Background and purpose Prostate cancer (PCa) is the second most common cancer in men, and the sixth leading cause of cancer death among men worldwide (1). Radical Prostatectomy (RP) is widely considered a gold standard treatment for clinically significant localized PCa. Robotic assisted laparoscopic radical prostatectomy (RALP) represents a modern minimally invasive technique for performing a RP. The aim of the study is to demonstrate a progression in the learning curve of two South Africa based urologists, as each embarks on their first series of RALP cases between September 2014 to July 2019. An audit of peri-operative outcomes for each surgeon's first uninterrupted series of RALP's has been undertaken. We also compare our results to international series to assess if local South African outcomes are similar to these. Materials and Methods We performed a retrospective audit of all patients who had a RALP with our two urologists between the dates of September 2014 to May 2019. Patients were only excluded if critical data could not be collected. For each included patient we collected peri-operative data. Pre-operative data collected was required for risk stratification grouping of patients according the D'Amico Risk group classification. Post-operative data included operative details (such as console time and blood loos), functional outcomes (such as potency and continence rates), and pathological outcomes (such a T-staging and positive surgical margin rates). The total number of patients for each of the two surgeons have been divided into a series of consecutive groups. The first 100 have been divided into groups of 25, and the subsequent patients into groups of 50. Results/main findings Our two surgeons have been designated Surgeon-X and Surgeon-Y. A total of 700 patients met our inclusion criteria, 400 and 300 cases for Surgeons-X and -Y respectively. Our study demonstrates that in a South Africa setting, for the parameters of median console time (CT), estimated blood loss (EBL), length of hospital stay (LOS), and positive surgical margins (PSM), there were notable improvements between the first and last groups of each surgeon's series. Although each parameter tends to fluctuate around a median value, there is a general trend towards improved outcomes. For the parameters of post-operative continence and potency our study failed to show a statistically significant improvement in outcomes between the first and last groups in each surgeon's series. Conclusions This study demonstrates that, similar to internationally published data, notable improvements in perioperative outcomes can be observed as each of our two surgeons gain experience in this relatively new operative approach to managing men with localized prostate cancer. The overall picture is one of improved outcomes with each consecutive group analysed and that when individually assessed, these outcomes display differing rates of improvement depending on which is being assessed. When analysing our outcomes of CT, EBL, PSM rate and LOS, we see that our results compare favourably to other internationally published data. For all intents and purposes our learning curve and peri-operative results are on par with our overseas counterparts and in some cases bette

Includes abstract. / Includes bibliographical references. / Prostate cancer is the most common male malignancy amongst black males in South Africa and the second commonest amongst white males (1,2). Prostate biopsy, via the rectum, is an essential part of diagnosing and treating this disease. Traditionally needle biopsies of the prostate were performed blindly by digital palpation of the gland per rectum.

The aim of this project is to study the clinical and pathological features of prostate cancer in men from different racial groups in the Western Cape in an attempt to define the characteristics of the disease locally. Specifically we wanted to compare black with coloured and white patients.

Includes bibliographical references. / To evaluate small intestinal submucosa (SurgiSIS) as a substitute for skin in endoscopic urethroplasty performed as treatment for inflammatory and iatrogenic stricutres of the male bulbar urethra and in the early treatment of bulbumembranous urethral injuries associated with recent pelvic fractures. The tissue integration and epithelialisation of surgiSIS used in endoscopic urethroplasty is assessed. The long term maintenance of urethral patency following this treatment from is assessed.

Includes bibliographical references / Objective: Radical cystectomy with extended lymphadenectomy and urinary diversion remains the standard of care for muscle-invasive urothelial carcinoma. Our centre (Groote Schuur Hospital) has been performing laparoscopic radical cystectomies since 2009. We aimed to audit our data regarding complications and oncological outcome and compare it to data obtained from patients undergoing open radical cystectomy by the same surgeon since 2007. The two procedures will be compared in terms of operative duration, intra-operative blood loss, peri-operative blood transfusion requirements, post-operative complications (using the Clavien Classification) and differences in pre- vs. post-operative staging. Patients and Methods: All adult patients (>18 years) that underwent open and laparoscopic radical cystectomy from 2007 to 2013 have been included in the study. Data on demographics, operative time, intra-operative blood loss, post-operative complications (as per Clavien-Dindo Classification), margin positivity, and lymph nodes (number obtained and number of positive nodes) was obtained retrospectively by means of folder review. Extracted data was collected on a Microsoft Excel spreadsheet. Only folders with complete data sets were included f or statistical analysis. Patients undergoing laparoscopic radical cystectomy converted to open were analysed on an intention-to-treat basis. Data was analysed using bivariate statistics and survival analysis was performed to compare mortality rate. Results: Physician's choice of surgical modality was associated with clinical disease staging with 59% of participants who underwent ORC presented with a palpable mass on examination under anaesthesia (EUA) compared to 36% of participants in the LRC arm. This association was confirmed on pathological staging. Participants undergoing ORC experienced shorter operative duration (301 minutes versus 382 minutes; p-value < 0.0001), increased blood loss (1376ml versus 778 ml; p-value = 0.00 2 3) and transfusion requirement (2 units versus 0; p-value = 0.071) in contrast to LRC. Post-operative complications were more prevalent in the ORC arm compared to the LRC arm (61% versus 43%) and this trend was reflected in the Clavien classification. The only complication that differed in its occurrence between the two arms was wound complications (18% for LRC versus 44% for ORC) with the main type being sepsis. Patients with a past medical history were at higher risk of experiencing post-operative complications (p-value = 0.04; Risk Ratio: 1.6). Margin positivity was comparable between the two arms. A trend was observed when comparing the number of lymph nodes sampled using the two techniques and this trend was maintained irrespective of the area sampled, whereby a higher number of nodes was sampled by the laparoscopic technique in this study (overall p-value = 0.07 ). Conclusion: Laparoscopic radical cystectomy is associated with longer operative times, decreased blood loss, and equivalent oncological outcomes when compared to open radical cystectomy. Laparoscopic RC is a feasible option in our setting. LRC affords patients a lower risk of requiring transfusion, with minimal risk of post-operative ileus and a lower risk of wound complications. Given the increasing number of laparoscopic procedures being performed at GSH, a prospective trial would be possible in order to confirm these findings.

To date there is little data on conservative management of penetrating renal trauma. The aim of this study was to review the management and outcome of a large patient cohort presenting with penetrating renal trauma to a tertiary referral centre in South Africa. All patients presenting with penetrating abdominal trauma and haematuria admitted to the Trauma Centre at Groote Schuur Hospital over a 19-month period was prospectively evaluated. Patients demographics, mechanism of injury, microscopic versus macroscopic haematuria, grade of injury, management decision (non-operative, laparotomy for other reasons without renal exploration or true renal surgery with Gerotas fascia opened), nonsurgical success rate, complications, hospital stay, transfusion requirements and nephrectomy rate were analysed.

Includes bibliographical references (leaves 54-59). / The objective of the thesis was to look at the epidemiology of patients needing this procedure, clinical presentation and investigation, pathology, complications related to the procedure, adjuvant and neoadjuvant treatment, and survival.

Includes bibliographical references. / To assess the association between ethnicity and grade of prostatic adenocarcinoma, prostatespecific antigen (PSA) and age, and to determine whether Africans of African descent (AAD) have higher grade cancers than other ethnic groups.

Aim: The primary aim of this study was to describe and compare the kidney stone composition of kidney stone patients receiving treatment at the Korle-Bu Teaching Hospital (KBTH), Accra (Ghana) and Groote Schuur Hospital (GSH), Cape Town (South Africa). Methods: The study was a retrospective folder review of patients treated for kidney stone disease at the Korle-Bu Teaching Hospital in Accra (Ghana) and Groote Schuur Hospital in Cape Town (South Africa). Patients who were treated for kidney stone disease between 1st June 2016 and 31st May 2018 were recruited and their folder numbers were retrieved from theatre log books. A total of hundred and sixty-three (n=163) folders (n=30 KBTH; n=133 GSH) were subsequently retrieved from the records department of the two facilities. Demographic data and kidney stone analysis results were extracted and analyzed using the R statistical software. Results: The age of participants at the KBTH ranged from 24 to 75 years with a median age of 45 years, while the ages of participants at the GSH ranged between 19 to 77 years with a median age of 48 years. Males were the majority stone formers for both hospitals [56.7% KBTH; 59.4% GSH]. However, there was no significant statistical difference in gender (p=0.9447) and age (p=0.2612) between the two groups. Calcium oxalate (86.7%) and uric acid (90.0%) were the commonest components of the kidney stones analyzed from the KBTH. Calcium oxalate (66.2%) and carbonate apatite (40.6%) emerged as the most common components of the stones analyzed from the GSH. Brushite (3.0%), cystine (3.8%) and struvite (19.6%) stones were only found in the stones of participants receiving treatment at the GSH. All kidney stones from the KBTH were mixed; made up of at least two chemical components. Pure kidney stones were only found among the GSH dataset constituting 48.9% of all the stones analyzed. While all KBTH stones were mixed stones, female patients from GSH formed more mixed stones than their male counterparts (M:F = 40.5%:66.67%). Infection kidney stones (struvite and carbonate apatite) were also predominantly found among female stone formers in this study. Conclusion: The findings indicate that the participants from the two facilities are not different in terms of gender and age. However, the composition of stones was found to be different between participants from both hospitals. This suggests that that kidney stone composition may be influenced by patients’ geographical location and/or cultural background. Further studies with prospective or longitudinal data and larger samples are needed to provide more insight into the composition of kidney stones of African patients.

Background and purpose Malignant conditions of the pelvis and/or abdomen can cause ureteric obstruction and associated impaired renal function, which can be managed by performing percutaneous nephrostomy (PCN) tube insertion. Nephrostomy tubes are associated with prolonged hospital stay which affects quality of life. The main objective of this study was to assess the changes in estimated glomerular filtration rate (eGFR) over the first six months following percutaneous nephrostomy for malignant ureteric obstruction. We also explored the role of UTIs in the changes of eGFR following PCN. Materials and Methods We performed a retrospective folder review of patients who had PCN procedures at Groote Schuur Hospital for malignant obstructive uropathy from January 2015 to 31 December 2017. For each included patient, eGFR was recorded at baseline pre-PCN, and at its best and worst value in the first six months after PCN. The timing of baseline, best and worst values were also recorded. Other data collected included demographic data, type of malignancy, laterality of nephrostomy and presence of confirmed UTI at least one week post PCN. Results/main findings A total of 90 patients fulfilled our inclusion criteria. The most common cancers in men were bladder 59% (n=32), prostate 20% (n=11), lymphoma 7% (n=4), and colorectal 4% (n=2). The most common cancers in women were cervix 64% (n=23), bladder 19% (n=7), lymphoma 6% (n=2), colorectal 6% (n=2) and endometrial 6% (n=2). Men were of higher age, median (IQR), 60 (56, 67) years, compared to women, 48 (40, 67). 64% of patients (n=58) had bilateral PCN procedures (as opposed to a unilateral procedure). 52% (n=47) of patients developed at least one episode of UTI post PCN during the six-month observation period. Median (IQR) timepoint of pre-PCN eGFR measurement was 1.0 (2.0, 0) day pre PCN. The best post-PCN eGFR measurement was 13.0 (6.0, 26.0) days post PCN. The worst post-PCN measurement was 33.5 (14.0, 92.5) days post PCN. Pre-PCN eGFR, median (IQR), was 9 (5, 26). Post-PCN eGFR improved to 48 (30, 75) before deteriorating to 23 (9, 44) within the six-month follow-up window. Compared to patients who do not develop UTI post-PCN, those who develop one or more post-PCN UTI(s) have a 6.15 (95% CI: 0.87, 11.43) unit lower eGFR at their worst eGFR measurement. There are also markedly fewer deteriorations in chronic kidney disease (CKD) stages between best and worst post-PCN interval in those without UTI (42%, 18/43), compared to those with at least one post-PCN UTI (72%, 34/47). Conclusions Our study confirmed a similar renal function trend post-PCN for malignant ureteric obstruction across different demographics. It is clear that although most patients’ renal function initially improve post-PCN, the general trend for the majority of patients is to deteriorate towards pre-PCN eGFR and CKD stage values. Our data suggest that urinary tract infections play an important role in poor renal function response within six months post-PCN. Future studies should explore whether the development of UTI following PCN is an independent and modifiable risk factor for poor renal outcome.