AUA Guidelines Research Articles

MP03-12 WIELDING A STONE ANALYSIS TO ITS FULL POTENTIAL: CAN PATIENTS WITH CAOX STONE DISEASE BE TREATED BASED ON COM VS COD?

INTRODUCTION AND OBJECTIVES:Calcium oxalate (CaOx) is the most common stone type in the United States. Current AUA guidelines suggest that a 24-hour urine collections should be obtained in high-ris...

MP19-15 PATIENT-REPORTED BARRIERS TO OBTAINING GENETIC COUNSELING IN EARLY-ONSET RENAL CELL CARCINOMA

INTRODUCTION AND OBJECTIVES:The 2017 AUA Guidelines for localized renal cell cancer (RCC) recommend genetic counseling for patients who are diagnosed ≤46 years. The objective of this study was to e...

MP04-04 PROACTIVE REPEAT IMAGING FOR BLUNT HIGH-GRADE RENAL TRAUMA WITH URINARY EXTRAVASATION DOES NOT IMPROVE OUTCOMES

INTRODUCTION AND OBJECTIVES:AUA guidelines state that high-grade renal injuries with urinary extravasation (UE) may be managed conservatively and followed with routine repeat imaging. We sought to ...

PD44-09 ADHERENCE TO THE AUA ANTIBIOTIC PROPHYLAXIS GUIDELINES IN DIABETIC PATIENTS IS ASSOCIATED WITH SIGNIFICANTLY HIGHER RISKS OF PENILE PROSTHESIS INFECTION

INTRODUCTION AND OBJECTIVES:The most devastating complication following penile prosthesis (PP) implantation is an infection requiring device explantation. Current AUA guidelines recommend antibioti...

MP46-17 POOR COMPLIANCE WITH POST-VASECTOMY SEMEN ANALYSIS: ANALYSIS OF FACTORS AND BARRIERS

INTRODUCTION AND OBJECTIVES:AUA Guidelines recommend that men obtain a post-vasectomy semen analysis (PVSA) to confirm sterility. Current literature suggests poor compliance. No studies specificall...

PD23-06 PREDICTION OF POST-OPERATIVE EGFR IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY: HARDER THAN IT LOOKS (ON SCANS)

INTRODUCTION AND OBJECTIVES:Most recent AUA guidelines suggest that an expected drop of estimated glomerular filtration rate (eGFR) below 45 ml/min/1.733 upon radical nephrectomy (RN) should guide ...

PD18-01 CONTEMPORARY OUTCOMES OF T1 HIGH-GRADE (T1HG) BLADDER CANCER: A SINGLE CENTER EXPERIENCE

INTRODUCTION AND OBJECTIVES:Per the 2016 AUA guidelines, cystectomy should be offered to patients with recurrent T1HG disease after a single course of intravesical bacillus Calmette-Guerin (BCG). W...

MP55-10 UTILIZATION OF ENDOSCOPIC MANAGEMENT FOR URETHRAL STRICTURES IN AQUA

INTRODUCTION AND OBJECTIVES:Repeated endoscopic management of urethral strictures has poor long-term success. Recent AUA guidelines on urethral stricture disease encourage early urethroplasty. Cont...

122 Diagnosis and Management of Testosterone Deficiency – Comparison of Current Guidelines

Testosterone deficiency (TD) is characterized by low levels of testosterone (T) with associated signs and symptoms. Several controversies related to the diagnosis and management of TD have been identified. In an attempt to provide clarity for patients and healthcare providers, several professional organizations have developed clinical practice guidelines focused specifically on TD. We compare current guidelines for the diagnosis and management of TD, as well as special considerations for specific patient populations. Guidelines from the following organizations were included for analysis: American Urological Association (AUA – 2018), Canadian Medical Association (CMAJ – 2015), European Association of Urology (EAU – 2018), and Endocrine Society (ES – 2018). The comparison focused on the biochemical definition (cut-off) for low T, principles of management of TD, and recommendations for patients with low-to-normal total testosterone, prostate cancer, or cardiovascular disease. General diagnostic and management principles are in agreement, however specific biochemical cut-offs range between 8 to 10.4 nmol/L (Table 1). The CMAJ guideline has no specific cut-off for low T and requires only one lab measurement of total T as opposed to the two measurements required in other guidelines. In patients with low-to-normal total T, there is consensus among the guidelines in recommending further hormonal evaluation. However, only the CMAJ guideline provides additional recommendations for testosterone replacement therapy (TRT) by suggesting a 3-month therapeutic trial if patients are symptomatic. The ES guideline has the strictest recommendations for patients with TD and prostate cancer. Other guidelines generally recommend against TRT in patients with metastatic prostate cancer. Although there is limited evidence linking TRT and risk of cardiovascular events (MI, stroke, sudden CV death), the AUA and EAU guidelines impose more restrictions in offering TRT to patients with cardiovascular disease. Notably, the AUA guideline recommends against TRT if patients experienced a cardiovascular event within the past 3-6 months, while the EAU guideline states that TRT is contraindicated in patients with NYHA Class IV heart failure. In contrast, the CMAJ guideline recommends TRT in patients with stable cardiovascular disease.

060 Discrepancy Between Vasectomy Guidelines and Practice Patterns in the Post 2012 AUA Guideline Era: What have we Learned?

In 2012, the American Urological Association published vasectomy guidelines to guide clinicians in best practices. To assess practice patterns of post-vasectomy semen analyses (PVSA) in a large, community cohort. We analyzed a database of men who underwent PVSA between 2011 and 2017 at a centralized laboratory. Samples were collected both on- and off- site. Samples collected off-site were transported to the laboratory in 40 ml of nutrient solution to maintain motility, if present. Samples were centrifuged if initial evaluation revealed azoospermia. Vasectomies were performed by both urologic and non-urologic providers in both academic and community settings. A total of 5,596 men underwent PVSA with 1,095 (19.5%) undergoing one or more repeat analyses. On initial analysis, 3,211 (57.4%) were azoospermic, 1,622 (28.9%) had rare non-motile sperm (<100k), 495 (8.8%) had >100k non-motile sperm, and 258 (4.6%) had motile sperm. Several observations were inconsistent with AUA guidelines. 11.7% (376) of patients with initial azoospermia had a repeat analysis, of whom 6.1% had rare non-motile sperm and 0.5% (2/376) had motile sperm (subsequent failure after initial clearance). 26.6% (431) of patients with rare non-motile sperm on initial semen analysis underwent repeat semen analysis, with 76.8% (331) of these men demonstrating azoospermia, 21.6% (93) with persistent non-motile sperm, and, importantly, 0% developing motile sperm. Of men with >100k non-motile sperm on initial analysis, 60.0% (297) did not obtain a repeat semen analysis, contrary to current AUA recommendations. Among the 198 men who did obtain a repeat analysis after an initial analysis with >100k non-motile sperm, 86.4% (167) were downgraded to either rare non-motile sperm or azoospermia at last semen analysis, 13.6% (27) had persistent >100k non-motile sperm, and 0% (0) subsequently developed motile sperm.

128 Treatment of Estrogen Levels in the Management of Hypogonadism: An Anonymous Survey of ISSM Members

With the significant increase in treatment of hypogonadism and the use of testosterone therapy, hormone management has evolved into a complicated topic, requiring specialized knowledge. When patients’ testosterone levels rise, aromatase converts testosterone into estrogen, leading to rising estrogen levels. Though the AUA guidelines mention the use of aromatase inhibitors as an option, and mention hyperestrogenemia as a risk of testosterone therapy, no further guidelines regarding management of hyperestrogenemia or hypoestrogenemia are provided. We aim to assess the variability in management of estrogen levels in men treated with testosterone therapy. An anonymous survey was sent to the membership of ISSM using survey monkey. The survey included questions on respondent demographics, including time practicing urology, and practice location, type, and specialty. In addition, we asked respondents their approach to management of estrogen in patients receiving testosterone therapy. Responses to the surveys were collected and tabulated using Survey Monkey (San Mateo, California, USA). Chi-square test was used to determine association between categorical variables.

Treatment disparities among patients in the National Cancer Database (NCDB) with clinical TIa and TIb renal masses.

648 Background: AUA guidelines on the management of renal cell carcinoma (RCC) recommend prioritizing partial nephrectomy (PN) for the treatment of clinical T1a (cT1a) tumors, using PN for clinical T1b (cT1b) tumors when feasible, and performing minimally invasive surgery (MIS) when possible. Since cT1 RCC is a heterogeneous disease, we evaluated patterns of care in this population to examine factors associated with receipt of PN and MIS. Methods: We queried the NCDB from 2010-2014 to identify patients treated surgically for cT1N0M0 RCC. Patient socio-demographics, clinical characteristics, and treatment parameters were compared between cT1a and cT1b patients. Logistic regression models examined factors associated with receiving MIS. Results: Our population included 69,694 patients (44,043 cT1a and 25,651 cT1b). For cT1a tumors, 70% of patients received PN, while 30% received RN; 35% of patients underwent an open procedure and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 68% received RN; 38% of patients underwent an open operation and 62% underwent MIS. In both cohorts, African Americans and those earning &lt;$62,000 were less likely to have MIS. Distance to treatment was not significant in cT1b patients, but cT1a patients who traveled &gt;31 miles were more likely to undergo MIS. Patients treated at a community hospital were less likely to receive MIS compared to those treated at academic centers (cT1a OR: 0.48, 95% CI: 0.44-0.53 and cT1b OR: 0.63, 95% CI: 0.56-0.7). cT1a patients without private insurance were less likely to receive MIS (OR range: 0.58-0.93). However, only uninsured cT1b patients were less likely to undergo MIS (OR: 0.74, 95% CI: 0.64-0.86). Conclusions: PN occurred more frequently for cT1a (70%) vs. cT1b (32%) tumors. Most cT1 tumors received MIS; 35% of cT1a patients and 38% of cT1b patients underwent an open procedure, presenting an opportunity for improvement. cT1a and cT1b patients with lower household income, without private insurance, and those treated outside academic centers were less likely to receive MIS. Based on these findings additional research on the impact of regionalization of RCC surgery on utilization of PN vs. RN, receipt of MIS, and outcomes is warranted.

State rurality does not increase risk of prostate cancer death.

119 Background: Prostate cancer is the third most common cancer among men. PSA based screening for prostate cancer was introduced in the 1980s and resulted in a significant decline in prostate cancer mortality. Current AUA guidelines recommend PSA screening in average risk patients between the ages of 55 and 69. There are public health concerns in rural areas of the United States (US) potentially due to decreased access of care. In this study, we sought to evaluate the prevalence of prostate cancer screening and death rate in rural communities within the US. Methods: After IRB approval, data was collected from several different sources. Annual prostate cancer death rate (2011-2015) was obtained from the American Cancer Society. Data from the Behavioral Risk Factor Surveillance System regarding prostate cancer screening during this time interval was acquired. Data regarding populations was obtained from the US Census. Descriptive analyses were used to describe the population and Pearson Correlation Coefficient to determine screened, death rates and rurality correlations. All analyses were completed using SPSS. Results: The median percent of US population residing in rural and urban areas was 25.8% (IQR 22.1%) and 73.8% (IQR 22.1%), respectively. The median percent of male patients screened using PSA 50 years and older was 56.2% (IQR 7.0%). The median death rate (per 100,000) from prostate cancer per state was 19.5 (IQR 1.7%). Prostate cancer death rate was found to have no correlation to percent of population screened (p = 0.29) and percent rurality (p = 0.98). The percent rural population versus percent of screened men over the age of 50 was also not significant (p = 0.20). Conclusions: Neither death rate nor screening rate for prostate cancer using PSA demonstrated a significant association with the percent of patient’s living in rural communities. This is evidence that within the US, rural communities are following guidelines for PSA screening for prostate cancer and therefore there is no discrepancy in prostate cancer death in these areas compared to urban. This study is evidence that the barriers that may be associated with living in rural communities, such as decreased access to healthcare do not translate into worse outcomes related to prostate cancer.

Risk of recurrence in patients with positive surgical margin at apex only versus other locations after radical prostatectomy.

124 Background: Some reported that positive surgical margin at radical prostatectomy (RP) was a prognostic factor of clinical recurrence and prostate cancer death, and others showed that was not necessarily true. The prostatic apex is most popular location of positive surgical margin at RP and the frequency of apex is reported to be about 20-40% of all positive cases. Prostatic apex is also reported to lack a well-defined capsule and to be hardly retracted during operation. In this study, we evaluated the effect of positive surgical margin at apex-only on prognosis after RP in a large cohort. Methods: We retrospectively evaluated 1019 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant or adjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. The operative approach (open, laparoscopic, or robotic) was decided by each institution. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014 criteria. Recurrence following RP was defined according to AUA guidelines. Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (range, 0.4–82 ng/ml). The median follow-up period was 69 (range, 0.7–135) months. Pathological T stage was in 72.5% of pT2 (n = 739), 23.4% of pT3a (n = 238), and 4.1% of pT3b (n = 42). There were 163 Grade Group (GG) 1 cases, 502 GG 2, 217 GG 3, 39 GG 4, and 98 GG 5 cases. 372 cases had positive surgical margin. Details were 201 (54%) apex only, 57 (15%) anterior, 43 (12%) posterior, 76 (20%) lateral, 40 (11%) bladder. Some patients showed multiple positive surgical margin. The patients with positive surgical margin at apex-only showed significantly better prognosis than other locations (P = 0.0001). This result was confirmed in each operative approach (open; P = 0.008, laparoscopic; P = 0.001, robotic; P = 0.01). Conclusions: Among surgical margin positive patients after RP, those at prostatic apex-only showed lower biochemical recurrence than other locations regardless of operative approach. Physician should follow such a patient carefully without adjuvant therapy.

AB002. AUA guideline: update on Peyronie’s disease

Peyronie’s disease (PD) is the most common cause of acquired deformity of the penis and is characterized by the development of fibrotic, collagen-containing plaques, and some time penile ossification within the tunica albuginea (TA) resulting in penile deformity, pain, and erectile dysfunction (ED). Currently, the prevalence of this disease has been reported to be between 3.2% and 8.9%. PD progresses in two phases: an acute phase that can last for up to one year, followed by a chronic phase. Formation of the plaque, the penile curvature, and the pain develop during the acute phase and the chronic phase is characterized by the stabilization of the curvature, decrease in penile pain, penile calcification or ossification, and development of ED. The AUA Guidelines Panel conducted a systematic review of the literature using the PubMed®, EMBASE® and Cochrane databases to identify peer-reviewed publications relevant to the diagnosis and treatment of PD. A copy of the 2015 guidelines is attached. The most relevant recommendations are listed below: (I) clinicians should not offer oral therapy with vitamin E, tamoxifen, procarbazine, omega-3 fatty acids, or a combination of vitamin E with L-carnitine. [Moderate recommendation; evidence strength grade B (vitamin E)/B (omega-3 fatty acids)/B (vitamin E propionyl-lcarnitine)/C (tamoxifen)/C (procarbazine)]. (II) Clinicians may administer intralesional collagenase clostridium histolyticum in combination with modeling by the clinician and by the patient for the reduction of penile curvature in patients with stable PD, penile curvature >30. (III) Clinicians should counsel patients with PD prior to beginning treatment with intralesional collagenase regarding potential occurrence of adverse events, including penile ecchymosis, swelling, pain. (IV) Clinicians may offer tunical plication surgery to patients whose rigidity is adequate for coitus (with or without pharmacotherapy and/or vacuum device therapy) to improve penile curvature. (Moderate recommendation; evidence strength grade C).

Ultrasonido Doppler de pene en la evaluación posterior a prostatectomía radical. Revisión bibliográfica y recomendaciones

Changes in sexual function are common in patients following radical prostatectomy for prostate cancer. Sexual rehabilitation after radical prostatectomy requires a complex process in which the diagnosis is refined, and an accurate treatment program is chosen. Penile Doppler ultrasound is a commonly used method for diagnosing erectile dysfunction and it is very useful in certain cases after surgery to improve the assessment of arterial evaluation, venous leaks, and quality of the cavernous tissue and fascia. A literature search was conducted using the databases from Google and PubMed to identify original and review articles that examined the uses of penile Doppler ultrasound in post-radical prostatectomy evaluation or post-surgery rehabilitation. Search terms included: Erectile dysfunction post radical prostatectomy, sexual function post radical prostatectomy, Penile evaluation post-prostatectomy, Diagnosis of erectile function after radical surgery, Penile Doppler ultrasound AND prostatectomy, Penile Doppler ultrasound AND sexual rehabilitation. The initial search resulted in 415 articles. After applying additional filters, 46 studies were included in the present review. Backgrounds of the most relevant guidelines were cited: Standard practice in sexual medicine, Standard operating procedure in sexual medicine, International Consultation on Sexual Medicine, and the EAU and AUA guidelines. Information on the use of penile Doppler ultrasound before surgery is extremely inconsistent in the literature. The recommendations for a successful evaluation of post-radical prostatectomy patients were included. Sexual rehabilitation after radical prostatectomy requires a complex process. There is great inconsistency in the literature with respect to the definition of what is considered normal erectile function before surgery and what may be considered normal erection after radical prostatectomy. The cost of penile Doppler ultrasound is a modest component of the penile post-radical prostatectomy rehabilitation process. Current evidence does not support the systematic use of penile Doppler ultrasound, but it must be included in the management algorithm of the patient undergoing radical prostate surgery so that erectile function can be properly evaluated. KEYWORDS: Prostate cancer; Sexual Dysfunction; Erectile dysfunction; Sexual rehabilitation; Penile Doppler ultrasound; Radical Prostatectomy.

Ultrasonido Doppler de pene en la evaluación posterior a prostatectomía radical. Revisión bibliográfica y recomendaciones

Changes in sexual function are common in patients following radical prostatectomy for prostate cancer. Sexual rehabilitation after radical prostatectomy requires a complex process in which the diagnosis is refined, and an accurate treatment program is chosen. Penile Doppler ultrasound is a commonly used method for diagnosing erectile dysfunction and it is very useful in certain cases after surgery to improve the assessment of arterial evaluation, venous leaks, and quality of the cavernous tissue and fascia. A literature search was conducted using the databases from Google and PubMed to identify original and review articles that examined the uses of penile Doppler ultrasound in post-radical prostatectomy evaluation or post-surgery rehabilitation. Search terms included: Erectile dysfunction post radical prostatectomy, sexual function post radical prostatectomy, Penile evaluation post-prostatectomy, Diagnosis of erectile function after radical surgery, Penile Doppler ultrasound AND prostatectomy, Penile Doppler ultrasound AND sexual rehabilitation. The initial search resulted in 415 articles. After applying additional filters, 46 studies were included in the present review. Backgrounds of the most relevant guidelines were cited: Standard practice in sexual medicine, Standard operating procedure in sexual medicine, International Consultation on Sexual Medicine, and the EAU and AUA guidelines. Information on the use of penile Doppler ultrasound before surgery is extremely inconsistent in the literature. The recommendations for a successful evaluation of post-radical prostatectomy patients were included. Sexual rehabilitation after radical prostatectomy requires a complex process. There is great inconsistency in the literature with respect to the definition of what is considered normal erectile function before surgery and what may be considered normal erection after radical prostatectomy. The cost of penile Doppler ultrasound is a modest component of the penile post-radical prostatectomy rehabilitation process. Current evidence does not support the systematic use of penile Doppler ultrasound, but it must be included in the management algorithm of the patient undergoing radical prostate surgery so that erectile function can be properly evaluated. KEYWORDS: Prostate cancer; Sexual Dysfunction; Erectile dysfunction; Sexual rehabilitation; Penile Doppler ultrasound; Radical Prostatectomy.

Determinants of guideline-based treatment in patients with cT1 bladder cancer.

e16518Background: Clinical T1 (cT1) bladder cancer is associated with high rates of recurrence, upstaging, and progression. AUA and NCCN guidelines recommend these patients be treated with adjuvant...

PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST Andrew Sun, Shufeng Li, and Michael Eisenberg Andrew SunAndrew Sun More articles by this author , Shufeng LiShufeng Li More articles by this author , and Michael EisenbergMichael Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is characterized by fibrous penile plaque formation that interferes with sexual function and quality of life. Many treatments have been proposed, the most recent being collagenase clostridium histolyticum (CCH) injections (FDA approved in 2014). Currently only verapamil, CCH, and surgical approaches are recommended by AUA guidelines. Given mixed evidence for efficacy of verapamil, invasive nature of surgery, and novel mechanism of CCH, there is significant interest in CCH use. We sought to evaluate the impact of CCH on the prevalence, treatment, and cost of PD. METHODS Optum is a national database with information from adjudicated and paid insurance claims of privately-insured individuals, covering between 6 and 7 million males from 2004 to 2016. We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6) and treatments. Both individual years and eras before and after CCH use (2004-2013 vs 2015-2016) were analyzed for prevalence of PD, overall rate of PD treatment, rate of penile injections, rate of CCH use, rate of surgical PD procedures, and cost associated with treatment. Analyses were conducted using SAS (version 9.3). RESULTS The annual prevalence of PD rose from 0.03% in 2004 to 0.08% in 2011 and remained stable thereafter. Among men >50, the prevalence remained between 13-14% after 2011. However, annual rates of PD treatment increased from an average of 11.1% for 2004-2013 to a high of 14.8% in 2015. Corresponding to this, annual penile injection rates increased from an average of 5.5% from 2004-2013 to 9.5% for 2015-2016. By 2016, CCH was 74.9% of all penile injections. Average annual rates of penile plication (3.3% vs 3.4%), penile grafting (1.0% vs 0.51%), and penile prosthesis (12.1% vs 12.1%) among men with a PD diagnosis remained stable for the same eras. The average annual cost of PD treatment per man increased from $1824.16 in 2004 to $4010.92 in 2016 (inflation adjusted). This was most pronounced from 2013 to 2016 where an average increase of $361.41 per year was observed, versus $122.50 for the years prior. CONCLUSIONS The prevalence of PD stabilized in 2011 and did not increase after CCH became available in 2014. Over the same period, the proportion of men receiving treatment for PD increased, associated with more injections and CCH use. In addition, the cost of treating PD increased more rapidly after CCH became available. Further research into CCH use is needed to assess if the increase in treatment has improved outcomes of men with PD. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e883 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Sun More articles by this author Shufeng Li More articles by this author Michael Eisenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP04-14 VALUE BASED CARE IN BENIGN PROSTATIC HYPERPLASIA: OFFICE-BASED PROCEDURES ARE MAJOR DRIVERS SECOND TO OPERATIVE INTERVENTIONS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Epidemiology & Evaluation1 Apr 2018MP04-14 VALUE BASED CARE IN BENIGN PROSTATIC HYPERPLASIA: OFFICE-BASED PROCEDURES ARE MAJOR DRIVERS SECOND TO OPERATIVE INTERVENTIONS Jack Webb, Victoria Valencia, Jessica Wenzel, Ashley Dixon, J. Stuart Wolf Jr., and E. Charles Osterberg Jack WebbJack Webb More articles by this author , Victoria ValenciaVictoria Valencia More articles by this author , Jessica WenzelJessica Wenzel More articles by this author , Ashley DixonAshley Dixon More articles by this author , J. Stuart Wolf Jr.J. Stuart Wolf Jr. More articles by this author , and E. Charles OsterbergE. Charles Osterberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current data demonstrates great variation in cost for both procedures and workup of benign prostatic hyperplasia (BPH). We sought to determine major drivers of total payments in BPH care longitudinally using a claims database. METHODS Commercial and Medicare claims from the Truven Health Analytics Markestscan® database for the Austin, Texas Metropolitan Service Area (MSA) from 2012-2014 were queried for encounters with diagnosis (ICD9 600.0-600.21) and procedural codes related to BPH. Patients under age 18 and with fewer than 2 years of follow-up were excluded. Age, employment status, payer status, year of index visit, ambulatory surgery center visits, diagnostic tests, operations, and prescriptions filled within 7 days of a BPH encounter were included as covariates. Multivariable linear regression was utilized to assess factors associated with total BPH-related payments. Patients with total two year payments greater than 2SD of the mean were excluded (N=9). RESULTS In total, 685 patients met inclusion criteria. Mean age was 63 (SD 12) with 61% using commercial insurance. Frequencies of office and operative procedures are reported in Table 1. Cohort payment amount was $676 ($1243) for all diagnostic/operative intervention(s). Linear regression shows that major drivers of total payments in BPH care were operative - transurethral resection of prostate (TURP) ($2778, 95% CI ($2385-$3171), p<0.001) and photoselective vaporization (PVP) ($3315, 95% CI ($2781-$3849) p<0.001). Most office procedures were also associated with increased payments, including cystoscopy ($708, 95%CI ($417-$999), P<0.001), uroflowmetry ($446, 95%CI ($225-668), P<0.001), urinalysis ($167, 95%CI ($32-$302), P=0.02), postvoid residual (PVR) ($245, 95%CI ($83-$407), P<0.001), and urodynamics ($1251, 95%CI ($405-2097), P<0.001). CONCLUSIONS The largest magnitude of total payments for BPH care in the Austin MSA are operative, but common office procedures like uroflometry (12% performed) and PVR (28% performed) also significantly impact cost. Current AUA guidelines suggest these diagnostics are optional. Cost-conscious, evidence-based medicine will be essential to contain unnecessary, yet prevalent, office diagnostics. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e38-e39 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jack Webb More articles by this author Victoria Valencia More articles by this author Jessica Wenzel More articles by this author Ashley Dixon More articles by this author J. Stuart Wolf Jr. More articles by this author E. Charles Osterberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...