- Email: [email protected]
V7-12 EVOLUTION OF REGIONAL HYPOTHERMIA IN ROBOTIC KIDNEY SURGERY
e738
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
both cases, extensive adhesions were found around the kidney, making anatomical identification and dissection difficult. Intra-operative ultrasound and a doppler probe were used to facilitate identification of anatomical structures. The fourth robotic arm and robotic hook were used to help mobilize the kidney and expose important structures. RESULTS: The results of the two cases are presented in Table 1. Both cases were completed robotically with no intraoperative complications. Post-operative course was uneventful and both the patients were discharged on day three. CONCLUSIONS: Salvage robotic kidney surgery for complications of robotic partial nephrectomy is rare but challenging. Intraoperative ultrasound, intraoperative doppler, the fourth robotic arm, and robotic hook can all be useful to define anatomy and facilitate dissection in difficult cases. Table 1 Perioperative outcomes of two cases undergoing salvage robotic kidney surgery. Case 1
Case 2
Console time (in minutes)
Outcome
200
200
Estimated blood loss (in ml)
250
200
Length of hospital stay (in days) Warm ischemia time (in minutes) Pathology
3
3
n/a
28
Atrophic kidney, no residual cancer
4.5 cm clear cell RCC, Fuhrman’s grade 2, negative surgical margins (Stage: pT1bN0Mx)
(RCC¼ Renal Cell Carcinoma)
Source of Funding: none
V7-10 ROBOTIC TRAPDOOR PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC TUMORS Blake W. Moore*, Ziho Lee, Lindsey A. Parkes, Philadelphia, PA; Mudhukar Patel, Lebanon, PA; Jack H. Mydlo, Daniel D. Eun, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Robotic partial nephrectomy (RPN) for entirely endophytic tumors has recently been shown to be feasible. Resecting a tumor that involves the central sinus fat at or near the hilum results in a deep cavity that may complicate the renorrhaphy due to the limited residual cortical tissue available for reapproximation. Furthermore, failure to tightly close the renal defect may increase the possibility for postoperative bleeding. We describe a novel Trapdoor RPN technique for completely endophytic tumors that utilizes a flap of renal parenchyma overlying the tumor to facilitate tight closure of the defect. METHODS: Our technique was performed in two patients by a single surgeon (DDE) between July and October 2013. After intracorporeal sonographic localization of the mass and clamping the hilum, sharp dissection was used to create our trapdoor, a “U” shaped flap of healthy parenchyma overlying the anterior surface of the tumor. The trapdoor was then propped open using a non-traumatic robotic grasping retractor, and the tumor was enucleated. Once the inner layer was closed and the hilum was unclamped, the trapdoor was closed and incorporated into the outer layer closure. RESULTS: For patient 1, warm ischemia time (WIT) was 39 minutes, estimated blood loss (EBL) was 200 milliliters, and console time was 125 minutes. Pathology showed a 2.5 cm T1a clear cell RCC with negative margins. For patient 2, WIT was 17 minutes, EBL was 100 millilters, and console time was 100 minutes. Pathology showed a 3.2 cm T1a clear cell RCC with negative margins. In both cases, there were no intraoperative or postoperative complications, and both patients were discharged on post operative day 1. CONCLUSIONS: Our Trapdoor RPN technique for completely endophytic tumors utilizes a flap of renal parenchyma overlying the tumor to assist in tight closure of the defect. Source of Funding: None
V7-11 ROBOT ASSISTED LAPAROSCOPIC PELVOVESICOSTOMY AND BLADDER HITCH FOR URETEROPELVIC JUNCTION OBSTRUCTION OF A RIGHT PELVIC KIDNEY WITH RETAINED URETERAL STENT William Brubaker*, Jack Zuckerman, Justin Watson, Shaun Wason, Norfolk, VA INTRODUCTION AND OBJECTIVES: Ureteropelvic junction (UPJ) obstruction occurs in one third of pelvic kidneys. The majority of cases are treated with dismembered pyeloplasty. The current patient presented with the additional complication of a retained and calcified ureteral stent that was refractory to endoscopic removal. Preoperative DMSA renal scan demonstrated 21% function in the right pelvic kidney, thus definitive repair was the objective. In this video we demonstrate a case in which a 31-year-old female with a right UPJ obstruction and a retained stent in a pelvic kidney is managed by robot assisted laparoscopic pyelovesicostomy with bladder hitch to the sacral promontory. METHODS: The patient was taken to the operating room for robot assisted laparoscopic pyelovesicostomy. The operation was performed utilizing dorsal lithotomy and steep Trendelenburg positioning. After incising the retroperitoneum the right ureter was traced posterior to the fallopian tube as it entered the bladder. The right ureter was divided distal to the UPJ and the retained stent as well as a more recently placed ureteral stent were both removed. The UPJ was widely spatulated. Pyeloscopy with a flexible cystoscope was performed demonstrating minimal stone debris. The bladder was filled and tunneled posterior to the right fallopian tube. The sacral promontory was cleared and the bladder was then hitched to the presacral fascia to ensure a tension-free anastomosis. The bladder was opened transversely and a watertight anastomosis of the right renal pelvis and bladder was performed. RESULTS: The patient recovered well and was discharged home on post-operative day one. She had a Foley catheter left indwelling for seven days. Post-operative CT urogram demonstrated no extravasation of urine. Renal Lasix scan at 6 weeks demonstrated excellent drainage through the right kidney and the patient continues to do well. CONCLUSIONS: The treatment for UPJ obstruction in a pelvic kidney can be safely and effectively performed through a minimally invasive approach. This allowed for removal of retained stent and pelvovesicostomy utilizing a hitch to the sacral promontory in a single session. Source of Funding: None
V7-12 EVOLUTION OF REGIONAL HYPOTHERMIA IN ROBOTIC KIDNEY SURGERY Craig Rogers*, Plymouth, MI; Deepansh Dalela, Ramesh Kumar, Wooju Jeong, Mani Menon, Detroit, MI; Mahesh Desai, Arvind Ganpule, Nadiad, India INTRODUCTION AND OBJECTIVES: Renal hypothermia has been used during open partial nephrectomy to help preserve renal function. Several techniques have been described to achieve renal hypothermia using a minimally invasive approach, but technical challenges have prevented widespread use. In this video, we demonstrate the evolution of a reproducible technique for achieving renal hypothermia during robotic kidney surgery. METHODS: Ice-cold saline irrigation and topical ice slush application were used to achieve renal hypothermia. A GelPOINT access port was used for ice delivery. Following hilar clamping, ice slush was introduced through a GelPOINT and applied over the kidney surface using modified disposable syringes, a sigmoidoscope, and a custom made ice syringe. An endoscopic bag placed over the kidney helped contain the ice slush during transperitoneal procedures. Renal parenchymal and core body temperatures were monitored by using thermal probes. RESULTS: A total of 10 patients underwent robotic renal procedures using ice slush hypothermia (partial nephrectomy n¼7, anatrophic nephrolithotomy n¼3). The results are summarized in Table 1. There were no intraoperative or postoperative complications. Renal
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
parenchymal temperatures of <10 C were achieved within 10 minutes of cold ischemia and there was no drop of >1 C in the core body temperature during any procedures. CONCLUSIONS: Cold ischemia during complex robotic kidney procedures is feasible and reproducible. Perioperative outcomes for patients undergoing robotic kidney surgery using regional hypothermia.
Mean Age (yr.) (Range) Mean R.E.N.A.L. Nephrometry score (Range) Mean Pre-op Creatinine (mg/dL) (Range) Median operative time (min) (IQR) Mean cold ischemia time (min) (Range) Median blood loss (ml) (IQR) Mean post-op creatinine at 1 month (mg/dL) (Range)
Robotic partial nephrectomy (n¼7) 60 (48-69) 8 (6-10)
Robotic anatrophic nephrolithotomy (n¼3) 39 (32-45) n/a
0.93 (0.7-1.3)
0.72 (0.66-0.75)
253 (44)
224 (31)
19.6 (8-37)
56.7 (39-67)
250 (175) 1.03 (0.67-1.52)
100 (50) 0.65 (0.63-0.66)
(IQR¼ Interquartile Range)
Source of Funding: None
V7-13 TRANSURETHRAL RESECTION OF FIBROTIC SCAR IN ADVANCE OF THERMO-EXPANDABLE STENTING FOR DISTAL URETHRAL STRICTURE
V7-14 OPTIMIZING PORT PLACEMENT AND DOCKING FOR ROBOTIC KIDNEY SURGERY Charles Metcalfe*, Sameer Chopra, Michael Santomauro, Raed Azhar, Andre Abreu, Mihir Desai, Monish Aron, Inderbir Gill, Andre Berger, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Robotic assisted renal surgery continues to gain popularity worldwide. Familiarity with conventional laparoscopic renal surgery does lend itself to similar techniques used with the robotic platform. The robotic platform allows the surgeon increased visualization, enhanced exposure, and advanced dexterity. Herein this report we establish reproducible port placement and robot docking techniques for robotic renal surgery by demonstrating transperitoneal partial nephrectomies and retroperitoneal nephrectomies. METHODS: Transperitoneal and retroperitoneal partial nephrectomy cases are presented to demonstrate our technique for optimizing robotic renal surgery. Photographs, schematics and intraoperative videos of both exterior robotic arms and surgical maneuvers are used to describe our systematic approach. RESULTS: Since 2010 over 800 robotic renal surgeries have been performed at our institution using our techniques. Our robot docking and port positioning has allowed us to successfully use the robotic platform to its fullest potential with no exterior robotic arm clashing as well as surgical precision. CONCLUSIONS: Optimizing the robotic platform for renal surgery can be challenging. Our detailed descriptions of our techniques allow for consistent and reliable results while performing transperitoneal and retroperitoneal renal surgery. Source of Funding: none
Cheol Yong Yoon*, Sang Woo Kim, Jong Jin Park, Ji Yun Chae, Jong Wook Kim, Jin Wook Kim, Mi Mi Oh, Hong Seok Park, Du Geon Moon, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Intraurethral fibrotic scar formation accompanied by spongiofibrosis is a main cause recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU) or dilatation. Here, we report on technical feasibility and short-term outcome of a new technique: Transurethral resection of pre-formed fibrotic tissue before the placement of a thermo-expandable urethral stent for distal urethral stricture. METHODS: The clinical records of 11 consecutive patients with distal urethra stricture (9 bulbous, 3 penile) were retrospectively reviewed (April 2011 e February 2013). As a first step, all patients were treated with transurethral resection of fibrotic tissue using 13Fr pediatric resectoscope to the level of normal looking corpus spongiosum and, then thermo-expandable urethral stents (MemokathTM 044TW) were deployed according to the conventional protocol. Stents were removed in 6-12 months of initial placement and urethral patency was determined in terms of the ability of pass 17Fr cystoscopy and the normal range of uroflowmetry (maximum ~ 15ml/sec). Also operational feasibility of new technique flow rate (Qmax) ¡A with focus on peri- and post-operative complication was accessed. RESULTS: Mean age of patients and operation time were 58.9 (32-83) years and 84.5 (30-110) minutes respectively. Mean follow-up duration was 14.9 (7-30) months and during this period in 9 from 11 patients, urethral stents were removed. Mean post-op Qmax (18.7¡3/45.7ml/sec) was significantly higher than that of pre-op (10.5¡3/42.6ml/sec, p < 0.05). Post-op urethral dilatation was performed mean 1.2 times (1-5) in 5 patients but no patients needed open urethroplasty during follow-up period. There were no significant complications including severe urethral bleeding, incontinence, erectile dysfunction, and intractable pain. CONCLUSIONS: Combined transurethral resection of fibrotic scar tissue and temporary urethral stenting is feasible, safe, and efficient technique for distal urethral stricture. Source of Funding: none
e739
Plenary Session III: Best Abstracts Tuesday, May 20, 2014
7:30 AM-7:51 AM
PIII-01 DOES TREATMENT STRATEGY FOR LOCALIZED PROSTATE CANCER IMPACT SURVIVAL AMONG IMMUNOSUPPRESSED RENAL TRANSPLANT PATIENTS? A POPULATION-BASED ANALYSIS Bhalaajee Meenaski-Sundaram*, Oklahoma City, OK; Oluwakayode Adejoro, Sean Elliott, Minneapolis, MN; Puneet Sindhwani, Joel Slaton, Oklahoma City, OK INTRODUCTION AND OBJECTIVES: We have recently reported that immunosuppressed renal transplant patients who have prostate cancer do not have inferior survival to the general population with prostate cancer. The immunosuppressed population typically has access to the same therapeutic modalities of the general prostate cancer patient population. We interrogated the SEER-Medicare Database to determine the patterns of therapy and the impact of such therapy on patients who develop prostate cancer just before and after renal transplantation. METHODS: We interrogated the SEER-Medicare Database from the years 1992-2007 to identify all prostate cancer patients who had treatment for prostate cancer within two years before renal transplantation and those who developed prostate cancer (total n¼602). Age, race, stage and grade as well as type of therapy (surgery, radiation, combination or none) were determined. Patterns of therapy were correlated with cancer-specific and overall survival and compared against the general prostate cancer population. RESULTS: Among RT patients being treated for prostate cancer. 31% underwent surgical extirpation, 49% received EBRT, 16% received both, and only 4% received no therapy. The overall survival
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
both cases, extensive adhesions were found around the kidney, making anatomical identification and dissection difficult. Intra-operative ultrasound and a doppler probe were used to facilitate identification of anatomical structures. The fourth robotic arm and robotic hook were used to help mobilize the kidney and expose important structures. RESULTS: The results of the two cases are presented in Table 1. Both cases were completed robotically with no intraoperative complications. Post-operative course was uneventful and both the patients were discharged on day three. CONCLUSIONS: Salvage robotic kidney surgery for complications of robotic partial nephrectomy is rare but challenging. Intraoperative ultrasound, intraoperative doppler, the fourth robotic arm, and robotic hook can all be useful to define anatomy and facilitate dissection in difficult cases. Table 1 Perioperative outcomes of two cases undergoing salvage robotic kidney surgery. Case 1
Case 2
Console time (in minutes)
Outcome
200
200
Estimated blood loss (in ml)
250
200
Length of hospital stay (in days) Warm ischemia time (in minutes) Pathology
3
3
n/a
28
Atrophic kidney, no residual cancer
4.5 cm clear cell RCC, Fuhrman’s grade 2, negative surgical margins (Stage: pT1bN0Mx)
(RCC¼ Renal Cell Carcinoma)
Source of Funding: none
V7-10 ROBOTIC TRAPDOOR PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC TUMORS Blake W. Moore*, Ziho Lee, Lindsey A. Parkes, Philadelphia, PA; Mudhukar Patel, Lebanon, PA; Jack H. Mydlo, Daniel D. Eun, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Robotic partial nephrectomy (RPN) for entirely endophytic tumors has recently been shown to be feasible. Resecting a tumor that involves the central sinus fat at or near the hilum results in a deep cavity that may complicate the renorrhaphy due to the limited residual cortical tissue available for reapproximation. Furthermore, failure to tightly close the renal defect may increase the possibility for postoperative bleeding. We describe a novel Trapdoor RPN technique for completely endophytic tumors that utilizes a flap of renal parenchyma overlying the tumor to facilitate tight closure of the defect. METHODS: Our technique was performed in two patients by a single surgeon (DDE) between July and October 2013. After intracorporeal sonographic localization of the mass and clamping the hilum, sharp dissection was used to create our trapdoor, a “U” shaped flap of healthy parenchyma overlying the anterior surface of the tumor. The trapdoor was then propped open using a non-traumatic robotic grasping retractor, and the tumor was enucleated. Once the inner layer was closed and the hilum was unclamped, the trapdoor was closed and incorporated into the outer layer closure. RESULTS: For patient 1, warm ischemia time (WIT) was 39 minutes, estimated blood loss (EBL) was 200 milliliters, and console time was 125 minutes. Pathology showed a 2.5 cm T1a clear cell RCC with negative margins. For patient 2, WIT was 17 minutes, EBL was 100 millilters, and console time was 100 minutes. Pathology showed a 3.2 cm T1a clear cell RCC with negative margins. In both cases, there were no intraoperative or postoperative complications, and both patients were discharged on post operative day 1. CONCLUSIONS: Our Trapdoor RPN technique for completely endophytic tumors utilizes a flap of renal parenchyma overlying the tumor to assist in tight closure of the defect. Source of Funding: None
V7-11 ROBOT ASSISTED LAPAROSCOPIC PELVOVESICOSTOMY AND BLADDER HITCH FOR URETEROPELVIC JUNCTION OBSTRUCTION OF A RIGHT PELVIC KIDNEY WITH RETAINED URETERAL STENT William Brubaker*, Jack Zuckerman, Justin Watson, Shaun Wason, Norfolk, VA INTRODUCTION AND OBJECTIVES: Ureteropelvic junction (UPJ) obstruction occurs in one third of pelvic kidneys. The majority of cases are treated with dismembered pyeloplasty. The current patient presented with the additional complication of a retained and calcified ureteral stent that was refractory to endoscopic removal. Preoperative DMSA renal scan demonstrated 21% function in the right pelvic kidney, thus definitive repair was the objective. In this video we demonstrate a case in which a 31-year-old female with a right UPJ obstruction and a retained stent in a pelvic kidney is managed by robot assisted laparoscopic pyelovesicostomy with bladder hitch to the sacral promontory. METHODS: The patient was taken to the operating room for robot assisted laparoscopic pyelovesicostomy. The operation was performed utilizing dorsal lithotomy and steep Trendelenburg positioning. After incising the retroperitoneum the right ureter was traced posterior to the fallopian tube as it entered the bladder. The right ureter was divided distal to the UPJ and the retained stent as well as a more recently placed ureteral stent were both removed. The UPJ was widely spatulated. Pyeloscopy with a flexible cystoscope was performed demonstrating minimal stone debris. The bladder was filled and tunneled posterior to the right fallopian tube. The sacral promontory was cleared and the bladder was then hitched to the presacral fascia to ensure a tension-free anastomosis. The bladder was opened transversely and a watertight anastomosis of the right renal pelvis and bladder was performed. RESULTS: The patient recovered well and was discharged home on post-operative day one. She had a Foley catheter left indwelling for seven days. Post-operative CT urogram demonstrated no extravasation of urine. Renal Lasix scan at 6 weeks demonstrated excellent drainage through the right kidney and the patient continues to do well. CONCLUSIONS: The treatment for UPJ obstruction in a pelvic kidney can be safely and effectively performed through a minimally invasive approach. This allowed for removal of retained stent and pelvovesicostomy utilizing a hitch to the sacral promontory in a single session. Source of Funding: None
V7-12 EVOLUTION OF REGIONAL HYPOTHERMIA IN ROBOTIC KIDNEY SURGERY Craig Rogers*, Plymouth, MI; Deepansh Dalela, Ramesh Kumar, Wooju Jeong, Mani Menon, Detroit, MI; Mahesh Desai, Arvind Ganpule, Nadiad, India INTRODUCTION AND OBJECTIVES: Renal hypothermia has been used during open partial nephrectomy to help preserve renal function. Several techniques have been described to achieve renal hypothermia using a minimally invasive approach, but technical challenges have prevented widespread use. In this video, we demonstrate the evolution of a reproducible technique for achieving renal hypothermia during robotic kidney surgery. METHODS: Ice-cold saline irrigation and topical ice slush application were used to achieve renal hypothermia. A GelPOINT access port was used for ice delivery. Following hilar clamping, ice slush was introduced through a GelPOINT and applied over the kidney surface using modified disposable syringes, a sigmoidoscope, and a custom made ice syringe. An endoscopic bag placed over the kidney helped contain the ice slush during transperitoneal procedures. Renal parenchymal and core body temperatures were monitored by using thermal probes. RESULTS: A total of 10 patients underwent robotic renal procedures using ice slush hypothermia (partial nephrectomy n¼7, anatrophic nephrolithotomy n¼3). The results are summarized in Table 1. There were no intraoperative or postoperative complications. Renal
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
parenchymal temperatures of <10 C were achieved within 10 minutes of cold ischemia and there was no drop of >1 C in the core body temperature during any procedures. CONCLUSIONS: Cold ischemia during complex robotic kidney procedures is feasible and reproducible. Perioperative outcomes for patients undergoing robotic kidney surgery using regional hypothermia.
Mean Age (yr.) (Range) Mean R.E.N.A.L. Nephrometry score (Range) Mean Pre-op Creatinine (mg/dL) (Range) Median operative time (min) (IQR) Mean cold ischemia time (min) (Range) Median blood loss (ml) (IQR) Mean post-op creatinine at 1 month (mg/dL) (Range)
Robotic partial nephrectomy (n¼7) 60 (48-69) 8 (6-10)
Robotic anatrophic nephrolithotomy (n¼3) 39 (32-45) n/a
0.93 (0.7-1.3)
0.72 (0.66-0.75)
253 (44)
224 (31)
19.6 (8-37)
56.7 (39-67)
250 (175) 1.03 (0.67-1.52)
100 (50) 0.65 (0.63-0.66)
(IQR¼ Interquartile Range)
Source of Funding: None
V7-13 TRANSURETHRAL RESECTION OF FIBROTIC SCAR IN ADVANCE OF THERMO-EXPANDABLE STENTING FOR DISTAL URETHRAL STRICTURE
V7-14 OPTIMIZING PORT PLACEMENT AND DOCKING FOR ROBOTIC KIDNEY SURGERY Charles Metcalfe*, Sameer Chopra, Michael Santomauro, Raed Azhar, Andre Abreu, Mihir Desai, Monish Aron, Inderbir Gill, Andre Berger, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Robotic assisted renal surgery continues to gain popularity worldwide. Familiarity with conventional laparoscopic renal surgery does lend itself to similar techniques used with the robotic platform. The robotic platform allows the surgeon increased visualization, enhanced exposure, and advanced dexterity. Herein this report we establish reproducible port placement and robot docking techniques for robotic renal surgery by demonstrating transperitoneal partial nephrectomies and retroperitoneal nephrectomies. METHODS: Transperitoneal and retroperitoneal partial nephrectomy cases are presented to demonstrate our technique for optimizing robotic renal surgery. Photographs, schematics and intraoperative videos of both exterior robotic arms and surgical maneuvers are used to describe our systematic approach. RESULTS: Since 2010 over 800 robotic renal surgeries have been performed at our institution using our techniques. Our robot docking and port positioning has allowed us to successfully use the robotic platform to its fullest potential with no exterior robotic arm clashing as well as surgical precision. CONCLUSIONS: Optimizing the robotic platform for renal surgery can be challenging. Our detailed descriptions of our techniques allow for consistent and reliable results while performing transperitoneal and retroperitoneal renal surgery. Source of Funding: none
Cheol Yong Yoon*, Sang Woo Kim, Jong Jin Park, Ji Yun Chae, Jong Wook Kim, Jin Wook Kim, Mi Mi Oh, Hong Seok Park, Du Geon Moon, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Intraurethral fibrotic scar formation accompanied by spongiofibrosis is a main cause recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU) or dilatation. Here, we report on technical feasibility and short-term outcome of a new technique: Transurethral resection of pre-formed fibrotic tissue before the placement of a thermo-expandable urethral stent for distal urethral stricture. METHODS: The clinical records of 11 consecutive patients with distal urethra stricture (9 bulbous, 3 penile) were retrospectively reviewed (April 2011 e February 2013). As a first step, all patients were treated with transurethral resection of fibrotic tissue using 13Fr pediatric resectoscope to the level of normal looking corpus spongiosum and, then thermo-expandable urethral stents (MemokathTM 044TW) were deployed according to the conventional protocol. Stents were removed in 6-12 months of initial placement and urethral patency was determined in terms of the ability of pass 17Fr cystoscopy and the normal range of uroflowmetry (maximum ~ 15ml/sec). Also operational feasibility of new technique flow rate (Qmax) ¡A with focus on peri- and post-operative complication was accessed. RESULTS: Mean age of patients and operation time were 58.9 (32-83) years and 84.5 (30-110) minutes respectively. Mean follow-up duration was 14.9 (7-30) months and during this period in 9 from 11 patients, urethral stents were removed. Mean post-op Qmax (18.7¡3/45.7ml/sec) was significantly higher than that of pre-op (10.5¡3/42.6ml/sec, p < 0.05). Post-op urethral dilatation was performed mean 1.2 times (1-5) in 5 patients but no patients needed open urethroplasty during follow-up period. There were no significant complications including severe urethral bleeding, incontinence, erectile dysfunction, and intractable pain. CONCLUSIONS: Combined transurethral resection of fibrotic scar tissue and temporary urethral stenting is feasible, safe, and efficient technique for distal urethral stricture. Source of Funding: none
e739
Plenary Session III: Best Abstracts Tuesday, May 20, 2014
7:30 AM-7:51 AM
PIII-01 DOES TREATMENT STRATEGY FOR LOCALIZED PROSTATE CANCER IMPACT SURVIVAL AMONG IMMUNOSUPPRESSED RENAL TRANSPLANT PATIENTS? A POPULATION-BASED ANALYSIS Bhalaajee Meenaski-Sundaram*, Oklahoma City, OK; Oluwakayode Adejoro, Sean Elliott, Minneapolis, MN; Puneet Sindhwani, Joel Slaton, Oklahoma City, OK INTRODUCTION AND OBJECTIVES: We have recently reported that immunosuppressed renal transplant patients who have prostate cancer do not have inferior survival to the general population with prostate cancer. The immunosuppressed population typically has access to the same therapeutic modalities of the general prostate cancer patient population. We interrogated the SEER-Medicare Database to determine the patterns of therapy and the impact of such therapy on patients who develop prostate cancer just before and after renal transplantation. METHODS: We interrogated the SEER-Medicare Database from the years 1992-2007 to identify all prostate cancer patients who had treatment for prostate cancer within two years before renal transplantation and those who developed prostate cancer (total n¼602). Age, race, stage and grade as well as type of therapy (surgery, radiation, combination or none) were determined. Patterns of therapy were correlated with cancer-specific and overall survival and compared against the general prostate cancer population. RESULTS: Among RT patients being treated for prostate cancer. 31% underwent surgical extirpation, 49% received EBRT, 16% received both, and only 4% received no therapy. The overall survival