program book - South Central Section of the AUA

Transcription

South Central Section of the
American Urological Association, Inc.
92 nd An n u a l Meeting
September 18 – 21, 2013
The Palmer House | Chicago, Illinois
PROGRAM B OOK
Table of Contents
Scientific Program Schedule at a Glance...........................................................02
Needs and Objectives........................................................................................04
Board of Directors..............................................................................................08
Board of Directors Representatives...................................................................09
Committee Listing...............................................................................................12
Past Presidents and Annual Meeting Sites........................................................15
Guest Speakers, Invited Speakers and Sessions Moderators...........................18
Promotional Partners..........................................................................................20
Exhibitors............................................................................................................21
General Meeting Information..............................................................................22
Industry Sponsored Events................................................................................25
Evening Functions..............................................................................................27
Optional Activities...............................................................................................28
Full Scientific Program Schedule.......................................................................32
Alphabetical Index of Moderators, Panelists, Guest and Invited Speakers........67
Alphabetical Index of Abstract Presenters..........................................................69
Podiums in Presentation Order..........................................................................73
Posters in Presentation Order............................................................................159
Annual Business Meeting Agenda – Education Fund........................................200
Financial Statements – Education Fund.............................................................201
Annual Business Meeting Agenda – General Fund............................................203
Financial Statements – General Fund................................................................204
Membership Summary Report...........................................................................206
Membership Candidates and Transfers.............................................................207
In Memoriam......................................................................................................210
SCS Bylaws........................................................................................................211
Mark Your Calendars..........................................................................................Back Cover
1
Scientific Program Schedule at a Glance
*All sessions located in Red Lacquer unless otherwise noted.
registration/Info desk
Location: Red Lacquer Foyer
Spouse/Guest
Hospitality Suite
Location: Price Room
Speaker ready room
exhibit Hall
Location: Exhibit Hall
6:30 a.m.
WEDNESDAY
th
SePteMber 18
tHurSdaY
th
SePteMber 19
8:00 a.m. – 5:00 p.m.
6:30 a.m. – 5:00 p.m.
7:30 a.m. – 10:30 a.m.
7:30 a.m. – 10:30 a.m.
10:00 a.m. – 5:00 p.m.
6:30 a.m. – 5:00 p.m.
6:00 p.m. – 8:00 p.m.
(Welcome reception)
7:00 a.m.
breakfast
Location:
Exhibit Hall
7:30 a.m.
8:00 a.m.
8:30 a.m.
9:30 a.m.
board of directors Meeting
Location: Crystal Room
10:30 a.m.
11:00 a.m.
11:30 a.m.
12:00 p.m.
12:30 p.m.
1:00 p.m.
1:30 p.m.
2:00 p.m.
2:30 p.m.
3:00 p.m.
3:30 p.m.
4:00 p.m.
4:30 p.m.
Your
Money or
Your life –
urology &
Financial
Survival in
2013
Location:
Red
Lacquer
video
Session
Location:
Wabash
Room
trauma & reconstruction Podium
9:00 a.m.
10:00 a.m.
7:30 a.m. – 4:00 p.m.
breakfast
Location:
Red
Lacquer
Foyer
Ivu Scholar abstract
State-of-the-art lecture: the new
Global Surgery: rethinking our careers
as citizens of the World
break/visit exhibits
Point/counterpoint – repair of complex
Peyronie’s Disease:
Graft vs. Plication
Prosthetic urology Podium
Presidential & Program chair
Welcomes and
aua Presidential address
resident essay finalist
Podium
female urology/voiding
dysfunction Poidum
break
State-of-the-art lecture:
onabotulinumtoxin a (botox)
use in urology: update on
Indications, efficacy and Safety
Gu tuberculosis, an uninvited
Guest
Industry
Sponsored lunch
Location: Wabash
Room
Industry
Sponsored lunch
Location: Crystal
Room
oncology Poster
Session
Location: Salon 4-5
Men’s Health
Poster Session
Location: Salon 8-9
Pediatric
urology
Poster
Session
Location:
Salon 8-9
General
urology
Poster
Session
Location:
Salon 10
oncology/
transplant
Poster
Session
Location:
Salon 4-5
oncology – bladder & testis
Podium
t. leon Howard Imaging Session
5:00 p.m.
5:30 p.m.
6:00 p.m.
6:30 p.m.
7:00 p.m.
7:30 p.m.
Welcome reception:
taste of chicago
neighborhoods
2
theme night:
chicago Gangsters & blues
(until 10:30 p.m.)
Location: Fulton’s on the River
*Buses depart Palmer House Wabash
Street entrance (street level) at 6:30 p.m.
Scientific Program Schedule at a Glance
registration/Info desk
Location: Red Lacquer
Foyer
Spouse/Guest
Hospitality room
Speaker ready room
Location: Red Lacquer
Foyer
exhibit Hall
6:45 a.m.
7:00 a.m.
frIdaY
th
SePteMber 20
SaturdaY
st
SePteMber 21
6:30 a.m. – 5:00 p.m.
6:30 a.m. – 1:30 p.m.
7:30 a.m. – 10:30 a.m.
7:30 a.m. – 10:30 a.m.
7:00 a.m. – 5:00 p.m.
7:00 a.m. – 12:00 p.m.
7:30 a.m. – 11:00 a.m.
Industry
Sponsored
breakfast
Location:
Crystal
Room
7:30 a.m.
8:00 a.m.
8:30 a.m.
9:00 a.m.
9:30 a.m.
10:00 a.m.
nominating
committee
Meeting
Location:
Indiana
Room
SMu
breakfast
Meeting
Location:
Wabash
Room
renal cancer/robotics Podium
aua Guidelines update
10:30 a.m.
urinary diversion/Stones Podium
11:00 a.m.
12:30 p.m.
1:00 p.m.
1:30 p.m.
Industry
Sponsored
lunch
Location:
Crystal
Room
Industry
Sponsored
lunch
Location:
Wabash
Room
3:00 p.m.
3:30 p.m.
4:00 p.m.
4:30 p.m.
5:00 p.m.
5:30 p.m.
6:00 p.m.
6:30 p.m.
7:00 p.m.
7:30 p.m.
Health
Policy
council
Meeting
Location:
Indiana
Room
aua course of choice: Prostate cancer
active Surveillance
2:00 p.m.
2:30 p.m.
State-of-the-art lecture: Prostate
cancer – early detection
break
Presidential address: reflections
from 15 Years of Humanitarian
Surgical Missions in Honduras
History lecture:
foleys and fabrications
Presidential Guest lecture:
Healthcare reform: If You are not at
the table, You are on the Menu!
11:30 a.m.
12:00 p.m.
Resident’s
board of
breakfast:
directors
“What I
Meeting
Have
(voting
Learned”
members
(residents
only)
only)
Location:
Location:
Crystal
Indiana
Room
Room
Prostate cancer –
treatment/diagnosis Podium
breakfast
Location:
Red
Lacquer
Foyer
Pediatric urology
Podium
break
Finance
committee
Meeting
Location: Indiana
Room
Industry Sponsored lunch
ScS aua annual business Meeting
Location: Red Lacquer Room
ScS urology chair and residency
Program director Meeting
Location: Indiana Room
residents Quiz bowl
residents reception Sponsored by the
AACU
annual reception & banquet
Location: Empire Room
(until 12:00 a.m.)
free night
3
General
Info
*All sessions located in Red Lacquer unless otherwise noted.
Educational Needs and Objectives
Needs
The President-elect of the SCSAUA (Charles A. McWilliams, MD), consulted
with SCSAUA Executive Committee members, including the current SCSAUA
President, Dr. Allen F. Morey; SCSAUA Past President, Dr. Randall B. Meacham;
SCSAUA Secretary, Dr. Jeffrey M. Holzbeierlein; SCSAUA Treasurer, Dr.
Timothy D. Langford; and Chair, Office of Education of the AUA, Dr. Elspeth
McDougall, regarding the needs we are attempting to fulfill through our annual
scientific program. It was agreed by the above committee members, Section Officers and Chair, Office of Education of the AUA that there continues to be significant
educational needs for our annual meeting and scientific program. Urologic
abnormalities can present with a myriad of clinical symptoms and signs. Accurate
differential diagnosis and disease management, which meets current standards of
care, requires ongoing review of the presentations of various urologic abnormalities
as well as the appropriate use of safe and cost-effective imaging modalities and
various pharmacologic, minimally invasive, and operative management options.
In addition, advancements in medical science and progress in management of
various urologic diseases require basic and clinical research. Presentation and
discussion of such peer reviewed and Abstract Reviewer-selected summaries and
results of investigations provide “cutting edge” updates for practicing clinicians and
essential feedback to researchers on the practical applications and translation of
their investigations to clinical practice.
There is a need to inform and educate urologic surgeons of the growing need for
the surgical and therapeutic management of American veterans returning from the
war zone with urologic injuries incurred during 21st century warfare. The AUA and
others believe this group of veterans is being underserved. A broader understanding
of the need and therapeutic options is important to the urologic community as it
treats these veterans.
Quality care is of utmost importance to the urologic community. The radical changes
occurring in the US health care delivery system are threatening physician’s ability
to provide quality care. Physicians need to know about these changes and better
understand how to improve the delivery of health care in America. The treating
physician often is faced with the detailed implementation of health care one patient
at a time. Without an understanding of the basis and big picture of the health care
needs in America, its implementation can be even more complex and difficult for
the practitioner who works on the front lines of health care delivery. The urologist
perspective will improve with a broader and deeper understanding of the system
as a whole.
The physician shortage predicted by most authorities is thought to be due to the
rapid growth of patients over 65 and those added to the health care rolls as a
result of the Affordable Care Act. Medical educators predict a 36% increase in
the baby boomer population reaching 65 and an additional 32 million Americans
under 65 who will be the newly insured under the Affordable Care Act. This leads
to a physician shortage of 62,900 by 2015 and 91,500 just 5 years later in 2020.
Physicians need to be aware of these needs. Subspecialists need to be aware of
the need to grow the residency slots and further develop the residency programs.
Educating the residents and urologists will help meet this growing need in America.
4
5
General
Info
Learning Objectives:
• Describe the science behind Onabotulinumtoxina’s effectiveness,
the appropriate selection of patients, the therapeutic outcomes
expected and the safety of its use.
• Recognize active surveillance for prostate cancer as a new and
evolving treatment option with selection criteria and treatment plans
that are still in formulation.
• Identify clinical presentation and treatment options of various urologic
abnormalities.
• Describe the various minimally invasive treatments for urologic
diseases and their risk/benefits.
• Apply Evidence Based Medicine (EBM) in urologic practice specifically
incorporating AUA Guidelines into daily practice.
• Describe optimal treatment strategies for prostate cancer patients
with early stage, intermediate stage and late stage disease.
• Integrate updated knowledge on AUA guidelines.
• Analyze data pertaining to various pharmacologic and surgical
treatments for voiding dysfunction and urinary incontinence.
• Identify results of various laparoscopic and robotic approaches and
techniques for benign and malignant urologic diseases.
• Describe common pediatric urologic diseases and treatment updates.
• Review surgical techniques in video format to gain a greater understanding of these techniques, as well as improve the detailed
application of advanced surgical management of urologic diseases.
• Identify socioeconomic factors affecting urologic training and clinical
practice.
• Enumerate the current controversies pertaining to prostate cancer
screening and the use of serum markers (PSA).
• Identify basic laparoscopic applications and results in adult and
pediatric patients.
• Integrate the latest diagnostic/treatment options for various renal
anomalies.
• Describe the current surgical treatment options for correction of
Peyronie’s disease.
• Review new information guiding the challenge of the early detection
of prostate cancer.
• Identify the needs and opportunities to serve which will further
develop urologic physician volunteers to help those in need around
the globe.
• Evaluate the advancements in surgical techniques for renal cancer
surgery to include robotic, laparoscopic and percutaneous.
ACCREDITATION INFORMATION
Accreditation: The American Urological Association (AUA) is accredited by the
Accreditation Council for Continuing Medical Education (ACCME) to provide
continuing medical education for physicians.
Credit Designation: The American Urological Association designates this live
activity for a maximum of 22.75 AMA PRA Category 1 CreditsTM. Physicians should
claim only the credit commensurate with the extent of their participation in the
activity.
Evidence Based Content: It is the policy of the AUA to ensure that the content
contained in this CME activity is valid, fair, balanced, scientifically rigorous, and
free of commercial bias.
AUA Disclosure Policy: All persons in a position to control the content of an
educational activity (i.e., activity planners, presenters, authors) participating in an
educational activity provided by the AUA are required to disclose to the provider
any relevant financial relationships with any commercial interest. The AUA must
determine if the individual’s relationships may influence the educational content and
resolve any conflicts of interest prior to the commencement of the educational
activity. The intent of this disclosure is not to prevent individuals with relevant
financial relationships from participating, but rather to provide learners information
with which they can make their own judgments.
The disclosure report for this meeting may be found in your registration packet.
Resolution of Identified Conflict of Interest: All disclosures will be reviewed
by the program/course directors or editors for identification of conflicts of interest.
Peer reviewers, working with the program directors and/or editors, will document
the mechanism(s) for management and resolution of the conflict of interest and
final approval of the activity will be documented prior to implementation. Any of the
mechanisms below can/will be used to resolve conflict of interest:
•
•
•
•
•
•
•
Peer review for valid, evidence-based content of all materials associated
with an educational activity by the course/program director, editor, and/or
Education Content Review Committee or its subgroup.
Limit content to evidence with no recommendations.
Introduction of a debate format with an unbiased moderator (point-counterpoint).
Inclusion of moderated panel discussion.
Publication of a parallel or rebuttal article for an article that is felt to be
biased.
Limit equipment representatives to providing logistics and operation
support only in procedural demonstrations.
Divestiture of the relationship by faculty.
6
Disclaimer: The opinions and recommendations expressed by faculty, authors
and other experts whose input is included in this program are their own and do not
necessarily represent the viewpoint of the AUA.
Audio, Video and Photographic Equipment: The use of audio, video and other
photographic recording equipment is prohibited by attendees inside AUA meeting
rooms.
Reproduction Permission: Reproduction of written materials developed for this
AUA course is prohibited without the written permission from individual authors
and the American Urological Association.
Special Assistance/Dietary Needs: The American Urological Association complies
with the Americans with Disabilities Act §12112(a). If any participant is in need of
special assistance or has any dietary restrictions, please see the registration desk.
7
General
Info
Off-label or Unapproved Use of Drugs or Devices: It is the policy of the AUA to
require the disclosure of all references to off-label or unapproved uses of drugs or
devices prior to the presentation of educational content. The audience is advised
that this continuing medical education activity may contain reference(s) to off-label
or unapproved uses of drugs or devices. Please consult the prescribing information
for full disclosure of approved uses.
SCS BOARD OF DIRECTORS 2012 – 2013
OFFICERS
President
Allen F. Morey, MD
University of Texas Southwestern Medical Center
Department of Urology
5323 Harry Hines Boulevard
Dallas, TX 75390-9110
President-Elect
Charles A. McWilliams, MD
Urology Centers of Oklahoma
4200 W. Memorial Road, Suite 1007
Oklahoma City, OK 73120-4919
Secretary
Jeffrey M. Holzbeierlein, MD
Kansas University Medical Center
3901 Rainbow Boulevard, MS 3016
Kansas City, KS 66160
Treasurer
Timothy D. Langford, MD
Arkansas Urology Associates, PA
1300 Centerview Drive
Little Rock, AR 72211
Immediate Past President
Randall B. Meacham, MD
University of Colorado School of Medicine
Division of Urology
12631 E. 17th Avenue, Box C319
Aurora, CO 80045
Historian
Robert E. Donohue, MD
UCDHSC Division of Urology
Academic Office One Building
12631 E. 17th Avenue
Box C319, Room L15
Aurora, CO 80045
8
AREA REPRESENTATIVES
General
Info
Arkansas
Jeffrey B. Marotte, MD
495 Hogan Lane, Suite 2
Conway, AR 72034
Colorado
Brian J. Flynn, MD
University of Colorado, Denver
Division of Urology, Room L15-5602
12631 E. 17th Avenue, Box C319
Aurora, CO 80045
Kansas
Tomas L. Griebling, MD, MPH
The University of Kansas Medical Center
Department of Urology, MS 3016
3901 Rainbow Boulevard
Missouri
James M. Cummings, MD
University of Missouri
Division of Urology
One Hospital Drive, M562
Columbia, MO 65212
Nebraska
Jon J. Morton, MD
The Urology Center, PC
111 S. 90th Street
Omaha, NE 68114-3324
New Mexico
Michael Davis, MD
University of New Mexico
Department of Surgery
MSC 10 5610
1 University of New Mexico
Albuquerque, NM 87131-0001
Oklahoma
William J. Cook, MD
Urologic Specialists of Oklahoma
10901 E. 48th Street
Tulsa, OK 74146-5830
9
Texas
Ashish M. Kamat, MD
MD Anderson Cancer Center
1155 Pressler Street, Unit 1373
Houston, TX 77030
Central America
Hector Morales-Martell, MD, FACS
Centro Medico Internacional
de la Clinica Biblica 150mts Este
Avenida 14, entre calles 3 y 5
San Jose 262-2010
Costa Rica
Mexico
Jose A. Rodriguez Rivera, MD
Hospital General De Occidente, SSJ
Nino Obrero 850 Col. Cd. de Los Ninos
Guadalajara 45040
Mexico
Ex-Officio SMU Representatives
Jose J. Espinosa-Monteros, MD
Loaiza 610-203
Los Mochis, Mexico
Ernesto Lopez Corona, MD
Dodge City Medical Center
4801 Linwood Blvd.
Kansas City, MO 64128
Daniel Olvera-Posada
Mexico
Representative to AUA Board of Directors
J. Brantley Thrasher, MD
University of Kansas Medical Center
Department of Urology – MS 3016
3901 Rainbow Boulevard
10
Steven E. Canfield, MD
University of Texas Medical School at Houston
6431 Fannin St., MSB 6.018
Houston, TX 77030
Vijaya M. Vemulakonda, MD
13123 East 16th Avenue, B463
Aurora, CO 80045
Representative to AUA JU Editorial Committee
Gary E. Lemack, MD
5323 Harry Hines Boulevard, J8-148
Dallas, TX 75390-9110
Arthur I. Sagalowsky, MD
Department of Urology
5323 Harry Hines Boulevard, J8-130
Dallas, TX 75390-9110
Executive Office
Executive Director
Wendy J. Weiser
South Central Section of the AUA
Two Woodfield Lake
1100 E. Woodfield Road, Suite 350
Schaumburg, IL 60173
Phone: (847) 605-0850; Fax: (847) 517-7229
Email: [email protected]
11
General
Info
AUA Leadership Program Representatives
Steven B. Brandes, MD
Washington University Medical Center
Campus Box 8242
4960 Children’s Place
St. Louis, MO 63110
South Central Section of the AUA, Inc.
Committee Listing
2012 – 2013
BYLAWS COMMITTEE
Damara L. Kaplan, MD, Albuquerque, NM (Chair)
John W. Davis, MD, Houston, TX
Jeffrey M. Holzbeierlein, MD, Kansas City, KS
FINANCE COMMITTEE
Steven C. Koukol, MD, Omaha, NE (Chair)
Roger V. Haglund, MD, Tulsa, OK
John M. House, MD, Irving, TX
Marc S. Milsten, MD, Tulsa, OK
Timothy D. Langford, MD, Little Rock, AR (Treasurer)
HEALTH POLICY COUNCIL
Ajay K. Nangia, MBBS, Kansas City, KS (Co-Chair)
Noel E. Shankey, MD, Denver, CO (Committee Chair)
Danilo K. Asase, MD, Harlingen, TX (Texas Delegate)
Mark S. Austenfeld, MD, Kansas City, MO (Missouri Delegate)
John B. Forrest, MD, Tulsa, OK (Oklahoma Delegate)
David C. Jacks, MD, Pine Bluff, AR (Arkansas Delegate)
Steven C. Koukol, MD, Omaha, NE (Nebraska Delegate)
Joseph C. Kueter, MD, Jonesboro, AR (Arkansas Delegate)
Allen W. McCulloch, MD, Farmington, NM (New Mexico Delegate)
Charles A. McWilliams, MD, Oklahoma City, OK (Oklahoma Delegate)
Randall B. Meacham, MD, Aurora, CO (Colorado Delegate)
Eduardo Orihuela, MD, Galveston, TX (Texas Delegate)
Steven C. Robeson, MD, Santa Fe, NM (New Mexico Delegate)
Arthur I. Sagalowsky, MD, Dallas, TX (Texas Delegate)
J. Brantley Thrasher, MD, Kansas City, KS (Kansas Delegate)
HISTORICAL & NECROLOGY COMMITTEE
Robert E. Donohue, MD, Denver, CO (Chair)
LOCAL ARRANGEMENTS COMMITTEE
Allen F. Morey, MD, Dallas, TX (Committee Chair)
NOMINATING COMMITTEE
Randall B. Meacham, MD, Aurora, CO (Committee Chair)
John B. Forrest, MD, Tulsa, OK
Anthony Y. Smith, MD, Corrales, NM
Mark R. Wakefield, MD, Columbia, MO (Member At Large)
Tomas L. Griebling, MD, MPH, Kansas City, KS (Board Member)
PAST PRESIDENTS COMMITTEE
Randall B. Meacham, MD, Aurora, CO (Chair)
12
RESIDENTS’ PROGRAM COMMITTEE
Tomas L. Griebling, MD, MPH, Kansas City, KS (Committee Chair)
Michael Coburn, MD, Houston, TX
John W. Davis, MD, Houston, TX
Brian J. Flynn, MD, Golden, CO
Matthew D. Katz, MD, Little Rock, AR
Ajay K. Nangia, MBBS, Kansas City, KS
Ismael Zamilpa, MD, LIttle Rock, AR
2012 – 2013 SCS Representatives to AUA Committees
AUA BOARD OF DIRECTORS
J. Brantley Thrasher, MD, Kansas City, KS (Delegate)
Randall B. Meacham, MD, Aurora, CO (Alternate Delegate)
AUA BYLAWS COMMITTEE
Damara L. Kaplan, MD, Albuquerque, NM (Delegate)
John W. Davis, MD, Houston, TX (Alternate Delegate)
AUA EDITORIAL BOARD COMMITTEE
Gary E. Lemack, MD, Dallas, TX (Delegate)
Arthur I. Sagalowsky, MD, Dallas, TX (Delegate)
AUA HEALTH POLICY COUNCIL
Mark S. Austenfeld, MD, Kansas City, MO (Delegate)
Ajay K. Nangia, MBBS, Kansas City, KS (Delegate)
AUA HISTORY COMMITTEE
Robert E. Donohue, MD, Denver, CO (Delegate)
AUA INVESTMENT COMMITTEE
Steven C. Koukol, MD, Omaha, NE (Delegate)
AUA JUDICIAL & ETHICS COUNCIL
Vijaya M. Vemulakonda, MD, Denver, CO (Delegate)
Steve W. Waxman, MD, JD, FCLM, Overland Park, KS (Delegate)
AUA LEADERSHIP PROGRAM
Steven B. Brandes, MD, St. Louis, MO (Representative)
Steven E. Canfield, MD, Houston, TX (Representative)
Vijaya M. Vemulakonda, MD, Denver, CO (Representative)
13
General
Info
PROGRAM COMMITTEE
Charles A. McWilliams, MD, Oklahoma City, OK (Committee Chair)
Jeffrey M. Holzbeierlein, MD, Kansas City, KS
Timothy D. Langford, MD, Little Rock, AR
Randall B. Meacham, MD, Aurora, CO
Allen F. Morey, MD, Dallas, TX
AUA NOMINATING COMMITTEE
Anthony Y. Smith, MD, Corrales, NM (Delegate)
E. David Crawford, MD, Denver, CO (Alternate Delegate)
AUA PRACTICE MANAGEMENT COMMITTEE
Stephen D. Confer, MD, Tulsa, OK (Delegate)
AUA RESEARCH COMMITTEE
Linda A. Baker, MD, Dallas, TX (Representative)
Hari K. Koul, MSc, PhD, FACN, FASN, Aurora, CO (Representative)
AUA RESIDENT’S COMMITTEE
Bradley Wilson, MD, Kansas City, KS (Representative)
AUA YOUNG UROLOGIST COMMITTEE
Paul D. Maroni, MD, Aurora, CO (Representative)
14
2012 Randall B. Meacham, MD
2011 Anthony Y. Smith, MD
2010 John B. Forrest, MD
2009 J. Brantley Thrasher, MD, FACS
2008 Mark S. Austenfeld, MD
2007 Arthur I. Sagalowsky, MD
2006 Steven C. Robeson, MD
Colorado Springs, CO
San Antonio, TX
White Sulphur Springs, WV
Scottsdale, AZ
San Diego, CA
Santa Fe, NM
Austin, TX
Dublin, Ireland
Boston, MA
Austin, TX
Montreal, Quebec, Canada
Santa Fe, NM
Cancun, Mexico
Bermuda
Vail, CO
Kansas City, MO
Vancouver, BC, Canada
Acapulco, DF, Mexico
Galveston, TX
Maui, HI
Santa Fe, NM
Orlando, FL
London, England, UK
San Antonio, TX
Guadalajara & Puerta Vallarta, Mexico
Houston, TX
St. Louis, MO
New Orleans, LA
Dallas, TX
Kansas City, MO
Albuquerque, NM
Tulsa, OK
San Antonio, TX
San Juan, PR
Denver, CO
Houston, TX
Guadalajara & Puerta Vallarta, Mexico
2005 Arturo Mendoza-Valdes, MD
2004 Robert E. Donohue, MD
2003 Michael M. Warren, MD
2002 James R. Wendelken, MD
2001 Charles W. Logan, MD
2000 John F. Redman, MD
1999 *George E. Hurt, Jr., MD
1998 Sushil S. Lacy, MD
1997 John W. Weigel, MD
1996*John A. Whitesel, MD
1995 Herbert S. Friedman, MD
1994 Joseph N. Corriere, Jr., MD
1993 *Jorge E. Dib, MD
1992 Steven K. Wilson, MD
1991 *Hal K. Mardis, MD
1990 Gilbert Ross, Jr., MD
1989 Milton B. Ozar, MD
1988*Bobby G. Smith, MD
1987 *Charles B. Dryden, MD
1986 Thomas P. Ball, Jr., MD
1985*John W. Posey, MD
1984 Edward L. Johnson, MD
1983*Winston K. Mebust, MD
1982 Henry Kammandel, MD
1981*Ralph A. Downs, MD
1980 Roger V. Haglund, MD
1979*Paul C. Peters, MD
1978 C. Eugene Carlton, Jr., MD
1977*Emmanuel N. Lubin, MD
1976*Ian M. Thompson, Sr., MD
1975*Charles A. Hulse, MD
1974
* Donald D. Albers, MD
1973*Abel J. Leader, MD
1972*William F. Melick, MD
15
General
Info
Past Presidents and Annual Meeting Sites
1971 *Robert O. Beadles, MD
1970*Hjalmar E. Carlson, MD
1969*Michael K. O’Heeron, MD
1968*Berget H. Blocksom, MD
1967*Horace V. Munger, MD
1966*A. Keller Doss, MD
1965*King Wade, Jr., MD
1964*Charles A. Hooks, MD
1963*Raul Lopez Engelking, MD
1962*Henry A. Buchtel, MD
1961*William L. Valk, MD
1960*J. R. Blundell, MD
1959*A. Lloyd Stockwell, MD
1958*Justin Cordonnier, MD
1957*Cecil M. Crigler, MD
1956*Irwin S. Brown, MD
1955*Harold A. O’Brien, MD
1954*R. H. Akin, MD
1953*John F. Patton, MD
1952*Harry M. Spence, MD
1951*Daniel R. Higbee, MD
1949*W. Joseph McMartin, MD
1948*Neil S. Moore, MD
1947*Harold T. Low, MD
1946*O. W. Davidson, MD
1945*Robert E. Cone, MD
1944*Robert E. Cone, MD
1943*Everett K. Akngle, MD
1942*Henry S. Browne, MD
1941*John B. Davis, MD
1940*D. K. Rose, MD
1939*R. E. Van Duzen, MD
1938*Charles McMartin, MD
1937*E. L. Cohenour, MD
1936*Arbor D. Munger, MD
1935*H. Fay H. Jones, MD
1934*Grayson Carroll, MD
1933*B. W. Turner, MD
1932*T. Leon Howard, MD
1931*R. Lee Hoffman, MD
1930*A. I. Folsom, MD
1929*Clinto K. Smith, MD
1928*H. King Wade, MD
1927*N. F. Ockerblad, MD
1926*H. McClure Young, MD
St. Louis, MO
Dallas, TX
San Antonio, TX
Kansas City, MO
Mexico City & Acapulco, DF, Mexico
Omaha, NE
Houston, TX
Mexico City & Acapulco, DF, Mexico
Hot Springs, AR
Albuquerque, NM
Denver, CO
St. Louis, MO
Oklahoma City, OK
Mexico, DF, Mexico
San Antonio, TX
Kansas City, MO
Hot Springs, AR
Houston, TX
St. Louis, MO
Fort Worth, TX
Hot Springs, AR
Kansas City, MO
No meeting because of war conditions
Lincoln, NE
Oklahoma City, OK
Galveston, TX
Denver, CO
Excelsior Spg., MO
Dallas, TX
Tulsa, OK
Omaha, NE
Little Rock, AR
St. Louis, MO
Houston, TX
Denver, CO
Kansas City, MO
Lincoln, NE
Dallas, TX
Hot Springs, AR
Kansas City, MO
St. Louis, MO
16
Oklahoma City, OK
Denver, CO
Kansas City, MO
Hot Springs, AR
Kansas City, MO
17
General
Info
1925*W. J. Wallace, MD
1924*Oliver Lyons, MD
1923*John Caulk, MD
1922*Ernest G. Mark, MD
1921*Ernest G. Mark, MD
*Deceased
92nd Annual Meeting
Guest Speakers, Invited Speakers
and Session Moderators
AUA Course of Choice Guest Speaker
Laurence H. Klotz, MD
Presidential Guest Speaker
John H. Armstrong, MD, FACS
Guest and Invited Speakers
John H. Armstrong, MD, FACS, Tallahassee, FL
William W. Bohnert, MD, Phoenix, AZ
Daniel J. Culkin, MD, Oklahoma City, OK
Catherine R. deVries, MD, Salt Lake City, UT
William F. Gee, MD, Lexington, KY
Michael S. Holzer, MD, Oklahoma City, OK
Steven J. Hudak, MD, San Antonio, TX
Michael Johnson, MD, Saint Louis, MO
Laurence H. Klotz, MD, Toronto, ON, Canada
Gary E. Lemack, MD, Dallas, TX
Ajay Nehra, MD, Chicago, IL
Mariano J. Sotomayor, MD, Mexico City, DF, Mexico
Ian M. Thompson, Jr., MD, San Antonio, TX
Steven K. Wilson, MD, La Quinta, CA
18
19
General
Info
Moderators
Frances M. Alba, MD, Los Ranchos, NM
Ashley B. Bowen, MD, Oklahoma City, OK
Joshua A. Broghammer, MD, Kansas City, KS
Brian S. Christine, MD, Birmingham, AL
Nicholas Cost, MD, Cincinnati, OH
James M. Cummings, MD, Columbia, MO
Rodney Davis, MD, Little Rock, AR
Rowena A. Desouza, MD, Houston, TX
Michael J. Finger, MD, Harlingen, TX
Javier Hernandez, MD, San Antonio, TX
Ty T. Higuchi, MD, PhD, Aurora, CO
Brad J. Hornberger, MPAS, PA-C, Dallas, TX
Ashish M. Kamat, MD, Houston, TX
Bryan T. Kansas, MD, Austin, TX
Mohit Khera, MD, Houston, TX
Chad A. LaGrange, MD, Elkhorn, NE
Ryan J. Mauck, MD, Dallas, TX
Charles A. McWilliams, MD, Oklahoma City, OK
Moben Mirza, MD, Kansas City, KS
Allen F. Morey, MD, Dallas, TX
Sunshine Murray, MD, Tulsa, OK
Dennis S. Peppas, MD, San Antonio, TX
Juan Prieto, MD, San Antonio, TX
Ganesh V. Raj, MD, PhD, Dallas, TX
Ronald Rodriguez, MD, PhD, San Antonio, TX
Thomas A. Rozanski, MD, San Antonio, TX
Puneet Sindhwani, MD, MS, MBBS, MSBS, Oklahoma City, OK
Kurt H. Strom, MD, Golf, IL
Ian M. Thompson, III, MD, San Antonio, TX
J. Brantley Thrasher, MD, Kansas City, KS
Ouida L. Westney, MD, Houston, TX
Duncan T. Wilcox, MBBS, MD, Aurora, CO
Thank You to Our 2013 Promotional Partners
Platinum Exhibit Level
Abbvie
Astellas Pharma US, Inc.
Bayer HealthCare
Lilly USA, LLC
Medivation/Astellas
Myriad Genetic Laboratories, Inc.
Pfizer, Inc.
Silver Exhibit Level
Genomic Health
Thank You to Our 2013 Contributors
Argos Therapeutics, Inc.
GTx
Thank You to Our Educational Grant Supporter
Allergan, Inc.
20
Thank You to Our 2013 Exhibitors
Exhibitors
AbbVie
Actavis
Allergan, Inc.
American Medical Systems, Inc.
AmeriPath
Astellas Pharma US, Inc.
Auxilium Pharmaceuticals, Inc.
Bayer HealthCare
BK Medical Systems
Boston Scientific Corporation
Coloplast Group
Cook Medical
Dendreon Corporation
Dornier MedTech
EDAP Technomed, Inc.
Ferring Pharmaceuticals
Genome Dx Biosciences, Inc.
Genomic Health
HealthTronics, Inc.
Hitachi Aloka Medical
Intuitive Surgical, Inc.
Janssen Biotech, Inc.
KARL STORZ Endoscopy-America, Inc.
Lilly USA, LLC
MDxHealth
MEDA Pharmaceuticals
Medispec, Ltd.
Medivation/Astellas
Mission Pharmacal Company
Myriad Genetic Laboratories, Inc.
Pfizer, Inc.
PLUS Diagnostics
Prometheus Laboratories, Inc.
Richard Wolf Medical Instruments, Corp.
Terumo Interventional Systems
Theralogix
Uroplasty, Inc.
USMD, Inc.
Wedgewood Pharmacy
21
General
Info
(as of 9/4/2013)
General Meeting Information
Registration/Information Desk Hours
Wednesday, September 18, 2013 8:00 a.m. – 5:00 p.m.
Thursday, September 19, 2013
6:30 a.m. – 5:00 p.m.
Friday, September 20, 2013
6:30 a.m. – 5:00 p.m.
Saturday, September 21, 2013
6:30 a.m. – 1:30 p.m.
Exhibit Hall Hours
Location: Exhibit Hall Room
Wednesday, September 18, 2013 6:00 p.m. – 8:00 p.m. (Welcome Reception)
7:30 a.m. – 4:00 p.m.
7:30 a.m. – 11:00 a.m.
Spouse/Guest Hospitality Suite Hours
Wednesday, September 18, 2013 7:30 a.m. – 10:30 a.m.
7:30 a.m. – 10:30 a.m.
7:30 a.m. – 10:30 a.m.
7:30 a.m. – 10:30 a.m.
Speaker Ready Room Hours
Wednesday, September 18, 2013 10:00 a.m. – 5:00 p.m.
6:30 a.m. – 5:00 p.m.
7:00 a.m. – 5:00 p.m.
7:00 a.m. – 12:00 p.m.
Scientific Sessions
Scientific sessions will be held in the Red Lacquer Room unless otherwise
noted. Sessions will begin on Wednesday, September 18, 2013, at 12:00 p.m.
Be sure to check the full scientific program for more information.
Annual Business Meeting
The annual business meeting will be held Saturday, September 21, 2013,
from 1:00 p.m. – 1:30 p.m. in the Red Lacquer Room.
Board of Directors Meetings
The Board of Directors, committee chairs and past presidents will meet Wednesday,
September 18, 2013, from 9:00 a.m. – 11:30 a.m., in the Crystal Room. In
addition, the Board of Directors will have a meeting Saturday, September 21,
2013, from 7:00 a.m. – 8:00 a.m., in the Crystal Room.
22
Committee Meetings
The Health Policy Council will be meeting on Friday, September 20, 2013, from
12:00 p.m. – 1:00 p.m. in the Indiana Room.
The Nominating Committee will be meeting on Friday, September 20, 2013, from
7:00 a.m. – 8:00 a.m. in the Indiana Room.
Past Presidents’ Luncheon
The Past Presidents’ Luncheon will be held on Thursday, September 19, 2013,
from 11:45 a.m. – 1:00 p.m. in the Indiana Room.
SMU Breakfast
The SMU Breakfast will be held on Friday, September 20, 2013, from 7:00 a.m.
– 8:00 a.m. in the Wabash Room.
Urology Department Chairs and Residency Program Directors Meeting
The Urology Department Chairs and Residency Program Directors’ meeting will
be held on Saturday, September 21, 2013, from 1:45 p.m. – 2:45 p.m. in Indiana
Room.
Registration Fee Includes:
• Scientific Sessions
• Poster Sessions
• Entrance to Technical Exhibits
• Breakfast, Lunch and Refreshment Breaks
• One Ticket to Welcome Reception
• One Ticket to Theme Night
• One Ticket to Annual Reception and Banquet
• Program Materials
Spouse/Guest Registration Fee Includes:
• Hospitality Suite
• Scientific Sessions*
• Poster Sessions*
• Breakfast
• Entrance to Technical Exhibits
• One Ticket to Welcome Reception
• One Ticket to Theme Night
• One Ticket to Annual Reception and Banquet
*If your Spouse/Guest would like to receive CME credit for attending the meeting,
you must register that person separately at the appropriate category.
Please Note
Badges are required for admission to the meeting area. Tickets are required for
entrance to all social functions.
23
General
Info
The Finance Committee will be meeting on Friday, September 20, 2013, from
2:15 p.m. – 3:15 p.m. in the Indiana Room.
Tickets – One ticket is included in meeting registration
If you wish to purchase additional tickets for the evening functions, they will be
available in the Registration/Information Desk for the following prices:
Welcome Reception: Taste of Chicago Neighborhoods!
$50 per adult
$20 per child (ages 11 – 17)
Complimentary (children 10 & under)
Theme Night – Chicago Gangsters & Blues
$150 per person
Annual Reception & Banquet
$185 per person
24
Industry Sponsored Events
12:00 p.m. – 1:00 p.m. Industry Sponsored Lunch
Location: Wabash Room
“XTANDI (enzalutamide) capsules: Inhibiting the
Androgen Receptor Signaling Pathway at Multiple
Steps”
Larry Karsh, MD, FACS
Attending Urologist and Director of Research
The Urology Center of Colorado
Denver, CO
“A Case-Based Approach to Treating OAB:
Including Landmark Study Results”
Scott MacDiarmid, MD
Alliance Urology Specialists
Greensboro, NC
FRIDAY, SEPTEMBER 20, 2013
6:45 a.m. – 7:45 a.m.
Industry Sponsored Breakfast
“Integrating Xofigo® Into Your Clinical Practice”
Paul R. Sieber, MD, FACS
Urological Associates of Lancaster
Lancaster, PA
25
General
Info
THURSDAY, SEPTEMBER 19, 2013
11:45 a.m. – 1:00 p.m.
Industry Sponsored Lunch
“Promoting Wellness in 2013 How to Save Time Reviewing What Works and What Is Worthless”
Mark Moyad, MD, MPH
Jenkins/Pokempner Director of Complementary and Alternative Medicine
Department of Urology, University of Michigan
Ann Arbor, MI
11:45 a.m. – 1:00 p.m.
“Prolaris®: A Novel Molecular Biomarker for
Prostate Cancer”
John W. Davis, MD, FACS
Associate Professor, Urology
Director, Urosurgical Prostate Program
The University of Texas MD Anderson Cancer Center
Houston, TX
SATURDAY, SEPTEMBER 21, 2013
11:45 a.m. – 1:00 p.m.
“Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms Pathophysiology to Improved Patient Care”
David R. Staskin, MD
Associate Professor of Urology
Tufts University School of Medicine
Director, Center for Male and Female Pelvic Health
Steward-St. Elizabeth’s Medical Center
Boston, MA
Karl-Erik Andersson, MD, PhD
Sector Editor, Journal of Urology
Editor-in-Chief, UroToday International Journal
Professor, Institute for Regenerative Medicine
Wake Forest School of Medicine
Winston-Salem, NC
26
Evening Functions
Welcome Reception: Taste of Chicago Neighborhoods!
Date: Wednesday, September 18, 2013
Time: 6:00 p.m. – 8:00 p.m.
Location: Exhibit Hall Attire: Business Casual
Cost:
One ticket included in registration fee; additional tickets are $50 for adults and $20 for children (11 – 17, under 10 complimentary).
Description: The SCSAUA welcomes attendees to the 92nd Annual Meeting.
Members can visit with exhibitors and connect with fellow members all while
experiencing the tastes of Chicago neighborhoods! Come enjoy delicious drinks
and hors d’oeuvres in our Exhibit Hall version of Wrigleyville, Greektown, Chinatown and Little Italy.
Theme Night: Chicago Gangsters & Blues
Date: Thursday, September 19, 2013
Time: 6:30 p.m. – 10:30 p.m.
Buses depart Palmer House Wabash Street entrance on street level at 6:30 p.m.
Attire: Casual
Cost:
One ticket included in registration fee; additional tickets are $150.
Description: Legendary tough guys such as Al Capone made Chicago home for
America’s most notorious gangsters. These hardened hooligans left a permanent
mark in the history books of this bustling city by coining the Windy City as their
center of operations for organized crime. The theme night will also feature a
performance from the illustrious Chicago blues band, Lil’ Ed and the Imperials.
Come experience Chicago’s gangster history at SCSAUA’s theme night at Fulton’s
on the River!
Annual Reception and Banquet
Date: Saturday, September 21, 2013
Time:
6:30 p.m. – 7:30 p.m. Reception
7:30 p.m. – 12:00 a.m. Dinner and “iO Improv” Comedy Group
Attire:
Black Tie Optional Cost:
One ticket included in registration fee; additional tickets are $185 each.
The annual reception and banquet is the perfect way to end the Chicago meeting.
You can enjoy an elegant evening at the Palmer House, dining and entertainment
as you reflect on this year’s meeting. Make sure to stay for dessert and a special
performance from the famous Chicago “iO Improv” comedy group!
*Tables are assigned during the meeting, so be sure to sign up with your
friends/colleagues on the boards posted by the SCS registration desk.
27
General
Info
One ticket to each evening function is included in your registration fee. Fees for
additional tickets are stated below.
Optional Activities
History is Hott: Historic Tour of the Palmer House
Date:
Wednesday, September 18, 2013
Time:
1:00 p.m. – 2:30 p.m.
Location: Meet in the lobby of the Palmer House at 1:00 p.m.
Price:
$30.00 per person
Includes: 45 minute lecture, 45 minute walking tour of hotel, gift bag, Bertha Palmer’s world famous brownie
Description: Chicago’s Palmer House has a rich 140-year history – the place
claims to have created the brownie, among other highlights. Tour the hotel’s artdeco lobby, grand ballrooms and see artifacts that aren’t usually open to the public,
including original Bertha Potter’s rare china. You will also visit a room dedicated to
the hotel’s history, which contains vintage menus, books and photography as well
as rare letters from Bertha Palmer.
Chicago Architectural River Cruise
Date: Thursday, September 19, 2013
Time:
9:15 a.m. – 12:00 p.m.
Location: Meet at SCS Registration Desk at 9:15 a.m.
Cost: $30.00 per person
Includes: Transportation and admission ticket to guided cruise tour
Description: Critics say that no other city has influenced and embodied the state-ofthe-art high-rise design and modern architecture as prominently as Chicago; virtually
every major architect has a signature building here. This is where architecture lives,
and history is still being etched upon the sky. Join us for a 90 minute, jaw-dropping
excursion through a city that defied all architecture expectations.
Art Institute Tour
Date:
Time:
1:00 p.m. – 2:30 p.m.
(Meet at SCS Registration by 1:00 p.m.)
Location: Meet at SCS Registration at 1:00 p.m.*
*Participants will be walking approximately 0.2 miles from the Palmer House to the Art Institute
Cost:
$40.00 per person
Includes: Admission ticket to Art Institute and guided tour
Description: The Art Institute of Chicago is an encyclopedic art museum located
in Chicago’s Grant Park. It has a collection of impressionist and post-impressionist
art in its permanent collection. This will be a one hour private guided tour, highlighting the main exhibits at the Art Institute of Chicago. After the tour concludes,
guests will have free time to explore the museum at their own leisure. Participants
should expect a moderate amount of walking on this tour, so please wear comfortable shoes.
28
After the show, hit The Magnificent Mile early for a fun day of shopping! Currently
Chicago’s largest shopping district, various mid-range and high-end shops line
this section of the street and approximately 3,100,000 square feet is currently
occupied by retail stores, restaurants, museums and hotels.
There is a maximum capacity of 40 people for this tour.
ADDITIONAL EVENTS (ON YOUR OWN)
About Chicago, IL
Located on the shores of Lake Michigan in the heart of the Midwest, Chicago is
home to the blues, several sports teams, an internationally acclaimed symphony orchestra, spectacular live theater, celebrated architecture and thousands of
restaurants, museums and shops.
Restaurants
Chicago features thousands of restaurants that offer culinary favorites to suit every
taste, budget and mood. Whether the preference is Chicago-style hot dogs or a
burger, fried clams or smoked ostrich, pirogues or pizza, Chicago has it all.
Soul food, Italian, Chinese, French, Japanese, Mexican, Asian or Spanish...
Chicago offers a virtual United Nations of eating choices. Ethnic neighborhoods
such as Chinatown, Greektown, West Rogers Park and Pilsen are among those
offering tempting tastes from around the world. Chicago is also proud to be home
of award-winning restaurants and world-renowned chefs, as well as home to deepdish pizza – one of Chicago’s most important contributions to 20th century culture.
Museums
Chicago is world-renowned for its diverse collection of museums, which explores
a variety of subjects including Chicago history, art, African-American culture,
astronomy and natural history.
29
General
Info
Nordstrom ‘Magnificent Mile’ Fashion Presentation
Date:
Time:
7:15 a.m. – 1:00 p.m.
Location: Meet at SCS Registration Desk at 7:15 a.m.
Price:
SCSAUA is covering the cost for 40 registered guests.
Includes: Transportation, tote bag with Nordstrom ‘goodies,’ $20 Nordstrom gift
card, coffee and light breakfast
Description: This annual, full stage production incorporates beauty and fashion
trends from around the nation! This exciting event delights attendees by presenting
the tricks of the trade by some of the nation’s top beauty and style experts. Every
guest receives a complimentary tote bag that will be filled with ‘goodies.’ There will
also be several giveaways throughout the show. Coffee and light breakfast treats
will be served.
Those visiting Chicago should plan on spending time at Chicago’s Museum
Campus. The scenic park conveniently joins the Adler Planetarium & Astronomy
Museum, the Shedd Aquarium/Oceanarium and the Field Museum of Natural
History, with easy access to all three locations.
The Shedd Aquarium offers the world’s largest array of more than 8,000 aquatic
mammals, reptiles, amphibians, invertebrates and fish. After exploring the oceans,
attendees can gaze up at the heavens in the nearby Adler Planetarium &
Astronomy Museum. The Field Museum offers exciting displays of mummies,
Egyptian tombs, Native American artifacts and dinosaur skeletons.
Other Chicago museums include the Chicago Historical Society (the city’s oldest
cultural institution), the Museum of Science and Industry, the DuSable Museum of
African-American History, the Art Institute of Chicago (one of the world’s leading art
museums), the Museum of Contemporary Art and the Museum of Contemporary
Photography.
Attractions
In addition to world-renowned museums, Chicago is home to a variety of spectacular
attractions including Navy Pier the city’s lakefront playground and the state’s
most popular attraction. Navy Pier offers visitors a unique blend of family-oriented
attractions, from the thrilling ride on the Wave Swinger in Pier Park to the 3-D
Time Escape ride. The Pier also boasts the 150 foot high Ferris wheel, a musical
carousel, the Chicago Children’s Museum, a variety of restaurants and the Chicago
Shakespeare Theatre.
In addition, the 24.5 acre Millennium Park has instantly become a world-class
attraction and a Chicago landmark. It contains an outdoor performing arts pavilion,
an indoor year-round theater, restaurant, ice-skating rink, contemporary garden,
public art, fountains, promenade area for special events, and landscaped walkways and green spaces.
Other attractions not to miss include Buckingham Fountain at Grant Park, the
Hancock Observatory and the Skydeck at Willis Tower, formerly the Sears Tower.
Skydeck Chicago’s “the Ledge,” which opened to the public last year, is a glass
box that extends out 4.3 feet from the skyscraper’s Skydeck on the 103rd floor,
providing an exhilarating and unparalleled view of the city.
Shopping
A visit to Chicago would be incomplete without a shopping spree. Shopping in
Chicago began on State Street, with the opening of the original Marshall Field’s
department store in 1852. Today, shoppers at Macy’s (the old Marshall Field’s
flagship store) will find an outstanding selection of men’s and women’s apparel,
an extensive house ware department, several fine restaurants, a food court and a
visitors’ center. State Street is also home to another famous Chicago department
store, Carson Pirie Scott, where customers are drawn into the entrance of the
store by the ornate ironwork designed by Chicago architect Louis Sullivan in 1899.
A shopping spree must include a visit to the famed “Magnificent Mile,” which runs along
Michigan Avenue from Oak Street to the Chicago River. Amidst department store gi-
30
An abundance of shopping can also be found at The Shops at North Bridge, Water
Tower Place, the 900 North Michigan Avenue Shops, Chicago Place Shopping
Center, Navy Pier, dozens of Chicago neighborhoods and The Shops at the Mart
located at Chicago’s Merchandise Mart.
Architecture
Visitors from around the world come to Chicago, the birthplace of the modern
building, to admire its architectural marvels. From historic landmark buildings
to contemporary technological masterpieces, Chicago is built of the unique and
innovative designs that have shaped American architecture. The city is a living
museum of architecture, thanks to the work of such greats as Daniel Burnham,
Louis Sullivan, Frank Lloyd Wright, Ludwig Mies van der Rohe, Helmut Jahn and
hundreds of others.
Chicago is home to the world’s first skyscraper, designed by William Le Baron
Jenney in 1885. Although the Home Insurance Building no longer stands, today
Chicago is also home to three of the world’s 10 tallest buildings, including the
Willis Tower (formerly known as the Sears Tower), which opened in 1974. Other
city landmark buildings include the Chicago Cultural Center – completed in 1897
in the Beaux Arts style, Adler and Sullivan’s 1889 Auditorium Building, and the
Art Deco-era Chicago Board of Trade Building, designed by Holabird and Root in
1929.
To learn more about Chicago’s acclaimed architecture, the Chicago Architecture
Foundation offers more than 50 walking or bus tours, conducted by knowledgeable
guides. Architectural boat cruises on the Chicago River, as well as self-guided,
taped walking tours, are also available.
31
General
Info
ants such as Neiman Marcus, Lord & Taylor, Saks Fifth Avenue and Bloomingdale’s,
are hundreds of specialty shops and boutiques offering goods from around the
world. Oak Street, just west of Michigan Avenue, is a boutique shopper’s dream.
92nd Annual SCS Meeting
September 18 – 21, 2013
Full Scientific Program Schedule
The abstract number appears next to the presenter’s time. See the abstract section in this
program book for complete text. Abstracts appear in presentation order. You may also
reference the Alphabetical Index of Presenters in this program book for the date, time, and
placement of presentations.
*All sessions located in The Red Lacquer Room unless otherwise noted.
Wednesday, September 18, 2013
7:30 a.m. – 10:30 a.m.
8:00 a.m. – 5:00 p.m.
9:00 a.m. – 11:30 a.m.
10:00 a.m. – 5:00 p.m.
Spouse/Guest Hospitality Suite
1:00 p.m. – 2:30 p.m.
History is Hott: Historic Tour of Palmer House
Registration/Information Desk
Board of Directors Meeting
Speaker Ready Room
6:00 p.m. – 8:00 p.m.Exhibit Hall
6:00 p.m. – 8:00 p.m.
Welcome Reception:
Taste of Chicago Neighborhoods!
General Session
12:00 p.m. – 12:05 p.m. Presidential Welcome
SCS President: Allen F. Morey, MD
Dallas, TX
12:05 p.m. – 12:10 p.m. Program Chair Welcome
Program Chair: Charles A. McWilliams, MD
Oklahoma City, OK
12:10 p.m. – 12:20 p.m. AUA Presidential Address
AUA President-Elect: William W. Bohnert, MD
Phoenix, Arizona
32
12:20 p.m. – 1:05 p.m. Resident Essay Finalist Podium
Moderators: Charles A. McWilliams, MD
Allen F. Morey, MD
12:20 p.m. #1
12:27 p.m.
#2
LAPAROSCOPIC RADIOFREQUENCY ABLATION
OF SMALL RENAL TUMORS: LONG–TERM
ONCOLOGIC OUTCOMES
Daniel Ramirez, Yun-Bo Ma, Selahattin Bedir,
Jodi Antonelli, Jeffery Gahan, Jeffery Cadeddu
UT Southwestern
(Presented by: Daniel Ramirez)
12:34 p.m. #3
HIGH ENERGY PENETRATING TRAUMA:
CONTEMPORARY MANAGEMENT AND
OUTCOMES OF RENAL GUNSHOT WOUNDS
James Tan, Lars E. Wallin, III, Michael Coburn,
Thomas Smith, III
Baylor College of Medicine
(Presented by: James Tan)
12:41 p.m. #4
EMPHYSEMATOUS PYELONEPHRITIS:
MULTICENTER CLINICAL AND THERAPEUTIC
EXPERIENCE IN MEXICO
Daniel Olvera-Posada¹, Ghislaine Armengod-Fischer²,
Luis Vázquez-Lavista³, Miguel
Maldonado-Ávila², Emmanuel Rosas-Nava², Hugo
Manzanilla-García², Mariano Sotomayor¹, Guillermo
Feria-Bernal¹, Francisco Rodríguez-Covarrubias¹
¹INNSZ; ²Hospital General de México; ³Instituto de
Seguridad Social del Estado de México y Municipios
(Presented by: Daniel Olvera-Posada)
33
WEDNESDAY
OUTCOMES OF ARTIFICIAL URINARY
SPHINCTER PLACEMENT IN HIGH–RISK
PATIENTS AS COMPARED TO AVERAGE RISK
PATIENTS. A MULTI–INSTITUTIONAL REVIEW
Paul Guidos¹, Christopher Powell¹, William Brant²,
Joshua Broghammer¹
¹University of Kansas Medical Center; ²University of
Utah
(Presented by: Christopher Powell)
12:48 p.m.
#5
MULTI–INSTITUTIONAL EVALUATION OF THE
PROGNOSTIC SIGNIFICANCE OF ALTERED
MAMMALIAN TARGET OF RAPAMYCIN (MTOR)
PATHWAY BIOMARKERS IN UPPER TRACT
UROTHELIAL CARCINOMA (UTUC)
Aditya Bagrodia¹, Bishoy Gayed¹, Payal Kapur¹,
Oussama Darwish¹, Ira Bernstein¹, Laura Krabbe¹,
Christoper Wood², Shahrokh Shariat³, Richard
Zigeuner4, Christian Bolenz5, Alon Weizer6, Jay
Raman7, Karim Bensalah8, Giacomo Novara9,
Hans-Martin Fritsche10, Arthur Sagalowsky¹, Yair
Lotan¹, Vitaly Margulis¹
¹UT Southwestern Medical Center; ²MD Anderson;
³Cornell; 4University of Graz; 5Mannheim;
6
University of Michigan; 7Penn State; 8University of
Rennes; 9University of Padua; 10Regensburg
University
(Presented by: Aditya Bagrodia)
12:55 p.m. #6
SURVIVAL OF PATIENTS UNDERGOING
CYTOREDUCTIVE NEHPRECTOMY COMPARED
TO THOSE TREATED WITH TARGETED THERAPY
AFTER STRAtIFICATION OF RISK AND
COMORBIDITIES
Brandon Manley, Joel Vetter, Seth Strope
Washington University in St. Louis
(Presented by: Brandon Manley)
1:05 p.m. – 2:15 p.m.
Female Urology/Voiding Dysfunction Podium
Moderators: Rowena Anne Desouza, MD
Houston, TX
Sunshine Murray, MD
Tulsa, OK
1:05 p.m.
#7
A NOVEL COMBINATION OF SURGICAL
TECHNIQUES TO RESOLVE LOWER URINARY
TRACT EROSION IN A SINGLE OPERATION:
NEAR TOTAL TRANSVAGINAL MESH EXCISION,
URINARY TRACT RECONSTRUCTION AND
CONCOMITANT REPAIR WITH A BIOLOGICAL
GRAFT
Ketul Shah, Dmitriy Nikolavsky, Brian Flynn
University of Colorado Denver
(Presented by: Ketul Shah)
1:12 p.m.
#8
HOW SUCCESSFUL IS SUBURETHRAL SYNTHETIC
TAPE REMOVAL?
Michael Belsante, Casey Seideman, Gary Lemack,
Philippe Zimmern
UT Southwestern Medical Center
(Presented by: Michael Belsante)
34
1:19 p.m.
#9
1:26 p.m.
#10
1:33 p.m.
#11
#12
1:47 p.m.
#13
PROSPECTIVE QUALITY OF LIFE FOLLOW–UP
OF BOTULINUM TOXIN A FOR URINARY
INCONTINENCE
Andrew Arther, Bradley Wilson, Katie Murray,
Tomas Griebling, Priya Padmanabhan
University of Kansas
(Presented by: Andrew Arther)
IDENTIFICATION OF NEURAL CORRELATES OF
VOIDING BY CONCURRENT FUNCTIONAL
MAGNETIC RESONANCE IMAGING AND
URODYNAMICS
Michael Shy¹, Rose Khavari², Tuangratch Chow²,
Steve Fung², Timothy Boone², Christof Karmonik²,
Sophie Fletcher²
¹Baylor College of Medicine; ²The Methodist Hospital,
Houston, TX
(Presented by: Michael Shy)
1:40 p.m.
BACTERIOLOGICAL ANALYSIS OF EXPLANTED
TRANSVAGINAL MESHES
COMBINATION THERAPY WITH FINASTERIDE
AND TADALAFIL ONCE DAILY FOR 6
MONTHS: A RANDOMIZED, PLACEBO–
CONTROLLED STUDY IN MEN WITH LOWER
URINARY TRACT SYMPTOMS SECONDARY TO
BENIGN PROSTATIC HYPERPLASIA
Adolfo Casabe¹, Claus Roehrborn², Luigi Da Pozza³,
Sebastian Zepeda4, Ralph Henderson5,
Sebastian Sorsaburu6, Carsten Henneges7,
David Wong8, Lars Viktrup6
¹Instituto Médico Especializado, Buenos Aires,
Argentina; ²University of Texas Southwestern Medical
Center, Dallas, TX, USA; ³Department of Urology and
Pathology, Ospedali Riuniti di Bergamo,
Bergamo, Italy; 4Saltillo University Hospital, Saltillo,
Mexico; 5Regional Urology, LLC, Shreveport,
USA; 6Lilly Research Laboratories, Eli Lilly and
Company, Indianapolis, USA; 7EU Statistics, Lilly
Deutschland GmbH, Bad Homburg, Germany;
8
Eli Lilly and Company
(Presented by: Craig F. Donatucci, MD)
35
Wednesday
PROSPECTIVE QUALITY OF LIFE ASSESSMENT
OF AUTOLOGOUS PUBOVAGINAL SLING
William Parker, Andrew Arther, Priya Padmanabhan
(Presented by: William Parker)
1:54 p.m.
#14
BOTULINUM TOXIN A: THE SHIFT TO A
MINIMALLY INVASIVE MANAGEMENT OF
NEUROGENIC BLADDER
Bradley Wilson, Andrew Arther, William Parker,
Tomas Griebling, Priya Padmanabhan
(Presented by: Bradley Wilson)
#15
withdrawn
2:01 p.m.
#16
VALUE OF FEMALE URETHROPLASTY FOR
TREATMENT OF FEMALE URETHRAL
STRICTURE DISEASE
Katie Murray, Priya Padmanabhan
(Presented by: Katie Murray)
2:15 p.m. – 2:30 p.m.
Break
2:30 p.m. – 3:00 p.m.
State-of-the-Art Lecture:
Onabotulinumtoxin A (Botox) Use in Urology: Update on Indications, Efficacy, and Safety
Invited Speaker:Gary E. Lemack, MD
Dallas, TX
3:00 p.m. – 3:20 p.m.Update from the SMU: GU Tuberculosis, an Uninvited Guest
Moderator: James M. Cummings, MD
Columbia, MO
Invited Speaker:Mariano Sotomayor, MD
Mexico City, Mexico
3:20 p.m. – 4:40 p.m.
Oncology – Bladder & Testis Podium
Moderators: Ashish M. Kamat, MD
Houston, TX
Moben Mirza, MD
Kansas City, KS
3:00 p.m.
#18
CONCOMITANT CARCINOMA IN SITU: EFFECT ON PATHOLOGIC AND PROGNOSTIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY
William Parker, Joshua Griffin, Moben Mirza,
Jeffrey Holzbeierlein
36
3:07 p.m.
#19
TRANSITIONAL CELL CARCINOMA OF THE BLADDER – IS HERR’S PARADIGM STILL VALID?
Robert Donohue
University of Colorado
(Presented by: Robert Donohue)
3:21 p.m.
#21
NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER CANCER: A MULTI–
INSTITUTIONAL EVALUATION OF PATHOLOGIC RESPONSE
Joshua Griffin¹, Hadley Wyre¹, Homi Zargar²,
Laura Mertens³, Chachen You4, Evanguelos Xylinas5,
Jeff Holzbeierlein¹, Dan Barocas4, Scott North6, Andrew Thorpe7, Bas Van Rhijn³, David Youssef²,
Nikhil Vasdev8, Simon Horenblas³, Shahrokh Shariat5, Peter Black²
¹Department of Urology, University of Kansas Medical Center, Kansas City, KS; ²Department of
Urological Sciences, University of British Columbia; ³Department of Urology, Netherlands Cancer
Institute, Amsterdam, The Netherlands; 4Department of Urology, Vanderbilt University, Nashville, TN;
5
Department of Urology, Weill Cornell Medical College, New York, NY; 6Cross Cancer Institute,
University of Alberta, Edmonton; 7Department of Urology, Freeman Hospital, Newcastle, UK;
8
Department of Urology, Lister Hospital, Stevenage, UK
(Presented by: Hadley Wyre)
3:28 p.m.
#22
TIME DELAYS TO RADICAL CYSTECTOMY BY USE OF NEOADJUVANT CHEMOTHERAPY
ASSOCIATED WITH HIGHER RATES OF PROGRESSION
Joshua Griffin¹, Avinash Nehra³,William Parker¹, Ernesto Lopez–Corona², Jeff Holzbeierlein¹
¹University of Kansas; ²Kansas City Veterans› Hospital; ³University of Missouri Kansas City School of Medicine
37
WEdnesday
3:14 p.m.
#20
THE ROLE OF ALVIMOPAN FOR RADICAL CYSTECTOMY
Zach Hamilton, Josh Griffin, Moben Mirza,
(Presented by: Zach Hamilton)
3:35 p.m.
#23
PHASE I TRIAL OF SEQUENTIAL INTRAVESICAL MITOMYCIN C AND BACILLE
CALMETTE–GUÑ RIN INSTILLATION FOR NON–
MUSCLE INVASIVE UROTHELIAL
CARCINOMA OF THE BLADDER
Robert S. Svatek¹, Edwin Morales¹,
Timothy T. Tseng¹, Joseph W. Basler¹,
Javier Hernandez¹, Tyler J. Curiel²
¹UTHSCSA Urology; ²UTHSCSA Medicine
(Presented by: Edwin Morales)
3:42 p.m.
#24
COMPLETE RESPONSE TO NEOADJUVANT CHEMOTHERAPY: DOES CLINICAL STAGING
MATTER?
William Parker, Joshua Griffin, Moben Mirza,
3:49 p.m.
#25
CONSERVATIVE MANAGEMENT OF SUPERFICIAL BLADDER TUMORS: TRANSURETHRAL RESECTION VERSUS DIATHERMIC ABLATION
Christian V. Sandoval, Jaime U. Yepez,
Fernando G. Navarro, Ricardo C. Molina
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
(Presented by: Christian V. Sandoval)
3:56 p.m.
#26
RADICAL CYSTECTOMY IS ASSOCIATED WITH LONG TERM REDUCTIONS IN BODY WEIGHT: ANALYSIS OF A SINGLE CENTER EXPERIENCE
David Flores¹, Joshua Griffin², Prabhakar Chalise³,
Jill Hamilton-Reeves4, Jeffrey Holzbeierlein5
¹University of Kansas Medical Center; ²Department of Urology University of Kansas Medical Center;
³Department of Biostatistics, University of Kansas Medical Center; 4Department of Dietetics and
Nutrition, University of Kansas Medical Center; 5
Department of Urology, University of Kansas Medical
Center
(Presented by: David Flores)
4:03 p.m.
#27
BCG–MEDIATED EFFECTS ON BLADDER TUMOR CELLS AND IMMUNE CELLS
Andrew T. Kingman, Kristofer Wagner, Richard Tobin, MK Newell Scott and White Memorial Hospital/Texas A&M
(Presented by: Andrew T. Kingman)
38
#28
WITHDRAWN
4:10 p.m.
#29
EFFECTIVENESS OF HYPERBARIC OXYGEN THERAPY ON RADIATION–INDUCED
HEMORRHAGIC CYSTITIS
Justin Johnson, Jeffrey Cooper, Lon Keim, Larry Siref
University of Nebraska Med Center
(Presented by: Justin Johnson)
6:00 p.m. – 8:00 p.m.
Welcome Reception in Chicago Neighborhoods!
6:30 a.m. – 7:30 a.m.Breakfast
6:30 a.m. – 5:00 p.m.
Speaker Ready Room
6:30 a.m. – 5:00 p.m.
7:30 a.m. – 10:30 a.m.
7:30 a.m. – 4:00 p.m.Exhibit Hall
9:15 a.m. – 12:00 p.m.Chicago Architectual River Cruise
6:30 p.m. – 10:30 p.m.Theme Night: Chicago Gangsters & Blues
*Buses depart at 6:30 p.m. – See page 27 for more information
39
THURSDAY
4:17 p.m.
#30
INCIDENCE AND MANAGEMENT OF LYMPHOCELE AFTER RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTIS CANCER
Kyle O. Rove, Roxanne Martinez, Paul D. Maroni
University of Colorado, Anschutz Medical Campus
(Presented by: Kyle O. Rove)
4:24 p.m.
#31
TESTIS TUMORS – PAIN AND OTHER SIGNS AT PRESENTATION
Robert Donohue
CONCURRENT SESSIONS
7:00 a.m. – 8:00 a.m.
“Your Money or Your Life - Urology and Financial Survival in 2013”
Invited Speaker: William F. Gee, MD
Lexington, KY
Location: The Red Lacquer Room
CONCURRENT SESSIONS
7:30 a.m. – 8:00 a.m.
Video Session
Moderator: Kurt H. Strom, MD
Columbia, MO
Video# 1
REPAIR OF LONG LS/BXO URETHRAL
STRICTURES USING BUCCAL AND BLADDER
SUBMUCOSA MATRIX
Ehab Eltahawy, MD, Bryce Pasko, BS
Jeffrey Marotte, MD
UAMS
(Presented by: Ehab Eltahawy)
Video# 2
TRANS–SCROTAL PLICATION FOR PEYRONIE’S
DISEASE WITH SYNCHRONOUS PENILE
IMPLANT
Michael Belsante, MD, Lee C. Zhao, MD
J. Francis Scott, BA, James R. Flemons, BBA
Allen F. Morey, MD
Video# 3
FIBRIN GLUE VASOVASOSTOMY: A SURGICAL
TEACHING VIDEO
Richard Knight, MD, Samuel Hakim, MD
Erin Bird, MD and Leroy Jones, MD
USAF
(Presented by: Richard Knight)
Video# 4
ROBOT–ASSISTED MITROFANOFF
APPENDICOVESICOSTOMY FOR NEUROGENIC
BLADDER
Scott Matz, MD, Kurt Strom, MD
(Presented by: Scott Matz)
40
General Session
8:00 a.m. – 9:10 a.m.Trauma & Reconstruction Podium
Moderators: Ty T. Higuchi, MD, PhD
Aurora, CO
Thomas A. Rozanski, MD
San Antonio, TX
8:07 a.m.
#33
VALIDATION OF THE URETHRAL STRICTURE SCORE (USS) IN ANTERIOR URETHRAL
STRICTURES TREATED BY URETHROPLASTY
Michael Johnson, Andrew Chang, Steven Brandes
Washington University School of Medicine
(Presented by: Michael Johnson)
8:14 a.m.
#34
POOR QUALITY OF LIFE IN URETHRAL STRICTURE AND BLADDER NECK CONTRACTURE PATIENTS TREATED WITH INTERMITTENT SELF–CATHETERIZATION
Jessica D. Lubahn¹, J. Francis Scott¹, Lee C. Zhao¹, Steven J. Hudak¹, Jay Simhan¹, Justin Chee²,
Ryan Terlecki³, Benjamin Breyer4, Allen F. Morey¹
¹UT Southwestern Medical Center; ²Edgewater Urology, Melbourne, Australia; ³Wake Forest University School of Medicine; 4University of California at San Francisco School of Medicine
(Presented by: Jay Simhan)
8:21 a.m.
#35
URETHROGRAPGY INTERPRETATION SKILLS OF
UROLOGY AND RADIOLOGY RESIDENT
AT TERTIARY CARE MEDICAL CENTERS
Andrew Chang¹, Daniel Rosenstein²,
Christopher Gonzalez³, Brandon Manley¹,
Joel Vetter¹, Steven Brandes¹
¹Washington University in St. Louis; ²Stanford
University; ³Northwestern University
41
Thursday
8:00 a.m.
#32
“PSEUDOSPONGIOPLASTY” USING PERIURETHRAL TISSUE FLAPS FOR SUPPORT OF VENTRAL BUCCAL MUCOSA GRAFTS IN DISTAL URETHRA: PROMISING INITIAL RESULTS
Lee C. Zhao¹, TJ Tausch², J. Francis Scott¹,
Allen F. Morey¹
¹UT Southwestern Medical Center;
²Madigan Army Medical Center
(Presented by: TJ Tausch)
8:28 a.m.
#36
SUCCESS RATE OF PRIMARY URETHRAL
REALIGNMENT IS INDEPENDENT OF THE
SEVERITY OF PELVIC TRAUMA AFTER TOTAL
POSTERIOR URETHRAL DISRUPTION
Michael Maccini¹, Alexandre Pompeo², David Sehrt²,
Renato Mariano da Costa, Jr.², Jason Phillips¹,
Wilson Molina², Philip Stahel², Ernest Moore²,
Fernando Kim²
¹University of Colorado; ²Denver Health Medical
Center
(Presented by: Michael Maccini)
8:35 a.m.
#37
MODIFIED YORK–MASON RECTOURETHRAL
FISTULA REPAIR WITH FAT GRAFT
INTERPOSITION
Ruiyang Jiang¹, Lee C. Zhao¹, TJ Tausch²,
Xiangrong Deng¹, Allen F. Morey¹
¹UT Southwestern Medical Center; ²Madigan Army
Medical Center
8:49 a.m.
#39
PRESENTATION AND OUTCOME IN
PENETRATING AND BLUNT BLADDER INJURY: A
CONTEMPORARY COMPARISON
Lars Wallin¹, Margaret Le², Michael Coburn¹,
Andrew Windsperger², Joshua Broghammer²,
Thomas Smith¹
¹Baylor College of Medicine; ²University of Kansas
(Presented by: Margaret Le)
TRENDS IN INCIDENCE, TYPE, AND REPAIR OF
URETERAL INJURY OCCURRING DURING
HYSTERECTOMY OVER TEN YEARS AT A SINGLE
INSTITUTION
Scott Matz¹, Andrew Christiansen², James Cummings³
¹University of Missouri; ²Medical student, University of
Missouri; ³Professor of Urology, University of
Missouri
8:42 a.m.
OUTPATIENT URETHROPLASTY PROVIDES
GOOD OUTCOMES FOR URETHRAL
STRICTURE REPAIR IN PATIENTS WITH A
HISTORY OF FAILED HYPOSPADIAS REPAIR
#38
8:56 a.m.
#40
42
9:03 a.m.
#41
9:10 a.m. – 9:20 a.m.
IVU Scholar Abstract
Guest Speaker: Michael Johnson, MD
Saint Louis, MO
9:20 a.m. – 9:50 a.m.
“The New Global Surgery: Rethinking our Careers as Citizens of the World”
Guest Speaker: Catherine Rhu deVries, MD
Salt Lake City, UT
9:50 a.m. – 10:00 a.m. Q&A
10:00 a.m. – 10:30 a.m. Break / Visit Exhibits
10:30 a.m. – 11:00 a.m. Point/Counterpoint – Repair of Complex Peyronie’s Disease: Graft vs. Plication
Moderator: Brian S. Christine, MD
Homewood, AL
Guest Speakers: Steven J. Hudak, MD
San Antonio, TX
Ajay Nehra, MD
Chicago, IL
11:00 a.m. – 12:00 p.m. Prosthetic Urology Podium
Moderators: Joshua A. Broghammer, MD
Kansas City, KS
Bryan T. Kansas, MD
Austin, TX
11:00 a.m.
#42
NEW “SCRATCH” TECHNIQUE FOR CORRECTION
OF PEYRONIE’S CURVATURE DURING
INFLATABLE PENILE PROSTHESIS PLACEMENT
Paul Perito¹, Steven Wilson²
¹Perito Urology, Coral Gables FL; ²Institute for
Urologic Excellence
(Presented by: Steven Wilson)
43
THURSDAY
LAPAROSCOPIC URETERONEOCYSTOSTOMY
FOR URETERAL INJURIES AFTER
HYSTERECTOMY: TEN YEAR EXPERIENCE
Alexandre Pompeo¹, Wilson Molina², David Sehrt³,
Marcos Tobias-Machado4, Antonio Pompeo4,
Fernando Kim²
¹Division of Urology, Department of Surgery, Denver
Health Medical Center, Denver, CO; ²Division of
Urology, Department of Surgery, Denver Health
Medical Center, Denver, CO; Division of Urology,
Department of Surgery, University of Colorado,
Aurora, CO; ³Denver Health Medical Center/University
of Colorado; 4Department of Urology, ABC Medical
School, Sao Paulo, Brazil
(Presented by: David Sehrt)
11:07 a.m.
#43
11:14 a.m. #44
SAFETY OF “DRAIN AND RETAIN” STRATEGY
FOR DEFUNCTIONALIZED UROLOGIC
PROSTHETIC BALLOONS AND RESERVOIRS
DURING AUS AND IPP REVISION SURGERY:
FIVE YEAR EXPERIENCE
Christopher A. Cefalu, Xiangrong Deng,
J. Francis Scott, Sandeep Mehta, Lee C. Zhao,
Allen F. Morey
(Presented by: Christopher A. Cefalu)
STAGGERED IPSILATERAL SUBMUSCULAR
PLACEMENT OF AUS PRESSURE REGULATOR
BALLOON AND IPP RESERVOIR: A PRELIMINARY
EXPERIENCE
Paul Chung, Lee C. Zhao, Allen F. Morey
University of Texas Southwestern Medical School
(Presented by: Paul Chung)
11:21 a.m. #45
LONG–TERM OUTCOMES FOR ARTIFICIAL
URINARY SPHINCTER REIMPLANTATION
FOLLOWING PRIOR DEVICE EXPLANTATION FOR
EROSION AND/OR INFECTION
Brian Linder, Daniel Elliott
Mayo Clinic
(Presented by: Daniel Elliott)
11:28 a.m.
#46
11:35 a.m. #47
11:42 a.m. #48
DOES IN SITU URETHROPLASTY AT TIME OF AUS
EXPLANTATION DECREASE RISK OF
URETHRAL STRICTURE?
Daniel Ramirez, Lee C. Zhao, Allen F. Morey
IS HIGH SUBMUSCULAR PLACEMENT OF AUS
PRESSURE REGULATING BALLOON
EQUIVALENT TO SPACE OF RETZIUS?
Gregory R. Thoreson, Lee C. Zhao, Xiangrong Deng,
Allen F. Morey
(Presented by: Gregory R. Thoreson)
SIGNIFICANT DIFFERENCE IN IN–VIVO VERSUS
EX–VIVO ARTIFICIAL SPHINCTER
REGULATING BALLOON PRESSURES AT THE
TIME OF REVISION: A MECHANISM OF
ACCELERATED URETHRAL ATROPHY?
Dominic Lee, Ouida Westney
(Presented by: Ouida Westney)
44
11:50 a.m.
#49
DECREASED NEED FOR REVISION SURGERY IN
ERA OF 3.5 CM ARTIFICIAL URINARY
SPHINCTER CUFF
Brian C. Mazzarella, Lee C. Zhao, Samir Derisavifard,
Steven J. Hudak, Allen F. Morey
(Presented by: Brian C. Mazzarella)
(See page 25 for more details.)
CONCURRENT POSTER SESSION I
1:15 p.m. – 2:15 p.m.
Men’s Health Poster Session
Moderator: Mohit Khera, MD
Houston, TX
Location: Salon 8–9
Poster# 1
LOWERING REVISION RATES IN PRIMARY
ARTIFICIAL URINARY SPHINCTER SURGERY:
RESULTS OF A CONTEMPORARY NATIONAL
DATABASE
Lee C. Zhao¹, Jay Simhan¹, Steven J. Hudak¹,
Laura Gintant², Allen F. Morey¹
¹UT Southwestern Medical Center; ²American Medical
Systems
Poster# 2
Poster# 3
FATE OF ERODED ARTIFICIAL URINARY
SPHINCTER (AUS)
Nirmish Singla¹, Ajay Singla²
¹The University of Texas Southwestern Medical
Center; ²Professor, Department of Urology, The
University of Toledo Medical Center
(Presented by: Nirmish Singla)
THE ROLE OF TGF–BETA IN URETHRAL
STRICTURE DISEASE
Kyle Keyes, Joseph Sonstein, Sasha Still, Kelli Gross
UTMB
(Presented by: Kyle Keyes)
45
THURSDAY
Poster# 4
SHORT TERM URINARY FLOW OUTCOMES
AFTER ROBOTIC SIMPLE PROSTATECTOMY
Igor Kislinger, Isabel H Lopez, Edward L Gheiler,
Paul Perito, Fernando J Bianco
Urological Research Network
(Presented by: Igor Kislinger)
Poster# 5
IMMEDIATE PENILE REHABILITATION THERAPY
FOLLOWING ROBOT–ASSISTED LAPAROSCOPIC
PROSTETECTOMY (RALP): A CASE STUDY
Zachary Hafez, Kurt Strom
University of Missouri School of Medicine
(Presented by: Zachary Hafez)
Poster# 6
VASECTOMY PAIN – PERCEPTION VERSUS
REALITY: A COMPARATIVE ANALYSIS OF
PATIENTS’ PRE AND POST VASECTOMY PAIN
SCORES UNDERGOING THE NO NEEDLE NO
SCALPEL TECHNIQUE
Adam Mellis, Puneet Sindhwani
University of Oklahoma HSC
(Presented by: Adam Mellis)
Poster# 7
MALE INFERTILITY FROM OVERUSE OF MEDICAL
TESTOSTERONE IN MEN IN THEIR REPRODUCTIVE
YEARS – AN UNNECESSARY PROBLEM
William Parker, Brian McCardle, Zachary Hamilton,
Ajay Nangia
Poster# 8
MEDICATION TREATMENT PATTERNS AMONG
HYPOGONADAL MEN INITIATED TOPICAL
TESTOSTERONE AGENTS
Michael Jay Schoenfeld, Emily Shortridge,
Zhanglin Cui, David Muram
(Presented by: David Muram)
Poster# 9
IDIOPATHIC SCROTAL CALCINOSIS
McCabe Kenny¹, Alexandre Pompeo², Wilson Molina²,
Garrett Pohlman¹, David Sehrt², Fernando Kim²
¹University of Colorado–Denver; ²Denver Health
Medical Center
(Presented by: McCabe Kenny)
46
Poster# 12
CAN WE PREDICT A RESPONSE TO IL–2 AFTER
CYTOREDUCTIVE NEPHRECTOMY?
Zach Hamilton, William Parker, David Duchene,
Moben Mirza, Peter Van Veldhuizen,
Poster# 13
SYNCHRONOUS PRIMARY RENAL CELL
CARCINOMA AND PANCREATIC MASSES
Laura Martinez, Gennady Slobodov
University of Oklahoma
(Presented by: Laura Martinez)
Poster# 14
CONFIRMATION OF THE FREE HORMONE
HYPOTHESIS: DECREASES IN PSA CORRELATE
WITH FREE TESTOSTERONE RATHER THAN
TOTAL TESTOSTERONE IN MEN WITH
ADVANCED PROSTATE CANCER TREATED WITH
GTX-758
Robert Getzenberg¹, Alvin Matsumoto²,
Christopher Coss¹, Michael Hancock¹, Xuemei Si¹,
James Dalton¹, Mitchell Steiner¹
¹GTx Inc; ²Geriatric Research, Education and Clinical
Center (GRECC), VA Puget Sound Health Care
System and Department of Medicine, Division of
Gerontology & Geriatric Medicine, University of
Washington
(Presented by: Robert Getzenberg)
47
THURSDAY
CONCURRENT POSTER SESSION I
1:15 p.m. – 2:15 p.m.
Oncology Poster Session
Moderators: Javier Hernandez, MD
San Antonio, TX
Ronald Rodriguez, MD, PhD
San Antonio, TX
Poster# 11
GENDER DIFFERENCES IN SURVIVAL OF
PATIENTS WITH INVASIVE BLADDER CANCER
Roxanne Martinez¹, Shandra Wilson²
¹University of Colorado, Anschutz Medical Campus;
²University of Colorado, Anschutz Medical Campus,
Division of Urology
(Presented by: Roxanne Martinez)
Poster# 15
SYNCHRONOUS AND METACHRONOUS TUMORS
OF PATIENTS WITH A UROLOGIC CANCER
Eduardo G. Cuenca, Christian V. Sandoval, Ricardo
C. Molina, Francisco R.Covarrubias,
Mariano Sotomayor, Guillermo F. Bernal,
Fernando G. Navarro
Instituto Nacional de Ciencias Médicas y Nutrición
Salvador Zubirán
Poster# 16
CARCINOMA OF THE PENIS – STAGE,
TREATMENT AND OUTCOME IN A TERTIARY
REFERRAL CENTER
Jerry Trulson, Tyler Haden, Gilbert Ross, Stephen
Weinstein, Mark Wakefield, Naveen Pokala
University of Missouri–Columbia
(Presented by: Jerry Trulson)
Poster# 17
SIMULTANEOUS BILATERAL VIDEO
ENDOSCOPIC INGUINAL LYMPHADENECTOMY
(VEIL) FOR PENILE CANCER: FIRST INITIAL
EXPERIENCE
Michael Maccini¹, Alexandre Pompeo², Jarkes Lucio²,
Wilson Molina², David Sehrt²,
Marcos Tobias-Machado², Fernando Kim²
¹University of Colorado; ²Denver Health Medical Center
Poster# 18
RADICAL LYMPHADENECTOMY MODIFIED
TECHNIQUE WITH SHAPE–S INCISION AND
USAGE OF PATENT BLUE FOR PENIS CANCER: A
STEP BY STEP APPROACH
Alejandro González Alvarado¹, Luis Alfredo Jimenez
Lopez², Hector R Vargas Zamora¹, Abel Antonio
Ricardez Espinosa¹
¹Centro Médico Nacional, UMAE N 14, Adolfo Ruiz
Cortinez, IMSS, Veracruz, México; ²IMSS
(Presented by: Luis Alfredo Jimenez Lopez)
Poster# 19
EARLY BIOCHEMICAL RECURRENCE AND
FACTORS RELATED IN PATIENTS UNDERGOING
RADICAL PROSTATECTOMY IN THE SERVICE OF
UROLOGY AT HOSPITAL GENERAL DE
OCCIDENTE IN THE PERIOD 2008–2010
Edgar I. Ibarra Navarro¹, Jose A. Rodriguez Rivera²,
Rodolfo R. Gomez³, Gilberto T. Arce³, Rocio V. Cuevas4
¹Hospital General De Occidente; ²Department of
Urology Head Hospital General Occidente. AUA
Member; ³Hospital General Occidente; 4Universidad
De Guadalajara
(Presented by: Edgar I. Ibarra Navarro)
48
CONCURRENT POSTER SESSION II
2:15 p.m. – 3:15 p.m.
Pediatric Urology Poster Session
Moderators: Nicholas Cost, MD
Denver, CO
Juan Prieto, MD
San Antonio, TX
Poster# 21
A CASE OF GENITOURINARY SCHISTOSOMIASIS
IN WEST TEXAS
Johnny Hickson¹, Alan Haynes²
¹TTUHSC; ²attending
(Presented by: Johnny Hickson)
Poster# 24
EPIC ELECTRONIC MEDICAL RECORD AS A
PROSPECTIVE DATA COLLECTION TOOL FOR
HYPOSPADIAS RESEARCH
David Chalmers, Georgette Siparsky,
Vijaya Vemulakonda, Duncan Wilcox
Children’s Hospital Colorado
(Presented by: David Chalmers)
49
Thursday
Poster# 22
GENDER AND PROFESSIONAL STATUS
INFLUENCE OPINIONS REGARDING
PROFESSIONAL USAGE OF ONLINE SOCIAL
MEDIA OUTLETS IN A MULTI–SPECIALTY
ACADEMIC MEDICAL CENTER
Aravind Chandrashekar, Erik Wallin, Alexander Pastuszak, Mimi Zhang, Michael Coburn, Thomas Smith
(Presented by: Aravind Chandrashekar)
Poster# 23
NATURAL HISTORY OF DETRUSOR LEAK POINT
PRESSURE EVOLUTION IN
MYELOMENINGOCELE PATIENTS
Nirmish Singla¹, Julian Wan², David Bloom²,
John Park²
¹The University of Texas Southwestern Medical
Center; ²Department of Urology, University of
Michigan
Poster# 25
COMPUTER ENHANCED VISUAL LEARNING
(CEVL) MODULE SIGNIFICANTLY IMPROVES
RESIDENT TRAINING IN A BASIC PEDIATRIC
UROLOGY PROCEDURE: SLEEVE
CIRCUMCISION
Mohammad Ramadan¹, Bradley Kropp²,
Max Maizels³, Blake Palmer²
¹University of Oklahoma HSC; ²Children’s Hospital
of Oklahoma, Oklahoma City, Oklahoma; ³Lurie
Children’s Hospital of Chicago, Department of
Pediatric Urology
(Presented by: Mohammad Ramadan)
Poster# 26
WITHDRAWN
Poster# 27
A CASE REPORT OF PROXIMAL URETERAL
STRICTURE IN A PATIENT WITH PRUNE BELLY
SYNDROME
Sarabeth Bailey¹, Ismael Zamilpa²
¹UAMS; ²ACH
(Presented by: Sarabeth Bailey)
Poster# 28
LEYDIG CELL HYPERPLASIA: ATYPICAL
PRESENTATIONS IN A PREPUBESCENT BOY
Bryan Pham, Dung Pham, Christopher Nguyen, David
Roth
Texas Children’s Hospital/Baylor College of Medicine
(Presented by: Bryan Pham)
Poster# 29
WITHDRAWN
Poster# 30
WITHDRAWN
2:15 p.m. – 3:15 p.m.
General Urology Poster Session
Moderators: Michael James Finger, MD
Harlingen, TX
Ryan J. Mauck, MD
Dallas, TX
Location: Salon 10
Poster# 31
THE UTILITY OF STANDARD POSTOPERATIVE
FEVER TESTING IN UROLOGIC PATIENTS: A
COST EFFECTIVENESS STUDY
Christopher Powell, Paul Guidos, Jeremy Davis,
50
Poster# 32
Poster# 33
Poster# 34
TESTICULAR SELF EXAMINATIONS: A COST
ANALYSIS COMPARISON
Michael Aberger, Bradley Wilson,
Jeffrey Holzbeierlein, Tomas L. Griebling, Ajay Nangia
(Presented by: Michael Aberger)
THE EFFECT OF POSTOPERATIVE STENTS ON
UPPER TRACT DRAINAGE IN THE STUDER
NEOBLADDER POPULATION
Yasmin Bootwala¹, Huong Truong², Clay Pendleton³,
Graciela Nogueras-Gonzalez¹, Ouida Westney¹
¹MD Anderson Cancer Center; ²Universtiy of Texas
Health Science Center – Houston; ³University of
Texas Health Science Center – Houston
Poster# 35
THE ROLE OF PREOPERATIVE HEALTH
ANALYSIS INDEX IN PREDICTING
POSTOPERATIVE OUTCOMES AFTER
TRANSURETHRAL RESECTION OF THE
PROSTATE
Jennifer Dwyer¹, Kendra Schmid², Georgia Seevers³,
Vikas Desai¹, Jason Johanning4, Chad LaGrange¹
¹University of Nebraska Medical Center, Division of
Urology; ²University of Nebraska Medical Center,
Department of Biostatistics; ³VA Medical Center, Department of Surgery; 4University of Nebraska
Medical Center, Division of Vascular Surgery
(Presented by: Jennifer Dwyer)
Poster# 36
THE SUPRAPUBIC PROSTATECTOMY:
RETROSPECTIVE REVIEW AT A UNITED STATES
RESIDENCY TRAINING PROGRAM
Rowena Desouza¹, Daniel Zapata, Run Wang²
¹Assistant Professor of Urology, University of Texas at
Houston; ²Professor of Surgery, Division of
Urology, University of Texas at Houston
(Presented by: Rowena Desouza)
51
Thursday
PERCUTANEOUS NEPHROLITHOTOMY IN SPINAL
CORD NEUROPATHY PATIENTS: A SINGLE
INSTITUTION EXPERIENCE
Philippe Nabbout, Gennady Slobodov,
Adamantios Mellis, Daniel Culkin
OUHSC
(Presented by: Philippe Nabbout)
Poster# 37
Poster# 38
TRIAMCINOLONE INJECTION VS FULGURATION
FOR TREATMENT OF HUNNER’S ULCER–TYPE
INTERSTITIAL CYSTITIS: PRELIMINARY RESULTS
OF A PROSPECTIVE RANDOMIZED TRIAL
Janine Oliver, Carl Klutke
(Presented by: Janine Oliver)
PUBLIC PERCEPTION AND AWARENESS ABOUT
BLADDER CANCER
Bradley Wilson, Katie Murray, Kacey Provanzano,
Jeffrey Holzbeierlein, Moben Mirza
SHORT–TERM QUALITY OF LIFE OUTCOMES
AFTER ROBOTIC PELVIC FLOOR
RECONSTRUCTION WITH SACROCOLPOPEXY
Igor Kislinger, Prashanth Kanagarajah,
Isabel E. Lopez, Edward L. Gheiler, Fernando J. Bianco
Poster# 40
WITHDRAWN
2:15 p.m. – 3:15 p.m.
Oncology/Transplant Poster Session
Moderators: Frances M. Alba, MD
Houston, TX
Puneet Sindhwani, MD, MS, MBBS, MSBS
Oklahoma City, OK
Location: Madison Room
Poster# 39
Poster# 41
FEASIBILITY OF OBTAINING BIOMARKER
PROFILES FROM ENDOSCOPIC BIOPSY
SPECIMENS IN UPPER TRACT UROTHELIAL
CARCINOMA: PRELIMINARY RESULTS
Aditya Bagrodia, Bishoy Gayed, Mansi Gaitonde,
Ramy Youssef, Payal Kapur, Arthur Sagalowsky,
Yair Lotan, Vitaly Margulis
52
PROGNOSTIC ROLE OF CELL CYCLE AND
PROLIFERATIVE BIOMARKERS IN PATIENTS
WITH CLEAR CELL RENAL CELL CARCINOMA
Aditya Bagrodia, Bishoy Gayed, Ramy Youssef,
Payal Kapur, Oussama Darwish, Laura-Maria Krabbe,
Arthur Sagalowsky, Yair Lotan, Vitaly Margulis
Poster# 43
TRANSCRIPTION FACTOR SPDEF REGULATES
AGGRESSIVE PHENOTYPE IN PCA BY
MODULATING E–CADHERIN EXPRESSION
Mintu Pal¹, Sweaty Koul¹, David Crawford¹, Hari Koul²
¹CUSOM; ²CU School of Medicine
(Presented by: Hari Koul)
Poster# 44
SALVAGING SEVERELY DAMAGED RENAL
ALLOGRAFTS WITH SYNTHETIC MESH
RENORRHAPHY AND NEOCAPSULE
RECONSTRUCTION
Adam Mellis, Nathan Bradley, Blake Palmer,
Bradley Kropp, Martin Turman, Puneet Sindhwani
Poster# 45
Poster# 46
ARE GENITOURINARY MALIGNANCIES MORE
COMMON AND MORE AGGRESSIVE IN
ORGAN TRANSPLANT PATIENTS COMPARED TO
THE GENERAL POPULATION?
Vikas Desai¹, Sudhir Isharwal¹, Michael Morris²,
Chad LaGrange¹, Jue Wang³
¹University of Nebraska Medical Center, Division of
Urology; ²University of Nebraska Medical Center,
Division of Transplant Surgery; ³University of Nebraska
Medical Center, Division of Oncology and Hematology
(Presented by: Vikas Desai)
IMPROVEMENT OF LIVING DONOR’S
GLOMERULAR FILTRATION RATE AFTER ONE
MONTH IS RELATED TO RECIPIENT’S
GLOMERULAR FILTRATION RATE AFTER ONE
YEAR
Christian Villeda Sandoval,
Ashmar Gomez Conzatti y Martínez,
Denny Lara Núñez, Gerardo Guinto Nishimura,
Francisco Rodríguez Covarrubias,
Bernardo Gabilondo Pliego
Salvador Zubirán
(Presented by: Christian Villeda Sandoval)
53
Thursday
Poster# 42
Poster# 47
INCIDENCE OF THROMBOPHILIA IN
AUTOIMMUNE VERSUS ANATOMIC CAUSES OF
PEDIATRIC END STAGE RENAL DISEASE (ESRD)
PATIENTS
Adam Mellis, Marshall Shaw, Blake Palmer,
Martin Turnman, Puneet Sindhwani
Poster# 48
A REVIEW OF THE TREATMENT OF RENAL
ANGIOMYOLIPOMAS WITH MAMMALIAN
TARGET OF RAPAMYCIN INHIBITORS IN
PATIENTS WITH TUBEROUS SCLEROSIS
COMPLEX OR SPORADIC
LYMPHANGIOLEIOMYOMATOSIS
Corinne Puzio, Puneet Sindhwani
Oklahoma University Health Science Center
(Presented by: Corinne Puzio)
3:15 p.m. – 3:45 p.m.
Break / Visit the Exhibits
General Session
3:45 p.m. – 5:00 p.m.
T–Leon Howard Imaging Session
Moderator: J. Brantley Thrasher, MD
Kansas City, KS
Case # 1
36 YEAR OLD MALE WITH HEMATOSPERMIA
Adam Mellis, MD, James Furr, MD, Jeffrey Davis, MD,
Gennady Slobodov, MD
Case # 2
46 YEAR OLD MALE WITH PENILE AND SCROTAL
MASS
Christopher Powell, MD, Joshua Broghammer, MD
Case # 4
15 YEAR OLD MALE WITH LEFT SCROTAL PAIN
Robert Donohue, MD
Case # 3
80 YEAR OLD MALE WITH RECURRENT UTIS AND
GROSS HEMATURIA
Sudhir isharwal, Vikas Desai, MD and Larry Siref, MD
UNMC
(Presented by: Sudhir isharwal)
54
Case # 5
Case # 6
Case # 7
Case # 8
62 YEAR OLD MALE WITH LEFT TESTICULAR
LESION
Andrew Arther, MD, William Parker, MD
Ernesto Lopez-Corona, MD
(Presented by: Andrew Arther, MD)
30 YEAR OLD MALE WITH LEFT
PARATESTICULAR MASS
Jeffrey Shoss, MD, Daniel Ramirez, MD
Allen Morey, MD
UT Southwestern
(Presented by: Jeffrey Shoss, MD)
41 YEAR OLD FEMALE WITH RIGHT FLANK PAIN
Martha Gomez, Urology Resident, Eduardo Razon,
Urology Resident, Fernando Gabilondo, Urologist
National Institute of Nutrition and Medical Science
(Presented by: Martha Gomez)
6:30 p.m. – 10:30 p.m. Theme Night
*Buses depart at 6:30 p.m. – See page 27 for more information
FRIDAY, SEPTEMBER 20, 2013
6:45 a.m. – 7:45 a.m.
Industry Sponsored Breakfast
7:00 a.m. – 8:00 a.m.Nominating Committee Meeting
7:00 a.m. – 8:00 a.m.
SMU Breakfast Meeting
6:30 a.m. – 5:00 p.m.
7:00 a.m. – 5:00 p.m.
7:30 a.m. – 10:30 a.m.
7:30 a.m. – 11:00 a.m.
Speaker Ready Room
Exhibit Hall
55
Friday
23 YEAR OLD MALE WITH PRIAPISM
Michael Belsante, MD, Lee Zhao, MD, Allen Morey, MD
(Presented by: Michael Belsante, MD)
12:00 p.m. – 1:00 p.m.
Health Policy Meeting
1:00 p.m. – 2:30 p.m.Art Institute Tour
2:15 p.m. – 3:15 p.m.Finance Committee Meeting
GENERAL SESSION
8:00 a.m. – 9:20 a.m.
Renal Cancer/Robotics Podium
Moderators: Ashley B. Bowen, MD
Oklahoma City, OK
Rodney Davis, MD
Little Rock, AR
8:00 a.m.
#50
RADIOFREQUENCY ABLATION OF SMALL RENAL
CORTICAL TUMORS IN HEALTHY ADULTS: 5
YEAR ONCOLOGIC OUTCOMES
Daniel Ramirez, Jeffery Gahan, Jodi Antonelli,
Jeffery Cadeddu
UT Southwestern
8:07 a.m.
#51
OPEN PARTIAL NEPHRECTOMY VERSUS
PERCUTANEOUS CRYOABLATION FOR CLINICAL
T1 RENAL TUMORS: PERIOPERATIVE AND
ONCOLOGICAL OUTCOMES
Philippe Nabbout¹, Ahmed Eldefrawy²,
Nathan Bradley¹, Gennady Slobodov¹
¹Ouhsc; ²Miami School of Medicine
8:14 a.m.
#52
ROBOTIC PARTIAL NEPHRECTOMY IS
ASSOCIATED WITH DECREASED LENGTH OF
STAY AND LESS BLOOD LOSS
Zach Hamilton, Margaret Le, Kahlil Saad,
David Duchene, Jeffrey Holzbeierlein, Moben Mirza
8:21 a.m.
#53
SARCOPENIA IS ASSOCIATED WITH ADVANCED
STAGE RENAL CELL CARCINOMA: A
RETROSPECTIVE ANALYSIS OF A
PROSPECTIVELY MAINTAINED INSTITUTIONAL
DATABASE
Christian V. Sandoval, Carolina C. García, Francisco
R. Covarrubias, Ricardo C. Molina
Salvador Zubirán
56
8:28 a.m.
#54
8:35 a.m.
#55
8:42 a.m.
#56
OUTCOMES IN RENAL CRYOABLATION THERAPY
FOR T1A AND T1B TUMORS
Cole Wiedel¹, David Sehrt², Wilson Molina³,
Alexandre Pompeo³, Fernando Kim³
¹University of Colorado School of Medicine; ²Division
of Urology, Department of Surgery, Denver Health
Medical Center, Denver, CO; ³Division of Urology,
Department of Surgery, Denver Health Medical
Center, Denver, CO; Division of Urology, Department
of Surgery, University of Colorado, Aurora, CO
(Presented by: Cole Wiedel)
PHASE I/II EVALUATION OF THE TOLERABILITY
OF SORAFENIB DOSE ESCALATION IN
ADVANCED RENAL CELL CARCINOMA
Katie Murray, Jeffrey Holzbeierlein,
Stephen Williamson, John Keighley,
Peter Van Veldhuizen
8:56 a.m.
#58
ROBOTIC–ASSISTED LAPAROSCOPIC VS OPEN
URETERAL REIMPLANTATION: A SINGLE
INSTITUTION MATCHED COHORT REVIEW
Daniel Zainfeld¹, Andrew Windsperger¹, Kirk Redger²,
David Duchene¹
¹University of Kansas Department of Urology;
²University of Kansas School of Medicine
(Presented by: Daniel Zainfeld)
CHARACTERISTICS AND CLINICAL OUTCOMES
OF PATIENTS WITH RENAL CELL CARCINOMA
AND SARCOMATOID DEDIFFERENTIATION
(SRCC)
Megan Merrill¹, Christopher Wood¹, Nizar Tannir¹,
Rebecca Slack¹, Kara Babaian¹, Eric Jonasch¹,
Lance Pagliaro¹, Zachary Compton²,
Pheroze Tamboli¹, Kanishka Sircar¹, Louis Pisters¹,
Surena Matin¹, Jose Karam¹
¹The University of Texas, M.D. Anderson Cancer
Center; ²The University of Texas Medical School at
Houston
(Presented by: Megan Merrill)
57
Friday
8:49 a.m.
#57
ROBOT–ASSISTED PARTIAL NEPHRECTOMY
VERSUS CRYOABLATION FOR SMALL RENAL
MASSES: SINGLE–CENTER EXPERIENCE
Youssef Tanagho, Eric Kim, Sam Bhayani,
Brian Benway, Robert Figenshau
(Presented by: Eric Kim)
9:03 a.m.
#59
9:10 a.m.
#60
ROBOTIC REDO PYELOPLASTY: SINGLE
INSTITIUTION EXPERIENCE
Bradley Wilson, Andrew Arther, Zachary Hamilton,
David Duchene
IMPROVING POSTOPERATIVE PAIN FOLLOWING
ROBOTIC–ASSISTED AND LAPAROSCOPIC
UROLOGIC SURGERIES: A COMPARISON OF
LIPOSOMAL BUPIVACAINE TO ROPIVACAINE
DELIVERED BY THE ON–Q PAIN RELIEF SYSTEM
Paul Walker¹, Michael White¹, Edwin Morales²,
Uzo Nwoye³, William Harmon¹
¹Urology San Antonio; ²UTHSCSA Urology;
³San Antonio Military Medical Center
9:20 a.m. – 10:00 a.m. AUA Guidelines Update
Speaker:
Daniel J. Culkin, MD
Oklahoma City, OK
10:00 a.m. – 10:30 a.m. Break / Visit the Exhibits
10:30 a.m. – 11:45 a.m. Urinary Diversion/Stones Podium
Moderators: Chad A. LaGrange, MD
Omaha, NE
Ouida L. Westney, MD
Houston, TX
10:30 a.m. #61
COMPARISON OF URINARY OUTCOMES IN
SUTURE–LINE VERSUS NEO–ORIFICE
URETHRAL ANASTOMOTIC TYPES IN THE
STUDER NEOBLADDER
Kathryn Cunningham¹, Yasmin Bootwala²,
Huong Truong¹, Clay Pendleton¹,
O. Lenaine Westney²
¹University of Texas Health Science Center –
Houston; ²MD Anderson Cancer Center
(Presented by: Kathryn Cunningham)
10:37 a.m.
#62
PATIENT REPORTED QUALITY OF LIFE AT 5
YEARS AFTER NEOBLADDER CREATION
Katie Murray, Brett Wahlgren, Andrew Arther,
58
10:44 a.m.
THE INFLUENCE OF PRE– & POST–OP STENTS
AND NEOADJUVANT CHEMOTHERAPY ON
NEOBLADDER PATIENTS POSTOPERATIVE
URINARY LEAK RATES
Yasmin Bootwala¹, Huong Truong², Clay Pendleton²,
Graciela Nogueras-Gonzalez¹, Ouida Westney¹
¹MD Anderson Cancer Center; ²University of Texas
Health Science Center – Houston
#63
10:51 a.m. #64
POST–CYSTECTOMY AND NEOBLADDER
URINARY DIVERSION: WHAT IS THE NEED FOR
FOLLOW UP SURGICAL PROCEDURES IN THIS
PATIENT POPULATION?
Katie Murray, Brad Wilson, Jeffrey Holzbeierlein
10:58 a.m.
#65
11:05 a.m.
#66
11:12 a.m.
#67
11:19 a.m.
#68
IS ENDOPYELOTOMY A VIABLE OPTION AFTER
FAILED PYELOPLASTY?
Daniel Zainfeld, David Duchene
University of Kansas Department of Urology
DEFINING THE VARIATION IN URINARY OXALATE
IN HYPEROXALURIC STONE–FORMING PATIENTS
Jodi Antonelli¹, Christopher Odom¹, John Poindexter¹,
Beverley Adams-Huet¹, Orson Moe¹,
Charles Pak¹, Craig Langman², Margaret Pearle¹
¹UT Southwestern Medical School; ²Northwestern
University
(Presented by: Jodi Antonelli)
SYMPTOMS ASSOCIATED WITH URETERAL
STENTS IN SPANISH SPEAKING POPULATION
Daniel Olvera-Posada, Eduardo Gonzalez-Cuenca,
Fernando Gabilondo-Navarro,
Ricardo Castillejos-Molina, Carlos E. Mendez-Probst
INNSZ
59
Friday
USE OF SIGMOID COLON IN MANAGEMENT OF
NEUROGENIC BLADDER DUE TO SPINAL CORD
INJURY (SCI) OR SPINA BIFIDA
Ehab Eltahawy¹, John Paddack¹, Mohamed Kamel¹,
Nabil Bissada²
¹University of Arkansas for Medical Sciences;
²University of Oklahoma
(Presented by: John Paddack)
11:26 a.m.
#69
THE IMPACT OF OBESITY AND DIABETES ON
COST AND PREVALENCE OF UROLITHIASIS
Jodi Antonelli, Naim Maalouf, Margaret Pearle,
Yair Lotan
UT Southwestern Medical School
11:33 a.m. #70
TEMPERATURE PROFILE OF LASTER
LITHOTRIPSY USING AN EX VIVO MODEL
Wilson Molina¹, McCabe Kenny², Igor Silva,
David Sehrt¹, Alexandre Pompeo¹, Jason Phillips²,
Elliot Handler², Fernando Kim¹
¹Denver Health Medical Center; ²University of
Colorado–Denver
11:45 a.m. – 1:00 p.m. Industry Sponsored Lunch
11:45 a.m. – 1:00 p.m. Industry Sponsored Lunch
general Session
1:00 p.m. – 2:15 p.m.
AUA Course of Choice: Prostate Cancer Active Surveillance
Guest Speaker: Laurence H. Klotz, MD
Toronto, ON
2:15 p.m. – 3:30 p.m.
Pediatric Urology Podium
Moderators: Dennis S. Peppas, MD
San Antonio, TX
Duncan T. Wilcox, MBBS, MD
Aurora, CO
2:15 p.m.
#71
PEDIATRIC BLUNT RENAL TRAUMA: IS IT TIME
TO ABANDON THE USE OF DELAYED IMAGING
DURING INITIAL WORKUP?
Thomas Pshak¹, Garrett Pohlman¹, Steven Moulton²,
Duncan Wilcox²
¹University of Colorado; ²Children›s Hospital Colorado
(Presented by: Thomas Pshak)
#72
WITHDRAWN
60
2:22 p.m.
#73
FACTORS ASSOCIATED WITH SURGICAL
INTERVENTION IN CHILDREN WITH HIGH–GRADE
HYDRONEPHROSIS
Vassilis Siomos¹, Susan Staulcup², Michelle Torok²,
Vijaya Vemulakonda²
¹University of Colorado School of Medicine;
²Children›s Hospital Colorado
(Presented by: Vassilis Siomos)
#74
WITHDRAWN
#75
COMPLICATIONS AND REOPERATIVE RATE OF
HYPOSPADIAS REPAIR BY LOCATION
David Chalmers, Georgette Siparsky, Duncan Wilcox
2:29 p.m.
2:36 p.m.
#76
2:43 p.m.
#77
MANAGING URETEROPELVIC JUNCTION
OBSTRUCTION IN A PEDIATRIC POPULATION:
COMPARISON OF LAPAROSCOPIC AND
ROBOTIC PYELOPLASTY
Ashay Patel¹, Nathan Littlejohn², Mark Pickhardt²,
Mallikarjuna Rettiganti¹, Chunqiao Luo¹,
Stephen Canon¹, Ismael Zamilpa¹
¹Arkansas Children›s Hospital; ²UAMS
(Presented by: Ashay Patel)
2:50 p.m.
#78
PARTIAL BLADDER OUTLET OBSTRUCTION IN
MICE MAY CAUSE FIBROSIS THROUGH A
HYPOXIA INDUCED PATHWAY
Naoko Iguchi¹, Amy Hou², Hari Koul¹, Duncan Wilcox²
¹University of Colorado Denver School of Medicine;
²Children›s Hospital Colorado
(Presented by: Naoko Iguchi)
61
Friday
SYMPTOMATIC URETEROPELVIC JUNCTION
OBSTRUCTION (DIETL’S CRISIS): A COMMONLY
MISSED ETIOLOGY OF RECURRENT ABDOMINAL
PAIN IN THE PEDIATRIC PATIENT POPULATION
Ismael Zamilpa¹, John Moore², Mark Pickhardt²,
Stephen Canon², Ashay Patel²
¹Arkansas Childrens Hospital; ²UAMS
(Presented by: Ismael Zamilpa)
2:57 p.m.
#79
INJECTION THERAPY FOR VESICOURETERAL
REFLUX IN THE OLDER CHILD AND
ADOLESCENT
Carrie Yeast, James Cummings, Phillip Fuller,
Scott Matz, Mark Wakefield
(Presented by: Carrie Yeast)
3:04 p.m.
#80
PREVALENCE AND ANALYSIS OF AUTONOMIC
DYSREFLEXIA DURING URODYNAMICS IN
CHILDREN AND ADOLESCENTS WITH SPINAL
CORD INJURY AND OTHER SEVERE
NEUROLOGICAL DISEASE
Stephen Canon¹, Marc Phan¹, Lynne Lapicz²,
Tanya Scheidweiler², Lori Batchelor²,
Christopher Swearingen²
¹UAMS; ²ACH
(Presented by: Annashia Shera, MD)
3:30 p.m. – 3:45 p.m.
Break
3:45 p.m. – 5:00 p.m.
Residents Quiz Bowl
Moderator: Brad J. Hornberger, MPAS, PA–C
Dallas, TX
5:00 p.m. – 6:30 p.m.
Residents Reception Sponsored by the AACU
SATURDAY, SEPTEMBER 21, 2013
6:30 a.m. – 1:30 p.m.
7:00 a.m. – 8:00 a.m.
Board of Directors Meeting (voting members only)
7:00 a.m. – 8:00 a.m.
Resident’s Breakfast: “What I Have Learned”
(residents only)
7:00 a.m. – 12:00 p.m.
Speaker Ready Room
7:15 a.m. – 1:00 p.m.Nordstrom ‘Magnificant Mile’ Fashion Presentation
7:30 a.m. – 10:30 a.m.
62
1:00 p.m. – 1:30 p.m.Annual Business Meeting
1:45 p.m. – 2:45 p.m.Urology Department Chairs and Residency
Program Directors Meeting
6:30 p.m. – 12:00 a.m.Annual Reception & Banquet
GENERAL SESSION
8:00 a.m. – 9:10 a.m.
Prostate Cancer – Treatment / Diagnosis Podium
Moderators: Ganesh V. Raj, MD, PhD
Dallas, TX
Ian M. Thompson III, MD
Nashville, TN
8:00 a.m.
#81
TRENDS IN ADHERENCE TO
RECOMMENDATIONS IN PATIENTS WITH
PROSTATE CANCER TREATED WITH ANDROGEN
DEPRIVATION THERAPY
Robyn Crowell, Eduardo Orihuela, Still Sasha
University of Texas Medical Branch
(Presented by: Robyn Crowell)
#82
WITHDRAWN
63
Saturday
8:07 a.m.
#83
UTILITY OF MULTIPARAMETER MAGNETIC
RESONANCE FOR EARLY DETECTION OF
PROSTATE CANCER
Edgar Mayorga Gómez¹, Yesenia Fernandez de Lara,
Alberto Jorge Camacho Castro², Victor Cornejo Dávila,
Alejandro Palmeros Rodríguez,
Israel Uberetagoyena Tello, Gerardo Garza Sainz,
Victor Osornio Sanchez, Francisco García Salcido,
Erick Muñoz Ibarra, Samuel Ahumada Tamayo,
Gerardo Fernández Noyola, Angel Martínez,
Mauricio Cantellano Orozco, Carlos Martínez Arroyo,
Gustavo Morales Montor, Carlos Pacheco Gahbler
¹Candidate Member AUA; ²Hospital General Dr.
Manuel GEA González
(Presented by: Alberto Jorge Camacho Castro)
8:14 a.m.
#84
OPPORTUNITIES FOR CHEMOPREVENTION IN
PATIENTS ON ACTIVE SURVEILLANCE FOR
PROSTATE CANCER: INITIAL OBSERVATIONS
FROM THE CANARY FOUNDATION PASS
COHORT
Edwin Morales¹, Stephen Unterberg²,
William M. Hilton³, Donna P. Ankerst²,
Lisa Newcomb4, Daniel W. Lin5, Robin J. Leach²,
Ian M. Thompson, Jr.6
¹UTHSCSA Urology; ²UTHSCSA; ³MSKCC;
4
Fred Hutchinson Cancer Research Center;
5
University of Washington; 6UTHSCSA/CTRC
8:21 a.m.
#85
8:28 a.m.
#86
THE MODIFIER 22 EFFECT ON PERIOPERATIVE
OUTCOMES OF ROBOTIC–ASSISTED
LAPAROSCOPIC PROSTATECTOMY
Joshua Griffin¹, Katie Murray², Yuan Feng³,
Brett Wahlgren4, David Duchene¹, Moben Mirza¹,
Ernesto Lopez-Corona5, J Brantley Thrasher¹
¹Department of Urology, University of Kansas Medical
Center, Kansas City, KS; ²University of Kansas;
³School of Medicine, University of Missouri–Kansas
City; 4School of Medicine, University of Kansas;
5
Kansas City Veterans’ Hospital
TETRANDRINE IMPAIRS PROSTATE CANCER
CELL SURVIVAL IN PART BY INHIBITING AR
SIGNALING PATHWAY
Sweaty Koul¹, Randall Meacham², Hari Koul³
¹CU SOM; ²CUSOM; ³CU School of Medicine
8:35 a.m.
#87
APPLICABILITY OF MIC–1 AS A POTENTIAL
BIOMARKER FOR RACIAL DISPARITY IN
PROSTATE CANCER
Daniel Zainfeld¹, Seema Dubey¹, Jo Wick²,
Jeffrey Holzbeierlein¹, Peter Van Veldhuizen³,
J. Brantley Thrasher¹, Dev Karan¹
¹University of Kansas Department of Urology;
²Department of Biostatistics; ³Department of Internal
Medicine, Division of Hematology/Oncology
8:42 a.m.
#88
REGULATION OF THE TUMOR METASTASIS SUPPRESSOR PROSTATE–DERIVED ETS
FACTOR (PDEF)
Joshua Steffan¹, Hari Koul²
¹CUSOM; ²CU School of Medicine
64
8:49 a.m.
#89
IDENTIFICATION OF AUTOANTIBODIES THAT
CORRELATE OR PREDICT CLINICAL
OUTCOMES IN PATIENTS THAT ARE HIGH RISK
FOR PROSTATE CANCER
Katie Murray, George Viehlhauer,
8:54 a.m.
#90
USE OF AMNION ALLOGRAFT TO REDUCE
CAVERNOSAL NERVE DAMAGE DURING
RADICAL PROSTATECTOMY
Naveen Kella
Urology & Prostate Institute
(Presented by: Naveen Kella)
9:10 a.m. – 9:40 a.m.
Prostate Cancer–Early Detection
Moderator: Ian M. Thompson, III, MD
Nashville, TN
Speaker:
Ian M. Thompson, Jr., MD
San Antonio, TX
10:45 a.m. – 10:55 a.m. History Lecture: Foleys and Fabrications
Speaker: Michael S. Holzer, MD
Oklahoma City, OK
10:55 a.m. – 11:00 a.m. Introduction
Dallas, TX
11:00 a.m. – 11:45 a.m. Presidential Guest Lecture: Healthcare Reform:
If You Are Not at the Table, You Are On the Menu!
Guest Speaker: John H. Armstrong, MD, FACS
Tallahassee, FL
11:45 a.m. – 1:00 p.m.
65
Saturday
9:40 a.m. – 10:00 a.m. Q & A
10:00 a.m. – 10:15 a.m. Break
10:15 a.m. – 10:45 a.m. Presidential Address: Reflections From 15 Years of Humanitarian Surgical Missions in Honduras
Dallas, TX
1:00 p.m. – 1:30 p.m.
6:30 p.m. – 12:00 a.m.
SCS AUA Annual Business Meeting
Annual Reception & Banquet
Disclaimer Statement
Statements, opinions and results of studies contained in the program are those of the
presenters/authors and do not reflect the policy or position of the SCS nor does the SCS
provide any warranty as to their accuracy or reliability.
Every effort has been made to faithfully reproduce the abstracts as submitted. However, no
responsibility is assumed by the SCS for any injury and/or damage to persons or property
from any cause including negligence or otherwise, or from any use or operation of any
methods, products, instruments, or ideas contained in the material herein.
66
Alphabetical Index of
Moderators, Panelists, Guest and Invited Speakers
Alba, Frances M.
9/19/2013
2:15 p.m.
Higuchi, Ty T.
9/19/2013
Armstrong, John H.
9/21/2013
11:00 a.m.
Holzer, Michael S.
9/21/2013
10:45 a.m.
Bohnert, William W.
9/18/2013
12:10 p.m.
Hornberger, Brad J.
9/20/2013
3:45 p.m.
Bowen, Ashley B.
9/20/2013
8:00 a.m.
Hudak, Steven J.
9/19/2013
10:30 a.m.
Broghammer, Joshua A.
9/19/2013
11:00 a.m.
Johnson, Michael
9/19/2013
9:10 a.m.
Christine, Brian S.
9/19/2013
10:30 a.m.
Kamat, Ashish M.
9/18/2013 3:00 p.m.
Cost, Nicholas
9/19/2013
Kansas, Bryan T.
9/19/2013 11:00 a.m.
2:15 p.m.
8:00 a.m.
Culkin, Daniel J.
9/20/2013
9:20 a.m.
Khera, Mohit
9/19/2013 1:15 p.m.
Cummings, James M.
9/18/2013
3:00 p.m.
Klotz, Laurence H.
9/20/2013 1:00 p.m.
Davis, Rodney
9/20/2013
LaGrange, Chad A.
9/20/2013 10:30 a.m.
8:00 a.m.
Lemack, Gary E.
9/18/2013
2:30 p.m.
deVries, Catherine R.
9/19/2013
9:20 a.m.
9/19/2013
9:50 a.m.
Mauck, Ryan J.
9/19/2013
2:15 p.m.
Finger, Michael J.
9/19/2013
2:15 p.m.
McWilliams, Charles A.
9/18/2013 12:05 p.m.
9/18/2013
12:20 p.m.
Gee, William F.
9/19/2013
Mirza, Moben
9/18/2013
3:00 p.m.
7:00 a.m.
Hernandez, Javier
9/19/2013
1:15 p.m.
Morey, Allen F.
9/18/2013 12:20 p.m.
67
MODERATORS, PANELISTS,
GUEST AND INVITED
SPEAKERS
Desouza, Rowena A.
9/18/2013
1:05 p.m.
Murray, Sunshine
9/18/2013 1:05 p.m.
Nehra, Ajay
9/19/2013 10:30 a.m.
Peppas, Dennis S.
9/20/2013 2:15 p.m.
Prieto, Juan
9/19/2013 2:15 p.m.
Raj, Ganesh V.
9/21/2013 8:00 a.m.
Rodriguez, Ronald
9/19/2013
1:15 p.m.
Rozanski, Thomas A.
9/19/2013 8:00 a.m.
Sindhwani, Puneet
9/19/2013
2:15 p.m.
Sotomayor, Mariano J.
9/18/2013 3:00 p.m.
Strom, Kurt H.
9/19/2013
7:30 a.m.
Thompson, III, Ian M.
9/21/2013
8:00 a.m.
9/21/2013
9:10 a.m.
Thompson, Jr., Ian M.
9/21/2013
9:10 a.m.
Westney, Ouida L.
9/20/2013
10:30 a.m.
Wilcox, Duncan T.
9/20/2013
2:15 p.m.
68
Author/Presenter, Date, Time and Abstract Placement
Due to time limitations, authors who do not have a time and date listed will not be
presenting their abstracts at this meeting. See Abstracts section for complete text.
Aberger, Michael
Poster #33 9/19/13
2:15 p.m.
Antonelli, Jodi
AB #67
9/20/13
AB #69
9/20/13
11:12 a.m.
11:26 a.m.
Arther, Andrew R.
Case #6
9/19/13
AB #11
9/18/13
3:45 p.m.
1:33 p.m.
Bagrodia, Aditya
Poster #41 9/19/13
Poster #42 9/19/13
AB #5
9/18/13
Cunningham, Kathryn
AB #61
9/20/13
10:30 a.m.
Desai, Vikas
Poster #45 9/19/13
2:15 p.m.
Desouza, Rowena A.
Poster #36 9/19/13
2:15 p.m.
Donatucci, Craig F.
AB #13
9/18/13
1:47 p.m.
2:15 p.m.
2:15 p.m.
12:48 p.m.
Bailey, Sarabeth
Poster #27 9/19/13
Donohue, Robert E.
Case #4
9/19/13
AB #31
9/18/13
AB #19
9/18/13
3:45 p.m.
4:31 p.m.
3:07 p.m.
2:15 p.m.
Belsante, Michael J.
AB #8
9/18/13
Video #2
9/19/13
Case #5
9/19/13
Dwyer, Jennifer
Poster #35 9/19/13
2:15 p.m.
1:12 p.m.
7:30 a.m.
3:45 p.m.
Elliott, Daniel S.
AB #45
9/19/13
11:21 a.m.
Eltahawy, Ehab
Video #1
9/19/13
7:30 a.m.
Flores, David
AB #26
9/18/13
3:56 p.m.
Camacho Castro, Alberto J.
AB #83
9/21/13
8:14 a.m.
Cefalu, Christopher A.
AB #43
9/19/13
11:07 a.m.
Chalmers, David
Poster #24 9/19/13
AB #75
9/20/13
Getzenberg, Robert H.
Poster #14 9/19/13
1:15 p.m.
2:15 p.m.
2:43 p.m.
Chandrashekar, Aravind
Poster #22 9/19/13
2:15 p.m.
Chung, Paul Hwan
AB #44
9/19/13
11:14 a.m.
Crowell, Robyn
AB #81
9/21/13
8:00 a.m.
69
Gomez, Martha
Case #8
9/19/13
3:45 p.m.
Hafez, Zachary
Poster #5 9/19/13
1:15 p.m.
Hamilton, Zachary A.
AB #20
9/18/13
AB #52
9/20/13
Poster #12 9/19/13
3:14 p.m.
8:14 a.m.
1:15 p.m.
abstract
presenter
index
Alphabetical Index of Abstract Presenters
Hickson III, Johnny Derroll
Poster #21 9/19/13
2:15 p.m.
Le, Margaret
AB #39
9/19/13
Ibarra Navarro, Edgar I.
Poster #19 9/19/13
1:15 p.m.
Lopez, Luis Alfredo Jimenez
Poster #18 9/19/13
1:15 p.m.
Iguchi, Naoko
AB #78
9/20/13
3:04 p.m.
Isharwal, Sudhir
Case #2
9/19/13
Maccini, Michael
AB #36
9/19/13
Poster #17 9/19/13
8:28 a.m.
1:15 p.m.
3:45 p.m.
Johnson, Justin
AB #29
9/18/13
4:17 p.m.
Manley, Brandon
AB #35
9/19/13
AB #6
9/18/13
8:21 a.m.
12:55 p.m.
Johnson, Michael
AB #33
9/19/13
8:07 a.m.
Martinez, Laura
Poster #13 9/19/13
1:15 p.m.
Kella, Naveen
AB #90
9/21/13
9:03 a.m.
Martinez, Roxanne
Poster #11 9/19/13
1:15 p.m.
Kenny, McCabe C.
AB #70
9/20/13
Poster #9 9/19/13
11:33 a.m.
1:15 p.m.
Matz, Scott
AB #40
9/19/13
Video #4
9/19/13
8:56 a.m.
7:30 a.m.
Keyes, Kyle T.
Poster #3 9/19/13
1:15 p.m.
Mazzarella, Brian C.
AB #49
9/19/13
11:50 a.m.
Khera, Mohit
Poster #49 9/19/13
1:15 p.m.
Kim, Eric
AB #56
9/20/13
8:42 a.m.
Mellis, Adam M.
Case #1
9/19/13
Poster #44 9/19/13
Poster #47 9/19/13
Poster #6 9/19/13
3:45 p.m.
2:15 p.m.
2:15 p.m.
1:15 p.m.
Kingman, Andrew T.
AB #27
9/18/13
4:03 p.m.
Merrill, Megan
AB #58
9/20/13
8:56 a.m.
Kislinger, Igor
Poster #4 9/19/13
Poster #39 9/19/13
1:15 p.m.
2:15 p.m.
Morales, Edwin E.
AB #84
9/21/13
AB #23
9/18/13
AB #60
9/20/13
8:21 a.m.
3:35 p.m.
9:10 a.m.
Knight, Richard B.
Video #3
9/19/13
7:30 a.m.
Muram, David
Poster #8 9/19/13
1:15 p.m.
Koul, Hari K.
AB #88
9/21/13
Poster #43 9/19/13
AB #86
9/21/13
8:49 a.m.
2:15 p.m.
8:35 a.m.
70
8:49 a.m.
8:56 a.m.
10:51 a.m.
10:37 a.m.
8:28 a.m.
8:35 a.m.
2:08 p.m.
Nabbout, Philippe
Poster #32 9/19/13
AB #51
9/20/13
2:15 p.m.
8:07 a.m.
Oliver, Janine
Poster #37 9/19/13
2:15 p.m.
Ramirez, Daniel
AB #46
9/19/13
AB #2
9/18/13
AB #50
9/20/13
11:28 a.m.
12:27 p.m.
8:00 a.m.
Rove, Kyle
AB #30
9/18/13
4:24 p.m.
Sehrt, David
AB #41
9/19/13
9:03 a.m.
Olvera-Posada, Daniel
AB #68
9/20/13
11:19 a.m.
AB #4
9/18/13
12:41 p.m.
Shah, Ketul
AB #37
9/19/13
AB #7
9/18/13
AB #10
9/18/13
8:35 a.m.
1:05 p.m.
1:26 p.m.
Shera, Annashia
AB #80
9/20/13
3:18 p.m.
Paddack, John M.
AB #65
9/20/13
10:58 a.m.
Shoss, Jeffrey
Case #7
9/19/13
3:45 p.m.
Parker, William
AB #24
9/18/13
AB #9
9/18/13
AB #18
9/18/13
AB #22
9/18/13
Poster #7 9/19/13
3:42 p.m.
1:19 p.m.
3:00 p.m.
3:28 p.m.
1:15 p.m.
Shy, Michael Y.
AB #12
9/18/13
1:40 p.m.
Simhan, Jay
AB #34
9/19/13
Poster #1 9/19/13
8:14 a.m.
1:15 p.m.
Patel, Ashay
AB #77
9/20/13
2:57 p.m.
Pham, Bryan
Poster #28 9/19/13
Singla, Nirmish
Poster #23 9/19/13
Poster #2 9/19/13
2:15 p.m.
1:15 p.m.
2:15 p.m.
Powell, Christopher
Poster #31 9/19/13
Case #3
9/19/13
AB #1
9/18/13
Siomos, Vassilis
AB #73
9/20/13
2:29 p.m.
2:15 p.m.
3:45 p.m.
12:20 p.m.
Tan, James
AB #3
9/18/13
12:34 p.m.
Pshak, Thomas
AB #71
9/20/13
2:15 p.m.
Tausch, Timothy J.
AB #32
9/19/13
AB #38
9/19/13
8:00 a.m.
8:42 a.m.
Puzio, Corinne
Poster #48 9/19/13
2:15 p.m.
Thoreson, Gregory R.
AB #47
9/19/13
11:35 a.m.
Trulson, Jerry
Poster #16 9/19/13
1:15 p.m.
Ramadan, Mohammad
Poster #25 9/19/13
2:15 p.m.
71
abstract
presenter
index
Murray, Katie
AB #89
9/21/13
AB #64
9/20/13
AB #62
9/20/13
AB #85
9/21/13
AB #55
9/20/13
AB #16
9/18/13
Villeda, Christian
AB #53
9/20/13
Poster #46 9/19/13
Poster #15 9/19/13
AB #25
9/18/13
8:21 a.m.
2:15 p.m.
1:15 p.m.
3:49 p.m.
Westney, Ouida L.
AB #63
9/20/13
AB #48
9/19/13
Poster #34 9/19/13
10:44 a.m.
11:42 a.m.
2:15 p.m.
Wiedel, Cole
AB #54
9/20/13
8:28 a.m.
Wilson, Bradley
Poster #38 9/19/13
AB #14
9/18/13
AB #59
9/20/13
2:15 p.m.
1:54 p.m.
9:03 a.m.
Wilson, Steven K.
AB #42
9/19/13
11:00 a.m.
Wyre, Hadley W.
AB #21
9/18/13
3:21 p.m.
Yeast, Carrie
AB #79
9/20/13
3:11 p.m.
Zainfeld, Daniel
AB #57
9/20/13
AB #66
9/20/13
AB #87
9/21/13
8:49 a.m.
11:05 a.m.
8:42 a.m.
Zamilpa, Ismael
AB #76
9/20/13
2:50 p.m.
72
Podium #1
OUTCOMES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT IN HIGH−
RISK PATIENTS AS COMPARED TO AVERAGE RISK PATIENTS. A MULTI−
INSTITUTIONAL REVIEW.
Paul Guidos1, Christopher Powell1, William Brant2, Joshua Broghammer1
1
University of Kansas Medical Center; 2University of Utah
73
PODIUMs
Objectives: Patients undergoing artificial urinary sphincter (AUS) revision or replacement have been shown to have similar outcomes to virgin cases. Limited data
exist regarding outcomes in high−risk patients undergoing revision. We compare
outcomes of AUS placement at two tertiary care centers to determine outcomes of
AUS placement in high−risk versus average risk patients.
Methods: A retrospective analysis of patients treated with AUS placement from
November 2008 to September 2012 was performed at two tertiary care centers.
All patients receiving AUS placement were included regardless of urinary incontinence etiology. Charts were analyzed for pre−operative risk factors as well as
post−operative complications, revisions, and pad usage.
Results: 101 patients underwent AUS placement during the study period. 69 patients undergoing AUS placement were considered high risk (HR), defined as having undergone prior radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history
of erosion or infection in a previous AUS. 32 patients were considered average
risk (AR). The post−operative complication rate was 36.2% in the HR group. Cuff
erosion was the most common complication, occurring in 10.1% of HR patients.
The post−operative complication rate was 9.4% in the AR group. Persistent incontinence due to sub cuff atrophy was the most common complication, occurring
in 6.3% of AR patients. Complications were defined as erosion, infection, pain,
mechanical failure, migration, fistula formation, and persistent, bothersome incontinence. Mean number of revisions was 1.06 and 0.53 for the HR and AR group
respectively. Patients with a history of prior erosion had 1.96 mean number of revisions and a complication rate of 47.8%. Mean postoperative pad use was similar
between the two groups 1.62 in AR group vs 1.15 in HR group. Percent decrease
in pad usage was similar (72% in AR group vs 84% in HR group). Mean follow−up
time was 6.9 months (range 1−35) for AR group and 17.4 months (range 1−102)
for HR group.
Conclusions: High−risk patients undergoing AUS placement are nearly four times
more likely to develop post−operative complications. Previous erosion increases
this risk to five−fold. Patients with a history of erosion have a nearly four−fold increase in revision rates as compared to AR patients. Post−operative pad usage
was similar between the groups. Despite a three to four fold increase in post−operative complication rate, good functional outcomes may be achieved in high−risk
patients.
Podium #2
LAPAROSCOPIC RADIOFREQUENCY ABLATION OF SMALL RENAL
TUMORS: LONG−TERM ONCOLOGIC OUTCOMES
Daniel Ramirez, Yun−Bo Ma, Selahattin Bedir, Jodi Antonelli, Jeffery Gahan,
Jeffery Cadeddu
UT Southwestern
Objectives: Unlike percutaneous RFA of small renal tumors, there is limited experience and follow up of patients who have undergone laparoscopic RFA. One
criticism of lap RFA is that the ablation cannot be visualized as reliably as the ‘ice
ball’ seen with cryoablation. However, laparoscopic RFA allows for improved mobilization of tissue and placement of probes under direct vision. We reviewed our
experience with laparoscopic RFA to assess oncologic outcomes. Our experience
has longest mean follow up to date.
Methods: We performed a retrospective study of 80 patients who had undergone
laparoscopic RFA for pT1a renal masses from April 2000 to April 2010. We reviewed demographic, clinical and radiologic data to assess indications and evidence for recurrence of disease. Radiologic recurrence was defined as any new
enhancement (> 10 Hounsfield units) after absence of enhancement on initial 6−
week computed tomography.
Results: A total of 79 patient s underwent laparoscopic RFA over the 10 year period had data to review. The median (range) age was 63.8 (18−85) years and the
lesion diameter 2.16 (0.9−4.2) cm. Preoperative needle biopsy was diagnostic in
75 or 79 patients (94.9%) of which 77.2% were renal cell carcinoma. At a mean
(range) follow up of 48 months (2−120) 5 yr disease−specific survival was 93.3%
with only 5 patients having recurrence of disease. Of those patients with recurrence, 4 were treated with repeat RFA while 1 underwent salvage cyroablation. Of
the tumors < 2.5 cm, the 5 yr disease−specific survival was 94.5%.
Conclusions: Long−term experience with laparoscopic RFA demonstrates that it
is a reasonable treatment option for small renal masses. 5 year results oncologic
outcomes are comparable to extirpation.
Podium #3
HIGH ENERGY PENETRATING TRAUMA: CONTEMPORARY MANAGEMENT
AND OUTCOMES OF RENAL GUNSHOT WOUNDS
James Tan, Lars Erik Wallin III, Michael Coburn, Thomas Smith III
(Presented by: James Tan)
Objectives: The purpose of our study is to analyze the presentation, management
and outcomes of renal gunshot wounds at a high volume, urban Level I trauma
center.
Methods: Patients with penetrating renal trauma were identified from the Ben Taub
General Hospital trauma database over the period of 1994−2013. Broad screening
criteria for patients evaluated include age ≥ 14 years, renal injury from gunshot
wound and survival after presentation > 24 hours. Presentation, management and
outcome were evaluated using descriptive statistics.
74
75
PODIUMs
Results: Two hundred four patients (208 renal units) with renal GSW were identified from our trauma database. The mean patient age was 29 and mean injury
severity score (ISS) was 19.7. Diagnosis was by CT in 37, IVP in 16 and operative in 151 with preoperative imaging documented in 26.0% (n = 53). Injury to
non−renal organs was present in 97.5% (199 of 204), with >1 non−renal organ
involved in 80.4%. Liver, colon, small bowel and diaphragm wounds were the most
common associated injuries. Using the American Association for the Surgery of
Trauma grading system, there were 23 grade 1 (G1), 30 G2, 68 G3, 48 G4, and 39
G5 injuries. Eighty−six renal units (excluding nephrectomy) underwent repair. The
renal salvage rate was 70.7% (n=147 of 208). The total number of nephrectomy
procedures was 60 of 208 renal units. Most common documented complications
associated with urologic intervention included perirenal abscess/intra−abdominal
abscess (n=10 of 148) and urine leak/urinoma (10 of 148). Postoperative imaging
was obtained in 49.0% (100 of 204) patients, and there were 10 cases of post−
injury hypertension documented from single follow−up blood pressure readings.
Overall survival was 90.2% (184 of 204).
Conclusions: Patients presenting to our level 1 trauma center have higher grade
injuries compared to prior series. Despite this, renal salvage rates greater than
70% can be achieved, with complication rates less than 15%, in the management
renal gunshot wounds.
Podium #4
EMPHYSEMATOUS PYELONEPHRITIS: MULTICENTER CLINICAL AND
THERAPEUTIC EXPERIENCE IN MEXICO
Daniel Olvera−Posada1, Ghislaine Armengod−Fischer2, Luis Vázquez−Lavista3,
Miguel Maldonado−Ávila2, Emmanuel Rosas−Nava2, Hugo Manzanilla−García2,
Mariano Sotomayor1, Guillermo Feria−Bernal1,
Francisco Rodríguez−Covarrubias1
1
INNSZ; 2Hospital General de México; 3Instituto de Seguridad Social del Estado
de México y Municipios
Objectives: Emphysematous pyelonephritis (EPN) is an acute upper urinary tract
infection characterized by the presence of gas and necrosis. It requires aggressive
medical management and sometimes invasive treatment. Different therapeutic
modalities have been recommended according to radiological features. We assessed clinical, radiological and treatment characteristics of patients with EPN. We
looked for prognostic factors associated with mortality.
Methods: We retrospectively reviewed all cases of EPN diagnosed by CT scan at
three Mexican health care centers from 2005 to 2012. Treatment was classified as
follows: medical management alone (MM) (hemodynamic stabilization and culture
oriented antibiotics), minimally invasive (double J stent, percutaneous drainage)
and surgical (open drainage or nephrectomy). Demographical, clinical, biochemical and radiological features were assessed. We performed univariate and multivariate logistic regression analysis to determine prognostic factors. The main end
point was mortality.
Results: 62 patients (49 females and 13 males), with mean age of 53.9 years were
included. The most common comorbidities were type 2 diabetes and hypertension
(69.3% and 40.3%, respectively). According to Huang criteria we found type 1 EPN
in 30.6%, type 2 in 27.4%, type 3a in 9.7%, type 3b in 21% and type 4 in 11.3%.
At initial workup, 70.9% had leukocytosis, 79% renal failure and 25.8% thrombocytopenia. Mean estimated glomerular filtration rate (eGFR) was 40.34 ± 33.07 ml/
min/1.73m2. E. coli was the most common isolated microorganism (62.7%). MM
was provided to 24.2%; minimally invasive therapy to 53.2%; open drainage to
22.5% and emergency nephrectomy after unsuccessful initial approach to 11.3%.
Overall mortality was 14.5%. Survivors were younger (p=0.005), had lower creatinine levels at admission (p=0.003) and higher eGFR (p=0.007). No differences were found in mortality comparing Huang classification. In univariate analysis,
age (p=0.009), creatinine serum levels (p=0.008) and the need for nephrectomy
(p=0.02) were associated with mortality. In multivariate analysis the creatinine level remained as an independent predictor of mortality (p=0.03). Age (p=0.05) and
the need for nephrectomy (p=0.05) showed a trend towards association.
Conclusions: To our knowledge, this is the largest series of EPN reported. Initial creatinine level was the strongest predictor of mortality. Age and the need for
nephrectomy were also associated with poor outcomes. Interestingly, radiological
classification had no correlation with mortality.
76
Podium #5
Objectives: Alterations in MTOR and HIF pathways may have prognostic significance in bladder carcinoma. We evaluated the predictive value of altered MTOR−
pathway biomarkers in UTUC.
Methods: Immunohistochemistry for phosphorylated−S6, mTOR, phosphorylated−mTOR, phosphoinositide 3−kinase (PI3K), phosphorylated 4E−binding protein−1 (p4E−BP), phosphorylated−AKT, PTEN, HIF−1a, Raptor, and Cyclin D was
performed on microarrays of patients treated for nonmetastatic UTUC. H scores
were calculated based on three stains/patient. Patients were separated into two
groups based on occurrence of event at two years (recurrence and/or cancer−
specific mortality (CSM)). Predictive markers were identified by univariate and
multivariate analyses for event at two years. Consistency was assessed by evaluating marker performance for event at two years, recurrence, CSM, and all−cause
mortality. Marker status (altered versus unaltered) was assigned based on natural
integer proportion cutpoints. Marker significance was assessed with Kaplan−Meier
and Cox regression analyses.
Results: Clinical information was available for 752 patients. Immunohistochemistry was performed on 532 patients. Mean age was 69 years. 36% of patients had
non organ−confined (T3/T4 and/or N+) disease. 75% of patients had high grade
disease and 21.6% had lymphovascular invasion (LVI) on final pathology. Over
median follow−up of 27.3 months, 25.3% of patients recurred and 21.9% died of
UTUC. On univariable analysis, PI3K, p4E−BP, and Cyclin D were identified as
significant biomarkers. On multivariable analysis, pI3K (OR 1.28, p=0.001) and
Cyclin D (OR 3.45, p=0.05) were significant predictors among the biomarkers.
PI3K H−score >1 and Cyclin D H−score <2 were considered altered. Cumulative
marker score was defined as low−risk (zero/one altered marker) or high−risk (Cyclin D AND P13K altered). High−risk patients had significantly higher proportions
of high grade disease (91% vs 70%, p<0.001), non−organ confined disease (60%
vs 33%), LVI (35 vs 20%, p=0.001), and nodal positivity (22% vs 6%, p<0.001).
Kaplan−Meier analysis demonstrated significant difference in CSM for risk groups
(Figure 1). On multivariable regression analysis incorporating non organ−confined
disease, grade, LVI, tumor architecture, and markers score, high−risk biomarker
profile was an independent predictor of CSM (HR 1.6, 95% CI 1.06−2.32, p=0.02).
77
PODIUMs
MULTI−INSTITUTIONAL EVALUATION OF THE PROGNOSTIC SIGNIFICANCE
OF ALTERED MAMMALIAN TARGET OF RAPAMYCIN (MTOR) PATHWAY
BIOMARKERS IN UPPER TRACT UROTHELIAL CARCINOMA (UTUC)
Aditya Bagrodia1, Bishoy Gayed1, Payal Kapur1, Oussama Darwish1,
Ira Bernstein1, Laura Krabbe1, Christoper Wood2, Shahrokh Shariat3,
Richard Zigeuner4, Christian Bolenz5, Alon Weizer6, Jay Raman7, Karim Bensalah8,
Giacomo Novara9, Hans−Martin Fritsche10, Arthur Sagalowsky1, Yair Lotan1,
Vitaly Margulis1
1
UT Southwestern Medical Center; 2MD Anderson; 3Cornell; 4University of Graz;
5
Mannheim; 6University of Michigan; 7Penn State; 8University of Rennes; 9University of Padua; 10Regensburg University
Conclusions: Alterations in MTOR biomarkers may have prognostic significance
in UTUC. High−risk biomarker profile was an independent predictor of CSM.
High−risk score uniformly correlated with poor pathologic features. Incorporation
of MTOR−based markers may allow for enhanced counseling, risk stratification,
and individualized treatment regimens.
Podium #6
SURVIVAL OF PATIENTS UNDERGOING CYTOREDUCTIVE NEHPRECTOMY
COMPARED TO THOSE TREATED WITH TARGETED THERAPY AFTER
STRAtIFICATION OF RISK AND COMORBIDITIES
Brandon Manley, Joel Vetter, Seth Strope
Washington University in St. Louis
Objectives: To compare survival for patients with metastatic renal cell carcinoma
(mRCC) receiving cytoreductive nephrectomy compared to patients who received
treatment with targeted therapy alone.
Methods: We retrospectively reviewed that charts of patients diagnosed with
mRCC at our institution from 2004 to 2012 using the Barnes−Jewish Hospital
cancer registry. We included patients with mRCC at diagnosis receiving targeted
therapy (Sutent, Temsirolimus, etc.) or cytoreductive nephrectomy as their primary
therapy. Patients were risk stratified according to the model developed by Heng et
al, and assigned a comorbidity score according to the ACE−27 system by Piccirillo
et al. There were no patients in our population with a favorable risk, i.e. zero risk
factors. Kaplan−Meier and Cox proportional hazard models were fit to assess differences in survival related to performance of cytoreductive nephrectomy.
78
79
PODIUMs
Results: Of 100 eligible patients, 74 underwent cytoreductive nephrectomy and
26 patients had targeted therapy. Mean age and comorbidity scores were similar
between the groups. Using Kaplan−Meier survival curves, with in the group of patients categorized as Poor risk; cytoreductive nephrectomy patients expected survival was significantly higher than targeted therapy patients (p=0.021). Comparing
patients with intermediate risk found cytoreductive nephrectomy patients expected survival was not statistically significant than those who had targeted therapy
patients (p=0.087)) but did show a trend for improved survival for cytroreductive
nephrectomy patients. Overall after adjustment for comorbidity and risk category,
survival was improved in the cytoreductive nephrectomy group (HR 2.12 95% HR
Confidence Interval 1.22, 3.67).
Conclusions: Patients who underwent cytoreductive nephrectomy compared to
those who had targeted therapy had an improved overall survival even when controlling for risk and comorbidities.
Podium #7
A NOVEL COMBINATION OF SURGICAL TECHNIQUES TO RESOLVE LOWER
URINARY TRACT EROSION IN A SINGLE OPERATION: NEAR TOTAL
TRANSVAGINAL MESH EXCISION, URINARY TRACT RECONSTRUCTION
AND CONCOMITANT REPAIR WITH A BIOLOGICAL GRAFT
Objectives: To present our experience of transvaginal removal of lower urinary
tract mesh erosion with concomitant reinforcement with a biological graft.
Methods: We retrospectively reviewed medical records of 189 patients undergoing transvaginal removal of polypropylene mesh from lower urinary tract or vagina.
The focus of this study is 25 patients with polypropylene mesh erosion into the
lower urinary tract. We excluded patients with erosion of other foreign bodies into
the lower urinary tract, or mesh that was removed due to isolated vaginal wall
exposure.
Results: 25 patients underwent surgical removal of mesh through a transvaginal
approach or combined transvaginal/abdominal approaches. The location of the
erosion was the urethra in 14 and the bladder in 11. The mean follow up was
21 months. There were no major intraoperative complications. Median postoperative length of stay was 2 (1−6) days. All patients had complete resolution of the
mesh complication and the primary symptom. Of the patients with urethral erosion,
continence was achieved in 10 of 14 (71.5%) patients while 3 patients required
re−operation due to urethral obstruction. Of the patients with bladder erosion, continence was achieved in 10 of 11 (91%) while 1 patient required re−operation due
to severe incontinence.
Conclusions: Lower urinary tract erosions after transvaginal mesh placement
presents a challenging issue for the pelvic surgeon. However, resolution of the
mesh erosion and concomitant treatment of incontinence can be achieved safely
and effectively in most instances in a single operation.
80
Podium #8
HOW SUCCESSFUL IS SUBURETHRAL SYNTHETIC TAPE REMOVAL?
Michael Belsante, Casey Seideman, Gary Lemack, Philippe Zimmern
1
Can JUrol, 19:6424−6430, 2012
81
PODIUMs
Objectives: Suburethral synthetic tape removals (STR) have risen as the rate
of mid urethral slings (MUS) has increased for treatment of stress predominant
urinary incontinence (SUI). We review our experience with mid and long−term outcomes after STR.
Methods: Following IRB approval, a retrospective chart review of all patients who
underwent STR1 for any indication from 2006−2011, with at least 6 months follow−up, was performed, including: indication for removal, pre and post−operative
symptoms defined by the Urogenital Distress Inventory questionnaire (UDI−6) and
a global quality of life score (QoL), as well as perioperative outcomes and need
for future procedures. Cure was strictly defined as continent, pain−free, sexually
active if active pre−operatively, and not requiring additional medical or surgical
therapy. Statistical analysis included Chi square and paired T−tests.
Results: Of 147 patients, 131 met inclusion criteria. Indications for STR were:
obstructive symptoms including urge incontinence and retention (60%), persistent
SUI (33%), dyspareunia or pain (28%), erosion or extrusion (26%) and recurrent
UTI (16%). Over half of patients (56%) had multiple indications for STR. Based on
the original operative note, the type of MUS was: 67 TVT (51%), 32 TOT (24%), 11
TVT−O (8%), 7 minisling (5%), and 14 unknown (11%). Mean age, parity, and BMI
were 61 years (30−85), 2.5 (0−6), and 28.8 (17−46) respectively. Mean time from
tape placement to removal was 33 (3−172) months. Mean length of follow−up was
21 months (6−74). There were no intraoperative complications (urethral injury or
blood transfusion), and mean and median length of stay was 1.2 (0−9) and 1 day
respectively. Concomitant surgeries in 63 (48%) patients included cystocele repair
(19), rectus fascia sling (8), both (5) and a variety of other surgeries (31). Subsequent reoperation for SUI included injectables (27), rectus fascia slings (4) or both
(5). Of 77 patients with UDI−6 and QoL scores preoperatively, total UDI− 6 score
(0−18) improved from 10.7 to 7.3 at last follow up visit (p<0.001), and QoL (0−10)
decreased from 8.6 to 4.3 (p<0.001). Resolution of dyspareunia was achieved in
73% of patients who complained of dyspareunia pre STR. Cure after STR was
achieved in 33 patients (25%).
Conclusions: Complications after MUS placement requiring removal are associated with variable degrees of improvement in presenting symptoms for many, but
a low overall cure rate.
Podium #9
PROSPECTIVE QUALITY OF LIFE ASSESSMENT OF AUTOLOGOUS
PUBOVAGINAL SLING
William Parker, Andrew Arther, Priya Padmanabhan
Introductions: In the present era of anti−incontinence therapy, the autologous
fascia pubovaginal sling (PVS) remains a gold standard. However, this approach
has not been routinely studied in the setting of women with prior transvaginal mesh
procedures.
Objectives: To report on quality of life outcomes following rectus fascia PVS in
a prospectively followed cohort stratified for prior transvaginal mesh procedures.
Methods: From 2010 to 2012, we prospectively followed patients undergoing
correction of SUI using rectus fascia PVS. All patients had routine history and
physicals and completed 5 validated questionnaires pre− and postoperatively:
Urogenital Distress Inventory (UDI−6), Incontinence Impact Questionnaire (IIQ−7),
Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ−12), Overactive Bladder Questionnaire (OAB−V8), and the Patient Global Impression of Improvement
(PGI−I). Patients who failed to complete the questionnaires and those with neurogenic bladders were excluded from analysis.
Results: We identified 16 patients who met inclusion criteria. The average age
of the cohort was 60 (38−78) years old with 62.5% having undergone a prior procedure for SUI, 50% involving mesh repairs. Mean preoperative pad usage was
1.8 pads (0−6) per day. At a mean follow−up of 4.9 (2−12) months pad usage and
performance on all validated questionnaires was improved significantly except the
PISQ−12 (Table 1).Similar trends towards improvement were found in the 50% of
patients who had failed mesh procedures for SUI, with significance achieved for
pad usage and OAB−V8 scores. At the time of final follow−up, patients described
themselves as either being “a little better”or “much better”on PGI−I, regardless of
prior mesh procedures. Complications of treatment included prolonged retention
(2), urinary urgency (3), and continued stress urinary incontinence (1).
Conclusions: In a prospectively followed cohort of women with rectus fascia
PVS, we showed a positive improvement across multiple validated questionnaires.
These outcomes were not significantly altered by prior surgical procedure or prior
use of transvaginal mesh for the treatment of SUI.
82
Podium #10
BACTERIOLOGICAL ANALYSIS OF EXPLANTED TRANSVAGINAL MESHES
Financial Funding: None
83
PODIUMs
Objectives: Subclinical contamination of polypropylene mesh has been demonstrated by bacteriological studies during mesh implantation and explantation. Subclinical mesh infection acquired during initial implantation may result in wound separation with subsequent mesh exposure. When vaginal mesh erosion is detected,
it raises the question of mesh colonization as a risk factor for erosion or whether
erosion exposes the mesh to vaginal bacteria. The aim of this study is to perform
bacteriological analysis of eroded and non−eroded transvaginal meshes to detect
if there is a difference in microbiology.
Methods: We retrospectively reviewed medical records of 50 patients who presented with mesh related complications requiring transvaginal removal of polypropylene mesh from vagina or lower urinary tract. The excised mesh was placed in
a sterile container and underwent aerobic, anaerobic and fungal analysis in the
microbiology department.
Results: 50 patients underwent surgical removal of mesh through transvaginal
or combined transvaginal / abdominal approaches from October 2011 to November 2012. The age ranged from 26 to 79 years (mean 52). Time since initial procedure to mesh explantation was 0.4 to 12 years (mean 3.1). Mesh placement
was performed for stress urinary incontinence (n=29), pelvic organ prolapse (n=6)
and combined (n=15) cases. Indications for mesh removal included painful mesh
(n=27), vaginal erosion (n=10), lower urinary tract erosion (n=9) and recurrent SUI
(n=4). Pelvic pain (n=32) was the most common presenting symptom followed by
dyspareunia (n=28) and recurrent SUI (n=13). Positive mesh culture was found in
40 (80%) patients and no bacterial growth was seen in 10 (20%) patients. Twenty
two patients had more than one organism in culture. A total of 23 pathogenic and
26 non−pathogenic organisms were identified. Enterococcus (n=6) was the most
common pathogenic organism and coagulase negative staphylococcus (n=8) was
the most common non−pathogenic organism. As seen in table 1, pathogenic organisms were found in patients with painful mesh (52%), erosion into urinary tract
(83%) and vaginal erosion (20%) (Fig 1)
Conclusions: Colonization of vaginally implanted mesh occurs frequently and
bacterial infection may account for pelvic pain in patients with painful mesh and
dyspareunia.
Podium #11
PROSPECTIVE QUALITY OF LIFE FOLLOW−UP OF BOTULINUM TOXIN A
FOR URINARY INCONTINENCE
Andrew Arther, Bradley Wilson, Katie Murray, Tomas Griebling,
Priya Padmanabhan
(Presented by: Andrew Arther)
Objectives: The FDA approved Botulinum toxin A (BTX−A) in August 2011 for the
treatment of neurogenic detrusor overactivity (NDO) and for overactive bladder
(OAB) in January 2013. Multiple studies have shown its effectiveness in neurogenic bladders (NGB) and for OAB with durable improvements in incontinence
episodes and urodynamic (UDS) parameters. Prospective data is limited on the
improvements BTX−A has made in the quality of life of these patients. We report
preliminary quality of life follow up in our cohort of BTX−A patients.
Methods: All patients underwent pre−operative voiding assessment and UDS
which confirmed detrusor overactivity. Patients underwent intra−detrusor injections
of BTX−A in a standard fashion. 100−300U of BTX−A were given for NGB and
OAB. Outcomes were measured pre− and post−operatively at 1, and 6 months
with validated questionnaires, including the Urogenital Distress Inventory (UDI−6),
Incontinence Impact Questionnaire (IIQ−7), Overactive Bladder questionnaire
(OAB−V8), and the Patient Global Impression of Improvement (PGI−I).
Results: Data for pre− and post−op evaluation was available for 36 patients with
at least 6 months follow up. 10 patients underwent more than 1 injection. NGB
patients averaged 5.25 months between injections and OAB patients averaged
13.25 months between repeat injections. 20 of the patients had neurogenic bladder disorders including: spinal cord injuries, spina bifida, multiple sclerosis, and
Parkinson’s disease. 16 patients had idiopathic detrusor overactivity. At 1 month
follow up patient’s averaged overall improvement in all validated questionnaires.
Improvement rates for OAB were overall higher than NGB patients except in IIQ−7.
PGI−I assessment was >1 full point better in the OAB patients. 22 out of 36 of patients reported improvement or no change in symptoms on PGI−I at 1 month. At 6
month follow up there was still improvement in baseline survey studies but overall
lower scores across both patient groups. OAB patients were a full point better
in their PGI−I assessment compared with NGB patients. PGI−I was the same or
worse in 14/36 patients at six months. 6 patients developed UTIs within the first
month post−operatively.. A total of 4 patients went into transient urinary retention.
Average PVR for NGB post−operatively was 169cc and for non−neurogenic bladder was 55cc at one month.
Conclusions: This was a prospective review of the effect BTX−A has on quality of
life for NGB and OAB OAB patients had more durable improvements in their quality of life. Further study to provide longer follow−up will help in counseling patients
on reasonable expectations.
84
Podium #12
IDENTIFICATION OF NEURAL CORRELATES OF VOIDING BY CONCURRENT
FUNCTIONAL MAGNETIC RESONANCE IMAGING AND URODYNAMICS
Michael Shy1, Rose Khavari2, Tuangratch Chow2, Steve Fung2, Timothy Boone2,
Christof Karmonik2, Sophie Fletcher2
1
Baylor College of Medicine; 2The Methodist Hospital, Houston, TX
(Presented by: Michael Shy)
85
PODIUMs
Objectives: The lower urinary tract has two functions: storage and voluntary elimination of urine. Normal voiding in neurologically intact patients is triggered by the
release of tonic inhibition from suprapontine centers, allowing the pontine micturition center to trigger the voiding reflex. Mediated through spinal centers, this reflex
initiates the relaxation of the pelvic floor musculature and the urethral sphincter.
The bladder then contracts and empties. Elegant animal studies in the literature
demonstrate the coordination of spinal centers for bladder function. However, supraspinal mechanisms of voluntary storage and voiding in humans could not be
studied until the advent of functional neuroimaging. In this preliminary study, we
seek to discover brain activity processes during voiding via functional magnetic
resonance imaging (fMRI) in normal female subjects.
Methods: Five healthy, premenopausal female volunteers were screened with
baseline clinic urodynamics to document normal voiding parameters. We then recorded brain activity via fMRI, and simultaneous urodynamics testing, including
the pressure−flow voiding phase. After motion correction of fMRI images, the Generalized Linear Model (GLM) was employed to create individual fMRI activation
maps for the initiation of voiding. A high−resolution structural scan of the brain was
also acquired for transformation of the individual fMRI activation maps into Talairach space. From these transformed datasets, an average fMRI activation map
was created, from which areas of significant activation during the act of micturition
were identified.
Results: All patients were able to void while supine. Consistent areas of activation
during initiation of voiding (asterisks, Figure 1) included regions for motor control
(cerebellum, thalamus, caudate, lentiform nucleus, red nucleus, supplementary
motor area, postcentral gyrus), emotion (anterior and posterior cingulate gyrus
and insula), executive function (left superior frontal gyrus), as well as the parahippocampal gyrus, precuneus, cuneus, occipital lobe (visual stimulus) and a focal
region in the midbrain.
Conclusions: Our preliminary findings demonstrate the activation of a brain network consisting of regions for motor control, executive function, emotion processing, as well as deeper brain structures (midbrain) during micturition. Further studies will be directed at creating and validating a model of brain activity during normal
voiding in women.
Podium #13
COMBINATION THERAPY WITH FINASTERIDE AND TADALAFIL ONCE
DAILY FOR 6 MONTHS: A RANDOMIZED, PLACEBO−CONTROLLED STUDY
IN MEN WITH LOWER URINARY TRACT SYMPTOMS SECONDARY TO
BENIGN PROSTATIC HYPERPLASIA
Adolfo Casabe1, Claus Roehrborn2, Luigi Da Pozza3, Sebastian Zepeda4,
Ralp Henderson5, Sebastian Sorsaburu6, Carsten Henneges7, David Wong8,
Lars Viktrup6
1
Instituto Médico Especializado, Buenos Aires, Argentina; 2University of Texas
Southwestern Medical Center, Dallas, TX, USA; 3Department of Urology and
Pathology, Ospedali Riuniti di Bergamo, Bergamo, Italy; 4Saltillo University
Hospital, Saltillo, Mexico; 5Regional Urology, LLC, Shreveport, USA; 6Lilly
Research Laboratories, Eli Lilly and Company, Indianapolis, USA; 7EU Statistics,
Lilly Deutschland GmbH, Bad Homburg, Germany; 8Eli Lilly and Company
(Presented by: Craig F. Donatucci, MD)
Objectives: Tadalafil , a phosphodiesterase 5 inhibitor, and finasteride , a 5−alpha
reductase inhibitor (5−ARI), have risk−benefit profiles that suggest advantageous
co−administration.
Methods: Men ≥45 years old with International Prostate Symptom Score (IPSS)
≥13, Qmax ≥4 to ≤15 mL/sec, prostate volume ≥30 mL, and 5−ARI treatment−
naïve, were randomized to finasteride/placebo (N=350) or finasteride/tadalafil
(N=346) in a double−blind, parallel−group design. Efficacy measures were assessed using mixed models for repeated measures.
Results: Baseline mean (SD) age was 63.7 (7.7) years; mean PSA, 2.4 (2.0) ng/
ml; and mean prostate volume, 49.4 (20.4) ml. The primary outcome, change in total IPSS from baseline to 12 weeks for tadalafil vs. placebo, was significant (−1.41,
p=0.001), as were differences at 4 and 26 weeks. The IPSS voiding subscore
improved significantly vs. placebo at all visits; the storage subscore improved at
weeks 4 and 12. The Treatment Satisfaction Scale−BPH improved with tadalafil
vs. placebo at endpoint (Week 26; p=0.031), driven by satisfaction with efficacy (p=0.025), with no significant difference for dosing or side effects. In sexually active men with ED who received tadalafil, the International Index of Erectile
Function−Erectile Function domain score improved vs. placebo at each visit (all
p<0.001). Tadalafil coadministered with finasteride was well tolerated, with most
adverse events mild or moderate in severity and few discontinuations.
Conclusions: In patients treated concomitantly with finasteride, tadalafil 5 mg
demonstrated a significant improvement vs. placebo in LUTS/BPH and ED from
first visit at Week 4 through 26 weeks. Treatment satisfaction was greater with
finasteride/tadalafil vs. finasteride/placebo.
86
Podium #14
BOTULINUM TOXIN A: THE SHIFT TO A MINIMALLY INVASIVE MANAGEMENT
OF NEUROGENIC BLADDER
Bradley Wilson, Andrew Arther, William Parker, Tomas Griebling,
Priya Padmanabhan
87
PODIUMs
Objectives: The key in management of neurogenic dysfunction of the lower urinary tract is the maintenance of low storage pressures. First line treatment is anticholinergic therapy with intermittent catheterization. Once patients are refractory
to anticholinergic therapy, augmentation cystoplasty (AC) has traditionally been
used to create a high capacity, low−pressure reservoir. Yet, this procedure is associated with a high complication rate. The FDA approved Botulinum toxin A (BTX−A)
in August 2011 for the treatment of neurogenic detrusor over activity (NDO). Multiple studies have shown its effectiveness in neurogenic bladders with associated
improvements in incontinence episodes and urodynamic parameters. Our study
reviews how the advent of BTX−A has changed modern treatment of NDO.
Methods: We performed a retrospective chart review from 2003−2013 of patients
seen in our Urology practice with anticholinergic refractory NDO that underwent
AC or cystectomy with urinary diversion. We analyzed their charts and testing data
to see how many patients would have met the indication for BTX−A. Furthermore
we compared our practice since in incorporation of BTX−A to see how our treatment of NDO has changed.
Results: 54 patients met inclusion criteria for our study. 34 patients underwent
reconstructive surgery for NDO. The remaining 20 patients have been managed
with BTX−A detrusor injections (available for the last 30 months). Review of the 34
patients that underwent open surgery revealed 21 (62%) would have met indication for BTX−A injections.
Additionally, 30 of the 34 patients that underwent reconstructive surgery had surgery in the first 8 years of the study resulting in nearly 4 open surgeries for NDO
per year. After BTX−A was introduced in 2011 the number of open reconstructive
surgeries at our institution was reduced to less than 2 per year. During that same
time period an average of 12 patients per year were managed with BTX−A.
Of the 34 reconstructive patients, 14 (41%) had a complication with 10 (29%)
requiring a repeat intervention. Conversely, only one BTX−A patient (5%) had a
complication and no patients required repeat procedures for complication.
Conclusions: Anticholinergic refractory NDO is a complex disorder that impairs
quality of life and often threatens the upper urinary tracts. Although it is not the
answer for every patient, BTX−A has become an effective minimally invasive alternative to urinary reconstruction. This study demonstrates how the addition of
BTX−A is evolving the care of NDO patients.
Podium #15
withdrawn
Podium #16
VALUE OF FEMALE URETHROPLASTY FOR TREATMENT OF FEMALE
URETHRAL STRICTURE DISEASE
Katie Murray, Priya Padmanabhan
Objectives: Increased training in urological residency programs has educated
graduates to perform more female urologic and reconstructive procedures than
their older counterparts. Yet, there is an alarmingly high use of urethral dilation
by new, 1st and 2nd time board certifiers for female urethral stricture disease,
an exceedingly rare condition. This study reviews subjective and objective results
of female urethroplasties performed by a fellowship trained pelvic reconstructive
surgeon.
Methods: Retrospectively reviewed the female urethroplasties performed at a single institution by a single fellowship trained urologist. Pre− and post−operative
post void residuals (PVR) were recorded and validated questionnaires (UDI−6,
IIQ−7, OAB−V8, and PGI−I) were completed by all patients.
Results: Over 2 years, 4 female patients underwent a complicated pelvic reconstruction with vaginal advancement flap urethroplasty. 3 of these patients also underwent a concomitant rectus fascia pubovaginal sling. Patients ranged in age
from 35 years to 70 years. Follow−up ranges from 3 months to 2 years. PVRs
reduced from a range of 25−260 mL to <75 mL in all 4 patients. All patients reported improvement on UDI−6 and 3 out of 4 reported improvement on the IIQ−7.
All patients reported that they were a little better or much better on the PGI−I. No
patient has required future catheterization, dilation, or surgical procedure related
to stricture disease.
Conclusions: Female urethroplasty is the best long−term treatment for female
urethral stricture. Patients have subjective and objective durable improvement.
88
Podium #18
CONCOMITANT CARCINOMA IN SITU: EFFECT ON PATHOLOGIC AND
PROGNOSTIC RESPONSE TO NEOADJUVANT CHEMOTHERAPY
William Parker, Joshua Griffin, Moben Mirza, Jeffrey Holzbeierlein
89
PODIUMs
Objectives: Residual disease at the time of cystectomy has been identified as
a risk factor for progression following neoadjuvant chemotherapy (NAC). Due to
concerns that carcinoma in situ may represent a risk factor for poor response to
NAC, we aimed to assess the effect of pretreatment concomitant carcinoma in situ
(cCIS) on pathologic and prognostic response to NAC.
Methods: A retrospective chart review from 2008 – 2012 was performed to identify patients who underwent radical cystectomy following NAC for de novo clinical
T2 urothelial cell carcinoma. This cohort was then stratified for the pretreatment
presence of cCIS. Pathologic response at the time of cystectomy and survival data
were abstracted and analyzed.
Results: 33 patients with clinical T2 urothelial cell carcinoma were identified. The
study cohort was predominately Caucasian males with an average age of 63 years.
cCIS was identified in 9 (27.3%) patients. No patients in the cCIS had a complete
pathologic response as compared to 36% of patients without cCIS (p=0.02). Upstaging was present in 55.6% of the cCIS group versus 31.8% of the non−cCIS
group (non−significant trend, p=0.12). No patient with cCIS demonstrated eradication of the CIS at the time of cystectomy. Progression and disease specific
mortality were 44.4% versus 31.8% (p=0.26) and 33.3% versus 27.2% (p=0.37) in
the cCIS cohort versus the non−cCIS cohort respectively. Non−significant trends
were demonstrated in time to progression and time to death (7.4mo versus 11.2mo
[p=0.17] and 9.6mo versus 15.8mo [p=0.18]), favoring the absence of cCIS.
Conclusions: NAC is not without risk of harm. Our review of pathologic response
rates show that patients with cCIS do not respond as well as those without cCIS.
Our results also indicate a trend towards worse progression−free survival, time
to progression, overall survival, and time to death – a result that was limited by a
small sample size. Given the increasing body of evidence that any residual disease at the time of cystectomy is a poor prognostic factor, our results suggest a
group of patients who may not benefit from NAC.
Podium #19
TRANSITIONAL CELL CARCINOMA OF THE BLADDER – IS HERR’S
PARADIGM STILL VALID?
Robert Donohue
Objectives: 72,570 new cases of transitional cell carcinoma of the bladder are expected to be diagnosed in 2013 with 15,230 deaths. 85% will be superficial, Ta and
T1 lesions. Recurrences are common with expensive, frequent surveillance with
cytology and cystoscopy, upper tract monitoring and in hospital treatment with anesthesia for recurrences. Herr recommended less frequent surveillance in Grade I
/ III, Stage Ta tumors with office fulguration under local anesthesia for tumors less
than 5 mm and 5 or fewer tumors in number. It worked in 2008. At 13 years, is this
approach still tenable?
Methods: 261 newly diagnosed TCC bladder tumors were diagnosed from
July 1, 2000 to October 1, 2009. 82 patients were Grade I, Stage Ta lesions.
Results: Early classic surveillance was completed successfully but since 2008,
Herr’s plan was performed. 44 patients remained tumor free; 38 patients experienced recurrences; 11 patients had 1 recurrence; 13 had two, 9 had 3 and 5 had 4
or more recurrences.9 patients progressed; 8 in grade 1 in grade and stage. This
patient underwent cystectomy and died 8 years later of metastatic male breast
cancer. The other 8 patients had recurrences of Grade I or II. None advanced in
stage. 36 second malignancies were diagnosed. 16 urologic with 11 Ca P, 1 renal
cell, 3 renal pelvic TCCs and 1 ureteral primary. 3 patients were diagnosed with
lung cancer, 5 of GI malignancy and 4 of lymphoma. 33 patients died during follow−up: CAD 6 patients, 3 COPD, 3 GI bleed, 1 patient each with cirrhosis, CHF
and necrotizing fasciitis.10 patients died of the second malignancy; 3 from lung
Ca, 3 from GI tumors, 2 from Ca P, and one from pyriform sinus tumor and ductal
carcinoma of the breast. !
Conclusions: Herr’s plan for less frequent cystoscopy and office fulguration for
recurrences in Grade 1, Ta bladder TCCs works ! The advantages are in 1] less
anxiety 2] cost, 3] time lost form work, 4] fewer office visits and procedures, 4]
fewer hospitalizations 5] less anesthesia
90
Podium #20
THE ROLE OF ALVIMOPAN FOR RADICAL CYSTECTOMY
Zach Hamilton, Josh Griffin, Moben Mirza, Jeffrey Holzbeierlein
91
PODIUMs
Objectives: Radical cystectomy is a major surgical procedure that results in delayed return of bowel function, due to primary intestinal anastomosis. Alvimopan
(Entereg) is an FDA approved peripherally acting µ−opiod receptor antagonist that
has shown favorable results for improved recovery of gastrointestinal function and
decreased hospital length of stay, including studies specifically examining radical
cystectomy. We aim to retrospectively review our experience utilizing Alvimopan
with patients undergoing radical cystectomy for bladder cancer.
Methods: A retrospective review was performed of patients undergoing radical
cystectomy at our institution. Patients were routinely provided with Alvimopan
12mg once preoperatively and twice daily postoperatively for a maximum of seven
days. At our institution, radical cystectomy patients were routinely started on a
clear liquid diet on postoperative day two, and a regular diet was given after return
of bowel activity, evidenced by flatus or bowel movement. Time from initiation of
clear liquid diet to tolerance of regular diet was recorded, as was total length of
hospitalization. An unpaired t−test was utilized for statistics.
Results: A total of 40 patients were given Alvimopan and 60 patients did not receive Alvimopan from July 2011 to January 2013. Mean age for the Alvimopan
cohort was 67.5 years and 67.7 years in the non−Alvimopan cohort. The Alvimopan cohort contained 78% male and 22% female. The non−Alvimopan cohort
contained 73.3% male and 26.7% female. The mean length of time until tolerance
of regular diet in the Alvimopan cohort was 2.3 days, and it was 3.1 days in the
non−Alvimopan cohort (p=0.036). Mean length of hospitalization for the Alvimopan
cohort was 5.9 days, while it was 6.6 days in the non−Alvimopan cohort (p=0.084).
Conclusions: When utilized for patients undergoing radical cystectomy, Alvimopan seem to provide the advantage of decreased time to tolerance of regular diet,
but holds no difference in time to hospital discharge. Further prospective studies,
including cost analysis, are needed to determine the most useful indication for this
medication.
Podium #21
NEOADJUVANT CHEMOTHERAPY FOR MUSCLE INVASIVE BLADDER
CANCER: A MULTI−INSTITUTIONAL EVALUATION OF PATHOLOGIC
RESPONSE
Joshua Griffin1, Hadley Wyre1, Homi Zargar2, Laura Mertens3, Chachen You4,
Evanguelos Xylinas5, Jeff Holzbeierlein1, Dan Barocas4, Scott North6,
Andrew Thorpe7, Bas Van Rhijn3, David Youssef2, Nikhil Vasdev8,
Simon Horenblas3, Shahrokh Shariat5, Peter Black2
1
Department of Urology, University of Kansas Medical Center, Kansas City, KS;
2
Department of Urological Sciences, University of British Columbia; 3Department
of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands;
4
Department of Urology, Vanderbilt University, Nashville, TN.; 5Department of
Urology, Weill Cornell Medical College, New York, NY; 6Cross Cancer Institute,
University of Alberta, Edmonton; 7Department of Urology, Freeman Hospital,
Newcastle, UK; 8Department of Urology, Lister Hospital, Stevenage, UK
(Presented by: Hadley Wyre)
Objectives: The efficacy of neoadjuvant chemotherapy (NC) for muscle invasive
bladder cancer (MIBC) was established with MVAC (methotrexate, vinblastine,
doxorubicin, cisplatin). However, given comparable response rates and better tolerability in patients with metastatic disease, gemcitabine and cisplatin (GC) has
become the most commonly used regimen in the neoadjuvant setting. Our goal
was to evaluate pathologic response rates to NC with different regimens based on
a large, multi−institutional cohort.
Methods: Data was collected retrospectively at seven international centers on all
patients with MIBC (clinical T2−T4a, N0−3) who received NC, consisting of at least
three cycles of chemotherapy, followed by radical cystectomy. Patients with variant
histology other than mixed squamous or glandular differentiation were excluded.
The primary outcome was pathologic stage at cystectomy.
Results: Data on 591 patients were collected, of whom 432 (73%) had a clinical
node stage N0 (cN0) and 159 (27%) had cN1−3. GC was utilized in the majority of
the patients (n=364; 62%), followed by MVAC (n=129; 22%), gemcitabine/carboplatin (n=63; 11%) and other regimens (n=35; 6%). In the cN0 group, 24% (n=105)
had pT0 on final histology and 45% (n=193) had pT1 or lower stage (pT1/pTa/pT0/
pTis). The rate of pT0 disease for cN0 patients was 23.7% for GC and 31.7% for
MVAC (p=0.2). For cN1−3 patients, 32.7% (n=52) had pT0 and 44% (n=70) had
≤pT1. For all patients with ≤T1 the median survival was 120 months versus 32
months for ≥pT2.
Conclusions: We have demonstrated an acceptable response rate to NAC in an
international cohort. We did not observe a difference between node negative and
node positive patients. There is a non−significant trend toward better pathologic
response to MVAC than to GC.
92
Podium #22
TIME DELAYS TO RADICAL CYSTECTOMY BY USE OF NEOADJUVANT
CHEMOTHERAPY ASSOCIATED WITH HIGHER RATES OF PROGRESSION
Joshua Griffin1, William Parker1, Ernesto Lopez−Corona2, Jeff Holzbeierlein1
1
University of Kansas; 2Kansas City Veterans’ Hospital
93
PODIUMs
Objectives: Neoadjuvant chemotherapy (NC) is often utilized to improve survival for patients with muscle invasive bladder cancer. However, this results in a
protracted treatment course as patients typically receive 3−4 cycles over several
months. Previous series have suggested that delays in radical cystectomy (RC)
from initial diagnosis of over 12 weeks are associated with inferior survival rates.
We investigated if similar trends are seen in a population of patients treated with
neoadjuvant chemotherapy prior to cystectomy.
Methods: A retrospective review of our RC database was performed to identify
patients treated with NC over the last five years. Demographic, clinical, and pathologic data were collected. Time interval was calculated from date of initial diagnosis of muscle invasive disease to date of surgery. Kaplan Meier methods were
used to compare recurrence free and cancer specific survival based on pathologic
stage, nodal status, margin status, and time to RC. Multivariate analysis using cox
proportional hazards controlling for gender, clinical and pathologic variables were
used to estimate hazard ratios.
Results: A total of 72 patients from 2006−2012 were identified. Mean age was
64 years and 80% were male. 79% of the cohort had 3 or more cycles of NC,
the most common regimen of which was gemcitabine−cisplatin (75%). Mean time
from diagnosis to RC was 173 days. Pathologic stage distribution was T2−20.8%,
T3−20.8%, T4− 18.1% and T0 status was obtained in 27.8%. 95% was of pure
urothelial carcinoma histology. Node positive disease was found in 30%. At most
recent follow up 33% of the cohort had died and 13% had recurrent disease. Higher tumor stage and positive nodal status were both associated with lower recurrence free and cancer specific survival. When stratifying the cohort by time to RC
(1−4 months, 5months, 6 months) there was no statistical difference in recurrence
free or cancer specific survival. However, on multivariate analysis patients who
had RC less than 5 months from diagnosis had lower rates of progression (OR .14
95% CI .02−.08, p 0.038) and those with RC after 6 months had higher likelihood
of disease progression but this was not statistically significant (OR 4.86 95% CI
0.9−26, p 0.06).
Conclusions: Time delays associated with use of NC of greater than five months
correlated with lower progression free survival rates in our cohort but there did not
appear to be any effect on cancer specific survival. This should be further validated
with a larger multicenter analysis.
Podium #23
PHASE I TRIAL OF SEQUENTIAL INTRAVESICAL MITOMYCIN C AND
BACILLE CALMETTE−GUÑ RIN INSTILLATION FOR NON−MUSCLE
INVASIVE UROTHELIAL CARCINOMA OF THE BLADDER
Robert S. Svatek1, Edwin Morales1, Timothy T. Tseng1, Joseph W. Basler1,
Javier Hernandez1, Tyler J. Curiel2
1
UTHSCSA Urology; 2UTHSCSA Medicine
Objectives: We present the preliminary results of a phase I study to determine
the safety and tolerability of sequential intravesical treatment with mitomycin C
(MMC) followed by Bacille Calmette−Guèrin(BCG). To our knowledge, this is the
first published report on the sequential intravesical treatment of non−muscle invasive bladder cancer (NMIBC) with both MMC and BCG.
Methods: Patients with intermediate or high−risk BCG−naïve NMIBC were considered eligible. MMC at escalating doses (see Table) was instilled into the bladder
for 30 minutes. The MMC was then removed after a 15 minute washout period with
60 cc of sterile water instilled by manual irrigation. BCG was then instilled into the
bladder at escalating doses with a standard 2 hour dwell time. Three dose levels
of BCG were tested (1/4 dose, ½ dose, & full dose). At each visit the patient was
administered a symptom questionnaire.
Results: Thus far 7 of 11 planned patients have completed therapy, including 3
at list strengths here. All patients were able to complete the entire 6 week induction course. No grade 3 or 4 toxicity was observed for any of the 7 patients.
At 10mg/20cc MMC and 1/2 dose BCG, the most common reported symptoms
were frequency (3 of 7) and fatigue (2 of 7). At 20mg/20cc MMC and full strength
BCG doses the most common symptoms were frequency (3 of 7) and self−limited
mild hematuria (3 of 7). Thus far at escalation doses of 20mg/20cc MMC and full
strength BCG, the most common symptoms were frequency, fatigue, and hematuria. The most common symptoms in all subjects were frequency and dysuria, followed by self−limited gross hematuria that spontaneously resolved in all patients
without intervention. One patient experienced a singular temperature >100° F that
never reached a clinical fever at a dose of full strength BCG in the 4th week of
treatment; that patient received no therapy. No patient was unable to tolerate the
full induction course or required deviation from the dose escalation protocol.
Conclusions: NMIBC has a tremendous capacity for recurrence and eventual
progression. Our preliminary findings demonstrate that sequential MMC & BCG
treatment of NMIBC is both safe and tolerable. We expect that the recommended
dosage for the subsequent phase II protocol will be 20mg/mL combined with full−
dose BCG.
94
Podium #24
COMPLETE RESPONSE TO NEOADJUVANT CHEMOTHERAPY: DOES
CLINICAL STAGING MATTER?
William Parker, Joshua Griffin, Moben Mirza, Jeffrey Holzbeierlein
Podium #25
CONSERVATIVE MANAGEMENT OF SUPERFICIAL BLADDER TUMORS:
TRANSURETHRAL RESECTION VERSUS DIATHERMIC ABLATION
Christian V. Sandoval, Jaime U. Yepez, Fernando G. Navarro, Ricardo C. Molina
Objectives: Superficial bladder tumors (SBT) are rarely metastatic. They usually
do not affect survival. However, recurrence is frequent and is related to their nuclear grade. Once a SBT has been staged with a transurethral resection (TUR), conservative management of recurrences has been proposed. An investigation about
the most adequate conservative treatment may impact on less morbidity and costs
for the patients. The objective of this study is to describe a population sample of
patients with SBT and to determine if diathermic ablation is a suitable conservative
treatment when compared to TUR.
95
PODIUMs
Objectives: There is significant evidence that pathologic response to neoadjuvant chemotherapy (NAC) is a predictor of long−term outcomes following radical
cystectomy (RC) for transitional cell carcinoma. In this background, we sought to
assess whether outcomes following complete response differed based on clinical
T stage.
Methods: Using a retrospective chart review we identified patients with cT2−T4
bladder cancer who underwent NAC followed by RC and assessed their pathologic response. Survival data was obtained and stratified for pre−treatment clinical
stage.
Results: 61 patients were identified who met the study criteria. Of the total cohort
33 (54.1%) presented with cT2, 16 (26.2%) with cT3, and 12 (19.7%) with cT4.
Following NAC, complete pathologic response (pT0) was noted in 18 (29.5%) of
patients. Patients who had a complete pathologic response has a progression free
survival rate of 89.9% versus 54.5% (p=0.005) for those with residual disease, and
overall survival rate of 77.8% versus 52.3% (p=0.03) respectively. By stage, complete response was noted in 55.6%, 11.1%, and 33.3% for cT2−cT4 respectively.
In those with a complete response, progression occurred in 4 (all cT4) and death
occurred in 4 (1 cT3 and 3 cT4).
Conclusions: Our data demonstrates that a complete response following NAC is
a predictor of progression−free and overall survival. Additionally our data suggests
that despite a complete response, those with a higher clinical stage are at greater
risk of progression and death following treatment. This raises the question as to
the use of additional adjuvant chemotherapy in those who fail to have a complete
pathologic response.
Methods: A retrospective review of an institutional bladder tumors was designed.
Patients with superficial (pTa) disease after TUR diagnosis were selected. Carcinoma−in situ was excluded. Overall survival (OS) and recurrence−free survival
(RFS) were assessed according to nuclear grade. Second−recurrence−free survival (SRFS) was analyzed after TUR or DA treatment. Treatment choice was dictated by the treating urologist. Progression−free survival was not included due to
lack of histologic diagnosis in the DA group.
Results: Ninety one patients were included, with 64 (70.3 %) men and 27 (29.7
%) women. Mean follow up was 90.3 ± 65.3 (min:2−max:305) months. There were
6 unrelated deaths during follow up. Fifty three patients had a recurrence with a
rate of 58.2 % was calculated. OS was 272 ± 13 months with no significant differences among nuclear grade groups. RFS was 73 ± 10 months with a significant
difference for the G1/G2 group over G3 (p=0.047). The treatment of the first recurrence was TUR for 19 (35.8 %) patients and DA for 34 (64.2 %) patients. A second
recurrence was identified in 66.6 %. There was no difference in global SRFS in
patients treated with TUR vs. DA, but a significant difference was found in favor
of treatment with TUR for G3 tumors with 58 ± 20 months vs. 26 ± 13 months with
DA (p=0.04).
Conclusions: High grade tumors have a greater risk of recurrence. Conservative
management with DA is a reasonable option for patients with low grade tumors,
but TUR offers longer RFS for high grade disease.
Financial disclosure: none
Podium #26
RADICAL CYSTECTOMY IS ASSOCIATED WITH LONG TERM REDUCTIONS
IN BODY WEIGHT: ANALYSIS OF A SINGLE CENTER EXPERIENCE
David Flores1, Joshua Griffin2, Prabhakar Chalise3, Jill Hamilton−Reeves4,
Jeffrey Holzbeierlein5
1
University of Kansas Medical Center; 2Department of Urology University of
Kansas Medical Center; 3Department of Biostatistics, University of Kansas
Medical Center; 4Department of Dietetics and Nutrition, University of Kansas
Medical Center; 5Department of Urology, University of Kansas Medical Center
(Presented by: David Flores)
Objectives: Radical cystectomy (RC) with urinary diversion is a complex operation with significant morbidity. Previous series have demonstrated markers of poor
nutritional status as a predictor of both complications and cancer specific survival.
However, there is little data demonstrating the natural trends in weight change after undergoing RC. In this study we assess the changes in weight up to six months
after surgery.
96
97
PODIUMs
Methods: We used the HERON database tool to identify patients with urothelial
bladder cancer who underwent radical cystectomy over the last two years. In order to meet inclusion subjects must have had a baseline body mass index (BMI),
weight measurement in kilograms(kg), and at least two other weights recorded
during follow up. Age, race, gender, baseline BMI, and weights at week 1, 2−4,
4−6, 6−10, 11−15, and 4−6 months were obtained. Mixed effects models adjusting
for age and baseline BMI were fitted to the data. In addition, pairwise comparisons
between mean weights at each time point were compared using t tests. A p value
of <.05 was considered statistically significant.
Results: 82 patients met inclusion criteria, with a mean age of 67 years (range
46−92) and 76% were male. Preoperative BMI classifications were normal
(20−24.9) in 20.7%, overweight (25−29.9) in 40.6%, and obese (>30) in 29.3%
with only 2.4% classified as underweight (<18.5). Mean weights demonstrated a
6% decline from baseline to 24 weeks with a mean weight loss of 5.3 kg. There
was a significant trend for decrease in weight with time after cystectomy (p < .001)
when adjusted for age and BMI. Pairwise comparisons revealed that mean baseline weight was significantly different from mean weights at weeks 2−4, 6−10,
11−15, and 16−24 weeks (with p−values<0.01 is each case). After the 2−4 week
timepoint, subsequent weights were not statistically different, suggesting that the
weight changes occur in the postoperative period and did not return to baseline for
the duration of follow up.
Conclusions: RC is associated with significant reductions in body weight that
appear to last beyond the postoperative period. This effect may be associated
with adverse oncologic outcomes and higher complication rates similar to those
with preoperative nutritional deficiency. Interventions to better optimize nutritional
support in patients undergoing RC are warranted.
Podium #27
BCG−MEDIATED EFFECTS ON BLADDER TUMOR CELLS AND IMMUNE
CELLS
Andrew T Kingman, Kristofer Wagner, Richard Tobin, MK Newell
Scott and White Memorial Hospital/ Texas A&M
(Presented by: Andrew T. Kingman)
Objectives: Mycobacterium bovis bacillus Calmette−Guerin (BCG) is a standard
immunotherapy used for non−muscle invasive bladder cancer. The recurrence
rate and progression of cancer following BCG therapy has fostered research to improve adjunctive therapy. Previous studies have shown that BCG increases MHC
class II expression on bladder tumor cells suggesting increased immune recognition of the tumor by CD4 T cells. Our preliminary data suggest that BCG increases
CD95 expression, a well−known mediator of cell death. From these observations,
our aim was to determine if the impact of BCG is partly direct or if the impact of
BCG is on B and/or T cell activation that facilitates bladder tumor recognition and
cell death.
Methods: In vitro, mouse bladder cells, mouse bladder tumor cells, human bladder tumor cells, and mouse splenocytes (C57BL6), as a source of mouse immune
cells, were treated with BCG at doses ranging from 0.1 to 500 µg/ml, based on the
clinically relevant dose of 270µg/ml. Cells were harvested at 24, 48, or 72 hours;
stained for MHC II, B220, CD19, CD95, CLIP, IgM, and IgD; and analyzed on a BD
FACS Canto II flow cytometer. Data was analyzed using FloJo Software (TreeStar,
Inc.).
Results: BCG led to increases in cell surface expression of MHC class II and
CD95 on the bladder tumor cells suggesting that BCG can increase the immunogenicity of the tumor cells directly. Furthermore, our data showed that BCG caused
significant human tumor cell death. Interestingly, BCG promoted polyclonal B cell
activation in cultured splenocytes. Concordantly, the frequency of CLIP expressing
B cells as well as CLIP density increased in a dose dependent manner. Previous
work suggests that polyclonal B cell activation and specifically CLIP+ B cells promote an inflammatory response. This suggests a component of the inflammatory
response to BCG administration is directly B cell mediated.
Conclusions: BCG therapy has been used as an effective, albeit limited, therapy
for recurrent non−muscle invasive bladder cancer. The mechanism of action is
immune−mediated, and has been proposed to be a T cell mediated. Our data
suggest a novel discovery that polyclonal B cell activation may contribute to T cell
activation in response to BCG; and that BCG may directly increase the immune
sensitivity of the bladder cancer cells to immune recognition. Understanding the
molecular mechanisms associate with the BCG anti−tumor response may provide
additional novel immune therapies as adjuncts to BCG.
98
Podium #28
WITHDRAWN
Podium #29
Objectives: Hemorrhagic cystitis is an unfortunate, but not unexpected, complication of radiation therapy for pelvic malignancies. Radiation therapy leads to progressive obliteration of small blood vessels in bladder mucosa, leading to hypoxia
and tissue damage. Symptom presentation ranges from lower urinary tract symptoms (frequency, urgency) through bleeding with clot retention. The incidence of
radiation−induced hemorrhagic cystitis is 3−5% and typically occurs 2 months to
15 years post−radiation therapy. Palliative treatments (cystoscopy with fulguration,
instillation of alum, silver nitrate, or formalin) may be ineffective at improving the
patient’s symptoms and do not treat the disease process pathogenesis. Studies
have shown that increasing oxygen tension can promote neoangiogenesis, neoosteogenesis, and neocollagenesis and hyperbaric oxygen (HBO) therapy has been
used for treatment of radiation−induced tissue injury and poorly healing wounds.
We assess the short−term and long−term efficacy of HBO therapy for radiation−induced hemorrhagic cystitis.
Methods: From July 2001 through July 2012, 20 patients with radiation−induced
hemorrhagic cystitis refractory to palliative treatments were treated with HBO therapy at our institution. A retrospective, chart−review was performed. Mean patient
age was 70.9 years (41−90 years). Primary pathologic conditions were prostate
cancer (80%), colorectal cancer (10%), and cervical cancer (10%). Mean time between radiation treatment and initiation of HBO therapy was 4.75 years (3 months
to 17 years). Mean HBO treatment was 39 sessions (range 16−51).
Results: Of the 20 patients treated with HBO therapy, 17 patients (85%) had
marked improvement or complete resolution of symptoms immediately following
completion of HBO therapy sessions. Of the remaining three patients, 2 were
considered treatment failures and subsequently had supravesical urinary diversions and 1 patient had treatment terminated due to medical comorbidities. Long
term follow−up (range 6 months to 11 years) of the 17 patients, 14 continued to
have marked improvement or complete resolution of symptoms, 1 patient had persistent/recurrent hematuria and had angioembolization procedure, 2 patients were
not available to assess long−term results.
Conclusions: Hyperbaric oxygen therapy for radiation−induced hemorrhagic cystitis is an efficacious treatment option, in the short−term and long−term, for patients that have failure to palliative treatment options.
99
PODIUMs
EFFECTIVENESS OF HYPERBARIC OXYGEN THERAPY ON RADIATION−
INDUCED HEMORRHAGIC CYSTITIS.
Justin Johnson, Jeffrey Cooper, Lon Keim, Larry Siref
University of Nebraska Med Center
(Presented by: Justin Johnson)
Podium #30
INCIDENCE
AND
MANAGEMENT
OF
LYMPHOCELE
AFTER
RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTIS CANCER
Kyle O. Rove, Roxanne Martinez, Paul D. Maroni
University of Colorado, Anschutz Medical Campus
(Presented by: Kyle O. Rove)
Objectives: Development of lymphocele is a known complication of retroperitoneal lymph node dissection (RPLND) for testis cancer. RPLND series in the
literature cite post−operative rates of lymphocele formation ranging from 0.7 to
5.0%. The natural history of lymphoceles remains uncertain, particularly in an era
of increased use of cross−sectional imaging for ongoing surveillance. We aim to
understand the clinical course of patients with lymphocele after RPLND, including
symptomatology if any, and need for intervention and determine whether there are
any clinical factors associated with development of lymphoceles.
Methods: 42 consecutive patients underwent RPLND performed by a single surgeon (PDM) at a tertiary care hospital from 2007−2013. We identified patients
noted to have a lymphocele on cross−sectional imaging and determined the presence or absence of symptoms and need for intervention. Descriptive statistics of
the population were calculated as mean ± standard deviation. Patients with and
without lymphoceles were compared using student’s T−test with P values ≤ 0.05
considered significant.
Results: Mean age and BMI at RPLND for all patients was 30.1±11.6 years and
25.3±4.8 kg/m². Mean follow up after surgery was 1.0±1.8 years, with the majority
of patients (n=29) electing to continue follow up with their local urologist or oncologist. 16.7% or 7 patients were noted to have lymphoceles post−operatively. 4
patients (57%) presented with symptoms, including abdominal pain, scrotal swelling, persistent nausea/vomiting, back pain, and buttock pain. Of the symptomatic
patients, 1 was managed expectantly and 3 required a total of 4 interventions
(drain placement). 2 patients requiring intervention were hospitalized for lymphocele management with one patient requiring 2 drain placements by interventional
radiology. When comparing patients who developed lymphoceles to those who did
not, there were no significant differences between age (P=0.50) or BMI (P=0.81).
All patients who developed lymphoceles had a post−chemotherapy RPLND. No
patients who received a primary RPLND developed lymphoceles in our series.
Conclusions: The common use of cross−sectional imaging may identify more
lymphoceles in patients undergoing RPLND. However, not all lymphoceles that
are discovered on surveillance imaging will require intervention or present symptomatically. Due to the rarity of testis cancer, longitudinal study of this population
remains challenging.
100
Podium #31
TESTIS TUMORS – PAIN AND OTHER SIGNS AT PRESENTATION
Robert Donohue
101
PODIUMs
Objectives: Testis tumors are described as painless scrotal swellings but over
30% of patients have complaints of pain, dragging scrotal discomfort or changes
in scrotal appearance.
The acute scrotum also presents challenges and infrequently may harbor a malignancy.
Methods: 11 patients presented with scrotal complaints of varying severity and
intensity.
Results: Two patients presented with an acute left varicocele at ages 39, recurrent
and 45, primary. Palpation revealed the testis mass and orchiectomy yielded a
seminoma and embryonal cell carcinoma. One patient, 57, with a chronic hydrocele had a testis mass at hydrocelectomy and frozen section revealed a Leydig
Cell carcinoma. One 15 year old male presented with left scrotal pain, r/o torsion
and workup revealed normal perfusion of that testis but a cyst with a calcified
rim in the contralateral testis. Local excision returned as a simple cyst but staining revealed a teratocarinoma. Orchiectomy showed no residual tumor and node
dissection was negative. A 27 year old male presented with acute, severe, right
testicular pain and hemorrhage into a testis. Orchiectomy revealed a seminoma.
A 23 year old male, following bilateral orchidopexy for torsion had a testis mass
at post−op visit and underwent orchietomy for an embyronal cell carcinoma. Two
patients, 39 and 35, presented with acute traumatic epididymo−orchitis, from a gun
and kick, and after treatment and normal examination, were found to have testis
masses; seminoma at 6 months and embryonal cell carcinoma at 2 years. A 17
year old male presented with acute epididymitis but with bed rest and elevation,
returned with a testis mass and left supraclavicular mass. Both were embryonal
cell carcinoma. Two patients, 41 and 43, presented with vague scrotal discomfort.
Ultrasound revealed bilateral testicular microlithiasis with a unilateral testis mass.
Orchiectomy completed with seminoma in both.
Conclusions: Testis tumors are uncommon. Careful history of cryptorchidism,
current or corrected, atrophy or trauma and bilateral careful physical exam, must
be completed in all patients with scrotal complaints. All patients after diagnosis
and treatment must be followed as recommended with examinations including self
examination. Testis tumors must never be forgotten!
Podium #32
“PSEUDOSPONGIOPLASTY”USING PERIURETHRAL TISSUE FLAPS FOR
SUPPORT OF VENTRAL BUCCAL MUCOSA GRAFTS IN DISTAL URETHRA:
PROMISING INITIAL RESULTS
Lee C. Zhao1, TJ Tausch2, J. Francis Scott1, Allen F. Morey1
1
UT Southwestern Medical Center; 2Madigan Army Medical Center
Objectives: For ventral buccal mucosa graft onlay during bulbar urethroplasty,
spongioplasty using advancement of the corpus spongiosum is ordinarily performed to stabilize and perfuse the graft. In the pendulous and distal bulbar urethra, the spongiosum is often too thin to allow complete graft coverage. We describe the results of our “pseudospongioplasty”technique of ventral graft coverage
using bilateral periurethral tissue flaps and we compared these results to those of
standard spongioplasty.
Methods: Retrospective review of all urethroplasties performed by a single surgeon at a tertiary care facility from July 2007 to July 2012. Single stage urethroplasty involving ventral buccal mucosa graft placement were selected for analysis.
Standard spongioplasty was performed whenever possible. When spongiosal tissue was inadequate for graft coverage, usually in the pendulous and distal bulbar
urethra, periurethral tissue flaps were mobilized bilaterally and sutured together
in the midline providing secure coverage of the buccal mucosa graft (figure). Outcomes of traditional spongioplasty were then compared to those involving pseudospongioplasty. Urethroplasty failure was defined as any subsequent operative
intervention, open or endoscopic.
Results: Among 519 urethroplasties performed during the 5−year study period,
68 patients met inclusion criteria (13%). Pseudospongioplasty was performed predominantly in the pendulous urethra (23/35, 66%) with success in 86% (mean
follow up 29 mo). Standard spongioplasty (mean follow up 32 mo) was performed
in a similar number of patients (33 patients, 49%) with an identical success rate
(85%). Length of stricture was comparable in the pseudospongioplasty group
(mean 5.7 cm) and the traditional spongioplasty group (mean 6.2 cm, p=0.51).
Stricture length was not significantly different between successful and failed urethroplasty (6.1 cm vs 5.1 cm, p=0.19).
Conclusions: Ventral buccal mucosa grafts can be reliably applied to various locations throughout the anterior urethra. For distal grafts, mobilization of periurethral tissue flaps appears to provide equivalent results to standard spongioplasty.
102
Podium #33
VALIDATION OF THE URETHRAL STRICTURE SCORE (USS) IN ANTERIOR
URETHRAL STRICTURES TREATED BY URETHROPLASTY
Michael Johnson, Andrew Chang, Steven Brandes
(Presented by: Michael Johnson)
103
PODIUMs
Objectives: Anterior urethral stricture description and grading is not standardized.
To objectively analyze and compare the urethroplasty literature is difficult. We developed a UREThRAL Stricture Score (USS) (Can Urol Assoc J 2012; 6(4)260−4)
to quantify the characteristics of the anterior urethral stricture. We attempt to validate the USS as a predictor of increasing surgical complexity and as a grading
scale.
Methods: A retrospective review of 91 consecutive patients who underwent anterior urethroplasty by a single surgeon (SBB) at Barnes−Jewish Hospital from 2009
to 2011. USS was calculated based on: 1) (UR)ethral stricture (E)tiology; 2) (T)otal
number of strictures; 3) (R)etention (luminal obliteration); 4)(A)natomic location;
5)(L)ength. Multivariate analysis (MVA) was used to assess USS to surgical complexity. The five components of USS were independently analyzed as predictor for
surgical complexity, specifically looking at estimated blood loss (EBL), operative
time, and complications.
Results: Mean USS for excision and primary anastomosis, buccal mucosa graft,
augmented anastomotic urethroplasty, flap and combination was 5.8, 8.8, 9.2, 11
and 15, respectively. Increasing USS correlated with increasing surgical complexity (p<0.01). A higher USS correlated to longer total operative time (p=0.01) and
pre−op post void residual (p=0.04). (E)tiology of inflammation or hypospadias was
a predictor of longer operative time (p=0.03), greater EBL (p=0.03), higher surgical failure rate compared to traumatic or idiopathic cause (p=0.043) and higher
pre−op American Urological Association symptom score (AUASS) (p=0.04). (T)
otal number of strictures was associated with decreased pre−op mean flow rate
(p=0.01). ((R)etention) was a predictor of post op ED (P=0.01). (A)natomical location with concomitant bulbar and pendulous urethral stricture was associated with
greater pre−op AUASS (p<0.01) and EBL (p=0.02). (L)ength of urethral stricture
was positively associated with longer operative time (p=0.01) and length >5cm
predicted greater EBL (p=0.02) and post−op post void residual (p=0.02). USS did
not correlate with post−op complications (p>0.05).
Conclusions: The USS is a straightforward and easy to calculate scoring system
that quantifies the complexity of anterior urethral stricture. Increasing USS positively correlates with increasing surgical complexity, operative time and EBL, while
it did not correlate with post−op complications. Longer follow up with a large cohort
will be needed to determine USS value at predicting post−op complications and
surgical outcomes.
Podium #34
POOR QUALITY OF LIFE IN URETHRAL STRICTURE AND BLADDER
NECK CONTRACTURE PATIENTS TREATED WITH INTERMITTENT SELF−
CATHETERIZATION
Jessica D. Lubahn1, J. Francis Scott1, Lee C. Zhao1, Steven J. Hudak1,
Jay Simhan1, Justin Chee2, Ryan Terlecki3, Benjamin Breyer4, Allen F. Morey1
1
UT Southwestern Medical Center; 2Edgewater Urology, Melbourne, Australia;
3
Wake Forest University School of Medicine; 4University of California at San
Francisco School of Medicine
Objectives: Clean Intermittent self−catheterization (CIC) has been popularized
as a conservative form of managing complex lower urinary tract dysfunction for
several decades. CIC is perceived as a relatively simple and painless procedure
that may prevent the complications of bladder outlet obstruction while obviating
the need for indwelling catheters or reconstructive surgery. We assessed patient
perceptions of CIC among men with urethral strictures who regularly self−catheterized.
Methods: We constructed a visual analog questionnaire to evaluate performance
of CIC by men referred for management of urethral strictures at four institutions.
Items assessed included the patient’s length of time, frequency, difficulty and pain
associated with CIC, as well as the interference of CIC with daily activity. The
questionnaire was distributed to stricture patients regularly performing CIC. The
primary outcome was the patient’s perceived quality of life (QOL). Multivariate
analysis was performed to assess factors that affected this outcome.
Results: Eighty−five patients were included with a mean age of 64 years (range
15 to 94). The mean length of time on CIC was 3.6 years (range 0.04 to 20), and
the mean frequency of catheterizations per day was 1.7 (range 0 to 10). Mean
difficulty with catheterization was 4.7± 2.7, and the mean pain score was 3.9±
2.7. Interference with daily life was low at a mean value of 3.3± 2.6. The overall
QOL (range 1−10, poor QOL defined as 7 or greater) had a mean score of 7.0±
2.6. On univariate analysis, reduced age (P < 0.01), interference with daily activity
(P=0.03), pain (P<0.01) and difficulty performing CIC (P = 0.03) correlated with a
poor QOL in a statistically significant manner. However, on multivariate analysis
only difficulty catheterizing (P<0.01) and reduced age (P=0.05) were statistically
significant predictors of poor QOL. Patients with strictures involving the posterior
urethra had a statistically significant increase in difficulty (P=0.04) and decrease in
quality of life (P=0.04).
Conclusions: Most urethral stricture patients on CIC rate their difficulty and pain
as moderate and their inconvenience as low, but they report a poor QOL that may
be independently associated with CIC, especially among young patients.
104
Podium #35
URETHROGRAPGY INTERPRETATION SKILLS OF UROLOGY AND
RADIOLOGY RESIDENT AT TERTIARY CARE MEDICAL CENTERS
Andrew Chang1, Daniel Rosenstein2, Christopher Gonzalez3, Brandon Manley1,
Joel Vetter1, Steven Brandes1
1
Washington University in St. Louis; 2Stanford University; 3Northwestern University
105
PODIUMs
Objectives: Retrograde urethrograms (RUG) and voiding cystourethrograms
(VCUG) are the gold standard imaging modalities to diagnose urethral stricture
disease. Precise diagnosis of stricture presence, number, location, and length is
of paramount importance in planning proper surgical treatment. The ability to accurately interpret urethrography is essential to selecting and performing the proper
urethral surgery. We attempt to examine the ability of the Urology and Radiology
residents to interpret these studies.
Methods: A standardized examination consisting of 10 RUG/VCUG combinations
of the male urethra was administered to urology and radiology residents from all
levels of training at Washington University (WU), Stanford University (SU) and
Northwestern University (NW). The residents were asked to evaluate for stricture
location(s) and estimate the length of strictures, if present. Each study center had
one faculty member who specialized in urethral surgery and another in Urologic
radiology.
Results: 60 residents took the quiz, consisting of 26 residents from WU, 15 residents from SU and 19 residents from NW. Average year of training for urology
and radiology was 3.6 and 2.8yrs, respectively (p=0.009). Anterior strictures were
identified 35.9% and 43.7% of the time by radiologists and urologists, respectively
(p=0.032). Posterior strictures were identified 32.6% and 17% of the time by radiologists and urologists, respectively (p=0.092). Overall accuracy (correctly identifying the location of the stricture and no false positives) was 24.2% for radiology
and 27.9% for urology (p=0.297). However, when multiple strictures were present
on a single study, the accuracy significantly declined to 3.23% for radiology and
6.9% for urology (p=0.192). With multiple strictures present, the accuracy for all
residents declined from 26% overall to 5% (p=<0.0001). A normal RUG was recognized by 65.5% of urologists and 58% of radiologists (p=0.5).
Conclusions: Current Radiology and Urology residents in the United States have
poor skills at interpreting urethrography, especially when multiple strictures are
present. A formal educational program for RUG/VCUG interpretation should be
designed and implemented into the radiology and urology resident curriculum.
Podium #36
SUCCESS RATE OF PRIMARY URETHRAL REALIGNMENT IS INDEPENDENT
OF THE SEVERITY OF PELVIC TRAUMA AFTER TOTAL POSTERIOR
URETHRAL DISRUPTION
Michael Maccini1, Alexandre Pompeo2, David Sehrt2, Renato Mariano da Costa, Jr.2,
Jason Phillips1, Wilson Molina2, Philip Stahel2, Ernest Moore2, Fernando Kim2
1
University of Colorado; 2Denver Health Medical Center
Objectives: Recent studies have shown a role for urethral primary realignment
after complex pelvic trauma. Technical difficulties may be overcome with appropriate technique and technology. We examined the success rate of urethral primary
realignment of total posterior urethral disruption after complex pelvic trauma and
the correlation of the severity of pelvic fracture.
Methods: An analysis of a prospective database was performed of patients with
pelvic fracture associated with total urethral disruption underwent urethral realignment from 2005 to 2012 at Level I Trauma Center. Fractures were classified
according to the orthopedic Young−Burgess classification. Initial urological management consisted of suprapubic tube insertion when the patient was unable to
void. We utilized anterograde flexible cystoscopy via suprapubic tube, retrograde
rigid cystoscopy and real−time fluoroscopy. Failure of realignment was defined as
the inability of urethral catheterization using a retrograde/anterograde approach.
Follow up consisted of urethrograms, urofluxometry and cystoscopy evaluation.
We also analyzed continence and erectile function after trauma. The necessity
of other procedures such as dilatation, DVIU or urethroplasty was also evaluated
after catheter removal.
Results: A total of 480 consecutive patients were screened and we found 18 patients with total posterior urethral disruption after complex pelvic trauma with the
inability to void. The mean patient age was 40 years. The success rate of the
procedure was 100%. Mean operating time was 47± 11 minutes. Estimated blood
loss was minimal. A total of patients 50.0% had associated organ related injuries.
The realignment was accomplished within 3 days after admission. There was no
correlation between the orthopedic type of classification and the success of urethral realignment. A total of 10 (56%) patients developed urethral strictures during
follow up. Urinary incontinence occurred in 3 (17%) patients and 10 (56%) patients
self−reported erectile dysfunction after the trauma. The mean follow up of these
patients were 30.2 months.
Conclusions: Primary endoscopic realignment of total posterior urethral disruption after complex pelvic trauma had 100% success rate due to technology and
surgical technique. Moreover, there was no correlation of the severity of pelvic
fracture. Pelvic orthopedic classification did not show correlation with post procedure urinary incontinence or erectile function after the trauma.
106
Podium #37
OUTPATIENT URETHROPLASTY PROVIDES GOOD OUTCOMES FOR
URETHRAL STRICTURE REPAIR IN PATIENTS WITH A HISTORY OF FAILED
HYPOSPADIAS REPAIR
107
PODIUMs
Objectives: We present our experience with outpatient urethroplasty for urethral
stricture in patients with failed hypospadias repair and discuss the outcomes.
Methods: We retrospectively reviewed the medical records of patients who had
undergone urethroplasty at our institution over a 10 year period. Inclusion criteria
were a prior history of hypospadias and hypospadias repair and a diagnosis of urethral stricture resulting in urethroplasty. We excluded patients with other etiologies
of urethral stricture as well as hypospadias patients who underwent non−standard
urethral repair or repair for reasons other than stricture. The size and location
of the stricture, type of repair, success rate, complications, and relevant clinical
and demographic data were recorded. Preoperatively patients underwent physical exam, uroflowmetry, retrograde urethrograms, voiding cystourethrograms, and
cystourethroscopy as appropriate. Urinary flow, cosmetic outcome, sexual function, and the presence of possible complications were evaluated postoperatively.
Results: 204 patients were identified as having undergone urethroplasty at our
institution. Of these patients, 29 patients with a history of hypospadias who underwent urethroplasty for urethral stricture repair were identified. Of 51 total procedures, 45 were performed on an outpatient basis and only 4 surgeries resulted
in unplanned hospital admission. Overall, 98% of patients were discharge after
<23 hours. 27 of 29 patients were available for follow−up, with overall successful repair of urethral stricture achieved in 23 of 27 patients (85%). In 16 patients
a planned single−stage repair was performed. Eleven patients underwent multistage repair, and 2 patients underwent one stage of a multistage repair. Primarily
successful repair occurred in 18/27 patients, including 6/9 patients who received
multistage repair and 10/16 patients receiving single stage repair, which improved
to 8/9 patients with multistage repair and 13/16 repaired primarily after additional
intervention. Persistent complications, defined as fistula, sexual dysfunction, or
mild cosmetic concerns, existed in 5 patients at the end of the follow−up period.
Conclusions: Repair of urethral stricture resulting from failed hypospadias reconstruction presents significant challenges for the reconstructive urologist, but
repairs are successful in the majority of patients. Outpatient surgery is able to
achieve success rates comparable to success rates of hypospadias repair reported in the literature.
Financial Funding: None
Podium #38
MODIFIED YORK−MASON RECTOURETHRAL FISTULA REPAIR WITH FAT
GRAFT INTERPOSITION
Ruiyang Jiang1, Lee C. Zhao1, TJ Tausch2, Xiangrong Deng1, Allen F. Morey1
1
UT Southwestern Medical Center; 2Madigan Army Medical Center
Objectives: The posterior sagittal approach (York−Mason) for rectourethral fistula
repair allows direct exposure for reliable repair, but interposition of tissue to provide an intervening layer is difficult to perform. Fat grafts have been advocated for
use in plastic surgery to promote wound healing. We report our experience using
fat graft interposition during York−Mason rectourethral fistula repair.
Methods: We retrospectively reviewed medical records of all patients who had
rectourethral fistula repair at our institution. A total of 8 patients underwent the York
Mason primary repair with fat graft interposition over the closed defect. All patients
underwent fecal diversions prior to the repair. Patients’ age ranged from 50 to 80
years (mean 64). The etiologies of the fistulae included microwave ablation of the
prostate (1), robot−assisted laparoscopic radical prostatectomy (6), and low anterior resection (1). The majority of the fistulae occurred near the trigone/neck of the
bladder. None of the patients had history of radiation.
Results: Seven of 8 patients (88%) had successful repair using our modified
York−Mason approach in a single procedure. Mean estimated blood loss was 186
cc (100−400 cc). No transfusions were required. One patient had concomitant
skin flap inlay for proximal bulbar stricture. Mean operative time was 210 minutes
(120−300 min). On average, patients were discharged by post−operative day 2.
The median length for urinary catheter removal was 4 weeks (4−6 wks) after the
operation. No fecal incontinence was reported. One patient received an AUS for
stress urinary incontinence. The one patient that failed York−Mason with fat graft
interposition had a 1cm fistula after unrecognized rectal injury during robotic assisted laparoscopic radical prostatectomy. Failure was attributed to the inability to
mobilize the surrounding tissues to provide an adequately tension−free anastomosis.
Conclusions: This modified approach provides excellent outcomes in treating
rectourethral fistula. Our result is comparable to the historical York−Mason series
and may provide an alternative modification to this established method.
Podium #39
PRESENTATION AND OUTCOME IN PENETRATING AND BLUNT BLADDER
INJURY: A CONTEMPORARY COMPARISON
Lars Wallin1, Margaret Le2, Michael Coburn1, Andrew Windsperger2,
Joshua Broghammer2, Thomas Smith1
1
Baylor College of Medicine; 2University of Kansas
(Presented by: Margaret Le)
Objectives: The purpose of our study is to compare diagnosis, management and
outcomes for different mechanisms of bladder injury at two urban Level I trauma
centers.
108
109
PODIUMs
Methods: Patients with bladder trauma were identified from the Ben Taub General Hospital and University of Kansas Medical Center trauma databases from
2000−2012. Broad inclusion criteria for patients evaluated include age ≥ 18 years
and survival after presentation > 24 hours. Mechanism, management and outcome
were evaluated using descriptive statistics.
Results: A total of 256 patients with bladder injury were identified with 211 meeting inclusion criteria. 89 (42%) were identified with extraperitoneal bladder injury
(EPI), 62 (29%) with intraperitoneal bladder injury (IPI), 27 (13%) with combined
injury (CI) and the remainder classified as contusions (n=27) or unknown (n=6).
The mean age was 33.2 years and mean injury severity score (ISS) was 23.4.
The mechanism of injury was blunt in 121 (57%) and penetrating in 90 (43%).
Diagnosis was by standard CT scan in 49, CT cystogram in 32, conventional cystogram in 43 and operative in 81. A total of 9 injuries were incompletely evaluated
on conventional CT scan, with 5 undiagnosed and 4 misdiagnosed injuries. There
was one missed bladder injury. In blunt injuries, 69 (67%) were managed with
initial operative repair and 34 (33%) with catheter drainage. In penetrating injuries,
75 of 76 injuries were managed with operative repair. Average catheter indwelling
time was 23.2 ± 18.7 days in penetrating injuries. In the blunt injury group, catheter
indwelling time averaged 24.9 ± 27.8 days in the operative group and 21.7 ± 10.8
in the conservative management group. Complications were reported in 26% of
patients (n=55). Major complications occurred in 8% of blunt injuries (n=10) and
12% of penetrating injuries (n=11).
Conclusions: At our institutions, operative management of bladder injury results
in similar catheter duration as conservative management regardless of mechanism. Overall complication rates were greater among penetrating bladder injuries,
likely related to concomitant injuries.
Podium #40
TRENDS IN INCIDENCE, TYPE, AND REPAIR OF URETERAL INJURY
OCCURRING DURING HYSTERECTOMY OVER TEN YEARS AT A SINGLE
INSTITUTION
Scott Matz1, Andrew Christiansen2, James Cummings3
1
University of Missouri; 2Medical student, University of Missouri; 3Professor of
Urology, University of Missouri
Objectives: To assess the changes in the incidence and repair of ureteral injury
that occur during hysterectomy over ten years and to compare those that occurred
during laparotomy to those occurring during laparoscopic and robotic procedures.
Methods: A retrospective review of the electronic medical record revealed 3366
hysterectomies since 2002. Codes consistent with open procedures revealed
1812 open hysterectomies, 799 vaginal hysterectomies, and 755 laparoscopic or
robotic hysterectomies. These records were then further evaluated for subsequent
codes identifying surgical ureteral interventions. Of these, 19 cases representing
clear ureteral injuries secondary to hysterectomy were found. These were evaluated for the dates of procedure, hysterectomy technique, timing of diagnosis and
treatment, and type of repair. Any ureteral injury requiring a multifaceted or difficult
repair such as a psoas hitch and/or boari flap was considered complex as compared to a simple reimplant, ureterorraphy or stenting alone..
Results: A statistically significant difference (p=0.0364) was noted in the complexity of repairs required for different hysterectomy procedures. Fewer ureteral
injuries resulting from robotic or laparoscopic hysterectomy required a high level of
complexity (1/7) compared to the open procedure (7/10). No significant difference
was noted in the overall incidence of injuries over time, the incidence in injury per
procedure type, or the immediate intraoperative identification of injuries requiring
repair per procedure type.
Conclusions: Over large populations, there may be a significant reduction in the
overall cost of robotic or laparoscopic hysterectomy as compared to laparotomy
due to the ease of repair of ureteral injuries sustained in those procedures. The
current data is limited by a relatively small number of injuries and by short follow
up for some of the robotic patients who were managed with a low complexity repair
such as with a stent alone. Further investigation may continue to demonstrate this
difference and further support the use of robotic technology for hysterectomy
110
Podium #41
Objectives: To report our series of laparoscopic ureteroneocystostomy for ureteral obstruction secondary hysterectomy.
Methods: We retrospectively reviewed a multi−institutional ten year experience in
patients who were treated for a ureteral injury following hysterectomy managed by
laparoscopic ureteroneocystostomy.
Results: A total of 9 patients presented with ureteral injury after hysterectomy
were identified. Seven of nine patients underwent open hysterectomy, 5 of these
patients due to myoma, 1from cervical cancer, and 1 due to uterine atony after
vaginal delivery. One patient had vaginal hysterectomy and another had a laparoscopic radical hysterectomy. A total of 5 of the cases were left side and 4 were right
side and all of them were distal. All cases were managed laparoscopically without
open conversion. Lich−Gregoir reimplatantion technique (Figure 1) was applied in
7 patients and a Psoas−Hitch was applied on 2 patients. Mean operative time (OR
time) was 206.6 minutes (120−280 min), mean estimated blood loss was 122.2 cc
(25−350 cc) and median hospital stay was 3.3 (1−7). There were no intraoperative
complications. Follow−up with CT scan cystogram or voiding cystourethrogram
showed no urine leak and ureteroneocystotomy patency in all cases.
Conclusions: Laparoscopic Ureteral Reimplantation may offer an alternative surgical approach for the management of distal ureteral injuries, with excellent cosmetic results and fast recovery.
111
PODIUMs
LAPAROSCOPIC URETERONEOCYSTOSTOMY FOR URETERAL INJURIES
AFTER HYSTERECTOMY: TEN YEAR EXPERIENCE
Alexandre Pompeo1, Wilson Molina2, David Sehrt3, Marcos Tobias−Machado4,
Antonio Pompeo4, Fernando Kim2
1
Division of Urology, Department of Surgery, Denver Health Medical Center,
Denver, CO; 2Division of Urology, Department of Surgery, Denver Health Medical
Center, Denver, CO; Division of Urology, Department of Surgery, University of
Colorado, Aurora, CO; 3Denver Health Medical Center/ University of Colorado;
4
Department of Urology, ABC Medical School, Sao Paulo, Brazil
(Presented by: David Sehrt)
Podium #42
NEW “SCRATCH” TECHNIQUE FOR CORRECTION OF PEYRONIE’S
CURVATURE DURING INFLATABLE PENILE PROSTHESIS PLACEMENT
Paul Perito1, Steven Wilson2
1
Perito Urology, Coral Gables FL; 2Institute for Urologic Excellence
(Presented by: Steven Wilson)
Objectives: Implantation of inflatable penile prosthesis (IPP) for patients with Peyronie’s Disease and impotence improves the curvature to <30º in approximately
40% of cases. Additional straightening can be achieved by adjunctive procedures
e.g. modeling, plication or plaque incision/excision. We introduce a new method of
incising the plaque from inside the corporotomy prior to cylinder placement. This
improves the curvature in more patients and if not satisfactory, makes modeling
easier to accomplish.
Methods: 52 patients underwent simultaneous modification of Peyronie’s curvature during implantation of IPP. Curvature ranged from 90−150º and mean age
was 67 (range 40−83). All patients received Coloplast Titan prosthesis with intracorporal incision of plaque via Hook Blade Knife (BP #12) immediately before
cylinders placed.
Surgical Technique: Patients received on table erection by saline injection. The
location of plaque was marked on penile skin. 46 infrapubic (PP) and 6 penoscrotal (SKW) incisions were utilized. Dilatation consisted of single passage of Furlow
or #11 Brooks dilator. A long nasal speculum was inserted into corporotomy and
spread to access plaque. #12 scalpel blade is used to “scratch”plaque several
times. Following plaque incision IPP conducted in usual fashion. If after IPP completion, and full inflation, curvature ≥30º was noted then, modeling once or twice
was accomplished.
Results: 40 (77%) patients’ curvature was ≤ 30º without any adjunctive measures.
The remainder had one (15) or two (8) modeling sessions with ≤30º resultant. Modeling was subjectively easier than patients whose plaque had not been incised.
The only adverse event was 8 (15%) had significant penile ecchymosis. No infections, sensation problems or cylinder hernia.
Conclusions: The scratch technique seems to assist IPP cylinders in overcoming
Peyronie’s curvature without adjunctive measures. If straightening is not optimum,
additional straightening by modeling seems easier to accomplish.
112
Podium #43
SAFETY OF “DRAIN AND RETAIN” STRATEGY FOR DEFUNCTIONALIZED
UROLOGIC PROSTHETIC BALLOONS AND RESERVOIRS DURING AUS AND
IPP REVISION SURGERY: FIVE YEAR EXPERIENCE
Christopher A. Cefalu, Xiangrong Deng, J. Francis Scott, Sandeep Mehta,
Lee C. Zhao, Allen F. Morey
(Presented by: Christopher A. Cefalu)
113
PODIUMs
Objectives: We present our five year experience using a minimally invasive “drain
and retain”strategy in which existing urologic prosthetic balloons and reservoirs
(UPBR) were emptied but not removed during routine artificial urinary sphincter
(AUS)/inflatable penile prosthesis (IPP) reoperation. This technique eliminates the
need for dissection into the retropubic space, and we hypothesize that it does not
increase the risk of infection.
Methods: All genitourinary prosthetic surgeries by a single surgeon from July
2007 to September 2012 were reviewed. Our “drain and retain”technique involved
defunctionalizing the existing UPBR by aspirating all its fluid, placing the tubing on
traction, and cutting proximally. Prosthetic replacement cases having both a new
contralateral UPBR placement and a retained empty UPBR comprised the study
group. Post−operative outcomes with specific attention to infection related to the
defunctionalized UPBR were reviewed and compared to patients receiving their
first prosthesis (control group). Complete device removals for gross infection and
revision cases utilizing the original UPBR were excluded.
Results: A total of 551 urologic prostheses (251 AUS and 300 IPP) were inserted
in 433 men with complete evaluable data during the 5 year study period. Among
120 reoperative prosthetic cases, UPBR were drained and retained in 55 patients (46%). The control group consisted of 390 patients undergoing initial AUS
and/or IPP placement. No difference in infection rate was identified between the
control group (6/390, 1.5%) and the “drain and retain”group (1/55, 1.8%, chi−
square=0.024, p=0.88).
Conclusions: Retention of defunctionalized genitourinary prosthetic balloons and
reservoirs does not increase infection rate following reoperative AUS and/or IPP
surgery.
Podium #44
STAGGERED IPSILATERAL SUBMUSCULAR PLACEMENT OF AUS
PRESSURE REGULATOR BALLOON AND IPP RESERVOIR: A PRELIMINARY
EXPERIENCE
Paul Chung, Lee C. Zhao, Allen F. Morey
University of Texas Southwestern Medical School
(Presented by: Paul Chung)
Objectives: During simultaneous placement of an artificial urinary sphincter (AUS)
and an inflatable penile prosthesis (IPP), the AUS pressure regulator balloon and
IPP reservoir have traditionally been placed bilaterally, one on each side of the
pelvis within the space of Retzius. We present our initial experience of staggered
ipsilateral submuscular placement of the AUS PRB and IPP reservoir.
Methods: Patients who had undergone simultaneous AUS and IPP placement
with staggered ipsilateral submuscular placement of the AUS pressure regulator
balloon and IPP reservoir were reviewed. For these patients a sub−rectus space
was created by blunt dissection using a long lung−grasping clamp through the external ring. The AUS pressure regulator balloon was placed in the superior portion
and the IPP reservoir in the inferior portion of the submuscular tunnel. Patients
completed a survey at the time of outpatient follow up assessing patient and physician palpability of the balloon and bother score on a scale of 1−3 (1 – not at all,
2 – slightly, 3 – markedly). Quality of life was also assessed on a scale of 1−7 (1
– delighted and 7 – terrible).
Results: Ten patients were identified who underwent staggered ipsilateral submuscular placement of the PRB and reservoir. Mean age and BMI were 66.1 years
and 32.0 kg/m2, respectively. Mean post−operative follow up was 6.0 months with
surveys completed at 4.3 months. The AUS balloon was inflated to 24.0 cc and the
IPP reservoir to 53.3 cc on average. Patient and physician ability to palpate the
reservoir and balloon were 1.1 and 1.2 on average. Bother score was 1.0 and QOL
was 1.4 on average. No patient reported complications with the IPP. One patient
developed urethral erosion of the AUS while another reported malpositioning of the
AUS pump, both which were surgically corrected. Continence improved for all patients with average use of 0−1 pad per day, except for the patient who developed
urethral erosion.
Conclusions: Staggered ipsilateral submuscular placement of the AUS PRB and
IPP reservoir is a feasible technique that does not cause discomfort to the patient
or hinder device function. This technique may reduce surgical time and trauma by
requiring only unilateral dissection and may be preferable in patients having scar
from prior pelvic surgery.
114
Podium #45
LONG−TERM OUTCOMES FOR ARTIFICIAL URINARY SPHINCTER
REIMPLANTATION FOLLOWING PRIOR DEVICE EXPLANTATION FOR
EROSION AND/OR INFECTION
Brian Linder, Daniel Elliott
Mayo Clinic
(Presented by: Daniel Elliott
115
PODIUMs
Objectives: To evaluate the long term clinical outcomes of patients managed with
artificial urinary sphincter (AUS) reimplantation following AUS explantation for erosion or infection.
Methods: We identified 739 consecutive AUS implantation procedures performed
at Mayo Clinic from 1998 to 2012. Of these, 582 were primary implantations (79%),
111 (15%) were revision surgeries for device malfunction and 46 patients (6%) had
undergone at least one prior AUS explantation secondary to urethral erosion and/
or device infection. 21 of the 46 patients (46%) had undergone multiple (range
1−5) prior reimplantation procedure. Patient follow−up was obtained through office
examination, written or telephone correspondence.
Results: Patients undergoing AUS reimplantation had a median age of 77 (IQR
71,80), with a median follow−up of 41 months (IQR 8,60). AUS reimplantation
occurred at a median of 8 months (IQR 6,13) after explantation. Patients undergoing reimplantation after erosion or infection were more likely to require repeat
explantation compared those undergoing primary implantation (8/46 [17%] versus
28/582 [4.8%], p= 0.0004). When including subsequent revision and explantation
procedures, the 2 and 5−year device survival rates following AUS reimplantation
after erosion or infection were 85% and 81%, respectively.
Conclusions: Our findings suggest that AUS reimplantation following explantation
for urethral erosion and/or device infection is associated higher rates of recurrent
erosion/infection requiring repeat explantation. However, in appropriately selected
patients clinically acceptable long−term success rates can be obtained.
Podium #46
DOES IN SITU URETHROPLASTY AT TIME OF AUS EXPLANTATION
DECREASE RISK OF URETHRAL STRICTURE?
Daniel Ramirez, Lee C. Zhao, Allen F. Morey
Objectives: Erosion rates in the literature range from 0−13% following initial
placement of artificial urinary sphincter. Urethroplasty at the time explantation for
erosion has not been described previously. We compare the outcomes of patients
who underwent in situ urethroplasty at time of AUS removal to those who did not.
Methods: All patients undergoing AUS removal for urethral erosion from
2005−2012 were reviewed. Of the 19 men who underwent AUS removal, 9 patients underwent in situ urethroplasty while 10 did not. We reviewed demographic,
clinical and radiologic data to assess indications and evidence for stricture disease
after repair. Stricture at the site of AUS cuff location was defined by inability to pass
a 16Fr flexible cystoscope or need for additional surgery to treatment of stricture.
Results: A total of 19 patients diagnosed with AUS erosions between April 2005
and February 2012 were identified. 9 of these men underwent primary repair of
urethral defect at time of AUS removal. The mean (range) age was 73 (61−83)
years with a mean (range) BMI of 28.2 (18.9 – 32.1). Average time (range) to
erosion from AUS placement was 7.8 months (1.2 – 23.9). At a mean (range)
follow up of 24.3 months (1.2 – 69.3) the rate of stricture after AUS explantation
80% in those who did not undergo urethroplasty, compared to 33% for those who
did (p = 0.036). Of the patients who developed urethral stricture, 3 underwent urethroplasty, 2 were treated with direct visual incision of urethral stricture (DVIU), 2
underwent urethral dilation, and 3 were managed with chronic suprapubic catheter
placement (SPT). None of these patients had undergone replacement of AUS at
time of completion of review. Stricture formation was not correlated with a history
of hypertension, pelvic radiation, diabetes, coronary artery disease, and smoking.
Conclusions: In situ urethroplasty at time of AUS explantation for urethral erosion
is associated with a lower rate of stricture development.
116
Podium #47
IS HIGH SUBMUSCULAR PLACEMENT OF AUS PRESSURE REGULATING
BALLOON EQUIVALENT TO SPACE OF RETZIUS?
Gregory R. Thoreson, Lee C. Zhao, Xiangrong Deng, Allen F. Morey
(Presented by: Gregory R. Thoreson)
117
PODIUMs
Objectives: Submuscular placement of pressure regulating balloons (PRB) and
inflatable penile prosthesis reservoirs has become a popular strategy in prosthetic
urology. Because artificial urinary sphincter (AUS) function depends upon pressure driven from the PRB into the cuff, we sought to determine whether continence
outcomes from AUS procedures having submuscular PRB placement were similar
to those having traditional placement in the Space of Retzius.
Methods: Patients undergoing AUS placement from 2007 to 2012 were reviewed.
Placement of the PRB was either into a high submuscular tunnel or within the
space of Retzius. Only 61−70 cm H2O PRBs were used. Continence (defined as
0−1 pads per day), AUS cuff erosion, surgical revision, explantation, cuff size, and
history of radiation were assessed.
Results: A total of 199 consecutive patients underwent AUS placement with a
mean follow up of 31 months. Space of Retzius placement was performed in 138,
submuscular placement was performed in 61. No statistically significant difference
was found between the submuscular and space of Retzius cohorts with regards
to erosion rate (6.6% vs. 10.1%, p = 0.42), surgical revision (4.9% vs. 11.6%, p
= 0.14), explantation (6.6% vs. 13.0%, p = 0.18), cuff size ([3.5 cm] 41.0% vs.
37.7%, p = 0.79), history of radiation (59.0% vs. 56.5%, p = 0.74). Continence was
improved within the submuscular group (97.0% vs. 82.8%. p = 0.04). Kaplan Meier
analysis of the durability showed no statistically significant between the groups (p
= 0.74). Mean follow up was longer for the space of Retzius placement cohort (37
vs. 10 months), which may account for the difference between the two groups but
maturation of this data would be required to confirm a durable significance.
Conclusions: Submuscular placement of the PRB does not appear to impair AUS
function or safety.
Podium #48
SIGNIFICANT DIFFERENCE IN IN−VIVO VERSUS EX−VIVO ARTIFICIAL
SPHINCTER REGULATING BALLOON PRESSURES AT THE TIME OF
REVISION: A MECHANISM OF ACCELERATED URETHRAL ATROPHY?
Dominic Lee, Ouida Westney
Objectives: Urethral atrophy is felt to result from a known pressure delivery to
the urethral spongiosal over time. We aimed to evaluate the relationship between
in−vivo and ex−vivo pressure measurements of the pressure−regulating balloon
(PRB) at the time of AUS revision.
Methods: We tested the in−vivo and ex−vivo PRB pressures in 7 patients undergoing revision for recurrent or persistent urinary incontinence after initial AUS
placement. Pre−operative cystoscopy was performed to exclude urethral erosion.
Results: The mean age at initial AUS was 65.6 yrs (range, 50−76) and time to
revision was 69 months (range, 46−116). Cuff sizes at initial implant were 4 cm
in 4 patients and 4.5 cm in 3 patients, and all patients had 61−70 cmH2O balloon
reservoirs. Mean aspirated balloon volume was 18 ccs (range 0 − 23). The mean
in−vivo reservoir pressures (cm H2O) at 23, 25 and 30 ccs (SD) were: 112(+/−49),
164(+/−126) and 166(+/−85) cmH2O respectively with a combined mean of
146.48(+/−90.79) [95% CI: 99.80 to 193.16]. Similarly, the mean ex−vivo reservoir
pressures were: 63(+/−5.3), 63(+/−7.3) and 70.5(+/−4.6) cmH2O respectively with
an overall mean of 65.47(+/−6.65); [95% CI: 62.47 to 68.50] [Figure 1]. The magnitude of difference on Wilcoxon ranks test between matched pairs was statistically
significant (p=0.0003).
Conclusions: There were significant pressure differences in−vivo and ex−vivo
measurements of the PRB. The ex−vivo pressure measurements were consistent with the manufacturer’s pressure specifications. This highlights the complex
biomechanical changes between the two measured conditions and suggests an
uncoupling between pressure deterioration and recurrent stress urinary incontinence. Further studies are required to establish the relationship of the in−vivo
pressures to etiology of AUS failure.
118
Podium #49
DECREASED NEED FOR REVISION SURGERY IN ERA OF 3.5 CM ARTIFICIAL
URINARY SPHINCTER CUFF
Brian C. Mazzarella, Lee C. Zhao, Samir Derisavifard, Steven J. Hudak,
Allen F. Morey
(Presented by: Brian C. Mazzarella)
119
PODIUMs
Objectives: Since 2009, use of the 3.5 cm artificial urinary sphincter (AUS) cuff
has become commonplace for treatment of men with severe stress urinary incontinence at our tertiary institution. Prior to the availability of the 3.5 cm cuff, many
patients receiving a 4.0 cm cuff appeared to have an oversized cuff, resulting in
revision surgery for persistent incontinence. We evaluated outcomes prior to and
after the introduction of the 3.5 cm cuff.
Methods: All men who underwent AUS placement by a single surgeon between
July 2007 and July 2012 were evaluated. A standardized perineal cuff placement
technique was used in all cases. Patients having cuff size 4.5 cm or larger, tandem
cuffs, or transcorporal cuff placement were excluded from analysis. The remaining
patients were classified into two groups based on time of surgery: era 1 was before
introduction of the 3.5 cm cuff, and era 2 was afterwards. Revision surgery was
performed for men with > 3 pads per day SUI. We compared continence, erosion,
and revision rates between the two eras.
Results: Over the 5 years of this study, 156 of the 192 AUS placements performed
met inclusion criteria. In the first era (mean follow−up 46.3 months), 45 cases
of 4.0 cm AUS placement were noted. In the second era (mean follow−up 20.9
months), 33 men received 4.0 cm AUS cuffs (29.7%) and 78 patients (70.3%)
received 3.5 cm cuff placement. The revision rate for persistent incontinence in
era 2 (5%) was much lower compared to era 1 (24%, p=0.001, figure). Among 78
patients receiving 3.5 cm AUS cuffs, 11 (14%) had erosion, but 50% of this group
were reoperative cases, and more had prior radiation (51% vs 28%, p=0.003) compared to 4.0 cm cuff patients. Men with a history of radiation therapy had a higher
risk of erosion for both cuff sizes.
Conclusions: Utilization of the 3.5 cm AUS cuff is associated with a lower rate
of revision surgery for persistent incontinence, likely due to better coaptation in
patients with atrophic tissues. This lower revision rate is balanced by an increased
erosion rate.
Podium #50
RADIOFREQUENCY ABLATION OF SMALL RENAL CORTICAL TUMORS IN
HEALTHY ADULTS: 5 YEAR ONCOLOGIC OUTCOMES
Daniel Ramirez, Jeffery Gahan, Jodi Antonelli, Jeffery Cadeddu
UT Southwestern
Objectives: To assess the oncologic outcomes in a series of healthy patients (ASA
≤ 2) with cT1a renal cortical tumors treated with radiofrequency ablation (RFA).
Methods: We reviewed our prospectively kept database of patients who had undergone RFA for small renal masses between March 2001 and July 2012. Healthy
(American Society of Anesthesiologist, ASA 1 and 2) patients with cT1a renal
masses were identified and clinical and radiographic date were reviewed to assess
indications complications and radiological evidence of disease recurrence. Radiological recurrence was defined as any new enhancement (>10 Hounsfield units)
after absence of enhancement on initial 6−week computed tomography.
Results: A total of 89 patients with ASA ≤ 2 were identified. Four patients were
ASA 1 and 85 were ASA 2. The median (range) age was 60.5 (22−84) years and
the lesion diameter 2.35 (0.9−3.2) cm. Preoperative needle biopsy was diagnostic
in 74 of 77 patients (96%) who underwent preoperative biopsy, including 74% diagnostic of renal cell carcinoma. At a mean (range) follow up of 62 months (2−120)
cancer specific survival was 98.9% with 1 death secondary to RCC recurrence and
disease free survival was 96.6% with only 3 patients having recurrence of disease.
Conclusions: RFA may be a reasonable treatment option for small renal masses
in healthy patients, with appropriate informed consent. 5 year results suggest excellent oncologic outcomes.
120
Podium #51
OPEN PARTIAL NEPHRECTOMY VERSUS PERCUTANEOUS
CRYOABLATION
FOR
CLINICAL
T1
RENAL
TUMORS:
PERIOPERATIVE AND ONCOLOGICAL OUTCOMES
Philippe Nabbout1, Ahmed Eldefrawy2, Nathan Bradley1, Gennady Slobodov1
1
OUHSC; 2Miami School of Medicine
121
PODIUMs
Objectives: Open partial nephrectomy (OPN) and percutaneous cryoablation
(CRYO) are well established treatment approaches for clinical T1 renal tumors.
Our aim is to compare the perioperative and oncological outcomes of the two
approaches
Methods: We retrospectively reviewed our institutional review board approved
database for patients who underwent either OPN or CRYO for clinical T1 renal
tumors. All relevant clinical and demographic information was collected and analyzed. Chi square test was used to compare categorical variables and independent
sample t test compared continuous variables. Log rank test was used to compare
the Kaplan Meier estimates of recurrence−free survival. A p value of ≤0.05 was
considered significant.
Results: Between April 2005 and August 2012, 78 consecutive patients underwent either OPN or CRYO for clinical T1 renal tumor. Forty three (55%) underwent OPN. Table 1 describes the clinical and demographic characteristics of the
2 cohorts. Average tumor size was similar in both groups. Patients in the CRYO
group were older and had more comorbidities. Operative time, hospital stay, blood
loss, and transfusion rate were significantly lower in the CRYO group. However, a
significantly higher recurrence rate was observed in the CRYO patients when we
compared the kaplan Meier recurrence free survival curves of the two groups(p=
0.037). Five patients (14.5%) in the CRYO group developed local recurrence. Of
these 5 patients, one underwent radical nephrectomy and another received CRYO
of the recurrent lesion with no evidence of further recurrence. Three patients are
being managed by active surveillance. There was significantly higher number of
patients with renal impairment or with solitary kidney in the CRYO group (Table 1) .
No patient in either group had worsening of renal function post−operatively. There
were no deaths over the study period.
Conclusions: Although CRYO is associated with a higher local recurrence rate
compared to OPN, it appears to be a viable approach for patients with multiple
comorbidities and/or renal impairement presenting with a small renal mass.
Source of Funding: none
Podium #52
ROBOTIC PARTIAL NEPHRECTOMY IS ASSOCIATED WITH DECREASED
LENGTH OF STAY AND LESS BLOOD LOSS
Zach Hamilton, Margaret Le, Kahlil Saad, David Duchene, Jeffrey Holzbeierlein,
Moben Mirza
Objectives: The latest SEER Cancer Statistics estimate that 60,000 new cases of
kidney cancer with be diagnosed within the United States each year. The standard
of care for small renal masses has transitioned from radical to partial nephrectomy
with strong data to support excellent oncologic outcomes, long−term preservation
of renal function, and better overall survival. Laparoscopic techniques have generally showed low morbidity, fast post−operative recovery and comparable oncologic
outcomes, while robotic techniques are emerging with comparable results. The
literature shows that laparoscopic approaches are favorable when compared to
open techniques, but outcomes in robotic surgery are still gaining data. The objective of this study is to perform a review of outcomes comparing open versus robotic
partial nephrectomy. Our hypothesis is that surgical outcomes and length of stay
will favor robotic surgery.
Methods: We performed a retrospective review of partial nephrectomies from
2009 through 2012 at the Kansas University Medical Center. Only cases involving
solitary masses for suspected renal carcinoma were included. Clinical parameters
including patient characteristics, estimated blood loss, intraoperative transfusion
and margin status were recorded. Nephrometry scores were calculated based on
preoperative imaging.
Results: A total of 78 open partial nephrectomies and 63 robotic partial nephrectomies were analyzed. In the open cohort, the surgical blood loss was higher compared to the robotic cohort (328ml vs. 222ml, P=0.03). Nephrometry scores were
also higher in the open cohort (7.3 vs 5.9, P<0.01). The mean mass size was
larger in the open cohort (3.2cm vs 2.7cm, P=0.01). No significant difference was
noted in age or BMI. Of note, there were five intraoperative blood transfusions in
the open group and none in the robotic group. Four margins were positive in the
robotic cohort and one in the open cohort. Nephrometry score and mass size did
not correlate with blood loss.
Conclusions: For partial nephrectomy blood loss is significantly lower with robotic
techniques as compared to open surgery. This relationship is not affected by mass
size or nephrometry score. Positive margins rate is higher in robotic surgery, while
blood transfusion rate is lower in robotic surgery. Length of stay is decreased with
robotic surgery. Robotic partial nephrectomy seems to afford the advantage of
decreased blood loss and decreased length of stay.
122
Podium #53
SARCOPENIA IS ASSOCIATED WITH ADVANCED STAGE RENAL CELL
CARCINOMA: A RETROSPECTIVE ANALYSIS OF A PROSPECTIVELY
MAINTAINED INSTITUTIONAL DATABASE
Christian V. Sandoval, Carolina C. García, Francisco R. Covarrubias,
Ricardo C. Molina
123
PODIUMs
Objectives: Sarcopenia has been suggested as a predictor of morbidity and mortality in patients with malignant and non−malignant disease. Specifically, in renal
cell cancer, sarcopenia has only been associated with toxicity after target or chemotherapy for advanced disease. The objective of this study is to find an association between sarcopenia and clinical or pathological characteristics of patients with
renal cell carcinoma.
Methods: A retrospective analysis of a prospectively maintained institutional database of patients with renal cell carcinoma treated with partial or radical nephrectomy was done. Patients with a preoperative computed tomography scan (CT scan)
were selected. A previously validated measurement of muscular tissue in an axial
CT scan was used to diagnose sarcopenia. An association between clinical variables (age, gender and body mass index [BMI]) and pathological variables (tumor
size, nuclear grade, metastatic disease, nodular extension and TNM stage) with
sarcopenia was investigated.
Results: One hundred and six patients were included. There were 46 woman
(43.4 %) and 60 men (56.6 %). Their mean age and BMI were 58.83 ± 12.85
(min:22 – max:85) years and 26.96 ± 5.25 (min:18 – max:46) kg/m2. Patients were
classified according to the 2002 TNM staging system and 39 (36.8 %) were considered to have an advanced disease with a T3 or T4 stage. Sarcopenia was found
in 58 patients (54.7%). A significant association was found with an age >65 years
(p=0.002), male gender (p<0.001), a BMI <30 kg/m2 (p<0.001), and advanced
disease (p=0.033). No significant association with tumor size, nuclear grade, metastatic disease or nodular extension was found. On univariate regression analysis,
sarcopenia significantly predicted advanced stage disease (HR 2.475 CI 1.068 –
5.737, p=0.035). With a mean follow−up of 24.7 ± 20.2 months, sarcopenia was
not a predictor of survival.
Conclusions: Preoperative sarcopenia is a predictor of advanced disease in renal cell carcinoma. It is related to elderly, not−obese, male patients. We expect a
more significant impact in survival as the follow−up and number of these patients
increases in our database.
Podium #54
OUTCOMES IN RENAL CRYOABLATION THERAPY FOR T1A AND T1B
TUMORS
Cole Wiedel1, David Sehrt2, Wilson Molina3, Alexandre Pompeo3, Fernando Kim3
1
University of Colorado School of Medicine; 2Division of Urology, Department of
Surgery, Denver Health Medical Center, Denver, CO; 3Division of Urology,
Department of Surgery, Denver Health Medical Center, Denver, CO; Division of
Urology, Department of Surgery, University of Colorado, Aurora, CO
(Presented by: Cole Wiedel)
Objectives: Laparoscopic renal cryoablation (LRC) has an ill−defined role in the
treatment of solid renal masses >4cm. We evaluated demographics, complications,
pathology, and renal function in patients who underwent LRC for T1a (≤4cm) and
T1b (4−7cm) tumors.
Methods: A retrospective review of 140 patients treated with LRC between April
2003 and February 2013 at a single medical center was conducted. Tumor size was
determined by preoperative computed tomography (CT). Patients were stratified by
tumor size (T1a versus T1b) and surgical outcomes were compared. Demographics,
Clavien Complications III−V, pathological evaluation, surgical outcomes, and short
and mid−term renal function were obtained. Data are presented as mean ± standard
deviation, frequency (percentage of total), and median [interquartile range].
Results: 125 patients with T1a tumors and 15 patients with T1b tumors were treated
with LRC. Tumor sizes averaged 2.49 cm in the T1a tumors and 4.34 cm in the T1b
group (p<0.001). The malignancy rate was lower in the T1a group versus the T1b
group (Table 1). There were no recurrences in the T1a group, and 1 pathological
recurrence in the T1b group (p=0.128). There was no difference in operating time
between the two groups (p=0.350). Conversions were to laparoscopic partial nephrectomy except for one T1b case, converted to laparoscopic nephrectomy due to
hilar location, intraoperative finding of another cyst, and previous partial nephrectomy. Clavien III−V complications in the T1a group included a diaphragm injury and
acute bleeding of a segmental artery. The T1b Clavien III−V complication involved
cracking of the tumor during biopsy between freeze cycles. Both groups had minimal
change in renal function.
Conclusions: LRC is a reasonable alternative for smaller T1b tumors in patients
who are poor surgical candidates and in whom preservation of renal function is desired. Despite the complexity of T1b tumors, successful ablation with relatively low
recurrence rates can be achieved using LRC. Treating T1b tumors with cryoablation
may increase the conversion rate. Further studies should help elucidate the role of
cryoablation in these larger tumors and possibly evaluate a staged cryoablation of
these tumors.
Financial Disclosure: Fernando Kim is a Principal Investigator for Olympus, Covidien, and Healthtronics. Wilson Molina has a Fellowship Grant with Boston Scientific.
The other authors have no disclosures.
124
Podium #55
PHASE I/II EVALUATION OF THE TOLERABILITY OF SORAFENIB DOSE
ESCALATION IN ADVANCED RENAL CELL CARCINOMA
Katie Murray, Jeffrey Holzbeierlein, Stephen Williamson, John Keighley,
Peter Van Veldhuizen
125
PODIUMs
Objectives: Metastatic renal cell cancer (mRCC) is one of the most treatment−
resistant malignancies, with the 5−year survival rate being <10%. Sorafenib is an
oral tyrosine−kinase inhibitor that was approved for treatment of patients with advanced renal cell carcinoma in 2005. The purpose of this study was to determine
the tolerability and tumor response rates of sorafenib dose escalation in advanced
renal cell carcinoma patients.
Methods: After IRB approval, patients with advanced renal cell carcinoma eligible
for sorafenib treatment were enrolled. A stepwise dose escalation study was utilized based on tumor response and toxicity. The starting dose of sorafenib was 400
mg by mouth twice daily with escalation of dose to 600 mg twice daily and then 800
mg twice daily. Patients were monitored for toxicity and tumor response.
Results: 25 patients were enrolled in the study and started on sorafenib treatment
and dose escalation. A total of 12 patients received dose escalation to 800 mg
twice daily but 50% of these patients had a subsequent dose reduction secondary
to adverse events. Of the 25 patients, 7 patients had dose limiting toxicity with the
starting dose. At a median follow up of 5.5 months there were 7 patients who died
of renal cell carcinoma while on study. 7 patients who were only able to tolerate
400 mg had disease progression, while 2 patients escalated to 600 mg dosage
had progression of disease. 8 of the 12 patients who were increased to 800 mg
had disease progression while on study. Although there were adverse events that
led to subsequent dose reduction, there were no deaths secondary to adverse
events to sorafenib.
Conclusions: Dose escalation of sorafenib can be performed and tolerated in
many patients with advanced RCC. This study demonstrates the feasibility of dose
escalation of sorafenib with acceptable toxicity. Clinical responses appear to be
limited with no overt improvement in progression free survival but a large phase II
trial would be necessary to confirm this.
Podium #56
ROBOT−ASSISTED PARTIAL NEPHRECTOMY VERSUS CRYOABLATION
FOR SMALL RENAL MASSES: SINGLE−CENTER EXPERIENCE
Youssef Tanagho, Eric Kim, Sam Bhayani, Brian Benway, Robert Figenshau
(Presented by: Eric Kim)
Objectives: The AUA guidelines endorse partial nephrectomy as the preferred
treatment option for small renal masses. However, patients with significant medical comorbidities who are not candidates for extirpative surgery may instead be
managed with an ablative approach. We compared perioperative, renal functional,
and oncologic outcomes between robot−assisted partial nephrectomy (RAPN) and
cryoablation (CA) at our institution.
Methods: A retrospective review was performed, evaluating 233 patients who underwent RAPN and 267 patients who underwent CA (149 laparoscopic and 118
percutaneous) for enhancing small renal masses at our institution from July 2000
to September 2012.
Results: Mean age−adjusted Charlson Comorbidity Index (CCI) was 6.5 in the
CA group and 2.1 in the RAPN group (p < 0.01). Mean tumor size was 2.5 vs
2.9 cm (p = 0.01). Mean blood loss was 74 vs 136 mL (p < 0.01). The perioperative complication rate was 8.6% vs 9.4% (p = 0.75). Increasing CCI (OR = 1.4,
p = 0.01) predicted a higher risk of perioperative complication on multiple logistic
regression. Estimated glomerular filtration rate (eGFR) at most recent follow−up
was 6.0% lower than preoperative eGFR in the CA group and 13.0% lower in the
RAPN group (p < 0.01). On multiple linear regression, CA treatment (p = 0.02),
smaller tumor size (p = 0.03), and hilar location (p = 0.01) predicted greater renal
functional preservation. In patients with pathologically proven renal cell carcinoma, 5−year Kaplan−Meier disease free survival (DFS), cancer specific survival
(CSS), and overall survival (OS) was 83.1%, 96.4%, and 77.1% in the CA cohort
vs 100%, 100%, and 91.7% in the RAPN group. Mean time to recurrence following
CA treatment was 16.2 months (range 0.03−42.0). Mean radiographic follow−up in
the CA group was 39.8 months vs 21.9 months in the RAPN group (p < 0.01). CA
treatment (HR = 11.4, p = 0.01) and endophytic tumor growth (HR = 46.9, p = 0.01)
were predictive of recurrence in a multivariate cox proportional hazards model.
Conclusions: Both CA and RAPN are safe, nephron−sparing treatment options in
the management of small renal masses, with similar complication rates and excellent renal functional preservation. Although RAPN offers improved DFS and CSS,
CA offers acceptable CSS in patients with significant medical comorbidity who are
poor candidates for extirpative surgery.
Source of Funding: Funded in part by a grant from Midwest Stone Institute.
126
Podium #57
ROBOTIC-ASSISTED LAPAROSCOPIC VS OPEN URETERAL REIMPLANTATION:
A SINGLE INSTITUTION MATCHED COHORT REVIEW
Daniel Zainfeld1, Andrew Windsperger1, Kirk Redger2, David Duchene1
1
University of Kansas Department of Urology; 2University of Kansas School of
Medicine
127
PODIUMs
Objectives: Minimally invasive procedures, particularly robotic−assisted, are performed with increasing frequency and many reported advantages. Distal ureteral
reconstruction and reimplantation is one such procedure which is often performed
laparoscopically with robotic assistance using the da Vinci robotic surgical system. We sought to evaluate and compare perioperative and long−term outcomes
among similar patients who underwent treatment with either robotic−assisted laparoscopic ureteral reimplantation (RALUR) or open ureteral reimplantation to assess for any clinical difference in outcomes between the two procedures.
Methods: Patients who underwent RALUR or open ureteral reimplantation between 7/2006 and 10/2012 were identified. All procedures were performed at a
single institution. Cohorts were matched in terms of patient characteristics and
indications for procedure. A retrospective review of perioperative and clinical data
was performed assessing operative time, estimated blood loss, length of admission, and success of procedure as indicated by the absence of obstruction on
follow−up imaging.
Results: A total of 21 patients underwent RALUR in the study period and were
matched to a similar cohort who underwent open ureteral reimplantation. Mean
ages of the groups were comparable at 43.2 and 46.5 years for the robotic and
open groups respectively. 20 of the RALUR were completed laparoscopically with
conversion to open in one patient. Etiology of injury was similar between cohorts,
including 11 due to gynecologic procedural injury and three secondary to iatrogenic ureteral injuries in each of the groups with the remainder comprised of congenital, non−gynecologic surgery, radiation, and idiopathic. Mean operative time
was 453 minutes for the open group in comparison to 237 minutes for the robotic
group. Mean estimated blood loss was 225cc for the open cohort versus a mean
of 85cc for those undergoing RALUR. Mean length of hospital admission in the
open reimplant group was 4.5 days compared to 3.1 days in those who underwent
RALUR. Currently, all patients remain non−obstructed among the RALUR by Lasix
renogram. Among the open group, one patient developed an obstruction and underwent repeat ureteral reimplant. An additional patient has been found to have
evidence of low grade partial obstruction on renogram but has not required further
intervention.
Conclusions: RALUR is a safe and effective option for distal ureteral reconstruction in appropriate patients and may have benefits in terms of decreased blood
loss, decreased duration of hospitalization, and potentially decreased operative
time in comparison to open ureteral reimplantation.
Podium #58
CHARACTERISTICS AND CLINICAL OUTCOMES OF PATIENTS WITH RENAL
CELL CARCINOMA AND SARCOMATOID DEDIFFERENTIATION (SRCC)
Megan Merrill1, Christopher Wood1, Nizar Tannir1, Rebecca Slack1,
Kara Babaian1, Eric Jonasch1, Lance Pagliaro1, Zachary Compton2,
Pheroze Tamboli1, Kanishka Sircar1, Louis Pisters1, Surena Matin1, Jose Karam1
1
The University of Texas, M.D. Anderson Cancer Center; 2The University of Texas
Medical School at Houston
(Presented by: Megan Merrill)
Objectives: sRCC is an aggressive subset of renal cell carcinomas that is associated with poor prognosis. We describe clinical and pathological characteristics
and outcomes of the largest single−institutional cohort of patients with sRCC who
underwent nephrectomy.
Methods: Data were collected from 1986−2011 for patients identified as having
sRCC. 218 patients with complete data who underwent a radical or partial nephrectomy and had a sarcomatoid component in the primary kidney tumor were
included in the analysis. Clinical and pathologic variables were reviewed and Kaplan−Meier curves and log−rank test were used to compare differences in overall
survival.
Results: Mean age at diagnosis was 57 years and median tumor size was 11cm
(range 1.5−27.0 cm). Ninety−three percent of patients were symptomatic at presentation and 97% had an ECOG performance status of 0 or 1. Twelve patients
had a preoperative biopsy that showed sRCC. Seventy−eight percent of patients
were pT3 or higher at time of nephrectomy and 69% presented with metastatic
disease. Of these, 11.8% had radiographic evidence of regional nodal involvement
alone and 88.2% had distant metastatic disease. The associated epithelial component was clear cell in 72% of the patients, papillary in 12.7% and chromophobe
in 3.1%. Twenty−nine patients received presurgical systemic therapy, while 161
patients received postoperative systemic therapy. During a median follow−up of
20.5 months, 184 patients (84%) died. Overall survival for the entire cohort at 1
year was 47%. Overall 1, 2 and 3−year survival rates for patients with metastatic
disease at presentation vs. no metastatic disease were 36, 20, and 16% vs. 64,
51 and 44% respectively (p <0.001). Patients with clear cell RCC epithelial component had a survival advantage over those with non−clear cell components with
1, 2 and 3−year survival rates of 51, 34 and 31% vs. 37, 19 and 12% (p=0.0057).
Conclusions: The majority of patients with sRCC who underwent nephrectomy
present with metastatic disease and outcomes are dismal despite surgical intervention and multimodal therapy. Overall survival is better for patients who present
without metastatic disease and have clear cell histology at time of nephrectomy.
128
Podium #59
ROBOTIC REDO PYELOPLASTY: SINGLE INSTITIUTION EXPERIENCE
Bradley Wilson, Andrew Arther, Zachary Hamilton, David Duchene
Subjects were followed 1,3, and 9 months postoperatively. Data was collected on
age, sex, symptoms, BMI, previous abdominal surgeries, presence of crossing
vessels, pre/postoperative hemoglobin, length of hospitalization, pre/postoperative renal scan, pre/postoperative creatinine levels, complications, and outcome
results
Results: The mean patient age was 41.3 years (median 34) – 62% were female.
UPJO occurred 44% on left and 56% on right, with 86% presenting with flank pain.
Crossing vessels were present in 41% and preserved in all cases. There were no
intraoperative complications.
For the 49 primary repairs, 94% had resolution of obstruction measured by renal
scan (T1/2 < 20 min) and 92% had resolution of their pain.
There were 16 patients in the redo pyeloplasty group. This group had a mean
post−operative diuretic T½ of 10.5 minutes (median 8.25). Twelve patients had objective resolution as measured by renal scan (75% success rate). Subjectively, ten
patients (62%) had complete resolution of their pain after the procedure. Closer
analysis showed that all but one (83%) of the patients who failed redo pyeloplasty
had undergone multiple UPJ procedures (ie pyeloplasty + endopyelotomy).
Conclusions: Many studies have demonstrated the excellent success of pyeloplasty in treatment of UPJO. However, the effectiveness of secondary pyeloplasty is less clear. Our study shows that while it is not as effective as the
primary procedure, redo pyeloplasty is an acceptable option with a success rate
of 75% and pain relief in 62%. Furthermore, we found that patients with multiple
UPJO procedures were more likely to fail redo pyeloplasty.
129
PODIUMs
Objectives: Ureteropelvic junction obstruction (UPJO) has become one of the
most successful surgically treated diseases in Urology. Multiple studies report objective success rates over 95% for open, laparoscopic, and robotic pyeloplasty.
However, very limited data exists on repeat pyeloplasty after previous failed repair.
We present our experience with redo pyeloplasty for treatment of symptomatic
UPJO.
Methods: We retrospectively reviewed 65 patients with symptomatic UPJO, who
underwent Robotic Assisted Laparoscopic Pyeloplasty (RAP), between 2006 and
2010. We identified 16 patients with previous primary failure prior to redo RAP at
our institution. The remaining 49 patients were primary repairs.
Podium #60
IMPROVING POSTOPERATIVE PAIN FOLLOWING ROBOTIC−ASSISTED AND
LAPAROSCOPIC UROLOGIC SURGERIES: A COMPARISON OF LIPOSOMAL
BUPIVACAINE TO ROPIVACAINE DELIVERED BY THE ON−Q PAIN RELIEF
SYSTEM
Paul Walker1, Michael White1, Edwin Morales2, Uzo Nwoye3, William Harmon1
1
Urology San Antonio; 2UTHSCSA Urology; 3San Antonio Military Medical Center
Objectives: Opioids given for postoperative analgesia often have serious side
effects such as nausea, constipation, sedation, and urinary retention; therefore, an
approach to minimize the use of narcotics after surgery is often desired following
urologic surgery. Optimal means of postoperative pain control remain to be fully
elucidated. This single institution, single surgeon, retrospective study compares
patients treated with two long acting local anesthetic regimens at the time of robotic−assisted and laparoscopic urologic surgeries in an effort to determine which
method most reduced postoperative opioid use.
Methods: Between September 2011 and October 2012, 108 robot−assisted or
laparoscopic urologic surgeries were completed. Fifty−four consecutive patients
were injected circumferentially along the trocars below and above the fascia with
the novel liposome bupivacaine. They were compared with 54 consecutive patients treated with 0.5% ropivacaine delivered by the On−Q system though 2 catheters placed under the fascia at the wound sites. All incisions were 3 cm or less.
The end points of morphine equivalent dose (MED) during a patient’s hospital stay,
time to first opioid use, number of patients free of opioids and length of hospital
stay were examined.
Results: The mean MED was less in the liposome bupivacaine group versus the
On−Q group (41.2 vs. 71.1; p = 0.0123). The mean time to first opioid use was
delayed in favor of liposome bupivacaine (186 vs. 63.9 minutes; p = 0.0043). Five
patients were free of opioid use with liposome bupivacaine versus 1 On−Q patient
(p = 0.0929). The mean length of hospital stay was similar (1.6 vs. 1.8 days; p =
0.6414).
Conclusions: Liposomal bupivacaine significantly reduced and retarded postoperative opioid use when compared to ropivacaine delivered by the On−Q system
in patients after robotic−assisted and laparoscopic urologic surgeries. Our practice
model has been adjusted to include the use of liposomal bupivacaine now as part
of standard postoperative analgesia.
130
Podium #61
Objectives: Studer and other investigators have postulated the negative effect of
the “funnel−shaped”outlet resulting from utilizing the inferior aspect of the anterior
neobladder wall closure for the urethral anastomosis. This technique has been
linked to dysfunctional voiding. We aimed to compare the functional results of
the two anastomotic types, the “funnel−shaped”or suture line and the neo−orifice
technique.
Methods: We reviewed the records of patients who underwent a Studer ileal neobladder reconstruction from 1/1/2000 to 5/30/2012 at our institution. In addition to
demographic information, the charts were evaluated for anastomotic leak on post−
operative cystogram, urinary incontinence (day and/or night), urinary retention and
subsequent procedures to correct incontinence or outlet obstruction. Incontinence
was defined as any leakage between regularly scheduled voids.
Results: 363 of 465 patients met the inclusion criteria of follow−up greater than
6 months. The majority were male, 90.6% (n=329), with a mean age at cystectomy of 59.7 years. Mean follow up was 49 months (range, 6.1 − 138.7). Urethral
anastomotic technique was divided between suture line and neo−orifice, 47% and
53%, respectively. Any urinary incontinence was identified in 41.8% of patients at
last follow up, with 20.3% reporting daytime incontinence and 39.2% complaining of nighttime incontinence. Surgical intervention for urinary incontinence was
performed on 23 patients (6.4%) including artificial urethral sphincter (15), male
sling (4), ileal conduit/catheterizable diversion (3), and transurethral injection (1).
There was no significant difference in regards to urinary incontinence, day or night,
with respect to anastomotic type (p=.241) [RR= 1.158095 , 95% CI .9080939 −
1.476923]. Urinary retention occurred in 16% of patients, with surgical intervention
required in 3.3%. No significant difference was seen in this outcome in regard to
type of anastomosis (p=0.247) [RR=1.36, 95%CI .845764 − 2.195388]. Suture line
anastomoses were more likely to have a leak identified on cystogram (24.1 vs.
15.2%, p=0.033, RR=1.59, 95% CI: 1.036366 − 2.430309).
Conclusions: Our data showed no significant difference in urinary functional outcomes – incontinence and retention − when comparing these two anastomotic
types. However, the suture−line technique was shown to have a higher risk of
anastomotic leak.
131
PODIUMs
COMPARISON OF URINARY OUTCOMES IN SUTURE−LINE VERSUS
NEO−ORIFICE URETHRAL ANASTOMOTIC TYPES IN THE STUDER
NEOBLADDER
Kathryn Cunningham1, Yasmin Bootwala2, Huong Truong1, Clay Pendleton1,
O. Lenaine Westney2
1
University of Texas Health Science Center − Houston; 2MD Anderson Cancer
Center
(Presented by: Kathryn Cunningham)
Podium #62
PATIENT REPORTED QUALITY OF LIFE AT 5 YEARS AFTER NEOBLADDER
CREATION
Katie Murray, Brett Wahlgren, Andrew Arther, Jeffrey Holzbeierlein
Objectives: The theoretical benefits of neobladder reconstruction after cystectomy have been reported as improved quality of life and improved body image,
although most of these reports focus on short term outcomes. The purpose of this
evaluation is to determine patient reported quality of life regarding urinary issues
at least five years after neobladder creation.
Methods: We retrospectively reviewed all the cystectomy and neobladders that
were performed at the University of Kansas from 2004 until 2008 after IRB approval. As a quality assurance and follow up, patients were called on the telephone and
asked to respond to the World Health Organization Quality of Life (WHOQOL)−
BREF. This instrument measures broad domains of physical health, psychological
health, social relationships, and environment. They were also asked some basic
questions about whether or not they would choose a neobladder again for their
urinary diversion.
Results: 31 patients were found to have neobladder creation during this time period. 8 patients of these patients were found to be deceased since surgery. Out of
the 31 patients, 15 patients were able to be contacted and completed the questionnaire. Thirteen patients stated they would choose a neobladder for their urinary
diversion if they had to make the decision again. The average satisfaction of physical health of the patients is 61.4% and 77% psychological satisfaction. The social
relationship domain showed 78.3% satisfaction in this group of patients. Patients
were asked about overall satisfaction on a 5 point scale with their neobladder.
Eight patients were extremely satisfied, 6 patients reported to be mostly satisfied
and 1 patient reported extremely dissatisfied.
Conclusions: Using a validated questionnaire we determined that after 5 years
with a neobladder for urinary diversion a large proportion of patients were very
satisfied with their quality of life. A majority of patients after 5 years were satisfied
enough with their neobladder that they stated if they had the decision to do over,
neobladder would be their choice of urinary diversion. This data supports the feasibility of good long−term results with neobladder reconstruction after cystectomy.
132
Podium #63
THE INFLUENCE OF PRE− & POST−OP STENTS AND NEOADJUVANT
CHEMOTHERAPY ON NEOBLADDER PATIENTS POSTOPERATIVE URINARY
LEAK RATES
Yasmin Bootwala1, Huong Truong2, Clay Pendleton2, Graciela Nogueras−Gonzalez1,
Ouida Westney1
1
MD Anderson Cancer Center; 2University of Texas Health Science Center − Houston
ing data for +/− urinary diversion stents on first cystogram. Preoperative
stents, neoadjuvant chemotherapy and postoperative stents did not affect
ureteroenteric or urethrovesical leak rates on first postoperative cystogram (see Table 1).
Conclusions: There is no conclusive evidence to support that the preoperative
stents, neoadjuvant chemotherapy, or prolonged postoperative urinary diversion
stents, influence the development of urinary leakage in the postoperative period.
133
PODIUMs
Objectives: In patients undergoing radical cystectomy, appropriate candidates are
selected for neobladder urinary diversion. Urinary leakage from the anastomoses
is a postoperative complication. Any maneuvers to prevent this occurrence would
reduce morbidity in these patients. We hypothesized there would be no difference
in urinary leak rate (ureteroenteric or urethrovesical anastomotic leak) in patients
post neobladder, who had indwelling urinary diversion stents versus those patients
who did not have stents in place at the time of first postoperative cystogram, generally 3 weeks postoperatively.
Methods: We retrospectively reviewed a single institution database of neobladder
patients who underwent cystectomy between 1/1/2000 and 8/31/2010. We extracted patient demographics including administration of neoadjuvant chemotherapy
and presence of preoperative stents. The first postoperative cystogram was evaluated to identify the presence of ureteroenteric or urethrovesical urinary leakage
and the presence of urinary diversion stents at the time of cystogram. Patients with
no postoperative cystogram or no data on presence of urinary diversion stents at
first cystogram were excluded. Statistical analysis was performed using STATA/
SE v. 12.1 using descriptive statistics, T−test (or One−way ANOVA) and Pearson’s
chi−square test (or Fischer’s exact test) to determine if there were significant differences between groups.
Results: Of the 405 patients in the neobladder database, the average age was
60 (range 32−80 years). The mean follow up was 43 months (range 0.2 to 142).
13 patients had missing data for anastomotic leakage. 32 patients had miss-
Podium #64
POST−CYSTECTOMY AND NEOBLADDER URINARY DIVERSION: WHAT IS
THE NEED FOR FOLLOW UP SURGICAL PROCEDURES IN THIS PATIENT
POPULATION?
Katie Murray, Brad Wilson, Jeffrey Holzbeierlein
Objectives: Many urologists are hesitant to perform orthotopic neobladder reconstruction for a variety of reasons. One quoted reason is the need for additional
future procedures in these patients. The purpose of this study was to determine
the need for follow up surgery and the types of surgeries in patients who undergo
cystectomy and ileal neobladder for urinary diversion.
Methods: We retrospectively reviewed all the patients who underwent cystectomy
with neobladder reconstruction at the University of Kansas from 2004 until 2010.
Specific data regarding the need for additional procedures performed at the University of Kansas were recorded. Procedures included were any urological stone
procedure, reconstructive procedures including artificial urinary sphincter (AUS)
and inflatable penile prosthesis (IPP), open procedures of the abdomen including
neobladder revisions and conversions to ileal conduits as well as incisional/ventral
hernia repairs, and endoscopic procedures of the urethra, neobladder or ureters.
Results: Eighty−five patients underwent ileal neobladder diversion and to date
21 of these patients are deceased. Twenty−seven patients (31.7%) have not required any other surgeries. The number of procedures performed ranged from 0−8
per person. 34% of these patients have only required 1 follow up surgery. Only 5
patients (8.6%) have required five or more procedures after neobladder construction. Four patients underwent conversion of their neobladder to an ileal conduit
diversion. Thirty−one (36.4%) patients have required at least one open procedure.
The most common open procedure was ventral or incisional hernia repair(s) in
eight patients. Thirty−three patients (38.8%) have required at least one endoscopic procedure not including stone procedures, and 5 patients have subsequently
undergone reconstructive surgery with either or both an AUS or IPP. Six patients
required urological stone manipulation including percutaneous nephrolithotomy or
antegrade ureteroscopy and cystolithalopaxy.
Conclusions: A majority of patients who undergo urinary diversion with ileal neobladder will require some follow up surgical procedure within a five year follow up.
It is important to explain this risk to patients when doing pre−operative counseling
about types of urinary diversions and the risks and benefits involved.
134
Podium #65
USE OF SIGMOID COLON IN MANAGEMENT OF NEUROGENIC BLADDER
DUE TO SPINAL CORD INJURY (SCI) OR SPINA BIFIDA
Ehab Eltahawy1, John Paddack1, Mohamed Kamel1, Nabil Bissada2
1
University of Arkansas for Medical Sciences; 2University of Oklahoma
(Presented by: John Paddack)
135
PODIUMs
Objectives: The choice of the bowel segment for augmentation or diversion depends on several factors including the availability, mobility of the segment, metabolic status, and the surgeon’s preference. The sigmoid colon has been used
in particular situations in augmenting small capacity/poor compliance neurogenic
bladder, or in forming a sigmoid conduit. We retrospectively review our results in
SCI and spina bifida patients.
Methods: Between December 2005 and July 2012, Fourteen patients (10 males,
and 4 females), underwent bladder augmentation (9 patients), bladder chimney
(3patients), or conduit (2patients) using the sigmoid colon. Mean patient age was
29 (23 to 54 years) of age. 9 patients had spina bifida, and 5 had SCI. Preoperative
cystoscope and urodynamic assessment, as well as upper tract imaging was part
of the workup. All patients had a one day bowel prep was performed. Two patients
had preoperative colostomy and the sigmoid stump was used to construct the
urinary conduits. Of the nine patients who had an augment, 4 patients had a catheterizable channel. Postoperative complications, bladder capacity, and continence
were assessed.
Results: After a mean follow−up of 22 months (range 6 to 40), all patients had
normal upper urinary tract without evidence of urinary obstruction. All patients had
normal renal function and no metabolic abnormalities. The bladder capacity increased in those who had an augment by a mean of 280ml (230−360). Complications included persistent urinary leakage in 1 requiring prolonged catheterization;
wound infection in 3; prolonged ileus in 6. All patients who had bladder augments
were catheterizing without problems, either through their original channel or per
urethra.
Conclusions: Although it may not be the preferred bowel segment in augmentation or urinary diversion, the sigmoid colon is more suitable in some patients.
Spinal cord patients typically have a large sigmoid because of the distension associated with constipation and neurogenic bowel. It is also situated in the pelvis
close to the bladder so does not require extensive mobilization. This is especially
relevant in those who have had a VP shunt associated intestinal adhesions limiting
its harvest. For those patients who have a colostomy, the sigmoid colon provides
a segment that does not require bowel anastomosis.
Podium #66
IS ENDOPYELOTOMY A VIABLE OPTION AFTER FAILED PYELOPLASTY?
Daniel Zainfeld, David Duchene
University of Kansas Department of Urology
Objectives: Pyeloplasty is the procedure of choice for repair of ureteropelvic junction (UPJ) obstruction with demonstrated durable success rates in excess of 90%.
In the setting of recurrent obstruction after pyeloplasty, or failed pyeloplasty, however, endopyelotomy is commonly offered as a less invasive option with reasonable success. We evaluated the success of laser endopyelotomy in the setting of
failed pyeloplasty to determine if this is truly a reasonable treatment option.
Methods: The records of all patients who underwent retrograde laser endopyelotomy for UPJ obstruction over the past four years were retrospectively identified.
Patients who underwent primary endopyelotomy without prior pyeloplasty were excluded. We reviewed patient demographics, indications for intervention, time from
pyeloplasty, and pre and post−operative imaging. Success was determined from
both an objective measure of improved radiographic features and as subjective
improvement in symptoms occurrence.
Results: A total of 13 patients had an endopyelotomy after previous failed pyeloplasty. Mean patient age at time of intervention was 35.5 (range 19−70). A total
of five patients (38%) had undergone pyeloplasty greater than 2 years previously.
High grade obstruction was demonstrated on renal scans in 7 of 13 patients (54%)
and an additional 3 patients presented with equivocal scans and symptoms. 71%
of patients (10/14) presented with pain. Mean follow−up was 11.6 months. 9/10
patients with reliable post−operative imaging showed successful outcome. The
one unsuccessful patient showed worsening obstruction on renal scan. Of those
with preoperative pain, 5 experienced significant improvement in their symptoms
or resolution. Only one patient experienced no improvement.
Conclusions: Laser endopyelotomy appears to be a reasonable minimally invasive management option for patients who have developed recurrence of UPJ
obstruction or continue to experience pain. Endopyelotomy can improve diuretic
drainage and pain in a large percentage of individuals while avoiding more invasive and costly repeat pyeloplasty. Long−term data is still needed to determine the
durability of this approach.
136
Podium #67
DEFINING THE VARIATION IN URINARY OXALATE IN HYPEROXALURIC
STONE−FORMING PATIENTS
Jodi Antonelli1, Christopher Odom1, John Poindexter1, Beverley Adams−Huet1,
Orson Moe1, Charles Pak1, Craig Langman2, Margaret Pearle1
1
UT Southwestern Medical School; 2Northwestern University
137
PODIUMs
Objectives: The etiologies of hyperoxaluria (HO) include rare endogenous overproduction (primary HO), and common secondary causes: excessive dietary intake (dietary HO), intestinal over−absorption (enteric HO), and idiopathic. Dietary
oxalate restriction, calcium supplementation, and pyridoxine are non−specific
treatments for secondary HO. A new drug designed to reduce secondary HO must
prove to consistently reduce urinary oxalate beyond its pathophysiologic variation.
In order to establish the pattern of normal variation in urinary HO, we evaluated
urinary oxalate at baseline and during standard treatment regimens in patients
with secondary HO.
Methods: We reviewed the charts of 142 recurrent stone formers who were evaluated in our metabolic stone clinic between 1988−2012 and diagnosed with secondary HO (urinary oxalate > 40mg/day). 24−hour urine samples were collected
at baseline and during follow−up after initiation of therapy. Mixed models were
constructed to analyze urinary oxalate values over time for individual patients and
as a group. Subgroup analyses were performed according to the etiology of HO
which was designated as enteric or idiopathic (comprising idiopathic and dietary)
after clinical chart review.
Results: The study group consisted of 114 men and 28 women with mean age
50.4 +/− 13.2 SD years. The etiology of HO was enteric in 15.5% and idiopathic
in 84.5% of patients. Among 715 urine collections analyzed, 166 oxalate values
were obtained from the enteric group and 549 from the idiopathic group. The mean
urinary oxalate value (mg/day) was significantly higher for the enteric group (68.2
+/− 35.3 SD) compared to the idiopathic group (43.7 +/− 15.5 SD, p<0.0001). Over
the course of this study, 54.6% of the enteric and 60.8% of the idiopathic patients
had at least one normal urine oxalate value. The coefficient of variance for the enteric and idiopathic groups was 40.2% and 27.9%, displaying random variation in
either direction. Compared to baseline, urinary oxalate values increased by >10%,
decreased by >10% or showed no change in 44.2%, 39.1%, and 22.7%, respectively, of the enteric patients and 37.0%, 31.9%, and 31.3%, respectively, of the
idiopathic patients.
Conclusions: Among patients with secondary HO, urinary oxalate demonstrates
significant, but inconsistent variation over time, with enteric HO demonstrating the
greatest variance. As such, single urinary oxalate values must be viewed with caution, and any new therapy for HO must produce a consistent 20−30% net favorable
change from baseline to show benefit.
Podium #68
SYMPTOMS ASSOCIATED WITH URETERAL STENTS
SPEAKING POPULATION
Daniel Olvera−Posada, Eduardo Gonzalez−Cuenca,
Fernando Gabilondo−Navarro, Ricardo Castillejos−Molina,
Carlos E. Mendez−Probst
INNSZ
IN
SPANISH
Objectives: Ureteral stents are commonly used in urological procedures; unfortunately are associated with bothersome symptoms and decreased quality of life.
The main purpose of this study is to validate the Spanish version of the USSQ
(Ureteral Stent Symptom Questionnaire). We also report the prevalence of symptoms associated with double J stents and their impact on quality of life.
Methods: We developed the Spanish version of the USSQ with double−back
translation method. All patients underwent unilateral double J stent placement
after non−complicated endourological procedure. Patients with urinary comorbidities, urinary tract infection and residual lithiasis were excluded. Cases were evaluated one week after stent placement and one week after removal. Internal consistency of the instrument and sensibility to change were analyzed. We compared
the results to a healthy control group. Prevalence of symptoms in the 6 domains
of the questionnaire was analyzed as well as quality of life. We compared the
means of the results by gender and age to find significant differences in associated
symptoms.
Results: Twenty patients were included in the validation analysis. Reliability test
showed satisfactory results, with a high degree of internal consistency on most
domains. The correlation between the domains of urinary symptoms, pain and
general health was high (Pearson Coefficient > 0.8). By analyzing the sensitivity to
change with and without ureteral stent, we obtained significant differences in the
mean scores of all domains except in sexual performance. Significant differences
were observed in all domains comparing cases with healthy controls. Forty four
patients were included in the final analysis of associated symptoms, with a median
age of 49.9 years. 82% underwent semirigid ureteroscopy. Patients with ureteral
stent reported significant urinary symptoms such as frequency, urgency, dysuria
and incontinence. 91% reported pain or discomfort in association with the stent.
Most common affected region was the lumbar area in 65% of the cases. Stent related symptoms affected physical activities, work performance and sexual health.
Global quality of life evaluation revealed that most patients had negative feelings
about the stent. We did not find a significant difference comparing mean score
symptoms by gender or age.
Conclusions: The proposed Spanish version of the USSQ is an appropriate instrument to evaluate the impact in quality of life of the double J stent in Spanish
speaking population. The double J stent significantly affects diverse aspects of
patients’ lives.
138
Podium #69
THE IMPACT OF OBESITY AND DIABETES ON COST AND PREVALENCE OF
UROLITHIASIS
Jodi Antonelli, Naim Maalouf, Margaret Pearle, Yair Lotan
UT Southwestern Medical School
139
PODIUMs
Objectives: The prevalence of urinary stones has increased over the last decade.
Risk factors for stones including obesity and diabetes rates have concomitantly
increased. We sought to determine the cost and prevalence of stones, accounting
for current and projected estimates of obesity, diabetes, gender disparities and
population rates.
Methods: Estimated cost for the diagnosis and management of nephrolithiasis
was obtained using data from the Urologic Diseases in America (UDA) Project for
the year 2000, taking into account the prevalence of stone disease at that time.
Year 2000 costs were converted to 2012 dollars using inflation calculators. The
prevalence of stones in both men and women for year 2000 were approximated
from the mean of stone prevalence over the periods 1988−94 and 2007−10 derived from the National Health and Nutrition Examination Survey (NHANES) datasets (as no prevalence data spanned year 2000). The cost per percent prevalence
was calculated by dividing the overall cost of stone disease by lifetime prevalence
estimates. The prevalence of stone disease stratified by BMI category, diabetes
rate, and population was calculated using 2007−10 NHANES data and, where
applicable, odds ratios for stone prevalence.
Results: The average lifetime prevalence of stones in 2000 was estimated as
7.025%. Adjusting for inflation resulted in a cost per percent prevalence of
$401,765,125 in 2012 dollars. Between 2007 and 2010, the rate of obesity increased 10% in men and 3% in women resulting in an increase in stone prevalence from 8.83% to 8.90% with cost estimates of $30 million. A projected lifetime
prevalence of stone disease of 9.21% will occur when an additional 10% of adults
are obese, costing $154 million. From 2007 to 2010 diabetes independently led to
an increase in lifetime stone prevalence to 9.00% and was associated with a cost
of $69 million. Every 1% rise in diabetes will produce a $20 million increase in the
cost of stone disease. Furthermore, for every 10 million increase in population the
cost of stone disease will increase by $118 million.
Conclusions: The rising prevalence of obesity and diabetes coupled with a growing population contribute to dramatic increases in the cost of urolithiasis, with at
least $200 million/year projected by 2030.
Podium #70
TEMPERATURE PROFILE OF LASTER LITHOTRIPSY USING AN EX VIVO
MODEL
Wilson Molina1, McCabe Kenny2, Igor Silva, David Sehrt1, Alexandre Pompeo1,
Jason Phillips2, Elliot Handler2, Fernando Kim1
1
Denver Health Medical Center; 2University of Colorado−Denver
Objectives: Laser lithotripsy is a well−established option for the treatment of urolithiasis. Stone cavitation phenomena are well understood but there is presently a
paucity of information regarding the energy spread during the exogenous process.
We established an ex vivo model to evaluate the temperature profile of the ureter
during laser lithotripsy.
Methods: An infrared camera was used for the thermal evaluation of laser lithotripsy in an ex vivo model (Ovis aries). Laser lithotripsy was performed with a
Holmium YAG laser and a 400µ fiber with calcium monohydrate stones. Measurements were made on the laser fiber, the ureteral urothelium, and the external wall
of the ureter. Irrigation of saline was varied and results were compared. Data are
presented as mean ± standard error.
Results: The laser fiber obtained a maximum temperature of 51.7°C±7.8° during
activation. During lithotripsy the ureteral urothelium temperature was recorded
as 49.7°±6.7° with irrigation and 112.4°±24.2° without (p=0.048). The external
ureteral wall obtained a temperature of 37.4°±2.5° with irrigation and 49.5°±2.3°
without (p=0.003). During intentional perforation the urothelium was recorded as
81.8°±8.8° and 145.0°±15.0° with and without irrigation respectively (p=0.003).
Conclusions: There is a notable increase in the ureteral temperature during activation of the Holmium YAG laser however thermal values are well below the
threshold for thermal damage with irrigation. Irrigation not only improves endoscopic visualization during lithotripsy but also reduces tissue temperatures and
thus the risk of perforation. This is the first laser lithotripsy thermography study and
establishes the framework for future studies.
140
Podium #71
PEDIATRIC BLUNT RENAL TRAUMA: IS IT TIME TO ABANDON THE USE OF
DELAYED IMAGING DURING INITIAL WORKUP?
Thomas Pshak1, Garrett Pohlman1, Steven Moulton2, Duncan Wilcox2
1
University of Colorado; 2Children’s Hospital Colorado
(Presented by: Thomas Pshak)
141
PODIUMs
Objectives: Evaluation and management of pediatric blunt renal trauma is more
conservative than a decade ago. At the forefront of this trend is the ALARA (As Low
As Reasonably Achievable) principle, which advocates keeping radiation exposure
to a minimum. It is our experience that the majority of children do not get delayed−
phase imaging on initial workup. We hypothesize that the lack of delayed imaging
has little impact on outcomes in pediatric blunt renal trauma.
Methods: From 2001 to 2011, 87 patients with 89 blunt renal injuries were treated.
All penetrating trauma and hemodynamically unstable patients were excluded. A
retrospective review was performed to analyze urologic intervention, urologic complications, loss of renal function, and additional imaging following injury.
Results: All 87 patients had a CT scan with IV contrast during initial evaluation. 69
patients had low grade (Grade 1−3) and 18 patients had high grade (Grade 4−5)
injuries. Delayed phase imaging was performed in 26/87 (30%) patients and 22/26
(84%) where low grade injuries. A urinary leak was diagnosed in 9 of 18 patients
with high grade renal injuries. Three of these patients did not have initial delayed
phase imaging and all underwent at least one additional CT triple phase study
within 4 days of the initial CT scan. One required ureteral stent placement 4 days
after injury. The other six patients with urinary leaks had initial delayed CT imaging.
Three of these patients underwent at least one additional CT triple phase study
and three required ureteral stent placement approximately 4 days after injury.
Conclusion: Our data suggests that lack of delayed images on the initial CT scan
has little to no impact on time to urologic intervention, loss of renal function, or
additional urinary complications. The marked overuse of delayed imaging for low
grade renal injuries (Grades 1−3) is counter to the ALARA principle. To reduce
the amount of ionized radiation exposure in children, we advocate for abandoning
delayed renal imaging at the time of initial CT scan. While this approach may result
in a delay in diagnosis of urinary leak in approximately 10% of patients, it would
theoretically save the remaining 90% of pediatric blunt renal trauma patients unnecessary ionizing radiation. To that end, substantiation of our findings by other
institutions is warranted.
Podium #72
WITHDRAWN
Podium #73
FACTORS ASSOCIATED WITH SURGICAL INTERVENTION IN CHILDREN
WITH HIGH−GRADE HYDRONEPHROSIS
Vassilis Siomos1, Susan Staulcup2, Michelle Torok2, Vijaya Vemulakonda2
1
University of Colorado School of Medicine; 2Children’s Hospital Colorado
(Presented by: Vassilis Siomos)
Objectives: Prior studies have shown demographic variability in the timing of pyeloplasty in thepediatric population. To date, no studies have evaluated differences
in children with high−grade (Society for Fetal Urology (SFU) Grade 3 or 4) hydronephrosis who undergo surgery compared to observation. The purpose of this
study is to identify demographic and clinical factors associated with surgery in this
population.
Methods: After IRB approval was obtained, a retrospective cohort study at the
Children’s Hospital Colorado was conducted in patients diagnosed with high−
grade hydronephrosis between January 2006 and December 2010. Data were
extracted regarding patient demographics (race/ethnicity, age, gender, insurance
status, primary language, referral source, and distance from the hospital) and clinical factors (timing of initial presentation, associated symptoms, initial SFU grade,
percent function and T½ on MAG−3 renogram). Children were excluded if there
was evidence of other urinary tract pathology such as posterior urethral valves,
neurogenic bladder, ectopic ureter, and vesicoureteral reflux. Children who underwent pyeloplasty were compared to children who were observed using Pearson
Chi−square and Fisher’s Exact tests.
Results: We identified 126 children who met study criteria. Median age at initial
visit was 50 days. 5 days (range 3−1085 days). The majority of children were white
(61.9%), non Hispanic (65.6%), and male (80.2%) with initial prenatal presentation
(96%). Less than 10% of children were symptomatic at presentation. Fifty two
patients (41.2%) in the cohort underwent pyeloplasty. Children who underwent
surgery were more likely to have SFU grade 4 hydronephrosis (p=0.01), percent
function of 20−40% (p=0.03), and T½ > 20 minutes (p=0.01). There was no difference in age, gender, race/ethnicity, distance to the hospital, insurance status,
primary language, type of referring provider, or age at initial presentation between
surgical and observational groups.
Conclusions: Our data suggest that initial imaging findings, including higher grade
of hydronephrosis, delayed drainage, and impaired function, are positively associated with surgical intervention in children with high−grade hydronephrosis. Unlike
prior studies, we did not find a statistically significant association between patient
demographic factors, including race/ethnicity and gender, and surgical intervention
in these children. Further prospective studies are needed to better understand the
surgical decision making
142
Podium #74
WITHDRAWN
Podium #75
Objectives: Outcomes following hypospadias surgery are difficult to predict due to
the broad spectrum of the phenotype and wide variety of operative techniques. Single
author reports and descriptions of novel techniques bias the literature towards optimistic expectations. Measures such as the Ongoing Professional Practice Evaluation by
the Joint Commissions represent a growing movement to increase transparency, evaluate clinical competence, and improve patient safety. Our aim was to evaluate our institutions hypospadias complications by complexity of case and compare these results
to broader reports, such as the Pediatric Health Information System (PHIS) database.
Methods: An IRB approved, prospective electronic medic al record database was analyzed. Results were verified by chart review. All patients who underwent hypospadias
repair from April, 2009 through October, 2012 were reviewed. Patients were grouped
by meatus location, including glanular, sub−coronal, mid−penile and proximal. Demographics and complications related to hypospadias surgery were recorded. Patients
who underwent procedures at other institutions were excluded. Patients who underwent a planned two−staged repair were not counted as having a complication−related
reoperation.
Results: 290 patients were eligible for review. See Table 1 for a description of case
complexity and total complications requiring reoperation. Mean age was 18 months
of age. Mean follow up was 6 months. Overall, 63 complications were recorded and
31 patients required additional operative interventions (10.6%). Distal hypospadias
repairs, including glanular and subcoronal locations, had a low reoperative rate of
approximately 5%. 31 patients underwent proximal repairs, which had a significantly
higher complication rate. In this group, there was a 32% fistula rate and a 48% reoperation rate.
Conclusions: Reported hypospadias outcomes in the literature can be skewed towards more positive outcomes due to publication bias. Our evaluation demonstrated
a higher complication rate compared to some reports, including an overall reoperation rate of 10.6% and nearly 50% risk for proximal repairs. However, these results
are consistent with other larger reports such as the PHIS database, which revealed
an overall complication rate of approximately 9.7%. As quality metrics are instituted
throughout the healthcare system, realistic benchmarks of success for hypospadias
surgery must be established to accurately gauge quality care.
143
PODIUMs
COMPLICATIONS AND REOPERATIVE RATE OF HYPOSPADIAS REPAIR BY
LOCATION
David Chalmers, Georgette Siparsky, Duncan Wilcox
Podium #76
SYMPTOMATIC URETEROPELVIC JUNCTION OBSTRUCTION (DIETL’S
CRISIS): A COMMONLY MISSED ETIOLOGY OF RECURRENT ABDOMINAL
PAIN IN THE PEDIATRIC PATIENT POPULATION
Ismael Zamilpa1, John Moore2, Mark Pickhardt2, Stephen Canon2, Ashay Patel2
1
Arkansas Childrens Hospital; 2UAMS
(Presented by: Ismael Zamilpa)
Objectives: Symptomatic ureteropelvic junction (UPJ) obstruction or Dietl’s crisis
is a commonly missed etiology of recurrent abdominal pain in pediatric patients.
We hypothesized that this condition is associated with a significant diagnostic delay and that the majority of patients with hydronephrosis and Dietl’s crisis result
from lower−pole crossing renal vessels.
Methods: This is a retrospective study of consecutive cases involving hydronephrosis and UPJ obstruction diagnosed due to abdominal pain. Variables analyzed
included time between onset of symptoms and diagnosis, patient’s age, number of
presentations to medical facilities for evaluation of abdominal pain, function of the
affected renal unit at the time of diagnosis, and history of prenatal hydronephrosis.
Operative findings, specifically the presence or absence of lower pole vessels,
were noted. Student’s t−test and linear regression were utilized for data analysis.
Results: Between 2010 and 2012 twenty−four patients were identified presenting
with abdominal pain due to a UPJ obstruction. Median delay in diagnosis from
the onset of symptoms was 3 months (0−95). Median patient age was 10 years.
Median number of presentations to an emergency room or provider for evaluation
was 2 (1−5). Median function of the affected unit at diagnosis was 43%. From this
cohort 84% had no previous diagnosis of prenatal hydronephrosis. 54% of these
cases were due to lower pole crossing vessels. No strong correlation was noted
between age and diagnostic delay (R2= 0.141). No strong correlation was noted
between diagnostic delay and diminished renal function (R2=0.029). No significant
difference was noted in diagnostic delay, number of visits to clinic or emergency
room, renal function, or age at diagnosis in those patients with crossing lower pole
vessels and those without, nor in those with and without prenatal hydronephrosis.
Conclusions: Symptomatic ureteropelvic junction obstruction or Dietl’s crisis
in pediatric patients can be associated with a significant delay in diagnosis and
treatment, often requiring several presentations to medical facilities before being
identified. A significant number of these cases result from lower pole crossing vessels and have no previous history of hydronephrosis. Providers caring for pediatric
patients should consider this condition in the differential diagnosis of recurrent
abdominal pain.
144
Podium #77
MANAGING URETEROPELVIC JUNCTION OBSTRUCTION IN A PEDIATRIC
POPULATION: COMPARISON OF LAPAROSCOPIC AND ROBOTIC
PYELOPLASTY
Ashay Patel1, Nathan Littlejohn2, Mark Pickhardt2, Mallikarjuna Rettiganti1,
Chunqiao Luo1, Stephen Canon1, Ismael Zamilpa1
1
Arkansas Children’s Hospital; 2UAMS
(Presented by: Ashay Patel)
145
PODIUMs
Objectives: Laparoscopic pyeloplasty (LP) remains technically challenging due
to diminished field size and intracorporeal suturing. Robotic assisted laparoscopic
pyeloplasty (RALP) eases this technically difficult aspect of surgery with increased
articulation and magnification. Our aim is to compare outcomes of RALP and LP in
children with UPJ obstruction.
Methods: We retrospectively reviewed all LP and RALP performed by three pediatric urologists at our institution from January 2010 to August 2012. We compared
age, surgical time, blood loss, hospital stay, intra−op and postoperative complications, and success rate. Between group comparisons were done using Fisher’s
exact test for categorical outcomes and Wilcoxon Rank Sum test for continuous
outcomes using SAS/STAT® version 9.3. All tests were two−sided using a significance level of 5%.
Results: Forty−five patients underwent repair of UPJ obstruction. In the RALP
group one open conversion was excluded because of intraoperative findings
(n=32). One conversion due to robot malfunction was included in LP group (n=12).
Age (year), gender and side of obstruction were not significantly different between
the groups. Mean age for LP and RALP were 6.77 and 8.74, respectively. There
were 8 (67%) males and 19 (59%) males in the LP and RALP group, respectively.
Left sided obstruction occurred 8 (67%) and 22 (68%) in the LP and RALP, respectively. One patient in the RALP had bilateral repair (3%). Mean follow up for LP and
RALP was 15.81 (2−29) and 7 (2−22) months, respectively. Success rate was not
significantly different with 90.9% (10) in LP and 100% (27) in RALP groups (p =
0.29). Surgery time (minutes) was significantly longer with LP (260.50; SD 42.52)
versus RALP (231.53, SD 43.57) (p = 0.04). Hospital stay in hours was similar for
LP (35) and RALP (35.8) groups (p = 0.7). There was no significant association
between blood loss (10 ml) and the type of surgery (OR 0.73; 95% CI: 0.06, 8.92).
Intra−operative complications per group were 17% in LP and 6% in RP groups
(p=0.3). However, post−op complications were significantly less likely for the RALP
group (4 versus 1) (p=0.02) (OR 0.06; 95% CI: 0.006, 0.66).
Conclusions: We present a comparative analysis of two minimally invasive modalities for treating UPJ obstruction in children. We demonstrated RALP was significantly shorter than LP and had fewer postoperative complications. Clinically
meaningful differences in success rate and intra−operative complications likely
didn’t achieve significance due to small sample size.
Podium #78
PARTIAL BLADDER OUTLET OBSTRUCTION IN MICE MAY CAUSE FIBROSIS
THROUGH A HYPOXIA INDUCED PATHWAY
Naoko Iguchi1, Amy Hou2, Hari Koul1, Duncan Wilcox2
1
University of Colorado Denver School of Medicine; 2Children’s Hospital Colorado
(Presented by: Naoko Iguchi)
Objectives: Posterior urethral valves (PUV) are the most common cause of bladder outlet obstruction (BOO) in the pediatric population. PUV is a devastating clinical
problem that ultimately results in urinary incontinence, neurogenic bladder and renal
impairment. Despite improvements in medical and surgical management, at least a
third of PUV patients will progress to end stage renal disease. Previously, small animal
bladder outlet obstruction (BOO) models were developed with females, due to technical difficulties. In order to get a better understanding the mechanism associated with
clinical BOO events, we generated partial BOO (PBOO) in male mice. We hypothesized that PBOO results in hypoxia induced fibrosis in the bladder.
Methods: After obtaining IRB approval from our institution, male mice underwent surgical obstruction or a sham operation, with sham animals serving as controls. Partial
bladder outlet obstruction (PBOO) was created by isolating the prostatic urethra and
tying 1Fr polyethylene tubing externally alongside the urethra, with 4−0 silk, and then
removing the tube. Sham animals underwent the same dissection, without undergoing urethral obstruction. All mice received carprofen intraperitoneally for postoperative
pain control. Bladders and kidneys were harvested from mice from each group at 24,
48, 72, and 120 hours post surgery and subjected to immunochemical and histological
analysis. The expression of fibrosis− and hypoxia−related genes was examined at
mRNA and protein level by RT−PCR and immunohistochemistry.
Results: The PBOO mice demonstrate significant increases in the bladder mass and
urinary retention compared to those in sham−operated mice. PBOO caused fibrosis
in the bladder, and induced the up−regulation of fibrosis−marker genes, Transforming
growth factor beta (TGF−β), Hypoxia induced factor−1α (HIF−1α), and Twist−1, a transcriptional factor which is suggested to play important role in development of tissue
fibrosis. The differences in HIF−1α and Twist−1 between the sham and the obstructed
mice were statistically significant.
Conclusions: We developed a male mouse model of PBOO that presented with significant increase in bladder weight and histological and molecular alterations consistent with fibrotic changes. The upregulation of HIF−1 α and Twist−1 pathways suggest
these pathways play important roles in the fibrotic processes that occur in the obstructed bladder.
146
Podium #79
INJECTION THERAPY FOR VESICOURETERAL REFLUX IN THE OLDER
CHILD AND ADOLESCENT
Carrie Yeast, James Cummings, Phillip Fuller, Scott Matz, Mark Wakefield
(Presented by: Carrie Yeast)
147
PODIUMs
Objectives: Periureteral injection with dextranomer−hyaluronic acid (Deflux) has
become first line therapy for children requiring intervention for vesicoureteral reflux
(VUR). Although most children receive such treatment relatively early in life, some
manifest problems with urinary tract infections (UTI) affecting the upper tracts at a
later age and thus may need aggressive intervention. We reviewed our experience
with utilizing Deflux injections to treat VUR in the 10−17 year age group to determine its safety and efficacy in older children.
Methods: Our divisional database of children undergoing Deflux injection was
reviewed. Results for children ages 10−17 were compared to those for children
under the age of 10.
Results: A total of 126 patients have received treatment for VUR with Deflux. Of
these 15 fell into the 10−17 years age group. The distribution of reflux grades,
duplicated systems, scarring and bilaterality were statistically equal between the 2
groups. In the older group, 4 patients (26%) had recurrent UTIs of whom 2 (15%)
were found to have persistent VUR. They were retreated with Deflux but failed
and ultimately underwent surgical reimplantation. Only 1 patient of the remainder
requires prophylactic antibiotics. In the younger age group, 46 (41%) had recurrent
UTIs of whom 19 had persistent VUR. Ten of these had repeat Deflux injection with
2 (2%) going on to reimplant surgery (p<0.02). Postoperative hydronephrosis on
post−injection renal ultrasounds was present in 33% of the older group as opposed
to 11% of the younger group (p<0.02)
Conclusions: Periureteral injection of Deflux for VUR is safe and effective in an
older group of children although there appears to have a higher rate of ultimately
requiring operative reimplantation in the older group. This occurs despite the apparent equality between the 2 groups in VUR staging and characteristics. There
may be undefined characteristics of the growing ureter that allow for better efficacy
in smaller children to account for this difference.
Podium #80
PREVALENCE AND ANALYSIS OF AUTONOMIC DYSREFLEXIA DURING
URODYNAMICS IN CHILDREN AND ADOLESCENTS WITH SPINAL CORD
INJURY AND OTHER SEVERE NEUROLOGICAL DISEASE
Stephen Canon1, Marc Phan1, Lynne Lapicz2, Tanya Scheidweiler2,
Lori Batchelor2, Christopher Swearingen2
1
UAMS; 2ACH
(Presented by: Annashia Shera, MD)
Objectives: Adult patients high spinal cord injury (SCI) are at risk of developing autonomic dysreflexia (AD) during bladder filling or other noxious stimuli. AD
causes uncoordinated autonomic responses leading to potential severe reactions,
including hypertensive crisis. The prevalence of AD in children and adolescents
with high SCI and severe neurological disease is unknown. Our purpose is to determine the prevalence and associations of AD, to review treatment and complications for AD, and to inspect for any evidence of AD in non−SCI severe neurological
disease.
Methods: All patients with SCI above T8 and with other severe neurological deficits undergoing UDS evaluation between 2007 and 2011 at our institution were
closely monitored by the UDS and anesthesia teams. Blood pressure monitoring
and clinical assessment were performed throughout UDS. We retrospectively reviewed multiple variables for these cohorts: age, sex, blood pressure during UDS,
presence of AD, bladder volume and compliance, presence of uninhibited detrusor
contractions, and the presence of bacteria at the time of UDS. Association of demographic and clinical features with AD was examined using repeated measures
analysis.
Results: 13 patients monitored for AD during UDS were reviewed: 8 patients with
SCI above T6 (6/8 cervical) and 1 at T8, 2 patients with transverse myelitis, and
2 patients with encephalomyelitis. 41 UDS studies were performed in all (average
3.2/patient) with an average age of 12.4 years. 2/9 patients with SCI (22.2%) experienced AD (1 cervical and 1 thoracic) and 0/4 patients with non−SCI deficits
experienced AD. 1/2 with AD was prepubertal at the time of UDS evaluation. Of
the two patients with AD, 1 patient had 6 episodes during 7 studies and 1 patient 2
episodes during 7 studies. We found no statistical associations of AD with gender,
actual/estimated bladder ratio, presence of uninhibited detrusor contractions, bladder compliance, or presence of bacteria during UDS. AD symptoms and hypertension universally resolved with bladder drainage only. No major complications were
observed.
Conclusions: Autonomic dysreflexia occurs in both prepubertal children and adolescents with SCI undergoing urodynamics. With clinical observation and monitoring during urodynamics, autonomic dysreflexia in this population is easily recognized and usually treated successfully with bladder drainage with minimal risk. No
evidence of autonomic dysreflexia for patients with transverse myelitis or encephalomyelitis in this setting exists.
148
Podium #81
TRENDS IN ADHERENCE TO RECOMMENDATIONS IN PATIENTS WITH
PROSTATE CANCER TREATED WITH ANDROGEN DEPRIVATION THERAPY
Robyn Crowell, Eduardo Orihuela, Still Sasha
University of Texas Medical Branch
(Presented by: Robyn Crowell)
149
PODIUMs
Objectives: Androgen Deprivation Therapy (ADT) is an established treatment modality for prostate cancer (Pca). The 2011 American Urologic Association (AUA)
update on the use of ADT for treatment of Pca recommends annual blood glucose
(BG) and lipid measurements and regular bone mineral density (BMD) screening,
as well as vitamin D and calcium supplementation. These guidelines ensure that
side effects resulting from treatment−induced hypogonadism are appropriately diagnosed and managed.
Objective: To determine the trends in adherence to AUA recommendations in patients treated with ADT for prostate cancer by comparing the management of these
patients in 2007 verses 2012.
Methods: We performed a retrospective chart review of patients with prostate
cancer undergoing ADT during 2007 (n=65 pts) and 2012 (n= 108 pts). Included
in the study, were those patients treated for a minimum of 6 months with ADT, and
those followed for a minimum of two years, during or after their treatment. We
compared the number of patients counseled to supplement with vitamin D and
Calcium, those who had BMD scans during their treatment, and those who had
annual BG and lipid studies.
Results: We reviewed 50 patients treated in 2007 with ADT and found 6% (3)
were counseled to supplement with vitamin D and Calcium, only 16% (8) had BMD
testing during their treatment, 68% (34) had annual blood glucose testing and 42%
(21) had annual lipid monitoring.
We then reviewed 50 patients treated in 2012 with ADT and found 52% (26) were
counseled to supplement with vitamin D and Calcium, 26% had BMD testing
during their treatment, 70% (35) had annual blood glucose testing, and 30% (15)
had annual lipid profiles.
Conclusions: Our results suggest, in our institution, there has been significant improvement in the management of patients treated with ADT for prostate cancer in
the past five years. However, in 2012, only half of our patients receive counseling
to supplement with vitamin D and Calcium and only 26% are screened for osteopenia/osteoporosis. Despite of the observed improvement, a disparity remains in
the screening for potential consequences of hypogonadism. Our hope is to bring
awareness to practicing urologists in adhering to the recommendations published
by the AUA in 2011 for patients treated with ADT for prostate cancer.
Podium #82
WITHDRAWN
Podium #83
UTILITY OF MULTIPARAMETER MAGNETIC RESONANCE FOR EARLY
DETECTION OF PROSTATE CANCER
Edgar Mayorga Gómez1, Yesenia Fernandez de Lara, Alberto Jorge Camacho
Castro2, Victor Cornejo Dávila, Alejandro Palmeros Rodríguez,
Israel Uberetagoyena Tello, Gerardo Garza Sainz, Victor Osornio Sanchez,
Francisco García Salcido, Erick Muñoz Ibarra, Samuel Ahumada Tamayo,
Gerardo Fernández Noyola, Angel Martínez, Mauricio Cantellano Orozco,
Carlos Martínez Arroyo, Gustavo Morales Montor, Carlos Pacheco Gahbler
1
Candidate Member AUA; 2Hospital General Dr. Manuel GEA González
(Presented by: Alberto Jorge Camacho Castro)
Objectives: Prostate cancer (PCa) is the second most common cancer in men
and the second with the highest mortality. Magnetic resonance (MRI) allows accurate staging of PCa and can reach a sensitivity and specificity of 95% in the preoperative setting. Multiparameter MRI allows detection of 46% of PCa in patients
with a previous negative biopsy.
Objectives: Determine the efficacy of MRI for the detection of PCa in patients with
risk factors and determine it’s utility as a diagnostic test.
Methods: A diagnostic test, transversal and analytic was performed in patients
with a prostate biopsy indication for elevation of prostate specific antigen (PSA) or
clinical suspicion. An MRI and prostate biopsy were performed in all patients. We
analyzed the accuracy of multiparameter MRI as a diagnostic test.
Results: 49 patients with a PSA of 14. 36 patients had a suspicious MRI. We
found cancer in 27.7% of all MRI reported as suspicious. 100% of all cancers had
an abnormal MRI. The MRI had a sensitility of 100% and specificity of 39%.
Discussions: Our results are different from the literature because they reported
suspicious MRI in 63% vs 72% in our study, the biggest difference were in the
biopsy results because we found cancer in 30% of the suspicious MRI vs a 50%
reported in the literature.
Conclusion: Multiparameter MRI cannot be considered a substitute for prostate
biopsy and will be a second line study reserved for patients with a previous negative biopsy and rising PSA.
150
Podium #84
OPPORTUNITIES FOR CHEMOPREVENTION IN PATIENTS ON
ACTIVE SURVEILLANCE FOR PROSTATE CANCER: INITIAL
OBSERVATIONS FROM THE CANARY FOUNDATION PASS COHORT
Objectives: Low−grade, low−stage prostate cancer is increasingly managed with active surveillance. Nonetheless, active surveillance is both expensive and may involves
multiple morbidities, including those related to the prostate biopsy procedure itself and
potential patient anxiety and worry. This heterogeneous population would be an ideal
medium for evaluating the role that potential chemoprevention medications such as
statins, metformin, 5−alpha reductase inhibitors, NSAIDs, or COX−2 inhibitors have
on the dichotomously variable natural history of the disease. Whether specific studies of these agents would be feasible in an active surveillance population, given the
ubiquity of their use in the general population, however, remains to be assessed in a
rigorous fashion.
Methods: We examined the rates of use of these medications in 618 subjects participating in the Canary Prostate Active Surveillance Study using intake demographics,
self reported information forms, and intake medicine reconciliation.
Results: The highest rates of use of potential preventive agents were NSAIDs (49%
current users, 59% in the past 10 years), 5−alpha reductase inhibitors (15% and 12%,
respectively), and statins (40% and 34%, respectively). Metformin and COX−2 inhibitor use was infrequent in this population.
Conclusions: Chemoprevention studies in men opting for active surveillance for prostate cancer are unlikely to be confounded by background rates of use of potential chemopreventive agents. Because active surveillance mandates serial prostate biopsy
with all the attendant risks of that procedure, any protocol that decreases the total biopsy burden would be a great improvement to this method of cancer surveillance and
de facto treatment. Given the morbidity of current paradigms of active surveillance, the
idea of chemoprevention of prostate cancer progression is indeed an attractive one,
and merits further study with dedicated clinical trials.
Source of Funding: Support of this study from the Canary Foundation, the Early
Detection Research Network, National Cancer
Institute (U01CA86402) and the Cancer Center Support Grant to the Cancer Therapy
and Research Center (P30CA054174)
151
PODIUMs
Edwin Morales1, Stephen Unterberg2, William M. Hilton3, Donna P. Ankerst2,
Lisa Newcomb4, Daniel W. Lin5, Robin J. Leach2, Ian M. Thompson, Jr.6
1
UTHSCSA Urology; 2UTHSCSA; 3MSKCC; 4Fred Hutchinson Cancer Research
Center; 5University of Washington; 6UTHSCSA/CTRC
Podium #85
THE MODIFIER 22 EFFECT ON PERIOPERATIVE OUTCOMES OF
ROBOTIC−ASSISTED LAPAROSCOPIC PROSTATECTOMY
Joshua Griffin1, Katie Murray2, Yuan Feng3, Brett Wahlgren4, David Duchene1,
Moben Mirza1, Ernesto Lopez−Corona5, J Brantley Thrasher1
1
Department of Urology, University of Kansas Medical Center, Kansas City, KS;
2
University of Kansas; 3School of Medicine, University of Missouri−Kansas City;
4
School of Medicine, University of Kansas; 5Kansas City Veterans’ Hospital
Objectives: Robotic−Assisted Laparoscopic Prostatectomy (RALP) is a mainstay
in the treatment of prostate cancer. However, there are several intraoperative factors that may increase the level of difficulty during RALP. Current procedure terminology (CPT) identifies a case that requires substantially greater effort than usual
by using the modifier 22 code (M22). During RALP there are several potential
factors that may lead to this designation. Our objective was to identify the most
common etiologies leading to M22 at our institution and determine the effect on
perioperative outcomes.
Methods: We reviewed our prostatectomy database from 2009−2012 to identify
patients who underwent RALP with and without M22. Reasons for M22 were determined by review of operative records. Comparisons were made using Chi−square
analysis for categorical data and independent t−tests or ANOVA for continuous
data. Logistic regression analysis was used to determine which variables were
associated with use of M22.
Results: Of 329 patients identified from our database whom had complete data,
168 had a M22. 38 patients had >2 documented reasons for M22. Enterolysis
was the most common reason for M22 followed by presence of inguinal hernia
mesh and large prostate +/− median lobe. Age, PSA, clinical and pathologic stage
distributions were similar in both groups. Body mass index (BMI) (27.9 vs 29.9),
prostate volume (42 vs 53.4g), operative time (229 vs 255 minutes), + margin status (11.3 vs 19.5%), and prolonged pelvic drain (2.5 vs 7.7%) were all significantly
higher in the M22 group. Patients with >2 modifiers had significantly higher BMI,
clinical T stage, operative times (OR), and pathologic prostate volume. Mean OR
time with >1 modifier was 271 minutes vs 249 for 1 modifier only and 235 for no
M22. Complications rates and blood transfusions were low in both groups precluding any relevant statistical inference. Positive margins (OR 2.79), BMI (1.11), and
prolonged pelvic drain usage (OR 7.39) all correlated with use of M22 code on
logistic regression analysis.
Conclusions: The M22 code is associated with longer OR times, larger prostates, and higher BMI. The higher positive margin rates and length of pelvic drain
requirement supports the challenging nature of these cases. In cases of large
prostates or median lobes, complex reconstruction of the bladder neck may be required which adds significant time and also may require prolonged use of surgical
drain. More research is needed to determine long term quality of life and oncologic
outcomes in this group of patients.
152
Podium #86
TETRANDRINE IMPAIRS PROSTATE CANCER CELL SURVIVAL IN PART BY
INHIBITING AR SIGNALING PATHWAY
Sweaty Koul1, Randall Meacham2, Hari Koul3
1
CU SOM; 2CUSOM; 3CU School of Medicine
153
PODIUMs
Objectives: Prostate cancer (PCa) is the second leading cause of cancer deaths
in men, and the majority of prostate cancer deaths are a result of emergence
of castrate resistant phenotype. Our previous studies indicated that Tetrandrine
(TET), a bis-benzylisoquinoline alkaloid isolated from the root of Stephania tetrandra inhibited cell cycle progression and promoted growth arrest at lower concentrations and promoted apoptosis at higher concentrations and at longer time
points. AR signaling is known to play a critical role in androgen responsive prostate
cancer cells.
Methods: In the present studies we evaluated the effects of TET on AR signaling
in androgen dependent (LNCaP cells) as well as castrate resistant (C4 and C42B
cells, castrate resistant lineages of LNCaP cells) prostate cancer cells. Exposure
of LNCaP cells to Tet resulted in a dose and time dependent decrease in PSA
protein (cell associated as well as secreted PSA).
Results: Further analysis revealed that Tet also decreased PSA mRNA as well as
PSA promoter activity, suggesting that Tet induced decrease in PSA was a result
of inhibition of PSA transcription. Since PSA is known to be an AR responsive
gene, these results led us to investigate the effects of Tet on AR signaling. Results
from these studies revealed that Tet inhibited AR activity as measured by TARP
promoter assay.
Conclusions: Taken together these studies suggest that Tet targets AR signaling
pathway effectively blocking AR target genes. In summary our results suggest that
Tet by inhibiting AR signaling pathway may work as an effective therapeutic agent
in prostate cancer, for which there is no cure to date.
Grant Support: Studies supported in part by VA Merit Award−01BX001258 (HK),
NIH/NCI R01CA161880 (HK) and Department of Surgery, School of Medicine
chair commitment (HK).
Podium #87
APPLICABILITY OF MIC−1 AS A POTENTIAL BIOMARKER FOR RACIAL
DISPARITY IN PROSTATE CANCER
Daniel Zainfeld1, Seema Dubey1, Jo Wick2, Jeffrey Holzbeierlein1,
Peter Van Veldhuizen3, Brantley Thrasher1, Dev Karan1
1
University of Kansas Department of Urology; 2Department of Biostatistics;
3
Department of Internal Medicine, Division of Hematology/Oncology
Objectives: Prostate cancer is a significant health problem for men in the United
States that disproportionately affects African American (AA) men in both incidence
and mortality rate in comparison to Caucasians. Although there is no clear evidence for the cause of such disparity, it is likely that differences in the biology of
prostate tumor may contribute significantly to the aggressive nature of prostate
cancer in AA men. In this pilot study, we sought to examine if serum MIC−1 (macrophage inhibitory cytokine−1) provides any predictive capability for the severity of
prostate cancer in pre−surgical diagnosed males.
Methods: Serum samples for 40 Caucasians and 40 AA men were obtained. Serum MIC−1 level was measured by sandwich ELISA. Due to the non−normality of
MIC−1 and PSA, natural log transformations were used to meet the assumptions
of correlation and regression analyses. Differences between AA and Caucasians
were identified using Wilcoxon tests for continuous variables and Fisher exact
tests for categorical variables. Pearson’s correlation coefficient, univariable linear
regression, and analysis of covariance were used to identify significant associations between continuous outcomes and differences among races. All p−values
reported are two−sided, and an a priori 5% level of significance was used.
Results: Forty Caucasian and forty AA men between the ages of 43 and 75 years
(Median = 60 years) were analyzed. Highly significant differences among the two
races were found in MIC−1 (p = 0.0001) and Gleason scores (p = 0.0009), with
AA having higher MIC−1 expression (Median 1220.4 versus 790.8) and Gleason
scores (Median 7 versus 6) than Caucasians, on average. PSA was also significantly higher in AA (Median 6.72 versus 6.35, p = 0.04). No differences in age or
stage of disease were detected between groups (p > 0.05). In Caucasians, MIC−1
expression was positively associated with PSA (p < 0.01), and age (p > 0.0001),
while Gleason score was positively associated with PSA (p < 0.05) and age (p <
0.05). Log−transformed PSA and MIC−1 were used for valid inferences. Thus,
higher levels of MIC−1 expression and higher Gleason scores were associated
with older patients when limiting our sample to Caucasians. In AA, however, both
older and younger patients had highly expressed MIC−1 and high Gleason scores.
Conclusions: Although a detailed sample analysis is required, these observations
indicate that addition of MIC−1 may help to improve the diagnostic capability of an
aggressive stage of prostate cancer at least in African American men.
154
Podium #88
REGULATION OF THE TUMOR METASTASIS SUPPRESSOR PROSTATE−
DERIVED ETS FACTOR (PDEF)
Joshua Steffan1, Hari Koul2
1
CUSOM; 2CU School of Medicine
155
PODIUMs
Objectives: Prostate−Derived ETS Factor (PDEF) is a transcription factor which
regulates multiple gene products involved in prostate tumorigenesis. PDEF expression decreases with increasing Gleason Score in human tumors and PDEF
functions as a tumor metastasis suppressor in mouse models of prostate cancer.
A common mechanism to inactivate tumor suppressor and metastasis suppressor
genes is through promoter hyper−methylation. Thus, the objective of this study is
to determine if the differential expression levels of PDEF protein in cell lines can be
attributed to the methylation status of the PDEF promoter or if other transcriptional
regulatory mechanisms play a role.
Methods: The methylation status of the PDEF promoter was analyzed in PC3,
DU145, LNCaP, and RWPE cell lines. These cell lines differ in their expression
level of PDEF. Cellular DNA was isolated and subjected to bi−sulfite modification.
Following this modification, various segments of the PDEF promoter were amplified and the DNA underwent sequencing. The sequencing data was then analyzed
for promoter methylation status. Moreover using published consensus sequences,
in−silico transcription factor binding site analysis was performed to determine other transcription factors which may regulate PDEF.
Results: Sequencing analysis located the specific location(s) of methylation within
the PDEF promoter and the degree of methylation between cell lines. Thus, the
pattern and degree of methylation of the PDEF promoter may correlate with the
expression of PDEF protein and affect prostate cancer progression. Furthermore,
over 60 transcription factor binding sites were identified on the 1.5 kb PDEF promoter alone, suggesting a complex network of transcription factors and upstream
signaling pathways may be responsible for PDEF regulation.
Conclusions: This study demonstrates for the first time that the PDEF promoter is
methylated and suggests a mechanism by which PDEF is down regulated during
prostate cancer progression. Further studies correlating the degree of PDEF promoter methylation with clinical outcomes using banked prostate biopsy tissue will
further validate the role hyper−methylation plays in regulating PDEF and perhaps
clinical outcome. Lastly, analysis continues to be performed to understand which
transcription factors and signaling pathways also regulate PDEF protein expression.
Funding: AEF−Seed grant/Chair Support (HK); AUA Foundation Research Scholar
Award to JJS.
Podium #89
IDENTIFICATION OF AUTOANTIBODIES THAT CORRELATE OR PREDICT
CLINICAL OUTCOMES IN PATIENTS THAT ARE HIGH RISK FOR PROSTATE
CANCER
Katie Murray, George Viehlhauer, Jeffrey Holzbeierlein
Objectives: Screening for prostate cancer (CaP) remains controversial due to
the inability to predict the men who may develop high−risk prostate cancer versus
those with indolent disease. Previous reports have shown that men with prostate
cancer elicit a detectable autoantibody response to their cancer. The objective of
this study is to define an autoantibody signature correlating with aggressiveness
of disease.
Methods: Phage libraries were created from patients with prostate intraepithelial neoplasia (PIN) lesions versus those with negative biopsies and subsequently
sera from patients with aggressive disease (Gleason 8−10) to identify candidate
proteins in the autoantibody signature. These candidate proteins were used to
create a high density phage microarray to conduct a training phase to identify an
autoantibody signature selective and specific for patients with high risk disease.
Results: Approximately 500 novel phages were identified with an affinity for autoantibodies in the serum of these patients with high risk aggressive disease separately identifiable from those with PIN or no evidence of cancer.
Conclusions: This study demonstrates that similar to previous reports unique autoantibodies can be detected in prostate cancer. Furthermore, we have demonstrated that unique autoantibody reactive proteins can be identified from patients
with high−risk aggressive prostate cancer.
156
Podium #90
USE OF AMNION ALLOGRAFT TO REDUCE CAVERNOSAL NERVE DAMAGE
DURING RADICAL PROSTATECTOMY
Naveen Kella
Urology & Prostate Institute
(Presented by: Naveen Kella)
157
PODIUMs
Objectives: Erectile dysfunction after radical prostatectomy can be a temporary
to permanent morbidity for patients. One contributing factor is cavernosal nerve
disruption. Amnion allograft has antiinflammatory properties and provides an extracellular matrix useful in wound repair. The feasibility and early experience of
allograft placement was examined in patients undergoing nerve−sparing prostatectomy.
Methods: Amnion allograft (4x6 cm, Surgilogix TM, city?) was cut in half and
placed to cover the neurovascular bundles after robotic radical prostatectomy prior
to the vesicourethral anastomosis. Patients filled out Expanded Prostate Cancer
Index Composite for Clinical Practice (EPIC−CP) at baseline and at follow−up visits. Patients were examined at three months after surgery.
Results: 30 patients underwent allograft placement. Additional OR time to place
the patch was negligible compared to overall OR time. No difference was noted in
hospital discharge rates or complication rates. PSA levels in all patients were undetectable. At 3 months, 93% of patients reported 0−1 pad usage for incontinence.
At 3 months, sexual function at least firm enough for masturbation or foreplay were
reported in 50% of patients. 23% reported erections firm enough for intercourse
with or without oral medication.
Conclusions: Amnion allograft appears safe and feasible for patients undergoing
prostatectomy. Early data is promising and indicates the need for further study with
randomized trials.
POSTERS
Poster #1
LOWERING REVISION RATES IN PRIMARY ARTIFICIAL URINARY SPHINCTER
SURGERY: RESULTS OF A CONTEMPORARY NATIONAL DATABASE
Lee C. Zhao1, Jay Simhan1, Steven J. Hudak1, Laura Gintant2, Allen F. Morey1
1
UT Southwestern Medical Center; 2American Medical Systems
Objectives: Introduced in 2010, the 3.5 cm artificial urinary sphincter (AUS) cuff
has become an important new treatment option for men with stress urinary incontinence and spongiosal atrophy (J Urol 2011, 185, 1962−1966). We hypothesized
that because many men with spongiosal atrophy now receive 3.5 cm cuffs primarily, lower revision rates among 4.0 cm primary AUS cases should be expected in
the contemporary era.
Methods: We queried the American Medical Systems Patient Information Forms
database among men undergoing first implants of AUS cuff sizes 3.5, 4.0, and 4.5
cm from 2008 to 2012. Revisions for all causes were evaluated in two intervals−−
before (2008−2009) and after (2010−2012) the introduction of the 3.5 cm AUS in
2010. Kaplan−Meier analysis was performed to compare survival of the 4.0 cm cuff
in the two eras. Survival of the 4.5 cm cuff was also evaluated as a control group,
since introduction of the 3.5 cm cuff would not be expected to be influence revision
rates for these patients.
Results: Overall, 21,510 AUS cases met inclusion criteria, and 2300 revision cases were identified. Overall revision rate for 4.0 cm cuffs placed in 2008−09 was
16.2%. Although the follow up was shorter, Kaplan−Meier analysis showed improved cuff survival for 4.0 cm cuffs after the introduction of the 3.5 cm cuff (figure),
p = 0.01. As expected, the survival for 4.5 cm cuffs was unchanged (7.3%) and
similar to the 4.0 cm cuff population after 2010 (7.5%). The revision rate among
3.5 cm cuffs was 8.9%.
Conclusions: A reduction in the rate of revision surgery among primary 4.0 cm
AUS cuff patients has been identified since the introduction of the 3.5 cm AUS cuff.
We believe this is because many patients with atrophic spongiosal tissues are now
receiving more correctly sized cuffs primarily, thereby leading to better coaptation
and enhanced continence. The 3.5 cm cuff has an important role in the surgical
treatment of male incontinence, limiting placement of inappropriately oversized
4.0 cm cuffs.
158
Poster #2
FATE OF ERODED ARTIFICIAL URINARY SPHINCTER (AUS)
Nirmish Singla1, Ajay Singla2
1
The University of Texas Southwestern Medical Center; 2Professor, Department of
Urology, The University of Toledo Medical Center
159
POsters
Objectives: The artificial urinary sphincter (AUS) is a gold standard treatment for
urinary incontinence, yet remains susceptible to several complications. Traditionally, AUS explantation is necessitated following cuff erosion or infection. In the
present study, however, we consider the role of conservative management and
query the need for immediate AUS removal after erosion.
Methods: We retrospectively reviewed our 10−year experience with AUS implantation, including complication rates. We focus on the outcomes of eroded sphincters including two patients who were managed nonsurgically for sterile cuff erosion.
Results: Between 2002 and 2012, 126 AUS units were implanted in 74 adult male
patients by single surgeon (AS). 25 patients (33.8%) required at least one additional procedure due to urethral atrophy (24.3%) or erosion or infection (9.5%). In
addition, two patients with congenital anomalies underwent AUS implantation at
bladder neck and were followed nonsurgically for several years after cuff erosion:
1.
Case 1: 42−year−old male with history of bladder extrophy and epispadias underwent AUS implantation in 1994, with development of cuff erosion in 1996.
He refused surgical management and has since remained continent, infection−
free, and asymptomatic.
2.
Case 2: 29−year−old female with history of myelomeningocele status
post Mitrofanoff appendicovesicostomy underwent AUS implantation in 1998 with
incidental discovery of eroded cuff in 2009. She refused surgical management and
has since remained continent, infection−free, and asymptomatic.
Conclusions: Our AUS complication rates are consistent with prior series. Our
unique experience with two patients illustrates that immediate removal of AUS
after sterile cuff erosion may not be necessitated in all patients. Larger prospective
series concerning patient selection for salvaging functional eroded AUS may be
warranted, thereby avoiding surgical morbidity.
Poster #3
THE ROLE OF TGF−BETA IN URETHRAL STRICTURE DISEASE
Kyle Keyes, Joseph Sonstein, Sasha Still, Kelli Gross
UTMB
(Presented by: Kyle Keyes)
Objectives: To establish Transforming Growth Factor− Beta (TGF−β) as a key
mediator in the formation of urethral stricture disease.
Wound healing is characterized by the precise cycle of inflammation, tissue destruction, and reformation. Many diseases arise from aberrations of this cycle.
Wound contractures, pulmonary fibrosis, and even chronic kidney disease are
consistently found to have TGF−β overexpression and excessive collagen deposition during the remodeling phase. In vitro studies have confirmed TGF−β is a powerful inducer of fibrosis. The cause of urethral strictures is poorly understood and
few studies evaluate the biochemical pathway of fibrosis during urethral stricture
disease (USD). Our aim is to establish TGF−β overexpression as a key factor in
the biochemical pathway of USD.
Methods: Following IRB approval, coded charges from 2008 to 2012 were
searched for 54310 and 54315 with the word urethroplasty. Exclusion criteria were
age <18, iatrogenic urethral stricture, and incarceration status, leaving 10 cases.
Charts were reviewed. Pathology specimens were retrieved from paraffin embedded blocks, resliced, and stained with TGF−beta (AB−66043) for immunohistochemical analysis. Positive controls were placental tissue supplied by histology
lab. Negative controls were penectomy cases without urethral invasion from 2008
to 2011.
Results: Nine urethroplasty specimens were reviewed. Mean age was 42 years
± 17 years. Stricture length ranged from 1 to 4 cm (mean 2 cm ± 1.4 cm). Of the
9 cases, 6 were repaired with primary anastomosis (66%), 2 with penile skin flap
(22%), and 1 with buccal graft (11%). The etiology was presumed to be idiopathic
in 6 cases. One case was attributed to trauma, 1 to recurrent UTI’s, and 1 to eroded artificial urethral sphincter. There was prior endoscopic urethrotomy or incision
attempt in 7 cases. Immunohistochemistry for anti−TGF−β stains is pending. Images are expected by April 1st. Six cases of partial penectomies were found as
negative controls, of which 1 was excluded for urethral invasion and 1 for complication of necrotizing fasciitis prior to surgery.
Conclusions: As results are pending, it is too early state a conclusion about the
role of TGF−b in urethral stricture disease. However, results are expected within
the next month.
Funding was supported by the Roland and Jane Blumberg Fund for Cystitis
160
Poster #4
SHORT TERM URINARY FLOW OUTCOMES AFTER ROBOTIC SIMPLE
PROSTATECTOMY
Igor Kislinger, Isabel H. Lopez, Edward L. Gheiler, Paul Perito, Fernando J. Bianco
161
posters
Objectives: Simple prostatectomy is an effective surgical option for patients with
symptomatic high prostate volume benign prostatic hyperplasia. Several series
have shown the feasibility of Robot Assisted Simple Prostatectomy (RASP). We
aimed to evaluate short−term uroflow outcomes after RASP.
Methods: A total of 34 men underwent RASP for treatment of BPH between February of 2010 and December of 2011.
All clinico−pathological and outcomes information was prospectively collected into
our RASP registry. Eligibility for this study was based on Uroflow and Post Void
Residual (PVR) assessment, within 3 months before RASP and between 3 and 6
months after
RASP. The paired t−test statistic was used to evaluate significance between maximal flow, average flow and PVR assessments.
Results: 27 (79%) men met eligibility criteria. A RASP retropubic approach was
used in 24 patients and a suprapubic in
3. Prostate ultrasound volumes ranged from 92cc to 276 cc. RASP console time
averaged 68 min (range 44−122). Hospital stay was 1 day and 2 days for 20 and
7 men, respectively. One patient required blood transfusion. There were no leaks
postoperatively. The median age was 71 (IQR 68,76). There were clinical and statistically significant (p<0.001) improvements in a 3 outcome measures − QMAX,
Average Flow and PVR. Three to 6 months after RASP, QMax flow improved by a
mean of 16.4 (95%CI 13−20) cc/s.
Average Flow improved by a mean of 11.1 (95%CI 9−13) cc/s. PVR showed a
decrease by a mean of 147 (95%CI 102−192) cc.
Conclusions: RASP short term results are very promising exhibiting limited risk,
short convalesce and objective improvement in uroflow outcomes measures.
Poster #5
IMMEDIATE PENILE REHABILITATION THERAPY FOLLOWING ROBOT−
ASSISTED LAPAROSCOPIC PROSTETECTOMY (RALP): A CASE STUDY
Zachary Hafez, Kurt Strom
University of Missouri School of Medicine
(Presented by: Zachary Hafez)
Objectives: Erectile dysfunction (ED) is a well−documented morbidity following
robot assisted laparoscopic prostatectomy (RALP). While the exact causes are
poorly understood, they are believed to be multi−factorial and include changes on
a tissue level including corporal fibrosis, apoptosis, and disruption of pelvic floor
nerves. The concept of penile rehabilitation following RALP has shown to improve
sexual function yet rarely prevents longer−term independence from pharmacologic
or surgical intervention. A major barrier to early penile rehabilitation is the presence
of the urinary catheter. It is believed tissue healing begins immediately following
surgery; therefore, early intervention may lead to improved results and independence from ED intervention. Here, a case study is presented detailing a novel
protocol for early, aggressive penile rehabilitation therapy beginning six hours after
RALP.
Methods: A 57 year old male with a Sexual Health Inventory for Men (SHIM) score
of 25 was consented for RALP with bilateral nerve sparing. Weeks before surgery,
a thorough physical exam was done and Bi−mix injection teaching was provided.
0.1cc was injected and a healthy erection response was noted and erection size
was measured. Six hours after RALP, 0.06cc injection of Bi−mix was injected with
urinary catheter in place. The patient was also started on daily Cialis (5mg). 0.1cc
injections of Bi−mix were injected every night for thirty days, then every other night
thirty days. SHIM scores were obtained before surgery, at day thirty, and day sixty
with regular followup exams.
Results: No adverse effects were noted during or following surgery. Healthy erections were induced prior to surgery and six hours post operatively with urinary
catheter in place. The patient has injected himself daily and has reported healthy
erections. Eleven days after surgery, the patient reported his first orgasm with ejaculate and sensation in his phallus, aided by injection. Twenty−three days post operation, a semi−rigid, morning erection was obtained and masturbation with ejaculate was possible. Twenty−five days after surgery the patient resumed jogging.
Conclusions: Protocols for penile rehabilitation therapy following RALP vary.
Long−term pharmacologic or surgical intervention for ED is common. This case
study illustrates that erections can be induced safely and effectively as soon as six
hours after surgery with a urinary catheter in place. This demonstrates that intervening early with rehabilitation, ED due to irreversible changes at the tissue level
may be reduced and normal sexual function may be obtained earlier than current
therapy and without the need for long−term intervention.
162
Poster #6
VASECTOMY PAIN − PERCEPTION VERSUS REALITY: A COMPARATIVE
ANALYSIS OF PATIENTS’ PRE AND POST VASECTOMY PAIN SCORES
UNDERGOING THE NO NEEDLE NO SCALPEL TECHNIQUE
Adam Mellis, Puneet Sindhwani
163
posters
Objectives: Vasectomy is the fourth most common contraceptive method in the
United States, used in 5.7 % of all US men between ages 15−44. Despite its low
failure rate, 45 % of men state that the decision to undergo vasectomy is difficult.
Many men have reservations about undergoing vasectomy due to fear of anticipated pain. The goal of our study is to measure patients’ anticipation of pain and
compare it to their actual pain in our cohort undergoing office based no scalpel no
needle vasectomy (NNNSV) and to determine the effect of age, medical history,
and NNNSV technique on their actual perception of pain.
Methods: A retrospective chart review was undertaken of the last 50 patients who
underwent NNNSV. Immediately prior to the vasectomy, all patients were asked
to rate their anticipated pain using the FACES visual analog scale (scale of 0−10,
10 being the worst pain). This was recorded as prevasectomy score. Anesthesia
was then performed using 1% lidocaine in a Madajet™ Medical injector device.
NNNSV was then performed in a standard fashion through a single puncture. Approximately 1.5 cm of vasa was excised after clips were placed on each side and
electrocautery used to seal each lumen. Patients were asked about the actual pain
felt during the procedure after completion using the FACES visual analog scale.
This was recorded as post−vasectomy score.
Results: Complete data was available for 45/50 men (range 25−52 years, mean
age 36.4 years) who underwent NNNSV. Average pre vasectomy pain score was
5.0 while the post vasectomy scores were 1.60 (p <0.005). When stratified to age,
patients 35 years and older (n = 22) actually had higher pre−vasectomy scores at
5.34, compared to 4.64 for patients less than 35 years old (n = 23, p=0.26). Both
patient populations had very low post vasectomy scores at 1.70 and 1.57, respectively (p=0.29). There was an elevated anticipation of pain as indicated by high
pre−vasectomy score of 6.0 in patients greater than 40 years old (n = 12). This
cohort had the lowest post vasectomy score of 1.29 with maximum change in the
mean pain score of 4.7.
Conclusions: Most men undergoing vasectomy had much higher anticipation
of pain than they actually experienced. Using NNNSV technique most of them
actually experienced only minimal self reported pain. This data may be used to
assuage patient fears and minimize the anticipation of discomfort over undergoing
vasectomy.
Poster #7
MALE INFERTILITY FROM OVERUSE OF MEDICAL TESTOSTERONE IN MEN
IN THEIR REPRODUCTIVE YEARS – AN UNNECESSARY PROBLEM
William Parker, Brian McCardle, Zachary Hamilton, Ajay Nangia
Objectives: To review the iatrogenic infertility caused by the use of medical testosterone in men of reproductive potential.
Methods: Men presenting with male infertility or hypogonadism in the reproductive years from 2008−2011 were studied. Analysis was performed of records of
the patients on medical testosterone with respect to our treatment modalities and
outcomes with respect to fertility and sperm recovery.
Results: During the study period, 373 patients met inclusion criteria for evaluation.
Primary infertility was the predominant presenting complaint (72%) with oligospermia (35.92%) and azoospermia (30.83%) representing the majority of the semen
analysis abnormalities (based on WHO 2010 criteria). Use of medical testosterone
was present in 24 patients (6.43%).Only 8/24 developed reproductive potential;
4 with a document pregnancy and 4 with sperm recovery. Among this group of
patients, all had received prior intramuscular testosterone with a mean length of
use of 12.7(6−24) months. Treatment choice consisted of human chorionic gonadotropin in 4, clomiphene citrate in 3, and discontinuation of testosterone in 1, with
an average time to recovery of 7.66(3−21) months. In the 16 patients who failed
to recover fertility: 3 remained infertile despite therapy; 6 were lost to follow−up; 4
stopped treatment due to cost; 2 decided not to pursue treatment; and 1 reverted
to testosterone.
Conclusions: Testosterone use in men of reproductive potential is a significant
source of male factor infertility and can have devastating outcomes on future fertility. Our experience highlights the need for improved education in the treatment of
hypogonadism in the reproductive age.
164
Poster #8
MEDICATION TREATMENT PATTERNS AMONG HYPOGONADAL MEN
INITIATED TOPICAL TESTOSTERONE AGENTS
Michael Jay Schoenfeld, Emily Shortridge, Zhanglin Cui, David Muram
(Presented by: David Muram)
165
posters
Objectives: Little is known about treatment patterns among hypogonadal men
initiating topical testosterone therapy (TRT).
To describe patient characteristics and treatment patterns in hypogonadal men
initiating TRT with AndroGel or Testim.
Methods: 15,435 hypogonadal men ≥18 years from the Thomson Reuters MarketScan® Database, newly initiating a TRT in 2009 were followed for 12 months.
Medication continuation was defined as having refills with medication gaps ≤30
days, ≤60 days, or ≤90 days (sensitivity analysis) between consecutive prescriptions. Restarting was defined as a refill of the index drug after a medication gap of
>30 days. Logistic regression analyses were conducted to identify factors associated with adherence.
Results: Treatment patterns were similar for both medications. Only 11% of testosterone initiators continued medication for 1 year. Restarting or changing medication was often done within the first 90 days after discontinuation of initial therapy. When patients resumed therapy, most (~90%) used the same medication and
dose. When the medication gap increased to 60 and 90 days, there was no change
in adherence or persistence, and length of therapy showed only modest increases.
Among comorbidities, significantly fewer men reported erectile dysfunction and
chronic fatigue syndrome at follow−up than at baseline (all p<0.05). A significant
increase in the use of PDE5 inhibitors was seen after initiation of TRT. Adherence
was better in older and in non−diabetic patients (all p<0.05).
Conclusions: This study was consistent with the literature on chronic diseases −
rates of adherence and persistence were low and not sensitive to several increasing continuation rate definitions.
Poster #9
IDIOPATHIC SCROTAL CALCINOSIS
McCabe Kenny1, Alexandre Pompeo2, Wilson Molina2, Garrett Pohlman1,
David Sehrt2, Fernando Kim2
1
University of Colorado−Denver; 2Denver Health Medical Center
Objectives: Scrotal calcinosis is a rare, benign condition that usually presents
in early adulthood (age 20−40 years) as multiple, yellow, calcified nodules in the
scrotal wall with minimal symptomatology (most often itching or scrotal fullness/
heaviness). It occurs in the absence of calcium and phosphate metabolism abnormalities. Controversy exists as to whether the disease is idiopathic or the result of
dystrophic calcification of existing structures such as cysts or degenerated dartos
muscle. We present two cases of scrotal calcinosis at Denver Health Medical Center in 2012 and discuss management.
Methods: A retrospective chart review of two patients presenting with possible
scrotal calcinosis was conducted following institutional review board approval.
Results: Both patients had multiple hard nodules isolated to the scrotum, endorsed minimal symptoms, and expressed dissatisfaction with cosmetic appearance. Work−up revealed no laboratory abnormalities. Both cases were presumed
idiopathic in etiology. Reconstruction was successfully performed and patients
were satisfied with outcomes. Pathology showed calcium deposits in the dermis
with associated foreign−body type granulomatous reaction consistent with scrotal
calcinosis.
Conclusions: The major indication for surgical excision and reconstruction is cosmetic and good outcomes can be obtained with care to excise all existing nodules
to prevent recurrence.
166
Poster #11
GENDER DIFFERENCES IN SURVIVAL OF PATIENTS WITH INVASIVE
BLADDER CANCER
Roxanne Martinez1, Shandra Wilson2
1
University of Colorado, Anschutz Medical Campus; 2University of Colorado,
Anschutz Medical Campus, Division of Urology
(Presented by: Roxanne Martinez)
167
posters
Objectives: A higher incidence of bladder cancer has been reported in men compared with women in past literature. However, men are generally thought to have a
better survival outcome than women. This difference has been attributed to time of
disease presentation, anatomic differences, and other factors. This retrospective
analysis examines the survival of men compared to women with invasive bladder
cancer requiring radical cystectomy.
Methods: Working with a statistician, we collected a database of male and female
patients with invasive bladder cancer requiring radical cystectomy between 2005
to 2013 at the University of Colorado Hospital. Through chart review, we sought to
perform a survival analysis to identify the hazard ratio between males and females.
Results: Between 2005 to 2013, male and female patients who received a radical cystectomy for invasive bladder cancer including transitional cell carcinoma,
adenocarcinoma, squamous cell carcinoma, and sarcomatoid carcinoma were included. The results were adjusted for age. The results were also analyzed with
adjustments for node and stage, but there was not a difference in hazard ratio. The
hazard ratio for sex was for males with higher risk at HR=1.08 (p=0.81).
Conclusions: Based on our results, males have an 8% higher risk of mortality
from invasive bladder cancer requiring radical cystectomy than women. Although
not yet statistically significant, this finding is different than the present literature
findings on bladder cancer. Additionally, the lack of impact from positive nodes or
stage indicates an independent factor risk from gender. This study continues to be
in a data collection phase as survival analyses take a long time to develop.
Poster #12
CAN WE PREDICT A RESPONSE TO IL−2 AFTER CYTOREDUCTIVE
NEPHRECTOMY?
Zach Hamilton, William Parker, David Duchene, Moben Mirza,
Peter Van Veldhuizen, Jeffrey Holzbeierlein
Objectives: Metastatic renal cell carcinoma (RCC) has a poor prognosis with a
median survival of 10 to 13 months. Within the realm of medical therapy, high−
dose Interleukin−2 (IL−2) is known to produce a durable response in a subset of
patients. Many patients will choose to undergo a cytoreductive nephrectomy prior
to initiation of IL−2 treatment, but predictors of response to this treatment protocol
are still unclear. The aim of our study was to identify predictors of response to IL−2
therapy for patients that underwent a cytoreductive nephrectomy for metastatic
RCC prior to initiation of IL−2 treatment.
Methods: We performed a retrospective review of patients with a diagnosis of
metastatic RCC at our institution from February 2004 to September 2012. Inclusion criteria included a diagnosis of metastatic RCC based on imaging, cytoreductive nephrectomy, and post−nephrectomy treatment with IL−2. Preoperative clinical staging, lab work, site of metastasis, IL−2 treatment variables, and outcomes
were recorded.
Results: A total of 21 patients were analyzed. Staging included T1 in 19%, T2
in 33%, T3 in 43%, and T4 in 5%. Sites of metastasis included lung (76%), liver
(10%), bone (29%), and other (29%). The mean length of time from nephrectomy
until initiation of IL−2 was 117 days. A complete or partial response to treatment
was noted in 33% of patients; however, 81% of patients eventually had progression of disease during the study period. The site of metastasis was not predictive
of response to IL−2. The length of time from nephrectomy until treatment with
IL−2 was not associated with response to treatment. Of note, the number of IL−2
cycles and cumulative number of IL−2 doses was associated with a response to
treatment.
Conclusions: IL−2 therapy is beneficial in a subset of patients with RCC; however, predictors of response are difficult to identify. In patients that present with
metastatic disease and undergo a cytoreductive nephrectomy prior to systemic
therapy, the site of metastasis and time from cytoreductive nephrectomy to IL−2
therapy are not predictive of response.
168
Poster #13
SYNCHRONOUS PRIMARY RENAL CELL CARCINOMA AND PANCREATIC
MASSES
Laura Martinez, Gennady Slobodov
University of Oklahoma
(Presented by: Laura Martinez)
169
posters
Objectives: Reports of synchronous tumors of the kidney and pancreas are very
rare. We report our experience with 5 patients with both primary renal cell carcinoma (RCC) and primary pancreatic tumors at presentation.
Methods: We retrospectively identified 5 patients who were found to have renal and pancreatic tumors between 2009 and 2012. Data was collected including
demographics, smoking history, type of surgical resection performed, renal and
pancreatic pathology, and post−operative outcome.
Results: Patient age ranged from 47−73, and 4 out of 5 were male. Four underwent double resection, which was performed in an open fashion in conjunction with
a general surgeon. Renal pathology was clear cell RCC in all 5 patients (pT1a in
4, pT3a in one). However, pancreatic pathology was widely varied (see Figure 1).
Hospital stay ranged from 8−9 days and one patient had perioperative complications. One had biopsy−proven metastatic disease to the lungs, and another had a
liver lesion pending biopsy.
Conclusions: Primary synchronous tumors of the pancreas and kidney are uncommon. To our knowledge, we have presented one of the largest case series
at one institution. Long−term outcome data is necessary to determine the best
course of treatment for these patients, and other studies are necessary to determine, which, if any genetic abnormalities may be present in these patients.
Poster #14
Confirmation of the Free Hormone Hypothesis: Decreases
in PSA Correlate with Free Testosterone Rather than Total
Testosterone in Men with Advanced Prostate Cancer Treated
with GTx-758
Robert Getzenberg1, Alvin Matsumoto2, Christopher Coss1, Michael Hancock1,
Xuemei Si1, James Dalton1, Mitchell Steiner1
1
GTx Inc; 2Geriatric Research, Education and Clinical Center (GRECC), VA Puget
Sound Health Care System and Department of Medicine, Division of Gerontology
& Geriatric Medicine, University of Washington
(Presented by: Robert Getzenberg)
Objectives: Androgen deprivation therapy (ADT) improves disease-free survival
but disease progression is related, in part, to ineffective castration. The free hormone hypothesis states that the biological activity of steroid hormones is affected
by its unbound (free) rather than its protein-bound concentration. Serum total testosterone (T) concentrations predominantly reflect the T bound to plasma proteins
and do not accurately predict prostatic levels of T.
Methods: In a Phase II study (G200705), men with advanced prostate cancer
(n=159) were randomized to receive 1000 mg or 2000 mg GTx-758 daily or leuprolide as their initial ADT. Serum total T (mass spectrometry), free T (equilibrium
dialysis), SHBG and PSA concentrations were measured. A second Phase II study
(G20007) was performed in men (n=9) with CRPC who then received GTx-758
2000 mg daily.
Results: Although both treatments reduced serum total T levels to < 50 ng/dL,
leuprolide decreased them to a greater extent. However, GTx-758 caused greater
reductions in serum PSA, suggesting that total T concentrations did not accurately
reflect the suppression of androgen activity. Both dosages of GTx-758 reduced
free T levels to a greater extent (mean of 0.7 and 0.4 pg/ml at day 60, and 0.4 and
0.4 pg/ml on day 90, respectively) than leuprolide (mean of 1.4 pg/ml on day 60
and 1.4 pg/ml on day 90; p values <0.03). Similar clinical results were observed in
CRPC patients where GTx-758 daily resulted in a 71% decrease in %free T and
clinically relevant PSA reductions in men maintained on ADT with LHRH agonists.
As a result of adverse events at higher doses of GTx-758, the trial was stopped
early.
Conclusions: The ERα agonist, GTx-758, reduced the biologically active form of
T, free T, to significantly lower levels than leuprolide. Reductions in PSA appeared
to be more highly associated with changes in free T. These data provide compelling evidence to support the free hormone hypothesis and suggest that serum free
T concentrations would provide a better measure of therapeutic efficacy in ADT
than total T. A Phase II clinical trial utilizing lower doses of GTx-758 (G200712) is
currently being performed.
Source of Funding: GTx, Inc.
170
Poster #15
SYNCHRONOUS AND METACHRONOUS TUMORS OF PATIENTS WITH A
UROLOGIC CANCER
Eduardo González Cuenca, Christian Villeda Sandoval,
Ricardo Castillejos Molina, Francisco Rodríguez Covarrubias,
Mariano Sotomayor, Guillermo Feria Bernal, Fernando Gabilondo Navarro
Financial disclosure: None
171
posters
Objectives: Multiple Primary Malignant Neoplasms (MPMN) were described at
the end of XIX century.It has been reported in the literature that a patient with cancer has a 1.29 fold risk of developing a second cancer over the general population.
The objective of this study is to determine the frequency and characteristics of
MPMN that include renal or prostate tumors in a tertiary referral center.
Methods: We retrospectively analyzed patient charts diagnosed with renal and
prostate cancer between 1999 and 2011 in our institute’s database. Patients were
classified in 4 MPMN groups: (1)first and second urological neoplasms, (2)first
urological and second non urological neoplasms, (3)first non urological and second urological neoplasms and (4)first and second non urological neoplasms with a
third urological neoplasm. They were grouped as synchronous or metachronous.
We analyzed differences in: gender, age at diagnosis, pathology report, size and
stage of tumor and time between neoplasms. Overall survival was analyzed using
Kaplan−Meier and Mantel−Cox test.
Results: Sixty patients with at least one urological neoplasm were selected. The
calculated frequency of MPMN in our population sample was 7.38%. There were
43(71.6%) male patients with a mean age of 59±13.1 years at diagnosis of the first
neoplasm and 60±13 years at the second neoplasm. The mean age at diagnosis of
the first neoplasm for females was 63±12.3 and 64±12.6 years for the second. Four
cases with 3 primary malignant neoplasms were found, with a mean age of 64±3.8
years at diagnosis of the third tumor. A first urological neoplasm followed by a non
urological one was the most common presentation. The association of kidney and
prostate neoplasms was the most frequent. The most typical first urological malignant neoplasm was a renal tumor. The most common non urological malignant
neoplasm were gastrointestinal tract tumors. The interval between the first and
second neoplasm for women was 54.96±58.25 months and 58.63±64.4 months
for men. Fifteen(25%) patients had synchronous tumors and 45(75%) had metachronous ones. Age at diagnosis of the first neoplasm (RR= 1.075, CI 1.020−1.13,
p<0.007) and tumor size of the first neoplasm (RR= 1.245, Cl 1.24−1.09, p<0.001)
were significant predictors of survival.
Conclusions: Our series reported a frequency of MPMN of 7.38%. Renal and
prostatic neoplasms were the most common MPMN association in our sample.
Follow up after a first malignant neoplasm is warranted. Age and tumor size are
significant survival predictors.
Poster #16
CARCINOMA OF THE PENIS – STAGE, TREATMENT AND OUTCOME IN A
TERTIARY REFERRAL CENTER
Jerry Trulson, Tyler Haden, Gilbert Ross, Stephen Weinstein, Mark Wakefield,
Naveen Pokala
University of Missouri−Columbia
(Presented by: Jerry Trulson)
Objectives: The purpose of this study is to look at the epidemiological and pathological association of penile cancer as well as the clinical results in patients managed at the University of Missouri Hospital and Clinics (UMHC).
Methods: Records were obtained of patients with a pathological diagnosis of
penile cancer from 2001−2011 at UMHC. These charts were retrospectively reviewed. Information regarding patient demographics, pathology, treatment, and
outcomes were recorded.
Results: A total of 24 patients with penile cancer were identified. Mean age at
diagnosis was 58 years. Twenty−two (92%) of the patients were Caucasian. Thirteen (54%) patients were uncircumcised before puberty. Fifteen (62%) patients
had a smoking history of greater than 10 pack−years. Seven (29%) patients had a
history of HPV infection. Twenty three (96%) patients were diagnosed with squamous cell carcinoma (SCC) while one (4%) patient was diagnosed with a Buschke−Lowenstein tumor. Of the 23 patients diagnosed with SCC, 5 (22%) patients
had CIS, 10 (43%) patients had locally invasive disease, and 8 (35%) patients
had nodal involvement. Three (13%) patients received chemotherapy, and 2 (8%)
patients received radiation therapy. Of the 8 Patients with node positive disease, 4
(50%) were deceased < 5 years after diagnosis (mean time of 8.5 months) whereas none of the patients with node negative disease were deceased < 5 years after
diagnosis.
Conclusions: Penile cancer is a rare malignancy where advanced disease carries
a poor prognosis. Node positive disease is associated with worse survival.
172
Poster #17
SIMULTANEOUS BILATERAL VIDEO ENDOSCOPIC INGUINAL LYMPHADENECTOMY (VEIL) FOR PENILE CANCER: FIRST INITIAL EXPERIENCE
Michael Maccini1, Alexandre Pompeo2, Jarkes Lucio2, Wilson Molina2,
David Sehrt2, Marcos Tobias−Machado2, Fernando Kim2
1
University of Colorado; 2Denver Health Medical Center
173
posters
Objectives: To report the surgical technique, procedural outcomes, and feasibility
of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL) in
the management of patients with indication for inguinal lymphadenectomy.
Methods: VEIL was applied in all patients using the oncological landmarks (the
adductor longus muscle medially, the sartorius muscle laterally and the inguinal
ligament superiorly). A 1.5 cm incision was made 2 cm distally to the lower vertex
of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working
space was insufflated with CO2 at 5−15 mmHg. The final trocar was placed 2 cm
proximally and 6 cm laterally from the first port.
Results: A total of 5 VEIL procedures in 3 patients were performed. Two patients
underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side
due to an enlarged node. All laparoscopic procedures were successfully performed
without conversion and maintained the oncological templates. One lymphocele
occurred in the patient who underwent the open procedure. None of the patients
presented with skin necrosis after the procedure. Mean number of nodes retrieved
was 6 from each side and 2 patients presented with positive inguinal nodes. After
one year of follow−up no recurrences were observed.
Conclusions: Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated
with inguinal lymphadenectomy while maintaining the oncological principles.
Poster #18
RADICAL LYMPHADENECTOMY MODIFIED TECHNIQUE WITH
SHAPE−S INCISION AND USAGE OF PATENT BLUE FOR PENIS CANCER:
A STEP BY STEP APPROACH.
Alejandro González Alvarado1, Luis Alfredo Jimenez Lopez2,
Hector R. Vargas Zamora1, Abel Antonio Ricardez Espinosa1
1
Centro Médico Nacional, UMAE N 14, Adolfo Ruiz Cortinez, IMSS, Veracruz,
México.; 2IMSS
(Presented by: Luis Alfredo Jimenez Lopez)
Objectives: We present a case of Modified Radical Lymphadenectomy with
shape−S1 incision and usage of patent blue, comparing it with the common technique; related to postoperative complications and oncologic effects is presented.
Methods: A Radical Modified Lymphadenectomy was performed in a patient with
penile carcinoma on March 2011. Subcutaneous patent blue (Guebert 2,5%−2ml)
was used, to limit the extended lymphatic dissection; a Shaped−S was performed;
a precise separation of the layers was done, using the anatomical references and
preserving the fascia lata. The surroundings of the dissection are the same as the
ones for the Radical Lymphadenectomy. Survival and morbidity were reported.
Results: 12 months follow−up; with survival of 24 months; T3N1M0; a total of
complications of chirurgical wound infection (+), skin necrosis (−), lymphedema
(+), seroma (+), lymphocele (−), and deep−vein thrombosis (−) were reported. A
total of 13 nodes right side and left surface 12, deep in each side 2, 1 right ganglion
Daseler zone 5 (+). Drains were removed on the third day after the operation, by
spending less than 10 ml per day.
Conclusions: The morbidity related to the inguinal dissection on patients with penile carcinoma, may be reduced and the oncologic effectiveness preserved using
this dissection technique.
Financial Disclosure: None.
174
Poster #19
EARLY BIOCHEMICAL RECURRENCE AND FACTORS RELATED IN PATIENTS
UNDERGOING RADICAL PROSTATECTOMY IN THE SERVICE OF UROLOGY
AT HOSPITAL GENERAL DE OCCIDENTE IN THE PERIOD 2008−2010
Edgar Ivan Ibarra Navarro1, Jose Arturo Rodriguez Rivera2,
Rodolfo Rivas Gomez3, Gilberto Tellez Arce3, Rocio Valenciano Cuevas4
1
Hospital General De Occidente; 2Department of Urology Head Hospital General
Occidente, AUA Member; 3Hospital General Occidente; 4Universidad De Guadalajara
(Presented by: Edgar Ivan Ibarra Navarro)
175
posters
Prostate cancer is one of the major health problems of the male population. Radical prostatectomy has demonstrated an excellent rate of long−term cure.
Objectives: Determine the percentage of patients and the factors involved in the
development of early biochemical recurrence after radical prostatectomy, in the
Department of Urology at the Hospital General de Occidente, Guadalajara, Jalisco; México.
Methods: Retrospective study including 33 patients who were operated for radical
prostatectomy in the period January 2008 to December 2010, in the Department of
Urology, at Hospital General de Occidente. Were taken into account seven parameters to determine the presence of biochemical recurrence: preoperative (prosatic
specific antigen) PSA, PSA velocity, the doubling time of PSA, clinical and pathological stage and Gleason score of the surgical and biopsy. It took into account
the postoperative follow−up PSA every 3 months during the first year and every
six months the following year, on the early biochemical relapse patients who had
control PSA> 0.2 ng / ml (AUA) during the first year after radical prostatectomy. We
excluded 3 patients who had no more than a single PSA measurement.
Results: 5 patients were excluded for not presenting PSA monitoring during the
first year. Six (27%) of the 28 patients who underwent radical prostatectomy at this
institution, presented early biochemical relapse, none had clinical recurrence. Six
patients were negative malignancy (2 NIPBG, 2 NIPAG, 2 BPH). Of all the variables analyzed, we found only a statistically significant difference in pathological
stage (p = 0.002). In the rest of the variables found no significant difference.
Conclusions: The PSA is the “gold standard” for detection of biochemical recurrence in patients undergoing radical prostatectomy. Apparently the starting PSA,
Gleason score of the biopsy and the waiting time between biopsy and surgery did
not influence the detection of early biochemical recurrence. Factors that appear
to influence early biochemical recurrence in general are surgical Gleason and
pathologic stage, but in this group of patients was only found a significant difference for pathological stage. The limitation of the study is the number of patients
included.
Poster #21
A CASE OF GENITOURINARY SCHISTOSOMIASIS IN WEST TEXAS
Johnny Hickson1, Alan Haynes2
1
TTUHSC; 2attending
(Presented by: Johnny Hickson)
Objectives: Genitourinary schistosomiasis is a chronic parasitic disease caused
by the trematode Schistosoma haematobium (S. haematobium). The disease is
predominantly found in the Middle East, Africa, and South West Asia especially
in poor communities with no access to safe drinking water or adequate sanitation1. This affects many people in developing countries, especially children, which
results in major socioeconomic and public health consequences. After Malaria,
schistosomiasis ranks second among human parasitic diseases in terms of public
health and socio−economic importance in these areas.
Methods & Results: Most cases of urinary schistosomiasis regress without treatment or result in mild urinary sequelae. Although, 10% of patients with significant
urinary schistosomiasis will suffer from more chronic symptomatic pathologic forms
of the disease2. Chronic urinary schistosomiasis can result in impaired function of
the kidneys, ureters, and bladder, and may even progress to cause death due to
renal failure or bladder cancer. It is important to address this disease appropriately
in order to curb its effect on population health and the economy.
Conclusions: The purpose of this article is to review the life cycle and disease
process of urinary schistosomes and to discuss the development of a possible
vaccine. A case of urinary schistosomiasis is presented to emphasize the importance of familiarity with this disease as it can be found throughout the world.
176
Poster #22
GENDER AND PROFESSIONAL STATUS INFLUENCE OPINIONS
REGARDING PROFESSIONAL USAGE OF ONLINE SOCIAL MEDIA OUTLETS
IN A MULTI−SPECIALTY ACADEMIC MEDICAL CENTER
Aravind Chandrashekar, Erik Wallin, Alexander Pastuszak, Mimi Zhang,
Michael Coburn, Thomas Smith
(Presented by: Aravind Chandrashekar)
177
posters
Objectives: Social media has introduced new debates within the healthcare community regarding the appropriate usage of internet resources such as Facebook
and Twitter. Previous studies have attempted to propose general guidelines for
physicians using online social networking sites. We describe current opinions
among residents, fellows and attendings in a multi−specialty academic medical
center with regards to professional usage of social media outlets in order to identify
factors that influence these attitudes.
Methods: We composed a survey using a five−point Likert scale consisting of five
demographic questions and twenty questions on the professional versus unprofessional usage of social media sites. Items were grouped into general social media
usage, friend requests, public posts and blogs. The optional questionnaire was
distributed to residents, fellows and attendings at the Baylor College of Medicine
(BCM) and two weeks allotted for completion of the survey between April and May
2012.
Results: 439 complete responses were collected. Trainees and attendings disagree on whether the use of social media generally represents professional behavior except in instances of HIPAA violation or where doctor−patient boundaries
are crossed (residents posting pictures of a patient’s wound, 4.66 vs. 4.79, p=0.11;
residents blogging about patients using identifiable information, 4.93 vs. 4.98,
p=0.12). Men and women disagree on whether establishing social network relationships (residents “friending” students, 2.71 vs. 3.09, p=0.01; residents “friending” hospital staff, 2.78 vs. 3.15, p=0.01) represents professional behavior.
Conclusions: Individuals tend to agree on issues that represent significant violations of HIPAA or other egregious infractions of professional standards such as
the doctor−patient relationship. When considering whether a scenario constitutes
professional or unprofessional behavior, gender, professional status and age tend
to influence opinions. Training level (junior vs. senior), educational status (resident
vs. fellow) and program type (medical vs. surgical) do not appear to influence
opinions. Respondent comments also demonstrate that professionalism is not well
defined and is context dependent, while some embrace social media as a tool for
professional networking.
Poster #23
NATURAL HISTORY OF DETRUSOR LEAK POINT PRESSURE EVOLUTION
IN MYELOMENINGOCELE PATIENTS
Nirmish Singla1, Julian Wan2, David Bloom2, John Park2
1
The University of Texas Southwestern Medical Center; 2Department of Urology,
University of Michigan
Objectives: Detrusor leak point pressure (LPP) has been demonstrated to hold
prognostic value in predicting the clinical course of patients with myelomeningocele. Although the importance of the initial urodynamic evaluation remains undisputed, the appropriate duration to follow these patients urodynamically has not
been established. Some have advocated an imaging−based follow−up beyond 5
years of life. We therefore interrogated the natural history of LPP evolution in myelomeningocele patients to determine whether it would be safe to stop the pressure−based monitoring at some point for patients with myelomeningocele.
Methods: We retrospectively reviewed our urodynamic data for myelomeningocele patients who were followed from 1984 to 2012. Data was collected and analyzed with regard to age, LPP trend over time, risk stratification, comorbidity including vesicoureteral reflux (VUR) and hydronephrosis, and interventions performed.
Results: In our follow−up of 642 myelomeningocele patients between 1984 and
2012, 256 patients (39.9%) have remained low−risk (LPP less than 40 cm H2O),
while 386 (60.1%) were found to be high−risk (LPP greater than 40cm H2O) at
some point. Of those who were categorized as high−risk, 197 patients (51.0%)
started out as low−risk and later converted, while 78 (20.2%) began and remained as high−risk throughout. Mean age for low−to−high risk conversion was
113.8±77.4 months (range 1−349). 56 patients began as high−risk and underwent
unidirectional conversion to low−risk, with mean age 96.7±82.8 months (range
3−340) at conversion. 197 patients had a variable course with multidirectional LPP
fluctuations between low and high risk over time.
Conclusions: Within our 28−year cohort of myelomeningocele patients, approximately 60% were categorized as high risk, of whom half had started as low−risk
and converted, based on the LPP of 40cm H2O threshold. For the patients who
underwent conversion from low to high risk, the mean age of conversion was just
under 10 years of age, but the age at conversion ranged widely from 1 month to
over 29 years of age. We conclude that myelomeningocele patients with low LPP
may not reliably remain low−risk within the defined time frame, and an indefinite
follow−up of these patients is warranted at this time.
178
Poster #24
EPIC ELECTRONIC MEDICAL RECORD AS A PROSPECTIVE DATA
COLLECTION TOOL FOR HYPOSPADIAS RESEARCH
David Chalmers, Georgette Siparsky, Vijaya Vemulakonda, Duncan Wilcox
179
posters
Objectives: The increased use of electronic medical records (EMR) in the United
States provides an opportunity to automatically capture data for research purposes in the course of clinical practice. Studies have suggested that incorporating
data fields throughout clinic note templates in the Epic EMR system can efficiently
gather information in the setting of a pediatric urology practice. The objective of
this study is to evaluate the feasibility and accuracy of integrating research data
fields within the setting of hypospadias repair.
Methods: Patients (age 0−18 years) who underwent primary hypospadias repair
by a single surgeon from April, 2009 to October, 2012 were included. IRB−approved templates with data collection fields specific to hypospadias were used to
collect metrics real−time. Three key hypospadias metrics were chosen for analysis. Meatus location was assessed by selecting among discrete options of “glanular”, “sub−coronal”, “mid−penile”, or “proximal”. Urethral plate was assessed by
selecting among discrete options of “good”, “moderate”, or “flat”. Follow up time
was automatically calculated from operative date to date of last clinic appointment.
Manual chart review was performed to verify completeness and accuracy.
Results: 164 patients who underwent hypospadias repair were available for analysis. Meatus location was automatically captured in 86% of patients. Urethral plate
quality was automatically captured in 84% of patients. The accuracy of the meatus
location and urethral plate information changed in 14% and 22% of patients respectively following automatically collected data from the operative report. 2 patients (1.2%) appeared to have inaccurately reported meatus location upon manual review. Urethral plate quality appeared to be accurate 100% of the time. Follow
up time was automatically captured in 78% of patients and was 100% accurate
when used.
Conclusions: This study suggests that integrated data fields in the clinical template note allows for accurate and complete prospective data collection. The use
of key fields related to hypospadias surgery ranged from 78−86% and was highly
accurate (>90%). The use of EMR templates may significantly aid the ease and
validity of pediatric urologic outcomes research. Further studies are needed to
assess the accuracy and completeness of this method for multicenter research.
Poster #25
COMPUTER ENHANCED VISUAL LEARNING (CEVL) MODULE SIGNIFICANTLY
IMPROVES RESIDENT TRAINING IN A BASIC PEDIATRIC UROLOGY
PROCEDURE: SLEEVE CIRCUMCISION
Mohammad Ramadan1, Bradley Kropp2, Max Maizels3, Blake Palmer2
1
University of Oklahoma HSC; 2Children’s Hospital of Oklahoma, Oklahoma City,
Oklahoma; 3Lurie Children’s Hospital of Chicago, Department of Pediatric Urology
(Presented by: Mohammad Ramadan)
Objectives: We are researching tools to teach and assess pediatric urology resident surgical training because our specialty will need such tools to determine
objectively if trainees have met set standards. Herein, we research the impact of
the Computer Enhanced Visual Learning (CEVL) method on training residents to
perform a basic pediatric urology procedure: sleeve circumcision.
Methods: The study design is a prospective, nonrandomized comparison of training of surgical skills in two groups (CEVL−naïve vs. CEVL−aware). The CEVL−
naïve group prepared for circumcision using traditional methods; the CEVL−aware
group accessed CEVL to prepare for circumcision. For each case, one author (BP)
assessed performance of the 10 procedure components and an inventory of seven
general surgical abilities.
Results: All Urology residents (7) enrolled in the study performed 62 circumcisions
(PGY 2=1, PGY 3=50, and PGY 4=11). Overall, the CEVL−aware group showed
a higher score (mean=92.7) vs. CEVL−naïve (mean=79) (t(48)=5.35, p<0.0005).
Training as assessed by attainment of proficiency and skill required fewer cases
for the CEVL−aware group than the CEVL−naïve group (mean=1 vs. 11.2 cases
for proficiency and 2.6 vs. 15 cases for skill acquisition, respectively).
Conclusions: We show resident utilization of a CEVL module to prepare for
sleeve circumcision improves training as demonstrated by significantly higher surgical performance scores and fewer cases performed in order to attain proficiency
and skill. We propose further research using the CEVL method will help develop
“gold standards”to train pediatric urology residents to do surgery.
Poster #26
WITHDRAWN
180
Poster #27
A CASE REPORT OF PROXIMAL URETERAL STRICTURE IN A PATIENT WITH
PRUNE BELLY SYNDROME
Sarabeth Bailey1, Ismael Zamilpa2
1
UAMS; 2ACH
(Presented by: Sarabeth Bailey)
Poster #28
LEYDIG CELL HYPERPLASIA: ATYPICAL PRESENTATIONS IN A PREPUBESCENT BOY
Bryan Pham, Dung Pham, Christopher Nguyen, David Roth
Texas Children’s Hospital/Baylor College of Medicine
(Presented by: Bryan Pham)
Objectives: Testicular tumors account for about 1% of all pediatric tumors. Leydig
cell hyperplasia accounts for about 1.5−3% of all testicular tumors in prepubertal
boys. Clinical triad includes pseudoprecocious puberty, unilateral testicular mass,
and increased testosterone. Our patient presented without precocious puberty and
a rapidly growing non−palpable mass.
Methods: Patient, an 8−year−old boy, was referred to us because of a right undescended testicle (UDT) and a left testicular mass. Physical exam revealed a right
retractile testicle and a normal left testicle. Outside ultrasound demonstrated left
lower pole mass with dimensions of 4 x 3 x 5 mm (Figure 1). Repeat of the ultrasound 6 weeks later demonstrated dimensions of 11 x 8 x 12 mm (Figure 1). Tumor
markers were all within normal range, but growth rate was concerning for malignancy. Patient was taken to the operating room for possible partial orchiectomy
through an inguinal incision. Partial orchiectomy was not possible due to the size
of the mass. An orchiectomy was performed with high cord ligation. There were
no surgical complications. After pathological diagnosis of Leydig cell hyperplasia
(LCH), patient was referred for an endocrine evaluation.
181
posters
Objectives: Prune Belly Syndrome also known as Eagle −Barrett Syndrome is a
syndrome that consists of three major findings including deficiency of abdominal
musculature, bilateral intra−abdominal testes, and an anomalous urinary tract. We
present the case of a 1−year old African American boy with a history of Prune Belly
Syndrome, solitary right kidney, and worsening hydronephrosis since birth.
Methods: Patient was taken to the operating room where a cystoscopy and retrograde pyelogram revealed a dilated tortuous distal ureter and narrowing of the
proximal ureter consistent with a proximal ureteral stricture. Patient subsequently
underwent open right pyeloplasty and bilateral Fowler−Stephens orchiopexies.
Results: We discuss the clinical presentation, imaging, and outcome of our case.
Conclusions: Proximal ureteral stricture is a very rare anomaly in a patient presenting with Prune Belly Syndrome and has only been reported in one other instance as pyeloureteral stenosis.
Results: Pathological staining coupled with findings of mature spermatocytes confirmed LCH. Gross measurements of the mass correlated with the ultrasound dimensions. Standard hormonal work−up was negative. However, radiographic bone
age determination revealed 2.7 standard deviations above the mean. This value
is equivalent to a bone age of an 11−year−old. Cytogenetics studies revealed an
XY karyotype and no mutation in the luteinizing hormone and choriogonadotropin
receptor (LHCGR gene). At nine−month clinical follow−up, the patient is doing well
with a normal right testicle.
Conclusions: This is only the third reported case of (LCH) in prepubertal boys
without precocious puberty. However,
those 2 reports did not include consecutive ultrasound to document growth. LCH
in this population is believed to be benign, and
partial orchiectomy is advocated. Testicular sparing is predicated on mass location
and percentage of involvement. This was evident in our case. LCH is rare and clinical course is benign. However, vigilance is required with regard to surgical timing.
This could be the factor that determines the feasibility of testicle sparing.
Financial Disclosure: We have nothing to disclose.
Poster #29
WITHDRAWN
Poster #30
WITHDRAWN
182
Poster #31
THE UTILITY OF STANDARD POSTOPERATIVE FEVER TESTING IN
UROLOGIC PATIENTS: A COST EFFECTIVENESS STUDY
Christopher Powell, Paul Guidos, Jeremy Davis, Jeffrey Holzbeierlein
183
posters
Objectives: A standard mantra of surgical principles is the performance of chest
imaging, urinary and blood cultures in the febrile postoperative patient. Limited
data in recent studies involving general, vascular, and thoracic surgery patients
have shown that the vast majority of fevers occurring prior to postoperative day
(POD) 4 are noninfectious in etiology. In an era of increasing interest in cost−containment the utility of such evaluations has been questioned. To our knowledge, no
similar study has been performed on patients undergoing urologic procedures. A
prospective study involving patients with postoperative fever after urologic surgery
was performed.
Methods: Prospective data collection was performed at our institution between
July 2007 and June 2008 on postoperative patients who developed a temperature
greater than 38.5 C. Data recorded included laboratory studies, cultures, imaging
studies, demographics, diabetic status, immunosuppression, lung disease, presence of catheter or invasive monitoring, and type of surgery. Patients were stratified by type of urologic procedure. Patients were subdivided based on a positive
evaluation (pathologic chest radiograph or positive culture) or negative evaluation
and timing of evaluation. Hospital fees were recorded. Chi square and t−test to
were performed. Significant results correlated with a P value <0.05.
Results: 2,906 procedures were performed during the study. Fifty−eight patients
were identified as having a postoperative fever >38.5 C and underwent complete
evaluation which included chest radiograph, urine culture, and 2 sets of blood cultures. 5/58 patients (8.6%) had a positive evaluation within POD 3. Urine cultures
were positive in 14/58 (31.1%) patients however, only 4/58 (7.3%) urine cultures
were positive within POD 3. 4/58 patients (7.3%) had a positive blood culture including 1/58 (1.7%) within POD 3. Correlation was identified between infectious
etiology and positive urine culture in patients presenting with a fever beyond POD
day 3 (p=0.0120), immunosuppression (p=0.0367), absence of a urinary catheter
(p=0.0233) and bowel manipulation (p=0.0043). Chest radiograph was indicative
of infectious process in 3/58 (5.7%) patients. Total cost of fever analysis in all 58
patients was $40,832.
Conclusions: Similar to previous studies, our study demonstrates that there is
little utility to the standard postoperative fever evaluation of chest radiograph and
urine and blood cultures. For this reason we recommend against indiscriminate
use cultures and radiographs in febrile patients within POD 3 following a urologic
procedure. Select patients undergoing urologic procedures which include bowel
manipulation, those with previous trauma or patients febrile after 3 days may benefit from traditional evaluation.
Poster #32
PERCUTANEOUS NEPHROLITHOTOMY IN SPINAL CORD NEUROPATHY
PATIENTS: A SINGLE INSTITUTION EXPERIENCE
Philippe Nabbout, Gennady Slobodov, Adamantios Mellis, Daniel Culkin
OUHSC
Objectives: Patients with spinal neuropathy are at an increased risk for urolithiasis. Data on percutaneous nephrolithotomy (PCNL) in this population are limited.
Our objective is to review our experience in managing stones with PCNL in patients with spinal neuropathy.
Methods: Twenty−one patients with spinal neuropathy underwent PCNL at our
institution between January 2005 and August 2011. Their medical records were
reviewed retrospectively to collect data relating to stone characteristics, treatment
outcomes, and complications.
Results: Forty−two PCNL were performed on 26 kidneys. Five patients had bilateral stones. They were 14 (66.7%) patients with spinal cord injury, 5 (23.8%) with
spina bifida, and 2 (9.5%) with other neurologic abnormalities. There were 90.5%
of patients with preoperative bacteriuria and 47.6% with severe scoliosis (Fig1),
making positioning for PCNL challenging. Complete staghorn stones occurred in
46.2% of kidneys, and 50% of stones were struvite. Only 53.8% of kidneys were
stone free after the first PCNL. The success rate increased to 80.8% after the
second and 88.5% after the third PCNL. Urosepsis developed in three (14.3%)
patients, necessitating admission to the intensive care unit postoperatively. Six
(28.6%) patients needed blood transfusion. One patient had a pneumothorax and
another had a perforation of the collecting system.
Conclusions: Based on our experience, PCNL in patients with spinal neuropathy
had a stone clearance rate comparable with that of the general population. These
patients, however, needed multiple PCNLs to be stone free and had a higher incidence of complications (especially infectious).
184
Poster #33
TESTICULAR SELF EXAMINATIONS: A COST ANALYSIS COMPARISON
Michael Aberger, Bradley Wilson, Jeffrey Holzbeierlein, Tomas L. Griebling,
Ajay Nangia
(Presented by: Michael Aberger)
185
posters
Objectives: The United States Preventive Services Task Force (USPSTF) has
recommended against screening for testicular cancer due to the lack of evidence
that testicular self examination (TSE) or clinician examination gives a better chance
of detecting cancer at a curable stage; the low incidence and high cure rate of the
disease; and harm with associated anxiety from diagnostic tests and procedures
for false−positive results. To date, there has been no cost analysis or validation
for this recommendation. TSE is a non−invasive and cost free screening tool. Our
study was designed to perform a cost comparison for different testicular evaluation
scenarios to determine fiscal effectiveness of early detection screening.
Methods: The average cost of treatment for a missed advanced stage testicular
tumor (both seminomatous and non−seminomatous) was compared to the average cost of six other scenarios involving the clinical evaluation of a testicular mass
discovered during self−examination (4 benign and 2 malignant). Medicare as opposed to regional reimbursement was used as an estimate for a national cost standard. In all scenarios involving a testicular malignancy, we estimated the average
cost of surveillance for ten years following initial diagnosis and treatment.
Results: The total treatment cost for an advanced stage seminoma ($40,476) or
non−seminoma ($40,278) equaled the cost of 263 benign office visits ($153), 150
office visits with scrotal ultrasound ($269), 89 office visits with serial scrotal ultrasounds ($451), 29 office visits resulting in radical inguinal orchiectomy for benign
pathology ($1383) or 3 office visits resulting in detection and treatment/surveillance
for an early stage testicular cancer ($13,750:seminoma, $16,106:non−seminoma).
Conclusions: A 3:1 cost benefit ratio was demonstrated for testicular cancer detected early versus advanced stage disease. A high number of clinical evaluations based on TSE for benign disease can be made compared with one missed
advanced stage tumor. Our analysis may underestimate the fiscal effectiveness
of early evaluation because we were unable to factor the costs associated with
morbidity of extended treatment in advanced cancer, lost work, lost fertility and
psychological morbidities, all of which are higher and cause more anxiety than a
false positive evaluation.
Poster #34
THE EFFECT OF POSTOPERATIVE STENTS ON UPPER TRACT DRAINAGE
IN THE STUDER NEOBLADDER POPULATION
Yasmin Bootwala1, Huong Truong2, Clay Pendleton3,
Graciela Nogueras−Gonzalez1, Ouida Westney1
1
MD Anderson Cancer Center; 2Universtiy of Texas Health Science Center − Houston;
3
University of Texas Health Science Center − Houston
Objectives: As of 2009 greater than half a million people in the USA are living
with bladder cancer. More patients who have surgical resection are selecting orthotopic neobladder urinary diversion if they are appropriate candidates. Ureteral
obstruction is a recognized, morbid postoperative complication occurring in 3−10%
of cases. Two to three weeks postoperatively, cystography is routinely performed
prior to removal of the urethral catheter at which time some patients have indwelling urinary diversion stents and others have had them removed. A refluxing ureteroenteric anastomosis to the afferent limb of the Studer ileal neobladder traditionally refluxes when fully distended. We aimed to identify the presence or absence of
reflux on postoperative cystogram as an indirect measure for upper tract drainage
in ileal neobladder patients.
Methods: We retrospectively reviewed a single institution database of ileal neobladder patients who underwent cystectomy between January 1, 2000 and August
31, 2010. We identified patient demographics, reviewed the first postoperative
cystograms for presence/absence of ureteroenteric reflux and the presence/absence of urinary diversion stents. Any patient without a postoperative cystogram or
no data on presence/absence of urinary diversion stents was excluded. Descriptive statistics and logistic regression models were used to determine if there were
significant differences between groups using STATA/SE v. 12.1.
Results: Of the 405 patients in the neobladder database, the mean age was 60
(range 32 to 80 years). The mean follow up was 43 months (range 0.2 to 142). At
first postoperative cystogram, there were 156 patients with no stents in place and
121 patients with bilateral stents in place. 106 (68%) of patients with no stents in
place had reflux compared to 68 (56%) of patients with stents in place with an odds
ratio of 0.6 (95% CI 0.37 to 0.99, p value = 0.045).
Conclusions: Patients who have urinary diversion stents in place at the time of
first postoperative cystogram have a higher risk of no reflux than patients without
stents in place. The absence of reflux via a refluxing anastomosis with neobladder
distension per cystogram protocol serves as an indirect clinical marker for partial
obstruction at the site of the anastomosis. Reflux occurs at a higher rate in patients
who are not stented, which implies that stent or associated edema may be the
culprit. Therefore, prolonged urinary diversion stents could unnecessarily compromise upper tract drainage across the ureteroenteric anastomosis.
186
Poster #35
THE ROLE OF PREOPERATIVE HEALTH ANALYSIS INDEX IN PREDICTING
POSTOPERATIVE OUTCOMES AFTER TRANSURETHRAL RESECTION OF
THE PROSTATE
Jennifer Dwyer1, Kendra Schmid2, Georgia Seevers3, Vikas Desai1,
Jason Johanning4, Chad LaGrange1
1
University of Nebraska Medical Center, Division of Urology; 2University of
Nebraska Medical Center, Department of Biostatistics; 3VA Medical Center,
Department of Surgery; 4University of Nebraska Medical Center, Division of
Vascular Surgery
(Presented by: Jennifer Dwyer)
187
posters
Objectives: Perioperative morbidity and mortality is a growing concern with
the aging medical population. Transurethral resection of the prostate (TURP) is
commonly performed in elderly and/or frail patients. However, non−surgical management of BPH with medications and catheterization is also an option in those
patients at high risk of perioperative complications or death. At the Omaha VA
Medical Center (VAMC), a Health Analysis Index (HAI) is performed on all surgical
patients preoperatively. The goal of this study is to evaluate the ability of this index
to predict postoperative morbidity and/or mortality in patients undergoing TURP.
Methods: The HAI was prospectively applied to 29 patients scheduled for TURP
between July 2011 and August 2012 at the Omaha VA Medical Center. The index,
based on and scored according to the 6−month MDS Mortality Risk Index−Revised (MMRI−R), requires simple patient questioning regarding co−morbidities
and activities of daily living (ADLs). Scoring was performed and mortality risk was
analyzed against various adverse outcomes within six months postoperatively.
Median scores were compared between those with and without postoperative
complications using a Mann−Whitney test for independent samples.
Results: The mean age of men included in this study was 69.2 (SD 9.2) years.
Two patients were ASA class 2, 26 were ASA 3, and one was ASA 4. Various postoperative outcomes were examined, as demonstrated in the table below. Those
who had a postoperative urinary tract infection (UTI) (p=0.04), Emergency Department (ED) visit (p=0.01), urinary retention (p=0.007), or altered mental status
(AMS) (p=0.03) had significantly higher mortality scores than those who did not.
None of the patients died within six months of surgery.
Conclusions: Overall, the Health Analysis Index accurately identified patients
who were at increased risk for postoperative complications. The ability of the HAI
to predict 6−month mortality was not demonstrable in this subset of patients because there were no mortalities. The HAI may help urologists identify patients
better served with non−surgical management of BPH and may also help predict
postoperative complications.
Poster #36
THE SUPRAPUBIC PROSTATECTOMY: RETROSPECTIVE REVIEW AT A
UNITED STATES RESIDENCY TRAINING PROGRAM
Rowena Desouza1, Daniel Zapata, Run Wang2
1
Assistant Professor of Urology, University of Texas at Houston; 2Professor of
Surgery, Division of Urology, University of Texas at Houston
(Presented by: Rowena Desouza)
Objectives: Since the introduction of minimally invasive procedures, the use of
open suprapubic prostatectomy has declined. There is a paucity of literature from
the United States on the utility and outcomes of suprapubic prostatecomy. For this
reason, we evaluated our experience to assess intraoperative and post−operative
complication rates in our teaching institution.
Methods: We retrospectively reviewed suprapubic prostatectomies at a county
hospital and a semi−private hospital over a 5 year period (2008−2012) done by
two attending urologists. We measured post−operative complication rates specifically erectile dysfunction, urinary incontinence, wound infection, urethral stricture
and urinary tract infection. We also reviewed pre−operative prostate sizes and
estimated blood loss. Finally, the demographics for Harris County were evaluated
to assess the population of the study.
Results: The demographic breakdown of patients who underwent suprapubic
prostatectomy includes 42.85% f Hispano−Latino population, 21.42% African
American, 7.14% Asian and 28.57% White/Caucasian. The major factor for choosing suprapubic prostatectomy as the treatment of choice was prostate size with a
mean of 96.32 grs with mean age of 65.32 years old. There were no intraoperative
complications noted. Post−operative complications included: erectile dysfunction
28% (4 out of 28), urinary incontinence 10.71% (3 out of 28), wound infection 3.5%
(1 out of 28), urethral stricture 3.5% (1 out of 28), urinary tract infection 7.14% (2
out of 28). The overall post−operative complication rate was 21.42% (6 out of 28).
Mean blood loss was 460.71cc.
Conclusions: Based upon our results, we strongly believe that suprapubic prostatectomy remains a good treatment option for patients with Benign Prostate Hyperplasia/Lower Urinary Tract Symptoms. Specifically it remains a satisfactory option
for patients in a county system who desire to avoid costly medications and/or the
potential for repeated surgeries. The complication, albeit higher than with minimally invasive treatments, does not preclude its utility in this setting and should at least
be offered to the patient. Moreover, open suprapubic prostatectomy should remain
in the armamentarium of urology residency training. It is important to continue to
review outcomes of procedures that we perform so that we can reassess their
utility and benefit for patients.
188
Poster #37
TRIAMCINOLONE INJECTION VS FULGURATION FOR TREATMENT OF
HUNNER’S ULCER−TYPE INTERSTITIAL CYSTITIS: PRELIMINARY RESULTS
OF A PROSPECTIVE RANDOMIZED TRIAL
Janine Oliver, Carl Klutke
(Presented by: Janine Oliver)
189
posters
Objectives: Classic interstitial cystitis (IC) is characterized by Hunner’s ulcers and
affects 5−10% of all IC patients. While both fulguration and steroid injection of
Hunner’s ulcers have been described as successful treatments, to date no studies
have compared these options. We sought to compare treatment response and
duration between these two therapies for Hunner’s ulcers.
Methods: Patients presenting with Hunner’s ulcer IC were recruited for the study
beginning in January 2012. We included patients with urgency, frequency, and
chronic pelvic pain consistent with IC as well as a cystoscopy and biopsy confirming the presence of Hunner’s ulcers. Patients were excluded if they had an active
urinary tract infection, history of bladder malignancy, recent bladder surgery, allergy to triamcinolone, or were pregnant or unable to undergo anesthesia.
Patients were randomized 1:1 to either fulguration using electrocautery or triamcinolone injection (10 ml of triamcinolonce acetonide, 40 mg/mL). Patients were
blinded to the type of procedure they received. The surgeon was blinded to the
type of procedure until just prior to the start of surgery in the operating room.
Treatment response was evaluated using 48 hour voiding diary and validated
questionnaires including the Pelvic Pain and Urgency/Frequency (PUF) symptom
scale, the IC Symptom and Problem Questionnaire (ICSPQ), and the Patient Global Impression of Change (PGIC) and were prospectively administered monthly
following the procedure.
Results: Of 10 patients recruited to the study thus far, average age is 68 years,
8 patients are female, and 2 are male. Follow−up data was only available in 4 patients in the triamcinolone arm and 2 patients in the fulguration arm. Patients who
received triamcinolone injection had an average improvement of 7.7 points on the
PUF symptom scale at 1 month postoperatively. At 3 months postoperatively, the
average PGIC score was 6.75 in the triamcinolone group vs. 5.5 in the fulguration
group. There was a trend toward persistent improved ICSPQ score up to 6 months
postoperatively in the triamcinolone group which was not seen in the fulguration
group. The number of voids per day was relatively unchanged in both groups.
Conclusions: While the number of patients evaluated thus far limits any definite
conclusions, our preliminary results agree with prior studies that submucosal injection of triamcinolone for Hunner’s ulcer IC offers improvement in patient symptoms
and quality of life. We await further results of this study which will allow better
comparison of these treatment options.
Financial Disclosure: None.
Poster #38
PUBLIC PERCEPTION AND AWARENESS ABOUT BLADDER CANCER
Bradley Wilson, Katie Murray, Kacey Provanzano, Jeffrey Holzbeierlein,
Moben Mirza
Objectives: Bladder cancer (BCa) is the fourth and eighth most common cancer
in men and women, respectively. Public awareness of this cancer is lacking. Patients with BCa are often unaware of risk factors. The purpose of this study was to
elucidate public perceptions of BCa.
Methods: We developed a survey that examined public awareness of BCa. We
presented 11 questions to an unscreened population of a large metropolitan area.
Information obtained includes age, educational level, and a known family member
with BCa. Participants were presented questions regarding risk factors for BCa,
age and gender of people affected, as well as aggressiveness. In an open ended
question, participants listed what they thought could cause bladder cancer and
the same question was repeated for lung cancer. Participants were then able to
choose suspected symptoms and causes of BCa from a list.
Results: 216 people participated in the survey. 14 were <18 years of age, 74 were
18−30 years, 56 were 31−50 years, and 72 were >50 years. 67 had a high school
education or less, 89 had a college degree, and 60 had a graduate degree. Only
10 participants knew someone with BCa. The majority identified women as more
often affected by BCa (58%) and believed that most patients affected were less
than 50 years of age (57%). Overwhelmingly, participants identified BCa as moderately or highly aggressive (63%). Only 24% identified smoking as a risk factor,
while 96% identified smoking as a risk factor for lung cancer. In a multiple−choice
question, 93% selected blood in the urine as a symptom, and 70% identified Urologists as the physicians who treat BCa. Participants with a graduate degree more
reliably identified smoking as a cause of BCa; however, the response in this group
was still modest at 33%. Only those with a friend or family member diagnosed with
BCa consistently associated smoking, age >50, and male gender with the disease.
Conclusions: This study demonstrates a lack of public awareness regarding
bladder cancer. In particular, the public is unaware of the relationship of smoking
with BCa, which is in stark contrast to lung cancer. We found a misconception
regarding alcohol and artificial sweeteners causing BCa. As expected, persons
with advanced degrees appeared to be somewhat more aware of risk factors and
demographics of BCa. In order to improve outcomes in bladder cancer and affect
changes in trends of bladder cancer, public awareness and education are critical.
190
Poster #39
SHORT−TERM QUALITY OF LIFE OUTCOMES AFTER ROBOTIC PELVIC
FLOOR RECONSTRUCTION WITH SACROCOLPOPEXY
Igor Kislinger, Prashanth Kanagarajah, Isabel E Lopez, Edward L Gheiler,
Fernando J Bianco
Poster #40
WITHDRAWN
191
posters
Objectives: The Urine Distress Inventory (UDI6) represents a valuable validated
tool to assess urine function quality of life. We aimed to explore short−term quality of life changes (QOL) after Robot Assisted Sacrocolpopexy with Pelvic Floor
Repair.
Methods: Patients with pelvic floor relaxation who opted for robotic pelvic floor
reconstruction with or without hysterectomy with sacrocolpopexy were provided
the Urine Distress Inventory (UDI6) with two additional questions: a – number of
pads wore on a daily basis and b− overall assessment of urinary function. The
same questionnaires were provided to patients 2 to 4 weeks after their surgery.
We aimed to determine the changes in QOL after robot−assisted sacrocolpopexy
with Pelvic Floor Repair.
Results: Thirty−two women underwent robotic pelvic floor reconstruction with sacrocolpopexy between April 2011 and
October 2012. Robotic hysterectomy was performed concomitantly in 8 of them
and no one had a sling procedure. A total of 27
(84%) of these responded the questionnaires before and within a month of surgery. Preoperatively, 78% (21/27) reported urinary incontinence, this improved to
37% (10/27) postoperatively, fisher exact, p=0.2. However, for questions 2−6 of
the UID−6 statistically significant improvements in scores were seen. Paired differences for Q2 (−1.37, p<0.01); Q3 (−1.11, p<0.01); Q4 (−1.30, p<0.01); Q5 (−0.82,
p<0.01); Q6 (−0.63, p=0.03). Q7 that assesses pain or discomfort in the lower
abdomen showed an insignificant increase of 0.12 (p=0.5) after surgery. Urinary
function perception showed the highest paired difference (greater improvement)
−2.15, p<0.01 after Surgery.
Conclusions: Within a month from Robotic pelvic floor reconstruction with or without hystectectomy with sacrocolpopexy a substantial improvement in urinary QOL
outcomes is observed.
Poster #41
FEASIBILITY OF OBTAINING BIOMARKER PROFILES FROM ENDOSCOPIC
BIOPSY SPECIMENS IN UPPER TRACT UROTHELIAL CARCINOMA:
PRELIMINARY RESULTS
Aditya Bagrodia, Bishoy Gayed, Mansi Gaitonde, Ramy Youssef, Payal Kapur,
Arthur Sagalowsky, Yair Lotan, Vitaly Margulis
Objectives: Molecular markers have been shown to predict pathologic and oncologic outcomes in patients undergoing nephrouterectomy (NU) for upper tract urothelial
carcincoma (UTUC). The feasibility of obtaining biomarker profiles from endoscopic
biopsy specimens has not been demonstrated. We prospectively evaluated feasibility
of obtaining reliable histochemical assessment of cell−cycle biomarkers from endoscopic biopsy specimens of UTUC patients.
Methods: Ten patients were available for evaluation and comparison of biopsy and
NU biomarker profiles. Biopsies were obtained using various endoscopic techniques.
Patient and tumor characteristics were recorded and primary tumors were prospectively evaluated for immunohistochemical expression of a panel including 5 biomarkers: p21, p27, p53, Cyclin E, Ki−67/pRb. Unfavorable biomarker score was defined as
>2 altered markers.
Results: All patients underwent successful biomarker staining of endoscopic biopsies.
Median age was 71 years (range 53−82) and 90% were male. Median follow−up was
5 months (range 1−40). 7/10 (70%) of the tumors were organ confined (T<2 N0) and
all were high grade. At the time of analysis, 2/10 (20%) patients had recurred and
died. Alterations in biopsy and NU biomarkers are shown in Table 1. An overall concordance rate of 70% was seen between biopsy and NU biomarker scores. 6/8 (75%)
and 0/2(0%) patients with favorable and unfavorable biopsy biomarker scores were
recurrence free, respectively. 6/7 (86%) patients with favorable NU biomarker score
were recurrence free while 1/3 (33%) patients with unfavorable NU score had recurred
at the time of analysis.
Conclusions: Preliminary results suggest that obtaining interpretable biomarker profile of ureteroscopic biopsy specimens is feasible. Tumor heterogeneity and limited
biopsy material may account for the discordance between biopsy and NU specimens.
Meaningful biopsy biomarker profiling could serve as a powerful tool for individualizing
treatment regimens and augmenting current predictive variables. Further studies are
needed to evaluate clinical applicability.
192
Poster #42
PROGNOSTIC ROLE OF CELL CYCLE AND PROLIFERATIVE BIOMARKERS
IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA
Aditya Bagrodia, Bishoy Gayed, Ramy Youssef, Payal Kapur, Oussama Darwish,
Laura−Maria Krabbe, Arthur Sagalowsky, Yair Lotan, Vitaly Margulis
193
posters
Objectives: Cell cycle regulatory molecules are implicated in various stages of
carcinogenesis. In this study we systematically evaluate the association of aberrant expression of cell cycle regulators and proliferative markers on oncological
outcomes of patients with clear cell renal carcinoma (ccRCC).
Methods: Immunohistochemistry for Cyclin D, Cyclin E, p16, p21, p27, p53, p57
and Ki67 was performed on tissue microarray constructs of 452 patients treated
with extirpative therapy for ccRCC between 1997−2010. Clinical and pathologic
data elements were collected and entered in to an IRB approved database. Univariate and multivariate Cox regression models were used to analyze predictors
of disease free survival (DFS), and cancer specific survival (CSS). A prognostic
marker score (MS) was defined as unfavorable if >4 biomarkers were altered. The
relationship between MS and pathological features and oncological outcomes was
evaluated.
Results: Median age and follow up was 57 years (range 17−85) and 24 months
(range 6−150), respectively. Unfavorable MS was found in 55 (12.2%) patients
and was associated with adverse pathological features, including advanced T
stage, high Fuhrman Grade, metastases, lymph node positivity, tumor necrosis,
lymphovascular invasion, extraparenchymal extension, venous thrombous, and
sarcomatoid differentiation. A significant correlation between unfavorable MS and
DFS (HR 26.62, 95% CI 43.38−100.04, p = 0.001) and with CSS (HR 8.15, 95%
CI 74.42−101.56, p = 0.004) was demonstrated in Kaplan Meier survival analysis
(Figure 1). In a multivariate analysis, unfavorable MS was an independent predictor of DFS (HR 2.63, CI 1.08−6.38, p = 0.033).
Conclusions: The cumulative number of aberrantly expressed cell cycle and proliferative biomarkers correlates with aggressive pathological features and inferior
oncologic outcomes in patients with ccRCC. Further research is needed to determine clinical applicability.
Poster #43
TRANSCRIPTION FACTOR SPDEF REGULATES AGGRESSIVE PHENOTYPE
IN PCA BY MODULATING E−CADHERIN EXPRESSION
Mintu Pal1, Sweaty Koul1, David Crawford1, Hari Koul2
1
CUSOM; 2CU School of Medicine
Objectives: Loss of E−Cadherin is one of the key steps in tumor progression. Our
previous studies demonstrate that SAM Pointed Domain ETS transcription Factor
(SPDEF) inhibited prostate cancer metastasis. However, the mechanism by which
SPDEF modulates its actions is not completely understood. In the present study,
we investigated the relationship between SPDEF and E−Cadherin expression in
an effort to understand the mechanism of action of SPDEF in cell migration and
invasion.
Methods: Prostate cancer cells were obtained from ATCC and were grown in the
RPMI−1640 medium, supplemented with 10 % FBS. The cells were cultured at
37 °C and 5 % CO2 in a humidified incubator. Human SPDEF was cloned into
pBABE vectors and cell migration, invasion and other properties were studied as
previously described by our group. Gene expression was evaluated by qRT−PCR
and protein expression by western blot and immunofluorescence staining. Interaction study of SPDEF transcription factor with the proximal E−Cadherin promoter
was performed by chromatin immunoprecipitation (ChIP) and promoter luciferase
assays.
Results: Our findings demonstrate a direct correlation between expression of E−
Cadherin and SPDEF in prostate cancer cells. Additional data demonstrate that
modulation of E−Cadherin and SPDEF had similar effects of cell migration/invasion. We also show that stable forced expression of SPDEF results in increased
expression of E−Cadherin, while as, down−regulation of SPDEF decreased E−
Cadherin expression. In addition, we demonstrate that SPDEF expression is not
regulated by E−Cadherin. Moreover, our chromatin immuno−precipitation and luciferase reporter assay revealed that SPDEF occupies E−Cadherin promoter site
and acts a direct transcriptional inducer of E−Cadherin in prostate cancer cells. In
addition, siRNA mediated knock down of E−Cadherin was sufficient to block the
effects of SPDEF on cell migration and invasion, suggesting a critical role for E−
Cadherin expression in mediating the effects of SPDEF.
Conclusions: Results provide a potential mechanism by which SPDEF suppresses cancer progression and metastasis, in part by directly modulating E−Cadherin
expression. Thus decreased expression of SPFEF and E−Cadherin may serve
not only as indicators of aggressive prostate cancer, but may also serve as novel
targets in management of aggressive prostate cancer and perhaps other malignancies.
194
Poster #44
SALVAGING SEVERELY DAMAGED RENAL ALLOGRAFTS WITH SYNTHETIC
MESH RENORRHAPHY AND NEOCAPSULE RECONSTRUCTION
Adam Mellis, Nathan Bradley, Blake Palmer, Bradley Kropp, Martin Turman,
Puneet Sindhwani
195
posters
Objectives: In an effort to expand the donor pool and narrow the gap between
renal allograft supply and demand, organs are now being utilized from non−heart
beating donors, expanded criteria donors, and other unconventional donors. Conventionally most of the injured renal allografts, such as with Grade 2 /3 renal parenchymal lacerations, capsular loss and total denudation of renal allograft were not
considered fit for transplantation due to concerns for post−operative hemorrhage,
urinoma and other severe complications that can ultimately lead to allograft loss.
These allografts are usually discarded or lost. In the transplant literature there is
no information available about salvagability, technique of repair, complications and
outcomes of such organs. We present our technique, postoperative imaging and
long term outcome in cases where damaged renal allografts that were salvaged
and transplanted using woven Polyglactin mesh.
Methods: In this technique, off−the−shelf 12x12 inch polyglactin 910 (Vicryl ®)
hernia mesh was fashioned around the kidney providing a non−constricting outlet
for the hilar vessels and the ureter to salvage allografts that had been damaged
due to donor or recipient factors. The two tails of above fashioned mesh then were
wrapped at the convex border of the allograft, closed with a running suture. The
technique was used in the following scenarios: i) Allograft with severe unidentified
capsular damage from repeated SWL for stone disease in the donor that ruptured
at post−transplant reperfusion ii) Allograft with unrecognized grade 3 traumatic laceration and calyceal injury, identified due to expanding hematoma post−perfusion
iii) Thrombophilic pediatric patient on anticoagulation with allograft damage and
total capsular denudation due to iatrogenic laceration with a needle used to drain
lymphocele. These three patients underwent successful transplantation, requiring
no adjustment to their immunosuppression. Postoperatively, ultrasonography was
successfully used to image these allografts. Close blood pressure monitoring was
done to rule out any development of compression causing Page Kidney.
Results: Using this technique, all three allografts were salvaged and no patient
developed complications of Page kidney, obstructive hydronephrosis, hemorrhage
or graft loss at follow up of 64, 15, and 27 months.
Conclusions: By adapting a technique previously utilized for managing renal trauma, we were able to achieve hemostasis, reverse renal failure, and provide a
scaffold on which a new capsule could proliferate, without surgical complications.
This easy to perform technique enabled us to salvage allografts that would have
been potentially lost.
Poster #45
ARE GENITOURINARY MALIGNANCIES MORE COMMON AND MORE
AGGRESSIVE IN ORGAN TRANSPLANT PATIENTS COMPARED TO THE
GENERAL POPULATION?
Vikas Desai1, Sudhir Isharwal1, Michael Morris2, Chad LaGrange1, Jue Wang3
1
University of Nebraska Medical Center, Division of Urology; 2University of
Nebraska Medical Center, Division of Transplant Surgery; 3University of Nebraska
Medical Center, Division of Oncology and Hematology
(Presented by: Vikas Desai)
Objectives: Prior studies have indicated an association between immunosuppression and an increased incidence of malignancies. However, few studies have investigated the effect of prolonged immunosuppression in organ transplant patients
and their increased risk of developing genitourinary (GU) malignancies. In this
study, we reviewed the incidence and characteristics of GU malignancies after
organ transplantation.
Methods: We performed a retrospective review of all patients in the University of
Nebraska Medical Center (UNMC) tumor registry and UNMC section of Hematology/Oncology database between 1991−2011 to identify all patients who underwent
organ transplantation (i.e. kidney, liver, heart, and bone marrow) and had been
diagnosed with GU malignancies (i.e. kidney, bladder, and prostate). Primary end
points included pathologic stage at diagnosis and treatment, time elapsed since
transplantation to diagnosis, treatment type, and incidence stratified amongst the
various types of GU malignancies compared to that seen in the general population.
Results: 6865 patients underwent organ transplantation at UNMC from 1991−2011.
From this cohort, 91 patients were identified with GU malignancies with a cumulative incidence of 1.320 %. Incidence of renal malignancies in our data was 0.724%,
incidence of prostate malignancies was 0.422 %, and incidence of bladder malignancies was 0.174 %. Where as the cumulative incidence of GU malignancies in
the general population calculated from the Surveillance, Epidemiology, and End
Results (SEER) data was found to be 0.191%. Similarly, the incidences of renal
malignancies of 0.015%, prostate malignancies of 0.155%, and bladder malignancies of 0.021% in the general population were drastically lower than that seen in
our study. The mean time to diagnosis of all GU malignancies after organ transplantation was 9.2 years. The average time to diagnosis after organ transplantation for renal malignancies was 8.4 years, for prostate malignancies was 8.7 years
and for bladder malignancies was 14.8 years. Most of the renal and prostate malignancies were diagnosed as pathologically localized. On the contrary, most of the
bladder malignancies were high grade invasive compared to non−invasive disease
being primarily diagnosed in the general population.
Conclusions: The increased incidence of GU malignancies and presentation at a
higher stage for bladder cancer is likely due to immunosuppression in transplant
patients and warrants closer follow−up and a lower threshold for diagnostic evaluation.
196
Poster #46
IMPROVEMENT OF LIVING DONOR’S GLOMERULAR FILTRATION RATE
AFTER ONE MONTH IS RELATED TO RECIPIENT’S GLOMERULAR
FILTRATION RATE AFTER ONE YEAR
Christian Villeda Sandoval, Ashmar Gomez Conzatti y Martínez,
Denny Lara Núñez, Gerardo Guinto Nishimura, Francisco Rodríguez Covarrubias,
Bernardo Gabilondo Pliego
197
posters
Objectives: Renal function behavior of the donor patient after nephrectomy seems
to be related to recipientÂ´s short− and long−term renal function. The objective of
this study is to determine if there is relationship between donor and recipient renal
function after renal transplantation.
Methods: A retrospective review of our institutional prospectively maintained renal
transplant database was performed. Donor−recipient couples were selected for
analysis. Estimated glomerular filtration rate (eGFR) using the CKD−EPI formula
was calculated. Preoperative and 1 month postoperative eGFR from the donor
was used to calculate the improvement in eGFR (“GFRd improvement”). eGFR
for the recipient (GFRr) was calculated at 1 and 2 years follow−up. “GFRd improvment”was classified in 3 groups as: 1) a decrease <20% or any increase, 2)
a decrease >20% but <40%; and 3) a decrease >40%. GFRr was dichotomized in
two groups with 60 ml/min as cut−off point. GFRr differences according to “donor
change”groups were calculated. A logistic regression analysis was done to define
the impact of “donor change“ groups in GFRr.
Results: Ninety−six donor−recipient couples were identified. Preoperative and 1
month postoperative donor eGFR were 105.9 ± 16.4 ml/min and 72.5 ± 15.4 ml/
min, respectively. Mean “GFRd improvement”was −34.4 ± 14.4%. GFRr was 72.8
± 20.6 ml/min at year 1 and 79.5 ± 27.6 at year 2 of follow−up. GFRr according
to “GFRd improvement”groups was 81.47 ± 11.3 ml/min for group 1, 78.9 ± 20.0
for group 2 and 63.9 ± 19.5 for group 3 (p=0.01). A significant correlation between “GFRd improvement”and GFRr at year 1 was found (Rho=0.252, p=0.04).
No correlation was found with GFRr at year 2. Using a logistic regression analysis,
“GFRd improvement”classification is a predictor of GFRr >60 ml/min at year 1 (HR
3.879 CI 1.327−11.335, p=0.013).
Conclusions: A sooner improvement of eGFR from donor patients in the first
month after donor−nephrectomy is a significant predictor of better eGFR in the
recipient after the first year from the transplant.
Poster #47
INCIDENCE OF THROMBOPHILIA IN AUTOIMMUNE VERSUS ANATOMIC
CAUSES OF PEDIATRIC END STAGE RENAL DISEASE (ESRD) PATIENTS
Adam Mellis, Marshall Shaw, Blake Palmer, Martin Turnman, Puneet Sindhwani
Objectives: In the pediatric renal transplant population, thrombophilic states can
lead to vascular complications. Literature addressing pre−transplant thrombophilia
incidence and screening in this population is sparse with no data examining the
incidence of thrombophilias across various etiologies of ESRD. The goal of our
study is to compare the thrombophilia incidence between anatomic (group A) vs.
autoimmune (non−anatomic group NA) categories of ESRD and to examine their
transplant outcomes. Our hypothesis is that thrombophilia will be more prevalent
in NA group of patients with worse graft outcomes.
Methods: A retrospective chart review was performed on all patients referred for
renal transplantation at our institution. Since 2005 thrombophilia screening was
performed on all referred pediatric ESRD patients. Patients with congenital dysplastic, reflux nephropathy, valve or exstrophy bladder as cause of ESRD were
categorized as anatomic group (A) and were compared with group of patients who
had ESRD due to autoimmune etiologies, glomerulonephritidis, and atypical HUS
(NA). These patients were managed post operatively with anticoagulation according to their coagulation risk profile. The incidences, types of thrombophilia (genetic
vs. non−genetic), and graft outcomes were compared between these categories.
Results: 63 patients were analyzed (mean age 11.2 years). 22/63 (35%) patients
were found to have one or more thrombophilia risk factors. 7 patients had unknown
causes of their ESRD, 33 patients were in group A, and 23 patients in group NA.
12/23 (52%) in the NA group and 9/33 (27.3%) in the A group, (p <0.05) and 1/7
(14.3%) in the unknown etiologic categories were found to have thrombophilia.
No difference in transplant outcomes was observed between groups A and NA or
those with and without thrombophilia. Most common thrombophilic defect in group
NA was Lupus anticoagulant in group A was MTHFR gene mutation
Conclusions: There was a high incidence of undetected thrombophilia in our
pediatric ESRD population when compared to the general population. This risk
is higher patients with ESRD of Non Anatomic etiology with a relatively higher
prevalence of lupus anticoagulant. High incidence with MTHFR was found in anatomic causes. By identifying and using postoperative anticoagulation based on
pre−transplant thrombophilia screening leads to equivalent transplant outcomes in
these two categories.
198
Poster #48
A REVIEW OF THE TREATMENT OF RENAL ANGIOMYOLIPOMAS
WITH MAMMALIAN TARGET OF RAPAMYCIN INHIBITORS IN PATIENTS
WITH TUBEROUS SCLEROSIS COMPLEX OR SPORADIC LYMPHANGIOLEIOMYOMATOSIS
Corinne Puzio, Puneet Sindhwani
Oklahoma University Health Science Center
(Presented by: Corinne Puzio)
199
posters
Objectives: The treatment of renal angiomyolipomas (AMLs) in patients with tuberous sclerosis complex (TSC) or sporadic lymphangioleiomyomatosis (sLAM)
has historically been limited to angioembolization or surgical resection. Patients
who develop multiple or large AMLs may have significant deterioration of renal
function and require multiple invasive treatments. The discovery of the molecular
processes underlying TSC−associated AMLs led to new treatment modalities, including mammalian target of rapamycin (mTOR) inhibitors, which offer systemic
treatment impacting several of the manifestations of TSC and sLAM. Clinical trials
are limited by the low incidence of these diseases. We investigated the available
data concerning use of mTOR inhibitors specifically concerning treatment of renal
AML.
Methods: Using OVID Medline, we performed a literature search for the terms
“angiomyolipoma”AND either “rapamycin OR sirolimus”and “everolimus”limited to
“English Language”, “Humans”, and “Therapeutics”. “Rapamycin OR sirolimus”returned 397 results with 7 relevant publications; “everolimus”returned 101 results
with 2 relevant studies. We screened these for abstracts and articles containing
case reports and larger treatment series and reviewed these studies for number
of patients treated, medication administration and dosing adjustment parameters,
duration of treatment, screening, and results with regard to decrease in target
AMLs size and incidence of hemorrhage, tolerability of medication, and complications and adverse events.
Results: The aggregated data returned 254 patients. 97 were treated with sirolimus and 157 with everolimus. 2 patients treated with sirolimus had at least one
lesion which did not respond. 2 treated with sirolimus had renal hemorrhages.
Several studies used a lower dose of sirolimus (1−6 ng/ml trough serum level)
titrated up (10−15 ng/ml) if a sufficient response was not seen after between 2 and
6 months of treatment. Everolimus was used at 5−15 ng/ml trough serum level in
78 patients and 10 mg/day in 79 patients. Of 34 patients followed after medication
was withdrawn 15 had progression of lesions, 18 remained stable, and 1 had sustained response.
Conclusions: mTOR inhibitors show promise as a systemic treatment for renal
AML associated with TSC and sLAM. The ideal dose and length of treatment is not
established. There is not sufficient evidence to determine whether this treatment
can decrease incidence of hemorrhage, preserve renal function, and prevent need
for invasive procedures.
Agenda
T. Leon Howard Education and Research Fund of the
1:00 p.m. – 1:30 p.m.
I.
Call to Order – Allen F. Morey, MD
II.
Minutes of Last Meeting – Jeffrey M. Holzbeierlein, MD
October 27, 2012, Colorado Springs, CO
III.
Treasurer’s Report – Timothy D. Langford, MD
IV.
Old Business
V.
New Business
VI.
Announcements
VII.
Adjourn
200
EDUCATION AND RESEARCH FUND OF THE
SOUTH CENTRAL SECTION OF THE
AMERICAN UROLOGICAL ASSOCIATION, INC.
NOTES TO FINANCIAL STATEMENTS
JANUARY 31, 2013 AND 2012
annual
reports
201
202
Agenda
1:00 p.m. – 1:30 p.m.
I. Call to Order – Allen F. Morey, MD
II. Minutes of Last Meeting – Jeffrey M. Holzbeierlein, MD
October 27, 2012, Colorado Springs, CO
III. Treasurer’s Report – Timothy D. Langford, MD
IV. Secretary’s Report – Jeffrey M. Holzbeierlein, MD
V. Committee Reports
A.
B.
C.
D.
E.
VI. Bylaws Committee – Damara L. Kaplan, MD
Historical & Necrology Committee – Robert E. Donohue, MD
Past President’s Committee – Randall B. Meacham, MD
Program Committee Report – Charles A. McWilliams, MD
Future Meetings Committee Report
AUA Committee Reports
A.
Representative to Executive Board –
J. Brantley Thrasher, MD
B. Representative to AUA Nominating Committee –
Anthony Y. Smith, MD
VII.
Old Business
VIII.
New Business
A.
Nominating Committee – Randall B. Meacham, MD
B. Election of Officers
C. Election of Member-at-Large for 2012 Nominating
Committee
D. Presentation of Applications for Membership –
Charles A. McWilliams, MD
E. Installation of New President 2013 – 2014
IX.
X.
Announcements
Adjourn
203
annual
reports
SOUTH CENTRAL SECTION OF THE
AMERICAN UROLOGICAL ASSOCIATION, INC.
NOTES TO FINANCIAL STATEMENTS
JANUARY 31, 2013 AND 2012
204
annual
reports
205
MEMBERSHIP SUMMARY REPORT
Report date: 09/04/2013
ACTIVE
Active Member995
Active Member – Fast Track – Transfer Internal 1
Active Member – Transfer Internal
1
Active Member – Transfer into Section
8
Total Active
1005
Allied
Allied Member
Total Allied
ASSOCIATE
Associate Member
Total Associate
1
1
89
89
HONORARY
Honorary 25
Total Honorary 25
SENIOR
Senior Member378
Senior Member – Transfer Internal 11
Total Senior389
GRAND TOTAL MEMBERSHIP
206
1509
Membership Candidates and Transfers
Report Date: 09/4/2013
*Application Not Complete
FT
AUA Fast Track Application
CANDIDATES FOR MEMBERSHIP
Active
MEMBERSHIP CANDIDATES
AND tRANSFERS
Acuna Barreda, Victor
Ampie, Juan Carlos
Arguedas, Glenda
Astorga, Ronald
Azua, Gonzalo
Barrantes, Gabriela
*Becerra Cardenas, Jaime
Bravo, Moises
*Camacho Trejo, Victor
Cantrill, Christopher
Cardoza Sanchez, Edward
Chavez, Ana Isabel
*Chon, Chris
*Dall’Era, Joseph
Denson, Melody
Duffey, Branden
Etienne, Adolfo
Fernandez Cruz, Jayme
Fernandez Marquez, Jorge Fernando
Fletes, Carlos
Fonseca, Henry
Fuentes, Alberto
Fuerst, Donald
Garza Montufar, Maria
Garzona, Danilo
* Girdler, Benjamin
Gomez, Alvaro
Gonzalez Cosio, Ricardo
Gonzalez Perez, Alejandro
Grunhaus, Arieh
Guzman, Alvaro
* Hakim, Samuel
Hernandez, Adrian
Herrera-Gonzalez, Gerardo
Huang, Cook John
Hurtado, Rommell
Jara, Manuel
Jimenez, Konrad
* Karam, Jose
* Kavoussi, Parviz
Knight, James
Lai, Henry
207
Leon, Carl
Lopez Falcony, Rodrigo
Lopez Valenzuela, Rafael
Madrid, Sonia
Maldonado-Alcaraz, Efrain
Medal, Rodolfo
Melendez, Javier Ruben
Merizalde Palomino, Jorge Walter
Mora, Kara
Morales Arcaute, Rafael
Murcia, Osvaldo
Neira, Carlos
*Novak, Thomas
Olivares, Denis
Orlich, Claudio
Otero-Garcia, Jose Manuel
Pacheco, Jose
Porta, Jorge
* Quayle, Sejal
Rivas, Francisco
Rodriguez Bolanos, Johnny
Rodriguez, Andres
Rodriguez, Carlos
Romo Sanchez, Gilberto
Salas, Allen
Salgado Medina, Ramon
* Schultz, Andrew
Solorzano, Ferrando
* Speck, Michael
* Stike, Aaron
*Tarry, Susan
*Tharian, Brenda
Valdivia, Hector
Villerreal, Jairo
Wakefield, Charles
Wimberly, Jennifer
Zamora-Montes De Oca, Maria
Zarnowski, David
FT
Buschemeyer, II, William
Total Active : 81
208
Associate
Aguilar, Manuel
Arriaga, Morales
*Chu, Lei
Godoy, Guilherme
Lee, Eugene
*Navarro, Teodoro
Recinos, Luis
Sreshta, Joseph
Tapia, Jorge
Wilcox, Duncan
FT
Bhavsar, Robin
FT
Mauck, Ryan
FT
Wambi, Chris
Total Associate : 13
Grand Total Candidates for Membership: 94
MEMBERSHIP STATUS TRANSFERS – (INTERNAL)
To Active Membership
MEMBERSHIP CANDIDATES
AND tRANSFERS
Anast, Jason
Bloom, Keith
Davis, Rodney
Dhanani, Nadeem
Gonzalez, Mark
Khouri, Daniel
Koh, Chester
Rodriguez, Ronald
Slaton, Joel
Webster, John
Ledgerwood, Geoff
Total To Active Membership: 11
Senior
Case, George
Elkins, Robert
Faricy, Patrick
Francis, II, Darryl
Goldsmith, Glen
Healey, Gordon
Licker, Kenneth
Logan, Charles
Reyna, Juan
Spence, Ritchie
Werth, Darrell
Total Senior: 11
Grand Total Membership Status Transfers – (Internal): 22
209
In Memoriam
The South Central Section of the AUA honors those members who have passed
away this year. We will always be thankful for their commitment to the section and
will miss them dearly.
Alexander J. Ashmore, MD
Corpus Christi, TX
Robert O. Beadles, MD
William H. Browning, MD
Wichita, KS
Charles H. Day, MD
Batesville, AR
Jorge E. Dib, MD
Mexico City, DF, Mexico
Casimir F. Firlit, MD
St. Louis, MO
George E. Hurt, Jr., MD
Dallas, TX
Walter S. Kerr, Jr., MD
Boothbay Harbor, ME
Charles H. Nicolai, MD
St. Louis, MO
Leon O. Rosenfeld, MD
Mexico City, DF, Mexico
Howard F. Poepsel, MD
Omaha, NE
Cyrus M. Robinson, MD
Little Rock, AR
Elgin W. Ware, Jr., MD
Dallas, TX
210
Amended October 2010
“The masculine pronoun refers to both masculine and feminine and herein is
used for convenience.”
ARTICLE I
MEMBERSHIP
Section 1 – Boundaries
An applicant for membership must be a resident of the South Central Section
(“SCS” or “Section”) at the time of application, which consists of the states of
Arkansas, Colorado, Kansas, Missouri, Nebraska, New Mexico, Oklahoma,
Texas, the Republics of Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Belize. Individuals who initially join the Section in which
they practice, and then at a future date relocate to another section of the
American Urological Association, Inc. (“AUA”), may retain membership in the
South Central Section.
Section 2 – Member Categories
The Association membership shall include: Active Members, Associate Members, Affiliate Members, Senior Members, Honorary Members, Corresponding
Members and Candidate Members.
Section 3 – Application Fees and Dues
All members except for Senior and Honorary members shall be assessed
application fees and due in an amount determined by the Board of Directors.
a) Any member who after appropriate notification does not pay membership
dues shall cease to receive SCS publications and notices.
Section 4 – Voting Status and Rights
Only Active and Senior members shall be eligible to vote. Active and Senior
members who are elected to Honorary Membership shall retain their voting
status. Only voting members are eligible to hold office. All members shall be
entitled to receive the latest available copy of Articles of Incorporation and
Bylaws, and the Roster of Membership.
Section 5 – Election/Approval of Membership
All members shall be elected at the Annual Business Meeting. New members
shall receive a certificate of membership from the Secretary, and the American Urological Association will be notified of their SCS membership.
Section 6 – Active Members
Requirements for Active members are as follows:
a) Possession of an unlimited license to practice medicine and surgery in
the State, Province or Country of the applicant’s practice.
b) Practice in the geographical boundaries of the AUA.
211
bylaws
Bylaws
c) Possession of an MD or DO degree, or United States medical licensure
equivalent, and completion of an ACGME accredited urology residency
or equivalent by the Royal College of Surgeons (RCS) in Canada or the
Quebec Board of Urology or the certifying Board of Urology in the country.
d) Limitation of practice to the specialty of Urology.
e) Certification by the American Board of Urology (ABU), the Royal College
of Surgeons (RCS) in Canada or the Quebec Board of Urology or the
certifying Board of Urology in the country where practicing within the geographic boundaries of the Section.
f) Recommendation for membership by two (2) voting members of the AUA,
except if certified within the last 24 months (as per item e in this section).
g) Letter of recommendation from the Chief of Urology, Medical Director, or
Chair of the Credentials Committee at the hospital(s) where the applicant
has privileges.
h) If an Active Member becomes decertified by the ABU, or other certifying
board, the member shall be automatically dropped for non-compliance
with the Section Bylaws, pursuant to Expulsion and Reinstatement Policies.
Section 7 – Senior Members
Members are eligible for Senior Membership in both the SCS and the AUA if
they have been Active members for 25 years in either the Section or the AUA
and have reached the age of 65. Active members who are retired or are permanently disabled and have been members for 20 years in either the Section
of the AUA are also eligible for Senior Membership.
Section 8 – Associate Members
Requirements for Associate membership are the same as Active membership,
except for Board certification.
a) Candidate members eligible for Fast Track Associate Status: Associate
membership will be offered to all Candidate members who have passed
the qualifying examination (Part I) of the American Board of Urology.
b) Non-Members eligible for Associate Status: Associate Membership is
available to non-member urologists who are practicing within the geographic boundaries of the Section but are not certified by the American
Board of Urology.
Doctors of Osteopathy who complete AOA-approved urology residency
programs and are certified by the American Osteopathic Board of Surgery are eligible for Associate Member Status.
c) Transfer to Active Membership. Associate Members who have passed
the ABU certifying exam (Part II) will be transferred to Active Membership
in the Section.
d) If an Active Member fails to become re-certified as required by the ABU
(or other certifying board), the Section will transfer the individual to Associate Member Status.
Section 9 – Affiliate Members
Affiliate membership is available to Non-Physician Scientists and is not usually available for physicians certified by medical boards. However, in exceptional instances, persons in related fields of medicine and science, who do not
212
Section 10 – Honorary Members
Honorary members are those whom the Section wish to honor. They shall be
nominated by the Past-Presidents Committee, approved by the Board of Directors and then elected at the annual business meeting. A two-thirds vote of
the active and senior members present shall be necessary for election. They
shall be exempt from all dues and assessments and shall enjoy all the privileges of active membership except the right to vote and hold office.
Section 11 – Corresponding Members
Corresponding Membership is available to urologists who practice in countries
beyond the geographic boundaries of the AUA and wish to be a member of the
SCS. The applicant shall be a member of the local or national urological organization in his country, and a letter of endorsement of that membership shall
be submitted to the SCS with the application form. If a national organization
does not exist within the applicant’s country, a waiver of this requirement may
be considered by the Executive Committee. The applicant’s practice must be
limited entirely to the specialty of urology. The applicant must be a graduate
of an acceptable medical school who has received a Doctor of Medicine or
equivalent degree. The applicant must be in practice for a minimum of two (2)
years after completion of residency.
Section 12 – Candidate Members
Candidate Membership is established to extend Sectional educational and
professional advantages to urological residents. The candidate must be practicing and studying within the geographic boundaries of the SCS.
a) ACGME. Medical Doctors (MD) or Doctors of Osteopathy (DO) enrolled
in a urology residency program approved by the Residency Review Committee and ACGME are eligible for Candidate Membership; and after
completing training and passing part 1 of the ABU qualifying examination
are eligible for Associate Member status (Fast Track), Section G.1. Those
who successfully pass all parts of the ABU qualifying examination are
eligible for Active Member status, Section 6.
b) AOA. Doctors of Osteopathy enrolled in an AOA-approved urology residency training program are eligible for candidate member status. DOs
completing their training and passing the American Osteopathic Board of
Surgery certifying examination are eligible for Associate Member status,
Section 8.
Section 13 – Publication of Names
The names of applicants for Active membership which have been approved
by the SCS Board of Directors shall be available to the membership prior to
the Annual Business Meeting.
213
bylaws
qualify for other categories of Association membership, may be considered for
Affiliate Membership provided they have contributed significantly to the specialty of Urology. They shall be nominated by two Active or Senior members
who shall furnish the Section Secretaries Committee with the curricula vitae
and other pertinent information.
Section 14 – Expulsion, Resignation and Reinstatement
Any member who has been expelled from the AUA shall automatically have
his/her SCS membership terminated; and likewise, any member terminated
by the SCS shall be terminated by the AUA. A member who has resigned or
whose membership has been deleted for non-payment of dues, or for other
reasons, may, after payment of any back dues owed, request reinstatement,
subject to approval of both the Section and AUA Board of Directors.
Section 15 – Transfer of Membership
Active members of other Sections of the AUA who move to the geographic area of the South Central Section may apply for transfer of membership.
After certification by the Secretary of the former Section and transfer of the
applicants’ dossier, he will become an active member following approval by
the Board of Directors and membership at the next annual business meeting.
Section 16 – Membership Waiver
In special instances, the Board of Directors may waive a qualification or requirement and recommend for membership, a urologist whose position and
achievement, in its opinion, warrants such action.
ARTICLE II
DUTIES OF OFFICERS
Section 1 – President
a) The President shall arrange for and preside at all meetings of the Board
of Directors and of the scientific and business sessions of the Section.
b) He shall call special meetings of the Board of Directors.
c) The President shall direct to the attention of the Board of Directors any
violations of the Bylaws and matters requiring discipline of members.
d) He shall receive reports of the Standing and Special Committees and
make recommendations.
e) He shall appoint the committees as specified in Article IV – Standing committees.
f) He shall appoint any other committees that are needed to carry out the
business of the Section.
g) At the conclusion of the meeting at which he assumes the office of President, he shall call a meeting of the program committee to discuss the
format for the next annual scientific program.
h) Shall chair the nominating committee the year following his presidency.
He shall propose budgetary recommendations to the Board of Directors
annually when received from the Treasurer for operations of the Section
designating the monetary needs for “operations”.
Section 2 – President-Elect
a) The President-Elect shall assist the President in the performance of his
duties and in the absence of the President, shall preside. In the event of
the Presidents’ death, resignation, or removal, the President-Elect shall
succeed in the office of the President for the unexpired term. His successor as President-Elect shall be selected at the next annual business
meeting.
214
Section 3 – Secretary
a) The term of office shall be four years or until his successor assumes the
office. The Secretary can serve one term in office only.
b) The Secretary shall attend all meetings of the Society and shall keep
minutes of their respective proceedings in an appropriate book, which
shall be preserved by his successors as a permanent record of the organization.
c) He shall employ, with the approval of the Board of Directors, such secretarial assistance as is necessary.
d) He shall be responsible for the maintenance of an alphabetical list showing the actual standing of all members, their applications, addresses and
a roster of attendance at the annual meeting.
e) He shall be responsible for the publication and distribution of newsletters
at such intervals as is agreed upon by him and the President.
f) He shall be responsible for notification of the annual meeting to all members at least six months before the meeting.
g) He will ensure publication of a newsletter at least 30 days prior to the
meeting, with information about the program that would be of interest.
h) He shall obtain the names of all committee members from the President
within sixty (60) days after the annual meeting and confirm their obligation in writing.
i) He shall report to the Chairman of the Nominating Committee before the
annual meeting as to vacancies which will occur in the offices of representative and alternate to the American Urological Association, Inc. and
other vacancies in the Section offices.
j) He shall report to the Secretary of the American Urological Association
Inc., the names of members of the Section who have been recommended
by the Board of Directors for membership in that organization and our
representative and alternate on the Board of Directors of the American
Urological Association, Inc., if there is a change. He shall report to the
Secretary of the American Urological Association, Inc., the names of all
newly elected members of the Section and of all officers, directors, and
representatives and alternates to various AUA committees requiring such
Section representation.
k) He shall prepare, with the President, and circulate among the members
at least ten (10) days in advance, an agenda for all meetings of the Executive Committee and Board of Directors.
Section 4 – Treasurer
a) The term of office shall be four years or until his successor assumes the
office. The treasurer can serve one term in office only.
b) He shall keep an accurate record of all property of the Section.
c) He shall be bonded for twenty thousand dollars ($20,000). The bond shall
be held by the Executive Secretary. He shall arrange the same bond for
all who handle monies of the Section.
215
bylaws
b) During his year as President-Elect, he will be organizing his committees
in order to make the appointments early after assuming office as the
President, since the place of meeting will have been selected.
c) President-Elect shall serve as Chairman of the Program Committee.
d) He shall demand and receive all funds due to the society together with all
the bequests and donations.
e) He shall keep in a general ledger an alphabetical list of all members
showing the financial status of each.
f) He shall report delinquent members promptly to the Secretary and to the
Board of Directors.
g) He shall have an annual audit of the Section’s financial records including
the records of the Local Arrangements Committee prepared by a Certified
Public Accountant.
h) A report of the above audit will be presented to the Board of Directors at
the annual meeting.
i) The Treasurer shall prepare with the assistance of the Executive Director, Chairman of Arrangements Committee, and Chairman of Program
Committee, a budget of all monies to be received and disbursed in connection with the annual meeting. The budget will be subject to review and
approved by the President or in his absence, the President-Elect, or in his
absence the Secretary. All annual meeting receipts and disbursements
shall be made by the Treasurer in accordance with the approved budget.
j) He shall receive advice from the Executive Director and annually provide
the President with over-all budgetary recommendations for the Section
including the needs for the annual meetings as specified in Article II, Section 4.
k) He shall authorize the purchase of securities in accordance with the
Guidelines for Investments for the Section upon authorization by the Investment Committee or an Investment Advisor if duly appointed by the
Boards of Directors.
l) He shall authorize the purchase of securities in accordance with the
Guidelines for Investments for the Section upon authorization by the Investment Committee or an Investment Advisor if fully appointed by the
Boards of Directors.
m) He shall provide periodic reports no more often than quarterly concerning the Investment Portfolios of the Section to the Investment Committee
with the assistance by the investment advisor if appointed by the Board
of Directors. Reports will include comparisons to appropriate comparable
indices (bench marks).
n) He shall receive recommendations fro the Investment Committee concerning selection of Investment Advisors for submission to the Board of
Directors.
Section 5 – Executive Director
The Executive Director shall be the assistant of the Secretary and the Treasurer to carry out the routine duties of the office under the direction of the
Secretary and the Treasurer such as, but not limited to, the following:
a) Mailing of all annual dues and notices to the membership and reminding
those in arrears individually.
b) Publication of the yearly roster, attending to the new addresses for each
changing year.
c) Attend to the details of sending out applications to the new members,
such information when received to be mailed to the Secretary’s office.
d) Answer all inquires that the Secretary or the Treasurer can place with the
necessary suggestions.
216
Section 6 – Historian
a) The Historian, as official biographer of the South Central Section AUA,
Inc. shall prepare an accurate history of the association and shall keep
records of changes in the association pertinent to its history. He shall
present an annual report to the Board of Directors and to the association
at the annual business meeting when requested by the President.
b) He shall prepare for publication any historical issue relative to the association and present to the Board of Directors.
c) Funds required for these purposes shall be voted on by the Board of
Directors.
Section 7 – National Board of Directors Representative
The duly elected National Board of Directors Representative will represent the
South Central Section on the Board of Directors of the American Urological
Association, Inc. He will become liaison officer for the Section in the National
organization.
a) He shall attend all Executive Committee meetings of the National Society
and will transmit to and report all instructions and mandates from the
Section in the National Board of Directors meeting.
b) He shall render an annual report of the proceedings of the Section’s
Board of Directors meeting and he shall advise the President of the Section as to all transactions concerning the Section which transpire at interval meetings of the Executive meeting of the AUA.
c) He shall be reimbursed by the Section for expenses to special meetings
of the American Urological Association Board of Directors when not covered by the parent organization.
d) He shall be a member ex-officio of the Section Board of Directors.
e) The representative to the Board of Directors shall be elected for terms of
two years and be limited to the maximum of two terms, alternates will be
elected. He will be elected at the annual meeting in odd number years
and will take office at the next annual meeting of the American Urological
Association, Inc.
f) He must be an active member of the Section and also a member of the
217
bylaws
e) Arrange for the publication of programs and mail same.
f) Be present at meetings of the Board of Directors to take down all pertinent data covering the Board of Directors meeting and arrange for presentation at the Business Session.
g) Publication and distribution of all Newsletters and communications required of Executive Officers.
h) Shall assist local arrangements committee acting as annual meeting
planner.
i) Budgetary recommendations for operations of the Section shall be submitted to the Treasurer for consideration for the President and Board of
Directors.
j) The Investment Committee will be assisted in its periodic meetings and
responsibilities.
Section 8 – Term of Office
All officers shall hold office for one year, or until their successors are elected
except as otherwise indicated herein. The Secretary and Treasurer will not
change office the same year.
Section 9 – Office Vacancies
a) Vacancies in office must be filled by the Board of Directors for the unexpired term except should the office of President become vacant, the President-Elect would automatically succeed the President. No one, however,
will hold two elective offices at the same time.
b) In case of a vacancy where there has been an alternate selected, the
alternate shall serve until the next annual meeting at which time a new
delegate shall be elected to complete the term.
ARTICLE III
BOARD OF DIRECTORS
Section 1
The Board of Directors, herein afterward known as the Board, shall consist of
the Officers, and one (1) Director from each state or territory of the Section
consisting of Arkansas, Colorado, Kansas, Missouri, Nebraska, New Mexico,
Oklahoma, Texas, The Republic of Mexico, and Central America, excluding
Panama, shall each have a duly elected member on the Board of Directors.
(Past-Presidents will be ex-officio members without vote.) Members recognized by the AUA as part of the Young Leadership Development Program
will serve as ex-officio members of the Board of Directors, without vote, for a
period of three years.
Section 2 – Executive Committee
The Executive Committee of the Board of Directors consisting of the President as Chairman, immediate Past-President, President-Elect, Secretary and
Treasurer, shall have responsibility for the interim business of the Section. All
actions taken by the committee are subject to acceptance or rejection by the
Board of Directors.
Section 3 – Duties
The Board of Directors shall have charge of the administration of the corporation. They will meet during the annual meeting of the Section and during the
national meeting when possible.
Section 4 – Quorum
Seven members of the Board of Directors shall constitute a quorum for the
transaction of business.
Section 5 – Election and Term of Office
The elected members of the Board of Directors shall hold office for three years
and may be elected to a second term. The election of members of the various
states or geographical areas will be scheduled so that two or three new members will be elected each year.
218
Section 7 – Membership Application
The Board of Directors through committee action, shall carefully review all
applications for membership and shall accept, reject or set aside for further
consideration such applications as come before them.
Section 8 – Nominations for Special Membership
The Board of Directors shall receive nominations or requests for all classifications of membership, and shall make recommendations to the Section.
Section 9 – Reports
The Board of Directors shall receive reports from standing and special committees and make recommendations.
Section 10 – Amendments
The Board of Directors shall make recommendations for amendments to the
Constitution and Bylaws when necessary to better conduct the Section.
Section 11 – Special Meetings
Special meetings of the Board of Directors may be called upon request of the
majority of its members or the President.
Section 12 – Annual Meeting of the Board of Directors
The time of the annual meeting or the Board of Directors shall be set by the
President who will preside and may be on the day preceding the annual meeting of the Section and also on the days during the annual meeting.
Section 13 – Applicants to American Urological Association, Inc.
It shall consider all applicants for membership to the American Urological Association, Inc., and endorse them to the Secretary of that organization if they
have the proper qualifications.
ARTICLE IV
STANDING COMMITTEES
The newly elected President shall appoint from the active and senior members the
following standing committees within sixty (60 days) following the annual meeting.
The terms of office of the committee members will be staggered. A member may
not continuously serve on a particular committee for more than six (6) years. He
may serve on the same committee after a two (2) year hiatus.
Section 1 – Committee on Arrangements
a) A chairman of the Committee on Arrangements will be appointed by the
President. This chairman will have the power to appoint all local chairmen
and committee members.
b) A Committee on Arrangements shall make all necessary arrangements
for the annual meeting and entertainment of the Section at such place as
selected by the Board of Directors.
219
bylaws
Section 6 – Time and Place of Annual Meeting
The Board of Directors shall select the time and place of the annual meeting.
c) The chairman of the Committee on Arrangements shall aid the Executive
Director and Treasurer in preparing the budget of the annual meeting. All
annual meeting receipts and disbursements shall be made by the Treasurer in accordance with the approved budget.
d) All expenditures must be authorized in advance by the chairman of the
committee.
e) The annual meeting is expected to be self-sustaining.
Section 2 – Program Committee
a) The Program Committee will consist of the President, President-Elect,
Immediate Past President, Treasurer, and Secretary. The President-Elect
will act as chairman.
b) It shall arrange the scientific program for the annual meeting and select
titles of the papers best suited for the program.
c) It shall be the prerogative of the Committee to invite any guest speaker
from outside the Section whom they feel would contribute to the program.
d) Shall aid the Executive Director and Treasurer in preparing the budget of
the annual meeting.
Section 3 – Bylaws Committee
a) The Bylaws Committee shall be composed of the Secretary and three
other members. One member to be appointed each year by the President to serve for a term of three years. In order to form the committee,
the first three appointments shall be for 1, 2, and 3 years. The President
must appoint the chairperson of the committee who will serve for a term
of three years.
b) The chairperson will represent the South Central Section on the Bylaws
Committee of the AUA, Inc.
c) The Bylaws Committee shall become familiar with the activities of the
association and the efficacy of the articles of corporation and bylaws. It
shall make a yearly report to the Executive Committee which shall include
any recommended amendments.
d) The members may succeed themselves.
Section 4 – History Committee
a) This committee will consist of the Historian and one other member, appointed by the President and allowed to succeed themselves for an indefinite period.
b) This committee shall report the names and a short biography of the members who have died in the preceding year in the program of the meeting,
and their names will be read at the annual meeting.
c) This committee shall prepare an accurate history of the Section and shall
keep record of changes in the Association pertinent to its history.
d) They shall report to the Board of Directors at the annual meeting.
Section 5 – Past-Presidents Committee
a) This committee shall be composed of all Past-Presidents of the Section
and shall have as its chairman the immediate Past-President.
b) It shall nominate candidates for possible election as honorary members
of the Section.
220
Section 6 – Health Policy Counsel
a) The Health Policy Counsel shall study and advise the Section on matters
pertaining to health policy activities.
b) The Committee shall consist of the Chairman who shall be elected by the
membership for a three year term and one member and one alternate
from each State in the Section who shall be appointed by the President
for three year terms at the direction of the state urological organizations.
If there is no active state organization, the President may appoint his
choice for both member and alternate from that state. The chairman will
act as a liaison between the AACU and the South Central Section, AUA,
Inc.
c) The chairman will represent the Section on the Health Policy Council of
the AUA.
Section 7 – Investment Committee
a) The Investment Committee shall consist of the Treasurer and four other
members with staggered terms, as appointed by the President in order to
provide continuing advice to the Treasurer, the President, and the Boards
of Directors in accordance with the Bylaws and the Guidelines of Investments. The Chairman will be specified by the President.
b) Members will be appointed for a three year staggered term. Members
may succeed themselves.
c) The members will review the investment portfolio and aid the Treasurer in
preparing a report to the Officers.
d) The Investment Committee will use the guidelines for the SCS, AUA as a
resource for evaluating investment allocation and performances.
e) The Committee will serve to recommend the selection and retention of
the Investment Advisor.
f) The Committee will receive periodic reports, not to exceed quarterly, concerning the investment portfolios of the Section.
ARTICLE V
MEETINGS
Section 1 – Time and Place
The annual meeting of the Section shall be held at such a time and place as
the Board of Directors shall designate and they shall arrange the meeting
place for future meetings.
Section 2 – Requirements for Attendance
Attendance at the meeting will be limited to those wearing the badge of appropriate registration. Registration is limited to Doctors of Medicine and participants in the program.
221
bylaws
c) It shall investigate, study and make such recommendations to the Board
of Directors as seem fitting and proper in order to further the avowed aims
of the organization.
Section 3 – Special Meetings
A special meeting may be called at any time by the President or a majority of
the Board of Directors or upon written request of twenty-five (25) members,
at a convenient time and place to be designated by the Board of Directors,
notice of which meeting shall be sent by mail to each member at least fifteen
(15) days prior, stating the place, date, hour, and special business for which
the meeting is called, and no other business shall be considered and enacted
except that stated in the call for the meeting.
Section 4 – Quorum
At all stated and special meetings, twenty-five (25) members shall constitute
a quorum for the transaction of business.
Section 5 – Scientific Sessions
The order of business at scientific sessions shall be:
a) President’s address.
b) Original communications.
c) Presentation of papers, specimens, apparatus, etc. This order,
however, may be changed at the discretion of the President and
Secretary-Treasurer.
d) Guest speakers may be asked to present papers before the Section.
The expenses of one guest speaker and his wife to be allowed from the
general treasury. Additional funds may be requested and paid for out
of the treasury of the Section after having been first agreed to by the
Executive Committee except as provided for in Article IV, Section 2.
Section 6 – Papers
The titles and abstracts of papers must be filed with the Executive Director at
a time determined by the Program Committee.
a) Any paper previously printed or presented before a Scientific society may
not be read before this Section except at the request or on approval of
the Program Committee.
b) All papers read before this Section are the property of the authors. Subsequent publication is permissible. Recognition that the work was first
presented at the South Central Section AUA Annual Meeting should be
given.
Section 7 – Discipline of Presenting Papers
All matters involving the time limits of papers, permission to be read by title
and absence of essayist will be handled by the Program Committee. In a case
of disciplinary action, the problem will be brought to the Board of Directors.
Section 8 – Rules of Order of Business Meeting
Rules of Order of the annual business meeting of the Section. Sturgis Standard Code of Parliamentary procedure shall govern all procedures. At the
business session the order of business shall be:
a) Reading of minutes of previous meeting.
b) Report of the Secretary.
c) Report of the Treasurer.
d) Report of the Board of Directors.
222
Report of the Committee on Arrangements and Program.
Report of the National Board of Directors.
Report of the Aids and Grants Committee.
Report of the Historian.
Unfinished business.
New business and resolutions.
Report of the Nominating Committee.
Election of officers.
ARTICLE VI
NOMINATING COMMITTEE
Section 1 – Membership of Committee
The Nominating Committee shall consist of five members; the three most recent Past-Presidents in attendance and two active members in good standing
in the Section, who shall serve one year.
a) The three most recent Past-Presidents in attendance shall assume this
duty automatically.
b) One member shall be a member of and nominated by the Board of Directors and will be elected by the Association if he receives the majority vote
of those present and voting at the annual business meeting.
c) Two or more active or senior members in good standing shall be nominated from the floor during the business meeting. The member who receives
the greatest number of votes of the members present and voting shall be
declared elected a member of the Nominating Committee.
d) The Chairman of this Committee shall be the most immediate Past-President.
Section 2 – Duties of the Committee
Members and alternates that automatically serve as Section representatives
on AUA Committees are to be elected by the Section. It shall be the duty of
the Nominating Committee to meet and present to the Section at its annual
business session a slate of nominees of active members in good standing in
the Section for the following positions:
a) One candidate for President-Elect.
b) One candidate each for Secretary and Treasurer when necessary.
c) Candidates for members of the Section Board of Directors as provided in
the constitution.
d) The Nominating Committee will select for election by the Section the
following positions for standing committees of the American Urological
Association:
i) One candidate for Bylaws Committee who is the chairman of the
South Central Section Bylaws Committee every two years.
ii) Three candidates for Editorial Committee every four years.
iii) One candidate for Board of Directors of the AUA, Inc. every two
years.
iv) One candidate for Historian.
v) One candidate for alternate Executive Committee every two years.
223
bylaws
e)
f)
g)
h)
i)
j)
k)
l)
vi) One candidate for Nominating Committee every two years not to be
an elected member of the AUA, Inc.
vii) One candidate for alternate Nominating Committee every two years
not to be an elected member of AUA, Inc.
viii) One candidate for Research Committee and an alternate in odd
numbered years for a four year term-to serve two years as alternate
and two years as a representative.
e) The American Urological Association Judicial Council candidate shall be
chosen in the following manner:
The Nominating Committee will recommend three (3) names to the President
of the American Urological Association, Inc. One candidate will be chosen by
the President of the AUA to serve. The candidate must be a Past President of
the South Central Section. The term of office is four years.
Section 3 – Vacancies on Committees
Vacancies or absences on the Nominating Committee shall be filled by the
President.
Section 4 – Report of Committee, Nominations, Voting, and Installation
The report of the Nominating Committee shall be called for by the President at
the proper place designated for it under Article V, Section 8 of these Bylaws.
a) The slate, having been read, the President shall then ask for other nominations from the floor for all elective offices.
b) Candidates for office must be elected by a majority vote of the members
present and voting.
c) The newly elected officers shall then be installed.
ARTICLE VII
DUES
Section 1 – Annual Dues and Fees
The initiation fee and annual dues shall be established by the Board of
Directors.
Section 2 – Special Assessments
It shall require a majority vote of the members present and voting at the
annual meeting to levy a special assessment.
Section 3 – Collection of Dues and Fees
a) On December first, the Executive Director shall mail to each member, a
notice of his dues for the coming year. A member not having paid his dues
by April first, shall be in arrears and may, at the discretion of the Board of
Directors, be suspended from membership if not paid up within one year.
b) Registrants at the annual meeting failing to pay the registration fee shall
be automatically suspended from membership. Exceptions would be
senior and honorary members and spouses who elect to attend the
meeting. The senior and honorary members and spouses will not be
required to pay full registration fees. There will be a social registration fee
for those senior and honorary members attending.
224
ARTICLE VIII
AMENDMENTS
Section 1 – Requirements for Amending
A quorum being present, these Bylaws may be amended by two-thirds vote
of the members present and voting at the annual meeting, provided that the
proposed changes shall have been provided to the membership on the notice
for the meeting at which time such action is to be taken, at least thirty (30)
days prior to the meeting.
Section 2 – Bylaws Committee
The Bylaws Committee shall, from time to time, suggest changes in the
Bylaws.
ARTICLE IX
FISCAL YEAR
The fiscal year shall begin February 1st and end January 31st of the following year.
225
bylaws
c) A member suspended for nonpayment of dues or assessments, may be
reinstated by vote of the Board of Directors upon payment of all dues and
assessments in arrears and the reinstatement fee as determined by the
Executive Committee.
NOTES
226

program book - South Central Section of the AUA

Transcription

Similar documents

Malakoplakia of the bladder associated with advanced obstructive

XIII International Workshop on Urethral Reconstruction

Installation of Scrolling Ceiling

Installation of Scrolling Banner CNFS00 1

project profile - Bowden Contracting Co.

Thursday, April 24 @ 7:30pm AMC BarryWoods 24

BETWEEN THE COVERS RARE BOOKS

Megacystis Microcolon Intestinal Hyperperistalsis

Leaving Cert Craft Exam-Poster Question By Ruth Graydon

Pictorial Modernism Art Deco