Justin Houman

Robotic repair of post-cystectomy ureteroileal anastomotic strictures: techniques for success.

INTRODUCTION Post-cystectomy ureteroileal anastomotic strictures that fail percutaneous or endourologic management require operative repair. These cases can be challenging, and few reports of robotic repairs exist in the available literature. Here we describe our stepwise approach to robotic surgical repair of ureteroileal strictures. TECHNIQUE The da Vinci(®) Si Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in all cases. The port configuration is similar to robotic cystectomy, although the ports are placed in a more cephalad location on the abdominal wall. The same port configuration was used for both right- and left-sided procedures. Principal surgical techniques used include dissection of the colonic mesentery, careful peeling of the ureter off of the common iliac vessels, and mobilization of the ureter on either side of the sigmoid colon. RESULTS Four patients with a mean age of 72 years underwent this procedure at our institution, including 2 with left-sided strictures and 2 with right-sided strictures. Three of the 4 patients had undergone prior abdominal surgery in addition to their cystectomy. All patients failed initial percutaneous and/or endourologic attempts to resolve their stricture. The ureteroileal strictures were successfully repaired robotically in all cases. With mean follow-up of 16 months no major complications were encountered, and all patients remain free of stricture recurrence to date. CONCLUSIONS Robotic ureteroileal anastomotic stricture repair is feasible for both right- and left-sided cases. A similar operative approach can be used regardless of stricture side.

MP32-17 THE IMPACT OF SOCIAL MEDIA PRESENCE ON ONLINE CONSUMER RATINGS AND SURGICAL VOLUME AMONG CALIFORNIA UROLOGISTS

were compared in terms of real in-hospital charges per surgical episode with a separate pre-ERAS cohort. Mean costs per patient were compared with Wilcoxon-rank sum test and t-test, with p-value < 0.05 considered statistically significant. RESULTS: A total of 257 consecutive patients were evaluated of which 112 were ERAS patients. The median age was 70 years with no difference between the groups (p 1⁄4 0.13). Median length of stay was 6 days (p 1⁄4 0.748). Table 1 lists itemized in-hospital charges. The mean total charges per patient were

PD54-08 WHAT IS THE IDEAL ANTIBIOTIC PROPHYLAXIS FOR INTRAVESICAL BOTOX INJECTION? A COMPARISON OF TWO DIFFERENT REGIMENS

63,364 vs. 65,151 in the ERAS vs. preERAS groups, respectively (p 1⁄4 0.412). The variances between the two groups were statistically significantly different (p < 0.001). ERAS patients incurred higher medication costs (

PD16-04 INFECTION PREVENTION BUNDLE FOR UPPER TRACT ENDOSCOPY FOR UROLITHIASIS

3,505 vs. 2,796, p 1⁄4 0.013). Pre-ERAS patients incurred higher supplies, treatment and miscellaneous charges (all, p < 0.05). Only 11 ERAS patients required intensive care vs. 31 pre-ERAS (p 1⁄4 0.017) with no difference in cost per patient (p1⁄4 0.101). CONCLUSIONS: Fewer patients in the ERAS group required intensive care. ERAS implementation did not increase overall health costs for cystectomy patients when compared to standard care. The ERAS group showed a decrease in cost variance likely due to standardization of care. ERAS elicited savings in supplies, treatment and miscellaneous costs.

PD44-12 FEMALE SEXUAL DYSFUNCTION TREATMENT: A META-ANALYSIS OF THE PLACEBO EFFECT ACROSS RANDOMIZED CONTROLLED TRIALS

were assessed at 4,12 and 24 weeks after injection. Treatment consisted of 30 injections distribuited into the detrusor muscle, avoiding trigone. The primary outcome was change in clinical status, including urinary frequency, urgency and urinary urgency incontinence (UUI) episodes. Secondary outcomes were changes in maximum cystometric capacity (MCC), volume at first desire to void (FDV) and post-void residual (PVR). Quality of life (QoL) was assessed using a visual analogue scale (VAS,0-10) and a patient global impression of improvement (PGI-I).Urinary retention, urinary tract infection (UTI) and required clean intermitent catheterization (CIC) were adverse events. RESULTS: A total of 22 patients were randomized to either 300U (n1⁄411) or 500U (n1⁄411) groups. Baseline demographics characteristics were comparable for both groups. All 21 patients reported urgency, with 90% of UUI before treatment. At 12 w, an important reduction in daily UUI episodes was observed in two groups, with 90% of them being dry. Decrease in mean episodes of nocturia and urinary frequency, increase FDV and CCM and a mean reduction in total ICIQOAB were observed. At 24 w, episodes of UUI had returned in 50% (300U) and 0% (500U) (p1⁄40,013). Patients had an impression of significant improvement in 70% (300U) and 88,9% (500U) at 12w; and 50% (300U) and 100% (500U),at 24w. Score of VAS was manteined higher in 500U group. There was a significant increase in mean PVR after treatment (4w) in both groups. Our incidence of UTI was 36,7% (300U) and 34,6% (500U). One patient (500U) required CIC for 2 weeks. CONCLUSIONS: Data from this study suggest 500U improves symptoms and quality of life for longer time than 300U. However, results are not significantly differents to determine which dose is safer. As far we know this is the first study to compare two doses of AbobotulinumtoxinA for refractory idiophatic OAB.

MP06-01 EVALUATION OF THE RELATIONSHIP BETWEEN THE DONOR AND RECIPIENT DURING KIDNEY TRANSPLANT

fragments less than 4mm in diameter following ureteroscopic laser lithotripsy using a decision analysis model. METHODS: :Outcomes data from a previously published analysis of residual fragments after ureteroscopic lithotripsy were utilized. A decision analysis model was constructed to compare the costeffectiveness of initial observation of residual fragments compared to immediate intervention. Cost for the observation arm consisted of ED visits, hospitalizations, and re-interventions. The cost-analysis model extended for 3 years to account for delayed re-intervention rates on fragments of this size. Expected value calculations and sensitivity analyses were performed to determine the optimal treatment pathway based on overall cost-effectiveness. RESULTS: Two hundred thirty-two patients were found to have asymptomatic residual fragments< 4mm on follow-up imaging following ureteroscopic lithotripsy. There were 191 patients in the observation group and 41 in the immediate-intervention group. Decision analysis modeling demonstrated that when comparing initial observation to immediate re-intervention, the cost was

Robot-Assisted Transumbilical Laparoendoscopic Single-Site Pyeloplasty: Technique and Perioperative Outcomes from a Single Institution

2965 vs.

Online Physician Reviews in Female Pelvic Medicine and Reconstructive Surgery: What Do Patients Really Want?

4504, respectively. The difference in cost was largely driven by the fact that over 3 years, approximately 56% of patients remain asymptomatic without ED visit, readmission or re-intervention wherease 44% of patients incurred at least one of those 3 complications. This represents an approximate annual per-patient savings of

V2163 ROBOTIC REPAIR OF POST-CYSTECTOMY URETEROILEAL ANASTOMOTIC STRICTURES: TECHNIQUES FOR SUCCESS

513, and

MP33-01 COST IMPACT OF ELECTIVE CESAREAN DELIVERY ON FUTURE PELVIC FLOOR DISORDERS

1539 over three years when observation is selected over immediate re-intervention. CONCLUSIONS: Our decision analysis model demonstrates superior cost-effectiveness for observation over immediate re-intervention for asymptomatic residual stones < 4mm following ureteroscopic lithotripsy. The cost-savings are primarily due to a plurality of patients not requiring intervention if observed. Based on these findings, careful stratification and selection of patients may enable surgeons to improve cost-effectiveness of managing small, asymptomatic residual fragments following ureteroscopic lithotripsy.