GFR (Beta �0.47, p�0.01) and age (Beta -0.44, p�0.01), but not typeof urinary diversion, were independently associated with 3-year renalfunction.

CONCLUSIONS: In bladder cancer patients undergoing radicalcystectomy, T-Pouch orthotopic urinary diversion did not mitigate areduction in renal function. Baseline GFR and age were independentpredictors of 3-year renal function. Extended follow-up of trial subjectsis ongoing.

Source of Funding: None

1157URINARY DIVERSION PRACTICE PATTERNS AMONGCERTIFYING AMERICAN UROLOGISTS

Jonathan Silberstein*, Stephen Poon, Alexandra Maschino, NewYork City, NY; William Lowrance, Salt Lake City, UT; Tullika Garg,Harry Herr, Sherri Donat, Guido Dalbagni, Bernard Bochner,Jaspreet Sandhu, New York City, NY

INTRODUCTION AND OBJECTIVES: Urinary diversions (UD)are complex and technically challenging operations. Submission of allprocedures (case logs) performed by applicants in a consecutive 6month period during the 18 months prior to certification or recertification(every 10 years) is required by the American Board of Urology (ABU).We sought to investigate contemporary trends in UD usage and sur-geon characteristics in the utilization of incontinent (IUD) and continenturinary diversions (CUD) from ABU case logs.

METHODS: Annualized case log data for UD were obtainedfrom the ABU for all applicants (certifying and recertifying), from 2002to 2010. Chi-squared tests and logistic regression models were used toevaluate the association between surgeon characteristics and the useof UD.

RESULTS: Among 5,096 non-pediatric urologist case logs ex-amined, only 37% (n�1,868) of urologists performed any UD; amongthese urologists, the median number of UD performed was 4 cases/yr(IQR 2, 6) with fewer than 12% (n�222) performing 10 or more UD peryear. Only 9% (n�471) of the total cohort of non-pediatric urologistsperformed any CUD . The likelihood of performing at least one CUDincreased with number of UD performed (OR 1.22, 95%CI 1.19-1.26;p�0.001). Surgeons with a self-identified “oncology” specialty (OR4.23, 95%CI 3.19-5.62; p�0.001) or “academic” practice (OR 2.74,95%CI 2.17-3.45; p�0.001) were most likely to perform CUD. Sur-geons who described their practice type as “private practice” were lesslikely to perform CUD (OR 0.49, 95%CI 0.4, 0.61; p��.0005). Surgeonage, year of certification, original versus recertification, practice areapopulation size and region had no influence on the likelihood of per-forming CUD. In multivariable analysis, only UD volume (OR 1.2,95%CI 1.16-1.24; P�0.001) and “private practice” (OR 0.74, 95%CI0.54,1.01; p�0.06) continued to predict likelihood of performing anyCUD. Additionally, surgeons performing the highest volume of UD werethose who performed the greatest percentage of CUD (see figure),regardless of certification type.

CONCLUSIONS: Only a minority of urologists perform any UD,and among these surgeons, CUD are most frequently utilized by highvolume surgeons. The type of UD a patient receives may dependlargely on the volume of UD performed by their surgeon. Furtherresearch is required to examine the surgeon’s decision making processin selecting IUD vs. CUD and role of specialized training.

Source of Funding: Supported by the Sidney Kimmel Centerfor Prostate and Urologic Cancers, by funds provided by DavidH. Koch through the Prostate Cancer Foundation, and by theNational Cancer Institute T32 CA082088-11 training grant.

1158INCIDENCE, PREDICTORS AND MANAGEMENT OF STONES INPATIENTS WITH ORTHOTOPIC NEO-BLADDERS: LONG-TERMFOLLOW-UP OF 983 PATIENTS

Scott Leslie*, Andre Luis de Castro Abreu,Pierre-Marie Lewandowski, Amar Patel, Gus Miranda, Jie Cai,Adrian Fairey, Inderbir S Gill, Eila C Skinner, Matthew Dunn, LosAngeles, CA

INTRODUCTION AND OBJECTIVES: Patients with urinary di-versions are at increased risk of urolithiasis. Different techniques ofbladder substitution have evolved over the years. We discuss theincidence, site of stones, predictors and management of stone diseasein the different types of orthotopic reconstructions, Kock urethra (KU),T-pouch (TP) and Studer neobladder (SN), performed at our institution.

METHODS: The records of 983 consecutive patients who un-derwent a radical cystectomy and orthotopic bladder reconstructionbetween April 1987 and November 2004 were reviewed. Informationregarding the type of bladder substitution, the stone characteristics andthe subsequent management of the calculi was obtained. Differences insurgical technique (including the use of staples) and other risk factorsfor urolithiasis were analyzed to determine the impact they had onstone formation and treatment.

RESULTS: Of the 983 patients identified, 445 (45%) had a KU,364 (37%) had a TP, and 174 (18%) had a SN. Overall 80 (8%) patientsdeveloped stones and the median time to the first stone episode was3.8 years. Overall estimated stone-free survival at 5 and 10 years were92% and 87% respectively. Stones occurred in 9.9% of patients whohad a KU, 9.6% for those that had a TP and 4.8% for those that had aSN (p � 0.022).

The table demonstrates that patients with a KU or TP formedstones almost exclusively within the bladder substitution. In contrast,stones within the SN group most commonly occurred in the uppertracts. The stone size was larger in the KU and TP groups, and thesestones were associated with staples in 58% of cases. The managementof the stones was also different with 66.7% of SN stones managedconservatively, whereas 82.3% of KU or TP stones required endo-scopic management. The stone clearance rate following treatment ofthe first stone was 95.4%. However, the recurrence rate followingtreatment of the first stone was 22.6%.

CONCLUSIONS: The differences in surgical technique, includ-ing use of staples in the KU group and an afferent nipple valve in boththe KU and TP group, are likely contributing factors to the incidence,site and size of calculi when compared to the SN group. Larger stones,located in the neo-bladder of the KU and TP groups often necessitated

Vol. 187, No. 4S, Supplement, Monday, May 21, 2012 THE JOURNAL OF UROLOGY� e469