Tim Ludwig

Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and functional outcomes

To determine the success rate, oral morbidity and functional outcomes of redo buccal mucosa graft urethroplasty (BMGU) for treatment of stricture recurrence after previous BMGU.

Outcomes of single- vs double-cuff artificial urinary sphincter insertion in low- and high-risk profile male patients with severe stress urinary incontinence

To evaluate continence and complication rates of bulbar single‐cuff (SC) and distal bulbar double‐cuff (DC) insertion in male patients with severe stress urinary incontinence (SUI) according to whether the men were considered low or high risk for unfavourable artificial urinary sphincter (AUS) outcomes.

Incidence, Risk Factors, Management, and Complications of Rectal Injuries During Radical Prostatectomy

Rectal injury (RI) during radical prostatectomy (RP) is a severe complication. So far, only limited data describing the incidence, risk factors, management, and complications of RI are available. In an analysis of data for 24178 patients, we identified 113/24076 patients (0.47%) undergoing open or robotic RP and 7/102 patients (6.86%) after salvage RP who experienced an RI. Besides salvage RP, local tumor stage, Gleason grade, lymph node status, and surgical experience, but not surgical approach (robotic vs open), could be identified as risk factors for RI in univariate and multivariate analysis. Intraoperative management of RI comprised closure with two to three layers. In 13/109 patients (11.9%), a diverting colostomy/ileostomy was carried out. Some 12% of men with closure of an RI developed a recto-anastomosis fistula, and 57% of those who had an additional diverting enterostomy. Thus, the overall incidence of recto-anastomosis fistula after RP was <0.1%. The extent of rectal laceration, prior radiation, and intraoperative signs of rectal infiltration were associated with the development of a subsequent recto-anastomosis fistula. Some 83% of patients with a recto-anastomosis fistula needed further intervention. PATIENT SUMMARY: We analyzed the incidence, risk factors, management, and complications of rectal injury during radical prostatectomy. Overall, the incidence of rectal injury and subsequent development of recto-anastomosis fistulas is low unless the patient has significant risk factors.

PD34-05 EFFECT OF PATIENT AND SURGICAL CHARACTERISTICS ON TREATMENT FAILURE IN 491 ONE-STAGE VENTRAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTIES

urethroplasty is 3.6 (range 0-36). Urethroplasty techniques were: anastomotic (33%, n1⁄443), dorsal graft (39%, n1⁄451), ventral graft (15%, n1⁄419), flap (6%, n1⁄48), perineal urethrostomy (2%, n1⁄43). 5% of patients underwent advanced reconstructive techniques such as: double graft, augmented dorsal anastomotic, Duckett, or first stage Johanson (n1⁄46). Overall success rate was 85% with an average time-to-failure of 23 months (range 2-151 months). Success rates for patients who had prior endoscopic intervention (urethrotomy or dilation) was 83% versus those with no prior endoscopic intervention who had a success rate of 100%, p> 0.05. Complications were reported in 17% of patients, including recurrent UTI, erectile dysfunction, urinary incontinence, and penile shortening. CONCLUSIONS: Our study represents the first multi-institutional report on the severity and management of post-TURP urethral strictures. Our data shows that the majority of post-TURP strictures are successfully managed with urethroplasty, with 85% success. Better success rates are seen in patients with no prior endoscopic intervention, suggesting early urethroplasty or referral to a reconstructive urology center is warranted.

MP36-15 LIVE SURGERY IN UROLOGY - EVALUATION OF THE EDUCATIONAL BENEFIT OF THE INTERNATIONAL MEETING ON RECONSTRUCTIVE UROLOGY (IMORU)

INTRODUCTION AND OBJECTIVES: Overall health quality of life (QOL) indicators may capture non-urological issues such as back pain or arthritis when used as patient reported outcomes measures (PROM) for urethral stricture surgery. We hypothesize that generic health QOL indicators are not meaningful in the assessment of urethral stricture surgery and should be replaced with stricture-specific measures. METHODS: Patient data was obtained from the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) collaborative database. Patients who underwent a successful urethroplasty, defined by passage of a cystoscope through the repair and no secondary procedure on post-operative evaluation, were included in this study. All patients completed preand post-operative questionnaires based on a recently published urethral stricture surgery questionnaire validated in 2013. RESULTS: Inclusion criteria were met by 201 patients who underwent successful urethroplasty at a mean age of 47 years. Postoperative questionnaires were completed at a mean time of 7.3 months after surgery. Urethral-stricture specific measures improved after surgery: mean LUTS score (13.1 to 4.0, p<0.05), Peelings voiding picture (3.1 to 1.7, p<0.05), and overall interference of urinary symptoms on life (3.0 to 1.6, p<0.05). Mean overall health status visual analog scale (74.2 to 80.0, p<0.05) and EQ-5D index scores (0.90 to 0.95, p<0.05) also improved; however, individual EQ-5D measures assessing mobility, self-care, and activity level did not change. Although individual EQ-5D measures for pain/discomfort (1.48 to 1.23, p<0.05) and anxiety/depression (1.33 to 1.21, p<0.05) improved, these measures did not correlate with a successful urethroplasty to the same extent as stricture-specific measures (Figure). Only 2 of the 11 patients who reported worse overall pain/discomfort also reported worse bladder or urethral/penile pain when asked about urological-specific pain. CONCLUSIONS: Generic health QOL indicators may capture medical issues not related to stricture disease and should be replaced with urethral stricture-specific outcomes measures. As PROMs become more prevalent and utilized to evaluate surgeon outcomes and determine reimbursements, it is important to ensure that appropriate condition-specific measures are assessed.

MP80-12 RETINAL TOXICITY AFTER CISPLATIN-BASED CHEMOTHERAPY IN PATIENTS WITH TESTICULAR CANCER

INTRODUCTION AND OBJECTIVES: Cisplatin-based chemotherapy (CBC) is a cornerstone in the treatment of advanced stage testicular cancer (TC). Since its introduction it has led to excellent survival rates and as TC usually is a cancer of young men, most patients live to experience significant shortand long-term side effects. These include infertility, cardiovascular disease, and sensomotoric impairment due to otoand neurotoxicity. Meanwhile little is known on retinal toxicity associated with CBC. We therefore sought to outline potential morphological and functional retinal alterations in CBC treated patients. METHODS: After ethics committee approval was obtained, we enrolled patients who had received at least one cycle of CBC at any of three Hamburg-based TC centers. Furthermore, a matched control group of healthy, untreated patients were included in this study. Subjects were evaluated for functional and morphological retinal dysfunction. This included testing of retinal nerve fiber thickness (RNFL), color vision, and visual acuity testing in CBC recipients. Additionally, full-field electroretinograms (ff-ERG) for CBC recipients and their healthy controls were conducted. Pearson correlation coefficient analysis was carried out to assess a possible correlation between cumulative Cisplatin dose and measured RNFL and ff-ERG. Endpoints of this study were differences in test measures as well as a dose dependency on outcomes. RESULTS: Both study groups (CBC recipients vs. healthy controls) consisted of N1⁄414 participants with a median patient age of 30 years (range: 22 52 years). Seminomatous and nonseminomatous germ cell tumors were exhibited in 6 (42.85%), and 8 (57.14%) out of 14 patients, respectively. Patients had received between one to seven cycles of a CBC regimen consisting of Cisplatin, Etoposide, and Bleomycin with a median Cisplatin dose of 627mg (range: 216mg 1,205mg). The median interval between last CBC and diagnostic evaluation was 19.8 month (range: 6 61.5 months).Morphological assessment revealed reduced RNFL in 11 of 14 patients (78.6%). While the reduction in RNFL was significantly correlated to the cumulative CBC dose received (?1⁄40.70; P1⁄40.004), it did not correlate with the time since cessation of CBC (?1⁄40.16; P1⁄40.1). ff-ERG showed significant differences between CBC recipients and the control-group in 2 of 5 tested categories (all P<0.001). Functional testing revealed no loss in visual acuity in all 14 CBC recipients, yet impaired color vision was observed in 6 of 14 patients (42.8%). CONCLUSIONS: Our study is limited in small sample size and short-term follow-up. However, it appears that CBC in TC patients leads to short-term functional and morphological retinal alterations. Future studies should address this circumstance, as there are major implications.

MP52-17 ENDOSCOPIC TREATMENT OF POSTERIOR URETHRAL STRICTURES FOLLOWING SIMPLE AND RADICAL PROSTATECTOMY: SUCCESS AND INCONTINENCE RATES

INTRODUCTION AND OBJECTIVES: Bladder neck contracture (BNC) after radical prostatectomy (RP) is a common yet understudied complication with significant adverse quality of life implications. Here we identify patient groups that are at highest risk for BNC after RP. METHODS: Years 1987 to 2013 of a prospectively maintained single institution RP registry were queried for patients with and without BNC. Those with prior TURP or radiotherapy were excluded. Descriptive statistics, univariate and multivariate logistic regressions (with forward stepwise entry), and receiver operating curves were employed to identify predictors of BNC. The impact of BNC on functional and oncologic outcomes was then assessed. RESULTS: Out of 17,954 men with a mean follow up of 10 years after RP, 858 (4.8%) developed BNC. Men with BNC had higher risk features than those without BNC: cT3/4 (10.3% vs 5.3%, p<0.001), biopsy Gleason score 8-10 (10.4% vs 7.3%, p<0.001), and higher PSA (11.9 vs 8.6, p<0.001). Multivariate logistic regression modeling identified several significant associations with BNC development after RP (Table 1). Importantly, BNC independently increases the risk of 1 or more incontinence pads per day at 1 year after RP (OR 1.755, 95% CI 1.405-2.191, p<0.001). However, the occurrence of BNC was not associated with 20-year oncologic outcomes. CONCLUSIONS: About 5% of patients will develop a BNC after RP and this incidence has declined over time. Nevertheless, the presence of a BNC is independently associated with a 75% increased risk of urinary incontinence following RP. Accordingly, we uncovered several novel risk factors for BNC, including: greater BMI, prostate volume, advanced pT stage, urine leak, early UTI, need for transfusion, and lack of nerve sparing. Validation of these findings is warranted to help design interventions that may reduce the incidence of BNC even further.

Divertikel der Urethra

Das Harnrohrendivertikel ist ein, mit der Harnrohre in Verbindung stehender Hohlraum. In den meisten Fallen entspricht es nicht der klassischen Definition eines Divertikels oder Pseudodivertikels. Diese sieht fur Divertikel den Aufbau aus allen Wandschichten des Ursprungsorgans vor. Als Pseudodivertikel werden mukosale Ausstulpungen durch die Muskularis eines Hohlorgans bezeichnet.