541 Pre-Operative Assessment of Patients Undergoing Elective TURBT or Rigid Cystoscopy + Bladder Biopsy: Is a Group & Save Clinically Required?

Aim

Method

Results

Conclusions

1202 Urinary Continence and Oncological Outcomes in Robotic-Assisted Radical Prostatectomy Patients According to Nerve Spare Technique

Aim

To assess the effects of nerve sparing (NS) on recovery of urinary continence, oncological outcome, and positive surgical margin (PSM) rates in patients undergoing robotic-assisted radical prostatectomy (RARP).

Method

Retrospective analysis of patients who underwent RARP between January-December 2017 at a single high- volume centre was undertaken. Urinary continence and symptoms according to different NS types (Non-NS, Unilateral, Bilateral) at 2, 6, 12, and 24 months were collated. COX proportional hazards model and Kaplan-Meier were used to correlate NS type with achievement of a dry-state; pad-free state; and oncological outcome defined by biochemical (PSA) recurrence (BCR), over 2 years follow-up. PSM occurrence was compared in non-nerve spared versus nerve spared prostate lobes.

Results

241 patients underwent full analysis, Non-NS = 30 (12%), Unilateral = 84 (35%), Bilateral = 127 (53%). Comparing each NS cohort, there was no significant difference in the Mean (±SD) number of pads used per day, or rates-of-dryness at all time points during follow-up. Both COX-regression and Kaplan-Meier analyses found no significant association between any NS-type and biochemical recurrence or final achievement of continence. There was no significant risk association between NS-type and PSM rate, or significant difference in the rate of PSM between lobes that were nerve spared or not.

Conclusions

The degree of nerve sparing does not appear to enhance post-RARP continence recovery and is not associated with worse oncological outcomes, studied as positive surgical margin rates and biochemical recurrence at all time points up to 2 years of follow-up.

681 How Much Can Medical Students Benefit from A Student-Led Surgical Mentorship Scheme?

Introduction

Mentorship programmes enable students to explore different specialties, observe surgeries and participate in audits, whilst helping trainees develop leadership and teaching skills. We developed such a scheme and asked participants to fill out several questionnaires, to assess its benefits and restrictions.

Method

We set up a student-led mentorship scheme, pairing 54 medical students with surgeons around London. Students completed questionnaires before, during and after the scheme and mentors completed a post-mentorship scheme feedback questionnaire, with the purpose of measuring the participants’ experience on Likert scales from 1 to 5. Quantitative data analysis was performed to assess trends.

Results

In the cohort of students who answered all three questionnaires (n = 34) the biggest improvements seen over the duration of the scheme were ‘exposure to surgery so far in medical school’ and ‘understanding the steps required to improve a surgical portfolio’, with mean values increasing by 1.653 and 1.733, respectively. The main challenges faced were mainly related to time restraints and communication issues.

Conclusions

Mentors and mentees can both benefit from a mentorship scheme, but certain variables, such as time constraints and goal-setting, need to be clearly established for both parties. In the future, the scheme would benefit from more guidance and stricter ruling.

Hyperamylasaemia and ischaemic colitis

INTRODUCTION

Ischaemic colitis is a differential diagnosis to be considered in patients who have a high cardiovascular risk. Presentation of severe ischaemia is usually that of an acute abdomen with passage of fresh blood per rectum, and hyperamylasaemia.

PRESENTATION OF CASE

A 66-year-old gentleman was admitted to A&E with a short history of central abdominal pain, nausea, vomiting and fresh bleeding per rectum. A diagnosis of ischaemic colitis was made by the computed tomography (CT) scan findings of colonic thickening and pneumatosis, in addition to colonoscopy demonstrating sloughy mucosa and ulceration. Symptoms did not resolve with conservative management, therefore laparotomy + Hartmann's procedure was performed. Histology showed extensive areas of both partial and full thickness ischaemia with stricture.

DISCUSSION

Amylase is an indicator of intra-abdominal inflammatory processes. Hyperamylasaemia (normal <100 U/l) is most frequently associated with pancreatitis; however, causation is not exclusive and other differentials including bowel ischaemia must be considered, although amylase is not a specific marker for ischaemic colitis. It is important to distinguish between ischaemic and ulcerative colitis.

CONCLUSION

Intestinal ischaemia is a serious acute abdominal pathology that is associated with hyperamylasaemia, and frequently requires prompt surgical intervention to prevent subsequent mortality.