Pakistan Kidney and Liver Institute, Lahore, Pakistan; 2 Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: Different scoring systems have been proposed recently to grade and predict the operative difficulty, stone free rates and complications. There have been no studies in the past regarding interobserver variability between junior surgeons and senior surgeons. This may lead to poor prediction of stone free rates and complications by junior surgeons while risk stratifying during surgical planning and counselling of their patients. The present study aimed at assessing the interobserver variability among the senior and fresh graduate surgeons in a developing country; performing the PCNL and compared the scoring done by both groups of surgeons for the Guy's stone score and S.T.O.N.E. nephrolithometry score. Patients who underwent PCNL between January 2016 and October 2017 were prospectively enrolled. Preoperative computed tomography was done in all these patients. The Guy's stone score and S.T.O.N.E. nephrolithometry score were calculated by 6 senior surgeons (more than 5 years endourology experience independently) and 7 junior surgeons (less than one year of endourology experience independently). All patients underwent either standard adult size PCNL by the senior consultants or junior consultants. Consistency among the scores was assessed using Cronbach's alpha. Each score was compared between the two groups for the stone free rates achieved and the complications incurred (operatively and postoperatively). Independent t-test was used for continuous variables and chi-square test was used to compare the categorical variables between the two groups value less than 0.05 was considered statistically significant. The mean Guy's grade was 1.5 and 1.4, while the mean S.T.O.N.E. score was 8.1 and 7.9 in the two groups respectively (P=0.06). The mean operative time was 140 ±64 minutes and 155 minutes while hospital stay was 2.3 and 1.9 days in senior and junior surgeons' group respectively (P=0.07). Mean fluoroscopy time was 6.2 ± 1.2 minutes and 7.4 minutes (P=0.08). The mean Guys score was 1.3 and 1.2 in the stone free patients in the two surgeons operated groups (p=0.07). The S.T.O.N.E. score was 7.8 and 7.6 in the two surgeon groups (P=0.06) for stone free patients. Both scores were strongly correlated to operative time (p value 0.008 for Guys and 0.013 for STONE score) in the senior surgeons' group. Similarly, these scores well predicted the operative time in the junior surgeons' group as well (P=0.004). Ancillary procedures were needed more in the junior surgeons' group when compared the Higher Guys and STONE score patients' subgroups of the patients. The re-admission rate was higher in the junior consultant group for higher Guys and STONE scores (P=0.03). Hospital stay was longer in junior surgeons' group in higher Guys and STONE scores (P=0.04). Need for blood transfusion was seen more in junior surgeons' group (p=0.04). Conclusion: More complications were seen in higher Guys and STONE scores in junior group. Both of the surgeon groups had good interobserver reproducibility of scores accurately. More studies are needed on how a fresh graduate improves surgical outcomes with time according to these scoring systems. Is it Feasible to Do TURP in Prostate Size More Than 100 Grams? Comparison of Outcomes of TURP in Small Versus Large Prostates Iqbal N 1 , Khalid M 2 , Akhter S 1 1 Pakistan Kidney and Liver Institute, Lahore, Pakistan; 2 Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: Benign prostatic hyperplasia is a condition in elderly men in which the prostate gland is enlarged. Trans Urethral Resection of prostate (TURP) has become a gold standard for treating bladder outlet obstruction due to prostate en-largement. In recent guidelines, it has been stressed that prostate should be preferred in prostate size less than 75 mL. It is suggested to opt for procedures such as laser enucleation and resection of prostate for large size prostate. However, such recent and advanced technologies are not easily available in third world countries. So, in poor countries such as Pakistan, either open prostatectomy is the choice or staged TURP is preferred in prostate size more than 100 grams. We aimed here to see single surgeon experiences in which TURP was done in prostate size more than 100 grams. We also compared outcomes between smaller and larger prostates TURP. A total of 205 cases were included in this prospective study, which were operated by a single surgeon trained in endourology and post fellowship experience of 10 years, with conventional monopolar TURP using standard technique. Group A had 116 cases of prostates smaller than 75 grams (based on EAU guidelines Cut off value for TURP), and group B had 89 cases of prostates size more than 100 grams. Intra-operative and post-operative complications, blood loss, pre and post-operative quality of life (QoL) and international prostate symptom score (IPSS), operative time, and hospital stay were compared between these groups. Results: Mean age of patients in group A was 61.2 ± 11.6 years and 63.4 ± 9.3 years respectively (P = 0.1). The mean preoperative size of prostate was 71.18 grams in group A and 110 ± 22.6 grams in group B (P = 0.001). Mean resection time was 43.4 ± 8.2 minutes and 73.4 ± 11.7 minutes in small and large size prostate groups respectively (P = 0.001). There were satisfactory improvements in terms of IPSS and QoL in both the groups which were comparable. Post-operative retention of urine was seen in 3 and 7 patients in the two groups (P = 0.1). No need for transfusion was seen in the large sized prostate group. TUR syndrome was not seen in any case of the large size prostate group. Urethral stricture was seen in one and two cases in respective groups (P = 0.1). In poor countries, TURP can be safely used even for large size prostates in single setting with meticulous, smooth and swift resection. Short procedure time is achieved by keeping continuous good vision by balancing suction pressure and the irrigation inflow meticulously. Surgeons hand and experience may have role which needs further research. Materials and Methods: A prospective, randomized study of 136 patients who underwent procedure of ureteroscopic (URS) stone removal for lower or mid ureteric calculi between January 2018 and March 2018. Patient of age more than 18 years were included in the study. They were divided into two groups, (Group A -who took alpha blockers) and group B (not taken alpha blockers for 5 days preoperatively). Patients with stone size > 1 cm, duplex system, who refused to enroll in study, and previous history of ureteroscopic interventions were excluded from study. Results: Out of the 136 patients, total of 68 patients were prescribed alpha blockers preoperatively (group A). Mean age of the study population was 32.13 + 11.34 years. Mean stone size was 41.42 + 9.5 mm 2 . There was seen no difference in rate of ureteroscope negotiation through ureteric orifice between the two groups while there was slight decrease in pain in the intervention group, but it was not significant (p= 0.61). It was concluded that preoperative use of alpha blockers had no extra beneficial effect in terms of ureteroscope negotiation in ureteric orifice and post-operative decrease in pain. Laser Lithotripsy Using Dusting Technique (Low Energy, High Frequency) for Symptomatic Upper Urinary Tract Stones Khedr M, Ashmawy A, Kassem A, Abdelhamid M, Abdelaziz A, Saad I, Zamel S Introduction and Objective: A prospective study to assess the feasibility of stone dusting technique (low energy and high frequency) during laser lithotripsy in symptomatic UUT (upper urinary tract) stones. Sixty patients with symptomatic single or multiple UUT stones less than 3 cm in diameter were included. Patients with coagulation disorders and active UTIs were excluded. All patients were clinically evaluated and underwent non-contrast spiral CT (NCSCT) to detect stone site, size, number, Hounsfield unit (HFU) and degree of hydroureteronephrosis (HUN). Rigid or flexible ureteroscope was used with stone dusting using the Ho: YAG laser at low energy and high frequency (0.5 J & 20 Hz) set. Operative and fluoroscopy time, total energy delivered, type of stent, hospitalization time, complications and its grade, number of treatment sessions and stone free status using NCSCT after 4 weeks were recorded. The mean stone size ± SD (range) was 1.55 ± 0.55 (0.5-3) cm, out of sixty patients (50 with single stone and 10 with multiple stones), fifty-five patients were stone free at 4 weeks. Complications had occurred in 11 patients (eight with grade I, two with grade II, and one with grade IIIa) according to Clavien-Dindo grading of surgical complications, Stone size was the only parameter which correlated significantly with stone-free rate. No significant correlation between incidence of complications and other parameters (stone size, site, BMI, age and operative time). Conclusion: Stone dusting technique is feasible, safe and effective in management of UUT stones. To prospectively compare the physiological effects of the Airseal system compared to the standard carbon dioxide (CO 2 ) insufflator in laparoscopic radical prostatectomy (LRP). Two cohorts of patients who underwent LRP with Airseal versus standard insufflation between January 2018 and October 2018 were prospectively analysed. In addition to clinicopathological data, various intraoperative physiological values (end-tidal CO 2 (ETCO 2 ), pH, pCO 2 , and base excess (BE)) were collected per pre-formed proforma and analysed. A p < 0.05 was considered statistically significant. Results: A total of 17 patients were included in this study; 9 (52.9%) had Airseal and 5 (47.1%) had standard insufflation. There was no difference in mean age (68 years vs 61 years, p= 0.34), PSA (12 vs 13, p= 0.99), and Gleason Score (p= 0.76) between Airseal and standard groups. There was significantly lower mean pCO2 in Airseal group at the 2-hour mark (54.9±5.3 mmHg vs 77.4 ± 22.3 mmHg, p= 0.04). There was a trend towards lower mean ETCO 2 in Airseal group compared to standard group at both 1 and 2 hours (43.8 ± 3.1 mmHg vs 47.1 ± 7.3 mmHg, p= 0.30 and 40.7 ± 5.7 vs 55.3 ± 11.1, p= 0.12 respectively) with smaller difference in ETCO 2 at 1 and 2 hours from baseline (4.3 ± 4.4 mmHg vs 9.8 ± 9.4 mmHg, p= 0.16, 8.8 ± 5.6 mmHg vs 17.4 ± 12.1 mmHg, p= 0.17 respectively). Airseal group was observed to have more stable mean pH at the 2-hour mark, although not statistically significant (7.25 ± 0.05 vs 7.23 ± 0.10, p= 0.71). Conclusion: Airseal is a novel valve-less system that enables stable pneumoperitoneum with continuous CO 2 recirculation which allows improved patient's exposure to CO 2 during LRP with more stable CO 2 circulation amongst Airseal group as observed by sig-nificantly lower mean pCO 2 at 2 hours, lower ETCO 2 , and less systemic acidosis. Introduction and Objective: With wide acceptance of laparoscopic partial nephrectomy (LPN) for the treatment of small renal masses < 4 cm (T1a), the concept has been extended to select > 4 cm (T1b) renal tumours. There are few isolated reports for laparoscopic partial nephrectomy for T1b renal tumours. Our objective was to evaluate the early surgical outcomes of LPN for pT1b tumours compared with LPN for pT1a tumours in a single center in India. We retrospectively reviewed data of 97 consecutive patients who underwent LPN in a single tertiary care centre of south India from 2010 to 2019. Patients were stratified into two groups according to radiographic tumour size. Patient demographics, perioperative outcomes and oncologic outcomes were recorded. Results: A total of 34 out of 97 patients who underwent LPN during the study period, had T1b tumours radiographically. The median tumour size was 4.9 cm (4.1 -6.6 cm). Two tumours were upgraded to pT3a due to sinus fat infiltration. The variables studied are compared in the table attached. Conclusion: Laparoscopic partial nephrectomy can be safely extended to select T1b renal tumours. The trifecta outcome was better for T1a tumours but showed no statistical difference. The warm ischemia time, operation time, complication rates and hospital stay were similar with a significantly increased total blood loss for T1b tumours. Management of Atypical Uretero-Pelvic Junction Obstruction in the Robotic Era: Experience from a Tertiary Centre and Algorithmic Approach Introduction and Objective: Uretero-pelvic junction obstruction (UPJO) occasionally present with complex problems such as giant hydronephrosis, atypical uretero-pelvic anatomy, solitary kidney, unavailable ureter (long segment ureteric strictures/previous ureteric anastomosis) and secondary UPJO. Such unusual situations pose significant challenges in surgical management. We aim to present an algorithmic approach in management of these patients along with our experience in robotic repair of complex and atypical UPJO. Materials and Methods: From 2015 to 2018, 7 cases (8 renal units) of UPJO with complex anatomic problems were operated robotically in our department. Four patients underwent 'Santosh-PGI' tabularized flap pyelovesicostomy in 5 renal units. All of them presented with giant hydronephrosis (HDN). One patient presented with giant HDN in a solitary kidney with multiple secondary calculi and underwent calico vesicostomy. Another female underwent robot assisted boari flap calico vesicostomy following failed robotic ureterocalicostomy for secondary UPJO. A young female with long segment upper ureteric calculus underwent ileocolic vesicostomy. All the patients were drained pre-operatively by percutaneous nephrostomy (PCN) and the anastomosis were based over a 16 Fr Foleys catheter placed suprapubically. The mean operative time was 180 minutes with an average blood loss of 100 mL. Results: There were no intraoperative or perioperative complications. All patients demonstrated good gravity dependent drainage with no contrast leakage or anastomotic narrowing on postoperative nephrostogram. On a follow-up period ranging from 4 months to 3 years, all patients are asymptomatic with no worsening of renal function. The patients were advised double voiding and are on regular follow up. The advent of robotic surgery has made complex reconstructions for the management of complex and atypical UPJO feasible and simple with minimal morbidity. A wide gravity dependent drainage forms the basis of these repairs and each case must be individualized according to the uretero-pelvic anatomy, functional status and clinical presentation of the patient. Laparoscopic Single-Channel Varicocele Dissection (LEVD) for Symptomatic Varicocele. A Novel Minimally Invasive Technique Introduction and Objective: Varicocele constitutes a significant abnormality in young men that may be a causative factor for infertility or chronic scrotal pain. It may be also an esthetic problem. The standard treatment includes open or laparoscopic spermatic vein ligation with excellent results. Nevertheless, the common tendency to minimize surgical approaches has gained varicocelectomy as well. One of the latest concepts is the Laparoscopic Single-channel Varicocele Dissection (LEVD). We present our initial experience with seven patients treated with this technique. From May 2017 to December 2018, we carried out seven LEVD procedures in 7 males of mean age 26.4 (range 22-40) suffering from infertility or scrotal pain. We used the fabric kit (LEVD, Wolf, Germany Tutlingen) that consists of a 5 mm trockar, 4 mm optic and appropriately designed working instruments (disector, monopolar forceps, scissors). No drainage was needed. We assessed operative and hospitalization times as well as safety and effectiveness of the method. Results: All patients were operated successfully with no complications or extra port insertion. The blood loss was minimal. The mean operative time was 13.4 min (range 7-38). The patients were discharged within 9,8 (range 6-22) hours of surgery. During a 1-year follow-up (range 4-20 months) all patients reported significant release of symptoms and two patients became fathers. No hydrocele was observed. In one patient a recurrent varicocele was managed with standard laparoscopy. The LEVD procedure is a safe and effective option for spermatic vein ligation because of its minimal invasiveness, short hospital stay and fast recovery time. Application of Ureteroscopic Balloon Dilatation in Treatment of Ureteral Stricture Introduction and Objective: To evaluate the clinical value of ureteroscopic balloon dilator in the treatment of urethral stricture. A retrospective analysis was performed on 22 patients who underwent ureteroscopic balloon dilatation in our hospital from 2015 to 2018. 5 patients' stricture was caused by a stone, 5 patients of upj and 2 patients was caused after pelvic radiotherapy. F7 double J tubes were indwelling postoperatively. IVP and renal B ultrasound were re-examined. Results: The ureteral balloon dilatation was successfully performed in 22 patients. The operation time last for 35~80 min. average 42.5 min. All patients were hospitalized for 2.9 days averagely. The tubes were removed or replaced 3 months after operations. Three cases had no obvious improvement after dilatation and required further treatment. Ureteral stricture was not observed in other patients. Ureteroscopic balloon dilatation is an effective treatment for ureteral stricture. It is a simple, safe and effective surgical method, and with fewer complications, less damage and shorter time. Introduction and Objective: To compare the efficacy of robotic-assisted laparoscopic and conventional laparoscopic ureteral reimplantation with psoas hitch. We retrospectively analyzed the data of 20 patients undergoing robotic-assisted laparoscopic ureteral reimplantation with psoas hitch and 15 patients undergoing conventional laparoscopic ureteral reimplantation between Jan 2014 and Feb 2016 at MPUH, Nadiad. The indications, surgical techniques and outcomes of the two procedures were compared. Results: All the patients completed the Robotic and laparoscopic procedures without conversion to open surgery. Robotic-assisted and conventional laparoscopic procedures were comparable in terms of the mean operation time (165.50 ± 52.57 vs 152.50 ± 73.60 min), mean volume of blood loss (81.00 ± 69.35 vs 46.67 ± 31.41 mL), mean duration of catheter retention (6.75 ± 1.74 vs 7.50 ± 2.43 days), and mean postoperative hospital stay (7.10 ± 2.08 vs 8.67 ± 3.14 days). The patients were followed up for a mean of 18 months, during which none of the patients experienced anastomotic leak, vesicoureteral reflux or hydronephrosis. The study shows no significant differences in surgical outcomes with respect to operative time, blood loss, surgical techniques or postoperative outcome between robotic-assisted and conventional laparoscopic procedures of ureteral reimplantation with psoas hitch. Early Postoperative urinary incontinence has a relevant negative effect on the satisfaction and quality of life of patients who undergo radical prostatectomy for prostate cancer. More than 80% of men will regain urinary continence at 1 year, and more will regain up to 2 years after the operation. Early urinary continence (UC) rates, however, are much worse. The prevalence of urinary incontinence after Robot Assisted Radical Prostatectomy (RARP) is influenced by preoperative patient characteristics, surgeon experience, and surgical technique. Surgical technique is the only modifiable factor among these, and therefore, identifying and developing an optimal operative technique is likely to impact on continence outcomes. To present the risk factors for urinary incontinence after RARP and to identify surgical techniques which helps in escalating UC recovery within 3 months after RARP. A literature search on studies reporting early UC, different risk factors and surgical techniques was conducted using the Medline. We evaluated our last 50 patients who underwent RARP for early UC at 7, 30 and 90 post-operative days. Results: High level of evidence for early UC recovery do exist for sparing of the sphincteric mechanism, as well as sparing, and reconstruction of the supportive structures. Using all these surgical techniques, in our series of 50 patients after RARP, the rate of urinary Utilizing da Vinci ® Surgical System to Treat Challenging Urinary Stones Introduction and Objective: A worldwide mounting in the incidence and prevalence of urolithiasis has been observed. The standard treatment of urologic stone disease (USD)has changed from open surgery to extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) or ureteroscopy depending on the size and location of the stone. we are sharing our experience in utilizing Da Vinci® robotic surgical system to treat patients with urolithiasis instead of open surgical approach. We reviewed prospectively collected data of 19 patients who underwent robotic assisted stone surgery (RSS) between January 2010 and March 2018 at our institute for USD involving 22 nephroureteral units. Results: A total number of 22 RSS were accomplished with no conversion to open. 3 patients had bilateral stone and needed to have RSS on each side separately. Eleven RSS were performed on the right. The indications for RSS included: morbid obesity (n= 8, mean BMI 56.4 kg/m2), need for concurrent renal surgery (n= 3) severe contractures limiting positioning for retrograde endoscopic surgery or PCNL (n= 2), symptomatic calyceal diverticular stone with failed endoscopic approach (n= 4) and after failed PCNL (n= 2). 20 nephrouretral unit (91%) were rendered stone free on the first attempt with complication occurring after 4 cases (18%). Conclusion: RSS is viable options in the treatment of challenging urologic stone (CUS) with high success rate and low risk of complication. The need for open stone surgery was eliminated by RSS at our center. UP.289, Table 2 . Operative results of the robotic assisted stone surgery. UP.289, Table 3 . Stone composition. UP.289, Figure 1 . Computed tomography urography scan showing renal calculi in a closed diverticulum UP.289, Figure 5 . Patient positioning. Introduction and Objective: Minimally invasive techniques of kidney surgery have developed worldwide. The technical aspects of laparoscopic nephrectomy have been refined over the years. The purpose of this study was to evaluate the safety, feasibility and efficacy of the LigaSure vessel closure system during laparoscopic nephrectomy. The LigaSure device was used in 5 patients (3 female, 2 male) undergoing laparoscopic nephrectomy for non-functional kidneys between January 2018 and April 2018, three on the left and two on the right. For laparoscopy, all patients were in the lateral decubitus position and a transperitoneal approach was used. Nephrectomy was carried out without the use of clips or sutures for vessel closure. All trocars were removed, and all incisions were closed by suturing of the skin, no drainage was put in the renal lodge. Results: In all patients, operations were completed laparoscopically, and no conversions to open surgery were needed. All nephrectomy were carried out with the use of the LigaSure device for blood vessel closure. The mean operative time was 29 ± 12.6 min. According to the modified Clavien grading system, no Grade IV or V complication was seen, and no patients required blood transfusion. Mean blood loss was 63 mL (range 45 to 100 mL). The hospital stay was 24 hours for all patients. Conclusion: For vessel closure during laparoscopic nephrectomy, the LigaSure device seems to be safe, effective and made the procedure easier to do, with shorter operative times and less blood loss. For patients with conditions such as non-functional kidneys to be the best available procedure for diagnosis and management of impalpable undescended testes. Creation of tunnel in open technique is usually simpler but in LO tunnel creation is little cumbersome usually using haemostatic forceps from below or dissecting forceps from above in grown up children and adults where pneumoperitoneum is usually lost, and procedure becomes blind quiet often. We are using this novel technique to create more precise safe and better controlled access and tunnel. We present our initial experience with points of technique. Materials and Methods: Thirty patients age 5 to 30 years with low impalpable testes are included in study from 2013 to 18 in Dept. Of Surgery KGMU, Lucknow. We used standard three port technique after DL, cases suitable for single stage LO were taken up and testis mobilisation was done with standard technique. Then scrotal subdartos pouch created and a PCNL guide is passed through pouch via base of scrotum superolaterally to pubic tubercle into the abdomen through neohiatus between medial and lateral ligament. Tract dilated with serial dilators and finally 14 mm Lap-trocar passed, and laparoscopic forceps used to hold Gubraanaculam and testis is brought down to scrotum and placed in subdartos pouch. Results: LO was done in 30 cases using this novel technique, access & tunnel creation was more precise, simpler, smooth and without any complication. Conclusion: LO in grown up children and adults using this novel technique of access to peritoneal cavity and tunnel creation is more precise smooth ,simpler and safe with better control on pneumoperitoneum and better visualisation. The Benefit of Robotic Surgery in a Contemporary Practice of Radical Cystectomy with ERAS Protocols -Propensity Score Adjusted Analysis of Peri-Operative Outomes Sengkang General Hospital, Singapore, Singapore Introduction and Objective: While enhanced recovery after surgery (ERAS) in radical cystectomy is established in our institution, the additional benefits of robotic surgery with intracorporeal urinary reconstruction in radical cystectomy (iRARC) have not been evaluated formally. To evaluate the potential benefit of iRARC in a contemporary ERAS practice, comparing peri-operative outcomes with open radical cystectomy (ORC). With CIRB approval (Singhealth CIRB 2009/1027/D), all consecutive patients who underwent radical cystectomy and managed under an ERAS protocol, from December 2013 to October 2018 were reviewed. The demographics and peri-operative outcomes were analysed. Propensity score adjustment was performed to reduce biases attributable to covariate imbalances. iRARC was performed with a Da Vinci Si system with 3 robotic arms. Intracorporeal ileal conduit (IC) reconstruction was performed in a Wallace fashion anastomosis while orthotopic bladder reconstruction (OBS) was created using a modified Studer OBS technique mimicking the open technique. Results: There were 18 iRARC and 21 ORC patients. There were no significant differences in demographic or pathological characteristics, and no significant propensity score adjustment in baseline characteristics was required between cohorts. The iRARC cohort was associated with lower estimated blood loss (EBL) and transfusion rates (300 vs 600 mL, p= 0.05). There was also a trend towards a shorter duration of ileus (4 vs 5 days, p= 0.09) and shorter duration of post-operative opioid administration (1.5 vs 3 days, p= 0.11). These benefits were apparent despite a longer operative time for iRARC (581 vs 446 min, p= 0.03), and a higher proportion of orthotopic bladder reconstruction (27.8% vs 4.8%, p= 0.07) and salvage cystectomies (11% vs 0%, p= 0.16). Comparable perioperative complications (11 vs 5%, p 0.26) and length of stay (8.2 vs 7.4 days, p= 0.56) were observed in the iRARC cohort. Conclusion: When compared to an equivalent ORC cohort, iRARC has peri-operative benefits of lower EBL and transfusion rates, with a trend towards faster bowel recovery and a shorter duration of opioid analgesia despite a longer operative time, and a higher proportion of OBS reconstruction. These benefits are apparent even with an ERAS care protocol in contemporary practice. Intermediate Oncological Outcomes in a Contemporary Series of Robotic and Open Cystectomies -A Propensity Score Adjusted Analysis Tan YG 1 , Allen JC 2 , Tay KJ 1 , Lee LS 3 1 Singapore General Hospital, Singapore, Singapore; 2 Duke-NUS Medical School, Singapore, Singapore; 3 Sengkang General Hospital, Singapore, Singapore Introduction and Objective: Minimally invasive techniques for radical cystectomy have been proposed to reduce peri-operative morbidities associated with open surgeries. However, the oncological benefits of robotic surgery with intracorporeal urinary reconstruction in radical cystectomy (iRARC) have not been evaluated formally. To evaluate the potential oncological benefit of iRARC in a contemporary cohort, compared with open radical cystectomy (ORC). With CIRB approval (Singhealth CIRB 2009/1027/D), all consecutive patients who underwent radical cystectomy from December 2013 to October 2018 were reviewed. The demographics, clinicopathological characteristics and survival outcomes were analysed. Propensity score adjustment was performed to reduce biases attributable to covariate imbalances. Extended template pelvic lymph node dissection was routinely performed in either approach. Results: There were 18 iRARC and 21 ORC patients respectively. No significant propensity score adjustment in baseline characteristics was required between cohorts. More patients (38.9 vs 14.3%) in the iRARC group received neoadjuvant chemotherapy (NACT) (p= 0.14). A higher proportion of orthotopic bladder reconstruction (27.8% vs 4.8%, p= 0.07) and salvage cystectomies (11% vs 0%, p= 0.16) were performed in the iRARC group. The pathological outcomes were similar in both groups (50 vs 47.6% > T2 disease, p= 0.856; 27.8 vs 33.3% lymph node involvement, p= 0.742). All patients achieved negative margins on final histology. Patients who underwent ORC had a nonsignificant tendency towards higher lymph node yield (34 vs 28 nodes, p= 0.256). The mean follow up time was 34.0 and 32.4 months in the iRARC and ORC groups respectively. The intermediate oncological outcomes for both groups were similar. The mean recurrence free survival (RFS) in the iRARC group was 37.5 months, compared to 21.4 months in ORC (p= 0.093). The mean overall survival (OS) was 43.0 months in the iRARC group and 35.5 months in ORC (p= 0.14). Conclusion: Compared to an equivalent ORC cohort, iRARC achieved similar oncological outcomes and survival profile in intermediate-term analyses. Despite a non-randomised study, the cohort is largely equivalent with minimal propensity score adjustment. The favourable oncological outcomes support the implementation of iRARC as a reasonable alternative Introduction and Objective: The miniaturization of access sheath in Mini-Percutaneous Nephrolithotomy (Mini -PCNL) surgery has significantly reduced the intervention related morbidity. The clinically relevant endpoints for PCNL are the rates of stone clearance and major complications. Cost is the main barrier behind model or simulator based PCNL training in low income countries. Considering the less invasiveness of Mini-PCNL the outcome was evaluated for learning curve. This is a prospective cohort study where single urologist without previous experience of independent PCNL surgery performed Mini PCNL under supervision. The endpoint was 60 Mini-PCNL procedures. The inclusion criteria were patient age ≥ 15 years and renal stone sized 10-30 mm. Patient with congenital anomalies, solitary kidney and urinary tract infection were excluded. Informed consent was taken, and ethical clearance was taken from institutional review board. All the procedure was performed with Ureteroscope (7.5/11.5 Fr or 6.5/ 9.5Fr) and Pneumatic lithotripter. The outcome is measured in terms of stone free rate and postoperative complications. The mean age of study group was 37.0 ± 9.9 years. The overall mean operative time was 55.0 ± 19.0 minutes. The mean stone size was 16.8 ± 2.9 mm and stone free rate was 98.0%. The mean drop in hemoglobin was 1.3 ± 0.8 gm/dl. The grade I complications was 16% and grade II and III was 8% each. Stone free rate was significantly associated with stone numbers (r= -0.47, p= 0.004). Similarly fall in hemoglobin was associated with total operative time (r=0.49, p= 0.003). The mean operative time decreases significantly after 30 cases (p< 0.05). 56% patient underwent tubeless procedure and average hospital stay was 2.6 ± 1.3 days. Conclusion: Mini PCNL is safe and effective for small and medium sized (10-30 mm) renal stones in hands of novice urologist. It can be adopted for hands on training for residents under supervision. Use of Ureteroscope, pneumatic lithotripsy, higher rate of tubeless procedure and lesser hospital stay serve well for low income countries. Review For intra-renal stones: mean calculus size was 7.0 mm (range 2-15mm). For ureteric stones, mean calculus size was 6.9mm (range 4-14mm) and 31 patients had insertion of ureteric stent prior to treatment. Mean treatment time was 49 minutes. Median American Society of Anaesthesiologists (ASA) grade of patients was 2. Stone clearance was achieved in 80% (N=108) of patients. Only 8 patients required readmission for complications following ESWL. N=5 re-admitted for steinstrasse requiring ureteric stent insertion and subsequent endourological clearance, N=2 patients UTI requiring intravenous antibiotics, N= 1 for renal hematoma was managed conservatively. 30-day readmission rate was 5.7%, in which the average stone size was 9.3mm with the majority being lower pole and ureteric stones. Follow up data was not available for N=24 patients. Conclusion: Day case ESWL service at this site is efficacious in treating renal & ureteric calculi with overall low complication rates and comparable stone clearance rates. Service delivery could be improved by optimizing selection of smaller stones in favorable anatomical positions The Margin Strategy in Laparoscopic Partial Nephrectomy with Selective Renal Artery Clamping: Anatomical Basis, Surgical Technique and Comparative Outcomes Introduction and Objective: To evaluate the possibility and efficiency of a modified margin strategy in laparoscopic partial nephrectomy with selective renal artery clamping. Seventy-six cases of laparoscopic partial nephrectomy with segmental renal artery clamping in Shanghai Changhai Hospital between July 2014 and September 2017 were retrospectively reviewed. Relevant clinical data were recorded including baseline patient and tumor characteristics, and surgical outcomes (segmental artery mobilization time, operating time, warm ischemic time, estimated blood loss, complications, and so on). A comparative analysis between standard technique and margin strategy was performed. Results: In 38 cases, margin strategy to mobilize segmental artery was successfully performed. In the other 38 cases, the surgery was performed in traditional method. The use of new strategy led to a shortened segmental artery mobilization time (5 min vs 12 min, p<0.001). There was no difference in terms of perioperative complications between the two techniques. The margin strategy is a practical method in laparoscopic partial nephrectomy with selective renal artery clamping. It provides a simplified way of finding segmental arteries. Further studies are needed to confirm these preliminary findings. Introduction and Objective: Traditional practice following percutaneous nephrolithotomy (PCNL) is to leave a nephrostomy drain. 'Tubeless' PCNL involves placement of a ureteric stent in lieu of a nephrostomy drain. In 'totally-tubeless' PCNL, no drainage is left. The purpose of this study was to demonstrate that standard and miniaturised PCNL can be performed tubeless or totally tubeless with excellent outcomes. Materials and Methods: Fifty-two tubeless or totally-tubeless PCNLs were performed between 2013 and 2018. PCNLs were performed in the modified supine position. Data on outcomes and complications were collected prospectively. Decision to omit nephrostomy drain or ureteric catheter/stent was made at time of surgery in cases that were deemed suitable (e.g. no solitary kidney, minimal bleeding and fluoroscopic/ visual complete stone clearance at operation completion). Stone clearance rates, length of hospital stay, and complications were determined. Results: 13 tubeless and 39 totally tubeless PCNLs were performed. Miniaturised equipment was utilised in 11 of the totally tubeless group. Overall stone-free rate was 86%. Median length of stay was 1 day. The rate of complications (Clavien-Dindo grade 3 and above) was 8%. Conclusion: Omitting a nephrostomy drain or ureteric stent is a safe option in suitable patients. We have demonstrated excellent stone free rates with minimal complications and length of hospital stay. We plan to conduct a pilot trial assessing the clinical outcomes, feasibility and acceptability of tubeless miniaturised versus tubeless conventional PCNL using validated pain scores and PROMs. Women Should Not Be Urologists in Taiwan? The Differences of Service Patterns of Female Urologists, Gynecologists, and General Surgeons Chang TW, Hu HY, Cheng W, Chiu YC Introduction and Objective: Sexual stereotype is a key factor for physicians to choose their carrier. Traditionally, surgery is viewed as the field of man in Tai- wan. The condition is even worse in urology, because it deals with the abnormalities of genital areas, especially male patients. Nevertheless, there are more and more females devoting themselves into surgery-related specialties. In this study, we try to compare the differences of service patterns of female physicians among different gender-specific specialties, including urology, gynecology, and general surgery. Insurance Dataset (2000LHID) is one of the datasets of National Health Insurance Research Database in Taiwan, including all the medical insurance information from one million randomly-selected residents in Taiwan. The claim data including the yearly inpatient and outpatient service volumes, total and major surgical volumes, revenues, and sex ratio of patients of each female and male attending urologist, gynecologists, general surgeons with practice more than five years between 1995 to 2013 were recruited. The differences of female-to-male ratio of these factors were compared among urologists, gynecologists, and general surgeons with ANOVA test. P < 0.05 was viewed as statistically significant. Results: Female accounts for 6.7%, 51.3%, and 7.0% of urologists, gynecologists, and general surgeons, respectively. Their differences of their service and revenue were shown in Table 1 . Female urologists and general surgeons had fewer patient services and revenues than male, while female gynecologist performed better. Nevertheless, when it comes to inpatient service, female general surgeons and urologists were doing better than gynecologists. There are no differences between female general surgeons and urologists. Conclusion: There are limitations of female urologists and general surgeons, rather than gynecologists in their clinical service. Female urologists are non-inferior than other female general surgeons in Taiwan. Efforts should be done to improve the gender inequality in the field of urology and surgery. Materials and Methods: CPP patients completed histories and standardized questionnaires: genitourinary pain index (GUPI), patient health questionnaire (PHQ-4) for anxiety and depression, interstitial cystitis symptom index (ICSI), and pelvic floor distress inventory . Scores and number of comorbidities compared to pain catastrophizing scale (PCS) by linear regression. "Extreme catastrophizing" (score ≥ 30) associated with worse outcomes in the literature also analyzed. nostic test accuracy of the Glasgow Prognostic Score (GPS) as a prognostic factor for renal cell carcinoma (RCC). Studies were retrieved from PubMed, Cochrane, and EMBASE databases and we performed comprehensive searches to identify studies that evaluated the prognostic impact of pre-treatment GPS in RCC patients. We assessed sensitivity, specificity, summary receiver operating characteristic curve (SROC) and area under the curve (AUC). Heterogeneity was significant and meta-regression revealed that presence of metastasis was might be the potential source of heterogeneity. Subgroup analysis also demonstrated that presence of metastasis might be the source of heterogeneity. Conclusion: GPS demonstrated a good diagnostic accuracy as a prognostic factor for RCC and especially in case of non-metastatic RCC. Pilot Study Assessing the Utility of a Novel Uro-Oncology Android Phone Application in the Outpatient Setting Tan Tock Seng Hospital, Singapore, Singapore Introduction and Objective: Uro-oncology follow up has been standardised according to guidelines from international associations such as the European Association of Urology (EAU) and the American Urological Association (AUA). Adherence to guidelines is the standard of care, however in our busy urology outpatient clinics, compliance may be an issue. We created our own android phone application with easy access to a summary of current uro-oncology surveillance recommendations according to the EAU 2018 guidelines. In our pilot study, we assessed the utility of this phone application in the outpatient setting. From January to February 2019, 13 junior doctors at Tan Tock Seng Hospital, Singapore, were encouraged to download an android application which contained the 2018 EAU oncology guidelines surveillance protocols. It was utilised in the outpatient clinics when consulting uro-oncology patients. At the end of the study period, they were given a questionnaire to assess, using a 10-point scale, their knowledge of current EAU oncology surveillance protocols, according to the guidelines, and their confidence of adherence to the guidelines, before and after using the application. Results: Six doctors managed to utilise the application. The others were non-android phone users. Student Paired T test was calculated. There was a significant improvement in knowledge of the current EAU uro-oncology guidelines (p ≤ 0.01) and confidence in adhering to uro-oncology surveillance protocols (p= 0.04) after using the application. The application was rated as useful, and all the doctors who utilised the application would recommend it to fellow junior doctors in Urology. Conclusion: Ideally, surveillance of oncological cases should adhere to standardised guidelines. However, certain cases may be unique and follow up plans may be at the discretion of the physician. Nevertheless, clinicians should cultivate their clinical decisions based on guidelines. Our android application has been shown to improve knowledge and confidence regarding adherence to current guidelines. Further work to improve our phone application is in process. Perceived Sources and Consequences of Intraoperative Stress: A Qualitative Study This study aims to describe surgical team members' perspectives on the causes of intraoperative stress and their impact on performance and team dynamics. A secondary aim is to assess the concordance with the surgical stress effects (SSE) conceptual framework. We recruited participants from surgical team roles (surgeons, nurses, scrubs, anesthesia providers) in one large Midwestern VA and conducted semi-structured individual interviews. We elicited narratives of stressful intraoperative situations involving near misses or adverse events to explore factors and behaviors that influence intraoperative individual and team performance. Two coders inductively identified initial codes from transcripts in Nvivo (version 11). Codes were compared and discrepancies adjudicated. We then ran queries exploring codes to identify themes. Finally, we compared the SSE conceptual framework with these themes to assess how well the SSE predicts team dynamics and performance during high stress intraoperative situations. Results: We conducted 28 interviews. Results indicate that stress is ubiquitous during surgery, especially from difficult anatomy, equipment issues, and assistant incompetence. The salience of particular stressors varies by role. Emotional and behavioral reactions to stress vary, tending to be negative. Frustration and anger were the most commonly mentioned emotions in these scenarios, followed by fear and anxiety. Negative behavioral reactions to stressors (usually by surgeons) not only upset and distracted other staff, but often led to silence and perceived decrease in psychological safety, reduced communication, and negative patient outcomes. The negative impact of surgeon behavior on team dynamics was perceived to be greater than other roles. The sources and consequences of intraoperative stress described by our cohort are consistent with the existing SSE framework. Conclusion: This qualitative study describes various causes and consequences of intraoperative stress. Subjective experiences of surgical team members are consistent with the existing surgical stress effects (SSE) conceptual framework and additionally suggest that interventions targeting surgeon behavior (or reducing stressors surgeons perceive as important) have the greatest potential to improve team performance and patient outcomes. Introduction and Objective: Testosterone deficiency is a known risk factor for osteopenia and osteoporosis in elderly men. The aim of this study is to investigate the relationship between low testosterone level and male bone density. We retrospectively reviewed all male patients who underwent bone density measurement by DEXA scan in the period from September 2016 to September 2018 including patients who had pre-scan testosterone, FSH, LH, estrogen, and vitamin D level. Patients with parathyroid dysfunction, renal dysfunction, or those receiving androgen deprivation therapy were excluded. We studied the group of patients who had a testosterone level below 15 nmol/L. Data were analyzed using appropriate statistical tests and SPSS package, version 20. The analysis included factors that may affect bone density. Results: Out of the 715 patients who underwent bone density measurement, 85 met the inclusion criteria. The mean age of these 85 patients was 50.08 ± 19.2, the mean testosterone level was 8.8 nmol/L, FSH level 14.4, LH 8.5, estrogen level 117.3, and the mean vitamin D level 59.3. Of the 85 patients, 51 (60%) had normal bone density, while 34 (40%) had low bone density or osteoporosis or osteopenia. On multivariate analysis, testosterone level, estrogen level, FSH and LH had no statistically significant impact on bone density (p 0.767, 0.350, 0.364, 0.564, respectively). Factors that were found to affect bone density were the age and vitamin D level (p <0.001). Conclusion: Bone density as assessed by DEXA scan is mainly affected by the age and vitamin D level. The variations in testosterone level and other related hormones have no effect on bone density. However, further study using tubercular bone function is needed. Cystoscopic Removal of Misplaced Intrauterine Device in the Bladder Introduction and Objective: Intrauterine devices are one of most popular, cheap and reversible contraception methods, but in rare cases they can cause uterine perforation. The mechanism is unknown, but there are underlying risk factors such as congenital anomalies, infections, and history of abortion. The aim of this study is to report on a unique case of misplaced intrauterine device in the urinary bladder, which was removed and treated endoscopically. Case report: A 35-year old lady, mother for 3 kids underwent placement of intrauterine device (IUCD) for birth control in the office 4 Months prior to her presentation. She presented with lower abdominal pain, and recurrent urinary tract infection (UTI). On CT scan, she was found to have misplaced IUCD in the urinary bladder. After starting IV antibiotics, she underwent cystoscopy, which revealed a Copper T 380A (IUCD) penetrating the posterior bladder wall with redness and edema around its exit point in the bladder with no other bladder pathology. The Device was grasped and delivered to urinary bladder lumen without any resistance at exit point then extracted completely with its thread. The urinary bladder defect was fulgurated, and patient was kept on urinary catheter. Follow up cystogram after one week showed normal study and the catheter was then removed. Conclusion: Endoscopic management of misplaced intrauterine device (IUCD) is feasible endoscopically in similar situations. Recurrent cystitis and lower abdominal pain can be the presenting symptoms of misplaced IUCD in the urinary bladder. Predicting Introduction and Objective: It is well documented that a flexible cystoscopy performed under local anaesthetic can provoke anxiety. The objective of this study was to provide a better understanding of the patient, procedural and pathological factors that contribute to anxiety during a flexible cystoscopy. Patients enrolled for a flexible cystoscopy at Royal Hobart Hospital were prospectively asked to complete a standardized questionnaire. One male doctor performed flexible cystoscopies under local anaesthetic in an outpatient setting. Data collection included patient demographics, medical history, preference for surgical gowning and gender of medical personnel present. Univariate statistical analysis and ANOVA testing was conducted using Microsoft Excel with p values <0.05 considered statistically significant. Results: 70 males and 35 females (n = 105) completed the questionnaire. Throughout the cohort overall anxiety levels were decreased after the procedure (pre cystoscopy 3.05 vs. post cystoscopy 1.69, p <0.05). ANOVA analysis showed anxiety scores to be highest amongst those aged 40-70, lowest amongst those > 70 years and patients <40 years showed the greatest decrease in anxiety scores. Patients who had a preference for the gender of medical staff present had overall higher levels anxiety before and after the procedure compared to the rest of the cohort (pre cystoscopy 4.64 vs. 2.81, p <0.05 and post cystoscopy 2.92 vs. 1.49, p<0.05). Patients with pre-existing mental health burden had higher pre-cystoscopy anxiety scores (4 vs. 2.63, p<0.05). Level of education, income, rurali-ty, religious affiliation, drug and alcohol dependency did not have a significant impact on patient anxiety. Indication for cystoscopy, number of previous cystoscopies and operative gowning preferences did not impact anxiety levels significantly. Haemorrhagic cystitis is one of the complications associated with pelvic radiotherapy. It can be associated with significant patient morbidity and mortality, resulting in multiple presentations to hospital and subsequent burden to the healthcare system. This study aims to establish the incidence of radiotherapy exposure in admissions for haematuria and characterise its significance. We conducted a retrospective audit of patients admitted between 30/10/2017 and 30/10/2018 to the Urology department at The Canberra Hospital with haematuria. Patients were identified through the electronic medical record system with a primary diagnosis of "haematuria", "clot retention" or "radiation cystitis". Patients meeting the inclusion criteria were collected consecutively from the electronic Clinical Record Information System (CRIS). Patients directly transferred from other hospitals or left against medical advice were excluded due to incomplete data. Results: A total of 128 admissions were included in the study-84 (65.6%) elective and 44 (34.3%) from the emergency department. 21 of the admissions (16.4%) had documented history of previous radiotherapy, with the majority for treatment of prostate cancer (16), followed by bladder cancer (3), endometrial (1) and colorectal (1). Admissions via ED were associated with higher odds of having previous exposure of radiotherapy (13/44) compared to elective. Additionally, patients with history of radiotherapy were more likely to have multiple presentations to hospital for haematuria, with 5/14 (35.7%) of radiotherapy-exposed patients admitted 2 or more times within the study period. This is in contrast to 5/100 patients with no radiotherapy history. The average duration was also higher in patients with a history of radiotherapy exposure (6.7 vs 1.2 days, p= 0.05). Conclusion: This study confirms that radiation cystitis is a common complication of pelvic radiotherapy, associated with recurrent presentations to the emergency department with haematuria. This may have implications for deciding between radiation vs surgical management of pelvic malignancies, particularly for prostate cancer. Additionally, due to the higher re-admission rates, patients with radiation cystitis may benefit from more aggressive early treatment with intra-vesical agents, cysto-diathermy or in severe cases conduit diversion. Urologists are often presented with patients managed by oral AC and oral AP drugs recommended for prevention of recurrent events related to coronary artery disease, cerebrovascular accidents and peripheral artery disease as well as for primary prevention of cardiovascular disease. Data on the use of oral AC and AP therapy amongst patients undergoing urological procedures are lacking. We investigated the prevalence of AC/AP use in these patients in relation to their estimated thrombotic risk. We studied a cohort of 450 patients (81.5% men, age 64.1 ±15.7 years) hospitalized for emergency or elective urologic surgery between February and April 2018. Records of prescriptions and indications for AC/AC use were obtained during admittance. Risk of venous thromboembolism (VTE) was calculated according to recent EAU recommendations. The vast majority (89.5%) of the cohort was hospitalized for elective surgical procedures Almost a quarter of them (23.6%) were receiving anticoagulants; 87.8% of them were on single AP therapy. Patients' risk of VTE was low (no risk factors) in 313 (69.6%), medium (any of the following: age ≥ 75 years, body mass index ≥ 35 Kg/m2, VTE in first degree relative) in 134 (29.8%), and high (prior VTE or any combination of three or more risk factors) in 3 (0.7%). Half of the already anticoagulated patients had no risk factors of VTE while the other half had medium risk. Urologists should familiarize with estimation of baseline risk of VTE. Managing patients who are already anticoagulated is challenging; carrying out randomized clinical trials is difficult; therefore, recommendations can only be based on credible observational studies of procedure-specific risks. Urologists should also be familiar with the stipulated time period needed to elapse for performing a certain procedure after stopping an anticoagulant as well as with the bridging therapy protocols. Introduction and Objective: Deep infiltrating endometriosis (DIE) affecting the urinary tract is a rare condition. Its presence augments the complexity of DIE, making difficult the surgical treatment, and if misdiagnosed can lead to irreversible loss of renal function. We describe our experience in the management of this condition. Retrospective study analysing the cases of DIE affecting the urinary tract treated in our center between 2006-2018. Preoperative data recorded include age, serum creatinine, renogram and imaging studies performed. We analyzed the location of DIE, surgical approach, and the type of intervention. Complications related to treatment were also recorded according to the Clavien-Dindo classification. Results: From 255 patients with DIE, 47 (18%) presented urinary tract involvement. The most frequent site was the left ureter (23 cases, 9%), followed by the right ureter (21, 8%) and the bladder (13, 5%). Median age at the time of surgery was 37 years (22-54). Median creatinine value was 0.8 mg/dL (0.4-1.6), only 3 patients had impaired renal function (6.25%). Renogram was performed in 18 patients (37.5%) and 14 of them showed renal impairment. Main imaging technique used for diagnosis was MRI (73%) followed by ultrasound (71%), and 71% of the patients had 2 or more imaging tests documented. Median hospital stay was 8.5 days (3-42). Laparoscopy was the main surgical approach (83%), needing to turn into open surgery in two cases. Interventions performed included 25 ureterolysis (53%), 9 ureteral reimplantations (19%) and 13 partial cystectomies (28%). Direct ureteral reimplantation technique was more performed than the psoas hitch technique (6 vs. 3). Nephrectomy was performed in two cases. A total of 16 complications were documented, six of them Clavien 3, and four Clavien 4. Conclusion: Urinary tract impairment due to DIE is a rare condition. Collaboration between Gynecology and Urology departments is of high importance for optimizing the diagnosis and treatment of these patients, in order to preserve good renal function. Is Twitter Just Social? The Use of Twitter at Urological Conferences: 2017-2018 Introduction and Objective: The use of Twitter® has been largely encouraged at Urological conferences; including asking delegates their 'Twitter handle' at registration. Some value it as a method of education and networking, others view as social media platform. However, there have been controversies; including photographs taken at conferences and then disseminated on Twitter which can breach intellectual property rights and/or patient confidentiality. Our aim is to better understand the evolving content of photographs shared via Twitter during urological conferences. The 'top Tweets' of Urological conferences were compared using respective hashtags: #AUA18, #BAUS18, #EAU18, #WCE18. The inclusion of photograph(s) and content was analysed according to predefined categories of presentation slides, clinical, research, speaker, social and industry. Results were compared to previous work analysing tweets: #BAUS17, #EAU17, #WCE17. The majority of tweets analysed contained photographs; the proportion of tweets containing text-only was 12-35% in 2017 and 14-26% in 2018. 4 videos of conference presentations were tweeted in 2018. Photographs containing presentation slides were the most common in 2017: 21-33%. In 2018 social themed photographs were the most common at #AUA18 and #WCE18, and pictures of presenters at #BAUS18 and #EAU18 (see table) . 'Research' related photographs made up 6-7% of tweets in 2017 compared to 8-20% in 2018. 'Clinical' tweets (including radiological or operative photos) has increased from 1-4% in 2017 to 0-8%; furthermore, there were 4 tweets that were analysed as containing 'sensitive content' (2018). Overall non-academic tweets (excluding industry) accounted for 42-53% in 2018 and 13-29% in 2017. 'Industry' tweets were analysed in 2018 only: 10-20%. Conclusion: There is a predominance of 'social' tweets sent at Urological conferences, but there is also ongoing dissemination of photographs containing presentation slides, research findings and confidential Bone-Anchored Penile Implants in Transgender Men After Phalloplasty Salter C 1 , Gonzales-Alabastro C 2 , Liu W 1 , Dy G 1 , Levine J 1 , Bluebond-Langer R 1 , Zhao L 1 1 New York University, New York, United States; 2 Introduction and Objective: Penile prostheses in transgender males have unique challenges. Given the high rate of prosthesis revision and explantation in this population, we have been using removable bone-anchors for proximal fixation to facilitate removal of hardware in case of explantation. We describe bone-anchored penile prosthesis placement in transgender males as an alternative technique. Retrospective study analyzing patient characteristics and outcomes. Descriptive statistics used to define study population and results. Operative techniques outlined in detail. Results: 19 implants were placed in 15 patients using a bone-anchored technique from February 2015 to January 2019. Mean age was 34.8 ± 9.6. There were no patients with diabetes mellitus; although none were active smokers, 40% of patients had a smoking history. Most patients had a radial forearm free flap phalloplasty. Five patients had undergone prior penile prosthesis placement. A total of 11 inflatable and 8 malleable implants were placed. Surgery was performed through a 3 cm incision lateral to the neoscrotum, contralateral to the vascular pedicle of the neophallus. The distal tip of the cylinder was capped with a 2 cm long piece of hernia mesh or alloderm. The proximal tip was secured to the pubic rami using Twinfix Titanium (Smith&Nephew) bone anchors. Sutures attached to the bone anchors are sutured to the rear-tip extender to prevent device migration. Mean OR time was 280 ± 91 minutes. Postoperatively, there were complications in 13 cases. There was a 21% infection rate, 26% revision rate and 26% explantation rate for erosion. During explantation, the bone anchors could be identified and removed. Mean follow-up was 340 ± 440 days. Our overall complication rate is comparable to contemporary studies for penile implants in a neophallus. The use of bone anchors is an alternative technique for penile prosthesis placement after phalloplasty. Introduction and Objective: Symptoms that are not bothersome and subtle are ignored by patients many a times. Renal stone are presented many times with mild symptoms. Sometimes patients were diagnosed with stone on imagine but they are not seeking for management as symptoms are not bothersome. Lack of awareness to renal health can lead to delaying the management. We have analysed the socio-economical burden on health care system due to delaying the stone management. Material and Methods: After institutional ethical and scientific committee approval prospective analytic study was conducted from January 2018 to January 2019. All the patients who were admitted for their stone management were asked about predefined sets of questions regarding their stone disease symptoms and their previous reports were noted in data sheet. Cases were considered as delayed management if there is a gap of > 8 weeks between diagnosis of surgically active stone and its management. Results: Out of 1000 patients we had reviewed 67% had delaying their stone management. Average delaying time was 5 months. 78% patients had consulted multiple urologist for their symptoms. 54% had multiple radiological investigations. 13% were presented to emergency at least once in their delaying period and 27% had more than 1 course of antibiotics during their delaying period. 29% had increase stone size or number, 4% needed nephrectomy and 9% had any form of complications due to delaying the management. Average economical lost per patient was 12000 -15000 INR. Conclusion: Delaying the stone management of surgically active stone for >8 weeks increase socio-economical burden to health care system of developing countries. As a health care provider, it is also our duty to provide awareness to the society regarding their renal health. Cancellation of Planned Surgery in a Tertiary Hospital in the United Kingdom Introduction and Objective: Operating theatres require high cost and resources to maintain and run smoothly yet provide a main source of income for hospitals. The cancellation of elective cases not only results in loss of income but also negatively affects patient experience. We report on reasons for elective theatre cancellation in a major trauma centre in England. analysis of semi-structured interviews with surgeons, anaesthetists, theatre managers, admissions unit and recovery unit staff was conducted to supplement the retrospective analysis. Results: A total of 453 cancellations were recorded across all surgical specialities. Eighty-four cancellations were urology cases, representing an estimated loss of ≤26,928 in earnings. Across the specialities the most common category for cancellation was a 'non-clinical hospital related' reason (37.5%) followed by a 'clinical hospital related' reason (29.8%), 'patient related' reason (27.2%) and 'other' reason (5.5%). Interview data analysis highlighted that some causes for cancellations may not be accurately represented due to limitations with cancellation reporting. Conclusion: Cancellation of theatre cases is a result of both modifiable and non-modifiable causes. Mismatch between the available staff as well as resources to accommodate the volume of operations listed appears to be central to many modifiable causes. Novel improvements in efficiency of patient flow through theatres must be implemented to avoid cancellations -examples of this being staggered working patterns to maximise use of resources. Factors for Clinical Coding Errors in a Single Centre Urology Department in the United Kingdom Introduction and Objective: Clinical coding is important for income, policy making also research in healthcare. Remuneration of National Health Service (NHS) trusts has greatly depended on accurate coding of care provided to its patients. We examine the accuracy of coding and the factors that influence this within a single centre urology department in England. Retrospective review of completed consultant episodes for Endourology over a 30-day period was performed with a clinical coding manager. Any coding errors or deficiencies were revised to populate correct healthcare resource group codes. Further qualitative analysis was conducted using semi-structured interviews of clinicians and coders as well as non-participant observation of the coding process. Thematic analysis of the interviews and observations was performed to identify factors for coding errors. Results: A total of 49 completed consultant episodes were identified in the specified period. Inaccuracies were identified in 40.8% of episodes. Of these inaccurately coded episodes, 80% resulted in reduced income while the remaining 20% made no change to income. Once correctly coded, an increase income of ≤17,226 was generated. Analysis of interviews and observations highlighted several factors, which contribute to coding errors. Chiefly among these include limited clinical knowledge by coders, clinicians' limited understanding of the coding process, time constraints and lack of engagement between clinicians and coders. The cause of clinical coding errors is multi-factorial and implicates both clinicians and coders. We recommend changes that could improve the coding process to accurately represent services provided by the urology department. Ileal Conduit with or without Cystectomy for Benign Bladder Tillu N, Patwardhan S, Patil B Introduction and Objective: Ileal conduit for benign bladder conditions is last resort in cases of intractable lower urinary tract conditions. There has been a debate on how to manage the bladder at the same time. Diversion without a cystectomy may result in pyocystis, bladder spams or possibility of a malignancy. However, cystectomy can increase the operative time and morbidity of the procedure. The decision can be difficult as these patients are seldom encountered in day-to-day practice. From January 2014 to December 2017, 18 patients underwent urinary diversion in the form of an ileal conduit for benign disease. 7 underwent cystectomy and 11 had bladder preservation. We retrospectively compared the demographics, comorbid illness and primary indication for surgery. Primary outcome measures were length of hospital stay, mortality and complications -highest Clavien grade complication at POD 30 (early), and 90 (late). Results: Indications for ileal conduit were -neurogenic bladder (5), radiation cystitis (4), complex vesico-vaginal fistula (3), recto-urethral fistula (1), genitourinary tuberculosis (4), exstrophy bladder (1). Important results are tabulated in the table given Conclusion: Although associated with a high risk of perioperative complications, urinary diversion in the form of ileal conduit might offer these patients their only chance at relief from their debilitating urological conditions. Predicting feasibility of cystectomy in patients requiring urinary diversion remains a perioperative decision, subject to patients' comorbidities, and intraoperative feasibility of dissection in the pelvis. It is imperative that patients be individually counselled regarding the anticipated risks and benefits of undergoing cystectomy versus not undergoing it at the time of diversion. The one-stop clinic (OSC) was devised to improve the efficiency of outpatient urology services by streamlining investigations. The concept facilitates consultation, investigation and management plan in a single appointment, with the aim to improve patient experience by reducing the Age (median, range) 38 (19-65) 41 (18-62) No. of females 9 5 Mean Charleson Comorbidity index (CCI) 5.4+/-1.3 3.8+/-1.9 No.of patients with chronic kidney disease 4 0 The decision to avoid a cystectomy depended upon the preoperative comorbidity status and ECOG score. Those with a higher score (≥2) tended to not undergo cystectomy inorder to reduce operative time and blood loss. Cystectomy was avoided in the patients with "frozen pelvis" as seen in patients with genitourinary tuberculosis, radiation cystitis with fistula and previously operated vesicovaginal fistula. To evaluate the sustainability of this service, the efficacy of the OSCs were assessed immediately after initiation of the service (2011), and at 3 and 7 years to assess ongoing use of resources and patient outcomes. Clinic data were analyzed for all OSC appointments (405) over a period of 1 month. In-depth clinic activity data was recorded for one weeks' attendances (101) including presenting complaint, investigations performed and clinical outcomes. Patient satisfaction questionnaire results were analyzed. Results were compared to our previous analyses of OSC. Results: There were 13 OSCs over the month assessed. DNA rate 2.27%. Average wait between referral and appointment was 7.9 weeks. Average number of admin letters generated was 1.3/patient. 58.4% of patients had investigations performed on the day compared to 52.6% in 2013. Average patient satisfaction score was 9.5/10 (n=104). 100% of patients reported they would recommend the OSC to a friend or family member. The results suggest that the OSC is sustainable -our data compares favorably with previous analysis and the published literature. In a climate of limited resources, the OSC approach is efficient and we have maintained a high-quality service with excellent patient satisfaction. Calcium In recent years, the nano drug delivery system with mesoporous silica as the carrier has overcome many flaws of traditional anti-tumor treatment, especially the mesoporous silica nanosystem for controlling reactive oxygen species (ROS) generation which has excellent tumor targeting property and biocompatibility, and minimal injury effects on normal tissues. Herein, we report a ROS controlled-release nanoplatform using hollow mesoporous silica nanoparticles (HMSNs) as carriers, loading calcium peroxide (CaO2) in the channels and cavity of HMSNs and coating polyacrylic acid (PAA) on the functional materials (CaO2@HMSNs-PAA). CaO2@HMSNs-PAA could release more ROS in a simulated tumor acidic microenvironment (pH 6.5), which could provide efficient anti-tumor efficacy without obvious damage to normal tissues. Structural morphology of the nanosystem was observed by transmission electron microscope. The preparation process was monitored using Fourier-transform infrared spectroscopy, zeta potential measurement, thermogravimetric analysis and nitrogen adsorption/desorption isotherm. CaO2 loading capacity and release profiles in different buffer solution were measured by inductively coupled plasma-optical emission spectrometry. In vitro drug delivery efficacy was evaluated on PC-3 prostate cancer cell line using confocal laser scanning microscopy. ROS produced by CaO2@HMSNs-PAA was detected by fluorescence microscopy and fluorescence spectroscopy. CCK-8 assay, scratch wound healing assay, transwell assay, and flow cytometry were used to evaluate in vitro anti-cancer effects including inhibition of proliferation, migration and invasion and promotion of apoptosis. In vivo biosafety and therapeutic experiments were carried out using BALB/c mice and BALB/c nude mice subcutaneously transplanted with PC-3 prostate cancer cells respectively. The experimental results evidently demonstrate that the developed nanocarrier could effectively deliver CaO2 to the tumor site and release them in response to the decreased pH of tumor microenvironment, resulting in improved anticancer efficacy both in vitro and in vivo. Moreover, this nanosystem caused no obvious damage to normal tissues according to the vivo experiments. Conclusion: CaO 2 @HMSNs-PAA could provide efficiently anticancer effects by controlled-releasing ROS under acidic tumor microenvironment, while simultaneously alleviating the adverse effects. The current study presents a promising integrated nanosystem toward effective and safe cancer treatment. Reducing the Hospital Stays for Hernia Surgery by Process Modification Introduction and Objective: Taiwan's national health insurance system aims to reduce unnecessary surgery, examination and medication. The leaders of hospitals try their best to reduce medical costs, such as promote clinical pathways, strengthen management mechanisms, improve medical care quality and efficiency, and reduce hospital stays. Even so, the patients can still satisfy with the content and quality of medical services. We try to adjust the hospitalization process in our urology department. The patients who will undergo hernioplasty come to the urological clinic. We complete the relevant examination before admission to the ward. This can reduce the unnecessary time after checking-in the ward for the surgery-related examination. The working hours of medical staffs also decrease. Completion of all the surgery-related examination in the outpatient clinic, hospitalization days could be shortened, and the turnover rate of the bed would be increased. Since March 2017, we established a team, calculated the time of waiting for examination and surgery, and designed questionnaires for those who will receive hernioplasty in the urology department. We evaluate current situation. Then we separately develop improvement strategies and choose selected programs, such as: establish the standardization process before the operation of hernia surgery and simplify the computerization of the outpatient computer. The outpatient department completes the pre-operative examination preparation and consent form. Special urological outpatient nurses were arranged to teach and explain the inspection sequence and uses the QR code to clearly guide the examination room route. The completion rate of pre-operative examination in hernia surgery increased from 41.7% to 66.7%. The total waiting time from 783.2 minutes to 93.1 minutes. The number of hospital stays decreased from 3 days to 2 days. The waiting time for all examinations decreased, including 18.8 to 10 minutes for blood test, 12 to 7 minutes for the X-ray examination, 14 to 8 minutes for the ECG examination, 18 to 7 minutes for anesthesia visits. The overall satisfaction increased from 89.2 points to 98.1 points. This project objectively improves all the various tasks for operation. With these obvious improvements, we promote the satisfaction and quality of medical care in patients who will receive hernioplasty in our hospital. Lack of Consensus in Uncommon Urethral Obstructions in Children: Results of the International Web Based Obscure (Obstruction to the Child Urethra) Study Introduction and Objective: Obstructive urethral lesions except posterior urethral valves (PUV) are uncommon in children and lack firm treatment algorithms. We report the findings of an international survey that examines the consistency of diagnosis, prognosis and treatments in uncommon urethral lesions in children. An ethics approved, online survey was administered to members of various international Urological societies. The survey included 22 questions including those on diagnosis (n=7), investigations (n=4), prognosis (n=2) and management (n=1) in children with uncommon posterior urethral obstructive lesions with two questions on PUV as embedded controls. The index cases involved children of various ages and presentations with circumferential narrowing in the posterior or bulbar urethra. Two sets of paired questions were offered with an increasing amount of information provided to see the effect of endoscopic appearances on urologists' decision making. Kappa estimates were developed for intra-rater and inter-rater concordance in these paired questions with additional clinical information. Gini indices were estimated for the majority of multiple-choice questions. Results: 121 participants responded to the survey including members of ESPU (20); SAUA (18) and SPUNZA (13). 71% of respondents attested to seeing less than 5 cases of urethral obstructions other than PUV every year. The majority admitted to answering based on extrapolation rather than specific teaching. 75 (IQR 67-90) responses were received for each question. Moderate to high intra-rater concordance (kappa 0.4-0.6) was observed for paired questions with additional clinical information with only 7% of participants changing their answers (17/242). However, in the diagnostic group, the kappa estimate was low (0.17 95%CI 0.13, 0.21) suggesting a high interrater variability and 0.1 (95%CI 0.05, 0.15) between questions in the investigation group. Gini coefficient was lower for the diagnosis of uncommon urethral lesions (0.35) indicating a higher variability in responses compared to posterior urethral valve (0.51). Conclusion: This international web-based survey identifies significant variability among paediatric urologists in dealing with cases of atypical posterior and bulbar urethral obstructive lesions. Participants' responses confirm a lack of reference resources and hence, the urgent need for firm guidelines. Bencic M 1,2 , Bizic M 1,2 , Stojanovic B 1,2 , Kisic J 3 , Djordjevic M 1,2 Introduction and Objective: Vaginal agenesis is a very rare congenital anomaly, with an incidence of 1/4000 to 1/10000 women. Generally, patients with vaginal agenesis and functional endometrium present with primary amenorrhea and cyclic chronic abdominal pain related to hematometra. A 14-year old girl was referred several times to the pediatric emergency department, complaining to the abdominal pain without menarche. Clinical and laboratory finding was normal. Further abdominal echotomographic exam-ination revealed abdominal cystic mass positioned in the lower part of abdominal cavity. After magnetic resonance was performed, we discovered lower vaginal atresia with extremely distended proximal vagina, filled with blood, and with constriction at the level of the cervix. Any associated anomaly was not found, and uterus was normally developed. Explorative laparoscopy and vaginoplasty by using local skin flaps were performed. The treatment of congenital adrenal hyperplasia (CAH) is multidisciplinary, and cooperation of a neonatologist, pediatric endocrinologist, pediatric urologist and pediatric psychologist is necessary for successful outcome. The aim of clitoral surgery is to achieve typical clitoral anatomy without compromised sensation and sexual pleasure in the future. Materials and Methods: During ten-years period (March 2008-March 2018), 11 patients with CAH, aged from 1 to 12 years (mean 3.5 years), underwent reduction clitoroplasty together with urethroplasty and introitoplasty. Surgical treatment included complete disassembly of the clitoris into glans with neurovascular bundle and urethral plate and cavernosal bodies. Degloving of the clitoris begun with circumferential incision line about 1 cm under the corona level. Neurovascular bundle was dissected from the corpora cavernosa with caution to preserve its' structures. Glans cap was then separated from the tips of the cavernosal bodies, avoiding the injury of arteries. Maximal reduction of cavernosal bodies and glans reduction were performed, followed by glans reconstruction and reassembly of all entities, in order to attain characteristic clitoral morphology. It is very important to maximally reduce cavernosal bodies and prevent postoperative pain related to erection of cavernosal remnants. Results: Follow-up ranged from 12 to 132 months (mean 54 months). A satisfying aesthetic outcome with normal appearance of the clitoral glans was achieved in all cases. Sensitivity of the reduced clitoris seemed preserved in all patients, but complete assessment was impossible due to the patients' age. Conclusion: Clitoral disassembly followed by reduction clitoroplasty presents a good choice for clitoromegaly in patients with CAH. This approach leaves the neurovascular bundle intact and completely preserves the glans cap and urethral plate blood supply. It also prevents pain due to erection of cavernosal bodies' remnants during the arousal. Long-term fol-low-up and psychosexual assessment are necessary for evaluation of sensation and sexual function in these patients. Conclusion: Experience with testicular lesions is generally low. The incidence of uncommon BLs is not exceptional. TSS is a safe and acceptable surgical choice for BLs, teratoma and EC, especially when they are well recognizable at USS. TSS should continue to be done via inguinal approach. Trans-scrotal TSS is reserved for high volume centers only until prospective data will be available, preferably from large series. Anterior Corporeal Mobilization with Subperiosteal Osteotomy: Application of a Recognized Epispadias Technique in DSD for Phallus Elongation Introduction and Objective: A paradigm shift has happened in surgical management of under masculinized male patients from complete feminization toward masculinizing the poorly developed male structure. Techniques for phallus elongation in these cases are clearly required. A recent development in the territory of exstrophy modern reconstruction has been RSTMI. In this technique every effort including sub-periosteal osteotomy has been made for penile elongation. Thirteen patients of 46 XY DSD and/or gonadal dysgenesis spectrum considered to be assigned to male gender with severe hypospadias and small phallus were operated between 2014 to 2015. The classic coronal incision was done, and corpora were released down the pubic bone at dorsal aspect. Ventrally first urethral plate was elevated, and dissection continued till bulbar urethra reflecting off the Denonvillier fascia sometimes to the level of bladder neck. The urethral plate was transected. At dorsal aspect, dissection was continued down reaching inferior aspect of pubis. A bone flake was avulsed in a sub periosteal plane underneath the pubis either the flake was detached or left alone on the corpora. In 4 cases that the elongation above the superior level of pubis was deemed insufficient, laterally subperiosteal osteotomies were done partially on inferior pubic rami on both sides. Pulling the glans stitch up the phallus was positioned in the maximal stretched upright position; corporal midline septum was longitudinally tagged on superior pubic bone by 3/0 Prolene suture holding the phallus in new uplifted position. The rest of the procedure was continued applying principles of STAG including serial ventral corporotomies and either preputial or buccal grafts. Results: Age of patients was between one year and 13 years with a median of three. Stretched penile length was below two standard deviations of penile length in age matched normal children in all patients. After subpubic release and subperiosteal osteotomy in each case 0.5-1 m was added to the stretched suprapubic length appraised during the operation. Conclusion: This surgical technique may be an effective way to increase penile length in cases of 46 XY DSD/microphallus. The Nephroscopy was performed using an 8/9.8 Fr rigid ureteroscope. Lithotripsy was performed using pneumatic or holmium laser. Then we inserted a 4.7 Fr double-J stent and placed a 14 Fr nephrostomy tube after procedure. To assess the results, type-B ultrasonic or CT was performed at the time of 3 days after the procedure. The initial SFR was calculated at hospital discharge. The final SFR was calculated 3 months later. Postoperative recurrence and renal function in children were followed up. Results: The stone of 124 kidney units were removed with one session while 3 kidney units were removed with two sessions. Single tract established in 126 kidney units and two tracts established in 1 kidney unit. The mean operative time was 69.3 ± 29.9 min and mean hemoglobin drop was 10.6 ± 6.9 g/L. The time of nephrostomy removal was 3.9 ± 2.0 days and the mean postoperative hospital stay was 6.6 ±3.7 days. The stone-free rate at hospital discharge was 87.4% (111/127). The final stone free rate was 95.2% (121/127). Complications occurred in 17 (16.4%) patients included fever in 17 (14.9%) patients. The mean follow up was 8.6 months (range, 3-18 months). The renal function was in normal range and hydronephrosis was not aggravated in these patients. Stone recurrence (>5mm) was found in 13 (11.4%) pediatric patients but without surgical treatment. The MPCNL has a high stone free rate and low incidence of complications in the treatment of upper urinary calculi. Managing Repair of Exstrophy-Epispadias Complex by Adopting Kulkarni Method Introduction and Objective: The repair of exstrophy-epispadias complex (EEC) poses a challenge to pediatric urological surgeons. Many techniques have evolved over time to treat this congenital anomaly and they have their own pros and cons. In any type of epispadias repair care is taken of achieving goals of correction of dorsal Chordee, glanular reconstruction and satisfactory cosmetic appearance. In 2002 Bharati Kulkarni reported a new method for repairing of exstrophy-epispadias complex (EEC) at a second stage by using flaps from the area of skin between the penis and scrotum. They said that it had good cosmetic outcome in terms achieving normal penoscrotal relation in all patients, who underwent repair by this technique. We evaluated outcome of epispadias repair by this technique in 5 children in terms of successful cosmetic results and complications. We used this technique in 5 patients (age between 1 and 7 years). All of them were males. As described by Kulkarni Flaps were marked on normal pigmented skin area lying between penis and scrotum. Incision was then encircled around root of penis and urethral strip of adequate size was marked. Flaps were raised exposing attachment of corpora cavernosa to ischiopubic rami and bulbospongiosus muscle. Urethral strip was tabularized over 6 or 8 Fr feeding tube. Absorbable 6/0 suture was used for this tabularization of urethra. Corpora cavernosa were approximated in midline over ventralized urethral tube. Normal pigmented skin flaps (skin area between penis and scrotum) were rotated superiorly and sutured in symphyseal area by absorbable vicryl rapid 4/0. A tight dressing was placed around the penis for 7 days and catheter kept in place for 7 to 10 days. Patients were followed for 1 to 6 months. They were evaluated in terms of cosmetic appearance and correction of Chordee and quality of urine stream. The Cosmetic and functional results were much satisfactory in all of the 5 patients in terms of penis dependent appearance, urine stream was good in all patients and near to normal penoscrotal anatomical appearance was achieved in all operated cases. No wound infections or other complications were seen. Conclusion: This modified technique can give good results in terms of successful repair and good cosmesis. Outcome of Pyeloplasty Penile Hair Tie in Young Children Introduction and Objective: Penile hair tie is one of the entrapment syndromes that can occur in extremities like the genitalia, the penis, toes and fingers and mostly due to hair shed by the mother specially in young children but may be other materials are involved like machine belts specially in adults. Penile hair tie is an uncommon health problem that leads to devastating injuries to the urethra and penis including urethral fistula up to urethral complete transaction and penile injury up to penile amputation. We are going to discuss our experience with the problem. Materials and Methods: 17 patients had been operated upon for various degrees of Penile hair Entrapment syndrome. 12 had simple single urethral fistula, and 5 had complete urethral fistula including one with incomplete glanular bisection. Their ages ranged between 1.5 years to 4.6 years. Follow up ranged between 6 months to 1.4 years. Each patient was investigated and examined at the emergency room for other entrapment syndromes and the causative agent was removed and the patients were admitted for managing their urethral and penile injuries. Simple urethral fistula was managed by fistulectomy after fistulous tract dissection and urethral closure with dartos fascial cover. Complete urethral transection was managed by dissection of a ventral penile skin onlay flap to cover the defect followed by using a dartos fascial cover for the repair Results: All 15 patient but 1 had complete healing with fistula healing and normal voiding with no meatal stenosis or urethral diverticulum. 1 patient had incomplete urethral closure with redo operation and fistula closure. We should emphasize on penile hair tie prevention. There should be public awareness and mothers should seek medical advice in case of any suspicious finding. Penile hair tie syndromes are uncommon urological health problems that can affect young children and the urologist should be prepared to manage it as early as possible to prevent further damage of the valuable urethra and penis. Introduction and Objective: To study factors affecting outcome of multimodality treatment in Wilms tumor in low income country. Retrospectively data of patients presenting from 2003-2018 was studied. Factors studied: subject factors (age, sex, nutrition, stage and size of disease), socioeconomic factor (source factor -literacy, income and employment of parents), and healthcare facilities available (support factor -cost of treatment, specialties and services available in India). Results: Total 60 patients were included. 64% patients with age < 10yrs were underweight. 50% patients presented after 5 years of age. Average size of tumor was 10cm in each stage (range 5cm -20cm). Most common presentation was lump followed by pain. 52% patients presented with stage I, 23%, 10%, 8% and 7% with stage II, III, IV and V respectively. Only 33% parents had their graduation completed. 40% families had no permanent source of income and their mean income was $305 USD/month. Average cost of hospital stay during surgery was 546USD. Mean cost of single cycle of chemotherapy was 87 USD.Most of the centers dealing with Wilms tumor lack specialized pediatric staff and doctors. Special stains and flow cytometric evaluation of DNA-ploidy is also not routinely done in low-and medium-income countries. Mean follow up period was 50 months. The estimated 5 years survival rate was 84%, 80%, 66%, 60% and 50% for stage I, II, III, IV and V respectively. 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 9 events occurred in total including metastasis and recurrences. 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. Education of parents, their level of awareness and financial status leads to late presentation with advance disease, malnutrition and failure to complete treatment. Healthcare facilities are overburdened and far less specialists are there then needed. Social assistance and treatment adapted to local circumstances are key to improving results. To evaluate the efficacy and safety of supracostal percutaneous nephrolithotomy (PCNL) through the 11th intercostal space and compare it with subcostal PCNL in children with renal calculi. Materials and Methods: Patients younger than 18 years with renal calculi who underwent PCNL between January 2010 and December 2017 were divided into two groups: supracostal PCNL (group 1) and subcostal PCNL (group 2). Patient characteristics, stone location, stone burden, location of the access points, operative time, postoperative pain according to visual analog score (VAS), success rate, hospital stay, and complications according to the modified Clavien Dindo classification were compared between group 1 and group 2. For statistical analysis, comparison of medians was done using the Mann Whitney U test and the means were compared using t test. Statistical analysis was done using SPSS (version 16.0). Results: In total, 110 pediatric patients underwent PCNL during this period. Group 1 had 50 patients while group 2 had 60 patients. The stone-free rate was 84.0% and 85.0% in groups 1 and 2 respectively after one session of PCNL (p= 0.77). After auxiliary procedures, it increased to 96.0% and 96.6% respectively (p= 0.98). The mean fall in hematocrit was 0.9% in group 1 and 1.5% in group 2 (p= 0.26) whereas the median VAS score was 4 in group 1 and 3 in group 2 (p= 0.37). In all, 54 complications were recorded, the most common among which were grade I (81.5%). Twenty-nine complications were observed in group 1 while 25 complications were observed in group 2 (p=0.79). One patient developed nephropleural fistula while another patient developed hydropneumothorax. Both belonged to group 1. Conclusion: Supracostal access for PCNL is an effective and safe alternative to subcostal access for children with renal calculi in terms of stone free rate and complications. However, when a TAI ≥ 20% was measured at the first measurement a higher chance of ending with a TAI ≥ 20% was observed (p= 0,041 for controls and p= 0,002 for varicoceles), as of those with a TAI ≥ 20% at the last measurement 65% and 21.74% also had a TAI ≥ 20% during the first measurement for boys with and without a varicocele respectively. Of the 29 adolescents without varicocele and of the 35 boys with a left varicocele whose TAI normalized during follow-up, 24 (83%) and 26 boys (74%) experienced a catch-up growth of the left testis and 5 (17%) and 9 boys (26%) had a hypotrophy of the right testis, respectively. Conclusion: A TAI ≥ 20% is a rather prevalent phenomenon in boys with and without a varicocele. Although normalization of a high TAI occurs in the great majority of cases, both boys with and without a left varicocele who have an initial TAI ≥ 20% have a higher risk at a TAI ≥ 20% in the future. The normalization of a high TAI is most frequently due to catchup growth of the left testis which usually occurs in Tanner stages 3 and 4 and at a mean age of 15 years for boys without a varicocele and 14 years and 10 months for boys with a left varicocele. In conclusion, the TAI has to be considered as a fluctuating parameter which should be interpreted carefully and should be evaluated by means of multiple measurements. A Case Presentation: A 1-year-old boy was brought to hospital by his parents with voiding difficulty accompanied with intermittent fever, there was no history of reddish urine or sign of renal insufficiency. Cystoscopic findings revealed the bladder mass was arising from anterior bladder wall, extending to the prostate and the bladder neck. Pathologic findings from transurethral resection revealed granuloma of bladder mucosa. Abdomen and pelvis CT scan revealed isodens, inhomogenous mass arising from anterior bladder wall extending to the prostate and bladder neck. Due to discrepancy between pathologic finding from cystoscopy and clinical findings, we decided to perform partial cystectomy. Intraoperatively we found a 3x2 cm pedunculated mass from anterior wall of the bladder. There was no sign of abdominal wall infiltration or ureteral orifices obstruction. Pathologic examination revealed composition of sheets, which were randomly arranged and tightly packed. Small blue cells were arranged in serpiginous aggregates (blastemal component) and primitive neuroepithelial cells between fibromyxoid tissues, suggested extrarenal Wilms' tumor without lymphovascular infiltration 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK and favorable histopathology. The patient had vesicocutaneous fistulae that developed at second post operation day but require no further surgical management. The fistulae resolved spontaneously at 10 th post operation day with just maintaining a larger foley catheter. Conclusion: Bladder cancer in pediatric population is a rare entity, and primary Wilms' tumor of the bladder is even rarer. The pathologic finding from cystoscopy and specimen from surgery may be different. In this condition, clinical decision based on clinical findings of malignancy may be essential in management of these patients. Single- This study aims to describe our single-stage urethroplasty experience and determine factors associated with urethrocutaneous fistula after the procedure in our institution. We include all hypospadias patients without any prior urethroplasty history, who underwent single-stage urethroplasty, dated from July 2010 until January 2018. Total 179 patients, aged 6 months until 29 years, were included in this study and followed for at least 1 year after the operation. The types of hypospadias were recorded, as well as operation techniques, chordee degree, preoperative pyuria (urine white blood cell >5/HPF), urethral length defect, and urethrocutaneous fistula formation. The posterior hypospadias (penoscrotal, scrotal, perineal) were the most common found with 103 cases (57.5%), followed by middle (57 cases) and anterior (19 cases). The most versatile techniques used were Onlay preputial island flap (71 cases), then Snodgrass' Tubular Incised Plate (46 cases) and Duckett's transverse preputial island flap (35 cases). The mean follow up time was 47.1 ± 25.8 months. Urethrocutaneous fistula were formed in 23 patients (12.8%) and significantly occurred in posterior hypospadias group (p = 0.025). Chordee degree was not associated with urethrocutaneous fistula formation (p = 0.886), while preoperative pyuria (p < 0.001) was significantly associated. Nonparametric analysis showed that longer urethral defect was significantly associated with fistula formation (median difference 10 mm; p = 0.007). Whilst age was not a significant factor associated with urethrocutaneous fistula formation (p = 0.187). Conclusion: Single-stage urehtroplasty is an amenable procedure for various hypospadias cases with urethrocutaneous fistula rate 12.8%. Posterior hypospadias, preoperative pyuria, and longer urethral defect were associated with urethrocutaneous fistula formation. The Introduction and Objective: Our aim is to standardise radiological findings on voiding cystourethrography (VCUG) and transabdominal ultrasound in a new scoring system and assess its validity to predict the presence of posterior urethral valves (PUV) on cystoscopy. Between January 2017 and December 2018, a total of 52 patients underwent VCUG, transabdominal ultrasound and cystoscopy. The decision to perform cystoscopy was based on clinical consensus between a paediatrician, paediatric urologist and paediatric radiologist disregarding the total score of the VCUG on the scoring system. Mean patient age was 4.5 years (range 1 week to 12 years); 38/52 (73.1%) patients had PUV on cystoscopy. The total score is calculated as follows: the visible urethral obstruction -vesicoureteral reflux + residual volume + bladder wall thickness. Table 1 shows the weight of each parameter in the total score. A total score of 3 or more was defined as suspected for PUV. Interobserver agreement is calculated between three investigators, one experienced radiologist and two blinded research students. Results: If we define the cut-off value at 3 the sensitivity and specificity are 89.5% and 57% respectively. The area under the curve is 0.799. In our study population, 6/52 (11.54%) patients scored 3 or more than 3 but did not have PUV on cystoscopy. 4/52 (7.69%) were false negatives. The interobserver agreement on visible urethral obstruction (mean kappa= 0.62) and residual volume (mean kappa= 0.63) was good. The agreement for vesicoureteral reflux was very good (mean kappa= 0.8). Conclusion: Our scoring system has a high sensitivity of 89.5%, indicating that this scoring system is useful for ruling out PUV. The overall interobserver agreement among 3 investigators was good. Therefore, this tool can be easily used in practice. Stricture urethra is relatively common and leads to debilitating conditions if not well treated. Novel biological injections and grafts were potential to replace the current surgical treatments. Rats, rabbits and porcine urethra were utilized as an animal model for stricture urethra. Our aim was to create a durable larger animal model of urethral stricture. Seven male Mongrel dogs, 2 years old, average weight 20 kg, were randomized into three groups. One animal utilized as a negative control, three animals had a urethral injury by sharp perforating needle, three animals had a surgical urethrotomy distal to the penoscrotal junction. The animal protocol was approved by the animal research committee. After anesthesia, ascending urethrograms were performed for all animals using Urografin 76% through 12 Fr. catheters. After 4 weeks, ascending urethrograms were obtained under anesthesia. Urethral tissues were harvested afterward for histological evaluation. Results: All animals showed normal caliber urethras without strictures before the intervention. All animals were able to survive without retention. The urethrotomy injured animals presented mild gross haematuria after the procedure which resolved within the first postoperative week. After 4 weeks of induction of urethral damage, the minimally injured urethra (sharp perforating needle group) didn't present a change in the caliber of the urethra in the urethrogram. However, epithelial thinning and mild spongiofibrosis were observed in histological sections. Surgical urethrotomy group presented radiologically identified urethral stricture after one month of injury. Conclusion: Urethral stricture is a fibrotic process with varying degrees of spongiofibrosis related to the extent of the injury. Surgical urethrotomy might be sufficient to create a reliable canine model of urethral stricture disease. However, a larger number of animals, different urethral areas, and longer time points are needed. Urethrotomy incision revealed urethral stricture after a month of the injury which might be utilized for testing of novel cellular, biological or tissue engineering modalities. The Outcome of Stented Versus Stentless Snodgrass Urethroplasty for Distal Hypospadias Repair Introduction and Objective: Hypospadias is one of the most common congenital anomalies in children. Patients with distal hypospadias can be treated successfully with TIP (tubularized incised plate) urethroplasty with a urethral stent to divert urine into the diaper or urine bag for approximately 1 week, but sometimes the stent causes unwanted adverse effects and complications. My objectives are to determine the safety of distal penile hypospadias repair without a postoperative stent and to look for any unacceptable complication which might justify its use. Results: During this study, 50 children underwent tubularized incised plate urethroplasty for distal hypospadias repair, their age ranging from (2-12) years, and mean age was 5.96 years old. In 25 cases stent removed within one week and other 25 cases, no post-operative stents were placed. The overall complication rate for a stentless group was 17 (68%), and for a stented group was 12 (48%). In a stentless group, 2 patients (8%) developed fistula after surgery, while in stented group, only one patient (4%) had a postoperative fistula, surgery for repair the fistula was done after 6 months. Neourethral stenosis occurred in one case (4%) of non-stented repair and one case (4%) of stented repair. Glans dehiscence occurred in one case (4%) of non-stented repair and one case (4%) in stented repair. Conclusion: According to our evidence in this study, it is suggested that there is no outcome difference between stented and stentless distal hypospadias repair. Introduction and Objective: Hypospadias is generally diagnosed and treated during early childhood, however, several patients with hypospadias require surgical intervention during adulthood because of missing mild disease or complications related childhood hypospadias repair. We report our surgical outcomes of hypospadias repair during adulthood. We retrospectively reviewed the records of hypospadias patients who required surgical intervention during adulthood between 2015 and 2019. Data on the presenting complaints, past medical and surgical history, surgical approach and postoperative complications were collected and analyzed. Results: A total of 18 patients were included, of which 4 presented for primary repair and 14 for secondary repair because of complications related past surgical treatments. In primary repair group, their complaints were abnormal penile appearance or downward urinary stream in all patients. Preoperatively the urethral meatus was glandular in 1 patient, coronal in 2, distal shaft in 1. All patients underwent dorsal inlay graft (DIG) urethroplasty using prepuce at the mean age of 21 years, and had no postoperative complications such as stricture, fistula and curvature at the mean follow-up of 13 months. In secondary repair group, their complaints were difficulty on urination related stricture in 11 patients, urinary and ejaculation disturbance related fistula in 2, glandular dehiscence in 1. In all 3 patients with fistula or glandular dehiscence, their complaints began during childhood. However, difficulty on urination related stricture was developed at the mean age of 41 years. Ten patients with stricture underwent 2-stage urethroplasty using buccal mucosa. DIG urethroplasty using redundant prepuce was performed in 1 patient with stricture and all 3 patients with fistula or glandular dehiscence. One patient had postoperative urinary tract infection, however, no patient had postoperative stricture, fistula or curvature at the mean follow-up of 15 months. Conclusion: Follow-up of patients performed hypospadias repair should extend into adulthood, as a significant portion of adult presentations ultimately require surgical intervention. DIG urethroplasty using prepuce or 2-stage urethroplasty using buccal mucosa are effective methods for hypospadias repair during adulthood and leads to good cosmetic outcome with low risk of complications. Combined Sleeve-Slit Technique for Adult Circumcision Introduction and Objective: About 15% of men suffer from scrotal varicocele and 2% to 10% of them complain of pain. The many mechanisms for pain were suggested. Nearly 80% of testicular pain relived post varicocelectomy. The grade of varicocele, the nature and duration of pain, body mass index, prior conservative management, and the type of surgical method used, are predictors for the success of varicocelectomy. Our aim was to explore the predictors of pain resolution post varicocelectomy on our patients. Introduction and Objective: The purpose of this study was to report the outcomes of patients undergoing penile implantation with an AMS 700 LGX inflatable penile prosthesis (IPP) in a single center by a single surgeon. A total of 342 patients with erectile dysfunction who underwent implantation with an AMS 700 LGX IPP between October 2014 and April 2016 were included in this study. All patients were evaluated using the International Index of Erectile Function questionnaire preoperatively and 3, 6, and 12 months postoperatively. We also investigated the mean stretched flaccid penile length before and after surgery, as well as the complications that are related to and mechanical reliability of the IPP. The questionnaire scores at 12 months were statistically, significantly higher than the baseline scores. The mean stretched flaccid penile length was 11.1 ± 0.8 cm at baseline and was longer at 6 months (12.0 ± 0.9 cm, P<0.001) and 12 months (12.2 ± 0.7 cm, P<0.001) postoperatively. There were no intraoperative or perioperative complications. However, one patient experienced infection, and mechanical failure Introduction and Objective: The rupture of the penile urethra during penile fracture is a rare condition. It mainly concerns young men. Our objective is to evaluate the frequency of this association during a long term study and to evaluate the results of its surgical treatment. Our study is retrospective spread over 28 years and covers 6 cases of rupture of the penile urethra among 107 cases of Corpora Cavernosa Rupture: a rate of 5.6%. Results: The average age of our patients was 36 years old (17 to 45 years). Diagnosis was suspected by the presence of a painful penis hematoma. The associated urethral rupture was suspected by the presence of urethrorrhagia in all patients. The treatment was surgical for all patients. In 3 cases, the urethral rupture was incomplete associated with a fracture of a single cavernous body; in the other 3 cases, it was a complete urethral rupture associated with a fracture of both cavernous bodies. The procedure consisted of a suture of the cavernous bodies and a urethrography after urethral catheterization. The immediate postoperative course was favorable for all patients. Two patients had urethral stricture, one at 6 months well evolved with calibration, the other at 2 years requiring endoscopic internal urethrotomy. In circumstances of difficult catheterisation the urologist on-call may be asked to catheterise; a range of specialist equipment is available, however iatrogenic urethral trauma is associated with early and long-term morbidity, is costly, causes patient distress and should be avoided. We aimed to Materials and Methods: Prospective data collection (from January 2019) of patients referred to on-call Urologist with one or more of the following inclusion criteria post-catheterisation: failure to catheterise, haematuria, non-draining catheter. Failed re-insertion of SPC was also included. Exclusion criteria: traumatic removal of catheter. Data was collected and a suggested grading scale applied: 0 -underlying urological problem preventing catheterisation (e.g. stricture) +/-previous SPC in situ, 1 -suspected urethral trauma (e.g. haematuria) + standard urethral catheter +/-urological advice, 2 -suspected urethra trauma + urological intervention +/-specialist catheter, and 3 -cystoscopic proven urethral trauma +/-theatre +/-SPC. Results: Eleven patients met inclusion criteria in 3 months of data collection: mean age 75 years. Five had a urological diagnosis requiring long term catheterisation: 4 SPC, 1 Urethral.64% (n=7) were referred from Emergency department; 64% (n=7) were referred by SHOs. As per our suggested grading scale: Grade 0 =3, Grade 1 =2, Grade 2 =2, Grade 3 =4. Six patients (55%) required theatre; 2 were found to have cystoscopic proven, significant urethral trauma as a result of multiple catheter attempts (Grade 3); both required SPC insertion. 3 patients with SPC in-situ (history of urethral stricture) had failed catheterisation leading to SPC re-insertion in theatre. Two patients required urology review and manipulation/ re-insertion of urethral catheter. The urology team did not re-attempt catheterisation in 2 patients as advice was sufficient. Conclusion: Cystoscopic confirmed iCAUT occurred in 2 patients; this represents a small, but significant cohort with subsequent SPC dependence and urological follow up. The majority of surgical interventions were related to SPC re-insertions and suggests increased education may be required in this area. This ongoing project will continue to assess iCAUT and implement educ ation and training. The studies on varicocelectomy for pain were mostly performed with a small number of patients and a short follow-up period, the success rate and prognostic factors were also different. The purpose of this study was to evaluate the long-term outcome and improvement factors for pain resolution. We retrospectively analyzed 312 patients who were treated with pain resolution out of 490 patients who underwent varicocelectomy from 2004 to 2017. The success of surgery was defined as resolution of both varicocele and pain, otherwise, it was defined as failure. The improvement of semen analysis was defined as when an increase of more than 20% was observed based on preoperative semen analysis. Results: Mean age, duration of pain and follow up period were 24.4 ± 7.6 years, 17.2 (0.25-192) months and 8.9 (0-108) months, respectively. 96.5% of the varicocele were unilateral, grade I, II and III were 2.6%, 22.1% and 75%, respectively. The testis volume difference over 20% was 35.3%. Dull pain and dragging pain were 88.5% and 4.2%. Complete resolution of varicocele, pain and semen analysis were 96.8%, 78.8%, and 33.3%, respectively. Total success rate of surgery was 77.2%. In multivariable analysis, younger age (p= 0.020), shorter duration of pain (p= 0.001) and non-surrounded of internal spermatic artery (p= 0.037) were good prognosis factors of pain resolution. Conclusion: It has been found that varicocelectomy was an effective treatment for patients with varicoceles who were suffering from scrotal pain. The younger the age, the shorter the duration of pain, the better. Urologist Directed Varicocele Embolisation -Outcomes Over a 10-Year Period Teh J 1,2,3 , Papa N 1,2 , Khan M 1 , 2 , O'Connor E 1,2 , Ranatunga D 1,2 , Bolton D 1,2 , Lawrentschuk N 1,2,3 Introduction and Objective: Varicocele is a common disorder typically affecting younger males and is the most common correctable cause of male infertility. Varicocele repair is indicated in patients with palpable varicocele and abnormal semen parameters. Treatment options for varicocele are surgical and radiological. We aimed to determine the efficacy and complications of radiological embolization for the treatment of varicoceles over a 10-year period. Materials and Methods: We retrospectively analysed all varicocele embolization procedures performed at our tertiary centre from July 2005 to June 2015. Information including side, indication, duration, length of coil and case abandonment were collected from operation reports. To determine if recurrence occurred treating urologists were contacted. Documentation of a follow-up visit or phone call was obtained up to a maximum period of 18 months post procedure. Recurrence was defined as sonographic presence of varicocele or referral for repeat procedure. Results: We collected data for 131 patients who had varicocele embolization. Allowing for a 3.8% abandonment rate, we obtained complete follow-up data for 124 patients. There was an intraoperative complication rate of 6.3%, all of which were minor with no recorded post-operative complications. Analysing follow-up data demonstrated a recurrence rate of 4.0%. We demonstrate that radiological embolization is an effective modality for the treatment of varicoceles with comparable results in terms of completion, complication and recurrence rate versus surgical treatment. Our findings, together with ability to perform embolization as a day procedure under local anaesthesia make it an effective option comparable to surgery for the treatment of varicoceles. Introduction and Objective: Painful nocturnal erections (PNE) refer to repeated, prolonged and painful erectile episodes during sleep that resolve spontaneously upon awakening. Patients also present with significant sleep disturbance, irritability and fatigue. The aetiology of PNE remains unknown, yet an association to REM sleep has been proposed in view of its occurrence in this sleep cycle stage. We aim to develop a new treatment protocol that reduces the burden of currently prescribed drugs such as benzodiazepines and their side-effects. Materials and Methods: Information on patient and disease characteristics as well as previous treatments were collected prospectively from PNE patients in our unit. A sleep diary and standardised template were used to collect sleep-wake pattern, blood results, visual analogue of pain score (VAS) and international index of erectile function (IIEF). Results: Nine patients were identified as PNE sufferers with a median age of 55 (IQR:46-57), all of whom had normal baseline IIEF and testosterone levels. PNE episodes occurred at least once per night in these patients, ranging from 5-30 minutes in duration. Treatments used included baclofen, etilefrine, clonazepam and corporal aspiration (table 1) . We have developed a new protocol that involves a brain MRI scan, sleep study and referral for pelvic floor physiotherapy (PFPT) (table 2). Early results show improved VAS scores (reduction in mean from 2.6 to 0.4) following PFPT. Our new protocol was utilised by all patients referred with PNE to our tertiary centre. We hypothesize that this defined stepwise pathway will reduce the requirement for such drugs, as well as streamlining PNE management. Penile Conclusion: Node positive penile cancer carries bad outcome and poor prognosis. These results underline the importance of seeking early treatment and help us discuss prognostics with the patient. Pelvic node positivity stands as the worst prognostic factor. Introduction and Objective: Small testicular masses are described as non-palpable asymptomatic lesions with diameter less than 2 cm. They can be benign in up to 80% of cases implying that radical orchiectomy may represent an overtreatment in these patients. We present a series of benign small testicular lesions in our institution. Between January 2010 and August 2015, 18 patients with potentially benign testicular lesions underwent partial orchiectomy in our institution. Testicular exteriorisation was executed via inguinal approach. Intraoperatively, the localization of the lesion was performed via palpation or by intraoperative ultrasound examination. Tunica albuginea above the tumor was incised and the tumor was removed together with the surrounding apparently healthy tissue and sent for pathological examination. Follow-up of patients consisted only of scrotal and abdominal ultrasound and was performed once in 6 months. Patients were followed up to 5 years. Introduction and Objective: Primary carcinoid tumor of testis is a rare neoplasm of neuroectoderm origin. This study presents a rare case of primary carcinoid tumor of testis. A 53-year-old gentleman presented with painless swelling of the left testis with normal tumor markers, and underwent left high inguinal orchidectomy. The histopathology revealed an atypical carcinoid tumor with insular and trabecular growth pattern and mitotic activity of more than 3 per 10 high power fields with no other germ component or teratomatous components identified after extensive sampling. The tumor cells were diffusely immunopositive for cytokeratin, synaptophysin, and chromogranin but immune-negative for SALL4. Following a diagnosis of carcinoid tumor, serum testing for chromogranin A level and urinary excretion of 5-hydroxy indole acetic acid (5-HIAA) were done, which were within normal limits. Further staging whole body 68 Gallium-DOTANOC Positron Emission Tomography (PET) scan was done, which did not reveal any evidence of somatostatin receptor expressing residual disease in the body. Patient has been kept on surveillance with follow up CT scan and metabolic markers with no evidence of recurrence at six months follow-up. Results: Though the carcinoid tumors conventionally described as tumors of low malignant potential, atypical carcinoids are known to be associated with 25% prevalence of metastasis and hence, close follow-up forms an integral part of management Conclusion: Carcinoid syndrome rarely presents as an atypical carcinoid tumor of testis and surgical management along with metastasis workup and close surveillance form an integral part of management. Mucinous Adenocarcinoma of the Skene's Gland -A Case Report Introduction and Objective: We report one case of mucinous adenocarcinoma of Skene's gland in a 55-year-old female who presented with mild pain and swollen around urethra. There was a cyst in periurethral glands, reaching bladder on MRI. We have performed laparoscopic and transvaginal resection of the cyst. Pathological result of the tumor was Mucinous adenocarcinoma of urethra staging pT3N0M0. Chemotherapy with Xeloda and radiation therapy was added one month after the surgery. Thereafter, we have performed laparoscopic radical cystectomy, urethra removal, total laparoscopic hysterectomy with bilateral salpingo-oophorectomy, anterior vaginal wall resection, ileal conduit procedure and both sides in the internal iliac and obturator nerve lymph node resection. The Pathology showed residual mucinous adenocarcinoma of Skene's gland involving the urethra and urinary bladder with negative margins. The two-month follow-up, the abscesses ware found in the left labia majora, adductor muscle and dorsal part of pubis on the CT. We have drained the abscesses of all of those areas. Results: During over the three-year follow-up, there was no evidence of recurrence and metastasis by radiologic evaluation after the surgeries. We have experienced a very rare case of mucinous adenocarcinoma of Skene's gland with no recurrence or metastasis over three years after the surgery. Introduction and Objective: Bleomycin pulmonary toxicity (BPT) is the most feared complication for patients who received first-line chemotherapy for metastatic germ cell tumor (GCT). However, predictive biomarkers of BPT have not been investigated. The aim of this study is to assess the predictive value of inflammation-based scores. Materials and Methods: Fifty-seven metastatic GCT patients were retrospectively evaluated. BPT was defined as the presence of asymptomatic decline in pulmonary function test, pulmonary symptoms, or interstitial pneumonia on computed tomography without infection. Patients were divided according to the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), albumin to globulin ratio (AGR), Prognostic Nutritional Index (PNI), Glasgow Prognostic Index (GPS) and C-reactive protein (CRP). The area under the receiver operating characteristics curve (AUC) was calculated to assess the predictive ability of each scoring systems. Univariate and multivariate analyses were performed to identify the predictive scores associated with BPT. Results: Of the 57 patients, 15 patients developed BPT. The NLR had a highest AUC value (0.763) followed by PNI (0.749) in comparison with other inflammation-based scores. In the multivariate analysis, the NLR (odds ratio 11.5, p= 0.009) and PNI (odds ratio 9.07, p= 0.013) were independently associated with development of BPT. Conclusion: This study demonstrated that the NLR and PNI are independent predictive markers of developing BPT and superior to the other inflammation-based predictive scores. Introduction and Objective: Persistent mullerian duct syndrome (PMDS) or male with uterus is an autosomal recessive and rare disease which is usually discovered intra-operatively; only 222 cases are reported in the literature. Testicular cancer is more frequent with males aged between 15 and 34. Its incidence is 0.5 to 0.7% in the general population, whereas it is 2 to 3% in cryptorchid patients even the descended ones. The association between cancer in ectopic testis and PMDS is exceptional, only 58 cases were reported, 7 of them were bilateral with an impact of 12%. The objective is to specify etiopatogenic particularities, clini-cal, histological, therapeutic and particularities of this rare syndromic association. Our study consists of a descriptive and retrospective analysis of 6 cases of cancer occurring among non descended cryptorchid testicles in abdominal position associated with PMDS, out of a total of 162 testicular tumors indexed over a period of 34 years. Results: The average age was 39.8 years. Abdominal pain was the main revealing symptom associated with abdominopelvic mass. All patients were infertile except one. A primary infertility exploration constituted a circumstance of cancer discovery in 1 case. Excision of Mullerian duct was performed for all cases. The whole tumor was excised in 5 cases. For the sixth case, the act was limited to a biopsy due to the inoperability of the tumor. The tumor is germinal non-seminomatous in 100% of cases. Adjuvant chemotherapy was performed in all patients. The evolution was fatal in 5 out of 6 cases within 3 years. The association of cancer on cryptorchid testicle and PMDS is rare. The diagnosis is usually late. The tumor is intra-abdominal and voluminous, and its excision is difficult and in some cases impossible. Chemotherapy is indicated in all cases due to the advanced stage and the histological type of the tumor. The prognosis is reserved and multidisciplinary care is necessary. Early diagnostic and therapeutic measures are needed to ameliorate the results of this pathology. Preputial , while the single and most prominent causative factor was phimosis. Micturition problems, acute urinary retention and foul-smelling purulent penile discharge were among the most common presenting symptoms (16/20 patients, 80%). A greater proportion of patients had multiple stones (68.5%), versus a single preputial stone (31.5%). Stone size ranged from 0.4 to 4 cm. Calcium phosphate, calcium oxalate and uric acid stones appeared to be the most predominant stone compositions. Circumcision was the most frequently performed surgical procedure for the treatment of preputial stones. In two cases (10%) penile cancer was diagnosed. Follow-up lacked critical information (available for 3 patients, 15%). Conclusion: Preputial calculi represent a very rare form of lower urinary tract urolithiasis. Inspissated smegma, urine stagnation and chronic preputial irritation play a crucial role in stone formation while phimosis adds to it as a causative factor. Circumcision remains the cornerstone of treatment. Prompt diagnosis and definitive treatment help to avoid potential long-term complications, namely obstructive uropathy, preputial skin fistula, and penile malignancy. Squamous Cell Carcinoma of Urethra -Late Complication of Urethroplasty? Ulrich CM, Götz M, Krah X Introduction and Objective: The primary squamous cell carcinoma of the urethra is one of the rarest malignancies of urinary tract (<1%). We give a clinical review of diagnostic and therapeutic aspects using a case report. We report the rare case of a 69-year-old patient who presented to us with perineal pain. Eight years earlier he received an augmentation urethroplasty done with oral mucosa graft. On clinical evidence of a perineal abscess a surgical exploration was performed. Intraoperatively a periurethral abscess near a urethral lesion was seen. After successful wound conditioning, secondary wound closure was performed. Histologically, malignancy was excluded. Four months later, the patient presented again with a wound healing disorder. In MRI morphological abscess formation was seen. Again, we performed surgical therapy with successive wound conditioning. Histologically, a squamous cell carcinoma was described this time. Despite extensive resection, complete tumor removal could not be achieved. In x-ray imaging, metastasis was excluded. After consulting with the NCT (National Center For Tumor Diseases) in Heidelberg, Germany, platinum-based neoadjuvant chemotherapy has been recommended prior to an eventually radical surgical treatment. Results: Squamous cell carcinoma of the urethra is an extremely rare disorder with a high malignant potential. Diagnostics and therapeutics require a high degree of professional competence and interdisciplinarity. Conclusion: Due to the poor prognosis of urethral carcinoma, early and targeted diagnosis is essential for the further course of the disease. In addition, curative therapy settings require early radical surgical therapy. Introduction and Objective: Prostate cancer (PCa) is the second most frequent cause of cancer-related death in men worldwide. It is a heterogeneous disease at molecular and clinical levels which makes its prognosis and treatment outcome hard to predict. The epithelial-to-mesenchymal transition (EMT) marks a key step in the invasion and malignant progression of PCa. We sought to assess the co-expression of epithelial cytokeratin 8 (CK8) and mesenchymal vimentin (Vim) in locally-advanced PCa as indicators of EMT and consequently predictors of the progression status of the disease. Co-expression of CK8 and Vim was evaluated by immunofluorescence (IF) on paraffin-embedded tissue sections of 122 patients with PCa who underwent radical prostatectomies between 1998 and 2016 at the American University of Beirut Medical Center (AUBMC). EMT score was calculated accordingly and then correlated with the patients' clinicopathological parameters and PSA failure. The co-expression of CK8/Vim (EMT score), was associated with increasing Gleason group. A highly significant linear association was detected wherein higher Gleason group was associated with higher mean EMT score. In addition, the median estimated biochemical recurrence-free survival for patients with <25% EMT score was almost double that of patients with more than 25%. The validity of this score for prediction of prognosis was further demonstrated using cox regression model. Our data also confirmed that the EMT score can predict PSA failure irrespective of Gleason group, pathological stage, or surgical margins. This study suggests that assessment of molecular markers of EMT, particularly CK8 and Vim, in radical prostatectomy specimens, in addition to conventional clinicopathological prognostic parameters, can aid in the development of a novel system for predicting the prognosis of locally-advanced PCa. Correlation Results: NLR ratio was calculated and compared for Gleason score primary, secondary and total on biopsy and pathology specimens, using NLR < 3 or > 3 as comparison. Gleason score 4 and 5 primary and Gleason 8 total had the highest NLR > 3 percentage, with no statistical significance. NLR ratio was also calculated on Gleason score classification of biopsy and pathology specimens. Gleason classification 4 was found to have the highest NLR > 3 percentage in both groups (31.7% and 22.2% respectively), however, no statistical significance was found (p-value 0.159 and 0.630 respectively). Presence of lymphovascular invasion on pathology was associated with higher NLR > 3 percentage (30% vs. 15%), however, difference was not statistically significant (p-value 0.068). Positive lymph node on pathology was associated with higher NLR > 3 percentage (30% vs. 15%), with no sta-tistical significance (p-value 0.108). No association or statistical significance was found between perineural invasion or extraprostatic extension and NLR ratio. Pre-op PSA and NLR ratio were also compared with no statistical significance found. The NLR mean and median were calculated and compared on the same categories, however, no significance was observed. Conclusion: In our retrospective study, higher preoperative NLR was not significantly associated with higher PSA value, or Gleason score nor with positive EPE, SM, SV, and LVI. Thus higher NLR was not associated with a more aggressive disease. Thus, the hypothesis of using preoperative hematological workup as a risk assessment of prostate cancer was not supported by our data. The Introduction and Objective: In today's information era, patients often seek information regarding their health using the internet. We aimed to assess the reliability and validity of information available on the internet regarding 'Prostate Cancer' (PCa). The search term 'Prostate Cancer' was used on the Google website (June 2017). Critical Analysis was performed on the first 100 hits attained, using the JAMA benchmarks, DISCERN score, HON (Health on the Net) seal. Results: A total of 33 500 000 hits were returned, with the Top 100 hits, critically analysed. Ten links (duplicate links (7/10)/book reviews (1/10)/ dead sites (2/10)) were excluded. Therefore only 90 were analysed. The subcategories assessed, included; commercial (53,33%), University/Medical Centre (24,44%), Government (13,33%) and NGO/Not for Profit (8,89% Conclusion: Using transrectal ultrasound, calculated prostate volumes were on average 9.24 mL larger than when using MRI. All 3 urologists over measured the prostate when compared with MRI, with the most experienced urologist reaching the smallest difference. With the recent increase of PSA density usage, accurate prostate volume measurement has gained importance as even small change in volume may influence a decision whether biopsy will or will not be performed. Interim analyses such as this one may help clinicians find and improve their weak points. Optimizing the sensitivity and specificity of the sTT/PSA ratio using the ROC provided a cutoff point of 4.2, which corresponded to 84% and 92% sensitivity for stage and grade respectively. However, we found less specificity in predicting the same. However, when compared with PSA alone, sTT/PSA ratio was found to have significantly less sensitivity and specificity. Our study results do not support the additional utility of using of the sTT-to-PSA ratio for Did Robotic Prostatectomy Make Things Different -For Patient or Surgeon? Adapala RKR, Prakash G, Pal M Introduction and Objective: The surgical approach for radical prostatectomy has witnessed a paradigm shift over the years from open retropubic radical prostatectomy (ORP) to robot assisted radical prostatectomy (RARP). We compared the pre-operative parameters and postoperative outcomes of these two procedures. Materials and Methods: A total of 182 patients underwent radical prostatectomy, from year 2010 till 2018 which included 49 ORP and 133 RARP, by the dedicated Uro-oncologists. Robotic cases were operated by da Vinci Xi ® system after the installation in year 2014. We retrospectively analysed the preoperative and perioperative parameters of prospectively maintained database of radical prostatectomy at a tertiary care cancer institute. Results: RARP scored over ORP for estimated blood loss, length of hospital stay and day of catheter/ drain removal (p= 0.000). On the other hand, ORP had better outcomes in terms of lymph node yield (0.046), overall margin positivity (0.006) and multifocal margin positivity (0.004). RARP cohort had a significantly higher proportion of patients with pT3a and pT3b stages (p= 0.015). There was significantly higher up-staging of T stage in RARP, whereas for ORP there was significant down-staging (p= 0.000). In grade group 4 & 5, a trend towards upstaging was seen in both RARP & ORP, but statistical significance was achieved only in ORP cohort. Here, the cost and functional outcomes were not compared as median follow up; in both approaches were different [67 months ORP VS 12 months RARP]. Conclusion: When oncological outcomes are taken into consideration ORP scores over RARP. The subtle advantages of robotic prostatectomy and the obvious surgeon comfort of view, dexterity of dissection, ease of doing anastomosis, finally contributing to ease of surgery would make surgeons prefer a robotic approach whenever robot is available. The Introduction and objective: Serum PSA is an organ-specific marker that may be affected by any prostatic disease. False high PSA value not also resulted in unnecessary prostatic biopsy in benign prostatic hyperplasia, but also upgrade the risk group stratification of prostate cancer resulting in over-treatment. Previous studies examining antibiotic therapy had yielded conflicting results in PSA changes. This prospective study aimed to investigate the possible effects of 3-4 weeks of antibiotic on PSA. Materials and Methods: In a tertiary urology center, men presented with elevated PSA underwent prostatic biopsy continued on antibiotic as ciprofloxacin 500 mg B.I.D for 3-4 weeks. An additional PSA measurement was also performed at end of the treatment. Results: Among 512 patients at prostate unit, 153 completed the treatment and the additional PSA measurement had decreased PSA from 11.6 (0.4-109) to 7.7 (0. Initial work has demonstrated that a-DG expression is decreased in many types of adenocarcinoma, including prostate, and potentially associated with the development of metastatic disease. However, the consistency between prostate and lymph node a-DG staining has not been previously reported. Further, lack of DG staining has been associated with increased mortality in renal, gastric and pancreatic cancer. Identification of an immunohistochemical marker associated with prostate cancer grade, stage, need for adjuvant or salvage therapy and mortality would have potential clinical value. Node positive, margin negative radical prostatectomy specimens at a single institution from 1982 to 2012 were reviewed and identified 35 prostate specimens, including 26 patients with available tissue from both the primary prostatectomy and lymph node specimens. The expression levels of the a-DG subunit were analyzed using immunohistochemistry and graded from 0 to 4. Survival was compared in different staining pattern groups. Results: Strength of a-DG staining was found to be consistent between prostate and lymph node specimens (p <0.004). The median overall survival was shorter in those without a-DG staining in the prostate compared to those with positive staining, but this difference was not statistically significant ( Conclusion: DG expression by immunohistochemistry staining was consistent between prostate and metastatic lymph node specimens. In a small cohort of prostate cancer patients with margin negative but node positive disease, DG staining was associated with a numeric, albeit non-statistically significant, increase in serum PSA, Gleason grade, pathologic stage and adjuvant therapy utilization. Given lack of DG staining association with decreased survival in renal, gastric and pancreatic cancers, we believe its further assessment in prostate cancer is warranted. Salvage Introduction and Objective: Following focal irreversible electroporation (IRE) for prostate cancer, a proportion of men will develop recurrent disease. Currently there is no consensus on how to best manage these patients. One option is radical prostatectomy (RP). However, there is only limited data on the oncological and functional outcomes of RP post focal-IRE. This study aimed to assess these outcomes of RP post focal IRE. We retrospectively identified 9 cases of patients who underwent salvage robot assisted radical prostatectomy (RARP) for recurrent prostate cancer after focal irreversible electroporation (IRE) at our institution between 2014 and 2018. We present the oncological and functional outcomes in this group of patients. Results: Nine patients underwent RARP (median age 63, median PSA at time of RP 6.8 ng/mL median follow up 19 months). All cases were indicated following transperineal biopsy proven prostate cancer recurrence. Two cases had both infield and outof-field recurrence at a median of 13.5 months post focal IRE. One case had an infield only recurrence at 64 months post IRE and six cases had an out-of-field only recurrence at a median of 29 months post IRE. Bilateral nerve sparing could be performed in 5 cases (56%), whilst in 4 cases (44%), only partial nerve sparing could be performed. In two cases, there was significant dense scarring, as a result of the previous IRE, near the neurovascular bundle that needed to be sacrificed in the interest of oncological safety. Six cases had negative surgical margins, two cases had a small focus of positive surgical margin and one had a positive surgical margin. Eight patients had no significant post-operative complications; however, one patient developed a pelvic collection from a ureteric leak requiring drainage and a nephrostomy tube, which was thought to be due to difficulty in a left sided prostatic dissection and anastomosis of the bladder to the urethra. All patients with >12-month follow up are continent and have reasonable erectile function with the aid of medical therapy. Conclusion: Although scarring is evident at the time of operation, salvage RP after focal IRE is safe and yields an acceptable oncological and functional outcome in most patients. Introduction and Objective: Around one third of patients who undergo whole gland radiotherapy as primary treatment for localised prostate cancer have radio-recurrent disease. Radical prostatectomy post radiotherapy is challenging and is associated with significant morbidity. Focal ablative treatments may be an emerging therapy in these patients and there is a lack of studies evaluating their efficacy. Thus, the objective of this presentation is to evaluate the oncologic and functional outcomes of salvage irreversible electroporation (s-IRE) for radio-recurrent prostate cancer. This prospective study protocol received institutional ethics approval. 44 patients with localised, radio-recurrent prostate cancer without evidence of metastatic disease were recruited between 2013 and 2018 and underwent s-IRE. Oncological outcomes were evaluated according to serial PSA, 6-month mpMRI and 12-month transperineal prostate biopsy. Functional outcomes were collected using the Expanded Prostate Cancer Index Composite (EPIC), the AUA symptom score and the 12-item short-form health survey. Conclusion: Surveillance mpMRI adds significant value in the diagnostic surveillance of patients in active surveillance and is able to reduce the number of required standardized biopsies. Any new lesion on surveillance mpMRI should be biopsied due to the high change for sPCa (>50%). As sPCa is still being missed any standardized biopsy should not be omitted. Accuracy of MRI-US Fusion Prostate Biopsy for the Assessment of Focal Therapy Eligibility Using Intermediate/High-risk Criteria Introduction and Objective: Focal therapy (FT) in prostate cancer has been intensively discussed in the last years. While some urologists consider FT as an alternative to active surveillance, others emphasize its potential role in selected intermediate/high-risk cases. As MRI-targeted biopsy improves the accuracy of prostate cancer diagnosis, we reviewed its role in the assessment of FT eligibility in comparison with whole mount prostatectomy specimen. Between October 2017 and January 2019, a total of 244 patients underwent MRI-US fusion prostate biopsy. Of these patients, 101 were diagnosed with prostate cancer and 41 underwent minimally-invasive radical prostatectomy with whole mount pathology analysis in our department and were included in the current analysis. FT eligibility criteria were considered as follows: T2c, PSA 20 ng/ mL, Gleason score 4+3 in any biopsy core, Gleason 6+6 with minimum cancer core length of 4 mm, unilateral clinically significant prostate cancer. The presence of Gleason 6+6 in less than 4 mm or bilateral clinically significant prostate cancer were considered exclusion criteria. Results: Of the total number of patients, 16 (39%) would have been eligible for FT according to whole mount analysis and previous stated criteria. MRI-US fusion prostate biopsy had a sensitivity, specificity and accuracy for the prediction of eligibility of 87.5%, 68% and 77.8%, respectively. In 10 cases, the MRI-US fusion biopsy was discordant with whole mount pathology, due to the presence of clinically significant disease in the contralateral lobe (80%) or the association of bilateral disease and upgrading of prostate cancer (20%). In all discordant cases, the pre-biopsy MRI showed only unilateral suspicious areas for clinically significant disease. Conclusion: MRI-US fusion prostate biopsy has a good accuracy for the prediction of FT eligibility using intermediate/high-risk criteria. Improvement and standardization of multiparametric MRI assessment of prostate might increase the concordance between targeted biopsy and whole mount specimen. Introduction and Objective: Prostate cancer development and growth is directly proportional to androgenic activity in the body. Currently, hormone therapy (combined androgen blockade: CAB) for prostate cancer is positioned as a standard treatment for metastatic prostate cancer. Hot flashes are a common stressful symptom for individuals with prostate cancer who are treated with CAB. We evaluated the relation between hot flashes and rates of change of testosterone (T) and estrogen (E2) during hormone therapy for prostate cancer. September 2018, forty-eight patients and their CAB treatments were studied in Toho University, Omori medical center. The mean age at the beginning of hormone therapy was 73 years old and ranged from 60 to 92 years old. Serum T, E2 were measured at the beginning of CAB, after one month, two months, three months, six months and twelve months. We then recorded the levels after CAB for those who experience hot flashes and for those patients who did not. Conclusion: PSAD was an excellent discriminator for low risk prostate cancer at RP in AA men, and PSAD performed better in AA men than in CA men. A PSAD cut off score of 0.12 ng/mL/gm can be used to help identify AA men with low risk disease who may be candidates for active surveillance. Introduction and Objective: The maximum age for radical prostatectomy (RP) has always been a matter of debate. In fact, less than 13% of men over 73 yrs old with localized aggressive carcinoma and a life expectancy for at least 10 years, receive radical treatment, instead of younger men with a similar life expectancy. Consequently, these older patients are more likely to receive radiotherapy or androgen deprivation therapy, possibly because their urinary functional outcomes after radical prostatectomy were underestimated. We prospectively evaluated 314 patients who underwent open RP performed by the same principal surgeon from 6/2006 through 12/2017 at a single institution and had extended oncologic follow-up at 12 mo. Average patient age was 65 years (yr) (range 44 to 76). A comparison was performed between the overall patient cohort and the population aged over 73 years for urinary functional (UF) recovery. In this study, we incorporated the collection of patient-reported outcomes as part of routine clinical practice based on function at 3 months (mo) interval time points in the first year and 6 mo thereafter. We addressed potential response biases by using pad-free usage as a primary outcome. Results: Continence rates in our cohort study of 314 patients at 3, 6, and 12 mo were 43% (134 of 314), 74% (231 of 314), 84% (264 of 314), respectively. During a 4 yr period post-RP, we found a 9% cumulative risk of manifesting anastomose stenosis (AS) requiring surgery (29 patients submitted to urethrotomy, 64% in the first 12 mo). Continence rates in men in their seventies (73 to 76) at 3, 6 and 12 mo were 41% (7 of 17), 71% (12 of 17) and 88% (15 of 17), respectively, and only one man had AS requiring surgery (6%). We found similar functional recovery at 12 months postoperatively throughout the cohort regardless of ages up to 76 years old. Therefor this study conveys the idea that we should not condition our therapeutic decision for fear of worse functional recovery in men in their seventies. Men with high-risk UP.386, Figure 1 . To investigate the feasibility and surgical technique of extraperitoneal single-port robotic-assisted laparoscopic prostatectomy (espRALP). Materials and Methods: We retrospectively analyzed the clinical data of 5 prostate cancer (PCa) patients who had undergone espRALP from November to December 2018. Patients aged 69.2 years (range, 65 to 80 years), with a median initial prostate specific antigen of 12.0 ng/mL (range, 0.94-17.09 ng/mL). All patients were clinically organ confined (cT2a-cN0M0), in which 4 patients were treatment-naive and 1 was non-metastatic castration-resistant prostate cancer with previous history of androgen deprivation therapy (ADT). Surgical procedures, techniques, and short-term follow-up outcomes were concluded. The surgical incision was made from 4 cm below the umbilicus to 5 cm above the pubis symphysis, where the laparoscopic port of 100 mm in diameter was inserted. 30-degree up lens was adopted, and no patient had undergone pelvic lymph node dissection, while 1 patient had undergone bilateral intrafascial preservation of neurovascular bundles (NVB). Results: Surgical procedures were successfully performed in the 5 patients, with no open conversion. Time of operation was 110 min (range, 85-150 min), console time was 82 min (range, 45-131 min). Estimated blood loss was 100 mL (range, 50-150 mL) with no blood transfusions. Postoperative pathology revealed locally-advanced prostate cancer in all 5 patients (pT3a-bNx), with 2 positive surgical margins. All patients passed gas on postoperative day 1-2 and were off-bed on the first day. Postoperative length of stay was 2-4 days. All pelvic drainages were removed. Postoperative continence recovery on the 2nd and 3rd month were 60% and 80% respectively, while postoperative potency at 3-month was 20%. No biochemical recurrence was observed during follow-up. One patient with CRPC had postoperative PSA nadir >0.2 ng/mL, and adjuvant ADT was given. Conclusion: Extraperitoneal single-port robotic-assisted laparoscopic prostatectomy can be performed on a routine basis, and may have its own advantage in terms of operative time, surgical expense, postoperative stay and cosmesis. Further large-sample controlled studies are in need of further verification. To introduce the surgical technique and investigate short-term follow-up of maximal peri-prostatic anatomy preservation in robotic-assisted laparoscopic radical prostatectomy (MPAP-RALP). Patients receive a course of intensity-modulated radiotherapy (IMRT) in 22-25 consecutive daily fractions to the prostate and the affected lymph nodes, followed by radical prostatectomy and extended pelvic lymphnode dissection within 6-8 weeks after RT completion. We have planned a 3×3 cohort of radiotherapy dose escalation of 39.6Gy to 54Gy. Primary outcomes were RT-associated toxicities, as well as perioperative safety. Results: Shanghai Changhai Hospital, which is well established in performing radical prostatectomy and RT for prostate cancer, is the single center that participates in the trial. The trial has been approved by the institutional review board of Shanghai Changhai hospital and registered at Chinese Clinical Trial Registry (ChiCTR1900022716). Ten patients have been included so far and the accrual is expected to be completed in September 2019. The feasibility and safety profile, as well as the outcomes regarding tumor control is expecting. Further randomized controlled clinical trials should be conducted as well. Introduction Conclusion: TAM infiltration is associated with response to ADT and increased tumor angiogenesis in PCa. Gleason score, ADT type and MVD in PCa specimens is a useful predictive factor for poor response to ADT. Increasing TAM density and positive metastatic status were prognostic factors for a poorer survival in PCa patients. Comparison of MP-MRI Targeted A total of 40 patients were studied over a duration of 18 months. All patients with a PSA level of (4-20ng/mL) were included in the study. All men were offered pre-biopsy MP-MRI with a 2 core targeted biopsies (TRUS guide) when a lesion was found in MP MRI followed by Systematic TRUS biopsy (STB) and results were compared. 2) were identified in 14 (78%) and insignificant prostate cancer (Grade group 1) in 4 (22%). Gleason grade group 4 and 5 were detected in 3 (17%) and 6 (33%) respectively.Prophylactic antibiotics was used in 35 (81%) patients. In total, 5 patients had post biopsy complications (Clavien 1 = 3, Clavien 2 = 2). Sepsis was noted in only 1 (2.3%) patient, who did not receive prophylactic antibiotics. All the patients tolerated the procedure well and did not require additional per oral or parenteral analgesia. Office TP biopsy PPTAS is feasible and safe, even in the elderly population. In our initial series, cancer detection rate is acceptable. Post biopsy sepsis rates are very low and peri-procedural antibiotics may be required in appropriate patients to reduce the infection complications. Introduction and Objective: Pelvic Lymphadenectomy (PLND) in prostate cancer (PCa) has not been shown to improve overall survival but it is essential for detecting lymph nodes metastasis, which occurs in 1-26% of radical prostatectomy (RP), depending on features of PCa at diagnosis and extension of PLND; when extended (eLND) the detection rate improves but increases the duration of RP with about 20% of complications. There are predictive models for positive eLND (+) that select patients for eLND in PR, with high sensitivity and negative predictive value (NPV) as the nomogram of Briganti (BN), if < 5% discourages eLND. We present our experience. We accept not performing eLND with BN <5%. The cut-off value that justifies its realization is not clear, but it seems to be superior to 5% suggested by Briganti. Introduction and Objective: Ultrasound-guided prostate biopsy is now the standard of care in the diagnosis of prostate cancer. The use of transrectal ultrasound-guided prostate biopsy (TRUS-biopsy) requires fewer resources and is less labor-intensive as compared to template prostate biopsy (TP-biopsy). However, the safety profile of the latter is better. The Prostate Imaging -Reporting and Data System Version 2 (PI-RADS™ v2) defines PI-RADS 3 as -Intermediate (the presence of clinically significant cancer is equivocal). Which in current practice will warrant a prostatic biopsy. The objective of this study is to compare the diagnostic yield of TRUS-biopsy and TP-biopsy in patients with a raised prostate-specific antigen (PSA) and PIRADS (Prostate Imaging -Reporting and Data System) 3 lesions on multi-parametric magnetic resonance imaging (MP-MRI). Twenty patients were contacted via telephone and asked their opinion on the previously developed pathway, over a one-month period, as part of quality improvement. Details were recorded as part of patient reported outcome measures. Results: Twenty patients were contacted and 100% responded. Thematic analyses led to identification of the following subject areas and generation of overarching themes: Requirement for additional CNS dedicated to chemo patients, Gender related issues/ Age related issues, Implementation of national standards for psychosexual care/ early access to therapy needed, Standardized pathway for follow-up required, Lack of therapy for emotional and sexual concerns including counselling and medical therapy or devices, Post-operative problems for which specialist care is required, Requirement for explanation on side effects of surgery, Pre-operative counselling, Additional CNS needed, Access to continence devices, Survivorship support group, National pathway with continence devices and PFE and ED therapy. The subject areas were drawn out of the patient focus group and healthcare professional interviews, after manual tabulation. Subject areas were identified by being highlighted and the overarching themes into which these fit, were named. In the T-group, radical prostatectomy (RP) was performed in all men.All but 3 had a Gleason-score (GS)6, and all but 1 a primary GS=3.Tumor grade: G2 in all 12 (100%).Tumor stage: T2a in 7 (58%), T2b in 3 (25%), and T2c in 2 (17%). All but 2 patients are back on TTh after an average time of 25 months.In CTRL, RP was performed in all but 6 patients who received radiation therapy (RT).2 had GS6, 7 a GS=7, 21 a GS=8, and 12 a GS=9.4 men had a primary Gleason-score of 3, 29 had 4, 9 had 5.Tumor-grade: G2 in 9 (21%), G3 in 33 (79%).Tumor-stage: T2a in 2 (5%), T2c in 1 (2%), T3b in 15 (36%), T3c in 24 (57%).In CTRL, biochemical recurrence occurred in 11 (26%) patients. These received androgen-deprivation-therapy (ADT). 12 (34%) died of whom 7 were on ADT.In the T-group, no biochemical recurrences or deaths occurred during the observation time. Introduction and Objective: Prostate Specific Membrane Antigen (PSMA) scan became increasingly popular in prostate cancer staging and may outperform multi-parametric MRI (mpMRI). The most commonly utilized modality Gallium-68 PET is expensive and less readily available. PSMA bound to Tc-99m is a more recent development which is more readily accessible and cost effective. We aimed to compare the PSMA Tc-99m SPECT findings in patients undergoing radical prostatectomy to mpMRI findings and radical prostatectomy specimens. We analysed our prospectively maintained Tc-99m PSMA database for patients who had pre-operative mpMRI prior to radical prostatectomy. Prostatectomy histopathology results were used as the gold standard against PSMA-Tc99m and mpMRI findings. Local staging findings were compared between PSMA-Tc-99m and mpMRI. Data were analysed using SPSS 24.0. Results: Six patients with a mean age of 64.5 years had prostatic cancer confirmed on histology. Two patients had Gleason 3+4=7 cancer. Two had Gleason 4+3=7 disease. The remaining two had Gleason 4+5=9 and 5+4=9 disease. All index lesions were identified on both MRI and PSMA. Of the five patients had bilateral diseases on histopathology, one was identified as unilateral disease on both PSMA-Tc99m and mpMRI, one on PSMA-Tc99m and one on mpMRI. Three out of four tumours with extra-prostatic extension were identified on mpMRIs but none on PSMA-Tc99m. Of the two tumours with bilateral seminal vesicle invasion, one was correctly identified on both mpMRI and PSMA-Tc99m, the other was not identified on PSMA-Tc99m and only unilateral involvement on mpMRI. One patient with suggestion of unilateral SV involvement on mpMRI was not identified on histo-Introduction and Objective: The use of adjuvant androgen deprivation therapy (ADT) in selected cohorts of patients with prostate cancer (PC) treated with radiation therapy (RT) is supported by multiple studies showing a benefit in both cancer specific survival (CSS) and in overall survival (OS). Unfortunately, the side effect associated with this treatment limits its use in daily practice. We set out to determine whether adjuvant ADT is beneficial for elderly subpopulations of men with high risk treated with primary RT. In the competing risk analysis ADT still conferred better CSS (p= 0.0141) but there was no difference in the competing risk curve (p= 0.155). We then used IPW to remove the bias due to group differences and repeated the analysis confirming the findings. Competitive risk curves were similar after IPW (Figure 1 ). As expected, ADT results in a decrease in BCR and even CSS, but not OS as was noted within the entire cohort. Competing risks in part due to ADT-related adverse effects among men >75 years old questioning the use of ADT on this population. Prostate Biopsy Diagnosis Over 20-Years in a Large Volume Center Introduction and Objective: Prostate biopsie (PBx) is the gold standard for diagnosis of prostate cancer (PCa). The usage and timing of this procedure has evolved over time, especially with the introduction of prostate specific antigen (PSA). We present the diagnosis and rate of positive biopsies over 20 years in a high-volume tertiary center. initiation (2004-2006, 2007-2009, 2010-2012) Conclusion: In our study population, there was no difference in overall survival between ABI and ENZA as second-line treatments in the post-chemotherapy setting in mCRPC. Further evaluation of both drugs using real-world data is necessary to assess differences in other health outcomes such as treatment-related complications and use of health services. Impact have examined MRI in ideal circumstances, typically at tertiary referral centres with the benefits of high-volume radiologists, strict protocols and inclusion criteria. Our hypothesis is that aspirational outcomes from publications such as PROMIS may not be generalizable in a multi-centre 'real world' hub and spoke system with diversity in scanner type, protocols and experience. The aim was to assess the correlation between radiological mpMRI staging and the final whole mount prostatectomy specimens in all patients who underwent Robotic Assisted Laparoscopic Prostatectomies (RALP) at the sole regional centre offering this operation in the West of Scotland. The outcome measures of interest were comparing T stage, Gleason score and prostate size. A retrospective review of a prospectively held database was carried out of all patients who underwent RALP from December 2015 to August 2018 in NHS Greater Glasgow & Clyde. This is a regional service for the West of Scotland and reflects all robotic prostatectomies happening for a region of four health boards comprising eleven hospitals with urology services. Comparison was made between pre-op radiological staging to the corresponding histopathology report; this included the post-operative T stage, Gleason score and prostate size. We then linked the pre-op staging score of each MRI study to the corresponding histopathology report, which included Gleason score and pathological stage. Robotic prostatectomy was performed by numerous surgeons in the same institution. Introduction and objective: Although the incidence of prostate cancer in Japan is increasing, it is still lower than in the United States. However, incidence of prostate cancer within Japanese migrants to the United States has increased. So, it has been suggested that environmental factors play an important role in the progression of prostate cancer. We focused on diet and obesity as an outcome result. Therefore, we hypothesized that the volume of adipose tissue correlates with the aggressiveness of prostate cancer. This study included 128 prostate cancer patients who underwent robot-assisted radical prostatectomy without neo-adjuvant hormonal therapy at Kyushu University between 2016 and 2017. We quantitated the volume of adipose and muscle tissues in preoperative computed tomography images using image analyzer (SYNAPSE VINCENT®). Then, we evaluated whether there were significant correlations between adipose and muscle tissue proportion and clinicopathological parameters such as the post-operational pathological Gleason grade group. Results: Median age of the patients, the ratio of adipose tissue volume, body mass index (BMI) and the muscle-to-height ratio were 67 (50-77), 32% (4.8 -52.6%), 23.9 (17.0 -30.6) and 2.315 (0.24 -3.288), respectively. The Gleason grade group was significantly higher in patients with higher ratio of adipose tissue. Analysis using the group with BMI of 23 or more showed that the Gleason grade group was significantly lower in the group with larger muscle volume/height ratio, and the Gleason grade group was significantly higher in the cases with higher volume of visceral adipose tissue. In patients with prostate cancer who underwent robot-assisted radical prostatectomy, it was suggested that malignant potential was higher in patients with higher volume of adipose tissue, especially in the group of higher visceral adipose tissue. In addition, patients with higher muscle percentage in the body showed lower malignant potential. The Results: Metformin delays prostate cancer progression, especially the neuroendocrine transdifferentiation of prostate cancer. In TRAMP model, we found that metformin treatment significantly inhibited the progression from Well-differentiated Adeno to Undifferentiated carcinoma (supposed to be NEPC), and reduced the area occupied by the NEPC cells (AR-negative, Syn-, and CD56-positive). In LNCaP cell line, metformin could repress neuroendocrine transdifferentiation induced by hormone deprivation and IL-6 treatment. Mechanistically, metformin is capable of inhibiting tumor-associated macrophage (TAM) infiltration during the progression of prostate cancer and after androgen deprivation therapy, evidenced by reduced CD68+, CD163+ and CD204+ cells in metformin treatment group. By using in vitro macrophage migration assays, we found that metformin could also inhibit the recruitment of macrophage by the tumor cells. Conclusion: Metformin is capable of repressing the neuroendocrine transdifferentiation of prostate cancer by inhibiting infiltration of tumor-associated macrophages, especially those induced by ADT suggesting that a combination of ADT with metformin could be a more efficient therapeutic strategy for NEPC treatment. Impact of Prostate Volume on Tumour Detection Rate in MRI-targeted Fusion Biopsy Introduction and Objective: Magnetic resonance imaging (MRI) guided prostate biopsy has established itself in the diagnostic pathway for localised prostate cancer. Co-registration of MRI and real-time TRUS is essential to the success of MRI-targeted fusion biopsy (TB), however, uncertainty remains around its accuracy and subsequent tumour yield in larger prostates. We evaluated differences in rates of cancer detection using TB between small, medium and large-sized prostates. Conclusion: MRI-targeted fusion biopsy detects less CS disease in large compared with medium-sized prostates, however, there is no significant difference between medium and small-sized prostates. Reasons for this finding in large prostates could include poor co-registration on fusion biopsy, low incidence of PI-RADS 3-5 lesions, or high PSA confounding the decision to biopsy. Toxicity as a Limiting Factor in the Sequential Treatment of Metastatic Castration-Resistant Prostate Cancer in Real Practice Introduction and Objective: We focused on treatment tolerance in sequential administration of ARTA preparations, chemotherapy, and radium 223 in men with metastatic castration-resistant prostate cancer. We evaluated the treatment toxicity of 121 patients with sequential administration of ARTA preparations, chemotherapy, and radium 223 in men with metastatic castration-resistant prostate cancer.In the pre-chemo indication abiraterone acetate with prednisone in 56 men with PS 0-1 at the age of 49-87 (median 66 years). In post chemoindication with enzalutamide in 52 patients with PS 0-2 at the age of 49-91 years (median 69 years). We focused on the toxicity after treatment with cabazitaxel in 54 patients with PS 0-1 aged 48-76 (median 64 years) after previous docetaxel treatment. The adverse effects of radium 223 treatment in patients with bone metastases were evaluated in 10 patients with PS 0-1 at the age of 67-80 years (median 68 years). Results: Of the side effects, after treatment with abiraterone acetate with prednisone, we observed grade (G) 2 anemia in 6%, G 2 vomitus in 4%, hypertension G 2 in 2%, FISI in 2%, G 1 in 4%, constipation G 1 and diarrhea G 1 in 4% , vertigo G1 in 4%, problems associated with mineralocorticoid changes in 2% of patients. After administration of enzalutamide, after previous docetaxel and cabazitaxel treatment, we observed G2 anemia in 12.5%, G 2 neutropenia in 4%, fatigue, weakness G ½ in 25%, hypokalemia G1 in 6%, acute myocardial infarction in 2%. We focused on the toxicity after treatment with cabazitaxel after previous docetaxel treatment. Lipegfilgrastim was administered preventively 24 hours after chemotherapy in each of the treated patients. Of the adverse reactions, G1 anemia was 8.5%, G3 neutropenia was 4%, fatigue G 2 was 35%, G2 diarrhea at 6%, anorexia G½ was 4.3%, vomiting G3 was 2%, skin changes 2%, leg edema 3% of treated patients. The adverse effects of radium 223 treatment in patients with bone metastases. One man was treated with radium-223 for contraindication to docetaxel and 4 after previous two-second treatment and 5 after three-sequential treatment. We recorded diarrhea G 1 in 2 patients, hematologic toxicity anemia G½ in 5 patients and thrombocytopenia G ½ 3 patients, G 3 1 patient. Radium 223 administration in earlier stages of sequential treatment is accompanied by less toxicity. Conclusion: Treatment of castrate-resistant metastatic prostate cancer with both ARTA (abiraterone + enzalutamide) and cabazitaxel and especially radium-223 radionuclide has been shown to be accompanied by good tolerance and toxicity of lower grade in patients in routine clinical practice. Evaluation to the brachytherapy, was also observed in PSMA levels. Serum PSA and PSMA levels in patients that received hormonal therapy decreased markedly and remained low at 2 years. Biochemical recurrence occurred in 3 patients, who all showed increased PSMA and PSA levels. Although nerve-sparing radical prostatectomy is a currently acceptable surgical option in locally confined prostate cancer, pathological stage and grade of surgical specimen can be inconsistent after radical prostatectomy. To select an appropriate surgical technique, it is important to predict pathological result in clinically localized prostate cancer applicable to nerve-sparing radical prostatectomy. Recently, several reports have highlighted that preoperative low serum testosterone level is associated with high stage and grade prostate cancer. Therefore, we analyzed factors including preoperative serum testosterone to predict upstaging and upgrading of clinically localized prostate cancer, which is applicable to nerve-sparing radical prostatectomy. We retrospectively evaluated patients who underwent radical prostatectomy from January 2015 to May 2018 at our institution. Patients with Grade group 1 or 2 (Gleason score 6 (3+3) or 7 (3+4)) on biopsy, PSA < 10, and clinical stage T2 were included in this study. Exclusion criteria included that all patients who had previously received 5α-reductase inhibitors, LH-releasing hormone analogues or testosterone replacement treatment, and neo-adjuvant radiotherapy. Upstaging and upgrading were defined as pathological stage T3a and Grade group 4 (Gleason score 8 (4+4)) after radical prostatectomy, respectively. We evaluated the patient demographics and outcomes after radical prostatectomy according to upstaging and upgrading. Predictive factors for upstaging and upgrading after radical prostatectomy were analyzed using a multivariate logistic regression model. Of 108 patients included in this study, upstaging and upgrading after radical prostatectomy were observed in 24 (22.2%) and 36 (33.3%) patients, respectively. Preoperative low serum testosterone level, small prostate size, and positive core number 4 on biopsy were identified as predictive factors for upstaging in multivariate analysis. Although preoperative low serum testosterone level and Grade group 2 on biopsy were related with upgrading, any factors did not have statistical significance in multivariate analysis. upgrading after radical prostatectomy in clinically localized prostate cancer. Therefore, more attention and reconsideration are needed in patients with low serum testosterone level who are planned to undergo nerve-sparing radical prostatectomy. Introduction and Objective: Not a few patients who were negative in the initial prostate biopsy were identified as prostate cancer in the second biopsy. Therefore, it is important to identify predictive factors of clinically significant prostate cancer in a second biopsy. We evaluated the factors for predicting positive repeat biopsy in patients with initially negative prostate biopsy. From January 2011 to December 2017, overall 211 patients performed transrectal ultrasound-guided prostate biopsy more than once due to persistent high PSA and initially negative biopsy. Among them, we excluded the patients who did not perform blood test including AST/ALT or had hepatitis or was not followed up regularly. Finally, 124 patients who met these criteria were enrolled and we retrospectively reviewed the medical records. Group 1 (n=82) was defined as patients without prostate cancer on second prostate biopsy, and group 2 (n=42) was defined as patients who were detected prostate cancer on second prostate biopsy. Prognostic Impact of Non-Regional Lumps Node (NRLN) Metastasis in Bone Metastatic Prostate Cancer (PCa) Introduction and Objective: To elucidate the clinical impact of non-regional lymph node (NRLN) metastasis in prostate cancer (PCa), we compared the prognosis of bone metastatic PCa (M1b) According to Simon's two-stage minimax design, assuming that the expected overall response rate will be at least 22% and the minimum acceptable response rate 10%, a sample of 39 patients have to be enrolled in the first step of the study. If a minimum of 5 responses is observed, a total of 56 patients had to be accrued. Thereby, if at least 9 responses occur, the probability of accepting a treatment with a real response rate of less than 10% will be 5%. On the other hand, the risk of rejecting a treatment (at the second stage) with a response rate of more than 22% will be 20%. Results: There was no patient with a documented complete response, whereas a partial response was documented in 1 patient (2.6%). Four patients (10.3%) achieved disease stabilization and 34 (87.1%) disease progression. Based on the serum PSA levels, 4/31 patients experienced a biochemical response (50% decrease of the PSA levels) whereas 27 had a biochemical progression. The median PFS for the whole group of patients was 2.1 months, while in patients with a biochemical response and biochemical disease progression the median PFS was 2.4 months and 2 months respectively (p= 0.384). The median OS was 8.3 months. The results presented in the current study confirm that Temsirolimus monotherapy is not an effective therapeutic option in both chemotherapy naïve and chemo resistant castration-resistant prostate cancer. Investigation of Paramagnetic Centers in Blood and Tumor Tissues of the Men with Prostate Cancer Introduction and Objective: The aim of the given work was to study paramagnetic centers in blood and tumor tissue of men with prostate tumors. Materials and Methods: EPR spectra were recorded in the temperature interval of 90-100K, using EPR method. In case of blood investigations, the material of the study was blood samples of practically healthy men and men with cancer of prostate (CaP). In case of tumor tissue EPR studies the material was tumor tissues of men with benign hyperplasia of prostate (BHP) and CaP and the mitochondrial suspensions gained from these tissues, respectively. Introduction and Objective: Somatosensory evoked potential (SSEP) has been studied in erectile dysfunctions (ED). We aimed to evaluate correlation with SSEP and ED in patients undergoing radical prostatectomy (RP). We used pudendal nerve SSEP. We prospectively analyzed data from 23 patients who underwent radical prostatectomy from January 2015 and December 2017, with at least 6 months of follow-up. Patients were divided into 2 groups depending on the presence/absence of erectile dysfunction. Demographic characteristics, preoperative evaluations, postoperative outcomes and pudendal nerve SSEP before and after RP were assessed. In pudendal nerve SSEP, stimulating electrodes are placed at penis, and recording electrodes are placed at levels of lumbar spine (L1) and cortex. Cortical and lumbar latencies were obtained with stimulation of the pudendal nerve using averaging technique. Erectile function recovery was defined as question 2 and 3 on the Ineternational Index of Erectile Function (IIEF)-5. Results: Patients with/without postoperative erectile dysfunction were 10 and 13, respectively. Demographic characteristics and perioperative outcomes according to presence/absence of erectile dysfunction were similar. Patients with erectile dysfunction showed significant increase in lumbar (17.7 vs 16.3 ms, p=0.045) and cortical (52.1 vs 47.0 ms, p=0.001) latencies of pudendal nerve SSEP after surgery. They also showed significant prolongation of lumbar (1.4 vs 0.1 ms, p=0.001) and cortical (4.1 vs 0.5 ms, p=0.03) latencies of pudendal nerve SSEP before and after RP. Our results suggest that pudendal nerve SSEP can be an effective tool in the evaluation of patients with erectile dysfunction. The test can be used to provide more definitive assessment of erectile dysfunction. pudendal nerve SSEP after RP were assessed. In pudendal nerve SSEP, stimulating electrodes are placed at penis, and recording electrodes are placed at levels of lumbar spine (L1) and cortex. Cortical and lumbar latencies were obtained with stimulation of the pudendal nerve using averaging technique. Erectile function recovery was defined as question 2 and 3 on the International Index of Erectile Function (IIEF)-5. Breast Metastasis from Prostate Carcinoma Mimicking as a Second Primary: A Case Report Introduction and Objective: The occurrence of a breast mass in a patient known to have prostatic carcinoma may cause confusion, whether it is a primary breast carcinoma or a metastasis from prostate carcinoma. Both breast metastasis from prostate carcinoma and primary breast carcinoma in men are rare. The objective of this report is to present a case of a patient diagnosed with metastatic castrate-resistant prostatic adenocarcinoma who developed a breast mass. Specifically, this report aims to differentiate a primary breast carcinoma from a breast metastasis from prostate carcinoma through immunohistochemistry staining. This patient presented with a breast mass while undergoing hormonal therapy for prostatic adenocarcinoma. The initial histopathologic diagnosis of the breast specimen was a primary breast carcinoma on top of a primary prostate adenocarcinoma. The patient was initially managed as a double primary carcinoma of the breast and prostate with Docetaxel. After four cycles of Docetaxel, the breast mass enlarged. Immunostaining with prostate-specific antigen (PSA), prostatic acid phosphatase (PSAP) and cytokeratin 7 (CK7) were done on the breast specimen to validate the initial diagnosis. The immunostains revealed a negative PSA, moderately staining PSAP and negative CK7. These stains later confirmed the diagnosis of a breast metastasis from prostatic adenocarcinoma. Although uncommon, the need to differentiate between primary breast carcinoma and breast metastasis from prostate carcinoma is crucial because of the consequences it has on hormonal treatment and prognosis. It is recommended that all patients with prostate carcinoma presenting with a breast mass, be examined thoroughly. Biopsy and immunostaining should be utilized as an important tool to differentiate between the two diseases for prognostication and appropriate management. Conclusion: Our data validate the superiority of MP-MRI in the identification, localization and characterization of prostate cancers. We also verified the positive correlation between PI-RADS score and Gleason score. Results: At 12 months the PSA observed was between 0.032 and 2.4 ng/mL, with a mean of 0.24 ng/mL. The PSA of 2.4 ng/mL was in a hemi-ablation pt. The IPSS score at 6 months after treatment was between 2 and 19, with a mean of 9. At 6 months urinary incontinence revealed 28 patients did not use any pads, 5 a security pad, 1 used 2 pads, and 2 used 3 or more pads. The IIEF score after treatment was between 5 and 25, with a mean of 9. Of the men with a IIEF score > 18, 10 maintained that level of function. Introduction and Objective: Prostate-specific membrane antigen (PSMA) is overexpressed by most primary and secondary prostate cancers. PSMA positron emission tomography (PET) is a relatively new image modality that highlights PSMA expressive tissues to assist in the staging of prostate cancer. We audited our local results of PSMA PET scans at a single institution to assess if it is changing the management of prostate cancer. March 2019, a total of 656 PSMA PET scans were performed at Monash Health associated facilities. With permission from our local ethics commission we conducted a retrospective audit of PSMA PET scans collecting data on the indication, serum prostate specific antigen (PSA), result, comparison to conventional staging and whether it changed patient management. Results: Biochemical recurrence post radical prostatectomy, defined as a serum PSA greater than 0.5 ug/L, was associated with an increased probability of a positive PSMA PET scan. This association was direct-ly proportional to the value of PSA. In many instances PSMA PET scans were able to identify PSMA positive lymphadenopathy that were negative on conventional staging. However, the clinical significance of these often small but positive nodes on PSMA PET remains unknown. Conclusion: PSMA PET imaging is changing the management of prostate cancer at our institution however the overall clinical benefit has yet to be fully established. Out To assess erectile functional outcomes, we used International Index of Erectile Function (IIEF-5) before and 1, 3, 6, 12 months after surgery. Skeletal muscle at the level of L3 was measured automatically using volume analyzer software and normalized for height (cm 2 /m 2 ) to calculate SMI. We excluded the patients who had not taken a computed tomography (CT) before surgery, those who were not able to evaluate IIEF-5, whose IIEF-5 before surgery was extremely low (IIEF5 < 4) and those with follow-up less than 1 year. We defined the patients who had low IIEF-5 less than 4 as erectile dysfunction (ED) groups and more than 5 as non-ED group. Results: Forty-two patients were included in this retrospective study. The median age was 63 years-old and body mass index was 24.7 kg/m 2 and preoperative IIEF-5 was 15. There were no significant differences between two groups in preoperative IIEF-5. In ED group, the SMI was significantly lower than non-ED group (48.1 vs 55.5, p= 0.0018). In simple and multiple linear regression analysis revealed that SMI was the independent associating factor of ED after RARP with NS group (OR= 1.16, p= 0.032). The patients with low SMI would have worse erectile functional outcomes after NS RARP. SMI might be a predictive factor of postoperative ED. Further stratification with the Gleason score in addition to De Ritis ratio identified a stepwise reduction in biochemical recurrence (BCR)-free probability, in which the highest BCR-free probability was found in prostate cancer cases both low Gleason score (≤7) and with a De Ritis ratio of less than 1.325 (0 factor), while the lowest was in prostate cases shown to be high Gleason score (≥8) and having a De Ritis ratio of greater 1.335 (2 factors). UP.452, Figure 1 . A predictive model for biochemical recurrence which incorporates De Ritis ratio and Gleason score Introduction and Objective: Multiparametric magnetic resonance imaging (mpMRI) facilitates targeting of regions of interest and improves the detection and accuracy of clinically significant prostate cancer. There is emerging data to support the use of expensive fusion devices to assist in biopsy targeting, however, due to limited resources our tertiary referral centre utilizes a cognitive registration method to target regions of interest. The purpose of this study was to investigate the presence of any significant learning curve in patients who undergo cognitive-registration targeted biopsy. A retrospective observational cohort study was performed of consecutive patients attending a large public tertiary training centre. We 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK describe data of patients referred for clinical suspicion of prostate cancer who underwent mpMRI and biopsy. Standard clinical, histopathological, mpM-RI-related and financial parameters were collected. Diagnostic accuracy of operator (consultant, resident/registrar) and biopsy approach was analysed on a year-to-year basis. Fisher's was used for comparing binary variables and Mann-Whitney was used for continuous variables. Results: A total of 653 men underwent mpMRI, 344 of whom proceeded to subsequent prostate biopsy. Analysis of outcomes over three years demonstrated diagnostic accuracy for each PIRADS score similar to that reported by other studies. This was maintained across the study period, suggesting a steep learning curve. Conclusion: In our large public tertiary teaching hospital, introduction of a mpMRI-based triage pathway has been shown to be effective and adapted quickly within the first year of implementation. The Introduction and Objective: Multiparametric magnetic resonance imaging (mpMRI) improves detection of clinically significant prostate cancer (csPCa) by reducing negative biopsies and facilitating targeted biopsy (fusion technology, cognitive-registration or in-gantry MRI guidance). The purpose of this study was to evaluate the feasibility of implementing a mp-MRI-based triage pathway, including cost analysis, diagnostic performance and applicability to training. A retrospective observational cohort study was performed of consecutive patients attending a large public tertiary training hospital who were referred for clinical suspicion of prostate cancer (PCa) and underwent mpMRI and biopsy. Standard clinical, histopathological, mpMRI-related and financial parameters were collected for analysis of diagnostic accuracy, biopsy avoidance and logistical (including financial) and operator (consultant/registrar/ resident) feasibility. Results: A total of 653 men underwent mpMRI, of which 344 proceeded to prostate biopsy producing a biopsy avoidance rate of 47%. 240 men were diagnosed with PCa of which 208 (60.5%) were clinically significant (Gleason 3+4). Higher PIRADS scores on mpMRI observed higher rates of csPCa. In patients who underwent both targeted and systematic biopsy, targeted cores detected csPCa in 16.6% and 12.7% more men than systematic cores for PIRADS 4 and 5 respectively; whereas systematic cores detected csP-CA in 3.2% and 5% of patients where targeted cores did not. The approach was cost effective and demonstrated a high level of performance which was maintained over the study period. Conclusion: Implementation of a mpMRI-based triage pathway into a large public teaching hospital is cost-effective, feasible and leads to high rates of csP-Ca diagnosis, whilst reducing detection of insignificant PCa and unnecessary biopsies. Implementation of a mpMRI-based triage pathway into a large public teaching hospital is cost-effective, feasible and leads to high rates of csPCa diagnosis, whilst reducing detection of insignificant PCa and unnecessary biopsies. The Introduction of a MPMRI-Based Triage Pathway into a Large Public Tertiary Training Hospital is Cost Effective Morton A, Donato P, Roberts M, Yaxley J Introduction and Objective: Multiparametric magnetic resonance imaging (mpMRI) has been shown to improve detection of clinically significant prostate cancer (csPCa), facilitate biopsy targeting, and reduce rates of unnecessary biopsy. A mpMRI-based triage pathway was introduced for men referred for suspicion of prostate cancer at our large public tertiary referral centre. The purpose of this study was to perform a cost analysis of implementing this pathway. A retrospective observational cohort study was performed of consecutive patients attending a large public tertiary training hospital who underwent mpMRI for suspicion of prostate cancer. Financial parameters for imaging, pathology and other costs incurred were collected for analysis. Biopsy avoidance was defined as the rate of patients who avoided prostate biopsy where, in the absence of mp-MRI, would have otherwise undergone biopsy. Results: A total of 653 patients underwent mpMRI with 344 proceeding to subsequent prostate biopsy, resulting in a 47% biopsy avoidance rate. Across the study period, our mpMRI-triage pathway, including biopsy, (approximately AUD$450 per mpMRI scan and $3,000) per biopsy) produced an expenditure of $1,325,850 ($293,850 for mpMRI and $1,032,000 for biopsy). If all patients referred with an elevated PSA underwent biopsy, the total expenditure is approximately $1,959,000, resulting in a cost saving of $633,150. The implementation of a mpMRI-based triage pathway into a large public tertiary teaching hospital is cost effective and leads to increased rates of clinically significant cancer diagnosis, whilst reducing biopsy-related morbidity. Primum Results: Twenty-two men with PIRADS 1 were biopsied, with detection of 1 CS-PCa: PSAd, in this case was 0.26. Twenty-one with PIRADS 2 lesions were biopsied, 1 CS-PCa detected: PSAd was 0.28. Seventy-four PIRADS 3 were biopsied, 22 CS-PCa detected: PSAd (mean, SD) was 0.2 (± 0.07). Fifty-six with PIRADS 4 were biopsied, 43 CS-PCa detected: PSAd 0.27 (± 0.16). Ninety PIRADS 5 were biopsied, 83 CS-PCa detected: PSAd 0.55 (± 0.63). Among the 263 biopsied patients, a pathway offering biopsy if PIRADS is 3 or PSAd 0.1 spares 11 (4.2 %) biopsies compared to baseline practice, with sensitivity 100 %, specificity 9.7 %, positive predictive value 59.5 % and negative predictive value 100 % for biopsy detected CS-PCa. Diagnostic yield is 59.5 %. Conclusion: Biparametric MRI can be used to risk assess suspected PCa, reducing need for biopsy, and increasing diagnostic yield from 57 % to 59.5 %. Given the risks of gadolinium and pragmatic benefits of increasing scanner throughput, we recommend this as an alternative to full mpMRI. The Feasibility and Safety of Focal Treatment of Localized Prostate Cancer Using MRI-Guided Transurethral Ultrasound Ablation Introduction and Objective: We review the feasibility and safety of focal treatment of localized prostate cancer using MRI-guided and controlled transurethral ultrasound ablation (TULSA). From March 2017, a total of 117 patients with localized prostate cancer of Gleason grades 3+3, 3+4, and 4+3, confirmed by multiparametric MRI (mpMRI) and MRI guided biopsies, underwent focal therapy with TULSA. The concept of TULSA, similar to HIFU, is based on secondary ablation of tissue, which is thermally coagulated by the application of therapeutic ultrasound. In contrast to HIFU, in TULSA the ultrasound applicator is placed transurethrally. Treatment planning and monitoring is achieved by real-time MRI and MRI based closedloop thermal feedback control. This provides precise ablation of desired treatment zones while adjacent Introduction and Objective: To investigate the effects of an exercise programme on cardiometabolic health in newly diagnosed prostate cancer patients receiving androgen deprivation therapy (ADT). Fifty recently diagnosed prostate cancer patients (age: 72.0 ± 4.8 years; body mass index [BMI]: 28.0 ± 3.3 kg/m2) to be treated with ADT were randomised to a standard care control group (n = 26) or standard care plus exercise group (n = 24). The exercise group completed 12-weeks of supervised aerobic and resistance training (twice weekly for 60 min). Outcomes of cardiopulmonary exercise testing, anthropometry, blood-borne biomarkers and health-related quality of life were assessed at baseline, post-intervention and after a 24-week follow-up period. Between-group differences at post-intervention and follow-up endpoints were analysed by ANCOVA using baseline values as covariates. Conclusion: Exercise training improved body composition and ameliorated the adverse effects that ADT on cardiopulmonary fitness. Exercise also increased sex-hormone-binding globulin, which could provide therapeutic benefit to prostate cancer patients by lowering androgen bioavailability. Introduction and Objective: Transrectal prostate biopsies are associated with a risk of sepsis. Ciprofloxacin and/or Gentamicin are usually used for prophylaxis, however resistance to these antibiotics is common. We performed rectal-swabs and aimed to reduce the rate of sepsis by identifying patients with positive rectal-swabs and using targeted antibiotics following TRUS or by replacing TRUS with TP biopsy. A total of 1232 patients were included in our study. Group A (609 patients) received an empirical prophylactic antimicrobial regimen of gentamicin, metronidazole, and ciprofloxacin from January 2014 -September 2015. Group B (403 patients) had rectal swab cultures performed prior to biopsy from February 2016 -September 2017. Patients with organisms resistant to ciprofloxacin or gentamicin received a targeted prophylaxis regimen of fosfomycin, amikacin, and metronidazole. Group C (220 patients) from June 2018 -March 2019 underwent either TRUS (113 patients, no antibiotic resistant organisms on rectal swab) or TP biopsies (107 patients). 13 patients with resistant organisms on rectal swab were re-assigned to TP biopsy and received a single dose of oral co-amoxiclav. Results: There was a total of 21 cases of sepsis; 12 (2%) in Group A, 9 (2.2%) in B and none in C. There was no significant overall difference in the rate of sepsis between Group A and B (p = 0.82). Patients in Group B with ciprofloxacin-resistant rectal flora had a significantly higher rate of sepsis than those without (9.1% vs 1.1%; p =0.003). Sepsis rates were reduced in Group C (0%) versus A (p = 0.04) and B (p = 0.03). Ciprofloxacin resistant organisms were identified in 70 patients; 56 in Group B (13.8%) and 14 (6.4%) in Group C. There was a reduction in sepsis rates in cases of ciprofloxacin resistance between Group B and C which did not reach statistical significance (9% vs 0%) (p = 0.58). Conclusion: Risk-stratifying patients undergoing prostate biopsy to a TP approach, in cases of antibiotic resistant rectal flora, reduces sepsis incidence and has helped eliminate sepsis risk in our cohort. Further data is required to specifically demonstrate this benefit in cases of ciprofloxacin resistance. Introduction and Objective: Prostate Cancer (PCa) is the most prevalent cancer in men. Currently, one of the main treatments for PCa is radical prostatectomy (RP), which may be followed by adjuvant radiotherapy. An alternative procedure is to wait and perform salvage radiotherapy if necessary. The adjuvant vs salvage radiotherapy debate has encouraged researchers to put effort in finding markers that assist us in making the best choice. Decipher is a novel genomic classifier, developed to prognose PCa in patients. The test is based on gene-expression microarray analysis of 22 RNA biomarkers and produces scores ranging between 0 and 1. Results are then classified into low-risk, intermediate-risk, and high-risk groups (for scores <0.45, between 0.45 and 0.6, and >0.6, respectively). In this review we studied all pubmed-indexed articles focusing on the use of decipher after RP and summarized findings. Results: Almost all studies have confirmed Decipher as a reliable predictor of metastasis, recurrence and mortality, although one study showed contradicting results. Studies showed that likelihood of metastasis after RP could be as low as 5.5% in patients with low risk disease based on Decipher score and as high as 26.7% in patients with high risk Decipher score. In addition, 10-year recurrence rate of 2.6% and 13.6% was noted for low and high risk patients, respectively. Decipher was also capable of predicting cancer specific mortality after RP (5-year PCa specific mortality rate of 0% for low risk patients compared to 9.4% for high risk Decipher group). Decipher was able to reduce decisional conflicts in clinical recommendations and demonstrated an incremental cost-effectiveness ratio of $90,833 per QALY, which can be indicated as cost-effective. Conclusion: While proposing radiotherapy is aimed for PCa relapse prevention, short-and long-term side effects must be taken into account. Although Decipher has shown to be capable of predicting disease recurrence, metastasis and mortality in multiple studies, further investigations are required to prove Decipher's role in clinical outcome improvement in patients receiving Decipher-based course of treatment compared with those receiving usual care. Peritoneal Introduction and Objective: Peritoneal metastasis is exceedingly rare in prostate cancer. The majority of peritoneal metastasis is a result of disseminated metastatic disease, rather than following curative surgical intervention for localized disease. Here, we report a case series of peritoneal metastasis following radical prostatectomy using minimally invasive robotic assisted technique. We identified three patients who presented with peritoneal metastasis following radical treatment of prostate cancer. A retrospective analysis was performed to identify patient demographics, presentation and management, as well as literature review. Results: All three patients underwent radical prostatectomy via laparoscopic robotic-assisted technique. Time to diagnosis of peritoneal disease was 3 months, 6 months and 8 years. No cases had evidence of other distant metastatic disease. Two patients were found to have extensive peritoneal disease which presented with subacute bowel obstruction. The remaining patient was identified to have a solitary, likely port-site related metastatic deposit following PSMA-PET for rising PSA. All patients underwent surgical metastectomy, of which two were successfully treated to undetectable PSA levels. To the best of our knowledge we report the first case series of peritoneal metastasis following robotic assisted radical prostatectomy. Our case series demonstrates that peritoneal metastasis can present over a broad time span, in a variety of ways. This ranges from solitary localized disease to disseminated peritoneal carcinomatosis. Tumour characteristics are likely to be a key factor in predisposition for development of peritoneal metastasis, however larger case series are needed to evaluate this infrequent occurrence. Evaluation of Phospholipid Profile of Prostate Cancer Cell Lines by LCMS and GCMS Analysis Okasho K 1 , Inoue T 1 , Nakayama K 1,2 , Kimura H 1 , Kamiyama Y 1 , Li X 1 , Mizuno K 1 , Goto T 1 , Akamatsu S 1 , Kobayashi T 1 , Ogawa O 1 1 Kyoto University, Kyoto, Japan; 2 Shimadzu Techno-Research, Kyoto, Japan Introduction and Objective: In recent years, morbidity of prostate cancer has been increasing in Japan. There are epidemiological data suggesting that high-fat diet and obesity are involved in the onset and progression of prostate cancer, and lipid metabolisms have been considered to play important roles. We have reported that the profile of phospholipid in prostate cancer tissues is different from that in benign tissues in imaging mass spectrometry. However, the precise roles remain unknown. We have two objectives in this research. First of them is to establish experimental methods to analyze the phospholipid profile in Liquid Chromatography-Mass spectrometry (LCMS). And another objective is to analyze the profiles of phospholipid in prostate cancer cell lines and to compare them. We extracted lipid based on Folch method. We analyzed phospholipids by LCMS/ MS using SHIMADZU LCMS-8050 together with LC/MS/MS MRM library (Shimadzu). First, using the synthetic phospholipids, we confirmed that we could detect phosphatidylcholine, phosphatidylinositol, lysophosphatidylcholine, lysophosphatidyl-ethanolamine and Sphingomyelin, simultaneously. The dilution series of each phospholipid showed linear relationship between concentration and intensity in LCMS. We evaluated phospholipid compositions of four prostate cancer cell lines, LNCaP, PC3 and DU145 and AI-LNCaP which is androgen-independent cell line established from LNCaP. Gas Chromatography-Mass spectrometry (GCMS) was performed to analyze double bonds in each fatty acid composing phospholipids in detail by the methods which were previously established. Results: We established experimental methods to analyze the phospholipid profile in LCMS. As a result of analyzing the profile of phospholipid in the cell lines, we found that the expression of phospholipids with polyunsaturated fatty acids (PUFAs) were higher in PC3 and DU145 than that in LNCaP. Conversely, the expression of phospholipids composed of saturated fatty acids or monounsaturated fatty acids in LNCaP were higher than that in PC3 and DU145. We focused on phosphatidylcholine which is most abundant phospholipid, and analyzed these cell lines by GCMS. And similar findings were observed in GCMS also. Conclusion: PC3 and DU145 have more malignant biological potential than LNCaP. These results suggest that PUFAs might be related to aggressiveness of prostate cancer. There is increasing evidence linking the microaerophylic bacterium Propionibacter acnes with prostate cancer (PC). That circumcision reduces PC risk further supports a role for anaerobes as circumcision reduces their presence on the glans penis. That persistent anaerobic bacterial infection is carcinogenic has been established from studies associating Helicobacter pylori to stomach cancer (also linked to Vitamin D deficiency). This presentation has undertaken a literature review of studies linking anaerobes with PC and summarises the evidence that Vitamin D deficiency could be playing a "Co-Carcinogenic" role in this process. Materials and Methods: Eight searches of abstracts was undertaken using prostate as primary term vs 1 of 8 different terms relating to anaerobic bacteria in general and specifically diagnosis of Acne, P. acnes and H.pylori. This revealed 254 abstracts whose titles were reviewed and 17 papers selected for review in this presentation. Six case control studies (5 for P. acne and 1 for H. pylori) showed overall OR 0.98 (p NS). The only one reporting significant risk of OR 1.2 correlated it with teenage acne problem only. There were 3 case control studies involving 288,081 normal individuals followed for up to 36 years reporting significant risk of late occurence of PC if the subject had teenage acne (OR 1.67, 1.7, 1.43). Finally, 8 papers were reviewed that reported significant association in specific anaerobic bacterial studies when comparing malignant vs benign prostate tissues at time of diagnosis. Conclusion: These observations provide a new insight into explaining the link between early puberty and increased risk of prostate cancer. Studies of serum Vitamin D levels and PC have not shown a strong positive link while less specific geographic studies of ambient sunshine have been more consistently positive. Over 10-40 years, repeated episodes of Vitamin D deficiency induced innate immune dysfunction, could explain PC linkage with the sun-sensitive P.acnes. In light of the results found in this report, the technology used to produce bacterial vaccines to treat women with recurrent cystitis could offer new approaches to separate low verses high grade PC as could study of low dose check point inhibitors. Waiting The waiting time for prostate cancer diagnosis varies between different institutions in different countries. It is considered by some as a measure of the quality of health care delivery. There is no evidence locally to suggest how long patients with clinically suspected prostate cancer wait to have a prostate biopsy done in Nigeria.The study aimed to document the prostate biopsy waiting times and the efficiency of getting a prostate biopsy done at the Lagos State University Teaching Hospital Nigeria with a view to identify the possible delays and improve on service delivery. We retrospectively reviewed the data of the patients who had prostate biopsy done over a five year period (January 2011 -December 2015). Data retrieved and analyzed were patients' age, serum PSA and the various time lines -referral to presentation, presentation to biopsy, biopsy to histology report and histology to treatment. Conclusion: Though most of the patients with suspected prostate cancer presented late with high PSA values, there was still a significant delay within the hospital system in getting a prostate biopsy done and retrieving/discussing the histology report. There is the need for a review of the present practice. Testosterone Monitoring for Men Under Androgen Deprivation Treatment (ADT) for Prostate Cancer: Practice Patterns in 8 European Countries Mitropoulos D 1 , Chlosta P 2 , Haggman M 3 , Papaioannou C 1 , Strom T 4 , Markussis V 5 Introduction and Objective: Achievement of castration levels of testosterone is associated with improved clinical outcomes such as increased overall survival, biochemical progression free survival and freedom from progression to castrate-resistant disease in men receiving ADT for non-metastatic or metastatic hormone-naïve prostate cancer. Current guidelines do not clearly define the ideal testosterone suppression goal orthe timing of measurements. A clear-cut recommendation is only given for cases under ADT with rising PSA and/or clinical progression to confirm a castrate-resistant state. We explored the corresponding practice patterns of physicians treating prostate cancer patients across a range of European countries. A survey was conducted using a structured questionnaire in 8 EU countries (CZ, GR, HU, LT, LV, PL, ROM, SWE) between February and May 2018. The questionnaire covered general respondent information (specialty, years of practice, practice affiliation), and, among others, their attitude towards target castration levels and frequency of estimating testosterone levels during treatment. Results: In total, 375 physicians (70% urologists, 30% medical oncologists) completed the survey (response rate 58%), affiliated to university hospital/cancer center (50%), non-teaching hospital (36%) and private sector (14%). Target nadir testosterone levels varied significantly by country; in certain countries (CZ, LT) a considerable percentage (up to 22%) of treating physicians had no target nadir level. Target castration level differed significantly between urologists and oncologists with urologists opting more frequently for testosterone levels <20 ng/dL (p= 0.045), independently of practice affiliation (p= 0.2). Testosterone monitoring practice also differed significantly among countries regarding timing of measurement before LHRH initiation (6%-72%), within 3 months of LHRH initiation (13%-44%), during LHRH treatment (7%-60%), orwhen PSA increased (46%-93%). A higher proportion of oncologists than urologists measured testosterone levels before the initiation of ADT (55% v 27%, p <0.001) while more urologists measured it at the time of PSA increase (64% v 44%, p <0.001). Conclusion: Testosterone monitoring practices vary significantly across Europe as well as among treating physicians. Failure to comply with recent scientific guidelines on testosterone monitoring may have a significant impact on patients' outcomes. Implementation strategies may be needed to ensure improved guideline adherence. Prediction However, side effects of procedure including sepsis or pain might be harmful, various parameters was developed for accurate diagnosis and avoiding unnecessary biopsies. In this study, we developed a prediction model using prostate-specific antigen (PSA) through machine learning (ML) algorithm, particularly, a logistic regression model. We designed our method to predict prostate biopsy results based on patient's PSA level and PSA velocity. Our method was mainly comprised of two parts: (i) preprocessing the raw EMR data into fixed time-serial input data suitable for modeling and (ii) applying ML model to predict and test prostate biopsy results, whether if the biopsy result would come out to be benign or to have adenocarcinoma. It applied the ML algorithm at this point with six variables, including the five PSA levels and subjects' age. Results: Total 270 patients who underwent prostate biopsy were analyzed and 72 patients were diagnosed prostate cancer. PC patients groups were significantly older than benign group. (67 years vs 71 years; p <0.01). Mean PSA level was 4.54 ng/mL. PSA level was not different between two groups. Ten-fold validation was conducted in logistic regression with accuracy of 67 percent, sensitivity of 67 percent and specificity of 66 percent using ML algorithm. Introduction and Objective: Prostate specific antigen (PSA) screening test has been widely spread in recent decades, physicians should consider prostate biopsy when there is PSA level elevation. However, side effects and lower detection rates of prostate cancer (PC) of prostate biopsy have led physicians to question whether they should perform prostate biopsy in the PSA grey zone (4~10 ng/ml). Also, low-risk prostate cancer was recommended active surveillance due to side effects of definitive local treatment. In this study, we investigated predictors for high grade PC at prostate biopsy which needs definitive treatment in PSA grey zone patients. We investigated PC patients underwent transrectal prostate biopsy in PSA grey zone and who visited our institution. PSA grey zone was defined as PSA level from 4 to 10 ng/ml. High grade PC was defined as Gleason grade above Gleason grade 1. Clinical parameters were evaluated to predict High grade PC at prostate biopsy using logistic regression analysis. Receiver operating characteristics (ROC) curves and Youden Index was performed to determine for cut-off value to predict high grade PC in PSA grey zone. Results: Total 1467 PC patients with PSA grey zone was included. Median age was 65 years and median PSA level was 6.4 ng/ml. Median prostate volume measured by trans-rectal ultrasonography was 31cc UP.474, Figure 1 . and median PSA density was 0.20 ng/ml/cc. In univariable and multivariable logistic regression analyses for prediction of high-grade PC, age and PSA density was significantly associated with high grade PC. Age above 65 years and PSA density above 0.21 was proposed as cut-off value to predict high grade PC in prostate biopsy. Conclusion: In PSA grey zone, age above 65 years and PSA density >0.21 ng/ml/cc was associated with high grade PC in prostate biopsy. Physicians might consider these parameters whether perform prostate biopsy in PSA grey zone patients. Introduction and Objective: Docetaxel (DTX) chemotherapy has historically been the first-line treatment for metastatic castration-resistant prostate cancer for several decades. However, long-term DTX treatment is known to promote tumor cell resistance to apoptosis induction, and the mechanisms by which resistance develops are still incompletely understood. Hence, this study was conducted to evaluate the potential effect of protein disulfide isomerase 4 (PDIA4) on chemoresistance to DTX in prostate cancer (PCa) and to investigate the underlying mechanisms. Materials and Methods: Two types of DTX resistant PCa cells, i.e., DTX resistant PC-3 (PC-3/DTXR) and C4-2B (C4-2B/DTXR) cells, as well as the parental PC-3 and C4-2B cells were developed to investigate these issues. shRNAs targeting human PDIA4 to knockdown the expression, or PDIA4 expressing adenoviral vectors to overexpress the PDIA4 were transfected to PCa cells respectively, to study the underlying mechanisms of PDIA4 involving in PCa DTX resistance. Results: Results showed that PDIA4 exhibited a dramatic overexpression in PC-3/DTXR and C4-2B/ DTXR cells. Down-regulation of PDIA4 by infecting PC-3/DTXR and C4-2B/DTXR cells with shPDIA4 lentivirus stimulated cell death by prompting apoptosis. UP.regulation of PDIA4 by infecting PC-3 and C4-2B cells with PDIA4 expressing adenoviral vectors showed severer resistance to DTX. In addition, the expression level of Bcl-2 was remarkably down-regulated, whereas the expression of Bax showed a significant up-regulation in PDIA4 knockdown DTX resistant PCa cells. Meanwhile, PDIA4 up-regulation induced phosphorylated Akt expression, while PDIA4 knockdown significantly inhibited the expression in PCa cells. Our study indicates that PDIA4 is a negative regulator of PCa cell apoptosis and plays a critical role in PCa DTX resistance by activating the Akt-signaling pathway. DTX resistance is mediated by apoptosis with multiple changes in pro-and anti-apoptotic genes and proteins. Thereby, it indicates that targeting PDIA4 could be a potential therapeutic approach against DTX resistance in PCa. Introduction and Objective: Hypoxia-induced erythropoietin (EPO) signaling pathway plays an important role in the development of tumors. This study aimed to investigate the role of erythropoietin signaling pathway in the development of castration-resistant prostate cancer. tion-resistant prostate cancer (CRPC) were obtained after transurethral resection of the prostate and the expression of EPO/EPO receptor (EPOR) in the specimens was detected by immunohistochemistry. In addition, LNCaP cells were induced under hypoxic environment with 1% oxygen concentration for 14 days, and then, RT-PCR and Western blotting were used to detect the expression of EPO and EPOR in LNCaP cells under hypoxic and normoxic conditions. Finally, the growth of LNCaP cells in androgen-stripped culture medium was determined after knock-down of EPOR using siRNAs. The EPO and EPOR expression scores for CRPC and ADPC were 7.55 vs 4.5, and 7.45 vs 5.9, respectively (p < 0.001). Compared with these LNCaP cells cultured under nomoxia, hypoxia-induced LN-CaP cells grown faster in androgen-deprived culture medium. And as with this, hypoxia-induced LNCaP cells had significantly increased EPO and EPOR expression. Meanwhile, LNCaP cells could not be cultured in androgen stripped culture medium after EPOR suppression. The EPO-EPOR self-secretion loop played an important role in the advancement of prostate cancer from androgen dependence to castration resistance. Results: Kruskal-Wallis analysis of continuous variables (α= 0.05; CI = 95%) showed no statistically significant difference between controls and localized prostate cancer viscoelasticity. Mann-Whitney U test found significant difference between metastatic disease and localized disease K-time p= 0.01; α -Angle p= 0.02; MA p=0.01; G p= 0.01; MRTG p= 0.009; TTG p= 0.01. Whole blood micrographs of Metastatic group showed RBC changes suggesting oxidative stress from chronic inflammation evidenced by increased eryptosis. RBC also showed loss of structural integrity and proteinaceous debris on membrane suggesting altered membrane potentials. Whole blood clots have deformed matted clumped fibrin suggesting RBC cell leak of ferritin from damaged RBCs and architectural distortion suggesting beta-amyloid misfolding. Introduction and Objective: Robotic-assisted radical prostatectomy (RARP) is known as same oncological safety procedure compared to radical prostatectomy. Patient with positive margin after operation has a higher risk of biochemical failure. However, the treatment after positive margin was still controversial. The aim of this study was to find out the risk of biochemical failure over patients with positive margin after operation. We evaluated total 462 patients who received RARP at LinKou Chang Gung Memorial Hospital during 2006-2014 with 61 patients with positive margin and didn't receive any treatment before biochemical failure. 1 patient was excluded due to lost following up. COX regression analysis and Kaplan-Meier Curve were used to compared between patient with biochemical failure (n= 19) and without biochemical failure (n= 41). Results: Overall 13.2% of patients had positive margin with 31.7% turned out to be biochemical failure (BCF). The mean followed up months was 43.66 months (42.42 vs. 46.35(BCF), p= 0.51). In multivariable analysis, platelet and lymphocyte ratio (PL ratio) (6.26 vs. 8.02 (BCF), p= 0.001) showed statistically significant. And, if we separated the patients to two group by pathology grading group <2 and >3 (p= 0.001), it also showed statistically significant. Kaplan-Meier Curve was also used to analyze when PL ratio <=9 or >9 and it showed p value = 0.017. 0%, respectively) and an increase in the incidence of PC with moderate and high expression of antigen (from 64.3% to 89.5%, respectively) with Glisson score rise (r= 0.39). It has been established that recurrence of PC is associated with an increase in the incidence of tumors with moderate and high expression of Ki-67 and decrease in the number of tumors, positive for E-cadherin (r= 0.62 and -0.58 correspondently). Conclusion: Investigation of Ki-67 and E-cadherin expression in PC cells is valuable for prediction of the course of the disease and the development of a personalized treatment tactic. Introduction and Objective: It still remains unclear whether prostate cancer (PC) is one of the Lynch syndrome (LS)-associated cancers. Loss of DNA mismatch repair (MMR) proteins, especially MSH2, has been reported to be frequently shown in high grade and/or advanced PCs. On the other hands, the incidence of germline mutations in MMR genes has been reported to be less than 1% in patients with PC, compared to 2-4% in patients with colorectal cancer. The exact prevalence of putative LS-associated PC has not been clarified. Here, we estimate the prevalence of putative LS-associated primary PC. A total of 129 surgical specimens from radical prostatectomy performed at Toranomon Hospital between 2012 and 2015, were retrospectively tested immunohistochemically for the expression of the MMR proteins MLH1, PMS2, MSH2 and MSH6 as universal screening. For all suspected MMR-deficient patients, germline genetic tests focusing on MMR genes were carried out. Results: Loss of MMR proteins were found in only one patient (0.8%) who showed dual loss of MSH2/ MSH6. The patient showed a single nucleotide germline mutation from c.1129 C to T (p.Glc377*) at exon 7 in the MSH2 gene. He was diagnosed with primary PC at the age of 66. He had a documented history of LS (Muir-Torre syndrome) with prior colon cancer, sebaceous tumor and keratoacanthoma, and a subsequent bladder cancer, which all also showed dual loss of MSH2/MSH6. In addition, he had a strong family history of colorectal and other LS-associated cancers. The pathological stage was pT3aN0M0, and the pathological grade was Gleason 7(4+3) with tertiary pattern 5. Conclusion: This is the first report that universally examined all four MMR proteins as immunohistochemical screening in primary PCs. PC has been suggested to be one of the LS-associated cancers. However, the prevalence of germline mutations of the MMR genes (LS) was lower than expected in patients with primary PC, compared with other LS-associated cancers. To develop an eHealth application for men on active surveillance (AS) for prostate cancer (PCa) and to provide them with the opportunity to monitor their disease, plan and manage appointments, and chat with their urologist. It is hypothesized that the use of such a tool will encourage active participation of patients and can have a positive effect on their quality of life (QoL). Furthermore, it can improve the quality of care as it can focus on patients' needs more specifically. A two-phased implementation study. The first phase consists of the development and utility testing of the Follow MyPSA app. In the second phase of the study approximately 100 men currently on AS or newly diagnosed patients choosing AS in The Netherlands will be invited to participate in the study and use the Follow MyPSA app. At baseline, after 6, 9 and 12 months, men will complete the SF-12, the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), the Patient Activation Measure (PAM), and knowledge questions (at baseline and after 12 months). Furthermore, focus groups with users of the Follow MyPSA app will be organized at 6 and 12-months to discuss the usability of the app and whether improvements to the app are necessary. Results: Psychological symptoms will be assessed to determine their prevalence and severity over time. The results of the baseline measurement will be presented during the meeting. In a situation where lowrisk PCa is becoming more of a chronic condition, we stimulate patients to become actively engaged in their disease process, which we hypothesize will lead to an increased sense of control and therewith a better QoL. We predict that providing men with a low-cost, easy to use eHealth tool will allow them to engage in their disease process, leading to an increased sense of control and therewith better QoL, reducing any potential distress that may come from living with untreated PCa. The objective of this study was to assess the utility of different clinic-pathological risk criteria to predict insignificant prostate cancer (PCa) in radical prostatectomy (RP) specimens. Men who underwent RP for clinical stage T2, PSA <20 ng/mL, Gleason score <8, PCa diagnosed by transperineal template mapping biopsy were included to this analysis. The performance of Klotz (cT1c-T2a, PSA 10 ng/mL for patients of age under 70 years and 15 ng/mL for patients over 70 years), Roemeling (cT1c, 15 ng/mL, Gleason 7), Epstein (cT1c, PSA density <0.15, Gleason 6, no more than two cores with cancer or cancer involving no more than 50% of any core), D' Amico (cT1c-T2a, PSA 10 ng/mL, Gleason 6) and Simmons (Gleason 6 and maximum cancer core length 3 mm) criteria to predict insignificant PCa upon RP defined as Gleason score6 and total tumor volume <2.5 mL were assessed. Results: Between January 2016 and December 2018 at our department we identified 43 men who fulfilled the inclusion criteria. After RP 7 men had clinically insignificant PCa. Based on biopsy results 3 (7%) men fulfilled Epstein, 5 (11.62%) -Roemeling, 40 (93%) -Klotz, 24 (55.8%) -D' Amico and 10 (23.25%) -Simmons criteria. The ability of the five criteria to predict insignificant PCa in RP specimen was examined (see Table 1 ,2). Simmons criteria showed a superior trade-off between sensitivity and specificity for clarifying insignificant PCa that can guide treatment and be used as the best reference test after transperineal prostate mapping biopsy. The The neutrophil-to-lymphocyte ratio (NLR) has been reported to be a prog-nostic marker in prostate cancer. In this study, we assessed the association between preoperative NLR and the clinicopathological characteristics, biomolecular features and prognosis of patients with localized prostate cancer treated with radical prostatectomy. A total of 994 subjects were retrospectively enrolled, and the histological specimens of 210 patients were retrieved for constructing a tissue microarray. Immunohistochemistry was then performed to assess the expression of AR, ERG, PTEN, p-AKT, Bcl-2, Beclin-1, Ki-67, CD3, CD4, CD8, IFN-γ and TNF-α. Results: No significant differences in the NLR distributions among clinicopathological variables were observed (P > 0.05) when the original NLR data were utilized. When we dichotomized the NLR value into the high-NLR group (NLR < 2) and low-NLR group (NLR < 2), we found that the patients in the high-NLR group had more prostate capsule invasion (P = 0.047). Additionally, no significant correlation was found between the NLR and infiltrating CD3+ cells, the CD4/CD8 ratio, AR, ERG, PTEN, p-AKT, Bcl-2, Beclin-1, Ki-67, IFN-γ or TNF-α (P > 0.05). When we analyzed the data of patients without postoperative adjuvant hormone therapy or radiotherapy, univariate and multivariate survival analysis indicated that a high NLR was a predictor of better BCR-free survival (P < 0.05). When analyzing the entire cohort, univariate survival analysis showed that the high-NLR group had significantly poorer overall survival (P < 0.05). Conclusion: NLR cannot reflect prostate cancer characteristics or the local immune microenvironment, but a high NLR can serve as an independent predictor of better BCR. UP.510, Table 2 . Outcomes of area under the reciever operating characteristic analysis of the five analysed criteria. Introduction and Objective: Membrane-associated guanylate kinase (MAGUK) family protein MA-GUK invert 2 (MAGI-2) has been demonstrated to be involved in the tumorigenic mechanism of prostate cancer via gene rearrangement. The objective of this study was to investigate the expression profile of MAGI-2 at mRNA and protein levels. The prognostic value of MAGI-2 in Han Chinese patients with prostate cancer was also investigated. Expression data of MAGI-2 were assessed through database retrieval, analysis of sequencing data from our group and tissue immunohistochemistry using digital scoring system (H-score). The clinical and pathological data were collected. The sources of follow-up data were the medical record, the database named "PC-follow", and telephone calls to the patients or relatives. The expression of MAGI-2 expressions in prostate tumor tissues and prostate normal tissues were evaluated and compared. MAGI-2 expression was associated with clinical parameters including tumor stage, lymph node status, Gleason scores, PSA level and biochemical recurrence of prostate cancer. The relative expression of MAGI-2 mRNA was lower in the tumor tissue in the TCGA database and sequencing data (p<0.001). There is no difference in MAGI-2 protein expression between tumor and normal tissues in Tissue microarray (TMA) results. MAGI-2 expression was associated with pathological tumor stage (p=0.02), Gleason score (p=0.05) and pre-operation PSA (p=0.04). A positive correlation was identified between MAGI-2 and PTEN expressions through analysis of TCGA and TMA data (p<0.001). Patients with higher MAGI-2 expression had longer biochemical recurrence BCR-free survival in the univariate (p=0.005), which indicated indicates an optimal prognostic value of MAGI-2 in Han Chinese patients with prostate cancer. Conclusion: MAGI2 expression gradually decreases with tumor progression and can be used as a predictor of tumor recurrence in Chinese patients. The Protective Effect of Lycopene on Prostate Growth Inhibitory Efficacy by Decreasing Insulin Growth Factor-1 in Indonesian Human Prostate Cancer Cells Tjahjodjati T 1 , Sugandi S 1 , Umbas R 2 , Satari M 2 , Wijayanti Z 1 Introduction and Objective: The Korean urological association (KUA) organized the prostate cancer (Pca) clinical practice guideline (CPG) developing committee composed of experts in the field of oncology with the Korean Urological Oncology Society (KUOS). The purpose is to provide current and comprehensive recommendations for the medical and surgical treatment of Pca. The committee comprised of 27 members determined to develop CPG with mainly adapting from existing guidelines. The CPG development committee consulted to experts for the search of data. The committee determined 22 key questions under the principle of PICO (population, intervention, comparison and outcome). A comprehensive literature review was carried out primarily from 2007 to 2016 using medical search engines including data from Korea. Ten committee members evaluated the quality of the selected guidelines for adaptation with K-AGREE II (the Korean Appraisal of Guidelines for Research & Evaluation II). The Delphi method was used to make consensus for recommendations through three rounds. A peer-review for the recommendations selected by consensus was done by review committee with an independent process. Results: CPG draft was reviewed by expert peer reviewers and outside public hearings also discussed at an expert consensus meeting until final agreement was achieved. This CPG was certified by the KUA and KUOS and obtained the certification mark from the Clinical Practice Guideline Evaluation System of KAMS (Korean Academy of Medical Science). Table 1 shows the summary of recommendations in low-risk Pca. Conclusion: This guideline was the first guideline for Pca that was certified by the KUA and KUOS and obtained the certification of KAMS in Korea. Introduction and Objective: Recurrent penile adhesions associated with lichen sclerosus (LS) may cause pain, bleeding and disfigurement. We present a novel surgical technique for treatment of refractory penile adhesions using a sub-coronal buccal mucosal graft (BMG) resurfacing. A retrospective, international multi-institutional study was conducted to include patients with refractory penile adhesions who were treated with this technique. The procedure included circumferential excision of the diseased skin segment and replacing it with a circumferential 1-cm strip of BMG. Patients with <1-year follow-up were excluded. The primary outcomes were recurrence and surgical complications. Secondary outcomes were patient-reported outcomes measures (PROMS) including SHIM questionnaire and global response assessment (GRA) questionnaire administered to measure functional and esthetic outcomes. The GRA scale ranges from -3 (markedly worse) to +3 (markedly improved). Results: Sixteen men with mean age of 61 (46-74) underwent the procedure in five institutions between 3/2014 and 3/2018. Twelve men with >1-year follow-up met inclusion criteria. Prior treatments included topical agents (5/12), oral agents (2/12) and circumcision (5/12). Histologically-proven LS was the most common etiology (8/12). At the mean follow-up of 21 (13-72) months no patients developed recurrence. Mean SHIM score remained unchanged at 15 (p= 0.83). Overall improvement of symptoms on GRA was reported by all patients: 50% GRA+3; 25% GRA+2, 25% GRA+1. All patients saw improvement in pain with intercourse: 33% GRA+3; 17% GRA+2, 50% GRA+1. Ten patients (83%) reported an improvement in esthetic appearance, 1 patient reported no change, and 1 patient mild worsening. Baseline pe-nile sensation was preserved in 9/12 (75%). The majority would recommend the procedure to a friend/ relative (11/12, 92%). Conclusion: Refractory penile adhesions in the setting of LS are notoriously difficult to treat. A sub-coronal BMG resurfacing is feasible. This initial patient cohort demonstrated no recurrence and overall high satisfaction. A prospective study with long-term follow up is warranted. Nearly all prior reports on adults with urethral strictures after failed hypospadias repairs are case series from single centers and surgeons. To our knowledge, our report is the first population-based experience on adult hypospadias care in the real world. We queried the Statewide Panning and Research Cooperative System (SPARCS) database: a large comprehensive database of all payer data reporting system in New York State, between the years 1995-2014. SPARCS collects details on patients in both the inpatient and outpatient settings utilizing ICD9 and CPT codes. The inclusion criteria for the study were patients 18 years and older, with a diagnosis of hypospadias. We captured all urethral operative procedures in this cohort and all subsequent urethral procedures during the follow up period. Success was defined as not requiring subsequent urethral procedure. Results: 726 adults, mean age 46.9 yrs, who underwent a total of 1,051 procedures. Overall, the most common procedures were urethral dilation (36%) and DVIU (7.6%). The most common co-morbidities were diabetes (10.7%) and hypertension (17%). Patients were divided based on the initial procedures upon entrance to the database. 388 had endoscopic treatments, mean age 57.9 and 340 had urethral reconstruction, 4 were coded as first stage procedures, mean age 36.1 (p<0.01). In those starting with endoscopic treatment, 30 patients had subsequent procedures at a mean time of 32.95 months and among the reconstruction group 52 underwent unplanned subsequent procedures at a mean 18.48 months, translating to 15% failure rate. In multivariable analysis, increasing age was associated with decreased likelihood of secondary procedures (p=0.002), which correlates with the findings in figure 1. In a statewide population-based evaluation, the success rate for urethral reconstruction in adults with prior failed hypospadias is reasonable. However, despite the high reported failure of endoscopic management, the community excessively uti- Table 4 . Logistic regression for BMI-adjusted PSA density in predicting adverse pathology of prostate biopsy (adjusted with age, prostate volume, and institutions) Introduction and Objective: Hypospadias and its surgical correction may impact quality of life (QoL) and psychosexual development of patients. We aim to evaluate the long-term functional and cosmetic outcomes in adult life of patients who underwent hypospadias surgery during childhood. We selected patients operated in our Hospital of distal or penile hypospadias during childhood. Those now 16 years-old were contacted. In clinic, we performed physical examination, uroflowmetry and post-void residual (PVR) measurement. Sexual, urinary and cosmetic outcomes were assessed using validated questionnaires: IIEF-5, IPSS, PROM-urethra, HOSE, PPS, JGPS. Original degree of hypospadias, previous surgeries and follow-up were collected from patient records. Descriptive analysis was conducted. Results: Twenty-nine patients participated (response rate: 55.8%). Mean age was 19.0(SD 2.9) years. Mean time since last operation was 12.9 (SD 3.5) years. Hypospadias at birth was glandular in 15, distal penile in 10 and mid penile in 4 cases. They underwent a mean of 1.9 operations (range 1-6) for correction. On exam, 86.2% had neomeatus on glans tip, 2 on glans, 2 on sulcus. Mean penile length was 11 (SD 2.6) cm. 3 patients had urethrocutaneous fistula. Two patients had urethral strictures. Mean flowmetry values were: Qmax 20.53 (SD 7.4) mL/seg, Qave 9.4 (SD 3.9) mL/ seg, voided volume 270.5 (SD 169.6) mL, 2 patients showing plateau pattern. Mean PVR was 13.8 (SD 41.4) mL, only 2 cases >50 mL. Voiding symptoms were mainly postmicturition dribble and spraying. PROM showed no impact on QoL, with 88.75/100 (SD 12.6) on health status. Seventeen were sexually active, only 1 reporting erectile dysfunction; mean IIEF-5 21.7 (SD 6.9). 89.7% declared being satisfied with penile length, and 86.2% with penile cosmetic appearance. Conversely, PPS test showed 5 patients dissatisfied with general penile appearance and 7 with penile length. PPS mean score was 8.8/12 (SD 2.3). JGPS mean score was 25.8 (SD 4.1), with 10 patients dissatisfied with flaccid penile size. In HOSE, 89.7% scored 14/16, only 3 patients below "acceptable outcome" cutoff. Conclusion: Surgical outcomes of paediatric hypospadias repair are good. However, patients should be assessed in adulthood to exclude underdiagnosed complications. Patients have impaired self-imaging of genitalia, despite normal sexual function and good objective cosmesis. Introduction and Objective: Buccal mucosal graft onlay has recently being considered as an approach for female urethroplasty. Here in, we present our institutional surgical approach and immediate to intermediate-term surgical outcome. All female patients diagnosed with urethral stricture managed in our institution from 2014 to 2018 were identified and reviewed for surgical management and subsequent outcome. Successful surgical outcome was defined as no further surgical intervention such as catheterization, dilatation, urethrotomy or open reconstruction and patient able to micturate freely. Patient characteristics and clinical variables were extracted by performing a medical chart review and summarized according to surgical approach and evaluated for the outcomes including associated morbidities as reported in their last clinic follow-up. Results: A total of 11 female patients with mean age of 55.7 years old underwent onlay urethroplasty using buccal mucosal graft. Seven (63.6%) patients had panurethral stricture, 4 (36.4%) had midurethral strictures. The average luminal calibration preoperatively was approximately 8 Fr), all patients had at least one prior urethral dilatation and or additional instrumentations such as urethrotomy prior to the urethroplasty. At the time of surgery, the patients' mean body mass index was 32.9. All patients had dorsal buccal graft onlay, while three patients (27.3%) had additional ventral graft onlay. Buccal graft surface area had an average of 8.5 cm 2 . Overall mean operative time was 164 minutes and mean estimated blood loss was 139 cc. Average length of hospital stay was 52.4 hours and average catheter indwelling time was 22.6 days. One patient was lost to follow-up post-operatively. The mean follow-up duration was 15 months post-urethroplasty with at least a cystourethroscopy, flow rate, post-void residual and or radiographic study to evaluate surgical outcome. All patients had a satisfactory outcome. One complication of vaginal abscess was noted which was managed with drainage and antibiotics. Three (27.3%) patients did report some oral tightness post-operatively, while 4 (36.4%) patients noted new occurrence of urgency on follow-up which was adequately managed with anticholinergic agents. Conclusion: Our institutional series on buccal mucosal graft onlay for female urethroplasty has shown that this procedure is an acceptable option for female stricture with high immediate to intermediate term success rate and low morbidity reported. Introduction and Objective: To assess long term clinical and functional outcomes post pyeloplasty in unilateral UPJO in poorly functioning kidneys in an exclusive adult population. We reviewed the database of all cases admitted with unilateral UPJO treated with pyeloplasty and preoperative split renal function (SRF) was < 30% (by diuretic MAG-3 renography). We further subdivided patients into two groups; group (A) SRF 20% and group (B) SRF >20% and <30%. Renal function difference was evaluated by the changes in SRF at last follow up, where 5 % change was considered significant. Functional success was defined as absence of obstructive pattern on diuretic renogram with no decline in renal function. Clinical success is defined as no need for secondary intervention (re-do pyeloplasty, nephrectomy, stenting or endoyelotomy). Results: Among 211 patients. The mean ±SD of SRF was 20.5 ± 6.6%. After a median (range) follow up of 67.1 ± 11.8 Months, SRF increased significantly to 23.5 ± 7.5 (p<0.0001). SRF was static, improved and decreased in 150 (67.9%), 59 (26.7%) and 12 (5.4%) patients, respectively. In group (A) 92 patients, SRF increased from 14.3 ± 4.9 to 18.7 ± 7.1 (p<0.0001). Functional success was achieved in 88 (95.6 %) patients. Whereas, in group (B) , 24.9 ± 3.3 to 27.2 ± 6.3 (p<0.0001) at last follow up. Functional success was achieved in 121 (95 %) patients. Conclusion: Pyeloplasty provides high rates of functional success in poorly functioning kidneys. All attempts should be done to repair UPJO regardless of the SRF. Introduction and Objective: Kulkarni Panurethroplasty with one side dissection technique is today practiced at many centers across the globe. The advantage of one side dissection is it preserves the neurovascular supply on the opposite side of urethra. It is minimally invasive urethroplasty. The urethra opens like a book and can be attached to exact same location as before unlike circumferential mobilization Materials and Methods: The Kulkarni Urethroplasty can be used in 3 different scenarios. It is best suited for a single stage, penile invagination, dorsal onlay, one sided dissection buccal graft urethroplasty for Panurethral strictures. This is especially true for lichen sclerosus where staged approach is fraught with recurrence. The penile invagination approach can be applied to penile strictures. Through a perineal incision, penis is invaginated, Urethra mobilized on one side, dorsal onlay urethroplasty done from meatus till entire length of stricture. This can be done without penile incision. In hypospadias fistula, simple fistula closure often fails as usually there is a distal stricture. Buccal graft augmentation with dorsal inlay has been practiced. With Kulkarni one side dissection, urethra can be mobilized dorsally, Fistula closed from inside, and augmented with a dorsal onlay buccal graft. A onlay graft is always bigger and has better attachment to underlying corpora. Introduction and Objective: Single stage urethroplasty for distal penile urethral strictures using buccal mucosal graft (BMG), historically, have been carried out in two stages with an interval of 6 months in-between the stages and a 10% chance of revision interstage due to cross-fibrosis. Here we present the result of our centre, classified as low volume, for single stage distal penile urethroplasties performed solely for BXO related strictures. Single stage distal penile urethroplasty was carried out on 37 patients, all suffering from BXO, by a single surgeon at what is classified as a low volume centre. Of these 7 had previous failed hypospadias repair. A naso-laryngeal tube was placed by the anaesthetist. Urethral plate divided and fibrotic tissue excised. BMG was laid in the place thus created and then fenestrated and quilted. Dartos flap was used to cover the repair. Urethra was closed over a 14F Foley's catheter. Catheter was removed on day 11. Patient was advised application of Vaseline twice a day at the tip. Follow up was at 6 weeks, 3 months and then 6 months for 2 years with urethroscopy, flow rate and post void residuals. Recurrence was described as on endoscopy. Results: All patients had BXO induced distal penile stricture with previous dilatation and ISD with recurrence. The mean follow-up time was 42.5 months (range= 10-78 months). The average stricture length was 5.3 cm (range 1.5-12 cm). Five out of 37 patients suffered a recurrence of their strictures just at the tip (13.5%). Small urethral fistula developed in 13.5% of patients (5/37). All were surgically repaired, recurrences with BMG and fistulas with dartos flap with no residual issues. Besides recurrence and fistulae, other complications included persistent graft site pain in one patient and penile haematoma in 1 patient (managed conservatively). Standard flowmetry measurements using a Urodyn system showed an average improvement in patient Qmax from 9.1 to 20.6 ml/sec (p <0.005) and a drop of the average post void residual from 30 mLs to 15 mLs. Our centres experience of single stage buccal mucosal urethroplasties for BXO induced distal penile strictures would suggest that this procedure is safe and effective as a first line surgical option. Failure rates are at accepted levels for such a procedure and patients benefit from a single hospital stay and a shorter overall recovery/treatment period. To present the results of our double buccal mucosal urethroplasty series for panurethral strictures. Materials and Methods: We in-cluded the first 35 patients who had one stage double buccal mucosal graft urethroplasty with one side dissection of the urethra which was described by Kulkarni, between January 2015 and June 2018 and had at least 6 months follow-up. From the first case, all data were recorded prospectively and patient age, etiology of the stricture, comorbidities, previous treatments, postoperative maximal flow rate, pre and post-operative erectile function, perioperative and postoperative complications and quality of life questionnaire for this study. Results: The mean patient age was 58.8 and mean stricture length was 13.6 (10-16) centimeters. Patients had previously 1 to 17 procedures. Patients had a mean peak flow rate of 25.4 mL/sec at the first postoperative visit. During the follow-up period, 6 patients had recurrence and managed with urethral dilation (1), direct vision internal urethrotomy (2), meatoplasty (1) and re-urethroplasty (2). The responses to the questions about satisfaction from the surgery showed that 31 (88.6%) patients were satisfied with the surgery, 33 (94.3%) would prefer this procedure again, if needed, and 31 (88.6%) patients recommended this procedure to others. When patients were grouped according to age, recurrence rate was 35.7% in patients older than 65 years and 4.8% in patients 65 years old. Our study showed that Kulkarni's onestage double buccal mucosa urethroplasty technique has a high success rate. The patient satisfaction is high because of the good functional outcomes and low complication rate. Materials and Methods: This is retrospective study depending on database of renal transplantation unit in our hospital. We have 385 patients post-RT who are following up in our center. Patients records were reviewed to evaluate the duration of pre-RT hemodialysis, type of kidney donor (cadaveric or live donor, related or unrelated), immunosuppression protocol, the post transplantation time until developing malignancy, also type of diagnosed malignancy, and its management protocol. Results: Out of 385 cases of RT who has follow up in our center from 2000 to 2018, 9 cases (2.34%) of post-RT malignancy has been diagnosed; 4 cases with skin cancer (3 cases basal cell carcinoma, one case squamous cell carcinoma), 2 cases with thyroid papillary carcinoma, one case with testicular seminoma, one case with muscle invasive bladder urothelial carcinoma and last case with graft renal cell carcinoma. Mean age at diagnosis was 53.6 years while mean post-transplantation duration before malignancy was 10.5 years. Two of them received unrelated kidney donors, one cadaveric kidney and one had second kidney transplant. Two cases (22.2%) died of malignancy including a case of advanced graft RCC who died of inoperable malignancy. The risk of developing post renal transplantation malignancy is higher than normal population. Patients receiving kidneys of unrelated donor, cadaver or re-transplant are at higher risk possibly due to more aggressive immunosuppressive protocols. Aggressive behavior of these malignancies highlights the necessity of long life follow up putting a high index of malignancy suspicion for early diagnosis. Also, immunosuppression protocols need to be tailored after cancer diagnosis. Right open radical graft nephroureterectomy was performed. Intra-operatively, dense adhesions between the posterior surface of the kidney with external iliac vessels were present. There were no perioperative complications. Histopathological diagnosis confirmed High-grade urothelial malignancy with the invasion of renal parenchyma and no lymph nodal spread, T3N0 disease. We report a rare case report of TCC developing in first graft kidney and requirement of multimodality treatment for the same. Many challenges were encountered in the form of, multiple alterations of Immunosuppression regime to best suit the patient profile, moderating neoadjuvant chemotherapy in a renal allograft recipient and surgical difficulties encountered during removing the kidney with minimal morbidity. Patient has completed her 3 months follow up and is doing well. Single Center Experience of Pediatric Renal Transplantation at PKI, SIH. Iqbal N 1 , Hussain I 2 , Hasan A 1 , Bashir A 1 , Akhter S 1 1 Pakistan Kidney and Liver Institute, Lahore, Pakistan; 2 Shifa International Hospital, Islamabad, Pakistan Introduction and Objective: The pediatric kidney transplant recipients have challenges drug metabolism and clearance, perfusion of transplanted organs, and risk for post-transplant lymphoproliferative disease. They have special quality of life issues such as cosmetic side effects, stunted growth, problem of adolescent children nonadherence to immunosuppressive therapy. We hereby share our experience regarding outcome and complications in pediatric transplant. Total of 37 patients underwent Live related kidney transplant at our center from June 2005 till December 2015. They were evaluated before renal transplant and cross matching and HLA typing was done. Twenty-three children had single antigen match, while 5 patients had 2 antigen match, 7 patients had 3 antigen match, one had 4 antigen match and 1 patient had 6 antigen match. Kidney transplant was done by standard technique, and kidney was placed in the abdomen, and renal artery was anastomosed to the aorta. Ureter was anastomosed to the bladder by creating a submucosal tunnel for antireflux mechanism. We collected data retrospectively for variables like age, weight, mean operative time, mean hospital stay and JJ stent. Results: We operated 37 children having end stage renal disease for renal transplant having a mean age of 13.06± 3.90 years. Mean dry weight was 37.53±15.40 kilograms. Mean operative time was 396.57±25.04 minutes and mean hospital stay was 6.14±0.89 days. There was single renal artery in 35 patients while 2 children had 2 renal arteries. Permanent Graft dysfunction was seen in 6 patients while graft failure in 5 patients. Time of rejection was 6 months for 5 children,7 to 12 months for 1 patient while 4 patients had it after 1 year. one patient had graft failure after 10 years. We used Double J stent for ureter in 5 patients. Recurrent UTI was seen in 9 patients. One patient had a stricture at vesicoureteric junction while another patient had ureteric stricture at mid ureter. They were managed by reimplantation of the ureter. We had 94.6% graft survival in first six months, 91.9% after one year and 86.5% survival after 5 years. Conclusion: Pediatric renal transplant poses challenges like graft failure, medication compliance and follow up problems in developing country, but with meticulous follow up and education of parents can result in overall improved results. Impact Introduction and Objective: Even with potent nucleos(t)ide analogue (NA) therapy, rapid viral replication and hepatic disease progression are frequently encountered in Hepatitis B virus (HBV)+ ESRD patients after renal transplantation (KT). However, its real long-term disease nature in HBV+ ESRD patients were still unclear. Objectives behind this study was to evaluate long-term clinical outcome and associated risk factors of HBV+ KT in different period of NA availability and National Health Insurance (NHI) reimbursement, and further, to improve current treatment strategies. We conducted a nationwide retrospective population-based cohort study during 2000-2013 period. The enrolled participants were categorized into two cohorts based on the presence of HBV infection, HBV+ cohort and non-HBV+ cohort. The main primary outcomes were patient survival and graft survival. Secondary outcomes were rate of HBV-related renal and hepatic complications (hepatic decompensation and liver cancer). All data analysis was performed with SAS 9.4 software (SAS Institute Inc.). Results: Of 5819 KT recipients, 4438 patients were recruited, consisting of 416 in HBV-group and 4422 in non-HBV group. The baseline clinic-demographic characteristics were well balanced except higher rate of male participants and younger in HBV group than those in non-HBV group. There was no significant difference in graft survival (p=0.215), but inferior patient survival (p<0.001) in HBV group. During study period, HBV group had a higher incidence of liver cancer (Hazard ratios (HR), 7.80 [95%confidence interval (CI),4.80-12.67], p<0.001), but were not significantly different from non-HBV group regarding the rate of re-dialysis, acute kidney injury and hepatic UP.560, Introduction and Objective: Neoplasia is one of the most serious late complications of kidney transplantation. The neoplastic risk is multiplied by 3 to 5 compared to the general population. Immunosuppressive therapy is the predominant promoting factor. Radiological exploration plays an essential role in the pre-transplant assessment of the tumor-seeking donor and in the long-term follow-up of the graft to detect tumors at an early stage for conservative treatment. This is a retrospective study of a series of 5 kidney transplant patients between 1994 and 2018 in whom a solid tumor was found in follow-up. The sex ratio women/men was 4. The average age was 38.5 years old (range 26-51). The delay between renal transplantation and the positive diagnosis of the tumor was 2.5 years. An abdominal or thoracoabdominopelvic CT scan was performed in all 5 cases. An abdominal ultrasound in 3 cases. Histological confirmation was obtained in all 5 cases. Tumors found in our series were Kaposi's sarcoma in two cases with digestive and cutaneous localization (1 case) and digestive, cutaneous and thoracic localization (1 case). Lymphoma was found in two cases, including large cell lymphoma with bowel and ganglion involvement (1 case) and Hodgkin's disease (1 case). Adenocarcinoma of the graft was found in one case. Each patient had the targeted treatment of his disease. The kidney transplantation is at risk of neoplastic complications due to immunosuppressive therapy. This risk is very often linked to oncogenic viral infections that partly explain the originality of the cancers observed. The most common tumors are: cutaneous tumors, cervical and rectal cancer, renal cell carcinoma, Kaposi's sarcoma and lymphoproliferative syndroms. Radiological exploration is involved in pre-transplantation procedure screening for neoplasia and plays an essential role in long-term follow-up of the graft. Indeed, regular ultrasound monitoring makes it possible to detect these tumors at early stages, for which conservative treatment is possible. We assessed the predictors for ureterovesical leak in a group of recently operated renal transplant recipients. Materials and Methods: 790 recipients who underwent live related renal transplantation at a high volume transplant center in North India during a 6 year time period between January 2012 to May 2018 were retrospectively analysed and studied in a nested case-control design. All donor nephrectomies were done by experienced urologists taking special care to preserve the golden triangle. The recipient surgeries were also done by experienced surgeons and all ureterovesical anastomoses were done using stented extravesical tunneled Lisch-Gregoire technique. Cases with abnormal bladder profile in the recipients were excluded. 12 cases of ureterovesical leak were identified. 48 controls were taken by selecting 2 patients prior and 2 after each case of leak according to their number in the transplant register. Both the groups were comparable in terms of basic demographic parameters. Chi-square test was used for univariate analysis and multivariate analysis was done using binary logistic regression. Results: 12 out of 790 (1.5%) patients presented with ureterovesical leak in the postoperative period requiring intervention. ABO incompatibility, complete HLA mismatch, acute rejection, plasmapheresis and increased age were found to significant factors while plasmapheresis, complete HLA mismatch and increased age were significant in multivariate analysis also with plasmapheresis having the highest Odd's ratio of 33.64 (95% CI from 3.84 -294.36). Factors such as diabetes, ATG induction and second transplant status were not significant. None of the patients required surgical intervention as leak resolved in all these patients by conservative therapy. Conclusion: ABO incompatibility, rejection and antirejection therapy involving plasmapheresis and increased age were found out to be significant factors contributing to ureterovesical leak post renal transplantation. Is There A Place For Prostate-Specific Antigen Screening in Renal Transplant Patients? Wang Z, Yeo J, Vathsala A, Tiong HY National University Hospital, Singapore, Singapore Introduction and Objective: The rising age of renal transplant recipients is accompanied by the increased risk of potential malignancies. Prostate cancer is one of the most common cancer amongst men, however, the role of Prostate-Specific Antigen (PSA) screening has been a topic of much debate in recent times. In the unique population of immunocompromised renal transplant patients, the risks and benefits of prostate cancer screening are even more poorly defined. In our institution, PSA screening was performed within 1 month of transplant if patients were within the at-risk age group, then on an annual basis. 12 core transrectal ultrasound guided biopsies were performed if they had 2 consecutive raised PSA levels. We performed a retrospective evaluation of the prevalence of prostate biopsies and prostate carcinoma occurrence among 421 male renal transplant recipients who had their transplants from 1983 to 2018. The majority of the patients were Chinese, which accounted for 67.5% of the patients. Median age was 40 years old (range 38-72). Sixteen patients had raised PSA levels with a mean of 10.25 ng/mL (range 4.78-20.8) and underwent biopsies. There were no post-biopsy sepsis or related complications. Six were subsequently diagnosed with prostate carcinoma at a mean of 9 years (SD 5.5) post-transplant. All the prostate carcinomas were localised at diagnosis, with Gleason grade group which ranged from 1 to 3. 3 (50.0%) underwent robotic prostatectomy and the remaining 3 (50.0%) had radiotherapy. Good graft and oncological survivals were obtained, with 5-year graft survival and biochemical progression free survival of 100%, and 83.3% respectively. Overall survival was 83.3%. The minimal morbidity rates following diagnosis and treatment for renal transplant recipients with prostate carcinoma suggest that screening may be safely implemented with appropriate precautions. However, the incidence rate of prostate cancer amongst the predominantly Chinese local population is significantly lower at 1.4% compared to the incidence rate of 6.4% in the European Randomized Study of Screening for Prostate Cancer trial. Our data suggests that whilst PSA screening in transplant recipients may be safe, the utility of screening has yet to be proven. Further work evaluating financial and psychological costs should be performed. Patient Introduction and Objective: Until this time the best modality for treatment of end stage renal failure (ESRD) is kidney transplantation, but the most important problem with that is shortage of donor. A deceased donor is the main provider of kidney and a relative and unrelated live donor is secondary provider of kidney for transplantation. But in the deceased donor, compared with the live donor there is not a time for complete evaluation and also almost deceased donor is in a bad condition so it seems that there will be some difference in deceased and live donor outcome. We investigated patient and graft survival in deceased donor in one year after transplantation in our center. From 2003 until 2018 in our center there were 88 ESRD patients between the ages of 12 to 67 years; 33 females 55 males that have been transplanted with deceased donors, donors ( between ages 5-to 60 years; 12 females and 35 males) but we just only approached 85 cases of recipients (43 males and 42 females) and investigated for patient and graft survival: All of the recipients have been treated with induction of ATG and then triple medicines Sandimune or Tacrolimuse and prednisolone and Imuran or Cellcept. And operation has been carried out with one team OF surgery. Results: Eight cases expired in about the first 2 months of operation (8 cases in early times) and 77 patients were live in one year (%90/58) and overall 16 allograft loss in one year, 69 allografts survived in one year (81/17%). In our center one-year graft survival was 81/17% and patient survival was 90/58% which results may be comparable with other centers and it seems that the result can be better than this in our center which we will discuss in this paper. Introduction and Objective: Modern techniques in urology have some complications that may be a disaster, one of them is ureteroscopy which may be complicated by complete avulsion or strictures of ureter. Here we present 4 cases with complete avulsion of ureters which managed successfully after complete evaluation. Materials and Methods: Four cases, three women and one man, between ages of 55-80 years which in all of their ureters had been avulsed completely by urologist during TUL, one of the cases were from our department and three others have been referred by other centers of urology. Auto transplant was done for all of them at more than three days post trauma to the ureter. Results: All of them discharged at least at day 6 post-transplant with good condition without sever complication. Conclusion: It seems that after complete evaluation and preparation patients repairing complete avulsion of ureter may be safe and reasonable. Introduction and Objective: Kidney transplant is an ideal option for treatment of chronic kidney failure and kidney allograft from live donor is better than deceased donor in which overall patient and graft survival is superior, but a big problem with live donor is right kidney in which short renal vein predisposes for thrombosis of vein but in some cases for example size and function (GFR) of kidneys dictate to select right kidney we present a technique of nephrectomy for right kidney which elongates the vein and assist for challenging of short vein. In ten cases of live unrelated kidney donors because of difference in size and GFR of kidney obligatory right side kidneys were selected for nephrectomy during dissecting renal vein and venae cava about 1 cm in caudal and 1 cm in cephalic to renal vein on vena cava skeletonized and Stansky applied to take the vein of vena cava 1 cm above and 1 cm below of vein of renal and with a calf of 5 mm, after removing kidney the kidney was placed in right iliac of kidney recipient without any trim nation of vein and donor 2 days after surgery discharged from hospital and followed after one month and then every 6 months. Introduction and Objective: Erectile dysfunction (ED) is a common sexual problem that many patients find difficult to raise with their doctors. In this study, we seek to evaluate the erectile dysfunction among apparently healthy Nigerian men who had volunteered for routine prostate cancer screening Materials and Methods: Participants who completed the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) were recruited from the community in 3 local government areas of Lagos State. The age, weight, height, body mass index, hip, waist circumference and blood pressure were recorded. They provided blood sample for serum prostate specific antigen (PSA) and had digital rectal examination (DRE). Results: There were 698 Participants in the study. The mean age was 57.6 (range, 35-97) years. The mean (and range) weight, BMI, waist-hip ratio was 73.5 (44.0-125.0) kg, 25.8 (16.9-35.5) kg/m2, 0.96 (0.67-1.66) respectively; 399 (57.2%) were found to have hypertension. Varying degrees of ED were reported by 438 (62.8%) participants. Moderate to severe LUTS were reported by 83 (11.9%) patients. The median IPSS score was 2 (interquartile range of 1.0,-4.0). Median PSA was 1.21 (interquartile range 0.66, 2.48); 595 patients (85.2%) had PSA <4.0, 65 (9.3%) had PSA of 4-10, 21 (3%) had between 10.1-20, and 17 (2.4%) had >20. 28 (4.0%) patients had abnormal DRE findings. ED was significantly associated with age, weight, BMI, W-H ratio, the systolic blood pressure and the IPSS score on univariate analysis. Only age and IPSS score remained as independent predictors of ED on multivariate logistic regression analysis. with tadalafil 5mg daily alone (control group) or associated to LIESWT (experimental group). Inclusion criteria were baseline IIEF-5 18 and a nerve sparing RP (at least one side). The LIESWT was performed using RENOVA device (DIREX) once a week during 8 consecutive weeks (2.400 pulses per session, totalizing 19.200). We've re-assessed the IIEF-5 score at the end of the follow up (12 th week). In addition, stressful events and continent status were evaluated. The complication rate was reported according to Clavien-Dindo classification. For statistical comparisons, the student t-test, Mann-Whitney and x 2 tests were conducted using R software (version 3.4.2). Results: As of October 1, 2018, a total of 64 patients (control = 33; experimental = 31) complete the follow-up. One patient was submitted to radiotherapy following surgery, and five patients lost the follow-up, thus they were excluded from the analysis. The baseline characteristics between groups were similar including IIEF-5 (21.3 Vs. 21.6; p= 0.626) ( Table 1 ). The postoperative IIEF-5 score was higher in the experimental group (12.8 Vs. 9.2; p <0.001) (Table 2, Figure 1 ). UP.571, Table 2 . Outcomes procedure-related UP.571, Figure 1 . Final IIEF-5: control x experimental Introduction and Objective: Priapism is a urological emergency requiring immediate management to prevent erectile dysfunction. The reason to perform this study is to study different hematological conditions causing priapism and to develop an algorithm for management of such patients. All patients with priapism due to hematological conditions presenting to us from 2010-17 were studied. As a protocol medical management was initiated, followed by simultaneous aspiration and wash. If no response was seen at 24 hours, patient was subjected to Al-Ghorab, Grayhack surgeries. Patients with erectile dysfunction were given an option of penile prosthesis. UP.577, Figure 1 . OAB is a symptom syndrome which can substantially impede the quality of life. Women with OAB experience the increased incidence of sexual problems, sometimes with the consequent personal distress and sexual partner compatibility issues. Mirabegron is a b 3 adrenergic agonist that improves the storage capacity of the bladder and recently introduced as an oral treatment for OAB. The trial aimed to evaluate the effect of mirabegron, used for OAB treatment, on female sexual function and distress. Materials and Methods: Seventy sexually active women suffering from OAB enrolled in the study. Females were divided into two groups. In Group A (control group), 35 women received no treatment, and in Group B, 35 patients received mirabegron 50 mg/daily for three months. All women completed a 3-day-bladder diary at the beginning and the end of the three-month trial. The number of incontinence episodes and the number of pads used were evaluated, as well. All women were assessed with the Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) at the beginning and the end of the study. Results: At the end of the three months, there was a statistically significant improvement in most of the domains of FSFI in Group B compared with Group A. At the end of the three months, within Group B, post-treatment mean value (2.2±1.1) in incontinence episodes was significantly lower than pre-treatment (3.7±2.1). Furthermore, within Group B, post-treatment number of used pads (2.3±1.2) was significantly smaller than pre-treatment (3.4±1.4). Introduction and Objective: A 28 years woman in 30.th week of pregnancy referred to emergency room for abdominal and right flank pain from 3 days ago. Patient doesn't have fever or acute abdominal problem. Urine analysis showed microscopic hematuria without any bacteriuria. Abdominal us showed a 14 mm upper rt ureter stone with severe hydronephrosis. Under general anesthesia rt side 4.8 fr dj inserted to rt kidney. Results: Patient discharged 2 day later with good general condition. After normal delivery 8 weeks later, patient comes to removal of rt dj and endoscopic stone removal. Kub showed that dj is in upper part of abdomen and lower thorax. Ct scan showed dj in vana cava and rt atrium of heart. Echocardiography showed upper part of dj with multiple theombosis in rt atrium. Patient had been ready for open surgery and then dj extract with 6 fr ureteroscope without any problem. Conclusion: Dj malposition has occurred in 3% of patients with severe complications. Direct vision and placement without force is essential. Imaging after placement is necessary. Introduction and Objective: With recent advances in endoscopic procedures, refinement of endoscopic tools, and increased experiences in endourology; complex procedures like ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) can be performed as a simultaneous same-session procedure in appropriately-selected patients. We aimed to study the cut-off value or the stone range in which URS and PCNL can be performed on the same session safely in comparison to the staged procedure as a control arm. A retrospective analysis between January 2007 and December 2017 that included patients operated on for unilateral simultaneous ureteral and renal stones by URS and PCNL. All had routine laboratory workup. Ultrasonography and abdominal X-ray (KUB) were done as a routine for all patients, in addition to either multislice non-contrast CT or IVU that were used to measure the stone size and burden. Ureteroscopy and PCNL were performed using standard surgical procedures. The primary outcomes were the immediate stone-free rate and total hospital costs. The second outcomes were the operative and anesthesia times, the complication rate, and hospital stay. The data was collected using SPSS 21 ®. Out of 193 patients, 180 were found to have complete files eligible for review. The mean age of the study group was 50+14years, 140 (77%) were male, 79 (50%) were right-sided and 14 (7%) had solitary kidneys. Ninety-five patients had same-session URS and PCNL, as compared to a matched control group (85 patients) who had staged sessions. Same-stage procedure was the appropriate choice for those who couldn't tolerate multiple anesthetic settings like elderly patients and patients with ASA III. Also, this group had a shorter operative time and hospital stay. The same-stage approach helped patients to recover quickly and to return work earlier. It had a similar stone-free rate similar to the staged group. However, surgeons preferred to operate on staghorn as big stones required multiple punctures in a staged-approach. Late complications included three cases of ureteral stricture, two in the staged and one in the same-session group, with new significant backpressure by imaging. Two cases, one in each arm required endoureterotomy. Conclusion: Same session URS and PCNL (in prone position) can be performed as a same-session procedure in appropriately-selected patients. It can be done with equal results to the staged procedure in renal stones with a median of 18mm (range, 10-30mm) in presence of 7mm or less ureteral stones. Introduction and Objective: To compare the safety and efficacy of opioid sparing analgesia as xylocaine gel and ketorolac compared to pethidine for SWL pain. A single-blinded randomized controlled trial (RCT) for 132 patients with renal and upper ureteral stones amenable for SWL. The 1 st patient group received pethidine 25 mg IV bolus injection before session, placebo gel and pethidine 25 IV infusion during session, the 2 nd received ketorolac 30 mg IV bolus injection plus placebo gel then 30 mg IV infusion; the 3 rd group received lidocaine 2% gel locally plus 10 mg normal saline IV bolus then IV normal saline infusion. Disintegration were classified to no (no change from basal by KUB or US), partial (fragmented and >4 mm residual) and complete (4 mm residual). Stone disintegration was assessed by kidney, ureter, and bladder (KUB) x-ray and Ultrasound scan (US). The pain was evaluated using Numeric Pain Rating Scale (NPRS). Introduction and Objective: Extracorporeal shockwave lithotripsy (ESWL) is an outpatient treatment for patients with renal calculi. Standard of care involves offering oral analgesia prior to commencing the treatment. It has been suggested that distraction techniques may be equivalent to oral analgesia in improving tolerability of ESWL treatment. Questions have been raised about the efficacy of oral analgesia administered directly before ESWL. We aimed to assess if distraction techniques improve comfort and tolerability of treatment for patients undergoing ESWL. We carried out a prospective randomised control trial of all patients undergoing ESWL for the first time. Patients were randomised into three groups. All patients were offered oral analgesia, as part of the standard of care in our depart- There is a 50% recurrence rate within 7 years. British Association of Urological Surgeons (BAUS) have provided guidelines for management and follow up for ureteric calculi. We present our experience of managing and follow up of patients presenting to a multi-centre district general hospital in the United Kingdom. Data was retrospectively collected from March 2017 to February 2018. Electronic medical records, patient medical notes, and radiology software were used to collect data. Data collected included surgical intervention, medical management and follow up. Results were compared with the BAUS ureteric colic guidelines. Results: A total of 228 patients presented with ureteric colic in 12 months. 68 patients had an acute intervention with 50 patients undergoing ureteric stent insertion, 6 patients were nephrostomised and 12 patients had primary ureteroscopy (URS). 5 patients who had ureteric stent insertion had further URS within 4 weeks. 160 of the total cohort were initially treated expectantly with only 42 patients seen in the stone clinic within 4 weeks. The readmission rate prior to clinic or intervention was 11%. Conclusion: Our study shows that only 30% of patients with symptomatic ureteric colic had an acute intervention as per the BAUS guidelines. Primary intervention was restricted mainly due to limited availability of emergency theatres. It is postulated that prompt access to emergency theatres and/or dedicated acute theatre slots will encourage clinicians to offer more primary ureteroscopies. A robust system of following up patients in clinic e.g. a dedicated clinic slot or establishing urgent stone clinics will ensure timely follow up. Limited availability of resources remains a challenge in achieving these goals. We evaluated the feasibility of a non-opioid discharge protocol compared to standard opioid medications for postoperative pain following URS and stent placement over an 8 months period. Charts review of patients who underwent URS with stent placement was done over an 8-month period from February 2018 to October 2018 were retrospectively reviewed. Patients were discharged on paracetamol or diclofenac (NSAID) or tramadol (opioid) in groups 1, 2 and 3 respectively. Postoperative pain intensity was measured by nurse in the recovery room and at 0,6, 12, 24, 48, and 72 hours using the Verbal Intensity Pain Scale (VIPS). A mean pain score of less than 2 for each category of surgical procedures or analgesics group was defined as satisfactory pain control. Anova t test was applied to see for statistically significant difference in mean pain scores between these groups. Total of 120 patients underwent URS with double j stent placement: With 40 patients in each group. Eighty patients (of group 1 and 2) were not given opioids and were then discharged on opioid 307 free pain killer. The mean pain score was > 2 at 6 h postoperative in all three groups. However, pain was satisfactorily controlled in 90%, 92.5% and 90% in the respective groups 1, 2 and 3 (p= 0.09). Of those discharged without an opioid, 60 received paracetamol and 20 received diclofenac as pain killer. It was noted that the different analgesics prescribed for postoperative pain management provided satisfactory pain control based on mean pain score obtained at different intervals during 3 days after the surgery. There was no difference in the percentage of patients who had postoperative visits to the ER for genitourinary-related concerns (3/40 patients receiving opioids and 7/80 patients without opioids; p= 0.89). In case of TUL for ureteral impacted stones, surgical difficulty is higher due to the inability to insert a guide wire easily and poor visualization by ureteral mucosal edema, compared to non-impacted stones. In addition, we have to take care of intraoperative complications especially ureteral injury. In this study, we investigated the predictive factor for ureteral impacted stones. In 117 patients who underwent TUL for ureteral stones in our hospital, we divided them into impacted stone group (Group A: 28 cases) and a non-impacted stone group (Group B: 89 cases). We defined the stones that could not insert a guide wire or whose ureteral mucosal edema was remarkable by endoscopic findings as ureteral impacted stones. We investigated the factors included age, sex, body mass index (BMI), stone location (proximal or middle, distal) hydronephrosis above grade 3, stone volume, Hounsfield units of stone, ureteral wall thickness, operating time, stone free rate, and intraoperative complications. The ureteral wall thickness at the stone site was evaluated on computed tomography. Statistical analysis was performed using t test and logistic regression analysis, and p <0.05 was regarded as significant difference. Table 2 . Perioperative data according to participation in pre-assistance course and the performed procedures Introduction and Objective: To assess the learning curve of Thulium:Yttrium aluminium garnet (Tm:YAG) assisted prostatectomy techniques in the management of benign prostatic obstruction (BPO) based on the opinion of the surgeons. A survey questioning previous surgical background information and Tm:YAG experience was distributed to Urology Departments in Germany employing the Revolix TM 120W surgical laser (LISA laser products, Katlenburg, Germany) for laser prostatectomy. Results: A total of 65 questionnaires were distributed to respective urological surgeons. 38% of them responded. All participants were familiar with Transurethral Resection of the Prostate (TURP) while 48% of them had previous knowledge of other kinds of laser prostatectomy before initiating the Tm:YAG experience. Yet only 5% of them considered previous experience with other types of laser prostatectomies necessary to safely embark on Thulium surgery. Ninety-six percent of surgeons had technical training by the company and 80% received training in congresses and workshops. Only 36% of them had mentor assistance in the first procedures. According to the self-assessment of competence by the surgeons, a mean number of 24 cases were necessary to reach a plateau in performance. Still, according to 12% of responding surgeons more than 50 procedures might be considered necessary to reach surgical expertise. Furthermore, 92% of survey responders considered their experience with Tm-YAG laser prostatectomy as positive and recommendable. Conclusion: Thulium (Tm:YAG) prostatectomy has an acceptable learning curve with a mean of 24 procedures required to achieve surgical confidence. Laser-naive urologists can learn how to perform a Tm:YAG-assisted prostatectomy even without proctoring. Technical training by the Tm:YAG laser manufacturing company seemed to be of great value for learning the operative techniques. Self-assessment by surgeons provides valuable insight into the learning curve of the procedure. Further evaluation investigating the clinical outcomes is deemed necessary to determine more accurately the learning curve of this laser technique. UP.641, Figure 2 . Correlation of % correct estimation of illusions to GRS Introduction and Objective: We conducted a retrospective evaluation of the extended ureteral recon-Introduction and Objective: The aim of this prospective, single-cohort study was to confirm 36-month effectiveness of the Virtue quadratic male sling in postprostatectomy incontinence and gather post-marketing safety data from 14 urological departments. Between August 2012 and February 2015, a total of 117 patients without predominant overactive bladder, previous incontinence surgery, urethral stricture, or radiation history were implanted. Primary objective endpoint was defined as >50% decrease in 24 h Pad Weight Test. Patient-reported improvement using the PGI-I and satisfaction index defined the subjective success. The ICIQ-SF was completed. Qmax, PVR and complications were reported. Subgroups were analyzed by baseline severity incontinence on 24hPWT, pads usage and BMI. Results: At baseline mean and median urinary loss were 227 g ± 292 (5-1471 g) and 113 g (54-296 g) respectively. At 36 months, objective and subjective successes were achieved in 72% and 69% (29% very much; 40% much; 21% a little better) respectively. Satisfaction was achieved in 69% of patients. Mean and median urinary leakage in 24h PWT were 72 g ± 158 Severity number of pads 1 or 2 vs 3 or 4 0.505 1 or 2 vs 5 or more 0.637 64%, managed by urethroplasty (3pt), repeated DVIU (2pt), suprapubic catheter (SPT) Chronic obstructive pulmonary disease; HBV: hepatitis B virus; KT: Kidney transplantation; NTD: New Taiwan dollar @Plus-minus are mean±SD. Because of rounding, percentages may not sum to 100 Priapism in Hematological Disorders-A Prospective Observational Study of 47 Cases Patil B Ketorolac and Lidocaine Gel as Analgesics for Pain Control in Shockwave Lithotripsy (SWL): A Single Blinded Randomized Controlled Trial (RCT) Atwa AM 1 , Hashem A 1 , Kamal F 1 , A. Elbaset M 1 , Fadallah M 1 , Laymon M 1 , Badawy M 1 , Elshabrawy M 1 , Tharwat M 1 , Elsaeed E 1 4%) for pethidine; 19 (35.8%) ABSTRACT BOOK operating time A) pre-and (B) post-intervention. Prescription and administration of anti-emetics recorded. Education of doctors and nurses; reminders at electronic prescribing Wagner L 3 , Ferro M 4 , Shabbir M 5 United Kingdom; 6 Puerta del Mar University Hospital Conclusion: LL can be done in almost all patients irrespective of age/gender/number of calculi. It has minimal morbidity/fast recovery and can be combined with prostate surgery. Open surgery is an alternative with risk of wound infection and longer hospital stay. We believe LL is the golden wand in the surgeons' hand for vesical stone management. Since there are other options, we propose the algorithm in figure 1. Conclusion: From this cohort, the overall anxiety burden during a flexible cystoscopy remains low, however patients with pre-existing mental health conditions, those with a gender preference for their urologist (male or female) and those aged between 40-70 are likely to have higher anxiety levels. Interestingly, the cohort data also reflects that conventional socio-economic determinants including patient gender as well as indication and frequency of cystoscopy surveillance do not significantly affect pre and post procedure anxiety scores. Introduction and Objective: Hypogonadism was added to the 2018 AUA Guidelines with 31 Statements, none of which mentioned kidney function. In an ongoing registry study in a single urology practice, we monitored treated and untreated hypogonadal men and continuously calculated GFR. We report data from 776 men with symptomatic hypogonadism participating in our registry study started in 2004. 400 men received testosterone undecanoate (TU) injections 1000 mg/12 weeks following an initial 6-week interval (T-group), 376 opted against TTh serving as controls (CTRL) . Longitudinal changes of GFR and T-levels were compared between the two groups. Mixed effect model with a random intercept and fixed effects including testosterone, time, age at entry, baseline BMI, waist circumference, blood pressure, fasting glucose, lipids and quality of life was fit to the data among controls only to investigate the natural association between GFR and T-levels. GFR was calculated using the Modification of Diet in Renal Disease (MDRD) formula.Results: Mean follow-up: 84 months. Age at study entry was 57.7±7.4 years in T-group and 63.9±4.7 years in CTRL. Testosterone levels at baseline were 9.7 nmol/L in both groups (p=0.841). Systolic blood pressure decreased from 152±17 to 131±5 mmHg (T-group) and increased from 142±14 to 148±15 mmHg (CTRL) . As compared to the control group, which experienced a more rapid decline in both T-levels and GFR, those measurements in the T-group remained relatively stable over time. The mixed-effect model showed that for one nmol/L increase in serum T-levels, the GFR increases by 0.308 ml/min/1.73 m2 (p=0.005), after adjusting for confounders. During observation, there were 16 deaths (3.9%) in the T-group. In CTRL, there were 74 deaths (18.8%), 70 MIs (17.8%) and 59 strokes (15%).Conclusion: Long-term testosterone therapy in hypogonadal men may stabilize GFR despite advancing age. In an untreated control group, GFR deteriorated. An Audit of Hospital Admissions for Haematuria Secondary to Pelvic Radiotherapy He Y 1 , Guo C 1 , Kam J 1 , 2 , 3 , Yiu T 1 , Gordon L 1 , Al-Sameraaii A 1 , Chan HF 1 , Hart K 1 , Kahloon M 1 , Haxhimolla H 1 , 4 A Novel Urinary Catheter for Use in Haematuria Kesavan A National University Health System, Singapore, Singapore Introduction and Objective: A common problem is a patient on a standard Foley catheter who develops gross haematuria and clot retention. A manual bladder washout using a syringe and sterile water often cannot be performed satisfactorily through this existing foley catheter as the excessive negative pressure applied to evacuate clots often results in catheter wall collapse. We have designed a new rubber catheter with a unique balloon insufflation channel that runs in a spiral along the surface of the catheter. It is soft and atraumatic for easy insertion but when its balloon is insufflated the catheter walls become turgid allowing increased negative pressure before collapse.Materials and Methods: Initial prototypes were made in 70-80 Fr sizes for proof of concept testing. The final prototype was 3D printed to a 20 Fr size using a rubber polymer. 8 catheter prototypes were subjected to suction pressure using a 150-cc nozzle syringe. Catheter tips were occluded (simulating blockage from a clot) and increasing negative pressure via suction from the syringe was applied. At the point of wall collapse, the volume of air within the syringe was recorded and this was then repeated again, with the balloon channel insufflated. We utilised Van der Waals equation to calculate the pressure that led to the wall collapse in mbar.Results: 8 different catheter prototypes were tested, and the collapse pressures recorded (see table 1 ). In our final prototype, with the balloon channel insufflated, the catheter was able to withstand more than double the negative pressure before collapse.Conclusion : We have shown that a catheter with its balloon port channels running in a spiral through its walls can increase its rigidity and defer the point of collapse when suctioning and negative pressure is applied. This would be specifically useful in the context of evacuating blood clots causing catheter obstruction. Limitations or Advantages? The Differences of Female and Male Urologists' Career in Taiwan Li SW, Cheng WM, Hsueh T, Hu HY Introduction and Objective: Urology is the field concerning the abnormalities of genital areas of human bodies, especially male patients. It is believed that female urologists have more limitations in career development because embarrassment of male patients and childbearing. In the present study, we try the reveal the differences of practice pattern of male and female urologist in Taiwan. Health Insurance Dataset (2000LHID) is one of the datasets of the National Health Insurance Research Database in Taiwan, including all the medical insurance information from one million randomly-selected residents in Taiwan. The claim data including the yearly inpatient and outpatient service volumes, total and major surgical volumes, revenues, and sex ratio of patients of each female and male attending urologists with practice more than five years between 1995 to 2013 were recruited. Student's t-test was used to compare the differences of these factors between female and male attending urologists. P <0.05 was viewed as statistically significant.Results: One-hundred-and-eighty male (93.2%) and 13 female (6.8%) urologists were included. Their differences of their service and revenue were shown in Table 1 . Female urologists had significantly more female patients than male urologists. Although they had similar volumes of outpatient service, the yearly revenue attributed to female urologists was significantly less. On the other hand, there is no differences when it comes to inpatient service or yearly surgical volumes.Conclusion: Female patients are prone to visit a female urologist in Taiwan. There are minor limitations of female urologists in outpatient services, representing as less yearly outpatient revenue, but not in inpatient care and surgery. Efforts should be done to improve the gender inequality in the field of urology. Noviandrini E 1 , Budi Santoso R 2 , Usfie Harahap E 2 1 Universitas Indonesia, Jakarta, Indonesia; Cipto Mangunkusumo Hospital Jakarta, Jakarta, Indonesia; 2 Dharmais National Cancer Hospital, Jakarta, Indonesia Introduction and Objective: The dilemma regarding percutaneous nephrostomy is about patient quality of life (QOL) and advantages of this procedure in improving kidney function in patient with uropathy obstructive due to malignancy. This study was made to evaluate patient QOL who underwent percutaneous nephrostomy as the treatment for ureteral obstruction in malignancy case in Dharmais National Cancer Hospital Jakarta, as the main referral cancer hospital in Indonesia. We selected 33 patients who underwent percutaneous nephrostomy during January 2019 -March 2019. Patient quality of life was then evaluated by using Quality of Life-C30 (EORTC QLQ-C30) questionnaire before and 1 month after nephrostomy procedure. Variables described in this study includes gender, age, quality of life, hemodialysis after nephrostomy, and complication after procedures.Results: From 33 patients, we evaluated 24 female patients (72.7%) and 9 male patients (27.3%), aged between 29-62 years old (mean 51.39±86). Most of the malignancies found were gynecology, 22 case (66.6%), following by urinary tract malignancies, 8 case (24.3%) and 3 digestive case (9.1%). Quality of Life (QOL) scoring in patients with digestive cancer before nephrostomy was 87-103 points, 74-100 points for gynecology cancer, and 75-100 points for urinary tract (bladder) cancer. In one month's follow up, Quality of life score in patients were improved in digestive, gynecology, and urinary tract malignancies (87-101, 73-104, 70-90) respectively. About 18 patients underwent hemodialysis around 1-3 times a week before nephrostomy. After nephrostomy, 23 patients (69.7%) showed improvement in kidney function, proven by reduced frequency of hemodialysis after nephrostomy procedure. nephrostomy insertion were dislodged and reinsertion (4 case, 12.1%). About 3 patients (9.1%) came to repair the fixation. Two patients (6%) died before 1 month's follow-up due to sepsis and coagulopathy problems.Conclusion: Nephrostomy might be chosen as the treatment for uropathy obstructive due to malignancy. Despite the change in patient quality of life was insignificant, it does show improvement in patient kidney function. Anticoagulants (AC) and Antiplatelets (AP) Use by Patients Undergoing Urological ProceduresFrangiadis E 1 , Papaioannou C 1 , Moulavasilis N 1 , Tsela S 1 , Stratigopoulou P 2 , Constantinidis C 1 , Mitropoulos D 1 219 developed in 10 patients during the follow-up duration. The results of our study suggest that the AMS 700 LGX IPP could be used to preserve the penile length in patients undergoing IPP implantation. Furthermore, erectile function and patient satisfaction were improved excellently. Predictive Factors to Determine Treatment Course of Patients with First-Time PriapismPalka J, DuComb W, Begun E, Soto-Aviles O Introduction and Objective: Most clinical guidelines advocate management of ischemic with intracavernosal injection therapy (IIT) of sympathomimetic agents, with or without aspiration and irrigation. Subsequent therapy includes corporoglandular shunting (CS) for refractory cases of first line therapy procedures. We sought to establish predictive factors of patients who present with first-time ischemic priapism episodes who fail IIT and ultimately require CS. A retrospective review was done of all patients over the age of 18 who presented with first episode ischemic priapism over the past ten years to our institution. Variables assessed are included in Table 1 . A receiver operating characteristic (ROC) curve was performed to determine the duration of erection at which proceeding to CS directly would be optimal (Table 2) .Results: 147 patients met inclusion criteria of which 24 patients underwent CS. There was no difference between shunted patients and non-shunted patients with regards to age or etiology. Patients who underwent CS required more phenylephrine, were more likely to undergo penile irrigation, and were more likely to follow up with Urology post-procedure. ROC curve analysis revealed an area under of the curve of 0.9 with an optimum cut-off point of erection duration of 15.5 hours with 87.5% sensitivity and 86.1% specificity. Our study suggests that patients who present with erections lasting greater than 15.5 hours may be spared the morbidity of corporal aspiration and irrigation, and may benefit by proceeding directly to CS. Urethral Rupture Secondary to Corpora Cavernosa Fracture: About 6 Cases Introduction and Objective: According to EAU Guidelines, long-term androgen deprivation therapy (ADT) on primary external beam radiation therapy for localised high-risk prostate cancer is recommended, however, further stratified optimum strategy is not still fully defined. To inductively evaluate this aspect, we analysed 10-year oncologic outcomes of intensity-modulated radiation therapy (IMRT) for high-risk prostate cancer. A total of 1,327 Japanese prostate cancer patients underwent IMRT (76 Gy) between 2007 and 2014 for the first-line treatment in our single institution. Of them, 719 (54.2%) cases were categorized as high-risk group of 2017 EAU classification, which comprised the current study cohort. Definition of recurrence is based on Phoenix criteria or initiation of the second-line treatments.Results: Median age and PSA were 72 (range: 42-87) years old and 14.8 (3.1-481.3) ng/mL, respectively. Median follow-up period was 75 (2-143) months. A total of 502 (69.8%) cases received median 9 monthlong (range: 1-163) ADT. Remaining 217 patients (30.2%) were not administered any of ADT (No ADT). Biochemical recurrence (BCR) was occurred in 109 (15.2%) cases and cancer-specific death was observed in 6 (0.8%) patients. Five-and 10-year BCRfree rates were 86.3% and 76.7%, respectively. Patients with No ADT were significantly younger than ADT patients (average 70.3 vs 72.6 years old) and had lower PSA (11.6 vs 35.8 ng/mL), Gleason score (GS) (average 7.5 vs 7.9) and % of cT3 stage (30.0% vs 58.8%) (all: p <0.0001). Among clinical factors available prior to the treatment, a sole significant predictive factor of BCR in No ADT group was PSA >10 (Hazard Ratio 3.05, p=0.0003). Indeed, 5-and 10-year BCRfree rates of No ADT patients with PSA 10 (n=129) were 90.2% and 77.3%, respectively, and statistically significant survival was obtained when compared to No ADT patients with PSA >10 (n= 88, p= 0.0001, Log-rank test). We have achieved long-term adequate efficacy by IMRT without ADT in a subset of patients with localised high-risk cancers. We inductively identified significant favorable factor was PSA 10. Highrisk patients with PSA 10 may be little benefit with adjuvant ADT. Further cautious validation should be required to confirm our findings. We prospectively monitored 86 out bore prostate cancer focal laser areas ablation and the surrounding tissues with four K-type house made thermocouples placed 1 cm long apart circumferentially of the treated area. The mean area volume was 0.59 cm 3 (0.50 -1.8 cm 3 ). All areas were treated with 980 nm diode laser end fire fiber with a modified low energy setting (5 watts for 75s). 45 o C was set as the lowest efficient cutoff temperature while 60 o C was set as the upper temperature treatment limit. All the 4 max measurements values were recorded during area treatment. Results: We calculated with in vivo and ex vivo studies that an elliptical necrotic tissue area of a 0.5 mm of diameter is formed with the above applied energy settings (5w x 75 s). Positive biopsies were found in 7 patients out of 54 (12.9%) which corresponds to 13 treated areas out of 86 (15.11%) at 3 months follow up. 5 of those patients had a pretreatment Gleason score of 7 (3+4) while the remained 2 had a GS of 6 (3+3). The latter two had larger cancerous areas than the previous five ones. In all of the recurred areas the mean temperature value recorded was 47 o C( 45 o C-50 o C ).As regard to the successfully treated cancerous areas (n= 73,84,89%) the mean temperature value recorded was 54 o C (52 o C-60 o C) and the GS was 6 (3+3) for the 50 of them and 7 (3+4) in the remaining 23.Conclusion: Low diode laser energy settings is safe and at the same time equally effective for the majority of patients treated but temperatures under 50 o C seems to be inadequate especially when treating intermediate ISUP 2 localised prostate cancers. Further correlations need to be done in order to precisely identify the parameters who play a crucial role in treatment failure. De Ritis Ratio (AST/ALT) a Significant Prognostic Factor in Patients with Localized Prostate Cancer Following Robot-Assisted Laparoscopic Radical ProstatectomyMitsui Y, Yamabe F, Hori S, Aoki K, Kobayashi H, Nagao K, Nakajima K Introduction and Objective: De Ritis proposed the ratio of aspartate transaminase (AST) to alanine transaminase (ALT) as a characteristic to determine acute viral hepatitis in the 1950s. Interestingly, recent studies have shown that the De Ritis ratio can also reflect tumor aggressiveness and predict worse pathological outcomes for many types of cancer, including urological malignancy. We investigated the significance of the De Ritis ratio for predicting pathological outcomes and prognosis in patients with localized prostate cancer who underwent a robot-assisted laparoscopic radical prostatectomy (RALP) procedure. Clinicopathological data for 181 patients with localized prostate cancer who underwent surgery between October 2013 and May 2017 were retrospectively evaluated. Blood samples were collected 1-14 days before RALP and examined, including AST and ALT measurements. Based on previous studies, elevated AST and ALT values were defined as greater than 40 and 56 IU/L, respectively.Results: The median De Ritis ratio was 1.250 (0.614-3.750), and all patients were classified into 2 groups based on the previously reported cutoff value of 1.325. An elevated De Ritis ratio was significantly related to higher pathological stage (p=0.0302) and Gleason score (p=0.0303), as well as high biochemical recurrence (BCR) after RALP (p=0.0072). In addition, multivariate backward stepwise Cox regression analysis revealed that De Ritis ratio and Gleason score were independent predictors for BCR. Further stratification with Gleason score in addition to De Ritis ratio identified a stepwise reduction of BCR-free probability.Conclusion: This is the first report to show that the De Ritis ratio can be used to predict prognosis of localized prostate cancer patients after undergoing RALP. Impact Clinical efforts to verify its accuracy for risk stratification of prostate cancer (PCa) in Japanese men, who have differences in age of onset, biological aggressiveness, and tumor size in PCa than men in Western countries, have recently started. Therefore, the aim of the study was to evaluate the cancer detection rate of PI-RADS v2 in Japanese men with elevated PSA levels using MRI-US fusion-guided biopsy. This study included 63 men with primary or prior negative biopsies with elevated PSA levels (median age, 70 years; median PSA, 6.87 ng/mL) who underwent MRI-ultrasound fusion-targeted biopsy (Trinity®; Koelis, France) after 3T multiparametric prostate MRI examination (mpMRI). Single radiologist (TT) evaluated mpMRI using PI-RADS v2 by consensus. Targeted biopsy was performed for lesions with PI-RADS categories of 2 to 5. After targeted biopsy, concurrent standard systematic 12-core systematic prostate biopsy was performed in all patients. All lesions were rated according to PI-RADS v2 and lesions with PI-RADS v2 category 2 or greater were biopsied. Gleason 3 + 4 or greater was defined as clinically significant PCa.Results: A total of 100 lesions with a mean of 1.6 suspicious lesions per patient were detected by mpMRI were classified as PI-RADS category 2 in 15 lesions, category 3 in 32 lesions, category 4 in 43 lesions, and category 5 in 10 lesions. A median of 2.9 target biopsy cores per suspicious lesion were taken.The overall cancer detection rate of PI-RADS v2 categories 2, 3, 4 and 5 was 7%, 28%, 65% and 100% for all PCa, and 0%, 13%, 49% and 80% for all clinically significant PCa, respectively. The PI-RADSv2 categories were significantly associated with the presence of PCa and clinically significant PCa (each p <0.05). Negative or clinically insignificant PCa in the target biopsy but clinically significant PCa in the systemic biopsy was observed in 8 of 33 cases (24%).Conclusion: PI-RADS v2 is significantly associated with the presence of clinically significant PCa in Japanese men with elevated PSA levels. However, when performing targeted biopsy, the combination with systematic biopsy still provides the highest detection of clinically significant PCa. Adult Male Anogenital Distance -Comparability and Reproducibility of Two Different Methods 'Reina Sofia' University General Hospital, Murcia, Spain, Introduction and Objective: The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. The use of anogenital distance in human studies is still very limited and the quality and consistency of measurements is an important methodological issue. The aim of this study was to assess the feasibility and reproducibility of adult male anogenital distance measurements by two different methods.Materials and Methods: All men were attending an outpatient clinic at a university hospital and underwent an andrological examination and completed a brief questionnaire. Two variants of anogenital distance [from the anus to the posterior base of the scrotum (AGD AS ) and to the cephalad insertion of the penis (AGD AP )] by two methods (lithotomy or froglegged position) were assessed in 70 men. Within and between coefficient of variations, intra-class correlation coefficients, two-way repeated-measures analysis of variance, and scatter and Bland-Altman plots were calculated. The two methods produced similar values for AGD AP but different estimates for AGD AS . Nonetheless, the overall agreement (ICC 0.80) was acceptable for both measures.Conclusion: Therefore, both methods are internally consistent and adequate for epidemiological studies and may be used depending on the available medical resources, clinical setting, and populations. Association Between Prostate Cancer and Anogenital Distance, a Biomarker of Prenatal Androgen Milieu 'Reina Sofia' University General Hospital, Murcia, Spain, Introduction and Objective: The distance from the genitals to the anus, anogenital distance, reflects androgen concentration during prenatal development in mammals. To evaluate the association between anogenital distance (AGD), as a biomarker of prenatal androgen milieu, and risk of prostate cancer (PCa). A case-control study was conducted on 260 men attending a university hospital where underwent a physical and andrological examination and completed a brief questionnaire. PCa patients were confirmed by biopsy of the tumor. Controls were men without PCa attending the urology outpatient clinic for routine examinations. Two variants of AGD [from the anus to the posterior base of the scrotum (AGD AS ) and to the cephalad insertion of the penis (AGD AP )] were measured. Unconditional multiple logistic regression was used to estimate the association between AGD measurements and presence of PCa, and Odds Ratios and 95% confidence intervals (CI) were calculated.Results: Cases showed significantly shorter AGD AP and AGD AS than controls. Subjects with AGD AP and AGD AS in the lowest compared to the upper tertile were 2.6-times (95% CI 1.2-5.6) and 3.2-times (95% CI 1.5-6.9) more likely to have PCa, respectively. We found that shorter measurements of both distances (AGD AS and AGD AP ) were associated with higher risk of PCa. A previous study reported similar results, showing that longer AGD AP was associated with lower risk of PCa, but this relationship was not found for AGD AS , as it was in our study with a larger sample size. Accuracy of Anogenital Distance as a Prostate Cancer Diagnosis Tool 'Reina Sofia ' University General Hospital, Murcia, Spain Introduction and Objective: The distance from the genitals to the anus [anogenital distance (AGD)] reflects androgen concentration during prenatal development in mammals. There is only one study suggesting the relationship between AGD and risk of prostate cancer (CaP) . The goal of this study was to assess the performance and clinical utility of AGD, as a biomarker of prenatal androgen milieu, and risk of CaP in a larger population, in CaP diagnosis. A case-control study was conducted on 260 men attending a hospital outpatient clinic where underwent a physical and andrological examination and completed a brief questionnaire. CaP patients were confirmed by biopsy of the tumor. Controls were men without CaP attending the urology outpatient clinic for routine examinations. Two variants of AGD [from the anus to the posterior base of the scrotum (AGD AS ) and to the cephalad insertion of the penis (AGD AP )] were measured. Parametric and non-parametric tests andreceiver operating characteristic (COR) analyses were used to determine relationships between AGD and presence of CaP.Results: The highest area under curve (0.69; 95% CI 0.60 to 0.78 and 0.69; 95% CI 0.61 to 0.77) was obtained for the Gleason= 7 subgroup with the AGD AS and AGD AP measurement, with a sensitivity and specificity of 83% and 55%, and 91% and 41%, the predictive positive value of 39% and 35% and negative value of 90% and 93% respectively. 259 structures, e.g. sphincter and neurovascular bundles, are spared avoiding thermal damage. Immediately after TULSA, treatment effects are confirmed by contrast-medium enhanced MRI. Treatment was done in general anesthesia in the MRI. A suprapubic catheter was placed. Patients were hospitalized for one night. A database was kept prospectively for all patients. All patients had mpMRI and PSA before treatment, and at 3-and 12-months follow-up. Complications and functional results were achieved by interviews, IPSS and IIEF questionnaires. To date, 38 patients completed 1-year follow-up.Results: All procedures were completed, no complications occurred intraoperatively. In the early postoperative phase, n=5 pts had symptomatic UTIs, n=2 unilateral epididymitis, which resolved with antibiotic therapy. All patients achieved spontaneous voiding within 2 weeks, no secondary retention occurred after catheter removal. No incontinence or de-novo erectile dysfunction was reported. All patients maintained ejaculatory function, n=9 reported a decrease of ejaculate volume. PSA decreased from 8.61 ng/ml preoperatively to 2.01 at 3 months and 1.99 ng/ml at 12 months. At 12 months, in all patients no residual necrotic tissue and no residual cancer lesions were detected in mpMRI.Conclusion: Focal treatment of low and intermediate risk prostate cancer using MRI-guided and monitored transurethral thermal ultrasound ablation is feasible and safe. There is a fair chance to maintain continence, erectile function, and ejaculatory function. Short term oncological control was achieved. Longer follow-up in a larger number of patients and randomized controlled studies are required to evaluate oncological control. Tumor Salvage therapies can defer the use of subsequent systemic therapies, which tend to be non-curative with significant side-effects. The results of a large single-centre cohort of salvage cryotherapy (sCryo) patients is presented here with median 12 years follow-up. Patients treated with salvage cryotherapy from 1995 to 2004 were included. Patients had histological confirmation of local recurrence with a transrectal ultrasound guided biopsy. Metastatic screen with CT and radionucleotide bone scan were negative. Pre-salvage data was collected to predict oncological outcomes. Kaplan-Meier analysis was performed to assess overall survival (OS), prostate cancer specific survival (PCSS), metastases free survival (MFS), development of castrate resistant prostate cancer (CRPC) and biochemical diseas-free survival (BDFS) according to the Phoenix definition. Cox-regression was used to assess predictive factors for OS, PCSS, CRPC and MFS.Results: A total of 187 patients with completed data were treated with sCryo. Median follow-up was 149 months. Median age before salvage was 71 years (interquartile range [IQR] 66-74), median PSA pre-salvage 11 ng/mL . Twelve-year OS was 56% (CI 49-64). Pre-salvage age and PSA nadir post-salvage predicted overall mortality. Twelve-year PCSS was 81% . Pre-radiation Gleason score 8-10 and stage (T3a -T4), pre-salvage PSA and PSA-nadir post-salvage cryotherapy predicted PCSS in multivariable analysis. Twelve-year freedom from CRPC was 80%, . Multivariable analysis showed primary stage and PSA-nadir post-salvage treatment to be significant predictors of CRPC.Twelve-year MFS was 78% (CI 71-85). T3a-T4 and PSA-nadir post-salvage cryotherapy predicted metastases in multivariable analysis. Median time to biochemical recurrence was 58 months (CI 44 -79); with median time to ADT 101 months (CI -65 -NA). Ninety-one patients (48.7%) were ADT free at end of follow up.Conclusion: Salvage cryotherapy for localized radiorecurrent prostate cancer can provide durable response, with PCSS and MFS of approximately 80% at 12 years. OS, PCSS, CRPC and MFS are affected by a combination of primary T-stage, pre-radiation Gleason score, pre-salvage PSA and PSA-nadir post-salvage. Salvage treatment can achieve ADT free status in selected patients and delay in those who subsequently developed systemic disease. Pathological Significance of Large Tumor Suppressor-2 Expression in Prostate Cancer Nakamura Y, Miyata Y, Araki K, Matsuo T, Ohba K, Furusato B, Fukuoka J, Sakai H Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan Introduction and Objective: Hippo pathway plays important roles for tumour growth and progression in various cancers. Yes Associated Protein (YAP) is most well-known in Hippo pathway and reported to stimulate cell proliferator, invasion and metastasis in cancers including prostate cancer. Large Tumor Suppressor (LATS)-1/2 are most important inhibitors of YAP activation, but pathological significance of LATS-2 in prostate cancer is not fully understood. We analyzed 2 prostate cancer cell lines (LNCaP and PC3) and 63 prostate cancer tissues without neo-adjuvant therapy. In addition, 25 specimens of castration-resistant prostate cancer (CRPC) were also examined. In cell lines, changes of cell survival and migration by knock-down (KD) of LATS-2 expression were evaluated. In human tissues, LATS-2 expressions and proliferation index were evaluated by immunohistochemical technique.Results: In LNCaP cell, KD of LATS-2 expression lead to increasing of cell proliferation and migration. However, in PC3 cell, LATS-2 was negatively associated with cell migration, but not with cell proliferation. In RP tissues, 34 patients (54.0%) were judged as positive staining of LATS-2, and its ration is lower than those in non-tumoral tissues (53/60= 88.3%). In addition, positively stained ratio of LATS-2 in pT3 patients (7/27= 25.9%) was significantly lower (P <0.001) than that in pT2 patients (27/36= 75.0%) . Similarly, LATS-2 expression was negatively associated with Gleason score (P= 0.014). Proliferation index in LATS-2-positive tissues (mean= 6.4/ SD= 3.9%) was significantly lower (P= 0.001) than that in negative ones (10.7/5.6%). In CRPC, 4 of 25 tissues (16.0%) was judge as positive for LATS-2 expression, and its ratio was significantly lower than RP tissues (P <0.001). Our results showed that LATS-2 plays as tumour suppressor in prostate cancer cells; however, its anti-cancer activities were dependent of androgen-dependency. In short, although its expression was negatively associated with cell proliferation and migration in androgen-dependent prostate cancer cells, whereas it was done with cell migration only in androgen-independent cells. In addition, LATS-2 expression is decreased according to loss of androgen-dependency. The finding on cell proliferation was confirmed in human cancer tissues. We suggest that LATS-2 may potential therapeutic target for patients with prostate cancer, especially in CRPC. Impact of Alternative Antiandrogen Therapy for Japanese Prostate Cancer Patients in the Era of New Hormonal Therapy Introduction and Objective: After introducing new hormone therapy, such as abiraterone acetate and enzalutamide, alternative antiandrogen (AA) therapy has gone out of use worldwide. In Japan, new hormone therapies were introduced in 2014. According to Japanese Clinical Practice Guidelines in 2012, AA therapy was recommended grade B, but was not documented in 2016 Guidelines as well world trend. However, the sensitivity of the hormone therapy is high in Japanese compared to Caucasians, and AA therapy is thought to be still useful in the era of new hormonal therapy. In this study, we evaluated the prognostic significance of AA therapy, in addition the relation of prostate-specific antigen (PSA) response with AA therapy and new hormone therapy. Between 2001 and 2015, 141 patients with advanced prostate cancer (PC) who underwent AA therapy with flutamide following the failure of initial maximum androgen blockade (MAB) using bicalutamide in Osaka Rosai Hospital were retrospectively reviewed. Data collected on each patient included age, clinical T (cT) stage, biopsy Gleason Score, values of serum initial PSA (iPSA), lactate dehydrogenase (LDH) and alkaline phosphatase (ALP), hemoglobin (Hb) concentrations, duration of MAB therapy, PSA response for AA therapy, using or not for new hormone therapy and follow-up data. Prognostic outcomes and these 10 factors were analyzed. The significant prognostic values were determined by Kaplan-Meier method and COX's proportional hazard model. duction of AA therapy, the number of patients who achieve PSA decline more than 50%, less than 50% and PSA remaining elevation was 43, 37 and 61. These responders had significantly better OS than non-responders (p= 0.0011). This study was including 50 patients received new hormone therapy, and PSA decline was detected in 41 patients (82%). These new hormone users had significantly better OS than non-users (p <0.001). Multivariate analysis revealed that age, LDH level, more than 24 months duration of response to MAB therapy, responder for AA therapy and use of new hormone therapy were independent risk factors for OS (p <0.05). Furthermore, PSA decline for new hormone therapy was significantly more detected (p= 0.0225) in responders (22/28, 92.86%) for AA therapy than non-responders (15/22, 68.18%). Conclusion: AA therapy was effective for 56.7% patients and independent predictor of OS. Furthermore, cross resistance between AA therapy and new hormone therapy was not detected, to the contrary responders to AA therapy have still hormonally sensitivity and can be expected the effect for new hormone therapy compared to non-responders. These findings suggested AA therapy is thought to be of therapeutic value for Japanese advanced prostate cancer patients in the era of new hormonal therapy. Can Exercise Training Ameliorate the Adverse Cardiometabolic Side Effects of ADT in Newly Diagnosed Prostate Cancer Patients?Ndjavera W 1 , Orange S 2 Introduction and Objective: This study was conducted to compare the accuracy of bi-parametric magnetic resonance imaging (bpMRI) with high b-value (b= 1000 s/mm 2 , b1000) diffusion-weighted imaging (DWI) to that of bpMRI with ultra-high b-value (b= 1800 s/mm 2 , b1800) DWI to detect clinically significant prostate cancer (csPCa). A total of 408 patients with suspected PCa were evaluated by bpMRI prior to biopsy. One reader retrospectively reviewed all images for confirmation of Prostate Imaging-Reporting and Data System (PI-RADS) score. Cognitive MR/ultrasound fusion target biopsy was done for all visible lesions (PI-RADS 3-5). Systematic biopsy was done for all cases. The csPCa detection rates were compared according to the bpMRI protocol (with/without b1800 DWI) or PI-RADS score. The accuracy of PI-RADS score was estimated using the receiver operating characteristics curve. The signal intensity (SI) ratio (visible lesion/surrounding background) was evaluated. per 1,000 person-years). However, there was no significant difference between ADT and non-ADT group in the matched cohort (14.9 vs 14.6 per 1000 person-years). The adjusted hazard ratio for CI for PC patients who received ADT was 1.045 (95% CI: 0.943-1.159, P = 0.401) compared with those who did not receive ADT. In addition, cumulative duration of use ADT was not also associated with an increased risk of cerebral infarction. However, old age, hypertension, diabetes, myocardial infarction, congestive heart failure, peripheral vascular disease, renal disease, dementia, and atrial fibrillation were revealed as contributing factors to cerebral infarction. In this nationwide, population-based study, the use of ADT was not associated with CI after adjusting for potential confounders. The The present study aims to evaluate the diagnostic value of cell-free DNA (cfDNA), its comparison with prostate-specific antigen (PSA) level in prostate cancer screening and also in patients with localized prostate cancer, metastatic form, and benign prostatic hyperplasia (BPH). The participants of this study were selected from 126 patients with genitourinary symptoms suspected prostate cancer, rising PSA, and/or abnormal rectal examination results and 10 healthy subjects as controls. Peripheral blood plasma before any treatment measures was considered. cfD-NA was extracted using a commercial kit, and PSA levels were measured by ELISA. The ANOVA test was used to compare the average serum level of PSA and plasma concentration of cfDNA between the groups. The correlation between variables was measured by the Pearson test.Results: The subgroups consisted of 50 patients with localized prostate cancer, 26 patients with metastatic prostate cancer, 50 patients with BPH, and 10 healthy subjects; the average concentration of cfDNA in these subgroups were 15. 04, 19.62, 9.51, and 8.7 ng/μl, respectively. According to p < 0.0001 obtained from multivariate test, there was a significant difference between all the groups.Conclusion: Our findings indicated significant differences between cfDNA levels of patients with localized and metastatic prostate cancer, and differences between these two groups from BPH and healthy cases show the importance of this biomarker in non-invasive diagnostic procedures. ical prostatectomy. Patients whose original biopsy specimens from outside hospitals were reviewed by a urological pathology expert in our institution were included. Patients who had received neoadjuvant hormonal therapy were excluded. Logistic regression analysis was used to identify predictors of upgrading among GGG 1 diagnoses. Results: A total of 403 patients were included. Agreement in GGG between initial and second-opinion diagnoses was present in 256 cases (63.5%). Although opinion-matched cases improved concordance between biopsy and prostatectomy specimen GGG compared with single-opinion cases (initial, 35.2%; second-opinion, 36.5%; matched, 41.4%), 71% (56/79) of cases classified as GGG 1 were upgraded after prostatectomy. Multivariate analysis revealed that prostate-specific antigen density, and Prostate Imaging Reporting, and Data System version 2 score were significant predictors of upgrading (odds ratio 1.10, p=0.01; odds ratio, 1.88; p=0.03, respectively). The GGG concordance rate between needle-core biopsy and radical prostatectomy specimens was higher in opinion-matched cases; however, 71% of opinion-matched GGG1 cases were upgraded after robot-assisted radical prostatectomy. Urologists would propose treatment strategies or further biopsy rather than active surveillance r patients with GGG1 and a high PSAD and/or PI-RADS score. Results: 52 patients (19.8%) had recurrence. 36 patients received initially salvage radiation therapy to the margin and pelvic lymph nodes. Among these 36 patients, 10 patients needed further treatment with anti-androgen drug or androgen deprivation therapy or both. All of these 10 patients were stage III. 8 patients were T3b and 2 patients were T3a. Among the rest of 26patients who only received salvage radiation therapy, 10 patients were T2, 11 patients were T3a and 5 patients were T3b. Prostate cancer-specific mortality was 0%. Conclusion: Salvage radiation therapy might have larger impact on oncological outcome than extended pelvic lymph node dissection. But we need further observation. Pathological examinations of resected prostatic tissues revealed prostatic cancer in 14 (2,27%) of them. They were T1a and T1b in respectively 5 and 9 patients. Clinical features including age, serum prostate specific antigen (PSA) levels, prostatic volume and PSA density (PSAD) were compared between patients with prostatic cancer and those with BPH. Results: PSA was not significantly different between cancer and BPH patients (p= 0,72). Mean PSA density in cancer patients was a bit higher than in patients with BPH but the difference was not significant (p= 0.1). The only tested parameter related to prostatic cancer was age, with a statistically significant difference (p= 0,0001). Postoperatively, radical prostatectomy was proposed for one patient and hormonal therapy was performed in 7 patients. The remaining 6 patients were followed with no specific treatment for prostatic cancer. Eight patients are still living and have shown no findings suggesting recurrence. The incidence of incidental prostate cancer was low. PSA values and ultrasound were not good predictors of incidental cancer. Aged patients showed higher incidence of cancer. It seems of importance to explain preoperatively the possible detection of prostatic cancer in association with TUR-P, particularly for elderly patients aged 70 years or older. Abiraterone-Withdrawal-Syndrome: Rare Phenomenon or Therapeutic Tool?Schnöller TJ 1,2 , Martini T 1 , Hirning C 1 , Steinestel J 3 1 University of Ulm, Ulm, Germany; 2 UroZentrum, Mindelheim, Germany; 3 Universtiy of Augsburg, Augsburg, Germany Introduction and Objectives: Prostate cancer is the most frequently diagnosed malignancy and the second leading cause of cancer specific death in aging male in the western world. The androgen deprivation therapy remains the standard of care for men with advanced prostate cancer. While the withdrawal-syndrome is well reported for all primary antiandrogens, it is a rarity in the therapy with Abiraterone. We report about two patients from our day-to-day praxis with a significant Abiraterone (AA) withdrawal syndrome and a PSA decrease of more than 80% and more than 50% respectively after cessation of AA and discuss the available literature respecting molecular mechanism and therapeutic consequences. The definite mechanism remains unclear. Nevertheless, the syndrome arises at a low percentage of patients. If this circumstance is kept in mind and recognized at an early stage, it can be used as a therapeutic tool in tumour therapy. To assess the rates and types of complications in MR/US transrectal guided biopsies followed by a systematic 12 core biopsy. We evaluated a total of 506 patients who underwent transrectal 18-gauge needle prostate biopsy. All patients had systematic 12-core prostate biopsy with additional samples taken from MR suspicious lesions using MRI/US fusion guidance. Quinolones were the preferred prophylactic antibiotics, with Trimethoprim-Sulphametoxazole used in patients with Quinolone allergy. Anticoagulants were stopped at least a week before biopsy, in ambiguous cases, laboratory tests of parameters of hemocoagulation were done before biopsy. We only included the rates of infection, retention and severe hematuria, as symptoms like hemospermia are often inconsistently reported by patients and do not present a medical problem. All complications we graded using the Clavien-Dindo (CD) scale.Results: A total of 506 patients were evaluated with an average age of 63 years (31 -91), mean PSA of 8,28ng/ mL (0,52 -75,0). On average 2,7 (0-9) MR/US guided cores were performed prior to the 12-core systematic biopsy. We registered a total of 17 complications (3,36%), comprising 11 CD1, 5 CD2, and 1 CD4 grade complications. Complication rates and types of complications are presented in the table below.Conclusion: Our analysis of MRI/US target biopsy followed by systematic 12 core biopsy show low overall complications rates. Most of the complications belong to Clavien-Dindo groups 1 or 2, severe complications are rare. Results are comparable to those in recent literature. Conclusion: If patients who received RARP with positive margin had PL ratio >9 by pre-operation lab data and pathology grading group >3, we strongly suggested early intervention should be applied over these patients. Can Clinical Study of Prostate Cancers with a Prostate-Specific Antigen Level of more than 1000 ng/mL at Diagnosis. Introduction and Objective: High prostate-specific antigen (PSA) at diagnosis is associated with high tumor burden and worse outcomes in patients with prostate cancer. We report the results of a clinical study of patients with prostate cancer who had a PSA level of more than 1000 ng/mL at prostate cancer diagnosis. Between January 2001 and February 2018, a total of 53 patients (PSA> 1000 ng/ mL) were newly diagnosed prostatic cancer and treated with androgen deprivation therapy at our hospital. Descriptive analysis was performed to capture clinical characteristics, treatment selection and response, and outcomes in this cohort. The median age and PSA at diagnosis were 73 (55-86) and 2160 ng/mL . Most of the patients (79.2%) had symptoms due to prostate cancer. A high Gleason score (8) and distant metastases were identified in 83.5% and 96.2% (bone 42, extra-regional lymph node 21, lung 6, liver 1) of the patients, respectively. All the patients were treated with androgen deprivation therapy. However, 5-year PSA failure-free survival and 5-year overall survival were 22.8% and 43.3%, respectively. Multivariate analysis showed nadir PSA level (10 mg/mL) time to PSA nadir <6 months and high Gleason score (9 or 10) independently predicted shorter overall survival. Many patients had PSA failure and their prognosis was poor. Nevertheless, long-term survival rate was achieved in some patients. We need to ascertain the precise prognostic marker to androgen deprivation therapy. Introduction and Objective: Robot-assisted laparoscopic radical prostatectomy (RALP) has become a standard treatment choice for localized prostate cancer. RALP requires a steep Trendelenburg position, which leads to a significant increase in intraocular pressure (IOP). This study evaluated the effect on the retinal structure and function in patients undergoing RALP. Between March and September of 2016 at Kagawa University Hospital, we enrolled a total of 24 consecutive male patients who underwent the RALP procedure. Standard automated perimetry (SAP) and optical coherence tomography (OCT) were performed in 20 males scheduled for RALP at 1 month and 1 day before the operation and at 1 and 3 months after the operation. IOP measurements were made in the supine position at 5 min after intubation under systemic anesthesia (T1), at 6 discrete time points (5, 30, 60, 120, 180 and 240 min; T2-7), and at 5 min after returning to a horizontal supine position (T8). The Guided Progression Analysis software program was used to assess serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression.Results: Average IOP (mmHg) for each time point was as follows: T1=12.3 ± 2.6, T2=20.4 ± 4.2, T3=23.3 ± 3.8, T4=24.0 ± 3.2, T5= 24.3 ± 3.4, T6=27.1 ± 7.2, T7=29.8 ± 8.7 and T8=20.1 ± 4.4. During RALP, IOP significantly increased. There was no progression of the visual field and RNFL thickness after surgery or any other ocular complications found.Conclusion: Although IOP significantly increased during RALP, there were no significant changes in the retinal structure and function between the pre-and post-operation observations. Transperineal magnetic resonance imaging-targeted biopsy may perform better than transrectal route in the detection of prostate cancer? A systematic review and meta-analysis such as tomatoes. Several growth factors, including insulin-like growth factor 1 (IGF-1), play important roles in carcinogenesis and metastasis. The IGF-1 is mitogens that play important roles in the regulation of proliferation, differentiation, and apoptosis. Binding of IGF-1 to its cognate membrane receptor activates Ras/Raf/MAP kinase signaling pathways, which regulate cell-cycle progression, cell survival, and transformation. Lycopene has its protective effect, which affects multiple IGF-1 activated signaling pathways. Lycopene stimulates apoptosis through intrinsic pathways, by stimulating the pro-apoptotic factor of the mitochondrial cavity such as the Bax/Bak protein (an apoptotic promotor). Although tomatoes are widely consumed in Indonesia, there is no research study about effect of lycopene on prostate cancer in Indonesia. Hence, this study is conducted to measure the influence of lycopene on the level of insulin-like growth factor-1 (IGF-1) in Indonesian human prostate cancer cells.Material and Methods: An experimental study was conducted on Indonesian human prostate cancer cell from a patient with Gleason score 6, divided into 5 groups: 2 control groups and 3 treatment groups that received 1 µM, 2 µM and 4 µM of lycopene respectively. Measurement of mean IGF-1 level was performed by ELISA. A comparative analysis was performed by two-ways ANOVA. The result showed that there was a significant difference of mean IGF-1 levels in the provision of various concentrations of lycopene and time of observation (p <0.05). Increased level of mean IGF-1 appeared on 2 µM dose of lycopene at 48 hours observation and began to decline in 72 hours observation. This happened also on 4 µM lycopene at 24 hours observation and began to decline in 48 hours observation (p <0.05).Conclusion: Lycopene could be administered as an adjuvant therapy for prostate cancer patients to increase apoptosis, and eventually inhibit progressivity of cancer cells. Influence of the Prostate-Specific Antigen Change Rate on Prostate Cancer Detection Just Before a Prostate Biopsy Yamada D, Oda K, Takemaru H, Hayashi N, Uematsu K Introduction and Objective: Patients are being introduced to our urology department with a high prostate-specific antigen (PSA) level at a medical checkup or inspection at a family doctor with increasing frequency. In our department, we re-examine the PSA level at the time of their visit to our hospital in principle. We examined the influence of the rate of change between the referral PSA level and the PSA level measured at our hospital on prostate cancer detection. A total of 747 patients were introduced to our department and underwent a prostate biopsy due to a PSA high level from March 2014 to August 2018. In 391 of those 747 patients, the levels of the referral PSA and that measured at our hospital were confirmed. We examined the relationship between the detection rate of prostate cancer and the PSA change rate for these 391 patients. In 49 patients, the PSA level had dropped by 20%, and the detection rate of prostate cancer in those patients was 24.5% (12/49). There were 222 patients whose PSA change rate was within ±20%, and the detection rate of prostate cancer in those patients was 79.3% (176/222). There were 120 patients whose PSA level increased by 20%, and the detection rate of prostate cancer in those patients was 50.8% (61/120). The rate of prostate cancer detection in patients with a declining PSA trend was significantly lower than in those whose PSA level remained stable or increased. In addition, the rate of prostate cancer detection in the cases whose PSA level increased by 20% was also about 50%, which was slightly lower than assumed. This phenomenon may have been influenced by fluctuations in the PSA levels in large sized cases of benign prostatic hyperplasia or those with inflammation. Patients with very low-risk and low-risk prostate cancer whose life expectancy is less than 10 years can be considered for observation. (A, I) 2. Does radical prostatectomy or radiation therapy have a higher survival rate than active surveillance in patients with low-risk prostate cancer whose life expectancy is more than 10 years? Active surveillance, radiation therapy or radical prostatectomy are recommended for low-risk patients with a life expectancy of more than 10 years. (A, II) 3. Does radical prostatectomy have a higher survival rate than radiation therapy in patients with low-risk prostate cancer?Because radical prostatectomy and radiation therapy are not significantly different in survival rates in patients with low-risk prostate cancer, both therapy can be recommended. (A, I) 4. Does adjuvant radiotherapy have a benefit from survival rate in patients with low-risk prostate cancer who had pathologic poor prognostic factors after radical prostatectomy?Patients with low-risk prostate cancer who have a life expectancy more than 10 years are recommended to receive adjuvant radiotherapy or salvage radiotherapy if they had pathologic poor prognostic factors after radical prostatectomy or postoperative prostate-specific antigen elevation. (A, I) 5. Does radical prostatectomy with pelvic lymphadenectomy have a better survival rate than radical prostatectomy only in patients with low-risk prostate cancer?Pelvic lymphadenectomy does not improve survival rate in patients with low-risk prostate cancer, so pelvic lymphadenectomy may be avoided. The Epidemiology of Urethral Introduction and Objective: The true incidence of urethral stricture disease is still unknown. In the past decades, patients increased seeking medical advice regarding this condition due to better patient education and ease of access to variety of medical resources. Causes categorized into inflammatory, traumatic, iatrogenic and idiopathic. The aim of this study is to identify the incidence and etiologies of urethral stricture disease in Kuwait, and type of intervention done. Data of patients diagnosed with urethral stricture disease from 4 different medical centers: Farwaniya, Amiri, Sabah Alahmad and Military hospital, were collected and analyzed. Data from The Public Authority of Civil Information was used to estimate the total population covered by each center. We included all the patients with urethral stricture above the age of 12 from Jan 2008 to June 2018. Demographic data, possible etiology, and location of urethral strictures were studied. Moreover, the treatment modality used in terms of endoscopic or urethroplasty was noted. Patients with incomplete data were excluded from the study. The diagnosis of urethral stricture was made on the basis of retrograde urethrogram and cystoscopy.Results: A total of 243 patients met our inclusion criteria. The mean age of the group studied was 47 years old. The estimated incidence is 2 cases per 100,000 per year. The most common etiology of urethral strictures was iatrogenic (41.6%), followed by idiopathic causes (30.5%). Other etiologies that accounted for urethral strictures were Infection (16.5%), trauma (8.6%), and Lichen sclerosis (6%). The location of the stricture was classified as penile (8.2%), penobulbar (1.6%), bulbar (83.1%), membranous (1.2%) and panurethral (5.8%).As end point treatment, urethroplasty was performed in 94 patients (38.7% of the cases).Conclusion: Urethral stricture disease is uncommon urological condition. The most common attributable cause in our study is iatrogenic. One of the main goals following phalloplasty in transmen is an erectile function with the possibility to engage in sexual intercourse. To enable full rigidity penile prostheses, either inflatable or semirigid, are used. Our objective was to evaluate outcomes of penile prosthesis insertion (PPI) after total musculocutaneous latissimus dorsi (MLD) phalloplasty in our series of transmen. During the period of 8 years (January 2009-May 2017), we performed PPI in 61 transmen. All patients have previously undergone total MLD phalloplasty. There was a mean period of 13 months (range: 9-23 months) between phalloplasty and PPI. Semirigid penile prostheses were inserted into the neophallus using dorsal and/or phalloscrotal approach. The proximal end of each cylinder was fixed to the pubic symphysis preventing their displacement. In case of a three-component inflatable prosthesis, cylinders were inserted using dorsal approach. Pump was placed in the proper scrotal sac at opposite side from microvascular anastomosis, while the reservoir was placed retrovesically using the inguinal approach. All patients were evaluated by either a psychologist or a psychiatrist after complete healing.Results: Follow-up ranged from 20 to 120 months (mean 41 months). Inflatable and semirigid penile prostheses were implanted in 22 and 39 patients, respectively. Good functioning with full rigidity was reported in 15 and 37 patients. Rejection of penile prostheses due to infection was noted in 2 patients (inflatable prosthesis) and one patient (semirigid prosthesis), respectively. Inflatable prosthesis was replaced by a semirigid prosthesis in two patients, due to malfunctioning i.e. migration of cylinders with subsequent rigidity of only proximal part of the neophallus and inability to engage the intercourse. Three patients reported no utilization of inflatable implants. Semirigid prosthesis was replaced in two patients because it was broken due to trauma. All patients who engaged in sexual intercourse reported satisfying penetration.Conclusion: Transmen who desire penetrative sexual intercourse require penile prosthesis implantation. Second stage of gender affirmation surgery with PPI represents complex procedure with possible complications, like rejection or malfunctioning. Musculocutaneous latissimus dorsi phalloplasty provides neophallus of good volume and dimensions, offering simple and safe insertion of penile prosthesis. Our study proves lower complication rate in comparison to PPI in other phalloplasty techniques. The Introduction and Objective: Urethroplasty is the gold-standard curative treatment for bulbar urethral strictures. Nevertheless, many are still managed by urethrotomy/dilatation. This study evaluates the cost-effectiveness of urethroplasty on one hand and urethral dilatation on the other within the framework of the UK National Health Service funding system. All previously untreated bulbar strictures managed by urethroplasty or urethral dilatation between January and December 2013 were included. Our prospectively compiled database was retrospectively searched to identify patient and stricture characteristics, treatment outcome and management of failures. Cost of urethroplasty was ≤2964.Dilatation was done as a day case procedure costing ≤934 (Dilatation as an outpatient costs ≤194 for the dilatation alone or ≤317 including flexible cystoscopy). All patients were followed up for five years. Cost of treatment per patient over the entire period from the initial procedure to date was calculated. 90.9% of patients satisfied with their outcomes. Statistically significant differences were found between both groups regarding age (P= 0.012), and background of multioperated hypospadias (P= 0.035), being higher in urethrostomy group. We did not find differences in diabetes, smoking or vascular disease. Stricture length was significantly longer in the augmented urethroplasty group (P= 0.015). We found no statistical differences in stricture recurrence, satisfaction rate and hospital stay.Conclusion: For panurethral stricture surgical management, buccal mucosal graft urethroplasty and perineal urethrostomy are acceptable options, with high satisfaction and success rates. Patient selection should include age, aetiology, and comorbidities, along with patient preferences. Surgical Introduction and Objective: Bladder exstrophy is rare and complex congenital abnormality identified in the neonatal period and reconstruction is usually undertaken within the first 12 months of life. Further surgery is likely through childhood and into adulthood. Management is initially with paediatric urologists but transition to adult care can be difficult. Patients need a motivated urologist with a skill set that covers reconstruction, urodynamics, endourological stone management and an awareness of the other areas of sexual health and fertility. Engaging with other specialists and an ongoing relationship with paediatric and other subspecialist urologists is vital. We reviewed patients with a history of bladder exstrophy who transitioned from paediatric services to adult services in the private care setting within an Australian metropolitan area. We identified 8 patients with a history of bladder exstrophy with ongoing urological care through a single practice where one reconstructive urologist with a specific interest. All patients underwent extensive reconstructive surgery throughout childhood. Seven have also required input from other medical specialists as young adults, including general or plastic surgeons, and gynaecologists in all three female patients. A paediatric urologist was involved in revision of bladder augment and catheterisable channel as adults in three patients. Despite the broad skill set of the interested urologists who specialise in the care of these adult patients, involvement of urologists with different sub-speciality interests is important. In all patients, lifelong surveillance for deterioration of renal function, metabolic issues, bone health second-ary to chronic acidosis and rare bladder malignancy is required.Conclusion: Patients need referral to urologists with the expertise and support structures to look after their complex ongoing issues and provide the necessary ongoing surveillance. The multidisciplinary team is essential. Paediatric surgeons are needed as an integral resource in management of these adult patients. The current randomness of transitional care may mean that exstrophy patients might present acutely for crisis management in emergency departments or as new referrals to general urologists. At these times it is important to appreciate the complexity of their problems and ensure a secure ongoing urological connection. Long Etiology of PD was variable: penile trauma during sexual intercourse in 4, urethral catheterization (post-radical prostatectomy) in 1, urethral endoscopic instrumentation in 1, penile blunt trauma 1 and idiopathic in 4. Mean penile curvature was 65º (range 45-90º). Mean operative time was 95 min (range 75-120 min). Mean follow-up varied from 4 to 13 months (mean 5). Pre-operatively, penile length measured from 11 cm to 16 cm in erection (mean 14). Post-operatively, 2 patients noted penile length reduction of < 1 cm, 5 patients reported no change and 4 noted a slight increase between 1-1.5 cm in erection. Post-operative residual curvature was < 15º in 3 patients. Patients and partners satisfaction were high.Conclusion: This procedure is safe and efficacious with no or minimal impact on erectile function and penile length. The use of simple incisions only and Ta-choSil® seems to avoid the potential adverse effects of veno-occlusive dysfunction created by the large grafted tunical defects and the frustrating complication of penile length decrease. The Introduction and Objective: The treatment of lichen sclerosus (LS), affecting the urethra, is challenging because of its uncertain aetiology, the variable response to treatment and the tendency to recur. Super-potent topical steroids are the mainstay of the treatment of the skin disease and may also be used for distal urethral disease by using clean intermittent self-catheterisation (CISC) to push steroid cream into the distal urethra. In advanced cases urethroplasty is the mainstay of treatment with variable results.Materials and Methods: 91 men with a mean age of 57 years (range 35-82) were treated for LS urethral strictures between January 2016 and December 2018. Outcomes were assessed with symptoms (PROMs), flow rates, urethrograms and the need for further surgery.Results: All patients had a urethral dilatation (UD) as the first line of treatment. 42 patients continued to be managed thereafter by UD, as required. Of these 42 patients, 14 eventually underwent urethroplasty, or perineal urethrostomy. The other 49 patients were started on CISC and most of these used the CISC to push Clobetasol cream through the meatus and into the fossa navicularis and distal penile urethra. 30 of those patients remain on CISC but 11 eventually had surgery. Management by CISC with or without Clobetasol was successful in 73% of patients and tended to be highest in the more distal strictures or the shorter strictures. It isn't clear whether it is the length or the location that matters. Of the patients using Clobetasol only 13% came to surgery, whereas 40% of the patients not using Clobetasol needed surgery. Urethroplasty was successful in 70% of patients with distal strictures, 50% with penile strictures and 0% in those with full length strictures. In patients with LS affecting the meatus and distal urethra CISC using Clobetasol as a "lubricant" is effective. With longer strictures, more advanced or more aggressive disease, the results of interval dilatation or self-catheterisation are less satisfactory but should always be tried because the results of surgery are poor. When surgery is indicated perineal urethrostomy seems to be a better option. Conclusion: Kulkarni one sided dissection is a simple, minimally invasive approach which can be applied to Panurethral strictures, Penile stricture and hypospadias fistula/stricture. This is a minimally invasive, neurovascular preserving urethroplasty. 3D Printing of Pelvic Fracture Urethral Injuries Introduction and Objective: In Pelvic fracture urethral injuries, as per Mundy et al rate limiting step in urethroplasty is finding the posterior urethra. Even for the most experienced surgeons, at times this step can be challenging. For novice reconstructive urologists, trainees it is essential to understand the anatomy of posterior urethra and to predict the need for pubectomy. We describe a novel technique for understanding the 3 D anatomy to make urethroplasty easy for everyone. Ours is a tertiary referral center with experience of more than 1307 cases of PFUDD. This study was done between January-July 2018. Ethics approvals were taken. No patients incurred any cost for the study. A CT scan is performed with bladder filled with contrast saline. A spiral CT Scan is performed with a scan time of 10 seconds. 3D Images are reconstructed. These images are fed to 3D Ultimaker imprinter. The printing is done at a scale of 0.8 of real size. This printing takes about 20 hours.Results: 10 models were created. This included 9 males and 1 female with PFUDD and incontinence. The models along with conventional urethrogram were shown to fellows and observers. Visually they gave a score of 4.3/5. In correlation with urethroplasty, the models helped in decreasing the surgical time and understanding the anatomy of posterior urethra.In the female patient, the model was accurately able to predict hypsoapdiac meatus, urethro vaginal fistula with introital narrowing which helped in decision making.Conclusion: 3 D Printing can be applied to PFUDD to understand anatomy of posterior urethra, its distance from rectum, length of gap, relation to posterior urethra, direction of displacement of urethra, if Pubectomy is required or not. The next step in our mind is to do 3D printing using composite material, mimicking bone so that the urologist can practice pubectomy before performing urethroplasty. Katz M, Dy G, Nolan I, Bluebond-Langner R, Zhao L Introduction and Objective: The gold standard in neovaginal reconstruction in male to female transgender patients is penile skin inversion with or without scrotal flaps. Complications after penile inversion vaginoplasty (PIV) include stenosis, necrosis, decreased depth, and fistula formation. Revision vaginoplasty is a challenge due to paucity of tissue, requiring extragenital skin grafts or use of enteric segments. The objective of this study was to evaluate the efficacy and safety of a novel technique using a robotic approach with peritoneal flaps for revision vaginoplasty in transgender females. and March 2019, we identified 12 transgender female patients who underwent robotic peritoneal flap revision vaginoplasty after initial PIV. Two peritoneal flaps measuring approximately 8 cm wide by 10 cm long are raised from the anterior aspect of the rectum and sigmoid colon, and the posterior aspect of the bladder. The two peritoneal flaps are advanced distally to serve as an attachment for inverted penile skin from previously created stenosed vaginal cavity. The proximal edges of the flap form the neovaginal apex. Charts were retrospectively reviewed, and descriptive statistics were used to analyze patient demographics, intraoperative and postoperative outcomes. Glans Reconstruction in Lichen Sclerosus Atrophicus Introduction & Objective: Distal urethral or Navicular fossa strictures along with totally denuded glans of its skin cover due to Lichen Sclerosus Atrophicus (LSA) are a unique subset of patients. Creation of adequate long-lasting lumen and cosmesis are important concerns. This is a step by step demonstration of total glans reconstruction involving buccal mucosal graft (BMG) urethroplasty of Navicular fossa stricture and resurfacing of glans with a full thickness skin graft (FTSG). A 41 year-old male, diabetic, previously had a pan-urethroplasty for a long anterior stricture including graft repair of the distal urethra. At that time, his foreskin and glans skin were scarred due to LSA and was excised. Over time, the wound healed with proximal penile skin covering the surface. He presented with recurrent obstructing symptoms. His glans showed unhealthy skin puckered onto the stenosed meatus. His flow was significantly obstructed. His urethrogram showed distal urethral stricture. Proximal urethra showed successful repair. During the glans repair, unhealthy puckered skin was excised. Penis was degloved. Ventral glans incision including urethrotomy was done, extending well into the proximal healthy urethra. This lumen was <4F. The unhealthy mucosa along with underlying fibrosis was excised. The healthy glanular bed thus created was grafted with a BMG. Ventral urethral layer, glanular sponge, fascia and skin were closed. Penile shaft skin was sutured to the corona. Glans was then resurfaced with FTSG from non-hirsute skin of the lower abdomen. Accurate closure was done with cutaneous approximation at corona and mucocutaneous anastomosis at the meatal edge. Compression tie-over dressing was done over 14 F catheter.Results: When the catheter was removed after urethrogram at three weeks, patient voided well. There was no anastomotic leak. The patient had been voiding well with a good flow and remains under follow up.Conclusion: Glans reconstruction in a devastated Navicular fossa and loss of skin cover in LSA is a challenge. However, as long as there is a healthy glanular sponge, excision of the fibrous urethra and grafting entire surface with BMG followed by external resurfacing with nongenital FTSG achieves a good outcome. In terms of statistics, the time of hospitalization has reduced from a median of 4 to 1.2 days, along with the operative time in all kinds of surgical procedures. In modern urological reality, reconstructive urology is no longer the last solution but the first-line treatment for a wide range of pathologies. Responsible counseling, flexibility and versatility in the surgical treatment and structured postoperative follow-up are of utmost importance in our department, combining suitably trained, qualified personnel as well as an appropriate infrastructure. In this way, it has been possible to create a reference center in Greece, capable of providing high-quality medical care, as well as a structured environment for reconstructive urology training. Urethroplasty: Evolution and Results from a Tertiary Reference CenterKousournas G 1 , Spanos N 2 , Levis P 2 , Adamakis I 2 The majority were performed for anterior strictures, mostly due to endoscopic manipulation. All posterior strictures were due to traumatic injuries. The characteristics of the strictures and previous approaches were registered during the preoperative assessment. All patients were treated with anastomotic and/or augmentation urethroplasty. In case of graft usage, the type and placement were recorded. All patients were postoperatively evaluated using a scheduled follow-up plan. The overall success of urethroplasty (no instrumentation) was 83.9% (91.4% in anastomotic urethroplasty and 80.95% in augmentation urethroplasty), reaching 100% in cases with none or one previous treatment. The incidents that required further treatment, as well as the type of treatment, were analyzed. In addition, the minor post-operative complications that occurred were recorded. The progress in the clinical practices applied is reported, in terms of postoperative evaluation methods and operative techniques.Conclusion: Urethroplasty is an effective and durable treatment for urethral strictures, with low morbidity and high patient satisfaction. It requires excellent knowledge of the applied techniques, ongoing training and thorough pre-operative assessment, in order to personalize the treatment strategy in all cases. We present our experience of 22 patients over past 10 years who underwent laparoscopic and robot assisted redo pyeloplasty for recurrent UPJO. All patients who underwent laparoscopic and robot assisted redo pyeloplasty from 2009 to 2018 were included. Patients who were lost to follow up or inadequate follow up (at least 3 months) were excluded. All patients were followed up with clinical visits and DTPA scan at 3 months and then annually for 5 years after the surgery. All complications were recorded using Clavien Dindo grades (CDG). Statistical analyses was done using simple descriptive statistics.Results: A total of 22 patients were included. Eighteen (81.8%) underwent laparoscopic and 4 (18.18%) robot assisted redo pyeloplasty. Eighteen (81.8%) patients had resection of strictured segment and spatulated reanastomosis and 4 (18.18%) patients underwent ureterocalicostomy. Mean age of the patients was 28 years. Mean operative time was 152.5 min in laparoscopic approach and 124.5 min in Robot assisted one (p= 0.0403). Mean duration of hospital stay and mean time to drain removal were 2.5 days and 2.3 days respectively. Mean duration of stent removal was 42 days. Intraoperative complications were seen in 2 patients (9%). Post operative complications were seen in 3 patients (13%) (1 with CDG II and 2 with CDG I).No mortality was seen. Treatment success as defined by resolution of symptoms and non obstructed drainage on DTPA scan at 3 months after stent removal, was seen in 20 (91%) of all patients. All patients who underwent robot assisted surgery had complete treatment success.Conclusion: Redo pyeloplasty gives excellent results with minimally invasive approach. Most cases can be managed by excision of the scar tissue with strictured segment and spatulated re-anastomosis. Robot assisted technique reduces the operative time and provide meticulous dissection in difficult cases. Management of Glans Penis Amputation with Primary Anastomosis and Hyperbaric Oxygen Therapy Introduction and Objective: Penile amputation is a rare complication of a circumcision in Urology and the management of this condition requires immedi-ate microvascular surgical re-implantation of the amputated penis. We present a case report of successful penile re-implantation without microvascular anastomosis and with the use Hyperbaric Oxygen Therapy. While in the literature, there is paucity of data and mainly limited to cases reports, it is difficult to define a specific management protocol for this complication. The case was obtained from a patient who presented in our department with a penile amputation after a Guillotine circumcision. The results of re-implantation without microvascular anastomosis and with the use of Hyperbaric Oxygen Therapy were excellent. Patient recovered satisfactorily functionally and cosmetically. The above results demonstrate that the management of penile amputation, may be successful with the use of re-anastomosis without Microvascular surgery and with the use of Hyperbaric Oxygen therapy. Robotic patients underwent robotic remnant vaginectomy/ excision of urethral diverticulum for relief of urinary symptoms. Patients were a mean age of 36 years (range 26 -50) and were a mean 26 months (range 20 -39) post-op following their primary radial forearm free flap (n=3) or anterolateral thigh (n=1) phalloplasty. All had multiple urological complications after primary phalloplasty, most commonly urinary retention (n=4), urethral stricture (n=3), fistula (n=3), dribbling (n=2), and obstruction (n=2). Indication for revision was obstruction and retention (n=3) and/ or dribbling (n=2). In each case, the robotic transabdominal dissection freed remnant vaginal tissue from the adjacent bladder and rectum. Concurrent first-or second-stage urethroplasty was performed in all cases at a more distal portion of the urethra, using buccal mucosa, vaginal or skin grafts. Intraoperative cystoscopy was used in each case to confirm complete resection and closure of the diverticulum.Results: At mean follow-up of 262 days (range 106-412), none had persistent recurrence of vaginal cavity/urethral diverticulum on cystoscopic follow-up. Of 3 patients who wished to ultimately stand to void, 2 were able to do so at follow-up.Conclusion: Robotic transabdominal approach to remnant vaginectomy/excision of urethral diverticulum allows for excision without opening the perineal closure for management of symptomatic remnant/ diverticulum in transgender men after vaginectomy. Quality Introduction and Objective: Orthotopic neobladder (ONB) and Ileal conduit (IC) are the most commonly practiced techniques for urinary diversion following cystectomy for bladder cancer. Choice of urinary diversion is influenced by both patient and surgeon preferences, with health-related quality of life (HRQoL) post-operatively being recognized as an important outcome measure. We aimed to assess patient perspectives and HRQoL following urinary diversion surgery using a patient-designed survey. The study included 293 patients who had undergone radical cystectomy for bladder cancer, comprising 186 with ONB and 107 with IC. HRQoL was evaluated using a voluntary electronic survey which was made freely available to patients through Bladder Cancer Australia Charity Foundation website. The survey was designed and initiated by patients, then circulated through patient community groups in Australia, New Zealand, UK, Canada and USA.Results: Patients in the ONB group had a median surgery satisfaction score of 9 (IQR, 7-10), not significantly greater than the IC group (8, 8-9) (p=0.61).There was no significant difference in the rate of patients experiencing bowel dysfunction in the ONB (99, 57.6%) and IC (50, 53.2%) groups (p=0.52). Median sex satisfaction score was 2 (0-5) and 1 (1-6) in ONB and IC patients, respectively (p=0.48). Males who underwent ONB had a median orgasm score of 2 (1-3), similar to 2 (0-3) in men who underwent IC (p=0.37). Conversely, females who underwent ONB had a lower median orgasm score of 0.5 (0-3.25) compared to 3 (0-3) in females who underwent IC, although not significant (p=0.57). Overall there was no significant difference in HRQoL outcomes between ONB and IC groups. This is in keeping with recent meta-analyses which show conflicting results. Unique to our study is the development of a HRQoL survey made independently by patient groups, adapted from existing models. Further validation of this survey is required to assess its benefit in future practice. Materials and methods: Indocyanine Green (ICG) evaluation was performed in 7 patients who underwent urethral reconstructive surgery due to urethral stricture with various etiology. Intravenous administration of 5 grams ICG diluted in 2 mL normal saline prior and after intervention of urethroplasty was performed. Near-infrared fluorescent (NIRF) imaging with SPY system (Novadaq) was used to evaluate the expression of ICG in corpus spongiosum.Results: There were seven patients included in this study. The mean age was 47,29 ± 8.46 years. Five patients with traumatic stricture and planned for excision and primary anastomosis (EPA). The other two patients were idiopathic and planned for substitution urethroplasty. During the surgery, the ICG expression showed 6 patients had favorable corpus spongiosum that treated as preoperative surgical planning. All these patients had successful outcome. One patient who had unfavorable corpus spongiosum due to trauma had changed the intervention from EPA to vascular sparring anastomotic urethroplasty. At the 3-month follow up, this patient had also good outcome with IPSS score 3 and Q-max 22 mL/s. There were no immediate or delayed adverse effects attributable to intravenous ICG administration.Conclusion: Intravenous injection of ICG during urethral reconstruction surgery allows for real-time vascularization of corpus spongiosum and helps reconstructive surgeon to determine appropriate urethroplasty techniques. However, many symptomatic patients are reluctant to undertake the IC due to the significant morbidity associated with the procedure and multiple consultations required before they consent. The aim of this study was to assess the outcomes of IC from patient's perspective. We conducted a survey among SCI patient who had IC from 2009 to 2014 at our department. We used the 30 items Qualiveen questionnaire, which has been validated for neurogenic bladder dysfunction. To avoid recall bias, 10 randomly selected SCI who opted for IC served as controls. The primary endpoint was the change in total Qualiveen score. The secondary outcomes were the changes in the Qualiveen domains, quality of life score and the degree of satisfaction in a scale from 0-10. Pearson test was used for correlations and t-test to assess intra-group variability. Substitution of the Distal Ureter Utilizing da Vinci ® Robotic Surgical System. Introduction and Objective: Ureteroneocystostomy, occasionally with creation of Boari flap, is the best option to substitute for the loss of the distal ureter in both benign and malignant conditions. The procedure is usually performed through a large midline or Gibson incision. Utilizing the robotic da Vinci® surgical system made it feasible to achieve the objectives of the procedure with minimally invasive approach. Our aim is to report our first series of robotic assisted ureteral substitution with and without creation of Boari flap. and March 2018, we used the de Vinci® robotic system to reconstruct 23 distal ureters for 11 benign and 12 malignant conditions. The distal ureter was excised with bladder cuff in cases of TCC involving the distal ureter. The proximal ureteral end was spatulated and re implanted to the bladder either directly or after developing Boari flap to enable tension free, leak proof anastomosis. The robotic surgical system fwe implanted 6 right ureters and 7 left ureters into theoretically created Boari Flap. Negative margin was insured in all the malignant cases.Results: The average patient age was 67 years (ranging from 34-79). We had 6 male and 7 female patients. All cases were completed robotically with no conversion, the patients were followed for an average of 35 months (ranging from 3 months to 72 months). The ureters were patent in all of the 4 (30%) patients who had benign ureteral stricture. However, 3 patients (23%) who had lower ureteral TCC developed ureterovesical anastomosis stricture. All of the strictures were due to high grade TCC on the initial and final pathology after nephroureterectomy with excision of the flap. One patient with history of high grade TCC of the lower ureter developed multifocal high grade TCC in the renal pelvis on the same side 3 years later.Conclusion: Robotic reconstruction of the lower ureter with Boari flap is feasible and has an acceptable oncologic outcome. High grade TCC of the lower ureter is predictor of recurrence at the anastomosis. Longer follow up is needed especially in cases of malignancy. Schulster M, Zhao L, Jun M Introduction and Objective: The rectus abdominal muscle is a useful flap for multiple surgical repairs including complex urethral fistula repair. Traditionally, open harvest with anterior sheath violation has been performed with significant donor site morbidity including hernias, bulges, infections as well as poor cosmesis due to a large incision. The increasing ubiquity and minimally invasive nature of robotics allows for a fascial sparing technique, mitigating morbidity. Materials and Methods: In 2018, four robotic rectus muscle harvests were performed at our institution by the surgeon authors, a urologist and a plastic surgeon, for complex urethral fistula repair. The operating robot (XI or SP) was docked with a GelPort into the intra-fascial space through a 3mm incision. The rectus muscle was freed robotically up to its costal and subxiphoid margin and brought down off the posterior and surrounding fascial sheath. The flap was subsequently used for pelvic soft tissue repair. Demographic as well as peri-operative variables and outcomes were recorded. Results: A total of 632 patients (LMG 323, BMG 309) from 12 comparative studies (4 RCTs and 8 non-randomized) were included for meta-analysis. Overall pooled effect estimates revealed no significant difference between the groups on reported urethroplasty outcomes and operative stricture-related complications. Effect estimates for patient-reported graft harvest site morbidities such as bleeding, pain/discomfort and food intake did not show any differences between the groups at <1-month, 1-3 months and up to 6-12 months follow-ups. However, LMG group reported a higher proportion of patients with difficulty speaking (RR 6.96, 95%CI 2.04-23.70) and tongue protrusion (RR 12.93, 95%CI 3.07-54.51) within 3-21 days postop. The LMG group had significantly less incidence of early post-procedural harvest site swelling (RR 0.39, 95%CI 0.25-0.61) and numbness at <1-month (RR 0.48, 95%CI 0.23-0.97) and 3-6 months (RR 0.52, 95%CI 0.30-0.90) follow-ups. Difficulty in mouth opening was also reported to be significantly lower among LMG group at <1-month follow-up (RR 0.21 95%CI 0.12-0.37). The evidence suggests no overall significant difference between LMG and BMG in urethroplasty outcomes, harvest site bleeding, pain/discomfort and food intake during up to 12-month follow-up. However, patients undergoing LMG urethroplasty have a higher chance of experiencing difficulty of speech and tongue protrusion within 1-month postop. The BMG group has a higher likelihood of experiencing early harvest site swelling, mouth opening difficulty in 1-month post-op, and numbness up to 3-6 months. In To investigate the clinical efficacy of in situ replantation emergent repair of ureteroscopy-related full-length ureteral avulsion, and to provide a reference for the treatment of such serious complications. A retrospective analysis of 4 cases of ureteroscopy-related full-length ureteral avulsion repaired by in situ emergent replantation in 4 comprehensive hospitals in Shanghai in recent 5 years was performed. The proximal end-to-end ureteroureterostomy combined with distal ureteroneocystostomy was resorted to during the repair. Perioperative and follow-up related parameters were analyzed.Results: The average operation time of the 4 patients was 4.75±0.65 hours (4.0-5.5 hours). 3 cases (75%) were treated with greater omentum investment and 1 case (25%) underwent anti-reflux ureteroneocystostomy plus vesico-psoas hitch. Percutaneous nephrostomy was performed in 2 cases (50%). The median follow-up time was 24 months (6-54 months). The average DJ stent duration was 6.75±1.89 months (4-8 months) and the average nephrostomy duration was 7.25±11.41 months (0-24 months). The renal function and hydronephrosis of all the 4 patients were generally stable during the perioperative period and follow-up. In situ replantation emergent repair based on end-to-end ureteroureterostomy and ureteroneocystostomy should be given priority to under the equal condition due to restoring the natural structure and physiological function of the ureter to effectively protect the renal function. Use Results: From 2016 to 2019, 28 patients underwent this procedure, of average age 32.8 ± 8.9 years, BMI 29.5 ± 5.0, and ASA class 1.8 ± 0.6. The average length of operation was 423.6 ± 86.9 minutes, with an estimated blood loss of 208.9 ± 88.6 mL. Patients were typically out of bed on post-operative day 1, ambulating on post-operative day 2, and discharged home on post-operative day 3 (average day of discharge 3.2 ± 1.4 days). At mean follow-up time of 404.5 ± 272.6 days, 9 (32.1%) patients had developed urethrocutaneous fistulas (with 2 patients developing 2 fistulas) and 2 (7.1%) patients had developed either a stricture or stenosis. Of the 9 patients who developed fistulas, all were at the base of the neophallus near the penoscrotal junction. In two cases, patients developed both a midshaft and penoscrotal fistula. Two fistulas healed spontaneously, and the remainder required surgical repair with one patient developing recurrence. One patient developed a stricture 5mm from the bladder neck after robotic vaginectomy which was refractory to balloon dilation requiring suprapubic tube placement.Conclusion: Use of the split gracilis muscle in first stage phalloplasty represents a novel approach of providing well-vascularized tissue for both urethral support and closure of intra-pelvic dead space with a single flap, in a safe, efficient, and reproducible manner. While fistulas are a common complication after 2 nd stage urethroplasty, they are detected rapidly and managed without complication in the majority of cases. Clinicopathological data were extracted from medical records. Primary outcome was BNC recurrence rate. Secondary outcome was changes to incontinence and other significant complications. Results: Ten men were included with a median age of 68 (IQR 62-71). The cause of BNC was radical prostatectomy in eight patients and endoscopic prostatectomy in two patients. The median number of endoscopic procedures for BNC prior to BNI and MMC injection was 3 (IQR 2-4). The median time between each endoscopic treatment was 2.5 months (IQR 1-7). We injected 0.8mg of MMC in two patients, 1mg in seven patients and 2mg in one patient. Seven patients (70%) had a successful outcome with a median follow-up of 12 months (IQR 10-22). Two men underwent a repeat procedure with one having durable response after 9 months. Both patients with urinary continence pre-operatively remained continent post-operatively.No Clavien-Dindo grade 3 or above complications directly related to MMC were recorded. Results: 8 strictures (57%) were bulbar, 2 penile (14%) and 4 pan-urethral (29%). 5 patients (36%) had obliterative strictures and were referred with a suprapubic tube in-situ; 5 (36%) presented with poor flow; 4 (28%) had recurrent urinary infections. In the 12 patients with strictures after transplantation, contributory factors to stricture formation were traumatic catheterisation and urinary tract infections. 2 patients had concomitant pancreatic transplants. In them, irritation of the urethral mucosa by pancreatic enzymes was the most likely cause. 7 patients (50%) underwent urethroplasty (2 non-transecting anastomotic bulbar; 1 augmented non-transecting bulbar; 2 dorsal patch augmentation bulbar; 2 single-stage pan-urethral with bilateral sublingual grafts). Surgery was successful in 6 of the 7 (86%). 3 patients were managed with perineal urethrostomy, 2 by interval urethral dilatation and the other 2 perform self-catheterisation. . Nephrectomy duration and warm ischemia time correlated inversely with case number (r=-0,686, p<0,001 and r=-0,485, p=0,019 respectively). According to the Clavien-Dindo system, 5 patients (23%) had grade 2 complications, and 4 (18%) grade 3 complications. Two patients lost the kidney (9%), one due to arterial thrombosis and another due to renal vein thrombosis.The rate of autotransplant success was 91% (n=20), and these kidneys presented normofunction during the all-time of follow-up. No significant difference was found between preoperative mean serum creatinine (Cr) (0,82 mg/dL) and postoperative Cr (0,81 mg/dL) at a mean follow-up of 33±19 months (p=0.89).In 53% patients there was a reduction in the mean arterial pressure, traducing in a lower number of anti-hypertensive agents or diminished dosages.Conclusion: LN is a feasible minimally invasive alternative to treat RAA with indication for autotransplant. It decreases morbidity, while presenting low complication rates and preserving renal function with excellent long-term results. The better surgical results with the increase in case number reflect the importance of referral for tertiary centers. DE Novo Malignancy After Kidney Transplantation 291 decompensation. Family income seemed to exert a protective effect on renal complications.Conclusion: Socioeconomic disparity and co-morbidities impacted negatively on renal and hepatic complications after KT in HBV+ ESRD patients, worsening particularly in renal counterparts, though short-term patient and kidney allograft survival in HBV+ recipients were comparable to HBV-recipient in contemporary era of potent NAs. The There was no effect on renal function in dominant side kidney donor compared to recessive side.Conclusion: There was no difference in renal function after dominant side kidney donor up to 10% when determining the donor aspect with the split renal function. Monitoring Introduction and Objective: Maintaining the balance between over-and under-immunosuppression has a critical role for successful immunosuppressive therapy after renal transplantation. We studied the predictive value of our functional immune assay, which works based on adenosine triphosphate (ATP) levels, in determining risk of infection and rejection among renal transplant recipients (RTRs). A total of 65 RTRs with less than 1 month (RTRL1) and 48 RTRs with more than 6 months (RTRM6) of post-transplant time, and 56 healthy individuals were included. Upon lymphocyte activation by phytohemagglutinin (PHA), CD4+ T cells were separated using magnetic beads (Dynabeads), the intracellular ATP (iATP) concentrations were measured by luciferin-luciferase reaction, and compared within and between the groups.Results: Activated CD4+ cells iATP production directly correlated with posttransplant time (r= 0.32, P= 0.011). The iATP levels were significantly lower in both RTRL1 and RTRM6 groups compared to control (P <0.001), and in the RTRL1 group compared to the RTRM6 (P <0.05). The iATP concentrations were significantly lower in patients who suffered from infection versus the RTRs with stable graft function (SGF). However, the iATP levels were higher in those with allograft rejection episode (ARE). Our optimization experiments showed that best iATP levels cutoffs were 472.5 and 572.5 ng/mL for predicting risk of ARE, and 218.5 and 300.5 ng/mL for predicting risk of developing infection in RTRL1 and RTRM6 patients, respectively.Conclusion: iATP levels measured by immune function assay might be a promising predictive tool for identifying RTRs who are at risk of developing infection or allograft rejection. Introduction and Objective: Kidney grafts with multiple arteries have been suspected to be associated with a higher incidence of vascular and urological complications and to affect subsequent renal function. We intend to compare renal transplant short and long-term outcomes between grafts with single versus multiple arteries. We analyzed retrospectively data from 219 living donors kidney transplanted patients between 2001 and 2018. Renal grafts were divided into 2 groups: 159 with single renal artery (SRA), and 43 with multiple renal arteries (MRA). Patient and graft survival were compared between these 2 groups using Kaplan-Meier survivorship curves and the results were compared using the log rank test.Results: Both groups were also comparable regarding acute rejection, post-transplantation hypertention, post surgery renal artery stonosis and urological complications. Only hemorragic complications and renal artery thrombosis were significantly higher in MRA: p value 0.027 and 0.003 respectively. Warm ichemia timewas significantly longer in MRA without any influence on the incidence of acute tubular necrosis (p= 0.2). Mean creatinine clearance at 1 year was 65 vs. 50 mL/min/1.73 m2 (p= 0.5). At 5 years, it was 60 vs. 55 ml/min/1.7 m2 (p= 0.1) respectively in SRA and MRA. Return to hemodialysis was necessary for 18.8% of the SRA group and 16.1% of the MRA group.Conclusion: The use of MRA allograft is a safe and successful surgical procedure, without influence on patient or graft survival and without increasing of surgical complications rate. Solid Tumors After Kidney Transplantation: About 5 Cases To measure the sexual functioning in our samples, we used Sexual History Form (SHF), which showed a statistically significant difference among the two groups in favor of control group (p < 0.05).Conclusion: Long-term follow-up of patients who have undergone hypospadias repair is still missing. We suggest that it is necessary to reveal possible complications that require further diagnostics and treatment, all in order to enable a normal psychosexual functioning in adulthood. Introduction and Objective: Trans-rectal ultrasound (TRUS) guided biopsy of the prostate has been reported to be associated with post procedural erectile dysfunction (ED). We evaluated the prevalence of ED post TRUS guided prostatic biopsy in our institution. Between September 2017 and December 2018, 526 patients who were scheduled to undergo systematic TRUS biopsy of the prostate were interviewed. The patients who reported being sexually active were recruited into our study. Biodata such as age, race, comorbidities and smoking history were collected. The International Index of Erectile Function (IIEF-5) questionnaire with an added SEP 2 question was adapted into the 4 main languages used locally. These were given to the consenting patients based on the language they were most comfortable with. They answered the questionnaire before undergoing the procedure and 2 weeks after.Results: 71 patients were sexually active and of these, 61 consented and completed the pre and post TRUS biopsy questionnaire. Overall, the mean pre TRUS biopsy IIEF-5 score was 15.44 (5-25), whilst the post TRUS biopsy IIEF-5 score was 15.34 (5-25). There was no statistically significant difference between these two means (p= 0.9178). Of all these patients, only one patient reported a drop in IIEF-5 score, which met the minimal clinically important difference (MCID) criteria of 4 points in the EF domain. Two patients reported a drop in IIEF-5 score post TRUS biopsy. Five patients reported severe ED, 10 had moderate ED, 19 had mild to moderate ED, and whilst 19 had mild ED. Eight patients did not have erectile dysfunction prior to the biopsy. There was also no statistical difference between the pre and post procedural mean IIEF-5 score in the mild (p= 1), mild-moderate (p= 0.0748), moderate (p= 1) and severe (p= 0.5796) pre procedural ED groups. There was also no change in the pre and post TRUS biopsy SEP2 domain, with all 45 patients who were able to have penetrative vaginal intercourse prior to the biopsy remaining so.Conclusion: Trans-rectal ultrasound guided biopsy is not associated with post procedural erectile dysfunction. Male Materials and Methods: Forty-two consecutive male patients underwent weight-losing surgeries during the period between February 2013 to July 2016. They were contacted by phone on July 2018, and then the International Index of Erectile Function (IIEF) short version (SHIM) was mailed to them. Unmarried patients were excluded from the study. We added questions regarding the use of phosphodiesterase inhibitors, the feeling regarding the sexual function before and after surgery, as well as his fertility post-surgery. All data were analyzed using specific statistical tests and SPSS package version 20.Results: One patient was excluded from the analysis. Thirty patients responded completely to the survey. Their mean age was 41.9 years (range 26-62), and mean preoperative BMI was 46.3 ±7.5 with a significant reduction postoperatively to a mean of 30 ±5.5. IIEF score improved and the overall satisfaction and feeling better was 76.7%. Only 16.7% needed PDEI before intercourse after the operation. Thirteen (43.3%) patients had children after the operation. Univariate and multivariate analysis showed that age was a significant factor in association with both erectile function and fertility after bariatric surgeries (p= 0.02). Fertility was better in patients who underwent laparoscopic sleeve gastrectomy than gastric bypass surgery (p= 0.005). The weight-losing surgeries have a significant effect on the erectile function, and they improve patient sexual satisfaction. Most of these patients feel better sexual function after bariatric surgeries. Fertility seems to have a relationship with the type of surgery. However, a larger sample size and further studies are needed to clarify this point. The purpose of this is to assess the effect of the penile lengthening technique by division of the penile suspensory ligament. From September 2017 to January 2019, a total of 2328 penile augmentation surgeries were analyzed for this article. In total, 2328 patients with a variety of etiologies were included. Of these, 1247 patients underwent division of the penile suspensory ligament in our clinic's ingenious way, 5-points permanent fixation. According to the extent of the division of penile suspensory ligament, we classified into the three groups. The outcome was assessed objectively based on increase in flaccid stretched penile length (SPL). The post-operation mean increase in SPL of 1081 patients (group 1) without division of the penile suspensory ligament was 1.5 ±1.2 cm (range, 0 to +4.5 cm). The post operation mean increase in SPL were 3.0 ±1.2 cm (range, 0 to +5.5 cm) in group 2, 3.2 ±1.0 cm (range, -0.5 to +7.0 cm) in group 3 and 3.3 ±1.1 cm (range, 1 to +7.0 cm) in group 4, respectively (p <0.05). The overall patient satisfaction rate was 75% and no one had other critical side effects.Conclusion: Division of the penile suspensory ligament or other augmentation techniques may increase penile length. Suspension ligament incision tends to be reluctant to be decreased angle at the time of erection, However, in this study, there was no such anxiety of the patient and it proved to be a satisfactory technique for lengthening the flaccid state of penis. Evaluation outcomes than conservative therapy, surgery is not suitable for all patients with PD. Therefore, oral therapy for PD is still a frequently used treatment due to low cost, convenience and limited side effects. However, current literature on the efficacy of oral therapy in PD is inconclusive. Pentoxifylline and colchicine have both shown some promise though further studies are required to confirm their effectiveness. Our aim is therefore to assess the effect of oral therapy for PD including pentoxifylline or colchicine coupled with the Andropenis® penile traction therapy (PTT) extender on degree of penile curvature and plaque size. June 2018, a prospectively collected database for patients receiving oral therapy for PD (pentoxifylline and/or colchicine) was reviewed. Perioperative data were compared at baseline and after 6 months of treatment, including degree of curvature, plaque size and penile doppler ultrasound parameters (peak systolic velocity, minimum diastolic velocity, pulsatility index). PTT was applied by the patient for a total of one hour per day for 6 months. The study aims to share our clinical experience in management of penile fracture, its complications and specifically highlights the impact of time delay on postoperative outcome in patients presenting with penile fracture. The study is a prospective observational study conducted from July 2007 till January 2017. All the patients presenting to the emergency with a clinical presentation of penile fracture and a tear in the tunica albuginea of the penile cavernosal tissue, (confirmed on ultrasound) were included in this study. Intraoperative and postoperative data were analyzed. The study enrolled a total of 77 patients and most common cause for fracture noted was coitus. The average time delay from the time of insult to presentation to the emergency department was 25.11 ± 12.48 hours. The parameters that have significantly been altered by a time delay of more than 24 hours include post-operative wound infection, erectile dysfunction at 1 year and post-operative hospital stay. Two patients developed chordee at 6 and 9 months respectively, and both patients delayed beyond 24 hours. Also, all patients with hematoma size on color Doppler of more 10 cc and intraoperative tear >10 mm had developed post-operative wound infection. Patients with urethral injury, post-operative cavernositis or wound infection had significant association with erectile dysfunction.Conclusion: Penile fracture although a rare urologic emergency has a significant impact on sexual health of a young man. An early intervention along with identifying and managing early complications factors would definitely help patients of penis fracture lead an almost normal sexual life. Results: Priapism was seen in 47 hematological patients, out of which 35 were CML cases, 9 had sickle cell disease and 3 were having polycythemia vera. The most highlighting aspect was that 15 among the 47 patients (31.91%) presented priapism as the first clinical manifestation of their underlying hematologic disorder. One patient of CML died before any surgical intervention. Erectile function was preserved in those 2 CML patients who were presented and treated within 24 hrs. One polycythemic patient who did not respond to HU and phlebotomy has undergone shunt surgery.Conclusion: The management of priapism in patients of hematological disorders should involve an integrated approach, as missing even a single case of hematologic disorder presenting with priapism will have disastrous implications. Urologists need to have a broader outlook in management of priapism. The aspect of this sexual dysfunction is very variable according to the sex, so in the male population the erectile dysfunction was observed in 35.3%, 9.8% for the function of the desire, 15.7% for the orgasmic function, 19.6% for the satisfaction with sexual intercourse and 17.6% for overall satisfaction of sexual function. In the female population, dyspareunia was the most common sexual dysfunction in 53% of cases. In the male population, creatinine clearance at the time of the study (p= 0.04), diabetes (p= 0.041), treatment with cyclosporine A (p= 0.038) and depressive disorders (p= 0.026) ) were factors associated with a high risk of erectile dysfunction with significant prevalence values. In the female population, depression was the only factor associated with a high risk of sexual dysfunction after renal transplantation (p= 0.019). Conclusion: Sexual problems in patients with chronic kidney disease should be considered as a major health problem. Strategies should be developed to incorporate the sexological assessment into the standard clinical follow-up program for these patients. Male Results: In the first group, the functional dimension of sexuality was positive with an overall score of 81%, the sexual discomfort score was assessed at 26 % and the sexual satisfaction score was 77%. In the second group, sexual function was considered conserved in all cases with a satisfaction score estimated at 98%. These patients reported a feeling of well-being following the disappearance of urinary incontinence with integrity of their body images. In contrast, in the last group, relatively impaired sexual function was noted (65%) with a satisfaction score estimated at 59%. These disorders were multifactorial, mainly related to neurological causal pathology.Conclusion: To our knowledge, this is the first study about male sexuality in patients with a continent urinary diversion type Mitrofanoff. Marital status has a major role in the sexuality of these patients. A prospective study with pre-and postoperative evaluation will better clarify the factors affecting sexuality in these patients. Stem Results: Upon cavernosal nerve stimulation 4 weeks after nerve injury and ADSC injection, the peak ICP/ MAP ratio of the rats in Group A (ADSC) demonstrated improvement in the graphical analysis of the data in comparison to Group B (control) . The statistical analysis (P=.16) for the reviewed groups did not reveal great improvement.Conclusion: Previous work suggests that ADSC has resulted in the recovery of erectile function in rats with ED. The mechanism of this effect may be paracrine or by stimulation of own cell to regenerate. This novel therapy can offer a minimally invasive option using the patient's own cells to treat the devastating complication of ED after radical prostatectomy. Low Intensity Shock Waves to Treat Erectile Dysfunction: Is it Safe for Patients Treated with Anticoagulants?Kalyvianakis D, Memmos D, Mykoniatis I, Kapoteli P, Hatzichristou D Introduction and Objective: A large proportion of patients with vascular erectile dysfunction present a history of cardiovascular disease and are under anticoagulation or antiplatelet therapy. The aim of the study is to test the safety of low intensity shockwave therapy (LiST) in this group of patients.Materials and Methods: Data were collected from two randomized clinical trials conducted by our research team and a pooled analysis was performed.The studies followed the same design and moreover the same shockwave machine (Dornier Aries 2) and the same application technique were used. Of the 138 patients who participated in both studies 35 were under single (n = 31) or double (n = 4) anticoagulation/ antiplatelet therapy. These patients, according to the study they participated, were exposed to 6 (n = 2), 12 (n = 29) or 18 (n = 4) LiST sessions, using energy of UNMODERATED ePOSTERS 298 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK 0.05 mJ/mm2 (n =23) or 0.1 mJ/mm2 (n = 12). Before and after each treatment session, patients were screened for bleeding events (clinical examination, medical history). Also, penile ultrasound was also performed on all patients during the 1 st and 3 rd month follow-up visit.Results: None of the patients reported symptoms related to the treatment. No evidence of a bleeding event was found and the penile ultrasound was normal after even 18 sessions with frequency up to 3 times a week.Conclusion: LiST to treat erectile dysfunction seems to be a safe and well tolerated method in patients under anticoagulation/ antiplatelet treatment Assessing There was no statistically significant difference in the change of all outcome measures from baseline to 6-month FU visit between different frequency or EFD groups (Table 1) . No treatment-related side effects were reported. The frequency per week of LiST does not have any impact in the efficacy and safety when delivered within 6 weeks without a 3-week break period. Higher EFD (0.096 mJ/mm 2 vs. 0.05 mJ/mm 2 ) is associated with a trend for improved efficacy without any safety concerns. The urethral trauma was not classified. 6 (50%) patients underwent anastomotic urethroplasty and 6 Direct visual internal urethrotomy with an average of 3 DVIU reviews. All of the patients had normal voiding functions, normal penile duplex ultrasonography but none has any pre-surgical evaluation of erectile function. Conclusion: Erectile dysfunction is common in victims of PFUI and can persist over so many years. It is mostly neurogenic but can also be psychogenic or mixed. A realistic expectation of erectile dysfunction should be discussed with the patient as soon as possible after injury, and early penile rehabilitation considered after healing of the trauma. Results: At 6 months compared with the preoperative data, there was a significant improvement in PFDI-20 total mean score (15 vs 86,1 P < 0.05). At 12 months, the improvement remained significant (10,2 vs 86,1 P < 0.05) for all scores compared with the preoperative scores. But there was no difference between results at 6 months and those at 12 months. The results showed a significant improvement in the PFIQ-7 score at 6 (12.2 vs 111.4, P < 0.05) and 12 months (7.2 vs 111.4, P < 0.05). Again, there was no significant difference between the scores at 6 months and those at 12months. The total PISQ-12 score was linked significantly to pelvic symptoms (P < 0.05) but not with urinary symptoms andano-rectal ones. At 6 months, the total mean PISQ-12 score had improved significantly compared with the preoperative score (35.1 vs 22.3, P < 0.05). The total mean score remained significantly improved at 12 months (34.8 vs 22.3, P < 0.05) and there was no statistical difference compared with the results at 6 months. Conclusion: Laparoscopic sacrocolpopexy resulted in the early improvement (primarily during the first 6 months) of all symptoms, HRQL and sexual function. This improvement was persistent in the medium term. Penis , preoperative quality of life < 2 (QoL visual scale from delightful equals 0 to terrible equals 6) and absence of diabetes, cardiovascular disease or metabolic syndrome.One month after the operation all patients received Vitaros TM twice a week and re-evaluated after 3 and 6 months.Results: One month after the operation, without any treatment, only 2 patients reported spontaneous erection (mostly tumescence, not rigid erections) and no one having sexual intercourse.After 3 months period of intraurethral administration of Vitaros TM , mean IIEF5score was 15 from 23 preoperatively, mean EHS score was 2.5 from 3.2, the numberof weekly sexual intercourses was 1.2 from 2.3, 61% had a positive SEP2 and 54% apositive SEP3 response and the QoL score was increased to 2.8 from 1.6. At the endof the first 3 months, 5 patients discontinued (due to economic reasons or severe pain). After another 3 months, total 6 of Vitaros TM usage the mean IIEF5score was 19, mean EHS score was 3.1, the number of weekly sexual intercourseswas 1.6, 73% had a positive SEP2 and 68% a positive SEP3 response with QoLscore decreased to 2.2. At the end of the evaluation, 1 more patientdiscontinued due to economic reasons and 3 switched to tri-mix injection therapydue to poor response to Vitaros TM (2 of them did not respond also to penileinjections as well). The intraurethral use of alprostadil cream (Vitaros TM ) after RARP for rehabilitation reasons seems to be a promising alternative to the well-established use of PDE5Is or intracavernous injections in well-selected patients. Role of Physical Tenderness in the Elderly's Sexual Activities Gas Containing Partial Staghorn Renal Stone: A Case Report and Literature Review Changi General Hospital, Singapore, Singapore Introduction and Objective: Gas containing renal stones are very rare. There are only 9 cases reported in the literature worldwide. We aim to describe the clinical presentation, microbiological and radiological findings of the case and a review of literature. A 92-year-old Chinese Female presented with fever and urinary tract symptoms. Complete blood count revealed no leucocytosis but procalcitonin was markedly raised at > 100 microgram/L. Urinalysis showed hemopyuria and urine culture grew Escherichia coli. Her renal function, calcium phosphate uric acid levels were within normal limits. Initial abdominal radiograph revealed no radio-opaque calculus. She was empirically treated with intravenous piperacillin-tazobactam. An uncontrasted CT kidney-ureter -bladder showed a gas containing large partial staghorn stone measuring 5.2 x 3.4 x 2.6 cm within the right renal pelvis. There was no significant perinephric fat stranding or hydronephrosis.Results: She responded well to antibiotics and was afebrile after two days of antibiotics. Her inflammatory markers were downtrending. A CT urogram was performed one day prior to her discharge showed the stone was stable in size. There was no renal abscess, hydronephrosis or evidence of pyelonephritis. She was discharged upon completion of two weeks of intravenous antibiotics.Conclusion: Gas containing renal stones are very rare. Aggressive antibiotic therapy in carefully selected patients coupled with surgical intervention, when necessary can lead to excellent outcomes. Co-relation of type of renal stone with Histopathological examination and appearance of renal papilla. Conclusion: This study gives clue regarding separate mechanisms in non-oxalate types of stone formation which results in characteristic visible papillary changes and proves the safety and feasibility of papillary biopsy without any morbid complications. Studying the histological examination of papillary tissue may provide a clue about the nature and level of deposition of crystalline material and may help in long term understanding the mechanism of stone formation. 303 ment. Group 1 received stress balls to squeeze during treatment as an adjunct to standard of care. Group 2 were provided headphones to listen to music during treatment as an adjunct to standard of care. Group 3 received standard of care treatment. All patients completed a validated health anxiety inventory score prior to treatment. All patients completed a validated pain questionnaire and visual analogue score (VAS) after treatment. Primary outcomes were completion of ESWL treatment and pain score results. Results: Fifty-two patients were randomised as outlined above. There was no significant difference between groups in terms of size or position of stone, presence of a stent and body mass index. One patient in the control group stopped treatment early due to pain. VAS was significantly lower in controls compared to Group 1 (1.93 vs 3.69 p= 0.08). On subgroup analysis of non-anxious patients, pain questionnaire scores were significantly lower in controls compared to Group 1 (2.58 vs 4.77, p= 0.06). On subgroup analysis of patients who received stress ball distraction alone compared to patients who received oral analgesia, VAS was significantly lower in controls (4.07 vs 1.92, p= 0.05). Across all subgroups pain scores tended to be lower in the control group compared to the distraction groups, but did not achieve significance. Prophylactic Antibiotics in the WHO Checklist Chau E, Coscione A, Acher P, Young T, Pietrzak P Introduction and Objective: Prophylactic antibiotics are essential in endourology to reduce the risk of post-operative urosepsis. These regimes are tailored to each patient according to prior urine cultures and sensitivities resulting in a variety of different agents such as gentamicin, co-amoxiclav, meropenem, amikacin, teicoplanin, and combination therapies. The required antibiotics are agreed during the team brief prior to the start of the operating list. As part of the "time out" within the WHO checklist, the administration of antibiotics is confirmed by the anaesthetic team. However, this check point does not require verification of whether the correct antibiotics have been given. This audit aims to assess how often the antibiotic regime given prior to the start of surgery matches those agreed at the team brief. were compared to what was given prior to the start of surgery over a 2-month period for endoluminal endourology lists. The agreed antibiotics were recorded prospectively and subsequently compared to scanned anaesthetic records. This project was registered as a clinical audit and was exempt from ethical approval.Results: A total of 64 cases were identified, 2 did not have scanned records at the time of data collection and were excluded. 24 cases (38.7%) required complex antibiotic regimes (more than 1 agent). Seven cases were identified where the agreed antibiotic regime had not been given prior to the start of surgery; this comprises 11.3% of all cases and 29.1% of those requiring complex antibiotic regimes. The variety and complexity of antibiotic regimes used in endoluminal endourology likely increases the susceptibility to errors. This risk is amplified in the context of high turn-over of cases, changes to the order of operating lists and rotating theatre staff who may be unfamiliar with endourology. We propose an adaptation to the WHO "time out" to include verification of the antibiotics in the setting of endoluminal procedures to improve patient care and reduce the risk of post-operative urosepsis. Diet In first time stone formers, it is recommended that serum corrected calcium (+/-parathyroid hormone) and urate is ordered as part of the initial serum investigations to determine if adjunct pharmacologic management or parathyroidectomy is required. Currently as part of this initial screening process, the utility of serum calcium and urate in determining further adjunct management is unknown. The aim of this study was to determine the effectiveness of these routine serum investigations in the management of first time stone formers. A retrospective chart review was conducted of all first time stone formers that underwent definitive stone management at a Melbourne metropolitan centre. Patient demographics, serum calcium and urate levels and stone analysis findings were collected. If high risk features were present (such as multiple stones), a 24 hour urine collection was also performed. The primary outcome was need for adjunct management.Results: Thirty-six first time stone formers underwent definitive stone management between July and September 2018. The median age was 49 years old. All patients had a serum calcium and urate. Three patients (11%) had hypercalaemia and of these one patient had primary hyperparathyroidism (with a normal 24 hour urine collection) requiring a parathyroidectomy. There were no cases of hyperuricaemia. Twelve patients (33%) who were deemed high risk also had a 24 hour collection. All patients who underwent a 24 hour urine collection had a risk factor identified with the most common being low daily urine volume (less than 2 litres). All of these patients had specific dietary modification and 2 patients started adjunct medical therapy for hypercalciuria. Mini Percutaneous Nephrolithotomy with Clear Petra ® Suction-Evacuation Access Sheath: An Initial Experience Efthimiou I, Chousianitis Z, Kritikos N, Maliou C, Vergi C, Skrepetis K Introduction and Objective: Percutaneous nephrolithotomy (PCNL) in supine position is being performed for more than 25 years. Modifications of initial position and introduction of miniaturized nephroscope facilitated even more dissemination of this technique. A recent development constitutes the Clear Petra® Suction-Evacuation Access Sheath which permits the evacuation of stone fragments spontaneously under suction. Herein we present our initial experience with the use of this new technique. We retrospectively studied 12 patients with mean age 55 years (range: 34-78 years) that underwent mini PCNL. All procedures were carried out in the modified Valdivia-Galdakao position, using a 16 Fr Clear Petra® Access Sheath and a 12 Fr MIP-M Nephroscope (Karl -Storz). Initial puncture was done under ultrasonic and fluoroscopic guidance. Lithotripsy was achieved through Holmium laser in all cases. Stone-free rates were assessed postoperatively and one month after the procedure with KUB and renal ultrasound. Patients considered stone free (SF) if there were no residual fragments >4 mm. The variables of surgery duration, stone-free rate, hospital stay, complication rates and ancillary procedures were evaluated.Results: Eight cases had single stone and 4 cases multiple calculi. Mean aggregate stone diameter was 18 mm (range: 14-30mm). All the cases had a single puncture (9 cases in the lower calyx and 3 cases in the middle calyx). Mean operative time was 70 min (range 65-180) and mean hospital stay was 2.7 days (range: 2-4 days). Stone extraction was achieved in 83%(10/12) with suction only. Two cases required complementary use of basket for complete stone removal. At the end of the procedure a reentry Malekot catheter 16 Fr was placed in 11 cases and a Council catheter 16 Fr with a 6 Fr double-J stent in one case. Four cases required postoperatively a flexible nephroscopy to achieve complete stone clearance. Overall SF rate after the first month was 92% (11/12 cases). There were no major complications and none of the patient required blood transfusion. Two patients developed fever and were managed conservatively. Mean drop of haemoglobin was 0.9 g/dL (range: 0.4-2.1 g/dL). Mini PCNL with Clear Petra® Suction-Evacuation Access Sheath is a safe and effective treatment modality for the management of nephrolithiasis. This technique, also, appears to be suitable for large kidney stones, with known advantages of the supine position. Managing We prospectively enrolled patients with renal uric acid stones who received K citrate from 2013-2018. Patients demographics were collected. All patients were evaluated using non-contrast CT scan to measure the stone size and density. JJ ureteric stent was inserted prior to the initiation of treatment. At follow up, all patients underwent urine analysis for pH and to detect UTI. CT was repeated at one month and those patients who showed incomplete stone resolution underwent repeated course of treatment for another month. CT was repeated prior to stent removal. The presence of encrustations was inspected and collected using the modified encrustation score. We collected 59 patients with a median age of 36 years (18-73) and median stone burden of 26 mm3 (15-50). The median stone density was 310 HU (175-498). Twenty-one patients (35.6%) received potassium citrate treatment for one-month while the remaining patients had 2 months of treatment. Sixteen patients (27.1%) had a complete stone dissolution, 41 patients (69.5%) had more than 50% decrease of stone burden while only 2 patients (3.4%) had stones with poor dissolution. Four patients (6.8%) experienced UTI while 2 patients (3.4%) had visible JJ encrustations. Most of these complications occurred when the treatment was offered for a second month.Conclusion: Short-term use of ureteral stents is safe during management of uric acid stones with potassium citrate. Staghorn Calculi Treated by Flexible Ureteroscopy is a Challenging Performance -Experience of an Academic Single Center Geavlete P, Multescu R, Stan M, Georgescu D, Bucur C, Geavlete B Introduction and Objective: Following the technological progress, the actual indications of flexible ureteroscopy are continuously improved. The aim of our study was to evaluate the efficacy and safety of this procedure in staghorn calculi (complete and incomplete). We retrospectively analyzed the efficacy and morbidity associated with flexible ureteroscopic approach in 55 cases of staghorn calculi (7 complete and 45 incomplete), struvite (composed of magnesium, ammonium, and phosphate) related to urinary tract infection in 87% of cases (Proteus, Klebsiella and Pseudomonas) and 11% calcium phosphate, 39 cases with Type 1 staghorn <5000 mm3 total stone volume (TSV) and <5% unfavorable calyx stone percentile volume (UFCSPV); 11 cases with Type 2a 5000-20,000 mm3 TSV and <5% UFCSPV and 5 cases with Type 2b <20,000 mm3 TSV and >5% UFCSPV. The success of the procedure was defined as presence of residual stone fragments of less than 3 mm. Patients required a single procedure in 7 cases, two procedures in 28 cases, three procedures in 18 cases and four procedures in 2 cases. Complications rate was 19.1%, similar to the general one associated with flexible ureteroscopy in our experience. Clavien I and II occurred in 14.7% of cases, while Clavien III occurred in 4.4% of cases. No Clavien IV and V complications were registered.Conclusion: Flexible ureteroscopy is a possible alternative to percutaneous access in staghorn calculi treatment. Its efficacy seems to be good, but depends of the patient preference (acceptance of multiple procedures), stone composition, high stone centers and experience of the endourologist. Guddeti RS, Chawla A, Thomas J, Hegde P Introduction and Objective: Ureteral stent placement is a common procedure in urologic practice. Though there has been no definition for "forgotten" as any such term does not exist, but many previous studies consider a variable period of greater than 3 to 6 months to constitute a forgotten stent. Forgotten DJ stent can lead to encrustation, infection, migration, hydronephrosis and fragmentation. Forgotten, encrusted ureteral stents represent a difficult problem for urologists, and a consensus on the best therapeutic approach is lacking. We present our experience with endoscopic management of this challenging problem and discuss the chosen treatment combinations.Materials and Methods: Total 6 patients with forgotten double J stent at urology department of the tertiary teaching hospital from October 2018 to March 2019 were included in this retrospective study. The details reviewed included the indwelling time, presenting complaints, radiological and laboratory investigations, their management techniques and complications of the interventions.Results: Five were male while 1 was female with mean patient age of 38.83 years. Most common presenting complaints were loin pain and fever. Four patients had completely encrusted stent with significant sized calculus formation at the ends of stent in bladder and kidney with encrustation in ureter, while two had broken stent with the parts of stent surrounded by calculus formation. One patient was diagnosed with pyonephrosis. All cases were completely cleared off the stent and calculi using combined endourological techniques of cystolithotripsy, URS and PCNL. After stent removal one patient developed sepsis. Biochemical analyses of stent encrustations revealed that encrustations consisted mainly of calcium oxalate, calcium phosphate and ammonium magnesium phosphate.Conclusion: Imaging evaluation and documentation of negative urine culture are imperative prior to any attempt to remove the stent. The use of various combinations of endourological techniques can achieve effective stent and stone treatment after a single anesthesia session with minimal morbidity and short hospital stay. Stent register, computer-based tracking system along with patient education is the key to ensure safety in developing countries. To compare the operative outcomes in patients undergoing laser lithotripsy using a ball-tip versus flat-tip laser fibre. A prospective comparative study was performed comparing the usage of ball-tip (Boston Scientific TracTip TM ) to flat-tip (Boston Scientific, LightTrail TM ) laser fibres for patients undergoing lithotripsy for renal tract calculi at the Canberra Hospital, using the Boston Scientific Auriga XL. Operative outcomes analysed included operative time, laser fibre damage, and the number of laser pulses used, as well as 30-days complication rates and the need for follow up relook pyeloscopy. In addition, we examined the ability of the fibres to pass down disposable flexed ureteroscope, post-operatively. Data were analysed using SPSS 24.0.Results: Sixty-seven patients were included in our prospective study with a mean age of 54.3 years, 36% of patients were female. The average number of stones treated per patient was 2.6 with a mean burden of 16.8 mm. Sixty-one percent of the cases contained lower pole renal calculus. There was no significant difference between patient demographics or stone characteristics between the two groups. There was a significant difference in laser fibre damage incidence (p= 0.008) with a larger degree of burn back length in the flat-tip fibre group (p= 0.02). The burn back length in the ball-tip fibre group was 0.4 mm (range 0-6 mm) compared to 1.6 mm (range 0-2.2 mm) in the flat-tip fibre group. There was no statistical significance in operative outcome or complications in both groups. We noted a tendency of difficult flexed ureteroscope insertion of the flat-tip fibres with a statistically significant rate of fibre breakage (p= 0.03). The ball-tip laser fibre was more robust and results in less fibre damage during laser lithotripsy without compromising operative outcomes for patients. To know the consequences of post op complications and stone free rates. We retrospectively analyzed 128 procedures in patients with ureteral stones who underwent URSL between January 2015 and September 2018. Maximum UWT at the stone site and Hounsfield units of ureter wall above and below stone was measured from computed tomography images. Clinical predictors of impacted stones were assessed using univariate and multivariate logistic regression analyses. Moreover, we evaluated the association between UWT and endoscopic findings, as well as surgical outcomes.Results: Of the total procedures, 37 (28.9%) patients had impacted stones. The univariate analysis showed significant differences in hydronephrosis, stone location, stone volume, Hounsfield units of ureter below stone, and UWT in patients with and without impacted stones, and the multivariate analysis showed that stones in the middle ureter, and UWT (P < 0.01) were independent predictors of impacted stones. The receiver operating characteristic analysis showed that 3.61 mm was the optimal cut-off value for UWT. High UWTs and Hounsfield units of ureter wall below stone were associated with the presence of ureteral edema, mucosal erosions and bleeds, stone fixation, longer operation times, and higher stone retropulsion rates, as compared with non-impacted stone group.Conclusion: High UWT and Hounsfield units of ureteral wall below stone was associated with a higher risk of impacted stones and poor endoscopic results in ureteral stones undergoing URSL. Further research is needed on multi-centeric basis as well. This study demonstrates the feasibility of a non-opioid postoperative protocol even in acute setting in recovery for those undergoing URS in carefully selected patients. There should be such studies on other urologic procedure as well in future to look for Non opioids and even NSAIDS free pain killers. Karafotias A, Prifti F, Pericleous S, Eleftheropoulos I, Konstantinides C, Delakas D Introduction and Objective: Percutaneous nephrolithotripsy (PCNL) is the surgical therapy of choice for staghorn stones. However, the presence of residual lithiasis after PCNL is not rare. We studied the safety and the efficacy of extracorporeal shock wave lithotripsy (ESWL) as a complementary treatment for residual nephrolithiasis following PCNL. The data of 72 patients undergoing PCNL followed by ESWL for the treatment of residual nephrolithiasis were studied. All patients were divided in three groups according to the location of the residual stones. Forty-six cases involved patients with stones in the upper calyx group, 15 in the middle group and 11 in the lower group. The average size of the residual stones was 8mm (range 7-12 mm), while among 35 of all the patients were detected with 2-3 stones. Lithiasis composition based on post-PCNL stone analysis was mainly calcium oxalate (50%) and struvite (35%).Results: In 48 cases, automatic stone expulsion was observed after ESWL. Of these, 35 were stones located to the upper calyx group, 11 of the middle and 2 of the lower group. Complications were reported; in one case, perirenal hematoma requiring hospitalization was diagnosed, in 5 cases urinary tract infections which were treated with pos antibiotics and in 11 cases macroscopic hematuria consistent for over 2 days. Fourteen patients required additional treatment with ureterolithotripsy after a month period.Conclusion: Using the ESWL in the treatment of residual nephrolithiasis after PCNL is considered to be a safe and effective method, mainly for upper and middle calyx group stones. The incidence of macroscopic hematuria and the risk of renal injury appear to decrease as long as both treatment methods are spaced longer than 3 weeks. Safety We compared perioperative outcomes in patients undergoing flexible ureterorenoscopy for kidney stones with or without anticoagulation. We reviewed the records of 167 patients on anticoagulation with Coumadin, clopidogrel or aspirin undergoing flexible ureterorenoscopy for kidney stones from July 2013 to July, 2018. Patients who continued the medications at perioperation comprised the control group (Group A) and who discontinued the medications at least a week before surgery comprised the control group (Group B). The 2 groups were compared with regard to the operative time, the stone-free rate, hematuria and intraoperative and postoperative complications. The 2 groups were matched for stone size, stone location, stone composition and ASA score. Group A has longer operation time (50.0 vs 44.0 min, P = 0.020). No procedure had to be terminated in the anticoagulation group due to poor visibility from bleeding. There were no patients in both groups who needed blood transfusion. There were no major bleeding complications in the two groups during the perioperative surgery. There was no significant difference in stone clearance within the three subgroups, Group A and Group B (89.5% vs 85.2%, P = 0.826). Flexible ureterorenoscopy holmium laser lithotripsy may be the best option for kidney stones in patients on anticoagulation therapy without the need for perioperative manipulation. Safety Bilateral simultaneous tubeless MiniPCNL is a safe and effective in treating bilateral stones disease in single anaesthesia in selected cases. But the larger number of cases are needed to be studied to further confirm the efficacy of bilateral tubeless miniPCNL. Ureteral Wall Thickness is Predictive Factor for Ureteral Impacted Stones Inclusion criteria were HSK with stones larger than 2 cm, lower calyceal stones and other failed endourology treatments. Stone location, operative time, fluoroscopy time, mean hospital stay, stone free rate (SFR) in one month evaluated by C.T. and auxiliary procedures were analyzed. Results: Mean age was 46,6 ±12,3 years. Mean stone maximal diameter was 2,9 ±1,2 cm. Four patients had staghorn stones, 5 patients had pelvic stones and 2 patients had lower calyceal stones only. Access was obtained with simultaneous use of ultrasound and fluoroscopy through the upper calyx in all cases. Fluoroscopy time and operative time were 105 ±44 seconds and 93 ±29 minutes. Flexible nephroscopy was performed in 5 patients. Mean hospital stay was 4 ±2 days. SFR was 72,7% in a single session, 2 patients received a second PCNL and 1 patient had flexible ureteroscopy. The mean Hgb drop was 34 ±8 gr/dL. Three (27,2%) patients had fever and 2 patients required blood transfusion after the procedure.Conclusion: Despite altered calyceal orientation, PCNL in the Galdakao Modified Supine Valdivia position in horseshoe kidney seem a feasible and safe procedure considering its high SFR and short operative time. Early Experience with Mini Percutaneous Nephrolithotomy in a Single Centre Oliyide A, Sihra N, Counsell A, Lynch N, Gall Z, Adeyoju A Introduction and Objective: Although recognised for its good stone clearance, conventional percutaneous nephrolithotomy (cPNCL) is associated with a significant degree of morbidity in terms of blood loss, need for transfusion, analgesic requirements as well as a significant length of stay. The aim of this study was to document and evaluate the introduction and early experience of mini-percutaneous nephrolithotomy (mPCNL) using the 12 Fr in the treatment of renal calculi in a single centre (Stepping Hill Hospital). We enrolled consecutive patients who underwent mPCNL from March 2016 to September 2017. This followed the introduction of the mPCNL Karl Storz kit. Data on patient position (PP), number of punctures (NP), puncture location, stone clearance, post operative drainage (POD) and length of hospital stay (LOS) was recorded and analyzed.Results: Twenty-four patients underwent 25 mP-CNL procedures. Mean age was 56.8 years with mean stone size being 13.7 (7-16.6) mm. PP was the Galdakao-modified Valdivia supine position in all patients and mean NP was 1.1 (1-3) . Most punctures were made in the lower pole calyx (81.3%). Four patients had completely tubeless procedures, four were stented while the rest had ureteric catheters which were removed within 24 hours. No transfusion was recorded. Mean LOS was 1.2 days (1-2) and 88% were documented as being stone free at the end of the procedure.Conclusion: The MIP system performed in the supine position has many advantages over conventional PCNL (cPCNL). There is reduced risk of blood loss and reduced length of stay, while preserving the ability to perform flexible nephroscopy. Several anaesthetic, patient and surgeon benefits are also realised. A greater ease in performing tubeless procedures is also confirmed. It's been shown here to be a safe, useful and effective alternative to cPCNL or an adjunct to ureteroscopy. Would the 4.5 Fr. Semirigid Ureteroscope Overcome the Regular 6.5 Fr. Ureteroscope in Upper, Middle or Lower Ureteric Stones? Introduction and Objective: The aim of the study was to compare the safety and efficacy of a 4.5 Fr uretero-scope (43 cm) with a 6.5 F ureteroscope in the treatment of upper, middle and lower ureteric stones. Ninety-eight patients with the first episode and failed medical expulsive therapy of a ureteric stone were randomized into two groups according to the type of ureteroscope used: group 1 (Wolf 4.5 F) and group 2 (n = 56, Wolf 6.5 F). We collected patient's demographic and stone characteristics, intraoperative and postoperative outcomes including stone clearance rate, need for auxiliary procedure and incidence of complications.Results: Fifty-three patients underwent ureteroscopy in group 1 while fifty-six in group 2 with mean patient age 45 ±23 years. The mean stone-free rate was 92 % for group 1 and 79% in group 2 with an insignificant difference (p= 0.06). However, when compared between patients with BMI <31, groups 1 showed a higher success rate (95%) in comparison to group 2 (68%) with (p= 0.001). Conclusion: The 4.5 Fr ureteroscope showed better outcomes for treatment of ureteral stones especially those with BMI <31. We recommend the use of the 4.5 ureteroscope, especially in those with slimmer bodies and lower BMI. Catching Kidney Stones: A Novel Tool for Patient Use Introduction and Objective: Kidney stone disease is a common diagnosis with high recurrence rates. In many cases, kidney stones that are passed are not collected for analysis due a lack of an appropriate collection device. Analysis of kidney stones can help by reducing the risk of repeat episodes and in guiding treatment. Currently there is no consistent or reliable device to give to patients in order to catch stones for analysis. The 'Kidney Stone Catcher®' has been created as a medical device to capture kidney stones. It provides a simple and discreet methodology to 'strain' urine, as it streams, through a stainless-steel mesh 'catcher' . The primary objective of this study is to determine the convenience, ease of use and practicality of the device as per patient satisfaction questionnaires. Materials and Methods: Ethics approval was obtained through the Epworth Hospital Ethics Committee. Patients with renal colic treated conservatively were asked to participate. Written consent was obtained and fifty patients in total were selected to participate. A sample of the device was given to the patient to use every time they passed urine. Patients were called at the two week and six-week mark and a survey was completed.Results: Of the 50 patients who used the Kidney Stone Catcher, 48 completed the survey either via the internet-based survey platform or paper format. The majority of patients found the 'Kidney Stone Catcher ®' easy to use, convenient to handle and carry every day. A large percentage would use the device again or recommend it to others and would use it over a makeshift device such as a strainer or sieve. The 'Kidney Stone Catcher ®' is a simple method of filtering urine and catching stones. It rated highly among users for ease of use, practicality and safety. The majority of users would recommend the device to others and would use the device again. Our study highlights that the 'Kidney Stone Catcher ®' is a simple solution for a common problem. We recommend the distribution of the device to patients with conservatively managed renal colic. Is Metabolic Profile Mandatory in Pediatric Surgically Active Stone Disease? Yes, it is Panwar G Introduction and Objective: Stone in pediatric population is considered as high risk for future stone development. Ideal treatment of stone disease consists of surgery for surgically active stone disease, and prevention of further episode. We did metabolic profiles of 100 pediatric stone patients to detect common abnormalities in our province. After institutional scientific and ethical committee approval, 100 cases of pediatric stone disease, operated at our institute from January 2015 to January 2018 were enrolled in the study. Patients with anatomical abnormality like PUJ obstruction or horse shoe kidney were excluded. After surgery stone analysis was done with FT-IR spectroscopy. Urine sample was collected after 21 day of stent removal if the patient did not have active UTI or heamaturia. Urine samples were collected by either spot urine sample (mostly for non-toilet trained patients), or 24 hour urine collection in container with preservatives. The samples were collected while patients were on a normal diet without any restriction. Serum panel consist of calcium, potassium, bicarbonate, uric acid, phosphorus and creatinine was performed.Results: Mean age of patients were 7.8 years with male to female ratio 62:38. 82% of cases sample was collected as 24-hour urine and in 18% cases it was spot urine collection. 70% of stones were calcium oxalate (50% monohydrate and 20% dihydrate), 18% were ammonium urate, 8% were uric acid and 2% of struvite and calcium phosphate each. 34% had isolated hypercalciuria, 7% had isolated hypocitraturia, 2% had hyperuricosuria and 15% had combine hypercalciuria and hypocitraturia with low urine volume. Out of total 49% of patients who had hypercalciuria, 10% had hypercalcemia and 4% had Hyperkalemia on serum profile. 5% of patients had Hyperurisemia. The majority of pediatric stone diseases have some form of abnormality underlying. Surgery alone doesn't prevent recurrence. Identify underlying metabolic abnormality by metabolic profile can help to assist proper preventive measure. So, it is recommended to do metabolic profile study in all pediatric stone disease. Journey of Bladder Stone Management: From Painful Lethal Complications to Painless Daycare Surgery Introduction: There are three possible approaches to bladder stone to cut down to base from perineal approach, from suprapubic approach or crush the stone by passing instrument through urethra. All these modalities had painful history of centuries to turn into painless daycare surgery.History: Bladder stone was found from 4500-5000 years old mummy. First description for bladder stone management was mentioned by Hippocrates. Perineal lithotomy was described by Celsus in 1st century, which was most effective for children compare to adults. Formally, known as apparatus minor, as incision was made in front of anus upto bladder base. Stone was pushed from anus and removed with hook. In 1520 Marinus from Italy, pass sound from urethra and cut over it to remove stone known as apparatus major which leaves patients in sever Hemorrhage and sepsis. If patients survived, then he had total incontinence. Suprapublic lithotomy, 1st done by Calot on prisoners in 1475 and then and popularized by Peire from, France in 1561. In 1719 John Douglass suggested that distended bladder could be open suprapubic extra peritoneal approach and Cheslden performed 3 surgeries with high success but later they left it due to high bowel injury and bladder bursting injury. In July 1824, John Civiale introduced grasping forceps and started the era of lithotripters. In 1858, Sir Henry Thompson by accident popularized the concept of sterility of instruments to decrease mortality from lithotripsy. Biglow in 1894 form sturdy lithotripters. Meanwhile development of optics in 1879 by Nitze and then by Hopking improves cystoscopy vision. Young and Macken developed cystoscopic lithotripsy in 20th century and later Mulvaney in 1953 apply ultra sound for stone fragmentation. In 1986 laser was introduced.Conclusion: Thus, the management of bladder stone evolved from painful lethal complications. But last few decades due better optics and energy sources it is possible to manage bladder stone as day care procedure. The Introduction and Objective: Treatment of urinary tract stone was variable by size or location of stone or physician's preference. In our knowledge, trend of treatment for urinary tract stone (UTS) in South Korea remains unknown. In this study, we investigated trend of treatment for UTS via national health insurance database. Materials and Methods: The incidence of UTS and frequency of treatments were retrieved from national health insurance database. Treatments included extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), open, laparoscopic and endoscopic ureterolithotomy. We analyzed patients by their age, sex, socioeconomic status and place of residence. Results: The incidence of UTS was from 180,000 to 200,000 patients in each year. Among them, patients with ureter stone was 82%. The incidence of UTS increased in the 50s or older, however, decreased in other age group. High socioeconomic status group was diagnosed with UTS more than lower group. ESWL was the most frequently performed procedure for UTS, accounting 93% of the total procedure. In ESWL, 77% of patients were treated in one session and 98.7% of patients were treated in single endoscopic treatments. Conclusion: UTS have increased in people over 50 years, and ESWL was the most frequently performed procedure for UTS in South Korea. The Efficacy of the Disposable Flexible Ureterorenoscopy (Lithovue ® ) for Lower Pole Renal Stone Park SC 1 , Oh TH 1 , Lee JW 1 , Jeong YB 2 , Seo IY 1 1 Wonkwang Univeristy, Iksan, South Korea; 2 Chonbuk National University, Jeonju, South Korea Introduction and Objective: With advances in technology, flexible ureteroscopy is the most rapidly growing intervention for removal of urolithiasis. Lithovue® is the first disposable digital ureterorenoscopy in the world. The aim of this study was to evaluate the efficacy of Lithovue® for lower pole renal stone. Patients who underwent retrograde intrarenal surgery for lower calyceal stone by Lithovue® were included in the study between January and December 2016. Flexible ureterorenoscopic procedure was followed by the same methods in the previous investigations. Holmium laser was used to perform dusting or fragmentation for stones. Non-contrast computed tomography (CT) scans were acquired preoperatively and follow-up images of plain KUB or CT scans were obtained postoperatively within 3 months to assess the presence of remnant stones. Stone-free was defined as the absence of any residual stone, or a remnant stone of less than 3 mm without any symptoms.Results: A total of 45 patients were enrolled in the study. The mean age was 54.5±11.4 years and the male to female ratio was 29 (64.4%) to 16 (35.6%). The mean stone burden was 16.9±8.9 mm and mean Hounsfield Unit (HU) was 773.8±379.1. The stone compositions were calcium oxalate monohydrate (29, 64.4%), uric acid (10, 22.2%), and carbonite apatite (2, 4.4%). The overall stone-free rate of Lithovue® was 80.0% (36/45). The mean remnant stone size was 6.33 mm. The mean infundibular pelvic angle (IPA) was Conclusion: Lithovue® is a feasible alternative to reusable flexible ureterorenoscopy in patients with lower calyceal stones. Lithovue® can overcome the limitations for reusable flexible ureteroscopy such as scope fragility, maintenance fee for sterilization, and costs. Additional studies for efficacy and cost are needed to confirm these results. Intrauterine Device Migration -A Rare Cause of Bladder Stone Ramos N 1 , Ramos R 2 , Marialva C 2 , Dappa E 2 , Silva E 2 1 Hospital Garcia de Orta, Almada, Portugal; 2 Instituto Português de Oncologia, Lisboa, Portugal Introduction and Objective: The intrauterine device (IUD) is a safe contraceptive method, which has been used for many years. We report a case on a 55-years-old woman with cervical cancer treated with radio-chemotherapy in whom the IUD migrated into the bladder with stone formation. We review a case of IUD perforation with migration into the bladder and subsequent stone formation, treated with laparoscopic approach. Results: A 55-year-old woman with history of cervical carcinoma treated with radio-chemotherapy, presents 9 years later, with recurrent urinary tract infection and urinary incontinence. CT scan showed a large bladder calculus (maximum diameter 4.5 cm) with severe bilateral hydronephrosis. Furthermore, vesicovaginal fistula was identified. The patient underwent surgery, under general anaesthesia, with a bilateral ureteral stent's placement and cystolithotomy by laparoscopic approach. After incision of a markedly thickened bladder wall, calculus fragmentation with IUD extraction was arduously achieved. The fragments of the calculus were removed with use of Endobag®. Due to difficult access, uncertain identification of fistula tract and high risk of infection, vesicovaginal fistula correction was postponed. The IUD is usually a safe contraceptive method. Although, an IUD perforation is uncommon, serious complication may present with bladder migration and secondary stone formation. Laparoscopic surgery was safely used for stone fragmentation and removal of IUD. Moses Technology in ClearPetra MiniPerc: In Pursuit of Total Stone Clearance Introduction and Objective: Reaching a total stone free state in kidney in one treatment episode remains a challenge for conventional miniperc procedures, especially for 1-2 cm sized stones. Even with all newer advancements in PCNL, migration of small fragments during laser lithotripsy remains a concern, which may result in incomplete stone clearance. In pursuit of finding a better method for total stone clearance, we describe a new technology: Miniperc with 18 Fr ClearPetra(Well Lead INC, China) sheath and Moses (Lumenis INC, Israel) laser fiber technology which promises to disintegrate the stone into dust and fragments, thus helping in total stone clearance. This is a prospective study involving 30 consecutive patients who underwent miniperc with ClearPetra 18 Fr sheath and Moses laser fiber technology from July 2018-December 2018. Surgery was performed using 12 Fr nephroscope and the 18 Fr ClearPetra sheath integrated with suction and Moses 365 DFL laser fiber technology. All patients underwent pre-op CT urography and Plain CT-KUB within 48 hours of procedure to assess stone free status. At 30 day follow up, Plain CT-KUB was done only for those patients with residual stones in immediate post-operative period. Silodosin as a Medical Expulsive Therapy for Distal Ureteral Stones. What are the Failure Causes? Sallami S 1 , Abou El Makarim S 1 , Moula L 2 1 Mohamed Tahar Maamouri Teaching Hospital, Nabeul, Tunisia; 2 Mahmoud Matri Teaching Hospital, Tunis, Tunisia Introduction and Objective: Medical expulsive therapy with alpha-blockers is recommended for treating small and distal ureteral stones. We aim to investigate the efficacy of silodosin 8 mg/day for medical expulsive therapy (MET) of distal ureteral stones and to determine failure causes. We conducted a prospective study in department of emergency and urology in Mâamouri teaching hospital -Nabeul since March 2017. We included adult patients with unique small (< 8 mm) distal ureteral stone. They were treated with silodosin 8 mg/day for one month only and asked them to increase their fluid intake to achieve a daily urine output of 2 liters. Age, gender, main symptom, stone size, the distance between the stone and ureterovesical junction, stone passage rate, duration of stone passage after starting MET, and adverse effects were noted. They were 54 males and 19 females with a mean age of 47,5 +/-5,2 years. Stone size ranges from 4 to 7 mm. The main symptom was renal colic (n= 67).Results: After 1 month spontaneous stone passage was seen in 54 (73,9%) patients. Three patients pass their stones spontaneously after one month of treatment. No major side effect was reported. Ureterolithotripsy was performed in the remaining patients. Preoperatively, we discovered major mucosa edema (n= 4), impacted stone (n= 6) and distal ureteral stenosis (n= 5). All patients were stone free at the end of the treatment. Conclusion: Silodosin 8 mg/day is efficient and safe for MET in distal ureteral stones. Impacted stone and distal ureteral stenosis are main causes of MET failure. Bacteriological Correlation of Urinary Stones and Preoperative Urine Exam: Is There a Significatif Impact on Postoperative Infectious Risk? Introduction and objectives: The aim of this study is to determine the bacteriological correlation between preoperative urine exam and urinary stones and their impact on postoperative infectious risk. A prospective monocentric study included 61 patients whom underwent urolithiasis surgery between January and June 2018. Extracted stones were sent for culture analysis. Clinical variables, stone configuration, microbiology reports of cultures were recorded. We analyzed the impact of bacteriological study of urine and stone cultures on postoperative urinary risk. The bladder location of the stone was observed in 52.5%, pyelic in 27.9%, ureteral in 19.7%. The extraction of the stone was carried out in monoblock in 72.1% and in fragments in 27.9%. The average age of our series was 55.3 years with a male predominance of 77%. Postoperative urinary sepsis was observed in 7 patients (11.5%). The urinary colonization rate was 29.5% (18 out of 61) whereas the rate of colonized stones was 31.1% (19 out of 61). The occurrence of urinary sepsis was found in 33.4% (6 out of 18) of patients with urinary colonization compared to 36.8% of patients with colonized stones (7 out of 19). On stones culture, we identified Escherichia coli as the most predominant colonizing pathogen (42.1% of cases) followed by Enterococcus feacalis and coagulase-negative Staphylococcus (15.8% for each). The chemical nature of colonized stones was predominantly calcium oxalate (monohydrate, dihydrate) and struvite (p = 0.02, p = 0.02) respectively. There is a statistically significant correlation between preoperative urine exam, bacteriological culture of stones, and postoperative urinary sepsis (p = 0.002, p = <0.0001), respectively. Conclusion: Our findings confirm that simultaneous tubeless bilateral percutaneous nephrolithotomy is a safe and effective modality of treatment with no higher morbidity than unilateral method. It reduces the need of a second anesthetic exposure, hospitalization time and costs. This has a significant socioeconomic impact on the outlook of patients presenting with bilateral renal stone disease. No stone with a length of 0.4 cm or more in KUB taken 2 weeks after surgery was considered to be successful. Gender, age, stone laterality, stone retention time, preoperative collecting system width, stone parameters (CT value, length, number), anesthesia method, presence or absence of difficult access, NTrap used or not, laser parameters (energy, frequency, power) were compared between the groups of success and failure for the surgery. Hierarchical comparison was used for some factors. Independent t test, Mann-Whitney U test and chi square test were performed by SPSS20.0. Logistic regression analysis was used to find the main influencing factors of treatment outcome. The overall success rate of lithotripsy was 91.55%. The success rate of right and single calculi was higher than that of left and multiple calculus. The success rate of those who have difficult access was significantly reduced. Cases with longer stone retention time, wider collecting system and higher CT value of the stone got lower success rate. Whether there was difficult access and the separation width of collecting system were the main factors affecting the treatment outcome in the surgery. The regression coefficients were -1.265 and -0.043, respectively. The total prediction accuracy was 91.50%. The success rate of cases with difficult access was 0.282 times of those without difficult access, and the success rate of cases with Conclusion: This is the largest case series on PCNL in patients with haemophilia. Ensuring of replacement factors, multidisciplinary team approach, minimizing nephroscopy time, limiting the size of the access sheath and complete clearance to prevent recurrent haematuria are some of the key points to be considered in these patients. Combined Sonographic X-Ray Control with Lateral-PCNL Tryfonyuk L 1 , Milinevsky V 1 , Pavlukovich N 2 1 Rivne Regional Hospital, Rivne, Ukraine; 2 Higher State Educational Establishment of Ukraine, Kyiv, Ukraine; Bukovinian State Medical University, Chernivtsi, Ukraine Introduction and Objective: Traditionally, access to the kidney cavity is carried out in the patient's position on the back and directly and under X-ray control for percutaneous nephrolithotripsy (PCNL). In order to reduce the X-ray impact on the staff, decrease the number of kidney punctures same as possibility of pelvicalyceal system puncture for the first time, ultra-sound control was applied for the puncture of pelvicalyceal system, and for the further formation of the operation channel -X-ray control. To reduce the risk of intestinal trauma, lateral PCNL was performed.Material and Methods: Two hundred and sixty lateral-PCNLs in 243 patients, ages 23-78 years, perfomed from 2013 to 2018 were analyzed. In 226 (87%) cases puncture of the middle and lower calyces of the kidney was performed. Endoscopic optical system Karl Storz F24-26 and ultrasound lithotripter were used for surgical procedures. Surgical treatment of kidney stones 2.5-7 cm was performed. The multiple (2-3) accesses were used in 28 (10.7%) in case of coral stones of complex stereometric configuration. The average duration of the operation was 86 minutes. Total blood loss was less than 100 mL. In 251(96.5%) cases operation was completed by a nephrostomy, which remained for 12-36 hours during post-operative period.Results: Experience of pelvicalyceal system puncture under control of the puncture adapter resulted in quick and unequivocally successful puncture of the hollow system of the kidney, in no case leading to perforation. The use of X-ray control only for dilatation of the working channel and post-operative "stone free" control reduced the overall radiological impact on the patient and the staff. Post-operative complications (such as exacerbation of chronic pyelonephritis, macrohematuria) were observed in 39 (15%) cases. Bleeding which required substitution hemostransfusion, in the post-operative period, was not detected. The "stone free" effect was achieved in 239 (92%) cases. Our experience of ultrasound monitoring application for pelvicalyceal puncture and subsequent X-ray monitoring for reduction of the radiation impact on staff and patient, usage of nephrostomy allows the lateral-PNL stones to be carried out in a sufficiently efficient and safe manner. Moreover, results of the surgical treatment are comparable to the world-wide practice of other approaches to access and patient position during PCNL. Efficacy of Ureteroscopy with Pneumatic Lithotripsy for Ureteral Stone Veselaj F, Hyseni S, Selmani L, Kryeziu D, Frangu B Introduction and Objective: To study the outcome and safety of ureteroscopy (URS) using pneumatic lithotripsy for treatment of ureteral stones. A 2-years retrospective study (between April 2016 -March 2018) identified 112 patients undergoing URS lithotripsy with pneumatic lithotripter in Urology Clinic "VITA Hospital" in Prishtina.Results: There were 56.25% man and 43.75% women. The mean age was 42.5 age (range 14 -73 ages). In 53.6% of patient's stones were located in the right ureter, in 39.3% of patients in left ureter and in 7.1% of patient's stones were located in both ureters. Stones in 27 cases (24.1%) were located in the proximal ureter, in 29 cases (25.9%) were located in the middle ureter and in 56 (50.0%) were located in the distal ureter. 81.6% of patients were with stones smaller than 10 mm (range 4-33mm) and 28.9% of patients were with multiple ureteral stones. 16.9% of stones were treated UNMODERATED ePOSTERS SIU 2019 ABSTRACT BOOK -39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE 313 by extraction only 29.5% of patients were stendet before URS and 52.7% of patients were stendet during URS. The success rate depended on the location of the ureteral stone: proximal ureter 70.4%, middle 89.7% and distal 96.4%. The rate of stone moving to lower pole calyces were 6.25%. URS showed an overall success rate of 87.5%. Finally, only 7 patients (6.25%) required an open stone surgery. We did not confront major complication.Conclusion: Ureteroscopy using pneumatic lithotripsy for treatment of ureteral stones has been shown to be an efficient and safe procedure. Influence of Pre-Instructing the Assistant Prior to Laparoscopic Urological Surgeries on Operative Time of Different Laparoscopic Procedures Abdallah MM 1 , Wallner C 2 , Abdel-Baky T 3 , Hodhod A 1,4 , Kamarad L 2 , El-Gharabawy M 1 , Leidl S 2 , Badreldin M 1 , Grubmueller K 2 , Gamal El-Deen A 1 , Abdel Aal AM 1,5 Introduction and Objective: Laparoscopy has become an integral part of residency training programs in different specialties worldwide. Most of laparoscopic surgeries require harmonic cooperation between the main surgeon and the 1 st Assistant. Laparoscopic instruments have become enormous and more complex. Inability to handle the instruments in an optimal way can offer the main surgeon a hard challenge to safely complete the laparoscopic procedure. We aimed to evaluate the impact of pre-instructing medical students during their practical year (PYMS) before getting to assist in laparoscopic procedures on the operative time. We underwent a retrospective cohort review of prospectively collected data from three different laparoscopic procedures done by three laparoscopic surgeons with comparable experience over a period of 2 years (02.2017 and 01.2019). Assistants were PYMS with no previous experience in laparoscopic operations. 70 PYMS were divided into 2 groups: Group A (N=35): received 180 minutes training about basic laparoscopic armamentarium including practice on a pelvitrainer and laparoscopic anatomy of abdomen and pelvis; meanwhile Group B (N=35): didn't receive such training.Demographic and clinical data were retrospectively collected and statistically analyzed.Results: Patients' age and BMI distribution were comparable in both groups. Age in Group A: 60 (44-76) in Group B: 63 (39-78) (p=0.64). BMI in Group A: 22.4 (18.6 -28.2) and in . Patients in Group A vs Group B were 29 (82.8%) vs 25 (71.4%) males, whereas females were 6 (17.2%) vs 10 (28.6%) respectively. In each group, 15 laparoscopic radical prostatectomies, 15 laparoscopic nephrectomies and 5 laparoscopic adrenalectomies were evaluated. Mean overall operative time was 110 minutes (69-142) in group A vs. 129 minutes (93-160) in group B (p=<0.001*). Perioperative complications were 1 (2.8%) vs (11,4%) in group A and group B respectively. Offering a briefing course for medical students with no previous laparoscopic experience prior to assisting in laparoscopic procedures can significantly reduce the operative time. We recommend offering PYMS and young residents such course before getting to assist in laparoscopic procedures. To determine the educational quality of YouTube lithotripsy videos as a teaching resource for urology trainees and/ or patients. YouTube was searched using search terms; "lithotripsy", "kidney stone laser", "How to do ureteroscopy", "shockwave lithotripsy for doctors". The first 10 pages of videos for each search were screened by 2 assessors. We excluded videos that were animations, wrong topics, non-English, and duplicates. Included videos were assessed for usefulness by devising a scoring system with a maximum score of 19. To assess content, we created an objective scoring criteria derived from AUA and EAU guidelines for the treatment of kidney stones. This included five major criteria relating to the accuracy of the procedure description and five minor criteria related to the aesthetic of the video were also devised. Videos were deemed useful if they met all five major criteria as well as 3/5 of the minor criteria.Results: A total of 580 videos were screened, with subsequent scoring of those that met inclusion criteria. The useful videos had more views per day, more likes per 100 views and were longer. Statistical analysis was pending.Conclusion: YouTube is a vast resource for free online medical education, but only a small number of videos on lithotripsy demonstrated an educational quality that would benefit a urology trainee or even a patient. YouTube should be used as an adjunct educational aid, not a standalone resource. Omnecell-An Innovative Digital Prostate Cancer Journey of the Landmark Papers Introduction and Objective: There are currently several problems with the current literature: First of all, It is hard to find the most pertinent research papers for a specific disease treatment decision point. The literature is dead; there is no ongoing discussion of the strengths, weaknesses, and key messages of landmark papers and resources. Most doctors have only a superficial understanding of relevant medical literature. There is currently no central repository of analytical reviews and insights of the current literature. Our objective is to create an online crowd-sourced collaborative platform bringing together the best analytical reviews, insights, tweets, journal clubs and conference discussions about the important landmark papers and resources vital to the prostate cancer journey. We aim to bring literature to life and vastly improve doctors' understanding of literature to ensure we apply the right evidence to the right patient. Omnecell is an online information and educational resource like the "Wikipedia" of prostate cancer that doctors and patients can use to navigate their way through the literature of the entire prostate cancer journey from prevention to palliation. Use the six primary page types to create content for the platform, which are: Home page (Figure 1 ), disease stage, treatment/investigation page, journal article (example in Figure 2 ), knowledge page, MDT page. The first phase prototype is in final stages of development with "23Digital" web page. Founding curators/moderators to be briefed about content creation and disease state curation. So far, activating the 50 Key Opinion Leaders from around the world have expressed enthusiasm for the platform.UP.639, Figure 1 . Example home page which is zoomable and interactive. To investigate the impact of decade-long dedicated laparoscopic urology surgical skills course on the successful implementation of surgical services by the participants. We maintained a database maintained for all the participants in urological laparoscopic courses run by a single dedicated unit between January 2006 and December 2016. Data on various variables were collected using a follow-up validated questionnaire exploring speciality of clinical practice, challenges and need for additional training to establish clinical services, improvement in quality and frequency of laparoscopic courses. A subset of participants reported their data in BAUS Audit. One hundred sixty-one delegates from 18 countries attended laparoscopic skills courses during the study period of 10 years. Data were available for 154(95.65%) participants. There were only 20 (20/154;12.9%) responses to online website questionnaires despite 3 reminders. Further, follow-up through websites/telephonic contact/organisational contacts improved the response rate to 93% (143/154). Of the participants,95% (135/143) felt that these courses should be continued, and they agreed to recommend them to their trainees in the future. More than 50% (81/143; 56.6%) of the participants performed laparoscopic/robotic surgery at various centres. Sixty-two (62/143; 43.3%) did not pursue laparoscopic surgery as a career choice. Fifty-six (56/81; 69%) participants were established laparoscopic surgeons were from the UK, and of them, 30 (30/56;53.57%:30/81;37.04%) that contributed to BAUS Surgical outcome AUDIT. Results of all of these surgeons are within the normal range of their peers. A dedicated course had a significant impact on the skills of participants, helping to establish clinical practice catering to a large proportion of the UK population and internationally. Visual Illusions Perception Correlates with Skills on a Virtual Reality TUR-P Simulator Levis P 1,2 , Deliyiannis D 1 , Tsavdaris D 1 , Anastasiou I 1 , Adamakis I 1 , Papageorgiou C 1 , Mitropoulos D 1 Introduction and Objective: Endoscopic surgeons need to form visual impressions of a three-dimensional structure from a two-dimensional monitor on which depth information is limited. Visual-spatial perception and perceptual-motor correlation are essential for the safe and successful completion of certain endoscopic procedures such as transurethral resection of the prostate (TURP). Visual illusions perception has been correlated to spatial cognitive abilities. The purpose of this study was to investigate the relationship of illusions perception with assessments of performance in the TURPSim™ by the supervisor assigned to the educational task. The TURPSim™ (Simbionix Ltd, Israel) is a simulator of TURP operating in Virtual Reality (VR) environment while providing tactile feedback. In a sample of 26 urology trainee's performance was evaluated by the supervising instructor based on a customized global rating scale. In addition, participants were presented a series of 39 visual illusions accompanied with certain statements that should be rated as "correct" or "wrong". The percentage of "correct" answers was correlated to the GRS score.Results: The rate of correctly assessed illusions ranged from 44 to 85% (64 ± 12) and the GRS scores from 13 to 24 (18.3 ± 3.1). The correlation between them was statistically significant (r 2 = 0.282, p= 0.005).UP.639, Figure 2 . Example journal article page type with ability to comment on papers and discuss strengths, limitations, and key messages. Visual illusions can be used to identify trainees of possible low performance in the TURP-Sim™ simulator. Future studies will show whether this also applies to objectively assessed performance in the operating theater. Early identification of poor performers with possible limited vision-spatial perception may help in adapting training to individual needs and search out alternative methods to increase spatial cognitive ability, playing with optical illusions being one of them. Percutaneous Nephrolithotomy Training Program for Urology Residents at Hasan Sadikin Hospital Introduction and Objective: Percutaneous nephrolithotomy (PCNL) is accepted to be the first line of treatment for large renal stones. However, potential complication such as bleeding occur. Improved skill and modification of the procedure may reduce the probability of adverse outcomes. Percutaneous endourological procedures require an advanced level of skill. Novice surgeon experiences longer median operative time and lower stone free rate compared to the experienced surgeon. In Indonesia, there are not many medical centers that provide PCNL education. Fortunately, at Hasan Sadikin Hospital, we provide urology resident with adequate PCNL education. In this study, we found no significant difference based on complications, median operative duration, and stone free rate between PCNL done by urology consultants and trained urology residents. This is a retrosprospective study. We evaluate the difference between PCNL that was done by resident which compared to urology consultant in our hospital. Complications, stone free rate, and PCNL duration were documented. We analyze the differences using t test methods. Data analysis was done using SPSS version 21.0.Results: Among 52 patients, based on the number of bleeding complications from the surgery performed by urology consultant there was no significant difference with the amount of bleeding from the surgery performed by the residents (P>0.05). Based on the stone-free level, it was found that postoperative stonefree conditions carried out by urology consultants there was no significant difference with post-operative stone-free conditions carried out by the residents (P>0.05). While based on the duration of the operation, the duration of surgery performed by urology consultant, does not have a significant difference with the surgery carried out by the residents (P>0.05). Based on the unpaired t-test, no significant differences were found in complications, stone-free rates and average duration of operation in PCNL surgery by urology consultants and urology residents. Conclusion: PCNL is one of the main endoscopic procedure for stone treatment, but it still remains difficult procedure with long life learning. More structure training program, restriction of working hour on training, and training under supervised clinical practice would improve learning capability for PCNL. Surgeons' Self-Assessed Learning Curve for Thulium (Tm-YAG) Laser Prostatectomy: Evaluation of a Nationwide Survey 317 Hospital Episode Statistics (HES) database (2000-12); Qualitative data: urology trainees (2018).Results: A total of 2,451 non-private procedures were recorded in BAUS SOA; 65% (n=1,718) included mesh. Non-mesh SUI procedures reflect lower volume surgery, despite an increasing trend; BAUS SOA: Autologous fascial sling: 340(13%); Colposuspension: 130(5%); Bulkamid 351(13%). BAUS estimated 310 trainees (2016); suggesting 7.9 procedures per trainee over 3years. Trainee numbers and volume varied per region (6-35, 0-332). Male SUI is not included in BAUS SOA; published HESS data: 250 cases (2012) with an increasing trend. Male SUI is mainly performed in specialist, tertiary referral centres; interest trainees need to arrange their placement within these centres. Botulinum toxin injections into the bladder has increased significantly; from 51 (2000) to 7,970 in 2012 (HES data). 78% (n=18) of UK trainees surveyed wanted UI procedures included in CCT requirements; 48% (n=11) felt confident they would achieve this; 65% (n=15) were concerned the 'mesh pause' would affect their training. Trainees are concerned about their ability to achieve UI indicative numbers; importantly there is a loss of 68-69%% of SUI surgery in our regions due to 'mesh pause' . UK urology training may need to take into account other methods of teaching continence procedures. Introduction and Objective: Forgotten double J stent has a potential to cause significant morbidity as well as medico-legal issues and amplified cost. We highlight the ethical and legal implications of the treating urologist who accidentally left a stent in a patient. We reviewed all patients who underwent double J stenting between January 2009 and December 2018 in three teaching hospitals in the north of Tunisia. We analyzed the stenting indication, the quality of information given to the patient (according to the medical folder) and any secondary complications due to the stent. We asked also both patients (n=14) and urologists (n=7) about ethical and legal aspects of this accident.Results: The series accounts 12 male patients and two females with a median age of 52+/-6,2 years. The primary pathology was urolithiasis (n=9), ureteral injury (n=2), sepsis (n=1) and renal trauma (n=2). Most of patients (n=9) seems to be not explicitly and adequately informed about the procedure and the stent. In only 10 cases, the urologist and the stuff seem to make a serious effort to contact the "absent" patient. Various complications were reported: non-functioning kidney (n=1), encrusted double J stent (n=6), lumbar pain (n=7), urinary infection (n=3), haematuria (n=5) and LUTS (n=10). Seven patients pointed on the urologist responsibility, 3 the hospital respon-sibility and 3 their own responsibility. All urologists but one engages their legal and ethical responsibilities in such situation.Conclusion: Leaving a double J stent in a patient may result in disastrous situation. The indication should be well discussed and the patient well informed about the stent and possible complications. Basic appointment card system is not that efficient, and patient must be contacted in case of delay. Psychological Morbidity and Learning Styles in Medical Students Rotating Through Urology Wang Z, Tiong HY National University Hospital, Singapore, Singapore Introduction and Objective: Medical students have distinctive learning styles. These have been characterised into four domains (active/reflective, sensing/ intuitive, visual/verbal and sequential/global). Incongruity between these learning styles and the methodologies employed in medical school may come at a psychological cost. We hypothesize that specific learning styles may also have an impact on the psychological well-being of the students. This study aims to define the distribution of learning styles amongst local students and identify any patterns in relation to reported psychological morbidity. The study evaluated the prevalence of depression, anxiety and stress symptoms among medical students who were enrolled in the National University of Singapore and rotating through Urology in September to December 2019. The students completed the validated Index of Learning Styles Questionnaire and the Depression Anxiety Stress Scale (DASS 42). The data was analysed using bivariate Spearman's Correlation test using SPSS Statistics.Results: 56.2% of the 96 medical students were of female gender and mean age was 22.6 years. Our results report that a majority of the students preferred global (62.5%) style over sensing. The percentage of active and reflective learners were fairly evenly distributed (46.9% vs 53.1%). 16.3% of medical students had moderate or severe scores for depression, 31.3% for anxiety and 18.8% for stress. Depressive levels are correlated with being a reflective learner (Spearman's rho= 0.371, p= 0.036) and being a global learner (Spearman's rho= 0.411, p= 0.02). Gender or age did not have any significant impact on the active/reflective or sequential/global domains. Anxiety and stress levels did not show any correlation to the learning styles.Conclusion: Urology teaching tends to be more active as opposed to reflective. Depressive levels are correlated with reflective and global learning styles, hence there should be greater efforts to reach out to learners whose styles may be marginalised during urology postings. In addition, medical education should include tutelage of student to adopt a more active learning style through problem-based learning and direct interactions. Three-Dimensional Printing Models in Bladder Radical Cystectomy: A Valuable Tool for Surgical Training and Education Xie Y, Fan G, Zhu S, Ye M, Han W Introduction and Objective: To evaluate the impact of 3D bladder models on how clinical medical students understand and learn about bladder anatomy and radical cystectomy processes following clinical education.Materials and Methods: 45 first-year graduate clinical medical students enrolled into this study, then were randomized to either a 3D+CT group educated with 3D models+CT images or a 3D group educated with 3D models only or a CT group educated with CT images only. Pre-/post-training testing and a third part assessment were carried out for assessment of knowledge acquisition. Student feedback was measured by filling out questionnaires. The results of the test, the third part evaluation and the student feedback were collected and compared. The pre-and post-training test results indicated that all three groups have the same effect on knowledge acquisition, the P value compared with each group were >0.05. Meanwhile, the third part of the assessment showed that the students of the 3D+CT group and 3D group benefited over the CT group, in area of understanding the bladder spatial structure and RC processes (P<0.05), while there is no difference between 3D+CT group and 3D group on it. The average self-evaluation score in the 3D+CT group and 3D group were 20.4 (±0.57) and 20.13 (±0.53), respectively, while it was 16.8 (±0.66) in the CT group. 3D physical models could improve the students' satisfaction on surgical training. Conclusion: 3D physical models could help medical students in improving their understanding of the bladder spatial structure and help in the education of bladder radical cystectomy. Minimally Invasive Treatment of Traumatic or Iatrogenic Complicated Intraperitoneal Bladder Rupture Fragkoulis C 1 , Glykas I 1 , Lamprou S 1 , Papadopoulos G 1 , Dellis A 2 , Stathouros G 1 , Aristas O 1 , Ntoumas K 1 1 General Hospital of Athens "G. Gennimatas", Athens, Greece; 2 National and Kapodistrian University of Athens Medical School, Athens, Greece; Aretaieion Hospital, Athens, Greece; Laiko Hospital, Athens, Greece Introduction and Objective: Bladder rupture is practically classified as extraperitoneal or intraperitoneal and is usually caused by trauma (blunt, penetrating, iatrogenic). Non iatrogenic intraperitoneal ruptures are caused by a sudden rise in intravesical pressure secondary to a blow to the pelvis or lower abdomen. As far as it concerns treatment, intraperitoneal bladder ruptures by blunt trauma are usually managed by surgical exploration. Small uncomplicated iatrogenic intraperitoneal perforations can be managed conservatively. The objective of this study is to present our ex-UNMODERATED ePOSTERS 318 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK perience in the minimally invasive management of iatrogenic or traumatic intraperitoneal bladder ruptures. During the years 2012-2016 a total of 7 patients with complicated intraperitoneal bladder rupture were managed in a minimal invasive way. The cause of the rupture was endoscopic procedures in the bladder in 3 patients, blunt trauma in 2 patients and obstetric surgery in 2 patients. In all patients a two-way foley catheter was placed. In addition, an intraperitoneal drainage tube was inserted by ultrasound or CT guidance. The decision of this minimally approach was due to concomitant diseases which prevented us from open surgery or due to the patients' denial to undergo surgery.Results: Mean duration of catheterization was 18 days. The intraperitoneal drainage tube was removed in an average of 5 days after its initial insertion. All patients underwent cystography prior to the removal of the two-way foley catheter which confirmed the successful management of the rupture. No patient underwent open surgery and no severe complications were noted (fever, renal failure, intraperitoneal abscess).Conclusion: Complicated intraperitoneal bladder ruptures caused by iatrogenic maneuvers or blunt trauma can be managed in a minimal invasive way by a combination of a two-way foley catheter in the bladder plus an intraperitoneal drainage tube inserted via ultrasound or CT guidance. All patients initially managed in this way in our department presented no need of open surgical exploration. As a result, minimally invasive treatment is a viable and safe choice especially in patients with concomitant diseases unfit for open surgical exploration. Spontaneous Bladder Rupture After Radical Treatment for Pelvic Malignancy Harabayashi T, Takada N, Kurosawa R, Maruyama S, Nagamori S Hokkaido Cancer Center, Sapporo, Japan Introduction and Objective: Spontaneous bladder rupture is a rare disease occurring as acute abdomen. In cases after the treatment of pelvic malignancy, the diagnosis is often challenging because of treatment-associated bladder neurogenic dysfunction. We experienced 6 bladder ruptures in the past 15 years. All 6 female patients received surgery and radiotherapy for uterine cancer. Median age was 70 years old (range 47-77), and median duration after primary disease treatment were 20 years (range 6-36).Results: The chief complaint was acute abdomen in 5 and abdominal distention in 1. The diagnosis was made by cystoscope findings (1), ascitic fluid (6), and transient serum Cr increase (5). Median time to diagnosis from symptom onset was 7 months (range 0-24). All 6 patients were conservatively managed by urethral catheter placement (UC) and fasting followed by intermittent catheterization (IC). Three patients experienced several episodes of acute abdomen. At last follow-up, IC required in 5 patients and UC in 1. Correct diagnosis was often difficult because urinary tract symptoms are not clear and hidden in gastrointestinal symptoms. The low-pressure management of the bladder for lifetime is most important when accurate diagnosis is made. Recently, it has been known effectively to perform primary endoscopic urethral realignment for traumatic urethral injury as early as possible. However, there are limitations of failure of endoscopic operation due to poor visual field if severe bleeding is present or patients of general condition who can't perform surgery. We evaluated the outcomes of primary endoscopic urethral realignment (PEUR) vs radiologic interventional urethral realignment (RIUR) in these patients as an alternative treatment. This retrospective study included 35 patients with traumatic urethral injuries between 2012 and 2018. These patients were divided two groups (PEUR group vs RIUR group). The primary outcome was the success rate of primary realignment, procedure time, length of hospital day, duration of urethral catheterization. Secondary outcomes were the incidence and time to develop symptomatic urethral stricture.Results: Procedure of PEUR and RIUR were technically successful in 15 of 20 patients (75.0%), 11 of 15 patients (73.3%) respectively. The rest of the patients (9/35,25.7%) underwent suprapubic cystostomy. There was no statistically significant difference between two groups. Mean procedure time of PEUR group was significantly longer than that of RIUR group (35 ±10.5 vs 22 ±18.8 min, p <0.001). And the former required general or spinal anesthesia, but the latter was only sufficient for local anesthesia. While there were no significant differences in the period of hospital day, duration of urethral catheterization between both groups, respectively(7.6 ±1.4 vs 6.4 ±2.2 days, p >0.05), (15.5 ±3.8 vs 13.4 ±4.9 days, p >0.05) although terms of the former were slightly longer than these of the latter. There were no immediately important complications related to both procedures, although the 7 patients (7/15, 46.7%) treated with PEUR and 6 (6/11, 54.5%) with RIUR developed symptomatic urethral stricture after procedure. Mean time to develop symptomatic urethral stricture after procedure was 3.3 ±1.8, 2.4 ±1.2 months in each group. There were slightly higher incidence and shorter time to develop urethral stricture in the RIUR group, but they were not statistically significant difference (p >0.05, respectively).Conclusion: RIUR is excellent short-term outcomes such as simplicity of anesthesia and short procedure time, while PEUR has a merit that the incidence of urethral stricture, which is a complication, is low and takes longer time. Introduction and Objective: Immediate surgical repair is the standard of care for penile fracture. The study was done to assess the outcome of surgical repair of fracture penis. This study was a quasi experimental study which was conducted during the period of January 2017 to December 2018 in urology department of DMCH. Thirty-five patients with fracture of penis were included in the study by maintaining the selection criteria. After proper evaluation and taking informed written consent, surgery was performed under spinal anesthesia. The tear of corpora cavernosa and concomitant urethral injury repaired with polyglactin suture material. Intraoperative artificial erection was performedin all cases. Patients were advised to abstain from sexual activity for 6 weeks following surgery. Follow up was given at 6 weeks, 3 months and at 6 months. Postoperative erectile function assessed by validated questionnaires of IIEF-5 for married and single question self report (SQSR) for unmarried patients. Voiding status through IPSS. All patients were interviewed to complete the same questionnaires retroactively for assessment of erectile function and voiding status before fracture of penis.Results: The patients were in the age range of 24 to 60 years, and mean age was 36.4 years. The most common precipitating cause for fracture was vigorous sexual intercourse (68.57%). Mean time of occurrence to surgery was 10.26 ±2.3 hours (4hrs to 48 hrs). Rupture of tunica albugenia occurred in all cases with rupture of corpora cavernosa in right, left and bilateral was 65.71%, 25.71% , 8.51% subsequently. Urethral injury found in 4 cases. Four patients developed mild form and three had mild to moderate form of erectile dysfunction. Two patients had mild urinary symptoms according to IPSS score. Wound infection was present in 3 cases, four patients had developed mild penile curvature. Nodule presented at fracture site in every case with gradual reduction in size. All patients complained of pain during intercourse, but pain gradually subside with time with adequate erection.Conclusion: Early surgical correction of fracture penis is associated with good outcome with preservation of erectile and voiding functions. Reconstruction of Extended Ureteral Defects: The Role of Boari Bladder Flap Demchenko V 1 , Lesovoy V 1 , Shchukin D 1 , Harahatyi A 1 , Antonyan I 2 319 structions with the help of open Boari bladder flap performed within one specialized center. The study included 70 patients who were operated on from 2008 to 2018. Based on the length of the bladder flap, all patients were divided into three groups: Group 1 -reconstruction of the lower third of the ureter to the level of the iliac vessels (n= 31); Group 2 -reconstruction of the lower and middle third of the ureter to the level of 3 cm above the iliac vessels (n= 33); Group 3 -reconstruction of the lower and middle third of the ureter to the level of its upper third (n= 6). The average follow-up period was 24.6±3.4 months. The length of the bladder flap varied from 3 to 21 cm and averaged 9.8±1.4 cm. The total level of intraoperative complications did not exceed 12.9%. This parameter was significantly higher in the third group (p <0.017), whereas no statistical differences between Group 1 and 2 (p <0.678) were registered. In most cases, those complications presented as severe scar tissue formation and inflammatory changes in the retroperitoneal space. Early postoperative complications were recorded in 36% of the patients. They included pyelonephritis (32.9%), urine leakage from the postoperative wound (11.4%) and chronic urinary retention (2.9%), which were observed with equal frequency in all three groups. Severe dysuria occurred in 10% of the patients and was significantly more frequent in Group 3 (p <0.016 for Groups 1 and 3, p <0.046 for Groups 2 and 3). The total level of positive long-term results was 91.5% (n= 64). Nephrectomy due to negative results of the surgery was performed in 2 (2.3%) cases. Persistent decrease in bladder capacity was registered in 2 of 70 (2.3%) patients.Conclusion: Boari bladder flap reconstruction helps to restore patency of the lower and middle third of the ureter in most patients with good functional results. Ureteral Avulsion Following Ureteroscopy: A Single Center Experience Venkat Ramanan S, Leela Krishna K, Velmurugan P Introduction and Objective: We present our experience with ureteral avulsions following semi-rigid ureteroscopy for ureteral stones. It is a retrospective study done between January 2000 to December 2018.Results: There were 7 cases of ureteral avulsions. Four of them happened in-house and three were referred from other centers. All were males with a mean age of 35.7 years. Avulsion involved left side in 4 patients and right in 3. All patients had impacted relatively large (mean 11.3 mm) ureteric stones with proximal ureteric location in 6 and distal ureteric location in 1. The semi-rigid ureteroscopes used ranged from 4.5/6 F to 8/9.5 F. Five cases had two-point avulsions with loss of the whole length of ureter. Two cases had one-point avulsion-one distal ureteric and the other mid-ureteric. Three avulsions were caused by senior-consultants, 3 by junior consultants, and 1 by a trainee. One distal ureteric avulsion was repaired by immediate uretero-neo-cystostomy. In a case of one-point mid-ureteric avulsion with ureteroscope and stone basket stuck at the injured site, immediate laparotomy was done, instruments were disentangled followed by uretero-ureterostomy. Two patients with two-point avulsions were managed with immediate laparotomy and classical ileal replacement of ureter. Three cases with two-point avulsion referred from elsewhere were initially managed with percutaneous nephrostomy (PCN). Subsequent definitive repair involved classical ileal replacement of ureter in 2 patients and complete ureteral replacement by yang-Monti technique in one. All patients had satisfactory outcome.Conclusion: This is one of the largest series of ureteral avulsions. Two-point avulsion was commoner than one-point avulsion. Risk factors for ureteral avulsions were male gender and relatively large impacted proximal ureteral stones. Small size of the scope and long experience of the surgeon are not necessarily safeguard against ureteral avulsion. Prevention involves avoiding forceful endoscopic maneuver and staging the procedure in case of difficulty. The classical ileal replacement of ureter is a reliable salvage option in the acute situation. Yang-Monti technique of ileal replacement of ureter is also a viable option in a stable patient who has been managed initially with PCN for few weeks. "An Erotic Retention": A Case Report of a Self-Inflicted Urethral Foreign Body Introduction and Objective: A foreign body inside the male urethra is an uncommon complaint that urologists encounter. This case report describes the management and patients' profile in dealing with urethral foreign body. We report a case of a 50-year old male, who was initially managed as a case of acute urinary retention. Further workup included a KUB ultrasound which showed a suspicious linear echogenic shadowing structure. Pelvic X-ray was done to confirm the suspicious findings, which revealed a tubular like opacity which looked very similar to a pen. The patient underwent cystoscopy with foreign body extraction, and later on developed penile and scrotal abscess. The patient was scheduled for emergency cystoscopy with extraction of foreign body. A metallic pen was retrieved from the urethra. The patient tolerated the procedure well. On the 3 rd post-operative day, there was noted increase in swelling in the patient's penis and scrotal area. Due to the persistent swelling and appearance of necrotic areas with purulent discharge, the patient was scheduled to undergo wound debridement and incision/ drainage of abscess. He was also advised psychiatric evaluation for further evaluation as an outpatient.Conclusion: There are only a few published articles on insertion of foreign bodies on male urethras. The diagnosis of a foreign object may be difficult due to inconsistent claims during history taking. Consequently, patients may come in for consult due to the secondary complications. Management of these cases is primarily surgical which include cystourethroscopy to diagnose urothelial injuries and to directly visual-ize if there are no fragments left. These objects can be successfully extracted by endoscopic methods with the aid of forceps, snares, and baskets. Psychiatric intervention is later warranted to these patients. Introduction and Objective: Nocturnal Enuresis (NE) is a common problem in the pediatric population, affecting up to 8en at 10 years of age. NE can have a profound psychologic impact on a child'self-esteem and social interactions as well as contribute to parental frustrations and anxiety. in this study we aim to investigate the effect of percutaneous tibial nerve stimulation (PTNS) in children with primary monosymptomatic nocturnal enuresis Materials and Methods: A total of 60 patients were included in this prospective study. They were divided into two groups: Group 1: Included 30 patients, each patient was submitted to one PTNS session per week for 12 week each session last for 30 minutes. Group 2: Included 30 patients, each patient was submitted to medical treatment. Results: By using 12 weekly sessions of PTNS, remarkable clinical results were obtained. About 81% of patients post treatment reported a statistically significant subjective improvement in reduction of frequency of NE, 73.3% showed partial response and 6.7% showed full response Conclusion: This study demonstrates that posterior tibial nerve stimulation is a well-tolerated, safe, non-invasive, reduce the frequency of nocturnal enuresis episodes in children and improve the quality of life. Is Detrusor Overactivity a Predictor until December 2018. Hospital Institutional review board was obtained before starting the study. Patients' demographic data, diagnosis, voiding diary pre and post Posterior Tibial Nerve Stimulation (PTNS) treatment, and outcome collected. All patients had baseline investigations (urine analysis, serum Creatinine, Urodynamic study, Renal Ultrasound). Each Patient had to fill a voiding diary and quality of life questionnaire at the beginning of therapy (Week 0) and after completion of the initial weekly therapy (week 12). The success of treatment was defined as 50% or more improvement of voiding dysfunction symptoms in voiding diary. PTNS was continued for 24 sessions in patients who showed 50% improvement or more of symptoms after 12 sessions. Patients who were considered as success completed another twice/month session for three months then once/month sessions for another 6 months (total of 12 Months therapy).Results: Forty-nine patients (35 female and 14 male) with a mean age of 43 years (range 18-77) were included. Two patients were excluded from the study because no urodynamic study was done. Twenty-nine patients (59.2%) had no DO and 20 patients (40.8%) had DO. PTNS treatment showed an overall success rate of 61.5%. In OAB patients with no DO, 15 patients (51.7%) had improvement, while 16 OAB patients with DO (80%) had Improvement. There is a statistically significant difference between the outcomes in both groups (p < 0.05). All patients have completed all sessions with no complications or significant side effects. Results showed that patients with proven detrusor Over activity by Urodynamic study have a statistically significant outcome over those who has urgency frequency syndrome without Urodynamic proven Over activity. In patients with OAB, a urodynamic proven Detrusor Over activity (DO) predicts posterior Tibial Nerve Stimulation outcome. Success rate is more frequently encountered after PTNS treatment in patients in whom urodynamic evaluation showed DO compared to those with negative DO on urodynamic (Urgency frequency syndrome). Differences in Quality of Life and Health Seeking Behaviors between Neurological and Non-Neurological Patients with Urinary Incontinence Michailidou S 1 , Holeva V 1,2 , Damianidou K 1,2 , Samarinas M 3 , Delithanasi A 1,2 , Apostolidis A 1,2 1 Aristotle University of Thessaloniki, Thessaloniki, Greece; 2 Papageorgiou General Hospital, Thessaloniki, Greece; 3 General Hospital of Larissa, Larissa, Greece Introduction and Objective: Despite the high prevalence of Urinary incontinence (UI) among neurological patients, only a small fraction of them seek medical advice for UI. We conducted a questionnaire-based study aiming to record the differences in quality of life (QoL), UI severity and health seeking behaviors between neurological and non-neurological patients. We also developed and studied the psychometric properties of the Health Behavior Questionnaire (HBQ), a three-domain gender-specific tool to assess embarrassment, fear and decision making when seeking medical advice for UI. Materials and Methods: Neurological and non-neurological patients with UI who attended a public teaching hospital's Urology outpatient clinics were interviewed. The study tool comprised five modules: 1) demographics and medical history, 2) King's Health Questionnaire (KHQ), 3) International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI) 4) HBQ, 5) a previously validated treatment adherence questionnaire.Results: We recruited 100 neurological and 100 non-neurological patients (36 men, 164 women). Most neurological patients (52%) suffered from MS. Almost half (55.1%) had sought medical advice. Of them, 68.7% were under UI medication for more than a year. Neurological patients scored higher in the KHQ domains of incontinence impact (p=0.018), physical (p=0.028) and social (p=0.000) limitations, personal relationships (p=0.008), emotions (p=0.002) and embarrassment related to UI (p=0.048). The two groups demonstrated similar severity of UI in ICIQ-SF scores. HBQ Validation. The HBQ modules showed either excellent (Cronbach's α =0.852 and 0.757 for embarrassment and fear modules, respectively) or moderate reliability (α =0.601 for decision making about treatment seeking). HBQ results. Neurological patients scored higher in fear to reveal bad habits to physicians (p=0.046), were more commonly referred to a Urologist by their treating Neurologist (p=0.01), more concerned about outpatient clinics' accessibility and facilities (p=0.021), but less concerned about possible financial burden associated with medical visits (p=0.01), more compliant with the timing of administration of medication (p=0.024) and a daily medical regimen (p=0.047), and understanding the need for medical treatment (p=0.047).Conclusion: Neurological patients were more severely affected in their QoL by UI than non-neurological patients, and showed differences in factors affecting decision-making when seeking medical advice and in adherence to treatment. The HBQ might become a reliable tool to explore health behaviors towards treatment-seeking for UI. Results: Case 1: 19-year-old female with history of urogenital sinus anomaly status post vaginal reconstruction with total urogenital mobilization 10 years prior. The patient had been doing self vaginal dilation for vaginal stenosis when she developed discomfort and acute onset urinary incontinence. Exam revealed a 24Fr urethrovaginal fistula immediately distal to the most stenotic portion of the vagina and 2cm proximal from meatus. Cystoscopy revealed no additional urologic trauma. With the patient in prone jackknife position, the vagina was repaired at the same time to allow exposure. The fistula tract was excised and the urethra repaired in 3 layers. The stenotic segment of the vagina was incised and augmented posteriorly using a 2x2 cm vaginal mucosal graft harvested from redundant distal vaginal tissue. A 16Fr catheter was left for 2 weeks. At most recent follow-up, she has no urinary symptoms, urethral stricture or fistula. Case 2: 27-year-old female with history of Mayer-Rokitansky-Küster-Hauser syndrome and vaginal agenesis managed with vaginal dilation. During vaginal self-dilation, the patient developed vaginal bleeding. Intra-operative exam revealed an anterior vaginal wall tear and ventral urethral disruption to the level of the bladder neck. Cystoscopy revealed no additional urologic trauma. The urethra was repaired in two layers in dorsal lithotomy position. A 16fr catheter was left for 7 days. At follow-up, she has mild stress urinary incontinence but has no urethral stricture or fistula. These are the first two reported cases of urologic trauma while using vaginal dilators. We describe management and successful outcomes of immediate repair for urethral trauma following vaginal dilation. Proper exposure is difficult, but urologic repair can be achieved with or without concomitant vaginal repair. Autologous and Transobturator Sling Surgery as Primary Treatment for Post-Prostatectomy Urinary Incontinence: A Systematic Review and Meta-Analysis Bochinski A 1 , Bratsos S 1 , Raison N 2 1 Imperial College London, London, United Kingdom; 2 King's College, London, United Kingdom Introduction and Objective: Transobturator slings are an established treatment option of post-radical prostatectomy stress urinary incontinence (pRP-SUI), but little is known about the outcomes of autologous sling surgery. This review aims to evaluate the efficacy and safety of transobturator and autologous sling surgery in pRP-SUI. Materials and Methods: MEDLINE, EMBASE and CENTRAL were systematically searched for prospective studies investigating the outcomes of transobturator and autologous sling surgeries for pRP-SUI. The primary outcomes were cure and improvement rates of pRP-SUI. The secondary outcome was the rate of surgical complications.Results: Fourteen studies (eleven involving transobturator and three autologous slings) with a total of 877 patients were included in the meta-analysis. Cure rates were 50% (95% Cl 39% -60%) in transobturator and 82% (95% Cl 58% -93%) in autologous slings, whereas improvement rates were 30% (95% Cl 26% -34%) and 20% (95% Cl 14% -28%), respectively. Complication rates were 12% (95% Cl 6% -20%) and 10% (95% Cl 3% -27%) in transobturator and autologous slings, respectively. Our findings indicate that both transobturator and autologous slings are effective in curing and improving pRP-SUI, with similar complication rates. Evidence is insufficient to support superiority of either surgical treatment. Further randomised controlled trials are necessary to directly compare the two procedures. Impact of Surgeon's Experience in Long-Term Outcome of Sacral Neuromodulation Elterman D, Saadat SH, Shabataev V Introduction and Objective: Management of overactive bladder symptoms, urinary retention (non-mechanical), and chronic pelvic/bladder pain can be refractory pelvic floor physiotherapy, oral medications and intravesical injections/instillations. Sacral Neuromodulation (SNM) has shown to be a very effective treatment option for these refractory symptoms. Although this treatment modality has been available for decades, to our knowledge there is no data on the impact of surgeon's experience on long-term outcomes.Materials and Methods: Failure of SNM was reviewed in patients who had received the implant during the first year in practice of a single surgeon and compared to failure rates in those who received the implant after 18 months of the surgeons' experience. The outcomes were categorized into (1) initial results (at the first two post-implant visits), (2) early results (during the first 18 months) and (3) long-term results (18-36 months). The study period was confined between December 2013 and December 2015 to allow for three years follow-up. Failure was defined as (1) < 50% improvement despite conservative management or (2) revision of the implant due to inefficacy or bothersome symptoms resulting from the implant.Results: A total of 25 patients had received SNM implants during the first year of the surgeon's experience while 31 implantations were done between 18 and 24 months of experience. The demographic data, including age, sex, BMI and the distribution of patients with storage symptoms, urinary retention and pelvic pain were similar in the two groups (p >0.05). Mean implantation time during the first and second years of experience were 55 minutes (25-142) and 36 minutes (24-60) respectively; with 34% of surgeries in the first year lasting > 60 minutes. Initial failure rates were higher during the first year (12% vs 6.25%); however, this was not statistically significant (p= 0.44). Although Log-rank (Mantel-Cox) test did not show significant outcome difference during 36 months of follow-up (p= 0.6), the long term outcomes (after 540 days of follow-up) were significantly better in patients who had received the implants during the second year of surgeon's experience (p= 0.04). Introduction and Objective: Radical prostatectomy is one of the most commonly used treatments for localized prostate cancer. Urinary incontinence and erectile disfunction are frequent consequences of the procedure. They are the main predictors of patients´ quality of life. Age and body mass index appears to be the main predictors for urinary incontinence after surgery. Some studies suggest that membranous urethra characteristics are associated with urinary incontinence after surgery. We reviewed the rates of continence and compared with membranous urethra characteristics evaluated by magnetic resonance. Two patients referred "a small amount", 6 patients "a moderate amount" and 10 patients "a large amount". Mean urethral length in continent patients was 14.0 mm. Mean sphincter width was 12.75 mm. Among patients with moderate and large amount of urinary leak mean urethral length was 17.0 mm and mean sphincter width was 11.0 mm. No significant difference was found between both groups. Conclusion: Urinary incontinence is a major concern in patients´ quality of life after radical prostatectomy. Our study didn´t show any difference between continence status and membranous urethra characteristics in magnetic resonance. Cystitis Cystica: Knowing the Nature of Unknown Voiding Dysfunction Garg H, Singh P, Nayak B, Kaushal S Introduction and Objective: To study the presentation and natural course of cystitis cystica-a controversial premalignant lesion of the bladder. A retrospective analysis of patients with histopathologically proven cystitis cystica for bladder lesion between 2016 till 2018 was done. Perioperative details along with the last available follow-up were included in the analysis.Results: In total, 10 patients were included. The mean age (±SD) was 33.4 (±11.9) years and 9 (90%) were males. The most common presentation was irrita-tive and obstructive lower urinary tract symptoms (90%) along with haematuria (30%), suprapubic pain (40.0%) and acute urinary retention (10%). All of the patients underwent transurethral resection of the bladder tumor as diagnosed on preoperative imaging. All of the patients had a trigonal lesion with bullous appearance partially obstructing the bladder neck. Five patients (50%) had backpressure changes in the kidneys and underwent either bilateral JJ-stenting or percutaneous nephrostomy. The mean follow-up duration was 15.4 months. Patients were kept on surveillance cystoscopy along with upper tract evaluation. The mean number of recurrences was 1.7 (±0.8) with a mean number of recurrent resections was 1.4 (±0.4). One of the patients had to undergo bilateral ureteric reimplantation with resection of the lesion along with augmentation cystoplasty while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. In addition, there was no evidence of malignancy subsequent to this entity in any of the patients.Conclusion: Cystitis cystica is a rare entity and usually occurs in the younger population. Exact etiology and natural course of the disease is still unknown. Princess Alexandra Hospital, Brisbane, Australia Introduction and Objective: Urinary continence post radical robotic prostatectomy (RRP) arises from a complex interplay between pre-morbid state, operative technique and rehabilitation. Pelvic floor structures vary between patients and contribute to continence post RRP. This study aims to assess if preoperative MRI mapping of pelvic floor structures can predict continence post RRP. A retrospective review of pre-operative MRI imaging for RRP performed by two urologists with similar techniques over a 12-month period were considered. Measurements of the length of puboprostatic ligament (PPL), membranous urethra (MU), prostatic urethra (PU), pubourethralis (PUr), rectourethralis (RU), pelvic floor thickness and descent were performed. Continence was assessed at 3 and 12 months post RRP and was defined as 0-1 pads per day for occasional dribble. Statistical analysis was performed using Welch's t test with p value <0.1 considered to be statistically significant Results: Preoperative, surgical and post-operative care was standardized for all 33 patients included in this study. 45% of patients achieved full continence by 3 months. The mean PPL, MU and PU measurements were 1.16cm +/-0.24cm, 0.88cm +/-0.23cm and 4.97cm +/-1.23cm respectively. Comparing those with full continence versus those ongoing rehabilitation; a short PPL length and long MU (>1cm, p=0.001) and PU (>4cm, p=0.09) lengths were most predictive of functional outcome. The mean PPL length for continence at 3 months was (1.14cm +/-0.21cm), continence at 12 months (1.17cm +/-0.24cm) and incon-UNMODERATED ePOSTERS 322 39th CONGRESS OF THE SOCIÉTÉ INTERNATIONALE D'UROLOGIE -SIU 2019 ABSTRACT BOOK tinence at 12 months (1.27cm +/-0.18cm). This trend was statistically significant (p=0.0849) when PPL length was taken as a ratio of individualized pelvic floor length.Conclusion: This study assessed various physical dimensions of the pelvic floor in patients undergoing RRP. Measurements such as PPL and MU were predictive of functional outcome and may be used in the future to help counsel patients or tailor pelvic floor exercise post RRP. Is There a Role for B3 Agonists or Anticholinergics in the Treatment of the Lower Urinary Tract Symptoms (LUTS) in Patients with Multiple Sclerosis (MS)?Glykas I 1 , Fragkoulis C 1 , Mitsikostas D 2 , Papatsoris A 3 , Mitsogiannis I 3 , Papadopoulos G 1 , Skolarikos A 3 , Gkialas I 1 , Ntoumas K 1 , Dellis A 4,5 is the most frequent autoimmune demyelinating disease of the Central Nervous System. Patients suffering from MS usually present with overactive bladder syndrome. Most common symptoms are increased frequency, urgency, incontinence and nocturia which intervene negatively in the quality of life and also affect the ability of patients to work. LUTS occur on average 6 years after the onset of the disease while all patients experience LUTS within a period of 10 years since the initial diagnosis. Our objective is to study the efficacy and safety of treating patients with MS and LUTS using either b3 agonist (mirabegron) or anticholinergics.Material and Methods: This is a randomized controlled trial including 40 patients with MS and LUTS from a single center. At baseline all patients underwent thorough clinical examination including neurological examination and DRE. Medical history was recorded. All patients underwent urine test, urine cultivation and abdominal ultrasound. All patients completed a urination diary (for at least 3 consecutive days) and specific questionnaires such as MusiQoL and NBSS. At second visit and after all the above were completed, all patients were administered either a b3 agonist (mirabegron) or anticholinergics. The choice of which anticholinergic drug to be used was random as no such drug shows any superiority compared to the others. More specifically, twenty patients (the 1 st group) received mirabegron 25mg and twenty patients (the 2 nd group) received solifenacin 5mg, tolterodine 2mg or fesoterodine 4mg. The treatment was always carried out alongside with the MS treatment. Reevaluation was performed 3 months after the first visit. All patients underwent the same clinical and imaging tests that were carried out at first visit. We compared several clinical and imaging parameters (scores of the 2 questionnaires, potential pelvic or calyceal dilatations, increased urine residual volume, infection, Qmax flow rate) between the two groups at first visit and month 3 after treatment. In both groups, improvement in LUTS was recorded. A statistical analysis was performed in both groups us-ing the t-test. No statistical difference was noted between the mirabegron group and the antimuscarinic group in terms of LUTS improvement. Adverse events were reported in both groups.Conclusion: All MS patients receiving either mirabegron or antimuscarinic therapy for LUTS showed an improvement. Nevertheless, no statistical difference was noted between the two groups. Experience with SARS (Sacral Anterior Root Stimulator) in Suprasacral Spinal Cord Injury Patients: Lessons Learned Velarde LG 1 , Gomez RG 1,2 , Campos RA 1 , Castano JC 3 Introduction and Objective: SARS (Sacral Anterior Root Stimulator) is an implantable electronic device to provide voluntary control of micturition, defecation and erectile function in spinal cord injury patients (SCI). It includes a bilateral dorsal rhizotomy and implantation of electrodes at S2-S4 roots. We review our results focusing on device function. Between January 2013 and March 2019, 15 SARS were implanted, 13 men and 2 women. There were 8 quadriplegics and 7 paraplegics, average age 44 years (range 31-59). Average follow-up was 49 months (range 8-74). The system is evaluated in 3 dimensions: bladder, intestinal and erectile function. Bladder function: 87% (13/15) use SARS successfully 4-5 times/ day, with a 250-700cc voiding volume and 50cc post void residual. One patient with de novo sphincter incompetence received a synthetic male sling. Three pt. (20%) require occasional bladder catheterization (all caregiver-dependent quadriplegics). Two pt. (13%) failed urinary management: 1 pt. did not increase bladder capacity, remaining incontinent and the other did not tolerate SARS due to painful stimulations; both required a continent urinary diversion. Six pt. (40%, all quadriplegics) presented symptomatic urinary tract infections (UTIs), related to poor caregiver technique. Defecatory function: 93% (14/15) successful daily use. Erectile function: 85% (11 of 13 males) obtain good erections with SARS stimulation. However, of the 6 patients sexually active preSARS, only two (33%) use SARS for intercourse because of displacement of the external antenna. Eventually, 4 patients (31%) require a penile prosthesis implantation. Complications included: two patients (13%) showed postoperative neurapraxia, which resolved spontaneously after 12 months, and two other patients (13%) suffered extrusion of the internal antenna. We observed malfunction/damage of the external hardware in 10pt (67%), mostly related to operator misuse.Conclusion: SARS success was 87% for micturition, 93% for defecation and 33% for intercourse. Our main difficulties were in caregiver-dependent quadriplegics due to operator misuse, causing damage of the external hardware or symptomatic urinary tract infections. Loss of reflex erections was also an undesired side effect in sexually active patients. According to this, we believe the best candidate for SARS is an adult able paraplegic, without use of his reflex erections for intercourse. Long-Term Efficacy and Safety of Adjustable Device for Treatment of Male Stress Urinary Incontinence González-López R 1,2 , Garde-Garcia H 1 , Gonzalez-Enguita C 1,2 1 Fundación Jiménez Díaz University Hospital, Madrid, Spain; 2 Infanta Elena University Hospital, Valdemoro, Spain Introduction and Objective: We report our experience with an adjustable device (ATOMS ® ) in the treatment of male SUI with a long follow-up. Retrospective, nonrandomised, multicentre study. Eighty-two ATOMS ® devices have been implanted in two tertiary hospitals in Spain, from September 2012 to March 2019. 78 were analyzed (6 months follow-up) Clinical data, etiology and SUI severity were initially collected. Preoperative evaluation was performed by cough stress test, cystoscopy, 24-hours pad-test and urodynamics. Outcomes, complications and evolution were registered during follow-up. Statistical analysis was done through Stata 2.0.Results: Mean age was 67 years (±4.8). Radical prostatectomy was the most common cause of SUI (86%). 22% had received external radiotherapy (ERT) previously.33 patients had mild-to-moderate SUI and 58% were severe SUI. Median follow-up was 37.8 months (±21). Continence-rate (dry or less 10g/24h): 74% at 6 months, 78% at 12 months, 79% at 24 months, 83% at 36 months, 80% at 48 months and 88% at 60 months. No differences in continence rate were found between mild, moderate or severe SUI. Continence rate in ERT patients was lower (p<0.0001): 39%, 37%, 38%, 55%, 57% and 60%, respectively. Device refill was performed in 87% patients (3.3±2.24 times each). 5 abdominal valves, 17 scrotal valves and 56 scrotal pre-assembled valves (72%) have been implanted. There were no complications during surgery.Minor complications: 11 spontaneous voided devices and 3 acute urinary retentions. These complications were less frequent in pre-assembled devices (p<0.04). Major complications: 4 valves were removed (3 infections and 1 extrusion). 2 patients needed burying valve. 5 devices were totally removal due to infection (3) and urethral perforation (2).Reoperation rate was 14%.Patient satisfaction was assessed with visual analogical scale: 8.7.Conclusion: ATOMS ® device is safe, easy to implant and can treat male SUI successfully with a low rate of complications and device explanations. Previous ERT might influence the achievement of complete continence after implantation. Counselling with radiated patient before implantation is necessary to warn about lower rates of total continence. The aim of this study is to report our results on the efficacy and safety of a novel adjustable single-incision sling (Altis ® Coloplast, France) for the treatment of female stress urinary incontinence (SUI). Retrospective, nonrandomised, multicentre study. Two-hundred seventy-three women (273) underwent sling placement in two tertiary hospitals from February 2012 to March 2019.Preoperative assessment was performed by cough stress test, urinalyses, and urodynamics. Outcomes were measured by a cough stress test, questionnaire ICIQ-SF and recording of complications following IUGA recommendations. We analyzed 197 patients with a minimum follow-up of 12 months. 8 patients were missing. Mean age was 57.5 years (±12.7). One-hundred eighteen patients (59.9%) presented mixed incontinence (MI). Thirty patients (15.2%) underwent simultaneous surgical intervention for pelvic organ prolapse (POP). Median follow-up was 35.4 months (12-70). Success was achieved in 134 patients (92%) two years postoperatively. During follow-up, five patients were reoperated with adjustable TVT procedure. After five years of follow-up, 89% of patients were dry.Thirty patients had recurrent SUI (15.2%) and all had resolution.About MI, 91% were cured of SUI and 66% were cured of urgency. Urgency decreased at one month, from 59.9% to 20.6% (p< 0.001). Early complications: 1% vaginal extrusion (3AT1S3 and 3AT2S1), 2% vaginal hematoma (no IUGA), 2% voiding dysfunction (4BT1S5 y 2x4BT2S5), 5.2% groin pain (1Bd-eT1-2S3). Lower age and absence of previous urgency were risk factors associated with early complications (OR:0.96, CI 95%:0.92-0.99, p=0.017; OR:0.39, CI 95%:0.15-0.93, p=0.033).Late complications:2.6% urgency de novo,2.2% voiding dysfunction (4BT2S5), 2% UTI (no IUGA), 4.2% chronic groin pain (1Bd-eT2S3). Two patients required total sling removal for pain relief.Previous SUI surgery was the only factor associated with late complications (OR:2.88, CI 95%:1.01-7.61, p=0.047).Decreasing ICIQ-SF index showed high statistical significance during follow-up (p<0.001). Satisfaction and benefit were high. The Altis ® Single incision sling is an efficacious and safe device for the treatment of female SUI and can cure urgency in 66% of case of MI. Previous surgery or urgency and younger age are risk factors for developing complications. Radical prostatectomy was the most common cause of SUI (89.6%). External radiation therapy (ERT) was performed in 16 patients (and HIFU in one of them). Previous treatments: Three AMS-800™, 2 Virtue™ male sling, 1 Remeex™ male sling and Flow-Secure™ after, 2 botulinum toxin and 1 Urolastic™.Cervicectomy was performed in 10 patients, and 4 patients had prior history of recurrent urinary tract infections (RUTI).Median pad test was 1070g (range 260-1533). Urodynamic study was performed showing urinary incontinence in all patients, plus overactive bladder in five.No intraoperative complications were recorded, and patients were discharged 1-3 days after surgery. The device was inactivated 50 days after surgery on average (range 45-60).Refill was performed in 16 patients (1-5 times each) with a median volume of 1.2 ml. Ten of these patients have received ERT (including the patient after HIFU, 62.5%).Complications:Erosion was developed in 4 patients and the device was explanted; three patients had prior ERT. Mechanical failure was demonstrated in two patients and devices were changed (Clavien-Dindo III). No risk factors were found (p>0.5). After 1 year of follow-up, persistent urinary incontinence has been diagnosed in 8 patients, 5 with prior ERT (p>0.5). Continence immediately after activation was related with continence during follow-up (OR: 19.6, IC 95%: 2.61-4.18, p=0.002). The refillable artificial urinary sphincter ZSI 375 PF is a reliable alternative with good continence results and a low complications rate. Patient Reported Outcomes Measures for Intradetrusor Injections: Local or General Anaesthesia-Which Gives Better Outcomes? Goonewardene S 1,2 , Bambang T 1 , Khan Y 1 , Pietrzak P 1 1 Southend University Hospital NHS Foundation Trust, United Kingdom; 2 East of England Deanery, London, United Kingdom Introduction and Objective: Symptoms of overactive bladder, refractory to medical therapy, can often be managed successfully with onabotulinum toxin. These can be done under local or general anaesthetic. The aim of this study is to review patient reported outcome measures on response to intradetrusor injections. A retrospective case-control study was conducted including 62 patients were treated from 2008-2016, 8 cases of neurogenic detrusor overactivity, 54 with idiopathic detrusor overactivity. Urodynamic and clinical parameters were compared between groups. The primary endpoint was the rates of success defined as the combination of urgency, urinary incontinence, and detrusor over activity resolution.Results: All cases in both GA and LA groups had Urodynamics beforehand and ISC taught. ISC was used in 5 cases in each group. The patient reported response was 18/18 in the GA group and 19/22 in the LA group. The average time to response was 15.3 months in the GA group and 10.5 months in the LA group. There were 4 UTIS in each cohort, but two with voiding dysfunction and one with retention of urine in the LA group.Conclusion: Intradetrusor botox injection is efficacious and safe, with a good patient response. Patient reported outcome measures are successful for assessing outcomes from onabotulinum therapy. Total patients were ninety women with equal severity for stress and urge MUI. Postoperative SG were 66 patients (73.3%) and DG were 24 patients (26.7%). PSR included CG were 84 (93.3%) and FG were 6 (6.7%). In PS, significant difference included body mass index (BMI) (P= 0.028), Valsalva leak point pressure (VLPP) (P= 0.041) and overactive bladder symptom score (OABSS) (P <0.001) between SG and DG. In PSR, significant difference revealed VLPP (P= 0.011), OABSS (P <0.001) and Stamey symptom grade (P= 0.028) between CG and FG. In multivariate analysis, VLPP (P= 0.008) and OABSS (P <0.001) were independent predictor of PS and VLPP (P <0.001) was only independent factor of PSR. Especially, in post Hoc comparison analysis, significant difference of PS revealed between intrinsic sphincter deficiency (ISD) and anatomical incontinence (AI) in VLPP (P= 0.008) and between mild and severe symptom in OABSS (P= 0.002). Significant difference of PSR revealed between ISD and AI in VLPP (P= 0.001). The higher VLPP, the higher both PS and PSR. The OABSS is also independent predictor for the PS. It is possible to help for evaluation and the appropriate management for MUI. However, more studies are needed to find diverse factors that can predict the postoperative results of stress or urge predominant MUI. Long-Term Use of Intra-Detrusor BotulinumToxin A in Adults with Spina Bifida Leung LY 1 , Thomas A 2 , Nguyen LT 2 , Carey M 1 , Lee F 1 , Sharma D 1 , Seth J 1 Introduction and Objective: Intra-detrusor Botulinum Toxin A (BTX-A) is an effective and established treatment for neurogenic detrusor overactivity (DO) in children, and adults with multiple sclerosis or spinal cord injury. Little evidence exists for BTX-A in adults with Spina Bifida (SB). This study aims to report long-term clinical outcomes of intra-detrusor BTX-A in adults with SB; evaluating patient satisfaction, quality of life (QoL) and treatment durability. We retrospectively analysed the clinical records of all SB patients at a large neurosciences centre treated with BTX-A. Demographic, clinical, QoL and urodynamic data were acquired. Urodynamic assessment was performed pre-BTX and follow up when feasible. We identified 152 adult patients with SB, mean age 26 years (18-47), 82 males, 70 females. 17 (11%) patients received BTX-A, with first treatment at mean age 11 years (4-19). Mean number of rounds was 6 per patient (1-13), totalling 89 individual treatments. 53/89 (59%) had Dysport (mean dose 1000 U) and remainder had onabotulinumtoxinA (250 U). Mean follow up was 11 years. All patients were taking an antimuscarinic concurrently. 13 (76%) performed Clean Intermittent Self Catheterisation pre-treatment and all continued afterwards. 10 (58%) patients had previous reconstructive urinary tract and bowel surgery. Pre-treatment urodynamics demonstrated mean bladder capacity of 350 mL (200 to 480), 13 (76%) DO, 11 (64%) compliance loss, 4 (24%) stress urinary incontinence, 7 (41%) recurrent urinary tract infections (UTIs), and 5 (29%) vesicoureteric reflux also requiring treatment. 5 (29%) patients discontinued BTX-A due to inefficacy or worsened UTIs; 2 (12%) had augmentation cystoplasty, 1 (6%) ileal conduit, 1 (6%) renal transplantation and 1 is awaiting urinary diversion. Patient self-reported satisfaction showed mild-moderate benefit on a Likert scale. Mean ICIQ-OAB scores pre and 3 months post latest BTX was 6.8 and 4.1 respectively, with bother score improving from 17.8 to 8.6. This study attempts to examine longterm durability of BTX-A treatment in a very complex patient group. We identified competing factors that may lead to treatment discontinuation; including compliance loss, recurrent UTIs, vesicoureteric reflux and stress urinary incontinence. 14/17 (82%) patients elected for repeat BTX-A, with positive self-reported satisfaction and improved QOL scores. The present study aims to test the functionality of a new device for intermittent bladder emptying in female patients with failure of bladder filling and emptying mechanisms in a longterm analysis. A randomized clinical trial was conducted from March 2015 to December 2018 involving 177 female patients suffering mostly from neurogenic bladder. Patients were allocated in Group I -Device Group (DG) and Group II-Clean Intermittent catheterization (CIC). The primary outcome was defined as the impact on Quality of life (QoL) in both groups. Data from episodes of urinary tract infection (UTI), adverse effects, number of pads per day as well as costs related to other forms of treatment were also evaluated. The new device was applied in an outpatient basis. No important inconveniences were observed during the procedure. Devices were replaced every 2 months following the same protocol. A complete urologic evaluation was done every 6 months to check urinary tract status.Results: There was a significant improvement in Qol when comparing pre and post implantation of the device (p <0.001). A significant decrease in UTI episodes was detected (p <0.001) (Figure1). No significant adverse effects were observed. There was also a significant reduction in the number of pads per day. The longterm study of this group of patients showed very promising results specially with improvement of QoL and decreasing on the occurrence of UTI. This may represent a significant step forward concerning the way of dealing with females with deficiency of mechanisms of filling and emptying of the bladder. The Incidence of Acute Urinary Retention after Botulinum Toxin Intradetrusor Injection Persu C, Narcis C, Jinga V "Th Burghele" Clinical Hospital, Bucharest, Romania; "Carol Davila" University of Medicine, Bucharest, Romania Introduction and Objective: Botulinum toxin is nowadays widely used for the treatment of detrusor overactivity. Unlike antimuscarinics, botulinum toxin might induce acute urinary retention, imposing clean intermittent catheterization (CIC) for voiding. Our prospective trial focused on the real-life incidence of acute retention or high volume PVR imposing CIC in our center. A total of 52 consecutive patients were included in this study and followed for 12 months. They were treated with at least two different antimuscarinics before being switched to second line therapy because of lack of efficacy. Abobotulinum toxin type A 500U was injected as per our standard of care. CIC was started if the PVR reached or exceeded 250 mL or if the patient complained about severe voiding dysfunction and had a PVR of at least 50 mL. Monthly visits were performed. If CIC was started, its total duration was also monitored. The demographics, number of urgency episodes per day, leakage, PVR and King's Health Questionnaire Social Limitations (KHQ-SL) score were analyzed using contemporary statistics. The overall incidence of CIC in our series was 5.7% with a median duration of 44±24 days (p<0.0001). In the group who did not use CIC, the PVR increased with a mean value of 55±25 mL (p<0.0005). The KHQ-SL score at 6 months showed consistent improvement across the series, with median values lowered by 20.7±2.2 (p<0.00001). No significant AEs were reported in this series.Conclusion: Although acute urinary retention or high volume PVR are possible complications of this technique and the patient should be informed and consented before treatment, our study demonstrates that their incidence is low. The series was too small to allow age or gender corrections, but since the overall result is very good, we state that age, gender or the condition behind detrusor overactivity are not important predictor factors for the need of CIC. Evaluation of Urodynamic Study Parameters Associated with Continence After Robot-Assisted Radical Prostatectomy in Aged Patients Tanaka T, Kuratsukuri K, Hamada K, Nakatani T, Minami A Osaka City University, Osaka, Japan Introduction and Objective: While robot-assisted radical prostatectomy (RARP) is also a safe operation for aged patients with localized prostate cancer, urinary functional outcomes after RARP critically influence their quality of life. Regarding data about predictors of early or intermediate-term continence following RARP, some factors, including age, obesity, membranous urethral length, surgical procedures and prostate volume, were reported. However, estimations of urodynamic study (UDS) parameters in prediction of continence after RARP were limited. In this study, we investigated the characteristics of UDS data in recovery of urinary incontinence of elder patients underwent RARP.Materials and Methods: Between April 2014 and December 2017, seventy patients with prostate cancer received UDS before and at 3 months after RARP at our institution. We divided them into two groups; young group (less than 70 years old, n=43) and senior group (70 years old and over, n=27), and then classified each group as urinary continence (UC) or incontinence (UI) in the assessment of urinary function at 3 months post-RARP. Continence was defined by 0-pad or 1-safety pad usage at 3month follow-up. Patient and operative characteristics included body mass index (BMI), initial prostate-specific antigen (iPSA), staging, prostate volume, operation time, blood loss volume and performance of nerve sparing.Results: There is no significant difference in continence rate at 3months after RARP between the young and senior group (67.4% vs 66.7%, p= 0.596). In the senior group, the maximum urethral closure pressure (MUCP) of UI was significantly lower than that of UC (71.1± 40 vs 112.8± 50.7, p= 0.038). The presence rate of detrusor overactivity (DO) at 3 months post-RARP in UI of senior group was significantly higher than that in UC of them (75% vs 35.3%, p= 0.01). Other variables (BMI, iPSA, staging, prostate volume, operation time, blood loss volume and nerve sparing) did not differentiate significantly between UC and UI in senior group. Moreover, multivariate regression analysis in total patients revealed that the post-operative DO was an independent predictor of continence 3 month following RARP (odds ratio [OR] 0.19, confidence interval [CI] 95%: 0.06, 0.6). In elder patients, low MUCP before RARP may be a potential risk of the delayed recovery of UI. The presence of DO after RARP may greatly contribute to the persistent UI regardless age. and 7 g respectively. No difference per baseline incontinence severity, BMI and pads usage were found at 36 months. Median ICIQ-UI SF score decreased from 16 (mean 15; range 6-21) to 9 (mean 9; range 0-21). No significant degradations of assessed parameters were registered from 3 to 36 months follow up. No significant change on Qmax and PVR were reported. The main postoperative complications were discomfort or pain: perineal of whom 9 patients (7.7%) required a specific antalgic treatment and 1 (0,8%) a sling revision, genital paresthesia (11; 9.4%), hematoma (4; 3.4%), transient urinary retention (9; 7.7%) and urge symptoms (12; 10.2%). The Virtue quadratic male sling is a safe and efficacious treatment for postprostatectomy incontinence. Further long-term investigations should confirm these findings, especially in moderate to severe and over weighted incontinent patients. Reasons and Limitations of Choosing Urethral Sling Technique for Anti-Incontinent Surgery Thimsuwan R, Nuanthaisong U Vajira Hospital -Navamindradhiraj University, Bangkok, Thailand Introduction and Objective: Urethral slings are currently popular procedure for management of female stress urinary incontinence. While pubovaginal sling (PVS) still be the gold standard one, synthetic mesh sling procedures has been developed with high efficacy and showed shorter operative time. In order to choose suitable surgical technique for individual patient, decision making have to balance on multiple factors. Patient's comorbidity, incontinence severity, socioeconomic status as well as national reimbursement system that synthetic mesh can't reimbursed would be impact on patient's desire and expectation. Procedure familiar or limitation to offer alternative procedures of surgeons could also be the bias as well with the world situation of awareness of vaginal mesh used and synthetic mesh sling procedures were suspended in England on July 2018. This study aims to identify reasons and limitations of choosing urethral sling technique of the patient and evaluate treatment outcomes in term of effectiveness and complications. A retrospective, descriptive study was conducted at Vajira Hospital, Thailand from October 2013 -October 2018. Seventy patients underwent urethral sling procedures. One patient died and four patients couldn't be contacted. Consequently, 65 patients participate in this study.Results: Thirty patients choose synthetic mesh sling procedures due to afraid of PVS's complications include pain, retention, increase operative time that's related to impact on patient's comorbidity. Thirty-five patients choose PVS due to financial problem or surgeon recommendation on incontinence severity. Effectiveness of each technique is not different. But PVS seem to have more complication in some aspects (i.e.urinary retention, suprapubic wound complications). No urethral mesh erosion or infection were observed in this study.Conclusion: Principle concern that's affected on patient's decision making is post-operative compli-cations and financial problem as well with national reimbursement system. Second concern is surgeon recommendation. In order to satisfy the patient and improve treatment outcome, we have to break those limitations with the surgeon providing suitable treatment options for individual patient. Moreover, this study's results can urge institutes and government to realize in patient's limitations and find the way to solve these problems leading to improve treatment strategies, develop our country and make it standardization. Overactive bladder (OAB), a symptom syndrome presenting with frequency, urgency, and urge incontinence, substantially affects the lives of millions of people. The symptoms associated with OAB can significantly affect the social, psychological, occupational, domestic, physical, and sexual aspects of those who suffer from it. The main therapeutic modalities are conservative therapies, such as pharmacological treatment and behavioral therapy. Mirabegron, a b3-adrenergic agonist, is established as an alternative monotherapy to antimuscarinics for the treatment of OAB symptoms. Pelvic floor muscle training (PFMT) is a behavioral intervention aiming at reducing detrusor activity. The study aimed to evaluate if PFMT improves the therapeutic effect of mirabegron in women suffering from OAB. One hundred and twenty women suffering from OAB were randomly divided into four groups and followed a three-month program. In Group A 30 women received instructions about lifestyle changes and educational programs. In Group B 30 women received treatment for OAB, mirabegron 50 mg/day. In Group C 30 women used a PFMT program to ameliorate symptoms of OAB supervised by a therapist. In Group D 30 women received mirabegron 50 mg/day and followed a supervised program of PFMT. All women were evaluated at the beginning and the end of the three-month program with a three-day bladder diary.Results: At the end of the three-month program there were the following results. At the final evaluation of women, between Group B, and Group D, there were statistically significant differences (p <0.05) in frequency, incontinence episodes and pads/day domains.Conclusion: PFMT improves the effect of mirabegron on women suffering from OAB especially in domains of frequency, incontinent episodes, and daily pads used. The objective is to assess the efficacy of PTNS in treatment of patients with voiding dysfunction (OAB, Non-Obstructive urinary retention (NOIUR) and / or chronic Pelvic pain syndrome (CPPS)) who are unresponsive to medical therapy. Single center retrospective study, reviewed charts of adult patients with voiding dysfunction who underwent PTNS in our center between January 2012 until December 2018. Patients' demographic data, diagnosis, voiding diary pre and post PTNS treatment, and outcome collected. All patients had baseline investigations (U/A, Creatinine, UDS, US). Each Patient had to fill a VD and QOL questionnaire at the beginning of therapy (Week 0) and after completion of the initial weekly therapy (week 12). The success was defined as 50% or more improvement of symptoms. PTNS was continued for 24 sessions in patients who showed 50% improvement or more of symptoms after 12 sessions. Patients who were considered as success completed another twice/month session for three months then once/month sessions for another 6 months (total of 12 Months therapy).Results: 108 charts were reviewed. 70 patients (41 female, 29 male) were included the study.38 patients were excluded due to missing data. Age ranged between 18-77 years (mean 42). OAB in 51 (73%), NOI-UR in 14 (20%), and CPPS in five patients (7%). 61.2 % of overall patients had 50% or more improvement of symptoms. Success rate was 62.2 %, 76.9% and 40% in patients with OAB, NOIUR, and with CPPS, respectively. Although PTNS is a well-known alternative second line treatment therapy for patients with OAB symptoms, our results showed that this therapy is even more effective in patients with NOIUR. In addition, it showed less efficacy in patients with CPPS. In addition, all patients have completed the first 12 327 session with no complications or significant side effects. Missing data was a major concern due to lack of some information in the file because this is a retrospective study.Conclusion: PTNS is a safe and effective treatment modality in treating patients with voiding dysfunction who failed conservative treatment. PTNS showed a higher success rate in patients with NOIUR compared with other disorders. Reduction of Radiation Dose Received by Surgeons and Patients During Percutaneous Nephrolithotomy Surgery: A New Shielding Method Introduction and Objective: Due to high prevalence of urolithiasis, endourologic interventions have also been increased for the treatment of patients with urinary stones. During fluoroscopy-gued Percutaneous Nephrolithotomy (PCNL), the surgeon and the patient are exposed to X-ray and its harmful effects. The aim of this study was to assess reduction of the radiation dose received by surgeon and patient after using the new shielding method. In this study, the dose of radiation exposure by surgeon and patient during PCNL under fluoroscopic procedure with conventional shielding methods was compared to a new shielding method designed by the researcher. For this purpose, shields and lead cone with a thickness of 0.5 mm were used and to evaluate the dose of radiation received by surgeons and patients in different parts of the body, Thermoluminescent dosimeters (TLD) were used.Introduction and Objective: Bladder cancer is one of the most common cancers in the world. In some studies, the vitamin D deficiency in these patients has been reported. Vitamin D deficiency may increase the risk of bladder cancer by interrupting bladder cell reactions against abnormal cells. The increase rate of addiction and its abroad society complications is well known. One of the most important organs which may have dysfunctions in drug abusers is reproductive system. Evaluating this potential risk may lead to increasing family awareness. Thirty 60-day-old male rats were divided into target and control groups. The target group undergoes 5 mg/kg intraperitoneal injection of morphine twice a day while the control group underwent normal saline injection instead (using the same dosage). After 60 days rats became unconscious and after blood sampling, underwent bilateral orchiepididymectomy. Histological and hormonal evaluation were performed on samples. The level of spermogramatic features and spermatogenesis has a meaningful reduction in target group comparing to the control group. LH level shows meaningful decrease in target group but not FSH and testosterone levels. Evaluating histological sections, mature sperms have meaningful decrease in target group.Conclusion: Chronic usage of opioids may lead to inducing spermogramatic features as well as sexual hormones. Therefore opioids have potency to cause infertility. These changes may result from the effect of drugs on hypophysis or hypothalamus, the direct effect of drugs on seminiferous tubules or compound of both mentioned etiologies. This study suggested that public awareness against addiction may decrease the infertility rate in the society. Evaluation of the Effect of Meatal Stenosis on the Urinary Tract by Using Ultrasonography Introduction and Objective: Circumcision is one of the oldest surgical procedures that originated for religious purposes. Circumcision in infancy is a common procedure in our country and secondary meatal stenosis due to circumcision is a common complication.The aim of our study is to determine the effect of meatal stenosis on the lower and upper urinary tract of circumcised boys by using ultrasonography. In this cross-sectional study, we enrolled 87 circumcised boys between 4 to 8 years old with severe meatal stenosis. Clinical findings of our subjects were gathered by a checklist that included: thin stream of urine, upward urine stream deviation, infrequent voiding, urinary tract infections, voiding dysfunction, and urge incontinency. In lab data analysis, complete blood cell count (CBC), urine analysis, urine culture, blood urea nitrogen (BUN), and plasma creatinine level were evaluated. Ultrasonography detected hydronephrosis, hydroureter, bladder wall thickening in a full and empty bladder, bladder volume, and residual urine volume.Results: Narrowing of urine stream is commonly seen (about 54%) among patients with severe meatal stenosis, and similarly in sonographic evaluations the most common symptoms among patients was thickening of the bladder wall that increased in an empty and a full bladder (about 82%). The author of this study recommends performing long-term follow up after circumcision and ultrasonography to detect meatal stenosis before permanent renal damage occurs. Assessment of Adverse Effect of Methylphenidate on the Function and Histopathology of the Male Rat Kidney Introduction and Objective: The objective is to assess the adverse effect of the two common dosages of methylphenidate on the function and histopathology of the male rat kidney Materials and Methods: Twenty seven adult male rats were randomize into one control group (normal saline) and two intervention groups (2 and 10 mg/kg methylphenidate for 40 days). The rats were anesthetized after the treatment period and blood sampling was conducted from their heart. The biochemistry markers including urea, creatinine, Na, and K were analyzed and the kidney of the rats underwent pathologic assessment after surgical removal. The mean weights of the rats did not differ significantly between the groups (p value=0.15) but the weight of kidneys the rats showed notable difference between the study groups (p value=0.03). Na (p value= 0.31), K (p value= 0.07), and also urea (p value=0.32) and creatinine (p value= 0.70) showed no considerable difference between the three groups. The pathologic assessments showed 8 cases of congestion, 8 cases of hydropic degeneration, 8 cases of hyaline cast, 3 interstitial nephritis, and 2 lymphocyte infiltration cases in the two intervention groups. However, there was no necrosis or glomerular changes. Furthermore, the above mentioned pathologies showed no difference between the groups The biochemistry measurements in our study showed no significant renal dysfunction except to some degree for potassium changes; however, the histology showed signs of kidney injury. Further studies are needed to complete the results of this study. The Effect of Chronic Administration of Methylphenidate on Spermatogenesis and Hormonal Parameters in Male Rate Introduction and Objective: According to common use of methylphenidate (MPH) for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) and the role of the reproductive system in the production of gametes, studying the effects of this medication on the serum testosterone concentration, morphometry of testes, and fertility rate was the aim of this study. Fifty-four 2-weeks-old male rats were divided into control and tow target groups. The target groups gavaged with 2 and 10 mg/kg methylphenidate daily while the control group gavaged with normal saline (at the same dosage). After 60 days, the rats were anesthetized, and after blood sampling, they underwent bilateral orchiepididymectomy. Then spermatogram histological and hormonal evaluations were performed on the samples. The results of this study revealed that prescription of methylphenidate cause Reduce in sperms number and motility that seen in all target groups compared with control group. Also, changes were seen histologically in all groups that were gavaged with methylphenidate And Testis weight and rat weight were reduce compare with control group.Conclusion: Using methylphenidate in long term, may lead to alterations in sexual features and sexual hormones, therefore, methylphenidate have the potential to cause infertility. These changes may result from the effect of the drugs on central nervous system including hypophysis or hypothalamus, the direct effect of the drugs on the testis, or both of them. These findings suggest that methylphenidate must be used just in indicated patients and overuse of this drug can lead to raise of infertility rate in society. So, awareness about its adverse effect may cause decreased infertility rates. The Effect of Antibiotic Levofloxacin on Spermatogenesis and Male Sex Hormones Introduction and Objective: The increasing incidence of infertility in society is considered as one of the problems of the health system of the community. The imposition of heavy fertility costs on the part of families and the community health system on the one hand, and the psychological and social harm caused by this issue on the other, is proof of the importance of this great problem. The purpose of this study was to identify the effect of levofloxacin antibiotic on male infertility, if possible, as an instruction to reduce infertility in the community. control group and receives normal saline as a placebo. Three other groups of rats receive 6, 8 and 10 mg/kg of body weight per day, using levofloxacin via gavage. After 60 days, the four groups were anesthetized by the ether, the testicles were surgically removed, samples were epidydime and blood samples were sent to the lab and the tests included spermatogenesis, testicular tissue pathology and sex hormones levels in the blood, will be done.Results: After reviewing the data, levofloxacin significantly reduced sperm motility in all three groups receiving levofloxacin. Also, in studies of testicular tissue, there were significant pathological changes in all three groups receiving the drug, which increased with increasing dosage of the drug. FSH level increased in 2 groups that receive levofloxacin, but there were no significant changes in the number of sperms, LH and testosterone.Conclusion: The use of levofloxacin as a commonly used drug in the treatment of infections, especially in cases of prolonged use, can have an adverse effect on the male reproductive system. Therefore, the administration of this drug to men of reproductive age should be based entirely on indications and only if necessary. Results: A total of 11 men with a mean age of 61.8±5.7 (ranging from 55 to 71) were enrolled for analysis.Median serum PSA level at baseline and at the time of PSMA PET CT scanning was 9.2 ng/mL (Interquartile range: 6.4-13.2) and 1.5 ng/mL (Interquartile range:1.1-3.2) respectively. Following SLND, PSA decreased to undetectable levels in 72.7% of patients and 54.5% of patients remained free from biochemical recurrence during a median follow-up period of 11 months (ranging from 3 to 39 months). Figure 1 shows the Kaplan-Meier Curve for biochemical recurrence free survival. The median time to biochemical recurrence following SLND was 15 months (95%CI: 11.7-18.3).Moreover, No grade 3 or 4 complications were recorded based on Clavien-Dindo classification system. Our findings showed that salvage lymph node dissection in patients with CRPC is safe and has the potential to significantly defer the need for systemic treatments. Introduction and Objective: After the development and introduction of Endourology and the invention of PCNL, various methods for removal of kidney stones were described. The main differences in these methods were in the patient's positioning and using ultrasound or fluoroscopy as a guide for stone removal. In all of the guidelines, PCNL has been proposed as a Gold standard to remove large (above 2 cm) and staghorn kidney stones. The strength of PCNL versus other methods has been higher Stone Free Rate in most studies. However, in all studies, high rates of complications of PCNL have been reported (up to 87%). On the other hand, by increasing the length of the surgical procedure, the risk of complications related to anesthesia and surgery, especially in patients with advanced age and underlying cardiovascular and pulmonary problems increases. To overcome these issues, we described the new method of stone removal is PCNL (Enbloc through the skin). After insertion of the ureteral stent, by a cystoscope or ureteroscope in the lithotomy position and under general anesthesia, the patient position was changed to Prone. Under the guide of the fluoroscopy, and retrograde injection of meglumine through ureteral stent, by a 21-18 g needle and guide wire, access was obtained. Then, the tract is dilated to 30 fr with Amplatz and Amplatz sheet. After visualizing the stone by nephroscopy, Amplatz sheath is removed. Skin incision increased to the minimum diameter of the stone. Then by a stone grasper, stone was taken out of the tract. The skin incision site was compressed in case of active bleeding and then suturing with nylon yarn with far & near method was done.Results: Between 2016 -2019, by consent of the patients in our center about 200 Enbloc PCNL was performed by a single surgeon. About 50 cases were followed-up, and at month 6, IVP was performed to investigate the damage to the pyelocaliceal system. We had no side effects such as damage to the colon, pleura, urinary tract system, and no mortality. The use of this new technique can reduce duration of operation and decrease some of the complications of the surgery, such as, anesthetic complications, hospitalization time and medical costs. Inflammation and Prostate Cancer tory diseases, and environmental exposures may act as triggers to prostate inflammation whether solely or mutually. In addition, emerging evidence underlines the significance of genomic alterations in the occurrence of prostate cancer (e.g. polymorphisms). In this review, we aim to perform a comprehensive revision on the role of inflammation in the development of prostate cancer searching the existing literature. Our objective is to focus on etiologic factors proceeding prostatitis and obtaining a mechanistic approach to immunology, genetics, and molecular interactions regarding inflammation of the prostate and its assumed association with prostate cancer. We review the current evidence on the association between inflammation and prostate cancer focusing on the role of presumed risk factors and immunological interactions within the tumor microenvironment recruiting PubMed library.Results: Dietary components, hormonal imbalance, infectious agents, corpora amylacea and urine reflux could induce inflammation of the prostate gland. Available evidence confirms the causative role for chronic inflammation in the formation of prostatic inflammatory atrophy which could eventually develop into precancerous lesions known as prostatic intraepithelial neoplasia. Recent studies advocate the contribution of the innate and adaptive immune system in prostate cancer tumorigenesis mediated by infiltration of immune cells and release of proinflammatory cytokines. However, the effect of immunologic response ranges from tumor progression to suppression depending on the stage of cancer. Intriguingly, Interleukin gene polymorphism has been shown to have an impact on the incidence rate of prostate cancer, emphasizing the significance of both genetic background and inflammatory state in the pathogenesis of the disease. In line with former findings, recent studies confirm the association between chronic prostatitis and prostate cancer. However, the need for further investigations to illuminate the exact mechanisms seems to be substantial. Re-do Female Genitoplasty for Previously Failed Genitoplasty in Male to Female Gender Reassignment Surgeries Materials and Methods: Twenty-one patients who had undergone male to female genitoplasty in other centers underwent re-do genitoplasty. All patients were referred to our center with the complaint of deformity or dysfunction of the external genitalia due to clitromegaly, inappropriate site of the clitoris, vaginal stenosis, inadequate depth of vagina, etc. All surgeries were performed by a single surgical team. For each patient the appropriate reconstructive surgery was planned based on the patient's complaint and complications. Follow-up visits were scheduled for 1 week, 1, 3 and 12 months, postoperatively.Results: Eleven patients had a history of vaginoplasty using the small intestine, whereas in 10 patients it was done with penile and perineal skin. Three cases needed clitoroplasty. Increased vaginal depth was indicated in four patients due to vaginal shrinkage which was repaired using amniotic membrane and a vaginal stent. Urethroplasty was performed in 5 patients. Skin Removal was required in 4 cases. In 5 patients in whom their previous vaginoplasty had been performed as a superficial pouch at the perineal area, vaginoplasty was done with our classic method. None of the patients reported any major complications during this period and were generally satisfied with their sexual intercourse.Conclusion: Using the various methods of redoing reconstruction of the external genitalia when the surgeon has enough experience might lead to desirable functional and aesthetic results. Evaluation of the Results of the Total Penile Disassembly Technique in Patients with Peyronie's disease is a connective tissue disease that is characterized by fibrotic lesions in tunica albuginea and ultimately leads to deformity of the penis causing physiological and psychological problems for the patient. The main method of treatment is surgery for cases that fail to respond to medical therapy. The aim of this study was to determine the success rate of total penile disassembly technique in treatment of patients referred to Imam Reza Hospital during a ten-year period. This cross-sectional (retrospective) study was performed on the patients referring to the reconstructive center of the urology department of Imam Reza Hospital in the period from 2007 to 2017, who had undergone a surgical treatment for Peyronie's disease using total penile disassembly technique. Patients' demographics and clinical data including age, duration of the disease, penile curvature and plaque location were extracted from the patient records. The result of the patients' evaluationduring surgery including the angle of curvature and also the anatomy of the penis using artificial erection were extracted and recorded in the patient checklist. All patients have been visited at regular intervals after surgery and the postoperative success rate as well as the complications were assessed and documented based on various factors. Finally, the data were analyzed by SPSS software version 16.Results: A total of 100 patients with a mean age of 36.35 ± 9.02 years were studied. Plication and grafting technique was used in 66 (66%) and 34 (34%) patients, respectively. The two groups were not statistically different in terms of demographic and clinical features including age, duration of disease, history of diabetes, history of penis trauma, history of penile surgery and Plaque dispersion (p value> 0.05). The median follow-up period was 12 months. The penile length remained unchanged in 86 patients (86%) but reduced in 14 patients (14%) (11 cases less than one cm (11%) and 3 (3%) more than one centimeter) which this reduction more significantin the plication compared to the graft group (p = 0.004). The anatomical success rate of treatment (access to the penis with curvature less than 15 degrees) was observed in 100% of patients, which was the same in the two groups (p = 0.91). Postoperative erectile dysfunction was observed in 17% of patients (de novo erectile dysfunction in 6 patients (6%)) whichwas higher in the plication group (p = 0.03). Overall satisfaction rate was 86% which was not significantly different in the two groups (p = 0.09).Conclusion: Total penile disassembly technique is an appropriate method oftreatment in patients with Peyronie's disease, which can be performed with acceptable success rate and low complications. Effect One of the most urologic surgery in urology is scrotal surgeries absorbable sutures are mostly used for scrotal skin repair and infection is known as important complication. We used topical tetracycline ointment after scrotal surgery in addition of routine drugs and compared with other group that received only the routine drugs (antibiotic and analgesics for wound infection and scrotal discomfort ). In the first group, after 48 hours of scrotal surgery no wound dressing was performed. In the retrospective study, we evaluated 84 patients since April 2014 to August 2017 for wound infection and scrotal discomfort and pain after scrotal surgeries. The patients were divided in two groups; group A (used tetracycline topical ointment) without would dressing (n= 36.43%) after hospital discharge, and group B (used routine drugs) with daily wound dressing(n= 48.57%), after 10-14 days of scrotal surgery all patients were visited and evaluated for wound infection and scrotal pain and discomfort. Introduction and Objective: Post-operation pain after hernioraphy is a common complication of the surgery that is caused by inflammation, trauma and burning through the surgery. It causes more hospitalization time and patient disability after surgery. In this study, we are going to know the effect of slow-released NSAIDs tablets before surgery on postoperative pain of inguinal hernia surgery. In this study, the specimens were selected among patients with inguinal hernia surgery (direct and indirect hernia) in Urology department of Ghaem Hospital in Mashhad. They were randomly divided into two groups of intervention and control. The experimental group received a dose of 100 mg of slow-released diclofenac or 75 mg indomethacin tablet before the operation and the control group did not receive the drug. During the first 24 hours after the operation, the pain was evaluated and the two groups were compared.Also, the patients' requests for receiving analgesics during the first 24 hours after operation were evaluated that determined the patient's pain with the Pain Questionnaire, then the two groups were compared. The study included 76 patients, all of them were male and the mean of age was 42/28 ± 13/75. There were 38 patients in the control group, and 38 patients in the intervention group. The mean age of the control group was 41.77± 13.5 and mean age of intervention group was 42.8± 14.62 two groups, had not obvious differences (P value= 0/744) also the side and .The type of hernia in two groups, had no obvious differences, (P value= 0/766) .During this study , the mean of patients' pain score in the control group was 6.43± 1.9 and the mean of patients' pain score in the intervention group was 4/33 ±1/86 (P value <0/001). Patients were also evaluated for postoperative severity of pain. In the control group, 29 patients (96/7%) and in the intervention group, 14 patients (46.7%) asked and received the first dose of post-operative analgesic due to the pain (P value <0/001). Also, 11 patients (36.7%) from control group and one patient (3.3%) from intervention group received the second dose of analgesic after surgery due to severe pain (P value <0/001).Conclusion: According to this study, we saw that patients who had recieved 100 mg slow released diclofenac or 75mg of indomethcine before surgery had a significant decrese in postoperative pain and also the intervetion group experienced fewer period of pain and received less analgesic in comparison to control group. Outcomes of Ultra Mini PCNL for Renal and Upper Ureter Calculi Less than 20 mm in Children Under 8 Years OldSoufimajidpour H 1 Introduction and Objective: The aim of this study was to evaluate the outcomes of ultra mini PCNL for renal and upper ureter calculi less than 20mm in children under 8 years old. A total of 22 children (33 kidnies) aged less than 8 years old with renal and upper ureter calculi less than 20mm who had inclusion criteria, and were operated by UMP method between January 2016 and November 2018 at Tohid and Kowsar hospitals in Sanandaj, Iran were evaluated. Inclusion criteria were; single unilateral kidney stone, stone size between 10-20mm, normal renal function test and no congenital anomaly. The "UMP" system (LUT, Germany) consists of a 1 mm (3F) telescope, 7.5F nephroscope inner sheath with three ports (one each for telescope, saline irrigation inlet, and laser fiber), and 11 or 13F metallic outer cannula which serves as the Amplatz sheath.Results: The average age of children was 5.22 years. A total of 14 (63.6%) were male and 8 (36.4%) were female. In 15 cases (68.2%) stones were in the right kidney and in 18 cases (82%) the stones located in upper ureter. In terms of stone type in 13 cases (59%) the stones were calcium oxalate. The average size of stones was 15.5 mm. The mean surgical time was 58.6 minutes and the average admission time was 44.7 hours. Post operative fever was reported in 4 cases (18.2%) and 3 cases (13.5%) need a supplementary method (JJ stent, ureteroscopy). Free stone rate was 95.5% (21 cases) and no post operative septicemia, damage to adjacent organs and need for blood transfusions were reported. The ultra mini PCNL is a minimally invasive, safe and effective method for the treatment of renal and upper ureter calculi less than 20mm in children under 8 years old. Moderated ePosters The Application of ERAS Protocol in the Treatment of Patients Under Robot Assisted Laparoscopic ProstatectomyCao J, Ren P, Guo X, Ding Y Introduction and Objective: To investigate the application of ERAS protocol in the treatment of patients under radical prostatectomy with quality of care and efficacy. A total of 100 cases of patients with radical prostatectomy were randomly divided into the control group and the intervention group. The patients in the control group were given the conventional health care strategy, the patients in the intervention group were given the ERAS protocol. This research observed and recorded the first time of flatus, postoperative complications, and the average length of stay after surgery, treatment costs and patient comfort level and other indicators between two groups of patients and compared, during the postoperative period.Results: In the intervention group, the time of the first flatus, the average length of stay was significantly shortened, the treatment cost was significantly reduced, the incidence of postoperative discomfort and complications was reduced, and the comfort level of the patients was improved. The differences of the observed indicators between two groups were statistically significant (P <0.05). The application of ERAS protocol in robotic assisted radical prostatectomy for prostate cancer patients is safe and effective, which can improve the efficiency of medical and nursing work and optimize the utilization of medical resources. Effect of Warm Bladder Irrigation Fluid for Benign Prostatic Hyperplasia Patients on Perioperative Hypothermia, Blood Loss and Shiver: A Meta-AnalysisCao J, Ding Y Introduction and Objective: To find out whether warm bladder irrigation fluid can decrease the occurrence of perioperative hypothermia, blood loss and shiver in patients treated with benign prostatic hyperplasia (BPH). Continuous bladder irrigation, used widely intra-and postoperatively for patients treated surgically for BPH, is regarded to be related to hypothermia, blood loss and shiver. It remains controversial whether warm irrigation fluid can reduce the risk of these complications. A comprehensive literature review and meta-analysis that included randomized controlled trials (RCTs) related to temperature of irrigation fluid in the perioperative treatment for BPH. The relevant literature were searched in Chinese database, such as Retrieval Chinese Journal Full-text Database, VIP Journal Database (1989e2018), Wanfang database, as well as in English search engine and database, including Embase, Cochrane and Medline till January 2018. The study quality was assessed by recommended standards from Cochrane Handbook (version 5.1.0). A total of 28 RCTs and 3858 patients were included. The results showed that the incidence of shiver (Risk Ratio (RR)= 0.32, 95% confidence interval: 0.28-0.36, p <0.0 01, I2=0%) and hypothermia (RR= 0.36, 95% confidence interval (CI): 0.21-0.59, p <0.001, I2= 67%) in the group of warm irrigation fluid were lower than the group having room temperature fluid. Room-temperature irrigation fluid group caused a greater drop in body temperature compared to warm irrigation fluid group (p <0.001, I2= 96%). We performed a narrative descriptive statistics only because of substantial heterogeneity.Conclusion: Warm bladder irrigation fluid can decrease the drop of body temperature and the incidence of hypothermia and shiver during and after the operation for BPH. Warm irrigation fluid should be considered as a standard practice in BPH surgeries. Homeflow Introduction and Objective: Paper based frequency volume charts(FVC) are an established method for evaluation of voiding disorders in children, including enuresis nocturna, but often not reliable because of incomplete registration by the patiënt or parent. A home-uroflowmetry -automatically registering voiding volume and time -connected to an online app to enter intake, urge and leakages can be an alternative. In this study we will assess the user feasibility and experience of the the Homeflow with children. Eight patients (mean 11,1 years, 4-18 years, M:6 F:2) were included to use the Homeflow at home for 2 consecutive days. Every void was collected in the Homeflow and every intake registered in the app. User-experience data (completeness, reliability, feasibility) was collected through daily questionnaires by the parents/child. Data was analyzed by percentage-based descriptive statistics.Results: All patients (100%) reported their Homeflow FVC (voids, intake, leakages) to be complete.Most subjects considered their diary as representative (50%) or rather representative(37.5%) for a normal day/night. The experience with the app was rated as user-friendly (50%) or rather user-friendly(37.5%).Since the home-uroflowmeter fits on a normal toilet, most patients (87,5%) considered their voiding posture neutral with no refrain(87.5%). All 4 patients with pre-existing experience preferred the Homeflow over paper based FVC. 71.4% preferred the Homeflow over uroflowmetry in the hospital. The Homeflow was preferred by parents and children over paper based FVC and uroflowmetry in the hospital. Complete registration of voiding was achieved through automated measurements. Based on this user-experience data the Homeflow is considered to be a user-friendly, hygienic, comfortable method to evaluate voiding disorders at home. Decision-Making Style and Influencing Factors of Patients with ProstatectomyCao J, Ding Y Introduction and Objective: To investigate the types of participation in surgery decision-making of informed prostate cancer patients and to explore its influence factors. A questionnaire survey was conducted for 163 patients with prostate cancer who were admitted to 4 comprehensive hospitals in Shanghai from December 2017 to March 2018, using the convenience sampling method. The questionnaire included general information of the patients, decision type scale and so on. Statistical methods included non-parametric Spearman rank correlation analysis and orderly classification logistic regression, were used to analyze the influencing factors of decision types for prostate cancer patients. The factors influencing decision-making in patients with prostate cancer are age, cultural level, family participation, medical payment and so on in univariate analysis. 44.8% of patients are passive decision type, 15.3% of patients illustrate shared decision-making, 39.9% of patients show the active decision-making. According to logistic regression, the type of patient's participation in decision-making is related to 4 factors, which are the patient's age, education background, medical payment style, and whether it is the first time of hospitalization.Conclusion: Currently, the participating attitude of Chinese patients with prostate cancer in surgical decision-making is more positive than before, but participation in decision-making status is not ideal, so it is a long and arduous task to promote the surgical decision-making of patients with prostate cancer. Medical staff should assess patients' decision-making needs, strengthened communication with patients and their families, in order to promote the degree of patients' participation in the decision-making of surgery. Introduction and Objective: Decision-making around treatment for non-metastatic prostate cancer (PCa) is notoriously complex. Shared decision-making depends upon both clinician and patient having a good understanding of the benefits and harms of different management options. We created PREDICT Prostate, a newly released individualised prognostic model that provides long-term survival estimates for men diagnosed with non-metastatic PCa. The objective of this study is to assess if PREDICT: prostate affects clinician estimates of prognosis and therefore its potential impact on treatment recommendations. A multivariable model estimating individualised 10-and 15-year survival outcomes was constructed and validated with multi-national data from over 12,000 men diagnosed with non-metastatic PCa. PREDICT Prostate uses routinely collected clinicopathological information such as age, prostate-specific antigen (PSA), histological grade, biopsy core involvement, stage, and primary treatment to determine PCa-specific mortality. PRE-DICT Prostate also contextualizes treatment benefit against non-PCa specific mortality by factoring in comorbidities and age. The tool is now freely available through an easy-to-understand webpage (www.prostate.predict.nhs.uk). In total, 190 clinicians (63% urologists, 17% oncologists, 20% other) were randomised into two groups and shown 12 clinical vignettes. Each group viewed opposing vignettes with clinical information alone, or alongside PREDICT Prostate estimates. 15-year clinician survival estimates and treatment recommendations, with and without the tool, were measured. The model demonstrated good discrimination, with a C-index of 0.84 (95% CI: 0.82-0.86) for 15-year PCa-specific mortality, comparing favourably to international risk-stratification criteria. Clinician estimates of PCa-specific mortality exceeded PRE-DICT estimates in 10/12 vignettes, and their estimates for treatment survival benefit were more than 5 fold higher. Viewing PREDICT Prostate led to significant reductions in likelihood of recommending radical treatment in 7/12(58%) vignettes, particularly in older patients. Overall, 81% of respondents felt PRE-DICT Prostate would be a useful clinical tool. We compared clinician estimates of survival against the model's predictions, and assessed its value as a clinical tool. Prognostic power is high despite using only routinely collected clinicopathological information. Our data suggest clinicians overestimate cancer-related mortality and radical treatment benefit. Using an individualised prognostic tool like PREDICT Prostate may help clinicians and patients make more informed, appropriate treatment decisions. Effect Study of Enhanced Recovery After Surgery in Robot-Assisted Laparoscopic Radical Prostatectomy Patients Introduction and Objective: To explore the effect of enhanced recovery after surgery in robot-assisted laparoscopic radical prostatectomy patients. A total of 92 cases of patients with robot-assisted laparoscopic radical prostatectomy were included in the urological department of a first-class hospital in Shanghai from November 1, 2017 to October 30, 2018. All the subjects were divided into experimental group and control group by random number method, the experimental group received ERAS, the control group received traditional perioperative nursing intervention.Results: The first time of anal exhaust time in experimental group is (19.50-11.24) h, the first time of drinking water in experimental group is (4.045 + 0.32) h, and the hospitalization days in experimental group is (4.29 + 0.93) days, all of these times are shorter than in control group. The satisfaction of the medical care from patients in experimental group is higher than in control group, comparing the two groups have statistical significance (P <0.05). The process of ERAS in Radical Prostatectomy Patients is safe and effective, which is of great significance to shorten the length of stay in hospital, improve the patient's comfort level and improve the satisfaction of the medical care, and it has clinical implementation velue. Improving Outpatient Clinical Care Efficiency for Urethral Stricture Patients Using the Home UFlow Meter™ Introduction and Objectives: Flow rate measurement is an important and objective clinical investigation for assessing patients with urethral strictures. It is used to diagnose a urethral stricture and to monitor outcomes following surgical intervention. Routine clinical practice has been to bring patients to the hospital to assess their flow rates, however patients are not always prepared to void urine "on demand" and therefore flow rate results may not be wholly reliable on low voided volumes. To assess the feasibility of using the Uflow Meter™, a home flow measurement device, to enable patients to self-monitor their urine flow at home and to engage with their clinical team as required avoiding unnecessary visits to hospital. This video describes the Uflow Meter™ device and shows its clinical application.Results: This simple funnel-shaped plastic cup has 3 chambers. It indicates the speed of urine flow and is used by patients at home. Patients keep a weekly Uflow Meter™ voiding diary. If they have persistent Uflow Meter™ 'bottom chamber' recordings, which suggests that the flow rate is less than 10ml/s, they should contact the clinical team by phone or email to arrange a clinic consultation. The Uflow Meter™ is a useful device which allows patients to monitor their flow rates at home. It empowers and engages patients in their own clinical management avoiding unnecessary clinic visits. The Uflow Meter™ is a cost-effective and safe clinical follow-up option for urethral stricture patients to monitor disease progression at home. New Nurse Innovated Procedure RN Position in Urology Practice Introduction and Objective: Busy Urology Practice introducing nurse-led innovated "Procedure Nurse" position to ensure efficacy, safety and patient satisfaction. Kettering Cancer Center with multiple off site locations for voiding dysfunction cancer patients, ages 40 to 94; two surgeons, two RNs, with duties ranging from triaging urgent calls, coordinating / referring patients, performing teachings (self catheterization, pessary fitting and changes, setting patients for uroflow / bladder scanning, obtaining specimens, reporting abnormal lab values, changing suprapubic / Foley catheters) to performing up to six urodynamic evaluations per clinic (1 -1.5 hours each test). During clinics two RNs are assigned to perform up to 6 UDS alternating with all other duties; three 10 -hour clinics a week with average 40 patients per clinic. The voiding dysfunction, urology certified RN has taken an additional step to become a continence certified RN and provide customized and broader care to patients. The initiative insight developed a new approach: nurseled practical suggestion created a new procedure nurse, who is dedicated to patients. To meet this goal, new RN visits were scheduled for patients to determine weaknesses. More time was spent, demonstration with positive teaching reinforcement provided for better outcomes. The nurse leader responded favorably to suggested actions for improvements. A procedure nurse position was developed. The new design displayed proper management of cases with more thorough assessment, evaluation of psycho -social state, personal, cultural needs in a safer environment, providing emotional support as well. The dedicated RN continued function through development, maintenance, protection of certification process to commit for patients and their families. Complex and challenged situations are managed by a new dedicated procedure RN for each patient. Realistic goals are individualized and established for each patient who leave happy, satisfied and hopeful at the end of the day. have more certified urology nurses who are being mentored and taught to make a difference for patients who loose their hopes and confidence, suffering silently. The new "procedure" nurse with exceptional technical skills became an asset to department to aid in voiding dysfunction program by performing urodynamic evaluations, as well as multiple other procedures. Urologists Together