Mark Hockenberry

High rates of advanced disease, complications, and decline of renal function after radical nephroureterectomy

OBJECTIVES Recurrences remain common following radical nephroureterectomy (RNU) for locally advanced upper-tract urothelial carcinoma (UTUC). We review a cohort of RNU patients to identify the incidence of locally advanced disease, decline in renal function, complications, and utilization of adjuvant chemotherapy (AC). METHODS Institutional databases from 7 academic medical centers identified 414 RNU patients treated between 2003 and 2012 who had not received neoadjuvant chemotherapy. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation. Complications were classified according to the modified Clavien system. Cox proportional hazard modeling and Kaplan-Meier analysis determined factors associated with cancer-specific survival. RESULTS Of 414 patients, 177 (43%) had locally advanced disease, including 118 pT3N0/Nx, 13 pT4N0/Nx, and 46 pTanyN+. Estimated 3- and 5-year cancer-specific survival was 47% and 34%, respectively. Only 31% of patients with locally advanced UTUC received AC. Mean estimated glomerular filtration rate declined from 59 to 51 ml/min/1.73 m(2) following RNU, including a new-onset decline below 60 and 45 ml/min/1.73 m(2) in 25% and 15% of patients, respectively (P<0.001 for both). Complications occurred in 46 of 177 (26%) patients, of which one-quarter were grade III or IV. Increasing age (Hazard Ratio (HR) 1.4, P = 0.03), positive surgical margins (HR 2.1, P = 0.01), and positive lymph nodes (HR 4.3, P<0.001) were associated with an increased risk of death from UTUC, whereas receipt of AC (HR 0.85, P = 0.05) was associated with a decrease in UTUC mortality. CONCLUSIONS Under one-third of RNU patients with locally advanced UTUC cancers received AC. Perioperative complications and decline in renal function may have contributed to this low rate. Such data further underscore the need for continued discussion regarding the use of chemotherapy in a neoadjuvant setting for appropriately selected patients with UTUC.

A Novel Use of Near-Infrared Fluorescence Imaging During Robotic Surgery Without Contrast Agents

We describe a novel use of near-infrared fluorescence (NIRF) imaging without contrast agents, like indocyanine green, to identify otherwise obscured intraluminal areas of interest during robot-assisted laparoscopic (RAL) surgery marked by the white light (WL) of endoscopic instruments. By filtering light wavelengths below near-infrared, NIRF imaging causes the WL of the endoscopes to illuminate green while allowing simultaneous vision of the surrounding tissues. With this visualization, intraoperative ureteroscopy was used to identify the extent of a ureteral stricture in a patient undergoing RAL partial ureterectomy. Cystoscopy was used to identify bladder diverticula and tumor locations in three patients undergoing RAL partial cystectomy with or without diverticulectomy and the ureteral orifice in another patient undergoing RAL nephroureterectomy. This technique enabled more precise identification of important areas and successful completion of RAL surgery in these five patients, which serves as proof of concept for broader applications in RAL surgery.

Vasectomy reversal: decision making and technical innovations

Vasectomy is the method of contraception chosen by more than 500,000 American men annually, and by upwards of 8% of married couples worldwide. However, following the procedure, nearly 20% of men express the desire for children in the future, and approximately 2–6% of American men will ultimately undergo vasectomy reversal (VR). VR is a complex microsurgical procedure. Intraoperative decision-making, surgical technique, and postoperative management are each critical step in achieving high success rates. The aim of this article is to provide a detailed description of the operative and perioperative procedures employed by surgeons performing VRs.

MP13-12 SHIFT WORKERS WITH SHIFT WORK SLEEP DISORDER HAVE INCREASED LOWER URINARY TRACT SYMPTOMS

but a significant difference was observed in terms of energy ratio 1⁄4 Energy delivered / prostate volume (Graphic 2) : 3.2kJ / ml [ 2.5 , 4.1kJ] ( Montreal ) vs 2.5kJ / ml [ 1.7-3.0] ( Paris ) vs 4.1kJ / ml [ 2.9-5.2] (Toulouse) (p < 0.0001). (Figure 2) No differences were observed in terms of postoperative complications (17.6% vs. 22.3% vs. 19.8%; p1⁄40.64) CONCLUSIONS: This is the first study to support that the outcomes obtained during PVP learning curve may be influenced by patients and surgeons’ characteristics. In this study, 100 Greenlight 180-W XPS PVP procedures were required before to reach a plateau in intraoperative parameters.

MP91-06 INCREASED RISK OF HYPOGONADAL SYMPTOMS IN SHIFT WORKERS WITH SHIFT WORK SLEEP DISORDER

ABSTRACT Objective To examine the association between shift work sleep disorder (SWSD), a primary circadian rhythm disorder characterized by excessive day-time sleepiness associated with shift work, and hypogonadal symptoms in shift workers. Methods Men presenting to an andrology clinic between July 2014 and June 2017 completed questionnaires assessing shift work schedule, SWSD risk, and hypogonadal symptoms ([quantitative] Androgen Deficiency in the Aging Male [qADAM, ADAM]). The impact of nonstandard shift work and SWSD on responses to qADAM and ADAM was assessed using ANOVA and linear regression. Results About 24.1% (619/2571) of men worked nonstandard shifts. Of those, 196 (31.7%) were considered to have SWSD. Controlling for age, comorbidities, and testosterone (T) levels, nonstandard shift workers had qADAM scores 1.12 points lower than day-time workers (P Conclusion Nonstandard shift workers with SWSD have even worse hypogonadal symptoms and lower T levels than day-time workers and nonstandard shift workers without SWSD. This suggests that poor sleep habits, as identified by SWSD, may contribute to the more severe hypogonadal symptoms seen in nonstandard shift workers.

Penile prosthesis in the management of erectile dysfunction following cancer therapy

Erectile dysfunction (ED) is a common problem in older men and occurs with even greater frequency following the treatment of pelvic malignancies. Inflatable penile prosthesis (IPP) implantation is a safe and effective form of definitive ED treatment for those men who fail more conservative measures, and it can be used with similar outcomes in men following cancer therapy. Although many of these men remain dissatisfied with other therapeutic options for ED, IPPs are underutilized in this population. This review will discuss the current practice patterns, outcomes and nuances to surgical technique regarding the use of IPPs in patients with ED following cancer therapy.

MP89-16 CHARACTERISTICS AND MOTIVATIONS OF MEN WHO SEEK VASECTOMY REVERSAL

childless vs those with children, bilateral VV performed in 74% vs 66%, bilateral VE performed in 10% vs 12% and combination VV/VE in 13% vs 16%; these differences were not significant. Patency was 98% (n1⁄4102) for childless men and 94% (n1⁄4949) for men with prior children. CONCLUSIONS: This retrospective review sheds light on a unique population of men for which there is a paucity of data in the literature. To our knowledge this is the first study examining childless men electing vasectomy reversal. This data offers important information that may be included in preoperative counseling targeted specifically to men whom have not fathered children.

PD45-08 INTERNATIONAL VARIABILITY IN PENILE DUPLEX ULTRASOUND PRACTICE PATTERNS, TECHNIQUE AND INTERPRETATION

There were no statistically significant differences in I-PSS or NIH-CPSI scores between the two groups. High intensity cyclists had a significantly higher mean SHIM score compared to lower intensity cyclists (20.6 vs 19.5) p<0.01, but no significant differences were found in I-PSS and NIH-CPSI scores. After adjusting for age, cyclists had significantly higher odds of perineal numbness compared to non-cyclists, odds ratio1⁄410.6 (95% confidence interval 8.3-13.7). Bike seat type had no significant effect in any of the above mentioned results. CONCLUSIONS: Contrary to prior studies suggesting that cycling may cause ED, our study shows that cyclists have no worse erectile function than non-cyclists. We also showed that cycling does not affect LUTS. Further research is warranted to gain insight into these results, but this study suggests that cardiovascular benefits of exercise may outweigh any theoretical deterrent of cycling.