Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Poster Session 3: Urologic Benign Diseases 1 MP3-06 Quantitative Stone Analysis Software’s Utility in Analyzing Kidney Stone Characteristics and Predicting Outcomes Following Extracorporeal Shockwave Lithotripsy S. Sappal 1 ;A.L.Yang 2 ; M. Erdman 2 ; E. Lehman 2 ; N. Streeper 1 ; J. Raman 1 ; J. Knoedler 1 1 Penn State Health, Hershey, PA, USA; 2 Penn State University, Hershey, PA, USA Introduction: Quantitative stone analysis software (qSAS) is a novel program that uses computed tomography (CT) images to analyze the three-dimensional characteristics of kidney stones in a reproducible and standardized manner. The information provided by the software may be clinically relevant for determining effectiveness of intervention. It may be especially relevant when considering extracorporeal shock wave lithotripsy (ESWL), which has known limitations for treating large, complex stones. The primary objective of this study is to determine if enhanced stone characterization using the qSAS is associated with potentially adverse clinical outcomes following ESWL. Materials & Methods: We performed a retrospective review of 154 patients with nephrolithiasis who underwent ESWLat a single institution. The qSAS was used to analyze stone characteristics based on preoperative CT imaging. Patient electronic medical records were surveyed for complications, including the need for further surgical intervention, occurring within sixty-days postoperatively. Wilcoxon Rank Sum and Chi Square tests were applied to determine statistical significance. Results: Per patient, mean stone density was 473.4 Hounsfield units (HU) (IQR = 198.8 HU), andmean stone volume was 518.9 mm3 (IQR = 256 mm3).As calculated by the qSAS, patients with greater mean stone density were significantly more likely to develop acute kidney injury (668 HU v. 469.5 HU; p = 0.01), steintrasse formation (528.9 HU v. 465.1 HU; p = 0.04), and need further surgical intervention (580.6 HU v. 459.2 HU; p = 0.001). Notably, patient’s with greater stone volume were more likely to require further surgical intervention (mean volume 1,130.5 mm 3 v. 437.9 mm 3 ; p = 0.004). Conclusions: Greater qSAS-calculated mean stone density and stone volume are positively correlated with development of complications and need for further surgical intervention following ESWL. Further prospective studies should investigate the utility of the qSAS for improved patient selection and surgical planning for nephrolithiasis. A Pilot Study Evaluating the Utility of Next Generation DNA Sequencing in Detecting Microorganisms in Explanted Urologic Prosthetics T. Hardacker; A. Das; P. Shenot; L. Gomella; P. Chung Thomas Jefferson University, Philadelphia, PA, USA Introduction: Device infection is a serious complication of urologic implants. Device cultures unfortunately return as negative or nonspecific growth in 30-81% of cases. Next-generation DNA sequencing (NGS) is an emerging technology with the ability to evaluate entire genomes and potential to improve organismdetection. We hypothesize that NGS may improve detection of microorganisms compared to conventional culture in penile prostheses and artificial urinary sphincters explanted for device malfunction and infection. Materials & Methods: A retrospective review of patients who underwent device explant for device malfunction (device leak, urethral atrophy, cylinder resizing) or infection (gross infection, urethral erosion, cylinder extrusion) with or without device replacement from June 2018 to September 2019 was performed. At explant, devices were swabbed and sent for NGS testing (MicroGen Diagnostics, Lubbock, TX, USA). Devices were sent for conventional microbiology culture. Patient demographics, surgical course, and outcome were evaluated. Results: Thirty-four patients underwent 35 device explants (14 penile prostheses, 21 artificial urinary sphincters) with 26 simultaneous device replacements. Reasons for explant included mechanical failure (n = 25) and infection (n = 10). NGS and standard culture demonstrated presence of microorganisms in 17 (49%) and 27 (77%) devices, respectively (p = 0.03). NGSwas more effective in detectingmicroorganisms in devices explanted for infection (n = 8, 80%) compared to mechanical failure (n = 9, 36%) (p = 0.05). NGS detected additional microorganisms not detected on standard culture in 15 (43%) devices. One patient developed a de novo infection after device replacement; however, initial device explant culture was negative and did not affect the clinical course. Conclusions: NGS detected organisms less frequently than device culture andmay best be further evaluated in patients who undergo device explant due to infection rather than mechanical failure. NGS may also help to further characterize the microbiome of urologic devices. Further study is warranted to evaluate optimal clinical use of this emerging technology. MP3-04 27 MP3-05 AMulti-institutional Experience with Robotic Vesicovaginal and Ureterovaginal Fistula Repair After Iatrogenic Injury M. Lee 1 ; Z. Lee 1 ; L. Kidd 1 ; S. Liu 2 ; E. Rangel 3 ; N. Ahmed 1 ; A. Hemal 2 ; R. Sotelo 3 ; D. Eun 1 1 Temple University, Philadelphia, PA, USA; 2 Wake Forest, Winston-Salem, NC, USA; 3 University of Southern California, Los Angeles, CA, USA Introduction: We describe our multi-institutional experience with robotic vesicovaginal fistula (VVF) and ureterovaginal fistula (UVF) repair after iatrogenic injury. Materials &Methods: We retrospectively reviewed our multi-institutional database to identify patients who underwent robotic VVF and UVF repair after iatrogenic injury between 01/2010 and 05/2019. All patients who underwent UVF failed conservative management with nephroureteral stenting. Use of tissue interposition between the reconstructed genitourinary and gynecologic systems was determined based on clinical history and intraoperative findings. Postoperatively, patients were assessed for clinical success (absence of urinary leakage). Results: Robotic VVF and UVF repairs were performed in 22/30 (73.3%) and 8/30 (26.7%) patients, respectively. Median time from diagnosis to repair was 48 days (IQR 22-105). During VVF repair, omentum, peritoneum, and sigmoid mesentery/ epiploic appendage was interposed between the bladder and vagina in 14/22 (63.6%), 3/22 (13.6%), and 3/22, (13.6%) cases, respectively. During UVF repair, the ureter was reconstructed via ureteroureterostomy in 2/8 (25.0%) patients and ureteral reimplantation in 6/8 (75.0%) patients; 5/6 (83.3%) ureteral reimplantations required a psoas hitch. Omentum was interposed between the ureter and vagina in 2/8 (25.0%) cases. Overall median operative time was 173 minutes (IQR 131- 214), estimated blood loss was 50 milliliters (IQR 50-94), and length of stay was 1 day (IQR 1-2). There was 1/30 (3.3%) postoperative complication (Clavien > 2) in a patient who required intensive care management after exacerbation of chronic lung disease. At a median follow-up of 5 months (IQR 2-13), 28/30 (93.3%) cases were clinically successful. Both failures occurred after VVF repair with omental interposition within 6 months of surgery. One patient underwent successful repeat robotic repair and the other underwent successful transvaginal repair. Conclusions: Robotic VVF and UVF repair secondary to iatrogenic injury may be performed with high success rates. Although surgical failures may occur after fistula closure and tissue interposition, they may be managed with repeat surgery.