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90 IS TRANSPUBIC URETHROPLASTY PERFORMED FREQUENTLY IN CHILDREN?
Vol. 187, No. 4S, Supplement, Saturday, May 19, 2012
anterior urethral strictures. This procedure results in a long term high success rate with few complications that occurs primarily during the first 12 postoperative months. Source of Funding: None
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median age was 44 years (range 11-75). Median follow-up was 12 months (range 1 month to 20.75 years). Overall, 139 patients (83%, 139/168) were successfully treated. For patients who failed, median time to failure was 18 months (range 7 months and 15.7 years). CONCLUSIONS: Re-operative urethroplasty is a successful treatment option for most men, but rates of success were lower than for men undergoing their first urethroplasty. Patients who failed treatment had longer strictures and more complex repairs.
RECONFIGURATION OF BUCCAL MUCOSA GRAFT FOR URETHROPLASTY: TECHNIQUE AND RESULTS Yuka Yamaguchi*, Ty Higuchi, Hadley Wood, Kenneth Angermeier, Cleveland, OH INTRODUCTION AND OBJECTIVES: While buccal mucosa is the most commonly used graft in urethral reconstruction, the size of the graft that can be harvested from 1 cheek may be limited by the patient’s anatomy. In order to try to avoid use of other oral sites, we have reconfigured buccal grafts to provide improved length and width. The objective of this study is to report the surgical technique and patient outcomes utilizing this approach. METHODS: We retrospectively identified patients who had undergone urethral reconstruction using buccal graft reconfiguration from 1997-2011. Reconfiguration was performed by harvesting a trapezoidal graft, excising the widened part of the graft distally and suturing it to the narrower proximal end to create a rectangle. Forty-one patients were identified who met study criteria and were included in the analysis. Data collected included stricture location, urethrotomy defect length, type of repair, complications and postoperative follow-up. RESULTS: Of the 41 patients, 7.3% (3/41) had penile, 12.2% (5/41) penile-bulbar and 80.5% (33/41) bulbar strictures. The types of urethroplasty performed included 29.3% (12/41) dorsal onlay, 9.8% (4/41) dorsal augmented anastomotic urethroplasty (AAU), 22.0% (9/ 41) ventral onlay and 39.0% (16/41) ventral AAU. Median urethrotomy defect length was 7cm (range: 5-9.5cm) and median graft length was 6.5cm (range: 5-9.5cm). Thirty-nine patients had three-week postoperative VCUG available for review. All were normal. At a median follow-up of 7.0 months (range 3.9-60.2), 95.1% (39/41) were patent with no evidence of recurrence. Two patients were noted cystoscopically to have focal stricture recurrence at 3.9 and 25.8 months after surgery, but neither has required an additional procedure to date. There was no increased morbidity at the donor site compared to our standard buccal graft population. CONCLUSIONS: We conclude that buccal graft reconfiguration is a useful technique to increase the size of the graft that may be harvested from 1 cheek. This allows preservation of other oral sites for future use if necessary. Source of Funding: None
88 RE-OPERATIVE URETHROPLASTY FOR FAILED PRIOR URETHRAL RECONSTRUCTION: OUTCOMES OF A 35 YEAR EXPERIENCE Sarah D. Blaschko, MD*, Jack W. McAninch, MD, Jeremy B. Myers, MD, Benjamin N. Breyer, MD, San Francisco, CA INTRODUCTION AND OBJECTIVES: Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment of urethral strictures, fewer studies have addressed treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We sought to examine outcome results for re-operative urethroplasty. METHODS: A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with re-operative urethroplasty after failed prior urethral reconstruction. Stricture length, stricture location, re-operative urethroplasty intervention, and time until re-operative urethroplasty failure were evaluated. RESULTS: Of 1156 cases, 168 patients underwent a re-operative urethroplasty after at least one failed prior urethroplasty. Patients
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Source of Funding: None
89 URETHROPLASTY AFTER FAILED OPEN REPAIR – FUNCTIONAL RESULTS AND PATIENT SATISFACTION Daniel Pfalzgraf*, Luis Kluth, Philip Reiss, Margit Fisch, Roland Dahlem, Hamburg, Germany INTRODUCTION AND OBJECTIVES: With good long-term results of open reconstruction for urethral strictures, most pts remain recurrence-free after urethroplasty. However, data on patient satisfaction and quality of life as well as on the results for open reconstruction after failed urethroplasty is limited. METHODS: Retrospective analysis by chart review and a nonvalidated standardized questionnaire. 43 pts were treated with open reconstruction after failed urethroplasty 01/2009-10/2010. Previous surgeries, recurrence rates, complications and change in quality of life were assessed. RESULTS: Mean age 43 years (range, 17-77), mean follow-up 12.4 months (range, 4-23). Stricture length up to 2cm in 12% of pts, 2-6cm in 44% and ⬎6cm in 44%. 22 pts (51.6%) had had stricture dilation before: 6 once, 5 two to five times, and 11 more than 5 times, Stricture incision had been performed on 69.8%: once in 5pts, two to five times in 20 and more than five times in 5. Previous open surgery had been performed once in 30 patients (69.8%), more than once in 13pts (30.2%). The success rate was 81.4% with all recurrences after buccal mucosa graft (BMG). Urinary dribbling was almost never or rarely seen in 20 pts (45.1.9%), sometimes in 13 (30.2%) and often or nearly always in 5 (11.6%). Urinary stress incontinence grade I was reported by 4 pts (9.3%), in one patient (2.3%) with transsphincteric stricture, an incontinence grade III was found. Penile shortening and deviation: no deviation in 35 pts (81.4%), slight in 4 (9.3%), some in 3 (7%) and strong in 1 (2.3%). Slight shortening in 9 (20.9%), some in 4 (9.3%), strong in 2 (4.7%); no shortening in 28 (65.1%). Glans sensitivity: 29 pts (67.4%) no change, 10 (23.3%) altered (non disturbing), 4 (9.3%) disturbing alteration. Ejaculation was normal in 25 pts (58.1%) and slightly reduced in strength in 9 (20.9%), reduced in 2 (4.7%). No patient experienced relevant pain at ejaculation. Overall satisfaction with surgery was 69.8%; 7% were indifferent, 18.6% (8pts) dissatisfied (these comprise five with stricture recurrence; in the remaining three, no data about the reason for dissatisfaction is available). An improvement in quality of life (QoL) was found in 76.7%, in 11.6% it was unchanged. A slight reduction in QoL was observed in 4,7%, no serious reduction occurred. CONCLUSIONS: Urethroplasty after failed open repair gives good functional results and shows a high patient satisfaction rate. However, results are not quite as good as for primary repair, emphasizing the importance of a successful primary repair. Source of Funding: None
90 IS TRANSPUBIC URETHROPLASTY PERFORMED FREQUENTLY IN CHILDREN? Mamdouh koraitim*, Alexandria, Egypt INTRODUCTION AND OBJECTIVES: Transpubic urethroplasty has been repeatedly reported to be used more frequently in children than in adults. Also, it has been claimed that this is attributed to the confined perineum and delicate structures in children. In this
e38
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study we attempted to learn how much frequently the transpubic urethroplasty is performed in children compared to adults. Also, we attempted to determine the reasons for the use of the transpubic approach in this group of patients. METHODS: A total of 45 boys, 3 to 18 years old, underwent anastomotic repair of a post-pelvic fracture urethral injury (PFUI) between 1995 and 2009. During the same period 87 adults, 19 to 50 years old, underwent the same urethral repair of a PFUI. All preoperative, operative and postoperative data were recorded prospectively in our data base. The preoperative urethrograms were reinterpreted to measure the length of bulboprotatic urethral gap, length of bulbar urethra and transverse diameter of the pubic arch (as a representative of the operative space available in the perineum). In addition, we calculated the index of gapo/urethrometry (G/U) by dividing the length of urethral gap by that of bulbar urethra. RESULTS: Of 45 children 26 (58%) were corrected by a simple perineal bulbo-prostatic urethral anastomosis and 19 (42%) by a perineo-abdominal transpubic procedure. Of 87 adults 61 (70%) were corrected via the perineum and 26 (30%) via a transpubic approach. In children group the mean (range) of width of the pubic arch of cases who underwent perineal and transpubic repair was 3.6 (3.0-4.5) cm vs. 3.4 (3.0-4.5) cm, respectively (p ⬎0.05). The mean (range) of urethral gap length and G/U index of same cases were 1.3 (0.5-2.7) cm vs. 3.5 (2.5-6.0) cm, and 0.20 (0.11-0.34) vs. 0.64 (0.40-0.90), respectively (p ⬍0.001). CONCLUSIONS: The transpubic approach for posterior urethroplasty is more frequently used in children than in adults (42% vs. 30%, p ⬍0.05). It seems that the “confined perineum” in children is not a significant determinant of the frequently used transpubic approach in this group of patients. Rather, this may be explained by the normally inherited short bulbar urethra and, consequently, the high value of Gapo/Urethrometry index in children. Source of Funding: None
91 THE SURGICAL CORRECTION OF BLADDER NECK CONTRACTURE (BNC) FOLLOWING THE TREATMENT OF PROSTATE CANCER Anthony Mundy*, Daniela Andrich, London, United Kingdom INTRODUCTION AND OBJECTIVES: The majority of patients with BNC following surgery or radiotherapy for prostate cancer can be treated endoscopically but this is not always successful. On the other hand surgical correction is rarely reported, indeed only 24 cases have been described in the English literature. Herein we describe our experience with 32 patients and distinguish between BNC due to surgery and BNC due to radiotherapy. METHODS: Group 1: 17 patients with BNC following radical retropubic prostatectomy (RRP). Group 2: 6 patients with BNC following RRP plus salvage external beam radiotherapy (EBRT). Group 3: 9 patients with BNC following EBRT with or without other salvage treatment with either brachytherapy or HIFU. All patients had failed to respond to several attempts at urethrotomy, bladder neck incision and/or bladder neck resection. Patients in group 1 and 2 were treated by transperineal excision of their BNC and re-do vesico-urethral anastomosis (VUA). Patients in Group 3 underwent salvage RRP. RESULTS: Two of the 17 patients in Group 1 developed a recurrent BNC which was successfully dealt with by a further redo-VUA so that ultimately all 17 were cured of their BNC. Two of the 6 patients in Group 2 developed a recurrent BNC and were managed with a long term suprapubic catheter (SPC). Of the 21/23 success in Groups 1 and 2, all 21 needed implantation of an AUS to restore continence. Six of the 9 patients in Group 3 had successful correction of their BNC one of whom needed an AUS to restore continence. The 3 failures in Group 3 were managed by a long-term SPC. In the patients who had had EBRT, surgery was technically more challenging, the post-operative recovery was more protracted and the outcome was less satisfactory.
Vol. 187, No. 4S, Supplement, Saturday, May 19, 2012
CONCLUSIONS: Re-do VUA is a very successful management of patients with refractory post-surgical BNC but all patients require an AUS so treatment is a two-stage process. After irradiation, surgery is significantly more complicated and the outcome less satisfactory but nonetheless successful in the majority. Source of Funding: None
92 RADIATION ASSOCIATED BLADDER OUTLET MORBIDITY: AN UNDERREPORTED CLINICAL CHALLENGE Olivia Lee*, Hao Nguyen, Anna Lawrence, Anthony Stone, Sacramento, CA INTRODUCTION AND OBJECTIVES: Urethral stricture and bladder neck contracture (BNC) associated with radiation therapy for prostate cancer, have poor outcomes. The objective of this study is to compare the outcomes of bladder outlet management in irradiated and non-irradiated patients after prostate cancer treatment. METHODS: A retrospective review was performed on 28 patients with bladder outlet problems after treatment of prostate cancer. Fifteen patients had been irradiated (BNC, urethral stricture, nonhealing urethra) and 13 presented with BNC after radical prostatectomy (RP) only. Success was measured by the number of procedures required to establish voiding and continence. RESULTS: Irradiated patients received an average of 4 endoscopic procedures, with 27% (4/15) (p⬍.01) achieving spontaneous voiding. Forty percent (6/15) required intermittent catheterization and the remaining 33% (5/15) required indwelling catheter. The non-irradiated patients received an average of 3 endoscopic procedures, and 84% (12/13) (p⬍.01) achieved spontaneous voiding. One patient required intermittent catheterization. Only 6/15 patients (40%) were continent in the radiation group, compared to 12/13 (92%). In this latter group, 6 patients had successful artificial sphincter (AUS) placement, whereas none of the radiation patients were deemed appropriate for AUS. Median follow up time was 25 months. A subset of 7 patients in the radiation group presented with dystrophic calcification with particularly worse outcomes. CONCLUSIONS: Endoscopic bladder outlet procedures should be used judiciously in irradiated patients. Failure of endoscopic treatment should prompt consideration of non traditional management such as stent or diversion. Patients considering radiation therapy should be counseled on this morbidity, which significantly impairs quality of life. Source of Funding: None
93 MULTIVARIATE ANALYSIS OF PROLONGED CATHETERIZATION AND OTHER CLINICAL FACTORS ASSOCIATED WITH ARTIFICIAL URINARY SPHINCTER CUFF EROSION Casey Seideman*, Jesse Mierzwiak, Steven Hudak, Mehrad Adibi, Allen Morey, Dallas, TX INTRODUCTION AND OBJECTIVES: Erosion of the artificial urinary sphincter (AUS) cuff is a devastating event previously linked to various risk factors such as prior radiation and hypertension. We have noted that prolonged catheterization (PC) often precedes the presentation of cuff erosion. We reviewed a 10-year series of AUS patients to determine precipitating circumstances and comorbid conditions associated with cuff erosion events. METHODS: Following IRB approval, we reviewed all men having AUS implantation or revision at our tertiary institution from 2000-10 with at least 6 months follow-up. Clinic notes were examined to determine whether patients sustained PC(⬎ 48 hours) following AUS placement. Comorbidities including radiation therapy, diabetes, coronary artery disease, and erectile dysfunction were recorded. Surgical details including AUS cuff size and incision location (penoscrotal, transcorporal, perineal) were recorded, as well as concomitant IPP placement. RESULTS: Of 258 AUS patients reviewed, 200 met inclusion criteria with average follow-up of 24 months. AUS cuff erosions were
anterior urethral strictures. This procedure results in a long term high success rate with few complications that occurs primarily during the first 12 postoperative months. Source of Funding: None
87
THE JOURNAL OF UROLOGY姞
median age was 44 years (range 11-75). Median follow-up was 12 months (range 1 month to 20.75 years). Overall, 139 patients (83%, 139/168) were successfully treated. For patients who failed, median time to failure was 18 months (range 7 months and 15.7 years). CONCLUSIONS: Re-operative urethroplasty is a successful treatment option for most men, but rates of success were lower than for men undergoing their first urethroplasty. Patients who failed treatment had longer strictures and more complex repairs.
RECONFIGURATION OF BUCCAL MUCOSA GRAFT FOR URETHROPLASTY: TECHNIQUE AND RESULTS Yuka Yamaguchi*, Ty Higuchi, Hadley Wood, Kenneth Angermeier, Cleveland, OH INTRODUCTION AND OBJECTIVES: While buccal mucosa is the most commonly used graft in urethral reconstruction, the size of the graft that can be harvested from 1 cheek may be limited by the patient’s anatomy. In order to try to avoid use of other oral sites, we have reconfigured buccal grafts to provide improved length and width. The objective of this study is to report the surgical technique and patient outcomes utilizing this approach. METHODS: We retrospectively identified patients who had undergone urethral reconstruction using buccal graft reconfiguration from 1997-2011. Reconfiguration was performed by harvesting a trapezoidal graft, excising the widened part of the graft distally and suturing it to the narrower proximal end to create a rectangle. Forty-one patients were identified who met study criteria and were included in the analysis. Data collected included stricture location, urethrotomy defect length, type of repair, complications and postoperative follow-up. RESULTS: Of the 41 patients, 7.3% (3/41) had penile, 12.2% (5/41) penile-bulbar and 80.5% (33/41) bulbar strictures. The types of urethroplasty performed included 29.3% (12/41) dorsal onlay, 9.8% (4/41) dorsal augmented anastomotic urethroplasty (AAU), 22.0% (9/ 41) ventral onlay and 39.0% (16/41) ventral AAU. Median urethrotomy defect length was 7cm (range: 5-9.5cm) and median graft length was 6.5cm (range: 5-9.5cm). Thirty-nine patients had three-week postoperative VCUG available for review. All were normal. At a median follow-up of 7.0 months (range 3.9-60.2), 95.1% (39/41) were patent with no evidence of recurrence. Two patients were noted cystoscopically to have focal stricture recurrence at 3.9 and 25.8 months after surgery, but neither has required an additional procedure to date. There was no increased morbidity at the donor site compared to our standard buccal graft population. CONCLUSIONS: We conclude that buccal graft reconfiguration is a useful technique to increase the size of the graft that may be harvested from 1 cheek. This allows preservation of other oral sites for future use if necessary. Source of Funding: None
88 RE-OPERATIVE URETHROPLASTY FOR FAILED PRIOR URETHRAL RECONSTRUCTION: OUTCOMES OF A 35 YEAR EXPERIENCE Sarah D. Blaschko, MD*, Jack W. McAninch, MD, Jeremy B. Myers, MD, Benjamin N. Breyer, MD, San Francisco, CA INTRODUCTION AND OBJECTIVES: Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment of urethral strictures, fewer studies have addressed treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We sought to examine outcome results for re-operative urethroplasty. METHODS: A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with re-operative urethroplasty after failed prior urethral reconstruction. Stricture length, stricture location, re-operative urethroplasty intervention, and time until re-operative urethroplasty failure were evaluated. RESULTS: Of 1156 cases, 168 patients underwent a re-operative urethroplasty after at least one failed prior urethroplasty. Patients
e37
Source of Funding: None
89 URETHROPLASTY AFTER FAILED OPEN REPAIR – FUNCTIONAL RESULTS AND PATIENT SATISFACTION Daniel Pfalzgraf*, Luis Kluth, Philip Reiss, Margit Fisch, Roland Dahlem, Hamburg, Germany INTRODUCTION AND OBJECTIVES: With good long-term results of open reconstruction for urethral strictures, most pts remain recurrence-free after urethroplasty. However, data on patient satisfaction and quality of life as well as on the results for open reconstruction after failed urethroplasty is limited. METHODS: Retrospective analysis by chart review and a nonvalidated standardized questionnaire. 43 pts were treated with open reconstruction after failed urethroplasty 01/2009-10/2010. Previous surgeries, recurrence rates, complications and change in quality of life were assessed. RESULTS: Mean age 43 years (range, 17-77), mean follow-up 12.4 months (range, 4-23). Stricture length up to 2cm in 12% of pts, 2-6cm in 44% and ⬎6cm in 44%. 22 pts (51.6%) had had stricture dilation before: 6 once, 5 two to five times, and 11 more than 5 times, Stricture incision had been performed on 69.8%: once in 5pts, two to five times in 20 and more than five times in 5. Previous open surgery had been performed once in 30 patients (69.8%), more than once in 13pts (30.2%). The success rate was 81.4% with all recurrences after buccal mucosa graft (BMG). Urinary dribbling was almost never or rarely seen in 20 pts (45.1.9%), sometimes in 13 (30.2%) and often or nearly always in 5 (11.6%). Urinary stress incontinence grade I was reported by 4 pts (9.3%), in one patient (2.3%) with transsphincteric stricture, an incontinence grade III was found. Penile shortening and deviation: no deviation in 35 pts (81.4%), slight in 4 (9.3%), some in 3 (7%) and strong in 1 (2.3%). Slight shortening in 9 (20.9%), some in 4 (9.3%), strong in 2 (4.7%); no shortening in 28 (65.1%). Glans sensitivity: 29 pts (67.4%) no change, 10 (23.3%) altered (non disturbing), 4 (9.3%) disturbing alteration. Ejaculation was normal in 25 pts (58.1%) and slightly reduced in strength in 9 (20.9%), reduced in 2 (4.7%). No patient experienced relevant pain at ejaculation. Overall satisfaction with surgery was 69.8%; 7% were indifferent, 18.6% (8pts) dissatisfied (these comprise five with stricture recurrence; in the remaining three, no data about the reason for dissatisfaction is available). An improvement in quality of life (QoL) was found in 76.7%, in 11.6% it was unchanged. A slight reduction in QoL was observed in 4,7%, no serious reduction occurred. CONCLUSIONS: Urethroplasty after failed open repair gives good functional results and shows a high patient satisfaction rate. However, results are not quite as good as for primary repair, emphasizing the importance of a successful primary repair. Source of Funding: None
90 IS TRANSPUBIC URETHROPLASTY PERFORMED FREQUENTLY IN CHILDREN? Mamdouh koraitim*, Alexandria, Egypt INTRODUCTION AND OBJECTIVES: Transpubic urethroplasty has been repeatedly reported to be used more frequently in children than in adults. Also, it has been claimed that this is attributed to the confined perineum and delicate structures in children. In this
e38
THE JOURNAL OF UROLOGY姞
study we attempted to learn how much frequently the transpubic urethroplasty is performed in children compared to adults. Also, we attempted to determine the reasons for the use of the transpubic approach in this group of patients. METHODS: A total of 45 boys, 3 to 18 years old, underwent anastomotic repair of a post-pelvic fracture urethral injury (PFUI) between 1995 and 2009. During the same period 87 adults, 19 to 50 years old, underwent the same urethral repair of a PFUI. All preoperative, operative and postoperative data were recorded prospectively in our data base. The preoperative urethrograms were reinterpreted to measure the length of bulboprotatic urethral gap, length of bulbar urethra and transverse diameter of the pubic arch (as a representative of the operative space available in the perineum). In addition, we calculated the index of gapo/urethrometry (G/U) by dividing the length of urethral gap by that of bulbar urethra. RESULTS: Of 45 children 26 (58%) were corrected by a simple perineal bulbo-prostatic urethral anastomosis and 19 (42%) by a perineo-abdominal transpubic procedure. Of 87 adults 61 (70%) were corrected via the perineum and 26 (30%) via a transpubic approach. In children group the mean (range) of width of the pubic arch of cases who underwent perineal and transpubic repair was 3.6 (3.0-4.5) cm vs. 3.4 (3.0-4.5) cm, respectively (p ⬎0.05). The mean (range) of urethral gap length and G/U index of same cases were 1.3 (0.5-2.7) cm vs. 3.5 (2.5-6.0) cm, and 0.20 (0.11-0.34) vs. 0.64 (0.40-0.90), respectively (p ⬍0.001). CONCLUSIONS: The transpubic approach for posterior urethroplasty is more frequently used in children than in adults (42% vs. 30%, p ⬍0.05). It seems that the “confined perineum” in children is not a significant determinant of the frequently used transpubic approach in this group of patients. Rather, this may be explained by the normally inherited short bulbar urethra and, consequently, the high value of Gapo/Urethrometry index in children. Source of Funding: None
91 THE SURGICAL CORRECTION OF BLADDER NECK CONTRACTURE (BNC) FOLLOWING THE TREATMENT OF PROSTATE CANCER Anthony Mundy*, Daniela Andrich, London, United Kingdom INTRODUCTION AND OBJECTIVES: The majority of patients with BNC following surgery or radiotherapy for prostate cancer can be treated endoscopically but this is not always successful. On the other hand surgical correction is rarely reported, indeed only 24 cases have been described in the English literature. Herein we describe our experience with 32 patients and distinguish between BNC due to surgery and BNC due to radiotherapy. METHODS: Group 1: 17 patients with BNC following radical retropubic prostatectomy (RRP). Group 2: 6 patients with BNC following RRP plus salvage external beam radiotherapy (EBRT). Group 3: 9 patients with BNC following EBRT with or without other salvage treatment with either brachytherapy or HIFU. All patients had failed to respond to several attempts at urethrotomy, bladder neck incision and/or bladder neck resection. Patients in group 1 and 2 were treated by transperineal excision of their BNC and re-do vesico-urethral anastomosis (VUA). Patients in Group 3 underwent salvage RRP. RESULTS: Two of the 17 patients in Group 1 developed a recurrent BNC which was successfully dealt with by a further redo-VUA so that ultimately all 17 were cured of their BNC. Two of the 6 patients in Group 2 developed a recurrent BNC and were managed with a long term suprapubic catheter (SPC). Of the 21/23 success in Groups 1 and 2, all 21 needed implantation of an AUS to restore continence. Six of the 9 patients in Group 3 had successful correction of their BNC one of whom needed an AUS to restore continence. The 3 failures in Group 3 were managed by a long-term SPC. In the patients who had had EBRT, surgery was technically more challenging, the post-operative recovery was more protracted and the outcome was less satisfactory.
Vol. 187, No. 4S, Supplement, Saturday, May 19, 2012
CONCLUSIONS: Re-do VUA is a very successful management of patients with refractory post-surgical BNC but all patients require an AUS so treatment is a two-stage process. After irradiation, surgery is significantly more complicated and the outcome less satisfactory but nonetheless successful in the majority. Source of Funding: None
92 RADIATION ASSOCIATED BLADDER OUTLET MORBIDITY: AN UNDERREPORTED CLINICAL CHALLENGE Olivia Lee*, Hao Nguyen, Anna Lawrence, Anthony Stone, Sacramento, CA INTRODUCTION AND OBJECTIVES: Urethral stricture and bladder neck contracture (BNC) associated with radiation therapy for prostate cancer, have poor outcomes. The objective of this study is to compare the outcomes of bladder outlet management in irradiated and non-irradiated patients after prostate cancer treatment. METHODS: A retrospective review was performed on 28 patients with bladder outlet problems after treatment of prostate cancer. Fifteen patients had been irradiated (BNC, urethral stricture, nonhealing urethra) and 13 presented with BNC after radical prostatectomy (RP) only. Success was measured by the number of procedures required to establish voiding and continence. RESULTS: Irradiated patients received an average of 4 endoscopic procedures, with 27% (4/15) (p⬍.01) achieving spontaneous voiding. Forty percent (6/15) required intermittent catheterization and the remaining 33% (5/15) required indwelling catheter. The non-irradiated patients received an average of 3 endoscopic procedures, and 84% (12/13) (p⬍.01) achieved spontaneous voiding. One patient required intermittent catheterization. Only 6/15 patients (40%) were continent in the radiation group, compared to 12/13 (92%). In this latter group, 6 patients had successful artificial sphincter (AUS) placement, whereas none of the radiation patients were deemed appropriate for AUS. Median follow up time was 25 months. A subset of 7 patients in the radiation group presented with dystrophic calcification with particularly worse outcomes. CONCLUSIONS: Endoscopic bladder outlet procedures should be used judiciously in irradiated patients. Failure of endoscopic treatment should prompt consideration of non traditional management such as stent or diversion. Patients considering radiation therapy should be counseled on this morbidity, which significantly impairs quality of life. Source of Funding: None
93 MULTIVARIATE ANALYSIS OF PROLONGED CATHETERIZATION AND OTHER CLINICAL FACTORS ASSOCIATED WITH ARTIFICIAL URINARY SPHINCTER CUFF EROSION Casey Seideman*, Jesse Mierzwiak, Steven Hudak, Mehrad Adibi, Allen Morey, Dallas, TX INTRODUCTION AND OBJECTIVES: Erosion of the artificial urinary sphincter (AUS) cuff is a devastating event previously linked to various risk factors such as prior radiation and hypertension. We have noted that prolonged catheterization (PC) often precedes the presentation of cuff erosion. We reviewed a 10-year series of AUS patients to determine precipitating circumstances and comorbid conditions associated with cuff erosion events. METHODS: Following IRB approval, we reviewed all men having AUS implantation or revision at our tertiary institution from 2000-10 with at least 6 months follow-up. Clinic notes were examined to determine whether patients sustained PC(⬎ 48 hours) following AUS placement. Comorbidities including radiation therapy, diabetes, coronary artery disease, and erectile dysfunction were recorded. Surgical details including AUS cuff size and incision location (penoscrotal, transcorporal, perineal) were recorded, as well as concomitant IPP placement. RESULTS: Of 258 AUS patients reviewed, 200 met inclusion criteria with average follow-up of 24 months. AUS cuff erosions were