RESULTS: A total of 43 men (n�22 DOBG, n�21 ANTA) witha mean followup of 20�15 months were identified. There were nosignificant differences between ANTA patients and DOBG patientsin terms of age, previous treatment, location of the stricture withinthe bulbar urethra, or postoperative followup. ANTA was significantlymore likely to be used for an obliterative type stricture (found in 50%versus 18% of those who underwent a DOBG, p�0.043). There wasno significant difference between groups in the use of bilateralbuccal grafts; mean buccal length harvested was significantly less inthe ANTA group (5.1�1.7cm) versus the DOBG group (6.0�1.9cm,p�0.048). Overall, there were 6 patients with minor postoperativecomplications, and 1 patient with a postoperative periurethral ab-scess requiring conversion to a staged procedure. From the medicalrecords, no new postoperative erectile dysfunction or chordee wasreported in either group. There was no significant difference in postvoid dribbling between the two groups (ANTA 32% versus DOBG25%, p�0.65). Mean Qmax at last followup was similar in bothgroups (ANTA 23�12 mL/sec versus DOBG 22�9 mL/sec, p�0.92).Overall success rate was 93% and not statistically different betweengroups, with one ANTA patient and two DOBG patients requiring apost-urethroplasty dilation.

CONCLUSIONS: The ANTA has results similar to DOBG in thispopulation. Significantly less buccal graft is required when using theANTA technique compared to traditional DOBG. ANTA can be used forobliterative type strictures that would have otherwise required a tran-sected AAU.

Source of Funding: None

96NEUROPHYSIOLOGIC INTRAOPERATIVE MONITORING OFSOMATOSENSORY EVOKED POTENTIALS TO DETECTNEUROLOGIC INJURIES DUE TO PATIENT POSITIONING

Marc Manganiello*, Jay Shils, Carl Borromeo, Jill Buckley,Burlington, MA

INTRODUCTION AND OBJECTIVES: To determine if intraop-erative somatosensory evoked potential (SSEP) monitoring may detectand prevent upper and lower extremity peripheral positioning relatedneuropathies in high risk urologic patients.

METHODS: 64 patients underwent urethral reconstruction andintraoperative neuromonitoring by a single surgeon (JB) from March2009 through August 2010. During the procedure, electrodes wereplaced at the wrist to stimulate the radial, ulnar and/or median nerve.The SSEP’s were recorded at the brachial plexus (for upper limbnerves), the cervical spine, and the cortex. The functional integrity ofthe pathway was monitored using the characteristic SSEP waveformparameters (amplitude and latency) from the various recording sites.The surgical and anesthesia teams were alerted when significantwaveform changes (50% reduction in amplitude) occurred and re-positioning of the patient was performed. Patients were assessedpostoperatively for neurologic deficits.

RESULTS: 9 of the 64 patients in our cohort experiencedsignificant intra-operative SSEP changes. The SSEP changes weredetected on all upper extremity leads (1), all right upper extremityleads (2), right ulnar lead (1), left ulnar lead (3), and left median lead(2). 8 of these SSEP reductions were detected within ten minutes ofthe beginning of the case and returned to baseline with repositioningof the affected extremity. One event occurred after repositioning thepatient during the case with correction bringing the SSEP back tobaseline. In these 9 patients, there were no postoperative events. 2of the 64 patients awoke with neurologic symptoms that were notdetected intraoperatively. One experienced bilateral forearm numb-ness and hand extensor weakness, which resolved by the time ofdischarge. The second experienced right upper extremity sensoryand motor weakness that required extensive neurologic assessmentand prolonged physical therapy until 95% resolution at 3 months. Nolower extremity neuropathies occurred.

CONCLUSIONS: SSEP is a useful monitoring device to detectand prevent common position related neuropathies. Patients undergo-ing prolonged procedures or those at a high risk of a positioning relatedneuropathy may avoid postoperative neuropathies with SSEP monitor-ing. Detection of potential peripheral nerve damage largely occurredwithin the first ten minutes after positioning with resolution after re-positioning and no post-operative events.

Source of Funding: None

97EXTRAPERITONEAL BLADDER RUPTURES: COMPLICATIONSASSOCIATED WITH OPERATIVE VERSUS NON-OPERATIVEMANAGEMENT AT THE TIME OF ANTERIOR PELVICFIXATION OR ABDOMINAL EXPLORATION FOR OTHERINJURIES

Michael Taylor*, William Brant, Chad Wallis, Molly McFadden, SaltLake City, UT; Mark Stevens, Jay Bishoff, Murray, UT; RaminderNirula, Jeremy Myers, Salt Lake City, UT

INTRODUCTION AND OBJECTIVES: We sought to under-stand whether complication rates, in patients with extraperitonealbladder rupture, were influenced by the management of these inju-ries with either an operative versus a non-operative approach at thetime of anterior pelvis fixation or abdominal exploration for otherinjuries.

METHODS: Patients with bladder injury were identified from theprospective trauma registry from all designated trauma 1 hospitals inUtah from 1996–2010. Multiple patient data points were collectedpertaining to injury presentation, management, and outcomes. Patientswere excluded from our study if they had any component of intraperi-toneal bladder injury.

RESULTS: A total of 259 patients were identified with possi-ble lower urinary tract injury, 121 of these patients had bladderinjury, and 73 of these bladder injuries were extraperitoneal. Themean age of the patients was 38.4 years. The predominant mech-anism of injury was blunt trauma (93.2%) and the mean injuryseverity score was 24.3. Concomitant injuries included pelvic frac-ture in 64 (87.7%), solid organ injury in 19 (26.0%), and urethralinjury in 10 (13.7%). 63 patients had bladder specific followup to ruleout persistent urinary leak; the remaining patients died or had noradiologic follow up of their injury. The rate of persistent leak, in allpatients with extraperitoneal injuries, with operative versus conser-vatively managed cases, was 5.6% (1/18) and 17.7% (8/45)(p�0.04). At the time of anterior pelvic fixation, operative versusconservative management was associated with persistent leak in12.5% (1/8) and 20.0% (2/10) (P�1.0). During abdominal explora-tion for other injuries, operative versus conservative management ofbladder injury was associated with persistent leak in 0% (0/6) and16.7% (1/6) (P�0.44).

CONCLUSIONS: Extraperitoneal bladder injuries had a non-significant trend to have lower rates of persistent urinary leak whenthey were managed operatively. This trend was found in the entirecohort, as well as at the time of anterior pelvic fixation or abdominalexploration for other injuries. This finding was the stimulus for anongoing multi-institutional analysis of bladder injury to determine ifthis trend is significant with a greater number of patients. Given thisfinding, trauma surgeons should consider operative management ofextraperitoneal bladder injury at the time of anterior pelvic fixation orabdominal exploration.

Source of Funding: None

Vol. 185, No. 4, Supplement, Saturday, May 14, 2011 THE JOURNAL OF UROLOGY� e41