Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Poster Session 6: Urologic Oncologic Disease AComparative Analysis of Cosmetic Preferences Based on Operative Approach to Radical Prostatectomy M. Huang; M. Biles; Z. Schwen; R.Alam; H. Patel; P. Pierorazio; J. Day; C. Pavlovich Johns Hopkins Hospital, Baltimore, MD, USA Introduction: Recent developments in minimally invasive approaches to radical prostatectomy (RP) may improve cosmesis. Our aim was to evaluate surgical scar appearance based on operative approach to RP. Materials & Methods: Men between the ages of 45 to 80 were surveyed on a crowdsourcing platform. Well-healed surgical scars after open, multiport (MP) robotic (transperitoneal and extraperitoneal), and single-port (SP) robotic RP were digitally rendered by a medical illustrator on stock photos (Figure 1). Respondents evaluated images using items from the SCAR-Q, a validated patient reported outcome instrument assessing appearance and perceived psychosocial impact on a scale of 0 (worst) to 100 (best). Additionally, different RP scars were ranked. Responses were compared using appropriate statistical tests. Results: After excluding respondents who had undergone RP or incorrectly completed the survey, 234 men were included for analysis. The median age was 54 (IQR: 49-61) and 35% (85/234) had previous abdominal surgery, of which 45% (38/85) was performed laparoscopically or robotically. SP scars had higher SCAR-Q scores for appearance (87 vs. 58 and 45 out of 100) and psychosocial impact (100 vs. 69 and 58 out of 100) compared to MP and open, respectively (both p < 0.001) (Figure 2). SP had a median ranking of 1 (IQR: 1-1) and was consistently ranked higher than MP (2, IQR: 2-3) and open (3, IQR: 3-4) (p < 0.001). Conclusions: SP scars scored higher on validated psychosocial and appearance instruments than MP and open RP scars, and were consistently ranked higher in appearance. These findings may be informative for optimizing cosmetic outcomes for patients undergoing RP. Microwave Ablation of the T1a Small Renal Mass: Expanding Beyond 3 cm C. Ballantyne 1 ; J. Mershon 1 ; I. Richie 1 ; M. Tuong 1 ; M. Clements 1 ; J. Lobo 2 ; T. Krupski 1 ; N. Schenkman 1 1 University of Virginia, Charlottesville, VA, USA; 2 University of Virginia Department of Public Health Science, Charlottesville, VA, USA Introduction: AUAguidelines support thermal ablation (TA) for small renal masses (SRM) 3 cm or less in a select patient population. While TA success rates decline with increasing size, studies support TA for SRMs up to 4 cm with acceptable oncologic outcomes. The advantages of microwave ablation (MWA) over older ablation modalities may improve success rates in larger T1a SRMs. Materials & Methods: An institutional review board approved SRM database included retrospective data from 2009 but prospective data after April 2015 concordant with the inception of a multidisciplinary conference to determine treatment consensus. Options included partial nephrectomy (PN), ablation, or active surveillance. Local recurrence events were defined as residual mass or enhancement. Kaplan-Meier plot and pairwise log-rank tests assessed outcomes. Results: Of 190 treated renal tumors, 155 were stage T1a and 71 had tumor size of 3 to 4 cm. Of this 3-4 cm cohort, 39 underwent MWA, 29 underwent PN, and 3 were lost to follow-up. Median postoperative follow-up was 673 days. Each treatment group experienced two local recurrences, with no difference in recurrence rate (p = 0.97). Clavien-Dindo complications > 3 were 5% and 27.5 % for MWA and PN, respectively. Recurrence in the 3-4 cm cohort was not significantly different from patients with tumors < 3 cm (p = 0.79). Conclusions: While longer follow-up is needed, this data suggest that in select patients MWAdoes not appear inferior in treating 3-4 cmmasses relative to < 3 cm masses. If larger studies confirm these findings, the indication for ablative therapies may warrant expansion. MP6-13 MP6-12 45

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