Casey Kowalik

The advance transobturator male sling for post-prostatectomy incontinence: subjective and objective outcomes with 3 years follow up.

To determine patient‐perceived and clinical outcomes of the AdVance sling at 3 years follow‐up in men with post‐prostatectomy incontinence (PPI).

Intermediate Outcomes After Female Urethral Reconstruction: Graft vs Flap

OBJECTIVE To evaluate the outcomes of women after urethral reconstruction with a vaginal flap urethroplasty (VFU) or dorsal buccal mucosal graft (BMG). METHODS We retrospectively identified 10 women undergoing urethral reconstruction between February 2007 and October 2012. All patients had evidence of urethral stricture on cystoscopy and/or urodynamic study indicating bladder outlet obstruction. Recurrent stricture was defined using the same criteria. Follow-up included urethral calibration (>16F), symptom assessment, voiding cystourethrogram, and cystoscopy when there was difficulty voiding or symptoms recurred. RESULTS Mean age was 49 years (range, 32-74). The indication for urethral reconstruction was urethral stricture in 9 patients. One woman had a traumatic 2-cm ventral urethral laceration associated with a pelvic fracture. Location was mid in 6 and distal in 4 women. Average stricture length was 1.25 cm (range, 0.2-2). All patients with urethral stricture had previously undergone multiple urethral dilations. There were no major postoperative complications. Two patients undergoing VFU had a recurrent stricture requiring dilation. No patients undergoing dorsal BMG had a recurrent stricture. CONCLUSION Female urethral reconstruction, either VFU or dorsal BMG, is a safe and successful procedure that should be offered to women with urethral strictures. The dorsal BMG approach is well tolerated and results are promising, but longer-term follow-up is needed. Women should be offered urethral reconstruction as a definitive management option rather than repeated urethral dilations.

Profiling microRNA from nephrectomy and biopsy specimens: predictors of progression and survival in clear cell renal cell carcinoma

To identify microRNA (miRNA) characteristic of metastatic clear cell renal cell carcinoma (ccRCC) and those indicative of cancer‐specific survival (CSS) in nephrectomy and biopsy specimens. We also sought to determine if a miRNA panel could differentiate benign from ccRCC tissue.

PD39-05 FACTORS OTHER THAN URGENCY, FREQUENCY AND INCONTINENCE CONTRIBUTING TO PERCEPTION OF CONDITION SEVERITY IN OVERACTIVE BLADDER

demographics, bladder diaries, subjective response rates, ICIQ-OAB and PGI-I scores were recorded. Success was defined as greater than 50% symptom improvement in urgency, urge incontinence, and a greater than 50% improvement in voided volume or reduction of postvoid residual volumes. RESULTS: Twenty patients underwent stage 1 trial of SNM. Average age was 68.5 years, IQR (54.25 -76.25). 13 (65%) patients were female. 13/20 (65%) of patients had a response to the detrusor overactivity component. 10/20 (50%) of patients showed an improvement in the voiding component. 9/20 (45%) of patients showed responses to both components. 6/20 (30%) patients had no response whatsoever. Overall, 12/20 (60%) patients proceeded to insertion of an IPG. At follow up of 17 months, IQR (1.5 e 35), 11/12 (91.7%) of patients were still using the SNM device, median PGI score was 2, IQR (2 e 4). In addition, SNM resulted in statistically significant improvement in voided volume (p1⁄40.016), PVR (p1⁄40.0296), ICIQ-OAB score (p<0.0001) and ICIQ-OAB bother score (p1⁄40.016). CONCLUSIONS: SNM is a potential treatment option for DHIC with an acceptable success rate, treating both the detrusor hyperactivity, and impaired contractility components of this condition.

126 UNDERUTILIZATION OF IMMEDIATE ADJUVANT INTRAVESICAL CHEMOTHERAPY FOLLOWING TURBT: RESULTS FROM THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP)

INTRODUCTION AND OBJECTIVES: A single peri-operative dose of intravesical chemotherapy (IVC) following transurethral resection of bladder tumors (TURBT) for non-muscle invasive bladder cancer has demonstrated a reduction in recurrence and is recommended by both the American Urological Association and European Association of Urology. A previous study of nationwide claims data from 1997-2004 identified only 0.33% of patients received same day IVC following TURBT. In this study, we investigate whether IVC following TURBT continues to be underutilized. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) user files, a national prospective outcomes-based database designed to measure surgical quality of care, we identified patients undergoing TURBT for small, medium, and large bladder tumors by Current Procedural Terminology (CPT) codes 52234, 52235, and 52240, respectively. We then crossreferenced this group for the CPT code 51720 to identify patients receiving concurrent intravesical therapy. Operative time, length of hospital stay, and perioperative complications were evaluated. RESULTS: From January 1 to December 31, 2010, 1,782 patients underwent TURBT. The median age was 73 years and 74% (n 1326) were male. Based on CPT code, there were 668 (37%) small, 650 (36%) medium, and 464 (26%) large tumors treated. The majority of patients had general anesthesia (84%) and were treated as outpatients (81%). Of all 1,782 patients, only 36 (2%) received concurrent IVC. There was no difference in average operative times (36.8 v. 33.3 mins, p 0.584) or average length of hospital stay (1.5 v 0.3 days, p 0.538) in patients receiving perioperative IVC. In the group not receiving IVC, there were 64 (3.75%) urinary tract infections, 37 (2.1%) incidences of bleeding requiring transfusion, and 10 (0.5%) patients with sepsis or septic shock. There were no reported peri-operative complications in the IVC cohort. CONCLUSIONS: Only 2% of patients received concurrent IVC with TURBT. No added morbidity was observed for patients receiving IVC, although patient selection could account for low perioperative complications in this group. We also acknowledge other limitations of this data set since timing of IVC following TURBT and details regarding specific tumor characteristics and any prior TURBT procedures are not available. In addition, IVC may have been administered and not billed. Despite current recommendations, peri-operative intravesical chemotherapy following TURBT remains underutilized.

Minimally Invasive Partial Nephrectomy and Ablative Procedures for Small Renal Masses

Partial nephrectomy is the standard technique for treatment of small renal masses (SRMs) ≤4 cm (Guideline for management of the clinical stage 1 renal mass. American Urological Association Research and Education; 2009). Minimally invasive (laparoscopic and robotic assisted) partial nephrectomy (MIPN) is gaining momentum. Studies have demonstrated similar oncologic and functional outcomes between open and MIPN (Lane BR, Gill IS. 7-Year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol. Elsevier Inc. 2010; 183(2):473–9.). The clinical benefits of laparoscopy in renal surgery, including shorter hospital time, faster convalescence, and reduced narcotic pain medication requirements postoperatively, make MIPN an attractive option in patients with SRMs (Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, et al. Laparoscopic versus open radical nephrectomy: a 9-year experience. J Urol. 2000; 164(4):1153–9, Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr., et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007; 178(1):41–6). In this chapter, we describe the techniques for laparoscopic partial nephrectomy (LPN) and robotic-assisted laparoscopic partial nephrectomy (RALPN) and postoperative management and provide an overview of intra- and postoperative complications. A contemporary review of minimally invasive ablative therapies, including cryoablation and radiofrequency ablation, is also presented.