Dmitriy Nikolavsky

Stem cell therapy for stress urinary incontinence.

The rhabdosphincter at the mid urethra is critical for maintaining urinary continence. In a setting of stress urinary incontinence stem cells transplanted into the site of the rhabdosphincter may augment sphincter regeneration and also release trophic factors promoting muscle and nerve integration of this muscle. We hereby review the use of cellular therapy for SUI and our experience with the development of muscle‐derived stem cells (MDSCs). Neurourol. Urodynam. 29:S36–S41, 2010.

Cellular Therapy for Treatment of Stress Urinary Incontinence

A critical mechanism to maintain urinary continence in women and men is the striated muscle sphincter (rhabdosphincter) that forms a ring around the mid urethra. Cellular therapy and the use of stem cells transplanted into the site of the rhabdosphincter in a setting of stress urinary incontinence may augment sphincter regeneration. Implanted cells may also release trophic factors promoting muscle and nerve integration into this muscle. We hereby review the use of cellular therapy for SUI and our experience with the development of muscle-derived stem cells.

Comparison of patients undergoing a two-stage sacral nerve stimulation procedure: is there a cost benefit for a single-stage procedure?

AimsSacral neurostimulation (SNS) involves a two-stage procedure to assess outcomes prior to permanent implantation. Stage 1 involves placement of a sacral lead that is externalized and tested for 2xa0weeks. Stage 2 is the implantation of a pulse generator in responders (≥50% improved). This study’s purpose was to determine the overall response rate, costs of a two-staged versus single-stage approach, and explore predictors of a positive response.MethodsA prospective database of 145 patients undergoing SNS was analyzed. Demographics, history, and operative data were collected from the medical records. Cost data were collected from our institutions’ reported average reimbursement for all stages of Interstim implantation and explantation in 2008. Wilcoxon rank test were used for analysis.ResultsOf 145 patients, 131 (90.3%) progressed to Stage 2 and 14 (9.7%) had removal. Explanted patients were older (mean 63xa0years) than implanted patients (56xa0years); however, this was not statistically significant. Total Medicare and Blue Cross/Blue Shield (BCBS) reimbursement for a two-stage procedure was calculated at

Impact of Short-Stay Urethroplasty on Health-Related Quality of Life and Patient’s Perception of Timing of Discharge

21,428/case and

PD34-03 POST-TURP URETHRAL STRICTURES CAN BE MANAGED SUCCESSFULLY WITH URETHROPLASTY

26,968. Implanting the lead and generator as a single-stage would cost Medicare and BCBS

V12-01 TRANSURETHRAL VENTRAL BUCCAL MUCOSA GRAFT (BMG) INLAY URETHROPLASTY FOR DISTAL URETHRAL STRICTURES

20,696 and

URINE LEVELS OF SELECTED CHEMOKINES POSITIVELY CORRELATE WITH LOWER BLADDER CAPACITY AND PSYCHOMETRIC SCORES IN IC/PBS PATIENTS

21,602, respectively. Since 9.7% were explanted, overall cost saving might be significant: a single-stage approach would yield savings of

MP25-06 PRESENTING SYMPTOMS TO A RECONSTRUCTIVE UROLOGIST AFTER FEMALE TO MALE GENITAL RECONSTRUCTIVE SURGERY

3,655/case (BC/BS) over a two-stage approach (after the cost of explantation is factored in).ConclusionsThe majority of patients tested with SNS would benefit from a single-stage procedure (90.3%). This would reduce operative and anesthesia risks, time lost from work, and burden on patients and providers.

PD21-05 ANDROGEN RECEPTOR EXPRESSION IN LICHEN SCLEROSUS URETHRAL STRICTURE DISEASE

Objective. To evaluate health-related quality of life in patients after a short-stay or outpatient urethroplasty. Methods. Over a 2-year period a validated health-related quality-of-life questionnaire, EuroQol (EQ-5D), was administered to all patients after urethroplasty. Postoperatively patients were offered to be sent home immediately or to stay overnight. Within 24 hours after discharge they were assessed for mobility, self-care, usual activities, pain or discomfort, and anxiety and depression. An additional question assessing timing of discharge was added to the survey. Clinical and operative characteristics were examined. Results. Forty-eight patients after anterior urethroplasty completed the survey. Mean age and mean stricture length were 51.6 years (21–78) and 60u2009mm (5–200u2009mm), respectively. Most etiologies were idiopathic (50% n = 24), trauma (19%, n = 9), and iatrogenic (19%, n = 9). Forty-one patients (85%) stayed overnight, while 7 patients (15%) chose to be discharged the same day. Overall, ninety-six percent were discharged within 23 hours of surgery. In the short-stay and the outpatient cohorts, 90% and 86%, respectively, felt they were discharged on time. No patient reported a severe problem with postoperative pain or mobility. Conclusions. The majority of patients discharged soon after their procedure felt that discharge timing was appropriate and their health-related quality of life was only minimally affected.

PD21-02 INITIAL MULTI-INSTITUTIONAL EXPERIENCE OF INCISIONLESS BUCCAL MUCOSA GRAFT INLAY FOR DISTAL URETHRAL STRICTURES

INTRODUCTION AND OBJECTIVES: Anastomotic urethroplasty is an effective but occasionally controversial treatment for short bulbar urethral strictures. Non-transecting variations of anastomotic urethroplasty were created in part to address this controversy. The objective of this study is to assess current outcomes of anastomotic urethroplasty and compare outcomes of transecting and non-transecting techniques. METHODS: 171 patients with complete follow-up underwent anastomotic bulbar urethroplasty from September 2003 to May 2016. Patient age, stricture length, location, etiology, 90-day complications and semi-quantitative assessment of sexual dysfunction were recorded. The primary (objective) outcome was success defined as urethral patency >16Fr on routine follow-up cystoscopy. Secondary outcome measures included 90-day complications (Clavien 2) and de novo sexual dysfunction assessed at 6 months. Statistical comparison between transecting and non-transecting cohorts was made using Cox Regression Analysis and Chi-square when appropriate. RESULTS: One hundred and thirty patients underwent transecting anastomotic urethroplasty while 41 had a non-transecting anastomotic urethroplasty. Mean stricture length was 1.5 0.5cm (range 1-3) with a mean patient age of 43.0 18.0 years. 78.9% of patients failed prior endoscopic treatment (135/171) and 2.4% failed prior urethroplasty (4). Overall there was a 98.2% (168/171) success rate with a mean follow-up of 74.9( 46.7) months. 7.0% (12/171) of patients experienced a 90-day postoperative complication of Clavien 2 including 2.9% wound-related complications (5), 1.8% scrotal hematomas (3), 1.8% UTI (3), and 0.6% urethral bleeding (1). 9.9% reported an adverse change in sexual function including 6.4% erectile dysfunction (11), 1.8% ejaculatory dysfunction (3), 1.2% painful erection (2), and 0.6% chordee (1). When comparing transecting and non-transecting technique success using Cox Regression analysis there was no difference in urethroplasty success (97.7% vs. 100%; p1⁄40.63) and no difference in postoperative complications (7.7% vs. 4.9%; p1⁄40.73) but patients undergoing transecting anastomotic urethroplasty were more likely to report an adverse change in sexual function (13.1%; vs. 0%; p1⁄40.013). CONCLUSIONS: Anastomotic urethroplasty remains a highly effective treatment for short-segment bulbar urethral strictures with relatively minimal associated morbidity. Newer non-transecting anastomotic urethroplasty techniques appear to compare favorably in the short-term and may reduce the risk of associated sexual dysfunction.