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[45] Role of nephrometry scoring systems (R.E.N.A.L.-PADUA) in planning nephron-sparing surgery in patients with renal masses: Retrospective study of 88 cases

Objective To assess the utility of nephrometry scoring systems (R.E.N.A.L.-PADUA) in planning nephron-sparing surgery (NSS) in patients with renal masses. NSS has become the standard for the management of localised renal masses; however, an objective preoperative evaluation is needed. The nephrometry scores role is preoperative evaluation of the complexity of partial nephrectomy (PN) and evaluation of possible postoperative complications, and these scores are not yet standardly used in many countries including Algeria. Methods We retrospectively evaluated the clinical records of patients who underwent surgical treatment of renal masses between 2013 and 2016 for clinical renal tumours in the Urology Department of Annaba University Hospital, Algeria. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E.N.A.L. scores were retrospectively assessed for each of the 88 patients. Uni- and multivariate analyses were used to evaluate the correlations between age, gender, Charlson Comorbidity Index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories, and grade of postoperative complications. Results We noticed that only nine patients had NSS and all the others a total nephrectomy; however, 20 of them had a moderate complexity score for PN and seven a low complexity score. Then we compared with the results with the management in 2017 and 2018, the attitude was more liberal with the number of PNs greater than that of the 6 years previously. Conclusion A precise stratification of patients with both PADUA and R.E.N.A.L before nephrectomy is recommended to consider the potential threats and benefits of NSS. They are valuable tools to categorise renal tumours based on anatomical features and to prevent patients from abusive total nephrectomies conserving significant nephronic capital.

[44] Long-term outcome of shockwave lithotripsy in the management of patients presenting with calcular acute urinary retention Mohamed Ali Mohsen, Tamer Zewin, Khaled Sheir, Ahmed Shokeir

Mansoura University, Mansoura, Egypt
Objective: To evaluate the efficacy of shockwave lithotripsy in the long-term in the treatment of calcular acute urinary retention (AUR).
Methods: From March 2015 to February 2017, a prospective study was conducted, and included a total of 50 male patients who were diagnosed with AUR as a result of urethral or vesical radio-opaque stone(s) at the Mansoura Urology and Nephrology Center. All patients underwent extracorporeal shockwave therapy.
Results: A total of 47 of 50 patients (94%) were included, as only they underwent an initial successful treatment by shockwave lithotripsy. The mean (SD) age was 44.5 (11.8) years, the mean (SD) stone greatest dimension was 12.2 (3) mm, 33 stones (70.2%) were migratory and 14 stones (27.6%) were secondary in nature. At long-term follow-up of this patient cohort, there was recurrence of vesical stones in none, two (4%), and seven (15%) at 6-, 12-and 18-month intervals, respectively. The mean (SD) age of the nine recurrent cases (19%) was 52.3 (5.7) years and eight were secondary with one migratory in nature.
Conclusion: Shockwave lithotripsy is a successful modality of treatment in vesical stones; however, it should be used with caution in patients aged >50 years and with a history suggestive of infravesical obstruction. Objective: To assess the utility of nephrometry scoring systems (R.E.N.A.L.-PADUA) in planning nephron-sparing surgery (NSS) in patients with renal masses. NSS has become the standard for the management of localised renal masses; however, an objective preoperative evaluation is needed. The nephrometry scores role is preoperative evaluation of the complexity of partial nephrectomy (PN) and evaluation of possible postoperative complications, and these scores are not yet standardly used in many countries including Algeria.
Methods: We retrospectively evaluated the clinical records of patients who underwent surgical treatment of renal masses between 2013 and 2016 for clinical renal tumours in the Urology Department of Annaba University Hospital, Algeria. All patients underwent preoperative computed tomography or magnetic resonance imaging to define the clinical stage and anatomical characteristics of the tumours. PADUA and R.E. N.A.L. scores were retrospectively assessed for each of the 88 patients. Uni-and multivariate analyses were used to evaluate the correlations between age, gender, Charlson Comorbidity Index, clinical tumour size, PADUA and R.E.N.A.L. complexity group categories, and grade of postoperative complications.
Results: We noticed that only nine patients had NSS and all the others a total nephrectomy; however, 20 of them had a moderate complexity score for PN and seven a low complexity score. Then we compared with the results with the management in 2017 and 2018, the attitude was more liberal with the number of PNs greater than that of the 6 years previously.
Conclusion: A precise stratification of patients with both PADUA and R.E.N.A.L before nephrectomy is recommended to consider the potential threats and benefits of NSS. They are valuable tools to categorise renal tumours based on anatomical features and to prevent patients from abusive total nephrectomies conserving significant nephronic capital. Objective: To report an initial experience of cognitive transrectal ultrasonography-guided targeted prostate needle biopsies based on multi-parametric magnetic resonance imaging (mpMRI) findings. Random biopsy of the prostate is a crude way to identify prostate cancer hoping to hit the area of disease and hence the yield has never exceeded 30%. The introduction of mpMRI has tremendously enhanced our ability to identify specific suspicious areas with significant disease [Prostate Imaging -Reporting and Data System (PI-RADS) 4 and 5] and to target those areas thus improving the detection of significant disease with fewer biopsies.
Methods: In all, 97 consecutive patients with elevated prostate-specific antigen levels and suspicious mpMRI underwent targeted biopsies from the suspicious lesion (five) and two random biopsies from the nonsuspicious areas. The biopsies were performed using cognitive identification of the suspected area on MRI by a team comprised of a Urologist and Radiologist. All patients had routine pre-biopsy preparation.
Results: In all, 55 of 97 patients (57%) had positive biopsies, whilst 41/97 patients (42%) had negative biopsies, and two patients had atypical small acinar proliferation. The median number of cores taken was seven. Of the 55 patients with positive biopsies, 42 had significant Gleason grade P7 disease, 27 had bilateral disease and in 11 of these 27 one contralateral side was negative on MRI but positive at biopsy.
Conclusion: Cognitive-targeted biopsies of the prostate based on pre-biopsy MRI mapping for suspicious areas has tremendously enhanced our yield of important disease detection and not insignificant ones. In addition, this is done with fewer biopsies thus reducing potential complications. Objective: To review the management and outcome of complications (erosion, extrusion, pain and obstruction) following urinary incontinence (UI) surgery. Stress UI (SUI) has been treated with synthetic mesh and implants procedures for >20 years with good success rates. A recent review indicated safety and efficacy of mid-urethral slings (MUS) for women with SUI. With increasing public and legal interest in litigation cases related to mesh complications, there is a growing need for surgeons to share their experiences to establish best practice care. York is one of the nationally recognised salvage centres for management of women with mesh-related problems.
Methods: Retrospective review of all women who presented with complications related to mid-urethral tapes and implants to our unit since 2012.
Results: In all, 64 patients referred with complications related to SUI surgery were included; the majority had their initial UI procedure in other units. The International Continence Society (ICS)/International