Purpose of review Interspinous process devices (IPDs) are used in the surgical treatment of lumbar spinal stenosis. The purpose of this review is to compare the first generation with the next-generation devices in terms of complications, device failure, reoperation rates, symptom relief, and outcome. Recent findings Thirty-seven studies were included from 2011 to 2016. Device failure occurred at a mean of 3.7%, with a lower tendency to happen with next-generation IPDs. Reoperations occurred at a lower rate with the nextgeneration devices, with a mean follow up of 24 months (3.7% vs. 11.1%). The clinical outcome is not influenced by the type of IPD. Summary The long-term functionality of these devices is questionable, with radiologic changes and recurrence of symptoms often seen by 2 years following implantation. Next-generation devices do not appear to be subject to the same "bounce back" effect of symptom re-emergence after several years.

Nine out of ten patients were high risk according to EAU guidelines. Being high-risk was not identified as a predictor of SDO and of positive semen cultures at first evaluation. On the contrary, recurrent haemospermia, history of STD and history of rUTI were identified as independent predictors of reporting positive semen cultures in the real-life settings.

INTRODUCTION AND OBJECTIVE: FG management is performed by either reconstructive urology (RU) or surgery/burn (SB) at our institution. Component separation closure (CSC) has become method by the RUs over split-thickness skin grafting (STSG), which is still favored by SB. The purpose of this study was to compare surgical management and outcomes between these cohorts and to determine patient and wound predictors for the need for split thickness skin grafting and post-operative wound morbidity.METHODS: Between 2009-19, 138 men underwent debridement for FG; 82 (59%) were managed with debridement alone (þ/wound vac (WV)), and 8 (6%) died w/in 72 hours, leaving 48 that underwent surgical reconstruction. Reconstruction was performed by RU (n[29) and BP (n[19). FG anatomical extent (AE) was categorized as none (0), <50% (1) and >50% (2) for the penis, scrotum, perineum and suprapubic region, with a total AE score that ranged from 1 (min) to 8 (max). CSC involves debridement of granulation tissue with a VER-SAJET, aggressive mobilization of skin flaps and involved spermatic cordsþ/-hydrocelectomy, with the goal of primary closure of all defects when a tension free anastomosis can be obtained and sexual/urinary compromise is not predicted. Closure over a drain is performed with 2-0 polygactin (deep) and 3-0 nylon interrupted for skin. Unclosed areas after CSC are treated with either STSG or secondary intentionþ/-WV (Figure 1). RESULTS: Cohort FG AE is depicted in Figure 2, with scrotum (n[44, 92%) and perineum (n[29, 60%) being most affected. STSG was utilized in 100% of cases closed by SB and 31% (9/29) closed by RU, though mean AE was higher in SB managed wounds versus RU (4.5 v 2.7, p[0.001). STSG use by RUs was predicted by site number with >50% loss (each site OR 4.1,p[0.0017) and total AE (each point OR 3.2,p[0.0156) controlling for age, BMI and days to closure. Minor and major (requiring intervention) wound morbidity was noted in 13 (27%) and 3 (6%), not predicted by RU/SB, AE or STSG use.CONCLUSIONS: CSC of FG wounds significantly decreases the need for STSG without increasing wound morbidity.

285 Background: Widespread availability of NGS and an expanding repertoire of targeted therapies has garnered significant enthusiasm for the concept of NGS directed therapy. FoundationOne (Foundation Medicine, Cambridge, MA) is a validated comprehensive genomic profiling (CGP) assay intended to guide therapy decisions based upon tumor specific genetic variations. We reviewed our experience with FoundationOne testing in advanced genitourinary (GU) cancer and examined whether NGS effected therapy in a meaningful way. Methods: Retrospective review of patients with advanced GU cancer seen between 2/1/2013–8/13/2018 who had FoundationOne CGP testing. We then compared the duration patients were maintained on NGS directed therapy to the duration of each non-NGS therapy. Results: A total of 73 patients were identified with NGS testing for prostate (25, 34%), urothelial (30, 41%), and kidney (18, 25%) cancer. 11 (15%) of these patients had therapy directed against a genetic alteration indicated by NGS. Of the treated patients, 46% (5) had urothelial, 36% (4) had kidney, and 18% (2) had prostate cancer. The average duration that each non-NGS therapy was effective in patients with urothelial, kidney, and prostate cancer was 165, 417, and 382 days respectively. Duration of NGS directed therapy averaged 226, 367, and 278 days for urothelial, kidney, and prostate cancer. The range of the duration of response to NGS directed therapy for urothelial, kidney, and prostate cancer was 66-616 days, 106-467 days, and 28-528 days. Four (36%) patients treated with NGS directed therapy achieved a duration of response greater than the average duration of all other non-NGS directed therapy they had received (Table). Conclusions: A minority of patients received NGS directed therapy following NGS testing. Treated patients demonstrated varying responses with 4 patients experiencing a longer duration of response compared to non-NGS directed therapy. Our experience illustrates that NGS has a limited but evolving role in the management of advanced GU malignancies at this time while also demonstrating a benefit to a subset of patients. Future studies should focus on identifying which patients are most likely to benefit from this technology.