Verbal Abstracts
Note: Abstracts are listed alphabetically by the last name of the first presenting author, where approval for sharing has been granted.
ONCOLOGICAL AND SAFETY OUTCOMES FOLLOWING NEOADJUVANT [177LU]LU-PSMA-617 PRIOR TO RADICAL PROSTATECTOMY: LONG-TERM FOLLOW-UP OF THE LUTECTOMY TRIAL
Abdullah
Al-Khanaty, David Hennes, Renu Eapen, Aice Thomson, Price Jackson, Catherine
Mitchell, Sheng Oon, Lachlan McIntosh, Nattakhorn Dhiantravan, Arun Azad,
Mohammed Haskali, Dan Moon, Nathan Lawrentschuk, Paul Neeson, Declan Murphy,
Michael Hofman, James Buteau
Peter MacCallum Cancer Centre
Background:
Neoadjuvant prostate-specific membrane antigen (PSMA)-targeted radioligand
therapy (RLT) is a potential treatment intensification strategy for high-risk
localised prostate cancer. We report extended follow-up from the LuTectomy
trial, focusing on long-term safety and biochemical recurrence (BCR) following
neoadjuvant [¹⁷⁷Lu]Lu-PSMA-617 before radical prostatectomy.
Methods:
LuTectomy was a prospective, single-centre, open-label phase I/II study of men with untreated high-risk localised or locally advanced prostate cancer and high PSMA expression on PET/CT. Patients received one or two cycles of [¹⁷⁷Lu]Lu-PSMA-617 (5 GBq/cycle), followed by robotic radical prostatectomy with pelvic lymphadenectomy if indicated. The primary endpoint was long-term safety (CTCAE v5.0). Exploratory endpoints included BCR, BCR-free survival, salvage treatment, metastatic progression and overall survival.
Results:
Twenty patients completed treatment and radical prostatectomy. Median follow-up was 45.6 months (95% CI 36.0–NR). One patient with pre-existing hypertension, diabetes and renal impairment developed grade 2 chronic kidney disease of uncertain attribution. No grade 3–4 treatment-related adverse events, significant delayed haematological toxicity, persistent salivary dysfunction, treatment-related surgical complications, secondary malignancies or treatment-related deaths occurred. BCR occurred in 10 patients (50%), with median BCR-free survival of 32.1 months (95% CI 19.4–NR). Seven underwent salvage radiotherapy, of whom two subsequently progressed to mCRPC and commenced doublet therapy. Three patients with BCR declined salvage radiotherapy.
Conclusions:
Extended follow-up demonstrates a sustained favourable safety profile for neoadjuvant [¹⁷⁷Lu]Lu-PSMA-617 before radical prostatectomy, with no significant late toxicities after nearly four years. Oncological outcomes remain exploratory and support continued prospective evaluation in high-risk localised and locally advanced prostate cancer.
FIRST REPORT OF A HEMINEPHRECTOMY FOR A RARE CASE OF HORSESHOE KIDNEY TUMOREMPLOYING THE NEW TRANSABDOMINAL LUMBAR APPROACH FOR ROBOTIC-ASSISTED RENALSURGERY (TALA)
Uwe Bieri, Franziska-Maria Heining, Christopher Tschung, Philipp Maletzki, Jean-Pascal Adank, Tilo Nieman, Antonio Nocito, Lukas John Hefermehl
Kantonsspital Baden, Urologie, Baden, Schweiz
Introduction & Objectives:
Surgical resection of tumours arising in horseshoe kidneys poses unique challenges. The highly variable vascular anatomy, aberrant isthmus anatomy, and fixed, poorly mobile nature of horseshoe kidneys complicate minimally invasive procedures in these patients. To overcome these challenges, the novel surgical approach, the transabdominal lumbar approach (TALA) - which integrates the advantages of thetransabdominal (TA) and retroperitoneal (RP) techniques, was applied.
Materials & Methods:
Here, we present a Case of TALA as a safe and feasible option for robotic-assisted renal surgery in a patient with a horseshoe kidney tumour.
Results:
A 53-year-old female with a 8 cm incidentally discovered tumour in the lower pole of a horseshoe kidney underwent robotic heminephrectomy using the TALA technique. Preoperative imaging revealed a midline isthmus with aberrant vasculature, including accessory renal arteries. Operative time was 341 minutes with 200 mL estimated blood loss. Total warm ischemia time was 16 minutes. Final pathology showed a chromophobe renal cell carcinoma with negative surgical margins (pT2a pN0 L0 V0 Pn0 R0). The patient was discharged on postoperative day 4 with no complications. At 6-month follow-up, there has been no recurrence.
Conclusions:
TALA facilitated robotic-assisted heminephrectomy in a patient with a horseshoe kidney tumour. By combining the advantages of the TA and RP approach, TALA provided optimal instrument manoeuvrability and control of the complex vasculature.
ARE NEPHROMETRY SCORES TRULY VALIDATED FOR RENAL TUMOUR COMPLEXITY? A STRUCTURED METHODOLOGICAL REVIEW
Brendan Dittmer, Jake Carmody, Nathan Lawrentschuk, Niall M. Corcoran, Dinesh K. Agarwal
Western Health
Nephrometry scores are used to describe renal tumour complexity, stratify case mix, and compare outcomes after partial nephrectomy. Most systems have historically been evaluated through association with perioperative outcomes, but this is influenced by surgeon experience, operative approach, patient factors and institutional systems. We examined whether published nephrometry scores have been validated against tumour-related operative complexity as the construct they are intended to assess.
A structured literature search was performed to identify original renal nephrometry scoring systems published between January 2009 and December 2025. Systems were reviewed according to anatomical parameters, development methodology, validation endpoint and validation framework. Validation was classified as outcome-based when based primarily on perioperative or postoperative outcome association, and construct-based when directly aligned with tumour-related operative difficulty.
Fourteen scoring systems met inclusion criteria: R.E.N.A.L., PADUA, C-index, DAP, CSA, NePhRO, RTII, RAIV, SARR, RPS, CLAMP, ABC, SPARE and RPN. Thirteen systems were developed and evaluated primarily through outcome-based validation, including association with warm ischaemia time, operative duration, blood loss, complications, urinary leak, renal function, treatment selection or composite endpoints. Direct measurement of surgeon-perceived operative difficulty during score development was uncommon. RPN was the only identified framework incorporating direct surgeon assessment of operative difficulty, regression-based anatomical weighting and subsequent internal and external validation.
Most nephrometry scores have been validated against perioperative outcomes rather than directly against tumour-related operative difficulty. Outcome correlation remains clinically useful, but may not fully establish validity for tumour complexity assessment. Construct-aligned validation provides a complementary framework for future nephrometry development, RAPN reporting, case-mix adjustment and benchmarking.
FIRST-IN-HUMAN PROOF-OF-CONCEPT STUDY OF THE ALPHA PROTOTYPE OF AKEEKO STENT INSERTER FOR URETERIC STENT PLACEMENT IN ACUTE RENAL COLIC
Patrick GORDON, Damien BOLTON, Oneel PATEL, Joseph ISCHIA.
Department of Urology, Austin Health
AIM:
To present the first-in-human trial of the Akeeko Stent Inserter (ASI), a novel bedside ureteric stent insertion device. The primary objective was to assess device feasibility and functional performance, with secondary evaluation of procedural efficiency and safety.
METHOD:
A single centre pilot study included adults requiring ureteric stent insertion for routine urological care or for acute renal colic secondary to ureteric obstruction. Exclusion criteria included stones >1cm, radiological evidence of stone impaction, prostate volume >100 cc and severe sepsis. Following informed consent, stent insertion was attempted using the ASI.
RESULTS:
Eight participants were enrolled (mean age 52 years; 50% male). Stone size ranged from 4-10 mm, with 50% located in the proximal ureter. The first five procedures were performed under general anaesthesia in the operating theatre, with successful stent insertion in three.
The subsequent three procedures were performed at the bedside in the emergency department (ED), with “Frog-leg” positioning and methoxyflurane (Penthrox) for analgesia. Procedure duration ranged from 8-18 minutes and decreased with operator experience. Bedside insertion was successful in one of three participants. Both unsuccessful procedures occurred in male participants with high bladder necks, which impeded visualisation of the ureteric orifice. Overall, successful stent insertion was achieved in four of eight participants (50%). Four participants experienced mild to moderate adverse events, including urinary frequency, pain, and haematuria. No serious adverse events occurred.
CONCLUSION:
This first-in-human trial demonstrates the feasibility and clinical potential of the ASI while identifying technical limitations of the alpha prototype design, particularly in male patients with high bladder neck anatomy. The next-generation prototype will incorporate design modifications addressing the identified technical limitations, with the aim of providing a safe and effective alternative to conventional operating theatre-based ureteric stent insertion.
BEYOND THE INCISION: PAIN OUTCOMES AFTER ROBOTIC VERSUS OPEN MESH REMOVAL
Snigdha Priya Gurrala 12, Eva Fong 3, Shomik Sengupta 12, Henry Yao 12
1. Eastern Health Clinical School, Monash University, Melbourne, Victoria
2. Urology department, Eastern health, Melbourne, Victoria
3. Urology department, Southern Cross Brightside Hospital, Auckland, New Zealand
Background
Pelvic mesh-related pain is a common indication for mesh removal; however, patient-reported outcomes following surgery remain variable. Comparative evidence evaluating robotic-assisted versus open mesh removal is limited. This study aimed to compare patient-reported pain outcomes following robotic and open pelvic mesh removal using the Patient Global Impression of Improvement (PGI-I) questionnaire.
Methods
A retrospective cohort study was conducted of women undergoing pelvic mesh removal for mesh-related complications at a tertiary referral centre between March 2013 and December 2024. Pain improvement was assessed using the PGI-I questionnaire, with responses dichotomised as improved ("very much better", "much better", or "a little better") or not improved ("no change" or any degree of worsening). Secondary analyses evaluated the impact of pain phenotype, extent of mesh removal, surgical complexity, and mesh type on postoperative improvement.
Results
A total of 364 women underwent pelvic mesh removal, with pain reported in 271 patients (74.4%). PGI-I data were available for 273 patients, of whom 150 (54.9%) reported improvement following surgery. Robotic-assisted mesh removal was associated with significantly greater odds of postoperative improvement than open surgery (67.4% vs 49.2%; OR 2.14, 95% CI 1.25–3.65; p = 0.0043). Complete mesh excision was also associated with higher rates of improvement compared with partial excision (61.9% vs 45.2%; OR 1.97, 95% CI 1.21–3.22; p = 0.0063). Pain phenotype, mesh type, and surgical complexity were not significantly associated with patient-reported improvement.
Conclusions
Pelvic mesh removal provides meaningful patient-reported pain improvement for women with mesh-related complications. Robotic-assisted mesh removal and complete mesh excision were associated with significantly greater postoperative improvement than open surgery and partial excision, respectively. These findings provide novel comparative evidence to support surgical planning and patient counselling.
CUTTING EDGE OR CUTTING OPEN? ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY FOR BLADDER CANCER: A SYSTEMATIC REVIEW
Snigdha Priya Gurrala 1, Nisal Ekanayake 1, Prof Shomik Sengupta 1,2
1. Urology Department, Eastern Health, Box Hill, Australia
2. Eastern Health Clinical School, Monash University, Box Hill, Australia
Eastern Health
Background:
Radical cystectomy remains the standard of care for muscle-invasive and selected high-risk non-muscle-invasive bladder cancer. Robot-assisted radical cystectomy (RARC) has emerged as a minimally invasive alternative to open radical cystectomy (ORC), though its comparative benefits remain debated.
Objective:
To synthesise evidence from randomized controlled trials (RCTs) comparing perioperative, oncological, and functional outcomes between RARC and ORC.
Methods:
A systematic literature search of PubMed, MEDLINE, and the Cochrane Library was conducted up to May 2025. RCTs directly comparing RARC and ORC in patients with bladder cancer were included. Outcomes assessed included operative time, estimated blood loss, complications, length of stay, oncological outcomes, quality of life, and cost.
Results:
Eight RCTs were included. RARC was associated with lower estimated blood loss (median reduction ~317 mL) and reduced rates of selected complications, including thromboembolic and wound complications. Operative time was consistently longer for RARC (median increase of 117 minutes). Length of hospital stay and readmission rates were largely comparable, with modest improvements in some studies. Oncological outcomes, including margin status, lymph node yield, and survival, were equivalent between approaches. Early functional recovery and quality of life outcomes favoured RARC in some trials, though differences diminished over time. Costs were higher with RARC where reported.
Conclusions:
RARC provides some perioperative advantages while maintaining oncological equivalence to ORC, supporting its role as a safe and effective alternative in appropriately selected patients. However, higher costs and longer operative times remain limitations. Further research is required to clarify long-term functional outcomes and the impact of intracorporeal urinary diversion.
Keywords:
Bladder cancer, Intracorporeal diversion, Open radical cystectomy, Perioperative outcomes, Quality of life Robotic-assisted radical cystectomy.
A RARE CASE OF MALIGNANT MELANOMA OF THE PROSTATE: PRIMARY VS METASTASIS?
Chloe Hobson (Research Fellow) - North East Urology, Peter Liodakis (Urologist) - North East Urology
North Eastern Urology
IS A SINGLE VOID SUFFICIENT FOR A TRIAL OF VOID FOLLOWING INDWELLING URINARY CATHETER REMOVAL? A RETROSPECTIVE REVIEW AT MONASH HEALTH, VICTORIA
Siyu Huang, Evan Jenkins, Sean Ong, Weranja Ranasinghe
Monash Health
Background
In Australia, 10–15% of hospitalised patients have an indwelling urinary catheter (IDC) during admission (1,2). IDC removal is typically followed by a trial of void (TOV). The Monash Health protocol defines a successful TOV as at least two successful voids with a post-void residual (PVR) <150–200 mL. This study investigated whether a single successful void can predict the outcome of a multiple-void TOV following IDC removal.
Methods
Following ethics approval, a retrospective review was conducted of patients undergoing TOV at Monash Health between 1 October and 31 December 2025. A successful first void was defined as a voided volume greater than the PVR and PVR <150 mL. First-void outcomes were compared with final multiple-void TOV outcomes. Discordant classifications were assessed using the exact McNemar test.
Results
Of 222 patients identified, 93 had complete voided volume and PVR data and were included (82 outpatients; 11 inpatients). 45 patients passed their first void, of whom 43 (95.6%) subsequently passed the multiple-void TOV and 2 (4.4%) failed. Of 48 patients who failed their first void, 19 (39.6%) subsequently passed the multiple-void TOV. Overall agreement between the two approaches was 77.4%, with a significant difference in discordant classifications (exact McNemar test, p<0.001).
Conclusion
A successful first void was highly predictive of successful multiple-void TOV, with 95.6% subsequently passing the full protocol. A single-void TOV may therefore be sufficient in patients meeting first-void success criteria, potentially reducing monitoring and facilitating earlier discharge. However, failure of the first void should not be considered TOV failure, as 39.6% subsequently passed.
References
Smith J, et al. J Perioper Pract. 2024;34(5):175–183.
Montalvo I, et al. J Clin Nurs. 2020;29(15–16):2920–2928.
EARLY PROSPECTIVE EXPERIENCE COMPARING THE DA VINCI 5 VERSUS XI PLATFORMS FOR ROBOT-ASSISTED RADICAL PROSTATECTOMY
Thomas McMaster, Yee Chan, Nathan Lawrentschuk, Andrew Troy, Kapil Sethi, Dixon Woon
Epworth Healthcare Freemasons, Melbourne, Australia
Methods: A single-centre prospective observational cohort study of consecutive patients undergoing robot assisted radical prostatectomy, from February 2026. Cases were performed by five urologists using either the Xi or DV5 platforms. Robot allocation occurred according to routine theatre scheduling and equipment availability. Patient baseline demographics, robot console metrics, oncological and perioperative data were collected. Outcomes include console time, active time, instrument count, intra- and perioperative performance and oncological outcomes. Initial surgeon-reported experience was also assessed using a validated questionnaire (SURG-TLX1).
Results: Fifty-four patients were included in this preliminary analysis (Xi n=26; DV5 n=28), with recruitment ongoing toward a cohort of 80. Baseline patient and tumour characteristics were comparable between groups. The Xi cohort had a longer median console time (163 mins, IQR 132-193) versus the DV5 group (161mins, IQR 135-188) (p=0.6), while median active time was also longer in the Xi group versus the DV5 cohort (149 mins, IQR 119-169 vs 148 mins, IQR 121-170, respectively) (p=0.9). No significant differences in short-term perioperative outcomes were identified. Positive surgical margins occurred in 1/26 (3.8%) Xi and 8/28 (28.6%) DV5 cases (p=0.015). Initial surgeon-reported assessment of the DV5 demonstrated lower mental and physical workloads and a greater satisfaction with console ergonomics and visualisation compared to Xi.
Conclusion: Early prospective experience with the DV5 demonstrates comparable perioperative performance to Xi. Median console and active times using the DV5 were shorter, however, this was not statistically significant on preliminary analysis. Observed difference in positive surgical should be interpreted with caution and requires reassessment following cohort completion. Ref: 1.Wilson, M. R., et al (2011)
ESTABLISHING A REZŪM SERVICE IN AUSTRALIAN PUBLIC HOSPITALS: A THREE-YEAR COMBINED METROPOLITAN AND REGIONAL EXPERIENCE
Kunind Oberoi, Harrison Lucas, Edward Risbey, Anita Clarke, Kapil Sethi
The University of Melbourne
Aims: Rezūm water vapour thermal therapy is an established minimally invasive surgical therapy (MIST) for lower urinary tract symptoms secondary to benign prostatic hyperplasia. Published outcomes derive largely from trials and high-volume private centres; no Australian data exist, and public-hospital outcomes are scarce. We describe establishing a Rezūm service across Australian metropolitan and regional public hospitals.
Methodology: Retrospective cohort study of consecutive patients undergoing Rezūm at two Victorian public hospitals (December 2023–April 2026), reported per STROBE. None were excluded for prostate volume, retention, prior surgery or comorbidity. Paired International Prostate Symptom Score (IPSS), IPSS quality-of-life subscale, maximum urinary flow rate (Qmax) and post-void residual were compared on complete cases at 6–12 months. Procedural details, catheter outcomes, complications and retreatment were recorded.
Results: Seventy-two men underwent Rezūm (55 metropolitan, 17 regional). Median prostate volume was 53 mL (range 16.4–140); 75% had ≥2 chronic conditions. All four functional measures improved significantly: mean IPSS fell 6.2 points (95% CI 2.8–9.6, p=0.002) and mean Qmax rose 3.9 mL/s (95% CI 0.8–7.0, p=0.017), although IPSS was paired in only 11 patients. Sixty-nine of 71 procedures (97.2%) used general anaesthesia. Median time to catheter-free status was seven days; 51 of 66 men (77.3%) voided at first trial. Complications occurred in 26 of 60 men (43.3%), most commonly urinary tract infection (23.3%); nine presented to emergency within 30 days. Six of 64 men (9.4%) underwent retreatment at a median of six months.
Conclusion: Rezūm was safe and effective in an unselected public-hospital cohort. Establishing the anaesthetic pathway and structured outcome capture, rather than technical proficiency, were the principal challenges. Near-universal general anaesthesia may forfeit the access advantages underpinning MIST in a constrained public system, and catheter management appears a modifiable determinant of unplanned care.
A CRITICAL APPRAISAL OF THE TRACTION TRIAL: A HOSPITAL POLICY OF TRANEXAMIC ACID TO REDUCE TRANSFUSION IN MAJOR NONCARDIAC SURGERY
Jessica Paynter
Peninsula University Hospital
Background:
Major urological procedures, including radical cystectomy, radical prostatectomy and nephrectomy may be associated with substantial perioperative blood loss and transfusion risk. Routine tranexamic acid (TXA) use remains inconsistent, partly due to concern regarding venous thromboembolism (VTE), particularly in oncological patients.
Methods:
The TRACTION trial was a multicentre, double-blind, cluster-randomised, placebo-controlled trial evaluating a hospital-wide policy of intraoperative TXA in patients at high risk of transfusion undergoing major non-cardiac surgery. Ten Canadian hospitals were randomly assigned at 4-week intervals to a hospital-wide policy of intraoperative TXA or placebo. Co-primary outcomes were red-cell transfusion during the index admission and VTE within 90 days. Mixed-effects modelling accounted for the cluster-crossover design.
Results:
Among 8,273 evaluable patients, 60.5% underwent oncological surgery and 17.3% (1,434) underwent urological procedures. Red-cell transfusion occurred in 7.4% receiving TXA compared with 9.8% receiving placebo (RR 0.73, 95% CI 0.61–0.86), an adjusted absolute reduction of 2.7 percentage points and approximate number needed to treat of 37. VTE occurred in 2.1% of both groups (RR 0.96, 95% CI 0.65–1.38), meeting the prespecified criterion for non-inferiority. No significant differences were demonstrated in myocardial infarction, stroke, length of stay, ICU admission or 90-day survival.
Conclusion:
TRACTION provides high-quality evidence that implementation of routine perioperative TXA reduces transfusion without a detectable increase in VTE following major non-cardiac surgery. Its pragmatic design and substantial oncological and urological representation support applicability to major urological surgery. However, procedure-specific benefits remain uncertain, and extrapolation to individual high-risk urological operations requires consideration of baseline transfusion and thrombotic risk.
A SONG OF FIRE AND ICE; A CRITICAL APPRAISAL OF 10 YEARS OUTCOMES FOR FOCAL HIFU AND CRYOTHERAPY IN PROSTATE CANCER
Sachin Perera, Briony Norris, Nathan Lawrentschuk
The Royal Melbourne Hospital
Aims:
To critically appraise the methodology, validity, and clinical applicability of a large-scale cohort study reporting oncological outcomes following focal HIFU and cryotherapy for nonmetastatic prostate cancer, and to evaluate the strength of evidence it provides for focal therapy within the current treatment pathway.
Methodology:
The appraisal examined the study design, patient selection, outcome definitions, follow-up methodology, and statistical approach of the pooled HEAT and ICE registry cohort. Appraisal criteria included risk of selection bias, presence of comparator groups, standardisation of failure and recurrence definitions, adequacy of follow-up duration relative to prostate cancer's natural history and oncological endpoints.
Results:
There were several methodological limitations identified. Patient and lesion dat carried significant heterogeneity limiting generalisability. No comparator arm (radical prostatectomy, radiotherapy, or active surveillance) was included. Definitions of treatment "failure," PSA kinetics, and MRI/biopsy-based recurrence detection varied across sites, risking outcome misclassification. Follow-up, while adequate for intermediate oncological endpoints such as failure-free and metastasis-free survival, remains insufficient to confidently assess long-term metastasis or cancer-specific mortality and lacks statistical acuity. Functional and quality-of-life outcomes, central to focal therapy's rationale, were not reported alongside oncological data.
Conclusion:
This analysis represents the current largest real-world dataset on focal therapy for prostate cancer but methodological limitations mean findings should be regarded as hypothesis-generating rather than definitive. Randomised comparison, standardised outcome reporting, longer follow-up are required before focal therapy can be legitimately established within the nonmetastatic prostate cancer treatment pathway.
PRIMARY FOCAL IRREVERSIBLE ELECTROPORATION FOR INTERMEDIATE RISK PROSTATE CANCER: FIRST EXPERIENCE AT AN AUSTRALIAN PUBLIC HOSPITAL
Cameron Powell 2, Jeremy Cheng 1,2, Eugene Wang 3, Ashley Baring 4, Mohammadmehdi Adhami 1,2, Dennis King 1,2, John Yaxley 5,6,7, Helen Kavnoudias 1,8, Jeremy Grummet 1,2
Affiliations:
1. School of Translational Medicine, Monash University, Melbourne, Australia
2. Department of Urology, Alfred Health, Melbourne, Australia
3. Department of Urology, The Royal Melbourne Hospital, Melbourne, Australia
4. Alfred Health, Melbourne, Australia
5. Wesley Urology Clinic, Brisbane, Australia
6. Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
7. School of Medicine, University of Queensland, Brisbane, Australia
8. Department of Radiology, Alfred Health, Melbourne, Australia
School of Translational Medicine, Monash University, Melbourne, Australia
Aims:
Focal irreversible electroporation (IRE) is an emerging treatment for localised prostate cancer with excellent functional and encouraging early oncological outcomes. In Australia, until now, access has been limited to the private sector for upfront treatment.
Methodology:
FIREFLY is an ongoing prospective single-centre registry of patients undergoing focal IRE for intermediate-risk localised prostate cancer at an Australian public hospital.
Key inclusion criteria: PI-RADS score 3-5 or lesion on PSMA PET/CT; ISUP GG2 (any length) or ISUP GG3 (longest core < 10mm) PCa; template biopsies negative or clinically insignificant PCa (< 10mm ISUP GG1).
Patients reviewed at six weeks, three months, and three-monthly thereafter. Data included: serial PSA; adverse events using CTCAE; IPSS; IIEF-5; EPIC bowel score; FACT-G7.
Per-protocol mpMRI and repeat biopsy scheduled 18-24 months post-IRE.
Results:
From July 2025, 13 patients underwent focal IRE with median (IQR) follow-up 6 (5-10) months. Median age 67 (67-69) years and baseline PSA 8.5 (4.6-9.3) ng/mL. Nine patients had ISUP GG2 disease and four ISUP GG3. Technical success achieved in all cases without intraoperative complications.
At six-weeks: three Grade 1 and four Grade 2 adverse events. One patient required continence pads temporarily at six-weeks. No further adverse events.
IPSS improved from median of 7 (4–11) to 2 (2–5) at 3 months (p=0.02).
No significant change in any other PROM at six-weeks or three-months.
Mean (SD) PSA decreased from 7.5 (2.4) at baseline to 2.9 (1.7) at six-weeks (p<0.001) and remained 2.9 (2.1) at 3 months (p<0.001), 2.7 (2.2) at 6 months (p=0.001), and 3.5 (2.7) at 9 months (p=0.004).
Conclusions:
Focal IRE safely implemented within an Australian public hospital, demonstrating favourable early safety outcomes, and minimal functional impact. PSA kinetics promising and consistent with similar studies. Longer term oncological outcomes awaiting histological confirmation.
ESCHERICHIA COLI RESISTANCE PATTERNS IN REGIONAL VICTORIA: ARE PROPHYLACTIC ANTIBIOTICS HELPING PATIENTS OR SUPER BUGS?
Calliope Stavrou, Jess Wynn, Peter Stapleton, Niranjan Sathianathen, Lachlan Dodds, Robert J Commons, Ashani Couchman
Grampians Health Ballarat
BACKGROUND:
Urinary tract infections (UTIs) account for 30% of all healthcare-associated infections, resulting in heavy reliance on antibiotics. However, more than 50% of UTIs are prescribed the incorrect antibiotic class or duration. The most common uropathogen is Escherichia coli, responsible for approximately 80% of all UTIs. This review aims to assess patterns of E. coli resistance at an Australian tertiary regional hospital in the context of changes to national guidelines for empiric antibiotic treatment of UTIs.
METHODS:
This is a retrospective cohort study of all urine culture and sensitivity tests completed at a tertiary regional hospital over a 10-year period, from January 1, 2013 to December 31, 2023. Each urine culture was assessed for its dominant organism, which were then analysed for resistance patterns to common antimicrobials. Cross sectional analysis and tabulation was used to assess prevalence of uropathogens over time and changes in their resistance patterns.
RESULTS:
The final sample size was 8,388 urine cultures positive for E. coli from 2013 to 2023. The total incidence of E. coli UTIs increased from 2013 to 2023, with 18.1 more E. coli UTIs recorded per year (p = 0.004, CI 9.0 – 27.2). E. coli isolates had the greatest sensitivity to nitrofurantoin (96.7%, SD 1.5%) and gentamicin (96.25%, SD 2.7%) and the greatest resistance to cotrimoxazole and amoxicillin. However, gentamicin also demonstrated the fastest development of resistance over time, with a decline in sensitivity of 0.54% per year (p = 0.026, CI −0.15 to −0.93).
CONCLUSION:
UTIs remain one of the most common infections. This study demonstrates the increasing incidence of E. coli related UTIs and the changes in resistance profiles over a decade of surveillance. The overall antibiotic sensitivities suggest that adequate treatment options remain available for most patients with E. coli UTIs.
INDOCYANINE GREEN (ICG) FLUORESCENCE FOR INTRAOPERATIVE IDENTIFICATION OF ILEAL CONDUITS IN ROBOT-ASSISTED SURGERY: A CASE SERIES
Dr Calliope Stavrou, Professor Nathan Lawrentschuk, Dr Dilshan Udayasiri
Royal Melbourne Hospital
Introduction:
Identifying ileal conduits during abdominal or pelvic surgery can be challenging due to adhesions and altered anatomy from prior procedures. Indocyanine green (ICG) fluorescence imaging, widely used for tissue perfusion assessment and lymphatic mapping, has emerging applications in urological surgery. We present two cases in which ICG, instilled via the ileal conduit, facilitated intraoperative identification of the conduit and ureters in anatomically complex patients undergoing robotic surgery.
Case Presentation:
Case 1: A 59-year-old male with previous cystectomy and ileal conduit diversion for muscle-invasive bladder urothelial carcinoma 2 years prior presented with left ureteroileal stenosis causing hydronephrosis and a parastomal hernia. He underwent robot-assisted left ureteroileal re-anastomosis and parastomal hernia repair. ICG was administered intraoperatively via a catheter through the conduit, enabling ureteric identification using the integrated Firefly fluorescence system of the Da Vinci Xi robot. This facilitated identification of the ureter for re-anastomosis and helped avoid inadvertent injury to the ileal conduit during the hernia repair.
Case 2: A 72-year-old female with a history of laparoscopic salpingo-oophorectomy and cystectomy with ileal conduit diversion 2 years prior for intractable incontinence presented with symptomatic midline and parastomal hernias, the latter containing small bowel loops. She underwent robot-assisted hernia repair, where intraoperative ICG instillation enabled clear visualisation of the conduit and ureters via Firefly fluorescence imaging.
Discussion/Conclusion:
This case series demonstrates the feasibility and utility of ICG fluorescence imaging as an adjunct for intraoperative identification of ileal conduits and ureters in patients with prior intra-abdominal surgeries. The technique was well tolerated, with no adverse effects. Further studies are needed to standardise dosing, timing, and administration routes for this application.
A HEALTH ECONOMIC ANALYSIS OF THE IMPACT OF MULTI-SPECIALTY ROBOTIC-ASSISTED SURGERY ON HOSPITAL PRODUCTIVITY
N.Sutiyawan, C. Schilling, D.Tong, M.McSweeney, C.Robinson, L.Wong
The University of Melbourne and St Vincent Melbourne, Australia
Methodology: The study population comprised individuals undergoing robot-assisted surgery at St Vincent’s Hospital Melbourne, a large tertiary public hospital in Australia, from 1 January 2024 to 30 June 2025. At the procedure group level, average length of stay and total cost was analysed using generalised linear multivariate models with a log link and Gamma family. At the ward level, an interrupted time series and a difference-in-differences analysis were used to compare changes in outcomes within wards (4E, 7E, 7W) before and after the introduction of the robotic system with contemporaneous changes observed in non-robotic wards (9E, 9W).
Outcomes included weekly ward-level activity, case-mix weighed activity (National Weighted Activity Units), total costs, net revenue and adverse event outcomes. Results: A total of 278 robotic procedures were performed across the study period. Robotic surgery was associated with a significant reduction in ALOS of 0.92, but with higher average total costs of $9,527. At the ward level, the interrupted time series multivariate analysis found no statistically significant association between the percentage of robotic procedures and the number of weekly separations or total NWAU, but a significantly lower net revenue.
Conclusion: We find clear evidence that robotic surgery reduces ALOS at the procedure level, but no evidence that these gains translate into increased throughput or revenue at the ward level. The adoption of robotic surgery alone is unlikely to improve hospital financial performance without complementary changes to system-level planning and resource allocation.
CAN QUESTIONNAIRES PREDICT OBJECTIVE FEMALE VOIDING DYSFUNCTION? A SYSTEMATIC REVIEW
Dr David Toro Tole, A/Prof Caroline Dowling, Prof Shomik Sengupta
Eastern Health Clinical School, Monash University
Aims
Female voiding dysfunction is difficult to diagnose from symptoms alone, while urodynamic assessment is invasive and not universally available. This systematic review evaluated whether validated symptom-based questionnaires predict objectively confirmed female voiding dysfunction.
Methodology
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase and Cochrane databases were searched from 1995 to June 2026 for studies comparing validated symptom questionnaires with objective measures of female voiding dysfunction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.
Results
Of 1,183 records identified, four studies met inclusion criteria. Considerable heterogeneity existed in questionnaires, definitions and reference standards. The International Prostate Symptom Score voiding-to-storage ratio showed the strongest performance, with 92.9% sensitivity, 62.2% specificity and 97% negative predictive value at a cut-off >1.33. The International Prostate Symptom Score voiding subscore demonstrated 33.3% sensitivity and 78.8% specificity, while the Bristol Female Lower Urinary Tract Symptoms questionnaire demonstrated 45.5% sensitivity and 78.9% specificity. The Urinary Symptom Profile demonstrated 92% sensitivity and 71% specificity in a small multiple sclerosis cohort.
Conclusion
Symptom-based questionnaires have limited ability to diagnose objective female voiding dysfunction. The International Prostate Symptom Score voiding-to-storage ratio shows promise as a rule-out tool, but no questionnaire has sufficient accuracy to replace objective assessment. Prospective validation of female-specific prediction tools using standardised definitions is required.
A CASE-BASED PROSTATE MRI TRAINING COURSE TO IMPROVE PERFORMANCE OF CLINICIANS IN INTERPRETING PROSTATE MRI
Eugene Wang, Lyle Gurrin, Aqua Asif, Veeru Kasivisvanathan, Jeremy Grummet
Royal Melbourne Hospital
Aims:
Interpretation of prostate multiparametric magnetic resonance imaging (mpMRI) requires experience and is associated with a measurable learning curve. This study evaluates the effectiveness of an mpMRI training course in improving clinician accuracy in detecting prostate cancer on mpMRI.
Methodology:
MRI PRO is an online mpMRI training course comprising 300 practice cases depicting histologically verified clinically significant prostate cancer or benign findings. Learners select a Prostate Imaging-Reporting and Data System (PI-RADS) score for each case, which is dichotomised into positive (PI-RADS 3-5) or negative (PI-RADS 1-2), and compared against predetermined correct answers from expert radiologists verified with histopathology.
Generalised linear mixed models and receiver operating characteristic (ROC) curves were used to evaluate learner performance in correctly interpreting mpMRI cases over the duration of the course.
Results:
Performance of 679 learners was analysed. There was a 41% increase in odds of getting a case correct for every 100 cases completed (p<0.001). There was a 4% increase in odds of getting cases correct for each additional practice session completed on a separate day (p<0.001). Learners with higher levels of previous MRI experience had increased odds of getting cases correct, as did those from a radiology background.
In learners who completed the entire course (N = 123), area under the ROC curve increased from 0.812 (95% confidence interval [CI] 0.76-0.86) for the first tertile of attempted cases to 0.909 (95% CI 0.88-0.93) for the last tertile of attempted cases.
Conclusion:
A case-by-case and day-by-day increase in odds of correctly identifying positive and negative cases was observed, reflecting improvement in mpMRI interpretation skills during the course. This study supports wider adoption of case-based training courses to upskill clinicians in reading mpMRI.
ACCESS TO ROBOTIC-ASSISTED SURGERY IN REGIONAL AND RURAL AUSTRALIA – MAPPING THE DIVIDE
Eugene Wang, Ellen Kelsey, Jia Tian, Janelle Brennan
Bendigo Health
Aims:
Australians living in regional and rural areas face barriers to accessibility of health services and advanced health technology. This study analyses the geographic and sectoral allocation of robotic-assisted surgery (RAS) systems in Australia, evaluating implications for equitable access among metropolitan and regional/rural communities.
Methodology:
This cross-sectional ecological study identified all public and private hospitals with RAS systems approved by the Therapeutic Goods Administration as of June 2025. Rates of RAS availability per 100,000 population were calculated using data from the Australian Bureau of Statistics, stratified by state, health sector and rurality (defined using the Australian Statistical Geography Standard Remoteness Area (ASGS-RA) classification). Geospatial accessibility of RAS platforms across Australia was evaluated using a choropleth graph mapped to Australian Local Government Areas.
Results:
A total of 123 active RAS platforms were identified, with 89% located in metropolitan areas and 73% situated within private hospitals.
The prevalence of RAS devices was significantly greater in metropolitan regions (0.55 per 100,000 population) compared to regional or rural areas (0.19 per 100,000 population), representing a rate ratio of 0.34 (p < 0.001). No RAS installations were recorded in the Northern Territory, and both South Australia and Western Australia only had RAS platforms in metropolitan areas.
Private hospitals had over three times the number of RAS devices per capita as public hospitals (rate ratio = 3.33, p < 0.001).
Conclusion:
Disparities exist in RAS accessibility across geographical remoteness and health sectors in Australia. Improving access to robotic surgery will require targeted investment in public institutions and regional infrastructure, policy-driven equitable distribution of medical technology, and support for regional and rural surgical training pathways.
THE UTILISATION OF NEOADJUVANT THERAPY IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER IN A REGIONAL INSTITUTION
G Wei, S Norton, P Preece, K McLeod, R Grills
Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong
Introduction
The management of muscle-invasive bladder cancer (MIBC) is rapidly evolving with data supporting neoadjuvant chemotherapy (NAC) and, more recently, the addition of peri-operative immunotherapy. Currently, access to immunotherapy via the Pharmaceutical Benefits Scheme (PBS) is subject to the patient receiving platinum-based NAC, highlighting the importance in optimising NAC uptake. We aimed to audit the utilisation of NAC in patients undergoing radical cystectomy for MIBC in a regional centre.
Methods
All patients who underwent radical cystectomy for MIBC between November 2017 and August 2026 at a tertiary regional institution were retrospectively identified. Data obtained included patient age, renal function, histopathological data, ECOG status, Modified Monash Model (MMM) score, administration of NAC, follow-up duration, presence of metastases and cancer-specific mortality. Areas classified MMM≥2 were considered remote.
Results
37 patients were included in our study with a mean age of 68.4 years. 35 (94.6%) patients were discussed in a multidisciplinary meeting. 20 (54.1%) patients were eligible for NAC. Of these patients, 8/20 (40%) patients received NAC.
16 (43.2%) patients were from MMM1 areas with three of these patients (18.8%) receiving neoadjuvant therapy. 21 (56.8%) patients were from areas classified ≥MMM2 with five of these patients (23.8%) receiving neoadjuvant therapy.
Over a mean follow-up period of 27.4 months, 8 patients (21.6%) developed metastatic disease and 7 (19.0%) died from cancer-related causes.
Conclusion
In our cohort, geographical remoteness was not a factor influencing patients receiving NAC. The rate of NAC uptake at our institution was comparable to what has been reported in metropolitan Australian registry data. However, the majority of NAC eligible patients did not receive NAC, highlighting ongoing underutilisation of NAC. Further studies assessing barriers to NAC delivery are required in order to improve NAC uptake.
IS A GLEASON PATTERN 3 POSITIVE MARGIN TRULY “POSITIVE”? A SYSTEMATIC REVIEW AND META-ANALYSIS COMPARING OUTCOMES WITH NEGATIVE SURGICAL MARGINS
Xinyi Wei, Thomas Read, Yashvrdhan Khanna, James Huang, Nieroshan Rajarubendra, Kevin Chu, Munad Khan, Matthew Harper, Scott Donnellan, Weranja Ranasinghe
Monash Health
Introduction:
Positive surgical margins (PSM) post radical prostatectomy (RP) traditionally signify adverse oncological outcomes. However, specific margin characteristics, particularly the Gleason grade at the inked edge, alter prognosis. While Gleason pattern 3 (GP3) tumours have minimal metastatic potential, the prognostic behavior of an isolated GP3 PSM - whether it acts like a negative surgical margin (NSM) or a higher-grade margin remains ambiguous. We systematically reviewed and meta-analyzed the literature to determine the prognostic impact of GP3-only PSMs on biochemical recurrence (BCR) compared to NSMs, and secondarily quantified the BCR risk of higher-grade (GP4–5) versus GP3 margins.Methods:A PRISMA-compliant search across five databases (Embase, MEDLINE, Web of Science, Dimensions, Scopus) was conducted. Primary analysis targeted studies providing adjusted hazard ratios (HRs) comparing NSMs to strict GP3-only margins. Secondary analysis evaluated GP4-5 vs. GP3 margins. Adjusted log-HRs were pooled using random-effects models. Results: Seventeen retrospective studies comprising 23,352 patients met inclusion criteria. Comparing NSMs to GP3 margins, a meta-analysis of three studies found no significant difference in BCR risk for GP3-only margins vs NSMs after adjusting for primary tumour grade (pooled HR 1.11, 95% CI 0.81–1.51; I²=0%). Descriptive syntheses corroborated highly comparable 5- and 8-year BCR-free survival rates. Conversely, a meta-analysis of 12 studies revealed high-grade (GP4–5) disease at the margin confers a roughly two-fold increased BCR risk compared to GP3 margins (pooled HR 2.09, 95% CI 1.64–2.65; I²=55.6%).
Conclusions:
Isolated GP3 margins do not show an increased BCR risk compared to negative margins when adjusting for primary tumour grade, whereas GP4-5 margins significantly elevate recurrence risk. Therefore, isolated GP3 margins may permit safe active surveillance, while high-grade margins demand rigorous monitoring.
PROGNOSTIC VALUE OF QUANTITATIVE PATTERN 4 DISEASE BURDEN VS. ISUP GRADE GROUP IN RADICAL PROSTATECTOMY PATIENTS
Xinyi Wei 1, Cameron Powell 2, Jeremy Grummet 2,3
Faculty of Medicine, Nursing and Health Science, Monash University, Victoria, Australia
Urology Unit, Alfred Care Group, Bayside Health, Victoria, Australia
Department of Surgery, School of Translational Medicine, Monash University, Victoria, Australia
Alfred Hospital, Bayside Health
Background:
The ISUP Grade Group categorizes continuous biological variation into discrete tiers. This study evaluated if quantitative metrics assessing the volume of Gleason pattern 4 at prostate biopsy—specifically pattern 4 percentage (ratio of pattern 4 to total tumor), total length (cumulative mm across all cores), longest core length (maximum mm in a single targeted core), and core-adjusted length (length divided by total cores taken) provide independent prognostic value for biochemical recurrence (BCR) and adverse pathology beyond standard Grade Group in radical prostatectomy (RP) patients.Methods: We retrospectively analyzed 101 RP patients (2014–2024) at Alfred Hospital. Predictive performance for BCR and composite adverse pathology (extraprostatic extension, seminal vesicle invasion, node-positive disease, or positive margins) was assessed and compared using the area under the curve (AUC). Moreover, multivariable logistic regression- adjusting for total cores taken, preoperative PSA, and margin status was used to identify independent predictors.Results: For predicting BCR, biopsy pattern 4 percentage (AUC 0.746, p=0.0002), total length (AUC 0.728, p=0.005), and core-adjusted systematic length (AUC 0.719, p=0.034) outperformed Grade Group (AUC 0.649, p=0.010), with percentage showing significant superiority (AUC comparison p=0.032). For adverse pathology, total length (AUC 0.706, p=0.007) and core-adjusted systematic length (AUC 0.704, p=0.006) were the strongest predictors. In the multivariable analysis for BCR, total pattern 4 length (OR 2.011, p=0.014) and margin status (OR 3.826, p=0.017) remained independent predictors. Conclusions: Quantifying pattern 4 volume at prostate biopsy offers superior prognostic stratification over categorical Grade Grouping. Pattern 4 percentage best predicts BCR, while total and core-adjusted lengths best predict adverse pathology. Total length retains independent predictive value despite variations in core counts, supporting the integration of these volume metrics into routine reporting.
FEASIBILITY AND PRELIMINARY OUTCOMES OF IRREVERSIBLE ELECTROPORATION: A SINGLE SURGEON EXPERIENCE
Sarah Whitty, Mohammad Asghari Jafarabadi, Weranja Ranasinghe, Mark Frydenberg
Cabrini Health
Introduction
The Nanoknife uses irreversible electroporation (IRE) for focal therapy of intermediate risk prostate cancer to provide oncological benefit whilst limiting side effects. This study looks at the preliminary experience of 80 patients who have undergone Nanoknife treatment and aims to review the safety and feasibility or IRE implementation.
Materials and Methods
A total of 72 patients with organ-confined PCa ≤ T2c, prostate-specific antigens (PSAs) ≤ 15 ng/mL, and ISUP 2 or greater disease were eligible. Patient demographics, disease characteristics and adverse events were collected. Outcomes of interest included negative biopsy at twelve-months and adverse event occurrence and severity. Clinically significant PCa was defined as >5mm of Gleason 3+3 or any amount of Gleason 3+4 and greater.
Results
The mean (SD) age at IRE was 68.25 (8.07) years. PIRADS score distribution at baseline included 11 (15%) with PIRADS ≤3, 47 (65%) with PIRADS 4 and 14 (19%) with PIRADS 5. Gleason score distribution at baseline was 56 (73.7%) with 3+4 disease and 18 (23.7%) with 4+3 disease. At 12 months post IRE, 38 (53%) had a negative biopsy, 22 (31%) had infield disease and 12 (17%) had outfield disease. 20 (69%) of those with infield disease had significant cancer, compared with 1 (8%) of those with outfield disease. Mean pre-operative PSA was 5.82 ng/mL (95% CI 5.12–6.51) and declined markedly by 3 months to 2.76 ng/mL (95% CI 2.25–3.27) whilst remaining relatively stable thereafter. There were 4 (6%) patients who experienced adverse events, 3 (75%) were grade 2 and 1 (25%) grade 1. The majority of patients were suitable for active surveillance (AS) post operatively, 5 (13.9%) underwent repeat IRE and 4 (11.1%) had salvage robotic-assisted radical prostatectomy (RARP).
Conclusions
This preliminary study supports current findings on the safety and feasibility of Nanoknife treatment as a means for less invasive therapy for carefully selected individuals with intermediate risk prostate cancer. Final, long-term results are necessary to complete analysis.
RE-INDUCTION BCG VERSUS INDUCTION GEMCITABINE AND DOCETAXEL AFTER RECURRENCE FOLLOWING INITIAL BCG IN HG-NMIBC
Sarah Whitty, Janice Downie, Sarah Ransley, Jincy Kuriakose, Weranja Ranasinghe
Monash Health
Aims
To compare recurrence rates between patients who received re‐induction Bacillus Calmette‐Guérin (BCG) versus induction gemcitabine‐docetaxel (iGem/Doce) following failure of induction BCG for high‐grade (HG) non‐muscle invasive bladder cancer (NMIBC).
Methodology
A retrospective dataset was collected of patients with high-grade non-muscle invasive bladder cancer who received induction of BCG. Included patients were those who underwent either re-induction BCG or iGem/Doce for persistent HG NMIBC, between November 2021 and June 2026, when Gem/Doce was first available at this institution.
Results
237 patients received induction BCG, with 28 (12%) having persistent HG NMIBC necessitating further intra-vesical therapy. 16 (57%) received iGem/Doce and 12 (43%) received re-induction BCG. Of those that received iGem/Doce, three had CIS (19%), ten (62%) had HGTa and three (19%) had HGT1 disease. Comparatively, of those that had re-induction BCG, five (42%) had CIS, five had HGTa (42%) and two (16%) had HGT1 disease. Lower urinary tract symptoms (LUTS) were present in 12 (75%) patients in the iGem/Doce group, compared with 10 (83%) in the re-induction BCG group. Whilst all patients in the iGem/Doce cohort were able to complete 6 sessions of induction therapy, only 9 (75%) of the re-induction BCG group completed 6 sessions secondary to worsening LUTS and inability to retain therapy for sufficient time. On post therapy biopsy, within the iGem/Doce cohort, one (6%) patient had HGTa, two (13%) patients had LGTa and the remaining 13 (81%) were benign. In the re-induction BCG cohort only one (8%) patient had persistent LGTa disease, and one (8%) with HGT2 disease, the other 10 (84%) patients had benign biopsies. Each cohort had a single patient that developed metastatic disease and subsequently passed away from disease progression.
Conclusion
The initial experience with iGem/Doce suggests that it is better tolerated allowing for completion of induction therapy, with comparable recurrence rates compared to re‐induction BCG in patients with BCG‐failure NMIBC.
COMPARISON OF NURSE PRACTITIONER AND DOCTOR-PERFORMED TRANSPERINEAL PROSTATE BIOPSIES: FINAL RESULTS OF A CLINICAL AUDIT IN A REGIONAL PUBLIC HOSPITAL
Qianxi Wu, Janelle Brennan, Samantha Koschel, Dave Heath
Bendigo Health
Background
Rising PSA screening volumes have placed significant strain on healthcare systems to deliver prompt prostate biopsies, especially in regional areas where urologist access is constrained. Engaging nurse practitioners in transperineal biopsy procedures represents a potential solution to shorten waiting times for diagnosis.
Aim
This study seeks to evaluate whether nurse practitioner‑performed MRI‑targeted transperineal prostate biopsies achieve comparable diagnostic accuracy to those carried out by consultant urologists or registrars.
Methods
A retrospective analysis was performed on transperineal prostate biopsies at Bendigo Health from June 2024 to June 2025. A total of 287 cases were reviewed, comprising 180 performed by nurse practitioners (NP group) and 107 by urology registrars or consultants (Urologist group). Cognitive MRI targeting and a modified Barzell template were employed for all procedures. Target concordance was defined as concordance in laterality and anterior-posterior location, or the presence of cancer in targeted cores.
Results
Among those with PIRADS >2 lesions, the urologist and NP groups demonstrated comparable baseline characteristics including median age and prostate volume. The NP group detected Grade Group 4 cancer in 28% of cases versus 19% in the urologist group, and Grade Group 5 in 10% versus 7.5%. Combined GG4–5 disease was identified in 38% of NP cases compared to 26.5% of urologist cases. Positive core percentages were similar between groups (median 22.2% vs 23.3%). Target concordance was 89% for urologists and 83% for NPs.
Conclusion
Nurse practitioner-performed MRI-targeted transperineal prostate biopsies achieved a target concordance rate of 83%, compared to 89% for urologist-performed procedures. The overall detection rates and positive core percentages remained comparable. These findings suggest that trained nurse practitioners can effectively perform transperineal prostate biopsies in regional settings, offering a viable strategy to improve diagnostic access and reduce waiting times without compromising accuracy.
CRITICAL APPRAISAL OF THE PRIME TRIAL: BIPARAMETRIC VERSUS MULTIPARAMETRIC MRI FOR PROSTATE CANCER DIAGNOSIS
Jennifer Xu
Peninsula University Hospital
Introduction:
The use of magnetic resonance imaging (MRI) in diagnosing clinically significant prostate cancer (csPCa) has become the standard of care, although widespread adoption is limited by resource constraints. Biparametric MRI (bpMRI) omits the use of the gadolinium contrast sequence, and offers a shorter and cheaper alternative. The PRIME trial evaluated whether bpMRI is non-inferior to multiparametric MRI (mpMRI) for detecting csPCa. Given the potential practice-changing implications, a critical appraisal of this trial was undertaken.
Methods:
Critical appraisal was conducted using the Critical Appraisal Skills Programme checklist for diagnostic test studies. The study’s validity, methodology and clinical applicability were assessed.
Results:
PRIME was a prospective, international, multicentre, within-patient non-inferiority diagnostic trial with robust methodology and good external validity. The primary and secondary outcomes were proportion of men with csPCa and clinically insignificant PCa, respectively. bpMRI was non-inferior to mpMRI for detecting csPCa (143 of 490 men (29.2%) compared to 145 of 490 men (29.6%) (difference, -0.4 [95% CI, -1.2 to 0.4] percentage points; P = .50). BpMRI detected clinically insignificant cancer in 45 of 490 men (9.2%), compared with 47 of 490 men (9.6%) with the use of mpMRI (difference, -0.4 [95% CI, -1.2 to 0.4] percentage points). Diagnostic performance was comparable, with similar sensitivity, specificity and negative predictive value.
Conclusion:
PRIME provides high-quality evidence supporting bpMRI as an alternative to mpMRI for biopsy-naïve men being worked up for suspected prostate cancer. Omitting contrast-enhanced imaging may reduce scan time, costs and gadolinium exposure without compromising diagnostic accuracy, potentially improving MRI access. mpMRI remains important in selected clinical settings, including active surveillance, recurrent disease and complex staging.
FORMAL TRIAL OF VOID IS NOT NECESSARY POST RADICAL PROSTATECTOMY FOR MEN WITH PROSTATE CANCER
Jennifer Xu, Joseph Ischia, Dixon Woon, Damien Bolton, Peter Liodakis
Austin Health
Introduction
Urinary catheterization following radical prostatectomy (RP) is essential to protect the vesicourethral anastomosis and reduce urine extravasation with subsequent bladder neck contracture (BNC). At our institution, patients undergo a formal outpatient trial of void (TOV) POD7-14 to confirm adequate bladder emptying post catheter removal. This process can be resource-intensive and contributes substantially to outpatient workload. We evaluated TOV failure rates post RP to determine whether this pathway could be optimized.
Methods
We performed a retrospective review of all men undergoing RP for localized prostate cancer at Austin Health between January 2023 and June 2025. TOV failure was defined as same-day catheter reinsertion for acute urinary retention (AUR). Patient demographics, perioperative variables and post-operative outcomes were collected from electronic medical records. Categorical variables were reported as percentages and continuous variables as median (IQR). Ethics approval was obtained (HREC/112411/Austin-2024).
Results
A total of 206 patients were included. Median age was 63 years (IQR 58–67), median BMI was 27.7 kg/m² (IQR 25.1–30.9), and median time to TOV was 13 days (IQR 11–16). The same-day TOV failure rate was 0.5% (1/206). AUR within four weeks occurred in 1.9% of patients. Overall, 41% underwent TOV beyond the intended 7–14-day window, with 32% experiencing delays without a documented clinical indication. BNC developed in 5.3% of patients during a median follow-up of 137 days (IQR 64–350).
Conclusion
Same-day TOV failure following RP was exceedingly uncommon, suggesting that a formal outpatient TOV process may be unnecessary. Routine catheter removal with discharge and appropriate safety-net advice could reduce outpatient resource utilization, improve patient flow, and facilitate more timely catheter removal. Prospective studies incorporating cost-effectiveness analyses are warranted to validate these findings.
PERI-PROSTATIC CELLULAR ANGIOFIBROMA RESECTED VIA ROBOT-ASSISTED RADICAL PROSTATECTOMY
Yuming Zheng, Abdullah Al-Khanaty, Claire Abou-Seif, Declan Murphy
Peter MacCallum Cancer Centre
Aims:
To report a rare peri-prostatic cellular angiofibroma (CAF) mimicking a prostatic stromal tumour and highlight the diagnostic and management challenges associated with this uncommon benign mesenchymal neoplasm.
Methodology:
A retrospective case report was undertaken describing the presentation, investigation, operative management and histopathological findings of a patient with a large peri-prostatic mass.
Results:
A man in his 70s was incidentally found to have a large right pelvic mass. Multiparametric magnetic resonance imaging demonstrated a 92 × 70 × 36 mm well-circumscribed mass appearing to arise from the prostate. Core biopsy demonstrated a low-grade spindle cell proliferation, with prostatic stromal tumour of uncertain malignant potential and cellular angiofibroma (CAF) as the principal differential diagnoses. Following multidisciplinary review and shared decision-making, the patient underwent robot-assisted radical prostatectomy with excision of the mass. Histopathology demonstrated an 85 × 70 × 27 mm well-circumscribed spindle cell tumour arising within peri-prostatic soft tissue, separate from the prostate. Characteristic morphology and immunohistochemistry, including loss of RB1 expression, confirmed CAF. There was no evidence of prostatic malignancy.
Conclusion:
CAF should be considered in the differential diagnosis of a well-circumscribed spindle cell mass of apparent prostatic or peri-prostatic origin. Imaging and core biopsy may not reliably distinguish CAF from specialised prostatic stromal tumours. Definitive diagnosis may require integration of radiological, histopathological and immuno-histochemical findings from the resection specimen.
SAFETY AND EFFICACY OF EXTRACORPOREAL SHOCK WAVE THERAPY FOR THE MANAGEMENT OF CHRONIC PELVIC PAIN SYNDROME: A SYSTEMATIC REVIEW
Yuming Zheng, Philip Dundee, Paul Manohar, Sarah Sneddon, Paul Anderson
Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia,
Aim:
To summarize findings of clinical trials from the past 10 years regarding the safety and efficacy of extracorporeal shock wave therapy (ESWT) for the management of chronic pelvic pain syndrome (CPPS) in male patients, and highlight any current knowledge gap.
Methods:
We performed a systematic review (CRD420251164315) of MEDLINE and EMBASE, for clinical trials investigating ESWT in men with CPPS published between 2015 and October 2025. Main outcomes assessed were National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score and domains. Additional measures include visual analog scale (VAS); International Prostate Symptom Score (IPSS); International Index of Erectile Function (IIEF); UPOINT phenotype system.
Results:
Eleven studies were included. All demonstrated significant improvement in NIH-CPSI total and pain measures (NIH-CPSI pain domain and/or VAS) following ESWT, compared with baseline and/or control. Eight studies evaluated the NIH-CPSI quality-of-life domain, all reported significant improvement. Eleven studies evaluated urinary symptoms (NIH-CPSI urinary domain and/or IPSS), 9 reported significant improvement. No major adverse events occurred, minor events included 1 first-degree burn and 4 cases of transient haematuria and haematospermia.
Conclusion:
ESWT appears to be a safe and effective treatment for CPPS, improving pain and quality-of-life outcomes across trials. Larger randomised trials with longer follow-up are warranted to confirm findings and define optimal protocols.
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USANZ VSM Registration Team
Royal Australasian College of Surgeons
250-290 Spring Street, East Melbourne VIC 3002 Australia
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