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

MA-AUA 2021 Abstracts Display Posters The Social Impact of Surgery for Nephrolithiasis: Results from the Endourological Society TOWER Research Collaborative A. Jones 1 , G. Lin 1 , H. Stambakio 1 , B. Chew 2 , J. Stern 3 , J. Ziemba 1 1 University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; 2 University of British Columbia, Vancouver, BC, Canada; 3 Intermountain Healthcare - Park City Hospital, Park City, UT, USA Introduction and Objective: Nephrolithiasis is among the most common urological conditions; however, the social impact of the disease remains significantly understudied, particularly following surgical intervention. We prospectively captured patient-reported ability to participate in social roles and activities in patients following ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for nephrolithiasis. Methods: Adults undergoing URS or PCNL for renal/ureteral stones were eligible for inclusion (10/2020-3/2021). Patients prospectively completed PROMIS-Ability to participate in social roles and activities instrument pre- operatively (POD 0) and via email on POD 1, 7, and 14. Scores are reported as T-scores (normalized to US pop., mean=50) with a change of 5 (0.5 SD) considered clinically significant. Results: A total of 68 patients completed enrollment at POD 0 (POD 1=40, POD 7=39, POD 14=32). For the overall cohort, there was a clinically and statistically significant difference in scores over each subsequent time comparison (repeated measures ANOVA; p < 0.001). Repeated measures ANOVAshow statistically significant difference in scores between POD 0 and 1 and between POD 7 and 14 for URS patients (Figure 1; p <0.001), but not PCNLpatients (Figure 2). URS patients return to baseline social participation by POD 14, and PCNL patients return to baseline by POD 7. Conclusions: Ability to participate in social roles and activities declines immediately post-operatively. PCNL patients see normalization in social participation by POD 7, but PCNL patients experience social interference for longer and return to baseline by 14 days. Results offer meaningful insight to assist counseling patients for surgical treatment of nephrolithiasis. DP-18 Utilizing da Vinci ®Robotic Surgical System to treat Distal Ureteral Cancer, Functional and Oncological Outcome A. Dahman, M. Salkini West Virginia University, Morgantown, WV, USA Introduction and Objective: Nephroureterectomy used to be the classical treatment for transitional cell carcinoma (TCC) affecting the distal ureter. Contemporary reports demonstrate equal oncologic outcome for distal ureterectomy when compared to nephroureterectomy. However, the distal ureterectomy showed better renal functional outcome. Distal ureterectomy necessitates ureteral reimplantation or substitution, and both traditionally required large midline or Gibson incision. In this study, we are reporting on the functional and oncologic outcomes of alternatively utilizing a minimally invasive technique to treat distal ureter TCC via the da Vinci® robotic surgical system. Methods: We retrospectively collected the data of 20 patients with distal ureteral TCC, who presented to our department for treatment between September 2009 and February 2020. We utilized the da Vinci® robotic surgical system to perform distal ureterectomy and ureteral reimplantation or substitution with Boari flap. The distal ureter was excised with the bladder cuff and pelvic lymph node dissection was performed. The proximal ureteral end was spatulated and re-implanted either directly to the bladder or after developing a Boari flap as needed to ensure tension-free, leak-proof anastomosis. Negative margins for invasive TCC was achieved in all cases. Results: The average patient age was 73 years (ranging from 55-82). Of the 20 patients, 14 were male and 6 female. All cases were completed robotically. The patients were followed for an average of 38.4 months (ranging from 3 months to 84 months). Four patients (20%) who had lower ureteral TCC developed ureterovesical anastomosis stricture, all except one of which had high grade TCC. Conclusions: Robotic distal ureterectomy with lymph node dissection and ureteral reimplantation/substitution with Boari flap is an effective minimally invasive alternative with good functional and oncologic outcomes. Longer follow-up is needed. DP-17 53