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EP161 Diagnostic and clinical value of post PCNL nephrostogram
A B S T R A C T S / E U R O P E A N U R O L O G Y S U P P L E M E N T S 13 (2014) 103—194
Material & Methods: Data from men who had MRI and TTMB between August 2012 and May 2014 was collected retrospectively. The diagnostic performance of MRI was analysed against histopathological findings from TTMB. Concordance with TTMB was determined at whole-gland level. Sub-group analyses were performed of men who had stMRI or mpMRI for clinically significant and non-significant lesions. Clinically significant lesions were defined as Gleason score >3 or maximum core length >5mm. Results: One hundred and eighteen (118) men were identified who had MRI prior to TTMB. Sixty-four (64) had mpMRI and 54 had stMRI. The median age was 66 (range 43-80). Of the men biopsied, 41.5% (n=49) had positive biopsies, of which 81.6% (n=40) were clinically significant. In the mpMRI group, for any cancer, sensitivity was 87.5%, specificity 17.5%, positive predictive value (PPV) 38.9% and negative predictive value (NPV) 70.0%. For significant cancers, sensitivity was 100.0%, specificity 20.8%, PPV 29.6% and NPV 100.0%. In the stMRI group, for any cancer, sensitivity was 72.0%, specificity 24.1%, PPV 45.0% and NPV 50.0%. For significant cancers, sensitivity was 70.8%, specificity 23.3%, PPV 42.5% and NPV 50.0%. Conclusions: A large proportion of malignant prostate lesions can be detected with MRI. In this cohort, mpMRI demonstrated superior performance characteristics to stMRI. The high sensitivity and NPV suggest that a negative mpMRI can eliminate the necessity for further biopsy. Our findings support the use of mpMRI in the diagnostic pathway of men with suspected prostate cancer. EP159 Experience of cryoablation for small renal masses in our institute F. Hongo 1 , Y. Naya 1 , Y. Yamada 1 , T. Ueda 1 , T. Nakamura 1 , K. Kamoi 1 , K. Okihara 1 , O. Tanaka 2 , K. Yamada 2 , T. Miki 1 . 1 Kyoto Prefectural University of Medicine, Dept. of Urology, Kyoto, Japan; 2 Kyoto Prefectural University of Medicine, Dept. of Radiology, Kyoto, Japan Introduction & Objectives: Thermal ablation for small renal masses (SRM) includes percutaneous radiofrequency ablation (RFA) and cryoablation. In Japan, cryoablation for SRM began to be covered by health insurance in 2011. We started cryoablation therapy for SRM in March 2013, and herein report our initial experience with this procedure. Material & Methods: In March 2013, our hospital started cryoablation therapy in patients who were not indicated for radical surgery under general anesthesia because of active double cancer or complications, or who did not wish to undergo surgery because of having only one kidney or for some other reason. Thirty patients underwent cryoablation therapy before March 2014. Their median age was 71 years (range, 31–86). The median tumor diameter was 25 mm (range, 10–42 mm). Under local anesthesia, the cryoprobe was introduced under CT guidance. As a rule, percutaneous tumor biopsy was performed for histopathological diagnosis before or at the time of cryoablation. The response to treatment was evaluated using the mRECIST by performing, in principle, contrast-enhanced CT. Results: Seventeen and 3 patients achieved CR and PR, respectively, and 4 and 3 patients had SD and PD, respectively. Intra- and postoperative complications included hematoma, pleural effusion, perforation into the renal pelvis, fever, and hydronephrosis in 1, 2, 1, 2, and 1 patient, respectively. Two patients who had PD underwent a second cryoablation: 2 of them had a CR, and 1 of them had PD. Conclusions: Although further studies involving more patients are needed to evaluate long-term treatment results, cryoablation therapy for SRM, a percutaneous thermal ablation procedure for renal cancer, seems to be a useful treatment option for SRM. The 3 patients with PD were among the 6 patients in our initial experience. The 7th and subsequent patients underwent preoperative marking with lipiodol in view of the tumor location and other factors, and none of them had PD.
173
EP161 Diagnostic and clinical value of post PCNL nephrostogram A. Babu 1 , M. Abdulmajed 1 , I. Shergill 1 , S. Agarwal 2 , V. Jones 2 . Maelor Hospital, Dept. of Urology, Wrexham, United Kingdom; 2 Wrexham Maelor Hospital, Dept. of Radiology, Wrexham, United Kingdom
1 Wrexham
Introduction & Objectives: Nephrostomy tube insertion after percutaneous nephrolithotomy (PCNL) is commonly used in current practice. Post-PCNL nephrostogram (PPN) can be performed to ensure free urine drainage to the bladder post-operatively. We critically reviewed diagnostic and clinical value of performing PPN at our institution. Material & Methods: We performed a retrospective radiological and case note review of all patients at our institution that had undergone unilateral PCNL and nephrostomy insertion for stone disease, between January 2006 and December 2013. Demographic data on patients and clinico-radiological outcomes of PPN were assessed. Results: A total of 166 PPN were performed. The median age was 58 years (21–95); 87 males (53.0%) and 79 females (47.6%). PPN (Left, n=88; Right, n=78) was performed on all patients on median postoperative day 3 (range 1–8 days). 128 out of 166 PPNs (77.1%) were deemed satisfactory, with free drainage, and nephrostomy tube was removed uneventfully. Repeat PPNs were obtained in the remaining 38 patients (once, n=29; twice, n=7; thrice, n=2) and nine cases required antegrade ureteric stenting. Subsequently, only 2 of these patients had confirmed ureteric stone on retrograde studies requiring ureteroscopic stone extraction, the remainder had obstruction due to clot/oedema. There were no significant differences in outcomes in males and females, or timing of PPN. Conclusions: Unsatisfactory initial PPN was detected in less than a quarter of cases and resulted in no significant change to clinical outcome. Overall incidence of patients requiring antegrade ureteric stenting was found to be remarkably low. EP162 MRI-guided salvage IMRT for prostate cancer P. Dirix 1 , G. Buelens 1 , L. Van Walle 1 , F. Deckers 2 , F. Van Mieghem 2 , R. Weytjens 1 , B. De Laere 3 , P. Huget 1 . 1 Iridium Kankernetwerk, Dept. of Radiation Oncology, Antwerp, Belgium; 2 GZA St Augustinus, Dept. of Radiology, Antwerp, Belgium; 3 Iridium Kankernetwerk, Dept. of Translational Cancer Research, Antwerp, Belgium Introduction & Objectives: Radiotherapy can salvage patients with a PSA recurrence (rPSA) following radical prostatectomy, provided that all disease is encompassed within the planning target volume (PTV) and a sufficient radiation dose is delivered to the PTV. We hypothesized that both those requirements are easier to achieve with MRIguided radiation treatment planning. Material & Methods: From November 2012 to April 2014, 77 patients with a biochemical recurrence after radical prostatectomy were referred to our department for salvage radiotherapy. Patients received distant staging (bone scan and/or choline PET-CT) depending on the rPSA value and the discretion of the referring urologist. According to our protocol, patients received a planning CT without IV contrast as well as a planning MRI in treatment position. MRI consisted of T1-, T2-, and diffusion-weighted (with an apparent diffusion coefficient (ADC) map) sequences without gadolinium-enhanced contrast. Prescribed dose to the prostate bed PTV was 66.0 Gy in 33 fractions for all patients, delivered through intensity-modulated radiotherapy (IMRT). Results: Sixty-four patients received an MRI, 13 patients received CT-only radiotherapy planning because of pacemaker (n=5), MRIincompatible prosthesis (n=3), or patient refusal (n=5). None of the patients had clinically palpable disease on digital rectal examination. All distant staging, if performed, was negative. Patients were referred a mean 37.5 months (range: 6–175 months) after radical
Material & Methods: Data from men who had MRI and TTMB between August 2012 and May 2014 was collected retrospectively. The diagnostic performance of MRI was analysed against histopathological findings from TTMB. Concordance with TTMB was determined at whole-gland level. Sub-group analyses were performed of men who had stMRI or mpMRI for clinically significant and non-significant lesions. Clinically significant lesions were defined as Gleason score >3 or maximum core length >5mm. Results: One hundred and eighteen (118) men were identified who had MRI prior to TTMB. Sixty-four (64) had mpMRI and 54 had stMRI. The median age was 66 (range 43-80). Of the men biopsied, 41.5% (n=49) had positive biopsies, of which 81.6% (n=40) were clinically significant. In the mpMRI group, for any cancer, sensitivity was 87.5%, specificity 17.5%, positive predictive value (PPV) 38.9% and negative predictive value (NPV) 70.0%. For significant cancers, sensitivity was 100.0%, specificity 20.8%, PPV 29.6% and NPV 100.0%. In the stMRI group, for any cancer, sensitivity was 72.0%, specificity 24.1%, PPV 45.0% and NPV 50.0%. For significant cancers, sensitivity was 70.8%, specificity 23.3%, PPV 42.5% and NPV 50.0%. Conclusions: A large proportion of malignant prostate lesions can be detected with MRI. In this cohort, mpMRI demonstrated superior performance characteristics to stMRI. The high sensitivity and NPV suggest that a negative mpMRI can eliminate the necessity for further biopsy. Our findings support the use of mpMRI in the diagnostic pathway of men with suspected prostate cancer. EP159 Experience of cryoablation for small renal masses in our institute F. Hongo 1 , Y. Naya 1 , Y. Yamada 1 , T. Ueda 1 , T. Nakamura 1 , K. Kamoi 1 , K. Okihara 1 , O. Tanaka 2 , K. Yamada 2 , T. Miki 1 . 1 Kyoto Prefectural University of Medicine, Dept. of Urology, Kyoto, Japan; 2 Kyoto Prefectural University of Medicine, Dept. of Radiology, Kyoto, Japan Introduction & Objectives: Thermal ablation for small renal masses (SRM) includes percutaneous radiofrequency ablation (RFA) and cryoablation. In Japan, cryoablation for SRM began to be covered by health insurance in 2011. We started cryoablation therapy for SRM in March 2013, and herein report our initial experience with this procedure. Material & Methods: In March 2013, our hospital started cryoablation therapy in patients who were not indicated for radical surgery under general anesthesia because of active double cancer or complications, or who did not wish to undergo surgery because of having only one kidney or for some other reason. Thirty patients underwent cryoablation therapy before March 2014. Their median age was 71 years (range, 31–86). The median tumor diameter was 25 mm (range, 10–42 mm). Under local anesthesia, the cryoprobe was introduced under CT guidance. As a rule, percutaneous tumor biopsy was performed for histopathological diagnosis before or at the time of cryoablation. The response to treatment was evaluated using the mRECIST by performing, in principle, contrast-enhanced CT. Results: Seventeen and 3 patients achieved CR and PR, respectively, and 4 and 3 patients had SD and PD, respectively. Intra- and postoperative complications included hematoma, pleural effusion, perforation into the renal pelvis, fever, and hydronephrosis in 1, 2, 1, 2, and 1 patient, respectively. Two patients who had PD underwent a second cryoablation: 2 of them had a CR, and 1 of them had PD. Conclusions: Although further studies involving more patients are needed to evaluate long-term treatment results, cryoablation therapy for SRM, a percutaneous thermal ablation procedure for renal cancer, seems to be a useful treatment option for SRM. The 3 patients with PD were among the 6 patients in our initial experience. The 7th and subsequent patients underwent preoperative marking with lipiodol in view of the tumor location and other factors, and none of them had PD.
173
EP161 Diagnostic and clinical value of post PCNL nephrostogram A. Babu 1 , M. Abdulmajed 1 , I. Shergill 1 , S. Agarwal 2 , V. Jones 2 . Maelor Hospital, Dept. of Urology, Wrexham, United Kingdom; 2 Wrexham Maelor Hospital, Dept. of Radiology, Wrexham, United Kingdom
1 Wrexham
Introduction & Objectives: Nephrostomy tube insertion after percutaneous nephrolithotomy (PCNL) is commonly used in current practice. Post-PCNL nephrostogram (PPN) can be performed to ensure free urine drainage to the bladder post-operatively. We critically reviewed diagnostic and clinical value of performing PPN at our institution. Material & Methods: We performed a retrospective radiological and case note review of all patients at our institution that had undergone unilateral PCNL and nephrostomy insertion for stone disease, between January 2006 and December 2013. Demographic data on patients and clinico-radiological outcomes of PPN were assessed. Results: A total of 166 PPN were performed. The median age was 58 years (21–95); 87 males (53.0%) and 79 females (47.6%). PPN (Left, n=88; Right, n=78) was performed on all patients on median postoperative day 3 (range 1–8 days). 128 out of 166 PPNs (77.1%) were deemed satisfactory, with free drainage, and nephrostomy tube was removed uneventfully. Repeat PPNs were obtained in the remaining 38 patients (once, n=29; twice, n=7; thrice, n=2) and nine cases required antegrade ureteric stenting. Subsequently, only 2 of these patients had confirmed ureteric stone on retrograde studies requiring ureteroscopic stone extraction, the remainder had obstruction due to clot/oedema. There were no significant differences in outcomes in males and females, or timing of PPN. Conclusions: Unsatisfactory initial PPN was detected in less than a quarter of cases and resulted in no significant change to clinical outcome. Overall incidence of patients requiring antegrade ureteric stenting was found to be remarkably low. EP162 MRI-guided salvage IMRT for prostate cancer P. Dirix 1 , G. Buelens 1 , L. Van Walle 1 , F. Deckers 2 , F. Van Mieghem 2 , R. Weytjens 1 , B. De Laere 3 , P. Huget 1 . 1 Iridium Kankernetwerk, Dept. of Radiation Oncology, Antwerp, Belgium; 2 GZA St Augustinus, Dept. of Radiology, Antwerp, Belgium; 3 Iridium Kankernetwerk, Dept. of Translational Cancer Research, Antwerp, Belgium Introduction & Objectives: Radiotherapy can salvage patients with a PSA recurrence (rPSA) following radical prostatectomy, provided that all disease is encompassed within the planning target volume (PTV) and a sufficient radiation dose is delivered to the PTV. We hypothesized that both those requirements are easier to achieve with MRIguided radiation treatment planning. Material & Methods: From November 2012 to April 2014, 77 patients with a biochemical recurrence after radical prostatectomy were referred to our department for salvage radiotherapy. Patients received distant staging (bone scan and/or choline PET-CT) depending on the rPSA value and the discretion of the referring urologist. According to our protocol, patients received a planning CT without IV contrast as well as a planning MRI in treatment position. MRI consisted of T1-, T2-, and diffusion-weighted (with an apparent diffusion coefficient (ADC) map) sequences without gadolinium-enhanced contrast. Prescribed dose to the prostate bed PTV was 66.0 Gy in 33 fractions for all patients, delivered through intensity-modulated radiotherapy (IMRT). Results: Sixty-four patients received an MRI, 13 patients received CT-only radiotherapy planning because of pacemaker (n=5), MRIincompatible prosthesis (n=3), or patient refusal (n=5). None of the patients had clinically palpable disease on digital rectal examination. All distant staging, if performed, was negative. Patients were referred a mean 37.5 months (range: 6–175 months) after radical