Jay B. Hollander

Fate of Patients Started on Clean Intermittent Self-Catheterization Therapy 10 Years Ago

We evaluated 60 patients placed on a clean intermittent catheterization program more than 10 years ago to determine their outcome. To date 27 patients still are performing self-catheterization, 18 have discontinued the procedure and 15 have been lost to followup. No patient has had deterioration in renal function. Prior incontinence was alleviated completely in 10 of the 27 patients still on the program and 10 of the 18 patients no longer on catheterization have returned to normal voiding. Clean intermittent catheterization is an effective treatment modality in properly selected patients, with few complications and excellent long-term results.

Bladder Neck Obstruction in Women: A Real Entity

Bladder neck obstruction in women is rare. Recently, we encountered 3 cases with similar findings. Clinically, the patients had chronic bladder symptoms of obstruction and irritation. The bladder showed trabeculation, diverticula and/or vesicoureteral reflux. Urinary flow rates were poor or absent. Endoscopy was unreliable in evaluating the outlet. The voiding pressure-flow cystourethrography study established the diagnosis. Specific operations to relieve bladder neck obstruction may be justified with proper urodynamic documentation.

PROSTATISM: Benign Prostatic Hyperplasia

This article is devoted to the most common cause of outlet obstruction in the male geriatric population, benign prostate hyperplasia (BPH). The prevalence, pathophysiology, and natural history of BPH is discussed, along with the work-up and indications for medical or surgical intervention. The authors also focus on medical and surgical options now available for management of BPH.

SUCCESS WITH PENILE PROSTHESIS FROM PATIENT'S VIEWPOINT

This study is designed to explore the patients point of view on success with penile prosthesis. Detailed questionnaires were sent to 57 penile prosthesis recipients, 38 of whom responded. Overall, 89 per cent claimed improved sexual satisfaction, and 76 per cent noted improved self-image with their prostheses. Seventy-six per cent claimed their partners approved of the prosthetic device. Prosthetic appearance was satisfactory to 87 per cent. Five patients, knowing what they now know, would not have had the prosthetic implantation. A significant factor in 4 of the 5 patients was lack of partner approval. We conclude penile prosthesis implantation is successful in returning satisfactory sexual intercourse to impotent men and their partners. Partners of those desiring penile prosthesis should be included in the preoperative evaluation process.

Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

Introduction. To explore the long term incidence and predictors of incisional hernia in patients that had RARP. Methods. All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair. Results. Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams; P = 0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480); P = 0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias. Conclusion. Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

Scrotal Fat Necrosis

A case of scrotal fat necrosis is presented. The clinical presentation usually is characteristic and the condition can be managed nonoperatively.

TRIAMTERENE BLADDER CALCULUS

A case report of triamterene bladder calculus is presented. Triamterene containing antihypertensives should be used with caution in patients with predisposition to form stones.

PD58-02 A QUALITY IMPROVEMENT FOLEY PROJECT TO REDUCE CATHETER RELATED TRAUMA IN A LARGE COMMUNITY HOSPITAL

Log-rank comparisons showed improved recurrence-free and overall survival in NAC-responsive vs. high-risk NMIBC patients (p<0.02 and p<0.02) but not in non-NAC-responsive vs. high-risk NMIBC patients (p1⁄40.34 and p1⁄40.43). In Cox regression, tumor 2 cm was independently associated with increased risk of cancer recurrence (HR1⁄42.31, p1⁄40.02) and overall mortality (HR1⁄42.10, p1⁄40.02) CONCLUSIONS: Patients with NAC-responsive MIBC had better post-surgical outcomes than patients with high-risk NMIBC. Highrisk NMIBC patients had a higher prevalence of tumor 2 cm, which was an independant predictor of cancer recurrence. Despite being node negative, almost a quarter of recurrences in patients with high-risk NMIBC occurred distantly. Further work is needed to identify whether patients with unresectable or high volume NMIBC could benefit from NAC.

MP76-09 FACTORS ASSOCIATED WITH POOR RETURN OF URINARY FUNCTION AFTER ROBOTIC ASSISTED RADICAL PROSTATECTOMY: EVALUATION OF EXPANDED PROSTATE CANCER INDEX COMPOSITE (EPIC) SCORES

awakening response (CAR) and baseline salivary cortisol samples were obtained in all participants prior to TSST and at defined intervals postTSST. Paired T-Tests were used to compare baseline cortisol (obtained 15minutesbeforeTSST) to stress responsecortisol (obtained50minutes after TSST) in OAB patients and controls. RESULTS: Eight patients with OAB and 5 controls completed the performance task and provided all requested salivary samples. No difference in CAR was detected between OAB women and controls. A trend toward greater physiologic responsiveness in women with OAB compared to controls was noted (Figure 1, p1⁄40.066). CONCLUSIONS: Women with OAB have similar baseline physiologic measures of stress response to controls. Women with OAB may have greater physiologic responsiveness to stress as measured by salivary cortisol following TSST. Evaluation of markers of stress response may provide targets for potential diagnostic and therapeutic interventions.

438 CAN WE PREDICT WHICH PATIENTS URINARY SYMPTOMS IMPROVE FOLLOWING A ROBOTIC PROSTATECTOMY? RESULTS OF EXPANDED PROSTATE CANCER INDEX COMPOSITE (EPIC) URINARY QUALITY OF LIFE OUTCOMES FOLLOWING ROBOTIC PROSTATECTOMY IN A COMMUNITY BASED HEALTHCARE SYSTEM

INTRODUCTION AND OBJECTIVES: Herein we describe various preoperative, operative and pathological variables associated with an improvement in EPIC urinary symptom scores following a robotic prostatectomy. METHODS: From October 2003 to June 2009 Expanded Prostate cancer Index Composite (EPIC) scores and demographic information were prospectively obtained from 623 patients who underwent a robotic radical prostatectomy. Patients received EPIC questionnaires preoperatively 6, 12, 24, 36, 48 and 60 months post-surgery. Two binary outcome variables were created: improvement in urinary incontinence and improvement in urinary bother. Improvement is defined by comparing the value at each post-operative time point to the subject’s baseline value on that subscale, and coding the subject as “improved” if his value at that time point was at least .5 standard deviations greater than his baseline value; otherwise he was considered as “not improved”. This longitudinal data was analyzed with the use of generalized estimating equations (GEE) models that relate the proportion of patients with improvement since procedure to various variables. RESULTS: The highest proportions reporting improvement was 14% at 5 years post-procedure for urinary incontinence and 37.8% at 4 years for urinary bother. The final model with proportion showing improvement in urinary incontinence score included recovery time, African-American race, employment status, nerve-sparing, and prostate weight. Recovery time (P 0.01), African-American race (P 0.01, OR 0.375), and increased prostate weight (P 0.01;OR 2.677) were significantly associated with improvement in urinary incontinence score. The final model with the outcome of proportion showing improvement in urinary bother score included recovery time, body mass index (BMI) category, smoking status, employment category, presence of hypertension, nerve-sparing, and prostate weight. However only recovery time, (p 0.0001), BMI, (P 0.03), (OR 1.108 for overweight compared to low-normal and 0.695 for obese compared to low-normal), and prostate weight had a significant positive association (P 0.0049, estimated odds ratio 1.891). CONCLUSIONS: Various demographic variables are associated with improved urinary quality of life measures. These factors may better identify ideal surgical candidates for a robotic prostatectomy.