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

© The Canadian Journal of Urology TM : International Supplement, August 2020 Scientific Session I: Oncology I Computer Generated vs. Human Generated R.E.N.A.L Nephrometry Score to Predict Surgical Outcomes in Renal Cell Carcinoma Zach Edgerton, MD University of Minnesota Medical School, Minneapolis, MN Introduction: R.E.N.A.L. nephrometry score is associated with pathological outcomes, complication rates and survival. Despite its success, widespread uptake has been limited by interobserver variability and time investment to generate scores. We developed an algorithm to produce a computer generated (CG) RENAL score, and compared this with human generated (HG) scores to predict RCC, high grade (Fuhrman 3-4), high stage (pT3-4) and tumor necrosis. Materials & Methods: Retrospective review of 544 patients undergoing nephrectomy following CT for suspected RCC from 2010-2018. After manually delineating tumors on CT using an internally-made application, we developed an algorithm to automatically generate each RENAL score component. Each tumor was also manually, independently scored by one of five medical professionals. We used ROC curve analysis to quantify the discriminative ability of HG and CG RENAL scores. Results: CT imaging was available for 195 patients. 183 (94%) had malignant tumors. Interobserver agreement between CG and HG RENAL scores was significant, but slight (kappa = 0.32, p < 0.001). However, CG score had good discriminative ability for cancer (AUC 0.76), greater than HG (0.67). CG (0.59) and HG (0.62) scores were comparable for high grade, whilst HG score (0.80) outperformed CG (0.62) scores for high stage. HG (0.74) also outperformed CG (0.63) score for tumor necrosis. Conclusions: CG RENAL scores demonstrate significant agreement with HG RENAL scores and have similar ability to predict clinically important pathologic outcomes. These are promising results and, with further refinement, automated RENALscores may be more reliable, cheaper, faster and potentially supersede human RENAL scoring in predicting post-operative outcomes. 8 Robot-Assisted Laparoscopic Transdiaphragmatic Right Adrenalectomy Robin Djang, MD , John Seigne, BCh, David Finley, MD Dartmouth Hitchcock Medical Center, Lebanon, NH Introduction: Multiple surgical approaches are available for consideration when an adrenalectomy is indicated by either open or laparoscopic means. We offer a video demonstration of a less utilized approach - a transdiaphragmatic adrenalectomy from a right sided approach with robotic assistance. Materials & Methods: A 78 year-old male patient was found to have a solitary, biopsy-proven renal cancer metastasis to the right adrenal gland approximately nine years following right radical nephrectomy for T1bN0M0 grade 2 clear cell RCC. In the interim, he had undergone a large ventral hernia repair with placement of a large piece of intraabdominal mesh. Given the concerns for a hostile abdomen and retroperitoneum, the patient underwent a right sided adrenalectomy via a transdiaphragmatic approach with robotic assistance. Results: The accompanying video illustrates the following principles; #1: Appropriate considerationofthevarioussurgicalapproachesforan indicatedadrenalectomy;#2:Patient positioning and port placement considerations; #3: Collaboration with anesthesiologists and thoracic surgeons comfortable with robotic surgical approaches; #4: The use of intraoperative ultrasound in guiding the surgical plan; #5: Consideration of the various helpful anatomic landmarks in the course of a transdiaphragmatic approach. Conclusions: The accompanying video illustrates the principles and considerations for a robotic-assisted laparoscopic transdiaphragmatic approach to a right-sided adrenalectomy. Collaboration with thoracic surgery colleagues as well as a thorough understanding of the thoracic and retroperitoneal anatomy is crucial to success in this less utilized approach. Long TermOutcomes of Organ Sparing Surgery for Penile Cancer at a Single Institution Yefri A. Baez, BA 1 , Emily J. Ji, BA 1 , Alberto C. Pieretti, MD 1 , Nicole Kim, Jeffrey K. Twum-Ampofo, MD 1 , Andrew Gusev, BA 1 , Carl A. Ceraolo, MS 1 , W. Scott McDougal, MD 1 , Adam S. Feldman, MD, MPH 1 1 Massachusetts General Hospital, Boston, MA, 2 Harvard University, Boston, MA Introduction: Organ sparing surgery (OSS) for penile cancer has been shown to be a viable option for low-stage disease. However, recurrence rates are higher than non-OSS approaches, and there is limited long term follow-up within the literature. The objective of our study is to report our single institution experience with OSS for squamous cell carcinoma (SCC) of the penis over the last 26 years. Materials & Methods: The charts of all patients at our institution undergoing OSS for penile SCC from 1993 to 2019 were retrospectively reviewed. Kaplan-Meier survival time to event analysis was conducted for recurrence. Patient and tumor characteristics were compared based on recurrence using bivariate analysis, and a Cox-proportional hazard model was used for survival analysis of time to event of recurrence. Model covariates included disease stage, tumor grade, presence of lymphovascular invasion, tumor size, age at diagnosis, and HPV status. Results: 99 patients underwent OSS. Mean follow up was 54.9 months. Overall rate of recurrence was 30%. On a Kaplan-Meier analysis, T1 disease had a significantly higher rate of recurrence than Tis (47% vs. 24%, p = 0.014, fig. 1). On multivariate analysis, positive HPV status was the only predictor of disease recurrence (OR 5.50 [CI 1.06-28.4], p = 0.042). OSS patients underwent an average of 2.23 procedures.Approximately 85% of recurrences occurred in the first 5 years, with 60% occurring in the first 2 years (fig. 2). 11 patients (11.1%) progressed to partial penectomy with an average time to progression of 40 months. Only 1 patient (< 1%) progressed to total penectomy after 41 months. Conclusions: Patients with T1 disease have a higher rate of recurrence compared to Tis. Positive HPV status is correlatedwith a higher risk of recurrence after OSS. Patients should be followed closely within the first 2 years of OSS with a minimum overall follow-up of 5 years. Patients undergoing OSS should be counseled preoperatively regarding possible additional procedures with an 11% progression rate to partial penectomy and a < 1% progression rate to total penectomy. 9 7 4