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Video Poster 1 WHERE I GO: BUILDING a MOBILEMEASURE FACTORS THAT APPLICATION SOCIO/ENVIRONMENTAL to AFFECT a WOMAN's DECISION to PEE

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Video Poster 1 WHERE I GO: BUILDING a MOBILEMEASURE FACTORS THAT APPLICATION SOCIO/ENVIRONMENTAL to AFFECT a WOMAN's DECISION to PEE VIDEO POSTER 1 Video Poster 1 Video Poster 2 WHERE I GO: BUILDING A MOBILE APPLICATION TO ENDOSCOPIC REPAIR OF BLADDER AND URETHRAL MESH MEASURE SOCIO/ENVIRONMENTAL FACTORS THAT INJURIES AFFECT A WOMAN'S DECISION TO PEE A. Plair1,2,C.A.Matthews1,2,J.Zambon2,G.Badlani1,2. 1Wake Forest Baptist J. M. Miller1,E.R.Mueller2,I.T.Moore3,M.A.Nowak3,H.L.Chang3,C.L. Health, Winston-Salem, NC, 2Wake Forest Baptist Health, Winston-Salem, NC Carter3,J.Semerad3, W.Newhosue3,E.M.Hershey3,L.C.An4. 1University of Objective: There are various approaches to surgical management of urethral Michigan, Ann Arbor, MI, 2Loyola University Chicago Stritch School of and bladder mesh injuries with the endoscopic approach having the least Medicine, Maywood, IL, 3University of Michigan, Ann Arbor, MI, 4Univer- wide-spread knowledge and experience. Our video aims to orient and inform sity of Michigan, Ann Arbor, MI the viewer to the nature of urethral and bladder mesh injuries as well as demon- 10/08/2020 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3wX04VDhDA665Sl9/NTOH1xg0OrtA2lflobv0x/UJAIR7ywyNpe37WQ== by http://journals.lww.com/jpelvicsurgery from Downloaded Introduction: Knowledge of factors that influence a woman’s decision to void strating appropriate methods for endoscopic removal. (plain language "pee") is important for promotion of bladder health. These in- Methods: A literature search was performed to assess current knowledge on Downloaded clude location and access to toilets, autonomy to use the toilet, safety and endoscopic removal of urethral and bladder mesh injuries. Video was obtained cleanliness, and how women plan for and manage urge sensations in daily life. and edited from a bladder wall mesh extrusion case and from a case of mesh embed- Other factors include adaptive strategies such as anticipating peeing opportuni- ded into the proximal urethra/bladder neck that were managed in our department. from ties, adjusting fluid intake, and avoiding triggers. Development of innovative Results: Bladder and urethral mesh injuries are rare with a prevalence of <1% http://journals.lww.com/jpelvicsurgery technologies is needed to adequately measure these factors in the moment of of female pelvic mesh cases. Patients with such injuries can present with lower decision-making. urinary tract symptoms including recurrent urinary tract infections, overactive Objective: To describe the conceptualization, design, and build of a smartphone bladder symptoms, hematuria, and pelvic pain. Surgery is mandatory for proper mobile application named “Where I Go.” management. Adequate inspection of the urethra and bladder preoperatively is Methods: Over 45 investigators from the Prevention of Lower Urinary Tract important for proper surgical approach planning. The decision between open, Symptoms (PLUS) Research Consortium brainstormed and voted on the critical laparoscopic/robotic, vaginal, and endoscopic approaches is usually based on demographics and individual socio/environmental factors to be included in the the location and extent of mesh exposure as well as surgeon experience. Endo- by app. We eliminated factors if equally well obtained by traditional paper or elec- scopic removal can be appropriate for patients requiring the least invasive ap- BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3wX04VDhDA665Sl9/NTOH1xg0OrtA2lflobv0x/UJAIR7ywyNpe37WQ== tronic survey or by necessity clinical exam. Variance in “Where” women pee was proach possible and for those with poor tissue healing. Endoscopic removal identified as a central factor, thus GPS capability was incorporated into the app. can utilize sharp endoscopic instruments, laser transection, and electrocautery Location labeling for “home” and up to four other commonly frequented sites for mesh removal. We present two cases demonstrating endoscopic approaches was required for use, with options for adding location labels across days of app to mesh removal, one from the bladder side wall and one from the proximal ure- use. The technical design and build team from the University of Michigan Center thra / bladder neck. for Health Communications Research (CHCR) simultaneously built the app for dual platforms (Android and IOS) to maximize inclusivity. CHCR applied prin- ciples of: 1) no more than six taps in any interaction with the app, 2) ability of the woman to self-initiate app interaction for in-the-moment reports, and 3) pushed notifications (five times per day) for reporting on look-back periods of 3-4 hours (ecological momentary assessment. In its design and build, we used an interactive process of early and frequent informal feedback from consortium members and community users of Where I Go. Effort was prioritized towards design ap- peal and usability ease (Fig). Early testing involved 48-hour use of Where I Go, but the application can extend to any number of days desired. Results: The current app prototype offers, eg 10+ demographics, repeated mea- sures for 20+ factors potentially influencing a void decision, location of the par- ticipant at each interaction with the app (GPS markers of latitude and longitude), among others. Formal usability testing is completed, was successful, and is re- ported in detail elsewhere, as a separate abstract. Conclusions: Where I Go is a novel mobile app data collection tool that offers women opportunity to comprehensively report factors influencing decisions about if, when, why, and where to pee (OTT Ref. No.: 2019-292). on 10/08/2020 Disclosures: J. M. Miller: Nothing to disclose; E. R. Mueller: Nothing to disclose; I. T. Moore: Nothing to disclose; M. A. Nowak: Nothing to disclose; H. L. Chang: Nothing to disclose; C. L. Carter: Nothing to disclose; J. Semerad: Nothing to disclose; W. Newhosue: Renalis: Consultant; E. M. Hershey: Nothing to disclose; L. C. An: Nothing to disclose. S82 www.fpmrs.net Female Pelvic Medicine & Reconstructive Surgery • Volume 26, Number 10S, Supplement 1, October 2020 Copyright © 2020 American Urogynecologic Society. Unauthorized reproduction of this article is prohibited. Female Pelvic Medicine & Reconstructive Surgery • Volume 26, Number 10S, Supplement 1, October 2020 Abstracts Conclusions: Due to the rare occurrence of bladder and urethral mesh injuries, 100 cc. The patient had an uncomplicated inpatient post-operative course and was knowledge pertaining to managing these injuries needs to be widely shared discharged on post-operative day 5. A 3-week follow-up voiding cystourethrogram within the pelvic reconstructive surgery community. Although endoscopic re- confirmed no frank extravasation prior to removal of her suprapubic and urethral pair is not the recommended surgical approach in many cases, it can offer an ap- catheters. Within the month following surgery, her serum creatinine level steadily im- propriate endoscopic approach for certain cases. proved to most recently 1.54 mg/dL. Additionally, she has had resolution of her both- Disclosures: A. Plair: Nothing to disclose; C. A. Matthews: Neomedic: Grant/ ersome urinary complaints and has had no urinary tract infections since her surgery. Research Support, Boston Scientific: Consultant and Grant/Research Support, Conclusions: Augmentation cystoplasty, although invasive, is a safe and effec- Johnson and Johnson: Expert witness; J. Zambon: Nothing to disclose; G. tive procedure for neurogenic bladder patients with storage symptoms related to Badlani: Nothing to disclose. decreased bladder capacity, poor compliance, and/or symptomatic detrusor over activity who have failed other conservative and less invasive measures. Disclosures: T. Tam: Nothing to disclose; A. Mahdy: Nothing to disclose. Video Poster 3 DUPLICATED COLLECTING SYSTEM Video Poster 5 E. S. Chang1,R.J.Hidalgo1, L. R. Wiegand2, A. M. Wyman1. 1University of 2 LONGITUDINALVAGINAL SEPTUM RESECTION VIA South Florida, Tampa, FL, University of South Florida, Tampa, FL HANDHELD VESSEL SEALER AND TISSUE DIVIDER Objective: The objectives of this video is to discuss the presentation, evalua- tion, and treatment of duplicated urinary collecting systems, and to present a Z. S. Cope. University of Louisville, Louisville, KY, S. L. Francis. University of case of duplicated collecting system with ectopic ureteral implantation at the Louisville, Louisville, KY, O. Cardenas-Trowers. University of Louisville, vaginal introitus. Louisville, KY,andA. Gupta. University of Louisville, Louisville, KY Methods: We present the case of a 56 year-old female presenting with a history Objective: To present, via video, resection of a vaginal septum with a handheld of recurrent urinary tract infections starting in adolescence. She reported symp- vessel sealer and tissue divider. toms of urinary urgency, frequency, and incontinence. She additionally reported Methods: An 18-year-old female with uterine didelphis, bicollis and symptom- an unclear history of an incidental diagnosis of ureteral anomaly in childhood. atic longitudinal vaginal septum presented for surgical management. We de- For evaluation, a computed tomography urogram was performed, which revealed scribe our technique for resection of the septum using a hand-held vessel a right duplicated kidney with upper ureter inserting into the bladder neck, and sealer and tissue divider with minimal blood loss. After excision of the septum lower ureter with unclear course. Avoiding cystogram was performed to evaluate the vaginal edges were reapproximated with absorbable suture. for ureteral reflux which was not demonstrated. A renal MAG3 scan was per- Results: Video
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