Table of Contents

Scientific Program Schedule at a Glance...... 002 Needs and Objectives...... 004 Board of Directors...... 008 Board of Directors Representatives...... 009 Committee Listing...... 012 Past Presidents and Annual Meeting Sites...... 015 Guest Speakers and Invited Speakers...... 018 Promotional Partners...... 019 Exhibitors...... 020 General Meeting Information...... 021 Industry Sponsored Events...... 024 Evening Functions...... 026 Optional Activities...... 027 Full Scientific Program Schedule...... 032 Alphabetical Index of Moderators, Panelists, Guest and Invited Speakers...... 071 Alphabetical Index of Abstract Presenters...... 073 Podiums in Presentation Order...... 077 Posters in Presentation Order...... 152 Videos in Presentation Order...... 194 Annual Business Meeting Agenda – Education Fund...... 196 Financial Statements – Education Fund...... 197 Annual Business Meeting Agenda – General Fund...... 199 Financial Statements – General Fund...... 200 Membership Summary Report...... 202 Membership Candidates and Transfers...... 203 In Memoriam...... 207 SCS Bylaws...... 208 Mark Your Calendars...... Back Cover

1 Scientific Program Schedule at a Glance

All sessions will be located in the Oasis Ballroom unless otherwise noted.

2 Scientific Program Schedule at a Glance General Info All sessions will be located in the Oasis Ballroom unless otherwise noted.

3 Educational Needs and Objectives

Educational Needs The President-Elect of the SCSAUA (Damara L. Kaplan, PhD, MD), consulted with SCSAUA Executive Committee members, including the current SCSAUA President, Dr. Charles A. McWilliams; SCSAUA Past President, Dr. Allen F. Morey; SCSAUA Secretary, Dr. Jeffrey M. Holzbeierlein; SCSAUA Treasurer, Dr. Timothy D. Langford; and Chair, Office of Education of the AUA, Dr. Elspeth McDougall, regarding the needs we are attempting to fulfill through our annual scientific program. It was agreed by the above committee members, Section Officers and Director of the Office of Education of the AUA that there continues to be significant educational needs for our annual meeting and scientific program.

There is a need for urologists to effectively manage noninvasive bladder cancer. This may include improved detection, resection and by utilizing methods to prevent or delay recurrence. This need will be met by a state-of-the-art lecture. To meet the educational needs of treating advanced bladder cancer, a podium session will be presented. This session will further inform the attendees of the most current management of advanced bladder cancer.

Urologists need to better understand the role of cytoreductive for metastatic renal cancer. As tyrosine kinase inhibitors are used more frequently to treat advanced disease, the role for nephrectomy is changing. A state-of-the-art lecture which reviews the current literature will provide new insights in management including cytoreductive nephrectomy. The podium session will provide up-to-date research in the management of both localized and metastatic renal cancer.

There is a need for improved surgical management of renal stones. A critical evaluation of the three most widely used techniques will be provided to the attendees using the point-counterpoint format. Given that the majority of stones are managed endoscopically, there is a need for ongoing improvement in ureteroscopic techniques. A state-of-the-art lecture will address complex problems in and provide instruction about their management. Finally, there is a great need for improved understanding of the medical management of stones. This will be addressed during the AUA guidelines presentation.

To help meet the needs of the practicing urologist, a podium session will discuss the management of the failed sling and other mesh complications. Other presentations will address complex voiding dysfunction and the utilization of alternative treatments.

The growing need for rational management of all stages of cancer will be addressed using two separate formats. Two podium sessions will be employed. During the podium sessions, both diagnosis and treatment methods will be discussed. Finally, the updated AUA Guidelines on the management of resistant will be presented.

To meet the growing need for the most current management strategies in pediatric urology, two formats will be used. The podium session will address common

4 problems in pediatric urology and present the most up-to-date research. The topic of will specifically be addressed in the AUA Guidelines presentation. General Info A state-of-the-art lecture will be presented, which will outline the current advances in tissue engineering in urology.

There is a need for urologists to better understand the causes for failure of the artificial urinary sphincter and improve their surgical techniques. This willbe addressed in a podium session.

Learning Objectives: At the conclusion of the 2014 SCSAUA meeting, attendees should be able to: 1. Describe the indications for cytoreductive nephrectomy in the era of TK inhibitors. 2. Explain the current management of non-muscle invasive bladder cancer. 3. Identify the specific health policy concerns of private practice urologists, academic urologists and employed urologists. 4. Review the role of ESWL, PCNL and ureteroscopy in the management of renal stones. 5. Demonstrate how improved ureteroscopic techniques may lead to improved surgical outcomes. 6. Integrate the new AUA guidelines into daily practice, to include the Urotrauma Guideline, CRPC Guideline and Medical Management of Kidney Stones Guideline. 7. Evaluate strategies for managing stress in patients with a prior failed sling. 8. Analyze emerging technologies to include novel robotic techniques and the expanding role of tissue engineering in the field of urology.

5 CME ACCREDITATION INFORMATION

Accreditation: The American Urological Association (AUA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The American Urological Association designates this live activity for a maximum of 26.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Evidence-Based Content: It is the policy of the AUA to ensure that the content contained in this CME activity is valid, fair, balanced, scientifically rigorous and free of commercial bias.

AUA Disclosure Policy: All persons in a position to control the content of an educational activity (i.e., activity planners, presenters, authors) participating in an educational activity provided by the AUA are required to disclose to the provider any relevant financial relationships with any commercial interest. The AUA must determine if the individual’s relationships may influence the educational content and resolve any conflicts of interest prior to the commencement of the educational activity. The intent of this disclosure is not to prevent individuals with relevant financial relationships from participating, but rather to provide learners information with which they can make their own judgments.

The disclosure report for this meeting may be found in your registration packet.

Resolution of Identified Conflict of Interest: All disclosures will be reviewed by the program/course directors or editors for identification of conflicts of interest. Peer reviewers, working with the program directors and/or editors, will document the mechanism(s) for management and resolution of the conflict of interest and final approval of the activity will be documented prior to implementation. Any of the mechanisms below can/will be used to resolve conflict of interest:

• Peer review for valid, evidence-based content of all materials associated with an educational activity by the course/program director, editor, and/or Education Content Review Committee or its subgroup • Limit content to evidence with no recommendations • Introduction of a debate format with an unbiased moderator (point- counterpoint) • Inclusion of moderated panel discussion • Publication of a parallel or rebuttal article for an article that is felt to be biased • Limit equipment representatives to providing logistics and operation support only in procedural demonstrations • Divestiture of the relationship by faculty

Off-label or Unapproved Use of Drugs or Devices: It is the policy of the AUA to require the disclosure of all references to off-label or unapproved uses of drugs or devices prior to the presentation of educational content. The audience is advised 6 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 General for full disclosure of approved uses. Info

Disclaimer: The opinions and recommendations expressed by faculty, authors and other experts whose input is included in this program are their own and do not necessarily represent the viewpoint of the AUA.

Audio, Video and Photographic Equipment: The use of audio, video and other photographic recording equipment is prohibited by attendees inside AUA meeting rooms.

Reproduction Permission: Reproduction of written materials developed for this AUA course is prohibited without the written permission from individual authors and the American Urological Association.

General Disclaimer for the South Central Section of the AUA, Inc.: The opinions of the program participants are their own and do not necessarily represent those of the South Central Section of the AUA, Inc. Participation by the guest experts and by members of the South Central Section of the AUA, Inc. is not to imply endorsement of products and services by the South Central Section of the AUA, Inc. Exhibition by industry does not necessarily represent endorsement of these exhibited products or services by the South Central Section of the AUA, Inc.

Special Assistance/Dietary Needs: The American Urological Association (AUA), 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) 605-0850.

7 SCS BOARD OF DIRECTORS 2013 – 2014

OFFICERS

President Charles A. McWilliams, MD Urology Centers of Oklahoma 4200 W Memorial Road, Suite 1007 Oklahoma City, OK 73120

President-Elect Damara L. Kaplan, PhD, MD Albuquerque Urology Associates 610 Broadway Blvd. NE Albuquerque, NM 87102

Secretary Jeffrey M. Holzbeierlein, MD, FACS University of Kansas Medical Center 3901 Rainbow Blvd. MS-3016 Kansas City, KS 66160

Treasurer Timothy D. Langford, MD Arkansas Urology Associates, P.A. 1300 Centerview Drive Little Rock, AR 72211

Immediate Past President Allen F. Morey, MD University of Texas Southwestern Medical Center Department of Urology 5323 Harry Hines Blvd. Moss Building, Eighth Floor, Suite 122 Dallas, TX 75390

Historian Robert E. Donohue, MD UCDHSC Division of Urology Academic Office One Building 12631 E 17th Ave. Box C319, Room L15 Aurora, CO 80045

8 AREA REPRESENTATIVES General

Arkansas Info Jeffrey B. Marotte, MD 495 Hogan Lane, Suite 2 Conway, AR 72034

Colorado Fernando J.W. Kim, MD, FACS Denver Health Medical Center Division of Urology, MC0206 777 Bannock St. Denver, CO 80204

Kansas Tomas L. Griebling, MD, MPH The University of Kansas Medical Center Department of Urology - MS 3016 3901 Rainbow Blvd. Kansas City, KS 66160

Missouri James M. Cummings, MD University of Missouri Division of Urology One Hospital Drive, M562 Columbia, MO 65212

Nebraska Jon J. Morton, MD The Urology Center, PC 111 S 90th St. Omaha, NE 68114

New Mexico Michael Davis, MD University of New Mexico Department of – MSC10 5610 1 University of New Mexico Albuquerque, NM 87131

Oklahoma William J. Cook, MD Urologic Specialists of OK 10901 E 48th St. Tulsa, OK 74146

9 Texas Ashish M. Kamat, MD MD Anderson Cancer Center 1515 Holcombe Blvd., Unit 1373 Houston, TX 77005

Central America Hector Morales-Martell, MD, FACS Centro Medico Internacional de la Clinica Biblica 150mts Este Av.14, entre calles 3 y 5 San Jose 262-2010 Costa Rica

Mexico Jose Arturo Rodriguez Rivera, MD Hospital General De Occidente, SSJ Nino Obrero 850 Col. Cd. De Los Ninos Guadalajara 45040 Mexico

Ex-Officio SMU Representative Jose J. Espinosa-Monteros, MD Loaiza 610-203 Los Mochis, Mexico

Ernesto Lopez Corona, MD KCVA Medical Center 4801 Linwood Blvd. Kansas City, MO 64128

Daniel Olvera-Posada, MD Vasco De Quiroga 15 Colonia Sección XVI Tlalpan Mexico City 14000 Mexico

Representative to AUA Board of Directors Randall B. Meacham, MD University of Colorado School of Medicine Division of Urology 12631 E 17th Ave. M/S C-319 Aurora, CO 80045

10 AUA Leadership Program Representatives

John W. Davis, MD, FACS General

MD Anderson Cancer Center Info 1515 Holcombe Blvd. Unit 1373 Houston, TX 77030

David A. Duchene, MD University of Kansas Medical Center Department of Urology 3901 Rainbow Blvd., MS 3016 Kansas City, KS 66160

Vitaly Margulis, MD University of Texas Southwestern Medical Center Department of Urology 5323 Harry Hines Blvd. Dallas, TX 75390

Representative to AUA JU Editorial Committee Gary E. Lemack, MD University Texas Southwestern Medical Center 5323 Harry Hines Blvd., J8 Room 148 Dallas, TX 75390

Arthur I. Sagalowsky, MD University of Texas Southwestern Medical Center Department of Urology 5323 Harry Hines Blvd., J8 Room 130 Dallas, TX 75390

Executive Office

Executive Director Wendy J. Weiser

South Central Section of the AUA Two Woodfield Lake 1100 E Woodfield Road, Suite 350 Schaumburg, IL 60173 Phone: (847) 605-0850 Fax: (847) 517-7229 Email: [email protected]

11 South Central Section of the AUA, Inc. Committee Listing 2013 – 2014

AUA SECTION SECRETARIES/MEMBERSHIP COUNCIL Jeffrey M. Holzbeierlein, MD, FACS; Kansas City, KS

BYLAWS COMMITTEE Damara L. Kaplan, PhD, MD; Albuquerque, NM (Chair) John W. Davis, MD, FACS; Houston, TX Jeffrey M. Holzbeierlein, MD, FACS; Kansas City, KS To Be Determined

FELLOW PRIZE COMMITTEE Tomas L. Griebling, MD, MPH; Kansas City, KS (Chair) Joseph W. Basler, MD, PhD; San Antonio, TX Ashish M. Kamat, MD; Houston, TX Moben Mirza, MD; Kansas City, KS

FINANCE COMMITTEE Steven C. Koukol, MD; Omaha, NE (Chair) Roger V. Haglund, MD; Tulsa, OK Charles W. Logan, MD; Little Rock, AR Gilbert Ross, Jr., MD; Columbia, MO Timothy D. Langford, MD; Little Rock, AR (Treasurer)

HEALTH POLICY COUNCIL Noel E. Sankey, MD; Denver, CO (Chair) Ajay K. Nangia, MBBS; Kansas City, KS (Co-Chair) Danilo K. Asase, MD; Harlingen, TX (Texas Delegate) Mark S. Austenfeld, MD; Kansas City, MO (Missouri Delegate) John B. Forrest, MD; Tulsa, OK (Oklahoma Delegate) David C. Jacks, MD; Pine Bluff, AR (Arkansas Delegate) Steven C. Koukol, MD; Omaha, NE (Nebraska Delegate) Joseph C. Kueter, MD; Jonesboro, AR (Arkansas Delegate) Allen W. McCulloch, MD; Farmington, NM (New Mexico Delegate) Charles A. McWilliams, MD; Oklahoma City, OK (Oklahoma Delegate) Randall B. Meacham, MD; Aurora, CO (Colorado Delegate) Eduardo Orihuela, MD; Galveston, TX (Texas Delegate) Steven C. Robeson, MD; Santa Fe, NM (New Mexico Delegate) Arthur I. Sagalowsky, MD; Dallas, TX (Texas Delegate) J. Brantley Thrasher, MD; Kansas City, KS (Kansas Delegate)

HISTORICAL & NECROLOGY COMMITTEE Robert E. Donohue, MD; Denver, CO (Chair) William L. Parry, MD; Oklahoma City, OK

LOCAL ARRANGEMENTS COMMITTEE Charles A. McWilliams, MD; Oklahoma City, OK (Chair) 12 NOMINATING COMMITTEE

Allen F. Morey, MD; Dallas, TX (Chair) General

Randall B. Meacham, MD; Aurora, CO Info Ajay K. Nangia, MBBS; Kansas City, KS (Member At Large) Anthony Y. Smith, MD; Corrales, NM James M. Cummings, MD; Columbia, MO (Board Members)

PAST PRESIDENTS COMMITTEE Allen F. Morey, MD; Dallas, TX (Chair)

PROGRAM COMMITTEE Damara L. Kaplan, PhD, MD; Albuquerque, NM (Chair) Jeffrey M. Holzbeierlein, MD, FACS; Kansas City, KS Timothy D. Langford, MD; Little Rock, AR Charles A. McWilliams, MD; Oklahoma City, OK Allen F. Morey, MD; Dallas, TX

RESIDENTS PROGRAM COMMITTEE Tomas L. Griebling, MD, MPH; Kansas City, KS (Chair) Michael Coburn, MD; Houston, TX John W. Davis, MD, FACS; Houston, TX Brian J. Flynn, MD; Golden, CO Matthew D. Katz, MD; Little Rock, AR Ajay K. Nangia, MBBS; Kansas City, KS Ismael Zamilpa, MD; LIttle Rock, AR

2013 – 2014 SCS Representatives to AUA Committees

AUA BOARD OF DIRECTORS Randall B. Meacham, MD; Aurora, CO (AMA Delegate) Anthony Y. Smith, MD; Corrales, NM (AMA Alternate Delegate)

AUA BYLAWS COMMITTEE Damara L. Kaplan, PhD, MD; Albuquerque, NM (AMA Delegate) John W. Davis, MD, FACS; Houston, TX (AMA Alternate Delegate)

AUA EDITORIAL BOARD COMMITTEE Gary E. Lemack, MD; Dallas, TX (AMA Delegate) Arthur I. Sagalowsky, MD; Dallas, TX (AMA Delegate)

AUA HEALTH POLICY COUNCIL Mark S. Austenfeld, MD; Kansas City, MO (AMA Delegate) Ajay K. Nangia, MBBS; Kansas City, KS (AMA Alternate Delegate)

AUA HISTORY COMMITTEE Robert E. Donohue, MD; Denver, CO (AMA Delegate)

AUA JUDICIAL & ETHICS COUNCIL Vijaya M. Vemulakonda, MD,JD, FCLM; Aurora, CO (AMA Delegate) Steve W. Waxman, MD, JD, FCLM; Overland Park, KS (AMA Delegate) 13 AUA LEADERSHIP PROGRAM John W. Davis, MD, FACS; Houston, TX (Representative) David A. Duchene, MD; Kansas City, KS (Representative) Vitaly Margulis, MD; Dallas, TX (Representative)

AUA NOMINATING COMMITTEE Anthony Y. Smith, MD; Corrales, NM (AMA Delegate) Tomas L. Griebling, MD, MPH; Kansas City, KS (AMA Alternate Delegate)

AUA PRACTICE MANAGEMENT COMMITTEE Stephen D. Confer, MD; Tulsa, OK (AMA Delegate)

AUA RESEARCH COMMITTEE Linda A. Baker, MD; Southlake, TX (Representative) Timothy B. Boone, MD, PhD; Houston, TX (Representative)

AUA RESIDENT’S COMMITTEE Kyle Rove, MD; Aurora, CO (Representative)

AUA YOUNG UROLOGIST COMMITTEE Paul D. Maroni, MD; Aurora, CO (Representative)

14 South Central Section of the AUA, Inc. Past Presidents and Annual Meeting Sites General Info

2013 Allen F. Morey, MD Chicago, IL

2012 Randall B. Meacham, MD Colorado Springs, CO 2011 Anthony Y. Smith, MD San Antonio, TX 2010 John B. Forrest, MD White Sulphur Springs, WV 2009 J. Brantley Thrasher, MD, FACS Scottsdale, AZ 2008 Mark S. Austenfeld, MD San Diego, CA 2007 Arthur I. Sagalowsky, MD Colorado Springs, CO 2006 Steven C. Robeson, MD Santa Fe, NM 2005 Arturo Mendoza-Valdes, MD Austin, TX 2004 Robert E. Donohue, MD Dublin, Ireland 2003 Michael M. Warren, MD Boston, MA 2002 James R. Wendelken, MD Colorado Springs, CO 2001 Charles W. Logan, MD Austin, TX 2000 John F. Redman, MD Montreal, Quebec, Canada 1999 * George E. Hurt, Jr., MD Santa Fe, NM 1998 Sushil S. Lacy, MD Cancun, Mexico 1997 John W. Weigel, MD Bermuda 1996 * John A. Whitesel, MD Vail, CO 1995 Herbert S. Friedman, MD Kansas City, MO 1994 Joseph N. Corriere, Jr., MD Vancouver, BC, Canada 1993 * Jorge E. Dib, MD Acapulco, DF, Mexico 1992 Steven K. Wilson, MD Galveston, TX 1991 * Hal K. Mardis, MD Maui, HI 1990 Gilbert Ross, Jr., MD Santa Fe, NM 1989 Milton B. Ozar, MD Orlando, FL 1988 * Bobby G. Smith, MD Colorado Springs, CO 1987 * Charles B. Dryden, MD London, England, UK 1986 Thomas P. Ball, Jr., MD San Antonio, TX 1985 * John W. Posey, MD Guadalajara & Puerta Vallarta, Mexico 1984 Edward L. Johnson, MD Houston, TX 1983 * Winston K. Mebust, MD St. Louis, MO 1982 Henry Kammandel, MD New Orleans, LA 1981 * Ralph A. Downs, MD Dallas, TX 1980 Roger V. Haglund, MD Kansas City, MO 1979 * Paul C. Peters, MD Albuquerque, NM

15 1978 C. Eugene Carlton, Jr., MD Colorado Springs, CO 1977 * Emmanuel N. Lubin, MD Tulsa, OK 1976 * Ian M. Thompson, Sr., MD San Antonio, TX 1975 * Charles A. Hulse, MD San Juan, PR 1974 * Donald D. Albers, MD Denver, CO 1973 * Abel J. Leader, MD Houston, TX 1972 * William F. Melick, MD Guadalajara & Puerta Vallarta, Mexico 1971 * Robert O. Beadles, MD St. Louis, MO 1970 * Hjalmar E. Carlson, MD Dallas, TX 1969 * Michael K. O’Heeron, MD Colorado Springs, CO 1968 * Berget H. Blocksom, MD San Antonio, TX 1967 * Horace V. Munger, MD Kansas City, MO 1966 * A. Keller Doss, MD Mexico City & Acapulco, DF, Mexico 1965 * King Wade, Jr., MD Omaha, NE 1964 * Charles A. Hooks, MD Houston, TX 1963 * Raul Lopez Engelking, MD Colorado Springs, CO 1962 * Henry A. Buchtel, MD Mexico City & Acapulco, DF, Mexico 1961 * William L. Valk, MD Hot Springs, AR 1960 * J. R. Blundell, MD Albuquerque, NM 1959 * A. Lloyd Stockwell, MD Denver, CO 1958 * Justin Cordonnier, MD St. Louis, MO 1957 * Cecil M. Crigler, MD Oklahoma City, OK 1956 * Irwin S. Brown, MD Mexico, DF, Mexico 1955 * Harold A. O’Brien, MD San Antonio, TX 1954 * R. H. Akin, MD Colorado Springs, CO 1953 * John F. Patton, MD Kansas City, MO 1952 * Harry M. Spence, MD Hot Springs, AR 1951 * Daniel R. Higbee, MD Houston, TX 1949 * W. Joseph McMartin, MD Colorado Springs, CO 1948 * Neil S. Moore, MD St. Louis, MO 1947 * Harold T. Low, MD Fort Worth, TX 1946 * O. W. Davidson, MD Hot Springs, AR 1945 * Robert E. Cone, MD Kansas City, MO 1944 * Robert E. Cone, MD No meeting because of war conditions 1943 * Everett K. Akngle, MD Lincoln, NE 1942 * Henry S. Browne, MD Oklahoma City, OK 1941 * John B. Davis, MD Galveston, TX 1940 * D. K. Rose, MD Denver, CO

16 1939 * R. E. Van Duzen, MD Excelsior Spg., MO General 1938 * Charles McMartin, MD Dallas, TX

Info 1937 * E. L. Cohenour, MD Tulsa, OK 1936 * Arbor D. Munger, MD Omaha, NE

1935 * H. Fay H. Jones, MD Little Rock, AR 1934 * Grayson Carroll, MD St. Louis, MO 1933 * B. W. Turner, MD Houston, TX 1932 * T. Leon Howard, MD Denver, CO 1931 * R. Lee Hoffman, MD Kansas City, MO 1930 * A. I. Folsom, MD Lincoln, NE 1929 * Clinto K. Smith, MD Dallas, TX 1928 * H. King Wade, MD Hot Springs, AR 1927 * N. F. Ockerblad, MD Kansas City, MO 1926 * H. McClure Young, MD St. Louis, MO 1925 * W. J. Wallace, MD Oklahoma City, OK 1924 * Oliver Lyons, MD Denver, CO 1923 * John Caulk, MD Kansas City, MO 1922 * Ernest G. Mark, MD Hot Springs, AR 1921 * Ernest G. Mark, MD Kansas City, MO

* Deceased

17 93rd Annual Meeting South Central Section of the AUA, Inc. Guest Speakers and Invited Speakers

AUA Course of Choice Guest Speaker Demetrius H. Bagley, MD; Philadelphia, PA

Presidential Guest Speaker Retired Navy Lt. James Downing; Colorado Springs, CO

Guest and Invited Speakers Jodi Antonelli, MD; Dallas, TX Anthony Atala, MD; Winston-Salem, NC Jonathan A. Coleman, MD; New York, NY Brian J. Flynn, MD; Aurora, CO Jeffrey M. Frankel, MD; Seattle, WA William F. Gee, MD; Lexington, KY Jeffrey E. Kaufman, MD; Santa Ana, CA Mark N. Painter; Denver, CO Julie M. Riley, MD; Albuquerque, NM Jose A. Rodriquez Rivera, MD; Guadalajara, Mexico Robert S. Svatek, MD; San Antonio, TX

18 Thank You to Our 2014 Promotional Partners (as of 09/24/14) General Info

Platinum Exhibit Level AbbVie Genomic Health Medivation/Astellas Myriad Genetic Laboratories, Inc. PCEC

Gold Exhibit Level Astellas Pharma US, Inc. Auxilium Pharmaceuticals, Inc. Janssen Biotech, Inc.

Thank You to Our 2014 Contributors (as of 09/24/14)

Astellas Pharma US, Inc. Janssen Biotech, Inc. Medivation Pfizer, Inc.

19 Thank You to Our 2014 Exhibitors (as of 09/24/14) Exhibitors AbbVie Actavis Allergan, Inc. American Medical Systems, Inc. American Urological Association, Inc. Astellas Pharma US, Inc. Auxilium Pharmaceuticals, Inc. Bard Medical Division Bayer HealthCare BK Medical/Analogic Ultrasound Boston Scientific Corporation Bostwick Laboratories Cardinal Health Coloplast Group Cook Medical Dendreon Corporation Dornier MedTech EDAP Technomed, Inc. Endo Pharmaceuticals Epoch Men’s Health Ferring Pharmaceuticals Genomic Health HealthTronics, Inc. Hitachi Aloka Medical Hospital Corporation of America Janssen Biotech, Inc. KARL STORZ Lilly Lisa Laser USA Medispec, Ltd. Medivation/Astellas Mimic Technologies, Inc. Mission Pharmacal Company Myriad Genetic Laboratories, Inc. NeoTract, Inc. Olympus PCEC Pfizer, Inc. Prometheus Laboratories Inc. Richard Wolf Medical Instruments, Corp. TOLMAR Pharmaceuticals University Compounding Pharmacy Uroplasty USmd, Inc. Vision Sciences, Inc. Wedgewood Pharmacy 20 General Meeting Information General

Registration/Information Desk Hours Info Location: Rancho Mirage Foyer Wednesday, October 8, 2014 6:30 a.m. – 5:10 p.m.

Thursday, October 9, 2014 6:30 a.m. – 5:00 p.m. Friday, October 10, 2014 7:00 a.m. – 5:00 p.m. Saturday, October 11, 2014 7:00 a.m. – 12:15 p.m.

Exhibit Hall Hours Location: Celebrity DE Wednesday, October 8, 2014 6:00 p.m. – 8:00 p.m. (Welcome Reception) Thursday, October 9, 2014 7:30 a.m. – 4:00 p.m. Friday, October 10, 2014 7:30 a.m. – 11:00 a.m.

Spouse/Guest Hospitality Suite Hours Location: Suite 517 Wednesday, October 8, 2014 7:30 a.m. – 10:30 a.m. Thursday, October 9, 2014 7:30 a.m. – 10:30 a.m. Friday, October 10, 2014 7:30 a.m. – 10:30 a.m. Saturday, October 11, 2014 7:30 a.m. – 10:30 a.m.

Speaker Ready Room Hours Location: Rancho Mirage Foyer Wednesday, October 8, 2014 6:30 a.m. – 5:10 p.m. Thursday, October 9, 2014 6:30 a.m. – 5:00 p.m. Friday, October 10, 2014 7:00 a.m. – 5:00 p.m. Saturday, October 11, 2014 7:00 a.m. – 11:45 a.m.

Scientific Sessions Scientific sessions will be held in the Oasis Ballroom unless otherwise noted. Sessions will begin on Wednesday, October 8, 2014, at 7:30 a.m. Be sure to check the full scientific program for more information.

Annual Business Meeting The annual business meeting will be held Saturday, October 11, 2014, from 11:45 a.m. – 12:15 p.m. in the Oasis Ballroom.

Board of Directors Meetings The Board of Directors, committee chairs and past presidents will meet Tuesday, October 7, 2014, from 2:00 p.m. – 6:00 p.m., in Celebrity B/C. In addition, the Board of Directors will have a meeting Saturday, October 11, 2014, from 7:00 a.m. – 8:00 a.m., in Ambassador I.

21 Committee Meetings

The Health Policy Council will be meeting on Thursday, October 9, 2014, from 7:00 a.m. – 8:00 a.m. in the Mission Hills Boardroom.

The Nominating Committee will be meeting on Thursday, October 9, 2014, from 12:00 p.m. – 1:00 p.m. in the Polo Room.

The Finance Committee will be meeting on Friday, October 10, 2014, from 7:00 a.m. – 8:00 a.m. in Celebrity BC.

SMU Breakfast The SMU Breakfast will be held on Thursday, October 9, 2014, from 7:00 a.m. – 8:00 a.m. in the Rancho Mirage.

Past Presidents’ Luncheon The Past Presidents’ Luncheon will be held on Thursday, October 9, 2014, from 12:00 p.m. – 1:00 p.m. in Ambassador I.

SCS Urology Department Chair, Residency Program Director, and Academic Faculty Meeting “Milestones, the Clinical Competency Committee and Residency Program Organization – Sharing Best Practices” The SCS Urology Department Chair, Residency Program Director, and Academic Faculty Meeting will be held on Saturday, October 11, 2014, from 12:15 p.m. – 1:15 p.m. in the Oasis Ballroom.

Registration Fee Includes: • Scientific Sessions • Poster Sessions • Entrance to Technical Exhibits • Refreshment Breaks • One Ticket to Welcome Reception • One Ticket to Theme Night: South Central Section State Fair • One Ticket to Annual Reception and Banquet • Program Materials

Spouse/Guest Registration Fee Includes: • Hospitality Suite • Scientific Sessions* • Poster Sessions* • Entrance to Technical Exhibits • One Ticket to Welcome Reception • One Ticket to Theme Night: South Central Section State Fair • One Ticket to Annual Reception and Banquet

*If your Spouse/Guest would like to receive CME credit for attending the meeting, you must register that person separately at the appropriate category.

22 Please Note

Badges are required for admission to the meeting area. Tickets are required for General entry to all social functions. Info

Tickets If you wish to purchase additional tickets for the evening functions, they will be available in the Registration/Information Desk for the following prices:

Welcome Reception $50 per adult $20 per child (ages 11 – 17) Complimentary (children 10 & under)

Theme Night – South Central Section State Fair $150 per person

Annual Reception & Banquet $185 per person

23 Industry Sponsored Events

WEDNESDAY, OCTOBER 8, 2014

10:45 a.m. – 11:45 a.m. Industry Sponsored Lunch Location: Rancho Mirage Room “Prolaris: A Novel Genomic Test For Prostate Cancer”

John W. Davis, MD, FACS Associate Professor, Urology Director, Urosurgical Prostate Program University of Texas M.D. Anderson Cancer Houston, TX

THURSDAY, OCTOBER 9, 2014

12:00 p.m. – 1:00 p.m. Industry Sponsored Lunch Location: Celebrity BC “The Impact of Genomic Assays on Prostate Cancer Management”

Steven Canfield University of Texas M.D. Anderson Cancer Houston, TX

12:00 p.m. – 1:00 p.m. Industry Sponsored Lunch Location: Rancho Mirage Room “XTANDI (enzalutamide) capsules: An Option for Continuing the Care of Patients with mCRPC in the Urology Practice”

Larry Karsh, MD, FACS The Urology Center of Colorado Denver, CO

24 FRIDAY, OCTOBER 10, 2014 General

6:45 a.m. – 7:45 a.m. Industry Sponsored Breakfast Info Location: Rancho Mirage Room “Biomarkers in Prostate Cancer: Integration & Utility”

E. David Crawford, MD Professor of Urology/Surgery/Radiation Oncology University of Colorado, Denver Aurora, Colorado

11:45 a.m. – 1:00 p.m. Industry Sponsored Lunch Location: Rancho Mirage Room “Promoting Wellness in 2014: How to Save Time Reviewing What Works and What is Worthless”

Mark Moyad, MD, MPH Jenkins/Pokempner Director of Complementary and Alternative Medicine Department of Urology, University of Michigan Ann Arbor, Michigan

11:45 a.m. – 1:00 p.m. Industry Sponsored Lunch Location: Celebrity BC “ZYTIGA (): Clinical Decision- Making in Treating Patients With mCRPC Who Have Progressed on ADT”

Jonathan Henderson, M.D. Urologist Regional Urology, LLC Shreveport, LA

25 Evening Functions One ticket to each evening function is included in your registration fee. Fees for additional tickets are stated below.

Welcome Reception Date: Wednesday, October 8, 2014 Time: 6:00 p.m. – 8:00 p.m. Location: Exhibit Hall Attire: Business Casual Cost: One ticket included in registration fee; additional tickets are $50 for adults and $20 for children (11 – 17, under 10 complimentary). Description: The SCSAUA welcomes attendees to the 93rd Annual Meeting. Members can visit with exhibitors and connect with fellow members. Come enjoy delicious drinks and hors d’oeuvres in our Exhibit Hall.

Theme Night: South Central Section State Fair Date: Thursday, October 9, 2014 Time: 6:30 p.m. – 10:30 p.m. Location: Pete Dye Driving Range Attire: Casual Cost: One ticket included in registration fee; additional tickets are $150. Description: Bring the family for the First Annual SCSAUA State Fair! Midway games, music and food with surprises around every corner! Theme night will take you back to feeling like a kid again!

Annual Reception and Banquet Date: Saturday, October 11, 2014 Time: 6:30 p.m. – 7:30 p.m. Reception 7:30 p.m. – 12:00 a.m. Dinner and Entertainment Location: Ambassador Ballroom Attire: California Cocktail Casual Cost: One ticket included in registration fee; additional tickets are $185 each. Description: The Annual Reception and Banquet is the perfect way to end the 93rd Annual Meeting. You can enjoy a relaxing evening at The Westin Mission Hills Resort & Spa with dining and entertainment as you reflect on this year’s meeting. Tables are assigned during the meeting, so be sure to sign up with your friends/colleagues on the boards posted by the SCS registration desk.

26 Optional Activities Times & Activities subject to change General Info Celebrity House Drive and City Orientation Tour Date: Wednesday, October 8, 2014

Time: 1:00 p.m. – 3:30 p.m. Location: Meet in The Westin Mission Hills Resort & Spa lobby by 12:15 p.m. Price: $40.00 per person Includes: Transportation, tour and exploration time in Palm Springs Description: Take a star-studded tour and see where some of Hollywood’s most famous residents like Frank Sinatra, Elvis and Liberace lived. Learn insightful stories about the history of the Coachella Valley and its Native American heritage as you drive through and acquaint yourself with this amazing area.

Palm Springs Aerial Tramway Tour Date: Thursday, October 9, 2014 Time: 10:00 a.m. – 2:00 p.m. Location: Meet in The Westin Mission Hills Resort & Spa lobby by 9:15 a.m. Cost: $85.00 per person Includes: Transportation and admission ticket to guided tram tour Description: Experience a breathtaking journey aboard the World’s Largest Rotating Tram and travel up the sheer cliffs of Chino Canyon. Begin your 10-minute ride at the Valley Station and ride two miles up to the Mountain Station. Lunch is available on your own in Peaks Restaurant and Pines Cafe, a casual restaurant. Enjoy spectacular views, gift shops, a natural history museum and a movie about how the Tramway was built. Please note the Tram Tour reaches an elevation of 8,516 ft; sensitivity to altitude will be experienced. The Tram ride does sway with the wind and at the tower sites along the route, riders should be aware if they have a history of vertigo or fear of heights. Wear comfortable walking shoes and dress in layers as the temperature can differ up to 30°F from the valley to the summit.

El Paseo Shopping and Museums Date: Friday, October 10, 2014 Time: 11:00 a.m. – 2:30 p.m. Location: Meet in the Westin Mission Hills Resort & Spa lobby at 10:15 a.m. Cost: $40.00 per person Includes: Transportation and guided tour Description: Located in Palm Desert, the world famous El Paseo Shopping District features over 300 world-class shops, clothing boutiques, art galleries, jewelers, restaurants and much more. This one-of-a-kind mile is lined with beautifully maintained picture-postcard floral decorations and statues! Known as the Rodeo Drive of the Desert, El Paseo boasts a wide spectrum of stores from Sak’s Fifth Avenue to individually owned boutiques. From classic bronze sculpture to cutting-edge contemporary works, Palm Desert is home to an amazing variety of art – and you can find it all in the city’s myriad of art galleries. Participants should expect a moderate amount of walking on this tour, so please wear comfortable shoes.

27 Jeep Tour Date: Saturday, October 11, 2014 Time: 1:30 p.m. – 4:30 p.m. Location: Meet in the Westin Mission Hills Resort & Spa Lobby at 12:30 p.m. Price: $85.00 per person Includes: Transportation and guided tour Description: This awe-inspiring journey in our classic Big Red Jeep Scramblers (CJ-8’s) takes you deep into the heart of the San Andreas Fault. Learn about geology and earthquakes as you travel into the center of the San Andreas Fault system where you will see the twisted and tormented landscape created by the collision of the Pacific and North American tectonic plates. Explore a pristine natural palm oasis with crystal clear water seeping up from the underground aquifer. Learn how this water makes our desert unique as you enjoy a naturalist-guided nature walk through the oasis. Discover how the Cahuilla Indians used the desert’s plants and other materials for survival as you tour our Cahuilla Indian Village exhibit where artifacts, tools, weapons and interpretive displays showcase the culture and lifestyle of the Cahuilla People. Spectacular scenery, stunning landscapes and great photo opportunities abound on this exciting 4x4 adventure!

Golf Date: Saturday, October 11, 2014 Time: 1:30 p.m. – 5:30 p.m. (Shotgun start) Location: Palm Springs Golf Resort Price: $195.00 per person Includes: Green and tournament fees Description: Golf Digest recently named The Westin Mission Hills Golf Resort & Spa as one of the top 75 resorts in North America. Two championship courses are available to guests, the Pete Dye Course adjacent to the resort and the Gary Player Signature Course. Each course offers a completely different type of experience to challenge even the most extreme golf enthusiast and features stunning desert-scape and mountain skyline views. Our Palm Springs golf resort is located at the corner of Bob Hope and Dinah Shore drives, named for two celebrities intimately associated with the game of golf.

Tennis Date: Saturday, October 11, 2014 Time: 12:30 p.m. – 3:00 p.m. Location: Palm Springs Tennis Courts Price: $20.00 per person Includes: Court fees and water Description: Treat yourself to the finest Palm Springs tennis experience at The Westin Mission Hills Golf Resort & Spa. We are very excited to retain the services of the internationally recognized management company Peter Burwash International (PBI) to direct our Palm Springs tennis program. Our PBI Director of Tennis, Pat Dennehy, with over 25 years of coaching experience offers an exciting and fun-filled menu of activities on our beautifully landscaped seven- court complex, complete with a full-service tennis pro shop.

28 Family Fun

The Westin Mission Hills Golf Resort & Spa offers an array of great activities, designed General to keep the whole family entertained. We have a dedicated Director of Fun who works Info to ensure your time with us is enjoyable, exciting and FUN for everyone. The Westin Kids Club Discovery Room is a chance for children to play and learn, while parents explore the resort.

Kids Night Out (Friday & Saturday evenings only): While Mom and Dad head out for the night, kids ages 4-12 are invited. Join the FUN team from 5:00 p.m. – 9:00 p.m. for arts, dinner, movies and more! Cost: $60 per child, including dinner. Advanced reservations and confirmations from Kids Club attendant is required; please call The Westin Kids Club Discovery Room at (760) 770-2181.

Kids & Junior Tennis: Through interactive lessons and clinics, kids ages 6-10, and juniors player ages 11-18, can learn or experience their game with Pat Dennehy, Director of Tennis. For more information, or to make a reservation, please contact Pat directly at (760) 202-2021.

Twilight Golf Experience: Golf as a family and introduce your children to the world’s greatest game. Junior plays golf for free after 3:00 p.m. when playing with a paying adult, and enjoy a complimentary Callaway club rental. For more information, please contact the Golf Pro Shop at (760) 770-6790.

Pool Games at Las Brisas: Our family friendly resort is also home to our Las Brisas 60-foot water slide available to guests. The waterslide pool depth is 3½ feet so guests must be at least 42” to ride the slide. Children between 42” and 48” are required to wear a life vest. All guests must ride individually. Join us for complimentary children’s activities held daily at our Las Brisas Pool to include activities such as: Treasure Dives, Hula Hoop Contests, etc.

Bicycle Rentals: Cruise The Westin Mission Hills Golf Resort & Spa with our exclusive Nirve Beach Cruisers. Ride throughout the resort or take your bike for a spin throughout Rancho Mirage. Bicycle rentals are available on an hourly, daily or weekly basis by dialing ext. 2297 or stop by Las Brisas Pool.

The Hideaway: Step away from the sun and tuck yourself in the Hideaway. Full of your favorite arcade games, Jukebox, PlayStation, Kinect stations and more. The Hideaway is the perfect spot to stay cool and energized! Located just adjacent to the Oasis Den.

The Children’s Discovery Museum of the Desert: It inspires and promotes intellectual curiosity and self-expression through inventive and interactive exhibits and programs. It encourages children to learn about themselves and the world around them by exploring the natural environment and the community. The Museum serves children of all ages with particular emphasis on primary school age children of the Coachella Valley. The Museum also serves as a resource to its community through the development of special programs and collaborations with other organizations. Located close to The Westin Mission Hills Resort & Spa, The Children’s Discovery Museum of the Desert is open Tuesday – Saturday from 10:00 a.m. – 5:00 p.m. Admission is $8.00 per person aged 2 and up. Find out more at www.cdmod.org.

29 Additional Events (On Your Own)

About Rancho Mirage, CA Rancho Mirage is located in the Greater Palm Springs Area. You’ll find everything you need to create an unforgettable vacation in Palm Springs, from places to take your breath away to people who go out of their way to make you feel welcome and well-taken care of. Greater Palm Springs has it all — amazing restaurants, vibrant nightclubs, amenity-filled resorts, rich history, culture, beautiful desert terrain, outdoor adventure, shopping, family fun and so much more.

Restaurants Put the ‘epic’ in epicurean during your visit to Greater Palm Springs. Whether you’re in the mood for a great burger and fries, incredible California cuisine or something more exotic, you’ll find amazing food and unforgettable dining experiences throughout Palm Springs and the Coachella Valley. From the chic cuisine options of downtown Palm Springs to the family-owned local favorites in the surrounding cities and the world-class kitchens located in the area’s destination resorts and luxury hotels, there are so many distinctive dining experiences to be had you might want to extend your trip to taste them all. Just because you’re in the desert doesn’t mean there’s nothing to eat or drink. You’ll find fresh seafood, mouth-watering steaks, spicy Asian fusion, traditional tacos and much more. If you’re celebrating a special occasion, there are some amazing restaurants with memorable menus and impeccable service. Whatever your taste buds desire, you’ll find it here.

Attractions and Activities Greater Palm Springs activities and attractions offer a wealth of things to do during your vacation, including museums, casinos, tours, family fun, outdoor recreation and much more. Once you’ve had your fill of relaxing by the pool, discover all the fun and excitement offered around the area. Enjoy the beautiful desert landscape from the heights of the aerial tram as you ride up Mount San Jacinto. Soak up culture with a tour of midcentury modern homes. Have a desert adventure in the iconic Joshua Tree National Park or explore the area’s amazing natural beauty on a hike or tour of sites like Indian Canyons, Tahquitz Canyon and the Coachella Valley Preserve. No matter what your interests, from Native American history to modern art, you’ll find plenty to love during your trip to Greater Palm Springs.

Arts and Culture The Coachella Valley is home to a diverse array of engaging artistic and cultural assets. Spend a day exploring the halls and galleries of the Palm Springs Art Museum, take flight into history at the Palm Springs Air Museum of Flying, learn about the desert’s flora and fauna at the Living Desert Zoo and Botanical Garden, take a tour of fabulous midcentury modern homes, experience the cultural heritage and traditions of the local Cahuilla Indian tribe, catch a show at a local casino, enjoy a local theater production or plan a trip during one of the area’s film or art festivals. You’ll find plenty of opportunities to soak up some culture during your stay.

30 Shopping

Shopping in Greater Palm Springs offers a variety of options. From street fairs to General chic boutiques and outlet malls to specialty stores, there’s something for every Info taste and want. You can spend a day exploring the best of Palm Springs’ shopping scene with visits to retro-fabulous vintage stores and interesting eateries along Palm Canyon Drive in downtown Palm Springs. There are also nationally known brands and fun local shops at Palm Desert’s El Paseo District. Or you could enjoy some retail therapy, entertainment and dining at The River in Rancho Mirage. If you enjoy big savings and special deals, check out the Desert Hills Premium Outlets in Cabazon. While in town, don’t forget to stop at Shield’s Date Garden where you can stock up on some sweet, locally grown treats. Rancho Mirage has a newer addition, The River, which is a water-featured entertainment complex with boutiques, spas, a winery and an outdoor amphitheater with seasonal entertainment along the river walk. The list of trendy boutiques include: Diane’s Beachwear, LIK Gallery, Hats Unlimited and Tulip Hill Winery. Aside from The River, there are many other shopping locations, including two different shopping centers on Bob Hope Drive.

Weather The average annual temperature in Greater Palm Springs is 88°F in the daytime and a refreshing 55°F at night. In October, the average high is 91°F during the day and a comfortable 65°F at night.

31 93rd Annual SCS Meeting October 8 – 11, 2014 Full Scientific Program Schedule The abstract number appears next to the presenter’s time. See the abstract section in this program book for complete text. Abstracts appear in presentation order. You may also reference the Alphabetical Index of Presenters in this program book for the date, time, and placement of presentations.

All sessions located in Oasis Ballroom unless otherwise noted.

WEDNESDAY, OCTOBER 8, 2014

OVERVIEW 6:30 a.m. – 5:10 p.m. registration/Information Desk Hours Location: Rancho Mirage Foyer

6:30 a.m. – 5:10 p.m. Speaker Ready Room Hours Location: Rancho Mirage Foyer

7:00 a.m. – 8:00 a.m. Continental Breakfast Location: Oasis

7:30 a.m. – 10:30 a.m. Spouse/Guest Hospitality Suite Hours Location: Suite 517

1:00 p.m. - 3:30 p.m. Celebrity House Drive and City Orientation Tour

6:00 p.m. – 8:00 p.m. Welcome Reception in Exhibit Hall Location: Celebrity DE

SCIENTIFIC/GENERAL SESSION 7:30 a.m. – 10:45 a.m. Health Policy Forum

7:30 a.m. – 8:30 a.m. Coding and Billing Update Speaker: Mark N. Painter Denver, CO

8:30 a.m. – 9:15 a.m. Health Policy: Where Are We and How Do We Get There? Speaker: William F. Gee, MD Lexington, KY

9:15 a.m. – 10:00 a.m. Panel Discussion: Physician Survival: Private Practice, Academic Medicine and the Employed Physician Panelists: Jeffrey M. Frankel, MD Seattle, WA Ian M. Thompson, III, MD San Antonio, TX Michael Case Austin, TX 32 10:00 a.m. – 10:45 a.m. evolving Health Care Delivery in 2014 Speaker: Jeffrey E. Kaufman, MD Santa Ana, CA

10:45 a.m. – 11:45 a.m. Industry Sponsored Lunch Symposium Location: Rancho Mirage Room (See page 24 for more details.) W E D NE SD A 12:00 p.m. – 12:05 p.m. Presidential Welcome SCS President: Charles A. McWilliams, MD Oklahoma City, OK Y 12:05 p.m. – 12:10 p.m. Program Chair Welcome Program Chair: Damara Kaplan, PhD, MD Albuquerque, NM

12:10 p.m. – 12:20 p.m. aUA Presidential Address AUA President: William F. Gee, MD Lexington, KY

12:20 p.m. – 1:05 p.m. resident Essay Finalist Podium Moderators: Charles A. McWilliams, MD Oklahoma City, OK Damara Kaplan, PhD, MD Albuquerque, NM

12:20 p.m. #1 CLEAN-INTERMITTENT CATHETERIZATION AS AN INITIAL MANAGEMENT STRATEGY PROVIDES FOR ADEQUATE PRESERVATION OF RENAL FUNCTION IN PATIENTS WITH PERSISTENT CLOACA David J. Chalmers, MD1, Kyle O. Rove, MD2, Cole A. Weidel, MD2, Suhong Tong, MS3, Georgette L. Siparsky, PhD4 and Duncan T. Wilcox, MD1 Division of Pediatric Urology, Children’s Hospital Colorado; 2Department of Surgery, Division of 1Urology, University of Colorado; 3Department of Biostatistics and Information, University of Colorado; 4Children’s Hospital Colorado (Presented by: Kyle O. Rove)

12:27 p.m. #2 PREVALENCE OF PENILE CANCER IN THE STATE OF ARKANSAS Mark Jackson, MD1, Jody Purifoy, APN1, Horace Spencer, MS1, Mohammad Azam, BS1, Susan Thapa, BS1, Abby Holt, BS2 and Matthew Katz, MD1 1UAMS; 2AR Cancer Registry (Presented by: Mark Jackson) 33 12:34 p.m. #3 SURVIVAL OUTCOME IN MEN RECEIVING RADICAL AFTER RADIATION FOR ADENOCARCINOMA OF THE PROSTATE Danny Huynh, MD, Alex Henderson, BS, Naveen Pokala, MD University of Missouri – Columbia (Presented by: Danny Huynh)

12:41 p.m. #4 FOLLOW-UP SURGICAL INTERVENTIONS IN PATIENTS WITH : A COMPARISON BETWEEN ORTHOTOPIC NEOBLADDERS AND ILEAL CONDUITS David Flores, MD, Katie Murray, DO, Daniel Zainfeld, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas (Presented by: David Flores)

12:48 p.m. #5 INCREASING FRAILTY AS MEASURED BY RISK ANALYSIS INDEX PREDICTS POSTOPERATIVE COMPLICATIONS AND MORTALITY IN UROLOGY PATIENTS Sudhir Isharwal, MBBS, Jason Johanning, MD, Kendra Schmid, MD, Roy Williams, MD, Chad Lagrange, MD UNMC (Presented by: Sudhir Isharwal)

12:55 p.m. #6 “DOES INSTRUCTION MODIFIED TO VARK® QUESTIONNAIRE LEARNING STYLE AFFECT PSYCHOMOTOR TRAINING IN DA VINCI SI® ROBOTIC TRAINEES?” Susan Tarry, MD, Daniel Ballow, MD, William Tarry, MD, Justin Fang, MD UTMB (Presented by: Daniel Ballow)

1:05 p.m. – 2:15 p.m. reconstruction/Male Incontinence Podium Session Moderators: Steven J. Hudak, MD San Antonio, TX Ty T. Higuchi, MD, PhD Aurora, CO

1:05 p.m. #7 THE “TRAVELING PUMP”: A NOVEL APPROACH TO PREVENT PUMP MIGRATION IN PATIENTS UNDERGOING TWO INCISION ARTIFICIAL URINARY SPHINCTER PLACEMENT Brian Christine Urology Centers of Alabama (Presented by: Brian Christine) 34 1:12 p.m. #8 3.5 CM AUS CUFF EROSION OCCURS PREDOMINANTLY IN RADIATED PATIENTS: ANALYSIS OF THE FIRST 100 CASES Jay Simhan, MD, Nirmish Singla, MD, Timothy J. Tausch, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Nirmish Singla) We d ne sd a 1:19 p.m. #9 HIGH SUBMUSCULAR VERSUS SPACE OF RETZIUS PLACEMENT OF AUS PRESSURE REGULATING BALLOONS Nirmish Singla, MD, Jay Simhan, MD, Gregory R. Thoreson, MD, Timothy J. Tausch, MD, J. Francis y Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Nirmish Singla)

1:26 p.m. #10 ARTIFICIAL URINARY SPHINCTER REPLACEMENT LEADS TO HIGHER RATES OF MECHANICAL FAILURE AND URETHRAL EROSION Jairam Eswara, MD, Valary Raup, MD, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

1:33 p.m. #11 OUTCOMES OF INTRA-URETHRAL TRIAMCINOLONE INJECTIONS IN THE TREATMENT OF POST- RECURRENT STRICTURE DISEASE Jennifer Robles, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University of Saint Louis School of Medicine − Division of Urology (Presented by: Jennifer Robles)

1:40 p.m. #12 “7-FLAP” PERINEAL URETHROSTOMY: AN EFFECTIVE OPTION FOR OBESE MEN WITH DEVASTATED Nathan R. Starke, MD, Jay Simhan, MD, Timothy N. Clinton, BA, Timothy J. Tausch, MD, Jordan A. Siegel, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Jordan A. Siegel)

1:47 p.m. #13 ANASTOMOTIC REOPERATIVE URETHROPLASTY Jordan A. Siegel, MD, Timothy J. Tausch, MD, Lee C. Zhao, MD, MS, Jay Simhan, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Jordan A. Siegel) 35 1:54 p.m. #14 MINIMALLY INVASIVE VENTRAL SLIT/ SCROTAL FLAP TECHNIQUE FOR RECONSTRUCTION OF ADULT BURIED Mary E. Westerman, BA, Timothy J. Tausch, MD, Lee C. Zhao, MD, MS, Jay Simhan, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Timothy J. Tausch)

2:01 p.m. #15 IMPACT OF PELVIC RADIATION ON GRACILIS FLAP RECTOURINARY FISTULA REPAIR Valary Raup, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

2:08 p.m. #16 RADIOGRAPHIC PARAMETERS TO DISTINGUISH BENIGN PROSTATIC OBSTRUCTION FROM CONCOMITANT Jairam Eswara, MD, Jennifer Robles, MD, Kerry Madison, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

2:15 p.m. – 2:30 p.m. Break

2:30 p.m. – 3:05 p.m. State-of-the-Art Lecture: Management of Non- Muscle Invasive Bladder Cancer Guest Speaker: Robert S. Svatek, MD San Antonio, TX

3:05 p.m. – 3:15 p.m. Q&A

3:15 p.m. – 3:35 p.m. SMU Lecture: Focal Therapy for Prostate Cancer, Mexico Experience Guest Speaker: Jose A. Rodriguez-Rivera, MD Guadalajara, Mexico

3:35 p.m. – 5:00 p.m. Bladder Cancer/Testis Podium Session Moderators: Ashish M. Kamat, MD Houston, TX Matthew D. Katz, MD Little Rock, AR

36 3:35 p.m. #17 POST-OPERATIVE WOUND AND STEROID USE ARE INDEPENDENT RISK FACTORS FOR MIDLINE FASCIAL DEFECTS IN PATIENTS AFTER RADICAL WITH ILEAL CONDUIT Hajar Ayoub, MD, Andrew Pisters, Wei Wei, Colin Dinney, MD, H. Barton Grossman, MD, Ashish Kamat,

MD, Jay Shah, MD, O. Lenaine Westney, MD W Ed ne sd a MD Anderson Cancer Center (Presented by: Hajar Ayoub)

3:42 p.m. #18 STANDARDIZING CARE AFTER RADICAL CYSTECTOMY: A MEANS TO IMPROVE QUALITY y AND OUTCOMES William Parker, MD, Zachary Hamilton, MD, Samuel Hund, Moben Mirza, MD, Eugene Lee, MD, Jeffrey Holzbeierlein, MD University of Kansas Medical Center (Presented by: William Parker)

3:49 p.m. #19 OUTCOMES OF IMPAIRED PERIOPERATIVE GLUCOSE REGULATION IN A RADICAL CYSTECTOMY POPULATION Hadley Wyre, MD, Griffin Josh, MD, Moben Mirza, MD, J. Brantley Thrasher, MD, Jeffrey Holzbeierlein, MD, Eugene Lee, MD University of Kansas (Presented by: Hadley Wyre)

3:56 p.m. #20 PT0N0 AFTER RADICAL CYSTECTOMY WITHOUT NEOADJUVANT CHEMOTHERAPY: PATIENT CHARACTERISTICS Zach Hamilton, MD, William Parker, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

4:03 p.m. #21 INTRAVESICAL CHITOSAN/IL−12 IMMUNOTHERAPY INDUCES TUMOR-SPECIFIC SYSTEMIC IMMUNITY AGAINST BLADDER CANCER Sean Smith1, Bhanu Koppolu, PhD1, Sruthi Ravindranathan, PhD Candidate1, Samantha Kurtz, MS Student1, Lirong Yang, PhD1, Matthew Katz, MD2 and David Zaharoff, PhD1 1University of Arkansas; 2University of Arkansas for Medical Sciences (Presented by: Sean Smith)

37 4:10 p.m. #22 RADICAL CYSTECTOMY AFTER PRIMARY TREATMENT OF PROSTATE CANCER: IS ROBOTIC SURGERY A VIABLE OPTION? William Parker, MD, Zachary Hamilton, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas Medical Center (Presented by: William Parker)

4:17 p.m. #23 DOES THE PRESENCE OF VARIANT HISTOLOGY EFFECT PATHOLOGIC OUTCOMES FOLLOWING NEOADJUVANT CHEMOTHERAPY William Parker, MD, Moben Mirza, MD, Maura O’Neil, MD, Jeffrey Holzbeierlein, MD University of Kansas Medical Center (Presented by: William Parker)

4:24 p.m. #24 PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER ARE AT HIGHER LONG- TERM RISK OF DYING FROM A SECOND METACHRONOUS PRIMARY NEOPLASM THAN FROM THEIR INITIAL BLADDER CANCER Laura Martinez, Ji Li, PhD, Hanh Dung Dao, PhD, Kai Ding, PhD, Joel Slaton, PhD University of Oklahoma (Presented by: Laura Martinez)

4:31 p.m. #25 PERIOPERATIVE OUTCOMES OF ROBOTIC SALVAGE CYSTECTOMY AND INTRACORPOREAL URINARY DIVERSION Alvin Goh, MD1, Monty Aghazadeh, MD2, Brian Miles, MD1, Monish Aron, MD3, Mihir Desai, MD3 and Inderbir Gill, MD3 1Houston Methodist Hospital; 2Baylor College of Medicine; 3University of Southern California (Presented by: Monty Aghazadeh)

4:38 p.m. #26 URETEROINTESTINAL STRICTURE RATE IS NOT AFFECTED BY ROBOTIC TECHNIQUE FOR RADICAL CYSTECTOMY Zach Hamilton, MD, William Parker, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

38 4:45 p.m. #27 PATHOLOGIC RISK FACTORS FOR OCCULT METASTATIC DISEASE IN POST-PUBERTAL PATIENTS WITH STAGE I TESTICULAR STROMAL TUMORS Kyle O. Rove, MD1, Paul D. Maroni, MD1, Carrye R. Cost, MD2, Diane L. Fairclough DrPH, MSPH3, Gianluca Giannarini, MD4, Kris Ann Schultz, MD5 and 1

Nicholas G. Cost, MD W Ed ne sd a 1Department of Surgery, Division of Urology, University of Colorado; 2Department of Pediatrics, Division of Pediatric Oncology, University of Colorado; 3Department of Biostatistics and Informatics, University of Colorado; 4Department of Urology, y University of Bern; 5Department of Pediatrics, Division of Pediatric Oncology, Children’s Hospitals and Clinics of Minnesota (Presented by: Kyle O. Rove)

4:52 p.m. #28 PATHOLOGIC RISK FACTORS IN PRE-PUBERTAL PATIENTS WITH STAGE I TESTICULAR STROMAL TUMORS Kyle O. Rove, MD1, Paul D. Maroni, MD1, Carrye R. Cost, MD2, Diane L. Fairclough, DrPH, MSPH3, Gianluca Giannarini, MD4, Kris Ann Schultz, MD5 and Nicholas G. Cost, MD1 1Department of Surgery, Division of Urology, University of Colorado; 2Department of Pediatrics, Division of Pediatric Oncology, University of Colorado; 3Department of Biostatistics and Informatics, University of Colorado; 4Department of Urology, University of Bern; 5Department of Pediatrics, Division of Pediatric Oncology, Children’s Hospitals and Clinics of Minnesota (Presented by: Kyle O. Rove)

5:00 p.m. – 5:10 p.m. aUA Guidelines on Castration Resistant Prostate Cancer: 2014 Update Speaker: Michael S. Cookson, MD Oklahoma City, OK

6:00 p.m. – 8:00 p.m. Welcome Reception Location: Celebrity DE

39 THURSDAY, OCTOBER 9, 2014

OVERVIEW 6:30 a.m. – 5:00 p.m. registration/Information Desk Hours Location: Rancho Mirage Foyer

6:30 a.m. – 5:00 p.m. Speaker Ready Room Hours Location: Rancho Mirage Foyer

7:00 a.m. – 8:00 a.m. Continental Breakfast Location: Celebrity DE

7:00 a.m. – 8:00 a.m. SMU Breakfast Meeting Location: Rancho Mirage

7:30 a.m. – 10:30 a.m. Spouse/Guest Hospitality Suite Hours Location: Suite 517

7:30 a.m. – 4:00 p.m. exhibit Hours Location: Celebrity DE

10:00 a.m. – 2:00 p.m. Palm Springs Aerial Tramway Tour

12:00 p.m. – 1:00 p.m. nominating Committee Meeting Location: Polo Room

6:30 p.m. – 10:30 p.m. Theme Night Location: Pete Dye Driving Range

SCIENTIFIC/GENERAL SESSION 7:30 a.m. – 8:15 a.m. Video Session Moderator: David A. Duchene, MD Kansas City, KS

Video # 1 ROBOTIC-ASSISTED EPIGASTRIC ARTERY HARVEST: AN APPLICATION OF MINIMALLY INVASIVE TECHNOLOGY FOR SUCCESSFUL PENILE REVASCULARIZATION Michael Aberger, MD, Katie Murray, MD, Josh Broghammer, MD, David Duchene, MD University of Kansas (Presented by: Michael Aberger)

Video # 2 LAPAROSCOPIC ASSISTED Gwen Grimsby, MD1, Patricio Gargollo, MD2 and Micah Jacobs, MD, MPH3 1UTSW/CMC; 2Texas Children’s, Houston, TX; 3UT Southwestern Medical Center, Dallas, TX (Presented by: Gwen Grimsby) 40 Video # 3 ROBOTIC ASSISTED LAPAROSCOPIC TAKEDOWN OF SUTURES AND ANTEGRADE URETHROLYSIS WITH OMENTAL INTERPOSITION Robert Chan, MD1, Zach Jeng, BA2, Alvin Goh, MD1 and Rose Khavari, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

Video # 4 ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION Daniel Zainfeld, MD, Andrew Windsperger, MD, David Duchene, MD

University of Kansas T hu r sd a (Presented by: Daniel Zainfeld)

Video # 5 AN INNOVATIVE INSIDE-OUT APPROACH TO SUPRAPUBIC INSERTION IN y THE OBESE PATIENT WITH A NEUROGENIC BLADDER: THE TRANSURETHRAL SUPRAPUBIC ENDO-CYSTOSTOMY DEVICE Vassilis Siomos MD, Thomas Pshak MD, Robert Larke MD, Brian Flynn MD University of Colorado (Presented by: Vassilis Siomos)

Video # 6 CYSTOSCOPIC FINDINGS OF PLACENTA PERCRETA WITH BLADDER INVOLVEMENT Ahmed Alghrouz, Stephanie Tran, Satyan Shah, MD University of New Mexico School of Medicine (Presented by: Ahmed Alghrouz)

8:15 a.m. – 9:30 a.m. renal and Ureteral Disease Podium Session Moderator: Jeffrey M. Holzbeierlein, MD, FACS Kansas City, KS Rodney Davis, MD Little Rock, AR

41 8:15 a.m. #29 ONCOLOGIC OUTCOMES FOLLOWING SURGICAL RESECTION OF RENAL CELL CARCINOMA WITH IVC THROMBUS EXTENDING ABOVE THE HEPATIC VEINS: A CONTEMPORARY MULTI-CENTER COHORT Ahmed Haddad1, Christopher Wood2, E. Jason Abel3, Laura-Maria Krabbe1, Oussama Darwish1, R. Houston Thompson4, Jennifer Heckman3, Megan Merril2, Bishoy Gayed1, Arthur Sagalowsky1, Stephen Boorjian4, Vitaly Margulis1 and Bradley Leibovich4 1The University of Texas Southwestern Medical Center, Dallas, TX; 2The University of Texas, MD Anderson Cancer Center, Houston, Texas; 3University of Wisconsin School of Medicine and Public Health, Madison WI; 4Mayo Medical School and Mayo Clinic, Rochester, MN (Presented by: Ahmed Haddad)

8:22 a.m. #30 CYTOREDUCTIVE NEPHRECTOMY VERSUS TARGETED THERAPY ALONE FOR METASTATIC RENAL CELL CARCINOMA Brandon Manley, MD, Eric Kim, MD, Joel Vetter, Seth Strope, MD, MPH Washington University School of Medicine (Presented by: Eric Kim)

8:29 a.m. #31 RADICAL NEPHROURETERECTOMY FOR PATHOLOGIC T4 UPPER TRACT UROTHELIAL CANCER: CAN ONCOLOGIC OUTCOMES BE IMPROVED WITH MULTIMODALITY THERAPY? Ramy Youssef, MD1, Yair Lotan, MD2, Arthur Sagalowsky, MD2, Shahrokh Shariat, MD3, Christopher Wood, MD4, Jay Raman, MD5, Vitaly Margulis, MD2, Marco Roscigno, MD6, Francesco Montorsi, MD7, Christian Bolenz, MD8 and Wassim Kassouf, MD9 1Duke University; 2UT Southwestern, Dallas, TX; 3Medical University of Vienna, Vienna, Austria; 4MD Anderson, Houston, TX; 5Penn State Milton S. Hershey Medical Center, Hershey, PA; 6Ospedali Riuniti of Bergamo, Italy; 7Vita Salute University, Milan, Italy; 8Universitatsklinikum, Mannheim, Germany; 9McGill University, Montreal, Canada (Presented by: Ramy Youssef)

42 8:36 a.m. #32 TALL SCORE FOR PREDICTION OF ONCOLOGICAL OUTCOMES AFTER RADICAL NEPHROURETERECTOMY FOR HIGH GRADE UPPER TRACT UROTHELIAL CARCINOMA Ramy Youssef, MD1, Yair Lotan, MD2, Shahrokh Shariat, MD3, Arthur Sagalowsky, MD2, Christopher Wood, MD4, Alon Weizer, MD5, Jay Raman, MD6, Marco Roscigno, MD7, Francesco Montorsi, MD8, Christian Bolenz, MD9, Wassim Kassouf, MD10, Laura- Maria Krabbe, MD11 and Vitaly Margulis, MD2 1Duke University; 2UT Southwestern, Dallas, TX; 3Medical University of Vienna, Vienna, Austria; 4MD Anderson, Houston, TX; 5University of Michigan, Ann Arbor, MI; 6Penn State Hershey Medical 7 Center, Hershey, PA; Ospedali Riuniti of Bergamo, THU R SD A Bergamo, Italy; 85Vita-Salute University, Milan, Italy; 9Universitätsklinikum Mannheim, Mannheim, Germany; 10McGill University, Montreal, Quebec, Canada; 11University of Muenster Medical Center, Y Muenster, Germany (Presented by: Rammy Youssef)

8:43 a.m. #33 INITIAL CLINICAL EXPERIENCE WITH PERCUTANEOUS IRREVERSIBLE ELECTROPORATION OF KIDNEY TUMORS Monica Morgan, MD1, Jeffrey Gahan, MD1, Asim Ozayar, MD1, Clayton Trimmer, DO2 and Jeffrey Cadeddu, MD1 1Dept of Urology, University of Texas Southwestern; 2Dept of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (Presented by: Monica Morgan)

8:50 a.m. #34 OPEN SURGICAL MANAGEMENT OF RETROPERITONEAL FIBROSIS: A SINGLE INSTITUTION 11-YEAR EXPERIENCE Andrew Windsperger, MD, Robert Larke, MD, Ty Higuchi, MD, PhD, Paul Maroni, MD, Brian Flynn, MD University of Colorado (Presented by: Andrew Windsperger)

8:57 a.m. #35 ILEAL URETERAL REPLACEMENT FOR COMPLEX URETERAL STRICTURES: A SINGLE INSTITUTION 11 YEAR EXPERIENCE Andrew Windsperger, MD, Robert Larke, MD, Ty Higuchi, MD, PhD, Paul Maroni, MD, Brian Flynn, MD University of Colorado (Presented by: Andrew Windsperger)

43 9:04 a.m. #36 RISK STRATIFICATION OF PATIENTS UNDERGOING NEPHROURETERECTOMY FOR UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT Daisaku Hirano, MD1, Ryo Hasegawa, MD1, Yasuhiro Okada, MD2, Yataroh Yamanaka, MD3, Kenya Yamagichi, MD3, Nozomu Kawata, MD3 and Satoru Takahashi, MD3 1Higashi-matsuyama Municipal Hospital; 2Kobari Hospital; 3Nihon University School of Medicine (Presented by: Daisaku Hirano)

9:11 a.m. #37 VALIDATION OF MAMMALIAN TARGET OF RAPAMYCIN BIOMARKER PANEL IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA Ahmed Haddad1, Nirmish Singla1, Payal Kapur1, Jay Raman2, Matthew Then2, Phillip Nuhn3, Alexander Buchner3, Patrick Bastian4, Christian Seitz5, Sharokh Shariat5, Karim Bensalah6, Nathalie Rioux-Leclercg6, Yair Lotan1 and Vitaly Margulis1 1The University of Texas Southwestern Medical Center, Dallas, TX; 2Penn State Milton S. Hershey Medical Center, Pittsburgh, Pennsylvania; 3University of Munich, Munich, Germany; 4Paracelsus-Klinik Golzheim, Dusseldorf, Germany; 5Medical University of Vienna, Vienna General Hospital, Vienna, Austria; 6University of Rennes, Rennes, France (Presented by: Ahmed Haddad)

9:18 a.m. #38 T1A AND T1B RENAL MASSES TREATED WITH LAPAROSCOPIC : SHORT- TERM ONCOLOGICAL OUTCOMES AND PER- OPERATIVES RESULTS Rodrigo Donalisio da Silva, MD1, Thomas Pshak, MD1, Diedra Gustafson, MD2, Nicholas Westfall, MD1, Leticia Nogueira, MD1, Wilson Molina, MD1 and Fernando Kim, MD1 1Denver Health Medical Center; 2Denver Health Medical Center (Presented by: Rodrigo Donalisio da Silva)

9:25 a.m. #39 RENAL CELL CARCINOMA METASTASES; TYPE, GRADE, STAGE AND SITES OF METASTASES Robert Donohue, MD University of Colorado (Presented by: Robert Donohue)

44 9:30 a.m. – 10:05 a.m. State-of-the-Art Lecture: Cytoreductive Nephrectomy in the Era of Tyrosine Kinase Inhibitors Invited Speaker: Jonathan A. Coleman, MD New York, NY

10:05 a.m. – 10:15 a.m. Q&A

10:15 a.m. – 10:30 a.m. Break – Visit Exhibits

10:30 a.m. – 11:00 a.m. Point-Counterpoint: Management of Renal Stones Moderator: Chad A. LaGrange, MD Omaha, NE Speakers: Jodi Antonelli, MD

Dallas, TX THU R SD A Julie M. Riley, MD Albuquerque, NM Timothy Yu-Ting Tseng, MD San Antonio, TX Y

11:00 a.m. – 12:00 p.m. Stones/ Podium Session Moderators: Jodi Antonelli, MD Dallas, TX Timothy Yu-Ting Tseng, MD San Antonio, TX

11:00 a.m. #40 PREDICTORS OF SEPTIC SHOCK IN PATIENTS WITH OBSTRUCTIVE URETERAL CALCULI AND INFECTION Jodi Antonelli, MD, Justin Friedlander, MD, Daniel Mollengarden, MD, Beverley Adams-Huet, MS, Jeffrey Shoss, MD, Clayton Trimmer, DO, Sanjeeva Kalva, MD, Yair Lotan, MD, Margaret Pearle, MD, PhD UT Southwestern Medical Center (Presented by: Jodi Antonelli)

11:07 a.m. #41 SEASONAL VARIANCE OF PRESENTATION FOR MANAGEMENT OF UROLITHIASIS Christopher Slayden, MD, Michael Davis, MD, Julie Riley, MD University of New Mexico School of Medicine (Presented by: Christopher Slayden)

11:14 a.m. #42 COMPARISON OF HISPANICS TO CAUCASIANS IN METABOLIC EVALUATION OF NEPHROLITHIASIS Jessica Ming, MD, Julie Riley, MD University of New Mexico (Presented by: Jessica Ming)

45 11:21 a.m. #43 HIGH INCIDENCE OF, DONOR GIFTED LITHIASIS FROM CADAVERIC GRAFTS SCREENED USING NON-CONTRASTED COMPUTERIZED AXIAL TOMOGRAPHY INITIAL RESULTS FROM A TERTIARY-CARE CENTER IN MEXICO CITY Jorge Magaña, MD, Christian Villeda, MD, Carolina Culebro, MD, Jaime Herrera-Cáceres, MD, Olivia Gomez, MD, Ricardo Castillejos, MD, Bernardo Gabilondo, MD, Jorge Vazquez, MD, Carlos Mendez, MD INCMNSZ (Presented by: Jaime Herrera-Cáceres)

11:28 a.m. #44 TRANSURETHRAL ULTRASONIC URETERAL : INITIAL REPORT Thomas Pshak, MD1, Rodrigo Donalisio da Silva, MD2, Vassilis Siomos, MD1, Fernando Kim, MD2 and Wilson Molina, MD2 1University of Colorado; 2Denver Health (Presented by: Thomas Pshak)

11:35 a.m. #45 URINALYSIS FINDINGS ARE NOT PREDICTIVE OF POSITIVE URINE CULTURES IN PATIENTS WITH INDWELLING URETERAL STENTS. Aydin Pooli, MD, Chad LaGrange, MD UNMC (Presented by: Aydin Pooli)

11:42 a.m. #46 BACTERIAL RESISTANCE IS COMMON IN PATIENTS WITH INDWELLING URETERAL STENTS Aydin Pooli, MD, Chad LaGrange, MD UNMC (Presented by: Aydin Pooli)

11:49 a.m. #47 MANAGEMENT OF COMPLICATED URINARY TRACT INFECTIONS IN A MEXICAN GENERAL HOSPITAL Victor Cornejo Davila, Edgar Mayorga Gomez, Mario A. Palmeros Rodriguez, Israel Uberetagoyena Tello de Meneses, Gerardo Garza Sainz, Victor Osornio Sanchez, Luis Trujillo Ortiz, Jorge E. Sedano Basilio, Gerardo Fernandez Noyola, Mauricio Cantellano Orozco, Carlos Martinez Arroyo, Jorge G. Morales Montor, Carlos Pacheco Gahbler Hospital General Dr. Manuel Gea Gonzalez (Presented by: Victor Cornejo Davila)

46 12:00 p.m. – 1:00 p.m. Industry Sponsored Lunch Location: Celebrity BC (See page 24 for more details.)

12:00 p.m. – 1:00 p.m. Industry Sponsored Lunch Location: Rancho Mirage Room (See page 24 for more details.)

1:00 p.m. – 2:10 p.m. CONCURRENT POSTER SESSION I Oncology I Poster Session Location: Celebrity F Moderators: Shandra S. Wilson, MD Aurora, CO Jeffrey A. Jones, MD

Houston, TX THU R SD A

Poster #1 PROGNOSTIC BIOMARKERS FOR BILHARZIAL AND NON-BILHRAZIAL RELATED BLADDER CANCER: IMMUNOHISTOCHEMISTRY STUDY OF Y 14 MARKERS Ramy Youssef, MD1, Payal Kapur, MD2, Ahmed Mosbah, MD3, Hassan Abol-Enein, MD3, Mohamed Ghoniem, MD3 and Yair Lotan, MD2 1Duke University; 2UT Southwestern, Dallas, TX; 3Urology and Nephrology Center, Mansoura, Egypt (Presented by: Ramy Youssef)

Poster #2 CLINICO-BIOLOGICAL PROGNOSTIC SCORE FOR PREDICTION OF ONCOLOGICAL OUTCOMES AFTER RADICAL CYSTECTOMY FOR SQUAMOUS CELL CARCINOMA OF THE BLADDER Ramy Youssef, MD1, Payal Kapur, MD2, Dina Khalil, MD2, Ahmed Mosbah, MD3, Hassan Abol-Enein, MD3, Mohamed Ghoniem, MD3 and Yair Lotan, MD2 1Duke University; 2UT Southwestern, Dallas, TX; 3Urology and Nephrology Center, Mansoura University, Egypt (Presented by: Ramy Youssef)

Poster #3 MEASURING SYSTEMIC IMMUNE-RESPONSE TO INTRAVESICAL BCG FOR SUPERFICIAL BLADDER CANCER USING COMMERCIALLY AVAILABLE IMMUKNOW® ASSAY: CORRELATION WITH OUTCOMES AND LOWER URINARY TRACT SYMPTOMS Ryan Baker1 and Puneet Sindhwani, MD2 1University of Oklahoma College of Medicine; 2OUHSC, Department of Urology (Presented by: Ryan Baker)

47 Poster #4 IN WOMEN – EXPERIENCE WITH SEVEN PATIENTS AT A TERTIARY REFERRAL CENTER Jerry Trulson, MD, Majdee Islam, Naveen Pokala, MD, Mark Wakefield, MD University of Missouri (Presented by: Jerry Trulson)

Poster #5 PRACTICE PATTERNS OF GENITOURINARY CANCER NOMOGRAMS: A NATIONAL SURVEY Sudhir Isharwal, MBBS, Vikas Desai, MD, Chad Lagrange, MD UNMC (Presented by: Sudhir Isharwal)

Poster #6 CLINICAL UTILITY OF THE GENOMIC PROSTATE SCORE (GPS) IN DECISION MAKING FOR NEWLY DIAGNOSED PROSTATE CANCER Gerald Andriole, MD1, Mike Kemeter MSPAS2, Vahan Kassabian, MD3, Seth Strope, MD1, Eric Wallen, MD4, Greg Hanson, MD5, Megan Rothney, PhD2, H. Jeffrey Lawrence, MD2 and Bela Denes, MD2 1Washington University; 2Genomic Health, Inc.; 3Georgia Urology; 4University of North Carolina; 5Metro Urology (Presented by: Bela Denes)

Poster #7 METABOLIC SYNDROME IN PATIENTS WITH PROSTATE CANCER IN TREATMENT WITH DEPRIVATION THERAPY Victor Osornio, Resident, Alberto Camacho, Urologist, Carlos Martinez, Urologist, Carlos Pacheco, Urologist Hospital General Dr Manuel Gea Gonzalez (Presented by: Victor Osornio)

Poster #8 A PROSPECTIVE STUDY OF THE RELATIONSHIP BETWEEN CLINICAL EFFICACY OF SECONDARY HORMONE THERAPY AND NEUROENDOCRINE DIFFERENTIATION IN PATIENTS WITH RELAPSED PROSTATE CANCER AFTER FIRST-LINE HORMONE THERAPY Daisaku Hirano, MD1, Ryo Hasegawa, MD1, Yataroh Yamanaka, MD2, Kenya Yamaguchi, MD2, Nozomu Kawata, MD2 and Satoru Takahashi, MD2 1Higashi-matsuyama Municipal Hospital; 2Nihon University School of Medicine (Presented by: Daisaku Hirano)

48 Poster #9 PRACTICE AND REFERRAL PATTERNS AMONG PRIMARY CARE PHYSICIANS IN PATIENTS WITH MICROSCOPIC AND GROSS HEMATURIA John Bishay, MD, Anthony Oberle BS, CNMT, Chad Lagrange, MD University of Nebraska Medical Center (Presented by: John Bishay)

Poster #10 PERIOPERATIVE IMMUNONUTRITION FOR RADICAL CYSTECTOMY PATIENTS: INITIAL PILOT STUDY RESULTS Zach Hamilton, MD, Misty Bechtel, Amy Schleper MS, RD, Joshua Griffin, MD, Jeffrey Holzbeierlein, MD, Eugene Lee, MD, Moben Mirza, MD, Hadley Wyre,

MD, Jill Hamilton-Reeves, PhD, RD, LD T hu r sd a University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

1:00 p.m. – 2:10 p.m. CONCURRENT POSTER SESSION I y Stricture Disease, Male Incontinence Poster Session Location: Celebrity G Moderators: Steven Brandes, MD St. Louis, MO Erin T. Bird, MD Temple, TX

Poster #11 IMPACT OF OBESITY ON ARTIFICIAL URINARY SPHICNTER FOR THE TREATMENT OF POST- PROSTATECTOMY INCONTINENCE Christopher Graziano, MD1, Robert Chan, MD2, Jason Scovell, BS1 and Timothy Boone, MD, PhD2 1Baylor College of Medicine; 2Houston Methodist (Presented by: Christopher Graziano)

Poster #12 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY Christopher Powell, MD1, Travis Dum, MD1, William Brant, MD2 and Joshua Broghammer, MD1 1University of Kansas Medical Center; 2University of Utah (Presented by: Christopher Powell)

49 Poster #13 SURGICAL MANAGEMENT OF POST- PROSTATECTOMY BLADDER NECK CONTRACTURES: A META-ANALYSIS AND SYSTEMATIC REVIEW Joseph Song, MD, Jairam Eswara, MD, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Poster #14 OPTIMIZING SUCCESS WHEN PLACING THE ADVANCE TRANSOBTURATOR MALE SLING: KEY STEPS THAT HAVE BEEN IDENTIFIED AFTER IMPLANTING OVER 1000 DEVICES Brian Christine1 and L. Dean Knoll, MD2 1Urology Centers of Alabama; 2The Center for Urological Treatment, Nashville, TN (Presented by: Brian Christine)

Poster #15 INCREASING BMI IS NOT ASSOCIATED WITH AN INCREASED RATE OF AUS MECHANICAL FAILURE Jairam Eswara, MD1, Robert Chan, MD2, Joel Vetter1, H. Henry Lai, MD1, Timothy Boone, MD2 and Steven Brandes, MD1 1Washington University; 2Methodist Hospital (Presented by: Jairam Eswara)

Poster #16 INTERMEDIATE TERM FOLLOW-UP FOR PATIENTS UNDERGOING INTERVAL ARTIFICIAL URINARY SPHINCTER REIMPLANTATION FOLLOWING PREVIOUS ARTIFICIAL URINARY SPHINCTER EXPLANTATION Christopher Powell, MD1, Travis Dum, MD1, William Brant, MD2 and Joshua Broghammer, MD1 1University of Kansas Medical Center; 2University of Utah (Presented by: Christopher Powell)

Poster #17 FAILURE OF THE 3.5CM ARTIFICIAL URINARY SPHINCTER CUFF: AN EMERGING TREND? Brian Christine1 and Michael Kennelly, MD2 1Urology Centers of Alabama; 2McKay Urology, Charlotte, NC (Presented by: Brian Christine)

Poster #18 TRENDS IN INTERSTIM NEUROSTIMULATOR BATTERY SURVIVAL Carrie Yeast, MD, Louis Zhang, BS, James Cummings, MD University of Missouri (Presented by: Carrie Yeast) 50 Poster #19 ACUTE MANAGEMENT AND OUTCOMES OF AUS EXPLANTATION AND URETHRAL REPAIR AT TIME OF EROSION Travis Dum, MD, Christopher Powell, MD, Joshua Broghammer, MD, FACS University of Kansas Medical Center (Presented by: Travis Dum)

Poster #20 PROSPECTIVE COMPARISON OF PATIENT REPORTED OUTCOME MEASURES (PROM) OF ANTERIOR URETHRAL STRICTURE MANAGED SURGICALLY OR BY DAILY SELF-DILATION Anashia Shera, MD, Tolulope Bakare, MD, Ehab Eltahawy, MD

UAMS T hu r sd a (Presented by: Tolulope Bakare)

2:10 p.m. – 3:20 p.m. CONCURRENT POSTER SESSION II oncology II Poster Session y Location: Celebrity H Moderators: Frances M. Alba, MD Albuquerque, NM Moben Mirza, MD Kansas City, KS

Poster #21 THE USE OF EPIDURALS IN RADICAL CYSTECTOMY TO REDUCE LENGTH OF HOSPITAL STAY AND RATE OF COMPLICATIONS Roxanne Martinez, MS1 and Shandra Wilson, MD2 1University of Colorado, Anschutz Medical Campus; 2University of Colorado, Anschutz Medical Campus, Division of Urology (Presented by: Roxanne Martinez)

Poster #22 CCP SCORE STRATIFIES RISK FOR PROSTATE CANCER PATIENTS AT BIOPSY: INITIAL COMMERCIAL RESULTS E. David Crawford1, Neal Shore, MD2, Peter T. Scardino, MD, FACS3, John W. Davis, MD, FACS4, Jonathan Tward, MD, PhD5, Lowndes Harrison, MD6, Kelsey Moyes, MStat7, Lisa Fitzgerald8, Steve Stone, PhD8 and Michael K. Brawer, MD7 1University of Colorado at Denver; 2Carolina Urologic Research Center; 3Memorial Sloan-Kettering Cancer Center; 4The University of Texas, MD Anderson Cancer Center; 5University of Utah Huntsman Cancer Hospital; 6Gadsden Regional Cancer Center; 7Myriad Genetic Laboratories, Inc.; 8Myriad Genetics, Inc. (Presented by: E. David Crawford)

51 Poster #23 THE BCL2 CLINICAL CORRELATION’S IN CASTRATION RESISTANT PROSTATE CANCER Rafael-Francisco Velazquez-Macias, MD1, Ramon- Mauricio Coral-Vazquez, Profesor2, Claudia-Camelia Calzada-Vazquez, Profesor2, Fernando-E. De- La-Torre-Rendon Pathologist3, Guillermo Ramos- Rodriguez Pathologist3 and Esperanza Tamariz- Herrera Pathologist3 1Hospital Regional Adolfo Lopez Mateos; 2Polytechnic National Institute of Mexico; 3Adolfo Lopez Mateos General Hospital (Presented by: Rafael-Francisco Velazquez-Macias)

Poster #24 LOW DOSE GTX−758 DECREASES FREE TESTOSTERONE AND PSA IN MEN WITH METASTATIC CASTRATION RESISTANT PROSTATE CANCER (MCRPC) Robert Getzenberg, PhD1, Evan Yu, MD2, Jordan Smith MS1, Michael Hancock MS1, Ronald Tutrone, MD3, Thomas Flaig, MD4, Karl Westenfelder, MD5, Miklos Szucs, MD6, James Dalton, PhD1 and Mitchell Steiner, MD1 1GTx, Inc.; 2U of Washington; 3CURA; 4University of Colorado; 5Five Valleys Urology; 6Semmelweis University (Presented by: Robert Getzenberg)

Poster #25 RESULTS OF AN ONLINE SURVEY OF PHYSICAL, EMOTIONAL AND PRACTICAL CONCERNS FOR PROSTATE CANCER SURVIVORS IN THE UNITED STATES Oussama Darwish, MD, Prajakta Adsul, MD, Sameer Siddiqui, MD Saint Louis University (Presented by: Oussama Darwish)

Poster #26 CELL CYCLE PROGRESSION (CCP) SCORE SIGNIFICANTLY MODIFIES TREATMENT DECISIONS IN PROSTATE CANCER: RESULTS OF AN ONGOING REGISTRY TRIAL Ashok Kar, MD1, Mark Scholz, MD2, Jeffrey Fegan, MD3, E. David Crawford, MD4, Rajesh Kaldate, MS5 and Michael K. Brawer5 1St. Joseph Hospital; 2Prostate Oncology Specialists, Inc.; 3Rocky Mountain Urology Associates; 4University of Colorado at Denver; 5Myriad Genetic Laboratories, Inc. (Presented by: E. David Crawford)

52 Poster #27 VALIDATION OF AN RNA CELL CYCLE PROGRESSION SCORE FOR PREDICTING PROSTATE CANCER DEATH IN A CONSERVATIVELY MANAGED NEEDLE BIOPSY COHORT Jack Cuzick1, Steven Stone2, Gabrielle Fisher1, Zi Hua Yang1, Daniel Berney3, Luis Beltran3, David Greenberg4, Henrik Moller5, Julia E. Reid2, Alexander Gutin2, Jerry Lanchbury2, Michael K. Brawer6 and Peter T. Scardino7 1Wolfson Institute of Preventive Medicine; 2Myriad Genetics, Inc.; 3Barts Cancer Institute; 4Public Health England; 5King’s College London; 6Myriad Genetic Laboratories, Inc.; 7Memorial Sloan−Kettering Cancer

Center T hu r sd a (Presented by: Michael K. Brawer)

Poster #28 DOES THE TOTAL ANDROGEN DEPRIVATION TREATMENT DRUG CHANGES MODIFY THE y PROSTATE CANCER RESPONSE TREATMENT IN ADVANCED PROSTATE CANCER? Rafael-Francisco Velazquez-Macias, MD1, Mauricio Schroeder-Ugalde, MD2 and Alberto Gonzalez- Pedraza-Aviles Biologist3 1Hospital Regional Adolfo Lopez Mateos; 2Adolfo Lopez Mateos General Hospital; 3Faculty of Medicine of National University of Mexico (Presented by: Rafael-Francisco Velazquez-Macias)

Poster #29 BLADDER CANCER EDUCATION AMONG MEDICAL STUDENTS Margaret Le1, Brett Wahlgren, BS2, Hadley Wyre, MD2, Eugene Lee, MD2, Jeffrey Holzbeierlein, MD2, Brantley Thrasher, MD2, Tomas Griebling, MD, MPH2 and Moben Mirza, MD2 1University of Kansas; 2KUMC (Presented by: Margaret Le)

Poster #30 IMPROVED PATIENT OUTCOMES FROM RADICAL CYSTECTOMY THROUGH VIDEO EDUCATION Roxanne Martinez, MS, Elise Yerelian, Shandra Wilson, MD University of Colorado, Anschutz Medical Campus (Presented by: Shandra Wilson)

53 2:10 p.m. – 3:20 p.m. CONCURRENT POSTER SESSION II General Urology Poster Session Location: Celebrity F Moderators: Steven C. Koukol, MD Omaha, NE Parvis K. Kavoussi, MD Austin, TX

Poster #31 DO PATIENTS WANT TO KNOW ABOUT SURGEON EXPERIENCE? Jennifer Wimberly, MD, Emily C Rosenfeld, Alana Christie, Philippe E. Zimmern, MD University of Texas Southwestern (Presented by: Jennifer Wimberly)

Poster #32 ROBOTIC SIMULATION AMONGST MEDICAL STUDENTS: PREDICTING SKILL AND INTEREST Travis Dum, MD, Zach Hamilton, MD, Hadley Wyre, MD, Eugene Lee, MD, David Duchene, MD, Jeffrey Holzbeierlein, MD, J. Brantley Thrasher, MD, Moben Mirza, MD. University of Kansas Medical Center (Presented by: Travis Dum)

Poster #33 CURRENT PRACTICES OF MEASURING AND REFERENCE RANGE REPORTING OF SERUM FREE AND TOTAL TESTOSTERONE IN THE UNITED STATES Margaret Le1, David Flores, MD2 and Ajay Nangia, MBBS2 1University of Kansas; 2KUMC (Presented by: Margaret Le)

Poster #34 A MODERN LOOK AT : DEMOGRAPHICS, COMPLICATIONS AND POST- OPERATIVE FOLLOW-UP: THE UROLOGY CENTER OF COLORADO EXPERIENCE Kevin Carter, BS1, Joseph Walker, BS1 and Jesse Mills, MD2 1University of Colorado; 2TUCC (Presented by: Jesse Mills)

Poster #35 A COMPARISON OF THE ANALYSIS AND REPORTING OF MALE REPRODUCTIVE HORMONE REFERENCE VALUES IN THE UNITED STATES Margaret Le1, David Flores, MD2 and Ajay Nangia, MBBS2 1University of Kansas; 2KUMC (Presented by: Margaret Le) 54 Poster #36 THE FIRST UNITED STATES SERIES USING THE TRANSURETHRAL SUPRAPUBIC ENDO- CYSTOSTOMY DEVICE FOR SUPRAPUBIC CATHETER INSERTION Robert Larke, MD, Vassilis Siomos, MD, Andrew Windsperger, MD, Brian Flynn, MD University of Colorado (Presented by: Robert Larke)

Poster #37 USE OF LIGASURE(TM) VESSEL SEALING SYSTEM FACILITATES RAPID EXCISION OF MASSIVE GENITAL LYMPHEDEMA: A MULTI- INSTITUTIONAL EXPERIENCE Jordan A. Siegel, MD1, Jay Simhan, MD1, Michael 1 1 J. Belsante, MD , Lee C. Zhao, MD, MS , Timothy T hu r sd a J. Tausch, MD1, J. Francis Scott, BA1, Alexander J. Vanni, MD2 and Allen F. Morey, MD1 1UT Southwestern Medical Center; 2Lahey Clinic (Presented by: Jordan A. Siegel) y

Poster #38 TIME-RESPONSE RELATIONSHIP AND CLINICALLY MEANINGFUL IMPROVEMENT OF LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA (LUTS/BPH) DURING TADALAFIL TREATMENT Matthias Oelke, MD1, Rajesh Shinghal, MD2, Craig Donatucci, MD3, Simin Baygani, MS3 and Angelina Sontag, PhD3 1Hannover Medical School; 2Palo Alto Medical Foundation; 3Eli Lilly and Company (Presented by: Craig Donatucci)

Poster #39 POST-RADIATION INCONTINENCE AFTER ENTEROURINARY FISTULAE REPAIR IS ASSOCIATED WITH SUBSEQUENT REPAIR FAILURE Valary Raup, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Poster #40 TREATMENT OF CHRONIC PROSTATITIS IN INFERTILE MEN IMPROVES LEUKOCYTOSPERMIA Nabeel Uwaydah, MD, Marshall Shaw BS, Puneet Sindhwani, MD University of Oklahoma Health Science Center (Presented by: Nabeel Uwaydah)

55 2:10 p.m. – 3:20 p.m. CONCURRENT POSTER SESSION V: Trauma, Transplant, Robotics Poster Session Location: Celebrity G Moderators: Michael Davis, MD Albuquerque, NM Daniel B. Decker, MD Mountain Home, AR

Poster #41 COMPARISON OF OUTCOMES IN PEDIATRIC TRANSPLANTATION IN UROLOGIC VERSUS NON- UROLOGIC CAUSES OF ESRD Mohammad Ramadan, MD, Ryan Baker, Puneet Sindhwani, MD University of Oklahoma Health Sciences Center (Presented by: Mohammad Ramadan)

Poster #42 COMPARISON OF OUTCOMES AND COMPLICATIONS IN PEDIATRIC RENAL TRANSPLANT PATIENTS WITH AUTOIMMUNE VERSUS UROLOGIC CAUSES OF END STAGE RENAL DISEASE (ESRD) Ryan Baker1, Mohammad Ramadan, MD2 and Puneet Sindhwani, MD2 1University of Oklahoma College of Medicine; 2OUHSC, Department of Urology (Presented by: Ryan Baker)

Poster #43 OUTCOME OF RENAL TRANSPLANTATION IN PATIENTS WITH VASCULAR EMERGENCIES Jonathan Nelson, MD, Julie Riley, MD, Michael Davis, MD, Antonia Harford, MD University of New Mexico (Presented by: Jonathan Nelson, MD)

Poster #44 POST-OPERATIVE COMPLICATIONS IN TRAUMA PATIENTS UNDERGOING DAMAGE CONTROL NEPHRECTOMY Kyle Spradling, MD, Jairam Eswara, MD, Janine Oliver, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Poster #45 VESSEL PRESERVING POSTERIOR URETHROPLASTY AFTER PRIMARY REALIGNMENT: INITIAL EXPERIENCE Anashia Shera, MD, Ted Ritchie, MD, Ehab Eltahawy, MD UAMS (Presented by: Ted Ritchie)

56 Poster #46 OUTCOMES OF GENITOURINARY INJURIES DURING COLORECTAL SURGERY Valary Raup, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Poster #47 FACTORS ASSOCIATED WITH ADRENAL SURGERY AFTER ADRENAL INJURIES Valary Raup, MD, Jairam Eswara, MD, Julio Geminiani, MD, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Poster #48 THE ROBOTIC ASSISTED MULTIPLEX PARTIAL T hu r sd a NEPHRECTOMY Ryan Hankins, MD1, Annerleim Walton Diaz, MD2 and Adam Metwalli, MD2 1 2 National Institutes of Health; NIH/NCI y (Presented by: Ryan Hankins)

Poster #49 WITHDRAWN

Poster #50 EXTERNAL VALIDATION OF GLOBAL EVALUATIVE ASSESSMENT OF ROBOTIC SKILLS Monty Aghazadeh, MD1, Isuru Jayaratna, MD2, Andrew Hung, MD2, Inderbir Gill, MD2, Mihir Desai, MD2 and Alvin Goh, MD3 1Baylor College of Medicine; 2University of Southern California; 3Houston Methodist Hospital (Presented by: Monty Aghazadeh)

3:20 p.m. – 3:45 p.m. Break – Visit Exhibits

3:45 p.m. – 5:00 p.m. T-Leon Howard Imaging Session Moderator: J. Brantley Thrasher, MD Kansas City, KS

Case #1 46 YEAR OLD MALE WITH LEFT TESTICULAR ENLARGEMENT AND PAIN Zach Hamilton, MD, Brad Wilson, MD, Jeff Holzbeierlein, MD University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

Case #2 57 YEAR OLD MALE WITH MICTURITION PAIN Thomas Brush, Medical Student1 and Larry E. Siref, MD, FACS2 1University of Nebraska Medical Center; 2Creighton University College of Medicine (Presented by: Thomas Brush) 57 Case #3 6 YEAR OLD MALE PRESENTS WITH LEFT TESTICULAR MASS Vikas Desai, Sudhir Isharwal, MD, Steven Koukol, MD University of Nebraska Medical Center (Presented by: Vikas Desai)

Case #4 70 YEAR OLD MALE WITH RECURRENT SCROTAL MASS Laura Martinez, MD, Michael Cookson, MD University of Oklahoma (Presented by: Laura Martinez)

Case #5 60 YEAR OLD MALE WITH LEFT PARATESTICULAR MASS Juan Ochoa, Resident1, Olivia Gomez, Resident2, Jorge Magaña, Resident2 and Mariano Sotomayor, Resident2 1instituto Nacional De Ciencias Medicas Y Nutricion “Salvador Zubiran”; 2INNSZ (Presented by: Juan Ochoa)

Case #6 81 YEAR OLD FEMALE WITH DM II AND RENAL MASS PRESENTING WITH FATIGUE James Furr, Jonathan Heinlen, MD University of Oklahoma (Presented by: James Furr)

Case #7 65 YEAR OLD FEMALE PRESENTS WITH LEFT FLANK PAIN AND GROSS HEMATURIA Sylvain Collura, Intern INNSZ (Presented by: Sylvain Collura)

Case #8 21 YEAR OLD FEMALE WITH PAINFUL OBSTRUCTIVE VOIDING SYMPTOMS Michael Aberger, MD, Priya Padmanabhan, MD University of Kansas (Presented by: Michael Aberger)

FRIDAY, OCTOBER 10, 2014

OVERVIEW 7:00 a.m. – 5:00 p.m. registration/Information Desk Hours Location: Rancho Mirage Foyer

7:00 a.m. – 5:00 p.m. Speaker Ready Room Hours Location: Rancho Mirage Foyer

6:45 a.m. – 7:45 a.m. Industry Sponsored Breakfast Location: Rancho Mirage Room (See page 24 for more details.) 58 7:00 a.m. – 8:00 a.m. finance Committee Meeting Location: Celebrity BC

7:30 a.m. – 10:30 a.m. Spouse/Guest Hospitality Suite Hours Location: Suite 517

7:30 a.m. – 11:00 a.m. exhibit Hours Location: Celebrity DE

11:00 a.m. – 2:30 p.m. el Paseo Shopping and Museums

SCIENTIFIC/GENERAL SESSION 8:00 a.m. – 9:20 a.m. female Urology/Voiding Dysfunction Podium Session Moderators: Priya Padmanabhan, MPH, MD Kansas City, KS Gennady Slobodov, MD Oklahoma City, OK

8:00 a.m. #48 THE VALUE OF RETROPUBIC SLINGS FOLLOWING FAILED PRIOR ANTI-INCONTINENCE PROCEDURES F r id a Michael Aberger, MD1, William Parker, MD1, Alexander Gomelsky, MD2 and Priya Padmanabhan, MD1 1University of Kansas; 2Louisiana State University y (Presented by: Michael Aberger)

8:07 a.m. #49 CONCURRENT EXCISION OF MID-URETHRAL SLING DURING REPEAT MID-URETHRAL SLING IS NOT ASSOCIATED WITH CONTINENCE OUTCOMES Robert Chan, MD1, Jason Scovell, BS2, William Johnson BA2, Rose Khavari, MD1 and Danielle Antosh, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

8:14 a.m. #50 FACTORS ASSOCIATED WITH FAILURE OF A REPEAT MID-URETHRAL SLING PROCEDURE Robert Chan, MD1, Jason Scovell, BS2, James Tan, MD2 and Alex Gomelsky, MD3 1Houston Methodist Hospital; 2Baylor College of Medicine; 3LSU Health Sciences Center – Shreveport (Presented by: Robert Chan)

59 8:21 a.m. #51 EARLY EXPERIENCE WITH ROBOTIC-ASSISTED LAPAROSCOPIC SACROCOLPOPEXY (RALS) WITH ALLOGRAFT FASCIA LATA IN PATIENTS WITH PRIOR MESH COMPLICATIONS Andrew Windsperger, MD, Nicholas Westfall, MD, Paul Knoll, MD, Brian Flynn, MD University of Colorado (Presented by: Andrew Windsperger)

8:28 a.m. #52 SURGICAL MANAGEMENT OF LOWER URINARY MESH PERFORATION AFTER TREATMENT FOR PELVIC ORGAN PROLAPSE: MESH EXCISION AND URINARY TRACT RECONSTRUCTION Nicholas Westfall, MD1, Ketul Shah, MD2, Paul Knoll, MD1, Andrew Windsperger, MD1 and Brian Flynn, MD1 1University of Colorado; 2The Ohio State University (Presented by: Nicholas Westfall)

8:35 a.m. #53 THE USE OF CENTRALIZED DATA TO EVALUATE COMPLIANCE WITH THE AUA/SUFU GUIDELINE ON OVERACTIVE BLADDER – A COLLABORATIVE EFFORT OF THE AUA GUIDELINE COMMITTEE AND HEALTHTRONICS IT SOLUTIONS Robert Dowling, MD1, Gregory Auffenberg, MD2, William Meeks3 and J. Stuart Wolf, MD4 1Dowling Medical Director Services; 2Northwestern University; 3American Urologic Association; 4University of Michigan (Presented by: Robert Dowling)

8:42 a.m. #54 ANALYSIS OF PAIN AND QUALITY OF LIFE FOR INTERSTITIAL CYSTITIS PATIENTS FROM A LARGE ACADEMIC PRACTICE Zach Hamilton, MD, Charles Graham, MSIII, Tomas L. Griebling, MD, MPH University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

8:49 a.m. #55 RANDOMIZED CONTROLLED TRIAL OF PROPHYLACTIC URETERAL STENT PLACEMENT BEFORE UTEROSACRAL LIGAMENT SUSPENSION Robert Chan, MD1, Sophie Fletcher, MD2, Danielle Antosh, MD1, Rose Khavari, MD1, Julie Stewart, MD1, Jonathan Zurawin, BS3, Juan Flores, MD1, Jiong Chen, BS4 and Keith Reeves, MD1 1Houston Methodist Hospital; 2Kaiser Permanente; 3Baylor College of Medicine; 4MD Anderson Cancer Center (Presented by: Robert Chan)

60 8:56 a.m. #56 LONG-TERM EFFICACY OF SACRAL NERVE STIMULATION IMPLANTATION FOR NON- OBSTRUCTIVE REFRACTORY TO MEDICAL THERAPY Charles Snyder, MD, Timothy Buff, BS, Magdee Islam, BS, Woodson Smelser, BS, James Cummings, MD University of Missouri (Presented by: Charles Snyder)

9:03 a.m. #57 ONABOTULINUMTOXINA IMPROVES URINARY INCONTINENCE AND QUALITY OF LIFE IN OVERACTIVE BLADDER PATIENTS, REGARDLESS OF USE OF CLEAN INTERMITTENT CATHETERIZATION OR THE PRESENCE OF URINARY TRACT INFECTION Jennifer Gruenenfelder1, Karel Everaert, MD2, Heinrich Schulte-Baukloh, MD3, Steven Guard, DPhil4, Yan Zheng, PhD5 and David Sussman, MD6 1Orange County Urology Associates; 2Ghent University Hospital, Gent, Belgium; 3St. Hedwig- Krankenhaus, Berlin, Germany; 4Allergan, Ltd, F r id a Marlow, United Kingdom; 5Allergan, Inc, Bridgewater, New Jersey, United States; 6Rowan University School of Osteopathic Medicine, Stratford, New Jersey, y United States (Presented by: Jennifer Gruenefelder)

9:10 a.m. #58 EFFICACY OF INTRADETRUSOR BOTOX INJECTIONS IN PATIENTS WITH URGENCY INCONTINENCE Carrie Yeast, MD, Majdee Islam, BS, James Cummings, MD University of Missouri (Presented by: Carrie Yeast)

9:20 a.m. - 9:50 a.m. State-of-the-Art Lecture: “Regenerative Medicine: New Approaches to Healthcare” Speaker: Anthony Atala, MD Winston Salem, NC

9:50 a.m. – 10:00 a.m. Q&A

10:00 a.m. – 10:30 a.m. Break – Visit Exhibits

10:30 a.m. – 11:45 a.m. Pediatrics and Miscellaneous Podium Session Moderators: Vijaya M. Vemulakonda, MD, JD, FCLM Aurora, CO Ismael Zamilpa, MD Little Rock, AR

61 10:30 a.m. #59 MULTI-INSTITUTIONAL STUDY COMPARING HEIGHT OF VCUG CONTRAST Mohammad Ramadan, MD1, Christopher Cooper, MD2, Blake Palmer, MD1, Kathleen Kieran2, Douglas Storm2, Yutaka Sato2, Brad Kropp, MD1 and Dominic Frimberger, MD1 1University of Oklahoma Health Sciences Center; 2University of Iowa College of Medicine (Presented by: Mohammad Ramadan)

10:37 a.m. #60 NOBOX: A NOVEL CANDIDATE GENE UNDERLYING AND CRYPTORCHIDISM Abhishek Seth, MD1, Shayne Lewis, PhD1, In-Seon Choi, PhD1, James Sander, MD1, Josephine Addai, PhD1, Nathan Wilken, PhD1, Irina Stanasel, MD2, Chester Koh, MD1, David Roth, MD1, Carolina Jorges, PhD1 and Dolores Lamb, PhD1 1Texas Children’s Hospital; 2Texas Children’s Hospital/ Baylor College of Medicine (Presented by: Irina Stanasel)

10:44 a.m. #61 LAPAROSCOPIC-ASSISTED URETEROURETEROSTOMY FOR DUPLICATION ANOMALIES IN CHILDREN Gwen Grimsby, MD1, Zahra Merchant2, Micah Jacobs, MD, MPH1 and Patricio Gargollo, MD3 1UTSW/CMC, Dallas, TX; 2UTSW, Dallas, TX; 3Texas Childrens/Baylor, Houston, TX (Presented by: Gwen Grimsby)

10:51 a.m. #62 URETHRAL LENGTHENING: LONG-TERM DURABILITY OF CONTINENCE AND EASE OF CATHETERIZATION Elizabeth Malm-Buatsi, MD1, Adam Becker, MD2, Blake Palmer, MD1, Dominic Frimberger, MD1, Brad Kropp, MD1 and Kenneth Kropp, MD2 1University of Oklahoma; 2University of Toledo (Presented by: Elizabeth Malm-Buatsi)

10:58 a.m. #63 THE FATE OF TRANSITIONAL UROLOGY PATIENTS REFERRED TO A TERTIARY TRANSITIONAL CARE CENTER Robert Chan, MD1, Jason Scovell, BS2, Zach Jeng BA2, Saneal Rajanahally, BS2, Timothy Boone, MD, PhD1 and Rose Khavari, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

62 11:05 a.m. #64 NATURAL HISTORY OF HYDRONEPHROSIS AFTER ROBOTIC EXTRAVESICAL URETERAL REIMPLANTATION IN CHILDREN Dennis Lee, MD1, Leo Dalag1, Mukil Patil, MD1, Roger De Filippo, MD2, Andy Chang, MD2, Irina Stanasel, MD3 and Chester Koh3 1USC; 2CHLA / USC; 3Texas Children’s Hospital/ Baylor (Presented by: Chester Koh)

11:12 a.m. #65 PRELIMINARY EXPERIENCE WITH HIDES ROBOTIC EXTRAVESICAL URETERAL REIMPLANTS: A NEW STANDARD OF CARE? Gwen Grimsby, MD1,Sudhir Isharwal, MD2, Carlos Villanueva, MD2 1UTSW/CMC; 2Children’s Hospital and Medical Center/University of Nebraska Medical Center (Presented by: Gwen Grimsby)

11:19 a.m. #66 REDUCTION IN SURGICAL FOG WITH WARM HUMIDIFIED GAS MANAGEMENT PROTOCOL IN PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC F r id a PROCEDURES SIGNIFICANTLY SHORTENS PROCEDURE TIME Bhalaajee Meenakshi-Sundaram, MD, Elizabeth y Malm-Buatsi, MD, Nguyen Edward, PhD, Frimberger Dominic, MD, Palmer Blake, MD University of Oklahoma College of Medicine (Presented by: Bhalaajee Meenakshi-Sundaram)

11:26 a.m. #67 DO URINALYSIS FINDINGS BEFORE URODYNAMIC EVALUATION IMPACT THE RATE OF URINARY TRACT INFECTION AFTER THE STUDY? Lynn Lapicz1, Stephen Canon, MD2, Ashay Patel, MD2 and Ismael Zamilpa, MD2 1Arkansas Children’s Hospital; 2UAMS (Presented by: Lynn Lapicz)

11:33 a.m. #68 FRAILTY AND DELIRIUM – UROLOGICAL SURGICAL ISSUES? Robert Donohue, MD, Thomas Robinson, MD University of Colorado (Presented by: Robert Donohue)

11:45 a.m. – 1:00 p.m. Industry Sponsored Lunch Location: Celebrity BC (See page 24 for more details.)

63 11:45 a.m. – 1:00 p.m. Industry Sponsored Lunch Location: Rancho Mirage Room (See page 24 for more details.)

1:00 p.m. – 1:45 p.m. aUA Course of Choice: Advanced Ureteroscopy: Overcoming Challenging Problems Invited Speaker: Demetrius H. Bagley, MD Philadelphia, PA

1:45 p.m. – 2:45 p.m. Prostate Cancer I Podium Session Moderators: John W. Davis, MD, FACS Houston, TX Jeffrey A. Jones, MD Houston, TX

1:45 p.m. #69 A NOVEL OPTICAL PROBE TO DETECT POSTIVE MARGINS IN PROSTATE CANCER SPECIMENS Monica Morgan, MD1, Jeffrey Gahan, MD1, Xinlong Wang2, Venki Kavuri2, Hanli Liu2, Claus Roehrborn, MD1 and Jeffrey Cadeddu, MD1 1Dept of Urology, University of Texas Southwestern; 2Dept of Bio-engineering, University of Texas Arlington (Presented by: Monica Morgan)

#70 WITHDRAWN

1:52p.m. #71 MULTIPARAMETIC PROSTATE MRI: A NATIONAL SURVERY OF UROLOGISTS TO ASSESS ACCESSIBILITY, ROLE, AND PERCEIVED ACCURACY Brandon Manley, MD1, John Brockman, MD1, Kathryn Fowler, MD2, Goutham Vemana, MD1, Valary Raup3 and Gerald Andriole, MD1 1Washington University School of Medicine Division of Urology; 2Washington University School of Medicine Mallinckrodt Institute of Radiology; 3Washington University School of Medicine (Presented by: John Brockman)

64 1:59 p.m. #72 PROSTATE FIELD CANCERIZATION: DYSREGULATED EXPRESSION OF MACROPHAGE INHIBITORY CYTOKINE 1 (MIC−1) AND PLATELET DERIVED GROWTH FACTOR A (PDGF−A) AND LIPID BIOSYNTHESIS IN HISTOLOGICALLY NORMAL TISSUE ADJACENT TO TUMOR Anna Jones, BS1, Kresta Antillon, BA1, Shannon Jenkins, BS1, Heidi Overton, BA1, Sara Janos, BS1, Virginia Severns, MS1, Kristina Trujillo, PhD1 and Marco Bisoffi, PhD2 1University of New Mexico School of Medicine; 2Chapman University, Schmid College of Science and Technology (Presented by: Anna Jones)

2:06 p.m. #73 FIRST-IN-HUMAN CLINICAL TRIAL DATA SHOW OPTICALLY ADJUNCT BIOPSY NEEDLES CAN INCREASE DIAGNOSTIC YIELD OF PROSTATE BIOPSIES E. David Crawford, MD1, Edward A. Jasion, MS2, Yongjun Liu, PhD1, John W. Daily, PhD3, S. Russell F r id a Nash, MD, PhD4, Paul Arangua1 and Priya N. Werahera, PhD1 1University of Colorado Denver Anschutz Medical y Campus; 2Precision Biopsy LLC; 3University of Colorado Boulder; 4Centennial Pathologists, PC (Presented by: E. David Crawford)

2:13 p.m. #74 CLINICAL UTILITY OF TEMPLATE GUIDED TRANSPERINEAL SATURATION PROSTATIC BIOPSIES UNDER TRANSRECTAL ULTRASOUND GUIDANCE John Forrest, MD1 and Brian Bock, MD2 1Urologic Specialist of Oklahoma, Inc; 2St. John Medical Center (Presented by: John Forrest)

2:20 p.m. #75 KU675, A CONCOMITANT HEAT SHOCK PROTEIN INHIBITOR OF HSC70 AND HSP90 THAT MANIFESTS ISOFORM SELECTIVITY FOR HSP90Α William Parker, MD, Weiya Liu, PhD, Doug Brown, Eugene Lee, MD, Jeffrey Holzbeierlein, MD, George Vielhauer, PhD University of Kansas Medical Center (Presented by: William Parker)

65 2:27 p.m. #76 AN OPTIMAL MARKER FOR EFFICACY DURING TREATMENT WITH RADIUM-223: ANALYSIS OF OUR FIRST 42 PATIENTS John Bishay, MD1, Matthew McDonald, BS, CNMT2, Samuel Mehr, MD2 and Luke Nordquist, MD2 1University of Nebraska Medical Center; 2Urology Cancer Center & GU Research Network, Omaha, NE (Presented by: John Bishay)

2:34 p.m. #89 ALGORITHMIC APPROACH FOR PRECISE PENILE STRAIGHTENING DURING PENILE PROSTHESIS SURGERY Timothy J. Tausch, MD, Paul H. Chung, MD, Lee C. Zhao, MD, MS, Jay Simhan, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Timothy J. Tausch)

2:45 p.m. – 2:55 p.m. Break

2:55 p.m. – 3:35 p.m. State-of-the-Art Lecture: Surgical Management of Transvaginal Mesh Complications: Mesh Pain, Infection, Exposure and Perforation Invited Speaker: Brian J. Flynn, MD Aurora, CO

3:35 p.m. – 3:45 p.m. Q&A

3:45 p.m. – 5:00 p.m. resident Quiz Bowl Moderators: Robert E. Donohue, MD Denver, CO Ajay K. Nangia, MBBS Kansas City, KS Judges: E. David Crawford, MD Aurora, CO Paul D. Maroni, MD Aurora, CO Arthur I. Sagalowsky, MD Dallas, TX J. Brantley Thrasher, MD Kansas City, KS

5:00 p.m. – 6:30 p.m. residents Reception (Sponsored by AACU) Location: Ambassador 4-7

66 SATURDAY, OCTOBER 11, 2014

OVERVIEW 7:00 a.m. – 12:15 p.m. registration/Information Desk Hours Location: Rancho Mirage Foyer

7:00 a.m. – 8:00 a.m. Board of Directors Meeting (Voting Members Only) Location: Ambassador I

7:00 a.m. – 11:45 a.m. Speaker Ready Room Hours Location: Rancho Mirage Foyer

7:00 a.m. – 8:00 a.m. Continental Breakfast Location: Oasis Foyer

7:30 a.m. – 10:30 a.m. Spouse/Guest Hospitality Suite Hours Location: Suite 517

12:30 p.m. – 3:00 p.m. Tennis

1:30 p.m. – 4:30 p.m. Jeep Tour

1:30 p.m. – 5:30 p.m. Golf

11:45 a.m. – 12:15 p.m. annual Business Meeting Location: Oasis Ballroom Sa 12:15 p.m. – 1:15 p.m. SCS Urology Department Chair, Residency tu r d a Program Director, and Academic Faculty Meeting

Location: Oasis Ballroom y

6:30 p.m. – 12:00 a.m. annual Reception & Banquet Location: Ambassador 1-3

SCIENTIFIC/GENERAL SESSION 8:00 a.m. – 9:10 a.m. Prostate Cancer II Podium Session Moderators: Steven E. Canfield, MD Houston, TX Vitaly Margulis, MD Dallas, TX

8:00 a.m. #77 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER McCabe Kenny, MD, Andrew Windsperger, MD, Ty Higuchi, MD, PhD University of Colorado-Denver (Presented by: McCabe Kenny) 67 8:07 a.m. #78 OPEN OR ROBOT-ASSISTED RADICAL PROSTATECTOMY AS THE PRIMARY TREATMENT OF HIGH RISK PROSTATE CANCER: ONCOLOGIC OUTCOMES AND INCIDENCE OF SUBSEQUENT THERAPIES Jenny Nguyen, Mary Achim, BS, Brian Chapin, MD, Surena Matin, MD, John Davis, MD UTMDACC (Presented by: Jenny Nguyen)

8:14 a.m. #79 ACTIVE SURVEILLANCE AS AN INITIAL MANAGEMENT IN MEN WITH PHENOTYPICALLY HETEROGENEOUS EARLY STAGE PROSTATE CANCER John Davis, MD, Mary Achim, BS, John Ward, MD, Curtis Pettaway, MD, Brian Chapin, MD, Xuemei Wang, Deborah Kuban, MD, Steven Frank, MD, Andrew Lee, MD, Louis Pisters, MD, Surena Matin, MD, Jay Shah, MD, Jose Karam, MD, John Papadopoulos, MD, Karen Hoffman, MD, Thomas Pugh, MD, Seungtaek Choi, MD, Christopher Logothetis, MD, Patricia Troncoso, MD, Jeri Kim, MD MD Anderson Cancer Center (Presented by: John Davis)

#80 WITHDRAWN

8:21 a.m. #81 A SINGLE COMMUNITY CENTER’S EXPERIENCE WITH ABIRATERONE USING STRICT PCWG2 DEFINITION OF PROGRESSION OF DISEASE Thomas Longo, MD, Luke Nordquist, MD UNMC (Presented by: Thomas Longo)

8:28 a.m. #82 TREATMENT CHOICE FOR PROSTATE CANCER BY COUNTY OF RESIDENCE: A SURVEILLANCE, EPIDEMIOLOGY, AND END Results: (SEER) REVIEW Jonathan Heinlen, MD1, Nora Ruel, MA2 and Timothy Wilson, MD2 1University of Oklahoma; 2City of Hope National Medical Center (Presented by: Jonathan Heinlen)

68 8:35 a.m. #83 A NOVEL NATURAL COMPOUND ALTERNOL INDUCES ROS-DEPENDENT BAX ACTIVATION AND APOPTOTIC CELL DEATH IN PROSTATE CANCER CELLS David Flores, MD, Yuzhe Tang, J. Brantley Thrasher, MD, Benyi Li, MD, PhD University of Kansas (Presented by: David Flores)

8:42 a.m. #84 MODIFIER 22 IN PATIENTS UNDERGOING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AT A TERTIARY CARE CENTER Katie Murray, DO1, Daniel Zainfeld, MD1, Moben Mirza, MD1, Ernesto Lopez-Corona, MD2, Brantley Thrasher, MD1 and David Duchene, MD1 1University of Kansas; 2Kansas City Veterans Administration (Presented by: Daniel Zainfeld)

8:49 a.m. #85 HEIGHT-BASED RATHER THAN WEIGHT-BASED, DOSING AS A MORE APPROPRIATE METHOD OF TREATING WITH RADIUM-223 Thomas Longo, MD1, Matthew McDonald, CNMT2, Samuel Mehr, MD2 and Luke Nordquist, MD2 1UNMC; 2Urology Cancer Center (Presented by: Thomas Longo)

#86 WITHDRAWN

9:10 a.m. – 9:50 a.m. aUA Guidelines Update Speaker: Allen F. Morey, MD Dallas, TX

9:50 a.m. – 10:00 a.m. Q&A Sa

10:00 a.m. – 10:20 a.m. Break tu r d a

10:20 a.m. – 10:30 a.m. IVUmed Scholar Report Speaker: Monty Aghazadeh, MD y Houston. TX

10:30 a.m. – 10:50 a.m. fellowship Essay Finalist Podium Moderator: Tomas L. Griebling, MD, MPH Kansas City, KS

69 10:30 a.m. #87 CAN URINARY NERVE GROWTH FACTOR (NGF) BE USED AS A BIOMARKER IN ANATOMICALLY OBSTRUCTED FEMALE PATIENTS? Robert Chan, MD1, Julie Stewart, MD1, Alvaro Munoz, PhD1, Evan Wenker, BA2, Timothy Boone, MD, PhD1 and Rose Khavari, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

10:37 a.m. #88 URETHRAL LENGTHENING UTILIZING PROXIMAL PERINEAL SKIN TUBE FOR SEVERE CASES OF PROXIMAL HYPOSPADIAS REPAIR Elizabeth Malm-Buatsi, MD1, Blake Palmer, MD2, Dominic Frimberger, MD2 and Brad Kropp, MD2 1University Of Oklahoma; 2University of Oklahoma (Presented by: Elizabeth Malm-Buatsi)

10:50 a.m. – 11:00 a.m. History Update: Dr. Willet F. Whitmore, Jr., Father of Modern Urologic Oncology Speaker: Robert E. Donohue, MD Denver, CO

11:00 a.m. – 11:45 a.m. Presidential Guest Lecture: “My Most Important Lessons Learned in 101 Years” Introducer: Charles A. McWilliams, MD Oklahoma City, OK Presidential Guest Speaker: James Downing Colorado Springs, CO

11:45 a.m. – 12:15 p.m. annual Business Meeting Location: Oasis Ballroom

6:30 p.m. – 12:00 a.m. annual Reception and Banquet Location: Ambassador 1-3

Disclaimer Statement Statements, opinions and results of studies contained in the program are those of the presenters/authors and do not reflect the policy or position of the SCS nor does the SCS provide any warranty as to their accuracy or reliability.

Every effort has been made to faithfully reproduce the abstracts as submitted. However, no responsibility is assumed by the SCS for any injury and/or damage to persons or property from any cause including negligence or otherwise, or from any use or operation of any methods, products, instruments, or ideas contained in the material herein.

70 Alphabetical Index of Moderators, Panelists, Guest and Invited Speakers

AGHAZADEH, Monty DONOHUE, Robert 10/11/2014 10:20 a.m. 10/10/2014 3:45 p.m. 10/11/2014 10:50 a.m. ALBA, Frances 10/9/2014 2:10 p.m. DOWNING, James 10/11/2014 11:00 a.m. ANTONELLI, Jodi 10/9/2014 10:30 a.m. DUCHENE, David 10/9/2014 11:00 a.m. 10/9/2014 7:30 a.m.

ATALA, Anthony FLYNN, Brian 10/10/2014 9:20 a.m. 10/10/2014 2:55 p.m.

BAGLEY, Demetrius FRANKEL, Jeffrey 10/10/2014 1:00 p.m. 10/8/2014 9:15 a.m.

BIRD, Erin GEE, William 10/9/2014 1:00 p.m. 10/8/2014 8:30 a.m. 10/8/2014 12:10 p.m. BRANDES, Steven 10/9/2014 1:00 p.m. GRIEBLING, Tomas 10/11/2014 10:30 a.m. CANFIELD, Steven 10/11/2014 8:00 a.m. HIGUCHI, Ty 10/8/2014 1:05 p.m. COLEMAN, Jonathan 10/9/2014 9:30 a.m. HOLZBEIERLEIN, Jeffrey 10/9/2014 8:15 a.m. COOKSON, Michael 10/8/2014 5:00 p.m. HUDAK, Steven GU E ST 10/8/2014 1:05 p.m. M O D ERA

CRAWFORD, E. David AN D I N VIT E SP EA K ER S 10/10/2014 3:45 p.m. JONES, Jeffrey T

10/9/2014 1:00 p.m. OR S, P DAVIS, John 10/10/2014 1:45 p.m. 10/10/2014 1:45 p.m. KAMAT, Ashish ANEL ISTS, DAVIS, Michael 10/8/2014 3:35 p.m. 10/9/2014 2:10 p.m. KAPLAN, Damara DAVIS, Rodney 10/8/2014 12:05 p.m. 10/9/2014 8:15 a.m. 10/8/2014 12:20 p.m.

DECKER, Daniel 10/9/2014 2:10 p.m. 71 KATZ, Matthew SLOBODOV, Gennady 10/8/2014 03:35 p.m. 10/10/2014 8:00 a.m.

KAUFMAN, Jeffrey SVATEK, Robert 10/8/2014 10:00 a.m. 10/8/2014 2:30 p.m.

KAVOUSSI, Parviz THRASHER, James 10/9/2014 2:10 p.m. 10/9/2014 3:45 p.m. 10/10/2014 3:45 p.m. KOUKOL, Steven 10/9/2014 2:10 p.m. TSENG, Timothy 10/9/2014 10:30 a.m. LAGRANGE, Chad 10/9/2014 11:00 a.m. 10/9/2014 10:30 a.m. VEMULAKONDA, Vijaya MARGULIS, Vitaly 10/10/2014 10:30 a.m. 10/11/2014 8:00 a.m. WILSON, Shandra MARONI, Paul 10/9/2014 1:00 p.m. 10/10/2014 3:45 p.m. ZAMILPA, Ismael MCWILLIAMS, Charles 10/10/2014 10:30 a.m. 10/8/2014 12:00 p.m. 10/8/2014 12:20 p.m. 10/11/2014 11:00 a.m.

MIRZA, Moben 10/9/2014 2:10 p.m.

MOREY, Allen 10/11/2014 9:10 a.m.

NANGIA, Ajay 10/10/2014 3:45 p.m.

PADMANABHAN, Priya 10/10/2014 8:00 a.m.

PAINTER, Mark 10/8/2014 7:30 a.m.

RILEY, Julie 10/9/2014 10:30 a.m.

RODRIGUEZ RIVERA, Jose 10/8/2014 3:15 p.m.

Sagalowsky, Arthur 10/10/2014 3:45 p.m.

72 Alphabetical Index of Abstract Presenters p re s en t er Author/Presenter, Date, Time and Abstract Placement a bst ra ct Due to time limitations, authors who do not have a time and date listed will not be presenting their abstracts at this meeting. See Abstracts section for complete text.

ABERGER, Michael CHAN, Robert C. Video #1 10/09/14 7:30 a.m. Video #3 10/09/14 7:30 a.m. Case #8 10/09/14 3:45 p.m. AB #49 10/10/14 8:07 a.m. AB #48 10/10/14 8:00 a.m. AB #50 10/10/14 8:14 a.m. AB #55 10/10/14 8:49 a.m. AGHAZADEH, Monty AB #63 10/10/14 10:58 a.m. AB #25 10/08/14 4:31 p.m. AB #87 10/11/14 10:30 a.m. Poster #50 10/09/14 2:10 p.m. CHRISTINE, Brian S. ALGHROUZ, Ahmed AB #7 10/08/14 1:05 p.m. Video #6 10/09/14 7:30 a.m. Poster #14 10/09/14 1:00 p.m. Poster #17 10/09/14 1:00 p.m. ANTONELLI, Jodi AB #40 10/09/14 11:00 a.m. COLLURA MERLIER, Sylvain Case #7 10/09/14 3:45 p.m. AYOUB, Hajar I. AB #17 10/08/14 3:35 p.m. CORNEJO DAVILA, Victor AB #47 10/09/14 11:49 a.m. BAKARE, Tolulope Poster #20 10/09/14 1:00 p.m. CRAWFORD, E. David Poster #22 10/09/14 2:10 p.m. BAKER, Ryan Poster #26 10/09/14 2:10 p.m. Poster #3 10/09/14 1:00 p.m. AB #73 10/10/14 2:06 p.m. Poster #42 10/09/14 2:10 p.m. DA SILVA, Rodrigo D. BALLOW, Daniel J. AB #38 10/09/14 9:18 a.m. AB #6 10/08/14 12:55 p.m. DARWISH, Oussama BISHAY, John H. Poster #25 10/09/14 2:10 p.m. Poster #9 10/09/14 1:00 p.m. AB #76 10/10/14 2:27 p.m. DAVIS, John W. AB #79 10/11/14 8:14 a.m. BRAWER, Michael K. Poster #27 10/09/14 2:10 p.m. DENES, Bela S. Poster #6 10/09/14 1:00 p.m. BROCKMAN, John AB #71 10/10/14 1:52 p.m. DESAI, Vikas Case #3 10/09/14 3:45 p.m. BRUSH, Thomas Case #2 10/09/14 3:45 p.m. DONATUCCI, Craig F. Poster #38 10/09/14 2:10 p.m.

73 DONOHUE, Robert E. HAMILTON, Zachary A. AB #39 10/09/14 9:25 a.m. AB #20 10/08/14 3:56 p.m. AB #68 10/10/14 11:33 a.m. AB #26 10/08/14 4:38 p.m. Poster #10 10/09/14 1:00 p.m. DOWLING, Robert A. Case #1 10/09/14 3:45 p.m. AB #53 10/10/14 8:35 a.m. AB #54 10/10/14 8:42 a.m.

DUM, Travis W. HANKINS, Ryan Poster #19 10/09/14 1:00 p.m. Poster #48 10/09/14 2:10 p.m. Poster #32 10/09/14 2:10 p.m. HEINLEN, Jonathan ESWARA, Jairam R. AB #82 10/11/14 8:28 a.m. AB #10 10/08/14 1:26 p.m. AB #15 10/08/14 2:01 p.m. HERRERA-CACERES, Jaime AB #16 10/08/14 2:08 p.m. AB #43 10/09/14 11:21 a.m. Poster #39 10/09/14 2:10 p.m. Poster #44 10/09/14 2:10 p.m. HIRANO, Daisaku Poster #46 10/09/14 2:10 p.m. AB #36 10/09/14 9:04 a.m. Poster #47 10/09/14 2:10 p.m. Poster #8 10/09/14 1:00 p.m. Poster #13 10/09/14 1:00 p.m. Poster #15 10/09/14 1:00 p.m. HUYNH, Danny L. AB #3 10/08/14 12:34 p.m. FLORES, David M. AB #4 10/08/14 12:41 p.m. ISHARWAL, Sudhir AB #83 10/11/14 8:35 a.m. AB #5 10/08/14 12:48 p.m. Poster #5 10/09/14 1:00 p.m. FORREST, John B. AB #74 10/10/14 2:13 p.m. JACKSON, Charles M. AB #2 10/08/14 12:27 p.m. FURR, James Case #6 10/09/14 3:45 p.m. JONES, Anna AB #72 10/10/14 1:59 p.m. GETZENBERG, Robert H. Poster #24 10/09/14 2:10 p.m. KENNY, McCabe C. AB #77 10/11/14 8:00 a.m. GRAZIANO, Christopher E. Poster #11 10/09/14 1:00 p.m. KIM, Eric H. AB #30 10/09/14 8:22 a.m. GRIMSBY, Gwen M. Video #2 10/09/14 7:30 a.m. KOH, Chester J. AB #61 10/10/14 10:44 a.m. AB #64 10/10/14 11:05 a.m. AB #65 10/10/14 11:12 a.m. LAPICZ, Lynn GRUENENFELDER, Jennifer AB #67 10/10/14 11:26 a.m. AB #57 10/10/14 9:03 a.m. LARKE, Robert J. HADDAD, Ahmed Poster #36 10/09/14 2:10 p.m. AB #29 10/09/14 8:15 a.m. AB #37 10/09/14 9:11 a.m.

74 LE, Margaret PARKER, William P. p re s en t er Poster #29 10/09/14 2:10 p.m. AB #18 10/08/14 3:42 p.m. a bst ra ct Poster #33 10/09/14 2:10 p.m. AB #22 10/08/14 4:10 p.m. Poster #35 10/09/14 2:10 p.m. AB #23 10/08/14 4:17 p.m. AB #75 10/10/14 2:20 p.m. LONGO, Thomas A. AB #81 10/11/14 8:21 a.m. POOLI, Aydin AB #85 10/11/14 8:49 a.m. AB #45 10/09/14 11:35 a.m. AB #46 10/09/14 11:42 a.m. MALM-BUATSI, Elizabeth A. AB #62 10/10/14 10:51 a.m. POWELL, Christopher L. AB #88 10/11/14 10:37 a.m. Poster #12 10/09/14 1:00 p.m. Poster #16 10/09/14 1:00 p.m. MARTINEZ, Laura AB #24 10/08/14 4:24 p.m. PSHAK, Thomas J. Case #4 10/09/14 3:45 p.m. AB #44 10/09/14 11:28 a.m.

MARTINEZ, Roxanne RAMADAN, Mohammad Poster #21 10/09/14 2:10 p.m. Poster #41 10/09/14 2:10 p.m. AB #59 10/10/14 10:30 a.m. MEENAKSHI-SUNDARAM, Bhalaajee RITCHIE, Ted AB #66 10/10/14 11:19 a.m. Poster #45 10/09/14 2:10 p.m.

MILLS, Jesse N. ROBLES, Jennifer Poster #34 10/09/14 2:10 p.m. AB #11 10/08/14 1:33 p.m.

MING, Jessica ROVE, Kyle AB #42 10/09/14 11:14 a.m. AB #1 10/08/14 12:20 p.m. AB #27 10/08/14 4:45 p.m. MORGAN, Monica S. C. AB #28 10/08/14 4:52 p.m. AB #33 10/09/14 8:43 a.m. AB #69 10/10/14 1:45 p.m. SIEGEL, Jordan A. AB #12 10/08/14 1:40 p.m. NELSON, Jonathan S. AB #13 10/08/14 1:47 p.m. Poster #43 10/09/14 2:10 p.m. Poster #37 10/09/14 2:10 p.m.

NGUYEN, Jenny SINGLA, Nirmish AB #78 10/11/14 8:07 a.m. AB #8 10/08/14 1:12 p.m. AB #9 10/08/14 1:19 p.m. OCHOA DEL REAL, Juan M. Case #5 10/09/14 3:45 p.m. SIOMOS, Vassilis J. Video # 5 10/09/14 7:30 a.m. OSORNIO SANCHEZ, Victor Poster #7 10/09/14 1:00 p.m. SLAYDEN, Christopher P. AB #41 10/09/14 11:07 a.m.

SMITH, Sean AB #21 10/08/14 4:03 p.m.

75 SNYDER, Charles T. WIMBERLY, Jennifer M. AB #56 10/10/14 8:56 a.m. Poster #31 10/09/14 2:10 p.m.

STANASEL, Irina WINDSPERGER, Andrew AB #60 10/10/14 10:37 a.m. AB #34 10/09/14 8:50 a.m. AB #35 10/09/14 8:57 a.m. TAUSCH, Timothy J. AB #51 10/10/14 8:21 a.m. AB #14 10/08/14 1:54 p.m. AB #89 10/10/14 2:34 p.m. WYRE, Hadley Whitney AB #19 10/08/14 3:49 p.m. TRULSON, Jerry J. Poster #4 10/09/14 1:00 p.m. YAACOUB, Ramy Y. AB #31 10/09/14 8:29 a.m. UWAYDAH, Nabeel Ibrahim AB #32 10/09/14 8:36 a.m. Poster #40 10/09/14 2:10 p.m. Poster #1 10/09/14 1:00 p.m. Poster #2 10/09/14 1:00 p.m. VELAZQUEZ-MACIAS, Rafael- Francisco YEAST, Carrie E. Poster #23 10/09/14 2:10 p.m. Poster #18 10/09/14 1:00 p.m. Poster #28 10/09/14 2:10 p.m. AB #58 10/10/14 9:10 a.m.

WESTFALL, Nicholas ZAINFELD, Daniel E. AB #52 10/10/14 8:28 a.m. Video # 4 10/09/14 7:30 a.m. AB #84 10/11/14 8:42 a.m. WILSON, Shandra S. Poster #30 10/09/14 2:10 p.m.

76 PODIUMS

Podium #1 CLEAN-INTERMITTENT CATHETERIZATION AS AN INITIAL MANAGEMENT STRATEGY PROVIDES FOR ADEQUATE PRESERVATION OF RENAL FUNCTION IN PATIENTS WITH PERSISTENT CLOACA David J. Chalmers, MD1, Kyle O. Rove, MD2, Cole A. Weidel, MD2, Suhong Tong, 3 4 1

MS , Georgette L. Siparsky, PhD and Duncan T. Wilcox, MD P O DIUM s 1Division of Pediatric Urology, Children’s Hospital Colorado; 2Department of Surgery, Division of Urology, University of Colorado; 3Department of Biostatistics and Information, University of Colorado; 4Children’s Hospital Colorado (Presented by: Kyle O. Rove)

Objective: Persistent cloaca is a rare, congenital anomaly involving the genital, urinary and rectal organ systems. While prompt bowel diversion is the standard of care, the optimal method of genitourinary decompression is unclear. Bladder outlet obstruction and hydrometrocolpos are common complications that can lead to obstructive uropathy, abdominal distention, infection, perforation and acidosis. Proposed management strategies include early surgical diversion (vesicostomy, vaginostomy, ureteroscopy, ) or clean-intermittent catheterization (CIC) of the common channel. We hypothesized that CIC is an adequate means of genitourinary decompression and preservation of renal function, regardless of the severity of cloacal anomaly. Methods: We reviewed all patients with persistent cloaca from a single, tertiary care center from 1995 to 2013. We collected data regarding renal function (serial serum creatinine prior to definitive reconstruction, and baseline estimated GFR), presence of hydrocolpos, hydronephrosis, vesicoureteral reflux (VUR) or renal dysplasia, and length of the common channel. A linear mixed model was used to calculate creatinine change over time in relation to method of management and child age. Estimated GFR was calculated using the Schwartz equation for neonates = 0.33 x height in cm / serum creatinine in mg/dL. T−test was used for continuous data and Fisher’s exact test was used for binomial data. P<0.05 was considered significant. Results: 25 patients were identified. 9 (36%) patients underwent early surgical diversion vs 16 (64%) managed by CIC prior to formal reconstruction. 7 had short common channels (< 3 cm) and 18 had long common channels (≥ 3 cm). 22 patients had serum creatinine data available for analysis. Hydrocolpos was present in 14 (56%) of all patients. When comparing the two management groups, there was no significant difference in hydronephrosis, high-grade hydronephrosis (grades III−IV, p = 0.62), any VUR (p = 0.33), high-grade VUR (grades III−V, p = 0.62), hydrocolpos (p = 0.21) or renal dysplasia (p = 0.42). No significant differences were found between mean baseline GFR for diversion (16.8 mL/min per 1.73 m2) versus CIC (28.7 mL/min per 1.73 m2, p = 0.22). There was no difference in creatinine trend between the two groups (See Figure). Conclusion: CIC is an adequate initial management strategy to decompress the genitourinary tract in patients with persistent cloaca. CIC preserves renal function similar to early surgical decompression.

77 Continued on next page Podium #2 PREVALENCE OF PENILE CANCER IN THE STATE OF ARKANSAS Mark Jackson, MD1, Jody Purifoy, APN1, Horace Spencer, MS1, Mohammad Azam, BS1, Susan Thapa, BS1, Abby Holt, BS2 and Matthew Katz, MD1 1UAMS; 2AR Cancer Registry (Presented by: Mark Jackson)

Objective: Penile cancer (PC) occurs in less than 1 out of 100,000 men in the U.S. Herein, we examined the period prevalence of Penile Cancer from 2001−2010 in the state of Arkansas (AR). We hypothesized that the period prevalence (PP) in AR is higher than the US national average. Methods: Data was collected on patients treated at the University of Arkansas for Medical Sciences (UAMS) for PC using the International Classification of Diseases 9th Revision (IDC−9) and Current Procedural Terminology (CPT) codes from 2001−2010. ICD−9 and CPTs were obtained using UAMS’s data warehouse, which compiles all diagnoses and procedures performed at our institution. To include patients not treated at UAMS, we used Arkansas Central Cancer registry which collects data on cancer cases diagnosed and treated throughout AR. Patients with ICD−9: 187.2, 187.3, and 187.4 and a CPT of: 38500, 38760, 38765, and 54105, were included. The incidence and period prevalence of penile cancer were calculated and adjusted for age to compare with the US rates, which were derived from the CDC-Wonder system. Information was gathered regarding age, smoking status, insurance type and race. Results: A total of 539 cases of PC were identified. 491 patients were AR residents. For AR residents treated at UAMS: the PP of PC was 3.58 cases per 100,000; the age-adjusted overall PP was 3.43 cases per 100,000; Whites—4.02 cases per 100,000 (n=464); African-Americans—3.02 cases per 100,000 (n=66); and Hispanics—0.65 cases per 100,000 (n=5). For the entire state the overall PP was 1.4 per 100,000 (95% CI: 1.2−1.6); Whites—1.2 per 100,000 (95% CI: 1.2−1.6); African Americans—1.0 per 100,000 (95% CI: 0.4−1.7). Smoking information was available for 196 patients: 85.2% (n=167) smoked and 14.7% (n=29) non-smokers. For patients treated at UAMS, 3 had Medicare Part A, 65 had Medicaid of AR, 9 had both Medicaid and Medicare Part A, 66 were self-pay, and 396 had some form of additional third party insurance. Conclusion: Our results suggest an overall higher period prevalence of penile 78 Continued on next page cancer in Arkansas when compared to the US national average over the 10 year period of our review (US rate of 0.8 per 100,000). Possible explanations could be lower rates of , higher smoking rates, or poorer access to healthcare. Yet, exact causes to explain the increased risk of penile cancer in AR remains unclear.

Podium #3 SURVIVAL OUTCOME IN MEN RECEIVING RADICAL PROSTATECTOMY P O DIUM s AFTER RADIATION FOR ADENOCARCINOMA OF THE PROSTATE Danny Huynh, MD, Alex Henderson, BS, Naveen Pokala, MD University of Missouri – Columbia (Presented by: Danny Huynh)

Objective: Salvage prostatectomy in radiation resistant prostate cancer is feasible in select patients that do not have metastatic disease. The long-term survival benefit following salvage prostatectomy has not been clearly established. This study evaluates the long-term survival outcome in men that underwent radical prostatectomy (RP) following radiation. Methods: SEER 18 registry was searched to identify patients that underwent RP following radiation for adenocarcinoma of prostate between 1988 and 2010. The patients were analyzed for demographics, grade and stage at presentation and surgical procedure. Patients with more than one primary or unknown stage were excluded. The primary endpoint of the study was overall survival (OS) and cancer specific survival (CSS). Results: 364 men were identified. The mean age was 63.6 years, 86.3% were white (n=314), 9% were black (n=33) and 4.7% other (n=17). The grade was well differentiated (WD) (n=12), moderately differentiated (MD) (n=198), poorly differentiated (PD) (n=150) and unknown (n=4). 78.6% (n=286) of the patients underwent pelvic lymph node dissection (PLND) at the time of RP. 198 of these patients had a recorded nodal yield between 0−38 nodes. The pT stage distribution was pT2 (n=178), pT3 (n=90) and pT4 (n=96). 280 patients had nodal metastasis status recorded and 40 patients had node positive disease. The 10 and 20−year OS was 86.2% and 65.8 % and the CSS was 93% and 83.6%, respectively. The 10 and 20−yr OS by grade was 81.6% and 40.5% (MD) and 67.9% and 32.8% (PD). The CSS was 93.6% and 74.6% (MD) and 79.9% and 69.6% (PD), respectively. The OS and CSS for the WD group was 58.3% and 91.3% respectively. CSS in the node negative and node positive groups was lower at 10 years, 83.5% vs 78%, but similar at 15 years, 66.9% vs 67.3%, respectively. On multivariate analysis, grade, PLND status and node positive status did not significantly affect survival. Conclusion: Radical prostatectomy following primary radiation treatment offers patients good long-term survival. Patients with node positive disease that survive over 10 years seem to have similar outcomes to node negative patients at 15 years.

79 Podium #4 FOLLOW-UP SURGICAL INTERVENTIONS IN PATIENTS WITH URINARY DIVERSION: A COMPARISON BETWEEN ORTHOTOPIC NEOBLADDERS AND ILEAL CONDUITS David Flores, MD, Katie Murray, DO, Daniel Zainfeld, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas (Presented by: David Flores)

Objective: Patients undergoing radical cystectomy with urinary diversion often require additional surgical interventions related to their urinary diversion. The objective of this study was to compare the type of urinary diversion performed with the type of surgical interventions that patients underwent related to their cystectomy and urinary diversion to assess if the type of urinary diversion increased the likelihood of requiring follow-up surgical procedures. Methods: We retrospectively reviewed patients undergoing a radial cystectomy with either a neobladder or ileal conduit reconstruction at the University of Kansas from 2004 until 2013. Specific data regarding the need for additional surgical procedures performed at the University of Kansas were recorded. Procedures included were any urological stone procedure, reconstructive procedures including artificial urinary sphincter (AUS) and inflatable penile prosthesis (IPP), open procedures of the abdomen including ureteral anastomosis revisions as well as incisional/ventral hernia repairs, and endoscopic procedures of the , neobladder, ileal conduit or . Results: We analyzed the data of 120 patients that underwent creation of a neobladder and 120 patients that underwent the creation of an ileal conduit and found that patients that had a neobladder were roughly six times more likely to require an endoscopic intervention (78 vs.12) and were twice (76 vs. 37) as likely to require additional open surgical interventions when compared to patients that underwent the creation of an ileal conduit. 51 patients in the neobladder arm and 94 in the ileal conduit arm did not require any addition surgical intervention. The mean age of patients in the neobladder arm was 60 years and 68 years for the conduit arm. Conclusion: Many patients undergoing a radial cystectomy will require additional surgical procedures throughout the remainder of their lives and this is important to consider when counseling patients about the choice of urinary diversion. This study documents that patients undergoing the creation of an orthotopic neobladder are much more likely to require additional surgical procedures, which may be an important factor in counseling this population with may comorbidities.

Podium #5 INCREASING FRAILTY AS MEASURED BY RISK ANALYSIS INDEX PREDICTS POSTOPERATIVE COMPLICATIONS AND MORTALITY IN UROLOGY PATIENTS Sudhir Isharwal, MBBS, Jason Johanning, MD, Kendra Schmid, MD, Roy Williams, MD, Chad Lagrange, MD UNMC (Presented by: Sudhir Isharwal)

Objective: Our objective was to determine the impact of preoperative frailty, as 80 Continued on next page measured by validated risk analysis index (RAI), on the occurrence of postoperative complications after urologic in a national database comprised of diverse practice groups and cases. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005−2011 for a list of abdominal, vaginal, transurethral and scrotal urological surgeries using current procedural terminology codes (CPT). The study population was subdivided into two groups based on the nature of procedures performed: complex procedures (abdominal or vaginal) and simple procedures

(transurethral or scrotal). Risk analysis index was calculated using preoperative P O DIUM s NSQIP variables to determine preoperative frailty. Major postoperative morbidities (pulmonary, cardiovascular, renal and infectious), mortality, return to operating room, discharge destination and readmission to hospital were examined. Results: The study identified 42,715 patients who underwent urological procedures – 25,693 complex and 17,022 simple procedures. Mean RAI score (range) was 7.75 (0−53). The majority of patients scored low on the RAI (90.57 % with RAI < 10). As the RAI score increased, there was a significant linear increase in postoperative complication and mortality rate (both P<0.0001). Similarly, rate of return to operating room and hospital readmission rate increased as RAI increased (both P<0.0001). Additionally, rate of discharge to home decreased. Interestingly, mortality rate in patients with high RAI did not differ comparing simple to complex procedures (P=0.90) whereas complications were significantly greater in the complex operation (P=0.01). Conclusion: Increase in frailty, as measured by RAI score, is associated with increased postoperative complications and mortality. RAI may allow for rapid identification and counseling of patients who are at high-risk for adverse perioperative outcomes.

81 Podium #6 “DOES INSTRUCTION MODIFIED TO VARK® QUESTIONNAIRE LEARNING STYLE AFFECT PSYCHOMOTOR TRAINING IN DA VINCI SI® ROBOTIC TRAINEES?” Susan Tarry, MD, Daniel Ballow, MD, William Tarry, MD, Justin Fang, MD UTMB (Presented by: Daniel Ballow)

Objective: We hypothesize that administering instructional education for da Vinci Si® robotic trainees that is based upon their learning style as defined by the validated VARK® learning style questionnaire (visual, auditory, reading/ writing, kinesthetic or multimodal) will result in significantly greater improvement in performance metrics when tested against trainees who were taught with non- tailored instructional materials. Our primary aim is to test this hypothesis and our secondary aims include designing curricula based upon VARK® learning style, and to identify attributes that predict a successful learner. Methods: Fifty volunteer medical students and surgical residents were recruited. They completed the validated VARK® questionnaire to determine their preferred learning style, and a novel questionnaire asking demographic information and experience in exercises requiring manual dexterity. Next, they completed 3 exercises representative of actual robotic surgery on the da Vinci Si® simulator: Ring Walk 2, Energy and Dissection 2, and Tubes. The participants were randomized into two groups: a group with an educational intervention matched to their Vark® learning style, and a group with a randomized intervention unmatched to their learning style. Next, they completed the same three exercises on the da Vinci Si® surgical simulator. Performance metrics were recorded from the simulator scores for pre-intervention and post-intervention. The overall score (OS) and the critical errors (CE) score were analyzed using logistic regression models. Results: Regression Analysis showed that for the Overall Score (OS), any experience with musical instrument was predictive of improved performance post-intervention (OR: 0.431, 95% CI 0.2−0.9). Matching for learning style did not appear to improve the performance on the simulator with regards to OS. However, for the regression specific to the Critical Errors (CE) outcomes both matching for VARK intervention and any experience with a musical instrument was predictive for outcome: Matched VARK® OR: 7.25, (95% CI 0.95−55.2) and musical experience OR: 0.939, (95% CI 0.168−0.918). Conclusion: Our study is ongoing but preliminary results reveal that while an educational intervention matched to VARK® learning style has not significantly improve Overall Score (OS) on the da Vinci Si Skills Simulator®, it does reduce Critical Errors (CE). In addition, CE is significantly reduced and OS is significantly improved in individuals with experience with musical instruments. Financial Disclosure: Study was funded in part by Intuitive Surgical, Inc.

82 Continued on next page P O DIUM s

Podium #7 THE “TRAVELING PUMP”: A NOVEL APPROACH TO PREVENT PUMP MIGRATION IN PATIENTS UNDERGOING TWO INCISION ARTIFICIAL URINARY SPHINCTER PLACEMENT Brian Christine Urology Centers of Alabama (Presented by: Brian Christine)

Objective: A potential complication of pump placement when an artificial urinary sphincter (AUS) is placed through two incisions is cephalad migration of the pump. The resulting high riding pump can make use of the AUS difficult or painful. We call this migration the “traveling pump.” Surgeons have relied upon the patient pulling the pump down into the to prevent pump migration. We describe use of an external purse-string suture to prevent the complication of the traveling pump. Methods: From January, 2010, through March 1, 2014, one hundred thirty-nine (151) patients underwent AUS placement through two incisions. The pump was secured in a dependent position using an externally placed purse-string suture. After device placement, a suture of 2−0 PDS was passed through the skin of the scrotum as follows: the tubing of the pump was held against the under surface of the scrotal wall and the needle of the PDS was passed under the tubing and out the scrotal skin; the tubing was then allowed to fall away from the scrotal wall and the needle of the PDS was passed through the skin over the tubing; the suture was tied over the tips of suture scissors. Patients returned in 5−7 days for stitch removal. Results: No pump migration occurred. Patients report the pump to be in an accessible position in the scrotum. No infections or complications related to the purse string stitch occurred, though one (1) patient did require explantation of the AUS secondary to infection. Conclusion: Use of an externally placed purse string stitch to secure the optimum pump position of a two incision AUS is safe and effective. Additionally, the surgeon does not have to rely upon the patient to maintain his pump in good position. Use of this technique eliminates the complication of the traveling pump.

83 Podium #8 3.5 CM AUS CUFF EROSION OCCURS PREDOMINANTLY IN RADIATED PATIENTS: ANALYSIS OF THE FIRST 100 CASES Jay Simhan, MD, Nirmish Singla, MD, Timothy J. Tausch, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Nirmish Singla)

Objective: Since its pre-market availability in September 2009, the 3.5 cm artificial urinary sphincter (AUS) cuff has become the predominant size implanted at our tertiary care center. We report the first 100-case clinical experience using the 3.5 cm cuff in an attempt to identify risk factors for cuff erosion. Methods: All patients undergoing 3.5 cm AUS cuff placement by a single surgeon from September 2009 to August 2013 were reviewed. Each patient underwent perineal cuff placement; those undergoing transcorporal or tandem cuff surgery were excluded. Preoperative characteristics, technical considerations, and postoperative outcomes were analyzed. Risk factors associated with cuff erosion were also evaluated. Results: Of 163 consecutive men who underwent AUS placement at our institution during the 4-year study period, 100 (61%, mean age 70 yrs, range 46−86) received the 3.5 cm cuff (mean follow-up 31 mo) and were the subject of this analysis. Cuff erosions occurred in 13/100 of these men (13%), the vast majority of whom had a history of pelvic radiation (11/13, 85%). Most 3.5 cm cuff patients had a history of radiation (52/100, 52%) with erosion occurring in 11/52 (21%); cuff erosion occurred in only 2/48 (4%) of non-radiated men (p<0.05). History of radiation was the only significant risk factor associated with an erosion event (OR 6.2, CI [1.3−29.5]). Conclusion: Men with a history of radiation who undergo placement of a 3.5 cm AUS cuff experience an increased risk of cuff erosion. Men without radiation appear to have no higher erosion risk compared to other cuff sizes.

Podium #9 HIGH SUBMUSCULAR VERSUS SPACE OF RETZIUS PLACEMENT OF AUS PRESSURE REGULATING BALLOONS Nirmish Singla, MD, Jay Simhan, MD, Gregory R. Thoreson, MD, Timothy J. Tausch, MD, J. Francis Scott BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Nirmish Singla)

Objective: Traditional placement of artificial urinary sphincter (AUS) pressure regulating balloons (PRB) within the space of Retzius (SOR) may be challenging and subject to troublesome complications. We recently developed a novel high submuscular (HSM) technique for PRB placement beneath the rectus abdominis muscle during AUS implantation. We report our longitudinal experience utilizing this technique and compare functional outcomes of HSM placement to traditional SOR placement of the PRB. Methods: We retrospectively reviewed a prospectively maintained database of AUS patients between July 2007 and January 2014. Only 61−70 cm H2O PRBs were placed through a trans-scrotal approach via an HSM tunnel or within the SOR. Demographics, perioperative risk factors, cuff durability and functional

84 Continued on next page outcomes were compared between groups. Results: 232 consecutive patients underwent AUS placement with a mean follow up of 38 months. SOR placement was performed in 139 (60%) patients while HSM placement was performed in 93 (40%). A trend towards improved continence (defined as 0−1 pads/day) was noted in the HSM group (88% vs. 81%, p=0.15), and fewer revisions were needed in HSM patients (6.5% vs. 18%, p=0.01). Other functional outcomes were similar between groups (Table). Although mean follow- up was longer for patients undergoing SOR placement (51 vs. 20 mos, p<0.001),

Kaplan-Meier analysis revealed no difference between groups with regards to P O DIUM s rates of explantation (p=0.71) or revision (p=0.36). Conclusion: High submuscular placement of the PRB at the time of AUS implantation offers a safe and effective alternative with equivalent functional outcomes to traditional SOR.

Podium #10 ARTIFICIAL URINARY SPHINCTER REPLACEMENT LEADS TO HIGHER RATES OF MECHANICAL FAILURE AND URETHRAL EROSION Jairam Eswara, MD, Valary Raup, MD, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Objective: AUS failure can be due to urethral atrophy/erosion, device failure, or infection. The purpose of this study was to characterize the results of AUS revisions and replacements. Methods: From 1988−2012, 261 men underwent 388 AUS placements (214), revisions (76), or replacements (98). Revision was performed for recurrent/ persistent SUI. Replacement was performed for urethral erosion/infection or mechanical failure. Endpoints included reoperation, worsening SUI, urethral erosion, and infection. Results: Mean age was 69.1 years and median follow-up 34.6 months. AUS replacement was associated with higher rates of mechanical failure (p=0.036) and urethral erosion (p<0.001) than virgin AUS placement. AUS replacement after urethral erosion was associated with a higher rate of subsequent urethral erosions (p<0.001) than virgin AUS placement, while AUS replacement after mechanical failure had no higher rate of persistent SUI (p=0.980), mechanical failure (p=0.112), or urethral erosion (p=0.332). There was no difference between the virgin AUS placement group and the AUS revision group with regard to 85 Continued on next page persistent SUI (p=0.244), mechanical failure (p=0.310), urethral erosion (p=0.448), or overall failure (p=0.336). Median times to revision and replacement after virgin AUS placement were 33.1 months and 48.6 months, respectively. After initial AUS placement, the rate of subsequent revision was 21% and replacement was 17%. Among AUS replacements, median time to erosion was 5.7 months and median time to mechanical failure was 33.1 months. Conclusion: AUS replacement is associated with higher rates of mechanical failure and urethral erosion. AUS revision surgery is as safe, effective and durable as virgin AUS placement.

Podium #11 OUTCOMES OF INTRA-URETHRAL TRIAMCINOLONE INJECTIONS IN THE TREATMENT OF POST-URETHROPLASTY RECURRENT STRICTURE DISEASE Jennifer Robles, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University of Saint Louis School of Medicine − Division of Urology (Presented by: Jennifer Robles)

Objective: Although urethroplasty remains the gold standard for the treatment of recurrent strictures, the ideal management of post-urethroplasty recurrences remains undefined. Intra-urethral injections of triamcinolone, a long-acting corticosteroid, have been proposed to reduce stricture formation, though published data is minimal. We evaluated our results with intra-urethral triamcinolone injections for the management of recurrent short strictures after urethroplasty. Methods: We retrospectively identified 48 optical internal performed at our institution from 1998−2011 for recurrent post-urethroplasty strictures. Surgeries were performed by a single surgeon (SBB) with radial cuts using a Sasche urethrotome. Triamcinolone (400mg) was injected in the site in 33 patients. Stricture recurrence was defined as any subsequent urethral operative procedure. Fisher’s Exact Test was used to determine statistical significance. Patients were stratified by age, stricture location and size, smoking and diabetes history. Results: Thirty-three patients who underwent internal urethrotomy and triamcinolone injections (T+) were compared to 14 patients who underwent internal urethrotomy alone (T−). Stricture locations were bulbar in 70% and mean stricture lengths were 1.4cm (T+) and 1.25cm (T−) with p>0.05. Overall, one quarter (24%) of T+ patients required another surgical procedure compared to over half (57%) of T− patients (p: 0.045). The relative risk was 0.42 (0.2−0.9). The absolute risk reduction was 33% and the relative risk reduction was 58%. Neither type of secondary procedure nor time to procedure were significantly different. Age, stricture location and length were not significantly different between groups. Smoking and diabetes history had no impact on stricture recurrence in either group. Conclusion: Intra-urethral triamcinolone injections at time of internal urethrotomy for short post-urethroplasty strictures may decrease stricture recurrence by more than half. However, it does not affect the type of next treatment nor the time to recurrence.

86 Podium #12 “7-FLAP”PERINEAL URETHROSTOMY: AN EFFECTIVE OPTION FOR OBESE MEN WITH DEVASTATED URETHRAS Nathan R. Starke, MD, Jay Simhan, MD, Timothy N. Clinton, BA, Timothy J. Tausch, MD, Jordan A. Siegel, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Jordan A. Siegel)

Objective: We present an updated experience using our previously reported P O DIUM s lateral perineal “7-flap” technique for perineal urethrostomy (PU), highlighting its role in a variety of patients with advanced urethral stricture disease. Methods: All patients who underwent 7-flap PU from 2009−2013 were reviewed. PU was constructed by advancing a “7”-shaped laterally based perineal skin flap into a spatulated, amputated bulbo-membranous urethra. The contralateral side of the amputated proximal urethra was then matured to the advanced perineal skin. Patients were stratified by body mass index (BMI) and outcomes were compared. Results: Among 748 patients having urethroplasty during the study period, 22 men (2.9%; mean age 61, range 31−80) underwent 7-flap PU for advanced stricture disease (mean follow up 32 mo). A majority of patients (14/22, 64%) were obese (BMI ≥30). Disease etiologies consisted primarily of lichen sclerosus (9/22, 41%) while 6/22 (27%) had failed prior urethral reconstructions elsewhere. Mean operative time was 108 min (range 54−214), mean EBL was 76 cc (30−200), and all patients were discharged immediately after surgery. Urethrostomy performance was possible in all patients regardless of BMI (mean 33, range 22−43), and there were no differences with regards to EBL (p=0.71), operative time (p=0.38), or success rate (p=0.76) in obese patients undergoing 7-flap PU. The vast majority of patients (21/22, 95%) are voiding spontaneously on follow-up without the need for any additional procedure. Conclusion: In our updated experience, performance of 7-flap urethrostomy has resulted in durable long-term success with acceptable performance in technically challenging cases.

Podium #13 ANASTOMOTIC REOPERATIVE URETHROPLASTY Jordan A. Siegel, MD, Timothy J. Tausch, MD, Lee C. Zhao, MD, MS, Jay Simhan, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Jordan A. Siegel)

Objective: We examined our institutional experience with single-stage urethroplasty using an excision and primary anastomosis (EPA) technique, comparing outcomes of reoperative cases to those of initial anastomotic reconstructions. Methods: We reviewed our database of patients who underwent urethroplasty for stricture disease at our tertiary referral center from 2007−2013, and identified patients with a history of prior urethral reconstruction. The chosen technique of reoperative urethroplasty was based on stricture length, location, and severity, regardless of prior repair. We recorded the number of prior urethroplasties, previous urethroplasty technique, time to reoperation, interval endoscopic treatment, stricture characteristics, and reoperative urethroplasty methods. Outcomes were

87 Continued on next page analyzed and results were compared to those patients who underwent primary anastamotic urethroplasty during the same study interval. Results: Among the 736 urethroplasties performed at our center during the 6 year study period, data were available for 586 (80%). Of those 586, 75 (13%) were reoperative cases and EPA was the most common salvage technique performed (42/75, 56%). Reoperative EPA was successful in 37/42 (88%), which was similar to the success rate of primary EPA urethroplasty at our institution during the same study period (329/354, 93%, p=0.22). Among reoperative cases, failed skin or buccal mucosal graft repairs constituted the most common initial repair type (34/75, 45%), which were amenable to EPA in almost half of the cases (15/34, 44%). Among 17 patients who failed a prior EPA, 3 (18%) with a history of radiation therapy failed repeat EPA. Of the remaining 14/17 re-do EPA cases (82%), repeat EPA was successful in 12/14 (88%). Failed endoscopic treatment preceded reoperative urethroplasty in the majority of cases (44/75, 59%). Median time from primary to secondary urethroplasty was 96 months (range 0.5−518). Conclusion: EPA urethroplasty is highly reliable for reconstruction of both primary and reoperative urethral strictures without a history of radiation therapy.

Podium #14 MINIMALLY INVASIVE VENTRAL SLIT/SCROTAL FLAP TECHNIQUE FOR RECONSTRUCTION OF ADULT BURIED PENIS Mary E. Westerman, BA, Timothy J. Tausch, MD, Lee C. Zhao, MD, MS, Jay Simhan, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Timothy J. Tausch)

Objective: We present our experience using a new minimally invasive reconstructive technique based on a long ventral preputial slit combined with a rotational scrotal flap (VSSF) employed in an effort to avoid skin grafts in selected cases of buried penis. Methods: We reviewed all patients who underwent reconstruction of buried penis between 2008 and 2013. The VSSF surgical technique consisted of an initial release of phimosis by making a ventral midline penile incision extending into the scrotum. After anchoring the prepuce back to the proximal lateral penile shaft bilaterally, lateral scrotal flaps were developed and then rotated to resurface the ventral penile shaft (Figure). Results: Among 31 patients having reconstruction of buried penis during the study

88 Continued on next page interval, 15 (48%) had the VSSF procedure, while 11 (35%) had a more invasive procedure involving excision and split-thickness skin grafting (STSG). Five patients (16%) who underwent excision with adjacent tissue transfer were excluded. Mean age and BMI were similar for VSSF and STSG patients [age 51 years (26−75) vs. 54 (29−73), p = 0.51; BMI 41.7 kg/m2 (29.8−51.4) vs. 38.6 (23.0−47.8), p = 0.30]. The majority of VSSF patients (13/15, 87%) had a pathologic diagnosis of lichen sclerosus (LS). Six patients (40%) presented with voiding difficulties, and 7/15 (47%) had failed at least one prior intervention. Each patient underwent VSSF as an outpatient with no perioperative complications. Mean estimated blood loss was P O DIUM s significantly less in VSSF procedures (57mL vs. 132mL, p = 0.03). Average length of stay was significantly longer (5.3 days, p<0.01) for patients who underwent STSG. An equivalent proportion of VSSF patients and STSG patients (12/15, 80.0% vs. 10/11, 90.9%; p = 0.75) remained satisfied with no further interventions. Recurrences in 3/15 VSSF patients (20.0%) were due to LS, panniculus migration, and concealment by redundant, edematous groin tissue. Two of these patients underwent subsequent successful skin grafting. Conclusion: VSSF is a safe, effective, and minimally invasive reconstructive option for patients with buried penis.

Podium #15 IMPACT OF PELVIC RADIATION ON GRACILIS FLAP RECTOURINARY FISTULA REPAIR Valary Raup, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Objective: Bladder outlet dysfunction (BOD) is a common complication of pelvic radiation. Patients who receive pre-operative radiation are predisposed to developing BOD due to bladder neck contracture (BNC) or stress urinary incontinence (SUI). Here, we review our experience with gracilis flap fistula repairs for rectourinary fistulae (RUF) in patients who underwent pelvic radiation. Methods: We reviewed 20 patients who underwent surgical repair of a RUF with

89 Continued on next page gracilis flap at Barnes-Jewish Hospital between 2003 and 2013. Patients were assessed for post-operative fistula closure and BOD due to SUI or BNC. Possible risk factors associated with repair failures were examined, such as age, ASA score, diabetes, coronary artery disease, hypertension, obesity, smoking, intraoperative urinary/fecal diversion and prior radiation. Results: The mean age in our series was 62 years (50−73) at time of surgery with median follow-up of 23.6 months (3.6−64.9). Among patients who underwent pelvic radiation prior to fistula repair, 11/13 (85%) developed BOD compared to 2/7 (29%) who were not radiated (p=0.02). Flap failure was noted in 4/13 radiated patients vs. 3/7 non-radiated patients (p=0.65). Of the 7 flap failures, revisions included repeat gracilis flap (2), coloanal pull-through (2), rectal advancement flap (1), sliding flap (1), and omental flap (1). The median time to revision was6.7 months (3.5−24.9). Conclusion: RUF repairs in radiated patients should be undertaken with caution. Even if the fistula is successfully repaired, patients may still have bladder outlet dysfunction. Consequently, patients should be counseled about all possible procedures, including permanent urinary diversion as primary therapy.

Podium #16 RADIOGRAPHIC PARAMETERS TO DISTINGUISH BENIGN PROSTATIC OBSTRUCTION FROM CONCOMITANT URETHRAL STRICTURE Jairam Eswara, MD, Jennifer Robles, MD, Kerry Madison, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Objective: Urodynamic parameters used to assess patients with urethral strictures (e.g., PVR, peak flow, and pressure/flow) have values overlapping those of patients with benign prostatic obstruction (BPO). Correction of the stricture in these patients may not relieve their lower urinary tract symptoms, thus it is useful to identify patients who have concurrent BPO. Herein we identify radiographic parameters on (RUG) and voiding cystourethrogram (VCUG) that distinguish patients who have BPO and a urethral stricture from those who have only a urethral stricture. Methods: This is a retrospective review of 15 consecutive patients who underwent anterior urethroplasty with a diagnosis of BPO along with 15 consecutive patients who underwent anterior urethroplasty without BPO. In addition, 4pts with stricture without BPO and 11pts with both stricture and BPO had data that allowed comparison for certain variables (total 19 w/o BPO and 26 with BPO). All surgeries were performed by 1 surgeon (SBB) from 2000 to 2012. Patients were identified as having BPO by urodynamics or by symptomatic relief with an alpha- blocker. 9/15pts who had BPO required TURP/PVP after urethroplasty for BPO. Radiographic characteristics were evaluated by RUG and VCUG by 2 independent reviewers (JRE, SBB). Univariate and multivariable analysis were performed. Results: Median age was 49yrs in the non-BPO group and 50yrs in the BPO group (p=0.88). Features associated with BPO and urethral stricture included narrowed prostatic urethra on RUG (p=0.016), bladder trabeculation/diverticula (p=0.0000003), inability to complete VCUG (p=0.03), PVR>180cc after VCUG (p=0.00006), narrow bladder neck (BN) width on VCUG (mean 1.0cm vs. 1.8cm, p=0.0002), BN shape (concave vs. convex, p=0.003), and lower BN/ 90 Continued on next page prostatic length ratio (0.40 vs. 0.57, p=0.01). Factors not associated with BPO in the setting of urethral stricture included non-visualization of proximal urethra on RUG (p=0.063), enlarged bladder (p=0.12), and closed BN on VCUG (p=1.0). The multivariable model including BN width, BN shape, PVR, and trabeculation/ diverticula showed that each additional variable increased the odds of having BPO 13.4−fold (p=0.009). Conclusion: Urethral stricture patients with urethrographic findings of narrowed prostatic urethra, bladder trabeculation/diverticula, inability to complete VCUG,

PVR>180cc, narrow BN, concave BN on VCUG, and low BN/prostatic length ratio P O DIUM s should be counseled that they may need subsequent therapy to treat prostatic obstruction in addition to their urethroplasty.

Podium #17 POST-OPERATIVE WOUND INFECTIONS AND STEROID USE ARE INDEPENDENT RISK FACTORS FOR MIDLINE FASCIAL DEFECTS IN PATIENTS AFTER RADICAL CYSTECTOMY WITH ILEAL CONDUIT Hajar Ayoub, MD, Andrew Pisters, Wei Wei, Colin Dinney, MD, H. Barton Grossman, MD, Ashish Kamat, MD, Jay Shah, MD, O. Lenaine Westney, MD MD Anderson Cancer Center (Presented by: Hajar Ayoub)

Objective: Radical cystectomy with ileal conduit is the most commonly performed treatment for patients with muscle invasive bladder cancer. Midline fascial defects including wound dehiscence and incisional hernia are morbid postoperative events. Our objective was to identify predisposing factors for midline fascial defects in this population with multiple morbidities. Methods: The records of all patients who underwent cystectomy and ileal conduit between 1994 and 2011 were reviewed. Wound dehiscence was defined as a midline separation of the fascia requiring operative reclosure. Post-operative incisional hernia was defined as a palpable fascial defect on follow-up physical exam. Univariate and multivariate logistic regression models of factors that may be predictive of midline fascial defect were conducted. Results: A total of 963 patients were identified with an average age of 70.65 years and mean follow-up of 27.7 months (SD, ± 32.2). Ninety-four patients (9.8%) developed a midline fascial defect (51 wound dehiscences, 43 incisional hernias). A multivariate logistic regression model for midline fascial defects demonstrated that steroid usage and post-operative wound infections were independent predictors. Fewer than expected wound events occurred in patients who received neoadjuvant chemotherapy. In the wound dehiscence sub-group, post- operative wound infection was the only significant factor (p=<0.0001, OR=12.69, 6.15−25.51). Patient age, body mass index, prior abdominal surgery and post-op pneumonia were not independently predictive of either midline fascial defect or wound dehiscence. Conclusion: Based on our ileal conduit population, post-operative wound infection is the most important predictor of the devastating complication of wound dehiscence and the development of midline defects overall. Steroid usage was a factor for midline fascial defects but not specifically wound dehiscence. In our cohort, patients who received neoadjuvant chemotherapy had fewer wound complications. This phenomenon may be related to supplemental fascial closure techniques in this sub-group. 91 Continued on next page Podium #18 STANDARDIZING CARE AFTER RADICAL CYSTECTOMY: A MEANS TO IMPROVE QUALITY AND OUTCOMES William Parker, MD, Zachary Hamilton, MD, Samuel Hund, Moben Mirza, MD, Eugene Lee, MD, Jeffrey Holzbeierlein, MD University of Kansas Medical Center (Presented by: William Parker)

Objective: Radical cystectomy (RC) is a unique operation that is marked by numerous challenges to both patient and physician. At the University of Kansas, we recently implemented a clinical care pathway for RC patients that encompasses pre-operative, perioperative and post-operative care with an emphasis on reducing hospital stay and unnecessary testing. Herein we present our initial experience with our clinical pathway. Methods: Beginning in late 2013, we initiated a clinical care pathway to standardize care before and after RC. Key points include an emphasis on a 4-day hospital stay during pre-operative counseling, standardization of perioperative medications and routine in-hospital care, which includes the use of a clinical nurse educator that provides daily education and post-hospital follow-up. A cessation of lab draws (unless clinically indicated) on post-operative day 1 is performed if laboratory results are normal at that time. Beginning on postoperative day 1 patients receive 24 ounces of clear fluids which is liberalized to unlimited clears on post-operative day 2 until return of bowel function (flatus) at which point it is increased toa regular diet. Once on a regular diet diversion stents are removed and the patient is discharged after tolerating a diet for 1 day. As a means of quality assurance, we reviewed the records of immediately prior to and after implementation of the pathway. Results: A total of 48 patients were included for review; 33 prior to implementation and 15 after. After implementation of the pathway, LOS was reduced from 8.4 to 5.5 days (p=0.0001) and time to regular diet was reduced from 6.7 to 4.3 days (p=0.0005). With this reduction in length of stay (LOS) as well as the focus on reducing unnecessary lab tests, we were able to reduce the number of routine labs (BMP and CBC) from 16.8 to 11.4 (p=0.02). Prior to implementation the rate of in- hospital complication (Clavien dindo grade II or higher) was 48% as compared to 40% after implementation. While the hospital stay was reduced and the number of tests performed was reduced, there was no significant reduction in the rate of 30 day readmissions (6 patients prior to implementation (20%) versus 3 patients after implementation (18%)). Conclusion: The implementation of an aggressive clinical pathway has resulted in a reduction in length of stay and routine in-hospital testing in our population of patients undergoing RC. Additionally, there was no apparent increased risk of in- hospital complication or readmission. 92 Podium #19 OUTCOMES OF IMPAIRED PERIOPERATIVE GLUCOSE REGULATION IN A RADICAL CYSTECTOMY POPULATION Hadley Wyre, MD, Griffin Josh, MD, Moben Mirza, MD, J. Brantley Thrasher, MD, Jeffrey Holzbeierlein, MD, Eugene Lee, MD University of Kansas (Presented by: Hadley Wyre)

Objectives: Bladder accounts for 70,000 new cancer cases and 15,000 deaths P O DIUM s per year in the United States. Diabetic patients have up to a 40% increase risk of bladder cancer. Diabetes has also been shown to be a risk factor for progression and recurrence in non-muscle invasive disease and portends a lower survival. However, to our knowledge diabetes and impaired glucose regulation have never been evaluated in a radical cystectomy population. We hypothesized that impaired perioperative glucose control correlates with increased perioperative complications and worse pathologic stage. Methods: We retrospectively reviewed our institutional radical cystectomy database between July 2006 and June 2010. We compared the effect of preoperative, postoperative (postoperative day 1), and follow-up (3 month) glucose on perioperative complications as well as pathologic tumor and nodal stage. 95 percent confidence intervals were calculated in the standard fashion. Results: We identified 42 patients who had complete glucose values, pathologic data, and perioperative outcomes. The risk of having any complication after surgery was 47% vs 70% for those with a preoperative glucose below 100mg/dL and above 100mg/dL, respectively, with a relative risk of 1.60 (0.85−3.02). The risk of having pT3 or greater was also increased in patients with preoperative glucoses above 100mg/dL, 21% vs 40% (RR=1.67, 0.70−3.97). When examining the effect of follow-up glucose, we found that there was an increased risk of both complications and pathologic stage, but not as profound as the preoperative glucose, with a relative risk of 1.12 (0.44−2.85) and 1.32 (0.44−3.96), respectively. There was no correlation between immediate post-operative glucose and perioperative complications or pathologic stage. Conclusion: There was a trend towards increased perioperative complications and increased pathologic tumor stage in those patients with a single preoperative or follow-up glucose above 100mg/dL. Further investigating with larger numbers is warranted in the future to determine the effect of perioperative glucose regulation on radical cystectomy patients and pathologic outcomes.

Podium #20 PT0N0 AFTER RADICAL CYSTECTOMY WITHOUT NEOADJUVANT CHEMOTHERAPY: PATIENT CHARACTERISTICS Zach Hamilton, MD, William Parker, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

Objective: Historical studies have demonstrated that the rate of pT0 in patients undergoing radical cystectomy (RC) without neoadjuvant chemotherapy is approximately 10%. Furthermore, patients with pT0N0 staging have improved

93 Continued on next page outcomes after RC, including excellent survival and low risk of recurrence. However, no study has attempted to identify factors which may predict pT0 status at the time of RC. The aim of our study was to determine the characteristics of patients with pT0N0 after RC that did not receive neoadjuvant chemotherapy. Methods: A retrospective review of RC for urothelial cell carcinoma from 2010 – 2013 was performed. Patients with a final stage of pT0N0 that did not receive neoadjuvant chemotherapy served as the study population. Clinicopathologic characteristics including clinical stage, grade, information regarding previous number of transurethral resections (TUR) and intravesical treatments were collected. Results: Of 242 patients, 18 (7.4%) were identified as having pT0N0 disease without neoadjuvant chemotherapy at RC. The clinical stage was 22% Ta, 22% Tis, 11% T1 and 44% T2. Mean time from last TUR to RC was 88.9 days. The mean number of TUR treatments prior to RC was 2.8. The median time from diagnosis to cystectomy was 197.5 days. Eleven patients (61%) had received intravesical treatment, predominantly with induction BCG. Lymphovascular invasion (LVI) was only noted in 1 patient. There were no cancer recurrences in the mean follow up of 534 days. No factors were predictive of pT0N0 status. Conclusion: It is difficult to predict which patients are downstaged to T0, and it is unclear whether this is a function of resection, chemotherapy, cancer biology or a combination. In this cohort, 7.4% had pT0N0 status without neoadjuvant chemotherapy. In addition, 44% of patients had T2 disease and were downstaged to T0, affirming that resection alone can downstage patients. The absence of LVI may relate to a cancer biology that is more favorable and amenable to this downstaging. Stage pT0N0 after RC is a good prognostic indicator with long survival and low rates of recurrence. Better stratification of patients who can be downstaged may help identify those with favorable cancers and avoid neoadjuvant chemotherapy.

Podium #21 INTRAVESICAL CHITOSAN/IL−12 IMMUNOTHERAPY INDUCES TUMOR- SPECIFIC SYSTEMIC IMMUNITY AGAINST BLADDER CANCER Sean Smith1, Bhanu Koppolu, PhD1, Sruthi Ravindranathan, PhD Candidate1, Samantha Kurtz, MS Student1, Lirong Yang, PhD1, Matthew Katz, MD2 and David Zaharoff, PhD1 1University of Arkansas; 2University of Arkansas for Medical Sciences (Presented by: Sean Smith)

Objective: Bladder cancer is a highly recurrent disease in need of novel, durable treatment strategies. This study assessed the ability of an intravesical immunotherapy composed of a coformulation of the biopolymer chitosan with interleukin−12 (CS/IL−12) to induce adaptive tumor-specific immunity. The durability of immunity and the potential for intravesical immunotherapy to control metastases were also explored. Methods: Intravesical CS/IL−12 immunotherapy was used to treat established orthotopic MB49 and MBT−2 bladder tumors. To investigate the durability and extent of the resultant adaptive immune response, cured mice were rechallenged both locally (intravesically) and distally. The ability of splenocytes from cured mice to lyse targets in a tumor-specific manner was assessed in vitro. The antitumor efficacy of intravesical CS/IL−12 immunotherapy against simultaneous orthotopic 94 Continued on next page and subcutaneous MB49 tumors was also investigated. Results: All mice receiving intravesical CS/IL−12 immunotherapy experienced high cure rates of orthotopic disease. Cured mice rejected 100% of intravesical tumor rechallenges and up to 100% of distant subcutaneous rechallenges in a tumor- specific manner. Protective immunity was durable, lasting for at least 18 months after immunotherapy. In vitro studies revealed that lytic activity of splenocytes from cured mice was robust and tumor-specific. In an advanced bladder cancer model, intravesical CS/IL−12 immunotherapy controlled both orthotopic and subcutaneous tumors in 70% of treated mice. P O DIUM s Conclusion: Intravesical CS/IL−12 immunotherapy creates a robust and durable tumor-specific adaptive immune response against bladder cancer. The specificity, durability and potential of this therapy to treat both superficial and muscle-invasive disease are deserving of consideration for clinical translation. Support provided by the National Cancer Institute (K22CA131567 to D. A. Z)

Podium #22 RADICAL CYSTECTOMY AFTER PRIMARY TREATMENT OF PROSTATE CANCER: IS ROBOTIC SURGERY A VIABLE OPTION? William Parker, MD, Zachary Hamilton, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas Medical Center (Presented by: William Parker)

Objective: Robotic assisted radical cystectomy (RARC) is a minimally invasive technique that in early results appears oncologically equivalent to open radical cystectomy (ORC). Additionally, there is evidence that RARC is associated with similar perioperative complication rates. We sought to evaluate perioperative outcomes in a high-risk population of patients undergoing radical cystectomy after prior primary therapy for adenocarcinoma of the prostate. Methods: A retrospective review from 2010−2013 was performed of patients undergoing RARC or ORC after primary therapy for prostate cancer (either primary radical prostatectomy or radiation therapy). An additional group of patients undergoing RARC for bladder cancer without prior therapy for prostate cancer was included as a comparison control. Pre-operative clinicopathologic data, operative data and post-operative course were included for evaluation. Results: 52 patients met criteria for evaluation; 5 RARC and 13 ORC after primary therapy, and 34 RARC without prior therapy. In patients undergoing RC after primary treatment of prostate cancer, 13 had undergone external beam radiation therapy, 3 with , and 7 with radical prostatectomy. Average time from radiation to RC was 100.3 months. Average OR time was longer in the RARC group compared to ORC (401 minutes versus 312 minutes; p = 0.03) after prior therapy (restricted to those undergoing lymphadenectomy), however there was no difference in estimated blood loss (528ml versus 615ml, p=0.69), nodal yield (12.7 versus 18.0 nodes, p=0.75), LOS (7 v 7.4 days, p=0.92), 30 day readmission rates (0 versus 3 patients, p=0.14), or 90 day readmission rates (0 versus 1 patient, p=0.68). At the time of final follow-up (mean 13.7months) there were no ureteroenteric strictures in either group. When comparing RARC after primary therapy for prostate cancer to control RARC, there was no difference in OR time (401 minutes versus 465 minutes, p=0.22), estimated blood loss (528ml versus 375ml, p=0.24), nodal yield (12.7 versus 18.3 nodes, p=0.11), or LOS (7 versus 95 Continued on next page 9.3 days, p=0.12). Conclusion: RARC after a primary treatment for prostate cancer appears to be no different when compared to ORC with respect to EBL, nodal yield, LOS and readmission rates, and while OR time is longer in the RARC group, it is no different than RARC controls. While our data are limited by our small sample size, it supports the use of this modality in a population at higher-risk for operative difficulty and complication.

Podium #23 DOES THE PRESENCE OF VARIANT HISTOLOGY EFFECT PATHOLOGIC OUTCOMES FOLLOWING NEOADJUVANT CHEMOTHERAPY William Parker, MD, Moben Mirza, MD, Maura O’Neil, MD, Jeffrey Holzbeierlein, MD University of Kansas Medical Center (Presented by: William Parker)

Objective: Neoadjuvant chemotherapy (NAC) is the mainstay of treatment for muscle invasive bladder cancer. The diagnosis is based on pathologic review of TUR specimens; however, review of cystectomy specimens can reveal the presence of variant histology. We sought to review the effect of unrecognized variant histology on outcomes following NAC. Methods: Using a retrospective chart review we identified patients with cT2−T4 bladder cancer who underwent NAC followed by RC with the presence of residual disease for pathologic re-review. Clinical and pathologic data were analyzed. Results: 45 patients were identified for analysis. Variant histology was present in 33.3% of patents. Most common variants included squamous cell carcinoma in 7, clear cell in 3, and micropapillary in 2. When comparing the presence of variant histology, upstaging, stable disease, and down staging were present in 46.6% versus 26.6% (p = 0.31), 53.3% versus 23.3% (p=0.09), and 0% versus 100% (p = 0.002) respectively. There was no difference in progression-free survival or cancer specific survival between groups. Conclusion: Our data demonstrates a similar rate of variant histology as has been previously described in review of non-NAC specimens. Additionally there is a trend towards inferior pathologic response to NAC in those patients with unrecognized variant histology prior to NAC. While our data is limited by small numbers, it does suggest a group of patients who are at a higher risk of inferior response to chemotherapy.

Podium #24 PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER ARE AT HIGHER LONG-TERM RISK OF DYING FROM A SECOND METACHRONOUS PRIMARY NEOPLASM THAN FROM THEIR INITIAL BLADDER CANCER Laura Martinez, Ji Li, PhD, Hanh Dung Dao, PhD, Kai Ding, PhD, Joel Slaton, PhD University of Oklahoma (Presented by: Laura Martinez)

Objective: Patients with non-muscle invasive bladder cancer (NMIBC) are at risk for developing recurrent tumors or even progressing to higher stages requiring expensive long-term surveillance. However, of potentially greater interest, this

96 Continued on next page population is at risk for developing a metachronous second primary tumor that will significantly impact their survival. We interrogated the SEER database to identify the range of secondary primary tumors presenting in patients with bladder cancer and the relative risk of dying from nonurothelial cancers. Methods: We examined the SEER database from 1992−2007 to identify all patients presenting with nonmetastatic bladder cancer. Patients were stratified by stage [NMIBC (T1, T1, CIS) vs MIBC (T2,T3,T4)] The population was then assessed for the development of second primary tumors (lung, colorectal, head and neck, and breast − prostate was excluded due to risk of overidentification in P O DIUM s a urology population). Parameters assessed included time to development of the secondary primary and risk of dying from a metachronous second primary tumor versus their initial bladder cancer Results: 16717 patients with nonmetastatic primary bladder cancer were identified 79% NMIBC and 21% MIBC. Among this population, 3668 patients (22%) developed a metachronous second primary cancers included lung in 57%, colorectal in 25%, head and neck in 9%, and breast in 10% (up to 35% in the female population). More than 70% of these metachronous second primary tumors occurred among patients with NMIBC. In general, 19% of these second primary tumors were identified in the first 12 months, 34% by 24 months and 65% by 60 months with similar distributions among the various types of neoplasms. Depending upon the neoplasm, the risk of a patient with a NMIBC dying from the metachronous second primary tumor was 2−8 fold higher than the risk of dying from the initial bladder cancer. Conclusion: Most patients who develop a metachronous second primary tumor following bladder cancer present within the first five years of discovery of the first bladder tumor. Ironically while much expense is put into the surveillance for recurrent bladder tumors, patients with NMIBC bladder cancer are at higher risk of dying from a second primary tumor than from their bladder cancer. There results suggest a need for working with primary care provider to develop a long term strategy to screen these for a second primary tumor.

Podium #25 PERIOPERATIVE OUTCOMES OF ROBOTIC SALVAGE CYSTECTOMY AND INTRACORPOREAL URINARY DIVERSION Alvin Goh, MD1, Monty Aghazadeh, MD2, Brian Miles, MD1, Monish Aron, MD3, Mihir Desai, MD3 and Inderbir Gill, MD3 1Houston Methodist Hospital; 2Baylor College of Medicine; 3University of Southern California (Presented by: Monty Aghazadeh)

Objective: Open salvage cystectomy is a viable option for select patients with bladder cancer who have failed definitive chemotherapy/radiation (XRT) treatment or received prior pelvic therapy for prostate cancer. However, there is limited data regarding safety and feasibility of robotic cystectomy in the salvage setting. We report perioperative outcomes with salvage robotic cystectomy and intracorporeal urinary diversion from two centers of excellence. Methods: Between January 2011 and September 2013, 12 patients underwent robotic salvage cystectomy and intracorporeal urinary diversion for bladder cancer. Patients who 1) failed previous chemotherapy and XRT for bladder cancer or 2) those with a history of surgery or XRT for prostate cancer were considered salvage 97 Continued on next page cases. Demographics and perioperative outcomes, including complications and survival data, were prospectively collected. Results: Of the 12 patients, 4 (33.3%) had previously failed treatment of bladder cancer with XRT/chemotherapy and 8 patients (66.7%) underwent prior treatment for prostate cancer (5 XRT, 3 robotic prostatectomy). All patients were male, 9 (75.0%) patients were ASA class ≥ 3, mean age was 73.9 years (range, 65−85), and mean BMI was 26.4 kg/m2 (17.7−34.9). Intracorporeal diversions included ileal conduit in 11 patients (91.7%) and ileal neobladder in 1 patient (8.3%). All cases were completed without intraoperative complications with mean operative time of 7.3 hours (5.6−11.9) and mean estimated blood loss (EBL) 284.2cc (60−500). There were no observed rectal injuries, urinary fistula, ureteral strictures, or bowel leaks. Median length of hospital stay was 5.5 days (4−24). Final pathology revealed TCC in all patients, with T4, T3, T2, and TIS disease in 4(33.3%), 2(16.7%), 4(33.3%), and 2(16.7%) patients, respectively. Mean lymph node (LN) yield was 40.8 (0−164). Non-organ confined disease was found in 7 (58.3%) on final pathologic analysis, 1 (8.3%) patient had positive nodes and 1 (8.3%) had positive soft-tissue margins. Within 90 days, high-grade complications (≥ Clavien grade 3) occurred in 3 patients (30.0%) and 2 (20.0%) patients required readmission. At mean follow-up of 129 days, only 1 patient (8.3%) experienced a recurrence (distant). Conclusion: We demonstrate safety and feasibility of salvage robotic cystectomy with intracorporeal diversion in patients with bladder cancer. Early oncologic outcomes and 90-day complication rates appear promising, despite the high incidence of locally advanced disease and increased surgical complexity. Although this is the largest reported experience to our knowledge, further investigation with a larger cohort and longer follow up is necessary.

Podium #26 URETEROINTESTINAL STRICTURE RATE IS NOT AFFECTED BY ROBOTIC TECHNIQUE FOR RADICAL CYSTECTOMY Zach Hamilton, MD, William Parker, MD, Moben Mirza, MD, Jeffrey Holzbeierlein, MD University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

Objective: Robotic-assisted laparoscopic surgery is now being utilized in the setting of radical cystectomy (RC). Retrospective reviews comparing open and robotic RC favor robotic RC for decreased estimated blood loss (EBL) and shorter hospital stays. Furthermore, a decreased rate of perioperative and 90-day complications has been reported for robotic techniques. Ureterointestinal stricture rates after open RC range from 10−20%. Rates of ureterointestinal stricture have not been extensively studied between robotic and open techniques. We aim to determine if such a difference exists between robotic and open RC at our institution. Methods: A retrospective review was performed comparing open to robotic RC at our institution involving two fellowship trained oncologic urologists. A cohort of patients undergoing robotic RC from 2012−2013 with curative intent for bladder cancer was compared to a previous cohort undergoing open RC. In order to remove potential for selection bias towards robotic surgery, we chose an equally sized open cohort from 2009−2010 when robotic RC was not routinely being utilized. All patients underwent Bricker ureterointestinal anastomosis. Patient demographics, 98 Continued on next page perioperative variables, and rates of ureterointestinal stricture were measured. Results: Rates of ileal conduit and neobladder urinary diversion were similar between groups and there was no difference with respect to mean age or BMI. The mean EBL was significantly lower in the robotics cohort (388mL vs 754mL, p=0.0002); however, the mean operating time was significantly higher for the robotic cohort (457 vs 310 min, p=0.0001). There was not a statistically significant difference in the rate of ureterointestinal strictures between cohorts (open 20% vs robotics 12.5%, p=0.5).

Conclusion: Robotic surgery for RC provides an advantage of decreased EBL. P O DIUM s There does not appear to be a statistically significant difference in ureterointestinal stricture rates between open or robotic technique.

Podium #27 PATHOLOGIC RISK FACTORS FOR OCCULT METASTATIC DISEASE IN POST-PUBERTAL PATIENTS WITH STAGE I TESTICULAR STROMAL TUMORS Kyle O. Rove, MD1, Paul D. Maroni, MD1, Carrye R. Cost, MD2, Diane L. Fairclough DrPH, MSPH3, Gianluca Giannarini, MD4, Kris Ann Schultz, MD5 and Nicholas G. Cost, MD1 1Department of Surgery, Division of Urology, University of Colorado; 2Department of Pediatrics, Division of Pediatric Oncology, University of Colorado; 3Department of Biostatistics and Informatics, University of Colorado; 4Department of Urology, University of Bern; 5Department of Pediatrics, Division of Pediatric Oncology, Children’s Hospitals and Clinics of Minnesota (Presented by: Kyle O. Rove)

Objective: Testicular stromal tumors (TSTs) are rare, representing 3−5% of testicular tumors. Most TSTs (90%) present with clinically-localized disease (Clinical Stage I), with up to 10% behaving in a malignant fashion. We reviewed existing literature to analyze the impact of previously identified pathologic risk factors on harboring occult metastatic disease (OMD) in post-pubertal male patients with Clinical Stage I TSTs. Methods: A literature search using PubMed was conducted using the terms: “testicular stromal tumors,” “testicular leydig cell tumors,” “testicular sertoli tumors,” “testicular interstitial tumors,” “testicular granulosa tumor,” and “testicular sex cord tumors.” Post-pubertal patients (≥13 years or noted pubertal status) with Clinical Stage I TSTs were included. Study exclusion criteria included: publication pre- 1980, non-English language articles, and those lacking data on: clinical stage, pathologic risk factors, or post- follow-up. Pathologic risk factors were: tumor >5cm, ≥3 mitoses/HPF, positive margins at orchiectomy, rete testis invasion, lymphovascular invasion, cellular atypia, and necrosis. For analysis we included only those with data on recurrence, survival, and time-to-event. OMD was defined as positive nodes at primary retroperitoneal lymph node dissection (RPLND) or relapse on surveillance. We hypothesized that patients with ≥2 risk factors would experience lower 5yr OMD Free Survival (OMDFS) than those with <2 risk factors. Analysis was performed using log-rank analysis to compare groups. Results: 231 patients from 44 publications were included with a median age at diagnosis of 35yrs (range 12−76). 5yr OMD-free survival (OMDFS) and overall survival in patients with Stage I TSTs were 91.2% and 93.2%, respectively. When comparing those who harbored OMD to those who did not, we observed 99 Continued on next page an increased risk of OMD for each risk factor (p<0.001). This observed effect was cumulative, with more risk factors being associated with increased risk. 5yr OMDFS was 98.1% for those with <2 risk factors vs. 44.9% for those with ≥2 risk factors (p<0.001). Conclusion: The existing literature on pathologic risk factors for OMD in this population is insufficient to make broad clinical recommendations. However, these factors appear to risk-stratify patients and may be useful for future research investigating adjuvant therapy (i.e., RPLND) in higher-risk patients. This review indicates that such a stratification system has a rational basis.

Podium #28 PATHOLOGIC RISK FACTORS IN PRE-PUBERTAL PATIENTS WITH STAGE I TESTICULAR STROMAL TUMORS Kyle O. Rove, MD1, Paul D. Maroni, MD1, Carrye R. Cost, MD2, Diane L. Fairclough, DrPH, MSPH3, Gianluca Giannarini, MD4, Kris Ann Schultz, MD5 and Nicholas G. Cost, MD1 1Department of Surgery, Division of Urology, University of Colorado; 2Department of Pediatrics, Division of Pediatric Oncology, University of Colorado; 3Department of Biostatistics and Informatics, University of Colorado; 4Department of Urology, University of Bern; 5Department of Pediatrics, Division of Pediatric Oncology, Children’s Hospitals and Clinics of Minnesota (Presented by: Kyle O. Rove)

Objective: Testicular stromal tumors (TSTs) are rare, representing 10% of pre- pubertal testicular tumors. Fortunately, in the pre-pubertal male, these lesions are almost universally benign, with only rare case reports of metastases. In post- pubertal TSTs, various pathologic risk factors have been identified in patients with clinically-localized disease (Clinical Stage I) that increase the risk of occult metastatic disease (OMD). We systematically reviewed existing literature to analyze the impact of these risk factors on OMD in pre-pubertal patients. Methods: A literature search using PubMed was conducted using the terms: “testicular stromal tumors,” “testicular leydig cell tumors,” “testicular sertoli tumors,” “testicular interstitial tumors,” “testicular granulosa tumor,” and “testicular sex cord tumors.” Pre-pubertal patients (<13yr or noted pubertal status) with Clinical Stage I TSTs were included. Study exclusion criteria included: publication pre-1980, non- English language articles, and those lacking data on clinical stage, pathologic risk factors, or post-orchiectomy follow-up. Pathologic risk factors were: tumor >5cm, ≥3mitoses/HPF, positive margins, rete testis invasion, lymphovascular invasion, cellular atypia, and necrosis. For analysis we included only those with data on recurrence, survival, and time-to-event. OMD was defined as positive nodes at

100 Continued on next page primary retroperitoneal lymph node dissection (RPLND) or relapse on surveillance. Results: 80 patients from 21 studies were included with a median age at diagnosis of 7.2 months (range 1.2mo to 13.9yr). The tumor types were as follows: sertoli cell tumors in 31 patients (39%), juvenile granulosa cell tumor in 27 (34%), leydig cell tumor in 8 (10%), mixed in 7 (9%) and undifferentiated tumors in 7 (9%). Endocrinologic manifestations (virilization or feminization) were reported in 7 (9%). Leydig cell and large cell calcifying sertoli cell tumors presented later (median 8.6 and 8.0yr, respectively) than classic sertoli cell, juvenile granulosa cell or undifferentiated tumors (7.2, 1.2, and 3.6mo, respectively). No patients P O DIUM s were identified to have OMD at RPLND (1 patient) or during follow up surveillance (median follow up 45.6mo, range 4.9–360mo). 99% of patients had 0−1 pathologic risk factor (79 patients) with only 1 patient having 2 risk factors. The most common risk factor was ≥3 mitoses/HPF (16 patients). Thus, no correlation was seen between any particular risk factor and OMD. Conclusion: Pre-pubertal patients with Clinical Stage I TSTs appear to behave in a benign manner. The clinical impact of pathologic factors considered to place post-pubertal TST patients at risk for OMD remains unclear in the pre-pubertal setting.

Podium #29 ONCOLOGIC OUTCOMES FOLLOWING SURGICAL RESECTION OF RENAL CELL CARCINOMA WITH IVC THROMBUS EXTENDING ABOVE THE HEPATIC VEINS: A CONTEMPORARY MULTI-CENTER COHORT Ahmed Haddad1, Christopher Wood2, E.Jason Abel3, Laura-Maria Krabbe1, Oussama Darwish1, R. Houston Thompson4, Jennifer Heckman3, Megan Merril2, Bishoy Gayed1, Arthur Sagalowsky1, Stephen Boorjian4, Vitaly Margulis1 and Bradley Leibovich4 1The University of Texas Southwestern Medical Center, Dallas, TX; 2The University of Texas, MD Anderson Cancer Center, Houston, Texas; 3University of Wisconsin School of Medicine and Public Health, Madison WI; 4Mayo Medical School and Mayo Clinic, Rochester, MN (Presented by: Ahmed Haddad)

Objective: Supra-hepatic IVC tumor thrombus in RCC has historically portended a poor prognosis. With advances in perioperative management of patients with high level thrombi, contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical management of RCC patients with level III−IV IVC thrombi treated at high volume centers. Methods: Clinical and pathologic data of RCC patients with level III−IV thrombus who had surgery from January 2000−June 2013 at 4 tertiary referral centers was examined. Survival outcomes and associated prognostic variables were assessed with Kaplan-Meier and multivariable Cox-regression analyses. Results: 166 patients were identified (69 with level III, and 97 with level IV thrombus). Median post-operative follow-up was 27.8 months. Patients with no evidence of nodal or distant metastases (pN0/X,M0) had 5-yr CSS and OS of 49.0% and 42.2% respectively. There were no differences in survival based on the level of tumor thrombus or pathologic tumor stage. Variables associated with increased risk of death from kidney cancer on multivariable analysis were: regional nodal metastases (HR 3.94,p<0.0001), systemic metastases (HR 2.39,p=0.01), tumor grade 4 (HR 2.25,p=0.02), histologic tissue necrosis (HR 3.11,p=0.004), 101 Continued on next page and elevated pre-operative serum alkaline phosphatase level (HR 2.30, p=0.006). Conclusion: Contemporary surgical management achieves nearly 50% 5-year survival in non-metastatic patients with RCC tumor thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histologic necrosis and elevated pre-operative serum alkaline phosphatase. These findings support an aggressive surgical approach to the management of RCC patients with advanced tumor thrombi. Financial Disclosure: None

Podium #30 CYTOREDUCTIVE NEPHRECTOMY VERSUS TARGETED THERAPY ALONE FOR METASTATIC RENAL CELL CARCINOMA Brandon Manley, MD, Eric Kim, MD, Joel Vetter, Seth Strope, MD, MPH Washington University School of Medicine (Presented by: Eric Kim)

Objective: To externally validate preoperative patient and tumor factors described in the literature to be predictive of a survival benefit of cytoreductive nephrectomy (CN) over targeted therapy alone (TT) in patients with metastatic renal cell carcinoma (mRCC). Methods: We retrospectively reviewed our single institutional cohort of mRCC patients who were evaluated for CN versus TT from 2005 to 2013. Prognostic factors (PF) described in the literature were recorded, specifically: albumin, liver metastasis, symptomatic metastasis, clinical > T3 disease, retroperitoneal and supradiaphragmatic lymphadenopathy. Results: We identified 88 patients undergoing CN and 35 patients undergoing TT. Of patients undergoing CN, 7% (6/88) had 0 PF, 58% (51/88) had 1−2 PF, and 35% (31/88) had 3−5 PF. Of patients undergoing TT, 0% (0/35) had 0 PF, 40% (14/35) had 1−2 PF, and 60% (21/35) had 3−5 PF. Receiving CN versus TT was not predictive of overall survival (OS), when controlling for age, adult comorbidity evaluation (ACE), and PF (p=0.37). Significant predictors of OS include serum albumin (HR 2.1, p<0.001), retroperitoneal lymphadenopathy (HR 2.1, p=0.002), and supradiaphragmatic lymphadenopathy (HR 1.9, p=0.009). Additionally, the number of PF was a significant predictor of OS (HR 1.7, p<0.001). For patients with 0−2 PF, Kaplan-Meier estimated median OS was 663 days for CN and 174 days for TT (log-rank p=0.04). For patients with 3−5 PF, Kaplan-Meier estimated median OS was 184 days for CN and 155 days for TT (log−rank p=0.91). Conclusion: The PF identified in the literature are predictive of OS in our population of patients with mRCC. Patients should be carefully selected for CN. For patients with 0−2 PF, cytoreduction provided a significant survival benefit. However, for patients with 3−5 PF, cytoreductive nephrectomy did not significantly improve survival compared to targeted therapy alone.

Podium #31 RADICAL NEPHROURETERECTOMY FOR PATHOLOGIC T4 UPPER TRACT UROTHELIAL CANCER: CAN ONCOLOGIC OUTCOMES BE IMPROVED WITH MULTIMODALITY THERAPY? Ramy Youssef, MD1, Yair Lotan, MD2, Arthur Sagalowsky, MD2, Shahrokh Shariat, MD3, Christopher Wood, MD4, Jay Raman, MD5, Vitaly Margulis, MD2, Marco

102 Continued on next page Roscigno, MD6, Francesco Montorsi, MD7, Christian Bolenz, MD8 and Wassim Kassouf, MD9 1Duke University; 2UT Southwestern, Dallas, Tx; 3Medical University of Vienna, Vienna, Austria; 4MD Anderson, Houston, Tx; 5Penn State Milton S. Hershey Medical Center, Hershey, PA; 6Ospedali Riuniti of Bergamo, Italy; 7Vita Salute University, Milan, Italy; 8Universitatsklinikum, Mannheim, Germany; 9McGill University, Montreal, Canada (Presented by: Ramy Youssef) P O DIUM s Objective: To report the outcomes of patients with pathologic T4 UTUC and investigate the potential impact of peri-operative chemotherapy combined with radical nephroureterectomy (RNU) and regional lymph node dissection (LND) on oncologic outcomes. Methods: Patients with pathologic T4 UTUC were identified from the cohort of 1464 patients treated with RNU at 13 academic centers between 1987 and 2007. Oncologic outcomes were stratified according to utilization of perioperative systemic chemotherapy and regional LND as an adjunct to RNU. Results: The study included 69 patients, 42 males (61%) with median age 73 (range 43−98). Median follow-up was 17 months (range: 6−88). Lymphovascular invasion was found in 47 (68%) and regional lymph node metastases were found in 31 (45%). Peri-operative chemotherapy was utilized in 29 (42%) patients. Patients treated with peri-operative chemotherapy and RNU with LND demonstrated superior oncologic outcomes compared to those not treated by chemotherapy and/or LND during RNU (3Y−DFS: 35% vs. 10%; P = 0.02 and 3Y−CSS: 28% vs. 14%; P = 0.08). In multivariate Cox regression analysis, administration of peri- operative chemotherapy and utilization of LND during RNU was associated with lower probability of recurrence (HR: 0.4, P = 0.01), and cancer specific mortality (HR: 0.5, P = 0.06). Conclusion: Pathological T4 UTUC is associated with poor prognosis. Peri- operative chemotherapy combined with aggressive surgery, including lymph node dissection, may improve oncological outcomes. Our findings support the use of aggressive multimodal treatment in patients with advanced UTUC.

103 Podium #32 TALL SCORE FOR PREDICTION OF ONCOLOGICAL OUTCOMES AFTER RADICAL NEPHROURETERECTOMY FOR HIGH GRADE UPPER TRACT UROTHELIAL CARCINOMA Ramy Youssef, MD1, Yair Lotan, MD2, Shahrokh Shariat, MD3, Arthur Sagalowsky, MD2, Christopher Wood, MD4, Alon Weizer, MD5, Jay Raman, MD6, Marco Roscigno, MD7, Francesco Montorsi, MD8, Christian Bolenz, MD9, Wassim Kassouf, MD10, Laura-Maria Krabbe, MD11 and Vitaly Margulis, MD2 1Duke University; 2UT Southwestern, Dallas, Tx; 3Medical University of Vienna, Vienna, Austria; 4MD Anderson, Houston, Tx; 5University of Michigan, Ann Arbor, MI; 6Penn State Hershey Medical Center, Hershey, PA; 7Ospedali Riuniti of Bergamo, Bergamo, Italy; 85Vita-Salute University, Milan, Italy; 9Universitätsklinikum Mannheim, Mannheim, Germany; 10McGill University, Montreal, Quebec, Canada; 11University of Muenster Medical Center, Muenster, Germany (Presented by: Rammy Youssef)

Objective: Grade remains the main factor determining treatment decisions for UTUC. We created a simple prognostic tool for prediction of outcomes after radical nephroureterctomy (RNU) for high grade non-metatstatic upper tract urothelial carcinoma (UTUC). Methods: Data from UTUC collaboration database was utilized to include 586 patients who underwent RNU for non-metastatic, node negative, high grade UTUC. A score was defined based on the sum of the selected independent prognostic variables from univariate and multivariate survival analyses. Survival outcomes were compared according to the score. Results: The study included 382 males (65%), 374 kidney tumors (64%) and 212 (34%) ureteric tumors. Pathological tumor stage (T) was ≤ T2 in 304 (52%) and ≥ T3 in 282 (48%) patients. Sessile architecture (A) was found in 204 (35%) and lympho-vascular invasion (LVI) in 152 (26%). Lymphadectomy (L) was performed in 245 (42%). Independent prognostic factors holding significance in multivariate analysis included: T, A, LVI and L. The sum of T (0 < T1, 1= T1, 2= T2, 3= T3 and 4 equal T4), A (papillary = 0 and sessile = 1), LVI (negative = 0 and positive = 1) and L (lymphadenectomy = 0 and no lympadenectomy = 1) was entered into a TALL score (0−7). Disease free survival (DFS) and cancer specific survival (CSS) was stratified into 4 risk categories according to the TALL score: low (n= 172 [29%], TALL 0−2), intermediate (n= 152 [26%], TALL = 3), high (n= 109 [19%], TALL = 4) and very high risk (n= 153 [26%], TALL ≥ 5) using Kaplan- Meier survival analyses (figure). 3 and 5 year DFS and CSS were 90, 86, 92, 90 in low, 73, 71, 79, 75 in intermediate, 63,57,69,58 in high and 39, 34, 47, 38 in very high risk categories. Conclusion: We developed a simple prognostic tool for the prediction of oncological outcomes after RNU for high grade UTUC. This postoperative simplified prediction model can be utilized for counseling of patients, selection for adjuvant systemic therapies and design of clinical trials.

104 Continued on next page P O DIUM s

Podium #33 INITIAL CLINICAL EXPERIENCE WITH PERCUTANEOUS IRREVERSIBLE ELECTROPORATION OF KIDNEY TUMORS Monica Morgan, MD1, Jeffrey Gahan, MD1, Asim Ozayar, MD1, Clayton Trimmer, DO2 and Jeffrey Cadeddu, MD1 1Dept of Urology, University of Texas Southwestern; 2Dept of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas (Presented by: Monica Morgan)

Objective: Irreversible electroporation (IRE) is a nonthermal tissue ablation technique where high voltage electric pulses of microsecond duration are applied to create irreversible nanoscale defects in the cell membrane, leading to apoptosis. We evaluated our initial IRE experience to assess feasibility, safety, effectiveness and radiographic outcomes of IRE renal tumor ablation. Methods: A retrospective analysis of all IRE cases between April and November 2013 was performed. The NanoKnife 15 cm monopolar probe was used for all patients. All procedures were performed under general and with cardiac synchronization. All patients underwent CT guided ablation and a post- procedure contrast-enhanced CT. 11 patients had a minimum of 6 week follow-up with a contrast enhanced CT. Results: A total of 17 tumors underwent IRE. Mean age was 66 years old. Median tumor size was 2cm (1.2−3.6cm). Median R.E.N.A.L. score was 5. Eight patients had biopsy proven RCC (7 clear cell, 1 papillary) and 1 an oncocytic neoplasm. Four patients had a prior history of RCC. One patient had VHL syndrome. The remaining 2 patients had insufficient tissue or a lesion too small for biopsy. There was no significant difference between pre and post-procedure serum Cr (0.95 vs. 0.98 respectively). Procedure time from anesthesia start to finish ranged from 1 to 3.9 hours. The median number of probes placed was 4 (2−5). Median length of stay was 1 day (0−1). There were no complications. CT scan immediately post procedure typically showed decreased perfusion with an enhancing rim at the ablation site. CT scan at 6 weeks was completed in 11 patients (12 tumors). Nine patients (10 tumors) demonstrated no enhancement (< 10 HU) in the ablation site. Two patients with tumors 3.6cm and 1.8cm failed IRE. These patients’ CT scan demonstrated a persistent rim of enhancement. Both underwent successful salvage radiofrequency ablation. The remaining 5 patients have follow-up pending. 105 Continued on next page Conclusion: Percutaneous IRE of kidney tumors has shown to be feasible and safe in our retrospective review of 16 patients. Additional follow-up is needed to confirm the oncologic efficacy of IRE. Comparative studies with other ablative techniques is warranted.

Podium #34 OPEN SURGICAL MANAGEMENT OF RETROPERITONEAL FIBROSIS: A SINGLE INSTITUTION 11-YEAR EXPERIENCE Andrew Windsperger, MD, Robert Larke, MD, Ty Higuchi, MD, PhD, Paul Maroni, MD, Brian Flynn, MD University of Colorado (Presented by: Andrew Windsperger)

Objective: Retroperitoneal fibrosis (RPF) due to inflammatory sources, prior treatment of abdominal and pelvic malignancy, and idiopathic causes can lead to significant ureteral obstruction with subsequent need for intervention. Our institution has managed a large volume of ureteral obstruction due to RPF in an operative fashion with various reconstructive techniques. We sought to review this experience and develop an algorithm for primary treatment and management of failures. Methods: Utilizing a previously constructed database of 139 patients who had undergone ureteral reconstruction over an eleven year period at a single institution, we identified patients with a primary or secondary diagnosis of RPF. Data from three surgeons (TTH, PJM, BJF) including source of RPF, type of repair, preoperative management, comorbid factors, length of follow up, success rate, complications, and need for secondary procedures was obtained. Success rate was defined based on ureteral patency or improvement of renal function. Results: 21 patients met inclusion criteria, of which 11 were bilateral systems, for a total of 32 renal units. Presumed source of RPF was from vascular disease in 3, treatment of lymphoma in 1, radiation-induced in 10, idiopathic in 7, and iatrogenic in 1. Patients were treated via a total of 37 procedures, including 11 ureterolyses, 5 ureterolyses with omentoplasty, 12 ileal ureteral replacements, 3 ureteral reimplantations, 2 ureteroureterostomies with , 1 transureteroureterostomy, 1 Boari Flap, and 2 . Average length of the obstructed segment of was 7.89cm. Our primary success rate was 82%, with primary failures counted for 5 repeat procedures and 2 patients that required nephrectomy. Our overall success rate was 94% with normal eventual drainage of 30/32 renal units. Patients experiencing operative failures were all salvaged with ileal ureteral replacement. Major complications Clavien grade 3 or greater numbered 4 including wound infection requiring debridement or drainage in 2 patients, renal failure requiring , and development of 1 colovesical fistula. Conclusion: Cases of RPF present difficult clinical decision-making and treatment scenarios, and often require complex reconstructive techniques for proper management. Despite this complexity, a high overall success rate can be achieved. Patient factors may contribute to failed initial management, particularly in patients post-radiation or multiple retroperitoneal procedures.

106 Podium #35 ILEAL URETERAL REPLACEMENT FOR COMPLEX URETERAL STRICTURES: A SINGLE INSTITUTION 11 YEAR EXPERIENCE Andrew Windsperger, MD, Robert Larke, MD, Ty Higuchi, MD, PhD, Paul Maroni, MD, Brian Flynn, MD University of Colorado (Presented by: Andrew Windsperger)

Objective: The use of an ileal segment in ureteral substitution or replacement P O DIUM s represents an underutilized option for long, complex ureteral strictures. Our institution has amassed a large cohort of patients treated with ileal ureteral replacement for ureteral obstruction and injuries from multiple sources including retroperitoneal fibrosis, iatrogenic injury, and injuries sustained during the treatment of stone disease. We sought to review this experience and describe our management of unilateral and bilateral ureteral disease. Methods: Utilizing a previously-constructed database of 139 patients who had undergone ureteral reconstruction over an eleven year period at a single institution, we identified patients who had undergone ileal ureteral replacement. Data from three surgeons (TTH, PJM, BJF) including type of injury, type of repair, preoperative management, comorbid factors, length of follow up, success rate, complications, and need for secondary procedures was obtained. Success rate was defined based on ureteral patency or improvement of renal function. Results: 32 patients met inclusion criteria, of which 10 were bilateral systems, for a total of 42 renal units. Mechanism of injury included retroperitoneal fibrosis in 11, prior failed ureteral reconstruction in 5, iatrogenic injury in 5, complications from UPJ obstruction in 3, complications from nephrolithiasis in 4, non-urologic malignancy in 7, and complications of urinary pouch diversion in 7. 14/32 (44%) patients had received prior abdominopelvic radiation. The average length of ureteral defect was 7.3cm. The type of repair included non-tapered ileal ureteral replacement in 20 cases, “reverse seven”ileal ureteral replacement for bilateral disease in 5 patients (10 renal units), ileal Monti tube ureteral replacement in 5 cases, and 7 colonic ureteral replacements. Our overall success rate was 95%, with only 2 long-term failures. Major complications Clavien grade 3 or greater numbered 2, both of which were related to urine leak with need for stent or drain placement. Median length of follow up was 301 days. Conclusion: Ureteral ileal substitution offers excellent reconstructive outcomes even in patients with complex ureteral strictures. Patients with multiple comorbid factors, including a history of treatment with radiation, retroperitoneal fibrosis, and prior failed ureteral reconstruction can experience renal salvage with these techniques.

107 Podium #36 RISK STRATIFICATION OF PATIENTS UNDERGOING NEPHROURETERECTOMY FOR UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT Daisaku Hirano, MD1, Ryo Hasegawa, MD1, Yasuhiro Okada, MD2, Yataroh Yamanaka, MD3, Kenya Yamagichi, MD3, Nozomu Kawata, MD3 and Satoru Takahashi, MD3 1Higashi-matsuyama Municipal Hospital; 2Kobari Hospital; 3Nihon University School of Medicine (Presented by: Daisaku Hirano)

Objective: Upper urinary tract urothelial carcinoma (UUT-UC) is relatively rare, account for 5−10 % of all urothelial carcinomas. In previous studies several factors such as pathological stage (pT-stage), grade, lymphovascular invasion (LVI) and tumor location have been identified as the major prognostic factors in UUT-UC. However, the impact of these potential prognostic factors and the relationship between them on UUT-UC remain vague. The purpose of this study was to clarify prognostic factors in patients with UUT-UC who treated by nephroureterectomy, and seek a better way of finding more favorable clinical results for these patients based on a model for risk stratification. Methods: We retrospectively identified a study population of 174 consecutive patients without distant metastasis and lymph node involvement who underwent nephroureterectomy for UUT-UCs between 1996 and 2013. The clinical and pathological data were analyzed to evaluate predictive factors using Cox proportional hazards models. Prognostic factors assessed were age, gender, preoperative urinary cytology, mode of operation, tumor laterality, tumor location, tumor multifocality, stage (pT2 or less: 81 vs pT3 or more: 93), grade (low: 71 vs high 103), LVI (negative: 85 vs positive: 89), peri-operative chemotherapy, and metachronous intravesical recurrence. Median follow-up was 36 months. Results: In multivariate analysis grade (HR: 2.15, p=0.038), pT−stage (HR: 3.13, p=0.014), and LVI (HR: 5.76, p=0.002) were independent predictors for disease- specific survival (DSS). The relative risk of death could be calculate with the formula, exp (0.788×grade＋1.14×pT−stage＋1.75×LVI). In this equation grade equaled 1 if grade was high, and grade equaled 0 if grade was low, pT−sage equaled 1 if pT−stage was pT3/4 and 0 if pT2 or less. LVI equaled 1 if LVI was present and 0 if absent. Based on the relative risk of death, patients with UUT-UC were divided into 3 risk groups of low (relative risk of death=1), intermediate (2.15 to 12.30) and high (17.99 to 38.86). According to the risk stratification, 42 patients were in the low risk group, 71 patients in the high risk group and 61 patients in the intermediate risk group. Ten-year DSS were 100% in the low risk group, 76% in the intermediate risk group and 19% in the high risk group (p<0.001). Conclusion: Pt-stage, grade and LVI are independent prognostic factors for DSS and the risk stratification using these factors is useful for guide of adjuvant therapy strategies. Patients in the high and /or intermediate risk groups may benefit from postoperative systematic chemotherapy. Financial Disclosure: None

108 Podium #37 VALIDATION OF MAMMALIAN TARGET OF RAPAMYCIN BIOMARKER PANEL IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA Ahmed Haddad1, Nirmish Singla1, Payal Kapur1, Jay Raman2, Matthew Then2, Phillip Nuhn3, Alexander Buchner3, Patrick Bastian4, Christian Seitz5, Sharokh Shariat5, Karim Bensalah6, Nathalie Rioux-Leclercg6, Yair Lotan1 and Vitaly Margulis1 1The University of Texas Southwestern Medical Center, Dallas, TX; 2Penn State Milton S. Hershey Medical Center, Pittsburgh, Pennsylvania; 3University of Munich, P O DIUM s Munich, Germany; 4Paracelsus-Klinik Golzheim, Dusseldorf, Germany; 5Medical University of Vienna, Vienna General Hospital, Vienna, Austria; 6University of Rennes, Rennes, France (Presented by: Ahmed Haddad)

Objective: Previously we demonstrated that degree of dysregulation of mammalian target of rapamycin (mTOR) pathway correlated with oncologic outcomes in patients with clear cell renal carcinoma (ccRCC). We sought to externally validate these findings in a multi-institutional cohort. Methods: Immunohistochemistry for 5 mTOR pathway markers was performed on tissue microarrays of patients with non-metastatic ccRCC treated surgically at four high volume centers. The markers employed were phosphatase and tensin homolog (PTEN), phosphoinositide 3−kinase (PI3K), phosphorylated−mTOR (p− mTOR), phosphorylated−S6 (p−s6), and phosphorylated 4E−binding protein−1 (p−4EBP1). Kaplan Meier analysis was used to determine survival probabilities and univariate and multivariate Cox regression was used to correlate marker status and oncologic outcomes. Results: 528 patients with a median follow-up of 51 months were included. The majority of study patients had localized tumors (71.4%, pT1−2) and low grade histology (78.0%, grade 1−2). Expression of PI3K, PTEN, p−mTOR, p−4EBP1 and p−S6 was altered in 52%, 78%, 26%, 86% and 30% of patients respectively. In univariate analyses, pathologic stage, nodal status, grade and the presence of histologic necrosis predicted disease recurrence and cancer specific mortality. In a multivariate model adjusting for stage and grade, the number of altered biomarkers predicted for disease recurrence but not cancer-specific survival (HR 3.45, p=0.01 for patients with 4−5 altered biomarkers compared to 0−1 altered markers). Kaplan-Meier estimated 5-yr recurrence free survival (RFS) for patients with 0−1 altered markers vs. 4−5 altered markers was 92.8% vs. 75.9% respectively (p=0.008). A biomarker panel consisting of only 2 markers (p−S6 and p−4EBP1) independently predicted for worse RFS (HR 3.92, p=0.005 for patients with 2 altered markers compared to patients with 0 altered markers). Both the 5−biomarker panel and 2−biomarker panel significantly increased the predictive accuracy of the standard clinicopathologic prognostic model. Conclusion: m−TOR pathway related biomarkers add prognostic information in addition to standard pathologic variables in ccRCC patients and may identify patients who could benefit from additional treatments or closer post-operative surveillance.

109 Podium #38 T1A AND T1B RENAL MASSES TREATED WITH LAPAROSCOPIC CRYOABLATION: SHORT-TERM ONCOLOGICAL OUTCOMES AND PER- OPERATIVES RESULTS Rodrigo Donalisio da Silva, MD1, Thomas Pshak, MD1, Diedra Gustafson, MD2, Nicholas Westfall, MD1, Leticia Nogueira, MD1, Wilson Molina, MD1 and Fernando Kim, MD1 1Denver Health Medical Center; 2Denver Health Medical Center (Presented by: Rodrigo Donalisio da Silva)

Objective: Oncological outcomes of laparoscopic renal cryoablation (LCA) for small renal masses (<4cm) is comparable to PN, but there are not any previous studies comparing oncological outcomes for (LCA) in patients with tumors higher than 4cm. The aim of this study is to describe the feasibility and outcomes of LCA between T1a and T1b renal masses. Methods: A retrospective analysis, from our single center prospective maintained renal cancer database, was performed. All patients with T1 renal masses submitted to RCA between 2003 and 2013 were included. Follow-up were performed 7 days after surgery and 3, 6 and 12-month intervals for all patients diagnosed with RCC, and annually thereafter. Results: 144 patients were submitted to LCA at this institution, 127 patients with T1a and 17 with T1b tumors. The tumor size average was 2.49cm in the T1a patients and 4.4 cm in T1b group (p<0.001). The rate of malignancy was lower in the T1a group (46.5%) versus the T1b group (76.5%, p=0.036) (Table 1). Recurrences was comparable between groups (0% in T1a patients and 1 (7.7%) pathological recurrence in the T1b group, p=0.181). There was no difference in operating time (p=0.208), number of probes used (T1a− 2.92 probes and T1b−3.14, p=0.575), conversions from LCA to laparoscopic partial nephrectomy (p=0.226). High grade complications (Clavien III−V) for T1a was 1.6% and 5.6% for T1b (p=0.290), and there was statistically no significant difference between two groups. There was minimal change in renal function following LCA in either group at 12 months (p=0.256) and 24 months (p=0.267). The follow-up period for the T1a group was 18.5 months (9.7 – 36.1months)and 24.1 months for the T1b group (16.0 – 32.8 months), and were similar between groups (p=0.699). Conclusion: Short -term oncological outcomes between T1a and T1b renal masses seem similar to conventional surgical therapy, i.e.; partial nephrectomy and radical nephrectomy. Longer follow-up is necessary to recommend LCA as a standard option to treat T1b renal masses, and a new staging system including masses <5 cm should be considered.

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Podium #39 RENAL CELL CARCINOMA METASTASES; TYPE, GRADE, STAGE AND SITES OF METASTASES Robert Donohue, MD University of Colorado (Presented by: Robert Donohue)

Objective: Renal Cell Carcinoma is assuming epidemic proportions with the increased use of abdominal imaging. Do stage, grade and tumor type affect metastatic disease and sites? Methods: From 1994 to 2009, 152 renal cell tumors were treated with radical nephrectomy or partial nephrectomy. 17 upper tract TCCs and 25 non-malignant masses also underwent surgery. Results: There were 106 clear cell carcinomas, 76%, 24 papillary, 17%, 5 chromophobe, 1 collecting duct and 4 unclassifiable tumors. Fuhrman Grade 2 predominated with 59 tumors; 56%, while Grade 3 occurred in 27 patients, 25%. 23 patients developed metastases. 18 patients had clear cell tumors; 2 papillary, 1 chromophobe while 2 were unclassifiable. No Grade 1 clear cell patients had metastases: 6 Grade 2; 11 Grade 3 and 2 Grade 4 became metastatic. In Stage pT1, two patients developed metastases, in pT2, 3, pT3, 11 and N1, 2 patients. Metastases were to lung, 11, multiple sites in all 11; bone, 11, multiple sites in all 11, lymph nodes, 4, liver 4, epidural space, 3, cervical, thoracic, lumbar and vertebrae in 3, contra-lateral adrenal in 2 and brain and humeral tumors occurred once. Multifocality exists. Two patients had clear cell and papillary tumors. One clear cell Grade 2 had Grade 4 metastases. One patient had two oncocytomas, One AML occurred with a clear cell, Grade 3 and one in the kidney of a Grade III / III primary TCC of the ureter. Two RMITs were associated with Fuhrman Grade 1 tumors. Conclusion: Clear cell carcinoma predominated in the metastatic tumors with Fuhrman 3 and 4. And Stages T3 and N1 predominating. Multifocality exists. Multiple foci per metastatic organ and multiple separate organ metastases sites, in bone, were common. The “Internist’s Tumor”has become the “Imaging Specialist’s Tumor.” 111 Podium #40 PREDICTORS OF SEPTIC SHOCK IN PATIENTS WITH OBSTRUCTIVE URETERAL CALCULI AND INFECTION Jodi Antonelli, MD, Justin Friedlander, MD, Daniel Mollengarden, MD, Beverley Adams-Huet, MS, Jeffrey Shoss, MD, Clayton Trimmer, DO, Sanjeeva Kalva, MD, Yair Lotan, MD, Margaret Pearle, MD, PhD UT Southwestern Medical Center (Presented by: Jodi Antonelli)

Objective: Obstructive pyelonephritis due to renal/ureteral calculi is a urologic emergency requiring urgent decompression of the collecting system. However, despite prompt intervention, some patients still do poorly. We sought to determine predictors of septic shock in patients presenting with obstructing stones and infection. Methods: With institutional review board approval, we identified 317 patients who underwent urgent drainage (stent or nephrostomy) for an obstructing stone in the setting of presumed infection between December 2008 and January 2014. We excluded 22 patients who presented already in septic shock defined as refractory hypotension in the setting of sepsis. We compared baseline parameters at the time of presentation as well as time to intervention for the remaining 295 patients to determine differences in those who did and did not ultimately develop septic shock. Statistical comparisons between groups were performed using Wilcoxon Rank Sum for continuous variables and Fisher’s Exact for categorical variables. Univariate analysis and multivariable logistic regression were used to determine independent predictors of septic shock. Results: Among the 295 study patients, 40 (13.6%) were diagnosed with septic shock after presentation. No significant differences in demographic factors were found between groups. The univariate analyses comparing parameters between groups are listed in the Table. On multivariable analysis, after controlling for mean artieral pressure, heart rate, leukocyte count, creatinine, and stone history, every one-unit increase in heart rate portended a 4% increase in septic shock (OR= 1.040, 95% CI= 1.021−1.060, p< 0.001). Serum creatinine was associated with a 2 fold higher likelihood of developing septic shock (OR = 2.043, 95% CI= 1.370−3.046, p< 0.001. Furthermore, those with a previous history of stones were 68% less likely to develop shock (OR = 0.319, 95% CI= 0.141−0.723, p= 0.006). Conclusion: In the largest series of patients undergoing drainage for obstructive pyelonephritis due to stones, those who developed shock exhibited more significant abnormalities at presentation, consistent with greater severity of illness. Correlating presenting and laboratory values with shock risk will help to further identify those patients at highest risk with the hope that early identification will lead to better outcomes. Prospective studies investigating other predictors of shock are under way.

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Podium #41 SEASONAL VARIANCE OF PRESENTATION FOR MANAGEMENT OF UROLITHIASIS Christopher Slayden, MD, Michael Davis, MD, Julie Riley, MD University of New Mexico School of Medicine (Presented by: Christopher Slayden)

Objective: It is well-known that dehydration is an overwhelming risk factor for urolithiasis. This would likely lead to increased symptomatic presentation of stone disease in the hot summer months. The aim of this study was to determine if there is a seasonal variance in the presentation of urolithiasis at a single institution within a desert environment. Methods: A retrospective review of all adult patients seen over a 14-year period at a tertiary care center was performed. Patients were identified by ICD−9 codes specific for urolithiasis (592, 592.0, 592.1, 592.9). We included any location of presentation, which included outpatient, inpatient, and the emergency department. Children were excluded because of the increased rate of metabolic rather than environmental causes of urolithiasis in this population. Results: There were a total of 12,513 diagnoses. These were organized by month and meteorological season for further analysis. Peak diagnosis of urolithiasis was seen in August (1291), with a low in December (847). Summer had the greatest number of diagnoses (3432), followed by fall (3216), spring (3040), and winter (2825). Conclusion: Overall presentation of urolithiasis appears to increase in the summer months and is decreased during the winter months, as expected. Further studies are needed to determine if this is applicable to more wide spread populations with differing climates. We presume that dehydration increases in the summer months, but additional studies are needed to determine the cause of these findings.

Podium #42 COMPARISON OF HISPANICS TO CAUCASIANS IN METABOLIC EVALUATION OF NEPHROLITHIASIS Jessica Ming, MD, Julie Riley, MD University of New Mexico (Presented by: Jessica Ming)

Objective: It is well-known that nephrolithiasis is related to urinary metabolic abnormalities. However, it is not known what, if any, difference exists between

113 Continued on next page Caucasians and Hispanics. The southwest United States offers a unique patient population to compare these two groups. Materials: A retrospective study was performed at a single institution of all patients that underwent 24 hour urine studies over a 5 year period. All urine studies were performed by Litholink. We also evaluated age, racial groups, BMI, 24 hour urine parameters, serum electrolytes and type of stone. Racial group or ethnicity was determined by patient self-selection. We excluded those patients that did not select Hispanic or Caucasian. We then analyzed any difference in the metabolic evaluation of these patients in regards to risk of nephrolithiasis. Results: A total of 97 patients were included in the study with 184 Litholink tests. There were 50 patients with 106 urinary tests in the Caucasian population (group A) and 47 patients with 78 urinary tests in the Hispanic population (group B). Average age was 51.1 in group A and 50.0 in group B which was not statistically different. The BMI was slightly lower in group A at 28.5 vs. 30.7 in group B (p=0.05). Twenty four hour urinary volume, oxalate, potassium and magnesium were found to be significantly higher in Group A compared to Group B at 2.29 L vs. 1.89 L (p=.0029), 40.6 vs 34.7 mg/day (p=0.01), 69.3 vs. 54.1 mg/day (p=0.0002) and 102.8 vs 86.9 mg/day (p=0.01), respectively. Citrate, supersaturation of calcium oxalate and calcium phosphate, pH and uric acid excretion were not significantly different. Serum chemistries were similar between the two groups as well. Stone composition was similar between the groups with the majority having calcium oxalate stones. Conclusion: Our results demonstrate that there is a difference in metabolic evaluation between Caucasians and Hispanics. Caucasians have increased risk due to increased oxalate excretion while Hispanics demonstrate increased risk due to lower urinary volumes. Further studies are needed to confirm these findings and to determine the clinical significance for urinary stone prevention.

Podium #43 HIGH INCIDENCE OF, DONOR GIFTED LITHIASIS FROM CADAVERIC GRAFTS SCREENED USING NON-CONTRASTED COMPUTERIZED AXIAL TOMOGRAPHY INITIAL Results: FROM A TERTIARY-CARE CENTER IN MEXICO CITY Jorge Magaña, MD, Christian Villeda, MD, Carolina Culebro, MD, Jaime Herrera- Cáceres, MD, Olivia Gomez, MD, Ricardo Castillejos, MD, Bernardo Gabilondo, MD, Jorge Vazquez, MD, Carlos Mendez, MD INCMNSZ (Presented by: Jaime Herrera-Cáceres)

Objectives: Urinary lithiasis is a rare complication in , occurring in less than 1% of the transplanted organs; due to its low incidence, screening imaging in cadaveric donors is not routinely performed in most centers, this could place cadaveric graft recipients at a higher risk of donor gifted lithiasis. We present our initial experience using non contrasted computed tomography (NCCT) for urinary lithiasis screening in cadaveric donor kidneys (ex vivo). Methods: We prospectively performed NCCT to all cadaveric donor kidney received at our institution from March to May 2013; at their arrival, organs were removed from transport coolers and placed in the computed tomography gantry and scanned using a multi-detector scanner with a constant 3 mm slice interval and a slice thickness of 0.06 to 3 mm, all images were then viewed using multi- 114 Continued on next page planar reconstruction by a board certified radiologists. Results: During the study period a total of 8 kidneys from cadaveric donors were screened, urinary lithiasis was present in 6 organs (75%), 4 organs from 2 male donors and 2 organs from 1 female donor; the mean donor age was 36 years (range 25 to 50), one organ was a horseshoe kidney. In total 11 stones were found, the mean stone diameter was 2.1 mm (range 1 to 4 mm), stones were located in a calyx in all cases, the range of stone density was from 154 to 764 HU (mean 285 HU). All cases were further corroborated by ex vivo flexible , 5 organs were successfully transplanted, in 2 organs stone extraction was successfully P O DIUM s performed at the back-table using flexible nephroscopy, stone baskets and irrigation. Conclusions: In these preliminary results we have found an incidence of 75% of lithiasis in cadaveric allografts. We are currently investigating the optimal scan parameters. At this point, due to the small size of the located stones, treatment may not be warranted in every case; however, long-term surveillance of the stone bearing grafts for complications is ongoing.

Podium #44 TRANSURETHRAL ULTRASONIC URETERAL LITHOTRIPSY: INITIAL REPORT Thomas Pshak, MD1, Rodrigo Donalisio da Silva, MD2, Vassilis Siomos, MD1, Fernando Kim, MD2 and Wilson Molina, MD2 1University of Colorado; 2Denver Health (Presented by: Thomas Pshak)

Objective: The benefit of ultrasonic lithotripsy, which combines stone fragmentation and efficient removal of stone fragments via aspiration, is well established in the use of percutaneous approaches for kidney stones. The purpose of this study is to report our early results on the efficacy and safety of recently FDA approved ureteral ultrasonic lithotripter. Methods: Cybersonics CyberWand hollow semi-flexible ureteral probe and Olympus 7fr MRO742a semi-rigid ureteroscope with a 5.4 fr working channel were used for this study. The probe has a working length of 58.5 cm and outer diameter of 1.65 mm allowing it to be used in rigid or semi-rigid ureteroscopes with a working channel of 5 to 7 french diameter. After obtaining institutional IRB approval, two patients with distal ureteral calculi were recruited into the study. Patient demographics, ureteral stent prior to the procedure, operative time, lithotripsy time, stone size, location, density and stone free status were collected in a prospective manner. Stone free status was defined as no residual fragments or fragments < 2mm after rigorous endoscopic inspection and fluoroscopy with magnification at the end of the procedure. Results: Patient, stone and intraoperative data are listed in table 1. Of the two patients recruited, both were stone free after their procedure. The operative times were 20 and 36 minutes with actual lithotripsy times of 3.5 and 2.5 minutes respectively. Both patients required minimal basket extraction of some stone fragments and had ureteral stents placed at the end of the procedure. Neither patient required ureteral dilation. There were no complications. Conclusion: Transurethral ultrasonic ureteral lithotripsy appears to be safe and efficacious in the treatment of distal ureteral calculi. Additional benefits of minimizing stone migration due to simultaneous aspiration, decreased amount 115 Continued on next page operative, lithotripsy and basketing time may be attainable with the use of this device. Further validation and investigation of our early results is warranted.

Podium #45 URINALYSIS FINDINGS ARE NOT PREDICTIVE OF POSITIVE URINE CULTURES IN PATIENTS WITH INDWELLING URETERAL STENTS. Aydin Pooli, MD, Chad LaGrange, MD UNMC (Presented by: Aydin Pooli)

Objective: Ureteral stent placement is very common in contemporary urologic practice. Indwelling stents may produce lower urinary tract symptoms (LUTS) and urinalysis findings mimicking urinary tract infection (UTI). As a result, patients with stents are frequently treated for UTIs without positive urine culture confirmation. In this study, we investigated the association of urinalysis (UA) with urine culture results in patients with indwelling ureteral stents. Methods: All patients with ureteral stents who underwent stent removal in urology clinic between July 2013 and January 2014 were included. Clean catch urine samples were sent for urine culture immediately prior to stent removal. Urine culture results as well as urinalysis findings, age, gender, duration of indwelling stent, and reason for stent placement were collected. Results: A total of 67 patients were included in this study. The reasons for ureteral stent insertion included calculus disease (44 patients), renal transplant (18 patients), ureteral reimplant (1 patient), retroperitoneal lymph node dissection (1 patient), pyeloplasty (1 patient), metastatic pancreatic cancer (1 patient) and uretero- (1 patient). Urine cultures were positive in eight patients (11.9%). Urinalysis was performed for 47 participants at the time of stent removal. Our data as shown in the table suggest that positive findings in UA are very common in patients with ureteral stents since 91.4%, 68% and 12.7% of our cohort had positive findings for RBCs, leukocytes and nitrites in their urine, respectively. However, Only one patient with positive urine nitrites had positive urine culture and out of 43 patients with positive UA findings (RBCs, Leukocytes or nitrites), only four patients (0.93%) also had a positive urine culture. On the other hand none of the patients with a negative UA had a positive culture. Conclusion: In our study, positive findings for RBCs, nitrites and leukocytes in

116 Continued on next page urinalysis were common in patients with indwelling ureteral stents. However, the majority of patients with positive UA findings had negative urine culture (91.4%). Our data suggest that while a negative UA is reassuring in patients with indwelling ureteral stents, positive findings in UA and LUTS do not necessarily indicate UTI and confirmation by urine culture is required in terms of high index of suspicion. P O DIUM s

Podium #46 BACTERIAL RESISTANCE IS COMMON IN PATIENTS WITH INDWELLING URETERAL STENTS Aydin Pooli, MD, Chad LaGrange, MD UNMC (Presented by: Aydin Pooli)

Objective: American Urologic Association (AUA) guidelines recommend treating patients undergoing stent removal with one dose of fluoroquinolone or trimethoprim-sulfamethoxazole preoperatively. We hypothesize that a significant number of patients with positive urine cultures would have bacteria resistant to these antibiotic choices. Methods: All patients with ureteral stents who underwent stent removal in urology clinic between July 2013 and January 2014 were included. Clean catch urine sample was sent for urine culture immediately prior to stent removal. Urine culture results were collected and evaluated. Results: 67 patients were included in this study. The reason for ureteral stent insertion included calculus disease (44 patients, 65.6%), renal transplant (18 patients, 26.8%), ureteral reimplant (1 patient, 1.4%), retroperitoneal lymph node dissection (1 patient, 1.4%), pyeloplasty (1 patient, 1.4%), metastatic pancreatic cancer (1 patient, 1.4%) and uretero-ureterostomy (1 patient, 1.4%). Urine cultures were negative in 79.1% of patients (53/67) while eight patients (11.9%) had positive urine culture. Six patients (8.9%, all female) had contaminated samples which were found to be negative in repeat culture. Among the 8 patients with positive urine culture, 5 patients (62.5%) had bacteria resistant to fluoroquinolones, trimethoprim/sulfamethoxazole or both, and one patient grew yeast. Conclusion: If suspected for urinary tract infection, urine culture should be sent for patients with ureteral stents. Proper antibiotic must be administered per culture sensitivity as considerable number of patients may have resistant bacteria to common antibiotic regimen. Pre operative administration of fluoroquinolone or trimethoprim/sulfamethoxazole may not be adequate for patients with positive urine cultures as 62.5% of patient with positive urine culture had resistant bacteria in our institution. 117 Podium #47 MANAGEMENT OF COMPLICATED URINARY TRACT INFECTIONS IN A MEXICAN GENERAL HOSPITAL Victor Cornejo Davila, Edgar Mayorga Gomez, Mario A. Palmeros Rodriguez, Israel Uberetagoyena Tello de Meneses, Gerardo Garza Sainz, Victor Osornio Sanchez, Luis Trujillo Ortiz, Jorge E. Sedano Basilio, Gerardo Fernandez Noyola, Mauricio Cantellano Orozco, Carlos Martinez Arroyo, Jorge G. Morales Montor, Carlos Pacheco Gahbler Hospital General Dr. Manuel Gea Gonzalez (Presented by: Victor Cornejo Davila)

Objective: To describe the management of patients with complicated urinary tract infections in a mexican general hospital; its clinical course and evolution determining which are the most common isolated microorganisms in these patients and their sensibility/resistance to antimicrobials. Methods: The clinical records of patients hospitalized with complicated urinary tract infections from January 2012 to July 2013 were reviewed. Patients with a clinical diagnosis of complicated urinary tract infection supported by imaging and laboratory studies, with or without a positive culture, were included. Results: 173 patients were included, 87 men and 86 women with a mean age of 50.1 years. The most common clinical entity was acute pyelonephritis (53.2%). The most common pathogen was E. coli (83% of all positive cultures), with ESBL prevalence of 71.4% (60% of all positive cultures) and quinolone, cephalosporin and trimethoprim/sulfamethoxazole global resistance of 91.8, 65.6 and 59%. The most common predisposing factors were previous antibiotic usage (95.4%) and obstructive uropathy (73.4%). The mean hospital stay was 11.9 days. 41% received carbapenems as primary treatment; 40.5% received minimal invasion procedures, including 64.3% of emphysematous pyelonephritis and 76.1% of abscesses. The overall mortality was 2.9% with isolation of ESBL E. coli in 80% of these patients. Conclusion: Wide-spectrum antimicrobial therapy and minimal invasion approaches are the most common treatments for complicated urinary tract infections in our hospital; an update on antimicrobial use has to be done. Source of Funding: None

Podium #48 THE VALUE OF RETROPUBIC SLINGS FOLLOWING FAILED PRIOR ANTI- INCONTINENCE PROCEDURES Michael Aberger, MD1, William Parker, MD1, Alexander Gomelsky, MD2 and Priya Padmanabhan, MD1 1University of Kansas; 2Louisiana State University (Presented by: Michael Aberger)

Objective: Mid-urethral slings (MUS) are considered first-line surgical treatment of stress urinary incontinence (SUI). However, there is a paucity of data regarding the use of retropubic slings for patients who failed a prior sling. This study compares the outcomes of retropubic mid-urethral slings (SPARC) to autologous pubovaginal rectus fascial slings (pvs) for sling refractory incontinence. Methods: A retrospective review of 213 consecutive patients undergoing placement of SPARC (n=152) or pvs (n=61) by two fellowship trained urologists for prior failed

118 Continued on next page sling surgery was conducted over an eight-year time span. Mean follow-up was 29 months (range 3 to 93). Pre- and post-operative pad use was recorded for all patients in addition to completion of four validated questionnaires pre- and post- operatively: Stress-related leak, Emptying ability, Anatomy, Protection, Inhibition, Quality of life, Mobility and Mental status Incontinence Classification System (SEAPI−QMM), Incontinence Impact Questionnaire (IIQ−7), Urogenital Distress Inventory (UDI−6) and Visual Analog Score (VAS). Results: The overall subjective cure rate was 61.0%. 27 total patients (12.7%) required additional anti-incontinence procedures and the incidence of de novo P O DIUM s urgency was 9.9% (21 patients). Short-term (<30days) urinary retention was the most common complication recorded (4.04% of all patients). The number of pads used per day reduced from a mean of 3.26 to a mean of 0.77 (p<0.0001) post- operatively. A statistically significant improvement between pre- and post-operative SEAPI total, IIQ−7, UDI−6 and VAS was demonstrated (p<0.0001). Sub-analysis comparing the SPARC to the rectus pvs used for secondary repair demonstrated no significant differences in subjective cure rates, post-operative pad use, SEAPI total, IIQ−7, UDI−6 or VAS between groups (Table 1). Conclusion: The widespread use of surgical slings for SUI has led to an increase in the absolute number of patients who fail their primary procedures. Secondary repair with a retropubic MUS is as durable and effective in improving QoL as the rectus pvs. This provides invaluable information for patient education and surgical planning for refractory .

Podium #49 CONCURRENT EXCISION OF MID-URETHRAL SLING DURING REPEAT MID- URETHRAL SLING IS NOT ASSOCIATED WITH CONTINENCE OUTCOMES Robert Chan, MD1, Jason Scovell, BS2, William Johnson BA2, Rose Khavari, MD1 and Danielle Antosh, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

Objective: The role of excision prior to a repeat mid-urethral synthetic sling for recurrent or persistent stress urinary incontinence is unknown. The purpose of our study was to evaluate if excision of a prior sling during repeat mid-urethral sling placement is associated with greater success or failure. Methods: Retrospective chart review was performed for all women who had undergone a sling procedure at our institution between 2009 and 2013. We identified patients receiving repeat mid-urethral slings and evaluated outcomes by quantifying the number of pads used before and after surgery. Cure was defined as no pads, improvement as less pads compared to before surgery, and failure was

119 Continued on next page defined as the same or increased amount of pads. Success was defined as either cure or improvement. Success and failure were evaluated for women who had their prior sling excised or left in place. Statistical analysis was performed using Mann-Whitney to calculate significance (p < 0.05). Median values are reported. Results: 30 women with prior mid-urethral sling underwent a repeat mid-urethral sling for primary failure or recurrence. 17 initial slings were excised (none for extrusion or erosion), and 13 were left in place. There was no difference in success between women who had their sling excised or left in place (88.2% vs. 100%, p = 0.49), and cure rates were similar (76.5% vs. 76.9, p = 1.00). Women whose sling was excised or left in place were similar in age (56.3 y vs. 64.5 y, p = 0.08) and follow-up (15.6 weeks vs. 16.8 weeks, p = 0.60), but women with sling excision had a lower BMI (24.6 vs. 29.2, p = 0.02). Conclusion: Excision was not associated with improved success in women who underwent a repeat mid-urethral sling.

Podium #50 FACTORS ASSOCIATED WITH FAILURE OF A REPEAT MID-URETHRAL SLING PROCEDURE Robert Chan, MD1, Jason Scovell, BS2, James Tan, MD2 and Alex Gomelsky, MD3 1Houston Methodist Hospital; 2Baylor College of Medicine; 3LSU Health Sciences Center – Shreveport (Presented by: Robert Chan)

Objective: We sought to determine factors that are associated with failure of a repeat mid-urethral sling procedure. Methods: Data was collected prospectively for 152 consecutive women undergoing a repeat mid-urethral sling using a retropubic approach (SPARC) after prior sling failure. Patients were accrued between September 2009 and June 2012, and surgeries were performed by a single surgeon at a single institution. Cure was defined as both an absence of objective (negative cough stress-test) and subjective (zero on SEAPI stress subset) stress urinary incontinence. Patient characteristics were collected. Means and frequencies were reported. Statistical analysis included student t-test and chi-square where appropriate. Results: 152 women underwent a repeat mid-urethral sling procedure for previous sub-urethral sling failure. 60.0% (n=91) of women were continent and 40.0% (n=61) continued to remain symptomatic with a mean follow-up of 27.3 months vs. 32.5 (p=0.11). Patients who remained incontinent had a greater number of pre- operative pads per day (4.2 vs. 3.0, p=0.02), and reported greater scores on SEAPI sub-scores of protection (2.6 vs. 2.1, p<0.01) and inhibition (1.9 vs. 1.5, p=0.01) as well as a greater overall total SEAPI score (7.8 vs. 6.7, p<0.01). Surprisingly, there was no difference in the prevalence of urethral hypermobility between patients who failed and succeeded a repeat mid-urethral sling procedure (48.0% vs. 58.2%, p=0.232). The pre-operative IIQ scores trended towards significance (13.9 vs. 12.0, p=0.052). There was no difference between patient BMI (30.7 vs. 29.5, p=0.233), gravidity (3.0 vs. 2.9, p=0.233), parity (2.6 vs. 2.6, p=0.99), Baden- Walker grades of cystocele (1.2 vs. 1.3, p=0.72), rectocele (0.7 vs. 0.5, p=0.15), vaginal or cervical prolapse (0.7 vs. 0.8, p=0.51), unstable detrusor contractions during UDS (10.0% vs. 6.6%, p=0.46), VLPP (74.6 cm H2O vs. 81.4, p=0.19). There was no difference between pre-operative UDI (10.1 vs. 9.9, p=0.68) or VAS (2.1 vs. 2.3, p=0.38) scores. 120 Continued on next page Conclusion: Understanding the factors associated with the failure of a repeat mid- urethral sling procedure is important in patient counseling and management. Our subjective cure rate (60.0%) was similar to other published rates in repeat mid- urethral slings (62.0%) 1. We found that women who were using a greater number of pads per day were more likely to fail a repeat mid-urethral sling. Furthermore, the SEAPI and IIQ questionnaires may also be useful in identifying the appropriate patients for a mid-urethral sling.

Podium #51 P O DIUM s EARLY EXPERIENCE WITH ROBOTIC-ASSISTED LAPAROSCOPIC SACROCOLPOPEXY (RALS) WITH ALLOGRAFT FASCIA LATA IN PATIENTS WITH PRIOR MESH COMPLICATIONS Andrew Windsperger, MD, Nicholas Westfall, MD, Paul Knoll, MD, Brian Flynn, MD University of Colorado (Presented by: Andrew Windsperger)

Objective: Sacrocolpopexy (SC) with mesh represents the gold-standard treatment of recurrent apical pelvic organ prolapse. Recurrent prolapse is a common issue in women following total or near total mesh removal for transvaginal mesh (TVM) complications. Many of these women desire treatment of their prolapse due to bladder incomplete emptying, but are fearful of mesh complications, even from an abdominal approach. Those patients deferring treatment with mesh have been offered reconstruction with a biological option, allograft fascia lata (FL). We report our early results of Robotic-assisted laparoscopic sacrocolpopexy (RALS) with allograft FL in women with aversion to polypropylene mesh. Methods: A retrospective review of women undergoing RALS with allograft FL for recurrent pelvic organ prolapse in the past 6 months was performed. Women with a prior negative experience with TVM, or those with an aversion to mesh were included. Patients having undergone RALS with mesh were excluded. Clinical information, including preoperative, operative, and post-operative follow up data was obtained. Y−grafts were created from allograft fascia lata in a standard fashion and affixed to the vagina and sacrum with 2−0 gortex. Results: 19 patients were reviewed, and ten patients identified as having undergone RALS with allograft FL. Concomitant procedures included: SC mesh removal (2), supracervical hysterectomy (2), vesicovaginal fistula repair (1), TVT removal (1), repair of a small bowel mesh erosion (1). Indications for use of allograft FL included: patient preference (1), patient-physician preference (10). Prior surgeries included: TVM kit (8), TVT (1), RALS with mesh (1), removal of TVM (8), hysterectomy (8). Average operative time was 295 minutes with mean estimated blood loss of 112 ml across the series. Complications Clavien Dindo grade 3 or greater included: intraoperative ureteral injury (1) and bladder injury (1). No patient has experienced recurrent prolapse at a mean follow up of 3 (1−5) months, and no patient has developed graft-related complications. 4 of 6 women experienced resolution of bladder incomplete emptying. No patient developed de novo stress urinary incontinence (SUI) while 1 patient has had persistence of her SUI. Conclusion: RALS with allograft FL appears to be a safe alternative, in the short- term, to RALS with polypropylene mesh in women who wish to avoid mesh-related complications. Our initial experience with allograft FL for RALS is encouraging, however long-term follow up is necessary to determine if outcomes will be durable. 121 Podium #52 SURGICAL MANAGEMENT OF LOWER URINARY MESH PERFORATION AFTER TREATMENT FOR PELVIC ORGAN PROLAPSE: MESH EXCISION AND URINARY TRACT RECONSTRUCTION Nicholas Westfall, MD1, Ketul Shah, MD2, Paul Knoll, MD1, Andrew Windsperger, MD1 and Brian Flynn, MD1 1University of Colorado; 2The Ohio State University (Presented by: Nicholas Westfall)

Objective: Mesh bladder perforation represents a devastating injury to the lower urinary tract (LUT), and often requires complex reconstruction in order to resolve the issue. Our center has managed a large volume of pelvic organ prolapse mesh (POPM) complications, and we therefore sought to review our management of LUT mesh bladder perforation using a novel combination of surgical techniques including total or near total mesh excision and urinary tract reconstruction. Methods: We retrospectively reviewed the medical records of patients undergoing removal of polypropylene mesh from the lower urinary tract or vagina. Patients experiencing bladder perforation from their POPM were selected. Clinical information, including preoperative, perioperative, and postoperative data was obtained. Results: 10 patients met inclusion criteria for the study. Mean patient age was 60 years of age with a mean BMI of 30.7. 10 patients experienced bladder perforation from anterior mesh grafts, while the final patient experienced perforation from a sacrocolpopexy mesh graft. Only 1 patient had undergone attempted treatment prior to referral, and this consisted of attempted endoscopic excision. Vaginal pain or bleeding was the most common presenting symptom, present in 7/10 patients. Patients had a mean of 22 months from time of symptom onset to the time of referral for treatment. 8/10 patients were managed with transvaginal approaches, while 1 patient was treated with a robotic-assisted laparoscopic approach and 1 treated with a combined abdominal/vaginal approach. Patients were treated via mesh excision and other procedures including cystorraphy (10), biological allograft sacrospinous ligament fixation (7), vesicovaginal fistula repair (2), pubovaginal sling with autologous rectus fascia (3), biological allograft sacrocolpopexy (1), bladder augmentation (1) and ureteral reimplantation (1). Complications Clavien Dindo grade 3 or greater numbered 1, with 1 postoperative ventral hernia requiring delayed intervention. Mean length of follow up for all patients was 1.16 years. 9 of 10 had resolution of their mesh complication in a single operation, while 1 required a second transvaginal procedure 3 years later for recurrent LUT perforation. Five patients underwent a total of 7 subsequent surgeries for SUI or prolapse following mesh removal. Conclusion: Total or near total removal of POPM with the use of adjunctive reconstructive techniques can resolve LUT mesh perforation in a single operative setting. Transvaginal approaches were successful without need for abdominal exploration in the majority of cases. Patients may require additional procedures to manage complications of mesh removal including recurrent prolapse and incontinence following initial treatment.

122 Podium #53 THE USE OF CENTRALIZED DATA TO EVALUATE COMPLIANCE WITH THE AUA/SUFU GUIDELINE ON OVERACTIVE BLADDER – A COLLABORATIVE EFFORT OF THE AUA GUIDELINE COMMITTEE AND HEALTHTRONICS IT SOLUTIONS Robert Dowling, MD1, Gregory Auffenberg, MD2, William Meeks3 and J. Stuart Wolf, MD4 1Dowling Medical Director Services; 2Northwestern University; 3American Urologic Association; 4University of Michigan P O DIUM s (Presented by: Robert Dowling)

Objective: To evaluate Guideline’s effect on provider behavior, we investigate urinalysis (UA) performance in overactive bladder (OAB) evaluations by urologists who use an electronic medical record (EMR) furnished by Healthtronics Information Technology Solutions (HITS). Methods: HITS analysts evaluated warehoused OAB encounters occurring in their systems from 5/1/10 to 10/18/13. Patient data including age, gender, co- morbidities, smoking status, insurance carrier, performance of UA, and date of OAB diagnosis was collected. De-identified, safe-harbor compliant data was turned over to our research team for independent analysis. Using two tailed z-test, we compared the rate of UA performance before and after 5/1/12 to determine the potential impact of the Guideline on UA performance. Results: Between 5/1/10− 5/1/12, 27,248 patients were evaluated for OAB. Between 5/2/12 − 10/18/13, 57,946 patients were evaluated. Among those seen after 5/1/12 there was a significantly lower rate of UA performance (Table). Sub- groups showed differing changes in UA performance rate (Table). Conclusion: A small but significant decrease in the rate of performance of UA was seen after 5/1/12. This study importantly demonstrates data discovery through clinician collaboration with an EMR vendor. This type of collaboration may prove to be an exciting development in patient-related data analysis. Source of Funding: American Urological Association, Healthtronics Information Technology Solutions Inc.

Podium #54 ANALYSIS OF PAIN AND QUALITY OF LIFE FOR INTERSTITIAL CYSTITIS PATIENTS FROM A LARGE ACADEMIC PRACTICE Zach Hamilton, MD, Charles Graham, MSIII, Tomas L. Griebling, MD, MPH University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

Objective: Interstitial cystitis (IC) is estimated to affect as many as 500,000 US citizens, and it is characterized by pelvic pain and urinary complaints. Many studies have suggested that IC has a significant impact on quality of life, and future studies focusing on the psychological basis of the disease may help to characterize this relationship. We sought to determine the association between IC symptoms, pain, and quality of life at our academic center. Methods: A single-center, cross-sectional study with questionnaire data was performed. We included the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF), Brief Pain Inventory (BPI), and World Health Organization Quality of Life-abbreviated (WHO) as our questionnaires. Unpaired t−test was utilized for 123 Continued on next page statistical analysis. Results: Ninety patients were sampled, of whom 86% were female with a mean of 9 years since initial diagnosis of IC. Overall, patients experienced significantly lower mean quality of life score in the physical domain, as compared to the highest quality of life in the environmental domain (p=0.0001). Utilizing the WHO Quality of Life questionnaire, patients were divided into a “poor/neutral” quality of life cohort (35 patients) and a “good” quality of life cohort (55 patients). Patients with a poor/neutral quality of life had significantly higher pain levels reported on the PUF questionnaire (mean 21.8 vs 15.6, p=0.0001). Furthermore, patients with a poor/neutral quality of life had significantly higher pain severity (mean 5.8 vs 3.6, p=0.0001) and pain interference (mean 6.2 vs 3.1, p=0.0001) on BPI. Of note, the quality of life was not significantly related to the time from diagnosis. Conclusion: Interstitial cystitis, while not a life-threatening disease, is a chronic condition with a major impact on quality of life. This impact can be measured objectively and is significantly associated with multiple pain scores, yet isnot associated with the time from diagnosis. The use of these instruments in clinical practice is recommended to better understand how the disease affects individuals.

Podium #55 RANDOMIZED CONTROLLED TRIAL OF PROPHYLACTIC URETERAL STENT PLACEMENT BEFORE UTEROSACRAL LIGAMENT SUSPENSION Robert Chan, MD1, Sophie Fletcher, MD2, Danielle Antosh, MD1, Rose Khavari, MD1, Julie Stewart, MD1, Jonathan Zurawin, BS3, Juan Flores, MD1, Jiong Chen, BS4 and Keith Reeves, MD1 1Houston Methodist Hospital; 2Kaiser Permanente; 3Baylor College of Medicine; 4MD Anderson Cancer Center (Presented by: Robert Chan)

Objective: This prospective randomized study aims to evaluate whether placement of prophylactic ureteral stents can aid surgeons in avoiding injury to the ureters at the time of uterosacral ligament suspension (USLS) suture placement. Methods: We performed a prospective randomized controlled trial of prophylactic ureteral stent placement in women undergoing USLS for pelvic organ prolapse (POP) at our institution from April 2010 and November 2013. Women with stage II−IV POP undergoing USLS apical suspension with or without total vaginal hysterectomy (TVH) were invited to participate. Patients were randomized to intraoperative ureteral stent placement in the operating room prior to USLS surgery or no stent placement. Our primary outcome was intraoperative ureteral injury with kinking or obstruction during USLS. Intraoperative ureteral injury was assessed by administration of intravenous blue dye with to confirm bilateral efflux from both ureteral orifices following tying the suspension sutures. Results: 93 patients were randomized in our study (47 no stents and 46 with pre- USLS stents). There was no difference in age between groups. Preoperative and postoperative degree of vault, anterior, and posterior prolapse in the stent and no- stent groups are shown in table 1. One patient in the stents group was excluded from analysis because her procedure was aborted secondary to dense adhesions. One patient in the no stents group was excluded from analysis because she only underwent a cystocele repair. Three out of 45 patients (6.7%) in the stents group had a ureteral injury. 4 out of 46 patients (8.7%) in the no-stent group had a ureteral injury (p−value = 0.51). 124 Continued on next page Prolapse assessment with POP−Q staging was performed at 1 month and 3 months postoperatively. 1 month post-operative support was similar in the patients with stents group compared to patients without stents for Ba (p=0.0891), Bp (p=0.5268), and C (p=0.2866) points. Conclusion: The addition of prophylactic ureteral stent placement does not confer an ability to reduce ureteral injury. Although the ureter can easily be identified during the USLS procedure with the stent in place, often times, there is not enough room to place the suspension suture and feel the ureter simultaneously limiting the effectiveness of prophylactic ureteral stent placement. Our rates of ureteral injury P O DIUM s were consistent with the existing literature.

Podium #56 LONG-TERM EFFICACY OF SACRAL NERVE STIMULATION IMPLANTATION FOR NON-OBSTRUCTIVE URINARY RETENTION REFRACTORY TO MEDICAL THERAPY Charles Snyder, MD, Timothy Buff, BS, Magdee Islam, BS, Woodson Smelser, BS, James Cummings, MD University of Missouri (Presented by: Charles Snyder)

Objective: Urinary retention is a common and disruptive condition, and represents a significant burden to those affected. Patients with this condition experience a spectrum of morbidity from mild to severe retention, incontinence, recurrent urinary tract infection, with many requiring intermittent or chronic indwelling catheterization. These patients are often considered for sacral nerve stimulation for management of these symptoms using the Interstim device. Studies have demonstrated a high rate of initial efficacy following treatment with Interstim; however, studies characterizing the long-term efficacy of SNS are fairly rare and inconclusive. We examined the outcomes and durability of Interstim implantation as treatment for non-obstructive urinary retention at a single institution. Methods: We performed a retrospective analysis of all patients receiving sacral neuromodulation at our institution from 2004−2013 for an indication of urinary retention refractory to medical therapy. We defined treatment failure as patient- reported lack of therapeutic benefit following InterStim placement. Patients were subsequently followed post-procedure in clinic, and outcomes documented. Results: We identified 49 patients who underwent first stage Interstim implantation for urinary retention, with mean age 49.6 years. Of these patients, 38/49 (77.5%) proceeded to stage two implantation. Mean post-procedure follow up was 28 months. Mean age of these patients was 47.9 years. 12 (32%) of these patient experienced resolution of retention; 12 (32%) required continued CIC; 2 (5%) required continued use of suprapubic catheter; 7 (18%) were lost to follow up;

125 Continued on next page 7 (18%) required removal of device due to complications. Mean time to return of symptoms in delayed failures was 30.6 months. Mean number of device calibrations was 4.3. Mean battery life was 46.4 months, with 8/38 (21.1%) patients requiring battery exchanges within the follow up period. Among those treated successfully, former or current smoking status was a statistically significant indicator for therapy success (p=0.006). Patients without a history of abdominal or spinal surgery were more likely to benefit from therapy (p=0.01). Conclusion: Sacral nerve stimulation is an effective treatment for non-obstructive urinary retention. Our analysis demonstrated a greater benefit for sacral neuromodulation in those who had never undergone spinal or abdominal surgery.

Podium #57 ONABOTULINUMTOXINA IMPROVES URINARY INCONTINENCE AND QUALITY OF LIFE IN OVERACTIVE BLADDER PATIENTS, REGARDLESS OF USE OF CLEAN INTERMITTENT CATHETERIZATION OR THE PRESENCE OF URINARY TRACT INFECTION Jennifer Gruenenfelder1, Karel Everaert, MD2, Heinrich Schulte-Baukloh, MD3, Steven Guard DPhil4, Yan Zheng, PhD5 and David Sussman, MD6 1Orange County Urology Associates; 2Ghent University Hospital, Gent, Belgium; 3St. Hedwig-Krankenhaus, Berlin, Germany; 4Allergan, Ltd, Marlow, United Kingdom; 5Allergan, Inc, Bridgewater, New Jersey, United States; 6Rowan University School of Osteopathic Medicine, Stratford, New Jersey, United States (Presented by: Jennifer Gruenefelder)

Objective: Pooled analyses of two onabotulinumtoxinA phase 3 trials evaluated efficacy and quality of life (QOL) outcomes by the use of clean intermittent catheterization (CIC) and the presence of urinary tract infection (UTI). Methods: Patients received intradetrusor injections of onabotulinumtoxinA 100U (n=557) or placebo (n=548). Proportions of patients with a positive response (condition ‘greatly improved’ or ‘improved’) on the Treatment Benefit Scale (TBS), incontinence−QOL (I−QOL) total score, and King’s Health Questionnaire (KHQ) domains of role, social, physical limitations, and incontinence impact were analyzed by CIC use and UTI status during the first 12 weeks of treatment. Change from baseline at week 12 in UI episodes/day was assessed by UTI status. Minimal important differences (MID) were +10 and −5 points for I−QOL and KHQ, respectively. Results: Treatment benefit with onabotulinumtoxinA was not diminished by CIC use (positive TBS responders: 62.9% and 61.7% with and without CIC, respectively). Irrespective of UTI status, onabotulinumtoxinA reduced UI episodes/ day versus placebo (−3.01 vs −1.19 episodes/day with UTI; −2.76 vs −0.93 without UTI) and increased the proportion of positive TBS responders (52.5% vs 33.3% with UTI, and 63.8% vs 27.6% without UTI). Improvements >MID were observed with onabotulinumtoxinA in I−QOL and all evaluated KHQ domains, irrespective of CIC use or UTI status. Conclusion: In overactive bladder patients who were inadequately managed by an anticholinergic, CIC use did not diminish the perception of treatment benefit and QOL improvements with onabotulinumtoxinA. Furthermore, onabotulinumtoxinA reduced UI and improved both perception of treatment benefit and QOL, regardless of UTI status. Funding: This study was funded by Allergan, Inc. 126 Podium #58 EFFICACY OF INTRADETRUSOR BOTOX INJECTIONS IN PATIENTS WITH URGENCY INCONTINENCE Carrie Yeast, MD, Majdee Islam, BS, James Cummings, MD University of Missouri (Presented by: Carrie Yeast)

Objective: OnabotulinumtoxinA (Botox) injections are an increasingly widely used therapy for urinary incontinence and overactive bladder. Critical appraisals of the P O DIUM s efficacy of this technique since FDA approval have been lacking. We reviewed our initial experience in the use of Botox for urgency incontinence. Methods: Medical records were reviewed for patients who underwent intradetrusor Botox injection for urge incontinence at the University of Missouri from 2009−2013. Our technique was to dilute 200 units of Botox in 30 cc saline and inject the solution in multiple aliquots spread over the entire detrusor muscle. Patient charts were analyzed for demographics, prior procedures and treatments, outcomes, and other relevant information. Patients who did not have a follow up visit or whose therapy result was not specified post-injection were excluded. Results: A total of 33 patients with incontinence who were treated with Botox injection(s) were identified. The mean age of all patients was 58.7. Overall, 73% of the injections were successful (no recurrence of symptoms), with an average time of success of 4.7 months. Those who previously had abdominal/pelvic surgery including midurethral slings were statistically more likely to have treatment failure than those who did not (p < 0.003). In 20.8% of patients, symptom resolution lasted greater than 6 months. Multiple injection sessions were performed in 36% of patients. The mean length of success for the first injection was 4.7 months, and mean length of success of injections thereafter was 4.15 months. Success in injections after the first injection was 85%. Conclusion: OnabotulinumtoxinA injection is an effective treatment for urinary incontinence refractory to medical management. Though limited by small numbers in the study, success of intradetrusor onabotulinumtoxinA injections in incontinent patients appears to be limited by previous abdominal/pelvic surgery. We can also conclude that in multiple injection patients, subsequent injections are more likely to be successful, though for an approximately equal length of time.

Podium #59 MULTI-INSTITUTIONAL STUDY COMPARING HEIGHT OF VCUG CONTRAST Mohammad Ramadan, MD1, Christopher Cooper, MD2, Blake Palmer, MD1, Kathleen Kieran2, Douglas Storm2, Yutaka Sato2, Brad Kropp, MD1 and Dominic Frimberger, MD1 1University of Oklahoma Health Sciences Center; 2University of Iowa College of Medicine (Presented by: Mohammad Ramadan)

Objective: The gold standard for evaluating and diagnosing vesicoureteral reflux (VUR) is voiding (VCUG). No standards exist for testing parameters and institutional variation in these parameters may affect detection of reflux and impair comparison of results. The aim of this study is to assess the effect of contrast height on reflux detection.

127 Continued on next page Methods: In a prospective, non-randomized, observational study at the University of Oklahoma (OU) and University of Iowa, patients undergoing VCUG for routine analysis were selected. Indications for performing VCUG included febrile UTIs, pyelonephritis, hydronephrosis, or history of VUR. Inclusion criteria were male and female patients aged 1 to 10 years without known genitourinary anomalies. In this study, the VCUG was performed per protocol, except for a change in contrast height. The initial fill was performed at a contrast height of 50cm above the patient, and the second fill at a contrast height of 100cm. Each filling was performed until void and the bladder emptied between fillings. Data collected included the volume filled with each filling phase and the estimated volume at reflux. Estimated bladder capacity (EBC) was calculated using the formula: (age + 2) × 30 mL. The actual bladder volume filled was compared to the estimated bladder capacity as a percentage (%EBC filled = [Volume filled divided by EBC] x 100). A Wilcoxon signed rank test was used to test for difference between VCUG contrast heights of 50cm and 100cm in overall reflux grade and %EBC filled. Results: From May 2012 through Nov 2013, 184 patients were enrolled in the study from OU and UI. All studies were interpreted by staff pediatric radiologists at our institution, and, if present, VUR was graded from 1 to 5 as defined by the International Reflux Study Committee. Of these, 88 exhibited reflux at 50cm and 100 at 100cm. The Kappa coefficient of agreement between the 50cm and 100cm fills for presence of VUR showed substantial agreement and there was no significant difference in VUR grade. The percent of estimated bladder capacity filled at each height was available on 122 patients of the OU cohort and was significantly different (p < 0.0001). Conclusion: In this study, there is no significant difference in the detection of VUR with contrast heights of 50cm and 100cm. A significant difference was found in the average filled volume over expected bladder capacity at one institution.

Podium #60 NOBOX: A NOVEL CANDIDATE GENE UNDERLYING HYPOSPADIAS AND CRYPTORCHIDISM Abhishek Seth, MD1, Shayne Lewis, PhD1, In-Seon Choi, PhD1, James Sander, MD1, Josephine Addai, PhD1, Nathan Wilken, PhD1, Irina Stanasel, MD2, Chester Koh, MD1, David Roth, MD1, Carolina Jorges, PhD1 and Dolores Lamb, PhD1 1Texas Children’s Hospital; 2Texas Children’s Hospital/Baylor College of Medicine (Presented by: Irina Stanasel)

Objective: Congenital GU abnormalities such as hypospadias and cryptorchidism are among the most commonly diagnosed birth defects. Cryptorchidism occurs in 6% of full-term newborn boys and by one year of age, the incidence declines to about 3%. Hypospadias occurs in nearly 1 in 100 live male births. The etiology of these congenital GU birth defects is poorly understood but likely involve genetic, endocrine and environmental factors. We used comparative genomic hybridization microarray (aCGH) analysis to discover a novel gene candidate, NOBOX, which is strongly associated with both cryptorchidism and hypospadias. NOBOX is a homeobox gene encodes a transcription factor that is thought to play a role in oogenesis in females. We hypothesize that microduplications in the NOBOX gene are strongly associated with combined cryptorchidism and hypospadias. Methods: Genomic DNA from pediatric patients with combined hypospadias and 128 Continued on next page cryptorchidism was analyzed by aCGH using 720K NimbleGen arrays (Roche). Sex-matched genomic DNA (gDNA) from men of proven and normal development served as a control in the arrays. This data was then analyzed using Nexus Copy Number software (BioDiscovery). Quantitative PCR was performed using CNV−taqman assays to validate putative regions of duplications in the NOBOX gene that were distinct from CNVs found throughout the genome. DECIPHER database was then used to find incidence of defects in the NOBOX gene and to find other patients with this defect and concomitant GU anomalies.

Phenotypic analysis in transgenic mouse models is now being conducted. P O DIUM s Results: 3 patients with combined hypospadias and cryptorchidism were identified with microduplications in the NOBOX gene in CGH microarray analysis. These were further validated with qPCR. An additional patient with isolated penoscrotal hypospadias was found to have CNVs in this gene. Incidence of defects in the NOBOX gene is exceedingly low and is approximately .04% as extracted from the DECIPHER database. To further strengthen the association, we found 2 other patients in the DEIPHER database with GU birth defects who also had defects in the NOBOX gene. Conclusion: We have used aCGH analysis to identify NOBOX as a possible novel gene defect that may be responsible for cryptorchidism and hypospadias. Phenotypic analysis of NOBOX knockout mice is currently being conducted and will be used to prove causation beyond association.

Podium #61 LAPAROSCOPIC-ASSISTED URETEROURETEROSTOMY FOR DUPLICATION ANOMALIES IN CHILDREN Gwen Grimsby, MD1, Zahra Merchant2, Micah Jacobs, MD, MPH1 and Patricio Gargollo, MD3 1UTSW/CMC, Dallas, TX; 2UTSW, Dallas, TX; 3Texas Childrens/Baylor, Houston, TX (Presented by: Gwen Grimsby)

Objective: To describe a novel laparoscopic assisted technique for ureteroureterostomy (UU) for the surgical treatment of a completely duplicated collecting system with an obstructed and/or ectopic ureter. Methods: A laparoscopic camera is placed through a 5−mm infra-umbilical port and the duplicated ureters identified and delivered through a port-site sized inguinal incision with a Babcock clamp. The UU is performed in an open fashion through the small incision. The mean operative time, length of stay, success, and complications of 9 patients who underwent this technique were reviewed and compared with a cohort of 19 patients who underwent open UU via unpaired t tests. A description of 4 patients who underwent a robotic UU is also provided but a statistical comparison not performed secondary to small sample size. Results: There were no statistically significant differences in operative time, length of stay, complications, or rates of success between the open and laparoscopic assisted UU groups, Table 1. In the robotic group, length was 1 day for all patients and mean operative time was 189 minutes. Conclusion: Laparoscopic assisted ureteroureterostomy is a successful technique for the treatment of an ectopic and/or obstructed ureter in a completely duplicated collecting system. Operative time and length of stay were similar to an established open cohort and shorter than our robotic experience. In addition, this technique has 129 Continued on next page improved cosmesis and less overall cost compared with a robotic approach. This novel laparoscopic assisted technique combines the speed of the open procedure with the improved ureteral identification and retrieval offered with a laparoscopic approach and is thus a useful tool for the pediatric urologist. Financial Disclosure: none

Podium #62 URETHRAL LENGTHENING: LONG-TERM DURABILITY OF CONTINENCE AND EASE OF CATHETERIZATION Elizabeth Malm-Buatsi, MD1, Adam Becker, MD2, Blake Palmer, MD1, Dominic Frimberger, MD1, Brad Kropp, MD1 and Kenneth Kropp, MD2 1University of Oklahoma; 2University of Toledo (Presented by: Elizabeth Malm-Buatsi)

Objective: Urethral lengthening has been used as one of the main procedures for managing the bladder neck in patients with neurogenic bladder undergoing urinary reconstruction at two institutions. Previous reports from one institution regarding the long-term continence and ease of catheterization with a mean follow up of 8.4yrs showed a continence rate of 85%. Ninety-three percent of their patient population had no difficulties with urethral catheterization. The goal of this study is to evaluate the long-term durability of continence with the urethral lengthening procedure using data from the two institutions as well as the ease of catheterization. Methods: We reviewed the records of 48 patients, using retrospective chart review, telephone and mail surveys regarding age at surgery, difficulty with urethral catheterization, continence rate via urethra and stoma, length of follow up, stone formation, additional bladder neck surgeries. Daytime dryness was defined as wearing no pads while performing clean intermittent catheterization every 2−4 hours. Results: Of the 48 patients reviewed, 23 were males and 25 were females with average age at surgery of 10.5 yrs. (4 −26 yrs.). Twenty-eight patients (58.3%) were dry per urethra with the urethral lengthening procedure after a mean follow up of 11 yrs. (5 mths – 21.5 yrs.). Thirty-nine (81.3%) patients were dry per their catheterizable stoma. Forty-two patients (87.5%) had no difficulty with urethral catheterization. Conclusion: We report a 58.3% long term continence rate after urethral lengthening. Ease of catheterization remained high at 87.5% in our patient population with longer follow up compared to earlier results.

130 Podium #63 THE FATE OF TRANSITIONAL UROLOGY PATIENTS REFERRED TO A TERTIARY TRANSITIONAL CARE CENTER Robert Chan, MD1, Jason Scovell, BS2, Zach Jeng BA2, Saneal Rajanahally, BS2, Timothy Boone, MD, PhD1 and Rose Khavari, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

Objective: The transitional care clinic at the Center for Restorative Pelvic Medicine P O DIUM s (CRPM) at Houston Methodist Hospital was established in 2010 to aid the transition of children with neurogenic bladder or genitourinary congenital anomalies to an adult urological team dedicated to their long term care. The aim of this study was to assess changes in management after transition to CRPM. Methods: We performed a retrospective study of patients with neurogenic bladder or genitourinary congenital abnormalities referred to our CRPM in the age range of 16−26 years between 2010 and 2013. Data analyzed included patient characteristics cause of neurogenic bladder, method of bladder management, recurrent UTI, stones, kidney function, upper tract studies, video urodynamics, and change in management after transitioning care to CRPM. Results: 24 patients with an average age of 22.0 ± 2.7 years were included in analysis. Management was altered in 70.8% of patients (n=17). Surgical management was instituted in 58.3% (n=14/24) of patients and included bladder augmentation or urinary diversion (n=7), intravesical botox injections (n=5), cystolitholapaxy or cystolithotomy (n=2). Conservative management was changed in 12.5% (n=3) of patients and included initiating anticholinergic medication (n=2) or clean intermittent catheterization (n=1). Follow-up was 8.9 ± 12.1 months. Conclusion: There is an immense need for transitional care of patients with neurogenic bladder or GU congenital abnormalities as they grow into adulthood. Nearly 71% of patients had a change in their bladder management with 38% undergoing a major surgery. This study emphasizes the necessity for a dedicated adult urologic team in conjuncture with a comprehensive medical team to be involved in the care of these complex patients since their urological care and needs may vary significantly from their childhood.

Podium #64 NATURAL HISTORY OF HYDRONEPHROSIS AFTER ROBOTIC EXTRAVESICAL URETERAL REIMPLANTATION IN CHILDREN Dennis Lee, MD1, Leo Dalag1, Mukil Patil, MD1, Roger De Filippo, MD2, Andy Chang, MD2, Irina Stanasel, MD3 and Chester Koh3 1USC; 2CHLA / USC; 3Texas Children’s Hospital/Baylor (Presented by: Chester Koh)

Objective: Robotic surgery in children is an expanding minimally invasive alternative to open surgery in children, such as for the surgical management of vesicoureteral reflux (VUR) via extravesical ureteral reimplantation. While the reported incidence of hydronephrosis after open reimplantation surgery is low, the natural history of hydronephrosis after robotic reimplantation surgery is unknown. We reviewed our experience to determine the natural history of hydronephrosis after robotic ureteral reimplantation surgery in children.

131 Continued on next page Methods: 50 pediatric patients with primary VUR (38 unilateral and 12 bilateral for a total of 62 refluxing units) underwent robotic ureteral reimplantation surgery via an extravesical technique. An institutional review board-approved retrospective chart review was performed to collect patient demographic and perioperative data. Results: The operative success rate, defined as complete resolution of the VUR on the voiding cystourethrogram at the 4-month mark after surgery, was 95%, which is equivalent to those of historical open surgery series. No perioperative complications were noted. De novo mild to moderate hydronephrosis was noted in 18 kidney units (29%) at the 1-month mark after surgery, with a median time to resolution of 5 months (range: 3 – 14 months). No evidence of obstruction was identified, and no intervention was required in any of the cases. Conclusion: Robotic ureteral reimplantion surgery in children is associated with high success rates and low complication rates that appear to be equivalent to those of open reimplantation surgery. De novo hydronephrosis can occur after robotic ureteral reimplantation surgery similar to open surgery; however, the hydronephrosis appears to have a temporary and self- limited natural history without the need for intervention.

Podium #65 PRELIMINARY EXPERIENCE WITH HIDES ROBOTIC EXTRAVESICAL URETERAL REIMPLANTS: A NEW STANDARD OF CARE? Gwen Grimsby, MD1,Sudhir Isharwal, MD2, Carlos Villanueva, MD2 1UTSW/CMC; 2Children’s Hospital and Medical Center/University of Nebraska Medical Center (Presented by: Gwen Grimsby)

Objective: A large series of contemporary robotic extravesical ureteral reimplants (Kasturi, Urology, 2012) shows the procedure to be comparable or superior to its open counterpart. However, this surgery leaves 2 visible scars from the robotic trocars and can be considered inferior cosmetically to a Pfannenstiel incision. Hidden Incision Endoscopic Surgery (HIDES), initially described by Gargollo for pyeloplasties and kidney surgery, consists of port placement under the waist line resulting in no visible scars. We report on consecutive patients undergoing robotic extravesical reimplants following HIDES principles. Methods: A transumbilical incision is made for a 12 mm ribbed trocar. Two 8 mm robotic working ports are placed below the waist line, lateral and just slightly superior to the internal inguinal ring, and secured with steri-strips and tegaderm. After docking, robotic trocars are “burped”superiorly and laterally to create distance between bladder and ports. After dissection of ureter, a 3−4 cm detrusor incision down to the mucosa is performed, extended ¾ of the way around the circumference of the ureter. Four to five interrupted stiches of 3−0 polyglactin are placed from distal to proximal to close the detrusorraphy over the ureter. is left overnight. Patient is discharged home within 24 hours of surgery. A postoperative VCUG is done only for febrile UTIs. A renal ultrasound is obtained at 3 months. Results: Five patients total have had the surgery – 2 bilateral, 3 unilateral. The ports never had to be repositioned higher. The procedures were completed without incidents. During the cases, at least 1 robotic port had to be replaced between 1 to 3 times due to port coming out of the skin. One bilateral surgery patient developed bladder spasms 1 week after surgery which improved on oxybutynin. There haven’t 132 Continued on next page been any other complications. Cosmetic results 2 weeks after surgery are shown in Figure 1. Operative times from incision to closing were 126 and 175 minutes (bilateral) and 153, 105, and 119 minutes (unilateral). Conclusion: HIDES port placement offers improved cosmesis without compromising surgical technique. With further replication of our preliminary experience at other centers, HIDES robotic extravesical reimplant could become the standard of care in the surgical correction of vesicoureteral reflux. P O DIUM s

Podium #66 REDUCTION IN SURGICAL FOG WITH WARM HUMIDIFIED GAS MANAGEMENT PROTOCOL IN PEDIATRIC ROBOT-ASSISTED LAPAROSCOPIC PROCEDURES SIGNIFICANTLY SHORTENS PROCEDURE TIME Bhalaajee Meenakshi-Sundaram, MD, Elizabeth Malm-Buatsi, MD, Nguyen Edward, PhD, Frimberger Dominic, MD, Palmer Blake, MD University of Oklahoma College of Medicine (Presented by: Bhalaajee Meenakshi-Sundaram)

Objective: The adoption of robotic-assisted laparoscopic (RAL) procedures in the field of urology has occurred rapidly and to date without pediatric specific instrumentation. Surgical fog is a significant barrier to safe and efficient laparoscopy. This appears to be a significant challenge when adapting 3D 8.5mm scopes to use in pediatric RAL surgery in children. Our objective was to compare matched controls from a prospectively collected database to procedures done utilizing special equipment and a protocol to minimize surgical fog in pediatric RAL procedures. Methods: A prospectively collected database of all patients undergoing RAL pediatric urology procedures was used to compare procedure, age, sex, ASA score, weight, console time, number of times the camera was removed to clean the lens during a procedure, length of hospital stay, and morphine equivalents required in the post-operative period. A uniquely developed protocol that used humidified (95% relative humidity) and warmed CO2 gas (95°F) insufflation via Insuflow® on a working trocar with active smoke evacuation via PneuVIEW®XE on the opposite working trocar with a gas pass through of 3.5−5 L per minute was utilized and outcomes compared to matched controls. Results: The novel gas protocol was utilized in 13 procedures (pyeloplasty=5, revision pyeloplasty=2, ureteroureterostomy (UU)=3, nephrectomy=3) and 133 Continued on next page compared to 13 procedures (pyeloplasty=6, revision pyeloplasty=1, UU=3, nephrectomy=3) prior to the development of the protocol. There was no statistical difference in age (p=0.78), sex (p=0.11), ASA score (p=1.00), or weight (p=0.69). The average console time was 176.6 minutes in the no protocol group vs 141.6 minutes in the gas protocol group (p<0.05). The average number of camera removals to clean the lens was 5.9 in the no protocol group vs 0.6 in the gas protocol group (p<0.05). The average hospital stay was 40.2 hours in the no protocol group vs 28.3 hours in the gas protocol group (p=0.15) and the morphine equivalents required in the post-operative period were 0.2/kg in the no protocol group vs 0.1/kg in the gas protocol group (p=0.09). There were no open conversions, Clavien grade 2 or higher complications, or readmissions within 30 days in either group. Conclusion: Our novel gas protocol yields a statistically significant procedure decreasing the number of times the camera is required to be pulled during the case by more than 5 occurrences and saves approximately 35 minutes on average per case.

Podium #67 DO URINALYSIS FINDINGS BEFORE URODYNAMIC EVALUATION IMPACT THE RATE OF URINARY TRACT INFECTION AFTER THE STUDY? Lynn Lapicz1, Stephen Canon, MD2, Ashay Patel, MD2 and Ismael Zamilpa, MD2 1Arkansas Children’s Hospital; 2UAMS (Presented by: Lynn Lapicz)

Objective: Urodynamic studies have been avoided when urinalysis findings prior to the procedure suggest gross contamination or infection. Over the last twelve months urodynamic studies have been performed at our institution despite urinalysis findings before the study. The study is postponed only if patients present with signs and/or symptoms suggestive of a urinary tract infection. The primary objective of this study was to determine if urinalysis findings before urodynamic evaluation impacted the rate of urinary tract infection after the procedure. Methods: This was a retrospective review of consecutive urodynamic studies performed at our institution. Urinalysis findings before the study were examined along with the number of febrile and non-febrile urinary tract infections after the urodynamic evaluation. Patient characteristics analyzed included gender, medical condition (myelomeningiocele, dysfunctional voiding, etc.), method of bladder management (self-voider, clean intermittent catheterization, vesicostomy). Chi square analysis and Fisher exact tests were performed. Results: A total of 175 urodynamic studies were performed. Urinalysis was positive in 70 patients before the procedure, 91 patients had a negative urinalysis. One urinary tract infection was noted after the procedure. Method of bladder management, medical condition, nor gender impacted the rate of urinary tract infection after the study. Conclusions: Urinalysis findings in asymptomatic patients before urodynamic studies did not impact the rate of urinary tract infection after the study.

134 Podium #68 FRAILTY AND DELIRIUM – UROLOGICAL SURGICAL ISSUES? Robert Donohue, MD, Thomas Robinson, MD University of Colorado (Presented by: Robert Donohue)

Objective: The American population over 65 is increasing. 45% of Urologic surgical patients are more than 65 years of age. Surgical outcomes matter. Frailty and delirium adversely affect outcomes. P O DIUM s Methods: What is frailty? Frailty is global reduced physiologic reserve which increases the risk of adverse health care events. What is delirium? Delirium is an acute fluctuating change in mental status, with inattention and altered levels of consciousness. How do we assess, respond, prophylax and treat them these conditions? Results: Routine preoperative assessment of the vulnerable older adult should include assessment of cognitive ability, identifying risks for delirium, documentation of functional status, determination of frailty, assessment of nutritional status, medications and polypharmacy, treatment goals and family and social support. Preoperatively, frailty assessment includes measuring and summing abnormalities in activities of daily living, walking speed, geriatric syndrome, cognition, chronic disease and undernutrition. The goal of defining the frail, older adult is to optimize the surgical outcomes in this high risk population. Strategies to improve the outcome of the frail include pre-rehabilitation [exercise training and inspiratory muscle training] and modifying pre-operative counseling, Attention to fall prevention is mandatory. Post-operative complications, hospital length of stay, 30 day readmission rate, discharge to institutional care facility, cost in hospital and six month readmission skyrocket with frailty. Delirium is the most common post-operative complication in the elderly. In Surgical and Trauma ICUs, delirium incidence ranges from 44 to 59%. Interventions include pre-rehabilitation, orientation protocol, sleep enhancement, early mobilization, early vision and hearing protocols, pain control and appropriate medication choices. The use of special geriatric wards and geriatric surgical centers minimizes functional and cognitive decline of the hospitalized older adult. Conclusion: Almost half of current Urologic patients undergoing surgery are older than 65. Frailty assessment and institution of rehabilitation measures modify frailty and aids outcome. Risk factors for post-operative delirium and supportive measures to prevent post-operative delrium must be routinely instituted for high risk elderly. The Urologist must be at the forefront of these issues.

Podium #69 A NOVEL OPTICAL PROBE TO DETECT POSTIVE MARGINS IN PROSTATE CANCER SPECIMENS Monica Morgan, MD1, Jeffrey Gahan, MD1, Xinlong Wang2, Venki Kavuri2, Hanli Liu2, Claus Roehrborn, MD1 and Jeffrey Cadeddu, MD1 1Dept of Urology, University of Texas Southwestern; 2Dept of Bio-engineering, University of Texas Arlington (Presented by: Monica Morgan)

Objective: Currently, frozen sections are used to determine intraoperative positive surgical margins (PSM); however, this process is time intensive. It is well

135 Continued on next page established that with a tissue’s light absorption and scattering characteristics, light reflectance spectroscopy (LRS) can be used to differentiate between benign and malignant tissue. Autofluorescence lifetime spectroscopy (AFLS) which uses certain wavelengths to target and excite lifetime signatures of multiple endogenous fluophores can also discriminate malignant from benign surrounding tissues in animal models. These two techniques have been implemented into a novel optical dual-modality probe (dMOD). We report our findings using this probe to detect surgical margins on radical prostatectomy specimens. Methods: Eight patients undergoing RALP who were high risk for extraprostatic extension (EPE) as seen on MRI and who had high grade disease were selected for study from June to September 2013. Optical analysis was performed immediately following specimen extraction using the dMOD probe. This probe detects tumor up to 2.5mm from the prostate surface. The optical readings were taken from selected areas including the area of clinically suspected EPE (n=8) as well as areas of clinically benign tissue (n=8). These readings were then calibrated and compared to final histology taken specifically from these labeled sites. Results: Both LRS and AFLS techniques demonstrate statistically different signatures (scattering coefficient and fluorescence half-life respectively) between benign normal prostate tissue and prostate adenocarcinoma. Of the 8 clinically suspected EPE sites, 5 were histologically confirmed to have cancer at the margin and 3 were benign. The dMOD probe correctly identified the 5 positive margin cases however; it also reported cancer in 2 of the 3 histologically confirmed benign margin cases. All 8 locations of clinically suspected benign tissue margin where histologically confirmed benign. Of these, the optic probe reported 8 of 8 cases as benign. This resulted in a sensitivity and specificity of 100% and 81%; and a positive predictive value and negative predictive value of 80% and 100% respectively. Conclusion: The results of the dMOD probe show that there is significant difference between malignant and normal tissue on the prostatic capsule in ex vivo prostate specimens. Additional cases and further analysis will be presented to assess the feasibility of intra-operative optical biopsy in order to decrease positive margin rates during radical prostatectomy.

Podium #70 WITHDRAWN

Podium #71 MULTIPARAMETIC PROSTATE MRI: A NATIONAL SURVERY OF UROLOGISTS TO ASSESS ACCESSIBILITY, ROLE, AND PERCEIVED ACCURACY Brandon Manley, MD1, John Brockman, MD1, Kathryn Fowler, MD2, Goutham Vemana, MD1, Valary Raup3 and Gerald Andriole, MD1 1Washington University School of Medicine Division of Urology; 2Washington University School of Medicine Mallinckrodt Institute of Radiology; 3Washington University School of Medicine (Presented by: John Brockman)

Objective: The use of multiparametric MRI (MP−MRI) to diagnose prostate cancer has been the subject of intense research. Studies have shown high diagnostic

136 Continued on next page performance with possible utility in active surveillance. Yet the widespread use of MP−MRI by urologists has been slow to gain traction. The purpose of our study was to survey urologists to better understand the accessibility, role, and perceived accuracy of MP−MRI in practice. Methods: We constructed a 20 question survey that asked urologists about their current use and beliefs related to both the specific and general use of MP−MRI in their practice. Surveys were electronically sent to 7,400 practicing urologists who are American Urological Association members with a current email address.

Responses to the survey were voluntary and anonymous. We analyzed responses P O DIUM s and compared the frequency of answers among a variety of demographics. Results: Our survey elicited 279 responses. When asked if respondents felt access to MP−MRI or the cost of MP−MRI limits its use, 71.6% and 59.3% respectively, agree or strongly agree. Only 25.2% of respondents agree or strongly agree that MP−MRI should be used in active surveillance protocols. In a patient with a negative biopsy and elevated PSA, 39.2% reported MP−MRI to be very useful. 33.7% reported the regular use of MP−MRI targeted biopsies. Academic urologists ordered more MP−MRI studies per year than those in private practice (>10 MP−MRI per year, 43.3% vs. 21.1%; p−value < 0.001; see table). Urologists who performed more than 30 a year compared to those who performed less than 30 were more likely to feel that an MP−MRI would change their surgical approach (37.5% vs. 19.6%, p−value=0.002). Conclusion: Currently, urologists express hesitation toward the use of MP−MRI based on its unclear role in prostate cancer and a perceived lack of accuracy. Respondents found access to facilities and the cost of the study to be significant limitations. While MP−MRI has shown promising results in the literature, there is little support for its routine implementation. Future efforts within the urology community should be aimed at clarifying the role of MP−MRI and validating its accuracy in routine clinical practice.

Podium #72 PROSTATE FIELD CANCERIZATION: DYSREGULATED EXPRESSION OF MACROPHAGE INHIBITORY CYTOKINE 1 (MIC−1) AND PLATELET DERIVED GROWTH FACTOR A (PDGF−A) AND LIPID BIOSYNTHESIS IN HISTOLOGICALLY NORMAL TISSUE ADJACENT TO TUMOR Anna Jones, BS1, Kresta Antillon, BA1, Shannon Jenkins, BS1, Heidi Overton, BA1, Sara Janos, BS1, Virginia Severns, MS1, Kristina Trujillo, PhD1 and Marco Bisoffi, PhD2 1University of New Mexico School of Medicine; 2Chapman University, Schmid College of Science and Technology (Presented by: Anna Jones) Objective: Histologically normal tissues adjacent to prostate adenocarcinomas harbor genetic and biochemical alterations, an observation called field cancerization. 137 Continued on next page Accordingly, we have previously identified the transcription factor early growth response protein 1 (EGR−1) as a marker of prostate field cancerization. Our current objective is to identify additional protein indicators of this pathologic feature. Methods: Expression of Macrophage Inhibitory Cytokine 1 (MIC−1) and Platelet Derived Growth Factor A (PDGF−A), proteins potentially regulated by EGR−1, was determined by quantitative immunofluorescence (qIF) applied to human prostate adenocarcinomas, matched tumor adjacent histologically normal tissues, and disease-free prostate tissues. In addition, lipid biosynthesis was analyzed by quantitative staining using Oil Red O. Finally, regulation of MIC−1 and PDGF−A by EGR−1 was studied by quantitative reverse transcriptase polymerase chain reaction (qRT−PCR) following EGR−1 plasmid over-expression and EGR−1 siRNA silencing in the DU145 human prostate cell model. Results: Quantitative analysis indicated increased expression of MIC−1 and PDGF−A in tumor adjacent tissue when compared to disease-free tissues and were similar to the values found when comparing cancerous with disease-free tissues. In addition, lipid biosynthesis was also dysregulated in these tissues. Finally, qRT− PCR analysis revealed that EGR−1 over-expression induced expression of MIC−1 and PDGF−A, while silencing EGR−1 reduced expression of MIC−1 and PDGF−A in DU−145 cells. Conclusion: Tissues adjacent to prostate adenocarcinomas are histologically normal yet molecularly altered, i.e. field cancerized. Prostate field cancerization is characterized by a network of dysregulated and inter-dependent factors, as shown by our previous and present work on the transcription factor EGR−1, the lipogenic enzyme Fatty Acid Synthase (FAS), the inflammatory cytokine MIC−1, and the autocrine growth factor PDGF−A. Future research will show whether it is possible to expand the target region from tumor tissue, which is elusive in a 12 core biopsy, to structurally intact field cancerized tissue, a novel approach with potential to improve diagnostics in the pre- and post-surgical setting and in the treatment of prostate cancer. Support: We acknowledge support from the NIH/INBRE, DOD PCRP, and UNM Departments of Biochemistry & Molecular Biology, and Surgery/Urology.

Podium #73 FIRST-IN-HUMAN CLINICAL TRIAL DATA SHOW OPTICALLY ADJUNCT BIOPSY NEEDLES CAN INCREASE DIAGNOSTIC YIELD OF PROSTATE BIOPSIES E. David Crawford, MD1, Edward A. Jasion, MS2, Yongjun Liu, PhD1, John W. Daily, PhD3, S. Russell Nash, MD, PhD4, Paul Arangua1 and Priya N. Werahera, PhD1 1University of Colorado Denver Anschutz Medical Campus; 2Precision Biopsy LLC; 3University of Colorado Boulder; 4Centennial Pathologists, PC (Presented by: E. David Crawford)

Objective: Diagnostic yield of current transrectal prostate biopsies are very low as >90% of biopsy cores are benign. We conducted a clinical trial to determine efficacy of an optical biopsy needle adjunct with fluorescence spectroscopy (FS) to improve diagnostic yield of prostate biopsies. Optical sensor at the tip of the needle can separate benign areas from those positive for cancer analyzing natural fluorophores such as tryptophan. Hence, biopsies can now be directed to suspicious areas instead of benign regions. Methods: Optical sensor uses 8x100µm fibers for excitation and 1x200µm fiber 138 Continued on next page to collect FS data. Custom made fluorometers with 2 light-emitting diodes at 290 and 340nm and a spectrometer were used to measure FS of prostate tissue. User interface for fluorometer operation and data collection was developed using LabView software. Each spectral data acquisition takes ~250 milliseconds. The in vivo biopsies were performed during radical prostatectomy surgery on the exposed prostate with blood flow to the gland intact. A tissue biopsy core was obtained from each biopsy site after acquisition of FS data. Above procedure was repeated ex vivo after surgical excision of the prostate. Biopsy cores were histopathologically classified as benign or malignant and correlated with corresponding FS data. P O DIUM s Partial Least Square analysis of the FS data was performed to determine principal components (PCs) at each excitation wavelength. Using linear support vector machine and leave-one-out cross validation method, several combinations of PCs were tested for their ability to classify benign vs. malignant prostatic tissue. Results: Thirteen patients were consented and enrolled. A total of 208 in vivo biopsies (29 malignant) and 224 ex vivo biopsies (51 malignant) were studied. Results for benign vs. malignant prostatic tissue classification based on number of PCs used are given in the table. Conclusion: Our optical biopsy needle has a very high NPV to indicate benign tissue while sufficient SE and SP for real-time diagnosis of PCa by targeting areas positive for cancer within the prostate gland. Hence, systematic use of optical biopsies can potentially increase diagnostic yield of prostate biopsies. Source of Funding: Research grant from the State of Colorado Bioscience Discovery Evaluation Grant Program (BDEGP) and Precision Biopsy LLC, a private company financially supported by Allied Minds, Inc. of Boston, MA.

Podium #74 CLINICAL UTILITY OF TEMPLATE GUIDED TRANSPERINEAL SATURATION PROSTATIC BIOPSIES UNDER TRANSRECTAL ULTRASOUND GUIDANCE John Forrest, MD1 and Brian Bock, MD2 1Urologic Specialist of Oklahoma, Inc; 2St. John Medical Center (Presented by: John Forrest)

Objective: Since January of 2011, a total of 46 patients have undergone template-guided transperineal saturation prostatic biopsies under transrectal prostate ultrasound guidance. All were performed under general anesthesia in an outpatient setting. All patients had undergone standard 12 core in-office transrectal prostatic ultrasound and transrectal biopsies with a standard 12 core technique prior to the saturation technique. All transperineal biopsies were performed by a single surgeon. All biopsies were interpreted by a single dedicated genitourinary pathologist with intradepartmental review. The clinical indications for this technique defined four patient groups: rising PSA with previous negative biopsies, rising PSA with previous suspicious biopsies, active surveillance patients with rising PSA, and post radiation therapy patients with a rising PSA. 139 Continued on next page Materials: Twenty-two patients were in the rising PSA group with previously negative prostate biopsies. Twelve patients in this group demonstrated no cancer and eight patients demonstrated adenocarcinoma of the prostate. One patient with PIN and one patient with ASAP were identified. Seven of the eight patients had clinically significant cancer and elected definitive therapy. Twelve patients were in the group of previously suspicious biopsies. Of that group undergoing saturation biopsies, five patients were benign, three demonstrated clinically significant adenocarcinoma of the prostate, three demonstrated PIN and one demonstrated ASAP. Five patients in an active surveillance protocol underwent saturation biopsies for significant PSA velocity changes. Three patients were found to have upgrading of their disease and subsequently underwent definitive therapy. Results: One patient was confirmed to have low volume disease and one was entirely benign. Seven patients underwent saturation biopsies following radiation therapy for suspicious PSA rises. Four were found to have persistent/recurrent prostate cancer and three were benign. Complications across all groups were uncommon. Urinary retention occurred in two patients (4%), urinary clot retention in one patient (2%), and acute prostatitis not requiring hospitalization in one patient (2%). No surgical intervention was required in any of those patients. In conclusion, saturation biopsy across all groups revealed 19 (41%) positive biopsies; 17 of 19 biopsies (89%) were felt to be clinically significant. Conclusion: Comparing the clinical subgroups, saturation biopsies yielded the greatest group benefit in the active surveillance group in terms of changing management. The vast majority of all cancer diagnosed with this technique are clinically significant malignancies resulting in definitive therapy. Disclosures: none

Podium #75 KU675, A CONCOMITANT HEAT SHOCK PROTEIN INHIBITOR OF HSC70 AND HSP90 THAT MANIFESTS ISOFORM SELECTIVITY FOR HSP90Α William Parker, MD, Weiya Liu, PhD, Doug Brown, Eugene Lee, MD, Jeffrey Holzbeierlein, MD, George Vielhauer, PhD University of Kansas Medical Center (Presented by: William Parker)

Objective: Heat shock protein 90 (Hsp90) is overexpressed in prostate cancer and has been shown to have a role in tumorigenesis through the stabilization of oncogenic proteins, promotion of mitochondrial efficiency in low-nutrient environments, and the induction of an inflammatory stromal environment, making it an important target for drug discovery. Unfortunately, clinical trial results with N−terminal Hsp90 inhibitors have been disappointing, as toxicity and resistance resulting from induction of the heat shock response (HSR) has led to both scheduling and administration concerns. KU675 is a novel C−terminal inhibitor of Hsp90 we sought to further characterize with respect to the effect on tumor growth, isoform selectivity, and HSR. Methods: Hormone dependent and refractory prostate cancer cells were used in both direct and indirect in vitro Hsp90 inhibition assays (antiproliferative, luciferase refolding, and Western blot for client protein degradation) to characterize the effects of KU675 in PC3−MM2 and LNCaP−LN3 cell lines. Direct binding studies were conducted using fluorescence spectroscopy and Hsp90α, Hsp90β and Hsc70 recombinant proteins. 140 Continued on next page Results: KU675 exhibits anti-proliferative and cytotoxic activity along with client protein degradation without induction of the heat shock response (HSR) in prostate cancer cell lines. Furthermore, KU675 demonstrates direct inhibition of Hsp90 as measured by the inhibition of luciferase refolding in cancer cells. In direct binding studies, KU675 was used with fluorescence spectroscopy to measure the binding constant (KD) to recombinant Hsp90α, Hsp90β and Hsc70. The KD for Hsp90α and Hsp90β was 191μM and 726 μM, respectively demonstrating the relative isoform selectivity of KU675. Western blot experiments of cancer cells having knockdown of Hsp90α or Hsp90β by shRNA support the isoform selectivity binding data by P O DIUM s revealing the degradation of Hsp90α specific client proteins. KU675 also displays binding to HSC70 with a KD value at 76.3uM, which is supported by decreased expression of HSC70 specific client proteins in Western blot studies. Conclusion: KU675 is a C−terminal inhibitor of Hsp90 that has selectivity for the α-isoform as well as co-inhibition of Hsc70. Given the novel inhibition pattern of KU675 these results suggest the possibility of designing selective isoform inhibitors of Hsp90, which might escape the limiting toxicities of prior attempts at inhibiting Hsp90 in the treatment of human cancers.

Podium #76 AN OPTIMAL MARKER FOR EFFICACY DURING TREATMENT WITH RADIUM-223: ANALYSIS OF OUR FIRST 42 PATIENTS John Bishay, MD1, Matthew McDonald, BS, CNMT2, Samuel Mehr, MD2 and Luke Nordquist, MD2 1University of Nebraska Medical Center; 2Urology Cancer Center & GU Research Network, Omaha, NE (Presented by: John Bishay)

Objective: RAD−223 (Xofigo®) is approved for the treatment of patients with castration resistant prostate cancer with symptomatic bone metastases. It is a first-in-class radiopharmaceutical that emits alpha particles and has demonstrated an overall survival benefit and a delay in time to first symptomatic skeletal event. It is approved for 6 monthly injections, but no optimal marker for efficacy has been identified. Methods: This is a retrospective, observational study of patients who received RAD−223 at the Urology Cancer Center. Prostate specific antigen (PSA) and alkaline phosphatase (alk phos) trends were reviewed from baseline through the course of RAD−223. Skeletal scintigraphy after 6 doses was compared to baseline. Patient’s pain was assessed by chart review. Results: As of February 2014, a total of 42 patients received 190 doses of RAD−223. Of those, 36 were included in our study. Concurrent therapies while receiving RAD−223 included: androgen deprivation (100%), denosumab (94%), abiraterone (31%), enzalutamide (36%), and (8%). 63% of the patients completed 6 doses at the time of this analysis. In regards to PSA, 6% had >50% decline, 8% had >90% decline, 8% had >50% rise, 25% had >90% rise and 53% had no change. In regards to alk phos, 33% increased, 61% decreased and 6% remained the same. Skeletal scintigraphy for 16 patients who completed 6 doses demonstrated 2 with complete resolution, 4 patients with significant improvement, 5 patients were stable, 2 patients demonstrated progression and 3 patients had a mixed response. Evaluation of pain demonstrated 33% remained stable, 59% had improvement and 8% had increased pain. Although there appears 141 Continued on next page to be some correlation between pain response and skeletal scintigraphy, there does not appear to be a reliable correlation between PSA or alk phos and pain or skeletal scintigraphy. Conclusion: PSA and alk phos do not seem to be reliable indicators of efficacy for patients receiving RAD−223. Rises in these markers did not correlate with responses seen on skeletal scintigraphy or with clinical symptoms. Further investigation is necessary to determine more optimal markers of response to RAD−223. Patients should not discontinue therapy with RAD−223 prematurely for rises in PSA or alk phos only.

Podium #77 MANAGEMENT OF PUBIC OSTEOMYELITIS FOLLOWING RADIATION THERAPY FOR PROSTATE CANCER McCabe Kenny, MD, Andrew Windsperger, MD, Ty Higuchi, MD, PhD University of Colorado-Denver (Presented by: McCabe Kenny)

Objective: Pubic osteomyelitis (PO) is a rare complication following ablative therapy for pelvic malignancies and has been reported following surgery, radiation, and cryotherapy for prostate cancer. PO can cause significant morbidity and few studies have investigated the optimal treatment for this devastating condition. We describe our experience with management of pubic osteomyelitis following radiation therapy for prostate cancer. Methods: We retrospectively reviewed patients presenting with PO with a history of treatment for prostate cancer from 2012−2014. PO was diagnosed radiographically with CT or MRI. We recorded patient demographics, prostate cancer treatment history, urinary history, preoperative labs and imaging results, management and outcomes. Results: Seven patients met study criteria and all patients had biopsy proven prostate cancer. Treatment for prostate cancer included: XRT (n=2), brachytherapy (1), prostatectomy with adjuvant XRT (3), XRT plus brachytherapy with salvage brachytherapy (1). Median time from last dose of radiation to development of PO was 11 years (range 6−17). All patients had radiographic diagnosis of PO, suprapubic pain waddling gait and elevated CRP (range 1.3−38.2). Five patients had a history of posterior urethral stricture and underwent a median number of two transurethral treatments (range 1−3). Six patients required oral narcotics for pain control. Pubocutaneous fistula was present in four patients. Surgical management included cystectomy with orthopedic pubic debridement in three patients (including an omental flap in two and a gracilis flap in one), cystectomy with orthopedic hemipelvectomy in one, and bilateral nephrostomy tubes in one patient who was not a surgical candidate. Two patients are awaiting surgery. Three of the four surgical patients were continued on 6 weeks of IV antibiotics. Median follow up in patients who have undergone surgery is 9 months (range 9−12) and all surgical patients have had improvement in their pubic pain. Conclusion: Pubic osteomyelitis is a devastating condition that presents with pelvic pain, waddling gait and elevated CRP. A majority of patients also have undergone transurethral treatment of posterior urethral stricture which may seed the pubic bone. Surgical removal of the lower with pubic debridement and an extended course of antibiotics appears to be the treatment of choice.

142 Podium #78 OPEN OR ROBOT-ASSISTED RADICAL PROSTATECTOMY AS THE PRIMARY TREATMENT OF HIGH RISK PROSTATE CANCER: ONCOLOGIC OUTCOMES AND INCIDENCE OF SUBSEQUENT THERAPIES Jenny Nguyen, Mary Achim, BS, Brian Chapin, MD, Surena Matin, MD, John Davis, MD UTMDACC (Presented by: Jenny Nguyen) P O DIUM s Objective: High-risk prostate cancer (HRPCa) has no uniform standard of care. Radical prostatectomy (RP) has been advocated as the first step in the treatment of advanced disease with the application of multimodal therapies based on pathologic/PSA outcomes. We sought to determine clinical and biologic outcomes after open (ORP) and robotic RP (RRP) in a large academic practice. Methods: A retrospective analysis of HRPCa patients undergoing RP with lymphadenectomy from 5/2006−6/2010 by 5 surgeons at one center was conducted. A total of 215 patients were classified as HRPCa (NCCN guidelines: PSA>20ng/mL, Gleason Score ≥8, Clinical stage ≥T3a). Baseline demographics, perioperative/pathologic outcomes and adjuvant/salvage therapies were included. Adjuvant external beam radiation (adj−XRT, defined in the setting of a non- detectable PSA and ≤9 months of RP). Biochemical failure (BCF) was defined as a PSA of ≥0.2ng/mL. Results: Median age was 62 (43−80), pre-operative PSA 5.6ng/mL (0.1−119). 33 (53%) of 66 patients receiving neoadjuvant therapy were on clinical trial. Median follow-up was 4.7 yrs (1.4−9). Surgical approach was open in 91 (42%) and robotic for 124 (58%). RP was the only treatment applied in 108 (50.2%) of patients. Organ confined disease was present in 128 (60%) patients. Rate of positive surgical margins (SM+) rate was 27% (RRP 21%, ORP 35%). 56 (26%) were pathologic N1 (pN1). Adj−XRT was applied to 7 (3.3%) patients while 46 (21.4%) underwent salvage XRT. BCF at 6 weeks post RP was found in 15 (7%) of patients, while BCF free survival at 5 yrs was 51% (median not reached). On univariate analysis pathologic stage (p<0.001), SM+ (HR: 2.21, 1.5−3.4), pN1 (HR: 3.6, 2.3−5.4), and number of high-risk features (2−2.6, 1.77−4.59 vs 3−6.8, 2.7−17) were predictors of BCF. On multivariable analysis preoperative PSA (HR: 1.02, 1.01−1.04), path Gleason score (4+3, p=0.15; 8, 9 or Hormone, p=0.03), path stage (3a, p=0.3; 3b, p=0.05; 4, p=0.01) and pN1 status (HR: 1.98, 1.20−3.27) remained significant predictors of BCF. Surgical approach was not a significant predictor of BCF on univariate or multivariable analysis. Conclusion: Multiple therapeutic pathways exist for the treatment of HRPCa. Standardized approaches are unlikely given the inconsistency and variability in clinical and biologic outcomes. RP, regardless of approach, is a reasonable first step in the multimodality treatment of HRPCa.

143 Podium #79 ACTIVE SURVEILLANCE AS AN INITIAL MANAGEMENT IN MEN WITH PHENOTYPICALLY HETEROGENEOUS EARLY STAGE PROSTATE CANCER John Davis, MD, Mary Achim, BS, John Ward, MD, Curtis Pettaway, MD, Brian Chapin, MD, Xuemei Wang, Deborah Kuban, MD, Steven Frank, MD, Andrew Lee, MD, Louis Pisters, MD, Surena Matin, MD, Jay Shah, MD, Jose Karam, MD, John Papadopoulos, MD, Karen Hoffman, MD, Thomas Pugh, MD, Seungtaek Choi, MD, Christopher Logothetis, MD, Patricia Troncoso, MD, Jeri Kim, MD MD Anderson Cancer Center (Presented by: John Davis)

Objective: Active surveillance (AS) in prostate cancer (PC) is predicated on slow, stepwise disease progression. Patient (Pt) selection, although not standardized in prospective AS trials, is based on clinical stage, prostate − specific antigen (PSA), and phenotypic characteristics of tumors on biopsy (BX). Changes on repeat BXs often trigger intervention. In a single-institution prospective cohort study, pts with early stage PC were stratified to AS group (GR) I (favorable risk), II (pt’s choice), or III (competing comorbidities prevent local therapy [Tx]). We describe early results for GR II, use of confirmatory and subsequent BX, and reclassification and Tx rates. Methods: A multidisciplinary team of physicians 2006−2012 enrolled 191 men into GR I and 370 into GR II. GR I required a single core of Gleason score (GS) 3+3 < 3mm, or 3+4 < 2mm, and a PSA < 4 ng/mL (adjusted for prostate size). Pts with life expectancy >10 years (yr) selecting AS were considered GR II. Pts had mandatory confirmatory BX at registration or within 6 months (mo) of diagnostic BX, and then repeat BXs every 1−2 yr. PSA and digital rectal examination were done every 6 mo. Disease (dz) was reclassified to higher risk based upon increases in tumor volume (TV) or grade. Results: Of 370 GR II pts, 161 (44%) met the GR I BX criteria, but not the PSA cutoff. Clinical stage cT1c was found in 86%; median PSA was 4.4 ng/mL; and GS was 3+3 in 77%, 3+4 in 19%, and 4+3 in 3%. After a median 3 years follow-up, 120 (32%) had been treated with curative modalities—surgery (43%), radiation (mixed modalities) (53%), and cryotherapy (3%). Time on-study pre-Tx was <6 mos in 53%, 6 to <12 mos in 8%, 12 to <24 mos in 24%, 24 to <36 mos in 9%, and 36 to >48 mos in 5%. Dz was reclassified on BX that triggered Tx in 106 pts based on increased BX TV and/or GS upgrading in 73 (69%). Fourteen of 120 had Tx without tumor reclassification on BX. Conclusion: In a prospective AS cohort with phenotypically heterogeneous tumors, one third were eventually treated for cure—mostly in the first year, owing to BX variability. Biologically concerning Tx triggers (GS 6/7 to 8/9) occurred in 12% of treated. Despite limitations of selection criteria and monitoring tools, AS is an important initial option in localized PC. Source of Funding: Departmental

Podium #80 WITHDRAWN

144 Podium #81 A SINGLE COMMUNITY CENTER’S EXPERIENCE WITH ABIRATERONE USING STRICT PCWG2 DEFINITION OF PROGRESSION OF DISEASE Thomas Longo, MD, Luke Nordquist, MD UNMC (Presented by: Thomas Longo)

Objective: Abiraterone, an androgen synthesis inhibitor has been successfully used in the treatment of castration-resistant prostate cancer (CRPC). A rise in PSA P O DIUM s has long been one of the criteria used to define progression of disease (POD) on hormone manipulation by clinicians. The Prostate Cancer Work Group (PCWG2) defines POD as a rise in PSA plus radiographic progression or clinical deterioration. It has been our practice to closely follow these guidelines and continue therapy despite a PSA failure until another sign or symptom of POD is present. While this practice is not controversial, it has not become routine in the general community practice and patients may be taken off therapy prematurely. We believe that our practice pattern gives the patient maximum benefit from their therapy. Methods: Clinical data were retrospectively analyzed for prostate-specific antigen (PSA), and other signs of progression of disease as defined by PCWG2. A PSA failure is defined as an increase of 25% over the nadir, with an absolute value greater than 2 ng/mL. The primary objective was to see the difference in time between a failure as defined by PSA versus PSA failure plus an additional criterion. A total of 55 patients were identified as having received abiraterone and demonstrated POD. Results: A total of 55 patients received abiraterone for an average duration of 11.6 months. Thirty three of these patients experienced an isolated PSA failure based upon PCWG definition at an average of 6.8 months. It took an average of 4.8 months before these patients experienced a second sign of POD; this gain in therapy ranged from 0 to 31 months. Conclusion: Abiraterone is a novel, noncytotoxic hormone therapy, and the PSA appears to have a novel response. In our practice we strictly follow PCWG2 criteria. Many practices will discontinue treatment based solely on the PSA criteria and our data suggests that sacrifices nearly 5 months of therapy. It is not unreasonable to assume that a less rigid definition of PSA rise is used in the community. While PSA remains an invaluable marker, it is not infallible in the setting of treatment without intent to cure. Once cure is no longer the intent of treatment, the definition of POD should be adjusted to maximize the benefit and duration of each therapy.

Podium #82 TREATMENT CHOICE FOR PROSTATE CANCER BY COUNTY OF RESIDENCE: A SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS (SEER) REVIEW Jonathan Heinlen, MD1, Nora Ruel, MA2 and Timothy Wilson, MD2 1University of Oklahoma; 2City of Hope National Medical Center (Presented by: Jonathan Heinlen)

Objective: Choice of prostate cancer treatment has traditionally been shown to vary between major regions of the United States as well as between centers of treatment. This is a sign of poor standardization of care and overall quality of care for localized prostate cancer. This study was designed to show the difference in

145 Continued on next page treatment choice based on the patient’s county of residence at the time of diagnosis. Methods: From the SEER database, 18 registries were queried for all men under 65 years of age who underwent treatment for prostate cancer between 2000 and 2009. Men were grouped by their county of residence at the time of diagnosis. Only men who underwent surgery or a form of radiation were included. Results were compared to county factors such as population, rate of obesity, incidence of prostate cancer, and per capita income. Rate of radiation usage was then plotted on a map of each SEER region by county. Results: Although there was a difference between states and regions in usage of radiation, differences observed at a county level were striking. Some counties in the SEER database have as high as 80% utilization of radiation, whereas other counties are as low as 15%. No individual demographic measure predicted choice of radiation over surgery. Conclusion: Choice of treatment for localized prostate cancer varies widely between counties included in the SEER database. Despite publication of treatment algorithms for localized prostate cancer, standardization of treatment for prostate cancer is poor. This has potential implications for payers as cost and quality of care in prostate cancer increase in significance.

Podium #83 A NOVEL NATURAL COMPOUND ALTERNOL INDUCES ROS-DEPENDENT BAX ACTIVATION AND APOPTOTIC CELL DEATH IN PROSTATE CANCER CELLS. David Flores, MD, Yuzhe Tang, J. Brantley Thrasher, MD, Benyi Li, MD, PhD University of Kansas (Presented by: David Flores)

Objective: Effective therapeutic options for castration resistant prostate cancer are limited, necessitating the development of novel therapies to ameliorate this disease. This study investigated anti-neoplastic effects of a novel compound on prostate cancer cells. Alternol is a natural compound isolated from the bark of Alternaria alternata var monosporus. Methods: Seven prostate cell lines were incubated with Alternol in a time- and

146 Continued on next page dose-dependent course in vitro. Cell viability was assessed utilizing a trypan blue test and a western blot analysis was performed to detect indicators of apoptosis. To assess whether the Alternol-induced apoptosis pathway was dependent on the presence of the BAX gene, DU−145 cells were transfected with exogenous BAX plasmids and then analyzed for indicators of apoptosis after Alternol treatment. Alternol induced apoptosis was also tested in vivo using PC3 and DU−145 cell lines. A suspension of 2.0×106 cells of each cell type was inoculated into the flanks of athymic mice to induce tumor growth. When tumors were palpable (4−6 weeks), mice were treated with Alternol (20 mg/kg) by intraperitoneal injection. Tumor size P O DIUM s was determined by measuring the length (L) and the width (W) of the tumor and immunohistochemical staining was done to monitor the apoptosis rate in situ. Results: Alternol was effective in inducing a time-dependent and dose-dependent apoptotic response in majority of prostate cancer cell lines, while sparing non- malignant cell lines. This compound induced an intracellular oxidative response through the formation of Reactive Oxygen Species (ROS), and initiated the apoptosis through activation of the pro-apoptotic BAX gene. Interestingly, inducing the BAX gene expression in BAX-deficient cell lines, sensitized them to Alternol induced apoptosis. The effect of this compound was seen both in vitro and in vivo. Experiments in nude mice with PC3 xenografts showed Alternol suppressed xenograft tumor growth in PC3 cell lines. Conclusion: Alternol induces a massive intracellular oxidative stress through the production of ROS in a dose- and time-dependent manner in prostate cancer cell lines. The BAX- dependent apoptotic cell death appears to be isolated to prostate cancer cells lines while sparing benign tissue. This study demonstrates that Alternol may be an effective treatment option for prostate cancer in the future. Key words: Alternol; prostate cancer; apoptosis; Reactive oxygen species, tumor suppression.

Podium #84 MODIFIER 22 IN PATIENTS UNDERGOING ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY AT A TERTIARY CARE CENTER Katie Murray, DO1, Daniel Zainfeld, MD1, Moben Mirza, MD1, Ernesto Lopez- Corona, MD2, Brantley Thrasher, MD1 and David Duchene, MD1 1University of Kansas; 2Kansas City Veterans Administration (Presented by: Daniel Zainfeld)

Objective: Physician reimbursement for services is based on a resource-based relative value scale. Current Procedural Terminology (CPT) codes are billed to insurance companies and Medicare for services provided with modifier codes available to differentiate non-routine cases and adjust reimbursement accordingly. The 22 modifier code (M22) is a component of CPT that is used by surgeons to designate a surgical case that was particularly complicated and required greater than the usual effort in order to complete. We sought to determine the rate and amount of reimbursement for robotic-assisted laparoscopic prostatectomy (RALP) and M22. Methods: Data on patients who underwent RALP from January 2009 through August 2012 was collected retrospectively. With assistance from the billing department, we identified non-charity cases in which M22 was used with RALP (CPT 55866). Information obtained included procedure, surgeon, payee, reimbursement 147 Continued on next page obtained for the procedure, and contract reimbursement amount for the procedure. A descriptive analysis was used to explain the payment possibilities and amounts. A chi square analysis was used to determine the likelihood of collecting payment between differing insurance and government entities. Results: A total of 579 RALP procedures performed by three staff urologists were identified in the study period. Of these, 208 (36%) had a M22 recorded based on the immediate post-procedure note and surgeon’s operative report. The billing department had applied the M22 on 164 patients based on adequate information to cover the M22. Analysis was completed on 141 patients in whom contracted reimbursement for the procedure from their insurance company was known. 111 of the 141 (78.8%) were found to have collected greater than the contracted amount with an average extra payment of $473.53 ($62.76−$1284.23). The likelihood of increased payment with M22 was greater than 96% when billed to government agencies versus 67% with private insurance companies (p<0.0001). Conclusion: The 22 modifier code is a reasonable addition in appropriate RALP procedures as it increases reimbursement in almost 80% of those cases in which it is applied. In the setting of tertiary care centers, where complicated procedures are performed more commonly, this may be especially relevant. This study suggests improved reimbursement with appropriate application of M22 may apply for other urologic procedures as well.

Podium #85 HEIGHT-BASED RATHER THAN WEIGHT-BASED, DOSING AS A MORE APPROPRIATE METHOD OF TREATING WITH RADIUM-223 Thomas Longo, MD1, Matthew McDonald, CNMT2, Samuel Mehr, MD2 and Luke Nordquist, MD2 1UNMC; 2Urology Cancer Center (Presented by: Thomas Longo)

Objectives: Radium 223 is approved for use in patients with symptomatic bone metastasis from castrate resistant prostate cancer. It is currently dosed in a weight based fashion, however it is only active in the skeleton, and it is distributed primarily to the bone. It is then excreted by the intestines. Our study looks at the safety and efficacy of radium 223 in the context of a height based dosing regimen. Methods: This is a retrospective, observational study of all patients receiving radium 223 at the Urology Cancer Center. As of January 2014 40 patients received a total of 178 doses of RAD−223 at our site. All patients received the FDA approved dose of 50 kBq/kg . The dose each patient received was then re−calculated based upon the patient’s height. The medical record was then examined for reported toxicities and the patient’s response to a pain scale after each dose. Results: The lowest dose based on height administered was 17.39 kBq/cm and the highest dose was 40.7 kBq/cm with an average dose of 27.4 kBq/cm. The side effect profile did not show any trends across the different levels of dosing regarding the number or grade of toxicity. Grade 1 nausea was experienced by 25% of the patients and 10% had grade 2 nausea. Diarrhea was experienced by 33% of the patients; 6 of the 11 patients with diarrhea had a prior history of pelvic radiation. Anemia was experienced by roughly 20% of the patients; most hematologic toxicities were reported prior to initiating RAD−223 and remained stable. When the pre- and post-treatment pain scale was examined, patients with a 148 Continued on next page BMI≥28 experienced an average 2 point reduction, while those with a BMI≤27 had only an average 0.2 reduction in their pain scale. Conclusions: A height based dosing regimen may be more appropriate for a drug designed to treat only the skeleton. In our population, we administered a wide variety of doses when administered by height. Higher doses appear to be well tolerated, and the optimal dose has yet to be determined. The EMR confirmed that nearly every patient experienced relief of pain after starting therapy based on pre- and post-treatment pain scales. We propose future studies with height-based dosing escalation to look at the safety and efficacy. P O DIUM s

Podium #86 WITHDRAWN

Podium #87 CAN URINARY NERVE GROWTH FACTOR (NGF) BE USED AS A BIOMARKER IN ANATOMICALLY OBSTRUCTED FEMALE PATIENTS? Robert Chan, MD1, Julie Stewart, MD1, Alvaro Munoz, PhD1, Evan Wenker, BA2, Timothy Boone, MD, PhD1 and Rose Khavari, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

Objective: The urinary biomarker, nerve growth factor (NGF), has been previously shown to be elevated in male patients with bladder outlet obstruction (BOO) and other lower urinary tract symptoms (LUTS). No published studies have examined NGF as a potential urinary biomarker in females with BOO. The aim of this prospective study is to evaluate NGF levels in women with anatomic BOO resulting from pelvic organ prolapse (POP) and/or previous incontinence surgery. Methods: From January – September 2012, all female patients referred for evaluation and management of BOO from POP or previous incontinence surgery were screened for enrollment. Inclusion criteria included: elevated post-void residual (PVR), valsalva voiding on urodynamics (UD) or urinary peak flow (Qmax) ≤ 12 mL/s. A control group of 10 asymptomatic age-matched female volunteers was also recruited. In all subjects, urinary NGF and creatinine (Cr) levels were measured by enzyme-linked immunosorbent assay. The total urinary NGF levels were normalized to the urinary Cr concentrations (NGF/Cr). Results: A total of 10 female patients with anatomic BOO (mean age of 66.2 ± 12.3 years) and 10 female control subjects (mean age of 62 ± 7 years) were recruited. Etiologies of BOO in the study group included POP (n=6), previous incontinence surgery (n=3) or a combination (n=1). Nine out of 10 patients underwent UD, all with evidence of valsalva voiding. Two patients were unable to void. The mean Qmax for the other 7 patients was 6.3 ± 4.9 mL/s. The one patient who did not undergo UD had frank urinary retention with a PVR of 1200 mL. The urinary NGF/ Cr levels in the study patients with BOO (mean ± standard error 20.8 ± 13.6 pg/ mg) were significantly higher (p=0.006) than the levels in the age-matched control group (5.595 ± 0.656 pg/mg). After treatment with release of prior anti-incontinence procedure or POP repair, the urinary NGF/Cr level significantly decreased to 6.67 ± 2.6 pg/mg (p=0.0009). The urine NGF/Cr levels continued to be significantly decreased (p = 0.008) at the 3 months post-op (5.1 ± 68 pg/mg). Conclusion: In this study, female patients with anatomic BOO resulting from

149 Continued on next page POP and/or previous incontinence surgery had significantly higher urinary NGF/ Cr levels when compared to age-matched controls. After surgical correction, the urinary NGF/Cr levels significantly decreased. Urinary biomarkers are attractive as a possible adjunct to the evaluation and monitoring of various LUTS. Our future investigations will work to refine the observed correlation in women with BOO.

Podium #88 URETHRAL LENGTHENING UTILIZING PROXIMAL PERINEAL SKIN TUBE FOR SEVERE CASES OF PROXIMAL HYPOSPADIAS REPAIR Elizabeth Malm-Buatsi, MD1, Blake Palmer, MD2, Dominic Frimberger, MD2 and Brad Kropp, MD2 1University Of Oklahoma; 2University of Oklahoma (Presented by: Elizabeth Malm-Buatsi)

Objective: There are several well-described procedures for severe proximal hypospadias repair with the major complication being the development of a fistula. We report our experience with our new technique for proximal hypospadias with severe chordee in which the urethral plate is divided proximally and a hairless perineal skin between the bifid scrotum is rolled into a urethral tube to bridge the gap for urethral lengthening (XOLO tube). Methods: A total of 17 patients with proximal hypospadias associated with very severe chordee and poor urethral plate underwent urethral lengthening tube repair from 2/2005 to 8/2013. This new technique involved proximal division of the urethral plate with tubularization of non-hair bearing proximal perineal skin as a single or two-stage repair. Six cases were 46 XY DSD. Four patients underwent single stage and 13 had two-stage repairs. Scrotal tube flap width ranged from 10 − 25 mm and length from 20 – 45 mm. Results: Patient follow up ranged from 8 months to 8 years. Fistula rate of the non-hair bearing scrotal tube was zero. The only complication from the scrotal urethral tube was meatal stenosis in 5 patients (29%). Meatal stenosis was always recognized prior to the second stage urethroplasty. When the non-hair bearing scrotal tube in the bifid scrotum was greater than 15 mm wide the meatal stenosis rate was 12.5% but increased to 66.7% when less than 15 mm wide (p−value = 0.091). Thirteen patients required a second stage urethroplasty of the distal penile skin for completion of their hypospadias repair. Complication rates in this second stage were similar to those reported in the literature. All portions of the scrotal urethral tube were intact and did not contribute to the complications involving the second stage. Of 15 patients with follow up data, 13 have strong stream and 2 patients have some dribbling with voiding. Conclusion: The major advantage of this technique is the zero fistula rate of the proximal scrotal urethral tube. This new technique appears to be a good alternative for lengthening the proximal urethra in select cases of severe hypospadias. When complications do occur, they tend to be less often in the cases with wider tubes. Therefore, if the non-hair bearing region in the bifid scrotum is less than 15mm wide, we recommend using an alternative method for repair.

150 Podium #89 ALGORITHMIC APPROACH FOR PRECISE PENILE STRAIGHTENING DURING PENILE PROSTHESIS SURGERY Timothy J. Tausch, MD, Paul H. Chung, MD, Lee C. Zhao, MD, MS, Jay Simhan, MD, J. Francis Scott, BA, Allen F. Morey, MD UT Southwestern Medical Center (Presented by: Timothy J. Tausch)

Objective: We present a novel algorithm for treating patients undergoing inflatable P O DIUM s penile prosthesis (IPP) surgery who have concomitant penile curvature, either known or unknown preoperatively. Methods: Patients receiving IPP placement who also had penile curvature were reviewed. When penile deformity was known preoperatively, the patient underwent penile plication immediately prior to IPP insertion, via the same penoscrotal incision. Patients whose penile curvature was revealed after the test inflation of the newly inserted IPP were treated with a Yachia (Heineke-Mikulicz) corporoplasty. This was accomplished by incising the tunica albiginea over the cylinder with low current electrocautery for 1−2 cm longitudinally, and then closing the corportomy horizontally with 2−0 braided, non-absorbable sutures. A qualitative survey assessing penile curvature, adequacy for intercourse and overall patient satisfaction after surgery was administered. Results: Among 405 men receiving IPP at our institution from 2007−2013, 26 received synchronous reconstruction for penile curvature (6%): 21 of 26 (81%) with known deformity underwent plication immediately prior to IPP, and 5/26 (19%) having penile curvature revealed only after IPP placement underwent a Yachia corporoplasty. Mean pre-op curvature was 37° corrected to <5°. A median of 4 sutures (range 3−6) were used for plication with each suture providing correction of approximately 8°. No patient suffered postoperative complications and all patients were discharged home on post-op day one. Average operative times were only 24 minutes longer compared to patients who underwent IPP placement only (88 vs 64 minutes, p<0.05). At an average 8 months of follow-up, 17/18 (94%) of patients who completed surveys reported no residual curvature, erections adequate for sexual intercourse and an improved overall condition. One patient (7%) who underwent a complex biplanar repair reported minor residual curvature. No patient reported continued pain or required revision of sutures. Conclusion: Penile curvature can be safely and reliably reconstructed at the time of IPP placement, whether or not the deformity was identified preoperatively.

151 POSTERS

Poster #1 PROGNOSTIC BIOMARKERS FOR BILHARZIAL AND NON-BILHRAZIAL RELATED BLADDER CANCER: IMMUNOHISTOCHEMISTRY STUDY OF 14 MARKERS Ramy Youssef, MD1, Payal Kapur, MD2, Ahmed Mosbah, MD3, Hassan Abol- Enein, MD3, Mohamed Ghoniem, MD3 and Yair Lotan, MD2 1Duke University; 2UT Southwestern, Dallas, TX; 3Urology and Nephrology Center, Mansoura, Egypt (Presented by: Ramy Youssef)

Objective: Herein we define the best prognostic biomarkers in bilharzial and non- bilharzial related bladder cancer (BBC and NBBC) after radical cystectomy (RC). We also determine the clinico-pathological differences between BBC and NBBC. Methods: Immunohistochemical (IHC) staining for 14 markers (p53, p21, p27, cyclin E, ki67, COX−2, EGFR, FGF−2, VEGF, Bcl−2, Caspace−3, Bax, ERK, TSP−I) was performed in 315 patients treated with RC. Patients were divided into 2 groups: Group 1 comprised 205 patients (65%) with BBC and group 2 comprised 110 patients (35%) with NBBC. Clinico-pathological differences were compared and markers were correlated to clinical outcome in both groups. Results: The study included 315 patients (239 males and 76 females) with median age 54 y (range 31−79). There was significant difference in histological types, tumor stage, grade, and architecture between both groups (P < 0.05). BBC presented with lower grade, higher stage, and non-papillary non-urothelial carcinoma. COX−2 expression was the best independent predictor of disease recurrence (HR 1.9, CI 0.99−3.626 and P= 0.05) and cancer specific mortality (HR 2.8, CI 1.155−6.73 and P= 0.023) in BBC. Ki−67 was the only marker associated with disease recurrence in NBBC in Kaplan-Meier survival analyses (HR 4.2, p =.038) Conclusion: BBC differs pathologically and biologically from NBBC. BBCs present more frequently as low-grade, high stage non-papillary and non-urothelial cancers. Our findings support the need for further evaluation of COX−2-targeted prevention and therapies in bladder cancers developing on top of chronic inflammation. Ki−67 might represent a good prognostic marker regardless to histological type of BC at Western countries, but this should be further studied.

152 Poster #2 CLINICO-BIOLOGICAL PROGNOSTIC SCORE FOR PREDICTION OF ONCOLOGICAL OUTCOMES AFTER RADICAL CYSTECTOMY FOR SQUAMOUS CELL CARCINOMA OF THE BLADDER Ramy Youssef, MD1, Payal Kapur, MD2, Dina Khalil, MD2, Ahmed Mosbah, MD3, Hassan Abol-Enein, MD3, Mohamed Ghoniem, MD3 and Yair Lotan, MD2 1Duke University; 2UT Southwestern, Dallas, TX; 3Urology and Nephrology Center, Mansoura University, Egypt (Presented by: Ramy Youssef)

Objective: Clinico-biological prognostic score was correlated to clinical outcomes in patients treated with radical cystectomy (RC) due to squamous cell carcinoma (SCC) of the . Methods: Immunohistochemistry for 14 biomarkers (p53, p21, p27, cyclin E,

ki67, COX−2, EGFR, FGF−2 VEGF, Bcl−2, Caspace−3, Bax, ERK, TSP−I) was p o st er s performed on tissue microarray sections of 151 RC with pure SCC. The prognostic biomarkers were determined and a 3 risk category molecular score was defined based on number of alterations. A 3 risk category clinical score was defined based on disease free survival (DFS) probabilities estimated by MSKCC post cystectomy nomogram combining 7 clinico-pathological parameters (http://nomograms. mskcc.org/Bladder/PostSurgery.aspx). The sum of 2 scores was used to define unfavorable prognostic score (> 3 prognostic sum) that was correlated to DFS. Results: The study included 151 patients (98 men and 53 women, mean age 52 years, 122 (81%) associated with bilharziasis). The pathological stage was T2 in 50%, T3 in 38%, T1 and T4 in 6% each; lymph node metastasis in 30.5% and lymphovascular invasion in 16% of patients. Median follow up was 63.2 months. The best prognostic panel of markers included (COX−2, FGF−2, P53, Bax) according to significance in Kaplan-Meier analyses. The marker score was defined as (1 or low risk if no or 1 marker altered, 2 or intermediate risk if 2 markers were altered, and 3 when > 2 markers were altered). The clinical score was defined as (1 or low risk if DFS probability is > 80%, 2 or intermediate risk if DFS is 60−80%, and 3 when DFS < 60%). The poor prognostic score was defined if the sum of 2 scores was > 3). The poor prognostic score was associated with disease recurrence Kaplan Meier analyses (P < 0.001); and was an independent predictor of disease recurrence (HR 3.2, and p=0. 02, CI 1.168−8.524) Conclusion: Biomarkers can help classic clinic-pathological prognostics for prediction of poor outcome after radical cystectomy for SCC. A prognostic score combining clinical and molecular prognostics can be utilized for patient counseling, selection for adjuvant therapies and design of clinical trials.

153 Continued on next page Poster #3 MEASURING SYSTEMIC IMMUNE-RESPONSE TO INTRAVESICAL BCG FOR SUPERFICIAL BLADDER CANCER USING COMMERCIALLY AVAILABLE IMMUKNOW® ASSAY: CORRELATION WITH OUTCOMES AND LOWER URINARY TRACT SYMPTOMS Ryan Baker1 and Puneet Sindhwani, MD2 1University of Oklahoma College of Medicine; 2OUHSC, Department of Urology (Presented by: Ryan Baker)

Objective: Bacillus Calmette­-Guerin (BCG) therapy is the main immunotherapeutic agent for the treatment and prophylaxis of non­ muscle invasive bladder cancer (NMIBC). However, 20−40% of patients fail this treatment, and 5­7% discontinue due to intolerable cystitis symptoms. There remains a need for a non­invasive test that can reliably predict a patient’s response to BCG therapy so that more aggressive/alternative treatment options can be offered to non­responders. We examine the utility of the commercially available Immuknow® assay which measures CD4+ T Cell immune response levels, to predict response rate and symptomatology of patients receiving BCG induction therapy. Methods: Serial follow up of 22 male patients with NMIBC (Ta, T1, or Tis) who underwent transurethral bladder tumor resection followed by BCG administration for the first time, with Immuknow ® assay prior to each intravesical instillation. Follow up Cystoscopy & cytology after induction therapy were used to classify patients as responders, non­responders, or inconclusive. Patients were classified as symptomatic or asymptomatic according the presence/absence of lower urinary tract symptoms. Results: A statistically significant rise was found in ImmuKnow levels when comparing the differences between each week of treatment (F (4, 73) =4.76, p=0.0018). Largest increase was seen between the 3rd and 4th BCG treatment (p=0.076). 64% patients were classified as responders, 9% non­responders, and 27% data was incomplete. There was no statistically significant difference in average ImmuKnow levels between responders and non­responders (p=0.455), or symptomatic and asymptomatic patients. Conclusion: A significant increases in Immuknow assay is seen between the 3rd and 4th weeks of BCG induction therapy, a finding that corroborates similar increases in urinary cytokines IL­2 and IFN­γ suggesting a strong T cell­ 154 Continued on next page mediated response. A larger sample size and longer followup using these 2 parameters concurrently is needed.

Poster #4 URETHRAL CANCER IN WOMEN – EXPERIENCE WITH SEVEN PATIENTS AT A TERTIARY REFERRAL CENTER Jerry Trulson, MD, Majdee Islam, Naveen Pokala, MD, Mark Wakefield, MD University of Missouri (Presented by: Jerry Trulson)

Objective: Urethral Cancer is a rare malignancy and the only urological malignancy that is more common in women vs men. The purpose of this study is to look at the epidemiological and pathological association of female urethral cancer as well the clinical outcomes in patients managed at the University of Missouri.

Methods: Medical records were obtained for women with a diagnosis of primary p o st er s urethral cancer from 2002−2012 at the University of Missouri. These charts were retrospectively reviewed, and information regarding patient demographics, pathology, treatment, and outcomes were recorded. Results: A total of 7 women with a primary urethral cancer were identified. Mean age at diagnosis was 62.1 years. Five patients had a distal urethral lesion, while one had a proximal lesion, and one had a panurethral lesion. Three patients had urothelial carcinoma, two had squamous cell carcinoma, one had a urothelial/ squamous cell tumor, and one had malignant melanoma. Both patients with distal squamous cell carcinoma presented at Stage T1 or lower, were treated with distal urethectomy, and showed no evidence of disease at 1 and 1.5 years follow up. Three of four patients with urothelial carcinoma presented at Stage T3 or higher, and 1 had inguinal node positive disease. Two of these patients were treated with ± neoadjuvant chemo/RT and showed no evidence of disease at 7.5 and 3.75 years follow up. Of the 2 patients with urothelial disease that were not treated with definitive surgery, one received chemo/RT and progressed to distant metastases but was alive with cancer at 23 months after presentation; the other was treated with chemo and progressed to nodal positive disease, then received chemo/radiation therapy and died 45 months after presentation. The patient with malignant melanoma presented with T1 disease, progressed to distant metastases, and passed away within a year. Conclusion: Though limited by small number in this case series of female urethral cancer, tumor histology appeared to affect prognosis. We recommend distal with observation for patients with non-invasive squamous cell carcinoma. For urothelial carcinoma, we recommend a more aggressive approach with early cystourethectomy ± neoadjuvant chemo/RT.

155 Continued on next page Poster #5 PRACTICE PATTERNS OF GENITOURINARY CANCER NOMOGRAMS: A NATIONAL SURVEY Sudhir Isharwal, MBBS, Vikas Desai, MD, Chad Lagrange, MD UNMC (Presented by: Sudhir Isharwal)

Objective: Genitourinary (GU) cancer nomograms are important clinical decision making tools to predict the severity of diseases, recurrence rates and survival rates. We studied the patterns for the usage of these nomograms in addition to the factors that hinders, and factors that would increase their application. Methods: A web based 12 questions survey was sent to all the accredited US urology programs listed at AUA website. Reminder emails were sent before closure of survey to increase recruitment. Apple itunes app store was searched on November 1, 2013 using keywords “cancer”or “nomogram”. All the apps were reviewed for GU cancer nomograms. Results: A total of 106 respondents filled out the survey: 61.9% are training residents and 39.1 % are staff faculty. 85.71% respondents used GU cancer nomograms and 76.77% respondents find them significantly helpful in making their clinical decisions. Among the urologists using these nomograms, prostate cancer nomograms are most frequently used (98.89%), followed by kidney cancer (23.33%) and bladder cancer (22.22%) nomograms. Multiple nomograms leading to confusion (37.5 %) was the most common factor hindering their application. 48.48% urologists think that integration of these nomograms in the electronic medical record would increase their use followed by mobile devices applications (33.33%). Search on Apple applications store for “cancer”or “nomogram”generated 1017 results. All the results were screened − only 3 prostate cancer nomograms apps including Partin tables and 1 bladder cancer nomogram app were found. Conclusion: Use of GU cancer nomograms is highly prevalent among respondent urologists and majority of them find their use significantly helpful in the clinical decisions. Prostate cancer nomograms are the most frequently used GU nomograms. Streamlining multiple nomograms, integrating then in electronic medical record system and developing more apps for mobile devices can increase 156 Continued on next page clinical applications of GU cancer nomograms. These factors would be important to consider while developing and implementing the use of GU nomogarms in clinical use.

Poster #6 CLINICAL UTILITY OF THE GENOMIC PROSTATE SCORE (GPS) IN DECISION MAKING FOR NEWLY DIAGNOSED PROSTATE CANCER Gerald Andriole, MD1, Mike Kemeter MSPAS2, Vahan Kassabian, MD3, Seth Strope, MD1, Eric Wallen, MD4, Greg Hanson, MD5, Megan Rothney, PhD2, H. Jeffrey Lawrence, MD2 and Bela Denes, MD2 1Washington University; 2Genomic Health, Inc.; 3Georgia Urology; 4University of North Carolina; 5Metro Urology (Presented by: Bela Denes)

Objective: Treatment decisions for prostate cancer, including the selection of p o st er s patients for active surveillance (AS), can be difficult because of concerns that the histologic features of the diagnostic biopsy may not reflect the true biology of the tumor. We have developed a novel biopsy-based RT−PCR assay, providing a 100−unit Genomic Prostate Score (GPS) as a measure of biological risk. The test has been analytically validated (Knezevic et al. BMC Genomics 2013), and clinically validated to predict likelihood of low-grade organ-confined disease at radical prostatectomy (Cooperberg et al. AUA 2013). Here we evaluate the potential of GPS results to influence urologists’ initial treatment recommendations and the likelihood of recommending AS. Methods: We performed an on-line clinical utility survey to identify physician need and to assess treatment recommendations before and after receiving GPS results for 5 hypothetical PCa cases– 1 NCCN very low risk, 3 NCCN low risk and 1 NCCN intermediate risk. Participants were 18 high-volume urologists − 4 academic and 14 community physicians − practicing in several US regions. Participants received no specific educational materials regarding the test prior to the survey. Results: 78% of participants agreed that the risk of under-grading and/or under- staging at biopsy is a concern when selecting patients for active surveillance, and 89% indicated that a test predicting high-grade or non-organ confined disease would likely influence their decision to recommend AS. In the case studies where GPS predicted a lower biological risk than the patient’s clinical risk category, AS recommendations increased from 12/36 to 23/36 decisions. GPS results that predicted higher biological risk than the clinical risk category were associated with recommendations for increased treatment intensity in 15/36 decisions. In 40% of decisions, participants indicated that the GPS would change their treatment recommendation. In 93% of decisions, they indicated that GPS was clinically useful, including a case where the predicted biological risk was consistent with the clinical risk category. Conclusion: The survey highlights a strong unmet clinical need for tools that provide better risk stratification for early-stage PCa. While the case studies were hypothetical and further study is warranted, our findings suggests that urologists anticipate modifying their recommended treatment intensity based upon the biological risk assessment provided by the GPS. Financial Disclosure: Funded by Genomic Health, Inc.

157 Poster #7 METABOLIC SYNDROME IN PATIENTS WITH PROSTATE CANCER IN TREATMENT WITH ANDROGEN DEPRIVATION THERAPY Victor Osornio, Resident, Alberto Camacho, Urologist, Carlos Martinez, Urologist, Carlos Pacheco, Urologist Hospital General Dr Manuel Gea Gonzalez (Presented by: Victor Osornio)

Objective: Prostate cancer (PCa) is the most common cancer in men. 86% are diagnose in local or locally advanced disease, however in Mexico and Latin America the most of cases are present in metastasic disease. Androgen deprivation therapy (ADT) is widely used in many options of PCa treatment even like adjuvant in locally advanced disease or alone in recurrent and metastasic disease. Metabolic syndrome (MS) is present nearly in 50% of patients who recieve ADT, increasing the risk of cardiovascular disease, wich has become the most common cause of non PCa−related deaths. Recently, male hypogonadism has emerged as an independent risk factor in the development of MS. The objective was to evaluate the proportion of patients with MS and the relationship between the kind and the time of ADT. Methods: The study design was retrospective, cross sectional and observational. We reviewed the record of the patients with PCa and ADT who has attended between the period of August 2012 and January 2013. The MS was defined according to the Adult Treatment Panel III criteria. Results: The universe of study was 75 patients. More than a half of men (57%) had metastasic disease and 43% had locally advanced disease. The more used treatment was ADT alone (77.3%). The level of prostate specific antigen (PSA) was less than 4.0 ng/ml in 87% of the patients. 69% was treatment with agonist GnRH + therapy and 31% with orchiectomy, we did not use antagonist GnRH. The average of ADT time was 24.5 months. The prevalence of MS was 48%. Among the components of MS, hypertriglyceridemia had highest prevalence (71%). Hypertension and the low HDL levels were 50% of prevalence. Abdominal obesity was the less frequency (27%). 84% had testosterone levels less than 50 ng/ml and the 65% had less than 20 ng/ml. The prevalence of hypogonadism was 93%. Conclusions: Nearly half of men had MS and the prevalence was similar to international literature reports. We didn’t find statistic association between the kind and the time of ADT with MS. (X2=1.749, gl=1, p>0.05). We didn’t find statistic association between the low testosterone levels with MS. (X2=0.309, gl=1, p>0.05). Prospective and long-term studies are needed to give more statistic power and determine the timing of the onset of MS and the role of changes in the life style.

158 Poster #8 A PROSPECTIVE STUDY OF THE RELATIONSHIP BETWEEN CLINICAL EFFICACY OF SECONDARY HORMONE THERAPY AND NEUROENDOCRINE DIFFERENTIATION IN PATIENTS WITH RELAPSED PROSTATE CANCER AFTER FIRST-LINE HORMONE THERAPY Daisaku Hirano, MD1, Ryo Hasegawa, MD1, Yataroh Yamanaka, MD2, Kenya Yamaguchi, MD2, Nozomu Kawata, MD2 and Satoru Takahashi, MD2 1Higashi-matsuyama Municipal Hospital; 2Nihon University School of Medicine (Presented by: Daisaku Hirano)

Objective: Prostate cancer (PCa) responds to primary androgen-deprivation therapy (ADT). However, only transient efficacy in most advanced patients can be observed, and the majority of patients ultimately develop tumor progression. Despite advances in ADT, some patients with castration-resistant prostate

cancer (CRPC) who have undergone initial ADT might respond to second-line p o st er s hormone therapy. Recently, attention has focused on the clinical significance of neuroendocrine differentiation (NED) in PCa, and ADT is hypothesized to induce NED, and neuroendocrine cells contribute to androgen independent growth of PCa in an androgen deprived environment. To our knowledge, the relationship between clinical efficacy of secondary hormone therapy and NED for CRPC after first-line hormone therapy has not been investigated. We prospectively studied to verify the relationship between clinical efficacies of secondary hormone therapy and NED. Methods: Between December 2006 and May 2011, after a diagnosis of anti- androgen withdrawal syndrome had been excluded in case of combined androgen blockade with LHRH agonist and bicalutamide as first-line hormone therapy, a total of 46 consecutive patients with CRPC following first-line hormone therapy who were treated with (375mg/day) as secondary hormone therapy were prospectively assessed with a median follow-up of 21 months. Serum chromogranin A (CgA) as a NED marker was measured using an immunoradiometric assay. Results: Of the 46 patients 22 (48%) responded to the second-line hormone therapy as a 50% or more reduction from baseline PSA with a median response duration of 9.2 months. The PSA response group was correlated with significantly favorable cancer-specific survival (92% vs. 59% at 5-year; P=0.015) compared to the non-response group. Above-normal CgA levels at the study entry were detected in 15 patients (33%), but identified no association regarding cancer- specific survival. Data on CgA kinetics were available in 35 patients. The CgA levels before and at 3 months during the treatment were similar. However, 8 patients (23%) with a quarter or more increase of the CgA level from baseline had a tendency of worse cancer-specific survival (63% vs. 84% at 5-year; P=0.051) compared to the remaining patients. Conclusion: Within limitations, in this study second-line hormone therapy is effective for CRPC following first-line hormone therapy. The above-normal CgA level in the first-hormone resistance phase is mostly unrelated to prognosis. However, some patients with a remarkable increase of CgA in a short duration may have an unfavorable prognosis caused by NED as well. Financial Disclosure: None

159 Poster #9 PRACTICE AND REFERRAL PATTERNS AMONG PRIMARY CARE PHYSICIANS IN PATIENTS WITH MICROSCOPIC AND GROSS HEMATURIA John Bishay, MD, Anthony Oberle BS, CNMT, Chad Lagrange, MD University of Nebraska Medical Center (Presented by: John Bishay)

Introduction: Hematuria is highly prevalent, affecting up to 16% of the adult population with initial presentation to primary care physicians (PCPs). The American Urological Association (AUA) and American Academy of Family Physicians (AAFP) have both recently released guidelines to provide a clinical framework for the diagnosis, evaluation, and follow-up of hematuria. We sought to evaluate the referral patterns among PCPs at our institution. Methods: Anonymous questionnaires were distributed to the Family Medicine department via paper copy and Survey Monkey. Questions were designed to cover each physician’s knowledge base and personal approach to men and women with asymptomatic microscopic (AMH) and gross hematuria (GH). Results: Out of 66 surveys, 38 were returned. Of the respondents, only 55% knew the correct definition of AMH as ≥3 red blood cells per high power field on a single urinalysis. 74% recognized that up to 5% of patients with AMH might have a malignancy, but only 5% recognized that up to 40% of patients with GH might have a malignancy. Even though they did associate malignancy with hematuria, only 21% and 16% would refer a 52-year-old male to urology with AMH and GH respectively. With the addition of Coumadin in the patient’s history, only 11% would refer for AMH. In regards to a 40-year-old female with asymptomatic GH, only 37% would refer to urology; 21% would treat with antibiotics while another 32% would obtain a renal ultrasound (RUS). Only 34% recognized that all patients above 35-years-old need cystoscopic evaluation for AMH. In regards to gross hematuria, only 21% recognized that all patients above 35-years-old need cystoscopic evaluation, but an additional 53% said that all patients should undergo cystoscopy. In regards to imaging, only 37% and 39% would start with a computed tomography urogram (CTU) as the best initial imaging study for AMH and GH. Instead, 47% and 50% would start with a RUS respectively. Conclusion: While PCPs commonly evaluate both asymptomatic microscopic and gross hematuria, practice and referral patterns do not seem to be in accordance with recently published guidelines. Because the timely diagnosis of malignancy is associated with decreased morbidity and mortality, quality improvement projects to further educate our PCPs should be implemented to provide earlier urologic evaluation.

160 Poster #10 PERIOPERATIVE IMMUNONUTRITION FOR RADICAL CYSTECTOMY PATIENTS: INITIAL PILOT STUDY RESULTS Zach Hamilton, MD, Misty Bechtel, Amy Schleper MS, RD, Joshua Griffin, MD, Jeffrey Holzbeierlein, MD, Eugene Lee, MD, Moben Mirza, MD, Hadley Wyre, MD, Jill Hamilton-Reeves, PhD, RD, LD University of Kansas, Kansas City, KS (Presented by: Zach Hamilton)

Objective: Current standard of care for invasive bladder cancer is neoadjuvant chemotherapy followed by radical cystectomy (RC). However, RC is associated with significant morbidity, and 90-day readmission rates reach 25%. Furthermore, loss of body weight is a common postoperative observation for many RC patients and has been associated with increased complications. The Impact ® Advanced Recovery is a nutritional drink that has been shown to lower infectious p o st er s complications, regardless of baseline nutrition status, for multiple malignancies including RC due to immune-enhancing ingredients. We sought to determine if Impact Advanced Recovery® can modulate immune and inflammatory response compared to a standard nutritional supplement in RC patients. We present early data regarding this pilot study. Methods: A single-blinded, randomized, placebo-controlled pilot clinical trial for men who are scheduled for RC was conducted after IRB approval at the University of Kansas Hospital. Subjects receive an immune-modulating nutrition drink or an iso-caloric/iso-nitrogenous supplement. The intervention cohort consumes Impact Advanced Recovery® between meals during the five days before and five days after surgery, while placebo patients consume Boost Plus®. Demographics, perioperative outcomes, side effects, and complications were measured. Translational lab work, anthropometric measures, and dual-energy x-ray absorptiometry analyzing body composition are tracked as well. Results: Fifteen subjects have been screened and eight subjects are currently enrolled, thus four subjects have received the intervention and four subjects received the supplement. For all subjects, mean age is 65.5 years and mean BMI is 24.6. Mean preoperative weights were equivalent between cohorts. There were no significant early differences in patient characteristics or perioperative results, including time to bowel function, length of stay or 30 day readmission rates between the two groups. The mean difference in weight from preoperative visit to the first postoperative outpatient visit was −0.1kg for control and +2.0kg for the intervention. Conclusion: Initial results with Impact Advanced Recovery® nutrition after RC shows no significant differences in time to return of bowel function, length of stay or weight loss, although a trend for decreased weight loss is seen for the intervention group. We present early ongoing pilot data for a placebo-controlled trial evaluating its use with RC. Further enrollment and increased follow up will elucidate the relationship with immune response and body composition changes, as well as long term complications.

161 Poster #11 IMPACT OF OBESITY ON ARTIFICIAL URINARY SPHICNTER FOR THE TREATMENT OF POST-PROSTATECTOMY INCONTINENCE Christopher Graziano, MD1, Robert Chan, MD2, Jason Scovell, BS1 and Timothy Boone, MD, PhD2 1Baylor College of Medicine; 2Houston Methodist (Presented by: Christopher Graziano)

Objective: Obesity can result in worse continence outcomes for certain anti- incontinence procedures such as the male sling. We reviewed the impact of obesity on outcomes of artificial urinary sphincter (AUS) placement for post-prostatectomy incontinence. Methods: We analyzed the records of 67 male patients during a 17 year period between 1993 to 2009. Patients were stratified by body mass index (BMI). There were 25 patients in the normal group with BMI < 25), 24 patients in the overweight group with BMI 25 to 30, and 18 patients in the obese cohort with BMI ≥ 30. Mean age was 69, 66, and 66 years in the normal, overweight, and obese groups, respectively. All patients underwent an initial artificial urinary sphincter placement for post-prostatectomy incontinence. Long-term follow-up was obtained through office examination. Medians are reported, and Kruskal-Wallis and chi-square were calculated for significance (p < 0.05). Results: The mean time from prostatectomy to AUS placement was 49, 40, and 57 months with mean followup of 46, 31, and 46 months in the normal, overweight, and obese groups. AUS placement resulted in a median decrease of daily pads in normal (4.0), overweight (4.0), and obese men (3.0). Patient BMI did not affect pad use changes (p = 0.54). The complication rate was 4% (1 cuff erosion), 12.5% (3 infections) and 5.6% (1 reservoir infection) in the normal, overweight, and obese groups, and was not associated with BMI (p = 0.49) Conclusion: Obesity did not significantly impact continence parameters after artificial urinary sphincter placement for post-prostatectomy incontinence. In light of available data in literature, AUS should be preferred over male sling in the obese patient population.

Poster #12 SUCCESS RATES OF ARTIFICIAL URINARY SPHINCTER PLACEMENT FOLLOWING URETHROPLASTY Christopher Powell, MD1, Travis Dum, MD1, William Brant, MD2 and Joshua Broghammer, MD1 1University of Kansas Medical Center; 2University of Utah (Presented by: Christopher Powell)

Objective: Patients undergoing artificial urinary sphincter (AUS) following urethroplasty are often categorized as high-risk due to previous urethral instrumentation and theoretical altered urethral vascular supply. Limited data exist regarding outcomes in these patients making appropriate patient counseling difficult at best. We compare outcomes of AUS placement at two tertiary care centers to determine outcomes of AUS placement in patients who had undergone previous urethroplasty. Methods: A retrospective analysis of patients treated with AUS placement from

162 Continued on next page November 2008 to December 2013 was performed at two tertiary care centers. All patients receiving AUS placement were included regardless of urinary incontinence etiology. Patients were divided into “average risk”(AR) and previous urethroplasty (PU) cohorts. Patients with a history of radiation therapy, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS and were excluded from the AR cohort. Charts were analyzed for pre-operative risk factors as well as post-operative complications, revisions, and pad usage. Results Obtained: 141 patients underwent AUS placement during the study period. 13 patients undergoing AUS placement had a history of previous urethroplasty (PU). Patients were included regardless of indication for urethroplasty. Indications for urethroplasty included urethral stricture, AUS erosion, and bladder neck contracture in 9, 3, and 1 patient respectively. 63 patients were considered average risk (AR). Post-operative complication rate was 15.4% (n=2, RR 1.38, p=0.66) in

the PU group and 11.1% (n=7) in the AR group. Complications in the PU group p o st er s included persistent bothersome incontinence and erosion each in a single patient. Mean postoperative pad use was 0.96 (n=53) in AR group vs 2.1 in PU group (n=8). Mean follow-up time was 10.9 months (range 1−35) for AR group and 4 months (range 1−9) for PU group. Conclusion: Patients who had previously undergone a urethroplasty for any indication were not statistically more likely to develop a postoperative complication than “average risk”patients. Post-operative pad usage was twice that of the AR group. While longer follow-up is necessary, these data suggest that patients undergoing AUS placement following urethroplasty may have a similar complication rate to that of the general population.

Poster #13 SURGICAL MANAGEMENT OF POST-PROSTATECTOMY BLADDER NECK CONTRACTURES: A META-ANALYSIS AND SYSTEMATIC REVIEW Joseph Song, MD, Jairam Eswara, MD, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Introduction: To review the literature for different bladder neck contraction (BNC) treatment modalities in order to summarize the best management of BNC as supported by current evidence. Methods: A MEDLINE search was performed for the terms “bladder neck OR post- prostatectomy OR vesicourethral OR anastomotic”AND “stricture OR stenosis OR contracture”AND “prostate OR prostatectomy”. Studies published after 2000 with >5 patients were included. Studies were evaluated for design, patients’ prior history of BNCs, the specific treatment being studied, rate of de-novo incontinence after the intervention, complications, and the success rate of each intervention. Results: Twenty studies fit the inclusion and exclusion criteria (table 1). Dilation, transurethral incision of the bladder neck (TUIBN), “deep”TUIBN resulting in incontinence, transurethral resection of bladder neck (TURBN), urethral stenting, and open repair resulted in initial success rates of 53%, 74%, 91%, 86%, 65%, and 74%, respectively. When repeat attempts at treatment were made, success rates for all modalities increased. For recalcitrant BNCs with >2 prior treatment failures, more invasive procedures had higher success rates, with open repair leading to success in 96% of patients. De-novo incontinence, however, increased 163 Continued on next page in league with treatment invasiveness, with 63% of patients incontinent after open repair. Weighted success rates and incontinence rates were calculated and used to create a treatment algorithm. Conclusion: Several options are available for managing bladder neck contractions. Repeat attempts of minimally invasive methods improve success rate. Repeat procedures and more invasive techniques lead to higher incontinence rates. A major weakness of the literature is cohort heterogeneity, lack of reported stricture lengths, and objective functional measures (e.g., flow rate, PVR, IPSS, etc.).

Poster #14 OPTIMIZING SUCCESS WHEN PLACING THE ADVANCE TRANSOBTURATOR MALE SLING: KEY STEPS THAT HAVE BEEN IDENTIFIED AFTER IMPLANTING OVER 1000 DEVICES Brian Christine1 and L. Dean Knoll, MD2 1Urology Centers of Alabama; 2The Center for Urological Treatment, Nashville, TN (Presented by: Brian Christine)

Introduction: The treatment of persistent stress urinary incontinence (SUI) following radical prostatectomy (RP) has undergone a significant shift towards the use of the transobturator, suburethral male sling. While male slings have shown efficacy when used to treat mild-to-moderate SUI, success is not guaranteed. The authors have a combined surgical experience in excess of 1000 procedures to place the AdVance male sling (American Medical Systems, Inc). We have identified five (5) key steps during AdVance placement that facilitate optimum outcomes. Methods: From February, 2006 through June, 2013 one thousand forty (1040) AdVance transobturator male slings were placed by the authors. The surgical technique used by each is virtually identical, one (LDK) having trained the other (BSC). A thorough review of the surgical steps involved during sling placement was carried out. Those steps believed to be most critical for success were identified. Results: Five (5) steps were felt to be of key importance leading to successful outcomes following sling placement: 1. Identification of the point at which the central tendon inserts onto the corpus spongiosum. 2. Permanently marking this point by placing a deep stitch into the corpus spongiosum. 3. Divide the central tendon adequately to allow 3−4cm of mobility of the bulbar urethra during sling tensioning. 4. Ensure an exit of the helical transobturator needle high on the undersurface of the ischiopubic ramus, within 1cm of the junction of the symphysis pubis and ramus. 5. Ensure that the proximal edge of the sling is sutured to the corpus spongiosum at the previously indentified insertion point of the central 164 Continued on next page tendon. Attention to these key steps has yielded a dry rate of 82% overall (defined as no longer using pads), with an 87% dry rate in those patients with mild SUI. Conclusions: Five (5) steps felt to be critical to obtaining success when placing the AdVance transobturator male sling have been identified by two surgeons highly experienced with the procedure. We feel that attention to these key steps contributes to optimal patient outcomes, and we offer these observations in an attempt to help surgeons attain consistent, predicable results.

Poster #15 INCREASING BMI IS NOT ASSOCIATED WITH AN INCREASED RATE OF AUS MECHANICAL FAILURE Jairam Eswara, MD1, Robert Chan, MD2, Joel Vetter1, H. Henry Lai, MD1, Timothy Boone, MD2 and Steven Brandes, MD1 1Washington University; 2Methodist Hospital

(Presented by: Jairam Eswara) p o st er s

Introduction: Previous research has shown that suburethral slings in obese men have a higher rate of failure (Grimsby Can J Urol 2012 Feb; 19(1)). The purpose of this study was to determine whether there is an association between increasing BMI and rates of artificial urinary sphincter (AUS) mechanical failure. Methods: From 1998−2012, 238 virgin AUS placements were performed at 2 institutions with body mass index (BMI) available for all patients. Mechanical failure was defined as recurrent or persistent SUI requiring AUS revision including urethral cuff downsizing, replacement of the pressure-regulating balloon, cuff repositioning, or tandem cuff placement was performed for. AUS replacement was performed for urethral erosion/infection or mechanical failure. Endpoints were reoperation or worsening stress urinary incontinence (the use of pads) as described by the patient. Results: Mean age in this series was 69.1 and median follow-up was 34.6 months. The mean BMI of patients in this series was 27. An increasing BMI trended toward a higher rate of mechanical failure although this did not achieve statistical significance (p=0.07). Patients with a BMI <30 had a lower rate of mechanical failure compared to those with a BMI >30, although this was not statistically significant (HR 1.45, p=0.11). Conclusion: Patients with higher BMIs did not experience a higher rate of AUS mechanical failure compared to those with lower BMIs.

Poster #16 INTERMEDIATE TERM FOLLOW-UP FOR PATIENTS UNDERGOING INTERVAL ARTIFICIAL URINARY SPHINCTER REIMPLANTATION FOLLOWING PREVIOUS ARTIFICIAL URINARY SPHINCTER EXPLANTATION Christopher Powell, MD1, Travis Dum, MD1, William Brant, MD2 and Joshua Broghammer, MD1 1University of Kansas Medical Center; 2University of Utah (Presented by: Christopher Powell)

Objective: Patients undergoing artificial urinary sphincter (AUS) revision or replacement have been shown to have similar outcomes to virgin cases. Limited data exist regarding outcomes in patients with a previous AUS erosion undergoing

165 Continued on next page interval AUS replacement. We compare intermediate-term outcomes of AUS placement at two tertiary care centers to determine outcomes of AUS placement in patients with a previously eroded device. Methods: A retrospective analysis of patients treated with AUS placement from November 2008 to December 2013 was performed at two tertiary care centers. All patients receiving AUS placement were included regardless of urinary incontinence etiology. Patients were divided into “average risk”(AR) and previous erosion (PE) cohorts. Patients with a history of radiation therapy, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS and were excluded from the AR cohort. Charts were analyzed for pre-operative risk factors as well as post-operative complications, revisions, and pad usage. Results: 141 patients underwent AUS placement during the study period. 14 patients undergoing AUS placement had a history of erosion or infection in a previous AUS (PE). 63 patients were considered average risk (AR). Post-operative complication rate was 42.8% (n=6, RR 3.85) in the previous erosion group and 11.1% (n=7) in the AR group. Complications were defined as erosion, infection, pain, mechanical failure, migration, fistula formation, and persistent, bothersome incontinence. Mean postoperative pad use was similar between the two groups 0.96 (n=53) in AR group vs 1.15 in PE group (n=10). Percent decrease in pad usage was equivalent (82% in AR group vs 82% in PE group). Mean follow-up time was 10.9 months (range 1−35) for AR group and 19.6 months (range 3−59) for PE group. Postoperative complications rates were 25% (n=2) and 67% (n=4) for patients undergoing transcorporal and standard AUS placement techniques respectively. Conclusion: Patients with a previous AUS erosion undergoing interval AUS replacement are nearly four times more likely to develop post-operative complications. Post-operative pad usage was similar between the groups. Patients should be counseled that previous AUS erosion or infection significantly increases their complication risk during AUS replacement. Despite a nearly four-fold increase in post-operative complication rate, good functional outcomes may be achieved in patients with previously a eroded AUS undergoing interval reimplantation.

Poster #17 FAILURE OF THE 3.5CM ARTIFICIAL URINARY SPHINCTER CUFF: AN EMERGING TREND? Brian Christine1 and Michael Kennelly, MD2 1Urology Centers of Alabama; 2McKay Urology, Charlotte, NC (Presented by: Brian Christine)

Introduction: The 3.5cm cuff was introduced in 2009, and has expanded the cuff size options available to the surgeon during both primary and revision artificial urinary sphincter (AUS) placement. Those men with a less generous urethral caliber may benefit from use of this cuff. However, the authors have identified a subset of men in whom a 3.5cm cuff was placed and later developed a leak in a very specific location on the cuff which necessitated device revision. Methods: From September, 2009 through December, 2013 the authors identified five (5) men who had undergone placement of an AUS utilizing a 3.5cm cuff and who required revision of their device secondary to development of a leak in the 166 Continued on next page cuff. These cuffs had been placed from 3−24 months prior to failure. Results: All of the failed cuffs had developed a leak; further, the leak point in each cuff was identical occurring in one of the creases that are part of the 3.5cm cuff’s design. These creases are necessary to allow “pillowing”of the cuff when inflated. This pillowing of the cuff produces the coaptation of the urethral mucosa necessary to restore continence. The early failure of these cuffs, each developing a leak at a crease, raises concern that the design of the 3.5cm cuff presents a point of premature failure. Conclusion: A subset of men whose 3.5cm AUS cuff failed prematurely and in an identical fashion have been identified. The early failure of these cuffs, each developing a leak at exactly the same point, raises concern that the design of the 3.5cm cuff presents a point of weakness. Whether the crease point is itself weak or allows cuff-on-cuff friction and material degradation is unclear. Further analysis of the cuffs is ongoing. Surgeons may want to consider what seems to be an emerging trend when choosing a cuff during AUS surgery. p o st er s

Poster #18 TRENDS IN INTERSTIM NEUROSTIMULATOR BATTERY SURVIVAL Carrie Yeast, MD, Louis Zhang, BS, James Cummings, MD University of Missouri (Presented by: Carrie Yeast)

Objective: Devices for sacral neuromodulation (Interstim) have been increasingly used over the past decade for a variety of bladder conditions. As with any battery- powered device, battery life is finite and the efficacy of the Interstim may decrease over time. In 2008, a new smaller generator was introduced in hopes that it would be easier to place, more easily concealed, and more comfortable for the patient. The new battery, however, was known to have a shorter battery life. With these changes in mind, we investigated trends in times to battery change in our series of patients undergoing sacral neuromodulation. Methods: Medical records were obtained for patients who underwent Interstim placement since 2008. All patients who have had a battery change since that time were identified. Charts were reviewed retrospectively and analyzed for demographics, reason for Interstim placement, time to battery change, reason for battery change, and other associated notable comorbidities or subsequent procedures. Results: Our division at the University of Missouri placed an Interstim device in 129 patients since 2008. Of those, 31 battery changes have occurred in a total of 21 of these patients (16.3%). Devices were placed for interstitial cystitis (23%), neurogenic bladder (6.5%), overactive bladder (29%), retention (35%), or generalized incontinence (6.5%). Battery changes were performed for a variety of reasons, including low or dead battery, infection, damage to the battery, or overall decrease in function of the Interstim. Ten (32%) patients underwent a simple battery change at an average of 31 months, while 16 (51%) patients required lead revision also at the time of battery change at an average of 27 months. Urinary retention patients had the shortest length of time to battery change (15 months), and neurogenic bladder and generalized incontinence patients had the longest (45 months). Conclusion: With the newer, smaller battery, patients who undergo battery change are more likely to undergo these procedures at intervals much shorter 167 Continued on next page than the expected battery life. While it does appear that certain conditions and certain subgroups of patients undergo battery changes more quickly than others, the range of time to battery change is extremely variable and most differences are not statistically significant. More data is needed to identify specific trends in Interstim battery life.

Poster #19 ACUTE MANAGEMENT AND OUTCOMES OF AUS EXPLANTATION AND URETHRAL REPAIR AT TIME OF EROSION Travis Dum, MD, Christopher Powell, MD, Joshua Broghammer, MD, FACS University of Kansas Medical Center (Presented by: Travis Dum)

Objective: Artificial urinary sphincter (AUS) is the gold standard treatment for stress urinary incontinence. Urethral erosion is a complication, with a reported incidence of 6%. Conventional management of urethral erosion consists of device explantation and placement of Foley catheter to allow for urethral healing. In some cases the defect is large and healing is prolonged by catheterization alone. Urethral stricture development has also been reported. Our hypothesis is that urethral erosion may be better managed with urethrorrhaphy in small defects and anastomotic urethroplasty in larger defects. Methods: We performed retrospective review of all AUS explants for urethral erosion at our institution from 2008 to 2013 and collected patient specific data regarding prior procedures, AUS explantation, urethral management, need for further procedures, and overall outcomes. Results: 16 total patients were identified with urethral erosions. 3 patients were excluded because of insufficient follow-up (n=2) and a patient death near time of explantation (n=1). Group 1 (n=8) was managed with explantation and catheter placement. Mean follow up was 437 days. Four patients developed urethral complications with 3 urethral strictures and 1 prolonged urethrocutaneous fistula. Further surgery was required in 3 of 8 patients including delayed anastomotic urethroplasty, suprapubic tube diversion, and cystectomy with ileal conduit. Three patients were able to undergo eventual AUS reimplantation. Group 2 (n=5) was managed with urethrorrhaphy (n=3) for defects <50% urethral circumference or anastomotic urethroplasty (n=2) for defects >50% urethral circumference. Urethral mobilization was required in 4 of 5 patients. Mean follow- up was 209 days. Zero patients developed a stricture. One patient was able to undergo AUS reimplantation. Another patient was stricture free and eligible for AUS reimplantation but instead elected for urethral closure and suprapubic tube placement. Conclusion: For patients with urethral erosion due to AUS, urethral repair at time of explantation is a viable management option and should be considered. Our numbers are small but have shown that management with catheter only resulted in urethral complications in 50% of patients, compared with 0 in 5 patients managed with repair. Larger studies are needed to further investigate the potential benefit of immediate urethral repair at time of erosion over conventional management with catheter placement alone.

168 Poster #20 PROSPECTIVE COMPARISON OF PATIENT REPORTED OUTCOME MEASURES (PROM) OF ANTERIOR URETHRAL STRICTURE MANAGED SURGICALLY OR BY DAILY SELF-DILATION Anashia Shera, MD, Tolulope Bakare, MD, Ehab Eltahawy, MD UAMS (Presented by: Tolulope Bakare)

Objective: Self-dilation of recurrent or non-operable urethral strictures offers an alternative in some cases of urethral stricture. However, there is limited data regarding patient satisfaction regarding different treatment options. Using a validated patient reported patient outcome (PROM) questionnaire for urethral stricture disease we prospectively asses the two options. Methods: Patients who underwent urethroplasty, and those who were started on

self-dilation (once daily for 6 months, then 3 weekly for another 6 months) for p o st er s management of recalcitrant urethral strictures, and who were not candidates for reconstruction were asked to complete the PROM questionnaire at 12 months of follow up. Urethral patency was confirmed by either urethrocystoscope in the surgical group or easy passage of a 16 Fr catheter in the self-dilation group. All patients had uroflowmetry, and estimate of post void residual by ultrasound. Results: A total of 33 patients completed the study. 23 patients underwent urethroplasty for anterior urethral strictures (group A), and another 10 men were kept on self-dilation (group B). The median follow- up was 16 months. Total LUTS scores (0 = least symptomatic, 24 = most symptomatic) were a median of 6(1−20) in group A, while it was 5(3−23) in group B. A total of 20 in group A and 7 in group B, felt their urinary symptoms did not, or interfered very little with their life (score of 1−2). Overall, 20 men remained “satisfied”or “very satisfied”with the outcome of their operation (score of 1−2) in group A, while 8 in group B. Health status visual analogue scale scores (10 = best imaginable health, 0 = worst) median was 8.1 in group A, and 7.7 in group B. Conclusion: Utilizing a validated PROM we found no difference in LUTS, overall QOL, or satisfaction rates between men who underwent surgical repair of urethral stricture or daily self- dilation for one year. This suggests daily urethral dilation is an acceptable alternative in select cases when reconstruction is not feasible.

Poster #21 THE USE OF EPIDURALS IN RADICAL CYSTECTOMY TO REDUCE LENGTH OF HOSPITAL STAY AND RATE OF COMPLICATIONS Roxanne Martinez, MS1 and Shandra Wilson, MD2 1University of Colorado, Anschutz Medical Campus; 2University of Colorado, Anschutz Medical Campus, Division of Urology (Presented by: Roxanne Martinez)

Objective: Surgical epidural anesthesia has become a standard of care for many patients undergoing a variety of urological procedures, especially for those receiving a radical cystectomy due to invasive bladder cancer. Epidural anesthesia is believed to positively affect a variety of neuroendocrine modulators regulating pain and various morbidities with the potential for cost savings. We examined if epidural anesthesia could affect length of stay (LOS) or rate of complications in

169 Continued on next page patients who had received a radical cystectomy for invasive bladder cancer. Methods: A retrospective review of radical cystectomy patients operated on by a single provider at our institution between 2009 to 2013 was performed with a focus on patients who had received epidurals. Patients were selected for epidural based on the patient’s preference. All patients were offered epidural so there was no apparent selection bias with epidural selection based on medical comorbidity or cancer stage. Multivariate analyses were performed. Each model to predict LOS was adjusted for patient age, gender, complication, and whether an epidural was used. Complications were treated as binary, and the type of complication was noted for historical purposes. Results: The study included 105 patients, 74 men and 31 women, performed by a single surgeon over the 5 year period. 49 patients received an epidural. The majority of complications were respiratory or cardiac in nature or involved ileus. The average LOS for patients with epidural was 10.37 (±7.51) days versus an average LOS of 11.23 (±6.78) days for patients without an epidural. In all statistical models, epidural was not significantly associated with LOS, p=0.312. There may be a trend for increased length of stay with epidural. Additionally, under all schema, neither gender, age, or epidural was associated with rate of complications. Conclusion: Epidural use for anesthesia was not shown to decrease length of stay or rate of complications in patients who had received a radical cystectomy for bladder cancer. With only 105 patients, the sample size may yet be too small to detect a difference in LOS. Also, a stratification of type of complication may also show an effect from use of an epidural. In future studies, we hope to investigate if increased length of stay correlates with decreased re-admission rate for cost saving purposes.

Poster #22 CCP SCORE STRATIFIES RISK FOR PROSTATE CANCER PATIENTS AT BIOPSY: INITIAL COMMERCIAL RESULTS E. David Crawford1, Neal Shore, MD2, Peter T. Scardino, MD, FACS3, John W. Davis, MD, FACS4, Jonathan Tward, MD, PhD5, Lowndes Harrison, MD6, Kelsey Moyes, MStat7, Lisa Fitzgerald8, Steve Stone, PhD8 and Michael K. Brawer, MD7 1University of Colorado at Denver; 2Carolina Urologic Research Center; 3Memorial Sloan-Kettering Cancer Center; 4The University of Texas, MD Anderson Cancer Center; 5University of Utah Huntsman Cancer Hospital; 6Gadsden Regional Cancer Center; 7Myriad Genetic Laboratories, Inc.; 8Myriad Genetics, Inc. (Presented by: E. David Crawford)

Objective: New prognostic markers for prostate cancer play an important role in addressing the controversies of over diagnosis and treatment. The cell cycle progression (CCP) score (Prolaris™, Myriad Genetic Laboratories, Inc.) is an RNA- based marker which improved the prediction of prostate cancer aggressiveness in eight separate cohorts. Each one-unit increase in CCP score corresponds with approximately a doubling of the risk of the studied event (recurrence or death from prostate cancer). In this analysis, we characterized the CCP score distribution from our initial CCP commercial testing. Methods: Our current laboratory database was evaluated for patients whose biopsy was analyzed with the CCP test and whose clinicopathologic data was collected by the ordering physician. Formalin fixed, tissue from 2219 patients diagnosed with adenocarcinoma ordered by more than 400 physicians were 170 Continued on next page analyzed. The CCP score was calculated by measuring the RNA expression of 31 cell cycle progression genes normalized to 15 housekeeping genes. Results: Of the 2219 samples that contained sufficient carcinoma (>0.5mm linear extent), 2176 (98.1%) provided quality RNA for analysis. This retrospective analysis showed a normal distribution for the CCP−CR score ranging from −2.9 to 3.1. Correlation with Gleason score was r=0.35. Based on the CCP score, 29.1% of men had a less aggressive cancer compared to the clinicopathologic prediction and were assigned to a lower risk group while 26.3% of patients had a more aggressive cancer. Conclusion: The CCP test is a novel assay that can improve risk stratification for men with prostate adenocarcinoma independent of the Gleason score and PSA level. Over 50% of men initially tested in the commercial assay were assigned to a different risk category than predicted by their clinicopathologic features alone.

Poster #23 p o st er s THE BCL2 CLINICAL CORRELATION’S IN CASTRATION RESISTANT PROSTATE CANCER Rafael-Francisco Velazquez-Macias, MD1, Ramon-Mauricio Coral-Vazquez, Profesor2, Claudia-Camelia Calzada-Vazquez, Profesor2, Fernando-E. De- La-Torre-Rendon Pathologist3, Guillermo Ramos-Rodriguez Pathologist3 and Esperanza Tamariz-Herrera Pathologist3 1Hospital Regional Adolfo Lopez Mateos; 2Polytechnic National Institute of Mexico; 3Adolfo Lopez Mateos General Hospital (Presented by: Rafael-Francisco Velazquez-Macias)

Introduction: Bcl2 is an anti-apoptotic protein investigated in localized prostate cancer, but not in advanced prostate cancer. Objective: To identify Bcl2 in advanced prostate cancer resistant and sensible to castration, and to correlate Bcl2 to age, body weight (BW), height, body mass index (BMI), prostatic specific antigen (PSA), plasmatic testosterone, Gleason score, bone metastasis, disease lasting and time to rise castration resistance. Methods: An ambilective, transversal, comparative, case-control assay was made. Advanced prostate cancer patients without prostatectomy or bilateral orchiectomy, without any kind of radiotherapy, and under hormonal treatment were included. There were two groups, the castration resistant (CRPC) and the castration sensible (CSPC). The mentioned clinical data were determined. Bcl2 was identified by immunohistochemistry in a simple blind way using the paraffin blocks. A p<0.05, Mann-Whitney U test, Chi square test, and Pearson/Spearman correlation test were used. It was calculated the odds ratio for Bcl2 and hormonal treatment associations. Results: Each group included 19 patients; there were no statistical difference between both groups with respect to age, BW, height, BMI (t student: p=0.417, p=0.328, p=0.157, p=0.929, respectively). PSA was higher in CRPC than CSPC (median: 6.06 vs. median 0.09, respectively; Mann-Whitney U p=0.000). Bone metastasis were observed in 26% of CRPC, and in 11% of CSPC; CRPC Gleason’s score mean was 6.58, and CSPC Gleason’s score was 7 (Chi square: p=0.075; t student: p=0.386; respectively). Plasmatic testosterone was under castration level and not showed statistical difference (Mann-Whitney U p=0.885). Lasting disease was higher in CRPC (39.71 months vs. 23.89 months; t student p=0.041). Mean time to rise resistance in CRPC was 30.05 months. Bcl2 was identified in 171 Continued on next page 63.16% of CRPC, and in 84.21% of CSPC (Chi square p=0.141; odds ratio: 0.32 95%CI 0.07−1.45). Low Bcl2 staining intensity (1−10%) was observed in 47.37%, and moderate intensity (11−30%) in 15.79% of CRPC. In CSPC low intensity was 57.89%, and moderate intensity was 26.32% (Chi square: p=0.317). Bivariate analysis did not show correlation between Bcl2 presence, and Bcl2 staining intensity with clinical data studied. Conclusion: Bcl2 was identified in both advanced prostate cancer castration resistant and castration sensible. Bcl2 showed higher expression in castration sensible prostate cancer, but without statistical significance. There were no correlations between Bcl2 presence, and Bcl2 staining intensity to age, BW, height, BMI, PSA, plasmatic testosterone, Gleason score, bone metastasis, disease lasting and time to rise castration resistance.

Poster #24 LOW DOSE GTX−758 DECREASES FREE TESTOSTERONE AND PSA IN MEN WITH METASTATIC CASTRATION RESISTANT PROSTATE CANCER (MCRPC) Robert Getzenberg, PhD1, Evan Yu, MD2, Jordan Smith MS1, Michael Hancock MS1, Ronald Tutrone, MD3, Thomas Flaig, MD4, Karl Westenfelder, MD5, Miklos Szucs, MD6, James Dalton, PhD1 and Mitchell Steiner, MD1 1GTx, Inc.; 2U of Washington; 3CURA; 4University of Colorado; 5Five Valleys Urology; 6Semmelweis University (Presented by: Robert Getzenberg)

Objective: LHRH agents used for androgen deprivation therapy (ADT) were designed to lower total testosterone (T) levels to those achieved by orchiectomy. Contemporary assays reveal that 30−40% of men on LHRH agonists do not achieve castrate total T levels of <20ng/dL. There is growing literature showing that lower T levels correlate with improved outcomes. Additionally, the biologically active form of T is unbound, free T. GTx−758 (Capesaris) is an oral estrogen receptor α agonist that increases sex hormone binding globulin (SHBG), lowers free T levels, and ameliorates estrogen deficiency side effects associated with ADT. Methods: In a Phase 2 open label study (G200712, NCT01615120), 38 men with mCRPC were continued on their current form of ADT along with a low dose of GTx−758, 125 mg, for at least 90 days. Exclusion criteria included men at increased risk for venous thromboembolic events (VTE). Results: The initial cohort of 38 patients receiving daily 125 mg has completed enrollment. The mechanism of drug action, induction of SHBG and reduction of free T, was confirmed in the 36 patients with available values, with 83% having levels of SHBG more than double from baseline and a reduction in free T in 92%, with 81% having at least a 50% reduction in free T. Of the 22 patients who completed at least 90 days on the trial, 91% experienced decreases in PSA levels, with 36% exhibiting a decrease greater than 30% and 14% a decrease greater than 50%. GTx−758 impacted the estrogen deficiency side effects associated with ADT with a majority of subjects experiencing hot flashes prior to taking GTx−758 displaying improvement (38%) and/or stabilization (43%). Bone turnover biomarkers including CTX and bone specific alkaline phosphatase decreased in a majority (60% and 52% respectively) of the subjects. The 125mg arm was well tolerated with no reported venous thromboembolic events or deaths. Conclusion: The 125mg arm has completed enrollment of 38 patients with 172 Continued on next page metastatic CRPC, and following a planned safety review by an independent data safety monitoring board, the study is now enrolling an additional 38 patients in the 250mg oral daily dose arm. While the Phase 2 clinical trial is ongoing, and full results are forthcoming, these preliminary findings show that 125 mg of GTx−758 has activity and is well tolerated. Financial support: GTx, Inc.

Poster #25 RESULTS OF AN ONLINE SURVEY OF PHYSICAL, EMOTIONAL AND PRACTICAL CONCERNS FOR PROSTATE CANCER SURVIVORS IN THE UNITED STATES Oussama Darwish, MD, Prajakta Adsul, MD, Sameer Siddiqui, MD Saint Louis University (Presented by: Oussama Darwish) p o st er s Objective: Prostate cancer survivors face numerous health concerns after treatment. The type of treatment received may have a significant impact on the physical, emotional and practical concerns of the patient. Methods: We analyzed self-reported data from the 2010 LIVESTRONG survey for people affected by prostate cancer. Survey questions were divided into 3 sections including physical, emotional, and practical concerns in the survivorship period. Survey was administered online between June 20, 2010 and March 31, 2011 on the LIVESTRONG.org website. Results: Of the 12,307 respondents, 281 males were included in the analysis based on a primary diagnosis of prostate cancer and US residency status. Mean age was 60 years (range, 41−94) and the majority were white men (90%). The 3 most common physical concerns were decrease in sexual function (70%), urinary frequency (54%) and fatigue (35%). The leading emotional concerns were fear of cancer recurrence (61%), grief about death of other cancer patients (52%) and worry about cancer genes in family members (51%). Practical concerns were cost beyond insurance coverage (90%), financial debt (40%), and inability to continue previous work (6%). One way ANOVA was conducted to detect differences in number of physical, emotional and practical concerns across types of treatment received (surgery, radiation, hormonal and combination). Significant differences were seen in number of physical (p=0.02), emotional (p=0.04) and practical (p<0.001) concerns for patients receiving different treatments (Table 1). Patient concerns also varied based on length of follow-up after treatment. Conclusion: Based on treatment type, hormonal patients have the greatest physical and emotional concerns compared to other treatment options, while surgery patients demonstrate the most practical concerns. The results of the survey illuminate the principal physical, emotional and practical concerns of prostate cancer survivors, and can assist in prioritizing and addressing major patient concerns after prostate cancer treatment.

173 Continued on next page Poster #26 CELL CYCLE PROGRESSION (CCP) SCORE SIGNIFICANTLY MODIFIES TREATMENT DECISIONS IN PROSTATE CANCER: RESULTS OF AN ONGOING REGISTRY TRIAL Ashok Kar, MD1, Mark Scholz, MD2, Jeffrey Fegan, MD3, E. David Crawford, MD4, Rajesh Kaldate MS5 and Michael K. Brawer5 1St. Joseph Hospital; 2Prostate Oncology Specialists, Inc.; 3Rocky Mountain Urology Associates; 4University of Colorado at Denver; 5Myriad Genetic Laboratories, Inc. (Presented by: E. David Crawford)

Objective: The CCP signature test (Prolaris™, Myriad Genetic Laboratories, Inc.) is a novel prognostic assay that has been validated in multiple cohorts and provides accurate risk of prostate cancer-specific disease progression and mortality risk when combined with standard clinicopathologic parameters. This study evaluated clinicians’ judgment regarding the clinical utility of the CCP test in a prospective registry. Methods: Clinicians ordering the CCP signature test commercially were asked to complete a survey regarding their treatment recommendations before and after they received the CCP test result. Clinicians were also asked how influential the CCP test result was in making therapeutic decisions on a five point scale. Results: In 65% (198/305) of cases, there was a change recorded between the therapy initially planned and the therapy actually selected. In 122 of 305 cases (40%), clinicians indicated they would reduce the intended therapeutic burden post-CCP test. The CCP signature test influenced treatment selection to a ‘High’ or ‘Very High’ degree in 173 men (55%) and had “Low“Noin 12% of cases. Conclusion: Based on the judgment of ordering physicians, the CCP score appears to add meaningful new information to risk assessment for localized prostate cancer patients. Test results led to major changes in treatment decisions with a significant increase in conservative management options.

174 Poster #27 VALIDATION OF AN RNA CELL CYCLE PROGRESSION SCORE FOR PRE- DICTING PROSTATE CANCER DEATH IN A CONSERVATIVELY MANAGED NEEDLE BIOPSY COHORT Jack Cuzick1, Steven Stone2, Gabrielle Fisher1, Zi Hua Yang1, Daniel Berney3, Luis Beltran3, David Greenberg4, Henrik Moller5, Julia E. Reid2, Alexander Gutin2, Jerry Lanchbury2, Michael K. Brawer6 and Peter T. Scardino7 1Wolfson Institute of Preventive Medicine; 2Myriad Genetics, Inc.; 3Barts Cancer Institute; 4Public Health England; 5King’s College London; 6Myriad Genetic Labo- ratories, Inc.; 7Memorial Sloan-Kettering Cancer Center (Presented by: Michael K. Brawer)

Introduction: Our goal was to validate the predictive value of a cell cycle progres- sion (CCP) score and a pre-specified linear combination of the score with CAPRA

(combined clinical risk (CCR) score) for predicting prostate cancer death in a co- p o st er s hort of conservatively managed patients diagnosed by needle biopsy. Methods: The study employed a retrospective cohort of men diagnosed by needle biopsy in the UK from 1990−2003 using UK cancer registry data supplemented by hospital records and histopathology review of diagnostic needle biopsies. The pri- mary endpoint was prostate cancer death. Clinical variables consisted of centrally reviewed Gleason score, baseline PSA, age, clinical stage, and extent of disease; these were combined into a single predefined risk assessment (CAPRA) score. Results: In univariate analysis, the CCP score hazard ratio (HR) was 2.08 (95% CI (1.76, 2.46), P < 10−13) for one unit change of the score. In multivariate analysis including CAPRA, the CCP score HR was only marginally decreased (HR=1.76, 95% CI (1.44, 2.14)) and remained highly significant (P < 10−6). The predefined combination score, CCR, was highly predictive (HR = 2.17; 95% CI (1.8, 2.6), χ ² = 89.0 P < 10−20) and captured all available prognostic information. The predicted value of the CCP score was maintained for 10 years. There was no significant interaction with other prognostic factors. Conclusion: The CCP score provides substantially more pre-treatment prognos- tic information than available from clinical variables and is useful for determining which patients can be safely managed by a conservative policy avoiding radical prostatectomy.

Poster #28 DOES THE TOTAL ANDROGEN DEPRIVATION TREATMENT DRUG CHANGES MODIFY THE PROSTATE CANCER RESPONSE TREATMENT IN ADVANCED PROSTATE CANCER? Rafael-Francisco Velazquez-Macias, MD1, Mauricio Schroeder-Ugalde, MD2 and Alberto Gonzalez-Pedraza-Aviles Biologist3 1Hospital Regional Adolfo Lopez Mateos; 2Adolfo Lopez Mateos General Hospital; 3Faculty of Medicine of National University of Mexico (Presented by: Rafael-Francisco Velazquez-Macias)

Introduction: The total androgen deprivation treatment (ADT) is used as an alternative in advanced prostate cancer. Due to logistic features in the Adolfo Lopez Mateos General Hospital’s Urology Service, unexpected changes in treatment can occur, so patients receive different ADT combinations through their disease course. 175 Continued on next page Objective: To evaluate the ADT unexpected changes in advanced prostate cancer patients, and to know the combinatios efficacy. Methods: A retrospective study was made in 46 advanced prostate cancer patients with an average age of 70.8 years, T4−N0/1−M0/1, suffering ADT unexpected changes through treatment course. Change was produced by the Hospital ´s pharmacy product existence, and not by the disease characteristics. It were determined co-morbidities, digital rectal findings, prostatic specific antigen pre and post treatment values, Gleason score, abdominal computed tomography and bone scintigraphy findings, and ADT type. Statistical significance level of 0.05, Wilcoxon test related samples, Kruskal-Wallis test, and 20th SPSS edition were used. Results: Initially 16 patients received /goserelin, 9 nilutamide/ leuprolide, 6 bicalutamide/leuprolide, 5 flutamide/goserelin, 5 flutamide/ leuprolide and 5 nilutamide/buserelin. Afterwards 17 were change to nilutamide/leuprolide, 13 to nilutamide/goserelina, 6 to bicalutamide/ leuprolide, 4 to bicalutamide/ buserelin, 3 to nilutamide/busereline, 1 to bicalutamine/gosereline and 1 to flutamide/gosereline. The total ADT follow up was 6 to 30 month. BothADT schemes decrease the PSA (Wilconxon signed-rank test, z initial schedules= 5.796 p=0.000 and the unexpected changes schedules z= 4.443 p=0.000). There was no difference related to different ADT types. (Kruskal-Wallis test initial schedules p=0.550 and unexpected changes schedules p=0.018). Conclusion: The total ADT unexpected changes does not affect negatively the advanced prostate cancer patient´s disease control, all combinations used at ADT decrease similarly PSA.

Poster #29 BLADDER CANCER EDUCATION AMONG MEDICAL STUDENTS Margaret Le1, Brett Wahlgren BS2, Hadley Wyre, MD2, Eugene Lee, MD2, Jeffrey Holzbeierlein, MD2, Brantley Thrasher, MD2, Tomas Griebling, MD, MPH2 and Moben Mirza, MD2 1University of Kansas; 2KUMC (Presented by: Margaret Le)

Objective: To evaluate the ability of medical students to identify tobacco as a primary risk factor for bladder cancer and appropriately initiate diagnostic testing of hematuria. Methods: Medical students from the University of Kansas Medical Center of education levels one through four were electronically surveyed on 11 questions and one of three case studies that varied in social history. The survey focused on the epidemiology and risk factors of bladder cancer as well as demographic questions pertaining to the participant. Case studies were oriented towards diagnostic evaluation of hematuria. All medical students were eligible for the study. Individuals with an invalid email address or who submitted an incomplete survey were excluded. Students were categorized as either preclinical (1st and 2nd year) or clinical (3rd and 4th year). Descriptive statistics were used to stratify results based on level of education. Results: Of 745 surveys distributed electronically, 276 were returned completed. Preclinical and clinical students overwhelmingly identified smoking as a risk factor, 86% and 98% respectively, for bladder cancer. They recognized hematuria (97% and 99% respectively) as a presenting symptom of bladder cancer. Diagnostic evaluation of hematuria resulted in a selection of cystoscopy 24% and 42% of 176 Continued on next page time. In the setting of a case study where smoking was listed in the social history, 26% of pre- clinical students chose cystoscopy as the initial evaluation compared to 52% of their clinical counterparts. Conclusion: Medical students at the University of Kansas Medical Center recognize smoking as an important risk factor for bladder cancer and hematuria as a presenting sign. In spite of this, when presented with a case study highlighting tobacco use and hematuria, only 52% of students at the clinical level of their education selected the correct option in management. The initial evaluation of hematuria often takes place in the primary care setting. As an institution that ranks second in graduating students into Family Medicine and where overall, nearly 50% of students enter a primary care field, our study demonstrates discordance between medical knowledge and application. This raises the question of how can we improve medical education with the goal of preventing future delays in diagnoses and referral.

p o st er s Poster #30 IMPROVED PATIENT OUTCOMES FROM RADICAL CYSTECTOMY THROUGH VIDEO EDUCATION Roxanne Martinez MS, Elise Yerelian, Shandra Wilson, MD University of Colorado, Anschutz Medical Campus (Presented by: Shandra Wilson)

Objective: There is an intense focus on improved patient outcomes, satisfaction and cost in medical care in 2014 with the new healthcare measures being implemented. Educational videos have been shown to improve patient knowledge with reconstructive urological procedures. Radical cystectomy is a complex operation with the potential for lengthy, prolonged post-operative hospital stays. Consequently, we designed a study that evaluated the benefit of twelve low-cost videos about bladder cancer as related to patient satisfaction, cancer education, and length of stay (LOS) in the hospital. Methods: Working with a biostatistician we designed a questionnaire that covered both fact-based educational questions as well as patient satisfaction questions. The study was designed with the statistician and was IRB approved in January 2013. A retrospective review of the patients’ charts was performed to measure LOS in the hospital. Results: 17 patients (6 females and 11 males) have been enrolled in the study. 8 patients have watched the videos, and 9 patients have not. The average age of patients is 66 years. Average LOS for patients who watched the videos is 7.38 days, and the average LOS for patients without the videos was 8 days (p value = 0.258). Patients generally felt more prepared for their hospital stay(p=0.26) and more prepared for life after surgery (p=0.03) after watching the videos. Conclusion: This study is still in the data collection phase, but we wanted to examine preliminary results of the videos in case implementation for other major urological surgeries could be warranted. Certainly, the mechanics of the study seem to be reasonable for our patient population at the University of Colorado, which is varied in age, gender, and stage of disease. Early trending seems to show a possible reduction in LOS, but more patients will be needed to gain statistical power. Ultimately, we hope to show that these videos are a cost-effective method of providing improved patient outcomes with reduced medical costs.

177 Poster #31 DO PATIENTS WANT TO KNOW ABOUT SURGEON EXPERIENCE? Jennifer Wimberly, MD, Emily C Rosenfeld, Alana Christie, Philippe E Zimmern, MD University of Texas Southwestern (Presented by: Jennifer Wimberly)

Objective: In the context of three FDA notifications encouraging women undergoing synthetic sling repair to request information on their surgeon’s training, we assessed patient’s interest to obtain such information as part of their informed consent before undergoing a “new”procedure. Methods: After receiving IRB approval, a survey was administered by neutral third parties to patients in 2 separate outpatient settings. Exclusion criteria included a sub-6th grade reading level, non-English speakers, and . Demographic data included age and race, as gender was controlled for only females. Occupational health care background was investigated at clinic 2 only. The survey had three components: the REALM−SF(rapid adult literacy estimate based on seven medical words), STAI−X2(trait anxiety questionnaire), and a specifically designed Observer Questionnaire (OQ) with yes/no answers. The OQ included Q1. Should the consent form include the number of times a surgeon has performed this type of “new”surgery?, Q2. Should the consent form include since when the surgeon started to perform this “new”surgery? Descriptive statistics were used. Results: 22 patients at Location 1 and 97 patients at Location 2 met inclusion criteria. 77.3% of patients from both locations to receive this information for Q1 and Q2. Age (p= 0.0153) and race (p=0.0250) were statistically significant factors for Q1 but not for Q2. REALM−SF, STAI−X2 scores did not significantly affect responses at either location, nor did occupational health care background at clinic 1. Conclusion: Three quarters of queried patients would like to know more about their surgeon’s expertise with a new type of procedure before consenting to it. Further research is needed to identify age and race variables that were predictive of desiring to know surgeon experience.

Poster #32 ROBOTIC SIMULATION AMONGST MEDICAL STUDENTS: PREDICTING SKILL AND INTEREST Travis Dum, MD, Zach Hamilton, MD, Hadley Wyre, MD, Eugene Lee, MD, David Duchene, MD, Jeffrey Holzbeierlein, MD, J. Brantley Thrasher, MD, Moben Mirza, MD. University of Kansas Medical Center (Presented by: Travis Dum)

Objective: Robotic surgery is quickly becoming a necessary skill set, yet novice surgeons may encounter barriers to robotic surgery, including lack of familiarity with the robotic platform and undeveloped hand-eye skills. Studies have shown the da Vinci robotic surgical simulator has face, content, and construct validity, which may be most useful in novice surgeons seeking basic robotic skills. In our study, we report on the robotic surgical simulation experience amongst medical students

178 Continued on next page with no prior robotic experience. Utilizing questionnaire data, we assessed for underlying characteristics that predict an individual’s innate ability with robotic simulation and the natural learning curve. Methods: An email was sent to all third and fourth year medical students at our university. Interested subjects received a brief introduction to the da Vinci skills simulator. Next a 2-minute practice session on an introductory task was allowed to gain familiarity with the robotic device. Then, each subject was instructed to perform three sequential attempts at our predetermined virtual task, Peg Board 2, and the built-in scoring algorithm was utilized. Each subject then completed a post- study questionnaire developed by the research team to evaluate extracurricular activities and interest in surgical procedures. Results: 19 medical students completed the simulator exercises and questionnaire. Students demonstrated statistically significant improvement in time to complete, total score, and economy of motion at each performance point. Instrument

collision and drops were only significant from the first to third attempt, but not p o st er s from first to second. There was no significant change in instrument out of view, master workspace, and excessive instrument force. A student’s interest in surgery did not change from having participated, but their interest in minimally invasive surgery and confidence in robotic surgery was significantly improved. There was no correlation between robotic simulator performance and USMLE step 1 score, class rank, age, or types of hobbies. Conclusion: The robotic simulator training environment is an excellent tool for introduction and improvement of robotic skills for medical students. Students’ interest and confidence in minimally invasive surgery improves after participating in the simulator environment. Traditional measures like USMLE scores, class rank, and motor skills related hobbies do not correlate with robotic skills.

Poster #33 CURRENT PRACTICES OF MEASURING AND REFERENCE RANGE REPORTING OF SERUM FREE AND TOTAL TESTOSTERONE IN THE UNITED STATES Margaret Le1, David Flores, MD2 and Ajay Nangia, MBBS2 1University of Kansas; 2KUMC (Presented by: Margaret Le)

Objective: The evaluation of male hypogonadism and the use of testosterone replacement therapy are becoming more prevalent. Management should be based on symptomatic history and serum testosterone levels. This relies on accurate lab testing and reporting of reference values. Our objective was to determine the defined reference values and assays for free and total testosterone by clinical laboratories in the USA. Methods: Upper and lower reference values, assay methodology and source of published reference ranges were obtained from individual laboratories across the country. Attempts were made to contact two to three laboratories from all fifty states by phone. A standardized questionnaire was reviewed with laboratory technicians and supervisors by direct phone contact. Only laboratories that had complete data were included in the study. Descriptive statistics was used to tabulate results Results: 117 hospitals, centralized and independent laboratories representing forty states were surveyed. Of these 95 had complete data on total testosterone

179 Continued on next page and 103 for free testosterone. Seventy one percent of laboratories measured total testosterone in their own core testing facilities of which 94% used high throughput instruments employing an immunoassay. The remaining 29% sent their studies to 4 larger centralized reference facilities. The mean lower reference value for total testosterone was 235 ng/dL (range 160−300, SD 50) and upper limit was a mean of 856 ng/dL (range 726−1130, SD 159). One third of laboratories stratified their ranges by male age. Nine percent of laboratories who performed in house total testosterone levels created their own reference values through small local population studies. The rest of the laboratories only validated their instrument’s recommended reference values with test samples. For free testosterone, 86/103 (84%) of laboratories sent the testing to large centralized reference laboratories who used equilibrium dialysis, calculated, or mass spectrophotometry . The remaining laboratories predominantly use published algorithms to calculate serum free testosterone. Conclusion: Current total testosterone reference values have significant variability in the USA. They are largely based on very small population studies of men with unknown medical histories, sexual or reproductive function or validation of assay instrument reference package inserts values. These limited reference value definitions, especially lower limit, affect how clinicians determine treatment sometimes without knowledge of evaluation and/or treatment guidelines. Free testosterone level is thought to be a more accurate test and largely performed by large centralized reference labs in the USA.

Poster #34 A MODERN LOOK AT VASECTOMY: DEMOGRAPHICS, COMPLICATIONS AND POST-OPERATIVE FOLLOW-UP: THE UROLOGY CENTER OF COLORADO EXPERIENCE Kevin Carter, BS1, Joseph Walker, BS1 and Jesse Mills, MD2 1University of Colorado; 2TUCC (Presented by: Jesse Mills)

Objective: Vasectomy is a common office procedure to provide permanent male birth control. We wanted to determine in a large modern series its complication rate, effectiveness and need potential for revising current post-operative recommendations for tracking analysis. Methods: This is a retrospective review of 2889 men undergoing vasectomy at a Large Group Urology Practice in Colorado by 13 board-certified urologists from 2008−2013. Demographics of men deciding to pursue vasectomy, including number of children and age of male at time of vasectomy were recorded. Complications were defined as anything requiring additional office visit and were also evaluated and reported. Time to azoopsermia was also recorded. Results: There were 3 out of 2889 men who had rare motile sperm at the 6 week who had zero motile by their 12 week analysis. There were 3 redo , 2 with persistent motile sperm, 1 with copious non-motile that was redone at surgeon’s discretion. No men developed motile sperm at their 12 week analysis if they had nonmotile or azoopsermia at their 6 week analysis. The most common complication requiring additional office visit was swelling at 2%. Infection rate was 0.24% with no doctor administering pre-op antibiotics. Bleeding or hematoma rate requiring additional office visit was 0.10% with none requiring additional operation. 180 Continued on next page Conclusion: Vasectomy is a safe, cost-effective solution for permanent male . Current recommendations state that men need to produce a 6 week and 12 week semen analysis to determine success of vasectomy. If men are azoospermic or have nonmotile sperm at their 6 week analysis, they appears to be no need to recheck a semen analysis at a later date. Financial Disclosures: The authors received no funding for this study and have no financial disclosures.

Poster #35 A COMPARISON OF THE ANALYSIS AND REPORTING OF MALE REPRODUCTIVE HORMONE REFERENCE VALUES IN THE UNITED STATES Margaret Le1, David Flores, MD2 and Ajay Nangia, MBBS2 1University of Kansas; 2KUMC (Presented by: Margaret Le) p o st er s Objective: Upper and lower reference values for reproductive hormones are poorly defined for males. The values are important to determine testicular/spermatogenic function and are predictive for treatment. The objective was to compare reported reference ranges of FSH, LH, and prolactin by clinical laboratories across the USA to determine the variability of these values in the evaluation of male reproductive dysfunction. Methods: Upper and lower reference values, assay methodology and source of published reference ranges were obtained from individual laboratories across the country. Attempts were made to contact two to three laboratories from all fifty states by phone. A standardized questionnaire was reviewed with laboratory technicians and supervisors by direct phone contact. Only laboratories that had complete data were included in the study. Descriptive statistics was used to tabulate results. Results: 117 independent and hospital based laboratories representing forty states were surveyed. Thirteen laboratories sent all hormone assays to larger reference laboratories. Of those remaining, 95 had complete data on prolactin, FSH and LH and 78 on estradiol. The lower and upper reference values of each of the hormones are tabulated in Table 1. Two laboratories did not measure FSH and LH at their own institutions, while the remaining measured theirs in-house on high throughput analyzers. All laboratories with the exception of 1 validated their instrument’s recommended reference values for FSH and LH with test samples locally sourced. Fifteen out of 67 (22%) labs sent out estradiol for measurement. The remaining laboratories uniformly used a high throughout analyzer to measure estradiol. Seventy-eight of 80 (98%) labs measured prolactin in-house on high throughput analyzers. The reported reference ranges for each of the hormones predominantly came from the instrument’s reference package inserts values. Conclusion: There is a wide difference in reference ranges among commonly evaluated hormones in the evaluation of male reproductive dysfunction. The upper limit of normal for FSH reported in the USA is high as it relates to known literature on normal spermatogenic function. This can affect diagnosis and treatment. Values for the other hormones are in line with literature on normal male reproductive physiology. Our study demonstrates that reported reference values are largely based on limited data on men with undefined sexual and reproductive function.

181 Continued on next page Poster #36 THE FIRST UNITED STATES SERIES USING THE TRANSURETHRAL SUPRAPUBIC ENDO-CYSTOSTOMY DEVICE FOR SUPRAPUBIC CATHETER INSERTION Robert Larke, MD, Vassilis Siomos, MD, Andrew Windsperger, MD, Brian Flynn, MD University of Colorado (Presented by: Robert Larke)

Objective: The Transurethral Suprapubic endo-Cystostomy Device (T−SPeC®) device, is a new device used for introducing a suprapubic catheter via a retrourethral (inside-to-out) approach. This device can be compared to a Lowsley retractor, however the T−SPeC®device adjusts to compensate for abdominal girth and is disposable. An early Canadian series of four patients demonstrated the device to be safe and efficient. The objective of this study is to review our early experience using the T−SPeC® device. Methods: After receiving patient consent, urology patients at the University of Colorado Hospital underwent placement of a suprapubic catheter via the T−SPeC® device by a single surgeon. Results: Thirty-five 18F suprapubic were successfully placed in patients using the T−SPeC® device. The indications for placement were for neurogenic bladder, urethral stricture, urinary retention, or for urethral rest as a part of complex genitourinary reconstruction. Thirty of the patients were female. Thirty-three patients underwent general anesthesia, one with sedation, and another with strictly . The mean patient age was 56 (range 41−90) and the mean BMI was 29 kg/m2 (range 17−50). The average skin to bladder distance was 6.6 cm (range 4−11). The mean operative time was 4.2 minutes (range 3−5.5). There were no intra-operative complications and all patients had successful placement of a suprapubic catheter. The capture housing was missed twice following activation of the trocar, but this did not affect the outcome. There were no post-operative complications within 30 days of the procedures, such as urinary tract infection or wound infection. Three urinary tract infections were reported within 60 days of procedure. One patient required a urethral catheter due to recurrent catheter obstruction from urinary sediment and another patient pulled out her suprapubic catheter. Conclusion: Our series demonstrates that the T−SPeC® device can be placed safely, efficiently, and effectively in patients requiring long-term or temporary suprapubic tube placement. 182 Poster #37 USE OF LIGASURE(TM) VESSEL SEALING SYSTEM FACILITATES RAPID EXCISION OF MASSIVE GENITAL LYMPHEDEMA: A MULTI-INSTITUTIONAL EXPERIENCE Jordan A. Siegel, MD1, Jay Simhan, MD1, Michael J. Belsante, MD1, Lee C. Zhao, MD, MS1, Timothy J. Tausch, MD1, J. Francis Scott, BA1, Alexander J. Vanni, MD2 and Allen F. Morey, MD1 1UT Southwestern Medical Center; 2Lahey Clinic (Presented by: Jordan A. Siegel)

Objective: We present a multi-institutional series of patients who underwent surgical treatment for massive genital lymphedema and explore the utility of the LigaSure(TM) hemostatic vessel sealing system for resection of advanced cases. Methods: A chart review of all patients who underwent surgical treatment of

massive genital lymphedema from 2008−2013 was performed. The LigaSure(TM) p o st er s hemostatic vessel sealing system was used in cases of extensive disease to mitigate bleeding and improve operative times. Results were compared to cases having Bovie(R) electrocautery alone. Reconstruction was then performed using adjacent tissue transfer (ATT), split-thickness skin grafting (STSG), or both (Figure). Preoperative characteristics and technical considerations were analyzed. Results: Twelve patients (mean age 49, range 24−64) underwent 16 procedures (mean specimen weight 1298g, 100−4500g) for the treatment of massive genital lymphedema during the study period (mean follow-up 30 months). Therapy consisted of excision of affected tissue with ATT (7/16, 44%), STSG (4/16, 25%), or both (5/16, 31%). Surgical sites included scrotal (4/16, 25%), penile (1/16, 6%), penoscrotal (6/16, 38%), abdominopenoscrotal (4/16, 25%), and suprapubic (1/16, 6%). Surgical technique included excision using Bovie(R) electrocautery alone in 11/16 (69%) and LigaSure(TM) in 5/16 (39%). Mean operative time was 173 minutes while mean blood loss was 320 ml. Specimen weights for patients treated with the LigaSure(TM) were far greater than patients treated with Bovie(R) electrocautery only (2470 g vs. 1298 g, p<0.001). The LigaSure(TM) allowed for lymphedema resection to be performed nearly at twice the rate of patients undergoing surgery with Bovie(R) electrocautery alone (10.4 g/min vs. 5.3 g/min, p<0.01). Of the 12 patients, 2 Bovie(R) electrocautery patients recurred (17%) and required a total of 5 procedures for lymphedema treatment. Conclusion: Genital lymphedema can be treated effectively in even the most extreme cases with single-stage excision and skin grafting. Aggressive resection using the LigaSure(TM) device offers promising results in the management of advanced disease with the potential for faster resections and a low rate of recurrence.

183 Continued on next page Poster #38 TIME-RESPONSE RELATIONSHIP AND CLINICALLY MEANINGFUL IMPROVEMENT OF LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA (LUTS/BPH) DURING TADALAFIL TREATMENT Matthias Oelke, MD1, Rajesh Shinghal, MD2, Craig Donatucci, MD3, Simin Baygani, MS3 and Angelina Sontag, PhD3 1Hannover Medical School; 2Palo Alto Medical Foundation; 3Eli Lilly and Company (Presented by: Craig Donatucci)

Objective: Physicians currently lack evidence of the onset of clinically meaningful improvement (CMI) in patients being treated with tadalafil for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). This post- hoc analysis identified the cumulative proportion of men who achieved CMI as a function of time on therapy. Methods: This is a post-hoc analysis of pooled data from four randomized, double- blind, placebo-controlled, 12-week studies investigating tadalafil 5 mg (N=742) or placebo (N=735) in men aged ≥45 years with International Prostate Symptom Score (IPSS) ≥13. CMI was defined as an improvement in total IPSS of ≥2 for patients with moderate LUTS at baseline, ≥6 for patients with severe LUTS at baseline and ≥3 for the overall population. All studies measured IPSS at Weeks 4, 8, and 12; additionally, two studies collected IPSS data at Week 1 and one study collected IPSS data at Week 2. Results: At the 12-week study endpoint, 69% of men on tadalafil vs. 55% on placebo achieved a CMI across all four studies (≥3 IPSS improvement; p≤0.001). Among the men who achieved CMI at Week 12 with tadalafil , 55−64% achieved CMI by Week 1, 58% by Week 2, 75−84% by Week 4, and 82−87% by Week 8 (≥3 IPSS improvement). Time-to-onset of CMI was generally shorter for men with moderate vs. severe LUTS at baseline. Conclusion: Of the men who respond to tadalafil therapy (69% of the study population), approximately 60% respond within 1−2 weeks and approximately 80% within 4 weeks.

184 Poster #39 POST-RADIATION INCONTINENCE AFTER ENTEROURINARY FISTULAE REPAIR IS ASSOCIATED WITH SUBSEQUENT REPAIR FAILURE Valary Raup, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Introduction: Enterourinary fistulae (EUF) can be treated surgically by either excision with primary closure of the bladder using an omental, sliding, or muscle flap, or by simple excision and placement of a urinary catheter to allow healing by secondary intent. Incontinence is a common finding after these repairs. Here, we review our experience with non-muscle flap repairs of EUF. Methods: We reviewed 37 patients who underwent non-muscle flap repairs of EUF at Barnes-Jewish Hospital between 2004−2013 (26 primary closure of bladder,

11 excision without cystorrhaphy). Patient outcomes were assessed including p o st er s post-operative fistula closure and urinary incontinence. Multiple variables were examined for association with poor outcomes, such as age, ASA score, diabetes, coronary artery disease, hypertension, obesity, smoking, excision vs. repair of fistulae, intraoperative urinary/fecal diversion, and prior radiation. Results: The mean age in our series was 56 years (21−82) at time of surgery with median follow-up of 20 months (1−137). Among patients who underwent primary bladder closure, radiation was associated with incontinence (p=0.0001), but not repair failure (p=0.28), while developing incontinence was independently associated with repair failure (p=0.02). Among all patients with >1yr follow-up, 0/9 patients who underwent excision of the fistula tract without cystorrhaphy developed urinary incontinence vs. those who underwent primary closure 8/14 (57%) (p=0.007). Conclusion: The development of incontinence after primary bladder closure for EUF is associated with subsequent repair failure. Patients who undergo pelvic radiation prior to repair are at higher risk for developing post-surgical incontinence.

Poster #40 TREATMENT OF CHRONIC PROSTATITIS IN INFERTILE MEN IMPROVES LEUKOCYTOSPERMIA Nabeel Uwaydah, MD, Marshall Shaw BS, Puneet Sindhwani, MD University of Oklahoma Health Science Center (Presented by: Nabeel Uwaydah)

Objective: The role and origin of leukocytospermia in male factor and indications for treatment remain controversial. Leukocytes are present in semen of fertile and infertile men, even in the absence of genital infection. We seek to evaluate the treatment effect of chronic prostatitis (CP) in the setting of leukocytospermia in infertility patients. Methods: We retrospectively analyzed the charts of male patients who presented to the University of Oklahoma Urology Clinic for infertility from 2009−2013. We selected patients who were found to have leukocytospermia on their semen analysis and were subsequently treated for CP. The following standardized 6-week antibiotic protocol was used: patients with history of sexually transmitted

185 Continued on next page infections or concern for atypical infections were given Doxycycline or Tetracycline; patients with history of urinary infections or genitourinary instrumentation were given Ciprofloxacin or Bactrim. If repeat semen analysis was positive for leukocytospermia, then repeat antibiotic treatment from a different group was administered. Results: Of charts reviewed, 70 infertility patients fit our search criteria. 15 patients (21%) reported orchalgia, 20 (29%) had LUTS, 18 (26%) reported history of GU infection; incidence of clinically diagnosed CP was 67% (n=47). Treatment regimen included: Doxycycline/Tetracycline (n=54; 77%), Ciprofloxacin (n=9; 13%), Bactrim (n=7; 10%). After a single treatment course, 58 patients (83%) had full resolution of leukocytospermia; however, 12 patients (17%) required multiple treatments. Pre-antibiotic mean semen parameters: Vol−3.1cc, Motility−39%, Total motile sperm count (TMSC)−39.1 million, WBC−2.4 million; Post-antibiotics: Vol−3.1cc, Motility−42%, TMSC−43.0 million (p<0.57), WBC−0.4 million (p<0.001). Treatment effect was seen most pronounced in those patients with CP, as these patients had resolution of their LUTS, GU pain symptoms and leukocytospermia. Of patients diagnosed with CP, the mean semen parameters pre-antibiotics: Vol−3.3cc, motility−41.7%, TMSC−52.0 million, WBC−2.8 million; post-antibiotics: Vol−3.1cc, motility−46.1%, TMSC−51.5 million (p<0.86), WBC−0.6 million (p<0.001). Clearance of leukocytospermia in unrecognized CP patients was 92% (n=62). Conclusion: Leukocytospermia is a proposed risk factor for ; however, its relationship to CP is unclear. Clearance of leukocytospermia in unrecognized CP was reported as 92%. We report that use of a standardized antibiotic treatment protocol for CP improves symptoms related to CP and leukocytospermia. Resolution of leukocytospermia is more pronounced in those men with clinical CP compared to those without. Utilizing protocol-based antibiotics results in significant improvement of leukocytospermia. More studies should be undertaken to understand its impact on fertility.

Poster #41 COMPARISON OF OUTCOMES IN PEDIATRIC TRANSPLANTATION IN UROLOGIC VERSUS NON-UROLOGIC CAUSES OF ESRD Mohammad Ramadan, MD, Ryan Baker, Puneet Sindhwani, MD University of Oklahoma Health Sciences Center (Presented by: Mohammad Ramadan) Objective: Renal transplant is the most effective long term treatment for pediatric end-stage renal disease (ESRD). The etiology of ESRD can have a significant effect on the outcomes of renal transplantation. Our study aims to compare the incidence of complications, especially urologic ones, between urologic/anatomic (group U) and non-urologic/autoimmune (group NU) etiologies of ESRD. Methods: A retrospective analysis was done on patients referred for transplantation. The urologic (group U) causes of renal failure identified were congenital dysplasia, hydronephrosis, reflux nephropathy, valve or exstrophy bladder etc. The autoimmune/non-urologic (group NU) causes of renal failure identified were glomerulonephritis, atypical HUS, membranous glomerulonephropathy, etc. We specifically compared the incidences of pyelonephritis, ureteral strictures, hydronephrosis, vesicoureteral reflux (VUR), urinary tract infection (UTI), and cellular rejection after transplantation between the U and NU groups. Results: 66 patients were analyzed. 24/66 (36.4%) were in group NU, 36/66

186 Continued on next page (54.5%) were in group U, and 6/66 (9.1%) had an unknown etiology of ESRD. Pyelonephritis was the only urologic complication more common in group U (p<0.05). There were no statistically significant differences in the incidences of UTI or other urologic complications (VUR, hydronephrosis, or stricture) between the 2 groups (p>0.05). Patients in group NU were more likely to have rejection of their transplanted kidneys than patients in group U (p<0.05). Conclusion: Patients with urologic causes of ESRD had a higher incidence of pyelonephritis, but a lower incidence of cellular rejection when compared to pediatric patients with non-urologic causes of renal failure. There was no significant difference in the incidences of other complications between the two groups.

Poster #42 COMPARISON OF OUTCOMES AND COMPLICATIONS IN PEDIATRIC RENAL TRANSPLANT PATIENTS WITH AUTOIMMUNE VERSUS UROLOGIC

CAUSES OF END STAGE RENAL DISEASE (ESRD) p o st er s Ryan Baker1, Mohammad Ramadan, MD2 and Puneet Sindhwani, MD2 1University of Oklahoma College of Medicine; 2OUHSC, Department of Urology (Presented by: Ryan Baker) Objective: Renal transplant is the most effective long term treatment for pediatric end-stage renal disease (ESRD). The etiology of ESRD can have a significant effect on the outcomes of renal transplantation. Our study aims to compare the incidence of complications, especially urologic ones, between urologic/anatomic (group U) and non-urologic/autoimmune (group NU) etiologies of ESRD. Methods: A retrospective analysis was done on patients referred for transplantation. The urologic (group U) causes of renal failure identified were congenital dysplasia, hydronephrosis, reflux nephropathy, valve or exstrophy bladder etc. The autoimmune/non-urologic (group NU) causes of renal failure identified were glomerulonephritis, atypical HUS, membranous glomerulonephropathy, etc. We specifically compared the incidences of pyelonephritis, ureteral strictures, hydronephrosis, vesicoureteral reflux (VUR), urinary tract infection (UTI), and cellular rejection after transplantation between the U and NU groups. Results: 66 patients were analyzed. 24/66 (36.4%) were in group NU, 36/66 (54.5%) were in group U, and 6/66 (9.1%) had an unknown etiology of ESRD. Pyelonephritis was the only urologic complication more common in group U (p<0.05). There were no statistically significant differences in the incidences of UTI or other urologic complications (VUR, hydronephrosis, or stricture) between the 2 groups (p>0.05). Patients in group NU were more likely to have rejection of their transplanted kidneys than patients in group U (p<0.05). Conclusion: Patients with urologic causes of ESRD had a higher incidence of pyelonephritis, but a lower incidence of cellular rejection when compared to pediatric patients with non-urologic causes of renal failure. There was no significant difference in the incidences of other complications between the two groups.

187 Poster #43 OUTCOME OF RENAL TRANSPLANTATION IN PATIENTS WITH VASCULAR EMERGENCIES Jonathan Nelson, MD, Julie Riley, MD, Michael Davis, MD, Antonia Harford, MD University of New Mexico (Presented by: Jonathan Nelson, MD) Objective: Vascular access emergencies are defined as patients that have run out of viable vascular access for dialysis. These patients are rare in the end stage renal disease (ESRD) population and are difficult to treat. Without renal transplant these patients will die of ESRD. Limited renal transplant programs are willing to manage these patients and little is known regarding the outcomes of grafts in this population. Methods: A retrospective review of all renal transplants in vascular emergency patients at a single institution was performed. The outcome of the renal graft was evaluated utilizing postoperative creatinine and estimated glomerular filtration rate (eGFR) and incidence of failure. The time to failure and cause for dysfunction were examined as well as patient comorbidities and graft ischemia time. Results: A total of 7 patients were identified from 2006−2013. Average age was 55 years (46−71) with 3 male and 4 female recipients. Cause of ESRD was diabetes (4), membranoproliferative glomerulonephritis MPGN (1), IgA nephropathy (1), and glomerulonephritis (1). Three were expanded criteria donors with the remaining standard donors. Three patients had delayed graft function (defined as needing dialysis within the first 7 days post-transplant) and average creatinine was 3.3, 1.5, 1.6 and 1.8 at 7 days, 30 days, 180 days and 365 days respectively. eGFR was 28.5, 49.7, 48.9, and 44.1 at 7 days, 30 days, 180 days and 365 days respectively. Average cold ischemia time was 24.6 hours (12.3−40). Four patients had graft failure between 1−6 years after transplantation and two additional patients died, one 2 years after transplant due to complications of a fall and the other at 3 years due to sepsis. The remaining functional graft is currently one year out from transplantation. Conclusion: Renal transplantation in patients with vascular emergencies has poor outcomes in regards to graft failure and overall mortality. More data regarding the outcome of transplant in these patients is necessary. While these patients have few options, they should be counseled regarding graft survival and complications of renal transplantation.

Poster #44 POST-OPERATIVE COMPLICATIONS IN TRAUMA PATIENTS UNDERGOING DAMAGE CONTROL NEPHRECTOMY Kyle Spradling, MD, Jairam Eswara, MD, Janine Oliver, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Objective: Renal injuries account for 3% of all trauma admissions in the US. Severely injured patients who are unstable due to hemorrhage or metabolic derangement require damage control nephrectomy. The purpose of this study is to describe the complications associated with damage control nephrectomy performed for trauma.

188 Continued on next page Methods: From 2000–2013, 49 patients underwent emergent damage control nephrectomy as a result of blunt or penetrating traumatic injury at a single institution. Endpoints were re-hospitalization, reoperation or additional procedures due to complications. Results: Median age at time of surgery was 24 (15−82) years and median follow- up was 11 months. Median revised trauma score and injury severity score were 7.84 and 26, respectively. Thirty-two patients underwent additional abdominal visceral surgeries (10 splenectomies, 7 liver resections or repairs, 19 small or large bowel resections or repairs, and 6 distal pancreatectomies). Median length of initial hospitalization was 13 days (range 1−49). Of the 49 patients studied, 7 (14%) died during initial hospitalization. Of the 42 who survived, 9 (21.4%) were re-hospitalized and 7 (16.7%) required reoperation or additional procedures due to complications. The median time until postoperative complication was 40 days. The most common complication was infection or abscess formation (14.2%).

Of note, patients who underwent damage control nephrectomy and removal of p o st er s one or more additional abdominal visceral organs had a higher rate of major complications (Clavien grade ≥ 3) within 30 days than patients who underwent emergent nephrectomy alone (30% vs. 0%, p = 0.04). Conclusion: Complications are common among trauma patients who undergo damage control nephrectomies. Among patients who undergo trauma nephrectomy, requiring additional surgical procedures to other abdominal organs is associated with higher incidences of post-operative complications. Patients who underwent damage control nephrectomy alone, however, had very low rates of readmission, reoperation or reintervention.

Poster #45 VESSEL PRESERVING POSTERIOR URETHROPLASTY AFTER PRIMARY REALIGNMENT: INITIAL EXPERIENCE Anashia Shera, MD, Ted Ritchie, MD, Ehab Eltahawy, MD UAMS (Presented by: Ted Ritchie)

Objective: Primary realignment after post traumatic urethral distraction (PUD) can be successful in up to 50% of the cases. In the other 50% an excision and primary anastomosis (EPA) uretrhroplasty is required. Similar to the vessel sparing anterior urethroplasty, a similar technique is propsed for select patients who had PUD, and attempted primary alignment. Methods: After IRB approval, a retrospective chart review was done for 8 patients who failed primary realignment for PUD and subsequently underwent vessel preserving EPA. All patients had a suprapubic tube placed at least 6 weeks prior to surgery. The preoperative evaluation was done by urtherogram and cystourethroscope, and penile duplex ultrasound to confirm adequate pudendal circulation. The procedure starts by a temporary vesicostomy followed by perineal dissection to identify the proximal end of the urethra. The intervening scar was then carved out as usual, and inter-crural incision was done if additional length was needed. The dissection is carried out such that the blood supply ventrall is not severed. Anastomoses are carried out as usual, Catheter stent was left 3 weeks, followed by voiding urethrogram. Urethrocystoscope is done at 3 months, and patient reported outcome questionnaire, uroflow and post void residual at 12 months. 189 Continued on next page Results:7 patients had a short distraction defect <3 cm on preop evaluation, one patient had a combined 3 cm distal bulbous stricture that required a buccal graft done at the same time of the posterior repair. The first patient in this series had a congenital distal hypospadias. Prior to the procedure and after the initial realignment 3 patients had DVIU once, and 5 patients had 2−5 DVIUs/dilations. All the 8 patients had open urethra at a mean follow up of 18 (6−33) months. Intercrural incision was required in 4 patients; bone resection however was not required in any. Conclusion: Urethral realignment after posterior urethral distraction makes the subsequent vessel preserving EPA possible without extensive dissection. Preservation of the blood supply that has not been damaged by the initial trauma is particularly useful if the blood supply of the distal segment is compromised by hypospadias or anterior urethral stricture.

Poster #46 OUTCOMES OF GENITOURINARY INJURIES DURING COLORECTAL SURGERY Valary Raup, MD, Jairam Eswara, MD, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Objective: The purpose of this study is to quantify and categorize genitourinary injuries during colorectal surgery. Methods: We retrospectively reviewed patients who underwent colorectal surgery at Barnes Jewish Hospital and developed iatrogenic genitourinary complications requiring surgical repair between 2003−2013. Endpoints included GU repair failures. Results: There were 75 patients in this series, with a mean age of 57.5 years (22−91) at time of surgery and median follow-up of 16.7 months (0−127). Sixty- four patients had single GU repairs and 11 patients had multiple GU repairs, with 18 patients having a failure of their initial repair. Colorectal procedures included colectomies (16), lower abdominal resections (15), lower abdominal and abdominoperineal resections with total abdominal hysterectomies and bilateral salpingo- (13), and abdominoperineal resections (9). The most common initial GU repairs were cystorrhaphy (24), ureteroureterostomy (22), ureteroneocystotomy with psoas hitch (12), and ureteroneocystotomy (11). Secondary GU repairs included stent placement or PCN for persistent ureteral leak (5), fistula repair (3) stent placement or cystorrhaphy for persistent bladder leak (2), and repair of recurrent ureteral strictures (1). Twenty-seven patients (36%) had prior radiation and 35 patients (47%) had prior chemotherapy. Fifty patients (67%) are alive, with a 30-day mortality rate of 4%. Pre-operative radiation was associated with failure of the GU repair (11/28 vs.7/47, p=0.025). Pre-operative chemotherapy was also associated with GU repair failure (13/35 vs. 5/40, p=0.016). Conclusion: Pre-operative radiation and chemotherapy are associated with increased repair failure rates of GU injuries during colorectal surgery.

190 Poster #47 FACTORS ASSOCIATED WITH ADRENAL SURGERY AFTER ADRENAL INJURIES Valary Raup, MD, Jairam Eswara, MD, Julio Geminiani, MD, Joel Vetter, Steven Brandes, MD Washington University (Presented by: Jairam Eswara)

Objective: Adrenal trauma is rare and thus large series analyses are lacking. Herein, we report an analysis of adrenal injuries using the National Trauma Data Bank (NTDB). Methods: We performed a retrospective analysis of the NTDB from 2007−2011. Patient demographics, Injury Severity Score (ISS), mechanism of injury, and blunt versus penetrating trauma, associated injuries and hypovolemic shock

were assessed. Multivariable models were used to determine associations with p o st er s outcomes such as mean length of stay, need for ICU, need for surgery, type of surgery and death. Results: Of 1,766,606 trauma cases in the data set, 8683 were identified as adrenal injuries including 7835 blunt and 663 penetrating. Of 8683 adrenal injuries, 80 (0.9%) required surgery including 0/184 isolated adrenal injuries (p=0.42). No isolated adrenal injuries were associated with death (12% vs. 0%, p<0.0001). The most common associated organ injuries were ribs (50.9%), thoracic (50.0%), liver (41.6%), vertebrae (30.9%), kidney (27.8%), spleen (22.0%). Logistic regression showed that higher ISS score (p=0.007), penetrating injury (p<0.001), race (Black) (p=0.029) as well as concurrent injuries to the spleen (p<0.001) and intestines (p=0.016) were associated with a higher likelihood of requiring adrenal surgery while injuries to the thorax (p=0.0014) and multiple abdominal injuries (p<0.001) were associated with a lower rate of undergoing adrenal surgery. Factors associated with isolated adrenal injury include lower ISS (p<0.001), younger age (p<0.001), and penetrating injury (p<0.001). Older age (p<0.001), higher ISS score (p<0.001), race (Black, Other) (p=0.03, p=0.02), penetrating injuries (p<0.001) and injuries to the aorta/vena cava (p=0.008), vessels (p=0.001), thorax (p=0.03), ribs (p=0.005), stomach (p=0.02), liver (p=0.03), multiple abdominal injuries (p=0.002), and brain/spinal cord (p<0.001) were associated with a higher mortality rate. Conclusion: Adrenal injuries are uncommon, comprising 0.49% of all injuries. None of the isolated adrenal injuries required surgery, and isolated adrenal injures are not fatal. Younger age, higher ISS score, penetrating injury, race (Black) and concurrent injuries to the spleen, and intestines were associated with a higher likelihood of requiring adrenalectomy.

Poster #48 THE ROBOTIC ASSISTED MULTIPLEX PARTIAL NEPHRECTOMY Ryan Hankins, MD1, Annerleim Walton Diaz, MD2 and Adam Metwalli, MD2 1National Institutes of Health; 2NIH/NCI (Presented by: Ryan Hankins)

Objective: Robotic surgery has enabled the expansion of minimally invasive surgery that was previously prohibited with pure laparoscopy. Robotic partial nephrectomy has become a well established technique in the management of renal

191 Continued on next page cell carcinoma and is now used more frequently for complex multifocal disease. The Urologic Oncology Branch at the National Institutes of Health has a very unique patient population with many patients experiencing multifocal renal cell carcinoma syndromes that are surgically treated with robotic partial nephrectomy. We have termed robotic surgery on a single kidney with more than three masses in complex locations as a Robotic Assisted Multiplex Partial Nephrectomy (RMxPNx). To our knowledge, this is the largest series of RMxPNx to date. This series focuses on renal function outcomes following RMxPNx. Methods: We evaluated patients from a single institution (NIH/NCI) that underwent Robotic Multiplex Partial Nephrectomy from 2007 to 2013. All patients underwent RMxPNx for 3 or more masses in a single kidney. Data was compiled retrospectively with statistical analysis performed on renal function outcomes. Results: A total of 54 patients underwent RMxPNx from 2007 to 2013 (mean age 46, range 20 to 84). The mean BMI was 30.5 (range 22.5 to 41.6). The mean number of tumors removed was 8.63 (range 3 to 52). Hilar occlusion was used in 18% of cases with a mean warm ischemic time of 23.3 minutes (range 15 to 37 minutes). The mean blood loss was 1434mL (range 250 to 8500). The robotic to open conversion rate was 11% with all 6 conversions occurring in the first 20 patients of the series. Mean preoperative creatinine and eGFR were 1.02±0.25mg/ dL and 68.9±20.8mL/min, respectively. The mean increase in creatinine in the immediate post-operative hospitalization was 0.45 mg/dL (p<0.001). Similarly a mean decrease in eGFR of 24.6mL/min was observed (p<0.001). These changes occurred on average day 1.7 (range 0 to 11). By 3 month follow-up, the mean creatinine increase from baseline was 0.038mg/dL (p=0.148) and mean decrease in eGFR was 2.04mL/min (p=0.331). Conclusion: Robotic multiplex partial nephrectomy is a safe and feasible approach to patients with multifocal renal masses. These complex surgeries have a demonstrated learning curve but this minimally invasive approach for nephron sparing surgery allows patients to preserve renal function where they would otherwise require open surgery or a radical nephrectomy.

Poster #49 WITHDRAWN

Poster #50 EXTERNAL VALIDATION OF GLOBAL EVALUATIVE ASSESSMENT OF ROBOTIC SKILLS Monty Aghazadeh, MD1, Isuru Jayaratna, MD2, Andrew Hung, MD2, Inderbir Gill, MD2, Mihir Desai, MD2 and Alvin Goh, MD3 1Baylor College of Medicine; 2University of Southern California; 3Houston Methodist Hospital (Presented by: Monty Aghazadeh)

Objective: Global Evaluative Assessment of Robotic Skills (GEARS) is a clinical assessment tool for robotic surgical skills, previously developed and validated in an intraoperative environment. We now demonstrate the construct validity, reliability, and utility of GEARS in an independent cohort, using an in vivo animal training model. Methods: Forty-seven participants were enrolled. Demographics and previous

192 Continued on next page surgical experience were captured using a standardized questionnaire. Participants were categorized based on previous robotic experience as either experts (completed >30 robotic cases as primary surgeon), intermediates (≥5 but ≤30), or novices (<5). All participants completed a standardized in vivo robotic task in a porcine model. Task performance was evaluated by two blinded expert robotic surgeons and self-assessed by the participants using the 6-metric (see table) GEARS assessment tool. Kruskal-Wallis test was used to compare the GEARS performance scores across groups to determine construct validity; Spearman’s rank correlation measured inter-observer reliability; and Cronbach’s alpha was used to assess internal consistency. Results: Performance evaluations were completed on 9 experts and 38 trainees (14 intermediate, 24 novice). Experts (median age 42.5 years) had completed a median of 350 robotic cases (150−2000) over 5.5 (4−9) years of experience; intermediates (age 30.5 years) had completed 10 (5−30) cases over 1.5 (0.5−4

years); and novices (age 30 years) had completed 0 (0−3 cases) over 0 (0−2) p o st er s years. Experts demonstrated superior performance compared to intermediates and novices overall and in all individual domains (p<0.001) [see Table]. In comparing intermediates and novices, the overall performance difference trended towards significance (p=0.051), while the individual domains of efficiency and autonomy were significantly different between groups (p=0.028 and 0.042, respectively). Inter-observer reliability between expert ratings was confirmed with a strong correlation observed (r=0.857, 95% CI [0.691, 0.941]). Experts and participant scoring showed less agreement (r=0.435, 95% CI [0.121, 0.689] and r=0.422, 95% CI [0.081, 0.0672]). Internal consistency was excellent for experts (a=0.96, 0.98) and participants (a= 0.93). Conclusion: In an independent cohort, GEARS was able to differentiate between different robotic skill levels, demonstrating excellent construct validity. As a standardized assessment tool, GEARS maintained consistency and reliability for an in vivo robotic surgical task. GEARS may be applied for skills evaluation in a broad range of robotic procedures.

193 VIDEOS

Video #1 ROBOTIC-ASSISTED EPIGASTRIC ARTERY HARVEST: AN APPLICATION OF MINIMALLY INVASIVE TECHNOLOGY FOR SUCCESSFUL PENILE REVASCULARIZATION Michael Aberger, MD, Katie Murray, MD, Josh Broghammer, MD, David Duchene, MD University of Kansas (Presented by: Michael Aberger)

This video reviews a novel option for the application of minimally invasive technology for penile revascularization as we demonstrate the technique of successful robotic-assisted epigastric artery harvest.

Video #2 LAPAROSCOPIC ASSISTED URETEROURETEROSTOMY Gwen Grimsby, MD1, Patricio Gargollo, MD2 and Micah Jacobs, MD, MPH3 1UTSW/CMC; 2Texas Children’s, Houston, TX; 3UT Southwestern Medical Center, Dallas, TX (Presented by: Gwen Grimsby)

The video features a novel laparoscopic assisted technique for Ureteroureterostomy for the treatment of an obstructed and/or ectopic ureter in children.

Video #3 ROBOTIC ASSISTED LAPAROSCOPIC TAKEDOWN OF URETHROPEXY SUTURES AND ANTEGRADE URETHROLYSIS WITH OMENTAL INTERPOSITION Robert Chan, MD1, Zach Jeng, BA2, Alvin Goh, MD1 and Rose Khavari, MD1 1Houston Methodist Hospital; 2Baylor College of Medicine (Presented by: Robert Chan)

This video shows the feasibility of a minimally invasive approach to iatrogenic bladder outlet obstruction caused by bladder neck suspension sutures for stress urinary incontinence.

Video #4 ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION Daniel Zainfeld, MD, Andrew Windsperger, MD, David Duchene, MD University of Kansas (Presented by: Daniel Zainfeld)

Presentation of our technique for robotic-assisted ureteral reimplantation and results to date.

194 Video #5 AN INNOVATIVE INSIDE-OUT APPROACH TO SUPRAPUBIC CATHETER INSERTION IN THE OBESE PATIENT WITH A NEUROGENIC BLADDER: THE TRANSURETHRAL SUPRAPUBIC ENDO-CYSTOSTOMY DEVICE Vassilis Siomos MD, Thomas Pshak MD, Robert Larke MD, Brian Flynn MD University of Colorado (Presented by: Vassilis Siomos)

We present the Transurethral Suprapubic endo Cystostomy Device (T−SPeC®) device, which is a new device used for introducing a suprapubic catheter via a retrourethral (inside-out) approach. Our video demonstrates how to safely, efficiently, and effectively place a suprapubic catheter using the T−SPeC® device in patients with a neurogenic bladder who cannot self-catheterize.

Video #6 CYSTOSCOPIC FINDINGS OF PLACENTA PERCRETA WITH BLADDER INVOLVEMENT Ahmed Alghrouz, Stephanie Tran, Satyan Shah, MD University of New Mexico School of Medicine (Presented by: Ahmed Alghrouz)

This video highlights key cystoscopic findings of two cases of placenta percreta VID EO S involving the bladder along with case related information and management summaries.

195 Agenda Annual Business Meeting T. Leon Howard Education and Research Fund of the South Central Section of the AUA, Inc. Saturday, October 11, 2014 11:45 a.m. – 12:15 p.m.

I. Call to Order – Charles A. McWilliams, MD

II. Minutes of Last Meeting – Jeffrey M. Holzbeierlein, MD September 21, 2013, Chicago, IL

III. Treasurer’s Report – Timothy D. Langford, MD

IV. Old Business

V. New Business

VI. Announcements

VII. Adjourn

196 EDUCATION AND RESEARCH FUND OF THE SOUTH CENTRAL SECTION OF THE AMERICAN UROLOGICAL ASSOCIATION, INC.

NOTES TO FINANCIAL STATEMENTS JANUARY 31, 2014 AND 2013 re p or ts ann u al

197 198 Agenda Annual Business Meeting South Central Section of the AUA, Inc. Saturday, October 11th, 2014 11:45am - 12:15pm

I. Call to Order – Charles A. McWilliams, MD

II. Minutes of Last Meeting – Jeffrey M. Holzbeierlein, MD September 21, 2013, Chicago, IL

III. Treasurer’s Report – Timothy D. Langford, MD

IV. Secretary’s Report – Jeffrey M. Holzbeierlein, MD

V. Committee Reports

A. Bylaws Committee – Damara L. Kaplan, MD B. Historical & Necrology Committee – Robert E. Donohue, MD C. Past President’s Committee – Allen F. Morey, MD D. Program Committee Report – Damara L. Kaplan, PhD, MD E. Future Meetings Committee Report

VI. AUA Committee Reports

F. Representative to Executive Board – J. Brantley Thrasher, MD G. Representative to AUA Nominating Committee – Anthony Y. Smith, MD re p or ts ann u al VII. Old Business

VIII. New Business

H. Nominating Committee – Allen F. Morey, MD I. Election of Officers J. Election of Member-at-Large for 2014 Nominating Committee K. Presentation of Applications for Membership – Damara L. Kaplan, PhD, MD L. Installation of New President 2014 – 2015

IX. Announcements

X. Adjourn

199 SOUTH CENTRAL SECTION OF THE AMERICAN UROLOGICAL ASSOCIATION, INC.

NOTES TO FINANCIAL STATEMENTS JANUARY 31, 2014 AND 2013

200 re p or ts ann u al

201 South Central Section of the AUA, Inc. MEMBERSHIP SUMMARY REPORT Report date: 09/18/2014

ACTIVE Active Member 950 Active Member – Transfer into Section 4 Total Active 954

ASSOCIATE Associate Member 67 Associate Member – Fast Tracked 1 Associate Member – Transfer into Section 3 Total Associate 71

HONORARY Honorary 25 Total Honorary 25

SENIOR Senior Member 380 Senior Member – Transfer Internal 25 Total Senior 405

GRAND TOTAL MEMBERSHIP 1455

202 South Central Section of the AUA, Inc. Membership Candidates and Transfers Report Date: 09/18/14

*Application Not Complete FTAUA Fast Track Application

CANDIDATES FOR MEMBERSHIP

Active AGUILAR MORENO, MD Jose ALBA, MD Frances * BEVAN-THOMAS, MD Richard BISCHOFF, MD Carl * BOLANOS, Sr., MD Mario CALDERON OLIVARES, MD Julio E. * CAMACHO TREJO, MD Victor CARMEL, MD Maude CERVANTES CRUZ, MD Jose * CHON, MD Chris CORTES-GONZALEZ, MD Jeff DALL’ERA, MD Joseph * DAVALOS, MD Mauricio DEROSA, MD Chad EISENBERG, DO Lauren * ESPINOZA GUERRERO Xavier FAJARDO, MD Carlos * FUERST, MD Donald M E MB ER SHIP C AN DID A * GAMINO SABAGH, MD Carlos

GARCIA, MD German AN D tRAN S FER GILDARDO, MD Manzo GIRDLER, MD Benjamin GUTIERREZ OCHA, MD Jose * HAKIM, MD Samuel HAMMOND, Jr., MD Gaines * HOLGUIN, MD Felipe

HUDAK, MD Steven T E S KARAM, MD Jose KAVOUSSI, MD Parviz * KAYE, MD Jonathan * KEFER, MD, PhD John LEOS GALLEGO, MD Carlos LEWIS, MD Richard LOPEZ ALVARADO, MD Sotero MACIP NIETO, MD Gerardo MARTINEZ, MD Carlos MENDEZ-PROBST, Jr., MD Carlos * MODI, MD Achal * NOVAK, MD Thomas

203 PENA-GEORGE, MD Christopher PEREZ, Sr., MD Erick * PALACIOS SANCHEZ, MD Pedro * QUAYLE, MD Sejal * RIVERA, MD Francisco RODRIGUEZ-COVARRUBIAS, MD Francisco SIDDIQUI, MD Sameer STIKE, MD Aaron TARRY, MD Susan THARIAN, MD Brenda VENEGAS, MD Pablo * VITE VELAZQUEZ, MD Enrique * ZENIL MEDINA, MD Adan FT ANDREOIU, MD Matei FT BUESO MADRID, MD Gustavo FT DILLON, MD Benjamin FT GOH, MD Alvin FT KHAVARI, MD Rose FT MAYER, MD Wesley FT MURALLES, MD Luis FT OGLES, MD Mitchell FT SCHULTZ, MD Andrew FT SPECK, MD Michael Total Active : 61

Associate ANTONELLI, MD Jodi CARRILLO BAUTISTA, MD Oscar CASTILLO MARTINEZ, MD Gery CHAN, MD Robert COST, MD Nicholas CUNZA, MD Duncan DOUBRAVA, DO Russell * GARCIA ARANO, MD Gildardo * HEGDE, MD Huong HEINLEN, MD Jonathan HOANG, MD An * LEE, DO Michael MCCARTY, MD Melina * NAVAI, MD Neema * NAVARRO, MD Teodoro * NUSS, MD Geoffrey * RAMOS, MD William RILEY, MD Julie * SAWYER, MD Mark SERGIO, MD Duran * SHREVE, MD Eric STRATTON, MD Kelly * TARACENA, MD Fabricio VILLANUEVA, MD Carlos 204 FT BECERRA CARDENAS, MD Jaime FT BOCI, MD Mirian FT CHINCHILLA, MD Daniel FT DAVIES, MD Judson FT DHIR, MD Rohit FT EVANS, DO Grant FT FRIEBEN, MD Ryan FT FULLER, MD Phillip FT GREENE, MD Richard FT GYORFI, MD Justin FT HOLYOAK, MD Joshua FT MCLENNAN, MD Gregory FT MOORE, MD John FT MORILLA, MD Daniel FT PIONTEK, MD Elizabeth FT SCHLOMER, MD Bruce FT SCHNEIDER, MD Steven FT TRUONG HEDGE, MD Huong FT VILLARREAL, MD Humberto FT WILSON, MD Bradley FT WOOTTON, MD Cole Total Associate : 42

Grand Total Candidates for Membership: 103

MEMBERSHIP STATUS TRANSFERS – (INTERNAL)

To Active Membership CHAKRABARTY, MD MS FRCS FICS Amit M E MB ER SHIP C AN DID A CLAYBROOK, MD Douglas DUEL, MD Barry AN D tRAN S FER HAYES, MD Joseph Total To Active Membership: 4

To Associate Membership LENG, MD Wendy SCHUSTER, DO Tina T E S WILLIAMS, MD Stephen Total To Associate Membership: 3

Senior BIBER, MD Robert CICHOCKI, MD Gerald COCHRAN, MD James COKER, MD Joe DE JUANA, MD Carlos FITZIG, MD Sanford FREIDEN, MD Floyd GARCIA IRIGOYEN, MD Carlos HARPER, MD David 205 HARRISON, II, MD Clanton HIGGINBOTHOM, Jr., MD William HSU, MD Cheng MARIA-SOOSAI, MD Manuel MUELLER, MD Edward NEUMAN, MD Neal NEWTON, MD Jerry RUTLEDGE, MD Elizabeth SCHMIDT, MD Richard SCHUESSLER, MD William THAYER, Jr., MD Kent URBAUER, MD Craig VORDERMARK, MD Jonathan WELL, MD Michael WERNER, Jr., MD Jan ZONANA-FARCA, MD Elias Total Senior: 25

Grand Total Membership Status Transfers – (Internal): 32

LOSSES Deceased Members ALFARO, MD Luis BOONE, Jr., MD Ted COGGINS, MD James DICKEY, MD Billy ROBERTS, MD Roy RODGERS, MD George WAY, MD Kenneth Deceased Members Losses: 7

Total Losses: 7

206 In Memoriam

The South Central Section of the AUA honors those members who have passed away this year. We will always be thankful for their commitment to the section and will miss them dearly.

Luis C. Alfaro, MD El Salvador

Ted B. Boone, Jr., MD Desoto, TX

James T. Coggins, MD Dallas, TX

Billy M. Dickey, MD El Paso, TX

Roy R. Roberts, MD Lubbock, TX

George H. Rodgers, MD Prairie Vlg, KS

Kenneth E. Way, MD Denver, CO In Me m or i a

207 South Central Section of the AUA, Inc. Bylaws

Amended October 2010

“The masculine pronoun refers to both masculine and feminine and herein is used for convenience.”

ARTICLE I MEMBERSHIP

Section 1 – Boundaries An applicant for membership must be a resident of the South Central Section (“SCS” or “Section”) at the time of application, which consists of the states of Arkansas, Colorado, Kansas, Missouri, Nebraska, New Mexico, Oklahoma, Texas, the Republics of Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Belize. Individuals who initially join the Section in which they practice, and then at a future date relocate to another section of the American Urological Association, Inc. (“AUA”), may retain membership in the South Central Section.

Section 2 – Member Categories The Association membership shall include: Active Members, Associate Members, Affiliate Members, Senior Members, Honorary Members, Corresponding Members and Candidate Members.

Section 3 – Application Fees and Dues All members except for Senior and Honorary members shall be assessed application fees and due in an amount determined by the Board of Directors. a) Any member who after appropriate notification does not pay membership dues shall cease to receive SCS publications and notices

Section 4 – Voting Status and Rights Only Active and Senior members shall be eligible to vote. Active and Senior members who are elected to Honorary Membership shall retain their voting status. Only voting members are eligible to hold office. All members shall be entitled to receive the latest available copy of Articles of Incorporation and Bylaws, and the Roster of Membership.

Section 5 – Election/Approval of Membership All members shall be elected at the Annual Business Meeting. New members shall receive a certificate of membership from the Secretary, and the American Urological Association will be notified of their SCS membership.

Section 6 – Active Members Requirements for Active members are as follows: a) Possession of an unlimited license to practice medicine and surgery in the State, Province or Country of the applicant’s practice. b) Practice in the geographical boundaries of the AUA. c) Possession of an MD or DO degree, or United States medical licensure 208 equivalent, and completion of an ACGME accredited urology residency

or equivalent by the Royal College of Surgeons (RCS) in Canada or the by la Quebec Board of Urology or the certifying Board of Urology in the country.

d) Limitation of practice to the specialty of Urology. ws e) Certification by the American Board of Urology (ABU), the Royal College of Surgeons (RCS) in Canada or the Quebec Board of Urology or the certifying Board of Urology in the country where practicing within the geographic boundaries of the Section. f) Recommendation for membership by two (2) voting members of the AUA, except if certified within the last 24 months (as per item e in this section). g) Letter of recommendation from the Chief of Urology, Medical Director, or Chair of the Credentials Committee at the hospital(s) where the applicant has privileges. h) If an Active Member becomes decertified by the ABU, or other certifying board, the member shall be automatically dropped for non-compliance with the Section Bylaws, pursuant to Expulsion and Reinstatement Policies.

Section 7 – Senior Members Members are eligible for Senior Membership in both the SCS and the AUA if they have been Active members for 25 years in either the Section or the AUA and have reached the age of 65. Active members who are retired or are permanently disabled and have been members for 20 years in either the Section of the AUA are also eligible for Senior Membership.

Section 8 – Associate Members Requirements for Associate membership are the same as Active membership, except for Board certification. a) Candidate members eligible for Fast Track Associate Status: Associate membership will be offered to all Candidate members who have passed the qualifying examination (Part I) of the American Board of Urology. b) Non-Members eligible for Associate Status: Associate Membership is available to non-member urologists who are practicing within the geographic boundaries of the Section but are not certified by the American Board of Urology. Doctors of Osteopathy who complete AOA-approved urology residency programs and are certified by the American Osteopathic Board of Surgery are eligible for Associate Member Status. c) Transfer to Active Membership. Associate Members who have passed the ABU certifying exam (Part II) will be transferred to Active Membership in the Section. d) If an Active Member fails to become re-certified as required by the ABU (or other certifying board), the Section will transfer the individual to Associate Member Status.

Section 9 – Affiliate Members Affiliate membership is available to Non-Physician Scientists and is not usually available for physicians certified by medical boards. However, in exceptional instances, persons in related fields of medicine and science, who do not qualify for other categories of Association membership, may be considered 209 for Affiliate Membership provided they have contributed significantly tothe specialty of Urology. They shall be nominated by two Active or Senior members who shall furnish the Section Secretaries Committee with the curricula vitae and other pertinent information.

Section 10 – Honorary Members Honorary members are those whom the Section wish to honor. They shall be nominated by the Past-Presidents Committee, approved by the Board of Directors and then elected at the annual business meeting. A two-thirds vote of the active and senior members present shall be necessary for election. They shall be exempt from all dues and assessments and shall enjoy all the privileges of active membership except the right to vote and hold office.

Section 11 – Corresponding Members Corresponding Membership is available to urologists who practice in countries beyond the geographic boundaries of the AUA and wish to be a member of the SCS. The applicant shall be a member of the local or national urological organization in his country, and a letter of endorsement of that membership shall be submitted to the SCS with the application form. If a national organization does not exist within the applicant’s country, a waiver of this requirement may be considered by the Executive Committee. The applicant’s practice must be limited entirely to the specialty of urology. The applicant must be a graduate of an acceptable medical school who has received a Doctor of Medicine or equivalent degree. The applicant must be in practice for a minimum of two (2) years after completion of residency.

Section 12 – Candidate Members Candidate Membership is established to extend Sectional educational and professional advantages to urological residents. The candidate must be practicing and studying within the geographic boundaries of the SCS. a) ACGME. Medical Doctors (MD) or Doctors of Osteopathy (DO) enrolled in a urology residency program approved by the Residency Review Committee and ACGME are eligible for Candidate Membership; and after completing training and passing part 1 of the ABU qualifying examination are eligible for Associate Member status (Fast Track), Section G.1. Those who successfully pass all parts of the ABU qualifying examination are eligible for Active Member status, Section 6. b) AOA. Doctors of Osteopathy enrolled in an AOA-approved urology residency training program are eligible for candidate member status. DOs completing their training and passing the American Osteopathic Board of Surgery certifying examination are eligible for Associate Member status, Section 8.

Section 13 – Publication of Names The names of applicants for Active membership which have been approved by the SCS Board of Directors shall be available to the membership prior to the Annual Business Meeting.

Section 14 – Expulsion, Resignation and Reinstatement Any member who has been expelled from the AUA shall automatically have 210 his/her SCS membership terminated; and likewise, any member terminated

by the SCS shall be terminated by the AUA. A member who has resigned or by la whose membership has been deleted for non-payment of dues, or for other

reasons, may, after payment of any back dues owed, request reinstatement, ws subject to approval of both the Section and AUA Board of Directors.

Section 15 – Transfer of Membership Active members of other Sections of the AUA who move to the geographic area of the South Central Section may apply for transfer of membership. After certification by the Secretary of the former Section and transfer of the applicants’ dossier, he will become an active member following approval by the Board of Directors and membership at the next annual business meeting.

Section 16 – Membership Waiver In special instances, the Board of Directors may waive a qualification or requirement and recommend for membership, a urologist whose position and achievement, in its opinion, warrants such action.

ARTICLE II DUTIES OF OFFICERS

Section 1 – President a) The President shall arrange for and preside at all meetings of the Board of Directors and of the scientific and business sessions of the Section. b) He shall call special meetings of the Board of Directors. c) The President shall direct to the attention of the Board of Directors any violations of the Bylaws and matters requiring discipline of members. d) He shall receive reports of the Standing and Special Committees and make recommendations. e) He shall appoint the committees as specified in Article IV – Standing committees. f) He shall appoint any other committees that are needed to carry out the business of the Section. g) At the conclusion of the meeting at which he assumes the office of President, he shall call a meeting of the program committee to discuss the format for the next annual scientific program. h) Shall chair the nominating committee the year following his presidency. He shall propose budgetary recommendations to the Board of Directors annually when received from the Treasurer for operations of the Section designating the monetary needs for “operations”.

Section 2 – President-Elect a) The President-Elect shall assist the President in the performance of his duties and in the absence of the President, shall preside. In the event of the Presidents’ death, resignation, or removal, the President- Elect shall succeed in the office of the President for the unexpired term. His successor as President-Elect shall be selected at the next annual business meeting. b) During his year as President-Elect, he will be organizing his committees 211 in order to make the appointments early after assuming office as the President, since the place of meeting will have been selected. c) President-Elect shall serve as Chairman of the Program Committee.

Section 3 – Secretary a) The term of office shall be four years or until his successor assumes the office. The Secretary can serve one term in office only. b) The Secretary shall attend all meetings of the Society and shall keep minutes of their respective proceedings in an appropriate book, which shall be preserved by his successors as a permanent record of the organization. c) He shall employ, with the approval of the Board of Directors, such secretarial assistance as is necessary. d) He shall be responsible for the maintenance of an alphabetical list showing the actual standing of all members, their applications, addresses and a roster of attendance at the annual meeting. e) He shall be responsible for the publication and distribution of newsletters at such intervals as is agreed upon by him and the President. f) He shall be responsible for notification of the annual meeting to all members at least six months before the meeting. g) He will ensure publication of a newsletter at least 30 days prior to the meeting, with information about the program that would be of interest. h) He shall obtain the names of all committee members from the President within sixty (60) days after the annual meeting and confirm their obligation in writing. i) He shall report to the Chairman of the Nominating Committee before the annual meeting as to vacancies which will occur in the offices of representative and alternate to the American Urological Association, Inc. and other vacancies in the Section offices. j) He shall report to the Secretary of the American Urological Association Inc., the names of members of the Section who have been recommended by the Board of Directors for membership in that organization and our representative and alternate on the Board of Directors of the American Urological Association, Inc., if there is a change. He shall report to the Secretary of the American Urological Association, Inc., the names of all newly elected members of the Section and of all officers, directors, and representatives and alternates to various AUA committees requiring such Section representation. k) He shall prepare, with the President, and circulate among the members at least ten (10) days in advance, an agenda for all meetings of the Executive Committee and Board of Directors.

Section 4 – Treasurer a) The term of office shall be four years or until his successor assumes the office. The treasurer can serve one term in office only. b) He shall keep an accurate record of all property of the Section. c) He shall be bonded for twenty thousand dollars ($20,000). The bond shall be held by the Executive Secretary. He shall arrange the same bond for all who handle monies of the Section. d) He shall demand and receive all funds due to the society together with all 212 the bequests and donations.

e) He shall keep in a general ledger an alphabetical list of all members by la showing the financial status of each.

f) He shall report delinquent members promptly to the Secretary and to the ws Board of Directors. g) He shall have an annual audit of the Section’s financial records including the records of the Local Arrangements Committee prepared by a Certified Public Accountant. h) A report of the above audit will be presented to the Board of Directors at the annual meeting. i) The Treasurer shall prepare with the assistance of the Executive Director, Chairman of Arrangements Committee, and Chairman of Program Committee, a budget of all monies to be received and disbursed in connection with the annual meeting. The budget will be subject to review and approved by the President or in his absence, the President- Elect, or in his absence the Secretary. All annual meeting receipts and disbursements shall be made by the Treasurer in accordance with the approved budget. j) He shall receive advice from the Executive Director and annually provide the President with over-all budgetary recommendations for the Section including the needs for the annual meetings as specified in Article II, Section 4. k) He shall authorize the purchase of securities in accordance with the Guidelines for Investments for the Section upon authorization by the Investment Committee or an Investment Advisor if duly appointed by the Boards of Directors. l) He shall authorize the purchase of securities in accordance with the Guidelines for Investments for the Section upon authorization by the Investment Committee or an Investment Advisor if fully appointed by the Boards of Directors. m) He shall provide periodic reports no more often than quarterly concerning the Investment Portfolios of the Section to the Investment Committee with the assistance by the investment advisor if appointed by the Board of Directors. Reports will include comparisons to appropriate comparable indices (bench marks). n) He shall receive recommendations fro the Investment Committee concerning selection of Investment Advisors for submission to the Board of Directors.

Section 5 – Executive Director The Executive Director shall be the assistant of the Secretary and the Treasurer to carry out the routine duties of the office under the direction of the Secretary and the Treasurer such as, but not limited to, the following: a) Mailing of all annual dues and notices to the membership and reminding those in arrears individually. b) Publication of the yearly roster, attending to the new addresses for each changing year. c) Attend to the details of sending out applications to the new members, such information when received to be mailed to the Secretary’s office. d) Answer all inquires that the Secretary or the Treasurer can place with the 213 necessary suggestions. e) Arrange for the publication of programs and mail same. f) Be present at meetings of the Board of Directors to take down all pertinent data covering the Board of Directors meeting and arrange for presentation at the Business Session. g) Publication and distribution of all Newsletters and communications required of Executive Officers. h) Shall assist local arrangements committee acting as annual meeting planner. i) Budgetary recommendations for operations of the Section shall be submitted to the Treasurer for consideration for the President and Board of Directors. j) The Investment Committee will be assisted in its periodic meetings and responsibilities.

Section 6 – Historian a) The Historian, as official biographer of the South Central Section AUA, Inc. shall prepare an accurate history of the association and shall keep records of changes in the association pertinent to its history. He shall present an annual report to the Board of Directors and to the association at the annual business meeting when requested by the President. b) He shall prepare for publication any historical issue relative to the association and present to the Board of Directors. c) Funds required for these purposes shall be voted on by the Board of Directors.

Section 7 – National Board of Directors Representative The duly elected National Board of Directors Representative will represent the South Central Section on the Board of Directors of the American Urological Association, Inc. He will become liaison officer for the Section in the National organization. a) He shall attend all Executive Committee meetings of the National Society and will transmit to and report all instructions and mandates from the Section in the National Board of Directors meeting. b) He shall render an annual report of the proceedings of the Section’s Board of Directors meeting and he shall advise the President of the Section as to all transactions concerning the Section which transpire at interval meetings of the Executive meeting of the AUA. c) He shall be reimbursed by the Section for expenses to special meetings of the American Urological Association Board of Directors when not covered by the parent organization. d) He shall be a member ex-officio of the Section Board of Directors. e) The representative to the Board of Directors shall be elected for terms of two years and be limited to the maximum of two terms, alternates will be elected. He will be elected at the annual meeting in odd number years and will take office at the next annual meeting of the American Urological Association, Inc. f) He must be an active member of the Section and also a member of the American Urological Association, Inc.

214 Section 8 – Term of Office by la All officers shall hold office for one year, or until their successors are elected

except as otherwise indicated herein. The Secretary and Treasurer will not ws change office the same year.

Section 9 – Office Vacancies a) Vacancies in office must be filled by the Board of Directors forthe unexpired term except should the office of President become vacant, the President-Elect would automatically succeed the President. No one, however, will hold two elective offices at the same time. b) In case of a vacancy where there has been an alternate selected, the alternate shall serve until the next annual meeting at which time a new delegate shall be elected to complete the term.

ARTICLE III BOARD OF DIRECTORS

Section 1 The Board of Directors, herein afterward known as the Board, shall consist of the Officers, and one (1) Director from each state or territory of the Section consisting of Arkansas, Colorado, Kansas, Missouri, Nebraska, New Mexico, Oklahoma, Texas, The Republic of Mexico, and Central America, excluding Panama, shall each have a duly elected member on the Board of Directors. (Past-Presidents will be ex-officio members without vote.) Members recognized by the AUA as part of the Young Leadership Development Program will serve as ex-officio members of the Board of Directors, without vote, for a period of three years.

Section 2 – Executive Committee The Executive Committee of the Board of Directors consisting of the President as Chairman, immediate Past-President, President-Elect, Secretary and Treasurer, shall have responsibility for the interim business of the Section. All actions taken by the committee are subject to acceptance or rejection by the Board of Directors.

Section 3 – Duties The Board of Directors shall have charge of the administration of the corporation. They will meet during the annual meeting of the Section and during the national meeting when possible.

Section 4 – Quorum Seven members of the Board of Directors shall constitute a quorum for the transaction of business.

Section 5 – Election and Term of Office The elected members of the Board of Directors shall hold office for three years and may be elected to a second term. The election of members of the various states or geographical areas will be scheduled so that two or three new members will be elected each year. 215 Section 6 – Time and Place of Annual Meeting The Board of Directors shall select the time and place of the annual meeting.

Section 7 – Membership Application The Board of Directors through committee action, shall carefully review all applications for membership and shall accept, reject or set aside for further consideration such applications as come before them.

Section 8 – Nominations for Special Membership The Board of Directors shall receive nominations or requests for all classifications of membership, and shall make recommendations to the Section.

Section 9 – Reports The Board of Directors shall receive reports from standing and special committees and make recommendations.

Section 10 – Amendments The Board of Directors shall make recommendations for amendments to the Constitution and Bylaws when necessary to better conduct the Section.

Section 11 – Special Meetings Special meetings of the Board of Directors may be called upon request of the majority of its members or the President.

Section 12 – Annual Meeting of the Board of Directors The time of the annual meeting or the Board of Directors shall be set by the President who will preside and may be on the day preceding the annual meeting of the Section and also on the days during the annual meeting.

Section 13 – Applicants to American Urological Association, Inc. It shall consider all applicants for membership to the American Urological Association, Inc., and endorse them to the Secretary of that organization if they have the proper qualifications.

ARTICLE IV STANDING COMMITTEES

The newly elected President shall appoint from the active and senior members the following standing committees within sixty (60 days) following the annual meeting. The terms of office of the committee members will be staggered. A member may not continuously serve on a particular committee for more than six (6) years. He may serve on the same committee after a two (2) year hiatus.

Section 1 – Committee on Arrangements a) A chairman of the Committee on Arrangements will be appointed by the President. This chairman will have the power to appoint all local chairmen and committee members. b) A Committee on Arrangements shall make all necessary arrangements for the annual meeting and entertainment of the Section at such place as 216 selected by the Board of Directors.

c) The chairman of the Committee on Arrangements shall aid the Executive by la Director and Treasurer in preparing the budget of the annual meeting.

All annual meeting receipts and disbursements shall be made by the ws Treasurer in accordance with the approved budget. d) All expenditures must be authorized in advance by the chairman of the committee. e) The annual meeting is expected to be self-sustaining.

Section 2 – Program Committee a) The Program Committee will consist of the President, President-Elect, Immediate Past President, Treasurer, and Secretary. The President-Elect will act as chairman. b) It shall arrange the scientific program for the annual meeting and select titles of the papers best suited for the program. c) It shall be the prerogative of the Committee to invite any guest speaker from outside the Section whom they feel would contribute to the program. d) Shall aid the Executive Director and Treasurer in preparing the budget of the annual meeting.

Section 3 – Bylaws Committee a) The Bylaws Committee shall be composed of the Secretary and three other members. One member to be appointed each year by the President to serve for a term of three years. In order to form the committee, the first three appointments shall be for 1, 2, and 3 years. The President must appoint the chairperson of the committee who will serve for a term of three years. b) The chairperson will represent the South Central Section on the Bylaws Committee of the AUA, Inc. c) The Bylaws Committee shall become familiar with the activities of the association and the efficacy of the articles of corporation and bylaws. It shall make a yearly report to the Executive Committee which shall include any recommended amendments. d) The members may succeed themselves.

Section 4 – History Committee a) This committee will consist of the Historian and one other member, appointed by the President and allowed to succeed themselves for an indefinite period. b) This committee shall report the names and a short biography of the members who have died in the preceding year in the program of the meeting, and their names will be read at the annual meeting. c) This committee shall prepare an accurate history of the Section and shall keep record of changes in the Association pertinent to its history. d) They shall report to the Board of Directors at the annual meeting.

Section 5 – Past-Presidents Committee a) This committee shall be composed of all Past-Presidents of the Section and shall have as its chairman the immediate Past-President. b) It shall nominate candidates for possible election as honorary members 217 of the Section. c) It shall investigate, study and make such recommendations to the Board of Directors as seem fitting and proper in order to further the avowed aims of the organization.

Section 6 – Health Policy Counsel a) The Health Policy Counsel shall study and advise the Section on matters pertaining to health policy activities. b) The Committee shall consist of the Chairman who shall be elected by the membership for a three year term and one member and one alternate from each State in the Section who shall be appointed by the President for three year terms at the direction of the state urological organizations. If there is no active state organization, the President may appoint his choice for both member and alternate from that state. The chairman will act as a liaison between the AACU and the South Central Section, AUA, Inc. c) The chairman will represent the Section on the Health Policy Council of the AUA.

Section 7 – Investment Committee a) The Investment Committee shall consist of the Treasurer and four other members with staggered terms, as appointed by the President in order to provide continuing advice to the Treasurer, the President, and the Boards of Directors in accordance with the Bylaws and the Guidelines of Investments. The Chairman will be specified by the President. b) Members will be appointed for a three year staggered term. Members may succeed themselves. c) The members will review the investment portfolio and aid the Treasurer in preparing a report to the Officers. d) The Investment Committee will use the guidelines for the SCS, AUA as a resource for evaluating investment allocation and performances. e) The Committee will serve to recommend the selection and retention of the Investment Advisor. f) The Committee will receive periodic reports, not to exceed quarterly, concerning the investment portfolios of the Section.

ARTICLE V MEETINGS

Section 1 – Time and Place The annual meeting of the Section shall be held at such a time and place as the Board of Directors shall designate and they shall arrange the meeting place for future meetings.

Section 2 – Requirements for Attendance Attendance at the meeting will be limited to those wearing the badge of appropriate registration. Registration is limited to Doctors of Medicine and participants in the program.

218 Section 3 – Special Meetings

A special meeting may be called at any time by the President or a majority of by la the Board of Directors or upon written request of twenty-five (25) members,

at a convenient time and place to be designated by the Board of Directors, ws notice of which meeting shall be sent by mail to each member at least fifteen (15) days prior, stating the place, date, hour, and special business for which the meeting is called, and no other business shall be considered and enacted except that stated in the call for the meeting.

Section 4 – Quorum At all stated and special meetings, twenty-five (25) members shall constitute a quorum for the transaction of business.

Section 5 – Scientific Sessions The order of business at scientific sessions shall be: a) President’s address. b) Original communications. c) Presentation of papers, specimens, apparatus, etc. This order, however, may be changed at the discretion of the President and Secretary- Treasurer. d) Guest speakers may be asked to present papers before the Section. The expenses of one guest speaker and his wife to be allowed from the general treasury. Additional funds may be requested and paid for out of the treasury of the Section after having been first agreed to by the Executive Committee except as provided for in Article IV, Section 2.

Section 6 – Papers The titles and abstracts of papers must be filed with the Executive Director at a time determined by the Program Committee. a) Any paper previously printed or presented before a Scientific society may not be read before this Section except at the request or on approval of the Program Committee. b) All papers read before this Section are the property of the authors. Subsequent publication is permissible. Recognition that the work was first presented at the South Central Section AUA Annual Meeting should be given.

Section 7 – Discipline of Presenting Papers All matters involving the time limits of papers, permission to be read by title and absence of essayist will be handled by the Program Committee. In a case of disciplinary action, the problem will be brought to the Board of Directors.

Section 8 – Rules of Order of Business Meeting Rules of Order of the annual business meeting of the Section. Sturgis Standard Code of Parliamentary procedure shall govern all procedures. At the business session the order of business shall be: a) Reading of minutes of previous meeting. b) Report of the Secretary. c) Report of the Treasurer. d) Report of the Board of Directors. 219 e) Report of the Committee on Arrangements and Program. f) Report of the National Board of Directors. g) Report of the Aids and Grants Committee. h) Report of the Historian. i) Unfinished business. j) New business and resolutions. k) Report of the Nominating Committee. l) Election of officers.

ARTICLE VI NOMINATING COMMITTEE

Section 1 – Membership of Committee The Nominating Committee shall consist of five members; the three most recent Past-Presidents in attendance and two active members in good standing in the Section, who shall serve one year. a) The three most recent Past-Presidents in attendance shall assume this duty automatically. b) One member shall be a member of and nominated by the Board of Directors and will be elected by the Association if he receives the majority vote of those present and voting at the annual business meeting. c) Two or more active or senior members in good standing shall be nominated from the floor during the business meeting. The member who receives the greatest number of votes of the members present and voting shall be declared elected a member of the Nominating Committee. d) The Chairman of this Committee shall be the most immediate Past- President.

Section 2 – Duties of the Committee Members and alternates that automatically serve as Section representatives on AUA Committees are to be elected by the Section. It shall be the duty of the Nominating Committee to meet and present to the Section at its annual business session a slate of nominees of active members in good standing in the Section for the following positions: a) One candidate for President-Elect. b) One candidate each for Secretary and Treasurer when necessary. c) Candidates for members of the Section Board of Directors as provided in the constitution. d) The Nominating Committee will select for election by the Section the following positions for standing committees of the American Urological Association: i) One candidate for Bylaws Committee who is the chairman of the South Central Section Bylaws Committee every two years. ii) Three candidates for Editorial Committee every four years. iii) One candidate for Board of Directors of the AUA, Inc. every two years. iv) One candidate for Historian. 220 v) One candidate for alternate Executive Committee every two years.

vi) One candidate for Nominating Committee every two years not to be by la an elected member of the AUA, Inc.

vii) One candidate for alternate Nominating Committee every two years ws not to be an elected member of AUA, Inc. viii) One candidate for Research Committee and an alternate in odd numbered years for a four year term-to serve two years as alternate and two years as a representative. e) The American Urological Association Judicial Council candidate shall be chosen in the following manner: The Nominating Committee will recommend three (3) names to the President of the American Urological Association, Inc. One candidate will be chosen by the President of the AUA to serve. The candidate must be a Past President of the South Central Section. The term of office is four years.

Section 3 – Vacancies on Committees Vacancies or absences on the Nominating Committee shall be filled by the President.

Section 4 – Report of Committee, Nominations, Voting, and Installation The report of the Nominating Committee shall be called for by the President at the proper place designated for it under Article V, Section 8 of these Bylaws. a) The slate, having been read, the President shall then ask for other nominations from the floor for all elective offices. b) Candidates for office must be elected by a majority vote of the members present and voting. c) The newly elected officers shall then be installed.

ARTICLE VII DUES

Section 1 – Annual Dues and Fees The initiation fee and annual dues shall be established by the Board of Directors.

Section 2 – Special Assessments It shall require a majority vote of the members present and voting at the annual meeting to levy a special assessment.

Section 3 – Collection of Dues and Fees a) On December first, the Executive Director shall mail to each member, a notice of his dues for the coming year. A member not having paid his dues by April first, shall be in arrears and may, at the discretion of the Board of Directors, be suspended from membership if not paid up within one year. b) Registrants at the annual meeting failing to pay the registration fee shall be automatically suspended from membership. Exceptions would be senior and honorary members and spouses who elect to attend the meeting. The senior and honorary members and spouses will not be required to pay full registration fees. There will be a social registration fee for those senior and honorary members attending. 221 c) A member suspended for nonpayment of dues or assessments, may be reinstated by vote of the Board of Directors upon payment of all dues and assessments in arrears and the reinstatement fee as determined by the Executive Committee.

ARTICLE VIII AMENDMENTS

Section 1 – Requirements for Amending A quorum being present, these Bylaws may be amended by two-thirds vote of the members present and voting at the annual meeting, provided that the proposed changes shall have been provided to the membership on the notice for the meeting at which time such action is to be taken, at least thirty (30) days prior to the meeting.

Section 2 – Bylaws Committee The Bylaws Committee shall, from time to time, suggest changes in the Bylaws.

ARTICLE IX FISCAL YEAR

The fiscal year shall begin February 1st and end January 31st of the following year.

222 Notes N o t e s

223 Notes

224