- Email: [email protected]
MP29-01 MULTI-INSTITUTIONAL STUDY OF ROBOTIC BUCCAL MUCOSA GRAFT URETEROPLASTY: INITAL RESULTS
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
CONCLUSIONS: The learning algorithm presented for ThuVEP is safe and effective, and allows the trainee to gain surgical proficiency in a reasonable timeframe. Once surgical proficiency is achieved, ThuVEP should be considered a viable treatment option in all patients with symptomatic BPE, including those on anticoagulation and those with massive prostates. Source of Funding: August Kurten Foundation
V3-14 TRANSURETHRAL BIPOLAR ENUCLEATION OF THE PROSTATE, A NOVEL TECHNIQUE FOR BLADDER OUTLET OBSTRUCTION James M. Tracey, MD*, Jonathan N. Warner, MD, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: Enucleation of the prostate has been found to be an effective treatment for bladder outlet obstruction. Traditional techniques, such as the HOLEP, require specialized equipment and training that are not widespread amongst Urologists. Bipolar enucleation has recently been reported as a new method of prostate surgery but the nuances of the surgery are not yet well known. METHODS: We present our technique using common endoscopic equipment in video format with early post-operative outcome data. RESULTS: N¼13 patients. Mean prostate size, operative time, and EBL were 61.2 grams, 111 minutes, and 62.5mL, respectively. Mean hospital stay was 1.08 days. Pre-operative and six week postoperative parameters shown in Table 1 below. CONCLUSIONS: Transurethral Bipolar Enucleation (TuBE) is likely an effective procedure that can be accomplished with basic endoscopic equipment. Table 1 Efficacy Measures PreOperative
PostOperative
Post Void Residual (mL)
251.2
82.3
AUASI - Total
23.5
8.0
AUASU - QOL
4.7
1.5
Prostate Size vs Pathology Weight (grams)
61.2
17.3
Source of Funding: none
Trauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II Moderated Poster 29 Saturday, May 16, 2015
3:30 PM-5:30 PM
MP29-01 MULTI-INSTITUTIONAL STUDY OF ROBOTIC BUCCAL MUCOSA GRAFT URETEROPLASTY: INITAL RESULTS Lee C. Zhao*, Yuka Yamaguchi, Darren J. Bryk, New York, NY; Michael M. Maddox, Mary K. Powers, New Orleans, LA; Andrew Harbin, Ziho Lee, Laura Giusto, Philadelphia, PA; Benjamin R. Lee, New Orleans, LA; Daniel D. Eun, Philadelphia, PA; Michael D. Stifelman, New York, NY INTRODUCTION AND OBJECTIVES: Established techniques for treatment of long proximal or multifocal ureteral strictures such as ileal ureter or auto-transplantation have considerable associated morbidity. We previously presented robotic buccal mucosa graft ureteroplasty as an alternative approach to surgically manage complex strictures. We now present the initial results of a multi-institutional study of robotic buccal mucosa graft ureteroplasty.
e339
METHODS: Between October 2013 and November 2014, robotic assisted ureteral reconstructions using buccal mucosa graft were performed at three institutions in seven patients (mean age 46.3, range 23-67). The indication for surgery was a proximal or multifocal stricture not amenable to ureteroureterostomy or pyeloplasty. RESULTS: All seven patients underwent successful robotic assisted reconstruction of the ureter using buccal mucosa graft. There were no intra-operative complications. Mean operative time was 256 minutes (range 192-363) and mean estimated blood loss was 100mLs (range 40-200). Mean length of hospitalization was 2 days (range 1-3). At a median follow up of 158 days (range 11-368) there have been no post-operative complications. Five of the patients underwent retrograde or antegrade pyelogram at 6-7 weeks at the time of their stent removal, which confirmed patent anastomoses. Three patients underwent diuretic renal scans at 3-4 months post-operatively to confirm absence of obstruction. Further imaging is pending on the remaining patients. CONCLUSIONS: Robotic buccal mucosa graft is a feasible and reproducible option for reconstruction of complex ureteral strictures. Given the rarity of complex ureteral strictures requiring this type of reconstruction, multi-institutional studies are necessary to further study and optimize the procedure. Source of Funding: none
MP29-02 PREOPERATIVE PAD USAGE AND ELEVATED BMI ARE INDEPENDENTLY ASSOCIATED WITH FAILURE OF MALE TRANSOBTURATOR SLINGS IN OTHERWISE WELL SELECTED PATIENTS Logan Zemp*, Nathan Hoy, Keith Rourke, Edmonton, Canada INTRODUCTION AND OBJECTIVES: Trans-obturator urethral slings have been used successfully to treat men with postprostatectomy incontinence. Unfortunately sling failures occur even in otherwise well selected patients for reasons that are often poorly understood. The purpose of this study is to determine which clinical factors are associated with transobturator sling failure in properly selected men undergoing treatment for post-prostatectomy incontinence (PPI). METHODS: A retrospective review of 82 trans-obturator male sling procedures for post-prostatectomy incontinence (PPI) was performed over a 5-year period with a mean follow-up of 11 months. Patients with known risk factors for sling failure were excluded from this study including severe incontinence, radiation therapy, untreated detrusor overactivity, or neurogenic detrusor dysfunction. Clinical factors examined were patient age, co-morbidities, BMI, number of pre-operative pads, and a history of vesicourethral (VU) stenosis. The primary outcome measure was achieving continence defined as 1 or less pads postoperatively if preoperative pads were equal or greater than 2 or no pads if preoperative pads used was 1. A logistic regression was run using STATA software. RESULTS: The overall continence rate was achieved in 83% (N¼68) of patients. Mean pad usage pre-operatively was 2.8 pads per day. BMI and increasing preoperative pad usage were independently associated with failure to achieve continence. There was a difference in continence rates, 87.3% vs. 33.3% (p¼0.05), for BMI <35 and BMI>35 respectively. Continence rates differed with increasing preoperative pads from 93.5%, 88.0%, and 40.0% (p¼0.01) for 1-2, 3-4, and 5 pads respectively. Patient age and a history of vesicourethral stenosis did not significantly influence continence. CONCLUSIONS: Elevated BMI and increasing preoperative pad usage are associated with an increased risk of failure after transobturator slings for post-prostatectomy incontinence in patients otherwise deemed good candidates for male sling procedures. Source of Funding: None
Vol. 193, No. 4S, Supplement, Saturday, May 16, 2015
CONCLUSIONS: The learning algorithm presented for ThuVEP is safe and effective, and allows the trainee to gain surgical proficiency in a reasonable timeframe. Once surgical proficiency is achieved, ThuVEP should be considered a viable treatment option in all patients with symptomatic BPE, including those on anticoagulation and those with massive prostates. Source of Funding: August Kurten Foundation
V3-14 TRANSURETHRAL BIPOLAR ENUCLEATION OF THE PROSTATE, A NOVEL TECHNIQUE FOR BLADDER OUTLET OBSTRUCTION James M. Tracey, MD*, Jonathan N. Warner, MD, Ann Arbor, MI INTRODUCTION AND OBJECTIVES: Enucleation of the prostate has been found to be an effective treatment for bladder outlet obstruction. Traditional techniques, such as the HOLEP, require specialized equipment and training that are not widespread amongst Urologists. Bipolar enucleation has recently been reported as a new method of prostate surgery but the nuances of the surgery are not yet well known. METHODS: We present our technique using common endoscopic equipment in video format with early post-operative outcome data. RESULTS: N¼13 patients. Mean prostate size, operative time, and EBL were 61.2 grams, 111 minutes, and 62.5mL, respectively. Mean hospital stay was 1.08 days. Pre-operative and six week postoperative parameters shown in Table 1 below. CONCLUSIONS: Transurethral Bipolar Enucleation (TuBE) is likely an effective procedure that can be accomplished with basic endoscopic equipment. Table 1 Efficacy Measures PreOperative
PostOperative
Post Void Residual (mL)
251.2
82.3
AUASI - Total
23.5
8.0
AUASU - QOL
4.7
1.5
Prostate Size vs Pathology Weight (grams)
61.2
17.3
Source of Funding: none
Trauma/Reconstruction: Ureter, Bladder, External Genitalia and Urotrauma II Moderated Poster 29 Saturday, May 16, 2015
3:30 PM-5:30 PM
MP29-01 MULTI-INSTITUTIONAL STUDY OF ROBOTIC BUCCAL MUCOSA GRAFT URETEROPLASTY: INITAL RESULTS Lee C. Zhao*, Yuka Yamaguchi, Darren J. Bryk, New York, NY; Michael M. Maddox, Mary K. Powers, New Orleans, LA; Andrew Harbin, Ziho Lee, Laura Giusto, Philadelphia, PA; Benjamin R. Lee, New Orleans, LA; Daniel D. Eun, Philadelphia, PA; Michael D. Stifelman, New York, NY INTRODUCTION AND OBJECTIVES: Established techniques for treatment of long proximal or multifocal ureteral strictures such as ileal ureter or auto-transplantation have considerable associated morbidity. We previously presented robotic buccal mucosa graft ureteroplasty as an alternative approach to surgically manage complex strictures. We now present the initial results of a multi-institutional study of robotic buccal mucosa graft ureteroplasty.
e339
METHODS: Between October 2013 and November 2014, robotic assisted ureteral reconstructions using buccal mucosa graft were performed at three institutions in seven patients (mean age 46.3, range 23-67). The indication for surgery was a proximal or multifocal stricture not amenable to ureteroureterostomy or pyeloplasty. RESULTS: All seven patients underwent successful robotic assisted reconstruction of the ureter using buccal mucosa graft. There were no intra-operative complications. Mean operative time was 256 minutes (range 192-363) and mean estimated blood loss was 100mLs (range 40-200). Mean length of hospitalization was 2 days (range 1-3). At a median follow up of 158 days (range 11-368) there have been no post-operative complications. Five of the patients underwent retrograde or antegrade pyelogram at 6-7 weeks at the time of their stent removal, which confirmed patent anastomoses. Three patients underwent diuretic renal scans at 3-4 months post-operatively to confirm absence of obstruction. Further imaging is pending on the remaining patients. CONCLUSIONS: Robotic buccal mucosa graft is a feasible and reproducible option for reconstruction of complex ureteral strictures. Given the rarity of complex ureteral strictures requiring this type of reconstruction, multi-institutional studies are necessary to further study and optimize the procedure. Source of Funding: none
MP29-02 PREOPERATIVE PAD USAGE AND ELEVATED BMI ARE INDEPENDENTLY ASSOCIATED WITH FAILURE OF MALE TRANSOBTURATOR SLINGS IN OTHERWISE WELL SELECTED PATIENTS Logan Zemp*, Nathan Hoy, Keith Rourke, Edmonton, Canada INTRODUCTION AND OBJECTIVES: Trans-obturator urethral slings have been used successfully to treat men with postprostatectomy incontinence. Unfortunately sling failures occur even in otherwise well selected patients for reasons that are often poorly understood. The purpose of this study is to determine which clinical factors are associated with transobturator sling failure in properly selected men undergoing treatment for post-prostatectomy incontinence (PPI). METHODS: A retrospective review of 82 trans-obturator male sling procedures for post-prostatectomy incontinence (PPI) was performed over a 5-year period with a mean follow-up of 11 months. Patients with known risk factors for sling failure were excluded from this study including severe incontinence, radiation therapy, untreated detrusor overactivity, or neurogenic detrusor dysfunction. Clinical factors examined were patient age, co-morbidities, BMI, number of pre-operative pads, and a history of vesicourethral (VU) stenosis. The primary outcome measure was achieving continence defined as 1 or less pads postoperatively if preoperative pads were equal or greater than 2 or no pads if preoperative pads used was 1. A logistic regression was run using STATA software. RESULTS: The overall continence rate was achieved in 83% (N¼68) of patients. Mean pad usage pre-operatively was 2.8 pads per day. BMI and increasing preoperative pad usage were independently associated with failure to achieve continence. There was a difference in continence rates, 87.3% vs. 33.3% (p¼0.05), for BMI <35 and BMI>35 respectively. Continence rates differed with increasing preoperative pads from 93.5%, 88.0%, and 40.0% (p¼0.01) for 1-2, 3-4, and 5 pads respectively. Patient age and a history of vesicourethral stenosis did not significantly influence continence. CONCLUSIONS: Elevated BMI and increasing preoperative pad usage are associated with an increased risk of failure after transobturator slings for post-prostatectomy incontinence in patients otherwise deemed good candidates for male sling procedures. Source of Funding: None