OP2-08 HYPERURICEMIA IS ASSOCIATED WITH DE NOVO CHRONIC KIDNEY DISEASE AFTER PARTIAL NEPHRECTOMY

THE JOURNAL OF UROLOGYâ

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patients with cutaneous ureterostomy, ileal conduit and neobladder substitution, respectively. Univariate analysis of several parameters identified the presence of hypertension, that of hydronephrosis and the episode of acute pyelonephritis, but not the type of UD, as significant predictors of postoperative renal deterioration. Furthermore, the presence of hypertension and the episode of acute pyelonephritis appeared to be independently associated with postoperative renal deterioration on multivariate analysis. CONCLUSIONS: These findings suggest that the incidence of renal deterioration was shown to be comparatively high in patients undergoing radical cystectomy, irrespective of the type of UD; therefore, special attention should be paid on the long-term preservation of renal function in these patients, particularly those with hypertension and/or the episode of acute pyelonephritis. Source of Funding: None

OP2-08 HYPERURICEMIA IS ASSOCIATED WITH DE NOVO CHRONIC KIDNEY DISEASE AFTER PARTIAL NEPHRECTOMY Jason Woo*, Hak Lee, Song Wang, Michael Liss, Nishant Patel, Ramzi Jabaji, Fuad Elkhoury, Michelle McDonald, Kerrin Palazzi, San Diego, CA; Reza Mehrazin, Anthony Patterson, Memphis, TN; Ithaar Derweesh, San Diego, CA INTRODUCTION AND OBJECTIVES: Uric acid elevation has been associated with an increased risk of chronic kidney disease (CKD) in the medical setting. We investigated the relationship between uric acid levels and renal function in patients with cortical renal masses undergoing partial nephrectomy (PN). METHODS: A multi-institutional retrospective study was performed of patients who underwent PN for renal cortical neoplasms, and who had preoperative and postoperative serum uric acid determined at 6 months follow-up. Data was analyzed between two groups: Patients who had hyperuricemia (>7mg/dL for males, >5.7 mg/dL for females) at 6 months follow up and patients with normal uric acid levels at 6 months follow up. Demographics, RENAL nephrometry score, peri-operative outcomes, and renal function were analyzed and compared. Rate of de novo estimated glomerular filtration rate<60 mL/ min/1.73 m2 (eGFR at most recent follow-up, MDRD equation) was primary outcome. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated for association of hyperuricemia with de novo eGFR <60. Multivariable analysis (MVA) was performed to identify factors associated with de novo eGFR<60 at last follow-up. RESULTS: 298 patients were identified with appropriate uric acid data from patients undergoing PN at UC San Diego Health System and the University of Tennessee Health Science Center (8/ 2005-8/2013). 112 had postoperative hyperuricemia and 186 had normal uric acid levels. Demographics, median ischemia time (normal uric acid 23 minutes vs. hyperuricemia 24 minutes, p¼0.1) and tumor size (normal uric acid 3.4 cm vs. hyperuricemia 3.5 cm, p¼0.153) were similar. More patients in the hyperuricemia group were male, non-Caucasian, obese with BMI >30, hypertensive and smokers (p <0.05). Rate of de novo eGFR<60 was significantly higher with hyperuricemia vs. normal uric acid levels (20.5% vs. 4.3% p<0.001). Hyperuricemia had sensitivity 74.2%, specificity 66.7%, PPV 20.5%, and NPV 95.7% for de novo eGFR<60. MVA for de novo eGFR<60 demonstrated hyperuricemia (OR 14.9, p<0.001) and increasing RENAL nephrometry score (OR 3.5, p¼0.017) as independent factors associated with development of de novo eGFR<60. CONCLUSIONS: Uric acid elevation postoperatively is independently associated with renal functional degeneration after PN. Further studies are requisite to clarify the etiology of this association. Source of Funding: None

Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014

OP2-09 DORSAL ONLAY SKIN GRAFT VERSUS BUCCAL MUCOSAL GRAFT FOR REPAIR OF LONG ANTERIOR URETHRAL STRICTURE; A PROSPECTIVE RANDOMIZED STUDY Mohamed Hussein*, Mohamed Zaki, Wael Gamal, Esam Salem, Ahmed Hammady, Sohag, Egypt INTRODUCTION AND OBJECTIVES: To compare between penile skin and buccal mucosa as a dorsal onlay graft for management of long anterior urethral stricture. METHODS: Between march 2008 and January 2012, 45 patients with bulbo-penile urethral stricture received dorsal onlay skin graft (DSG¼24) or dorsal onlay buccal mucosal graft (DBMG¼21) urethroplasty. Patients with lichen sclerosis and previous urethroplasty were excluded. Patients were evaluated by urethrography at 3 m, 6 m, 1 y and then when needed. Any subsequent intervention was considered a failure. Chi-square and Student-t test were used for analysis. RESULTS: Mean age of the patients was 38.5 y(21-62)&35 y(25-50) in DSG&DBMG respectively (p¼0.08). Stricture length was 11.6 cm (7-18)&9.9cm (5-15) in DSG&DBMG respectively (p¼0.16). Operative time was 121 min (90-150) &132 min(100-160) in DSG&DBMG respectively (p¼0.04). Mean follow up was 39 m(20-55) &34.8 m (16-50) in DSG&DBMG respectively (p¼0.09). One patient had wound infection and one had skin numbness in DSG group. Weak erection occurred in 3&2 patients in DSG&DBMG respectively who improved within 6-12 months. No donor site complications occurred. Stricture recurred in 3(12.5%) &2(9.5%) patients in DSG&DBMG respectively (p¼0.07). All recurred cases received anastmotic urethroplasy. CONCLUSIONS: Both penile skin and buccal mucosa had high and comparable success rate as a dorsal onlay graft for management of long bulbo-penile stricture with low complication rate. Source of Funding: none

OP2-10 PERFORMANCE OF ROBOTIC SIMULATED SKILLS TASKS IS POSITIVELY ASSOCIATED WITH CLINICAL ROBOTIC SURGICAL PERFORMANCE Monty Aghazadeh*, Michael Pan, Miguel Mercado, Brian Dunkin, Alvin Goh, Houston, TX INTRODUCTION AND OBJECTIVES: To date, there is no data in the robotic environment showing a significant relationship between simulation and clinical performance. Our group has previously demonstrated face, content, and construct validity of 4 Fundamental Inanimate Robotic Skills Tasks (FIRST) as well as 8 daVinci Skills Simulator (dVSS) virtual reality tasks. Herein, we compare user performance of these simulated robotic skills tasks (inanimate and virtual reality) to intraoperative performance (concurrent validity) during robotic prostatectomy (RP) METHODS: Seventeen urologic surgeons of varying robotic experience, including urology residents, fellows, and attendings, were enrolled in the study. Demographic and prior robotic experience were captured using a standardized questionnaire. User performance was assessed concurrently in simulated (FIRST exercises and dVSS tasks) and clinical environments (endopelvic dissection during RP). Intraoperative robotic clinical performance of participants was scored by the attending surgeon using the previously validated 6-metric Global Evaluative Assesment of Robotic Skills (GEARS) tool (expert performance was scored by a separate attending observer). Simulator and clinical performance were correlated using Spearman’s analysis. RESULTS: Performance was assessed in 13 trainees (PGY 2-6) and 4 expert robotic surgeons with >30 cases (1 fellow, 3 attendings). Median age (range) of the trainee and expert group was 29 (26-33) and 36.5 years old (33-48), respectively (p¼0.001). Median number of robotic cases (range) performed as primary surgeon for the trainee group was 16 (0-27) and 117 (58-600) for the expert group