pd29-11 withdrawn: prolapse repair with non-frozen cadaveric fascia lata: long-term results

e784 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014

PD29-11WITHDRAWNPROLAPSE REPAIR WITH NON-FROZEN CADAVERIC FASCIALATA: LONG-TERM RESULTS

Kulwant Singh*, Gary Leach, Sharron Mee, Los Angeles, CA

PD29-12ROBOTIC-ASSISTED PROLAPSE SURGERY: INITIAL 5-YEAREXPERIENCE AT A TRAINING INSTITUTION

Jamie Bartley*, Michael Ehlert, Kim Killinger, Jason Gilleran,Melissa Fischer, Royal Oak, MI

INTRODUCTION AND OBJECTIVES: Development of a ro-botic-assisted prolapse surgery (RAPS) program at a training institutionis feasible yet challenging. Durability and safety have been established,though contemporary studies have favored expert surgeons and nottrainees in a community setting.

METHODS: RAPS performed between 2007-2012 were iden-tified. A retrospective chart review was performed. Patient de-mographics, surgical data, intra-operative and post-operativecomplications were all categorized. Short term outcomes were alsoavailable for analysis.

RESULTS: 100 patients underwent RAPS by 3 urologists:94 sacrocolpopexies, 5 sacrohysteropexies, 1 enterocele repair.Mean age was 61 +/-10 years and median follow up was 4.0 months(2 weeks- 50 months). 53 patients had prior abdominal surgery, and24 had prior prolapse repair. 86 patients had grade 3 or greaterprolapse (83 Anterior, 52 Posterior, 61 Apical, 29 Uterine) with79 presenting with multiple compartment prolapse. Concomitantprocedures included 45 SUI procedures, 37 hysterectomies (34 ro-botic, 3 vaginal) and 11 vaginal repairs. Mean OR time was 269+/-96minutes. 8 intra-operative complications occurred (3 Cystotomies,1 each: Bowel injury, Conversion to open, Aborted procedure, Vagi-notomy, Arrythmia). Early complications (<30 days) occurred in 35patients (20 Urinary retention, 3 UTI, 3 Abdominal pain, 2 Ileus/Constipation, 1 each: Blood transfusion, Neuropathy, Reoperation,DVT, Corneal abrasion, Sore Throat, ICU admission). Late compli-cations occurred in 31 patients (9 Symptomatic prolapse, 9 Dyspar-eunia/pelvic pain, 6 Mesh exposure, 6 Additional prolapse surgeries,3 Suture granulomas, 1 each: Mesh erosion, Sacral Osteomyelitis,Perineal pain). On follow-up exam, 14 patients had Grade 2 prolapseand 7 patients had Grade 3 prolapse.

CONCLUSIONS: RAPS includes a variety of minimally inva-sive techniques for prolapse with low recurrence rates. excellentoutcomes are obtainable at a high-volume community training center.However, it is not without risks and patients should be counseledappropriately.

Source of Funding: Ministrelli Program for Urology Researchand Education (philanthropic gift)

Male Voiding/Infection/Infertility/Testis

Video

Tuesday, May 20, 2014 8:00 AM-10:00 AM

V8-01USE OF BOWEL FOR VAGINOPLASTY IN MALE TO FEMALETRANSSEXUAL

Carlo Trombetta, Trieste, Italy; Ciro Imbimbo, Naples, Italy;Giovanni Liguori, Trieste, Italy; Paolo Verze, Naples, Italy;Bernardino de Concilio, Nicola Pavan*, Trieste, Italy; Vincenzo Mirone,Naples, Italy

INTRODUCTION AND OBJECTIVES: The surgical manage-ment of neovaginal stenosis in a transsexual patient is a complexproblem and constitutes a significant technical challenge.

Where a primary vaginoplasty yields unsatisfactory functional re-sults, a secondary vaginoplasty using intestinal segments represents anelegant means to achieve vaginal reconstruction.

In this video we present our surgical techniques of vaginoplasty byusing sigmoid colon and ileum.

METHODS: Since 2006, 19 patients aged from 23 to 41 years(mean 33 years) came to our observation for neovaginal stenosis.Sigmoid colon was utilized in 8 cases, while ileum in 11.

RESULTS: The mean operating time was 220 min (range185e250). No intra-operative complication occurred.

Post-operative pain was minimal and the course was uneventful:only one patient had a urinary tract infection. The mean hospital staywas 8.6 days (range 7e11). The median follow-up of this series was 18months (range, 9 months to 4.1 years). All patients had transient vaginaldischarge which resolved within 6 months. The mean length of theneovagina at the first postoperative control was 12 cm (range10.5e14 cm).

CONCLUSIONS: Use of sigmoid colon is usually the first lineoption for vaginal reconstruction due to anatomical proximity andeasy mobilization of the vascular pedicle of this part of the bowel.Other advantages of using sigmoid segments include the limitedneed for dilatations in the post-operative period, the relatively stron-ger resistance of the mucosa to trauma and the ability of the intestinalmucus to act as lubrifier. Vaginoplasty by the use of an ileal segmentis another possible option. There are several reasons to preferileum instead of sigmoid colon. First of all, ileum is technically theleast difficult of conduits to create and this is why, it has becomethe segment of choice in conduit diversion in urological practice.Secondly ileum has a lower mucus production as compared to largebowel.

Source of Funding: None

V8-02FREE HAND TRANSPERINEAL ULTRASOUND GUIDEDPROSTATE BIOPSY

Matthew Allaway*, Cumberland, MD

INTRODUCTION AND OBJECTIVES: An estimated 800,000prostate biopsies are performed annually in the United States1. Themajority of the biopsies are performed via a transrectal approach thruthe rectal wall, which introduces bacteria into the prostate paer-enchyma2. Coliform bacteria resistance to flouroquinolone antibiotics isestimated at 22%2,3,4. Accordingly, infectious complications are ashigh as 7% and the risk of hospitalization as high as 4%5. This studydemonstrates a significant reduction in rate of infection and