Objectives: To validate each of the sino-nasal outcome test and the sinus and nasal quality of life (SN5) surveys for the adolescent population defined as 12 to 18 years old, and to determine if they correlate in regard to reports of sinonasal symptoms and quality of life.Study Design: Cross-sectional study.Methods: Adolescent patients, age 12 to 18 years old, presenting to our otolaryngology clinic between August 2020 and June 2021 were asked to fill both the SNOT-22 and the SN5 forms. Demographics and comorbidities were reviewed. Patients recruited were then divided into a sinonasal cohort (those with chronic sinonasal symptoms) and a control cohort (those who did not have any sinonasal disorders at time of visit).Results: One hundred fifteen patients completed both surveys, 80 patients in the sinonasal cohort and 35 patients in the control cohort. Average age was 14.9 years, and 49.6% were female. Mean SNOT-22 and SN5 scores were significantly higher in the sinonasal cohort as compared with the control cohort which confirmed validity of both surveys for the adolescents. Good test-retest reliability for both surveys was obtained (r = 0.76 for SNOT-22, and r = 0.64 for SN5). SNOT-22 and SN5 scores correlated well in both the sinonasal cohort (r = 0.63, p < 0.0001) and the control cohort (r = 0.61, p = 0.0003). Both surveys strongly predicted chronic sinonasal disorders with an odds ratio of 2.5 for SNOT-22 and 2.2 for SN5.Conclusion: Both instruments can be used to study the outcome of treatment for sinonasal disorders in adolescent patients.

Objective To report our experience on the complications of primary pediatric endoscopic sinus surgery (ESS). Methods Case series of pediatric ESS performed from 1991 to 2016 on children who failed maximal medical therapy and/or adenoidectomy. Inclusion criteria were children (age <12 years old) who underwent primary ESS with or without adenoidectomy for chronic rhinosinusitis (CRS) after failed maximal medical therapy and/or adenoidectomy. All patients underwent maxillary antrostomy ± partial or total ethmoidectomy. Patients with complicated acute rhinosinusitis were excluded. Complications reviewed included: skull base injury and CSF leak, orbital injuries (blindness, orbital hemorrhage, emphysema, periorbital swelling and bruising, fat exposure), and bleeding requiring intervention. Results A total of 352 patients underwent ESS between 1991 and 2016. There were no blindness or orbital hematoma reported, and no major nasal bleeding requiring intervention. The total number of complications was 31 (8.8%): 1 (0.3%) CSF leak, 3 (0.85%) orbital emphysema, 5 (1.4%) periorbital ecchymosis, and 22 (6.3%) lamina papyracea violation with orbital fat exposure. Conclusions Complications of primary pediatric ESS can be rare dependent on surgeon's experience, the most common being orbital injury. Level of evidence: 4.

Introduction Erectile dysfunction (ED) affects up to 30 million men in the United States and as many as 150 million men worldwide. Although the most common contributing factors such as cardiovascular disease, obesity, and diabetes currently receive the most attention, cancer diagnosis as an independent risk factor deserves further scrutiny. Prior studies have shown increased incidence of ED in cancer patients with both direct and indirect pathways postulated. Despite this, documentation of a history of ED before and after cancer treatment remains understudied. Objective To document the difference in SHIM scores between a group of patients carrying a urologic malignancy diagnosis and a second group of general urologic patients. Secondary endpoints included prevalence of several comorbid conditions and descriptive statistics of ED prevalence and both desire for and treatment of ED. Methods A standardized questionnaire was prospectively administered at a tertiary care academic urology clinic which treats all forms of urologic malignancy in a rural population of about 2 million. The survey included the validated Sexual Health Inventory for Men (SHIM), information regarding oncologic diagnosis, and comorbid medical conditions including BPH, tobacco use disorder, alcohol consumption, diabetes, depression, hypertension, and high cholesterol. Surveys were administered pre- and post-treatment to all consenting patients. The control group consisted of male urologic patients with no present or past diagnosis of urologic malignancy (UM). Mann-Whitney U tests were used to compare means for continuous variables and chi-squared tests for categorical variable comparison. Results A total of 762 patients completed the entire survey, with 214 (28.1%) patients reporting a history of UM. Sixty-one (28.1%) were bladder cancer diagnoses with an additional 83 (38.8%) renal cancer and 125 (58.4%) prostate cancer. Analysis revealed a statistically significant difference in mean SHIM scores between patients with UM and without UM (p &lt;0.05), with SHIM total mean 15.478 +/− 7.823 in UM patients while non-oncologic patients scored 17.598 +/− 7.574. There were no significant differences in the prevalence of 7 of the 8 studied comorbid conditions (HTN p=0.007). Only 2.8% of oncology patients reported receiving treatment for ED while 64% reported interest in receiving treatment for ED. Conclusions Urologic malignancy is significantly associated with lower SHIM scores. More striking however is the large discrepancy between those interested in treatment and those receiving it, especially at a tertiary care academic center. As a result, our institution is working towards a urologic cancer survivorship protocol involving evaluation by a sexual dysfunction specialist within one year of treatment or earlier. The present study emphasizes the need for physician vigilance and both physician and patient education to improve outcomes in a distressed population. Disclosure No

Arteriovenous malformations (AVMs) secondary to renal-cell carcinoma (RCC) are well-described in the literature. Independently, renal vein and inferior vena cava tumor thrombi can be detected in locally-advanced RCC. A 67-year-old gentleman presented with a cT1b renal mass detected on workup for elevated creatinine. Multiphase CT imaging obtained for partial nephrectomy surgical-planning revealed an initially-missed renal cortical AVM. This drastically changed the plan for intervention, including use of an open approach with AVM embolization by interventional radiology prior and avoidance of a nephron-sparing approach. Final pathology confirmed the AVM and a subclinical renal vein thrombus masked by arterial flow on CT imaging, making this the first concurrent case described in the literature. Herein, we describe avoidance of catastrophic intraoperative hemorrhage by careful review of preoperative imaging and provide a literature review of imaging modalities for both renal surgical-planning and detection of tumor thrombi in RCC.

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