Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Moderated Poster Session 5: Surgical Technology/Imaging Ureteral Stricture Prevention Through a Multi-modal Intervention for Robotic Intracorporeal Ileal Conduit Urinary Diversion S. Wang, M. Phelan, M. Siddiqui University of Maryland School of Medicine, Baltimore, MD, USA Introduction and Objective: An important complication of radical cystectomy and urinary diversion is benign uretero-enteric anastomosis (UEA) stricture, with reported rates up to 15%. In this study, we reported the impact on UEA stricture formation from the introduction of a multi-modal surgical technique combining the use of firefly visualization of ureteral blood flow, a wound-healing promotingwrap of decellularized umbilical tissue, and a retro-sigmoidal ileal conduit reconstruction to alleviate left ureteral tension. Methods: We retrospectively reviewed patients with bladder cancer undergoing RARC and intracorporeal ileal conduit in our center by the same urologist (MMS) from December 2015 to June 2020. Patients were divided into two groups based on the ileal conduit reconstruction (multi-modal retro-sigmoidal conduit or standard conduit with optional use of firefly/ wound-healing promoting wrap). Patients demographics, postoperative complications, andUEAstatus were collected and compared between groups. Results: 52 patients received RARC and intracorporeal ileal conduit and 45 had been followed up, with 25 in the standard group and 20 in the retro- sigmoidal group. Most variables were comparable between groups. With a median follow-up time of 19months (IQR 6-36) in standard group vs 8months (IQR 4.75-11.5) in retro-sigmoidal group, the global UEA stricture rates were 34.8% vs 0% (p=0.009, Figure 1). Among the 10 benign UEA strictures (per ureter), the median time of stricture formation was 6 months (IQR 3-8.5). The postoperative 30-day, 90-day complication rate, and 30-day readmission rate were comparable between groups. Conclusions: The use of this multi-modal retro-sigmoidal ileal conduit technique in RARC may reduce the UEA stricture rate. Further studies with larger cohorts are needed to validate this finding as well as help elucidate if some component of the multi-modal intervention is most important. MP5-08 The Outcome of Utilizing Robotic Surgical System to Treat Ureteroenteric Anastomotic Stricture A. Dahman, M. Salkini West Virginia University, Morgantown, WV, USA Introduction and Objective: Ureteroenteric anastomotic strictures develop in up to 20% of patients after urinary diversion. The surgical revision of the anastomosis, though yields the best outcome, is challenging and traditionally required a largemidline incision, due to the adhesions and scarring. We report on the outcome of robotic reimplantation to ileal conduit. Methods: Nine patients presented to our service with stricture of the ureteroenteric anastomosis after urinary diversion. Two patients presented with ureteral anastomotic structure to ileal neobladder. The remaining seven presented with ureteroenteric structure at the ileal conduit. Of the nine, two patients had bilateral ureteral anastomotic stricture, two right-sided strictures of a solitary kidney, and five had isolated left ureteral anastomotic stricture. Results: The average patient’s age at presentation was 72 years (range 59-82) with 2 females (22%). All cases were done robotically with no conversion. The average length of the procedures was 201 min (90-460). An average blood loss of 183 ml (50-800). The average hospital length of stay was 4.2 days (1-14). Two patients developed transient ileus that resolved with no intervention. One patient developed a DVT (11%) after surgery, and another had an AKI (11%). All the anastomoses were patent after follow-up of an average of 16 months (6-32). None of the patients progressed to chronic renal failure or required dialysis. Conclusions: Robotic ureteral anastomotic repair is a viable option for ureterointestinal anastomotic structure. The robotic approach minimizes the invasiveness of the procedure with favorable outcomes. Longer follow-up is needed to ensure the reliability of the technique. MP5-07 36