JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 17

Abstracts
VH will miss a significant number of UTC. We recommend
that all patients presenting with VH patients and NVH
patients t 40 years have investigations for haematuria.
P1-7 Can CT intravenous urogram be
replaced with renal tract ultrasound for nonvisible haematuria?
Tan W1, Feber A1, Sarpong R1, Rodney S1, Williams N1,
Brew-Graves C1, Kelly J1, DETECT I investigators
1University College London, United Kingdom

Background: NICE does not specify a preference for
upper tract imaging modality for haematuria while the
American Urology Association recommends CT intravenous urogram (IVU). We determined the diagnostic accuracy of CT IVU and renal tract ultrasound (RTU) at
identifying urinary tract cancer (UTC).
Methods: The DETECT I study (clinicaltrials.gov
NCT02676180) prospectively recruited patients investigated for haematuria at 40 UK hospitals. All patients had
cystoscopy +/- resection of bladder tumour and CT IVU
and/or RTU.
Results: 3566 patients with a median age of 68 years
(IQR: 57, 76) were recruited.The overall incidence of UTC
was 9.6% (bladder cancer: 7.8%, renal cancer 1.1%, upper
tract TCC: 0.7%). 448 patients (13%) had both RTU and
CT IVU. RTU had a sensitivity of 89% (n=8) and a PPV of
53% for identifying renal parenchymal cancers. NPV of
RTU for renal cancer was >99.5%. Of the 6 upper tract
TCC identified on CT IVU, RTU missed 3 cases. The incidence of upper tract TCC presenting with NVH was
<0.01% (1/3566 patients). 2104 patients (59%) had RTU
while 1608 patients (45%) had CT IVU. The diagnostic
accuracy for URT to detect bladder cancer was: sensitivity:
66%, specificity 99%, PPV 82% and NPV 98%. CT IVU identified bladder cancer with a sensitivity of 87%, specificity of
97%, PPV of 79% and NPV of 99%.
Conclusions: CT IVU can be replaced with URT in
patients presenting with NVH. CT IVU is recommended
for VH due to 1% risk of upper tract TCC.
P1-8 Outpatient flexible cystoscopy and
transurethral laser ablation (TULA) for
urothelial tumours using the 1470 nm diode
laser: Our experience so far
Bedi N, Stefanova I, Shamsuddin A
1Northwick Park Hospital, London, United Kingdom

Introduction: Transurethral Laser Ablation (TULA)
under local anaesthesia is an effective treatment for recurrent urothelial tumours (1, 2), particularly useful in high
ASA grade or anticoagulated patients. TULA is a time-efficient procedure, associated with improved haemostasis,

17
avoidance of the obturator-nerve-reflex and reduced risk
of bladder perforation.We report our initial experience in
introducing the service in our department.
Patients and Methods: We performed a prospective
evaluation of the outpatient TULA flexible cystoscopy service. Patients were referred with suspicious lesions for
diagnosis and treatment or known bladder cancer.
Predominant referrals were for G1/2 pTa TCC recurrences, higher grade tumours were treated only on the
MDT recommendation.
Results: There were 133 attendances to the TULA list
between September 2016 and June 2017. TULA was performed in 81 cases: TCC (71/81), red patch (7/81), squamous metaplasia (1/81), radiation cystitis (1/81) and small
cell cancer (1/81). Post-procedure one patient required
hospital admission with bleeding and one patient complained of discomfort. In 10 cases, suspicious red patches
were reviewed and 7 of them were treated. Other attendances revealed: normal cystoscopy (43/52), stricture (1/52)
or large/multiple tumours requiring TURBT (8/52). In total
14 patients were anticoagulated (5/14 warfarin).
Conclusion: Outpatient TULA service is an effective
alternative to theatre-based procedures, also enabling the
treatment of anticoagulated or high ASA patients. The service reduces pressure on waiting lists and can save costs
for a department.
P1-9 The value of photodynamic diagnosis
(PDD) in combination with dedicated TURBT
training - a controlled study evaluating
outcomes
Dooher M1, Simpson H, Gietzmann W, Smith H, Mains
E, Mistry K, Mariappan P
1Western General Hospital, Edinburgh, United Kingdom

Introduction: A good quality TURBT improves staging
accuracy while reducing both recurrence and (potentially)
the need for routine early re-resection. When augmented
with Photodynamic diagnosis (PDD), recurrence rates
have been shown to fall, consequent to improved detection and tumour clearance. As part of a series of studies
on real-world experience, we evaluated the putative benefit of PDD as a training tool.
Methods: Six Urology specialist trainees participated in
the study: 3 (PDD-ST group) were trained exclusively in
the early phases of TURBT training using PDD while the
other 3 (WL-ST group) trained using white light (WL) cystoscopy. All trainees initially carried out 50 (mandatory)
'training' operations with PDD and WL in the PDD-ST and
WL-ST groups, respectively. Subsequently, trainees carried
out 50 WL TURBTs each (study sample). Operations were
prospectively entered into surgical logbooks. Analysis of
association was carried out between each group and specific end-points including complications, specimen detrusor

http://www.clinicaltrials.gov

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