V8-12 MALFUNCTION OF LINEAR CUTTING STAPLER IN KIDNEY SURGERY Rene Sotelo*, Caracas, Venezuela; Erik Castle, Scottsdale, AZ; Robert De Andrade, Luis Medina, Leonardo Brunacci, Oscar Martín, Igor Kislinger, Nelson Ramírez-Troche, David Canes, Caracas, Venezuela; Paul Andrews, Scottsdale, AZ; Camilo Giedelman, Hern an Aponte, Bogota, Colombia INTRODUCTION AND OBJECTIVES: Numerous techniques exist for hilar control during laparoscopic and robotic nephrectomy. These include locking polymer clips, titanium clips, and individual or en bloc staple ligation. Staplers are most commonly employed for renal vein division and control. Stapling has proven safe, reproducible, rapid, and secure. Nevertheless, various types of stapler malfunction have been reported in the MAUDE (Manufacturer and User Device Experi- ence) database with a failure incidence of 0.003%. Urologists must be acutely aware of these rare but potentially devastating scenarios. This video summarizes and illustrates various malfunction scenarios, and their proper management. METHODS: This video is a multicenter cases collection including 6 videos which exemplify linear cutting stapler failure on both the artery, and vein. Both inciting factors, and techniques for the sur- geon to extricate themselves from these terrifying scenarios are depicted. The authors collected their experiences to offer recommen- dations, technical maneuvers and tips, both to prevent and solve these problems. RESULTS: There are two mechanism of action, depending on the brand and stapling mechanism. Some simultaneously staple and cut, others make a complete staple line, followed by cutting. We only present malfunction that occur with the second mechanism. Failures depicted include complete vein or artery transection, cutting failure with incomplete staple line, failure to release from tissue, staple line over a previous clip, as well as an unspecified stapler malfunction. CONCLUSIONS: Staplers are frequently used in urologic sur- gery, however the incidence of malfunction is quite low, so low that a resident may never see a staple malfunction during training. This educational video was therefore made to demonstrate the spectrum of potential types of device malfunctions. We hope that our recommen- dations serve as a teaching tool to minimize the risk of stapler misuse, and to deal with these dangerous complications. Source of Funding: None V8-13 ACUTE INSERTION OF PENILE PROSTHESES FOR REFRACTORY ISCHEMIC PRIAPISM Paul Chung*, Timothy Tausch, Jordan Siegel, James Flemons, Allen Morey, Dallas, TX INTRODUCTION AND OBJECTIVES: Patients with refractory ischemic priapism (RIP) frequently develop severe erectile dysfunction (ED) and ultimately require penile prosthesis insertion. We describe the technique of malleable penile prosthesis (MPP) insertion in the acute setting of refractory ischemic priapism. METHODS: We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007-2013. Data analyzed included duration of erection, number of ER visits, hospital admissions, days of hospitalization and postoperative course. Costs were estimated using standard Medicare reimbursement rates. Surgery began with a 2-in longitudinal penoscrotal incision due to the need for larger corporoto- mies necessary to facilitate MPP insertion. Three pairs of traction su- tures of 2-0 PDS were placed along each corporal body. A 3-cm corporotomy was made, allowing for escape of ischemic blood and irrigation of clot. Rosello cavernotomes (Coloplast, Minneapolis, MN) were used to sequentially dilate the corpora and remove damaged intracavernosal tissue. To minimize the risk of distal erosion, the MPP was undersized by 1 cm, so that the cylinder tip resided just proximal to the coronal sulcus. A drain was placed overnight. The corporotomies and wound were closed in multiple layers with absorbable sutures. RESULTS: During the study period, 14 men underwent MPP placement acutely for refractory priapism for sickle cell anemia, medi- cation-induced or idiopathic RIP. Average preoperative duration of RIP was 82 hours (range 3.5-240) with considerable consumption of health care resources [average $83,818 estimated cost, 4 emergency room visits (range 1-27), 2 hospital admissions (range 1-5), 1.5 shunt pro- cedures (range 1-3), 5 irrigation and drainage procedures using phen- ylephrine injection (range 2-20) and 5 hospital admission days (range 2-14)]. All patients were discharged within 24 hours of MPP surgery. CONCLUSIONS: MPP insertion is efficacious for the immediate resolution of RIP and treatment of ED, which subsequently develops in many patients. MPP also has potential cost and resource benefits. Source of Funding: none V8-14 ROBOTIC SALVAGE CYSTECTOMY: TIPS AND TRICKS Neel Srikishen*, Michael Pan, Monty Aghazadeh, Brian Miles, Alvin Goh, Houston, TX INTRODUCTION AND OBJECTIVES: Robotic cystectomy has continued to become an increasingly accepted and utilized surgical approach. To our knowledge, there have been no published series of robotic cystectomy in the salvage setting, as patients who have had prior therapy for advanced prostate or bladder cancer are typically offered open salvage cystectomy. METHODS: Since 2013, we have performed robotic salvage cystectomies after a variety of prior treatment modalities including cryotherapy, brachytherapy, external beam radiotherapy, and radical prostatectomy. We followed the basic steps of a robotic cystectomy as is done in the non-salvage setting, with particular emphasis being placed on the posterior and urethral dissections. All patients underwent an intracorporeal ileal conduit urinary diversion. RESULTS: We performed seven robotic salvage cystectomies at our institution. Mean total operative time was 6.5 hours (range 4.8-8.4 hours) and mean estimated blood loss was 300 mL (range 200-500 mL). There were no bowel injuries or gastrointestinal fistulae. CONCLUSIONS: Robotic salvage cystectomy, though chal- lenging, can be safely done after a variety of prior primary therapies. More data is needed to determine long-term oncologic and functional outcomes. Source of Funding: none Plenary Session I - Best Abstracts Monday, May 18, 2015 7:30 AM-12:00 PM PI-04 DURABLE REDUCTIONS IN URINARY INCONTINENCE WITH LONG-TERM ONABOTULINUMTOXINA TREATMENT IN PATIENTS WITH OVERACTIVE BLADDER SYNDROME: FINAL RESULTS OF 3.5-YEAR STUDY Victor Nitti*, New York, NY; Dirk De Ridder, Leuven, Belgium; David Sussman, Stratford, NJ; Peter Sand, Evanston, IL; Karl-Dietrich Sievert, Lubeck, Germany; Christopher Chapple, Sheffield, United Kingdom; Brenda Jenkins, Irvine, CA; Yan Zheng, Bridgewater, NJ; Sidney Radomski, Toronto, Canada INTRODUCTION AND OBJECTIVES: Here we present final results of a multicenter, extension study which evaluated long-term Vol. 193, No. 4S, Supplement, Monday, May 18, 2015 THE JOURNAL OF UROLOGY â e719