e410 THE JOURNAL OF UROLOGY� Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014

Parameter

Bladder outlet

obstruction (n¼31)

Detrusorunderactivity

(n¼17)

p-value

Qmax (ml/s)

15.9�7.6 18.5�12.0 0.425

PVR (ml)

21.0�26.2 19.1�24.9 0.807

Voiding trial atpostoperative 3rd month

Failure of voiding trial (%)

0 (0%) 1 (5.8%) 0.170

Qmax (ml/s)

14.3�7.0 12.6�6.2 0.514

PVR (ml)

11.7�6.9 27.4�46.7 0.292

Voiding trial atpostoperative 12th month

Failure of voiding trial (%)

2 (6.4%) 2 (11.7%) 0.480

Qmax (ml/s)

11.5�2.3 12.2�7.7 0.383

PVR (ml)

10.0�10.0 26.5�32.9 0.261

Continence (%)

31 (100%) 16 (94.1%) 0.172

Qmax: maximal urine flow rate; PVR: postvoid residual urine volume; Pdetmax:maximal detrusor pressure; PdetQmax: detrusor pressure at maximal urine flowrate; VLPP: valsalva leak point pressure; CIC: clean intermittent catheterization

Source of Funding: none

MP38-19THE UTILIZATION OF INCONTINENCE PROCEDURES VARIES BYRACE IN PROSTATE CANCER SURVIVORS

Shubham Gupta*, Aaron Lentz, Michael Granieri, Ngoc-Bich Le,Matthew Fraser, Andrew Peterson, Durham, NC

INTRODUCTION AND OBJECTIVES: Voiding dysfunction andurinary incontinence after radical prostatectomy has been reported torange from 3% to as high as 90%. In addition, little is known about racialdifferences in post prostatectomy incontinence and the utilization ofanti-incontinence procedures. We analyzed the rates of anti-inconti-nence procedures after radical prostatectomy with respect to race at asingle institute.

METHODS: We conducted an IRB approved retrospective re-view of the billing data of patients with prostate cancer who underwentradical prostatectomy (open, laparoscopic, or robotic) at a single insti-tute over a 10-year period. Demographic data including race andethnicity, marital status, age at treatment and surgical therapy for uri-nary incontinence with either a male sling or artificial urinary sphincter(AUS) were reviewed.

RESULTS: 4401 men underwent radical prostatectomy over thestudy period. 30% of the patients underwent laparoscopic or roboticprostatectomy, 8.5% underwent perineal prostatectomy, and 60% un-derwent retropubic radical prostatectomy.

74.3% of the patients were Caucasian (mean age of 62.7 years attreatment), and 22.1% were African American (mean age of 60 years attreatment). 165 (3.7%) patients underwent a total of 191 procedures formale urethral sling or artificial urinary sphincter placement. Among menwho underwent incontinence surgery, the mean age at radical prosta-tectomy was 63 years, and the median time from prostatectomy to firstincontinence surgery was 20 months. The first incontinence procedurewas a male sling in 63% and AUS in 37% of patients. White Caucasianmen had a higher rate of anti-incontinence procedure utilizationcompared to African American men (4.3% versus 2.1%, p ¼0.001) andhad a shorter time to incontinence surgery after prostatectomy (19.8months versus 28.3 months, p <0.05). There was no racial difference inthe types of incontinence procedure performed (sling versus AUS).There was no difference noted in incontinence procedure utilizationbased on ethnicity, marital status, or religion.

CONCLUSIONS: The overall rate of incontinence surgery afterradical prostatectomy at our institute is 3.7%. African American menreceive anti- incontinence procedures at a lower rate and with a longerdelay after prostatectomy than Caucasian men. Further studies areneeded to define the potential reasons for this racial disparity in urinaryincontinence surgery in the prostate cancer survivor.

Source of Funding: none

MP38-20THE EFFICACY OF BOTULINUM TOXIN A FOR CONTROL OFURINARY INCONTINENCE IN PATIENTS WITH A SUPRAPUBICCATHETER

Bashir Mukhtar*, Shafiul Chowdhury, Mahreen Pakzad, Julian Shah,Jeremy Ockrim, Tamsin Greenwell, Rizwan Hamid, London,United Kingdom

INTRODUCTION AND OBJECTIVES: There are a variety ofmethods for bladder drainage in disease state including suprapubiccatheterisation (SPC). A proportion of these patients continue to haveurgency related urinary incontinence refractory to antimuscarinics.Intradetrusor Botulinum toxin A (BTX) is an accepted treatment forcontrol of detrusor overactivity (DO). However, the efficacy of BTX incontrolling incontinence in patients with SPC is not well documented.We present our experience with BTX in this setting.

METHODS: We compiled a retrospectively collated databaseof patients that between September 2012 and September 2013 hadundergone intradetrusor injections of BTX into multiple sites of thebladder wall at our institution. 206 patients were identified, of which16 had SPC as a method of bladder drainage. All but one hadurodynamic proven DO with urinary incontinence. 12 had a pre-treatment diagnosis of neuropathic bladder dysfunction, with themajority of these being secondary to multiple sclerosis. 3 had idio-pathic bladder dysfunction and 1 had a diagnosis of chronic pelvicpain syndrome.

Data on urodynamics results, including evidence of DO, leakage,BTX dose and further treatment, was collected from the trust computerdatabase. Associated complications, improvement in symptoms, dura-tion of cessation of leakage and if subsequent BTX treatment waseffective, was collected via clinic letters, repeat urodynamics and sub-jectively via a telephone interview.

RESULTS: The mean age of the cohort was 59 years (range;34-77 years). Gender ratio was 12 females to 4 males (3:1). From ourcohort of 16 patients, 10 reported significant improvement in symp-toms with quality-of-life improving effects. 3 had no discernableimprovement in symptoms. In 3 the result could not be established. 6/10 patients with improvements were cured of incontinence. Indeed, atthe time of follow-up, only one had reported a relapse (at 7 months).The others were within 3,3,5,5 and 9 months of their treatment and stillasymptomatic for leakage. In those that had repeat BTX within thestudy time, all (5/5) reported excellent efficacy. Only 1 patient expe-rienced significant discomfort from the treatment, which resulted incessation of the procedure. No others reported any peri-operativedifficulties (15/16).

CONCLUSIONS: In patients with urodynamic diagnosed DOwho have SPC as a means of bladder drainage, and who experienceurinary incontinence that is refractory to antimuscuranics, BTX is aneffective treatment option, with good tolerability and beneficial effectsthat appear to be sustained with repeated injections.

Source of Funding: None.