tive systemic treatment for patients with metastatic renal cell carci-noma (mRCC), with upfront cytoreductive nephrectomy (CN) indi-cated for patients suitable for surgery and with good performancestatus. However, the role of CN for patient with mRCC is stillcontroversial and conflicting in the era of targeted therapy, withoutselection criteria for CN. The aim of study was to identify preoper-ative factors that might be used to better identify patients whoprobably will benefit from CN.

METHODS: We reviewed the medical records of 119 patientswho presented with synchronous clear cell type mRCC at the AsanMedical Center from November 2006 to December 2010 and hadreceived no systemic therapy before enrollment. Of the 119 studypatients 71 underwent CN followed by targeted therapy (CN group) and48 received targeted therapy alone (nonCN group). Kaplan-Meier curveand Cox proportional hazards model were used for overall survival(OS) analysis. Potential prognostic factors included age at treatment,sex, Karnofsky score, duration from diagnosis to treatment, CN ornonCN, sarcomatoid feature, numbers of metastatic sites, metastaticsite (bone, liver, central nervous system), hemoglobin, lactate dehydro-genase, corrected calcium.

RESULTS: Mean OS for CN vs. nonCN groups was 29.0 and14.6 months, respectively (p�0.001). On multivariate analysis to pre-dict the probability of death Karnofsky score (�70%, hazard ratio[HR]�4.3, p�0.001), numbers of metastatic sites (�2, HR�2.4,p�0.001), and any sarcomatoid feature (HR�2.0, p�0,040) wereindependent predictors of death. CN did not affect the probability ofoverall mortality on multivariate analysis (HR�0.64, p�0.111). Even inanalysis according to each prognostic factors, CN was not an indepen-dent predictor. In 38 patients with Karnofsky score�70%, single met-astatic site, and no sarcomatoid feature, mean OS for CN vs. nonCNgroups was 42.2 and 20.9 months, respectively (p�0.032). On multi-variate analysis to predict the probability of death only CN (HR�0.28,p�0.044) was an independent predictor of death.

CONCLUSIONS: The 3 preoperative factors (Karnofskyscore�70%, single metastatic site, and no sarcomatoid feature) iden-tified from present study results can be used to help identify patientswith mRCC who will benefit from CN. Therefore, the treatment ofthose unable to meet selection criteria can be directed towardtargeted therapy alone, helping them to avoid the unnecessarymorbidity of CN.

Source of Funding: None

1841LONG TERM MANAGEMENT AND OUTCOMES OFRECURRENCES FOLLOWING RADIO FREQUENCY ABLATIONOF RENAL TUMORS

Gideon Lorber*, Arturo Castro, Mehul Doshi, Vladislav Gorbatiy,Reymond Leveillee, Miami, FL

INTRODUCTION AND OBJECTIVES: We present the longterm management and oncological outcomes of patients diagnosedwith recurrent renal tumors following primary radiofrequency ablation(RFA) of renal cell carcinoma (RCC).

METHODS: We reviewed our prospectively collected databaseof patients with renal masses treated between November 2001 andOctober 2012 with laparoscopic (LRFA) or computed tomography (CT)guided percutaneous RFA (CTRFA). All treatments were performedwith real-time temperature monitoring to ensure target ablation temper-ature was adequately obtained. Inclusion criteria consisted of patientswith a follow-up (FU) longer than 48 months who developed a recur-rence following RFA of a biopsy confirmed RCC. FU consisted ofphysical examination, serum creatinine and contrast enhanced radio-graphic imaging (CT or MRI). Recurrence was defined as enhancementof �20 Hounsfield units post contrast confirmed as RCC by biopsy ordocumented to exhibit persistent growth on serial imaging. We re-viewed the management approaches of these patients as well ascomplication rate and overall survival.

RESULTS: Out of 434 RFA cases, a total of 77 treatments in 67patients had a FU longer than 48 months. In this group 6 cases, in 5patients, met the inclusion criteria of recurrent RCC following primarytreatment for RCC. Five were biopsy confirmed recurrent RCC tumor.The mean disease free interval was 27 months (5 to 42 months), themean FU was 71 months (54 to 96 months) and the mean renal masssize was 2.8 cm (1 to 4 cm). The management of the recurrencesconsisted of repeat CTRFA in 3 cases, repeat LRFA in 2 cases andnephrectomy in 1 case. Complication rate was 17% (1 out of 6) whichconsisted of Clavien grade 1 complication. One patient died in thecourse of the study bringing our survival rate to 83%.

CONCLUSIONS: The low recurrence rate of 8% and adequatesecondary treatment with no significant morbidities point to the onco-logic efficacy and safety of RFA.

Source of Funding: None

Urodynamics/Incontinence/Female Urology: FemaleUrology (II)

Podium Session 32

Tuesday, May 7, 2013 1:00 PM-3:00 PM

1842MINIMALLY INVASIVE LAPAROSCOPIC MANAGEMENT OFURETERAL ENDOMETRIOSIS. PROSPECTVE ANALYSIS OF 54CASES WITH A MEAN FOLLOW UP OF 36 MONTHS

Oskar Kaufmann*, Heloisa Ferreira Brudniewski, Winston Chen,Rosa Maria Neme, Sao Paulo, Brazil

INTRODUCTION AND OBJECTIVES: Endometriosis of theurinary tract is rare, compromising 1% to 2% of all endometriosis cases.Most cases are localized in the bladder (84%) or in the lower third of theureter (10%). The aim of the study was to evaluate prospectively theefficacy of laparoscopic management of ureteral endometriosis.

METHODS: We have prospectively followed 54 patients pre-senting with ureteral endometriosis from October 2008 to October2012.

RESULTS: From 635 endometriosis cases operated from Oc-tober 2008 to October 2012 in a private clinic, we have found anincidence of 8.5% (54 cases) with preoperative evidence of moderate-severe ureter dilatation. Dysmenorrhea (91%) and dyspareunia (68%)were the symptoms more frequently reported; but only 29.6% (16patients) had urinary symptoms and one patient had renal exclusion. In51 cases, laparoscopic ureterolysis and resection of endometriosis wasdone, in two laparotomic ureterocystoneostomy, and in 1 laparoscopicnephrectomy was performed. In 23 cases we had associated bladderlesions simply treated by laparoscopic resection. No major complica-tions were found. The left ureter was affected in 83 % (n�45) of casesand disease was bilateral in just 2 cases. Median follow-up time was 36months.

CONCLUSIONS: Laparoscopic diagnosis and management ofureteral endometriosis is safe and efficient. Preoperative planningshould be rigorous, and complete surgical excision of ureteral endo-metriosis should be ensured by a team of experts familiar with endo-metriosis, and its management.All patients who undergo laparoscopyfor endometriosis should be evaluated for possible ureteral involvementregardless the presence or absence of urinary symptoms or priorradiological evaluation.

Source of Funding: None

e756 THE JOURNAL OF UROLOGY� Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013