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Objectives To describe the burden and trend of prostate cancer (CaP) in the Caribbean island of Barbados. Methods All urologic pathology reports in Barbados between 1990 and 2009 were entered into the Barbados Urologic Diseases Survey (BUDS) database. All new cases of CaP were identified and the database was used to assess trends in CaP epidemiology over the study period. Results 3066 new cases of CaP were identified between 1990 and 2009. The world age-standardized rate increased steadily from 71.8 (95% CI 57.8–88.4) per 100 000 in 1990 to 112.4 (95% CI 94.0–133.7) per 100,000 in 2009, with a peak rate of 148.9 (95% CI 127.0–172.8) in 2004. The cumulative risk up to 74 years of age also increased from 11.1% in 1990 to 23.8% in 2009 with a peak of 29.9% in 2004. The mean age at diagnosis decreased from 73.1 years in 1990 to a nadir of 66.2 years in 2009. The rate of high-grade cancer (Gleason score ≥8) and intermediate-grade cancer (Gleason score = 7) at presentation rose between 2000 and 2009 while the rate of low-grade cancer (Gleason score ≤6) decreased. Conclusions Barbados suffers an unusually high burden of CaP with a trend towards more aggressive disease over the last decade. The results are important as they highlight the utility of the BUDS initiative in epidemiologic evaluation, but should be looked at cautiously due to a lack of specific details regarding screening practices in this population.

A 21-year-old male with a history of Down's syndrome presented with hematuria and right flank pain. Computed Tomography (CT) of the abdomen/pelvis revealed right hydronephrosis and a right-sided pelvic vascular abnormality. Angiography revealed an arteriovenous malformation (AVM) fed by the right superior and inferior vesical arteries and nephrostogram showed a long segment of obstructed distal right ureter. Cystoscopy revealed erythema and edema of the right hemi-bladder and biopsy diagnosed polypoid cystitis. Treatment was performed by transarterial embolization with ethylene vinyl alcohol copolymer. Follow up cystoscopy and retrograde pyelography at 3 months post-procedure showed resolution of all visible pathology.

Minimally invasive surgical techniques have revolutionized the surgical management of kidney cancer. Current evidence suggests that the surgical developments gained by traditional laparoscopy have been advanced by the robotic platform, particularly as it has been applied to techniques for nephron preservation.The medical literature from peer-reviewed journals was reviewed to evaluate the feasibility and efficacy of robotic-assisted surgery in the management of renal cell carcinoma. Particular attention was paid to studies comparing robotic-assisted surgery with more traditional surgical techniques. In this review, we have highlighted the evolution of robotic assistance for renal surgery as it pertains to renal oncology. The differing approaches to standard surgeries are discussed as well as current trends to improve perioperative outcomes.In addition, we have reviewed the application of robotic assistance to more complex cases and highlight technological advancements that have pushed the boundaries of surgical care.Robotic-assisted renal surgery is effective for appropriately selected patients. Robotic-assisted radical nephrectomy provides equivalent outcomes to traditional open and laparoscopic approaches, albeit with added financial burden. Robotic-assisted partial nephrectomy - through either transperitoneal or retroperitoneal access - can provide superior outcomes to laparoscopic approaches due to several technical advantages,including improved instrument articulation.Robotic assistance has transformed the delivery of surgical care to the patient with renal cell carcinoma. For renal surgery, morbidity and patient satisfaction are potentially improved when using robotic platforms compared with open and traditional laparoscopic approaches without compromising oncological control, and this is particularly true for nephron-sparing surgery.

Nephron-sparing surgery is the accepted standard of care for the small renal mass, and minimally invasive techniques have increasingly gained recognition. Robotic-assisted transperitoneal partial nephrectomy (RATPN) has been well described but there are few reports assessing the retroperitoneal approach. Therefore, we present our initial experience with robotic-assisted retroperitoneal partial nephrectomy (RARPN). We identified 14 patients from a single-surgeon IRB-approved database who underwent RARPN for suspected renal cell carcinoma. Our results showed a mean pathologic tumor size of 2.6 cm (SD = 0.9) and a median R.E.N.A.L. nephrometry score of 8. Mean estimated blood loss was 178 cc (SD = 182) and mean warm ischemia time was 28.9 min (SD = 8.9). There were no intra-operative or post-operative complications and mean length of stay was 2.9 days (SD = 1.6). At an average of 4-month follow-up, the mean decrease in renal function was 7.3 %. RARPN is an effective alternative to RATPN and can be safely and successfully applied to selected patients with tumors amenable to nephron preservation.

Introduction To describe the technique of injecting Lipiodol in the submucosa of the urinary bladder wall as a novel modality to improve localization of muscle-invasive bladder tumors before image-guided radiation therapy. Technical Considerations Eight patients underwent submucosal Lipiodol injections at transurethral bladder tumor reresection. A rigid cystoscope with a working port was used to inject Lipiodol into bladder submucosa circumferentially around the tumor bed (2-3 mm from margin of resection). Approximately 20-30 injections were used to demarcate the tumor bed for external beam radiation therapy, which was used as part of a bladder-sparing approach. All patients were diagnosed with clinically localized, high-grade, muscle-invasive carcinoma and were deemed nonsurgical candidates or were unwilling to undergo radical cystectomy. Five of the 8 patients received radiation at our institution. Lipiodol injections (95%) were visible on treatment planning computed tomographic scans and kilovoltage portal images throughout the 7-week course of image-guided radiation therapy. In 2 of 5 patients, the tumor bed based on Lipiodol extended outside a planning target volume that would have been treated with radiation therapy based on cystoscopy reports and computed tomographic scans without Lipiodol. There were no adverse events or treatment-related toxicities secondary to Lipiodol injection. Conclusion Intravesical Lipiodol injection is an easy-to-perform technique that is safe and effective. Lipiodol serves as a fiducial marker that improves tumor bed localization for radiation therapy, thereby reducing the likelihood of missing the tumor.

337 Background: Bladder sparing trimodality therapy consisting of maximal TURBT, radiation, and chemotherapy offers a feasible and effective option to patients with muscle invasive bladder cancer that are unwilling to undergo cystectomy. The shape and position of the bladder change significantly during radiation therapy, and it is possible to miss the tumor bed when a radiation boost is delivered to only part of the bladder. This study describes the technique of injecting ethiodized oil in the submucosa of the urinary bladder wall as a novel modality to improve localization of muscle invasive bladder tumors prior to image-guided radiation therapy (IGRT). Methods: Eight patients underwent submucosal ethiodized oil injections at the time of transurethral bladder tumor re-resection. A rigid cystoscope with a working port was used to inject ethiodized oil into bladder submucosa circumferentially around the tumor bed (2-3 mm from margin of resection). Roughly 20-30 injections were used to demarcate the tumor bed for external beam radiation therapy, which was used as part of a bladder sparing approach. All patients were diagnosed with clinically localized, high-grade, muscle invasive carcinoma and were deemed nonsurgical candidates or were unwilling to undergo radical cystectomy. Results: 5 of the 8 patients underwent IGRT at our institution. 95% of ethiodized oil injections were visible on treatment planning CT scans and kV portal images throughout the 7-week course of IGRT. In 2 of 5 patients, the tumor bed based upon ethiodized oil extended outside a planning target volume that would have been treated with radiation therapy based upon cystoscopy reports and computed tomography scans without ethiodized oil. There were no adverse events or treatment-related toxicities secondary to ethiodized oil injection. Conclusions: Intravesical ethiodized oil injection is an easy-to-perform technique that is safe and effective. Ethiodized oil serves as a fiducial marker that improves tumor bed localization for radiation therapy, thereby reducing the likelihood of missing the tumor.

Cellular angiofibromas (CAF) are rare, benign soft-tissue tumours. The diagnosis of CAF is important given the heavy resemblance to other tumors. Herein, we describe the case of a rapidly growing, very large (13.5 cm) CAF located in the deep pelvis of a middle-aged male who presented with difficulty voiding.