Objective Testosterone replacement is generally considered likely to be required only at testicular radiation doses in excess of 20Gy. Long‐term data are not available for patients receiving 9‐14.4Gy as part of Total Body Irradiation in childhood. Design Retrospective cohort study. Data collection: notes review, laboratory results, prescription of testosterone. Patients Forty‐two of 96 boys who received Total Body Irradiation (9‐14.4Gy) and Haematopoietic Stem Cell Transplantation for childhood leukaemia at Great Ormond Street Hospital between 1981‐2011 and survived >5 years. Measurements The serum concentrations of testosterone and gonadotrophins and the prescription of testosterone were recorded. Results Of the 42 boys included, 37 (88%) entered puberty spontaneously and 5 required induction. Median length of follow‐up was 19.4 years (range 5‐33.1). At last follow‐up, 23 of the 37 (62%) with spontaneous puberty were receiving testosterone replacement and 4 of the 5 (80%) with induced puberty. Conclusion This study with the benefit of long follow‐up indicates that Leydig cell failure occurs with radiation doses <20Gy. It may occur many years after irradiation and mandates long‐term screening for hypogonadism.

ObjectivesTo report the United Kingdom's largest single centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure -adjacent frozen-section (NeuroSAFE) technique. We describe its' efficacy on histopathological and functional outcomes, to aid units in their early stages of adoption of this technique. Patients & methodsWe prospectively collected data from November 2012 -December 2019 on 520 patients who underwent RALP with NeuroSAFE at our Institution. Exclusion criteria was pre-operative indication to perform an extra-fascial nerve spare or wide local excision prostatectomy, including salvage RALP. Our Institution's database was analysed for false positive frozen section (FS) margins as confirmed on paraffin histopathological analysis; console and FS report time; functional outcomes of potency, continence, surgical margins and biochemical recurrence (BCR). ResultsThe median (range) of operative console time of our NeuroSAFE RALPs was 145 (90-300) minutes.The mean time of FS processing to report was 35 minutes. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of cases (147/160). The neurovascular bundles (NVBs) that underwent secondary resection, contained tumour in 26.8% (43/160) of cases. 77.5% T2, 22.3% T3 cancer was found on final prostate specimen analysis.Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. Bilateral nerve spare (NS) RALP was statistically significant for potency, over wide excision from positive FS. There was insufficient evidence of statistically significant association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. ConclusionOur mid to long term results of NeuroSAFE RALP describes acceptable functional outcomes. NeuroSAFE enables intra operative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by wide resection of the NVB. This spared 1 in 4 men from positive margins posterolaterally in our series. No other technique has been validated to offer intraoperative feedback on the oncologic safety of NS RALP. Limitations are absence of a matched cohort of NS RALP without NeuroSAFE in our centre; three surgeons and three Uro-pathologists performing this technique; and the absence of centralised cancer database to capture all outcomes.

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