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 6: Trauma/Sexual Dysfunction Multi-Institutional Comparison of Non-Transecting Versus Transecting Primary Robotic Pyeloplasty for Ureteropelvic Junction Obstruction D. Strauss 1 , M. Lee 1 , Z. Lee 1 , A. Asghar 1 , R. Lee 1 , S. Kuppa 1 , M. Stifelman 2 , D. Eun 1 1 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 2 HackensackMeridian School of Medicine at Seton Hall University, Nutley, NJ, USA Introduction and Objective: There is a paucity of literature describing non-transecting pyeloplasty in the primary setting of ureteropelvic junction obstruction (UPJO) repair. Our objective is to describe surgical techniques and peri-operative outcomes of primary non-transecting robotic pyeloplasty (RP) compared to standard dismembered RP. Methods: The Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) multi-institutional database was queried retrospectively for all patients who underwent primary RP between 04/2012-08/2020. Patients were grouped according to surgical approach;Anderson-Hynes dismembered (transecting) RP or non-transecting RP (Fenger or Y-V Flap). Perioperative outcomes were compared using nonparametric independent sample median tests and chi-square tests; p<0.05 was considered significant. Results: Of 133 patients, 115 (86.5%) underwent transecting and 18 (13.5%) underwent non-transecting RP. Median operative time (138.0 vs 134.0 min, p=0.66) and estimated blood loss (50 vs 50cc, p=0.12) were similar between transecting and non-transecting groups, respectively. Likewise, there was no difference in major (Clavien>2) complications between the surgical technique groups (p=0.08). At a median follow-up of 12.9 months, there was no difference in success between transecting and non transecting groups (92.2% versus 88.9%, respectively; p=0.64). Conclusions: Given variable anatomical configurations of ureteropelvic junction obstruction (UPJO), including ureteral, vascular, and perihilar variations, a “one-size-fits-all” approach to pyeloplasty is inappropriate. Primary non-transecting RP showed similar operative time, EBL, complication rates, and surgical success to dismembered RP. The authors do not intend to suggest non transecting pyeloplasty replace dismembered pyeloplasty in the primary setting, especially for indications such as a crossing vessel; however rather hope to demonstrate that a primary non transecting approach in select patients is not inferior to a dismembered approach, and serves as an important technique in the armamentarium of the robotic urologist approaching difficult UPJO repairs. MP6-09 General Surgeons’Comfort and Urologists’ Perceptions of Bladder Trauma Management J. Leong, J. Schultz, J. Marks, T. Zhan, P. Chung Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA Introduction and Objective: Bladder injuries often require immediate care and management by general surgeons (GS) and/or urologists. The extent of collaboration between the two specialties may vary between institutions and by presentation. Herein, we assess factors influencing GS to involve urologists in the management of bladder trauma. Methods: Questionnaires were distributed electronically to GS and urologists throughAmerican College of Surgeons andAmerican Urological Association chapters. Questionnaires contained eight bladder injury scenarios of increasing severity or complexity. Responses were graded on a Likert scale of 1-5 (1: least likely). GSwere queried on their comfort level with each injury and likelihood that they would consult urology. Urologists were asked to provide their comfort level of GS managing each injury and likelihood that they would be consulted. Univariate and multivariate analyses were performed. Results: Overall, 108 GS and 104 urologists responded to the questionnaire. While the perceived comfort of GS by urologists in the management of Grade I to Grade V bladder injuries decreased from 84% to 5%, respectively, GS reported a significantly higher comfort level when faced with these injuries (Grade I: 88% and Grade V: 31%, p<0.001). Despite this, the likelihood that GS would consult urology increased significantly as the injury severity increases (Grade I injury: OR 1.95, 95% CI 1.17-3.25, p=0.01; Grade V injury: OR 5.21, 95% CI 1.47-18.52, p=0.01). Contrary to urologists’ perception, most GS indicated that pre-operative CT imaging demonstrating bladder injury, presentation outside normal working hours, and an intraoperative diagnosis were not factors as to whether urology would be consulted (all p<0.01). GS and urologists equally utilized a two-layer bladder closure (94%, p=1.0). Conclusions: GS-reported comfort levels in the management of bladder injuries remained higher than urology-perceived comfort levels. We believe this work will allow for continued open discussion on the best manner to approach multidisciplinary management of bladder trauma. MP6-08 Surgical Planning for Urethral Reconstruction: Is Retrograde Urethrogram Alone Sufficient C. Robey 1 , T. Zagade 1 , A. Gaddipati 1 , J. Kim 2 , M. Chua 2 , K. McCammon 1 , R. Virasoro 1 , J. Delong 1 1 Eastern VirginiaMedical School, Norfolk, VA, USA; 2 University of Toronto, Toronto, ON, Canada Introduction and Objective: TheAUAGuidelines for male urethral stricture recommends use of cystoscopy, retrograde urethrography (RUG), voiding cystourethrography(VCUG), or ultrasound to evaluate urethral strictures. The current gold standard for stricture evaluation is RUG. The addition of VCUG aids in better visualization of the posterior urethra. In this study, we aim to determine if RUG can be used alone for preoperative planning. Methods: After IRB approval, 247men between 2015-2019 underwent urethral reconstructive procedures at our institution. Men who had prior urethral reconstruction and RUGs performed at outside facilities were excluded. The EMR of the resulting 192 men were evaluated for procedure listed in the preoperative visit as well as the procedure documented in the operative notes. Patients were divided into two groups: those who had procedure as planned and those who had intraoperative plan changes. Records of both groups were analyzed for whether or not RUG alone was performed versus RUG plus VCUG. Additionally, we analyzed the extent to which surgical plans changed. Results: 192 men were analyzed. All RUGs were performed by the same surgeon who performed the reconstruction. In the planned group (N=168), VCUG was performed in 60% of patients. In the changed group (N=24), VCUG was performed in 67%. Univariate analysis using Fisher’s Exact was used to analyze whether performance of VCUG correlatedwith intraoperative plan changes. There was no significant correlation between intraoperative surgical plan changes and performance of VUCG (p=0.65). With regards to how operative plans changed, 7 patients needed more extensive procedures and 17 patients needed less extensive procedures. There was no difference between extent of changed procedure between those patients who had VCUG performed and those who did not (p=0.2). Conclusions: This data did not show a correlation with VCUG and intraoperative plan changes, indicating RUG alone may be sufficient for evaluation of urethral strictures MP6-07 42