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

MA-AUA 2021 Abstracts Moderated Poster Session 6: Trauma/Sexual Dysfunction Robotic Approach for Distal Ureteral Reconstruction in Post-Radiation Ureteral Stricture A. Elbakry 1 , K. Aldabek 2 , T. Trump 1 , K. Mitchell 1 , M. Salkini 1 1 West Virginia University Hospital - Morgantown, Morgantown, WV, USA; 2 West Virginia University School of Medicine, Morgantown, WV, USA Introduction and Objective: We are aiming to evaluate the role of robotic surgery in ureteral reconstruction following pelvic radiation. Methods: We retrospectively identified all patients who underwent robotic reconstruction of the distal ureter in the last 10 years. Data collection included demographic data, preoperative baseline clinical data, operative data (operative time, EBL, conversion to open, surgical technique) and postoperative outcomes (early postoperative complications, hospital stay, 30-days readmission, postoperative and delta eGFR, and reintervention rate). Results: A total of 31 cases of robotic distal ureteral reconstruction were identified. Patients were categorized into 2 groups. Group 1 includes radiation naive patients and group 2 includes patents with history of pelvic radiation. The two groups were similar regarding baseline demographic data. Initial presentation was similar in both groups with evaluation for hydronephrosis being the most common presentation. Operative time, EBL, conversion to open, and length of stay were similar in both groups. There was no difference regarding early complications, 30-days readmissions, and the duration of foley catheter or ureteral stent. Majority of patients in both groups reported symptoms improvement (100% in group 1 and 93.3% in group 2. Delta eGFR showed decrease eGFR in group 2 by 12 ml/min and improvement in group 1 by 3.1 ml/min, with no significant difference. One patient (6.7%) in group 2 required reintervention and underwent nephrectomy, while no patients in group 1 required reintervention. Conclusions: Robotic surgery is a feasible approach for post-radiation distal ureteral reconstructionwith a high success rate and relatively similar outcome to radiation naive patients. More studies with a larger number of patients are needed to fully evaluate the role of robotic surgery in post-radiation settings as an alternative for classic open surgery. MP6-11 Demucosalized Detrusor Muscle Flaps for Management of Complex Urethral Fistula M. Loecher, R. Morales-Lopez, M. Metro Temple University Health System, Philadelphia, PA, USA Introduction and Objective: Radiation associated rectourethral (RUF) and urosymphyseal fistulas (USF) are complex urologic problems that often require urinary diversion. While reconstruction for RUF and USF have been studied in small case series with good short-term outcomes, little information exists on the optimal approach when reconstruction fails. We present a novel approach to fistula management using urinary diversionwith subtotal cystectomy/ileal conduit (SC/IC) and creation of demucosalized detrusor muscle flaps (DDMF) for pelvic interposition. We propose that this technique optimizes wound healing and eliminates empty space in a hostile and infected field. Methods: We performed a retrospective review of six patients with USF/ RUF treated with SC/ICwith DDMF performed by a single surgeon between January 2018 andDecember 2020. Surgical technique and perioperative follow upwas described. Preoperative data, radiation history and prior interventions were collected. Short-term outcomes and peri-operative complications were recorded. (Table) Results: Median age was 78 years old (range 71-81). All men had been treated for CaP with RT without evidence of biochemical recurrence. Of the six patients, three had transurethral resection of a bladder neck contracture prior to onset of symptoms. Two RUF patients had failed prior reconstruction. Mean length of stay was eleven days. Median follow up was four months. All USF patients have not had reoccurrence of pelvic sepsis at follow up. Thirty- day post-operative complications were all Clavien-Dindo 1 or 2. Conclusions: Demucosalized detrusor muscle flaps with urinary diversion are a safe and feasible option for patients who fail or are not candidates for definitive reconstruction of RUF or USF. We propose that using vascularized muscle flaps allows for tissue interposition without added morbidity, need for distant muscle flaps or need for plastic surgery consultation. MP6-10 43