Abstracts from the New England Section of the AUA 2021

NE-AUA 2021 Abstracts Scientific Session III: BPH/RECON 28 “En Bloc” with Early Apical Release Compared to StandardHolmiumLaser Enucleation of the Prostate During Initial Learning Curve Benjamin Press, MD , Eric Ghiraldi, DO, Hari Nair, BS, Katelyn Johnson, MD, Daniel Kellner, MD Yale University School of Medicine, New Haven, CT, USA Introduction: Holmium laser enucleation of the prostate (HoLEP) has emerged as an alternative treatment to transurethral resection of the prostate for bladder outlet obstruction. Widespread adaptation has been limited by the steep learning curve necessary to master HoLEP. We sought to compare operative efficiency of HoLEP using both the standard, multi-incisional approach and “en bloc” with early apical release (EBAR) during the initial learning curve. Materials &Methods: We retrospectively reviewed the initial 95 consecutive men who underwent HoLEP between April 2019 and September 2020 by a single surgeon. 50 patients underwent standard HoLEP procedure, and 45 patients underwent EBAR. We compared patient demographics, pre and post-operative metrics, (Table 1) as well as intra-operative metrics (Table 2) between both groups. Differences between groups were evaluated with Mann-Whitney U and Kruskal-Wallis tests. Results: There were no statistically significant differences between groups among the variables listed in Table 1 . Compared to a standard HoLEP, EBAR was associated with lower volume of saline irrigation used (48.66 L vs. 57.99 L, p = 0.037) and decreased operative time (131.84 minutes vs. 152.90 minutes, p = 0.007) ( Table 2 ), even with similar weight of tissue removed. There was no difference in length of stay (0.91 days vs. 0.96 days, p = 0.362) or in laser energy used (204.19 kJ vs. 203.34, kJ, p = 0.897). There were no differences in Clavien ≥ 2 complications between the groups. Conclusions: The utilization of the EBAR technique during the initial learning curve allows for a faster, more efficient operation without any difference in functional outcomes or major complications compared to a standard HoLEP. Urine miRNA Biomarkers that are Differentially Expressed in Lichen Sclerosus Induced and Non-Lichen Sclerosus Induced Urethral Stricture Disease Karl Benz, MD , Travis Sullivan, MS, Thomas Kalantzakos, BA, Amanda Sherman, MD, Harjivan Kohli, MD, Eric Burks, MD, Kimberly Rieger-Christ, PhD, Alex Vanni, MD Lahey Hospital and Medical Center, Burlington, MA, USA Introduction: Identifying non-invasive biomarkers that distinguish Lichen Sclerosus (LS) induced from non-LS induced urethral strictures would have broad implications for the diagnosis, counseling, and treatment of urethral stricture disease (USD). The objective of this study is to determine which miRNAs are differentially expressed in urine samples from patients with LS USD versus non-LS USD. Materials & Methods: A prospectively maintained institutional USD database of patients who underwent urethroplasty was queried for patients with an available pre-operative voided urine sample obtained between July 2018 and February 2020. Urine miRNA were analyzed in patients with and without histologically confirmed LS USD. Total RNAwas isolated and reverse transcribed from each urine supernatant sample. miRNAexpressionwas then profiled using RT-qPCR arrays for 376 unique miRNAs. Urine samples were excluded if there was recent catheterization, if the urine was obtained from a suprapubic tube, or if the patient had a history of hypospadias. Results: In total, 24 patients met inclusion criteria, 14 (58%) of which were post-operatively histologically classified as having LS. There were no significant differences between the LS and non-LS USD groups regarding patient age, body mass index, history of smoking, or history of diabetes mellitus. Of the 376 miRNAs tested, forty-five unique miRNAs were differentially expressed in LS urines (p<0.05), 4 of which had a p-value of <0.01. Of those four, miR-186-5p (p=0.002, AUC 0.736) and miR-185-5p (p=0.003, AUC 0.764) were upregulated in LS, while miR-153-3p (p=0.005, AUC 0.701) and miR-509-3p (p=0.006, AUC 0.688) were downregulated ( Figure 1 ). Conclusions: This is the first study to demonstrate unique urine miRNA that distinguish LS from non-LS USD. This discovery could be used to create a non-invasive urine test to distinguish the LS vs non-LS USD, therefore obviating the need for biopsy. The two most promising candidates, miRNAs 185-5p and 186-5p, have been shown to mediate the androgen receptor, fibrosis pathways, and cell proliferation pathways. Further investigation is needed to validate these findings in a larger cohort. Figure 1 : Relative expression levels of the top four microRNA differentially expressed in the urine of LS patients. 27 15