SPEAKERS' ABSTRACTS

- UROFAIR Virtual 2021 -

Date: 4 June 2021

Time: 1300-1345 hrs

Topic: A New PDE5 Inhibitor for Treating ED—How is it different?

Speaker: Peter Lim Huat Chye

 

Urologists are all familiar with the use of PDE5 Inhibitors as first line treatment for ED. However how to select the right PDE5 I for the right patient is not so that simple. The clinician must take into consideration the likes and dislikes of the patient and his partner, the right personal dynamics of the relationship of the couple, the  co-morbidities of the patient and his psyche, the physiological incompatibilities of the patient with respect to each particular drug and most perhaps what may be most important for consideration - the synchronization of the timing of the sexual encounter.

 

This latest advance provides the patient the advantage of a quick response after taking the PDE5I so that the intended activity can proceed pretty much forthwith within 15 to 30 minutes after ingestion of the pill. Hitherto no other formulation can deliver such a quick response and the advantages to the sexual initiator begs for no further explanation. The talk will take the audience through the properties of this drug and show how it compares with the range of PDE5I’s currently available in the marketplace together with its attributes and advantages for routine andrological practice in sexual medicine.

 

 

Date: 5 June 2021

Time: 0930-0945 hrs

Topic: Urological Malignancies and Kidney Transplantation

Speaker: Tiong Ho Yee

This presentation will discuss on the clinical and management aspects of urological cancers in kidney transplant patients, with a focus on kidney and urothelial cancers.  It aims to highlight the challenges in managing these patients and to provide some guidance based on available data. 
 

 

Date: 5 June 2021

Time: 0955-1025 hrs

Topic: Post RRP ED: Case Presentations and Treatment Strategies – The American Experience

Speaker: Faysal Yafi

Radical prostatectomy is considered standard of care for many types of prostate cancer. Following surgery, certain complications may occur, particularly sexual dysfunction and urinary incontinence. For penile rehabilitation purposes, there is conflicting data regarding the true benefits of on-demand and daily use of PDE5 inhibitors. Other options include vacuum erection devices, intracavernosal injection therapy and penile prosthesis placement. Newer regenerative modalities such as shockwave therapy are still considered investigational. There is also now a growing body of evidence supporting the safety and benefits of testosterone replacement therapy in men with prostate cancer following radical prostatectomy. Post-operative stress urinary incontinence may be managed with physical exercises such as Kegel exercises as well as surgical options such as sub urethral slings and artificial urinary sphincters. Post-operative climacturia is a common, yet underreported, complication of radical prostatectomy. While conservative approaches are rarely successful in its management, surgical options such as the Mini-Jupette sling have shown durable and excellent results in controlling associated urine leakage.

 

Date: 5 June 2021

Time: 0955-1025 hrs

Topic: Post RRP ED: Case Presentations and Treatment Strategies – The Australian Experience

Speaker: Eric Chung

 

Erectile dysfunction is common in men following prostate cancer treatment and penile rehabilitation has been accepted as the standard of care especially in men following nerve-sparing radical prostatectomy. The addition of radiation and androgen deprivation therapy adversely impact penile erection. While medical and surgical therapies are effective in erectile function recovery and/or preservation, psychological and sexual counselling are equally important in sexual rehabilitation. Other domains such as urinary (and bowel) dysfunction, supportive partner and economic consideration, can play an important role in sexual function. Indeed, a comprehensive multidisciplinary approach is necessary to better understand and optimally assist and manage the men, their partners and families.

 

Date: 5 June 2021

Time: 1025-1040 hrs

Topic: Management of Penile Paraffinoma

Speaker: Supanut Lumbiganon

 

Penile paraffinoma is not an uncommon condition in South East Asia. Around 2000 cases were reported from all over the world in the literature with the real number expected to be much more. This condition usually causes sequelae which leads to the need for surgical treatment. Surgical treatments which are commonly performed include excision and primary closure for small lesions, excision and reconstruction with scrotal flap either single or two-stages or excision and full thickness skin graft or even native penile skin graft for selected cases. Although surgical treatments can get rid of the foreign body but most of the procedures usually result in unnatural look of the penis and wound complications in some cases.  

 

 

 

Date: 5 June 2021

Time: 1040-1110 hrs

Topic: Penile Preserving Surgery and Sentinel Node Biopsy in the Management of Penile Carcinoma - The Leeds Experience

Speaker: Ian Eardley

15 years ago, the management of penile cancer in the United Kingdom was centralised into 10 cancer centres, each treating a population of at least 4 million people. The urology department at Leeds was one of those centres, and since 2006 Leeds has received an annual referral practice of 40 to 50 new cases of penile cancer per annum.

 

Historically, the surgical treatment of men with penile cancer demanded a 2cm margin for resection of the primary tumour while the surgical treatment of nodal disease required inguinal lymphadenectomy with all its associated morbidity.

 

More recently it has become clear that more conservative surgical approaches, such as penile preserving surgery and sentinel node biopsy appear to be safe. This paper will describe both the rationale for these approaches and our experience, including both the functional and the oncological outcomes.

 

 

 

Date: 5 June 2021

Time: 1110-1130 hrs

Topic: Augmented Anastomotic Urethroplasty - A Useful Adjunct to the EPA Procedure

Speaker: Ian Eardley

The traditional treatment of recurrent urethral strictures involves anastomotic urethroplasty for short strictures and augmentation urethroplasty, usually using buccal mucosa, for longer strictures.

 

Some strictures do not fit easily into treatment by either of these approaches either because they are slightly too long for excision and anastomosis or because the lumen of the stricture is so narrow, or even obliterated, as to make augmentation urethroplasty impractical.

 

Under these circumstances the augmented anastomotic urethroplasty provides a useful technique whereby a short obliterated segment can be excised and combined with a dorsally placed graft.

 

This paper will discuss the indications, technique and utility of this approach.

 

 

 

Date: 5 June 2021

Time: 1240-1255 hrs

Topic: Lasers in urolithiasis in 2021

Speaker: Pankaj Maheshwari

 

For last three decades Holmium Laser (HoL) has been the gold standard for intra-corporeal lithotripsy as HoL can fragment all types of calculi irrespective of its size, site and hardness.

As of 2021, we have understood how to manage the energy, frequency and the pulse width of HoL to get the best results based on the type of the stone. Still the problems are that lithotripsy by HoL is erratic, time-consuming and can lead to fiber burn-back and calculus retropulsion.

 

Moses technology is a innovation in the pulse delivery of the HoL by which the wave is split in two parts. This leads to better delivery of energy with faster fragmentation, better dusting and reduced retropulsion.

 

Thulium Fiber Laser (TFL) is the new kid on the block with a huge potential. It can generate very high frequency, very low pulse energy and very wide and uniform pulse width thus leading to much better & faster dusting with practically no retropulsion. The only drawback is the heat generation during TFL use.

 

Presented in this talk are the details of these three technologies with the literature review comparing these technologies. There is also a peep in the future looking at the innovations in the auxiliary technologies and fiber-tip designs that would make the laser delivery more effective and faster. 

 

 

Date: 5 June 2021

Time: 1255-1310 hrs

Topic: Scopes and Sheaths

Speaker: Palaniappan Sundaram

Ureteroscopy has interested many urologists over the years. It was Bagley who introduced modern flexible ureteroscopy with irrigation and a working channel for instruments. Later advances in technology led to miniaturisation and smaller telescopes. The development of the electronic imaging sensors enabled digital ureteroscopes. Now we even have single use lightweight flexible ureteroscopes that are always available as they do not need reprocessing. Fibre optic ureteroscopes are usually smaller compared to digital ureteroscopes. In general, this makes it more manoeuvrable and has better deflection to reach the lower pole. The working channel is variable but commonly sited at 3 and 9 o’clock. These positions are important when when choosing the correct ureteroscope for treatment of renal stones. The ureteral access sheath were also developed way back in 1970s. They come in many different sizes. It reduces intra renal pressures which decreases the risk of post operative fever and sepsis. The has to be weighed against the risk of injuring the ureter. The sheath with an inner diameter of 10Fr is most suitable for ureters. New innovations such as access sheaths that monitor pressure in the kidney and those that allow suctioning of the stone dust have been explored.

 

Date: 5 June 2021

Time: 1310-1325 hrs

Topic: Approaches and Techniques in stone fragmentation

Speaker: Fabio Sepulveda

Are you a “classic stone breaker” or a “modern duster”?
Do you really think that all techniques for urinary stone fragmentation can be summarized in a simple dichotomous way “dusting” vs “basketing”?
In this lecture we summarize the approaches and techniques in intra-renal stone fragmentation, in light of their concepts, critical evaluation of their results and how to select the ideal strategy based on patient and stone characteristics. We also addressed the new trends in stone fragmentation such as “dust-suction” and how “stone clearance” can be a good variable for establishing efficiency in lithotripsy by different equipments and/or strategies.

 

 

Date: 5 June 2021

Time: 1325-1355 hrs

Topic: Mini, ultra-mini, micro PCNL and ECIRS: Is smaller always better?

Speaker: Heng Chin Tiong

The miniaturization of Percutaneous Nephrolitotripsy (PCNL) systems has been the subject of much discussion and study in recent years, including randomized studies and meta-analyses. This has largely shown a gradual trade-off of pros and cons, including operative time, bleeding rate, stone free rate and recovery time. Combine that with the natural variation of stone anatomy, stone load and complexity, there would not logically be an easy sweet spot in terms of the size of the puncture. For each case, the surgeon would need to tailor his approach to the stone, vis-à-vis his own skills of devices and available armamentarium. In this lecture I will use real world cases as a basis for the discussion on these issues.

 

 

 

Date: 5 June 2021

Time: 1355-1410 hrs

Topic: Advancements in ESWL in 2021

Speaker: Kemal Sarica

This session is based on advanced shockwave applications. To understand the advancement of shockwave application, we need to start our journey from the first lithotripter Dornier HM3 and understand the key benefits and features of Dornier HM3. Different shockwave generation technologies used after HM3, key pro and cons of the different shockwave technologies. Shockwave parameters of different shockwave generation technologies. Development to improve the shockwave parameters. Improvement in imaging during shockwave lithotripsy.  Scientific results of various new features and imaging techniques like Doppler ultrasound Elastography and OptiVision used in modern lithotripters. Later discussion on new shockwave lithotripters under pre-clinical testing.

Date: 5 June 2021

Time: 1410-1430 hrs

Topic: Bilateral stone surgery - pushing the boundaries, or maximising OR time?

Speaker: Guido Giusti

As for many other dogmas in medicine and in urology, my lecture challenges that historical thought that bilateral endourologic surgical procedures performed in the same session increase the patients’ risk of morbidity and complication.

Contrary to what was previously postulated, bilateral single-session endoscopic procedures for renal calculi have been demonstrated to be safe and advantageous both for the patient and the health care system. As such, it should be considered a viable treatment option in adequately selected patients, performed by experienced urologists in high-volume centers respecting rigorously the cornerstones of the technique in order to achieve good results with a complication rate similar to that of unilateral procedures.

Nevertheless, further randomized well conducted studies with larger population are needed to establish the real effectiveness and safety of bilateral single-session endoscopic procedures as alternative to staged surgeries in patients with bilateral renal calculi.

 

Date: 5 June 2021

Time: 1430-1500 hrs

Topic: ECIRS is the future?

Speaker: Cecillia Cracco

The acronym ECIRS means Endoscopic Combined IntraRenal Surgery and indicates a comprehensive endourologic treatment of large and/or complex urolithiasis consisting in the combined antegrade and retrograde approach to the collecting system performed with both rigid and flexible endoscopes. ECIRS was explored in the late Eighties in the United States, standardized and popularized in Italy since 2005, and only recently - more than 30 years after its first appearance - is becoming widespread all over the world.

 

ECIRS can be considered a mature and improved version of percutaneous nephrolithotomy from the anesthesiologic, management and urologic point of view, being a comprehensive and versatile approach tailoring all the intraoperative choices on the single patient, the urolithiasis and the anatomy of the collecting system. In particular, simultaneous retrograde flexible ureteroscopy has an essential dual role, being both diagnostic (dynamic anatomy!) and active (through-and-through guidewire insertion, Endovision control of the percutaneous access, lithotripsy in calyces parallel to the single tract, final exploration of all calyces for residual fragments).

 

 

Date: 5 June 2021

Time: 1500-1520 hrs

Topic: Residual Stones - Best Management Strategies

Speaker: Esteban Emiliani

To think about the management of residual fragments one must first think about what is a successful treatment in urolithiasis. Nowadays, there is no consensus regarding the definition of a successful treatment nor the definition of stone free status. What is generally accepted in the literature is that a successful treatment is not a stone free patient as small residual fragment can be acceptable, also the quality of life of patients is also acknowledged. The stone free status is commonly known as a patient with the absence of stones and small unubstructive and asymptomatic residual fragments are commonly known as clinically insignificant fragments (CIF). These fragments are usually accepted if they are of less than 4 mm.  As residual fragments can appear in up to 25% of RIRS and 40% of PCNL with large stones, their management becomes of paramount importance.

 

CIF that are asymptomatic may be managed as any asymptomatic small stone as 60% will remain asymptomatic. CIF may be treated if located in the renal pelvis, if they grow or if symptoms appear. Initial treatment may be considered in high risk patients as in solitary kidneys.

 

When decided to treat any stone it is recommended to follow the guidelines considering PCNL for stones >2cm, RIRS or PCNL for 1-2 cm stones and RIRS and SWL for stones of <1cm. SWL can be spatially considered if the stone composition is soft as struvite or CaOxDi. Stone composition also is of great use to think about medical treatment in uric acid stones and to assure stone free status in patients with high risk of re-growth in strutive, brushite and cysteine patients. Finally, be aware of not over treat patients and consider the patient’s preference beforehand.

 

 

Date: 5 June 2021

Time: 1520-1540 hrs

Topic: Suction in Endourology: The New Game Changer?

Speaker: Vineet Gauhar

The modern era of endourology has seen an exponential growth in technology and is constantly evolving due to increasing incidence of urolithiasis and need for attaining better outcomes with minimal morbidity. Suctioning was used mainly in PCNL for past 25 years in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques including RIRS. The Trifecta of any successful endourology surgery  being Clear intraoperative vision, High single stage Stone free rate and no Complications. Miniaturisation of instruments and minimally invasive approaches to stones have further fuelled the need to develop the field  in which suction plays a key role.

 

Several centers have presented innovative UAS and PCNL sheaths or nephroscopes equipped with suctioning mechanisms. .The aim of the presentation is to highlight  the role of suction in modern endourology ,its benefits and  limitations in real world practice and future directions as we gain insight into intrarenal pressure / temperature and laser technology.

 

 

Date: 5 June 2021

Time: 1600-1620 hrs

Topic: Robotic Transperitoneal partial Nephrectomy

Speaker: Seok-Soo Byun

Robotic partial nephrectomy (RPN) has become the most common surgical technique of partial nephrectomy in some countries. About two thirds of partial nephrectomy was performed with robotic approach last year in South Korea and the rate is gradually increasing. RPN offers the benefits of minimally invasive surgery with a shorter learning curve compared with its laparoscopic counterpart. This procedure can be performed via transperitoneal or retroperitoneal approach with their own advantages and disadvantages. It provides oncologic and functional outcomes comparable to open and laparoscopic partial nephrectomy.

Furthermore, this surgery has facilitated technical advancements, including shortening warm ischemia time and expanding indications for complex tumors, leading to more kidney saving rate. In this lecture, I’d like to share experiences of our department’s transperitoneal protocol with accumulated 1,909 cases of robotic partial nephrectomy as of Apr 2021 since its 1st adoption in Sep 2008.  

 

 

Date: 5 June 2021

Time: 1620-1635 hrs

Topic: Advanced upper tract robotic surgery - Retroperitoneal partial nephrectomy and beyond

Speaker: Scott Leslie

Robotic retroperitoneal partial nephrectomy has the advantage of accessing the kidney whilst avoiding the peritoneum. This is particularly useful for patients that have had multiple large abdominal surgeries where there is a high chance of encountering dense intrabdominal adhesions. The retroperitoneal approach is also preferable for posteriorly based lesions where there is more direct access to both the hilar structures as well as the tumour. The disadvantage of the retroperitoneal approach includes, unfamiliar planes and less working space for the robotic instruments as well as for the assistant. However, it is an invaluable technique to be able to offer, particularly for patients with a “battle-scar” abdomen and a posterior tumour.

 

The robotic platform is ideal to allow a minimally invasive approach for numerous other upper tract operations including nephroureterectomy, ureteric reimplant, pyeloplasty, intracorporeal ileal conduit and IVC thrombectomy, amongst others.

 

 

Date: 5 June 2021

Time: 1635-1645 hrs

Topic: Robotic Complex Adrenalectomy

Speaker: Chin Chong Min

Laparoscopic adrenalectomy is the standard for majority of adrenal lesions. However, there will be cases where pure laparoscopy will be challenging to do, due to the inherent limitations of two-dimensional visuals, limited manoeuverability of instruments with counterintuitive movements. Examples of complex lesions are: tumour size > 6 cm, malignancy either primary or metastatic, surrounding adhesions from infections, inflammation or past surgery. Such cases pose a higher risk of complications and conversion to open surgery.

Robotic adrenalectomy (RAd) overcomes the technical limitations for such difficult cases; the intuitive dexterity of the robotic instruments, three-dimensional view in a comfortable seated position overcome the difficulties during dissection and reduce the chances of conversion to open. While the final outcome may be similar to pure laparoscopy, comparative studies do show RAd to have less blood loss, shorter hospital stay1 and lower conversion rate to open 2,3. For the complex adrenal, the additional benefit is less stress. One pre-requisite is an experienced assistant to sort out any intra-operative difficulty and external robotic arm clash.

While an experienced laparoscopic urologist can handle a complex adrenal tumour with standard lap instruments, the robotic method confers superior ergonomics and vision to make such adrenalectomies doable with lower conversion rate.

Date: 11 June 2021

Time: 1800-1830 hrs

Topic: Metastatic Castration-Sensitive Prostate Cancer (mCSPC) – What is the Best Treatment Sequence Today?

Speaker: Axel Merseburger

 

Metastatic Castration-Sensitive Prostate Cancer (mCSPC) is an early advanced stage of prostate cancer. The goal of treatment intervention in mCSPC is to delay progression of patients to metastatic Castration-Resistant Prostate Cancer (mCRPC) while maintaining good quality of life. Patients with mCRPC experience more extensive disease-related symptoms such as bone pain and bone fractures, decline in health-related quality of life (HRQoL) and patients have a poor prognosis. Recently, multiple phase III studies have demonstrated improved outcomes for patients with mCSPC with the addition of an androgen signaling inhibitor to standard backbone androgen deprivation therapy (ADT). It is clear now that ADT only is no longer enough for mCSPC and reserving the best drugs for mCRPC does not result in overall survival equivalent to patients who receive early, intensified treatment. In my lecture, I will be reviewing the recent practice changing clinical data that has emerged in the mCSPC landscape and the considerations given when choosing the right drug for the patient.

 

Date: 11 June 2021

Time: 1830-1840 hrs

Topic: Management of Oligometastatic CSPC

Speaker: Jeffrey Tuan

 

Oligometastatic prostate cancer is being considered as a unique clinical situation that represents a transitional state between localized and widespread metastatic disease. It may represent isolated sites of disease (five or fewer) or coexist with micro-metastases. The mainstay of treatment remains systemic therapy with androgen deprivation in combination with chemotherapy or novel hormonal agents. As these patients may have more indolent course, outcomes may be improved by escalating local and/or regional and metastasis-directed ablative therapy in addition to systemic therapy. This requires multidisciplinary consideration, with surgery, radiotherapy and systemic therapy potentially of benefit singularly or in combination. Mounting evidence suggest durable disease-free intervals and possibly cure with such multimodal strategy. However, this needs to be balanced against the toxicity of treatment and quality of life measures on a individual patient basis. Advent of new, highly sensitive imaging technologies will allow earlier detection of metastatic sites and guide further management. Such MRI and PET based modalities will need to be validated. Arrival of prospective clinical data and better understanding of biology will inform how best to treat men of this disease.

 

Date: 11 June 2021

Time: 1840-1850 hrs

Topic: Management of Older Adults with mCSPC

Speaker: Ravindran Kanesvaran

 

Not available at the time of print.

 

Date: 12 June 2021

Time: 0905-0925 hrs

Topic: Specialist Nurse Role in the Urology Discipline: Past, Present & Future

Speaker: Yim Mei-Sum

 

Development of college training prepared nurses to become more competent in planning service development and specialization. Urology nurse specialist role has further expanded to meet services need and development to more advanced level.

  

Urology nurse clinic had developed in Hong Kong since late 80. Main objectives of urology nurse clinic were to improve patient access to care through advanced health assessment and symptoms management in clinic. As a leader in urology nursing, nurse specialists set up varies clinics to meet patient need. With the advancement of urology nursing, first Urology Nurse Consultant developed in 2011.

 

As the leader in urology nursing, Urology Nurse Consultant help to plan urology service development and help in improve patient journey through multidisciplinary liaison and support. With the COV-19 pandemic, some urology nursing activities had to be changed to meet patient need. Telehealth service has been implemented and main objective is to diminish face-to-face contact in hospital.

 

Last but not the least, urology training and education is important in urology nursing specialization. Preceptorship in urology nursing training is important in bringing more nurses to urology nursing and development in urology nurse services.  

 

Date: 12 June 2021

Time: 0925-0950 hrs

Topic: Urology Nursing Assessment

Speaker: Karine Sim

 

Nursing was founded in the mid-19th century and has continuously evolved to what it is today - Evidence Based Nursing. Nurses are taking on expanded roles in the 21st century and more will be expected from us as we move forward as a profession. Besides the expanded roles, we are constantly performing nursing assessment in our daily work.

 

Urological Nursing Assessment aims to reinforce on the proper technique that a nurse could undertake to assess patients that are presented with common urological disorders and how this initiative could make a huge impact to patient care, and uplifting nursing standards as a whole.

 

 

 

Date: 12 June 2021

Time: 0950-1005 hrs

Topic: Trial Off Catheter: Resource Planning, Investigations, Results, Follow-Up Plan

Speaker: Shao Yu Qian

 

Acute retention of urine (ARU) is an emergency condition, which urinary catheter insertion for urine drainage is the common practice for patients, however, with a urethral indwelling catheter inserted, patients experience discomfort & inconvenience in their daily living. Therefore, to facilitate early trial off catheter and reduction of doctor’s clinic resource, TOC clinic was implemented in Tan Tock Seng Hospital Urology Clinic in 2012 which is overseen by our urology nurse clinician.

 

Trial off catheter (TOC) is used to assess patients’ bladder function and establish the ability to effectively and successfully empty their bladder unaided. It is a common procedure can be carried out in many clinical settings.

 

There are different pathways to refer to TOC clinic. Uroflow and bladder scan are used to interpret TOC result. Other than failure to void successfully, other negative outcomes for the patient can include problems such as incontinence and urgency and frequency.

 

Nurses in the urology clinic have a unique role for conducting effective and efficient care in helping patients shorten their barrier time of using indwelling catheter meanwhile greater satisfaction on the given care could be achieved.

 

 

Date: 12 June 2021

Time: 1005-1025 hrs

Topic: A Hospital’s Initiative in Reducing Catheter Associated Urinary Tract Infection (CAUTI)

Speaker: Cui Hai Hua

 

Catheter associated urinary tract infection(CAUTI) is one of the most common healthcare acquired infection. It significantly increases patients’ length of stay, hospital cost and mortality and morbidity. Many efforts were done to reduce CAUTI incidence.  Early removal of catheter is the most effective way to prevent CAUTI. Daily catheter review to assess the need of the catheter advocates for the early removal. Insertion bundle must be in place, including buddy system to ensure aseptic technique insertion adhered throughout the process of catheterization.  Maintenance and care bundle, composing of daily cleaning of catheter, proper securement of catheter and draining of the urine must be well practiced. Frequent audit is necessary to ensure nurses’ compliance with good practice and find any gaps on the ground. Last but not least, leadership support and commitment are vital to promote a safety culture to achieve zero CAUTI for our patients.

 

Date: 12 June 2021

Time: 1100-1120 hrs

Topic: Intermittent Catheterisation: Assessment, Teaching & Monitoring

Speaker: Liang Qing

 

Intermittent catheterization (IMC) is the insertion and removal of a catheter several times a day to empty the bladder which is widely advocated as an effective bladder management strategy for patients with neurogenic bladder dysfunction. It helps to protect the kidneys, promote bladder function and prevent incontinence. This type of catheterization can be used on a short-term or long-term basis depending on the bladder’s ability or inability to return to normal function.

 

IMC often used abbreviation of Clean Intermittent Catheterisation(CIC) or Clean Intermittent Self-Catheterisation(CISC) which is the same procedure that technique used differently. The procedure can be self-performed or done by a caregiver who has been trained. In general, urologic nurses are at the forefront of educating and teaching patients or caregiver how to catheterize.

 

This talk will be provided an overview of the indications, types of catheter and the benefits of IMC. The main focus is on the role of nurse for patient and family education including patient assessment, teaching and monitoring.

 

 

Date: 12 June 2021

Time: 1120-1140 hrs

Topic: Introduction of PureWick™ Female External Catheter

Speaker: Camille Newton

 

Urinary incontinence patients can suffer from moisture associated skin injuries due to prolonged use of diapers and underpads. These patients also have an increased risk of Catheter-Associated Urinary Tract Infections (CAUTI) due to prolonged use of indwelling catheters. It is well documented that both issues drive up the cost for hospitals and have detrimental impact on patients physically, mentally and emotionally. For CAUTI, the risk is higher for female patients due to the short urethra length. However, unlike male patients, female patients in Singapore do not have an option of external catheters. PureWick™ is the first female external urinary catheter in Singapore that is going to be introduced in June 2021. It can provide non-invasive urine output management while reducing CAUTI rates. This presentation discusses how PureWick™ works and appropriate patient selection. The impact and case studies of PureWick™ in the United States, where it first launched in January 2016, will also be reviewed.

 

Date: 12 June 2021

Time: 1140-1200 hrs

Topic: ERAS & MILES Pre-OP Assessment Clinic

Speaker: Ramya John Peter

 

The demand for surgical services is increasing and major surgery, in particular, presents major challenges for our patients. Evidence suggests that managing patients holistically at all stages of their surgical journey improves outcome and enhances recovery.  At NUH, we have instituted two nurse-led peri-operative care programs for patients going for major surgery. These are holistic and individualized programs providing multidisciplinary care throughout the patient’s surgical journey. For patients less than 65 years old, we have the Enhanced Recovery After Surgery (ERAS) program. For patients aged 65 and above, we have the Management and Innovation for Longevity in Elderly Surgical (MILES) patients program, an enhanced version of the ERAS program. This is because elderly patients are at higher risk of developing complications after surgery compared to their younger counterparts. We believe that nurses play an important role in reducing the stresses of surgery and thus, ensuring the well-being of patients throughout the peri-operative process. As anticipated, these programs have been led by nurses with excellent outcomes.

 

My presentation will start with a brief introduction on these nurse - led peri-operative care programs at NUH. I will then describe the workflow, the progress and how these programs benefitted patients and the health system. The presentation will conclude with our future plans to improve the program.

Date: 12 June 2021

Time: 1405-1435 hrs

Topic: Current Treatment Landscapes of Advanced Prostate Cancer

Speaker: Henry Ho

 

 Not available at the time of print

 

Date: 12 June 2021

Time: 1435-1505 hrs

Topic: Staging and Imaging of Prostate Cancer

Speaker: Melvin Chua

 

Not available at the time of print.

 

Date: 12 June 2021

Time: 1505-1535 hrs

Topic: A Prostate Cancer Patient Journey

Speaker: Sarah Chen

 

Prostate Cancer accounts for 12% of all male cancers. It is the 3rd most common form of cancer that afflicts men in Singapore. Prostate Cancer treatment affects these men’s quality of life. With the creation of the Prostate Cancer Specialist Nurse role, a prostate cancer patient’s journey is enhanced & complete. These men are able to benefit from the additional education, support & advocacy that these nurses are able to expertly provide at a short notice.

 

 

Date: 12 June 2021

Time: 1610-1640 hrs

Topic: Management of Side Effects of Surgery in Prostate Cancer

Speaker: Wang Ziting

 

Radical prostatectomy used to be an operation with severe blood loss and morbidities. With the advent of numerous techniques, preservation of anatomic structures such as the urinary sphincter and neurovascular nerve bundles, and minimally invasive technologies, radical prostatectomy is fast becoming a surgery where men can return home safe and sound with hardly any issues. 

 

In this talk, we discuss the complications that can occur within days to weeks after a radical prostatectomy and the measures taken to mitigate their impact on the patients. Complications would include incontinence, erectile dysfunction, deep vein thrombosis, pulmonary embolism, wound infection and lymphocele formation. Measures that can be adopted include patient counselling, lifestyle changes, pharmacotherapy or other interventions. We also discuss the importance of the nursing role in preserving and accelerating recovery of urinary control and sexual function.

 

 

 

Date: 12 June 2021

Time: 1640-1710 hrs

Topic: Management of Side Effects of Novel Hormonal Agents in the Treatment of Prostate Cancer

Speaker: Akhil Chopra

 

The last decade has seen a number of important advances in the treatment of prostate cancer that has resulted in our patients living longer and better. Principal amongst these advances is the introduction of novel hormonal agents into the treatment paradigm of advanced prostate cancer. However, the remarkable anti-cancer benefits from these new drugs can also be associated with side effects that may impact the quality of life of our patients. Dr Chopra will discuss the historical perspective behind hormonal manipulation in the form of androgen deprivation therapy (ADT) to treat prostate cancer. He will cover earlier generation of hormonal agents, their mechanism of action and potential toxicities followed by discussion of the newer and novel hormonal agents, their mechanism of actions, and toxicities.

 

 

 

Date: 12 June 2021

Time: 1710-1740 hrs

Topic: Getting Patients Back to Work

Speaker: Christopher Cheng

 

I thought I knew about prostate cancer. I thought I knew what the patients were going through before and after surgery, that was before I became a patient myself. From the biopsy to the waiting for results and having to live with an indwelling catheter, the talk is a personal account of the patient journey. Being able to understand what the patients undergoing surgery for cancer is experiencing immediately makes one the best friend in need. Being one step ahead of what issues there may be and warn the patients, providing solutions will go a long way to help them weather the ups and downs of post-operative recovery. All patients wish is to recover and get their life back after surgery. If we can be part of the healing process both physically and emotionally, we would have truly earned our place in their hearts. If getting back to work is the goal, having a smooth journey through surgery is very much down to the numerous details discussed in this talk. Patients will be grateful for the care and emotional support we give in equal measures.

 

Date: 12 June 2021

Time: 1405-1420 hrs

Topic: Uro-Oncological answers and it’s presentation in the general population

Speaker: Png Keng Siang

 

Not available at the time of print.

 

Date: 12 June 2021

Time: 1420-1435 hrs

Topic: Embracing the Hard Truth on ED

Speaker: Lee Fang Jann

 

Not available at the time of print.

 

Date: 12 June 2021

Time: 1435-1450 hrs

Topic: Testosterone Replacement – Making a Difference for Low Testosterone Diabetics

Speaker: Lau Wei Da

 

Testosterone deficiency syndrome (TDS), diabetes mellitus (DM) and metabolic syndrome are common conditions affecting Singaporean men. In this talk, the relationship between testosterone deficiency and diabetes mellitus is explained. Overall, men with TDS suffer from symptoms of metabolic syndrome including obesity, insulin resistance and dyslipidaemia. There is increasing evidence that testosterone replacement is associated with improved diabetes control. The latest T4DM study shows that testosterone replacement therapy (TRT) can potentially reverse the onset DM in pre-diabetics. It is now recognised that type 2 diabetics should be screened for presence of testosterone deficiency. An overview of the diagnostic criteria of TDS, the contraindications of TRT, the monitoring requirements of TRT, and the various therapeutic options of TRT is discussed.

 

 

 

Date: 12 June 2021

Time: 1450-1505 hrs

Topic: Recurring Urinary Tract Infection (UTI) – What Else Besides UTI Advice?

Speaker: Tricia Kuo

 

Patients with recurrent UTI have >3 episodes of UTI per year or > 2 episodes in 6 mths.  They are typically given multiple courses of antibiotics. This invariably leads to antibiotic resistance in the urine culture and sensitivities after repeated use e.g. ESBL & fluoroquinolone resistance in gram negative bacilli. The use of antibiotics usually then escalates to the intravenous route and use of penems for acute symptomatic severe infections. This then also renders the use prophylactic antibiotics as continuous daily prophylaxis invalid. 

 

Other means of prevention or prophylaxis of UTI e.g. probiotics, cranberry supplements have mixed, weak and inconclusive evidence in literature. Hence there is a need to expand the armamentarium for treatment of recurrent resistant UTI as part of antibiotic stewardship and avoiding collateral damage from antibiotics. Beside resistance, patients commonly have side effects from antibiotics including nausea, abdominal bloatedness and diarrhoea from pseudomembranous colitis. Lastly, healthcare costs are also increased with collateral damage and antibiotic resistance. 

 

 

 

Date: 12 June 2021

Time: 1505-1520 hrs

Topic: Cutting Edge BPH Treatment Without the Cut

Speaker: Ronny Tan

 

As urologists, we used to concentrate on the bladder outlet where the prostate gland is situated so as to improve the urinary flow. We were able to improve lower urinary tract symptoms (LUTS) as well as the urinary flow, but at the expense of the sexual function of the prostate. We used to cut out the prostate and then cut the prostate with diathermy and laser to deal with the bladder outlet obstruction. Retrograde ejaculation and decreased ejaculation and even dry painful orgasms were the "accepted" side effects of these treatments. With the improved awareness of LUTS due to BPH, men are presenting earlier and with the younger age of presentation, would deem sexual function as something that is treasured and most would want to retain their ejaculatory function, not to mention erectile function. Early treatment of BPH would also prevent bladder failure and hence improving bladder health, which would go a long way in the holistic treatment of BPH LUTS. 

 

UroLift is a novel minimally invasive treatment  for BPH LUTS that does not damage the prostatic tissue. In addition, it is the only current minimally invasive surgical treatment that has no post-operative sexual dysfunction. 

 

Date: 12 June 2021

Time: 1520-1535 hrs

Topic: Killing Two Birds With One Stone – Treating Both LUTS and ED Simultaneously

Speaker: Man Kay Li

 

There is a high correlation of erectile dysfunction with age and lower urinary tract symptoms. In one of the studies in the Asian male population we found that in men over 60 years with severe LUTS, up to 90% will have ED and 56% had severe ED with IIEF (Erectile Function score) less than 12. It is therefore logical approach for the General Practitioners to recommend one medication that will be able to treat both conditions at the same time. Conventional use of Tamsulosin for LUTS can cause ED as an adverse event in 5% of patients.

 

A daily dose of Tadalafil 5 mg has been researched to be the optimum dose and the efficacy rate is comparable to taking Tadalafil 20 mg on demand for ED. This is due to the long half-life of Tadalafil which is 17.5 hours. While taking a low dose daily means that the blood level will be at a steady state instead of high peaks when taking a 20 mg on demand. That minimized the adverse events such as headache and muscle pain resulting in lower discontinuation rates. In another study the adverse events of daily 5mg was similar to placebo. From some of my patients, they find that taking Tadalafil 5 mg on alternate days has similar results.

 

Another study was conducted to compare the efficacy of Tadalafil and Tamsulosin and it showed similar improvement on the LUTS scores. Tadalafil is the first in this class to treat both LUTS and ED.

Date: 19 June 2021

Time: 0845-0915 hrs

Topic: Chronic pelvic pain syndrome:

Pathophysiology, Diagnosis and Management

Speaker: Peggy Chu

 

Chronic Pelvic Pain Syndrome was first named by the National Institute of Health in 1999. Initially it was considered an inflammatory condition of the prostate which may be caused by bacterial infection of the prostate. However, in the past two decades, research had suggested that it is a more systemic condition rather than organ specific to the urological system. Patients with genetic predisposition, under certain environmental situation with imposing triggering factors, e.g. bacterial infection, or other trauma etc. may trigger off an immune response to the prostate. On the other hand, the reception, integration and co-ordination of the peripheral pain by the central nervous system may have been altered which may further aggravate the pain in the pelvic region. The current concepts of treatment of pelvic pain syndrome should be a personalized multidisciplinary approach according to the phenotypes of the symptoms that the patient is suffering from.

Date: 19 June 2021

Time: 0915-0945 hrs

Topic: Laser in the Treatment of Lower Urinary Tract Symptoms

Speaker: Stefano Salvatore

 

Laser is and energy based device widely used in many medical specialties. Over the last few years many authors have reported its use for the treatment of genitourinay syndrome of menopause. The two most used lasers are the fractional CO2 and the Erbium:YAG. For both systems many papers are now available showing a significant efficacy in vulvo vaginal atrophy symptoms and sexual function, together with a good safety profile. The mechanism of action of lasers is based on thermal effect that induce, in the treated tissue, a cascade of events, starting from the activation of different heat shock proteins that stimulate fibroblasts to produce extracellular matrix, new collagen and elastic fibers. Neovascolarization i salso observed.

 

The efficacy of laser on urinary symptoms has also been explored. The actual evidence is, however, mostly based on longitudinal studies. Only two randomized contolled studies have been publisehd. In any case, very promising results show a consistent improvement in all the storage symptoms of the lower urinary tract. Future randomized controlled studies are necessary but, particularly for the mini-invasiveness of the laser treatment, performed in an outpatient setting, there are good premises for an future important role, at least in postmenopausal women.

Date: 19 June 2021

Time: 0945-1000 hrs

Topic: Postpartum voiding dysfunction

Speaker: Harvard Lin

 

Postpartum Voiding Dysfunction is defined as the failure to pass urine spontaneously within 6 hours of vaginal delivery or catheter removal after delivery. This occurs in up to 4% of deliveries.

The postpartum bladder has a tendency to be underactive due to trauma to the bladder, pelvic floor muscles and nerves. It is therefore prone to acute retention. Left untreated, this can lead to bladder underactivity, prolonged voiding dysfunction with complications such as recurrent urinary tract infection and incontinence.

All obstetric practice should have a guidelines for bladder care and the management of postpartum voiding dysfunction.

 

Date: 19 June 2021

Time: 1000-1030 hrs

Topic: Advances in UDS technology

Speaker: Margot Damaser

 

Not available at the time of print.

 

 

Date: 19 June 2021

Time: 1030-1130 hrs

Topic: Emerging BPH Technologies in BPH - New kids on the block

Speaker: Christopher Hollowell

BPH & its symptoms have always been a serious medical problem affecting aging men. For many years the only viable options for

treatment were medications and surgery. Medications can have modest symptomatic improvements. However, they can be many times ineffective, have unwanted side effects, expensive, and fleeting in response duration. Surgery (TURP) is usually highly effective in symptomatic improvements, but can have many permanent sequela. in the last five years new novel BPH treatments have emerged to bridge this treatment gap. The minimally invasive technologies Rezum and Urolift are uniquely different in their approach, but they both provide equally excellent symptomatic improvements, reproducible results, and low side effect profiles. Recent American 5 year data has shown rapid sustained improvements. Providing patients surgical results without actually having surgery.

Date: 19 June 2021

Time: 1130-1145 hrs

Topic: Detrusor underactivity and men

Speaker: Adrian Wagg

 

Underactive bladder, defined as the perception of detrusor underactivity, characterized by symptoms of prolonged voiding, hesitancy, slow and/or intermittent stream, and/or sensation of incomplete emptying is increasingly common in later life and may occur in association with overactive bladder symptoms.  The aetiology of underactive bladder is most likely multi- aetiological, with a combination of bladder fibrosis, outflow tract obstruction and relative tissue ischaemia resulting in architectural changes to the bladder which impair contractile function.  The loss of contractile efficiency results in a progressive reduction in observed urinary flow rate and increase in prevalence of post void residual volumes.  In men, underactive bladder symptoms significantly overlap with those secondary to bladder outflow tract obstruction which, without a pressure flow plot cannot be differentiated.  This has led to a search for noninvasive methods of assessment which might accurately separate the two conditions, with some promising results which require further evaluation.  Underactive bladder may not worsen over time, potentially enabling active surveillance as a management strategy.  However should treatment be required behavioural and double voiding techniques may be effective prior to establishing clean intermittent catheterization.  De-obstructing surgery may result in the regaining of voiding function in up to 50% men with a Bladder Contractility Index <100. At the moment, there is no recommended pharmacotherapeutic option which leads to improvement in voiding efficiency.

 

 

 

Date: 19 June 2021

Time: 1145-1205 hrs

Topic: Male AUS vs slings-complications and pitfalls

Speaker: Neil Harris

A significant proportion of patients undergoing robotic or open radical prostatectomy develop bothersome stress urinary incontinence (SUI) and around 10% undergo surgical treatment of their incontinence. The surgical options consist of either the artificial urinary sphincter (AUS) or the male transobturator sling.   Recent preliminary data from the MASTER trial confirm that both the AUS and male sling offer effective treatment for post-prostatectomy SUI, although overall patient satisfaction rates seems to favour the AUS, particularly in men with more severe leakage or in men who have undergone adjuvant radiotherapy.   

We recommend that urologists who wish to offer surgical treatment of male SUI need to undergo robust training and mentoring in the surgical procedures.  In addition, support from pelvic floor physiotherapists, specialist nurses and access to multidisciplinary team working is essential in order to maximise surgical outcomes and patient satisfaction following this type of surgery. 

 

Date: 19 June 2021

Time: 1215-1300 hrs

Topic: Reality and Expectations of the Novel Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP)

Speaker: Naeem Bhojani

 

Endoscopic enucleation of the prostate (EEP) has become the Gold standard treatment for benign prostatic hyperplasia. Since its development in the late 1990’s, EEP has been demonstrated to have excellent long-term outcomes, with a low retreatment rate and to be prostate size independent. Although the first EEP was performed using the Holmium: YAG laser, a number of different energy sources have been and are currently being used to perform EEP including the Thulium:YAG laser, Green Light laser and bipolar cautery. In this presentation I will discuss the novel thulium fiber laser with regards to its application in EEP. After discussing the technology and comparing it to the Holmium:YAG laser, I will demonstrate with video support the novel Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) procedure. I will also discuss the realities and expectations for this novel laser in EEP and I will briefly discuss same day ThuFLEP.

Date: 19 June 2021

Time: 1330-1430 hrs

Topic: Contemporary ADT in Elderly Patients with Advanced Prostate Cancer: Issues and Concerns

Speaker: Melvin Chua, Ravindran Kanesvaran, Tan Teck Wei

 

In this Ferring sponsored session, distinguished panelists will share their rich clinical experiences on ADT for elderly prostate cancer patients. Dr. Tan Teck Wei will firstly set up the scene on the rationale of focusing on ADT in elderly PCa patients (disease burden, co-morbidity such as CV, bone health), followed by Professor Ravi’s talk that walks the audience through Geriatric Oncology principles/consensus (from SIOU), ADT (agonist vs. antagonist, patient benefits), toxicity profiling, and paint out a list of issues of ADT in elderly PCa vis-à-vis  risk profiles, and move to ADT/combinatorial therapy (with C/T, novel AA) for which subgroups of patients, esp. metastatic PCa (HSPC, CRPC), followed by Professor Melvin’s talk about trials on ADT + Radiation therapy in advanced prostate cancer, review on toxicities of ADT, advent/evidence for GnRH antagonist, then having a deep dive of HERO trial, with 2 case studies (M1 PCa/high risk, with heart attack within 6 months). Dr. Tan Teck Wei will continue to exemplify an elderly patient with high volume mHSPC including extensive bone/spine mets, renal impairment, cardiac issues - to highlight the points mentioned by the speakers and the challenges in managing these cases. An interactive live Q and A session will ensue.