Black race was associated with discontinuation of AS for treatment. This relationship persisted when adjusted for socioeconomic and clinical parameters.

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Background: Ischemia is thought to contribute to benign ureteroenteric stricture (UES) after radical cystectomy with urinary diversion (RCUD). Our institution adopted the use of ureteral perfusion assessment during all RCUDs using real-time indocyanine green angiography using the SPY fluorescence imaging platform (Stryker Corp., Kalamazoo, MI, USA). This guides the location of ureteral transection prior to ureteroenteric anastomosis. We sought to compare UES rates before and after adoption of SPY. Methods: A retrospective chart review was undertaken for the first 47 consecutive cases of RCUD using SPY as well as the previous 47 consecutive cases, which were performed without SPY. Fisher’s exact and Wilcoxon rank-sum tests were used to compare benign UES rates and the length of ureter excised during anastomosis. A p < 0.05 indicated statistical significance. Results: Median follow up was 12.0 months for SPY cases and 24.3 months for non-SPY cases. The UES rate for SPY RCUDs was 0% (0/93 ureters) compared with 7.5% (7/93 ureters) for non-SPY RCUDs ( p = 0.01). Amongst SPY RCUDs, 86 ureters had no hydronephrosis and 7 had mild hydronephrosis with reflux on loopogram. A total of 34.4% of ureters (32/93) had poor distal perfusion, requiring a more proximal anastomosis. The median length excised for ureters with poor distal perfusion was 3.8 cm, compared with 2.2 cm for ureters with good distal perfusion ( p < 0.0001). No complications attributable to the use of SPY were noted. Conclusion: Use of SPY to assess ureteral perfusion was associated with a decrease in the UES rate after RCUD. A total of 34.4% of ureters demonstrated poor distal perfusion, requiring a significantly more proximal ureteroenteric anastomosis.

A 17-year-old man presented with signs of rupture of a high cervical internal carotid aneurysm. Following angiographic demonstration of the aneurysm, he was immediately treated by balloon catheter occlusion. Eight days later the ligation of the supraclinoid portion of the internal carotid on the left was prompted by the formation of blood clots and emboli from this segment. The patient tolerated both procedures well.

ObjectiveTo describe the management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa). MethodsWe conducted a single-centre retrospective review, over a 6-year period (2010)(2011)(2012)(2013)(2014)(2015), to identify men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined therapy (radical prostatectomy [RP] followed by external beam radiotherapy [EBRT], EBRT + low-dose-rate [LDR] brachytherapy, EBRT + high-dose-rate [HDR] brachytherapy or other combinations of RT) or monotherapy RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage) UAEs. ResultsWe identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of RP + EBRT (n = 19), HDR brachytherapy + EBRT (n = 19), LDR brachytherapy + EBRT (n = 5), and other combined RT (n = 1). Twenty-nine (40%) patients had monotherapy consisting of EBRT (n = 4), HDR brachytherapy (n = 11), LDR brachytherapy (n = 12), or proton beam therapy (n = 2). UAEs were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion (UD) in 23 men (32%). Reconstruction included: ureteric (n = 4), recto-urethral fistula repair (n = 2), and posterior urethroplasty (n =13), of which 14/16 surgeries (88%) with follow-up >90 days were successful. ConclusionsAlthough the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high-grade complications require UD. Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.

Purpose In patients with loin pain hematuria syndrome (LPHS), a response to percutaneous renal hilar blockade (RHB) and a multidisciplinary team (MDT) evaluation predicts patient’s potential renal auto-transplantation (RAT) success. Methods A pain assessment was performed using a 0–10 numeric pain rating scale prior to a percutaneous RHB under CT guidance. If the pain score was reduced > 50% immediately after the RHB, patients were evaluated for RAT by a MDT. Pre-operative and 1-year post-operative quality-of-life surveys were administered to each RAT patient. Results 43 LPHS patients were referred for RHB. Of the 38 patients who received a RHB, 31 had > 50% reduction in pain scores. Pre- and post-RHB mean pain scores were 6/10 and 0.7/10, respectively, in patients who had > 50% reduction in pain. 22 of the patients who responded favorably then proceeded to RAT. Twelve patients had at least 1-year follow-up after RAT. All patients had a meaningful decrease in their pain. Mean pain score at 1 year was 0.8/10 for an 85% overall reduction in pain. 92% of patients experienced a ≥ 50% reduction in pain at 1 year. Mean Beck Depression Inventory (BDI) score (0–66) 1 year after RAT decreased from 25.2 pre-op (moderate depression) to 12.8 post-op (minimal depression). Conclusions A MDT approach utilizing a RHB should be considered as a tool to select appropriate LPHS patients for RAT to achieve long-term success in reducing chronic pain and depression while increasing quality of life.

INTRODUCTION AND OBJECTIVES: To evaluate surgical outcomes after urinary diversion (UD) for complications of radiation therapy (XRT) for prostate cancer (CaP).METHODS: Men were identified who underwent UD (conduit or continent catheterizable pouch) due to complications following XRT for CaP from the Trauma and Urologic Research Network of Surgeons (TURNS) from 2007-2015. Patient records were reviewed for demographics, co-morbidities, XRT specifics and complications, surgical details, and perioperative and long-term complications. The data was summarized using descriptive and inferential statistics and were adjusted for institutional differences.RESULTS: Seventy-one patients met inclusion criteria. The mean age was 70.9 years. Fifty-six (79%) patients had combined-modality therapy (prostatectomy with adjuvant XRT or various combinations of XRT). The median duration from XRT to UD was 8 years. The mean number of operations for XRT-associated complications prior to UD was 3.7. Twelve (17%) patients underwent a continent catheterizable pouch and fifty-nine (83%) urinary conduit. Overall complication rate was 68% within 3 months. Grade 3a or greater Clavian-Dindo complications within three months of UD occurred in 19 (32%), including Grade 3a (intervention without general anesthesia) in 1 (2%), Grade 3b (reoperation) in 8 (13%), Grade 4 (ICU admission) in 7 (12%), and Grade 5 (death) in 3 (5%). Readmission within 6 weeks occurred in 21 (35%) patients. There was no association between perioperative complications and type of XRT, combined-modality therapy, Charlson comorbidity index or prior number of urologic procedures. Men with a lower BMI developed more serious complications than their heavier counterparts. Long-term complications requiring surgical intervention occurred in 12 (21%) patients (median follow up 15.9 months) and were not predicted by pre or perioperative characteristics.CONCLUSIONS: UD in CaP survivors with prior XRT exposure has a considerable complication rate that is higher than cystectomy for bladder cancer. Men with a lower BMI developed higher-grade complications within 3 months. There were no other associated preoperative patient characteristics that predicted post-operative complications.

INTRODUCTION AND OBJECTIVES: Open partial nephrectomy (OPN) is considered the gold standard treatment for patients with renal tumours in solitary functioning kidneys. The ability to offer satisfactory cancer outcomes combined with potential avoidance of long term dialysis drives this treatment. However in some cases an OPN is technically not possible, due to size, location within the kidney and together with concerns about the oncological safety of a partial nephrectomy in stage T2 or higher disease. The conventional management has been a radical nephrectomy which renders these patients anephric and dialysis dependent.Since 2005, renal autotransplantation (EPN) for renal cell cancer has been carried out in Oxford for masses that would not historically have been considered suitable for nephron-sparing surgery. The program received national commissioning in the UK from 2012, the only urological procedure to be considered suitable for this at the time.METHODS: 36 patients in the UK have been assessed in the renal autotransplant program in Oxford between 2005-2018 and subsequently undergone a renal autotransplant. The patients were either recruited from within region or throughout the United Kingdom through national commissioning. RESULTS: Number of Patients treated [ 36 ( 24 M: 12F) Mean Age 64 (37-82) Renal history: Solitary Kidney [ 25 Bilateral Cancer [ 8 Non-functioning contralateral kidney [ 3 Tumour size 6.2 cm (2.6-18 cm) Single tumour [ 31 Multi-focal disease [ 5 R.E.N.A.L. Nephrometry score Highly complex [ 34 Moderately complex [ 2 Peri-operative outcomes Positive Surgical Margins 2/36 (5.5%) Post operative dialysis 18/36 (50%) Complications (Clavien III-V) 20/36 (56%) 30 day mortality 2/36 (5.6%) Long term outcomes Duration of Follow up: Mean [ 60 months (6-156) Cancer Specific Survival 96% Recurrence free Survival 79% Overall Survival 88% Dialysis free survival 83% of patients still alive CONCLUSIONS: EPN though complex and potentially hazardous offers an excellent chance of renal preservation without compromising cancer control EPN should be considered a viable treatment option in selected patients