OBJECTIVE:To assess the etiology, evaluation, and subsequent management of patients who developed gross hematuria following radical cystectomy (RC) and orthotopic neobladder (ONB) urinary diversion. METHODS:All patients who underwent RC and ONB between 2017 and 2021 and later developed gross hematuria necessitating cystoscopy were identified. Patient demographics, cystoscopy reports, cytology findings, and relevant imaging were reviewed to determine the etiology of hematuria, the subsequent management, and the ultimate outcome. Causes of hematuria were categorized as recurrence, inflammation/infection, anticoagulation-related, or undetermined. RESULTS:Twenty-one patients underwent cystoscopy for gross hematuria following RC and ONB during the study period. Most patients were male (n = 19, 90.5%), and the median age was 71 years (IQR: 67-75). Five (23.8%) patients had hematuria secondary to cancer recurrence-4 urethral and one upper tract recurrence. Other etiologies of hematuria included pouchitis (n = 5, 23.8%) and presumed anticoagulation-related bleeding (n = 2, 9.5%). In 9 (42.9%) patients, the etiology of hematuria remained undetermined despite comprehensive workup. Among the 5 patients whose hematuria was secondary to cancer recurrence, the median time from cystectomy to hematuria was 29 months (Interquartile range: 15-36). CONCLUSIONS:Up to a quarter of patients who present with gross hematuria following RC with ONB may have cancer recurrence. Consequently, a thorough evaluation is warranted in all patients.

You have accessJournal of UrologyCME1 Apr 2023MP65-12 EVALUATION OF LONG-TERM FUNCTIONAL OUTCOMES OF ORTHOTOPIC NEOBLADDER IN THE ELDERLY USING A VALIDATED QUESTIONNAIRE Seyedeh Sanam Ladi Seyedian, Kasen Wong, Muhannad Alsyouf, Gus Miranda, Jie Cai, Kevin Wayne, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Seyedeh Sanam Ladi SeyedianSeyedeh Sanam Ladi Seyedian More articles by this author , Kasen WongKasen Wong More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Kevin WayneKevin Wayne More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elderly patients who require radical cystectomy (RC) are more likely to undergo an incontinent urinary diversion due to unclear long-term functional outcomes of a continent diversion. Herein, we evaluate the continence outcomes in elderly males undergoing orthotopic neobladder (ONB) diversion after RC using a validated questionnaire. METHODS: Using our IRB approved bladder cancer database, we identified male patients, 70 years old or older, who underwent open RC and ONB from 2002 to 2021. Beginning in 2012 the patients completed a validated pictorial pad use questionnaire at each follow-up visit. The questionnaire assessed pad number, size and wetness as well as catheter use. Continence was defined as use of “no pads” or pads that are “almost dry”. Urinary retention was defined as ≥3 catheterizations/day or a self-reported inability to void without a catheter. Patients with artificial urinary sphincters or less than 6 months of follow up were excluded from the study. Kaplan-Meier curves and cox regression were used to analyze the data. RESULTS: A total of 156 male patients with median age of 74 years (IQR: 72-77) and BMI of 26.7 (IQR: 24.2 - 29) were included. 64 (41%) patient were>75 years old. 42 (27%) patients received neoadjuvant chemotherapy. 71 (45.5%) patients had Charlson comorbidity index (CCI) score of>2. Fifteen (10%) patients had pathological staging >pT3 and 23 (15%) had pathological nodal disease. At 1 year following the surgery, half of the patients gained daytime continence and 30% gained nighttime continence which increased over the study period. Day and nighttime continence rates were 74% and 68% at 5 years postoperatively (figure 1). Only 13 (8%) patients developed retention over the study period. Patients>75 years old had worse nighttime continence outcome compared to <75 years old (p=0.07) (figure 1). Multivariate cox regression model including age, CCI, BMI, diabetes, and perioperative chemotherapy did not show any significant risk factor for daytime incontinence, however; age>75 was significantly associated with nighttime incontinence (HR 1.07, p=0.04). CONCLUSIONS: Orthotopic neobladder represents a viable option for urinary diversion in selected elderly males undergoing radical cystectomy and age alone should not be considered a contraindication. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e895 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh Sanam Ladi Seyedian More articles by this author Kasen Wong More articles by this author Muhannad Alsyouf More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Kevin Wayne More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP56-20 ETIOLOGY, EVALUATION, AND MANAGEMENT OF HEMATURIA FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION Daniel I. Sanford, Muhannad Alsyouf, Sanam Ladi-Seyedian, Kevin Wayne, Alireza Ghoreifi, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Daniel I. SanfordDaniel I. Sanford More articles by this author , Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Sanam Ladi-SeyedianSanam Ladi-Seyedian More articles by this author , Kevin WayneKevin Wayne More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 20% of patients presenting with gross hematuria have underlying urologic malignancy. In patients with orthotopic neobladder (ONB) following cystectomy, the occurrence of hematuria at follow-up has not been evaluated. Here, we assessed the etiology, evaluation, and subsequent management of patients who developed hematuria following ONB diversion. METHODS: All patients who underwent radical cystectomy and ONB between 2017-2022 and who subsequently underwent cystoscopy for hematuria were identified. Patient demographics, cystoscopy reports, cytology findings, and relevant imaging were reviewed to determine the etiology of hematuria and subsequent management. Causes of hematuria were categorized as recurrence, anticoagulation-related, inflammation/infection, or undetermined. A univariate analysis was performed to identify factors predictive of oncologic recurrence presenting with hematuria. RESULTS: Of 55 patients with ONB who underwent subsequent cystoscopy on follow-up, hematuria was the indication in 24 (44%) patients (Table 1a). Median patient age was 71 (IQR 66-74) years. Seven patients (29%) had hematuria secondary to cancer recurrence, including four with urethral recurrence, one with ureteral recurrence, and two with positive urine cytology. Other etiologies of hematuria included anticoagulation (13%), pouchitis (13%), mesh erosion into neobladder (4%), and bladder inflammation (4%). Nine patients (37%) had an undetermined cause of hematuria. In patients with recurrence, median time from cystectomy to development of hematuria was 20.1 (15.6–32.8) months. Positive surgical margins were associated with cancer recurrence in our cohort (p<0.05) (Table 1b). CONCLUSIONS: The majority of patients presenting with gross hematuria following radical cystectomy and ONB have benign etiology, yet up to one-third of patients will have underlying malignancy. A thorough evaluation is required for all patients, especially those with positive surgical margins. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e783 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel I. Sanford More articles by this author Muhannad Alsyouf More articles by this author Sanam Ladi-Seyedian More articles by this author Kevin Wayne More articles by this author Alireza Ghoreifi More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

ObjectivesTo investigate the prevalence of catheterisation and urinary retention in male patients with bladder cancer after radical cystectomy (RC) and orthotopic neobladder (ONB) and to identify potential predictors.Patients and MethodsUsing an Institutional Review Board approved, prospectively maintained bladder cancer database, we collected information using a diversion‐related questionnaire from 299 consecutive male patients with bladder cancer upon postoperative clinic visit. Urinary retention was defined as ≥3 catheterisations/day or a self‐reported inability to void without a catheter. Uni‐ and multivariable Cox regression analysis was performed to identify predictors of catheterisation and urinary retention.ResultsSelf‐catheterisation was reported in 51 patients (17%), of whom, 22 (7.4% of the total patients) were in retention. Freedom from any catheterisation at 3, 5, and 10 years after RC was 85%, 77%, and 62%, respectively. Freedom from retention at 3, 5, and 10 years after RC was 93%, 88%, and 79%, respectively. Multivariable Cox regression showed that higher body mass index (BMI; ≥27 kg/m2) significantly increased the need for catheterisation (hazard ratio [HR] 2.34, 95% confidence interval [CI] 1.26–4.32) as well as retention (HR 5.20, 95% CI 1.74–15.51). Greater medical comorbidity (Charlson Comorbidity Index score ≥2) correlated with the need for any catheterisation (HR 1.84, 95% CI 1.02–3.3), but not retention. Pathological stage and type of diversion were not significant predictors of the need to catheterise or urinary retention.ConclusionIn males undergoing RC with ONB, retention requiring catheterisation to void is uncommon. Patients with a BMI of ≥27 kg/m2 are at significantly increased risk of retention and need for self‐catheterisation.

OBJECTIVE To assess both short- and long-term constipation symptoms and their impact on quality of life in patients who underwent radical cystectomy (RC) with three different types of urinary diversion: orthotopic neobladder (ONB), continent cutaneous diversion (CCD), and ileal conduit (IC). MATERIALS AND METHODS The validated Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires were administered to all patients at follow-up greater than 30 days from surgery. Clinical and pathological characteristics were prospectively recorded in an institutional review board approved bladder cancer database. Using multivariable linear regression analyses, we determined significant predictors of improved constipation symptoms and quality of life scores. RESULTS A total of 198 patients completed 255 PAC-SYM and PAC-QOL questionnaires with a median follow-up time of 1.7 years (IQR: 0.7 - 3.0 years). ONB, CCD, and IC were performed in 78%, 5.5%, and 16.5% of patients, respectively. Higher bowel function scores (i.e. worse symptoms) were noted at 3 months post-operatively, while these scores significantly improved over time for PAC-SYM total score (P =.004), abdominal subscore (P =.001), and rectal subscore (P =.018). On multivariable analysis, we found that patients <70 years old (B -2.1, P =.004), with follow-up >1 year (B -4.8, P =.001), and who received an IC (B -2.4, P =.02) had significantly lower PAC-SYM scores. CONCLUSION Patients have few constipation symptoms and are overall satisfied with their bowel function at long-term follow-up after RC. While patients with IC have significantly fewer constipation symptoms compared to those with ONB or CCD, all patients had significant improvement one year after the surgery. (C) 2021 Elsevier Inc.

OBJECTIVE:To report sexual health outcomes in male patients undergoing open radical cystoprostatectomy using a validated questionnaire. MATERIALS AND METHODS:Beginning in 2017, male patients were asked to complete a validated questionnaire during scheduled post-cystectomy clinic visits that assessed sexual function using the 5 item International Index of Erectile Function (IIEF-5) and supplemental questions which evaluated libido, orgasm, partner interest, and adequacy of pre-operative counselling. Baseline data and functional outcomes were compared and multivariable analysis performed. RESULTS:A total of 134 patients who met inclusion criteria completed the questionnaire. Pre-operative IIEF-5 was available in 78 patients with a median score of 16 (IQR:5-23). In those patients, median age at cystectomy was 68.9 years (IQR:60.2-72.4) and median duration of follow-up was 17.3 months (IQR:6.3-28.7). Median IIEF-5 score at time of survey completion was 1 (IQR:1-11). Increasing age, shorter follow-up duration, insufficient counselling, and absence of partner interest were predictive of lower scores. Younger age, pre-operative erectile function, and neurovascular preservation were predictive of a higher IIEF-5 score on univariate and multivariate analysis. Median libido score was 2 "low" (IQR:1-3) and ability to orgasm was reported by 34 (43.6%) patients. Neurovascular preservation (OR:3.03 95% CI:1.10-8.26, P = .03) and sufficient preoperative counselling (OR:3.078 95% CI:1.17-8.098, P = .02) were associated with preserved ability to orgasm. Libido was influenced by partner interest (OR 11.7, 95% CI:3.793-6.14, P <.0001). CONCLUSION:Sexual dysfunction after radical cystoprostatectomy is prevalent with many contributing factors. As such, establishing appropriate expectations and goals during preoperative counseling, performing neurovascular preservation when appropriate, and readily identifying and treating dysfunction in follow-up may improve sexual recovery.

We previously reported that elevated precystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive bladder cancer (BC). Herein, we evaluated the effect of neoadjuvant chemotherapy (NAC) on elevated tumor marker levels and their association with oncological outcomes. Under IRB approval, serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 480 patients with invasive BC from August 2011 through December 2016. In the subgroup undergoing NAC, markers were measured prior to the first and after the last cycle of chemotherapy (prior to cystectomy). Three hundred and thirty-seven patients were eligible for the study, with a median age was 71 years (range 34–93) and 81% (272) male. Elevated precystectomy level of any tumor markers (31% of patients) was independently associated with worse recurrence-free survival (hazard ratio [HR] = 2.81; P < 0.001) and overall survival (HR = 3.97; P < 0.001). One hundred and twenty-five (37%) patients underwent NAC, of whom 59 had a complete tumor marker profile and 30 (51%) had an elevated pre-NAC tumor marker. Following completion of chemotherapy, 10/30 (33%) patients normalized their tumor markers, while 20/30 (67%) had one or more persistently elevated markers. There was no difference in clinical or pathological stage between groups (P = 0.54 and P = 0.09, respectively). Further analysis showed a significantly lower rate and longer median time to recurrence/progression in the responder group (50% in responders vs. 90% in nonresponders at a median time of 22 vs. 4.8 months, respectively; P = 0.015). There was also significant difference in mortality rates and median overall survival between the study groups (30% in responders vs. 70% in nonresponders at a median time of 27.3 vs. 11.6 months respectively; P = 0.037). Two of the three patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death. To our knowledge, this is the first study showing tumor marker response to NAC. Patients with persistently elevated markers following NAC have a very poor prognosis following cystectomy, which may help identifying chemotherapy-resistant tumors. A larger, controlled study with longer follow up is needed to determine their role in predicting survival.

Introduction and Objectives: We previously reported that elevated precystectomy serum levels of epithelial tumor markers predict worse oncological outcome in patients with invasive bladder cancer (BC). Herein, we evaluated the effect of neoadjuvant chemotherapy (NAC) on elevated tumor marker levels and their association with oncological outcomes. Methods: Under IRB approval, serum levels of Carbohydrate Antigen 125 (CA-125), Carbohydrate Antigen 19-9 (CA 19-9) and Carcinoembryonic Antigen (CEA) were prospectively measured in 480 patients with invasive BC from August 2011 through December 2016. In the subgroup undergoing NAC, markers were measured prior to the first and after the last cycle of chemotherapy (prior to cystectomy). Results: Three hundred and thirty-seven patients were eligible for the study, with a median age was 71 years (range 34-93) and 81% (272) male. Elevated precystectomy level of any tumor markers (31% of patients) was independently associated with worse recurrence-free survival (hazard ratio [HR] = 2.81; P < 0.001) and overall survival (HR = 3.97; P < 0.001). One hundred and twenty-five (37%) patients underwent NAC, of whom 59 had a complete tumor marker profile and 30 (51%) had an elevated pre-NAC tumor marker. Following completion of chemotherapy, 10/30 (33%) patients normalized their tumor markers, while 20/30 (67%) had one or more persistently elevated markers. There was no difference in clinical or pathological stage between groups (P = 0.54 and P = 0.09, respectively). Further analysis showed a significantly lower rate and longer median time to recurrence/progression in the responder group (50% in responders vs. 90% in nonresponders at a median time of 22 vs. 4.8 months, respectively; P = 0.015). There was also significant difference in mortality rates and median overall survival between the study groups (30% in responders vs. 70% in nonresponders at a median time of 27.3 vs. 11.6 months respectively; P = 0.037). Two of the three patients that died in the normalized tumor marker group had tumor marker relapse at recurrence prior to their death. Conclusions: To our knowledge, this is the first study showing tumor marker response to NAC. Patients with persistently elevated markers following NAC have a very poor prognosis following cystectomy, which may help identifying chemotherapy-resistant tumors. A larger, controlled study with longer follow up is needed to determine their role in predicting survival. (C) 2018 Elsevier Inc. All rights reserved.

OBJECTIVES To determine the impact of radical cystectomy and orthotopic neobladder (NB) diversion on device-related outcomes in patients who undergo subsequent placement of both, an artificial urinary sphincter (AUS) and 3-piece inflatable penile prosthesis. MATERIALS AND METHODS Using an institutional prosthetic database, we identified 39 patients who underwent radical cystectomy and NB and subsequent implantation of both prosthetic devices from 2003 to 2017. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection, mechanical failure, revision surgery, and functional outcomes were examined and compared to an appropriate matched group of patients (n = 48, non-neobladder group). RESULTS No intraoperative complications were observed. After median follow-up of 94 months (12-177 months), 1 patient developed an infection of their penile prosthesis and 4 patients developed an erosion of their AUS. In each case, the infection did not involve the other device. Two patients required revision surgery of their penile prosthesis due to mechanical failure (reservoir leak, n = 1; cylinder aneurysm, n= 1). Twenty-one patients underwent elective revision surgery to improve continence (cuff downsizing, n = 18; pressure-regulating balloon exchange, n = 3). There were 6 cases of AUS mechanical failure. No reservoir-related complications such as herniation or erosion were observed. Compared to the control group of non-neobladder patients, there were no significant differences in prosthetic infection, mechanical failure, and revision surgery. CONCLUSION The AUS and 3-piece inflatable penile prosthesis can coexist safely in patients with NB without an increased risk of device-related complications. (C) 2019 Elsevier Inc.

Background: Pelvic radiation is a known risk factor for the development and progression of erectile dysfunction. When medical therapy fails, the 3-piece inflatable penile prosthesis (IPP) can offer patients a definitive treatment option. Because of radiation-induced vascular changes and tissue fibrosis, a careful surgical approach is necessary to avoid intraoperative complications and attain successful outcomes. Despite its widespread use in prostate cancer treatment, there are no contemporary studies examining the effects that pelvic radiation can have on 3-piece IPP placement and device survival. Aim: To present technical considerations and contemporary outcomes of placing a 3-piece IPP for refractory erectile dysfunction in patients with a history of pelvic radiation. Methods: We retrospectively reviewed 78 patients who underwent placement of a 3-piece IPP (AMS 700; Boston Scientific, Marlborough, MA, USA) after being treated with pelvic radiotherapy from 2003 through 2016. All patients had been treated with external beam and/or brachytherapy for treatment of prostate malignancy. An infrapubic approach was used in all patients, with reservoir placement in the space of Retzius or in the lateral retroperitoneal space. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. Outcomes: Rates of device infection, revision surgery, and reservoir complications. Results: No intraoperative complications were observed. After a mean follow-up of 49.0 months (6.6-116.8), 2 patients developed an infection of their prosthesis that required explantation. These patients underwent successful IPP removal and immediate reimplantation. 11 patients (14.1%) required revision surgery (pump replacement, n = 4; pump relocation, n = 2; cylinder replacement, n = 4; reservoir replacement owing to leak, n = 1). No reservoir-related complications such as herniation or erosion into adjacent structures were observed. Clinical Implications: The 3-piece IPP can be placed safely in a broad range of patients treated with pelvic radiotherapy. Strengths and Limitations: This study describes contemporary long-term outcomes of the IPP in patients treated with pelvic radiation and includes patients with prior pelvic surgery and artificial urinary sphincter, which are commonly encountered in practice. It is limited by its single-center experience and lacks a comparison group of patients. Objective patient satisfaction data were not available for inclusion. Conclusions: The 3-piece IPP can be placed successfully in patients with a history of pelvic radiation without a significant increase in infectious complications, reservoir erosion, or mechanical failure compared with the global literature. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Background: After radical cystoprostatectomy (RC), postoperative erectile dysfunction (ED) is a common consequence with multiple contributing etiologies. The inflatable penile prosthesis (IPP) offers patients a definitive treatment option when ED is refractory to medical therapies. Because of the hostile postoperative anatomy of these patients, a careful surgical approach is necessary for successful outcomes and to avoid adjacent organ injury. To date, there is no series describing the outcomes of 3-piece IPP placement in patients with urinary diversions. Aim: To present contemporary outcomes and a description of our technique in placing a 3-piece IPP for postoperative ED in patients with a history of RC with orthotopic neobladder, ileal conduit, or continent cutaneous diversion. Methods: We retrospectively reviewed 80 patients who underwent primary placement of a 3-piece IPP (AMS 700; American Medical Systems Inc, Minnetonka, MN, USA) after RC and urinary diversion from 2003 through 2016. 79 patients underwent RC in their treatment of urologic malignancy (71 for bladder cancer, 8 for prostate cancer) and 1 underwent RC for refractory interstitial cystitis. An infrapubic approach was used in most patients, with reservoir placement in the lateral retroperitoneal space through a counterincision medial to the anterior superior iliac spine. Patient demographics, perioperative data, and postoperative outcomes including prosthetic infection and mechanical failure were examined and statistical analysis was performed. Outcomes: Rates of device infection, revision surgery, and reservoir complications. Results: After mean follow-up of 53.9 months (6.5-150.7 months), 4 patients developed infection of the prosthesis that required explantation. 3 of those patients underwent successful IPP reimplantation. 5 patients required revision surgery (pump replacement, n = 3; pump relocation, n = 1; cylinder replacement for cylinder aneurysm, n = 1) for mechanical failure. No statistically significant associations were found between infection and comorbidities, urinary diversion, exposure to chemotherapy, radiation, or presence of an artificial urinary sphincter. Clinical Implications: The 3-piece IPP is an effective treatment option for medication-refractory ED that can be placed safely in patients with all forms of urinary diversion. Strengths and Limitations: This study represents the 1st series that describes a successful technique and long-term outcomes of patients with urinary diversion. It is limited by its single-surgeon, single-center experience and lacks validated patient satisfaction data in follow-up. Conclusions: The 3-piece IPP, with reservoir placement in the lateral retroperitoneum, can be implanted successfully in patients with all forms of urinary diversion without a significant increase in infectious complications, reservoir erosion, or mechanical failure. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-02 EVALUATION OF URINARY CONTINENCE FOLLOWING NERVE SPARING OPEN RADICAL CYSTOPROSTATECTOMY AND ORTHOTOPIC URINARY DIVERSION Zhoobin Bateni, Ankeet Shah, Soroush Bazargani, Kevin Wayne, Gus Miranda, Jie Cai, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Zhoobin BateniZhoobin Bateni More articles by this author , Ankeet ShahAnkeet Shah More articles by this author , Soroush BazarganiSoroush Bazargani More articles by this author , Kevin WayneKevin Wayne More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2114AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been suggested that nerve-sparing (NS) techniques can improve urinary continence following radical prostatectomy but there is lack of strong evidence in the literature about the effect of NS techniques on urinary continence following radical cystoprostatectomy (RCP). We evaluated urinary continence in male patients undergoing ONB diversion following NS versus non-NS RCP using a validated pad usage questionnaires. METHODS Beginning in 2012, we started to use an IRB approved, validated, pictorial pad usage questionnaire assessing the number, size, and wetness of pads at each follow-up visits of patients with ONB. We found 253 male patients which had filled out pad usage questionnaires at least one time. The time of the RCP was from 2002 to 2017. Continence was defined as no pad usage or pads as almost dry. We evaluated whether a nerve-sparing approach had any impact on continence. RESULTS The median age of 67 years and median BMI of 27.3 kg/m2. The median follow-up was 729 days. There was no significant difference between pathologic stage, adjuvant or neoadjuvant therapies, BMI, diabetes, history of smoking and perioperative care/catheter management of the two groups. There was a significantly shorter median time to daytime continence in the NS group compared to non-NS group (133 days vs 216 days; p=0.01). Kaplan-Meier curves showed significantly higher daytime continence rates in NS group at one year compared to non-NS ones (63% +/- 5% vs. 54% +/- 4%; p=0.002). A similar pattern was observed for one-year nighttime continence rates between the groups (43% +/- 5% in NS vs. 35% +/- 4% in non-NS; p=0.011) (figure 1). After controlling for potentially confounding factors including age, BMI, diabetes, comorbidities, smoking, pathological stage, pelvic floor muscle training, operative time, and blood loss, multivariate Cox regression model revealed that patients in NS group, were 1.6 times more likely to gain daytime continence by one year (OR:1.6 [95%CI, 1.2-2.2]; p=0.003). CONCLUSIONS Men with ONB following NS RCP have faster return to daytime and nighttime continence in the first year compared to the non-NS ones. Further research with randomization and a larger sample size is needed to rule out confounding factors to support the value of doing NS surgery on continence after RCP and ONB. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e877 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Zhoobin Bateni More articles by this author Ankeet Shah More articles by this author Soroush Bazargani More articles by this author Kevin Wayne More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVES To determine patient satisfaction with testicular prostheses (TP) for testicular cancer. Reconstruction represents an important part of surgical oncology, yet placement of TP following orchiectomy is infrequently performed. Improved data on patient satisfaction with TP would help in counseling patients with testicular cancer. MATERIALS AND METHODS Forty patients who underwent orchiectomy and TP placement for testicular cancer participated in a survey that was blinded to the providers in an outpatient clinic (2012-2014) to evaluate TP satisfaction. Categorical variables associated with satisfaction were compared using the Fisher's exact test. RESULTS Median age at TP placement was 31 years (17-59). Most patients had their prosthesis in place for >1 year (81%) at the time of the survey. No patient reported complications from the TP and none underwent explantation. All patients felt that being offered an implant before orchiectomy was important. Overall, 33 patients (82.5%) rated the TP as good or excellent, and 35 men (87.5%) would have the prosthesis implanted again. Thirty- seven patients (92.5%) found the TP to be comfortable or very comfortable. However, 44% considered the TP too firm and 20% felt the position was not appropriate. Appropriate size, appropriate position, and TP comfort were significantly associated with good or excellent overall TP satisfaction (P <.05). CONCLUSION Overall satisfaction with testicular implants after orchiectomy for testicular cancer is high. Patients should be offered a testicular prosthesis, especially at the time of orchiectomy. Efforts should be made to optimize implant firmness, and care should be given to proper size selection and positioning. (C) 2017 Elsevier Inc.

AimWe report the rates of artificial urinary sphincter (AUS) mechanical failure in a contemporary cohort of patients stratified by component type and size to determine if the 3.5‐cm cuff is at higher risk of failure.MethodsFrom 2005–2016, a total of 486 male patients with stress incontinence underwent implantation or revision of an AUS. 993 individual cases were retrospectively reviewed (465 primary placements and 528 revisions). Components were separately tallied and cases of mechanical failure were identified. Multiple variables including duration until failure and follow‐up interval were collected and analyzed for each malfunction.ResultsAfter median follow‐up of 31.5 months, there were 48 distinct cases of mechanical failure. The urethral cuff was the most common component to fail (n = 27, 56.3%), followed by the pressure regulating balloon (PRB) (n = 6, 12.5%), tubing (n = 6, 12.5%), and the control pump, (n = 5, 10.4%). Four (8.3%) cases did not have the source of malfunction identifiable in available records though fluid loss was evident at the time of device interrogation. Sub‐analyses of cuff failure events showed that the 3.5‐cm cuff had a statistically significant higher risk of failure (HR: 7.313, (P < .0001) compared to larger cuff sizes.ConclusionsWhile each component is prone to malfunction, our study suggests that the 3.5‐cm urethral cuff is more susceptible to failure and failure events occur earlier after placement than larger cuff sizes.

INTRODUCTION AND OBJECTIVES: Despite accumulating evidence that long noncoding RNAs (lncRNAs) are associated with cancer development and drug resistance in multiple types of cancer, the biological roles of many lncRNAs in human clear cell renal cell carcinoma (ccRCC) develop and sunitinib resistant have not been well characterized.METHODS: At first, we established sunitinib resistant cell lines and then detected the differential lncRNAs by q-RT-PCR and found that ZFAS1 have higher expression in sunitinib resistant cells than parental cells.We separated the cytoplasm and nucleus of renal cancer cell lines to confirm the localization of ZFAS1.Western blot and luciferase assay were performed to verify that zfas1 can regulate EZH2 expression through competitively binding miR-30c-5p in ccRCC.RNA-seq analysis was used to identify differentially expressed mRNA in renal cancer cell lines transfected with sh-Lacz compared to cell lines transfected with sh-ZFAS1.RESULTS: We found that ZFAS1 expression was significantly upregulated in ccRCC tissues.In vitro and in vivo experiments revealed that ZFAS1 promoted renal cancer cell proliferation and metastasis.Knockdown ZFAS1 can also relieve renal cancer cell resistant to sunitinib.Further studies demonstrated that ZFAS1 could function as a competing endogenous RNA (ceRNA) by sponging miR-101-3p in ccRCC cells.The effect of sh-ZFAS1 was partially attenuated by miR-101-3p inhibitor on proliferation, metastasis and resistant to sunitinib.Moreover, further investigations disclosed that EZH2 was a downstream target of miR-101-3p and ZFAS1.EZH2 can also promote ccRCC cell proliferation, metastasis and resistant to sunitinib.The RNA-seq data implied that p-AKT pathway are downstream of ZFAS1-miR-101-3p-EZH2 axis.CONCLUSIONS: Overall, we concluded that the ZFAS1/miR-101-3p/EZH2/p-AKT axis may be a ponderable and promising therapeutic target for ccRCC.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy I1 Apr 2018PD26-01 EFFECT OF ORAL DDAVP ON NIGHT-TIME INCONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION Soroush Bazargani, Zhoobin Bateni, Thomas Clifford, Kevin Wayne, Jie Cai, Gus Miranda, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Soroush BazarganiSoroush Bazargani More articles by this author , Zhoobin BateniZhoobin Bateni More articles by this author , Thomas CliffordThomas Clifford More articles by this author , Kevin WayneKevin Wayne More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We evaluated the effect of oral desmopressin (DDAVP) on male patient with persistent nighttime incontinence following orthotopic neobladder (ONB) diversion following radical cystectomy (RC) using validated pad usage questionnaires and in a subgroup who underwent pelvic floor physical therapy (PFPT). METHODS Using our IRB approved database, we identified 1716 patients who underwent open RC from 2002 to 2017. ONB was constructed in 1129 (66%) patients, of whom 964 (86%) were male. Beginning in 2012, patients were prospectively followed, completing a validated, pictorial pad usage questionnaire, assessing the number, size, and wetness of pads, as well as catheter use, at follow up visits. Continence was defined as no pad usage, or pads as “almost dry.” A subgroup of patient with persistent nighttime incontinence after 12 months, were offered oral desmopressin (DDAVP), 0.2-0.4 mg at bedtime. Inclusion criteria were male gender, estimated GFR >50 mL/min/1.73 m2, normal baseline electrolytes and complete daytime urinary continence. Patients were also educated for lifestyle and behavioral modifications including reducing nighttime liquid intake and emptying bladder before going to bed. Patients were followed up with phone calls at 2 and 4 weeks following therapy, and with regular clinic follow-ups thereafter. RESULTS A total of 283 male patients with available pad usage questionnaires were followed from September 2012 to August 2017. 23 patients were eligible for DDAVP treatments with a median age of 71 yrs. There was no significant difference between groups for age, BMI, or Carlson comorbidity index. Median time from cystectomy to treatment was 25 months. 10 patients were excluded from the study (5 never started treatment, 4 went into retention and started CIC, and one developed an allergic reaction). After completion of follow up, out of the 12 who entered the study, 10 patients reported a decrease in urine production, 8 reported a decrease in the number of pads used during nighttime and 7 achieved full nighttime continence. The number of patients who reached nighttime continence was statistically significant compared to baseline (7 out of 12(59%); P = 0.009). 3 patients increased the dose from 0.2 to 0.4 mg after first follow up, one of whom was still unresponsive. Two complications were recorded during the study period, one allergic skin reaction (rash; medication discontinued) and one diarrhea (resolved with continuation of therapy). CONCLUSIONS DDAVP significantly improved nighttime continence. A larger sample size or randomized trial is needed to provide more robust evidence to support the value of DDAVP for nighttime incontinence after RC and ONB. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e551 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Soroush Bazargani More articles by this author Zhoobin Bateni More articles by this author Thomas Clifford More articles by this author Kevin Wayne More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Purpose: We evaluated continence outcomes in male patients undergoing orthotopic neobladder diversion after radical cystectomy using a validated questionnaire.Materials and Methods: Using our institutional review board approved bladder cancer database we identified 1,269 patients who underwent open radical cystectomy from 2002 to 2015. Orthotopic neobladder was constructed in 935 (74%) patients, of whom 798 (85%) were male. Beginning in 2012 the patients completed a validated pictorial pad use questionnaire at each followup visit. The questionnaire assessed pad number, size and wetness as well as catheter use. Continence was defined as use of no pads or pads that are almost dry. Questionnaires were stratified into distinct postoperative intervals for analysis. Female patients, or patients with artificial urinary sphincters or prior radiotherapy were excluded from the study.Results: A total of 188 male patients with available questionnaires were followed from September 2012 to August 2015. Overall 447 questionnaires were collected, with 351 interval distinct questionnaires separated into intervals of less than 3, 3 to 6, more than 6 to 12, more than 12 to 18, more than 18 to 36 and more than 36 months after surgery (64, 61, 58, 49, 61 and 58 questionnaires, respectively). Daytime continence increased from 59% at less than 3 months postoperatively to 92% by more than 12 to 18 months. Nighttime continence increased from 28% at less than 3 months postoperatively to 51% by more than 18 to 36 months. Nearly 50% of patients reported daytime and nighttime continence by 18 to 36 months.Conclusions: After orthotopic neobladder diversion in male patients, continence improves significantly by 6 months and subsequently plateaus with 92% daytime continence by more than 12 to 18 months. Orthotopic neobladder represents an excellent functional option for urinary diversion.

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion I1 Apr 2015PD9-01 CONTINENCE OUTCOMES FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC NEOBLADDER Swar Shah, Soroush Bazaragani, Gus Miranda, Kevin Wayne, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Swar ShahSwar Shah More articles by this author , Soroush BazaraganiSoroush Bazaragani More articles by this author , Gus MirandaGus Miranda More articles by this author , Kevin WayneKevin Wayne More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.928AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Orthotopic neobladder reconstruction arguably represents the gold standard form of urinary diversion following radical cystectomy. However, no contemporary continence information is available. Herein, we evaluate the continence outcomes in patients undergoing orthotopic neobladder following radical cystectomy using a validated pad usage questionnaire. METHODS Using our IRB approved database, we identified 1545 patients that underwent open radical cystectomy from 2000 to 2014. Orthotopic neobladder was constructed in 1057 (68%) patients, of whom 892 (84%) were male. Starting in 2012, these patients were prospectively followed, and completed a validated, pictorial pad usage questionnaire during their follow up visits assessing the number, size, and wetness of pads, and mucus leakage. Continence was defined as reporting no pad usage, or pads as “almost dry,” and questionnaires were stratified into distinct postoperative time intervals. For patients who completed multiple questionnaires within an interval, the most recent was used in the analysis. Patients with artificial urinary sphincters or a history of radiation therapy were excluded. RESULTS A total of 180 male patients with available pad usage questionnaires were followed from August 2012 to October 2014. A total of 284 pad usage questionnaires were collected, with 243 interval distinct pad usage questionnaires identified and separated into intervals of < 3 months, 3–6 months, 6–12 months, 12–18 months, 18–36 months, and more than 36 months after surgery (n= 42, 39, 41, 34, 45, and 42, respectively). Daytime continence rates were 55%, 69%, 78%, 88%, 87%, and 81%, respectively. The corresponding numbers for nighttime continence rates were 26%, 38%, 46%, 44%, 58%, and 45%, respectively. In the 18–36 month range, 53% of patients reported both day and nighttime continence. CONCLUSIONS Following orthotopic urinary diversion, there is significant improvement in continence by 6 months, and 88% of patients achieved daytime continence by 12 months. There is a plateau in continence rates at one year. Orthotopic diversion represents an excellent functional option for urinary diversion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e195 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Swar Shah More articles by this author Soroush Bazaragani More articles by this author Gus Miranda More articles by this author Kevin Wayne More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...