Daniel Elliott

MP46-05 PREDICTING URETHRAL ATROPHY IN PATIENTS UNDERGOING PRIMARY PLACEMENT OF ARTIFICIAL URINARY SPHINCTER

INTRODUCTION AND OBJECTIVES: Long-term data on effects of testosterone therapy (TTh) on urinary function in hypogonadal men published so far are from observational studies without a control group. We present registry data including an untreated hypogonadal control group. METHODS: Registry study in 656 men with testosterone 350 ng/dL and hypogonadal symptoms. 360 received TU 1000 mg/12 weeks following an initial 6-week interval (T-group). 296 men opted against TTh and served as controls (CTRL). 8-year data are presented. Changes over time between groups were compared by a mixed effects model for repeated measures with a random effect for intercept and fixed effects for time, group and their interaction. Changes were adjusted for age, weight, waist circumference, blood pressure, fasting glucose, lipids and quality of life to account for baseline differences between groups. In order to further validate results, propensity matching was performed for baseline age, BMI, and waist circumference. 82 men in each group fulfilled criteria. RESULTS: Total group: mean age was 57.4 7.3 years in the T-group and 64.8 4.3 in CTRL, median follow-up time 7 years for both. In the T-group, IPSS decreased from 6.4 4.0 to 2.1 1.0 with a change from baseline of 5.0 points. In CTRL, IPSS increased from 4.5 2.0 to 6.5 2.6 after 8 years by 1.8 points (p<0.0001 for both). Residual urine volume decreased from 47.3 22.8 to 13.7 4.6 mL in the T-group and increased from 48.3 16.3 to 64.5 22.2 in CTRL. Prostate volume increased from 29.2 10.4 to 31.1 11.5 mL in the T-group (p<0.0001) and fell from 34.5 5.9 to 33.5 12.0 in CTRL (NS). Propensity-matched group: mean age was 61.7 5.1 years in the T-group and 61.6 2.9 in CTRL, median follow-up time 8 years in the T-group and 7 in CTRL. In the T-group, IPSS decreased from 7.4 4.2 to 2.0 0.9 with a change from baseline of 5.4 points. In CTRL, IPSS increased from 4.3 2.3 to 7.0 2.6 after 8 years by 1.9 points (p<0.0001 for both). Residual urine volume decreased from 50.6 23.6 to 14.0 4.7 mL in the T-group and increased from 45.7 16.4 to 64.6 16.7 in CTRL. Prostate volume increased from 31.4 12.0 to 33.2 12.7 mL in the T-group (p<0.0001) and from 33.4 6.2 to 33.6 11.0 in CTRL (NS). CONCLUSIONS: Urinary function is improved and preserved for a prolonged period of time by TTh in hypogonadal men and deteriorates in untreated hypogonadal men. The observed changes seem independent of prostate volume.

MP63-08 CAN URODYNAMIC PARAMETERS PREDICT SLING REVISION FOR VOIDING DYSFUNCTION IN WOMEN UNDERGOING SYNTHETIC MIDURETHRAL SLING PLACEMENT?

INTRODUCTION AND OBJECTIVES: Human detrusor smooth muscle (DSM) can exhibit low amplitude rhythmic contractions (LARC) which may contribute to overactive bladder (OAB) in some patients. The aim of this study was to develop an objective method to identify LARC during urodynamics (UD), categorize patients with significant LARC, and potentially begin to characterize a LARC-mediated OAB/detrusor overactivity subtype. METHODS: An algorithm was developed to analyze UD filling data in low volume (1st 410 seconds) and high volume (final 410s) regions. Fast Fourier Transform (FFT) analysis identified the frequency (F) in the 1-6 cycle/min range associated with the maximum amplitude of the vesical pressure (Pves) in each region (Fig 1). A patient-specific range of interest corresponding to F 0.5 cycles/min was determined. Pves and Pabd amplitudes were analyzed separately to identify both significant (higher than average) and independent (distinct from Pabd) Pves signals. To be significant, Pves amplitude must be > 1.35 standard deviations (SD) above average Pves amplitude. To be independent, the Pabd amplitude must be < 1.35 SD above the average Pabd amplitude. SD of 1.35 was chosen using an iterative process in 0.05 SD increments to identify the maximum number of significant and independent signals. RESULTS: This algorithm was used to retrospectively analyze 43 consecutive UD studies which included 25 (14 neurogenic, 11 idiopathic) with detrusor overactivity (58%). The average age of the entire group was 55 2 years and included 14 men and 29 women. FFT analysis identified a significant and independent Pves signal in 12/43 patients (28%) of which 8/12 (67%, 5 neurogenic, 3 idiopathic) had detrusor overactivity. The average age of patients with significant and independent signals was 54 5 years and included 6 men and 6 women. CONCLUSIONS: Analysis of LARC during UD testing identified a subset of patients with a significant and independent slow wave frequency in Pves. Further refinements of this technique may help identify subsets of individuals with LARC-mediated OAB/detrusor overactivity.

MP46-11 CAN TIME TO FAILURE PREDICT ARTIFICIAL URINARY SPHINCTER COMPONENT FAILURE?

INTRODUCTION AND OBJECTIVES: Artificial urinary sphincter (AUS) malfunctions can occur in any of the individual components. Preoperative identification of the malfunctioned component may be valuable for preoperative counseling and determining surgical approach. As such, we sought to evaluate the relationship of time to failure with failed component. METHODS: A total of 1,082 male patients underwent primary AUS placement from 1983 to 2011 at our institution. Clinical variables were evaluated for association with component failure (urethral cuff, abdominal reservoir, scrotal pump, and tubing). Bootstrap was used to estimate the differences in the time to reach 1% failure for each pair of components. RESULTS: One hundred and fifteen patients experienced mechanical device malfunction at a median follow-up of 4.2 years (IQR, 0.8, 7.9). There were no differences in clinical variables between patients with and without device failure. Cuff, reservoir, pump and tubing malfunction occurred in 53 (4.9%), 26 (2.4%), 11 (1.0%), and 25 (2.3%) patients, respectively. Increasing age at time of primary surgery was associated with lower rates of cuff malfunction (HR 0.968, 95%CI 0.938-0.999, p1⁄40.04). There was no evidence that clinical variables were associated with reservoir, pump or tubing failure. Likewise, there was no evidence proving a significant difference in time to 1% component failure between any pairwise comparisons of components. However, 3 years postoperatively, incidence of cuff failure appears to outpace other component failures (Figure 1) but further analyses would be required to confirm this trend. CONCLUSIONS: Clinical predictors for AUS failure continue to be difficult to establish. There was no evidence proving differences in time to 1% component failure. Source of Funding: none