TH
ANNUAL MEETING Southeastern Section of the American Urological Association, Inc. March 17 − 20, 2011 Marriott New Orleans New Orleans, Louisiana
PROGRAM BOOK th
Annual Meeting
Raju Thomas, MD, FACS, MHA 2010 – 2011 President Southeastern Section of the American Urological Association, Inc. Table of Contents
Schedule at a Glance------2 Mission Statement, Needs, and Objectives------6 Disclaimer Statement, Copyright Notice and Filming/Photography Statement------7 CME Accreditation------8 SESAUA Contact Information------9 Officers, Board of Directors, Standing and Special Committees of SESAUA------10 Numerical Membership of the SESAUA------14 General Meeting Information Registration------14 Board of Directors and Committee Meetings------14 Convention Center Floor Plan------15 Exhibit Hall Hours------17 Speaker Ready Room Hours------17 Spouse/Guest Hospitality Suite Hours------17 Annual Business Meeting------17 Industry Sponsored Events------17 Evening/Optional/Sporting Events------19 Exhibitors------22 Special Thanks to Sponsors------23 Named Lectures and Contests------25 Full Scientific Program Schedule Thursday------27 Friday------36 Saturday------49 Sunday------55 Alphabetical Index of Presenters------60 Abstracts in Presentation Order------68 Posters in Presentation Order------128 Annual Business Meeting Agenda------172 Minutes of the 74th Annual Business Meeting of the SESAUA------173 Preliminary SESAUA Treasurer’s Report for 2010------179 2010 Proposed Bylaws Changes------180 Membership Candidates and Transfers------181 Necrology Report------183 Report of the SESAUA Representative to the AUA Board of Directors------184 Roster of State Societies and Officers------185 Previous Officers and Annual Meeting Sites------186 Schedule for Future Meetings of the SESAUA------193
1 Program Schedule At A Glance *All sessions located in La Galeries, 1 – 3, unless otherwise noted.
THURSDAY, MARCH 17 Registration/Info Desk 6:00 a.m. – 6:00 p.m. Location: Preservation Hall Foyer Spouse/Guest Hospitality Room st 7:30 a.m. – 10:30 a.m. Location: St. Charles, 41 Floor Speaker Ready Room 7:00 a.m. – 4:00 p.m. Location: Regent Exhibit Hall 9:00 a.m. – 4:00 p.m. Location: Preservation Hall 6:00 p.m. – 8:00 p.m. 6:00 a.m. Breakfast Location: Preservation 6:30 a.m. Hall Foyer 7:00 a.m. Session 1: 7:30 a.m. Live Surgical Event Robotic Partial Nephrectomy 8:00 a.m. Surgical Panel Disucssion: The 8:30 a.m. Least Invasive Approach: Laparoendoscopic Single Incision 9:00 a.m. Surgery (LESS) an Natural Orifice Surgery 9:30 a.m. Break/Visit Exhibits 10:00 a.m. Session 2: Opening Remarks – SESAUA President 10:30 a.m. 11:00 a.m. Session 3: Kidney Cancer Podium 11:30 a.m. Session 4: Wrap-Up Controversies in the Management of 12:00 p.m. Renal Masses: Poke It, Probe It, Cut It or Leave It Alone?
12:30 p.m. Session 5: Industry Sponsored Luncheon 1:00 p.m. Session 6: 1:30 p.m. Urodynamics and Bladder Function 2:00 p.m. Podium Session 7: Location: Mardi Simultaneous Session 8: Gras, IJ NPP (Non- Concurrent Video Session 6.1: Physician Session I Wrap-Up – Providers) Location: Practical Forum 2:30 p.m. La Galeries, 1 – 3 Urodynamics: Location: Mardi What You Need Gras, ABC for Day-to-Day Survival
3:00 p.m. Break/Visit Exhibits 3:30 p.m.
4:00 p.m. Session 9: Young Session 10: Concurrent Poster Urologists Forum 4:30 p.m. Session – Prostate Cancer Location: Location: Mardi Gras, LMN 5:00 p.m. La Galeries, 1 – 3 5:30 p.m.
6:00 p.m. 6:30 p.m. Welcome Reception 7:00 p.m. Location: Preservation Hall 7:30 p.m. 8:00 p.m. 8:30 p.m. 9:00 p.m.
2 FRIDAY, MARCH 18 Registration/Info Desk 6:30 a.m. – 5:00 p.m. Location: Preservation Hall Foyer Spouse/Guest Hospitality Room st 7:30 a.m. – 10:30 a.m. Location: St. Charles, 41 Floor Speaker Ready Room 7:00 a.m. – 5:00 p.m. Location: Regent Exhibit Hall 6:30 a.m. – 4:00 p.m. Location: Preservation Hall 6:00 a.m. Session 11: Industry Breakfast 6:30 a.m. Sponsored Breakfast Location: Preservation Hall Foyer 7:00 a.m. 7:30 a.m. Session 12: Bladder Cancer Podium 8:00 a.m. Session 13: Endourology 8:30 a.m. and Stone Disease Podium Location: La Galeries, 1 – 3 Session 14: Radiology and Session 13:1: Wrap-Up – Imagery Podium 9:00 a.m. Role of Flexible Uretero- Location: Mardi Gras, IJ Nephroscopy in Urologic Practice Today 9:30 a.m. Break/Visit Exhibits 10:00 a.m. Session 15: History: SESAUA 10:30 a.m. Session 16: Montague Boyd Essay Contest 11:00 a.m. Session 17: Ballenger Lecture: Minimally Invasive Urological Surgical Procedures in Children: Translating 11:30 a.m. Lessons Learned from Adult Counterparts Session 18: Address by SES President – SESAUA Update: Charting the Future 12:00 p.m. Session 19: AUA Update
12:30 p.m. 1:00 p.m. Session 20: Industry Sponsored Luncheon
1:30 p.m. Session 21: Presidential Lecture: Role of PSA Screening, Surveillance, and Management of Metastatic 2:00 p.m. Session 23: Prostate Cancer – Update for the Concurrent Practicing Urologist Poster Session – 2:30 p.m. Location: La Galeries, 1 – 3 All Inclusive Session 22: Prostate Cancer Podium Location: Mardi Gras, LMN 3:00 p.m.
3:30 p.m. Break/Visit Exhibits 4:00 p.m. Session 24: Laparoscopic Session 25: Concurrent & Robotic Surgery – Upper Poster Session – Pediatrics 4:30 p.m. Tract Podium Location: Location: Mardi Gras, LMN 5:00 p.m. La Galeries, 1 – 3 Session 26: Panel Discussion – Identifying and Managing 5:30 p.m. Complications of Robotic and Laparoscopic Surgery 6:00 p.m.
6:30 p.m. 7:00 p.m. 7:30 p.m. 8:00 p.m. Residents’ Night Out 8:30 p.m. (program directors and residents only) 9:00 p.m. 9:30 p.m. 10:00 p.m.
3 SATURDAY, MARCH 19 Registration/Info Desk 6:30 a.m. – 12:30 p.m. Location: Preservation Hall Foyer Spouse/Guest Hospitality Room st 7:30 a.m. – 10:30 a.m. Location: St. Charles, 41 Floor Speaker Ready Room 7:00 a.m. – 12:00 p.m. Location: Regent Exhibit Hall 6:30 a.m. – 12:00 p.m. Location: Preservation Hall 6:00 a.m. Session 27: Industry Breakfast 6:30 a.m. Sponsored Breakfast Location: Preservation Hall Foyer 7:00 a.m. Session 28: Pediatrics Session 29: Concurrent Podium Video Session II 7:30 a.m. Location: Mardi Gras, IJ Location: La Galeries, 1 – 3 8:00 a.m. Session 30: Laparoscopic & Robotic Surgery – Lower Tract Podium 8:30 a.m. Session 31: Concurrent Location: La Galeries, 1 – 3 Poster Session – Session 30.1: Wrap-Up – Tips Urooncology and Tricks for Solving 9:00 a.m. Location: Mardi Gras, LMN Challenging Anatomic Variations During Robotic Surgery 9:30 a.m. Break/Visit Exhibits 10:00 a.m. Session 32: Socioeconomic Session I – Ambrose-Reed Lecture: Healthcare in the US: How We Got Into This Mess 10:30 a.m. and How Can We Possibly Get Out of It Session 32.1: Making Your Practice More Efficient and More Productive 11:00 a.m. 11:30 a.m. Session 33: T-Leon Imaging Session 12:00 p.m.
12:30 p.m. Industry Sponsored Lunch 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. 5:00 p.m. 5:30 p.m. 6:00 p.m. 6:30 p.m. 7:00 p.m. 7:30 p.m. 8:00 p.m. 8:30 p.m. 9:00 p.m. 9:30 p.m.
4 SUNDAY, MARCH 20 Registration/Info Desk 6:30 a.m. – 12:00 p.m. Location: Preservation Hall Foyer Spouse/Guest Hospitality Room st 7:30 a.m. – 10:30 a.m. Location: St. Charles, 41 Floor Speaker Ready Room
Location: Regent Exhibit Hall
Location: Preservation Hall 6:00 a.m. Breakfast 6:30 a.m. Location: Preservation Hall Foyer 7:00 a.m. Session 34: Concurrent Video Session 36: Session III Concurrent Poster 7:30 a.m. Session 35: Location: La Session – ED/Infertility Galeries, 1 – 3 Nephrolithiasis Podium Location: Mardi Gras, 8:00 a.m. LMN 8:30 a.m. 9:00 a.m. 9:30 a.m. Session 37: Socioeconomic Session II 10:00 a.m.
10:30 a.m.
11:00 a.m. Session 38: Annual Business Meeting 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. 5:00 p.m. 5:30 p.m. 6:00 p.m. 6:30 p.m. 7:00 p.m. 7:30 p.m. 8:00 p.m. 8:30 p.m. 9:00 p.m. 9:30 p.m.
5 Southeastern Section of the American Urological Association, Inc.
Mission Statement: To be the professional organization in the southeastern United States that fosters the highest standards of urologic care through education, research and socioeconomic awareness. SESAUA goals: • Support excellence in urologic care of patients • Education of urologists • Encourage research • Forum for presentation of: . Clinical interest . Clinical and basic research . Support the AUA in health care policy and share ideas with the AUA, Inc.
Scientific Program SESAUA Secretary, Raymond J. Leveillee, MD has planned a dynamic program that is certain to provide practicing urologists cutting-edge information. Detailed information about the scientific program begins on page 27.
Needs Assessment The Secretary of the SESAUA (R.J. Leveillee, MD), consulted with other members of the Committee on Science and Education; the Executive Committee members, including Dr. Raju Thomas, the current SESAUA President; Dr. Dean Assimos, Director of Science and Education, SESAUA; and Dr. Elspeth McDougal, Chair of the Office of Education of the AUA, 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 of the 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 increase communication among urologic oncology and endourological researchers and forge a strong relationship between the National Cancer Institute and the Society of Urologic Oncology, as well as the society’s members and others interested in Kidney, Bladder, and Prostate Cancers. In addition, many urologists treat patients with a myriad of non-malignant conditions such as urinary incontinence, benign prostatic hypertrophy, obstructive uropathy, spinal cord injuries, infertility, erectile dysfunction and congenital (pediatric) diseases among the most common. Improving relationships with these subspecialties, and appropriate governmental funding sources (such as National Institute of Diabetes and Digestive and Kidney diseases – NIDDK/NIH) will provide a community of urologists with the most up-to-date research that will provide optimal patient care.
Educational Objectives At the conclusion of the meeting, participants should be able to: • Recognize 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. • Discuss the role of thermal therapies (e.g., Radiofrequency, Cryoablation, etc.) in the treatment of urologic malignancies. • Discuss the evolving role of single site and natural orifice surgeries as they apply to laparoscopic urology. • Improved understanding of the current patterns of utilization of urine based biomarkers and the role of these additional tests for the management of urothelial carcinoma. • Identify basic laparoscopic applications and results in adult and pediatric patients. • Analyze data pertaining to various pharmacologic and surgical treatments for voiding dysfunction and urinary incontinence. • Discuss and make informed choices regarding diagnostic work-up, testing and implementation of appropriate treatment strategies for OAB, SUI and painful bladder. • Recognize the latest diagnostic/treatment options for various renal anomalies. • Indicate current management options for urolithiasis (EBM). • Utilize evidence based treatment algorithms to enhance decision making when treating patients with various forms of urolithiasis. • Discuss new and modified treatments for erectile dysfunction, infertility and penile malignancies. • Identify results of various laparoscopic and robotic approaches and techniques for benign and malignant urologic diseases. 6 • Appraise research results and clinical series on management of prostate cancer and early diagnosis/ screening in various patient populations. • Describe common pediatric urologic diseases and treatment updates. • Recognize prognostic significance and treatments of various stages and grades of bladder cancer. • Review surgical techniques in video format to gain a greater understanding. • Identify socioeconomic factors affecting urologic training and clinical practice. • Design wrap-up session to highlight current practice patterns. Understand the management issues pertaining to patients with spinal cord injuries (SCI) and the unique urologic needs of such patients. • Employ a state of science look at the evidence supporting peri-operative chemotherapy as part of a multimodality treatment for invasive bladder cancer. • Identify non-radical cystectomy options for managing muscle invasive bladder cancer with a focus on the proper selection of patients for the various treatment modalities. • Describe the mechanisms of injury caused by renal ischemia. • Identify the risk and benefits of partial nephrectomy for the large renal mass. • Identify the role of cytoreductive nephrectomy in the targeted therapy era. • Report recent advances in systemic therapy for advanced prostate carcinoma. • Identify new biomarkers assessing risk in patients with locally advanced prostate carcinoma. • Describe optimal treatment strategies for prostate cancer patients with intermediate risk disease. • Illustrate an algorithm for managing small residual masses after chemotherapy for metastatic germ cell testicular tumors.
Disclaimer Statement Statements, opinions and results of studies contained in the program and abstracts are those of the presenters/ authors and do not reflect the policy or position of the SESAUA nor does the SESAUA 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 SESAUA 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.
Copyright Notice Individuals may print out single copies of abstracts or slides contained in this publication for personal, non- commercial use without obtaining permission from the author or the SESAUA. Permission from both the SESAUA and the author must be obtained when making multiple copies for personal or educational use, for reproduction for advertising or promotional purposes, for creating new collective works, for resale or for all other uses.
Filming/Photography Statement No attendee/visitor at the SESAUA 2011 annual meeting may record, film, tape, photograph, interview, or use any other such media during any presentation, display, or exhibit without the express, advance approval of the SESAUA Executive Director. This policy applies to all SESAUA members, non-members, guests, and exhibitors, as well as members of the print, online, or broadcast media.
7 75th Annual SESAUA Meeting March 17 – 20, 2011 New Orleans, Louisiana CME
Accreditation: The American Urological Association Education & Research, Inc. (AUAER) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation: The American Urological Association Education & Research, Inc. designates this live activity for a maximum of 24.75 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The AUAER takes responsibility for the content, quality, and scientific integrity of this CME activity.
AUAER Disclosure Policy: As a provider accredited by the ACCME, the AUAER must ensure balance, independence, objectivity and scientific rigor in all its activities.
All faculty participating in an educational activity provided by the AUAER are required to disclose to the provider any relevant financial relationships with any commercial interest. The AUAER must determine if the faculty’s relationships may influence the educational content with regard to exposition or conclusion and resolve any conflicts of interest prior to the commencement of the educational activity. The intent of this disclosure is not to prevent faculty with relevant financial relationships from serving as faculty, but rather to provide members of the audience with information on which they can make their own judgments.
Off-label or Unapproved Use of Drugs or Devices: It is the policy of the AUAER 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.
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 AUAER.
General Disclaimer for the Southeastern Section of the AUA, Inc. The opinions of the program participants are their own and do not necessarily represent those of the Southeastern Section of the AUA, Inc. Participation by the guest experts and by members of the Southeastern Section of the AUA, Inc. is not to imply endorsement of products and services by the Southeastern Section of the AUA, Inc. Exhibition by industry does not necessarily represent endorsement of these exhibited products or services by the Southeastern Section of the AUA, Inc.
Evidence Based Content: As a provider of continuing medical education accredited by the ACCME, it is the policy of the AUAER to review and certify that the content contained in this CME activity is valid, fair, balanced, scientifically rigorous, and free of commercial bias.
Special Assistance/Dietary Needs The American Urological Association Education & Research, Inc. (AUAER), an organization accredited for Continuing Medical Education (CME), complies with the Americans with Disabilities Act §12112(a). If any participant is in need of special assistance or has any dietary restrictions, a written request should be submitted at least one month in advance. For additional assistance with your request please call (847) 969-0248.
8 SESAUA Contact Information To expedite the business of the Southeastern Section of the American Urological Association, Inc., inquiries should be referred to the SESAUA Secretary or the SESAUA office as follows:
SESAUA Secretary: Raymond J. Leveillee, MD, FRCS-G University of Miami School of Medicine Dept. of Urology/Div. of Endourology 1400 NW 10 Ave., Suite 509 Miami, FL 33135 Phone: (305) 243-4562 Fax: (305) 243-3381 Email: [email protected]
All inquiries and information regarding the scientific program of the annual meeting.
SESAUA Office: Two Woodfield Lake 1100 East Woodfield Drive, Suite 520 Schaumburg, IL 60173-5116 Phone: (847) 969-0248 Fax: (847) 517-7229 Email: [email protected] Executive Director: Wendy J. Weiser
Inquiries about or applications for membership in the SESAUA and the AUA. Membership roster information. (changes/corrections to the present listing) Any requests or information that one may wish to communicate. All inquiries and reports regarding the standing and special committees of the SESAUA. All matters needing the attention of or action by the Executive Committee.
9 Southeastern Section of the AUA, Inc. Officers, Board of Directors, Special & Standing Committees 2010 – 2011
OFFICERS
President Raju Thomas, MD, FACS, MHA; New Orleans, LA 2011
President Elect Randall G. Rowland, MD, PhD; Lexington, KY 2011
Secretary Raymond J. Leveillee, MD, FRCS-G; Miami, FL 2012
Treasurer W. Terry Stallings, MD; Daphne, AL 2011
Member at Large Jon S. Demos, MD; Lexington, KY 2011
Chair, Committee on Education and Science Dean G. Assimos, MD; Winston-Salem, NC 2012
Immediate Past President Thomas F. Stringer, MD; Inverness, FL 2011
Historian Hector H. Henry, II, MD, MPH, MS; Salisbury, NC 2011
Executive Director Wendy J. Weiser; Schaumburg, IL
Associate Director Sue O’Sullivan; Schaumburg, IL
REGIONAL REPRESENTATIVES TERM EXPIRES
Alabama Representatives Lee N. Hammontree, MD; Homewood, AL 2012 John F. Pirani, MD; Gadsden, AL 2012
Alabama Alternate Representatives Kristie A. Blanchard Burch, MD; Mobile, AL 2012 Manish Shah, MD; Gadsden, AL 2012
Florida Representatives Michael S. Grable, MD; DeLand, FL 2011 George A. Hill, MD; Bradenton, FL 2012 Steven J. Hulecki, MD; Vero Beach, FL 2012 David H. Jablonski, MD; Orlando, FL 2013 Michael A. Jenkins, MD; Panama City, FL 2011
Florida Alternate Representatives Michael A. Binder, MD; Gainesville, FL 2012 Vincent G. Bird, MD; Gainesville, FL 2012 Rafael E. Carrion, MD; Tampa, FL 2011 Michael J. Erhard, MD; Jacksonville, FL 2011 Joshua T. Green, MD; Sarasota, FL 2013
Georgia Representatives Jack M. Amie, MD; St. Simons Island, GA 2012 Chad W.M. Ritenour, MD; Atlanta, GA 2012 Pablo J. Santamaria, MD; Dublin, GA 2013 10 Georgia Alternate Representatives Henry N. Goodwin, Jr., MD; Augusta, GA 2013 John G. Pattaras, MD; Atlanta, GA 2013 James D. Quarles, Jr., MD; Augusta, GA 2012
Kentucky Representative Christopher E.W. Smith, MD; Louisville, KY 2013
Kentucky Alternate Representative Charles G. Ray, MD; Lexington, KY 2013
Louisiana Representatives Stephen M. LaCour, MD; Metairie, LA 2013 Lester J. Prats, MD; New Orleans, LA 2012
Louisiana Alternate Representatives Alexander Gomelsky, MD; Shreveport, LA 2013 Wayne J.G. Hellstrom, MD; New Orleans, LA 2013
Mississippi Representative Woodie J. Wilson, Jr., MD; Hattiesburg, MS 2012
Mississippi Alternate Representative To Be Determined
North Carolina Representatives Luis M. Perez, MD; Charlotte, NC 2011 Thomas J. Polascik, MD; Durham, NC 2011 Thomas S. Stewart, MD; New Bern, NC 2012
North Carolina Alternate Representatives Raj S. Pruthi, MD; Chapel Hill, NC 2011 To Be Determined Ralph N. Vick, MD; Huntersville, NC 2011
Puerto Rico Representative Felix Mendoza-Rosa, MD; Cayey, PR 2012
Puerto Rico Alternate Representative Ricardo F. Sanchez-Ortiz, MD; Hato Rey, PR 2012
South Carolina Representatives John J. Britton, Jr., MD; Charleston, SC 2012 J. Kevin O’Kelly, MD; Florence, SC 2011
South Carolina Alternate Representatives Elizabeth W. Bozeman, MD; Spartanburg, SC 2012 David H. Lamb, MD; Lexington, SC 2011
Tennessee Representatives Timothy K. Duffin, MD; Clarksville, TN 2013 S. Duke Herrell, MD; Nashville, TN 2011
Tennessee Alternate Representatives Joel R. Locke, MD; Franklin, TN 2011 Donald T. McKnight, Jr., MD; Jackson, TN 2013
Representative to AUA Board of Directors B. Thomas Brown, MD, MBA; Daytona Beach, FL 2011
AUA Leadership Program Representatives Rafael E. Carrion, MD; Tampa, FL 2012 Benjamin R. Lee, MD; New Orleans, LA 2012 Scott W. Lisson, MD; Rocky Mountain, NC 2012
11 Resident Representatives Matthew A. Collins, MD; Augusta, GA 2013 Samir P. Shirodkar, MD; Miami, FL 2013 Charles R. Vincent, MD; Gainesville, FL 2013 Lucas R. Wiegand, MD; Tampa, FL 2013
SESAUA STANDING COMMITTEES
BYLAWS COMMITTEE Scott B. Sellinger, MD; Tallahassee, FL (Chair) 2011 John J. Britton, Jr., MD; Charleston, SC 2011 Gerard D. Henry, MD; Shreveport, LA 2013 Raymond J. Leveillee, MD, FRCS-G; Miami, FL (Secretary) 2012 Gregory F. Murphy, MD; Greenville, NC 2013 John F. Pirani, MD; Gadsden, AL 2012
COMMITTEE ON EDUCATION AND SCIENCE Dean G. Assimos, MD; Winston-Salem, NC (Chair) 2012 Michael S. Cookson, MD; Nashville, TN (Committee Member – Imaging) 2012 Benjamin R. Lee, MD; New Orleans, LA (Committee Member – Videos) 2010 Ronald W. Lewis, MD; Augusta, GA (Committee Member – 2012 Montague Boyd Essay) Stephen E. Strup, MD; Lexington, KY (Committee Member – Residents) 2011 Charles R. Pound, MD; Jackson, MS (Member at Large) 2012 Johannes W.G. Vieweg, MD; Gainesville, FL (Member at Large) 2013
FINANCE COMMITTEE David M. Kraebber, MD; Shreveport, LA (Chair) 2011 Alexander Gomelsky, MD; Shreveport, LA 2011 Michael S. Grable, MD; DeLand, FL 2013 Scott D. Miller, MD; Atlanta, GA 2013 William R. Sanderson, MD; Mobile, AL 2012 W. Terry Stallings, MD; Daphne, AL (Treasurer) 2011
HEALTH POLICY COUNCIL Martin K. Dineen, MD; Daytona Beach, FL (Chair) 2013 J. Christian Winters, MD; New Orleans, LA (Vice Chair) 2013 Lorie G. Fleck, MD; Mobile, AL (Alternate Chair) 2013 Jerry E. Jackson, MD; Sumter, SC (Alternate Vice Chair) 2013 Jack M. Amie, MD; St. Simons Island, GA (Georgia Representative) 2013 Ingrum W. Bankston, Jr., MD; Tuscaloosa, AL (Alabama 2013 Alternate Representative) Paul R. Bretton, MD; Cape Coral, FL (Florida Representative) 2013 John W. Brock, II, MD; Nashville, TN (Tennessee Alternate Representative) 2013 Stephen V. Goryl, MD; Cookeville, TN (Tennessee Representative) 2013 Ralph J. Henderson, MD; Shreveport, LA (Louisiana Representative) 2013 Edward W. Killorin, Jr., MD; Columbus, GA (Georgia Alternate Representative) 2013 Felix Mendoza-Rosa, MD; Cayey, PR (Puerto Rico Representative) 2013 Oliver T. Newcomb, II, MD; Morehead, KY (Kentucky Representative) 2013 Thomas H. Phillips, MD; Matthews, NC (North 2013 Carolina Alternate Representative) John F. Pirani, MD; Gadsden, AL (Alabama Representative) 2011 Thomas J. Polascik, MD; Durham, NC (North Carolina Representative) 2013 Charles R. Pound, MD; Jackson, MS (Mississippi Representative) 2013 Lester J. Prats, MD; New Orleans, LA (Louisiana Alternate Representative) 2011 Terrence C. Regan, MD; Palm Coast, FL (Florida Alternate Representative) 2013 Gilberto Ruiz-Deya, MD; Ponce, PR (Puerto Rico Alternate Representative) 2013 To Be Determined; (Kentucky Alternate Representative) Richard M. Vise, MD; Meridian, MS (Mississippi Alternate Representative) 2013 William C. Gates, Jr., MD; West Point, MS (Consultant) William F. Gee, MD; Lexington, KY (Consultant) Josiah F. Reed, Jr., MD; Montgomery, AL (Consultant)
LOCAL ARRANGEMENTS COMMITTEE Dr. H. Anthony and Mrs. Ann Fuselier; New Orleans, LA (Chair) 2012
12 MEMBERSHIP COMMITTEE Stephen V. Goryl, MD; Cookeville, TN (Chair) 2011 Rafael E. Carrion, MD; Tampa, FL 2013 David M. Kraebber, MD; Shreveport, LA 2011 Arthur M. Matthews, Jr., MD; Gulfport, MS 2011 Charles G. Ray, MD; Lexington, KY 2011 J. Christian Winters, MD; New Orleans, LA 2011
NOMINATING COMMITTEE Dennis D. Venable, MD; Shreveport, LA (Chair) 2011 Charles H. Coleman, Jr., MD; Augusta, GA (Member at Large) 2011 Stephen V. Goryl, MD; Cookeville, TN (Member at Large) 2012 Martin K. Dineen, MD; Daytona Beach, FL (Past President) 2012 Thomas F. Stringer, MD; Inverness, FL (Immediate Past President) 2012
SESAUA REPRESENTATIVES TO AUA COMMITTEES
AUA BOARD OF DIRECTORS B. Thomas Brown, MD, MBA; Daytona Beach, FL (Representative) 2011 Dennis D. Venable, MD; Shreveport, LA (Representative) 2011
AUA BYLAWS COMMITTEE Gerard D. Henry, MD; Shreveport, LA 2011 Scott B. Sellinger, MD; Tallahassee, FL 2011 W. Terry Stallings, MD; Daphne, AL 2011
AUA EDITORIAL BOARD COMMITTEE Philipp Dahm, MD, MHSc, FACS; Gainesville, FL 2013 Raj S. Pruthi, MD; Chapel Hill, NC 2013 Raju Thomas, MD, FACS, MHA; New Orleans, LA 2012
AUA HEALTH POLICY COUNCIL Martin K. Dineen, MD; Daytona Beach, FL 2011 Ralph J. Henderson, MD; Shreveport, LA 2011 J. Christian Winters, MD; New Orleans, LA 2011
AUA HISTORY COMMITTEE Hector H. Henry, II, MD, MPH, MS; Salisbury, NC 2011
AUA INVESTMENT COMMITTEE W. Terry Stallings, MD; Daphne, AL 2011
AUA JUDICIAL & ETHICS COUNCIL Donald D. Kidd, MD; Mobile, AL 2011 Charles R. Pound, MD; Jackson, MS 2011 Harriette M. Scarpero, MD; Nashville, TN 2011
AUA LEADERSHIP PROGRAM Rafael E. Carrion, MD; Tampa, FL (Representative) 2013 Benjamin R. Lee, MD; New Orleans, LA (Representative) 2013 Scott W. Lisson, MD; Rocky Mountain, NC (Representative) 2013
AUA NOMINATING COMMITTEE Charles R. Pound, MD; Jackson, MS (Alternate Representative) 2011 J. Christian Winters, MD; New Orleans, LA (Representative) 2011
AUA PRACTICE MANAGEMENT COMMITTEE Alexander Gomelsky, MD; Shreveport, LA 2011
AUA RESEARCH COMMITTEE Michael S. Cookson, MD; Nashville, TN 2014 Robert C. Newman, MD; Gainesville, FL 2014 Johannes W.G. Vieweg, MD; Gainesville, FL 2013
AUA RESIDENT’S COMMITTEE Beau N. Dusseault, MD; Lexington, KY (Representative) 2011
AUA YOUNG UROLOGIST COMMITTEE Rowena A. Desouza, MD; Shreveport, LA (Representative) 2011 13 Numerical Membership of the SESAUA
Active 1477
Affiliate 5
Associate 107
Corresponding 1
Honorary 64
Senior 604
Grand Total Membership 2258
Registration /Information The SESAUA Registration/Information Desk is located at the Marriott New Orleans, Preservation Hall Foyer. Tickets to attend the social events, sporting events and tours can be purchased at the registration/information desk.
SESAUA Registration Includes: • Continental Breakfasts • Scientific Sessions • Welcome Reception • Annual Reception & Banquet
SESAUA Spouse/ Guest Registration Includes: • SESAUA Spouse/Guest Hospitality Suite • Welcome Reception • Annual Reception & Banquet • Admission to Seasonal Celebrations with Style (Pre-registration required)
Board of Directors and Executive Committee Meetings
Executive Committee Meeting: Wednesday, March 16th 7:30 a.m. - 11:30 a.m. Location: Bacchus
Board of Directors Meetings: Wednesday, March 16th Board of Directors Lunch 11:30 a.m. - 12:30 p.m. Location: Mardi Gras, IJ
Wednesday, March 16th Board of Directors Meeting 12:30 p.m. - 4:30 p.m. Location: Mardi Gras, D
14 MAP OF HOTEL
15 MAP OF HOTEL
16 Technical Exhibits The SESAUA invites you to visit the exhibit area, which is located at the Marriott New Orleans, Preservation Hall. In addition to bringing educational benefits to the meeting, these exhibitors are also contributors to the scientific and social aspects of this convention.
Exhibit Hours Thursday, March 17, 2011 9:00 a.m. – 4:00 p.m. Welcome Reception 6:00 p.m. – 8:00 p.m. Friday, March 18, 2011 7:00 a.m. – 4:00 p.m. Saturday, March 19, 2011 7:00 a.m. – 12:00 p.m.
*Continental breakfasts, coffee breaks and box lunch will be available in the exhibit hall.
Speaker Ready Room The Speaker Ready Room is in the Marriott New Orleans, Regent. The room will be open for speakers to turn in and/or review their slides during the following hours:
Thursday, March 17, 2011 7:00 a.m. – 4:00 p.m. Friday, March 18, 2011 7:00 a.m. – 5:00 p.m. Saturday, March 19, 2011 7:00 a.m. – 12:00 p.m.
Spouse/Guest Hospitality Suite The Spouse/Guest Hospitality Suite is located at the Marriott New Orleans, St. Charles, 41st Floor. *Registered spouse/guests only allowed into the room. Please have your badge with you at all times in the room.
Thursday, March 17, 2011 7:30 a.m. – 10:30 a.m. Friday, March 18, 2011 7:30 a.m. – 10:30 a.m. Saturday, March 19, 2011 7:30 a.m. – 10:30 a.m. Sunday, March 20, 2011 7:30 a.m. – 10:30 a.m.
Annual Business Meeting The SESAUA Annual Business Meeting will be held on Sunday, March 20, 2011 from 11:00 a.m. – 12:00 p.m. at the Marriott New Orleans, in La Galeries 1-3. All meeting attendees are welcome and encouraged to attend. Please note that only Active and Senior members may vote. Voting for the AUA President will occur during the Business Meeting. Members need not be registered for the scientific portion of the conference to attend the Business Meeting. Industry Sponsored Events
THURSDAY, MARCH 17, 2011 12:15 p.m. – 1:30 p.m. Industry Sponsored Luncheon Location: La Galeries 5 “XGEVATM (denosumab): Clinical Data Review in Prostate Cancer”
Judd W. Moul, MD, FACS James H. Semans, MD, Professor of Urology Chief, Division of Urologic Surgery Duke University Durham, North Carolina
Funding Provided By: Amgen Coordinated by: MedReviews, LLC
THURSDAY, MARCH 17, 2011 12:15 p.m. – 1:30 p.m. Industry Sponsored Luncheon Location: La Galeries 6 “PROVENGE (Sipuleucel-T) in Advanced Prostate Cancer”
Vahan S. Kassabian, MD Research Director Georgia Urology PA Atlanta, Georgia
Funding Provided By: Dendreon
17 FRIDAY, MARCH 18, 2011 6:00 a.m. – 7:00 a.m. Industry Sponsored Breakfast Location: La Galeries 6 “Advanced Prostate Cancer Disease Awareness: Novel Mechanisms of Androgen Regulation and Modulation in Disease Progression”
Sam Chang, MD, FACS Professor of Urologic Surgery Vanderbilt University Nashville, Tennessee
Funding Provided By: Centocor Ortho Biotech
FRIDAY, MARCH 18, 2011 12:30 p.m. – 1:35 p.m. Industry Sponsored Luncheon Location: La Galeries 5 “Meeting the Challenges of OAB Therapy with Clinical and Practical Approaches”
Michael Kennelly, MD
Funding Provided By: Pfizer, Inc.
FRIDAY, MARCH 18, 2011 12:30 p.m. – 1:35 p.m. Industry Sponsored Luncheon Location: La Galeries 6 “Androgen Deprivation Therapy: Patient and Practice Conveniences of a 6-Month LHRH Agonist”
Gerald Chodak, MD Director, Midwest Prostate Health Center Chicago, Illinois
Paul R. Sieber, MD, FACS Urological Associates Lancaster Lancaster, Pennsylvania
Funding Provided By: Watson, Inc. Coordinated by MedReviews, LLC
SATURDAY, MARCH 19, 2011 6:00 a.m. – 7:00 a.m. Industry Sponsored Breakfast Location: La Galeries 6 “Surge-free Testosterone Suppression: An Innovative Approach”
Michael G. Desautel, MD
Funding Provided By: Ferring Pharmaceuticals
SATURDAY, MARCH 19, 2011 12:30 p.m. – 1:30 p.m. Industry Sponsored Lunch Location: La Galeries 6 “Promoting Wellness 3: How to Save Time Discussing What Works and What is Worthless”
Mark Moyad, MD, MPH Jenkins/Pokempner Director of Preventive and Alternative Medicine Department Of Urology, University of Michigan Ann Arbor, Michigan
Funding Provided By: Abbott Laboratories
18 EVENING FUNCTIONS One ticket to each function is included in your registration fee. Individual tickets may be purchased at the registration/information desk (prices listed below).
Thursday, March 17, 2011
WELCOME RECEPTION & WINE TASTING Time: 6:00 p.m. – 8:00 p.m. Location: Preservation Hall, Marriott New Orleans Welcome to the “Big Easy”! Come and catch up with colleagues and exhibitors as you are entertained by a strolling Dixieland band. The night will feature New Orleans style food, Hurricanes and green beer in celebration of St. Patrick’s Day! Dress: Business Casual Cost: Included in registration. Extra tickets: $50.00 adult; $20.00 child.
Friday, March 18, 2011
RESIDENTS’ NIGHT OUT (Residents and Program Chairs only) Time: Depart from Marriott New Orleans lobby at 7:00 p.m. Dress: Casual
Saturday, March 19, 2011
2011 ANNUAL RECEPTION AND BANQUET Time: Reception 7:00 p.m. – 8:00 p.m. Dinner and Entertainment 8:00 p.m. – 12:00 a.m. Location: Marriott New Orleans, Mardi Gras, A-D and E-H The closing social event of the 75th annual meeting of the SESAUA is sure to please with an expertly crafted menu and New Orleans themed musical entertainment and dancing. Dress: Black Tie Optional Cost: Included in registration. Extra tickets: $220.00.
OPTIONAL EVENTS (Availability of tours subject to change) Optional and sporting events are not included in your registration fee. Optional and sporting events are filled on a first-come, first-served basis; therefore, it is recommended that you preregister to avoid disappointment. In addition, some tours may have minimum and maximum limitations. The SESAUA reserves the right to cancel tours and refund payment if registration does not meet the minimum number of persons required per tour, at least three (3) weeks prior to the meeting. Because guarantees will be based on advanced ticket sales, refunds or ticket exchanges will not be available two (2) weeks prior to or on- site at the meeting.
All tours will depart from the Canal Street entrance of the Marriott New Orleans. Please arrive 10 minutes prior to departure time.
Wednesday, March 16th
CITY ESTATE AND GARDENS TOUR Time: 1:00 p.m. – 4:00 p.m. The Botanical Gardens has its roots in the Great Depression as a project of the Works Progress Administration (WPA). Originally known as the City Park Rose Garden, the garden opened in 1936 as New Orleans’ first public classical garden. It is one of the few remaining examples of public garden design from the WPA and Art Deco Period, remaining today as a showcase of three notable talents: New Orleans Architect Richard Koch, Landscape architect William Wiedorn and Artist Enrique Alferez. Reborn as the New Orleans Botanical Garden in the early 1980s, the garden’s collections contained over 2,000 varieties of plants from all over the world set among the nation’s largest stand of mature live oaks.
After a drive through the park, you will visit an exciting city-estate, formerly the home of Edith and Edgar Stern. A bamboo-lined road will lead you to Longue Vue House and Gardens, which blends the old with the new, the classical with the whimsical and the exquisite with the inviting-creating a reflection of the city in which it is so proudly located! Longue Vue is the center of an eight-acre estate famous not only for its interior, but also for its formal and informal gardens adorned with musical fountains and a plethora of flowering plants and numerous patios. Inside the home, you will learn about the special antique collections, including Chinese rice paper screens, priceless Turkish rugs, Wedgwood pottery and many other exquisite objects d’art found at Longue Vue. Upon leaving the house, you will discover the garden designed by Ellen Biddle Shipman, including the Canal and Walled Gardens, the Spanish Court inspired by the Generalife Gardens of the Alhambra in Granada, the East Terrace and the Pan Garden. Cost: $60.00 per ticket (includes transportation, professional informed tour guide and admission to New Orleans City Park Botanical Gardens and Longue Vue House and Gardens) 19 Thursday, March 17th
SOUTHERN ELEGANCE ALONG THE AVENUE Time: 12:00 p.m. – 3:30 p.m. The Garden District is gracious and stately – an elegantly adorned window to a bygone era. Developed mainly between 1840 and 1900, it comprises one of the best-preserved collections of historic mansions in the South—if not the entire country. The Garden District is a brilliant tapestry of architectural styles and period designs. The spacious home sites and rich, garden-ready soil immediately began attracting wealthy New Orleanians – particularly the many well-heeled Americans that had flooded the city after the Louisiana Purchase in 1803. Disdained by the old French Creole gentry in the French Quarter, these new arrivals thumbed their noses at the Creoles by constructing sumptuous mansions and the Garden District was born. Your tour will include a stop at a private home on St. Charles Avenue. This charming Garden District home dates back to the late 1800s. Right on the streetcar line, this private residence is replete with English and French antiques. The home’s owner will be on hand to share her passion for art, as her home is a treasure trove of Louisiana artists. Cost: $50.00 per ticket (includes transportation, tour of a private home led by the home’s owner and light refreshments)
Friday, March 18th
TASTE OF NEW ORLEANS COOKING CLASS AND LUNCH Time: 11:00 a.m. – 2:30 p.m. The popularity of Cajun and Creole cooking is sweeping the United States, and after this exciting class you will be able to join this culinary bandwagon! You will laugh and learn while watching the preparation of some of the wonderful foods of Louisiana. A highly skilled and entertaining chef will share the secrets of preparing and seasoning flavorful local favorites such as Chicken Andouille Gumbo, Spicy Jambalaya, delicious Bread Pudding and Pecan Pralines. Not only will you learn the secrets of New Orleans cooking, but you will also partake in generous portions during a tastetempting lunch following the class. The cooking demonstration will be easy for you to duplicate at home with the complimentary recipes and cooking tips you will receive at the end of the class. Cost: $65.00 per ticket (includes transportation, lunch/class with cooking school instructor and apron)
Saturday, March 19th
SEASONAL CELEBRATIONS WITH STYLE Time: 10:30 a.m. – 12:00 p.m. Beverly Church, a New Orleans native and an author, designer and magazine editor, will discuss her tips and tricks to mastering the art of entertaining. She will offer ideas and demonstrate how to create eye-catching centerpieces, colorful invitations and more! Mrs. Church’s southern style has been featured on Good Morning America, in Flower Magazine and on specials for Home and Garden Television (HGTV). Cost: No cost to REGISTERED spouses/guests. Must pre-register.
SPORTS DAY (Times and dates are subject to change)
TENNIS AT THE HILTON HEALTH CLUB Time: 12:30 p.m. – 3:30 p.m. Depart from the Marriott at 12:00 p.m. The 2011 SESAUA Tennis Tournament will take place on the only indoor, airconditioned courts in New Orleans. Recently renovated with a new professional Plexipave hard court surfaces, these courts regularly host USTA tournaments and a number of events throughout the year. Cost: $65.00 per ticket (includes transportation, boxed lunch, court rental and tournament coordination)
GOLF AT TPC LOUISIANA Time: 12:30 p.m. shotgun start (concludes at approximately 5:00 p.m.) Depart from the Marriott at 12:00 p.m. The TPC Louisiana will be the location of the 2011 SESAUA Golf Tournament. The tournament will be scramble format on Saturday afternoon of the meeting. Bringing championship golf to the vibrant charm of New Orleans, TPC Louisiana is as unique as the celebrated city itself. Legendary architect Pete Dye designed the course to be a perfect complement to the local ambiance – meandering between the rolling hills, lush wetlands and native cypress trees that lie just across the great Mississippi. The course is home to the state’s only PGA TOUR event, the Zurich Classic of New Orleans. A stadium design brings fans up close to the action at every hole, making for a superb spectator experience. Five sets of tees on each hole ensure a rewarding round for every player – no matter his or her ability. Cost: $180.00 per ticket (includes transportation, green fees and tournament coordination)
20 CHILDCARE SERVICES
Dependable Kid Care Phone: (504) 486-4001 Fax: (504) 486-5000 Address: 702 N Carrollton Ave. New Orleans, LA 70119-4709
Accent on Children’s Arrangements Phone: (504) 524-1227 Fax: (504) 486-5000 Address: 938 Lafayette, 2nd Floor New Orleans, LA 70113
21 75th Annual SESAUA Meeting March 17 – 20, 2011 Technical Exhibits Alphabetical as of 3/1/11
Company Name Abbott Laboratories Allergan American Medical Systems, Inc. American Urological Association Amgen, Inc. Angiotech Astellas Pharma US, Inc. Auxilium Pharmaceuticals, Inc Avero Diagnostics Bayer HealthCare Pharmaceuticals Boston Scientific Corporation Caris Life Sciences CBLPath, Inc. CIMplify, Inc. Coloplast Cook Medical Covidien/Liebel Flarsheim Cynogen (Abbott Labs) Dendreon Corporation ERBE USA, Inc. Ferring Pharmaceuticals, Inc. Galil Medical HealthTronics Hitachi Medical Systems America, Inc. Intuitive Medical Software Intuitive Surgical, Inc. IPC Medical Corp IVU Med Karl Storz Endoscopy - America Know Error Life-Tech, Inc. MaxiFlex LLC Medispec, Ltd. Mediwatch USA, Inc. Meridian EMR. Inc. Microbionetics, LLC Mission Pharmacaal Company Neuisys, LLC NextMed, LLC Olympus/Gyrus ACMI Onco Diagnostic Laboratory, Inc. Pfizer, Inc. PLUS Diagnostics QDx Pathology Services Richard Wolf Medical Instruments, Corp. Rush Health Systems Siemens Medical Solutions USA, Inc. Slate Pharmaceuticals Strata Pathology Services TTMED-Urology/Thomson Reuters United Medical Systems Urologix, Inc. Uromatrix Medical Systems Uroplasty, Inc. US HIFU Watson Pharma, Inc.
22 The SESAUA Wishes to Thank and Recognize Our 2011 Industry Partners. Thank You for Your Support. Diamond Level Industry Partners:
Centocor Ortho Biotech Inc
23 Ruby Level Industry Partners:
Thank you to our 2011 Educational Grant Providers Allergan Amgen Ethicon Women’s Health & Urology Dendreon Medtronic
24 75th Annual SESAUA Meeting March 17 – 20, 2011 Named Lectures and Contests
The Ballenger Memorial Lecture Dr. Edgar Ballenger was the Southeastern Section president in 1935 and president of the AUA in 1939. The Annual Ballenger Memorial Lectureship was established after his death in 1946 and serves as our major scientific presentation.
The Montague Boyd Prize Essay Contest Dr. Montague Boyd was the founder of the Southeastern Section, and he served as president in 1933 and 1934. The prize was established in 1967 and is given to a resident, fellow, or urologist in private practice less than ten years.
The Ambrose-Reed Lecture Dr. Samuel Ambrose was the Southeastern Section president in 1975, and in 1981 became the first chairman of the AUA Public Relations Committee, later to be called the Socioeconomic Committee. Dr. Mason who served as president formed this committee, which later became the Health Policy Council. Dr. Josiah Reed was the Southeastern Section president in 1992, and chairman of the AUA Socioeconomic Committee in 1986. This award honors these two pioneers in the field of health policy.
The T. Leon Howard Imaging Conference Dr. T. Leon Howard was president of the South Central Section in 1932. He was a founding trustee of the American Board of Urology in 1934 and AUA president in 1941. He became an honorary member of the Southeastern Section in 1947.
25 Scientific Program 2011 SESAUA Program Schedule 75th Annual Meeting March 17 – 20, 2011 Marriott New Orleans New Orleans, Louisiana 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 La Galeries 1 – 3, unless otherwise noted.
WEDNESDAY, MARCH 16, 2011
7:30 a.m. – 11:30 a.m. SESAUA EXECUTIVE COMMITTEE MEETING Location: Bacchus
10:00 a.m. – 4:00 p.m. REGISTRATION/INFORMATION DESK OPEN Location: Preservation Hall Foyer
11:30 a.m. – 12:30 p.m. SESAUA BOARD OF DIRECTORS LUNCH Location: Mardi Gras, IJ
1:00 p.m. – 4:00 p.m. CITY ESTATE AND GARDENS TOUR Location: Depart from Marriott New Orleans lobby at 1:00 p.m.
12:30 p.m. – 4:30 p.m. SESAUA BOARD OF DIRECTORS MEETING Location: Mardi Gras, D
26 THURSDAY, MARCH 17, 2011
6:00 a.m. – 6:00 p.m. REGISTRATION/INFORMATION DESK OPEN Location: Preservation Hall Foyer
7:00 a.m. – 4:00 p.m. SPEAKER READY ROOM HOURS Location: Regent
7:30 a.m. – 10:30 a.m. SPOUSE/GUEST HOSPITALITY SUITE OPEN Location: St. Charles, 41st Floor
9:00 a.m. – 4:00 p.m. EXHIBIT HALL OPEN Location: Preservation Hall
12:00 p.m. – 3:30 p.m. SOUTHERN ELEGANCE ALONG THE AVENUE THURSDAY Location: Depart from Marriott New Orleans lobby at 12:00 p.m.
6:00 p.m. – 8:00 p.m. WELCOME RECEPTION WITH EXHIBITORS Location: Preservation Hall ______
GENERAL SESSION 7:00 a.m. – 9:30 a.m. SESSION 1:
LIVE SURGICAL EVENT
Robotic Partial Nephrectomy Ashok K. Hemal, MD, FRCS, from Wake Forest University Procedure will be beamed live into the lecture hall. Step-by-step approach, equipment needed and details will be discussed by surgeon and panel.
SURGICAL PANEL DISCUSSION: THE LEAST INVASIVE APPROACH: LAPAROENDOSCOPIC SINGLE INCISION SURGERY (LESS) AND NATUARL ORIFICE SURGERY Moderator: Benjamin R. Lee, MD New Orleans, LA
What is LESS? Lab and Clinical Experience to Date Wesley White, MD Knoxville, TN
Is LESS Really More? Li-Ming Su, MD Gainesville, FL
Future Developments in Natural Orifice Surgery S. Duke Herrell, MD Nashville, TN
Economic Considerations of LESS Stephen E Strup, MD Lexington, KY
9:30 a.m. – 10:00 a.m. BREAK/VISIT EXHIBITS
10:00 a.m. – 10:30 a.m. SESSION 2: OPENING REMARKS – SESAUA PRESIDENT
President: Raju Thomas, MD, FACS, MHA SESAUA New Orleans, LA
Welcoming You Back to a Resurgent New Orleans Benjamin Sachs, MD
27 10:30 a.m. – 12:00 p.m. SESSION 3: KIDNEY CANCER PODIUM
Moderators: Stephen E. Strup, MD Lexington, KY
Li-Ming Su, MD Gainesville, FL
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
10:30 a.m. #1 PRE-OPERATIVE NUTRITIONAL STATUS IS ASSOCIATED WITH SURVIVAL AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA Dominic Tang¹, Todd Morgan², Daniel Barocas², Christopher Anderson², Kelly Stratton², S. Duke Herrell², Sam Chang², Michael Cookson², Joseph Smith² and Peter Clark² ¹Meharry Medical College, Nashville, TN; ²Vanderbilt University School of Medicine, Nashville, TN (Presented By: Todd Morgan)
10:36 a.m. #2 POST-OPERATIVE COMPLICATIONS FROM CYTOREDUCTIVE NEPHRECTOMY AFTER NEO-ADJUVANT TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA Brian F. Chapin¹, Scott E. Delacroix¹, Stephen H. Culp¹, Graciela M. Nogueras- Gonzalez² and Christopher G. Wood¹ ¹The University of Texas M.D. Anderson Cancer Center Department of Urologic Oncology, Houston, Texas; ²The University of Texas M.D. Anderson Cancer Center Department of Biostatistics, Houston, Texas (Presented By: Brian F. Chapin)
10:42 a.m. #3 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL MASSES: A PROSPECTIVE, MULTI−CENTER STUDY Wesley White¹, Michael White², Georges-Pascal Haber², Ricardo Autorino², Frederick Klein¹, W. Bedford Waters¹ and Jihad Kaouk² ¹Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville, Knoxville, TN; ²Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH (Presented By: Wesley White)
10:48 a.m. #4 ASSOCIATION OF R.E.N.A.L. NEPHROMETRY SCORE AND ISCHEMIA TIME DURING PARTIAL NEPHRECTOMY Jason Bylund, Dustin Gayheart, Ramakrishna Venkatesh, David Preston, Stephen Strup and Paul Crispen University of Kentucky, Lexington, KY (Presented By: Jason Bylund) 10:54 a.m. #5 ASSESSMENT OF PREOPERATIVE C-REACTIVE PROTEIN AS AN INDEPENDENT PREDICTOR OF FURHMAN NUCLEAR GRADE IN THE SETTING OF A SMALL RENAL MASS Austin DeRosa, S. Mohammad Jafri, Kenneth Ogan, Timothy Johnson, John Pattaras, Kenneth J. Carney, Peter Nieh and Viraj Master Emory University, Atlanta, GA (Presented By: Austin DeRosa)
11:00 a.m. #6 MOLECULAR MARKERS MAY AID IN THE IDENTIFICATION OF ONCOCYTOMA Jeffrey Gahan¹, Vincent Bird², Soloway Mark¹ and Vinata Lokeshwar¹ ¹University of Miami Department of Urology; ²University of Florida Department of Urology (Presented By: Jeffrey Gahan)
11:06 a.m. #7 ESR-BASED LOW, INTERMEDIATE, AND HIGH RISK CATEGORIES PREDICTING OVERALL SURVIVAL IN LOCALIZED RENAL CELL CARCINOMA Brian Cross¹, Austin DeRosa¹, Timothy Johnson¹, Ammara Abbasi¹, Andrew Michigan¹, Ken Ogan¹, John Pattaras¹, Peter Nieh¹, Fray Marshall¹, Jeff Carney¹, Omer Kucuk², Wayne Harris² and Viraj Master¹ ¹Emory University Department of Urology, Atlanta, GA; ²Emory University Department of Hematology and Oncology, Atlanta, GA (Presented By: Brian Cross)
28 11:12 a.m. #8 ASSESSING THE IMPACT OF NON-NEOPLASTIC RENAL DISEASE AFTER PARTIAL NEPHRECTOMY Michael Garcia-Roig, Monica Garcia-Buitrago, Carlos Parra-Hernan, Merce Jorda, Bruce Kava, Murugesan Manoharan, Mark Soloway and Gaetano Ciancio Miami, FL (Presented By: Michael Garcia-Roig)
11:18 a.m. #9 CHARACTERIZING FOLLOW-UP IMAGING AFTER PARTIAL NEPHRECTOMY Jason Reynolds, Rizk El-Galley, Erik Busby and Jan Colli University of Alabama at Birmingham (Presented By: Jan Colli)
11:24 a.m. #10 IMPORTANCE OF SELECTION CRITERIA IN PERFORMING RADICAL NEPHRECTOMY WITH CONCOMITANT IVC THROMBECTOMY IN PATIENTS WITH
METASTATIC RENAL CELL CARCINOMA THURSDAY Tony Kurian¹, Timothy Kim¹, Wade Sexton2, Julio Pow-Sang2, John Seigne2, Hui-Yi Lin2, Paul Armstrong¹, Devanand Mangar¹ and Philippe Spiess2 ¹University of South Florida, Tampa FL; ²Moffitt Cancer Center, Tampa FL (Presented By: Timothy Kim)
11:30 a.m. #11 LONG TERM OUTCOMES AFTER PERCUTANEOUS RADIOFREQUENCY ABLATION FOR RENAL CELL CARCINOMA Ronald Zagoria¹, Joseph Pettus², Morgan Rogers¹, David Werle², David Childs¹ and John Leyendecker¹ ¹Department of Radiology, Wake Forest University Health Sciences, Winston-Salem, NC; ²Department of Urology, Wake Forest University Health Sciences, Winston-Salem, NC (Presented By: David Werle)
11:36 a.m. #12 RETROGRADE RENAL HYPOTHERMIA TECHNIQUE: ROBOTIC PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Philip Dorsey, Sarah Conley, Brian Richardson and Benjamin Lee Department of Urology, Tulane University School of Medicine, New Orleans, LA (Presented By: Philip Dorsey)
11:42 a.m. #13 PROSPECTIVE MINIMALLY INVASIVE APPROACHES TO MANAGEMENT OF ENHANCING RENAL MASSES: EVIDENCE OF SIGNIFICANT INTERVAL GROWTH OR SIZE GREATER THAN 3 CM PRIOR TO INTERVENTION Robert Carey, Amar Raval and Tariq Hakky Florida State University College of Medicine, Sarasota Florida (Presented By: Robert Carey)
11:48 a.m. #14 URETEROSCOPIC CORRELATION WITH FINAL PATHOLOGY SPECIMEN IN UPPER TRACT UROTHELIAL CANCER John Pattaras, Yamile Morales, Kenneth Ogan and Viraj Master Emory University, Atlanta, GA (Presented By: John Pattaras)
11:52 a.m. #15 ENHANCING RENAL TUMORS IN PATIENTS WITH PRIOR NORMAL ABDOMINAL IMAGIING: INSIGHT INTO THE NATURAL HISTORY OF RENAL CELL CARCINOMA Gregory Stewart¹, Aldiana Soljic², Alex Kutikov³, Paul Crispen¹ and Robert Uzzo³ ¹University of Kentucky, Lexington, KY; ²University of Miami, Miami, FL; ³Fox Chase Cancer Center, Philadelphia, PA (Presented By: Gregory Stewart)
12:00 p.m. – 12:15 p.m. SESSION 4: WRAP-UP CONTROVERSIES IN THE MANAGEMENT OF RENAL MASSES: POKE IT, PROBE IT, CUT IT OR LEAVE IT ALONE? Invited Speaker: S. Duke Herrell, MD Nashville, TN 12:15 p.m. – 1:30 p.m. SESSION 5: INDUSTRY SPONSORED LUNCHEON Location: La Galeries 5 “XGEVATM (denosumab): Clinical Data Review in Prostate Cancer”
Judd W. Moul, MD, FACS James H. Semans, MD, Professor of Urology Chief, Division of Urologic Surgery Duke University
Funding Provided By: Amgen Coordinated by: MedReviews, LLC 29 12:15 p.m. – 1:30 p.m. SESSION 5: INDUSTRY SPONSORED LUNCHEON Location: La Galeries 6 “PROVENGE (Sipuleucel-T) in Advanced Prostate Cancer”
Vahan S. Kassabian, MD Research Director Georgia Urology PA Atlanta, Georgia
Funding Provided By: Dendreon
CONCURRENT SESSIONS 1:30 p.m. – 2:45 p.m. SESSION 6: URODYNAMICS AND BLADDER FUNCTION PODIUM Location: Mardi Gras, IJ
Moderators: Christopher Chermansky, MD New Orleans, LA
Yvonne K. Koch, MD Miami, FL
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
1:30 p.m. #16 MATRIX METALLOPROTEINASE 1 GENETIC VARIANT IS ASSOCIATED WITH STRESS URINARY INCONTINENCE AND PELVIC ORGAN PROLAPSE Ilya Gorbachinsky¹, Patrick McKenzie¹, Lysanne Campeau², Jan Rohozinski²,³, Karl- Erik Andersson², Doug Case4 and Gopal Badlani¹ ¹Wake Forest University Baptist Medical Center, Department of Urology, Winston- Salem, NC; ²Wake Forest University Institute for Regenerative Medicine, Winston- Salem, NC; ³Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX; 4Wake Forest University Baptist Medical Center, Department of Biostatistical Science, Winston-Salem, NC (Presented By: Ilya Gorbachinsky)
1:36 p.m. #17 COLPOCLEISIS FOR ADVANCED PELVIC ORGAN PROLAPSE Michelle Koski¹, Denise Chow¹, Ahmet Bedestani², Joanna Togami¹, Ralph Chesson² and J. Christian Winters¹ ¹LSU and Ochsner Departments of Urology; ²LSU Department of Obstetrics and Gynecology (Presented By: Michelle Koski)
1:42 p.m. #18 PHENOTYPING MEN WITH INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME Adam Stewart, Edward Kim, James Bienvenu, Ragi Doggweiler and Frederick Klein University of Tennessee Graduate School of Medicine, Knoxville, TN (Presented By: Adam Stewart)
1:48 p.m. #19 CARDIOVASCULAR RISK FACTORS AND DISEASE IN WOMEN WITH OVERACTIVE BLADDER “WET” VS “DRY” Ekene Enemchukwu, W. Stuart Reynolds, Michelle Koski, Gregory Broughton, Douglas Milam, Harriette Scarpero, David Penson, Roger Dmochowski and Melissa Kaufman Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN (Presented By: Ekene Enemchukwu)
1:54 p.m. #20 EFFECTS OF TOPICAL AND ORAL OXYBUTYNIN ON COGNITIVE AND PSYCHOMOTOR FUNCTIONS IN OLDER ADULTS—A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY Gary Kay¹, David Staskin², Scott MacDiarmid³, Marilyn McIlwain4 and Naomi Dahl4 ¹Cognitive Research Corporation, St. Petersburg, FL; ²Tufts University Medical Center, Boston, MA; ³Alliance Urology Specialists, Greensboro, NC; 4Watson Laboratories, Inc., Morristown, NJ (Presented By: Gary Kay)
30 2:00 p.m. #21 LONG TERM FOLLOW-UP DATA ON THE MINIARC™ SINGLE INCISION SLING SYSTEM FOR THE TREATMENT OF STRESS URINARY INCONTINENCE Ryan Pickens, Adam Stewart, Jared Moss, Wesley White, Bedford Waters and Frederick Klein UTMCK (Presented By: Ryan Pickens)
2:06 p.m. #22 THE VIRTUE SLING FOR POST-PROSTATECTOMY INCONTINENCE – SAFETY, EFFICACY, AND URODYNAMIC CHANGES AT 6 MONTHS FOLLOW-UP Craig Comiter¹, Michael Kennelly², Victor Nitti³ and Eugene Rhee4 ¹Stanford University Medical Center, Stanford, CA; ²McKay Urology, Charlotte, NC; ³NYU Urology Associates, New York, NY; 4Kaiser Permanente San Diego Medical Center, San Diego, CA (Presented By: Michael Kennelly) THURSDAY 2:12 p.m. #23 TREATMENT OF MALE STRESS URINARY INCONTINENCE WITH THE ADVANCE TRANSOBTURATOR SLING: RECENT CHANGES IN SURGICAL TECHNIQUE YIELD BETTER PATIENT OUTCOMES Brian Christine¹ and L. Dean Knoll² ¹Urology Centers of Alabama, Birmingham, AL; ²The Center for Urological Treatment and Research, Nashville, TN (Presented By: Brian Christine)
2:18 p.m. #24 MIDURETHRAL SLING SURGERY IN THE OBESE WOMAN: DOES DEGREE OF OBESITY INFLUENCE SURGICAL OUTCOMES AND COMPLICATIONS? Paul W. Walker, Andre P. Broussard, Kristi L. Hebert, B. Jill Williams and Alex Gomelsky LSUHSC – Shreveport, Shreveport, LA (Presented By: Paul W. Walker)
2:24 p.m. #25 TREATMENT OF MALE STRESS URINARY INCONTINENCE WITH THE ADVANCE TRANSOBTURATOR SLING: LONG TERM FOLLOW-UP REVEALS HIGH PATIENT SATISFACTION L. Dean Knoll¹ and Brian Christine² ¹The Center for Urological Treatment, Nashville, TN; ²Urology Centers of Alabama, Birmingham, AL (Presented By: L. Dean Knoll)
2:30 p.m. #26 EARLY ERECTILE FUNCTION FOLLOWING ROBOTIC PROSTATECTOMY PREDICTS RESOLUTION OF SEVERE INCONTINENCE Scott Miller Georgia Urology, Atlanta, GA (Presented By: Scott Miller)
2:36 p.m. #27 LONG-TERM FOLLOW-UP OF BOVINE DERMIS AS A BIOLOGIC SUBSTITUTE FOR AUTOLOGOUS TISSUE IN PUBOVAGINAL SLING SURGERY Joshua Holstead, B. Jill Williams and Alex Gomelsky LSUHSC – Shreveport, Shreveport, LA (Presented By: Joshua Holstead)
2:45 p.m. – 3:00 p.m. SESSION 6.1: WRAP-UP – PRACTICAL URODYNAMICS: WHAT YOU NEED FOR DAY-TO-DAY SURVIVAL
Invited Speaker: J. Christian Winters, MD New Orleans, LA
1:45 p.m. – 3:15 p.m. SESSION 7: SIMULTANEOUS NPP (NON-PHYSICIAN PROVIDERS) FORUM Location: Mardi Gras, ABC
Moderator: Mary Mathe, PA-C Celebration, FL
1:30 p.m. Welcome Raju Thomas, MD, FACS, MHA New Orleans, LA
1:35 p.m. Role of the NPP in Urologic Practice Today Mary Mathe, PA-C Celebration, FL 31 1:45 p.m. Importance of the “Team” in Urology Vipul R. Patel, MD Celebration, FL
2:00 p.m. Work Up and Treatment of Incontinence and OAB Harriette M. Scarpero, MD Nashville, TN
2:15 p.m. Work Up and Treatment of BPH and Elevated PSA Daniel Cohen, MD Winter Park, FL
2:30 p.m. Anticoagulation Prophylaxis in Urologic Surgery: When and Why? Todd Doran, PA-C Nashville, TN
2:40 p.m. Stone Disease Updates Dean G. Assimos, MD Winston-Salem, NC
2:55 p.m. Non-Surgical Management of Erectile Dysfunction and Peyronie’s Disease Wayne J.G. Hellstrom, MD New Orleans, LA
3:10 p.m. Wrap Up and Thank You Mary Mathe PA-C Celebration, FL
1:30 p.m. – 3:15 p.m. SESSION 8: CONCURRENT VIDEO SESSION I Location: La Galeries 1 – 3
Moderators: Benjamin R. Lee, MD New Orleans, LA
Viraj A. Master, MD, PhD, FACS Atlanta, GA
Video #1 ROBOTIC ASSISTED LAPAROSCOPIC RECONSTRUCTION OF RETROCAVAL URETER: DESCRIPTION AND VIDEO OF TECHNIQUE Timothy LeRoy, David Thiel and Todd Igel Mayo Clinic, Jacksonville, FL (Presented By: Timothy LeRoy)
Video #2 INTRAOPERATIVE MONITORING AND QUANTITATION OF RENAL ISCHEMIA DURING PARTIAL NEPHRECTOMY: A PILOT STUDY USING NEAR INFRARED TISSUE OXIMETRY Sarah Conley, Amanda Feige, Mathew Oommen, E. Alton Sartor, Erin Johnson and Benjamin Lee Tulane University School of Medicine – New Orleans, LA (Presented By: Mathew Oommen)
Video #3 V-LOC™ BARBED SUTURE TO FACILITATE THE VESICOURETHRAL ANASTOMOSIS DURING ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY Ryan Turpen, Hany Atalah and Li-Ming Su University of Florida, Gainesville, FL (Presented By: Ryan Turpen)
Video #4 RETROGRADE RENAL HYPOTHERMIA TECHNIQUE: ROBOTIC PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Sarah Conley¹, Brian Richardson², Ashley Bowen³, Van Vo², Zhenggang Xiong², Raju Thomas² and Ben Lee² ¹Oakland, CA; ²New Orleans, LA (Presented By: Ashley Bowen)
32 Video #5 EARLY RETROGRADE NERVE PRESERVATION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY IMPROVES POTENCY OUTCOMES Marcelo Orvieto, Sanket Chauhan, Ananthkrishnan Sivaraman, Rafael Coelho, Kenneth Plamer and Vipul Patel GRI (Presented By: Marcelo Orvieto)
Video #6 MODIFIED TECHNIQUE OF ROBOT ASSISTED SIMPLE PROSTATECTOMY: ADVANTAGES OF A VESICO-URETHERAL ANASTOMOSIS Rafael Coelho, Sanket Chauhan, Ananthkrishnan Sivaraman, Marcelo Orvieto, Kenneth Plamer and Vipul Patel GRI (Presented By: Marcelo Orvieto)
Video #7 ROBOTIC SACRAL COLPOPEXY WITH CONCOMITANT SUPRACERVICAL THURSDAY HYSTERECTOMY Wesley White¹, Ryan Pickens¹, Robert Elder² and Frederick Klein¹ ¹Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville, Knoxville, TN; ²Department of Obstetrics and Gynecology, The University of Tennessee Medical Center, Knoxville, Knoxville, TN (Presented By: Wesley White)
Video #8 SALVAGE ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (SRALP) FOR RADIORECURRENT PROSTATE CANCER: DESCRIPTION OF TECHNIQUE AND MULTI-INSTITUTIONAL OUTCOMES Rafael Coelho¹, Sanket Chauhan¹, Ananthkrishnan Sivaraman¹, Marcelo Orvieto, Kenneth Plamer¹, Manoj Patel¹, Michael Liss², Thomas Ahlering², Robert Ferrigni³, Erik Castle4, Jean Joseph5 and Vipul Patel¹ ¹GRI; ²UCI; ³Mayo Clinic; 4Mayo Clinic; 5University of Rochester (Presented By: Marcelo Orvieto)
Video #9 ROBOTIC SURGICAL MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Joseph Pugh, Sijo Parekattil and Li-Ming Su University of Florida, Department of Urology, Gainesville, Florida (Presented By: Joseph Pugh)
Video #10 TRANSVAGINAL COLPOCLEISIS IN THE TREATMENT OF ADVANCED VAGINAL PROCIDENTIA IN THE ELDERLY FEMALE: SURGICAL TECHNIQUE Denise Chow¹, Michelle Koski², Joanna Togami², Ralph Chesson³, Ahmet Bedestani³ and Jack Winters² ¹LSU/Ochsner Departments of Urology; ²LSU/ Ochsner Departments of Urology, New Orleans, Louisiana; ³LSU Department of Gynecology, New Orleans, Louisiana (Presented By: Denise Chow)
3:15 p.m. – 3:45 p.m. BREAK/VISIT EXHIBITS
CONCURRENT SESSIONS 3:45 p.m. – 5:45 p.m. SESSION 9: YOUNG UROLOGISTS FORUM Location: La Galeries 1 – 3 Moderators: Philipp Dahm, MD, MHSc, FACS Gainesville, FL
Alexander Gomelsky, MD Shreveport, LA
3:45 p.m. Welcome and Introduction Alexander Gomelsky, MD Louisiana State Health Sciences Center Department of Urology Shreveport, LA
3:55 p.m. Negotiating Your First Contract: How to Avoid Common Pitfalls Thomas Crawford, MBA, FACHE University of Florida Department of Urology
33 4:25 p.m. Will I Still be Able to Make a Living in 2020? – Health Care Reform and Implications for Urologists’ Reimbursement Brian Bailey American Urological Association Health Policy Council
4:55 p.m. No Longer in Credit Card Debt – What Next? Investment Strategies for the Savvy Urologist Jim Wyland Financial Advisor, AAMS Edward Jones Investments
5:25 p.m. Questions and Answers, Wrap-up
5:45 p.m. Adjourn
3:45 p.m. – 5:45 p.m. SESSION 10: CONCURRENT POSTER SESSION – PROSTATE CANCER Location: Mardi Gras, LMN
Moderators: Sean M. Collins, MD Metairie, LA
Sanjay Razdan, MD, MCh Miami, FL
Poster #1 THE INFLUENCE OF SOCIO-DEMOGRAPHIC FACTORS, RACE, ETHNICITY, AND THE DOCTOR-PATIENT RELATIONSHIP ON PSA SCREENING BEHAVIOR Eminajulo Adekoya, Robert Mitchell, III¹, David Penson¹,²,³, Jay Fowke4 and Daniel Barocas¹,² ¹Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University Medical Center, Center for Surgical Quality and Outcomes Research, Nashville, TN; ³Tennessee Valley Veterans Administration Health System, Nashville, TN; 4Vanderbilt University Medical Center, Division of Epidemiology, Nashville, TN (Presented By: Daniel Barocas)
Poster #2 HIFU AND THE INTERNET: A QUALITY CONTROL STUDY OF ONLINE INFORMATION Joshua Langston, J. Patrick Selph, Ankur Manvar, James Fergueson, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston)
Poster #3 TUMOR VOLUME AS A PREDICTOR OF ADVERSE PATHOLOGIC FEATURES AND BIOCHEMICAL RECURRENCE (BCR) IN RADICAL PROSTATECTOMY SPECIMENS; A TALE OF TWO METHODS Ian Thompson, III¹, Shady Salem¹, Sam Chang¹, Peter Clark¹, Rodney Davis¹, S. Duke Herrell¹, Yakup Kordan¹, Roxelyn Baumgartner¹, Sharon Phillips², Joseph Smith, Jr.¹, Michael Cookson¹ and Daniel Barocas¹ ¹Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN (Presented By: Ian Thompson, III)
Poster #4 MARIJUANA USE AND PROSTATE CANCER OUTCOMES IN VETERANS Sisir Botta, Daniel Linn and Martha Terris Medical College of Georgia, Augusta, GA (Presented By: Sisir Botta)
Poster #5 THE FATE OF MEN WITH INCIDENTAL PROSTATE CANCER DIAGNOSED AT THE TIME OF RADICAL CYSTECTOMY J. Patrick Selph, Joshua Langston, James Fergueson, Ankur Manvar, Angela Smith, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: J. Patrick Selph)
Poster #6 THE IMPACT OF ABNORMAL DIGITAL RECTAL EXAMINATION ON PROSTATE CANCER DETECTION IN OBESE MEN David Chu, Daniel Moreira, Leah Gerber, Madeline McKeever, Stephen Freedland and Lionel Bañez Division of Urologic Surgery, Department of Surgery, Duke University, Durham, NC (Presented By: David Chu) 34 Poster #7 EVALUATION OF BIOAVAILABLE TESTOSTERONE LEVELS, ERECTILE DYSFUNCTION AND PROSTATE CANCER AGGRESSIVENESS IN MEN UNDERGOING TREATMENT FOR LOCALIZED PROSTATE CANCER Alexander Parker, Andrea Tavlarides, Nancy Diehl, Michael Heckman, Kristin Green and Gregory Broderick Mayo Clinic – Florida Campus (Presented By: Alexander Parker)
Poster #8 PRE-SALAVAGE PSA IS AN IMPORTANT FACTOR IN SELECTING PATIENT FOR SALVAGE CRYOABLATION OF THE PROSTATE IN PATIENTS WITH BIOCHEMICAL RECURRENCE AFTER RADIATION THERAPY Ahmed El-Zawahry, Harry Clarke and Thomas Keane Medical University of South Carolina, Charleston, SC (Presented By: Ahmed El-Zawahry) THURSDAY Poster #9 RISK OF DEVELOPMENT OF PROTEINURIA WITH ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, John Stites, Travis Pagliara, Anthony Patterson, Ithaar Derweesh, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin)
Poster #10 ALTERED SUBCELLULAR LOCALIZATION OF BETA-CATENIN IN HUMAN PROSTATE CANCERS DETECTED BY A NOVEL PHOSPHO-SPECIFIC BETA-CATENIN ANTIBODY K.C. Balaji Wake Forest University (Presented By: K.C. Balaji)
Poster #11 LOW YIELD OF SCREENING FOR HEMATURIA IN PATIENTS WITH A HISTORY OF PELVIC RADIATION FOR PROSTATE CANCER Marina Cheng, Jeffrey Lee, Sravankumar Kavuri and Martha Terris MCG (Presented By: Marina Cheng)
Poster #12 EFFICACY AND SAFETY OF A ONCE-YEARLY HISTRELIN ACETATE IMPLANT (VANTAS®) COMPARED WITH 3-MONTH GOSERELIN ACETATE IMPLANTS IN PATIENTS WITH METASTATIC PROSTATE CANCER Samira Harper and John Campbell Endo Pharmaceuticals, Chadds Ford, Pennsylvania (Presented By: John Campbell)
Poster #13 CANCER CURE AND FUNCTIONAL OUTCOMES WITH ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALRP): 500 CASES AT A TERTIARY CANCER CARE REFERRAL Robert Carey¹, Amar Raval² and Tariq Hakky² ¹Florida State University College of Medicine, Sarasota Florida; ²Florida State University College of Medicine (Presented By: Robert Carey)
Poster #14 AN ALGORITHM UTILIZING PROSTATE BIOPSY AND FUSED CAPROMAB PENDETIDE SCANNING (CPS) HELP TO SELECT PATIENTS FOR SALVAGE CRYOSURGICAL ABLATION OF THE PROSTATE (CSAP) Ahmed El-Zawahry, Matthew Eskridge, Georgiana Onisiscu, Elizabeth Garett-Meyer, Harry Clarke and Thomas Keane Medical University of South Carolina, Charleston, SC (Presented By: Ahmed El-Zawahry)
Poster #15 EVALUATION OF THE PHARMACOKINETICS AND PHARMACODYNAMICS OF A ONCE-YEARLY HISTRELIN ACETATE IMPLANT (VANTAS®) IN PATIENTS WITH PROSTATE CANCER AND RENAL OR HEPATIC IMPAIRMENT Samira Harper and John Campbell Endo Pharmaceuticals, Chadds Ford, Pennsylvania (Presented By: John Campbell)
Poster #16 ROBOT-ASSISTED RADICAL CYSTECTOMY VERSUS OPEN RADICAL CYSTECTOMY IN THE ELDERLY: IMPLICATIONS ON PERI-OPERATIVE MORBIDITY Kyle A. Richards, A. Karim Kader, Joe A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards) 35 FRIDAY, MARCH 18, 2011
6:30 a.m. – 7:00 a.m. BREAKFAST Location: Preservation Hall
6:30 a.m. – 5:00 p.m. REGISTRATION/INFORMATION DESK OPEN Location: Preservation Hall Foyer
6:30 a.m. – 4:00 p.m. EXHIBIT HALL OPEN Location: Preservation Hall
7:00 a.m. – 5:00 p.m. SPEAKER READY ROOM HOURS Location: Regent
7:30 a.m. – 10:30 a.m. SPOUSE/GUEST HOSPITALITY SUITE OPEN Location: St. Charles, 41st Floor
11:00 a.m. – 2:30 p.m. TASTE OF NEW ORLEANS COOKING CLASS AND LUNCH Location: Depart from Marriott New Orleans lobby at 11:00 a.m.
7:00 p.m. – 10:30 p.m. RESIDENTS’ NIGHT OUT (program directors and residents only) Location: Depart from Marriott New Orleans lobby at 7:00 p.m. ______
GENERAL SESSION
6:00 a.m. – 7:00 a.m. SESSION 11: INDUSTRY SPONSORED BREAKFAST Location: La Galeries 6 “Advanced Prostate Cancer Disease Awareness: Novel Mechanisms of Androgen Regulation and Modulation in Disease Progression”
Sam Chang, MD, FACS Professor of Urologic Surgery Vanderbilt University Nashville, Tennessee
Funding Provided By: Centocor Ortho Biotech
7:00 a.m. – 8:15 a.m. SESSION 12: BLADDER CANCER PODIUM
Moderators: Murugesan Manoharan, MD Miami, FL
Mathew C. Raynor, MD Chapel Hill, NC
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
7:00 a.m. #28 COMPARISON OF RECURRENCE PATTERNS FOR UPPER TRACT UROTHELIAL CARCINOMA TREATED WITH NEPHRON-SPARING SURGERY OR WITH RADICAL EXTIRPATIVE SURGERY Mark Anderson, G.M. Preminger and B.A. Inman Duke University Medical Center, Durham, NC (Presented By: Mark Anderson)
7:06 a.m. #29 PREDICTING THE PROBABILITY OF 90-DAY SURVIVAL IN ELDERLY BLADDER CANCER PATIENTS TREATED WITH RADICAL CYSTECTOMY Nedim Ruhotina, Todd Morgan, Sam Chang, Daniel Barocas, Kirk Keegan, David Penson, Peter Clark, Joseph Smith, Jr. and Michael Cookson Vanderbilt University School of Medicine, Nashville, TN (Presented By: Nedim Ruhotina)
36 7:12 a.m. #30 BLADDER CONSERVATION FOR MYOINVASIVE UROTHELIAL CARCINOMA David Kraebber LA (Presented By: David Kraebber)
7:18 a.m. #31 PRIOR PELVIC IRRADIATION DOES NOT RESULT IN FALSE POSITIVE UROVYSIONTM FLUORESCENCE IN SITU HYBRIDIZATION (FISH) TEST RESULTS Marina Cheng, Jeffrey Lee, Sravankumar Kavuri and Martha Terris MCG (Presented By: Marina Cheng)
7:24 a.m. #32 NUCLEAR MARTIX PROTEIN 22, URINARY CYTOLOGY, AND CYSTOSCOPY: A ONE YEAR COMPARISON STUDY Anthony Schlake¹, Timothy Atkinson¹, Daniel Davenport¹, Paul Crispen¹ and David Preston² ¹University of Kentucky, Lexington, KY; ²Department of Veterans Affairs and University of Kentucky, Lexington, KY (Presented By: Anthony Schlake)
7:30 a.m. #33 SDF1 Β VARIANT AND CXCR7 AS DIAGNOSTIC AND PROGNOSTIC MARKERS FOR BLADDER CANCER Obi Ekwenna, Travis Yates, Miguel Gosalbez, Soum Lokeshwar, Samir Shirodkar, Murugesan Manoharan, Mark Soloway and Vinata Lokeshwar University of Miami, Miami, Florida (Presented By: Obi Ekwenna)
7:36 a.m. #34 MANAGEMENT OF PRIMARY SMALL CELL CARCINOMA OF THE BLADDER Adam Stewart, Bedford Waters, Paul Hatcher and Frederick Klein
University of Tennessee Graduate School of Medicine, Knoxville, TN FRIDAY (Presented By: Adam Stewart)
7:42 a.m. #35 CLINICAL AND PATHOLOGIC DIFFERENCES BETWEEN PATIENTS UNDERGOING TURBT FOR NEWLY-DIAGNOSED VERSUS RECURRENT BLADDER LESIONS DETECTED BY CYSTOSCOPY. Joshua Langston, J. Patrick Selph, Ankur Manvar, James Fergueson, Sean Sawh, Angela Smith, Mathew Raynor, Matthew Nielsen, Culley Carson and Raj Pruthi (Presented By: Joshua Langston)
7:48 a.m. #36 CYTOREDUCTIVE SURGERY WITH INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY FOR PATIENTS WITH PERITONEAL DISSEMINATION OF URACHAL ADENOCARCINOMA L. Spencer Krane, Mary Cromer, A. Karim Kader and Edward A. Levine Wake Forest University, Winston-Salem, NC (Presented By: L. Spencer Krane)
7:54 a.m. #37 PATTERNS OF UTILIZATION OF URINE-BASED MARKERS IN NON-MUSCLE- INVASIVE BLADDER CANCER: RESULTS FROM THE BCAN / SUO / AUA / LUGPA ELECTRONIC SURVEY J. Patrick Selph, Joshua Langston, Sean Sawh, James Fergueson, Ankur Manvar, Angela Smith, Eric Wallen, Raj Pruthi, Yair Lotan and Matthew Nielsen (Presented By: J. Patrick Selph)
8:00 a.m. #38 RISK-SPECIFIC INTENSITY OF SURVEILLANCE PRACTICES IN NON-MUSCLE- INVASIVE BLADDER CANCER: RESULTS FROM THE BCAN / SUO / AUA / LUGPA ELECTRONIC SURVEY J. Patrick Selph, Joshua Langston, Sean Sawh, James Fergueson, Ankur Manvar, Angela Smith, Eric Wallen, Raj Pruthi, Yair Lotan and Matthew Nielsen (Presented By: J. Patrick Selph)
8:06 a.m. – 8:15 a.m. Q&A
37 CONCURRENT SESSIONS 8:15 a.m. – 9:15 a.m. SESSION 13: ENDOUROLOGY AND STONE DISEASE PODIUM Location: La Galeries, 1 – 3
Moderators: Nicole L. Miller, MD Nashville, TN
E. James Seidmon, MD Jackson, MS
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
8:15 a.m. #39 SINGLE CENTER CLINICAL COMPARISON OF TWO REINFORCED URETERAL ACCESS SHEATHS FOR RETROGRADE URETEROSCOPIC TREATMENT OF URINARY LITHIASIS Rajinikanth Ayyathurai, John Shields, Prashanth Kanagarajah, Ezekiel Young, Alina Alvarez and Vincent Bird University of Miami Miller School of Medicine (Presented By: Ezekiel Young)
8:21 a.m. #40 IMPACT OF DIETARY CALCIUM AND OXALATE, AND OXALOBACTER FORMIGENES COLONIZATION ON STONE RISK Juquan Jiang¹, John Knight², Linda Easter³, Rebecca Neiberg4, Ross Holmes² and Dean Assimos² ¹Department of Microbiology and Biotechnology; ²Wake Forest University School of Medicine Winston-Salem, North Carolina; ³GCRC Bionutrition Unit, Wake Forest University Medical School, Winston-Salem, North Carolina; 4Dept of Public Health Sciences, Wake Forest University Medical School Winston-Salem, North Carolina (Presented By: Dean Assimos)
8:27 a.m. #41 PROSPECTIVE ANALYSIS OF THE SAFETY AND EFFICACY OF ESWL AT A MULTI-PRACTICE SINGLE CENTER: AN EVALUATION OF 14,397 PATIENTS Bhavin Patel, Manesh Patel and John Smith Wake Forest University, Department of Urology, Winston Salem, NC (Presented By: Bhavin Patel)
8:33 a.m. #42 STAGE II PERCUTANEOUS NEPHROLITHOTOMY: A NOVEL TECHNIQUE FOR RESIDUAL STONE DISEASE Arthur Caire, Aaron Boonjindasup, Aaron Bernie, Luke Fifer and Raju Thomas Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
8:39 a.m. #43 COMPARATIVE ANALYSIS OF ANTERIOR AND POSTERIOR TREATMENT PLANES UTILIZING THE DORNIER DELTA COMPACT ELECTROMAGNETIC LITHOTRIPTER Ryan Pickens, Adam Stewart, Brent Hardin, Wesley White, Bedford Waters and Frederick Klein UTMCK (Presented By: Ryan Pickens)
8:45 a.m. #44 GLYOXAL METABOLISM: A NOVEL PATHWAY IN ENDOGENOUS OXALATE SYNTHESIS Kyle Wood, Dean Assimos, John Knight and Ross Holmes Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (Presented By: Kyle Wood)
8:51 a.m. #45 A MULTI-CENTER PROSPECTIVE RANDOMIZED TRIAL COMPARING THREE INTRA-CORPOREAL LITHOTRITES DURING PERCUTANEOUS NEPHROLITHOTOMY Michael Lipkin, Agnes Wang, Dorit Zilberman, Michael Ferrandino and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin)
8:57 a.m. #46 RISK OF DIABETES MELLITUS AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) OR URETEROSCOPY (URS) FOR URINARY STONE DISEASE Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, Jessica Lange, Matthew Kincade, Kevin Walls, Anothony Patterson, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin)
38 9:15 a.m. – 9:30 a.m. SESSION 13.1: WRAP-UP – ROLE OF FLEXIBLE URETERO- NEPHROSCOPY IN UROLOGIC PRACTICE TODAY
Invited Speaker: Glenn M. Preminger, MD Durham, NC
8:15 a.m. – 9:30 a.m. SESSION 14: RADIOLOGY AND IMAGERY PODIUM Location: Mardi Gras, IJ
Moderators: Vincent G. Bird MD Gainesville, FL Gilberto Ruiz-Deya, MD Ponce, PR
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
8:15 a.m. #47 POSTOPERATIVE IMAGING IS UNNECESSARY AFTER ANASTOMOTIC URETHROPLASTY Ryan Terlecki¹, Matthew Steele², Celeste Valadez² and Allen Morey² ¹Wake Forest University, Winston-Salem NC; ²UT Southwestern, Dallas, TX (Presented By: Ryan Terlecki)
8:21 a.m. #48 A COMPARISON STUDY OF THE RADIATION DOSE OF IN-OFFICE CT SCANNERS WITH HOSPITAL SCANNERS IN THE SAME PATIENTS Phillip Wise¹, Narbik Manukian², John Lovett³, Denton Harris IV4, Tom Patterson5, Winston Wilfong6 and Joseph Jenkins7 ¹Spectrum Hospital, Grand Rapids, MI; ²Physicist, Los Angeles, CA; ³Wilmington, NC; 4Beaumont, TX; 5Galesburg, IL; 6Macon, GA; 7Neuysis, Chapel Hill, NC FRIDAY (Presented By: Phillip Wise)
8:27 a.m. #49 NOVEL USE OF MRI TO DETECT REFLUX IN A BLADDER MODEL WITHOUT CATHETERS, IONIZING RADIATION, OR CONTRAST...OH MY! Bhavin Patel, Gordon McLorie, Anthony Atala, Robert Kraft and Steve Hodges Wake Forest University, Department of Urology, Winston Salem, NC (Presented By: Bhavin Patel)
8:33 a.m. #50 THE USE OF MR UROGRAPHY AS AN ADJUVANT TO LAPAROSCOPIC PYELOPLASTY John Pattaras, Yamile Morales, Diego Martin, Bobby Kalb and Kenneth Ogan Emory University, Atlanta, GA (Presented By: John Pattaras)
8:39 a.m. #51 IS PREOPERATIVE IMAGING IN PROSTATE CANCER OVERUSED? AN ANALYSIS OF THE 2010 NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES Arthur Caire, Aaron Boonjindasup, Neils Johnson, Aaron Bernie, Raju Thomas and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
8:45 a.m. #52 ARE COMPUTERIZED TOMOGRAPHY ANGIOGRAMS, MAGNETIC RESONANCE ANGIOGRAMS AND ANGIOGRAMS NECESSARY FOR MINIMALLY INVASIVE PARITAL NEPHRECTOMIES? Michael McDonald Florida Hospital Celebration, Celebration, FL (Presented By: Michael McDonald)
8:51 a.m. #53 ENHANCED RESIDENT EDUCATION AND PATIENT CARE PROVIDED BY MOBILE COMPUTING DEVICES Kush Patel¹, Arthur Caire¹, Ashley Bowen¹, Gordon Fifer¹ and Raju Thomas² ¹Tulane University School of Medicine, Department of Urology, New Orleans, LA; ²Chairman, Tulane University School of Medicine, Department of Urology, New Orleans, LA (Presented By: Kush Patel)
39 8:57 a.m. #54 MULTIMEDIA COMPUTER-BASED VERSION OF A STANDARD MEDICAL QUESTIONNAIRE RELIABLE REGARDLESS OF PATIENT’S COMPUTER FAMILIARITY Michael Bryant, Evan Schoenberg, Timothy Johnson and Viraj Master Emory University Department of Urology (Presented By: Michael Bryant)
9:03 a.m. #55 ACUTE STONE EPISODE ASSOCIATED WITH DEPRESSION Jordan Angell, Michael Bryant, Hukang Tu, Michael Goodman, John Pattaras and Ken Ogan Emory University, Atlanta, GA (Presented By: Jordan Angell)
9:09 a.m. #56 RISK OF HYPERTENSION AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) OR URETEROSCOPY (URS) FOR URINARY STONE DISEASE Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, Jessica Lange, Evan Dunn, Mattew Kincade, Kevin Walls, Anthony Patterson, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin)
9:30 a.m. – 10:00 a.m. BREAK/VISIT EXHIBITS
10:00 a.m. – 10:30 a.m. SESSION 15: HISTORY: SESAUA
Presenter: Hector H. Henry, II, MD, MPH, MS Salisbury, NC
10:30 a.m. – 11:00 a.m. SESSION 16: MONTAGUE BOYD ESSAY CONTEST
Presiding: Ronald W. Lewis, MD Augusta, GA
(Finalists listed in alphabetical order) Gregory J. Broughton, MD; Vanderbilt University School of Medicine Philip Dorsey, MD; Tulane University School of Medicine Daniel L. Willis, MD; University of Florida Department of Urology
11:00 a.m. – 11:50 a.m. SESSION 17: BALLENGER LECTURE: MINIMALLY INVASIVE UROLOGICAL SURGICAL PROCEDURES IN CHILDREN: TRANSLATING LESSONS LEARNED FROM ADULT COUNTERPARTS
Guest Speaker: Pasquale Casale, MD Philadelphia, PA
11:50 a.m. – 12:05 p.m. SESSION 18: ADDRESS BY SES PRESIDENT – SESAUA UPDATE: CHARTING THE FUTURE
President: Raju Thomas, MD, FACS, MHA SESAUA New Orleans, LA
12:05 p.m. – 12:30 p.m. SESSION 19: AUA UPDATE AUA President-Elect: Sushil S. Lacy, MD Univ. of Nebraska Medical Center Clinical Professor of Surgery, Section of Urology Lincoln, NE
12:30 p.m. – 1:35 p.m. SESSION 20: INDUSTRY SPONSORED LUNCHEON Location: La Galeries 5 “Meeting the Challenges of OAB Therapy with Clinical and Practical Approaches”
Michael Kennelly, MD
Funding Provided By: Pfizer, Inc.
40 12:30 p.m. – 1:35 p.m. SESSION 20: INDUSTRY SPONSORED LUNCHEON Location: La Galeries 6 “Androgen Deprivation Therapy: Patient and Practice Conveniences of a 6-Month LHRH Agonist”
Gerald Chodak, MD Director, Midwest Prostate Health Center Chicago, Illinois
Paul R. Sieber, MD, FACS Urological Associates Lancaster Lancaster, Pennsylvania
Funding Provided By: Watson, Inc. Coordinated by MedReviews, LLC
CONCURRENT SESSIONS 1:35 p.m. – 2:15 p.m. SESSION 21: PRESIDENTIAL LECTURE: ROLE OF PSA SCREENING, SURVEILLANCE, AND MANAGEMENT OF METASTATIC PROSTATE CANCER – UPDATE FOR THE PRACTICING UROLOGIST Location: La Galeries, 1 – 3
Guest Speaker: Oliver Sartor, MD New Orleans, LA
2:15 p.m. – 3:30 p.m. SESSION 22: PROSTATE CANCER PODIUM
Moderators: Harry S. Clarke, Jr., MD, PhD
Charleston, SC FRIDAY
Daniel A. Barocas, MD Nashville, TN
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
2:15 p.m. #57 SIX WEEKS OF FLUOROQUINOLONE ANTIBIOTIC FOR ASYMPTOMATIC PATIENTS WITH ELEVATED PSA IS NOT CLINICALLY BENEFICIAL: A RANDOMIZED CONTROLLED CLINICAL TRIAL Robin Bhavsar¹, Ahmed El-Zawahry¹, Susan Caulder², Jeanette Byers², John Tissot², Thomas Keane¹, Harry Clarke¹ and Stephen Savage¹ ¹Medical University of South Carolina, Charleston, SC; ²Ralph A. Johnson Veterans Hospital, Charleston, SC (Presented By: Robin Bhavsar)
2:21 p.m. #58 SHOULD OUTSIDE INSTITUTION PROSTATE BIOPSIES BE REVIEWED PRIOR TO RADICAL PROSTATECTOMY? Aaron Boonjindasup¹, Arthur Caire², Aaron Bernie², Lekha Mikkillineni², Kayleen Bailey², Sarah Conley², Raju Thomas² and Benjamin Lee² ¹Tulane University Dept. of Urology, New Orleans, LA; ²Tulane University SOM, New Orleans, LA (Presented By: Aaron Boonjindasup)
2:27 p.m. #59 TOREMIFENE 80 MG DEMONSTRATES REDUCTION IN FRACTURE RISK IN MEN WHO ARE LESS THAN 80 YEARS OF AGE ON ANDROGEN DEPRIVATION THERAPY Paul Hatcher¹, Lewis Kriteman², Sean Heron³ and Michael Brawer4 ¹UT Medical Center, Knoxville, TN; ²North Fulton Urology, Roswell, Georgia; ³Pinellas Urology, St. Petersburg, Florida; 4GTx, Inc., Memphis, Tennessee (Presented By: Paul Hatcher)
2:33 p.m. #60 IN AN EQUAL ACCESS HOSPITAL, BLACK MEN ARE LESS LIKELY TO GET A RADICAL PROSTATECTOMY Joseph Klink, Daniel Moreira, Leah Gerber, Jean-Alfred Thomas, Madeline McKeever, Lionel Bañez and Stephen Freedland Durham VA and Duke Urology, Durham, NC (Presented By: Joseph Klink) 41 2:39 p.m. #61 PROSTATE CANCER RISK AND 1,25-DIHYDROXYVITAMIN D3 LEVELS James Bennett¹,²,³, Gina Kirkpatrick4, Jenelle Foote¹,²,³, Paul Alphonse, Jr¹, Leila Bucary¹, Adwoa Asare-Kwakye¹ and Yesilyne Gonzalez¹ ¹Midtown Urology & Midtown Urology Surgery Center; ²Emory University School of Medicine Department of Family Practice; ³Morehouse School of Medicine, Atlanta, Georgia; 4Philadelphia College of Osteopathic Medicine, Philadelphia, PA (Presented By: Gina Kirkpatrick)
2:45 p.m. #62 PROSTATE SIZE AS A PREDICTOR OF GLEASON SCORE UPGRADING IN LOW- RISK PROSTATE CANCER PATIENTS Monty Aghazadeh, Judson Davies, Sharon Phillips, Shady Salem, Peter Clark, Michael Cookson, Rodney Davis, S. Duke Herrell, Justin Gregg, Sam Chang, Joseph Smith and Daniel Barocas Vanderbilt University Department of Urologic Surgery, Nashville, TN (Presented By: Judson Davies)
2:51 p.m. #63 NEOADJUVANT DOCETAXEL / ESTRAMUSTINE PRIOR TO RADICAL PROSTATECTOMY OR EXTERNAL BEAM RADIOTHERAPY IN HIGH RISK LOCALIZED PROSTATE CANCER: A PHASE II TRIAL Joshua Langston, J. Patrick Selph, Sean Sawh, William Kim, Paul Godley, Young Whang, Kim Rathmell, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston)
2:57 p.m. #64 PSA AND PROSTATE BIOPSY RESPONSE TO VITAMIN D SUPPLEMENTATION IN PATIENTS UNDERGOING ACTIVE SURVEILLANCE FOR PROSTATE CANCER Erin Burns¹, David Marshall¹, Stephen Savage¹, Sebastiano Gattoni-Celli¹ and John Lacy² ¹MUSC, Charleston, SC; ²UK, Lexington, KY (Presented By: Erin Burns)
3:03 p.m. #65 EVALUATION OF THE ASSOCIATION OF OBESITY AND PATHOLOGIC FEATURES OF AGGRESSIVENESS AMONG MEN UNDERGOING RADICAL PROSTATECTOMY FOR PROSTATE CANCER Alexander Parker, Michael Heckman, Andrea Tavlarides, Nancy Diehl and Todd Igel Mayo Clinic – Florida Campus (Presented By: Alexander Parker)
3:09 p.m. #66 EFFECT OF CESIUM-131 BRACHYTHERAPY AND EXTERNAL BEAM RADIATION ON URINARY SYMPTOMS, ERECTILE FUNCTION, AND QUALITY OF LIFE FOR INTERMEDIATE TO HIGH RISK PROSTATE CANCER: A PROSPECTIVE EVALUATION Joshua G Griffin¹, John Burns², Michael Baird³, William C. Woods³ and Charles R. Pound³ ¹University of Mississippi Medical Center; ²University of Mississippi Medical Center and Veterans Administration Hospital Jackson, MS; ³University of Mississippi Medical Center, Jackson, MS (Presented By: Joshua G. Griffin)
3:15 p.m. #67 ONCOLOGICAL OUTCOMES OF RADICAL PROSTATECTOMY WITH POSITIVE SURGICAL MARGINS AND OTHERWISE FAVORABLE PROGNOSTIC FACTORS Joshua G. Griffin¹, Jade Smith² and Charles R. Pound² ¹University of Mississippi Medical Center & VA Medical Center, Jackson, MS; ²University of Mississippi Medical Center (Presented By: Joshua G. Griffin)
3:21 p.m. #68 RADICAL PROSTATECTOMY POSITIVE MARGIN RATES AMONG SURGEONS IN THE EARLY PART OF THE LEARNING CURVE Jordan Angell, Tim Johnson, Chad Ritenour, Fray Marshall and Viraj Master ¹Emory University, Atlanta, GA (Presented By: Jordan Angell)
42 1:45 p.m. – 3:30 p.m. SESSION 23: CONCURRENT POSTER SESSION – ALL INCLUSIVE Location: Mardi Gras, LMN
Moderators: Jan L. Colli, MD New Orleans, LA
Rowena A. Desouza, MD Shreveport, LA
Poster #17 IN VITRO FORMATION OF NEUROMUSCULAR JUNCTION (NMJ) FOR ACCELERATED RESTORATION OF MUSCLE FUNCTION In K. Ko, Sang J. Lee, Tamer Aboushwareb, James J. Yoo and Anthony Atala Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC (Presented By: Tamer Aboushwareb)
Poster #18 AN INNOVATIVE APPROACH TO BUILDING CLINICALLY RELEVANT SIZED TISSUES FOR UROLOGICAL RECONSTRUCTION Jaehyun Kim, Tanner Hill, Tamer Aboushwareb, Sang Jin Lee, James J. Yoo and Anthony Atala Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC (Presented By: Tamer Aboushwareb)
Poster #19 STEM CELL RECRUITMENT FOR IN SITU TISSUE REGENERATION FOR UROLOGIC APPLICATIONS In Kap Ko, Timothy Chen, Tamer Aboushwareb, Young Min Ju, James J. Yoo, Sang Jin Lee and Anthony Atala WFIRM, Winston-Salem, NC (Presented By: Tamer Aboushwareb) FRIDAY Poster #20 HALOFUGINONE AND CHITOSAN COATED AMNION MEMBRANES DEMONSTRATE IMPROVED ABDOMINAL ADHESION PREVENTION L. Spencer Krane, Scott Washburn, Jamie Jennell and Steve J. Hodges Wake Forest University, Winston-Salem, NC (Presented By: L. Spencer Krane)
Poster #21 IN VITRO MODEL OF MICROPOROUS POLYSACCHARIDE HEMOSPHERES Sisir Botta and Martha Terris Medical College of Georgia, Augusta, GA (Presented By: Sisir Botta)
Poster #22 URETHRAL CATHETERIZATION TECHNIQUES: A SURVEY OF CURRENT ACADEMIC AND CLINICAL PRACTICES Kevin Walls, Travis Pagliara, Keefu Du, Jordan Kurta, Tommie Norris and Anthony Patterson University of Tennessee Health Science Center, Memphis, TN (Presented By: Kevin Walls)
Poster #23 URETHRAL REST: ROLE AND RATIONALE IN ANTERIOR URETHROPLASTY Ryan Terlecki¹, Matthew Steele², Celeste Valadez² and Allen Morey² ¹Wake Forest University, Winston-Salem, NC; ²UT Southwestern, Dallas, TX (Presented By: Ryan Terlecki)
Poster #24 ANOMALOUS VASCULAR ANATOMY SHOULD NOT EXCLUDE POTENTIAL RENAL TRANSPLANT DONORS Zachary Reardon, Sean J. Clark, Kristin Broderick, Rizk El-Galley and J. Erik Busby Department of Surgery, Division of Urology, University of Alabama at Birmingham, Birmingham, AL (Presented By: Kristin Broderick)
Poster #25 RESIDENTS FOR QUALITY IMPROVEMENT IN UROLOGY (RESQU): THREE YEAR EXPERIENCE WITH A RESIDENT-CENTERED QUALITY IMPROVEMENT INITIATIVE Bryant Whiting, Marc Cohen, Scott Gilbert, Tom Crawford, Johannes Vieweg and Philipp Dahm Department of Urology, University of Florida, Gainesville, FL (Presented By: Bryant Whiting)
43 Poster #26 INCIDENTAL PROSTATE CANCER DURING HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A MULTI-INSTITUTIONAL STUDY Davis P. Viprakasit¹, Rafael Nunez², Mitchell R. Humphreys² and Nicole L Miller¹ ¹Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ²Department of Urology, Mayo Clinic, Phoenix, Arizona (Presented By: Davis P. Viprakasit)
Poster #27 HOLMIUM LASER ENUCLEATION OF ABLATED PROSTATE (HOLEAP): AN INNOVATIVE SURGICAL TECHNIQUE FOR BENIGN PROSTATIC HYPERPLASIA Sanjay Razdan, Ashish Sabharwal and Tony John International Robotic Prostatectomy Institute, Miami, FL (Presented By: Sanjay Razdan)
Poster #28 DOES PROSTATE VOLUME AFFECT SILODOSIN-MEDIATED IMPROVEMENT OF SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA? Steven Kaplan¹, Claus Roehrborn², Lawrence Hill³, Weining Volinn³ and Gary Hoel³ ¹Weill Cornell Medical College, New York City, NY; ²Southwestern Medical Center, Dallas, TX; ³Watson Laboratories, Inc., Salt Lake City, UT (Presented By: Lawrence Hill)
Poster #29 URINARY INFECTIONS IN U.S. HOSPITALS, 1993 TO 2008 Jan Colli University of Alabama at Birmingham (Presented By: Jan Colli)
Poster #30 EPIDEMIOLOGY, ANTIBIOTIC RESISTANCE AND VARIATION IN MANAGEMENT OF BLOODSTREAM INFECTIONS FOLLOWING TRANSRECTAL PROSTATE BIOPSY PROCEDURES Charles Scales¹, Luke Chen², Russell Staheli², Daniel Sexton², Deverick Anderson² and Brant Inman¹ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Division of Infectious Diseases, Duke University Medical Center, Durham, NC (Presented By: Charles Scales)
Poster #31 SURVEY BASED ANALYSIS OF ANTIBIOTIC PROPHYLAXIS IN UROLOGIC CASES INVOLVING PROSTHETIC IMPLANTS Jordan Kurta, Jamin Brahmbhatt, Ali-Reza-Sharif Afshar, Robert Wake and Michael Aleman UT Health Science Center, Memphis, TN (Presented By: Jeremy Norwood)
Poster #32 GIANT RETROVESICAL CYST APPENDICEAL CYSTADENOMA RESEMBLING SEMINAL VESICLE CYST Ruben Urena and Walter Morales Complejo Hospitalario Arnulfo Arias Madrid, Caja Del Seguro Social, Panama City, Panama (Presented By: Walter Morales)
Poster #33 INFLAMMATORY CELL TYPE IN PATIENTS WITH INTERSTITIAL CYSTITIS/ PAINFUL BLADDER SYNDROME UNDERGOING CYSTOSCOPY WITH HYDRODISTENSION AND BIOPSY Brent Hardin, John Beddies, James Bienvenu, Wesley White and Frederick Klein University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Urology, Knoxville, TN (Presented By: Brent Hardin)
Poster #34 A MODEL OF BLADDER HYPOCONTRACTILITY IN THE RAT: PELVIC NERVE CRUSH Christopher Chermansky¹, Denise Chow¹, Qiang Wu¹ and Matthew Fraser² ¹LSUHSC Department of Urology, New Orleans, LA; ²Duke Division of Urology, Durham, NC (Presented By: Christopher Chermansky)
Poster #35 CENTRAL ROLE OF BOARI FLAP PROCEDURE IN UPPER URETERAL RECONSTRUCTION Ryan Mauck¹, Ryan Terlecki² and Allen Morey¹ ¹UT Southwestern, Dallas, TX; ²Wake Forest University, Winston-Salem, NC (Presented By: Ryan Terlecki) 44 Poster #36 A LONGITUDENAL EVALUATION OF SUBJECTIVE POSTOPERATIVE SYMPTOMS AND DISSATISFACTION IN WOMEN CURED OF STRESS INCONTINENCE AFTER SLING SURGERY Alex Gomelsky and B. Jill Williams LSUHSC – Shreveport, Shreveport, LA (Presented By: Alex Gomelsky)
Poster #37 IMPACT OF OBESITY ON SURGICAL OUTCOMES OF SINGLE INCISION MID- URETHRAL SLINGS Ryan Pickens, John Beddies, Adam Stewart, Bedford Waters, Wesley White and Frederick Klein UTMCK (Presented By: Ryan Pickens)
Poster #38 QUANTITATIVE ANALYSIS OF RENAL ISCHEMIA IN REAL TIME USING DIGITAL IMAGE ANALYSIS AND NEAR INFRARED TISSUE OXIMETRY DURING PARTIAL NEPHRECTOMY Arthur Caire, Xavier Alvarez, Sarah Conley and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
Poster #38.5 SHORT TERM OUTCOMES OF ROBOTIC-ASSISTED ABDOMINAL SACROCOLPOPEXY FOR THE REPAIR FOR PELVIC ORGAN PROLAPSE Ryan Pickens, John Beddies, Brent Hardin, Jared Moss, James Bienvenu, Robert Elder and Wesley White UTMCK (Presented By: Ryan Pickens)
3:30 p.m. – 4:00 p.m. BREAK/VISIT EXHIBITS FRIDAY
CONCURRENT SESSIONS 4:00 p.m. – 5:30 p.m. SESSION 24: LAPAROSCOPIC & ROBOTIC SURGERY – UPPER TRACT PODIUM Location: La Galeries, 1 – 3
Moderators: Stephen J. Savage, MD Charleston, SC
Wade J. Sexton, MD Tampa, FL
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
4:00 p.m. #69 QUANTITATIVE REAL TIME MONITORING OF RENAL ISCHEMIA DURING PARTIAL NEPHRECTOMY: A PILOT STUDY USING NEAR INFRARED TISSUE OXIMETRY Sarah Conley¹, Amanda Feige¹, Alton Sartor¹, Ashley Bowen² and Ben Lee¹ ¹New Orleans, LA; ²LA (Presented By: Ashley Bowen)
4:06 p.m. #70 THE PREDICTIVE VALUE OF NEPHROMETRY SCORE ON OUTCOMES FOLLOWING ROBOT-ASSISTED PARTIAL NEPHRECTOMY Amanda Feige, Sarah Conley, Michael Pinsky, Erin Johnson and Benjamin Lee Tulane University, Dept of Urology, New Orleans, LA (Presented By: Amanda Feige)
4:12 p.m. #71 A COMPARISON OF OUTCOMES IN PATIENTS UNDERGOING STANDARD LAPAROSCOPIC VERSUS MICROLAPAROSCOPIC HYBRID PYELOPLASTY Davis P. Viprakasit, Mark D. Sawyer, Hernan O. Altamar, Nicole L. Miller and S. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (Presented By: Davis P. Viprakasit)
45 4:18 p.m. #72 ROBOTIC PARTIAL NEPHRECTOMY DEMONSTRATES FAVORABLE ISCHEMIA TIMES COMPARED TO LAPAROSCOPIC PARTIAL NEPHRECTOMY Arthur Caire, Aaron Bernie, Will Armstrong, Aaron Boonjindasup and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Aaron Bernie)
4:24 p.m. #73 TESTICULAR PAIN AFTER LAPAROSCOPIC DONOR NEPHRECTOMY: A FREQUENT COMPLICATION WITH SIGNIFICANT MORBIDITY Samir Shirodkar¹, Vincent Bird², Michael Gorin¹, Alberto Zarak¹ and Gaetano Ciancio³ ¹University of Miami; ²Department of Urology, University of Florida; ³University of Miami/Jackson Memorial Hospital (Presented By: Samir Shirodkar)
4:30 p.m. #74 LAPAROSCOPIC NEPHROPEXY FOR NEPHROPTOSIS: IS IT SHAM SURGERY? Lydia Laboccetta¹, Matthew Young² and Stephen J. Savage³ ¹Resident, Medical University of South Carolina, Charleston, SC; ²Resident, Medical University of South Carolina Urology, Charleston, SC; ³Attending, Medical University of South Carolina Urology, Charleston, SC (Presented By: Lydia Laboccetta)
4:36 p.m. #75 INDUCTION OF RENAL HYPOTHERMIA VIA COUNTINOUS RETROGRADE IRRIGATION: RESULTS IN PORCINE MODEL AND INITIAL EXPERIENCE IN A SERIES OF PATIENTS UNDERGOING ROBOTIC PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Philip Dorsey, Brian Richardson, Sarah Conley and Benjamin Lee Department of Urology, Tulane University School of Medicine, New Orleans, LA (Presented By: Philip Dorsey)
4:42 p.m. #76 ROBOT-ASSISTED PARTIAL NEPHRECTOMY OUTCOMES AT A SINGLE INSTITUTION Scott Castle, Vladislav Gorbatiy, Watid Karjanawanichkul, Nelson Salas and Raymond Leveillee University of Miami, Department of Urology, Miami, FL (Presented By: Scott Castle)
4:48 p.m. #77 ROBOTIC SURGICAL MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Joseph Pugh, Daniel Willis, Aaron Grossman, Sijo Parekattil and Li-Ming Su University of Florida, Department of Urology, Gainesville Florida (Presented By: Joseph Pugh)
4:54 p.m. #78 IS ROBOT-ASSISTED PARTIAL NEPHRECTOMY AN EFFECTIVE TECHNIQUE ON T1B (4-7CM) RENAL LESIONS? Arthur Caire, Chris Bayne, Aaron Bernie, Aaron Boonjindasup and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
5:00 p.m. #79 ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY AFTER FAILED HIGH- INTENSITY FOCUSED ULTRASOUND: EFFICACY AND OBSERVATIONS Adam Stewart, Jared Moss, Bruce Woodworth and Paul Hatcher University of Tennessee Graduate School of Medicine, Knoxville, TN (Presented By: Adam Stewart)
5:06 p.m. #80 LAPAROENDOSCOPIC SINGLE SITE SURGERY: INITIAL EXPERIENCE IN ADULTS AND PEDIATRIC PATIENTS Alejandro Rodriguez, Mark Rich, Fernando Coste-Delvecchio, Raoul Salup and Hubert Swana University of South Florida, Department of Urology, Tampa, Florida (Presented By: Alejandro Rodriguez)
5:12 p.m. #81 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: THE FIRST 10 CASES IN A COMMUNITY HOSPITAL SETTING Michael McDonald Florida Hospital Celebration, Celebration, FL (Presented By: Michael McDonald)
46 5:18 p.m. #82 RADIOFREQUENCY ABLATION OF SMALL RENAL MASSES: 8.75 YEAR EXPERIENCE AT A SINGLE INSTITUTION Raymond Leveillee, Scott Castle, Nelson Salas, Vladislav Gorbatiy and Watid Karjanawanichkul University of Miami, Department of Urology, Miami, FL (Presented By: Scott Castle)
4:00 p.m. – 5:30 p.m. SESSION 25: CONCURRENT POSTER SESSION – PEDIATRICS Location: Mardi Gras, LMN
Moderators: Steve J. Hodges, MD Winston-Salem, NC Christopher C. Roth, MD New Orleans, LA
Poster #39 THE UTILITY OF LUMBOSACRAL MRI IN THE MANAGEMENT OF ISOLATED DYSFUNCTIONAL ELIMINATION Gregory J. Broughton, Douglass B. Clayton, Stacy T. Tanaka, John C. Thomas, Mark C. Adams, John W. Brock, III and John C. Pope, IV Vanderbilt University Medical Center, Nashville, Tennessee (Presented By: Gregory J. Broughton)
Poster #40 RESIDENT PARTICIPATION IN HYPOSPADIAS REPAIR: AN INTEGRAL COMPONENT OF UROLOGY TRAINING? Christopher Bean, Edwin Harmon and Darlenia Andrews University of Mississippi, Jackson, MS (Presented By: Christopher Bean)
Poster #41 SALVAGE OF BILATERAL ASYNCHRONOUS PERINATAL TESTICULAR TORSION FRIDAY Jeremy Speeg¹, Christopher Roth², Gerald Mingin³ and Joseph Ortenberg² ¹New Orleans, LA; ²Children’s Hospital New Orleans, LA; ³Burlington, VT (Presented By: Jeremy Speeg)
Poster #42 UTILITY OF VALIDATED BLADDER/BOWEL DYSFUNCTION QUESTIONNAIRE IN THE CLINICAL PEDIATRIC UROLOGY SETTING Beth Drzewiecki, John Thomas, John Pope, IV, Mark Adams, John Brock, III and Stacy Tanaka Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN (Presented By: Beth Drzewiecki)
Poster #43 VULVOVAGINITIS CAUSES URINARY TRACT INFECTIONS BY INCREASING PERIURETHRAL COLONIZATION OF UROPATHOGENS Ilya Gorbachinsky, Gordon McLorie, Anthony Atala and Steve Hodges Wake Forest University Baptist Medical Center, Department of Urology, Winston- Salem, NC (Presented By: Ilya Gorbachinsky)
Poster #44 HYDROCELE AFTER LAPAROSCOPIC VARICOCELECTOMY: DOES DIVISION OF SPERMATIC VESSELS AFFECT INCIDENCE? Beth Drzewiecki, Stacy Tanaka, John Thomas, John Pope, IV, Mark Adams and John Brock, III Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN (Presented By: Beth Drzewiecki)
Poster #45 PAIN AS THE PRESENTING SYMPTOM OF PRIMARY MEGAURETER IN CHILDREN Christopher B. Anderson, Mark C. Adams, Stacy T. Tanaka, John C. Pope, IV, John W. Brock, III and John C. Thomas Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt (Presented By: Christopher B. Anderson)
Poster #46 A 15-YEAR EXPERIENCE WITH PEDIATRIC GENITAL BURNS AT A LEVEL-1 BURN CENTER: OUTCOMES AND ANALYSIS Zachary Klaassen¹, Pauline H. Go¹, E. Hani Mansour², Michael A. Marano², Sylvia J. Petrone², Abraham P. Houng², Sandra Johansen² and Ronald S. Chamberlain³ ¹Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ; ²Department of Surgery, Division of Burn Surgery, Saint Barnabas Medical Center, Livingston, NJ; ³Chairman, Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ (Presented By: Zachary Klaassen) 47 Poster #47 RADIOGRAPHIC ASSESMENT OF STOOL BURDEN IN NORMAL CHILDREN Ted Manny¹ and Steve Hodges² ¹Wake Forest University, Winston-Salem, NC; ²Assistant Urology Professor, Wake Forest University, Winston-Salem, NC (Presented By: Ted Manny)
Poster #48 PRIAPISM IN CHILDREN WITH HEMOGLOBIN S: IS THERE A ROLE FOR SYMPATHOMIMETICS? Jamin Brahmbhatt, Reza Mehrazin, Kathleen Kieran, Mark Williams, Gerald Jerkins and Dana Giel University of Tennessee Health Science Center, LeBonheur Children’s Hospital, Memphis, TN (Presented By: Jamin Brahmbhatt)
Poster #49 OCHOA (UROFACIAL) SYNDROME CULPRIT IDENTIFIED AS HEPARANASE 2 GENE – IMPLICATIONS OF A 15 YEAR STUDY Junfeng Pang¹, Shu Zhang¹, Bobbilynn H. Lee², Ping Yang¹, Jixin Zhong¹, Yushan Zhang¹, Bernardo Ochoa³, Jose A.G. Agundez4, Marie-Antoinette Voelckel5, Weikuan Gu6, Wen-Cheng Xiong7, Lin Mei¹, Jin-Xiong She¹ and Cong-Yi Wang¹ ¹Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta, GA; ²Department of Surgery, Urology and Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta, GA; ³Department of Pediatric Surgery, University Hospital San Vicente de Paul, University of Antioquia, Medellin, Colombia; 4Department of Pharmacology, Medical School, University of Extremadura, Badajoz, Spain; 5Department of Medical Genetics, Hospital d’Enfants de la Timone, Marseille, France; 6Department of Orthopedic Surgery, Campbell Clinic and Pathology, University of Tennessee Health Science Center, Memphis, TN; 7Institute of Molecular Medicine and Genetics and Department of Neurology, Medical College of Georgia, Augusta, GA (Presented By: Bobbilynn H. Lee)
Poster #50 INCIDENCE OF UROLOGIC ABNORMALITIES ON SCROTAL ULTRASOUND IN THE PEDIATRIC POPULATION Jamin Brahmbhatt, Reza Mehrazin, Patrik Luzny, Kathleen Kieran, Dana Giel and Mark Williams University of Tennessee Health Science Center, LeBonheur Children’s Hospital, Memphis, TN (Presented By: Jamin Brahmbhatt)
Poster #51 DIAGNOSING EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS IN THE EMERGENCY ROOM: DO UROLOGISTS AND PEDIATRIC EMERGENCY PHYSICIANS DIFFER? Jamin Brahmbhatt, Reza Mehrazin, Kathleen Kieran, Patrik Luzny, Dana Giel and Mark Williams University of Tennessee Health Science Center, LeBonheur Children’s Hospital, Memphis, TN (Presented By: Jamin Brahmbhatt)
5:30 p.m. – 6:00 p.m. SESSION 26: PANEL DISCUSSION – IDENTIFYING AND MANAGING COMPLICATIONS OF ROBOTIC AND LAPAROSCOPIC SURGERY
Moderator: Benjamin R. Lee, MD New Orleans, LA
Panelists: Raymond J. Leveillee, MD, FRCS-G Miami, FL
Vipul R. Patel, MD Celebration, FL
Scott D. Miller, MD Atlanta, GA
48 SATURDAY, MARCH 19, 2011
6:30 a.m. – 7:00 a.m. BREAKFAST Location: Preservation Hall
6:30 a.m. – 12:30 p.m. REGISTRATION/INFORMATION DESK OPEN Location: Preservation Hall Foyer
6:30 a.m. – 12:00 p.m. EXHIBIT HALL OPEN Location: Preservation Hall
7:00 a.m. – 12:00 p.m. SPEAKER READY ROOM HOURS Location: Regent
7:30 a.m. – 10:30 a.m. SPOUSE/GUEST HOSPITALITY SUITE OPEN Location: St. Charles, 41st Floor
10:30 a.m. – 12:00 p.m. BEV CHURCH: SEASONAL CELEBRATIONS WITH STYLE Location: St. Charles, 41st Floor
12:30 p.m. – 3:30 p.m. TENNIS AT THE HILTON HEALTH CLUB Location: Depart from Marriott New Orleans lobby at 12:00 p.m. for the Hilton Health Club
12:30 p.m. – 5:00 p.m. GOLF AT TPC LOUISIANA Location: Depart from Marriott New Orleans lobby at 12:00 p.m. for the TPC Louisiana
7:00 p.m. – 8:00 p.m. 2011 ANNUAL RECEPTION Location: Mardi Gras
8:00 p.m. – 12:00 a.m. 2011 SESAUA ANNUAL BANQUET Location: Mardi Gras ______
6:00 a.m. – 7:00 a.m. SESSION 27: INDUSTRY SPONSORED BREAKFAST Location: La Galeries 6 “Surge-free Testosterone Suppression: An Innovative Approach”
Michael G. Desautel, MD SATURDAY
Funding Provided By: Ferring Pharmaceuticals
CONCURRENT SESSIONS 7:00 a.m. – 8:00 a.m. SESSION 28: PEDIATRICS PODIUM Location: Mardi Gras, IJ
Moderators: John A. Mata, MD Shreveport, LA
John S. Wiener, MD Durham, NC
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
7:00 a.m. #83 THE CURRENT STATE OF SURGICAL INTERVENTION FOR PERINATAL TORSION: AN INTERNATIONAL SURVEY OF PEDIATRIC UROLOGISTS AND REVIEW OF THE LITERATURE Benjamin G. Martin, David M. Kitchens, C.D. Anthony Herndon and David B. Joseph University of Alabama at Birmingham, Birmingham AL (Presented By: Benjamin G. Martin)
49 7:06 a.m. #84 RISK FACTORS FOR HEMORRHAGIC CYSTITIS AFTER BONE MARROW TRANSPLANTATION IN 849 CHILDREN Jodi Antonelli¹, Hasan Irkilata², Jeremy Wiygul³, Dan Moreira¹, Paul Martin¹ and John Wiener¹ ¹Durham, NC; ²Ankara, Turkey; ³Long Island, NY (Presented By: Jodi Antonelli)
7:12 a.m. #85 A SIX YEAR EXPERIENCE OF OPEN RENAL AND BLADDER SURGERY PERFORMED AT A FREE-STANDING PEDIATRIC SURGERY CENTER Adam Stewart¹ and Preston Smith² ¹University of Tennessee Graduate School of Medicine, Knoxville, TN; ²East Tennessee Children’s Hospital, Knoxville, TN (Presented By: Adam Stewart)
7:18 a.m. #86 USE OF FIBRIN GLUE AS AN ADJUNCT IN HYPOSPADIAS REPAIR Ayme Schmeeckle, Dennis Venable and John Mata LSUHSC Shreveport, LA (Presented By: Ayme Schmeeckle)
7:24 a.m. #87 L5-S3 LUMBAR TO SACRAL NERVE REROUTING TO RESTORE BLADDER AND BOWEL FUNCTION IN NEUROGENIC PATIENTS: A NEUROSURGICAL PERSPECTIVE Ravish Patwardhan¹, Ryan Vidrine², John Mata² and Timothy Gilbert¹ ¹Interactive Neuroscience Center, LLC & Comprehensive Neurosurgery, LLC, Shreveport, LA; ²Dept. of Urology, Louisiana State University Health Sciences Center – Shreveport, LA (Presented By: Ryan Vidrine)
7:30 a.m. #88 UTILITY OF URODYNAMICS IN THE MANAGEMENT OF OCCULT TETHERED CORD IN CHILDREN Oxana Munoz, David Kitchens, Anthony Herndon and David Joseph University of Alabama at Birmingham, Department of Surgery, Division of Urology, Birmingham, Alabama (Presented By: Oxana Munoz)
7:36 a.m. #89 IS A VALIDATED SYMPTOM SCORE PREDICTIVE OF ABNORMAL FINDINGS ON UROFLOWMETRY IN CHILDREN WITH BLADDER/BOWEL DYSFUNCTION? Benjamin M. Whittam, Douglass B. Clayton, John C. Thomas, John C. Pope, IV, Mark C. Adams, John W. Brock, III and Stacy T. Tanaka Vanderbilt University, Nashville, TN (Presented By: Benjamin M. Whittam)
7:00 a.m. – 8:00 a.m. SESSION 29: CONCURRENT VIDEO SESSION II Location: La Galeries, 1 – 3
Moderators: Joseph E. Busby, MD Birmingham, AL
Ramakrishna Venkatesh, MD, MS, FRCS Lexington, KY
Video #11 ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY: TIPS AND TRICKS David Thiel¹, Paul Young², Michael Wehle², Gregory Broderick², Steven Petrou² and Todd Igel² ¹Mayo Clinic Jacksonville, Jacksonville, FL; ²Mayo Clinic Jacksonville (Presented By: David Thiel)
Video #12 NOT ALL PROSTATES ARE CREATED EQUAL: ROBOTIC PROSTATECTOMIES – LESSONS LEARNED Sarah Conley, Amanda Feige, Mathew Oommen, Luke Fifer, Benjamin Lee and Raju Thomas Tulane University School of Medicine – New Orleans, LA (Presented By: Mathew Oommen)
50 Video #13 LEST WE FORGET: OPEN PARTIAL NEPHRECTOMY IN THE ERA OF LAPAROSCOPY AND ROBOTICS Brian Richardson, Anil Paramesh and Raju Thomas Tulane University New Orleans, LA (Presented By: Brian Richardson)
Video #14 ROBOT ASSISTED BLADDER DIVERTICULECTOMY Marcelo Orvieto, Sanket Chauhan, Ananthkrishnan Sivaraman, Rafael Coelho, Kenneth Plamer and Vipul Patel GRI (Presented By: Marcelo Orvieto)
Video #15 MODIFIED LATZKO PROCEDURE (PARTIAL COLPOCLEISIS) FOR VESICOVAGINAL FISTULA REPAIR: TECHNIQUE AND OUTCOMES
Denise Chow¹, Ahmet Bedestani², Ralph Chesson² and J. Christian Winters¹ THURSDAY ¹Louisiana State University/Ochsner Clinic Foundation, New Orleans, LA; ²Louisiana State University, New Orleans, LA (Presented By: Denise Chow)
Video #16 KNOTLESS SUTURING DURING OPEN PARTIAL NEPHRECTOMY WITH THE SLIDING-CLIP TECHNIQUE Michael Gorin, Rajan Ramanathan, Scott Castle, Bruce Kava and Raymond Leveillee Department of Urology, University of Miami Miller School of Medicine, Miami, FL (Presented By: Michael Gorin)
Video #17 THE S.P.E.C.I.A.L.™ TECHNIQUE FOR NERVE PRESERVATION DURING ROBOTIC PROSTATECTOMY Scott Miller Georgia Urology, Atlanta, GA (Presented By: Scott Miller)
CONCURRENT SESSIONS 8:00 a.m. – 9:15 a.m. SESSION 30: LAPAROSCOPIC & ROBOTIC SURGERY – LOWER TRACT PODIUM Location: La Galeries, 1 – 3
Moderators: Robert I. Carey, MD, PhD Sarasota, FL
Scott D. Miller, MD SATURDAY Atlanta, GA
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
8:00 a.m. #90 THE INCIDENCE OF LYMPHOCELES AFTER ROBOT-ASSISTED PELVIC LYMPH NODE DISSECTION Marcelo Orvieto, Sanket Chauhan, Rafael Coelho, Kenneth Palmer, Pablo Marchetti, Ananth Sivaraman and Vipul Patel (Presented By: Marcelo Orvieto)
8:06 a.m. #91 DOES ROBOTIC RADICAL CYSTECTOMY FOR BLADDER CANCER AFFECT LONG-TERM HEALTH-RELATED QUALITY OF LIFE? J. Patrick Selph, Joshua Langston, James Fergueson, Ankur Manvar, Angela Smith, Sachin Vyas, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: J. Patrick Selph)
8:12 a.m. #92 ROBOTIC RADICAL CYSTECTOMY: MEDIUM-TERM ONCOLOGIC FOLLOW-UP J. Patrick Selph, Joshua Langston, Aaron Martin, Angela Smith, Sean Sawh, Mathew Raynor, Matthew Nielsen, Eric Wallen, Erik Castle and Raj Pruthi (Presented By: J. Patrick Selph)
8:18 a.m. #93 IMPACT OF ROBOT ASSISTED RADICAL CYSTECTOMY ON PERI-OPERATIVE MORBIDITY: COMPARISON OF 150 CONSECUTIVE RADICAL OPEN AND ROBOTIC CYSTECTOMIES Kyle A. Richards, A. Karim Kader, Joseph A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards) 51 8:24 a.m. #94 POSITIVE SURGICAL MARGINS AND THEIR LOCATIONS FOLLOWING ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY Sanket Chauhan, Rafael Coelho, Ananthakrishnan Sivaraman, Marcelo Orvieto, Kenneth Palmer and Vipul Patel GRI (Presented By: Ananthakrishnan Sivaraman)
8:30 a.m. #95 INFLUENCE OF MODIFIED POSTERIOR RECONSTRUCTION OF THE RHABDOSPHINCTER ON EARLY RECOVERY OF CONTINENCE AND ANASTOMOTIC LEAK RATES AFTER RALP. Rafael Coelho, Sanket Chauhan, Ananthakrishnan Sivaraman, Kenneth Palmer, Marcelo Orvieto and Vipul Patel GRI (Presented By: Ananthakrishnan Sivaraman)
8:36 a.m. #96 ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: EVALUATION OF THE FUNCTIONAL AND ONCOLOGIC LEARNING CURVE Joshua Langston, J. Patrick Selph, James Fergueson, Ankur Manvar, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston)
8:42 a.m. #97 ANATOMIC APPROACH TO BLADDER NECK PRESERVATION DURING ROBOTIC PROSTATECTOMY IS SAFE AND EFFECTIVE Scott Miller Georgia Urology, Atlanta, GA (Presented By: Scott Miller)
8:48 a.m. #98 PREVIOUS THERAPY FOR PROSTATE CANCER IS NOT A CONTRAINDICATION FOR ROBOT-ASSISTED RADICAL CYSTECTOMY: A SINGLE INSTITUTION EXPERIENCE Kyle A. Richards, A. Karim Kader, Joseph A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards)
8:54 a.m. #99 THE EVALUATION OF THE LEARNING CURVE ASSOCIATED WITH ROBOTIC RADICAL CYSTECTOMY: INITIAL 100 CASES Joshua Langston, J. Patrick Selph, James Fergueson, Ankur Manvar, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston)
9:00 a.m. #100 ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY: IDENTIFICATION OF PATIENTS WHO BENEFIT FROM THE ROBOTIC APPROACH Michael Knox, Rizk El-Galley and Erik Busby ¹University of Alabama – Birmingham, Birmingham, AL (Presented By: Michael Knox)
9:06 a.m. #101 GRADING THE DEGREE OF LEAK ON CYSTOGRAM AFTER ROBOTIC PROSTATECTOMY CAN PREDICT FOR BLADDER NECK Michael Knox, Seena Safavy, Rizk El-Galley and Erik Busby ¹University of Alabama – Birmingham Birmingham, AL (Presented By: Michael Knox)
9:15 a.m. – 9:30 a.m. SESSION 30.1: WRAP-UP – TIPS AND TRICKS FOR SOLVING CHALLENGING ANATOMIC VARIATIONS DURING ROBOTIC PROSTATECTOMY Invited Speaker: Vipul R. Patel, MD Celebration, FL
8:00 a.m. – 9:30 a.m. SESSION 31: CONCURRENT POSTER SESSION – UROONCOLOGY Location: Mardi Gras, LMN
Moderators: Charles R. Pound, MD Jackson, MS
Raj S. Pruthi, MD Chapel Hill, NC 52 Poster #52 EXTRAMAMMARY PAGET’S DISEASE IN MALES: A SEER STUDY IN SURVIVAL Lindsey Herrel, Timothy Johnson, Keith Delman and Viraj Master Emory University, Atlanta, GA (Presented By: Lindsey Herrel)
Poster #53 ONCOLOGIC OUTCOMES FOR NODE-POSITIVE PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY J. Patrick Selph, Joshua Langston, Aaron Martin, Angela Smith, Sean Sawh, Mathew Raynor, Matthew Nielsen, Eric Wallen, Erik Castle and Raj Pruthi (Presented By: J. Patrick Selph)
Poster #54 RE-RESECTING T1 BLADDER TUMORS: SINGLE-INSTITUTION ANALYSIS IN A MODERN COHORT OF PATIENTS J. Patrick Selph, Joshua Langston, Ankur Manvar, James Fergueson, Angela Smith, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: J. Patrick Selph)
Poster #55 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON ANEMIA AND PERIOPERATIVE OUTCOMES AT THE TIME OF CYSTECTOMY Timothy Atkinson, Randall Rowland, John Rinehart, Daniel Davenport, Garrett Korrect, Beau Dusseault, Stephen Strup and Paul Crispen University of Kentucky, Lexington, KY (Presented By: Timothy Atkinson)
Poster #56 IS PROLONGED STENTING A SOLUTION FOR THE LEFT CROSS-OVER URETER DILEMMA IN ABDOMINAL WALL DIVERSIONS? Alejandro Rodriguez, Alexandre Lockhart, Jeff King, Lucas Wiegand, Rafael Carrion, Raul Ordorica and Jorge Lockhart University of South Florida, Department of Urology, Tampa, Florida (Presented By: Alejandro Rodriguez)
Poster #57 CAN CONTEMPORARY TARGETED THERAPIES PROVIDE CLINICALLY MEANINGFUL CHANGES IN RENAL CELL CARCINOMA VENOUS TUMOR THROMBI? Scott E. Delacroix, Jr.¹, Brian F. Chapin¹, Nicholas Cost², Jose A. Karam¹, Stephen Culp¹, E. Jason Abel¹, Graciela Gonzales³, Vitaly Margulis² and Christopher G. Wood¹ ¹Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; ²Department of Urology, The University of Texas Southwestern, Dallas, Texas; ³Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
(Presented By: Scott E. Delacroix, Jr.) SATURDAY
Poster #58 PERIOPERATIVE BLOOD TRANSFUSION AND SURVIVAL IN PATIENTS UNDERGOING NEPHRECTOMY FOR RENAL CELL CARCINOMA Todd Morgan, Kelly Stratton, Michael Cookson, Daniel Barocas, Rodney Davis, Duke Herell, Joseph Smith, Jr., Sam Chang and Peter Clark Vanderbilt University (Presented By: Todd Morgan)
Poster #59 FLANK PAIN AS A COMMON COMPLICATION AFTER PERCUTANEOUS RENAL CRYOABLATION Bruce Shingleton¹ and H. D’Agostino² ¹Ochsner Clinic; ²LSUHSC, Shreveport, LA (Presented By: Bruce Shingleton)
Poster #60 COST ANALYSIS OF ROBOTIC-ASSISTED- VERSUS LAPAROSCOPIC-VERSUS OPEN PARTIAL NEPHRECTOMY Joshua Langston, J. Patrick Selph, James Fergueson, Ankur Manvar, Sean Sawh, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston)
Poster #61 COMPARISON OF REIMBURSEMENT AMONG VARIOUS NEPHRON-SPARING SURGERIES (NSS) FOR SMALL RENAL MASSES Scott Castle, Vladislav Gorbatiy, Nelson Salas, Ahmed Eldefrawy, Watid Karnjanawanichkul and Raymond Leveillee University of Miami, Department of Urology, Miami, FL (Presented By: Scott Castle)
53 Poster #62 COSTS FOR UROLOGIC HOSPITALIZATIONS IN THE U.S., 1997 TO 2007 Jan Colli University of Alabama at Birmingham (Presented By: Jan Colli)
Poster #63 DOES PROSTATE WEIGHT AFFECT PERIOPERATIVE, ONCOLOGIC AND EARLY CONTINENCE OUTCOMES AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY PERFORMED BY AN EXPERIENCED SURGEON? Rafael Coelho, Sanket Chauhan, Ananthakrishnan Sivaraman, Kenneth Palmer, Marcelo Orvieto and Vipul Patel GRI (Presented By: Ananthakrishnan Sivaraman)
Poster #64 OUTCOMES FOLLOWING UROLOGIC PROCEDURE IN NONAGENARIANS AND CENTENARIANS: A SAFETY AND FEASIBILITY ANALYSIS Sachin Patil and Ronald Chamberlain Saint Barnabas Medical Center, Livingston, NJ (Presented By: Sachin Patil)
Poster #65 MOVED TO POSTER #38.5
Poster #66 ROBOT-ASSISTED RADICAL CYSTECTOMY VERSUS OPEN RADICAL CYSTECTOMY FOR EXTRAVESICAL DISEASE: A SINGLE CENTER EXPERIENCE Kyle A. Richards, A. Karim Kader, Joseph A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards)
Poster #67 THE ECONOMICS OF ROBOTIC UROLOGIC SURGERY AND ITS ROLE WITHIN A COMMUNITY HOSPITAL AND CANCER CENTER Rajesh Laungani¹, Jade Smith² and Nikhil Shah³ ¹Saint Josephs Hospital, Atlanta, Georgia; ²Philadelphia College of Osteopathic Medicine, Georgia Campus; ³Saint Joseph’s Hospital (Presented By: Rajesh Laungani)
Poster #68 LAPAROSCOPIC-GUIDED RADIOFREQUENCY ABLATION IS AN EFFECTIVE TREATMENT MODALITY FOR ENHANCING RENAL MASSES AT INTERMEDIATE TERM FOLLOW-UP Elie Antebi¹, Michael Gorin¹, Robert Carey² and Vincent Bird³ ¹Department of Urology, University of Miami Miller School of Medicine, Miami, FL; Urology Treatment Center, Sarasota, FL; ³Department of Urology, University of Florida College of Medicine, Gainesville, FL (Presented By: Elie Antebi)
Poster #69 LAPAROSCOPIC-GUIDED RADIOFREQUENCY ABLATION IS SAFE FOR TREATMENT OF ENHANCING RENAL MASSES IN PATIENTS TAKING WARFARIN AND/OR ANTIPLATELET AGENTS Michael Gorin¹, Elie Antebi¹, Robert Carey² and Vincent Bird³ ¹Department of Urology, University of Miami Miller School of Medicine, Miami FL; ²Urology Treatment Center, Sarasota, FL; ³Department of Urology, University of Florida College of Medicine, Gainesville, FL (Presented By: Michael Gorin)
9:30 a.m. – 10:00 a.m. BREAK/VISIT EXHIBITS
10:00 a.m. – 10:50 a.m. SESSION 32: SOCIOECONOMIC SESSION I – AMBROSE-REED LECTURE: HEALTHCARE IN THE US: HOW WE GOT INTO THIS MESS AND HOW CAN WE POSSIBLY GET OUT OF IT?
Kenneth Phenow, MD Senior Vice President & Chief Medical Officer, Blue Cross Blue Shield
10:50 a.m. – 11:15 a.m. SESSION 32.1: MAKING YOUR PRACTICE MORE EFFICIENT AND MORE PRODUCTIVE
Invited Speaker: Neil H. Baum, MD New Orleans, LA 54 11:15 a.m. – 12:30 p.m. SESSION 33: T-LEON HOWARD IMAGING SESSION
Moderator: Michael S. Cookson, MD Nashville, TN
Case # 1 Presented By: Florian Schroeck, MD Case # 2 Presented By: Robin Bhavsar, MD Case # 3 Presented By: Gerard Henry, MD Case # 4 Presented By: Jeffrey Gahan, MD Case # 5 Presented By: Austin DeRosa, MD Case # 6 Presented By: Denise Chow, MD Case # 7 Presented By: S. Mohammad Jafri, MD Case # 8 Presented By: Christopher Bean, MD
12:30 p.m. – 1:30 p.m. INDUSTRY SPONSORED LUNCH Location: La Galeries 6 “Promoting Wellness 3: How to Save Time Discussing What Works and What is Worthless”
Mark Moyad, MD, MPH Jenkins/Pokempner Director of Preventive and Alternative Medicine Department Of Urology, University of Michigan Ann Arbor, Michigan
Funding Provided By: Abbott Laboratories
SUNDAY, MARCH 20, 2011
6:30 a.m. – 7:00 a.m. BREAKFAST Location: Preservation Hall Foyer
6:30 a.m. – 12:00 p.m. REGISTRATION/INFORMATION DESK OPEN Location: Preservation Hall Foyer
7:30 a.m. – 10:30 a.m. SPOUSE/GUEST HOSPITALITY SUITE OPEN Location: St. Charles, 41st Floor ______
CONCURRENT SESSIONS 7:00 a.m. – 8:00 a.m. SESSION 34: CONCURRENT VIDEO SESSION III Location: La Galeries, 1 – 3
Moderators: Michael A. Aleman, MD Memphis, TN
Rizk El-Galley, MD Birmingham, AL
Video #18 APPLICATION OF “CINCH AND TIE” TECHNIQUE TO ROBOTIC NEPHROPEXY FOR POSTERIOR ABDOMINAL WALL FIXATION Scott Castle, Watid Karnjanawanichkul, Vladislav Gorbatiy, Nelson Salas and Raymond Leveillee
University of Miami, Department of Urology, Miami, FL SUNDAY (Presented By: Scott Castle)
Video #19 INCREMENTAL NERVE PRESERVATION DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY Marcelo Orvieto, Sanket Chauhan, Ananthkrishnan Sivaraman, Rafael Coelho, Kenneth Plamer and Vipul Patel GRI (Presented By: Marcelo Orvieto)
55 Video #20 TECHNIQUE OF ROBOT ASSISTED LAPAROSCOPIC DISMEMBERED PYELOPLASTY – A MULTIINSTITUTIONAL REVIEW OF OUTCOMES Ananthkrishnan Sivaraman, Sanket Chauhan, Rafael Coelho, Marcelo Orvieto, Kenneth Plamer and Vipul Patel GRI (Presented By: Marcelo Orvieto)
Video #21 THE PRO-VAS® SPRING CLIP TECHNIQUE FOR VAS DEFERENS OCCLUSION Douglas Swartz McIver Urological Clinic, Jacksonville, FL (Presented By: Douglas Swartz)
Video #22 ROBOTIC PARTIAL NEPHRECTOMY WITH SELECTIVE SEGMENTAL ARTERIAL CLAMPING Wesley White, Joe Mobley, John Beddies, W. Bedford Waters and Frederick Klein Division of Urologic Surgery, University of Tennessee Medical Center, Knoxville, Knoxville, TN (Presented By: Wesley White)
Video #23 ROBOTIC EXCISION OF MULTIFOCAL URETERAL POLYPS Scott E. Delacroix, Jr.¹, Richard Vanlangendonck² and Joseph Ortenberg³ ¹Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas; ²Department of Urology, Ochsner Clinic Foundation, New Orleans, Louisiana; ³Department of Urology, Louisiana State Health Sciences Center, New Orleans, Louisiana (Presented By: Scott E. Delacroix, Jr.)
Video #24 ROBOTIC SALVAGE PROSTATECTOMY FOR RADIORECURRENT PROSTATE CANCER Ananthkrishnan Sivaraman, Sanket Chauhan, Marcelo Orvieto, Rafael Coelho, Kenneth Plamer and Vipul Patel GRI (Presented By: Marcelo Orvieto)
7:30 a.m. – 8:30 a.m. SESSION 35: ED/INFERTILITY PODIUM
Moderators: Gerard D. Henry, MD Shreveport, LA
Sijo J. Parekattil, MD Gainesville, FL
Presentations will last 6 minutes with a Q&A session following each presenter. If a presenter exceeds the 6-minute timeslot, there will be no Q&A discussion.
7:30 a.m. #102 THE ROLE OF TESTOSTERONE IN VASCULAR SMOOTH MUSCLE CELL MEDIATED MATRIX METALLOPROTEINASE EXPRESSION AND FUNCTION John Beddies, James Bienvenu, Deidra Mountain, Stacy Kirkpatrick, Wesley White, Oscar Grandas and Frederick Klein University of Tennessee Graduate School of Medicine (Presented By: John Beddies)
7:36 a.m. #103 DOES THE NEED FOR A REPLACEMENT INFLATABLE PENILE PROSTHESIS LEAD TO DECREASED PATIENT SATISFACTION? Arthur Caire, Aaron Boonjindasup, Brian Richardson and Wayne Hellstrom Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
7:42 a.m. #104 CHARACTERISTICS OF PAIN IN VARICOCELE: DOES VARICOCELECTOMY REALLY RELIEVE THE PAIN? Majid Mirzazadeh¹, Adel Tizno² and John J. Smith, III¹ ¹Wake Forest University, Winston-Salem, NC; ²Iran University of Medical Sciences, Tehran, Iran (Presented By: Majid Mirzazadeh)
56 7:48 a.m. #105 HIGHER TESTOSTERONE LEVELS ARE NOT CORRELATED WITH BETTER SEMEN PARAMETERS IN INFERTILE MEN Eric Laborde¹, Ross Hogan², Daniel Stein¹, Vishal Bhalani¹, John Cashy¹, Tobias Kohler³ and Robert Brannigan¹ ¹Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL; ²Ochsner/Louisiana State University School of Medicine, New Orleans, LA; ³Department of Surgery Southern Illinois University School of Medicine, Springfield, IL (Presented By: Ross Hogan)
7:54 a.m. #106 INFECTION OUTCOMES IN PATIENTS UNDERGOING MULTIPLE PENILE PROSTHETIC-RELATED OPERATIONS: A POTENTIAL NOVEL RISK FACTOR Sisir Botta and Ronald Lewis Medical College of Georgia, Augusta, GA (Presented By: Sisir Botta)
8:00 a.m. #107 SAFETY OF INFLATABLE PENILE PROSTHESIS INSERTION IN PATIENTS ON SOME ANTICOAGULANT THERAPIES: A REPORT OF 20 CASES Paul Perito¹, John Grimaldi², John Mulcahy³ and Steven Wilson4 ¹Miami, FL; ²Vincennes IN; ³Birmingham AL; 4Indio CA (Presented By: Paul Perito)
8:06 a.m. #108 MOMENTARY SQUEEZE PUMP CYLINDERS THAT ARE UNABLE TO INFLATE, RESCUED WITH PULL/STRETCH TECHNIQUE Gerard Henry¹ and Elizabeth Rae² ¹Regional Urology, Shreveport, LA; ²Patient Liaison – American Medical Systems, Minneapolis, MN (Presented By: Gerard Henry)
8:12 a.m. #109 COUNTERFIET PDE5I: HOW BIG IS THE PROBLEM NOW? Philip Dorsey and Wayne Hellstrom Department of Urology, Tulane University School of Medicine, New Orleans, LA (Presented By: Philip Dorsey)
8:18 a.m. #110 SIMULTANEOUS ADVANCE MALE SLING AND AN INFLATABLE PENILE PROSTHESIS: CONCURRENT PLACEMENT DOES NOT INCREASE POTENTIAL FOR IMPLANT INFECTION Brian Christine¹ and L. Dean Knoll² ¹Urology Centers of Alabama, Birmingham, AL; ²The Center for Urological Treatment, Nashville, TN (Presented By: L. Dean Knoll)
8:24 a.m. #111 COMORBID ERECTILE DYSFUNCTION IN MEN REQUIRING SURGICAL INTERVENTION FOR POST-PROSTATECTOMY URINARY INCONTINENCE Ekene Enemchukwu, Benjamin Whittam, Todd Doran, Melissa Kaufman and Douglas Milam Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN (Presented By: Ekene Enemchukwu)
7:30 a.m. – 8:30 a.m. SESSION 36: CONCURRENT POSTER SESSION – NEPHROLITHIASIS Location: Mardi Gras, LMN
Moderators: Vincent G. Bird, MD
Gainesville, FL SUNDAY
Richard M. VanLangendonck, Jr., MD New Orleans, LA
Poster #70 THE USE OF AIR RETROGRADE PYELOGRAM DURING FLUOROSCOPIC ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY IS ASSOCIATED WITH DECREASED RADIATION EXPOSURE Michael Lipkin, John Mancini, Agnes Wang, Dorit Zilberman, Michael Ferrandino, Michael Miller and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin)
57 Poster #71 RISK OF DIABETES MELLITUS AND HYPERTENSION AFTER EXTRACORPOREAL SHOCK WAVE (ESWL) THERAPY FOR URINARY STONE DISEASE Reza Mehrazin, Michael Aleman, Jamin Brahmbhatt, Jessica Lange, Lindsey Hartsell, Evan Dunn, Kevin Walls, Matthew Kincade, Anthony Patterson, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin)
Poster #72 FACTORS AFFECTING RADIATION EXPOSURE DURING URETEROSCOPY Michael Lipkin, Agnes Wang, John Mancini, Dorit Zilberman, Michael Ferrandino and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin)
Poster #73 PROFILE OF THE PEDIATRIC BRUSHITE STONE FORMER Davis P. Viprakasit, Douglas B. Clayton, Mark D. Sawyer, John C. Thomas and Nicole L. Miller Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (Presented By: Davis P. Viprakasit)
Poster #74 RISK OF DETERIORATION IN RENAL FUNCTION AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) OR URETEROSCOPY (URS) FOR URINARY STONE DISEASE Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, Jessica Lange, Evan Dunn, Anothony Patterson, Chrisopher Ledbetter, Jim Wan, Ithaar Derweesh and Robert Wake (Presented By: Reza Mehrazin)
Poster #75 OPTIMIZATION OF TREATMENT STRATEGY EMPLOYED DURING SHOCK WAVE LITHOTRIPSY TO MAXIMIZE STONE FRAGMENTATION EFFICIENCY John Mancini, Daniel Yong, Michael Lipkin, Anges Wang, Neal Simmons, Michael Ferrandino, Pei Zhong and Glenn Preminger Durham, NC (Presented By: John Mancini)
Poster #76 IN VIVO STONE FRAGMENTATION AND TISSUE INJURY USING A NEW ACOUSTIC LENS DESIGN FOR ELECTROMAGNETIC SHOCKWAVE LITHOTRIPTERS John Mancini, Neal Simmons, Daniel Yong, Eliza Raymundo, Michael Lipkin, Agnes Wang, Michael Ferrandino, Pei Zhong and Glenn Preminger Durham, NC (Presented By: John Mancini) Poster #77 CONTRIBUTION OF GLYCINE AND PHENYLALANINE METABOLISM TO URINARY OXALATE EXCRETION John Knight, Dean Assimos and Ross Holmes Wake Forest University School of Medicine, Winston-Salem, North Carolina (Presented By: Dean Assimos)
Poster #78 DETERMINATION OF RADIATION DOSE DURING PERCUTANEOUS NEPHROLITHOTOMY USING A VALIDATED PHANTOM MODEL Michael Lipkin, John Mancini, Agnes Wang, Greta Toncheva, Colin Anderson-Evans, Neal Simmons, Michael Ferrandino, Terry Yoshizumi and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin)
Poster #79 USE OF HEMOSTATIC AGENTS IN PERCUTANEOUS NEPHROLITHOTOMY TRACT MAY REDUCE URINE LEAK RATE IN A PORCINE MODEL Michael Lipkin, John Mancini, Agnes Wang, Neal Simmons, Eliza Raymundo, Daniel Yong, Michael Ferrandino, David Albala and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin)
58 8:30 a.m. – 11:00 a.m. SESSION 37: SOCIOECONOMIC SESSION II
8:30 a.m. Status of Urology Work Force in the US and Its Impact on Urologic Practice
Martha K. Terris, MD Augusta, GA
8:50 a.m. Panel: What Does the AUA Mean to Me?
Anton J. Bueschen, MD Atlanta, GA
9:20 a.m. Your Money or Your Life – How to Keep Both
Billing and Coding Update for 2011 Stephanie N. Stinchcomb, CPC, CCS-P, ACS-UR Senior Manager, Reimbursement & Regulation AUA
The RUC and Reimbursement, What You Need to Know William F. Gee, MD, AUA RUC Representative
ICD-10 The Coming Storm – Impact on Your Practice Stephanie N. Stinchcomb, CPC, CCS-P, ACS-UR
Medicare, Congress and the Future William F. Gee, MD
Audience Questions
11:00 a.m. – 12:00 p.m. SESSION 38: ANNUAL BUSINESS MEETING
Disclaimer Statement Statements, opinions and results of studies contained in the program and abstracts are those of the presenters/ authors and do not reflect the policy or position of the SESAUA nor does the SESAUA 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 SESAUA 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. SUNDAY
59 Alphabetical Index of AUTHORS 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.
Aboushwareb, Tamer AB# - 3/18/11 1:45 p.m. Poster #17 AB# - 3/18/11 1:45 p.m. Poster #18 AB# - 3/18/11 1:45 p.m. Poster #19
Anderson, Christopher B. AB# - 3/18/11 4:00 p.m. Poster #45
Anderson, Mark AB# 28 3/18/11 7:00 a.m.
Angell, Jordan E. AB# 55 3/18/11 9:03 a.m. AB# 68 3/18/11 3:21 p.m.
Antebei, Elie AB# - 3/19/11 8:00 a.m. Poster #68
Antonelli, Jodi AB# 84 3/19/11 7:06 a.m.
Assimos, Dean G. AB# 40 3/18/11 8:21 a.m. AB# - 3/20/11 7:30 a.m. Poster #77
Atkinson, Timothy AB# - 3/19/11 8:00 a.m. Poster #55
Balaji, K.C. AB# - 3/17/11 3:45 p.m. Poster #10
Barocas, Daniel AB# - 3/17/11 3:45 p.m. Poster #1
Bean, Christopher M. AB# - 3/18/11 4:00 p.m. Poster #40 AB# - 3/19/11 11:15 a.m. Case #8
Beddies, John AB# 102 3/20/11 7:30 a.m.
Bernie, Aaron AB# 72 3/18/11 4:18 p.m.
Bhavsar, Robin AB# 57 3/18/11 2:15 p.m. AB# - 3/19/11 11:15 a.m. Case #2
Boonjindasup, Aaron AB# 58 3/18/11 2:21 p.m.
Botta, Sisir AB# - 3/17/11 3:45 p.m. Poster #4 AB# - 3/18/11 1:45 p.m. Poster #21 AB# 106 3/20/11 7:54 a.m.
60 Bowen, Ashley B. AB# - 3/17/11 1:30 p.m. Video #4 AB# 69 3/18/11 4:00 p.m. AUTHORS
Brahmbhatt, Jamin AB# - 3/18/11 4:00 p.m. Poster #48 AB# - 3/18/11 4:00 p.m. Poster #50 AB# - 3/18/11 4:00 p.m. Poster #51
Broderick, Kristin AB# - 3/18/11 1:45 p.m. Poster #24
Broughton, Gregory J. AB# - 3/18/11 4:00 p.m. Poster #39
Bryant, Michael AB# 54 3/18/11 8:57 a.m.
Burns, Erin AB# 64 3/18/11 2:57 p.m.
Bylund, Jason R. AB# 4 3/17/11 10:48 a.m.
Caire, Arthur AB# 42 3/18/11 8:33 a.m. AB# 51 3/18/11 8:39 a.m. AB# - 3/18/11 1:45 p.m. Poster #38 AB# 78 3/18/11 4:54 p.m. AB# 103 3/20/11 7:36 a.m.
Campbell, John AB# - 3/17/11 3:45 p.m. Poster #12 AB# - 3/17/11 3:45 p.m. Poster #15
Carey, Robert I. AB# 13 3/17/11 11:42 a.m. AB# - 3/17/11 3:45 p.m. Poster #13
Castle, Scott AB# 76 3/18/11 4:42 p.m. AB# 82 3/18/11 5:18 p.m. AB# - 3/19/11 8:00 a.m. Poster #61 AB# - 3/20/11 7:00 a.m. Video #18
Chapin, Brian F. AB# 2 3/17/11 10:36 a.m.
Cheng, Marina AB# - 3/17/11 3:45 p.m. Poster# 11 AB# 31 3/18/11 7:18 a.m.
Chermansky, Christopher AB# - 3/18/11 1:45 p.m. Poster# 34
Chow, Denise AB# - 3/17/11 1:30 p.m. Video #10 AB# - 3/19/11 7:00 a.m. Video #15 AB# - 3/19/11 11:15 a.m. Case #6
Christine, Brian S. AB# 23 3/17/11 2:12 p.m.
Chu, David AB# - 3/17/11 3:45 p.m. Poster #6
61 Colli, Jan L. AB# 9 3/17/11 11:18 a.m. AB# - 3/18/11 1:45 p.m. Poster #29 AB# - 3/19/11 8:00 a.m. Poster #62
Cross, Brian W. AB# 7 3/17/11 11:06 a.m.
Davies, Judson D. AB# 62 3/18/11 2:45 p.m.
Delacroix, Jr., Scott E. AB# - 3/19/11 8:00 a.m. Poster #57 AB# - 3/20/11 7:00 a.m. Video #23
DeRosa, Austin B. AB# 5 3/17/11 10:54 a.m. AB# - 3/19/11 11:15 a.m. Case #5
Dorsey, Philip AB# 12 3/17/11 11:36 a.m. AB# 75 3/18/11 4:36 p.m. AB# 109 3/20/11 8:12 a.m.
Drzewiecki, Beth AB# - 3/18/11 4:00 p.m. Poster #42 AB# - 3/18/11 4:00 p.m. Poster #44
Ekwenna, Obi O. AB# 33 3/18/11 7:30 a.m.
El-Zawahry, Ahmed M. AB# - 3/17/11 3:45 p.m. Poster #8 AB# - 3/17/11 3:45 p.m. Poster #14
Enemchukwu, Ekene A. AB# 19 3/17/11 1:48 p.m. AB# 111 3/20/11 8:24 a.m.
Feige, Amanda AB# 70 3/18/11 4:06 p.m.
Gahan, Jeffrey C. AB# 6 3/17/11 11:00 a.m. AB# - 3/19/11 11:15 a.m. Case #4
Garcia-Roig, Michael AB# 8 3/17/11 11:12 a.m.
Gomelsky, Alexander AB# - 3/18/11 1:45 p.m. Poster #36
Gorbachinsky, Ilya AB# 16 3/17/11 1:30 p.m. AB# - 3/18/11 4:00 p.m. Poster #43
Gorin, Michael AB# - 3/19/11 7:00 a.m. Video #16 AB# - 3/19/11 8:00 a.m. Poster #69
Griffin, Joshua G. AB# 66 3/18/11 3:09 p.m. AB# 67 3/18/11 3:15 p.m.
Hardin, Brent AB# - 3/18/11 1:45 p.m. Poster #33
62 Hatcher, Paul A. AB# 59 3/18/11 2:27 p.m. AUTHORS
Henry, Gerard D. AB# - 3/19/11 11:15 a.m. Case #3 AB# 108 3/20/11 8:06 a.m.
Herrel, Lindsey AB# - 3/19/11 8:00 a.m. Poster #52
Hill, Lawrence AB# - 3/18/11 1:45 p.m. Poster #28
Hogan, Ross AB# 105 3/20/11 7:48 a.m.
Holstead, Joshua AB# 27 3/17/11 2:36 p.m.
Jafri, S. Mohammad AB# - 3/19/11 11:15 a.m. Case #7
Kay, Gary AB# 20 3/17/11 1:54 p.m.
Kennelly, Michael J. AB# 22 3/17/11 2:06 p.m.
Kim, Timothy AB# 10 3/17/11 11:24 a.m.
Kirkpatrick, Gina AB# 61 3/18/11 2:39 p.m.
Klaassen, Zachary AB# - 3/18/11 4:00 p.m. Poster #46
Klink, Joseph C. AB# 60 3/18/11 2:33 p.m.
Knoll, L. Dean AB# 25 3/17/11 2:24 p.m. AB# 110 3/20/11 8:18 a.m.
Knox, Michael L. AB# 100 3/19/11 9:00 a.m. AB# 101 3/19/11 9:06 a.m.
Koski, Michelle E. AB# 17 3/17/11 1:36 p.m.
Kraebber, David M. AB# 30 3/18/11 7:12 a.m.
Krane, Loius S. AB# 36 3/18/11 7:48 a.m. AB# - 3/18/11 1:45 p.m. Poster #20
Laboccetta, Lydia AB# 74 3/18/11 4:30 p.m.
Langston, Joshua AB# - 3/17/11 3:45 p.m. Poster #2 AB# 35 3/18/11 7:42 a.m. AB# 63 3/18/11 2:51 p.m. AB# - 3/19/11 8:00 a.m. Poster #60 AB# 96 3/19/11 8:36 a.m. AB# 99 3/19/11 8:54 a.m. 63 Laungani, Rajesh G. AB# - 3/19/11 8:00 a.m. Poster #67
Lee, Bobbilynn H. AB# - 3/18/11 4:00 p.m. Poster #49
LeRoy, Tim J. AB# - 3/17/11 1:30 p.m. Video #1
Lipkin, Michael E. AB# 45 3/18/11 8:51 a.m. AB# - 3/20/11 7:30 a.m. Poster #70 AB# - 3/20/11 7:30 a.m. Poster #72 AB# - 3/20/11 7:30 a.m. Poster #78 AB# - 3/20/11 7:30 a.m. Poster #79
Mancini, John G. AB# - 3/20/11 7:30 a.m. Poster #75 AB# - 3/20/11 7:30 a.m. Poster #76
Manny, Ted B. AB# - 3/18/11 4:00 p.m. Poster #47
Martin, Benjamin AB# 83 3/19/11 7:00 a.m.
McDonald, Michael W. AB# 52 3/18/11 8:45 a.m. AB# 81 3/18/11 5:12 p.m.
Mehrazin, Reza AB# - 3/17/11 3:45 p.m. Poster #9 AB# 46 3/18/11 8:57 a.m. AB# 56 3/18/11 9:09 a.m. AB# - 3/20/11 7:30 a.m. Poster #74 AB# - 3/20/11 7:30 a.m. Poster #71
Miller, Scott D. AB# 26 3/17/11 2:30 p.m. AB# - 3/19/11 7:00 a.m. Video #17 AB# 97 3/19/11 8:42 a.m.
Mirzazadeh, Majid AB# 104 3/20/11 7:42 a.m.
Morales, Walter AB# - 3/18/11 1:45 p.m. Poster #32
Morgan, Todd M. AB# 1 3/17/11 10:30 a.m. AB# - 3/19/11 8:00 a.m. Poster #58
Munoz, Oxana AB# 88 3/19/11 7:30 a.m.
Norwood, Jeremy AB# - 3/18/11 1:45 p.m. Poster #31
Oommen, Mathew AB# - 3/17/11 1:30 p.m. Video #2 AB# - 3/19/11 7:00 a.m. Video #12
64 Orvieto, Marcelo A. AB# - 3/17/11 1:30 p.m. Video #5 AB# - 3/17/11 1:30 p.m. Video #6 AUTHORS AB# - 3/17/11 1:30 p.m. Video #8 AB# - 3/19/11 7:00 a.m. Video #14 AB# 90 3/19/11 8:00 a.m. AB# - 3/20/11 7:00 a.m. Video #19 AB# - 3/20/11 7:00 a.m. Video #20 AB# - 3/20/11 7:00 a.m. Video #24
Parker, Alexander AB# - 3/17/11 3:45 p.m. Poster #7 AB# 65 3/18/11 3:03 p.m.
Patel, Bhavin N. AB# 41 3/18/11 8:27 a.m. AB# 49 3/18/11 8:27 a.m.
Patel, Kush AB# 53 3/18/11 8:51 a.m.
Patil, Sachin AB# - 3/19/11 8:00 a.m. Poster #64
Pattaras, John G. AB# 14 3/17/11 11:48 a.m. AB# 50 3/18/11 8:33 a.m.
Perito, Paul E. AB# 107 3/20/11 8:00 a.m.
Pickens, Ryan B. AB# 21 3/17/11 2:00 p.m. AB# 43 3/18/11 8:39 a.m. AB# - 3/18/11 1:45 p.m. Poster #37 AB# - 3/18/11 1:45 p.m. Poster #38.5
Pugh, Joseph AB# - 3/17/11 1:30 p.m. Video #9 AB# 77 3/18/11 4:48 p.m.
Razdan, Sanjay AB# - 3/18/11 1:45 p.m. Poster #27
Richards, Kyle A. AB# - 3/17/11 3:45 p.m. Poster #16 AB# - 3/19/11 8:00 a.m. Poster #66 AB# 93 3/19/11 8:18 a.m. AB# 98 3/19/11 8:48 a.m.
Richardson, Brian E. AB# - 3/19/11 7:00 a.m. Video #13
Rodriguez, Alejandro R. AB# 80 3/18/11 5:06 p.m. AB# - 3/19/11 8:00 a.m. Poster #56
Ruhotina, Nedim AB# 29 3/18/11 7:06 a.m.
Scales, Jr., Charles D. AB# - 3/18/11 1:45 p.m. Poster #30
Schlake, Anthony M. AB# 32 3/18/11 7:24 a.m.
Schmeeckle, Ayme AB# 86 3/19/11 7:18 a.m. 65 Schroeck, Florian R. AB# - 3/19/11 11:15 a.m. Case #1
Selph, J. Patrick AB# - 3/17/11 3:45 p.m. Poster #5 AB# 37 3/18/11 7:54 a.m. AB# 38 3/18/11 8:00 a.m. AB# - 3/19/11 8:00 a.m. Poster #53 AB# - 3/19/11 8:00 a.m. Poster #54 AB# 91 3/19/11 8:06 a.m. AB# 92 3/19/11 8:12 a.m.
Shingleton, William B. AB# - 3/19/11 8:00 a.m. Poster #59
Shirodkar, Samir P. AB# 73 3/18/11 4:24 p.m.
Sivaraman, Ananthakrishnan AB# - 3/19/11 8:00 a.m. Poster #63 AB# 94 3/19/11 8:24 a.m. AB# 95 3/19/11 8:30 a.m.
Speeg, Jeremy S. AB# - 3/18/11 4:00 p.m. Poster #41
Stewart, Adam F. AB# 18 3/17/11 1:42 p.m. AB# 34 3/18/11 7:36 a.m. AB# 79 3/18/11 5:00 p.m. AB# 85 3/19/11 7:12 a.m.
Stewart, Gregory AB# 15 3/17/11 11:52 a.m.
Swartz, Douglas A. AB# - 3/20/11 7:00 a.m. Video #21
Terlecki, Ryan AB# 47 3/18/11 8:15 a.m. AB# - 3/18/11 1:45 p.m. Poster #23 AB# - 3/18/11 1:45 p.m. Poster #35
Thiel, David AB# - 3/19/11 7:00 a.m. Video #11
Thompson, III, Ian M. AB# - 3/17/11 3:45 p.m. Poster #3
Turpen, Ryan M. AB# - 3/17/11 1:30 p.m. Video #3
Vidrine, Steven R. AB# 87 3/19/11 7:24 a.m.
Viprakasit, Davis P. AB# - 3/18/11 1:45 p.m. Poster #26 AB# 71 3/18/11 4:12 p.m. AB# - 3/20/11 7:30 a.m. Poster #73
Walker, Paul W. AB# 24 3/17/11 2:18 p.m.
Walls, Kevin AB# - 3/18/11 1:45 p.m. Poster #22
66 Werle, David M. AB# 11 3/17/11 11:30 a.m. AUTHORS
White, Wesley AB# 3 3/17/11 10:42 a.m. AB# - 3/17/11 1:30 p.m. Video #7 AB# - 3/20/11 7:00 a.m. Video #22
Whiting, Bryant M. AB# - 3/18/11 1:45 p.m. Poster #25
Whittam, Benjamin M. AB# 89 3/19/11 7:36 a.m.
Wise, Phillip G. AB# 48 3/18/11 8:21 a.m.
Wood, Kyle AB# 44 3/18/11 8:45 a.m.
Young, Ezekiel AB# 39 3/18/11 8:15 a.m.
67 PODIUM #1
PRE-OPERATIVE NUTRITIONAL STATUS IS ASSOCIATED WITH SURVIVAL AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA Dominic Tang¹, Todd Morgan², Daniel Barocas², Christopher Anderson², Kelly Stratton², S. Duke Herrell², Sam Chang², Michael Cookson², Joseph Smith² and Peter Clark² ¹Meharry Medical College, Nashville, TN; ²Vanderbilt University School of Medicine, Nashville, TN (Presented By: Todd Morgan)
Introduction: The role of preoperative nutritional status has not been well studied in patients undergoing nephrectomy for renal cell carcinoma (RCC). We sought to evaluate whether impaired preoperative nutritional status is an important determinant of overall survival following radical or partial nephrectomy for RCC. Methods: In this retrospective analysis of a prospective database, we identified 369 consecutive patients who underwent partial or radical nephrectomy from 2003 to 2008 for locoregional RCC. Impaired nutritional status was defined as either a BMI <18.5 kg/m2, albumin <3.5 g/dL, or pre-operative weight loss > 5% of total body weight. Primary outcomes were overall and disease-specific mortality. Covariates evaluated included age, Charlson Comorbidity Index (CCI), tumor stage, Fuhrman grade, and presence of positive lymph nodes. Multivariate analysis was performed using Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product limit method. Results: Total median follow-up was 22.3 months (IQR 14.3 – 37.1 months). Median follow-up for patients alive at time of censuring was 23.6 (IQR 15.6 – 38.3). Mean age was 60.2 years (SD ± 12.8 years). A total of 85 patients (23%) were categorized as having impaired nutritional status. Three-year overall survival was 57.6% in the nutritionally impaired cohort and 85.4% in the control group (p<0.001). Kaplan-Meier curves for disease-specific survival are shown in the figure. On multivariate analysis, nutritional status was an independent predictor of both overall (HR 2.86, 95% CI 1.67 – 4.90) and disease-specific mortality (HR 3.4, 95C%CI 1.47 – 7.89) after correcting for age, CCI, stage, grade and lymph node status. Conclusion: Our data demonstrate that nutritional impairment is associated with a significant mortality risk after nephrectomy for RCC, independent of key clinical and pathologic factors. Given these findings, evaluating nutritional status preoperatively and counseling appropriately should be a priority.
68 PODIUM #2
POST-OPERATIVE COMPLICATIONS FROM CYTOREDUCTIVE NEPHRECTOMY AFTER NEO- ADJUVANT TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA Brian F. Chapin¹, Scott E. Delacroix¹, Stephen H. Culp¹, Graciela M. Nogueras-Gonzalez² and Christopher G. Wood¹ ¹The University of Texas M.D. Anderson Cancer Center Department of Urologic Oncology, Houston, Texas; ²The University of Texas M.D. Anderson Cancer Center Department of Biostatistics, Houston, Texas (Presented By: Brian F. Chapin)
Introduction and Objectives: Neoadjuvant treatment of metastatic renal cell carcinoma (RCC) with targeted systemic therapies is under investigation. Post-operative complications that occurred after cytoreductive nephrectomy (CRN) preceded by neoadjuvant systemic therapy were assessed.
Methods: A retrospective review of all patients with clinical evidence of metastasis that underwent CRN PODIUM SESSIONS was performed. Of 683 surgical patients with metastatic disease, 67 had received pre-operative targeted therapy. Preoperative, operative and postoperative characteristics were evaluated for each patient. Surgical complications were assessed using the modified Clavien system. A multivariate regression model was developed using significant or clinically relevant preoperative variables in an attempt to predict surgical complications within 1 year of CRN. Results: Complications occurred in 64% (43/67) of patients within 365 days of CRN. Clavien Grade ≥3 complications occurred in 30% (20/67) patients. The most common occurrences were acute renal failure (27%), superficial wound dehiscence (25%) and wound infection (15%). On univariate analysis there were no statistically significant differences between groups in regards to age, race, gender, smoking history, follow-up, Charlson co- morbidity index, MSKCC risk groups or time from cessation of targeted therapy to surgery. Significant predictors of complications included BMI≥30 (p=0.007), EBL (p=0.019), presence of matted nodes (p=0.043) and surgical approach (p=0.001). Change in albumin during targeted therapy (p=0.056) and clinical T-stage and N-stage (p=0.068, p=0.073) approached significance. On multivariate analysis Charlson co-morbidity index ≥8(OR 5.2, 95% CI 1.23, 21.99) and clinical N-Stage (OR 5.11, 95%CI 1.21, 21.66) were significant predictors of post- operative complications. Conclusion: In this series of patients treated with neoadjuvant targeted therapy, a majority of patients experienced a post-operative complication after cytoreductive surgery. A Charlson co-morbidity index ≥8 or clinical node positivity predicted for an increased risk of post-operative complications. The use of neo-adjuvant systemic targeted therapy prior to cytoreductive nephrectomy is investigational and adequate assessment of operative morbidity is needed prior to wide spread adoption. Funding: Work Supported by NCI Grant P30 CA016672.
PODIUM #3
ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL MASSES: A PROSPECTIVE, MULTI- CENTER STUDY Wesley White¹, Michael White², Georges-Pascal Haber², Ricardo Autorino², Frederick Klein¹, W. Bedford Waters¹ and Jihad Kaouk² ¹Division of Urologic Surgery, The University of Tennessee Medical Center, Knoxville, Knoxville, TN; ²Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH (Presented By: Wesley White)
Introduction and Objectives: We present perioperative outcomes in an observational cohort of patients who underwent Robotic Partial Nephrectomy (RPN) for complex renal masses. Methods: A prospective, multi-center study was performed to evaluate operative outcomes following RPN for moderately or highly complex renal masses. Complexity was determined using the R.E.N.A.L. nephrometery scoring system. Masses with a R.E.N.A.L. score 7 – 9 were considered moderately complex while masses with a R.E.N.A.L. score of 10 – 12 were considered highly complex. Salient demographic and radiographic data were obtained. Operative data including estimated blood loss (EBL), operative time and warm ischemia time (WIT) were recorded. Pathology was reviewed and classified according to the AJCC staging system. Patients were followed post-operatively for evidence of immediate and delayed complications. Adverse events were graded using the Clavien Classification System. Statistical analysis was performed. Results: Between February 2007 and August 2010, a total of 182 patients underwent RPN for radiographic evidence of an enhancing renal mass. Of this cohort, 78 patients demonstrated a R.E.N.A.L. score of ≥7. Specifically, 65 patients demonstrated a R.E.N.A.L. score of 7 – 9 and 13 patients had a R.E.N.A.L. score of 10 – 12. Among those with a moderately or highly complex mass, mean tumor size was 3.7cm (1.2 – 11cm), mean operative time was 176 minutes (110 – 190 minutes), and mean EBL was 213mL. Mean WIT was 19.7 minutes. Pathology demonstrated renal cell carcinoma in 65 patients and benign tumors in the remaining 13 patients. One positive margin was noted. Adverse Events included 3 Clavien Class 1 complications, 11 Class 2 complications, and 2 Class 3 complications. At a mean follow-up of 10 months, overall and disease-specific survival is 100%. Conclusion: Robotic Partial Nephrectomy is a safe and feasible option for moderately or highly complex renal masses as determined by the R.E.N.A.L. nephrometry scoring system. 69 PODIUM #4
ASSOCIATION OF R.E.N.A.L. NEPHROMETRY SCORE AND ISCHEMIA TIME DURING PARTIAL NEPHRECTOMY Jason Bylund, Dustin Gayheart, Ramakrishna Venkatesh, David Preston, Stephen Strup and Paul Crispen University of Kentucky, Lexington, KY (Presented By: Jason Bylund)
Introduction and Objectives: The R.E.N.A.L. Nephrometry Score (RNS) was introduced in attempt to standardize the reporting of renal tumors based upon tumor size, location and depth. The proposed scoring system may reveal surgical complexity, especially when applied to patients undergoing partial nephrectomy. However the scoring system has yet to be validated or associated with intraoperative outcomes. Here then, we evaluate the association of the RNS with intraoperative outcomes at the time of partial nephrectomy. Methods: Patients undergoing partial nephrectomy, open or laparoscopic, with available contrast enhanced cross sectional preoperative imaging were identified between from 2005 to 2009. RNS were assigned according to the previously described protocol. Tumors were further characterized as being of low (score 4 – 6), moderate (score 7 – 9), and high (score 10 – 12) complexity. Associations between total RNS and estimated blood loss, ischemia time and total operative time were examined using the Kruskal-Wallis Test. Results: A total of 106 patients were identified with appropriate preoperative imaging prior to partial nephrectomy. Median patient age was 59 years. 51% of the tumors were located in the right kidney. Median tumor size was 2.6 cm (range 1.0 – 7.7). RNS ranged from 4 to 11, with 65% (69/106) low, 31% (32/106) moderate, and 5% (5/106) highly complex tumors. Median estimated blood loss, ischemia time and total operative were 200cc, 24 minutes, and 203 minutes, respectively. Estimated blood loss was not significantly associated with total RNS (p = 0.552) or complexity (p = 0.80). Ischemia time was significantly associated with total RNS (p = 0.029) and complexity (p = 0.0004), with lower scores and lower complexity tumors having shorter arterial clamp times. Total RNS (p =0.85) and complexity (p = 0.64) were not significantly associated with total operative time. Conclusion: The RNS is a reproducible system that reflects the surgical complexity of renal tumors undergoing partial nephrectomy based upon renal ischemic time. These findings support the use of the RNS during preoperative planning and when comparing surgical outcomes in patients undergoing partial nephrectomy.
PODIUM #5
ASSESSMENT OF PREOPERATIVE C-REACTIVE PROTEIN AS AN INDEPENDENT PREDICTOR OF FURHMAN NUCLEAR GRADE IN THE SETTING OF A SMALL RENAL MASS Austin DeRosa, S. Mohammad Jafri, Kenneth Ogan, Timothy Johnson, John Pattaras, Kenneth J. Carney, Peter Nieh and Viraj Master Emory University, Atlanta, GA (Presented By: Austin DeRosa)
Introduction and Objectives: With the increased utilization of cross-sectional imaging, enhancing small renal masses (SRM) have been detected at smaller and smaller sizes. Studies have shown that a fraction of resected SRMs have non-malignant pathology. Conversely, some patients with SRMs do develop metastatic disease. In an era of active surveillance of SRMs, predictors of poorly differentiated cancers besides size may be helpful. In order to further risk stratify patients with stage T1 kidney cancer, we hypothesize that preoperative C-reactive protein (CRP) levels may help predict Fuhrman nuclear grade in patients undergoing renal surgery. Methods: From November 2006 to 2009, we retrospectively examined 194 patients with stage T1 kidney cancer undergoing surgery. Clinicopathologic features examined included age, race, gender, BMI and Charlson Comorbidity Index (CCI). Surgical pathology reports were used to establish diagnosis. Tumor characteristics examined included tumor size, benign vs. malignant pathology and Fuhrman nuclear grade. Receiver Operating Characteristics (ROC) curves were constructed to determine the Area Under the Curve (AUC) and relative sensitivity and specificity of preoperative CRP in predicting Grade 4 versus Grades 1 – 3 disease. The optimal threshold value was determined as the point on the ROC curve with a maximal Youden Index (sensitivity + specificity – 1). Lastly, binary logistic regression analysis was conducted to assess preoperative CRP’s potential to predict Grade 4 versus Grade 1 – 3 disease, adjusting for other patient and tumor characteristics. Results: Of the total cohort, 6.2% were Grade 4 disease, while 4.6%, 46.9% and 42.3% were Grades 1 – 3, respectively. After controlling for patient age, race, gender, CCI, and tumor size, preoperative CRP was an independent significant predictor of Grade 4 disease (OR 1.026, CI1.007 – 1.045). Preoperative CRP exhibited an AUC (95% CI, p-value) of 0.786 (0.648 – 0.924, p=0.001). A cut-off of CRP >8.0 mg/L exhibited the highest Youden Index (0.148). Binary logistic regression analysis utilizing categorical CRP showed that patients with a preoperative CRP >8.0 mg/L experienced a 9-fold increased risk of Grade 4 disease (OR 9.094, CI 2.021 – 40.913). Conclusion: Preoperative CRP levels can independently Fuhrman nuclear grade prior to renal surgery. This laboratory value may guide clinical decision-making in treating patients with small renal masses. Although tumor size may portend favorable tumor histology, a small subset of patients will still have aggressive, virulent cancers. The use of CRP may help distinguish this group of patients and help define prognosis and guide treatment plans for small enhancing renal masses.
70 PODIUM #6
MOLECULAR MARKERS MAY AID IN THE IDENTIFICATION OF ONCOCYTOMA Jeffrey Gahan¹, Vincent Bird², Soloway Mark¹ and Vinata Lokeshwar¹ ¹University of Miami Department of Urology; ²University of Florida Department of Urology (Presented By: Jeffrey Gahan)
Introduction: The use of advanced imaging techniques has increased the number of small renal masses (<4cm) identified. Effective surgical intervention is often indicated for these lesions, but is not without risk.Recent studies have identified 16 – 28% of tumors less than 4 cm to have benign pathology. Approximately half of these tumors will be oncocytoma which presents a challenge as these are radiologicaly similar to RCC. Percutaneous biopsy may differentiate between oncocytoma and renal cell carcinoma; however, this relies on the presence of histopathological architecture to yield a definitive diagnosis. Moreover, differentiation between oncocytoma and chromophobe RCC is often difficult. We use RT-PCR to examine molecular markers known to be associated with PODIUM SESSIONS renal cell carcinoma and compared these findings to expression levels in oncocytoma. These include hyaluronic acid receptors (RHAM, CD44s), inflammatory cytokine receptors (CXCR4, CXCR7) and chemokines (SDF1v1, SDF1v2). Materials and Methods: All patients included in our institutional approved study underwent tissue harvesting at time of renal surgery. Fresh tissue from neoplasm and normal kidney from 80 patients was processed and RT-PCR was performed to identify expression levels of mRNA. Expression levels of RHAM, CD44s, CXCR4, CXCR7 and SDF1 were normalized to the expression level of a previously validated housekeeping gene, Tata Binding Protein. Histopathological examination of surgical specimens demonstrated 75 tumors to be malignant and 5 to be oncocytoma. Statistical analysis was performed using a non-parametric t test. Results: All molecular markers were seen to be significantly associated with tumor compared to normal tissue. CXCR4 was found to be significantly down regulated in oncocytoma versus tumor (p=0.044, mean 394+/−145 vs. 2370+/−1162). RHAM also showed a difference in expression (p=0.063) but only approached significance. On subset analysis, CXCR4 expression in oncocytoma was compared to chromophobe RCC and a difference was observed (p=0.086, mean 394+/−145 versus 2255+/−940), but did not become significant due to limited sample size. Conclusion: Molecular markers represent a way to further characterize small renal masses without needing tissue architecture. We have identified one marker (CXCR4) that is significantly over expressed in RCC and possibly chromophobe RCC but not in oncocytoma. More studies will be needed to validate these finding. Further studies to identify additional markers may aid in the differentiation between benign and malignant disease, and eventually incorporated into treatment decision-making with regard to small renal masses.
PODIUM #7
ESR-BASED LOW, INTERMEDIATE, AND HIGH RISK CATEGORIES PREDICTING OVERALL SURVIVAL IN LOCALIZED RENAL CELL CARCINOMA Brian Cross¹, Austin DeRosa¹, Timothy Johnson¹, Ammara Abbasi¹, Andrew Michigan¹, Ken Ogan¹, John Pattaras¹, Peter Nieh¹, Fray Marshall¹, Jeff Carney¹, Omer Kucuk², Wayne Harris² and Viraj Master¹ ¹Emory University Department of Urology, Atlanta, GA; ²Emory University Department of Hematology and Oncology, Atlanta, GA (Presented By: Brian Cross)
Introduction: Renal cell carcinoma (RCC) is a malignancy whose grade and tumor progression have been linked to systemic inflammation. Erythrocyte sedimentation rate (ESR) reflects systemic inflammation in other diseases states. However, the relationship between ESR and survival remains unclear in localized RCC following potentially curative nephrectomy. Methods: 241 patients undergoing nephrectomy for localized RCC had ESR measured preoperatively. Receiver Operating Characteristics (ROC) curves were constructed and used to determine the Area Under the Curve (AUC) and relative sensitivity and specificity of preoperative ESR in predicting overall survival. From this curve, cut-offs for Low Risk (0.0 – 20.0 mm/hr), Intermediate Risk (20.1 – 50.0 mm/hr), and High Risk (> 50.0 mm/hr) groups were created. Kaplan-Meier analysis was conducted to assess the univariate impact of these ESR-based risk groups on overall survival. Finally, univariate and multivariate Cox regression analysis was conducted to assess the potential of these groups to predict overall survival, adjusting for other patient and tumor characteristics. Results: Of the total cohort, 55.2% were in the Low Risk group, while 27.0% and 17.8% were in the Intermediate Risk and High Risk groups, respectively. Median (95% CI) survival for these groups was 44.1 (42.6 – 45.5) months, 35.5 (32.3 – 38.8) months and 32.1 (25.5 – 38.6) months, respectively (Figure 1). After controlling for patient age, race, gender, Charlson Comorbidity Index, T-Stage, Fuhrman Nuclear grade and tumor size, Intermediate Risk and High Risk groups experienced a 4.5-fold (HR: 4.509, 95% CI: 0.735 – 27.649) and 18.5- fold (HR: 18.531, 95% CI: 2.117 – 162.228) increased risk of overall mortality, respectively. Conclusion: ESR represents a robust categorical predictor of overall survival. Clinicians may consider including ESR measurements in counseling patients before nephrectomy and managing patients according to their ESR- based risk category.
71
PODIUM #8
ASSESSING THE IMPACT OF NON-NEOPLASTIC RENAL DISEASE AFTER PARTIAL NEPHRECTOMY Michael Garcia-Roig, Monica Garcia-Buitrago, Carlos Parra-Hernan, Merce Jorda, Bruce Kava, Murugesan Manoharan, Mark Soloway and Gaetano Ciancio Miami, FL (Presented By: Michael Garcia-Roig)
Introduction: During partial nephrectomy for renal tumors a sample representative of the resection margin is taken. A negative margin provides confirmation of cancer control and provides tissue representative of non-neoplastic kidney, which can be used to assess non-neoplastic pathologic changes. The main objective of this study was to assess the pathologic changes in non-neoplastic renal parenchyma in partial nephrectomy (PN) specimens. Material and Methods: A retrospective analysis of the University of Miami Urologic Oncology database found 183 patients who underwent partial nephrectomy from 2002 to 2008, with a mean follow-up of 27.5 months. Of those patients, pathologists at our institution examined non-neoplastic changes in 31 partial nephrectomy specimens including glomerular, tubuloinsteritial and vascular changes. The center’s institutional review board approved the study. Results: Patients had a mean age of 62.7 years (range 32 – 79). Tumor stage was as follows – 22 (71%) T1a, 4 (13%) T1b, and 4 (13%) T2; one was recorded as T1. Seven patients had type 2 diabetes, 19 had hypertension and there were 7 smokers, of whom four smoked > 30 pack years. Nine patients (29%) did not have diabetes, hypertension or smoking history. No patients required postoperative long-term dialysis. No glomerulosclerosis was found in 9 (29%) patients, mild glomerulosclerosis was seen in 18 (58%), moderate in 3 (10%) and severe disease in 1 (3%). Four (57%) patients had Diabetic Nephropathy (DN) class I, two (29%) patients showed DN class IIa and 1 (14%) patient had DN class III (Kimmelstiel-Wilson). Seventeen patients (54%) had no significant interstitial fibrosis, 5 (16%) had mild, 7 (23%) moderate and 2 (6%) severe interstitial fibrosis. Nineteen (61%)patients had mild, 10 (32%) moderate and 2 (6%) severe artheriosclerosis. Only one patient was free of all of the above pathologic findings. Three (10%) patients died during the study period (mean follow up 21.3 months). Conclusion: Examination of the non-neoplastic tissue is an opportunity to identify those patients that ultimately are at risk of developing progressive renal disease after PN. This could essentially provide early preventive treatment to avoid further deterioration of renal function.
72 PODIUM #9
CHARACTERIZING FOLLOW-UP IMAGING AFTER PARTIAL NEPHRECTOMY Jason Reynolds, Rizk El-Galley, Erik Busby and Jan Colli University of Alabama at Birmingham (Presented By: Jan Colli)
Introduction: The interpretation of radiographic findings in renal tumors treated with partial nephrectomy is critical in assessing treatment failures and renal tumor recurrences. Follow-up imaging after partial nephrectomy is generally performed every 6 to 12 months. Because previous studies describing imaging characteristics after partial nephrectomies are limited, we reviewed our experience and report the unique CT scan findings after partial nephrectomy. A second goal of this study was to identify characteristic CT scan features of various hemostatic agents used during partial nephrectomy. A final objective was to follow imaging results over 2 years to assess for changes with time. PODIUM SESSIONS Methods: After IRB approval, we constructed a single-institution database of partial nephrectomies that had been performed between 1/2006 – 1/2008. We analyzed the database to identify patients who were followed with serial CT scans at the University of Alabama at Birmingham. We retrospectively reviewed the CT scans findings to identify characteristics after partial nephrectomy and compared the findings to the type of hemostatic agent used, in addition to following the imaging changes over time. Results: Overall, 71 partial nephrectomies were performed. We had complete imaging results and two year follow-up data for 54 patients. Of these, 33% postoperative CT scans were interpreted as abnormal; including 10 with persistent postoperative changes, 2 with hematomas, 2 with questionable renal abscess, and 3 had possible cancer recurrence. Consistent postoperative findings were found in a few of the hemostatic agents used. Nonabsorbable gortex graft revealed a persistent bright nonenhancing rim around the partial nephrectomy site. Absorbable agents such as surgical bolsters and floseal demonstrated hyperdense residual changes in the kidney soft tissues, sometimes indiscernible from possible recurrence, which generally resolved after three to six months. Argon beam usage occasionally led to gas changes in the renal parenchyma surrounding the surgical site, which diminished over time. None of the patients had confirmed cancer recurrences during the study interval. Conclusion: When comparing postoperative imaging following partial nephrectomies performed by a variety of techniques, we identified a few characteristic appearances of certain methods. When biodegradable methods were used, postoperative changes generally resolved within 3−6 months; compared to nonabsorbable grafts, where changes to the partial nephrectomy bed remained permanently. We found postoperative changes were easy to differentiate from tumor recurrence, due to lack of enhancement after contrast administration in cases without cancer recurrence. No conflicts.
PODIUM #10
IMPORTANCE OF SELECTION CRITERIA IN PERFORMING RADICAL NEPHRECTOMY WITH CONCOMITANT IVC THROMBECTOMY IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA Tony Kurian¹, Timothy Kim¹, Wade Sexton2, Julio Pow-Sang2, John Seigne2, Hui-Yi Lin2, Paul Armstrong¹, Devanand Mangar¹ and Philippe Spiess2 ¹University of South Florida, Tampa FL; ²Moffitt Cancer Center, Tampa FL (Presented By: Timothy Kim)
Objectives: To determine the merit of performing radical nephrectomy with concomitant IVC thrombectomy in patients with or without metastatic renal cell carcinoma (RCC). Introduction: Nephrectomy with concomitant IVC thrombectomy is the recommended treatment option for RCC with tumor thrombus extending into the IVC. Data assessing the merit of the invasive and potentially morbid surgical procedure in patients with metastatic RCC remains to be determined. Methods: An IRB protocol was developed and approved prior to conducting the present study. A total of 100 patients underwent nephrectomy and IVC thrombectomy in the context of RCC at our respective center from 11/1989 to 7/2010, and they are the basis of this report. Patients were subdivided among patients with metastatic disease and patients without metastatic disease at the time of operation. Several parameters including demographic data, level of tumor thrombus, blood loss and follow-up data were gathered and contrasted among groups. Data are presented as median (mean ± SD). Results: Thirty-four patients (34%) had metastatic RCC and 66 patients (66%) did not have metastatic RCC at time of operation. Of the patients who had metastatic disease, there was 1 site of metastasis in N=24 (71%), 2 sites in N=9 (26%) and multiple sites in N=1 (3%). The patients were 73% male of age 67 (65±11.0) years. The level of tumor thrombus was level 1 in N=24 (24%), level 2 in N=35 (35%), level 3 in N=22 (22%) and level 4 in N=19 (19%). Estimated blood loss was 1900 (2700±2280) ml. Upon last follow-up, 26% of patients had no evidence of disease, 24% were alive with disease, 43% died of disease, 5% died of other causes and 2% died of unknown causes. In the metastatic cohort, 10 patients (29%) are alive with disease and 23 patients (68%) died of disease. In the nonmetastatic patient cohort, 14 patients (21%) are alive with disease and 20 patients (30%) died of disease. Median time until death for patients who died of disease was 5.6 months for the metastatic patient cohort and 9.1 months for the nonmetastatic patient cohort.
73 Conclusion: Patients with metastatic disease at time of nephrectomy with concomitant IVC thrombectomy have a two time higher likelihood of dying of disease, with most patients within six months. In this regard, we propose that careful selection criteria must be employed when recommending nephrectomy with IVC thrombectomy in the context of metastatic disease.
PODIUM #11
LONG TERM OUTCOMES AFTER PERCUTANEOUS RADIOFREQUENCY ABLATION FOR RENAL CELL CARCINOMA Ronald Zagoria¹, Joseph Pettus², Morgan Rogers¹, David Werle², David Childs¹ and John Leyendecker¹ ¹Department of Radiology, Wake Forest University Health Sciences, Winston-Salem, NC; ²Department of Urology, Wake Forest University Health Sciences, Winston-Salem, NC (Presented By: David Werle)
Objectives: To assess long term oncologic efficacy of radiofrequency ablation (RFA) for patients with renal cell carcinoma (RCC). Materials and Methods: In this IRB-approved retrospective study, the records and imaging studies for all patients with proven RCC who underwent percutaneous RFA with curative intent prior to the year 2005 were reviewed. We used descriptive methods to analyze demographics and tumor characteristics and Kaplan-Meier methods for survival estimates. Results: 48 RCCs in 41 patients were treated with RFA. Median age of patients was 70 (IQR: 58, 78). Median size of RCC treated was 2.6 cm (range 0.7 – 8.2 cm). Of the 48 treated RCCs, five (12%) had recurrent tumor after a single ablation session. Seventeen (41%) patients with 18 treated RCCs died during the follow up period at a median time of 34 (IQR: 10, 47) months. One patient (2%) died from metastatic RCC, while 16 died from causes unrelated to RCC. Twenty-four patients with 30 RCCs treated with RFA survived. Of these one had a nephrectomy for 2 RCCs following RFA due to evidence of tumor progression. For the remaining 28 RCCs, median follow up was 61 (IQR: 54, 68) months. No patients in this group of survivors had metastatic RCC, one had recurrence diagnosed at 68 months. The long-term recurrence free survival rate is 88% after RFA. Conclusion: RFA can result in a durable cure for small, localized RCCs in most cases. RFA is a reasonable treatment option for patients with small RCCs who are not good surgical candidates.
PODIUM #12
RETROGRADE RENAL HYPOTHERMIA TECHNIQUE: ROBOTIC PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Philip Dorsey, Sarah Conley, Brian Richardson and Benjamin Lee Department of Urology, Tulane University School of Medicine, New Orleans, LA (Presented By: Philip Dorsey)
Introduction: We present our technique of cold ischemia during robotic assisted laparoscopic partial nephrectomy (RALPN) in a patient with a solitary kidney and 6 cm left upper pole mass. Materials and Methods: After informed consent was obtained, a 10 Fr dual lumen ureteral catheter was placed. The patient was then repositioned in modified flank position. Utilizing the daVinci Surgical System standard 3 trocar configuration the renal hilum was dissected Using the laparoscopic ultrasound a 1 cm margin was scored on the renal capsule. Starting 15 minutes prior to renal artery clamping, ice cold saline was continuously irrigated through the distal port of the 10 Fr dual lumen catheter under gravity. Free efflux was allowed to drain. The mass was excised and the kidney was reconstructed in standard fashion. After the renal artery was unclamped, the cold saline irrigation was discontinued and the ureteral catheter was exchanged for a stent. Results: Cold ischemia time was 18 minutes. Core body temperature decreased to 34 degrees Celsius. Final pathology revealed grade 2 T1bNxM0 clear cell renal cell carcinoma with negative margins. Two weeks postoperatively the patient’s serum creatinine was 1.1 mg/dl and eGFR was 35 ml/min/1.73m2. Conclusion: Our technique of retrograde renal cooling during RALPN is a safe and potentially beneficial addition to our treatment of a stage T1b renal mass in a solitary kidney. While the robotic approach to partial nephrectomy has significantly shortened warm ischemia times during partial nephrectomy, renal hypothermia may provide additional nephro-protective effects.
74 PODIUM #13
PROSPECTIVE MINIMALLY INVASIVE APPROACHES TO MANAGEMENT OF ENHANCING RENAL MASSES: EVIDENCE OF SIGNIFICANT INTERVAL GROWTH OR SIZE GREATER THAN 3 CM PRIOR TO INTERVENTION Robert Carey, Amar Raval and Tariq Hakky Florida State University College of Medicine, Sarasota Florida (Presented By: Robert Carey)
Introduction: For management of renal malignancies, nephron-sparing surgery (NSS) and minimally invasive techniques (laparoscopy or percutaneous entry) are preferable to whole kidney removal or open surgery whenever possible. For solid, enhancing renal masses less than 3 cm, watchful waiting (WW) should be encouraged in older patients unless the mass has demonstrated interval growth.
Methods: Institutional Review Board Approval was obtained for this study. 238 patients with an enhancing renal PODIUM SESSIONS mass presented to a single surgeon fellowship−trained in endourology over a 40 month period. Patients with a solid, enhancing cortical mass less than 3 cm were strongly encouraged to elect conservative management. Patients with larger tumors were offered partial nephrectomy, radical nephrectomy,or radiofrequency ablation. Patients with suspected upper tract urothelial carcinoma were stratified for endoscopic biopsy and diagnosis followed by appropriate treatment. Results: Of 238 patients, 42 (17.6%) had renal masses less than 3 cm and elected watchful waiting. Those treated elected for laparoscopic radiofrequency ablation (RFA) (71, 29.8%, avg tumor size 3.8 cm), laparoscopic partial nephrectomy (6, 2.5%, avg size 2.2 cm), laparoscopic radical nephrectomy (59, 24.8%, avg tumor size 8.2 cm), laparoscopic nephroureterectomy (38, 16%), endoscopic fulguration of urothelial carcinoma (5, 2.1%), open partial nephrectomy (3, 1.3%, avg tumor size 4.1 cm), open radical nephrectomy (15, 6.3%, avg tumor size of 15.4 cm). No patients with NSS progressed to metastatic disease. No transfusions or visceral injuries occurred in the NSS group. Only four patients in the WW group showed interval growth requiring treatment (avg follow-up 14 months). In the NSS group, 100% had tissue pathology and all were diagnosed as either renal cell carcinoma (n = 66), oncocytic tumor (n = 12), angiomyelolipoma (n = 1), or lung cancer metastasis (n = 1). There were no intraoperative deaths and one perioperative death (at 2 months from DVT/embolism in a cytoreductive radical nephrectomy for metastatic disease). Conclusion: No WW or NSS patients with minimum 2 year follow up developed metastatic disease. Only 3 were WW patients (tumor size less than 2 cm) were lost to intervention at a separate institution. 6 patients progressed from WW to NSS intervention based on interval growth to tumor size greater than 3 cm.
PODIUM #14
URETEROSCOPIC CORRELATION WITH FINAL PATHOLOGY SPECIMEN IN UPPER TRACT UROTHELIAL CANCER John Pattaras, Yamile Morales, Kenneth Ogan and Viraj Master Emory University, Atlanta, GA (Presented By: John Pattaras)
Objectives: We review our experience with ureteroscopic biopsies/washings in correlation to final nephroureterectomy and resection specimens. Methods: Between 2000 to 2010, 37 patients presented with predominantly upper tract urothelial cancer and underwent nephroureterectomy (27) or percutaneous resection (1) by a single surgeon. Of these 24 underwent ureteroscopic diagnostic evaluation (URS). Four methodologies of pathologic evaluation included URS forceps biopsy sent to surgical pathology(1) ± cytopathology(2), (3) URS direct visual barbotage and (4)retrograde barbotage washings sent to cytopathology. Results: High grade urothelial carcinoma was found in 30/37 (81.1%) of nephroureterectomy specimens. URS retrograde washings/barbotage was positive in 11/22, atypical in 7/22 and 4 negative. Little difference was noted between retrograde washings and direct barbotage. URS forceps biopsy was conclusive for 17/19 (89.5%) and under staged 7/19 (36.8%) final high-grade tumors; 5 low grade, 1 atypical & 1 negative). Low grade final specimens 7/37 (18.9%) showed atypical cells on direct barbotage 3/4 (75%) and low grade TCC 5/5 (100%) from biopsy. Washing cytologies were positive in 2 cases of negative or atypical biopsy and both had high grade on final pathology. Conclusion: Diagnostic evaluation of upper tract urothelial cancer is an important prognostic tool. Washings either though retrograde catheters or under direct vision ureteroscopy are sensitive for diagnosis and can be used in place of formal biopsy. URS biopsies routinely under stage upper tract urothelial carcinoma therefore detailed counseling is necessary regarding nephron-sparing surgery. We suggest both URS washings and biopsy prior to counseling patients on definitive treatment options.
75 PODIUM #15
ENHANCING RENAL TUMORS IN PATIENTS WITH PRIOR NORMAL ABDOMINAL IMAGIING: INSIGHT INTO THE NATURAL HISTORY OF RENAL CELL CARCINOMA Gregory Stewart¹, Aldiana Soljic², Alex Kutikov³, Paul Crispen¹ and Robert Uzzo³ ¹University of Kentucky, Lexington, KY; ²University of Miami, Miami, FL; ³Fox Chase Cancer Center, Philadelphia, PA (Presented By: Gregory Stewart)
Introduction and Objectives: Prior reports suggest that small renal tumors may grow proportionally faster than larger tumors consistent with gompertzian growth. Patients undergoing serial cross sectional abdominal imaging to evaluate abdominal symptomatology may develop a renal tumor during their follow up of an unrelated disease process. Evaluation of such patients provides an opportunity to further define the natural history and growth patterns of renal tumors. Methods: A review of two institutions’ renal tumor databases was performed for patients who developed an enhancing renal tumor with a prior normal cross sectional radiographic examination of the kidneys. All initial studies were retrospectively reviewed. Variables evaluated included: age, gender, tumor size at presentation, assumed tumor growth rate, observed tumor growth rate and pathology in patients undergoing definitive treatment. Results: We identified 25 patients, 15 were male. Average age was 64 yrs (range 44 – 82). The initial and follow up imaging modality utilized in all patients was CT scan. Average time between normal renal imaging and development of an enhancing renal tumor was 40 months (range 14 – 105). Mean tumor size on presentation was 2.3 cm (range 1.0 – 5.0). 7/25 patients had a minimum of 12 mo of observation after diagnosis, mean 33 months (range 12 – 94). The observed tumor growth rate in these patients was 0.17 cm/yr (range 0.002 – 0.42). The assumed growth rate of these tumors from the time of the prior normal CT scan to the time of tumor detection,1.15 cm/yr (range 0.38 – 2.6), and was significantly greater than the observed growth rate, p = 0.001. 16/25 patients have undergone surgical intervention, the majority of which were malignant, 14/16. Conclusion: Enhancing renal tumors developing in patients with prior normal renal imaging represent a unique group which can provide insight into the natural history of small renal tumors. The assumed growth rate of the tumors was significantly greater than the observed growth rate which is consistent with the theory of gompertzian growth.
PODIUM #16
MATRIX METALLOPROTEINASE 1 GENETIC VARIANT IS ASSOCIATED WITH STRESS URINARY INCONTINENCE AND PELVIC ORGAN PROLAPSE Ilya Gorbachinsky¹, Patrick McKenzie¹, Lysanne Campeau², Jan Rohozinski²,³, Karl-Erik Andersson², Doug Case4 and Gopal Badlani¹ ¹Wake Forest University Baptist Medical Center, Department of Urology, Winston-Salem, NC; ²Wake Forest University Institute for Regenerative Medicine, Winston-Salem, NC; ³Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX; 4Wake Forest University Baptist Medical Center, Department of Biostatistical Science, Winston-Salem, NC (Presented By: Ilya Gorbachinsky)
Introduction and Objectives: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) impact millions of American women. The connective tissue structures supporting the pelvic floor are rich in extracellular matrix (ECM) proteins such as collagen. Previous studies have shown that decreased collagen content may weaken lower genitourinary tract support, culminating in SUI/POP. A possible etiology is elevated activity of ECM collagen degrading enzymes. Matrix Metalloproteinases (MMPs) are one such group of collagenases. MMP-1 is known to degrade collagen type-1, a major component of these tissues. Increased MMP-1 activity may therefore decrease pelvic floor integrity. We suspect that a genetic etiology may be implicated. The MMP-1 promoter contains a single nucleotide polymorphism (SNP) consisting of one guanine (G) insertion 1,607 bases upstream of the MMP-1 transcriptional start site (termed “2G”). This alteration serves as an Ets transcription-factor binding site known to up-regulate MMP-1 expression. Increased MMP-1 activity in women with SUI/POP may be linked to this 2G allele. The aim of this study is to determine whether the 2G allele associates with SUI and/or POP. Methods: 49 adult female patients with surgically corrected SUI or POP and 81 control patients were identified through the Department of Urology and/ or Obstetrics/Gynecology. Patients with a history of connective tissue disorders and cancer were excluded. After blood samples (10ml) were obtained, red blood cells were lysed and DNA isolated. The promoter region spanning the 1607 GG/ G− allele site was sequenced and the genotypes scored. Results: The 2G allele was present in 44 of the 49 patients (frequency of 0.90) with SUI and/or POP compared to 47 of 81 controls (frequency of 0.58). A chi-squared test assessed the difference between the observed frequency in the SUI/POP population versus the general population (P value = .0001, odds ratio = 6.4, 95% CI = 2.3−17.7, Study Power = 98.8%, chi-square value 7.11, df 1 and population of 49 SUI/POP and 81 Control). Conclusion: There is a highly significant positive association between the 2G promoter variant of MMP-1 and the presence of SUI and/or POP. This suggests that enhanced MMP-1 transcription plays an important role in the development of POP and SUI.
76 PODIUM #17
COLPOCLEISIS FOR ADVANCED PELVIC ORGAN PROLAPSE Michelle Koski¹, Denise Chow¹, Ahmet Bedestani², Joanna Togami¹, Ralph Chesson² and J. Christian Winters¹ ¹LSU and Ochsner Departments of Urology; ²LSU Department of Obstetrics and Gynecology (Presented By: Michelle Koski)
Introduction and Objectives: Several apical prolapse repairs exist, but for advanced prolapse in older women who do not seek to preserve vaginal coital function, colpocleisis offers high anatomic success rates and patient satisfaction. This repair has not been documented broadly in the urologic literature and we sought to characterize our experience with the procedure. Methods: A retrospective review of patients who underwent colpocleisis from 10/2004 to 7/2010 was performed to assess demographics, preoperative urodynamics and clinical characteristics, procedures, complications and outcomes. Patients with prior hysterectomy underwent total colpocleisis; those with uterus in situ underwent the PODIUM SESSIONS Le Fort variation. Results: 30 patients were identified, with mean age 80 (range 67 – 90), mean vaginal parity 3.2 (0–11), and mean BMI 25.9 (19.3 – 31.8). 10% had undergone prior continence surgery. 63.3% presented with primary chief complaint of bulge. Preoperatively, 22 patients had incontinence (4 stress, 3 urge, 15 mixed) and 6 had bowel symptoms (4 fecal incontinence, 2 constipation). Exams were all POP-Q stage 3 or greater or Baden Walker grade 3 or higher. 59.1% had stress incontinence (SUI) on urodynamics (of 22 patients with documented urodynamics) with mean abdominal leak point pressure of 29.6 (17 – 75). 63.3% underwent total colpocleisis and 36.7% Le Fort. 63.3% underwent concomitant sling (14 retropubic midurethral, 3 transobturator and 2 pubovaginal). There were no intraoperative complications of ureteral injury/kinking, blood loss requiring transfusion, or cystotomy. There was no postoperative de novo urgency, no recurrence of prolapse and no urinary retention requiring chronic catheterization or surgical management. One patient with de novo SUI was treated successfully with urethral bulking injection. Conclusion: In a selected patient population, colpocleisis is safe and efficacious. Sling may be performed safely at the time of colpocleisis. De novo SUI may result from colpocleisis alone and patients should be screened for occult SUI with their prolapse reduced to determine those who will benefit from concomitant sling placement. In an aging patient population with expected increase in demand for pelvic floor reconstruction, colpocleisis is a useful approach for the urologist.
PODIUM #18
PHENOTYPING MEN WITH INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME Adam Stewart, Edward Kim, James Bienvenu, Ragi Doggweiler and Frederick Klein University of Tennessee Graduate School of Medicine, Knoxville, TN (Presented By: Adam Stewart)
Introduction and Objectives: Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) is most commonly characterized by urgency and frequency of urination, painful urination, and chronic pelvic pain. IC/PBS is less commonly diagnosed in men. Men with refractory pelvic pain and lower urinary tract symptoms who are ultimately found to have IC/PBS frequently demonstrate a common constellation of non-genitourinary symptoms. The purpose of this study was to review the signs, symptoms and co-morbidities of men with pelvic pain and voiding dysfunction in order to make an earlier diagnosis and institute treatment in men with IC/PBS. Methods: A retrospective analysis of male patients who underwent cystoscopy and hydrodistension for pelvic pain and lower urinary tract symptoms in the last 6 years was performed. Most patients’ workup included a detailed history and physical, urine and semen cultures, and multiple courses of antibiotics. The diagnosis of IC/ PBS was based on glomerulations found in the bladder mucosa after cystoscopic hydrodistension under general anesthesia. Demographic and treatment related outcomes were reviewed. Results: From January 2005 to July 2010, 166 men underwent cystoscopy with hydrodistension under general anesthesia for clinical symptoms of IC/PBS. A total of 96 men demonstrated National Institute of Diabetes and Digestive and Kidney Diseases objective criteria for IC/PBS. In addition to their chronic pelvic pain, 84% of these men had common associated co-morbidities including chronic gastrointestinal complaints (45%), anxiety/ depression (41%), chronic back pain (38%), chronic joint pain/neuropathy (26%) and/or migraines (11%). Also, 35% of patients have a history of narcotic and/or benzodiazepine dependence. Conclusion: Based on our experience, men with IC/PBS demonstrate characteristic psycho-social, chronic pain and gastrointestinal problems that concomitantly and adversely affect quality of life which are similar to those found in women. These clinical findings support the role of a multi-disciplinary approach for males with IC/ PBS and should alert the urologist to have a low threshold for cystoscopy with hydrodistension.
77 PODIUM #19
CARDIOVASCULAR RISK FACTORS AND DISEASE IN WOMEN WITH OVERACTIVE BLADDER “WET” VS “DRY” Ekene Enemchukwu, W. Stuart Reynolds, Michelle Koski, Gregory Broughton, Douglas Milam, Harriette Scarpero, David Penson, Roger Dmochowski and Melissa Kaufman Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN (Presented By: Ekene Enemchukwu)
Introduction and Objectives: As part of an ongoing investigation studying the potential relationship between overactive bladder (OAB) and cardiovascular disease (CVD), the prevalence of CVD and risk factors were determined in female OAB patients with incontinence (OAB wet) compared to those without incontinence (OAB dry). Materials and Methods: A retrospective review of female patients presenting with OAB in 2008 – 2009 analyzing demographics, CVD risks and comorbidities, and symptoms and excluding patients with prior urologic surgery, recurrent UTI, neurologic disease or mixed urinary symptoms. Patients were characterized as “wet” (OABW) if they reported urinary incontinence and “dry” (OABD) if they did not. Manifestations of CVD were considered coronary artery disease (CAD), cerebrovascular disease (CVA), and peripheral vascular disease (PVD); CVD risk factors included age ≥ 65, family history of CAD, smoking, hypertension (HTN), diabetes mellitus (DM), dyslipidemia (DysL) and body mass index (BMI) ≥ 30. Metabolic syndrome was defined as any 3 of preceding 4 risk factors. Results: 66 OABD and 58 OABW patients were included with mean ages 44.4 (range 14 – 80) and 57.6 (range 25 – 85) [p<0.0001] and mean BMI 25.0 (range 17.5 – 49.9) and 28.6 (range 17.3 – 42.6) [p=0.018], respectively. 7 (11%) OABD patients reported CVD manifestations vs. 9 (16%) of OABW patients. Of CVD risk factors, OABW patients had higher rates of age≥ 65 (33% vs 12% OABD, p=0.002), smoking (57% vs 23% OABD, p=NS), BMI≥30 (27% vs 14% OABD, p=0.049), DM (16% vs 8% OABD, p=NS), DysL (28% vs 11% OABD, p=0.02) and HTN (45% vs 25% OABD, p=0.02). Family history of CAD was more common in OABD (52% vs 36%, p=NS). 30% of OABD patients had no CVD risk factors vs. 3% of OABW patients (p=0.0001); however, 38% of OABD patients had ≥ 2 risk factors vs. 69% of OABW patients (p=0.0006). Prevalence of metabolic syndrome was not significantly different (3% OABD vs 9% OABW). Conclusion: Results of this pilot study comparing OAB wet and OAB dry patients demonstrate a higher prevalence of CVD manifestations and risk factors in OAB wet patients. The prevalences of age ≥ 65, smoking, BMI ≥ 30, DM, DysL and HTN were all higher in OAB wet patients. A greater number of OAB dry patients had 0 risk factors while a greater proportion of OAB wet patients had ≥ 2 risk factors. Differences in CVD and risk factors appear to exist between OAB dry and OAB wet patients. Greater numbers of patients are needed to substantiate these findings and to appropriately power the study.
PODIUM #20
EFFECTS OF TOPICAL AND ORAL OXYBUTYNIN ON COGNITIVE AND PSYCHOMOTOR FUNCTIONS IN OLDER ADULTS—A DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY Gary Kay¹, David Staskin², Scott MacDiarmid³, Marilyn McIlwain4 and Naomi Dahl4 ¹Cognitive Research Corporation, St. Petersburg, FL; ²Tufts University Medical Center, Boston, MA; ³Alliance Urology Specialists, Greensboro, NC; 4Watson Laboratories, Inc., Morristown, NJ (Presented By: Gary Kay)
Objectives: Oral formulations of oxybutynin, a common therapy for overactive bladder, often have anticholinergic adverse effects, and may impair cognitive function in older adults. In contrast, oxybutynin topical gel 10% (OTG), a new transdermal formulation of oxybutynin, caused few anticholinergic effects in a placebo-controlled phase 3 study. This randomized, double-blind phase 1 study compared performances on cognitive and psychomotor tests (CPTs) in older adults taking OTG, oral oxybutynin immediate-release (OXB−IR), or placebo (PBO). Methods: Healthy adults aged 60 to 79 years received OTG, OXB-IR, or PBO for 1 week. Participants applied 1 gram OTG or PBO gel once daily to rotating sites on the abdomen, upper arms/shoulders or thighs, and took 1 capsule of OXB−IR 5 mg or PBO 3 times/day. CPTs were conducted at baseline and study end. The primary end point was delayed recall on the Name-Face Association Test (NFA). Treatment effects were compared by analysis of covariance. Results: Of 152 study participants (mean age, 68 years), 49 took OTG, 52 OXB-IR, and 51 PBO. No significant treatment effect on NFA delayed recall test performance was observed (overall, P=.2733; OTG vs PBO, P=.1551; OXB-IR vs PBO, P=.1767). In contrast, a significant treatment effect was seen for the Misplaced Objects Test (overall P=.0294; OTG vs PBO, P=.3678; OXB−IR vs PBO, P=.0692). Scores improved for PBO and OTG and declined for OXB-IR. Other measures of delayed recall (First-Last Name Association Test, Hopkins Verbal Learning Test [HVLT]-Delayed Recall, Retention or Delayed Recognition Index) and measures of immediate recall/working memory (NFAT, Facial Recognition Test, HVLT-Total Free Recall) revealed no significant differences in performance among treatment groups. Analysis of Reliable Change scores for the HVLT-R (e.g., a decline ≥ 6 from baseline on the Total Recall score) showed more participants declining following treatment with OXB-IR (10) than for PBO (6) or OTG (5). No significant treatment effects were detected on measures of reaction time or self-reported memory difficulty. Dry mouth, the most common adverse event, affected more participants receiving OXB-IR (38 [73.1%]) than those receiving OTG (3 [6.1%]) or placebo (4 [7.8%]). Conclusion: OTG had no clinically meaningful effects on recent memory, other cognitive functions, or psychomotor functions in older, healthy adults. Anticholinergic events occurred with similar frequency in the OTG and placebo groups. OTG may have safety and tolerability advantages over oral oxybutynin in older adults. Funding: Funding provided by Watson Laboratories, Inc. 78 PODIUM #21
LONG TERM FOLLOW-UP DATA ON THE MINIARC™ SINGLE INCISION SLING SYSTEM FOR THE TREATMENT OF STRESS URINARY INCONTINENCE Ryan Pickens, Adam Stewart, Jared Moss, Wesley White, Bedford Waters and Frederick Klein UTMCK (Presented By: Ryan Pickens)
Introduction and Objectives: There is a paucity of data with respect to long-term follow-up data for single incision slings for the treatment of stress urinary incontinence (SUI). We present longitudinal surgical and quality of life outcomes in an observational cohort of patients that underwent treatment of their SUI with the MiniArc™ Single Incision Sling System. After having initial success with the MiniArc™ Single Incision Sling System at one month and one year, we investigated whether the procedure was still successful in regards to symptoms related to SUI, urge incontinence (UI), overall quality of life, and sexual function. PODIUM SESSIONS Methods: A prospective analysis of patients with stress urinary incontinence who underwent surgical intervention with the MiniArc™ Single Incision Sling System was performed. Patients were sent an envelope and asked to fill out and return: a quality of life questionnaire, a female sexual function index (FSFI), an IIQ-7 form, and an UDI-6 form. We used our quality of life questionnaire to determine how many patients would now be considered treatment failures at two years. We used our FSFI to determine how the procedure affected their sexual activity. Results: From September 2007 to August 2008, a total of 120 patients underwent placement of the MiniArc™ Single Incision Sling System at our institution for stress urinary incontinence. 105 patients (88%) completed follow-up. Mean patient age was 58.4 (range 26 – 87). Forty−two (35%) patients had concomitant urge incontinence pre-operatively. Mean Body Mass Index (BMI) of our patients was 27.2. Preoperative pad usage was 2.40 per day per patient. Mean IIQ-7 and UDI-6 scores pre-op were 2.6 and 2.5 respectively. At a mean follow-up of 24 months, 98 of the 105 responders (90%) denied having any symptoms of SUI, 8% reported occasional leakage and 2% reported full return of symptoms of SUI. Average pads per day were 0.2 (p<0.005). Average IIQ-7 and UDI-6 scores were 0.3 and 0.3 respectively at two years. Twenty (19%) patients reported urge incontinence on a daily basis, five of which was de novo urgency. Average quality of life scores went from 4.2 pre-operatively to 9.1 at two year follow-up. Based on FSFI results, 50% of our patients never have discomfort with intercourse, 4% sometimes have discomfort and 2% always have discomfort. Forty-four percent of our patients are currently sexually inactive. Conclusion: Based on our experience, treatment outcomes with the MiniArc™ Single Incision Sling System are durable with long term follow-up. Quality of life is significantly improved with minimal impact on sexual function.
PODIUM #22
THE VIRTUE SLING FOR POST-PROSTATECTOMY INCONTINENCE – SAFETY, EFFICACY, AND URODYNAMIC CHANGES AT 6 MONTHS FOLLOW-UP Craig Comiter¹, Michael Kennelly², Victor Nitti³ and Eugene Rhee4 ¹Stanford University Medical Center, Stanford, CA; ²McKay Urology, Charlotte, NC; ³NYU Urology Associates, New York, NY; 4Kaiser Permanente San Diego Medical Center, San Diego, CA (Presented By: Michael Kennelly)
Introduction and Objectives: The Virtue® Male Sling (Coloplast, Humlebaek, Denmark) is a suburethral polypropylene mesh. The device is indicated for the surgical treatment of male stress urinary incontinence (SUI), and is designed to provide a broad area of urethral compression and to achieve proximal relocation of the membranous urethra. We report on the initial cohort undergoing implantation of this new device. Methods: A prospective, multi-center study was performed to assess the efficacy and safety of the Virtue® Male Sling. A 24-hour pad test, uroflowmetry, measurement of post void residual urine (PVR), the International Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF) and the incontinence section from the UCLA- RAND questionnaire were completed pre-operatively and at 1.5, 3 and 6 months postoperatively. In addition, query regarding adverse events and the Patient Global Impression of Improvement (PGI-I) questionnaire was administered post-operatively. Results: Mean age was 67 years (range 48 – 88). 80 men with 6 month follow-up were studied. 24-hour pad weight improved from a median of 200 to 71 g (p<0.001). Overall, 79% of men realized a decrease in pad weight and 54% had > 50% reduction in pad weight at 6 months. On the PGI-I, 67% of patients reported subjective improvement at 6 months, while 23% had no change and 10% had worse incontinence. UCLA-RAND scores improved in the domains of bother (mean 38.9±34.1 vs 13.7±20.7, p<0.001) and function (mean 37.7± 28.1 vs 17.1±12.6, p<0.001) at 6 months compared to baseline. ICIQ-SF scores also improved (mean 11.7±6.5 vs 16.6±3.2). There was no significant change in maximum urinary flow rate following surgery (mean =20±10 vs 23 ±18 ml/s) or in PVR (16 ± 27 vs 15 ± 48 ml). Adverse events were uncommon with 1 instance each of bladder perforation, wound infection, hematoma, urinary infection and urinary retention requiring recatheterization, all of which were managed non-operatively. 11% and 13% of patients reported parasthesias and post-operative perineal pain, respectively.
79 Conclusion: The Virtue Sling is associated with significant improvements in incontinence, as measured by pad weight, pad use and quality of life. The sling is associated with few complications, and does not adversely affect voiding function. Longer-term follow-up will determine the ultimate success of this novel quadratic sling, which combines a trans-obturator and prepubic approach, providing both urethral elevation and compression, for treating men with SUI. Modifications of the surgical technique, including an improved method of fixation, should improve outcome even more than is observed in this initial cohort study.
PODIUM #23
TREATMENT OF MALE STRESS URINARY INCONTINENCE WITH THE ADVANCE TRANSOBTURATOR SLING: RECENT CHANGES IN SURGICAL TECHNIQUE YIELD BETTER PATIENT OUTCOMES Brian Christine¹ and L. Dean Knoll² ¹Urology Centers of Alabama, Birmingham, AL; ²The Center for Urological Treatment and Research, Nashville, TN (Presented By: Brian Christine)
Introduction: Treatment of persistent stress urinary incontinence after radical prostatectomy has undergone a significant change since the introduction of the non-bone anchored AdVance* male sling. Initial reported success was encouraging, but modifications to the surgical technique have yielded more impressive results. Objectives: We describe significant changes to the surgical technique for the placement of the AdVance male sling. We also report our outcomes prior to initiating these changes and subsequently. Methods: From February 2006 to June 2008, men were implanted with the AdVance male sling as per the protocol in the US clinical trials. In June 2008, modifications to the surgery were introduced. Specifically, greater care is now taken to ensure exit of the helical needle at the junction of the ischiopubic ramus and symphysis pubis, lateral to the corpus spongiosum (urethra). Also, dissection on the ventral surface of the corpus spongiosum proximal to the central tendon (perineal body) is carried out in a less aggressive fashion. Lastly, emphasis is placed on suturing the proximal limb of the sling to the corpus spongiosum at the exact location where the central tendon is released from the spongiosum. Patients were followed-up in the clinic at 2 and 6 weeks post-sling then every 6 months. All patients were contacted by phone in preparation of this abstract. Results: From February 2006 through May 2008, eighty-one (81) men were treated with the AdVance sling. Pre-op pad use ranged from 1 – 5 pads/day. Currently, 55/81 (68%) report 0 pad use, 11/81 (13%) report the need for 1 pad/day and 15/81 (19%) report the use of 2 or more pads/day. Eighty-three percent (83%) of patients are “very satisfied” or “satisfied”; 17% are unsatisfied. Transient retention (5 – 10 days) was present in 16%; no long term retention occurred. From June 2008 thru October 2009, 130 men underwent the AdVance procedure using the modified surgical technique. Pre-op pad use was 1 – 6 pads/day. Currently, 105/130 (81%) report 0 pad use, 18/130 (14%) use 1 pad/day and 7/130 (5%) use 2 or more pads/day. Eighty-seven percent (87%) are “very satisfied” or “satisfied”; 13% are “unsatisfied”. Transient retention was present in 19%, and 1 patient (<1%) experienced retention lasting longer than 4 weeks requiring lysis of the sling and eventual artificial urinary sphincter. Conclusion: Surgical modifications to the AdVance procedure have yielded greater success and better patient outcomes regarding return to continence and patient satisfaction. Concomitantly, a higher transient retention rate is now seen following sling placement. Funding: *American Medical Systems, Minnetonka, MN
PODIUM #24
MIDURETHRAL SLING SURGERY IN THE OBESE WOMAN: DOES DEGREE OF OBESITY INFLUENCE SURGICAL OUTCOMES AND COMPLICATIONS? Paul W. Walker, Andre P. Broussard, Kristi L. Hebert, B. Jill Williams and Alex Gomelsky LSUHSC – Shreveport, Shreveport, LA (Presented By: Paul W. Walker)
Introduction and Objectives: When compared with non-obese women, our previous analysis revealed that obese women have lower stress incontinence (SUI)-specific and global cure rates after undergoing 3 types of slings. Complication rates, however, were not greater in obese women. In the current study, we compare the outcomes and complications in obese (BMI=30 – 34.9) and very obese (BMI ≥ 35) women undergoing retropubic (RP) and transobturator (TO) midurethral slings. Methods: Since 2004, 298 women with BMI≥30 underwent MUS and had ≥12-month follow-up: 120 RP, 178 TO. There was no statistical bias toward choosing a sling material based on BMI. Pre- and post-operative assessment included pelvic exam, SEAPI classification (SUI, Emptying, Anatomy (anterior vaginal wall descent), Protection (pad use) and Inhibition (UUI)) and quality of life (QoL) questionnaires IIQ SF-7, UDI-6, Global Satisfaction visual analog scale (VAS, 1 – 10). “Global cure” equaled subjective-SEAPI composite=0 and subjective satisfaction (VAS≥8). “SUI cure” equaled SEAPI(S) subset=0 and a negative cough-stress test. Demographics and perioperative morbidity were abstracted from the hospital and clinic charts. Statistical comparisons were conducted.
80 Results: After controlling for BMI, age, parity, presenting symptoms, daily pad use, preoperative SEAPI scores and QoL, indices were not statistically (NS) different within each sling group. Very obese women had higher “global” cure rates, but lower SUI-specific cure rates than obese women within each sling group, although the difference was NS. Over 65% of women in each group had no intraoperative or postoperative complications (NS) and increasing BMI was not associated with increased rates of complications. Statistically significant improvement in postoperative SEAPI scores, IIQ, UDI and VAS was achieved for each group. After controlling for BMI, the improvement in SEAPI score and QoL indices within each group was similar (NS). Conclusion: While there are differences in outcomes based on midurethral sling approach and concomitant surgery, increasing obesity in itself does not appear to be a risk factor for poorer results and additional complications in women undergoing RP and TO midurethral slings.
PODIUM #25
TREATMENT OF MALE STRESS URINARY INCONTINENCE WITH THE ADVANCE TRANSOBTURATOR PODIUM SESSIONS SLING: LONG TERM FOLLOW−UP REVEALS HIGH PATIENT SATISFACTION L. Dean Knoll¹ and Brian Christine² ¹The Center for Urological Treatment, Nashville, TN; ²Urology Centers of Alabama, Birmingham, AL (Presented By: L. Dean Knoll)
Introduction: Post-surgical stress urinary incontinence in men, following radical prostatectomy (RP) or transurethral resection of the prostate (TURP), can have a significantly negative impact on the patient’s quality of life. Placement of the AdVance* sling has emerged as an effective treatment option in these men. While several authors have reported on continence rates following sling placement, the literature has no large series where patient satisfaction is the primary metric addressed. Objectives: We report patient satisfaction in a series of men who underwent placement of the AdVance male sling for the treatment of post-surgical stress urinary incontinence. Methods: From June, 2008 through October, 2009 one hundred-thirty (130) men underwent placement of the AdVance sling to treat post-surgical stress urinary incontinence. Patient follow-up in the clinic occurred at 2 weeks and 6 weeks after surgery, then every 6 months thereafter. In addition, in preparation of this abstract all of these patients were contacted by a dedicated research nurse and queried as to degree of satisfaction. Results: Mean follow-up was 14 months post-sling (range 8 – 24 months). Etiology of incontinence was RP in 127/130 patients and TURP in 3/130. Preoperative pad use ranged from 1 – 6 pads/day. When asked to categorize themselves as either “very satisfied”, “satisfied”, or “unsatisfied” with the results of the male sling, 87% were very satisfied (49%) or satisfied (38%) and 13% were unsatisfied. Eighty-six percent (86%) of patients would recommend the procedure. Short-term retention (5 – 10 days) occurred in 25/130 (19%). A single patient had long term retention (>4 weeks) requiring lysis of the sling and eventual treatment with an artificial urinary sphincter. One patient had a perineal hematoma requiring drainage and 1 patient experienced osteomyelitis of the ischiopubic ramus requiring sling removal. Conclusion: The AdVance male sling yields a high degree of patient satisfaction in the treatment of stress urinary incontinence, with 87% being “very satisfied” or “satisfied” with their outcome. In addition, 86% of the men who have undergone the male sling would recommend this treatment option. Funding: *American Medical Systems, Minnetonka, MN
PODIUM #26
EARLY ERECTILE FUNCTION FOLLOWING ROBOTIC PROSTATECTOMY PREDICTS RESOLUTION OF SEVERE INCONTINENCE Scott Miller Georgia Urology, Atlanta, GA (Presented By: Scott Miller)
Introduction: Several pre-operative factors can predict the likelihood of long-term incontinence following robotic prostatectomy. Post-operative prognosticators can also be helpful in setting patient expectations during recovery. We examine the relationship between early erectile function and recovery of continence. Methods: A total of 168 patients with normal pre-operative erectile function (SHIM*>23) were identified as using greater than 3 pads per day 6 weeks following robotic prostatectomy. Patients with pre-operative SHIM<23 or extended bladder neck resection were excluded. All data was collected contemporaneously but analyzed retrospectively. Results: Of the 168 patients with severe incontinence at 6 weeks post-op, 56 were able to complete intercourse during this early period. Of these 56 patients, 53 (95%) were using zero pads per day at 12 months. In the group with inadequate erectile function (n=112), 93 (83%) were using one and zero pads per day at 12 months. Conclusion: Early erectile function following robotic prostatectomy predicts resolution of severe incontinence. This finding can help reassure post-operative patients concerning their prognosis. Possible reasons forthis observation will be discussed. Funding: *Sexual Health Inventory for Men.
81 PODIUM #27
LONG-TERM FOLLOW-UP OF BOVINE DERMIS AS A BIOLOGIC SUBSTITUTE FOR AUTOLOGOUS TISSUE IN PUBOVAGINAL SLING SURGERY Joshua Holstead, B. Jill Williams and Alex Gomelsky LSUHSC – Shreveport, Shreveport, LA (Presented By: Joshua Holstead)
Introduction and Objectives: We have previously reported medium-term outcomes of acellular bovine dermis (BOV) as a substitute for autologous rectus fascia (ARF) in women at high risk for surgical failure after sling surgery. We now evaluate long-term outcomes after sling surgery with both materials in a “high-risk” population (advanced age/hypoestrogenic state, failure of previous anti-incontinence surgery and intrinsic sphincter deficiency). Methods: Women were assigned to a sling material by hospital, as BOV was not available at one of two participating institutions. All slings were placed at the bladder neck. Pre- and post-operative assessment included pelvic exam, SEAPI classification (Stress incontinence (SUI), Emptying, Anatomy (anterior vaginal wall descent), Protection (pad use) and Inhibition (urge incontinence)) and quality of life (QoL) questionnaires SF-IIQ-7, UDI-6, and visual analog scale (VAS, 1 – 10). “Global cure” was defined as SEAPI subjective composite=0 and VAS≥8. “SUI cure” was defined as SEAPI-subjective(S) subset=0 and a negative cough-stress test. Demographics and perioperative morbidity were abstracted from the hospital and clinic charts. Statistical evaluation was conducted. Results: 106 women completed a minimum follow-up of 36 months (41 BOV, 65 ARF). Due to differences in patient populations between the 2 hospitals, women in the BOV group were significantly older, more parous and had greater degrees of concomitant prolapse. Preoperative SEAPI scores and QoL indices were not statistically different (NS) between groups. SUI cure rates for BOV and ARF were 80.5% and 73.8%, respectively (NS). Global cure rates for BOV and ARF were 48.8% and 47.7%, respectively (NS). SUI cure rates remained relatively stable with longer follow-up, while global cure rates declined. Perioperative complications, rates of short-term and long- term voiding dysfunction and rates of reoperation for SUI or prolapse were similar (NS). For each material, there was a significant postoperative improvement in SEAPI scores and all QoL indices and improvement was similar between ARF and BOV groups (NS). Conclusion: At long-term follow-up, BOV continues to be a durable substitute for ARF in a population at “high−risk” for surgical failure. Global and SUI-specific clinical outcomes are similar to the ARF sling, and rates of complications continue to be low. PODIUM #28
COMPARISON OF RECURRENCE PATTERNS FOR UPPER TRACT UROTHELIAL CARCINOMA TREATED WITH NEPHRON-SPARING SURGERY OR WITH RADICAL EXTIRPATIVE SURGERY Mark Anderson, MD, G.M. Preminger, MD, B.A. Inman, MD Duke University Medical Center, Durham, NC (Presented By: Mark Anderson, MD)
Objectives: To better understand the recurrence pattern of upper tract urothelial carcinoma (UTUC) treated either endoscopically (nephron-sparing surgery, NSS) or by radical nephroureterectomy (RNU). Methods: A retrospective review of 317 UTUC cases was performed. Clinicopathologic and outcomes data were collected and compared between patients initially managed with RNU or NSS. Categorical variables were compared between groups with the chi−square test and continuous variables with the t test. Univariate survival analyses consisted of cumulative incidence plots compared with the logrank test while Cox regression was used for multivariate survival analysis. Results: The two arms had similar distributions of age, gender, medical comorbidities, ASA and Charlson scores. Mean length of stay was 3.2 and 6.8 days for the NSS and RNU groups, respectively (p<0.001). The average number of procedures required to treat the UTUC was 2.3 for NSS and 1.2 for RNU. The presence of a solitary kidney with UTUC, preoperative renal insufficiency or bilateral disease were similar between the two groups (p=0.489, 0.719, and 0.661 respectively). RNU cases were more likely to be high grade (52% v. 37%, p<0.001) and of high stage (TNM stage group II – IV) (54% v. 20%, p<0.001). The 2-year cumulative incidence of recurrent cancer was the same for the bladder location (20% v. 20%, p=0.689) but much higher in the upper tract location for the NSS group (46% v. 18%, p<0.001). The 4-year metastasis-free survival was slightly lower in the RNU group, though this was not significant (62% v. 69%, p=0.234). Multivariate Cox modeling confirmed that NSS was associated with a substantially higher risk of local upper tract recurrence (HR=3.82, p<0.001). Conclusion: Patients with UTUC treated with NSS have a dramatically higher risk of local upper tract recurrences. However, these recurrences are usually manageable with other minimally-invasive procedures and do not appear to increase the long-term metastasis rate. Careful upper tract surveillance is mandatory for UTUC treated with NSS.
82 PODIUM SESSIONS
PODIUM #29
PREDICTING THE PROBABILITY OF 90-DAY SURVIVAL IN ELDERLY BLADDER CANCER PATIENTS TREATED WITH RADICAL CYSTECTOMY Nedim Ruhotina, Todd Morgan, Sam Chang, Daniel Barocas, Kirk Keegan, David Penson, Peter Clark, Joseph Smith, Jr. and Michael Cookson Vanderbilt University School of Medicine, Nashville, TN (Presented By: Nedim Ruhotina)
Objectives: Despite the increased morbidity and mortality of radical cystectomy (RC) in elderly individuals with bladder cancer, numerous studies have demonstrated that surgery can provide a survival benefit. Given the inherent potential risks of RC in this population, however, we sought to better identify those patients at increased risk of mortality following surgery. Methods: We evaluated 151 consecutive patients age 75 years and older treated with RC for bladder cancer at a single institution (2000 – 2008) in whom complete information was available. A Cox proportional hazards model was used to determine the value of pre-cystectomy clinical information (age, gender, clinical stage [non-muscle invasive vs. muscle invasive], Charlson Co-morbidity Index [CCI], pre-operative albumin and smoking status) in predicting 90-day survival post RC. These results were then used to create a nomogram predicting the probability of 90-day survival post RC. Results: The cohort had an average age of 79.8 years (range 75 – 94). There were a total of 15 deaths (10%) within 90 days post RC. In the Cox regression analysis, older age (HR 2.99, CI 1.41 – 6.31) and lower pre- operative albumin (HR 0.31, CI 0.12 – 0.80, p=0.015) were significant predictors of 90-day mortality. A nomogram based on age, gender, clinical stage, CCI and albumin predicting the likelihood of 90-day mortality was created and is shown in the Figure. Conclusion: Balancing the risks and benefits of RC for elderly individuals with bladder cancer remains challenging. Given the relatively high 90-day mortality rate in these individuals observed in this and other studies, predictive tools are needed to help guide the management of these patients. Individualized risk estimations using this nomogram may help with pre-operative risk assessment and provide clinicians with an added tool that may help to individualize treatment decisions in this challenging patient population.
83 PODIUM #30
BLADDER CONSERVATION FOR MYOINVASIVE UROTHELIAL CARCINOMA David Kraebber LA (Presented By: David Kraebber)
Introduction: Radical cystectomy for myo-invasive urothelial carcinoma in the elderly or those with significant co-morbidities can result in major intra-operative, peri-operative complications or death. Despite this aggressive therapy SWOG data shows 50% have unrecognized distant metastasis, which present within two years. Bladder conservation can be accomplished with the use of extensive TURBT combined with intravenous chemotherapy and pelvic radiation therapy. The object of the retrospective review was to confirm that these patients received adequate treatment of their cancers while avoiding the long- and short-term complications of cystectomy. Methods: A retrospective chart review of all patients with urothelial cancer treated by one surgeon between 1992 and 2007 was performed. Patients with Ta or T1 disease, any >N1, M1 disease, non-urothelial cancers or treatment with cystectomy were excluded. Treatment consisted of extensive TURBT with or without MVAC or carboplatin/ gemcitabine and with or without pelvic radiation therapy at 64.8 Gy. Post chemo/radiation; repeat CT imaging and TURBT assessed any residual myo-invasive disease. Residual Ta, T1 or Tis was treated with BCG and followed with Cystoscopy, urine cytology and upper tract imaging. Results: Fifty-nine myo-invasive patients were identified. Six with non-urothelial cancer, four whose charts had been destroyed, eight with initial metastatic disease and nine treated with cystectomy were excluded. Twenty-two were identified with non-metastatic T2 or T3 urothelial carcinoma. Five patients with pT3 have refused any further follow up. The seventeen remaining averaged 77 years of age ranging from 59 to 90. Six patients had TURBT monotherapy. Eight patients received MVAC and 64.8 Gy pelvic radiation following TURBT. Two patients received carboplatin/gemcitabine and 64.8 Gy of pelvic radiation therapy following TURBT. One patient only received carboplatin/gemcitabine after TURBT. Follow up was from 6 to 106 months. Four patients were found at follow up with Ta or Tis and all became pT0 with intravesicle BCG. Eleven of the seventeen patients were alive throughout follow up and pT0. Five died of non-urologic disease and there was one disease specific death. There were no intra-operative or peri-operative deaths or major complications. Conclusion: Bladder conservation with the option of chemotherapy and pelvic radiation therapy can provide adequate cancer control in a select group of patients who are poor surgical candidates, refuse cystectomy or request alternative treatment other than cystectomy for myo-invasive urothelial carcinoma. Further prospective studies are recommended.
PODIUM #31
PRIOR PELVIC IRRADIATION DOES NOT RESULT IN FALSE POSITIVE UROVYSIONTM FLUORESCENCE IN SITU HYBRIDIZATION (FISH) TEST RESULTS Marina Cheng, Jeffrey Lee, Sravankumar Kavuri and Martha Terris MCG (Presented By: Marina Cheng)
Introduction and Objectives: UroVysionTM FISH analysis is a test for chromosomal abnormalities in bladder cells in voided urine specimens designed to improve detection of bladder cancer. Radiation therapy can induce chromosomal changes and can, theoretically, result in false positive results by UroVysionTM FISH testing. We compared the results of UroVysionTM FISH analysis of urine from patients with microscopic hematuria and a history of prior pelvic radiotherapy for prostate cancer to a comparable control group of patients who had undergone other therapies for prostate cancer. Materials and Methods: From July 2009 to July 2010, all patients presenting for routine prostate cancer follow-up at our facility were screened for microhematuria. After excluding patients with a history of transitional cell carcinoma or existing urinary tract infections, there were 42 patients identified with microhematuria who had undergone prior pelvic irradiation for their prostate cancer and 36 patients identified with microhematuria who underwent prostate cancer therapies other than radiation therapy. All patients underwent hematuria evaluation including analysis of voided urine specimens by UroVysionTM FISH testing. Irradiated patients ranged in age from 55 to 91 years (mean 69.7 years) while the non-irradiated control group ranged from 53 to 92 years (mean 70.4 years). There was no statistically significant difference in the ages of the patients in the two groups. Irradiated patients ranged from 2 to 20 years (mean 8.5 years) since completion of their radiation therapy. Results: All 42 of the previously irradiated patients and all 36 of the non-irradiated control patients had negative UroVysionTM FISH results. Of the irradiated patients, 17.9% had atypical urine cytologies and none were found to have malignant cells on cytologic examination. In the control group, 19.4% of patients had atypical cytology results and none were found to be malignant. There was no statistically significant difference in the rate of atypical cytologies between the two groups. No other findings suspicious for urothelial carcinoma were found in either the irradiated or control group on endoscopy or imaging studies. Conclusion: Prior pelvic radiation did not induce false positive UroVysionTM FISH test results in our patient population. UroVysionTM FISH testing may be a reasonable addition to evaluation for bladder cancer in patients with prior radiotherapy. Funding: There was no outside funding. 84 PODIUM #32
NUCLEAR MARTIX PROTEIN 22, URINARY CYTOLOGY, AND CYSTOSCOPY: A ONE YEAR COMPARISON STUDY Anthony Schlake¹, Timothy Atkinson¹, Daniel Davenport¹, Paul Crispen¹ and David Preston² ¹University of Kentucky, Lexington, KY; ²Department of Veterans Affairs and University of Kentucky, Lexington, KY (Presented By: Anthony Schlake)
Introduction and Objectives: NMP-22 is a marker of urothelial cell death and has been shown to be elevated in patients with urothelial carcinoma (UC). NMP-22 is an accepted adjunct to cystoscopy in screening for recurrent or primary UC. Urinary cytology has been used for decades in this role, but suffers from low specificity in the diagnosis of UC. Urine cytology is more costly than NMP-22 (avg $150 vs $25 per test). We compared the performance of NMP-22, urinary cytology and office cystoscopy to diagnose UC in a AV Urology Practice. PODIUM SESSIONS Methods: 391 office cystoscopy procedures encounters were examined during the study period from 2007 – 2008. Reasons for office cystoscopy included, hematuria, surveillance for UC recurrence and lower urinary tract symptoms. NMP-22 (point of care test) and cytology testing were performed on the urine specimens of patients on presentation to urology clinic. Office cystoscopy was performed under local anesthesia with a flexible cystoscope. Bladder biopsy or tumor resection was performed for positive cystoscospy, positive NMP-22 or positive urinary cytology. Results of the NMP-22, urinary cytology, office cystoscopy and bladder biopsy/tumor resection were recorded and compared. Results: A total of 351 patient encounters were identified where cystoscopy, NMP-22 and urinary cytology were available for analysis. Tumor resection or biopsy was performed in 77 patients. UC was identified in 42 subjects and upper tract UC was identified in 2 subjects. NMP-22, urinary cytology, and cystoscopy had positive predictive values of 67%, 64%, and 55% respectively, in our analysis. The relative risk for positive tissue resection/biopsy showing UC was 2.70 (p< 0.05), 1.95 (p>0.05), and 1.82 (p>0.05) for NMP-22, urinary cytology and cystoscopy, respectively. Sensitivity and specificity for NMP-22, urinary cytology and cystoscopy in this analysis were (50%/97%), (35%/98%) and (85%/64%), respectively. Conclusion: NMP-22 point of care testing in an office setting may be a useful adjunct tool both in the diagnosis of urothelial carcinoma and in surveillance for UC. NMP-22 performed no better than urinary cytology in our analysis except in sensitivity for the diagnosis of UC. Its only other advantage over urinary cytology in this analysis was cost savings. Cystoscopy was the most sensitive test for the diagnosis of UC in this analysis.
PODIUM #33
SDF1 Β VARIANT AND CXCR7 AS DIAGNOSTIC AND PROGNOSTIC MARKERS FOR BLADDER CANCER Obi Ekwenna, Travis Yates, Miguel Gosalbez, Soum Lokeshwar, Samir Shirodkar, Murugesan Manoharan, Mark Soloway and Vinata Lokeshwar University of Miami, Miami, Florida (Presented By: Obi Ekwenna)
Introduction and Objectives: Inflammatory chemokines and cytokines promote cancer growth and metastasis. Stroma-derived factor SDF-1, is a chemokine that binds to CXCR4 and CXCR7, the two membrane G-protein linked receptors. Six splice variants of SDF-1 are known. Very few studies have examined CXCR7 and SDF-1 expression in cancer and none have been conducted in bladder cancer (BCa). We examined the expression of SDF-1 splice variants α and β and of CXCR4 and CXCR7 in bladder tissues and in urine specimens and evaluated CXCR4 and CXCR7 function in BCa cell lines. Methods: BCa tissues (n=44) were collected from patients undergoing surgery. Normal bladder (NBL, n=28) tissues were collected from organ donors or at the time of cystectomy. Urine specimens were collected from 186 study individuals (BCa = 57; normal = 27; benign urologic conditions = 55; history of BCa: 30, other cancers = 17). RNA was isolated from tissues and exfoliated cells and subjected to real time RT-PCR for SDF1 (α and β), CXCR4 and CXCR7. CXCR4 and CXCR7 protein expression in tissues was evaluated by immunohistochemistry. CXCR4 and CXCR7 functions in BCa cell lines were examined by siRNA transfection. Results: CXCR7 and SDF-1 β levels were 7 – 8-fold elevated in BCa tissues (CXCR7: 3.0 +/− 2.2; SDF1 β: 1.22 +/− 0.39) when compared to NBL tissues (P < 0.0001); CXCR4 and SDF1 α levels did not change significantly. CXCR7 staining increased in BCa tissues (189 +/− 97.7) when compared to NBL tissues (28 +/− 37.7; P < 0.001). In multivariate analysis CXCR7 mRNA levels was an independent prognostic indicator for metastasis (P=0.024; RR: 1.72) and CXCR7 independently associated with disease specific mortality (P = 0.038). Urinary CXCR7 mRNA levels had high sensitivity (80.7%; high-grade BCa: 92.3%) and specificity (75.9%) to detect BCa. The SDF1 α/β ratio had 100% sensitivity and 83.4% specificity to detect BCa. While over expression of CXCR7 promoted cell growth and chemotactic motility of BCa cells, its down regulation by siRNA inhibited both functions. Conclusion: CXCR7 expression is up-regulated in BCa and correlates with BCa metastasis. CXCR7 promotes BCa growth and chemotactic motility. SDF1 β/α ratio may be a sensitive marker for BCa detection and promote BCa growth and progression.
85 PODIUM #34
MANAGEMENT OF PRIMARY SMALL CELL CARCINOMA OF THE BLADDER Adam Stewart, Bedford Waters, Paul Hatcher and Frederick Klein University of Tennessee Graduate School of Medicine, Knoxville, TN (Presented By: Adam Stewart)
Introduction and Objectives: Primary Small Cell Carcinoma (SCC) of the bladder represents less than 1% of primary bladder tumors. It tends to behave more aggressively than urothelial carcinoma of the bladder and often presents with larger tumors at a later stage. It also behaves similarly to lung SCC which affects the treatment strategy. Treatment typically involves surgery, platinum based chemotherapy and/or radiation therapy, which can be tailored based, on the stage of disease and health of the patient. Methods: We performed a retrospective review of all patients at our institution diagnosed with primary small cell carcinoma (SCC) from 2000 to 2010 to document the clinical details and outcomes while highlighting management. Results: Thirteen patients were diagnosed with primary SCC of the bladder with a mean age of 70 (49 – 87). All were diagnosed after having gross hematuria which led to transurethral resection of a bladder tumor. Twelve of the thirteen had a significant history of tobacco use. Four patients had T1 disease, of which, 1 died of an unrelated issue and the other 3 patients underwent 4 cycles of platinum based chemotherapy and external beam radiation and have no evidence of disease after 2.7 years of follow up. There were 6 patients with T2 disease. Of those, 2 died before or during planned chemotherapy, one of which had known metastases at the time of diagnosis. The other 4 patients with T2 disease have no evidence of disease after either Cystectomy alone (2) or platinum based chemotherapy and external beam radiation (2). Three patients had T3 disease with metastases. Two are dead after palliative cystectomy, platinum based chemotherapy. The other patient with T3 disease also had positive pelvic lymph nodes and underwent chemotherapy and has no evidence of disease with 4 years of follow up. This patient is the only one of 4 patients who had metastatic disease who is alive with no evidence of disease. The mean survival for all stages is 2.98 years, for T1 2.25 years, T2 4 years and T3 1.9 years. Conclusion: In our experience, treatment of primary bladder SCCis similar to other case reviews. Treatment with platinum based chemotherapy and radiation for stage T1 prevented the need for cystectomy in 3 of our patients. Our patients who presented with stage 2 disease without significant co-morbidities have benefited from platinum based chemotherapy and early cystectomy.
PODIUM #35
CLINICAL AND PATHOLOGIC DIFFERENCES BETWEEN PATIENTS UNDERGOING TURBT FOR NEWLY- DIAGNOSED VERSUS RECURRENT BLADDER LESIONS DETECTED BY CYSTOSCOPY Joshua Langston, J. Patrick Selph, Ankur Manvar, James Fergueson, Sean Sawh, Angela Smith, Mathew Raynor, Matthew Nielsen, Culley Carson and Raj Pruthi (Presented By: Joshua Langston)
Objectives: We analyzed the demographic, clinical and pathologic differences between patients who underwent transurethral resection of bladder tumor (TURBT) for newly-diagnosed versus recurrent bladder lesions/tumors. Methods: 439 patients underwent TURBT for a cystoscopically-diagnosed bladder lesion or tumor at our tertiary care facility from 2007 – present. Demographic, clinical and pathologic differences between patients presenting with recurrent tumors versus new lesions were analyzed. Results: 269 patients noted to have recurrent tumors and 170 patients with new tumors. Mean age of entire cohort was 68.5 years with recurrent tumor patients being significantly older than new tumor patients (70.0 vs. 66.2; p = 0.002). Differences were also observed with regard to gender with fewer females in the recurrent group versus new group (25% vs. 36%; p = 0.017). There were also differences with regard to smoking status with fewer never smokers (25% vs. 40%; p = 0.032) and trending toward more current smokers (25% vs. 19%; p = 0.068) in the recurrent group versus the new group. With regard to pathologic findings at TURBT, several significant differences were observed. Recurrent tumors were more often high grade (54% vs. 32%; p = 0.004) and lamina propria invasive (30% vs. 19%; p = 0.008) although no difference was observed in rates of muscle invasive disease (8% vs. 10%). Quite significantly, new tumors were far more likely to be non−malignant (30% vs. 4%; p < 0.001). Conclusion: Significant demographic, clinical and pathologic findings are observed in patients undergoing TURBT for a cystoscopically−diagnosed bladder lesion at a tertiary care center.
86 PODIUM #36
CYTOREDUCTIVE SURGERY WITH INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY FOR PATIENTS WITH PERITONEAL DISSEMINATION OF URACHAL ADENOCARCINOMA L. Spencer Krane, Mary Cromer, A. Karim Kader and Edward A. Levine Wake Forest University, Winston-Salem, NC (Presented By: L. Spencer Krane)
Introduction and Objectives: Urachal adenocarcinoma with peritoneal dissemination is a rare presentation for urachal adenocarcinoma. It is associated with poor outcomes and aggressive presentation, with historical median survivals of between 12 and 24 months. We describe our 18 year experience in managing these patients with cytoreductive surgery (CRS) followed by intraperitoneal hyperthermic chemotherapy (IPHC). Materials and Methods: Five patients undergoing 6 CRS with IPHC for disseminated urachal cancer were identified. Demographics, perioperative data, and oncologic results were reviewed. PODIUM SESSIONS Results: All patients underwent successfully CRS followed by IPHC with Mitomycin C. Three patients had prior urachal mass excision and one had previous cystoprostatectomy with ileal conduit. At time of surgery, complete resection of all visible disease was only achieved in 2 patients. All patients developed local or distant disease recurrence at a median of 13 months post-operatively (range 7 – 31). The majority of patients (3/5) underwent postoperative chemotherapy for recurrence. Median survival following date of surgery was 27 months (range 21 – 87). Symptomatic control of peritoneal disease was achieved in 2/5 (40%) of the cases. Conclusion: Urachal adenocarcinoma with peritoneal dissemination is an aggressive rare variant which is uniformly fatal. In our experience, we find that cytoreductive surgery with intraperitoneal hyperthermic chemotherapy may increase overall survival and potentially may have palliative benefits. Aggressive multimodality therapy of this rare tumor may improve outcomes.
PODIUM #37
PATTERNS OF UTILIZATION OF URINE-BASED MARKERS IN NON-MUSCLE-INVASIVE BLADDER CANCER: RESULTS FROM THE BCAN / SUO / AUA / LUGPA ELECTRONIC SURVEY J. Patrick Selph, Joshua Langston, Sean Sawh, James Fergueson, Ankur Manvar, Angela Smith, Eric Wallen, Raj Pruthi, Yair Lotan and Matthew Nielsen (Presented By: J. Patrick Selph)
Introduction: In addition to cytologic evaluation, there are currently four urine-based tests approved by the FDA for bladder cancer detection. At this point, the Guidelines panels from the AUA and EAU do not make specific recommendations about the ideal role of these tests. Furthermore, there is a paucity of data on current patterns of care in this area of urologic practice. Objectives: To determine self-reported practices of the use of cytology and urine-based markers in the settings of general use, surveillance and assessment of response after intravesical therapy for patients with NMIBC. Methods: An electronic survey was developed by the Bladder Cancer Advocacy Network (BCAN) to elicit self- reported utilization of different management strategies for NMIBC. The survey was circulated to urologists via the AUA, SUO and LUGPA distribution lists. 512 respondents completed the survey. Results: Among all respondents, 93% report sending cytology routinely (via barbotage 25% of the time) in general use. In contrast, 37% report using NMP22 in this setting, 54% report using FISH, and 32% (45% of SUO respondents vs. 31% of AUA respondents, p=0.04) responded that there is “no role for urine-based markers in this setting.” Similar proportions were reported in the specific settings of routine surveillance and post-BCG assessment. When presented with the vignette of a positive marker test and negative cytology and cystoscopy, 36% of respondents chose to proceed to the OR for biopsy, 37% chose to repeat cystoscopy and cytology in 3 months, 21% chose “no role for markers in this setting” and 13% chose “other.” Conclusion: In the absence of more specific guidance, the results of this electronic survey suggest considerable variation in the use and interpretation of urine-based markers in NMIBC. FISH is the marker reported to be used most commonly in multiple settings, however 31 – 45% of respondents report “no role” for any of the tests in their practice. Greater than one out of three respondents reported taking patients for biopsy under anesthesia in the setting of an isolated positive marker. These preliminary data underscore the need for prospective studies to validate the optimal role of urine-based markers in the setting of NMIBC.
87 PODIUM #38
RISK-SPECIFIC INTENSITY OF SURVEILLANCE PRACTICES IN NON-MUSCLE-INVASIVE BLADDER CANCER: RESULTS FROM THE BCAN / SUO / AUA / LUGPA ELECTRONIC SURVEY J. Patrick Selph, Joshua Langston, Sean Sawh, James Fergueson, Ankur Manvar, Angela Smith, Eric Wallen, Raj Pruthi, Yair Lotan and Matthew Nielsen (Presented By: J. Patrick Selph)
Introduction: The ideal surveillance regimen for patients with a history of non-muscle-invasive bladder cancer (NMIBC) is uncertain. Given different grade- and stage-specific risks of recurrence and progression, there is some question whether it might be acceptable to pursue less intensive surveillance practices for patients with lower risk disease; and, importantly, there is a paucity of data on current patterns of care in this area of urologic practice. Objectives: To determine self-reported practices of cystoscopy, cytology and radiographic testing in the setting of surveillance for patients with a history of NMIBC. Methods: An electronic survey was developed by the Bladder Cancer Advocacy Network (BCAN) to elicit self- reported utilization of different management strategies for NMIBC. The survey was circulated to urologists via the AUA, SUO and LUGPA distribution lists. 512 respondents completed the survey. Results: Among respondents, 66% report performing cystoscopy every 3 months on all patients for at least the first two years following diagnosis of NMIBC. The remaining 33% report performing surveillance cystoscopy less frequently, 95% of whom report doing so in the setting of low grade pathology. Similarly, 51% report using cytology with every cystoscopy, 23% do so for all high grade cases and 30% report not using cytology with every cystoscopy. In the absence of recurrence for patients with an initial high grade diagnosis, upper tract reimaging is performed annually in 48%, biannually in 37% and never in 3%. The corresponding figures for patients with an index diagnosis of low grade disease are 14%, 37% and 28%, respectively. In the event of a recurrence in the bladder, 80% of respondents report reimaging the upper tracts for patients with high grade disease, versus 45% in the event of a low grade recurrence. Conclusion: A substantial segment of urologists responding to an electronic survey report using relatively less intensive surveillance practices in patients with lower risk NMIBC. These results suggest a lack of consensus on the ideal intensity of cystoscopy, cytology and imaging in this setting, and provide a basis for prospective studies to validate the safest and most cost-effective strategies for surveillance in this setting.
PODIUM #39
SINGLE CENTER CLINICAL COMPARISON OF TWO REINFORCED URETERAL ACCESS SHEATHS FOR RETROGRADE URETEROSCOPIC TREATMENT OF URINARY LITHIASIS Rajinikanth Ayyathurai, John Shields, Prashanth Kanagarajah, Ezekiel Young, Alina Alvarez and Vincent Bird University of Miami Miller School of Medicine (Presented By: Ezekiel Young)
Introduction: Difficulties in the use of ureteral access sheaths (UAS), including sheath distortion, buckling, and placement problems, have been reported. However, few clinical comparisons exist. We present the first large-scale comparison of the Applied ForteXE® and Gyrus ACMI Uropass® UAS. Methods: We maintain a database of all patients undergoing ureteroscopy for urolithiasis. From this database we identified all patients with whom we had used one of two types of UAS: Applied Forte XE® or Gyrus ACMI Uropass®. Demographics, operative parameters, and outcomes were assessed. Statistical analysis was performed. Results: During the study period, 524 ureteroscopic procedures were performed. A total of 194 UAS inclusive procedures occurred in 125 (64.4%) males and 69 (35.6%) females. Mean age was 50 years. The mean total stone burden was 1.1 cm. 113 (58.2%) Applied Forte XE® and 81 (41.8%) Gyrus ACMI Uropass® were utilized. Success rates for sheath deployment were as follows: overall=186/194 (95.8%); Applied=107/113(94.7%) and Gyrus ACMI =79/81(97.5%) (p=0.472). From the entire group, 131/194 (67.5%) patients had a pre-existent stent. Sheath failures occurred in 7 males and 1 female, of which 4/8(50%) had no pre-existent stent. Limitations of deployed sheaths occurred infrequently for Applied 17/107 (15.9%) and Gyrus ACMI 6/79 (7.6%), with no significant difference observed (p=0.120). Limitations in use was increased in males (p=0.019). Mean follow-up was 41 months. Follow-up imaging included unenhanced computed tomography 184 (94.8%), intravenous urography 19 (9.8%), ultrasonography 18 (9.3%), magnetic resonance imaging 1 (0.5%), and diuretic scintirenography 44 (22.7%). The mean follow-up was 41 months (range 9 to 93). No ureteral strictures were noted in the study group during follow-up. Conclusion: No significant differences were seen in overall success rates for the two reinforced sheaths. Both showed high deployment success rates and similar low frequency of sheath-related limitations. We noted increased sheath failures in males without a pre-existent stent. Difficulty in use was also significantly increased in males. Successful sheath use may depend on both the sheath itself and patient/operative factors.
88 PODIUM SESSIONS
PODIUM #40
IMPACT OF DIETARY CALCIUM AND OXALATE, AND OXALOBACTER FORMIGENES COLONIZATION ON STONE RISK Juquan Jiang¹, John Knight², Linda Easter³, Rebecca Neiberg4, Ross Holmes² and Dean Assimos² ¹Department of Microbiology and Biotechnology; ²Wake Forest University School of Medicine Winston-Salem, North Carolina; ³GCRC Bionutrition Unit, Wake Forest University Medical School, Winston-Salem, North Carolina; 4Dept of Public Health Sciences, Wake Forest University Medical School Winston-Salem, North Carolina (Presented By: Dean Assimos)
Introduction: Enteric colonization with Oxalobacter formigenes (O. formigenes), a bacterium whose main energy source is oxalate, has been demonstrated to reduce the risk of recurrent calcium oxalate kidney stone formation. Methods: We assessed the impact of O. formigenes colonization on urinary and fecal analytes in subjects administered 2 sets of controlled diets with varying amounts of calcium and oxalate (250 mg of oxalate per day and either 400 mg, 1000 mg or 2000 mg of calcium per day; 1000 mg of calcium per day and either 50 mg, 250 mg or 750 mg of oxalate per day). Results: Urinary calcium excretion increased and oxalate excretion decreased as calcium intake increased in colonized and non-colonized subjects. Urinary oxalate excretion increased and urinary calcium excretion decreased in both cohorts with increasing oxalate intake. When oxalate intake was fixed and calcium intake was varied, a significant interaction between colonization and oxalate excretion and the supersaturation of calcium oxalate was demonstrated. A post hoc analysis with pairwise testing demonstrated that these parameters were only lower in the colonized subjects during consumption of a low calcium diet. The fecal environment of colonized and non-colonized subjects was significantly different during all dietary phases with the colonized subjects having lower levels of fecal oxalate. Conclusion: These results suggest that O. formigenes colonization reduces stone risk during periods of low calcium and moderate oxalate intake.
PODIUM #41
PROSPECTIVE ANALYSIS OF THE SAFETY AND EFFICACY OF ESWL AT A MULTI-PRACTICE SINGLE CENTER: AN EVALUATION OF 14,397 PATIENTS Bhavin Patel, Manesh Patel and John Smith Wake Forest University, Department of Urology, Winston Salem, NC (Presented By: Bhavin Patel)
Introduction and Objectives: Since its introduction, extracorporeal shock wave lithotripsy (ESWL) has changed the treatment of urinary stone disease. As it is non-invasive and straightforward to use, ESWL is used as first line therapy by many urologists. The objective of this study was to evaluate the safety and efficacy of ESWL at a single center with a rigid pre-operative assessment and treatment algorithm, used by unrelated community and academic urologists. Methods: 17,244 patients underwent ESWL during the 5 years of this study, January 2004 to December 2008 at the Piedmont Stone Center. This center employs 3 mobile ESWL units. These machines are Dornier HM3 units. Data was obtained prospectively from the treating urologist and parameters reviewed were BMI, presence of comorbidity, stone location and size, stone compositionpost-procedural complications, and stone free/ fragmentation rates.
89 Results: Of the 17,244 patients, data was available on 14,397 (83.5%). The average age of the patient was 54 years, with 63% male and 37% female. The average BMI was 30. The overall stone free rate was 59%. There was an indirect relationship between BMI and stone free rate. Lower pole stone location, presence of hypertension, presence of diabetes, and initial stone size were all associated with significantly lower rates of stone clearance on multi-factorial analysis. Calcium oxalate and phosphate stones were associated with significantly higher stone free rates. 705 (5%) patients had post-ESWL obstructive fragments, with 493 (3%) of these patients treated with ureteral stenting and 53 (0.4%) being treated with percutaneous nephrostomy drainage. 1 patient required splenectomy due to procedural splenic injury. BMI, the presence of hypertension and the presence of diabetes were all associated with an increased risk of post-procedureal complication. Conclusion: Our data indicates that the rigid pre-treatment algorithm and treatment protocol used by a multi- practice stone center provides a safe and effective means for treatment of urinary lithaisis. Additionally, stone location and BMI were both related to stone free rates.
PODIUM #42
STAGE II PERCUTANEOUS NEPHROLITHOTOMY: A NOVEL TECHNIQUE FOR RESIDUAL STONE DISEASE Arthur Caire, Aaron Boonjindasup, Aaron Bernie, Luke Fifer and Raju Thomas Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
Objectives: To review a novel technique of stage II PCNL and determine its efficacy and efficiency. Materials and Methods: A cohort of 7 recent patients who underwent stage II PCNL was identified. Residual stone fragments were identified on post PCNL CT or under fluoroscopic guidance during stage I. The nephrostomy tube and ureteral stent was left upon discharge. Upon return patients underwent conscious sedation, were positioned upright in a non-mobile stool and flexible nephroscopy was performed through the mature percutaneous tract. The collecting system was evaluated under direct visualization and residual stones were fragmented with the holmium laser, if needed, and basket extracted. Results: Median age of patients at time of surgery was 61 (range: 48 – 67). Median time between first and second look was 14 days (range: 9 – 33). On second look, 85.7% were found to have residual stone fragments which were removed. Pre and post operative creatinine values showed minimal change in all patients (median change = 0.05; range: −0.4 to 1.3) All patients were rendered stone-free after completion of second stage. Conclusion: The upright percutaneous nephroscopy for Stage II PCNL was feasible and effective in the management of residual renal calculi.
PODIUM 43
COMPARATIVE ANALYSIS OF ANTERIOR AND POSTERIOR TREATMENT PLANES UTILIZING THE DORNIER DELTA COMPACT ELECTROMAGNETIC LITHOTRIPTER Ryan Pickens, Adam Stewart, Brent Hardin, Wesley White, Bedford Waters and Frederick Klein UTMCK (Presented By: Ryan Pickens)
Introduction and Objectives: Extracorporeal shockwave lithotripsy (ESWL) has been shown to be a safe and effective modality for the treatment of renal and upper ureteral calculi. Proper treatment of calculi requires visualization and localization of stones via two-dimensional fluoroscopy. In certain cases, stone position and patient body habitus prohibit stone localization in the posterior plane. In these circumstances, the patient must be repositioned prone or an alternate treatment modality must be investigated. A few lithotripters allow for rotation of the treatment head for localization of the calculus in the anterior plane. Limited data exists concerning efficacy and complications of the anterior treatment approach. We present longitudinal data comparing the safety and efficacy of these two approaches from a large cohort of patients treated by our regional stone center. Methods: Data was obtained by a retrospective review of all after care reports from the database of patients treated on a Dornier delta compact lithotripter with rotating treatment head. Parameters such as stone location, stone size and treatment approach were reviewed. Outcomes were determined and compared for each treatment group including rates of success and post-treatment adverse events. Results: Between 1/1/2000 and 12/31/2009, 14,313 patients underwent 22,463 treatments for renal or ureteral calculi by ESWL. Mean stone size was 9.04mm. A total of 20,810 stones (79.5%) were treated with a posterior approach and 5,363 stones (20.5%) were treated via an anterior approach. Success rates were 91% and 89% from the posterior and anterior approaches, respectively. Rates of hematoma formation were 0.3% and 0.1% for posterior and anterior approaches, respectively. The rate of post-operative obstruction was 1.0% and the hospital admission rate post-operatively was 0.68% for the entire cohort. Four Clavien grade 4 – 5 complications occurred in the entire cohort, all of which were treated in the posterior position. Conclusion: Based on observational, non-randomized data, the anterior approach appears to offer comparable results to posterior treatments in terms of efficacy and safety. Lithotripters with a rotational head offer safety and convenience to the patient and staff by facilitating anterior treatment positions without changing patient position.
90 PODIUM #44
GLYOXAL METABOLISM: A NOVEL PATHWAY IN ENDOGENOUS OXALATE SYNTHESIS Kyle Wood, Dean Assimos, John Knight and Ross Holmes Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC (Presented By: Kyle Wood)
Introduction and Objectives: Despite the importance of endogenous oxalate synthesis in calcium oxalate stone disease, our basic knowledge about oxalate formation is limited. Glyoxal is a reactive dialdehyde and a known product of glucose autoxidation, lipid peroxidation, and glycation of proteins. It plays a significant role in conditions of oxidative stress and is known to be elevated in patients with diabetes mellitus, who have recently been reported to have increased oxalate excretion. Therefore, a potential link between glyoxal, oxalate production and diabetes mellitus may exist. Glyoxal may represent a novel pathway in oxalate formation. The aim of this study was to demonstrate that glyoxal is a precursor to oxalate formation. PODIUM SESSIONS Methods: To test whether glyoxal metabolism results in oxalate synthesis two model systems were employed: HepG2 cells, a hepatoma cell line that retains many hepatocyte-specific functions and red blood cells which have a simplified metabolism. These cells were incubated with varying concentrations of glyoxal (0.01mM to 5mM), and over time (0 to 48 hours) glyoxylate, glycolate and oxalate were measured in both the cells and incubation media by ion chromatography, ion chromatography coupled with mass spectroscopy, and high pressure liquid chromatography. HepG2 cells and erythrocytes were incubated with 5mM and 50mM carbon 13 labeled glucose and using ion chromatography mass spectroscopy the level of carbon 13 glycolate and carbon 13 oxalate were measured over time. The effect of glutathione depletion on erythrocyte conversion of glyoxal to oxalate and glycolate was also studied in these cells. Results: As glyoxal concentrations were increased from 0 to 2.5 mM in HepG2 cells, there was a linear increase in both glycolate and oxalate production; significantly more glycolate is produced that oxalate (>10 times more). Human erythrocytes cultured with C13 labeled glucose yielded both C13 labeled glycolate and oxalate. Furthermore, incubating red blood cells with both glyoxal and menadione (an inhibitor of glutathione) resulted in significantly more production of both oxalate and glycolate. Menadione inhibited the detoxification of glyoxal and increases the flux of glyoxal to oxalate formation. Conclusion: Glyoxal resulting from autoxidation of glucose is a precursor to oxalate formation. Increased oxalate formation occurs with glutathione depletion. A novel pathway for oxalate formation has been discovered and may play a significant role in calcium oxalate stone formation, particularly in patients with type II diabetes and Primary Hyperoxaluria.
PODIUM #45
A MULTI-CENTER PROSPECTIVE RANDOMIZED TRIAL COMPARING THREE INTRA-CORPOREAL LITHOTRITES DURING PERCUTANEOUS NEPHROLITHOTOMY Michael Lipkin, Agnes Wang, Dorit Zilberman, Michael Ferrandino and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin)
Introduction: Stone fragmentation can be accomplished by either ultrasonic or pneumatic or combination lithotripters during percutaneous nephrolithotomy (PNL). We present preliminary data on a multi-center, prospective, randomized trial comparing three lithotrites during PNL. Methods: Patients with renal calculi > 2 cm were eligible for inclusion. Patients were randomized to 1 of 3 lithotrites: Cyberwand (CW), Lithoclast Select (LS) or Stonebreaker (SB). Stone burden was determined from pre-operative abdominal x-ray or non-contrast computed tomography (NCCT). Time for stone clearance time was determined as the time lithotripsy was initiated to the time the surgeon switched to a flexible nephroscope to look for fragments. Clearance rate was calculated by dividing stone burden by stone clearance time. Stone free status was determined by either second look nephroscopy or NCCT. Results: A total of 24 patients have been enrolled, 8 for each lithotrite. All patients underwent PNL through a single access tract. Table 1 summarizes the results. There was 1 device complication for the CW, 2 for the LS and none for the SB. Two patients required post-operative transfusion, both in the SB group. Conclusion: The Cyberwand, Lithoclast Select and Stonebreaker all appear to have similar stone clearance rates. The stone free status appears to be lower for the Stonebreaker. Additional studies are warranted to determine the best lithotrite to use in specific circumstances.
91 PODIUM #46
RISK OF DIABETES MELLITUS AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) OR URETEROSCOPY (URS) FOR URINARY STONE DISEASE Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, Jessica Lange, Matthew Kincade, Kevin Walls, Anothony Patterson, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin)
Introduction and Objectives: We evaluated whether the treatment of urinary stone disease with extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy (URS) is associated with an increased risk of de novo diabetes mellitus (DM). Methods: In this retrospective case-control study of 761 consecutive patients treated with ESWL and 198 consecutive patients treated with URS at our institution, we analyzed the subjects’ demographic information (including BMI, age, race, and gender), laterality of stone burden and treatment modality, and presence of preoperative and postoperative DM to determine whether there were statistically significant relationships. Groups were compared using chi-square test and logistic regression analysis. Results: Of the 761 ESWL patients, 150 patients had pre-existing DM, versus 198 and 42 in the URS group. Of the remaining patients, 56 (9.2%) developed de novo DM in the ESWL group versus 10 (6.4%) in the URS group (p=0.35). Average BMI and age in the ESWL group were 28.7 and 56.1, respectively, versus 29.5 and 62.0 in the URS group. Average follow-up was 65.6 months for ESWL versus 49.3 for URS. Average follow-up was 49.3 months. Upon multivariate analysis of the ESWL cohort, Caucasian race (p=0.035), BMI >30 (p<0.0001) and more than one treatment (p=0.035) were found to be associated with the development of DM. Laterality of stone burden was not predictive of DM onset. In the URS cohort, while decrease in GFR showed a trend toward significance (p=0.062), no analyzed variables were found to be associated with the development of DM. When comparing the ESWL and URS groups who developed de novo DM, the only statistically significant difference was a higher number of treatments in the ESWL group (1.7 vs. 1.5, p=0.026). Age, gender, ethnicity and laterality of stone disease were similar between the two groups. Conclusion: Obesity, Caucasian race, and increased number of ESWL treatments were found to be the risk factors for development of de novo DM after ESWL, while no significant predictors after URS were identified. When comparing both treatment modalities, an increased number of ESWL treatments significantly predicted the onset of DM compared to URS. Further prospective studies that include a more detailed history and other risk factors are in order, but overall the risk of de novo DM was similarly low after ESWL and URS.
PODIUM #47
POSTOPERATIVE IMAGING IS UNNECESSARY AFTER ANASTOMOTIC URETHROPLASTY Ryan Terlecki¹, Matthew Steele², Celeste Valadez² and Allen Morey² ¹Wake Forest University, Winston-Salem NC; ²UT Southwestern, Dallas, TX (Presented By: Ryan Terlecki)
Objectives: We evaluated the necessity and clinical impact of post-urethroplasty imaging. Materials and Methods: We reviewed our database of all urethroplasties performed by a single surgeon at our referral center during a two year period. Patients underwent voiding cystourethrography (VCUG) at a mean of 24 days postoperatively. Data analyzed included patient history and demographics, operative details, imaging results and clinical outcomes. Results: From 2007 – 2009, 210 patients underwent urethral reconstruction at our center. Patients undergoing meatoplasty or staged repairs were excluded, leaving 156 patients with postoperative imaging for analysis. Of 110 anterior urethroplasties, 59 (54%) consisted of excision and primary anastomosis (EPA), 28 (25%) had an augmented anastomotic (AA) procedure, and 23 (21%) were pure ventral onlays (flap or graft). All 46 posterior urethroplasties (PU) were performed with scar excision and primary anastomosis. Of the 156 patients, only 4 (3%) had extravasation on postoperative VCUG (2 PU, 1 AA, 1 ventral onlay)—all were successfully managed with catheter replacement and removal at a mean of 8 days afterward. None of the 59 men having EPA procedures demonstrated extravasation. Conclusion: Extravasation on post-urethroplasty VCUG is rare after approximately three weeks of catheter drainage. Imaging can be omitted following uncomplicated EPA urethroplasty.
92 PODIUM #48
A COMPARISON STUDY OF THE RADIATION DOSE OF IN−OFFICE CT SCANNERS WITH HOSPITAL SCANNERS IN THE SAME PATIENTS Phillip Wise¹, Narbik Manukian², John Lovett³, Denton Harris IV4, Tom Patterson5, Winston Wilfong6 and Joseph Jenkins7 ¹Spectrum Hospital, Grand Rapids, MI; ²Physicist, Los Angeles, CA; ³Wilmington, NC; 4Beaumont, TX; 5Galesburg, IL; 6Macon, GA; 7Neuysis, Chapel Hill, NC (Presented By: Phillip Wise)
Objectives: There has been an increase in public awareness of the potential hazards of radiation dose exposure from medical imaging. In order to show the importance of site of service, we carried out a comparative, retrospective review of the computed tomography dose index (CTDI) of patients for whom a CT scan from an in-office state of the art two-slice CT scanner was compared with a prior scan of exactly the same PODIUM SESSIONS type from one of several hospital-owned 64-slice and 16-slice scanners. Methods: From five urology practices throughout the country, we were able to identify 51 total patients: all 51 patients had a two-slice CT scan and 31 had a comparable scan at one of several hospital-owned 64-slice scanners and 20 patients had scans from hospital owned 16-slice scanners. Because each practice had purchased the exact same new two slice CT scanner, the NeuViz Dual manufactured by Neusoft Medical and FDA approved in November 2006, the variable of differences in the in-office scanners was eliminated. For the purposes of statistics, comparisons were made according to body part. Results: For hospital owned 64-slice scanners, the mean CTDI was 25.13 mGy with a standard deviation of 6.95. For the physician owned scanners, the mean CTDI was 11.57 with a standard deviation of 1.44. The two-tailed P value, the probability that the two sets of values are selected from the same distribution, is less than 0.0001. For hospital owned 16 slice scanners, the mean CTDI was 19.88 mGy with a standard deviation of 9.96 and for physician owned scanners, the CTDI was 10.12 mGy and the standard deviation was 2.84. Conclusion: The radiation dose as measured by CTDI for 64-slice hospital scanners is statistically more than twice as much, and the CTDI for the hospital owned 16-slice scanner is nearly twice as much as the radiation dose from the physician owned two slice scanner. Not only did the urology practices offer convenient, same day CT services for their patients, they also did so using the latest technology while giving their patient less than 50% of the radiation dose that the patient received during a previous hospital CT scan. Funding: No industry funding was used for this study.
PODIUM #49
NOVEL USE OF MRI TO DETECT REFLUX IN A BLADDER MODEL WITHOUT CATHETERS, IONIZING RADIATION, OR CONTRAST...OH MY! Bhavin Patel, Gordon McLorie, Anthony Atala, Robert Kraft and Steve Hodges Wake Forest University, Department of Urology, Winston Salem, NC (Presented By: Bhavin Patel)
Objectives: Novel scanning and processing protocols have been developed to augment the diagnostic ability of magnetic resonance imaging (MRI). Single Shot Fast Spin Echo pulse sequencing (SSFSE) is one such technology. It allows one to image directional flow independent of contrast. We propose that using this technology, unenhanced urine can be used as an endogenous tracer, allowing for the measurement of urine flow back to the kidney. This could allow for the diagnosis of reflux without a catheter, contrast agent or ionizing radiation. Methods: A model of the urinary tract was created with a “bladder” (reservoir and pump) designed to move normal saline along two 3mm diameter plastic tubes “ureters” at a rate mimicking urine flow, 3 – 5 mm/sec. In the MRI scanner, the protons of the “fluid” in the “bladder” were excited in a 90 degree axial spin. As the urine moved into the ureters a 180 degree pulse was performed along the sagittal plane. With reflux present (flow up the tubes), the fluid excited by the 90 degree pulse would leave the reservoir, but since it is constrained by the tubes it would also be excited by the 180 degree pulse. Only fluids that “see” both RF pulses are visible in the SSFSE sequencing, so only refluxing urine would enhance. Results: Performing the described modification of SSFSE MRI, we were able to excite the fluid in the model bladder for approximately 4 seconds, allowing the visualization of fluid reflux up the model urinary tract without the use of contrast agents. The temporal resolution was in the millisecond range. Conclusion: Using a modification of a SSFSE, we were able to detect retrograde flow in a model ureter and bladder system using MRI. We hope to apply this technology to allow us to detect reflex in children without contrast, catheterization or ionizing radiation.
93 PODIUM #50
THE USE OF MR UROGRAPHY AS AN ADJUVANT TO LAPAROSCOPIC PYELOPLASTY John Pattaras, Yamile Morales, Diego Martin, Bobby Kalb and Kenneth Ogan Emory University, Atlanta, GA (Presented By: John Pattaras)
Objectives: Laparoscopic and now robotic pyeloplasty (LP) has become the standard of care at our institution for correction of UPJ obstruction. Pre- and post-operative imagings are necessary to assess renal function, obstruction and anatomy. Magnetic resonance has the advantage of offering a non-radiation assessment of the kidney, ureter, as well as the potential for assessing renal function. We report our experience with dedicated MR urograms (MRU) in UPJ patients and endoscopic correlation by a single surgeon. Methods: Twenty-three of 109 pyeloplasty patients who presented with UPJ obstruction, mean age 45 yrs (26 – 64), underwent preoperative MRU’s while two were assessed postoperatively. Preoperative radiologic evaluation was compared to intraoperative findings at the time of LP with respect to cause of anatomic obstruction (±crossing vessel). Renal function was assessed by gadolinium cortical-medullary transit time. Results: Of the 23 UPJ patients, 19 (82.6%) were correctly evaluated by MRU with respect to renal/ureteral anatomy. The presence of accessory vessels was preoperatively identified in 8/19 and correlated surgically. Intraoperatively, four patients were found to have obstructing crossing vessels not identified on MRU. One patient was found to have crossing vessels identified on MR but not recognized during LP due to prior surgical scarring. Conclusion: As a single study, MR urography has the potential to replace renal scans, intravenous urograms and CT’s as a solitary study utilizing no radiation. In addition, functional analysis can be provided pre and post- operatively. Further experience will allow a more specific interpretation of renal function. PODIUM #51
IS PREOPERATIVE IMAGING IN PROSTATE CANCER OVERUSED? AN ANALYSIS OF THE 2010 NATIONAL COMPREHENSIVE CANCER NETWORK GUIDELINES Arthur Caire, Aaron Boonjindasup, Neils Johnson, Aaron Bernie, Raju Thomas and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire)
Objectives: To evaluate the outcomes of 2010 NCCN guidelines on preoperative metastatic work up for prostate cancer patients. Materials and Methods: A cohort of 170 robotic-assisted radical prostatectomies (RARP) performed in 2009 at a single tertiary care institution was isolated. Biopsy Gleason sum, clinical stage and preoperative PSA were evaluated using 2010 NCCN guidelines for metastatic work up. Patients with T1 – T2 disease and PSA >20 or biopsy Gleason ≥8 or T3, T4 or if symptomatic was used as criteria for bone scan. Patients with T3, T4 or T1 – T2 and a probability of lymph node involvement >20% was used as criteria for preoperative CT or MRI. Patients with preoperative bone scans, CTs, and MRIs were placed in two groups: 1) criteria met 2) criteria not met and analyzed in relationship to number of positive lymph nodes. Results: Approximately 25.9% (44) had a preoperative bone scan and 29.4% (50) had a preoperative CT or MRI. Of the patients with preoperative bone scans, 14 (31.8%) met the NCCN criteria and no patients who underwent a bone scan had positive lymph nodes on final pathology. Of the patients who underwent CT or MRI preoperatively, 11 (22%) met the NCCN criteria and no patients who underwent a CT or MRI had positive lymph nodes on final pathology. Conclusion: The NCCN guidelines were effective in preventing patients with metastatic disease from undergoing RARP. Bone scans, CT scans, and MRIs may be over used in the metastatic evaluation of prostate cancer leading to higher cost and potentially harmful radiation exposure.
PODIUM #52
ARE COMPUTERIZED TOMOGRAPHY ANGIOGRAMS, MAGNETIC RESONANCE ANGIOGRAMS AND ANGIOGRAMS NECESSARY FOR MINIMALLY INVASIVE PARITAL NEPHRECTOMIES? Michael McDonald Florida Hospital Celebration, Celebration, FL (Presented By: Michael McDonald)
Introduction and Objectives: To determine the need for angiographic studies prior to minimally invasive renal surgery. Methods: A prospective study was done to assess the need for CTA, MRA or angiography prior to performing 10 robotic assisted laparoscopic partial nephrectomies. We reviewed all studies ourselves and with one radiologist to determine preoperatively renal vascularity. We determined CTA, MRA or angiograms were unnecessary prior to surgery.
94 Results: Between June of 2009 and February 2010 a total of 10 patients underwent minimally invasive partial nephrectomies. There were 5 right sided and 5 left sided renal lesions. The renal lesions ranged in size from 15mm to 53mm. Mean estimated blood loss was 222.5cc (range 50 – 900). Seven of the 10 patients had renal cell carcinoma. Two patients had non-cancerous renal cysts and one patient had chronic focal nephronia. No patients required conversion to open surgery. In one patient an unseen upper pole vessel caused excessive bleeding that was eventually controlled. No intraoperative or post operative blood transfusions were required. Conclusion: With the advent of improved imaging including 3 dimensional views and coronal sectioning of images it appears that angiographic imaging is not necessary in many straight forward cases of nephron sparing surgery. In the instances of prior surgery, hilar lesions, solitary kidneys or multiple lesions of the kidney angiography may be useful.
PODIUM #53
ENHANCED RESIDENT EDUCATION AND PATIENT CARE PROVIDED BY MOBILE COMPUTING DEVICES Kush Patel¹, Arthur Caire¹, Ashley Bowen¹, Gordon Fifer¹ and Raju Thomas² ¹Tulane University School of Medicine, Department of Urology, New Orleans, LA; ²Chairman, Tulane University PODIUM SESSIONS School of Medicine, Department of Urology, New Orleans, LA (Presented By: Kush Patel)
Introduction: To analyze the effect of mobile computing devices (MCD) on resident training and education. Methods: The Tulane University Department of Urology implemented a novel MCD program. The department subsidized half of the cost of iPads® (Apple, Cupertino, CA) to facilitate resident acquisition. The cost of the iPads® ranged from $499 to $869 depending on the specific model selected. The department also fully subsidized non-mobile hardware/software to interface with the iPads®. The full details of this hardware/software and their implementation will be elucidated in this presentation. The MCD program was monitored over a 4 month period. The devices were used for all aspects of residency training and patient care; including didactic conferences, point of care medical reference, knowledge base improvement, portable electronic medical records and film acquisition/interpretation. Residents participated in a basic 5 question survey inquiring about usage, satisfaction and enhancement of resident education. Results: Six out of eight residents elected to participate in the MCD program. The average self-reported Ipad® usage for residency related activities was 8.7 hrs per week. All residents (100%) reported that the iPads® improved their educational experience and would recommend that other urologic departments offer the iPads® to their residents. 50% of residents would have purchased the device even if it was not subsidized by the department. The majority of residents also preferred the iPads® in comparison to laptop computers for use in the hospital environment. Conclusion: The MCD iPads® program enhanced resident education and improved optimum privacy-based patient care.
PODIUM #54
MULTIMEDIA COMPUTER-BASED VERSION OF A STANDARD MEDICAL QUESTIONNAIRE RELIABLE REGARDLESS OF PATIENT’S COMPUTER FAMILIARITY Michael Bryant, Evan Schoenberg, Timothy Johnson and Viraj Master Emory University Department of Urology (Presented By: Michael Bryant)
Introduction and Objectives: Computer-based forms of education and data-collection offer great potential; however, studies examining older and underserved populations have shown mixed results regarding their receptivity and comfort working with technology and computers. While computer educational materials have been effective for computer naïve patients, less is known about the reliability of collecting health data via a computer. We previously developed a novel multimedia version of a standard written medical screening tool, the American Urological Association – Symptom Score (AUA-SS). We demonstrated that patients using the multimedia computer version gave more accurate answers than patients using the written version of the same screening tool. We reexamined this data to determine whether patients with more computer experience will provide more accurate information to a multimedia computer-based screening tool than patients with less computer experience. Methods: This randomized controlled trial divided 232 patients into a control arm who self-administered the traditional written version of the AUA-SS and an experimental arm who self-administered the new multimedia computer version. Patients were asked to rate computer familiarity on a scale of 1 – 10. Patients from both arms were later administered the AUA-SS a second time by an interviewer for comparison. Using multivariate analyses, we measured the disagreement between the self-administered and interviewer-administered scores and compared the two arms. Results: Computer familiarity was divided into two groups: Unfamiliar (Likert Score: 1 – 5) had 106 individuals (47.7%) and Familiar (Likert Score: 6 – 10) had 116 individuals (52.3%). Multivariate analyses revealed an adjusted OR of 1.092 (p=0.675) that the unfamiliar group would be more likely to misrepresent their true symptom score by greater than three points thus concluding that there was no significant differences between the groups. Conclusion: The multimedia computer version of the AUA-SS has been shown to increase understanding and reduce scoring errors possibly allowing doctors to more effectively treat patients. While half of our patients described themselves as being unfamiliar with computers, they were equally as reliable when providing information as those patients who were familiar with computers. Our findings should encourage health professionals to incorporate multimedia education and data collection into their practice even with computer naïve populations. 95 PODIUM #55
ACUTE STONE EPISODE ASSOCIATED WITH DEPRESSION Jordan Angell, Michael Bryant, Hukang Tu, Michael Goodman, John Pattaras and Ken Ogan Emory University, Atlanta, GA (Presented By: Jordan Angell)
Introduction: Urolithiasis is associated with frequent recurrences. As such, patients with urolithiasis may develop a chronic condition associated with a poor quality of life. This may then lead to a higher risk of depression. Objectives: We hypothesized that patients with urolithiasis would have a higher prevalence of depression compared to the general population. The frequency and severity of stones episodes would relate to depressive symptoms. Materials and Methods: In an International Review Board approved study, we prospectively recruited 115 patients who were evaluated for urolithiasis over the last 5 years. All patients completed an Emory stone questionnaire covering the demographics of their stone disease and a validated CES-D depression questionnaire. Score comparisons and statistical analyses were made with those of US societal norms and within the cohort for demographics and clinical variables. Results: On the CES-D depression questionnaire 35% of patients scored ≥ 16, which is “clinically significant level of physiological distress”. The lifetime prevalence of depression in the United States is 2 – 15%. Determinants of depression included: stone episode within the last 12 months (p=0.018), proximity to an acute stone episode (p =0.017), and >1 emergency room visit for stone disease (p=0.021). Additionally, patients with a Charlson co- morbidity score of <1 were more likely to be depressed than those with a score >1 (OR 2.89). There was no association of depression with the number of lifetime stones, the years treated for stone disease and the number of stone related surgeries. Conclusion: Urolithiasis is a chronic disease punctuated with acute episodes. The acute episodes are associated with clinically significant psychological distress, while the chronic variables of stone disease show no association. Appreciation of this issue in the acute setting may allow for better patient care.
PODIUM #56
RISK OF HYPERTENSION AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) OR URETEROSCOPY (URS) FOR URINARY STONE DISEASE Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, Jessica Lange, Evan Dunn, Mattew Kincade, Kevin Walls, Anthony Patterson, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin)
Introduction and Objectives: While guidelines for the treatment of stone disease are currently determined based on stone-free rates and immediate post-operative morbidity, little is known about potential long-term sequelae of these treatment modalities. We investigated whether the treatment of urinary stone disease with extracorporeal shock wave lithotripsy (ESWL) is associated with an increased risk of hypertension (HTN) when compared to ureteroscopy (URS). Methods: In this retrospective case-control study of 761 consecutive patients treated with ESWL and 198 consecutive patients treated with ureteroscopy at our institution, we analyzed the subjects’ demographic information, including BMI, age, race and gender, laterality of stone burden, treatment modality, pre- and post-treatment renal function and presence of preoperative and postoperative HTN to determine whether there were statistically significant relationships. HTN diagnoses were based on a computerized diagnosis list and/or the presence of medical therapy for the disease. The data were then analyzed by chi-square test and logistic regression analysis. Results: 419 of 761 ESWL patients had pre-existing HTN, versus 108 of 198 in the URS group. Of the remaining patients, 87 (25.1%) developed de novo HTN in the ESWL group versus 14 (15.6%) in the URS group (p=0.067). Average BMI and age in the ESWL group were 28.7 and 56.1, respectively, versus 29.5 and 62.0 in the URS group. Mean follow-up in the ESWL and URS groups were 65.6 months and 49.3 months, respectively. Upon multivariate analysis of the patients who underwent ESWL, BMI > 30 (p=0.017), right sided treatment (P=0.008) and decreased GFR (p=0.041) were found to be significantly associated with de novo HTN after ESWL. After URS, on univariate and multivariate analysis, only African American race was found to be associated with the development of de novo HTN (p=0.041). When comparing the patients with de novo HTN after ESWL and URS, only a higher number of right-sided treatments per patient in the ESWL group was associated with the development of HTN compared to the URS group (0.8 ESWL vs. 0.6 URS treatments, p=0.012). Age, gender, race, BMI and total treatments were not different in the two groups with de novo HTN. Conclusion: A higher risk of postoperative HTN after ESWL compared to URS was noted, although this did not reach statistical significance. The risk of HTN may be higher after an increased number of right-sided ESWL treatments as compared to URS treatments. Further studies are warranted to determine if stone laterality is an important consideration in choosing a treatment modality for nephrolithiasis.
96 PODIUM #57
SIX WEEKS OF FLUOROQUINOLONE ANTIBIOTIC FOR ASYMPTOMATIC PATIENTS WITH ELEVATED PSA IS NOT CLINICALLY BENEFICIAL: A RANDOMIZED CONTROLLED CLINICAL TRIAL Robin Bhavsar¹, Ahmed El-Zawahry¹, Susan Caulder², Jeanette Byers², John Tissot², Thomas Keane¹, Harry Clarke¹ and Stephen Savage¹ ¹Medical University of South Carolina, Charleston, SC; ²Ralph A. Johnson Veterans Hospital, Charleston, SC (Presented By: Robin Bhavsar)
Introduction and Objectives: It is common practice for practitioners to reflexively give an extended course of fluoroquinolones in patients who present with an elevated prostate specific antigen (PSA). We soughtto determine whether a six week course of a fluoroquinolone would reduce the PSA sufficiently to reduce the need for a prostate biopsy in these patients.
Methods: All asymptomatic patients referred to the urology clinic for an initial evaluation of an elevated PSA PODIUM SESSIONS between 4.0 ng/ml and 20.0 ng/ml were eligible for this study. Patients were randomized to either 6 weeks of ciprofloxacin 500 mg twice daily or 6 weeks of observation alone. PSA levels were redrawn at 8 weeks from randomization. Those patients with an elevated PSA or prostate nodule were recommended to proceed with biopsy. Those with a PSA less than 4.0 ng/ml were offered to either proceed with a biopsy or be monitored closely. Results: A total of 150 patients have enrolled, and 141 have completed the 8 week study period and are available for analysis. The mean and median pre-intervention PSA for treatment (tx) patients was 6.35 ng/mL and 5.53 ng/mL, respectively, and 5.58 ng/mL and 4.96 ng/mL among observation patients, respectively. At baseline, this represented a statistically significant difference between arms (p=0.042). The mean and median post-intervention PSA was 5.63 ng/mL and 5.01 ng/mL among antibiotic patients and 5.71 ng/mL and 5.06 ng/mL among observation patients. Post-intervention, the two arms did not differ significantly in mean PSA (p=0.873). The mean PSA decreased 0.717 ng/dL (−11.3%, p=0.203) in the tx arm and increased 0.10 ng/mL (+1.79%; p=0.718) in the observation arm. Neither group had statistically significant changes. Of the 141 patients, 37 patients’ PSA decreased to <4 ng/mL (18 in antibiotic arm, 19 in observation arm). Prostate cancer was found in 16 patients in the tx arm and 18 patients in the observation arm. Conclusion: A six week trial of fluoroquinolones in men who present with a PSA above 4.0 ng/mL does not reduce PSA significantly when compared to observation, neither statistically nor clinically and thus, does not effectively identify those patients who would be recommended to undergo biopsy. Therefore, we would recommend that this common practice be discontinued.
PODIUM #58
SHOULD OUTSIDE INSTITUTION PROSTATE BIOPSIES BE REVIEWED PRIOR TO RADICAL PROSTATECTOMY? Aaron Boonjindasup¹, Arthur Caire², Aaron Bernie², Lekha Mikkillineni², Kayleen Bailey², Sarah Conley², Raju Thomas² and Benjamin Lee² ¹Tulane University Dept. of Urology, New Orleans, LA; ²Tulane University SOM, New Orleans, LA (Presented By: Aaron Boonjindasup)
Introduction: Pathologic interpretation of prostate biopsies is important in guiding surgical approach, specifically whether a nerve sparing will be performed. Pathologic upstaging is well documented, however repeated pathological analysis prior to surgery increases cost. Objectives: To determine if pre-operative prostate biopsies from referral centers are reliable compared to biopsies at a tertiary care center. Methods: After obtaining IRB approval, we retrospectively reviewed 176 consecutive patients who underwent robotic-assisted radical prostatectomies (RARP) in 2009. Biopsy Gleason scores were compared to final pathologic Gleason scores and stratified based on location (outside vs. home institution). Other pathologic features were also analyzed. Results: A total of 32 patients (18%) underwent biopsies at our institution, while 144 patients (82%) had biopsies performed at outside institutions. Agreement between biopsy and final pathological Gleason scores for home institution was 46.9% and was 41.0% for outside institutions (p=0.54). There was no statistical difference in Gleason upgrading (Home=28.1%, Outside=36.81%, p=0.35), capsular penetration (31.0%, 36.7%, p=0.56), seminal vesicle involvement (6.9%, 14.5%, p=0.27), perineural invasion (83.3%, 87.0%, p=0.60), lymphovascular invasion (13.3%, 14.18%, p=0.90) and nodal involvement (3.23%, 0.71%, p=0.56) between groups. Conclusion: Biopsies from referral centers were consistent in terms of pathological outcome as those obtained at a tertiary care institution. Routine re-analysis of biopsies is not required and may contribute to increased health care cost. In patients with low volume disease, confirmation of Gleason score may be beneficial.
97 PODIUM #59
TOREMIFENE 80 MG DEMONSTRATES REDUCTION IN FRACTURE RISK IN MEN WHO ARE LESS THAN 80 YEARS OF AGE ON ANDROGEN DEPRIVATION THERAPY Paul Hatcher¹, Lewis Kriteman², Sean Heron³ and Michael Brawer4 ¹UT Medical Center, Knoxville, TN; ²North Fulton Urology, Roswell, Georgia; ³Pinellas Urology, St. Petersburg, Florida; 4GTx, Inc., Memphis, Tennessee (Presented By: Paul Hatcher)
Introduction and Objectives: The use of androgen deprivation therapy (ADT) in prostate cancer is associated with increased fracture risk. Previously we demonstrated in a Phase III trial that toremifene, a selective estrogen receptor modulator (SERM), significantly decreased fracture incidence in men receiving ADT. Similar to other SERMs, there was an increase in venous thromboembolic events. This risk appeared to stratify to men ≥80 years of age. VTEs occurred in 1.5% and 2.5% of men <80, ≥80 respectively in the overall study. To identify a patient population with the greatest benefit/risk profile we assessed the fectef of toremifene in men <80 years. Methods: In this analysis of men <80 years of age receiving ADT for prostate cancer, 430 received toremifene 80 mg and 417 received placebo (orally daily). All subjects were on ADT for ≥ 6 months, had a serum PSA ≤4 ng/mL, were >70 years of age or were at or below WHO thresholds for spine or hip (BMD). The primary endpoint was new vertebral fractures. Secondary endpoints included fragility fractures and bone mineral density (BMD). Results: Toremifene 80 mg demonstrated a 79.5% relative risk reduction in the incidence of new vertebral fractures (CI0.95: 29.8%−94.0%; P<0.005). The absolute reduction was 3.8% (4.8% placebo, 1.0% toremifene). Toremifene 80 mg significantly increased BMD at all sites measured (P<0.001 for all comparisons). There was a concomitant decrease in markers of bone turnover (P<0.001 for all comparisons). Venous thromboembolic events occurred in 2.1% of the toremifene patients compared to 1.0% (P=0.26) of the placebo patients. Other adverse events were similar between groups. Conclusion: In men <80 years receiving ADT for prostate cancer, toremifene significantly decreased the incidence of new vertebral fractures. Toremifene also significantly improved BMD, bone turnover markers, and breast pain and tenderness. The risk of VTE was lower than in the overall study population. These results suggest an improved benefit/risk profile in men <80 years receiving ADT.
PODIUM #60
IN AN EQUAL ACCESS HOSPITAL, BLACK MEN ARE LESS LIKELY TO GET A RADICAL PROSTATECTOMY Joseph Klink, Daniel Moreira, Leah Gerber, Jean-Alfred Thomas, Madeline McKeever, Lionel Bañez and Stephen Freedland Durham VA and Duke Urology, Durham, NC (Presented By: Joseph Klink)
Introduction: Black men have the highest prostate cancer incidence and death rates in the world. The cause is multifactorial, but some have proposed that black men’s worse outcomes are caused by lack of access to care. We assessed whether black men at the Durham Veterans Affairs Medical Center, an equal access hospital, are more or less likely than other races to receive a radical prostatectomy for biopsy proven prostate cancer. Methods: We performed a retrospective review of all men (n=1,008) who were found to have cancer on their initial prostate biopsy at the Durham Veterans Affairs Medical Center between 1994 and 2008. We analyzed demographic information and prostate cancer treatment modality for black versus white men. We used Chi squared and logistic regression to examine whether black men were as likely as white men to receive a radical prostatectomy, after adjusting for multiple clinical factors. Results: Of the 1,008 men diagnosed with prostate cancer on biopsy, demographic and treatment information were available for 460 black and 409 white men. Of these men, 155 (34%) and 152 (37%) of black and white men, respectively, underwent radical prostatectomies (p=.622). Black men at time of diagnosis were more likely to be younger (64 vs. 67 years, p<0.001), have a higher PSA (8.5 vs. 6.9 ng/ml, p=0.001), and have a normal digital rectal examination (66% vs. 56%, p=0.004). After adjusting for age, PSA, year of biopsy, Gleason score, BMI and DRE findings, black men were significantly less likely to undergo radical prostatectomy (OR 0.63, CI 0.40—0.98). On multivariate analysis, black men were significantly more likely to receive external beam radiation therapy (OR 1.48, CI 1.004—2.19). Conclusion: In the setting of equal access to all forms of prostate cancer treatment, black men with prostate cancer are less likely than white men to be treated with radical prostatectomy and they are more likely to receive external beam radiation therapy. The cause of this disparity is unknown, but is unlikely to be related to access to care. Further study is needed to determine what factors are driving these observations.
98 PODIUM #61
PROSTATE CANCER RISK AND 1,25-DIHYDROXYVITAMIN D3 LEVELS James Bennett¹,²,³, Gina Kirkpatrick4, Jenelle Foote¹,²,³, Paul Alphonse, Jr¹, Leila Bucary¹, Adwoa Asare- Kwakye¹ and Yesilyne Gonzalez¹ ¹Midtown Urology & Midtown Urology Surgery Center; ²Emory University School of Medicine Department of Family Practice; ³Morehouse School of Medicine, Atlanta, Georgia; 4Philadelphia College of Osteopathic Medicine, Philadelphia, PA (Presented By: Gina Kirkpatrick)
Introduction and Objectives: Numerous epidemiological and prospective studies have shown that 1,25-dihydroxyvitamin D3 (vitamin D3) has antitumor effects on colorectal, breast and prostate cancer (PCa), in vitro. However, studies that evaluate whether vitamin D3 levels are directly correlated with the risk or incidence of prostate cancer have been limited with mixed outcomes. With the goal of identifying a potentially high-risk PODIUM SESSIONS group for PCa, a Vitamin D3 screening protocol was implemented. A retrospective review was conducted to determine if a relationship existed between deficiency or insufficiency of Vitamin D3 levels in men with PCa. We also evaluated if there was an association between Vitamin D3 levels and PCa in those men with a family history of PCa. Methods: A retrospective review of charts from September 2008 through January 2010 was conducted at an outpatient urology clinic. All patients were screened for vitamin D3 and were classified as having sufficient vitamin D3 levels (≥ 30 ng/mL), insufficient (20ng/mL – 29ng/mL) or deficient (<20ng/mL) levels. Family history (Johns Hopkins criteria) of PCa was an additional variable collected. Results: Of the negative PCa group (n=858, mean age= 60.45) 32% were vitamin D3 deficient, 29.2% were vitamin D3 insufficient and 38.69% were vitamin D3 sufficient. In the PCa group (n=865, mean age 68.52), 28% were deficient, 27.9% were insufficient and 43.9% had sufficient levels. Using t-test of statistical significance between the vitamin D levels of men with and without PCa, the mean Vitamin D level of the negative (PCa) group was 27.78 + 12.457 and 29.89+ 14.329 for the group with PCa (P= 0.001164). There was not a statistical difference in Vitamin D levels in either group. The second analysis evaluated the prevalence of PCa in men with
a family history of PCa, and their vitamin D3 status. There were (n=470) 36% of subjects with a positive family FRIDAY history, Vitamin D3 insufficient/deficient, with PCa. There were 15.74% of subjects with positive family history, vitamin D3 sufficient, without PCa. The Odds Ratio (OR) of PCa in the former group compared to the latter group was 3.0 with a 95% confidence interval (CI: 2.2−4.1) and the Relative Risk (RR) was 2.28 (95%CI: 1.79−2.9). The OR indicates that men with a family history of PCa and deficient or insufficient in Vitamin D3 (<30ng/mL) were at an increased risk of PCa compared to those with a family history and sufficient (>30ng/mL) levels of Vitamin D3. Conclusion: Subjects with a family history of PCa had an increased risk if they were found to have Vitamin D3 levels <30ng/mL. However, when family history was not an independent variable, Vitamin D3 levels did not influence PCa risk.
PODIUM #62
PROSTATE SIZE AS A PREDICTOR OF GLEASON SCORE UPGRADING IN LOW-RISK PROSTATE CANCER PATIENTS Monty Aghazadeh, Judson Davies, Sharon Phillips, Shady Salem, Peter Clark, Michael Cookson, Rodney Davis, S. Duke Herrell, Justin Gregg, Sam Chang, Joseph Smith and Daniel Barocas Vanderbilt University Department of Urologic Surgery, Nashville, TN (Presented By: Judson Davies)
Introduction: Gleason score upgrading (GSU) between clinical and surgical pathologic staging occurs in 30 – 50% of cases. Predicting the likelihood of GSU in men with low-risk prostate cancer may be particularly important, since the presence of higher-grade disease influences management decisions and impacts prognosis. Objective: To determine clinical predictors of GSU between prostate biopsy and radical prostatectomy (RP) specimens in low-risk prostate cancer patients. Materials and Methods: The cohort consisted of 3,087 men that underwent RP at our institution between January 2000 and June 2008. 1709 (55.4%) patients had low-risk disease by D’Amico risk classification. Patients with prior treatment (167), 5-alpha reductase inhibitor use (41), or incomplete data (250) were excluded. The remaining 1,251 patients were divided into three groups according to pathologic Gleason score (no GSU, minor GSU [3+4=7] and major GSU [≥4+3=7]) based on differential outcomes in the entire cohort. Clinical variables compared between groups included pre-operative PSA, age, BMI, race, number of cores, number of positive cores, percent tumor involvement in biopsy specimens, prostate volume, and interval between biopsy and surgery. A multivariate model was fit to identify clinical predictors of any GSU or major GSU.
99 Results: 387 of 1,251 patients (31.0%) were upgraded; 324 (26%) had minor GSU and 63 (5%) had major GSU. On univariate analysis, older age, higher PSA, later year of surgery, higher number of positive cores, higher percentage of cores positive, higher percentage of cancer involvement in any section or core and smaller prostate volume were associated with GSU (p values all <0.01). On multivariate analysis, age (OR 1.65, 95% CI [1.37 – 1.98], p<0.01), PSA (OR 1.50, 95% CI [1.29 – 1.74], p<0.01), percent cancer involvement in biopsy specimens (OR 1.32, 95% CI [1.14 – 1.53], p<0.01), year of surgery (OR 1.66, 95% CI [1.24 – 2.23], p<0.01) and smaller prostate volume (OR 0.58, 95% CI [0.48 – 0.69], p<0.01) were independent predictors of any GSU (≥3+4=7). However, only age (OR 1.61, 95% CI [1.11 – 2.33], p=0.01), PSA (OR 1.58, 95% CI [1.18 – 2.11], p<0.01), and smaller prostate volume (OR 0.67, 95% CI [0.49 – 0.96], p=0.03) were independent predictors of major GSU. Men with prostate volumes at the 25th percentile (36 grams) were 50% more likely to experience GSU compared to men with prostate volumes at the 75th percentile (58 grams). Conclusion: Nearly one third (31%) of low-risk patients were upgraded at final pathology. Older age, higher PSA and smaller prostate size predict major GSU. Identifying low-risk patients at risk for GSU could play a role in counseling patients regarding management and prognosis.
PODIUM #63
NEOADJUVANT DOCETAXEL / ESTRAMUSTINE PRIOR TO RADICAL PROSTATECTOMY OR EXTERNAL BEAM RADIOTHERAPY IN HIGH RISK LOCALIZED PROSTATE CANCER: A PHASE II TRIAL Joshua Langston, J. Patrick Selph, Sean Sawh, William Kim, Paul Godley, Young Whang, Kim Rathmell, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston)
Introduction and Objectives: Patients with high risk prostate cancer are at significant risk of having disease recurrence despite definitive local therapy. We evaluated the two-year progression-free survival of subjects treated with chemotherapy administered prior to definitive therapy with surgery (RP) or radiation (XRT). Materials and Methods: Patients (n=24) with locally advanced and high risk localized prostate cancer were treated with neoadjuvant docetaxel (36 mg/m2 IV weekly for 3 weeks) and estramustine (140 mg orally tid for three consecutive days every 28 days) prior to definitive treatment with RP or XRT. The primary objective of the study was to determine the biochemical (PSA) progression rate 2 years after the completion of treatment. Results: All evaluable patients, except one, completed the proposed cycles of neoadjuvant chemotherapy with minimal dose reductions or delays. Of the 22 evaluable patients, 12 underwent RP and 10 underwent XRT. No patient who underwent RP was found to pT0 disease. Of RP patients, 6 of 12 (50%) had organ confined disease on pathology. Of the entire cohort, 21/22 (95%) patients achieved a PSA reduction > 25%. All patients had a minimum follow up of 24 months, and the two-year progression free survival was 55%. The table shows the characteristics of those who progressed versus those who did not. Conclusion: Our findings support the safety, tolerability and efficacy of neoadjuvant chemotherapy in patients with men with high risk prostate cancer. The effectiveness of neoadjuvant chemotherapy in preventing prostate cancer relapses should be studied in a randomized trial.
100 PODIUM #64
PSA AND PROSTATE BIOPSY RESPONSE TO VITAMIN D SUPPLEMENTATION IN PATIENTS UNDERGOING ACTIVE SURVEILLANCE FOR PROSTATE CANCER Erin Burns¹, David Marshall¹, Stephen Savage¹, Sebastiano Gattoni-Celli¹ and John Lacy² ¹MUSC, Charleston, SC; ²UK, Lexington, KY (Presented By: Erin Burns)
Introduction and Objectives: It has been shown that calcitriol, the biologically active form of Vitamin D, is the key mediator in several biochemical pathways that are implicated in the initiation and progression of prostate cancer (CaP). We sought to determine if Vitamin D supplementation had any effect on prostate specific antigen (PSA) levels and prostate biopsy results in patients with biopsy proven low-grade CaP that had elected management with active surveillance (AS). Methods: This prospective, open label study included 50 patients with low-grade CaP (Gleason score ≤3+3, PODIUM SESSIONS PSA levels ≤10, Clinical stage T1c or T2a) who elected to undergo AS. Baseline measurements including PSA, Vitamin D levels, serum Ca, PTH, and Ca/Cr ratio were obtained. The patients were followed over the course of one year, with lab values repeated every two months. All patients received 4000 International Units (IU) Vitamin D daily. The patients were stratified according to their baseline Vitamin D levels of severely deficient (<20 ng/mL, Group A), moderately deficient (20 – 40 ng/mL, Group B), and normal (>40ng/mL, Group C). Results: 38 patients have completed the study, and 25 have pre- and post-study biopsy data available thus far. The attached table shows mean PSA and biopsy changes for each Vitamin D group. PSA increased in the Vitamin D deficient groups (A and B), and decreased in Group C. The Vitamin D deficient groups also had 2/8 (Group A), and 1/14 (Group B) individuals progress in Gleason score on repeat biopsy, whereas Group C had 0/3 progressions in Gleason’s score. Conclusion: Patients with lower levels of Vitamin D had higher initial PSA values, increases in PSA, and more incidences of progression in Gleason score on follow-up biopsy. Lower levels of Vitamin D at baseline may portend a worse prognosis in patients choosing AS. Further studies are warranted to determine if there are particular population groups in which this supplementation should routinely be recommended.
PODIUM #65
EVALUATION OF THE ASSOCIATION OF OBESITY AND PATHOLOGIC FEATURES OF AGGRESSIVENESS AMONG MEN UNDERGOING RADICAL PROSTATECTOMY FOR PROSTATE CANCER Alexander Parker, Michael Heckman, Andrea Tavlarides, Nancy Diehl and Todd Igel Mayo Clinic – Florida Campus (Presented By: Alexander Parker)
Introduction and Objectives: The reported inverse association between obesity and PSA level suggests a hemodilution effect on PSA in obese men secondary to increased circulating blood volume. Based on this, some have suggested new PSA cut points for obese men while others have developed equations to standardize PSA test results for differences in body size. While the evidence of a hemodilution effect is clear, what remains in question is whether obese men ultimately present with more aggressive prostate cancer (PCa) when compared to non−obese men of the same age with similar screening PSA levels. To address this, we conducted a nested case control study within our prospective cohort of men undergoing radical prostatectomy for newly diagnosed PCa. Materials and Methods: From our prospective registry, we identified 164 obese men with a BMI >30 kg/m2 (cases) and 115 men with a BMI<25 kg/m2 (controls) who underwent surgery to treat newly diagnosed PCa at our institution between 2007 – 2009. We compared age, PSA level and pathologic features of aggressiveness between those men with a BMI>30 and those with BMI<25 using chi-square, two sample t-test and Fisher’s exact tests. We employed logistic regression analysis to evaluate the association of obesity with pathologic features of aggressiveness after adjusting for PSA and age at diagnosis. Results: Patients with a BMI<25 and those with a BMI>30 were of similar age (median = 64 vs. 62 respectively, p=0.50) and had similar PSA levels at diagnosis (median = 5.32 ng/mL vs. 5.58 ng/mL, respectively; p=0.92). In comparison to patients with a BMI<25, those with a BMI>30 did not have a significantly higher risk of prostatic capsule involvement (OR: 1.29, 95% CI: 0.70 – 2.38, p=0.42), did not have a higher risk of pT3 or higher disease (OR: 1.17, 95% CI: 0.58 – 2.36, p=0.67), and did not have a higher risk of a Gleason score of 7 or higher (OR: 1.11, 95% CI: 0.67 – 1.85, p=0.68). Results were similar when comparing outcomes between patients with a BMI of <25 and those morbidly obese men with a BMI>35.
101 Conclusion: We observed that obese men do not present with more aggressive PCa tumors when compared to normal weight men of similar age and with similar PSA screening values. If our data are confirmed in larger studies, this would not support the need to alter or adjust PSA values for screening in obese men to account for hemodilution effect. That being said, the need to adjust PSA values for surveillance after surgical treatment for PCa remains in question.
PODIUM #66
EFFECT OF CESIUM-131 BRACHYTHERAPY AND EXTERNAL BEAM RADIATION ON URINARY SYMPTOMS, ERECTILE FUNCTION AND QUALITY OF LIFE FOR INTERMEDIATE TO HIGH RISK PROSTATE CANCER: A PROSPECTIVE EVALUATION Joshua G Griffin¹, John Burns², Michael Baird³, William C. Woods³ and Charles R. Pound³ ¹University of Mississippi Medical Center; ²University of Mississippi Medical Center and Veterans Administration Hospital Jackson, MS; ³University of Mississippi Medical Center, Jackson, MS (Presented By: Joshua G. Griffin)
Introduction and Objectives: Data is lacking in regards to the immediate effect of combined Cesium-131 (Cs) brachytherapy (Br) and external beam radiation (XR) on urinary and erectile function. Most data on side effects and tolerability have been reported in a retrospective manner, relying on physician reported outcomes. Given its short half-life, we propose that Cs may be associated with less toxicity. We evaluated the side effect profile immediately after Br in a prospective cohort of patients with intermediate to high risk prostate cancer (Pca) based on validated questionnaires. Methods: In this phase I single arm trial patients with intermediate to high-risk Pca who met inclusion criteria were treated with combined Br/Xr. All subjects were given the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) and Functional Assessment of Cancer Therapy – Prostate (FACT-P) questionnaires at baseline and weekly for the first 6 weeks after Br. Box plots were constructed for each category and ANCOVA used to establish significant trends. Results: A total of 13 patients were evaluated. Mean age was 62.8 (range 51 – 80). Mean Gleason sum was 8 and median prostate specific antigen 12 (mean 41.8). 11 patients were treated with neoadjuvant hormonal therapy. Baseline surveys were complete for all subjects and weekly for six weeks after Br. At least 80% of questionnaires were complete in each category. IPSS scores appeared to have greatest amount of change during followup. Subjects with baseline IPSS over 15 tended to have a greater increase than those below this level (Figure 1). FACT-P components remained stable throughout the study interval while IIEF scores were low at baseline and remained so. ANCOVA models did not show statistical significance in IPPS scores with time, although the sample size makes interpretation difficult. Conclusion: Although this cohort is small, Cs Br appeared to be well tolerated in the immediate post implantation period with no significant effects on urinary symptoms or quality of life. Erectile function in this population was likely already compromised by hormonal therapy. Data during XR and post treatment is still being collected in a prospective manner.
102 PODIUM #67
ONCOLOGICAL OUTCOMES OF RADICAL PROSTATECTOMY WITH POSITIVE SURGICAL MARGINS AND OTHERWISE FAVORABLE PROGNOSTIC FACTORS Joshua G. Griffin¹, Jade Smith² and Charles R. Pound² ¹University of Mississippi Medical Center & VA Medical Center, Jackson, MS; ²University of Mississippi Medical Center (Presented By: Joshua G. Griffin)
Introduction: Positive surgical margins (PSM) after radical prostatectomy (RP) have been demonstrated to have adverse effects on both biochemical recurrence and cancer specific survival. Postoperative radiation, in either an adjuvant or salvage setting, has been increasingly used in efforts to improve these endpoints. We report our experience of overall survival and biochemical recurrence in patients who underwent RP with PSM but otherwise favorable pathologic findings. PODIUM SESSIONS Methods: We retrospectively reviewed from our database all patients between 2000 – 2009 who underwent radical prostatectomy and had PSM. Inclusion criteria were prostate specific antigen (PSA) <10, Gleason Sum <7, pathologic tumor stage PODIUM #68 RADICAL PROSTATECTOMY POSITIVE MARGIN RATES AMONG SURGEONS IN THE EARLY PART OF THE LEARNING CURVE Jordan Angell, Tim Johnson, Chad Ritenour, Fray Marshall and Viraj Master ¹Emory University, Atlanta, GA (Presented By: Jordan Angell) Introduction and Objectives: Surgical margin status serves as an important oncologic end point for prostate cancer. Recent studies have shown that the number of positive surgical margins (PSM) and biochemical recurrence is directly associated with surgeon experience levels. Patients treated by experienced surgeons who had performed 250 procedures when compared to patients treated by a surgeon with 10 cases have a PSM absolute risk reduction of 15% and a PSM relative risk reduction of 40%. A logical extension of these data is for patients to undergo care at high volume centers. We examined the relationship of surgeon experience and its role in positive surgical margins in open radical prostatectomy for prostate cancer. We particularly focused on the surgeons with the lowest training experience. Materials and Methods: We reviewed 117 open radical prostatectomy cases (RRP) over the years 2000−2010 at an inner−city hospital primarily serving the indigent. Cases were performed by the chief resident and supervised by the attending faculty surgeon. Multivariable statistical analyses were performed to assess the relationship between positive surgical margin and surgeon while controlling for various patient and disease characteristics. Results: The positive surgical margin rate was 28%. 26 surgeons (chief residents) averaged 4 to 5 RRP’s in their respective four−month rotation. These PSM rates were comparable to experienced surgeons in other reported studies. Pre−operative PSA was the only variable associated with PSM rates (p−value = 0.05). Mean pre−operative PSA was 10 and 57% of the cohort had Gleason sum score of 7. Surgeon experience, surgeon time, grade, stage, and order in the surgeons’ learning curve were insignificant. Conclusion: Surgeons must undergo a learning curve in their career. These data indicate oncologic endpoints can be maintained during the early learning curve. Further, these results indicate that the PSM rates of surgeons at the early part of their learning curve (chief residents) are at least equivalent to other studies. These PSM rates were maintained on a patient population that has more high-risk surgical features. These findings do not support the regionalization of care. 103 PODIUM #69 QUANTITATIVE REAL TIME MONITORING OF RENAL ISCHEMIA DURING PARTIAL NEPHRECTOMY: A PILOT STUDY USING NEAR INFRARED TISSUE OXIMETRY Sarah Conley¹, Amanda Feige¹, Alton Sartor¹, Ashley Bowen² and Ben Lee¹ ¹New Orleans, LA; ²LA (Presented By: Ashley Bowen) Introduction and Objectives: Assessment of recovery of renal function following hilar clamping during partial nephrectomy is currently performed indirectly, with no quantitative assays for real-time measurement. Our goal was to determine the feasibility of using near infrared tissue oximetry to quantify local renal ischemia during and recovery after hilar clamping in a porcine model. Materials and Methods: After approval by the Institutional Animal Care and Use Committee, measurements of local tissue oxygen saturation (StO2) on six renal units of adult female Yorkshire swine were performed before, during and after renal artery and vein clamping. Local tissue StO2 values were measured and recorded at four second intervals immediately prior to clamping the renal hilum, during warm ischemia, and for five minutes after unclamping using a near infrared tissue oximeter, the ViOptix T.Ox™ Tissue Oximeter (ViOptix Inc., Fremont, CA). Clamp times were 15, 30, 45 and 60 minutes. Clamp times and sequence were randomized in each renal unit. Results: A total of 14,967 StO2 measurements were obtained for analysis. The device reflected baseline StO2 levels prior to clamping, an ischemic drop in tissue oxygen concentration during clamping followed by a rise to post- unclamping plateau values. The median time to post-unclamping plateau levels was 12.1 seconds (SD=4.8). There were no overall differences in preclamp StO2 values compared to the post-unclamp values, including recovery of renal function following 60 minute hilar clamp time. Conclusion: Tissue oximetry quantitates an ischemic drop in tissue oxygen saturation during periods of renal ischemia in a porcine model. The findings from this preliminary study suggest that reversible renal function may exist with clamp times as long as 60 minutes. The noninvasive real time measurements may have broad clinical implications for surgeons performing complex reconstruction during partial nephrectomy. PODIUM #70 THE PREDICTIVE VALUE OF NEPHROMETRY SCORE ON OUTCOMES FOLLOWING ROBOT-ASSISTED PARTIAL NEPHRECTOMY Amanda Feige, Sarah Conley, Michael Pinsky, Erin Johnson and Benjamin Lee Tulane University, Dept of Urology, New Orleans, LA (Presented By: Amanda Feige) Introduction: R.E.N.A.L. nephrometry scoring has been used to quantify the salient anatomy of renal masses, aiding urologists in surgical decision-making. Our goal was to evaluate the predictive role of nephrometry scoring following robot-assisted laparoscopic partial nephrectomy (RALPN). Materials and Methods: After obtaining institutional review board approval, we performed a retrospective review of 252 consecutive patients that underwent RALPN between August 2008 and March 2010. R.E.N.A.L. nephrometry scores (r = radius, e = exophytic or endophytic, n = nearness to collecting system, a = anterior or posterior, l = relation to polar lines) were assigned based on preoperative computed tomography or magnetic resonance imaging. Patients with a score <7 were compared with patients with a score of ≥7. Various clinical factors were analyzed. Statistical analysis was performed using the unpaired t-test. Results: A total of 23 patients had preoperative imaging available and were included in the analysis. Mean age was 59 years (range 38 – 84). 23 of 252 patients had pre-operative imaging available to assign a nephrometry score and were included in the analysis. The average nephrometry score across all patients was 6.7. The ≥7 group had scores between 7 and 11, while the <7 group had scores between 4 and 6 (p < 0.0001). The average operative time across all patients was 168.7 minutes. In the group ≥7 it was 163.8 minutes and in the group <7 it was 175.1 minutes (p = 0.57). The average EBL across all patients was 215.4 mL. In the group ≥7 it was 234.6 mL and in the group <7 it was 190.5 mL (p = 0.64). The average length of stay across all patients was 2.3 days. In the group ≥7 it was 2.2 days and in the group <7 it was 2.5 days (p = 0.57). The average final surgical pathology specimen size across all patients was 3.0 cm. In the group ≥7 it was 3.1 cm and in the group <7 it was 2.8 cm (p = 0.59). The average serum creatinine change across all patients was an increase by 0.04 mg/dL. In the group ≥7 it increased by 0.08 mg/dL and in the group <7 there was no change (p = 0.55). Overall, 4 patients had positive margins, 3 in the ≥7 group and 1 in the <7 group (p = 0.44). The average warm ischemia time across all patients was 23.6 minutes, in the group ≥7 it was 29.6 minutes and in the group <7 it was 15.7 minutes (p = 0.01). The difference was statistically significant. Conclusion: Patients with nephrometry score ≥7 may have longer warm ischemia times during RALPN compared to scores <7. This information may be helpful to urologic surgeons when planning RALPN on complex renal masses. 104 PODIUM #71 A COMPARISON OF OUTCOMES IN PATIENTS UNDERGOING STANDARD LAPAROSCOPIC VERSUS MICROLAPAROSCOPIC HYBRID PYELOPLASTY Davis P. Viprakasit, Mark D. Sawyer, Hernan O. Altamar, Nicole L. Miller and S. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (Presented By: Davis P. Viprakasit) Introduction and Objectives: In an effort to further minimize surgical scars and improve cosmesis in select patients, we utilize microlaparoscopic (<3mm) trocars / instrumentation for the performance of laparoscopic pyeloplasty for symptomatic ureteropelvic junction obstruction (UPJO). We sought to compare perioperative outcomes in patients treated with standard laparoscopic versus microlaparoscopic hybrid approaches. Methods: After IRB approval, we reviewed our last 21 consecutive patients undergoing laparoscopic pyeloplasty. The laparoscopic approach utilized was based on surgeon preference. PODIUM SESSIONS Results: From January 2009 to April 2010, 10 patients underwent hybrid microlaparoscopy with a 5mm periumbilical trocar and <3mm working ports. Two required conversion to 5mm ports and were excluded. 10 patients underwent standard laparoscopy with 5/12mm ports. 1 patient underwent robotic pyeloplasty and was excluded. Gender, BMI and prior surgical history were similar between groups. Patients undergoing microlaparoscopy were significantly younger and more likely to have a crossing vessel. Perioperative parameters including operative time, complications, pain scores and morphine equivalents were similar between groups. At a mean follow-up of 140 days, operative success as noted by strict lasix renal scan criteria was noted in 86% and 100%, respectively (p=0.38). Cosmesis and follow-up wound evaluation were rated ‘outstanding’ by patients undergoing microlaparoscopy. Conclusion: Microlaparoscopic hybrid pyeloplasty can be safely and efficiently performed for treatment of adult UPJO. Perioperative parameters including operative times, complications and success rates did not differ from standard therapy. Such approaches can be utilized to further minimize scar size and improve cosmesis in select patients. PODIUM #72 ROBOTIC PARTIAL NEPHRECTOMY DEMONSTRATES FAVORABLE ISCHEMIA TIMES COMPARED TO LAPAROSCOPIC PARTIAL NEPHRECTOMY Arthur Caire, Aaron Bernie, Will Armstrong, Aaron Boonjindasup and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire) Objectives: To analyze the difference in ischemia time between robot-assisted and pure laparoscopic partial nephrectomy. Materials and Method: A cohort of 78 patients who underwent a partial nephrectomy from 2004 to 2009 was retrieved from the Tulane nephrectomy database. Age at surgery, preoperative tumor size, change in creatinine, ischemia time, estimated blood loss, pathological tumor size and pathologic subtype underwent univariate analysis stratified by surgical approach. Estimated blood loss, ischemia time, pathological tumor size and change in creatinine underwent multivariate analysis stratified by surgical approach. Results: The cohort consisted of 48 (61.5%) pure laparoscopic partial nephrectomies and 30 (38.5%) robotic- assisted partial nephrectomies. Robot-assisted procedures had a significantly shorter ischemia time 23 (17.8, 29.5) min vs 38 min (30.3, 46.8) compared to the laparoscopic approach. No significant difference was seen in pathologic tumor size between the two groups (robotic 3.0 (2.0, 4.0), laparoscopic 2.5 (1.8, 3.5)). The robot- assisted group had a favorable change in post procedural creatinine (robotic 0 (−0.01, 0.2), laparoscopic 0.2 (0.0, 0.3)). There was a significant difference in ischemia time in multivariate analysis (p <0.001). Conclusion: Robot-assisted partial nephrectomy results in shorter ischemia times. The decreased ischemia may lead to greater preservation of post operative renal function compared to the pure laparoscopic approach. PODIUM #73 TESTICULAR PAIN AFTER LAPAROSCOPIC DONOR NEPHRECTOMY: A FREQUENT COMPLICATION WITH SIGNIFICANT MORBIDITY Samir Shirodkar¹, Vincent Bird², Michael Gorin¹, Alberto Zarak¹ and Gaetano Ciancio³ ¹University of Miami; ²Department of Urology, University of Florida; ³University of Miami/Jackson Memorial Hospital (Presented By: Samir Shirodkar) Introduction and Objectives: The laparoscopic approach to donor nephrectomy is becoming increasingly common, with most centers performing laparoscopic procedures when possible. While it is felt that the recovery from the laparoscopic nephrectomy is quicker and less painful, a number of complications have been reported. A rarely reported complication, but one with significant morbidity to the patient, is ipsilateral testicular pain. Methods: The donor nephrectomy database was evaluated for complications after the procedure. A total of eight patients complained of ipsilateral orchalgia after donor nephrectomy. The charts were reviewed retrospectively of these patients and pre-, peri-, and post-operative factors were recorded. The duration of orchalgia was ascertained either from the chart or from direct contact with the patients. 105 Results: From 1998 to 2008, a total of 413 donor nephrectomies had been performed at the local center. Of these, 257 were hand-assisted laparoscopic donor nephrectomies. Eight men complained of ipsilateral orchalgia de novo postoperatively. All of them were in the laparoscopic cohort. No other complications were reported in this group of patients. The average duration of orchalgia in this group was 402 days (range 24 – 1,100). Patients reported significant morbidity related to this complication when it occurred. However, no patient needed further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Conclusion: Ipsilateral orchalgia in men undergoing donor nephrectomy was seen only in the laparoscopic cohort. While this complication is seen infrequently, it can be a source of significant morbidity for the patient. A number of theories exist for the source of pain, however no definitive cause has been identified. PODIUM #74 LAPAROSCOPIC NEPHROPEXY FOR NEPHROPTOSIS: IS IT SHAM SURGERY? Lydia Laboccetta¹, Matthew Young² and Stephen J. Savage³ ¹Resident, Medical University of South Carolina, Charleston, SC; ²Resident, Medical University of South Carolina Urology, Charleston, SC; ³Attending, Medical University of South Carolina Urology, Charleston, SC (Presented By: Lydia Laboccetta) Introduction: Nephropexy is a surgical procedure which dates back to the beginnings of urology, and has previously been over diagnosed and over treated with a great deal of morbidity secondary to the deep dissection and flank incision required to perform this surgery in an open fashion, but may potentially now be underdiagnosed. With the advent of minimally invasive surgery and imaging techniques, one can appropriately diagnose and treat symptomatic nephroptosis with little morbidity. Herein, we present our experience with this procedure in carefully selected patients. Methods: After obtaining IRB approval, we retrospectively reviewed patients who had undergone laparoscopic nephopexy at our institution. Five patients were identified who were found to have radiologic evidence of nephroptosis and corresponding pain symptoms. Radiologic evidence included supine and upright renal scan in order to identify decreases in flow and/or drainage in the ptotic kidney. Results: All patients were female with right-sided nephroptosis and pain. Of the five patients, 2 had pre-existing anxiety, and one had pre-existing psychosis. Four patients underwent fixation of the kidney to the psoas in three points, and one had five point fixation to the psoas. Approach was retroperitoneal in 3 and transperitoneal in 2 patients. All patients were observed for 23 hours post-operatively, and were subsequently discharged. There were no complications. 2 patients reported complete resolution of their symptoms, and 3 had continued pain. 3 patients had improved function on nuclear medicine scan and four had radiographic evidence of complete renal fixation post−operatively. One patient required subsequent ureteroscopic endopyelotomy for ureteropelvic junction obstruction which was worse after nephropexy that resolved the symptoms. There were no other required interventions. Average follow up was 5.8 months. Conclusion: Nephropexy may be performed safely laparoscopically with minimal morbidity to the patient. Given the high incidence of psychiatric comorbidities in this small series, it may be important to stress preoperatively that intervention may not relieve symptoms, but given the observed improvement in renal function, it is certainly medically sound to intervene. In the absence of demonstrable functional abnormalities, one may potentially defer nephropexy. Post-operative radiologic findings assist in patient counseling regarding resolution of nephroptosis. PODIUM #75 INDUCTION OF RENAL HYPOTHERMIA VIA COUNTINOUS RETROGRADE IRRIGATION: RESULTS IN PORCINE MODEL AND INITIAL EXPERIENCE IN A SERIES OF PATIENTS UNDERGOING ROBOTIC PARTIAL NEPHRECTOMY IN A SOLITARY KIDNEY Philip Dorsey, Brian Richardson, Sarah Conley and Benjamin Lee Department of Urology, Tulane University School of Medicine, New Orleans, LA (Presented By: Philip Dorsey) Introduction: Renal hypothermia is commonly utilized during nephron sparing surgery to minimize ischemia induced tissue damage. In open renal surgery, ice slush packing is used to surround the kidney to decrease renal temperature. While effective for open procedures, this method is not practically applicable to laparoscopic procedures. We propose an endourologic technique to induce renal hypothermia using continuous retrograde irrigation of iced saline via a duel lumen ureteral catheter and report our successful application of this technique in a porcine model. We also report outcomes of in a series of patients with either functional or anatomic solitary kidney undergoing RALPN for renal lesions. 106 Materials and Methods: We performed preliminary investigations on 3 porcine kidneys. A 10 Fr dual lumen ureteral catheter was introduced into the collecting system of the kidney and cooled saline was infused at a rate of 10 ml/min via the distal port for a total of 900 second. The second port was left open for drainage. Temperature was taken continuously and recorded at 10 second intervals. Three patients with solitary kidney undergoing (RALPN) volunteered for intra-operative retrograde renal cooling. A 10 Fr dual lumen ureteral catheter was placed retrograde prior to surgery. Starting 15 minutes prior to renal artery clamping, ice cold saline was continuously irrigated through the distal port of the catheter under gravity. Free efflux was allowed to drain via the uncapped second port. The mass was excised and the kidney was reconstructed in standard fashion. After the renal artery was unclamped, the cold saline irrigation was discontinued and the ureteral catheter was exchanged for a stent. Results: Baseline porcine kidneys temperature was 24.5 °C. Cortical temperature fell an average of 12.1 °C over an average of 685 seconds. In one example, temperature was reduced by 5°C within 870 seconds due to a disrupted collecting system. Patient volunteers were similar in age and co-morbidities. Baseline patient creatinine was 1.27, 0.8, 1.08 and post operative creatinine measured within two weeks post operatively was PODIUM SESSIONS 1.4, 1.1, 1.1 respectively. Average clamp time was 20 minutes. All patients had negative surgical margins. Conclusion: While the robotic approach to partial nephrectomy has significantly shortened warm ischemia times during partial nephrectomy, renal hypothermia may provide additional nephro-protective effects. Our technique to induce renal hypothermia via continuous retrograde irrigation of iced saline via a duel lumen ureteral catheter is a safe, effective and potentially beneficial means of maximally preserving renal function during robotic assisted laparoscopic partial nephrectomy (RALPN). PODIUM #76 ROBOT-ASSISTED PARTIAL NEPHRECTOMY OUTCOMES AT A SINGLE INSTITUTION Scott Castle, Vladislav Gorbatiy, Watid Karjanawanichkul, Nelson Salas and Raymond Leveillee University of Miami, Department of Urology, Miami, FL (Presented By: Scott Castle) Introduction and Objectives: Partial nephrectomy is the current gold standard treatment of small renal masses. The articulated instruments of the Da Vinci surgical system have made the laparoscopic approach even more feasible. We present our experience with 49 robot-assisted partial nephrectomy (RAPN) surgeries. Methods: From July 2008 to July 2010, 49 elective RAPN were performed utilizing the Da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) at our institution by a single surgeon. All patients had a single enhancing renal mass shown on contrast enhanced CT scan preoperatively. Clinicopathologic outcomes, surgical outcomes, and renal function (Cockcroft-Gault formula) was recorded prospectively and analyzed. Results: Mean age, BMI, and Age Adjusted Charlson Comorbidity Index of 32 male and 17 female patients was 56.8 years (34 – 80), 30.3 kg/m2 (20.8 – 43.0), 4.2 (2 – 7) respectively. 29 (59%) of tumors were exophytic and 20 (41%) endophytic. Eight tumors (16%) involved the collecting system. Mean tumor size, length of surgery, warm ischemia time (WIT), and hospital length of stay were 3.5cm (1 – 8), 286 minutes (133 – 608), 29.1 minutes (11 – 42), and 3.9 days respectively. Intraoperatively, 5 (11%), 34 (74%) and 7 (15%) of patients had no vascular occlusion, artery and vein occlusion and artery occlusion only respectively. There were 32 (69.5%), 12(26.1%), 1(2.2%), and 1(2.2%) of T1A, T1B, T2, and T3 tumors respectively. Three (7.6%) patients had a positive surgical margin. 36 (78%) were RCC. Two (4.3%) intraoperative complications (bleeding and bowel serosal injury) and 2 (4.3%) post-operative complications (Ileus and abdominal pain), occurred (all Clavien grade I). Three patients required conversion to open procedures. Cancer free survival rate was 100% at a mean follow−up time of 5.1 months (0.3 – 26) with a 0% recurrence rate. Mean preoperative eGFR was 96 mg/mL (46.9 – 191) while mean post−operative creatinine was 1.1 mg/mL (0.6 – 2.1) with eGFR of 96mL/min (47 – 191). Mean individual change in creatinine from preoperative to post operative was a decrease by 0.07 mg/mL, ranging (−)1.0 to (+)0.7. Conclusion: The robotic-assisted partial nephrectomy is a safe and effective operation for the treatment of renal masses. We show the feasibility of RAPN in a variety of tumor sizes and locations with a low complication rate, low morbidity, and renal preservation. Our experience adds value to the existing literature and is valuable in the assessment of RAPN. 107 PODIUM #77 ROBOTIC SURGICAL MANAGEMENT OF UPPER TRACT UROTHELIAL CARCINOMA Joseph Pugh, Daniel Willis, Aaron Grossman, Sijo Parekattil and Li-Ming Su University of Florida, Department of Urology, Gainesville Florida (Presented By: Joseph Pugh) Introduction: Robotic upper urinary tract surgery has become more commonplace in the field of urology. Herein, we present our institution’s experience and outcomes of robotic management of upper tract TCC including robotic nephroureterectomy (RNUx) and distal ureterectomy with psoas hitch reconstruction. Purpose: This retrospective study evaluates the efficacy of robotic surgical management for upper tract urothelial cancers with respect to oncologic and perioperative outcomes. Materials and Methods: 12 patients mean age 63 underwent RNUx between 5/16/2007 and 6/10/2010. In addition, four patients mean age 65 underwent robotic distal ureterectomy between 10/1/2008 and 6/15/2009. A three armed robotic technique was utilized in all cases with a two robot docking configuration for the RNUx cases. The entirety of all procedures was performed by robotic technique. Results: In the RNUx operations (7L sided/5R sided), mean operative time was 254 minutes (165 – 390), blood loss 96 mL (50 – 300) and length of hospital stay 2.6 days (1 – 5). Pathology was T1a in 7, T3a in 4, and one carcinoma in situ and nephrogenic adenoma. The distal ureterectomies were all left-sided, mean operative time was 248 minutes (210 – 285), blood loss 56 mL (50 – 75) and length of hospital stay 2.2 days (1 – 3). Pathology was pT3, CIS and two fibrosis. All surgical margins were negative. There was only one perioperative complication in the distal ureterectomy group involving an isolated incident of rhabdomyolysis and prolonged ileus. No recurrences have been found on routine surveillance cystoscopy with a mean followup period of 16 months. Conclusion: RNUx and distal ureterectomy are an alternative to laparoscopic and open techniques and may be most beneficial for surgeons with limited laparoscopic experience or robotic teams hoping to expand their robotic offerings. These techniques may also serve as a stepping stone to performing more complex robotic renal surgery such as a robotic partial nephrectomy. PODIUM #78 IS ROBOT-ASSISTED PARTIAL NEPHRECTOMY AN EFFECTIVE TECHNIQUE ON T1B (4 – 7CM) RENAL LESIONS? Arthur Caire, Chris Bayne, Aaron Bernie, Aaron Boonjindasup and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire) Introduction: Robotic-assisted partial nephrectomy (RAPN) has become more widely used for removal of renal lesions >4 cm. Objectives: To analyze robot-assisted partial nephrectomy( RAPN) compared to laparoscopic radical nephrectomy (LRN) on clinical T1b (4 – 7cm) lesions Materials and Methods: A cohort of 279 laparoscopic and robotic nephrectomies from 2000 to 2010 was reviewed. Age at surgery, preoperative tumor size, estimated blood loss (EBL) and pathological data including margin status as well as upstaging and downstaging data was compared between RAPN and LRN for all lesions 4 – 7 cm on preoperative imaging. Preoperative size, EBL, and surgical approach underwent multivariate analysis comparing surgical margin status. Results: There were 53 patients that met the inclusion criteria: RAPN (15.1% ) and LRN (84.9%). The median preoperative tumor size for the RAPN group was 4.7 cm (4.2, 5.8) (median (interquartile range)) and 5.2 cm (5.0, 6.2)for the LRN group (p=0.012). Age at surgery (RAPN: 55.5 years (52.3, 65.8) LRN: 64.0 years (54.0, 73.5)), EBL (RAPN: 200 cc (100, 250) LRN: 100 cc (50,200)) or pathological tumor size (RAPN: 4.4 cm (4.0, 5.0) LRN: 5.0 cm (4.4, 6.0) showed no significant difference (p >0.05). There was no significant difference in surgical margin status, upstaging or downstaging between the RAPN group and the LRN group (p >0.05). Multivariate analysis showed no difference in surgical margin based on surgical approach, EBL, or preoperative size (p> 0.05). Conclusion: RAPN is an effective approach for preoperative renal lesions measuring 4 – 7 cm given appropriate patient selection and an experienced robotic surgeon. 108 PODIUM #79 ROBOTIC ASSISTED LAPAROSCOPIC PROSTATECTOMY AFTER FAILED HIGH-INTENSITY FOCUSED ULTRASOUND: EFFICACY AND OBSERVATIONS Adam Stewart, Jared Moss, Bruce Woodworth and Paul Hatcher University of Tennessee Graduate School of Medicine, Knoxville, TN (Presented By: Adam Stewart) Introduction and Objectives: High-Intensity Focused Ultrasound (HIFU) is used for the treatment of localized, low risk prostate cancer; however, data regarding efficacy is scant and it is not currently approved for use in the United States. Methods: We retrospectively reviewed 2 patients who underwent HIFU with curative intent for the treatment of clinically low grade and low volume prostate cancer. They subsequently had robotic-assisted laparoscopic prostatectomy for incompletely treated and progressive prostate cancer. PODIUM SESSIONS Results: Prior to HIFU treatment, both of our patients had unilateral disease, Gleason score 3 +3 = 6 pathology, and PSA of less than 10. After HIFU treatment, they both had an initial decrease in PSA, but, 6 – 9 months later, they had a rising PSA which prompted a repeat prostate needle biopsy. Repeat biopsies revealed persistent cancer and both patients underwent robotic-assisted laparoscopic prostatectomy. Surgical dissection was modified secondary to a loss of natural tissue planes. Final pathology showed bilateral, high-volume and high- grade disease. After a median of 2.5 years (range 2 – 3 years) of follow up, both patients have an undetectable PSA. Conclusion: Based on our experience, HIFU can lead to incompletely treated prostate cancer still confined to the prostate gland with early failure and the need for definitive treatment by a standard modality. Robotic- assisted laparoscopic prostatectomy can be performed with acceptable short term PSA control in patients who have previously undergone HIFU. Longer follow-up and more patients would be needed to evaluate long-term cancer control outcomes. PODIUM #80 LAPAROENDOSCOPIC SINGLE SITE SURGERY: INITIAL EXPERIENCE IN ADULTS AND PEDIATRIC PATIENTS Alejandro Rodriguez, Mark Rich, Fernando Coste-Delvecchio, Raoul Salup and Hubert Swana University of South Florida, Department of Urology, Tampa, Florida (Presented By: Alejandro Rodriguez) Introduction and Objectives: Laparoendoscopic single site (LESS) surgery has recently been applied in adult urological cases. We report our initial experience with LESS surgical techniques for the treatment of pediatric and adult urology cases. Methods: From May 2009 to July 2010, 15 LESS surgical cases were performed. We analyzed the single port device used, patient’s age, height, weight, BMI, operative room (O.R) time, complications, and follow-up. Results: Of the 15 cases performed, twelve were varicocelectomies, one simple nephrectomy, one partial nephrectomy and one bilateral gonadectomies. In two patients, we used the “ASC” single port device and in thirteen, the “Covidien” single port. For the varicocele cases and the gonadectomy case the mean patient age, height, weight, BMI, and O.R. times were: 15 years (11−18), 1.6 meters (1.59−1.81), 64 kilograms (39−121), 21.9 (15.2−38.6), 45.5 minutes (29−68), respectively. The patient that had the simple nephrectomy was 14 years, 1.77 meters, weighted 66 kg, had a BMI of 21, and the O.R time was 150 minutes. The partial nephrectomy was 62 years, 1.80 meters, weighted 100 kgs, had a BMI of 31, and the O.R time was 160 minutes. It was a 3 cm exophitic cystic mass, and surgery was done without vascular clamping. The varicocelectomies and gonadectomies were outpatient surgeries. The simple left nephrectomy was discharged 48 hours after surgery. The partial nephrectomy was discharged 3 days after surgery. No patient had intraoperative, or early complications. Mean follow-up was 10 months, and no patient had late complications. Conclusion: LESS surgery in pediatric and adult urological patients is feasible, and our initial experience is encouraging. LESS surgery should be an option for both pediatric and adult surgical candidates that would like to benefit of a key-hole scarless (umbilical) surgery. Funding: None. 109 PODIUM #81 ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: THE FIRST 10 CASES IN A COMMUNITY HOSPITAL SETTING Michael McDonald Florida Hospital Celebration, Celebration, FL (Presented By: Michael McDonald) Introduction and Objectives: Robotic assisted laparoscopic partial nephrectomy (RALPN) is the fastest growing procedure in minimally invasive urologic surgery. Primarily these surgeries are being performed in academic institutions and a few private practice settings. I report our initial experience with RALPN in a private practice setting. Materials: Between June of 2009 and February of 2010, 10 patients underwent Robotic assisted laparoscopic partial nephrectomy. In total 7 males and 3 females with an age range of 29 – 71 years underwent surgery. There were 5 right sided lesions and 5 left sided lesions. All patients had bilateral functioning renal units and all lesions were solitary in nature. Vascular control was performed in all cases but one with bulldog clamps. Results: Robotic assisted Laparoscopic Partial Nephrectomy was performed in all 10 patients. Mean estimated blood loss was 222.5cc (range 50 – 900cc). Mean warm ischemic time was 26.3 minutes (range 19 – 37minutes) in the 9 patients that had vascular occlusion. Mean hospital stay was 2 days (range 1 – 3 days). Postoperative serum creatinine levels remained at baseline in all patients. Postoperative CT scans done in 9/10 patients revealed normal functioning renal units in all cases. Tumor size ranged from 13mm to 5.3 cm. Seven of the 10 patients had renal cell carcinoma with one margin being positive. This case culminated in nephrectomy 3 months after the initial surgery was performed with a residual 9mm cancerous mass at the prior resection site. One patient had chronic focal nephronia, while 2 patients had non cancerous complicated renal cysts. Conclusion: Robotic assisted laparoscopic partial nephrectomy was performed in the private practice setting with success. It appears that RALPN can be initiated in the private practice setting and utilized along with open and laparoscopic techniques for nephron sparing surgery. PODIUM #82 RADIOFREQUENCY ABLATION OF SMALL RENAL MASSES: 8.75 YEAR EXPERIENCE AT A SINGLE INSTITUTION Raymond Leveillee, Scott Castle, Nelson Salas, Vladislav Gorbatiy and Watid Karjanawanichkul University of Miami, Department of Urology, Miami, FL (Presented By: Scott Castle) Introduction and Objectives: With the increased incidence of low stage renal cancers, thermal ablation technology has emerged as a viable treatment option. Current AUA guidelines include thermal ablation as a treatment modality in select individuals. We present an 8-year, single institution experience with radiofrequency ablation (RFA) of small renal masses. Materials and Methods: We reviewed our prospectively collected RFA database of patients with renal masses treated from Nov 2001 to Aug 2010 undergoing laparoscopic or CT guided percutaneous RFA with or without simultaneous peripheral fiber-optic thermometry (Lumasense, Santa Clara, CA). Data was collected for patient demographics, surgical outcomes and clinic-pathologic outcomes. Results Obtained: A total of 291 patients (208 male, 83 female) aged 31 – 88 years (mean 67) with 308 renal tumors underwent laparoscopic (116) or percutaneous (192) RFA with CT guidance. 11 patients had more than 1 tumor ablated during surgery (11 Lap, 6 CT, one patient with 6 ablations), and 38 (13%) had no peripheral thermometry. 115 complications occurred in 73 patients, where 74, 16, 11, 4 were Clavien grade I, II, III, IV respectively. 155 Right-sided and 153 Left-sided tumors had a mean size of 2.6cm (0.8 – 5.3). Intraoperative biopsy, prior to ablation, was performed in 304/308 (98.7%) tumors, with 204 (67%) being Renal Cell Carcinoma (RCC), 84 (28%) benign tumors, 14 (4.6%) with an indeterminate biopsy, and 1 biopsy with metastatic lung cancer. Patients were followed by contrast enhanced CT scans at 1 month, 6 months, and annually with a mean follow−up of 20.6 months (0.5 – 84). Nine patients were followed with a non-contrast MRI due to renal insufficiency. 14/204 (6.9%) patients with RCC had persistent enhancement on follow-up imaging. Of those, 10 patients underwent re-ablation with concurrent biopsy whereas 3 patients chose to undergo a re-biopsy, and one refused biopsy. Six patients had persistent RCC on biopsy. Biopsy proven recurrence rate was 2.9%. Two patients died due to metastatic RCC, and 6 of other causes. Cancer free survival rate was 99.0% at mean follow up of 20.6 months. Patients had a no change in renal function based on preoperative and postoperative eGFR. Conclusion: RFA has shown to be clinically effective, nephron-sparing and safe the treatment of small renal masses. Our large cohort adds to the building evidence for the efficacy of RFA for small renal masses. 110 PODIUM #83 THE CURRENT STATE OF SURGICAL INTERVENTION FOR PERINATAL TORSION: AN INTERNATIONAL SURVEY OF PEDIATRIC UROLOGISTS AND REVIEW OF THE LITERATURE Benjamin G. Martin, David M. Kitchens, C.D. Anthony Herndon and David B. Joseph University of Alabama at Birmingham, Birmingham AL (Presented By: Benjamin G. Martin) Introduction: The workup and treatment of perinatal testicular torsion, both prenatal and postnatal torsion, is controversial. Classic teaching dictates the use of an inguinal incision to approach the testicle; however, many urologists choose to perform a scrotal incision. While prompt surgical treatment is the rule for postnatal torsion, the timing of surgery for prenatal torsion is controversial. The management of the contralateral testicle at the time of surgery is also variable. We performed an international survey to assess current trends. Methods: In May of 2010 an internet survey was administered to members of two pediatric urology societies (SFU and SPU). Three clinical scenarios outlined cases of prenatal, postnatal, and bilateral prenatal torsion. PODIUM SESSIONS Respondents were asked if they would use ultrasound to confirm the diagnosis, when they would operate, what incision they would use and how they would manage the contralateral testicle. Results: We had a total of 121 responses to the survey. The respondents were academic faculty (68%), private practice with a focus in pediatric urology (30%) and fellows (2%). When presented with a scenario outlining a child with a classic prenatal torsion, 84% would perform an ultrasound to confirm the diagnosis. The time frame to operate for prenatal torsion was immediate (34%), urgent (26% ) (within 72 hrs), elective (28%), and no exploration (12%). 93% would perform a contralateral orchiopexy at the same time. 75% would use a scrotal incision while 25% would use an inguinal incision. When presented with a child that has a classic postnatal torsion 77% would confirm the diagnosis with an ultrasound. The time frame to operate for postnatal torsion was immediate (89%), urgent (1%), elective (2%) and no exploration (8%). 96% would perform a contralateral orchiopexy at the same time. 75% would use a scrotal incision while 25% would use an inguinal incision. Finally, a case of bilateral prenatal torsion was described and 93% said they would confirm the diagnosis with an ultrasound. The time frame to operate for bilateral prenatal torsion was immediate (90%), urgent (1%), elective (2%), and no exploration (7%). 80% would use a scrotal incision for this case. Conclusion: We documented variability of timing for intervention of prenatal torsion and confirmed that most view postnatal torsion as a surgical emergency. Interestingly, most choose to perform a contralateral orchiopexy for prenatal torsion despite the fact that most cases are extravaginal and not associated with fixation defects. While the timing for treatment of prenatal torsion remains controversial, the surgical approach via a scrotal incision appears to be popular. PODIUM #84 RISK FACTORS FOR HEMORRHAGIC CYSTITIS AFTER BONE MARROW TRANSPLANTATION IN 849 CHILDREN Jodi Antonelli¹, Hasan Irkilata², Jeremy Wiygul³, Dan Moreira¹, Paul Martin¹ and John Wiener¹ ¹Durham, NC; ²Ankara, Turkey; ³Long Island, NY (Presented By: Jodi Antonelli) Introduction and Objective: Hemorrhagic cystitis (HC) is a well-known complication in patients undergoing bone marrow transplantation (BMT). We sought to identify factors associated with HC in pediatric patients undergoing BMT for benign and malignant diseases. Methods: After obtaining institutional review board approval, 849 children (age 4 days – 25 yrs, median 5.9 yrs) who underwent BMT between Jan. 1999 and Dec. 2008 at Duke University Medical Center were included in this study. HC was graded 1 – 4 (1= microscopic, 2= gross hematuria without clots, 3= gross hematuria with clots requiring transfusion, 4= gross hematuria that required surgery). Grades 3 – 4 were considered severe HC. Age at BMT, gender, race, underlying diagnosis, prior transplantation, BMT type (allogeneic vs autologous), and source of cells (peripheral blood, bone marrow, cord blood) were obtained by retrospective chart review. Univariate analyses were performed with rank sum and chi-square and multivariate analyses were performed with multivariate logistic regression. Results: HC was found in 120 patients: 76 (9%) Grade 2, 33 (4%) Grade 3, and 11 (1%) Grade 4. Older age at BMT was a risk factor for development of HC (p<0.01) and severe HC (p<0.01). African-American race was strongly associated with HC (p<0.01) and severe HC (p<0.01). Additionally, a race of “other” was associated with severe HC (p<0.01). Patients with a history of prior bone marrow transplantation had a significantly higher incidence of severe HC (p=0.03). Patients undergoing allogeneic transplants had a significantly higher incidence of HC (p<0.01) and severe HC (p=0.01) compared to patients undergoing autologous transplant. Additionally, patients transplanted with marrow or cord blood cells had a higher incidence of HC (p<0.01) and severe HC (p=0.05) than those undergoing peripheral blood cell transplants. On multivariate analysis older age (OR= 1.09, p<0.001), black race (OR= 3.27, p<0.001), and source of cells, specifically marrow (OR= 5.35, p=0.027) and cord (OR= 12.68, p<0.001) were predictors of HC. Similarly older age (OR= 1.08, p=0.004), race of black (OR= 6.98, p<0.001), and “other” (OR= 4.38, p=0.001), and donor characteristics specifically haplo (OR= 10.01, p=0.013) and unrelated (OR= 2.55, p=0.062) were significant predictors of severe HC. Conclusion: To our knowledge, this is the largest study of its kind. These results suggest that age at BMT, race, underlying diagnosis and source of cells are factors that can affect development of HC in pediatric BMT patients. Defining these risk factors may be an important step in determining the pathophysiology and developing preventative measures for this significant morbidity. 111 PODIUM #85 A SIX YEAR EXPERIENCE OF OPEN RENAL AND BLADDER SURGERY PERFORMED AT A FREE-STANDING PEDIATRIC SURGERY CENTER Adam Stewart¹ and Preston Smith² ¹University of Tennessee Graduate School of Medicine, Knoxville, TN; ²East Tennessee Children’s Hospital, Knoxville, TN (Presented By: Adam Stewart) Introduction and Objectives: More ambulatory urologic surgeries are being performed in children because of innovations in techniques and trends in medical care. Pediatric ambulatory surgery centers are now encountering more complex procedures that were traditionally hospital based. Methods: From July 2003 – October 2009, 343 open renal and bladder surgeries were performed by a single pediatric urologist at a free-standing pediatric surgery center located 12 miles from a children’s hospital. Retrospective chart analyses were performed to determine the demographics and complications that necessated a hospital stay within 48 hours of discharge. The renal procedures were usually pyeloplasty and nephrectomy. Bladder surgeries usually consisted of ‘simple’ reimplantations (unilateral, bilateral, duplications) and ‘complex’ reimplantations (tapering, ureteroceles, diverticula). Protocol prevented children with significant comorbidities to have surgery at the center. Multiple factors including patient age, surgical scheduling, and parent preference influenced the surgeon’s decision on whether to perform the procedure at the outpatient center. Results: Twenty-eight children (18 male, 10 female) ages 4 mos – 6 yrs (mean 1.62 yrs) underwent nephrectomy and 50 (male 25, female 25) ages 3 mos – 12 yrs (2.92 yrs) underwent pyeloplasty. Simple reimplantations were performed on 216 children (34 male,182 female) ages 8 mos – 21 yrs (4.01 yrs). Complex reimplantations were performed in 49 children (20 male, 29 female) ages (5 mos – 12 yrs)(2.79 yrs). Thirteen patients underwent additional unrelated procedures at the time of their renal or bladder surgery. Ureteral and bladder catheters were rarely used during renal and simple reimplantation procedures. Two children were acutely transferred to the hospital due to pain management (1) and respiratory distress (1). Two other children were admitted to a hospital within 48 hours; one due to partial ureteral obstruction and one due to dehydration and UTI. All 4 of these patients underwent ‘simple’ reimplantation surgeries. Conclusion: In our surgery center experience of 343 open renal/bladder surgery in children, only 2 were transferred to a hospital and 2 were admitted within 48 hours. Carefully selected children undergoing open renal and bladder procedures can be expected to be discharged the same day. Older children, those with significant comorbidities and those performed later in the day may not be ideal outpatient candidates. Nephrectomy, pyeloplasty, and ureteral reimplantations are excellent outpatient procedures in most children. PODIUM #86 USE OF FIBRIN GLUE AS AN ADJUNCT IN HYPOSPADIAS REPAIR Ayme Schmeeckle, Dennis Venable and John Mata LSUHSC Shreveport, LA (Presented By: Ayme Schmeeckle) Introduction: Previously, we reported a positive experience with fibrin glue (Tisseel TM) in securing skin grafts during genital reconstruction. It has been suggested that fibrin glue may decrease incidence of urethrocutaneous fistulae and postoperative bleeding when used during hypospadias surgery. Herein, we report our results ofa retrospective review comparing a cohort of patients with mid to distal shaft hypospadias undergoing primary tubularized incised plate (TIP) with and without fibrin glue. Methods: We reviewed a group of 39 patients, ages 7 months to 14 years, who underwent a TIP hypospadias repair from 2008 to 2010. 13 patients had a thin layer of fibrin glue applied over the neourethra and 26 patients did not. Averages ages were 27 months in the fibrin group and 10 months in the non-fibrin group. Two patients in the fibrin group had midshaft hypospadias compared to seven in the non-fibrin group. All patients had urethral catheters for 5 to 7 days postoperatively and Tegaderm dressings. We compared the complication rates of the two groups at a mean follow-up of 15 months. Results: Although there was a subjective assessment that minor bleeding stopped more readily in the fibrin group intraoperatively, estimated blood loss in all patients was negligible since all repairs were done with tourniquet control. No patient in either group developed significant hematoma or required return to the operating room for postoperative bleeding. In the fibrin group, 6 of the 13 (46.15%) patients developed a urethrocutaneous fistula compared to 2 of 26 (7.69%) in the non-fibrin group. One patient in each group had a partial glans dehiscence associated with the fistula. All patients who elected for fistula repair received successful surgical correction in the standard fashion without fibrin glue at 6 months postoperatively. 112 Conclusion: Patients receiving fibrin glue had a greater than six fold increased incidence of fistula formation. These findings suggest that fibrin glue may disrupt normal tissue incorporation in the postoperative healing phase. Although fibrin glue helped stop bleeding from glansplasty, it made no difference in the overall estimated blood loss. Many factors potentially influence healing of the neourethra in hypospadias repair including technique, suture material, tissue quality, the use of preoperative hormones, barrier layers, urinary diversion and dressings. Further basic science studies on wound healing with fibrin glue as well as larger clinical prospective, randomized trials are needed to help define the role of fibrin glue in hypospadias surgery. Until the results of such trials are known, fibrin glue should be used with caution in patients undergoing hypospadias repair. PODIUM #87 L5-S3 LUMBAR TO SACRAL NERVE REROUTING TO RESTORE BLADDER AND BOWEL FUNCTION IN NEUROGENIC PATIENTS: A NEUROSURGICAL PERSPECTIVE Ravish Patwardhan¹, Ryan Vidrine², John Mata² and Timothy Gilbert¹ PODIUM SESSIONS ¹Interactive Neuroscience Center, LLC & Comprehensive Neurosurgery, LLC, Shreveport, LA; ²Dept. of Urology, Louisiana State University Health Sciences Center – Shreveport, LA (Presented By: Ryan Vidrine) Introduction and Objectives: We present the Xiao technique involving splicing a portion of L5 into S3 to restore bladder and bowel function in patients suffering myelomeningocele (MMC), spinal cord injury and in a unique case in which a patient presented six years after traumatic gunshot injury to the lumbosacral roots. Methods: One seven-year-old patient who suffered a gunshot wound to her spine six years prior leaving her with urinary incontinence, and two female patients born with MMC-related incontinence (ages 5 and 26) were treated using the Xiao (L5-S3) anastomosis. All patients underwent pre- and post-operative urodynamics. Results: The surgical procedure was technically feasible in all cases. The 7-year-old girl had dramatic restoration of her bladder function in less than 4.5 months. At two years post-operation, she has regained sensation and markedly improved continence. In each of the MMC patients, successful nerve anastomosis was achieved, with incontinence control pending in both. One of these patients suffered spinal headaches relieved by injecting fibrin glue but no other significant complications were noted. Conclusion: Our experience has led us to identify many unique aspects of this procedure: (1) Somatic-to- visceral nerve anastomosis can be performed after trauma such as a gunshot wound, (2) the anastomosis can successfully restore function even after an extended period, (3) the rerouting procedure can be done without any perceptible weakness in leg function or numbness, (4) the procedure does not rely only on unilateral nerves (L5 can be connected to the contralateral S3 with the same outcomes) and (5) this procedure has the ability to restore both bowel and bladder function. Thus, for selected cases, the Xiao L5-S3 nerve rerouting may be a reasonable option to restore both bladder and bowel function. PODIUM #88 UTILITY OF URODYNAMICS IN THE MANAGEMENT OF OCCULT TETHERED CORD IN CHILDREN Oxana Munoz, David Kitchens, Anthony Herndon and David Joseph University of Alabama at Birmingham, Department of Surgery, Division of Urology, Birmingham, Alabama (Presented By: Oxana Munoz) Introduction and Objectives: Treatment of occult tethered cord is controversial. Recently, we have noted an increase in neurosurgical requests for urodynamic studies (UDS) prior to release of occult tethered cord. We attempted to determine if normal preoperative UDS influence the neurosurgeon’s decision to operate on an otherwise asymptomatic patient with a tethered cord. Methods: A retrospective review was performed of 120 patients diagnosed with primary tethered cord from 2007 – 2010. Inclusion criteria included MRI diagnosis of tethered cord and UDS performed by one of three pediatric urologists. Exclusion criteria included any neurologic or urologic dysfunction or associated syndromes, as well as other significant co-morbidities. Results: 41 patients (female 29; male 12), mean age of 3.4 years (0.4 – 16.3) were diagnosed with an occult tethered cord. Various conditions prompted a MRI that led to the diagnosis, including asymmetric gluteal cleft (10), sacral dimple/coccygeal pit (11), scoliosis work up (7), cutaneous hemangioma (6). All urodynamic parameters were reviewed pre and post operatively, including capacity, compliance, PVR, DSD, VUR, detrusor overactivity, and evaluation of bladder neck on video urodynamics. The majority of the patients had normal preoperative renal ultrasounds. 78% (32) children had normal preoperative UDS, 31% (10) of those patients did not undergo a surgical intervention. Postoperatively, two patients had improved UDS parameters and 2 had worsening UDS parameters, including high PVR and DSD. Of the 9 patients with abnormal UDS, 8 were female with normal renal ultrasound findings and no other significant differences in presentation than the patients with normal UDS. Conclusion: In children with occult tethered cord preoperative UDS do not significantly impact the decision to surgically intervene in children with primary tethered cord. There is not a significant correlation between abnormal preoperative UDS and imaging. More studies need to be performed to evaluate the utility of this invasive procedure in the preoperative setting in this patient population. 113 PODIUM #89 IS A VALIDATED SYMPTOM SCORE PREDICTIVE OF ABNORMAL FINDINGS ON UROFLOWMETRY IN CHILDREN WITH BLADDER / BOWEL DYSFUNCTION? Benjamin M. Whittam, Douglass B. Clayton, John C. Thomas, John C. Pope, IV, Mark C. Adams, John W. Brock, III and Stacy T. Tanaka Vanderbilt University, Nashville, TN (Presented By: Benjamin M. Whittam) Purpose: The importance of objective data to characterize symptoms of pediatric bladder / bowel dysfunction is well recognized. We sought to determine if objective data from a validated symptom score questionnaire correlated to uroflowmetry data. Methods: Starting in January 2010, we had families of children being seen for LUTS and/or recurrent UTI complete the University of British Columbia symptom score questionnaire for dysfunctional elimination syndrome (K Afshar et al, J Urol 182:1939, 2009). The UBC symptom score ranges from 0 to 52 where scores > 11 show good sensitivity and specificity for dysfunctional elimination syndrome. We retrospectively reviewed symptom scores in patients undergoing uroflowmetry with or without videourodynamics. We excluded patients with known reasons for neuropathic bladder dysfunction. We determined whether increased symptom score was associated with an abnormal study where abnormal study was defined as intermittent or staccato flow pattern, abnormal pelvic floor EMG while voiding, and/or residual volume >30% of expected capacity. Responses to individual questionnaire items were also compared to specific uroflowmetry findings. Results: To date, 26 eligible patients have completed the symptom score questionnaire. Only 21 were included in this analysis because of insufficient voided volume on uroflowmetry (<100mL) in 5. The average symptom score was 17.9 (range: 5 to 31). Abnormal uroflowmetry was found in 14. Additional abnormal videourodyamics findings in these patients included pressure > 10cm H2O at expected capacity and detrusor overactivity. Abnormal uroflowmetry was not associated with higher symptom scores (p>0.05, logistic regression). Interestingly, the questionnaire item querying intermittent stream was not associated with intermittent or staccato stream on uroflowmetry (p >0.05, Fisher’s exact test). Conclusion: Data from symptom score questionnaires are much needed in clinical studies to quantify symptoms in patients with bladder / bowel dysfunction. However, they cannot replace other objective findings such as noninvasive uroflowmetry. PODIUM #90 THE INCIDENCE OF LYMPHOCELES AFTER ROBOT-ASSISTED PELVIC LYMPH NODE DISSECTION Marcelo Orvieto, Sanket Chauhan, Rafael Coelho, Kenneth Palmer, Pablo Marchetti, Ananth Sivaraman and Vipul Patel (Presented By: Marcelo Orvieto) Introduction and Objectives: The frequency of lymphocele formation after pelvic lymphadenectomy (PLND) during robot-assisted radical prostatectomy (RARP) is unclear and likely underestimated. We sought to determine the incidence and predictive factors of lymphocele formation in patients undergoing PLND during RARP. Methods: Between April – December 2008, 76 consecutive patients underwent PLND during RARP for ≥cT2b, PSA≥10, Gl≥7 prostate cancer. All patients were prospectively followed with pelvic CT at 6 – 12 weeks after the procedure. All pts received subcutaneous heparin preoperatively and postoperatively. PLND was limited to zones 1 & 2 as defined by Studer. Plasma-kinetic (PK) bipolar forceps were used for hemostasis during PLND. Results: Median lymph node yield was 6 nodes per side (range 2 – 12). At a mean follow up of 10.8 weeks, 51% (39/76) of pts had developed a lymphocele. Of these, 32/39 (82%) were unilateral, while 7 pts (18%) developed bilateral lymphoceles. Mean size was 4.3 x 3.2cm (range 1.5 – 12.3cm) with 41% lymphoceles <4cm, 53.9% 4 – 10cm, and 5.1% >10cm in diameter. Of the patients with radiologically apparent lymphoceles, 15.4% (6/39) were clinically symptomatic (pelvic pressure (5/6), abdominal distension with ileus (3/6), leg pain/weakness (1/6), and costovertebral tenderness (1/6) and one required intervention. On the logistic regression model the presence of nodal involvement, tumor volume in the prostate specimen and extracapsular extension were independent risk factors for the development of a lymphocele. There was no correlation between EBL, BMI, pathologic Gleason score and number nodes retrieved dissected to the presence of lymphocele. Conclusion: The incidence of lymphoceles was higher than anticipated given the believed protective effect of the transperitoneal approach against lymphocele formation. Furthermore, PK bipolar forceps do not seem to adequately seal lymphatic channel and prevent lymphocele formation. The risk of lymphocele seemed to increase linearly with the presence of more extensive disease, particularly ECE and nodal involvement. The benefit of PLND during RARP should be weighed against the elevated risk of lymphocele formation and its potential complications. Due to the exceedingly high lymphocele rate observed, we have switched to the use of Hemo-lock clips while performing PLND. Further studies are needed to evaluate the exact incidence of lymphocele formation with this technique. 114 PODIUM #91 DOES ROBOTIC RADICAL CYSTECTOMY FOR BLADDER CANCER AFFECT LONG-TERM HEALTH− RELATED QUALITY OF LIFE? J. Patrick Selph, Joshua Langston, James Fergueson, Ankur Manvar, Angela Smith, Sachin Vyas, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: J. Patrick Selph) Purpose: In recent years, surgeons have begun to report case series of minimally invasive approaches to radical cystectomy including robotic-assisted techniques—demonstrating the surgical feasibility of this procedure with reported benefits of reduced blood loss and more rapid return of bowel function and hospital discharge. However, the long-term effects on a patient’s health-related QOL remain uncertain. We compared the health related quality of life in patients undergoing radical cystectomy and urinary diversion for bladder cancer analyzing the impact of surgical technique on these outcomes measures. PODIUM SESSIONS Methods: The Functional Assessment of Cancer Therapy-Bladder (FACT−BL) and SF-12 QOL instruments were administered to 52 patients who had undergone a radical cystectomy and urinary diversion at our institution between 1/05 – 8/08. Patients were stratified based on the surgical technique utilized – robotic- assisted laparoscopic (n=33) versus open (n=19) approach. Results: The mean follow-up since cystectomy was shorter for the robotic versus open patients (21.7 vs. 29.6 months; p=0.041). No other differences were observed with regard to age, gender, race, or diversion type between the two groups. The table shows the FACT-Bl domain scores and SF-12 scores for robotic versus open patients. Note, no differences were noted among any of the FACT-Bl domains nor in the SF-12 physical and mental scores. The only statistically different score was found in the FACT-Bl questions addressing interest in sex (BL4) and ability to have/maintain an erection (BL5) – both which were higher for the robotic approach (p=0.011 and p=0.035, respectively). Conclusion: No significant differences occur with regard to long-term health-related quality of life measures between patients undergoing a robotic versus an open surgical approach to radical cystectomy for bladder cancer. Given the limited number of subjects in this study, a larger multi−institutional analysis is required to better study this important question. Key: GP=physical; GS= social/family; GE=emotional; GF=functional; AC=additional concerns; PCS=physical score; MCS=mental score 115 PODIUM #92 ROBOTIC RADICAL CYSTECTOMY: MEDIUM−TERM ONCOLOGIC FOLLOW−UP J. Patrick Selph, Joshua Langston, Aaron Martin, Angela Smith, Sean Sawh, Mathew Raynor, Matthew Nielsen, Eric Wallen, Erik Castle and Raj Pruthi (Presented By: J. Patrick Selph) Purpose: Little study has been undertaken to evaluate longer-term outcomes of robotic approaches to radical cystectomy – especially with regard to oncologic outcomes. We report our experience with robotic radical cystectomy (RRC) with regard to medium-term (at least 2 year) oncologic outcomes. Methods: 271 patients have undergone RRC and urinary diversion at one of two institutions for clinically-localized bladder cancer between 2005 – present. From this combined case series, we performed a retrospective analysis of the 139 patients who underwent surgery at least 2 years prior to allow for adequate clinical follow-up and time to recurrence. Medium term oncologic outcomes including recurrence rates, time to recurrence, RFS and DSS. Follow-up was measured from time of surgery to time of most recent clinical follow-up. Results: This cohort of patients with at least 2 years since their date of surgery consisted of 108 men (78%) and 31 women (22%) at a mean age of 67.3 years (range 45 – 86 years). Sixty-one (44%) patients had <=pT2 disease, 38 (27%) pT3/T4 disease, and 40 (29%) N+ disease. The mean number of lymph nodes removed was 18 (range 3 – 41). Mean clinical follow up in this case series was 35.9 months (range 24 – 64 months). At this follow-up, 39 patients have recurred, 27 patients died of disease, and 5 patients died of other causes giving RFS, DSS, and OS rates of 80%, 71%, and 68%, respectively. The mean (median) time to recurrence was 12.3 months (10 months). These findings are consistent with prior reports of such oncologic outcomes in open series. Conclusion: The oncologic follow-up of patients undergoing RRC appears to be favorable with acceptable outcomes in the medium-term (mean 36 months). As our follow-up increases, we should expect to truly define the long-term clinical appropriateness and oncologic success of this procedure. PODIUM #93 IMPACT OF ROBOT ASSISTED RADICAL CYSTECTOMY ON PERI-OPERATIVE MORBIDITY: COMPARISON OF 150 CONSECUTIVE RADICAL OPEN AND ROBOTIC CYSTECTOMIES Kyle A. Richards, A. Karim Kader, Joseph A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards) Introduction: Open radical cystectomy (ORC) with pelvic lymph node (LN) dissection is the standard of care for the management of muscle invasive and select, high grade, non-muscle invasive bladder cancers. This procedure carries high peri-operative morbidity rates. Purpose: To assess the impact of robot-assisted radical cystectomy (RARC) on peri-operative morbidity (as assessed by intra-operative blood loss, transfusion rate, 30-day complication rate and length of hospital stay) and short-term oncologic outcomes (as assessed by positive margin rate and LN yields) we compared our initial RARC series with a group of historical ORCs. Materials and Methods: A RARC program was established at out institution in January 2008. The RARC data was collected prospectively. An analysis was performed on a consecutive series of the last 150 patients (75 RARC and 75 ORC) undergoing radical cystectomy for curative intent from 2006 until 2010. Results: Patients in both groups had comparable pre-operative characteristics and demographics. Median blood loss and transfusion rates were less for RARC as compared to ORC patients, 275 mL (IQR 175, 500) vs. 700 mL (IQR 500, 1300) and 16% vs. 40% (p < 0.001) respectively, as were median hospital stays 7 (IQR 6, 8) vs. 8 days (IQR 7, 13) (p < 0.001). The complication rate for RARC was 39%, which compared favorably to 56% for ORC (p = 0.0495). There were also fewer major complications (Clavien ≥ 3) with RARC patients having 8% compared to 24% for ORC (p = 0.008). With respect to pathologic parameters, there were 5 positive margins (4% pT3, 30% pT4) in the ORC group compared to 9 (7% pT3, 44% pT4) in the RARC group (p = 0.262) with median LN yields of 15 (IQR 11, 22) and 16 nodes (IQR 11, 22) (p = 0.551) respectively. Conclusion: In a comparable cohort of patients we were able to demonstrate less morbidity for patients undergoing RARC as compared to ORC with similar short-term oncologic outcomes. These results are promising and warrant further investigation by way of validation from other series and analyses of longer-term outcomes. 116 PODIUM SESSIONS PODIUM #94 POSITIVE SURGICAL MARGINS AND THEIR LOCATIONS FOLLOWING ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: A MULTI-INSTITUTIONAL STUDY Sanket Chauhan, Rafael Coelho, Ananthakrishnan Sivaraman, Marcelo Orvieto, Kenneth Palmer and Vipul Patel GRI (Presented By: Ananthakrishnan Sivaraman) Objectives: Positive Surgical Margins (PSMs) are an independent predictive factor for biochemical recurrence following radical prostatectomy. We present a multi-institutional collaboration for Robot Assisted Laparoscopic Prostatectomy (RALP) to report the incidence, locations and distribution of PSMs and evaluate its predictive association with the patient’s age, BMI, serum PSA, biopsy Gleason’s grade, pathological stage and prostate weight on the location of PSMs. Methods: Between January 2002 and May 2009, we identified 8418 patients who underwent RALP at 7 institutions. The location and distribution of the margins were determined. To evaluate the trends of PSM according to pathological stage, Pearson’s chi square test was performed. To determine the predictive significance of the clinical parameters with PSM, a linear logistic regression analysis was performed on 6169 patients. Statistical analysis was performed using SAS 9.1 for Windows and a p value of <0.05 was considered statistically significant. Results: In our study, 1272/8095 patients (15.7%) had PSMs. The incidence of pT2, pT3, pT4 disease were 77.5%, 21.9% and 0.6% respectively while the PSM rates within these groups were 9.5%, 37.2% and 49% respectively. The prostate apex (35.9%) and the posteriolateral (PL) surface (28.7%) were the most common locations. On multivariate analysis, higher BMI (OR 1.03; CI 1.02 – 1.05) and lower prostate weight (OR 0.98; CI 0.979 – 0.988) were associative factors with a PSM. Higher pathological stage had higher odds of developing a PSM (pT4 vs pT2: OR 8.88; CI 4.24 – 18.62 while pT3 vs pT2: OR 4.59; CI 3.93 – 5.35). Similarly, patients with higher preoperative PSA were more likely to develop a PSM (PSA≤ 4 vs> 10: OR 2.92; CI 2.28 – 3.74). Conclusion: Prostate apex is the most common location for a PSM. Apical and PL margins are more common in organ confined disease as compared to pT3 and pT4. The independent associative factors for PSMs are increasing PSA, BMI, pathological stage and decreasing prostate size. 117 PODIUM #95 INFLUENCE OF MODIFIED POSTERIOR RECONSTRUCTION OF THE RHABDOSPHINCTER ON EARLY RECOVERY OF CONTINENCE AND ANASTOMOTIC LEAK RATES AFTER RALP Rafael Coelho, Sanket Chauhan, Ananthakrishnan Sivaraman, Kenneth Palmer, Marcelo Orvieto and Vipul Patel GRI (Presented By: Ananthakrishnan Sivaraman) Introduction and Objectives: Posterior reconstruction of the rhabdosphincter has previously been described during open Radical Prostatectomy (RP) and shorter times to return of continence were reported using this technical modification. Contradictory results have been reported, however, using this technique during Robotic- Assisted Radical Prostatectomy (RARP). We hereby describe a modified technique of posterior reconstruction (MPR) of the rhabdosphincter during RARP and report its impact on early recovery of urinary continence. Methods: We analyzed prospectively 803 patients who underwent RARP; 330 without performing MPR (group 1) and 473 with MPR (group 2), as described below. Outcomes analyzed included operative time, Estimated Blood Loss (EBL), days on catheter, presence of anastomotic leakage on cystogram and continence rates. Continence was defined as the use of ‘‘0 pads’’ based on the patient responses to the EPIC questions at 4, 12 and 24 weeks after RARP. The reconstruction was performed using two 3 – 0 poliglecaprone sutures tied together (12 cm each). The free edge of the remaining Denovilliers’ fascia was identified after prostatectomy and approximated to the posterior aspect of the rhabdosphincter and the posterior median raphe using one arm of the suture. The second layer of the reconstruction was then performed with the other arm of the suture approximating the posterior bladder neck to the initial reconstructed layer of posterior rhabdosphincter and posterior urethra. Results: There was no significant difference between the groups with respect to age, BMI, PSA, prostate weight, AUA-SS, biopsy Gleason score, EBL, operative time, number of nerve sparing procedures and days on catheter between the groups. The continence rates are described in table 1). The MPR technique resulted in statistically significant higher continence rates at 4 weeks after RARP ((42.7% vs 51.6%; p=0.016), although the rates at 12 and 24 weeks were not statistically significant. The incidence of cystographic leaks was also lower in the posterior reconstruction group compared to the group without reconstruction. (0.4% vs. 2.1%; p=0.036) Conclusion: The MPR of the rhabdosphincter during RALP resulted in statistically significant higher continence rates at 4 weeks after the procedure and lower anastomotic leak rates compared to RARP performed without posterior reconstruction. 118 PODIUM #96 ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: EVALUATION OF THE FUNCTIONAL AND ONCOLOGIC LEARNING CURVE Joshua Langston, J. Patrick Selph, James Fergueson, Ankur Manvar, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston) Introduction and Objectives: In less than a decade, robotic-assisted laparoscopic radical prostatectomy has rapidly become the most commonly performed surgical technique for prostate cancer. Some authors have analyzed the potential learning curve associated with this procedure by examining operative and pathologic metrics such as EBL, OR time and positive margins. However, little work has been undertaken to examine the longer-term effects of that learning curve with regard to functional and oncologic outcomes. We studied the impact of case experience of functional and short-term oncologic outcomes. PODIUM SESSIONS Methods: From an experience of over 700 robotic prostatectomies, we examined the outcomes of the first 300 patients in order to allow for a minimum of 18 months of clinical and oncologic follow-up. Patients were categorized in tertiles (1st 100, 2nd 100, 3rd 100 cases) in which the following outcome parameters were analyzed: PSA, EBL, LOS, positive margin rate, 1-year bRFS, 12 month continence (any pad and <=1 pad) and potency. Erectile function was classified as successful erections with or with oral meds in patients who were potent pre-operatively. Results: Differences in peri-operative factors were observed including EBL, LOS and PSM rates. Despite the differences in PSM rates, no differences in 1-year bRFS rates were observed. 12-month continence was higher in the most recent tertile, but no differences in potency was seen. Conclusion: The learning curve with robotic prostatectomy may have some long-lasting effects on continence (albeit mild), but no significant influence on short-term bRFS rates or potency. Further follow-up will be necessary to determine if these observations on functional and oncologic outcomes persist in the long term. PODIUM #97 ANATOMIC APPROACH TO BLADDER NECK PRESERVATION DURING ROBOTIC PROSTATECTOMY IS SAFE AND EFFECTIVE Scott Miller Georgia Urology, Atlanta, GA (Presented By: Scott Miller) Introduction: Bladder neck dissection during robotic prostatectomy can be the most challenging step to learn. Although more involved, bladder neck preservation can help define this complex anatomy. However, the possibility of increasing positive surgical margins and bladder neck contractures has remained the criticism of this technique. Methods: Bladder neck preservation was performed in 682 patients. Reasons for exclusion (bladder neck preservation not performed) include high volume and/or grade at prostate base, palpable nodule at prostate base, abnormal intra-operative bladder neck biopsy and technical inability to perform bladder neck preservation (anatomic considerations). The following steps of dissection were used: 1) entry (anterior); 2) peripheral; 3) intravesical; 4) median lobe; 5) exit (posterior); 6) retrotrigonal. Detailed bladder neck anatomy and brief surgical clips will be presented. Results: Positive margins were discovered at the bladder neck in 22 patients (3.2%). As an isolated positive margin, this finding was only present in 3 patients (<0.5%). These latter 3 patients have undetectable PSA’s (minimum follow up 20 months). Conclusion: Bladder neck preservation during robotic prostatectomy is safe and effective. This technique also helps facilitate urinary reconstruction. 119 PODIUM #98 PREVIOUS THERAPY FOR PROSTATE CANCER IS NOT A CONTRAINDICATION FOR ROBOT-ASSISTED RADICAL CYSTECTOMY: A SINGLE INSTITUTION EXPERIENCE Kyle A. Richards, A. Karim Kader, Joseph A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards) Introduction: Robot-assisted radical cystectomy (RARC) with pelvic lymph node (LN) dissection is a technically challenging operation. Patients with bladder cancer that have had previous surgical or radiation therapy for prostate cancer pose a unique challenge to the robotic surgeon. Objectives: A RARC program was established at our institution in January 2008. To assess the impact of a robotic approach, we compared our initial RARC series with a group of historical open radical cystectomy (ORC) identifying patients that had a prior history of radical prostatectomy (RP), external beam radiation (XRT), or brachytherapy. Materials and Methods: Our institution’s bladder cancer cystectomy database was queried to identify all patients with a history of RP, XRT, or brachytherapy. A total of 8 patients were identified for the RARC cohort and 6 for the ORC cohort. A retrospective analysis was performed on these 14 patients undergoing radical cystectomy for curative intent. Results: Patients in both groups had comparable pre-operative characteristics and demographics. Complete operative times (including change of position and re-draping) for RARC was a median of 475 minutes (IQR 369, 538) vs. 416 minutes for ORC (IQR 370, 479) (p = 0.245); however, median blood loss was less at 225 mL (IQR 181, 338) for RARC vs. 500 (IQR 475, 638) for ORC (p = 0.02). Median hospital stay was significantly less for RARC at 6 days (IQR 5, 6) vs. 13 (IQR 8, 21) for ORC (p = 0.003). The complication rate trended down for RARC at 25%, which compared favorably to 67% for ORC (p = 0.12). With respect to pathologic parameters, there was 1 positive margins in the ORC group compared to 3 in the RARC group with median LN yields of 8 (IQR 3, 11) and 14 (IQR 8, 19) (p = 0.09) respectively. Conclusion: In a small cohort of patients with prior surgical or radiation therapy for prostate cancer that underwent RARC compared to ORC, we were able to achieve similar short-term oncologic outcomes, less blood loss and shorter hospital stays. For those experienced with robotic surgery, RARC should be considered in these complex patients as it is feasible and may offer several advantages over ORC. 120 PODIUM #99 THE EVALUATION OF THE LEARNING CURVE ASSOCIATED WITH ROBOTIC RADICAL CYSTECTOMY: INITIAL 100 CASES Joshua Langston, J. Patrick Selph, James Fergueson, Ankur Manvar, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston) Introduction and Objectives: Radical cystectomy remains one of the most effective treatment for patients with localized, invasive bladder cancer. However, little study has been undertaken to evaluate less-invasive surgical approaches to this disease. Utilizing our mature experience with robotic-assisted laparoscopic radical cystectomy (RRC), we analyzed the changes in peri-operative outcomes that may reflect progress along the learning curve. Methods: 100 patients underwent radical cystectomy and urinary diversion at our institution from 1/06 – 8/08 for PODIUM SESSIONS clinically-localized bladder cancer. Operative outcomes, pathological results, and complications were stratified by quintiles with 20 cases in each group. Multiple paired regression models were also constructed t evaluate co-variates predictive of changes or breakpoints in the learning curve. Statistical analysis was performed using SAS version 9.2 (Cary, NC). Results: Tables show the mean outcomes based on time during the experience. Statistical cutpoint for OR time occurred at case 20. On multivariate analysis, statistical cutpoint for EBL was noted at the 20th case, with no significant changes thereafter. With regard to OR time, a statistical cutpoint was noted at the 40th case. No significant changes were noted for LN count, complication rates, bowel function, or length of stay. Conclusion: Our evolving experience with robotic radical cystectomy appears to be favorable with reduction in blood loss and operative times with increasing experience. These results come in the face of applying this technique to older patients with increased comorbidities. PODIUM #100 ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY: IDENTIFICATION OF PATIENTS WHO BENEFIT FROM THE ROBOTIC APPROACH Michael Knox, Rizk El-Galley and Erik Busby ¹University of Alabama – Birmingham, Birmingham, AL (Presented By: Michael Knox) Introduction: Multiple studies examining robotic-assisted radical cystectomy (RARC) have emerged showing improved perioperative parameters while maintaining equal oncologic efficacy when compared to open cohorts. What is not clear is whether there is a specific subset of patients who clearly benefit most. We sought to examine a robotic versus an open cohort of patients undergoing cystectomy to determine what parameters might identify those who should truly be most considered for the robotic approach. Methods: A total of 58 consecutive RARCs were performed at our institution from March 2008 – May 2010. These patients were compared to 84 consecutive open cystectomies from January 2006 – May 2010. Data collected included patient characteristics, perioperative variables, hospital recovery, ≤30 day complication rates, 31 – 90 day complication rates, and >90 day complication rates and corresponding Clavien scores. 121 Results: Comparing the two patient cohorts, we found a difference for ≤30 day complication rates for robotic approach (p<0.001) but not at 31 – 90 days (p=0.408) or at > 90 days (p=0.199). When stratifying by age using 70 years as a cut-point, superior results were demonstrated for ≤30 days complication rates even when comparing robotic patients ≥70 years vs. open patients <70 years (15.8% vs. 56.8% p=0.014). When comparing ≥70 years for both robotic and open, we again found a significant difference in ≤30 day complications favoring the RARC group (15.8% vs. 60%, p=0.015). The benefit of RARC was similarly maintained in patients <70 years (28.2% vs. 56.8%, p=0.01). Furthermore, the RARC cohort demonstrated decreased EBL (p<0.0001), decrease in intraoperative fluid requirement (p<0.0001) and need for transfusion (5.2% vs. 80.1%; p<0.0001). Mean time to flatus (4.3 vs. 5.9 days; p=0.028), regular diet (5.4 vs 8.1 days; p=0.009), and length of stay were all improved in the RARC cohort (6.3 vs 10.8 days; p=0.004). Conclusion: RARC has been previously shown to have improved perioperative outcomes with equivalent oncological outcomes when compared to open cystectomy. By using a cut-point of 70 years, we have identified that those patients ≥70 years are most likely to enjoy a benefit from RARC versus the open approach—a finding that persisted even when compared to younger patients undergoing the open approach. PODIUM #101 GRADING THE DEGREE OF LEAK ON CYSTOGRAM AFTER ROBOTIC PROSTATECTOMY CAN PREDICT FOR BLADDER NECK CONTRACTURE Michael Knox, Seena Safavy, Rizk El-Galley and Erik Busby ¹University of Alabama – Birmingham Birmingham, AL (Presented By: Michael Knox) Introduction: Cystograms are often obtained after robotic-assisted laparoscopic prostatectomy (RALP) to determine the integrity of the urethrovesical anastomosis. Depending on the severity of the leak that may be detected, there is an increased risk for healing to occur by scar and, therefore, an increased risk for postoperative complications including incontinence or bladder neck contracture. By stratifying the degree of post-RALP cystographic leaks, we examined whether there was indeed an increased risk for urinary complications over a one year period and what cut-point might most predict for worsened outcomes. Methods: We retrospectively reviewed 424 patients with clinically localized prostate cancer who underwent RALP at our institution from October 2005 – March 2009. Most patients underwent a cystogram 7 – 10 days following prostatectomy and 398 cystograms were available for review. These were graded as follows: Grade 0, no extravasation; Grade I, <3cm from the anastomosis; Grade II, 3 – 6 cm from the anastomosis; and Grade III >6cm from anastomosis. Results: A total of 137 (34.4%) patients demonstrated some evidence of extravasation on cystography. No difference was present between those patients who did or did not demonstrate extravasation in terms of age, prostate volume, blood-loss and body mass index. The most common extravasation was grade I (20.1%), typically described as a wisp of contrast, followed by grade II (9.8%) and grade III (4.5%). Eight of 66 (12.1%) patients with Grade I extravasation developed bladder neck contracture, and 5/38 (13.1%) with Grade II and 7/18 (38.9%) with Grade III extravasation developed a bladder neck contracture. At 12 months, there were no differences in the number of pads used among the grades (p=0.126). Grade III extravasation was predictive of bladder neck contracture (p<0.001) and surgical intervention (p<0.001). Comparing Grade 0 to Grades I and II also predicted contracture formation (p=0.012), but did not predict for surgical intervention. The duration of extravasation increased from Grade I (13.8 days) to Grade II (24.1), but did not differ significantly between Grades II and III (24.1) (p<0.001). Conclusion: Stratifying the degree of extravasation on cystography after RALP can incrementally predict for worsening scar-related complications such as bladder neck contracture and, likewise, the eventual need for intervention. Conversely, the degree of leakage does not impact the eventual return to continence. PODIUM #102 THE ROLE OF TESTOSTERONE IN VASCULAR SMOOTH MUSCLE CELL MEDIATED MATRIX METALLOPROTEINASE EXPRESSION AND FUNCTION John Beddies, James Bienvenu, Deidra Mountain, Stacy Kirkpatrick, Wesley White, Oscar Grandas and Frederick Klein University of Tennessee Graduate School of Medicine (Presented By: John Beddies) Introduction and Objectives: The role of androgen deficiency in vascular disease is controversial. Low testosterone levels have been linked to increased intimal hyperplasia (IH), a hallmark of vessel response to injury. Matrix metalloproteinase (MMP) activity is implicated in IH development by degrading the extracellular matrix (ECM) and allowing vascular smooth muscle cells (VSMC) to migrate from the tunica media to the intimal layer. Our group has previously shown that estrogen and progesterone stimulate female VSMC migration and modulate IH development via increased MMP enzymatic activity, specifically MMP-2, the isoform primarily responsible for vascular ECM remodeling. We hypothesize that testosterone modulates MMP expression and function in male VSMCs, thereby reducing IH. 122 Methods: Male human aortic VSMCs were treated with low to high physiological concentrations of dihydrotestosterone (DHT; 0.3nM−3µM) for 24h. Control cells were incubated with delivery vehicle only. Total RNA was isolated and subjected to qPCR. Cell lysates and conditioned media were collected and subjected to Western blot analysis and in-gel zymography. Statistical analysis was performed. Results: qPCR revealed no significant change in the gene expression of MMP-2, -3, -9, MT1-MMP, or TIMP-1 or -2 (n=3). However, Western blot analysis and in-gel zymography demonstrated increases in MMP-2 protein and enzymatic activity at low physiological levels (n=2 – 3, *p<0.05, Fig1). At high physiological concentrations, both MMP-2 protein and activity returned to or below basal levels (n=2 – 3, Fig1). Conclusion: Testosterone does not affect MMP and TIMP gene expression in VSMCs. However, MMP enzymatic activity is elevated in response to low testosterone levels and subsequently decreases in the presence of high testosterone levels. Future studies will investigate this pathway’s involvement in the downstream effects of VSMC migration and proliferation, major cellular processes involved in IH development. Our data suggests the risk of developing IH may decrease with higher physiological testosterone concentrations via the downregulation of MMP activity. PODIUM SESSIONS PODIUM #103 DOES THE NEED FOR A REPLACEMENT INFLATABLE PENILE PROSTHESIS LEAD TO DECREASED PATIENT SATISFACTION? Arthur Caire, Aaron Boonjindasup, Brian Richardson and Wayne Hellstrom Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire) Objectives: To analyze the reason for replacement and overall satisfaction of a cohort who underwent surgical replacement of an inflatable penile prosthesis (IPP). Materials and Methods: A cohort of 105 patients who underwent IPP placement from 2005 to 2007 was retrieved from the prosthesis database. Approximately 21.9% (23) underwent replacement of their prosthesis due to complications and were further analyzed. Reason for removal was stratified into infectious and non- infectious (erosion, non-function and patient discomfort). Age, race (African American vs non-African American), smoking history, hypertension, diabetes, coronary artery disease and hyperlipidemia were stratified by reason for removal. Finally we contacted patients via telephone and recorded subjective satisfaction with their revision IPP. Results: The reason for IPP removal was most commonly due to a non-function (47.8%), followed by infection (30.4%), erosion (17.4%) and patient discomfort (4.3%). Age and race did not show a significant difference when analyzing reason for replacement (p>0.05). Patients who were smokers (p=0.907) had hypertension (p=0.554), diabetes (p=0.591), or hyperlipidemia (p=0.219) did not have significantly higher infection rates. Approximately 58.3% were satisfied with their current prosthesis, 75% would have the surgery performed again and 91.7% would still recommend de-novo prosthesis surgery. Conclusion: Device malfunction was the primary reason for replacement/removal at our institution. Despite the complication of prosthesis removal, the majority of patients were still satisfied with their prosthesis, would have the surgery performed again and would recommend de-novo prosthesis surgery to a friend. 123 PODIUM #104 CHARACTERISTICS OF PAIN IN VARICOCELE: DOES VARICOCELECTOMY REALLY RELIEVE THE PAIN? Majid Mirzazadeh¹, Adel Tizno² and John J. Smith, III¹ ¹Wake Forest University, Winston-Salem, NC; ²Iran University of Medical Sciences, Tehran, Iran (Presented By: Majid Mirzazadeh) Introduction: Varicocele is found in 10 – 15% of young males. It can cause infertility, pain and testicular atrophy. Controversy still persists regarding the relationship between varicocele and pain, as well as varicocelectomy and pain relief. We proposed to address this subject, in a prospective study. Materials and Methods: In a tertiary teaching center, over a 14-month period, we operated on 36 men presenting with varicocele and pain. Surgery was done with inguinal (77%) or retroperitoneal approach (23%). History, physical exam, scrotal Doppler ultrasonography and semen analysis were done before and 6 & 12 months after surgical correction. All pain characteristics were evaluated pre and post operatively using questionnaire and visual analog pain scale. Results: Thirty patients completed follow up. Their age ranged from 17 to 34 years (24.5 +/− 0.4). In 17 cases (57%) pain was the only presenting complaint. In 9 (30%) infertility was chief complaint, but they were also complaining of pain. The last 4 cases (13%) presented with painful scrotal swelling. In 27 (90%) cases, varicocele was found on the left side and in 3 cases it was bilateral. Twenty-five (83%) patients had grade III, 3 (10%) had grade ll and 2 (7%) had grade l varicocele. Pain was described as sharp in 11 (37%), vague in 10 (33%), burning in 5 (17%) and dull in 4 (13%) of patients. In 2 cases (7%), pain was severe enough (>7/10) to interfere with daily activities. Scrotal (67%), inguinal (40%), lower abdominal (36%), inner thigh (10%) and flank (3%) were the most common sites of pain perception, respectively (some cases had pain in more than one area). Pain was aggravated by walking, standing and heavy lifting in 9 (30%), by tight underwear in 2 (7%) and by cold weather in 1(3%) patient. In 60% of cases no aggravating factor identified. One year after operation, 12 patients (40%) had complete pain relief, 7 (23%) had significant improvement, 7 (23%) stated moderate improvement. Two patients (7%) had minimal improvement and the last 2 (7%) denied any pain relief. No one reported increased pain. Both of the patients without any change in pain had recurrent varicocele confirmed by Doppler. There was no relationship between pain location, surgical approach and pain relief. Conclusion: Scrotal, inguinal, lower abdominal, inner thigh and flank are the most common areas to perceive varicocele pain. Varicocelectomy relieves pain completely in 40% and moderately or more in 87% of patients. In patient with no change in pain symptoms, recurrent varicocele should be considered. PODIUM #105 HIGHER TESTOSTERONE LEVELS ARE NOT CORRELATED WITH BETTER SEMEN PARAMETERS IN INFERTILE MEN Eric Laborde¹, Ross Hogan², Daniel Stein¹, Vishal Bhalani¹, John Cashy¹, Tobias Kohler³ and Robert Brannigan¹ ¹Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL; ²Ochsner/Louisiana State University School of Medicine, New Orleans, LA; ³Department of Surgery Southern Illinois University School of Medicine, Springfield, IL (Presented By: Ross Hogan) Introduction: Testosterone is a vital component of male reproduction. However, serum testosterone levels are extremely variable with a wide range of normal values (300 ng/dL−1000 ng/dL). It is not well understood how the variability of serum testosterone correlates with semen parameters. We examined the relationship between testosterone and semen characteristics in men with a normal serum testosterone. Methods: We performed a retrospective chart review of 292 men presenting for an infertility evaluation at our institution between 2002 and 2009. All men had a morning serum testosterone drawn at presentation and at least one semen analysis performed within 30 days of testosterone measurement. In men who had more than one semen analysis performed, the semen analyses were averaged. Men were then grouped into low−normal testosterone (300 ng/dL−500 ng/dL) or high−normal testosterone (501 ng/dL−1000 ng/dL). Two hundred and forty two patients were in the low−normal group, and 50 were in the high−normal group. Average age was 34.9 (14−61) years. One hundred and six were Caucasian, 11were African American, 4 were Asian, 9 were Hispanic, and the remaining were other. Results: The mean sperm concentration was 44.8 million/mL (95% CI; 38.3−51.2) and 36.4 million/mL (95% CI; 22.5−50.3) in the low and high−normal group, respectively. Mean ejaculate volume was 3.0 mL in each group. Average motility in the low−normal group was 47.9% and was 48.5% in the high−normal group. Mean morphology (using strict criteria) was 7.8% in the low−normal group and 7.7 in the high−normal. There was no statistically significant difference between any semen parameters that were compared. Conclusion: In men with normal testosterone, there is no statistical difference between men with low−normal or high−normal testosterone with respect to their semen parameters. 124 PODIUM #106 INFECTION OUTCOMES IN PATIENTS UNDERGOING MULTIPLE PENILE PROSTHETIC-RELATED OPERATIONS: A POTENTIAL NOVEL RISK FACTOR Sisir Botta and Ronald Lewis Medical College of Georgia, Augusta, GA (Presented By: Sisir Botta) Introduction: Surgical treatment of erectile dysfunction has continued to rely on the placement of penile prosthetics. Although the design and manufacture of these devices improves, infection remains a dreaded complication. We previously reported on the significant association between priapism and prosthetic infection; we sought to expand our prior analysis of the risk factors for infection in patients who undergo multiple penile prosthetic-related operations (PRO). Methods: We performed a single surgeon, retrospective review of patients who had a PRO between January PODIUM SESSIONS 1999 and June 2009. Of these, only patients with a history of more than one PRO were included. For each PRO, operative details and patient-specific factors were examined including race and medical history related to their ED, such as diabetes mellitus (DM), cardiovascular disease (CVD), history of priapism, sickle-cell disease, spinal cord injury (SCI) and Peyronie’s disease. The association of operative and patient variables with infection risk was examined using multiple logistic regression and linear regression for dichotomous and continuous variables, respectively. Results: We identified 89 men, including 57 (64%) Caucasians and 31 (35%) African-Americans, with a median age of 66 (range 30 – 78) years. Comorbidities were DM in 39%, CVD in 40% and SCI in 6%. There were 18 patients (20%) with Peyronie’s disease, and 7 patients (8%) with a history of prolonged or recurrent priapism, including six patients with sickle cell disease. Each patient underwent a median of 3 (range 2 – 15) PROs, and the majority (71%) had penile prosthetic surgery before their referral to our institution. Significant noninfectious complications included eroded cylinder, exposed tubing requiring revision twice in one patient, urinary tract injury, epididymitis and acute urinary retention. Twelve (13%) patients experienced a total of 14 prosthetic infections following an operation at our center, for an operative incidence of 8.1%. Significant predictors of prosthetic infections at our center included DM and history of priapism. However, multivariate analysis demonstrated that again, only priapism (p=0.003) remained significant. Number of prior PROs, antibiotic prophylaxis, prior pelvic radiation and choice of inflatable prosthesis all remained statistically insignificant. Conclusion: Any prosthetic operation carries risk of infection, but patients who require multiple prosthetic operations have a higher rate of infection. Our experiences reaffirms that a history of prolonged or recurrent priapism significantly increases this infection risk. PODIUM #107 SAFETY OF INFLATABLE PENILE PROSTHESIS INSERTION IN PATIENTS ON SOME ANTICOAGULANT THERAPIES: A REPORT OF 20 CASES Paul Perito¹, John Grimaldi², John Mulcahy³ and Steven Wilson4 ¹Miami, FL; ²Vincennes IN; ³Birmingham AL; 4Indio CA (Presented By: Paul Perito) Introduction: Inflatable Penile prosthesis (IPP) is commonly indicated in patients with cardiovascular disease. Some of these patients require long-term anticoagulant therapies and are unwilling or unable to wait until the anticoagulation therapy is discontinued before proceeding with IPP surgery. We review our combined experience in this group of unique patients. Materials and Methods: Twenty patients on anticoagulant therapy undergoing elective IPP were retrospectively reviewed. After careful consideration that weighed the potential for intra-operative and post-operative bleeding against a possible thromboembolic event, all patients reviewed chose to undergo the IPP. Anticoagulant medications—11 patients on daily aspirin, 9 patients on clopidogrel (Plavix®)—were not altered preoperatively. Surgical outcomes as well as excessive bleeding or thromboembolic complications were assessed. Results: With advanced planning and informed consent, all 20 patients safely underwent IPP. Continuous closure of the corporotomy, meticulous hemostasis with the electrosurgical unit, occasional use of Floseal were hallmarks. Partial inflation, pressure dressing & closed drainage (15 of 20) were adjunctive measures. All patients had uncomplicated post-operative courses with no adverse events or hematomas requiring drainage. No patient had more than 25% Hgb drop and none required transfusion. Conclusion: It is possible for patients with cardiovascular disease on anticoagulant therapies to safely undergo IPP. Compulsive hemostasis and strict attention to surgical detail are essential to a successful result. A careful risk/benefit analysis and informed consent must be undertaken with the patient. Further studies andlarger series will be necessary to document the safety of this treatment option in the anticoagulated patient population. 125 PODIUM #108 MOMENTARY SQUEEZE PUMP CYLINDERS THAT ARE UNABLE TO INFLATE, RESCUED WITH PULL/ STRETCH TECHNIQUE Gerard Henry¹ and Elizabeth Rae² ¹Regional Urology, Shreveport, LA; ²Patient Liaison – American Medical Systems, Minneapolis, MN (Presented By: Gerard Henry) Introduction: The Momentary Squeeze (MS) pump is a relatively new, easier to teach pump with the advantage of narrower proximal rear tip extenders for ease of implantation. The cylinder input tubing is at a sharper angle, giving it a lower profile, also easing cylinder implantation. However, there are reports of doctors and patients being unable to inflate the cylinders although ultrasound shows the pump and reservior full of fluid. Methods: A MS pump IPP patient at a high volume prosthestic urology practice where neither the patient nor the doctor could inflate the cylinders was identified. Scrotal ultrasound showed the 65cc reservior had 60cc in it and the pump was filled with fluid with no air in the system. A total of 5 patients at 3 practices were found to have the same complication. The patient liaison for the product was called for suggestions. Results: The patient liaison stated that due to the sharp input tubing angle going to the cylinders, they can be minimally “bent” right at the entry point to the cylinder causing inability to inflate the cylinders; especially after the tubing/cylinders are lying “static” for several weeks post-op. The patient was instructed to pull/stretch his penis out, up, down and side to side aggressively 2 – 3 times. Afterwards the patient was able to inflate his cylinders and avoided revision surgery. The patient liaison log shows that 46 of 51 MS IPPs where neither the doctor nor the patient were able to inflate the MS pump IPP cylinders were then able to inflate the cylinders after using the pull/ stretch technique. Conclusion: The pull/stretch technique appears to help MS pump cylinder inflation in cases of where neither the doctor nor the patient can inflate a new MS pump IPP that is filled with fluid and hopefully avoid unnecessary revision surgery. PODIUM #109 COUNTERFIET PDE5I: HOW BIG IS THE PROBLEM NOW? Philip Dorsey and Wayne Hellstrom Department of Urology, Tulane University School of Medicine, New Orleans, LA (Presented By: Philip Dorsey) Introduction: PDE5 inhibitors are a prime target for counterfeiting due to the reluctance of men to seek medical treatment for ED for fear of embarrassment and because of their high cost. Expectedly, Viagra® (sildenafil) is the most counterfeited Pfizer medication. Counterfeit medications pose significant health risks because they may contain unknown concentrations of active pharmaceutical ingredient, inappropriate active ingredients or unknown contaminants. Online monitoring by Pfizer shows that online pharmacies are a prime means for the distribution of counterfeit sildenafil due to the ease of access and anonymity afforded by these vendors. Over the last several years, Pfizer has implemented a successful campaign to address the growing market for counterfeit sildenafil, resulting in increasing annual seizures of counterfeit product. Through close collaboration with law enforcement agencies, heavy investment in anti-counterfeit technology and patient education on the potential risks of online pharmacy use and the prevalence of counterfeit sildenafil, they have developed a successful and effective strategy to prevent counterfeit Viagra from reaching patients. Objectives: Provide an update on current state of counterfeit sildenafil and efforts to curb their distribution. Materials and Methods: Publications from the FDA and WHO on counterfeit medications were searched for references to Viagra®. A PUBMED search was performed using the key words “counterfeit, PDE5i and Viagra.” Pfizer provided data on seizures of Viagra® tablets. Results: In 2009, more than 11 million dosages of counterfeit Pfizer medicines were seized; 88% were counterfeit sildenafil. Between 2006 and 2009, counterfeit seizures increased 37%, 31% increase in counterfeit sildenafil. 76% of the 483 sildenafil tablets obtained during online monitoring by Pfizer were counterfeit. Conclusion: Sildenafil is but one example of a highly counterfeited medication. While internet vendors continue to represent a significant source of these harmful counterfeits, Pfizer’s success suggests that improved patient education, innovative packaging technologies to identify counterfeit tablets and collaboration with law enforcement represent three components of an effective campaign against counterfeit medication distribution. 126 PODIUM #110 SIMULTANEOUS ADVANCE MALE SLING AND AN INFLATABLE PENILE PROSTHESIS: CONCURRENT PLACEMENT DOES NOT INCREASE POTENTIAL FOR IMPLANT INFECTION Brian Christine¹ and L. Dean Knoll² ¹Urology Centers of Alabama, Birmingham, AL; ²The Center for Urological Treatment, Nashville, TN (Presented By: L. Dean Knoll) Introduction: The simultaneous placement of the AdVance* male sling and an inflatable penile prosthesis* (IPP) has been shown to be an efficacious combination to address post-prostatectomy stress urinary incontinence (SUI) and erectile dysfunction (ED) under a single anesthetic. Infection of a penile prosthesis is perhaps the most feared complication of implant surgery. Current literature suggests an infection rate of 1 – 2% when antibiotic coated IPP’s are placed in men without risk factors such as diabetes or chronic steroid use. Objectives: We present a large series of men who underwent the simultaneous placement of the AdVance sling PODIUM SESSIONS and an IPP and report on rate of post-surgical infection. Methods: From July, 2007 through January, 2010 seventy-two (72) men underwent combined AdVance sling and an IPP. Placement of the AdVance sling was through a perineal incision in all patients. Thirty-two (32) patients had the IPP placed through a transverse scrotal incision, and 40 patients had the IPP placed via an infrapubic incision. Follow-up ranged from 6 to 36 months (mean 16 months). Patients were followed up in the clinic at regular intervals after surgery. Results: One (1) patient developed an infection of the IPP in the post-operative period (1.3%). This patient was treated with immediate salvage of the implant, leaving the sling in-place. He recovered uneventfully and at 8 months post-salvage is completely continent and using his IPP with high satisfaction. No other infections occurred. Conclusion: The simultaneous placement of an AdVance male sling and an IPP does not increase the potential for infection of the IPP beyond the expected infection rate when an IPP is placed alone. PODIUM #111 COMORBID ERECTILE DYSFUNCTION IN MEN REQUIRING SURGICAL INTERVENTION FOR POST− PROSTATECTOMY URINARY INCONTINENCE Ekene Enemchukwu, Benjamin Whittam, Todd Doran, Melissa Kaufman and Douglas Milam Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN (Presented By: Ekene Enemchukwu) Introduction and Objectives: As advances in prostate cancer treatment have impacted survival, the focus on improving quality of life related outcomes and patient satisfaction is evolving. Rates of post-prostatectomy urinary incontinence (PPI) and erectile dysfunction (ED) in the literature vary widely. Data regarding the relationship between these critical quality of life parameters is sparse and substantial controversy persists concerning the anatomic factors responsible for both complications. Herein we sought to determine the incidence of ED in men with moderate to severe PPI requiring surgical intervention. Methods: Retrospective chart review was performed for patients who had undergone artificial urinary sphincter (AUS) implant or bulbar male sling +/− inflatable penile prosthesis (IPP) from 1/2004 to 7/2009. Data collected included American Urologic Association Symptom Index scores (AUASI), Sexual Health Inventory for Men scores (SHIM), demographics and complications. Outcomes were assessed in the following subgroups: AUS only, AUS + IPP, male sling only and male sling + IPP. Results: Ninety seven radical prostatectomy patients met inclusion criteria. Forty patients underwent male sling and 57 patients AUS. All patients presenting for surgical intervention for PPI reported severe ED with average pre-op SHIM scores of 3.25 for the AUS group and 3.32 for the sling patients (Table 1). Interestingly, these scores did not demonstrate improvement for patients undergoing an isolated incontinence intervention (3.49 for AUS and 5.18 for sling). With regards to urinary symptoms, AUS patients displayed improvement (AUASI –7.83 for AUS only and –4.6 for AUS + IPP). In male sling patients the AUASI decrease was a modest –2.74 and curiously, scores were higher in the sling + IPP group (+0.2). Conclusion: This analysis demonstrates the comorbid nature of incontinence and ED in the post-prostatectomy population. Herein we reveal a 100% rate of ED in patients presenting for PPI interventions. Several critical parameters including nerve sparing status could not be evaluated in this analysis and prospective studies are ongoing to further define parameters contributing to ED in PPI patients. 127 POSTER #1 THE INFLUENCE OF SOCIO-DEMOGRAPHIC FACTORS, RACE, ETHNICITY, AND THE DOCTOR-PATIENT RELATIONSHIP ON PSA SCREENING BEHAVIOR Eminajulo Adekoya, Robert Mitchell, III¹, David Penson¹,²,³, Jay Fowke4 and Daniel Barocas¹,² ¹Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University Medical Center, Center for Surgical Quality and Outcomes Research, Nashville, TN; ³Tennessee Valley Veterans Administration Health System, Nashville, TN; 4Vanderbilt University Medical Center, Division of Epidemiology, Nashville, TN (Presented By: Daniel Barocas) Introduction and Objectives: Racial variation in the stage at presentation and outcomes of prostate cancer may be explained in part by differences in screening behavior. We analyzed the impact of socio-demographic data (age, race and ethnicity, income, employment status and native language) and communication factors (physician recommendation, opportunity to ask questions and trust) on self-reported utilization of screening tests for prostate cancer. Methods: We used data from the 2005 Health Information National Trends Survey (HINTS), which includes a weighted sample of 973 men over the age of 45, without prior history of prostate cancer, representing a population of 40,136,650 males of which 83.23 % were Non-Hispanic White, 8.55% were Hispanics and 8.23 % were African American. We used univariate and multivariate logistic regression models to determine the effect of socio-demographic characteristics and patient-physician communication on PSA screening behavior. The primary outcome was PSA screening within the 2 years preceding the survey. Results: On univariate analysis Hispanic (H) ethnicity was marginally associated with decreased rates of PSA screening, but there was no significant difference between African-American (AA) and White (W) respondents (64.7% W, 60.7 AA, 37.4 H, p=0.06). On multivariate analysis, however, older age, higher income, retired employment status and English as a first language predicted higher likelihood of screening, while race and ethnicity were not significant.86.6 % of men said their doctor recommended a PSA test; 74% felt their questions about PSA were answered by their doctors, and 67% said they trusted their doctor. On multivariate analysis controlling for race/ethnicity and other socio−demographic factors, decreased trust or a doctor not recommending screening predicted low rates of screening. Conclusion: Race and ethnicity do not have significant influences on rates of PSA screening. Instead, a patient’s trust in their doctor and doctor recommendations appear to be most influential. POSTER #2 HIFU AND THE INTERNET: A QUALITY CONTROL STUDY OF ONLINE INFORMATION Joshua Langston, J. Patrick Selph, Ankur Manvar, James Fergueson, Angela Smith, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston) Introduction: Over the last few years, patients have started using the Internet to supplement medical information from their physicians. In fact, it has been estimated that over 80% patients utilize the Internet as a primary source of oncology-related information. While there are a vast number of health-related websites, the online content is quite variable. We sought to evaluate current information on the Internet that exists in regard to high intensity frequency ultrasound (HIFU) for prostate cancer. Methods: Two top search engines, Google and Yahoo, were used to search the term “HIFU for prostate cancer” and obtain the top 50 websites for each. The provider sites (n=53) were analyzed with regard to presence and accuracy of information on three outcome measures; procedural efficacy, including risks and benefits, functional outcomes, and side effects from HIFU for prostate cancer. (Peer-reviewed literature was used as the primary source of information including the recent Cancer Care Ontario’s Program in Evidence-Based Care practice guidelines (Can Urol Assoc J. 2010 Aug;4(4):232−6). Results: Of the 100 websites, 49 were from private provider sites, 4 from academic institutions, 22 news articles, 8 links to published manuscripts, 2 programs and 15 support groups/blogs/videos. Analysis of the 53 provider sites showed that only 45% of providers posted evidence-based (EB) information concerning efficacy of HIFU, 9% had non EB information, 28% had both, and 17% of the sites had no information on the procedure itself. With regard to functional outcomes, a mere 15% of sites had EB information, and nearly 50% of the sites posted no information at all. With regard to side effects from HIFU, 30% of sites posted EB information, whereas 13% had non EB claims and 34% of sites had no information at all. Six sites had a link to the International HIFU website and 15 sites posted a link to a HIFU animated video online – both industry-based sites. 128 Conclusion: These findings suggest that providers are responsible for a majority of the information online about HIFU for prostate cancer, but do not always present evidence-based information. Although there is limited data on HIFU, much of the information that is posted is often unsubstantiated. This highlights the importance for providers to offer EB information to the public and avoid unproven claims in order to allow patients to gain accurate medical knowledge to facilitate decision-making about this and other treatment options. POSTER #3 TUMOR VOLUME AS A PREDICTOR OF ADVERSE PATHOLOGIC FEATURES AND BIOCHEMICAL RECURRENCE (BCR) IN RADICAL PROSTATECTOMY SPECIMENS; A TALE OF TWO METHODS Ian Thompson, III¹, Shady Salem¹, Sam Chang¹, Peter Clark¹, Rodney Davis¹, S. Duke Herrell¹, Yakup Kordan¹, Roxelyn Baumgartner¹, Sharon Phillips², Joseph Smith, Jr.¹, Michael Cookson¹ and Daniel Barocas¹ ¹Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN (Presented By: Ian Thompson, III) Introduction and Objectives: The prognostic value of tumor volume in predicting biochemical recurrence (BCR) after prostatectomy has been debated. Our aim in this study was to a) evaluate tumor volume as an independent predictor of adverse pathologic outcomes and BCR and b) determine the effect of two different methods of tumor volume estimation. Methods: We reviewed the charts of 3,087 patients who underwent radical prostatectomy at Vanderbilt University Medical Center between 2000 and 2008, of which 1,747 patients had at least 6 months of follow-up and complete data for analysis. Prostate specimens were processed as whole mount (WM) between 2000 and 2003 and then via systematic sampling (SS) from 2003 to 2008, with tumor volume directly measured by planimetry in the WM group and tumor volume estimated as a percent of the evaluated tissue that was involved with tumor in the SS group. The association between tumor volume and BCR was assessed with Kaplan-Meier curves and log-rank statistics, as well as by Cox proportional hazards models, stratified by pathologic method. Results: Tumor volume (TV) estimates were higher in SS (median 4.2cc, IQR 2.4−7.2) than WM (median POSTERS 1.67cc, IQR .7−3.5) p<0.001. There were significant associations between larger tumor volume and adverse pathological outcomes on univariate analysis, regardless of pathologic method (all with p<0.001). Controlling for other pathologic parameters, tumor volume was an independent predictor of pathologic Gleason score, extra− prostatic extension, and positive surgical margins in logistic regression models (p<0.001 for TV in all models). Tumor volume was demonstrated to be an independent predictor of BCR in the WM group (HR 1.06, 95% CI 1.01−1.11, p=0.013), though tumor volume was not a significant predictor of BCR in the SS group (HR 1.00, 95% CI [0.97−1.03], p=0.755). Conclusion: Though the prognostic value of tumor volume is debated, our results demonstrate that tumor volume, when calculated via planimetry on whole mount pathologic sectioning, is a significant predictor of biochemical recurrence after prostatectomy. Funding: No outside commercial support was used to fund this study. 129 POSTER #4 MARIJUANA USE AND PROSTATE CANCER OUTCOMES IN VETERANS Sisir Botta, Daniel Linn and Martha Terris Medical College of Georgia, Augusta, GA (Presented By: Sisir Botta) Introduction: Marijuana use has been demonstrated to be associated with an increased incidence of prostate cancer. In contrast, recent studies report that cannabinoids, the active component of marijuana, may have anti- tumor effects. The effect of marijuana use on prostate cancer outcomes following surgery is unclear. We evaluated the influence of marijuana use on risk for adverse pathology and biochemical recurrence following radical prostatectomy. Materials and Methods: The medical records 281 Veterans with available marijuana use data who underwent radical prostatectomy from 1988 to 2007 were retrospectively reviewed. Associations between repeated marijuana use and pathological Gleason grade, extracapsular extension, margin status and seminal vesicle invasion were evaluated using chi-squared and Mann-Whitney tests. Log-rank tests and Cox proportional hazards models were used to examine differences between recurrence-free survival among marijuana users and non-users. Results: Of 281 patients studied, 27 (9.6%) admitted to repeated marijuana use. Seventy percent of marijuana users had pathological Gleason sum ≥7 tumors compared to 49.6% among non-users (p = 0.04). Adjusting for various demographic and clinical covariates, there was a trend towards increased risk for Gleason ≥7 disease among marijuana users; however, this did not reach statistical significance. (OR= 2.85; 95% CI 0.94−8.64; p= 0.065). Marijuana use was not found to be associated with extracapsular extension, positive margins, seminal vesicle invasion nor biochemical recurrence. Conclusion: Data from our preliminary study suggest that marijuana use may influence prostate tumor grade but not the risk for biochemical recurrence following surgery. Further investigations examining the influence of marijuana use on metastasis and cancer-specific mortality are needed. POSTER #5 THE FATE OF MEN WITH INCIDENTAL PROSTATE CANCER DIAGNOSED AT THE TIME OF RADICAL CYSTECTOMY J. Patrick Selph, Joshua Langston, James Fergueson, Ankur Manvar, Angela Smith, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: J. Patrick Selph) Introduction: It has been estimated that 25 – 40% of men will be found to have incidental prostate cancer at the time of radical cystoprostatectomy for bladder cancer. Despite the high incidence of this finding, little is known about the outcomes of these patients with regard to prostate cancer-specific recurrence and mortality. This study evaluated the clinical outcomes of men with incidental prostate cancer at cystectomy. Methods: We identified 208 men who underwent radical cystoprostatectomy for bladder cancer with curative intent between 1997 – 2003 allowing for at least 5 years of clinical follow-up. Of these men, 71 were found to have prostate cancer detected in the operative specimen (34%). From this group, 10 men were noted to have a prior diagnosis of prostate cancer and were therefore excluded from analysis. Biochemical (i.e. PSA) and clinical follow- up were retrospectively reviewed as was fate from bladder cancer. Results: Of the 61 men, 9 were lost to follow-up before 5 years. Of the 52 remaining men, 14 men are known to have died from bladder cancer and another 4 men have had evidence of metastatic urothelial disease. No man has died from prostate cancer. Although all men had PSA follow-up for at least 2 years, only 26 (50%) had long-term PSA follow-up over 5 years. Fifty men (96%) have had undetectable PSA values, and 2 men (4%) had evidence of a detectable PSA: one man with a detectable PSA occurring 2 years after surgery with a subsequent PSADT of > 5 years– perhaps suggestive of residual benign prostate tissue. The second patient had a detectable PSA occurring 8 years after surgery with a current PSADT of 2 years. Neither has required intervention. Conclusion: The finding of incidental prostate cancer does not seem to have any significant impact on patients’ short- or long-term outcomes. PSA recurrence is rare and does not seem to have significant clinical implications. 130 POSTER #6 THE IMPACT OF ABNORMAL DIGITAL RECTAL EXAMINATION ON PROSTATE CANCER DETECTION IN OBESE MEN David Chu, Daniel Moreira, Leah Gerber, Madeline McKeever, Stephen Freedland and Lionel Bañez Division of Urologic Surgery, Department of Surgery, Duke University, Durham, NC (Presented By: David Chu) Introduction: Obese men diagnosed with prostate cancer (PC) are at higher risk for cancer-specific death than non-obese men. A potential contributor to worse PC outcomes in obese men is sub-optimal cancer detection due to lower prostate-specific antigen (PSA) levels and technical difficulties in performing a digital rectal exam (DRE). Objective: To examine the impact of DRE findings on cancer detection as a function of obesity in a multiethnic cohort of men undergoing prostate biopsy. Methods: Data were retrospectively collected from 1,039 men from the Durham VA hospital who underwent initial prostate biopsy between 1994 and 2009. Distribution of clinical parameters including DRE results was compared across body mass index (BMI) categories (<25, 25−29.9, ≥30 kg/m2) using ANOVA, Fisher’s exact and X2 tests. Odds of biopsy-proven PC attributed to abnormal DRE findings were estimated for each BMI group using crude and multivariable-adjusted logistic regression controlling for PSA, age, year of biopsy, and ethnicity while trend across BMI categories was compared using test for interaction. Results: Median age at biopsy was 63 years and median PSA was 6 ng/ml. The proportion of men with abnormal DRE decreased across BMI categories from 36.9, 27.5, 23.2% in normal weight, overweight and obese men, respectively (p=0.001). On crude analysis, the risk of PC diagnosis for an abnormal DRE was found to increase significantly across increasing BMI categories (p-trend=0.019;Table 1). This significant upward trend was maintained even after adjusting for clinical covariates (p−trend=0.027). Specifically, among men with an abnormal DRE, the odds of detecting PC among obese men were nearly two-fold greater than in normal weight men. Conclusion: Obese men are less likely to have an abnormal DRE compared to non-obese men. However, an abnormal DRE in an obese man portends a significantly greater risk of finding PC on biopsy than in a normal weight man. Together these findings suggest that PC detection using DRE is negatively impacted by excess body POSTERS weight. While performing DRE may be technically difficult in obese men, it should not be neglected because an abnormal DRE is a stronger predictor of PC in obese versus non-obese men. POSTER #7 EVALUATION OF BIOAVAILABLE TESTOSTERONE LEVELS, ERECTILE DYSFUNCTION AND PROSTATE CANCER AGGRESSIVENESS IN MEN UNDERGOING TREATMENT FOR LOCALIZED PROSTATE CANCER Alexander Parker, Andrea Tavlarides, Nancy Diehl, Michael Heckman, Kristin Green and Gregory Broderick Mayo Clinic – Florida Campus (Presented By: Alexander Parker) Introduction: Low levels of bioavailable testosterone (bT) have been associated with erectile dysfunction (ED); however, this association has not been adequately explored in men with localized prostate cancer (PCa). Motivated by this, we evaluated the association of serum bT levels and questionnaire-based measures of ED in PCa men prior to prostatectomy. Moreover, we examined whether bT levels are associated with pathologic features of PCa aggressiveness. 131 Methods: We prospectively identified 51 men scheduled to undergo prostatectomy for clinically localized PCa at our institution between August 2009 and June 2010 who agreed to provide a fasting blood sample prior to surgery. Of these, 40 (80%) provided baseline responses to question 3 (i.e., “how often are you able to penetrate your partner?”) and question 4 (i.e., “how often are you able to maintain your erection after penetration?”) on the International Index of Erectile Function (IIEF) survey. Following surgery, we abstracted pathologic features from the medical record. We employed Kendall’s tau rank correlation to evaluate the association of bT with IIEF responses and pathologic features of aggressiveness. Results: Men with lower bT reported poorer erectile function based on responses to IIEF question 3 (p=0.005) and question 4 (p=0.003); these associations remained apparent after adjustment for age. Interestingly, we observed no association between bT and Gleason score (p=0.3), pT stage (p=0.8) or extracapsular involvement (p=0.9). Conclusion: Our data suggest that low bT is associated with greater prevalence of ED among men with newly diagnosed PCa. In contrast, bT levels are not associated with more aggressive PCa. If confirmed, these data support further exploration of testosterone replacement in men with PCa who experience ED. POSTER #8 PRE-SALAVAGE PSA IS AN IMPORTANT FACTOR IN SELECTING PATIENT FOR SALVAGE CRYOABLATION OF THE PROSTATE IN PATIENTS WITH BIOCHEMICAL RECURRENCE AFTER RADIATION THERAPY Ahmed El-Zawahry, Harry Clarke and Thomas Keane Medical University of South Carolina, Charleston, SC (Presented By: Ahmed El-Zawahry) Introduction: Management of biochemical recurrence (BCR) of prostate cancer after radiation therapy (RT) is a dilemma. Salvage therapy depends on the site of recurrence. Urologists utilize clinical criteria such as PSA, PSA doubling time (PSADT), Gleason score and staging to select the appropriate therapy for patients. The aim of the study is to review clinical predictors associated with in patients with BCR who underwent salvage cryoablation of the prostate (CSAP) after RT. Methods: 57 patients who underwent CSAP. All patients had negative bone scans, local or negative signals on prostascint scan and positive prostate biopsy. Success after CSAP was defined as PSA nadir of ≤ 0.4ng.ml. Clinical parameters were compared relative to successful outcomes. Follow-up was performed at 3-month interval for 2 years then every 6 months. Results: The median age was 69 years old and mean follow up was 24 months. 67% of patients had successful nadir (PSA ≤0.4ng/ml). Pre-salvage PSA was the only statistically significant factor (p= 0.013). PSADT and Gleason score as well as staging were not statistically significant. The highest success rate was in patients with Pre-salvage PSA ≤ 2 (100%). This success trends down as PSA increases (PSA >2 – 4 ng/ml, >4 – 10, and > 10 were 83%, 55% and 54%). Other parameter were not statistically significant including Gleason score (p= 0.39), PSADT (p= 0.89) and stage (p= 0.67). Conclusion: Clinical parameters are often using to help selecting patients with BCR for appropriate therapy. Pre-salvage PSA should be strongly considered in the selection criteria. CSAP should be encouraged in indicated patients at lower PSA levels. POSTER #9 RISK OF DEVELOPMENT OF PROTEINURIA WITH ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, John Stites, Travis Pagliara, Anthony Patterson, Ithaar Derweesh, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin) Introduction and Objectives: Androgen deprivation therapy (ADT) remains an important treatment option for both primary and salvage therapy in select men with localized or advanced prostate cancer (CaP). Although risks of development of hypertension (HTN), diabetes mellitus (DM) and cardiovascular adverse effects have been published, there is a paucity of data describing the effect of ADT on renal function and development of proteinuria. Methods: After IRB approval, we retrospectively reviewed charts of patients receiving ADT for CaP between 7/1987 – 1/2010. Men receiving only neoadjuvant ADT or with incomplete information were excluded. Variables included were: age at ADT initiation, race, pre-ADT PSA, length of follow-up, pre- and post-treatment estimated GFR (using MDRD equation), and presence of preoperative and postoperative HTN, DM and proteinuria. Diagnoses of HTN, DM, renal failure or renal insufficiency were based on a computerized diagnosis list and/or the presence of medical therapy for the disease. The data were then analyzed by chi-square test and by logistic regression analysis. 132 Results: A total of 765 men were included in the cohort. Mean age at CaP diagnosis and ADT initiation were 69.8 (36.9 – 89.1) and 71.2 years (47.4 – 95.1), respectively. 305 (39.9%) patients were Caucasian, while 460 (60.1%) were African-American. Mean pre-ADT PSA was 114 ng/ml (median 16.4; 0.42−6031). During a mean follow-up of 87.7 months, 59.8%, 17.9%, 17.1% and 7.3% developed HTN, DM, proteinuria and chronic renal failure, respectively. Upon multivariable analysis, length of follow-up (p<0.0001) and BMI>30 (p=0.0063) were the only factors associated with development of de novo HTN and DM respectively. Comparably, age (p=0.0024) and African American race (p=0.0008) were found to be significant the variables associated with the development of proteinuria. On multivariable analyses, no analyzed variables were found to be associated with decline in GFR in the cohort; interestingly, a small overall mean increase in GFR of 0.30 mL/min/1.73m2 was noted among the entire cohort after ADT treatment. Conclusion: In our experience, African American race and age were found to be risk factors for development of de novo proteinuria in patients who receive ADT for CaP. Overall patients in our cohort showed improvement of GFR based on the MDRD equation, but a significant minority of these patients showed development of proteinuria.These contradictory findings may reflect a loss of muscle mass in these patients causing serum creatinine to remain stable despite renal deterioration, and suggests that other means of estimating GFR not primarily based on serum creatinine and age may be needed in these patients. POSTER #10 ALTERED SUBCELLULAR LOCALIZATION OF BETA-CATENIN IN HUMAN PROSTATE CANCERS DETECTED BY A NOVEL PHOSPHO-SPECIFIC BETA-CATENIN ANTIBODY K.C. Balaji Wake Forest University (Presented By: K.C. Balaji) Introduction and Objectives: Protein kinase D1 (PKD1) phosphorylates β-catenin at threonine-120 residue (T120), which is associated with membrane trafficking of β-catenin via trans-Golgi network. Methods: Here we show that PKD1 blocks both total and active β-catenin accumulation in response to Wnt and represses β-catenin/TCF transcription activity, suggesting that PKD1 antagonizes Wnt signaling. A newly POSTERS developed phosphor-threonine antibody which specifically recognizes the phosphorylated T120 (pT120) of β-catenin reveals that the pT120 β-catenin is mainly localized in trans-Golgi network in human normal prostate tissue (72%, 16/22) compared to only 7.5% (15/200, p < 0.001) of prostate cancer samples. Results: This distinct pattern of pT120 β-catenin suggests that loss of PKD1 activity may be a necessary step for prostate tumorigenesisdiscriminate benign from malignant prostate tissue. Conclusion: We propose that the pT120 β-catenin antibody is a useful reagent to interrogate spatial and temporal regulations of β-catenin in cells and tissues, and possibly as biomarker in prostate and other tissues. POSTER #11 LOW YIELD OF SCREENING FOR HEMATURIA IN PATIENTS WITH A HISTORY OF PELVIC RADIATION FOR PROSTATE CANCER Marina Cheng, Jeffrey Lee, Sravankumar Kavuri and Martha Terris MCG (Presented By: Marina Cheng) Introduction and Objectives: Pelvic irradiation is a recognized risk factor for the development of bladder cancer. Many patients diagnosed with prostate cancer elect for pelvic radiation therapy. Often these patients have microscopic or gross hematuria initiating further work-up in search of possible bladder malignancy. We investigated the utility of screening for hematuria in prostate cancer patients with a history of prior radiotherapy. Materials and Methods: Over a 12-month period, all patients presenting for routine prostate cancer follow- up visits were screened for microhematuria. Of the prostate cancer patients found to have microhematuria, those with urinary tract infections or prior history of bladder cancer were excluded leaving a total of 42 patients identified with microhematuria who had undergone prior pelvic irradiation for their prostate cancer and36 prostate cancer patients with microhematuria who underwent prostate cancer therapies other than radiation therapy. All patients underwent hematuria evaluation. Irradiated patients ranged in age from 55 to 91 years (mean 69.7 years) while the non-irradiated control group ranged from 53 to 92 years (mean 70.4 years). There was no statistically significant difference in the ages of the patients in the two groups. Irradiated patients ranged from 2 to 20 years (mean 8.5 years) since completion of their radiation therapy. Results: None of the prostate cancer patients found to have microhematuria were found to have evidence of urothelial malignancy on imaging, endoscopy, or UroVysionTM FISH analysis, regardless of whether or not they had previously undergone pelvic irradiation. Of the irradiated patients, 17.9% had atypical urine cytologies and none were found to have malignant cells on cytologic examination. In the control group, 19.4% of patients had atypical cytology results and none were found to be malignant. There was no statistically significant difference in the rate of atypical cytologies between the two groups. Conclusion: We found that screening for microhematuria in prostate cancer patients who have undergone radiotherapy does not yield significant findings. This low yield suggests a lack of justification for the cost and resources utilized in reflex screening for hematuria in asymptomatic patients with a history of pelvic radiation for prostate cancer. Funding: There was no outside source of funding for this study. 133 POSTER #12 EFFICACY AND SAFETY OF A ONCE-YEARLY HISTRELIN ACETATE IMPLANT (VANTAS®) COMPARED WITH 3-MONTH GOSERELIN ACETATE IMPLANTS IN PATIENTS WITH METASTATIC PROSTATE CANCER Samira Harper and John Campbell Endo Pharmaceuticals, Chadds Ford, Pennsylvania (Presented By: John Campbell) Introduction and Objectives: Androgen deprivation therapy forms the basis of treatment for men with metastatic prostate cancer. Initial administration of LH-RH agonists usually results in transient increases of serum levels of FSH, LH and testosterone. Testosterone is then suppressed with continuing LH-RH therapy. Continuous LH-RH therapy can be delivered through long-acting depot formulations or implants. Histrelin acetate is a potent synthetic nonapeptide LH-RH agonist, administered via a once-yearly hydrogel implant delivery system, and induces and maintains castrate serum testosterone levels. The primary objective of this 60-week, open-label, randomized, parallel, active-control study was to evaluate the safety and efficacy of a once-yearly histrelin acetate implant compared with 3-month goserelin acetate depot injections in patients with metastatic prostate cancer. Methods: Men aged ≥45 years with histologically confirmed metastatic prostate adenocarcinoma, M1 disease or rising or elevated PSA levels with failure of initial therapy, and serum testosterone >150 ng/dL were randomized to receive either histrelin acetate implants at day 1 and week 52 or goserelin acetate depot injections at day 1 and weeks 12, 24, 36, 48. Primary efficacy was evaluated by serum testosterone measurements to determine the proportions of patients with castrate levels (<50 ng/dL) at weeks 4 through 52. Safety was evaluated by adverse events (AE) reporting and clinical and laboratory findings. Results: Of 33 patients in the histrelin acetate treatment group mean (±SD) age was 69.6±8.8 years and 75.7% were Caucasian. The mean age in the goserelin acetate group (N=25) was 71.8±8.1 years and 76.0% were White. In patients with evaluable serum testosterone at weeks 4 and 52, 90.9% of patients who received histrelin acetate and 100% who received goserelin acetate, achieved castrate levels at week 4. By week 8 all patients had castrate levels which were maintained until week 52. All patients had a least one AE. Of these 75.8% (histrelin-treated) and 68% (goserelin-treated) of patients had AEs related to the study drug. Serious AEs were reported in 24.2% and 28.0% of histrelin and goserelin patients, respectively. The most frequently reported AE was hot flushes in 72.7% and 64.0% of patients treated with histrelin and goserelin, respectively. No patients discontinued due to AEs. Conclusion: A once-yearly histrelin acetate implant was as effective and safe as 3-month goserelin acetate depot injections for the treatment of advanced metastatic prostate cancer. The lower dosing frequency of histrelin-based therapy may be of benefit to some prostate cancer patients. Funding: Financial support provided by Endo Pharmaceuticals. POSTER #13 CANCER CURE AND FUNCTIONAL OUTCOMES WITH ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALRP): 500 CASES AT A TERTIARY CANCER CARE REFERRAL CENTER Robert Carey¹, Amar Raval² and Tariq Hakky² ¹Florida State University College of Medicine, Sarasota Florida; ²Florida State University College of Medicine (Presented By: Robert Carey) Introduction: Robotic-assisted laparoscopic radical prostatectomy (RALRP) is a technically demanding operation in which surgical outcomes depend upon the training and experience of the surgeon. We report the experience of a high volume fellowship-trained surgeon compared to published sampling of Medicare recipients undergoing minimally invasive radical prostatectomy (MIRP) and open radical prostatectomy (ORP). Methods: A total of 500 patients underwent RALRP over a period of 40 months with a single surgeon. Prospective data collection included Expanded Prostate Cancer Index Composite (EPIC), PSA, Gleason grade, and clinical stage. Operative parameters were estimated blood loss, length of surgery and complications. Post-operative parameters included length of hospital stay, pathology, return to continence, PSA, perioperative complications and salvage therapy. Results: The mean patient age was 64.1 years (46 – 79), mean BMI 28.4 (20.9 – 43.8), mean prostate size 53.7 (22.0 – 131), mean preoperative PSA 6.3. The mean follow-up is 16 months. Pathology stages were T2a−T2b (17.5%), T2c (60.9%), T3a (15.3%), T3b (5.8%) and T4 (0.5%). Gleason scores were 6 (45.6%), 7 (46.4%), 8 (4%), 9 (3.6%), and Gleason 10 (0.4%). Bilateral pelvic lymph node dissections were performed in 78% of patients (node range 4 – 17). The estimated blood loss for cases 1 – 50 was 170 mL, and for cases 51 – 500 was < 100 mL. Blood transfusion rate is 1.4% (7/500). The overall positive margin rates for this study are 11.9%, and 7.9% for cases 251−500. No positive margins were obtained for T2b or lower disease. Early continence was achieved in 63% of patients at one month and 93% at 3 months. Adjuvant therapy, either radiation or hormonal, for biochemical recurrence has been undertaken in 6.2% of patients at 16 months follow up. There has been one prostate cancer death and two deaths by other cause, yielding a 99.4% overall survival rate. There has been 1 (0.20%) anastomotic stricture and no artificial urinary sphincters placed (0%). In comparison, published sampling of Medicare recipients undergoing MIRP or ORP have rates of anastomotic stricture (15.2% and 12%), salvage therapy (27% and 9%) respectively. 134 Conclusion: Perioperative complication rates and oncologic outcomes obtained by a fellowship trained single surgeon dedicated to robotic surgery are markedly superior to that reported for a sampling of Medicare beneficiaries for either MIRP or ORP. Our data suggest that adequate training, supervision, and experience in RALRP are key factors in producing consistently excellent outcomes. POSTER #14 AN ALGORITHM UTILIZING PROSTATE BIOPSY AND FUSED CAPROMAB PENDETIDE SCANNING (CPS) HELP TO SELECT PATIENTS FOR SALVAGE CRYOSURGICAL ABLATION OF THE PROSTATE (CSAP) Ahmed El-Zawahry, Matthew Eskridge, Georgiana Onisiscu, Elizabeth Garett-Meyer, Harry Clarke and Thomas Keane Medical University of South Carolina, Charleston, SC (Presented By: Ahmed El-Zawahry) Introduction: Management of biochemical recurrence (BCR) of prostate cancer after radiation therapy remains controversial. Salvage androgen deprivation (ADT) is frequently initiated although it is not curative. ADT is associated with reduced quality of life and causes non-cancer related death. Additional tools are required to select patients with BCR for appropriate salvage therapy and avoid premature ADT. The aim of the study is to evaluate if utilizing an algorith including CPS combined with prostate biopsy would help to appropriately select patients with BCR after radiation therapy for salvage cryoablation of the prostate (CSAP) and avoid premature ADT. Methods: 69 patients referred for possible Salvage CSAP. Patients included when they had negative bone scans. Local or negative signals on CPS and positive prostate biopsy were used to select patient for CSAP. CSAP was performed through the perineum. Success was defined as PSA nadir of ≤ 0.4ng.ml. Outcomes compared against the clinically high-risk patients (High-risk:≥ T3B, Gleason score 4+3, PSA > 10 and PSADT, 10 months). Patients were also assessed for those who were spared ADT during follow up period. Follow-up was performed at 3-month interval for 2 years then every 6 months. Results: The median age was 69 year-old and mean follow up was 24 months. A total of 57 patients underwent POSTERS CSAP. 67% of patients had successful nadir (PSA ≤0.4ng/ml). Success was 64% in the high-risk patients vs. 74% in low-risk patients. Pre-salvage PSA was the only statistically significant factor (p= 0.013). Race was not significant factor ( p= 0.67). 44 patients avoided premature ADT and 35/44 in the high-risk patients avoided premature ADT. 12 patients were excluded by the algorithm: 6 had ADT for PSADT <6 months, one had chemotherapy of castrate refractory disease, one had bony metastasis, one had pathologic proven metastatic prostate cancer after adrenalectomy for metastatic disease, 2 patients had PSADT > 12 months and under observation. Conclusion: Clinical parameters alone are suboptimal for selecting patients with BCR for appropriate therapy. Utilizing an algorithm using CPS and prostate biopsy may enhance the selection criteria to identify patients appropriate for local salvage and avoid premature ADT. Pre-salvage PSA should be strongly considered in the selection criteria. POSTER #15 EVALUATION OF THE PHARMACOKINETICS AND PHARMACODYNAMICS OF A ONCE-YEARLY HISTRELIN ACETATE IMPLANT (VANTAS®) IN PATIENTS WITH PROSTATE CANCER AND RENAL OR HEPATIC IMPAIRMENT Samira Harper and John Campbell Endo Pharmaceuticals, Chadds Ford, Pennsylvania (Presented By: John Campbell) Introduction and Objectives: Histrelin acetate, a potent LH-RH agonist is administered via a once-yearly hydrogel implant. The implant reduces serum testosterone to a mean of 14.3 ng/dL (n=111) over a 52-week period with consistent testosterone suppression with successive re-implantation yearly for at least 3 years. Candidates for androgen deprivation therapy (ADT) treatment may have an increased risk of impaired renal function. This substudy of a prospective phase 3 study investigated the effect of renal impairment on the pharmacokinetics and pharmacodynamics of histrelin levels in advanced prostate cancer patients. Methods: Serum histrelin and testosterone levels were assessed before insertion of the 50 mg histrelin acetate implant and at the following times after implantation: 5, 15, 30, 45 minutes; 1, 2, 4, 6, 8, 12, 24, 48, 96 hours; week 1 and 2; monthly through week 52. A second implant was inserted at week 52, and samples obtained until week 60. Results: Ten of 17 patients had renal impairment (creatinine clearance <60 mL/min) and 2/17 had hepatic impairment. Peak histrelin concentrations were achieved at 12 hours in normal (0.81 ± 0.33 ng/mL [mean ± SD]), renally impaired (1.11 ± 0.38 ng/mL) and hepatically impaired (0.53 ± 0.75 ng/mL) patients. Histrelin levels then declined over the 52-week period. In patients with renal impairment mean (±SD) Cavg(0−52 wk) for histrelin was 0.292±0.05 ng/mL compared with 0.247±0.08 ng/mL for patients with normal renal function and mean (±SD) AUC(0−52wk) was 15.2±2.7 ng∙wk/mL compared with 12.8±4.4 ng∙wk/mL. A moderate testosterone surge was observed in all patients after implant insertion. Mean serum testosterone was 7.7 ng/dL within 4 weeks, well below castrate levels, remaining <20 ng/dL during the 52 week period. Following removal and insertion of a new implant, castrate levels of testosterone were maintained in all patients, without a testosterone surge, independent of renal impairment. 135 Conclusion: Higher, but not clinically relevant, serum histrelin levels were observed in patients with impaired renal function. Castrate serum testosterone levels were seen within 4 weeks irrespective of renal or hepatic function. Use of the histrelin implant in hepatically compromised patients is based on limited data. Serum testosterone levels of <20 ng/dL were maintained for 52 weeks with increases upon reimplantation independent of renal impairment. A once-yearly histrelin acetate implant remains a therapeutic option for long-term ADT in advanced prostate cancer patients with moderate to severe (CLcr <60 mL/min) renal impairment. These data are consistent with data described in the approved product label. Funding: Financial support provided by Endo Pharmaceuticals. POSTER #16 ROBOT-ASSISTED RADICAL CYSTECTOMY VERSUS OPEN RADICAL CYSTECTOMY IN THE ELDERLY: IMPLICATIONS ON PERI-OPERATIVE MORBIDITY Kyle A. Richards, A. Karim Kader, Joe A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards) Introduction: Open radical cystectomy (ORC) with pelvic lymph node (LN) dissection is the standard of care for the management of muscle invasive bladder cancer. This procedure carries significant morbidity and as a result may not be offered to the elderly. Furthermore, elderly patients pose a unique challenge as they often have comorbidities that might make a robotic approach more challenging. Purpose: To assess the impact of robot-assisted radical cystectomy (RARC) in the elderly on peri-operative morbidity, we compared our initial RARC series in the elderly with a group of historical ORC elderly controls. Materials and Methods: A RARC program was established at our institution in January 2008. Our institution’s bladder cancer cystectomy database was queried to identify all patients age ≥ 75. A total of 20 patients were identified for the RARC cohort and 14 for the ORC cohort. A retrospective analysis was performed on these 34 patients undergoing radical cystectomy for curative intent. Results: Patients in both groups had comparable pre-operative characteristics and demographics. Complete median operative times (including change of position and re−draping) were longer for the robotic approach 461 (IQR 331, 554) vs. 384 minutes (IQR 307, 518) (p = 0.195); however, median blood loss and transfusion rates were less 275 (IQR 150, 450) vs. 600 mL (IQR 500, 2038) and 20% vs. 71% (p = 0.003) as were median hospital stays 7 (IQR 5, 8) vs. 13.5 days (IQR 8, 20) (p < 0.001). The complication rate for RARC was 45%, which compared favorably to 86% for ORC (p = 0.016). There were also fewer major complications (Clavien > 2) with RARC having 10% compared to 50% for ORC (p = 0.009). With respect to pathologic parameters, there were 2 positive margins in the ORC group compared to 1 in the RARC group with median LN yields of 15 (IQR 11, 22) and 17 nodes (IQR 10, 25) (p = 0.390) respectively. Conclusion: In a comparable cohort of elderly patients, we were able to achieve similar short-term oncologic outcomes, less blood loss and shorter hospital stays. For those experienced with robotic surgery, RARC should be considered in the elderly as it may offer significant advantage with respect to peri-operative morbidity over ORC. 136 POSTER #17 IN VITRO FORMATION OF NEUROMUSCULAR JUNCTION (NMJ) FOR ACCELERATED RESTORATION OF MUSCLE FUNCTION In K. Ko, Sang J. Lee, Tamer Aboushwareb, James J. Yoo and Anthony Atala Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC (Presented By: Tamer Aboushwareb) Introduction: Engineering muscle tissue for functional restoration requires integration of nervous tissue, and failure of neural integration leads to atrophy and the tissue often becomes non-functional. Therefore, muscle innervation is a critical process in the recovery of function, and the timing of nerve integration is believed to be critically important. In this study we investigated whether pre-forming neuromuscular junctions (NMJ) on the engineered muscle fibers in vitro prior to implantation could accelerate nerve integration and result in rapid innervation to engineered muscle in vivo. Materials and Methods: Skeletal muscle precursor cells (C2C12) were used to form myotubes and to examine acetylcholine receptor (AChR) expression on the surface of myofibers. Myotubes were co-cultured with NG108 cells (neuroblastoma), grown with conditioned medium from NG108 cell culture, or treated with neurtoprohic factors (agrin). To confirm AChR expression, 10 µM of alpha-bungarotoxin (α−BTX) conjugated with fluorescent dye was added and visualized under fluorescent microscope. To assess AChR expression on myotubes in a 3-D culture system, C2C12 cells were embedded in fibrin gels and cultured in DMEM supplemented with 2% FBS. After 3 – 4 days, the constructs, were cryo-sectioned, and stained with α−BTX to determine the levels of AChR expression. To examine whether pre-fabrication of NMJs on myotubes by agrin treatment would enhance nerve outgrowth and facilitate integration, dorsal root ganglions (DRG) isolated from chick embryos (7 – 8 days) were cultured on myotubes treated with agrin. After co-culture, nerve outgrowth from the DRGs and integration with C2C12 myotubes were determined by α-BTX staining. Immunostaining against neurofilament protein was used for DRG nerve identification. Results: Agrin treatment significantly increased the percentage of AChR expressing myotubes from 15% to 100%. Treatment with conditioned medium (CM) derived from NG108 cells enhanced AChR expression by up POSTERS to 50%; however, when CM was added to growth medium, AChR expression on the surface of myotubes was not affected. Treatment with agrin also increased AChR expression on myotubes grown in a 3-D culture system consisting of fibrin gel. In an in vitro integration assay with DRG neurons, agrin treatment significantly promoted DRG nerve outgrowth and integration into myotubes. Conclusion: This study shows that expression of AchR can be controlled by the use of nerve, conditioned medium derived from neural cells or neurotrophic factors (agrin). These results suggest that pre-formation of NMJ prior to implantation of muscle cells may allow for more efficient neural integration and accelerate the recovery of muscle function. POSTER #18 AN INNOVATIVE APPROACH TO BUILDING CLINICALLY RELEVANT SIZED TISSUES FOR UROLOGICAL RECONSTRUCTION Jaehyun Kim, Tanner Hill, Tamer Aboushwareb, Sang Jin Lee, James J. Yoo and Anthony Atala Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC (Presented By: Tamer Aboushwareb) Introduction: Building a clinically relevant sized tissue or organ using cells requires maintenance of viable cells until host vasculature is established and integrated into the implanted engineered constructs. Several strategies have been proposed to overcome this challenge; however, none has demonstrated clinical relevance to date. One potential solution is to develop methods to maintain cell viability over a long-term by down-regulating cellular metabolism until host vascularization is established. In this study, we attempted to promote cell survival under hypoxic conditions by exploiting the role of adenosine as a modulator of ion-channel arrest for application in urological reconstruction. Materials and Methods: 500 µL of a cell suspension (C2C12 cells, murine myoblasts) in high glucose Dulbecco’s modified Eagle’s medium (DMEM, Gibco) was placed in each well of a 48-well culture plate at a density of 1052 and 2105 cells/cm2. Cells were incubated for 24 hr in normoxic conditions prior to placement in a hypoxic chamber (0.1% O2). A group with no adenosine was placed under hypoxia for up to 13 days to demonstrate eventual cell death. Another group receiving different daily doses of adenosine was incubated for up to 7 days under hypoxia and then placed back into normoxic conditions. Adenosine was refreshed daily through media exchange. Hypoxic Media was placed in 2% O2 for 24h prior to use. MTS assay was used to test the metabolic activity of viable cells. Results: The metabolic activity of cells grown in normoxic conditions increased linearly with respect to time. Hypoxic cells not treated with adenosine showed a similar pattern of increasing metabolic activity for 7 days under hypoxia, but this resulted in eventual cell death. However, when treated with adenosine, cells under hypoxic conditions maintained a steady state of metabolic activity and these cells resumed their normal metabolic activity instantly when they were returned to normoxic conditions and the adenosine was removed at 7 days. Increasing dose of Adenosine resulted in escalation of the steady hypometabolic state with eventual resuming of metabolic activity when moved to normoxic conditions. 137 Conclusion: In this study we demonstrate the concept that cell viability can be maintained by down-regulating cellular metabolism under hypoxic conditions. This concept represents a novel method for increasing cellular survival in tissue-engineered constructs during vasculogenesis and may be used for urological reconstruction. Funding: This study was supported, in part, by a grant from the Telemedicine and Advanced Technology Research Center (TATRC) at the USAMRMC (W81XWH−07−1−0718). Disclosures: The authors have nothing to disclose. POSTER #19 STEM CELL RECRUITMENT FOR IN SITU TISSUE REGENERATION FOR UROLOGIC APPLICATIONS In Kap Ko, Timothy Chen, Tamer Aboushwareb, Young Min Ju, James J. Yoo, Sang Jin Lee and Anthony Atala WFIRM, Winston-Salem, NC (Presented By: Tamer Aboushwareb) Introduction: In situ tissue regeneration holds great promise as this approach is designed to eliminate the need for donor cell procurement and subsequent in vitro cell manipulation. To achieve successful regeneration using host resources, adequate numbers of tissue specific stem cells or progenitor cells that support tissue formation must be present. This study focuses on two different bioactive factors that could be used to recruit and concentrate stem cells. (Substance P (SP), and stromal derived factor (SDF-1α). This study investigated whether controlled release of bioactive factors would result in effective recruitment of host stem cells into target locations. Materials and Methods: Poly(L-lactide) (PLLA) mesh scaffolds (Biomedical structures) were cut into pieces (2×2×1 mm3), coated with 0.5% gelatin, crosslinked with 0.5% glutaldehyde and lyophilized. They were then loaded with SP (Sigma) and SDF-1α (R&D system) at concentrations of 200 ng/mg and 50 ng/mg of scaffold material, respectively, and lyophilized. ELISA was used to quantify the amount of SP release, and MTS assay of hMSC was used to test the bioactivity of the released SP. The scaffolds were implanted subcutaneously under the dorsal skin of CD1 mice and included the following groups, 1) PLLA/gelatin only, 2) PLLA/gelatin with SP, 3) PLLA / gelatin with SDF-1α, and 4) PLLA/gelatin with SP and SDF-1α. Scaffolds were retrieved 2 weeks after implantation, and the infiltrated cells were counted using a hemocytometer. Other scaffolds were embedded in paraffin and sectioned (5 µm) for H&E and immunostaining. Results: A controlled release profile for both SP and SDF-1α was established using the PLLA/gelatin scaffold for 14 days in vitro. Bioactivity testing of the scaffolds containing SP showed evidence of increased proliferation at 100 nM of released SP (p=0.001). In the in vivo study, the combined delivery of SP/SDF-1 resulted in increased host cell infiltration into the scaffolds and yielded increased numbers of CD146/α-SMA positive cells in the infiltrates when compared to those observed in the other groups. Conclusion: Our results show that delivery of SP and SDF-1α individually from PLA/gelatin scaffolds leads to increased recruitment of host stem cells that may contribute to in situ tissue regeneration. However, dual delivery of both factors further enhanced host stem cell recruitment into the implanted scaffolds. The incorporation of multiple regulatory signals into a scaffolding system may be a promising approach for more efficient and effective tissue regeneration in situ for urologic applications. POSTER #20 HALOFUGINONE AND CHITOSAN COATED AMNION MEMBRANES DEMONSTRATE IMPROVED ABDOMINAL ADHESION PREVENTION L. Spencer Krane, Scott Washburn, Jamie Jennell and Steve J. Hodges Wake Forest University, Winston-Salem, NC (Presented By: L. Spencer Krane) Objectives: To determine whether coating amniotic membrane with halofuginone, a type 1 collagen synthase inhibitor, with or without the hemostasis inducing substance, chitosan, reduced the number and severity of adhesions in the rat uterine horn injury model. Methods: Sixty retired breeder Sprague-Dawley rats underwent midline laparotomy and a zone of ischemia was created in the left uterine horn of each animal. Rats were randomized to one of six treatment groups: A): untreated control or B): woven carboxymethylcellulose/hyaluronic acid (Interceed®) (CMCHA) or C): plain amnion or D): amnion coated on both sides with 0.5% solution of halofuginone (HAH) or E): amnion coated on one side with 0.5% halofuginone and on the other side with chitosan (CAH) or F): amnion coated on both sides with chitosan (CAC). The zone of ischemia in each left uterine horn was wrapped in each treatment. Rats were sacrificed two weeks after laparotomy and adhesions counted and scored for severity. Data were analyzed using Chi square and a p<0.05 was considered significant. Results: There were no differences in the percent of animals with adhesions in the untreated or CMCHA, plain amnion or CAC groups. No adhesions formed in any animal in the HAH group and only 14% of animals developed adhesions to the uterine horn in the CAH group (p<0.05). The percent animals with moderate and severe adhesions did not differ between untreated controls and the CMCHA groups, but were significantly reduced in all four of the amnion groups: plain amnion, HAH, CAH, and CAC (p<0.05). 138 Conclusion: Amnion coated with halofuginone alone or in combination with chitosan reduced the percent of animals with adhesions as well as the percent animals with moderate and severe adhesions compared to untreated controls and woven carboxymethylcellulose/hyaluronic acid in the rat uterine horn injury model. Amnion alone or coated with chitosan reduced the percent of rats with moderate and severe adhesions, but not the percent of rats with adhesions of any type compared to both untreated controls and woven carboxymethylcellulose/hyaluronic acid in the rat uterine horn injury model. POSTER #21 IN VITRO MODEL OF MICROPOROUS POLYSACCHARIDE HEMOSPHERES Sisir Botta and Martha Terris Medical College of Georgia, Augusta, GA (Presented By: Sisir Botta) Introduction: Microporous polysaccharide hemospheres (MPH) (commercially available as Arista and Hemaderm; Medafor, Inc, Minneapolis, MN) have been applied to cardiac, neurosurgical, abdominal surgeries with excellent functionality; however, only recently have these agents been applied upon endothelial mucosal tissue in a rabbit sinonasal model. There have not been any studies to evaluate the role of these hemostatic agents within the urinary tract. Our study aimed to prepare and characterize an in vitro model of MPH (Arista™AH) with hopes for endoscopic application. Methods: We established an in vitro system by instilling 1 gm of MPH (Arista™AH) to petri dishes containing human urine, sterile water and sterile saline (20 mL). Serial dilutions (1:2, 1:4, 1:8, 1:16, 1:32) of this initial sample were prepared in duplicate for a total of 10 samples per solvent. All urine samples were previously vacuum filtered. Samples were incubated at 37ºC, and monitored at 12, 24, 48, 72, 120 hours. The consistency and composition of these mixtures were analyzed and compared to controls. At each time interval, standard dipstick urinalyses of all samples were performed. Results: Initial application of Arista™AH to all solvents yielded a mucoid precipitate at all dilutions; however, by 12 hours, this precipitate dissolved in urine samples. However, sterile water and sterile saline samples never POSTERS exhibited dissolution of MPH; rather, the microspheres continued to expand, creating an increasingly viscous mixture with time. Urinalyses indicated a pH of 5.0 in sterile water and sterile saline solutions and a ph of 6.5 – 7.0 in urine solutions. Specific gravity also varied between 1.000 to 1.010, demonstrating a trend towards increasing values with time; otherwise, there did not appear to be any significant variability in specific gravity. After day 5, the urine samples indicated trace glucose; however, this effect was not observed in any controls, sterile water or sterile saline solutions. At the endpoint, all samples were centrifuged and noted to contain residual pellet. Conclusion: MPH (Arista™AH ) demonstrates in vitro delayed solubility in neutral pH urine samples and precipitation in weakly acidic sterile saline and sterile water solutions. Future studies to explore effects in hematuric samples as well as animal model and in vivo testing are needed prior to endoscopic application. POSTER #22 SATURDAY URETHRAL CATHETERIZATION TECHNIQUES: A SURVEY OF CURRENT ACADEMIC AND CLINICAL PRACTICES Kevin Walls, Travis Pagliara, Keefu Du, Jordan Kurta, Tommie Norris and Anthony Patterson University of Tennessee Health Science Center, Memphis, TN (Presented By: Kevin Walls) Introduction: Urethral catheterization is a skill performed by a wide range of medical personnel. Our experience has been that instruction is variable and has resulted in an excessive number of traumatic catheterizations and unnecessary injuries. We investigated the current teachings and actual clinical practices in urethral catheterizations. Methods: We performed a survey from March 2010 to July 2010 regarding catheterization techniques. This survey was distributed to all accredited nursing programs in Tennessee as well as current fourth year medical students at the University of Tennessee Health Science Center. Further questionnaires were also given to nurses at the VA Medical Center in Memphis, TN. Results: Total survey responses were 232 (28.9% nursing students, 22% nurses, 11.6% nursing professors, and 37.5% medical students). Total responses from all nurse types numbered 145 (nursing students, nurses, and nursing professors). 98.6% were instructed in catheter placement by a nursing professor while 2.8% received instruction by a nursing technician and 5.5% by a peer. For male catheter insertions, 22.8% reported inserting catheters only to the point at which they see urine, 60.7% reported inserting the catheter several inches further after seeing urine, and 15.9% reported inserting the entire length of the catheter. A total of 81.4% always test the balloon prior to insertion. 39.3% reported inflating the catheter balloon once urine was seen from the catheter while 51% did not inflate the balloon until the catheter was completely inserted and urine was seen. While 92.4% believed their instruction in catheter placement was adequate, 37.2% requested further instruction. 26.2% reported difficulty with catheter placement, and 84.1% were aware of common complications that might arise from urinary catheter placement. Responses from nurses and nursing students followed similar trends compared to nurses of all types. Compared to nursing responses, medical students reported a higher trend towards insertion of the entire length of the catheter as well as inflation of the catheter balloon once the catheter was completely inserted and urine was seen. 139 Conclusion: Urinary catheter placement methods differ between medical personnel types. This variability has led to an exceedingly high number of urethral traumas related to catheter placement. Fortunately, a number of catheter-related traumas may be avoided by learning proper technique. Because both initial and continuing education in catheter placement is highly variable, it is necessary to address correct technique in both settings. An outcomes project is currently underway at the University of Tennessee to address this issue. POSTER #23 URETHRAL REST: ROLE AND RATIONALE IN ANTERIOR URETHROPLASTY Ryan Terlecki¹, Matthew Steele², Celeste Valadez² and Allen Morey² ¹Wake Forest University, Winston-Salem, NC; ²UT Southwestern, Dallas, TX (Presented By: Ryan Terlecki) Introduction and Objectives: Many men referred for anterior urethral reconstruction often present soon after endoscopic manipulation of severe strictures. We report the outcomes of men managed initially with urethral rest to allow tissue recovery prior to anterior urethroplasty. Materials and Methods: We reviewed our database of all anterior urethroplasties performed by a single surgeon from 2007 – 2009. Urethral rest was accomplished by removal of indwelling catheter, cessation of self- catheterization and/or suprapubic urinary diversion prior to urethral reconstruction. Results: During the study period, 210 patients underwent urethral reconstruction at our center. Men having meatoplasty or posterior urethroplasty were excluded, leaving 128 anterior urethroplasty patients available for analysis. Of these, 28 (21%) were preoperatively placed on a period of urethral rest (median duration 3 months) due to recent urologic manipulation immediately prior to referral, 15 of whom received suprapubic catheters. Urethral rest promoted identification of severely fibrotic stricture segments which enabled focal or complete excision in 75% (excision and primary anastomosis – 12/28, 43%; augmented anastomotic – 9/28, 32%), a percentage similar to those reconstructed without preliminary manipulations mandating urethral rest (82%). Stricture recurrence among rest patients was noted in 4/28 (14%), which was again similar to the rest of the urethroplasty population not having rest (10%). Conclusion: Recently manipulated anterior urethral strictures often declare themselves to be obliterative within several months of urethral rest, thus enabling successful urethroplasty via focal or complete excision. POSTER #24 ANOMALOUS VASCULAR ANATOMY SHOULD NOT EXCLUDE POTENTIAL RENAL TRANSPLANT DONORS Zachary Reardon, Sean J. Clark, Kristin Broderick, Rizk El-Galley and J. Erik Busby Department of Surgery, Division of Urology, University of Alabama at Birmingham, Birmingham, AL (Presented By: Kristin Broderick) Introduction and Objectives: Previous studies have suggested that complex vascular anatomy in the donor kidney may result in exclusion of living renal donors due to evidence that it may negatively impact outcomes in the transplant recipient. The diagnosis of such anomalies has become more common with the use of Computed Tomography Angiography (CTA) to assess potential living renal donors. To determine whether these anomalies worsen outcomes, we examined the largest cohort to date of living laparoscopic kidney transplant donors with complex anatomy and their respective recipients. Furthermore, we analyzed the accuracy of donor preoperative CTA and operative findings. Materials and Methods: From 2007 to 2009, 341 patients underwent laparoscopic donor nephrectomy. The same number of patients received a living renal transplant. Retrospective chart review was performed to compare outcomes in both donors and recipients. Results: Of donors, 255 (74.8%) had one artery, 14 (4.1%) had an early-branching artery, 69 (20.2%) had two arteries, and 3 (0.9%) had three arteries. In terms of venous anatomy, 313 (91.8%) had one vein, 11 (3.2%) had two veins, 11 (3.2%) had retroaortic veins, and 6 (1.8%) had circumaortic veins. Donor estimated blood loss, operative time, hospital stay, discharge creatinine and complication rate were not significantly affected by complex vascular anatomy. Similarly, recipient discharge renal function, length of stay, transplant warm ischemic time, allograft loss and mortality rate were unaffected. Discrepancies on preoperative CTA were found in 24 of 341 (7%) laparoscopic nephrectomies, with an extra renal vein being the most common discordance. These discrepancies did not increase complications in donors or recipients. Conclusion: Laparoscopic donor nephrectomy on patients with anomalous renal vasculature does not negatively impact outcomes in either the transplant donor or recipient. Preoperative CTA may have a discordance rate of up to 7% compared to operative findings. Complex vascular anatomy should not automatically exclude a potential renal transplant donor. 140 POSTER #25 RESIDENTS FOR QUALITY IMPROVEMENT IN UROLOGY (RESQU): THREE YEAR EXPERIENCE WITH A RESIDENT-CENTERED QUALITY IMPROVEMENT INITIATIVE Bryant Whiting, Marc Cohen, Scott Gilbert, Tom Crawford, Johannes Vieweg and Philipp Dahm Department of Urology, University of Florida, Gainesville, FL (Presented By: Bryant Whiting) Introduction and Objectives: Efforts to improve quality of care and patient safety are critically important and considered a health care priority at national, institutional and departmental levels. The Accreditation Council for Graduate Medical Education (ACGME) recognizes this need by mandating resident involvement in quality assurance and improvement efforts in the core competencies of systems-based practice and practice-based learning and improvement. We developed and implemented an educational initiative to integrate urology residents in quality improvement efforts to improve patient quality of care and safety at an academic medical center. Methods: We instituted Residents for Quality Improvement in Urology (RESQU) in 2007 as an educational initiative within the Urology Residency Program at the University of Florida. Urology residents of postgraduate years (PGY) 2 – 5 were paired by PGY level and asked to self-identify important quality of care and safety issues for urological patients. Working in pairs of two or three and with a faculty mentor, residents took a structured approach to the identified quality of care/safety issue by: i) specifying the issue, ii) performing a systematic literature search, iii) identifying key stakeholders, iv) analyzing the problem and collecting baseline information, v) developing a practical solution, vi) implementing this solution and vii) evaluating the impact of the intervention. Results: Twelve quality improvement projects were initiated and successfully completed by urology residents over the last three academic years (2007 – 2010). At the end of each year, residents gave formal presentations that were independently judged. Award-winning projects have included the development and implementation of a web-based stent registry, preoperative order templates for perioperative antibiotics, deep vein thrombosis prophylaxis and beta-blocker administration according to evidence-based guidelines, as well as a streamlined hematuria work-up process at the Veterans Affairs Medical Center. Several of these projects have received POSTERS further support for formal implementation at the Departmental level. Conclusion: Resident-initiated quality improvement projects that are integrated into the residency program curriculum provide the opportunity to identify and address important patient-relevant issues and establish an institutional culture of continuous quality improvement. The RESQU initiative may provide a valuable model for other residency programs seeking to involve residents in quality improvement efforts. POSTER #26 INCIDENTAL PROSTATE CANCER DURING HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A MULTI-INSTITUTIONAL STUDY Davis P. Viprakasit¹, Rafael Nunez², Mitchell R. Humphreys² and Nicole L Miller¹ ¹Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; ²Department of Urology, Mayo Clinic, Phoenix, Arizona (Presented By: Davis P. Viprakasit) Introduction and Objectives: Incidental prostate cancer (PCa) diagnosed during holmium laser enucleation of the prostate (HoLEP) is a known pathologic finding with unclear significance. We characterized the significance of incidental PCa in patients undergoing HoLEP in the modern PSA era. Materials and Methods: After IRB approval, we identified patients from a multi-institutional HoLEP database who were diagnosed with PCa on pathology. Preoperative biopsy was performed in men with abnormal screening parameters and offered to all remaining patients. Results: From September 2007 to April 2010, 20 (9.8%) out of 204 men with no known history of PCa who underwent HoLEP for BPH were discovered to have PCa. Mean age was 74 years (54 – 87). Eight (40%) patients had negative preoperative biopsies (mean 2 ± 1.8). Two (10%) had a history of TURP. Median (IQR) preoperative PSA was 4ng/mL (1.9 – 8.8). Median (IQR) TRUS volume was 54ml (47 – 88). Median (IQR) resected tissue weight was 28gm (19 – 40). Eleven patients had Gleason ≤6 disease (55%), 8 (40%) with Gleason 7 and 1 (5%) with Gleason 10. In 16 patients with available follow-up (mean 5.7±4.6 months), 13 (81%) have had no progression on surveillance. One patient is disease-free after robotic prostatectomy. One patient is currently undergoing radiotherapy and one patient has had development of bone metastases despite combined androgen ablation and radiotherapy. Conclusion: The diagnosis of incidental PCa is possible during HoLEP, whereas in laser ablative and vaporization procedures it is not. The clinical implications and ideal treatment protocols for these patients are unclear. However, this underscores the importance of tissue diagnosis during laser treatments of BPH. 141 POSTER #27 HOLMIUM LASER ENUCLEATION OF ABLATED PROSTATE (HOLEAP): AN INNOVATIVE SURGICAL TECHNIQUE FOR BENIGN PROSTATIC HYPERPLASIA Sanjay Razdan, Ashish Sabharwal and Tony John International Robotic Prostatectomy Institute, Miami, FL (Presented By: Sanjay Razdan) Introduction and Objectives: Holmium Laser Ablation of the Prostate (HoLAP) was introduced as a better alternative to TURP. However, it is associated with a prolonged phase of irritative voiding symptoms and is not suitable for larger glands. In Holmium Laser Enucleation of Prostate (HOLEP),entire lobes are enucleated and removed using a transurethral morcellator. We introduced HoLEAP (Holmium Laser Enucleation of Ablated Prostate), as an amalgam of HoLAP and HOLEP. This technique circumvents the steep learning curve and additional instrumentation required for HoLEP while providing excellent results for moderate size glands. Methods: In HoLEAP, a 550 micron side firing holmium laser fiber is used. The depth of the prostatic adenoma is ascertained at one point and only the superficial prostate gland is ablated by “paint brush” movements of the laser fiber, akin to HoLAP. The ablated prostatic tissue is then enucleated, by “gentle saw like” movements of the laser fiber, similar to HoLEP. Large chunks of prostate tissue, are then scooped out like “ice cream scoops” to achieve a large “clean” cavity in an expeditious and almost bloodless field. The enucleated prostatic tissue does not require additional morcellation in the majority of cases as it is very friable and easily retrieved by the Ellick evacuator or a flexible grasping forceps. Results: 110 patients underwent HOLEAP for surgical correction of infravesical obstruction, secondary to BPH, over a 12 month period. The prostate size varied from 20 to 100 grams (average 60 grams). The mean operating time was 58 minutes. The average post operative hospital stay was 2 hours. All patients had excellent improvement in uroflow parameters. Two patients had recurrent urinary retention. 8 patients had irritative voiding symptoms post- op which resolved spontaneously. The overall patient satisfaction rate was 98 %. Conclusion: Holmium Laser Enucleation of Ablated Prostate (HOLEAP) is a safe and efficacious method for the surgical treatment of BPH. The advantages of HoLAP (reduced blood loss) and HOLEP (ability to manage larger glands and avoidance of postoperative irritative voiding symptoms) are combined in this technique. The need for a morcellator with its attendant risk of bladder injury is avoided. Furthermore, the more robust 550 micron sidelite fiber is used instead of the endfire fiber which is more flimsy and requires frequent stripping for larger glands. HoLEAP is expeditious and circumvents the steep learning curve and additional instrumentation required for HoLEP. The results are comparable to HoLEP for moderate sized glands. HoLEAP is easier to adopt for moderate sized glands. This is an outpatient procedure and hospital stay is avoided. POSTER #28 DOES PROSTATE VOLUME AFFECT SILODOSIN-MEDIATED IMPROVEMENT OF SYMPTOMS OF BENIGN PROSTATIC HYPERPLASIA? Steven Kaplan¹, Claus Roehrborn², Lawrence Hill³, Weining Volinn³ and Gary Hoel³ ¹Weill Cornell Medical College, New York City, NY; ²Southwestern Medical Center, Dallas, TX; ³Watson Laboratories, Inc., Salt Lake City, UT (Presented By: Lawrence Hill) Objective: In two 12-week, double-blind (DB), placebo-controlled phase 3 studies, silodosin significantly improved International Prostate Symptom Score (IPSS) in men ≥50 years old with symptoms of benign prostatic hyperplasia (BPH) [Marks et al. J Urol.2009;181.2634 – 2640]. Symptom improvement was maintained during a 9-month open- label (OL) extension period.[Marks et al. Urology 2009;74:1323 – 1324] This post hoc analysis evaluated whether estimated prostate volume (EPV) at baseline affected silodosin-mediated symptom improvement. Methods: EPV was calculated from prostate-specific antigen (PSA) levels using a published algorithm.[Roehrborn et al. Urology 1999;53:581 – 589] Last observations were carried forward to determine changes from baseline to the end of DB and OL treatment. All group comparisons were done by analysis of covariance. Results: Of 890 patients with PSA baseline data, 192 had EPV <30 mL and 698 had EPV ≥30 mL. In both subgroups, silodosin was associated with significant symptom improvement compared with placebo (Table). Among patients who received silodosin in the DB phase of the study, changes from baseline in IPSS (mean ± standard deviation [SD]) at the end of OL treatment were not significantly different between those with EPV <30 mL (n = 60, −7.0 ± 6.8) and those with EPV ≥30 mL (n = 242, −8.0 ± 7.1; P = 0.416). Among patients who received placebo during DB treatment, also no significant difference in IPPS change from baseline to the end of OL treatment was observed between those with EPV <30 mL (n = 62, −6.2 ± 8.1) and those with EPV ≥30 mL (n = 275, −6.7 ± 6.1; P = 0.339). Conclusion: The results suggest that silodosin is effective in relieving BPH-related symptoms, irrespective of prostate size, including in patients with enlarged prostates. Funding: Research funded by Watson Pharma, Inc. 142 POSTER #29 URINARY INFECTIONS IN U.S. HOSPITALS, 1993 TO 2008 Jan Colli University of Alabama at Birmingham (Presented By: Jan Colli) Introduction: In-hospital costs for urinary infections have increased more rapidly than any other urologic hospital stays during the last decade. The purpose of this study is to investigate the increase in hospital stays and costs for urinary infection from 1993 to 2008. In particular, we will investigate changes in patient characteristics, hospital types and geographic regions over that time period. Materials and Methods: This study presents data from the Healthcare Cost and Utilization Project (HCUP) on the trend in urinary infections over the 16 years from 1993 to 2008 and provides details on urinary hospitalizations for 2008. In particular, we will gather data on changes in the patients (age distribution, payer and sex) and hospitals (income for zip code, ownership, teaching status, bed size, location and geographic region). Results: In-hospital stays for urinary tract infections have increased from 382,387 cases in 1993 to 578,414 cases in 2008. Although the mean length of the stay decreased from 6.3 to 4.4 days the mean cost for the stay increased from $7,889 to $19,422. Total charges increased from $3,016,651,043 in 1993 to $11,233,956,708 in 2008. Examining the patient and hospital characteristics in 2008 found the following. Most patients were elderly, 38.8% were from 65 to 84 years old and 23.8% were older than 85 years of age. About 72.6% of patients were female compared to 27.3% that were male. Medicare was the payer in 62.8% of the cases followed by private insurance (19%) and Medicaid (12%). The percent hospitalization for urinary infection compared to total hospitalization was: higher for small hospitals (1.9%) compared to large hospitals (1.3%); geographically highest in the south (1.6%) and lowest in the west (1.25%); was higher in private for-profit hospitals (1.7%) than in private non-profit hospitals (1.40%); and higher in low income zip codes (1.6%) compared to not low income zip codes (1.4%). Conclusion: In-hospital costs for urinary infections more than tripled from about $3 billion in 1993 to over $11 billion in 2008 and represent increasingly high fraction of health care expenditures. The majority of hospitalizations for urinary tract infections were female and patients over 64 years old. Most of the patients were admitted to the POSTERS hospital for treatment of urinary infections after first being evaluated in the emergency room. Improvements in prevention of urinary tract infections targeting high risk populations are needed to help diminish the skyrocketing health care costs associated with urinary infections. Funding: This study has no financial funding. POSTER #30 EPIDEMIOLOGY, ANTIBIOTIC RESISTANCE AND VARIATION IN MANAGEMENT OF BLOODSTREAM INFECTIONS FOLLOWING TRANSRECTAL PROSTATE BIOPSY PROCEDURES Charles Scales¹, Luke Chen², Russell Staheli², Daniel Sexton², Deverick Anderson² and Brant Inman¹ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Division of Infectious Diseases, Duke University Medical Center, Durham, NC (Presented By: Charles Scales) Background: Bloodstream infection (BSI) is a rare but important complication of transrectal prostate biopsy (TRPB). Prophylactic antibiotics are typically prescribed for such procedures, but antimicrobial resistance is rising. Little data exist regarding antibiotic resistance patterns and clinical management of BSI after TRPB. Our aim was to describe patient characteristics, patterns of antibiotic resistance and patient management with BSI following TRPB. Methods: We used a retrospective case-cohort design of men undergoing TRPB procedures from 1/2005 to 12/2009 at Duke University Hospital – a 750-bed tertiary referral center. BSI was defined as any positive blood culture within 7 days of the procedure date. The Centers for Disease Control definitions for skin contaminants for BSIs were used. Medical records and the central infectious disease data repository were used to abstract data on demographics, patient co-morbidities, microbiology and treatment. Descriptive statistics were used for analysis. Results: During the study period, 2331 men underwent TRPB, among whom 17 (0.7%) developed BSIs within 7 days of biopsy (overall incidence = 0.73 BSI per 100 procedures). The average age was 59 +/− 11 years, and 41% were African-American. The most common bacterial organism was E. coli (15/17, 88%). One patient developed BSI with methicillin-resistant S. aureus, which could not be definitively attributed to TRPB due to an indwelling central venous catheter; this patient was excluded from further analysis. All (15/15, 100%) E. coli isolates were resistant to quinolones, 6/15 (40%) were resistant to aminoglycosides and 12/15 (80%) were resistant to at least one beta-lactam antibiotic. All patients were admitted for empiric intravenous antibiotic therapy and monitoring. Median length of inpatient stay was 3 days and no patient required intensive care. In this cohort, 7/16 (44%) were discharged on intravenous antibiotics. The most common class of antibiotics at discharge was beta-lactams (11/16, 69%), followed by sulfa drugs (4/16, 25%) and nitrofurantoin (1/16, 6%). Conclusion: Quinolone-resistant E. coli was the predominant organism causing BSI following TRPB. Significant variation existed in selection of route and class of antibiotic therapy, even when resistance patterns permitted multiple options for treatment. Further investigations should determine the impact of specific prophylactic regimens on the incidence of BSIs following TRPB. Finally, future studies should also identify management strategies for TRPB-associated BSI in order to optimize care of this important complication of prostate biopsy. 143 POSTER #31 SURVEY BASED ANALYSIS OF ANTIBIOTIC PROPHYLAXIS IN UROLOGIC CASES INVOLVING PROSTHETIC IMPLANTS Jordan Kurta, Jamin Brahmbhatt, Ali-Reza-Sharif Afshar, Robert Wake and Michael Aleman UT Health Science Center, Memphis, TN (Presented By: Jeremy Norwood) Introduction and Objectives: The 2008 AUA Best Practice Policy Statement on Antimicrobial Prophylaxis suggests that less than or equal to 24 hours of postoperative antibiotic prophylaxis is adequate for insertion of urologic prostheses. We conducted a survey on the practice patterns of urology physicians on the use of antibiotic prophylaxis in urologic cases involving prosthetic implants to determine the degree to which this policy is being adopted. Methods: We performed a computer-based survey study of urology physicians throughout the United States regarding awareness of and adherence to the AUA Best Practice Statement. Reasons for non-adoption were also elicited. Responses were analyzed to identify current practice patterns pertaining to antibiotic prophylaxis usage for prosthetic implant cases. Results: A total of 54 urologists responded to the survey. 72% of participants in the survey do not follow recommendations with 34% of these continuing antibiotics beyond 7 days. The most common reason physicians reported using greater than 24 hours of antibiotics were that this was standard practice in their training program (28%), no high-quality urologic studies supporting shorter duration exist (19%), high infection risk factors in their patient population (16%), mild side effects associated with antibiotic use (17%) and fear of medico-legal ramifications if the patient develops an infection (13%). The most commonly prescribed post operative antibiotic is a cephalosporin (47%). 83.7% of participants were aware that the Best Practice Policy Statement on antimicrobial prophylaxis for prosthetic cases recommended a duration of antibiotic use less than or equal to 24 hours postoperatively. 35% of participants plan on adopting these recommendations over the next few years. Conclusion: The overwhelming majority of urologists in our study are aware of the AUA Best Practices Policy Statement on antibiotics but do not follow these recommendations in prosthetic cases. The most common reasons cited were longer durations utilized during residency training and a lack of high-quality studies examining optimal prophylaxis regimens in the urologic literature. Due to a scarcity of high-quality studies in the urologic literature investigating antibiotic prophylaxis, more research is needed to evaluate the optimal duration of postoperative prophylaxis in urologic prosthetic surgery. POSTER #32 GIANT RETROVESICAL CYST APPENDICEAL CYSTADENOMA RESEMBLING SEMINAL VESICLE CYST Ruben Urena and Walter Morales Complejo Hospitalario Arnulfo Arias Madrid, Caja Del Seguro Social, Panama City, Panama (Presented By: Walter Morales) Introduction: The retrovesical cystic lesions are uncommon. They present as unspecific lower urinary tract symptoms (LUTS). Although the differential diagnosis is made through imaging studies, its confirmation is done intraoperatively. Methods: A 62 years old male patient presented with a 30 years history of LUTS. He had undergone previous cystoscopy, TURP, TUIP and urethral dilatations without clinical improvement. A pelvic US reported that although the bladder wall was thin, it showed internal echoes in its dome. An abdomen and pelvic CT scan was reported a cystic retrovesical mass of 13 x 6 x 6.8 cm that went from the right seminal vesicle up to the level of L5 suggestive of a right seminal vesicle cyst. Results: A diagnostic transperitoneal laparoscopy was performed. The retrovesical cyst was compressing the bladder anteriorly and was involving the appendix. A laparoscopic excision of the whole cyst and appendix was performed. The pathology reported an appendiceal cystadenoma. Conclusion: In case of a giant retrovesical or pelvic cysts, an abdomen / pelvic CT scan or MRI can miss the exact origin of the lesion. A giant seminal vesicle cyst can resemble an appendiceal cystadenoma. Its confirmatory diagnosis requires open or laparoscopic excision of the cystic mass. POSTER #33 INFLAMMATORY CELL TYPE IN PATIENTS WITH INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME UNDERGOING CYSTOSCOPY WITH HYDRODISTENSION AND BIOPSY Brent Hardin, John Beddies, James Bienvenu, Wesley White and Frederick Klein University of Tennessee Graduate School of Medicine, Department of Surgery, Division of Urology, Knoxville, TN (Presented By: Brent Hardin) Introduction and Objective: Despite a more mature understanding of the pathophysiology of Interstitial Cystitis/ Painful Bladder Syndrome (IC/PBS), the explicit causative role of certain inflammatory cell types remains speculative and undefined. We present correlative histologic outcomes among patients with clinical symptoms of IC/PBS. 144 Methods: A prospective pilot study was conducted to identify the presence and potential significance of plasma cells, mast cells and eosinophils in treatment naïve patients with clinical symptoms of IC/PBS. Patients with symptoms of IC/PBS as defined by the International Continence Society (ICS) were offered study enrollment. Accrued patients underwent cystoscopy with hydrodistention and bladder biopsy. Salient operative data was recorded. All specimens were reviewed by a genitourinary pathologist with a specific request to search for plasma cells, mast cells and eosinophils. The presence or absence of each cell type was recorded and statistical analysis performed to evaluate the potential causative role of these inflammatory cells types. Results: Between January 1, 2010 and August 15, 2010, a total of 57 patients with clinical symptoms of IC/ PBS underwent cystoscopy with hydrodistention and bladder biopsy. Median patient age was 40 years (range 16 – 79 years). Median bladder capacity of the entire cohort was 750mL (range 200 – 1400mL). Of this cohort, 35 patients demonstrated glomerulations in four quadrants of the bladder after distention (61.4 %). There was no significant difference in median bladder capacity among those with or without glomerulations (700mL versus 800mL, respectively, p > .05). Biopsy demonstrated plasma cells in 35 patients (61.4%), mast cells in 43 patients (75.4%), and eosinophils in 22 patients (38.6%). There was no significant difference in the presence or degree of inflammatory cell types among patients with or without glomerulations (p > .05). Conclusion: To our knowledge, this is the first study to investigate the histologic presence and potential significance of inflammatory cells in patients with clinical symptoms of IC/PBS. Although no significant correlation with bladder capacity and the presence of glomerulations was demonstrated, our findings may support a potential inflammatory component to IC/PBS. A prospective, randomized controlled trial including biopsy of patients without clinical symptoms of IC/PBS is ultimately needed. POSTER #34 A MODEL OF BLADDER HYPOCONTRACTILITY IN THE RAT: PELVIC NERVE CRUSH Christopher Chermansky¹, Denise Chow¹, Qiang Wu¹ and Matthew Fraser² ¹LSUHSC Department of Urology, New Orleans, LA; ²Duke Division of Urology, Durham, NC (Presented By: Christopher Chermansky) POSTERS Introduction and Objectives: Impaired contractility is a known cause of detrusor underactivity. Our objective was to produce a rat model of bladder hypocontractility with which to investigate treatments. We present preliminary results after bilateral pelvic nerve crush. Methods: Bilateral pelvic nerve crush (PNC) was performed in 5 adult female Sprague-Dawley rats under ketamine and xylazine anesthesia (90/10 mg/kg). A straight Jacobson micro mosquito clamp was used to crush each pelvic nerve for 30 seconds. The crush was performed proximal to each pelvic nerve’s entry into the major pelvic ganglion. As a control, 4 rats underwent a sham procedure during which the pelvic nerves were exposed but not crushed. After 1 week, cystometry was performed under urethane anesthesia (1.2 g/kg). A transvesical pressure catheter with a fire-flared tip (PE-90 tubing) was secured at the dome of the bladder and cystometry was performed using saline at a rate of 0.04 ml/min. Data were collected with the LabChart 6 software (AD Instruments). Specifically, intermicturition interval (IMI), intercontraction interval (ICI), bladder contraction duration (BCD), area under the curve (AUC) for both ICI and BCD, pressure threshold (PT ), opening pressure (OP) and closing pressure (CP) were all measured. Statistical comparisons between groups were performed using t test analysis with Prism statistical software (GraphPad Software, Inc.). Results: While both measures of functional bladder capacity (IMI and ICI) were doubled in the PNC group compared to the sham group, ICI AUC only tended to increase by 33%, likely due to halving of the ICI Minimum and Mean Pressures. These data together suggest increased bladder compliance and decreased afferent sensitivity during filling. Interestingly, while ICI was increased, PT was decreased by 50%, suggesting that the afferent signal to void is stretch rather than pressure. In addition, voiding bladder contraction AUCs were halved following PNC and both OP and CP tended to decrease. This implies a shorter voiding duration and a lower outlet resistance following PNC. Conclusion: Bilateral pelvic nerve crush in the rat is a promising model of bladder hypocontractility. Future studies will include single filling CMG and isovolumetric cystometry. In addition, our next report will include further time points post-PNC (2, 4, and 6 weeks). 145 POSTER #35 CENTRAL ROLE OF BOARI FLAP PROCEDURE IN UPPER URETERAL RECONSTRUCTION Ryan Mauck¹, Ryan Terlecki² and Allen Morey¹ ¹UT Southwestern, Dallas, TX; ²Wake Forest University, Winston-Salem, NC (Presented By: Ryan Terlecki) Purpose: To evaluate the role of Boari bladder flap (BF) reconstruction for both proximal and distal ureteral strictures. Materials and Methods: We reviewed our database of all cases of ureteral reconstruction performed by a single surgeon from 2007 – 2009. Data analyzed included patient history and demographics, operative details, stricture length and location, and clinical and radiographic outcomes. Patients were divided into 2 groups by whether stricture location was within the proximal 1/3 or distal 2/3 of the ureter. Results: During the study period, 29 ureteral reconstruction procedures were performed in 27 patients for stricture at our center; bowel segments were not used for any ureteral reconstruction at this institution during this time period. Cases involving the distal 2/3 of the ureter required BF in 10/17 (58.9%); the remaining 7 (41.1%) were managed with ureteral reimplantation +/− psoas hitch. Strictures of the proximal 1/3 ureter required BF in 10/12 (83%) and ureterocalycostomy (UC) in 2 (17%). Downward renal mobilization (DRM) was performed more often for proximal strictures (50% vs. 20%; p = 0.092). At a mean follow-up of 11.4 months, symptomatic failure among BF cases was 10%, regardless of stricture location; mean time to failure was 2 months. Success at 5 months was durable in all patients. De novo voiding complaints were noted in 3/20 (15%) of BF cases. Conclusion: Boari flap reconstruction is a versatile and reliable technique for proximal and distal ureteral strictures. POSTER #36 A LONGITUDENAL EVALUATION OF SUBJECTIVE POSTOPERATIVE SYMPTOMS AND DISSATISFACTION IN WOMEN CURED OF STRESS INCONTINENCE AFTER SLING SURGERY Alex Gomelsky and B. Jill Williams LSUHSC – Shreveport, Shreveport, LA (Presented By: Alex Gomelsky) Introduction and Objectives: In an earlier analysis of 728 women at ≥12 months after sling surgery, we determined that recurrent or persistent stress incontinence (SUI) accounted for only 25% of failures. However, of those dry from SUI, 28% had other subjective complaints, such as emptying difficulty and urge incontinence (UUI). Our goal was to re−evaluate 2 years later the changes in postoperative symptoms in those women who were dry from SUI. Methods: Women who underwent sling since 2002 at our institution were retrospectively identified. Pre- and postoperative assessment included pelvic exam, cough-stress test (CST), SEAPI classification (SUI, Emptying, Anatomy (anterior vaginal wall descent), Protection (pad use), Inhibition (UUI)), and Visual Analog Score (VAS, 1 – 10) measuring overall satisfaction. “SUI cure” was defined as SEAPI(S)=0 and a negative CST. “Global cure” was defined as subjective-SEAPI composite=0 and VAS≥8. Demographics and postoperative details were abstracted from clinic charts. Results: Of the original 153 women, who were cured of SUI but failed globally, 136 (89%) completed ≥36 months of follow−up (f/u). Overall improvements were seen in all SEAPI subscores, but were most prominent in emptying (46%→41%) and UUI (71%→64%). This appears to be related to optimizing complementary therapies, such as sling revision and antimuscarinics. The prevalence of protection (21.7%→21.4%) and anatomy (10%→8.5%) remained stable with longer f/u. In the initial study, a VAS<8 was recorded in 23.5% women and 10 of these (6.5%) had a SEAPI composite=0. Reasons for dissatisfaction were posterior and apical prolapse, pelvic and abdominal pain, dyspareunia, and urgency. Of these 10 women, only 3 (2.5%) remained dissatisfied with longer f/u. With longer f/u, an additional 16 of 136 women (12%) achieved “global cure,” while SUI recurred in 4 women. Conclusion: Post-operative SUI represents only a portion of those who “fail” sling surgery, while the prevalence of UUI and emptying difficulty may be significant in women who are cured of SUI. Optimizing complementary therapies may improve those factors contributing to “global” failure and increase rates of satisfaction with longer f/u. The longitudinal assessment of SEAPI or other multi-component scales provides valuable insight into the long- term outcomes after sling surgery. 146 POSTER #37 IMPACT OF OBESITY ON SURGICAL OUTCOMES OF SINGLE INCISION MID−URETHRAL SLINGS Ryan Pickens, John Beddies, Adam Stewart, Bedford Waters, Wesley White and Frederick Klein UTMCK (Presented By: Ryan Pickens) Introduction and Objectives: We present perioperative outcomes stratified by Body Mass Index (BMI) in a large cohort of patients that underwent single incision mid-urethral sling for the treatment of stress urinary incontinence. Methods: A retrospective chart review of all patients who underwent single incision mid-urethral sling for the treatment of SUI was performed. Demographic and operative data was obtained. BMI was calculated and classified. Objective operative outcomes and pre- and post-operative disease-specific quality oflife questionnaires were extracted. Statistical analysis was performed. Results: From September 2007 to August 2010, a total of 405 patients underwent placement of a single incision mid-urethral sling at our institution for stress urinary incontinence. Mean patient age was 55.3 years (range 25 – 87 years). One hundred eight patients (27%) demonstrated concomitant urgency and urge incontinence pre-operatively. Mean BMI of our cohort was 29.1kg/m2 (range 13 – 64). Pre-operative daily pad use was 2.2 pads/day. Average UDI and IIQ-7 scores were 13.3 and 15.2 pre-operatively. At one month post-operatively, 388 of the 405 patients (96%) denied having any symptoms of SUI, 13 patients (3%) reported occasional leakage and 4 patients (1%) reported full return of SUI symptoms. Average daily pad use postoperatively was 0.1 pads/ day. Average post-operative UDI-6 and IIQ-7 scores were 0.2 and 0.1, respectively. There was no significant difference in objective surgical outcomes or quality of life based on patient BMI (p > .05) (Table 1). BMI (kg/m2) <20 20 – 25 26 – 30 31 – 35 >35 Cure rate (no SUI) 10/12 (83%) 122/125 (98%) 128/132 (97%) 59/61 (97%) 69/75 (92%) Failure rate (any SUI) 2/12 (17%) 3/125 (2%) 4/132 (3%) 2/61 (3%) 6/75 (8%) De novo urgency 0/12 (0%) 6/80 (7.5%) 4/102 (4%) 4/46 (9%) 3/52 (6%) POSTERS No change in urgency 3/6 (50%) 28/45 (62%) 19/30 (63%) 6/15 (40%) 15/23 (65%) Improvement in urgency 3/6 (50%) 17/45 (38%) 11/30 37%) 9/15 (60%) 8/23 (35%) QOL score 9.4 9.3 9.2 9.2 9.0 Conclusion: Based on our experience, short-term outcomes with the single incision mid-urethral sling do not appear to be affected by a patient’s BMI. The incidence of de novo urgency, changes in urgency symptoms and QOL also appear to be unaffected by BMI. POSTER #38 QUANTITATIVE ANALYSIS OF RENAL ISCHEMIA IN REAL TIME USING DIGITAL IMAGE ANALYSIS AND NEAR INFRARED TISSUE OXIMETRY DURING PARTIAL NEPHRECTOMY Arthur Caire, Xavier Alvarez, Sarah Conley and Benjamin Lee Tulane Department of Urology – New Orleans, LA (Presented By: Arthur Caire) Purpose: Assessment of recovery of renal function following hilar clamping during partial nephrectomy is unknown. Our goal was to determine feasibility of integrating near infrared tissue oximetry (TO) together with digital image analysis to quantify ischemia. Materials and Methods: Near infrared renal ischemia and histogram analysis were measured on renal units of Yorkshire swine before, during and after renal hilar clamping. Interval measurements prior to clamping the renal hilum, during warm ischemia and after unclamping were made using a near infrared TO, the ViOptix T.Ox™ Tissue Oximeter (ViOptix Inc., Fremont, CA) as well as Matlab™ (Mathworks, Natick, Massachusetts). The Matlab software analyzed images from the laparoscopic camera at specific time periods and calculated an R/B ratio to track renal ischemia. The Tissue Oximeter measured tissue oximetry by direct infrared light and was placed adjacent to kidney during the procedure. Results: The R/B of change demonstrated a larger rate of change compared to TO during clamp time in the 15 minute experiment (R/B=96.0 vs. TO=52.1; unit/sec) as well as the 30 minute experiment (R/B=97.6 vs. TO=45.9). The R/B ratio of change demonstrated a larger rate of change compared to TO at 1 minute post clamp time in the 15 minute experiment (R/B=80.1 vs. TO=12.4). Both detection devices had similar change in pre and post clamp measurements in the 15 minute experiment (R/B=1.6 vs. TO=3.8) and the 30 minute experiment (R/ B=4.7 vs. TO=−4.5). Conclusion: Tissue oximetry and the histogram analysis demonstrated a reproducible an ischemic drop in tissue oxygen saturation during periods of renal ischemia in a porcine model. The findings from this preliminary study suggest that the R/B ratio shows a greater sensitivity in detecting renal ischemia. 147 POSTER #38.5 SHORT TERM OUTCOMES OF ROBOTIC-ASSISTED ABDOMINAL SACROCOLPOPEXY FOR THE REPAIR FOR PELVIC ORGAN PROLAPSE Ryan Pickens, John Beddies, Brent Hardin, Jared Moss, James Bienvenu, Robert Elder and Wesley White UTMCK (Presented By: Ryan Pickens) Introduction and Objectives: We present short term surgical and quality of life outcomes in a cohort of patients that underwent robotic-assisted abdominal sacrocolpopexy (RSCP) for repair of symptomatic pelvic organ prolapse (POP). Methods: A prospective analysis was performed to evaluate perioperative and quality of life outcomes following RSCP for the treatment of symptomatic POP. All patients underwent multi-disciplinary history and physical including pelvic examination. Prolapse was graded using the Baden-Walker classification system. Appropriate candidates underwent RSCP with or without concomitant supracervical hysterectomy and/or mid-urethral sling. Salient demographic and perioperative data was recorded. Patients were followed post-operatively for evidence of immediate and delayed adverse events as well as durability of the repair. Additionally, all patients completed disease-specific quality of life questionnaires (FSFI, IIQ-7, UDI-6) pre-operatively and at one month following surgery. Statistical analysis was performed. Results: From November 2009 to August 2010, a total of 16 patients with symptomatic apical pelvic organ prolapse underwent RSCP. Fourteen patients underwent concomitant mid-urethral sling placement and 5 patients underwent concomitant supracervical hysterectomy. Mean patient age was 66.5 years (range 51 – 78 years). Mean EBL was 60mL. Mean operative time was 142 minutes. Mean preoperative stage of prolapse was 2.25. There were no intraoperative or post-operative complications and no conversions. Mean duration of follow-up was 5 months. No patients demonstrated recurrence on follow-up examination. Patients demonstrated a significant improvement in quality of life following surgery based on mean UDI-6 (9.1 vs 0.6, p < .05) and IIQ-7 (9.25 vs 0.3, p < .05) scores, respectively. Based on FSFI results, no new onset dyspareunia has been reported. Conclusion: Based on our experience, RSCP is a safe and highly efficacious treatment option for women with symptomatic pelvic organ prolapse. Patients report a significant improvement in their quality of life following treatment with no reported new onset dyspareunia. POSTER #39 THE UTILITY OF LUMBOSACRAL MRI IN THE MANAGEMENT OF ISOLATED DYSFUNCTIONAL ELIMINATION Gregory J. Broughton, Douglass B. Clayton, Stacy T. Tanaka, John C. Thomas, Mark C. Adams, John W. Brock, III and John C. Pope, IV Vanderbilt University Medical Center, Nashville, Tennessee (Presented By: Gregory J. Broughton) Introduction and Objectives: Spinal magnetic resonance imaging (MRI) has been used to evaluate for occult neurologic disease in children with dysfunctional elimination refractory to conservative therapy. However, the utility of MRI in these patients is controversial due to reports of low diagnostic yield. We sought to determine the diagnostic value of spinal MRI in the management of pediatric dysfunctional elimination in patients with otherwise normal neuro-orthopaedic examinations. Materials and Methods: We identified a cohort of children with dysfunctional elimination (lower urinary tract voiding symptoms with or without bowel symptoms) who had subsequently undergone spinal MRI as a part of their evaluation. Lumbosacral MRI was ordered to rule out occult neurologic disease. Patients were excluded from analysis if any of the following were present: known neurological disorders, documented urinary tract pathology or congenital anomalies associated with neurogenic bladder dysfunction. Retrospective data collection included demographics, bowel/bladder complaints, conservative intervention, physical exam findings, imaging results, videourodynamic studies (VUDS) and referral to a neurologic or neurosurgical specialty. Review of bowel and bladder symptoms centered upon those active issues in the 12 months prior to the performance of the MRI. Results: From 8/2000 to 12/2009 56 MRIs were performed in 53 children (32 girls and 21 boys). Active bowel and bladder symptoms at the time of MRI included urgency/frequency in 74% of patients, daytime incontinence in 53%, constipation in 40%, encopresis in 40%, nocturnal enuresis in 38% and urinary retention in 9%. The mean age at the time of lumbosacral MRI was 8.4 years (range 2.1 to 17.0). Mean follow up prior to MRI was 15.8 months (range 0 to 85). A total of 5/56 (8.9%) MRIs revealed an abnormality, but in only 1/56 (1.8%) did the MRI reveal significant spinal pathology. This sole patient required neurosurgical intervention for a primary tethered cord. VUDS in this child one year prior to tethered cord release revealed only detrusor instability and low bladder capacity. Findings on the 4 remaining abnormal MRIs required no intervention. No obvious predictors of having an abnormal MRI were evident. Overall, 15/53 (28.3%) patients underwent VUDS prior to MRI. No significant correlation was found between abnormal UDS and abnormal MRI. 148 Conclusion: In this cohort of neuro-orthopaedically normal children with dysfunctional elimination, lumbosacral MRI rarely led to diagnosis of clinically-relevant spinal pathology. In an era of increasingly cost conscious health care, its usefulness in this population appears to be limited. POSTER #40 RESIDENT PARTICIPATION IN HYPOSPADIAS REPAIR: AN INTEGRAL COMPONENT OF UROLOGY TRAINING? Christopher Bean, Edwin Harmon and Darlenia Andrews University of Mississippi, Jackson, MS (Presented By: Christopher Bean) Introduction and Objectives: Hypospadias repair is considered an index case for urology resident surgical training. A recent survey of residents and pediatric urologists suggests that less than 50% of hypospadias repairs are performed by the resident. We evaluated the surgical outcomes of single stage hypospadias repairs performed by residents at our institution under the supervision of a single pediatric urologist. Methods: We performed a retrospective review of single stage hypospadias repairs from 2007 to 2010. At our institution, residents complete a total of 6 months of pediatric training equally divided amongst postgraduate years 2 (PGY-2) and 4 (PGY-4). The surgical planning of hypospadias repair is executed by the pediatric urologist with the resident completing the remaining portion of the operation under direct supervision. Each repair was assessed for age at repair, hypospadias location, type of repair, complications and the postgraduate year of the resident surgeon. Results: A total of 214 out of 234 single stage hypospadias repairs were available with a minimum follow up of 6 months. Age at the time of repair ranged from 5 months to 13 years (mean 16.8 months). The location of hypospadias was distal in 150 (70.1%), midshaft in 23 (10.7%), and proximal in 41 (19.1%). Meatal advancement and glanduloplasty were used in 45 (30%) distal hypospadias repairs. Tubularized incised plate urethroplasty was performed in 105 (70%) distal, 23 (100%) midshaft and 36 (87.8%) proximal hypospadias repairs. Five (12.2%) proximal hypospadias were repaired with transverse island flaps. Complications included POSTERS urethrocutaneous fistula in 15 (7.01%), meatal stenosis in 1 (0.47%) and recurrent chordee in 1 (0.47%). PGY-2 and PGY-4 residents completed 131 (61.2%) and 83 (38.8%) of the available hypospadias repairs, respectively. The complication rate was 6.1% for PGY-2 and 10.8% for PGY-4 residents. Conclusion: Hypospadias repair is a technically challenging operation accounting for the majority of repairs in urology residency training being performed by the attending pediatric urologist. Our complication rate is comparable to larger series of fellowship trained pediatric urologists. With appropriate supervision, hypospadias repairs performed by urology residents can be successful and allow for the further development of necessary surgical skills. POSTER #41 SALVAGE OF BILATERAL ASYNCHRONOUS PERINATAL TESTICULAR TORSION Jeremy Speeg¹, Christopher Roth², Gerald Mingin³ and Joseph Ortenberg² ¹New Orleans, LA; ²Children’s Hospital New Orleans, LA; ³Burlington, VT (Presented By: Jeremy Speeg) Introduction: Perinatal testicular torsion is a rare event with potentially devastating outcomes. Salvage rates for the affected testicle in prenatal and neonatal torsion are 5% and 40%, respectively [1,2]. Bilateral torsion can occur in up to 20% of newborns with perinatal torsion and is often an asynchronous event [3]. Neonatal torsion, as a component of asynchronous bilateral perinatal torsion, can present with subtle findings that are inconspicuous in the background of prenatal torsion in the index testis. The aim of this investigation is to highlight the role of scrotal exploration in patients with known prenatal torsion subsequently diagnosed with bilateral torsion at the time of exploration. Methods: We perform scrotal exploration in all medically stable newborn males with suspected perinatal torsion. For this study we performed a retrospective analysis of all patients diagnosed with asynchronous bilateral perinatal torsion. Results: Since 2000, 6 cases of bilateral perinatal torsion were identified. In 3 of the 6 cases, extravaginal torsion of the contralateral testis was incidentally identified at the time of surgical exploration. All 3 testes were noted to have normal Doppler flow prior to exploration though physical exam noted a hydrocele in 2 of the 3 patients. Testicular salvage was not successful in the two patients with bilaterally absent blood flow on newborn ultrasound. The 3 cases of incidentally diagnosed contralateral torsion and 1 case with preoperatively diagnosed contralateral torsion were successfully salvaged. Thus, 4 of 6 boys with bilateral torsion were left with one viable testis. Conclusion: Bilateral perinatal torsion can present in an asynchronous fashion. Ultrasound and physical exam will often miss early neonatal torsion. Utilizing early scrotal exploration, we identified 3 cases of incidental neonatal torsion in a background of contralateral prenatal torsion. Non-surgical management of these patients would have placed them at risk for bilateral testicular loss. Surgical exploration should be considered in all boys with prenatal testicular torsion to minimize the loss of testicular function. 149 POSTER #42 UTILITY OF VALIDATED BLADDER/BOWEL DYSFUNCTION QUESTIONNAIRE IN THE CLINICAL PEDIATRIC UROLOGY SETTING Beth Drzewiecki, John Thomas, John Pope, IV, Mark Adams, John Brock, III and Stacy Tanaka Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN (Presented By: Beth Drzewiecki) Introduction and Objectives: Bladder / bowel dysfunction (BBD) is common in children presenting to pediatric urologists. Recently, questionnaires to quantify pediatric BBD have arisen for use as research instruments, particularly in vesicoureteral reflux studies. We distributed a published validated questionnaire to our patients to determine its utility in the clinical setting. Methods: A validated BBD questionnaire was distributed prior to initial visit to all new pediatric urology patients. Patients and/or families were instructed to complete the questionnaire without assistance from clinic staff. The questionnaire was scanned into the medical record at time of initial visit. We retrospectively reviewed the charts of all new patients older than 4 years of age between May 1, 2010 and July 31, 2010. We excluded children without a questionnaire in the medical record (63) or who were not toilet trained (4). Patients with complete questionnaires were divided into two groups based on ICD9 diagnosis for that visit – those with BBD (lower urinary tract symptoms, urinary tract infection, vesicoureteral reflux or constipation) and those with other diagnoses. Total questionnaire scores were compared. Additionally, scores for individual questions on incontinence, dysuria, nocturnal enuresis and constipation were compared in those with corresponding ICD9 codes to those with other BBD diagnoses. Results: A total of 358 questionnaires were reviewed. Questionnaires could not be analyzed in 91 (25%) patients because they were not filled out completely. The remaining 267 were included in the analysis. In questionnaires analyzed, 76% reported it was very easy or easy to complete. Median age was 9 years (range 4 – 27). A diagnosis of BBD was given to 134 patients, of whom 59% were female. The patients with BBD diagnoses had a higher score on the validated questionnaire compared to patients with other diagnoses (p<0.001). Patients with ICD9 diagnoses for incontinence (p=0.016 – 0.025), dysuria (p=0.007) and nocturnal enuresis (p<0.001) had higher scores on corresponding items of the questionnaire than patients with other BBD diagnoses. The ICD9 diagnosis of constipation was not associated with higher scores for corresponding items. Conclusion: A validated BBD questionnaire is a useful tool in the pediatric urology clinical setting. The questionnaire can help patients and their families better define their lower urinary tract symptoms prior to their initial visit. Some families will not be able to fill out the questionnaire appropriately. In general, scores on the questionnaire items correspond to the physician’s assessment of the patient. 150 POSTER #43 VULVOVAGINITIS CAUSES URINARY TRACT INFECTIONS BY INCREASING PERIURETHRAL COLONIZATION OF UROPATHOGENS Ilya Gorbachinsky, Gordon McLorie, Anthony Atala and Steve Hodges Wake Forest University Baptist Medical Center, Department of Urology, Winston-Salem, NC (Presented By: Ilya Gorbachinsky) Introduction and Objectives: Vulvovaginitis has a known association with urinary tract infections in girls. We hypothesize that vulvovaginitis is a major contributor to urinary tract infections in prepubertal girls by increasing periurethral colonization with uropathogens. Methods: Periurethral swabs and urine specimens were obtained from a total of 100 girls (57 with vulvovaginitis and 43 without vulvovaginitis). Specimens were cultured for aerobic and anaerobic organisms. The dominant organism in the periurethral swabs and urine cultures were recorded and antibiotic sensitivity profiles were compared. Results: Periurethral swabs from children with vulvovaginitis were associated with a statistically significant increase in uropathogenic bacteria (79% Enterococcus or E. coli) as the dominant culture as compared to swabs from girls without vaginitis (18%) (p<0.05). 52% of the urine cultures in children with vulvovaginitis were positive for urinary tract infections, and the dominant organism in the urine cultures matched the species and antibiotic sensitivity profile of the corresponding periurethral swab. Only 11% of the urine cultures from girls without vulvovaginitis were positive for urinary tract infections. Conclusion: Vulvovaginitis causes urinary tract infections by increasing periurethral colonization of uropathogens. POSTER #44 HYDROCELE AFTER LAPAROSCOPIC VARICOCELECTOMY: DOES DIVISION OF SPERMATIC VESSELS AFFECT INCIDENCE? POSTERS Beth Drzewiecki, Stacy Tanaka, John Thomas, John Pope, IV, Mark Adams and John Brock, III Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN (Presented By: Beth Drzewiecki) Introduction and Objectives: We previously evaluated hydrocele formation after laparoscopic varicocelectomy and identified increased hydrocele rate with ligation and division of the spermatic vessels compared to ligation alone. We re-evaluated our results after accruing additional patients who had undergone ligation alone. Methods: We retrospectively reviewed patients who underwent laparoscopic varicocelectomy between January 1, 2000 and July 31, 2009. We excluded patients with who had no post operative follow up (30), who underwent repair for recurrent varicocele (1) or who had concomitant hydrocelotomy at time of surgery (19). Patients were divided into two groups—those that underwent ligation and division of the spermatic vessels and those that underwent ligation alone. The incidence of post operative clinically palpable hydrocele was compared by Kaplan Meier survival analysis. Because the severity of the hydroceles might be different between the two groups, we also compared the incidence of hydroceles that required surgical repair. Results: A total of 168 patients were included in the analysis. Median age at time of surgery was 14.5 years (range: 8.6 to 21.4). Postoperative clinically palpable hydrocele developed in 29 (17%). Median time to hydrocele formation was 11.9 months (range: 0.3 to 75.5). Median follow up time was 10.8 months (range: 0.3 to 86.1). Ligation and division of spermatic vessels was performed in 42 patients. Ligation without division of spermatic vesssels was performed in 126 patients. Kaplan-Meier survival curves for postoperative hydrocele formation were not statistically different between the groups (p=0.45). Kaplan-Meier survival curves for hydrocele formation that requires surgical repair were not statistically different between the groups (p=0.48). Conclusion: Although it is believed that preservation of lymphatics by ligation and not division of spermatic vessels improves post operative hydrocele formation following laparoscopic varicocelectomy, we found no difference in postoperative hydrocele rate whether or not spermatic vessels were divided. 151 POSTER #45 PAIN AS THE PRESENTING SYMPTOM OF PRIMARY MEGAURETER IN CHILDREN Christopher B. Anderson, Mark C. Adams, Stacy T. Tanaka, John C. Pope, IV, John W. Brock, III and John C. Thomas Division of Pediatric Urology, Monroe Carell Jr. Children’s Hospital at Vanderbilt (Presented By: Christopher B. Anderson) Introduction: It is understood that congenital ureteropelvic junction obstruction may initially present with symptoms of abdominal or flank pain. We have noticed similar presenting symptoms in patients ultimately found tohave primary megaureter. This finding is not well documented in the current literature. We sought to determine the prevalence of pain as the presenting symptom of primary megaureter. Methods: We retrospectively reviewed all patients diagnosed with megaureter treated at our institution between 1993 and 2009 (n=465). We included 103 patients with primary megaureter. Patients with pyelonephritis at presentation (n=2) and children younger than 12 months old (n=1) were excluded. We recorded several clinical variables including presenting symptoms, imaging results and initial management. Pain was classified as ipsilateral flank, ipsilateral abdominal, contralateral abdominal, contralateral flank or nonspecific abdominal pain. Results: Of the patients with primary megaureter, 17 children with 20 megaureters presented with pain. These patients presented at a median age of 68.9 months (range 37.9 – 208) and 82% (n=14) were male. Location of pain was distributed as follows: ipsilateral flank 29% (n=5), ipsilateral abdominal 12% (n=2), contralateral flank 6% (n=1), contralateral abdominal 12% (n=2) and nonspecific abdominal pain 41% (n=7). Fifteen patients underwent MAG-3 Lasix renography with obstruction diagnosed in 7 (T ½ > 20 minutes) and indeterminate findings in 3. The two patients who did not undergo renography were diagnosed with obstruction by delayed nephrogram on CT and retrograde pyelogram, respectively. All nine patients with an ultrasound at presentation demonstrated hydronephrosis ipsilateral to their megaureter. Ten patients had a CT scan, ordered specifically to rule out acute appendicitis in 4. Thirteen patients underwent VCUG with reflux diagnosed in 2. Initial management was surgery in 13 and observation in 4. Those treated with observation have been followed for a median of 10 months (range 6 – 28). One patient failed observation at 12 months due to worsening hydronephrosis and required surgery. Overall median follow-up for the entire cohort was 28 months (range 4 – 108). Conclusion: Approximately 17% of children ultimately diagnosed with primary megaureter presented with pain symptoms. The majority of these patients had ipsilateral or nonspecific abdominal pain (n=14, 82%) and evidence of obstruction (n=12, 71%). Most patients in our series underwent surgery. Although an uncommon cause of abdominal pain in the general population, physicians evaluating children with abdominal pain must recognize that primary megaureter may present with pain mimicking non-urologic disease states. POSTER #46 A 15-YEAR EXPERIENCE WITH PEDIATRIC GENITAL BURNS AT A LEVEL-1 BURN CENTER: OUTCOMES AND ANALYSIS Zachary Klaassen¹, Pauline H. Go¹, E. Hani Mansour², Michael A. Marano², Sylvia J. Petrone², Abraham P. Houng², Sandra Johansen² and Ronald S. Chamberlain³ ¹Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ; ²Department of Surgery, Division of Burn Surgery, Saint Barnabas Medical Center, Livingston, NJ; ³Chairman, Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ (Presented By: Zachary Klaassen) Introduction and Objectives: Genital and perineal burns are commonly seen in the context of extensive total body surface area (TBSA) burns due to protection provided by the thighs and abdomen. Genital burns in children usually result in extended hospital stays, are accompanied by severe morbidity and raise the issue of suspected abuse. The objective of this study was to review the outcomes of pediatric patients suffering genital burns admitted to the Level-1 Burn Unit at the Saint Barnabas Medical Center. Methods: A retrospective analysis of pediatric (<18 years of age) patients with a burn involving the genitalia from January 1, 1995 – December 31, 2009 comprised the study population. The parameters analyzed included: mean TBSA, mean genital TBSA, degree of genital burn, burn etiology, abuse, mean hospital and Burn intensive care unit (ICU) length of stay (LOS) and status at discharge. Results: A total of 1935 consecutive pediatric patients were admitted to the Burn Unit over the course of the study. One hundred and sixty patients (8.3%) had a burn involving the genitalia, including 105 patients <5 years of age (65.6%) and 55 patients between 5 and 18 years of age (34.4%) (Table 1). Overall mean TBSA was 13.8 ± 16.8%, mean TBSA (genitalia) was 0.84 ± 0.25%, mean LOS was 11.9 ± 11.9 days and mean Burn ICU LOS was 4.9 ± 9.7 days. Patients <5 years of age more often suffered scald injury (95.2% vs. 78.2%, p < 0.002) and were more often victims of abuse (22.9% vs. 5.4%, p < 0.007). Patients ≥5 years of age more often suffered a flame injury (12.7% vs. 1.9%, p < 0.008). The five in-hospital mortalities in patients ≥5 years of age were due to extensive burn injuries (mean TBSA – 87.6%; 4 flame burns, 1 gas explosion). 152 Conclusion: In patients <5 years of age a TBSA burn >10% with extensive genitalia involvement is almost always the result of a scald injury. Younger patients (<5 years old) are more often the victims of abuse and prolonged LOS is the norm (> 2 weeks). Patients ≥5 years of age are more often male with a TBSA burn >15% due to scald injury, with extensive genitalia involvement. Flame burns in pediatric patients significantly increase the burn TBSA and probability of in-hospital mortality. POSTERS POSTER #47 RADIOGRAPHIC ASSESMENT OF STOOL BURDEN IN NORMAL CHILDREN Ted Manny¹ and Steve Hodges² ¹Wake Forest University, Winston-Salem, NC; ²Assistant Urology Professor, Wake Forest University, Winston-Salem, NC (Presented By: Ted Manny) Introduction: Constipation and increased stool burden are thought to play a significant role in the etiology of many pediatric urologic complaints such as recurrent urinary tract infection, vesico-ureteral reflux, daytime incontinence and nocturnal enuresis1. Unfortunately the objective diagnosis of constipation and increased fecal burden remains elusive. Abdominal radiographs combined with a systematic scoring method has been described to help diagnose and clinically follow such patients, however, prior investigations have failed to include a convincing cohort of normal children2,3,4. Objectives: To determine the Leech score, a 0 – 15 score based on amount of stool present in three areas of the colon, and rectosigmoid to pelvic outlet ratio (RPOR) of normal children based on abdominal radiographs. Methods: Ninety-three children ages 3 – 10 who had an abdominal CT scan as part of initial work-up for trauma were included. We excluded studies revealing acute abdominal injury. The anterior-posterior scout image of each study was reviewed and stool burden was assessed by Leech criteria and determination of RPOR (distance between obturator fat stripes at level of femoral head). Results: The average Leech score was 7.26 (standard deviation 2.72), and average rectosigmoid to pelvic outlet ratio was 0.74 (standard deviation 0.19). Conclusion: The stool burden of normal children as assessed by Leech score is similar to that of other control populations in the literature. The RPOR may serve as a simple, objective and reproducible means of assessing stool burden. Further study is needed to evaluate if the RPOR correlates with symptomatology of pediatric voiding complaints. POSTER #48 PRIAPISM IN CHILDREN WITH HEMOGLOBIN S: IS THERE A ROLE FOR SYMPATHOMIMETICS? Jamin Brahmbhatt, Reza Mehrazin, Kathleen Kieran, Mark Williams, Gerald Jerkins and Dana Giel University of Tennessee Health Science Center, LeBonheur Children’s Hospital, Memphis, TN (Presented By: Jamin Brahmbhatt) Introduction: Patients with HbS may present with priapism during an acute crisis. Though published guidelines for the management of priapism exist in adults, there is no such algorithm for the pediatric population; in particular, the role of sympathomimetics (SMT) remains unclear in patients with HbS. 153 Methods: We reviewed our institutional experience with priapism in children with HbS in order to determine if outcomes differed in patients who did and did not receive SMT. Results: From July 2004 to July 2009, 15 patients with HbS (8HbSS, 3 HbSC, 3 HbSbeta-thalassemia, 1 HbSF) experienced 20 priapism episodes. One patient experienced 2 episodes and 2 patients experienced 3 episodes each. 1 patient had undergone prior surgical shunting. Mean age at presentation was 13.2 years (range 1.5 – 17.8). Hematocrit at presentation was higher in patients with HbSbeta-thalassemia (30.2) and HbSC (27) than in patients with HbSS (25.9) or HbSF (23.9). Mean episode duration at presentation was 38.2 hours (range 2.0 – 384); erections waxed and waned in 8 episodes and were continuous in 12. 7/20 (35%) episodes were associated with acute chest syndrome (ACS); these patients had lower room air oxygen saturation (92.7% vs 98.8%; p=0.04). All patients received treatment directed at the hemoglobinopathy with aggressive hydration (18/20 episodes), narcotic pain medication (19/20 episodes) and/or high-flow oxygen (5/20 episodes). No single therapeutic agent was associated with significant improvement in time to detumescence. Resolution of the priapism mirrored overall improvement in patients with ACS. In 5/20 (25%) episodes, patients required transfusion of packed red blood cells. One episode (5%) required a distal shunt after medical management failed. In 11 (55%) episodes, patients received adjunctive SMT; hematocrit (p=0.23) and episode duration at presentation (p=0.31) were similar in patients with and without SMT. Time to episode resolution was longer in patients who received SMT (76.8 vs 36.8 hours, p=0.09); however, the 1 patient who required shunting did not receive SMT. Conclusion: In patients with HbS, priapism is often a manifestation of the underlying disease process and rarely requires surgical intervention. Hemoglobinopathy-directed therapy should be individually tailored for patients with HbS-associated priapism, as no single agent has been shown to improve outcome. SMT use may be associated with delayed resolution of HbS-associated priapism. POSTER #49 OCHOA (UROFACIAL) SYNDROME CULPRIT IDENTIFIED AS HEPARANASE 2 GENE – IMPLICATIONS OF A 15 YEAR STUDY Junfeng Pang¹, Shu Zhang¹, Bobbilynn H. Lee², Ping Yang¹, Jixin Zhong¹, Yushan Zhang¹, Bernardo Ochoa³, Jose A.G. Agundez4, Marie-Antoinette Voelckel5, Weikuan Gu6, Wen-Cheng Xiong7, Lin Mei¹, Jin-Xiong She¹ and Cong-Yi Wang¹ ¹Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta, GA; ²Department of Surgery, Urology and Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta, GA; ³Department of Pediatric Surgery, University Hospital San Vicente de Paul, University of Antioquia, Medellin, Colombia; 4Department of Pharmacology, Medical School, University of Extremadura, Badajoz, Spain; 5Department of Medical Genetics, Hospital d’Enfants de la Timone, Marseille, France; 6Department of Orthopedic Surgery, Campbell Clinic and Pathology, University of Tennessee Health Science Center, Memphis, TN; 7Institute of Molecular Medicine and Genetics and Department of Neurology, Medical College of Georgia, Augusta, GA (Presented By: Bobbilynn H. Lee) Introduction and Objectives: The urofacial syndrome (UFS) [MIM 236730] was first described by Dr. Bernardo Ochoa, as an autosomal recessive disorder characterized by a severely neurogenic bladder, ureterovesical reflux and an inverted facial grimace. Our previous studies in patients originating from Colombia localized the disease gene to a region on chromosome 10q24 by homozygosity mapping. Subsequent fine mapping provided preliminary evidence that the disease gene could be located in a genomic interval of approximately 250 kb DNA between markers D10S2500 and D10S2511.6. Mutation screening in UFS patients was also carried out in two candidate genes, GOT1 (MIM 138180) and CNNM1 (ancient conserved domain protein 1, ACDP1) (MIM 607802). The objective of this study is to further identify the genetic basis of the syndrome. Methods: Mutation screening was performed by standard PCR and sequencing method for each candidate gene of the redefined disease interval. A control DNA pool was used to evaluate normal polymorphisms. PCR amplification followed by TaqI was used to genotype all the patients from Colombia. Results: This study identified three loss-of-function mutations in the HPSE2 gene in UFS patients from multiple countries, which provides evidence for the conclusion that HPSE2 is the culprit gene responsible for the syndrome. Both the facial muscle and urinary bladder showed high levels of HPSE2 expression. However, unlike urinary bladder, very low levels of HPSE2 mRNA were detected in the stomach and intestine, and, unlike facial muscle, HPSE2 was almost completely absent in the skeletal muscle. Conclusion: Because UFS patients share clinical, radiological, and urodynamic features with those patients with dysfunctional voiding in the general population, it will be interesting to determine whether altered HPSE2 function is implicated in the pathogenesis of general voiding disorders. Because of the involvement of both the urinary system and the facial muscles for the UFS phenotype, it has been thought that UFS may result from defects in a region of the brain that controls micturition and facial muscles. Given the phenotypic characteristics of UFS patients, our results suggest that HPSE2 could regulate the coordinated action of muscles implicated in facial expression and urine voiding in the periphery. Moreover, the characterization of the HPSE2 gene for the syndrome has now paved the way to fully dissect the underlying mechanisms for the puzzling observations on the clinical phenotype of patients with this devastating disease. Funding: This work was supported by grants from the National Institutes of Health (DK074957 to C.–Y.W. and DK53266 to J.–X.S.). 154 POSTER #50 INCIDENCE OF UROLOGIC ABNORMALITIES ON SCROTAL ULTRASOUND IN THE PEDIATRIC POPULATION Jamin Brahmbhatt, Reza Mehrazin, Patrik Luzny, Kathleen Kieran, Dana Giel and Mark Williams University of Tennessee Health Science Center, LeBonheur Children’s Hospital, Memphis, TN (Presented By: Jamin Brahmbhatt) Introduction: Scrotal pain is one of the most common presenting urologic diagnoses in both adult and pediatric emergency settings. Scrotal ultrasound (SUS) has emerged as an important diagnostic tool when evaluating patients with testicular pain. Although some patients will have emergent diagnoses such as testicular torsion, identification of a definitive etiology of the pain in patients without pathognomonic findings can be challenging. We sought to define the incidence of urologic abnormalities diagnosed on ultrasound as well as common discharge diagnoses in the pediatric emergency room population. Methods: We retrospectively reviewed all patients presenting to our emergency department between 2005 – 2009 with a complaint of scrotal and/or testicular pain and/or trauma. Patients without a SUS were excluded, as were patients that were seen for postoperative complications, penetrating trauma or other known medical etiology (eg. priapism). Results: 376 patients underwent SUS in our emergency department between 2005 – 2009, of whom 355 met inclusion criteria. The median age at presentation was 11 years (1 day – 18 years). The presenting complaint was testicular pain in 329 (92.7%) patients and a history of blunt scrotal trauma in 26 (7.3%). Pain was localized to the right testicle in 161 (45.3%) patients, to the left testicle in 165 (46.5%) patients and was bilateral in 29 (8.2%) patients. In 92 (25.9%) patients, the scrotal ultrasound was entirely normal. The most common ultrasound abnormalities were epididymal and testicular hyperemia (88; 24.8%), hydrocele (69; 19.4%), testicular torsion (35; 9.9%), epididymal cyst (10; 2.8%), varicocele (10; 2.8%), hematoma (10; 2.8%), scrotal cellulits/edema (9; 2.5%), torsed testicular appendix (9; 2.5%), hernia (8; 2.3%), undescended testicle (7; 2.0%), and other (8; 2.3%). The most common discharge diagnoses were epididymitis or epididymo-orchitis (117; 32.9%), general scrotal pain without etiology (83; 23.4%), hydrocele (69; 19.4%), testicular torsion (44; 12.4%), inguinal hernia POSTERS (8; 2.3%) and torsed appendix testis (11; 3.1%), varicocele (10 patients; 2.8%), other (13; 3.7%). Conclusion: In our experience, one-fourth of pediatric patients in the emergency room setting will have normal ultrasound and another one-fourth will have epididymal or testicular hyperemia. The other half will have a mix of various urologic abnormalities. A majority of patients will have their ultrasound finding listed as their final discharge diagnosis. Scrotal ultrasound remains an important diagnostic tool in pediatric patients presenting with scrotal pain in the emergency room setting but should never trump a thorough history and physical examination. POSTER #51 DIAGNOSING EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS IN THE EMERGENCY ROOM: DO UROLOGISTS AND PEDIATRIC EMERGENCY PHYSICIANS DIFFER? Jamin Brahmbhatt, Reza Mehrazin, Kathleen Kieran, Patrik Luzny, Dana Giel and Mark Williams University of Tennessee Health Science Center, LeBonheur Children’s Hospital, Memphis, TN (Presented By: Jamin Brahmbhatt) Introduction: Testicular pain is one of the most common presenting urologic diagnoses in an emergency setting. Epididymitis/epididymo-orchitis (EEO) is a common diagnosis in adult patients with testicular pain, but is less prevalent in children. We sought to define the incidence of clinical EEO and its management in the pediatric population. Methods: We retrospectively reviewed all patients presenting to our emergency department between 2005 – 2009 with a complaint of scrotal and/or testicular pain and/or trauma. Patients without a SUS were excluded, as were patients that were seen for postoperative complications, penetrating trauma or other known medical etiology (eg. priapism). Results: 376 patients underwent SUS in our emergency department between 2005 – 2009, of whom 355 met inclusion criteria. The median age at presentation was 11 years (1 day – 18 years). The presenting complaint was testicular pain in 329 (92.7%) patients and a history of blunt scrotal trauma in 26 (7.3%). Pain was localized to the right testicle in 161 (45.3%), left in 165 (46.5%) and was bilateral in 29 (8.2%) patients. In 92 (25.9%) patients, the scrotal ultrasound was entirely normal. The most common ultrasound abnormalities were epididymal and testicular hyperemia (88; 24.8%), hydrocele (69; 19.4%) and testicular torsion (35; 9.9). The most common discharge diagnoses were epididymitis or epididymo-orchitis (117; 32.9%), general scrotal pain without etiology (83; 23.4%), hydrocele (69; 19.4%) and testicular torsion (44; 12.4%). Out of the 117 patients with EEO as discharge diagnosis only 88 (75.2%) had SUS changes; 74/88 of these patients were discharged with antibiotics. A total 100/117 (85.5%) patients were discharged with antibiotics. In patients without a documented urologic emergency, EEO was diagnosed significantly less frequently in patients seen by ED physicians (28.8%) than in patients seen by a urologist (60.9%). The proportion of patients with sonographic abnormalities was similar in patients seen by urologists (30/39; 76.9%) and ED physicians (50/66; 75.8%). Urologists and ED physicians were equally likely to prescribe antibiotics for EEO (89.7% vs 83.3%). 155 Conclusion: In our experience, EEO remains a common clinical diagnosis in patients presenting to the emergency department with testicular pain. EEO was diagnosed more frequently in patients seen by urologists than by ED physicians, although the presence of sonographic abnormalities was similar in both groups. This may reflect differential history-taking or sensitivity to physical examination findings between physicians of differing backgrounds. Antibiotics were rarely prescribed when EEO was not a discharge diagnosis. POSTER #52 EXTRAMAMMARY PAGET’S DISEASE IN MALES: A SEER STUDY IN SURVIVAL Lindsey Herrel, Timothy Johnson, Keith Delman and Viraj Master Emory University, Atlanta, GA (Presented By: Lindsey Herrel) Introduction: Extramammay Paget’s disease (EMPD) in men is a rare malignancy with poorly described outcomes resulting primarily from single institution case series. Thus, we sought to use the Surveillance, Epidemiology, and End Results (SEER) registries to further define survival and predictors of survival in EMPD. Objectives: To identify patient and disease specific characteristics of men with EMPD that predict survival. Methods: The 17 SEER registries were queried for male patients diagnosed with EMPD from 1973 through 2007. Patients were categorized by four general primary sites: anorectum, scrotum, penis, and skin. Descriptive analyses were conducted to characterize each group according to age, year of diagnosis, race, tumor sequence, tumor stage, and treatment. Kaplan-Meier and both univariate and multivariate Cox regression analyses were conducted to assess overall survival across patient- and disease-related characteristics. Results: Our cohort consisted of 328 patients. Overall survival based on primary sites of EMPD were: anorectum (24.3%), scrotum (62.4%), penis (62.5%) and skin (50.8%). After controlling for patient and disease characteristics, significant factors negatively impacting survival were primary site in the anorectal region compared to scrotum, penis and skin (p <0.001, p=0.008, p=0.005 respectively), presence of distant disease versus localized disease (p=0.01) and radiation only treatment versus surgery alone (p=0.016). Additionally, no survival benefit was found in patients who underwent combined radiation and surgery treatment, as compared to those who were treated with surgery alone (p=0.614). Table 1 below. Conclusion: Negative predictors of survival in men with EMPD include location in the anorectal region, presence of distant disease and radiation only treatment. No survival benefit is offered with radiation therapy in addition to surgical management. POSTER #53 ONCOLOGIC OUTCOMES FOR NODE-POSITIVE PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY J. Patrick Selph, Joshua Langston, Aaron Martin, Angela Smith, Sean Sawh, Mathew Raynor, Matthew Nielsen, Eric Wallen, Erik Castle and Raj Pruthi (Presented By: J. Patrick Selph) Introduction: Pelvic lymphadenectomy is a critical adjunct to radical cystectomy for bladder cancer having important therapeutic and prognostic value. In recent years surgeons have described their outcomes with robotic radical cystectomy (RRC) with little report of oncologic consequences. We report the oncologic outcomes of node positive patients who have undergone RRC with regard to medium-term (at least 1 year) follow-up. Methods: 271 patients have undergone RRC and urinary diversion at one of two institutions for clinically-localized bladder cancer between 2005 – present. From this combined case series, we performed a retrospective analysis of the 50 patients who had LN positive disease and who underwent surgery at least 12 months prior to allow for adequate clinical follow-up and time to recurrence. Medium-term oncologic outcomes, including RFS and DSS, are reported in this group of patients. 156 Results: Overall rate of LN positivity was 26%. Characteristics of these patients include: 38 men (76%) and 12 women (24%) at a mean age of 69.2 years. Seventeen (34%) patients had <=pT2 disease and 33 (66%) pT3/T4 disease. 60% of patients received peri-operative chemotherapy in this series. The mean number of lymph nodes removed was 18 (range 5 – 35), and mean number of positive LNs was 3.1 (range 1 – 12). Mean LN density was 18%. Mean clinical follow up in this case series was 29 months (range 12 – 64 months). At this follow-up, 29 patients have recurred, 21 patients died of disease, giving a RFS and DSS of 42% and 58%, respectively. Mean (median) time to recurrence was 10.2 months (9 months). These findings are consistent with prior reports of such oncologic outcomes in node-positive patients in open series. Conclusion: The oncologic follow-up of patients undergoing RRC with LN positive disease appears to have acceptable outcomes in the medium term (mean 29 months). As our follow-up increases, we should expect to continue to truly define the long-term clinical appropriateness and oncologic success of this procedure in this high-risk population. POSTER #54 RE-RESECTING T1 BLADDER TUMORS: SINGLE-INSTITUTION ANALYSIS IN A MODERN COHORT OF PATIENTS J. Patrick Selph, Joshua Langston, Ankur Manvar, James Fergueson, Angela Smith, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: J. Patrick Selph) Introduction: Recent AUA guidelines (2007) have recommended the use of re-resection of T1 bladder tumors – especially for those in which no muscle is observed in the initial resection. Re-resections more accurately stage patients and provide valuable prognostic information that may aide in planning initial therapeutic approach. We examined the findings and outcomes of re-resection of T1 bladder tumors in a single institution analysis of a modern cohort of patients. Methods: A retrospective analysis was performed on a case series of 556 TURBT procedures at a single institution from 2007 – 2010—dating to the time since the AUA Guidelines Report. From this series, 56 patients POSTERS were noted to undergo re-resection for T1 bladder cancer, and these patients were utilized for this analysis. Results Mean follow-up of the study cohort was 22 months. Of the 56 patients, 15 patients had no muscle in the initial specimen and 41 patients had muscle. Those without muscle (vs. with muscle) in the initial specimen were more likely to be T2 on re-resection (27% vs. 2%) and less likely to have no residual disease (20% vs. 34%). Findings of re-resection were no residual disease (n=17), POSTER #55 IMPACT OF NEOADJUVANT CHEMOTHERAPY ON ANEMIA AND PERIOPERATIVE OUTCOMES AT THE TIME OF CYSTECTOMY Timothy Atkinson, Randall Rowland, John Rinehart, Daniel Davenport, Garrett Korrect, Beau Dusseault, Stephen Strup and Paul Crispen University of Kentucky, Lexington, KY (Presented By: Timothy Atkinson) Introduction and Objectives: While neoadjuvant chemotherapy (NC) prior to cystectomy has demonstrated a survival advantage in patients with T2-4aN0MO urothelial carcinoma, the impact of NC on anemia and perioperative outcomes is not well defined. Here we evaluate the impact of NC on preoperative anemia, need for blood transfusions in the perioperative period and postoperative complications at the time of cystectomy. 157 Methods: A single institution retrospective review from 2005 to 2009 for patients undergoing radical cystectomy for T2-4aN0M0 urothelial carcinoma was performed. Patients receiving NC were matched 2:1 with patients not receiving NC (controls) for age, gender and BMI. Comparisons of patient co-morbidity (Charlson score), hemoglobin (Hgb), need for transfusions, estimated blood loss, postoperative complications and severity of complications (Clavien grade) were made. Statistical comparisons were performed with Kruskal-Wallis Test and Chi-square Tests as appropriate. Results: 20 patients receiving NC were matched with 40 patients not receiving NC (controls). Patients receiving NC and controls did not differ significantly in age, BMI, Charlson co-morbidity score, operative time or estimated blood loss during surgery. Baseline Hgb (prior to NC) was similar between groups. Preoperative Hgb (following NC) was significantly lower in NC patients (11.7 + 1.7 g/dL) compared to controls (13.6 + 1.5 g/dL), p = 0.0014. Patients receiving NC (70%) were more likely to receive a blood transfusion during surgery compared to controls (38%), p = 0.17. Additionally, the number of units of blood transfused was significantly greater in NC patients (3.2 units) compared to controls (1.4 units), p = 0.004. Postoperative transfusion requirements, days until oral intake, length of hospital stay, postoperative complication rates and severity of postoperative complications were similar between groups. Conclusion: NC was not associated with an increased rate of postoperative complications. However, NC was associated with a lower preoperative Hgb and an increased need for blood transfusion during cystectomy. Despite increased blood transfusion requirements associated with NC, we continue to advocate the use of NC in appropriate candidates given the survival advantage noted in randomized trials. POSTER #56 IS PROLONGED STENTING A SOLUTION FOR THE LEFT CROSS-OVER URETER DILEMMA IN ABDOMINAL WALL DIVERSIONS? Alejandro Rodriguez, Alexandre Lockhart, Jeff King, Lucas Wiegand, Rafael Carrion, Raul Ordorica and Jorge Lockhart University of South Florida, Department of Urology, Tampa, Florida (Presented By: Alejandro Rodriguez) Introduction and Objectives: The reported rate of ureteral-ileal anastomosis related complications in ileal conduit series in general, ranges from 1.7% to 14%. The concern for obstruction is principally centered also in the crossover ureter (usually the left). This has been noticed in multiple case series, in which stricture developed in the left ureter, in a range of 60 to 80%. Cutaneous ureterostomies (CU) have been done sparingly in adults due to surgeons’ concern of obstruction. We present surgical technical modifications that have improved the outcomes of this type of urinary diversion. Methods: 310 patients with a median age of 71 years (38 – 88), received CU as a UD procedure. Median follow- up was 756 days (30 – 5229). The technique included: a) extensive mobilization of the left ureter and descending colon; b) transposition of the left ureter above the IMA to the right hemi abdomen; c) mobilization of the ileocecal segment with repositioning above both terminal ureters; d) fixation of the abdominal wall hiatus with four angles sutures; e) spatulation and Y V plasty of the ureters with edge to edge anastomosis for stoma creation. The first 161 patients (Group A, 59.1%) had the JJ stents removed in the immediate postoperative period. The second group of 111 patients (Group B, 40.8%), kept the stents longer (>3 months). The model used for analysis was binary logistic regression, which individually compared the binary response of left (L), right (R) and bilateral (B) renal obstruction, with the time patients had stent involvement. Results: Among 272 patients available for follow-up, ureteral obstructions occurred in 36 patients (13.2%). In the overall group, obstruction occurred on the right (R) in 6 patients (2.2%), on the left (L) in 29 patients (9.9%) and bilaterally (B) in 3 individuals (1.1%). Obstruction was treated with re-stenting in 20 pts (55.4%), stoma revision in 12 pts (33.3%) or conversion to conduit in 4 (11%). Ureteral obstruction occurred in Group A: R (3.7%), L (13.7%), and Bilateral (1.82%). In Group B: R (0%), L (4.5%) and Bilateral (0%). Length of stent placement did not affect obstruction on the right ureter. However, stenting time had an impact on the left ureter, with less obstruction in the group of patients receiving longer stent placement (> 3 months). (p = .01). Conclusion: As in other types of urinary diversions, obstruction of the left ureter is a common complication of bilateral cutaneous ureterostomies. In our experience, long term stenting (>3 months) as well as the surgical modifications applied, improved the clinical outcome of this type of urinary diversion in adults, achieving similar results that are comparable to the ileal conduit. Funding: None. 158 POSTER #57 CAN CONTEMPORARY TARGETED THERAPIES PROVIDE CLINICALLY MEANINGFUL CHANGES IN RENAL CELL CARCINOMA VENOUS TUMOR THROMBI? Scott E. Delacroix, Jr.¹, Brian F. Chapin¹, Nicholas Cost², Jose A. Karam¹, Stephen Culp¹, E. Jason Abel¹, Graciela Gonzales³, Vitaly Margulis² and Christopher G. Wood¹ ¹Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; ²Department of Urology, The University of Texas Southwestern, Dallas, Texas; ³Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Presented By: Scott E. Delacroix, Jr.) Introduction and Objectives: Cases of renal cell carcinoma (RCC) tumor thrombus regression after treatment with contemporary systemic therapies have been reported. We sought to identify clinically meaningful changes in tumor thrombi in a contemporary series of patients treated with targeted therapies. Methods: An M.D. Anderson institutional database was queried for patients treated with targeted therapy while the primary RCC remained in situ. The subset of patients with a vascular tumor thrombus was assessed for radiographic responses in tumor thrombus size and location. Pathologic criteria were available from a percutaneous biopsy or the surgical specimens in those patients in which a neoadjuvant strategy was employed. Surgical complications were graded using the modified Clavien system and assessed within 12 months of surgery. Clinically meaningful changes were defined as a change in tumor thrombus which could result in an alteration of surgical technique or a change in the anatomic thrombus level. Results: A total of 178 patients were treated with targeted therapy with the primary tumor in place. Venous tumor thrombus was present in 27% (n=48) and comprised our study cohort. The primary histology was clear cell in 75% of cases and 47/48 patients presented with metastatic disease. Prior to treatment, the tumor thrombus was within the renal vein (RV) in 60% (29/48 – Level 0), the first 2 cm of the inferior vena cava in 10% (5/48 – Level 1), > 2 cm above the RV in 21% (10/48 – Level 2), at the level of the hepatics but below the diaphragm in 6% (3/48 – Level 3), and above the diaphragm in 2% (1/48 – Level 4). After a median duration of therapy of 2.75 months, clinically meaningful changes occurred in 25% of patients (12/48). Of these, progression occurred in 58% (7/12) while POSTERS 42% (5/12) had regression of tumor thrombus. Fourteen patients (30%) received surgery after targeted therapy. Clavien categorized complications ≥ grade 3 occurred in 50% of surgical cases, with 71% of patients experiencing any grade complication. No patient experienced a pulmonary embolism with treatment or during follow up. Conclusion: To our knowledge, this is the largest reported series of RCC patients with an in-situ venous tumor thrombus treated with targeted therapy. Very few patients experienced a clinically meaningful change in the venous tumor thrombus—with progression rather than regression occurring more frequently. Although no patient experienced a pulmonary embolism, the use of targeted therapy with the primary goal of obtaining clinically meaningful reductions in tumor thrombi does not appear to be a promising therapeutic option. Funding: Work Supported by NCI Grant P30 CA016672. POSTER #58 PERIOPERATIVE BLOOD TRANSFUSION AND SURVIVAL IN PATIENTS UNDERGOING NEPHRECTOMY FOR RENAL CELL CARCINOMA Todd Morgan, Kelly Stratton, Michael Cookson, Daniel Barocas, Rodney Davis, Duke Herell, Joseph Smith, Jr., Sam Chang and Peter Clark Vanderbilt University (Presented By: Todd Morgan) Introduction: Perioperative blood transfusion (PBT) has been identified as a poor prognostic indicator in patients undergoing surgical treatment for several malignancies. Two mechanisms proposed to explain this relationship are reduced tumor surveillance secondary to immunosuppression from transfusion, and delivery of growth factors in transfused blood resulting in stimulation of tumor growth. Whether there is any impact of PBT on survival in patients with renal cell carcinoma (RCC) is not known. We sought to investigate the relationship between PBT and survival in patients undergoing nephrectomy for RCC. Methods: A retrospective analysis of a prospectively collected RCC database identified 559 consecutive patients who underwent radical or partial nephrectomy for locoregional RCC from 2003 – 2008 and in whom complete information was available. Primary outcome measures were overall survival (OS) and recurrence free survival (RFS). Covariates included age, Fuhrman grade, tumor stage, lymph node status, Charlson Comorbidity Index (CCI), estimated blood loss (EBL), anemia and PBT. Multivariate analysis was performed using a Cox proportional hazards model. Mortality rates were estimated using the Kaplan-Meier product limit method. Results: Mean follow-up was 27.9 months (IQR: 15.4 – 39.4 months) and mean age at the time of nephrectomy was 60.4 years. Average EBL was 410 ml, and 73 patients (13%) required PBT. The estimated 3-year OS for transfused patients was 58%, compared to 85% in the non-transfused cohort (p<0.01). On multivariate analysis, PBT was an independent predictor of OS (HR 1.88, 95%CI 1.01 – 3.52) but not RFS (HR 1.14, 95%CI 0.56 – 2.35) after correcting for age, grade, stage, lymph node status, CCI, EBL and anemia. 159 Conclusion: In patients undergoing nephrectomy for RCC, PBT may be an independent predictor of OS. However, PBT was not independently associated with RFS and, therefore, the impact of PBT in patients undergoing surgery for RCC remains unclear. While further studies are needed to better elucidate any potential relationship between PBT and survival in patients with RCC, these data support a continued need for strategies to decrease the use of blood products in patients undergoing cancer surgery. POSTER #59 FLANK PAIN AS A COMMON COMPLICATION AFTER PERCUTANEOUS RENAL CRYOABLATION Bruce Shingleton¹ and H. D’Agostino² ¹Ochsner Clinic; ²LSUHSC, Shreveport, LA (Presented By: Bruce Shingleton) Introduction: Cryoablation is a treatment option for small renal tumors. As this is being used more frequently, certain complications have arisen and patients need to be aware of them. Methods: We reviewed the medical records of all patients who underwent PCA for the past 4 years. Accounts were made of all complications and there outcomes. Methods to avoid these complications were reviewed. Results: A total of 75 patients underwent PCA. The most common complication was flank pain which occured in 14% of patients,the next complications in order of decreasing frequency were hematuria, wound infection and UTI. The location of the tumor and number of probes were evaluated to see if there were any trend leading to this complication of flank pain. There was no coorelation between tumor location and number of probes used. Conclusion: At the point in time all patients should be aware of the complication and be prepared for it. The good result of the complication is that all patients who had it had complete resolution of it over. Methods to try to avoid this will be discussed. POSTER #60 COST ANALYSIS OF ROBOTIC-ASSISTED- VERSUS LAPAROSCOPIC- VERSUS OPEN PARTIAL NEPHRECTOMY Joshua Langston, J. Patrick Selph, James Fergueson, Ankur Manvar, Sean Sawh, Mathew Raynor, Matthew Nielsen, Eric Wallen and Raj Pruthi (Presented By: Joshua Langston) Introduction and Objectives: Robotic-assisted partial nephrectomy (RAPN) is currently being evaluated as a means of increasing the dissemination of minimally invasive approaches to the realm of partial nephretomy while aiming to maximize surgeon learning curves, patient satisfaction and oncologic outcomes. However, the cost of RAPN to laparoscopic partial nephrectomy (LAPN) and open partial nephrectomy (OPN) remains unreported. Methods: We gathered patient-level financial data of all adult (age>18) partial nephrectomies at UNC-hospital from FY ’08 – ’10. Multi-procedure cases (eg simultaneous liver resection) were excluded. Procedures which were changed intra-op (partial −> radical) or RAPN −> OPN, were excluded. Cost data were calculated based on the allocation patterns of UNCH. (Non-disposable costs including robotic purchase costs, maintenance and reusable equipment (robotic and non-robotic) are amortized over their usage terms and allocated to all OR cases). 160 Results: Overall, 18 OPN, 25 LAPN and 18 RAPNs were performed. While OPN patients were older (58 yrs), the difference between LAPN and RAPN were insignificant (52 v 49 yrs). When compared to LAPN, RAPN had a slight cost savings ($11,932 v $12,322), which was abrogated when robotic costs ($1,071 per case given 300 cases/year) were allocated only to robotic cases. The savings were driven largely by a LOS decrease (RAPN: 2.8 days, LAPN 3.4, OPN 3.7) which decreased direct variable costs and allocated fixed costs. Operative times were increased in the RAPN group (209 mins) compared to OPN (182 mins) and LAPN (170 mins). Disposable OR costs were equivalent between RAPN ($1212) and LAPN ($1278). Conclusion: RAPN requires significant capital expenditure and longer OR times in relation to LAPN, however RAPN patients have a shorter LOS which helps to recoup capital expenditures. Cost analyses are complicated by cost allocation structures, but at least at this academic institution, robot-assisted partial nephrectomy is an economically viable approach. These findings are confounded by differences in patient characteristics between groups. Future studies should attempt to capture cost-benefits of decreased convalescence/decreased short- term disability claims and long-term outcomes, in a prospective manner if possible. POSTER #61 COMPARISON OF REIMBURSEMENT AMONG VARIOUS NEPHRON−SPARING SURGERIES (NSS) FOR SMALL RENAL MASSES Scott Castle, Vladislav Gorbatiy, Nelson Salas, Ahmed Eldefrawy, Watid Karnjanawanichkul and Raymond Leveillee University of Miami, Department of Urology, Miami, FL (Presented By: Scott Castle) Introduction: The evolution of treatment options for small renal tumors has presented Radical Nephrectomy (RN), Partial Nephrectomy (PN), thermal ablative therapies or observation as current therapies. With the advancement of new technology, it is unclear whether new therapies are cost-effective. The purpose of this study is to compare the costs associated with Nephron-Sparing Surgery (NSS) for small renal tumors and the immediate hospital stay in specifically Open Partial Nephrectomy (OPN), Laparoscopic Partial Nephrectomy POSTERS (LPN), Robot-assisted Partial Nephrectomy (RLPN), Laparoscopic Radio-frequency Ablation (LRFA), and Computed Tomography guided Radio−frequency Ablation (CTRFA). Materials and Methods: 71 patients with mean age of 57.4 years (21 – 86) diagnosed with a renal mass by contrast enhanced CT of MRI matched for tumor size and medical comorbidities underwent either OPN, LPN, RLPN, LRFA or CTRFA from 2004 to 2010. Data on each individual patient was collected for medicare use, surgeon fees and total hospital costs retrospectively for 12 OPN, 11 LPN, 15 RLPN, 21 LRFA and 12 CTRFA patients for the procedure and immediate hospital stay. Results: 71 patients with a mean tumor size of 2.8cm (1.0 – 6.4cm) and 31% using medicare underwent NSS for a small renal mass. Mean tumor diameter was 3.7, 2.8, 3.0, 2.5 and 2.5 for OPN, LPN, RLPN, LRFA and CTRFA respectively. Tumor size was not different between groups (p=0.52). LRFA and CTRFA had significantly lower total cost than OPN, LPN and RLPN (p<0.0001) and CTRFA < LRFA (p < 0.0001). Medicare and private insurance groups had equivalent total costs (p>0.05), except for LPN (p=0.004). Surgeon Fees were no different between groups (p>0.05). Medicare and private insurance groups had equivalent surgeon fees (p>0.05). Conclusion: Surgeon fees appear to be equivalent among various NSS techniques. There is no difference in reimbursement amounts among Medicare and private insurance patients. RFA has advantages over PN of decreased total cost while providing equivalent surgeon reimbursement. This information is helpful in the decision making process for both patients and physicians. 161 POSTER #62 COSTS FOR UROLOGIC HOSPITALIZATIONS IN THE U.S., 1997 TO 2007 Jan Colli University of Alabama at Birmingham (Presented By: Jan Colli) Introduction: In-hospital costs, which represent a sizable portion of all health care costs, have increased significantly over the last decade. The purpose of this study is to investigate the increase in hospital stays and costs for major urologic disorders from 1997 to 2007. A secondary objective is to compare increases in urologic disorders costs to changes in aggregate hospital costs over the time period. Materials and Methods: Data from the Healthcare Cost and Utilization Project (HCUP) trends in costs for major urologic hospitalizations during the years 1997 to 2007 were used for this study. Urologic disorders considered in this study were prostate cancer (PCa), bladder cancer (BCa), kidney cancer (KCa), prostate hyperplasia (BPH), urinary infections (UI) and kidney stones (KS). In particular, we gathered data on the total number of discharges, mean length of stay in days, mean charges ($) and total charges ($) for each urologic disorder over the time period. Results: Changes in the number of annual hospital discharges for urologic disorders from 1997 to 2007 are: PCa (103,194 to 102,346); BCa (48,125 to 38,064); KCa (29,530 to 46,887); BPH (112,456 to 63,731); UI (406,219 to 535,490) and KS (181,233 to 164,637). Mean length of hospital stay increased 15% for BCa (from 5.4 to 6.2 days), remained about the same for KS and decreased 8% to 35% for the other urological disorders. Overall mean hospitalization charges increased from 105% to 175% from 1997 to 2007. The percent increases in annual hospital costs for urologic disorders were: 154% for PCa ($1.3 to $3.2 billion); 116% for BCa ($0.7 to $1.6 billion); 226% for KCa ($0.6 to $1.9 billion); 30% for BPH ($0.9 to $1.1 billion); 208% for UI ($3.2 to 9.9 billion) and 150% for KS ($1.2 to $3.0 billion). After adjusting for inflation, percent increases in for urologic disorders over the time period were: 120% for PCa; 81% for BCa; 191% for KCa; 4.2% for BPH; 173% for UI and 115% for KS. Conclusion: Inflation-adjusted aggregate costs for hospital stays rose from $222.4 billion in 1997 to $343.9 billion in 2007—an increase of 55 percent according to data from HCUP. In-hospital costs for urinary infections increased sharply from $3.2 billion in 1997 to almost $10 billion in 2007 and represent the highest cost for any urologic hospitalization in this study by about a factor of three. Costs for hospital stays for all urologic disorders except BPH increased at rates far exceeding aggregate costs for all hospital stays from 1997 to 2007.This study has no financial funding. POSTER #63 DOES PROSTATE WEIGHT AFFECT PERIOPERATIVE, ONCOLOGIC AND EARLY CONTINENCE OUTCOMES AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY PERFORMED BY AN EXPERIENCED SURGEON? Rafael Coelho, Sanket Chauhan, Ananthakrishnan Sivaraman, Kenneth Palmer, Marcelo Orvieto and Vipul Patel GRI (Presented By: Ananthakrishnan Sivaraman) Purpose: To determine whether prostate weight has an impact on the pathological, operative and early continence outcomes after Robot Assisted Laparoscopic Radical Prostatectomy (RALP). Methods: We analyzed prospectively 1,009 consecutive patients who underwent RALP. All the procedures were performed by a single surgeon (VRP) with previous experience greater than 1000 procedures. Patients were stratified into three groups on the basis of pathological prostate weight: group 1 – less than 30g, group 2 – 30 to 49.9g, group 3 – 50 to 69.9g and group 4 – 70 or greater. Outcomes analyzed included operative time, Estimated Blood Loss (EBL), nerve-sparing procedure, hospital stay, days with catheter, presence of anastomotic leakage on cystogram, number of bladder neck reconstruction procedures, prostate weight, tumor volume, pathological stage, PSM rates, pathological Gleason score and continence rates. Continence was defined as the use of ‘‘no pads’’ based on the patient responses to the EPIC (Expanded Prostate Cancer Index Composite) questions at 4 weeks, 6 weeks, 3 months and 6 months after RALP. Results: Patients with a larger prostate (group 4) were older (mean age 64.9 years), had higher pretreatment PSA (median 6.5 ng/ml), higher AUA-SS (mean 12.8) longer operative time (mean 83.3 min) and higher estimated blood loss (median 129.2 cc) (p < 0.001 for all variables; table1). There was no association between prostate size and body mass index, biopsy Gleason Score, clinical stage, catheterization time, pathological stage, hospital stay, anastomotic leak rates, specimen gleason score and continence rates (at 1 month, 3 and 6 months). Overall positive surgical margin rates were slightly lower in patients with prostate size larger than 70g (p <0.001). Conclusion: RALP performed by an experienced surgeon in patients with an enlarged prostate is feasible with slightly higher operative time and estimated blood loss and without any impact on early continence rates. Pathologically larger prostates were associated with lower PSM rates even thought the pathological stage and specimen gleason score were similar between the groups. 162 POSTER #64 OUTCOMES FOLLOWING UROLOGIC PROCEDURE IN NONAGENARIANS AND CENTENARIANS: A SAFETY AND FEASIBILITY ANALYSIS Sachin Patil and Ronald Chamberlain Saint Barnabas Medical Center, Livingston, NJ (Presented By: Sachin Patil) Introduction: The number of individuals >85 years old will double and reach 9.6 million by 2030, and 20.9 million by 2050. Surgical outcome data for this group is limited to specific fields such as cardiac and orthopedic surgery. We sought to characterize the urologic pathology and surgical outcome in individuals over >90 years of age. Methods: Data for 1189 surgical procedures involving 951 patients between 2000 and 2010 was analyzed. Age, gender, ethnicity, co-morbidities, type of procedure, anesthesia type, length of procedure, length of stay, ICU admission and outcome were abstracted. Results: 128 patients underwent 194 urologic procedures. Mean age was 93.6 years (91 to 102 years) with an M: F ratio of 2.5:1. The most common co-morbidities were hypertension (33%), atrial fibrillation (14.9%) and coronary artery disease (10.8%). Ninety four procedures (48.5%) were performed under regional anesthesia, 88 (45.4%) under general anesthesia, 8 (4.1%) under managed anesthesia care (MAC) and 4 (2.1%) under local anesthesia. There were 120 (61.9%) bladder procedures, 47 (24.2%) prostate procedures, 13 (6.7%) urethra procedures, 6 (3.1%) kidney procedures, 5 (2.6%) ureter procedures, and 3 (1.5%) involving the external genitalia (Table 1). The mean surgery length was 48.4 min (10 – 275 min) and 5.1% of patients required ICU care. The average length of stay was 4.9 days (0 – 37 days). Eighty percent of patients were discharged to home, 14.4% of patients left to a nursing home, and 3% of patients went to rehabilitation facility. Overall mortality was 3.6% (N=7) with all of these in the prostatectomy group. Conclusion: Patients > 90 years old are a growing population that does and will utilize increasing surgical health care resources. Despite their age, outcome after urologic procedures in this group was acceptable with an operative mortality of 3.6%. Urologic procedures involving urinary bladder and prostate were the most POSTERS common operations on female and male patients, respectively. Restoration to the pre-operative status after urologic surgical care should be anticipated. 163 POSTER #65 MOVED TO POSTER 38.5 POSTER #66 ROBOT-ASSISTED RADICAL CYSTECTOMY VERSUS OPEN RADICAL CYSTECTOMY FOR EXTRAVESICAL DISEASE: A SINGLE CENTER EXPERIENCE Kyle A. Richards, A. Karim Kader, Joseph A. Pettus, John J. Smith, III and Ashok K. Hemal Wake Forest University Baptist Medical Center (Presented By: Kyle A. Richards) Introduction: Robot-assisted radical cystectomy (RARC) has been gaining popularity as a treatment option for select patients with all stages of bladder cancer; however, there is concern in regards to the oncologic efficacy of RARC in patients with extravesical disease (pT3, pT4). Objectives: A RARC program was established at out institution in January 2008. To assess the impact of a robotic approach on extravesical disease, we compared our initial RARC series with a group of historical open radical cystectomy (ORC). Materials and Methods: Our institution’s bladder cancer cystectomy database was queried to identify all patients with pT3 or pT4 pathology. A total of 33 patients were identified for the RARC cohort and 33 for the ORC cohort. A retrospective analysis was performed on these 66 patients undergoing radical cystectomy for curative intent. Results: Patients in both groups had comparable pre-operative characteristics and demographics. Complete median operative times (including change of position and re-draping) were 432 (IQR 346, 551) for RARC vs. 383 minutes (IQR 346, 454) for ORC (p = 0.09). Blood loss and transfusion rates were less for RARC vs. ORC with a median of 300 (IQR 175, 500) for RARC vs. 700 mL (IQR 525, 1000) for ORC and 27% vs. 48% respectively (p = 0.001). Hospital stays trended down with median of 7 (IQR 6, 8) for RARC vs. 8 days (IQR 7, 12) for ORC (p = 0.06). The complication rate for RARC was 36% compared to 48% for ORC (p = 0.453). With respect to pathologic parameters, there were more patients with pT4 disease in the RARC cohort (48%) compared to the ORC cohort (24%) (p = 0.04). There were 4 positive margins in the ORC group (rate of 4% pT3, 38% pT4) compared to 9 in the RARC group (rate of 12% pT3, 44% pT4) (p = 0.12) with median LN yields of 14 (IQR 10, 24) and 16 (IQR 10, 21) (p = 0.697) respectively. Conclusion: Our RARC cohort had more patients with pT4 pathology than the ORC cohort and likewise the number but not rate of positive margins were higher in the RARC group. Although RARC provided less blood loss with a trend towards shorter hospital stay, long-term oncologic follow-up will be essential to determine the true efficacy of RARC for patients with locally advanced disease. 164 POSTER #67 THE ECONOMICS OF ROBOTIC UROLOGIC SURGERY AND ITS ROLE WITHIN A COMMUNITY HOSPITAL AND CANCER CENTER Rajesh Laungani¹, Jade Smith² and Nikhil Shah³ ¹Saint Josephs Hospital, Atlanta, Georgia; ²Philadelphia College of Osteopathic Medicine, Georgia Campus; ³Saint Joseph’s Hospital (Presented By: Rajesh Laungani) Objectives: Robotic prostate surgery for treatment of prostate cancer continues to gain popularity in the US. Community hospitals continue to purchase robotic systems but have realized the pitfalls of robotic surgery including the expense related to purchase, maintenance and training of physicians. We discovered important points for incorporation of robotic surgery within a community hospital cancer center which translate into a significant reduction in costs for the hospital system. Methods: We reviewed outcome data related to hospital costs and patient hospital stay for a time period before and after the adoption of robotic surgery within the hospital system. Data was collected from January 2004 to December 2009. Number of cases, charges per case and length of stay were reviewed. Results: With the introduction of robotics we noticed an initial increase in cost per case; $16,495 for open prostatectomy to $25,593 for robotic prostatectomy. This cost significantly decreased after two years and continued to decline ($14,481) below charges for open radical prostatectomy. Case volume significantly increased; 269 robotic prostate cases in 2009 vs 39 open prostate cases in 2004. Patient length of stay (days) decreased significantly from 2.72 to 1.08. This equates to 460 patient days saved for robotic radical prostatectomy compared to open radical prostatectomy. Fellowship trained urologists translate into a large case volume experience with no separate training or learning curve required. Increased case volume decreased costs significantly; specifically related to use and maintenance of the robotic system and overall hospital related costs, ie decreased hospital stay, decreased complication rate, decreased need for pain medication and blood transfusion. Conclusion: In the US, a large percentage of robotic growth has occurred in the community hospital setting as POSTERS compared to the university setting. Investment in a robotic surgical system can be a daunting and expensive task for a community hospital, but we have found that over a period of 1 – 2 years benefits can extend to community hospital system in the form of decreased costs and charges, more efficient care and excellent patient outcomes. POSTER #68 LAPAROSCOPIC-GUIDED RADIOFREQUENCY ABLATION IS AN EFFECTIVE TREATMENT MODALITY FOR ENHANCING RENAL MASSES AT INTERMEDIATE TERM FOLLOW-UP Elie Antebi¹, Michael Gorin¹, Robert Carey² and Vincent Bird³ ¹Department of Urology, University of Miami Miller School of Medicine, Miami, FL; ²Urology Treatment Center, Sarasota, FL; ³Department of Urology, University of Florida College of Medicine, Gainesville, FL (Presented By: Elie Antebi) Objectives: Laparoscopic-guided radiofrequency ablation (LRFA) has been introduced as a minimally invasive nephron-sparing approach for the treatment of enhancing renal masses. Many patients who desire treatment present with multiple comorbidities. Our purpose is to present our intermediate-term oncologic outcomes using our technique of mulitipass LRFA. Methods: A retrospective analysis was performed of patients who underwent LRFA for treatment of an enhancing renal mass. Inclusion criteria required a minimum of six months follow-up. Preoperative biopsies were obtained in all patients. Perioperative demographic and surgical data, tumor characteristics and follow-up were evaluated. Statistical analysis was performed using the paired Student’s t-test. Results: A total of 75 patients met inclusion criteria. Mean patient age was 72 years with a mean ASA score of 2.6. Common comorbidities included hypertension (80.0%), coronary artery disease (30.7%) and diabetes (24.0%). Mean tumor size was 3.1 cm. Renal cell carcinoma was present in 65.3% of biopsies. Only one (1.3%) patient had a biopsy insufficient for histopathologic diagnosis. Intraoperative complications occurred in 5.3% of cases. Follow-up ranged from 6 to 42 months with a median of 18.3 months. Preoperative GFR decreased 73.0 to 69.1 ml/min (p<0.0001) following LRFA. Recurrence-free survival was observed to be 96.0% at median follow-up. Conclusion: LRFA can be safely used in an elderly, higher risk population with excellent oncologic outcomes. While we observed a statistical decline in GFR following this procedure, this decline was not clinically significant. 165 POSTER #69 LAPAROSCOPIC-GUIDED RADIOFREQUENCY ABLATION IS SAFE FOR TREATMENT OF ENHANCING RENAL MASSES IN PATIENTS TAKING WARFARIN AND/OR ANTIPLATELET AGENTS Michael Gorin¹, Elie Antebi¹, Robert Carey² and Vincent Bird³ ¹Department of Urology, University of Miami Miller School of Medicine, Miami FL; ²Urology Treatment Center, Sarasota, FL; ³Department of Urology, University of Florida College of Medicine, Gainesville, FL (Presented By: Michael Gorin) Objectives: Laparoscopic-guided radiofrequency ablation (LRFA) is an option for the treatment of enhancing renal masses in elderly patients with multiple comorbities. Often these patients are prescribed warfarin and/or an antiplatelet agent (aspirin or clopidogrel) for the management of comorbid diseases. These patients pose a management challenge due to the risk for perioperative bleeding and thrombotic events. We evaluate the safety and efficacy of LRFA in this specific patient group. Methods: From our institutional databases, we identified all patients who underwent LRFA for treatment of enhancing renal masses who were prescribed warfarin and/or an antiplatelet agent. Records were reviewed for patient demographics, perioperative data, tumor characteristics, blood loss, intraoperative complications and tumor recurrence. Statistical analysis was performed using the student’s t-test. Results: A total of 107 patients underwent LRFA during the study period. A cohort of 52 patients were identified to be taking warfarin and/or an antiplatelet agent (aspirin or clopidogrel) at the time of ablation. More specifically, 8 patients were taking warfarin, 30 aspirin and 7 clopidogrel in isolation. Seven patients were taking a combination of agents. All such medications were stopped within a week of LRFA. Mean patient age was 75 years, and mean ASA score was 3. Common comorbitities included coronary artery disease (55.8%), arrhythmias such as atrial fibrillation (21.2%) and diabetes mellitus (21.2%). Mean tumor size was 3.4 cm. Preablation biopsy revealed RCC in 36 (69.2%) cases. Mean estimated blood loss was 21 ml. Blood loss of the 55 patients who were not on one of these medications was a mean of 22ml, with no statistically significant difference observed. No patients experienced a bleeding related complication in the perioperative period. Moreover, no patients experienced a complication related to the stopping of these medications (i.e. no coronary or cerebral events). Conclusion: LRFA is safe in patients who are taking warfarin and/or antiplatelet agents. Intraoperative blood loss is minimal in this patient population when these medications are discontinued one week prior to ablation. These patients did not manifest any clinically evident thrombotic events in the perioperative period. POSTER #70 THE USE OF AIR RETROGRADE PYELOGRAM DURING FLUOROSCOPIC ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY IS ASSOCIATED WITH DECREASED RADIATION EXPOSURE Michael Lipkin, John Mancini, Agnes Wang, Dorit Zilberman, Michael Ferrandino, Michael Miller and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin) Introduction: Fluoroscopy is commonly used to obtain access for percutaneous nephrolithotomy (PNL). Patient and stone related factors have been shown to affect radiation exposure during PNL. Iodinated contrast is often used to opacify the collecting system to enable access during PNL. We currently use room air instead of contrast, as air has the advantages of filling the posterior calyces when the patient is in the prone position, allowing for clear visualization of the stone, while reducing the issues related to contrast extravasation. We compared the use of air and contrast during fluoroscopic access for PNL to determine if the use of air was associated with decreased radiation exposure. Methods: We retrospectively reviewed all PNL procedures performed at our institution by a single surgeon over the past 2 years. A total of 225 PNL procedures were performed, of these 125 were performed with air pyelograms (AP). There were 96 PNL procedures with information on radiation dosage included for analysis. The effective dose (ED) was calculated using accepted conversion tables. Multivariable linear regression was used to determine the association between ED and the use of air pyelogram controlling for factors known to increase radiation exposure (BMI, stone size, stone configuration and number of percutaneous access tracts). Results: Of the 96 PNL procedures included in the study, 60 (63%) were performed with an air pyelogram and 36 (37%) used iodinated contrast (IC). The mean ages were 50.7 and 52.8 years in the AP and IC groups, respectively. The AP group had a median BMI of 31.6 kg/m2 compared to 29.4 kg/m2 in the IC group. Median stone sizes were 4.0cm2 and 3.6cm2 for the AP and IC groups, respectively. The mean number of accesses for the AP and IC groups were 1.27 and 1.03 respectively. After controlling for BMI, stone burden/configuration and number of percutaneous tracts, multivariate linear regression showed significantly lower radiation exposure in the air pyelogram group compared to the contrast pyelogram group (p=0.001). Using an AP lowered the mean adjusted effective dose nearly two fold, from 7.67 (CI=5.99 – 9.81) to 4.45 (CI=3.68 – 5.38) mSv. Conclusion: Air retrograde pyelogram is associated with decreased radiation exposure during PNL when compared to contrast retrograde pyelogram. Factors that may lead to reduced radiation exposure include better visualization of the stone with air, lack of extravasation, and preferential filling of posterior calyces. These advantages facilitate fluoroscopic access during PNL. 166 POSTER #71 RISK OF DIABETES MELLITUS AND HYPERTENSION AFTER EXTRACORPOREAL SHOCK WAVE (ESWL) THERAPY FOR URINARY STONE DISEASE Reza Mehrazin, Michael Aleman, Jamin Brahmbhatt, Jessica Lange, Lindsey Hartsell, Evan Dunn, Kevin Walls, Matthew Kincade, Anthony Patterson, Christopher Ledbetter, Jim Wan and Robert Wake (Presented By: Reza Mehrazin) Objectives: We evaluated a consecutive series of ESWL patients at a single institution to determine the risk of developing de novo diabetes mellitus and hypertension after the procedure. We then compared patient characteristics between the groups that developed these outcomes and those who did not, to determine specific risk factors for their development. Methods: We retrospectively analyzed the demographic information of 761 consecutive patients treated with ESWL at our institution, including BMI, age, race, gender, laterality of stone burden, number of treatments, pre- and post-treatment renal function, and presence of preoperative and postoperative HTN and DM to determine whether there were statistically significant differences among those who did and did not develop HTN and DM. HTN and DM diagnoses were based on a computerized diagnosis list and/or the presence of medical therapy for the disease. The data were then analyzed by chi-square test and by logistic regression analysis. Results: Of the 761 patients, 150 and 419 patients had pre-existing DM or HTN, respectively. Of the remaining patients, 56 (9.2%) developed de novo DM, while 87 (25.1%) developed de novo HTN. Upon multivariate analysis, Caucasian race (p=0.035), BMI >30 (p<0.0001), and more than one treatment (p=0.035) were found to be associated with the development of DM. Moreover, on multivariate analysis, BMI > 30 (p=0.017), right sided treatment (P=0.008), and decreased GFR (p=0.041) were found to be significantly associated with de novo HTN after ESWL. The mean follow-up was 65.6 months. Conclusion: In our experience, obesity, Caucasian race and increased number of treatments were found to be risk factors for development of de novo DM after ESWL; and obesity, right-sided treatments, and decline in renal function after ESWL were found to be risk factors for development of de novo HTN. Obesity may be associated with the development of these diseases in general, and decreased GFR may represent a result POSTERS of the disease rather than a predictor of its development. The findings that repeat treatments and right-sided treatments predispose patients to the development of DM and HTN, respectively, are intriguing and may potentially influence the choice of treatment modality. These warrant further prospective study to determine if a true causal relationship exists. POSTER #72 FACTORS AFFECTING RADIATION EXPOSURE DURING URETEROSCOPY Michael Lipkin, Agnes Wang, John Mancini, Dorit Zilberman, Michael Ferrandino and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin) Introduction: Patients with nephrolithiasis are at risk for increased radiation exposure. We determined the effective dose (ED) of radiation patients were exposed to during ureteroscopy (URS) and identified risk factors for increased radiation exposure. Methods: We retrospectively reviewed all URS procedures performed at our institution over a 4 month period. A total of 78 URS for the treatment of stones were performed, and 68 with information on radiation dosage were included. The ED was calculated using accepted conversion tables. Multivariable linear regression was used to determine the association between ED and patient, stone and procedure characteristics thought to affect ED. Results: Of the 68 patients, 28 were male. The mean age was 53.6 years. The median body mass index (BMI) was 29.7 kg/cm2. There were 59 unilateral and 9 bilateral URS. A flexible ureteroscope was used in 32 cases, a semi-rigid in 19, and both in 16 cases. The median stone burden was 0.56 cm2. In 22 URS the stone was located in the distal ureter, 20 in the proximal ureter and 13 intra-renal. In 12 cases both a ureteral and intra- renal stone were treated. The median ED was 1.01mSv (0.13 – 9.56 mSv). On multivariate analysis, increased BMI was associated with increasing ED. The mean ED for BMI<25, 25 – 29.9, 30 – 40, >40 was 0.54 mSv, 0.97 mSv, 1.17 mSv and 2.5 mSv, respectively (p=0.001). Male gender was associated with greater ED, 1.14 mSv versus 0.86 mSv for females (p=0.011). Ureteral balloon dilation was also associated with greater ED, 2.03 mSv versus 0.81 mSv (p=0.005). Conclusion: Fluoroscopy during URS contributes to patient radiation exposure. Patients with higher BMI, male patients, and patients who undergo ureteral balloon dilation are at risk for increased radiation exposure. Prospective studies are needed to evaluate methods to reduce radiation exposure. 167 POSTER #73 PROFILE OF THE PEDIATRIC BRUSHITE STONE FORMER Davis P. Viprakasit, Douglas B. Clayton, Mark D. Sawyer, John C. Thomas and Nicole L. Miller Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee (Presented By: Davis P. Viprakasit) Introduction and Objectives: Despite an increased occurrence of brushite stones and overall stone disease in the literature, the incidence in the pediatric stone patient has not been previously reported. We sought to characterize the occurrence of brushite stones in the pediatric patient. Methods: After IRB approval, we identified patients with brushite urinary calculi from our stone database. Results: From 2004 – 2009, 7 (3.8%) (5 female, 2 male) out of 186 pediatric patients surgically treated for nephrolithiasis were noted with brushite stones on stone analysis. Mean age was 10 years (2 – 17). Four (57%) patients had other urologic abnormalities (UPJ obstruction, ureteral duplication, reflux) and three (43%) had a history of UTI. Prior stones were reported in 3 (43%) patients with 1 (14%) previously treated with shockwave lithotripsy (SWL). Mean stone area was 92 mm2 (6 – 312). Surgical procedures included 4 (57%) ureteroscopies and 3 (43%) percutaneous nephrolithotomies. Complete metabolic studies were available in four patients with three additional patients having urinary calcium / creatinine and pH. Abnormalities included: hypercalcuria in 5 (83%) and urine pH >6.2 in 7 (100%). Hypercalcemia was absent in the 5 patients with serum values. Medical management was initiated in 3 patients. At a mean follow-up of 69 months (2 – 185) since treatment, two (29%) patients had stone recurrence. Conclusion: Brushite stones can occur in the pediatric patient. Unlike in adults, there was no association with SWL suggesting that other factors such as chronic injury from anatomic abnormalities may be involved in the formation of brushite stones. Pediatric brushite patients should undergo metabolic evaluations with consideration of aggressive medical management. POSTER #74 RISK OF DETERIORATION IN RENAL FUNCTION AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) OR URETEROSCOPY (URS) FOR URINARY STONE DISEASE Reza Mehrazin, Jamin Brahmbhatt, Michael Aleman, Jessica Lange, Evan Dunn, Anothony Patterson, Chrisopher Ledbetter, Jim Wan, Ithaar Derweesh and Robert Wake (Presented By: Reza Mehrazin) Introduction and Objectives: While guidelines for the treatment of stone disease are currently determined based on stone-free rates and immediate post-operative morbidity, little is known about potential long-term sequelae of these treatment modalities. We investigated whether the treatment of urinary stone disease with extracorporeal shock wave lithotripsy (ESWL) is associated with an increased risk of renal functional decline when compared to ureteroscopy (URS). Methods: In this retrospective case-control study of 761 consecutive patients treated with ESWL and 198 consecutive patients treated with URS at our institution, we analyzed the subjects’ demographic information (including BMI, age, race and gender), laterality of stone burden and treatment modality and presence of preoperative DM and/or HTN, pre- and post-treatment glomerular filtration rate (GFR) to determine whether there were statistically significant relationships. GFR was calculated using Modification of Diet in Renal Disease (MDRD) calculator. The data were then analyzed by chi-square test and by logistic regression analysis. Results: Of the 959 patients who underwent either ESWL or URS, 192 (20.0%) patients had pre-existing DM, and 526 (54.8%) patients had pre-existing HTN. 924 (96.4%) were male vs. 35 (3.6%) were female. 788 (82.2%) Caucasian, 148 (15.4%) African American, and 9 (0.9%) others. Average BMI, age, and follow-up in the entire cohort were 29.2, 59.4 and 57.5 months, respectively. In the ESWL cohort, mean pre-treatment and post-treatment GFR were 73.6 mL/min/1.73m2 and 73.2 mL/min/1.73m2, respectively. In the URS cohort, mean pre-treatment and post-treatment GFR were 70.1 and 66.2, respectively. Age, gender, ethnicity, BMI and laterality of stone disease were not significant risk factors for decline in GFR. Conclusion: Compared to ESWL, URS treatment showed more decline in GFR function. As this was not a prospective, randomized trial, this finding was likely due to differences in the size, location and number of stones treated in the two groups. Further prospective experience and longer term outcomes are required for validation, but ESWL appears to be associated with a minimal decline in overall renal function, and therefore continues to be a safe modality for the treatment of urinary stone disease. 168 POSTER #75 OPTIMIZATION OF TREATMENT STRATEGY EMPLOYED DURING SHOCK WAVE LITHOTRIPSY TO MAXIMIZE STONE FRAGMENTATION EFFICIENCY John Mancini, Daniel Yong, Michael Lipkin, Anges Wang, Neal Simmons, Michael Ferrandino, Pei Zhong and Glenn Preminger Durham, NC (Presented By: John Mancini) Introduction: Previous studies have demonstrated that treatment strategy plays a critical role in ensuring maximum stone fragmentation during Shock wave lithotripsy (SWL). Objectives: To develop an optimal treatment strategy in SWL to produce maximum stone fragmentation. Materials and Methods: Four treatment strategies were evaluated using an in vitro experimental setup that mimics stone fragmentation in the renal pelvis. Spherical stone phantoms were exposed to 2,100 shocks using the Siemens Modularis (electromagnetic) lithotripter. The treatment strategies included increasing output voltage with 100 shocks at 12.3kV, 400 shocks at 14.8kV and 1600 shocks at 15.8kV, and decreasing output voltage with 1600 shocks at 15.8kV, 400 shocks at 14.8kV and 100 shocks at 12.3kV. Both increasing and decreasing voltage models were run at a pulse repetition frequency (PRF) of 1 and 2 Hz. Fragmentation efficiency was determined using a sequential sieving method to isolate fragments less than 2 mm. A fiber optic probe hydrophone was used to characterize the pressure waveforms at different output voltage and frequency settings. In addition, a high-speed camera was used to assess cavitation activity in the lithotripter field produced by different treatment strategies. Results: The increasing output voltage strategy at 1 Hz PRF produced the best stone fragmentation efficiency. This result was significantly better than the decreasing voltage strategy at 1 Hz PFR (85.8% vs. 80.8%, p = 0.017) and over the same strategy at 2 Hz PRF (85.8% vs. 79.59%, p = 0.0078). Conclusion: A pre-treatment dose of 100 low voltage output SWs at 60 SWs/min before increasing to a higher voltage output produces the best overall stone fragmentation in vitro. These findings could lead to increased fragmentation efficiency in vivo, and higher success rates clinically. POSTERS POSTER #76 IN VIVO STONE FRAGMENTATION AND TISSUE INJURY USING A NEW ACOUSTIC LENS DESIGN FOR ELECTROMAGNETIC SHOCKWAVE LITHOTRIPTERS John Mancini, Neal Simmons, Daniel Yong, Eliza Raymundo, Michael Lipkin, Agnes Wang, Michael Ferrandino, Pei Zhong and Glenn Preminger Durham, NC (Presented By: John Mancini) Introduction: Recent studies suggest that third-generation electromagnetic (EM) shock wave lithotripters produce less stone fragmentation than earlier generation electohydraulic (EH) lithotripters. A new acoustic lens for the Siemens Modularis (EM) has been developed that produces an idealized pressure waveform and a broader focal zone, that more closely mimics the profile of earlier generation EH lithotripters. Objectives: To evaluate stone fragmentation efficiency and tissue injury using a new acoustic lens forthe Siemens Modularis lithotripter. Methods: Stone fragmentation and tissue injury comparisons using the new and original lenses in a Siemens Modularis lithotripter were performed in a swine model. Fragmentation efficiency was determined by the weight percent of stone fragments less than 2mm. In a separate tissue injury cohort, kidneys were cast in paraffin wax, and sliced with digital images captured at 120 micron intervals. Digital images were processed to determine the volume of functional renal tissue damage. Results: After 500 shocks the fragmentation efficiency for the new and original lenses were 51.9 ± 16.7% and 48.0 ± 12.1% (p=0.599), respectively. However, after 2000 shocks, the new lens showed significantly improved stone fragmentation at 83.3 ± 8.5%, compared to 63.4 ± 17.4% for the original lens (p=0.001). Tissue injury caused by both the original and new lenses was minimal at 0.45 ± 0.46, and 0.29 ± 0.33% (p=0.520), respectively. Conclusion: Using the new acoustic lens, the Siemens Modularis shows significantly improved stone fragmentation. Additionally, tissue injury from the new lens appeared less and was not significantly different from the original lens. This new technology could potentially be retrofitted to existing lithotripters, thereby improving the clinical effectiveness of EM lithotripsy devices. 169 POSTER #77 CONTRIBUTION OF GLYCINE AND PHENYLALANINE METABOLISM TO URINARY OXALATE EXCRETION John Knight, Dean Assimos and Ross Holmes Wake Forest University School of Medicine, Winston-Salem, North Carolina (Presented By: Dean Assimos) Introduction and Objectives: Experiments in humans and rodents using oral doses of glycine and phenylalanine have suggested that the metabolism of these amino acids contributes to urinary oxalate excretion. To better define this contribution we have examined the primed, constant infusion of [1 – 13C1] phenylalanine and [1,2 – 13C2] glycine in the post-absorptive state in healthy adults. Methods: Following infusion with either 6 µmoles/kg/hr [1 – 13C1] phenylalanine or 6 µmoles/kg/hr [1,2 – 13C2] glycine, no isotopic glycolate or oxalate was detected in urine. Based on the limits of detection of our ion chromatography/mass spectroscopy method, these data indicate that < 0.7% of the urinary oxalate could be derived from phenylalanine catabolism and < 5% from glycine catabolism. Infusions with high levels of [1,2 – 13C2] glycine, 60 µmoles/kg/hr, increased mean plasma glycine by 29% and the whole body flux of glycine by 72%. Results: Under these conditions glycine contributed 16.0 ± 1.6% and 16.6 ± 3.2% to urinary oxalate and glycolate excretion, respectively. Experiments using cultured hepatoma cells demonstrated that only at supra-physiological levels (>1mM) did glycine and phenylalanine metabolism increase oxalate synthesis. Conclusion: These data suggest glycine and phenylalanine metabolism make only minor contributions to oxalate synthesis and urinary oxalate excretion. POSTER #78 DETERMINATION OF RADIATION DOSE DURING PERCUTANEOUS NEPHROLITHOTOMY USING A VALIDATED PHANTOM MODEL Michael Lipkin, John Mancini, Agnes Wang, Greta Toncheva, Colin Anderson-Evans, Neal Simmons, Michael Ferrandino, Terry Yoshizumi and Glenn Preminger Duke University Medical Center, Durham, NC (Presented By: Michael Lipkin) Introduction: Fluoroscopy time has been used to report on radiation exposure during urologic procedures. However, it is difficult to determine actual radiation dose delivered to patients based on fluoroscopy time alone. We calculated effective dose during right and left sided percutaneous nephrolithotomy (PNL) using a validated phantom model. Methods: A validated anthropomorphic adult male phantom was placed prone on an operating room table Metal Oxide Semiconductor Field Effect Transistor (MOSFET) dosimeters were placed at 20 organ locations in the model and were used to measure the organ dosages and the effective dose. A portable C-arm was used to provide continuous fluoroscopy for three 10 minute runs each to simulate a left and right PNL. The radiation dose (mGy) was determined for each organ. Organ dose rate (mGy/s) was determined by dividing organ dose by fluoroscopy time. The organ dose rates were multiplied by their tissue weighting factor and summed to determine effective dose rate (mSv/s). Two-dimentional radiation distribution in the abdomen during a left sided PNL was visually determined using radiochromic film (model XRQA, International Specialty Products). Results: The effective dose rate for a left sided PNL was 0.021 mSv/s ± 0.0008. The effective dose rate for a right sided PNL was 0.014 mSv/s ± 0.0004. The skin entrance was exposed to the greatest amount of radiation during left and right PNL, 0.24 mGy/s and 0.26 mGy/s respectively. The stomach was exposed to the second greatest amount of radiation on the left (00.07 mGy/s) and the gallbladder was exposed to the second greatest amount of radiation on the right (0.12 mGy/s). Radiochromic film demonstrates visually the non-uniform dose distribution as the x-ray beam enters through the skin from the radiation source. (Figure 1) Conclusion: The effective dose rate is higher for a left sided PNL compared to a right sided PNL. Effective dose is a way of reporting radiation dose risks as it takes into account organ doses and relative radio-sensitivities. The distribution of radiation exposure during PNL is not uniform. Further studies are needed to determine the long term implications of these radiation doses. 170 POSTER #79 USE OF HEMOSTATIC AGENTS IN PERCUTANEOUS NEPHROLITHOTOMY TRACT MAY REDUCE URINE LEAK RATE IN A PORCINE MODEL Michael Lipkin, John Mancini, Agnes Wang, Neal Simmons, Eliza Raymundo, Daniel Yong, Michael Ferrandino, David Albala and Glenn Preminger Duke University Medical Center, Durham, NC POSTERS (Presented By: Michael Lipkin) Introduction: Hemostatic agents have been used as an adjunct for tubeless percutaneous nephrolithotomy (PNL). We evaluated if the use of hemostatic agents in percutaneous tracts reduced urine leak rates after percutaneous access in a porcine model. We also pathologically evaluated the percutaneous tracts at different time intervals to determine what happens to these agents over time. Methods: Percutaneous access was obtained in 19 kidneys in 10 domestic pigs. The tracts were dilated to 30 Fr using a balloon dilator. Nephroscopy was performed to confirm access and a 30 Fr sheath was left in place for 15 minutes. Ten kidneys served as controls. Surgiflo® (Ethicon, Inc., Somerville, NJ) was injected into the tract of 4 kidneys and Evicel® (Ethicon, Inc., Somerville, NJ) was injected into the tract of 5 kidneys. Intravenous pyelogram (IVP) was performed on post-operative days (POD) 1 and 10 – 14 to assess for urine leak or obstruction. IVP was performed on 2 pigs at POD 30. The pigs were sacrificed and kidneys harvested for pathological evaluation. Results: Of the 10 control kidneys, 2 (20%) had a urine leak on IVP on POD 1. None of the kidneys treated with Surgiflo or Evicel had a urine leak on POD 1. None of the kidneys had a leak on IVP POD 10 – 14 or at POD 30. There was no evidence for obstruction in any of the kidneys on any of the IVPs. On pathological inspection, the tracts of all the control kidneys and Surgiflo kidneys had closed completely at POD 14. Two kidneys treated with Evicel had persistent tracts at POD 6 and POD 14. At POD 30, the tracts in the 2 control kidneys and 1 kidney treated with Surgiflo® had completely healed. Evicel remained in the tract at POD 30 (see Figure 1). Conclusion: The use of hemostatic agents in the tract may reduce the risk of urine leak after tubeless PNL. Surgiflo® is the preferable agent as the tract closed by POD10 – 14. Evicel® can persist in the tract for up to 30 days. Further clinical studies are needed to delineate the benefits of these agents after tubeless PNL. 171 Annual Business Meeting Agenda I. Report from the President – Raju Thomas, MD, FACS, MHA II. Minutes of the 2010 Annual Business Meeting – Raju Thomas, MD, FACS, MHA (see page 173) III. Secretary Report – Raymond J. Leveillee, MD, FRCS-G IV. Treasurer Report – W. Terry Stallings, MD (see page 179) V. Historian Report – Hector H. Henry II, MD, MPH, MS VI. Committee Reports 1. 2011 Local Arrangements Committee – H. Anthony Fuselier, MD 2. Committee on Education and Science – Dean Assimos, MD 3. Bylaws Committee – Scott Sellinger, MD (see page 180) 4. Finance Committee – David Kraebber, MD 5. Membership Committee – Stephen Goryl, MD (see page 181) 6. Health Policy Committee – Martin Dineen, MD VII. Representative to the Board of Directors of the AUA – B. Thomas Brown, MD, MBA (see page 184) VIII. Future Sites Committee – Edward Janosko, MD IX. Unfinished Business X. New Business XI. Honorary Members – Raju Thomas, MD, FACS, MHA XI. Nominating Committee Report and Elections – Dennis Venable, MD XIII. Introduction of Incoming President XIV. Adjournment 172 Minutes 74th Annual Business Meeting Southeastern Section of the American Urological Association, Inc. Miami Beach, FL Sunday, March 14, 2010 ______ Unless otherwise noted, actions were by unanimous vote and all committee reports were unanimously approved. I. WELCOME AND CALL TO ORDER: THOMAS STRINGER, MD Dr. Stringer welcomed the membership and called the 74th Annual Business Meeting to order at 11:05 a.m. II. APPROVAL OF MINUTES OF THE PREVIOUS MEETING Dr. Stringer presented the minutes of the 73rd Annual Business Meeting held Sunday, March 29, 2009 in Mobile, AL Action The minutes were approved as circulated. III. SECRETARY’S REPORT: RAYMOND J. LEVEILLEE, MD Dr. Leveillee reported on recent actions of the SESAUA Board of Directors as follows: A. The SESAUA Board of Directors appointed the following individuals to serve on SESAUA Committees: SESAUA Committees: Bylaws Gerard Henry, MD – reappointed Greg Murphy, MD - reappointed Committee on Education and Science Chair – Dean Assimos, MD Montague Boyd – Ron Lewis, MD Video – Dave Albala, MD – will need a reappointment – moving out of the section Imaging – Mike Cookson, MD until 2011 MINUTES Member-at-Large – Charles Pound, MD – until 2012 Member at Large – Johannes Viewig, MD – reappointed Finance Michael Grable, MD - reappointed Scott Miller, MD - reappointed Local Arrangements Chair – New Orleans Meeting Dr. Tony and Ann Fuselier All other SESAUA Committee positions remain current. B. The SESAUA Board of Directors appointed the following individuals to serve as SESAUA representatives on AUA Committees: AUA Committees: AUA Editorial Board Philipp Dahm, MD Health Policy Council: Martin Dineen, MD, Jonathan Henderson, MD Chris Winters, MD 173 History Committee Hector Henry, MD AUA Investment Committee W. Terry Stallings, MD AUA Practice Management Committee Alexander Gomelsky, MD AUA Residents Committee Beau Dussault, MD - reappointed All Other SESAUA Representatives positions remain current. C. The SESAUA Board of Directors made the following nominations for AUA Awards AUA Distinguished Contribution Award: Cully Carson, MD AUA Distinguished Service Award: Wendy Weiser AUA Gold Cane Award: Fletcher Derek, MD AUA Certificate of Achievement Award: Ronald Lewis, MD AUA Ramon Guiteras Award: Jay Smith, MD AUA Hugh Hampton Young Award – George Webster, MD AUA Gold Cystoscope Award: Sam Chang, MD AUA Lifetime Achievement Award: Lemar Weems, MD AUA Eugene Fuller Prostate Award – Mark Soloway, MD AUA Victor Politano Award – Roger Dmochowski, MD AUA William Didusch Art and History Award – Raju Thomas, MD D. 2010 AUA Award Recipients from the SESAUA Joseph Smith, MD – Hugh Hampton Young Award William Gee, MD – Distinguished Service Tom Stringer, MD – Presidential Citation Wendy Weiser – Presidential Citation E. SESAUA Representatives on the AUA Leadership Program Rafael Carrion, MD Ben Lee, MD Scott Lisson, MD F. IVU Scholar The SESAUA Board of Directors voted to support up to 2 IVU Scholar at $4,500 each in 2010. G. Committee Meetings to Continue via Teleconference The Board voted to continue to have the SESAUA Committees meet by teleconference prior to the SESAUA meeting to eliminate the need for a Saturday morning Board meeting. Committee reports should be handed in 30 days prior to the annual meeting for review and inclusion in the SESAUA Board Books. The Nominating Committee, however will meet in person during the SESAUA Annual meeting prior to the Annual Business Meeting. IV. SESAUA TREASURER’S REPORT AND FINANCE COMMITTEE REPORT: TERRY STALLINGS, M.D Dr. Stallings reviewed the Treasurer’s Report and gave a slide presentation of the current state of the SESAUA finances. The total income for the Section as of 12/31/09 was $1,296,457 which consists of operating income of $289,397, meeting income of $446,264 and investment income of $560,795, the majority which was gained from 4/1/09 until 12/31/09. The Section is back to its 3 to 1 ratio of total income to meeting expenses. Total expenses for the section as of 12/31/09 totaled 627,651 which consist of $228,296 in operating expenses, $335,933 in meeting expenses and Investment expenses of 63,422. The investment expenses consist of $13,422 in external fees for our investment management company, the resident’s stipends of $64,000 and $4,000 for the Traveling Resident. Net income totaled 668,805 which consisted of $61,101 in net operating income, $110,332 in net 174 meeting income and $497,372 in net investment income. The total assets for the section are $3,229,588 made up of $401,649 in our checking and savings account, $2,817,834 in the investment account and a deposit of $10,105 which will essentially pay for the Past President’s dinner. Dr. Stallings informed the membership that as a result of the events in 2008, the Ad Hoc Committee was formed to look at trends such as performance, investment philosophy and reporting. It came up with four goals they felt were important to accomplish: • What can be done to reduce volatility in the future – control internal costs. • Make sure there was accountability in our reporting. • Be able to reduce volatility by allowing our investment manager the ability to reallocate as well as rebalance in order to react appropriately to market conditions. • Get out of high risk bonds by instead investing in a class called “alternative investments”. The Ad Hoc Committee immediately addressed two of the issues by going with 15% in index funds and rebalancing the portfolio. After further discussion it was decided to get a request for proposal from our current financial manager as well as two additional firms that participated in the Investment Summit at WJ Weiser & Associates. After careful review and phone meetings, a decision was made to hire a new investment manager for the SESAUA. The Finance Committee met with the new investment manager in November and Dr. Stallings presented Clarke Lemons of Water Oak Advisors, formerly CNL Bank in Orlando, FL to the Board at their meeting on Wednesday to briefly explain the details of the changes in our investment policy. Our new investment manager will allow a little more change in the portfolio. The custodian will still be Charles Schwab. It provides a mix of stocks and bonds and adds alternative investments. The problem he saw with our previous investment policy was that it contained aggressive bond allocation and contained no alternative investments. Their plan eliminates the need for expensive active management. They provide an index/passive based mutual fund formal with no active management. He stressed that their alternative investments are not hedge funds. They are daily, liquid mutual funds and they provide non co-relation to US and international stocks. Alternative investments dampen volatility in the account and help to provide a solid return with a lower standard of deviation. Dr. Stallings also reported that after the line item review of the budget, the Section was able to save approximately $30,000 by making adjustments on fixed annualized costs to operating expenses. The annual audit of SES funds was performed and all is in order. The audit will continue to be performed each year. The SESAUA Treasury is very healthy. MINUTES Action The Treasurer’s report was accepted as presented. V. SESAUA HISTORIANS: HECTOR HENRY, MD Dr. Henry referred members to Page 179 for a full list of those members of the section that have died over the past year. As was mentioned, we lost a great leader in urology, Victor Politano, and the meeting will be dedicated to his honor. Dr. Henry is saddened by the many good friends that have passed this year and asks for a moment of silence in their honor. Action The Historian’s Report was accepted as presented. VI. REPORT OF THE AUA BOARD OF DIRECTORS: B. THOMAS BROWN, MD Dr. Brown reported that the AUA is currently in good financial health. Dr. Brown reported on planning for the Joint Advocacy Counsel, specifically how impacts are made and how decisions are arrived on in regards to legislative priorities. These are divided equally between the AACU and the AUA and each group are allowed two “asks” on Capitol Hill. This year the AUA will be introducing two bills to Congress, one on Uro Trauma and the second on Prostate Cancer. Those attending the JAC meeting will be asked to support these bills and lobby for them with their representatives. Dr. Brown provided an update on the issue of ER Pay. It has been determined that ER pay is allowable in certain specialties and urology is included on that list. Dr. Brown is serving on a workforce task force which presented five specific recommendations to the AUA Board for developing educational products and services for Allied Members, specifically nurse 175 practitioners and physician assistants. The AUA is dedicated to building the Allied membership class which consists of non-physician providers, particularly nurse practitioners and physician assistants. The AUA will be offering 16 educational classes at the upcoming AUA meeting, however the NP’s and PA’s would like to see more education at the local/regional level. Action The SESAUA Representatives Report is accepted as presented. VII. STANDING COMMITTEES REPORTS A. SESAUA Membership Committee – Thomas Stringer, MD In Dr. Goryl’s absence, Dr. Stringer presented the Membership Report which shows that the Southeastern Section has 2,283 total members, Dr. Stringer referred members to page 177 for a list of the candidates for membership along with the names of those individuals that have transferred into the Section over the past year. Action A motion is made to accept the Membership Committee Report and approve all transfers and candidates for membership as presented. B. Program Committee Report – Raymond Leveillee, MD Dr. Leveillee gave an overview of the 2010 Program reporting that we had 396 urologists pre-registered to attend the meeting, 38 on-site registrations for a total physician registration of 433. Total spouse registration was 66 and total exhibitors were 225 from 70 different companies. Grand total attendance – 724. C. SESAUA Committee on Education and Science – Dean Assimos, MD Dr. Assimos congratulated Dr. Leveillee for an excellent program and reported that the Committee will work closely with Dr. Leveillee to have more input on the educational content in the future. The Committee also liked the more objective abstract process put in place by Ray Leveillee, MD and Philipp Dahm, MD. They are also working on a new mentorship program to facilitate the development of outstanding surgeon scientists. D. Finance Committee – David Kraebber, MD Dr. Kraebber stated that most of his report was included in the Treasurers report and was highlighted by the hiring of a new financial manager for the Section. E. SESAUA Bylaws Committee – Scott Sellinger, MD Dr. Stringer presented the Bylaws report for Dr. Sellinger. He referred membership to Pages 181 in their Program Books for details of the Bylaws changes. The bulk of the changes pertain to aligning our bylaws, in particular as respects committee structures, with the changes made to the AUA Bylaws. Action The proposed changes were approved by the SESAUA membership. F. SESAUA Health Policy Report (HPC) – Martin Dineen, MD Dr. Dineen advised membership that the Health Policy Committee met on 2/17/10 by teleconference and had participation by 6 out of 8 committee members. Two of the items required Board action. The first is a request by the Health Policy Council to have the AUA Quality Improvement and Patient Safety Committee review the “doc in the box” clinics popping up in many of the states in the South to temporarily treat erectile dysfunction. Many of the doctors treating patients are not qualified and the clinics are poorly run. Most do not provide any follow up on the patients. It is recommended that the AUA create a white paper to explore patient care at these facilities. The second item that required the members attention was to follow up with the AUA to see if any action was taken on its request in 2009 to adopt a policy statement on fair compensation for emergency room duties. Dr. Tom Brown advised the membership that the Office of the Surgeon General has ruled that ER payments are allowed in certain specialties of which urology are one. Because of this ruling no AUA policy statement was necessary 176 VIII. SPECIAL COMMITTEES REPORTS A. Future Sites Committee – Ed Janosko, MD Dr. Janosko reported on the upcoming SESAUA meeting locations as follows: • 2011- New Orleans, LA March 17-20, 2011 Marriott New Orleans • 2012- Amelia Island, FL March 21-24, 2012 Ritz Carlton, Amelia Island Action The report from the Special Committee was approved as presented. IX. NEW BUSINESS A. Honorary Members – Thomas Stringer, MD Dr. Stringer asked that the Membership approve the following individuals for honorary membership: • Valentine Earhart, MD – Past President • Kevin Loughlin, MD • Paul Whelan, MD • Michael Blute, MD • John Forrest, MD • Andrew Schally, MD • Marc Buoniconti B. Elect Member-at-Large to the SESAUA Nominating Committee The section received two nominations from the floor: Stephen V. Goryl, MD Stephen E. Strup, MD After a vote from the membership is conducted, Dr. Thomas announced the winner – Stephen V. Goryl, MD who will serve as the next member at large to the SESAUA Nominating Committee. C. Report of the SESAUA Nominating Committee – Ed Janosko, MD Dr. Janosko presented the following nominees for open positions as determined by MINUTES the SESAUA Nominating Committee: SESAUA President-Elect: Randall Rowland, MD SESAUA Historian: Hector Henry, MD – reappointed AUA Board of Representatives Dennis Venable, MD (alternate) Florida Representative David Jablonski, MD 2010 – 2013 (replacing Julio Pow-Sang) Florida Representative – Alternate Joshua Green, MD 2010 – 2013 (replacing David Jablonski) Georgia Representative Pablo J. Santamaria, MD 2010 – 2013 (replacing Mark Lenon Cain, MD) Georgia Representative – Alternate John Pattaras, MD 2009 – 2012 (replacing Jim Brown who moved out of section) Henry Goodwin, MD 2010 – 2013 (replacing Pablo Santamaria, MD) Kentucky Representative Christopher E.W. Smith, MD 2010 – 2013 (replacing Jon Demos, MD) 177 Kentucky Representative – Alternate Charles Ray, MD 2010 – 2013 (replacing Christopher Smith, MD) Louisiana Representative Stephen LaCour, MD 2010 – 2013 (replacing William S. Kubricht, III, MD) Tennessee Representative Timothy Duffin, MD 2010 – 2013 (replacing Stephen V. Goryl, MD) Tennessee Representative – Alternate Donald McKnight, Jr., MD 2010 – 2013 (replacing Timothy K. Duffin, MD) The three remaining slots: Louisiana Alternate Representative Mississippi Alternate Representative North Carolina Alternate Representative Will be chosen at their upcoming state meeting and will be provided to the SESAUA Board. Action The nominating committee slate was accepted as presented. There were no nominations from the floor. All nominees were elected to their respective offices. X. INCOMING SESAUA PRESIDENT’S ADDRESS: RAJU THOMAS, MD Dr. Thomas is looking forward to serving as President and next year’s meeting in New Orleans. He will work hard to make it an excellent meeting and incorporate some new ideas suggested by membership. XI. ADJOURN Dr. Thomas adjourned the 2010 Annual Business Meeting at 12:00 p.m. Respectfully Submitted, Sue O’Sullivan Associate Director 178 Preliminary Treasurer’s Report Southeastern Section of the American Urological Association The Fund Balance as of December 13, 2010 totals $3,655,806. This reflects operating surplus of $386,283 for the period. Total income for the fiscal year ending December 31, 2010 was $1,171,623, and consists of Membership Dues of $287,435, Annual Meeting income of $525,178, and Dividends, Interest and Net Unrealized Gain on Investments totaling $356,476. Interest income from the savings account totaled $377, and income totaled $2,157. The SESAUA has one active checking account held at Chase Bank. This account is used for SES general operation and meeting related transactions. As of December 31, 2010, the checking account balance was $161,663. The balance in the saving account totals $43,854. A $2000 postage reserve is held at WJ Weiser & Associates, Inc. and is reconciled monthly with actual postage usage. The SES received $39,935 in meeting income for the 2011 Annual Meeting which has been deferred to recognize as 2011 income. The SESAUA investments are held at Charles Schwab & Co., Inc. the account is managed by Clarke Lemon of Water Oak Advisors, LLC in Orlando, FL. The portfolio composition consisted of: Cash & Money Market Funds $153,601 5% Fixed Income $968,321 28% Domestic Equity $1,095,085 32% International Equity $419,953 12% Alternative Investments $797,213 23% $3,434,173 100% Expenses as of December 31, 2010 totaled $785,340. A detailed listing of all expenses appears on the Operating Statement Detail Report and is reviewed monthly. The Finance Committee held its annual teleconference in January, 2011. Clarke Lemons reviewed the portfolio performance and answered questions posed by members. The committee voted to recommend no change in the Investment Policy and complimented Mr. Lemons on the portfolio’s performance and his reporting. In an effort to enhance transparency, all members of the Finance Committee began receiving copies of the Quarterly Performance Report in 2010. In addition, the Finance Committee Chairman is invited to participate in the quarterly teleconference with the Treasurer and Investment Manger. I will complete my 3 year term as Treasurer at the Annual Meeting in New Orleans. I would like to take this opportunity to thank the SESAUA for the honor and privilege of serving as Treasurer and for the confidence and support given to me during my term. Respectfully submitted, W. Terry Stallings, MD, FACS Treasurer REPORTS 179 Southeastern Section of the AUA Proposed Bylaws Changes 2010 – 2011 ARTICLE I - MEMBERSHIP Section E. ACTIVE MEMBERS Requirements for membership are as follows: 1. Possession of an unlimited license to practice medicine and surgery in the State, Province or Country of the applicant’s practice. territory within the geographical limits of the AUA. 2. Possession of an M.D. or D.O. 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. Section G. ASSOCIATE MEMBERS 2. 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. Section K. CANDIDATE MEMBERS Candidate Membership is established to extend Sectional educational and professional advantages to urological residents. The Candidate Member must be practicing and studying within the geographic boundaries of the Section. and must be enrolled in a residency program approved by the Residency Review Committee for Urology. 1. 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 E. 2. 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 G. ARTICLE X - AMENDMENTS Section A. REPEALING / AMENDING BYLAWS A Quorum being present these Bylaws may be repealed or amended by a two-third (2/3) vote of the Members present and voting at any Annual Business Meeting, provided that the proposed revision or amendment is provided have been circulated to the Membership at least thirty (30) days prior to the Annual Meeting at which such action is to be taken. 180 BYLAW CHANGES Southeastern Section of the AUA, Inc. Membership Candidates and Transfers 2011 BYLAWS * Application Not Complete FT AUA Fast Track Application Candidates for Membership Active FT Ballert, Katie Nicole Beckford, Cleveland *Benitez, Omar Carey, Robert Ira FT Cohen, Brian Evans, Aubrey *Gilbert, Scott M. *Guerra Dajer, Manuel Alfredo FT Holley, Thomas Douglas Inman, Brant FT Kasraeian, Ali FT Katz, Erin E. *Kim, Jay Hyun *Krick, James *Ledbetter, Christopher K *Malkin, Richard B. Mobley, Jonathan M. Moseley, John L. Moy, M. Louis Nehme, John David FT Purves, J. Todd Rutland, II, Harry Merritt *Sanchez, Marta Cecilia Santa-Cruz, Robert W. FT Singh, Amar Speeker-Cruit, Margaret *Stribling, Michael Dean Vick, Ralph Nelson White, Paige C. Total Active: 29 Associate * Barocas, Daniel Ari FT Becker, Aaron Blake FT Besharat, Kaveh FT Boudreaux, Jr., Kelly James FT Caillat, Alexandre Castellucci, Sean A. FT Cox, Jared Michael * Daugherty, Michael FT Dusing, Michael FT Gomez, Christopher Scot Hamilton, Jonathan FT Hernandez, David * Hines, Robert Lee FT Houser, II, Edward Ross FT Johnson, Bradlee Langford, Carolyn * Langston, Joshua * Luongo, Tony Martin, Frances Marian FT Mason, Barry Michael FT Miller, Jr., Javier * Montgomery, Melissa M. FT Morris, Brent Jerome * Nakamura, Kogenta FT Nicholson, Adam Foster * Perez Soto, Benjamin FT Rajamahanty, Srinivas 181 FT Reddy, Sujith Kundoor FT Robbins, David Alan * Ross, Sherry Roth, Christopher Charles FT Spencer, Jr., David Lamar Tanaka, Stacy T. Thomas, Shawn Wayne Tonkin, Jeremy Vasquez, Juan M. FT Weber, Timothy Anton FT Whitehead, Kristopher Wayne * Zmaj, Paul Michael Total Associate: 39 Grand Total Candidates for Membership: 68 MEMBERSHIP STATUS TRANSFERS (INTERNAL) Active Total Active: 0 Associate Total Associate: 0 Senior Almario, Joselito S. Bedsole, Dalton Anthony Brown, Ronald L. Del Porto, George B. DuPuy, Samuel Stuart Faber, Robert Branch Fontenot, Jr., Reed A. Goulding, Frederick J. Green, Bruce G. Herlong, James H. Holman, Jr., Charles M. Morganstern, Steven L. Rodosta, Frederick G. Rollins, Raleigh W. Sago, Alvin L. Wade, Jr., Stanley A. Total Senior: 17 Grand Total Membership Status Transfers - (Internal): 17 MEMBERSHIP TRANSFERS FROM OTHER AUA SECTIONS Active Balaji, K.C. Cargill, II, J. G. Diaz, Dilmer Luis Doerr, Anthony L. McCanse, Webb McLaughlin, Sean Patrick Morgan, III, James Orville Peterson, Andrew Charles Teague, Julius L. Weed, William Curtis Weeks, D. Champ Wilson, Tracey Small Total Active: 12 Senior Zimmerman, Norman Total Senior: 1 Grand Total Membership Transfers from Other AUA Sections: 13 182 Necrology Report 2011 In Loving Memory of: Charles K. Cartwright, MD Samual K. Cohn, MD Birmingham, AL MEMBERSHIP Clarence Driver, MD Jackson, TN Jack A. Evans Jr., MD Spartanburg, SC Theodore Everett, MD Augusta, GA Keith Edward Gawith, MD Conway, SC Andrew S. Griffin, MD Winston-Salem, NC B. Holly Grimm, MD New Orleans, LA Quentin Tally Lawson, MD Valdosta, GA Donald J. McKenzie, MD Hiawassee, GA Robert G. Rosser, Jr., MD Cocoa, FL Richard Dwayne Williams, MD Iowa City, IA 183 Report of the SESAUA Representative to the AUA Board of Directors 1. The President of the AUA for this year is Datta G. Wagle, MD of the Northeastern Section. The President-Elect is Sushil S. Lacy, MD of the South Central Section. 2. The total AUA membership by category is 17,247 and the membership by section is 12,763. This year the fastest growing category is international with 3,163 members. The SESAUA remains the largest section with 2,609 members. 3. The Secretary-Elect is our own Gopal Badlani of Winston-Salem. 4. The Joint Advocacy Conference will be held in Washington, DC from March 27 to March 29. Join us at that conference and let your voice be heard on Capitol Hill. 5. The AUA is in good financial health and has recovered from the downturn in the stock market in recent years. Its net worth increased over $6,000,000 in the last year mainly because of improvements in the market and budget constraints in the home office in Baltimore. 6. The Office of Education headed by Elspeth McDougal, MD continues to offer numerous and various education opportunities for the membership ranging from spaced learning to formal meetings. 7. The Health Policy Division headed by Steven Schlossberg, MD and David Penson, MD inform us of the happenings in the health policy arena and continue to cover our backs in Washington. 8. Johannes Vieweg, MD is off to a roaring start as the Director of Research for the AUA. 9. The AUA Board of Directors and the staff of the AUA are here to serve the membership of the AUA. Major programs continue to be the Annual Meeting (which is our largest money maker), the Journal of Urology, the AUA Guidelines and Update, the Health Policy Council, the Legislative Workgroup, the department of Governmental Relations and Advocacy, and the Practice Management Network to name a few. The entire AUA family is resolved to serve the educational and socio-economic needs of the membership. 10. It has truly been an honor and privilege to serve the SESAUA as its representative to the AUA Board of Directors for the last four years. This is my last year in this position and I will be replaced by Dennis Venable, MD after the May Annual Meeting. I know I speak for Dennis that we are here to work for the SESAUA and anything we can do now and in the future, please ask. I would like to thank the section for this opportunity and hope I have represented you well. Respectfully submitted, B. Thomas Brown, MD, MBA 184 Roster of the State Societies and Officers 2010 – 2011 Please help us keep our information about State Urological Societies accurate and current. Contact the SESAUA office at (847) 969-0248 if you have information about the following societies: Alabama Urology Society Information not available at time of printing Florida Urological Society President: Michael Stephen Grable, MD President-Elect: Terrence C. Regan, MD Bonita Springs, FL 2011 Meeting: September 1 – 4 Georgia Urological Association President: Todd Spry Jarrell, MD President-Elect: Amos M. Anderson III, MD Sea Island, GA 2011 Meeting: September 8 – 11 Kentucky Urological Association Information not available at time of printing Louisiana State Urological Society President: Charles H. Bowie, MD Lafayette, LA REPORTS 2011 Meeting: April 8 – 10 Mississippi Urologic Society Information not available at time of printing North Carolina Urological Association President: Ed Janosko, MD Puerto Rico Urological Association Information not available at time of printing South Carolina Urological Association President: Brian Willard, MD President-Elect: Ross A. Rames, MD 2011 Meeting: February 17 Tennessee Urological Association President Stephen V. Goryl, MD 185 Previous Officers and Annual Meeting Sites of the Southeastern Section of the AUA, Inc. u Indicates Deceased Member 1932 Birmingham, AL – Meeting to Organize No Officers u Edgar G. Ballenger, MD, Atlanta, GA Temporary Chair 1933 Richmond, VA u Montague L. Boyd, MD, Atlanta, GA Chair u Edgar G. Ballenger, MD, Atlanta, GA Vice Chair u Earl Floyd, MD, Atlanta, GA Secretary/Treasurer 1934 Atlanta, GA u Montague L. Boyd, MD, Atlanta, GA Chair u Edgar G. Ballenger, MD, Atlanta, GA Vice Chair u Earl Floyd, MD, Atlanta, GA Secretary/Treasurer 1935 Nashville, TN u Edgar G. Ballenger, MD, Atlanta, GA President u H. W.E. Walther, MD, New Orleans, LA President-Elect u Earl Floyd, MD, Atlanta, GA Secretary/Treasurer 1936 Charlotte, NC u H. W.E. Walther, MD, New Orleans, LA President u Hamilton McKay, MD, Charlotte, NC President-Elect u Earl Floyd, MD, Atlanta, GA Secretary/Treasurer 1937 Birmingham, AL u Hamilton McKay, MD, Charlotte, NC President u George Livermore, MD, Memphis, TN President-Elect u Earl Floyd, MD, Atlanta, GA Secretary/Treasurer 1938 Louisville, KY u George Livermore, MD, Memphis, TN President u Earl Floyd, MD, Atlanta, GA President-Elect u Raymond Thompson, MD, Charlotte, NC Secretary/Treasurer 1939 Biloxi, MS u Earl Floyd, MD, Atlanta, GA President u J. Ullman Reaves, MD, Mobile, AL President-Elect u Louis M. Orr, MD, Gainesville, FL Secretary/Treasurer 1941 Jacksonville, FL u J. Ullman Reaves, MD, Mobile, AL President u Jefferson C. Pennington, MD, Nashville, TN President-Elect u Louis M. Orr, MD, Gainesville, FL Secretary/Treasurer 1942 Chattanooga, TN u Jefferson C. Pennington, MD, Nashville, TN President u Louis M. Orr, MD, Gainesville, FL President-Elect u Harold P. McDonald Sr., MD, Atlanta, GA Secretary/Treasurer 1943 New Orleans, LA u Louis M. Orr, MD, Gainesville, FL President u William E. Coppridge, MD, Durham, NC President-Elect u Harold P. McDonald, Sr., MD, Atlanta, GA Secretary/Treasurer 1946 Augusta, GA u William E. Coppridge, MD, Durham, NC President u Hubert K. Turley, Sr., MD, Memphis, TN President-Elect u Harold P. McDonald, Sr., MD, Atlanta, GA Secretary/Treasurer 186 1947 Palm Beach, FL u Hubert K. Turley, Sr., MD, Memphis, TN President u Robert P. McIver, MD, Jacksonville, FL President-Elect u Harold P. McDonald, Sr., MD, Atlanta, GA Secretary/Treasurer 1948 Hollywood Beach, FL u Robert P. McIver, MD, Jacksonville, FL President u Harold P. McDonald, Sr., MD, Atlanta, GA President-Elect u Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer 1949 Boca Raton, FL u Harold P. McDonald, Sr., MD, Atlanta, GA President u James J. Ravenel, MD, Charleston, SC President-Elect u Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer 1950 Edgewater Park, MS u James J. Ravenel, MD, Charleston, SC President u Edgar Burns, MD, New Orleans, LA President-Elect u Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer 1951 Memphis, TN u Edgar Burns, MD, New Orleans, LA President u Temple Ainsworth, MD, Jackson, MS President-Elect u Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer 1952 Boca Raton, FL u Temple Ainsworth, MD, Jackson, MS President u W.R. Miner, MD, Covington, KY President-Elect u Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer 1953 Havanna- Cuba u W.R. Miner, MD, Covington, KY President u Russell B. Carson, MD, Vero Beach, FL President-Elect u Sidney Smith, MD, Raleigh, NC Secretary/Treasurer 1954 Palm Beach, FL u Russell B. Carson, MD, Vero Beach, FL President u Samuel L. Raines, MD, Memphis, TN President-Elect u Sidney Smith, MD, Raleigh, NC Secretary/Treasurer 1955 New Orleans, LA PREVIOUS OFFICERS u Samuel L. Raines, MD, Memphis, TN President u Sidney Smith, MD, Raleigh, NC President-Elect u Robet F. Sharp, Sr., MD, New Orleans, LA Secretary u Charles Reiser, MD, Atlanta, Treasurer 1956 Hollywood, FL u Sidney Smith, MD, Raleigh, NC President u Jarratt P. Robertson, MD, Atlanta, GA President-Elect u Robet F. Sharp, Sr., MD, New Orleans, LA Secretary u Charles Reiser, MD, Atlanta, Treasurer 1957 Atlanta, GA u Jarratt P. Robertson, MD, Atlanta, GA President u Lawrence P. Thackston, Sr., MD, Orangeburg, SC President-Elect u Robet F. Sharp, Sr., MD, New Orleans, LA Secretary u Frank M. Woods, MD, LaBelle, FL Treasurer 1958 Hollywood, FL u Lawrence P. Thackston, Sr., MD, Orangeburg, SC President u Robet F. Sharp, Sr., MD, New Orleans, LA President-Elect u James L. Campbell, Jr., MD, Orlando, FL Secretary u Frank M. Woods, MD, LaBelle, FL Treasurer 1959 Louisville, KY u Robet F. Sharp, Sr., MD, New Orleans, LA President u Rudolph Bell, MD, Thomasville, GA President-Elect u James L. Campbell, Jr., MD, Orlando, FL Secretary Hurbert K. Turley, MD, Memphis, TN Treasurer 187 1960 Jacksonville, FL u Rudolph Bell, MD, Thomasville, GA President u N Lewis Bosworth, MD, Lexington, KY President-Elect u James L. Campbell, Jr., MD, Orlando, FL Secretary Hurbert K. Turley, MD, Memphis, TN Treasurer 1961 Hollywood-by-the-sea-, FL u N Lewis Bosworth, MD, Lexington, KY President u Alfred D. Mason, Jr., MD, Memphis, TN President-Elect u James L. Campbell, Jr., MD, Orlando, FL Secretary u Henry Comfort Hudson, MD, Birmingham, AL Treasurer 1962 Belleair, FL u Alfred D. Mason, Jr., MD, Memphis, TN President u James L. Campbell, Jr., MD, Orlando, FL President-Elect u Louis C. Roberts, MD, Greensboro, NC Secretary u Henry Comfort Hudson, MD, Birmingham, AL Treasurer 1963 Nassau- Bahamas u James L. Campbell, Jr., MD, Orlando, FL President u Powell G. Fox, Sr., MD, Raleigh, NC President-Elect u Louis C. Roberts, MD, Greensboro, NC Secretary u Douglas E. Scott, MD, Lexington, KY Treasurer 1964 Belleair, FL u Powell G. Fox, Sr., MD, Raleigh, NC President u W. E. Kittredge, MD, New Orleans, LA President-Elect u Louis C. Roberts, MD, Greensboro, NC Secretary u Douglas E. Scott, MD, Lexington, KY Treasurer 1965 Miami Beach, FL u W. E. Kittredge, MD, New Orleans, LA President u Douglas E. Scott, MD, Lexington, KY President-Elect u David W. Goddard, MD, Daytona Beach, FL Secretary u Rafe Banks, Jr., MD, Gainesville, GA Treasurer 1966 Memphis, TN u Douglas E. Scott, MD, Lexington, KY President u Louis C. Roberts, MD, Greensboro, NC President-Elect u David W. Goddard, MD, Daytona Beach, FL Secretary u Rafe Banks, Jr., MD, Gainesville, GA Treasurer 1967 Hollywood, FL u Louis C. Roberts, MD, Greensboro, NC President u Charles Reiser, MD, Atlanta, President-Elect u David W. Goddard, MD, Daytona Beach, FL Secretary u John T. Karaphillis, MD, Belleair, FL Treasurer 1968 Atlanta, GA u Charles Reiser, MD, Atlanta, President u David W. Goddard, MD, Daytona Beach, FL President-Elect u R. Prosser Morrow, Jr., MD, New Orleans, LA Secretary u John T. Karaphillis, MD, Belleair, FL Treasurer 1969 Hollywood Beach, FL u David W. Goddard, MD, Daytona Beach, FL President u Henry Comfort Hudson, MD, Birmingham, AL President-Elect u R. Prosser Morrow, Jr., MD, New Orleans, LA Secretary Charlton P. Armstrong, III, MD, Greenville, SC Treasurer 1970 TS Hanseatic u Henry Comfort Hudson, MD, Birmingham, AL President u Milton M. Coplan, MD, Miami, FL President-Elect u R. Prosser Morrow, Jr., MD, New Orleans, LA Secretary Charlton P. Armstrong, III, MD, Greenville, SC Treasurer 1971 Miami Beach, FL u Milton M. Coplan, MD, Miami, FL President u R. Prosser Morrow, Jr., MD, New Orleans, LA President-Elect u Samuel S. Ambrose, MD, Atlanta, GA Secretary 188 u George W. Vickery, MD, Gulfport, MS Treasurer 1972 New Orleans, LA u R. Prosser Morrow, Jr., MD, New Orleans, LA President Charlton P. Armstrong, III, MD, Greenville, SC President-Elect u Samuel S. Ambrose, MD, Atlanta, GA Secretary u George W. Vickery, MD, Gulfport, MS Treasurer 1973 Palm Beach, FL u Charlton P. Armstrong, MD, President Hurbert K. Turley, MD, Memphis, TN President-Elect u Samuel S. Ambrose, MD, Atlanta, GA Secretary u Victor A. Politano, MD, N. Miami, FL Treasurer 1974 Marco Island, FL Hurbert K. Turley, MD, Memphis, TN President u Samuel S. Ambrose, MD, Atlanta, GA President-Elect u William Brannan, MD, The Woodlands, TX Secretary u Victor A. Politano, MD, N. Miami, FL Treasurer 1975 Atlanta, GA u Samuel S. Ambrose, MD, Atlanta, GA President u Rafe Banks, Jr., MD, Gainesville, GA President-Elect u William Brannan, MD, The Woodlands, TX Secretary u Victor A. Politano, MD, N. Miami, FL Treasurer 1976 Hollywood, FL u Rafe Banks, Jr., MD, Gainesville, GA President u James F. Glenn, MD, Versailles, KY President-Elect u William Brannan, MD, The Woodlands, TX Secretary u John I. Williams, MD, Fort Lauderdale, FL Treasurer 1977 New Orleans, LA u James F. Glenn, MD, Versailles, KY President u William Brannan, MD, The Woodlands, TX President-Elect u Miles W. Thomley, MD, Winter Park, FL Secretary u John I. Williams, MD, Fort Lauderdale, FL Treasurer 1978 Louisville, KY u William Brannan, MD, The Woodlands, TX President u Victor A. Politano, MD, N. Miami, FL President-Elect u Miles W. Thomley, MD, Winter Park, FL Secretary PREVIOUS OFFICERS u John I. Williams, MD, Fort Lauderdale, FL Treasurer 1979 Memphis, TN u Victor A. Politano, MD, N. Miami, FL President u Joseph Ward Hooper, Jr., MD, Wilmington, NC President-Elect u Miles W. Thomley, MD, Winter Park, FL Secretary u Fontaine Bruce Moore, Jr., MD, Memphis, TN Treasurer 1980 San Juan, Puerto Rico u Joseph Ward Hooper, Jr., MD, Wilmington, NC President u Miles W. Thomley, MD, Winter Park, FL President-Elect W. Lamar Weems, MD, Jackson, MS Secretary u Fontaine Bruce Moore, Jr., MD, Memphis, TN Treasurer 1981 Lake Buena Vista, FL u Miles W. Thomley, MD, Winter Park, FL President u John I. Williams, MD, Fort Lauderdale, FL President-Elect W. Lamar Weems, MD, Jackson, MS Secretary u Fontaine Bruce Moore, Jr., MD, Memphis, TN Treasurer 1982 New Orleans, LA u John I. Williams, MD, Fort Lauderdale, FL President Eugene C. St. Martin, MD, Shreveport, LA President-Elect W. Lamar Weems, MD, Jackson, MS Secretary Edward H. Ray, Jr., MD, Lexington, KY Treasurer 189 1983 Haines City, FL Eugene C. St. Martin, MD, shreveport, LA President W. Lamar Weems, MD, Jackson, MS President-Elect William Redd Turner Jr., MD, Folly Beach, SC Secretary Edward H. Ray Jr., MD, Lexington, KY Treasurer 1984 Nashville, TN W. Lamar Weems, MD, Jackson, MS President u Fontaine Bruce Moore, Jr., MD, Memphis, TN President-Elect William Redd Turner, Jr., MD, Folly Beach, SC Secretary Edward H. Ray, Jr., MD, Lexington, KY Treasurer 1985 Marco Island, FL u Fontaine Bruce Moore, Jr., MD, Memphis, TN President Jack Hughes, MD, Durham, NC President-Elect William Redd Turner, Jr., MD, Folly Beach, SC Secretary u Robert N. Webster, MD, Tallahassee, FL Treasurer 1986 Dorado Beach, Puerto Rico Jack Hughes, MD, Durham, NC President William Redd Turner, Jr., MD, Folly Beach, SC President-Elect u David M. Drylie, MD, Gainesville, FL Secretary u Robert N. Webster, MD, Tallahassee, FL Treasurer 1987 New Orleans, LA William Redd Turner, Jr., MD, Folly Beach, SC President Roy Witherington, MD, Augusta, GA President-Elect u David M. Drylie, MD, Gainesville, FL Secretary u Robert N. Webster, MD, Tallahassee, FL Treasurer 1988 Boca Raton, FL Roy Witherington, MD, Augusta, GA President Edward H. Ray, Jr., MD, Lexington, KY President-Elect u David M. Drylie, MD, Gainesville, FL Secretary u Robert B. Quattlebaum, Jr., MD, Savannah, GA Treasurer 1989 Hilton Head, SC Edward H. Ray, Jr., MD, Lexington, KY President u David M. Drylie, MD, Gainesville, FL President-Elect u Lloyd H. Harrison, MD, Tobaccoville, NC Secretary u Robert B. Quattlebaum, Jr., MD, Savannah, GA Treasurer 1990 Palm Beach, FL u David M. Drylie, MD, Gainesville, FL President u Robert N. Webster, MD, Tallahassee, FL President-Elect u Lloyd H. Harrison, MD, Tobaccoville, NC Secretary u Robert B. Quattlebaum, Jr., MD, Savannah, GA Treasurer 1991 Atlanta, GA u Robert N. Webster, MD, Tallahassee, FL President Josiah F. Reed, Jr., MD, Montgomery, AL President-Elect u Lloyd H. Harrison, MD, Tobaccoville, NC Secretary James C. Seabury, Jr., MD, Fort Myers Beach, FL Treasurer 1992 Charlotte, NC Josiah F. Reed, Jr., MD, Montgomery, AL President u Lloyd H. Harrison, MD, Tobaccoville, NC President-Elect J. William McRoberts, MD, Lexington, KY Secretary James C. Seabury, Jr., MD, Fort Myers Beach, FL Treasurer 1993 Nashville, TN u Lloyd H. Harrison, MD, Tobaccoville, NC President u Robert B. Quattlebaum, Jr., MD, Savannah, GA President-Elect J. William McRoberts, MD, Lexington, KY Secretary James C. Seabury, Jr., MD, Fort Myers Beach, FL Treasurer 190 1994 New Orleans, LA u Robert B. Quattlebaum, Jr., MD, Savannah, GA President Thomas C. McLaughlin, MD, Lakeland, FL President-Elect J. William McRoberts, MD, Lexington, KY Secretary Hector H. Henry, II, MD, Salisbury, NC Treasurer 1995 Lake Buena Vista, FL Thomas C. McLaughlin, MD, Lakeland, FL President J. William McRoberts, MD, Lexington, KY President-Elect David L. McCullough, MD, Kernersville, NC Secretary Hector H. Henry, II, MD, Salisbury, NC Treasurer 1996 Las Croabas, Puerto Rico J. William McRoberts, MD, Lexington, KY President James C. Seabury, Jr., MD, Fort Myers Beach, FL President-Elect David L. McCullough, MD, Kernersville, NC Secretary Hector H. Henry, II, MD, Salisbury, NC Treasurer 1997 Naples, FL James C. Seabury, Jr., MD, Fort Myers Beach, FL President Cecil Morgan, Jr., MD, Birmingham, AL President-Elect David L. McCullough, MD, Kernersville, NC Secretary Valentine A. Earhart, MD, New Orleans, LA Treasurer 1998 Birmingham, AL Cecil Morgan, Jr., MD, Birmingham, AL President David L. McCullough, MD, Kernersville, NC President-Elect Anton J. Bueschen, MD, Atlanta, GA Secretary Valentine A. Earhart, MD, New Orleans, LA Treasurer 1999 Charleston, SC David L. McCullough, MD, Kernersville, NC President William F. Gee, MD, Lexington, KY President-Elect Anton J. Bueschen, MD, Atlanta, GA Secretary Valentine A. Earhart, MD, New Orleans, LA Treasurer 2000 Orlando, FL William F. Gee, MD, Lexington, KY President Hector H. Henry, II, MD, Salisbury, NC President-Elect PREVIOUS OFFICERS Anton J. Bueschen, MD, Atlanta, GA Secretary B. Thomas Brown, MD, MBA, Daytona Beach, FL Treasurer 2001 New Orleans, LA Hector H. Henry, II, MD, Salisbury, NC President William F. Gee, MD, Lexington, KY Past President Anton J. Bueschen, MD, Atlanta, GA President-Elect Joseph A. Smith, Jr., MD, Nashville, TN Secretary B. Thomas Brown, MD, MBA, Daytona Beach, FL Treasurer Edward O. Janosko, MD, Wilmington, NC Member-at-Large 2002 Naples, FL Anton J. Bueschen, MD, Atlanta, GA President Hector H. Henry, II, MD, Salisbury, NC Past President Valentine A. Earhart, MD, New Orleans, LA President-Elect Joseph A. Smith, Jr., MD, Nashville, TN Secretary B. Thomas Brown, MD, MBA, Daytona Beach, FL Treasurer Edward O. Janosko, MD, Wilmington, NC Member-at-Large 2003 Savannah, GA Valentine A. Earhart, MD, New Orleans, LA President Anton J. Bueschen, MD, Atlanta, GA Past President B. Thomas Brown, MD, MBA, Daytona Beach, FL President-Elect Joseph A. Smith, Jr., MD, Nashville, TN Secretary Edward O. Janosko, MD, Wilmington, NC Treasurer Thomas F. Stringer, MD, Inverness, FL Member-at-Large 191 2004 Oranjestad, Arbua B. Thomas Brown, MD, MBA, Daytona Beach, FL President Valentine A. Earhart, MD, New Orleans, LA Past President Joseph A. Smith Jr., MD, Nashville, TN President-Elect Dennis D. Venable, MD, Shreveport, LA Secretary Edward O. Janosko, MD, Wilmington, NC Treasurer Thomas F. Stringer, MD, Inverness, FL Member-at-Large 2005 Charleston, SC Joseph A. Smith, Jr., MD, Nashville, TN President B. Thomas Brown, MD, MBA, Daytona Beach, FL Past President Culley C. Carson, III, MD, Chapel Hill, NC President-Elect Dennis D. Venable, MD, Shreveport, LA Secretary Edward O. Janosko, MD, Wilmington, NC Treasurer 2006 Rio Grande, Puerto Rico Culley C. Carson, III, MD, Chapel Hill, NC President Joseph A. Smith, Jr., MD, Nashville, TN Past President Edward O. Janosko, MD, Wilmington, NC President-Elect Dennis D. Venable, MD, Shreveport, LA Secretary Thomas F. Stringer, MD, Inverness, FL Treasurer 2007 Lake Buena Vista, FL Edward O. Janosko, MD, Wilmington, NC President Culley C. Carson, III, MD, Chapel Hill, NC Past President Dennis D. Venable, MD, Shreveport, LA President-Elect Raju Thomas, MD, FACS, MHA, New Orleans, LA Secretary Thomas F. Stringer, MD, Inverness, FL Treasurer 2008 San Diego, CA Dennis D. Venable, MD, Shreveport, LA President Edward O. Janosko, MD, Wilmington, NC Past President Martin K. Dineen, MD, Daytona Beach, FL President-Elect Raju Thomas, MD, FACS, MHA, New Orleans, LA Secretary Thomas F. Stringer, MD, Inverness, FL Treasurer 2009 Mobile, AL Martin K. Dineen, MD, Daytona Beach, FL President Dennis D. Venable, MD, Shreveport, LA Past President Thomas F. Stringer, MD, Inverness, FL President-Elect Raju Thomas, MD, FACS, MHA, New Orleans, LA Secretary W. Terry Stallings, MD, Mobile, AL Treasurer 2010 Miami Beach, FL Thomas F. Stringer, MD, Inverness, FL President Martin K. Dineen, MD, Daytona Beach, FL Past President Raju Thomas, MD, FACS, MHA, New Orleans, LA President-Elect W. Terry Stallings, MD, Mobile, AL Treasurer Raymond J. Leveillee, MD, FRCS-G, Miami, FL Secretary 2011 New Orleans, LA Raju Thomas, MD, FACS, MHA, New Orleans, LA President Thomas F. Stringer, MD, Inverness, FL Past President Randall G. Rowland, MD, PhD; Lexington, KY President-Elect W. Terry Stallings, MD, Mobile, AL Treasurer Raymond J. Leveillee, MD, FRCS-G, Miami, FL Secretary 192 FUTURE SESAUA MEETINGS SESAUA 76th Annual Meeting March 22 – 25, 2012 The Ritz-Carlton Amelia Island, Florida PREVIOUS OFFICERS SESAUA 77th Annual Meeting March 14 – 17, 2013 Williamsburg Lodge Williamsburg, VA 193 NOTES 194 NOTES NOTES 195 NOTES NOTES 196 SESAUA Two Wood eld Lake 1100 E Wood eld Road, Suite 520 Schaumburg, IL 60173 Phone: (847) 969-0248 | Fax: (847) 517-7229 Email: [email protected] | www.sesaua.org