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

NE AUA 2020 Abstracts The Pioneering and Diverse Contributions of Leonard N. Zinman, M.D. to Urology Marianne Casilla-Lennon, MD 1 , Stephanie Hanchuk, MD 1 , Alyssa Grimshaw, MS. 1 , Patrick Kenney, MD 1 , Alex J. Vanni, MD 2 , Jaime A. Cavallo, MD, MPHS 1 1 Yale School of Medicine, NewHaven, CT, USA; 2 Beth Israel Lahey Health, Burlington, MA, USA Introduction: Few surgeons have contributed as broadly to the field of urology as the visionary Leonard N. Zinman, M.D. We sought to chronicle the pioneering and diverse contributions of Dr. Zinman to renovascular surgery, urologic oncology, andmost notably as one of the founding fathers of reconstructive urology. Materials & Methods : A systematic literature search for the published work of Leonard N. Zinman, M.D. was performed inWeb of Science, Embase, Medline, Scopus, and Google Scholar. Data were abstracted from the literature search results. Results : After completing his urologic training at the Massachusetts General Hospital, Zinmanwasrecruited to theLaheyClinic in1964.ZinmancollaboratedwithJohnLibertino, M.D. to describe a hepatorenal arterial bypass for use in patients with renovascular hypertension for whom an aortorenal bypass was not possible. Zinman and Libertino also introduced a reversible right colocystoplasty as a capacious reservoir with an antireflux mechanism for bladder replacement.Among his landmark contributions, Zinman was the P6 first to apply the combined use of 5-fluorouracil and mitomycin with radiation therapy to the treatment of urethral squamous cell carcinoma. The Nigro chemoradiation protocol revolutionized the treatment of urethral squamous cell carcinoma from extirpative to genital-preserving therapy. Zinman pioneered the use of gracilis muscle interposition flaps in rectourethral fistula repairs, and gracilis muscle flaps as vascular beds for oral mucosa grafts in augmented urethroplasties. These innovative muscle flap applications converted previously irreparable fistulae and strictures requiring urinary diversion to reconstructable anatomy with excellent outcomes. Similarly, he significantly reduced the need for bladder neck reconstruction with the application of intralesional mitomycin C injections to endoscopic urethrotomy for recalcitrant contractures. He eliminated the need for bowel resection to procure rectal mucosa graft for urethral reconstruction by applying the transanal endoscopic microsurgery technique. He also described a novel urethral-preserving technique for the removal of Urolume stents. Zinman is a founding member of the Society of Genitourinary Reconstructive Surgeons, and is responsible for helping to define reconstructive urology as a urologic subspecialty. Conclusions : Asaurologistwithmasteryofreconstructiveskills,an innovatorwithdiverse landmark contributions to urology, and a leader who defined the field of reconstructive urology and educated generations of trainees, Leonard N. Zinman, M.D. has been one of the most valuable assets to the field of urology. Differential Expression of miRNA Involved in Biological Processes Responsible for Inflammation and Immune Response in Lichen Sclerosus Urethral Stricture Disease Harjivan S. Kohli, MD 1 , Brandon Childs, MD 1 , Travis B. Sullivan, MS 1 , Artem Shevtsov, MD 2 , Eric Burks, MD 2 , Thomas Kalantzakos, BS 1 , Kimberly Rieger-Christ, PhD 1 , Alex J. Vanni, MD 1 1 Lahey Hospital &Medical Center, Burlington, MA, USA; 2 Boston University School of Medicine, Boston, MA, USA Introduction: The pathophysiology of Lichen Sclerosus (LS) urethral stricture disease (USD) ispoorlyunderstood.MicroRNA(miRNA)arenon-codinggeneticmaterial involved in the regulation of gene expression. We sought to examine the pathophysiology of LS and non-LS USD by comparing miRNAexpression profiles in men undergoing urethroplasty. Materials &Methods: Total RNAwas extracted from formalin-fixed, paraffin-embedded tissue samples from 13 LS urethral strictures and 13 non-LS urethral strictures collected from 2005-2017. The pathologic evaluation of strictures were based on histologic features considered diagnostic of LS. Representative portions of the FFPE block containing diagnostic areas foci of LS or non-LS strictures were selected by the pathologist for molecular evaluation. Each of these samples was profiled via miRNART-qPCR arrays for 752 unique miRNA. Statistical analyses were performed using SPSS v25. Gene Ontology (GO) analysis was performed using DIANA-mirPath v. 3.0. Results: There were no significant differences regarding patient age, BMI, smoking history, or medical comorbidities between the LS vs. non-LS groups. Of the 143 miRNA detected for all samples, 27 were differentially expressed between the groups (false discovery p-value < 0.01). 15 of these miRNA each achieved an area under the curve (AUC) > 0.90 for discriminating between LS and non-LS strictures. MiR-155-5p specifically was found to be upregulated by 11 fold in LS vs. non-LS strictures (p < 0.001, AUC = 1.0). Conclusions: To our knowledge this is a novel investigation into the pathophysiology of LS USD; no existing studies have evaluated the miRNA expression profiles in LS and non-LS USD. We have identified 18 distinct miRNAthat differentiate USD caused by LS vs. other etiologies. The top eight differentially expressedmiRNAhave been linked to immune response processes as well as involvement in wound healing, primarily angiogenesis and fibrosis. Our models demonstrate excellent predictive value for distinguishing LS vs. non-LS USD samples and the differentially expressed miRNA identified in this study could potentially serve as biomarkers of LS. *Max K. Willscher Award Eligible P7* Urolithiasis Management in the Early 1900s: Howard A. Kelly and the Wax-Tipped Ureteral Catheter Timothy K. O’Rourke, Jr., MD 1 , Marc A. Lavine, MD 2 , Anthony A. Caldamone, MD 1 1 Brown University/Rhode Island Hospital, Providence, RI, USA; 2 Jefferson Health, Philadelphia, PA, USA Introduction: Diagnosis of ureteral and renal calculi was revolutionized with medical implementation of X-ray in the early decades of the 1900s. Diagnosis of urolithiases prior to X-ray was largely based on history and physical exam. Given the invasive nature of “cutting for stone” at that time, innovations aimed at improving diagnostic precision were needed. Dr. HowardAtwood Kelly, a gynecologist andmember of the “Big Four” founders of the Johns Hopkins Hospital in Baltimore, Maryland alongwithWilliamHalsted, William Welch, andWilliamOsler is known for many contributions to surgery.Among some of his perhaps lesser known contributions include aerocystoscopy and ureteral catheterization utilizing wax-tipped catheters to improve the diagnosis of ureteral and renal stones in the late 19 th century. His innovation in ureteral catheterization revolutionized the diagnosis of nephrolithiasis. Materials & Methods: Historical textbooks and manuscripts were reviewed in an effort to characterize methods of diagnosing ureteral and renal calculi in the late 1800s and early 1900s with specific interest in Howard A. Kelly and the wax-tip catheter utilized for such purposes. Results: Multiple references including those from Hugh Hampton Young, Guy LeRoy Hunner, Howard A. Kelly, and others were identified and reviewed to characterize early practice in wax-tip ureteral catheterization. The technique involved the creation of a “wax tip” associated with a silk renal catheter or rubber bougie, used to catheterize a ureter. Various methodologies were utilized to create the wax mixture. Dr. Young utilized “ordinary embedding paraffin,” while Dr. Hunner, a colleague at Hopkins, utilized beeswax. Dr. Kelly reportedly utilized a mixture including dental wax and olive oil. The bladder, instilled with air, was inspected cystoscopically with direct visualization of the ureteral orifices. The wax-tipped catheters were passed proximally, twirled, removed, and closely inspected for scratch marks or defects suggestive of contact with a hard surface, that is, a stone. Occasionally stone fragments would become embedded in the wax—thus the procedure could potentially serve therapeutic purposes. Conclusions: Although diagnosis of urolithiasis has been revolutionized by advanced imaging techniques including X-ray, computed tomography, and ultrasound, early innovations utilizing a wax-tip catheter were a significant advancement in management of nephrolithiasis in the 1890s and early 1900s. In 1926 Dr. Hugh H. Young commented on the importance of this innovation stating that with the diagnostic combination of X-ray and wax-tip ureteral catheterization “exploratory operations for kidney stone have become almost curiosities if not disgraceful.” Urologists have been known for decades to be on the forefront of surgical technology and innovation. Important discoveries such as the wax-tip catheter are not only of historical interest but inspirational to those walking in the footsteps of the giants that came before. P5 Poster Session I 33