PD11-12 PREDICTING A SUCCESSFUL OUTCOME WITH SACRAL NEUROMODULATION TESTING: ARE URODYNAMIC PARAMETERS DURING FILLING CYSTOMETRY PROGNOSTIC? Julie Jenks*, Eskinder Solomon, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, Julian Shah, Jeremy Ockrim, London, United Kingdom INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is an effective treatment modality for medically refractory over- active bladder (OAB). Standard selection criteria are based on fre- quency-volume charts, pad weight (objective) assessments, and patient reported (subjective) outcomes. Little is reported of the utility of urody- namic study in selecting patients for SNM therapy. We assessed whether the urodynamic parameters during filling cystometry correlated with successful outcome from first stage SNM testing. METHODS: All OAB patients were screened prior to first stage testing with urodynamics to confirm (idiopathic) detrusor overactivity (IDO). The mean voided volumes, peak amplitude of IDO contraction, compliance and end fill pressure was recorded. Primary outcomes were assessed using frequency-volume charts, pad testing and ICIQ/EQ5D questionnaires. Success was considered if patients achieved >50% improvement in urinary symptoms. Conversion to a permanent SNM implant was undertaken according to response. The predictive value of the four parameters was assessed using binary logistic regres- sion analysis. RESULTS: 177 consecutive IDO patients had first stage SNM evaluation between 2010 and 2013. The mean voided volume for pa- tients with successful response was 184 (147-223) mls and for those with failed response 171 (128-214) mls, peak DO pressure was 41.0 (29-52) cmH 2 0 compared to 40 (28-52) cmH 2 0, compliance pressure 12 (7-16) cmH 2 0 compared to 49 (3-95) cmH 2 0, and end fill pressure 25 (19-30) cmH 2 0 compared to 24 (14-33) cmH 2 0. Logistic regression analysis did not demonstrate any significant relationship between peak detrusor pressure and outcome (B ¼ -0.005, 0.001, 0.026, 0.016 respectively) (Figure 1). Figure 1: Box plots representing the distribution of mean void vol- ume, peak DO, compliance and end-fill pressures with first stage SNM testing. Box borders illustrate the upper, median and lower quartiles; whiskers depict the 99% interval. Extreme (star) and mild (circle) out- liers are also shown. CONCLUSIONS: There was no correlation between any uro- dynamic parameter and successful SNM outcome. SNM is an option for all IDO patients, regardless of their dynamic bladder function on filling cystometry. Source of Funding: None Female Pelvic Medicine & Reconstructive Surgery Video Sunday, May 18, 2014 8:00 AM-10:00 AM V1-01 W-V FLAP: A NEW PROCEDURE FOR RECONSTRUCTION OF FEMALE DISTAL URETHRA Divakar Dalela*, Deepansh Dalela, Rahul Yadav, Saurabh Gupta, Apul Goel, Satyanarayan Sankhwar, Lucknow, India INTRODUCTION AND OBJECTIVES: To demonstrate a new procedure utilizing local flaps of vestibular mucosa for reconstruction of distal urethra in women with totally obliterative urethral stricture. METHODS: A 34-years old lady presented with suprapubic catheter placed elsewhere to manage acute urinary retention following failed dilatation of distal urethral stricture. After informed consent, she underwent W-V flap urethroplasty in regional anesthesia and lithotomy position. A “W-shaped” area was demarcated in front and sides of urethral orifice in a manner that the base of ‘W’ faced towards the clitoris; each half of W descended on either side of urethral orifice for about 2.5 cms and the original orifice itself remained in the centre. Each half of W was raised as two separate V shaped flaps (base at 12 o’clock). The distal 1 cm of strictured urethra was dissected circum- ferentially and excised. The medial edges of two flaps representing halves of ‘W’ were sutured to each other converting the ‘W’ into ‘V’. The apex of ‘V’ was sutured circumferentially to the distal edge of urethra using interrupted absorbable sutures. The juxtaurethral part of flap was tubularised by suturing the lateral edges of flap together thus making a centimeter long neourethra. A 16 F foley catheter was placed through the tubularised flap and native urethra. RESULTS: The procedure took 80 minutes and estimated blood loss was less than 50 cc. The patient remained on indwelling urethral catheter as well as a SPC for 12 days after which she resumed normal continent voiding with a Qmax of 25 ml/sec and remained well till last follow up at 3 months. Her stream had normal forward direction but splayed. CONCLUSIONS: This procedure created a cone shaped tube from vestibular mucosa and provided an effective and simple alternative for distal urethral reconstruction. It maintained the normal forward di- rection of urinary stream. Further studies on larger number of patients are needed to standardize the procedure. Source of Funding: Nil Vol. 191, No. 4S, Supplement, Sunday, May 18, 2014 THE JOURNAL OF UROLOGY â e291