924 UTILIZATION AND COMPLICATIONS OF RETROPERITONEAL LYMPH NODE DISSECTION FROM THE NATIONWIDE INPATIENT SAMPLE

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THE JOURNAL OF UROLOGY姞

9.1%), precocious pseudopuberty (1 patient, 4.5%) or scrotal pain (1 patient, 4.5%). Three patients were monorchid after contralateral orchiectomy for inguinal hernia repair (1 patients, 28 years before surgery) and non seminomatous germ cell tumor (2 patients, 1 month and 6 years before surgery). Diagnosis after frozen section examination was Leydig cell tumor in 20 of 22 cases (91% ). Mean histological size of the nodule was 1.11 cm (range 0.5 to 2.5 cm.). Preoperative FSH and LH levels were high in 4 patients. Tumor markers were normal before and after surgery. Follow up was conducted for all patients every 3 to 6 months with physical examination, tumor markers, scrotal and abdominal ultrasound, chest x-ray. 6 patients underwent CT scan. No local recurrence or metastasis were observed. 100% of patients are still alive with a 100% free disease survival. CONCLUSIONS: When diagnosed early Leydig cell tumors present a favorable follow up even its potential metastatic behaviour. In selected cases with motivated patients sparing surgery proved to be a feasible and safe choice. Source of Funding: None

923 MINIMALLY INVASIVE INGUINAL LYMPHADENECTOMY VIA ENDOSCOPIC GROIN DISSECTION: COMPREHENSIVE ASSESSMENT OF IMMEDIATE AND LONG-TERM COMPLICATIONS Viraj A. Master, S. Mohammad A. Jafri*, Lindsey Herrel, Kenneth Ogan, David A. Kooby, Keith A. Delman, Atlanta, GA INTRODUCTION AND OBJECTIVES: Open inguinal lymphadenectomy has been associated with significant post-operative morbidity. Recently, small series have demonstrated the feasibility and efficacy of performing endoscopic groin lymphadenectomy as an alternative to open surgery. Previously we presented the favorable results of our initial experience. Few reports of novel surgical methods present long-term complications. This report presents a detailed analysis of immediate and long-term complications associated with the procedure using, importantly, standardized complications reporting methodology, including the Clavien classification. METHODS: From September 2008 to December 2009, 29 patients underwent an endoscopic groin dissection for inguinal lymphadenectomy. The indications for dissection were cutaneous malignancies of the genitourinary area and lower extremity. The endoscopic dissection was performed as previously published. Data was prospectively collected regarding patient demographics and minor/major complications both during the perioperative period as well as long-term complications over one year. Complications were described using the Clavien Classification, as well the complication profile as described by Bevan-Thomas et al. for open inguinal lymphadenectomy. Minor complications were defined as mild to moderate leg edema, seroma formation not requiring aspiration, minimal skin edge necrosis requiring no therapy, and cellulitis managed with antibiotics. Major complications comprised death, sepsis, venous thromboembolism, re-exploration or other invasive procedures, severe leg edema interfering with ambulation, skin flap necrosis, and re-hospitalization. RESULTS: 41 endoscopic groin dissections (12 single-session bilateral) were performed in 29 patients. Patient characteristics include: median BMI 30 (range 19-53, mean 31.1), median age 61 (range 16-86), median Charlson Comorbidity score 4 (range 1-11), and median LOS 1 (1-14). Median follow-up was 604 days (range 177-1172, mean 634). There were no perioperative mortalities. A total of 11 (27%) minor and 6 (14.6%) major complications occurred. CONCLUSIONS: Complications from endoscopic minimally invasive lymphadenectomy have low clinical morbidity. Analysis of the immediate and long-term complication profile using standardized Clavien complications reporting reveal that this is safe, even in patients with high Charlson Comorbidity score and BMI. Major complications were most often infection, requiring intravenous antibiotics. Source of Funding: None

Vol. 187, No. 4S, Supplement, Monday, May 21, 2012

924 UTILIZATION AND COMPLICATIONS OF RETROPERITONEAL LYMPH NODE DISSECTION FROM THE NATIONWIDE INPATIENT SAMPLE Diana K. Bowen*, Lee C. Zhao, John P. Cashy, Shilajit D. Kundu, Chicago, IL INTRODUCTION AND OBJECTIVES: Retroperitoneal lymph node dissection (RPLND) is an integral component of the management of testis cancer. We attempted to determine the utilization of open versus laparoscopic technique as well as the occurrence of common complications post-operatively. METHODS: Using the Nationwide Inpatient Sample Database (NIS), we identified 622 patients from the years 2002 to 2008 with ICD-9 codes for both testis cancer and excision of lymph nodes (189 and 40.3, 40.50-40.59 respectively) as representative of those undergoing RPLND. The mean age ⫾ SD was 29.8 ⫾ 10 years (range of 2 to 71). RESULTS: Length of hospital stay after RPLND was 5.5 ⫾ 3.6 days, with a range of 1-38 days. The vast majority of procedures (83%) were performed at urban teaching hospitals. Insertion of ureteral stent was performed in 4% of cases. Pulmonary embolism (PE) was reported at 2.4% (15 of 622), with no reported incidence of deep venous thrombosis (DVT). There were no reported mortalities. RPLND was performed laparoscopically in 1.93% of the total number of procedures (12 of 622). Complications that occurred too infrequently to report in the NIS included chylous leak, ileus or bowel obstruction as represented by TPN coding, vena cava resection, bowel injury, and post-operative respiratory distress. CONCLUSIONS: Complications of DVT and PE were relatively rare in this group of younger patients and with no associated mortality, an important observation as prophylactic anticoagulation may be associated with lymphatic leakage. Although these procedures were performed most frequently at urban teaching hospitals, RPLND was performed laparoscopically less than 2% of the time, perhaps reflecting persistent concerns over quality of dissection and oncologic control. Source of Funding: None

925 RANDOMIZED CONTROLLED TRIAL OF THE SHANG RING VERSUS CONVENTIONAL TECHNIQUES FOR ADULT MALE CIRCUMCISION IN KENYA AND ZAMBIA David Sokal*, Durham, NC; Mark Barone, New York City, NY; Raymond Simba, Homa Bay, Kenya; Quentin Awori, Kisumu, Kenya; Kasonde Bowa, Robert Zulu, Lusaka, Zambia; Peter Cherutich, Nicolas Muraguri, John Masasabi Wekesa, Nairobi, Kenya; Paul Perchal, NYC, NY; Prisca Kasonde, Lusaka, Zambia; Stephanie Combes, Durham, NC; Puneet Masson, Richard Lee, Marc Goldstein, Philip Li, New York, NY INTRODUCTION AND OBJECTIVES: Adult male circumcision (MC) reduces risk of HIV, HPV and HSV infection, but conventional MC requires a high degree of skill. The Shang Ring (SR) provides a minimally invasive approach with the potential to reduce training time and surgical duration as neither hemostasis nor suturing are needed. The objectives of this study were to compare pain, acceptability, safety and ease of use of SR vs. conventional MC. METHODS: The SR consists of inner and outer rings, with eversion of the foreskin over the inner ring before application of the outer ring and cutting of the foreskin. The device is removed one week later. We conducted a randomized controlled trial of SR vs. conventional MC (forceps guided in Kenya; dorsal slit in Zambia) with planned enrollment of 200 men aged 18 to 54 years at each site. A visual analog scale was used for pain evaluation at 5 timepoints in the first 48 hours after MC. Adverse events were graded as mild, moderate and severe using established criteria. RESULTS: We circumcised 198 men at each site. In Kenya, 96 men had ShangRing and 102 men had conventional procedures. One