SOUTHEASTERN SECTION OF THE AUA, INC.

79th Annual Meeting March 19 – 22, 2015 Westin Savannah Harbor Golf Resort & Spa Program Book Savannah, Georgia

Sponsored by the American Urological Association Education and Research, Inc. Jack M. Amie, MD 2014 – 2015 President Southeastern Section of the American Urological Association, Inc. Southeastern Section of the American Urological Association, Inc.

79th Annual Meeting March 19 – 22, 2015 The Westin Savannah Harbor Golf Resort & Spa Savannah, Georgia Table of Contents

Program Schedule at a Glance------2 Mission Statement, Needs and Objectives------4 Disclaimer Statement, Copyright Notice and Filming/Photography Statement------5 CME Accreditation------6 SESAUA Contact Information------8 Officers, Board of Directors, Special and Standing Committees of SESAUA------9 Numerical Membership of the SESAUA------15 General Meeting Information Registration------16 Board of Directors and Committee Meetings------16 Exhibit Hall Hours------16 Spouse/Guest Hospitality Suite Hours------16 Speaker Ready Room Hours------16 Annual Business Meeting------16 Industry Sponsored Events------17 Evening/Optional/Sporting Events------18 Technical Exhibits------22 Special Thanks to Industry Partners------23 Named Lectures and Contests------24 Full Scientific Program Schedule------27 Thursday, March 19, 2015------27 Friday, March 20, 2015------50 Saturday, March 21, 2015------63 Sunday, March 22, 2015------68 Alphabetical Index of Authors------78 Podiums in Presentation Order------83 Posters in Presentation Order------138 Videos in Presentation Order------261 Annual Business Meeting Agenda------264 Minutes of the 78th Annual Business Meeting of the SESAUA------265 Bylaws------270 Necrology Report------290 Preliminary SESAUA Treasurer’s Report for 2014------291 Membership Candidates and Transfers------292 Report of the SESAUA Representative to the AUA Board of Directors------294 Roster of State Societies and Officers------299 Previous Officers and Annual Meeting Sites------300 Schedule for Future Meeting of the SESAUA------309

1 Program Schedule at a Glance *All sessions are located in Savannah International Trade and Convention Center in Chatham Ballroom C, unless otherwise noted.

Thursday, March 19, 2015 friday, March 20, 2015 S ch ed u le at Registration/ Information desk 6:00 a.m. – 6:05 p.m. 6:30 a.m. – 6:15 p.m. Georgia International Gallery Speaker Ready Room 6:00 a.m. – 6:05 p.m. 6:30 a.m. – 6:15 p.m. Pulaski Boardroom Spouse/Guest Hospitality Suite 7:30 a.m. – 10:30 a.m. 7:30 a.m. – 10:30 a.m. Riverscape – Westin Savannah Harbor exhibit Hall 9:00 a.m. – 4:00 p.m. 7:00 a.m. – 4:00 p.m. Chatham Ballrooms A&B

7:00 a.m. Socioeconomic a outcomes, Health Urodynamics, Incontinence and Uro-Gynecology 7:30 a.m. Imaging and Miscellaneous Gl a n c e Services and Podium Session Poster Session Miscellaneous Poster Room 101 8:00 a.m. Session Room 100 female Pelvic Medicine and Reconstruction Panel

8:30 a.m. AUA Course of Choice: Prostate Cancer Update 9:00 a.m. 9:30 a.m. break - Visit exhibits Gee-dineen Health Policy forum 1 opening Remarks – SeSAUA President 10:00 a.m. Prostate Cancer Panel 10:30 a.m. break - Visit exhibits

11:00 a.m. Montague boyd essay Contest 11:30 a.m. Prostate Cancer Podium ballenger lecture: Can Stem Cells Revive the failing Penis?

12:00 p.m. State of the Art lecture: Intravesical Therapy for non-Muscle Invasive bladder Industry Sponsored Industry Sponsored Cancer: Current and future directions 12:30 p.m. lunch Symposium lunch Symposium Industry Sponsored Industry Sponsored Room 203-205 Room 200-202 lunch Symposium lunch Symposium 1:00 p.m. Room 200-202 Room 203-205

best Video Viewing Award and Presentation 1:30 p.m.

Presidential lecture: discovery and Innovations in “Screening for Prostate Cancer: Urology Is There a better Way? 2:00 p.m.

2:30 p.m. Pediatric Plenary Session 3:00 p.m. break - Visit exhibits break - Visit exhibits 3:30 p.m.

Pediatric Sub-Plenary Session 1 Room 101, bPH, 102/103 bladder Cancer, Incontinence, Upper Tract TCC Urodynamics, and Urinary 4:00 p.m. Reconstruction diversion, and Miscellaneous Miscellaneous Poster Session Kidney Poster Session Pediatric Stone and Room 101 Sub-plenary Young Room 100 endo- Prostate Session 2 Urologists urology Cancer Room 102/103 forum Poster Poster

Session Session Room 100 Room 101

4:30 p.m. State of the Art lecture: Management of Andrology, Small Renal Urethral Masses Stricture, Trauma Poster 5:00 p.m. Session Room 100 Renal Cancer 5:30 p.m. Podium Session

6:00 p.m.

6:30 p.m. Welcome Reception 7:00 p.m. Chatham Ballrooms A&B

7:30 p.m. 8:00 p.m.

*Video Presentations will be streaming throughout the Annual Meeting in Room 105/106

2 Program Schedule at a Glance *All sessions are located in Savannah International Trade and Convention Center in Chatham Ballroom C, unless otherwise noted.

Saturday, March 21, 2015 Sunday, March 22, 2015 Registration/ Information desk 6:00 a.m. – 1:00 p.m. 5:30 a.m. – 12:15 p.m. Georgia International Gallery Speaker Ready Room 6:00 a.m. – 1:00 p.m. 5:30 a.m. – 12:15 p.m. Pulaski Boardroom Spouse/Guest Hospitality Suite 7:30 a.m. – 10:30 a.m. 7:30 a.m. – 10:30 a.m. Riverscape – Westin Savannah Harbor exhibit Hall open 7:00 a.m. – 11:30 a.m. Chatham Ballrooms A&B 6:30 a.m. Video Andrology Session II 7:00 a.m. bPH and Urethral Video Session I Podium Session Renal Cancer and Room 105/106 Stricture Podium Session Room 105/106 Room 102/103 Miscellaneous Room 102/103 Poster Session 7:30 a.m. nephrolithiasis and endourology Room 100 State of the Art lecture: Podium Session 8:00 a.m. Management of Anterior Urethral Stricture AUA Guidelines: 8:30 a.m. Medical Management of Kidney Stones

AUA Uro-Trauma Guidelines 9:00 a.m. Gee-dineen Health Policy forum 2 Current Management of Invasive bladder Cancer and future directions 9:30 a.m.

bladder Cancer/Upper Tract TCC Podium Session 10:00 a.m.

10:30 a.m. break – Visit exhibits Report by the IVUmed Participants SeSAUA Urology Care foundation Scholar Report 11:00 a.m. Resident Quiz bowl

SeS Update 11:30 a.m. Annual business Meeting

AUA Update 12:00 p.m. T-leon Howard Imaging Session 12:30 p.m. 1:00 p.m. 1:30 p.m. 2:00 p.m. 2:30 p.m. 3:00 p.m. 3:30 p.m 4:00 p.m.

4:30 p.m 5:00 p.m. 5:30 p.m 6:00 p.m. 6:30 p.m. 2015 SeSAUA Annual Reception 7:00 p.m. 7:30 p.m. 2015 SeSAUA Annual banquet 8:00 p.m. (7:30 p.m. – 12:00 a.m.)

*Video Presentations will be streaming throughout the Annual Meeting in Room 105/106

3 Southeastern Section of the American Urological Association, Inc.

Mission Statement: To be the professional organization in the southeastern United States that fosters the highest standards of urologic care through education, research and socioeconomic awareness. The Southeastern Section of the American Urological Association goals: • Support excellence in urologic care of patients • Education of urologists • Encourage research • Forum for presentation of: . Clinical interest . Clinical and basic research . Support the AUA in healthcare policy and share ideas with the AUA, Inc.

Scientific Program SESAUA Secretary, Dean G. Assimos, MD, has planned a dynamic program that is certain to provide practicing urologists cutting-edge information. Detailed information about the scientific program begins on page 27.

EDUCATIONAL NEEDS & OBJECTIVES

Educational Needs The Secretary of the Southeastern Section of the American Urological Association (SESAUA) Dr. Dean G. Assimos consulted with other members of the Committee on Education and Gene ra l Info Science and the Executive Committee members, including SESAUA President Dr. Jack M. Amie; Past President Dr. Raymond J. Leveillee; Committee on Education and Science Chair Dr. S. Duke Herrell, III; and Office of Education of the AUA Chair Dr. Elspeth M. 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 Office of Education of the AUA chair that there continues to be significant educational needs for our annual meeting and scientific program.

Urologic abnormalities can present with a myriad of clinical symptoms and signs. Accurate differential diagnosis and disease management that meet current standards of care require ongoing review of the presentations of various urologic abnormalities, as well as appropriate use of safe and cost-effective imaging modalities and various pharmacologic, minimally invasive and operative management options. In addition, advancements in medical science and progress in management of various urologic diseases require basic and clinical research. Presentation and discussion of such peer-reviewed and abstract reviewer-selected summaries and results of investigations provide cutting-edge updates for practicing clinicians and essential feedback to researchers on the practical applications and translation of their investigations into clinical practice.

There is a need to increase communication among urologic oncology and endourological researchers and forge a strong relationship between the National Cancer Institute and the Society of Urologic Oncology, as well as the Society’s members and others interested in kidney, bladder and prostate cancers. In addition, many urologists treat patients with a myriad of nonmalignant conditions such as urinary incontinence, stone disease, benign prostatic hypertrophy, obstructive uropathy, spinal cord injuries, infertility, erectile dysfunction and congenital (pediatric) diseases among the most common. Improving relationships with these subspecialties and appropriate governmental funding sources such as the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) will provide a community of urologists with the most up-to-date research that will provide optimal patient care.

4 Educational Objectives At the conclusion of the 79th Annual Meeting of the SESAUA, attendees should be able to: • Apply Evidence-based Medicine (EBM) in urologic practice, specifically incorporating AUA guidelines into daily practice. • Analyze the optimal management of various common dilemmas in pediatric urology. • Describe the recent innovations for evaluation and management of patients undergoing urologic surgery. • Demonstrate a better understanding of prostate cancer detection and management. • Integrate new and modified testing and optimal medical treatment selection for prevention of stone disease and optimal outcomes. • Identify optimized management and pathways for noninvasive and invasive bladder cancer with a focus on the proper selection of patients for the various treatment modalities. • Describe recent important changes in socioeconomics impacting patients and urologic care. • Describe the state-of-the-art management of urethral stricture disease and common problems in female and reconstructive urology.

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

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

Copyright Notice Individuals may print out single copies of abstracts or slides contained in this publication for personal, non-commercial use without obtaining permission from the author or the SESAUA. Permission from both the SESAUA and the author must be obtained when making multiple copies for personal or educational use, for reproduction for advertising or promotional purposes, for creating new collective works, for resale or for all other uses.

Filming/Photography Statement No attendee/visitor at the SESAUA 2015 annual meeting may record, film, tape, photograph, interview or use any other such media during any presentation, display or exhibit without the express, advance approval of the SESAUA Executive Director. This policy applies to all SESAUA members, non-members, guests and exhibitors, as well as members of the print, online or broadcast media.

5 79th Annual Meeting of the SESAUA March 19 – 22, 2015 Savannah, Georgia CME

AUA 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 28.00 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. Gene ra l Info

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 that this continuing medical education activity may contain reference(s) to off-label or unapproved uses of drugs or devices. Please consult the prescribing information for full disclosure of approved uses.

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

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

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

Special Assistance/Dietary Needs: The American Urological Association complies with the Americans with Disabilities Act §12112(a). If any participant is in need of special assistance or has any dietary restrictions, please see the registration desk.

7 SESAUA Contact Information

To expedite the business of the Southeastern Section of the American Urological Association, Inc., inquiries should be referred to the SESAUA Secretary or the SESAUA office as follows:

SESAUA Secretary: Dean G. Assimos, MD University of Alabama – Birmingham Dept. of Urology, FOT 1105 1720 2nd Avenue, South Birmingham, AL 35294-3411 Fax: (205) 934-4933 Email: [email protected]

 All inquiries and information regarding the scientific program of the annual meeting.

SESAUA Office: Two Woodfield Lake 1100 E Woodfield Dr., Ste. 350 Schaumburg, IL 60173-5116 Phone: (847) 969-0248 Fax: (847) 517-7229 Email: [email protected] Executive Director: Wendy J. Weiser

 Inquiries about or applications for membership in Gene ra l Info the SESAUA and the AUA.  Membership roster information.  (changes/corrections to the present listing)  Any requests or information that one may wish to communicate.  All inquiries and reports regarding the standing and special committees of the SESAUA.  All matters needing the attention of or action by the Executive Committee.

8 Southeastern Section of the AUA, Inc. Officers, Board of Directors, Special & Standing Committees 2014 – 2015

OFFICERS President Jack M. Amie, MD; Brunswick, GA 2015

President-Elect Jon S. Demos, MD; Lexington, KY 2015

Secretary Dean G. Assimos, MD; Birmingham, AL 2015

Treasurer Scott B. Sellinger, MD; Tallahassee, FL 2017

Past President Raymond J. Leveillee, MD, FRCS-G; Cooper City, FL 2015

Historian Jerry E. Jackson, MD; Sumter, SC 2017 Member at Large David M. Kraebber, MD; Wilmington, NC 2017

Chair, Committee on Education and Science S. Duke Herrell III, MD; Nashville, TN 2015 2015 Planning Committee Dean G. Assimos, MD – Program Chair 2015 Jack M. Amie, MD; Brunswick, GA 2015 Jon S. Demos, MD; Lexington, KY 2015 S. Duke Herrell, III, MD, Nashville, TN 2015 David M. Kraebber, MD; Wilmington, NC 2015 Raymond J. Leveillee, MD, FRCS-G 2015 Scott B. Sellinger, MD; Tallahassee, FL 2015

REGIONAL REPRESENTATIVES TERM EXPIRES Alabama Representative Kristie A. Blanchard-Burch, MD; Mobile, AL 2015 Manish Shah, MD; Gadsden, AL 2015

Alabama Alternate Representative Peter N. Kolettis, MD; Birmingham, AL 2015 Merle L. Wade Jr., MD; Gadsden, AL 2015

Florida Representative Michael A. Binder, MD; Gainesville, FL 2015 Vincent G. Bird, MD; Gainesville, FL 2015 Alan M. Nieder, MD; Miami Beach, FL 2016 Sijo J. Parekattil, MD; Clermont, FL 2017 Rolando Rivera, MD; Naples, FL 2017

9 Florida Alternate Representative Michael A. Dennis Jr., MD; Port St. Lucie, FL 2015 Kevin K.D. Lee, MD; Gainesville, FL 2017 Vipul R. Patel, MD, FACS; Celebration, FL 2016 Christopher R. Williams, MD; Jacksonville, FL 2017 Paul R. Young, MD; Jacksonville FL 2015

Georgia Representative Henry N. Goodwin Jr., MD; Augusta, GA 2017 John G. Pattaras, MD, FACS; Atlanta, GA 2015 James D. Quarles Jr., MD; Augusta, GA 2015

Georgia Alternate Representative Kenneth Ogan, MD; Atlanta, GA 2015 Chad W.M. Ritenour, MD; Atlanta, GA 2017 Thomas Earl Shook, MD; Savannah, GA 2015

Kentucky Representative Charles G. Ray, MD; Lexington, KY 2015

Kentucky Alternate Representative Katie N. Ballert, MD; Lexington, KY 2015

Louisiana Representative Alexander Gomelsky, MD; Shreveport, LA 2015 Wayne J.G. Hellstrom, MD, FACS; New Orleans, LA 2016

Louisiana Alternate Representative Benjamin R. Lee, MD; New Orleans, LA 2015 Anna R. Smither, MD; Baton Rouge, LA 2017

Mississippi Representative E. James Seidmon, MD; Jackson, MS 2015 O ff ic e rs , bod

Mississippi Alternate Representative S ta nd i n g Co mmitt ee s Chadwick P. Huckabay, MD 2015

North Carolina Representative Richard W. Puschinsky, MD; High Point, NC 2015 Mathew C. Raynor, MD; Chapel Hill, NC 2017 Cary N. Robertson, MD; Raleigh, NC 2017 a nd S p e cia l &

North Carolina Alternate Representative Aaron Lentz, MD; Raleigh, NC 2017 Gregory F. Murphy, MD, FACS; Greenville, NC 2017 Matthew E Nielsen, MD; Chapel Hill, NC 2017

Puerto Rico Representative Ricardo F. Sanchez-Ortiz, MD; Hato Rey, PR 2015

10 Puerto Rico Alternate Representative Marcos R. Perez-Brayfield, MD; Caguas, PR 2015

South Carolina Representative T. Brian Willard, MD; West Columbia, SC 2017 Richard W. Young, MD; Myrtle Beach, SC 2017

South Carolina Alternate Representative Ross A. Rames, MD; Charleston, SC 2017 Alexander W. Ramsay, MD; Charleston, SC 2017

Tennessee Representative Peter E. Clark, MD; Nashville, TN 2017 Donald T. McKnight Jr., MD; Jackson, TN 2016

Tennessee Alternate Representative Sam S. Chang, MD; Nashville, TN 2016 Melissa R Kaufman, MD, PhD; Nashville, TN 2017

Representative to AUA Board of Directors Thomas F. Stringer, MD; Gainesville, FL 2015

AUA Leadership Program Representatives Daniel A. Barocas, MD, MPH; Nashville, TN 2015 Robert I. Carey, MD, PhD; Sarasota, FL 2015 Alberto J.R. Lopez, MD; Manati, PR 2015 Resident Representatives Jared L. Moss, MD; Knoxville, TN 2015 Matthew J. Mutter, MD; Memphis, TN 2015 Courtney L. Shepard, MD; Birmingham, AL 2015 C.J. Stimson, MD JD; Nashville, TN 2015

SESAUA STANDING COMMITTEES BYLAWS COMMITTEE Lee N. Hammontree, MD; Homewood, AL (Committee Chair) 2015(T1) Dean G. Assimos, MD; Birmingham, AL (Secretary) 2015(T1) Timothy K. Duffin, MD; Clarksville, TN 2015(T1) Ralph J. Henderson, MD; Shreveport, LA 2016(T1) Nicole L. Miller, MD; Nashville, TN 2016(T1) Michael J. Wehle, MD; Jacksonville, FL 2017(T1)

COMMITTEE ON EDUCATION AND SCIENCE S. Duke Herrell III, MD; Nashville, TN (Committee Chair) 2015 Christopher S. Gomez, MD; Miami, FL (Young Urologists) 2016(T1) Forum Representative) Benjamin R. Lee, MD; New Orleans, LA (Committee Member - Videos) 2016(T2) Glenn M. Preminger, MD; Durham, NC (Committee Member) 2015(T1) - Montague Boyd Essay) Chad W.M. Ritenour, MD; Atlanta, GA (Committee Member - Imaging) 2015(T1) 11 Stephen J. Savage, MD; Charleston, SC (Committee Member - Residents) 2017(T1) Charles R. Pound, MD; Jackson, MS (Member at Large) 2015(T2) Johannes W.G. Vieweg, MD; Gainesville, FL (Member at Large) 2016(T2)

FINANCE COMMITTEE Gerard D. Henry, MD; Shreveport, LA (Committee Chair) 2016 Brant Inman, MD, MS; Durham, NC 2017 Donald T. McKnight Jr., MD; Jackson, TN 2017 Felix Mendoza-Rosa, MD; Cayey, PR 2015 John F. Pirani, MD; Gadsden, AL 2016 Scott B. Sellinger, MD; Tallahassee, FL (Treasurer) 2017

HEALTH POLICY COUNCIL J. Christian Winters, MD, FACS; Baton Rouge, LA (Chair) 2015 Lorie G. Fleck, MD; Mobile, AL (Vice Chair) 2015 Ralph J. Henderson, MD; Shreveport, LA (Alternate Vice Chair) 2015 Jerry E. Jackson, MD; Sumter, SC (Alternate Chair) 2015 Vincent G. Bird, MD; Gainesville, FL (Florida Alternate Representative) 2016 John W. Brock III, MD; Nashville, TN (Tennessee Representative) 2016 Donald A. Elmajian, MD; Shreveport, LA (Louisiana Alternate Representative) 2016 William B. Gilbert, MD; Rome, GA (Georgia Alternate Representative) 2016 John M. Hassan, MD; Franklin, TN (Tennessee Alternate Representative) 2016 Steve J. Hodges, MD; Winston-Salem, NC (North Carolina Alternate) 2016 Representative) Edward W. Killorin Jr., MD; Columbus, GA (Georgia Representative) 2016 Charles R. Moore, MD; Hattiesburg, MS (Mississippi Alternate Representative) 2016 John M. Patterson, MD; Frankfort, KY (Kentucky Alternate Representative) 2016 Thomas H. Phillips, MD; Matthews, NC (North Carolina Representative) 2016 John F. Pirani, MD; Gadsden, AL (Alabama Representative) 2015 Lester J. Prats, MD; New Orleans, LA (Louisiana Representative) 2016 Ross A. Rames, MD; Mt. Pleasant, SC

(South Carolina Representative) 2016 O ff ic e rs , bod Terrence C. Regan, MD; Palm Coast, FL (Florida Representative) 2016

Brian E. Richardson, MD; Montgomery, AL (Alabama Alternate S ta nd i n g Co mmitt ee s Representative) 2016 Gilberto Ruiz-Deya, MD; Ponce, PR (Puerto Rico Representative) 2016 Bradley W. Steele, MD; Charleston, SC (South Carolina Alternate Representative) 2016 To Be Determined; (Puerto Rico Alternate Representative) Richard M. Vise, MD; Meridian, MS (Mississippi Representative) 2016 Charles S. Woolums, MD; Barboursville, WV a nd S p e cia l & (Kentucky Representative) 2016 Martin K. Dineen, MD; Daytona Beach, FL (Consultants) 2016

LOCAL ARRANGEMENTS COMMITTEE Thomas E. Shook, MD; Savannah, GA (Committee Chair) 2015

MEMBERSHIP COMMITTEE Chad W.M. Ritenour, MD; Atlanta, GA (Committee Chair) 2016 S. Duke Herrell III, MD; Nashville, TN 2015 Scott W. Lisson; Cary, NC 2015

12 Nicole L. Miller, MD; Nashville, TN 2017 James K. O’Kelly, MD; Florence, SC 2015 Harvey C. Taub, MD; Ocala, FL 2017

NOMINATING COMMITTEE Randall G. Rowland, MD, PhD; Lexington, KY (Committee Chair) 2017 Gerard D. Henry, MD; Shreveport, LA (Member at Large) 2015 Martha K. Terris, MD, FACS; Augusta, GA (Member at Large) 2017 Raymond J. Leveillee, MD, FRCS-G; Cooper City, FL (Immediate Past President) 2017 W. Terry Stallings, MD, FACS; Daphne, AL (Past President) 2016

SITE SELECTION COMMITTEE W. Terry Stallings, MD, FACS; Daphne, AL (Committee Chair) 2019 Dean G. Assimos, MD; Birmingham, AL 2015 Scott B. Sellinger, MD; Tallahassee, FL 2017

13 SESAUA REPRESENTATIVES TO AUA COMMITTEES

AUA BOARD OF DIRECTORS Raymond J. Leveillee, MD, FRCS-G; Cooper City, FL (Alternate Representative) 2015 Thomas F. Stringer, MD; Gainesville, FL (Representative) 2015

AUA BYLAWS COMMITTEE Lee N. Hammontree, MD; Homewood, AL 2015(T1) Gerard D. Henry, MD; Shreveport, LA 2015(T3) Gregory F. Murphy, MD, FACS; Greenville, NC 2015(T2)

AUA EDITORIAL BOARD COMMITTEE Ramakrishna Venkatesh, MD, MS, FRCS; Lexington, KY 2018 Wayne J.G. Hellstrom, MD, FACS; New Orleans, LA 2017 Nicole L.Miller, MD; Nashville, TN 2016

AUA HEALTH POLICY COUNCIL Lorie G. Fleck, MD; Mobile, AL 2017 Ralph J. Henderson, MD; Shreveport, LA 2015 J. Christian Winters, MD, FACS; Baton Rouge, LA 2015

AUA HISTORY COMMITTEE Jerry E. Jackson, MD; Sumter, SC 2015

AUA JUDICIAL & ETHICS COUNCIL Peter E. Clark, MD; Nashville, TN 2017 Gregory F. Murphy, MD, FACS; Greenville, NC 2017 Stephen E. Strup, MD; Lexington, KY 2019

AUA LEADERSHIP PROGRAM Daniel A. Barocas, MD, MPH; Nashville, TN (Representative) 2015 Robert I. Carey, MD, PhD; Sarasota, FL (Representative) 2015 Alberto J. Ramirez Lopez, MD; Manati, PR (Representative) 2015

AUA NOMINATING COMMITTEE Charles R. Pound, MD; Jackson, MS (Representative) 2015 Raju Thomas, MD, FACS, MHA; New Orleans, LA (Alternate Representative) 2015 O ff ic e rs , bod AUA PRACTICE MANAGEMENT COMMITTEE

David M. Kraebber, MD; Wilmington, NC 2017 S ta nd i n g Co mmitt ee s

AUA RESIDENT’S COMMITTEE John M. Lacy, MD; Lexington, KY (Representative) 2015

AUA YOUNG UROLOGIST COMMITTEE Christopher S. Gomez, MD; Miami, FL (Representative) 2015 a nd S p e cia l &

14 Numerical Membership of the SESAUA

Active 1503

Affiliate 5

Associate 96

Corresponding 1

Honorary 69

Senior 678

Grand Total Membership 2378

15 General Meeting Information Mee ti n g Info Registration/Information Desk Hours Location: Georgia International Gallery (Savannah International Trade and Convention Center)

Wednesday, March 18, 2015 10:00 a.m. – 4:00 p.m. Thursday, March 19, 2015 6:00 a.m. – 6:05 p.m. Friday, March 20, 2015 6:30 a.m. – 6:15 p.m. Saturday, March 21, 2015 6:00 a.m. – 1:00 p.m. Sunday, March 22, 2015 5:30 a.m. – 12:15 p.m.

Board of Director and Committee Meetings

Executive Committee Meeting: Wednesday, March 18, 2015 8:00 a.m. – 12:00 p.m. Location: Grand Ballroom F (The Westin Savannah Harbor Resort)

Board of Directors Meetings: Wednesday, March 18, 2015 Board of Directors Lunch 12:00 p.m. – 1:00 p.m. Location: Grand Ballroom E (The Westin Savannah Harbor Resort) Wednesday, March 18, 2015 Board of Directors Meeting 1:00 p.m. – 5:00 p.m. Location: Harbor Ballroom (The Westin Savannah Harbor Resort) Exhibit Hall Hours Location: Chatham Ballrooms A&B (Savannah International Trade and Convention Center) Thursday, March 19, 2015 9:00 a.m. – 4:00 p.m. Welcome Reception 6:00 p.m. – 8:00 p.m. Friday, March 20, 2015 7:00 a.m. – 4:00 p.m. Saturday, March 21, 2015 7:00 a.m. – 11:30 a.m.

Spouse/Guest Hospitality Suite Information Location: Riverscape (The Westin Savannah Harbor Golf Resort and Spa) Thursday, March 19, 2015 7:30 a.m. – 10:30 a.m. Friday, March 20, 2015 7:30 a.m. – 10:30 a.m. Saturday, March 21, 2015 7:30 a.m. – 10:30 a.m. Sunday, March 22, 2015 7:30 a.m. – 10:30 a.m.

Speaker Ready Room Hours Location: Pulaski Boardroom (Savannah International Trade and Convention Center) Thursday, March 19, 2015 6:00 a.m. – 6:05 p.m. Friday, March 20, 2015 6:30 a.m. – 6:15 p.m. Saturday, March 21, 2015 6:00 a.m. – 1:00 p.m. Sunday, March 22, 2015 5:30 a.m. – 12:15 p.m.

Annual Business Meeting The SESAUA Annual Business Meeting will be held on Sunday, March 22, 2015, from 11:15 a.m. - 12:15 p.m. at Savannah International Trade and Convention Center, in Chatham Ballroom C. All meeting attendees are welcome and encouraged to attend. Please note that only Active and Senior members may vote. Members need not be registered for the scientific portion of the conference to attend the Business Meeting.

16 Industry sponsored symposia

THURSDAY, MARCH 19, 2015 12:15 p.m. – 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 200-202 “Promoting Wellness 2015: What Works and What’s Worthless”

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

THURSDAY, MARCH 19, 2015 12:15 p.m. – 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 203-205 “XTANDI (enzalutamide) capsules in the Urology Practice: Continuing Care for Your Patients With Metastatic CRPC”

Dr. Vahan Kassabian, MD Medical Director, Georgia Urology Marietta, Georgia

FRIDAY, MARCH 20, 2015 12:30 p.m. – 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 200-202 “An Option in Testosterone Replacement Therapy”

Zamip Patel, MD Florida Urology Associates Orlando, Florida

FRIDAY, MARCH 20, 2015 12:30 p.m. – 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 203-205 “Integration of The Oncotype Dx® Prostate Cancer Assay In The Clinical Management Of Low-Risk Prostate Cancer”

Vahan Kassabian, MD Medical Director, Georgia Urology

17 EVENING FUNCTIONS One ticket to each function is included in your registration fee. Mee ti n g Info Individual tickets may be purchased on the registration form (prices listed below).

Thursday, March 19, 2015

Welcome Reception Time: 6:00 p.m. – 8:00 p.m. Location: Chatham Ballroom AB (Savannah International Trade and Convention Center) Attire: Business casual Cost: (1) ticket included in registration, additional tickets are $50.00 for adults and complimentary for children.

Welcome to Savannah! Come enjoy a glass of wine, local cuisine and entertainment while catching up with colleagues and exhibitors!

Saturday, March 21, 2015

2015 Annual Reception and Banquet Time: 6:30 p.m. – 7:30 p.m. Cocktails and Hors d’oeuvres 7:30 p.m. – 12:00 a.m. Dinner and Entertainment Location: Westin Grand Ballroom Attire: Black tie invited Cost: (1) ticket included in registration, additional tickets are $185.00.

The closing social event of the 79th Annual Meeting of the SESAUA is sure to please with an expertly crafted menu, musical entertainment and dancing.

OPTIONAL EVENTS (Availability of tours are subject to change)

Optional events are not included in your registration fee, except for the Presentation on the Foundation for Hospital Art “PaintFest.”

All optional tours depart from the main lobby of The Westin Savannah Harbor Golf Resort & Spa, unless otherwise noted. Please arrive 30 minutes prior to scheduled time.

THURSDAY, MARCH 19, 2015

Presentation on the Foundation for Hospital Art “PaintFest” Time: *9:30 a.m. – 9:50 a.m. *Presentation explaining PaintFest and the Foundation will be during this time, but art canvases will be available to paint during Spouse/Guest Hospitality Suite open hours throughout the conference. Location: Riverscape, Westin Savannah Harbor Golf Resort and Spa The traditional hospital setting is exemplified by white, sterile walls and ceilings. Examining rooms, waiting rooms, corridors – areas where health professionals and other caregivers work, where families and patients wait – are too often colorless, lifeless and certainly not inviting. The Foundation for Hospital Art was officially established in 1984, and is dedicated to involving patients and volunteers worldwide to create colorful, soothing artwork donated to hospitals to help soften the often stressful hospital experience. Information above, along with other information, can be found at www.hospitalart.com. Cost: Complimentary

18 The Historic Downtown Trolley Tour Time: *9:30 a.m. – 12:00 p.m. Location: Downtown Savannah This leisurely tour by trolley covers a lot of ground as you explore the city’s architectural gems and historic landmarks. The tour includes a stop at an elegantly restored historic house museum and at the breathtaking 19th century Gothic Cathedral of St. John the Baptist. This is the best way for attendees to see the largest urban landmark district in the United States, if only for a few hours. Cost: $48.00 per person (includes transportation, tour guides, and entrance into house museum) *Attendees should meet in the lobby at 9:00 a.m.

FRIDAY, MARCH 20, 2015

Shopping Tour in the Historic District Time: *11:00 a.m. – 2:30 p.m. Location: The Design District, Broughton Street and City Market Attendees will be picked up at the Westin via minibus and taken into the Historic District to begin their shopping tour. This guided shopping tour begins in the Design District right out the front door of Mrs. Wilkes. They will visit shops like One Fish, Two Fish, No. 4 Eleven, the Annex and many more. After the Design District, the group will hit Broughton Street where treasures of old and modern fashion are awaiting your arrival. Enjoy shopping in your tour guide’s favorite spots. The tour will continue to City Market where art studios, galleries and specialty shops fill the two-block space. There will be plenty of fine shops to find that special keepsake from your trip to the “Belle of the South!” After shopping, attendees will be taken back to the Westin. Cost: $40.00 per person (includes transportation and shopping guide) *Attendees should meet in the lobby at 10:30 a.m.

Historic District Walking Ghost Tour Time: *8:00 p.m. – 9:30 p.m. Location: Savannah Historic District During this tour, the group will hear the stories behind the things in Savannah that “go bump in the night” as they walk through the Historic District and visit some of Savannah’s most renowned haunted places. The group will learn about reported sightings of the ghosts of pirates, soldiers and grieving widows. Cost: $25.00 per person (includes tour guide) *Attendees should meet in the lobby at 7:30 p.m.

SATURDAY, MARCH 21, 2015

Tennis at The Westin Savannah Tennis Courts Time: *12:30 p.m. – 3:30 p.m. Location: The Westin Savannah Tennis Courts Treat yourself to the finest Savannah tennis experience at The Westin Savannah Harbor Golf Resort & Spa. The Westin’s four meticulously maintained Har-Tru Clay tennis courts offer a more physically sound surface on which to play. In addition to better tactical response between the surface and players’ shoes, the Har-Tru courts make it more enjoyable to play longer without the fear of overstressing knees, back or lower extremities. Come join us for an afternoon of tennis. Cost: $25.00 per person (includes court fees and water) *Attendees should meet at The Westin Savannah Tennis Courts by 12:00 p.m.

19 In Shore Fishing with Miss Judy Time: *1:00 p.m. – 4:00 p.m. Mee ti n g Info Location: Departs from the Westin Dock In Shore Fishing would be an exciting way to spend the afternoon! You could catch “the big one” or at least come back with a great fish tale! The boat will leave the Westin dock into the Savannah waterways and sounds where attendees will fish with live bait catching flounder, tarpon, spotted sea trout and spottail bass. Cost: $190.00 per person (includes chartered boat, captain, bait, tackle, snacks and drinks) *Attendees should meet at the Westin Dock by 12:30 p.m.

Golf at The Club at Savannah Harbor Time: 1:00 p.m. shotgun start (concludes at approximately 5:30 p.m.) Location: The Club at Savannah Harbor The Club at Savannah Harbor is the proud home of the PGA TOUR’s Champions Tour Liberty Mutual Insurance Legends of Golf since 2003. Each year the tournament attracts many of golf’s true legends, who descend up on Savannah to compete for over $3 million in prize money. Drawing thousands of viewers as well, the resort and city buzz with excitement each April. The resort’s impeccable Troon-managed golf course is open for play most days. Enjoy the genteel pleasures of a spa treatment or club dining with views of quiet marshes and feel Savannah’s magic. Tee off on this 18-hole championship course, designed by Robert Cupp and Sam Snead, offering excitement for both novice and experienced players. Cost: $160.00 per ticket (includes green fees, golf cart, range balls, tournament coordination and boxed lunch)

Hands-On Cooking Class at 700 Kitchen Cooking School Time: *1:30 p.m. – 4:30 p.m. Location: 700 Kitchen Cooking Class Whether your friends call you chef or you’ve never mastered the art of cooking pasta, the Mansion on Forsyth Park’s 700 Kitchen Cooking School will add new tastes and flavors to your life. This unique hands-on class is overseen by Chef Darin Sehnert, Culinary Director. No cooking experience necessary. Flavorful ethnic and regional cuisines, in-depth discussion and explanation of culinary technique are in store. Enjoy the company of other culinary enthusiasts as you enjoy eating the food you prepare. Cost: $125.00 per person (includes private cooking class, one glass of house wine or menu-oriented cocktail, non-alcoholic beverages and meal) Please note: space is limited for the cooking class so please sign up early to reserve a spot for this unique opportunity! *Attendees should meet in the lobby at 1:00 p.m.

2nd Annual Hector Henry 5K Time: 2:30 p.m. Location: The Westin Savannah Harbor Golf Resort & Spa Join us for the Second Annual Hector Henry 5K Run/Walk to honor our past president and historian! Prizes for the top male and female finishers in the run will be awarded at the Annual Banquet. All participants will receive a commemorative shirt. In addition, you will have the opportunity to be a donation sponsor of the event with the tax deductible proceeds going to the Georgia Leukemia and: Lymphoma Society. Please contact the Registration/Information Desk for more information. Cost to run: $25.00 per person SES Donation Site: http://pages.teamintraining.org/ga/yourway15/mwright

20 Child Care Information Sitting Service: Guardian Angels Sitting Service Contact: Melissa Monge, Owner Toll Free Phone/Local: (843) 681-4277 Email: [email protected] Disclaimer: SESAUA is happy to provide this information, but is not directly associated with the sitting service.

21 79th Annual Meeting of the SESAUA March 19 – 22, 2015 Mee ti n g Info Technical Exhibits Alphabetical as of 3/6/15

AbbVie Medispec, Ltd. Actavis Medivation/Astellas Allergan, Inc. MedWorks American Medical Systems, Inc. MiMedx Group American Urological Association, Inc. Mission Pharmacal Company Argos Therapeutics, Inc. Myriad Genetic Laboratories, Inc. Astellas Pharma US, Inc. NeoTract, Inc. Bayer HealthCare Novartis biolitec U.S., Inc OPKO Lab BK Ultrasound Olympus America, Inc. Boston Scientific Pacific Edge Diagnostics USA Ltd. Coloplast Pfizer, Inc. Cook Medical Physicians Choice Laboratory Services Dendreon Corporation Prometheus Laboratories Inc. Dornier MedTech Retrophin EDAP Technomed, Inc. Richard Wolf Medical Instruments, Corp. Endo Pharmaceuticals Sanofi Oncology Ferring Pharmaceuticals Siemens Medical Solutions USA, Inc. Galil Medical SRS Medical GenomeDx Strand Diagnostics Genomic Health SurgiQuest, Inc. HealthTronics, Inc. Tolmar Pharmaceuticals Hitachi-Aloka Medical TRT Janssen Biotech, Inc. United Medical Systems KARL STORZ University Compounding Pharmacy Lumenis, Inc. Uroplasty, Inc. Mallinckrodt Pharmaceuticals Wedgewood Marley Drug, Inc MDxHealth

22 The SESAUA Wishes to Thank and Recognize Our 2015 Industry Partners

Platinum Level Industry Partners AbbVie Endo Pharmaceuticals Genomic Health Medivation/Astellas

Gold Level Industry Partner Astellas Pharma US, Inc.

Silver Level Industry Partners Coloplast Janssen Biotech, Inc. Lumenis, Inc. Myriad Genetic Laboratories, Inc.

Thank You to Our 2015 Contributors Bard Medical Janssen Biotech, Inc Marley Drug, Inc Pfizer, Inc. Pikeville Medical Center, Inc.

23 79th Annual Meeting of the SESAUA March 19 – 22, 2015 Mee ti n g Info Named Lectures and Contests

The Ballenger Memorial Lecture Dr. Edgar Ballenger was the Southeastern Section president in 1935 and president of the AUA in 1939. The Annual Ballenger Memorial Lectureship was established after his death in 1946 and serves as our major scientific presentation.

Dr. Tom F. Lue graduated with highest honors from Kaohsiung Medical College in Taiwan in 1972. After completing urology residency at SUNY Downstate in 1981, he received a Valentine Fellowship from the New York Academy of Medicine to study neurourology at the University of California, San Francisco (UCSF). He is now professor and vice-chair of Urology at UCSF, Emil Tanagho Endowed Chair in Clinical Urology, and the founder of the Knuppe Molecular Urology Laboratory. He is a recipient of NIH MERIT Award for his translational research in penile physiology and erectile dysfunction. He has developed four diagnostic tests for erectile dysfunction. He has also developed seven new surgical procedures for Peyronie’s disease, priapism and erectile dysfunction. He has been the recipient of the AUA’s Gold Cystoscope Award and the American Foundation of Urological diseases’ Most Innovative Researcher Award. He chaired the International Consultation on Sexual Medicine held in Paris in July, 2003 and was the honorary president of the same meeting in July, 2009.

Dr. Lue’s current basic science research projects involve the development of a non-invasive progenitor cell therapy for various degenerative diseases.

The Montague Boyd Prize Essay Contest Dr. Montague Boyd was the founder of the Southeastern Section, and he served as president in 1933 and 1934. The prize was established in 1967 and is given to a resident, fellow, or urologist in private practice less than 10 years.

The Ambrose-Reed Lecture Dr. Samuel Ambrose was the Southeastern Section president in 1975, and in 1981 became the first chairman of the AUA Public Relations Committee, later to be called the Socioeconomic Committee. Dr. Mason who served as president formed this committee, which later became the Health Policy Council. Dr. Josiah Reed was the Southeastern Section president in 1992, and chairman of the AUA Socioeconomic Committee in 1986. This award honors these two pioneers in the field of health policy. Dr. J. Leonard Lichtenfeld currently serves as Deputy Chief Medical Officer for the American Cancer Society in the Society’s Office of the Chief Medical Officer located at the Society’s Corporate Center in Atlanta.

24 In 2014, Dr. Lichtenfeld assumed his current role in the Office of the Chief Medical Officer where he provides extensive support to a number of Society colleagues and activities. As a result of his over four decades of experience in cancer care, Dr. Lichtenfeld has testified regularly in legislative and regulatory hearings, and participated on numerous panels regarding cancer care, research, advocacy and related topics. He has served on a number of advisory committees and boards for organizations that collaborate with the Society to reduce the burden of cancer nationally and worldwide. He is well known for his blog (www.cancer.org/drlen) which addresses various topics related to cancer research and treatment.

A board certified medical oncologist and internist who was a practicing physician for over 19 years, Dr. Lichtenfeld has long been engaged in health care policy on a local, state, and national level. He is active in several state and national medical organizations and has a long-standing interest in professional legislative and regulatory issues related to health care including physician payment, medical care delivery systems, and health information technology.

Dr. Lichtenfeld is a graduate of the University of Pennsylvania and Hahnemann Medical College (now Drexel University College of Medicine) in Philadelphia. His postgraduate training was at Temple University Hospital in Philadelphia, Johns Hopkins University School of Medicine and the National Cancer Institute in Baltimore. He is a member of Alpha Omega Alpha and national honor medical society. Dr. Lichtenfeld has received several awards, and has been designated a Master of the American College of Physicians in acknowledgement of his contributions to internal medicine.

Dr. Lichtenfeld is married, and resides in Atlanta and Thomasville, Georgia.

The T. Leon Howard Imaging Conference Dr. T. Leon Howard was president of the South Central Section in 1932. He was a founding trustee of the American Board of Urology in 1934 and AUA president in 1941. He became an honorary member of the Southeastern Section in 1947.

The Gee-Dineen Health Policy Forum The Gee-Dineen Health Policy Forum will examine the impact of Government health policy, physician payment reform and the interaction between quality patient care and the pressures of trying to practice medicine amid ever increasing government regulation. These sessions serve to honor Drs. William Gee and Martin Dineen, past presidents of the society, for the major contributions they have made to the socioeconomic issues at both the sectional and national levels.

25 2015 Presidential Lecture: Peter T. Scardino, MD Peter T. Scardino is recognized internationally as an expert in the early Mee ti n g Info detection and surgical treatment of prostate cancer. He has led the way in developing surgical techniques that preserve function (the “trifecta” outcome) while optimizing cancer control. His research is focused on the early detection, natural history and treatment of clinically localized prostate cancer. Dr. Scardino is currently Chairman of the Department of Surgery at Memorial Sloan-Kettering Cancer Center and the inaugural incumbent of the David H. Koch Chair. He is also a Professor of Urology at Weill Medical College of Cornell University.

Dr. Scardino graduated from Duke University School of Medicine in 1971, then spent two years as a surgical resident at the Massachusetts General Hospital. He completed a fellowship in surgical oncology at the NCI before moving to UCLA School of Medicine to complete training in urology with Donald Skinner, MD. In 1979 he moved to Baylor College of Medicine, where he became Professor and Chair of the Department of Urology in 1989 and Distinguished Service Professor in 1995. He was elected to the Institute of Medicine of the National Academy of Sciences in 1996. In 1998 he moved to Memorial Sloan-Kettering Cancer Center to become Chief of Urology.

Dr. Scardino has received more than $30 million in grants from the National Cancer Institute. In collaboration with Michael Kattan, PhD, Dr. Scardino pioneered the use of nomograms to predict both the natural history of prostate cancer and the disease’s response to treatment. With Hans Lilja, MD, PhD, he discovered new PSA-related markers, and with Thomas Wheeler, MD, he defined the prognostic significance of post-irradiation biopsy results. With Hedvig Hricak, MD, PhD, he explored new diagnostic imaging modalities, including magnetic resonance imaging and molecular imaging. With Andrew Vickers, PhD, he described the learning curve for surgeons to achieve optimal outcomes after radical prostatectomy, developed metrics of performance for high-quality surgery, and cast light on the role of surgical technique on outcomes. His most recent research focuses on re-engineering screening for prostate cancer using new markers such as the 4K panel, defining the benefits of surgery for high-risk cancers and, together with investigators at Cancer Research UK (CRUK), developing molecular profiling to more accurately gauge prognosis in early-stage prostate cancer. Dr. Scardino is the author of more than 600 publications on prostate cancer. He was the founding editor-in-chief of Nature Reviews Urology and now is a member of its editorial board, as well as of the board of Annals of Surgical Oncology. He is an Associate Editor of the Annual Review of Medicine. Dr. Scardino has served as chair of the NCCN Guidelines Committee on the Treatment of Prostate Cancer and as co-chair of the National Cancer Institute Progress Review Group on Prostate Cancer.

26 79th Annual Meeting of the Southeastern Section of the AUA March 18 - 22, 2015 Westin Savannah Harbor Golf Resort & Spa 1 Resort Drive Savannah GA 31402

*All sessions will be located at the Savannah International Trade and Convention Center in Chatham Ballroom C unless otherwise noted

*Speakers and times are subject to change

WEDNESDAY, MARCH 18, 2015

OVERVIEW

8:00 a.m. - 12:00 p.m. SESAUA Executive Committee Meeting Location: Grand Ballroom F (Westin Savannah Harbor Resort)

10:00 a.m. - 4:00 p.m. Registration/Information Desk Open Location: Georgia International Gallery

12:00 p.m. - 1:00 p.m. SESAUA Board of Directors Luncheon Location: Grand Ballroom E (Westin Savannah Harbor Resort)

1:00 p.m. - 5:00 p.m. SESAUA Board of Directors Meeting Location: Harbor Ballroom (Westin Savannah Harbor Resort)

THURSDAY, MARCH 19, 2015

OVERVIEW

6:00 a.m. - 6:05 p.m. Registration/Information Desk Open Location: Georgia International Gallery

6:00 a.m. - 6:05 p.m. Speaker Ready Room Hours Location: Pulaski Boardroom

7:30 a.m. - 10:30 a.m. Spouse/Guest Hospitality Suite Open Location: Riverscape (Westin Savannah Harbor Resort)

9:00 a.m. - 4:00 p.m. Exhibit Hall Open Location: Chatham Ballrooms A&B

9:30 a.m. - 9:50 a.m. Presentation on the Foundation for Hospital Art “Paintfest” Location: Riverscape (Westin Savannah Harbor Resort)

9:30 a.m. - 12:00 p.m. The Historic Downtown Trolley Tour Location: Attendees should meet in the resort lobby by 9:00 a.m.

6:00 p.m. - 8:00 p.m. Welcome Reception Location: Chatham Ballrooms A&B

27 Concurrent Sessions Begin

Concurrent Session 1 of 2

7:00 a.m. - 8:30 a.m. Socioeconomic Outcomes, Health Services and Miscellaneous Poster Session Location: Room 100 Moderators: Angela M Smith, MD, MS Chapel Hill, NC Daniel Ari Barocas, MD, MPH Nashville, TN

Poster #1 CLEAR CELL RENAL CELL CARCINOMA: SOCIOECONOMIC PREDICTORS OF METASTATIC DISEASE AT DIAGNOSIS thurs d ay John M. DiBianco¹, Zachary Klaassen², Rita P. Jen², Lael Reinstatler², Austin J. Evans², Qiang Li², Rabii Madi² and Martha K. Terris² ¹Ross University School of Medicine; ²Medical College of Georgia - Georgia Regents University, Augusta, GA Presented By: John DiBianco

Poster #2 THE IMPACT OF A FELLOWSHIP AND CAREER FOCUS IN UROLOGY ON SOCIOECONOMIC, WORKFORCE, AND QUALITY OF LIFE ISSUES Nicholas Pruthi¹, Sophie Spencer¹, Matthew Lyons¹, Peter Greene¹, Max McKibben¹, Matthew Nielsen¹, Raj Pruthi¹, Mathew Raynor¹, Eric Wallen¹, Michael Woods¹, Christopher Gonzalez² and Angela Smith¹ ¹UNC, Chapel Hill, NC; ²Northwestern, Chicago, IL Presented By: Sophie Spencer

Poster #3 UNDERSTANDING THE RELATIONSHIP BETWEEN 30- AND 90-DAY EMERGENCY ROOM VISITS AND READMISSIONS FOLLOWING RADICAL CYSTECTOMY E. Sophie Spencer, Matthew Lyons, Peter Greene, Anne-Marie Meyer, Ke Meng, Raj Pruthi, Eric Wallen, Michael Woods, Matthew Nielsen and Angela Smith Chapel Hill, NC Presented By: Sophie Spencer

Poster #4 BEYOND BIOLOGY: THE IMPACT OF MARITAL STATUS ON SURVIVAL FOR PATIENTS WITH ADRENOCORTICAL CARCINOMA Zachary Klaassen¹, Lael Reinstatler², Chris Ellington², Qiang Li², Martha K. Terris², Willie Underwood, III³ and Kelvin A. Moses⁴ ¹Medical College of Georgia - Georgia Regents University, Augusta, GA; ²Medical College of Georgia - Georgia Regents University, Augusta, Georgia; ³Roswell Park Cancer Institute, Buffalo, New York; ⁴Vanderbilt University, Nashville, Tennessee Presented By: Zachary Klaassen

Poster #5 PHEOCHROMOCYTOMA DIAGNOSED PATHOLOGICALLY WITH PREVIOUS NEGATIVE SERUM MARKERS

28 Shira M Winters, Louis Spencer Krane, Jessica Lange and Majid Mirzazadeh Wake Forest Baptist Health, Winston Salem NC Presented By: Shira Winters

Poster #6 IMPROVING OPERATING ROOM THROUGHPUT EFFICIENCY AS A WAY TO INCREASE HOSPITAL SURGICAL VOLUME – IMPROVING FIRST CASE STARTS John C. Pope, IV¹, John W. Brock, III¹, Daniel M. Roke², Lori A. Graves³ and Derek W. Anderson³ ¹Vanderbilt University, Department of Urologic Surgery, Division of Pediatric Urology, Nashville, TN; ²Vanderbilt University, Division of Pediatric Anesthesiology, Nashville, TN; ³Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN Presented By: John Pope IV

Poster #7 EVALUATION AND ANALYSIS OF UROLOGIC CONSULTS AT A TERTIARY CARE CENTER Rishi Modh, James Mason, Akira Yamamoto and Paul Crispen University of Florida Presented By: Rishi Modh

Poster #8 ASSESSMENT OF PRACTICE PATTERNS FOR USE OF VOIDED URINE CYTOLOGY AND BLADDER WASH CYTOLOGY AMONGST UROLOGIC ONCOLOGIST Bayo Tojuola¹, Zachary Corr², Christopher Ledbetter² and Robert Wake² ¹The PUR Clinic, Orlando, FL; ²University of Tennessee, Memphis, TN Presented By: Bayo Tojuola

Poster #9 ADULT UROLOGIC SURGERY INPATIENT CONSULTATIONS: REVIEW OF COMMON PROBLEMS AND PATIENTS REQUIRING ACUTE UROLOGIC OPERATIVE INTERVENTION Stephen Kappa¹, Elizabeth Green², Niels Johnsen¹, Matthew Resnick¹ and Sam Chang¹ ¹Vanderbilt Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University School of Medicine, Nashville, TN Presented By: Stephen Kappa

Poster #10 REDUCING THE INCIDENCE OF RETAINED DOUBLE J URETERAL STENTS: A MULTIDISCIPLINARY APPROACH Alex Baumgarten, Michael Rydberg, Jenna Bates, Chris Teigland and Ornob Roy McKay Urology, Levine Cancer Institute, Carolinas Healthcare System Presented By: Jenna Bates

29 Poster #11 THE FEMINIZATION OF THE WORKFORCE IN UROLOGY: ECONOMIC, WORKFORCE, AND QUALITY OF LIFE ISSUES Nicholas Pruthi¹, Sophie Spencer¹, Matthew Lyons¹, Peter Greene¹, Max McKibben¹, Matthew Nielsen¹, Raj Pruthi¹, Mathew Raynor¹, Eric Wallen¹, Michael Woods¹, Christopher Gonzalez² and Angela Smith¹ ¹UNC, Chapel Hill, NC; ²Northwestern, Chicago, IL Presented By: Sophie Spencer

Poster #12 FAILURE OF THE 3.5CM ARTIFICIAL URINARY SPHINCTER CUFF: AN EMERGING TREND? Brian Christine¹ and Michael Kennelly² ¹Urology Centers of Alabama, Birmingham, Al; ²McKay Urology Charlotte, NC thurs d ay Presented By: Brian Christine

Concurrent Session 2 of 2

7:00 a.m. - 8:30 a.m. Imaging and Miscellaneous Poster Session Location: Room 101 Moderators: Murali K. Ankem, MD Louisville, KY Robert W. Wake, MD Memphis, TN

Poster #13 INCREASED RADIATION EXPOSURE FROM FLUOROSCOPY WITH FIXED TABLE VERSUS PORTABLE C-ARM Fernando Cabrera¹, Richard Shin², Giao Nguyen³, Chu Wang³, Ned Chung³, Charles Scales⁴, Michael Ferrandino², Glenn Preminger², Terry Yoshizumi³ and Michael Lipkin² ¹Duke Medical Center; ²Duke Medical Center, Durham, NC; ³Division of Radiation Safety, Duke University Medical Center, Durham, NC; ⁴Duke Medical Center, Duke Clinical Research Institute Durham, NC Presented By: Fernando Cabrera-Piquer

Poster #14 OPTIMIZED ADHESIVE PROBABILITY SCORE: A SUPERIOR CT-BASED SCORING SYSTEM TO PREDICT ADHERENT PERINEPHRIC FAT IN PARTIAL NEPHRECTOMY Yin Zheng¹ and Philippe Spiess² ¹H.Lee Moffitt Cancer Center, Tampa FL; ²H.Lee Moffitt Cancer Center Presented By: Yin Zheng

30 Poster #15 SARCOPENIA AS MEASURED BY PSOAS AND ERECTOR SPINAE MUSCLE DENSITY IS ASSOCIATED WITH HIGHER INCIDENCE OF POSTOPERATIVE COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER Mark Currin¹, Austin DeRosa², James Rosoff³, John Roebel², Matthew Jaenicke², Thomas Beckham², Andrew Hardie² and Sandip Prasad² ¹MUSC - Charleston, SC; ²MUSC; ³Yale Presented By: Mark Currin

Poster #16 PHYSICAL 3D KIDNEY TUMOR MODELS CONSTRUCTED FROM 3D PRINTERS IMPROVE TRAINEE PERFORMANCE Margaret Knoedler, Andrew Lange, Allison Feibus, Michael Maddox, Elisa Ledet, Raju Thomas and Jonathan Silberstein Tulane University School of Medicine, New Orleans, LA Presented By: Jonathan Silberstein

Poster #17 THE IMPACT OF REMOTE MONITORING AND SUPERVISION ON RESIDENT TRAINING USING NEW ACGME & ABU UROLOGY MILESTONE CRITERIA Ilan Safir, Adam Shrewsberry, Kenneth Ogan, Chad Ritenour, Catrina White, Jane Kimberl, Jerry Sullivan and Muta Issa Department of Urology, Atlanta VA Medical Center and Emory University School of Medicine, Atlanta, GA Presented By: Ilan Safir

Poster #18 UROLOGIC COMPLICATIONS OF URETERAL LOCALIZATION STENT PLACEMENT FOR COLORECTAL SURGERY (CRS) CASES Ram Pathak, Abby Taylor, Scott Alford, Gregory Broderick, Todd Igel, Steven Petrou, Michael Wehle, Paul Young and David Thiel Mayo Clinic Jacksonville, Florida Presented By: Ram Pathak

Poster #19 THE CHARACTERISTICS OF WOMEN TESTING POSITIVE FOR MYCOPLASMA HOMINIS AND UREAPLASMA UREALYTICUM IN THE URINARY TRACT Jessie Liang, Sarah Rentrop, Andrea Balthazar, Clifton F. Frilot II and Alex Gomelsky LSU Health - Shreveport, LA Presented By: Jessie Liang

Poster #20 IMPACT OF FELLOWSHIP TRAINING ON ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: BENCHMARKING PERI- OPERATIVE SAFETY AND OUTCOMES Abby Taylor¹ and David Thiel² ¹Mayo Clinic Florida, Department of Urology, Jacksonville, FL; ²Mayo Clinic Florida, Jacksonville, FL Presented By: Abby Taylor

31 Poster #21 PREFABRICATION OF NEUROMUSCULAR JUNCTION FOR ACCELERATED RECOVERY OF MUSCLE FUNCTION In Kap Ko, Sang Jin Lee, John Jackson, Anthony Atala and James Yoo Wake Forest School of Medicine, Winston Salem, NC Presented By: John Jackson

Poster #22 COMBINATION OF SMALL RNAS ENHANCES MUSCLE DEVELOPMENT NaJung Kim, James Yoo, John Jackson, Sang Jin Lee and Anthony Atala Wake Forest School of Medicine, Winston Salem, NC Presented By: John Jackson thurs d ay Poster #23 ARE SOME U.S. ACADEMIC CENTERS REGULATING THEMSELVES OUT OF MULTICENTER STUDIES? THE PROPPER REGISTRY EXPERIENCE WITH IRB AND CONTRACT APPROVAL Gerard Henry¹, Edward Karpman², Bryan Kansas³, William Brant⁴, Leroy Jones⁵, Nelson Bennett⁶, Mohit Khera⁷, Tobias Kohler⁸, Andrew Kramer⁹, Brian Christine¹⁰, Eugene Rhee¹¹, Rafael Carrion¹², Andrew Neeb¹³ and Anthony Bella¹⁴ ¹Regional Urology, Shreveport, LA; ²El Camino Urology, Mountain View, CA; ³The Urology Team, Austin, TX; ⁴University of Utah, Salt Lake City, UT; ⁵Urology San Antonio, San Antonio, TX; ⁶Lahey Clinic, Burlington, MA; ⁷Baylor College of Medicine, Houston, TX; ⁸Southern Illinois University, Springfield, IL; ⁹University of Maryland, Baltimore, MD; ¹⁰Urology Alabama, Birmingham, AL; ¹¹Kaiser, San Diego, CA; ¹²University of South Florida, Tampa, FL; ¹³Urology Specialists of Oregon, Bend, OR; ¹⁴Ottawa Hospital Research Institute, Ottawa, Canada Presented By: Gerard Henry

Poster #24 MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING FOR DETECTION AND LOCALIZATION OF PROSTATE CANCER: DIAGNOSTIC PROPERTIES Melissa Mendez¹, Matvey Tsivian¹, Rajan Gupta², Peter Qi¹, Michael Abern¹, Niccolo’ Passoni¹ and Thomas Polascik¹ ¹Division of Urology, Duke Cancer Institute, Durham, NC; ²Department of Radiology, Duke University Medical Center, Durham NC Presented By: Melissa Mendez

Concurrent Sessions End

8:30 a.m. - 9:30 a.m. AUA Course of Choice: Prostate Cancer Update Guest Speaker: William J. Catalona, MD Chicago, IL

9:30 a.m. - 10:00 a.m. Break - Visit Exhibits

32 10:00 a.m. - 10:10 a.m. Opening Remarks - SESAUA President President: Jack M. Amie, MD Brunswick, GA

10:10 a.m. - 10:50 a.m. Prostate Cancer Panel Moderator: Martin George Sanda, MD Atlanta, GA Panelists: William J. Catalona, MD Chicago, IL Peter T. Scardino, MD New York, NY Raju Thomas, MD, FACS, MHA New Orleans, LA

10:50 a.m. - 12:15 p.m. Prostate Cancer Podium Moderators: Martha K. Terris, MD, FACS Augusta, GA Ricardo F. Sanchez-Ortiz, MD Hato Rey, PR

10:50 a.m. #1 A MULTI-INSTITUTIONAL PROSPECTIVE TRIAL IN THE UNITED STATES CONFIRMS THE 4KSCORE ACCURATELY IDENTIFIES MEN WITH HIGH- GRADE PROSTATE CANCER Sanoj Punnen¹, Dan Sjoberg², Steve Zappala³ and Dipen Parekh⁴ ¹University of Miami; ²Memorial Sloan Kettering, New York, NY; ³Andover Urology, Andover, MI; ⁴University of Miami, Miami, FL Presented By: Sanoj Punnen

10:57 a.m. #2 ADVERSE PATHOLOGY AND UNDETECTABLE ULTRASENSITIVE PROSTATE-SPECIFIC ANTIGEN AFTER RADICAL PROSTATECTOMY: IS ADJUVANT RADIATION WARRANTED? Ross Simon¹,², Lauren Howard¹, Stephen Freedland¹, William Aronson³, Martha Terris⁴, Christopher Kane⁵, Christopher Amling⁶, Matt Cooperberg⁷ and Adriana Vidal¹ ¹Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; ²Urology Section, Veterans Affairs Medical Center, Durham, NC; ³Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, California; ⁴Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia; ⁵Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, California; ⁶Department of Urology, Oregon Health and Science University, Portland, Oregon; ⁷Department of Urology, University of California at San Francisco, San Francisco, California Presented By: Ross Simon

33 11:04 a.m. #3 EVALUATION OF THE PROSTATE HEALTH INDEX (PHI) AS A POTENTIAL TOOL FOR AGGRESSIVE PROSTATE CANCER DETECTION IN BIOPSY-NAÏVE MEN Claire M. de la Calle¹, Dattatraya Patil¹, John T. Wei², Douglas S. Scherr³, Lori Sokoll⁴, Daniel W. Chan⁴, Javed Siddiqui², Mark A. Rubin³ and Martin G. Sanda¹ ¹Emory University School of Medicine, Atlanta, GA; ²University of Michigan Medical School, Ann Arbor, MI; ³Weill Cornell Medical College, New York, NY; ⁴Johns Hopkins University School of Medicine, Baltimore, MD Presented By: Martin Sanda

11:11 a.m. #4 COMPARISON OF STANDARD FLUOROQUINOLONE PROPHYLAXIS VERSUS thurs d ay RECTAL SWAB TARGETED PROPHYLAXIS IN MEN UNDERGOING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Gautum Agarwal¹, Abera Gezahegn², Rod Quilitz¹, Yanina Pasikhova¹, Ramon Sandin¹, Adam Luchey¹, Wade Sexton¹, Philippe E Spiess¹, Micahel Poch¹, Scott Gilbert¹, John Greene¹ and Julio Pow-Sang¹ ¹H. Lee Moffitt Cancer Center, Tampa, Florida; ²University of South Florida, Tampa, FL Presented By: Gautum Agarwal

11:18 a.m. #5 RACIAL VARIATIONS OF PCA3 AND TMPRSS2 URINARY BIOMARKERS IN MEN UNDERGOING PROSTATE NEEDLE BIOPSY Allison Feibus¹, Oliver Sartor¹, Raju Thomas¹, Michael Maddox¹, Benjamin Lee¹, Justin Levy¹, Ian McCaslin¹, Julie Wang¹, Krishnarao Moparty² and Jonathan Silberstein¹ ¹Tulane University School of Medicine, New Orleans, LA; ²Southeast Louisiana Veterans Health Care Services, New Orleans, LA Presented By: Jonathan Silberstein

11:25 a.m. #6 RANDOMIZED, SINGLE CENTER TRIAL OF THE EFFECT OF EXTENDING TIME FROM PERI- PROSTATIC LIDOCAINE INJECTION TO ONSET OF TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY ON PATIENT-REPORTED PAIN SCORE Ram Pathak, Scott Alford, Mike Heckman, Julia Crook, Nancy Diehl, Alexander Parker and Todd Igel Mayo Clinic Jacksonville, FL Presented By: Ram Pathak

11:32 a.m. #7 INCREASED PROSTATE SIZE AND HISTORY OF PREOPERATIVE VOIDING DYSFUNCTION ASSOCIATED WITH GREATER URINARY TOXICITY AFTER POST-PROSTATECTOMY ADJUVANT OR SALVAGE RADIATION Juan Guzman-Negron¹ and Ricardo Sanchez-Ortiz² ¹University of Puerto Rico, San Juan PR; ²Robotic Urology and Oncology Institute, San Juan PR Presented By: Juan Guzman-Negron

34 11:39 a.m. #8 COGNITIVE FUSION MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE WITH TRANS-RECTAL ULTRASOUND GUIDED BIOPSY IMPROVES DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER Sean Douglas¹, Jessie Gills¹, Barry Sartin², Don Bell¹, Steve Lacour¹, J. Christian Winters¹, Bradley Spieler³ and Scott Delacroix¹ ¹Louisiana State University Department of Urology, New Orleans, Louisiana; ²East Jefferson General Hospital Department of Pathology, Metairie, Louisiana; ³Louisiana State University Department of Radiology, New Orleans, Louisiana Presented By: Sean Douglas

11:46 a.m. #9 ARE LOWER PSA LEVELS IN OBESE MEN DUE TO HEMODILUTION OR LOW ANDROGENS? RESULTS FROM REDUCE Zachary Klaassen¹, Lauren E. Howard², Daniel M. Moreira³, Gerald L. Andriole, Jr⁴, Martha K. Terris¹ and Stephen J. Freedland² ¹Medical College of Georgia - Georgia Regents University, Augusta, GA; ²Duke University Medical Center, Durham, NC; ³Mayo Clinic, Rochester, MN; ⁴Washington University School of Medicine, St. Louis, MO Presented By: Zachary Klaassen

11:53 a.m. #10 ADHERENCE TO QUALITY INDICATORS IN THE CARE OF MEN WITH LOCALIZED PROSTATE CANCER William Sohn, David Penson, Matthew Resnick, Tatsuki Koyama, Alicia Morgans, Sharon Phillips and Daniel Barocas Vanderbilt University, Nashville, TN Presented By: William Sohn

12:00 p.m. #11 DECLINING RATE OF PROSTATE BIOPSY IN THE VETERANS HEALTH ADMINISTRATION IN THE PAST DECADE: AN ALTERNATE APPROACH TO LIMITING THE OVERDIAGNOSIS AND OVERTREATMENT OF PROSTATE CANCER? Ryan Levey¹, Gowtham Rao², Azza Shoaibi³, Kathlyn Sue Haddock⁴ and Sandip Prasad¹ ¹Department of Urology, Medical University of South Carolina ; ²William J.B. Dorn Veterans Affairs Medical Center (Columbia, SC); ³Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina (Columbia, SC); ⁴Ralph H. Johnson Veterans Affairs Medical Center Presented By: Ryan Levey

12:07 p.m. #12 IMPLEMENTING MULTIPARAMETRIC MRI AND MRI/US FUSION-GUIDED BIOPSY TO DETECT CLINICALLY-SIGNIFICANT CASES OF PROSTATE CANCER Win Shun Lai¹, Melissa R. Dillard², Jennifer B. Gordetsky², John V. Thomas³, Jeffrey W. Nix¹ and

35 Soroush Rais-Bahrami¹,³ ¹Department of Urology, University of Alabama at Birmingham, Birmingham, AL; ²Department of Pathology, University of Alabama at Birmingham, Birmingham, AL; ³Department of Radiology, University of Alabama at Birmingham, Birmingham, AL Presented By: Win Shun Lai

12:15 p.m. - 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 203-205 See page 17 for full details

12:15 p.m. - 1:30 p.m. Industry Sponsored Lunch Symposium

Location: Room 200-202 thurs d ay See page 17 for full details

Concurrent Sessions Begin

Concurrent Session 1 of 2

1:30 p.m. - 5:45 p.m. Pediatric Sub-plenary Session 1 Location: Room 102/103

1:30 p.m. - 1:55 p.m. Pediatric Poster Viewing Location: Room 101

2:00 p.m. - 3:15 p.m. Pediatric Poster Oral Presentations Moderators: Ali Ziada, MD Lexington, KY Timothy Paul Bukowski, MD Raleigh, NC

Poster #99 INITIAL EXCRETORY PHASE CONTRASTED COMPUTED TOMOGRAPHY MAY NOT BE NECESSARY TO EVALUATE BLUNT ABDOMINAL TRAUMA IN CHILDREN Matthew Mason, Christina Ching, Stacy Tanaka, Douglass Clayton, John Pope, Mark Adams, John Brock and John Thomas Vanderbilt University, Pediatric Urology Presented By: Matthew Mason

Poster #100 MAGNETIC RESONANCE UROGRAPHY FOR THE EVALUATION OF HYDRONEPHROSIS IN PRUNE BELLY SYNDROME Michael Garcia-Roig¹, Angela Arlen², J. Damien Grattan-Smith³, Edwin Smith² and Andrew Kirsch² ¹Children’s hospital of Atlanta/ Emory University Department of Pediatric Urology; ²Children’s Hospital of Atlanta/ Emory University Department of Pediatric Urology; ³Children’s Hospital of Atlanta/ Emory University Department of Radiology Presented By: Michael Garcia-Roig

36 Poster #101 LONG-TERM OUTCOMES OF TETHERED CORD RELEASE IN PRIMARY TETHERED CORD SYNDROME PATIENTS: A SINGLE CENTER EXPERIENCE HsinHsiao Wang, Jacqueline Zillioux, Daniel Vargas, John Wiener and Jonathan Routh Duke University Medical Center, Durham, NC Presented By: Hsin-Hsiao Wang

Poster #102 ASSOCIATION OF MEGAURETER WITH UNDESCENDED TESTIS: A CASE FOR CAUSALITY? Kristin M. Broderick¹, Kelly McCormick², Edwin A. Smith¹ and Andrew J. Kirsch¹ ¹Emory University School of Medicine Department of Urology, Children’s Healthcare of Atlanta, Atlanta, GA; ²Department of Biostatistics, Children’s Healthcare of Atlanta, Atlanta, GA Presented By: Kristin Broderick

Poster #103 EVALUATION AND MANAGEMENT OF THE UNDESCENDED TESTIS IN PUERTO RICO: COMPARISON TO THE AUA CRYPTORCHIDISM GUIDELINES Ceciliana DeAndino¹, Karina Escudero², Francois Soto¹ and Marcos Perez-Brayfield¹ ¹University of Puerto Rico, San Juan, Puerto Rico; ²HIMA Caguas, Puerto Rico Presented By: Ceciliana De Andino

Poster #104 NATIONWIDE TRENDS AND VARIATIONS IN SURGICAL INTERVENTIONS AND RENAL OUTCOME FOR SPINA BIFIDA PATIENTS HsinHsiao Wang, Jessica Lloyd, John Wiener and Jonathan Routh Duke University Medical Center, Durham, NC Presented By: Hsin-Hsiao Wang

Poster #105 ADOLESCENT WITH CONCOMITANT TRANSVERSE AND LONGITUDINAL VAGINAL SEPTUM Sherita King¹, Jeffrey Donohoe², Larisa Gavrilova-Jordan¹, Lawrence Layman¹ and Paul McDonough¹ ¹GRU-MCG, Augusta, GA; ²Cleveland Clinic, Cleveland, OH Presented By: Sherita King

37 Poster #106 THE ROLE OF POSITIONAL INSTILLATION OF CONTRAST CYSTOGRAPHY (PIC) AND ENDOUROLOGICAL ANTIREFLUX SURGERY IN THE MANAGEMENT OF RECURRENT URINARY TRACT INFECTION (UTI). Wilson Rovira-Pena¹, Karina Escudero² and Marcos Perez-Brayfield¹ ¹Urology, RCM-UPR Rio Piedras, Puerto Rico; ²Urology, HIMA Caguas Puerto Rico Presented By: Wilson Rovira

Poster #107 “COMPARISON OF OUTCOMES FOLLOWING DISTAL HYPOSPADIAS thurs d ay REPAIRS. ARE URETHRAL STENTS NEEDED?” Anja Zann and Romano DeMarco University of Florida, Gainesville FL Presented By: Anja Zann

Poster #108 NON-OPERATIVE MANAGEMENT OF HIGH GRADE VESICOURETERAL REFLUX David C. Moore¹, Matthew D. Mason², Douglass B. Clayton², Stacy T. Tanaka², John C. Thomas², Mark C. Adams², John W. Brock, III² and John C. Pope, IV² ¹Vanderbilt University, Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University, Department of Urologic Surgery, Division of Pediatric Urology, Nashville, TN Presented By: David Moore

3:15 p.m. - 4:15 p.m. Panel Discussion: Surviving in Pediatric Urology Location: Room 102/103 Moderator: Sherry S. Ross, MD Chapel Hill, NC

3:15 p.m. - 3:35 p.m. Surviving in the Academic Environment Panelist: Douglas A. Husmann, MD Rochester, MN

3:35 p.m. - 3:55 p.m. Surviving Coding in Pediatric Urology Panelist: Edwin Agan Smith, MD Atlanta, GA

3:55 p.m. - 4:15 p.m. Surviving in the Clinic Panelist: David Jay Riden, MD Knoxville, TN

4:15 p.m. - 4:25 p.m. Break 4:25 p.m. - 5:45 p.m. Updates in Pediatric Urology Location: Room 102/103

38 4:25 p.m. - 4:45 p.m. Transition of Care in Pediatric Urology Speaker: Stacy T. Tanaka, MD Nashville, TN

4:45 p.m. - 5:05 p.m. Current Controversies in the Urologic Management of Klienfelter Syndrome Speaker: Jonathan Routh, MD MPH Durham, NC

5:05 p.m. - 5:25 p.m. Management of Penile Chordee in Pediatrics Patients with Hypospadias Speaker: Miguel Castellan, MD Miami, FL

5:25 p.m. - 5:45 p.m. Evaluating the Pediatric Varicocele Speaker: Aaron D. Martin, MD, MPH New Orleans, LA

Concurrent Session 2 of 2

1:30 p.m. - 3:10 p.m. Discovery and Innovations in Urology Moderator: Li-Ming Su, MD Gainesville, FL

1:30 p.m. - 1:50 p.m. Shunting Procedures for Ischemic Priapism: A 50 Year Mistake for Discovery and Innovation Invited Speaker: Tom F. Lue, MD San Francisco, CA

1:50 p.m. - 2:10 p.m. Emerging Concepts in Under-Active Bladders Speaker: Melissa R Kaufman, MD, PhD Nashville, TN

2:10 p.m. - 2:30 p.m. Metabolic Pathways Involved in Renal Cancer Speaker: Sunil Sudarshan, MD Birmingham, AL

2:30 p.m. - 2:50 p.m. Advances in Regenerative Medicine Speaker: Anthony Atala, MD Winston-Salem, NC

2:50 p.m. - 3:10 p.m. Q&A

Concurrent Sessions End

3:10 p.m. - 3:40 p.m. Break - Visit Exhibits

39 Concurrent Sessions Begin

Concurrent Session 1 of 3

3:40 p.m. - 6:00 p.m. Young Urologists Forum Moderator: Christopher Scot Gomez, MD Miami, FL

3:40 p.m. - 4:30 p.m. How to Preserve Independent, Private Practice: Urologic Practice as an Employer or Employee, an Integrated Approach Invited Speaker: Michael Dean Fabrizio, MD Virginia Beach, VA thurs d ay 4:30 p.m. - 5:15 p.m. Urology Without RVUs - International Volunteer Opportunities for Practicing Urologists Speaker: Joseph Anthony Costa, DO Jacksonville, FL

5:15 p.m. - 6:00 p.m. Contract Negotiations for the Young Urologist Invited Speaker: Thomas Crawford, PhD, MBA, FACHE Gainesville, FL Concurrent Session 2 of 3

3:40 p.m. - 6:05 p.m. Kidney Stones and Endourology Poster Session Location: Room 100 Moderators: Ramakrishna Venkatesh, MD, MS, FRCS Lexington, KY Davis Paul Viprakasit, MD Chapel Hill, NC

Poster #25 CAREFUL SELECTION OF DISPOSABLES CAN MINIMIZE THE COST OF URETEROSCOPY Joan Delto¹, Ajaydeep Sidhu¹, George Wayne², Rafael Yanes¹, Akshay Bhandari¹ and Alan Nieder¹ ¹Mount Sinai Medical Center, Miami Beach, FL; ²Florida International University, Miami, FL Presented By: Joan Delto

Poster #26 ROLE OF ROBOTIC SURGERY IN THE TREATMENT OF COMPLEX KIDNEY STONES – A SINGLE CENTER EXPERIENCE Curtis Cleveland¹, Zachary Klaassen¹, John M. DiBianco², Qiang Li¹, Sherita A. King¹ and Rabii Madi¹ ¹Medical College of Georgia - Georgia Regents University, Augusta, GA; ²Ross University School of Medicine, Dominica, West Indies Presented By: Zachary Klaassen

40 Poster #27 THE EFFECTS OF A WESTERNIZED DIET AND UREAPLASMA PARVUM URINARY TRACT INFECTION ON KIDNEY STONE FORMATION IN A RAT MODEL Tara Ortiz¹, Julie Sproule¹, Patrick Seed¹ and Sherry Ross² ¹Duke University Medical Center, Durham, NC; ²University of North Carolina, Chapel Hill, NC Presented By: Tara Ortiz

Poster #28 HUMAN MONOCYTES RESPONSE ENHANCES KIDNEY STONE CLEARANCE Paul Dominguez-Gutierrez, Benjamin Canales, Sergei Kusmartserv, Johannes Vieweg and Saeed Khan University of Florida, Gainesville, FL Presented By: Paul Dominguez-Gutierrez

Poster #29 DOES MEDICAL MANAGEMENT OF CYSTINURIA REDUCE STONE INTERVENTIONS? AN ASSESSMENT USING MEAN CUMULATIVE FUNCTION ANALYSIS Richard Shin¹, Fernando Cabrera¹, Jonathan Hanna¹, Momin Ghaffar¹, Borna Kassiri¹, Charles Scales², Glenn Preminger¹ and Michael Lipkin¹ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC Presented By: Richard Shin

Poster #30 ANALYSIS OF S.T.O.N.E. AND GUY’S SCORING SYSTEMS FOR REPRODUCIBILITY, PREDICTION OF STONE CLEARANCE, AND PREDICTION OF SECONDARY PROCEDURES AFTER PRIMARY PERCUTANEOUS NEPHROSTOLITHOTOMY Weil Lai, Arash Akhavien and Vincent G Bird University of Florida Department of Urology Presented By: Weil Lai

Poster #31 ANALYSIS OF GUIDEWIRE USE FOR COMMON ENDOUROLOGIC PROCEDURES: A COST PERSPECTIVE. James Mason¹ and Vincent G Bird² ¹University of Florida College of Medicine; ²University of Florida Department of Urology Presented By: James Mason

Poster #32 VALUE OF METABOLIC EVALUATION AND DIRECTED MEDICAL THERAPY IN PATIENTS WITH STRUVITE STONES Adam Kaplan¹, Richard Shin¹, Muhammad Iqbal², Ramy Youssef³, Fernando Cabrera¹, Jonathan Hanna¹, Anika Ackerman¹, Andreas Neisius¹, Charles Scales⁴, Michael Ferrandino¹, Glenn Preminger¹ and Michael Lipkin¹ ¹Duke Medical Center. Durham, NC; ²Shifa International Hospital ; ³University of California, Irvine (United States); ⁴Duke Medical Center, Duke Clinical Research Institute, Durham, NC Presented By: Adam Kaplan

41 Poster #33 ANTIMICROBIAL UTILIZATION PRIOR TO ENDOUROLOGICAL SURGERY FOR UROLITHIASIS: ENDOUROLOGICAL SOCIETY SURVEY RESULTS Anika Ackerman¹, Ramy Youssef², Richard Shin¹, Fernando Cabrera¹, Adam Kaplan¹, Andreas Neisius³, Charles Scales⁴, Roger Sur⁵, Michael Ferrandino¹, Brien Eisner⁶, Glenn Preminger¹ and Michael Lipkin¹ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Urologic Surgery, University of California, Irvine, Orange, CA; ³Department of Urology,

University Medical Center Mainz, Mainz, Germany; thurs d ay ⁴Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC; ⁵Division of Urologic Surgery, University of California San Diego, San Diego, CA; ⁶Massachusetts General Department of Urology, Boston, MA Presented By: Anika Ackerman

Poster #34 DOES INTRAVENOUS ACETAMINOPHEN IMPROVE PERCUTANEOUS NEPHROLITHOTOMY OUTCOMES? Jared Moss, Kyle Basham, Wesley White, Edward Kim, Frederick Klein, Bedford Waters and Ryan Pickens Presented By: Jared Moss

Poster #35 UPPER POLE UROLOGIST-OBTAINTED PERCUTANEOUS RENAL ACCESS FOR PCNL IS SAFE AND EFFICACIOUS Amar Patel, Don Bui, John Pattaras and Kenneth Ogan Emory University School of Medicine, Atlanta, GA Presented By: Amar Patel

Poster #36 FEASABILITY OF PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH HEPATIC INSUFFICIENCY Carrie Stewart, Julie Wang, Michael Maddox, Jonathan Silberstein, Benjamin Lee and Raju Thomas Tulane University School of Medicine Department of Urology Presented By: Carrie Stewart

Poster #37 INCREASED RADIATION EXPOSURE DURING URETEROSCOPY IN THE OBESE PATIENT. Fernando Cabrera¹, Richard Shin², Giao Nguyen³, Chu Wang³, Ned Chung³, Charles Scales⁴, Michael Ferrandino², Glenn Preminger², Terry Yoshizumi⁵ and Michael Lipkin² ¹Duke Medical Center; ²Duke Medical Center. Durham, NC; ³Duke Radiation Dosimetry Laboratory, Duke University Medical Center, Durham, North Carolina; ⁴Duke Medical Center,Duke Clinical Research Institute, NC; ⁵Division of Radiation Safety, Duke University Medical Center, Durham, NC Presented By: Fernando Cabrera-Piquer

42 Poster #38 THE EFFECT OF DRINKING WATER SOURCE ON KIDNEY STONE RISK FACTORS Matthew D. Lyons, E. Sophie Spencer, Peter S. Greene, Jonathan E. Matthews and Davis P. Viprakasit University of North Carolina, Chapel Hill, NC Presented By: Davis Viprakasit

Poster #39 SAFETY AND EFFICACY OF URETERAL STENT PLACEMENT AT THE BEDSIDE UNDER LOCAL ANESTHESIA Paymon Nourparvar, Andrew Leung, Adam Shrewsberry, Aaron Weiss, Salil Gabale, Kenneth Carney, Kenneth Ogan and Viraj Master Emory University, Atlanta, GA Presented By: Paymon Nourparvar

Poster #40 LAPAROSCOPIC AND ROBOTIC CALYCEAL DIVERTICULECTOMY: OUTCOMES AND MODIFICATIONS OF TECHNIQUE Abby Taylor¹ and David Thiel² ¹Mayo Clinic Florida, Department of Urology, Jacksonville, FL; ²Mayo Clinic Florida, Jacksonville, FL Presented By: Abby Taylor

Poster #41 BALL-TIP HOLMIUM LASER FIBER MAY REDUCE FLEXIBLE URETEROSCOPE DAMAGE Anika Ackerman¹, Richard Shin¹, Fernando Cabrera¹, Zachariah Goldsmith¹, Nicholas Kuntz¹, Ramy Youssef², Andreas Neisius³, Charles Scales⁴, Michael Ferrandino¹, Pei Zhong⁵, Glenn Preminger¹ and Michael Lipkin¹ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Urologic Surgery, University of California, Irvine, Orange, CA; ³Department of Urology, University Medical Center Mainz, Mainz, Germany; ⁴Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC; ⁵Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC Presented By: Anika Ackerman

Poster #42 BALL-TIP HOLMIUM LASER FIBER: IN VITRO STONE COMMINUTION AND FIBER TIP DEGRADATION Adam Kaplan¹, Adam Kaplan¹, Richard Shin², Jaclyn Lautz³, Fernando Cabrera², Zachariah Goldsmith², Nicholas Kuntz², Andreas Neisius⁴, Charles Scales⁵, Michael Ferrandino², Glenn Preminger² and Michael Lipkin² ¹Duke Medical Center. Durham, NC; ²Duke Medical Center-Durham, NC; ³Department of Mechanical Engineering and Materials Science, Duke University- Durham, NC; ⁴Department of Urology, University Medical Center Mainz ; ⁵Duke Medical Center, Duke Clinical Research Institute-Durham, NC Presented By: Adam Kaplan

43 Poster #43 IDEAL MODALITY OF TREATMENT FOR UROLITHIASIS IN PELVIC KIDNEYS: ROBOT PYELOLITHOTOMY WITH FLEXIBLE NEPHROSCOPY Michael Maddox, Anthony Tracey, Katie Powers, Benjamin Lee and Raju Thomas Tulane University, New Orleans, LA Presented By: Michael Maddox

Poster #44 NARCOTIC USE AND POSTOPERATIVE “DOCTOR SHOPPING” AMONG PATIENTS WITH NEPHROLITHIASIS REQUIRING OPERATIVE MANAGEMENT Stephen Kappa¹, Elizabeth Green², Nicole Miller¹, Duke Herrell¹, Christopher Mitchell¹, Hassan Mir³ and Matthew thurs d ay Resnick¹ ¹Vanderbilt Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University School of Medicine, Nashville, TN; ³Vanderbilt Orthopaedic Institute, Nashville, TN Presented By: Stephen Kappa

Poster #45 ANALYSIS OF COMMERCIAL O. FORMIGENES KIDNEY STONE PROBIOTIC SUPPLEMEN Melissa Ellis, John Knight, Dean Assimos and Win Shun Lai Birmingham, Alabama Presented By: Win Shun Lai

Concurrent Session 3 of 3

4:00 p.m. - 6:00 p.m. Prostate Cancer Poster Session Location: Room 101 Moderators: Thomas Edward Keane, MD Charleston, SC Stephen Edward Strup, MD Lexington, KY

Poster #46 IN VIVO CHARACTERIZATION AND LOCALIZATION OF PROSTATE CANCER WITH 3D ACOUSTIC RADIATION FORCE IMPULSE ELASTICITY IMAGING: CORRELATION WITH WHOLE MOUNT HISTOPATHOLOGY AND MRI CAPSULAR DIMENSIONS Melissa Mendez¹, Mark Palmeri², Zachary Miller², Tyler Glass², Stephen Rosenzweig², Andrew Buck³, John Madden³, Thomas Polascik¹ and Kathryn Nightingale² ¹Division of Urology, Duke Cancer Institute, Durham, NC; ²Duke Biomedical and Engineering; ³Duke Medical School, Department of Pathology Presented By: Melissa Mendez

Poster #47 PATHOLOGIC GLEASON 8-10: DO ALL MEN DO POORLY? RESULTS FROM THE SEARCH DATABASE Sean Fischer¹, Ross Simon²,³, Lauren Howard²,⁴, William Aronson⁵,⁶, Martha Terris⁷,⁸, Christopher Kane⁹, Christopher Amling¹⁰, Matt Cooperberg¹¹,¹²,¹³, Stephen Freedland²,³ and Adriana Vidal² ¹Duke Prostate Center, Division of Urological

44 Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; ²Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; ³Urology Section, Veterans Affairs Medical Center, Durham, NC; ⁴Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; ⁵Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, California; ⁶Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, California; ⁷Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, Georgia; ⁸Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, Georgia; ⁹Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, California; ¹⁰Department of Urology, Oregon Health and Science University, Portland, Oregon; ¹¹Department of Urology, University of California at San Francisco, San Francisco, California; ¹²Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California; ¹³Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, California Presented By: Sean Fischer

Poster #48 CAN GLEASON 7 PROSTATE CANCER EVER BE LOW-RISK? RESULTS FROM THE SHARED EQUAL ACCESS REGIONAL CANCER HOSPITAL (SEARCH) DATABASE Kathleen McGinley¹, Xizi Sun¹,², Lauren Howard¹,², William Aronson³,⁴, Martha Terris⁵,⁶, Christopher Kane⁷, Christopher Amling⁸, Matthew Cooperberg⁹ and Stephen Freedland¹,² ¹Duke University, Durham, NC; ²Veterans Affairs Medical Center, Durham, NC; ³Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; ⁴UCLA School of Medicine, Los Angeles, CA; ⁵Veterans Affairs Medical Center, Augusta, GA; ⁶Georgia Regents University, Augusta, GA; ⁷University of California San Diego Health System, San Diego, CA; ⁸Oregon Health Sciences University, Portland, OR; ⁹UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA Presented By: Kathleen McGinley

Poster #49 C-JUN NH2-TERMINAL KINASE-INDUCED PROTEASOMAL DEGRADATION OF C-FLIPL/S AND BCL2 SENSITIZE PROSTATE CANCER CELLS TO FAS- AND MITOCHONDRIA-MEDIATED APOPTOSIS BY TETRANDRINE. Pankaj Chaudhary and Jamboor Vishwanatha University of North Texas Health Science Center, Fort Worth, TX Presented By: Pankaj Chaudhary

45 Poster #50 THE PREVALENCE OF PROSTATE BIOPSY GLEASON SCORE ≥ 7(3+4) EXCEEDS 40% IN YOUNG PUERTO RICAN MEN SCREENED FOR PROSTATE CANCER: A CASE FOR EARLY DETECTION BEFORE AGE 55 IN OUR POPULATION Patricia Maymi and Ricardo Sanchez-Ortiz Robotic Urology and Oncology Institute, San Juan PR Presented By: Patricia Maymi

Poster #51 THE EFFECT OF NSAID USE ON DISEASE PROGRESSION IN PATIENTS ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER Joseph Spuches¹, Gautum Agarwal², Adam Luchey², Trushar Patel¹ and Julio Pow-Sang² thurs d ay ¹University of South Florida, Tampa, Florida; ²H. Lee Moffitt Cancer Center, Tampa, Florida Presented By: Gautum Agarwal

Poster #52 PRIOR GNRH AGONIST OVERUSE AND CONTEMPORARY QUALITY OF PROSTATE CANCER CARE Shellie Ellis¹, Matthew Nielsen², George Jackson³, Morris Weinberger², Stephanie Wheeler² and William Carpenter² ¹University of Kansas School of Medicine, Kansas City, KS; ²University of North Carolina, Chapel Hill; ³Duke University, Durham, NC Presented By: Shellie Ellis

Poster #53 IMPACT OF CCP TEST ON PERSONALIZING TREATMENT DECISIONS: RESULTS FROM A LARGE PROSPECTIVE REGISTRY OF NEWLY DIAGNOSED PROSTATE CANCER PATIENTS Mark L. Gonzalgo¹, Judd Boczko², Naveen Kella³, Brian Moran⁴, E. David Crawford⁵, Thaylon Davis⁶, Rajesh Kaldate⁶, Kirstin M. Roundy⁶, Michael K. Brawer⁶ and Neal Shore⁷ ¹University of Miami Miller School of Medicine, Miami, FL; ²WESTMED Medical Group, White Plains, NY; ³The Urology and Prostate Institute, San Antonio, TX; ⁴Chicago Prostate Cancer Center, Westmont, IL; ⁵University of Colorado at Denver, Aurora, CO; ⁶Myriad Genetic Laboratories, Inc., Salt Lake City, UT; ⁷Carolina Urologic Research Center, Myrtle Beach, SC Presented By: Mark Gonzalgo

Poster #54 ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER IN PUERTO RICAN PATIENTS SAFE ONLY AFTER OBTAINING A HISTOLOGY SLIDE REVIEW BY A FELLOWSHIP-TRAINED PATHOLOGIST Carlos Perez-Ruiz¹, Juan Serrano-Olmo², Curtis Pettaway³ and Ricardo Sanchez-Ortiz⁴ ¹University of Puerto Rico, San Juan PR; ²San Pablo Pathology Group, Bayamon PR; ³The University of Texas MD Anderson Cancer Center, Houston TX; ⁴Robotic Urology and Oncology Institute, San Juan PR Presented By: Carlos Perez-Ruiz

46 Poster #55 RACIAL DISPARITY IN POSITIVE PROSTATE NEEDLE BIOPSY TEMPLATES WHICH INCLUDE THE TRANSITION ZONE Justin Levy¹, Allison Feibus¹, Krishnarao Moparty², Ian McCaslin¹, Oliver Sartor¹ and Jonathan Silberstein¹ ¹Tulane University School of Medicine, New Orleans, LA; ²Southeast Louisiana Veterans Health Care Services, New Orleans, LA Presented By: Jonathan Silberstein

Poster #56 CHANGE IN PREDICTED PROGNOSIS AFTER RADICAL PROSTATECTOMY DURING FOLLOW-UP IN AN ACTIVE SURVEILLANCE COHORT John Eifler¹, Daren Diiorio¹, Chaochen You¹, Vidhush Yarlagadda², David Penson¹, Joseph Smith, Jr.¹, Sam Chang¹, Michael Cookson³ and Daniel Barocas¹ ¹Vanderbilt University Medical Center, Nashville, TN; ²University of Alabama at Birmingham, Birmingham, AL; ³University of Oklahoma College of Medicine, Oklahoma City, OK Presented By: John Eifler Jr.

Poster #57 PERIOPERATIVE, ONCOLOGICAL AND FUNCTIONAL OUTCOMES OF SALVAGE ROBOT ASSISTED RADICAL PROSTATECTOMY – A PROPENSITY SCORE MATCHED ANALYSIS Anthony Bates, Srinivas Samavedi, Anup Kumar, Rafael Coelho, Bernardo Rocco, Kenneth Palmer and Vipul Patel Department of Urology, University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health,Florida Presented By: Anthony Bates

Poster #58 POST-PROSTATECTOMY SERUM PSA CONTINUES TO RISE AFTER REACHING 0.1 NG/ML ON AN ULTRASENSITIVE ASSAY: A CASE FOR AN EARLIER DEFINITION OF FAILURE Jose Saavedra-Belaunde¹ and Ricardo Sanchez-Ortiz² ¹University of Puerto Rico, San Juan PR; ²Robotic Urology and Oncology Institute, San Juan PR Presented By: Jose Saavedra-Belaunde

Poster #59 MULTI-PARAMETRIC, DIFFUSION-WEIGHTED PROSTATE MRI IN CLINICALLY SUSPICIOUS PATIENTS WITH POSITIVE IMAGING: CAN WE IMPROVE OUR STANDARD REPORTING? Ryan Levey¹, Coti Phillips², Matt Young¹, James Rosoff³, Andrew Hardie⁴ and Stephen Savage¹ ¹Department of Urology, Medical University of South Carolina ; ²School of Medicine, Medical University of South Carolina ; ³Department of Urology, Yale School of Medicine (New Haven, CT); ⁴Department of Radiology, Medical University of South Carolina Presented By: Ryan Levey

47 Poster #60 PROSTATE CANCER LOCALIZATION ON NEEDLE CORE BIOPSY AS PREDICTOR FOR PATHOLOGIC STAGE Patrick Hensley¹, Lisa Bailey¹, Matthew Purdom², Daniel Davenport³ and Stephen Strup¹ ¹University of Kentucky College of Medicine Department of Urology; ²University of Kentucky College of Medicine Department of Pathology; ³University of Kentucky College of Medicine Department of Surgery Presented By: Patrick Hensley

Poster #61 NATURAL HISTORY OF MEN WITH A POSITIVE PROSTATE BIOPSY THAT IS OVERTURNED TO NEGATIVE AFTER A SECOND PATHOLOGICAL OPINION thurs d ay Eduardo Hernandez-Cardona¹, Juan Serrano-Olmo² and Ricardo Sanchez-Ortiz³ ¹University of Puerto Rico, San Juan PR; ²San Pablo Pathology Group, Bayamon PR; ³Robotic Urology and Oncology Institute, San Juan PR Presented By: Eduardo Hernandez-Cardona

Poster #62 CONTINENCE OUTCOMES OF ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN SUBOPTIMAL PATIENTS Anup Kumar, Srinivas Samavedi, Rafael Coelho, Bernardo Rocco, Kenneth Palmer and Vipul Patel Department of Urology, University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital-Celebration Health,Florida Presented By: Anup Kumar

Poster #63 CLINICAL OUTCOMES OF CONSERVATIVELY MANAGED PROSTATE CANCER AMONG AFRICAN AMERICAN MEN Amar Patel, Martin Sanda, Dattatraya Patil, Muta Issa and John Petros Emory University School of Medicine, Atlanta, GA Presented By: Amar Patel

Poster #64 DOES LARGER TUMOR VOLUME EXPLAIN THE HIGHER PSA LEVELS IN BLACK MEN WITH PROSTATE CANCER – RESULTS FROM THE SEARCH DATABASE Zachary Klaassen¹, Lauren Howard², Martha K. Terris¹, William J. Aronson³, Matthew R. Cooperberg⁴, Christopher L. Amling⁵, Christopher J. Kane⁶ and Stephen J. Freedland² ¹Medical College of Georgia - Georgia Regents University, Augusta, GA; ²Duke University Medical Center, Durham, NC; ³University of California, Los Angeles, Los Angeles, CA; ⁴University of California, San Francisco, San Francisco, CA; ⁵Oregon Health & Sciences University, Portland, OR; ⁶University of California, San Diego, San Diego, CA Presented By: Zachary Klaassen

48 Poster #65 UTILIZATION AND IMPACT OF SURGICAL TECHNIQUE ON THE PERFORMANCE OF PELVIC LYMPH NODE DISSECTION AT RADICAL PROSTATECTOMY: RESULTS FROM THE SEARCH DATABASE Kathleen McGinley¹, Xizi Sun¹,², Lauren Howard¹,², William Aronson³,⁴, Martha Terris⁵,⁶, Christopher Kane⁷, Christopher Amling⁸, Matthew Cooperberg⁹ and Stephen Freedland¹,² ¹Duke University, Durham, NC; ²Veterans Affairs Medical Center, Durham, NC; ³Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles,CA; ⁴UCLA School of Medicine, Los Angeles, CA; ⁵Veterans Affairs Medical Center, Augusta, GA; ⁶Georgia Regents University, Augusta, GA; ⁷University of California San Diego Health System, San Diego, CA; ⁸Oregon Health Sciences University, Portland, OR; ⁹UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA Presented By: Kathleen McGinley

Poster #66 PROSPECTIVE EVALUATION OF BLADDER NECK TUBULARIZATION DURING ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALRP) FOR PATIENTS WITH TRILOBAR HYPERTROPHY: FIVE YEAR FOLLOW-UP. Robert Carey, Paula Domino, Eliot Blau and James Pilkington Florida State University College of Medicine Presented By: Robert Carey

Poster #67 PERFORMANCE OF CCP ASSAY IN AN UPDATED SERIES OF BIOPSY SAMPLES OBTAINED FROM COMMERCIAL TESTING E. David Crawford¹, Neal Shore², Peter T. Scardino³, John W. Davis⁴, Jonathan Tward⁵, Lowndes Harrison⁶, Brent Evans⁷, Lisa FitzGerald⁸, Steven Stone⁸ and Michael K. Brawer⁷ ¹University of Colorado at Denver, Aurora, CO; ²Carolina Urologic Research Center, Myrtle Beach, SC; ³Memorial Sloan−Kettering Cancer Center, New York, NY; ⁴The University of Texas MD Anderson Cancer Center, Houston, TX; ⁵Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT; ⁶Gadsden Regional Cancer Center, Gadsden, AL; ⁷Myriad Genetic Laboratories, Inc., Salt Lake City, UT; ⁸Myriad Genetics, Inc., Salt Lake City, UT Presented By: E. David Crawford

Concurrent Sessions End

6:00 p.m. - 8:00 p.m. Welcome Reception Location: Chatham Ballrooms A&B

49 FRIDAY, MARCH 20, 2015

OVERVIEW

6:30 a.m. - 6:15 p.m. Registration/Information Desk Open Location: Georgia International Gallery

6:30 a.m. - 6:15 p.m. Speaker Ready Room Hours Location: Pulaski Boardroom

7:00 a.m. - 4:00 p.m. Exhibit Hall Open Location: Chatham Ballrooms A&B

7:30 a.m. - 10:30 a.m. Spouse/Guest Hospitality Suite Open Location: Riverscape (Westin Savannah Harbor Resort)

11:00 a.m. - 2:30 p.m. Shopping Tour in the Historic District Location: Attendees should meet in the resort lobby by 10:30 a.m.

7:00 p.m. - 10:30 p.m. Residents’ Night out (Program Chairs/Directors and Residents Only) Location: Westin Savannah Harbor Resort Dock

8:00 p.m. - 9:30 p.m. Historic District Walking Ghost Tour Location: Attendees should meet in the resort lobby by 7:30 p.m.

f ri d ay GENERAL SESSION

7:30 a.m. - 8:00 a.m. Urodynamics, Incontinence and Uro-Gynecology Podium Session Moderators: M. Louis Moy, MD Gainesville, FL Steven P. Petrou, MD Jacksonville, FL

7:30 a.m. #13 SUPERIOR EFFICACY OF COMBINATION PHARMACOTHERAPY FOR TREATMENT OF NEUROGENIC DETRUSOR OVERACTIVITY FOLLOWING SPINAL CORD INJURY Jessica Lloyd, Ngoc-Bich Le¹, John Wiener¹, Paul Dolber² and Matthew Fraser¹ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Durham Veterans Affairs Hospital, Durham, NC Presented By: Jessica Lloyd

7:37 a.m. #14 RECURRENT INCONTINENCE AFTER ARTIFICIAL URINARY SPHINCTER PLACEMENT: USE OF RADIOGRAPHIC CONTRAST AND OHMMETER ALLOWS SIMPLE TROUBLESHOOTING AND OBVIATES THE NEED FOR COMPLETE DEVICE REPLACEMENT Shubham Gupta, Patrick Selph, Michael Belsante, George Webster and Andrew Peterson Duke University, Durham, NC Presented By: Shubham Gupta

50 7:44 a.m. #15 CHANGING PRACTICE PATTERNS IN VAGINAL MESH SURGERY FOR PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE. Austin Younger¹, Goran Rac², Justin Ellett¹, Michelle Koski¹, Ross Rames¹ and Rovner Eric¹ ¹Department of Urology, Medical University of South Carolina, Charleston, SC; ²College of Medicine, Medical University of South Carolina, Charleston, SC Presented By: Austin Younger

7:51 a.m. #16 THE IMPACT OF OBESITY ON OUTCOMES AFTER RETROPUBIC MIDURETHRAL SLING FOR FEMALE STRESS URINARY INCONTINENCE Umar Karaman, Kevin Campbell, Clifton F. Frilot II and Alex Gomelsky LSU Health - Shreveport, LA Presented By: Umar Karaman

8:00 a.m. - 8:40 a.m. Female Pelvic Medicine and Reconstruction Panel Moderator: Tracey Small Wilson, MD Birmingham, AL

8:00 a.m. - 8:10 a.m. Sacral Neuromodulation Panelist: Tracey Small Wilson, MD Birmingham, AL

8:10 a.m. - 8:20 a.m. Urethral Bulking Agents Panelist: Ryan M. Krlin, MD New Orleans, LA

8:20 a.m. - 8:30 a.m. Mesh Sling Complications Panelist: Eric Scott Rovner, MD Charleston, SC

8:30 a.m. - 8:40 a.m. The Failed Sling Panelist: Alexander Gomelsky, MD Shreveport, LA

8:40 a.m. - 10:30 a.m. Gee-Dineen Health Policy Forum 1 Moderators: Martin K. Dineen, MD Daytona Beach, FL Raju Thomas, MD, FACS, MHA New Orleans, LA

8:40 a.m. - 9:10 a.m. Ambrose-Reed Lecture: The A.C.A One Year Later, Effects on Access and Specialty Care Invited Speaker: J. Leonard Lichtenfeld, MD, MACP Atlanta, GA

9:10 a.m. - 9:40 a.m. How to Maintain Your Independent Practice: Experiences of our Private/ Academic/Hospital Owned/Private Practice! Invited Speaker: Michael Dean Fabrizio, MD Virginia Beach, VA

51 9:40 a.m. - 10:10 a.m. The Quality Improvement Initiative: When Did the Train Go So Far Off the Tracks? Speaker: David F. Penson, MD, MPH Nashville, TN

10:10 a.m. - 10:30 a.m. Q&A 10:30 a.m. - 11:00 a.m. Break - Visit Exhibits 11:00 a.m. - 11:30 a.m. Montague Boyd Essay Contest Moderator: Glenn M. Preminger, MD Durham, NC Finalists: James Liu, BS New Orleans, LA Jessica C. Lloyd, MD Durham, NC Paymon Nourparvar, MD Atlanta, GA

11:30 a.m. - 12:05 p.m. Ballenger Lecture: Can Stem Cells Revive the Failing Penis? Introducer: Jack M. Amie, MD Brunswick, GA Invited Speaker: Tom F. Lue, MD San Francisco, CA

12:05 p.m. - 12:30 p.m. State of the Art Lecture: Intravesical Therapy for Non-Muscle Invasive Bladder Cancer: Current and Future Directions f ri d ay Invited Speaker: James Michael McKiernan, MD New York, NY

12:30 p.m. - 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 200-202 See page 17 for full details

12:30 p.m. - 1:30 p.m. Industry Sponsored Lunch Symposium Location: Room 203-205 See page 17 for full details

1:30 p.m. - 1:40 p.m. Best Video Viewing and Award Presentation Moderator: Benjamin R. Lee, MD New Orleans, LA

Video #1 COMPLEX ROBOTIC URETEROPLASTY USING BUCCAL MUCOSAL GRAFT ONLAY FOR TREATMENT OF 3 CM PROXIMAL URETERAL STRICTURE Carrie Stewart¹, Michael Maddox², Michael Ellis² and Benjamin Lee² ¹Tulane University School of Medicine Department of Urology ; ²Tulane University School of Medicine Department of Urology (New Orleans, LA, United States) Presented By: Michael Maddox

52 1:40 p.m. - 2:25 p.m. Presidential Lecture: “Screening for Prostate Cancer: Is There a Better Way?” Introducer: Jack M. Amie, MD Brunswick, GA Invited Speaker: Peter T. Scardino, MD New York, NY

2:25 p.m. - 3:25 p.m. Pediatric Plenary Session 2:25 p.m. - 3:00 p.m. Pediatrics Podium Session Moderators: Marcos R. Perez-Brayfield, MD Caguas, PR John Crittenden Pope, IV, MD, FAAP Nashville, TN

2:25 p.m. #17 COMPLICATIONS OF SACRAL NEUROMODULATION IN CHILDREN Matthew Mason, Christina Ching, Douglass Clayton, Stacy Tanaka, John Thomas, Mark Adams, John Brock and John Pope Vanderbilt University, Pediatric Urology Presented By: Matthew Mason

2:32 p.m. #18 MEDICAL EXPULSIVE THERAPY FOR PEDIATRIC UROLITHIASIS: SYSTEMATIC REVIEW AND META-ANALYSIS Nermarie Velázquez, Daniel Zapata, Hsin- Hsiao Wang, Sherry Ross, John Wiener, MIchael Lipkin and Jonathan Routh Duke University Medical Center, Durham, NC Presented By: Hsin-Hsiao Wang

2:39 p.m. #19 HEALTH-RELATED QUALITY OF LIFE IN CHILDREN WITH PRUNE BELLY SYNDROME AND THEIR CAREGIVERS Angela Arlen¹, Michael Garcia-Roig², Natan Seidel¹, Edwin Smith¹ and Andrew Kirsch¹ ¹Department of Pediatric Urology, Children’s Healthcare of Atlanta & Emory University School of Medicine; ²Children’s hospital of Atlanta/ Emory University Department of Pediatric Urology Presented By: Michael Garcia-Roig

2:46 p.m. #20 DAILY ENEMA REGIMEN IS SUPERIOR TO TRADITIONAL THERAPY FOR VOIDING DYSFUNCTION Steve Hodges Wake Forest Baptist Medical Center Presented By: Steve Hodges

2:53 p.m. #21 COMPLICATIONS RELATED TO LOWER URINARY TRACT RECONSTRUCTION IN A PEDIATRIC POPULATION: CLASSIFICATION BY CLAVIEN GRADE Deborah Jacobson, Matthew Mason, John Brock, John Pope, John Thomas, Stacy Tanaka, Douglass Clayton and Mark Adams Vanderbilt University, Nashville TN Presented By: Deborah Jacobson

53 3:00 p.m. - 3:25 p.m. Pediatric Urology State of the Art Lecture: Congenital Urologic Problems in Adulthood: Impact and Management Invited Speaker: Douglas A. Husmann, MD Rochester, MN

3:25 p.m. - 3:45 p.m. Break - Visit Exhibits

Concurrent Sessions Begin

Concurrent Session 1 of 6

3:45 p.m. - 4:40 p.m. BPH, Incontinence, Urodynamics, Reconstruction and Miscellaneous Poster Session Location: Room 100 Moderators: Ryan P. Terlecki, MD Winston-Salem, NC Andrew Charles Peterson, MD, FACS Durham, NC

Poster #68 3-D BIOPRINTING OF MUSCLE CONSTRUCTS FOR UROGENITAL RECONSTRUCTION Ji Hyun Kim, Young Joon Seol, In Kap Ko, Hyun Wook Kang, John Jackson, Sang Jin Lee, James Yoo and Anthony Atala

Wake Forest School of Medicine, Winston Salem, f ri d ay NC Presented By: John Jackson

Poster #69 ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY: ASSESSMENT OF OUTCOMES AND MODIFICATION OF TECHNIQUE Andrew Davidiuk¹, Camille Meschia², Paul Young¹ and David Thiel¹ ¹Mayo Clinic Florida, Jacksonville, FL; ²Jacksonville, FL Presented By: Andrew Davidiuk

Poster #70 EXTRAVASATION ON POSTOPERATIVE PERI- CATHETER RETROGRADE URETHROGRAM AFTER BULBAR URETHROPLASTY: TIME TO PULL THE RUG OUT? Michael Granieri, George Webster and Andrew Peterson Duke University Medical Center Presented By: Michael Granieri

Poster #71 LONG-TERM OUTCOMES OF ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH A PRIOR RECTOURETHRAL FISTULA REPAIR J. Patrick Selph, Michael J. Belsante, Andrew C. Peterson, George D. Webster and Aaron C. Lentz Duke University Medical Center, Durham, NC Presented By: John Selph

54 Poster #72 LONG-TERM RESULTS OF SALVAGE AUTOLOGOUS FASCIAL SLING PLACEMENT AFTER FAILED SYNTHETIC MIDURETHRAL SLING FOR STRESS URINARY INCONTINENCE IN WOMEN Andrew Davidiuk¹, Bhupendra Rawal² and Steven Petrou³ ¹Mayo Clinic Florida, Jacksonville, FL; ²Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL; ³Department of Urology at Mayo Clinic Florida-Jacksonville, FL Presented By: Andrew Davidiuk

Poster #73 WITHDRAWN Poster #74 DIFFERENTIAL EFFECTS OF STEPWISE PHARMACOLOGICAL AUTONOMIC DENERVATION OR DIRECT SMOOTH MUSCLE RELAXATION ON URODYNAMIC INDICES IN CHRONIC SPINAL CORD INJURED RATS Matthew O. Fraser¹, Danielle J. Degoski², Jillene M. Brooks² and Paul C. Dolber³ ¹Division of Urology, Department of Surgery and Department of Research and Development, Duke University and Durham Veterans Affairs Medical Centers, Institute for Medical Research, Durham, NC; ²Institute for Medical Research, Durham, NC; ³Division of Surgical Sciences, Department of Surgery and Department of Research and Development, Duke University and Durham VA Medical Centers, Durham, NC Presented By: Matthew Fraser

Poster #75 REGENERATION OF TISSUE THROUGH ENDOGENOUS CELL RECRUITMENT Young Min Ju, James Yoo, John Jackson, Sang Jin Lee and Anthony Atala Wake Forest School of Medicine, Winston Salem, NC Presented By: John Jackson

Poster #76 REVIEW OF DIFFICULT CATHETER CONSULTS OVER ONE YEAR AT A SINGLE TEACHING HOSPITAL Lindsey Hartsell, Glen Lau, Amanda Pettibone-Pond and Robert Wake UTHSC, Memphis, TN Presented By: Lindsey Hartsell

55 Concurrent Session 2 of 6

3:45 p.m. - 4:40 p.m. Bladder Cancer, Upper Tract TCC and Urinary Diversion, Miscellaneous Poster Session Location: Room 101 Moderators: Paul L. Crispen, MD Gainesville, FL Jonathan Silberstein, MD New Orleans, LA

Poster #77 PREDICTORS OF UPPER TRACT UROTHELIAL CARCINOMA IN PATIENTS WITH A HISTORY OF BLADDER CANCER Zachary Klaassen¹, Rita P. Jen¹, Lael Reinstatler¹, Daniel Belew¹, John M. DiBianco², Qiang Li¹, Rabii Madi¹ and Martha K. Terris¹ ¹Medical College of Georgia - Georgia Regents University, Augusta, GA; ²Ross University School of Medicine, Dominica, West Indies Presented By: Zachary Klaassen

Poster #78 TISSUE IS THE ISSUE: THE IMPACT AND BENEFIT OF PATHOLOGICAL REVIEW FOR UROTHELIAL CARCINOMA OF THE BLADDER AT A TERTIARY CARE CANCER CENTER Adam Luchey¹, Neal Manimala², Shohreh Dickinson², Jasreman Dhillon², Gautum Agarwal², Scott Gilbert², Philippe Spiess², Wade Sexton², Julio f ri d ay Pow-Samg² and Michael Poch² ¹H. Lee Moffitt Cancer Center, Tampa, Florida; ²H. Lee Moffitt Cancer Center, Tampa, FL Presented By: Adam Luchey

Poster #79 THE IMPACT OF DEFINITIVE PROSTATE CANCER TREATMENT ON POSITIVE MARGINS AT TIME OF RADICAL CYSTECTOMY Adam Luchey¹, Hui-Yi Lin², Binglin Yue², Gautum Agarwal², Julio Pow-Sang², Philippe Spiess², Michael Poch², Scott Gilbert², Jorge Lockhart² and Wade Sexton² ¹H. Lee Moffitt Cancer Center, Tampa, Florida; ²H. Lee Moffitt Cancer Center, Tampa, FL Presented By: Adam Luchey

Poster #80 RADICAL CYSTECTOMY WITH CURATIVE INTENT FOR REFRACTORY CARCINOMA IN SITU OF THE BLADDER: INSIGHT INTO PATIENT OUTCOMES AND PATTERNS OF CARE Gautum Agarwal, Oscar Valderrama, Patrick Espiritu, Adam Luchey, Jorge Lockhart, Julio Pow- Sang, Wade Sexton, Michael Poch and Philippe E Spiess H. Lee Moffitt Cancer Center, Tampa, Florida Presented By: Gautum Agarwal

56 Poster #81 SHORT TERM COMPLICATIONS RESULTING FROM TRANS-URETHRAL RESECTION OF BLADDER TUMOR IN A CONTEMPORARY SERIES Benjamin McCormick¹, Justin Gregg¹, Li Wang², Joseph Smith¹, Daniel Barocas¹, Matthew Resnick¹, Daniel Sun¹ and Sam Chang¹ ¹Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN Presented By: Benjamin McCormick

Poster #82 TRENDS AND PREDICTORS OF PALLIATIVE CARE SERVICES AND MORTALITY IN THE TREATMENT OF ADVANCED BLADDER CANCER Tracy Rose, Matthew Lyons, Allison Deal, E. Sophie Spencer, Peter Greene, Matthew Nielsen, Raj Pruthi, Eric Wallen, Matthew Milowsky and Angela Smith Chapel Hill, NC Presented By: Matthew Lyons

Poster #83 TEMPORAL TRENDS IN CONCOMITANT CYSTECTOMY WITH URINARY DIVERSION FOR BENIGN INDICATIONS IN THE NATIONWIDE INPATIENT SAMPLE Elizabeth T. Brown, David Osborn, Stephen Mock, Amy Graves, Laurel Milam, Douglas Milam, Melissa Kaufman, Roger Dmochowski and W. Stuart Reynolds Vanderbilt University Medical Center, Nashville, TN Presented By: Elizabeth Brown

Poster #84 IMPACT OF NEOADJUVANT SYSTEMIC CHEMOTHERAPY ON CARCINOMA IN SITU OF THE BLADDER: IMPLICATIONS FOR BLADDER PRESERVATION. Kamran Zargar-Shoshtari¹, Pranav Sharma¹, Michael A. Poch¹, Philippe E. Spiess¹, Shilpa Gupta¹, Jasreman Dhillon², Julio M. Pow-Sang¹, Jorge Lockhart¹ and Wade J. Sexton¹ ¹Departments of Genitourinary Oncology , Moffitt Cancer Center, Tampa, FL; ²Departments of Pathology, Moffitt Cancer Center, Tampa, FL Presented By: Kamran Zargar Shoshtari

Concurrent Session 3 of 6

3:45 p.m. - 5:45 p.m. Pediatric Sub-plenary Session 2 Location: Room 102/103

3:45 p.m. - 5:45 p.m. Ask the “Seniors” Moderator: David B. Joseph, MD Birmingham, AL Panelists: John S. Wiener, MD Durham, NC Douglas A. Husmann, MD Rochester, MN Edwin Agan Smith, MD Atlanta, GA

57 Concurrent Session 4 of 6

4:45 p.m. - 5:15 p.m. State of the Art Lecture: Management of Small Renal Masses Speaker: Viraj A. Master, MD, PhD, FACS Atlanta, GA

Concurrent Session 5 of 6

4:45 p.m. - 6:15 p.m. Andrology, Urethral Stricture, Trauma Poster Session Location: Room 100 Moderators: Peter Nicholas Kolettis, MD Birmingham, AL Matthew Coward, MD Chapel Hill, NC

Poster #85 RACIAL AND AGE DIFFERENCES IN IMPLANTATION OF INFLATABLE PENILE PROSTHESIS (IPP) FOR ERECTILE DYSFUNCTION (ED) THE PROSTATE CANCER SURVIVOR Divya Ajay¹, Shubham Gupta², Michael Belsante³, John Selph³ and Andrew Peterson³ ¹Division of Urology, Duke University Medical Center, Durham, NC; ²University of Kentucky, Lexington, KY; ³Duke University Medical Center, f ri d ay Durham, NC Presented By: Divya Ajay

Poster #86 OBSERVATION OF LOCAL CLINICAL PENILE PROSTHESES INFECTIONS INSTEAD OF IMMEDIATE SAVAGE RESCUE / REMOVAL: MULTICENTER STUDY WITH SURPRISING RESULTS Gerard Henry¹, Gary Price², Michael Pryor³, Jason Greenfield², Leroy Jones⁴, Tobias Kohler⁵, Irwin Goldstein⁶ and Paul Perito⁷ ¹Regional Urology, Shreveport, LA; ²Urology Associates of North Texas, Arlington, TX; ³Urology Center of Spartanburg, Spartanburg, SC; ⁴Urology San Antonio, San Antonio, TX; ⁵Southern Illinois University, Springfield, IL; ⁶Institute for Sexual Medicine, San Diego, CA; ⁷Perito Urology, Coral Gables, FL Presented By: Gerard Henry

Poster #87 COLOR DUPLEX DOPPLER ULTRASOUND (CDDU) ANALYSIS OF CAVERNOUS VENOUS OCCLUSIVE DISEASE (CVOD) PATIENTS: ARE ARTERIOGENIC RISK FACTORS IMPLICATED? Ram Pathak, Russell Chavers and Gregory Broderick Mayo Clinic Jacksonville, Florida Presented By: Ram Pathak

58 Poster #88 SURGICAL MANAGEMENT OF ERECTILE DYSFUNCTION IN THE VETERANS AFFAIRS (VA) POPULATION John Lacy, Jonathan Walker and David Preston University of Kentucky and VA Medical Center, Lexington KY Presented By: John Lacy

Poster #89 JUST THE TIP: CLOSED-SUCTION DRAIN CULTURES AFTER IMPLANTATION OF PENILE PROSTHESES Jonathan Beilan, John Hoenemeyer, Jared Wallen, Daniel Martinez, Justin Parker and Carrion Rafael Department of Urology, University of South Florida, Tampa, FL Presented By: Jonathan Beilan

Poster #90 THE CARRION CAST: AN UPDATE ON THE USAGE OF THE INTRACORPORAL ANTIMICROBIAL DOPED SPACER FOR THE TREATMENT OF PENILE IMPLANT INFECTION Daniel Martinez, Eihab Alhammali, Tariq Hakky, Justin Parker and Rafael Carrion University of South Florida, Tampa, FL Presented By: Daniel Martinez

Poster #91 EXERCISE AND BETTER ERECTILE FUNCTION: HOW MUCH EXERCISE IS NEEDED AND DOES RACE MATTER? Ross Simon¹,², Lauren Howard¹,³, Daniel Zapata¹,², Jennifer Frank¹,², Stephen Freedland¹,² and Adriana Vidal¹,² ¹Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; ²Urology Section, Veterans Affairs Medical Center, Durham, NC; ³Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC Presented By: Ross Simon

Poster #92 FUNCTIONAL OUTCOMES AND FOLLOW-UP CARE AFTER PRIAPISM TREATMENT: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION Stephen Kappa¹, Elizabeth Green², Shreyas Joshi¹, Melissa Kaufman¹ and Doug Milam¹ ¹Vanderbilt Department of Urologic Surgery, Nashville, TN; ²Vanderbilt University School of Medicine, Nashville, TN Presented By: Stephen Kappa

Poster #93 THE PRESENCE AND ETIOLOGY OF ERECTILE DYSFUNCTION (ED) IN PEYRONIE’S DISEASE (PD) PATIENTS AS DEMONSTRATED BY COLOR DOPPLER DUPLEX ULTRASOUND (CDDU) ANALYSIS Ram Pathak, Russell Chavers and Gregory Broderick Mayo Clinic Jacksonville, Florida Presented By: Ram Pathak

59 Poster #94 INCREASING AGE, PROSTATE WEIGHT, AND DIABETES INDEPENDENTLY ASSOCIATED WITH ERECTILE DYSFUNCTION AFTER ROBOTIC PROSTATECTOMY IN HISPANIC MEN Daniel Hoffman¹, Hector Lopez-Huertas², Ronald Cadillo-Chavez² and Ricardo Sanchez-Ortiz² ¹University of Puerto Rico, San Juan PR; ²Robotic Urology and Oncology Institute, San Juan PR Presented By: Daniel Hoffman

Poster #95 SALVAGE ULTRASOUND GUIDED TARGETED MICROCRYOABLATION OF THE PERI- SPERMATIC CORD FOR PERSISTENT CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt and Sijo Parekattil The PUR Clinic, Orlando, FL Presented By: Bayo Tojuola

Poster #96 DISPARITIES IN INTERPRETATION OF PRIMARY TESTICULAR GERM CELL TUMOR PATHOLOGY Pranav Sharma, Gautum Agarwal, Kamran Zargar- Shoshtari, Jasreman Dhillon and Wade Sexton Moffitt Cancer Center, Tampa, FL Presented By: Pranav Sharma f ri d ay Poster #97 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD. Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt and Sijo Parekattil The PUR Clinic, Orlando, FL Presented By: Bayo Tojuola

Poster #98 PRELIMINARY ASSESSMENT ON THE TREATMENT OF ERECTILE DYSFUNCTION WITH TRIMIX GEL Daniel Martinez¹, Joel Chechik², Carey Frasca² and Rafael Carrion¹ ¹University of South Florida, Tampa, FL; ²MenMD, Tampa, FL Presented By: Daniel Martinez

60 Concurrent Session 6 of 6

5:15 p.m. - 6:15 p.m. Renal Cancer Podium Session Moderators: David D. Thiel, MD Jacksonville, FL Donald Alan Elmajian, MD Shreveport, LA

5:15 p.m. #22 IS FOLLOW UP BEYOND 2 YEARS NECESSARY FOR PT1A RENAL CELL CARCINOMA TREATED WITH NEPHRON SPARING SURGERY? AN ASSESSMENT OF LATE RECURRENCES AND SURVEILLANCE COSTS. Kamran Zargar-Shoshtari¹, Tim Kim², Ross Simon², Hui-Yi Lin³, Binglin Yue³, Pranav Sharma², Philippe Spiess², Michael Poch², Julio Pow Sang² and Wade Sexton² ¹Departments of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL; ²Departments of Genitourinary Oncology, Moffitt Cancer Centre, Tampa, FL; ³Departments of Biostatistics, Moffitt Cancer Centre, Tampa, FL Presented By: Kamran Zargar Shoshtari

5:22 p.m. #23 LYMPH NODE STROMAL CELLS ENHANCE RENAL CELL CARCINOMA GROWTH, TRANSMIGRATION, AND METASTASIS IN AN ORTHOTOPIC XENOGRAFT MODEL John Nelson¹, Jessie Gills¹, Ravan Moret², Xin Zhang², Grace Maresh³, M’Liss Hudson¹, Marc Matrana¹, Ryan Hedgepeth¹, Shams Halat¹, Christudas Morais³, Glenda Globe³, David Johnson³, Stephen Bardot¹ and Li Li² ¹Ochsner Clinic Foundation; ²Ochsner laboratory of Translational Research; ³University of Queensland Centre for Kidney Disease Research Presented By: John Nelson

5:29 p.m. #24 L-2-HYDROXYGLUTARATE: A PUTATIVE ONCOMETABOLITE IN CLEAR CELL RENAL CELL CARCINOMA Jubilee Tan, Daniel Benson, Eun-Hee Shim and Sunil Sudarshan University of Alabama at Birmingham Presented By: Jubilee Tan

5:36 p.m. #25 DELAYED INTERVENTION OF SMALL RENAL MASSES ON ACTIVE SURVEILLANCE Mohit Gupta and Paul Crispen Department of Urology, University of Florida College of Medicine, Gainesville, FL Presented By: Mohit Gupta

5:43 p.m. #26 EXTERNAL VALIDATION OF THE MAYO CLINIC STAGE, SIZE, GRADE, AND NECROSIS (SSIGN) SCORE IN PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA TUMOR THROMBUS Viraj Master¹, C. Adam Lorentz¹, Caroline Tai¹, R.

61 Bertini², J. Carballido³, T. Chromecki⁴, G. Ciancio⁵, S Daneshmand⁶, C. Evans⁷, P. Gontero⁸, A. Haferkamp⁹, J. Gonzalez¹⁰, W. C. Huang¹¹, T. Hoppie¹², J. I. Martínez-Salamanca¹³, R. Matloob², J. McKiernan¹⁴, C. Mlynarczyk¹⁴, F. Montorsi², H. Nguyen⁷, G. Novara¹⁵, J. Palou¹⁶, R. Pruthi¹⁷, K. Ramaswamy¹¹, O. Rodríguez- Faba¹⁶, P. Russo¹⁸, S. Shariat¹⁹, M. Spahn²⁰, C. Terrone¹⁰, D. Tilki⁷, D. Vergho²⁰, E. Wallen¹⁷, E. Xylinas¹⁹, R. Zigeuner⁴ and J.A. Libertino¹¹ ¹Emory University, Atlanta, GA; ²Vita Salute San Raffaele University, Milano, Italy; ³Puerta de Hierro-Majadahonda, Madrid, Spain; ⁴Medical University of Graz, Graz, Austria; ⁵Miami University, Miami, FL; ⁶University of Southern California, Los Angeles, CA; ⁷University of California- Davis, Davis, CA; ⁸Molinette Hospital, Torino, Italy; ⁹University Hospital, Frankfurt, Germany; ¹⁰Hospital de Getafe, Madrid, Spain; ¹¹New York University Lagone Medical Center, New York, NY; ¹²Oregon Health & Science University, Eugene, Oregon; ¹³Puerta de Hierro- Majadahonda, Madrid, Spain; ¹⁴Columbia University, New York, NY; ¹⁵Padua University, Padova, Italy; ¹⁶Puigvert Fundación, Barcelona, Spain; ¹⁷University of North Carolina, Chapel Hill, NC; ¹⁸Memorial Sloan- Kettering Cancer Center, New York, NY; ¹⁹Weill Medical College at Cornell University, New York, NY; ²⁰University of Würzburg Clinic, Würzburg, Germany; ¹⁰Novara University, Novara, Italy; ¹¹Lahey Clinic Medical Center, f ri d ay Burlington, MA Presented By: Charles Lorentz

5:50 p.m. #27 OUTCOMES OF LAPAROSCOPIC CRYOABLATION OF RENAL TUMORS WITH ONCOLOGIC OUTCOMES REPORTED AND COMPLICATIONS CORRELATED TO R.E.N.A.L. NEPHROMETRY SCORES. A Scott Tully, Jr.¹, Thomas Holley² and Lee Hammontree³ ¹UAB School of Public Health, Birmingham AL; ²Urology Centers of Alabama, Birmingham AL; ³Urology Centers of Alabama, Birmingham, AL Presented By: Lee Hammontree

5:57 p.m. #28 MAYO ADHESIVE PROBABILITY (MAP) SCORE: AN ACCURATE IMAGE-BASED SCORING SYSTEM TO PREDICT ADHERENT PERINEPHRIC FAT IN PARTIAL NEPHRECTOMY Andrew Davidiuk¹, Alexander Parker², Colleen Thomas³, Bradley Leibovich⁴, Erik Castle⁵, Michael Heckman³, Kaitlynn Custer² and David Thiel⁶ ¹Mayo Clinic Florida, Jacksonville, FL; ²Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, FL; ³Division of Biomedical Statistics and Informatics at Mayo Clinic Florida, Jacksonville, FL; ⁴Department of Urology at Mayo Clinic, Rochester, MN; ⁵Department of Urology at Mayo Clinic Arizona, Phoenix, AZ; ⁶Department of Urology at Mayo Clinic Florida, Jacksonville, FL Presented By: Andrew Davidiuk

62 6:04 p.m. #29 SURGICAL MANAGEMENT OF RENAL CELL CARCINOMA IN OCTOGENARIANS AND NONAGENARIANS: DEFINING APPROPRIATE TREATMENT STANDARDS Zachary Klaassen¹, Rita P. Jen¹, John M. DiBianco², Lael Reinstatler¹, Daniel Belew¹, Qiang Li¹, Rabii Madi¹ and Martha K. Terris¹ ¹Medical College of Georgia - Georgia Regents University, Augusta, GA; ²Ross University School of Medicine, Dominica, West Indies Presented By: Zachary Klaassen

Concurrent Sessions End

SATURDAY, MARCH 21, 2015

OVERVIEW

6:00 a.m. - 1:00 p.m. Registration/Information Desk Open Location: Georgia International Gallery

6:00 a.m. - 1:00 p.m. Speaker Ready Room Hours Location: Pulaski Boardroom

7:00 a.m. - 11:30 a.m. Exhibit Hall Open Location: Chatham Ballrooms A&B

7:30 a.m. - 10:30 a.m. Spouse/Guest Hospitality Suite Open Location: Riverscape (Westin Savannah Harbor Resort)

12:30 p.m. - 3:30 p.m. Tennis at Westin Savannah Tennis Courts Location: Attendees should meet at the Westin Savannah Tennis Courts by 12:00 p.m.

1:00 p.m. - 4:00 p.m. In Shore Fishing with Miss Judy Location: Attendees should meet at the Westin Dock by 12:30 p.m.

1:00 p.m. - 5:30 p.m. Golf at The Club at Savannah Harbor Location: The Club at Savannah Harbor - 1:00 p.m. shotgun start

1:30 p.m. - 4:30 p.m. Hands-On Cooking Class at 700 Kitchen Cooking School Location: Attendees should meet in the resort lobby by 1:00 p.m.

2:30 p.m. 2nd Annual Hector Henry 5K Run/Walk 6:30 p.m. - 7:30 p.m. 2015 SESAUA Annual Reception Location: Grand Ballroom Pre-Function (Westin Savannah Harbor Resort)

7:30 p.m. - 12:00 a.m. 2015 SESAUA Annual Banquet Location: Grand Ballroom (Westin Savannah Harbor Resort)

63 Concurrent Sessions Begin

Concurrent Session 1 of 2

7:00 a.m. - 8:00 a.m. BPH and Urethral Stricture Podium Session Location: Room 102/103 Moderators: Muta M. Issa, MD MBA Decatur, GA Bruce R. Kava, MD Miami, FL

7:00 a.m. #30 ROBOTIC SIMPLE PROSTATECTOMY: A LARGE MULTI-INSTITUTIONAL OUTCOME ANALYSIS James Bienvenu¹, Kyle Basham¹, Riccardo Autorino², David Thiel³, W Bedford Waters¹ and Wesley White¹ ¹Division of Urology, University of Tennessee Medical Center - Knoxville, TN; ²University Hospitals Urology Institute; ³Mayo Clinic - Jacksonville, FL Presented By: James Bienvenu

7:07 a.m. #31 IS THE ETIOLOGY OF PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD) INJURIES EVOLVING? Divya Ajay¹, Michael Granieri², John Selph², Michael Belsante², George Webster² and Andrew Peterson² ¹Division of Urology, Duke University Medical Center, Durham, NC; ²Duke University Medical Center, Durham, NC Presented By: Divya Ajay

7:14 a.m. #32 CRITICAL ANALYSIS OF THE DELAY FROM DIAGNOSIS OF BULBAR URETHRAL STRICTURE DISEASE TO REFERRAL FOR DEFINITIVE URETHROPLASTY Divya Ajay¹, Michael Granieri², Michael Belsante², John Selph², Ngoc-Bich Phan Le², George Webster² and Andrew Peterson² ¹Division of Urology, Duke University Medical Center, S atur d ay Durham, NC; ²Duke University Medical Center, Durham, NC Presented By: Divya Ajay

7:21 a.m. #33 OUTCOMES OF DIRECT VISION INTERNAL URETHROTOMY WITH HIGH DOSE STEROID INJECTION FOR ANTERIOR URETHRAL STRICTURES: TECHNIQUE MODIFICATION Rishi Modh, Alyssa Sheffield and Lawrence Yeung University of Florida Presented By: Rishi Modh

64 7:28 a.m. #34 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES IN PATIENTS WITH PRIOR BENIGN PROSTATIC HYPERTROPHY (BPH) SURGERY Tracy Marien, Christopher Mitcherll¹, Ryan Pickens¹, Christopher Jaeger², Rafael Nunez Nateras³, Aaron Benson¹, Mark Sawyer¹, Davis Viprakasit⁴, Amy Krambeck⁵, Mitchell Humphreys³ and Nicole Miller¹ ¹Vanderbilt, Nashville, TN; ²Mayo, Rochester, AZ; ³Mayo, Scottsdale, AZ; ⁴UNC, Chapel Hill, NC; ⁵Mayo, Rochester, NY Presented By: Tracy Marien

7:35 a.m. #35 LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) IN A COMMUNITY PRACTICE Chandler Dora and Michael Guju Tampa, Florida Presented By: Chandler Dora

7:42 a.m. #36 DEVELOPMENT OF A NOVEL CONCENTRIC TUBE ROBOT FOR TRANSURETHRAL PROSTATE SURGERY Christopher Mitchell, Richard Hendrick, Tracy Marien, Robert Webster and S. Duke Herrell Vanderbilt University Medical Center, Nashville TN Presented By: Christopher Mitchell

7:49 a.m. #37 IMPLEMENTATION OF A SUPRAPUBIC CATHETER EDUCATION PROGRAM ON THE INPATIENT WARDS Gerald Heulitt, Rachel Baublet Head and Charles Pound University of Mississippi Medical Center Jackson, MS Presented By: Gerald Heulitt

Concurrent Session 2 of 2

7:00 a.m. - 8:00 a.m. Video Session I Location: Room 105/106 Moderator: Benjamin R. Lee, MD New Orleans, LA

Video #1 COMPLEX ROBOTIC URETEROPLASTY USING BUCCAL MUCOSAL GRAFT ONLAY FOR TREATMENT OF 3 CM PROXIMAL URETERAL STRICTURE Carrie Stewart¹, Michael Maddox², Michael Ellis² and Benjamin Lee² ¹Tulane University School of Medicine Department of Urology ; ²Tulane University School of Medicine Department of Urology (New Orleans, LA, United States) Presented By: Carrie Stewart

Video #2 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): STEP-BY-STEP Christopher Mitchell and Nicole Miller Vanderbilt University Medical Center, Nashville TN Presented By: Christopher Mitchell

65 Video #3 IDENTIFICATION OF THE S3 FORAMEN DURING TRANSFORAMINAL SACRAL NEUROMODULATION LEAD PLACEMENT - A NOVEL “ROLLING PEN” TECHNIQUE Amanda Saltzman¹, Kristi Hebert¹, Howard Woo² and Ryan Krlin¹ ¹Louisiana State University, New Orleans, LA; ²Ochsner Clinic Foundation, New Orleans, LA Presented By: Kristi Hebert

Video #4 ROBOTIC REPAIR OF RECTOVESICAL FISTULA: COMBINED ANTERIOR AND POSTERIOR APPROACH WITH OMENTAL FLAP INTERPOSITION Rishi Modh¹, Katherine Corbyons², Sanda Tan², Li- Ming Su² and Lawrence Yeung² ¹University of Florida; ²Unverisity of Florida Presented By: Rishi Modh

Video #5 A NOVEL DEVICE FOR INTRAPERITONEAL CAMERA CLEANING: ROBOTIC SURGERY WITH FLOSHIELD TECHNOLOGY Julie Wang, Michael Maddox, Philip Dorsey and Benjamin Lee Tulane University New Orleans, LA Presented By: Julie Wang

Video #6 POSTERIOR, TRANSVESICAL APPROACH FOR ROBOTIC SIMPLE PROSTATECTOMY AND BLADDER STONE REMOVAL Justin Ellett¹, Lydia Labocetta², Sandip Prasad and Harry Clarke² ¹MUSC; ²MUSC, Charleston, SC Presented By: Justin Ellett

Concurrent Sessions End S atur d ay 8:00 a.m. - 8:30 a.m. State of the Art Lecture: Management of Anterior Urethral Stricture Invited Speaker: Allen F. Morey, MD Dallas, TX

8:30 a.m. - 10:30 a.m. Gee-Dineen Health Policy Forum 2 Moderators: William F. Gee, MD Lexington, KY W. Terry Stallings, MD, FACS Pensacola, FL

8:30 a.m. - 9:00 a.m. Evolving Practice Patterns in the Ever Changing Payment Environment: Are You In or Out of the Corral? Invited Speaker: J. Leonard Lichtenfeld, MD, MACP Atlanta, GA

66 9:00 a.m. - 9:30 a.m. The Pathway for Survival of Academic Medical Centers in the Current Healthcare Environment Invited Speaker: William Ferniany, PhD Birmingham, AL

9:30 a.m. - 10:00 a.m. The ACA, the AUA and you: How is the Alphabet Soup Going to Effect the Average Urologist’s Practice? Speaker: David F. Penson, MD, MPH Nashville, TN

10:00 a.m. - 10:30 a.m. Q & A 10:30 a.m. - 11:00 a.m. Break - Visit Exhibits 11:00 a.m. - 11:30 a.m. Resident Quiz Bowl Moderator: Charles R. Pound, MD Jackson, MS

11:30 a.m. - 11:45 a.m. SESAUA Update President: Jack M. Amie, MD Brunswick, GA

11:45 a.m. - 12:00 p.m. AUA Update AUA President-Elect: William F. Gee, MD Lexington, KY

12:00 p.m. - 1:00 p.m. T-Leon Howard Imaging Session Moderator: Chad W.M. Ritenour, MD Atlanta, GA

Case #1 60 YEAR-OLD MALE WITH 4 WEEKS HISTORY OF PRIAPISM Abby Taylor MD¹ and Gregory Broderick MD² ¹Mayo Clinic Florida, Department of Urology, Jacksonville, FL; ²Mayo Clinic Florida, Departement of Urology, Jacksonville, FL Presented By: Abby Taylor

Case #2 A SUSPICIOUS RENAL MASS WITH HYPERTENSION Christopher Sherman MD and Jamie Messer MD University of Louisville, Louisville, KY Presented By: Christopher Sherman

Case #3 A CURIOUS CASE OF COMPROMISED CONTINENCE Amanda Saltzman MD and Christopher Roth MD Louisiana State University, New Orleans, LA Presented By: Amanda Saltzman

Case #4 A FEMALE WITH URINARY INCONTINENCE Jessica Lange MD and Majid Mirzazadeh MD Wake Forest Baptist Health, Winston-Salem, NC Presented By: Jessica Lange

Case #5 AN OBESE AFRICAN AMERICAN MALE WITH ABDOMINAL PAIN Matthew Mutter MD¹,² and Anthony Patterson MD¹,² ¹UT-Memphis; ²Memphis, TN Presented By: Matthew Mutter

67 Case #6 INCIDENTAL FINDING IN ADULT MALE WITH CHRONIC KIDNEY DISEASE Jacob Ark MD¹ and Kelvin Moses MD, PhD² ¹Vanderbilt University, Nashville, TN; ²Vanderbilt University Medical Center, Nashville, TN Presented By: Jacob Ark

6:30 p.m. - 7:30 p.m. 2015 SESAUA Annual Reception Location: Grand Ballroom Pre-Function (Westin Savannah Harbor Resort)

7:30 p.m. - 12:00 a.m. 2015 SESAUA Annual Banquet Location: Grand Ballroom (Westin Savannah Harbor Resort)

SUNDAY, MARCH 22, 2015

OVERVIEW

5:30 a.m. - 12:15 p.m. Registration/Information Desk Open Location: Georgia International Gallery

5:30 a.m. - 12:15 p.m. Speaker Ready Room Hours Location: Pulaski Boardroom

7:30 a.m. - 10:30 a.m. Spouse/Guest Hospitality Suite Open Location: Riverscape (Westin Savannah Harbor Resort)

Concurrent Sessions Begin

Concurrent Session 1 of 4

6:30 a.m. - 7:30 a.m. Video Session II Location: Room 105/106 Moderator: Soroush Rais-Bahrami, MD Birmingham, AL

Video #7 ROBOTIC RIGHT ADRENALECTOMY FOR PHEOCHROMOCYTOMA: A STEPWISE APPROACH Timothy Brock¹ and Wesley White² ¹University of Tennessee Medical Center, Knoxville, TN; ²University of Tennessee Medical Center Knoxville Presented By: Timothy Brock

Video #8 ROBOTIC EXTRAVESICAL REIMPLANT ON A

SOLITARY KIDNEY S u nd ay Anthony Tracey, Gregory Mitchell and Raju Thomas Tulane University School of Medicine - New Orleans, LA Presented By: Anthony Tracey

68 Video #9 ROBOT-ASSISTED LAPAROSCOPIC EXCISION OF UNCOMMON RETROPERITONEAL MASSES Jason Joseph, Akira Yamamoto and Li-Ming Su Department of Urology, University of Florida College of Medicine, Gainesville, FL Presented By: Jason Joseph

Video #10 ROBOTIC URETEROLITHOTOMY: OPTIMIZING CLEARANCE OF LARGE URETERAL STONE BURDEN GREATER THAN 2 CENTIMETERS Mary Powers, Michael Maddox, Julie Wang and Benjamin Lee Tulane University New Orleans, LA Presented By: Mary Powers

Video #11 VASECTOMY SIMULATION AND RESIDENT TRAINING: REQUIRED COMPLETION OF VASECTOMY CHECKLIST PRIOR TO LIVE SURGICAL EXPERIENCE Ram Pathak, Scott Alford, David Thiel and Todd Igel Mayo Clinic Jacksonville, Florida Presented By: Ram Pathak

Video #12 ADJUSTABLE SINGLE-INCISION MID- URETHRAL SLING FOR PURE STRESS URINARY INCONTINENCE James Bienvenu and Wesley White Division of Urology, University of Tennessee Medical Center - Knoxville, TN Presented By: James Bienvenu

Concurrent Session 2 of 4

6:30 a.m. - 8:30 a.m. Renal Cancer and Miscellaneous Poster Session Location: Room 100 Moderators: Antonio Puras-Baez, MD Santurce, PR Amar Singh, MD Chattanooga, TN

Poster #109 HIGH EXPRESSION OF MAJOR HISTOCOMPATIBILITY COMPLEX CLASS I IN CLEAR CELL RENAL CELL CARCINOMA IS ASSOCIATED WITH IMPROVED PROGNOSIS Rishi Sekar¹, Claire M. de la Calle¹, Sarah A. Holzman², Jonathan H. Huang², Haydn T. Kissick², Adeboye O. Osunkoya³, Brian P. Pollack⁴, Dattatraya Patil², Kenneth Ogan² and Viraj A. Master² ¹Emory University School of Medicine, Atlanta, GA; ²Emory University Department of Urology, Atlanta, GA; ³Emory University Department of Pathology, Atlanta, GA; ⁴Emory University Department of Dermatology, Atlanta, GA Presented By: Rishi Sekar

69 Poster #110 IMPACT OF SARCOPENIA ON OVERALL SURVIVAL AND COMPLICATIONS IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY FOR T3 OR T4 KIDNEY CANCER Charles Peyton, Spencer Krane, James Rague and Ashok Hemal Wake Forest Baptist Medical Center Presented By: Charles Peyton

Poster #111 COMPARISON OF SORAFENIB-LOADED PLGA AND LIPOSOME NANOPARTICLES IN THE IN VITRO TREATMENT OF RENAL CELL CARCINOMA James Liu¹, Benjawan Boonkaew², Katie Powers¹, Sree Harsha Mandava¹, Jaspreet Arora², Michael Maddox¹, Srinivas Chava³, Cameron Callaghan¹, Srikanta Dash³, Vijay John² and Benjamin Lee¹ ¹Tulane University School of Medicine, Department of Urology, New Orleans, LA; ²Tulane University, Department of Chemical Engineering, New Orleans, LA; ³Tulane University School of Medicine, Department of Pathology, New Orleans, LA Presented By: James Liu

Poster #112 PREOPERATIVE LABORATORY VALUES AS PREDICTORS OF INTRA-OPERATIVE COMPLEXITY AND POST-OPERATIVE COMPLICATION RISK IN IVC THROMBECTOMY FOR RENAL CELL CARCINOMA WITH INFERIOR VENA CAVA THROMBUS Christopher Russell¹, Kathy Lue¹, Patrick Espiritu², Tony Kurian², Gautum Argawal², Adam Luchey², Wade J. Sexton², Michael Poch², Julio Powsang² and Phillippe E. Spiess² ¹USF Morsani College of Medicine; ²H. Lee Moffitt Cancer Center Presented By: Christopher Russell

Poster #113 ALLOGRAFT TRANSPLANT RADICAL NEPHRECTOMY FOR RENAL CANCER: OUTCOMES IN A CONTEMPORARY COHORT Yoram Baum, Sarah Holzman, Adam Schell, Adeboye Osunkoya, Kenneth Ogan and Viraj Master Emory University, Atlanta, GA Presented By: Yoram Baum

Poster #114 HIGH PRE-OPERATIVE NEUTROPHIL-TO- LYMPHOCYTE RATIO IS ASSOCIATED WITH DECREASED OVERALL SURVIVAL IN PATIENTS WITH LOCALIZED CLEAR CELL RENAL

CARCINOMA S u nd ay Yoram Baum, Claire De La Calle, LA Harrel, Caroline Tai, Ruth Westby, Dattatraya Patil, Kenneth Ogan, Daniel Canter, John Pattaras, Peter Nieh and Viraj Master Emory University, Atlanta, GA Presented By: Yoram Baum

70 Poster #115 SIGNIFICANCE OF PERSISTENT ASYMPTOMATIC MICROSCOPIC HEMATURIA ONE-YEAR AFTER NEPHRON SPARING SURGERY: A REVIEW OF CLINICAL AND RADIOGRAPHIC FINDINGS Ceciliana De Andino¹, Hector Lopez-Huertas², Ronald Cadillo-Chavez² and Ricardo Sanchez-Ortiz² ¹University of Puerto Rico, San Juan PR; ²Robotic Urology and Oncology Institute, San Juan PR Presented By: Ceciliana De Andino

Poster #116 PRACTICE LEVEL IMPACT OF TRANSITIONING FROM HAND-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY TO ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY Abby Taylor¹, Alexander Parker², Bruce Lee³, Michael Wehle³, Paul Young³, Todd Igel³, Bhupendra Rawal², Kaitlynn Custer² and David Thiel³ ¹Mayo Clinic Florida, Department of Urology, Jacksonville, FL; ²Mayo Clinic Florida Department of Health Sciences Research and Division of Biomedical Statistics, Jacksonville, FL; ³Department of Urology, Mayo Clinic Florida, Jacksonville, FL Presented By: Abby Taylor

Poster #117 USE OF SINITINIB PRIOR TO CYTOREDUCTIVE NEPHRECTOMY IN CLEAR CELL RENAL CELL CARCINOMA Nima Baradaran, Harry Drabkin and Stephen Savage Medical University of South Carolina, Charleston, SC Presented By: Nima Baradaran

Poster #118 CAVAL THROMBUS VOLUME INFLUENCES OUTCOMES IN RENAL CELL CARCINOMA WITH VENOUS EXTENSION Kamran Zargar-Shoshtari¹, Patrick Espiritu¹, Pranav Sharma¹, Tony Kurian¹, Julio M Pow-Sang¹, Devanand Mangar², Paul Armstrong³, Wade J Sexton¹ and Philippe E Spiess¹ ¹Departments of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL; ²Anesthesiology, Tampa General Hospital, Tampa, FL,; ³Division of Vascular and Endovascular Surgery, Department of Evidence Based Medicine, University of South Florida, Tampa, FL Presented By: Kamran Zargar Shoshtari

Poster #119 PROSPECTIVE EVALUATION OF THE ASSOCIATION OF ADHERENT PERINEPHRIC FAT WITH PERIOPERATIVE OUTCOMES OF ROBOTIC- ASSISTED PARTIAL NEPHRECTOMY Andrew Davidiuk¹, Alexander Parker², Colleen Thomas³, Michael Heckman³, Kaitlynn Custer² and David Thiel⁴ ¹Mayo Clinic Florida, Jacksonville, FL; ²Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; ³Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL; ⁴Department of Urology, Mayo Clinic, Jacksonville, FL Presented By: Andrew Davidiuk

71 Poster #120 REPOPULATION OF PRIMARY RENAL CELLS FOR WHOLE ORGAN ENGINEERING: FUNCTIONAL EVALUATIONS Mehran Abolbashari, Mi Kyung Lee, Sigrid Agcaoili, Tamer Aboushwareb, John Jackson, In Kap Ko, James Yoo and Anthony Atala Wake Forest School of Medicine, Winston Salem, NC Presented By: John Jackson

Poster #121 FACTORS ASSOCIATED WITH ACUTE AND CHRONIC RENAL INJURY FOLLOWING MINIMALLY INVASIVE PARTIAL NEPHRECTOMY (MIPN) IN PATIENTS WITH NORMAL PRE- OPERATIVE GFR (GLOMERULAR FILTRATION RATE) Abby Taylor¹, Bruce Lee², Bhupendra Rawal³ and David Thiel¹ ¹Mayo Clinic Florida, Department of Urology, Jacksonville, FL; ²Mayo Clinic Florida, Jacksonville, FL; ³Mayo Clinic Florida Department of Health Sciences Research and Division of Biomedical Statistics, Jacksonville, FL Presented By: Abby Taylor

Poster #122 JOB SATISFACTION IN UROLOGY: THE INFLUENCE OF DEMOGRAPHIC, ECONOMIC AND WORKLOAD FACTORS Nicholas Pruthi¹, Sophie Spencer¹, Matthew Lyons¹, Peter Greene¹, Max McKibben¹, Matthew Nielsen¹, Raj Pruthi¹, Mathew Raynor¹, Eric Wallen¹, Michael Woods¹, Christopher Gonzalez² and Angela Smith¹ ¹UNC, Chapel Hill, NC; ²Northwestern, Chicago, IL Presented By: Sophie Spencer

Poster #123 PRIVATE PRACTICE, ACADEMICS, OR EMPLOYED: DOES EMPLOYMENT STATUS IMPACT WORK, INCOME, AND JOB SATISFACTION? Nicholas Pruthi¹, Sophie Spencer¹, Matthew Lyons¹, Peter Greene¹, Max McKibben¹, Matthew Nielsen¹, Raj Pruthi¹, Mathew Raynor¹, Eric Wallen¹, Michael Woods¹, Christopher Gonzalez² and Angela Smith¹ ¹UNC, Chapel Hill, NC; ²Northwestern, Chicago, IL Presented By: Sophie Spencer

Poster #124 ROBOTIC-ASSISTED RETROPERITONEAL VERSUS TRANSPERITONEAL PARTIAL NEPHRECTOMY: A SINGLE SURGEON’S EXPERIENCE Pranav Sharma, Justin Emtage and Wade Sexton

Moffitt Cancer Center, Tampa, FL S u nd ay Presented By: Pranav Sharma

72 Concurrent Session 3 of 4

7:00 a.m. - 7:30 a.m. Andrology Podium Session Location: Room 102/103 Moderators: Gerard D. Henry, MD Shreveport, LA Rafael E. Carrion, MD Tampa, FL

7:00 a.m. #38 DETERMING THE EFFECTS OF STEM CELL TREATMENT ON PEYRONIE’S DISEASE IN HUMANS Michael Zahalsky, Melissa Marchand, Leanne Iorio, Walquiria Cassini and Jason Levy Z Urology Presented By: Michael Zahalsky

7:07 a.m. #39 PREDICTORS OF ERECTILE RESPONSE IN PATIENTS WITH ARTERIAL DISEASE ON PENILE DOPPLER ULTRASOUND Casey McCraw, Patrick Fox, Carolyn Cutler, Andrew Ostrowski, Qiang Li, Zachary Klaassen and Ronald Lewis Georgia Regents University/Augusta, GA Presented By: Casey McCraw

7:14 a.m. #40 RADIOPROTECTION OF ERECTILE FUNCTION USING NOVEL ANTI-OXIDANT IN THE RAT Michael Granieri, Artak Tovmasyan, Hui Yan, Xiaochun Lu, Lan Mao, Everardo Macias, Ivan Spasojevic, Ines Batinic-Haberle, Andrew Peterson and Bridget Koontz Duke University Medical Center Presented By: Michael Granieri

7:21 a.m. #41 THE IMPACT OF VARIABLE SEMINOMATOUS INVOLVEMENT IN MIXED GERM CELL TUMORS ON INTRA-OPERATIVE COMPLEXITY AND POST-OPERATIVE COMPLICATIONS IN POST- CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION Christopher Russell¹, Gautum Agarwal², David Buethe², Patrick Espiritu², Adam Luchey², Philippe E. Spiess², Julio Powsang², Michael Poch² and Wade J. Sexton² ¹USF Morsani College of Medicine; ²H. Lee Moffitt Cancer Center Presented By: Christopher Russell

73 Concurrent Session 4 of 4

7:30 a.m. - 8:30 a.m. Nephrolithiasis and Endourology Podium Session Moderators: Vincent Gerard Bird, MD Gainesville, FL Kenneth Ogan, MD Atlanta, GA

7:30 a.m. #42 QUALITY OF ACUTE CARE FOR PATIENTS WITH KIDNEY STONES IN THE UNITED STATES Charles Scales¹, Li Lin², Jonathan Bergman³, Stacey Carter³, Greg Jack³, Christopher S. Saigal³ and Mark S. Litwin³ ¹Duke University, Durham, NC; ²Duke Clinical Research Institute, Durham, NC; ³UCLA, Los Angeles, CA Presented By: Charles Scales Jr.

7:37 a.m. #43 EMERGENCY DEPARTMENT REVISITS FOR PATIENTS WITH KIDNEY STONES Charles Scales¹, Li Lin², Christopher S Saigal³, Carol Bennett⁴, Ninez Ponce³, Carol M Mangione³ and Mark S. Litwin³ ¹Duke University, Durham, NC; ²Duke Clinical Research Institute, Durham, NC; ³UCLA, Los Angeles, CA; ⁴Greater Los Angeles VA Health System, Los Angeles, CA Presented By: Charles Scales Jr.

7:44 a.m. #44 A NOVEL WET COUPLING DESIGN FOR CONTEMPORARY ELECTROMAGNETIC LITHOTRIPTERS: ELIMINATION OF COUPLING DEFECTS AND IMPROVEMENT OF COMMINUTION EFFICIENCY Richard Shin¹, Daniel Concha², Jaclyn Lautz², Georgy Sankin², Fernando Cabrera¹, Ramy Youssef³, Charles Scales⁴, Michael Lipkin¹, Glenn Preminger¹, Hadley Cocks², Walter Simmons² and Pei Zhong⁵ ¹Division of Urologic Surgery, Duke University Medical Center, Durham, NC; ²Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC; ³Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Urologic Surgery, University of California, Irvine, Orange, CA; ⁴Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC; ⁵Division of Urologic Surgery, Duke University Medical Center, Durham, NC and

Department of Mechanical Engineering and Materials S u nd ay Science, Duke University, Durham, NC Presented By: Richard Shin

74 7:51 a.m. #45 HYDROXYPROLINE METABOLISM IN A MOUSE MODEL OF PRIMARY HYPEROXALURIA TYPE 1 Xingsheng Li¹, John Knight¹, Kevin Fitzgerald², William Querbes², Ross Holmes¹, Dean Assimos¹ and Win Shun Lai¹ ¹Birmingham, Alabama; ²Cambridge, Massachusetts Presented By: Win Shun Lai

7:58 a.m. #46 HUMAN MACROPHAGES MEDIATE KIDNEY STONE CLEARANCE THROUGH PHAGOCYTOSIS AND CLATHRIN-DEPENDENT ENDOCYTOSIS Sergey Kusmartsev, Paul Dominguez-Gutierrez, Benjamin Canales, Johannes Vieweg and Saeed Khan University of Florida, Gainesville, FL Presented By: Sergei Kusmartsev

8:05 a.m. #47 DEFINING THE RATE OF PRIMARY URETEROSCOPIC FAILURE IN NON- PRESTENTED PATIENTS: A MULTI- INSTITUTIONAL STUDY Christopher Mitchell¹, Thomas Fuller², Kevin Rycyna², Matthew Ferroni², Erin Ohmann³, Daniel Wollins³, Ojas Shah³, Michelle Semins² and Nicole Miller⁴ ¹Vanderbilt University Medical Center, Nashville TN; ²University of Pittsburgh Medical Center, Pittsburgh, PA; ³New York Langone Medical Center, New York, NY; ⁴Vanderbilt University Medical Center, Nashville, TN Presented By: Christopher Mitchell

8:12 a.m. #48 CHARACTERISTICS OF MIXED COMPOSITION RENAL CALCULI WITH DUAL ENERGY CT IMAGING Charles Stoneburner, Maria Jepperson, Joseph Cernigliaro, David Thiel and William Haley Mayo Clinic Jacksonville, Florida Presented By: Charles Stoneburner

8:19 a.m. #49 CHANGING MANAGEMENT OF THE IMPACTED URETERAL CALCULUS > 1.4 CM: ROBOTIC LAPAROSCOPIC URETEROLITHTOMY Mary Powers, Michael Maddox, Julie Wang, Raju Thomas and Benjamin Lee Tulane University School of Medicine, New Orleans, LA Presented By: Mary Powers

Concurrent Sessions End

8:30 a.m. - 8:50 a.m. AUA Guidelines: Medical Management of Kidney Stones Speaker: Glenn M. Preminger, MD Durham, NC

8:50 a.m. - 9:15 a.m. AUA Uro-Trauma Guidelines Invited Speaker: Allen F. Morey, MD Dallas, TX

75 9:15 a.m. - 9:45 a.m. Current Management of Invasive Bladder Cancer and Future Directions Invited Speaker: James Michael McKiernan, MD New York, NY

9:45 a.m. - 10:30 a.m. Bladder Cancer/ Upper Tract TCC Podium Session Moderators: Raj Som Pruthi, MD Chapel Hill, NC Wesley Mathew White, MD Knoxville, TN

9:45 a.m. #50 WHOLE EXOME SEQUENCING OF THE CANCER GENOME IN PATIENTS WITH VERY HIGH RISK MUSCLE INVASIVE BLADDER CANCER Kathleen McGinley¹, Wiguins Etienne¹, Christopher Moy², Stephen Szabo², Joel Greshock², Hui Zhou², Yuchen Bai² and Brant Inman¹ ¹Duke University, Durham, NC; ²GlaxoSmithKline, Collegeville, PA Presented By: Kathleen McGinley

9:52 a.m. #51 SARCOPENIA AS A PREDICTOR OF COMPLICATIONS IN PENILE CANCER PATIENTS UNDERGOING INGUINAL LYMPH NODE DISSECTION Pranav Sharma, Kamran Zargar-Shoshtari, Jamie Caracciolo, George Richard, Michael Poch, Julio Pow-Sang, Wade Sexton and Philippe Spiess Moffitt Cancer Center, Tampa, FL Presented By: Pranav Sharma

9:59 a.m. #52 PENILE CANCER: BASELINE HEALTH RELATED QUALITY OF LIFE Adam Luchey¹, Gautum Agarwal², Scott Gilbert², Philippe Spiesas², Wade Sexton², Julio Pow-Sang² and Michael Poch² ¹H. Lee Moffitt Cancer Center, Tampa, Florida; ²H. Lee Moffitt Cancer Center, Tampa, FL Presented By: Adam Luchey

10:06 a.m. #53 WITHDRAWN 10:13 a.m. #54 PARASTOMAL HERNIAS AFTER RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION: PRESENTATION, RISK FACTORS AND MANAGEMENT Harras Zaid¹, Nicholas Smith², Christopher Anderson³, Sam Chang², Daniel Barocas² and Michael Cookson⁴ ¹Vanderbilt University; ²Vanderbilt University, Nashville TN; ³Memorial Sloan Kettering Cancer S u nd ay Center, New York NY; ⁴University of Oklahoma, Oklahoma City OK Presented By: Harras Zaid

76 10:20 a.m. #55 PREDICTORS OF METASTATIC DISEASE AT DIAGNOSIS IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER Austin J. Evans¹, Zachary Klaassen¹, Rita P. Jen¹, Lael Reinstatler¹, John M. DiBianco², Qiang Li¹, Rabii Madi¹ and Martha K. Terris¹ ¹Medical College of Georgia, Georgia Regents University, Augusta, GA; ²Ross University School of Medicine, Dominica, West Indies Presented By: Austin Evans

10:30 a.m. - 11:00 a.m. Report by the IVUmed Participants Introducer: Martin K. Dineen, MD Daytona Beach, FL Speakers: Amanda F. Saltzman, MD New Orleans, LA Jared J. Wallen, MD Tampa, FL Kristi Lynn Hebert, MD New Orleans, LA

11:00 a.m. - 11:15 a.m. SESAUA Urology Care Foundation Scholar Report Speaker: Arindam Ghosh, PhD Birmingham, AL

11:15 a.m. - 12:15 p.m. Annual Business Meeting

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 SESAUA nor does the SESAUA provide any warranty as to their accuracy or reliability.

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

77 Alphabetical Index

of Al pha be tica l Inde x of AUTHORS Author/Presenter, Date, Time, and Abstract Placement Due to time limitations, authors who do not have a time and date listed will not be presenting their abstracts and this meeting. See Abstracts section for complete text.

ACKERMAN, ANIKA CAREY, ROBERT I. 3/19/2015 3:00 p.m. Poster #41 3/19/2015 4:00 p.m. Poster #66 3/19/2015 3:00 p.m. Poster #33 CHAUDHARY, PANKAJ AGARWAL, GAUTUM 3/19/2015 4:00 p.m. Poster #49 3/19/2015 10:00 a.m. AB #4 3/19/2015 4:00 p.m. Poster #51 CHRISTINE, BRIAN S.

3/20/2015 3:00 p.m. Poster #80 3/19/2015 7:00 a.m. Poster #12 auth o rs

AJAY, DIVYA CRAWFORD, DAVID E. 3/20/2015 4:00 p.m. Poster #85 3/19/2015 4:00 p.m. Poster #67 3/21/2015 7:00 a.m. AB #32 3/21/2015 7:00 a.m. AB #31 CURRIN, MARK 3/19/2015 7:00 a.m. Poster #15 ARK, JACOB 3/21/2015 12:00 p.m. Poster #6 DAVIDIUK, ANDREW J. 3/20/2015 3:00 p.m. Poster #69 BARADARAN, NIMA 3/20/2015 3:00 p.m. Poster #72 3/22/2015 6:00 a.m. Poster #117 3/20/2015 5:00 p.m. AB #28 3/22/2015 6:00 a.m. Poster #119 BATES, ANTHONY S. 3/19/2015 4:00 p.m. Poster #57 DE ANDINO, CECILIANA 3/19/2015 10:50 a.m. BATES, JENNA 3/19/2015 1:00 p.m. Poster #103 3/19/2015 7:00 a.m. Poster #10 3/22/2015 6:00 a.m. Poster #115

BAUM, YORAM DELTO, JOAN 3/22/2015 6:00 a.m. Poster #113 3/19/2015 3:00 p.m. Poster #25 3/22/2015 6:00 a.m. Poster #114 DIBIANCO, JOHN M. BEILAN, JONATHAN 3/19/2015 7:00 a.m. Poster #1 3/20/2015 4:00 p.m. Poster #89 DOMINGUEZ-GUTIERREZ, Paul BIENVENU, JAMES M. 3/19/2015 3:40 p.m. Poster #28 3/21/2015 7:00 a.m. AB #30 3/22/2015 6:00 a.m. Poster #12 DORA, CHANDLER D. 3/21/2015 7:00 a.m. AB #35 BROCK, TIMOTHY C. 3/22/2015 6:00 a.m. Poster #7 DOUGLAS, SEAN P. 3/19/2015 10:00 a.m. AB #8 BRODERICK, KRISTIN M. 3/19/2015 1:00 p.m. Poster #102 EIFLER JR., JOHN B. 3/19/2015 4:00 p.m. Poster #56 BROWN, ELIZABETH T. 3/20/2015 3:00 p.m. Poster #83 ELLETT, JUSTIN D. 3/21/2015 7:00 a.m. Poster #6 CABRERA, FERNANDO 3/19/2015 3:00 p.m. Poster #37 ELLIS, SHELLIE 3/19/2015 7:00 a.m. Poster #13 3/19/2015 4:00 p.m. Poster #52 78 EVANS, AUSTIN J. JACKSON, JOHN 3/22/2015 9:00 a.m. AB #55 3/19/2015 7:00 a.m. Poster #21 3/19/2015 7:00 a.m. Poster #22 FISCHER, SEAN 3/20/2015 3:00 p.m. Poster #75 3/19/2015 4:00 p.m. Poster #47 3/20/2015 3:00 p.m. Poster #68 3/22/2015 6:00 a.m. Poster #120 FRASER, MATTHEW O. 3/20/2015 3:00 p.m. Poster #74 JACOBSON, DEBORAH L. 3/20/2015 2:00 p.m. AB #21 GARCIA-ROIG, MICHAEL L. 3/19/2015 1:00 p.m. Poster #100 JOSEPH, JASON 3/20/2015 2:00 p.m. AB #19 3/22/2015 6:00 a.m. Poster #9

GONZALGO, MARK L. KAPLAN, ADAM G. 3/19/2015 4:00 p.m. Poster #53 3/19/2015 3:00 p.m. Poster #32 3/19/2015 3:00 p.m. Poster #42 GRANIERI, MICHAEL 3/20/2015 3:00 p.m. Poster #70 KAPPA, STEPHEN F. 3/22/2015 7:00 a.m. AB #40 3/19/2015 3:00 p.m. Poster #44 3/19/2015 7:00 a.m. Poster #9 GUPTA, MOHIT 3/20/2015 4:00 p.m. Poster #92 3/20/2015 5:36 p.m. Poster #25 KARAMAN, UMAR R. GUPTA, SHUBHAM 3/20/2015 7:00 a.m. AB #16 3/20/2015 7:00 a.m. AB #14 KING, SHERITA A. GUZMAN-NEGRON, JUAN 3/19/2015 1:00 p.m. Poster #105 3/19/2015 10:00 a.m. AB #7 KLAASSEN, ZACHARY HAMMONTREE, LEE N. 3/19/2015 10:00 a.m. AB #9 3/20/2015 5:50 p.m. Podium #27 3/19/2015 3:00 p.m. Poster #26 3/19/2015 4:00 p.m. Poster #64 HARTSELL, LINDSEY M. 3/19/2015 7:00 a.m. Poster #4 3/20/2015 3:00 p.m. Poster #76 3/20/2015 3:00 p.m. Poster #77 3/20/2015 5:00 p.m. AB #29 HEBERT, KRISTI L. 3/21/2015 7:00 a.m. Video #3 KUMAR, ANUP 3/19/2015 4:00 p.m. Poster #62 HENRY, GERARD D. 3/19/2015 7:00 a.m. Poster #23 KUSMARTSEV, SERGEY 3/20/2015 4:00 p.m. Poster #86 3/22/2015 7:00 a.m. AB #46

HENSLEY, PATRICK LACY, JOHN M. 3/19/2015 4:00 p.m. Poster #60 3/20/2015 4:00 p.m. Poster #88

HERNANDEZ-CARDONA, EDUARDO LAI, WEIL 3/19/2015 4:00 p.m. Poster #61 3/19/2015 3:40 p.m. Poster #30

HEULITT, GERALD M. LAI, WIN SHUN V. 3/21/2015 7:00 a.m. AB #37 3/19/2015 3:00 p.m. Poster #45 3/22/2015 7:00 a.m. AB #45 HODGES, STEVE J. 3/19/2015 10:00 a.m. AB #12 3/20/2015 2:00 p.m. AB #20 LANGE, JESSICA N. HOFFMAN, DANIELS. 3/21/2015 12:00 p.m. Poster #4 3/20/2015 4:00 p.m. Poster #94

79 LEVEY, RYAN S. MENDEZ, MELISSA

3/19/2015 10:00 a.m. AB #11 3/19/2015 4:00 p.m. Poster #46 Al pha be tica l Inde x of 3/19/2015 4:00 p.m. Poster #59 3/19/2015 7:00 a.m. Poster #24

LIANG, JESSIE MITCHELL, CHRISTOPHER 3/19/2015 7:00 a.m. Poster #19 3/21/2015 7:00 a.m. AB #36 3/21/2015 7:00 a.m. Poster #2 LIU, JAMES 3/22/2015 7:00 a.m. AB #47 3/22/2015 6:00 a.m. Poster #111 MODH, RISHI ASHOK LLOYD, JESSICA C. 3/19/2015 7:00 a.m. Poster #7 3/20/2015 7:00 a.m. AB #13 3/21/2015 7:00 a.m. Poster #4 3/21/2015 7:00 a.m. AB #33 LORENTZ, C. ADAM 3/20/2015 5:00 p.m. AB #26 MOORE, DAVID C. 3/19/2015 1:00 p.m. Poster #108 auth o rs LUCHEY, ADAM M. 3/20/2015 3:00 p.m. Poster #79 MOSS, JARED L. 3/20/2015 3:00 p.m. Poster #78 3/19/2015 3:00 p.m. Poster #34 3/22/2015 9:00 a.m. AB #52 MUTTER, MATTHEW LYONS, MATTHEW 3/21/2015 12:00 p.m. Poster #5 3/20/2015 3:00 p.m. Poster #82 NELSON, JOHN DALEY MADDOX, MICHAEL 3/20/2015 5:00 p.m. AB #23 3/19/2015 3:00 p.m. Poster #43 3/20/2015 1:00 p.m. Poster #1 NOURPARVAR, PAYMON 3/19/2015 3:00 p.m. Poster #39 MARIEN, TRACY 3/21/2015 7:00 a.m. AB #34 ORTIZ, TARA 3/19/2015 3:00 p.m. Poster #27 MARTINEZ, DANIEL 3/20/2015 4:00 p.m. Poster #90 PATEL, AMAR P. 3/20/2015 4:00 p.m. Poster #98 3/19/2015 3:00 p.m. Poster #35 3/19/2015 4:00 p.m. Poster #63 MASON, JAMES B. 3/19/2015 3:00 p.m. Poster #31 PATHAK, RAM 3/19/2015 10:00 a.m. AB #6 MASON, MATTHEW D. 3/19/2015 7:00 a.m. Poster #18 3/19/2015 1:00 p.m. Poster #99 3/20/2015 4:00 p.m. Poster #87 3/20/2015 2:00 p.m. AB #17 3/20/2015 4:00 p.m. Poster #93 3/22/2015 6:00 a.m. Poster #11 MAYMI, PATRICIA 3/19/2015 4:00 p.m. Poster #50 PEREZ-RUIZ, CARLOS 3/19/2015 4:00 p.m. Poster #54 MCCORMICK, BENJAMIN J. 3/20/2015 3:00 p.m. Poster #81 PEYTON, CHARLES C. 3/22/2015 6:00 a.m. Poster #110 MCCRAW, CASEY O. 3/22/2015 7:00 a.m. AB #39 POPE, IV, JOHN C. 3/19/2015 7:00 a.m. Poster #6 MCGINLEY, KATHLEEN 3/19/2015 4:00 p.m. Poster #48 POWERS, MARY K. 3/19/2015 4:00 p.m. Poster #65 3/22/2015 6:00 a.m. Poster #10 3/22/2015 9:00 a.m. AB #50 3/22/2015 7:00 a.m. AB #49

80 PUNNEN, SANOJ SPENCER, E. SOPHIE 3/19/2015 10:00 a.m. AB #1 3/19/2015 7:00 a.m. Poster #3 3/19/2015 7:00 a.m. Poster #2 ROVIRA-PENA, WILSON 3/19/2015 7:00 a.m. Poster #11 3/19/2015 1:00 p.m. Poster #106 3/22/2015 6:00 a.m. Poster #122 3/22/2015 6:00 a.m. Poster #123 RUSSELL, CHRISTOPHER 3/22/2015 6:00 a.m. Poster #112 STEWART, CARRIE A. 3/22/2015 7:00 a.m. AB #41 3/19/2015 3:00 p.m. Poster #36 3/21/2015 7:00 a.m. Poster #1 SAAVEDRA-BELAUNDE, JOSE A. 3/19/2015 4:00 p.m. Poster #58 STONEBURNER, CHARLES 3/22/2015 7:00 a.m. AB #48 SAFIR, ILAN J. 3/19/2015 7:00 a.m. Poster #17 TAN, JUBILEE 3/20/2015 5:00 p.m. AB #24 SALTZMAN, AMANDA F. 3/21/2015 12:00 p.m. Poster #3 TAYLOR, ABBY S. 3/19/2015 3:00 p.m. Poster #40 SANDA, MARTIN G. 3/19/2015 7:00 a.m. Poster #20 3/19/2015 10:00 a.m. AB #3 3/21/2015 12:00 p.m. Poster #1 3/22/2015 6:00 a.m. Poster #116 SCALES JR., CHARLES D. 3/22/2015 6:00 a.m. Poster #121 3/22/2015 7:00 a.m. AB #42 3/22/2015 7:00 a.m. AB #43 TOJUOLA, BAYO D. 3/19/2015 7:00 a.m. Poster #8 SEKAR, RISHI 3/20/2015 4:00 p.m. Poster #95 3/22/2015 6:00 a.m. Poster #109 3/20/2015 4:00 p.m. Poster #97

SELPH, J. PATRICK TRACEY, ANTHONY J. 3/20/2015 3:00 p.m. Poster #71 3/22/2015 6:00 a.m. Poster #8

SHARMA, PRANAV VIPRAKASIT, DAVIS P. 3/20/2015 4:00 p.m. Poster #96 3/19/2015 3:00 p.m. Poster #38 3/22/2015 6:00 a.m. Poster #124 3/22/2015 9:00 a.m. AB #51 WANG, HSIN-HSIAO 3/19/2015 1:00 p.m. Poster #101 SHERMAN, CHRISTOPHER M. 3/19/2015 1:00 p.m. Poster #104 3/21/2015 12:00 p.m. Poster #2 WANG, HSIN-HSIAO SHIN, RICHARD 3/20/2015 2:00 p.m. AB #18 3/19/2015 3:00 p.m. Poster #29 3/22/2015 7:00 a.m. AB #44 WANG, JULIE C. 3/21/2015 7:00 a.m. Poster #5 SILBERSTEIN, JONATHAN 3/19/2015 10:00 a.m. AB #5 WINTERS, SHIRA M 3/19/2015 4:00 p.m. Poster #55 3/19/2015 7:00 a.m. Poster #5 3/19/2015 7:00 a.m. Poster #16

SIMON, ROSS YOUNGER, AUSTIN 3/19/2015 10:00 a.m. AB #2 3/20/2015 7:00 a.m. AB #15 3/20/2015 4:00 p.m. Poster #91 ZAHALSKY, MICHEAL P. SOHN, WILLIAM 3/22/2015 7:00 a.m. Podium #38 3/19/2015 11:53 a.m. Podium #10

81 ZAID, HARRAS B.

3/22/2015 9:00 a.m. AB #54 Al pha be tica l Inde x of

ZANN, ANJA M. 3/19/2015 1:00 p.m. Poster #107

ZARGAR-SHOSHTARI, KAMRAN 3/20/2015 5:00 p.m. AB #22 3/20/2015 3:00 p.m. Poster #84 3/22/2015 6:00 a.m. Poster #118

ZHENG, YIN 3/19/2015 7:00 a.m. Poster #14

auth o rs

82 Podium #1 A MULTI−INSTITUTIONAL PROSPECTIVE TRIAL IN THE UNITED STATES CONFIRMS THE 4KSCORE ACCURATELY IDENTIFIES MEN WITH HIGH−GRADE PROSTATE CANCER Sanoj Punnen, MD1, Dan Sjoberg2, Steve Zappala, MD3 and Dipen Parekh, MD1 1University of Miami; 2Memorial Sloan Kettering, New York, NY; 3Andover Urology, Andover, MI Presented by: Sanoj Punnen, MD)

Introduction: Prostate cancer screening is associated with improved cancer-specific mortality, but comes at a high cost, with large numbers of men needing to be screened, biopsied, and treated to save one life. The 4Kscore is a blood test combining four kallikrein assays with clinical information in an algorithm that reports the probability of high-grade prostate cancer on biopsy of the prostate. It has been well validated in multiple retrospective European cohorts, but has never been tested in a U.S. population. This study is the first prospective evaluation of the 4Kscore for detecting high−grade prostate cancer among men referred for prostate biopsy in the United States. Methods: Prospective enrollment of 1,012 men scheduled for prostate biopsy, regardless of PSA level or clinical findings, was completed at 26 U.S. centers between Oct. 2013 and April 2014. The AUC, risk calibration, and decision curve analysis (DCA) were performed, along with comparisons of probability cut offs for achieving biopsy reduction and their impact on delaying diagnosis. Results: High-grade prostate cancer was found in 231 (23%) of the 1,012 patients. The 4Kscore showed excellent calibration with the predicted probability of high-grade cancer being similar to the observed. The 4Kscore demonstrated higher discrimination then the popular Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) (AUC 0.82 versus 0.74, p-value <0.0001). In addition, the 4Kscore displayed a higher net benefit by DCA then the PCPTRC and standard of care at all threshold probabilities used in common clinical practice. For example, if a 9% probability of high-grade cancer was used as a threshold for biopsy of the prostate, 434 (43%) unnecessary biopsies could have been avoided, while delaying diagnosis of only 24 (2.4%) high-grade cancers. Conclusion: The 4Kscore demonstrated excellent accuracy in detecting high-grade prostate cancer. It is a useful tool in selecting men who are likely to have high-grade disease and most likely to benefit from a prostate biopsy versus those men with no cancer or indolent cancer. Funding: OPKO Diagnostics, LLC

83 Podium #2 ADVERSE PATHOLOGY AND UNDETECTABLE ULTRASENSITIVE PROSTATE− SPECIFIC ANTIGEN AFTER RADICAL PROSTATECTOMY: IS ADJUVANT RADIATION WARRANTED? Ross Simon, MD1,2, Lauren Howard, MS1, Stephen Freedland, MD1, William Aronson, MD3, Martha Terris, MD4, Christopher Kane, MD5, Christopher Amling, MD6, Matt Cooperberg, MD7 and Adriana Vidal, MD1 1Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; 2Urology Section, Veterans Affairs Medical Center, Durham, NC; 3Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA; 4Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA; 5Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA; 6Department of Urology, Oregon Health and Science University, Portland, OR; 7Department of Urology, University of California at San Francisco, San Francisco, CA Presented by: Ross Simon, MD

Introduction: Men with adverse pathology (positive margins, extraprostatic extension, and seminal vesicle invasion) are at increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP) and are candidates for adjuvant radiation based on the AUA and ASTRO guideline. In contrast, men with an undetectable ultrasensitive PSA (<0.01) after RP have lower rates of BCR when compared to patients with detectable PSA, or undetectable PSA defined by a less-sensitive assay. As such, we assessed BCR outcomes among men with a mismatch – adverse pathology but an undetectable ultrasensitive post-RP PSA, to determine risk factors associated with BCR and to identify suitable candidates for adjuvant radiation.

Methods: We evaluated 411 patients treated with RP from 2001 to 2013 from the SEARCH Pod iums database who had an undetectable ultrasensitive post-RP PSA (<0.01) with either positive margins, extraprostatic extension, and/or seminal vesicle invasion. Men treated with pre or post−operative androgen deprivation or radiation therapy were excluded. All men were followed with serial PSA determinations and clinical visits at intervals according to attending physician’s discretion. BCR was defined as a single PSA >0.2 ng/ml, two concentrations at 0.2 ng/ml, or secondary treatment for elevated PSA. Multivariable Cox regression analyses were utilized to test the relationship between pathologic characteristics and BCR to identify groups of men at highest risk of early BCR (within three years of RP). Results: On multivariable analysis, among patients with adverse pathology and undetectable ultrasensitive post−RP PSA, only pathologic Gleason 7 (4+3), Gleason ≥8, and seminal vesicle invasion were independent predictors of BCR (p=0.019, p<0.001, and p=0.001). However, in terms of three-year BCR, men with Gleason 7 (4+3) had low rates of BCR (20.0%) which was not statistically different when compared to men with Gleason 6 (11.4%). On the contrary, men with Gleason ≥8 (with positive margins or extraprostatic extension) and seminal vesicle invasion (19% of the cohort) defined a group with higher rates of three-year BCR when compared to patients without those characteristics (50.4% vs. 11.9%, log-rank, p<0.001). Conclusion: Among men with adverse pathology but with an undetectable ultrasensitive post−operative PSA (<0.01), the benefits of adjuvant radiation are likely limited, except for a small group of men with Gleason 8-10 (with positive margins or extracapsular extension) or seminal vesicle invasion who are at high risk of early BCR.

84 Podium #3 EVALUATION OF THE PROSTATE HEALTH INDEX (PHI) AS A POTENTIAL TOOL FOR AGGRESSIVE PROSTATE CANCER DETECTION IN BIOPSY−NAÏVE MEN Claire M. de la Calle1, Dattatraya Patil, MBBS, MPH1, John T. Wei, MD2, Douglas S. Scherr, MD3, Lori Sokoll, PhD4, Daniel W. Chan, PhD4, Javed Siddiqui2, Mark A. Rubin, MD3 and Martin G. Sanda, MD1 1Emory University School of Medicine, Atlanta, GA; 2University of Michigan Medical School, Ann Arbor, MI; 3Weill Cornell Medical College, New York, NY; 4Johns Hopkins University School of Medicine, Baltimore, MD Presented by: Martin G. Sanda, MD

Objectives: The Prostate Health Index (PHI) is a new formula that combines three well- known biomarkers: total PSA, free PSA and [-2] proPSA (p2PSA). PHI has been shown to increase specificity of the individual biomarkers in cohorts comprised of subjects with previous prostate biopsies as well as subjects with no history of biopsy. Here we tested PHI’s ability to discern aggressive prostate cancer from indolent or no cancer on a biopsy-naïve population. Material and Methods: Two independent prospective cohorts of 561 and 395 subjects were used for validation of the results. Each cohort recruited patients at different institutions. Criteria of inclusion were no history of prostate cancer or of prostate biopsy. Each subject had serum collected for total pre−biopsy PSA, %free PSA and p2PSA testing on the Beckman Coulter Access 2 prior to biopsy. PHI was calculated as (p2PSA/freePSA)*sqrt (PSA). Bootstrap sampling provided the estimates for the performance measures including sensitivity and specificity. PHI cut point and corresponding specificities were calculated at fixed sensitivities of 95%, 90%, and 80%. Improvement in specificity was determined by bootstrap estimated standard error. Results: In the primary cohort, 20.3% of patients were found to have aggressive prostate cancer (Gleason score > 7). Higher PHI values were significantly associated with Gleason 7 score or higher. Mean PHI was 74.6 (SD ± 68.2) in the Gleason 7 score or higher group versus 32.2 (SD ± 18.9) in the less than Gleason 7 group (p<0.001). PHI’s ability to detect aggressive prostate cancer yielded an AUC of 0.815 and its specificity was significantly higher than total pre−biopsy PSA and % free PSA specificities. At 95% sensitivity PHI specificity was 36.0% versus 17.2% and 19.4% for total pre-biopsy PSA and % free PSA respectively. At 95% sensitivity in detecting aggressive prostate cancer, the optimal PHI cut point was 24, which would help avoid 41% of unnecessary biopsies. Validation cohort analysis confirmed the improvement of specificity with PHI overall. The pre-determined PHI cutoff of 24 led to 36% biopsies avoided and very few aggressive cancers missed. Conclusion: These results demonstrate that for a biopsy-naïve population PHI is significantly more specific than total pre-biopsy PSA and % free PSA in identifying aggressive prostate cancer versus indolent cancer. The study also shows that PHI use would decrease unnecessary biopsies. Funding: NIH U01 CA113913.

85 Podium #4 COMPARISON OF STANDARD FLUOROQUINOLONE PROPHYLAXIS VERSUS RECTAL SWAB TARGETED PROPHYLAXIS IN MEN UNDERGOING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Gautum Agarwal, MD1, Abera Gezahegn, MD2, Rod Quilitz Pharm, D1, Yanina Pasikhova Pharm, D1, Ramon Sandin, MD1, Adam Luchey, MD1, Wade Sexton, MD1, Philippe E Spiess, MD1, Micahel Poch, MD1, Scott Gilbert, MD1, John Greene, MD1 and Julio Pow−Sang, MD1 1H. Lee Moffitt Cancer Center, Tampa, FL;2 University of South Florida, Tampa, FL Presented by: Gautum Agarwal, MD1

Introduction: There is an increased incidence of symptomatic urinary tract infections and sepsis after transrectal ultrasound guided prostate biopsies (TRUSBx) due to fluoroquinolone (FQ) resistant bacteria. We aimed to assess the impact of performing rectal swab targeted prophylaxis on the incidence of symptomatic urinary tract infection in men undergoing TRUSBx Methods: Five hundred sixty-nine men underwent TRUSBx of which 420 patients were biopsied while on active surveillance for prostate cancer between December 2011 and December 2013. Those with rectal swab had their antimicrobial prophylaxis based upon their culture and antibiotic sensitivity testing, while those without rectal swab had empirical prophylaxis with a FQ antibiotic. The two cohorts were evaluated for reported infections for up to 30 days post-biopsy. Results: Of the 201 men that underwent rectal swab culture and sensitivity, 51(25.37%) had a FQ resistant organism. Subsequent tests for antibiotic susceptibility in these 51 men showed a 100% resistance to ciprofloxacin and levofloxacin and 88% resistance to ampicillin. FQ resistant strains demonstrated sensitivity to Ertapenem (100%), Amikacin (97%), Piperacillin/

Tazobactam (92%), Ceftazidine (82%) and Ceftriaxone (80%). All of these cases received Pod iums antibiotic prophylaxis based on their sensitivity, and only one patient developed a post-biopsy urinary tract infection (UTI). The remaining 368 men received empirical prophylaxis with a FQ antibiotic. There were four (1.08%) infections in those who took only empirical antibiotic prophylaxis. Two cases developed E. coli UTI and two pseudomonas infection (one sepsis and one UTI). Conclusion: There is a high rate of FQ resistant organisms present in patients that undergo TRUSBx. Targeted antibiotic prophylaxis is a method which decreases symptomatic infections after TRUSBx.

86 Podium #5 RACIAL VARIATIONS OF PCA3 AND TMPRSS2 URINARY BIOMARKERS IN MEN UNDERGOING PROSTATE NEEDLE BIOPSY Allison Feibus, MS1, Oliver Sartor, MD1, Raju Thomas, MD1, Michael Maddox, MD1, Benjamin Lee, MD1, Justin Levy, BS Candidate1, Ian McCaslin, MD1, Julie Wang, MD1, Krishnarao Moparty, MD2 and Jonathan Silberstein, MD1 1Tulane University School of Medicine, New Orleans, LA; 2Southeast Louisiana Veterans Health Care Services, New Orleans, LA Presented by: Jonathan Silberstein, MD

Introduction: Urinary assays PCA3 and TMPRSS2 have been previously established as valuable biomarkers for the detection of prostate cancer (PCa) with greater specificity than serum prostate specific antigen (PSA). However, established cohorts largely consist of Caucasian Americans (CA). Our objective was to evaluate the performance characteristics of these urinary assays in a cohort of self-identified African American (AA) men who elected to undergo prostate needle biopsy and compare these results to non-AA. Methods: Following IRB approval, from December 2013 to August 2014, post digital rectal exam (DRE) urine was collected in 118 consecutive patients without a prior diagnosis of PCa, prior to needle biopsy at three academic medical centers. Quantitative reverse transcription- polymerase chain reaction (qRT-PCR) was used to detect PCA3 and TMPRSS2 fusion transcript expression. The performance of TMPRSS2: ERG fusion and PCA3 as urinary biomarkers predicting PCa at biopsy were measured, with a focus on racial variations. Associations between biopsy outcome, molecular subgroups and clinical-pathological variables were assessed with a series of Mann-Whitney U tests. Results: Of the118 patients included in this study, 57 (48%) were AA and 59 were non-AA (50%), in which the majority of the non-AA patients were CA. Fifty eight patients in the cohort (49%) were diagnosed with prostate cancer. In the overall cohort, PCA3 and TMPRSS2 scores were both significantly greater in men with biopsy-proven PCa and Epstein criteria significant PCa. PCA3 scores were also significantly greater in men with greater volume disease based on number of positive cores and percentage of positive cores. Receiver operating characteristics (ROC) demonstrate that both PCA3 (0.7) and TMPRSS2 (0.68) perform better than serum PSA (0.58). For non-AA, PCA3 and TMPRSS2 scores were significantly greater in men with PCa and Epstein significant PCa. ROC curves show that both PCA3 (0.69) and TMPRSS2 (0.66) perform better than PSA. Similarly, for AA, PCA3 and TMPRSS2 scores were significantly greater in men with PCa and Epstein significant PCa. ROC curves show that both PCA3 (0.69) and TMPRSS2 (0.73) perform better than PSA. TMPRSS2 ROC curves were more accurate for AA than non-AA. Conclusion: PCA3 and TMPRSS2 urinary biomarkers demonstrate better accuracy than serum PSA for the detection of prostate cancer on biopsy, in both AA and non-AA populations. TMPRSS2 ROC values were higher in AA as compared to non-AA men. The authors declare no conflicts of interest. Source of funding: none

87 Podium #6 RANDOMIZED, SINGLE CENTER TRIAL OF THE EFFECT OF EXTENDING TIME FROM PERI-PROSTATIC LIDOCAINE INJECTION TO ONSET OF TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY ON PATIENT-REPORTED PAIN SCORE Ram Pathak, MD, Scott Alford, Mike Heckman, Julia Crook, Nancy Diehl, Alexander Parker, Todd Igel, MD Mayo Clinic Jacksonville, FL Presented by: Ram Pathak, MD

Introduction: Although the efficacy of peri-prostatic lidocaine injection in terms of site, dosage and method of administration has been previously described in prospective randomized control trials elsewhere, the time from lidocaine injection to prostate biopsy has not been thoroughly investigated. The primary aim was to compare Visual Analog Scale (VAS) pain scores between patients with a two-minute delay of lidocaine injection to onset of prostate biopsy and patients with a 10-minute delay. Secondary aims compared VAS scores with two injections versus three injections. Methods: A total of 80 prostate-biopsy naïve males underwent standard 12 core trans-rectal ultrasound−guided prostate biopsy by a single surgeon in this prospective, single-blinded randomized study between September 2011 and July 2014. Patients were randomized into four treatment arms: bibasilar injection at two minutes, bibasilar and single apical injection at two minutes, bibasilar injection at 10 minutes, and bibasilar and single apical injection at 10 minutes. Patients were asked to report their level of pain on the VAS (1-10, with 10 indicating unbearable pain) at the following intervals: probe insertion (baseline), after each core and post-procedure. All analyses were performed on the basis of intention-to-treat principle. Results: The mean age of the 80 patients was 65.0 years (41.9-90.3) with a median BMI of

29.5 (22.3-52.1). 92.4% of patients were Caucasian. All groups were comparable with respect Pod iums to age, BMI and prostatic volume. In general, VAS scores were fairly low with a mean of 1.7. Only 16% of patients reported a VAS score greater than 4 for any one core. VAS scores were significantly higher for the 2−minute delay group compared to the 10-minute delay group when subtracted from the baseline VAS score (mean: −0.7 vs. −1.6, p=0.025). Subset analysis of mean VAS scores during biopsies 1-3, 4-6, 7-9 and 10-12 minus baseline VAS score also demonstrated statistical significance when comparing two-minute to 10-minute delay (p=0.023, p=0.020, p=0.021 and p=0.043, respectively). Secondary aims comparing mean VAS scores subtracted from baseline VAS scores of two-injection vs. three-injection groups demonstrated a trend toward significance with a mean of -0.8 vs. -1.4, p=0.11. Conclusion: Extending the time from lidocaine injection to prostate biopsy results in lower VAS scores. Although this may lengthen the time of each individual prostate biopsy session, patients experience less pain, thereby reducing anxiety.

88 Podium #7 INCREASED PROSTATE SIZE AND HISTORY OF PREOPERATIVE VOIDING DYSFUNCTION ASSOCIATED WITH GREATER URINARY TOXICITY AFTER POST- PROSTATECTOMY ADJUVANT OR SALVAGE RADIATION Juan Guzman−Negron, MD1 and Ricardo Sanchez−Ortiz, MD2 1University of Puerto Rico, San Juan PR; 2Robotic Urology and Oncology Institute, San Juan PR Presented by: Juan Guzman-Negron, MD

Introduction: Animal models using the rabbit bladder have shown that outlet obstruction is associated with bladder fibrosis and diminished aerobic metabolism. Given that genitourinary toxicity in men undergoing radiation therapy (RT) after radical prostatectomy (RP) is related to ischemia, we set out to correlate the relationship between clinical factors affecting bladder circulation and urinary complications after RT. Methods: Patients with a history of postoperative (postop) RT were identified from a database of 542 consecutive men who underwent RP by a single surgeon. Indications included positive margins, pT3, or a serum PSA ≥ 0.2. All were continent and waited ≥ 6 months before RT. Of 508 patients with ≥ 6 months (mo.) follow-up, 50 received adjuvant (3.3%, 17/508) or salvage (6.5%, 33/508) intensity modulated RT (median dose of 69 Gy), with 15.1% (5/33) receiving androgen ablation in the salvage group. Urinary complications were classified using the Clavien system. SPSS was used for statistical analysis. Results: After a median follow-up of 37.9 mo., transient incontinence developed in one patient (2%) (Clavien grade II), and permanent incontinence in three men (6%), one managed medically (grade II), and the others with a sling and an artificial sphincter, respectively (grade III). Three patients (6%) developed bladder neck scars requiring incision. No urothelial malignancies were identified. Twenty percent of patients (10/50) developed hematuria requiring fulguration (grade III) (5 salvage and 5 adjuvant RT) followed by hyperbaric oxygen therapy in three patients. Patients with hematuria had higher pre-op International Prostate Symptom Scores (IPSS) (15.5 vs. 6.5, p<0.01) and larger prostates (51.7 vs. 39.3 g, p<0.01) compared with those without. Seventy five percent of patients with prostates ≥ 60 g developed hematuria compared with 9.5% of those with smaller glands (p<0.001). Diabetic patients showed a trend for hematuria (25% vs. 19.5%) and incontinence (12.5% vs. 7.3%) but this was not significant (only 8/50 radiated patients had DM). Urinary complications did not correlate with age, surgery type (80% robotic), salvage vs. adjuvant RT, body-mass index, smoking, hyperlipidemia, or hypertension. Conclusion: Our data show that grade III urinary complications may develop in up to 30% of patients treated with RT after RP. Gross hematuria was three times more common (20%) than incontinence (6%) or strictures (6%) and predominantly affected men with preop voiding dysfunction or large prostates (≥ 60 g). This study constitutes the first report on the importance of gland size in the post-prostatectomy RT setting and warrants validation with a larger cohort of patients.

89 Podium #8 COGNITIVE FUSION MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE WITH TRANS-RECTAL ULTRASOUND GUIDED BIOPSY IMPROVES DETECTION OF CLINICALLY SIGNIFICANT PROSTATE CANCER Sean Douglas, MD1, Jessie Gills, MD1, Barry Sartin, MD2, Don Bell, MD1, Steve Lacour, MD1, J. Christian Winters, MD1, Bradley Spieler, MD3 and Scott Delacroix, MD1 1Louisiana State University Department of Urology, New Orleans, LA; 2East Jefferson General Hospital Department of Pathology, Metairie, LA; 3Louisiana State University Department of Radiology, New Orleans, LA Presented by: Sean Douglas, MD

Introduction: Multi-parametric magnetic resonance imaging (mpMRI) of the prostate is a valuable tool in identifying clinically significant prostate cancer. We sought to improve sampling of prostate cancer over standard 12 core trans-rectal ultrasound guided prostate biopsy by utilizing pre-biopsy mpMRI. The purpose of this analysis is to evaluate the use of cognitive fusion targeted prostate biopsy versus standard 12 core biopsy for detection of clinically significant prostate cancer. Methods: Prospective data was collected for all patients undergoing prostate biopsy between January 2013 and June 2014. Patients underwent mpMRI imaging (T1, T2, diffusion weighted imaging with apparent diffusion coefficient mapping and dynamic contrast enhancement) prior to prostate biopsy. Regions of interest (ROI) were graded based on the prostate imaging reporting and data system (PI−RADS). Biopsies were performed with a side-fire trans-rectal ultrasound probe with simultaneous review of sagittal and axial mpMRI images. Biopsies were obtained from mpMRI ROI (cognitive fusion biopsy; CFB) followed by laterally directed standard sextant 12 core biopsies (SB) at the same setting.

Results: Forty-four men were included with a mean age of 65. Median PSA was 7.6 ng/dl Pod iums with a mean volume of 51.5 ml and mean PI−RADS score of 3.7. Digital rectal exam revealed no palpable abnormalities in 75% (n=33) of the cohort. Prostate cancer was detected in 26 out of 44 men (59%). A total of 612 biopsy cores were obtained with 136 (22%) positive for malignancy (per core). Of the 612 cores obtained, 540 were sextant biopsy cores and 72 MRI cognitive fusion targeted biopsy cores. In patients with no palpable abnormalities on DRE (n=33), clinically significant prostate cancer (any gleason 7 or greater, or gleason 6 in greater than 10mm total length) was diagnosed in 20% of men on SB vs 40% on CFB. In patients with no palpable abnormalities on DRE (n=33), the positive biopsy rate for per core (rather than per patient) for clinically significant prostate cancer was 86.9% for CFB vs 15% for SB. Conclusion: Multi-parametric MRI cognitive fusion biopsy increased detection of clinically significant prostate cancer compared to the standard laterally directed 12 core biopsy template. The benefit of mpMRI in the diagnosis of clinically significant prostate cancer was most pronounced in men with normal digital rectal exams.

90 Podium #9 ARE LOWER PSA LEVELS IN OBESE MEN DUE TO HEMODILUTION OR LOW ANDROGENS? RESULTS FROM REDUCE Zachary Klaassen, MD1, Lauren E. Howard, MS2, Daniel M. Moreira, MD3, Gerald L. Andriole, Jr., MD4, Martha K. Terris, MD1 and Stephen J. Freedland, MD2 1Medical College of Georgia − Georgia Regents University, Augusta, GA; 2Duke University Medical Center, Durham, NC; 3Mayo Clinic, Rochester, MN; 4Washington University School of Medicine, St. Louis, MO Presented by: Zachary Klaassen, MD

Introduction: Previous studies have suggested that obese men have lower PSA levels compared to non-obese men. Since men with higher body mass index (BMI) have greater plasma volumes, PSA hemodilution is a commonly proposed theory for lower PSA values in obese men. Testosterone (T) and dihydrotestosterone (DHT) are responsible for PSA production and are reduced in obese men. The degree to which these hormones affect PSA levels in obese individuals has not been evaluated but would provide an alternative explanation for lower PSA values in obese men. We tested the link of BMI and PSA, taking into consideration the effect of T and DHT. Methods: REDUCE was a four-year, multicenter, double-blind, placebo-controlled study of dutasteride vs. placebo for prostate cancer risk reduction. Eligible participants were men 50- 75 years old who met the requirements for serum PSA and had a single negative prostate biopsy within six months of enrollment. Among the 8,122 participants in REDUCE, complete data for this analysis was available for 7,275 men. Race, PSA (ng/mL), T (ng/mL) and DHT (ng/mL) were obtained at study enrollment. BMI was categorized as normal weight (<25 kg/ m2), overweight (≥25 to <30 kg/m2), obese (≥30 to <35 kg/m2) and moderate + severely obese (≥35 kg/m2). The associations between the predictor variables of BMI, T and DHT and the outcome of PSA were examined using linear regression. DHT was examined as a continuous variable after logarithmic transformation. In the first model, we adjusted for age, race and TRUS prostate volume to assess the association between BMI and PSA. Subsequent models adjusted for the above characteristics, and T and/or log-transformed DHT. Results: There were 1,964 (27.0%) normal weight, 3,826 (52.6%) overweight, 1,200 (16.5%) obese, and 285 (3.9%) moderately + severely obese men in our analysis. With increasing BMI, there was a progressive decrease in PSA (p=0.02), increase in prostate volume (p<0.001), and decrease in both T (p<0.001) and DHT (p<0.001). Using linear regression, increasing BMI was associated with decreasing PSA (β=−0.018, p=0.002). After adjusting for T or DHT, BMI remained inversely associated with PSA (β=−0.016, p=0.006 & β=−0.015, p=0.01, respectively). This was also true after adjusting for both T and DHT (β=−0.015, p=0.01). Lower T and DHT levels in obese men were responsible for 19% of the PSA reduction seen from higher BMI. Conclusion: In this analysis of men in the REDUCE study, only 19% of PSA reduction in obese men was attributable to lower T and DHT levels. Our results support the hypothesis that hemodilution is the primary reason for lower PSA values in obese men.

91 Podium #10 ADHERENCE TO QUALITY INDICATORS IN THE CARE OF MEN WITH LOCALIZED PROSTATE CANCER William Sohn, MD, David Penson MD, Matthew Resnick MD, Tatsuki Koyama PhD, Alicia Morgans MD, Sharon Phillips MSPH, Daniel Barocas MD Vanderbilt University, Nashville, TN Presented by: William Sohn, MD

Introduction: Quality of care may be quantified by measuring compliance with quality indicators that have been endorsed by organizations such as the National Quality Forum. Our objective was to determine the contemporary adherence to quality measures in the management of localized prostate cancer. Methods: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a population-based, prospective cohort study that enrolled 3691 men with clinically localized prostate cancer during 2011 and 2012, of which 2,781 underwent chart abstraction. Compliance with seven quality measures was assessed, including appropriate use of imaging, hormonal therapy (ADT) in high-risk patients undergoing radiation therapy, documentation of prostate cancer characteristics, discussion of treatment options, and documentation of pathologic features after surgery. Results: Compliance with three out of seven quality indicators was greater than 80%. In particular, documentation of disease characteristics approached 100% in those patients undergoing definitive primary therapy (Table). However, compliance with imaging guidelines (68.3−76.5%) and the appropriate use of ADT (75.0-77.1%) was lower. Conclusion: Adherence to quality measures involving documentation of disease characteristics is fairly consistent, perhaps owing to standardization of medical

documentation. By contrast, compliance with process measures involving clinical judgment Pod iums or use of potentially morbid therapies is lower. This may represent opportunities to improve quality of care versus appropriate variation based on unique clinical scenarios and patient preferences. It remains to be determined whether adherence to quality measures influences patient-centered outcomes. Funding Support: This study was supported by grant 1R01HS019356 from the US Agency for Healthcare Research and Quality (AHRQ) (to D.F.P.).

92 Podium #11 DECLINING RATE OF PROSTATE BIOPSY IN THE VETERANS HEALTH ADMINISTRATION IN THE PAST DECADE: AN ALTERNATE APPROACH TO LIMITING THE OVERDIAGNOSIS AND OVERTREATMENT OF PROSTATE CANCER? Ryan Levey, MD1, Gowtham Rao, MD, PhD, MPH2, Azza Shoaibi3, Kathlyn Sue Haddock PhD, RN4 and Sandip Prasad MD, MPhil1 1Department of Urology, Medical University of South Carolina, Charleston, SC; 2William J.B. Dorn Veterans Affairs Medical Center, Columbia, SC; 3Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia, SC; 4Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC Presented by: Ryan Levey, MD

Introduction: With increasing recognition of the overdiagnosis and overtreatment of prostate cancer, much attention has been placed on limiting prostate-specific antigen (PSA) testing for prostate cancer screening. An additional (but underexamined) intervention point to discourage prostate cancer screening is limiting the use of prostate biopsy by urologists. We analyzed the patterns of utilization of both PSA and prostate biopsy across the Veterans Health Administration (VHA) in the past decade. Methods: Men aged between 40 and 80 years with at least one PSA value between 2003 and 2012 were included for analysis. Once men were biopsied, they were subsequently removed from the eligible study population, creating a dynamic cohort of over 250,000 men per year. More than 24 million patient-years were included in the analysis. An autoregressive, ecological parametric model was created to demonstrate trends for prostate biopsy, focusing on differences by race and age. Results: The rate of prostate biopsy in the VHA has declined annually over the past decade (p<0.001). Non-African American men and those over age 55 years had the most precipitous decline in the rate of prostate biopsy, while African American men and veterans under 55 years of age have not experienced the same rate of change (p<0.001 for all groups). PSA screening has also declined, but not at a clinically significant pace. Conclusion: Overall rates of prostate biopsy across the VHA have declined in all cohorts over the past decade. Biopsies in men at perceived higher risk (African American race) or with greater benefit from screening (younger age) have a lower rate of decline than the rest of the veteran population. These findings may be the result of more judicious and selective use of prostate biopsy by urologists, although further research is needed.

93 Podium #12 IMPLEMENTING MULTIPARAMETRIC MRI AND MRI/US FUSION-GUIDED BIOPSY TO DETECT CLINICALLY-SIGNIFICANT CASES OF PROSTATE CANCER Win Shun Lai, MD1, Melissa R. Dillard, MD2, Jennifer B. Gordetsky, MD2, John V. Thomas, MD3, Jeffrey W. Nix, MD1 and Soroush Rais−Bahrami, MD1,3 1Department of Urology, University of Alabama at Birmingham, Birmingham, AL; 2Department of Pathology, University of Alabama at Birmingham, Birmingham, AL; 3Department of Radiology, University of Alabama at Birmingham, Birmingham, AL (Presented by: Win Shun Lai, MD)

Introduction: Multiparametric MRI incorporates high resolution anatomic imaging and functional imaging of tissue density and vascularity to aid in the detection of intraprostatic lesions suspicious for prostate cancer. We aim to identify the association between imaging findings on multiparametric prostate MRI (MP-MRI) and biopsy findings on MRI/US fusion- guided prostate biopsies Methods: A retrospective review was performed evaluating all men who underwent MP- MRI and MRI/US fusion-guided prostate biopsy between January and July 2014. Patient demographics, past biopsy history, MP-MRI findings, and biopsy pathology outcomes were reviewed. All MRI studies were reviewed by a radiologist and a urologist who assigned a modified NIH suspicion score to all suspicious lesions visualized based upon identification on each of three imaging parameters (T2-weighted MRI, diffusion weighted MRI, and dynamic contrast enhanced MRI). Patients underwent standard 12-core extended-sextant TRUS- guided biopsy and fusion-guided biopsies of MRI identified lesions using the UroNav biopsy platform. All biopsy pathology was reviewed by a single genitourinary pathologist. Results: Twenty-eight patients fit inclusion criteria for analysis. The median age was61

years (range 45-73) with median PSA of 5.6ng/mL (range 1.1-39.4). The majority of patients Pod iums had prior negative biopsies or biopsies with low-risk cancer findings consistent with active surveillance candidacy. Stepwise increase in MRI suspicion level was associated with an increased cancer detection rate (OR=5.55, p=0.019) on logistic regression modeling and increased risk stratification (no cancer vs Gleason 6 vs Gleason ≥7), p=0.027 by Fisher Exact probability testing. Furthermore, all patients (n=4) in our series who harbored high−risk disease (Gleason ≥8) on biopsy pathology had prebiopsy MP−MRI with assignment of the highest level suspicion score. Conclusion: Increased suspicion of prostate cancer on MP−MRI is associated with improved detection prostate cancer and importantly an increased detection of clinically-significant prostate cancer in the setting of MRI/US fusion-guided prostate biopsies augmenting the standard-of-care 12-core extended sextant biopsy.

94 Podium #13 SUPERIOR EFFICACY OF COMBINATION PHARMACOTHERAPY FOR TREATMENT OF NEUROGENIC DETRUSOR OVERACTIVITY FOLLOWING SPINAL CORD INJURY Jessica Lloyd, MD, Ngoc-Bich Le MD1, John Wiener, MD1, Paul Dolber, PhD2 and Matthew Fraser, PhD1 1Division of Urologic Surgery, Duke University Medical Center, Durham, NC; 2Durham Veterans Affairs Hospital, Durham, NC Presented by: Jessica Lloyd, MD

Introduction: Antimuscarinics are the mainstay of pharmacotherapy for neurogenic detrusor overactivity (NDO); however, bothersome side effects are common, including dry mouth, constipation, and even cognitive impairment. The use of pharmacological combination approaches to treat symptoms of NDO may afford the opportunity to utilize lower doses of each individual drug, allowing achievement of the same or better clinical benefit with fewer side effects. We sought to determine whether combination therapy would improve indices of detrusor hyperreflexia in a rat model of chronic spinal cord injury (SCI). Methods: After ~60 minutes of control open cystometry and three vehicle administrations, dose-response relationships were constructed in awake, restrained chronic suprasacral SCI rats (n= 8−9/group, ≥4 weeks post−SCI) using ½ log increments of fesoterodine (antimuscarinic; F), doxazosin (α1−adrenergic antagonist; D), CL−316,243 (β3−adrenergic agonist; CL) and pregablin (α2δ subunit modulator of N-type Ca2+ channels; P) as either monotherapies or in paired combinations (10 groups total). Vehicles and drugs were given at ~30-minute intervals. Bladder capacity (BC), filling compliance (FC), non−voiding contraction (NVC) count (#) and maximum amplitudes (MA) were captured and measured using PowerLab 16SP. Data were analyzed by Friedman test and 2-way ANOVA, P<0.05 was significant. All results are reported as means of data normalized to last vehicle. Results: All monotherapies resulted in significant increases in BC relative to control cystometry (22-69%), but were not different than each other. All combinations, except D+F, resulted in significant increases in BC (39-126%), with the greatest increment seen with CL+P (116%, p=0.0004) and CL+F (126%, p=0.0064). Only CL+P resulted in a significant increase in FC (115%, p=0.0181). NVC Max Amp was significantly decreased by all treatments (38−68%) except D, P, P+D, and P+F, with the greatest effect being seen in CL+F (68%, p=0.0005) and CL+D (54%, p=0.0043). NVC # was significantly decreased by D (52%, p=0.0045) and CL (47%, p=0.0067). Conclusion: Monotherapies were effective against hallmark characteristics of neurogenic bladder, including BC (all), NVC Max Amp (CL, F) and NVC # (CL, D). Combination therapies provided superior efficacy for BC (CL+F, CL+P), FC (CL+P), and NVC Max Amp (CL+F, CL+D). These results suggest that combination pharmacotherapy may provide similar or superior efficacy with reduced side-effect profiles for the treatment of neurogenic bladder.

95 Podium #14 RECURRENT INCONTINENCE AFTER ARTIFICIAL URINARY SPHINCTER PLACEMENT: USE OF RADIOGRAPHIC CONTRAST AND OHMMETER ALLOWS SIMPLE TROUBLESHOOTING AND OBVIATES THE NEED FOR COMPLETE DEVICE REPLACEMENT Shubham Gupta, Patrick Selph MD, Michael Belsante, MD, George Webster, MD, Andrew Peterson, MD, FACS Duke University, Durham, NC Presented by: Shubham Gupta

Introduction: No universal strategies exist for the evaluation of recurrent incontinence after artificial urinary sphincter (AUS) placement, and patients will often receive expensive diagnostic tests as well as complete device replacement for the same. We present the results of our algorithmic approach to the evaluation and treatment of these cases that includes the judicious use of clinical and radiographic evaluation to determine the best approach for revision. Methods: We conducted a retrospective review of all patients who underwent primary AUS placement for post-prostatectomy incontinence. A normo-osmolar mixture of radiographic contrast was used as the filling medium and an Ohmmeter was used for identification of the site of fluid loss intra-operatively. In general, the entire device is replaced if it is greater than three-year-old, while a component revision is attempted for younger devices. Results: From Jan. 1996 to Dec. 2011, 635 men underwent placement of an AUS, of whom 58 men underwent revision surgery. Thirty-three patients underwent component replacement at a median of 8.5 months after AUS placement. Twenty-five men underwent complete device replacement at a median of 68 months after AUS placement.

Among men who underwent component revision, 16 men had fluid loss which was readily Pod iums diagnosed with a plain radiograph in all but one patient (who did not have contrast in the system). The site of fluid loss was the pressure regulating balloon (PRB) in 11/16 (68.8%), and the cuff in 5/16 (31.2%) patients and was successfully localized intra-operatively using the Ohmmeter in all cases. The remaining patients (17/33) had subcuff atrophy and underwent either cuff downsizing (15/17 patients) or tandem cuff placement (2/17 patients). 8/33 patients (24%) underwent further operative intervention at a median of 21 months after component replacement. The average hardware cost for component replacement is estimated at $4664/patient. Among the 25 men who underwent replacement of all components, 16 (64%) had fluid loss. 17/25 patients (68%) also had subcuff atrophy and underwent cuff downsizing at the time of device replacement. 5/25 (20%) men underwent further operative intervention at a median of three months after device replacement. The average hardware cost for replacement of all components is estimated at $12,455/patient. Conclusion: Component revision of the AUS is feasible, inexpensive and is not associated with an increased risk of complications as compared to replacement of the entire device. The use of radiographic contrast material as filling medium and the Ohmmeter intraoperatively allow precise identification of the cause of recurrence and component replacement where possible.

96 Podium #15 CHANGING PRACTICE PATTERNS IN VAGINAL MESH SURGERY FOR PELVIC ORGAN PROLAPSE AND STRESS URINARY INCONTINENCE. Austin Younger, MD1, Goran Rac, BS2, Justin Ellett, MD1, Michelle Koski, MD1, Ross Rames, MD1 and Eric Rovner, MD1 1Department of Urology, Medical University of South Carolina, Charleston, SC; 2College of Medicine, Medical University of South Carolina, Charleston, SC Presented by: Austin Younger, MD

Introduction: Until recent years, the number of surgeries utilizing transvaginal mesh had been steadily increasing. The FDA statements in 2008 and 2011 regarding complications of transvaginal mesh may have likely slowed the growth of such implantation cases. However, it is unclear whether surgeries for mesh explantation are increasing. The objective of this study is to evaluate for trends in SUI/POP surgery including mesh revision surgery for mesh related complications over the last seven years at the Medical University of South Carolina. Methods: We retrospectively analyzed 249 patients who underwent transvaginal surgical intervention for pelvic organ prolapse, stress urinary incontinence or mesh revision surgery from 8/31/2007 until 8/30/2014. Indications for mesh removal were recorded. These were compared to the annual number of mesh implantation surgeries over the same period of time. In addition, intervention for SUI with autologous fascia pubovaginal sling was compared to the number of sling procedures using synthetic mesh. Results: Indications for mesh revision surgery overlapped in many patients and included: bladder outlet obstruction (65%), erosion (15%), exposure (30%), pain (39%), recurrent urinary tract infections (22%) and de novo lower urinary tract symptoms (11%). The total number of implantation and explantation surgeries is seen in Graphs 1 and 2. There is a proportional rise in the utilization of autologous fascia pubovaginal sling (AFPVS) for SUI when compared to total sling procedures using synthetic mesh as depicted in Graph 3. Conclusion: This study demonstrates a steadily rising incidence of surgical intervention for mesh related complications over the past seven years at a tertiary care center, in association with a comparable decrease in the number of new vaginal mesh surgeries. This trend could be related to changes in referral patterns, an increased awareness and recognition of potential mesh complications, an actual increase in mesh surgery implantation elsewhere, an actual increase in mesh complications or other factors.

97 Podium #16 THE IMPACT OF OBESITY ON OUTCOMES AFTER RETROPUBIC MIDURETHRAL SLING FOR FEMALE STRESS URINARY INCONTINENCE Umar Karaman, MD, Kevin Campbell, MS, Clifton F. Frilot II, PhD, Alex Gomelsky, MD LSU Health − Shreveport, LA Presented by: Umar Karaman, MD

Introduction: Obesity is a risk factor both for developing stress urinary incontinence (SUI) and failure of surgical therapy. We previously showed that obese women had significantly higher rates of persistent or recurrent SUI after three different slings, but had lower rates of postoperative voiding symptoms compared to non-obese women. We aim to evaluate the outcomes of retropubic midurethral slings (RPMUS) in obese women (BMI≥30). Methods: We performed an IRB−approved, retrospective chart review of women undergoing top−down RPMUS with follow-up of ≥12 months. We identified 622 women, 294 (47.3%) with a BMI≥30 and 328 with BMI<30 (52.7%). Women who had previous anti−incontinence surgery and those undergoing concomitant surgery were included. Pre- and post-operative assessment included pelvic examination, SEAPI assessment (stress incontinence, emptying, anatomy, protection, inhibition), and quality of life (QoL) questionnaires [SF−IIQ-7, UDI-6, and 10−point visual analog score (VAS)]. Cure was defined as no subjective or objective SUI and no additional procedures for SUI. Details regarding perioperative morbidity were abstracted from the hospital and clinic charts. Results: Mean follow-up was 22 months for the entire cohort. Mean age, parity, valsalva leak point pressure, SEAPI, IIQ, UDI, and VAS were not statistically (NS) different between obese and non-obese groups. Cure rates were 82.9% and 74.5% for all non-obese and obese women, respectively (Sig). When women undergoing sling only were considered,

76.9% of 65 non-obese women were cured, compared with 73.7% of 99 obese women (NS). Pod iums Cure rates waned over longer follow-up for both groups, but more rapidly for the obese group. Approximately 5% in each group had perioperative complications, with most being Clavien grade ≤3 (NS). Mean and median time to successful voiding was shorter in the obese group. Seven non-obese women had a total of 8 sling incisions, compared with 5 obese women (6 incisions) (NS). Two women in each group had sling revision for pain or extrusion. Improvement in postoperative SEAPI scores, IIQ, UDI, and VAS was achieved for each group (Sig) and the difference between groups was similar (NS). Nine non-obese women later underwent 13 anti−incontinence procedures (seven bulking, six slings), compared with 16 obese women (seven, nine). Conclusion: Our results indicate that obese women are not predisposed to additional complications during RPMUS surgery and surgical outcomes are similar in the short term. While overall satisfaction is high, recurrence of SUI may be more rapid in the obese population. While obesity alone should not be a deterrent in performing RPMUS, appropriate preoperative counseling is recommended. Funding: none

98 Podium #17 COMPLICATIONS OF SACRAL NEUROMODULATION IN CHILDREN Matthew Mason, MD, Christina Ching, MD, Douglass Clayton, MD, Stacy Tanaka, MD, John Thomas, MD, Mark Adams, MD, John Brock, MD, John Pope, MD Vanderbilt University, Pediatric Urology, Nashville, TN (Presented by: Matthew Mason)

Introduction: Sacral neuromodulation (SNM) has previously been shown to be safe and effective in children with refractory urinary dysfunction. Previous reports have estimated rates of complication requiring reoperation at 11-44%, due to device malfunction, pain, erosion or infection. We hypothesize that the majority of complications in children requiring reoperation are related to trauma to the device related to normal childhood activity. Methods: Pediatric patients undergoing SNM at our institution were included in this study. Indications for SNM were urinary symptoms refractory to conservative therapy including medical therapy, dietary and behavioral modification, and constipation treatment. Information regarding complications requiring reoperation was analyzed. Results: Twenty-five patients underwent SNM between December 2010 and July 2014. Median patient age was 9.1 years (range 5.5- 17.4). Median follow-up was 12.7 months (range 1.5 – 30.5). Ten complications requiring reoperation occurred in seven of 25 patients (28%), summarized in Table 1. Six of the seven patients (86%) had dislodgement or breakage of the device related to minor trauma from childhood activity. Patients with lead breakage had a mean body mass index (BMI) of 16.1 (range 14.7 – 18.4) kg/m2, versus a mean BMI of 23.5 (range 14.7-45.7) kg/m2 in the remainder of patients (p < 0.01). In all but one case, the families were happy with SNM function and requested replacement. Conclusion: In children undergoing sacral neuromodulation, the primary reason for reoperation is due to trauma to the device incurred during childhood activities. This type of complication was seen only in children with lower BMI. Families should be counseled regarding this possibility, especially in active children.

99 Podium #18 MEDICAL EXPULSIVE THERAPY FOR PEDIATRIC UROLITHIASIS: SYSTEMATIC REVIEW AND META-ANALYSIS Nermarie Velázquez, BS, Daniel Zapata,MD, Hsin-Hsiao Wang, MD, MPH, Sherry Ross, MD, John Wiener, MD, Michael Lipkin,MD, Jonathan Routh, MD, MPH Duke University Medical Center, Durham, NC (Presented by: Hsin-Hsiao Wang, MD, MPH)

Introduction: Despite its well-documented success in adults, published success rates of medical expulsive therapy (MET) for pediatric urolithiasis vary widely. Our objective was to determine whether the aggregated evidence supports the use of MET in children. Methods: We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, EMBASE databases and recent meeting abstracts for reports in any language. The bibliographies of included studies were then hand-searched. Manuscripts were assessed and data abstracted in duplicate with differences resolved by the senior author. Risk of bias was assessed using standardized instruments. The primary outcome was the odds ratio (OR) of spontaneous stone passage vs. placebo/NSAID. Descriptive statistical analyses were performed using OR and 95% confidence intervals (95% CI) as appropriate. For univariate pooling and meta-regression, standard Dersimonian-Laird random-effects models were used. Results: We identified 11,197 studies, five of which (three randomized controlled trials, two retrospective cohorts) were included in the pooled meta-analysis of 465 patients. Mean patient ages ranged from 5.6-14.5 years. Included study populations were from Turkey, Egypt, and the United States. All studies only used alpha-adrenergic blockers (tamsulosin/ doxazosin). Pooled results demonstrate that MET increased the odds of spontaneous stone

passage (OR 2.21, 95% CI 1.40−3.49, p=0.0007). Between-study heterogeneity was not Pod iums significant (I2=14%, p=0.36). Univariate meta-regression models revealed no significant association between the likelihood of stone passage and COI (0.9), country (p=0.7), age (p=0.4), gender (p=0.4), follow−up (p=0.3), or stone size (p=0.7). There was little evidence of publication bias via funnel plot. Selection bias could not be ruled out in any study. Adverse effects of MET were reportedly minimal (one study withdrawal out of 465 included patients). Conclusion: Consistent with the adult literature, pediatric studies demonstrate that MET results increases the odds of spontaneous stone passage with a low rate of adverse events. However, due to inconsistent reporting it is unclear whether published studies are at risk of bias.

100 Podium #19 HEALTH-RELATED QUALITY OF LIFE IN CHILDREN WITH PRUNE BELLY SYNDROME AND THEIR CAREGIVERS Angela Arlen, MD1, Michael Garcia-Roig, MD2, Natan Seidel1, Edwin Smith, MD1 and Andrew Kirsch, MD1 1Department of Pediatric Urology, Children’s Healthcare of Atlanta & Emory University School of Medicine; 2Children’s Hospital of Atlanta/ Emory University Department of Pediatric Urology (Presented by: Michael Garcia-Roig MD)

Introduction: Prune Belly Syndrome (PBS) is a rare disease characterized by deficiency of abdominal wall musculature, bilateral intra-abdominal testes and urinary tract abnormalities. Children and adolescents with PBS face numerous potential physical and psychosocial challenges. We compared health-related quality of life (HRQoL) in children with PBS and their caregivers to healthy age-matched controls. Methods: Subjects were recruited via the PBS Network (www.prunebelly.org). Participants completed the PedsQLTM 4.0 generic core scales (children) or the Q-LES-Q-SF (caregivers) in an online, anonymous format. PedsQLTM 4.0 is a 23-item, age-adjusted, validated questionnaire that assesses physical, emotional, social, and school functioning. Scoring ranges from 0 to 100 in each of the four scales, with higher values indicating a better quality of life. Comparative healthy sample was derived from the PedsQLTM 4.0 database. Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) is a validated, self-report measure that assesses various areas of daily functioning in adults, where normal quality of life is defined as within 10% of community norm. Results: PedsQLTM 4.0 was completed by 32 children with PBS. Total mean HRQoL score was 61.4 ± 18.2, significantly lower than reported values for healthy controls (83 ±14.8; p<0.0001). Individual physical, emotional, social, and school functioning scales were all significantly lower than in healthy children [Table 1]. Nineteen primary caregivers completed the Q-LES-Q-SF, with a mean raw score of 54.8 ± 9.6 (community norm total = 58). Eight of these caregivers (42.1%) reported quality of life scores significantly below the expected normal range for adults. Conclusion: PBS profoundly impacts HRQoL in children, negatively affecting physical, emotional, social and school functioning. Caregivers of PBS patients also report an overall lower quality of life, highlighting the challenges that families with chronically ill children often face. Future efforts will be aimed at HRQoL improvement via focused education and individualized patient assessment to determine which urologic interventions positively influence patient-reported quality of life. Funding: none

101 Podium #20 DAILY ENEMA REGIMEN IS SUPERIOR TO TRADITIONAL THERAPY FOR VOIDING DYSFUNCTION Steve Hodges, MD Wake Forest Baptist Medical Center, Winston Salem, NC

Introduction: Dr. Sean O’Regan linked uninhibited bladder contractions and pelvic floor dysfunction to acquired megarectum in children. It has been proven that megarectum often goes undiagnosed and undertreated in pediatric incontinence patients. We hypothesized that a daily enema regimen directed to the resolution of chronic rectal dilation would be an effective therapy for pediatric incontinence. Methods: We prospectively evaluated 60 children with non-neurogenic daytime incontinence with History and Physical, urinalysis, Bristol Stool Scale, Rome III criteria, KUB x-ray, and pediatric voiding dysfunction questionnaire. Forty children were treated with traditional therapies including timed voiding, PEG3350 regardless of bowel history to maintain daily, soft bowel movements, and in select cases anticholinergic medications and/or biofeedback therapy. Twenty children were prescribed only a daily enema (Pedialax liquid glycerin suppository for ages 2-5, Pedialax fleet enema for ages 6-11), with no other therapy or voiding schedule. All children were followed up at three months. Results: The average age of patients was five years old. As a whole, of the 60 patients evaluated only five patients (8.3%) had a reported history of constipation (per parental report, Bristol stool scale score of 1-2 or Rome III score of 2 or greater), yet all patients met the diagnostic criteria for constipation of a maximal rectal diameter of 3cm or greater regardless of timing of last defecation (Singh SJ et al J Pediatr Surg. 2005;40(12):1941-4.). The average pediatric voiding dysfunction score of all patients was 14, while upon follow up the average

score for traditionally treated patients was 12 while for enema treated patients was four. Only Pod iums 30% of the traditionally treated patients’ parents reported resolution of symptoms at three months’ time while 85% of enema patients did. Conclusion: In this limited study daily enema therapy is superior to traditional methods for the treatment of pediatric incontinence. These results raise questions regarding the current teachings on the origins of dysfunctional elimination in children and challenge us to re- evaluate theories first postulated by Dr. O’Regan almost 30 years ago.

102 Podium #21 COMPLICATIONS RELATED TO LOWER URINARY TRACT RECONSTRUCTION IN A PEDIATRIC POPULATION: CLASSIFICATION BY CLAVIEN GRADE Deborah Jacobson, MD, Matthew Mason, MD, John Brock, MD, John Pope, MD, John Thomas, MD, Stacy Tanaka, MD, Douglass Clayton, MD, Mark Adams, MD Vanderbilt University, Nashville, TN (Presented by: Deborah Jacobson, MD)

Introduction: Lower urinary tract reconstruction can be associated with substantial morbidity in the pediatric population. The Clavien Grading System, a standard in the consideration of post-operative complications, has not previously been applied in this patient population. The objective of this study was to determine the incidence and severity of all documented complications following lower urinary tract reconstruction in a longitudinal case series and to stratify them according to the Clavien grading system. Methods: Electronic record data was obtained for patients aged 21 or younger who underwent lower urinary tract reconstruction including augmentation of their native bladder between 2002 and 2014. Meticulous review of electronic records established a cohort of 83 patients whose post-operative course was continuously followed through May 1, 2014. Every post-operative complication was documented and categorized by Clavien grade. The summative data was used for qualitative review. Results: Eighty-three total patients met our inclusion criteria. The median age at surgery was 7.9 years. There were a total of 223 documented complications, with an average 2.7 complications per patient with a median patient follow-up of 5.0 years. 53.8% of the documented complications were Clavien grade 2 or lower. The incidence of key complications was as follows: death 1.2% (Clavien 5), bladder rupture 4.8% (Clavien 4), small bowel obstruction 6.0% (Clavien 1-4), bladder calculus 22.9% (Clavien 3B), upper tract calculus 10.8% (Clavien 1, 3B), and any difficult catheterization requiring provider intervention 37.3% (Clavien 1, 3B). Conclusion: Our case series represents a comprehensive review of the immediate and delayed complications associated with pediatric lower urinary tract reconstruction involving augmentation cystoplasty. While our rates of significant complications (Clavien grade 3+) are comparable to those of similar series, we have also documented the incidence of lower grade complications that impact quality of life. These events are common and accumulate for years after primary intervention. Our study data may be used to facilitate an informed discussion prior to surgical intervention.

103 Podium #22 IS FOLLOW UP BEYOND TWO YEARS NECESSARY FOR PT1A RENAL CELL CARCINOMA TREATED WITH NEPHRON SPARING SURGERY? AN ASSESSMENT OF LATE RECURRENCES AND SURVEILLANCE COSTS. Kamran Zargar−Shoshtari, MD1, Tim Kim, MD2, Ross Simon, MD2, Hui−Yi Lin, PhD3, Binglin Yue, MS3, Pranav Sharma, MD2, Philippe Spiess, MD2, Michael Poch , MD2, Julio Pow Sang, MD2 and Wade Sexton , MD2 1Departments of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL; 2Departments of Genitourinary Oncology, Moffitt Cancer Centre, Tampa, FL;3 Departments of Biostatistics, Moffitt Cancer Centre, Tampa, FL Presented by: Kamran Zargar−Shoshtari, MD

Introduction: American Urological Association has recommendations on surveillance strategies following nephron-sparing surgery (NSS). However, the capacity for early detection of recurrences must be balanced against the cost of additional investigations. Furthermore, some debate the ability of current guidelines to effectively detect recurrences following surgery. Aim: To assess the pattern of RCC recurrences in NSS patients, and to determine whether current guidelines for surveillance could be modified based on such patterns. A secondary aim includes estimating the cost implications related to the implementation of changes in surveillance strategies based on recurrence patterns. Method: Retrospective review of single institution NSS database. Pattern of RCC recurrences and factors associated with recurrence were analyzed using the univariate and multivariable (MVA) competing risk regression. Cost of surveillance was estimated based on Medicare charges.

Results: From 1999-2012, 505 patients had elective NSS. Primary T-stage included: pT1a Pod iums (394), pT1b (79) and pT2 or greater (32). Median follow-up was 38.3 (6-88) months, with 68% and 38% of patients followed for more than 24 and 48 months, respectively. Recurrence was detected in 26 patients (5.1%) at a median of 18.9 months and within the following tumor stages; 2.7% of pT1a, 12.7% of pT1b and 15.6% of pT2 or greater tumors. On MVA stage higher than pT1a (HR=6.0, CI= 2.8-13.1), the presence of multifocal or bilateral tumors (HR=2.9, CI=1.2-7.0) and left-sided lesions (HR=2.4, CI= 1.1-5.7) were likely to have recurrence. Only 10 patients recurred beyond 24 months (delayed recurrence), including seven asymptomatic patients diagnosed on surveillance imaging, one patient during workup for elective surgery and two patients based on symptoms (dyspnea and limb weakness). The latter two patients with symptoms were the only pT1a cases (0.5%) that relapsed beyond two years (at 50 and 74 months). Beyond 24 months, routine surveillance did not detect any recurrence in patients with pT1a tumors. Using current AUA guidelines, we estimate the cost savings from omitting routine surveillance beyond two years in our cohort of pT1a patients at $1M. Conclusion: Current guidelines adequately capture most clinically significant recurrences and with longer follow up, it may be possible to confirm that routine surveillance beyond two years may have little clinical significance for asymptomatic unifocal pT1a patients.

104 Podium #23 LYMPH NODE STROMAL CELLS ENHANCE RENAL CELL CARCINOMA GROWTH, TRANSMIGRATION, AND METASTASIS IN AN ORTHOTOPIC XENOGRAFT MODEL John Nelson, MD1, Jessie Gills, MD1, Ravan Moret, MS2, Xin Zhang, MD, PhD2, Grace Maresh, PhD3, M’Liss Hudson, MD1, Marc Matrana, MD1, Ryan Hedgepeth, MD1, Shams Halat, MD1, Christudas Morais, PhD3, Glenda Globe, PhD3, David Johnson, PhD3, Stephen Bardot, MD1 and Li Li, MD, PhD2 1Ochsner Clinic Foundation; 2Ochsner Laboratory of Translational Research; 3University of Queensland Centre for Kidney Disease Research Presented by: John Nelson, MD

Introduction: The incidence of renal cell carcinomas (RCC) is on the rise with an estimated 63,920 new cases in 2014. Despite increased incidental detection of lower clinically staged tumors, metastatic RCC still affects up to 25% of patients at the time of diagnosis. Lymph node (LN) involvement is a strong negative prognostic indicator. LN stromal cells have been shown to enhance tumor cell growth, tumorgenicity and chemotherapy resistance in breast and colon cancer models. However, there are currently no described RCC xenograft models that explore the role of RCC/LN interactions in RCC metastasis. Objective: Identification of molecular signals that play key roles in human RCC tumor formation and metastasis, and characterize their activity using a unique orthotopic patient- derived xenograft (PDX) intra-renal, sub-capsular (IK) injection NOD/SCID mouse model that mimics metastatic RCC under the influence of LN stromal cells. Methods: Freshly resected human RCC specimen (KiCa-Pt58) was obtained via radical nephrectomy. Six human RCC cell lines and KiCa-Pt58 cancer cells were tagged with luciferase (firefly) to enable bioluminescent imaging (BLI). RCC cells were cultured with or without human LN stromal cells (HK) for proliferation using transmigration assays. A unique PDX IK model was used to monitor tumor growth and metastasis weekly by BLI for up to 16 weeks. H&E, immunohistochemistry (IHC) staining and RT-PCR were performed on primary tumor and mouse lung specimens. Results: The presence of HK cells significantly enhanced the proliferation and transmigration of RCC cells. In our PDX IK model, co-injection of HK cells enhanced RCC tumor formation (in 3 out of 6 cell lines) and spontaneous distant metastasis to lung (in four out of six cell lines). Figure 1 Conclusion: Our PDX model provides a platform to study the determinant factors of tumor formation and metastasis with regard to LN stromal/RCC interaction. It can lead to the development of realistic, durable, and individualized treatments for RCC patients and establish co-clinical trials. Funding: FORCE Grant

105 Podium #24 L-2-HYDROXYGLUTARATE: A PUTATIVE ONCOMETABOLITE IN CLEAR CELL RENAL CELL CARCINOMA Jubilee Tan, Daniel Benson, MD, Eun−Hee Shim, PhD, Sunil Sudarshan, MD University of Alabama at Birmingham Presented by: Jubilee Tan

Introduction: Recent studies in renal cancer as well as other malignancies have identified putative oncometabolites, small molecules with transforming properties. Through unbiased metabolomics, we identified elevations of the metabolite 2-hydroxyglutarate (2HG) in clear cell renal cell carcinoma (RCC). We identified that kidney tumors demonstrate elevations specifically of the L enantiomer of 2HG (L-2HG). L-2HG elevation is mediated inpartby reduced expression of L-2HG dehydrogenase (L2HGDH). 2HG can inhibit 2-oxoglutaratre (2-OG) dependent dioxygenases which mediate epigenetic events including DNA and histone demethylation. Given the emerging role of epigenetics in renal carcinogenesis, we set out to explore the tumor promoting properties of L-2HG in renal epithelial cells. Methods: Standard in vitro assays were conducted in cellular models of L-2HG elevation. First, renal epithelial cells were treated with an esterified form of L-2HG to permit intracellular accumulation of L-2HG. In addition, shRNA was used to knockdown L2HGDH expression in renal epithelial cells in order to genetically raise cellular L-2HG levels. Finally, we identified multiple RCC lines with reduced L2HGDH expression and elevated L-2HG levels. We therefore re-expressed L2HGDH cDNA in these RCC lines to lower L-2HG as a complementary approach. Results: Cellular models of raised L-2HG demonstrate promotion of in vitro tumor phenotypes. Raising intracellular 2HG levels in renal epithelial cells promoted cell motility

as determined by wound healing assay. In addition, L2HGDH expression in RCC lowered Pod iums L-2HG levels and resulted in reduced proliferation and colony formation. Conclusion: Our studies indicate that L-2HG has properties of a bonafide oncometabolite. Correspondingly, the L2HGDH gene may have tumor suppressive properties in the context of renal cancer. Future studies will explore the mechanism by which L-2HG exerts these effects and the tumorigenic potential of this axis in vivo.

106 Podium #25 DELAYED INTERVENTION OF SMALL RENAL MASSES ON ACTIVE SURVEILLANCE Mohit Gupta, MD, Paul Crispen, MD Department of Urology, University of Florida College of Medicine, Gainesville, FL Presented by: Mohit Gupta, MD

Introduction: Although surgical excision is standard therapy for small renal masses (SRMs), there is growing recognition of active surveillance (AS) as an option in select patients. There is limited data, however, on the need and reasons for eventual definitive treatment after initiating a period of AS. In this study, we systematically reviewed the literature and performed a pooled analysis of AS series to evaluate the need for eventual definitive treatment. Methods: A literature search of English-language publications of the MEDLINE database was performed to identify clinical studies that reported AS of clinically localized SRMs. Data from individual series was pooled to evaluate the rate of and indications for delayed intervention. Results: Nineteen clinical series (1,246 patients, 1,327 lesions) met our selection criteria. Mean (± SD) lesion size at presentation was 2.64 ± 1.18 cm with a mean follow-up of 38 ± 18.42 months for all patients. Collectively, 31.38% of patients underwent delayed intervention. Rates of delayed intervention in individual series ranged from 3.64% to 70.27%. Of patients undergoing delayed intervention, the average time on active surveillance prior to definitive treatment was 30.12 ± 13.31 months. A pooled analysis revealed that 48.27% of patients underwent therapy secondary to tumor growth rate, and 46.67% secondary to patient or physician preference in the absence of clinical progression. Overall, 2.06% of all patients progressed to metastatic disease with a mean 14.83% noted all−cause mortality. Conclusion: AS may be an appropriate option for carefully selected patients with SRMs. Current data, however, suggests that delayed treatment is pursued in a significant percentage of patients within three years. Additional data from prospective registries and clinical trials with standardized indications for delayed intervention is needed to establish true rates of disease progressions and recommendations for delayed intervention.

107 Podium #26 EXTERNAL VALIDATION OF THE MAYO CLINIC STAGE, SIZE, GRADE, AND NECROSIS (SSIGN) SCORE IN PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA TUMOR THROMBUS Viraj Master, MD, PhD, FACS1, C. Adam Lorentz, MD1, Caroline Tai, MPH1, R. Bertini2, J. Carballido3, T. Chromecki4, G. Ciancio5, S Daneshmand6, C. Evans7, P. Gontero8, A. Haferkamp9, J. Gonzalez10, W. C. Huang11, T. Hoppie12, J. I. Martínez-Salamanca13, R. Matloob2, J. McKiernan14, C. Mlynarczyk14, F. Montorsi2, H. Nguyen7, G. Novara15, J. Palou16, R. Pruthi17, K. Ramaswamy11, O. Rodríguez-Faba16, P. Russo18, S. Shariat19, M. Spahn20, C. Terrone21, D. Tilki7, D. Vergho20, E. Wallen17, E. Xylinas19, R. Zigeuner4 and J.A. Libertino22 1Emory University, Atlanta, GA; 2Vita Salute San Raffaele University, Milano, Italy; 3Puerta de Hierro- Majadahonda, Madrid, Spain; 4Medical University of Graz, Graz, Austria; 5Miami University, Miami, FL; 6University of Southern California, Los Angeles, CA; 7University of California-Davis, Davis, CA; 8Molinette Hospital, Torino, Italy; 9University Hospital, Frankfurt, Germany; 10Hospital de Getafe, Madrid, Spain; 11New York University Lagone Medical Center, New York, NY; 12Oregon Health & Science University, Eugene, Oregon; 13Puerta de Hierro-Majadahonda, Madrid, Spain; 14Columbia University, New York, NY; 15Padua University, Padova, Italy; 16Puigvert Fundación, Barcelona, Spain; 17University of North Carolina, Chapel Hill, NC; 18Memorial Sloan-Kettering Cancer Center, New York, NY; 19Weill Medical College at Cornell University, New York, NY; 20University of Würzburg Clinic, Würzburg, Germany; 21Novara University, Novara, Italy; 22Lahey Clinic Medical Center, Burlington, MA Presented by: C. Adam Lorentz, MD

Introduction: Tumor size, Fuhrman grade, and presence of metastasis are prognostic factors of clinical outcomes in patients with renal cell carcinoma (RCC) with inferior vena cava (IVC) involvement. These are all elements of the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score, which have

been validated in various RCC populations, but never in patients with vena cava thrombus. We assess Pod iums the value of SSIGN score in a large multicenter cohort with RCC and IVC thrombus. Methods: A consortium of 22 international centers gathered retrospective data on 2147 patients treated with radical nephrectomy and IVC thrombectomy from 1971 to 2012. Only those with complete data on each SSIGN element were included in this analysis (n=598). SSIGN scores 0-15 were assigned and grouped in the analysis as in prior validation studies. Kaplan-Meier and Cox regression analyses examined overall survival (OS) and cancer-specific survival (CSS). Results: Within a median follow-up of 33 months (range: 0-239 months), 377 of the 598 patients (63%) died of any cause and 284 (47.5%) died of RCC. Median tumor grade was three and median diameter was nine cm (IQR: 6.6-12); 34.2% of patients presented with tumor metastasis. Median SSIGN score was 7 (IQR: 5-9), 2.7% having scores of [0-2], 16.2% [3-4], 21.7% [5-6], 35.6% [6-9], and 23.7% [10-15]. Table 1 shows the CSS rates. Harrell’s concordance index was 0.799 for prediction of CSS, compared to 0.814 and 0.823 in prior validation studies and 0.838 in the original study (Frank et al. J Urol 2002; 168(6)). Conclusion: We externally validated the high predictive accuracy of the SSIGN score in patients treated with radical nephrectomy and IVC thrombectomy for RCC. The SSIGN score could serve as a useful clinical tool in patients with IVC tumor thrombus with regard to follow-up counseling and clinical trial design.

108 Podium #27 OUTCOMES OF LAPAROSCOPIC CRYOABLATION OF RENAL TUMORS WITH ONCOLOGIC OUTCOMES REPORTED AND COMPLICATIONS CORRELATED TO R.E.N.A.L. NEPHROMETRY SCORES. A Scott Tully, Jr., BS1, Thomas Holley, MD2 and Lee Hammontree, MD3 1UAB School of Public Health, Birmingham, AL; 2Urology Centers of Alabama, Birmingham, AL; 3Urology Centers of Alabama, Birmingham, AL Presented by: Lee Hammontree, MD

Introduction: We report seven years of experience with laparoscopic renal cryoablation (LC) for renal tumors. The R.E.N.A.L. nephrometry score (NS) and complications were reviewed. We reviewed clinical and oncologic outcomes. Methods: We reviewed office, hospital, and radiological discs of patients who underwent LC from July 2006 until February of 2014. Age, tumor size, nephrometry score, local and metastatic kidney cancer recurrence, biopsy results, OR time, EBL, LOS and months of follow up were reviewed. NS was used to rank tumor complexity as low (4-6), moderate (7-9) and high (10-12). Results: A total of 274 patients underwent LC for 285 tumors. Mean age was 62.31 years (range 29-87). Mean tumor size was 2.52cm (range 1.6-4.5). Mean NS was 5.74 (4-28%, 5-24.1%, 6-18.7%, 7-31%, 8-10.9%, 9-5.1%, 10-1.2% 11-0.0%, and 12-0.0% N=257). Of the 257 patients, complexity of tumors was ranked as low in 183(71.2%), moderate in 71 (27.6) and high in three (1.2). There were 20 complications (7.3%) with Clavien−Dindo classification of grade I-8, grade II-3, grade III-7 and grade IV-2. Complication rates for low (4-2.2%), moderate (14-19.7%), and high complexity (2-66.6%) tumors were noted (p < 0.001). Higher complexity was independently associated with higher risk of complications (CO 0.3593, 95% CI 0.2478-0.4614, p < 0.001). Biopsies were non diagnostic in 23.4% and pathology types are reported. Recurrence of cancer or metastatic cancer was found in 13 patients (5% N=259) and was local in five (1.9% N=259) and metastatic in six (2.3%) and both in 1 (0.4%). The local recurrence rate was 0.53% in tumors size less than 3cm (1 of 190), 1.96% in tumors between 3-3.5cm (1 of 51), 6.25% in tumors between 3.5 and 4cm (1 of 16) and 17.65% in tumors over 4 cm (three of 17) (p = 0.0002). Surgery was performed on solitary kidney in 31 of the patients (11.5%). EBL mean was 74.0cc (range 5-1500, mode 10). LOS average was 2.04 nights (range 1−27, mode 1). OR time average was 90min (range21-289). Mean follow up to last CT known was 30.9 months (939.6 days, range: 3-4384 days). Conclusion: Laparoscopic cryoablation for renal masses 4cm and less is an effective treatment for small renal masses. The complications correlate with increased complexity of the tumors and pre op R.E.N.A.L. nephrometry scoring is useful for patient counseling and surgical planning. The recurrence rate locally is very low in this series and did statistically correlate to size of tumor in this size range. There is higher recurrence locally for tumors between 3.5 and 4cm.

109 Podium #28 MAYO ADHESIVE PROBABILITY (MAP) SCORE: AN ACCURATE IMAGE−BASED SCORING SYSTEM TO PREDICT ADHERENT PERINEPHRIC FAT IN PARTIAL NEPHRECTOMY Andrew Davidiuk, MD1, Alexander Parker, PhD2, Colleen Thomas, MS3, Bradley Leibovich, MD4, Erik Castle, MD5, Michael Heckman, MS3, Kaitlynn Custer, BS2 and David Thiel, MD6 1Mayo Clinic Florida, Jacksonville, FL; 2Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, FL; 3Division of Biomedical Statistics and Informatics at Mayo Clinic Florida, Jacksonville, FL; 4Department of Urology at Mayo Clinic, Rochester, MN; 5Department of Urology at Mayo Clinic Arizona, Phoenix, AZ; 6Department of Urology at Mayo Clinic Florida, Jacksonville, FL Presented by: Andrew Davidiuk, MD

Introduction: Image-based renal morphometric scoring systems are used to predict the potential difficulty of partial nephrectomy (PN), but they are centered entirely on tumor-specific factors and neglect other patient-specific factors that may complicate the technical aspects of PN. Adherent perinephric fat (APF) is one such factor known to make PN difficult. We developed an accurate imaged-based nephrometry scoring system to predict the presence of APF encountered during robotic assisted partial nephrectomy (RAPN). Methods: We prospectively analyzed 100 consecutive RAPN performed by one surgeon and defined APF as the necessity of sub-capsular renal dissection to isolate the renal tumor for RAPN. Associations of patient and tumor characteristics with the presence of APF during PN were evaluated using logistic regression models, where odds ratios (ORs) and 95% CIs were estimated. The scoring algorithm to predict the presence of APF was developed using a forward selection approach with a focus on improvement in the area under the receiver

operating characteristic curve (AUC). Pod iums Results: Thirty patients (30%, 95% confidence interval: 21%-40%) had APF. Single-variable analysis noted an increased likelihood of APF in male patients (P<0.001), higher BMI (P=0.003), greater posterior perinephric fat thickness (P<0.001), greater lateral perinephric fat thickness (P<0.001), and those with peri−renal fat stranding (P<0.001). Using posterior perinephric fat thickness (score 0−2) and stranding (score 0,2 or 3), we created a risk score (termed “MAP”) to predict the presence of APF with an AUC of 0.89 (95% CI: 0.81- 0.97). Of note, inclusion of other covariates in the model did not noticeably improve AUC. We observed APF in 6% of patients with a MAP score of 0, 16% with a score of 1, 31% with a score of 2, 73% with a score of 3-4, and 100% of patients with a score of 5. Conclusion: The simple, image-based MAP score accurately predicts the presence of APF in patients undergoing RAPN. This scoring system may serve as an adjunct to other known tumor based morphometric scoring systems. Prospective validation of the MAP score is required.

110 Podium #29 SURGICAL MANAGEMENT OF RENAL CELL CARCINOMA IN OCTOGENARIANS AND NONAGENARIANS: DEFINING APPROPRIATE TREATMENT STANDARDS Zachary Klaassen, MD1, Rita P. Jen, MPH1, John M. DiBianco2, Lael Reinstatler, MPH1, Daniel Belew1, Qiang Li, MD, PhD1, Rabii Madi, MD1 and Martha K. Terris, MD1 1Medical College of Georgia-Georgia Regents University, Augusta, GA; 2Ross University School of Medicine, Dominica, West Indies Presented by: Zachary Klaassen, MD

Introduction: Nearly 25% of all cases of renal cell carcinoma (RCC) are diagnosed in patients ≥80 years of age. Additionally, in the United States, the life expectancy at 80 years is 8.10 years for men and 9.61 years for women. Using a population-based cohort, we sought to evaluate the surgical treatment patterns and survival outcomes in octogenarians and nonagenarians with RCC. Methods: Patients ≥80 years of age with RCC treated either with radical nephrectomy (RN), partial nephrectomy or cryoablation were extracted from the SEER database from 1988-2010 (n=7,453). Sociodemographic variables, surgical treatment modality, cause of death, and median overall survival (OS) and disease specific survival (DSS) were reported. Descriptive statistics and Kaplan Meier analysis were performed to compare variables between stages and between treatment modalities within stages of RCC. Results: There were 4,528 patients (60.7%) with Stage I, 844 patients (11.3%) with Stage II, 1,398 patients (18.8%) with Stage III, and 683 patients (9.2%) with Stage IV RCC. Females were more likely to have advanced disease compared to males (female Stage I – 46.6% vs Stage IV – 34.7%; male Stage I – 53.4% vs Stage IV − 65.4%, p<0.0001). Furthermore, females were more likely to receive aggressive treatment for localized disease (Stage I RN – female 83.1% vs male 78.3%, p=0.001; Stage II RN – female 98.5% vs male 94.4%, p=0.009). Caucasians were more likely to have advanced disease compared to African Americans (AA) (Caucasian Stage I – 89.8% vs Stage IV – 91.3%; AA Stage I – 6.0% vs Stage IV – 4.1%, p =0.0007), however there were no differences in treatment modality between races for localized disease (p=0.11). Among patients with Stage I RCC, 10.6% were dead of disease (DOD) and 36.5% were dead of other causes (DOC) (OS 41 mos; DSS 22 mos). For patients with Stage II, 20.2% were DOD and 37.0% were DOC (OS 35 mos; DSS 21 mos); Stage III, 30.1% were DOD and 26.1% were DOC (OS 23 mos; DSS 14 mos); Stage IV, 39.1% were DOD and 48.5% were DOC (OS 33 mos; DSS 15 mos) (p<0.0001). Conclusion: In the current population-based analysis, octogenarians and nonagenarians with Stage I RCC are likely over treated and those with Stage IV disease likely do not enjoy a survival benefit from surgical management. Although RN in patients with stage IV RCC may not have a survival benefit, there may be some palliative benefit in symptomatic patients. Appropriately selected patients with Stage II and III disease may benefit from aggressive surgical treatment. We detected no racial disparities in the delivery of surgical treatment in this cohort, however female patients are more likely to receive aggressive management for localized RCC.

111 Podium #30 ROBOTIC SIMPLE PROSTATECTOMY: A LARGE MULTI−INSTITUTIONAL OUTCOME ANALYSIS James Bienvenu, MD1, Kyle Basham, MD1, Riccardo Autorino, MD2, David Thiel, MD3, W Bedford Waters ,MD1 and Wesley White, MD1 1Division of Urology, University of Tennessee Medical Center − Knoxville, TN; 2University Hospitals Urology Institute; 3Mayo Clinic − Jacksonville, FL Presented by: James Bienvenu, MD

Introduction: Robotic simple prostatectomy has been introduced with the aim of reducing the morbidity of the standard open technique. However, in the current era of transurethral surgery for the treatment of bladder outlet obstruction (BOO) due to benign prostatic hypertrophy (BPH), its role is yet to be defined. We present a large multi-center series of robotic simple prostatectomy (RSP) in order to analyze predictors of a favorable outcome. Methods: Consecutive cases of RSP performed between 2008 and November of 2014 at participating institutions in Europe and the Unites States were included for retrospective analysis. Each group carried out the procedure according to its own protocols, criteria, and techniques. Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed retrospectively. Results: Overall, 456 cases were included in the analysis. The mean patient age was 68 years old, mean patient BMI was 28 kg/m2, and mean Charlson comorbidity score was 2. In 24% of cases, the patients had a history of previous abdominal surgery. The patients had a prostate biopsy in 31%, and in 18%, they presented with urinary retention and an indwelling Foley catheter. Preoperative mean functional parameters were as follows: IPSS 23, Qmax 8 ml/sec, PVR 236 ml. Mean preoperative PSA was 8 ng/dl and mean prostate volume

was 119 ml. In the majority of cases (68%), a Millin technique was used. Mean operative Pod iums time was 144 minutes, and average estimated blood loss was 241 ml. The intraoperative complication rate was 3.3%, and an intraoperative transfusion was required in 5.9% of cases. Mean hospital stay was 3 days and mean time to catheter removal was eight days. The postoperative complication rate was 14%, being mostly low−grade complications. The average adenoma weight was 82 grams on pathologic analysis. Mean postoperative PSA was 2 ng/dl. The average postoperative IPSS was 7 with a mean Qmax of 25 ml/sec. Conclusion: This study provides the largest outcome analysis reported for RSP for BOO/ BPH. The present findings confirm that SP can be safely and effectively performed ina minimally invasive fashion by using a robot−assisted laparoscopic approach in multiple healthcare settings. Thus, RSP can be considered a viable surgical treatment and can be implemented in large prostate glands in the appropriately selected patients.

112 Podium #31 IS THE ETIOLOGY OF PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD) INJURIES EVOLVING? Divya Ajay, MD1, Michael Granieri, MD2, John Selph, MD2, Michael Belsante, MD2, George Webster, MB, ChB, FRCS, FACS2 and Andrew Peterson, MD, FACS2 1Division of Urology, Duke University Medical Center, Durham, NC; 2Duke University Medical Center, Durham, NC Presented by: Divya Ajay MD

Introduction: PFUDDs are rare but clinically challenging for urologists. Men who suffer these injuries have potential long-term morbidity including impotence, infertility, and stricture disease. Identifying the etiology of these injuries may inform efforts in prevention. Traditionally, the most common mechanism was motor vehicle accidents (MVA). Other mechanisms of injury include falls, pelvic crush injuries, being struck by a motor vehicle and gunshot wounds. We hypothesized that policy measures improving car safety and seat belt laws would decrease the number of PFUDDs caused by MVAs. We sought to examine the mechanism of injury in patients with PFUDD presenting to a single institution over time to appreciate this decrease. Methods: We conducted a retrospective review of all patients referred to our facility for PFUDD from 1996 to 2012. Etiology of each PFUDD was identified by chart review. MVA was defined when the injured patient was driver or passenger of a vehicle. All other injuries were included in the ‘other’ category. These included pelvic crush injuries from being struck by a truck, tractor or motor vehicle, pelvic crush from heavy objects falling on the patient, gunshot wounds and falls. Results: We identified 153 patients who underwent posterior urethroplasty for PFUDD. Of these, mechanism of injury was definitively identified in 140 patients (92%). 90 posterior urethroplasties were performed between 1996 and 2004 versus 50 between 2004 and 2012. This was an average of 11.3 (SD 5.8) posterior urethroplasties for PFUDD performed per year from 1996-2004 versus 5.6 (SD 3.8) performed from 2004 to 2012 (p=0.02). As demonstrated in figure 1, MVA remained the leading cause of PFUDD in both cohorts. MVA accounted for 48.6% (SD 18.3) of PFUDDs between 1996 and 2004 and 43.7% (SD 27.6) of PFUDDs between 2004 and 2012 (p=0.67). Conclusion: Our hypothesis that improvements in motor vehicle safety are changing the epidemiology of the mechanisms of PFUDD was refuted by this retrospective review, however, the overall decrease in numbers of PFUDD over the last 14 years may be indicative of improvement in motor vehicle safety. Confirmatory studies are warranted.

Financial funding: None

113 Podium #32 CRITICAL ANALYSIS OF THE DELAY FROM DIAGNOSIS OF BULBAR URETHRAL STRICTURE DISEASE TO REFERRAL FOR DEFINITIVE URETHROPLASTY Divya Ajay, MD1, Michael Granieri, MD2, Michael Belsante, MD2, John Selph, MD2, Ngoc− Bich Phan Le, MD2, George Webster, MB ChB, FRCS, FACS2 and Andrew Peterson, MD, FACS2 1Division of Urology, Duke University Medical Center, Durham, NC; 2Duke University Medical Center, Durham, NC Presented by: Divya Ajay, MD

Introduction: There is little information about the natural history of bulbar urethral stricture disease (USD) from the time of diagnosis to referral for definitive urethroplasty. Here we describe the patient experience from the time of USD symptom development to referral for urethroplasty in a cohort of patients who underwent urethroplasty for bulbar USD. Methods: We performed an IRB−approved retrospective review of our institution’s database and limited our review to men who underwent bulbar urethroplasty from 1996 to 2011. We reviewed patient demographics, stricture etiology and length, date of symptom development, prior procedures, and date of urethroplasty. Prior procedures (proc) included dilation, urethrotomy, self−calibration, and Urolume stent placement. Patients with prior history of urethroplasty were excluded. One-way ANOVA was used to compare mean age and stricture length, Fisher’s exact test to compare frequency of procedures, and Kruskal-Wallis test to compare median time to repair among all etiologies. Sub-group analysis was performed using paired t-test, Fisher’s exact test, and Wilcoxon Rank Sum, with Bonferroni correction. Results: We identified 357 consecutive patients who underwent urethroplasty for bulbar USD from January 1996 to September 2011. The median time from the initial development of

symptoms to urethroplasty was five years. Table 1 shows patient characteristics by etiology Pod iums of stricture. Those with iatrogenic etiology had a significantly shorter time to repair when compared to idiopathic (6 vs 3 Y, p<0.001). Patients with idiopathic etiology were more likely to have no procedures prior to referral when compared to iatrogenic etiology (9.2 vs 0%, p=0.003). Conclusion: The median time from the initial development of symptoms to referral for definitive urethroplasty is long, at approximately five years. Patients with idiopathic etiology had the longest delay in time to repair but, interestingly, had the highest rate of having no prior procedures. Given the high success rates of urethroplasty for bulbar stricture disease, earlier referral of patients for definitive repair would likely improve a variety of patient-related outcomes. Funding source: None

114 Podium #33 OUTCOMES OF DIRECT VISION INTERNAL URETHROTOMY WITH HIGH DOSE STEROID INJECTION FOR ANTERIOR URETHRAL STRICTURES: TECHNIQUE MODIFICATION Rishi Modh, MD, MBA, Alyssa Sheffield, Lawrence Yeung, MD University of Florida, Gainesville, FL Presented by: Rishi Modh, MD, MBA

Introduction: To prospectively evaluate the recurrence rate of urethral strictures managed with cold knife direct vision internal urethrotomy (DVIU) with high dose corticosteroid injection. Methods: Twenty-three patients with urethral strictures who underwent DVIU with high dose corticosteroid injection (triamcinolone 400mg) into the periurethral tissue to decrease the risk of stricture recurrence. Current literature describes the use of triamcinolone injections of 40mg. All patients had a urethral catheter post operatively for an average of 10 days. Patients were evaluated every three months for the first year with uroflowmetery, International Prostate Symptom Scores, and post void residuals. Cystoscopy was performed when needed to assess for recurrence. DVIU failure was defined by the need for a subsequent urethral procedure (urethroplasty, dilation, or repeat DVIU). Results: The mean age was 61 years and 74% of the patients previously had multiple procedures for management of urethral stricture. The stricture length averaged 2.1 cm based on retrograde urethrogram and 61% of all strictures were located in the bulbar urethra. The most common cause of stricture was prior radiation therapy (36%). Our technique modification (dose increase) demonstrates a recurrence rate of only 30% at a mean follow up of 17.6 months. There was a low rate of post-operative urinary tract infections seen (8.7%), and there were no other significant complications noted. Mean time to stricture recurrence was delayed to 8.1 months for those who failed. Conclusion: High dose corticosteroid injection at the time of DVIU is a safe and effective procedure for urethral strictures, particularly in those who have had prior intervention for urethral strictures. This appears to be a good option for men who may not be good candidates for urethroplasty. Long-term effectiveness remains to be evaluated.

115 Podium #34 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OUTCOMES IN PATIENTS WITH PRIOR BENIGN PROSTATIC HYPERTROPHY (BPH) SURGERY Tracy Marien, MD, Christopher Mitchell, MD1, Ryan Pickens, MD1, Christopher Jaeger, MD2, Rafael Nunez Nateras, MD3, Aaron Benson, MD1, Mark Sawyer, MD1, Davis Viprakasit, MD4, Amy Krambeck, MD5, Mitchell Humphreys , MD3 and Nicole Miller, MD1 1Vanderbilt, Nashville, TN; 2Mayo, Rochester, AZ; 3Mayo, Scottsdale, AZ; 4UNC, Chapel Hill, NC; 5Mayo, Rochester, NY Presented by: Tracy Marien, MD

Introduction: Many patients who fail an intervention for benign prostatic hyperplasia (BPH) are subsequently treated by another outlet procedure. Retreatment of BPH with holmium laser enuculeation of the prostate (HoLEP) is not well known. We aimed to define the outcomes of patients undergoing HoLEP following previous surgical or minimally invasive therapy for BPH. Methods: A prospectively maintained multi−institutional database of 615 patients who underwent HoLEP between June 2008 and May 2012 was reviewed to identify patients who had undergone prior surgical or minimally invasive procedures for BPH. Preoperative, perioperative and postoperative data was captured. Quality of life data was collected in the form of AUA symptom scores (AUASS), International Continence Society (ICS) questionnaire and the Sexual Health Inventory for Men (SHIM) questionnaire. A statistical analysis was performed. Results: We identified 96 patients who underwent HoLEP and had a prior BPH procedure including: 20 transurethral microwave therapy (TUMT), 14 transurethral needle ablations (TUNA), 40 transurethral prostate resections (TURP) and 22 laser type procedures. The

mean time between HoLEP and prior BPH therapy was 39 months (range: 4-96 months). Pod iums The mean age was 70.2 years old. The mean prostate volume before HoLEP was 98 grams (45-200 grams). The mean resected volume was 68 grams (20-146 grams). Average length of stay was 1.2 days. Complications were minor and included bladder neck contractures (two), transient urinary retention (five), transient stress incontinence (nine), and urinary tract infection (six). There was statistically significant improvement in AUASS, bother score, ICS score and urinary average and maximum flow rates on follow−up, see Table 1. There was no significant difference between patients undergoing a secondary procedure compared to those undergoing a primary BPH procedure with respect to preoperative demographics, operative data, postoperative subjective or objective outcomes or complications. Conclusion: HoLEP as retreatment for BPH following prior transurethral therapy has excellent functional and quality of life outcomes with no significant increase in complication rate.

116 Podium #35 LEARNING CURVE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) IN A COMMUNITY PRACTICE Chandler Dora, MD, Michael Guju, MS Tampa, FL Presented: Chandler Dora, MD

Introduction: HoLEP is a rigorously studied effective treatment for symptomatic benign prostatic hyperplasia (BPH). A frequent barrier to adaptation of HoLEP in community practice is a perceived steep learning curve. We present data from the first 100 men undergoing HoLEP by a single surgeon in a community urology practice. Surgeon training was obtained through a single session of direct observation and a single session of proctoring. Methods: Institutional Review Board approval was obtained. Retrospective chart review was performed on the first 100 consecutive men who underwent HoLEP by a single surgeon at St. Joseph’s Hospital in Tampa, Florida. The ratio of specimen weight to prostate volume, operative time, and catheter time were examined as a function of case number. Results: Catheter time vs. Case number (Figure 1), Operative time vs. Case number (Figure 2), and Specimen wt/transrectalultrasound (TRUS) volume vs. Case number (Figure 3). Conclusion: Proficiency in HoLEP can be measured using several parameters. Catheter time and operative time both decreased with surgeon experience during the first 100 cases. One of the most significant indicators of proficiency appears to be the ratio of specimen weight to prostate volume which increased significantly during the first 100 cases. We would encourage any urologist beginning HoLEP to measure prostate volume on every patient prior to surgery.

117 Podium #36 DEVELOPMENT OF A NOVEL CONCENTRIC TUBE ROBOT FOR TRANSURETHRAL PROSTATE SURGERY Christopher Mitchell, MD, Richard Hendrick, Tracy Marien,MD, Robert Webster, PhD, S. Duke Herrell, MD Vanderbilt University Medical Center, Nashville, TN Presented by: Christopher Mitchell, MD

Introduction: While many consider transurethral resection of the prostate (TURP) the gold standard treatment for benign prostate hyperplasia (BPH), recent evidence has shown that holmium laser enucleation of the prostate (HoLEP) is at least as effective as TURP, with less perioperative morbidity including shorter length of catheter use, lower transfusion rates, and shorter hospital stay. Despite the advantages of HoLEP, there has been reluctance of the urologic community to adopt the procedure, primarily as a result of a perceived steep learning curve. Thus, we sought to design and develop a novel transurethral endoscopic robotic platform for HoLEP. Methods: An intensive clinical collaboration between Vanderbilt engineers and urologists was undertaken to develop a handheld robot which passes through a standard endoscope with the specific goal of improving the ease with which HoLEP is able to be performed. Funded by NIH EB017467 and VU. Results: The robotic system design consists of 3 main modules: the user interface, the transmission, and the endoscope (Figure 1). The user interface consists of two handles, each with an embedded joystick and trigger which are linked to motors responsible for driving the concentric tube manipulators. The transmission section converts the motion of the motors into translation and rotation of the tubes. The endoscope contains optics, inflow/

outflow channels, and a five mm working channel through which two concentric tube robots Pod iums are passed. Each concentric tube consists of a straight outer tube and superelastic nitinol inner tube which is pre-shaped into a curved configuration. When these tubes are translated and rotated, their elastic interaction creates a “tentacle-like” motion. The entire hand-held robot is mounted on a counterbalanced arm to allow for manual manipulation and positioning of the entire robot by the surgeon. Conclusion: We have developed a concentric tube robotic platform passed through a standard endoscope capable of producing complex movements of the end effectors. Through these motions it possible to retract tissue with one arm and aim a laser with the other, thus alleviating one of the major challenges encountered during HoLEP.

118 Podium #37 IMPLEMENTATION OF A SUPRAPUBIC CATHETER EDUCATION PROGRAM ON THE INPATIENT WARDS Gerald Heulitt, MD, Rachel Baublet Head, MD, Charles Pound, MD University of Mississippi Medical Center Jackson, MS Presented by: Gerald Heulitt, MD

Introduction: The exchange and replacement of suprapubic catheters (SPC) on the in- patient ward is a common urologic procedure that is within the scope of practice of properly trained nursing staff. At our institution, the urology service is often consulted for routine SPC exchange and replacement. The ideal time to replace a SPC that has become dislodged or fallen out is within 5-10 minutes. This is most ideally performed by a ward nurse as a delay in replacement can lead to closure of the tract and the requirement of replacing the catheter in the operating room leading to increased cost to the healthcare system and risks of anesthesia to the patient. Methods: Our study investigated one inpatient ward’s nurses’ perception of their education and ability to perform a SPC replacement or exchange. An education program was established consisting of distribution of articles and guidelines on SPC care from nursing literature as well as in-person sessions to discuss these articles and answer questions regard SPC care. Then a post-education survey was performed. 18 RNs responded to our initial survey, of which two were educated on SPC exchange or replacement in nursing school and three had previously performed a SPC exchange or replacement. These previously performed SPC exchanges or replacements were all performed at other institutions. 13 RNs responded to our post- education survey, of which, 11 had taken part in an education session. Results: Eight reported feeling comfortable performing a SPC exchange or replacement. Working with the nurse educators at our institution, it was recommended we write a nursing policy and film a SPC educational video that would be distributed to the nurses. Currently, the policy we have written has been accepted at the institution and the video is being distributed for nurse education across the institution. Conclusion: While our initial attempt at nurse education was successful, it did not conform to the nursing standards at our institution. We were able to work with the nurse educators and institution to develop an education program that would be accepted as valid and can be easily distributed and repeated to educate future generations of nurses on this common urologic procedure.

119 Podium #38 DETERMING THE EFFECTS OF STEM CELL TREATMENT ON PEYRONIE’S DISEASE IN HUMANS Michael Zahalsky, MD, Melissa Marchand, PA, Leanne Iorio, Walquiria Cassini and Jason Levy Z Urology Presented by: Michael Zahalsky, MD

Introduction: Peyronies’ disease (PD) forms fibrous plaques in the tunica albuginea causing erectile dysfunction (ED), abnormal curvature and plaque formation in the penis. Stem Cells are thought to be able to assist in wound healing and improve vasulogenesis. We believe our study is the first human study to provide the results of using Stem Cells to treat PD. Methods: This study evaluated the feasibility and effects of using Plancetal Matrix derived Mesenchymal Stem Cells (PM-MSCs) in the treatment of PD. PM-MSC’s are a plancental stem cell product that mixes mesenchymal stem cells with growth factors, cytokines, and an extracellular matrix to promote wound healing, angiogenesis, and tissue repair. After obtaining Western IRB approval, patients with PD underwent informed consent and were evaluated using penile ultrasound to measure the number and size of the Peyronie’s Plaques. Next, patients were injected with 0.2 cc of Trimix for standardization of data and were evaluated for peak systolic velocity (PSV) and angle of curvature. On a separate visit, PM−MSCs were injected intracavernosally. First, 1 cc of PM-MSCs was diluted with 2 cc of isotonic saline to a total of 3 cc. Up to 2 cc of our diluted PM-MSCs was then injected in and around the Peyronie’s plaques. The remainder of the PM-MSCs was then injected evenly into each corpora at the base at the base of the penis. Patients were re-evaluated at six weeks, then three months. Results: There are five patients enrolled in the study. At six weeks, PSV increased in all

patients (39%-81%). Using unpaired t-tests this was statistically significant (p<0.01). Pod iums All five patients demonstrated a reduction on ultrasound in the size of the plaques. The four patients with three-month follow up had a 99%-100% reduction in plaque size. In total there were 10 plaques between five people in the study, and seven of those plaques completely disappeared on ultrasound. In the four patients that had curvature caused by plaques, the angle showed a 10°-85° improvement, corresponding to a 14%-100% reduction in curvature. The reduction is 43%- 100% in patients in the study for three months or more. All patients are happy with the treatment. Conclusion: This is possibly the first human study to report on the ability to use Stem Cells in the treatment of PD. Although the sample size is small, the results are statistically significant and very promising. The results show that PM-MSC treatment is likely the most effective non-surgical treatment for PD. PM-MSCs also increased the blood flow to the penis a statistically significant amount. This was a feasibility study using PM-MSCs on PD in humans. PM-MSCs need to be further studied in a multicenter clinical trial to validate these significant results.

120 Podium #39 PREDICTORS OF ERECTILE RESPONSE IN PATIENTS WITH ARTERIAL DISEASE ON PENILE DOPPLER ULTRASOUND Casey McCraw, BS, MD, Patrick Fox, BS, MD, Carolyn Cutler, BS, Andrew Ostrowski, BS, Qiang Li, BS, MD, Zachary Klaassen, BS, MD, Ronald Lewis, BS, MD Georgia Regents University, Augusta, GA Presented by: Casey McCraw, BS, MD

Introduction: Erectile Dysfunction (ED) is the inability to attain and maintain an erection for satisfactory sexual performance, and is a common worldwide condition affecting men both physically and psychologically. Penile Doppler (PD) ultrasound provides an objective measure of a patient’s erectile hemodynamic status and is a baseline diagnostic modality for ED evaluation and treatment. The objective of this study was to determine the characteristics that predict a response to intercavernosal injection (ICI) in patients with arterial disease using PD ultrasound. Methods: Between July 2008 and February 2013, 472 consecutive patients were evaluated for ED with a PD ultrasound of which 462 patients had complete data. Among this cohort, 254 patients (55.0%) had arterial disease, defined as peak systolic velocity (PSV) <30 cm/s. These patients were then divided into responders to ICI (>45 degree erection) (Group 1: n=56, 22.0%) and non-responders to ICI (<45 degree erection) (Group 2: n=198, 78.0%). Demographic and PD ultrasound parameters between the groups were compared using t-test for continuous variables and Fisher Exact test or Chi−square analysis for categorical variables. The odds ratios (OR) of clinical response associated with demographics and PD ultrasound variables were determined using a multivariable logistic regression model. Results: The mean age for Group 1 was 57.6 years and 58.8 years for Group 2 (p=0.54). Patients in Group 1 had a higher BMI compared to Group 2 (32.0 vs 29.6, p=0.04). There was no difference between the groups for race, marital status and smoking status. Patients in Group 1 had a greater mean PSV (26.9 vs 21.6, p=0.001), end diastolic velocity (EDV) (3.0 vs 1.4, p=0.004) and post−injection cavernosal artery diameter (CAD) (0.74 vs 0.62, p<0.001) compared to Group 2. After adjusting for age, race, BMI, marital status, smoking status, PSV, EDV, and post−injection CAD, the predictors of clinical response to ICI in patients with ED and arterial disease were BMI (OR 1.09; 95% CI 1.01-1.16, p<0.01), PSV (OR 1.05; 95% CI 1.01-1.09, p<0.01) and EDV (OR 1.11; 95% CI 1.01-1.25, p<0.03). Conclusion: This study shows that a higher BMI, PSV and EDV independently predict adequate erectile response to ICI on PD ultrasound when arterial disease is the underlying cause of ED. Although these results need to be confirmed in larger studies, this information may be useful in counseling patients with hypertension, diabetes mellitus and other risk factors for arterial disease.

121 Podium #40 RADIOPROTECTION OF ERECTILE FUNCTION USING NOVEL ANTI-OXIDANT IN THE RAT Michael Granieri, MD, Artak Tovmasyan, PhD, Hui Yan, PhD, Xiaochun Lu, PhD, Lan Mao, PhD, Everardo Macias, PhD, Ivan Spasojevic, PhD, Ines Batinic−Haberle, PhD, Andrew Peterson, MD, Bridget Koontz, MD Duke University Medical Center, Durham, NC Presented by: Michael Granieri, MD

Introduction: Oxidative stress within the penis plays a crucial role in the development of radiation induced erectile dysfunction (ED). We hypothesized that systemic treatment with the potent free radical scavenger and superoxide dismutase mimetic Mn(III) meso-tetrakis (N-n-butoxyethylpyridinium-2-yl) porphyrin, or MnBuOE, would protect erectile function (EF) after prostate-confined radiotherapy (RT). Methods: Twenty-two 12-week-old male rats were divided into control (n=4), RT alone (n=7), MnBuOE alone (n=4), or MnBuOE + RT (n=7) groups. Prostate confined RT was administered in a single 20Gy dose. MnBuOE was given at a dose of 0.5mg/kg SC daily beginning two days before RT and continued for 28 days after irradiation RT and then twice weekly until sacrifice at nine weeks. Measurement of EF was performed at four and nine weeks by counting the number of erectile events (EE) and yawns (Y) after injection of 0.1mg/ kg apomorphine. Intra-cavernosal pressure (ICP) measurements with left cavernosal nerve stimulation were performed at week 9. Statistical analysis performed using Student’s t-test between pairs for apomorphine and Student’s t−test between pairs and Pearson Chi Square for entire cohort for ICP (JMP Pro 10). Results: MnBuOE was tolerated well with no measurable toxicity. There were no differences

in EE or Y between the groups at four weeks. While no difference was maintained in the Pod iums control Y behavior at 9 weeks, there was a significant decrease in EE in the RT group when compared to control (control mean EF 2.5 + 0.6, RT mean EF 0.7 + 0.5, p=0.01). There was no statistical difference in EE between control and MnBuOE (MnBuOE mean EE 2.5 + 1.3, p=1.0), MnBuOE+RT and control (MnBuOE+RT mean EE 3.4 + 1.4, p=0.17), or MnBuOE and MnBuOE+RT (p=0.17). Small numbers limited ICP analysis with a non−significant trend for worse ICP/basal ratio between control and RT groups (p=0.27) but no difference among all groups (p=0.14). Conclusion: MnBuOE is a novel potent antioxidant which provided substantial radioprotection to erectile function. In other models, its radioprotection does not extend to tumors. Experiments are underway to confirm that MnBuOE is not protective of human prostate tumor prior to advancement of this compound into clinical study.

122 Podium #41 THE IMPACT OF VARIABLE SEMINOMATOUS INVOLVEMENT IN MIXED GERM CELL TUMORS ON INTRA-OPERATIVE COMPLEXITY AND POST-OPERATIVE COMPLICATIONS IN POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION Christopher Russell, BS1, Gautum Agarwal, MD2, David Buethe, MD2, Patrick Espiritu, MD2, Adam Luchey, MD2, Philippe E. Spiess, MD2, Julio Powsang, MD2, Michael Poch, MD2 and Wade J. Sexton, MD2 1USF Morsani College of Medicine, Tampa, FL; 2H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Christopher Russell, BS

Introduction: Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is an essential component in the management of metastatic testicular cancer (TC). A significant desmoplastic reaction is often encountered in the residual masses of patients with pure seminoma and has previously been reported to increase surgical complexity. The impact of mixed primary tumors with variable percentages of seminoma elements on PC-RPLND operative parameters has not yet been assessed. Methods: Patients undergoing PC-RPLND for residual TC following the completion of at least 1 induction course of cisplatin-based combination chemotherapy were identified through retrospective review. Primary orchiectomy specimens with pure seminoma (SGCT) and mixed seminoma containing germ cell tumors (SC-GCT) were compared to primary GCTs with no seminoma elements (true NSGCT) to assess for differences in intra- and post-operative outcomes. Linear and logistic regression models were used to assess for differences in parameters between percentages of seminoma elements. Results: Ninety-seven patients met inclusion criteria, consisting of 18 pure SGCT, 22 mixed SC-GCT, and 57 NSGCT. Mixed SC-GCT contained a mean of 31.4% (range 5%- 90%) seminoma elements. Pure SGCT demonstrated a significantly increased median EBL (p=0.049) and nephrectomy rate (p=0.006) compared to NSGCT. Patients with SC-GCT had significantly increased median operative time (p=0.008), EBL (p=0.048) and transfusion volume (p=0.004) when compared to NSGCT. In patients with mixed SC−GCT, linear and logistic regression revealed a significant correlation between increasing percentage of seminoma involvement in the primary orchiectomy tumor and median EBL (p=0.048) transfusion rate (p=0.02), and transfusion volume (p=0.0005). Post-operative complications occurred in 31 patients. There was no difference in complication rates according to histology. Although logistic regression failed to demonstrate any association between percentage of seminoma involvement and complication rates (p=0.611), there was an association with increased rates of complications ≥ Clavien grade 3 (p=0.049). Conclusion: Mixed SC-GCT results in an increased intra-operative complexity similar to that seen in pure seminoma and there is a significant correlation between the percentage of seminoma elements within the primary orchiectomy specimen and increased median EBL transfusion rates, transfusion volume, and high-grade complications following PC-RPLND.

123 Podium #42 QUALITY OF ACUTE CARE FOR PATIENTS WITH KIDNEY STONES IN THE UNITED STATES Charles Scales, MD, MSHS1, Li Lin MS2, Jonathan Bergman, MD, MPH3, Stacey Carter , MD3, Greg Jack, MD3, Christopher S. Saigal, MD MPH3 and Mark S. Litwin, MD MPH3 1Duke University, Durham, NC; 2Duke Clinical Research Institute, Durham, NC; 3UCLA, Los Angeles, CA Presented by: Charles Scales, MD, MSHS

Introduction: The prevalence of kidney stones has nearly doubled in the past 15 years, with a parallel rise in the rate of emergency department (ED) visits by patients with suspected kidney stones. In this clinical situation, current guidelines endorse imaging, laboratory testing (e.g., assess for leukocytosis), and use of medical expulsive therapy for appropriate patients. Despite these existing international guidelines, data regarding quality of care for these patients is lacking. To address this gap, our objective was to describe guideline adherence for patients with suspected kidney stones treated in the emergency department setting. Methods: We performed a cross-sectional analysis of visits recorded by the National Hospital Ambulatory Medical Care Survey (ED component) in 2007–2010. We measured adherence to clinical guidelines for diagnostic laboratory testing, imaging, and pharmacologic therapy. Multivariable regression models controlled for important covariates and identified associations between patient, provider and facility characteristics, and receipt of guideline- recommended care. Results: An estimated 4,956,444 ED visits for patients with suspected kidney stones occurred during the study period. Guideline adherence was highest for diagnostic imaging, with 3,122,229 (63%) visits providing optimal imaging. Complete guideline-based laboratory

testing occurred in only two of every five visits. Pharmacologic therapy to facilitate stone Pod iums passage was prescribed during only 17% of eligible visits. In multivariable analysis of guideline adherence, we found little variation by patient, provider or facility characteristics. Information from other care settings may be lacking. Conclusion: Guideline-recommended care was absent from a substantial proportion of acute care visits for patients with suspected kidney stones. These failures of care delivery likely increase costs and temporary disability and potentially risk serious health events, such as delayed recognition of sepsis from an obstructing stone. Targeted interventions to improve guideline adherence should be designed and evaluated to improve care for patients with symptomatic kidney stones. Funding: Robert Wood Johnson Foundation Clinical Scholars Program; US Department of Veterans Affairs; National Institute of Diabetes and Digestive and Kidney Diseases and the National Library of Medicine (HHSN276201200016C).

124 Podium #43 EMERGENCY DEPARTMENT REVISITS FOR PATIENTS WITH KIDNEY STONES Charles Scales, MD, MSHS1, Li Lin MS2, Christopher S Saigal, MD MPH3, Carol Bennett, MD4, Ninez Ponce, PhD3, Carol M Mangione, MD MSPH3 and Mark S. Litwin, MD MPH3 1Duke University, Durham, NC; 2Duke Clinical Research Institute, Durham, NC; 3UCLA, Los Angeles, CA; 4Greater Los Angeles VA Health System, Los Angeles, CA Presented by: Charles Scales, MD, MSHS

Introduction: Kidney stones affect nearly one in 11 persons in the United States, and among those experiencing symptoms, emergency care is common. After the initial emergent visit, little is known about the incidence of and factors associated with repeat emergency department visits. To address this knowledge gap, our objective was to identify associations between potentially modifiable factors and the risk of an emergency department revisit for patients with kidney stones in a large, all-payer cohort. Methods: We performed a retrospective cohort study of all patients in California initially treated and released from an emergency department for a kidney stone between February 2008 and November 2009. We created a multivariable regression model to identify associations between patient-level characteristics, area health care resources, processes of care, and the risk of a repeat emergency department visit. The primary outcome was a second emergency department visit within 30 days of the initial discharge from emergent care. Results: Among 128,564 patients discharged from emergent care, 13,684 (11%) had at least one additional emergent visit for treatment of their kidney stone. In these patients, nearly one in three required hospitalization or an urgent procedure (e.g., stent) at the second visit. On multivariable analysis, the risk of an emergency department revisit was associated with insurance status (e.g., Medicaid vs. private insurance, OR 1.52, 95% CI 1.43–1.61, P<.001). Greater access to urologic care was associated with lower odds of an emergency department revisit (highest quartile, OR 0.88 [95% CI 0.80–0.97, P<.01] vs lowest quartile). In exploratory models, diagnostic testing for signs of sepsis was associated with a decreased odds of revisit (OR = 0.86, 95% CI 0.75–0.97, P = 0.02). Conclusion: Repeat high-acuity care affects one in nine patients discharged from an initial emergent evaluation for a kidney stone. Potentially modifiable factors, such as access to urologic care and reliable delivery of guideline-adherent care, are associated with the risk of repeat emergent encounters. Efforts are indicated to monitor and improve outcomes of emergent care for patients with kidney stones. Funding: Robert Wood Johnson Foundation Clinical Scholars Program; U.S. Department of Veterans Affairs; National Institute of Diabetes and Digestive and Kidney Diseases and the National Library of Medicine (HHSN276201200016C).

125 Podium #44 A NOVEL WET COUPLING DESIGN FOR CONTEMPORARY ELECTROMAGNETIC LITHOTRIPTERS: ELIMINATION OF COUPLING DEFECTS AND IMPROVEMENT OF COMMINUTION EFFICIENCY Richard Shin, MD1, Daniel Concha2, Jaclyn Lautz2, Georgy Sankin, PhD2, Fernando Cabrera, MD1, Ramy Youssef, MD3, Charles Scales, MD, MSHA4, Michael Lipkin, MD1, Glenn Preminger, MD1, Hadley Cocks, PhD2, Walter Simmons, PhD2 and Pei Zhong, PhD5 1Division of Urologic Surgery, Duke University Medical Center, Durham, NC; 2Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC; 3Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Urologic Surgery, University of California, Irvine, Orange, CA; 4Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC; 5Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC Presented by: Richard Shin, MD

Introduction: Air bubbles trapped in shockwave lithotripsy coupling gel may contribute to the decreased stone comminution efficacy of contemporary lithotripters compared to the original HM3. We have developed a novel wet coupling technique and evaluated its impact on stone comminution in an electromagnetic lithotripter. Methods: The shockwave source of a Modularis electromagnetic lithotripter was fitted with a custom-designed, open-ended bellow allowing direct water-skin contact while adhering to the patient with a suction seal. The standard coupling was also tested with ultrasound gel applied in a spiral and bolus method. In-vitro comminution was performed in a torso model

using hard Begostone phantoms treated at E2.5 for 1000 shocks at 1 Hz pulse repetition Pod iums frequency. Percent comminution (fragments < 2 mm) was measured, and analyzed using ANOVA and Bonferroni corrected t-tests. Results: For each coupling method, 14 trials were performed. Unlike the spiral method, the bolus method produced minimal air defects while wet coupling ensured a perfect acoustic interface. Comminution (mean ± SD) was 30 ± 11% for the spiral method, 65 ± 20% for the bolus method, and 66 ± 15% for the wet coupling. The spiral method was significantly less effective than the bolus and wet coupling (p < 0.001). No statistical difference was observed between the bolus and wet coupling methods (p = 0.82). Conclusion: The performance of contemporary lithotripters depends critically on the quality of shockwave source-patient coupling interface. A novel wet coupling design is developed to overcome the vulnerability and inconsistency of gel coupling, ensuring an effective shockwave transmission through the coupling interface with improved lithotripsy efficacy. Funding: NIH

126 Podium #45 HYDROXYPROLINE METABOLISM IN A MOUSE MODEL OF PRIMARY HYPEROXALURIA TYPE 1 Xingsheng Li¹, John Knight¹, Kevin Fitzgerald², William Querbes², Ross Holmes¹, Dean Assimos¹ and Win Shun Lai¹ ¹Birmingham, Alabama; ²Cambridge, Massachusetts Presented By: Win Shun Lai

Introduction: Primary Hyperoxaluria is characterized by elevated urinary oxalate excretion, which can lead to calcium oxalate kidney stone formation and in some cases end stage renal failure. PH Type 1 is due to a deficiency in the liver peroxisomal enzyme alanine glyoxylate aminotransferase (AGT). Methods: The objective of this study was to determine the contribution of hydroxyproline metabolism to oxalate synthesis in a mouse model of PH1 and to examine the impact of siRNA knock down of enzymes involved in oxalate synthesis on 24 urinary oxalate excretion. Male mice lacking AGT and those having it (wild type) were acclimated in metabolic cages to collect 24-hour urine. Carbon 13 labeled hydroxyproline (13C-Hyp) was continuously intravenously infused and metabolism to 13C2-oxalate was measured by ion chromatography coupled to mass spectroscopy (IC/MS). siRNA (Alnylam Pharmaceuticals) targeted to liver hydroxyproline oxidase (HO) and glycolate oxidase (GO) were administered by tail vein and urine collected between days nine and 13 when the respective enzyme activities were maximally knocked down. Results: Urinary oxalate excretion was seven times higher in the AGT deficient animals as compared to wild type after 13C-Hyp infusion (p<0.05). The contribution of hydroxyproline was two times higher in the AGT deficient mice (p<0.05). siRNA to HO and GO resulted in significant reductions in oxalate excretion in the AGT deficient mice (see figure). Conclusion: Hydroxyproline contribute significantly to the urinary oxalate pool in AGT deficient mice. Inhibition of HO and GO with siRNA may prove to be a good treatment strategy for those with type 1 primary hyperoxaluria.

127 Podium #46 HUMAN MACROPHAGES MEDIATE KIDNEY STONE CLEARANCE THROUGH PHAGOCYTOSIS AND CLATHRIN-DEPENDENT ENDOCYTOSIS Sergey Kusmartsev, PhD, Paul Dominguez-Gutierrez, PhD, Benjamin Canales MD, Johannes Vieweg, MD, Saeed Khan, PhD University of Florida, Gainesville, FL Presented by: Sergey Kusmartsev, PhD

Introduction: Renal macrophages play a critical role to maintain healthy, functional kidneys. As professional phagocytes/scavengers, macrophages perform critical functions in tissue maintenance and its remodeling. Here we investigate macrophage phagocytic and inflammatory responses to naturally produced human kidney stones as well as to inorganic crystals-calcium oxalate (CaOx) and calcium phosphate (CaP) crystals. Methods: Monocytes were isolated from peripheral blood of healthy donors and differentiated in vitro toward macrophages with macrophage-colony stimulating factor (M− CSF). Macrophage phenotype was confirmed by flow cytometry. Macrophage response to the kidney stones, CaOx and CaP was evaluated using Proteome Profiling Arrays, RT−PCR, light and fluorescent microscopy. Results: We demonstrate that human macrophages are capable of engulfment and eroding naturally-produced kidney stones. Macrophages surround stones/crystals and then step-by- step destroy small and medium-sized naturally produced kidney stones. Phagocytosis and clathrin-mediated endocytosis involved in this processes. Uptake of kidney stones or calcium crystalline particles by macrophages led to release of certain chemokines and cytokine production, including chemokines CCL2, CCL3, CCL22, interleukin-1 receptor antagonist (IL−1ra), complement component C5/C5a and IL-8. The response to stones/crystals depends

on macrophage phenotype and activation status. Pod iums Conclusion: Macrophage colony-stimulating factor appears to be important for formation and function of kidney stone-clearing macrophages/ Together, obtained results suggest that human mature macrophage could play an important role in preventing kidney stone disease by removing and digesting stones in kidney tissue.

128 Podium #47 DEFINING THE RATE OF PRIMARY URETEROSCOPIC FAILURE IN NON-PRESTENTED PATIENTS: A MULTI-INSTITUTIONAL STUDY Christopher Mitchell, MD1, Thomas Fuller, MD2, Kevin Rycyna, MD2, Matthew Ferroni, MD2, Erin Ohmann, MD3, Daniel Wollins, MD3, Ojas Shah, MD3, Michelle Semins, MD2 and Nicole Miller, MD4 1Vanderbilt University Medical Center, Nashville TN; 2University of Pittsburgh Medical Center, Pittsburgh, PA; 3New York Langone Medical Center, New York, NY; 4Vanderbilt University Medical Center, Nashville, TN Presented by: Christopher Mitchell, MD

Introduction: In patients with nephrolithiasis undergoing primary ureteroscopy, a percentage will require a secondary procedure due to ureteral access failure. However, this rate of failure, ultimately requiring ureteral stent placement for passive dilation of the ureter with delayed stone treatment is poorly defined in the literature. Thus we aim to define the rate of failure of primary ureteroscopy and identify predictive factors that necessitate presenting. Methods: We conducted a multi-institutional retrospective review of 802 patients undergoing ureteroscopy from August 2011 to August 2013. The primary outcome was failure to gain access to the non-prestented ureter. No funding was obtained for this study. Results: The failure rate for accessing the non-prestented ureter was 6.1% (32/526). In the non-prestented ureter the median age of failed access was 48.5 years (95% CI 35, 57) vs 56 (95% CI 54, 58) years, respectively (p=0.009). Proximal ureteral stones had the highest failure rate for ureteral access at 14.15% (15/106), which was higher than the failure rate for renal stones (3.66%, 10/273) and distal ureteral stones (3.96%, 4/101), p<0.001 and p=0.015 respectively. Failure rate with stones greater than 10mm was lower than with stones less than 10mm, 2.4% (4/168) vs. 8.7% (28/322), p=0.006. On multivariate logistic regression, only stone size less than 10mm remained a significant predictor for failure of primary ureteroscopy, OR 0.50 (0.27, 0.95), p=0.034. Conclusion: At high volume academic medical centers, a low rate of ureteral access failure in non-prestented patients is shown. Stone size less than 10 mm is the best predictor of failure for primary ureteroscopic access to allow for stone treatment. Given this low rate of failure, it is reasonable to attempted primary ureteroscopy in the appropriately selected patients.

129 Podium #48 CHARACTERISTICS OF MIXED COMPOSITION RENAL CALCULI WITH DUAL ENERGY CT IMAGING Charles Stoneburner, MD, Maria Jepperson, MD, Joseph Cernigliaro, MD, David Thiel, MD, William Haley, MD Mayo Clinic, Jacksonville, FL Presented by: Charles Stoneburner, MD

Introduction: Dual energy computed tomography (DECT) is a novel technology that allows for determination of urinary calculi composition as uric acid (UA) or non-UA with a high level of accuracy. Identification of mixed (both UA and non-UA) calculi composition with DECT has been less thoroughly investigated. We evaluated the dual energy imaging characteristics of mixed calculi in order to examine the reliability of interpretation which may further our understanding of stone formation and guide appropriate treatment. Methods: Between January 2011 and December of 2013 patients with suspected renal calculi were scanned on a dual source DECT scanner (SOMATOM Definition Flash CT scanner, Siemens Healthcare). The radiologist characterized calculi detected as mixed, pure UA, or non-UA. Stone material and infrared (IR) stone composition analysis was obtained from 144 patients. The radiology reports were reviewed for accuracy of prospective prediction of stone composition and images were reviewed for DECT appearance. 112 patients were ultimately included in the study. Results: As expected, pure UA and non-UA calculi were characterized homogeneously by DECT analysis. After the data was reviewed the sample consisted of seven mixed, five UA and 100 non-UA stones based upon DECT imaging and six mixed, six UA and 100 non-UA stones based on IR analysis. Three imaging appearances of mixed calculi were identified:

central core, conglomerate/peripheral rim and homogeneous mimic (mimicking pure UA/ Pod iums non−UA) stones. Of the seven mixed composition stones on DECT, IR analysis proved five to be mixed stones (PPV 71%). Of the stones identified as homogenous on DECT, 104/105 were homogenous in composition by IR analysis (NPV 99%). All stones with 30% or greater UA composition were correctly identified as having a UA component. Conclusion: DECT was highly reliable in identifying homogenous calculi (non-mixed). DECT mixed calculi appeared in three patterns: central core, conglomerate/peripheral rim and homogenous mimic. These imaging patterns may further our understanding of stone formation and guide appropriate treatment. This work was supported by the Mayo Clinic O’Brien Urology Research Center U54 DK10022.

130 Podium #49 CHANGING MANAGEMENT OF THE IMPACTED URETERAL CALCULUS > 1.4 CM: ROBOTIC LAPAROSCOPIC URETEROLITHTOMY Mary Powers, MD, Michael Maddox, MD, Julie Wang, MD, Raju Thomas, MD, Benjamin Lee, MD Tulane University School of Medicine, New Orleans, LA Presented by: Mary Powers, MD

Introduction: Complex ureteral calculi present a difficult management dilemma with options including one stage Ureteroscopy with potential lengthy procedure time, two stage ureteroscopy, antegrade percutaneous extraction, shockwave lithotripsy or robotic/ laparoscopic ureterolithotomy. We reviewed incidence of ureteral stones and the recurrence rate of stricture. Risk factors such as previous endoscopic treatment by stone basket extraction or holmium laser lithotripsy were reviewed. Methods: All surgical cases performed at Tulane Medical Center from 2007-2014 were reviewed (n=49). Inclusion criteria was ureteral calculus with hydronephrosis. Stone impaction on CT scan was assessed with imaging demonstrating identical location of stone with thinning of the ureteral wall. Ureteral stent placement and duration were evaluated. Follow-up time, post operative imaging, stone recurrence, stricture recurrence and post operative complications were reported. Results: Fifteen ureterolithotomy procedures were performed on 14 patients. Seven of the procedures were robotic assisted, while eight of the procedures were completed laparoscopically. Location of the ureteral calculi was proximal ureter (n=13), mid (n=1) and distal ureter (n=1). The distal ureteral stone required ureteral reimplantation while the mid ureteral stone had end-to-end uretero-ureterostomy performed. All of the cases except one had ureteral stent insertion. The ureteral stents were removed on average of 3.275 months (range 1.4-9 months). Concomitant flexible nephroscopy with removal of renal calculi was performed in four patients. Average follow up for patients was 11.67 months (2-24 months). Post operative imaging consisted of ultrasound or CT scan. No recurrent strictures or residual ureteral calculi were identified. Four patients had had previous endoscopic attempt at stone removal or stent placement that was unsuccessful. Two patients had post operative complications including one respiratory distress and migrated stent proximally into the ureter. The migrated stent did require rigid ureteroscopy to undergo removal. All other stents were removed with flexible cystoscopy in the clinic setting. Size of stone of average was 1.42cm (0.8-2.2cm). The 0.8cm stone had failed previous endoscopic management at ureteroscopic with Holmium laser lithotripsy. Conclusion: Robotic or laparoscopic surgery for large upper tract ureteral stone management is an effective way to treat both stone disease and ureteral stricture disease with 100% stone free rates in our series of patients.

131 Podium #50 WHOLE EXOME SEQUENCING OF THE CANCER GENOME IN PATIENTS WITH VERY HIGH-RISK MUSCLE INVASIVE BLADDER CANCER Kathleen McGinley, DO1, Wiguins Etienne, BS1, Christopher Moy, MS2, Stephen Szabo, BA2, Joel Greshock, PhD2, Hui Zhou, MD2, Yuchen Bai ,MD, PhD2 and Brant Inman, MD, MS1 1Duke University, Durham, NC; 2GlaxoSmithKline, Collegeville, PA Presented by: Kathleen McGinley, DO

Introduction: The molecular profile of bladder cancer has been suggested to play a critical role in prognosis and treatment response. A greater understanding of the somatic mutations that arise, and co-exist, in advanced tumors could aid in the development of targetable therapies for bladder cancer. Methods: Fifty patients who underwent surgery for pT2+ urothelial carcinoma of the bladder with very high risk pathologic features and adequate tumor volume for DNA extraction were identified for whole exome sequencing of a set of 422 genes selected to represent the cancer genome. Demographic and clinical data were recorded. Known hotspot bladder cancer mutations (e.g. FGFR3, PIK3CA, KRAS, HRAS) were analyzed using standard Sanger sequencing. Whole genome sequencing using Solexa sequencing technology was completed. Bioinformatic analysis was subject to a rigorous analysis pipeline with multiple data filtering steps. Mutations were categorized by type, stratified against previously identified cancer loci in the COSMIC database, and evaluated in pathway analysis and co-mutation plots. Results: Median age was 64 years and 67% of subjects were male. At cystectomy, 36% had positive nodes, 33% were T3, and 28% were T4. With a mean follow-up of 2.1 years, 58% developed metastases and 80% died, demonstrating the very high risk nature of the cohort.

Sequencing of 422 genes and application of the multistep filtering algorithm revealed a core Pod iums set of 212 mutations. When compared to the COSMIC database, higher mutation rates were seen in several genes including PIK3CA, NOTCH2, MSH2, APC and p53. Pathway analysis demonstrated highly mutated pathways including the PI3K/mTOR pathway, the MAPK/ERK pathway, the cell cycle regulators, and epigenetic regulators. Co-mutation analysis showed frequent co-occurrence of mutations in RB and P53 as well as NF1 and PIK3CA. Conclusion: Discovery phase analysis of the somatic mutations in 50 very high risk MIBC specimens revealed several interesting mutation patterns. These patterns may be useful for designing systemic therapy regimens for patients at very high risk of disease metastasis and death. External Funding: GlaxoSmithKline

132 Podium #51 SARCOPENIA AS A PREDICTOR OF COMPLICATIONS IN PENILE CANCER PATIENTS UNDERGOING INGUINAL LYMPH NODE DISSECTION Pranav Sharma, MD, Kamran Zargar-Shoshtari, MD, Jamie Caracciolo, MD, George Richard, BS, Michael Poch, MD, Julio Pow-Sang, MD, Wade Sexton, MD, Philippe Spiess, MD Moffitt Cancer Center, Tampa, FL Presented by: Pranav Sharma, MD

Introduction: Lymphadenectomy (LND) is an important part of the surgical management of penile cancer since early dissection of involved lymph nodes improves survival in high- risk patients. LND, however, does have significant perioperative morbidity. The purpose of this study is to determine if sarcopenia, a novel marker of nutritional status measuring loss of skeletal muscle mass, is a predictor of postoperative 30-day complications in patients undergoing LND for penile cancer. Methods: Of the 79 patients that underwent LND for penile cancer at our institution from June 1999 to June 2014, 44 had available preoperative cross-sectional abdominal imaging for analysis. Lumbar skeletal muscle index (SMI) was calculated at the third lumbar vertebrae (L3) on axial computed tomography (CT) or magnetic resonance (MR) images, and a threshold SMI of 55 cm2/m2 was used to classify patients as sarcopenic versus not sarcopenic. This classification was then correlated with postoperative complications and survival outcomes to determine if sarcopenia, in addition to other standard preoperative variables, was a predictor of postoperative morbidity and mortality.

Results: In our study population of 44 patients, median lumbar SMI was 55 cm2/m2 with 22 (50%) patients categorized as sarcopenic versus 22 (50%) patients that were not sarcopenic. Twenty-seven postoperative complications occurred in 20 patients within 30 days, of which four (14.8%) were major (Clavien score >IIIb) and 23 (85.2%) were minor. The most common complications were wound dehiscence (n=7; 25.9%), wound infection (n=5; 18.5%), lymphocele (n=5; 18.5%), flap necrosis (n=4; 14.8%), lymphedema (n=3; 11.1%), and seroma formation (n=3; 11.1%). On univariate analysis, the presence of sarcopenia, nodal disease (pN>1), and lymphovascular invasion (LVI) were all predictors of postoperative complications. On multivariate analysis, however, only sarcopenia was an independent predictor of postoperative complications within 30 days (p=0.015; 95% confidence interval [CI]: 1.4-26.9). Although sarcopenia was not statistically associated with worse survival, there was a trend toward poorer outcomes in these patients. Conclusion: Sarcopenia can be a useful prognostic tool to predict the likelihood of postoperative complications after LND for penile cancer. Additional larger, prospective studies are necessary to understand the impact of sarcopenia on the long-term survival of these patients.

133 Podium #52 PENILE CANCER: BASELINE HEALTH RELATED QUALITY OF LIFE Adam Luchey, MD1, Gautum Agarwal, MD2, Scott Gilbert, MD2, Philippe Spiesas, MD2, Wade Sexton, MD2, Julio Pow-Sang, MD2 and Michael Poch, MD2 1H. Lee Moffitt Cancer Center, Tampa, Florida; 2H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Adam Luchey, MD

Introduction: Relatively little is known about the impact of penile cancer (PC) on patient quality of life, primarily because it is a rare and understudied disease. Although oncological control is a primary concern, quality of life issues prevalent among this patient group should be assessed and managed appropriately. Previous research has shown that penile cancer treatment interferes with patients’ lives and negatively impacts urinary and sexual function. The goal of this study was to assess health related quality of life (HRQoL) in patients newly diagnosed with penile cancer at our institution. Methods: A prospective study of PC patients was undertaken from 07/2013-07/2014 to assess HRQoL. Standardized and validated HRQoL measures, including the Center for Epidemiologic Studies Depression Scale Revised (CESD−R), SHIM, AUA SS, European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC), and body image scale (BIS), were used to assess baseline QOL prior to treatment. Median values on the AUA SS, SHIM, EORTC, and BIS questionnaires were compared between those that had symptoms of depression and those that did not utilizing the Kruskal−Wallis test. Results: Seventeen patients (7 CIS, 3 pTa, 1 pT1a, 1, pT1b, 1 pT2, 1 pT3, 1 pT4) were included in the study. Mean age was 57 years old (range 27-82). Two (12%) patients met criteria for major depressive episode while an additional 3/17 (18%) presented with

subthreshold depression symptoms, defined by the CESD-R. HRQoL measures are listed Pod iums in Table 1 and reported based on tumor location and depression symptoms on initial presentation. The SHIM and EORTC scores were similar between those that did and did not have symptoms of depression, however, the AUA SS and BIS trended towards significance with those being depressed having worse symptoms (p = 0.09 and 0.06 respectively). Conclusion: Patients presenting with PC may be experiencing significant pyschological distress. We identified 30% of patients in our study as having symptoms of depression which allowed for appropriate consultation with psychiatry.

134 Podium #53 EXTENT OF LYMPH NODE DISSECTION IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA IS ASSOCIATED WITH BETTER SURVIVAL Dominic Tang, MD1,2, Sanjay Patel, MD3,4, Daniel Barocas, MD1,2, Matthew Resnick, MD1,2 and Sam Chang, MD1,2 1Vanderbilt University; 2Nashville, TN; 3University of Chicago; 4Chicago, IL Presented by: Dominic Tang, MD

Introduction: Several studies suggest that lymph node (LN) status may have prognostic value after radical nephroureterectomy (RNU) and lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC). Given the rarity of disease, there have not been many large studies reporting impact of LND on clinical outcomes. Methods: Using a large, population-based database, we sought to determine the relationship between extent of LND and survival. Data were collected on 8,284 patients treated for UTUC in the United States between 1998 and 2006 from the National Cancer Data Base. 1,479 of these patients underwent concomitant LND. All patients were treated with RNU +/- bladder cuff excision. At treatment, patients were cN0/cNx, cM0, had no prior malignancies, and had at least 1 LN removed. Eight LNs removed was used as a cutoff based on prior UTUC studies. Patients were divided into two cohorts based on presence or absence of LN metastasis. Univariable and multivariable Cox regression models measured the association of node count and survival. Covariates include age, Charlson comorbidity index, stage, grade, positive LN number, and tumor site. Results: Median age was 70 years (range 38-90). Of 1,479 patients undergoing RNU with LND, 540 patients (36%) had LN metastases. Median number of LNs removed was two (mean 4, range 1-27). Multivariate analysis showed removing ≥8 LNs to be associated with improved survival after controlling for age, stage, grade, comorbidities, and LN status (HR 0.79; p=0.037). Stratifying by LN status (positive vs. negative), removing ≥ 8 LN was associated with improved survival on univariate (five-year survival 60.5% [95% CI 0.506- 0.690], p=0.025) and multivariable analysis (HR 0.72 [95% CI 0.52-1.0]; p=0.05) among pN0 patients. However, pN+ patients had no difference in survival based on node count in univariate (p=0.165) and multivariable analysis (p=0.957). Conclusion: The extent of LND in UTUC patients is independently associated with improved overall survival after controlling for other factors. Removing ≥8 LNs is independently associated with better overall survival in patients without nodal metastasis. However, node count is not an independent predictor of survival in node-positive patients.

135 Podium #54 PARASTOMAL HERNIAS AFTER RADICAL CYSTECTOMY AND ILEAL CONDUIT URINARY DIVERSION: PRESENTATION, RISK FACTORS AND MANAGEMENT Harras Zaid, MD1, Nicholas Smith, MD1, Christopher Anderson, MD2, Sam Chang, MD1, Daniel Barocas, MD, MPH1 and Michael Cookson, MD, MMHC3 1Vanderbilt University, Nashville, TN; 2Memorial Sloan Kettering Cancer Center, New York, NY; 3University of Oklahoma, Oklahoma City, OK Presented by: Harras Zaid, MD

Introduction: While complications following radical cystectomy and ileal conduit (RCIC) are common, few data exist on the incidence and management of parastomal hernias (PH). We sought to describe the incidence, presenting symptoms, risk factors and management of this post-operative complication. Methods: We performed a retrospective analysis of all patients undergoing RCIC at Vanderbilt University between 2000 and 2010. Patients with less than six months follow- up were excluded. Clinical and demographic covariates were examined including age, sex, race, body mass index (BMI), smoking status, Charlson Comorbidity Index (CCI), and receipt of neoadjuvant chemotherapy. Associated symptoms and operative management of patients with PH were also collected. Results: Our analytic cohort included 407 patients that underwent RCIC and had at least six months of follow-up (mean 35.9 months, SD 28.8). Of these, 113 (27.8%) developed a PH that was detected on clinical exam. Age was similar between those who developed a PH and those who did not (mean 69.0 vs. 69.2 years). Other demographic and clinical variables are displayed in Table 1. The mean time from RCIC to development of PH was 17.8 months (SD 18.1), although this varied widely (range 0.2-124.3; IQR 6.9− 24.1). 61 (53.9%) of patients

with PH presented with one or more symptoms. Among the most common complaints were Pod iums pain (28.3%) and pouching difficult (25.7%). In a multivariable analysis incorporating age, sex, race, BMI, smoking, CCI, and receipt of neoadjuvant chemotherapy, no single variable was independently associated with the development of PH. Operative repair was pursued in 49 (43.4%), of which 44 (89.8%) were elective and 5 (10.2%) were done on an urgent basis. Conclusion: Patients remain at risk for development of a PH over their lifetime following RCIC. While no single factor predicted PH in this cohort, the development of this complication occurs in almost one-third of patients and is likely multifactorial and presenting symptoms are varied. Fewer than half of our patients elected for operative management. Our findings suggest that long-term follow-up is necessary to monitor for this post-operative complication.

136 Podium #55 PREDICTORS OF METASTATIC DISEASE AT DIAGNOSIS IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER Austin J. Evans1, Zachary Klaassen, MD1, Rita P. Jen, MPH1, Lael Reinstatler, MPH1, John M. DiBianco2, Qiang Li, MD, PhD1, Rabii Madi, MD1 and Martha K. Terris, MD1 1Medical College of Georgia, Georgia Regents University, Augusta, GA; 2Ross University School of Medicine, Dominica, West Indies Presented by: Austin J. Evans

Introduction: Poor performance status and the presence of visceral metastasis are factors associated with poor prognosis in patients undergoing treatment for metastatic urothelial carcinoma (UC). However, to our knowledge factors that predict metastatic UC at diagnosis have not been reported. The objective of this study was to use a population-based cohort to identify independent predictors of metastatic disease at diagnosis in patients with UC of the bladder. Methods: Patients with UC of the bladder were extracted from the SEER database from 2004-2010 (n=108,417). The primary outcome was metastatic disease at diagnosis. Demographic variables included age, gender, race, and marital status. Socioeconomic variables included insurance status, as well as % of the population in the patient’s home county living in poverty, unemployed, <9th grade education, median family income, and foreign-born status. Descriptive statistics and multivariable logistic regression models were performed to generate odds ratios (OR) and identify predictors of metastatic disease at diagnosis. Results: There were 3,018 (2.8%) patients who had metastasis at diagnosis and 105,399 (97.2%) patients who had non-metastatic disease. Patients with metastatic disease were more likely to be female (29.6% vs 23.6%, p<0.0001), black (9.4% vs 5.0%, p<0.0001) and single/divorced/widowed (SDW) (44.1% vs 32.5%, p<0.0001) compared to patients with non- metastatic disease at diagnosis. Furthermore, patients with metastatic disease at diagnosis were more likely to be residing in a county with more people living in poverty (p=0.0002), unemployed (p<0.0001), poorly educated (% <9th grade, p<0.0001), foreign born (p<0.0001) and uninsured (p<0.0001) compared to patients with non−metastatic disease at diagnosis. After adjusting for age, gender, race, marital status, unemployed and foreign−born status, independent predictors of metastatic disease at diagnosis included female gender (vs male; OR 1.21, 95%CI 1.11-1.32), black race (vs white; OR 1.71, 95%CI 1.50-1.95), SDW status (vs married; OR 1.46, 95%CI 1.35-1.58), being unemployed (OR 1.02, 95%CI 1.01-1.03) and being foreign born (OR 1.01, 95%CI 1.00-1.01). Conclusion: Female gender, black race, unmarried, unemployed and foreign-born status are independent predictors of metastasis at diagnosis. Consistent with other non-urologic malignancies, surrogates of poor socioeconomic status are predictors of metastasis at presentation. Urologists and oncologists should be aware of these potential health care disparities when assessing patients for UC.

137 Poster #1 CLEAR CELL RENAL CELL CARCINOMA: SOCIOECONOMIC PREDICTORS OF METASTATIC DISEASE AT DIAGNOSIS John M. DiBianco1, Zachary Klaassen, MD2, Rita P. Jen, MPH2, Lael Reinstatler, MPH2, Austin J. Evans2, Qiang Li, MD, PhD2, Rabii Madi, MD2 and Martha K. Terris, MD2 1Ross University School of Medicine, Miramar, FL; 2Medical College of Georgia − Georgia Regents University, Augusta, GA Presented by: John M. DiBianco

Introduction: In patients with advanced clear cell renal cell carcinoma (ccRCC), lymph node and/or liver metastases, as well as poor performance status is associated with poor prognosis. To our knowledge, no previous studies have assessed possible predictors of metastatic ccRCC at diagnosis. Using a population-based cohort, we sought to identify independent predictors of metastatic disease at diagnosis in patients with ccRCC. Methods: Patients with ccRCC were extracted from the SEER database from 2004-2010 (n=63,589). The primary outcome was metastatic disease at diagnosis. Demographic variables included age, gender, race, and marital status. Socioeconomic variables investigated included insurance status and the patient’s home county median income, as well as % living in poverty, % unemployed, and % with <9th grade education. Descriptive statistics and multivariable logistic regression models were performed to generate odds ratios (OR) and identify possible predictors of metastatic disease at diagnosis. Results: There were 9,623 (15.1%) patients with metastatic disease at diagnosis and 53,966 (84.9%) patients with non-metastatic disease. Patients with metastatic disease were more frequently older (65 vs 63 years, p<0.001), male (66.3% vs 60.8%, p<0.001), and single, divorced, or widowed (SDW) (38.9% vs 33.4%, p<0.001) compared to patients with non- metastatic disease. Patients with metastatic disease at diagnosis were more often uninsured (p<0.001) and residing in a county with higher % people living in poverty (p<0.001) and poorly educated (% <9th grade, p<0.001). Adjusting for age, gender, race, marital status and % of people living in poverty, independent predictors of metastatic disease at diagnosis included older age (OR 1.02, 95%CI 1.02−1.02), male (OR 1.38, 95%CI 1.32-1.45), non- black or Caucasian race (vs Caucasian OR 1.08, 95%CI 1.02-1.15), SDW status (vs married OR 1.32, 95%CI 1.26-1.38), and home county % poverty (OR 1.01, 95%CI 1.00-1.01). Conclusion: Older age, male, non-black or Caucasian race, SDW status, and home county % poverty are independent predictors of ccRCC metastasis at diagnosis. Consistent with non−urologic malignancies and urothelial carcinoma of the bladder, surrogates of poor socioeconomic status are predictors of ccRCC metastasis at presentation. All clinicians should be aware of these potential health care disparities when assessing patients for ccRCC. Po st e rs

138 Poster #2 THE IMPACT OF A FELLOWSHIP AND CAREER FOCUS IN UROLOGY ON SOCIOECONOMIC, WORKFORCE, AND QUALITY OF LIFE ISSUES Nicholas Pruthi, BA1, E. Sophie Spencer, MD1, Matthew Lyons, MD1, Peter Greene, MD1, Max McKibben, MD1, Matthew Nielsen, MD1, Raj Pruthi, MD1, Mathew Raynor, MD1, Eric Wallen, MD1, Michael Woods, MD1, Christopher Gonzalez, MD2 and Angela Smith, MD1 1UNC, Chapel Hill, NC; 2Northwestern, Chicago, IL Presented by: E. Sophie Spencer, MD

Introduction: Although there are a variety of reasons for a young urologist to choose a fellowship and career focus in urology, the impact of such a choice on income, workload, and satisfaction remains unknown. We sought to evaluate the impact of a fellowship and of one’s career focus on these factors. Methods: We worked with the AUA to query its domestic membership of practicing urologists (out of training) regarding socioeconomic, workforce, and quality of life issues. In order to meet the study objectives, a thorough quantitative survey was designed by the AUA Marketing, Government Relations, and Practice Management Depts. A total of 6,511 valid survey invitations were sent via e-mail. The entire survey consisted of 26 questions and took approximately 13 minutes to complete. A total of 846 responses were collected for a total response rate of 13%. A total sample size of 846 is accurate within 3.43% at the 95% confidence level. The results relating to fellowship and primary special interest areas are herein reported. (Of note, respondents could choose up to three special interest areas.) Results: The results are demonstrated in the table including subgroups of: Yes = those with a fellowship in urology; No = those whose primary focus is oncology but have no fellowship; FIGURE LEGEND: Gender Male (M); Female (F); Practice Type = Self−employed (“private practice”) (S); Employed (E); Academic (A); Location = Rural (R); Suburban (S); Urban (U); Practice Size = mean number of urologists in your practice; % satisfied = % answered “very satisfied” or “somewhat satisfied” with current work;% choose urology again = % who would choose urology again as a specialty; The second table demonstrates the income, hours worked, and satisfaction stratified by primary special interest areas of the respondents (could choose up to three areas). Conclusion: A fellowship choice and a primary career interests are associated with a variety of career-related outcomes including income, practice location, practice type, and job satisfaction. Survey participants who have undergone fellowship report lower hourly wage but fewer call days per month. These outcomes (along with job satisfaction) vary widely based on primary career interest.

139 Poster #3 UNDERSTANDING THE RELATIONSHIP BETWEEN 30- AND 90-DAY EMERGENCY ROOM VISITS AND READMISSIONS FOLLOWING RADICAL CYSTECTOMY E. Sophie Spencer, MD, Matthew Lyons, MD, Peter Greene, MD, Anne-Marie Meyer, PhD, Ke Meng, PhD, Raj Pruthi, MD, Eric Wallen, MD, Michael Woods, MD, Matthew Nielsen, MD, MS, Angela Smith, MD, MS Chapel Hill, NC Presented by: E.Sophie Spencer, MD

Introduction: Readmissions are particularly common following radical cystectomy (RC) for bladder cancer, with several institutional case series demonstrating rates approximating 24%. Our objective was to determine the frequency of ER visits and readmissions within 30 and 90 days following RC for bladder cancer and establish the relationship between emergency room (ER) visits and readmissions at both time points using a statewide multi- payer database. Methods: Using a linked data resource combining North Carolina Central Cancer Registry with administrative claims data from Medicare, Medicaid, and private insurance plans, we included adult patients diagnosed with bladder cancer from 2003-2010 who received RC within 1 year after diagnosis. We identified readmissions and ER visits 30 and 31-90 days after discharge. Comparisons between 30- and 90-day readmissions and ER visits were performed using the chi-squared test. Results: 842 patients were identified as receiving RC within one year of diagnosis. Mean age was 69 years, with 72% male. Approximately 19% (n=161) presented to the ER within 30 days, and 18% (n=152) presented to the ER within 31−90 days (total n=313). Of those who presented to the ER within 30 and 31−90 days, 63% and 74% were subsequently readmitted, respectively. Only 26% of the patients presenting to the ER were observed at both time points (see table). Thirty and 90-day overall readmissions were also evaluated with 22% (n=189) readmitted within 30 days, and 21% (n=178) within 31-90 days. Approximately 30% of those readmitted within 30 days were also readmitted at 31−90 days. Finally, we evaluated those readmitted through the ER, with 12% (n=103) and 14% (n=115) readmitted within 30 days and 31-90 days after discharge, respectively. One quarter of patients readmitted through the ER within 30 days were also readmitted through the ER between 31-90 days. Conclusion: To our knowledge, these results represent the first evaluation of 30- and 90- day readmissions following RC for BC in a population-based sample. An equal proportion of readmissions occur within 30 and 31-90 days following RC for bladder cancer with anywhere from one quarter to one third being readmitted at both time points. Po st e rs

140 Poster #4 BEYOND BIOLOGY: THE IMPACT OF MARITAL STATUS ON SURVIVAL FOR PATIENTS WITH ADRENOCORTICAL CARCINOMA Zachary Klaassen, MD1, Lael Reinstatler, MPH2, Chris Ellington, MPH2, Qiang Li, MD, PhD2, Martha K. Terris, MD2, Willie Underwood III, MD, MPH, MSci3 and Kelvin A. Moses, MD, PhD4 1Medical College of Georgia − Georgia Regents University, Augusta, GA; 2Medical College of Georgia − Georgia Regents University, Augusta, GA; 3Roswell Park Cancer Institute, Buffalo, NY; 4Vanderbilt University, Nashville, TN Presented by: Zachary Klaassen, MD

Introduction: Despite advances in imaging and treatment regimens over the past 20 years, survival outcomes in patients with adrenocortical carcinoma (ACC) continue to remain poor. Therefore, clinicians must seek additional factors to optimize outcomes in this select group of patients. The objective of this study was to analyze the association of marital status and survival for patients with ACC using a population-based database. Methods: Patients with ACC were abstracted from the SEER database from 1988−2010 (n=1271). Variables included marital status (married vs single/divorced/widowed (SDW)), gender, age, race, tumor (T) and node (N) classification, receipt of surgery, and SEER stage. Statistical analysis was performed using Cox proportional hazard models to generate hazard ratios and 95% confidence intervals. Results: There were 728 (57.3%) females and median age was 56 years (IQR 44-66). Patients who were alive were more frequently married (65.6% vs 61.6%, p=0.008), female (61.1% vs 58.0%, p=0.001), younger (median 51 vs 57 years, p=0.0001), had adrenalectomy (88.6% vs 63.8%, p<0.0001), and more favorable SEER stage (p<0.0001) compared to patients dead of disease. On multivariable analysis, factors significantly associated with all− cause mortality were SDW status (HR 1.28, 95% CI 1.09-1.51), older age (HR 1.43, 95% CI 1.31-1.55), non-operative management (HR 3.18, 95% CI 2.57-3.95), and N+ disease (HR 2.27, 95% CI 1.74−2.97). Risk factors for disease-specific mortality included SDW status (HR 1.30, 95% CI 1.07-1.56), older age (HR 1.46, 95% CI 1.32-1.61), non-operative management (HR 3.56, 95% CI 2.80-4.52), T-classification (TX vs T1 – HR 2.58, 95% CI 1.30−5.13; T2 vs T1 – HR 2.19, 95% CI 1.14-4.22; T3 vs T1 – HR 3.66, 95% CI 1.87−7.14; T4 vs T1 – HR 3.97, 95% CI 2.05-7.69), and N+ disease (HR 2.37, 95% CI 1.76-3.19). Conclusion: ACC is a disease with an overall poor prognosis due to aggressive biological behavior. SDW status is associated with poorer survival in patients with ACC, suggesting that the decreased survival seen among SDW individuals in other urologic malignancies may also be relevant for patients with ACC. Health care providers caring for unmarried patients with ACC should be aware of the poor outcomes in these patients, highlighting an area for further research and implementation of improved support systems to reduce this disparity Po st e rs and improve their survival to that of married patients.

141 Poster #5 PHEOCHROMOCYTOMA DIAGNOSED PATHOLOGICALLY WITH PREVIOUS NEGATIVE SERUM MARKERS Shira M Winters, BA, Louis Spencer Krane, MD, Jessica Lange, MD, Majid Mirzazadeh, MD Wake Forest Baptist Health, Winston Salem, NC Presented by: Shira M. Winters, BA

Introduction: Patients presenting with adrenal masses require workup with catecholamine or metabolite measurements to rule out pheochromocytoma. However, there are a select portion of patients who have marker-negative pheochromocytoma. The aim of this study is to compare patient characteristics and clinical presentation between marker-positive and marker-negative tumors. Methods: We performed an Institutional Review Board-approved retrospective chart review of 88 cases of pheochromocytoma surgically excised at our institution from 1995 to 2013. During the period covered by this study, recommendations for laboratory assessment progressed, and we therefore considered any abnormal elevation in diagnostic test (plasma metanephrines and catecholamines, and urine metanephrines, catecholamines, and VMA) to be marker-positive. Comparisons between groups were performed with SPSS version 22 using chi-squared analysis for categorical variables and a t-test for continuous variables. Results: Of 88 cases of pheochromocytoma during the study period, 78 had laboratory results available for review. Among these patients, seven had no elevations in laboratory testing. There were no significant differences in age, or tumor size between groups, but marker-negative patients did have higher BMI than marker-positive patients. Patients with normal lab values were less likely to present with vertigo/dizziness (p-value 0.003) than were patients with elevations in lab tests. Neither group was more likely to have a genetic syndrome associated with increased risk of pheochromocytoma, including Von-Hippel Lindau (VHL) or Neurofibromatosis (NF). Conclusion: Marker-negative pheochromocytoma is a rare, but not uncommon subset of this tumor. Among patients with adrenal masses or presentation suspicious for catecholamine excess who have normal laboratory test results, those presenting with vertigo/dizziness may warrant a metaiodobenzylguanidine (MIBG) scan or repeat laboratory testing to rule out a clinically silent pheochromocytoma. Po st e rs

142 Poster #6 IMPROVING OPERATING ROOM THROUGHPUT EFFICIENCY AS A WAY TO INCREASE HOSPITAL SURGICAL VOLUME – IMPROVING FIRST CASE STARTS John C. Pope IV, MD1, John W. Brock III, MD1, Daniel M. Roke, MD2, Lori A. Graves, BSN, RN, CNOR3 and Derek W. Anderson, MMHC3 1Vanderbilt University, Department of Urologic Surgery, Division of Pediatric Urology, Nashville, TN; 2Vanderbilt University, Division of Pediatric Anesthesiology, Nashville, TN; 3Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN Presented by: John C. Pope IV, MD

Introduction: A strategic review at our children’s hospital indicated there was opportunity to grow surgical volume. Additional operating room (OR) capacity is necessary to meet these demands. A “Throughput Project” was initiated develop a plan for more effective use of OR time. Four areas of improvement were identified as critical to this plan, the initial of which was on-time first case starts (others included subsequent case start time, accurate scheduled case duration time, and the turnaround time between cases). An on-time start was defined as “the patient crossing the threshold of the operating room door” within five minutes of the scheduled start time. Methods: Seven categories of variables were identified that affect patient throughput from the time surgery is scheduled until discharge from the perioperative area: scheduling, admitting, holding room, Surgical team, Anesthesia team, OR staff team, PACU. Each category was prospectively monitored per case and reasons for delays were recorded. Members of the team were assigned to address areas needing improvement (i.e. surgeon member addressed surgical team delay with his physician colleagues). Success was gauged as an improvement in the percentage of on-time first case starts. Results: At the start of this project 32% of first cases started on time. Over the 15 months following implementation of the throughput team recommendations, the number of on time starts had risen to 75% and has saved an average of 15 minutes/room/day. This improvement alone equates to 5% more capacity in OR time. 60% of all delays were attributable to the surgical team (waiting on surgeon, no H&P/consent, etc), 12% were anesthesia related, 12% clinic/scheduling, 10% OR staff, 6% “other.” Increased cooperation from the surgical teams, led by the attending surgeon, has been the leading force of improvement. Other common problems were also identified. Patient satisfaction improves as the efficiency of the throughput process decreases their wait times and gives them a better perception of OR team cohesiveness. Conclusion: Improving OR efficiency is the first step in providing increased access to surgeons for surgical time. On time first case starts is the initial step in this improvement. Multiple variables effect efficient patient throughput and all of these variables can be assessed and improved. Increases first case start efficiency requires more hands on involvement and leadership by the attending surgeon. These initiatives have improved patient throughput and OR utilization throughout a given day, resulting in improved surgeon, staff and patient satisfaction while allowing increased surgical volume and the maintenance of safety and excellent surgical outcomes.

143 Poster #7 EVALUATION AND ANALYSIS OF UROLOGIC CONSULTS AT A TERTIARY CARE CENTER Rishi Modh, MD, MBA, James Mason, MD, Akira Yamamoto, MD, Paul Crispen, MD University of Florida, Gainesville, FL Presented by: Rishi Modh, MD, MBA

Introduction: To improve the quality of patient care and resident education during inpatient urologic consultations. Methods: Urologic consults were prospectively evaluated for six consecutive months. Urology consults were tracked for reason of consultation, final diagnosis, and procedures performed during admission. The IRB approved database was kept for departmental quality improvement on a secure server. Results: A total of 637 consults were captured over the six months time interval. The most common reasons for consultation were kidney or ureteral stones (14.1%), hematuria (11.8%), urinary retention (7.9%), difficult urethral catheterization (6.5%), flank pain (6%), and hydronephrosis (5.6%). These topics accounted for 52% of all urologic consultations over the time period. Only 7% of the consults were on pediatric patients. Forty-three percent of consults required bedside or operating room procedures. Of these procedures, 32% of the procedures were performed at the bedside while 68% required operating room management. The most common bedside procedure was difficult urethral catheter placement, while the most common operating room procedure was cystoscopy with ureteral stent placement. Of the 42 difficult urethral catheters placement consults captured over this time interval, only 14 (33%) required bedside cystoscopy with catheter placement over a wire, urethral dilation, or suprapubic tube placement. Conclusion: By acknowledging the most common urologic consultations requested and the most common procedures required, resident education can be geared to help optimize patient care. Residents should be prepared to manage these common inpatient consultations to avoid delays in patient care and improve patient safety.

Po st e rs

144 Poster #8 ASSESSMENT OF PRACTICE PATTERNS FOR USE OF VOIDED URINE CYTOLOGY AND BLADDER WASH CYTOLOGY AMONGST UROLOGIC ONCOLOGIST Bayo Tojuola, MD1, Zachary Corr, MD2, Christopher Ledbetter, MD2 and Robert Wake, MD2 1The PUR Clinic, Orlando, FL; 2University of Tennessee, Memphis, TN Presented by: Bayo Tojuola, MD

Introduction: The use of urine cytology in screening for bladder cancer during hematuria evaluation and during bladder cancer surveillance has been controversial. Recent studies suggest that routine use of cytology is not always required during routine hematuria evaluation and has a limited role during bladder cancer surveillance. The goal of this study is to evaluate utilization of voided cytology (VC) and bladder wash cytology (BWC) among urologic oncologist in the United States. Methods: A survey examining the utility of urine cytology (voided and bladder wash) was created using survey monkey and distributed to members of The Society of Urologic Oncology (SUO). Results: One hundred twenty-two of the 723 SUO members responded to the survey, resulting in a survey response rate of 17%. The majority of responders evaluated between 10-25 new hematuria patients per month. Sixty-nine percent routinely check VC as part of hematuria work up. Thirty two percent routinely collect BWC during cystoscopy and 38% report collecting BWC despite a negative cystoscopy, while 29% of responders will check a BWC if lesions are visible. A majority of responders, 82%, do not check a BWC if a VC was already checked. Sixty-two percent (62%) of responders report routinely checking VC before cystoscopy for bladder cancer surveillance. In addition, 28% report routinely collecting BWC during surveillance cystoscopy despite cystoscopic findings. Risk factors for urothelial carcinoma impact the decision of a majority of responders in checking VC (91%) and BWC (73%). Conclusion: The use of VC and BWC is commonplace amongst urologist. The role of BWC versus VC needs to be better defined in current guidelines. In the age of cost effective healthcare, more defined guidelines will be needed to address this issue.

145 Poster #9 ADULT UROLOGIC SURGERY INPATIENT CONSULTATIONS: REVIEW OF COMMON PROBLEMS AND PATIENTS REQUIRING ACUTE UROLOGIC OPERATIVE INTERVENTION Stephen Kappa, MD, MBA1, Elizabeth Green, BS2, Niels Johnsen, MD1, Matthew Resnick, MD, MPH1 and Sam Chang, MD1 1Vanderbilt Department of Urologic Surgery, Nashville, TN; 2Vanderbilt University School of Medicine, Nashville, TN Presented by: Stephen Kappa, MD, MBA

Introduction: Urologic consultation is common in the inpatient setting, although the nature of urologic consultation remains poorly characterized. This study sought to determine the most common inpatient consultations and percentage of patients who ultimately require acute urologic operative intervention. Methods: Retrospective review of consecutive patients evaluated by the inpatient urology service at a single tertiary care institution from January 2013 to December 2013 was performed. Demographic and clinical characteristics were abstracted from the medical record. Patients were grouped by reason for consultation. Hospital courses were then reviewed to determine need for operative intervention. Results: A total of 1,220 consultations for 1,007 unique patients were evaluated by the inpatient Urology service during the one-year study period. There were an average of 3.3 consultations seen per day, with 332 (27.2%) consultations requested at night (9pm to 5am). Patients had a mean age of 53.5 +/− 18.3 years and were predominantly male (62.6%) and caucasian (78.4%). The most common consultation was for obstructing ureteral stone (17.8%), followed by hematuria (11.7%), postoperative issues including pain, nausea/vomiting, and infection (9.5%), and urinary retention (7.5%). Ultimately, 354 (29%) consultation patients required acute urologic operative intervention. Conclusion: Obstructing ureteral stones, hematuria, postoperative issues, and urinary retention are the most common consultation requests for inpatient urologic evaluation and management. Nearly one-third of all consultations require acute urologic operative intervention. One in four consultations are requested between 9 p.m. and 5 a.m., revealing significant overnight utilization of the urology service in an era of resident work hour restrictions. Further studies should be conducted on this patient cohort to optimize the value of inpatient urologic consultation. Po st e rs

146 Poster #10 REDUCING THE INCIDENCE OF RETAINED DOUBLE J URETERAL STENTS: A MULTIDISCIPLINARY APPROACH Alex Baumgarten, BA, Michael Rydberg, BS, Jenna Bates, BS, Chris Teigland, MD, Ornob Roy, MD McKay Urology, Levine Cancer Institute, Carolinas Healthcare System; Charlotte, NC Presented by: Jenna Bates, BS

Introduction: Double J (DJ) ureteral stents are temporary tubes used for ureteral patency that can cause complications including hydronephrosis, renal failure and death if not removed within the specified time period. We developed a streamlined framework that allows for tracking of DJ stent placements in order to alert patients to the need for timely removal while minimizing the number of patients incorrectly captured by our system and notified. Methods: By creating a multidisciplinary committee, we developed a database based on all patients who presented to our facility between 2012 and 2014 for the placement of a DJ ureteral stent, excluding renal transplant patients. The database was populated by query of our billing system using ICD-9, HCPCS, and CPT codes. This query generates HIPAA- compliant stent removal reminder letters which are sent to the patient and the referring physician. We compared multiple query methods to a “gold standard” list. This list included all patients found on any of the following: operating room logs, interventional radiology logs, query A or query C that were confirmed to have a DJ stent through review of patient records. Query method B was excluded from the “gold standard” compilation because the large number of incorrectly captured patients made individual patient chart review logistically prohibitive. Results: Initially, the ICD-9 ureteral catheterization code was used to identify patients who had a DJ stent placed, which was only 28% sensitivity. Modification of our method, query B, using CPT or HCPCS codes resulted in 98% sensitivity. However, this method incorrectly captured many patients who had procedures other than a DJ stent insertion, resulting in patients who did not have a DJ stent receiving letters to remove their stent. Our final query method, query C, rectified that issue by using the ICD-9 code in combination with CPT or HCPCS codes. This resulted in a test with high sensitivity (78%), while minimizing the number of patients that incorrectly received letters, resulting in the most accurate tracking method. Conclusion: We have developed an automated and reproducible program in which we can identify and alert a high percentage of patients of the need to remove or exchange their stent within the specified timeframe while minimizing the number of patients who are incorrectly notified. We found repeated audits of our query methods in combination with regular meetings of a multidisciplinary DJ Stent Committee were integral to developing and maintaining this system. By promoting proactive awareness for patients and physicians alike, we are working towards minimizing the incidence of retained DJ stents and the associated complications.

147 Poster #11 THE FEMINIZATION OF THE WORKFORCE IN UROLOGY: ECONOMIC, WORKFORCE, AND QUALITY OF LIFE ISSUES Nicholas Pruthi, BA1, E. Sophie Spencer, MD1, Matthew Lyons, MD1, Peter Greene, MD1, Max McKibben, MD1, Matthew Nielsen, MD1, Raj Pruthi, MD1, Mathew Raynor, MD1, Eric Wallen, MD1, Michael Woods, MD1, Christopher Gonzalez, MD2 and Angela Smith, MD1 1UNC, Chapel Hill, NC; 2Northwestern, Chicago, IL Presented by: E. Sophie Spencer, MD

Introduction: In recent years there is a growing proportion of women in urology increasing from < 0.5% in 1981 to approximately 10% today. Furthermore, almost 25% of students matching in urology are female. This analysis sought to characterize the female workforce in urology in comparison to their male counterparts with regard to income, workload, and job satisfaction. Methods: We worked with the AUA to query its domestic membership of practicing urologists (out of training) regarding socioeconomic, workforce, and quality of life issues. In order to meet the study objectives, a thorough quantitative survey was designed by the AUA Marketing, Government Relations, and Practice Management Depts. A total of 6,511 valid survey invitations were sent via e-mail. The entire survey consisted of 26 questions and took approximately 13 minutes to complete. A total of 848 responses were collected for a total response rate of 13%. A total sample size of 848 is accurate within 3.43% at the 95% confidence level. The results relating to gender and career characteristics are herein reported. Results: The percentage of females in the urology workforce is 11% in this sample. With regard to primary special interest areas, women were more likely to choose female/neuro- urology and incontinence, and less likely to choose oncology and general urology. Other results are demonstrated in the table. Table Legend: Practice Type = Self-employed (“private practice”) (S); Employed (E); Academic (A); Location = Rural (R); Suburban (S); Urban (U) Practice Size = mean number of urologists in your practice; % satisfied = % answered “very satisfied”or “somewhat satisfied”with current work; % choose urology again = % who would choose urology again as a specialty Conclusion: There appear to be significant differences in female versus male urologists in a variety of career-related outcomes. Female urologists report less call days per month when compared to male urologists, with less median annual income, hourly wage, and a decreased desire to choose urology again Po st e rs

148 Poster #12 FAILURE OF THE 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFF: AN EMERGING TREND? Brian Christine, MD1 and Michael Kennelly, MD2 1Urology Centers of Alabama, Birmingham, AL; 2McKay Urology Charlotte, NC Presented by: Brian Christine, MD

Introduction: The 3.5 cm 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 3.5 cm 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 3.5 cm cuff and who required revision of their device secondary to development of a leak in the cuff. These cuffs had been placed from three−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 3.5 cm 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 3.5 cm cuff presents a point of premature failure. Conclusion: A subset of men whose 3.5 cm AUS cuff failed prematurely and in an identical fashion have been identified. The early failure of these cuffs, each developing a leakat exactly the same point, raises concern that the design of the 3.5 cm 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.

149 Poster #13 INCREASED RADIATION EXPOSURE FROM FLUOROSCOPY WITH FIXED TABLE VERSUS PORTABLE C-ARM Fernando Cabrera, MD1, Richard Shin, MD2, Giao Nguyen3, Chu Wang3, Ned Chung3, Charles Scales, MD, MSHS4, Michael Ferrandino MD2, Glenn Preminger, MD2, Terry Yoshizumi, PHD, MS3 and Michael Lipkin, MD2 1Duke Medical Center; 2Duke Medical Center, Durham, NC; 3Division of Radiation Safety, Duke University Medical Center, Durham, NC; 4Duke Medical Center, Duke Clinical Research Institute, Durham, NC Presented by: Fernando Cabrera, MD

Introduction: Fluoroscopy is widely used during endourologic procedures and is associated with significant radiation exposure. Our objective was to estimate patient radiation exposure during fluoroscopy with either a fixed table or portable C-arm during simulated ureteroscopy. Methods: A validated male anthropomorphic model was placed supine on both a cystoscopy operating room table and a fixed fluoroscopy table unit. A GE 9900 C-arm was usedto perform fluoroscopy with the cystoscopy table. Metal oxide semiconductor field effect transistor dosimeters were placed at 20 organ-specific locations in the model to measure organ specific dosages. Continuous fluoroscopy was performed for three separate five- to-six-minute runs. Measured organ dose rates (mGy/sec) were multiplied by their tissue weighting factor (International Commission on Radiological Protection) and summed to determine effective dose rate (EDR, mSv/sec). Results: Most organs, including: bone marrow, liver, stomach, spleen, pancreas and gallbladder were all exposed to significantly greater doses with the fixed table compared to the C-arm. The total EDR was significantly higher by an order of magnitude during fixed-table compared with portable C-arm fluoroscopy at 0.0240 ± 0.0019 mSv/sec and 0.0029 ± .0005 mSv/sec, respectively (p = 0.0024). Conclusion: Estimated organ doses and EDR are significantly higher during fluoroscopy using fixed-table compared with portable C-arm fluoroscopy. The majority of organs, including the most radio-sensitive organs, are exposed to more radiation using the fixed table. Urologists should be aware of this difference when considering operating room design and purchasing fluoroscopy equipment to perform ureteroscopy or percutaneous nephrolithotomy. Source of Funding: none Po st e rs

150 Poster #14 OPTIMIZED ADHESIVE PROBABILITY SCORE: A SUPERIOR CT-BASED SCORING SYSTEM TO PREDICT ADHERENT PERINEPHRIC FAT IN PARTIAL NEPHRECTOMY Yin Zheng, MS and Philippe Spiess, MD, MS, FRCS(C), FACS2 H.Lee Moffitt Cancer Center, Tampa FL Presented by: Yin Zheng, MS

Introduction: Adherent perinephric fat (APF) is a factor that may complicate the technical aspects of partial nephrectomy (PN). Various computer tomography (CT) based scoring system have been recently developed to predict the presence of APF encountered during PN. Our objective was to develop a comprehensive model that improves the sensitivity and specificity of current CT based APF scoring systems. Methods: We prospectively analyzed preoperative CT imaging from 41 open PN patients performed by one surgeon (PES) who identified the presence APF at the time of surgery. CT imaging was obtained to calculate the Mayo Adhesive Probability Score (MAP) (Davidiuk AJ, et al.) and Surface Density Pixel Unit (SDPU) (Zheng Y, et al.) for each patient. A multivariable logistic regression model was used to develop a new scoring algorithm, the Optimized Adhesive Probability score (OAP). OAP combines scoring properties of MAP and SDPU with a focus on improvement in the area under the receiver operating characteristic (ROC) curve. Results: Multivariate logistic regression analysis demonstrates that all three models OAP, SDPU, and MAP are highly predictive of APF (p<0.001). We observed APF in 16.7% of patients with an OAP score of 0, 25% with a score of 1, and 100% with a score of 2. In addition, we observed APF in 19% of patients with an SDPU under 7300, and 90% with an SDPU greater than 7300. In contrast, we observed APF in 22.2% of patients with an MAP score of 0, 0% with a score of 1, 50% with a score of 2, 33.3% with a score of 3, 76.9% with a score of 4, and 100% with a score of 5. Overall, OAP model demonstrated larger area under the ROC curve (AUC: 0.901, p<0.001) compared to SDPU (AUC: 0.883, p<0.001) and MAP (AUC: 0.828, p<0.001). Conclusion: In our cohort, OAP is a superior scoring system compared to SDPU and MAP in predicting the presence of APF in patients undergoing OPN. OAP is a quick scoring system that can be utilized to guide patient education, pre-operative surgical planning, and potential approach offered to patients.

151 Poster #15 SARCOPENIA AS MEASURED BY PSOAS AND ERECTOR SPINAE MUSCLE DENSITY IS ASSOCIATED WITH HIGHER INCIDENCE OF POSTOPERATIVE COMPLICATIONS FOLLOWING RADICAL CYSTECTOMY FOR BLADDER CANCER Mark Currin, MD1, Austin DeRosa, MD2, James Rosoff, MD3, John Roebel, MD2, Matthew Jaenicke, BA2, Thomas Beckham, BA2, Andrew Hardie, MD2 and Sandip Prasad, MD2 1MUSC − Charleston, SC; 2MUSC; 3Yale Presented by: Mark Currin, MD

Introduction: Sarcopenia, an objective measurement of frailty, has been associated with poor outcomes in malignancy, including lung, gastrointestinal, and breast cancers. This study examines the relationship between sarcopenia and postoperative complications in patients undergoing radical cystectomy for bladder cancer. Methods: Ninety-two consecutive patients who underwent radical cystectomy from November 2008 to July 2013 were identified from a prospectively collected institutional database. Demographic, staging, and treatment characteristics were identified along with postoperative complications as defined by the American College of Surgeons National Surgery Quality Improvement Program, within 90 day follow-up. Using preoperative CT scans, regions of interest were drawn around the psoas and erector spinae (ES) muscular compartments, and the density was recorded from the average of the measurements bilaterally by a genitourinary radiologist blinded to postoperative outcome. Student’s t-test and the ANOVA test were used to compare muscle densities across categorical variables. Continuous variables were analyzed with linear regression. Results: There were 190 complications identified in 75 patients (81.5%). Psoas density correlated moderately with ES muscle density (r2 = 0.39, p <0.0001), and measurements of psoas and erector spinae densities were found to be parametrically distributed. Both psoas and ES density correlated with age (r2 = 0.11, p = 0.001 and r2 = 0.25, p <0.0001 respectively). While psoas muscle density did not correlate with total complications, ES density was associated with a higher overall incidence of complications (p = 0.004). Specifically, lower psoas muscle density was associated with deep venous thrombosis, pulmonary embolism (PE)and wound infection, while lower ES density was associated with prolonged postoperative intubation, reintubation, PE and transfusion (p < 0.05 for all). Conclusion: Sarcopenia is associated with a higher incidence of postoperative complications in patients undergoing radical cystectomy for bladder cancer. Preoperative psoas and ES density measurement may be helpful to identify those patients at greater risk of major post− operative complications. Po st e rs

152 Poster #16 PHYSICAL 3D KIDNEY TUMOR MODELS CONSTRUCTED FROM 3D PRINTERS IMPROVE TRAINEE PERFORMANCE Margaret Knoedler, BS, Andrew Lange, BS, Allison Feibus, MS, Michael Maddox, MD, Elisa Ledet, PhD, Raju Thomas, MD, Jonathan Silberstein, MD Tulane University School of Medicine, New Orleans, LA Presented by: Jonathan Silberstein, MD

Introduction: To evaluate the impact of 3D printed physical renal models with enhancing masses on medical trainee appreciation, characterization, localization and understanding of renal malignancy. Methods: Specialized software was utilized to import standard computerized tomography (CT) cross sectional imaging into 3D printers to create physical 3D models of renal units with enhancing renal lesions in situ. Six different 3D models were printed from a translucent plastic resin with a red hue delineating the enhancing renal lesion. Medical students, who had completed their first year of training, were given an overview and then asked to complete a R.E.N.A.L. nephrometry score, separately using conventional CT imaging and physical 3D models. Trainees were also asked complete a questionnaire about their experience. Variability between trainees was determined using Intraclass Correlation Coefficients (ICC), and kappa statistic and weighted kappa were used to compare the trainee to experts. Results: Overall trainee nephrometry score accuracy was significantly improved with the physical 3D model versus CT scan (p<0.01). Furthermore, three of the four calculated components of the nephrometry score (radius, nearness to collecting system, and location) each showed significant improvement (p <0.001) using the models. There was also more consistent agreement among trainees when using the 3D models instead of CT scans to assess the nephrometry score (ICC 0.28 CT scan vs 0.72 models). Qualitative evaluation with questionnaires filled out by the trainees at the conclusion of the study showed universal agreement that the 3D physical models improved their ability understand and conceptualize the renal mass. Conclusion: Physical 3D models using readily available printing techniques improve trainees understanding and characterization of individual patients’ enhancing renal lesions.

The authors declare no conflicts of interest. Source of funding: none

153 Poster #17 THE IMPACT OF REMOTE MONITORING AND SUPERVISION ON RESIDENT TRAINING USING NEW ACGME & ABU UROLOGY MILESTONE CRITERIA Ilan Safir, MD, Adam Shrewsberry, MD, Kenneth Ogan, MD, Chad Ritenour, MD, Catrina White, Jane Kimberl, Jerry Sullivan, MD, Muta Issa, MD Department of Urology, Atlanta VA Medical Center and Emory University School of Medicine, Atlanta, GA Presented by: Ilan Safir, MD

Introduction: The new Joint Initiative of The Accreditation Council for Graduate Medical Education (ACGME) and The American Board of Urology (ABU) proposes semi-annual assessment of training milestones for urology residents. The objective of this study is to determine the impact of remote monitoring and supervision (RMS) in integrated endourology suites (IES) on residents achieving the milestones. Methods: First-year urology residents were asked to evaluate RMS in IES using a 25-question survey. Each IES was equipped with live visual, audio, and telestration communication that allowed urology faculty members to supervise urology residents remotely from a control room. The questionnaire included three sections: overall acceptability (8 questions), impact on training (11 questions) and pre- and post-training self-assessment of milestones (6 questions). For sections 1 & 2, we used a linear visual scale of 1-10. For section 3, we used the Patient Care Milestone #7 (endoscopic procedures for lower and upper urinary tracts) and Patient Care Milestone #9 (office-based procedures). Results: Nineteen residents completed the survey. Overall acceptability and satisfaction with RMS were high with a mean score of 9.1 out of 10. The majority of residents (18/19) felt very comfortable (scores of 8-10/10) being alone with the patient under remote supervision. Residents reported significant positive impact on the quality of training with regard to the following (mean scores): autonomy without compromising safety (8.6), level of supervision (8.4), achieving proficiency & independence (8.3), quality of education (8.1), rate of learning (8.1), clinical evaluation (7.9), clinical decisions (7.8), benefit of immediate feedback (7.6), and reducing the number of cases required to achieve proficiency (7.5). Residents perceived no issues with under- or over-supervision, and expressed that RMS should be the standard of training in all US residency programs. After four months of RMS, residents reported 2.47 and 2.53 mean level increases (out of a total of 5) in Patient Care Milestones for endoscopic procedures of the lower and upper urinary tracts, respectively. Furthermore, residents reported a 2.79 mean level increase (out of a total of 5) in Patient Care Milestone for office- based procedures. Conclusion: Remote monitoring and supervision (RMS) in integrated endourology suites (IES) enhances resident education and training. Using the new ACGME residency training Po st e rs milestones, the study demonstrated a significant increase in competency levels reported by residents following a relatively short period of training under RMS.

154 Poster #18 UROLOGIC COMPLICATIONS OF URETERAL LOCALIZATION STENT PLACEMENT FOR COLORECTAL SURGERY (CRS) CASES Ram Pathak, MD, Abby Taylor, MD, Scott Alford, Gregory Broderick, MD, Todd Igel, MD, Steven Petrou, MD, Michael Wehle, MD, Paul Young, MD, David Thiel, MD Mayo Clinic, Jacksonville, FL Presented by: Ram Pathak, MD

Introduction: The incidence of ureteric injury during CRS is estimated at 0.2-7.6%. Ureteral stents placed by Urologists aid in intra-operative localization and detection of suspected ureteral injury. We evaluated the incidence and management of urologic-induced complications secondary to ureteral localization stent placement during CRS in a single center. Methods: A retrospective review of all patients who underwent cystoscopy and ureteral localization stent placement at the time of CRS over a 12-month period (June 2013-June 2014) was performed. Age, BMI, pre and post-procedural creatinine, and utilization of guidewire during stent placement were examined for each patient. Complications were classified using the Clavien grading system. Further subgroup analysis in patients with urologic-induced complications was performed. All stents were placed with patients in dorsal lithotomy position utilizing a 22 French (Fr) cystoscope and 30 degree lens. Bilateral 5Fr by 70 cm localization stents were placed without fluoroscopic assistance in the CRS operating room. Ureteral stents were removed immediately following surgery or on post-operative day 1. Results: Ninety-nine patients (mean age 58.1, range 17-88) underwent ureteral localization stent placement during the 12 month time period with a male/female ratio of 44/55. The mean BMI was 26.8 (17.0-38.6). The mean pre and post-procedural creatinine was 0.91 and 1.01, respectively. 24/99 (24%) cases utilized bilateral guidewire insertion prior to placement of localization stents. The mean overall operating time was 5.5 hours with approximately 10 minutes devoted for stent placement. Four Clavien grade IIIb complications occurred. One male and one female patient were diagnosed with reflex anuria; one male patient suffered ureteral perforation as diagnosed by extravasation on imaging; and one female patient had significant ureteral clot burden causing obstruction. Three were managed purely endoscopically under anesthesia with bilateral ureteral stent placement. The ureteral perforation case required percutaneous nephrostomy tube placement. Subgroup analysis of the four Clavien grade IIIb complications revealed a mean age of 62.3, BMI of 26.98, pre and post-procedural creatinine of 0.95 and 4.83, respectively, and 100% utilization of guidewires. Mean overall operating time was 5.4 hours with an average of 3.5 days (2-5 days) until management of aforementioned complication. Conclusion: The incidence of urologic-induced complications during ureteral localization stent placement is approximately 4%. Future prevention strategies may require an elimination of blind placement of localization stents and adopting the use of fluoroscopy, obligatory.

155 Poster #19 THE CHARACTERISTICS OF WOMEN TESTING POSITIVE FOR MYCOPLASMA HOMINIS AND UREAPLASMA UREALYTICUM IN THE URINARY TRACT Jessie Liang, MD, Sarah Rentrop, MS, Andrea Balthazar, MS, Clifton F. Frilot II, PhD, Alex Gomelsky, MD LSU Health − Shreveport, LA Presented by: Jessie Liang, MD

Introduction: Mycoplasma hominis (M) and Ureaplasma urealyticum (U) may be isolated from cervicovaginal specimens in over 50% of asymptomatic, sexually active women. These organisms can also produce localized urogenital diseases, but much of the literature has focused on these opportunistic infections in “at risk” populations such as those in developing nations and the immunosuppressed. While there is some data regarding the asymptomatic female carriers of these bacteria, the literature is deficient in characterizing the symptomatic female population. We aim to characterize the population of women with urinary storage or emptying symptoms who test positive for M/U. Methods: This is a retrospective, IRB-approved chart review of all women who were tested for M/U in our urology clinic between 1/1/11 and 5/15/14. Pregnant women, prisoners, and those <18 years of age were excluded. Demographic variables and follow-up data were abstracted from the electronic health record. Results: Of 514 women who underwent culture for M/U, 208 (40.5%) tested positive (+): 21 (10.1%) were M(+), 155 (74.5%) were U(+), and 32 (15.4%) were (+) for both. The predominant symptom was dysuria (79.3%), followed by urinary urgency (55.2%), frequency (47.6%), urgency urinary incontinence (36.1%), and pelvic pain (30.3%). Nearly 53% were premenopausal and 57.7% were active or previous smokers. Microscopic hematuria (≥3 RBC/hpf) was present in 14.4% and only 4.3% had previously documented infections with gonorrhea and/or chlamydia. Over 68% previously had one or more culture-proven urinary tract infections (UTI), predominantly with gram (-) bacteria; however, only 12.5% had a concomitant UTI at the time of (+) M/U. Symptom improvement was seen in 81.3% after patient and current partner were treated with doxycycline; but, 4.8% became re-infected with M/U during the follow-up period and required additional therapy. During the course of work- up, 25.5% underwent cystoscopy and none were diagnosed with transitional cell carcinoma. Conclusion: Over 90% of our population testing (+) for M/U had Ureaplasma and most had dysuria as the main symptom. A history of prior sexually-transmitted infections was typically absent. Despite the heavy prevalence of previous or current smokers in our population, the prevalence of microscopic hematuria was low and any cystoscopic evaluations were negative for malignancy. The development of this patient profile may assist in more rapid screening and cost-effective management of women with urinary symptoms in the future. Po st e rs Funding: none

156 Poster #20 IMPACT OF FELLOWSHIP TRAINING ON ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: BENCHMARKING PERI−OPERATIVE SAFETY AND OUTCOMES Abby Taylor, MD1 and David Thiel, MD2 1Mayo Clinic Florida, Department of Urology, Jacksonville, FL; 2Mayo Clinic Florida, Jacksonville, FL Presented by: Abby Taylor, MD

Introduction: To provide perioperative benchmark data for surgeons entering practice from formal robotic training and performing robotic assisted laparoscopic partial nephrectomy (RAPN). Methods: Perioperative outcomes of the first 100 RAPN from a surgeon entering into practice directly from robotic fellowship training were analyzed. Post-operative complications were catergorized by Clavien-Dindo grade. Surgical “trifecta” outcomes were defined as negative margins, absence of grade 3 or higher complications, and no change in renal function. MIC scoring was utilized and defined as negative surgical margins, ischemia time under 20 minutes, and abscence of complications grade 3 or higher. The Spearman correlation was used to assess an association between total operative time and a RENAL score range. All two sided p-values less or equal to 0.05 were considered as statistically significant. Statistical analyses were performed using SAS (version 9.2; SAS Institute, Inc., Cary, North Carolina). Results: One patient was eliminated from analysis secondary to incomplete data. Median age of the cohort was 63 years (22−81 years) and 34 (34.3%) patients were over age 65. 41 (41.4%) of patients had a BMI > 30. Thirteen (13.1%) had RENAL 10−12 tumors and 22 (22.2%) were > 4 cm in size. Median warm ischemia time was 17 minutes and 13 patients had resection without warm ischemia. Five patients were converted to open partial nephrectomy and one patient was converted to laparoscopic nephrectomy. 21.2% of patients experienced a complication and six patients had a major (Clavien grade 3 or higher) complication with one grade 5 complication secondary to cardiac event two weeks post−operatively. Operating room time decreased with experience but surgical complications and hospital stay did not change with experience. MIC score of RCC patients was 74.7% while the surgical trifecta was reached in 71.3% of RCC patients. Conclusion: Surgeons may enter practice directly from training and perform RAPN with peri-operative outcomes, surgical complications, surgical trifecta scores, and MIC scoring in line with those of early adopters and the most experienced robotic partial nephrectomists. This experience may serve as benchmark data for surgeons entering practice directly from fellowship or residency training.

157 Poster #21 PREFABRICATION OF NEUROMUSCULAR JUNCTION FOR ACCELERATED RECOVERY OF MUSCLE FUNCTION In Kap Ko, PhD, Sang Jin Lee, PhD, John Jackson, PhD, Anthony Atala, MD, James Yoo, MD, PhD Wake Forest School of Medicine, Winston Salem, NC Presented by: John Jackson, PhD

Introduction: Surgical reconstruction involving muscle requires integration of nervous tissue for functional restoration. Failure of neural integration leads to atrophy and the tissue often becomes non-functional. Therefore, muscle innervation is a critical process in the recovery of function, this process is time sensitive and relies heavily on the host tissue microenvironment. Acceleration of nerve integration by facilitating the formation for neuromuscular junctions (NMJ) may be an option to restore muscle function after reconstruction. Methods: Toward this goal, we investigated whether muscle fibers cultured in vitro could form NMJ that would lead to rapid innervation to muscle tissue in vivo. Myotubes formed from muscle precursor cells (C2C12) were co-cultured with neuroblastoma cells (NG108), grown with conditioned medium derived from NG108, or treated with neurotrophic factors (agrin- containing medium). To confirm acetylcholine receptor (AChR) expression on the surface of myotubes, 10 µM of alpha-bungarotoxin (α-BTX) conjugated with fluorescent dye was added to the culture and visualized with a fluorescent microscope. AChR expressing myotubes were counted from randomly selected areas (n=9) in culture microplates. AChR expression on myotubes in a 3-D culture system was assessed. Results: Agrin treatment significantly increased the percentage of AChR expressing myotubes from 15% to 100%. Treatment with conditioned medium ( CM) derived from NG108 cells in differentiation medium enhanced AChR expression by up to 50%; however, when CM was added to growth medium, AChR expression on the surface of myotubes was not affected. Treatment with agrin also increased AChR expression on myotubes grown in a 3-D culture system consisting of fibrin gel. This study shows that expression of AchR can be controlled by the use of nerve, conditioned medium derived from neural cells or neurotrophic factors (agrin). Conclusion: These results suggest that formation of NMJ may allow for more effective neural integration and accelerate the recovery of muscle function. Furthermore, rapid integration of neural tissue would decrease the incidence of muscle atrophy and scarring.

Po st e rs

158 Poster #22 COMBINATION OF SMALL RNAS ENHANCES MUSCLE DEVELOPMENT NaJung Kim, PhD, James Yoo, MD, PhD, John Jackson, PhD, Sang Jin Lee, PhD, Anthony Atala, MD Wake Forest School of Medicine, Winston Salem, NC Presented by: John Jackson, PhD

Introduction: Repairing traumatic tissue defects are often challenged by the lack of available autologous tissues for grafting. Small RNAs have been known to direct the production of various cellular factors, which could promote in situ tissue regeneration at a targeted site. This study was performed to determine the feasibility of using small interfering RNAs (siRNA) to regenerate muscle tissue defects for recovery of muscle function. Methods: To evaluate the myogenic potentials of small RNAs in vitro, we used three different small RNAs, siGDF-8, miR-1, and miR-206, which are known as regulators of muscle development. Murine myoblasts were transfected with individual or combinations of the RNAs, and incubated in differentiation media until used for gene expression, proliferation, and differentiation analyses. For in vivo evaluation, chemically injured Lewis rat tibialis anterior (TA) muscles were treated with RNAs and analyzed for functional and structural recovery. Results: All of the individual small RNAs increased gene expression of myogenic regulatory factors (MRFs), including MyoD, myogenin, Pax7, and myosin heavy chain 1 (MyHC1). Combining two miRNAs, miR-1 and miR-206, did not have significant differences on the gene expression of MRFs. However, adding siGDF-8 to these miRNAs significantly increased gene expressions of all the myogenic regulatory factors tested. This combination of small RNAs also enhanced myosin protein expression by miR-1 and miR-206 suggesting improved differentiation of myoblasts into myotubes. This synergistic effect of small RNAs was reflected well on the recovery of chemically injured rat tibialis anterior (TA) muscles. Structural and functional recovery of hind leg was significantly accelerated by this combination delivery of siGDF-8, miR-1, and miR-206. Combinations of small RNAs enhanced myogenic activation by overexpressing MRFs such as MyoD, myogenin, Pax7, and MyHC1. This improved gene expression boosted the overall development capacity of myoblasts. Conclusion: The combination delivery accelerated in vivo regenerative efficiency, and may have a great therapeutic potential to fine-tune muscle recovery from traumatic injury.

159 Poster #23 ARE SOME U.S. ACADEMIC CENTERS REGULATING THEMSELVES OUT OF MULTICENTER STUDIES? THE PROPPER REGISTRY EXPERIENCE WITH IRB AND CONTRACT APPROVAL Gerard Henry, MD1, Edward Karpman, MD2, Bryan Kansas, MD3, William Brant, MD4, Leroy Jones, MD5, Nelson Bennett, MD6, Mohit Khera, MD7, Tobias Kohler, MD8, Andrew Kramer, MD9, Brian Christine, MD10, Eugene Rhee, MD11, Rafael Carrion, MD12, Andrew Neeb, MD13 and Anthony Bella, MD14 1Regional Urology, Shreveport, LA; 2El Camino Urology, Mountain View, CA; 3The Urology Team, Austin, TX; 4University of Utah, Salt Lake City, UT; 5Urology San Antonio, San Antonio, TX; 6Lahey Clinic, Burlington, MA; 7Baylor College of Medicine, Houston, TX; 8Southern Illinois University, Springfield, IL; 9University of Maryland, Baltimore, MD; 10Urology Alabama, Birmingham, AL; 11Kaiser, San Diego, CA; 12University of South Florida, Tampa, FL; 13Urology Specialists of Oregon, Bend, OR; 14Ottawa Hospital Research Institute, Ottawa, Canada Presented by: Gerard Henry, MD

Introduction: The “Prospective Registry of Outcomes with Penile Prosthesis for Erectile Restoration” (PROPPER) study is a multi−center clinical registry collecting real-world outcomes for patients with penile implants. PROPPER is designed to document outcomes for American Medical Systems (AMS) 700 and Ambicor inflatable penile prostheses (IPPs), and Spectra penile implants. Validated patient questionnaires and electronic data collection are used to record baseline patient characteristics and surgical implantation details, and to prospectively measure response to treatment annually to five years post-implantation including durability, complications, and effectiveness outcomes. There is no experimental treatments or randomization of patients. We evaluate IRB and contract approval timing and rates at 14 diverse centers. Methods: The first PROPPER registry patients were enrolled June 9, 2011. Seven sites are academic, seven sites are private practice with one Canadian academic site and the 13 U.S. sites spread across the country geographically. The private practice sites vary from small to large single specialty groups and large multi-specialty groups. The academic sites vary in size, number of urology residents, and academic veteran administration hospitals utilized. We evaluated the length of days for contract approval, IRB approval time, and enrollment/activation date for each site. Group 1 consists of the six U.S. academic sites while Group 2 consists of the seven U.S. private practice and the 1 Canadian academic site. Results: The time from the start of contract negotiation to contract approval date for the U.S. academic sites (Group 1) was 16- 892 (avg 295.5) days while Group 2 was 3-420 (126) days (p = 0.204). The time from the start of IRB submission to approval date for the Group 1 was 25-90 (53) while Group 2 was 4-190 (41.4) days (p = 0.709). Enrollment/activation date has occurred at all the US private practice/ Canadian academic sites (Group 2) while five of the six Group 1 sites have occurred. Conclusions: For this large multicenter prospective registry US academic centers have longer contract approval and IRB approval time in terms of length of days, but the difference is not statistically Po st e rs significant based on t test.

160 Poster #24 MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING FOR DETECTION AND LOCALIZATION OF PROSTATE CANCER: DIAGNOSTIC PROPERTIES Melissa Mendez, MD1, Matvey Tsivian, MD1, Rajan Gupta, MD2, Peter Qi1, Michael Abern, MD1, Niccolo’ Passoni, MD1 and Thomas Polascik, MD1 1Division of Urology, Duke Cancer Institute, Durham, NC; 2Department of Radiology, Duke University Medical Center, Durham,NC Presented by: Melissa Mendez, MD

Introduction: To evaluate the diagnostic properties of multiparametric MRI (mpMRI) in detection, localization and characterization of prostate cancer (PCa) using transperineal template mapping biopsy (TTMB) as the reference. Methods: A retrospective review of patients undergoing mpMRI of the prostate followed by TTMB was performed. The indications for TTMB were prior negative office-based biopsies or restaging of potential active surveillance or focal therapy candidates. For imaging and pathology data, the prostate was divided in octants with the urethra serving as midline. The index test properties were calculated using TTMB results as the reference test with the following endpoints: any cancer, any Gleason≥7, any Gleason ≥7 or ≥4mm of cancer in any given core, and any Gleason≥7 or ≥6mm of cancer in any given core. The latter two definitions correspond to 0.2 and 0.5cc of cancer volume respectively. Sensitivity, specificity, negative and positive predictive values (NPV, PPV) were calculated. Results: A total of 50 patients were included. Of 400 prostate octants evaluated, 114 (28.5%) had PCa on TTMB whereas 92 (23%) of octants were considered suspicious for cancer on mpMRI. NPV values for Gleason ≥7 cancers were 91-92%, and approached 90% for the detection of clinically significant cancers using both volume definitions. Similarly, specificity ranged between 82-97%. Sensitivity and PPV remained moderate for all the reference test definitions. Conclusion: In this study, the diagnostic properties of mpMRI demonstrated high NPVs and specificity suggesting this imaging modality could reliably rule out clinically significant cancer. As such mpMRI could be an important stratification tool. In the setting of active surveillance, the ability of mpMRI to accurately rule out the presence of clinically significant disease may aid in appropriate candidate selection. In the setting of focal therapy, mpMRI could suggest the anatomical regions of the prostate that could be spared. Finally, not only could mpMRI guide targeted biopsies and thus potentially avoid random sampling and associated morbidity as well as over diagnosis of potentially indolent lesions, but one could hypothesize that mpMRI could obviate the need for prostate biopsy in the presence of negative imaging results. These and other potential uses for mpMRI should be thoroughly investigated in future studies. No funding was obtained or utilized for this study.

161 Poster #25 CAREFUL SELECTION OF DISPOSABLES CAN MINIMIZE THE COST OF URETEROSCOPY Joan Delto, MD1, Ajaydeep Sidhu, MD1, George Wayne, BS2, Rafael Yanes, MD1, Akshay Bhandari, MD1 and Alan Nieder, MD1 1Mount Sinai Medical Center, Miami Beach, FL; 2Florida International University, Miami, FL Presented by: Joan Delto, MD

Introduction: There are numerous disposable products commercially available that enable surgeons to perform successful ureteroscopy. In the same context, costs accumulate through superfluous material selection or by operating room staff opening items that are not used. Our study focuses on costs incurred when gaining access for flexible ureteroscopy and laser lithotripsy. Certainly, many variables influence what is utilized at the time of surgery, however this study simply provokes the urologist to be cognizant of ureteroscopy costs. We aim to demonstrate that careful selection of disposables can significantly reduce expenses. Methods: We specifically evaluated four techniques of gaining upper tract access (see Table 1). List prices of disposables were obtained, and total costs per technique were compared. For each scenario, a retrograde pyelogram is performed and we employ both a safety wire and ureteral access sheath. Results: The most expensive combination was our “classic”technique, which costs approximately $294, and requires an open ended ureteral catheter, two sensor wires, a dual lumen catheter, and an access sheath. The most cost-effective method included a ureteral catheter, two heavy-duty wires, and an access sheath. Comparatively, this reduced costs by 48%. A flexor parallel access sheath eliminates the need for a second wire. When used with a single heavy-duty wire, it reduced costs by 43.5% compared to our classic method. Use of a heavy-duty rather than a sensor wire decreased costs by 68%. Utilizing an open ended ureteral catheter for retrograde pyelogram and safety wire placement can reduce costs by 65% when compared to a dual lumen catheter. The flexor parallel sheath may reduce costs by 17-44%. Conclusion: Urologist awareness and collaboration with operating room staff in the resourceful utilization of disposables can effectively reduce ureteroscopy costs. Based on our preliminary data, our department has mandated that disposables be opened only upon surgeon demand. Further prospective, multicenter trials are needed to assess other methods of cost reduction, preoperative variables, and long-term patient outcomes. The authors have no financial disclosures. Po st e rs

162 Poster #26 ROLE OF ROBOTIC SURGERY IN THE TREATMENT OF COMPLEX KIDNEY STONES – A SINGLE CENTER EXPERIENCE Curtis Cleveland1, Zachary Klaassen, MD1, John M. DiBianco2, Qiang Li, MD, PhD1, Sherita A. King, MD1 and Rabii Madi, MD1 1Medical College of Georgia − Georgia Regents University, Augusta, GA; 2Ross University School of Medicine, Dominica, West Indies Presented by: Zachary Klaassen, MD

Introduction: The use of robotic-assisted treatment modalities for complex staghorn kidney stones has recently been reported in the literature. We report our initial experience and outcomes with robotic anatrophic nephrolithotomy (RAN) and robotic pyelolithotomy (RP) for the treatment of complex kidney stones. Methods: Between October 2012 and August 2014, 13 patients underwent 14 robotic surgeries for complex kidney stones (RAN n=8; RP n=6). One patient underwent bilateral RP in a single setting for bilateral renal pelvic stones. RAN was mostly performed in patients with full staghorn stones, and RP was offered to patients with large stones located in an extra renal pelvis. Most patients failed previous endoscopic intervention or had an anatomic variation that precluded such intervention. Variables of interest included demographic (age, gender, body mass index (BMI)) and perioperative (pre, post-op day 1 and most recent creatinine (Cr), warm ischemia time (WIT), robotic time, operative time, estimated blood loss (EBL), length of stay (LOS)) outcomes. Stone free rates and median follow-up are reported. Results: Among 13 patients undergoing robotic procedures, the median age was 54 (IQR 41-57) years, BMI was 31.2 (IQR 25.1-33.2) kg/m2 and preoperative Cr was 0.87 (IQR 0.81- 1.25) mg/dL. Operatively, median WIT was 36 (IQR 31-42) min (for RAN patients only), robotic time was 158 (IQR 150-210) min, operative time was 195 (IQR 185−255) min, and EBL was 100 (IQR 75-100) mL. Median LOS was 2 (IQR 1-4) days, post-op day 1 Cr was 1.28 (IQR 0.84-1.51) mg/dL, and most recent follow-up Cr was 1.13 (IQR 0.81-1.41) mg/dL. All patients undergoing RP were completely stone free, while 50% of patients undergoing RAN were completely stone free. There were no perioperative complications. Three of five patients undergoing RP had known kidney anomalies (ectopic pelvic kidney, back-to-back pelvic fused kidneys, and ureteral pelvic junction obstruction). Median follow-up time was 2.0 (IQR 0.7-9.6) months. Conclusion: Robotic-assisted surgery of complex kidney stones is an emerging minimally invasive modality. Our RAN experience is encouraging, however early results suggest subsequent procedures may be necessary to achieve complete stone free rates in complex cases. Patients undergoing RP for renal pelvic stones have excellent stone free rates. Specifically, this approach may be indicated in patients with anatomic renal anomalies that are not amenable to traditional endoscopic options.

163 Poster #27 THE EFFECTS OF A WESTERNIZED DIET AND UREAPLASMA PARVUM URINARY TRACT INFECTION ON KIDNEY STONE FORMATION IN A RAT MODEL Tara Ortiz, MD1, Julie Sproule, BS1, Patrick Seed, MD, PhD1 and Sherry Ross, MD2 1Duke University Medical Center, Durham, NC; 2University of North Carolina, Chapel Hill, NC Presented by: Tara Ortiz, MD

Introduction: The incidence of pediatric stone disease has doubled over the last two decades. These findings may be related shifts to a westernized diet (WD). The consumption of large quantities of sugary beverages containing high-fructose corn syrup may be lithogenic. The resulting metabolic acidosis may also negatively impact bone health. Lastly, urinary tract infection (UTI) with urea splitting organisms may provide a nidus for stone formation. We hypothesize that a WD and Ureaplasma parvum (UP) are lithogenic factors. Methods: Forty young female rats were randomized to standard (SD, N=12) vs. high-fat and sucrose (HD, N=14) vs. high-fat, sodium and fructose (HFHS, N=14) diet for 12 weeks. Ten rats from each group underwent transurethral infection with UP at four and eight weeks. Infection was treated with enrofloxacin after 3 days. Basic serum chemistry, parathyroid hormone (PTH), Vitamin D (VitD), bone alkaline phosphatase (BAP) and 24-hour urine analysis was obtained at baseline, four and eight weeks. Ex-vivo CT scans of the kidneys and bladder were taken at 12 weeks, and stone burden was assessed using a standardized scoring system from zero to three by a blinded reviewer. Statistical analysis was performed using one-way ANOVA and Tukey post hoc testing. Results: The HD group had the highest weight gain and body fat (BF) at 12 weeks (wt gain|BF – SD 104g|15g, HD 127g|21g, HFHS 92g|12g, p<0.05). At eight weeks the HFHS group had lower urine magnesium (Mg) and citrate (cit), and higher 24-hour urine calcium (UCa) and uric acid (UUA) than the SD and HD groups (Mg|cit|UCa|UUA – SD 1.9mg/d|10.5mg/ d|2.1mg/d|1.3e−3g/d, HD 1.9mg/d|8.9mg/d|2.0mg/d|1.3e-3g/d, HFHS 0.9mg/d|2.8mg/ d|8.7mg/d|2.0e-3g/d, p<0.01). The HFHS group also had higher VitD and PTH than the SD and HD groups, while the SD group had lower BAP than both WD groups (Vit|BAP|PTH – SD 28.8ng/mL|17.6pg/mL|448ug/mL, HD 29.1ng/mL|26.5pg/mL|476ug/mL, HFHS 34.4ng/ mL|24.7pg/mL|699ug/mL, p<0.05). The 24-hour urine volumes and H2O consumption in the HFHS group were five times higher than the SD and HD groups, likely due to high sodium load. Lastly, highest stone burden was found in the HD, SD then HFHS groups respectively. There was no difference in stone burden between rats infected with UP vs. controls. Conclusion: These data suggest a WD, high in fat and refined sugar increase promotors and decrease inhibitors of urinary stone formation. Furthermore, there is evidence of increased bone turn over in rats consuming a WD. UP UTI had no effect on urolithiasis. However, chronic infection with urea splitting organisms may produce different results. Po st e rs

164 Poster #28 HUMAN MONOCYTES RESPONSE ENHANCES KIDNEY STONE CLEARANCE Paul Dominguez-Gutierrez, PhD, Benjamin Canales, MD, Sergei Kusmartserv, PhD, Johannes Vieweg, MD, FACS, Saeed Khan, PhD University of Florida, Gainesville, FL Presented by: Paul Dominguez-Gutierrez PhD

Introduction: In experimental hyperoxaluric animals, we have observed that macrophages first surround interstitial calcium oxalate (CaOx) deposits and eventually eliminate them from the kidney. Additionally, we have demonstrated enhanced phagocytosis and destruction of CaOx crystals in vitro by M2 macrophages pretreated with IL-1β, IL-6, and TNFα. Based on these observations, we hypothesize that monocytes provide key stimulatory factors to facilitate macrophage clearing of renal CaOx crystals thereby decreasing kidney stone formation in humans. Methods: Human monocytic THP-1 cells lines were seeded in 12-well plates three days prior to exposure to 10, 100, 1000ug/ml of CaOx, KOx (potassium oxalate), and HA (hydroxyapatite). Phagocytic changes were observed in an x200 and x400 field with a fluorescence microscope. Total RNA was collected at two-, four-, eight-, and 24-hour post exposure. Cytokine expression levels were measured with TaqMan® realtime quantitative PCR. Results: Within 24 hours, small CaOx crystals were visibly phagocytized by the THP- 1 cells; however, even after 72 hours no destruction was visible. Within two hours, 1000 ug/ml exposure of CaOx displayed increases over 160 fold of TNFa, IL-1β, IL-6, and IL-8 compared to the untreated. The 100 ug/ml CaOx displayed roughly one-tenth the fold change seen with 1000 ug/ml CaOx while no significant increase was seen with 10 ug/ml. KOx treatment displayed no significant increases for 1000 and 10 ug/ml; however, 100 ug/ml of KOx displayed greater than 25-fold increase at four hours exposure. Both CaOx, and KOx displayed gradua1 decrease of the chemokines from two to eight hours and rapid decrease after eight hours. HA, which was the negative control, displayed no significant change in cytokines. Conclusion: Although they cannot clear deposits alone, human monocytes are capable of phagocytizing CaOx crystals and display both time- and dose-dependent upregulation of cytokines (TNFa, IL-1β, and IL-6) known to enhance macrophage response to CaOx crystals. We speculate that this initial monocyte immune response may enhance macrophage clearance of CaOx deposits and be the mechanism responsible for promoting stone clearance.

165 Poster #29 DOES MEDICAL MANAGEMENT OF CYSTINURIA REDUCE STONE INTERVENTIONS? AN ASSESSMENT USING MEAN CUMULATIVE FUNCTION ANALYSIS Richard Shin, MD1, Fernando Cabrera, MD1, Jonathan Hanna1, Momin Ghaffar1, Borna Kassiri1, Charles Scales, MD, MSHA2, Glenn Preminger, MD1 and Michael Lipkin, MD1 1Division of Urologic Surgery, Duke University Medical Center, Durham, NC; 2Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC Presented by: Richard Shin, MD

Introduction: We report our long term experience with the efficacy of medical management for preservation of renal function and reduction of stone related events in patients with cystinuria. Methods: We performed a retrospective cohort study of patients with cystinuria treated at our facility over 24 years with ≥6 months follow up. Results of urine metabolic evaluations, renal function, side effects, patient-reported adherence and stone interventions (emergency room visits and surgical procedures) were reviewed. Using a Poisson framework regression model accounting for differential length of follow up, we assessed the relationship between cystine concentration and rate of stone interventions. Results: The cohort comprised 31 patients with a median age of 29 (IQR 19-44) years at initial presentation; median follow up was 7.6 (IQR 2.4-11) years. Females were 52% of the cohort. There was no significant change in serum creatinine during follow up (p = 0.45). Despite poor medication and follow up adherence, 39% obtained a mean cystine concentration <250 mg/L. Bivariate recurrence analysis demonstrated an association between cystine concentration <250 mg/L, urinary pH and intervention rate. On multivariable analysis, the effect of cystine concentration and urinary pH on intervention remained significant. Men achieving urine pH of 7 and cystine concentration <250 mg/L were predicted to require 0.7 interventions over five years, compared to 2.3 interventions for those with cysteine concentration >250 mg/L (p <0.001). Conclusion: Patients who are able to maintain low cystine concentrations reduce their likelihood of requiring stone interventions over time. However, adherence with medical therapy remains a challenge and demands continued focus. Po st e rs

166 Poster #30 ANALYSIS OF S.T.O.N.E. AND GUY’S SCORING SYSTEMS FOR REPRODUCIBILITY, PREDICTION OF STONE CLEARANCE, AND PREDICTION OF SECONDARY PROCEDURES AFTER PRIMARY PERCUTANEOUS NEPHROSTOLITHOTOMY Weil Lai, MD, Arash Akhavien, MD, Vincent G Bird, MD University of Florida Department of Urology, Gainesville, FL Presented by: Weil Lai, MD

Introduction: Percutaneous nephrostolithotomy (PCNL) is commonly performed for treatment of large, complex urinary stones. Scoring systems have been proposed to standardize reporting and facilitate prediction of outcomes. It is uncertain which systems/variables are most reproducible, can predict stone clearance, and need for further procedures. We evaluate the S.T.O.N.E. nephrolithometry and Guy’s stone score scoring systems (GSS) using CT imaging with strict criteria for stone clearance and prediction of stone free status/secondary procedures after primary PCNL. Methods: Inclusion criteria for a patient cohort undergoing PCNL included primary PCNL for renal calculi and availability of pre- and post-operative CT imaging. Patient demographics, residual stone size, and secondary procedures were recorded. S.T.O.N.E. and GSS parameters were scored by two independent readers. Inter-reader variability was assessed with weighted kappa. Group comparisons were performed using Wilcoxon rank-sum test and Kruskal-Wallis one-way analysis of variance. Prediction of stone clearance and retreatment were calculated with logistic regression. Results: Analysis included 151 patients. Mean scores (IQR) for S.T.O.N.E. and GSS were 9.13 (three) and 2.6 (one), respectively. For residual stone 0-2, 3-4, and >4 mm, mean S.T.O.N.E. scores were 8.35, 9.15, and 10.21, respectively (p<0.0001), and mean GSS scores were 2.35, 2.7, and 2.9, respectively (p=0.0001). For every unit increase in S.T.O.N.E. and GSS, there were 47% and 44% odds decreases in having stone <4 mm, respectively. Analysis of inter−reader variability showed “substantial agreement” for S.T.O.N.E. (k=0.648) and GSS (k=0.769). For patients with no residual stone or passage of fragments on imaging after one procedure, mean S.T.O.N.E. and GSS were 8.61 and 2.43, respectively. For those with secondary procedures (38%), mean S.T.O.N.E. and GSS were 9.98 and 2.9, respectively. Increase in either score predicts need for secondary procedures (odds increase of 63%/80% for S.T.O.N.E./GSS, respectively). There were 17 (11%) complications. Conclusion: Both S.T.O.N.E. and GSS correlate well with magnitude of residual stone status and are predictive of retreatment after primary PCNL. These results may be used in further development of quality assessments for PCNL and for counseling of patients. Analysis of inter-reader variability demonstrated that stricter parameters and definitions may be needed to improve reproducibility. Further investigation may determine if other parameters will improve these systems as predictive models for PCNL outcomes.

167 Poster #31 ANALYSIS OF GUIDEWIRE USE FOR COMMON ENDOUROLOGIC PROCEDURES: A COST PERSPECTIVE. James Mason, MD1 and Vincent G. Bird, MD2 1University of Florida College of Medicine; 2University of Florida Department of Urology; Gainesville, FL Presented by James Mason, MD

Introduction: A large variety of guide wires comprise the necessary endourologic armamentarium for treating urinary stones. Many “specialty wires” are purported to have specifications, such as shaft strength, specific lubricity, or tip flexibility, that may facilitate performance of endourologic procedures. However, it is unclear how often the use of these wires is required in regular clinical care. It is also undetermined how costly the overuse of unnecessary “specialty wires” is for standard endourologic procedures. Methods: We prospectively identified a cohort of patients undergoing five different types of consecutive endourologic procedures in which guidewires are used to facilitate access and performance of the procedure. Procedures included ureteral catheterization/stent placement (UC), ureteroscopy (URS), percutaneous renal access (PA), and first and second look percutaneous nephrostolithotomy (PCNL 1 and PCNL 2). All procedures were initiated with standard use of 0.035 inch teflon wire and stiff guidewires (ureteral access sheath for ureteroscopy and dilation of percutaneous tract). We noted use of standard wires for each procedure and use of extra wires when standard wires were deemed insufficient. All data was collated and statistical analysis was performed. Results: There was a total of 275 procedures included in the study with breakdown as follows; UC (n=134), URS (n=57), PA (n=39), PCNL 1 (n=38), PCNL 2 (n=7). Supplemental guidewires were required in 16.4% UC, 12.3% URS, 17.9% PA, 5.3% PCNL 1, and 28.6% PCNL 2. Indications for use of supplemental guidewires mostly related to gaining retrograde access in the case of obstructing ureteral stones, and in obtaining difficult nephroureteral access during PCNL. The most commonly used supplemental wire was the angled glide wire. Hospital costs are the following for a standard wires: teflon ($8.00), super stiff ($26.24), angled glide ($37.72), nitinol core-tungsten filled hydrophilic floppy tip ($44.52), and nitinol core/platinum tip ($40.05). As an example, cost analysis demonstrated that standard wire failure rates were well below that needed to justify the use of a “specialty wire” in every case. For the most common procedure, ureteral catheterization/stent, standard wire failure would have to occur every 2.86 cases (35.7%) to justify the use of an angled glide wire for each case. The high rate of standard wire failure in PCNL 2 is attributed to the low number of procedures (n=7) within that category. Conclusion: In most cases supplemental guidewires are not needed. As such, from a cost Po st e rs standpoint, we recommend that more costly supplemental wires only be employed after failure with standard lower cost guidewires.

168 Poster #32 VALUE OF METABOLIC EVALUATION AND DIRECTED MEDICAL THERAPY IN PATIENTS WITH STRUVITE STONES Adam Kaplan, MD1, Richard Shin, MD1, Muhammad Iqbal, MD2, Ramy Youssef, MD3, Fernando Cabrera, MD1, Jonathan Hanna, MD1, Anika Ackerman, MD1, Andreas Neisius, MD1, Charles Scales, MD4, Michael Ferrandino, MD1, Glenn Preminger, MD1 and Michael Lipkin, MD1 1Duke Medical Center, Durham, NC; 2Shifa International Hospital (Pakistan); 3University of California, Irvine, CA; 4Duke Medical Center, Duke Clinical Research Institute . Durham, NC Presented by: Adam Kaplan, MD

Introduction: Metabolic evaluation for patients with struvite stones remains controversial. We report our contemporary experience with metabolic evaluation and directed medical therapy in patients with struvite stones. Methods: Between 2005-2012, 56 patients treated with percutaneous nephrolithotomy (PNL) for struvite stones were identified. Seven had pure struvite stones with metabolic evaluation (Group 1), 32 had mixed struvite stones with metabolic evaluation (Group 2), and 17 had pure struvite stones without metabolic evaluation (Group 3). The frequency of metabolic abnormalities and stone activity (defined as stone growth, recurrence or stone related events) were compared between groups. Results: The median age was 55 years (IQR 42-63.5) and 64% were female. No significant difference in demographics including race, UTI history, family history, stone location or volume existed between groups. Metabolic abnormalities were found in 57% and 81% in Group 1 and 2; respectively. Antibiotic prophylaxis and Acetohydroxamic acid were used more frequently in patients with pure struvite stones while metabolic directed medical therapies were used in > 85% of patients with metabolic evaluation (group 1 and 2). Stone activity rates were 20%, 30% and 50%; in group 1, 2 and 3; respectively. Kaplan Meier analysis demonstrated earlier and more frequent stone events in group 3, those patients with no metabolic evaluation. Conclusion: Metabolic abnormalities in struvite stone formers, including patients with pure struvite stones, appear to be more common than previously reported. Correction of metabolic abnormalities in struvite stone formers may reduce stone activity. While a larger study is needed, metabolic evaluation and directed medical therapy may be considered for patients with pure struvite stones.

169 Poster #33 ANTIMICROBIAL UTILIZATION PRIOR TO ENDOUROLOGICAL SURGERY FOR UROLITHIASIS: ENDOUROLOGICAL SOCIETY SURVEY RESULTS Anika Ackerman, MD1, Ramy Youssef MD2, Richard Shin MD1, Fernando Cabrera MD1, Adam Kaplan MD1, Andreas Neisius MD3, Charles Scales MD4, Roger Sur MD5, Michael Ferrandino MD1, Brien Eisner MD6, Glenn Preminger MD1 and Michael Lipkin MD1 1Division of Urologic Surgery, Duke University Medical Center, Durham, NC; 2Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Urologic Surgery, University of California, Irvine, Orange, CA; 3Department of Urology, University Medical Center Mainz, Mainz, Germany; 4Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC; 5Division of Urologic Surgery, University of California San Diego, San Diego, CA; 6Massachusetts General Department of Urology, Boston, MA Presented by: Anika Ackerman, MD

Introduction: To determine variations in antimicrobial use prior to endourological surgery for urolithiasis and to correlate these variations to site, pattern and volume of clinical practice. Methods: An online survey was distributed by e-mail to members of the Endourologic Society. The survey queried the duration of antimicrobial therapy prior to uncomplicated ureteroscopy (URS) and percutaneous nephrolithotomy (PNL) with negative and asymptomatic positive pre-operative urine cultures. Results: The response rate was 18.5% with 369 responders (40% from U.S., 61% academic and 64% endourology fellowship trained). The majority of respondents reported giving a single perioperative dose in patients with a negative urine culture (71% and 59% prior to URS and PNL; respectively). In patients with positive cultures, there were more heterogeneous responses. In the presence of positive culture prior to URS: 13% preferred single perioperative dose, 29% preferred 1-3 days, 46% preferred 4-7 days and 12% preferred > 7 days of antibiotics before the procedure. In the presence of positive culture prior to PNL: 11% preferred single perioperative dose, 24% preferred 1-3 days, 49% preferred 4-7 days and 16 % preferred > 7 days. There were significant variations in antimicrobial utilization prior to endourological management by geographical location of practice (p < 0.05). Conclusion: There are considerable variations in antimicrobial utilization prior to endourological surgery for urolithiasis worldwide. According to current guidelines, almost one-third of urologists are over-utilizing antibiotics prior to stone management in patients with negative cultures. Well-designed prospective randomized studies are needed to guide appropriate duration of antibiotics in patients with positive cultures before these procedures. Po st e rs

170 Poster #34 DOES INTRAVENOUS ACETAMINOPHEN IMPROVE PERCUTANEOUS NEPHROLITHOTOMY OUTCOMES? Jared Moss, MD, Kyle Basham, MD, Wesley White, MD, Edward Kim, MD, Frederick Klein, MD, Bedford Waters,MD, Ryan Pickens, MD Presented by: Jared Moss, MD

Introduction: Incorporation of non-narcotic analgesic agents such as intravenous acetaminophen into surgical algorithms improves pain scores and decreases opioid requirements. Intravenous acetaminophen has few contraindications and a safe hematologic profile. Percutaneous nephrolithotomy can be a painful procedure, typically requires intravenous narcotics post-operatively, and places patients at risk for acute blood loss. We report our experience with intravenous acetaminophen and outcomes following percutaneous nephrolithotomy. Methods: We began incorporation of intravenous acetaminophen into our percutaneous nephrolithotomy algorithm in July 2013. Currently all patients receive intravenous acetaminophen per manufactures recommendations.We retrospectively compared the first 52 patients to receive intravenous acetaminophen with our previous 52 patients. Data procured includes: stone size, access type, narcotics given postoperatively, narcotic nativity, and length of stay, and patient demographics. Results: Thirty-five percent (18/52) of patients that received intravenous acetaminophen required no oral narcotics compared to only 9% (5/52) who did not receive acetaminophen. Forty-four percent (23/52) of patients that received intravenous acetaminophen did not require any intravenous narcotics post operatively compared to only 17% (9/52) prior to incorporation. Twenty-one percent (11/52) of patients that received intravenous acetaminophen required no narcotics post operatively. Both groups were similar with respect to sex, age, BMI, stone size, type of access, length of stay, and narcotic naivety. No patients experienced hematological complications requiring transfusion or return to operating room. Conclusion: As surgical outcomes continue to play an increasingly important role in modern medicine, physicians may desire analgesic options which are non-narcotic to improve patient outcomes without exposing them to unnecessary risk. In our experience, intravenous acetaminophen appears to be safe and effective at reducing post-operative narcotic consumption for patients undergoing percutaneous nephrolithotomy.

171 Poster #35 UPPER POLE UROLOGIST-OBTAINTED PERCUTANEOUS RENAL ACCESS FOR PCNL IS SAFE AND EFFICACIOUS Amar Patel MD, Don Bui, MD, John Pattaras, MD, Kenneth Ogan, MD Emory University School of Medicine, Atlanta, GA Presented by: Amar Patel, MD

Introduction: Interventional radiologists may be hesitant to obtain upper pole access for percutaneous nephrolithotomy (PCNL) due to a higher complication rate. However, optimal renal access may achieve higher stone-free rates and lower complication rates. We discuss our institution’s contemporary results of percutaneous renal access in the upper pole for nephrolithotomy performed by urologists. We believe that urologist-obtained upper pole access for PCNL is both safe and efficacious.

Methods: A retrospective chart review of PCNL performed by fellowship-trained endourologists was conducted from 2003 to 2014 at a single institution. The inclusion criteria included patients in which renal access was obtained by the urologist via the upper pole for subsequent nephrolithotomy. Variables analyzed included age, gender, BMI, ASA, initial stone size, operative time, rib level, change in hemoglobin (hgb), length of stay (LOS), and post-op complications. Stone-free status was determined by either KUB or CT scan on POD #1. Patients without stones visible on KUB or stones less than 4 mm on CT were considered stone-free. Results: A total of 144 renal units were percutaneously accessed via the upper pole for subsequent nephrolithotomy. Baseline demographics included: mean age of 52.7 years, 51 males/93 females, mean BMI of 29.7, median ASA of 3, mean Hgb change on post-operative day one of -1.8 g/dL, and a median hospital stay of one day. There were a total of 53 (36.8%) stones classified as staghorn calculi, of which 35 (24.3%) were partial staghorn stones. Renal access was obtained above the 11th rib in 12.5% (n=18), above the12th rib in 57.6% (n=83), subcostal in 14.6% (n=21), and undetermined in the rest. There were 15 (10.4%) major (Clavien grade 3 and 4) and eight (5.6%) minor (Clavien grade 1 and 2) complications. Blood transfusions were required in 4 (2.8%) patients. Hydropneumothorax requiring chest tube was seen in eight (4.9%) patients. Postoperative imaging revealed a stone-free rate of 64.6% after one procedure. Second look PCNL was performed in 24.3% of patients. Conclusion: Urologist-obtained upper pole percutaneous renal access for nephrolithotomy has a high success rate with an acceptable complication risk. There is an increased chance of thoracic complications, however, optimal access may decrease other complications and increase stone-free rates. It should be a part of the endourologist’s armamentarium who operates on large complex renal calculi. Po st e rs Funding: None

172 Poster #36 FEASABILITY OF PERCUTANEOUS NEPHROLITHOTOMY IN PATIENTS WITH HEPATIC INSUFFICIENCY Carrie Stewart, MD, Julie Wang, MD, MPH, Michael Maddox, MD, Jonathan Silberstein, MD, Benjamin Lee, MD, FACS, Raju Thomas, MD, FACS, MHA Tulane University School of Medicine Department of Urology (New Orleans, LA, United States) Presented by: Carrie Stewart, MD

Introduction: Patients with liver disease are at increased risk of morbidity often due to malnutrition and coagulopathy. We assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) in patients with hepatitis or cirrhosis. Methods: We retrospectively reviewed our experience with PCNL in patients with hepatic compromise. 10 patients with chronic hepatitis or cirrhosis underwent PCNL at Tulane between 2007 and 2014. All patients were male with an average age of 58.7 years, BMI of 25.7 kg/m2, and MELD score of 10.3 (range six-22). Etiology of liver disease included viral hepatitis (6), alcoholic hepatitis (2), cryptogenic cirrhosis (1), and hepatocellular carcinoma status post chemoembolization (1). Seven patients had confirmed cirrhosis, of whom two were awaiting transplant and one patient had previously received liver transplantation. Percutaneous access was performed on the day of surgery, and three patients required two accesses. Results: All PCNLs were successfully completed. Of the 10 procedures, two patients were transfused with platelets and fresh frozen plasma immediately before the surgery due to thrombocytopenia (<100k). Mean stone size was 1.9 cm and mean estimated blood loss was 169mL with no patient requiring transfusion post-op. Average hospital stay was 1.2 days (range 1−3). One patient with a MELD of 22 was readmitted with hepatic decompensation, and represents the sole complication.Only one patient required an auxiliary ureteroscopy due to inadequate percutaneous access placement. Conclusion: Liver disease does not preclude percutaneous treatment of nephrolithiasis with PCNL. A meticulous preoperative workup to determine the extent of liver dysfunction is instrumental prior to treatment.

173 Poster #37 INCREASED RADIATION EXPOSURE DURING URETEROSCOPY IN THE OBESE PATIENT Fernando Cabrera, MD1, Richard Shin, MD2, Giao Nguyen3, Chu Wang3, Ned Chung3, Charles Scales, MD, MSHS4, Michael Ferrandino, MD2, Glenn Preminger, MD2, Terry Yoshizumi, PhD, MS5 and Michael Lipkin, MD2 1Duke Medical Center; 2Duke Medical Center. Durham, NC; 3Duke Radiation Dosimetry Laboratory, Duke University Medical Center, Durham, NC; 4Duke Medical Center, Duke Clinical Research Institute, NC; 5Division of Radiation Safety, Duke University Medical Center, Durham, NC Presented by: Fernando Cabrera, MD

Introduction: Patients with urolithiasis are at increased risk of significant radiation exposure. We determined the effect of obesity on radiation exposure during simulated ureteroscopy (URS). Methods: A validated anthropomorphic adult male phantom with a Body Mass Index (BMI) of approximately 24 kg/m2, was positioned to simulate URS. Padding with radiographic characteristics of human fat was placed around the phantom to create an obese model with BMI of 30 kg/m2. Metal oxide semiconductor field effect transistor dosimeters were placed at 20 organ locations in both models to measure organ dosages. A portable C-arm was used to provide continuous fluoroscopy to simulate URS. Organ dose rates were calculated by dividing organ dose by fluoroscopy time. Effective dose rate (EDR, mSv/sec) was calculated as the sum of organ dose rates multiplied by a tissue weighting factor (ICRPP). Results: The mean effective dose rates were higher for the obese model compared with the non-obese model. The mean EDR during left URS was significantly increased in the obese model at 0.0092 ± .0004 mSv/sec compared to 0.0041 ± 0.0003 mSv/sec in the non-obese model (p = 0.006). The mean EDR during right sided URS was 0.0087 ± 0.0044 and 0.0036 ± 0.0003 mSv/sec in the obese and non-obese model, respectively (p = 0.180). Conclusion: Fluoroscopy during URS contributes to overall radiation dose. Obese patients are at even higher risk due to increased exposure during fluoroscopy. Efforts should be made to minimize the amount of fluoroscopy used during URS, especially in obese patients. Source of Funding: none Po st e rs

174 Poster #38 THE EFFECT OF DRINKING WATER SOURCE ON KIDNEY STONE RISK FACTORS Matthew D. Lyons, MD, E. Sophie Spencer, MD, Peter S. Greene, MD, Jonathan E. Matthews, MPH, Davis P. Viprakasit,MD University of North Carolina, Chapel Hill, NC Presented by: Davis P. Viprakasit, MD

Introduction: Increased water intake is a well-recognized therapeutic measure for kidney stone prevention. However, there is no consensus regarding the effects of water quality and its constituents on kidney stone risks. We sought to characterize the changes in urine and stone composition based on different sources of drinking water in a pilot study of kidney stone patients presenting to a tertiary referral state hospital. Methods: We prospectively reviewed patients with a kidney stone diagnosis presenting to the urology clinic. Participating patients completed a self-reported questionnaire detailing their fluid intake and drinking water source including city, well, and bottled water. Demographic data and prior urine and stone evaluations were compared based on type of fluid source using appropriate statistical measures. Patients with a known systemic cause for stone disease or associated medication were excluded from the study. Results: Of 149 patients, the median age was 53 years (range 18−79) and 45% were male. Recurrent stone formers comprised 75% of the cohort. Seventy-three percent of patients had documented stone analysis and 57% had a 24-hour urine study. Patients that utilized well water lived at their residence longer (median 13 vs. 8 years) than those with city water (p=0.02). Stone analysis did not differ significantly based on water source. Median urine volume was higher in patients with city water compared to well or bottled water (2.2 liters vs. 1.7 and 1.6, p=0.005). Urinary ammonia trended towards higher values in patients with city water, particularly those living in their homes at least five years. Urinary phosphorus levels were higher in patients drinking primarily well water who lived in their residences for over five and 10 years. Patients with city water had higher urinary oxalate and potassium levels. Use of a filtration system did not significantly change findings between city and well water drinkers. Conclusion: Water intake is an important modifiable method for kidney stone prevention. In this pilot study, however, we noted changes in kidney stone risk factors based on different sources of water intake. The clinical significance of these findings remains unclear but warrants further study.

175 Poster #39 SAFETY AND EFFICACY OF URETERAL STENT PLACEMENT AT THE BEDSIDE UNDER LOCAL ANESTHESIA Paymon Nourparvar, MD, Andrew Leung, BS, Adam Shrewsberry, MD, Aaron Weiss, MD, Salil Gabale, MD, Kenneth Carney, MD, Kenneth Ogan, MD, Viraj Master, MD Emory University, Atlanta, GA Presented by: Paymon Nourparvar, MD

Introduction: Ureteral stent placement for decompressing renal units obstructed by calculi is safe, and can be potentially lifesaving in the prompt resolution of the sequelae of renal obstruction, infection and an obstructing stone. Anecdotally, urologists trained outside the U.S. report that stents are often times placed without fluoroscopic guidance. At many institutions, there can be prolonged delay in getting patients to the operating room for stent placement. We hypothesized that it is both safe and efficacious to attempt ureteral stent placement under local anesthesia at the bedside without live fluoroscopic guidance. Methods: Patients presenting with symptomatic, obstructing ureteral calculi at our institution were given the option of bedside ureteral stent placement. Viscous lidocaine was placed into the urethra prior to cystoscopic examination. A 260- cm Bentson or Glidewire was used as initial access, with only 1 attempt at passage, using a flexible cystoscope. All stent placements were confirmed with immediate post-procedure KUB. There were no specific inclusion criteria. Patients presenting with signs of systemic infection were excluded from the study. Prospectively collected data were retrospectively analyzed on all patients who had an attempted bedside ureteral stent placement. Results: Forty-two patients underwent attempted bedside stent placement under local anesthesia without fluoroscopic guidance. Mean stone size was 8.33−mm and 59% of stones were in the proximal ureter. Ureteral stent placement was pursued in 18.2% of patients for infection and in 75.8% of patients for intractable pain. Thirty patients (71.4%) underwent successful ureteral stent placement. Of the 12 unsuccessful attempts, nine were secondary to impacted stones. Two of the failed attempts resulted from premature stent deployment in the proximal ureter and were immediately identified on the KUB. No cases were terminated secondary to patient discomfort. Statistical analysis did not reveal any significant predictors of successful stent placement in this cohort of patients. Conclusion: In our cohort, bedside ureteral stent placement was well tolerated, safe, and efficacious, expediting upper tract decompression in the setting of obstructed and potentially infected renal units in greater than 70% of patients. Further study is required, including confirmation of safety at other institutions. If safety is reproducible, this approach may be of significant value. Funding: None Po st e rs

176 Poster #40 LAPAROSCOPIC AND ROBOTIC CALYCEAL DIVERTICULECTOMY: OUTCOMES AND MODIFICATIONS OF TECHNIQUE Abby Taylor, MD1 and David Thiel, MD2 1Mayo Clinic Florida, Department of Urology, Jacksonville, FL; 2Mayo Clinic Florida, Jacksonville, FL Presented by: Abby Taylor, MD

Introduction: To examine the technique and outcomes of robotic and laparoscopic calyceal diverticulectomy in the management of symptomatic calyceal diverticulum at a single center. Methods: Perioperative outcomes of six minimally invasive calyceal diverticulectomies (four laparoscopic and two robotic) between March 2011 and May 2014 were analyzed. Postoperative complications were catergorized by Clavien−Dindo grade. Results: Median age of the cohort was 35 years (24-51 years), mean BMI was 24 and no patient had a BMI > 30. All six patients were female, and all presented with ipsilateral flank pain, while 3/6 had coexisting recurrent urinary tract infections attributed to the calyceal diverticulum. Five of six patients had failed prior surgical intervention, with either endoscopic intervention or extracorporeal shock wave lithotripsy (SWL). In all cases, intraoperative ultrasound was utilized and hilar dissection was performed, with hilar clamping performed in two of six cases, with a mean warm ischemia time (WIT) of 12 minutes (10 and 14 minutes). Mean operative time was 162 minutes (121-270 minutes), with no intraoperative complications. Mean blood loss was 150mL (50−300mL), with no blood transfusions. There was one Clavien Grade 1 complication of a urine leak and no major (Clavien Grade 3 or higher) complications. Mean hospital stay was two days (one-to-four days), mean decrease in hemoglobin preoperatively to post operative day 1 was 2.3 (0.4-5.8) and creatinine remained the same from preoperatively to post operative day one in all cases. Four of six patients were seen in follow-up and all had complete resolution of flank pain, urinary tract infections, and with no residual stones on imaging. Conclusion: Multiple treatment modalities, including ureteroscopy, shock wave lithotripsy, percutaneous interventions, are commonly used as first line intervention for symptomatic calyceal diverticula, with laparoscopic techniques commonly reserved for failed interventions. As lower success rates are seen with the previously mentioned interventions, laparoscopic and robotic calyceal diverticulectomy should be considered as a first line intervention for symptomatic calyceal diverticulum. This modality is a safe, effective treatment option for symptomatic calyceal diverticulum.

177 Poster #41 BALL-TIP HOLMIUM LASER FIBER MAY REDUCE FLEXIBLE URETEROSCOPE DAMAGE Anika Ackerman, MD1, Richard Shin, MD1, Fernando Cabrera, MD1, Zachariah Goldsmith, MD1, Nicholas Kuntz, MD1, Ramy Youssef, MD2, Andreas Neisius, MD3, Charles Scales, MD, MSHA4, Michael Ferrandino, MD1, Pei Zhong, PhD5, Glenn Preminger, MD1 and Michael Lipkin, MD1 1Division of Urologic Surgery, Duke University Medical Center, Durham, NC; 2Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Urologic Surgery, University of California, Irvine, Orange, CA; 3Department of Urology, University Medical Center Mainz, Mainz, Germany; 4Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC; 5Division of Urologic Surgery, Duke University Medical Center, Durham, NC and Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC Presented by: Anika Ackerman, MD

Introduction: Holmium laser fiber passage can damage the working channel of a ureteroscope. A recently released ball-tip laser fiber (TracTip-Boston Scientific) is designed to reduce scope trauma. We compared ureteroscope deflection and insertion forces of this ball-tip to a standard laser fiber. Methods: Ureteroscope deflection was measured using a 200 micron ball-tip (BT) and standard fiber (SF) (Flexiva − Boston Scientific) in three flexible ureteroscopes (URF-P5, URF-P6, URF−V − Olympus). Deflection angle was measured using AutoCAD software. Fiber insertion force was measured ina ureteroscope sheath model positioned in a 270° curve. The BT and SF fibers were advanced using a stage controller and a strain gauge measured force. ANOVA test was used to compare multiple groups and t-test with Bonferroni correction was used for intergroup comparison. Results: Both fibers caused equivalent reduction (10−30°) in ureteroscope deflection without statistical difference. Four virgin fibers and ureteroscope sheaths were used to test insertion force of each fiber. Maximum and mean insertion force for the SF was 998 ±394 mN and 603 ±163 mN, respectively. The BT insertion forces were significantly less, at 304 ±31 mN maximum (p = 0.04) and 213 ±31 mN mean (p = 0.03). One SF fiber caused significant damage to the sheath and could not be advanced completely. Conclusion: The ball-tip fiber has markedly reduced insertion force in a deflected ureteroscope without compromising maneuverability compared to a standard laser fiber. Minimal investment in the ball-tip fiber may result in cost savings by increasing ureteroscope longevity. Industry grant: BSC Po st e rs

178 Poster #42 BALL-TIP HOLMIUM LASER FIBER: IN VITRO STONE COMMINUTION AND FIBER TIP DEGRADATION Adam Kaplan, MD1, Adam Kaplan, MD2, Richard Shin, MD2, Jaclyn Lautz, PHD3, Fernando Cabrera, MD2, Zachariah Goldsmith, MD, PHD2, Nicholas Kuntz, MD2, Andreas Neisius, MD4, Charles Scales, MD, MSHS5, Michael Ferrandino, MD2, Glenn Preminger, MD2 and Michael Lipkin, MD2 1Duke Medical Center. Durham, NC; 2Duke Medical Center−Durham, NC; 3Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC; 4Department of Urology, University Medical Center Mainz (Germany); 5Duke Medical Center, Duke Clinical Research Institute-Durham, NC Presented by: Adam Kaplan

Introduction: Advancing a holmium laser fiber through a ureteroscope can damage the working channel. A ball-tip holmium laser fiber (TracTip-Boston Scientific) was designed to atraumatically pass through a deflected ureteroscope. We evaluated the stone comminution capabilities and tip degradation of this fiber. Methods: A 200-micron ball-tip (BT) fiber and standard fiber (SF) (Flexiva-Boston Scientific) were compared by delivering 4 kJ of energy to a Begostone over a constant surface area controlled by a 3D positioning system. Laser settings were 0.2J/50Hz, 0.6J/6Hz, 0.8J/8Hz, and 1J/10Hz. Tip degradation was concurrently measured. Fiber-stone contact was adjusted every 1 kJ to account for any loss in length. ANOVA or Kruskal Wallace test was used for multiple groups, and post hoc tests with Bonferroni correction were then applied (t-test, Wilcoxon). Results: Five virgin fibers were used to test each condition. Tip degradation trended with pulse energy for the SF but not the BT fiber. At 0.8J/8Hz and 1J/10Hz, SF degradation was greater than the BT fiber but the difference was not significant. Comminution was found to increase with pulse energy for both BT and SF fibers up to the 0.8J/8Hz setting (p < 0.003). No significant differences were found between BT and SF fibers at any energy setting. Conclusion: The ball-tip fiber exhibits similar comminution efficiency to a standard fiber. The new tip design shows minimal tip degradation at clinically relevant laser settings in our in vitro model. Financial Funding: Boston Scientific

179 Poster #43 IDEAL MODALITY OF TREATMENT FOR UROLITHIASIS IN PELVIC KIDNEYS: ROBOT PYELOLITHOTOMY WITH FLEXIBLE NEPHROSCOPY Michael Maddox, MD, Anthony Tracey, MD, MPH, Katie Powers, MD, Benjamin Lee, MD, Raju Thomas, MD, MHA Tulane University, New Orleans, LA Presented by: Michael Maddox, MD

Introduction: Pelvic kidneys present a unique challenge for the treating urologist in the setting of large burden urolithiasis. Traditional methods of management such as PCNL, ESWL, and even ureteroscopy may be impossible due to the location of the kidney/calculi and the anatomic limitations associated with pelvic kidneys and the treatments modalities. Methods: Seven patients between 8/2012 and 6/2014 were diagnosed with urolithiasis in anomalous pelvic kidneys, and underwent eight DaVinci robotic pyelolithotomy to treat the patient’s stone disease (one patient underwent a staged bilateral procedure). Trocar configuration was similar to that used in traditional robotic radical prostatectomy witha slight cephalad displacement. Two patients were started in a modified lateral position so as to provide the optimal approach to the calculi. Five of seven patients (71.4%) required intraoperative flexible nephroscopy with stone basketing through an assistant trocar site in order to clear stones in remote, dependent calyces. All patients were approached with a pyelotomy incision to access the renal pelvis and the calyceal stones. Results: The stone sizes ranged from 2 cm to 3.3 cm, with a mean stone diameter of 2.6 cm. All patients were rendered stone free. The average robotic console time was 126 minutes. The flexible nephroscopy time averaged 28 minutes. All patients were left with a jp drain for one week post-operatively, and there were no peri-operative complications noted. Conclusion: Because of the anomalous renal location and limitations associated with traditional urolithiasis treatment modalities, robotic pyelotomy with removal of renal pelvic and calyceal calculi is a reliable option for stone management in pelvic kidneys.

Po st e rs

180 Poster #44 NARCOTIC USE AND POSTOPERATIVE “DOCTOR SHOPPING”AMONG PATIENTS WITH NEPHROLITHIASIS REQUIRING OPERATIVE MANAGEMENT Stephen Kappa, MD, MBA1, Elizabeth Green, BS2, Nicole Miller, MD1, Duke Herrell, MD1, Christopher Mitchell, MD1, Hassan Mir, MD, MBA3 and Matthew Resnick, MD, MPH1 1Vanderbilt Department of Urologic Surgery, Nashville, TN; 2Vanderbilt University School of Medicine, Nashville, TN; 3Vanderbilt Orthopaedic Institute, Nashville, TN Presented by: Stephen Kappa, MD, MBA

Introduction: Nonmedical narcotic use poses a challenging public health problem for physicians and policymakers alike. This study sought to determine perioperative patterns of narcotic use and the prevalence of postoperative “doctor shopping” among patients with nephrolithiasis requiring operative management.

Methods: Retrospective review of consecutive patients residing in the state of Tennessee requiring ureteroscopy with holmium laser lithotripsy (URS/HLL) for nephrolithiasis at a single institution from January 2013-December 2013 was performed. Demographic and clinical characteristics were abstracted from the medical record, and linked to narcotic prescription data, obtained from the Tennessee Controlled Substances Medication Database. We evaluated perioperative narcotic use, including the six months before and 3 months after surgery. Patients were categorized by number of postoperative narcotic providers, and “doctor shopping” behavior was identified as any patient seeking multiple narcotic providers within three months of surgery. We identified demographic and clinical characteristics associated with “doctor shopping” behavior using appropriate bivariate parametric and non- parametric statistical testing. Results: A total of 200 eligible patients underwent URS/HLL for nephrolithiasis during the study period. Forty-eight (24%) patients were prescribed narcotics by more than one provider after surgery. Compared to those receiving narcotics from a single provider, patients with multiple narcotic providers were younger (48.1 vs. 54.2 years, p<0.001), less educated (83.3% vs. 58.7% high school education or less, p=0.014), were more likely to have a psychiatric history (37.5% vs. 16%, p<0.01) and were more likely to have had prior stone procedures (66% vs. 42%, p<0.01). Additionally, these patients were also more likely to use narcotics preoperatively (87.5% vs. 63.2%, p<0.001), required longer duration of postoperative narcotic use (39.1 vs. 6.0 days, p<0.001) and required higher average daily morphine equivalent dose (MED) per prescription (44.7 vs. 35.2 MED/day, p<0.001). Conclusion: Postoperative “doctor shopping” is common among patients with nephrolithiasis requiring operative management. Urologists should be acutely aware of this problem, and must use available registry data to reduce the likelihood of redundant narcotic prescribing.

181 Poster #45 ANALYSIS OF COMMERCIAL O. FORMIGENES KIDNEY STONE PROBIOTIC SUPPLEMEN Melissa Ellis, John Knight, Dean Assimos and Win Shun Lai Birmingham, Alabama Presented By: Win Shun Lai

Introduction: Oxalobacter formigenes (OF) is a non-pathogenic, Gram-negative, obligate anaerobic bacterium that commonly inhabits the human gut and degrades oxalate as its major energy and carbon source. A large case controlled study recently showed that the odds ratio for forming a recurrent stone when colonized with O. formigenes was 0.3; i.e., a 70% reduction in stone risk. The objective of this study was to determine the OF content and the oxalate degrading capacity of two commercial probiotic supplements. Methods: Capsules of Oxalo™ were purchased from Sanzyme Ltd, in Hyderabad, India, and a “kidney stone probiotic” supplement was purchased from ™PRO Lab, Ltd, Toronto, Canada. Probiotic preparations were cultured in a variety of rich media and OF selective medium B1 containing oxalate. Culture medium oxalate was measured by ion chromatography (IC). PCR analysis and sequencing was used to examine the preparations for both OF and other species of bacteria. Results: Measurement of culture media oxalate showed no loss of oxalate in any cultures of either probiotic preparation. 6S rRNA gene sequencing revealed the predominate organism in TMPRO Lab supplement was Lactococcus lactis. Sequencing of the Oxalo™ product revealed a number of bacterial species including Lactobacillus plantarum, and four Bacillus species. None of these bacterial species are known to degrade oxalate significantly in culture. When the DNA from both probiotics was exposed to oxalate decarboxylase OF specific primers, there was no no amplification demonstrated. Conclusion: Culture and PCR methods indicate the two commercial probiotic supplements, TMPRO Lab and OxaloTM, do not contain O. formigenes or other oxalate-degrading organisms. It is our belief that these probiotic supplements will be of little or no benefit to calcium oxalate kidney stone patients. Po st e rs

182 Poster #46 IN VIVO CHARACTERIZATION AND LOCALIZATION OF PROSTATE CANCER WITH 3D ACOUSTIC RADIATION FORCE IMPULSE ELASTICITY IMAGING: CORRELATION WITH WHOLE MOUNT HISTOPATHOLOGY AND MRI CAPSULAR DIMENSIONS Melissa Mendez, MD1, Mark Palmeri, PhD2, Zachary Miller2, Tyler Glass2, Stephen Rosenzweig2, Andrew Buck, MD3, John Madden, MD3, Thomas Polascik, MD1 and Kathryn Nightingale, PhD2 1Division of Urology, Duke Cancer Institute, Durham, NC; 2Duke Biomedical and Engineering; 3Duke Medical School, Department of Pathology Presented by: Melissa Mendez, MD

Introduction: Novel imaging systems are evolving that may allow for real-time characterization and spatial localization of high grade prostate cancer [PCa]. In this study, Acoustic Radiation Force Impulse Imaging [ARFI] was evaluated for its ability to localize high or low grade disease, compared to whole mount histology. We also sought to examine ARFI’s ability to evaluate whole gland [WG] volumes as compared to 3T T2-Weighted MR Imaging [MR T2W]. Methods: Twenty-nine men with biopsy confirmed PCa underwent ARFI imaging using a Siemens Acuson SC2000 scanner with an ER7B side-fire probe prior to radical prostatectomy. A 3D ARFI prostate volume was acquired. The extirpated prostate was sectioned, stained, and inked for PCa using whole mount pathology. ARFI images were reviewed blinded to histopathology, areas suspicious for PCa [ROIs] were identified, and assigned an index of suspicion based on a three-point scale. The approximate centers of the ARFI ROIs and histopathology lesions were mapped to a standardized 27-region anatomic grid, and correlated using a nearest neighbor approach. Pathologic tumors were stratified into four categories: posterior/anterior aggressive and posterior/anterior indolent disease. Indolent cancer was defined as having a volume < 0.5 cm3 and a Gleason grade of 3, whereas aggressive cancer had a volume > 0.5 cm3 and/or a Gleason grade greater than 3. In a subset of 16 patients, utilizing the prostate capsule dimensions, WG volumes measured by ARFI were compared to those found with MR T2W. Results: A total of 49 cancers were pathologically identified. ARFI identified 29 ROIs, and 27 of these ROIs [PPV: 93.1%, 27/29] correlated with histopathology. ARFI was more sensitive to posterior lesions [Overall: 65%, 26/40; Aggressive disease: 74%, 23/31; Indolent disease: 33%, 3/9] than anterior lesions [Overall: 11%, 1/9; Aggressive Disease: 14%, 1/7; Indolent Disease: none]. Volumetric analysis revealed well correlated WG volumes [R2= 0.77]. AFRI WG volumes were larger [16.82% ±22.45%] than those of MR T2W due to over estimation of the lateral capsular dimension [18.4%±13.9%] with less significant differences in the other dimensions [7.4%±17.6%, anterior-to-posterior, and −10.8%±13.9%, apex-to-base]. Conclusion: ARFI consistently identified pathologically aggressive cancers more commonly than indolent lesions and its WG volumetric measures were well correlated with those of MR T2W. ARFI’s high PPV coupled with its sensitivity toward aggressive disease offers a promising low-cost, portable, real-time imaging modality in both diagnostic targeted biopsy and focal, image-guided therapy. This work was supported by NIH grant R01CA142824 and a Duke-Coulter Translational Grant

183 Poster #47 PATHOLOGIC GLEASON 8-10: DO ALL MEN DO POORLY? RESULTS FROM THE SEARCH DATABASE Sean Fischer1, Ross Simon, MD2,3, Lauren Howard, MS2,4, William Aronson, MD5,6, Martha Terris, MD7,8, Christopher Kane, MD9, Christopher Amling, MD10, Matt Cooperberg, MD11,12,13, Stephen Freedland, MD2,3 and Adriana Vidal, PhD2 1Duke Prostate Center, Division of Urological Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA; 2Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; 33Urology Section, Veterans Affairs Medical Center, Durham, NC; 4Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; 5Urology Section, Department of Surgery, Veterans Affairs Medical Center of Greater Los Angeles, Los Angeles, CA; 6Department of Urology, University of California at Los Angeles Medical Center, Los Angeles, CA; 7Urology Section, Division of Surgery, Veterans Affairs Medical Center, Augusta, GA; 8Division of Urologic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA; 9Division of Urology, Department of Surgery, University of California at San Diego Medical Center, San Diego, CA; 10Department of Urology, Oregon Health and Science University, Portland, OR; 11Department of Urology, University of California at San Francisco, San Francisco, CA; 12Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA; 13Urology Section, Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA Presented by: Sean Fischer

Introduction: Pathologic Gleason 8-10 is associated with high risk of biochemical recurrence (BCR). However, whether there are subsets of men with Gleason 8-10 who have particularly high or low BCR risk is unknown. We examined predictors for early BCR (two years) after radical prostatectomy (RP), among patients with pathological Gleason 8-10. Methods: We identified 459 patients treated with RP with pathologic Gleason 8-10 in the SEARCH database. Patients were stratified into 5 groups based on pathological characteristics – Group 1: men with negative surgical margins and no extracapsular extension (−SM/−ECE), Group 2 (+SM/−ECE), Group 3 (−SM/+ECE), Group 4 (+SM/+ECE), and Group 5: men with seminal vesicle invasion (+SVI). BCR was defined as a single PSA greater than 0.2 ng/ml, two values of 0.2 ng/ml, or secondary treatment for an elevated postoperative PSA. Cox proportional hazard models were used to compare early BCR (two-years post-RP) among groups and a log-rank test was used to assess the difference between survival curves by group. Results: At two-years years post-RP, patients in Group 5 (+SVI) had the highest BCR risk (66%) whereas men in Group 1 (−SM/−ECE) had the lowest risk (14%, p<0.001). No Po st e rs significant difference in recurrence among groups 2 to 4 (~50% recurrence, log-rank, p=0.28) was found. On multivariable analysis after adjusting for PSA, age, pathological Gleason sum, and clinical stage; Group 5 had the highest recurrence risk, Groups 2-4 were at intermediate- risk with no differences among the groups, and Group 1 had the lowest risk of recurrence. Conclusion: In patients with high grade (Gleason 8-10) prostate cancer after RP, the presence of surgical margins, extracapsular extension, both surgical margins and extracapsular extension, and seminal vesicle invasion are all associated with an increased risk of early BCR. While patients with seminal vesicle invasion are at the highest risk of recurrence, the presence of any of these pathological features among patients with Gleason 8-10 may warrant adjuvant radiation. On the contrary, men with organ-confined margin negative disease have a very low risk of early BCR despite Gleason 8-10 disease.

184 Poster #48 CAN GLEASON 7 PROSTATE CANCER EVER BE LOW-RISK? RESULTS FROM THE SHARED EQUAL ACCESS REGIONAL CANCER HOSPITAL (SEARCH) DATABASE Kathleen McGinley, DO1, Xizi Sun, BS1,2, Lauren Howard, MS1,2, William Aronson, MD3,4, Martha Terris, MD5,6, Christopher Kane, MD7, Christopher Amling, MD8, Matthew Cooperberg, MD, MPH9 and Stephen Freedland, MD1,2 1Duke University, Durham, NC; 2Veterans Affairs Medical Center, Durham, NC; 3Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; 4UCLA School of Medicine, Los Angeles, CA; 5Veterans Affairs Medical Center, Augusta, GA; 6Georgia Regents University, Augusta, GA; 7University of California San Diego Health System, San Diego, CA; 8Oregon Health Sciences University, Portland, OR; 9UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA Presented by: Kathleen McGinley, DO

Introduction: Overtreatment of low-risk prostate cancer (PC) is a major problem. Increasing use of active surveillance (AS) will minimize this burden. Limited data are available on including men with intermediate risk PC (i.e. Gleason 7) into AS protocols. We examined if a subset of men with Gleason 7 (3+4) PC could be reasonable AS candidates. Methods: We used the SEARCH database to identify men undergoing radical prostatectomy from 2001-13 with >8 cores on prostate biopsy and complete demographic, pathological, and follow-up data. We compared men who fulfilled low-risk disease criteria (clinical stage T1c/T2a; biopsy Gleason ≤6; PSA ≤10 ng/mL) with the exception of biopsy Gleason 7 (3+4) vs. men who met all three low-risk criteria. Uni- and multivariable logistic regression models were used to test the association between biopsy Gleason 3+4 vs. ≤6 and pathological features. Biochemical recurrence (BCR) was examined using multivariable Cox hazards analysis adjusted for clinical and demographic features. To examine whether there was a subset of men with low-volume Gleason 7 who would have comparable outcomes to low-risk men, we repeated all analyses limiting the percentage positive cores to ≤ 33% and positive cores to ≤ 4, ≤ 3, or ≤ 2. Results: 885 men met study inclusion criteria, of which 505 had low-risk disease and 380 had Gleason 7 low-risk disease. Overall, the Gleason 7 low-risk group had increased risk of pathological Gleason ≥4+3 (p<0.001), positive margins (p=0.069), extracapsular extension (p<0.001), and seminal vesicle invasion (p<0.001) on univariable analysis. Men in the Gleason 7 low-risk group had significantly higher BCR risk (HR 1.65, p=0.004). Analyses were then repeated using increasingly strict definitions of low-volume disease. With the exception of higher pathological Gleason score (p<0.001), at ≤3 positive cores, there was no difference in adverse pathological features between groups (all p>0.1). Among men with ≤3 positive cores who met the other low-risk criteria (clinical stage T1c/T2a; PSA ≤10 ng/mL), BCR risk was similar in men with Gleason 6 or Gleason 7 (3+4) (HR 1.30; p=0.347) disease. Conclusion: Among men with PSA≤10 ng/mL and clinical stage T1c/T2a, those with Gleason 7 (3+4) PC in ≤3 positive cores have similar rates of adverse pathology and BCR as men with Gleason ≤6 disease. This finding, if confirmed in additional cohorts, may expand the inclusion criteria of AS protocols to further reduce PC overtreatment. External Funding: None

185 Poster #49 C-JUN NH2-TERMINAL KINASE−INDUCED PROTEASOMAL DEGRADATION OF C-FLIPL/S AND BCL2 SENSITIZE PROSTATE CANCER CELLS TO FAS- AND MITOCHONDRIA-MEDIATED APOPTOSIS BY TETRANDRINE. Pankaj Chaudhary, PhD, Jamboor Vishwanatha, PhD University of North Texas Health Science Center, Fort Worth, TX Presented by: Pankaj Chaudhary, PhD

Introduction: Tetrandrine, isolated from the root of Stephania tetrandra, is used in traditional Chinese medicine as an anti-rheumatic, anti-inflammatory, and anti-hypertensive agent for the past several years. During recent years, increasing number of studies have focused on the potential of tetrandrine in cancer therapy. Despite its great potential as an anti-cancer agent, the effect of tetrandrine in prostate cancer has not been studied. Therefore, in the present study, we demonstrate the cytotoxic efficacy of tetrandrine in human androgen- independent prostate cancer cells and delineate the mechanism of this effect. Methods: Prostate cancer cell lines, PC3 and DU145, and normal prostate PWR-1E cells were cultured in ATCC recommended medium. The toxicity of tetrandrine was analyzed by MTT and YO-PRO-1 assay. Western blotting was used to detect the expression of proteins involved in apoptosis. Results: Our results indicate that tetrandrine selectively inhibits the growth of PC3 and DU145 cancer cells compared to normal prostate PWR-1E cells. Tetrandrine-induced cell death in prostate cancer cells is caused by reactive oxygen species (ROS)-mediated activation of c-Jun NH2-terminal kinase (JNK1/2). JNK1/2-mediated proteasomal degradation of c-FLIPL/S and Bcl2 proteins are key events in the sensitization of prostate cancer cells to Fas- and mitochondria-mediated apoptosis by tetrandrine. Tetrandrine-induced JNK1/2 activation caused the translocation of Bax to mitochondria by disrupting its association with Bcl2 which was accompanied by collapse of mitochondrial membrane potential (MMP), cytosolic release of cytochrome c and Smac, and apoptotic cell death. Additionally, tetrandrine-induced JNK1/2 activation increased the phosphorylation of Bcl2 at Ser70 and facilitated its degradation via the ubiquitin-mediated proteasomal pathway. In parallel, tetrandrine-mediated ROS generation also caused the induction of ligand-independent Fas- mediated apoptosis by activating procaspase-8 and Bid cleavage. Inhibition of procaspase-8 activation attenuated the cleavage of Bid, loss of MMP and caspase-3 activation suggest that tetrandrine-induced Fas−mediated apoptosis is associated with the mitochondrial pathway. Furthermore, most of the signaling effects of tetrandrine on apoptosis were attenuated in the presence of antioxidant N-acetyl-L-cysteine, thereby confirming the involvement of ROS in these events. Conclusion: Our results demonstrated that tetrandrine-induced apoptosis in prostate cancer Po st e rs cells is initiated by ROS generation and that both intrinsic and extrinsic pathway contributes to cell death. Funding: This work was supported by National Institutes of Health Grant 1P20 MD006882.

186 Poster #50 THE PREVALENCE OF PROSTATE BIOPSY GLEASON SCORE ≥ 7(3+4) EXCEEDS 40% IN YOUNG PUERTO RICAN MEN SCREENED FOR PROSTATE CANCER: A CASE FOR EARLY DETECTION BEFORE AGE 55 IN OUR POPULATION Patricia Maymi, BS, Ricardo Sanchez-Ortiz, MD Robotic Urology and Oncology Institute, San Juan PR Presented by: Patricia Maymi, BS

Introduction: While in U.S. Census data only 8% of Puerto Ricans (PR) self-identified as “black or African American (AA),” genomic admixture studies show that average West African ancestry gene values in PR range between 17 and 32%. These data, and the known association between aggressive prostate CaP cancer in AA men may help explain the higher observed CaP mortality in PR. Our goal was to evaluate the pathologic features of young PR men diagnosed through PSA screening to ascertain whether this population should be deemed high-risk and targeted for screening from age 40. Methods: Our CaP database was queried for men who diagnosed with asymptomatic CaP through PSA screening before age 55. Clinical variables were compared to men age 55 and older. All slides were reviewed by a pathologist trained at an NCCN-designated cancer center. Statistical analysis was performed with SPSS. Results: Of 606 patients, 183 men were identified age<55 years (yrs.) (mean: 49.7 years, range 38 to 54). Mean serum PSA was 5.7 ng/ml, percent clinical stage T1c: 79.7%, and mean prostate size was 42.7 cc (range: 16.5 to 180). Patients had undergone prostate biopsy with a mean number of 11.7 cores and a mean number of 2.97 positive cores (range 1 to 14). On biopsy, 43.1% (79/183) of men had evidence of Gleason score ≥7(3+4). Patients younger than 55 (Y) were more likely to have a first-degree relative with CaP than older men (28% Y vs. 19.4%, p<0.01) but less likely to have smoked (22.8% Y vs. 33.3%, p< 0.02), have diabetes (9.4% Y vs. 19.6%, p <0.01), hypertension (34.8% Y vs. 58.7%, p< 0.01), a higher clinical stage (T1c 79.7% Y vs. 71.2%, p<0.03), or have Gleason score ≥7 on biopsy (43.1% Y vs. 56.4%, p<0.02). There were no significant differences between young and older men with regards to serum PSA value (5.7 ng/ml Y vs. 6.1 ng/ml), longest tumor length in any core per side (4.3 mm Y vs. 4.5 mm), total sum of tumor length per side (8.9 mm Y vs. 8.5 mm), percent positive cores (26.3% Y vs. 27.1%), or BMI (28.5 Y vs. 28.2). Conclusion: In this series of PR men found to have CaP through early detection, patients <55 yrs. exhibited a 43% risk of harboring Gleason score ≥ 7(3+4) on biopsy. Furthermore, despite a lower prevalence of palpable disease than older patients, younger men exhibited no difference with regards to serum PSA, longest tumor length, total tumor sum in millimeters, and percent positive biopsies, traditional surrogates for tumor volume. These data support the concept that, similar to AA patients, discussions regarding early detection in Puerto Rican men should begin at age 40.

187 Poster #51 THE EFFECT OF NSAID USE ON DISEASE PROGRESSION IN PATIENTS ON ACTIVE SURVEILLANCE FOR PROSTATE CANCER Joseph Spuches, BS1, Gautum Agarwal, MD2, Adam Luchey, MD2, Trushar Patel, MD1 and Julio Pow-Sang, MD2 1University of South Florida, Tampa, FL; 2H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Gautum Agarwal, MD

Introduction: Up to 50% of patients with low risk prostate cancer (CaP) on an active surveillance (AS) protocol will have disease progression. There is a growing body of literature demonstrating that nonsteroidal anti-inflammatory drugs (NSAIDS) can be utilized in the prevention and treatment of different malignancies. We investigated the relationship of NSAID use on disease progression in AS patients. Methods: We reviewed the Institutional Review Board approved Moffitt Cancer Center Oncology database for patients enrolled in an AS protocol for prostate cancer from 1994−2000. Inclusion criteria for AS included: < cT2a disease, PSA < 10 ng/ml, <50% of single core involvement, and gleason score < 7, as well as sufficient follow-up for evaluation (at least 1 subsequent transrectal ultrasound guided biopsy after initial diagnosis). The medication lists for all patients were thoroughly investigated for NSAID use. Progression was estimated with patients stratified by NSAID use using the Kaplan-Meier method. Results: There were 102 patients that met the inclusion criteria with median age of 70 years (IQR 68-73) with a median follow up of 9.25 years (IQR 6.1-12.2). The median time to progression was 4.7 years (IQR 2.8-7.9). Among the 102 patients, 51 (50%) were found to be NSAID users. There were no significant differences between the two groups on univariate analysis with respect to the median values for Age, PSA velocity, PSA doubling time, Gleason score, and follow up time. However, the non NSAID users were found to have higher median initial PSA, PSA density and lower body mass index. On multivariate analysis using binary logistic regression models taking into account NSAID use, initial PSA, age, PSA velocity, PSA doubling time, PSA density, and BMI; only NSAID use was significantly associated with stability of disease (OR 14.4, p=0.027). Conclusion: NSAID use was found to be associated with stability of disease on long-term follow up in patients on AS for prostate cancer. This is consistent with previous studies suggesting antineoplastic properties of NSAID use. Further prospective trials of NSAID use for the prevention and treatment of prostate cancer are warranted. Po st e rs

188 Poster #52 PRIOR GNRH AGONIST OVERUSE AND CONTEMPORARY QUALITY OF PROSTATE CANCER CARE Shellie Ellis, PhD1, Matthew Nielsen, MD2, George Jackson, PhD3, Morris Weinberger, PhD2, Stephanie Wheeler, PhD2 and William Carpenter, PhD2 1University of Kansas School of Medicine, Kansas City, KS; 2University of North Carolina, Chapel Hill; 3Duke University, Durham, NC Presented by: Shellie Ellis, PhD

Introduction: The overuse of gonadotropin releasing hormone (GnRH) agonists in localized prostate cancer decreased significantly during the last decade. Since primary GnRH agonists are not recommended for the treatment of localized prostate cancer, declining use should have improved overall quality of prostate cancer care, but no study to date has assessed the effect of prior overuse on the quality of initial treatment in a contemporary population. New treatment technologies may have undermined intended improvements. Methods: Using SEER-Medicare data, we retrospectively assessed whether the initial treatment delivered to 27,315 men diagnosed with incident prostate cancer and treated between 2006 and 2009 was concordant with National Comprehensive Cancer Network (NCCN) guidelines. We used multi-level logistic regression to test the association between guideline concordance and GnRH agonist overuse prior to Medicare Modernization Act (MMA) reimbursement cuts and, in individual models, the association between prior GnRH agonist overuse and use of new treatment modalities. Results: Pre-MMA GnRH agonist overuse was associated with lower odds of receiving guideline-concordant care in the contemporary period (OR 0.25, 95% CI 0.18, 0.34). Physicians who were high users of GnRH agonists in the earlier period were more likely to maintain GnRH agonist overuse and to provide non-guideline-concordant care among their localized cancer patients in the contemporary period. In separate analyses, prior overuse of GnRH agonists was not associated with adoption of new surgical procedures (OR 2.63, 95% CI 0.90, 7.67, n=6,265), radiation technologies (OR 1.15, 95% CI 0.39, 3.44, n=15,876), or guideline-concordant standards of surveillance (unadjusted, p=0.22, n=2,446). Conclusion: GnRH agonist overuse was not replaced with guideline-concordant care. Thus, overall quality of prostate cancer care may not have improved. Reimbursement reductions may not be an effective lever to improve quality, unless physicians have access to guideline- concordant alternatives. Funded by NCI Training Grant (R25CA116339).

189 Poster #53 IMPACT OF CCP TEST ON PERSONALIZING TREATMENT DECISIONS: RESULTS FROM A LARGE PROSPECTIVE REGISTRY OF NEWLY DIAGNOSED PROSTATE CANCER PATIENTS Mark L. Gonzalgo, MD, PhD1, Judd Boczko, MD2, Naveen Kella, MD3, Brian Moran MD4, E. David Crawford, MD5, Thaylon Davis, BS6, Rajesh Kaldate, MS6, Kirstin M. Roundy, MS6, Michael K. Brawer, MD6 and Neal Shore, MD7 1University of Miami Miller School of Medicine, Miami, FL; 2WESTMED Medical Group, White Plains, NY; 3The Urology and Prostate Institute, San Antonio, TX; 4Chicago Prostate Cancer Center, Westmont, IL; 5University of Colorado at Denver, Aurora, CO; 6Myriad Genetic Laboratories, Inc., Salt Lake City, UT; 7Carolina Urologic Research Center, Myrtle Beach, SC Presented by: Mark L. Gonzalgo, MD, PhD

Introduction: The cell cycle progression (CCP) test is a validated molecular assay that assesses risk of prostate cancer-specific disease progression and mortality when combined with standard clinicopathologic parameters. PROCEDE-1000 is the largest clinically- controlled, prospective registry to evaluate the impact of the CCP test towards personalizing prostate cancer treatment. Results of an interim analysis of 816 patients are presented. Methods: Untreated patients with newly diagnosed (≤6 months), clinically localized prostate adenocarcinoma were enrolled. The physician’s initial therapy recommendation (pre-CCP), based on clinicopathologic parameters, was recorded on the first questionnaire. The CCP test was then conducted on prostate biopsy tissue. Three consecutive post-CCP questionnaires recorded the physician’s revised treatment recommendation, physician/patient consensus treatment decision, and actual treatment administered after sufficient clinical follow-up. Changes in treatments between the initial recommendation and post-CCP questionnaires demonstrate the impact of CCP testing on treatment decision at each stage. Results: Visual analog scale measurements indicated a significant increase (p=0.0125) in the physician’s likelihood of recommending non−interventional treatment post-CCP test; there was an increase in active surveillance from the initial interventional therapy recommendation. From pre-CCP therapy recommendation, the CCP risk score caused a change in actual treatment administered in 44% of patients; of these changes, 72% were reductions in treatment. These reductions occurred in radical prostatectomy (27%), radiation therapy (44% primary; 56% adjuvant), brachytherapy (46% interstitial; 66% HDR) and hormonal therapy (33% neoadjuvant; 68% concurrent) treatments. Although a considerably high percentage of patients (35.9%; 293/816) were recommended for conservative management pre-CCP testing, a further 6.5% increase overall was recorded for non-interventional treatments during actual follow-up. In general, there was a significant reduction in the number of treatment options recorded at each successive evaluation (p<0.0001). Po st e rs Conclusion: The CCP risk assessment score has a significant impact in helping physicians and patients reach consensus on an appropriate personalized treatment decision, often with major reductions in interventional treatment burden. Source of Funding: Myriad Genetic Laboratories, Inc

190 Poster #54 ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER IN PUERTO RICAN PATIENTS SAFE ONLY AFTER OBTAINING A HISTOLOGY SLIDE REVIEW BY A FELLOWSHIP-TRAINED PATHOLOGIST Carlos Perez-Ruiz, MD1, Juan Serrano-Olmo, MD2, Curtis Pettaway, MD3 and Ricardo Sanchez-Ortiz, MD4 1University of Puerto Rico, San Juan PR; 2San Pablo Pathology Group, Bayamon PR; 3The University of Texas MD Anderson Cancer Center, Houston TX; 4Robotic Urology and Oncology Institute, San Juan PR Presented by: Carlos Perez-Ruiz, MD

Introduction: We previously reported that African American (AA) men with clinical stage T1c prostate cancer (CaP) treated with radical prostatectomy (RP) exhibit higher tumor volumes than matched Caucasian men (Sanchez-Ortiz et. Al., Cancer, 2006). While Puerto Rican (PR) residents are generally described as “Hispanic,” genomic admixture studies have shown that the average West African ancestry in Puerto Rican men exceeds 20%. These data may explain the higher observed CaP mortality in Puerto Rico and questions the appropriateness of active surveillance in all low-risk PR CaP patients. Herein we present pathologic outcomes and early follow-up among PR men with low-risk CaP who were candidates for active surveillance (AS). Methods: A database was developed to register 70 patients with low-risk CaP (Gleason 6 (3+3) in ≤2 cores, PSA density <15 ng/ml/ml, <50% involvement). All slides sent from 12 laboratories were reviewed by the same pathologist with fellowship training at an NCCN cancer center. Patients enrolled on AS were followed every six months with a physical exam and PSA (free and total), and a repeat biopsy after one year and then every two years (sooner for a rapid PSA rise). Clinical and pathological variables were reviewed. Results: Mean age of the cohort was 63.1 years (range: 50 to 79), mean PSA was 4.95 ng/ ml, and 94.2% were clinical stage ≤T2a. The mean number of positive cores was 1.44 with a mean number of total sampled cores of 11. Eight patients (11.1%) had received an LHRH agonist injection before referral. After initial pathology review, 55.7% (39/70) of patients had their slides upgraded to Gleason score ≥ 7 (3+4). All patients opted for treatment with RP (38) or external radiation (1). Of men who underwent RP, Gleason score ≥7(3+4) was seen in 76.3% (29/38) of RP specimens and 36.3% (10/38) exhibited extraprostatic extension. There were no differences between those upgraded or not with regards to clinical stage, BMI, history of hypertension, smoking, or diabetes mellitus. Thirty-one patients whose slides were not upgraded entered our AS program. After a median follow-up of 40.3 months and a mean number of 2.5 biopsies per patient, only 12.9% (4/31) of men progressed to a higher Gleason score and were treated. All patients remain alive and disease-free at last follow-up. Conclusion: We describe the first report of the use of active surveillance in a series of PR low-risk CaP patients. Slide review by a fellowship-trained pathologist was optimal in allowing the appropriate and early stratification of PR men for either definitive therapy or active surveillance based upon clinic-pathologic variables.

191 Poster #55 RACIAL DISPARITY IN POSITIVE PROSTATE NEEDLE BIOPSY TEMPLATES WHICH INCLUDE THE TRANSITION ZONE Justin Levy, BS Candidate1, Allison Feibus, MS1, Krishnarao Moparty, MD2, Ian McCaslin, MD1, Oliver Sartor, MD1 and Jonathan Silberstein, MD1 1Tulane University School of Medicine, New Orleans, LA; 2Southeast Louisiana Veterans Health Care Services, New Orleans, LA Presented by: Jonathan Silberstein, MD

Introduction: Recent reports suggest that African Americans (AA) with prostate cancer (PCa) have more frequent tumors and more aggressive tumors located in the transition zone (TZ). Our goal was to evaluate the value of TZ-directed prostate biopsies in a predominantly AA population at the Southeast Louisiana Veterans Health Care System. Methods: After obtaining IRB approval, we retrospectively reviewed all patients with PCa found on a minimum 12-core prostate biopsy between January 2010 and June 2014. Almost the entire cohort (94%) underwent a 14-core biopsy in which 12 needle biopsies were directed at the peripheral zone (PZ) and 2 at the TZ. Aggressiveness of disease and progression of treatment was defined by Gleason grade lesion, percent involvement of PCa in any core and NCCN classification. Self-identified race was recorded for all patients. A series of the Mann Whitney U and chi-square tests were used to compare variables. Results: The total patient cohort consisted of 398 men, in which 277 (70%) were AA. When compared with Caucasian Americans (CA), AA patients had more NCCN intermediate (32% vs 26%) and high risk (18% vs 13%) PCa. Most patients had PCa limited to the PZ (n=190) or in both the PZ and TZ (n=191). For 17 patients (4%), PCa was limited to TZ core(s) only, and a greater proportion were AA than CA, 14 (5%) vs 3 (2%) respectively. Of these 17 patients, 14 (82%) had Gleason 6 disease. Patients with PCa in both the PZ and TZ had higher grade lesions (P<0.01) and worse NCCN category (P = 0.001) than patients with PCa limited to the PZ. Of the 191 patients (48%) with positive biopsy cores in the PZ and TZ, 135 (49%) were AA and 56 (46%) were CA. The TZ had the highest grade of PCa in 21 (11%) men, thus upgrading the patient’s disease and potentially changing treatment recommendations. A greater proportion of these patients were CA (13%) than AA (10%). Conclusion: TZ-directed prostate needle biopsy cores were rarely the sole location of PCa and when found were low grade with no clear racial variation. Patients with PCa in both the PZ and TZ had more aggressive disease but without significant racial variation. TZ directed biopsies do not appear to be of greater benefit to AA than CA. The authors declare no conflicts of interest. Source of funding: none Po st e rs

192 Poster #56 CHANGE IN PREDICTED PROGNOSIS AFTER RADICAL PROSTATECTOMY DURING FOLLOW-UP IN AN ACTIVE SURVEILLANCE COHORT John Eifler, MD1, Daren Diiorio1, Chaochen You, PhD1, Vidhush Yarlagadda, MD2, David Penson, MD, MPH1, Joseph Smith, Jr., MD1, Sam Chang, MD1, Michael Cookson, MD, MMHC3 and Daniel Barocas, MD, MPH1 1Vanderbilt University Medical Center, Nashville, TN; 2University of Alabama at Birmingham, Birmingham, AL; 3University of Oklahoma College of Medicine, Oklahoma City, OK Presented by: John Eifler, MD

Introduction: The objective of active surveillance (AS) for prostate cancer is to delay the morbidities of curative intervention while minimizing the likelihood of developing incurable disease. To determine the curability of AS patients, we calculated the predicted pretreatment probability of biochemical recurrence within 10 years after radical prostatectomy (BCR-RP) at the time of each follow-up biopsy using a commonly available nomogram. Methods: The study population consisted of men with Gleason 3+3=6 prostate cancer who elected AS at our institution between 2004 and 2012. Biopsies were recommended every 12-18 months. Inclusion required at least one follow-up biopsy after diagnosis. At the time of each biopsy, the predicted BCR-RP was calculated using an externally validated preoperative nomogram. Survival analysis was performed to estimate the incidence of a BCR-RP >10% during AS. A separate logistic regression analysis was performed to evaluate clinical factors at the time of biopsy associated with suboptimal BCR-RP. Results: With a median follow-up interval of 21.4 months (range 3-89.7 mo) and median number of biopsies of two (range 2-7), 213 patients met inclusion criteria and underwent a total of 351 follow-up biopsies. Overall, the median predicted BCR-RP at the time of follow- up biopsy was 3 (range 0-36). Over the duration of follow-up, the proportion of patients with a likelihood of BCR−RP above 10% increased with each passing year (3.4%, 6.7%, 20.1%, 39.9%, and 63.3%). On multivariable logistic regression analysis, at the time of any follow-up biopsy, age (O.R. 1.06, p = 0.029), log PSA density (O.R. 4.06, p = 0.007), the number of positive cores on previous biopsy (O.R. 1.36, p = 0.013), and interval since the prior biopsy of ≥2 years (referent < 1 year, O.R. 4.68, p = 0.014) were associated with BCR-RP>10%. Conclusion: Active surveillance safely maintains curability in the majority of men with Gleason 6 prostate cancer. However, within five years of entering surveillance, more than half of men would have a predicted BCR−RP above 10%. Men electing active surveillance should consider that their prognosis may change over time, particularly when a long interval precedes their follow-up biopsy.

193 Poster #57 PERIOPERATIVE, ONCOLOGICAL AND FUNCTIONAL OUTCOMES OF SALVAGE ROBOT ASSISTED RADICAL PROSTATECTOMY – A PROPENSITY SCORE MATCHED ANALYSIS Anthony Bates, MD, Srinivas Samavedi, MD, Anup Kumar, MD, Rafael Coelho, MD, Bernardo Rocco, MD, Kenneth Palmer, MD, Vipul Patel, MD Department of Urology, University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital−Celebration Health, FL Presented by: Anthony Bates, MD

Introduction: To report the perioperative, functional and oncological outcomes of Salvage Robot-Assisted Laparoscopic Prostatectomy (s-RALP) versus cases treated with non- salvage (primary) Robot-Assisted Laparoscopic Prostatectomy (RALP) in a propensity score-matched analysis. Methods: From January 2008 through April 2014, 5279 consecutive patients underwent robot-assisted laparoscopic radical prostatectomy at our institution. There were 53 patients who underwent s-RALP for loco regional recurrence of prostate cancer following external beam radiotherapy and intensity modulated radiation therapy in 27 patients (50.9%), proton therapy in six patients (11.3%) , brachytherapy in 14 (26.4%) , cryotherapy in four (7.5%) and high intensity focused ultrasound in three (5.6%) patients. A propensity score-match analysis was conducted using 9 covariates in a multivariable design to identify comparable RALP patients (N=53). Perioperative, functional and oncological outcomes were compared between matched cohorts. Results: The mean age was comparable in two groups (p=0.691). Patients in the s-RALP group were at significantly higher risk, based on the D’Amico classification system (p=0.010). Between-group comparisons of the following outcomes: estimated blood loss, complication rate, hospital stay, BCR risk, persistent cancer where applicable, were similar. The s-RALP group had an increased prevalence of lymphovascular invasion (26.4% versus 13.2%; p=0.032), time to catheter removal (median 10.8 ± 6.9 versus 5.1 ± 0.9 days, p<0.010) and a higher prevalence of anastomotic leaks in the postoperative period (34.0% vs 5.7%, p<0.010). Continence at 36 months was higher in RALP group as compared to s-RALP group (96.2% vs. 76.9% respectively, p<0.001). The mean time to continence was significantly higher in s-RALP group as compared to RALP (6.5 months vs.3.04 months respectively=0.006). Also, in s-RALP group, potency at 36 months was lower than RALP group (26.4% vs. 49.4% respectively, p=0.02) but mean time to potency was comparable in two groups. (7.6 months vs. 5.6 months, p=0.38). Many of these patients in both groups were not potent pre-op or did not have nerve sparing surgery, leading to poor overall potency rates in the matched groups. Conclusion: In appropriately selected patients s-RALP is a safe and effective procedure. Po st e rs Salvage RALP patients tend to have more aggressive tumors and require a longer catheterization post surgery due to delayed healing of the anastomosis or breakdown. In addition the continence and potency rates are lower in the s-RALP group and the time to continence is significantly increased. These are important factors in counseling patients undergoing s-RALP.

194 Poster #58 POST-PROSTATECTOMY SERUM PSA CONTINUES TO RISE AFTER REACHING 0.1 NG/ML ON AN ULTRASENSITIVE ASSAY: A CASE FOR AN EARLIER DEFINITION OF FAILURE Jose Saavedra-Belaunde, MD1 and Ricardo Sanchez-Ortiz, MD2 1University of Puerto Rico, San Juan PR; 2Robotic Urology and Oncology Institute, San Juan PR Presented by: Jose Saavedra-Belaunde, MD

Introduction: ASTRO/AUA guidelines for radiotherapy (RT) after prostatectomy (RP) define prostate cancer (CaP) biochemical recurrence (BCR) as a prostate specific antigen (PSA) level ≥0.2 ng/ml with a confirmatory level ≥ 0.2 ng/ml. While this helps standardize patient selection for salvage therapy, the role of ultrasensitive PSA in patient selection for salvage therapy remains controversial. We report our experience using ultrasensitive PSA for CaP surveillance after RP. Methods: A prospective database was created of 542 consecutive CaP patients who underwent RP by a single surgeon. All patients underwent postoperative surveillance using an ultrasensitive PSA assay with the chemiluminescent method (detection level: 0.01 ng/ml) every four months if high risk or every six months otherwise. If a serum PSA of 0.1 ng/ml was reached, patients were followed more closely and salvage therapy was instituted if a PSA ≥ 0.2 ng/ml was reached. Results: Of the 508 patients who had one or more PSA levels available for review, 10.8% (55/508) reached a serum PSA of 0.1 ng/ml after a median follow-up of 30.4 months. Of these patients, 98.2% (54/55) had a serum PSA which continued to rise to the BCR definition ≥0.2 ng/ml in a median time of 18.7 months. As expected, patients with BCR had higher preoperative serum PSA values (8.7 vs. 5.5 ng/ml, p<0.001), positive margins (25.5% vs. 6.8%, p<0.001), pT3 on RP specimen (60% vs. 15.5%, p<0.001), and Gleason score ≥8 (25.4% vs. 2.47%, p<0.001) than those without BCR. While patients who underwent robotic RP had a lower BCR (8.6%, 31/359) compared with retropubic RP (16.1%, 24/149) (p< 0.02), this lost significance after adjusting for follow-up time. In patients with adverse pathologic features, 3.3% (17/508) had undergone adjuvant radiation, 6.4% (33/508) underwent salvage RT for a rising PSA, and 3.1% (16/508) received androgen deprivation for metastasis or a rapid PSA doubling time. There were no differences between patients with BCR and those without with regards to age (57.7 BCR vs. 57.5 years), BMI (28.5 BCR vs. 28.0), prostate weight (44.8 g BCR vs. 46.6 g), family history of CaP, history of diabetes mellitus, or hypertension. Conclusion: Our data show that CaP patients treated with RP with or without adjuvant RT exhibit a low rate of biochemical recurrence (10%). The use of a PSA threshold ≥ 0.1 ng/ml on an ultrasensitive assay identified 98.2% of patients who were destined to continue to rise to 0.2 ng/mll, suggesting that 0.1 ng/ml may be used to select patients for earlier salvage therapy. Whether administering salvage radiation at a serum PSA of 0.1 ng/ml translates into a lower rate of recurrence deserves further study.

195 Poster #59 MULTI-PARAMETRIC, DIFFUSION-WEIGHTED PROSTATE MRI IN CLINICALLY SUSPICIOUS PATIENTS WITH POSITIVE IMAGING: CAN WE IMPROVE OUR STANDARD REPORTING? Ryan Levey, MD1, Coti Phillips, BS2, Matt Young, MD1, James Rosoff, MD3, Andrew Hardie, MD4 and Stephen Savage, MD1 1Department of Urology, Medical University of South Carolina, Charleston, SC; 2School of Medicine, Medical University of South Carolina, Charleston, SC; 3Department of Urology, Yale School of Medicine, New Haven, CT; 4Department of Radiology, Medical University of South Carolina, Charleston, SC Presented by: Ryan Levey, MD

Introduction: Prostate biopsy is typically triggered by an elevated serum prostate specific antigen (PSA) or abnormal digital rectal examination (DRE); however, the false negative rate of initial biopsy can be as high as 35%. A diagnostic dilemma exists in those individuals with continued clinical suspicion of cancer and negative initial biopsy. MRI with gadolinium and diffusion-weighted imaging has increasingly been used in this setting. We sought to evaluate the current utility of prostate MRI in the setting of previous negative biopsy specifically as it relates to degree of suspicion of the interpreting radiologist. Methods: A retrospective review from two institutions, the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Hospital, was performed to identify patients who have had an MRI of the prostate after a previous negative prostate biopsy. Each patient underwent a multi-parametric, phased array coil MRI of the prostate including high resolution T1- and T2-weighted, diffusion-weighted and dynamic pre and post contrast sequences. Patients were identified as having an MRI with suspicious findings, and subsequently underwent transrectal ultrasound guided prostate biopsy. Suspicious findings on MRI were scored on a scale from 1-5 by one radiologist (AH), with “1” being of low suspicion for malignancy and “5” being of high suspicion (“5” being reserved for lesions with suspicious findings on all sequences). Patient charts were reviewed for biopsy results and techniques, PSA dynamics, age, and other clinical indicators. Results: Forty-five patients with a mean of two previous negative biopsies (range 1-5) were evaluated, with 25 (56%) with cancer diagnosed after MRI. Patients with subsequent positive biopsies had a significantly higher MRI score (4.12 vs 2.89; p <0.001) and higher PSA density than those with negative biopsies (0.24 ng/ml/cc vs 0.16 ng/ml/cc; p =0.049). No significant difference was found in the median PSA velocity (1.67 vs 2.19 ng/ml/year), median PSA doubling time (50.4 vs 55.5 months), or average number of biopsy cores taken (22.2 vs 21.5 cores). For those with subsequent positive biopsies, the median Gleason score was 7 (range 6-8) and 17 patient (68%) had cancer outside the traditional sextant biopsy template. Po st e rs Conclusion: MRI has become increasingly useful in patients with previous negative biopsies. Our results suggest that the level of suspicion of MRI findings when graded may lead to improved correlation with subsequent biopsy, and help guide physicians in management for patients with persistently elevated PSA and initial negative prostate biopsies in order to diagnose appropriate cancers and potentially reduce further negative biopsies.

196 Poster #60 PROSTATE CANCER LOCALIZATION ON NEEDLE CORE BIOPSY AS PREDICTOR FOR PATHOLOGIC STAGE Patrick Hensley1, Lisa Bailey, MD1, Matthew Purdom, MD2, Daniel Davenport, PhD3 and Stephen Strup, MD, FACS1 1University of Kentucky College of Medicine Department of Urology; 2University of Kentucky College of Medicine Department of Pathology; 3University of Kentucky College of Medicine Department of Surgery Presented by: Patrick Hensley

Introduction: Biopsy is an essential component to the diagnosis and pre-operative assessment of prostate cancer which influences the selection of surgical candidates and extent of resection. Predictive characteristics of extraprostatic extension on core biopsy may enhance the sensitivity of this preoperative assessment. Objectives were two-fold: (1) correlate the location of cancer on needle core biopsy to the incidence of extraprostatic extension upon radical prostatectomy; (2) validate pre-established predictors of extraprostatic extension in a case-matched series. Methods: Patients who underwent needle core biopsy followed by radical prostatectomy at the University of Kentucky from 01/01/02-01/01/13 were eligible for inclusion. Patients with T3/ T4 disease on final pathology were retrospectively case matched to patients with T2 disease using two criteria: (1) identical biopsy Gleason Grade (controlling for tumor aggressiveness) and (2) PSA <10, 10−20, or >20 ng/ml (controlling for tumor volume). Biopsy specimens were prospectively reviewed. Positive cores were stratified into 3 categories: polar (tumor ≤ 1mm from tissue edge), diffuse (tumor ≤ 1mm from tissue edge on both poles), and mid (tumor ≥ 1mm from both poles). Results: Thirty-two sets of patients with T3/T4 and T2 disease were case matched. Total percent polar involvement of cores was the strongest predictor of stage among all the measures analyzed (Table). Apex and base cores from T3/T4 cases exhibited statistically significantly more polar involvement than case matched T2 counterparts. Other significant differences were detected in the average highest Gleason Grade at the pole, average percent involvement of the single greatest core, and average length of core with greatest cancer involvement. Conclusion: Data suggest that prostate cancer within 1mm of the pre-operative needle core biopsy pole is associated with extraprostatic extension and pathologic upstaging. This association is strongest in the prostatic base and apex. To our knowledge this has not been reported in the literature. Furthermore, this study has verified previously described histologic parameters on biopsy correlating with increase tumor stage and grade.

197 Poster #61 NATURAL HISTORY OF MEN WITH A POSITIVE PROSTATE BIOPSY THAT IS OVERTURNED TO NEGATIVE AFTER A SECOND PATHOLOGICAL OPINION Eduardo Hernandez-Cardona, MD1, Juan Serrano-Olmo, MD2 and Ricardo Sanchez-Ortiz, MD3 1University of Puerto Rico, San Juan PR; 2San Pablo Pathology Group, Bayamon PR; 3Robotic Urology and Oncology Institute, San Juan PR Presented by: Eduardo Hernandez-Cardona, MD

Introduction: While interobserver variability is well recognized in the histologic evaluation of prostate biopsies, overturning a positive biopsy to negative after a second review is uncommon. Since the management of these men with a reversed diagnosis represents a therapeutic challenge for the urologist due to the lack of available data, we reviewed our experience to describe their natural history. Methods: A prospective database was created of 205 consecutive patients diagnosed with prostate cancer elsewhere whose slides were reviewed in second opinion by a single pathologist with a fellowship at an NCCN-designated cancer center. The frequency of a discordant result (negative vs. upgrading vs. downgrading) between the initial report and the review was ascertained. The slides of all men with a biopsy overturned to negative were presented at the departmental conference for confirmation. All patients with an overturned result were rebiopsied and followed with the same protocol we use for active surveillance. Clinical and pathological data were reviewed. Results: Mean age of the cohort was 58 years (range 38 to 69), mean PSA was 4.76 ng/ml, and 87.5% had T1c disease. All patients had Gleason score 6 (3+3) with a mean number of 1.2 positive cores (range 1 to 2) and a mean number of 11.2 sampled cores. Gleason score upgrading or downgrading discrepancies were observed in 32.2% (72/205) of patients and the revision was read as negative (or atypia) for cancer in 7.8% (16/205) of patients. Twenty-eight core transrectal biopsies were repeated under sedation in all 16 patients. Six (37.5%) of 16 patients had positive repeat biopsies and underwent surgery (five) or active surveillance (1). Ten patients with a negative 28-core repeat biopsy have been followed on surveillance; none have had evidence of cancer after a median follow-up of 35 months and a mean number of 2.2 additional biopsies. Conclusion: While interobserver variability in the histologic evaluation of prostate biopsies has been reported in up to one-third of patients, the likelihood of reversal of a biopsy to negative has not been well described. Our data show that after a review by an experienced pathologist, a biopsy may be overturned to negative in 7.8% of patients, of which 37.5% will have a positive repeat biopsy. If a 28-core repeat biopsy was negative, none of the patients were subsequently found to have cancer using a close surveillance program. Po st e rs

198 Poster #62 CONTINENCE OUTCOMES OF ROBOTIC ASSISTED RADICAL PROSTATECTOMY IN SUBOPTIMAL PATIENTS Anup Kumar, MD, Srinivas Samavedi, MD, Rafael Coelho, MD, Bernardo Rocco, MD, Kenneth Palmer, MD, Vipul Patel, MD Department of Urology, University of Central Florida School of Medicine & Global Robotics Institute, Florida Hospital−Celebration Health, FL Presented by: Anup Kumar, MD

Introduction: Large prostate, elderly age, higher BMI, salvage prostatectomy and TURP have been associated with poorer continence outcomes during prostatectomy. We analyze the continence outcomes of robotic assisted prostatectomy in this particular subset of patients. Methods: From January 2008 through November 2012, 4023 patients underwent RARP by a single surgeon (VP) at our institution. Retrospective analysis of prospectively collected data from our Institutional Review Board approved registry identified 3362 men who had one year of follow-up. This cohort of patients was stratified into six groups: Group I − age 70 and over (n=451); Group II – body mass index (BMI) 35 and over (n=197); Group III − prior bladder neck procedures (n=103); Group IV− prostate weight 80 g and over (n=280); and Group V− salvage prostatectomy patients (n=41). Group VI − contained patients (n=2447) with none of these risk factors. Continence was defined as the use of no pads at follow-up. Follow-up was completed at six weeks, three, six, nine and 12 months. Continence outcomes at follow-up were analyzed for all groups. Mean time to continence was compared among the groups using ANOVA and the Tukey-Kramer test to conduct multiple group comparisons. Results: The continence rate for patients 70 and over was 88.9% (401/451) and the mean time 3.2 ± 4.5 months; BMI 35 and over was 96.5% (190/197) 3.1 ± 4.5 months; prior bladder neck treatment 87.4% (90/103) 3.4 ± 4.7 months; prostate weight 80 g and over 89.3% (250/280) 3.3 ± 4.4 months; and salvage procedures 56.1% (23/41) 6.6 ± 8.3 months (p=0.015). Multiple group comparisons of mean time to continence between each group and the salvage group revealed significant differences (p=0.031). The time to continence was similar for Groups I, II, III, and IV. The continence rate for Group VI (non-risk patients) was 95.1% (2326/2447) and the mean time to continence was 2.4 ± 3.2 months. A comparison of the mean time to continence for all groups in the study (Groups I−VI) revealed a significance difference (p<0.001). Multiple group comparisons revealed a significant difference between the non-risk group (Group VI) and each of the risk groups (p<0.001). Conclusion: This study has demonstrated that selected risk factors including older age (70 and over), BMI 35 and over, prior bladder neck treatment, prostate weight 80g and over, and previously having undergone a salvage procedure adversely affect the return of continence following RARP. Patients with these risk factors should be counseled concerning expectations for achieving urinary continence. Patients with none of the risk factors assessed in the present study have an increased probability of achieving early continence following RARP

199 Poster #63 CLINICAL OUTCOMES OF CONSERVATIVELY MANAGED PROSTATE CANCER AMONG AFRICAN AMERICAN MEN Amar Patel, MD, Martin Sanda, MD, Dattatraya Patil, MBBS, MPH, Muta Issa, MD, John Petros, MD Emory University School of Medicine, Atlanta, GA Presented by: Amar Patel, MD

Introduction: Despite increasing utilization of non-intervention conservative care for prostate cancer, information about outcomes of conservative management among African American (AA) men is sparse. We sought to evaluate the outcomes of conservatively managed prostate cancer among African American men and their counterparts from other racial origin in the community-based, integrated care setting of the Atlanta VAMC. Methods: A prospective database of all patients undergoing prostate biopsy at the Atlanta VAMC from 2000 to 2013 was interrogated retrospectively to identify men diagnosed with prostate cancer who were managed conservatively. Demographic, clinical, and histopathological factors were evaluated for association with endpoints including biochemical progression (index PSA <10 with subsequent rise to >10), histopathological (progression conversion from Gleason 6 or less to Gleason > 6), clinical progression (metastatic disease) and death. Statistical analysis was performed by univariate and multivariate measure of associations and/or time-to-event analyses as indicated. Results: There were 163 (6.6%) patients that had conservatively managed prostate cancer. Median follow-up time was 10.9 months. There were a total of 71 (43.6%) patients with intermediate-risk disease and 9 (5.5%) with high-risk disease. The cohort consisted of 104 (63.8%) AA’s of which, 45 (43.3%) had intermediate-risk disease and 8 (7.7%) with high- risk disease. 36/163 (22.1%) patients underwent repeat biopsy and 9 had histo-pathological progression. There were no significant differences in biochemical progression between AA and non-AA’s (18.9% vs. 10.6%, p=0.22). Unexpectedly, non-AA’s had a higher rate of clinical progression (8.5% vs. 1.0%, p= 0.02), which may be attributed to verification bias secondary to an overall low number of repeat biopsies. There was no difference in deaths from prostate cancer (2.9% vs. 1.7%, p=1.0) between AA and non-AA’s, respectively. There was no significant difference in time to biochemical progression among AA vs Non-AA’s (Log rank p = 0.39). Although, compared to indolent PCa, in patients with aggressive PCa (Gleason’s score >=7) time to biochemical progression was significantly different between two racial groups (Log rank p=0.005) with Non-AA’s progressing much rapidly than AA’s. Conclusion: To our knowledge, this is the first report focusing on a prostate cancer conservative care cohort comprised predominantly of AA men. Our findings suggest that clinical outcomes among AA are not substantially worse than those of men with other racial Po st e rs background. Validation of these findings in a prospective active surveillance study ofAA patients with prostate cancer is warranted. Funding: None

200 Poster #64 DOES LARGER TUMOR VOLUME EXPLAIN THE HIGHER PSA LEVELS IN BLACK MEN WITH PROSTATE CANCER – RESULTS FROM THE SEARCH DATABASE Zachary Klaassen, MD1, Lauren Howard, MS2, Martha K. Terris, MD1, William J. Aronson, MD3, Matthew R. Cooperberg, MD, MPH4, Christopher L. Amling, MD5, Christopher J. Kane, MD6 and Stephen J. Freedland, MD2 1Medical College of Georgia − Georgia Regents University, Augusta, GA; 2Duke University Medical Center, Durham, NC; 3University of California, Los Angeles, Los Angeles, CA; 4University of California, San Francisco, San Francisco, CA; 5Oregon Health & Sciences University, Portland, OR; 6University of California, San Diego, San Diego, CA Presented by: Zachary Klaassen, MD

Introduction: Multiple population-based studies have shown that black men have higher PSA values. Additionally, PSA is associated with larger prostate size and larger tumor size. We previously showed that the racial differences in PSA values are not explained by differences in prostate weight. An alternative explanation for higher PSA values among black men with prostate cancer (CaP) may be increased tumor volume (TV). Thus, we assessed whether larger TV in black men explains the higher PSA levels in black versus white men with CaP. Methods: We retrospectively analyzed 2099 men from the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent radical prostatectomy (RP) from 1990 to 2013. The associations between race and the outcome variables of TV and preoperative PSA values were examined using linear regression. We adjusted for center, age, surgery year, pathologic Gleason sum, positive margins, extracapsular extension, seminal vesicle invasion, and lymph node metastasis. Adjusted median and interquartile range of TV and PSA were calculated by back-transforming the predicted logarithmic values from the linear regression models. Results: There were 1,236 (59%) white men and 863 (41%) black men. Black men were younger at surgery (60.3 vs. 63.1 years, p<0.001) had a higher preoperative PSA value (6.9 vs. 6.1 ng/mL, p<0.001), and more often had positive margins (48 vs. 38%, p<0.001) and seminal vesicle invasion (14 vs. 11%, p=0.03). White patients had worse clinical stage disease (p<0.001) and greater median TV (6.3 vs. 5.4 gm, p=0.004). After adjusting for demographics and cancer−specific characteristics, white men had a greater adjusted median TV (5.7 vs. 4.7 gm, p=0.02). However, when also adjusted for PSA, there was no racial difference in adjusted median TV (p=0.53). After adjusting for demographic and cancer−specific characteristics, black men had a higher median preoperative PSA compared to white men (7.5 vs. 6.1 ng/mL, p<0.001). To assess whether this difference was due to TV, we repeated the analysis of PSA but also adjusted for TV and again there was a significant difference in median preoperative PSA with black men having a 21% higher median preoperative PSA versus white men (7.4 vs. 6.1 ng/mL, p<0.001). Conclusion: In this study of men undergoing RP at multiple equal access medical centers, TV did not explain the higher PSA levels in black versus white men. These results suggest that black men may have an inherent genetic profile that predisposes to higher PSA values regardless of demographic and clinicopathologic factors.

201 Poster #65 UTILIZATION AND IMPACT OF SURGICAL TECHNIQUE ON THE PERFORMANCE OF PELVIC LYMPH NODE DISSECTION AT RADICAL PROSTATECTOMY: RESULTS FROM THE SEARCH DATABASE Kathleen McGinley, DO1, Xizi Sun,BS1,2, Lauren Howard, MS1,2, William Aronson, MD3,4, Martha Terris, MD5,6, Christopher Kane, MD7, Christopher Amling, MD8, Matthew Cooperberg, MD, MPH9 and Stephen Freedland, MD1,2 1Duke University, Durham, NC; 2Veterans Affairs Medical Center, Durham, NC; 3Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; 4UCLA School of Medicine, Los Angeles, CA; 5Veterans Affairs Medical Center, Augusta, GA; 6Georgia Regents University, Augusta, GA; 7University of California San Diego Health System, San Diego, CA; 8Oregon Health Sciences University, Portland, OR; 9UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA Presented by: Kathleen McGinley, DO

Introduction: Completion of a pelvic lymph node dissection (PLND) during radical prostatectomy (RP) is critical for staging and treatment of high-risk prostate cancer (PC). Conversely, performance of a PLND in low-risk PC contributes to morbidity with minimal benefit. Robot-assisted laparoscopic RP (RARP) is known to be associated with decreased PLND use. We evaluated PLND use over time, stratified by PC risk group and surgical technique. Methods: We used the SEARCH database to identify men undergoing open RP (ORP) or RARP from 2006-2013 with complete data. All SEARCH sites are academically affiliated VA hospitals that perform RARP. Univariable logistic regression was used to test the association between age, race, BMI, number of positive cores, AUA risk group, surgery year, center, and surgical technique on PLND use. Multivariable logistic analysis was used to examine surgical technique and PLND utilization stratified by AUA risk-group. Spearman correlation was used to examine temporal changes in PLND utilization stratified by risk-group and surgical technique. Results: One thousand, four hundred, thirty-nine men met our inclusion criteria. Of these, 66% had a PLND. On univariable analysis, age, surgery year, number of positive cores, AUA risk group, center, and surgical technique were significantly associated with PLND performance (all p<0.02). On multivariable analysis, when adjusted for age, race, BMI, number of positive cores, surgery year, and center, RARP was associated with a 89% decreased use of PLND in the low-risk group, 85% decreased in intermediate risk, and 86% decreased in high risk men (all p≤0.002). Over time, PLND was increasingly used with RARP in low-risk patients (p=0.022); a trend of increased PLND performance with RARP in high risk men was noted (p=0.077) reaching ~85% in 2012-2013 vs. ~95% in ORP. For ORP, PLND Po st e rs use did not significantly change over time except a trend of fewer PLND in low-risk men which decreased to ~35% (p=0.064) in 2012−2013. Conclusion: Regardless of risk group, PLND is markedly less likely to be performed when a RARP is done. Over time, PLND was increasingly performed in RARP reaching high but still sup-optimal levels in high-risk men. However, this was accompanied by increased use in low- risk men. Likewise, PLND use in ORP remains over-utilized in low-risk men. While improved over time, PLND remains over-utilized in low-risk men and under-utilized in high-risk men regardless of surgical technique. External Funding: None

202 Poster #66 PROSPECTIVE EVALUATION OF BLADDER NECK TUBULARIZATION DURING ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY (RALRP) FOR PATIENTS WITH TRILOBAR HYPERTROPHY: FIVE YEAR FOLLOW-UP. Robert Carey, MD, PhD, Paula Domino, Eliot Blau, MD, James Pilkington, MD Florida State University College of Medicine, Tallahassee, FL Presented by: Robert Carey, MD, PhD

Introduction: To assess bladder neck reconstruction by tubularization in patients with trilobar prostatic hypertrophy presenting for RALRP. Methods: Patients with prostate cancer presenting for RALRP with an AUA symptom score greater than 20, a bother score greater than 4 and either a TRUS size greater than 100 cc or documented trilobar hypertrophy on flexible cystoscopy were identified. A total of 20 patients out of 389 met entry criteria and have five year follow up. RALRP’s were performed by a single surgeon over a three-year period. Tubularization was performed using a double armed 3.0 monocryl suture, closing the inferior most portion of the bladder neck, leaving the ureteral orifices deep in the bladder, and performing the anastomosis with the superior (distal) end of the tube to the urethral stump. Institutional Review Board approval was obtained. Results: For the 20 patients meeting entry criteria, average prostate size was 101 grams (range 48-132 grams) and patient BMI 29.8 compared to 55.3 grams (range 26-110 grams) and and BMI 28.5 for the remainder of the 389 patients who underwent RALRP with the same surgeon during the same time period. In the bladder tube group 19/20 patients have an undetectable PSA on supersensitive assay (<0.01) and one patient has a PSA 0.1 at five years with no progression. All bother scores were 0 or 1 after surgery, and all patients were continent (no pads) at three months. 14/20 (70%) were continent, no pads at or before one month follow-up. All post-void residuals were less than 100 cc. AUA symptom scores reduced from an average of 22 prior to surgery to seven at two-year follow up. No anastomotic strictures occurred. Conclusion: For patients with large intravesical components and / or large prostate size, bladder neck tubularization prior to anastomosis during RALRP affords excellent early continence, marked improvement in AUA symptom scores in pre- to post-operative comparison, and absence of stricture formation at five-year follow up in patients who would otherwise be at high risk for incontinence.

203 Poster #67 PERFORMANCE OF CCP ASSAY IN AN UPDATED SERIES OF BIOPSY SAMPLES OBTAINED FROM COMMERCIAL TESTING E. David Crawford, MD1, Neal Shore, MD2, Peter T. Scardino, MD3, John W. Davis,MD, FACS4, Jonathan Tward, MD, PhD5, Lowndes Harrison, MD6, Brent Evans, MS7, Lisa FitzGerald, PhD8, Steven Stone, PhD8 and Michael K. Brawer, MD7 1University of Colorado at Denver, Aurora, CO; 2Carolina Urologic Research Center, Myrtle Beach, SC; 3Memorial Sloan−Kettering Cancer Center, New York, NY; 4The University of Texas MD Anderson Cancer Center, Houston, TX; 5Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT; 6Gadsden Regional Cancer Center, Gadsden, AL; 7Myriad Genetic Laboratories, Inc., Salt Lake City, UT; 8Myriad Genetics, Inc., Salt Lake City, UT Presented by E. David Crawford, MD

Introduction: The cell cycle progression (CCP) score is an RNA-based expression assay which has improved the prediction of prostate cancer aggressiveness in eight separate retrospective cohorts. In this analysis, we characterized the patient population and CCP score performance in commercial testing. Methods: Formalin-fixed prostate biopsy samples from 3,545 patients were submitted by 787 physicians to Myriad Genetic Laboratories for CCP test analysis. Patient clinicopathologic data was obtained from the test request form. The CCP score was calculated based on RNA expression of 31 cell cycle progression genes normalized to 15 housekeeping genes. Patients were sorted into AUA risk categories and assigned a relative classification of cancer aggressiveness based on the CCP score. Results: Of the 3,545 samples that contained sufficient carcinoma (>0.5mm linear extent), 3502 (98.8%) provided quality RNA for analysis. The CCP score distribution ranged from -2.9 to 3.4. Correlation with Gleason score was r=0.31 and the correlation with PSA was r=0.17. Based on the CCP score, 38.7% of men had a less aggressive cancer and 19.8% of patients had a more aggressive cancer than expected based on clinicopathologic prediction. Conclusion: The CCP test can improve risk stratification for men with prostate adenocarcinoma independent of other clinicopathologic variables. Fifty−eight percent of men tested in the commercial assay were assigned to a different risk category than predicted by their clinicopathologic features. Source of Funding: Myriad Genetic Laboratories, Inc. Po st e rs

204 Poster #68 3−D BIOPRINTING OF MUSCLE CONSTRUCTS FOR UROGENITAL RECONSTRUCTION Ji Hyun Kim, MD, Young Joon Seol, PhD, In Kap Ko, PhD, Hyun Wook Kang, PhD, John Jackson, PhD, Sang Jin Lee, PhD, James Yoo, MD, PhD, Anthony Atala, MD Wake Forest School of Medicine, Winston Salem, NC Presented by: John Jackson, PhD

Introduction: Recent advances in muscle tissue engineering present a promising new approach to address the current limitations involved with structural and functional recovery of muscle injury. The conventional tissue engineering approach produces muscle tissues in vivo, but building clinically applicable muscle constructs with necessary tissue organization appears to be inadequate. Methods: To achieve functional recovery in vivo, engineered muscle tissues must be integrated with the host nervous system following implantation, because failure of innervation results in muscle tissue atrophy. Therefore, timely integration of host nerve into engineered muscle tissue construct is critical to successful recovery of function. In this study we investigated whether 3−D bioprinted muscle constructs could be robust enough to maintain structural and functional characteristics in vivo. To engineer volumetric and functional muscle construct, bioprinted muscles construct which has multi-layered muscle-like structure was fabricated by using integrated organ printing technology and human muscle progenitor cells (hMPCs). Their cell viability and tissue development of muscle construct were evaluated in vitro, and structural maintenance, skeletal maturation, integration with host tissue were evaluated in vivo. Results: Our in vitro study showed that printed muscle construct have aligned muscle fibers with high cell viability. In in vivo study, implanted muscle cells developed aligned muscle fibers and maintained muscle characteristics, and blood vessels and nerve ingrowth into the implanted constructs were also observed. Conclusion: Our results demonstrate that creation of innervated volumetric engineered muscle tissues using the 3−D bioprinting system is possible and that muscle function can be achieved in an accelerated fashion.

205 Poster #69 ROBOTIC-ASSISTED BLADDER DIVERTICULECTOMY: ASSESSMENT OF OUTCOMES AND MODIFICATION OF TECHNIQUE Andrew Davidiuk, MD1, Camille Meschia, BS2, Paul Young, MD1 and David Thiel, MD1 1Mayo Clinic Florida, Jacksonville, FL; 2Jacksonville, FL Presented by: Andrew Davidiuk, MD

Introduction: We present outcomes of robotic assisted bladder diverticulectomy (RABD) and modification of technique that may improve results. Methods: Sixteen patients have undergone RABD at our institution by two experienced robotic surgeons from 12/31/2008-3/25/2014. All RABD were performed via intraperitoneal approach using three robotic ports, a 12 mm camera port, a 12 mm assistant port, and a 5 mm assistant port. Eleven patients (69%) underwent RABD using an external dissection approach, while five (31%) patients underwent RABD utilizing a modified internal dissection technique (immediate entry into the bladder diverticulum). Known malignancy in the diverticulum was a contraindication to the internal dissection technique. Results: The mean age of our cohort was 69.3 years old (range: 59−79 years) and 15/16 (93.8%) patients were male. Mean follow up since RABD was 12.7 months (0.43-53.3 months). Two patients had known malignancy and final pathology consistent with carcinoma in situ and papillary high grade transitional cell carcinoma. Eleven (69%) patients underwent pre-operative outlet procedure (9-TURP, 2-TUIP) at a mean time before RABD of 253.6 days (range: 26-622 days). Mean operative time for RABD was 206.9 minutes (range: 131-353 minutes). Mean operative time for external dissection of the bladder diverticulum was 230.8 minutes (range: 144-353 minutes), while the mean operative for the internal dissection technique was 140.3 minutes (range: 130-189 minutes). Mean EBL was 93.6 ml (range: 5−200 ml) and no patient required blood transfusions. There were no intraoperative complications. Mean hospital stay was 1.69 days (range: 1-3 days). There were no post- operative Clavien complications. Mean time to catheter removal was 13 days (range: 7-29 days). Mean PVR prior to intervention was 654.0 ml (range: 78-1100) compared to 160.4 ml (range: 46-527 ml) following RABD. Mean AUA symptom scores pre-operatively were 19.7 (range: 5-29) compared to nine (range: 2-21) post-operatively. Conclusion: RABD is safe with low risk of intra-operative or post-operative complications and results in both improved voiding symptoms as well as diminished post-void residuals. In addition, modification of our technique from an external dissection approach to an internal dissection approach has led to a dramatic reduction in operative time.

Po st e rs

206 Poster #70 EXTRAVASATION ON POSTOPERATIVE PERI-CATHETER RETROGRADE URETHROGRAM AFTER BULBAR URETHROPLASTY: TIME TO PULL THE RUG OUT? Michael Granieri, MD, George Webster, MD, Andrew Peterson, MD Duke University Medical Center, Durham, NC Presented by: Michael Granieri, MD

Introduction: To determine the incidence of extravasation on initial follow up of postoperative peri-catheter retrograde urethrogram (pcRUG) after bulbar urethroplasty and the relationship to repair type. Methods: We performed an IRB approved retrospective review of our institutional urethroplasty database to collect stricture related and post-operative information with emphasis on the pcRUGs. All men had a pcRUG at the initial post-operative follow up appointment. The foley catheter was removed if no extravasation and remained for an extra week with a repeat pcRUG if extravasation was noted. We assumed all negative initial pcRUGs would remain negative on subsequent pcRUGs. We performed statistical analysis using JMP Pro (Cary, NC) to compare the timing of pcRUGs and extravasation by repair type. Results: We identified 437 men who underwent only bulbar urethroplasty by two surgeons (GDW, ACP) from 1996 to 2013. 407 men (93%) had follow-up data available. The mean stricture length of our cohort was 1.97 cm ± 1.2 cm. Repair types were Excision and Primary Anastomosis (EPA) (n=232, 57%), Augmented Anastomotic Repair (AAR) (n=150, 37%) and Onlay repair (n=25, 6%). A 14 Fr foley catheter was placed postoperatively for all cases. In those patients who underwent EPA, we performed the1st pcRUG earlier than those who underwent AAR or Onlay repair. There was no difference in extravasation rates among all repair types (Table 1). The overall rate of extravasation on the 1st post-operative pcRUG significantly decreased in all patients (0.98% vs 5%, p=0.0008) and in those who underwent EPA (5.6% vs 0.4%, p=0.0016) when the foley catheter remained for an extra week (Table 1). Conclusion: Our findings indicate that men who undergo bulbar urethroplasty have a low extravasation rate (5.1%) on initial pcRUG with no difference among repair types. A follow up pcRUG with an additional week of foley catheterization decreases the rate to less than 1%. We now routinely leave the foley catheter for three weeks post-operatively urethroplasties and have abandoned the use of the pcRUG. Further analysis is needed to determine the cost-effectiveness of this practice.

207 Poster #71 LONG-TERM OUTCOMES OF ARTIFICIAL URINARY SPHINCTER IMPLANTATION WITH A PRIOR RECTOURETHRAL FISTULA REPAIR J. Patrick Selph, MD, Michael J. Belsante, MD, Andrew C. Peterson, MD, George D. Webster, MD, Aaron C. Lentz, MD Duke University Medical Center, Durham, NC Presented by: J. Patrick Selph, MD

Introduction: Rectourethral fistulas (RUF) are an uncommon, yet devastating occurrence after treatment for prostate cancer. Management is a surgical challenge and after successful repair, some men will be left with bothersome urinary incontinence. An artificial urinary sphincter (AUS) is a viable salvage option in men with persistent urinary incontinence after fistula repair (American Medical Systems, Minnetonka, MN, USA). In this study, we sought to determine the long-term outcomes of AUS implantation following a successful RUF repair. Methods: Between January 2006 and January 1, 2012, 26 patients underwent successful repair of an iatrogenic RUF. Stress urinary incontinence (SUI) was treated in 6 patients (23%) with implantation of an AMS 800 AUS. Preoperative and postoperative evaluation included demographic variables, voiding diaries, 24-hour pad weight, urodynamic characteristics, operative time, estimated blood loss, complication rates, follow-up time, and cuff selection. Results: All six patients underwent successful RUF repair with a modified York-Mason. Mean age was 64.3 years (range 58-74). Mean follow-up after repair was 62.2 months (range 39-109). RUF etiology included: radical prostatectomy (four), brachytherapy + external beam radiotherapy (one), and cryotherapy + external beam radiotherapy (one). All patients underwent reversal of their fecal diversion prior to AUS implantation. Average time between RUF repair and AUS was 14.7 months (range 2.3-30.2). No intraoperative complications occurred during AUS implantation. The average operative time was 61.8 minutes with an estimated blood loss of 24 mL. The initial cuff size selected was 4.0 or 4.5 cm and no patient required transcorporal cuff placement. Pad use was reported as ≤ 1 pad per day in 100% (six of six patients) of AUS patients at the initial three-month follow-up. No patients required revision or removal for mechanical complications, infection, or erosion. No patient had recurrence of their previously repaired RUF or new onset fecal incontinence. Conclusion: Patients who require placement of an AUS after a RUF repair seem to fare just as well as patients who undergo primary AUS implantation with seemingly no increase rate of complications postoperatively.

Po st e rs

208 Poster #72 LONG-TERM RESULTS OF SALVAGE AUTOLOGOUS FASCIAL SLING PLACEMENT AFTER FAILED SYNTHETIC MIDURETHRAL SLING FOR STRESS URINARY INCONTINENCE IN WOMEN Andrew Davidiuk, MD1, Bhupendra Rawal, MS2 and Steven Petrou, MD3 1Mayo Clinic Florida, Jacksonville, FL; 2Department of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL; 3Department of Urology at Mayo Clinic Florida, Jacksonville, FL Presented by: Andrew Davidiuk, MD

Introduction: We report long-term surgical outcomes for females who underwent salvage autologous fascial sling (AFS) placement after a failed synthetic midurethral sling (MUS). Methods: Following IRB approval, female patients with repeat AFS placement without concomitant pelvic surgery for a failed MUS utilizing mesh greater than 36 months ago were identified. Patient data collected included: date of surgery, age at time of surgery, removal of failed concomitant sling, type of failed MUS, presence of urinary urgency at the time of the salvage sling, date of last clinic visit, and continence status. In addition, attempts were made to contact the patients by telephone and administer the Patient Global Impression of Improvement (PGI-I), and Medical, Epidemiologic, and Social Aspects of Aging (MESA) urgency portion questionnaires and document current age, additional anti-incontinence operations or procedures since the salvage therapy, and desire to recommend the repeat surgery. Statistical analysis of data utilized either Fisher exact or Wilcoxon rank sum exact. Results: Seventeen patients were successfully contacted by telephone and completed the planned interview. Median age at surgery was 66 years old (range: 53-81) with 11 (64.7%) having documented urinary urgency pre−operatively and 8 (47.1%) having concomitant sling excision at the time of the salvage operation. The median age of patients surveyed was 71 years old (range: 63-84) with a median follow up of 66 months (range: 36-127). Current median MESA urgency score was 28 (range: 0-94). Of the 17 failed MUS slings, 12 were retropubic and five were transobturator. Total success as scored by PGI-I was noted in 12 patients (70.6%). Nine of 12 (75%) failed retropubic slings were successfully salvaged, while three of five (60%) failed transobturator slings were salvaged. There was no statistical difference in successful salvage rates between the two types of surgeries (p=0.60). One patient had an additional anti-incontinence surgery (5.9%). Positive surgical recommendation was given by 14 patients (82.4%). No patient currently requires CIC. A higher MESA urgency score was significantly associated with non-success (p=.024). Failure was not significantly correlated with sling excision (p=0.62). Preoperative urgency had no significant correlation with long term success on PGI-I (p=0.06). Also not significantly impacting PGI-I success were age at surgery (p=0.10), age at follow up (p=0.064) or longer length of follow up (p=0.51). Conclusion: Autologous fascial slings provide reasonable success long term as a salvage operation for failed mesh slings. Post-operative urinary urgency is significantly associated with negative outcomes.

209 Poster #73 WITHDRAWN

Poster #74 DIFFERENTIAL EFFECTS OF STEPWISE PHARMACOLOGICAL AUTONOMIC DENERVATION OR DIRECT SMOOTH MUSCLE RELAXATION ON URODYNAMIC INDICES IN CHRONIC SPINAL CORD INJURED RATS Matthew O. Fraser, PhD1, Danielle J. Degoski, BS2, Jillene M. Brooks, MS2 and Paul C. Dolber, PhD3 1Division of Urology, Department of Surgery and Department of Research and Development, Duke University and Durham Veterans Affairs Medical Centers, Institute for Medical Research, Durham, NC; 2Institute for Medical Research, Durham, NC; 3Division of Surgical Sciences, Department of Surgery and Department of Research and Development, Duke University and Durham Veterans Affairs Medical Centers, Durham, NC Presented by: Matthew O. Fraser, PhD

Introduction: Suprasacral spinal cord injury (SCI) often results in detrusor overactivity, causing low compliance and dangerously elevated bladder contraction pressures. We determined the relative contributions of parasympathetic and sympathetic nervous systems and spontaneous myogenic activity on urodynamic indices in chronic SCI rats. Methods: Chronic female SCI rats (>4 weeks) underwent conscious cystometry and drug treatment to achieve autonomic denervation (parasympathetic or sympathetic) or direct smooth muscle relaxation (n=10-12/ group). Following one-hour recovery from surgery and one-hour control cystometry, infusion pumps were stopped, bladders were emptied, vehicle controls were administered i.v. in all rats, and pumps were restarted. This pattern was repeated hourly. Control group animals received three additional vehicle doses. In the parasympathetic denervation (PD) group, rats sequentially received atropine (A; antimuscarinic), NF−449 (NF; purinergic antagonist) and hexamethonium (HEX, autonomic ganglion blocker). The sympathetic denervation (SD) group received phentolamine (P; α-adrenergic antagonist), propranolol and SR59230A (complete β-adrenergic block) and HEX. The smooth muscle relaxant (SMR) group received verapamil (V; Ca2+ channel blocker), CL-316,243 (CL; β3- adrenergic agonist) and isoproterenol (ISO; β1-3-adrenergic agonist). Data were analyzed by 2-Way Repeated Measures ANOVA, p<0.05 was considered significant. All reported results were significant. ^ = increased, as up arrow does not work. Results: We report true bladder capacity (TBC), functional bladder capacity (FBC), voiding efficiency (VE) and maximal bladder contraction amplitude (BCA). For PD, A ^ TBC (~60%) and ↓ BCA (~23%), but had no effect on FBC or VE. NF additionally ^ FBC (70%). HEX ^ Po st e rs TBC (130%) and reversed the NF effect on FBC. For SD, the only effects seen were with P ^ FBC and VE (55% and 30%, resp.), and HEX on TBC (130%). For SMR, V ^ VE (75%), and CL and ISO ^ TBC (30% and 130%, resp.), while only ISO ^ FBC and VE (150% and 75%, resp.). CL and ISO ↓ BCA by 16%. Conclusion: That specific PD ^ TBC and SD had no effect suggests ongoing parasympathetic tone during filling with no ongoing sympathetic influence in the bladder. Only α-adrenergic blockade had any effect in specific SD, and that was likely on urethral smooth muscle dyssynergia. A strategy combining parasympathetic and α-adrenergic block with direct bladder smooth muscle relaxation may ultimately provide the best therapeutic results. Funding Source: DOD, SCIRP IIR - SC110031 to MOF

210 Poster #75 REGENERATION OF TISSUE THROUGH ENDOGENOUS CELL RECRUITMENT Young Min Ju, PhD, James Yoo, MD, PhD, John Jackson, PhD, Sang Jin Lee, PhD, Anthony Atala, MD Wake Forest School of Medicine, Winston Salem, NC Presented by: John Jackson, PhD

Introduction: Conventional reconstructive procedures for repairing volumetric tissue defects involve the use of tissue flaps or grafts. However, this approach is not feasible in all cases. Tissue engineering strategy, which utilizes a cell-based scaffolding system, offers a promising solution to repair tissue defects. We investigated whether host cell resources could be utilized in situ to facilitate tissue regeneration, which would obviate the need for in vitro cell processing. Methods: We examined whether endogenous stem or progenitor cells could be mobilized and recruited into target-specific sites for in situ tissue regeneration. To determine whether muscle progenitor cells can be activated and directed into a biomaterial, nonwoven porous poly (L-lactic acid) (PLLA) scaffolds were implanted in the leg muscle of rats. The implanted scaffolds were retrieved at predetermined time points and infiltrating host cells were characterized. To determine whether infiltrating cells are able to differentiate into myogenic cells in vivo, gelatin-based scaffolds containing myogenic factors (HGF, SDF-1α, IGF-I, and bFGF) were implanted in the tibialis anterior (TA) muscle. Results: The scaffolds were retrieved at predetermined time points followed by characterization using Pax7 and MHC antibodies. The retrieved scaffolds showed progressive tissue ingrowth, consisting of inflammatory and stromal mesenchymal-like cells. Host muscle progenitor cells were present as evidenced by Pax7 expression. Formation of muscle fibers expressing Pax7 increased in the implants containing myogenic factors, suggesting that these factors can be used to mobilize and remodel muscle tissue. Conclusion: This study demonstrates that cells expressing muscle progenitor cell markers can be mobilized into an implanted biomaterial and that these cells are capable of differentiating into muscle cells. It may be possible to enrich the infiltrate with specific cell types and control their fate, provided the proper substrate-mediated signaling can be imparted into the scaffold. This study suggests that it may be possible to use the body’s biologic and environmental resources for in situ muscle tissue regeneration.

211 Poster #76 REVIEW OF DIFFICULT CATHETER CONSULTS OVER ONE YEAR AT A SINGLE TEACHING HOSPITAL Lindsey Hartsell, MD, Glen Lau, MD, Amanda Pettibone-Pond, MD, Robert Wake, MD UTHSC, Memphis, TN Presented by: Lindsey Hartsell, MD

Introduction: Assistance with urinary catheter placement is a common reason for urologic consultation. Many obstacles can make catheter placement more difficult, including strictures, false passages, phimosis, edema and BPH. Successful catheter placement is sometimes achieved by using different techniques or types of catheters, while other times more invasive methods are required. Here we review previous consults to see what methods were used for catheter placement. Methods: All urology consultations received at a single teaching hospital over a one-year period were reviewed. The consultations requesting assistance with Foley catheter placement were further examined to discover the intervention required to ultimately place the catheter. Results: After reviewing all the consults between June 2013 to July 2014, 43 involved difficulty placing a Foley catheter. Of the 43, 28 (65%) were addressed by non-invasive means, including manual compression of foreskin edema, change in catheter type, and using proper technique. The remaining 15 (35%) required more invasive means such guidewire use, flexible cystoscopy, and stricture dilation. Conclusion: While some consultations for difficult catheter placement will ultimately require invasive means for placement, often, successful catheterization can be achieved by improved technique or a change in catheter type. This highlights the importance of proper training for the hospital staff involved in Foley catheter placement. We currently are working with nursing education at this hospital, and have developed a training video, which reviews proper catheter placement technique along with ways to avoid catheter related trauma. Po st e rs

212 Poster #77 PREDICTORS OF UPPER TRACT UROTHELIAL CARCINOMA IN PATIENTS WITH A HISTORY OF BLADDER CANCER Zachary Klaassen, MD1, Rita P. Jen, MPH1, Lael Reinstatler, MPH1, Daniel Belew1, John M. DiBianco2, Qiang Li, MD, PhD1, Rabii Madi, MD1 and Martha K. Terris, MD1 1Medical College of Georgia − Georgia Regents University, Augusta, GA; 2Ross University School of Medicine, Dominica, West Indies Presented by: Zachary Klaassen, MD

Introduction: Patients with a history of bladder cancer (BC) are at a ~10-30% increased risk of subsequent upper tract urothelial carcinoma (UTUC). Despite this risk, the sociodemographics of these patients are not well defined. The objective of this study was to use a population based cohort to delineate predictors of UTUC in patients with a history of BC. Methods: Adults with a primary diagnosis of UTUC were extracted from the Nationwide Inpatient Sample (NIS) database, a part of the Healthcare Cost and Utilization Project (HCUP), from 2000 to 2010 (n=7,397). Variables of interest included age, gender, race, insurance status, and a history of BC, diabetes mellitus (DM), hypertension (HTN) and/or chronic kidney disease (CKD). Descriptive statistics and multivariable logistic regression models were performed to generate odds ratios (OR) to identify predictors of having a history of BC in patients with UTUC. Results: There were 752 UTUC patients (10.2%) with a history of BC and 6645 UTUC patients (89.8%) with no history of BC (no BC). Increasing age (by decade) (p<0.001), male gender (BC 72.2% vs no BC 57.5%, p<0.001), insurance status (Medicare – BC 74.6% vs no BC 63.6%; private – BC 21.0% vs. no BC 29.1%, p<0.001), and history of CKD (BC 10.5% vs. no BC 6.3%, p<0.001) was associated with a history of BC. There was no difference in race or incidence of DM or HTN between the two groups. Adjusting for age, gender, race, insurance status and history of CKD, independent predictors of a history of BC in patients with UTUC included male gender (OR 1.99, 95%CI 1.64-2.41, p<0.001) and history of CKD (OR 1.44, 95%CI 1.07-1.93, p=0.02). Conclusion: Patients with a history of BC that are male and/or have CKD are at a significantly increased risk of developing UTUC. In the current study, the etiology of CKD was not secondary to HTN and/or DM and requires further analysis to clarify the true etiology. This information may be helpful in counseling high-risk patients with BC regarding the importance of judicious upper tract surveillance.

213 Poster #78 TISSUE IS THE ISSUE: THE IMPACT AND BENEFIT OF PATHOLOGICAL REVIEW FOR UROTHELIAL CARCINOMA OF THE BLADDER AT A TERTIARY CARE CANCER CENTER Adam Luchey, MD1, Neal Manimala, MD2, Shohreh Dickinson, MD2, Jasreman Dhillon, MD2, Gautum Agarwal, MD2, Scott Gilbert, MD2, Philippe Spiess, MD2, Wade Sexton, MD2, Julio Pow-Samg, MD2 and Michael Poch, MD2 1H. Lee Moffitt Cancer Center, Tampa, FL;2 H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Adam Luchey, MD

Introduction: Treatment for Urothelial Carcinoma (UC) is driven by accurate pathological diagnosis of grade and stage of a transurethral bladder biopsy. Currently there is a paucity of data supporting the benefit of having biopsy tissue re-examined by dedicated GU pathologists. Our objective was to assess the extent of change from a pathological re-review of bladder biopsies performed and read at community hospitals and the impact it has on a patient’s treatment for UC. Methods: All patients with UC that were referred to our institution from 2009-2013 were eligible for this study. There were 1,386 cases that were reevaluated by GU dedicated pathologists, of which 1,191 had transurethral biopsy of the bladder and/or prostatic urethra. Major treatment changes were defined as altering recommendations for cystectomy, systemic chemotherapy regimen, or primary cancer diagnosis. These differences were secondary to understaging/overstaging or variant histology. Minor treatment changes were considered to be reclassifications in grade or stage that would potentially alter intra-vesical instillation regimens. Results: There were 322/1191 patients (27.0%) with a pathological change on review: grade 62/1191 (5.2%), stage 115/1191(9.7%), presence or absence of muscle in the specimen 29/1191 (2.4%) as well as the presence or absence of CIS 34/1191 (2.9%). Outside pathology did not address on the presence or absence of LVI in 620/759 (81.7%) of invasive cases (>pT1), of which, 35/620 (5.6%) were found to have LVI on review. Variant histology was detected in 200/1191(16.8%) with 117/200 (68.5%) resulting in reclassification by our pathologists to a distinct diagnosis. Only 2/33 (6%) micropapillary, 8/17 (47%) sarcomatoid and 0/3 plasmacytoid histological variants were accurately identified at referring hospitals. Any recommended treatment changes accounted for 187/1191 (15.7%) of cases with 141/1191 (11.8%) imparting major changes. There were 82/1191 (6.8%) changes in recommendation for a radical cystectomy, 21/1191 (1.8%) for change in chemotherapy regimen, and 38/1191 (3.2%) had a complete change in primary tumor type. Conclusion: The large number of patients with major changes in treatment demonstrates the importance of having patients with a diagnosis of UC to have their histology reviewed by high Po st e rs volume GU dedicated pathologists, as the effect on treatment and diagnosis is undeniable.

214 Poster #79 THE IMPACT OF DEFINITIVE PROSTATE CANCER TREATMENT ON POSITIVE MARGINS AT TIME OF RADICAL CYSTECTOMY Adam Luchey, MD1, Hui-Yi Lin, PhD2, Binglin Yue, PhD2, Gautum Agarwal, MD2, Julio Pow- Sang, MD2, Philippe Spiess, MD2, Michael Poch, MD2, Scott Gilbert, MD2, Jorge Lockhart, MD2 and Wade Sexton, MD2 1H. Lee Moffitt Cancer Center, Tampa, FL; 2H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Adam Luchey, MD

Introduction: Positive soft tissue surgical margins (PSM) during the time of radical cystectomy (RC) drastically diminish cancer specific survival (CSS). Definitive treatment of prostate cancer (DTPC) has been linked to a delay in bladder cancer diagnosis, higher grade at time of RC, and more aggressive histological variants leading to a poorer survival. Our objective was to evaluate an existing link between DTPC and its effect on PSM. Methods: There were 749 patients that underwent RC between 2000-2013. After excluding females and non-urothelial histologies, there were 561 men identified, of which 69 (12.3%) received single or multimodal DTPC (external beam radiation [7.1%], brachytherapy [7.0%], prostatectomy [1.1%], cryotherapy [0.2%] or hormonal therapy [3.4%]). We evaluated whether DTPC was associated with PSM as well as survival. Comparisons between categorical and continuous variables were analyzed using Fisher’s Exact Test and Wilcoxon Rank-Sum Test, respectively. Univariate and multivariable logistic regressions were used to determine the association between DTPC and PSM. Univariate and Multivariable Cox regression models were used to investigate the impact of DTPC and PSM on overall survival (OS) and recurrence-free survival (RFS). Competing risk regressions were also used to evaluate factors associated with CSS. Results: Median age for the male population was 70.0 (IQR: 62.5, 76.5). There were 57 PSM in our cohort of 561 men (10.2%). In men who underwent DTPC, 20/69 (29.0%) had PSM compared to 37/492 (7.5%) in men who never received DTPC (p < 0.0001). Brachytherapy (OR =6.89, CI: 3.30-14.36), radiotherapy (OR=3.57, CI: 1.58-8.06), hormonal therapy (OR=3.28, CI: 1.04-10.39) and prostatectomy (OR=6.15, CI: 1.09-34.69) alone or in combination significantly increased the PSM rate in the univariate analysis. Brachytherapy remained an independent predictor when controlling for other PSM−related variables (OR=4.79, CI: 1.83-12.55). PSM was associated with OS (HR=2.79, CI: 1.74-4.44), RFS (HR = 3.11, CI: 2.00-4.83), and CSS (HR = 4.16, CI: 2.36-7.33). Although a history of DTPC increased PSM, it did not have a direct impact on OS or RFS. Conclusion: Patients with a history of DTPC, specifically brachytherapy, are at increased risk of having PSM. In addition, PSM decreased OS, RFS and CSS. Careful planning along with wide surgical excision is crucial in dealing with patients undergoing a RC with a history of DTPC.

215 Poster #80 RADICAL CYSTECTOMY WITH CURATIVE INTENT FOR REFRACTORY CARCINOMA IN SITU OF THE BLADDER: INSIGHT INTO PATIENT OUTCOMES AND PATTERNS OF CARE Gautum Agarwal, MD, Oscar Valderrama, MD, Patrick Espiritu, MD, Adam Luchey, MD, Jorge Lockhart, MD, Julio Pow-Sang, MD, Wade Sexton, MD, Michael Poch, MD, Philippe E. Spiess, MD H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Gautum Agarwal, MD

Introduction: Determining whether to recommend radical cystectomy (RC) for patients with carcinoma in situ (CIS) of the bladder is dependent upon multiple factors including patient preference, accurate clinical staging and response to intravesical therapy. The purpose of this study was to determine the effects on upstaging and complications of late compared to early RC in patients with primary CIS of the bladder. Methods: We performed a single institution, IRB approved, retrospective review of patients who underwent RC for bladder cancer (BC) from 2001-2013. Statistical analyses (Kaplan- Meier) were performed between multiple variables including: age, number of TURBT’s performed, number of induction intravesical instillations (IVT), time from initial diagnosis to RC, complications based on the Clavien-Dindo scoring system, and ASA score. The early RC group included patients who had ≤ 2 IVT’s, or < 24 months between diagnosis and RC. Results: Seven hundred thirty-two patients were identified who underwent RC for BC; of this group 42 patients had primary CIS prior to surgery. There were 21 patients each in the early and late cystectomy cohorts. The median age of all patients was 73 years old (IQR 66-77), time from diagnosis to RC was 27 months (IQR 11-59), number of TURBT’s performed 3.5 (IQR 2.8-5) and IVT’s 2.5 (IQR 2-4). The median overall survival (OS) was five years (95% CI 3.3-6.8) and there was no significant difference in OS between early and late RC groups, p=0.37. Overall 31% of patients were upstaged (from CIS to cT1−T4 disease), with 43% upstaging in the late group compared to 21% for the early group. Older patients (p= 0.048) and those with higher ASA scores (p = 0.02) were more likely to have > 2 IVT’s and ≥ 24 months between diagnosis and RC respectively. Patients who had a late cystectomy were subject to a complication rate of 67% compared to 42% for those with early cystectomy. All patients except 2 received an induction course of BCG after their first TURBT. Po st e rs Conclusion: Our results demonstrate an increase in the number of patients that were upstaged and a higher complication rate in the late compared to early RC group for CIS of the bladder. In addition, patients who have a higher ASA score or are older are more likely to undergo late RC. In order to achieve optimal outcomes for patients with BCG refractory CIS of the bladder, it is imperative to perform radical cystectomy in a timely manner.

216 Poster #81 SHORT-TERM COMPLICATIONS RESULTING FROM TRANS-URETHRAL RESECTION OF BLADDER TUMOR IN A CONTEMPORARY SERIES Benjamin McCormick1, Justin Gregg, MD1, Li Wang, MS2, Joseph Smith, MD1, Daniel Barocas, MD, MPH1, Matthew Resnick, MD, MPH1, Daniel Sun, MD1 and Sam Chang, MD1 1Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN; 2Vanderbilt University Medical Center, Department of Biostatistics, Nashville, TN Presented by: Benjamin McCormick

Introduction: Transurethral resection of bladder tumor (TURBT) is essential in the diagnosis and management of non-muscle invasive bladder cancer (NMIBC). While rates of immediate complications such as bleeding and perforation following TURBT are well known, short-term complications of TURBT have been poorly characterized. We assessed the short-term rate and severity of complications after TURBT for non-muscle invasive bladder cancer (NMIBC) in a large cohort. Methods: From 2002-2011, 408 patients underwent TURBT at our institution for clinically localized urothelial cell carcinoma. Initial and subsequent TURBTs were reviewed for both immediate complications and those diagnosed within two weeks of surgery. Review was completed via use of the electronic medical record and included all patient visits, outside medical record documentation and outpatient phone calls recorded during the time period. Complications were classified using the Clavien-Dindo scoring system. We fit a multivariable logistic regression to determine whether age, ASA class, complication prior to arrival at our institution, tumor grade and stage were independently associated with complications after TURBT. Results: Out of a total of 721 TURBTs, 53 (7.4%) resulted in a complication. 42 out of 408 (10.3%) patients suffered a complication, with 11 patients suffering from multiple complications. Most of the complications were not severe in nature, with 22 (41.5%) being Clavien−Dindo grade I and 24 (45.3%) being grade II. Four (7.5%) patient complications required operative intervention (grade III). Two (3.8%) patients suffered from grade IV complications, one of which involved emergent perioperative coronary artery bypass grafting. One patient died (grade V) after being admitted to an outside hospital for a bowel perforation over 6 days after TURBT. Overall, there was a 0.6% rate of perforation, 1.4% rate of infection, 0.8% rate of bleed requiring intervention, and 2.2% rate of urinary retention after TURBT. The majority of the complications were managed on an outpatient basis with 30 (56.6%) requiring a prescription or phone call alone. Prior complication was independently associated with short-term complication after TURBT in our multivariable model (OR 16.3, 95% CI 3.9 to 68.0, p<0.01). Conclusion: Complications after TURBT are typically not severe in nature; however, they remain common. Previous patient complications, but not other patient or tumor-related factors, were found to be associated with short-term complications after TURBT. Urologists should be mindful of prior patient complications while counseling patients about and performing TURBT for NMIBC.

217 Poster #82 TRENDS AND PREDICTORS OF PALLIATIVE CARE SERVICES AND MORTALITY IN THE TREATMENT OF ADVANCED BLADDER CANCER Tracy Rose, MD, Matthew Lyons, MD, Allison Deal, MS, E. Sophie Spencer, MD, Peter Greene, MD, Matthew Nielsen, MD, MS, Raj Pruthi, MD, Eric Wallen, MD, Matthew Milowsky, MD, Angela Smith, MD, MS Chapel Hill, NC Presented by: Matthew Lyons, MD

Introduction: Palliation is an important therapeutic approach in patients with advanced bladder cancer when options for curative therapy are limited by extensive disease, comorbidities or poor performance status. Little data exist describing patterns of care in these patients. The objective of this study is to explore the frequency and predictors of different types of palliative treatment, as well as associated mortality, in advanced bladder cancer. Methods: We identified patients with AJCC clinical stage II-IV bladder cancer from 2003- 2010 using the National Cancer Data Base (NCDB), a national outcomes database that includes about 70% of all newly diagnosed cancer cases in the US. Palliative care in the NCDB was defined as care provided to aid symptoms without attempt to diagnose or treat the primary tumor. Results: Two thousand six hundred thirteen patients were identified who received palliative care as initial therapy for advanced bladder cancer. Thirty six percent were female, 87% Caucasian, and 67% were treated at a community program. Fitty four percent had stage IV disease. Mean age was 72. The most common type of palliative treatment was radiotherapy (XRT) for all stages. Patients with stage IV disease were more likely to receive chemo in 2007-2010 compared to 2003-2006 (p<0.01). Younger patients were more likely to receive chemo than surgery or XRT (p<0.01). Patients at academic centers were more likely to receive surgery than at community centers (p<0.01). Patients who had surgery were more likely to live further from their treating institution compared to patients receiving XRT or chemo (p<0.05). Chemotherapy was associated with the longest overall survival (OS) in stage III and IV patients (11.1 and 7.5 months, respectively). Multivariate analysis showed that type of care predicts OS after controlling for age, stage, metastases, distance to treating facility, facility type, and comorbidities (p<0.01). Conclusion: The most common palliative treatment for advanced bladder cancer was XRT. Age, facility type, and distance to treating facility were predictive of type of palliative care received. Chemotherapy was associated with the longest OS in stage III and IV patients. Type of palliative care received predicts OS on multivariate analysis. Po st e rs

218 Poster #83 TEMPORAL TRENDS IN CONCOMITANT CYSTECTOMY WITH URINARY DIVERSION FOR BENIGN INDICATIONS IN THE NATIONWIDE INPATIENT SAMPLE Elizabeth T. Brown, MD, MPH, David Osborn, MD, Stephen Mock, MD, Amy Graves, MPH, Laurel Milam, Douglas Milam, MD, Melissa Kaufman, MD, PhD, Roger Dmochowski, MD, W. Stuart Reynolds, MD, MPH Vanderbilt University Medical Center, Nashville, TN Presented by: Elizabeth T. Brown, MD, MPH

Introduction: There is controversy as to whether concomitant cystectomy at the time of urinary diversion is necessary for benign indications. However, beyond single institution reports, there is little data to describe how concurrent cystectomy is employed on a national level. The goal of our study was to analyze temporal trends in the use of cystectomy at the time of urinary diversion for benign indications in a nationally representative population. Methods: We identified patients undergoing urinary diversion with or without concurrent cystectomy for benign indications from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) data from 1998-2011 using ICD-9 diagnostic and procedure codes. Patients were categorized into those who underwent diversion alone (ICD9 56.51) or with concurrent cystectomy (ICD9 57.79, 57.71). We abstracted hospital- and patient-level factors, including Elixhauser Comorbidity Index, and analyzed temporal trends by year, incorporating standard weighting techniques for NIS data. Results: A total of 3,292 patients underwent urinary diversion for benign indications during the 14-year period. 2,427 (73%) patients underwent urinary diversion only; 865 (27%) patients underwent urinary diversion with concurrent cystectomy. There was a significant increase in the proportion of urinary diversions with concomitant cystectomy from 19% to 34% (p=0.0008, Figure 1). Increasing comorbidity (p=0.026), teaching hospital (vs. non-teaching) (p=0.025), and Medicare insurance (vs. private insurance) (p=0.009) were all associated with increased concurrent cystectomy over time. Geographically, use of concurrent cystectomy decreased in the Midwest and West relative to the Northeast (p=0.033 and 0.024, respectively), with no changes in the South. Age, gender, and hospital location (urban vs. rural) did not demonstrate significant changes. Conclusion: In the U.S., there has been an overall increase in the use of cystectomy at the time of urinary diversion for benign indications, although analyses suggest that this increase has not been consistent across several factors. Opportunities may exist for further study into practice patterns and outcomes from these procedures.

219 Poster #84 IMPACT OF NEOADJUVANT SYSTEMIC CHEMOTHERAPY ON CARCINOMA IN SITU OF THE BLADDER: IMPLICATIONS FOR BLADDER PRESERVATION. Kamran Zargar-Shoshtari, MD1, Pranav Sharma1, Michael A. Poch1, Philippe E. Spiess1, Shilpa Gupta1, Jasreman Dhillon2, Julio M. Pow-Sang1, Jorge Lockhart1 and Wade J. Sexton1 1Departments of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL;2 Departments of Pathology, Moffitt Cancer Center, Tampa, FL Presented by: Kamran Zargar-Shoshtari, MD

Introduction: Neoadjuvant Chemotherapy (NAC) for muscle invasive bladder cancer is well established. However, whether contemporary NAC regimens eliminate CIS is poorly studied. This is an important consideration in patients with invasive tumor and CIS prior to the delivery of NAC, specifically when bladder preservation is desired. Method: To investigate factors predicting CIS response to NAC in patients with synchronous bladder CIS and muscle invasive urothelial cancer undergoing radical cystectomy (RC). Methods: Using an IRB approved institutional database, patients who received NAC prior to RC were identified. Fisher’s exact test was used to compare binary data. Univariate (UVA) and multivariate (MVA) models were analyzed using Logistic regression. Variables with a p-value <0.1 were included in the MVA. Kaplan-Meier and Log-Rank tests were used for assessment of progression. Bivariate correlations are expressed using Pearson coefficient (r). Results: From August 2005 to January 2013, 156 patients received NAC, 28 (18%) of whom had pathologic confirmation of CIS on TURBT specimens prior to RC. A complete transurethral resection of all visible papillary tumors was accomplished in 53% of the CIS- positive patients compared to 43% of the CIS−negative patients (p=0.344) before NAC. Eighteen of 28 patients (64.3%) had no CIS detected following NAC and RC compared to 10 patients (35.7%) with persistent CIS. On UVA, Body Mass Index (BMI) less than 30 kg/ m2 (HR 7.8, CI 1.28-44.01, p=0.026), use of cisplatin containing NAC regimens (HR 5.32, CI 0.76-37.09, p=0.091) and absence of current tobacco use (HR 9.00, CI 0.93-83.3, p=0.057) had the strongest associations with absence of CIS following NAC, and were included in the MVA. On MVA, BMI<30 was an independent predictor of CIS response to NAC (HR: 12.5 CI 1.65-134.1, p=0.037). On final pathology, CIS response to NAC significantly correlated with the presence of organ confined (≤ pT2) disease (r=0.533, p=0.003) and node negative cancer (r=0.430, p=0.020). Extranodal extension was seen only in the persistent CIS group (n=3). Metastatic progression occurred in 40% of patients with persistent CIS compared to 22% without CIS, and the median time to progression was 101 days vs. 542 days, respectively (Log Rank p=0.844). Conclusion: NAC may treat preexisting CIS in a proportion of patients and BMI may influence this response. Persistent CIS may be an indicator of poor prognosis in patients Po st e rs undergoing NAC and RC.

220 Poster #85 RACIAL AND AGE DIFFERENCES IN IMPLANTATION OF INFLATABLE PENILE PROSTHESIS (IPP) FOR ERECTILE DYSFUNCTION (ED) THE PROSTATE CANCER SURVIVOR Divya Ajay, MD1, Shubham Gupta, MBBS2, Michael Belsante, MD3, John Selph, MD3 and Andrew Peterson, MD, FACS3 1Division of Urology, Duke University Medical Center, Durham, NC; 2University of Kentucky, Lexington, KY; 3Duke University Medical Center, Durham, NC Presented by: Divya Ajay, MD

Introduction: IPP is standard treatment for post-prostate cancer treatment ED refractory to non-surgical interventions. Previous studies in Medicare beneficiaries suggest a higher utilization of IPP surgery in African-American (AA) men but this study is limited to men greater than 65 years of age. We evaluated the post-prostatectomy patient population undergoing IPP surgery at our institution to establish if these observations hold true for a younger cohort. Methods: We conducted an IRB-approved retrospective review of patients with prostate cancer who underwent radical prostatectomy (RP) (open, laparoscopic, or robotic) or primary radiation therapy (external beam or brachytherapy) at a single institution from 2004 to 2013 using our patient data portal (DEDUDE). Data on demographic variables, age at treatment, and surgical therapy for ED were reviewed. Patients of all ages and payer status were included. Results: Four thousand six hundred ninety-three men underwent RP and 1540 had primary radiation treatment. Mean age at treatment was 61.7 (SD 7.9). In patients undergoing surgery, 74.3% were Caucasian (mean age 62.7 years), 21.8% were AA (mean age 60 years), 0.9% were American Indian, 0.6% were Asian and 2.3% classified themselves as ‘other’ or declined. Among men treated with radiation, 33.8% were AA (mean age 65.3 years), while 62.6% were Caucasian (mean age 67.8 years). 0.5% were American Indian, 0.6% were Asian and 2.5% were other or unknown. The IPP utilization for the entire cohort was 1.5%. Men undergoing RP had a higher penile implantation rate compared to men who received radiation (1.8% versus 0.6%, p=0.0003). In men treated with primary radiation, higher implantation rates were seen in AA men (1.1%) as compared to white Caucasian men to (0.2%) (p=.03). In patients who had a RP, there was a trend toward higher implantation rates in AA men as compared to white Caucasians (2.3% versus 1.7%, p= 0.2). Men who received an IPP were younger at the time of primary therapy as compared to men who did not. For RP: 61.8 (SD 7.9) versus 60.2 (SD 7.3) (P=0.03) and for primary radiation therapy 61.2 (SD5.7) versus 67.0 (SD9.8) (p=0.008). There was no difference in IPP utilization based on ethnicity, marital status, or religion. Conclusion: We analyzed IPP utilization rates in a younger patient population than those previously reported and find that the overall use of IPP in prostate cancer survivors remains low. IPP utilizers are younger than others, survivors status post RP are more likely to receive an IPP when compared to primary radiation and while not statistically significant, those of African-American race appear to receive penile implants at higher rates. Funding source: None

221 Poster #86 OBSERVATION OF LOCAL CLINICAL PENILE PROSTHESES INFECTIONS INSTEAD OF IMMEDIATE SAVAGE RESCUE / REMOVAL: MULTICENTER STUDY WITH SURPRISING RESULTS Gerard Henry, MD1, Gary Price, MD2, Michael Pryor, MD3, Jason Greenfield, MD2, Leroy Jones, MD4, Tobias Kohler, MD5, Irwin Goldstein, MD6 and Paul Perito, MD7 1Regional Urology, Shreveport, LA; 2Urology Associates of North Texas, Arlington, TX; 3Urology Center of Spartanburg, Spartanburg, SC; 4Urology San Antonio, San Antonio, TX; 5Southern Illinois University, Springfield, IL; 6Institute for Sexual Medicine, San Diego, CA; 7Perito Urology, Coral Gables, FL Presented by: Gerard Henry, MD

Introduction: Traditionally, post-operative Inflatable Penile Prosthesis (IPP) patients with culture positive wound drainage and/or greatly increasing erythema/tenderness/swelling or skin fixation of the device several days to months post implantation underwent immediate surgical removal or salvage rescue of their IPP. Many prosthetic urologists were sued for delayed surgical treatment of IPP infections and it has been proposed at scientific meetings that this delay was the number one reason to be sued for IPP infections. However, literature shows that most IPPs have bacteria present at the time of revision/replacement of clinically uninfected IPPs indicating that the body can heal over infected devices. We evaluated patients with local clinical infections of their wounds/IPPs with observation instead of surgical therapy. Methods: At 10 centers a total of 19 patients with locally positive, but no systemic signs and symptoms of wound IPP infection were reviewed. Demographics acquired included age, race, primary etiology, diabetic or not, IPP type, presence of infection retardant coating, primary or replacement with revision number and whether washout was done. Post−op data gathered were time to signs/symptoms, primary symptom, drainage, swelling, erythema, device fixation to the skin, increasing pain/tenderness, drainage organism cultured, antibiotic sensitivity, antibiotic given (if any), time to return to sexual activity/resolution of symptoms. Results: 15 patients were retrospectively reviewed. Demographics reveal age of 47 to 80 (mean 59.7), 14 Titans/ 3 700s/ 1 Genesis/ 1 Ambicor with only the Ambicor not having an infection retardant coating and 14 (74%) primary implantation with four (21%) being replacements and 1 (5.3%) into previous infected IPP scarred corporal bodies. Time to local wound infection after implantation was 7 to 40 days (mean 19.1 days), 18 (94.7 %) had incisional wound drainage with some described as large quality of fluid, five (26.3%) had significant swelling, six (31.7%) had localized erythema, one (5.3%) had device skin fixation and five (26.3%) of the 19 patients had significant increase in IPP pain/tenderness. Eleven different bacteria isolates were cultured out of the incisional drainage of nine patients Po st e rs with three Staph Epi, two pseudomonas, one enterococcus, two E. coli, one staph aureus, one alpha streptococcus and one proteus growths. Time to total resolution of symptoms was three-141 (mean 58.4) days: 17 patients having total resolution of symptoms and two currently under observation. Conclusion: Observation maybe an option for patients with local signs/symptoms of IPP infection, even with incisional drainage of culture positive bacteria, that traditionally indicated immediate surgical intervention.

222 Poster #87 COLOR DUPLEX DOPPLER ULTRASOUND (CDDU) ANALYSIS OF CAVERNOUS VENOUS OCCLUSIVE DISEASE (CVOD) PATIENTS: ARE ARTERIOGENIC RISK FACTORS IMPLICATED? Ram Pathak, MD, Russell Chavers, Gregory Broderick, MD Mayo Clinic Jacksonville, FL Presented by: Ram Pathak, MD

Introduction: CVOD is defined as a failure to maintain adequate erections despite appropriate arterial inflow and can be non-invasively diagnosed by CDDU analysis. The aim of our research is to evaluate the relationship between arteriogenic risk factors of Erectile Dysfunction (ED) and CVOD, as well as determine the severity of CVOD via CDDU analysis. Methods: A retrospective review was conducted on patients who underwent office testing with intracavernous pharmacologic erection augmented by visual sexual stimulation and analysis by CDDU from January 2010 to June 2013. Patients were diagnosed by pure CVOD, defined by persistent diastolic flows yielding resistive indices (RI) less than 1.00, given a peak systolic velocity (PSV) greater than 35 cm/s (RI=PSV-EDV/PSV). Arteriogenic risk factors of hypertension, diabetes, hyperlipidemia and heart disease were noted. Sexual Health Inventory for Men scores (SHIM) were also gathered. Further subgroup analysis was performed in (A) patients refractory to phosphodiesterase-5 inhibitor therapy, (B) primary ED, (C) Peyronie’s Disease (PD) and (D) history of prostatic surgery. Results: 156 patients, who had a mean age of 60 (19-87) and a mean BMI of 27.9 (18.9- 46.0), were diagnosed with CVOD. Forty-nine percent 16%, 41%, and 12% of patients reported hypertension, Diabetes, hyperlipidemia, and heart disease, respectively. PD represented 64/156 (41%) of the overall sample. Subgroup analysis of groups A-B can be seen in Table 1. SHIM and observed erectile rigidity scores were statistically compared to CDDU parameter of RI in an attempt to correlate self-rated ED with observed severity of ED based on in-office pharmaco-testing. Based on calculated RI, we propose an evidence based classification of CVOD as mild, moderate or severe. Conclusion: Our data suggest that arteriogenic risk factors do no correlate well with CVOD. No investigated variable represented more than 50% of our population. Therefore unlike arteriogenic ED, the etiology and risk factors for CVOD remain indeterminate. Subgroup analysis demonstrated that the history of prostate surgery negatively impacts RI values. Moreover, PD appears to play a significant role in the development of CVOD.

223 Poster #88 SURGICAL MANAGEMENT OF ERECTILE DYSFUNCTION IN THE VETERANS AFFAIRS (VA) POPULATION John Lacy, MD, Jonathan Walker, MD, David Preston, MD University of Kentucky and VA Medical Center, Lexington, KY Presented by: John Lacy, MD

Introduction: Age and sociodemographic factors have been shown to influence types of penile implants placed in civilian populations. We sought to evaluate the surgical management of erectile dysfunction in the VA system, theoretically removing the influence of insurance on type of implant placed. We also sought to study the incidence of primary implant placement compared to revision surgery as age increases.

Methods: A retrospective chart review was performed using the VA Informatics and Computing Infrastructure (VINCI) database to access the Corporate Data Warehouse (CDW). Current Procedural Technology (CPT) codes were used to define a cohort of any male who underwent penile prosthesis placement or removal between 1/2000 and 12/2013. Data were then grouped and analyzed based on age, race and CPT code. Results: A total of 11,486 procedures were performed during the study on a total of 9,223 patients. Mean number of procedures per patient was 1.25 and mean age at time of surgery was 63.2 years. 7,765 procedures (67.6%) performed were primary implant placements and the remaining 3,721 procedures (32.4%) were revision procedures. Of the primary placements, there were 6,705 (86.3%) inflatable penile prostheses and 1,060 (13.7%) malleable penile prostheses placed. There were no differences in type of implant placed based on age or race. There were no differences between type of surgery or numbers of surgeries per patient between races. As age increased there were fewer implant placements and more revision surgeries, as well as more implant removals without replacement (see chart below). Conclusion: In contrast to previously studied populations, age and race do not appear to play a role in the selection of malleable penile prostheses compared to inflatable penile prostheses in the veteran population. As veterans age, they are more likely to undergo revision surgery and more likely to have implants removed without replacement. Further studies are warranted to determine preoperative risk factors for eventual revision surgery. Po st e rs

224 Poster #89 JUST THE TIP: CLOSED−SUCTION DRAIN CULTURES AFTER IMPLANTATION OF PENILE PROSTHESES Jonathan Beilan, MD, John Hoenemeyer, BS, MS, Jared Wallen, MD, Daniel Martinez, MD, Justin Parker, MD, Carrion Rafael, MD Department of Urology, University of South Florida, Tampa, FL Presented by: Jonathan Beilan, MD

Introduction: Closed-suction drains are frequently used in penile prosthetic surgery to prevent post-operative hematoma formation. Use of these drains raises concern that such foreign bodies may actually increase the risk of infection by serving as a conduit for skin flora and other pathogens to migrate in a retrograde fashion into the surgical site. This study serves to analyze and present the culture results of these drains, taken at different distances from the skin, to assess for bacterial colonization. The study aims to verify that use of close- suction drains after penile prosthesis implantation is a sound post-operative technique to aid with hematoma prevention. Methods: This study updates our previous series of post-operative drains with an additional 10 surgeries, of which cultures were obtained from both the distal tip and the proximal end of each drain. The drains were left in 48 or 72 hours. An alcohol pad was first used to cleanse the surrounding skin prior to removing the drain in the standard fashion and sending the two portions for anaerobic and aerobic culture. Care was taken not to contaminate the drain specimens as both the distal tip and a section 1 cm from the skin were collected. Results: All 10 patients received a standardized regimen of pre- and postoperative antibiotics. None of the surgical cases had any evidence of hematoma formation at the time of drain removal. All 10 distal drain tip cultures were negative for bacterial growth after the standard 48-hour incubation period. Only one of the ten proximal sections (taken 1 cm beneath the level of the skin), grew bacteria. This culture resulted in two colony forming units (CFU) of Staphylococcus (coagulase negative); the other nine proximal specimens showed no growth. Conclusion: Hematoma formation after penile prosthetic surgery can cause patient discomfort, increased postoperative recovery time, and may even act as a medium for bacterial proliferation. In our series of prolonged drainage for at least 48 to 72 hours, none have developed infections or hematomas. Opponents of drain placement endorse the argument that there exists a hypothetical risk that longer drain placement is associated with a higher likelihood bacteria may contaminate the surgical site and compromise the implant. We present our initial series of differential drain cultures, taken at the distal tip of the drain and more proximally beneath the skin. Of our initial 10 patients, neither the distal nor proximal sections of the drains showed significant bacterial growth. While drain placement is still a surgeon preference, this data further supports the safe use of closed suction drains in penile prosthetic surgery for the prevention of hematoma formation.

225 Poster #90 THE CARRION CAST: AN UPDATE ON THE USAGE OF THE INTRACORPORAL ANTIMICROBIAL DOPED SPACER FOR THE TREATMENT OF PENILE IMPLANT INFECTION Daniel Martinez, MD, Eihab Alhammali, MD, Tariq Hakky, MD, Justin Parker, MD, Rafael Carrion, MD University of South Florida, Tampa, FL Presented by: Daniel Martinez, MD

Introduction: Since the inception of the penile prosthesis, infection has always been a significant risk. With the advent of antibiotic coated implants the rate has decreased to 1-3%, and with the “no touch technique,” 0.7%. Despite this, infection is still a reality, and a devastating complication; resulting in a decrease in penile size, increase in pain, and loss of sexual function. We present our updated series of the “Carrion Cast,” antimicrobial spacer that maintains size while treating infection, bridging the gap between explantation and reimplantation. Methods: From May 2012 to February 2014, nine cases have been performed using high purity CaSO4 mixed with antimicrobials for the management of infected penile prosthesis in patients who are not candidates for immediate salvage. All cases had either already failed an immediate salvage and/or presented with bacteremia/septicaemia. Five were Coloplast Genesis Semirigid Penile Prosthesis (SRPP), two were Coloplast Titan Inflatable Penile Prosthesis (IPP), and two were narrow SRPP’s, sizes ranging from 17 cm to 23 cm. All cases underwent complete removal of prosthetic material and modified “Mulcahy Salvage”wash. The amount of CaSO4 used varied, depending on the volume of corpora (20−30cc, split between the two corpora). Serum calcium, vancomycin and tobramycin levels remained stable while the cast was palpable within the corpora. Results: Time to reimplantation varied (six-18 weeks), but most at 6 weeks, the time it takes for the cast to dissolve. All patients were able to have a prosthesis replaced: one SRPP, three IPP’s, two narrow SRPP’s, and one narrow IPP, with sizes ranging from 17 cm to 20 cm; two cases are still pending reimplantation. The mean loss of penile prosthesis length was only 1.1 cm, meaning the average percent of penile length maintenance was 95%. Conclusion: Penile prosthesis infection is devastating. Thanks to the “Mulcahy Salvage Protocol,” most cases can be immediately reimplanted. These cases, however, can be technically challenging, carry a higher rate of reinfection, and some patients are too sick for an immediate salvage. Thus, many infected implants undergo explantation and are left with a scarred, severely shortened penis, and inability to perform coitus. Thanks to the “Carrion Cast,” our small, yet growing series shows that they can be bridged with this antimicrobial- doped spacer, and reimplanted at six weeks, maintaining their penile length by 95%. Albeit a Po st e rs small series at this time, the “Carrion Cast” provides hope to this subset of patients that would otherwise be left in a terrible predicament.

226 Poster #91 EXERCISE AND BETTER ERECTILE FUNCTION: HOW MUCH EXERCISE IS NEEDED AND DOES RACE MATTER? Ross Simon, MD1,2, Lauren Howard, MS1,3, Daniel Zapata, MD1,2, Jennifer Frank, MPH1,2, Stephen Freedland, MD1,2 and Adriana Vidal, PhD1,2 1Duke Prostate Center, Division of Urology, Department of Surgery and Pathology, Duke University School of Medicine, Durham, NC; 2Urology Section, Veterans Affairs Medical Center, Durham, NC; 3Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC Presented by: Ross Simon, MD

Introduction: As sedentary lifestyle is associated with erectile dysfunction, there is growing interest in exercise as a form of erectile dysfunction treatment. Although many studies have highlighted the relationship between better erectile function and exercise, black men have been underrepresented in the literature. As such we sought to determine whether or not exercise is associated with better erectile function in black men, as well as define a minimum exercise threshold for which better erectile function is seen in a cross-sectional study. Methods: Our study population consisted of 296 healthy controls from a case-control study assessing risk factors for prostate cancer conducted at the Durham Veterans Affairs Medical Center (DVAMC) which contained a substantial proportion of black men (n=94; 32%). Exercise and erectile function were both determined from self-reported questionnaires. Erectile function was defined by the validated Expanded Prostate Cancer Index Composite (EPIC) sexual assessment which was analyzed as a continuous variable (sexual function score). Clinically significant better function was defined as half a standard deviation (SD) (16.5 points). Subjects were stratified into four exercise groups: < 3 (sedentary), three to 8.9 (mildly active), nine to 17.9 (moderately active), and ≥ 18 (highly active) metabolic equivalents (MET) hours/week. The associations between exercise and erectile function as well the interaction between exercise and black race were addressed utilizing multivariable linear regression analyses. All multivariable models were adjusted for age (continuous), waist circumference (continuous), race (black vs. non-black), self-reported diabetes (categorical), and smoking status (current + former vs. never). Results: Median sexual function score was 53 (SD=33). Higher exercise was associated with better erectile function (p<0.001). Importantly, there was no interaction between exercise and black race (p-interaction=0.726), meaning more exercise was linked with better erectile function regardless of race. Overall, exercise ≥18 MET hours/week predicted better erectile function (p<0.001) with a clinically significant 19.3 point higher function. Exercise at lower levels was not statistically (p>0.066) or clinically (≤10.5 points higher function) associated with erectile function. Conclusions: In conclusion, in a racially diverse cohort, exercise ≥18 MET hours/week was associated with better erectile function regardless of race. If confirmed in future randomized trials, highly active exercise may be utilized as a guideline for future treatment of erectile dysfunction.

227 Poster #92 FUNCTIONAL OUTCOMES AND FOLLOW-UP CARE AFTER PRIAPISM TREATMENT: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION Stephen Kappa MD, MBA1, Elizabeth Green, BS2, Shreyas Joshi, MD1, Melissa Kaufman, MD, PhD1 and Doug Milam, MD1 1Vanderbilt Department of Urologic Surgery, Nashville, TN; 2Vanderbilt University School of Medicine, Nashville, TN Presented by: Stephen Kappa MD, MBA

Introduction: To assess functional outcomes and follow-up care after priapism treatment in a contemporary cohort of patients. Methods: Retrospective review of consecutive priapism cases at a single institution from January 2005 to June 2014 was performed utilizing an inpatient Urologic Surgery consultation database. After providing informed consent, patients completed a telephone survey consisting of the International Index of Erectile Function (IIEF)−15, Erection Hardness Score (EHS), and follow-up care since their last priapism episode. Results: There were 102 uniquely presenting cases of priapism during the study period from a total of 62 patients. Survey data was collected on 30 priapism cases (29.4% of total cases) from 13 patients (21.0% of total patients). Mean follow-up time from last priapism case was 30.1 +/− 25.6 months. Mean IIEF-15 was 37.9 +/− 21.3, with erectile function domain score of 13.9 +/− 11.5. Mean EHS was 3.7 +/− 0.7, with two patients reporting no erections during the followup period. The surveyed cohort was young (mean age 31.9 +/− 11.2 years) with sickle cell disease as the most common etiology (17 cases, 56% of cohort). Sickle cell patients reported similar functional outcomes (mean IIEF−15 of +/− 37.1 +/− 21.5, with erectile function domain score of 13.9 +/− 11.5) compared to patients with other priapism etiologies (mean IIEF−15 of +/− 38.8 +/− 22.7, with erectile function domain score of 13.9 +/− 11.8). Only two patients experienced additional episodes of priapism. Hematoma was reported after 16.7% of cases. Less than half of patients (36.7%) ultimately saw a urologic surgeon in follow-up. Conclusion: Long-term functional outcomes and follow-up from this large priapism case series reveals mild to moderate erectile dysfunction in a relatively young surveyed cohort with sickle cell disease as the predominant priapism etiology. Patients reported rare subsequent priapism episodes, relatively few complications after treatment, and poor urologic follow-up. This study demonstrates the feasibility of obtaining long-term follow-up data on priapism patients and provides a framework for further studies.

Po st e rs

228 Poster #93 THE PRESENCE AND ETIOLOGY OF ERECTILE DYSFUNCTION (ED) IN PEYRONIE’S DISEASE (PD) PATIENTS AS DEMONSTRATED BY COLOR DOPPLER DUPLEX ULTRASOUND (CDDU) ANALYSIS Ram Pathak, MD, Russell Chavers, Gregory Broderick, MD Mayo Clinic Jacksonville, FL Presented by: Ram Pathak, MD

Introduction: Peyronie’s Disease (PD) is a fibrotic disorder affecting the tunica albuginea of the corpora cavernosa. The location of the plaque and penile deformity can occur anywhere along the pendulous shaft, with the majority occurring along the dorsal midline. Erectile Dysfunction (ED) secondary to PD may be secondary to the penile deformity and the resultant changes in hemodynamic parameters. The aim of this study is to define CDDU characteristics in PD, with specific attention to describing the presence and etiology of ED in these patients. Methods: A retrospective review was completed of all patients who underwent office testing with intracavernous pharmacologic erection augmented by visual sexual stimulation and CDDU from January 2010 to June 2013 by one Urologist. Patients were further characterized by age, BMI, degree of penile curvature, cardiovascular risk factors, co-morbid diagnosis of Dupuytren’s contracture or hypogonadism, tunical plaque characteristics, Sexual Health Inventory for Men score (SHIM), and prior prostate surgical history. CDDU characteristics including pre and post-intracavernous peak systolic velocities (PSV) and resistive indices (RI) were also identified. Results: 298/763 (39%) patients were found to have PD, with a mean age of 62 years (26-88 years) and a mean BMI of 27.2 (18.1-46.1). 37/298 men had prior prostatic surgery (transurethral 15/298, radical prostatectomy 22/298). 41%, 11%, 40%, and 13% of patients reported hypertension, Diabetes, hyperlipidemia and heart disease, respectively. Thirteen percent(40/298) of men had a co-morbid diagnosis of Dupryten’s contracture, and 83% (246/298) expressed a degree of penile curvature greater than 15 degrees. CDDU analysis demonstrated 10% of PD patients with arterial insufficiency (AI), 27% with cavernous venous occlusive disease (CVOD), 24%, with mixed AI and CVOD, and 39% with normal arterial and venous responses. Conclusion: This analysis defines baseline CDDU characteristics in PD patients. Six out of 10 PD patients present with vascular irregularities as demonstrated by Doppler analysis. Our results indicate that the etiology of ED in patients with PD is variable.

229 Poster #94 INCREASING AGE, PROSTATE WEIGHT, AND DIABETES INDEPENDENTLY ASSOCIATED WITH ERECTILE DYSFUNCTION AFTER ROBOTIC PROSTATECTOMY IN HISPANIC MEN Daniel Hoffman, MD1, Hector Lopez-Huertas, MD2, Ronald Cadillo-Chavez, MD2 and Ricardo Sanchez-Ortiz, MD2 1University of Puerto Rico, San Juan PR; 2Robotic Urology and Oncology Institute, San Juan PR Presented by: Daniel Hoffman, MD

Introduction: According to the American Diabetes Association, Puerto Ricans have the highest rate of diabetes mellitus (DM) of any ethnicity in the US (13.8% vs. 7.1% of nonHispanic Caucasians). DM has been associated with a higher risk of post-prostatectomy erectile dysfunction (ED). We present the initial report of the impact of DM on erectile function after robotic prostatectomy (RP) in Puerto Rican men. Methods: Of 542 patients in our prospective single-surgeon RP database, 197 patients were identified who had normal preoperative erectile function, had undergone a bilateral nerve-sparing procedure, and had follow-up ≥ 1 year. Patients taking phosphodiesterase five inhibitors (PDE5I) preoperatively or who received postoperative radiation or hormonal therapy were excluded. Clinical variables were correlated with ED one year after surgery. Postoperative potency was defined as the ability to have intercourse with or without PDE5I (IIEF questions 3 and 4). Multivariate analysis was performed with SPSS. Results: After a median follow-up of 25.3 months, 19.5% (39/197) of men with normal preoperative erectile function exhibited ED despite bilateral nerve sparing. The mean age of the cohort was 56.6 (range 38 to 75) and 12.2% (24/197) percent of all patients had type II DM. In univariate and multivariate analysis, the only three clinical variables independently associated with post-RP ED were age (mean: 60.2 years (yrs.) in men with ED vs. 55.7 yrs, p<0.01) (Odds ratio (OR) for ED if ≥ 60 yrs: 3.30, 95% Confidence Intervals (CI): 1.54 to 7.11), prostate size (mean size 48.6 in men with ED vs. 41.7 g, p < 0.01) (OR for ED if ≥ 60 g: 5.02, 95% CI: 1.88 to 13.4), and the presence of DM (25.6% of men with ED had DM vs. 8.8% in those without ED, p < 0.02) (OR: 3.34, 95% CI: 1.25 to 8.89). The risk of ED was 41.7% in men with DM, 32.9% in men age ≥ 60 yrs, and 47.8% in those with a prostate ≥ 60 grams compared with 16.7%, 12.5%, and 16.2% in non-diabetics, men younger than 60, and men with prostates smaller than 60 g, respectively (p< 0.02). No other variables adversely affected potency including PSA, BMI, history of hypertension, hyperlipidemia, or smoking, operative time, or blood loss. Conclusion: Diabetes, a prostate size ≥ 60 g, and age ≥ 60 yrs were independently associated with more than a three-fold increased risk of ED in men with normal preoperative erectile function undergoing bilateral nerve-sparing RP. Given that Puerto Rican patients Po st e rs have double the incidence of DM than the US population, these are important data to discuss with patients in order to establish realistic expectations.

230 Poster #95 SALVAGE ULTRASOUND GUIDED TARGETED MICROCRYOABLATION OF THE PERI- SPERMATIC CORD FOR PERSISTENT CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD Bayo Tojuola, MD, Ibrahim Kartal, MD, Jamin Brahmbhatt, MD, Sijo Parekattil, MD The PUR Clinic, Orlando, FL Presented by: Bayo Tojuola, MD

Introduction: Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Our goal was to assess the use of Ultrasound guided targeted microcryoablation (UTM) of the peri-spermatic cord as a salvage treatment option for patients who fail MDSC. Methods: Retrospective review of 60 patients (69 procedures: nine bilateral, 22 left side, and 29 right side) that underwent UTM between November 2012 and August 2014 by two fellowship trained microsurgeons. All patients had failed prior MDSC. Targeted percutaneous cryoablation of the peri-spermatic cord was performed under ultrasound guidance using a 16-gauge cryo needle. Branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves were cryoablated medial and lateral to the spermatic cord at the level of the external inguinal ring. The primary outcome measure was the level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ−6, QualityMetric Inc., Lincoln, RI). Results: Median age was 44 years. Median operative duration was 10 minutes. Median duration of pain prior to the procedure was nine years. Median length of post-op follow up was 11 months. Subjective VAS patient pain outcomes: 74% significant reduction in pain (9% complete resolution, 65% reported a greater than 50% reduction in pain). Objective PIQ- 6 outcomes: significant reduction in pain in 59% of patients at six months and 56% at one- year post-op. Complications: one wound infection and one patient developed penile pain. Conclusion: Ultrasound guıded targeted microcryoablation of the peri-spermatic cord is a potentially safe and viable treatment option for the salvage management of persistent chronic scrotal content pain in patients who have failed MDSC. Further studies are warranted.

231 Poster #96 DISPARITIES IN INTERPRETATION OF PRIMARY TESTICULAR GERM CELL TUMOR PATHOLOGY Pranav Sharma, MD, Gautum Agarwal, MD, Kamran Zargar-Shoshtari, MD, Jasreman Dhillon, MD, Wade Sexton, MD Moffitt Cancer Center, Tampa, FL Presented by: Pranav Sharma, MD

Introduction: The high cure rate for testicular cancer is dependent upon precise histopathological diagnosis and staging as this guides future therapy. Accurate pathologic interpretation can be problematic due to the low incidence of primary testicular germ cell tumors (GCTs) and due to variations in histologic patterns. By analyzing changes in diagnosis of primary testicular specimens after secondary review by pathologists at our institution (MCC), we hoped to determine the degree of histological variation of GCTs and how these can impact prognosis and treatment. Methods: From 1999-2013, 388 patients were evaluated at our tertiary referral center with a diagnosis of testicular GCT. Of these patients, 235 underwent radical orchiectomy at an outside facility and had pathology specimens re-analyzed by our center’s pathologists with expertise in genitourinary (GU) malignancies. We identified variations and discrepancies in pathological reporting. Clinically significant differences that could alter subsequent management were noted. Results: In our study group of 235 patients, 50 (21.3%) had some variation in the interpretation of their radical orchiectomy specimens. A clinically significant alteration in pathologic findings was identified in 16 patients (6.8%) most commonly due to the recognition (or misrecognition) of lymphovascular invasion (LVI) associated with non-seminomatous germ cell tumors (NSGCTs). Ninety patients (38.3%) were referred with clinical stage I GCTs, and seven (7.8%) of these were identified to have clinically significant differences in their histopathological findings that resulted in changes in subsequent therapeutic interventions. The identification (or misidentification) of LVI resulted in upstaging or downstaging from cStage IA to cStage IB or vice versa in 6 patients with NSGCTs. Additionally, one patient with clinical stage I classic seminoma had been misclassified with nonseminoma. Conclusion: Testicular GCTs are rare malignancies. Inaccurate interpretation of primary orchiectomy specimens is not uncommon and may lead to incorrect tumor staging, imprecise assignment of progression risk, and inappropriate management recommendations. Secondary opinions of primary GCT orchiectomy specimens potentially facilitate appropriate counseling and therapeutic strategies.

Po st e rs

232 Poster #97 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM−A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD Bayo Tojuola, MD, Ibrahim Kartal, MD, Jamin Brahmbhatt, MD, Sijo Parekattil, MD The PUR Clinic, Orlando, FL Presented by: Bayo Tojuola, MD

Introduction: Botulinum-A toxin (Botox) has been shown to modulate the release of neuropeptides leading to inhibition of neurogenic inflammation and chronic pain. This provides an antinociceptive effect. Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Our goal was to assess the use of peri-spermatic cord Botox injections (Scrotox) to provide prolonged pain relief in men with refractory chronic scrotal content pain after MDSC. Methods: Retrospective review of 25 patients who underwent Scrotox (29 procedures: four bilateral, 10 right side, 11 left side) from July 2013 to July 2014. All patients had failed prior MDSC. 100 units of Botox diluted in 10cc of saline was injected medial and lateral to the spermatic cord at the level of the external inguinal ring to ablate branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves. The primary outcome measure was the level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). Results: Median age was 43 years. Median duration of pain prior to the procedure was 10 years. Median operative duration was 15 minutes. Median follow up post procedure was eight months. Subjective VAS patient pain outcomes: 70% significant reduction in pain (14% complete resolution, 56% reported a greater than 50% reduction in pain). Objective PIQ-6 outcomes: significant reduction in pain in 40% of patients at six months and 20% at one-year post-op. There were no complications in our small cohort. Conclusion: Scrotox is a potentially safe and viable treatment option for the salvage management of persistent chronic scrotal content pain in patients who have failed MDSC. Further studies are warranted to better understand the long-term durability of this treatment modality.

233 Poster #98 PRELIMINARY ASSESSMENT ON THE TREATMENT OF ERECTILE DYSFUNCTION WITH TRIMIX GEL Daniel Martinez, MD1, Joel Chechik2, Carey Frasca2 and Rafael Carrion, MD1 1University of South Florida, Tampa, FL; 2MenMD, Tampa, FL Presented by: Daniel Martinez, MD

Introduction: Trimix (papaverine, phentolomine and prostaglandin) has been used for intracavernosal injections (ICI) for 30+ years. Stabilization of injectable Trimix can be difficult and refrigeration is recommended. Intraurethral Trimix Gel (TMG) provides a stable, therapy with an easy, needle-free, non-refrigerated application. This data provides an early review of TMG outcomes for erectile dysfunction (ED). Methods: Over two months (5/2014-7/2014) n = 10 patients were prescribed TMG as principle modality for ED. Patients were unsatisfied with current treatments and not interested in ICI. Three (30%) had diabetes, five (50%) were post-radical prostatectomy and all (100%) had other comorbidities (i.e. hypertension, hyperlipidemia). Mean age was 66 (range 46-78). Formulation of TMG was 30mcg papaverine, 4mcg phentolamine and 1000mcg PGE1 (per ml). For injection, active agents mixed with standard gel, using a prefilled syringe system. Patients were instructed how to properly mix the gel and insert to promote absorption and maximize outcomes. Results: Comparing pre-TMG and post-TMG Sexual Health Inventory For Men (SHIM) scores, the average was 6.2 (range 1-16) and 19.7 (range 14-25), respectively. The pre-TMG scores represent patients being off all forms of ED therapy. Three of the 10 patients did not provide post-TMG SHIM scores and were excluded from the calculations. Patients responded favorably, and all positively responded regarding the medication’s efficacy. All patients were “very excited” about needle-free drug delivery. No adverse events were reported. Conclusion: Trimix Gel may have several advantages over both phosphodiesterase inhibitors (PDE5-I) and traditional, ICI. TMG can be stored at room temperature and provides greater stability (versus ICI) since it is only activated upon patient’s preparation. This needle-free option for Trimix is an important addition in sexual medicine, as patients require alternatives for ED care. Preliminary results with TMG are favorable, yet further clinical data will help determine its place in urologists’ armamentarium.

Po st e rs

234 Poster #99 INITIAL EXCRETORY PHASE CONTRASTED COMPUTED TOMOGRAPHY MAY NOT BE NECESSARY TO EVALUATE BLUNT ABDOMINAL TRAUMA IN CHILDREN Matthew Mason, MD, Christina Ching, MD, Stacy Tanaka, MD, Douglass Clayton, MD, John Pope, MD, Mark Adams, MD, John Brock, MD, John Thomas, MD Vanderbilt University, Pediatric Urology, Nashville, TN Presented by: Matthew Mason, MD

Introduction: While the indications for computed tomography (CT) in children after blunt abdominal trauma have been described in the literature, the role of excretory-phase CT imaging (EPCT) is unclear. The adult literature suggests that patients undergo EPCT to identify collecting system injuries in any grade 4 or 5 injuries, or those with perinephric, retroperitoneal, prevesical or pelvic fluid. At our pediatric level 1 trauma center, EPCT is not utilized in a standardized manner. Our objective was to determine the result of applying the adult recommendations to the pediatric population. Methods: Using a de-identified database derived from the medical record, all patients with blunt renal trauma under 17 years of age at time of trauma were identified. A single patient with autosomal-dominant polycystic kidney disease was excluded. Patient demographics and information regarding trauma were analyzed. Results: Fifty-five patients were identified. Median age was 13.6 years. All patients had CT imaging during their initial trauma workup. Thirty-nine patients met criteria for immediate EPCT as outlined in the adult literature, their management is shown in Figure 1. The remaining 16 patients with grade 1-3 injury and no fluid concerning for collecting system injury were all managed conservatively. Only two patients of 55 (3.6%) required intervention for collecting system injury, both with clinical signs prompting EPCT later in their hospital stay. Of all 55 patients, three (5%) were lost to follow-up, but in the remainder there were no symptoms concerning for missed collecting system injury. Only seven (13%) had follow up renal imaging, but none showed evidence of fluid collection. Conclusion: Of 55 patients with blunt renal trauma, only two had collecting system injury requiring intervention. Had initial EPCT been performed as recommended in the adult literature, it is possible these two patients would have had earlier diagnosis and treatment of their injuries. However, with only two of 55 patients requiring intervention on the basis of EPCT, it is possible that children do not need routine utilization of this ionizing imaging method.

235 Poster #100 MAGNETIC RESONANCE UROGRAPHY FOR THE EVALUATION OF HYDRONEPHROSIS IN PRUNE BELLY SYNDROME Michael Garcia-Roig, MD1, Angela Arlen, MD2, J. Damien Grattan-Smith, MD3, Edwin Smith, MD2 and Andrew Kirsch MD2 1Children’s Hospital of Atlanta/Emory University Department of Pediatric Urology; 2Children’s Hospital of Atlanta/Emory University Department of Pediatric Urology; 3Children’s Hospital of Atlanta/Emory University Department of Radiology Presented by: Michael Garcia-Roig, MD

Introduction: Use of magnetic resonance urography (MRU) has proved useful in the setting of complex anatomy or challenging diagnoses in pediatric urology. Prune belly syndrome patients have complicated & varying anatomy including significantly dilated but usually unobstructed urinary tracts. Surgical repair of abdominal wall defects is performed frequently in these patients along with concomitant repair of other urologic abnormalities. St&ard imaging modalities, such as ultrasound & nuclear medicine studies, may be misleading given the significant dilation & poor drainage seen bilaterally. We report the first series of 12 patients with prune belly syndrome who underwent MRU & describe the findings. Methods: Children with prune belly syndrome who underwent MRU from 2006-2011 at our institution were identified after IRB approval. Patient demographics, imaging prior to MRU, & radiographic data were collected to determine urinary tract anatomy, renal function, & drainage. Results: MRU was performed in 10 patients at a median age of 8.6 months (range 2.1- 145). All patients were male. All patients underwent a single study, with the exception of two patients, one with ureteropelvic junction obstruction (UPJO) & a second with calyceal diverticulum & a solitary kidney. Hydronephrosis was identified in 12 patients (100%), three (25%) did not have ureteral dilation. Unilateral upper urinary tract obstruction was diagnosed in two patients (17%), 1 with UPJO & a second with ureteropelvic junction obstruction (UVJO). Renal transit time (RTT) was recorded at a median of six minutes (range 2-35) overall, & > 15 minutes (range 15−35 mins) in the two obstructed kidneys. Median body surface area Patlak score was 42.2 ml/min/1.73 m2 (range 7.7-96) & renal dysplasia was noted in three (25%) patients. Median serum creatinine was 0.4 (range 0.2-2.7). A thickened bladder was found in three patients (25%) and two (17%) had a severely distended bladder at the time of the study despite bladder catheter drainage. Three patients underwent nuclear drainage studies, one with a solitary kidney. Median T1/2 was 5.6 and 12.4 (range 0.5-6.6 & 12.1-12.7, respectively) vs renal transit time of 6.5 & 22 (range 2.9-20 & 9−35, respectively). One patient demonstrated bilateral hydroureteronephrosis, and the second patient unilateral hydroureteronephrosis, however the severity could not be determined on MAG-3. MRU Po st e rs demonstrated severe hydroureteronephrosis without obstruction in both patients. Conclusion: MRU provides anatomic and functional detail of the collecting system in the setting of complex anatomy commonly encountered in prune belly syndrome. We report our experience with MRU in the setting of hydronephrosis in patients with prune belly syndrome. Funding: none

236 Poster #101 LONG-TERM OUTCOMES OF TETHERED CORD RELEASE IN PRIMARY TETHERED CORD SYNDROME PATIENTS: A SINGLE CENTER EXPERIENCE HsinHsiao Wang, MD, MPH, Jacqueline Zillioux, MD, Daniel Vargas, MD, John Wiener, MD, Jonathan Routh, MD, MPH Duke University Medical Center, Durham, NC Presented by: HsinHsiao Wang, MD, MPH

Introduction: Primary tethered cord symdrome (TCS) has been thought to be related to urinary and bowel outcomes. However, the long-term post-operative outcomes for TCS patients were not well-described in the literature. Our goal was to evaluate the long-term outcomes of TCS patients in our institution. Methods: We retrospectively reviewed all tethered cord release procedures for TCS patients younger than 18 years from March 1998 to Feb 2008. Patients with follow up shorter than one year or with spina bifida were excluded. Our primary outcome was defined as urinary or bowel incontinence in patients older than five years old. Propensity score weighting method was used in the multivariate analysis investigating predictors of long−term outcomes. Results: In total, we identified 50 boys and 52 girls with a mean age of 4.3 years at surgery. Median follow-up time was 6.8 years. 34 (33%) patients presented pre-operatively with urinary or bowel incontinence, lower urinary tract symptoms, UTI, and ambulatory deficiency. There were 19 lipoma, 29 syringomyelia, 30 fatty filum, 48 low conus location, and 20 vertebral body dysmorphism found on the MRI. Fifty (49%) patients had confirmed tethered cord on by the radiologists or neurosurgeon. Three patients had revision of de-tethering surgery in the follow up period. In the last follow-up, 17 patients continued to have urinary incontinence, and six with bowel incontinence. On bivariate analysis, long-term urinary or bowel incontinence was associated with worse pre-operative symptoms (p=0.01). After adjusting for age, gender, fatty filum, lipoma, confirmation of TC on MRI, pre-operative presentation remained significantly associated with worse long-term urinary or bowel incontinence (OR=6.2, p=0.003). By contrast, confirmation of TCS on MRI by radiologists or neurosurgeon was not associated with long−term urinary or bowel incontinence (p=0.34) after adjusting for age, gender, fatty filum, lipoma. Conclusion: In TCS children who underwent de-tethering surgery, those pre-operative symptoms at presentation are likely to have worse long-term urinary or bowel outcomes and thus may need closer follow-up. On the other hand, the radiologists or neurosurgeon’s confirmation of TCS on MRI does not appear to impact the long-term outcomes.

237 Poster #102 ASSOCIATION OF MEGAURETER WITH UNDESCENDED TESTIS: A CASE FOR CAUSALITY? Kristin M. Broderick, MD1, Kelly McCormick, MSPH2, Edwin A. Smith, MD1 and Andrew J. Kirsch, MD1 1Emory University School of Medicine Department of Urology, Children’s Healthcare of Atlanta, Atlanta, GA; 2Department of Biostatistics, Children’s Healthcare of Atlanta, Atlanta, GA Presented by: Kristin M. Broderick, MD

Introduction: We aim to identify a group of patients with undescended testes that were associated with megaureters. We speculate that large diameter ureters lead to anatomic disruption of normal testicular descent leading to cryptorchidism. Methods: A retrospective review was performed to include all patients with the diagnosis of megaureter (MU) and undescended testis (UDT) over a 10-year period between 2002 and 2012. Electronic medical records were reviewed to determine laterality of the MU and UDT, co-morbidities, type of surgery and imaging characteristics. Results: A total of 466 boys were identified with MU. Thirty-four (7.3%) were also diagnosed with UDT. Sixteen (47.1%) had either bilateral MU and bilateral UDT or unilateral MU and UDT on the same side. An additional 12 patients (35.3%) had either bilateral MU with unilateral UDT or unilateral MU with bilateral UDT. Only six boys had MU and contralateral UDT. Four of the six patients did not have any associated comorbidities, while two patients had non-functioning dysplastic kidneys on the side of the UDT, opposite the MU. Seventy- five percent of the ipsilateral UDT/MU group had associated comorbidities or anomalies including prune belly syndrome (n=6), posterior urethral valves (n=2), duplicated systems (n=3), ureterocele (n=3), myelomeningocele (n=2), and renal dysplasia (n=3). Fifty percent of the patients with contralateral UDT/MU underwent surgery for the MU, while 71% of patients with ipsilateral UDT/MU underwent surgery for their MU. Fischer’s exact test was used for statistical analysis. The ipsilateral UDT/MU group was more likely to undergo surgery for MU and more likely to have associated comorbidities or congenital anomalies (p<0.001). Conclusion: The association of MU and ipsilateral UDT seen in 82.4% of boys supports the hypothesis that MU can result in testicular maldescent. Children with ipsilateral MU/UDT were more likely to have associated comorbidities or congenital anomalies, and were also more likely to undergo surgery for their MU suggesting that the more dilated and obstructive MUs were more likely to be associated with ipsilateral undescended testes.

Po st e rs

238 Poster #103 EVALUATION AND MANAGEMENT OF THE UNDESCENDED TESTIS IN PUERTO RICO: COMPARISON TO THE AUA CRYPTORCHIDISM GUIDELINES Ceciliana DeAndino, MD1, Karina Escudero, MD2, Francois Soto1 and Marcos Perez- Brayfield, MD, FAAP, FACS1 1University of Puerto Rico, San Juan, Puerto Rico; 2HIMA Caguas, Puerto Rico Presented by: Ceciliana DeAndino, MD

Introduction: Cryptorchidism is an abnormality of the genitourinary tract by which one or both testes fail to descend into the scrotum. The AUA clinical guidelines for evaluation and treatment of cryptorchidism were recently published. The guidelines highlight the need for early diagnosis, and surgical correction. The guidelines emphasize that no imaging studies are indicated in the diagnosis of cryptorchidism. We review our experience with the evaluation and management of our patients and compare our findings to the current AUA crypthorchidism guidelines. Methods: Data was obtained from pediatric patients who underwent surgical intervention for non−descended testis from 2007-2014 at HIMA Hospital and at the University Pediatric Hospital in Puerto Rico by a single surgeon. A total of 551 patients were identified; 225 patients were excluded due to lack of follow up data (N=326). Data obtained included age, testis location, radiologic and surgical findings, and postoperative results. Results: A total of 326 patients were included for analysis with an average age of 5 years. 147 patients had bilateral cryptorchidism. Cryptorchid testis was palpable in 68% and nonpalpable in 32% of patients. The majority of patients (60%) presented to their initial evaluation with radiographic images. Radiographic findings were consistent with physical examination in 63% of patients and with surgical findings in 64%. (sensitivity 34%/ specificity 21%) The average age of patients who required orchiectomy at time of surgery was 5.8 years while those who underwent orchiopexy had an average age of 3.68 years. Excellent surgical outcomes were seen for both palpable and non palpable testis. Conclusion: Our data reveals that, despite its lack of usefulness, radiologic imaging continues to be included in the diagnostic workup of a newly identified child with cryptorchidism in Puerto Rico. In addition there is a significant delay in treatment with surgical intervention as compared to the guidelines. It is important to continue to educate our referring physicians on the new AUA guidelines in order to create awareness and encourage a proper diagnostic and treatment approach for cryptorchidism. No financial funding

239 Poster #104 NATIONWIDE TRENDS AND VARIATIONS IN SURGICAL INTERVENTIONS AND RENAL OUTCOME FOR SPINA BIFIDA PATIENTS HsinHsiao Wang, MD, MPH, Jessica Lloyd, MD, John Wiener, MD, Jonathan Routh, MD, MPH Duke University Medical Center, Durham, NC Presented by: HsinHsiao Wang, MD, MPH

Introduction: Bladder dysfunction poses a significant challenge in the care for spina bifida (SB) patients. Indications for surgery appear to vary between institutions, and the impact of urologic interventions on SB outcomes is unclear. Our objective was to examine trends and variations in urologic interventions and renal outcomes in SB patients. Methods: We retrospectively reviewed the Nationwide Inpatient Sample (NIS) for SB patients treated from 1998−2011. We used ICD-9- CM codes to identify urologic surgery (bladder augmentation, bladder neck sling, sphincterotomy, vesicostomy, artificial urinary sphincter, botox injection, appendicovesicostomy, or urinary diversion) and primary outcome (renal failure). Results: We identified 427,616 SB admissions (mean age 26y, 56% female); of these, 34,936 (8%) were for renal failure and 50,398 (12%) were for surgery. Over the study period, renal failure rates doubled (6-12%) and surgery rates declined (14-9%). There was a strong negative correlation between surgery and renal failure rates over time (Fig 1, r=-0.7, p=0.007). A moderately weak correlation was observed between states in surgery and renal failure rates (r=−0.4, p=0.01) with wide variation in surgical rates (3-22%) among states (Fig 2). Surgery was associated with younger age (p<0.001), male sex (p=0.008), white race (p<0.001), and lower renal failure rates (p<0.001). However, older age (p<0.001), male sex (p<0.001), black race (p<0.001), public insurance (p<0.001), and less surgery (p<0.001) were associated with higher risk of renal failure after adjusting for treatment year and income. Conclusion: We observed wide variation in urologic surgical rates among states and a significant temporal trend toward decreasing urologic surgery and increasing renal failure rates in SB patients. Further study is needed to define the factors behind these trends and variations in urological SB management. Po st e rs

240 Poster #105 ADOLESCENT WITH CONCOMITANT TRANSVERSE AND LONGITUDINAL VAGINAL SEPTUM Sherita King, MD1, Jeffrey Donohoe, MD2, Larisa Gavrilova-Jordan, MD1, Lawrence Layman, MD1 and Paul McDonough, MD1 1GRU-MCG, Augusta, GA; 2Cleveland Clinic, Cleveland, OH Presented by: Sherita King, MD

Introduction: We are presenting the only case to our knowledge of concomitant transverse and longitudinal vaginal septum (TVS, LVS) along with diagnosis and multidisciplinary surgical management of this unique anomaly. A 14-year-old Caucasian female with longstanding voiding dysfunction and hydronephrosis began complaining of cyclic abdominal pain. Methods: Renal ultrasound showed normal kidneys and a pelvic mass. Pelvic MRI revealed an anteverted arcuate uterus with normal cervix superiorly displaced by a large hematocolpos and two separate distal vaginal canals. Results: Exam under anesthesia revealed two vaginal orifices and palpable pelvic mass. Vaginoscopy showed two blind-ending narrow vaginal canals separated by LVS. First the distal two cm of the LVS was incised with bovie electrocautery and the remainder using an 11 French pediatric resectoscope with hook. At a later date, the excision of the TVS was performed in two steps. Interventional Radiology placed a balloon catheter into the hematocolpos to allow the TVS to be pulled toward the introitus. The TVS was incised to evacuate the hematocolpos revealing a palpable cervix. The TVS and redundant proximal vaginal mucosa excised with bovie electrocautery. The edges of the vaginal mucosa were the approximated with 2-0 Vicryl with interrupted horizontal mattress. To prevent postoperative vaginal narrowing a vaginal mold was placed past the surgical line. Three weeks after surgery, patient had her first normal menstrual bleeding and she successfully used vaginal tampons. Patient continued to use vaginal dilator daily for three months and was noted to have normal functional vaginal diameter. Conclusion: In a patient with cyclic abdominal pain and primary amenorrhea mullerian anomalies must be in the differential. This is the first case of a single patient having both a LVS and TVS. With a multidisciplinary approach, this rare anomaly was managed with an excellent outcome for the patient.

241 Poster #106 THE ROLE OF POSITIONAL INSTILLATION OF CONTRAST CYSTOGRAPHY (PIC) AND ENDOUROLOGICAL ANTIREFLUX SURGERY IN THE MANAGEMENT OF RECURRENT URINARY TRACT INFECTION (UTI) Wilson Rovira-Pena, MD1, Karina Escudero, MD2 and Marcos Perez-Brayfield,MD1 1Urology, R CM-UPR Rio Piedras, Puerto Rico; 2Urology, HIMA Caguas Puerto Rico Presented by: Wilson Rovira-Pena MD

Introduction: Recent studies have reported on the efficacy of PIC in diagnosing vesicoureteral reflux (VUR) in patients with recurrent complicated urinary tract infections and a negative workup. Subsequent treatment with endourologic surgery demonstrated significant reduction on UTI’s in this select group of patients. We report our clinical experience of PIC cystography and subsequent antireflux surgery (Defluxtm) on pediatric patients with recurrent febrile UTI. Methods: A total of 19 patients (seven males, 12 females) with recurrent febrile and a negative UTI workup were evaluated with PIC cystography from May 2008 to June 2014 with a mean F/U of 8 months. All patients had undergone voiding dysfunction evaluation and management. We analyzed preoperative data, intraoperative data including PIC results and postoperative outcomes. Statistical analysis was obtained with emphasis on resolution of febrile UTI episodes. Results: All patients had a preoperative VCUG with no evidence of clinically significant VUR. PIC cystography demonstrated VUR in 17 patients (17/19) and 29 ureteral units. The VUR grading presented were I, II, and III in 11, 12, and 16 units, respectively. Most patients had bilateral VUR (70%). All patients with VUR on PIC cystography underwent Deflux procedure. There was a significant reduction (p< 0.001) of UTI´s for our Defluxtm series with a mean reduction of 3.29 and CI (95%) from 2.02 to 4.56. UTI resolution was seen in 12/17 patients (70%). Conclusion: PIC cystography should be considered in the evaluation of patients with recurrent febrile UTI and a negative work up. In our series there was a significant reduction in UTI after Deflux treatment with 70% resolution. Our findings are consistent with previously published reports. Future prospective randomized trials are needed to confirm our results.

Po st e rs

242 Poster #107 “COMPARISON OF OUTCOMES FOLLOWING DISTAL HYPOSPADIAS REPAIRS. ARE URETHRAL STENTS NEEDED?” Anja Zann, MD, Romano DeMarco, MD University of Florida, Gainesville, FL Presented by: Anja Zann, MD

Introduction: While urethral stenting is commonplace following hypospadias surgery, several small series of stentless repairs have called into question the need for routine bladder drainage. To gain a better understanding of the need for stenting following distal hypospadias repairs, we performed a comparison study between stented and stentless repairs. Methods: We reviewed children who underwent distal (distal shaft to glanular) hypospadias surgery by a single surgeon over 3 year period. Data recorded included age, anatomic location of hypospadias, repair type, stented or stentless repair, use of caudal analgesia, and postoperative complications. Results: A total of 122 boys met the inclusion criteria. Ninety-three (76%) had surgery performed without the use of a stent, while 29 (24%) had a stent placed. The average age of the stentless group was 11 months (range 4-135 months) and 14 months (4-86 months) for the stented group. The location of the hypospadiac meatus in the stentless group was glans, corona, and distal shaft. The urethral location in the stented group was glans, coronal, and distal shaft. The breakdown of the repair type for the stented repairs was advancement, tubularization, and tubularization with incision of the urethral plate. Three (3%) patients in the stentless group experienced urinary retention. Two patients had slippage of the penile dressing below the glans causing a tourniquet effect and were treated with removal of the dressing on postoperative day two. One patient required placement of an indwelling urethral catheter on postoperative day two. No patients in the stented group had issues with urinary retention. No child in either group had development of a fistula or meatal stenosis on last follow-up. One child in the stented group required a redo chordee repair due to ventral skin scarring. Conclusion: While there was an increased rate in urinary retention in children undergoing stentless hypospadias repair, the overall rate was low and most commonly due to slippage of the penile dressing. Based on this report we do not routinely stent distal hypospadias repairs. However we do pay close attention to make sure that the penile dressing is adhered securely to the glans at the end of surgery.

243 Poster #108 NON-OPERATIVE MANAGEMENT OF HIGH GRADE VESICOURETERAL REFLUX David C. Moore1, Matthew D. Mason, MD2, Douglass B. Clayton, MD2, Stacy T. Tanaka, MD, MS2, John C. Thomas, MD2, Mark C. Adams, MD2, John W. Brock III, MD2 and John C. Pope IV, MD2 1Vanderbilt University, Department of Urologic Surgery, Nashville, TN; 2Vanderbilt University, Department of Urologic Surgery, Division of Pediatric Urology, Nashville, TN Presented by: David C. Moore

Introduction: Vesicoureteral reflux (VUR) is a common cause of pediatric urinary tract infection (UTI) and a frequent reason to visit a pediatric urologist. It is generally accepted that low grade VUR is more likely to resolve spontaneously than high grade VUR, and thus many of these patients are managed conservatively. However, few cohorts exist that detail patients with high grade VUR who were managed conservatively. The purpose of this study was to delineate which patients were managed non-operatively and determine if there is a subset of patients with high-grade reflux that might be spared an invasive operation by being treated conservatively. Methods: Patients were identified using Vanderbilt’s Synthetic Derivative database. A total of 9,343 patients were identified by CPT codes for vesicoureteral reflux from 1998 to 2014. Patient’s were excluded for non−grade V reflux, secondary VUR, poor follow-up or if they underwent any operation related to the treatment or complications of VUR. The final cohort included 28 patients seen in the pediatric urology clinic with Grade V VUR documented by voiding cystourethrogram (VCUG) managed non-operatively. Results: Patients were 64% male with an average length of follow-up of 44.9 months. 16 patients (57%) presented with UTIs at an average age of 8.6 months and 12 (43%) presented with antenatal hydronephrosis at an average age of 2.2 months. 13 patients (46%) had right grade V VUR, 10 (36%) had left VUR and five (20%) had bilateral VUR. 12 patients (43%) had renograms of which six (21%) showed decreased function, one showed obstruction and one showed renal scarring. Eleven patients (40%) had a breakthrough UTI while on antibiotics, and yet we continued to follow them conservatively. Eleven patients (40%) demonstrated no reflux on a subsequent VCUG and an additional 12 (43%) patients demonstrated downgraded reflux. Twenty patients (71%) were successfully weaned off antibiotics at an average age of 31.8 months with an average known follow-up of 19.6 months off antibiotics. Only one patient had to restart antibiotics because of a UTI was subsequently successfully weaned. Conclusion: This small cohort demonstrates it is possible to manage certain patients with high grade VUR non-operatively, and that as many as 40% will resolve completely. While not all patients showed complete resolution of reflux, most showed improvement and the majority were successfully weaned off antibiotics. What is not known is the long−term impact Po st e rs of a conservative approach on renal function. By comparing this cohort to patients managed operatively, future research will focus on determining clinicopathologic metrics that may be used to risk stratify this heterogenous group of patients.

244 Poster #109 HIGH EXPRESSION OF MAJOR HISTOCOMPATIBILITY COMPLEX CLASS I IN CLEAR CELL RENAL CELL CARCINOMA IS ASSOCIATED WITH IMPROVED PROGNOSIS Rishi Sekar¹, Claire M. de la Calle¹, Sarah A. Holzman², Jonathan H. Huang², Haydn T. Kissick², Adeboye O. Osunkoya³, Brian P. Pollack⁴, Dattatraya Patil², Kenneth Ogan² and Viraj A. Master² ¹Emory University School of Medicine, Atlanta, GA; ²Emory University Department of Urology, Atlanta, GA; ³Emory University Department of Pathology, Atlanta, GA; ⁴Emory University Department of Dermatology, Atlanta, GA Presented By: Rishi Sekar

Introduction: Around 30% of patients with localized clear cell renal cell carcinoma (ccRCC) who undergo nephrectomy will subsequently develop metastases. As the TNM staging and Fuhrman nuclear grade (FNG) system is imperfect, there is an increasing interest for immune markers to predict outcomes. In this study we analyzed Major Histocompatibility Complex Class I (MHCI) expression as a potential prognostic immune marker for patients with ccRCC. Methods: Thirty-four patients with localized ccRCC that underwent nephrectomy and had at least four years of clinical follow-up data were included. Immunohistochemical staining for MHCI was performed on tumor sections and an automated image analysis algorithm was applied to representative areas to quantitate MHCI expression. This algorithm generated the Positivity score, the ratio of positively stained pixels over the total number of pixels, correlating to the degree of MHCI expression and allowing rapid whole-slide scanning of digital slides. Results: Mean MHCI positivity score of the cohort was 0.72 (SE= ±0.03). At the end of the study, the patients who were alive had increased MHCI expression (0.80 positivity score; SE ±0.02) than those who died of disease (0.53 positivity score; SE= ±0.03; t test, p<0.0001). No patient deaths occurred in patients with greater than the mean MHCI positivity scores (Mantel-Cox, p<0.0001; Figure 1A). MHCI expression was higher among patients with no recurrence (0.79; SE= ±0.03) compared to those that recurred during the study period (0.65; SE= ±0.04; t test, p=0.01), and time-to-recurrence was longer in patients with higher than the mean MHCI positivity scores (Mantel-Cox, p<0.002; Figure 1B). Patients who were alive with recurrence had increased MHCI expression (0.81; SE= ±0.04) compared to those who succumbed to disease recurrence (0.53; SE= ±0.03; t-test, p<0.0001). No correlation was detected between FNG and tumor expression of MHCI (ANOVA, p=0.800, F=0.22). Conclusion: With the use of an automated high-throughput image analysis technique, this study demonstrates that MHCI expression may be an important prognostic factor in ccRCC for recurrence-free survival and for the prognosis of patients with recurrence. Funding: Robinson J, Reilly D.

245 Poster #110 IMPACT OF SARCOPENIA ON OVERALL SURVIVAL AND COMPLICATIONS IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY FOR T3 OR T4 KIDNEY CANCER Charles Peyton, MD, Spencer Krane, MD, James Rague, BS, Ashok Hemal, MD Wake Forest Baptist Medical Center, Winston-Salem, NC Presented by: Charles Peyton, MD

Introduction: Sarcopenia (muscle mass wasting) has been identified as a risk factor for complications and decreased survival at the time of radical cystectomy and surgical resection of other malignancies. We hypothesized that sarcopenia may be associated with decreased survival and increased complication rate in patients undergoing radical nephrectomy for advanced kidney cancer. Methods: We identified all T3 and T4 radical nephrectomies from an IRB approved prospectively maintained database between 2008-2012. We assessed sarcopenia with pre-operative cross-sectional imaging. The total psoas area (TPA) at the level of L3 was measured and controlled for height (m2). Sarcopenia was identified as TPA in the lowest gender-specific quartile. We evaluated the association of sarcopenia with age, tumor stage, BMI, and perioperative complications using student t-tests for continuous or Fisher exact tests for categorical variables. Kaplan-Meier survival curve estimates were generated for overall and gender-specific survival based on presence of sarcopenia. Results: We identified 110 pT3 or pT4 kidney cancer patients undergoing radical nephrectomy. Pre-operative cross-sectional imaging was available for 102 patients (93%, 69 men and 33 women). Mean TPA for men was 5.46 cm2/m2 vs. 4.27 cm2/m2 for women (p < 0.05). The mean age for sarcopenic and non-sarcopenic patients was similar, 63.8 and 62.8 years, respectively (p = 0.69). Sarcopenia was not significantly associated T3 vs T4 disease (p = 0.6), ASA status > 2 (p = 0.3), BMI > 30 (p = 0.09) or perioperative complication of any Clavian score (p = 0.7). Median follow up was 36.3 months. Kaplan-Meier estimates of overall survival were similar between sarcopenic and non-sarcopenic patients, even when controlling for gender differences (Figure 1). Conclusion: Sarcopenia was not predictive of perioperative complications or overall survival in this cohort of patients with advanced kidney cancer. Study limitations include small sample size and using psoas muscle-only to define sarcopenia. A multi-institutional assessment of sarcopenia and advanced kidney cancer surgical may further elucidate the value of this tool to predict outcomes for high-risk nephrectomy patients. Po st e rs

246 Poster #111 COMPARISON OF SORAFENIB-LOADED PLGA AND LIPOSOME NANOPARTICLES IN THE IN VITRO TREATMENT OF RENAL CELL CARCINOMA James Liu, BS1, Benjawan Boonkaew, PhD2, Katie Powers, MD1, Sree Harsha Mandava, MD1, Jaspreet Arora, BS2, Michael Maddox, MD1, Srinivas Chava, PhD3, Cameron Callaghan BS1, Srikanta Dash, PhD3, Vijay John, PhD2 and Benjamin Lee, MD1 1Tulane University School of Medicine, Department of Urology, New Orleans, LA; 2Tulane University, Department of Chemical Engineering, New Orleans, LA; 3Tulane University School of Medicine, Department of Pathology, New Orleans, LA Presented by: James Liu, BS

Introduction: Sorafenib, a tyrosine kinase inhibitor, is an FDA approved chemotherapeutic agent used in treatment of advanced renal cell carcinoma (RCC). However, treatment is often limited by systemic toxicity. The aim of this investigation was to develop and compare several biodegradable and biocompatible nanoparticles loaded with Sorafenib for improved drug delivery and tumor cell kill due to passive selective uptake and gradual drug release. Methods: Sorafenib-loaded Poly (lactic-co-glycolic) acid (PLGA), 1,2-dipalmitoyl-sn-glycero- 3-phosphocholine (DPPC) liposomes, and hydrophobically modified chitosan (HMC) coated DPPC liposomes were evaluated for several characteristics including zeta potential, % drug encapsulation, surface morphology, and in vitro drug release profile. Cytotoxicity and uptake trials were also studied using cell line RCC 786-0, a human metastatic clear cell histology renal cell carcinoma cell line. Results: Sorafenib-loaded PLGA particles and HMC-coated DPPC liposomes exhibited significantly improved cell kill compared to Sorafenib alone at lower concentrations, namely 10−-5 μM and 5-15 μM from 24-96h, respectively. At maximum dosage and time (15 μM and 96h), Sorafenib-loaded PLGA and HMC−coated liposomes killed 88.33 ± 1.75% and 98 ± 1.05% of all tumor cells, significant values compared to Sorafenib 81.82 ± 1.73% (p < 0.01). Likewise, HMC coating substantially improved cell kill for liposome model for all concentrations (5-15μM) and at time points (24-96h) (p < 0.01). Conclusion: PLGA and HMC-coated liposomes are promising platforms for drug delivery of Sorafenib. Likewise, due to different particle characteristics of PLGA and liposomes, each model can be further developed for unique clinical modalities.

247 Poster #112 PREOPERATIVE LABORATORY VALUES AS PREDICTORS OF INTRA-OPERATIVE COMPLEXITY AND POST-OPERATIVE COMPLICATION RISK IN IVC THROMBECTOMY FOR RENAL CELL CARCINOMA WITH INFERIOR VENA CAVA THROMBUS Christopher Russell, BS1, Kathy Lue, BS1, Patrick Espiritu, MD2, Tony Kurian, MD2, Gautum Argawal, MD2, Adam Luchey, MD2, Wade J. Sexton, MD2, Michael Poch, MD2, Julio Powsang, MD2 and Phillippe E. Spiess, MD2 1USF Morsani College of Medicine, Tampa, FL; 2H. Lee Moffitt Cancer Center, Tampa, FL Presented by: Christopher Russell, BS

Introduction: Radical nephrectomy with IVC thrombectomy remains the gold standard treatment of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus. Due to its associated technical complexity, a high rate of morbidity and mortality is often observed. The impact of pre-operative laboratory values on intra-operative parameters and postoperative outcomes has yet to be described. Here we report our experience with IVC thrombectomy and analysis of pre-operative laboratory values and their impact on intra-operative events and post-operative complications. Methods: Patients who underwent radical nephrectomy with IVC thrombectomy were identified through retrospective chart review. Pre-operative laboratory values used in analysis included creatinine (Cr), hemoglobin (Hgb), and calcium (Ca). Linear regression models were used to assess whether laboratory values were associated with blood loss (EBL), transfusion volume (TV) of packed red blood cells (PRBC’s), length of stay (LOS), or post-operative complication rates. Results: A total of 144 patients were identified meeting inclusion criteria. Our cohort consisted of 102 males and 42 females with a median age at surgery of 64 years. Median pre-operative Cr, Hbg, and Ca was 1.1 mg/dL (IQR 0.9-1.5), 11.8 g/dL (IQR10.7−13.7), and 9.3 mg/dL (IQR 9-9.7) respectively. Median EBL was 1900 mL (IQR 800-3300) and 67% of patients received a median of 6 U (IQR 3-12) PRBC’s. Median LOS was 7 days (IQR 5-9) and 69 patients experienced a post-operative complication. On linear regression models, pre-operative Cr demonstrated a significant correlation with EBL (p=0.022), TV (p=0.041), LOS (p=0.005), and post-operative complication rates (p<0.001). Pre-operative Hgb was associated with increased EBL (p<0.001) and TV (p<0.001), however failed to demonstrate a relationship with LOS (p=0.807) or post-operative complication rates (p=0.485). Pre- operative Ca was shown to be highly correlated with post-operative complications (p<0.001) despite an absence of association with EBL (p=0.072), TV (p=0.213), or LOS (p=0.077). Conclusion: Pre-operative Cr and Hbg are associated with increased intra-operative complexity marked by increased median EBL and transfusion volumes indicating that patients may benefit from pre-operative optimization with blood products and fluids. Additionally pre- Po st e rs operative Cr and Ca may serve as predictors of post-operative complications as both were strongly correlated with adverse post-operative events.

248 Poster #113 ALLOGRAFT TRANSPLANT RADICAL NEPHRECTOMY FOR RENAL CANCER: OUTCOMES IN A CONTEMPORARY COHORT Yoram Baum, MD, Sarah Holzman, MD, Adam Schell, Adeboye Osunkoya, MD, Kenneth Ogan, MD, Viraj Master MD, PhD Emory University, Atlanta, GA Presented by: Yoram Baum, MD

Introduction: Tumors within allograft kidneys represent a rare form of malignancy. There is a significant lack of literature for this rare phenomenon. We report a case series of eight patients discussing outcomes of radical transplant nephrectomy at our institution. Methods: We queried the Emory Kidney Cancer Database for transplant nephrectomies performed since 2004. Patients who had transplant nephrectomies for non-oncologic purposes were excluded. A retrospective analysis of eight patients with renal malignancy in their allograft kidney was performed. Results: Eight patients underwent transplant radical nephrectomy for renal cancer. The majority of patients were male (75%) and Caucasian (88%). Average age at the time of the transplant was 39.5+/− 8.7 years. Mean time from transplant to nephrectomy was 13.6+/− 5.2 years. Mean tumor size was 3.5+/−2.0 cm. Tumor histopathology included: urothelial carcinoma (2), papillary RCC (3), clear cell papillary RCC (2), and acquired renal cystic disease associated RCC (1). Final pathological stage was pT1a (2), pT1b (5) and pT2c (1). No patients had lymph node positive disease. Both patients with urothelial carcinoma had high grade disease and one-third (2/6) of patients with RCC had a high Fuhrman grade. Postoperative complications according to the Clavien-Dindo grading system was: none (2), grade I (2), grade IVa (2), IVb (1), and grade V (1). Mean follow up time post nephrectomy was 25.7 months. One patient was lost to follow up and one died 1 month post nephrectomy of a myocardial infarction. The overall survival (OS) was 85.7% (6/7) and the cancer specific survival (CSS) was 100%. Conclusion: Allograft renal transplant radical nephrectomy for renal cancer is rare. While complications may be significant in this cohort of patients, the CSS and OS are excellent. Longer follow up and multi-institutional studies are warranted.

249 Poster #114 HIGH PRE-OPERATIVE NEUTROPHIL-TO-LYMPHOCYTE RATIO IS ASSOCIATED WITH DECREASED OVERALL SURVIVAL IN PATIENTS WITH LOCALIZED CLEAR CELL RENAL CARCINOMA Yoram Baum, MD, Claire De La Calle, LA Harrel, MD, Caroline Tai, MS, Ruth Westby, MPH, Dattatraya Patil, MBBS-MPH, Kenneth Ogan, MD, Daniel Canter, MD, John Pattaras, MD, Peter Nieh, MD, Viraj Master, MD, PhD Emory University, Atlanta, GA Presented by: Yoram Baum, MD

Introduction: Inflammatory markers have proven to be powerful predictive tools of patient prognosis in cancer treatment. In this study we evaluated pre-operative Neutrophil-to- Lymphocyte (NLR) ratio as a predictive tool in localized clear cell Renal Carcinoma. Methods: Two hundred five patients with localized (T1-T3) clear cell Renal Carcinoma undergoing nephrectomy from 2001 to 2012 with curative intent were selected retrospectively from the Emory Nephrectomy Database. Only patients with pre-operative NLR were included in the study. For survival analysis, patients were categorized into high and low NLR score determined by the mean NLR value. Results: Total of 205 patients were analyzed. Mean age was 60 (range 26-89). Mean clinical follow up time was 42.5 months (range 0-121 months). Of the 205 selected patients, 128 (62.4%) presented at stage T1, 17 (8.29%) at stage T2 and 59 (28.8%) at stage T3. Fuhrman grade distribution was: six (2.92%) grade 1, 94 (45.9%) grade 2, 91 (44.4%) grade 3 and 13 (6.34%) grade 4. Mean NLR score was 3.45 (SE= ± 0.91) for the entire cohort. No significant difference was found in NLR score between stages at presentation (ANOVA, F=0.38, p=0.69) or grade (ANOVA, F=0.50, p=0.68). To investigate the impact of NLR score on patient survival, patients were stratified into two groups, those having higher, or lower than the mean NLR score. Patients with lower than the mean NLR had increased survival compared to patients with lower than the mean NLR (Mantel-Cox test, Chi square=4.19, p=0.04; Figure 1). Conclusion: Higher pre-operative neutrophil-to-lymphocyte ratio was associated with poor prognosis. Pre-operative NLR is a useful tool to predict prognosis in patients undergoing nephrectomy for curative intent and could help stratify patients for post-operative surveillance. Funding: Robinson J, Reilly D. Po st e rs

Figure 1: High Neutrophil-to-Lymphocyte Ratio (NLR) is associated with decreased overall survival High NLR defined as patients with NLR above mean of 3.45 (SE= ± 0.91) and low NLR group defined as patients with NLR below mean.

250 Poster #115 SIGNIFICANCE OF PERSISTENT ASYMPTOMATIC MICROSCOPIC HEMATURIA ONE-YEAR AFTER NEPHRON SPARING SURGERY: A REVIEW OF CLINICAL AND RADIOGRAPHIC FINDINGS Ceciliana De Andino, MD1, Hector Lopez-Huertas, MD2, Ronald Cadillo-Chavez, MD2 and Ricardo Sanchez-Ortiz, MD2 1University of Puerto Rico, San Juan PR; 2Robotic Urology and Oncology Institute, San Juan PR Presented by: Ceciliana De Andino, MD

Introduction: Occasionally patients exhibit microscopic hematuria (MH) which persists one year after nephron sparing surgery (NSS). The clinical significance of MH in this setting has not been reported. Methods: Ninety-five patients with renal masses were identified in our database treated with open or robotic NSS by a single surgeon. All had undergone preoperative (preop) CT or MR with thin renal cuts. Four patients with preop MH or bilaterality were excluded. Follow-up ≥ one year was available in 81 patients. Postoperative surveillance was based on the UCLA Integrated Staging System recurrence risk. MH was defined as ≥3 red blood cells per high power field in one urinalysis in the absence of an obvious benign cause. Regardless of the UCLAISS risk, a CT/MR urogram and cystoscopy were performed if MH was present beyond 12 months. Clinical findings were reviewed. SPSS was used for statistical analysis. Results: Of 81 patients treated with open or robotic NSS, 11.1% (9/81) had persistent MH after one year. CT or MR findings included two contralateral renal masses (15 mm, 10 mm) and a simple cyst (one). These patients would not have required CT/MR for another year based on their UCLAISS low risk. Both masses were malignant and managed with robotic NSS. No contralateral masses developed in patients without MH and there were no local recurrences after a median follow-up of 22 months. Cystoscopic findings included one urethral stricture. Aside from the higher risk for contralateral tumors (2/9 vs. 0/71, p< 0.02), patients with MH exhibited a greater mean increase in serum creatinine (Cr) after surgery (9.3% vs. 5.3% increase, p< 0.02), and a trend for older age (59.3 vs. 53.8 yrs, p=0.17). Pathologic findings included malignancy (81.4%), oncocytoma (6.2%), AML (5%), and benign cysts/adenoma (7.4%). There were no differences between the MH and non-MH groups regarding tumor size (3.6 cm), nephrometry score (4-6: 57%, 7-9: 27%,10-11:16%), grade, stage (pT2: 7.4%, pT3: 2.5%), preop Cr, percent kidney spared (80.3%), clamp time (26.1 min), collecting system entry (64.5%), blood loss, operative time, length of stay, open vs. robotic (14.8%), blood transfusion (1/81), BMI, gender, history of urine leak and stent (6.2%), pseudoaneurysm with embolization (2/81), history of hypertension, diabetes, or smoking. Conclusion: Asymptomatic MH may persist in 11.1% of patients one year after NSS. While cystoscopic findings were rare, MH was associated with a higher risk of contralateral tumors. Once validated with a larger cohort, these data suggest that if MH persists one year after NSS, repeat renal imaging may be warranted even if the mass exhibited low-risk characteristics.

251 Poster #116 PRACTICE LEVEL IMPACT OF TRANSITIONING FROM HAND-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY TO ROBOTIC ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY Abby Taylor, MD1, Alexander Parker, PhD2, Bruce Lee, BS3, Michael Wehle, MD3, Paul Young,MD3, Todd Igel, MD3, Bhupendra Rawal, MS2, Kaitlynn Custer, BS2 and David Thiel, MD3 1Mayo Clinic Florida, Department of Urology, Jacksonville, FL; 2Mayo Clinic Florida Department of Health Sciences Research and Division of Biomedical Statistics, Jacksonville, FL; 3Department of Urology, Mayo Clinic Florida, Jacksonville, FL Presented by: Abby Taylor, MD

Introduction: To evaluate the impact of transitioning from hand-assisted partial nephrectomy (HAPN) to robotic assisted partial nephrectomy (RAPN) for minimally invasive nephron sparing surgery (NSS) at a tertiary care institution. Methods: A total of 197 consecutive minimally invasive NSS were analyzed (98 HAPN and 99 RAPN) with respect to pre-operative parameters, peri-operative outcomes, and surgical margin status. MIC scores (resection margins, ischemia time, and complications) and surgical “trifecta” scores were compared between the two groups. Fisher’s exact test or Wilcoxon rank sum test were used for comparison of patient demographics, pre-operative, intra-operative and post-operative characteristics as well as complication rates between HAPN and RAPN. Results: HAPN and RAPN were comparable with regards to age, sex, ASA score and BMI. RAPN was peformed on 22 masses over 4 cm in size (22%) compared to 15 masses (15.3%) in the HAPN group (p=0.27). A majority of the HAPN were R.E.N.A.L. scores 4−6 (79.6%) with no complex (R.E.N.A.L. 10−12) resections while RAPN was peformed on 13 (13.1%) complex tumors and 48 (48.5%) moderate R.E.N.A.L. 7-9 tumors. Operating (OR) time was longer for RAPN (201 min. compared to 182 min. p <0.001). However this difference dissapated when only R.E.N.A.L. 4-6 tumors were analyzed. HAPN patients were more likely to be hospitalized longer than three days (35.7% vs 20.2% p = 0.018) and go home with a drain in place secondary to urine leakage (13.3% vs 2.0% p = 0.003). Overall complications (38.8% vs. 21.1% p = 0.008) and major complications (13.3% vs 6.1% p= 0.097) (Clavien score 3 or higher) were higher in the HAPN group Wound complications were markedly higher in the HAPN group (17.4% vs 2.0%, p<0.001). MIC and “Trifecta“ scores were equivalent between the two groups even with elimination of the R.E.N.A.L. 10- 12 tumors from analysis. Conclusion: At a practice level, transition from HAPN to RAPN allowed for minimally invasive NSS on more complex tumors while noting fewer complications and less hospital Po st e rs stay compared to HAPN although MIC and Trifecta scores were equivalent. The largest benefit of RAPN over HAPN may be decreased wound complications. These benefits appear to be at the expense of longer OR times and more patients being resected under warm ischemia conditions.

252 Poster #117 USE OF SINITINIB PRIOR TO CYTOREDUCTIVE NEPHRECTOMY IN CLEAR CELL RENAL CELL CARCINOMA Nima Baradaran, Harry Drabkin, MD, Stephen Savage, MD Medical University of South Carolina, Charleston, SC Presented by: Nima Baradaran

Introduction: Treatment of metastatic renal cell carcinoma has been revolutionized with use of new immune modulating drugs and multi−kinase/mTor inhibitor agents. Unlike many other metastatic conditions, cytoreductive nephrectomy has been shown to improve survival. Methods: After IRB–approval, records of all patients with metastatic clear cell renal carcinoma who were enrolled in the ongoing clinical trial of Sunitinib treatment prior to cytoreductive nephrectomy were identified and reviewed. Patients received 37.5mg of Sunitinib daily for eight weeks, prior to nephrectomy. Sunitinib was resumed four weeks after surgery unless there was disease progression or presence of side effects. The extent of disease was evaluated by imaging on entry and immediately before and 4 weeks after surgery. Results: Seventeen patients (58% males) were enrolled at the median age of 58.3 years. Median tumor size before Sunitinib was 9.3 cm (range: 2.8−20). Tumor was extended in renal vein in eight patients and IVC in 1. Tumor stage was 3b (n=5), 3a (n=3) and 2 (n=3). Six patients were excluded after initial enrollment due to disease progression in four and Sunitinib side effects in two (one GI toxicity and one thrombocytopenia and hematotoxicity). Eleven patients received median 66 days of Sunitinib treatments with two requiring dose reduction due to side effects. Common side effects were hypertension (two), elevation of transaminase (two), esophagitis/mucositis (two) and flare of arthritis (one). Surgical approach was laparoscopic in eight, robotic in one and open in two. Nephrectomy was aborted intraoperatively in two cases secondary to likely bowel invasion. Two patients (open surgery) had renal artery embolization one day prior to surgery. Median surgical time was 400 minutes (range: 150-00) with two days (range 1-6) hospital stay. There were no significant intraoperative or postoperative complications except for ileus in two patients. Tumor grade was 3 in 72% and 4 in the rest. During 17.1 (4.5-4) months of follow up, all patients had disease progression. Five patients expired after 7.4 (4.5-17.2) months post-enrollment, one was lost to follow up and the rest are alive with the disease. Median time to progression was 8.5 months (3-13.3). Six patients were initiated on at least one salvage agent after median 9.3 months (3.4-15.7). Average survival post-cytoreductive nephrectomy was 14.7 (2-60) months. Median time to death was 7.48 compared to 43% possibility of 12-month progression free survival predicted by metastatic RCC nomograms. Conclusion: Sunitinib treatment has a role in treatment of metastatic RCC and using it as a neoadjuvant treatment prior to cytoreductive nephrectomy is well tolerated by patients.

253 Poster #118 CAVAL THROMBUS VOLUME INFLUENCES OUTCOMES IN RENAL CELL CARCINOMA WITH VENOUS EXTENSION Kamran Zargar-Shoshtari, MD1, Patrick Espiritu, MD1, Pranav Sharma, MD1, Tony Kurian, BS1, Julio M Pow-Sang, MD1, Devanand Mangar, MD2, Paul Armstrong, MD3, Wade J. Sexton, MD1 and Philippe E. Spiess, MD1 1Departments of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL;2 Anesthesiology, Tampa General Hospital, Tampa, FL; 3Division of Vascular and Endovascular Surgery, Department of Evidence Based Medicine, University of South Florida, Tampa, FL Presented by: Kamran Zargar-Shoshtari, MD

Introduction: Surgery for renal cell carcinoma (RCC) with tumor thrombus has high potential morbidity rate and the current classification system based on proximal thrombus level (TTL) has not been shown to consistently predict outcomes. The aim of the purposed study is to determine if inferior vena cava tumor thrombus volume (IVC-TV) provides additional prognostic information. Methods: To assess the prognostic value of IVC−TV for determining the peri-operative complications as well as with survival endpoints. Method: From June 2001 to June 2012, we identified 147 patients that underwent radical nephrectomy with venous thrombi. Sixty- six patients had IVC involvement and available digitized cross sectional imaging for review. IVC-TV was measured by cross sectional area and height measurement for each axial slice. Selected end points were complications, transfusion rates, disease progression (PoD) and overall survival (OS). Complications were classified based on Clavien-Dindo system. TTL was based on Mayo classification system (0-IV). Linear and logistic models and Cox Proportional Hazard was used for analysis. Results: Median tumor size was 9 cm (IQR 6.5-12). Median IVC-TV was 16.5 cm3 (IQR 4.7−50), 18 patients had TTL ≥ III. Fifty-seven Clavien I-V complications were documented in 32 patients (eight intraoperative, 49 post-operative) including three deaths. On multivariate (MVA) Age > 65, ASA> 3 and IVC-TV > 15 cm3 were independent predictors for peri- operative complications. IVC-TV was the strongest predictor of need for RBC transfusion (beta coefficient 0.53, p<0.01). TTL was not an independent predictor in this setting. PoD occurred in 78% of patients with median duration of 5.75 months (IQR 2.4, 12,1). Presence of metastatic disease (HR 8.47, p<0.01) and pathological stage (HR 2.46, P=0.01) were independent predictors of PoD. Median time to death was 16 months (IQR 5.2, 42.9). On Cox regression metastatic disease, non-clear cell histology as well as IVC−TV> 15 cm3 and TTL III/IV were significantly associated with OS. As a pre-operative variable IVT−TV > 15 cm3 was shown to be an independent predictor of PoD (HR 2.3 p=0.01) and OS (HR 2.21 p=0.03). Po st e rs Conclusion: IVC-TV has value as a prognostic indicator, which is superior to TTL in this setting

254 Poster #119 PROSPECTIVE EVALUATION OF THE ASSOCIATION OF ADHERENT PERINEPHRIC FAT WITH PERIOPERATIVE OUTCOMES OF ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY Andrew Davidiuk, MD1, Alexander Parker, PhD2, Colleen Thomas, MS3, Michael Heckman, MS3, Kaitlynn Custer, BS2 and David Thiel, MD4 1Mayo Clinic Florida, Jacksonville, FL; 2Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL; 3Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL; 4Department of Urology, Mayo Clinic, Jacksonville, FL Presented by: Andrew Davidiuk, MD

Introduction: Adherent perinephric fat (APF), commonly referred to as “sticky fat,” is an overlooked surgical variable that can complicate robotic-assisted partial nephrectomy (RAPN) and may adversely affect perioperative outcomes. We prospectively analyzed the association of APF with perioperative outcomes of RAPN. Methods: We analyzed 100 consecutive RAPNs performed by a single experienced surgeon and defined APF as the necessity of subcapsular renal dissection to mobilize the kidney and isolate the renal tumor for RAPN. Our primary analysis focused on comparing perioperative outcomes, including operative time, warm ischemia time, estimated blood loss, postoperative complications, length of stay, and MIC score (margins, ischemia, complications) between patients with and without APF. To adjust for multiple comparisons, we used a Bonferroni- corrected p-value greater than or equal to 0.0042 to determine statistical significance. Results: Thirty patients (30%) had APF. Presence of APF was not significantly associated with blood loss, warm ischemia time, hospital stay, postoperative complications, or MIC score. We noted some evidence of longer operative times in patients with APF compared to those without APF (Median: 223 vs.199 minutes, P=0.026); however, this was not significant after adjustment for multiple variable testing. In multivariable analysis, we noted evidence of associations of increased operative time with RENAL score (P=0.011) and BMI (P=0.031) but not presence of APF (P=0.14). Conclusion: APF may be associated with longer operative times but does not appear to affect perioperative outcomes. Elevated RENAL scores and BMI may be better associated with surgical difficulty and perioperative outcomes than APF.

255 Poster #120 REPOPULATION OF PRIMARY RENAL CELLS FOR WHOLE ORGAN ENGINEERING: FUNCTIONAL EVALUATIONS Mehran Abolbashari, MD, Mi Kyung Lee, MD, Sigrid Agcaoili, MD, Tamer Aboushwareb, MD, John Jackson, PhD, In Kap Ko, PhD, James Yoo, MD, PhD, Anthony Atala, MD Wake Forest School of Medicine, Winston Salem, NC Presented by: John Jackson, PhD

Introduction: Renal transplantation is the only definitive treatment for end stage renal disease (ESRD), but is limited by the availability of donor organs. We previously demonstrated that repopulation of primary renal cells within acellular porcine kidney scaffolds leads to cell attachment and organization with maintenance of cellular phenotypes. In this study, we examined whether the recellularized porcine kidney scaffolds possess functional properties. Primary cultures of porcine renal cells were expanded, characterized, and seeded into upper pole of decellularized renal scaffolds, followed by bioreactor perfusion for 14 days. Methods: To evaluate renal function of the renal structures in the scaffold, the level of erythropoietin (EPO) and EPO mRNA expression was determined. Electrolyte or albumin re-adsorption by the cultured renal cells and repopulated cells within the scaffold was evaluated. The activity of amino acid transport gamma glutamyl transpeptidase (GGT) or leucine aminopeptidase (LAP) (hydrolase activity) on the renal cells was determined by measuring the transformed amino acids released in the cell culture. Results: Microscopic results demonstrated that fluorescently labeled sodium and albumin uptake by the renal cells on monolayer and the cells within the repopulated construct was present. Hydrolase activity assay revealed that the renal cells on monolayer as well as within the recellularized construct showed significant hydrolase activity, indicating that the re-organized renal structures within the recellularized kidney constructs retain almost the same level of hydrolase activity with that of native kidneys. The results of EPO quantification showed that the seeded cells produced EPO and the level increased over time, confirmed by EPO mRNA in the seeded cells. Functional evaluation assays revealed that the repopulated cells within the kidney construct had renal functions such as re-adsorption of sodium and protein, hydrolase activity, and production of erythropoietin. Conclusion: These results provide preliminary data for the generation of a transplantable renal graft as a potential treatment for ESRD. Po st e rs

256 Poster #121 FACTORS ASSOCIATED WITH ACUTE AND CHRONIC RENAL INJURY FOLLOWING MINIMALLY INVASIVE PARTIAL NEPHRECTOMY (MIPN) IN PATIENTS WITH NORMAL PRE-OPERATIVE GFR (GLOMERULAR FILTRATION RATE) Abby Taylor, MD1, Bruce Lee, BS2, Bhupendra Rawal, MS3 and David Thiel, MD1 1Mayo Clinic Florida, Department of Urology, Jacksonville, FL; 2Mayo Clinic Florida, Jacksonville, FL; 3Mayo Clinic Florida Department of Health Sciences Research and Division of Biomedical Statistics, Jacksonville, FL Presented by: Abby Taylor, MD

Introduction: We examined 198 consecutive MIPN (100 robotic/98 laparoscopic) completed in patients with two renal uints to determine factors associated with acute and chronic changes of GFR at defined post-operative time points (one day, one month, six months, and 12 months) . Methods: One hundred ninety-eight consecutive MIPN (median age 63 years [22-87]) performed on patients with two renal units were retrospectively reviewed. Demographics including age, sex, body mass index (BMI), RENAL score, ASA score, tumor size, hypertension (HTN), diabetic status (DM) were utilized along with operative variables of operative time (ORT), warm ischemia time (WIT), and operative complications to determine associations with alterations in GFR (measured in mL/min/1.73m2) following MIPN. Single and multivariable linear regression analyses were used to assess associations of having a pre-operative GFR > 60 and going to GFR < 60 at the defined post-operative time points. Analysis was completed with SAS (version 9.2 Cary, NC) and R statistical software (version 2.11, Vienna, Austria). Results: Eighty-five of the 198 MIPN were over age 65 (42.9%). 79 patients (39.9%) had BMI > 30. Twelve patients (6.1 %) had RENAL score of 10 or higher while 116 patients (58.6%) had RENAL score 4-6. One hundred twenty-three patients (62.1%) had diagnosis of HTN (taking at least one HTN medication at time of surgery) and 40 patients (20.2%) had DM at time of surgery. Ninety-one MIPN were performed without hilar clamping while 107 patients had clamping (median 17 minutes [seven-45 minutes]). Thirty-one patients (15.7%) had pre-operative GFR < 60 and were eliminated from the analysis. Of the 167 patients with pre-operative GFR > 60, 44 (26.3%) had GFR < 60 on POD#1 and 20 (11.9%) persisted with GFR < 60 at 12 months post−operatively. HTN (p=0.04), longer ORT (p=0.02), and hilar clamping (p=0.03) were associated with pre-operative GFR > 60 to GFR < 60 on POD#1 with single variable analysis but were non-significant association on multivariable analysis. At one month post-operatively, hilar clamping and HTN were the only two factors (both p-values <0.027) on multivariate analysis associated with pre−operative GFR >60 going to GFR <60. No factors were associated with GFR change with single variable or multivariable analysis at the six-month and 12-month evaluations. WIT longer than 20 minutes was not associated with GFR change at any of the post-operative intervals. Conclusion: In patients with two kidneys and pre-operative GFR > 60 that undergo MIPN, renal hilar clamping and HTN may be associated with GFR change in the early post-operative period but not at the six-month or 12-month follow up periods. WIT greater than 20 minutes was not associated with GFR change at any time period following MIPN up to 12 months.

257 Poster #122 JOB SATISFACTION IN UROLOGY: THE INFLUENCE OF DEMOGRAPHIC, ECONOMIC AND WORKLOAD FACTORS Nicholas Pruthi, BA1, E. Sophie Spencer, MD1, Matthew Lyons, MD1, Peter Greene, MD1, Max McKibben, MD1, Matthew Nielsen, MD1, Raj Pruthi, MD1, Mathew Raynor, MD1, Eric Wallen, MD1, Michael Woods, MD1, Christopher Gonzalez, MD2 and Angela Smith, MD1 1UNC, Chapel Hill, NC; 2Northwestern, Chicago, IL Presented by: E. Sophie Spencer, MD

Introduction: Urology continues to be a highly sought after medical specialty with hopes of high job satisfaction and personal fulfillment. We sought to evaluate the impact socioeconomic factors, workload, and practice type on job satisfaction in urology. Methods: We worked with the AUA to query its domestic membership of practicing urologists (out of training) regarding socioeconomic, workforce, and quality of life issues. In order to meet the study objectives, a thorough quantitative survey was designed by the AUA Marketing, Government Relations, and Practice Management Depts. A total of 6,511 valid survey invitations were sent via e-mail. The entire survey consisted of 26 questions and took approximately 13 minutes to complete. A total of 848 responses were collected for a total response rate of 13%. A total sample size of 848 is accurate within 3.43% at the 95% confidence level. Percent satisfied indicated those who answered “very satisfied” or “somewhat satisfied” with current work. The results evaluating job satisfaction as it relates to demographic and career characteristics are herein reported. Results: The overall job satisfaction in urology is 70% with 63% of respondents stating they would choose medicine again and 84% stating that they would choose urology again. Other results are demonstrated in the table. Table Legend: Practice Type = Self−employed (“private practice”) (S); Employed (E); Academic (A); Location = Rural (R); Suburban (S); Urban (U); Practice Size = mean number of urologists in your practice; % satisfied = % answered “very satisfied”or “somewhat satisfied”with current work; % choose urology again = % who would choose urology again as a specialty Conclusion: There appear to be a variety of factors that may influence job satisfaction in urology including age, income, practice type, location, and completion of a fellowship. Po st e rs

258 Poster #123 PRIVATE PRACTICE, ACADEMICS, OR EMPLOYED: DOES EMPLOYMENT STATUS IMPACT WORK, INCOME, AND JOB SATISFACTION? Nicholas Pruthi, BA1, E. Sophie Spencer, MD1, Matthew Lyons, MD1, Peter Greene, MD1, Max McKibben, MD1, Matthew Nielsen, MD1, Raj Pruthi, MD1, Mathew Raynor, MD1, Eric Wallen, MD1, Michael Woods, MD1, Christopher Gonzalez, MD2 and Angela Smith, MD1 1UNC, Chapel Hill, NC; 2Northwestern, Chicago, IL Presented by: E. Sophie Spencer, MD

Introduction: There are a variety of reasons for a urologist to choose certain employment types, and this employment status may have an impact on income, work, and job satisfaction. We sought to evaluate the impact of employment status on career-related measures. Methods: We worked with the AUA to query its domestic membership of practicing urologists (out of training) regarding socioeconomic, workforce, and quality of life issues. In order to meet the study objectives, a thorough quantitative survey was designed by the AUA Marketing, Government Relations, and Practice Management Depts. A total of 6,511 valid survey invitations were sent via e-mail. The entire survey consisted of 26 questions and took approximately 13 minutes to complete. A total of 848 responses were collected for a total response rate of 13%. A total sample size of 848 is accurate within 3.43% at the 95% confidence level. The results relating to an employment status are herein reported. Results: Employment status was categorized as either self-employed (“private practice”), employed, or academics. The results are demonstrated in table 1.

FIGURE LEGEND (table 1): Gender Male (M); Female (F) Location = Rural (R); Suburban (S); Urban (U) Practice Size = mean number of urologists in your practice % satisfied = % answered “very satisfied ”or “somewhat satisfied” with current work % choose urology again = % who would choose urology again as a specialty

The second table demonstrates the primary special interest areas of the respondents stratified by employment status. (Respondents could choose up to three.) Each row demonstrates the specialty area and the composition of urologist that make up that specialty focus by employment type (e.g. of those who focus on oncology, 25% are employed, 47% are self-employed, and 25% are in academics).

Conclusion: The decision to pursue private practice, an employed position, or academics can have an impact on career-related outcomes including income, practice location, practice type, job satisfaction, and specialty focus.

259 Poster #124 ROBOTIC-ASSISTED RETROPERITONEAL VERSUS TRANSPERITONEAL PARTIAL NEPHRECTOMY: A SINGLE SURGEON’S EXPERIENCE Pranav Sharma, MD, Justin Emtage, MD, Wade Sexton, MD Moffitt Cancer Center, Tampa, FL Presented by: Pranav Sharma, MD

Introduction: Robotic-assisted retroperitoneal partial nephrectomy (RARPN) is an infrequently utilized minimally-invasive approach for nephron preservation. There are technical advantages including direct access to the renal hilum and improved access to posteriorly situated renal tumors. Critics of this technique, however, have pointed to the small working space and unfamiliarity of surgical landmarks as disadvantages. This study compares surgical and oncological outcomes of RARPN to an established experience of robot-assisted transperitoneal partial nephrectomy (RATPN). Methods: From July 2008 to September 2014, 24 RARPN and 105 RATPN were successfully performed by a single surgeon for renal masses amenable to a minimally invasive approach. Four patients undergoing attempted RATPN required conversion to an open partial nephrectomy and were excluded. Clinical characteristics, intraoperative factors, tumor pathology, and postoperative outcomes were compared between the RARPN and RATPN groups using the t-test to determine differences in continuous variables and the Fisher exact test for categorical variables. Results: Patient demographic and preoperative renal function was no different between the RARPN and RATPN groups. Renal masses in the RARPN cohort were slightly more complex than those in the RATPN cohort with a higher median nephrometry score (seven versus six) and a greater percentage near the hilum (25% versus 14.3%) although these variables were not statistically different (p=0.174 and p=0.224, respectively). Intraoperative factors were similar between the two groups including median operative time, warm ischemia time, estimated blood loss, and rate of blood transfusion. Pathological factors were also similar including median tumor size, percentage of renal cell carcinoma (RCC), RCC histology, Fuhrman grade, positive surgical margin rate, and tumor stage. The only postoperative outcome that was statistically different between the two groups was average length of stay (LOS) favoring RARPN (2.67 versus 3.47 days, p=0.014), but the 30−day complication rates and postoperative change in estimated glomular filtration rate (eGFR) were similar. Median follow-up was significantly shorter in the RARPN group (3.75 versus 12.1 months, p=0.003), reflecting the more contemporary use of this approach. Conclusion: RARPN is a safe and effective approach for posteriorly situated small renal masses that results in equivalent surgical and oncological outcomes as RATPN with shorter LOS. Recognizing various study and selection biases, further evaluation is needed to Po st e rs accurately describe the learning curve associated with this procedure and the factors used for deciding when to incorporate this technique.

260 Video #1 COMPLEX ROBOTIC URETEROPLASTY USING BUCCAL MUCOSAL GRAFT ONLAY FOR TREATMENT OF 3 CM PROXIMAL URETERAL STRICTURE Carrie Stewart, MD1, Michael Maddox, MD2, Michael Ellis, MD2 and Benjamin Lee, MD, FACS2 1Tulane University School of Medicine Department of Urology, New Orleans, LA; 2Tulane University School of Medicine Department of Urology, New Orleans, LA Presented by: Carrie Stewart, MD

We present a case of a complex, long-segment, proximal ureteral stricture treated with robotic-assisted laparoscopic buccal mucosa onlay graft ureteroplasty.

Video #2 HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): STEP-BY-STEP Christopher Mitchell, MD, Nicole Miller, MD Vanderbilt University Medical Center, Nashville, TN Presented by: Christopher Mitchell, MD

This video provides a step-by-step description of how to perform HoLEP.

Video #3 IDENTIFICATION OF THE S3 FORAMEN DURING TRANSFORAMINAL SACRAL NEUROMODULATION LEAD PLACEMENT − A NOVEL “ROLLING PEN” TECHNIQUE Amanda Saltzman¹, Kristi Hebert¹, Howard Woo² and Ryan Krlin¹ ¹Louisiana State University, New Orleans, LA; ²Ochsner Clinic Foundation, New Orleans, LA Presented By: Kristi Hebert We demonstrate a technique for S3 foramen identification during sacral neuromodulation. Over 200 procedures have been performed during the past year by the two highest volume implanters in Louisiana, using this technique.

Video #4 ROBOTIC REPAIR OF RECTOVESICAL FISTULA: COMBINED ANTERIOR AND POSTERIOR APPROACH WITH OMENTAL FLAP INTERPOSITION Rishi Modh, MD, MBA1, Katherine Corbyons, MD2, Sanda Tan, MD2, Li-Ming Su, MD2 and Lawrence Yeung, MD2 1University of Florida, Gainesville, FL; 2Unverisity of Florida, Gainesville, FL (Presented by: Rishi Modh, MD, MBA)

In this video, we demonstrate robotic repair of a rectovesical fistula using a posterior and transvesical approach. Once the fistula is completely separated from the bladder, itis primarily closed and an omental flap is mobilized and secured over the fistula site to create a durable repair.

Video #5 A NOVEL DEVICE FOR INTRAPERITONEAL CAMERA CLEANING: ROBOTIC SURGERY WITH FLOSHIELD TECHNOLOGY Julie Wang, MD, MPH, Michael Maddox, MD, Philip Dorsey, MD, MPH, Benjamin Lee, MD Tulane University New Orleans, LA (Presented by: Julie Wang, MD, MPH)

In this video we demonstrate the technique of a new camera cleaning technology which allows wiping of the camera intraoperatively without removal of the camera from the trocar. We demonstrate assembly, application, and troubleshooting of the novel FloShield technology during a robotic partial nephrectomy.

261 Video #6 POSTERIOR, TRANSVESICAL APPROACH FOR ROBOTIC SIMPLE PROSTATECTOMY AND BLADDER STONE REMOVAL Justin Ellett, MD, PhD1, Lydia Labocetta, MD2, Sandip Prasad, MD and Harry Clarke, MD, PhD2 1MUSC; 2MUSC, Charleston, SC (Presented by: Justin Ellett, MD, PhD)

A posterior, transvesical approach to robotic simple prostatectomy improves exposure for bladder stone removal, and aids in visualization of the prostate. This approach is superior to approaches that enter the space of Retzius, and should be considered as a viable alternative for patients requiring simple prostatectomy.

Video #7 ROBOTIC RIGHT ADRENALECTOMY FOR PHEOCHROMOCYTOMA: A STEPWISE APPROACH Timothy Brock, MD and Wesley White, MD University of Tennessee Medical Center, Knoxville, TN (Presented by: Timothy Brock, MD)

This is a step-by-step guide for performing a robot-assisted laparoscopic adrenalectomy (performed in this instance for a 6cm, right sided pheochromocytoma). Our intent is to demonstrate a systematic, reproducible approach.

Video #8 ROBOTIC EXTRAVESICAL REIMPLANT ON A SOLITARY KIDNEY Anthony Tracey, MD, MPH, Gregory Mitchell, MD, MS, Raju Thomas, MD, FACS, MHA Tulane University School of Medicine, New Orleans, LA (Presented by: Anthony Tracey, MD, MPH)

Thirty-six-year-old female with a solitary right kidney and grade 3/4 vesicoureteral reflux with breakthrough febrile urinary tract infections despite antibiotic suppression. Patient undergoes a right robot assisted laparoscopic extravescial ​(Lich-Gregoir) reimplant, with excellent results.

Video #9 ROBOT-ASSISTED LAPAROSCOPIC EXCISION OF UNCOMMON RETROPERITONEAL MASSES Jason Joseph, BS, Akira Yamamoto, MD, Li-Ming Su, MD Department of Urology, University of Florida College of Medicine, Gainesville, FL (Presented by: Jason Joseph, BS)

Here we discuss a diagnostic approach to retroperitoneal masses, and present our experience performing robot-assisted excision for two of our patients in this setting.

Video #10 ROBOTIC URETEROLITHOTOMY: OPTIMIZING CLEARANCE OF LARGE URETERAL STONE BURDEN GREATER THAN TWO CENTIMETERS Mary Powers, MD, Michael Maddox, MD, Julie Wang, MD, Benjamin Lee, MD Tulane University New Orleans, LA vi deo s (Presented by: Mary Powers, MD)

This video demonstrates the robotic approach to ureterolithotomy with concomitant antegrade nephroscopy with Cyber Wand stone removal.

262 Video #11 VASECTOMY SIMULATION AND RESIDENT TRAINING: REQUIRED COMPLETION OF VASECTOMY CHECKLIST PRIOR TO LIVE SURGICAL EXPERIENCE Ram Pathak, MD, Scott Alford, David Thiel, MD, Todd Igel, MD Mayo Clinic, Jacksonville, FL (Presented by: Ram Pathak, MD)

Surgical simulation has been has been shown to improve surgeon performance in the operating room. Therefore, we have a constructed a vasectomy module workshop, complete with video demonstration and live skills practice under the supervision of an attending physician.

Video #12 ADJUSTABLE SINGLE-INCISION MID-URETHRAL SLING FOR PURE STRESS URINARY INCONTINENCE James Bienvenu, MD, Wesley White, MD Division of Urology, University of Tennessee Medical Center, Knoxville, TN (Presented by: James Bienvenu, MD)

We present our technique for a novel adjustable single-incision, mid-urethral sling in video format.

263 SESAUA Annual Business Meeting Agenda Sunday, March 22, 2015

I. Report from the President – Jack M. Amie, MD

II. Minutes of the 2014 Annual Business Meeting – Dean G. Assimos, MD

III. Secretary Report – Dean G. Assimos, MD

IV. Treasurer Report – Scott B. Sellinger, MD (see page 291)

V. Historian Report - Jerry E. Jackson, MD

VI. Committee Reports

1. 2015 Local Arrangements Committee – Thomas E. Shook, MD

2. Committee on Education and Science – S. Duke Herrell III, MD

3. Bylaws Committee: 2015 Bylaws Changes – Lee N. Hammontree, MD (see page 270)

4. Finance Committee – Gerard D. Henry, MD

5. Membership Committee – Chad W.M. Ritenour, MD (see page 267)

6. Health Policy Committee – J. Christian Winters, MD

VII. Representative to the Board of Directors of the AUA – Thomas F. Stringer, MD (see page 294)

VIII. Future Sites Committee – W. Terry Stallings, MD

IX. Unfinished Business

X. New Business

XI. Honorary Members – Jack M. Amie, MD

XII. Nominating Committee Report and Elections – Randall G. Rowland, MD

XIII. Introduction of Incoming President

XIV. Adjournment vi deo s

264 Minutes of the 78th Annual Business Meeting of the SESAUA Southeastern Section of the American Urological Association, Inc. Hollywood, Florida Sunday, March 23, 2014

Unless otherwise noted, actions were by unanimous vote and all committee reports were unanimously approved.

I. Report from the President – Raymond J. Leveillee, MD, FRCS-G Dr. Raymond Leveillee provided a brief report on the board actions: o Dr. S. Duke Herrell was approved to fill the vacancy of Chair on the Committee on Science and Education, replacing Michael Cookson who has transferred out of the Section, and is the new Chair at the University of Oklahoma Health Sciences Center. o The board introduced the 2014-2015 AUA Leadership Class: Daniel Barocas, MD, Robert Carey, MD, and Alberto Ramirez-Lopez, MD. The Southeastern section will continue the annual SES Robotics Course. o There were two presidential citation awards given at the annual banquet. . Dr. Vipul Patel for outstanding contributions to the Surgical Robotic Education and training of Residents and Fellows of the SESAUA. . Dr. Hernan Carrion for outstanding contributions to the surgical advancement of Erectile Dysfunction and for superior mentoring skills.

II. Minutes of the 2013 Annual Business Meeting – Dean G. Assimos, MD Dr. Dean Assimos presented the minutes of the 2013 Annual Business Meeting to the membership for approval.

Action: The minutes of the 2013 Annual Business Meeting were approved as presented.

III. Secretary Report – Dean G. Assimos, MD Dr. Assimos thanked WJWeiser and Associates as well as others for coordinating a wonderful meeting. There were 10 outside speakers on the program this year including the Ambrose Reed Lecturer, Dr. Donna Shalala, the Presidential Lecturer, Dr. Robert Flanigan and the Ballenger Lecturer, Dr. Inderbir Gill. One of the goals of this meeting was to reengage the Pediatric Urologists; Dr. Anthony Caldmone presented a Visiting Professor Lecture on Pediatric Urology. There were 348 abstracts submitted and 61% were approved for presentation. The section continues to promote the young urologists in the Southeastern Section. The section will now support five IVUmed Scholars starting next year. The section will also now support residents participating in the section’s quiz bowl.

Action: The Secretary’s Report was approved as presented.

IV. Treasurer Report – Jon S. Demos, MD Dr. Demos referred the board members to page 209 for a full written treasurer’s report. Based on the information provided by Dr. Assimos direct section expenses for resident’s education now exceeds $100,000 annually. The AUA Chief Resident Debate participants will also receive $1,000 stipends from the southeastern section. Regarding the Hector Henry Run a total of $5,250 was raised to the Leukemia and Lymphoma Society on Dr. Hector Henry’s behalf. Dr. Demos wanted to thank Dr. Janosko, Stringer and Stallings for their support during his term as Treasurer.

265 Action: The Treasurer’s Report was approved as presented.

V. Historian Report M i n ut e s Dr. Raymond Leveillee presented the Historian Report to the membership. Dr. Leveillee provided the listing of member in the Southeastern Section who have passed away this past year: Joel Avis, MD, William Boyce Jr., MD, Ruskin Brown, MD, Jorge Cuellar, MD, Allan Davis, MD, Charles Day, MD, Raymond Fitzpatrick, MD, Hector Henry II, MD, MPH, MS, Walter Kerr Jr., MD, Robert Leake, MD, George Maloney, MD, Peter Quinn II, MD.

A moment of silence was given to remember those members who have passed.

Action: The Historian Report was approved as presented.

VI. Committee Reports 1. 2014 Local Arrangements Committee – Bruce R. Kava, MD Dr. Kava thanked everyone for attending the 2014 Annual Meeting. There was a great turn out at the annual meeting and during all of the events. The resident’s truly enjoyed the resident’s night out and will be continued once again next year.

2. Committee on Education and Science – S. Duke Herrell III, MD Dr. Herrell thanked everyone for his appointment as Chair of Committee on Education and Science. He thanked the committee members for all of their assistance with the 2014 program as well as Dr. Leveillee and Dr. Assimos for their support.

3. Bylaws Committee – Lee N. Hammontree, MD Dr. Hammontree presented the bylaws change to the membership regarding the historian’s term. Article II - Officers Section G. Historian 1. This Section shall have a Historian who is elected annually by membership. He/She shall serve a term of three years, and can be re-elected to serve a second three year term. may succeed himself/herself in Office. He/She must be nominated for Office by the Committee on Nominations or from the floor and be elected at the Annual Business Meeting by a majority vote of those present and voting.

Action: The bylaws change was approved as presented.

4. Finance Committee – David M. Kraebber, MD Dr. Kraebber presented the Finance Committee report to the membership. The Southeastern Section had another great year financially. The section’s investment account exceeds $4.4 million. The section had a joint teleconference with the AUA and Vanguard. Vanguard offered the SES an opportunity to join Vanguard and choose from the AUA’s investment selections. The section would decrease their administrative costs if they went with Vanguard. There is still discussion as to whether or not this change will take place.

266 5. Membership Committee – Chad W.M. Ritenour, MD Dr. Ritenour presented the Membership Committee report to the membership. Our membership continues to grow with over 2,300 members including 16 new Panama members. There are a total of 74 candidates for membership as well as 49 internal transfers.

Action: The candidates for SES membership were approved.

6. Health Policy Committee – J. Christian Winters, MD Dr. John Henderson presented the Health Policy Committee report on behalf of Dr. Winters. There are four action items: 1. Asking for board approval of four funded health policy calls throughout the year 2. Ask the board to approve an hour long session regarding the RUC process 3. Ask the board to petition the AUA to release a statement that it is both ethical and understandable for a physician to charge the patient for the services required for preauthorization 4. Ask the board to consider adding a practice management seminar in the annual program aimed at residents and young urologists.

Action: All committee reports were approved as presented.

VII. Representative to the Board of Directors of the AUA – Dennis D. Venable, MD Dr. Dennis Venable presented the AUA Board of Directors report. The Southeastern section had the pleasure of hosting AUA President Dr. Pramod Sogani at our meeting this year. The AUA has over 20,000 members in the organization. Almost 4,000 members are senior members of the AUA. The AUA’s finances remain strong and continue to have threats of loss of support from pharmaceutical industries. The AUA spends over $32 million annually. The AUA’s foundation has been rebranded and named the Urology Care Foundation. The AUA Office of Education continues to perform well and produce valuable products to the membership. There is a day and a half course planned at the AUA meeting with 6 modules. There are both oral board and certification review courses in 2013 that were well received and will continue in 2014. The new AUA Secretary-Elect will be Dr. Manoj Monga. The AUA will have a new journal called the Urology Practice that will focus on four important areas of urology. Dr. Venable announced that it was his last year as the SES representative to the AUA Board of Directors and that Dr. Thomas Stringer will replace him in that capacity. Dr. Raymond Leveillee will replace Dr. Thomas Stringer as the Alternate Representative to the AUA Board of Directors.

VIII. Future Sites Committee – Thomas F. Stringer, MD Dr. Thomas Stringer presented the Future Sites Committee report to the membership. The 2017 SESAUA Annual Meeting will be held in Austin, Texas. There are currently two venues that the section is negotiating with, the JW Marriott and the Hilton Hotel.

Action: The Future Sites Committee report was approved as presented.

IX. Unfinished Business Nothing to report.

X. New Business Nothing to report.

267 XI. Honorary Members – Raymond J. Leveillee, MD, FRCS-G Dr. Raymond Leveillee announced names to be approved for Honorary

Membership: M i n ut e s • Donna Shalala, PhD • Inderbir Gill, MD • Robert Flanigan, MD • Christopher Gonzalez, MD • Jeffrey Kaufman, MD • Cynthia Ransburg-Brown, JD • Anthony Caldamone, MD • Christopher Chermansky, MD • Kevin McVary, MD • H. Ballentine Carter, MD • Pramod Sogani, MD

Action: The all individuals proposed were approved for Honorary Membership in the Southeastern Section.

XII. Nominating Committee Report and Elections – Raju Thomas, MD, FACS, MHA Dr. Raju Thomas presented the following slate of nominations for the SESAUA Board of Directors: President Elect - Jon Demos, MD Treasurer - Scott Sellinger, MD Historian - Jerry Jackson, MD Florida Representative - Sijo Parekattil, MD Florida Representative - Rolando Rivera, MD Florida Alternate Representative - Kevin Ki-Dong Lee, MD Florida Alternate Representative - Christopher Williams, MD Georgia Representative - Henry Goodwin, Jr., MD Georgia Alternate Representative - Chad Ritenour, MD Louisiana Alternate Representative - Anna Smither, MD North Carolina Representative - Matthew Raynor, MD North Carolina Representative - Cary Robertson, MD North Carolina Alternate Representative - Gregory Murphy, MD, FACS North Carolina Alternate Representative - Aaron Lentz, MD South Carolina Representative - T. Brian Willard, MD South Carolina Representative - Richard Young, MD South Carolina Alternate Representative - Ross Rames, MD South Carolina Alternate Representative - Alexander Ramsay, MD Tennessee Representative - Peter E. Clark, MD Tennessee Alternate Representative - Melissa Kaufman, MD

Dr. Raju Thomas presented the following nominations for SESAUA representative to AUA Committees: AUA JU Editorial Board: Steven Strup, MD, Erik Rovner, MD, Marcos Perez- Brayfield, MD AUA Board of Directors Representative: Thomas Stringer, MD AUA Board of Directors Alternate Representative: Raymond Leveillee, MD

Action: The nominations for the SESAUA Board of Directors and the SESAUA representatives to AUA Committees were approved as presented.

268 Dr. Raju Thomas called for nominations from the floor for the Member-At- Large position on the SESAUA Nominating Committee. Dr. Martha Terris was nominated from the floor.

Action: Dr. Martha Terris was appointed as Member-at-Large on the SESAUA Nominating Committee.

Dr. Raymond Leveillee thanked the board representatives that were rotating off of the Board of Directors for their service and commitment to the section. Dr. Leveillee also thanked Wendy Weiser and her team for their service to the section.

XIII. Introduction of Incoming President Dr. Leveillee thanked everyone for the opportunity to serve the section as President. Dr. Leveillee introduced Dr. Jack Amie as the incoming SESAUA President.

Dr. Jack Amie thanked the section for the opportunity and great honor to serve as the President of the Southeastern Section. Dr. Jack Amie thanked the Executive Committee for their patience and guidance. He thanked Dr. Assimos for creating a wonderful program this year. Dr. Amie congratulated Dr. Raymond Leveillee for a wonderful year.

XIV. Adjournment Dr. Raymond Leveillee adjourned the 2014 Annual Business Meeting.

Respectfully Submitted, Wendy J. Weiser Executive Director

269 Southeastern Section Bylaws Proposed Changes 2015

Section E. SECRETARY

1. He/she shall cause to be printed supplied at the expense of the Section:

a.The Membership Directory of the Section which shall be updated and mailed at least every two (2) years. shall be made available on the Section’s website. b. The Program and Abstracts which will be printed and, or provided in electronic format or electronically on the Section’s website, for distributed distribution for the yearly b y l aws Meeting only.

Section F. TREASURER 1. He/she shall purchase, sell or transfer securities of the Section only upon recommendation of the Committee on Finance or approval of the Executive Committee.

270 BYLAWS of the Southeastern Section American Urological Association, Inc.

PREAMBLE

Section A. Mission The Southeastern Section of the American Urological Association, Inc., (Section) is a professional organization devoted to the propagation of the highest standards of medical practice and to the discovery and dissemination of scientific knowledge and information. It is also the function of the Section to promote and advocate for the practice of urology.

Section B. objectives The stated objectives of the Section are to perpetuate the finest traditions of the medical arts, to encourage the scientific advances in the field of urology, to promote the improved practice of urology, and to benefit the general welfare. It is the Section’s paramount goal to offer increasing responsibilities to those vigorous young colleagues exhibiting enthusiasm and capability.

ARTICLE I MEMBERSHIP

Section A. CATEGORIES The Membership of the Southeastern Section of the American Urological Association, Inc., herein afterward known as the Section, shall consist of the following categories:

1. Active Members 5. Honorary Members 2. Senior Members 6. Corresponding Members 3. Associate Members 7. Candidate Members 4. Allied Members

Membership in the Section is afforded solely at the discretion of the Board of Directors and the Section Membership, with the advice of the Membership Committee. Application for membership in the Section must be made on forms approved by the Board of Directors and provided by the Secretary.

Section B. VOTING STATUS AND RIGHTS Only Active and Senior members, and those Active and Senior members who are elected to Honorary Membership, shall be eligible for office or have the right to vote. All members shall be entitled access to the latest available copy of the Articles of Incorporation and Bylaws and the Roster of Membership available on the Section Website.

271 Section C. MANDATORY AUA MEMBERSHIP Each member of the Section must also join the AUA. Each member of the AUA, except corresponding members, must also be a member of the Section.

Section D. eleCTION/APPROVAL OF MEMBERSHIP All members shall be elected at the Annual Business Meeting, except for Candidate Members who shall be approved by the Executive Committee periodically throughout the Association year, and Associate and Active Candidates referred by the AUA as otherwise fulfilling Active Membership requirements for those certified within the last 24 months (as per the AUA Bylaws) or Associate candidates moving through the AUA Fast Track Associate Status (as per the AUA Bylaws) who shall be approved by the Executive Committee periodically throughout the

Association year. b y l aws

Section E. ACTIVE MEMBERS Requirements for membership are as follows:

1. Possession of an unlimited license to practice medicine and surgery in the State, Province or Country of the applicant’s practice.

2. Possession of an M.D. or D.O. degree, or United States medical licensure equivalent, and completion of an ACGME accredited urology residency or equivalent by the Royal College of Surgeons (RCS) in Canada or the Quebec Board of Urology or the certifying Board of Urology in the country.

3. Limitation of practice to the specialty of Urology.

4. 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 for Urology in the country where practicing within the geographic boundaries of the AUA.

5. Recommendation for membership by two (2) voting members of the AUA, except if certified within the last 24 months (as per item 4 in this section). 6. 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.

Section F. SENIOR MEMBERS Members are eligible for Senior Membership in the Section if they have been Active Members for 25 years in either the Section or the AUA and have reached the age of 65, or 20 years or service and retired, or are permanently disabled.

272 Section G. ASSOCIATE MEMBERS Requirements for Associate membership are the same as Active membership, except for Board certification. Associate Members shall pay the annual dues, assessments, and initiation fees as determined by the Board of Directors. They shall not be eligible to vote or hold office, nor has right, title or interest in the real or personal property of the Section.

1. Candidate Members Eligible for Fast Track Associate Status. Associate membership in the Section and the AUA will be offered to all Candidate members who have passed the qualifying examination (Part I) of the American Board of Urology.

2. 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.

If an Active Member fails to become recertified as required by the American Board of Urology (or other certifying Board), the AUA and/or Section will transfer the individual to Associate Member Status. If an Active member becomes decertified by the American Board of Urology or other certifying board, the member shall be automatically dropped for non-compliance with AUA and/or Section Bylaws, pursuant to Expulsion and Reinstatement policies.

3. Waiver of First -Year Dues. Associate Members who have passed the ABU certifying examination (Part II) will be transferred to Active membership in both the Section and the AUA and notified that active membership dues are waived for the first year.

Section H. ALLIED MEMBERS Allied 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 Section Membership, may be considered for Allied Membership provided they have contributed significantly to the specialty of Urology. They shall be nominated by two Active or Senior members who shall furnish the Section Secretary with the curricula vitae and other pertinent information.

Allied Members shall pay the annual dues, assessments and initiation fees as determined by the Board of Directors. They shall not be eligible to vote or hold office.

Section I. HONORARY MEMBERS Honorary Members shall be scientists who have achieved outstanding prominence in a field of medicine related to Urology, Past Presidents of the Section who have retired from the active practice or Urology, and/or other distinguished urologists. Candidates must be nominated by the President and endorsed by at least two (2) Active or Senior Members. They must be elected by a majority vote of the Board of Directors and will be presented at the Annual Meeting of election. Honorary Members who have been Active or Senior Members shall retain their previous rights in the Section. 273 Section J. CORRESPONDING MEMBERS Corresponding Membership is available to urologists who practice beyond the geographic boundaries of the Section. The applicant shall be a member of the local or national urological organization in his/ her country, and a letter of endorsement of that membership shall be submitted to the Section 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 Board of Directors. 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 or Medicine or equivalent degree. The applicant must be in practice for a minimum of two (2) years after completion of residency.

Corresponding Members shall pay the annual dues, assessments and b y l aws initiation fees as determined by the Board of Directors.

Section K. CANDIDATE MEMBERS Candidate Membership is established to extend Sectional educational and professional advantages to urological residents. The Candidate Member must be practicing and studying within the geographic boundaries of the Section

1. ACGME. Medical Doctors (MD) or Doctors of Osteopathy (DO) enrolled in a urology residency program approved by the Residency Review Committee and ACGME are eligible for Candidate Membership; and after completing training and passing part 1 of the ABU certifying examination are eligible for Associate Member status (Fast Track), Section G.1. Those who successfully pass all parts of the ABU qualifying examination are eligible for Active Member status, Section E.

2. AOA. Doctors of Osteopathy enrolled in an AOA-approved urology residency training program are eligible for candidate member status. DOs completing their training and passing the American Osteopathic Board of Surgery certifying examination are eligible for Associate Member status, Section G.

Section L. PUBLICATION OF NAMES The names of applicants for Active membership which have been approved by the Secretary and Membership Committee shall be available to the membership prior to the Annual Business Meeting.

Section M. TRANSFER OF MEMBERSHIP An Active, Senior, or Associate member in good standing of the AUA and of another Section of the AUA who moves his or her residence or practice into the territory of this Section, and who meets all membership qualifications, is automatically eligible for membership in the Section upon presentation of credentials to the Board of Directors of the Section. These credentials shall include his or her previous Section records and a letter from that Section’s Secretary indicating the applicant’s membership status.

274 Section N. eXPULSION, DISCIPLINE, RESIGNATION AND REINSTATEMENT All matters of discipline shall be the responsibility of the AUA, in accordance with the Bylaws of the AUA. Members disciplined by the AUA will automatically be disciplined by the Section. Any member expelled by the AUA shall automatically have his or her Section membership terminated. All disciplinary actions taken may be appealed to the AUA in accordance with the Bylaws of the AUA.

Any member who has resigned or whose membership has been deleted for non-payment of dues, or for any other reason, may, after payment of any back dues owed, request reinstatement, subject to the approval of the Section Membership Committee.

ARTICLE II OFFICERS

Section A. OFFICERS OF THE SECTION 1. Officers of the Section shall be the President, the President-Elect, the Immediate Past President, the Secretary, the Treasurer and the Historian. 2. All Officers shall be elected at the Annual Business Meeting from the slate presented by the Committee on Nominations or by nomination from the floor. A majority vote of those present and voting shall be necessary for election.

3. Officers shall serve without financial remuneration and hold office from the conclusion of the Annual Meeting at which they are elected until the completion of their term of office or until their successors are elected in accordance with these Bylaws.

4. Vacancies that occur in any of the Offices may be filled by a majority vote of the Board of Directors.

5. Candidates for office shall be Active or Senior Members in good standing of the Section, or honorary members who previously were Active members in good standing of the Section. In either case, they must be members in good standing of the AUA.

Section B. PRESIDENT 1. The President shall be the Chief Executive Officer of this Section. He/she shall serve as Chairman of the Board of Directors and the Executive Committee. He/she shall preside at all meetings of these bodies and at the Scientific and Business Meetings of the Section. His/her term of office shall be one (1) year and he may not be re-elected.

2. He/she shall appoint Special and Ad Hoc Committees and shall make appointments to fill vacancies on committees appointed by the Executive Committee.

3. He/she may call special meetings of the Executive Committee and the Board of Directors.

4. He/she shall direct the attention of the Board of Directors to violations of the Bylaws and to matters of discipline of members.

275 5. He/she may make nominations for Honorary Membership.

6. He/She shall appoint an individual urologist and spouse to serve as Chair of the Committee on Arrangements.

7. He/She shall be a member of the Committee on Programs.

Section C. PRESIDENT-ELECT 1. The President-Elect after serving one (1) year in Office shall be elevated to the Office of President automatically and without standing for election.

2. He/she shall perform any duties which are assigned by the President and shall preside in the absence of the President. b y l aws 3. He/she shall be a Member of the Executive Committee, Committee on Programs and Board of Directors.

Section D. PAST PRESIDENT • The Immediate Past President shall be a Member of the Board of Directors, the Executive Committee, the Committee on Nominations and the Committee on Programs. His/her term of Office shall be one (1) year.

Section E. SECRETARY 1. His/her term of Office shall be three (3) years or until his/her successor assumes Office. He/she may not be elected to more than one (1) term.

2. He/she shall keep precise and complete records of all the business activities and correspondence of the Section.

3. He/she shall oversee the application process and membership records, shall receive and maintain the official Section documents, and shall give formal notice of the Annual Meeting and of special meetings. The Secretary shall preserve the Minutes and records of such meetings.

4. He/she shall notify by letter each newly elected Member of his/ her election and send him/her a Certificate of Membership with notification to visit the Section website for a copy of the Section Articles of Incorporation and Bylaws. He/she shall notify Members promptly of any change in their membership classifications.

5. He/she shall cause to be printed at the expense of the Section:

a. The Membership Directory of the Section which shall be updated and mailed at least every two (2) years.

b. The Program and Abstracts which will be printed and distributed for the yearly Meeting only.

6. He/she shall send official notice of the date, time and place of the Annual Meeting to each Member at his/her last known address at least sixty (60) days before the date of the opening session. Notices of Special Meetings giving the purpose, place, date and

276 hour shall be sent at least twenty-one (21) days before the date selected.

7. He/she shall arrange the order of business for meeting of the Executive Committee, Board of Directors and Annual Business Meeting of the Section.

8. He/she shall be a member of the Executive Committees, Board of Directors, the Committee on Programs, the Committee on Bylaws, the Committee on Arrangements and the AUA Membership Committee. The Secretary shall determine the program, including papers and panels, for the Annual Meeting. He/she shall be Chairman of the Committee on Programs.

9. He/she shall report to the Executive Committee at least thirty (30) days prior to the Annual Meeting all existing and expected vacancies on Standing Committees, Special Committees, and Representatives to AUA positions for which the Executive Committee determines appointments according to these Bylaws. The Secretary shall also report to the Committee on Nominations, at least (30) days prior to the Annual Meeting, all existing and expected vacancies for nominees for positions in the AUA and the Section in accordance with these Bylaws.

10. He/she shall notify the AUA of the names of members who have been selected to represent the Section on AUA Committees, and the name of any member who has not maintained Section membership in good standing.

11. He/she shall cause to be published appropriate newsletters during the year. All newsletters must be processed by the Secretary.

12. He/she shall notify, by letter, each newly elected officers or appointed committee member of his or her election or appointment and of the tenure of that office.

13. The Executive Director shall be the Assistant to the Secretary and shall carry out the routine duties of the Office under the direction of the Secretary.

Section F. TREASURER 1. His/her term of Office shall be for three (3) years or until his/her successor assumes Office and may not be elected to more than one (1) term.

2. The Treasurer shall be the custodian of the funds and all the property of the Section. The Treasurer shall work with the Executive Director overseeing all general accounting and financial record keeping functions. He/She shall assure prompt payment of all authorized bills of the Section.

3. He/she shall purchase, sell or transfer securities of the Section only upon recommendation of the Committee Finance or approval of the Executive Committee.

4. He/she shall, at the expense of the Section, give bond for such sum

277 as may be determined by the Board of Directors, but in no instance less than fifty thousand dollars ($50,000.00).

5. At the discretion of the Executive Committee or the Committee on Finance, he/she shall have an annual compilation made of the finances of the Section by a Certified Public Accountant and shall present a written report at the Annual Meeting of the Section.

6. He/she shall prepare annually a list of Members in arrears and present this list to the Board of Directors.

7. He/she shall be a member of the Board of Directors, the Executive Committee, the Committee on Programs, the Committee on Finance, and the Investment Advisory Committee. b y l aws 8. The Executive Director shall be the Assistant to the Treasurer and shall carry out the routine duties of the Office under the direction of the Treasurer.

Section G. HISTORIAN 1. This Section shall have a Historian who is elected by membership. He/she shall serve a term of three years, and can be re-elected to serve a second three year term. He/she must be nominated for Office by the Committee on Nominations or from the floor and be elected at the Annual Business Meeting by a majority vote of those present and voting.

2. The Historian is a non-voting member of the Board of Directors and has no functional duties within the Section other than those described below.

3. He/she shall prepare a history of the Section and shall keep records of changes in the Section to its history. He shall present an annual report to the Board of Directors and to the Section at the Annual Business Meeting.

4. He/she shall prepare for publication any historical issues relative to the Section and present them to the Board of Directors.

5. He/she shall be custodian of all records, papers and various paraphernalia which properties are no longer in the custodial care of the Secretary or other Officers of the Section.

6. He/she shall report at the Annual Business Meeting the names of all Members who died in the preceding year.

7. He/she shall be responsible for recording the activities and highlights of each Annual Meeting and shall obtain appropriate documentation of the Meeting.

Section H. Executive Director The Executive Director shall be the chief administrative office of the Association, and shall report directly to the Board of Directors, of which he/she shall be an ex officio, non-voting member. The Executive Director need not be a physician nor a member of the Section. He/she shall have the authority to carry out all policies and programs of the Section within the framework of the budget and subject to the direction of the elected officers and the Board of Directors. 278 ARTICLE III BOARD OF DIRECTORS

Section A. boARD OF DIRECTORS GENERAL CONSIDERATIONS 1. The Board of Directors, herein afterward known as the Board, shall consist of the Executive Committee, the Chairpersons of the Standing Committees, the Chairperson of the Health Policy Council, the Section Representative to the Board of Directors of the AUA and at least one (1) Director or one (1) Alternate from each state or territory of the Section in which ten (10) or more Active or Senior Members reside. States or territories in which more than one hundred (100) Active or Senior Section Members reside shall have an additional Director and Alternate for each one hundred (100) Active or Senior Members or fraction thereof. Members of the Board must be Active Members of the Section and of the AUA.

2. The Board is responsible for the administration and management of the Section.

3. Directors and one Alternate for each Director shall be elected for a term of three (3) years and may not succeed themselves. Serving as an Alternate shall not disqualify a Member from serving as a Director.

4. An unfinished term of a Director shall be served by the Alternate.

5. A majority of the Board of Directors shall constitute a quorum.

Section B. MEETINGS 1. Board shall meet annually at the time of the Annual Meeting of the Section.

2. Special Meetings of the Board may be called by the President or by request of a majority of Directors. Notice of special meetings must be sent out by the Secretary to each Board Member and Alternate at least twenty-one (21) days before the date of the Meeting.

3. The matters to be discussed and voted upon at any duly called meeting of the Board of Directors shall not be limited to those set forth in the notice of such meetings.

4. In order to become better acquainted with the activities of the Section, Alternates should attend Meetings of the Board as non- voting members when not substituting for a Director.

Section C. dUTIES 1. Order the disbursement of money.

2. Select the time and place of the Annual Meeting of the Section after considering the recommendation of the Committee to select meeting sites. The Annual Meeting may be omitted by a majority vote of the Board.

3. Receive the annual reports of the Secretary, Treasurer, Historian and the Executive, Standing and Special Committees and take any action on the reports it deems appropriate in accordance with these Bylaws.

279 4. Elect Honorary members from nominations received from the President. Names of elected members shall be read to the Membership at the Annual Business Meeting.

5. Elect every third year by a majority vote one current Member or past Director, other than an Officer, to serve on the Executive Committee of the Section. If the Director is currently serving as a State Director, that State may elect another Director to complete the unfinished term.

6. Every second year nominate two (2) Section Members interested in research to serve a four (4) year term on the AUA Research Committee. If appointed by the President of the AUA, the Members will serve for two (2) years as Alternate Representatives and two (2)

more years as Representatives on the AUA Research Committee. b y l aws

7. Elect by majority vote qualified Members to fill Unfinished terms in any elected position of the Section.

8. When the Board of Directors deems it appropriate, it may recommend to the Membership the nomination of any Member considered qualified for service as an officer of the AUA. On approval by the Membership, such nomination shall be forwarded to the AUA Nominating Committee by the Section Member of the Nominating Committee of the AUA.

9. Transact any business not specified or prohibited by these Bylaws.

10. It shall employ the Executive Director whose duties, responsibilities and authority shall be as specified in Article II, Section H of these Bylaws. Report all actions to the Membership at the Annual Business Meeting.

Section D. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS 1. The Executive Committee shall consist of the President, President- Elect, Immediate Past President, Secretary, Treasurer, Chairperson of the Committee on Education and Science, and one (1) Director elected by the Board for a term of three (3) years. The Director may not succeed himself/herself. The President shall be the Chairperson.

2. Duties.

a. To conduct the business of the Section between Meetings of the Board of Directors except as otherwise provided in these Bylaws. All action taken by the Committee shall be reviewed by the Board.

b. Approve Candidate member applications, and Associate and Active candidate members referred by the AUA as stipulated in Article I, Section D.

c. Appoint all Standing and Special Committees, excluding the Committee on Arrangements and Nominating Committee.

d. Nominate Section recipients for AUA Awards.

280 e. Unfinished terms of Representatives to AUA Committees shall be filled by the Executive Committee.

f. Constitute the Committee on Programs which is chaired by the Secretary.

3. The Committee shall meet on call of the President.

ARTICLE IV REPRESENTATIVES TO THE AUA

Section A. GENERAL CONSIDERATIONS Representatives to the AUA must be Active Members of the Section and the AUA. They shall reflect the expressed policies of the Section in keeping with the best interest of the AUA.

Section B. REPRESENTATIONS ACCORDING TO AUA BYLAWS In accordance with Article V, Section 1 of the Bylaws of the AUA, the Section will have Representatives as follows:

1. Editorial Committee: the number of representatives and terms shall be in accordance with the Bylaws of the American Urological Association. If there is more than one member on the Committee, One Member shall be appointed to serve as Chairperson of the Editorial Committee of the Section.

2. Board of Directors Representative: one (1) Member and one (1) Alternate Member elected in odd years to serve for two (2) years or until his/her successors are elected. The Member shall be limited to two (2) terms of service not counting any term(s) as Alternate.

3. Nominating Committee: one (1) Member and one (1) Alternate to serve for one year or until his/her successors are elected. The terms of service shall be in accordance with the Bylaws of the American Urological Association.

4. Research Committee: the number of representatives and terms shall be in accordance with the Bylaws of the American Urological Association. The Members will serve the first term as Alternates and the latter term as Representatives.

5. Health Policy Council: the number of representatives and terms shall be in accordance with the Bylaws of the American Urological Association. One member will be appointed to Chairperson, another Vice Chairperson, and if more than two members on the Committee, they shall be named members at large.

6. Membership Committee: one (1) Member who is the current Secretary of the Section.

7. Bylaws Committee: the number of representatives and terms shall be in accordance with the Bylaws of the American Urological Association. One member will be appointed to Chairperson, another Vice Chairperson, and if more than two members on the Committee, they shall be named members at large.

281 8. Audio-Visual Committee: the number of representatives and terms shall be in accordance with the Bylaws of the American Urological Association.

9. Judicial and Ethics Council: the number of representatives and terms shall be in accordance with the Bylaws of the American Urological Association.

Section C. START OF TERM OF SERVICE Representatives of the Section to the AUA shall begin their terms of office immediately following the AUA Meeting of the year in which they are elected or appointed. b y l aws Section D. RESPONSIBILITIES TO BOARD OF DIRECTORS These Representatives shall report to the Board of Directors annually.

ARTICLE V COMMITTEES

Section A. STANDING COMMITTEES 1. Each Standing Committee shall consist of at least six (6) Active Members of the Section. Appointments will be made by the Executive Committee. One of the Committee Members will be named Chairperson and one Vice-Chairperson by the Executive Committee. A Committee Member who is unable to participate actively in the work of the Committee may be replaced by the Executive Committee.

Two (2) Members of each Committee shall be appointed annually for a term of three (3) years and no Member may serve more than two (2) terms on any one Committee. The exception: an individual who rises to the level of Chair of the Committee on Education and Science shall have a three-year term as Chair.

2. A Standing Committee Chairperson may appoint sub-committees from the general Membership with a Standing Committee Member as Chairperson.

2. The Chairperson of each Standing Committee shall make a formal report to the Board of Directors annually.

3. There shall be four (4) Standing Committees as follows: (1) Education and Science, (2) Finance, (3) Membership, and (4) Bylaws.

a. THE COMMITTEE ON EDUCATION AND SCIENCE (1) It shall direct the scientific and educational activities of the Section, understanding that promotion of these activities is the primary purpose of the Section. The Committee should recognize that only its strong, dedicated and enlightened leadership can make worthwhile all other Section activities and accomplish the stated objective of the Preamble to these Bylaws. To this end, it should be boldly innovative both in its continuing effort to upgrade

282 the quality of the scientific sessions of the Annual Meeting and in its designs to stimulate the development of strong programs of postgraduate education and research within the Section.

(2) It shall cooperate with the Committee on Programs in making specific plans for the Scientific Sessions of the Annual Meeting and be responsible for the Visual Education Program, Pyelogram Program and Scientific Exhibits.

(3) It shall administer the Prizes and Awards Programs of the Section, be responsible for expansion of them and appoint Judging Committees to select the recipients.

(4) It shall supervise the Postgraduate Education Programs of the Section and cooperate with the AUA Committee on Continuing Education in its activities within the Section.

(5) Its Chairperson shall serve as a Member of the Executive Committee of the Board of Directors, and in so - doing as a Member of the Committee on Programs. Once elected Chair, the term of office shall be three years. b. THE COMMITTEE ON FINANCE (1) It shall advise the Board of Directors on the overall fiscal policies of the Section and, with the approval of the Board, formulate fiscal rules and regulations.

(2) The Committee shall examine and verify to the Section the annual compilation of finances of the Section submitted by the Section Treasurer and a compilation of the Arrangements and Seminar Committees. A certified audit of the Section’s account shall be requested when deemed appropriate.

(3) The Treasurer shall be a Member ex-officio.

(4) In cooperation with professional investment advisory services employed by the SESAUA shall advise the Treasurer on the sale, purchase, and/or transfer of the investments of the Section.

(5) It shall recommend the Section’s investment counselor(s) and/or growth managers; monitor the Section’s portfolio at least quarterly for adherence to establish guidelines and performance vs. objectives; and provide formal reports on performance with recommendations for Board of Directors meetings. c. COMMITTEE ON MEMBERSHIP (1) It shall examine applications for Active Membership and Associate Membership that have not been referred by the AUA as stipulated in Article 1, Section D.

(2) It shall solicit new Members from among the qualified

283 Non-member Urologists residing within the geographical boundaries of the Section.

d. COMMITTEE ON BYLAWS (1) It shall review the Articles of Incorporation and Bylaws annually and make recommendations to the Board of Directors as to any changes that seem desirable.

(2) It shall consider all proposed amendments to the Articles of Incorporation and Bylaws submitted in writing and make recommendations to the Board as to disposition.

(3) It is the responsibility of the Committee to draft proposed changes in the Articles of Incorporation and Bylaws and

to furnish them to the Secretary in such a time frame that b y l aws they may be published and circulated to the Membership at least thirty (30) days in advance of the Annual Meeting.

(4) The Secretary shall be Member ex-officio.

(5) The Chairperson and the Vice-Chairperson shall serve on the AUA Bylaws Committee.

Section B. SPECIAL COMMITTEES 1. COMMITTEE ON PROGRAMS a. The Committee on Programs shall consist of the Members of the Executive Committee; the Secretary shall be the Chairperson.

b. Duties. (1) It shall make long range plans for the content and general format of the Annual Meeting of the Section in close cooperation with the Committee on Education and Science.

(2) It shall arrange the Scientific Program for the Annual Meeting and select from submitted titles of papers those best suited to the contemplated plan of the program.

(3) The Chairperson shall report to the Board of Directors at the Annual Meeting.

2. COMMITTEE TO SELECT MEETING SITES a. The Committee to Select Meeting Sites shall consist of the Secretary, the Treasurer and a Chairperson, who shall be a Past President selected by the Executive Committee. The Chairperson shall serve for no more than five (5) years. b. It shall select the sites for future Annual Meetings subject to the approval of the Board of Directors.

3. COMMITTEE ON NOMINATIONS a. The Committee on Nominations shall consist of five (5) Members. These are the three (3) most recent living Past Presidents in attendance at the Annual meeting and two (2) at-large Members who are Active Members of the Section and

284 AUA. The At-Large Members are nominated and elected, or appointed by the Board of Directors to fill a vacancy, for a term of two (2) years by the Membership of the Section during the Annual Business Meeting. Those Committee Members elected by the Section Membership shall serve no more than two (2) consecutive terms. No more than two (2) Members of the Committee shall reside in the same state.

b. The Chairperson shall be the Past President with most seniority.

c. The Committee shall present to the Section Membership at its Annual Business Meeting a slate of nominees of Active Members in good standing in the Section and AUA. There shall be one (1) candidate for each position as follows:

(1) Nominees for positions in AUA: shall be in accordance with the Bylaws of the American Urological Association.

(2) Nominees for positions in Section:

(a) President-Elect who automatically shall assume office of President at the end of the term. Any nominee must have had three (3) years of satisfactory experience as a Member of the Board of Directors or have been General Arrangements Chairperson. Each year for one (1) year term.

(b) Historian who has no limitation on terms of service.

(c) Members and Alternate Members of the Board of Directors whose immediate predecessors are completing their three (3) year term of service, as prescribed in Article III, after consultation with the State Urological Societies. Term of election is three (3) years.

(d) Secretary of the Section. He/she may not be re- elected. Every three (3) years for three (3) year term:

(e) Treasurer of the Section. He/she may not be re- elected. Every Three (3) years for three (3) year term:

(f) No Member of the Nominating Committee shall be eligible for any elective position except that incumbents shall continue for their stated terms of office. (g) Nominations for all elected positions must be called for from the floor by the President at the Annual Business Meeting before any voting takes place.

3. COMMITTEE ON ARRANGEMENTS a. The Committee on Arrangements shall consist of the Executive Committee and one Active of Senior Member in good standing that shall be appointed by the President to

285 serve for one (1) year as Chair. The next meeting year’s Arrangements Chair shall serve on the Committee ex-officio. When a meeting does not fall within the Section’s boundaries, the Executive committee may elect not to appoint an active or senior member to serve as Chair, and the President shall assume those responsibilities.

b. The Committee on Arrangement shall make all necessary arrangements for the Annual Meeting under the direction of the President. It shall prepare a meeting budget that is financially self-supporting as its objective. The Committee on Arrangements shall keep adequate records of its activities.

c. The Chairperson shall have the power to appoint all local

subcommittees and name the Chairperson of each. b y l aws

d. The Chairperson shall make a final report to the Board of Directors at its next Annual Meeting.

e. With the approval of the President, the Committee shall arrange and supervise the Presidential Dinner to be held during the Annual Meeting. The cost of this dinner shall be borne by the Section. The dinner may be omitted by the majority vote of the Board of Directors.

6. HEALTH POLICY COUNCIL a. The Health Policy Council shall advise the Membership on professional relations, socioeconomic, medical, legal and insurance matters as they relate to the teaching and practice of Urology. They shall also advise on National and Local legislative initiatives effecting urology coding and reimbursement issues, and peer review.

b. It shall investigate all questions which concern principles of medical ethics and those involving the rights and standing of Members in relation to other Members to the public under the direction of the Board of Directors.

c. The Committee shall consist of one (1) Member from each state in the Section and Puerto Rico plus the Chairperson.

d. The State Representative and his/her alternate shall be elected by the State Society to serve a term of three (3) years.

e. The Chairperson of the Health Policy Council shall be appointed by the Executive Committee for three (3) years and shall serve as one Section Representative to the Health Policy Council of the AUA. f. The Vice-Chairperson of the Health Policy Council shall be appointed by the Executive Committee for three (3) years and shall serve as the Section’s second Representative to the Health Policy Council of the AUA. g. The Vice-Chairperson of the Health Policy Council may be advanced to be Chairperson of this Council after completion of the three (3) year term.

286 h. There shall be an Alternate for the Chairperson and a second Alternate for the Vice-Chairperson to serve as Alternate Representatives of the Health Policy Council of the AUA appointed by the Executive Committee.

Section C. AD HOC COMMITTEES 1. These Committees are appointed and the Chairperson named by the President annually to perform specific jobs not lying within the purview of any existing Committee. They may be reappointed or reconstituted; however, if the need for the Committee exists beyond three (3) years, it should become a Standing or Special Committee.

2. The Chairperson shall report to the Board of Directors when requested by the President.

ARTICLE VI MEETINGS

Section A. ANNUAL MEETINGS 1. The Annual Meeting of the Section shall be held at such time and place as is designated by the Board of Directors. The Annual Scientific Meeting may be omitted by majority vote of the Board.

2. Official notice of the time and place of the Annual Meeting must be sent to each member in the form of a newsletter or otherwise at least ninety (90) days before the meeting.

3. The order of the program of the scientific portion of the Annual Meeting shall be directed by the Secretary in cooperation with the Committee on Programs, the Committee on Education and Science and the Committee on Arrangements.

4. Papers.

a. Authors who wish to present papers at the Annual Meeting must submit titles and abstracts to the Secretary in accordance with deadlines established by the Committee on Programs.

b. Time allowed for presenting and discussing papers shall be determined by the Committee on Programs.

5. Officers shall be installed at the end of the Annual Business Meeting.

6. Business Meeting.

a. The Annual Business Meeting shall be held during the time of the Annual Meeting. b. The order of business at the Annual Business Meeting shall be set by the Secretary.

Section B. SPECIAL MEETINGS 1. Special Meetings of the Section for any purpose other than effecting changes in the Bylaws may be called by a two-thirds (2/3) vote of the Board of Directors and shall be held at such time and place as directed by the Board.

287 2. Notice of a Special Meeting must be sent to the Members at least twenty-one (21) before such a Meeting. The notice must contain a statement of the business to be conducted, and no other business shall be conducted at the Special Meeting.

Section C. QUORUM The members’ registered and eligible to vote who are present at the Annual Business Meeting and at any Special Meetings shall constitute a quorum for such meetings, and, unless otherwise specifically required by these Bylaws or applicable law, the vote of a majority of such members shall be required to approve any action at such meeting.

ARTICLE VII DUES AND FEES b y l aws Section A. dUES, FEES AND ASSESSMENTS - DETERMINATION The annual dues, the initiation fee and special assessments shall be determined by the Board of Directors on advice of the Committee on Finance. The annual dues are payable in advance. Any Member with a past due account over 120 days shall be dropped from the rolls and his/her name presented to the Board of Directors for appropriate action. Members requesting transfer to Senior status may delay payment of dues until the Board of Directors has ruled on their request.

Section B. fISCAL YEAR The fiscal year of the Section shall date from January first to December thirty-first.

ARTICLE VIII TERRITORY

The Section shall comprise the states of Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and the territories of Puerto Rico, Panama and the U.S. Virgin Islands. Individuals who initially join the Section in which they practice, and then at a future date relocate to another Section, may retain Section membership.

ARTICLE IX SEAL OF CORPORATION

The Corporate seal shall be inscribed thereon the name of the corporation and the word “Seal”. Said seal may be altered at the pleasure of the majority of the Membership voting at an Annual Meeting and may be used by causing it or a facsimile thereof to be impressed or otherwise used.

ARTICLE X AMENDMENTS

Section A. REPEALING / AMENDING BYLAWS A Quorum being present these Bylaws may be repealed or amended by a two-third (2/3) vote of the Members present and voting at any Annual Business Meeting, provided that the proposed revision or amendment is provided to the Membership at least thirty (30) days prior to the Annual Meeting at which such action is to be taken.

288 ARTICLE XI RULES OF ORDER

Sturgis Standard Code of Parliamentary Procedure, current edition, shall govern the proceedings of the Section unless otherwise provided in these Bylaws.

289 Necrology Report In Loving Memory of:

Carey Neilson Barry, MD Fort Myers, FL

Jordan David Baum, MD Zephyrhills, FL

Albert W. Beacham, MD Lafayette, LA

Joseph H. Brannen, MD Valdosta, GA b y l aws David A. Eberle, MD Louisville, KY

Christopher Fitzpatrick, MD Dublin, Ireland

Hugh Durell Good, MD Largo, FL

Edward Calhoun Graves, MD Louisville, KY

Steven J. Hulecki, MD Vero Beach, FL

Luis M. Isales, MD Boca Raton, FL

William T. Lucas, MD Augusta, GA

Bogdan Roman Marcol, MD Glasgow, KY

Travis E. Morgan, MD Knoxville, TN

Richard Earl Nallinger, MD Danville, KY

Thomas E. Nesbitt, Jr., MD Nashville, TN

Garrell C. Noah, Jr., MD Athens, AL

Logan P. Perkins, Jr., MD Lake Charles, LA

W. Glen Wells, MD Shreveport, LA

290 Preliminary Treasurer’s Report of the Southeastern Section of the American Urological Association

The SESAUA fund balance, as of December 31, 2014, totals $4,757,281 and reflects an operating deficit of $119,386 for the year 2014. The deficit is in part a result from a $54,000 net income from the 2014 annual meeting, offset by a $250,000 Urology Care Foundation 3rd Research Scholar Endowment Fund contribution.

SESAUA investments are now held at Vanguard. On 7/10/14, a wire transfer of $4,653,420 was sent from Water Oak Advisors to Vanguard. For period end December 31, 2014, the portfolio is as follows:

Fixed Income $1,588,295 35% Domestic Stocks $1,794,166 40% International Stocks $1,127,440 25% Total $4,509,901 100%

HIGHLIGHTS FOR 2014: 1. Unprecedented 3rd Urology Care Foundation research scholar. Total endowment to fund a scholar in perpetuity is $1.5 Million, with AUA contributing $1.25 Million, and SESAUA contributing $250,000. 2. Increase International Volunteers in Urology program funding from 3 to 5 residents. Each resident scholarship amounts to $4,500, totaling $22,500 annually. 3. SESAUA will send up to 5 individuals to the JAC conference annually, to include the President, President-elect, and in every odd year, the 3 SES representatives to the AUA Young Leadership Program. 4. Over $67,000 awarded to SES Residency programs to cover travel costs for residents to participate in the 2014 Annual SESAUA Meeting. 5. Continued support of resident robotic training course in January 2014. SESAUA pledges up to $25,000 annually to cover expenses. Approximately $5,000 was spent in 2014. 6. Funding for 6 residents to represent the SES team at the AUA Resident Bowl in May 2014, totaling $6,000. 7. Funding for 2 chief residents to attend the AUA Chief Resident Debate in May 2014, totaling $2,000. 8. Funding for 10 residents to attend the SESAUA Resident Mini-Bowl at the SESAUA annual meeting in March 2014, totaling $12,500. 9. Continued transfer of $10,000 monthly to Vanguard investment accounts.

It is an honor and privilege to serve as your Treasurer. Please feel free to contact me if you have any questions regarding our financials.

Respectfully Submitted, Scott B. Sellinger, MD Treasurer, SESAUA

291 Membership Candidates and Transfers Southeastern Section of the AUA, Inc. 2015 Membership Candidates and Transfers

* Application Not Complete FT AUA Fast Track Application Candidates for Membership

Active ALVARADO, MD Angel * MILES, MD Ruth * ART, MD Kevin MSEZANE, MD Lambda * BOUET, MD Rafael MYERS, MD Michael CANCEL, MD Quinton POBI, MD Kwabena DE LA ROSA, MD Norman PORTELA, MD Damian DEAN, Jr., MD Odell ROMAIN, MD Zaneta DUSSEAULT, MD Beau RUTLAND, MD Edward FLANAGAN, MD William SIMON, MD Michael * GOODWIN, MD Charles * UMBREIT, MD Eric * GUERRERO MONTEZA, MD Don FT BIGLER, MD Mark * GUPTA, MD Sanjeev FT CASO, MD, Mph Jorge * HARAWAY, MD Allen FT CASTELLAN, MD Miguel HILL, Jr., MD Lawrence FT DRAKE, MD John KHERA-MCRACKAN, MD Daniel FT ERCOLE, MD Barbara * KIM, MD Jay FT GOUDELOCKE, MD Colin KOZAKOWSKI, MD Kristin FT KRLIN, MD Ryan KURZER, MD Eleicer FT MONROE, MD Regina

LASTARRIA, MD Emilio FT PATEL, MD Zamip r e p o rts LOPEZ HUERTAS, MD Hector FT TAGHECHIAN, MD Shaya MARGUET, MD Charles

Allied FRASER, PhD Matthew

Associate * ALI, MD Ahmed * PATEL, MD Trushar * ALLAM, MD Christopher * PEACOCK, MD Elizabeth BEAN, MD Christopher PICKENS, MD Ryan CARLSEN, DO Jens * RAMPERSAUD, MD Edward CHAMBERLAIN, MD Jennifer SCALES, Jr., MD, MSHS Charles * COLON-IRIZARRY, MD Javier SHRIDHARANI, MD Anand CRAVEN, MD Brandon * VIERA, MD Luis EATON, MD Samuel WILLIAMS, MD Molly * FINE, MD Matthew * YOUNG, MD Matthew GRAVES, MD Reid ZIADA, MD Ali GUPTA, MD Shubham FT BAKER, MD Ashley * HINDS, MD Peter FT GUTTMAN, DO Marc HOGAN, MD Ross FT JORNS, MD Jacob JAMES, MD Andrew FT KEEL, DO Christopher JANSEN, MD Robert FT MEHTA, MD Akanksha * KANAROGLOU, MD Niki FT PURCELL, MD Matthew * KERNER, DO Steven FT PUZIO, MD Corinne * KIM, MD Timothy FT SHAH, MD Anish MARTIN, MD, MPH Aaron FT SHELDON, MD Matthew * MORALES-KILDEGAARD, MD Yubiry FT SHREWSBERRY, MD Adam MOSES, MD, PhD Kelvin FT STEWART, MD Gregory * PARKER, MD Justin FT WELLS, MD Sara

292 Internal Transfers

To Active Membership ABRAMSON, MD Richard NEAL, Jr., MD Durwood ALSTON, MD Celeste O’CONNOR, Jr., MD Laurence AVALLONE, MD, FACS Anthony PEPPAS, MD Dennis BENZ, MD Thomas ROBBINS, MD Steven BERKMAN, MD Scott SCIONTI, MD Stephen KATZ, MD Matthew

To Associate Membership EL-JACK, MD, FRCS Mohamad GERBOC, DO Jason SEA, MD Jason

To Senior Membership BARNETT, MD Lowell PREMINGER, MD Glenn BROWN, MD, MBA B. Thomas RICE, MD Samuel BUSCHEMEYER, Jr., MD W. ROPER, MD Ronald CALDWELL, Jr., MD Thomas SANGISETTY, MD, APMC Koti COLLIER, MD M. SCHMIED, MD William FAIREY, MD John SLABAUGH, Sr., MD Thomas FROMANG, MD David STEIN, MD Marvin GUZMAN-VIRELLA, MD Jose STREISAND, MD Warren HARTY, MD James STUBBS, MD Allston HOLCOMB, MD F. SUAREZ, MD George HOOVER, MD Dennis SWEITZER, MD Stephan JENKINS, MD Joseph TURNER, MD Michael KRZYZANIAK, MD Kenneth UNNIKRISHNAN, MD E.W. LEVINE, MD Richard VAUGHAN, MD Donald LIVINGSTON, Jr., MD Wilbur VENABLE, MD Dennis LOCKE, MD Joel VERHEECK, MD Kenneth MICHIGAN, MD Stephen WHEATLEY, MD Joseph MOBLEY, MD William WHITLOCK, MD Norris MOON, MD James YAVARI, MD Morteza PEARSON, MD Richard ZARUSKI, MD Andrew

293 Report of the SESAUA Representative to the AUA Board of Directors Annual SESAUA Board of Directors meeting – March 18, 2015 Membership

o Total membership 20,927 January, 2015 Domestic (Section) Member 14,011 SESAUA Voting Members 2,362 Total Members 2,791 Active 7,695 Resident/Fellow 2,268 Senior 3,257 International 4,006 International Resident-in-training 908 International Senior 292

o Practice area (U.S. members) Urban 92% Suburban 6.8% Rural 1.2%

Financial Eight year annual meeting trend of decreased revenue, decreased attendance and

rise in related cost resulting in falling net margin. The annual meeting provides more r e p o rts operating profit than any other AUA program.

AUAER and AUA, Inc., November 30, 2014 o Combined assets $147,568,000 Total Operating Revenue $33,491,000 Total Expense $41,950,000 Net Operating Deficit $7,984,0000

After Debt Service and Net Investment Income increase of $9.7 million, combined statement reflects increase in Net Assets of $1,573,000 to $123,757,000. UCF November 30, 2014 o Total assets $43,843,000 Total Operating Revenue $14,885,000 Total Expense $3,174,000 Net Surplus from Operations $11,711,000

After Debt Service and Net Investment Income of $1,884,000, the statement reflects an increase in Net Assets of $13,588,000 to $41,961,000

Action Item October, 2014 o AUA Consolidated Budget Guideline: Operating Deficit cannot exceed the prior year’s investment dividends and interest income.

294 Office of Education Journal of Urology Editor – Joseph A. Smith, MD Education chair – Victor Nitti, MD AUA Global Initiatives Chair – Inderbir Gill, MD AUA University o A comprehensive, centralized online location searchable by information type, therapeutic area or topic. . Customizable dashboard includes abstracts, Urology Core Curriculum, Journals, Guidelines and other educational resources. . Since May 2014: 152,000 sessions and over 566,000 page views . Non-members to be charged an annual access fee of $1,295 beginning in January, 2015

Science and Quality AUA Guidelines o Rated number one member benefit by domestic members and number two benefit for international members just behind the annual meeting. o The AUA board in October 2014 approved the following recommendations to maximize the value of the guidelines and to establish a stable and predictable budget: . To formalize the process to prioritize topics based on care quality need, disease burden, importance to urologists and quality of literature. . Increased efficiency through pursing a multi-strategy approach which includes efficient utilization of methodologists and partnering with other organizations. . Increasing the repository of clinical guidelines from 25 to 30 by 2015 . Increasing the guidelines budget $133,000 to allow 4 new guidelines annually, 5 new updated literature reviews, 3 quantitative new topics for literature assessment, and additional staffing. o Quality Summit 2014 . Conference Proceedings on Infectious Complications of Trans rectal Needle Biopsy . Summit scheduled every other year. 2016 topic “Implementing Shared Decision Making for PSA Testing into Urologic Practice” o AUA Guideline Amendment . Interstitial Cystitis/Bladder Pain Syndrome . AUA White Paper: Catheter-Associated Urinary Tract Infections: Definitions and Significance in the Urologic Patient. Submitted to Urology Practice for publication o AUA Quality Registry (AQUA) . The AUA Board approved direct access to limited data sets and institution of necessary security protocols to secure the data.

o AUA DATA GRANT PROGRAM 2015 Award: The AUA received nine (9) complete applications (from the 12 researchers invited to submit applications) for the AUA Data Grants

295 Program. All of the projects proposed to use “big data” approaches to answer their research questions. The selection process was led by the Data Grant Review Panel consisting of eight members, including Drs. David Miller and Benjamin Breyer, who served as chair, and vice chair, respectively. The panel unanimously selected two projects, summarized below:

• PI: Mitchell Sokoloff, MD, University of Massachusetts Medical School . Topic: “The impact of clinical care guidelines on prostate cancer screening practices in a population-based setting”

• PI: Bradley Erikson, MD, University of Iowa . Topic: “Urologic care in rural America: Assessing the impact of physician extension and physician extenders on the quality of bladder cancer care in the state of Iowa”

Urology Care Foundation Patient Education Council structure 5/2015 . Pediatrics . Prostate health . Bladder health . Reproductive & Sexual health . Kidney and Adrenal Health . Technology and Publications r e p o rts Research Research Council Chair o Aria Olumi, MD Research Council Structure o October 2014 AUA Board approved formalizing existing research subgroups into standing committees . Research Advocacy Committee . Research Grants and Investigator Support Committee . Research Education, Conferences & Communications Committee Research Scholars Program o 5:1 matching scholar grant program 2008 offered to Sections 2013 offered to subspecialty and related societies o 12/31/2014 – Matching program discontinued o As of 11/2014 – 22 endowment programs . SESAUA has 3 endowments

This represents more than $15 million that the AUA has designated for Research in the past year.

Consensus Statement on Advanced Practice Providers o Overview of the regulatory environment and guidance on integrating non physician providers into a urologic practice.

Expert Witness Registry o Launched September 2012 o 257 enrollees

296 Committees In February 2015, the board approved the following guiding principles for service on AUA Committees: o Term Limits The terms of committee members are dictated by the AUA Board with a maximum limit of eight years (not including years served as a consultant, chair or vice-chair). The total combined service an individual may serve in various roles on the same committee may not exceed ten years. Any exceptions may be approved by the Executive Committee of the AUA Board. o Concurrent Service on Multiple Committees The following recommendation was approved in an effort to maintain a balance of utilizing experienced members and allowing opportunities for new members to contribute a fresh perspective. Any exceptions may be approved by the AUA President. • Chairs - No individual may simultaneously serve as chair or more than one committee (excluding ex-officio positions). • Members - The maximum number of standing committees and/or Guideline Panels that one individual may simultaneously serve on is three (excluding ex-officio positions).

Bylaws Proposed 2015 amendments will be made available on AUA’s website in mid- March. There are several general updates recommended to committee, makeup and/or mission statements. Additional language relating to the following topics will be provided to the AUA Sections after this year’s annual May meeting:

1. Members in Good Standing – new language will define a member in good standing with respect to the obligations, benefits and privileges of membership.

2. Resignation and Reinstatement – new language will define how the Board may delay accepting a resignation request from a member who is the subject of an investigation until the conclusion of the disciplinary proceedings.

3. Section Representatives to the AUA Board – similar to protocols in place for current sitting board members, new language will explain how the Board may reject a nominee for grave misconduct or a serious conflict of interest.

4. Censure of a Member – a new disciplinary level is proposed that provides an opportunity for the Board to express disapproval of a member’s violation of AUA policy or other professional misconduct, without adversely impacting membership privileges.

5. Consequences of a Rebuke – new language will be closely related to definitions of Members in Good Standing. Referral – new language explaining that the AUA is legally required to report to the National Practitioners Data Bank (NPDB) any disciplinary action relating to patient health.

297 AUA Secretary’s Annual Meeting Update New Orleans Friday, May 15 – Tuesday, May 19

o Updated Clinical Guidelines . Peyronie’s Disease . Amendment to CRPC . Amendment to IC Guideline o Crossfire: Controversies in Urology o Second Opinion o Live Surgeries o AUA Town Hall . Testosterone: Too much or not enough o PG and IC courses . Over 90 courses with course pass o Resident Bowl

Public Policy/Practice Support DC Joint Advocacy Conference March 8 – 10, 2015

o Specific Asks . SGR repeal . Graduate medical education support . USPTF

. Stark in office ancillary exception r e p o rts

It has been my great honor and privilege to serve my fellow SESAUA members as your representative to the AUA BOD this past year. As demonstrated by my predecessors, including Dennis Venable who admirably preceded me, we serve at your discretion and to your service to provide communication and a conduit for information exchange between the section and the AUA. Please make your issues known to me so that I can truly represent our membership and the AUA.

Respectfully submitted,

Thomas F. Stringer, MD, FACS

298 Roster of the State Societies and Officers 2014 – 2015

Please help us keep our information about State Urological Societies accurate and current. Contact the SESAUA office at (847) 969-0248 if you have information about the following societies:

Alabama Urology Society Information not available at time of printing

Florida Urological Society President: Paul R. Young, MD President-Elect: Wade J. Sexton, MD 2015 Meeting: September 3 – September 6, Orlando, FL Georgia Urological Association President: Henry N. Goodwin, Jr., MD President-Elect: Kenneth Ogan, MD 2015 Meeting: September 10 – September 13, Sea Island, GA Kentucky Urological Association President: David P. Russell, MD 2015 Meeting: Fall 2015, Lexington, KY

Louisiana State Urological Society President: Scott M. Neusetzer, MD 2015 Meeting: May 1 – May 3, Lafayette, LA

Mississippi Urologic Society Information not available at time of printing

North Carolina Urological Association President: Gary Robertson, MD President-Elect: Greg Murphy, MD Puerto Rico Urological Association President: Roberto Vázquez Ramos, MD President-Elect: Richard Báez Tellado, MD FACS 2015 Meeting: Fall 2015

South Carolina Urological Association President: David Hinkle Lamb, MD President-Elect: Michael Scott Hay, MD 2015 Meeting: September 2015

Tennessee Urological Association President: S. Duke Herrell, MD

299 Previous Officers and Annual Meeting Sites

♦ Indicates Deceased Member

1932 Birmingham, AL ♦ Edgar G. Ballenger, MD, Atlanta, GA Temporary Chair

1933 Richmond, VA ♦ Montague L. Boyd, MD, Atlanta, GA Chair ♦ Edgar G. Ballenger, MD, Atlanta, GA Vice Chair ♦ Earl Floyd, MD, Atlanta, GA Secretary/Treasurer

1934 Atlanta, GA ♦ Montague L. Boyd, MD, Atlanta, GA Chair ♦ Edgar G. Ballenger, MD, Atlanta, GA Vice Chair ♦ Earl Floyd, MD, Atlanta, GA Secretary/Treasurer

1935 Nashville, TN ♦ Edgar G. Ballenger, MD, Atlanta, GA President ♦ H. W.E. Walther, MD, New Orleans, LA President-Elect ♦ Earl Floyd, MD, Atlanta, GA Secretary/Treasurer

1936 Charlotte, NC ♦ H. W.E. Walther, MD, New Orleans, LA President ♦ Hamilton McKay, MD, Charlotte, NC President-Elect

♦ Earl Floyd, MD, Atlanta, GA Secretary/Treasurer r e p o rts

1937 Birmingham, AL ♦ Hamilton McKay, MD, Charlotte, NC President ♦ George Livermore, MD, Memphis, TN President-Elect ♦ Earl Floyd, MD, Atlanta, GA Secretary/Treasurer

1938 Louisville, KY ♦ George Livermore, MD, Memphis, TN President ♦ Earl Floyd, MD, Atlanta, GA President-Elect ♦ Raymond Thompson, MD, Charlotte, NC Secretary/Treasurer

1939 Biloxi, MS ♦ Earl Floyd, MD, Atlanta, GA President ♦ J. Ullman Reaves, MD, Mobile, AL President-Elect ♦ Louis M. Orr, MD, Gainesville, FL Secretary/Treasurer

1941 Jacksonville, FL ♦ J. Ullman Reaves, MD, Mobile, AL President ♦ Jefferson C. Pennington, MD, Nashville, TN President-Elect ♦ Louis M. Orr, MD, Gainesville, FL Secretary/Treasurer

1942 Chattanooga, TN ♦ Jefferson C. Pennington, MD, Nashville, TN President ♦ Louis M. Orr, MD, Gainesville, FL President-Elect ♦ Harold P. McDonald, Sr., MD, Atlanta, GA Secretary/Treasurer

1943 New Orleans, LA ♦ Louis M. Orr, MD, Gainesville, FL President ♦ William E. Coppridge, MD, Durham, NC President-Elect ♦ Harold P. McDonald Sr., MD, Atlanta, GA Secretary/Treasurer

300 1946 Augusta, GA ♦ William E. Coppridge, MD, Durham, NC President ♦ Hubert K. Turley, Sr., MD, Memphis, TN President-Elect ♦ Harold P. McDonald, Sr., MD, Atlanta, GA Secretary/Treasurer

1947 Palm Beach, FL ♦ Hubert K. Turley, Sr., MD, Memphis, TN President ♦ Robert P. McIver, MD, Jacksonville, FL President-Elect ♦ Harold P. McDonald, Sr., MD, Atlanta, GA Secretary/Treasurer

1948 Hollywood Beach, FL ♦ Robert P. McIver, MD, Jacksonville, FL President ♦ Harold P. McDonald, Sr., MD, Atlanta, GA President-Elect ♦ Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer

1949 Boca Raton, FL ♦ Harold P. McDonald, Sr., MD, Atlanta, GA President ♦ James J. Ravenel, MD, Charleston, SC President-Elect ♦ Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer

1950 Edgewater Park, MS ♦ James J. Ravenel, MD, Charleston, SC President ♦ Edgar Burns, MD, New Orleans, LA President-Elect ♦ Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer

1951 Memphis, TN ♦ Edgar Burns, MD, New Orleans, LA President ♦ Temple Ainsworth, MD, Jackson, MS President-Elect ♦ Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer

1952 Boca Raton, FL ♦ Temple Ainsworth, MD, Jackson, MS President ♦ W.R. Miner, MD, Covington, KY President-Elect ♦ Russell B. Carson, MD, Vero Beach, FL Secretary/Treasurer

1953 Havanna, - Cuba ♦ W.R. Miner, MD, Covington, KY President ♦ Russell B. Carson, MD, Vero Beach, FL President-Elect ♦ Sidney Smith, MD, Raleigh, NC Secretary/Treasurer

1954 Palm Beach, FL ♦ Russell B. Carson, MD, Vero Beach, FL President ♦ Samuel L. Raines, MD, Memphis, TN President-Elect ♦ Sidney Smith, MD, Raleigh, NC Secretary/Treasurer

1955 New Orleans, LA ♦ Samuel L. Raines, MD, Memphis, TN President ♦ Sidney Smith, MD, Raleigh, NC President-Elect ♦ Robet F. Sharp, Sr., MD, New Orleans, LA Secretary ♦ Charles Reiser, MD, Atlanta, GA Treasurer

1956 Hollywood, FL ♦ Sidney Smith, MD, Raleigh, NC President ♦ Jarratt P. Robertson, MD, Atlanta, GA President-Elect ♦ Robet F. Sharp, Sr., MD, New Orleans, LA Secretary ♦ Charles Reiser, MD, Atlanta, GA Treasurer

301 1957 Atlanta, GA ♦ Jarratt P. Robertson, MD, Atlanta, GA President ♦ Lawrence P. Thackston, Sr., MD, Orangeburg, SC President-Elect ♦ Robet F. Sharp, Sr., MD, New Orleans, LA Secretary ♦ Frank M. Woods, MD, LaBelle, FL Treasurer

1958 Hollywood, FL ♦ Lawrence P. Thackston, Sr., MD, Orangeburg, SC President ♦ Robet F. Sharp, Sr., MD, New Orleans, LA President-Elect ♦ James L. Campbell, Jr., MD, Orlando, FL Secretary ♦ Frank M. Woods, MD, LaBelle, FL Treasurer

1959 Louisville, KY ♦ Robet F. Sharp, Sr., MD, New Orleans, LA President ♦ Rudolph Bell, MD, Thomasville, GA President-Elect ♦ James L. Campbell, Jr., MD, Orlando, FL Secretary Hurbert K. Turley, MD, Memphis, TN Treasurer

1960 Jacksonville, FL ♦ Rudolph Bell, MD, Thomasville, GA President ♦ N Lewis Bosworth, MD, Lexington, KY President-Elect ♦ James L. Campbell, Jr., MD, Orlando, FL Secretary Hurbert K. Turley, MD, Memphis, TN Treasurer

1961 Hollywood-by-the-sea-, FL ♦ N Lewis Bosworth, MD, Lexington, KY President ♦ Alfred D. Mason, Jr., MD, Memphis, TN President-Elect ♦ James L. Campbell, Jr., MD, Orlando, FL Secretary ♦ Henry Comfort Hudson, MD, Birmingham, AL Treasurer

1962 Belleair, FL ♦ Alfred D. Mason, Jr., MD, Memphis, TN President ♦ James L. Campbell, Jr., MD, Orlando, FL President-Elect ♦ Louis C. Roberts, MD, Greensboro, NC Secretary ♦ Henry Comfort Hudson, MD, Birmingham, AL Treasurer

1963 Nassau, Bahamas ♦ James L. Campbell, Jr., MD, Orlando, FL President

♦ off ic e rs P r e vi o us

Powell G. Fox Sr., MD, Raleigh, NC President-Elect ♦ Louis C. Roberts, MD, Greensboro, NC Secretary a nn ua l m ee ti n g sit e s ♦ Douglas E. Scott, MD, Lexington, KY Treasurer

1964 Belleair, FL ♦ Powell G. Fox, Sr., MD, Raleigh, NC President ♦ W. E. Kittredge, MD, New Orleans, LA President-Elect ♦ Louis C. Roberts, MD, Greensboro, NC Secretary ♦ Douglas E. Scott, MD, Lexington, KY Treasurer

1965 Miami Beach, FL

♦ W. E. Kittredge, MD, New Orleans, LA President a nd ♦ Douglas E. Scott, MD, Lexington, KY President-Elect ♦ David W. Goddard, MD, Daytona Beach, FL Secretary ♦ Rafe Banks, Jr., MD, Gainesville, GA Treasurer

302 1966 Memphis, TN ♦ Douglas E. Scott, MD, Lexington, KY President ♦ Louis C. Roberts, MD, Greensboro, NC President-Elect ♦ David W. Goddard, MD, Daytona Beach, FL Secretary ♦ Rafe Banks, Jr., MD, Gainesville, GA Treasurer

1967 Hollywood, FL ♦ Louis C. Roberts, MD, Greensboro, NC President ♦ Charles Reiser, MD, Atlanta, President-Elect ♦ David W. Goddard, MD, Daytona Beach, FL Secretary ♦ John T. Karaphillis, MD, Belleair, FL Treasurer

1968 Atlanta, GA ♦ Charles Reiser, MD, Atlanta, GA President ♦ David W. Goddard, MD, Daytona Beach, FL President-Elect ♦ R. Prosser Morrow, Jr., MD, New Orleans, LA Secretary ♦ John T. Karaphillis, MD, Belleair, FL Treasurer

1969 Hollywood Beach, FL ♦ David W. Goddard, MD, Daytona Beach, FL President ♦ Henry Comfort Hudson, MD, Birmingham, AL President-Elect ♦ R. Prosser Morrow, Jr., MD, New Orleans, LA Secretary Charlton P. Armstrong, II, MD, Greenville, SC Treasurer

1970 TS Hanseatic, ♦ Henry Comfort Hudson, MD, Birmingham, AL President ♦ Milton M. Coplan, MD, Miami, FL President-Elect ♦ R. Prosser Morrow, Jr., MD, New Orleans, LA Secretary Charlton P. Armstrong, II, MD, Greenville, SC Treasurer

1971 Miami Beach, FL ♦ Milton M. Coplan, MD, Miami, FL President ♦ R. Prosser Morrow, Jr., MD, New Orleans, LA President-Elect ♦ Samuel S. Ambrose, MD, Atlanta, GA Secretary ♦ George W. Vickery, MD, Gulfport, MS Treasurer

1972 New Orleans, LA ♦ R. Prosser Morrow, Jr., MD, New Orleans, LA President Charlton P. Armstrong, II, MD, Greenville, SC President-Elect ♦ Samuel S. Ambrose, MD, Atlanta, GA Secretary ♦ George W. Vickery, MD, Gulfport, MS Treasurer

1973 Palm Beach, FL ♦ Charlton P. Armstrong, MD President Hurbert K. Turley, MD, Memphis, TN President-Elect ♦ Samuel S. Ambrose, MD, Atlanta, GA Secretary ♦ Victor A. Politano, MD, N. Miami, FL Treasurer

1974 Marco Island, FL Hurbert K. Turley, MD, Memphis, TN President ♦ Samuel S. Ambrose, MD, Atlanta, GA President-Elect ♦ William Brannan, MD, The Woodlands, TX Secretary ♦ Victor A. Politano, MD, N. Miami, FL Treasurer

303 1975 Atlanta, GA ♦ Samuel S. Ambrose, MD, Atlanta, GA President ♦ Rafe Banks, Jr., MD, Gainesville, GA President-Elect ♦ William Brannan, MD, The Woodlands, TX Secretary ♦ Victor A. Politano, MD, N. Miami, FL Treasurer

1976 Hollywood, FL ♦ Rafe Banks, Jr., MD, Gainesville, GA President ♦ James F. Glenn, MD, Versailles, KY President-Elect ♦ William Brannan, MD, The Woodlands, TX Secretary ♦ John I. Williams, MD, Fort Lauderdale, FL Treasurer

1977 New Orleans, LA ♦ James F. Glenn, MD, Versailles, KY President ♦ William Brannan, MD, The Woodlands, TX President-Elect ♦ Miles W. Thomley, MD, Winter Park, FL Secretary ♦ John I. Williams, MD, Fort Lauderdale, FL Treasurer

1978 Louisville, KY ♦ William Brannan, MD, The Woodlands, TX President ♦ Victor A. Politano, MD, N. Miami, FL President-Elect ♦ Miles W. Thomley, MD, Winter Park, FL Secretary ♦ John I. Williams, MD, Fort Lauderdale, FL Treasurer

1979 Memphis, TN ♦ Victor A. Politano, MD, N. Miami, FL President ♦ Joseph Ward Hooper, Jr., MD, Wilmington, NC President-Elect ♦ Miles W. Thomley, MD, Winter Park, FL Secretary ♦ Fontaine Bruce Moore, Jr., MD, Memphis, TN Treasurer

1980 San Juan, Puerto Rico ♦ Joseph Ward Hooper, Jr., MD, Wilmington, NC President ♦ Miles W. Thomley, MD, Winter Park, FL President-Elect W. Lamar Weems, MD, Jackson, MS Secretary ♦ Fontaine Bruce Moore, Jr., MD, Memphis, TN Treasurer

1981 Lake Buena Vista, FL ♦ Miles W. Thomley, MD, Winter Park, FL President

♦ off ic e rs P r e vi o us

John I. Williams, MD, Fort Lauderdale, FL President-Elect W. Lamar Weems, MD, Jackson, MS Secretary a nn ua l m ee ti n g sit e s ♦ Fontaine Bruce Moore, Jr., MD, Memphis, TN Treasurer

1982 New Orleans, LA ♦ John I. Williams, MD, Fort Lauderdale, FL President Eugene C. St. Martin, MD, Shreveport, LA President-Elect W. Lamar Weems, MD, Jackson, MS Secretary Edward H. Ray, Jr., MD, Lexington, KY Treasurer

1983 Haines City, FL

Eugene C. St. Martin, MD, Shreveport, LA President a nd W. Lamar Weems, MD, Jackson, MS President-Elect William Redd Turner, Jr., MD, Folly Beach, SC Secretary Edward H. Ray, Jr., MD, Lexington, KY Treasurer

304 1984 Nashville, TN W. Lamar Weems, MD, Jackson, MS President ♦ Fontaine Bruce Moore, Jr., MD, Memphis, TN President-Elect William Redd Turner, Jr., MD, Folly Beach, SC Secretary Edward H. Ray, Jr., MD, Lexington, KY Treasurer

1985 Marco Island, FL ♦ Fontaine Bruce Moore, Jr., MD, Memphis, TN President Jack Hughes, MD, Durham, NC President-Elect William Redd Turner, Jr., MD, Folly Beach, SC Secretary ♦ Robert N. Webster, MD, Tallahassee, FL Treasurer

1986 Dorado Beach, Puerto Rico Jack Hughes, MD, Durham, NC President William Redd Turner, Jr., MD, Folly Beach, SC President-Elect ♦ David M. Drylie, MD, Gainesville, FL Secretary ♦ Robert N. Webster, MD, Tallahassee, FL Treasurer

1987 New Orleans, LA William Redd Turner, Jr., MD, Folly Beach, SC President Roy Witherington, MD, Sarasota, FL President-Elect ♦ David M. Drylie, MD, Gainesville, FL Secretary ♦ Robert N. Webster, MD, Tallahassee, FL Treasurer

1988 Boca Raton, FL Roy Witherington, MD, Sarasota, FL President Edward H. Ray, Jr., MD, Lexington, KY President-Elect ♦ David M. Drylie, MD, Gainesville, FL Secretary ♦ Robert B. Quattlebaum, Jr., MD, Savannah, GA Treasurer

1989 Hilton Head, SC Edward H. Ray, Jr., MD, Lexington, KY President ♦ David M. Drylie, MD, Gainesville, FL President-Elect ♦ Lloyd H. Harrison, MD, Tobaccoville, NC Secretary ♦ Robert B. Quattlebaum, Jr., MD, Savannah, GA Treasurer

1990 Palm Beach, FL ♦ David M. Drylie, MD, Gainesville, FL President ♦ Robert N. Webster, MD, Tallahassee, FL President-Elect ♦ Lloyd H. Harrison, MD, Tobaccoville, NC Secretary ♦ Robert B. Quattlebaum, Jr., MD, Savannah, GA Treasurer

1991 Atlanta, GA ♦ Robert N. Webster, MD, Tallahassee, FL President Josiah F. Reed, Jr., MD, Montgomery, AL President-Elect ♦ Lloyd H. Harrison, MD, Tobaccoville, NC Secretary James C. Seabury, Jr., MD, Fort Myers Beach, FL Treasurer

1992 Charlotte, NC Josiah F. Reed, Jr., MD, Montgomery, AL President ♦ Lloyd H. Harrison, MD, Tobaccoville, NC President-Elect J. William McRoberts, MD, Lexington, KY Secretary James C. Seabury, Jr., MD, Fort Myers Beach, FL Treasurer

305 1993 Nashville, TN ♦ Lloyd H. Harrison, MD, Tobaccoville, NC President ♦ Robert B. Quattlebaum, Jr., MD, Savannah, GA President-Elect J. William McRoberts, MD, Lexington, KY Secretary James C. Seabury, Jr., MD, Fort Myers Beach, FL Treasurer

1994 New Orleans, LA ♦ Robert B. Quattlebaum, Jr., MD, Savannah, GA President Thomas C. McLaughlin, MD, Lakeland, FL President-Elect J. William McRoberts, MD, Lexington, KY Secretary ♦ Hector H. Henry, II, MD, MPH, MS, Salisbury, NC Treasurer

1995 Lake Buena Vista, FL Thomas C. McLaughlin, MD, Lakeland, FL President J. William McRoberts, MD, Lexington, KY President-Elect David L. McCullough, MD, Winston-Salem, NC Secretary ♦ Hector H. Henry, II, MD, MPH, MS, Salisbury, NC Treasurer

1996 Las Croabas, Puerto Rico J. William McRoberts, MD, Lexington, KY President James C. Seabury, Jr., MD, Fort Myers Beach, FL President-Elect David L. McCullough, MD, Winston-Salem, NC Secretary ♦ Hector H. Henry, II, MD, MPH, MS, Salisbury, NC Treasurer

1997 Naples, FL James C. Seabury, Jr., MD, Fort Myers Beach, FL President Cecil Morgan, Jr., MD, Birmingham, AL President-Elect David L. McCullough, MD, Winston-Salem, NC Secretary Valentine A. Earhart, MD, New Orleans, LA Treasurer

1998 Birmingham, AL Cecil Morgan, Jr., MD, Birmingham, AL President David L. McCullough, MD, Winston-Salem, NC President-Elect Anton J. Bueschen, MD, Atlanta, GA Secretary Valentine A. Earhart, MD, New Orleans, LA Treasurer off ic e rs P r e vi o us

1999 Charleston, SC a nn ua l m ee ti n g sit e s David L. McCullough, MD, Winston-Salem, NC President William F. Gee, MD, Lexington, KY President-Elect Anton J. Bueschen, MD, Atlanta, GA Secretary Valentine A. Earhart, MD, New Orleans, LA Treasurer

2000 Orlando, FL William F. Gee, MD, Lexington, KY President ♦ Hector H. Henry, II, MD, MPH, MS, Salisbury, NC President-Elect Anton J. Bueschen, MD, Atlanta, GA Secretary

B. Thomas Brown, MD, MBA, Daytona Beach, FL Treasurer a nd

306 2001 New Orleans, LA Edward O. Janosko, MD, Wilmington, NC Member-at-Large ♦ Hector H. Henry, II, MD, MPH, MS, Salisbury, NC President William F. Gee, MD, Lexington, KY Past President Anton J. Bueschen, MD, Atlanta, GA President-Elect Joseph A. Smith, Jr., MD, Nashville, TN Secretary B. Thomas Brown, MD, MBA, Daytona Beach, FL Treasurer

2002 Naples, FL Edward O. Janosko, MD, Wilmington, NC Member-at-Large Anton J. Bueschen, MD, Atlanta, GA President ♦ Hector H. Henry, II, MD, MPH, MS, Salisbury, NC Past President Valentine A. Earhart, MD, New Orleans, LA President-Elect Joseph A. Smith, Jr., MD, Nashville, TN Secretary B. Thomas Brown, MD, MBA, Daytona Beach, FL Treasurer

2003 Savannah, GA Thomas F. Stringer, MD, Gainesville, FL Member-at-Large Valentine A. Earhart, MD, New Orleans, LA President Anton J. Bueschen, MD, Atlanta, GA Past President B. Thomas Brown, MD, MBA, Daytona Beach, FL President-Elect Joseph A. Smith, Jr., MD, Nashville, TN Secretary Edward O. Janosko, MD, Wilmington, NC Treasurer

2004 Oranjestad, Aruba Thomas F. Stringer, MD, Gainesville, FL Member-at-Large B. Thomas Brown, MD, MBA, Daytona Beach, FL President Valentine A. Earhart, MD, New Orleans, LA Past President Joseph A. Smith, Jr., MD, Nashville, TN President-Elect Dennis D. Venable, MD, Shreveport, LA Secretary Edward O. Janosko, MD, Wilmington, NC Treasurer

2005 Charleston, SC Joseph A. Smith, Jr., MD, Nashville, TN President B. Thomas Brown, MD, MBA, Daytona Beach, FL Past President Culley C. Carson, III, MD, Chapel Hill, NC President-Elect Dennis D. Venable, MD, Shreveport, LA Secretary Edward O. Janosko, MD, Wilmington, NC Treasurer

2006 Rio Grande, Puerto Rico Culley C. Carson, III, MD, Chapel Hill, NC President Joseph A. Smith, Jr., MD, Nashville, TN Past President Edward O. Janosko, MD, Wilmington, NC President-Elect Dennis D. Venable, MD, Shreveport, LA Secretary Thomas F. Stringer, MD, Gainesville, FL Treasurer

2007 Lake Buena Vista, FL Edward O. Janosko, MD, Wilmington, NC President Culley C. Carson, III, MD, Chapel Hill, NC Past President Dennis D. Venable, MD, Shreveport, LA President-Elect Raju Thomas, MD, FACS, MHA, New Orleans, LA Secretary Thomas F. Stringer, MD, Gainesville, FL Treasurer

307 2008 San Diego, CA Edward O. Janosko, MD, Wilmington, NC Immediate Past President Dennis D. Venable, MD, Shreveport, LA President Martin K. Dineen, MD, Daytona Beach, FL President-Elect Raju Thomas, MD, FACS, MHA, New Orleans, LA Secretary Thomas F. Stringer, MD, Gainesville, FL Treasurer

2009 Mobile, AL Dennis D. Venable, MD, Shreveport, LA Immediate Past President Martin K. Dineen, MD, Daytona Beach, FL President Thomas F. Stringer, MD, Gainesville, FL President-Elect Raju Thomas, MD, FACS, MHA, New Orleans, LA Secretary W. Terry Stallings, MD, FACS, Daphne, AL Treasurer

2010 Miami Beach, FL W. Terry Stallings, MD, FACS, Daphne, AL Treasurer Martin K. Dineen, MD, Daytona Beach, FL Immediate Past President Thomas F. Stringer, MD, Gainesville, FL President Raju Thomas, MD, FACS, MHA, New Orleans, LA President-Elect Raymond J. Leveillee, MD, FRCS-G, Miami, FL Secretary

2011 New Orleans, LA Thomas F. Stringer, MD, Gainesville, FL Immediate Past President Raju Thomas, MD, FACS, MHA, New Orleans, LA President Randall G. Rowland, MD, PhD, Indianapolis, IN President-Elect Raymond J. Leveillee, MD, FRCS-G, Miami, FL Secretary W. Terry Stallings, MD, FACS, Daphne, AL Treasurer

2012 Amelia Island, FL Raju Thomas, MD, FACS, MHA, New Orleans, LA Immediate Past President Randall G. Rowland, MD, PhD, Indianapolis, IN President W. Terry Stallings, MD, FACS, Daphne, AL President-Elect Raymond J. Leveillee, MD, FRCS-G, Miami, FL Secretary Jon S. Demos, MD, Lexington, KY Treasurer

2013 Williamsburg, VA Dean George Assimos, MD, Birmingham, AL Secretary Jon S. Demos, MD, Lexington, KY Treasurer off ic e rs P r e vi o us

W. Terry Stallings, MD, FACS, Daphne, AL President Randall G. Rowland, MD, PhD, Indianapolis, IN Past President a nn ua l m ee ti n g sit e s Raymond J. Leveillee, MD, FRCS-G, Miami, FL President-Elect

2014 Hollywood, FL Raymond J. Leveillee, MD, FRCS-G, Cooper City, FL President W. Terry Stallings, MD, FACS, Daphne, AL Past President Jack M. Amie, MD, St. Simons Island, GA President-Elect Dean George Assimos, MD, Birmingham, AL Secretary Jon S. Demos, MD, Lexington, KY Treasurer a nd

308 Future SESAUA Meeting

80th Annual Meeting of the Southeastern Section of the AUA March 17 – March 20, 2016 Omni Nashville Hotel Nashville, Tennessee

309 SESAUA Two Woodfield Lake 1100 E Woodfield Road, Suite 350 Schaumburg, IL 60173-5116 Phone: (847) 969-0248 Fax: (847) 517-7229 Email: [email protected] Website: www.sesaua.org