Abstracts from the New England Section of the AUA 2020: A Virtual Experience

NE AUA 2020 Abstracts 23 A Retrospective Comparison of 1470 nm Diode Laser Enucleation and Bipolar TransurethralResectionoftheProstatefortheTreatmentofBenignProstaticHyperplasia Sina H.B. Monfared, BS , Annaliese Ionson, MSc, Michael Emmerling, MA, Wesley Pate, MD, Mark H. Katz, MD, David S. Wang, MD, Richard K. Babayan, MD, Shaun E.L. Wason, MD Boston University School of Medicine, Boston, MA Introduction : One in 12 patients with BPH will require surgical management. TURP is the gold standard, but new technologies may provide similar outcomes with lower complication rates. The 1470 nm diode laser is a novel technology for use in endoscopic laser enucleation of the prostate (DiLEP). There is a paucity of data comparing bipolar TURP to 1470 nm DiLEP. We compared procedure efficacy, perioperative outcomes and complication rates between B-TURP and 1470 nm DiLEP. Materials & Methods: This is an IRB-approved retrospective review of patients who underwent DiLEP (n:114; November 2016-February 2020) or TURP (n:194; January 2016-December 2018). Patients with history of prostate cancer and/or prior TURP were excluded from analysis. DiLEP was performed by a single surgeon, while TURP was performed by multiple surgeons. Prostate sizing was calculated via transabdominal ultrasound. Patient characteristics, peri-operative outcomes, treatment efficacy (Q max , PVR) and complications(Clavien-Dindo) were compared. Statistical analyses with STATA were conducted using independent Student’s t-tests, Fisher exact test, Wilcoxon rank-sum test, and Wilcoxon signed-rank test. Results: Patients undergoing DiLEP had significantly larger prostates (92 ml (65.2- 115) vs. 65(48-88), p < 0.0001 ) and a greater proportion of median lobes(77% vs.57%, p = 0.01 ; Table 2). Both groups had significant improvements in Q max and PVR from baseline at all postoperative time points (1, 3, 6 and 12 months) with no significant difference between groups at any timepoint (Figure 1). DiLEP had a greater percentage of prostate tissue resected (36%(27-47) vs. 31%(20-42), p = 0.001 ) and a shorter length of stay (16.9 hours (2.9-25) vs.27.7 hours (24-33), p < 0.0001 ), but had longer operative times (133 minutes (108-157) vs. 54 minutes (39-74), p < 0.0001 ). 53(46%) patients undergoing DiLEP were discharged from the PACU, as compared to none undergoing TURP. Catheterization times were equivalent (24.5 hours (20-64) vs. 22.1 hours (18-67), p=0.13). Postoperative and < 30-day complications were similar in both groups (Table 3), however, DiLEP had significantly fewer complications >30 days post procedure and no grade IV complications. Conclusions: DiLEPand TURPhad similar efficacy for relieving obstruction and reducing PVR, however, when compared to TURP, DiLEP had longer operative times, but a lower > 30-day complication rate and a greater percentage of prostate resected. In addition, patients undergoing DiLEP had a shorter length of stay and just under half of patients were discharged home from the recovery room. These results support the non-inferiority of DiLEP relative to TURP for the surgical treatment of BPH. AMulti-Institutional Experience Comparing Internal Urethrotomy with Intralesional Mitomycin C for Recurrent Bladder Neck Contractures in Radiated vs. Non-Radiated Patients Alexander Rozanski, MD 1 , Lawrence Zhang, BA 1 , Daniel Holst, MD 2 , Steven Copacino, BA 1 , Alex Vanni, MD 1 , Jill Buckley, MD 2 1 Lahey Hospital and Medical Center, Burlington, MA; 2 UC San Diego, San Diego, CA Introduction: We have previously published our initial and intermediate-term experience with direct visual internal urethrotomy (DVIU) and intralesional mitomycin C (MMC) for recurrent bladder neck contractures (BNC). This study highlights our continued durable results in addressing this challenging clinical problem and specifically focuses on success rates in radiated vs. non-radiated groups. Materials & Methods: A retrospective review was performed of all patients who underwent DVIU with intralesional MMC for BNC between 2007 and 2019 at two institutions. Cold knife incisions were performed in a reproducible fashion followed by injection of 0.3 to 0.4 mg/ml MMC at each incision site. Patients with evidence of complete urethral obliteration, strictures of the entire posterior urethra, or less than 3 month follow-up were excluded. Success was defined as the ability to pass a 17-French cystoscope postoperatively without the need for catheterization or dilation. Results: Atotal of 86 patients were included in our analysis. The vast majority (91%) had at least 1 prior DVIU, 55% had at least 1 prior dilation or required a specific dilation schedule, and44%presentedwithan indwellingcatheterorperformed intermittentcatheterization.At a median follow-up of 21 months, the overall success rate was 90% (65% after 1 procedure, 83%after2procedures,and90%after3ormoreprocedures).Non-radiatedpatientsshowed a significantly higher success rate compared to radiated patients (94% vs. 76%, p = 0.04) (Table 1). Of the 9 patients with cystoscopic failure, 5 had minimal urinary symptoms and pursued observation. Only 2 patients with a history of previous catheterization or urethral dilationrequiredthispostoperatively.Twopatientsunderwentsubsequenturinarydiversion. Rigorous follow-up showed no long-term overall or MMC-specific complications. Conclusions: Radical DVIU with intralesional MMC continues to prove to be a safe and durable treatment strategy for BNC from various etiologies, although success rates are exceptional in patients without a history of pelvic radiation. 22 11 Scientific Session III: BPH/Recon