JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 65

Abstracts
P6-19 Extended pelvic lymph node dissection:
Long way to 'optimal case selection'
Panayi Z1, Jones R, Riley G, Kumar M, Nambirajan T
1Wirral University Teaching Hospital, Liverpool, United Kingdom

Background: Extended pelvic lymph node dissection
(EPLND) is performed with radical prostatectomy in
patients at risk of LN metastases. This carries prognostic
and therapeutic benefits, but also perioperative risks. The
European Association of Urology recommends patient
selection based upon a Briganti score of >5%, which predicts chance of LN metastasis.We aim to analyse the complications and histology outcomes, in patients selected for
EPLND using the Briganti nomogram.
Method: Retrospective analysis of patients undergoing
robotic EPLND from 2016 to 2017. Data included Briganti
parameters, perioperative complications, and histology.
Briganti score was calculated using both MRI and clinical T
stage.
Results: EPLND was performed in 81 patients. Using
D'Amico risk stratification, 88% were high, 11.1% intermediate and 1.2% low risk. Median Briganti score was 13%
using clinical T stage and 18% with MRI stage. Mean LN
yield was 17.7 (range 2-42). LN disease was found in 7
patients (8.6%), with Briganti scores of 9%, 23%, 49%, 60%,
22%, 75% and 66%. Intraoperatively, one patient had an
external iliac vein tear repaired without consequence. 15
post-operative complications (18.5%) were identified. 5
patients developed a lymphocele (one requiring drainage),
1 pelvic haematoma, 1 deep vein thrombosis with pulmonary embolus, and 8 developed transient lymphoedema.
Of these patients, two had LN positive disease.
Conclusion: EPLND is safe, with good LN yield, but is
not without complications. In the absence of a randomised
control trial, either a novel scoring tool or imaging with a
higher specificity is required, to minimise unnecessary
EPLND and its consequences
P6-20 High rate of adverse features at salvage
radical prostatectomy compared to initial
diagnosis in men who experience recurrence
following high intensity focused ultrasound as
primary treatment of localized prostate cancer
Thompson J1, Sridhar A1,2, Tan W2, Mazzon G1,
Khetrapal P2, Shaw G1, Rajan P1, Mohammad A1,
Wilkinson K1, Briggs T1, Nathan S1, Sooriakumaran P1,
Kelly J1,2
1University College London Hospital, United Kingdom, 2University
College London, United Kingdom

Introduction: Our objective was to describe the pathologic recurrence patterns at salvage robot-assisted radical
prostatectomy (sRARP) post-HIFU.

65
Patients and Methods: Retrospective analysis, 34 men
who underwent sRARP after primary HIFU, single institution 2012-2017. Clinico-pathological characteristics preHIFU and pre-sRARP were compared against final sRARP
histology. In-field recurrence (IFR), out-of-field disease
(OFD), PSMs and MRI accuracy were assessed.
Results: Median age 64yrs, PSA 7.8ng/dL, ISUP 2 (70.6%),
MCCL 7mm. 55.9% had multifocal disease pre-HIFU.
47.1% had known 'insignificant' cancer outside the treatment field. Median time to failure was 16 months.
Oncologic indications for sRARP were IFR 55.8%, OFD
20.6%, both 23.5%. No men were suitable for bilateral
nerve sparing: 16% underwent unilateral nerve-sparing,
84% bilateral wide excision. On sRARP histology, disease
was multi-focal in 94.2%; most frequently apical PZ (85.3%).
Significant (ISUPt2) IFR, OFD or both were found in
97.1%, 81.3% and 79.4% respectively. 82.4% experienced
adverse reclassification at sRARP versus pre-HIFU, 67.6%
versus pre-sRARP.
The PSM rate was 38.2% (30.8% pT2, 42.9% pT3; 14.7%
apical, 23.5% posterolateral), 85% were in-field or at HIFU
margins, despite wide excision of the HIFU-field. The sensitivities of post-HIFU MRI for IFR, OFD and T3a/b were
81.8%, 65.4% and 10% respectively.
Conclusions: In men failing primary HIFU, rates of
upgrading, upstaging and PSMs were high; nerve sparing
was infrequently feasible. Disease was under-estimated by
MRI/ targeted biopsy. This may inform primary treatment
and sRARP counselling. The high IFR rate demonstrates
HIFU occasionally fails to ablate the tumour in vivo, in
addition to the risk of OFD.

ePoster Session 7:
General Urology 1
Tuesday 26 June
14:00 - 15:00
Room 12
Chairs: David Thomas & Andrew
Moon
P7-1 Is it safe to carry out flexible cystoscopy
when urinary dipstick is positive for
'infection'? Results of a prospective clinical
study
Trail M1, Cullen JM1, Dick L1, Fulton E1, MacGregor E1,
Clayton F1, Kalima P2, Donat R1, Mariappan P1
1Department of Urology, Western General Hospital, Edinburgh,
United Kingdom, 2Department of Medical Microbiology and Virology,
Western General Hospital, Edinburgh, United Kingdom

Introduction: There is significant under-utilisation of valuable NHS resources when patients scheduled for flexible

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