1717 CONSISTENT AND PERSISTENT LONG-TERM EFFICACY AFTER REPEAT ONABOTULINUMTOXINA DETRUSOR INJECTIONS IN PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY

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with Mann-Whitney and Kruskal-Wallis tests for independent data, and Spearman’s correlation coefficient have been used to assess correlations between patients’ characteristics (sex, age, disease duration), psychological status and both urinary and sexual dysfunction. RESULTS: Patients’ clinical features are shown in Table 1. Significant correlations have been found in both sexes between depression, anxiety due to urogenital symptoms, and sexual function. Males seemed to be more affected than females by sexual dysfunction as due to both increasing age and neurological disease duration. In addition sexual dysfunction is strictly linked to imnsonnia in males (Table 2). CONCLUSIONS: In MS patients urinary symptoms and sexual dysfunction are strictly related to patients’ psychological status. It should be paid particular attention to urinary/sexual symptoms and to anxiety and depression to improve MS patient’s quality of life. Table 1 No. of patients

61

Sex (Males/Females)

Source of Funding: None

15/ 46

Age (yrs)

40.7⫾9.33

Males

38.1 ⫾ 10

Females

41.5 ⫾ 9.1

Disease duration (yrs)

6.6 ⫾ 4.8

Urinary/sexual symptoms duration (yrs)

3.5 ⫾ 3.18

Sexual function (I-QoL) - presence and severity of depression Both sexes (cc: -0.32; p⬍0.05)

Males

complication rate was 40%. The majority of complications were Grade I (18%) or II (45%). There was one (2%) mortality related to bowel leak and sepsis. Post-operative follow-up averaged 17 months (range 0-36). Mean serum creatinine was 0.64 (range 0.3 to 1.36). Urinary incontinence rate was 14% and included leakage per continent cutaneous stomas (2) and urethra (4). Of the 4 patients with urinary incontinence per the urethra, one had undergone concurrent urethral sling at the time of the bladder augmentation. Urinary tract infections were seen in 9 (21%), patients, of which 3 had recurrent infections. Two (4%) patients had evidence of stone disease. There was one patient with stomal stenosis. Five (12%) patients required a secondary surgery for the following indications: incontinence (3), small bowel leak (1), fistula(1). CONCLUSIONS: Lower urinary tract reconstruction remains a feasible option for NGB patients recalcitrant to medical management, with good short-term outcomes in terms of renal function and continence. The majority of peri-operative complications are of low grade and can be managed non-operatively.

Table 2 Sexual function (I-QoL) – anxiety due to urogenital symptoms (cc:-0.39; p⬍0.05)

Sexual Disease duration disturbancescentral –Sexual Age – Sexual insomnia (cc: disturbances disturbances (cc: 0.60; p⬍0.05) (cc: 0.69; p⬍0.05) 0.78; ⬍0.01)

1717 CONSISTENT AND PERSISTENT LONG-TERM EFFICACY AFTER REPEAT ONABOTULINUMTOXINA DETRUSOR INJECTIONS IN PATIENTS WITH NEUROGENIC DETRUSOR OVERACTIVITY Michael Kennelly*, Charlotte, NC; Brenda Jenkins, Jihao Zhou, Irvine, CA; Roger Dmochowski, Nashville, TN

Sexual disturbancesdelayed insomnia (cc: 0.73; p⬍0.05)

Age- Reduction in sexual activity Females (cc:-0.44; p⬍0.05)

Source of Funding: None

1716 CONTEMPORARY OUTCOMES OF LOWER URINARY TRACT RECONTSTRUCTION FOR NEUROGENIC BLADDER Patrick Ramos*, Teresa Danforth, David Ginsberg, Los Angeles, CA INTRODUCTION AND OBJECTIVES: This study provides a contemporary look at both the perioperative and short-term outcomes after lower urinary tract reconstruction for neurogenic bladder (NGB). METHODS: A retrospective chart review was performed on all NGB patients that underwent lower urinary reconstruction from January 1, 2009 to December 31, 2011. A total of 48 patients underwent reconstructive surgery during this period, of which 45 had complete perioperative records, and 42 had complete short-term follow-up records. Perioperative data was collected, including length of hospital stay (LOS) and complications. The Clavien-Dindo Grading Scale was used to categorize these complications. Renal function, continence, urinary infection rate, and stone disease data were collected to assess short-term outcomes. RESULTS: A total of 48 patients underwent lower urinary tract reconstruction with an average age of 34 years (range 19 to 69). The study population was predominantly male (81%) with traumatic spinal cord injury (SCI) being the most common underlying pathology for NGB at 84%. The procedures performed included: 30 ileocystoplasty (63%), 8 ileovesicostomy (17%), 6 urinary conduit (12%), and 4 continent urinary stoma (8%). Nine (19%) patients underwent concurrent continence surgery with either urethral sling (5) or bladder neck closure (4). Median LOS was 8 days and ranged from 5 to 65 days. The overall

INTRODUCTION AND OBJECTIVES: OnabotulinumtoxinA (onabotA) has been shown to be well tolerated and provide sustained efficacy in patients (pts) with UI due to neurogenic detrusor overactivity (NDO). However, many previous long-term studies were from single centers with few pts. Here we present an additional analysis of the large cohort of patients (with multiple sclerosis or spinal cord injury) treated in the long-term extension study of the two onabotA phase 3 pivotal studies, including over 100 pts receiving at least 5 onabotA injections administered via cystoscopy, avoiding the trigone. METHODS: The 3 year extension study allowed pts who completed the pivotal trials to continue receiving the same dose (200U or 300U) of intradetrusor onabotA as in the pivotal studies (until approval of the 200U dose for treatment of UI due to NDO, after which the protocol was amended so all pts receive 200U). Pts who received placebo during the pivotal studies received onabotA (reported here as treatment 1). Data were integrated across the pivotal and extension studies and analyzed by onabotA treatment cycle. Change from study baseline (BL) in daily UI episodes and volume/void at 6 wks after each treatment were assessed, as were adverse events (AEs) and initiation of clean intermittent catheterization (CIC). RESULTS: A total of 387, 348, 283, 195, 108, 59, and 40 pts received 1, 2, 3, 4, 5, 6, and 7 onabotA treatments. Repeat onabotA treatment consistently reduced the number of daily UI episodes from BL; at week 6, mean changes from BL ranged from -3.1 to -4.4 for onabotA 200U and -3.0 to -3.7 for onabotA 300U across treatment cycles 1-7 (Figure). Volume/void was ⬃150 mL at BL and increased to ⬃300mL following onabotA treatment across all cycles. Only 10 pts discontinued due to AEs. Most common AEs were urinary tract infections and urinary retention. No new safety signals were observed over repeat treatment. Risk of denovo CIC was highest after the first treatment and was greatly reduced after subsequent treatments. CONCLUSIONS: Consistent and persistent improvements in UI episodes and volume per void were observed, with no new safety signals identified, after repeat onabotA treatment (up to 7 treatment cycles).

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Transplantation and Urolithiasis Video Session 8 Tuesday, May 7, 2013

10:30 AM-12:30 PM

V1719 ROBOTIC-ASSISTED LAPAROSCOPIC TRANSPLANT TO NATIVE URETEROURETEROSTOMY Diana Bowen*, Jessica Casey, Earl Cheng, Edward Gong, Chicago, IL Source of Funding: Allergan, Inc.

Award Winning Video Session Video Saturday, May 4, 2013 10:30 AM-12:00 PM

V1718 LASER FIBERS, PULSE ENERGY AND RETROPULSION - WHAT WE CAN SEE AND WHAT WE CAN’T Peter Kronenberg*, Amadora, Portugal; Olivier Traxer, Paris, France INTRODUCTION AND OBJECTIVES: To evaluate through high-speed video analysis how retropulsion is affected by pulse energy, laser fiber diameter, the use of different lithotripters and by any other observable aspect. METHODS: Uniformly artificial stones (made of BegoStone plus姞) immersed in saline and inside a polypropylene cylinder were put in direct contact with a laser fiber tip, through which a single laser pulse was fired. Three different laser lithotripters were tested, using for each of them two different laser fiber diameters, a smaller one (200-273 ␮m) and larger one (550-600 ␮m) at various pulse energies (0.2-3.5 J). All experiences were recorded with high-speed video, the distance the stone travelled measured and each video analyzed in order to detect any unexpected event. RESULTS: As pulse energy rises, so does the distance the artificial stones travels after laser impact, whatever the lithotripter or laser fiber diameter used. At equal energy levels, larger laser fiber diameters are associated with significantly greater stone displacement, regardless of the level of pulse energy or the laser lithotripter used. High-speed video analysis detected other interesting effects: if the laser fiber tip is inside a fragmentation crater, retropulsion increases considerably (sometimes over 40% more retropulsion); formation of cavitation bubbles and their resulting shockwaves were recorded, showing that even those stones that are not in direct contact with the laser fiber tip may be affected over considerably large distances; with very high pulse energies (2.0 J or higher), the sudden stone displacement produces a turbulence wave which pushes the stone even further away than the retropulsion effect alone. CONCLUSIONS: Higher energy levels and larger laser fiber diameters promote an increased retropulsion effect. Retropulsion and stone position is significantly affected whether the laser fiber tip is barely touching the stone, inside a fragmentation crater or even at a substantially wider distance from the stone surface. High-speed video analysis can bring new insights concerning laser lithotripsy, and reveal details that might otherwise remain concealed to the human eye. Source of Funding: None

INTRODUCTION AND OBJECTIVES: A 14 year old girl with Fanconi’s syndrome five years post-kidney transplant for end-stage renal disease secondary to cystinosis presented to the pediatric urology clinic with the diagnosis of a transplant ureteral stricture involving two-thirds of her ureter with resulting hydronephrosis and elevated creatinine. We present a novel minimally-invasive surgical approach to a late transplant ureteral stricture. METHODS: Using a three-port technique with 8 millimeter instruments, we performed a robotic-assisted laparoscopic transplantto-native ureteroureterostomy with ureteral stent placement across the anastomosis. RESULTS: There were no intraoperative complications and blood loss was minimal. In the immediate post-operative period, the patient experienced a urine leak requiring an additional stent to the transplant kidney via the transplant ureter. The stents were removed and her hydronephrosis progressively decreased on ultrasound to stable mild upper pole pelviectasis with 10 month follow-up. Her creatinine stabilized at a baseline of 0.9 mg/dl. CONCLUSIONS: Robotic assisted laparoscopic transplant-tonative ureteroureterostomy is a technically feasible procedure. Improvement on this procedure would be to employ maximal drainage by use of a larger caliber stent if possible. Source of Funding: None

V1720 SIMPLIFIED METHOD OF PERCUTANEOUS NEPHROLITHOTOMY IN THE SIMPLE MALROTATION: TECHNICAL ASPECTS Jose Agudelo*, Euro Arias, Nasser Ktech, Luis Sanchez, Eduardo Peña, Ricardo Montiel, Manuel Riveros, Maracaibo, Venezuela INTRODUCTION AND OBJECTIVES: Renal malrotation is a malformation that is generally combined with other kidney anomalies. The isolated entity known as simple malrotation is rarely seen in a PCNL procedure. Simplified technique is a method described as a renal percutaneous approach that creates a plane of coincidence between the C arm beam axis and the needle axis. We are going to show the feasibility of this technique in the simple malrotation. METHODS: We present a video, with a female patient with a 1.4 cm stone, with 1116 Hounsfield units in a malrotated kidney. A percutaneous approach was planned with the patient in prone position. The inferior calyx was selected in this case, and it was marked with the C arm angulated as usual for this technique and the entrance point was selected. A more vertical puncture, parallel to the intervertebral muscle, was done with success. Dilation as well as stone management was accomplished, keeping the vertical orientation at all time. A stone free status was reached for this patient. RESULTS: The technique shown in the video was applied to 6 consecutive patients with this infrequent malformation. The mean stone size was 2.1 cm, 4 of them were located in the renal pelvis, a mean operative time of 52 minutes was recorded, a hemoglobin decrease of o.6 g/dl, mean hospital stay of 1.3 days, and the stone free status was reached in all patients.