History Of Pelvic Irradiation Research Articles

Does the suturing technique (barbed continuous versus conventional interrupted) impact the outcome of anastomotic urethroplasty?

To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2years and the mean stricture length was 19.3mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7min and 9.9 ± 1.6 vs. 15.8 ± 1.9min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.

Skin preparation before artificial urinary sphincter surgery: is there a difference between protocols?

Artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence (SUI). This study aims to evaluate the interest of a new cutaneous preparation regarding the risk of early device infection. A retrospective review of medical records has been built with all patients who underwent an AUS, implanted by experienced surgeons, between January 2010 and January 2023. Before January 2015, all AUS received a standard protocol (SP) of cutaneous cleansing with soap povidone iodine and disinfection with alcoholic povidone iodine. After January 2015, all AUS received the new protocol (NP) with two cleansings with soap povidone iodine and two disinfections with alcoholic povidone iodine. The primary focus was to compare the risk of early device infection between the two protocols. Multivariate analyses were done with several risk factors such as age, diabetes, underlying pathology (prostate cancer surgery, surgical treatment of benign prostatic hyperplasia or others), past history of pelvic radiation therapy and past AUS implantation. One hundred and fifty-six cases were enrolled, with 34 following the SP and 122 following the NP. In the univariate analysis, there were 15 explantations in the SP arm versus 8 for the NP arm due to infection (45.5% vs. 25%, P=0.09). The was no difference between the NP and the SP in multiparametric analysis [odds ratio (OR): 0.97; P=0.96]. No other risk factors were associated with increased risk of AUS removal. Our study showed no correlation between the two types of skin preparation and the risk of AUS removal or revision. Future studies are needed to highlight the legitimate risk factors.

Eficacia y seguridad del balón de dilatación uretral Optilume® en la práctica clínica real: análisis multicéntrico en España

IntroductionThe Optilume® paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. ObjectiveTo describe the success rate and analyze the safety of the device in real clinical practice. To evaluate possible predictors of treatment failure. Material and methodsRetrospective multicenter study in patients diagnosed with urethral stricture and treated with an Optilume® balloon in routine clinical practice. Data were collected from flowmetry, questionnaires (PROM and IPSS) and cystoscopy before surgery, and 3, 6 and 12 months after the procedure, according to standard practice. Surgical success was defined as the absence of subsequent urethral manipulation and a Qmax>10ml/s. Results238 patients treated with Optilume® in 12 Spanish hospitals between May 2021 and April 2024 were included in the study. Of these, 156 who had a minimum follow-up of 3 months, were analyzed. Median stricture length: 1.5cm (0.5 - 5.3), mainly in bulbar urethra (87.7%). Of the total, 12.8% of patients had a history of pelvic radiotherapy, and 81.4% had undergone prior urethral manipulation. Postoperative complications were reported in 14.2% of the total. The treatment success rate was 73.8%, with a median follow-up of 8 months (5-12). No predictors of stricture recurrence were identified. Recurrence rates were higher in strictures located in the posterior versus anterior urethra (42.9% vs. 24.6%, p=0.126). No significant differences were observed between patients with and without prior urethral manipulation. ConclusionTreatment with Optilume® has been shown to be safe and effective in short-term routine clinical practice.

Efficacy and safety of Optilume® paclitaxel-coated urethral dilatation balloon in real-life: experience in a Spanish multicenter study

IntroductionThe Optilume® Paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. ObjectiveTo describe the success rate and analyze the safety of the device in real clinical practice. To evaluate possible predictors of treatment failure. Materials and methodsRetrospective multicenter study in patients diagnosed with urethral stricture and treated with an Optilume® balloon in routine clinical practice. Data were collected from flowmetry, questionnaires (PROM and IPSS) and cystoscopy before surgery, and 3, 6 and 12 months after the procedure, according to standard practice. Surgical success was defined as the absence of subsequent urethral manipulation and a Qmax >10 ml/s. Results238 patients treated with Optilume® in 12 Spanish hospitals between May 2021 and April 2024 were included in the study. Of these, 156 who had a minimum follow-up of 3 months, were analyzed. Median stricture length: 1.5 cm (0.5–5.3), mainly in bulbar urethra (87.7%). Of the total, 12.8% of patients had a history of pelvic radiotherapy, and 81.4% had undergone prior urethral manipulation. Postoperative complications were reported in 14.2% of the total. The treatment success rate was 73.8%, with a median follow-up of 8 months (5–12). No predictors of stricture recurrence were identified. Recurrence rates were higher in strictures located in the posterior versus anterior urethra (42.9% vs. 24.6%, p = 0.126). No significant differences were observed between patients with and without prior urethral manipulation. ConclusionTreatment with Optilume® has been shown to be safe and effective in short-term routine clinical practice.

A novel clinical classification for male urinary incontinence: MI-CRONS

Introduction:The aim of this study is to develop a new simple and practical classification of male urinary incontinence (UI) based on the clinical features and type of urinary incontinence. Materials & methods:MI-CRONS classification is a system based on severity of incontinence and patients’ characteristics. Clinical evaluation of incontinence severity is based on preservation of voiding, proportion of void/lost urine, absorbable device usage, level of physical efforts that causes urine loss and nocturnal incontinence. Following patients’ characteristics of patients were included in classification system: history of radical prostatectomy, history of pelvic radiation, surgery for prostatic obstruction, neurogenic or non-neurogenic bladder disorders, and urethral strictures and disorders. This MI-CRONS classification system uses five uppercase Latin letters as follows: Male Incontinence — Cancer, Radiation, Obstruction, Neurogenic, Stricture. The classification could be used for stress, urgency, and mixed UI forms. Results:The new MI-CRONS classification system was applied to 85 of 86 patients evaluated in this retrospective study. Patients were classified by MI-CRONS to estimate an inclusiveness and complicity of proposed classification only. One patient was not classified using the new MI-CRONS classification due to history of bladder exstrophy and augmentation cystoplasty. Most of the men studied had a stress form of urinary incontinence and the most common types were 2 (n = 18) and 3 (n = 17) after radical prostatectomy. Conclusion:The MI-CRONS has demonstrated prompt potential for classifying male incontinence of any type. The classification is a simple tool to describe these patients and could be useful for daily practice and clinical trials. Although further multicenter studies are needed to evaluate the predictive value of this tool. A Delphi consensus would be proposed with international experts for the further development of MI-CRONS.

Pompe and Circumstance: A Cautionary Tale of Anchoring Bias and Delayed Diagnosis of Late-onset Pompe Disease in a Patient with a History of Pelvic Radiation (P11-11.006)

Pompe and Circumstance: A Cautionary Tale of Anchoring Bias and Delayed Diagnosis of Late-onset Pompe Disease in a Patient with a History of Pelvic Radiation (P11-11.006)

Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran.

Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.

(161) Is there a Difference in Inflatable Penile Prosthesis Mechanical Failure and Infections Rates in Relation to Prostate Cancer Treatment Modality (Radiation Therapy vs Radical Prostatectomy)

Abstract Introduction Inflatable Penile Prosthesis (IPP) implantation as a treatment for ED has high satisfaction rates in the general population; however, there is limited literature on quantification of complication rates as stratified by ED etiology. Objective Our aim was to compare mechanical failure and infection rates in patients undergoing IPP implantation for ED following Radical Prostatectomy (RP) versus radiation therapy (RT) for prostate cancer. Methods A retrospective chart review from our institutional database was conducted to identify 405 patients who underwent IPP placement at our institution from 2015–2019, then selecting for those whose etiology of ED was following RP or RT. To prevent crossover confounding; patients with history of pelvic radiation or salvage radiotherapy were excluded from the RP group and patients with history of RP were excluded from the RT group. Data was obtained from 75 patients who met criteria for inclusion: 44 patients in the RP group and 31 patients in the RT group. Mechanical failure, infection rates, mean EDITS scores and additional survey questions were compared between the radiation and RP groups. Results Patient demographic information and IPP complication and satisfaction rates are listed below in Table 1 and Figure 1. There was a statistically significant difference in number of patients experiencing IPP complications, 19.4% (n=6) of patients in the RT cohort and 4.5% (n=2) in the RP cohort, respectively. There was no statistically significant difference found in stratified complications- infection rates, device erosion rates, mechanical failure rates, or device removal and/or replacement rates between the two groups. The RP cohort had a significantly higher mean Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire score versus the RT cohort, 91.58 to 76.02, respectively. Conclusions These preliminary findings, while requiring large-scale follow up, suggest that there is a higher rate of IPP related complications in patients with device placement following RT for prostate cancer versus RP. Disclosure No.

(157) Prescribing Ozempic and Wegovy for Weight Loss is Associated with an Increased Risk of Erectile Dysfunction and Hypogonadism in Non-Diabetic Males

Abstract Introduction The use of antidiabetic medications, such as metformin or sulfonylureas, can have diverse effects on sex hormones, potentially influencing erectile function. While both Ozempic and Wegovy (semaglutide) include sexual dysfunction as a side effect of the medication, no study has assessed how frequently men will experience sexual dysfunction with these medications. Recently, semaglutide was approved in June of 2021 for weight loss in non-diabetic patients and has exploded in popularity. Objective Our objective is to assess the risk of developing ED in non-diabetic males after starting semaglutide using a large claims-based database. Methods We queried the TriNetX Research database, a comprehensive insurance claims database. Our study cohort included males aged 18 to 50 who have been prescribed semaglutide after June 1st, 2021. We excluded individuals with a history of pelvic radiation, prostatectomy, pulmonary hypertension, diabetes mellitus, or any hemoglobin A1c measurement ≥7%. Propensity-matching was performed between the cohorts for age, ethnicity, race, BMI, hypertension, sleep apnea, and hyperlipidemia. Our primary outcome was comparing the proportion of men that received an ED diagnosis and/or prescription for phosphodiesterase-5 inhibitors (PDE5i) from one day to any time after the index prescription of semaglutide. The secondary outcome of interest included the risk of developing testosterone deficiency. Risk was reported using relative risk (RR) with 95% confidence intervals (CI). Statistical significance was set using a two-sided alpha at 0.05. Results We found 2,117 non-diabetic males with a prescription of semaglutide, which were compared to an equivalent number of propensity matched controls (Table 1). Compared to matched controls, males with a semaglutide prescription were significantly more likely to be diagnosed with ED and/or prescribed PDE5i (1.4%) when compared to control males who were never prescribed semaglutide (0.14%) (RR: 10.0, 95% CI [3.05 – 32.82]). Similarly, males with a prescription for semaglutide were more likely to receive a subsequent diagnose of testosterone deficiency (3.83%) compared to controls (1.7%), (RR: 2.25, 95% CI [1.53 – 3.32]) from one day to any time after the index prescription. Conclusions In this claims-based analysis, we found that non-diabetic males with a prescription of semaglutide have a significantly higher risk of developing ED and testosterone deficiency. Rates of erectile dysfunction in men prescribed semaglutide are overall low at 1.4% but, we were surprised that these rates were so much higher than those not receiving semaglutide as we expected that weight loss drugs would improve erectile function. Further studies are needed to assess the impact of semaglutide in non-diabetic men to assess how this drug impacts the male hypothalamic-pituitary-gonadal axis. Despite its increasing popularity for weight loss, both clinicians and patients should be aware of potential hormonal effects when discussing and considering the medication. Disclosure No.

Longitudinal deterioration in lower urinary tract symptoms after artificial urinary sphincter implantation in patients with a history of pelvic radiation therapy.

To evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non-irradiated patients. This retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non-RT group, respectively) who were treated with primary AUS implantation for post-radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model. In the RT and non-RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow-up of 38 months, ICIQ-SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non-RT groups. In the RT group, ICIQ-SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non-RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ-SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non-RT group (p < .001, and .015, respectively). Longitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.

Diagnostic value of repeated comprehensive investigation with CT urography and cystoscopy for recurrent macroscopic haematuria.

To perform a descriptive analysis of a series of patients with recurrent macroscopic haematuria after a primary standard evaluation including computed tomography urography (CTU) and cystoscopy negative for urinary bladder cancer (UBC) and upper tract urothelial cancer (UTUC) and to identify potential factors associated with occurrence of recurrent macroscopic haematuria. All patients older than 50 years who underwent urological investigation for macroscopic haematuria with both cystoscopy and CTU 2015-2017 were retrospectively reviewed. A descriptive analysis of the primary and later investigations for recurrent macroscopic haematuria was performed. To investigate the association between explanatory variables and the occurrence of recurrent macroscopic haematuria, a Poisson regression analysis was performed. A total of 1395 eligible individuals with primary standard investigation negative for UBC and UTUC were included. During a median follow-up of 6.2 (IQR 5.3-7) years, 248 (18%) patients had recurrent macroscopic haematuria, of whom six patients were diagnosed with UBC, two with prostate cancer, one with renal cell carcinoma and one had a suspected UTUC at the repeated investigation. Within 3 years, 148 patients (11%) experienced recurrent macroscopic haematuria, of whom two patients were diagnosed with low-grade UBC (TaG1-2), one with T2G3 UBC and one with low-risk prostate cancer. The presence of an indwelling catheter, use of antithrombotic medication, pathological findings at CTU or cystoscopy or history of pelvic radiotherapy were all statistically significant independent predictors for increased risk for recurrent macroscopic haematuria. In the case of recurrent macroscopic haematuria within 3 years of primary standard evaluation for urinary tract cancer, there was a low risk of later urological malignancies in patients initially negative for UBC and UTUC. Therefore, waiting 3 years before conducting another complete investigation in cases of recurrent macroscopic haematuria might be appropriate.

Nomogram for predicting adhesive small bowel obstruction following emergency gastrointestinal surgery.

Postoperative adhesions are frequent and significant complications that typically arise following abdominal surgery. Currently, the existing evidence for predicting the risk of adhesive small bowel obstruction (ASBO) after emergency gastrointestinal surgery (EGS) remains inadequate. A reliable perioperative model that quantifies the risk of ASBO after EGS serves as a practical tool for guiding individually tailored surveillance. A consecutive series of 1296 patients who underwent EGS for radiologically confirmed bowel/visceral inflammation or perforation between 2012 and 2022 at a tertiary academic medical center were included in this study to establish a best-fit nomogram. The nomogram was externally validated by assessing discrimination and calibration using an independent cohort from a separate medical center. A total of 116 patients (8.9%) developed at least one episode of ASBO after EGS during a median follow-up duration of 26months. The results of multivariable logistic analysis indicated that male sex (P = 0.043), preoperative albumin level (P = 0.002), history of pelvic radiotherapy (P = 0.038), laparotomy (P = 0.044), and intensive care unit stay ≥ 72h (P = 0.047) were identified as independent risk factors for developing ASBO. By incorporating these predictors, the developed nomogram exhibited good accuracy in risk estimation, as evidenced by a guide-corrected C-index score of 0.852 (95% CI 0.667-0.920) in the external validation cohort. Decision curve analysis and clinical impact curve demonstrated a clinically effective predictive model. By incorporating the nomogram as a supplemental tool in perioperative management, it becomes possible to accurately assess the individual's likelihood of developing ASBOs. This quantification enables surgeons to implement appropriate preventive measures, ultimately leading to improved outcomes.

Urethral Slings for Irradiated Patients With Male Stress Urinary Incontinence: A Meta-analysis

To systematically compare success, cure and complication rates of urethral sling surgeries in stress urinary incontinence patients with and without a history of pelvic radiotherapy (RT). We searched PUBMED, EMBASE, and Web of Science to identify relevant articles. The primary outcomes were the success and cure rates. The secondary outcomes included the rates of infection, urethral erosion, total complications, explantation, and satisfaction. Outcomes were analyzed using a random-effects model to calculate the unadjusted odds ratio (OR) in patients with a history of RT compared with those without prior RT. On pooled analysis, we found significantly lower odds of success (OR 0.68; 95% confidence interval [CI] 0.53-0.87, P<.001) and cure (OR 0.67; 95% CI 0.55-0.82, P<.001) in radiated patients than in nonirradiated patients. Subgroup analysis by type of sling showed significantly lower odds of success in Advance subgroup (OR 0.66; 95% CI 0.45-0.95, P<.001) and significantly lower odds of cure in Advance (OR 0.59; 95% CI 0.36-0.95, P<.001) and Atoms subgroups (OR 0.70; 95% CI 0.54-0.93, P<.001). We also found significantly greater odds of sling explantation (OR 2.93; 95% CI 1.62-5.29, P<.001) and infection (OR 3.06, 95% CI 1.03-9.07, P<.001) in radiated patients than in nonradiated patients. Patients with a history of pelvic RT have lower odds of success and cure and higher odds of infection and sling explantation than those without a history of pelvic RT.

Decision-making for Subsequent Therapy for Patients With Recurrent or Advanced Endometrial Cancer Based on the Platinum-free Interval.

The aim of this study was to evaluate the progression-free survival (PFS) and overall response rate (ORR) of patients with recurrent endometrial cancer (REC) or advanced endometrial cancer (AEC) retreated with platinum-containing chemotherapy (PCC) based on the platinum-free interval (PFI). We compared our results with those reported in the KEYNOTE-775 study (that used pembrolizumab plus lenvatinib). A retrospective analysis was conducted of 65 patients with REC or AEC retreated with PCC between 2005 and 2020 at our hospital. Various clinicopathologic variables were analyzed: (1) age, (2) performance status, (3) histology, (4) history of pelvic irradiation in the adjuvant setting, (5) PFI, (6) chemotherapy regimen, (7) PFS and overall survival after retreatment with PCC, and (8) best ORR. Survival analyses were performed using Kaplan-Meier curves and log-rank tests. The best ORR and PFS were 43.3% and 9.5 months, respectively, in patients with REC/AEC with a PFI ≥6 months. These results were comparable with those of patients treated with pembrolizumab and lenvatinib. The best ORR and PFS of patients with a PFI of <6 months appeared to be inferior to those of patients treated with pembrolizumab plus lenvatinib. Pembrolizumab plus lenvatinib seems to be a better treatment choice for patients with REC or AEC with a PFI of <6 months. For a PFI of ≥6 months, pembrolizumab plus lenvatinib or PCC can be used depending on the degree of residual side -effects associated with cytotoxic agents.

(415) Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Prostate Cancer Radiation Therapy versus Radical Prostatectomy or Radical Cystoprostatectomy

Abstract Introduction Penile Prosthesis Surgery (PPS) is a commonly used treatment for Erectile Dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with urologic malignancies, such as prostate or bladder cancer, surgical interventions like radical prostatectomy (RP) and radical cystoprostatectomy (RCP) as well as alternative treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. There is limited data available on sexual satisfaction in patients with prosthesis implantation for ED following RP/RCP versus ED following radiation therapy for prostate cancer. Objective The primary objective for our study was to determine if there is a significant difference in device and sexual satisfaction rates between patients receiving PPS for ED post-RP/RCP versus post-prostate cancer radiation therapy quantified via a validated questionnaire. Methods A retrospective chart review from our institutional database was conducted to identify 970 patients who underwent PPS at our institution from 2011 to 2021. Only patients that had Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available were included. Eligible patients were screened and placed in one of two groups depending on etiology of ED- following RP/RCP or following prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP/RCP group and patients with history of RP/RCP were excluded from the radiation group. Data was obtained from 73 patients in the RP/RCP group (RP=66, RCP=7) and 32 patients in the radiation therapy group (Extended Beam Radiation Therapy (EBRT) = 26, Brachytherapy=6). Demographics, surgical information, etiology of ED, and penile doppler results were recorded for both groups. EDITS questionnaire responses were compared between the two groups as a measurement of device and sexual satisfaction. Additional subgroup analysis was conducted between RP and RCP patients. P&amp;lt;0.05 was statistically significant. Results There was a significant difference in mean survey responses for all 11 questions in the EDITS questionnaire between the RP/RCP group and the radiation group. Specifically, the RP/RCP group had a significantly higher mean score in questions surveying overall satisfaction (p=0.01), level to which device has met their expectations (p=0.03), as well as confidence in engaging in sexual activity with their partner (p&amp;lt;0.001). Additional survey questions administered also found RP/RCP patients reported significantly higher rate of satisfaction with size of penis post-operatively versus the radiation group (p=0.01). Subgroup analysis found no difference in satisfaction (p=0.16), device expectations (p=0.37), or confidence in engaging in sexual activity (p=0.82) between the RP and RCP groups. Conclusions These preliminary findings, while requiring large-scale follow up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP/RCP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following penile prosthesis placement. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Run Wang, MD, FACS is a consultant for Boston Scientific, Coloplast, and Teleflex.

Complicated Diverticulitis and Pelvic Radiation Leading to Colonic Stricture, Colorectal Fistula, and Anal Stenosis.

The purpose of this case is to highlight a rare case of sigmoid colon-to-rectum fistula. A 66-year-old man with a history of pelvic radiation and diverticulosis presented to the emergency department with a 3-week history of abdominal pain and watery diarrhea. Computed tomography (CT) imaging was significant for a sigmoid-to-rectum fistula with sigmoid stricture. The patient underwent a laparoscopic colectomy with end colostomy. Pathology revealed perforated diverticulitis. To date, there have been no cases reported in literature describing sigmoid-to-rectum fistula. In conclusion, it is important to consider the development of complex diverticular disease in patients with history of pelvic radiation.

Destroyed bladders: Characterization of progressive inflammatory cystitis.

We identified a subset of patients with noninfectious cystitis who develop refractory symptoms marked by diffuse inflammatory changes, reduced bladder capacity, and vesicoureteral reflux (VUR), termed here as "progressive inflammatory cystitis" (PIC). Our objective was to describe the phenotype, disease outcomes, and pathologic findings of PIC. A single institution retrospective cohort study of patients with PIC. Patients with a history of pelvic radiation, urologic malignancy, or neurogenic bladder were excluded. We describe cohort characteristics and use bivariate analyses to compare subgroups. Kaplan-Meier methods estimate time to urinary diversion. From 2008 to 2020, 46 patients with PIC were identified. The median age of symptom onset was 63 years old (interquartile range [IQR]: 56, 70) and the most common presenting symptoms were urinary urgency/frequency (54%) and incontinence (48%). Urodynamics showed a median maximum bladder capacity of 80 mL (IQR: 34, 152), commonly with VUR (68%) and hydronephrosis (59%). Ultimately 36 patients (78%) underwent urinary diversion at a median of 4.5 years (IQR: 2, 6.5) after symptom onset. Significant pathologic findings include presence of ulceration (52%), acute and chronic inflammation (68%), including eosinophils (80%), lymphoid follicles (56%), and mast cells in both lamina and muscularis propria (76%). PIC is a newly defined entity characterized by significantly diminished bladder capacity, upper tract changes, and relatively quick progression to urinary diversion. Larger prospective cohort studies are required to further characterize this severe phenotype of chronic noninfectious cystitis, aid earlier diagnosis, and guide management decisions.

Hyaluronic Acid as a Tissue Spacer Between Prostate and Rectum to Aid Dissection During Radical Prostatectomy

Introduction: We demonstrate a novel method of spacer gel injection immediately before prostatectomy, displacing the prostate away from the rectum to aid later dissection. Post-pelvic radiotherapy prostatectomy is associated with more complex resection and higher surgical morbidity. Tissue adhesion between rectum and prostate caused by radiotherapy scarring increases the risk of rectal injury from 0.5% in primary prostatectomy to 6.9% during prostatectomy in an irradiated pelvis. Barrigel® is a nonanimal stabilized hyaluronic acid. It is anechoic and, therefore, identifiable when injected percutaneously into Denonvillier's space under transrectal ultrasound guidance. Patients at a high risk of rectal injury during prostatectomy may undergo on-table transperineal Denonvillier hyaluronic acid injection. Methods: The technique is demonstrated on a 72-year-old man with pT3bN0M0 prostate cancer with a history of pelvic radiotherapy and evidence of scarring of Denonvillier's fascia on preoperative MRI. The patient should be positioned in lithotomy with a transrectal probe in situ. A 20 cm 18-gauge needle is inserted into Denonvillier's fascia through the perineum. About 3 to 10 mL of Barrigel is injected under ultrasound guidance separating the rectum from the prostate. The patient can then be positioned, prepped, and draped for prostatectomy. In this demonstration, the patient underwent robot-assisted laparoscopic radical prostatectomy. Results: Barrigel is typically absorbed fully in 12 months. There was no evidence of rectal injury on leak testing and the patient had a noncomplicated postoperative course. Pathologic review confirmed clear surgical margins. Conclusions: We demonstrate a novel technique of injecting Barrigel percutaneously into Denonvillier's fascia. The dissection of the prostate from the rectum during robot-assisted laparoscopic prostatectomy was effective with no complications. No competing financial interests exist. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. No funding was received. Runtime of video: 2 mins 11 secs

MP56-13 PERIOPERATIVE AND SURVIVAL OUTCOMES OF PATIENTS WITH A HISTORY OF PELVIC RADIATION UNDERGOING SALVAGE ROBOT-ASSISTED RADICAL CYSTECTOMY. AN RRC-ICUD COLLABORATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP56-13 PERIOPERATIVE AND SURVIVAL OUTCOMES OF PATIENTS WITH A HISTORY OF PELVIC RADIATION UNDERGOING SALVAGE ROBOT-ASSISTED RADICAL CYSTECTOMY. AN RRC-ICUD COLLABORATIVE STUDY Giovanni Cacciamani, Joge Ballon, Viktor Skokic, Gus Miranda, John Sfakianos, Etienne Lavallee, Yuan Shuo Wang, Linda Dey, Arad Hosseini, Juhana Rautiola, Gunnar Steineck, Monish Aron, Inderbir Gill, Abolfazl Hosseini, Reza Mehrazin, Peter Wiklund, and Mihir Desai Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Joge BallonJoge Ballon More articles by this author , Viktor SkokicViktor Skokic More articles by this author , Gus MirandaGus Miranda More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Etienne LavalleeEtienne Lavallee More articles by this author , Yuan Shuo WangYuan Shuo Wang More articles by this author , Linda DeyLinda Dey More articles by this author , Arad HosseiniArad Hosseini More articles by this author , Juhana RautiolaJuhana Rautiola More articles by this author , Gunnar SteineckGunnar Steineck More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Peter WiklundPeter Wiklund More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are lack of data on salvage robot-assisted radical cystectomy (sRRC) after pelvic radiation therapy (RT) in patients with bladder cancer. We present perioperative, oncological, and long terms survival outcomes for patients with a history of pelvic radiation who had undergone sRRC from 3 high-volume centers. METHODS: Data from prospectively maintained databases from 3 centers (USC, Karolinska Institute, Mount Sinai) from 2009-2019 were retrospectively reviewed. Patients with a history of pelvic radiation who underwent sRRC with Intracorporeal (ICUD) or extracorporeal (ECUD) for intent to cure bladder cancer were identified. Using a propensity score estimation (based on age, BMI, gender, ASA score, neoadjuvant chemotherapy, and clinical tumor stage (Caliper size 0.2), patients were matched 1:1 to a cohort undergoing RRC without prior history of pelvic radiation. Both groups were compared for perioperative, oncologic, and survival outcomes with up to 3 years of follow-up. RESULTS: A total of 92 sRRC were PS matched to 92 patients undergoing RRC. While both groups were similar in the proportion of ICUD (70.3 vs 78.3%, p=0.29), the sRRC had a lower proportion of continent diversion (6.7 vs 22.8%, p=0.004)). There were no significant differences between the 2 groups in operative time (333.8 vs 348.2 minutes, p=0.246), postoperative complications, at 30 days (p=0.36), and 31-90 days (p=0.64), and readmission rates at 30 days (16.3 vs 19.6%, p=0.70) and 31-90 days (16.5 vs 21.8%, p=0.48). The sRRC group had a lower number of lymph nodes (LNDs) retrieved (20.1 vs 29, p≤0.001), positive LNDs (0.3 vs 1.7, p=0.007), and positive LNDs rate (0.03 vs 0.07%, p=0.035). However no significant differences observed in tumor stage (p=0.41) and LNDs stage (p=0.065) and rate (23.9 vs 29.3; p=0.5). At 3 years, OSS (59.1 vs 67.8% p=0.27), CSS (74.9 vs 74.4% p=0.59), and RFS (70.7 vs 76.1 p=0.67) were similar between sRRC and RRC. CONCLUSIONS: This largest multi-institutional contemporary study provides the best evidence to date supporting the feasibility of sRRC. Perioperative and survival outcomes were comparable between the two groups indicating that sRRC is feasible for selected patients who have underwent pelvic RT. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e779 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cacciamani More articles by this author Joge Ballon More articles by this author Viktor Skokic More articles by this author Gus Miranda More articles by this author John Sfakianos More articles by this author Etienne Lavallee More articles by this author Yuan Shuo Wang More articles by this author Linda Dey More articles by this author Arad Hosseini More articles by this author Juhana Rautiola More articles by this author Gunnar Steineck More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Abolfazl Hosseini More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

PD42-09 INTRACAVERNOSAL INJECTION HISTORY IS ASSOCIATED WITH INCREASED INTRA- AND POSTOPERATIVE INFLATABLE PENILE PROSTHESIS COMPLICATIONS: A MULTI-INSTITUTIONAL ANALYSIS

PD42-09 INTRACAVERNOSAL INJECTION HISTORY IS ASSOCIATED WITH INCREASED INTRA- AND POSTOPERATIVE INFLATABLE PENILE PROSTHESIS COMPLICATIONS: A MULTI-INSTITUTIONAL ANALYSIS