Katie S. Murray

The effect of the new 2010 World Health Organization criteria for semen analyses on male infertility.

OBJECTIVE To quantify the effect of the new 2010 World Health Organization (WHO) semen analysis reference values on reclassifying previous semen analysis parameters and definition of patients with male factor infertility. DESIGN A multi-institutional retrospective chart review. SETTING University and private male infertility clinics. PATIENT(S) Men referred for infertility evaluation. INTERVENTION(S) Comparison of semen analysis values based on 2010 versus 1999 reference criteria. MAIN OUTCOME MEASURE(S) Quantification of the change based on individual sperm parameters and as a whole. RESULT(S) A total of 184 men had at least two semen analyses; 13 (7%), 17 (9.2%), 34 (18.4%), and 29 (15.7%) patients changed classification to being at or above the reference values by the 2010 criteria for semen volume, sperm concentration, motility, and morphology, respectively. A total of 501 men had one semen analysis on file; 40 (7.9%), 31 (6.2%), 50 (9.9%), and 74 (19.3%) would change classification for volume, concentration, motility, and morphology, respectively. Overall, 103 patients (15.1%) who had one or more parameter below the reference value on the original analysis were converted to having all parameters at or above the 2010 reference values. CONCLUSION(S) The 2010 reference values result in some infertile men being reclassified as fertile if status is based on semen analysis alone. This may lead to fewer men being referred for proper infertility evaluation or treatment.

A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy

To prospectively evaluate the effect of transrectal ultrasonography (TRUS)‐guided prostate biopsy on erectile and voiding function at multiple time‐points after biopsy.

Penile fracture and magnetic resonance imaging

A thirty-three-year-old male presented to an outside emergency department with scrotal swelling and pain after intercourse. A scrotal ultrasound revealed hematoma, with no other abnormalities and the patient was discharged. He then presented to our institution where examination showed diffuse ecchymosis through the shaft of the penis, suprapubic region, and scrotum without a palpable cavernosal defect. Magnetic resonance imaging (MRI) without contrast was obtained after the injection of 10 micrograms of intracavernosal alprostadil. The low signal tunica albuginea is easily demarcated compared to the high T2 and intermediate T1 signal of the corpora cavernosum (Figures 1-3) (1,2). Hematoma shows heterogeneous intermediate T1 and T2 signal (Figures 2 and 3) (1). Penile fracture is rupture of the corpus cavernosum from blunt trauma to the erect penis (3,4). Typical presentation is a pop during intercourse, immediate detumescence with edema, hematoma and penile deformity (3,4). In atypical presentations, radiological studies may be useful to determine the diagnosis. MRI provides the ability to identify disruption of the corpus cavernosum due to excellent tissue contrast and Penile Fracture and Magnetic Resonance Imaging _______________________________________________

Can we predict the need for clean intermittent catheterization after orthotopic neobladder construction

Introduction: We aimed to identify peri-operative and pathologic characteristics that may predict the need for clean intermittent catheterization (CIC) following radical cystectomy (RC) with orthotopic neobladder (ONB) in order to improve patient counseling on choice of urinary diversion. Materials and Methods: Between July 2004 and February 2013, all patients who underwent RC with ONB were identified. Peri-operative clinical and pathological features were evaluated and correlated with patients reported need for CIC. The independent T-test was performed for continuous variables and Chi-square test was performed for categorical variables. Multivariate forward stepwise logistic regression analysis was used to identify variables that correlated with need for CIC after ONB. Results: During the study period, 114 patients underwent RC with ONB creation. On univariate analysis, patients with higher body mass index, younger age, and non-vaginal or non-nerve-sparing procedures were more likely to require catheterization for complete emptying. Multivariate analysis demonstrates that conservative surgery (nerve sparing in males or vaginal sparing in females) was associated with a significantly lower rate of requiring CIC (Odds Ratio [OR] 0.20, P < 0.01). Surprisingly, older age was also associated with a slightly lower, but statistically significant, rate of requiring CIC (OR 0.92,P < 0.01). Conclusions: When counseling patients regarding the different types of diversions after RC, the potential need for long-term CIC after ONB must be discussed. The clinical factors that appear to increase the need for CIC include non-conservative RC (non-nerve sparing in males and non-vaginal sparing in females) and, to a certain degree, younger age.

Metastatic Papillary Renal Cell Carcinoma Regression After Cytoreductive Nephrectomy

CASE PRESENTATION previously healthy 69-year-old woman sought medical attention for stomach pain and distenAsion associated with a 10-pound weight loss. There was no hematuria, fevers, chills, night sweats, or fatigue. Past medical history was significant for hypertension. In 1989, she required a temporary colostomy after a partial colectomy secondary to a colonic perforation. Family history was significant for a brother with glioblastoma multiforme, and her mother had kidney disease of unknown etiology. She did not report any previous chemical exposure but is a current smoker with a 45-pack year history of tobacco abuse. Initial kidney, ureter, and bladder imaging was done and suggested constipation. Pain control was achieved with an aggressive bowel regimen and pain medication, but the sensation of abdominal fullness persisted. On presentation to our clinic, vital signs were normal except for a 10-pound weight loss over a 3-week period. Physical examination revealed a left large, palpable, flank mass that was tender to palpation but no other palpable adenopathy. Her initial laboratory evaluation was significant for hemoglobin 10.3 g/dL, creatinine 1.17 mg/dL, calcium 10.0 mg/dL, albumin 4.0 g/dL, and lactate dehydrogenase 543 U/L (100-210 U/L). A computed tomography scan of the abdomen and pelvis followed by magnetic resonance imaging (MRI) of the abdomen revealed a 13.6 11.6 9.9 cm heterogeneous left renal mass (Fig. 1) with bulky retroperitoneal lymphadenopathy, left renal vein thrombus, a nonocclusive inferior vena caval tumor thrombus, ipsilateral adrenal gland

MP88-17 PATIENT DERIVED XENOGRAFTS OF UPPER TRACT UROTHELIAL CARCINOMA: A POTENTIAL TOOL FOR PERSONALIZED MEDICINE

that tumor exosomes play in cancer development, metastasis and drug resistance. Tumor cells have been shown to selectively package certain proteins and RNA material into exosomes for the purpose of cell to cell communication. After internalization, recipient cells show altered gene expression, which in turn, modifies their invasiveness, apoptotic rate and sensitivity to therapeutic drugs. Few studies have examined the role of exosomal microRNAs (miRNA) in transference of drug resistance in bladder cancer. We hypothesize, that specific miRNAs have distinct roles in the establishment of chemoresistance. Here we strive to identify exosomal miRNAs profiles and their roles in Cisplatin, Gemcitabine and Cisplatin/Gemcitabine chemoresistance in bladder cancer. METHODS: Three resistant sublines of the human CUB III bladder carcinoma cell line were developed by gradually exposing the cells to increasing doses of Gemcitabine, Cisplatin or a combination of Gemcitabine and Cisplatin, over a period of 6 months. Exosomes were harvested and characterized by nanoparticle tracking analysis. Exosomal miRNAs were profiled via qRT-PCR array analysis. These distinct exosomal miRNA signatures were investigated in several additional bladder carcinoma resistant cell lines. RESULTS: Chemoresistant CUB III cells exhibit distinct miRNA profiles within their exosomes, which is unique depending on the drug of treatment. Of the 759 miRNA profiled, sixteen were differentially expressed (at least two-fold) across all the CUBIII resistant sublines relative to their parental line. Our data showed that 10 miRs were consistently down-regulated and 6 miRNAs were up regulated. Among the differentially expressed exosomal miRNAs in the resistant sublines, miR-Let-7i-3p was the most significantly down-regulated while miR-215p was the highest up-regulated compared to their chemosensitive counterpart. CONCLUSIONS: Our findings demonstrate that for each chemotherapeutic drug, resistant cells had differentially expressed miRNA profiles within their exosomes. Many of these miRNAs have been shown to play a role in oncogenesis or the development of drug resistance in other tumor types. After further validation these exosomal miRNAs may have utility as predictive biomarkers of treatment response and possibly as therapeutic targets to enhance drug response.

MP52-09 INTRAOPERATIVE IDENTIFICATION OF NERVES USING A MYELIN-BINDING FLUOROPHORE: COMPARATIVE EFFICACY OF INTRAVENOUS VS. TOPICAL ADMINISTRATION

patients instead of the 5 mm instruments is common due to the shorter wrist lengths. We hypothesized that the use of 5 mm instruments for RAL pyeloplasty in infants with smaller working spaces will not affect the perioperative parameters and surgical outcomes in comparison to older children with larger working spaces. METHODS: We compared the perioperative parameters and surgical outcomes of RAL pyeloplasties performed by a single surgeon in infants and non-infant pediatric patients over a 2 year period using an 8.5 mm camera and 5 mm robotic instruments. Patient demographics, operative times, intraand postoperative complications, hospital pain medication usage, hospital length of stay, and treatment success rates were compared between the two groups. RESULTS: A total of 65 pediatric RAL pyeloplasties were included in the study (16 infants and 49 non-infant pyeloplasties). There were no significant differences in gender, laterality, proportion of re-do pyeloplasty, or preoperative hydronephrosis grade between the two groups. All procedures were performed without conversion to open surgery or significant perioperative complications. There were no differences in segmental operative times (total operative time, console time, port placement time, time for dissection to UPJO, and anastomosis time), hospital pain medication usage, and hospital length of stay between the two groups (p > 0.05 for all comparisons). The treatment success rates were 93.8% (15/16) and 100% (49/49), respectively (p 1⁄4 0.08). CONCLUSIONS: RAL pyeloplasty is a safe and effective surgical modality even in infants with comparable perioperative parameters and outcomes as those in older children. The use of 5 mm instruments in infants with smaller working spaces does not affect these parameters as well, while offering the potential for improved cosmesis.

MP55-05 PARTIAL NEPHRECTOMY IN THE TREATMENT OF RENAL TUMORS WITH CONCOMITANT VENOUS TUMOR THROMBOSIS (VTT) OF RENAL VEIN BRANCHES: RETROSPECTIVE, MULTI-CENTER ANALYSIS OF PERIOPERATIVE, FUNCTIONAL, AND ONCOLOGIC OUTCOMES

INTRODUCTION AND OBJECTIVES: We assessed the impact of papillary renal cell carcinoma (RCC) on oncological outcomes after partial nephrectomy compared to clear cell RCC in patients with pathologic T1a RCC. METHODS: After excluding patients with synchronous multiple renal tumors, familial renal cell carcinoma, pathologic T1b or greater disease, and metastatic disease, 759 patients with clear cell and 84 patients with papillary RCC were included for the analysis. We compared the impacts of papillary RCC with clear cell RCC on oncologic outcomes. Median follow-up duration was 67 months. RESULTS: There was no differences in patient and tumor characteristics between the 2 groups except for Fuhrman grade (p1⁄40.006). In Kaplan-Meier analysis, 5-year recurrence free survival was 98.7% in patients with clear cell RCC and 95.6% in patients with papillary RCC. However, 10-year recurrence free survival in patients with clear cell and papillary RCC was 96.1% and 73.0%, respectively (p<0.001). Median time to recurrence was 31 months in patients with clear cell RCC and 77 months in patients with papillary RCC although statistical significance was not achieved (p1⁄40.190). In multivariate analysis, papillary RCC (HR; 5.309, p1⁄40.001) was determined as a significant risk factor for recurrence after partial nephrectomy in pathologic T1a RCC patients in addition to tumor size (HR; 1.861, p1⁄40.038) and Fuhrman grade (1⁄43) (HR; 5.176, p1⁄40.003). CONCLUSIONS: Recurrence after partial nephrectomy was more commonly occurred in pathologic T1a papillary RCC compared to clear cell RCC. Because median time to recurrence in papillary RCC was greater than 5-year after surgery, longer follow-up is needed for patients with papillary RCC even though pathologic stage is T1a.

MP100-20 CRYOTHERAPY AND THERMAL ABLATION FOR RENAL MALIGNANCY OVER 3 CENTIMETERS - COMPARATIVE ANALYSIS OF SURVIVAL WITH SMALL RENAL MASSES

INTRODUCTION AND OBJECTIVES: Objective: To compare the surgical, oncological, and functional outcomes of laparoscopic and percutaneous cryoablation for the treatment of small renal masses. METHODS: A systematic review of the literature was performed through March 2016 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing laparoscopic and percutaneous kidney cryoablation were included in the meta-analysis. RESULTS: Eleven studies were selected for the analysis including 1725 cases: 804 (46.6%) percutaneous and 921 (53.4%) laparoscopic cryoablation. Included studies were all retrospective comparative ones. Percutaneous cryoablation was performed more frequently for posterior tumors (p<0.001), whereas laparoscopy was more common for endophytic lesions (p1⁄40.01). The length of follow-up was longer for laparoscopy (p<0.001). Percutaneous cryoablation was associated with a significantly shorter hospital stay (p<0.001). A lower likelihood of residual disease was recorded for laparoscopic (p1⁄40.003), whereas tumor recurrence rate favored percutaneous cryoablation (p1⁄40.02). The two procedures were similar for recurrence free survival (p1⁄4 0.08), and overall survival (p1⁄40.51). No significant difference was found in post-operative eGFR (p1⁄40.78). CONCLUSIONS: Laparoscopic and percutaneous kidney cryoablation offer similar favorable oncological outcomes with minimal impact on renal function. The percutaneous access can offer shorter hospital stay and faster recovery, which can be appealing in an era of cost restraint. Determining which approach to use in clinical practice will depend on the available technology and specific expertise at each center. Source of Funding: none

Transrectal Ultrasound Guided Needle Aspiration of a Prostatic Abscess: Salvage Treatment After Failed Transurethral Resection

The treatment for prostate abscesses includes a combination of antimicrobial therapy and surgical drainage of the abscess cavity. There is a lack of published cases involving treatment options for a prostate abscess after a failed transurethral resection of the prostate. This is a case report describing a successful salvage treatment after a failed attempt at abscess drainage by a transurethral resection of the prostate. The patient was successfully managed with a needle drainage of his prostate abscess utilizing a transrectal ultrasound guided needle decompression his prostate abscess.