R. Hamid

775 Sacral Nerve Stimulation (SNS) for the treatment of idiopathic refractory overactive bladder: Cost-effectiveness compared to optimal medical therapy, botulinum toxin A (BoNT-A) and percutaneous tibial nerve stimulation (PTNS)

had yet requested re-tx in cycles 4 and 5 for an accurate estimate). Large improvements from BL in HRQOL that exceeded the minimally important difference were seen following each onabotA tx. The most common AE in each tx cycle was uncomplicated urinary tract infection (26.9, 24.2, 24.5, 20.4, and 14.9%). The proportion of pts requiring CIC due to elevated PVR was 4.6, 4.1, 4.7, 5.3, and 2.1% in onabotA 100U cycles 1 through 5. No change in the AE profile was observed. CONCLUSIONS: Repeated onabotA tx in OAB pts with UI inadequately managed with ACHs showed sustained improvements in OAB symptoms, pt perception of improvement in their condition, and HRQOL. A consistent safety profile was also seen, with no new safety signals.

898 The medium term outcomes of stoma formation for patients undergoing conduit diversion for functional aetiology: 5 Year follow-up

INTRODUCTION AND OBJECTIVES: Clostridium difficile (CD) colitis is at historically high levels, leading to increased complications and costs in patients undergoing major abdominal surgery involving the gastrointestinal tract. We sought to assess if screening and empiric treatment of preoperative asymptomatic CD carriers would decrease symptomatic CD colitis in patients undergoing cystectomy and urinary diversion METHODS: A prospective evaluation of CD carrier status was undertaken in patients undergoing cystectomy and urinary diversion between January-September 2015 by testing stool samples at the time of surgery. Patients identified as CD carriers were treated with intravenous metronidazole until return of bowel function. The incidence of clinically symptomatic CD colitis was assessed in this intention to treat cohort and compared to a retrospective cohort of 562 patients that underwent cystectomy during 2010-2013. RESULTS: A total of 78 patients were included in the intention to treat analysis, of which 62 (79%) were screened intraoperatively for CD. Of those screened, 18 (30%) were asymptomatic carriers of CD. The incidence of patients who developed symptomatic CD colitis in the intention to treat cohort was 3.8% (3/78 patients). Of those 3 patients, 2 were negative for CD preoperatively and 1 was unknown. None of the treated patients developed CD colitis or adverse outcomes. When compared to the historical cohort which had aCD colitis incidence of 8.8%, the relative risk reduction was 57% with a number needed to treat of 20. CONCLUSIONS: Cystectomy patients were found to have a high incidence of asymptomatic CD. Identification and treatment of asymptomatic carriers at time of surgery seems to decrease the incidence of CD colitis. Further studies are warranted to assess the utility and cost of testing for CD status followed with empiric treatment.