Andrew J. Davidiuk

Robotic-assisted Bladder Diverticulectomy: Assessment of Outcomes and Modifications of Technique.

OBJECTIVE To present outcomes of robotic-assisted bladder diverticulectomy (RABD) and technique modifications that may improve outcomes. METHODS Sixteen consecutive RABDs were performed at our institution by 2 experienced robotic surgeons. Charts were reviewed for patient characteristics, perioperative data, and long-term functional outcomes. Eleven patients (69%) underwent RABD using an external dissection approach, whereas 5 patients (31%) underwent RABD using a modified internal dissection technique (immediate entry into the bladder diverticulum). RESULTS The mean age of our cohort was 68 years (range, 59-79 years), and 15 of 16 patients (93.8%) were men. Two patients (12.5%) had known malignancy in the diverticulum. Eleven patients (69%) underwent a preoperative outlet procedure (9 transurethral resection of prostate and 2 transurethral incision of prostate) at a median time before RABD of 163.5 days (range, 26-622 days). Median operative time for external RABD was 228 minutes (range, 144-353 minutes) compared with that of 149 minutes (range, 130-189 minutes) for the internal dissection technique. No patient required blood transfusions, and there were no 30-day Clavien grade 3 or 4 complications. Median hospital stay was 2 days (range, 1-3 days). Median postvoid residual before intervention was 458 mL (range, 78-1100 mL) compared with that of 214 mL (range, 46-527 mL) after RABD. Mean American Urological Association symptom score was 18 (range, 5-29) preoperatively compared with that of 7 (range, 2-21) postoperatively. CONCLUSION RABD is safe with a low risk of intraoperative or postoperative complications and results in both improved voiding symptoms and diminished postvoid residuals. Modifications of technique from an external dissection approach to an internal dissection approach has led to a dramatic reduction in operative time.

Mayo Adhesive Probability Score Is Associated With Localized Renal Cell Carcinoma Progression-free Survival

OBJECTIVE To assess the association of the Mayo Adhesive Probability (MAP) score and progression-free survival (PFS) in patients with renal cell carcinoma (RCC). The MAP score is derived from cross-sectional imaging measurements of perinephric fat thickness and stranding. MATERIALS AND METHODS We identified 456 patients from a prospective registry who were treated surgically for localized RCC between 2002 and 2014. One reviewer calculated a preoperative MAP score (0-5) for each patient. Kaplan-Meier curves were utilized to estimate PFS. Cox proportional hazard models were used to estimate the association of MAP score with risk of progression univariately and after adjusting for covariates such as age, body mass index (BMI), and size, stage, grade, necrosis scores. RESULTS Patients with higher MAP scores (4-5) were more likely to be male, to be older, to have higher BMI, and to have larger tumors (all P <.01). Of our total cohort, 405 patients had MAP scores and follow-up data to assess PFS. Dichotomizing MAP scores into high (MAP 4-5) and low (MAP 0-3) yields a hazard ratio of 2.16 for the 4-5 group vs 0-3 (95% confidence interval: 1.15-4.06, P = .017). Adjustment for BMI did not alter the association (BMI-adjusted hazard ratio [HR] = 2.20 [1.07-4.52], P = .032). Of interest, the association with MAP and PFS remains for pT1 RCC patients (n = 287, HR = 3.46 [1.06-11.24], P = .039). CONCLUSION High MAP scores (4-5) are associated with decreased PFS in patients surgically treated for clinically localized RCC compared with patients with lower MAP scores (0-3). RCC aggressiveness may be associated with perinephric fat thickness and stranding.

Salvage autologous fascial sling after failed synthetic midurethral sling: Greater than 3-year outcomes.

To determine long‐term surgical outcomes of salvage autologous fascial sling placement after a failed synthetic midurethral sling.

Adult-onset hypogonadism: evaluation and role of testosterone replacement therapy

Testosterone deficiency (TD) has become a growing concern in the field of men’s sexual health, with an increasing number of men presenting for evaluation of this condition. Given the increasing demand for testosterone replacement therapy (TRT), a panel of experts met in August of 2015 to discuss the treatment of men who present for evaluation in the setting of low or normal gonadotropin levels and the associated signs and symptoms of hypogonadism. This constellation of factors can be associated with elements of both primary and secondary hypogonadism. Because this syndrome commonly occurs in men who are middle-aged and older, it was termed adult-onset hypogonadism (AOH). AOH can be defined by the following elements: low levels of testosterone, associated signs and symptoms of hypogonadism, and low or normal gonadotropin levels. Although there are significant benefits of TRT for patients with AOH, candidates also need to understand the potential risks. Patients undergoing TRT will need to be monitored regularly because there are potential complications that can develop with long-term use. This review is aimed at providing a deeper understanding of AOH, discussing the benefits and risks of TRT, and outlining each modality of TRT in use for AOH.

MP81-10 LONG-TERM RESULTS OF SALVAGE AUTOLOGOUS FASCIAL SLING PLACEMENT FOLLOWING FAILED SYNTHETIC MIDURETHRAL SLING FOR STRESS URINARY INCONTINENCE IN WOMEN

Value 41 to 50 15.7 (54) > 50 30.9 (106) Annual # of Revisions Performed for Obstructive Complications [% (n)]: 0 26.2 (90) 1 to 5 63.8 (219) 6 to 10 6.1 (21) 11 to 15 1.5 (5) 16 to 20 1.2 (4) > 20 1.2 (4) Annual # of Revisions Performed for Other Complications [% (n)]: 0 22.7 (78) 1 to 5 64.7 (222) 6 to 10 9 (31) 11 to 20 2 (7) > 20 1.5 (5) Note: * indicates respondents were asked to choose all that apply.