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

© The Canadian Journal of Urology TM : International Supplement, August 2020 Conservative Management of Lichen Sclerosus-induced Male Urethral Strictures: Can Urethral Reconstruction be Safely Avoided? Alexander Rozanski, MD, Lawrence Zhang, BA , Steven Copacino, BA, Alex Vanni, MD Lahey Hospital and Medical Center, Burlington, MA Introduction: Lichensclerosus-inducedurethralstricturedisease(LS-USD)createssurgical challenges for the reconstructive urologist due to the high risk of stricture recurrence and disease progression. We reviewed the outcomes of such patients at our institution to determine if conservative management can be an effective strategy. Materials & Methods: We retrospectively identified patients with LS-USD who were managed with urethral balloon dilation or clean intermittent catheterization (CIC) +/- intraurethral steroids. Any patient who had an obliterative stricture, underwent urethral reconstruction as the primary means of USD treatment, or had less than 3 months follow-up was excluded. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, and uroflowmetry values. Secondary outcome measures were Sexual Health Inventory for Men (SHIM) andMale Sexual Health Questionnaire (MSHQ) scores. Results: A total of 109 men met inclusion criteria between 2005-2019 with a median follow-up of 24 months (IQR 8-49). Median age was 52.2 years, body mass index was 35.5 kg/m 2 , and Charlson comorbidity index was 1. Median stricture length on retrograde urethrogramwas 10 cm (IQR 2-20). Stricture locationwas: meatus/fossa navicularis (33%), pendulous (9%), and bulbopendulous (58%). The most common urinary symptoms were slow flow (50%), sitting to void (25%), and spraying (23%). A total of 77 (71%) patients underwent subsequent urethral dilation. Median number of dilations per patient was 1 (IQR 1-3). CICwas utilized in 32% of patients, with 32% of this subgroup applying steroids intraurethrally via CIC. Uroflowmetry values and sexual health questionnaires showed no significant change between first and last visits (Table 1). Median serum creatinine at first and last visits remained unchanged at 1.0 mg/dL. Eight (7%) patients had an AUR episode requiring urgent treatment and 20 (18%) had a stricture-related UTI. Conclusions: Althoughcertainpatientswilldesireorrequireurethralreconstruction,many patients with LS-USD, across a wide range of stricture lengths and locations, appear to be safely managedwith urethral dilation or CIC +/- intraurethral steroids. Close observation is warranted due to the risk of stricture-related UTIs and AUR episodes. 26 AValidation Study of a Simplified Acquired Buried Penis Repair Classification System: Perioperative Complications and Outcomes Alexander Rozanski, MD, Lawrence Zhang, BA , Jaime Cavallo, MD, Alex Vanni, MD Lahey Hospital and Medical Center, Burlington, MA Introduction: A recently published buried penis repair classification system has been proposed to better predict perioperative complications and outcomes (Pariser et al, 2018). Our objective was to validate this classification system at our reconstructive center and assess its utility in predicting patient outcomes. Materials & Methods: Patients who underwent buried penis repair by a single surgeon between January 2012-December 2018 were included. The proposed classification system is as follows: Category I - penile unburying with local skin flap; II - skin graft; III - scrotal surgery; IV - escutcheonectomy; V - abdominal panniculectomy. High complexity was defined as category III or higher. Perioperative 90-day Clavien-Dindo complications were assessed. Failure was defined as the need for additional unburying surgery. Results: Fifty patients underwent repair with 88% considered highly complex. Median body mass index (BMI) was significantly higher in the high complexity group (41 vs. 33 kg/m2, p = 0.004). Thirteen (26%) patients had urethral strictures with no association to surgical complexity (p = 0.17). In the high complexity group, 3 (7%) patients had high grade complications (Clavien ≥ 3). There were zero complications, low or high grade, in the low complexity group. At a median follow-up of 10.4 months, successful repair was achieved in 90%. All failures occurred in the high complexity group. Conclusions: Utilizing this classification system as a predictor of perioperative outcomes, our study validates the pilot study findings. Patients requiring high complexity repairs have a higher BMI. High grade complications and failures only occurred in the high complexity group. Further multi-institutional studies should be pursued to assess this classification system and to refine important clinical variables and operative techniques to maximize patient goals and predict patient outcomes. Real-world Evidence with the Prostatic Urethral Lift and Rezum: a Retrospective Cohort Study on the Efficacy and Durability in 12-month Clinical Outcomes Mustufa Babar, BS , Matthew Ines, BS, Sandeep Singh, BS, Nazifa Iqbal, BA, Michael Ciatto, MD DSS Urology, Queens Village, NY Introduction: TheProstaticUrethralLift(PUL)andRez ū mareattractiveminimally invasive treatment options for patients with lower urinary tract symptoms (LUTS) secondary to benignprostatichyperplasia.PULreliesonamechanicalapproach,using implants tocreate a continuous channel between the prostate’s lateral lobes, while Rez ū m relies on convective water vapor thermal energy to ablate the prostate’s lateral and medial lobes. We report the first study analyzing 12-month real-world clinical outcomes between PUL and Rez ū m. Materials &Methods: Clinical outcomes for the PULgroupwere obtained frompublished retrospective literature while those for the Rez ū m group were obtained by conducting a retrospective study. International Prostate SymptomScore (IPSS) andQuality of Life (QoL) were assessed at 1-, 3-, 6-, and 12-month while maximumflow rate (Qmax) was assessed at 3-, 6-, and 12-month. Statistically significant differences between groups and frombaseline to follow-up were determined using a two-sample t-test and paired t-test, respectively. Results: A total of 1413 patients were included in the PUL group and 219 patients were included in the Rez ū m group. The PULgroup had a higher mean baseline age (70.0 years), IPSS (19.0 points), Qmax (13.0 mL/s), and PVR (135.0 mL) when compared to the Rez ū m group (63.3 years, 17.2 points, 11.5 mL/s, 29.2 mL, P < 0.05). The Rez ū m group had a higher mean baseline QoL (4.3 points) when compared to the PUL group (4.0 points, P < 0.01). There were no significant differences in mean baseline prostate volume and PSA between the groups. Both groups saw significant improvements in IPSS and QoL as early as 1-month which remained durable to 12-month (P < 0.01). At 1-month, the PUL group saw rapid percent changes in IPSS (-39%) and QoL(-43%) withmaximumpercent changes achieved at 3-month (-42%, -45%). The Rez ū m group saw gradual improvements in IPSS and QoL with maximum percent changes in IPSS (-37%) and QoL (-44%) achieved at 6- and 12-month, respectively. Improvements in Qmax were durable to 12-month in the Rez ū m group (P < 0.01) and to 6-month in the PUL group (P = 0.03). Maximum percent change in Qmax was seen at 3-month for the Rez ū m group (117%) and at 6-month for the PUL group (36%). Conclusions: Real-world application of PULand Rez ū m showed significant and durable improvements in LUTS and QoLup to 12 months. PULdemonstrated rapid relief in LUTS with maximum improvements achieved in 3 months while Rez ū m yielded gradual relief with maximum improvements achieved in 6 months, suggesting that cell necrosis from water vapor treatments with Rez ū m requires a longer healing period. However, Rez ū m demonstrated greater and more durable improvements in flow rates. 25 24 12 Scientific Session III: BPH/Recon