drainage of lesions is ineffective in curing the root cause of the problem, and persistence or worsening is the rule over time. Complete surgical resection followed by local flap or skin graft closure is possible, curative and most often successful, at the cost of a unsurprisingly high number of self limited wound complications. Urologists should endeavor to fix instead of merely manage this difficult problem. Source of Funding: None MP79-07 INDICATIONS FOR NOVEL INTERPOSITION MYOCUTANEOUS FLAP FOR THE REPAIR OF RECTO- URINARY FISTULA Alyssa Greiman*, Lawrence Dagrosa, Nima Baradaran, Eric Rovner, Harry Clarke, Charleston, SC INTRODUCTION AND OBJECTIVES: Recto-urinary fistula (RUF) is a rare complication following pelvic surgery, radiation or trauma. We report our experience using a perineal approach with a cremasteric myocutaneous interposition flap (CIF) for the treatment of symptomatic RUF and sought to compare their outcomes with patients undergoing repair with other interpositions. METHODS: We identified all patients undergoing RUF repair at a single institution from January 2001 to June 2014. Demographics, fistula etiology, surgical approach and outcomes were reviewed. Suc- cessful RUF repair was defined based on a post-operative voiding cystourethrogram without evidence of contrast extravasation. RESULTS: 26 patients underwent RUF repair by a single sur- geon at our institution. All patients underwent colonic diversion prior to repair. Initial repair was performed at the median age of 63 (21-83) years using a cremasteric interposition flap (CIF) in 12 patients, gracilis interposition flap (GIF) in 13 and a rectus myocutaneos flap (RMF) in one. Median follow-up was 8.8 (1-44) months. Fistulas were catego- rized as complex where radiation therapy, salvage cryoablation or APR was performed (69.2%), and simple when they occurred in the setting of radical prostatectomy, hemorrhoidectomy or trauma (30.8%). Pre-repair hyperbaric oxygen was performed in 57.7% of patients and was not associated with improved success in initial closure for either complex or simple fistulas (p¼0.16, 0.69). In the CIF group, 9 (75%) patients failed the initial repair with 2 subsequently undergoing successful second CIF, 4 with successful subsequent GIF and 2 lost to follow-up. One patient failed a repeat CIF. The majority of patients (88%) who failed initial repair with CIF had radiation-induced fistulas, whereas only 33% of patients with a successful initial repair had prior radiation exposure (p¼0.12). In the GIF group, 11(84.6%) had successful repair with initial surgery. Initial repair of simple fistulas was more successful than complex fistulas (p¼0.04). The use of GIF or rectus myocutaneous flap resulted in improved success in complex fistula repair as compared to CIF (p¼0.004). There was no difference seen in success of simple fistula repair when comparing GIF and CIF (p¼0.17). CONCLUSIONS: Perineal repair of RUF using CIF is a novel approach with potentially less morbidity than larger muscle interposition flaps. However, the CIF is less effective in complex fistulas and thus should only be considered in patients with simple fistulas. For complex fistulas, a more vascularized flap such as GIF or rectus myocutaneous flap is effective. Source of Funding: none MP79-08 UPDATED OUTCOMES OF EARLY ENDOSCOPIC REALIGNMENT FOR PELVIC FRACTURE URETHRAL INJURIES AT A LEVEL 1 TRAUMA CENTER Paul H Chung*, Hunter Wessells, Bryan B Voelzke, Seattle, WA INTRODUCTION AND OBJECTIVES: The initial management of pelvic fracture urethral injuries (PFUI) with early endoscopic realignment (EER) versus suprapubic tube (SPT) placement is contro- versial. At our institution, early endoscopic realignment (EER) is per- formed for all patients who undergo pelvic fracture repair. In our initial analysis from 2011, we evaluated 19 patients and reported a 21% success rate for EER. We sought to update our experience with EER following PFUI. METHODS: A retrospective review was performed of patients treated at our level 1 trauma center with EER for PFUI secondary to blunt pelvic trauma. EER was performed with a retrograde or a com- bined antegrade/retrograde approach with a cystoscope through the SPT tract. Failures of EER were defined as requiring a secondary procedure, permanent SPT management, or lost to follow up (LTF). Treatment success was defined as no secondary procedure or the ability to pass a cystoscope across the area of injury or surgical anastomosis. RESULTS: Thirty patients underwent EER at our institution between 2004-2016 with a mean follow up of 27 months (range 0-105). Mean time to realignment was 2 days (range 0-6). Delayed EER was scheduled with another surgical service in 22 patients (81%). Average operative time for EER was 46 minutes (range 6-100). No patient experienced complications from endoscopic realignment (i.e. pelvic abscess or orthopedic hardware infection). The catheter was removed on average 35 days (range 12-98) after EER. 26 pa- tients (87%) returned with obstructive voiding symptoms (mean 27 days, range 2-109) requiring delayed surgical treatment and 1 patient was LTF. Using an intent-to-treat analysis, 27 patients (90%) failed EER (Figure). 15 patients underwent primary urethroplasty with 100% success. 2 patients elected permanent SPT management. 9 patients underwent primary endoscopic management with dilation or DVIU with 22% success (2/9). Of the 7 patients who failed endoscopic man- agement, 6 patients underwent urethroplasty with 100% success and 1 patient was LTF. CONCLUSIONS: Our updated overall success rate for EER was 10%. The low long term success rates of EER should be balanced with potential benefits such as decreased orthopedic hardware infection after SPT removal and improved alignment in the case a subsequent urethroplasty is required. Source of Funding: None MP79-09 TITLE: ROBOT ASSISTED PENILE INVERSION VAGINOPLASTY A DESCRIPTION OF A NOVEL TECHNIQUE Brenton Armstrong*, Aaron Weinberg, NEW YORK, NY; Kiranpreet Khurana, cleveland, OH; Jamie Levine, Lee Zhao, NEW YORK, NY INTRODUCTION AND OBJECTIVES: Gender confirmation surgery represents an essential component in the management of gender identity disorder. The perineal dissection and creation of the neovaginal canal is the most challenging aspect of the penile inversion vaginoplasty (PiV) and poor visualization can lead to surgical com- plications. An incomplete dissection also results in a foreshortened neovagina, increased risk for vaginal stenosis and need for excessive postoperative dilations. Here we present the results of our first 15 patients performed at our intuition utilizing our robot assisted PiV (RAPiV). Vol. 197, No. 4S, Supplement, Monday, May 15, 2017 THE JOURNAL OF UROLOGY â e1075