Daniel Alexandre Israel Benamran

Transrectal Ultrasound-Guided Prostate Biopsy for Cancer Detection: Performance of 2D-, 3D- and 3D-MRI Fusion Targeted Techniques.

Introduction: The study aimed to evaluate 3 different modalities of transrectal ultrasound (TRUS)-guided prostate biopsies (PBs; 2D-, 3D- and targeted 3D-TRUS with fusion to MRI - T3D). Primary end point was the detection rate of prostate cancer (PC). Secondary end point was the detection rate of insignificant PC according to the Epstein criteria. Patients and Methods: Inclusion of 284 subsequent patients who underwent 2D-, 3D- or T3D PB from 2011 to 2015. All patients having PB for initial PC detection with a serum prostate-specific antigen value ≤20 ng/ml were included. Patients with T4 and/or clinical and/or radiological metastatic disease, so as these under active surveillance were excluded. Results: Patients with T3D PB had a significantly higher detection rate of PC (58 vs. 19% for 2D and 38% for 3D biopsies; p = 0.001), with no difference in Gleason score distribution (p = 0.644), as well as detection rate of low-risk cancers (p = 0.914). Main predictive factor for positive biopsies was the technique used, with respectively a 3- and 8-fold higher detection rate in the 3D- and T3D group. For T3D-PB, there was a significant correlation between radiological cancer suspicion (Prostate Imaging Reporting and Data System Score) and cancer detection rate (p = 0.02). Conclusions: T3D PB should be preferred over 2D PB and 3D PB in patients with suspected PC as it improves the cancer detection rate.

Post-kidney Transplant Robot-assisted Laparoscopic Ureteral (Donor-receiver) Anastomosis for Kidney Graft Reflux or Stricture Disease

OBJECTIVE To report our experience with robot-assisted ureteral anastomosis for kidney graft. Kidney graft complex ureteral strictures or symptomatic vesicoureteral reflux may require complex reconstruction. This is classically done through an open surgical access, which adds to the morbidity of kidney transplantation. The da Vinci robot enables performance of complex laparoscopic procedures and may hence be used for such reconstructions. PATIENTS AND METHODS We retrospectively reviewed all patients undergoing robotic surgical revision for stricture or reflux disease over a 3-year period. Contemporary patients who underwent open surgery were used as a control group. RESULTS Ten patients underwent a robotic attempt, of whom 4 needed conversion to open surgery. Seven patients underwent an open surgery. Preoperative demographics were similar in both groups. The median operative time was 293 minutes, with a shorter operative time in the open group. The group of patients who could be completed robotically had a significantly lower postoperative length of stay (5 vs 9 days), quicker return to normal food intake (postoperative day 1 vs 3), and quicker control of pain without opiates (postoperative day 1 vs 4) than the converted or open group. Morbidity was comparable with 1 late Clavien IIIb complication in each subgroup (open, converted, and robotic group). After a median follow-up of 43 months, renal function was stable and there were no recurrent graft infections. CONCLUSION Robotic ureteral reconstruction for kidney graft patients is feasible and efficient, and offers the classical advantages of minimally invasive surgery with outcomes comparable with open series.

Bulbomembranous anastomotic urethroplasty for strictures of the proximal bulbar urethra unassociated with pelvic trauma

1 Urabe F, Kimura T, Miki J, Shimizu K, Kishimoto K, Egawa S. Estimated glomerular filtration rate on postoperative day 1 is associated with renal functional outcome after percutaneous renal cryoablation for renal tumors. Int. J. Urol. 2017; 24: 553–4. 2 Altunrende F, Autorino R, Hillyer S et al. Image guided percutaneous probe ablation for renal tumors in 65 solitary kidneys: functional and oncological outcomes. J. Urol. 2011; 186: 35–41. 3 Zargar H, Atwell TD, Cadeddu JA et al. Cryoablation for small renal masses: selection criteria, complications, and functional and oncologic results. Eur. Urol. 2016; 69: 116–28. 4 Motzer RJ, Jonasch E, Agarwal N et al. NCCN clinical practice guidelines in oncology kidney cancer version 2.5-9. [Cited 20 Dec 2016.] Available from URL: http://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf 5 Ljungberg B, Bensalah K, Bex A et al. Guidelines on renal cell carcinoma. EAU 22–3. [Cited 20 Dec 2016.] Available from URL: http://www.euro peanurology.com/eau-guidelines 6 Escudier B, Porta C, Schmidinger M et al.; ESMO Guidelines Working Group. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2014; 25 (Suppl 3): iii49–56.

Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma.

Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications.

S&T-26 COMBINED INGUINAL HERNIA REPAIR WITH A SYNTHETIC MESH DURING ROBOT ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: About 10 % of patients undergoing radical prostatectomy (RP) present with an inguinal hernia. Its cure simultaneously with RP remains a concern with respect to the type of technique, and the risk to infect an eventual mesh The aim of this study was to evaluate the feasability, morbidity and efficacy of combined inguinal hernia synthetic mesh repair during robot assisted radical prostatectomy (RARP). METHODS: 526 medical records of patients who underwent transperitoneal RARP from 2006 to 2015 were reviewed. Demographics and peri-operative datas were analyzed for two groups (RARP alone vs RARP and hernia repair). Pre-operative iv cefazoline and gentamycine was given to all patients. Cure was performed using a polyester mesh (Parietex Covidien, New Haven, USA), placing the porous side against the wall for an efficient tissue integration, and the smooth side facing the structures on which tissular attachment had to be limited. The mesh was cut in a rectangle of approximately 10x8 cm or 18x8 cm for respectively unilateral and bilateral cures, and was anchored with absorbable staples (Absorbatack e Covidien), so as non absorbable sutures around the iliac vessels. Early complications were classified using ClavienDindo classification. Hernia recurrence was assessed during regular follow-up, or self-reported by patients. RESULTS: 49 patients (9 %) had a hernia repair associated with RARP (35 unilateral and 14 bilateral). Median age, BMI and ASA score were the same in both groups. Total operative time was 278 min for RARP vs 290 min for combined procedure. Post-operative length of stay (median 4 days) and blood loss were not affected by the combined procedure. There were no mesh infections nor migrations. Complication rate was identical in both groups. After a median follow-up of 44 months (IQR 17-86), 46 patients (94 %) were hernia-free, while 3 (6 %) presented a hernia recurrence. CONCLUSIONS: Combined inguinal hernia repair with a synthetic mesh during RARP is a feasible and efficient procedure which added no morbidity to standard RARP. Placing the mesh during an operation with urine spillage led to no infections. Efficacy after medianterm follow-up is similar to laparoscopic hernia repair alone. Combined hernia repair should therefore be discussed for patients undergoing RARP suffering from inguinal hernia.

Histologic confirmation of a biochemical recurrence after radical prostatectomy by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance imaging.

OBJECTIVE To obtain a histologic confirmation of biochemical recurrence after radical prostatectomy, which still remains a challenge. Historically, biopsy protocols have been designed but have provided rather unsatisfactory results. We report the first case of histologic confirmation of a biochemical recurrence in the prostatectomy bed by performing 3-dimensional transrectal ultrasonography-guided biopsy with fusion to magnetic resonance images. MATERIALS AND METHODS A 66-year-old man who underwent laparoscopic prostatectomy for a localized prostate cancer of Gleason sum 3+3=6 and preoperative prostate-specific antigen (PSA) level of 8.9 ng/L was followed up yearly. Postoperative serum PSA value was <0.04 ng/L. Nine years later, the patient developed a biochemical recurrence with an elevation of serum PSA level to 1.27 ng/mL. A 3-T endorectal positron emission tomography-magnetic resonance imaging (MRI) scan showed a 5 × 3 mm nodule in the prostatectomy bed in contact with the vesicourethral anastomosis without hypermetabolism. Two biopsies of this nodule were performed by using a 3-dimensional endorectal ultrasonography probe connected to the Koelis navigation system (Urostation; Koelis, Grenoble, France) with fusion to MRI images. RESULTS Histologic findings confirmed the presence of a recurrence of the prostate cancer of Gleason sum 4+3=7 in both biopsies, and the patient was addressed to the radio-oncologist for salvage therapy. CONCLUSION The use of a transrectal approach with 3-dimensional guidance and MRI fusion allows correct sampling of prostate cancer recurrence nodules in the prostate bed. This procedure is easily performed in the outpatient clinic but still has to be validated in a larger series.

674PHYPERTHERMIC INTRAPERITONEAL CHEMOTERAPY (HIPEC) AND CYTOREDUCTIVE SURGERY FOR SYNCHRONOUS PERITONEAL CARCINOMATOSIS (PC) FROM GASTRIC CANCER (GC) : RESULTS FROM A SINGLE CENTER EXPERIENCE

ABSTRACT Aim: The aim of this retrospective study was to asses the early- and long-term outcomes of patients undergoing neoadjuvant chemotherapy followed by combined cytoreductive surgery and HIPEC for PC arising from GC. Methods: We reviewed all cases of patients treated for PC from GC (any histology) in our institution from 2008 to 2012. Exclusion criteria were presence of visceral or extra-abddominal metatasis, poor performance status (ECOG > 2) and PCI score (Sugerbakers Peritoneal Cancer Index) > 12 at diagnostic pre-treatment laparoscopy. The identified patients were first treated with neoadjuvant chemotherapy (4 cycles of docetaxel 75mg/m2, cisplatin 75mg/m2 and 5-FU 300mg/m2) and then proceeded to cytoreductive surgery (including gastrectomy) combined with HIPEC (oxaliplatin 360mg/m2, 5-FU 400mg/m2 and leucovorin 20mg/m2). Adjuvant treatment was only conducted in cases of positive microscopic margins after surgery. Patients demographics were recorded. Major endpoints considered were short- and long-term survival, as well as morbidity and mortality of surgery. Overall survival, recurrence-free survival and cancer-specific survival were calculated using Kaplan-Meier estimators. Surgical morbidity was recorded using Clavien-Dindo classification. The study was approved by Ethics Committee of Geneva University Hospital. Results: 16 patients were included (male to female ratio 1:1). Mean age at surgery was 48.8 (+/- 8.7). All patients were operated by the senior author and considered free of macroscopic disease after surgery (completeness of cytoreduction CC0). Mean PCI score was 6 (+/- 4.3). 5 patients (31%) had positive margins at histopathological evaluation and 4 received adjuvant radiotherapy. Surgical complications were as follows : 1 Clavien 5 (death, 6.3%) and 1 Clavien 3b (6.3%). After a median follow-up of 17.5 months (2-63), median overall survival was 21 months (2-63), median recurrence-free survivall was 23 months (13-60) and median cancer-specific survival was 34 months. Conclusions: Combined neoadjuvant and cytoreductive surgery associated with HIPEC is a feasible and safe protocol with acceptable mobidity and mortality in experienced centers. Considering the fact that the median overall survival in GC patients with PC is 9-10 months, this combined treatment allows to achieve better outcomes for selected patients. Disclosure: All authors have declared no conflicts of interest.