Phil Dundee

• BSc MBBS FRACS
• Urological Surgeon at University of Melbourne

Objectives To evaluate the feasibility and safety of robotic‐assisted salvage radical cystectomy (RA‐SRC). Materials and Methods We retrospectively searched the prospectively collected surgical database of two highly experienced robotic urological surgeons for cases of RA‐SRC, defined as RARC performed post‐previous pelvic RT for palliative or onc...

Background and objective Although prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has impacted the investigation and management of biochemical recurrence (BCR) of prostate cancer, negative scans are common at low rising prostate-specific antigen (PSA) levels. PET/CT devices with an extended axial...

Introduction Radical prostatectomy (RP) remains a leading cause of erectile dysfunction (ED), primarily due to the inevitable damage to the cavernous nerves. Despite technical improvements in nerve-sparing surgery, post-prostatectomy rates of erectile dysfunction remain unacceptably high. Low-intensity electrostimulation (LIES) has been demonstrate...

Background: Multiparametric magnetic resonance imaging (mpMRI) is now the standard of care to guide prostate biopsies during workups and assessment of men with suspected prostate cancer (PCa). In addition to intraprostatic lesion detection, MRI usually covers the bony pelvis and pelvic lymph nodes, two of the commonest sites for metastatic disease....

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems. This Delphi consensus aimed to pr...

Simple Summary In this study, we investigated the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes in patients with prostate cancer. We found that the presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of po...

BACKGROUND The benefits of a robot-assisted radical cystectomy (RARC) compared to an open approach is still under debate. Initial data on RARC were from trials where urinary diversion was performed by an extracorporeal approach, which does not represent a completely minimally invasive procedure. There are now updated data for RARC with intracorpore...

Background The surgical difficulty of partial nephrectomy (PN) varies depending on the operative approach. Existing nephrometry classifications for assessment of surgical difficulty are not specific to the robotic approach. Objective To develop an international robotic-specific classification of renal masses for preoperative assessment of surgical...

Context Surgical outcomes and patient morbidity are often surrogate markers of health care quality and efficiency. These parameters can only be used with confidence if the reporting and grading of intra- and postoperative complications are reliable and reproducible. Without uniformity and regulation, the risk of under-reporting, and thus significan...

Background: The introduction of robotic surgical systems has significantly impacted urological surgery, arguably more so than other surgical disciplines. The focus of our study was length of hospital stay - patients have traditionally been discharged day 1 post-robot-assisted radical prostatectomy (RARP), however, during the ongoing COVID-19 pande...

Objective To conduct a systematic review of the literature to assess the diagnostic ability, complication rate, patient tolerability, and cost of local anaesthetic (LA) transperineal prostate biopsy. Methods Two reviewers searched Medline, the Cochrane Library, and Embase for publications on LA transperineal prostate biopsy up to March 2021. Outco...

We conducted a comprehensive review of surgical simulation models used in robotic surgery education. We present an assessment of the validity and cost-effectiveness of virtual and augmented reality simulation, animal, cadaver and synthetic organ models. Face, content, construct, concurrent and predictive validity criteria were applied to each simul...

Objectives: The aim of this study is to gain experienced nursing perspective on current and future complication reporting and grading in Urology, establish the CAMUS CCI and quality control the use of the Clavien-Dindo Classification (CDC) in nursing staff. Subjects and methods: The 12-part REDCap-based Delphi survey was developed in conjunction...

Background: The term local recurrence in prostate cancer is considered to mean persistent local disease in the prostatic bed, most commonly at the site of the vesicourethral anastomosis (VUA). Since the introduction of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging...

Background : Disease recurrence is common following prostatectomy in patients with localised prostate cancer with high-risk features. Although androgen deprivation therapy increases the rates of organ-confined disease and negative surgical margins, there is no significant benefit on disease recurrence. Multiple lines of evidence suggest that FGF/FG...

Objective This study examines the diagnostic accuracy of multi-parametric magnetic resonance imaging (mpMRI) in a high-volume centre to potentially stratify patients prior to prostate biopsy. Methods All biopsy naïve patients who had mpMRI prostate and transperineal biopsy of prostate (TPBx) in 2017 and 2018 were included. There were no exclusion...

Background Reproducible assessment of postoperative complications is essential for reliable evaluation of quality of care to enable comparison between healthcare centres and ensure transparent patient counselling. Currently, significant discrepancies exist in complication reporting and grading due to heterogeneous definitions and methodologies. Ob...

To enhance the clarity and quality of complication reporting and grading for clinicians and patients, the CAMUS-Collaboration aims to develop the following: (1) a data dictionary; (2) parameters required for reporting; (3) risk-based reporting; (4) nursing and patient opinions; and (5) prospective reporting and grading of short- and long-term compl...

Objectives: To compare data on transperineal template biopsy (TPTB) under general anesthesia (GA) compared with local anesthesia (LA) procedures using the PrecisionPoint™ Transperineal Access System (PPTAS) in relation to tolerability, cancer detection rate, complications, and cost. Methods: A prospective pilot cohort study of patients undergoin...

Background Prostate cancer is caused by genomic aberrations in normal epithelial cells, however clinical translation of findings from analyses of cancer cells alone has been very limited. A deeper understanding of the tumour microenvironment is needed to identify the key drivers of disease progression and reveal novel therapeutic opportunities. Re...

Objectives: To investigate the utility of Magnetic Resonance Imaging (MRI) for prostate cancer diagnosis in the Australian setting. Patients and methods: All consecutive men who underwent a prostate biopsy (transperineal or transrectal) at Royal Melbourne Hospital between July 2017 to June 2019 were included, totalling 332 patients. Data were re...

PURPOSE Androgen receptor (AR) signaling is important in prostate cancer progression, and therapies that target this pathway have been the mainstay of treatment for advanced disease for over 70 years. Tumors eventually progress despite castration through a number of well-characterized mechanisms; however, little is known about what determines the m...

Objective: To evaluate local clinical outcomes of sliding clip renorrhaphy, from inception to current utilization for open, laparoscopic, and robotically assisted partial nephrectomy. Methods: We reviewed prospectively maintained databases of three surgeons performing partial nephrectomies with the sliding-clip technique at teaching hospitals be...

Background Ductal adenocarcinoma is an uncommon prostate cancer variant. Previous studies suggest that ductal variant histology may be associated with worse clinical outcomes, but these are difficult to interpret. To address this, we performed an international, multi-institutional study to describe the characteristics of ductal adenocarcinoma, part...

Background Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians...

Objectives To describe the Agarwal loop‐ligation technique for the management of the distal ureter during laparoscopic radical nephroureterectomy (LRNU) for upper tract urothelial carcinoma (UTUC) and report on long‐term oncological outcomes. Patients and Methods In the Agarwal loop‐ligation technique, the distal ureteric stump is controlled using...

Background Active surveillance (AS) is a management option for men diagnosed with lower risk prostate cancer. There is wide variation in all aspects of AS internationally, from patient selection to investigations and follow-up intervals, and a lack of clear evidence on the optimal approach to AS. This study aimed to provide guidance for clinicians...

Prostate-specific membrane antigen (PSMA) PET/CT imaging is increasingly being utilised in clinical practice, demonstrating greater sensitivity in the detection of metastatic prostate cancer (mPC) compared to conventional imaging [1]. Prior studies have primarily focussed on its use following biochemical recurrence to detect oligometastatic disease...

Prostate cancer is caused by genomic aberrations in normal epithelial cells, however clinical translation of findings from analyses of cancer cells alone has been very limited. A deeper understanding of the tumour microenvironment is needed to identify the key drivers of disease progression and reveal novel therapeutic opportunities. In this study,...

Background Introduction of checkpoint inhibitors (anti PD-1/PD-L1) have resulted in improved survival for bladder cancer patients, however, only a subset will benefit. The utility of PD-L1 expression as a prognostic or predictive biomarker is limited, motivating the search for more robust biomarkers. Here, we examined the prognostic value of densit...

Objectives: To assess the performance of Ga-PSMA PET for positive lymph nodes on imaging after curatively intended radical prostatectomy. Patients and methods: Seventeen patients with biochemical recurrence after radical prostatectomy undergoing robot assisted salvage lymphadenectomy for positive lymph nodes on imaging were included in this sing...

Background: The aim of this study was to describe our initial Australian single surgeon experience with robotic-assisted radical cystectomy (RARC) and intracorporeal urinary diversion (ICUD) and to compare the outcomes with open radical cystectomy (ORC). Methods: Between January 2014 and June 2016, consecutive patients diagnosed with muscle inva...

Background: To perform a systematic examination of the available evidence identifying factors that predict the detection of occult nodal metastatic disease at the time of radical cystectomy in patients with urothelial cancer of the bladder (BCa). Methods: A systematic literature search of the Pubmed database was performed in August 2015 using me...

Objectives: TO DESCRIBE THE PROGRESS IN TRAINING FOR MINIMAL INVASIVE SURGERY (MIS) IN UROLOGY: METHODS: A group of experts in the field provided input to come to recommendations for MIS training. A literature search was done on MIS training in general and specific for urological procedures. Results: A literature search showed the rapidly develo...

Multidisciplinary care should serve to improve communication between specialists and ensure that prostate cancer patients receive optimal care based on best practice and evidence-based guidelines. Here, the authors describe the implementation of this model in a prostate cancer-specific clinic in Australia.

Objectives: To describe the progress in training for minimally invasive surgical (MIS) options in urology Methods: A group of experts in the field provided input to define the recommendations for MIS training. A literature search was carried out on MIS training in general and for urological procedures specifically. Results: A literature search show...

71 Background: Androgen receptor splice variants (ARvs) are upregulated in response to castration, and can activate transcription in the absence of ligand. Recent evidence indicates that CTC ARv7 expression is an accurate predictor of absence of response to abiraterone and enzalutamide, providing strong clinical support for ARv7 upregulation as pot...

Introduction Renal angiomyolipoma (AML) is a benign mesenchymal tumour of the kidney with a tendency of aneurysm formation at risk of rupturing. Due to increased maternal circulation and hormonal influences, rupture risk is greater in pregnancy, often leading to a vascular emergency and premature delivery or termination. Presentation of case A 24-...

There is growing interest in the use of trans-perineal template biopsy for the diagnosis of prostate cancer. This is principally due to the reduced sepsis rate and improved diagnostic accuracy when compared with transrectal prostate biopsy. However, the need for a brachytherapy stepper and template are limiting factors. Here we discuss trans-perine...

Culture is performed in patients presenting with symptoms of urinary tract infection in order to confirm diagnosis, identify the infecting organism(s), and determine antibiotic sensitivities. There are two ways in which urine is cultured: split agar, which is the most commonly employed method, and dipslide, which is a cheaper and simpler alternativ...

Vulvar hematomas occur rarely outside the obstetric population but may present after other trauma to the pelvis or perineum. Spontaneous rupture of the internal iliac artery is described mostly in the presence of an aneurysm, with atherosclerosis, connective tissue disease, infection, and trauma as causative factors. It most often presents with abd...

Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the investigation and management of pancreaticobiliary disease. There is a recognized potential for significant morbidity, and a number of studies have identified patient and operator risk factors for the development of complications, including small case volume. We...

Noncontrast spiral CT (NCCT) has emerged as the investigation of choice in patients presenting with renal-tract calculi. As management guidelines are based on stone size measured on plain radiography of the kidneys, ureters, and bladder (KUB), it is important to assess the accuracy of stone size measured on NCCT compared with KUB films. The NCCT an...

Paragangliomas are rare tumours of the autonomic nervous system that occur in both sporadic and hereditary forms. They are usually benign tumours with low mortality, but can cause significant morbidity related to mass effect. Genetic predisposition to develop paraganglioma can occur within known tumour syndromes and familial tumours tend to present...

Erdheim-Chester Disease (ECD) is a non-inherited multifocal lipid storing histiocytosis. It is a rare disease characterised by lipid-laden monocyte infiltration of long bones causing cortical sclerosis and characteristic X-ray appearances. It also involves extraskeletal tissue in up to 50% of cases including retroperitoneal and renal infiltration....