American Urological Association Quality Research Articles

A Multifaceted Assessment of Benign Prostatic Hyperplasia Practice and AUA Guideline Adherence.

Guidelines for benign prostatic hyperplasia (BPH) were initially formulated by the AUA to provide evidence-based reasoning for the management and care of men suffering from lower urinary tract symptoms due to BPH. Recommendations for a urinalysis and validated symptom questionnaire (AUA Symptom Score [AUASS]/International Prostate Symptom Score [IPSS]) have been long standing, making these data points a metric for examining guidelines adherence. A survey assessed providers' awareness of AUA BPH guidelines and practice patterns, and was sent to a randomly selected portion of the AUA membership. The AUA Quality (AQUA) Registry was queried to assess testing and practice patterns. Of 4884 invitations sent, 404 responses were received. Most survey respondents (91.8%) indicate they intend to get a urinalysis at initial evaluation. AQUA data found urinalysis was obtained in only 22.8% of patients. Symptom questionnaire use increased with increasing guideline familiarity, with 95.7% of those who are "extremely familiar" routinely using AUASS/IPSS compared to only 69.4% who are "somewhat familiar" (P < .005). Utilization increased by a factor of 2.7 (P < .005) for each increment in familiarity. The lowest use of AUASS/IPSS was in the group within 5 years of finishing training (P = .069). Discrepancies are noted between our practice survey and AQUA data. The AUASS/IPSS is less commonly used by providers with less guideline familiarity and in providers with the least clinical experience. The intent to obtain urinalysis is high; however, actual testing is unfortunately infrequent. These findings could point toward the need for increasing education of providers with regard to clinical guidelines.

Burden of non-muscle–invasive bladder cancer (NMIBC) leveraging a novel American Urological Association Quality Registry Qdata module: A real-world data analysis based on manual data abstraction.

Burden of non-muscle–invasive bladder cancer (NMIBC) leveraging a novel American Urological Association Quality Registry Qdata module: A real-world data analysis based on manual data abstraction.

Who Progresses to Third-Line Therapies for Overactive Bladder? Trends From the AQUA Registry.

Overactive bladder (OAB) patients who do not achieve satisfactory results with second-line OAB medications should be offered third-line therapies (percutaneous tibial nerve stimulation, sacral neuromodulation, onabotulinumtoxinA bladder injection [BTX-A]). We aimed to determine which clinical factors affect progression from second- to third-line OAB therapy. Between 2014 and 2020, the AUA Quality Registry was queried for adult patients with idiopathic OAB. For the primary outcome, patient and provider factors associated with increased odds of progression from second- to third-line therapy were assessed. Secondary outcomes included median time for progression to third-line therapy and third-line therapy utilization across subgroups. A total of 641,122 patients met inclusion criteria and were included in analysis. Of these, only 7487 (1.2%) received third-line therapy after receiving second-line therapy. On multivariate analysis, patients aged 65 to 79, women, White race, history of dual anticholinergic and β3 agonist therapy, metropolitan area, government insurance, and single specialty practice had the greatest odds of progressing to third-line therapy. Black and Asian race, male gender, and rural setting had lower odds of progressing to third-line therapy. BTX-A was the most common therapy overall (40% BTX-A, 32% sacral neuromodulation, 28% percutaneous tibial nerve stimulation). The median time of progression from second- to third-line therapy was 15.4 months (IQR 5.9, 32.4). Patients < 50 years old and women progressed fastest to third-line therapy. Very few patients received third-line therapies, and the time to progression from second- to third-line therapies is > 1 year. The study findings highlight a potential need to improve third-line therapy implementation.

Factors Influencing Medication Selection for Management of Overactive Bladder: Trends and Insights From AUA Quality Registry

ObjectiveTo determine how a patient’s demographics, including insurance type, race/ethnicity, gender, and age, may impact the choice of medication prescribed for overactive bladder. MethodsWe queried the AUA Quality Registry for adults between 2014 and 2020 with a diagnosis of overactive bladder for >1 year, excluding neurogenic causes. Variables included age, race/ethnicity, gender, insurance type, medication first prescribed, year of prescription, provider metropolitan status, and provider practice type. Primary outcome was which factors were associated with increased odds of beta-3 prescription as first medication choice. ResultsWe found 1,453,566 patients with overactive bladder, 641,122 (44.1%) with complete data. Of these, 112,021 (17.5%) were prescribed medication. On multivariate analysis, patients with Medicaid, Medicare, and other/self-pay insurance were less likely to receive a beta-3 versus an anticholinergic compared to private or military insurance. Compared to white patients, Asian, Black, and other races were less likely to receive a beta-3, as were patients outside of metropolitan areas. Age >50, prescriptions after 2014, and non-academic settings were associated with increased odds of beta-3 prescription. There was no difference between genders. ConclusionsMany nonclinical factors, including insurance type and race, may affect which medication is first prescribed for overactive bladder. This is useful for practicing urologists and may help lower barriers to beta-3 prescription through policy change and advocacy.

MP76-20 TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: DATA FROM THE AUA QUALITY (AQUA) REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP76-20 TRENDS IN SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA: DATA FROM THE AUA QUALITY (AQUA) REGISTRY Charles Jones, Benjamin Breyer, Rachel Mbassa, William Meeks, Raymond Fang, and Matthew Cooperberg Charles JonesCharles Jones More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , William MeeksWilliam Meeks More articles by this author , Raymond FangRaymond Fang More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The list of surgical options for benign prostatic hyperplasia (BPH) has exploded in recent years, but little is known about the uptake of these new procedures in community urology practice. In this study we aimed to examine surgical BPH practices and trends across the country using the American Urological Association Quality Registry (AQUA). METHODS: The AQUA Registry was launched in 2014 to centralize quality reporting and improvement, primarily among community-based urology practices. Data regarding surgical BPH management from 2014-2021 were accessioned directly from electronic health records at 245 practices across the country. Procedures were grouped by CPT code. These included prostatic urethral lift (Urolift), transurethral incision of the prostate (TUIP), transurethral resection of the prostate (TURP), repeat TURP, laser coagulation of the prostate, laser vaporization of the prostate, holmium laser enucleation of the prostate (HoLEP), transurethral microwave therapy (TUMT), transurethral needle ablation (TUNA), transurethral destruction of the prostate by water vapor thermal therapy (Rezum), simple prostatectomy, and other genitourinary procedure. Patients were characterized by race and age. Practice location was also examined. RESULTS: The mean age of BPH diagnosis was 66.4 years old. 72% were White, 7% Black, 1% Asian, and 20% unknown. A total of 300,215 BPH procedures were recorded from 2014-2021. TURP had the greatest overall decline from a relative incidence of 40.1% of total BPH procedures in 2016 to 25.6% in 2021. TURP was used for 32% of White patients, 34% of Black patients, and 26% of Asian patients. Urolift use grew from 0.7% of cases in 2014 to 30.1% in 2021. HoLEP comprised approximately 1% of procedures throughout the time period studied. CONCLUSIONS: There has been a large shift in the procedures of choice for surgical management of BPH within community urology practices in the United States, with Urolift having a significant increase in total and relative proportions of procedures performed since its FDA approval in 2013. There has been a concurrent decrease in TURP, while HoLEP has stayed relatively consistently uncommon in community practice. Source of Funding: AQUA Registry is funded by the American Urological Association © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1100 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Jones More articles by this author Benjamin Breyer More articles by this author Rachel Mbassa More articles by this author William Meeks More articles by this author Raymond Fang More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-08 DETERMINANTS OF BETA-3 AGONIST PRESCRIPTION FOR OVERACTIVE BLADDER ACCORDING TO THE AUA QUALITY REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP19-08 DETERMINANTS OF BETA-3 AGONIST PRESCRIPTION FOR OVERACTIVE BLADDER ACCORDING TO THE AUA QUALITY REGISTRY Max Bowman, Katherine Shapiro, Camille Velez, Rachel Mbassa, Raymond Fang, Benjamin Brucker, and Michelle van Kuiken Max BowmanMax Bowman More articles by this author , Katherine ShapiroKatherine Shapiro More articles by this author , Camille VelezCamille Velez More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , Raymond FangRaymond Fang More articles by this author , Benjamin BruckerBenjamin Brucker More articles by this author , and Michelle van KuikenMichelle van Kuiken More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: First-line treatment for overactive bladder (OAB) is behavioral therapy, followed by oral anticholinergics (ACH) or beta-3 agonists (B3). B3 agonists are better tolerated, but prescription rates between the two classes vary greatly. Using the AUA Quality (AQUA) Registry, we aim to determine which factors are associated with receiving a B3 agonist versus an ACH as the first prescription for OAB. METHODS: In this cross-sectional study, we queried the AQUA registry from 2014-2020 for adults with new diagnosis of OAB, including frequency, urgency, nocturia, and urge incontinence, examining the prescription rate and choice of first medication prescribed. Patients with neurogenic bladder or incomplete data were excluded. Insurance, age, race/ethnicity, gender, practice type, metropolitan status, and year of prescription were examined via multivariate analysis to determine which were associated with prescription of B3 agonists. RESULTS: 641,122 patients were diagnosed with OAB during the study period, and 112,021 (17.5%) received medication. Compared to those with private insurance, patients with Medicaid, Medicare, and other/self-pay were less likely to receive a B3 (OR 0.81, 0.91, and 0.68, respectively; p<0.001). Odds of receiving B3 increased over age 50: 51-64 (OR 1.11), 65-79 (OR 1.29), and >80 (OR 1.62) (p<0.001 for all). Compared to white patients, black (OR 0.87, p<0.001), Asian (OR 0.91, p=0.05) and those of other races (OR 0.84, p=0.005) had lower odds of receiving B3 agonists. Additionally, patients in rural areas (OR 0.85, p<0.001) and those seen in academic practices were less likely to receive B3 therapy than those seen in multispecialty, single specialty, or solo practices (Table 1). Patient gender was not associated with a difference in B3 prescription. CONCLUSIONS: Factors associated with increased B3 agonist prescription included white race, older age, having private or military insurance, and residence in a metropolitan area. Non-white patients, younger patients, those residing in rural areas, and those seen in academic practices were less likely to receive B3 prescription as their first choice of medication. These findings indicate that factors other than the patient’s disease affect treatment offered. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e267 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Bowman More articles by this author Katherine Shapiro More articles by this author Camille Velez More articles by this author Rachel Mbassa More articles by this author Raymond Fang More articles by this author Benjamin Brucker More articles by this author Michelle van Kuiken More articles by this author Expand All Advertisement PDF downloadLoading ...

MP75-16 LONGER SURGICAL WAIT TIMES AFTER VISIT TO UROLOGY CLINIC IS ASSOCIATED WITH DECREASED ODDS OF COMPLEX STONE SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP75-16 LONGER SURGICAL WAIT TIMES AFTER VISIT TO UROLOGY CLINIC IS ASSOCIATED WITH DECREASED ODDS OF COMPLEX STONE SURGERY Sudarshan Srirangapatanam, Cameron Hicks, Thomas Chi, Marshall Stoller, and David Bayne Sudarshan SrirangapatanamSudarshan Srirangapatanam More articles by this author , Cameron HicksCameron Hicks More articles by this author , Thomas ChiThomas Chi More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and David BayneDavid Bayne More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney stones are known to grow over time and delays between emergency department visits and surgical care are associated with more complex surgical intervention. As such, the objective of this study is to investigate the effect of the wait times from urology clinic visits to surgery on the eventual complexity of kidney stone surgery. METHODS: Urologic visits were identified using The AUA Quality (AQUA) Registry. Subsequently, adults (age ≥18) having a diagnosis of nephrolithiasis and undergoing ≥1 urologic stone procedure were identified. These patients were then followed for at least 365 days after their index surgery to determine the total burden of procedures. Any patients without 365 days of follow-up were excluded. Our outcomes were defined as percutaneous nephrolithotomy (PNL) vs. non-PNL index surgery, undergoing more than 1 urologic procedure within 365 days, and receipt of complex surgery (PNL as index surgery or >1 procedure within 365 days). Each outcome was analyzed using a multivariate logistic model with wait times as predictor controlling for age, gender, race, insurance, social deprivation index, obesity, diabetes, and flomax prescription. RESULTS: A total of 137,477 patients underwent ≥1 urologic stone procedure. Of these, 6,497 (4.7%) patients underwent index PNL and 40,968 (29.8%) patients underwent more than 1 procedure within 365 days. Stratifying patients by index procedure type revealed highers odds of undergoing PNL for any wait time (ref: 0-3 months) but little change was observed as wait times increased (slope=0.0005, p=0.29). Odds of undergoing multiple procedures (slope=-0.0035) and receipt of complex stone surgery (slope=-0.0031) both showed a decreased trend as wait times increased (p<0.001). CONCLUSIONS: Increased surgical wait times is generally expected to lead to worse outcomes due to disease progression in the patients. Paradoxically, we show that an increasing time interval from urologic clinic visits to surgical treatment associates with lower odds of complex surgery. Therefore, time from diagnosis to evaluation by a urologist may be the rate-limiting step in the time course of kidney stone treatment. And reducing this time may reduce previously recognized disparities in the eventual need for complex kidney stone surgery. Source of Funding: K12DK111028 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1086 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sudarshan Srirangapatanam More articles by this author Cameron Hicks More articles by this author Thomas Chi More articles by this author Marshall Stoller More articles by this author David Bayne More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-14 CHOICE OF FIRST MEDICATION PRESCRIBED FOR OVERACTIVE BLADDER CHANGES WITH TIME: TRENDS FROM THE AUA AQUA REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP37-14 CHOICE OF FIRST MEDICATION PRESCRIBED FOR OVERACTIVE BLADDER CHANGES WITH TIME: TRENDS FROM THE AUA AQUA REGISTRY Camille Vélez, Max Bowman, Katherine Shapiro, Rachel Mbassa, Raymond Fang, Benjamin Brucker, and Michelle van Kuiken Camille VélezCamille Vélez More articles by this author , Max BowmanMax Bowman More articles by this author , Katherine ShapiroKatherine Shapiro More articles by this author , Rachel MbassaRachel Mbassa More articles by this author , Raymond FangRaymond Fang More articles by this author , Benjamin BruckerBenjamin Brucker More articles by this author , and Michelle van KuikenMichelle van Kuiken More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is a clinical condition that can greatly affect quality of life. Pharmacological management of OAB may involve use of anticholinergic (ACH) or beta-3 agonists (B3) medications; however, there is increasing evidence of cognitive side-effects associated with the long-term use of ACH medications. Using the AUA AQUA Registry, we aim to evaluate how prescription trends between ACH and B3 agonists has changed over time. METHODS: We queried the AUA Quality (AQUA) Registry database, a national Qualified Clinical Data Registry, for patients >18 years with a new diagnosis of OAB including urinary urgency, frequency, and urgency urinary incontinence (UUI) from 2014-2020 using ICD-9 and ICD-10 codes. Patients with a diagnosis of neurogenic bladder or neurologic diagnosis associated with neurogenic bladder were excluded. The choice of first medication prescribed for OAB was assessed and these trends were observed and analyzed. RESULTS: A total of 641,112 patients were diagnosed with OAB over the study period, 17.5% of whom received a medication prescription. In 2014, ACH comprised 76.3% of OAB treatment prescriptions, while B3 agonists made up 22.1%; Over time, ACH use steadily declined to only 60.3% of first prescriptions, while B3 agonist prescriptions nearly doubled to a peak of 41.4% in 2019, leveling off to 38% in 2020. (Figure 1a). When comparing individual ACH medications, a sharp decrease was observed in solifenacin prescriptions, which went from the most prescribed ACH at 34.8% in 2014 to third most prescribed at 7.7% in 2020. As solifenacin use declined, oxybutynin ER use increased from 11.9% in 2014 to a peak of 26.4% in 2020 to become the most prescribed ACH (Figure 1b). CONCLUSIONS: These prescription trends illustrate that ACH medications remain the most common class of medications first prescribed for OAB, however B3 agonist use has steadily increased with time. Further investigation leveraging the AUA AQUA Registry will help understand what drives OAB medication prescription trends by urologists in the US. Source of Funding: This study was supported by AUA statistical services © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e519 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Vélez More articles by this author Max Bowman More articles by this author Katherine Shapiro More articles by this author Rachel Mbassa More articles by this author Raymond Fang More articles by this author Benjamin Brucker More articles by this author Michelle van Kuiken More articles by this author Expand All Advertisement PDF downloadLoading ...

Time Trends and Variation in the Use of Active Surveillance for Management of Low-risk Prostate Cancer in the US

Active surveillance (AS) is endorsed by clinical guidelines as the preferred management strategy for low-risk prostate cancer, but its use in contemporary clinical practice remains incompletely defined. To characterize trends over time and practice- and practitioner-level variation in the use of AS in a large, national disease registry. This retrospective analysis of a prospective cohort study included men with low-risk prostate cancer, defined as prostate-specific antigen (PSA) less than 10 ng/mL, Gleason grade group 1, and clinical stage T1c or T2a, newly diagnosed between January 1, 2014, and June 1, 2021. Patients were identified in the American Urological Association (AUA) Quality (AQUA) Registry, a large quality reporting registry including data from 1945 urology practitioners at 349 practices across 48 US states and territories, comprising more than 8.5 million unique patients. Data are collected automatically from electronic health record systems at participating practices. Exposures of interest included patient age, race, and PSA level, as well as urology practice and individual urology practitioners. The outcome of interest was the use of AS as primary treatment. Treatment was determined through analysis of electronic health record structured and unstructured clinical data and determination of surveillance based on follow-up testing with at least 1 PSA level remaining greater than 1.0 ng/mL. A total of 20 809 patients in AQUA were diagnosed with low-risk prostate cancer and had known primary treatment. The median age was 65 (IQR, 59-70) years; 31 (0.1%) were American Indian or Alaska Native; 148 (0.7%) were Asian or Pacific Islander; 1855 (8.9%) were Black; 8351 (40.1%) were White; 169 (0.8%) were of other race or ethnicity; and 10 255 (49.3%) were missing information on race or ethnicity. Rates of AS increased sharply and consistently from 26.5% in 2014 to 59.6% in 2021. However, use of AS varied from 4.0% to 78.0% at the urology practice level and from 0% to 100% at the practitioner level. On multivariable analysis, year of diagnosis was the variable most strongly associated with AS; age, race, and PSA value at diagnosis were all also associated with odds of surveillance. This cohort study of AS rates in the AQUA Registry found that national, community-based rates of AS have increased but remain suboptimal, and wide variation persists across practices and practitioners. Continued progress on this critical quality indicator is essential to minimize overtreatment of low-risk prostate cancer and by extension to improve the benefit-to-harm ratio of national prostate cancer early detection efforts.

Insights from the AQUA Registry: a retrospective study of anticholinergic polypharmacy in the United States.

Anticholinergic (ACH) burden is a risk factor for negative health outcomes among older adults. Several medications contribute to ACH burden, including antimuscarinics used to manage overactive bladder (OAB). This study aimed to understand the extent of ACH burden in an OAB population in the United States. Non-interventional retrospective analysis. Adults with OAB whose care providers participated in the American Urological Association Quality (AQUA) Registry between 2014 and 2020 were included in this study. An adapted version of the Pharmacy Quality Alliance (PQA) measure of anticholinergic polypharmacy (poly-ACH) was used to assess ACH burden. The primary outcome was the annual prevalence of poly-ACH, and a secondary outcome was the percentage of patients taking 0, 1, 2, 3, 4, or ⩾ 5 ACH medications by calendar year. Analyses were stratified by age category at diagnosis and sex. The sample comprised 552,840 patients with OAB. The mean age at initial OAB diagnosis was 65.7 years (58.2% male; 57.4% white). Prevalence of poly-ACH was highest in 2015 (3.7%) and lowest in 2020 (1.9%). Patients prescribed no ACH medications made up the largest proportion of each cohort, while those prescribed five or more comprised the smallest. The trend of decreasing proportions of patients taking increasing numbers of ACH medications was consistent. The proportion of patients prescribed no ACH medications increased from 63.3% in 2014 to 74.6% in 2020. The percentage of those prescribed three or more ACHs remained largely unchanged. Poly-ACH was highest among younger individuals (< 65 years of age) and females; temporal trends were similar overall and within each age and sex stratum. In this study, poly-ACH in patients with OAB was relatively infrequent and decreased over the study period. Further evaluation of poly-ACH is needed to assess whether the study findings reflect increased awareness of the negative effects of poly-ACH.

Patterns of Surgical Management of Male Stress Urinary Incontinence: Data From the AUA Quality Registry.

We examined contemporary patterns in treatment of male stress urinary incontinence and identified predictors of undergoing specific surgical procedures. Utilizing the AUA Quality Registry, we identified men with stress urinary incontinence utilizing International Classification of Disease codes and related procedures for stress urinary incontinence performed from 2014 to 2020 utilizing Current Procedural Terminology codes. Characteristics of the patient, surgeon, and practice were included in a multivariate analysis of predictors of management type. We identified 139,034 men with stress urinary incontinence in the AUA Quality Registry, of whom only 3.2% underwent surgical intervention during the study period. Artificial urinary sphincter was the most common procedure with 4,287/7,706 (56%) performed, followed by urethral sling with 2,368/7,706 (31%), and lastly urethral bulking with 1,040/7,706 (13%). There was no significant change by year in volume of each procedure performed during the study period. A large proportion of urethral bulking was performed by a disproportionately small number of practices; 5 high-volume practices performed 54% of the total urethral bulking over the study period. Open surgical procedure was more likely in patients with prior radical prostatectomy, urethroplasty, or care at an academic enter. Urethral bulking was more likely in patients with a history of bladder cancer or care by a surgeon of increasing age or female gender. Utilization of artificial urinary sphincter and urethral sling now exceeds utilization of urethral bulking for male stress urinary incontinence, though some practices continue to perform a disproportionate volume of bulking. Using data from the AUA Quality Registry, we can identify areas for quality improvement to facilitate guideline-adherent care.

MP43-03 ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: TIME TRENDS AND VARIATION IN THE AUA QUALITY (AQUA) REGISTRY

You have accessJournal of UrologyCME1 May 2022MP43-03 ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER: TIME TRENDS AND VARIATION IN THE AUA QUALITY (AQUA) REGISTRY Matthew Cooperberg, William Meeks, Raymond Fang, Franklin Gaylis, William Catalona, and Danil Makarov Matthew CooperbergMatthew Cooperberg More articles by this author , William MeeksWilliam Meeks More articles by this author , Raymond FangRaymond Fang More articles by this author , Franklin GaylisFranklin Gaylis More articles by this author , William CatalonaWilliam Catalona More articles by this author , and Danil MakarovDanil Makarov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) for low-risk prostate cancer is widely endorsed by major guidelines, but its use is variable as has evolved rapidly in recent years. Most extant analyses are either restricted to specific geographic regions or insurance carriers, and/or are subject to a long lag between diagnosis and data accessibility. METHODS: Data were collected from men with newly diagnosed prostate cancer in the AQUA Registry. AS was defined based on absence of active treatment and evidence of ongoing monitoring, augmented with natural language processing of physician notes. Patients were included who had known primary treatment and sufficient data to determine D’Amico risk group; those with Gleason grade group 1, PSA <10 ng/ml, and missing T stage were included as low risk. Data from 1906 urology providers at 206 practices were included. Descriptive and summary statistics were calculated, and patterns of treatment were analyzed over time and across individual practices and providers. RESULTS: From 2014 to 2019, 84,596 men in AQUA met inclusion criteria. Median (IQR) for age was 66 (61-72). Among those with known race, 79.6% were White, 15.9% Black, 1.8% Asian/Pacific Islander, 0.3% Native American, and 2.5% Other. Overall, 20.3% of men had low-risk disease at diagnosis; this proportion fell steadily from 24.6% in 2014 to 14.0% in 2019 (panel A). Across the study period, 37.1% of low- and 14.8% of intermediate-risk men chose AS as primary treatment. These figures did not vary meaningfully between White men (35.3% of low, 12.3% of intermediate risk) and Black men (34.1% of low, 12.2% of intermediate). AS rates rose over time for low-risk men from 29.6% in 2014 to 49.5% in 2019 and for intermediate-risk men from 10.4% to 20.4% (panel B). At both the practice and provider level, use of AS for men with low-risk disease ranged from 0 to 100%; provider-level AS use correlated with practice-level AS use (r=0.65, p<0.01), but with extensive provider variation within each practice (panel C). CONCLUSIONS: AS rates for low- and intermediate-risk prostate cancer have risen sharply across the US in the past half-decade but are still suboptimal for low-risk disease in particular, and local variation is profound. Further work is needed to improve and standardize both uptake and quality of AS nationwide. Source of Funding: AUA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e740 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Cooperberg More articles by this author William Meeks More articles by this author Raymond Fang More articles by this author Franklin Gaylis More articles by this author William Catalona More articles by this author Danil Makarov More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of the COVID-19 Pandemic on Urological Care Delivery in the United States.

We examined changes in urological care delivery due to COVID-19 in the U.S. based on patient, practice, and local/regional demographic and pandemic response features. We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urological practices and 3,165 providers across 48 U.S. states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Nonurgent outpatient visits decreased more across various nonurgent procedures (49%-59%) than for procedures performed for potentially urgent diagnoses (38%-52%); surgical procedures for nonurgent conditions also decreased more (43%-79%) than those for potentially urgent conditions (43%-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of recovery to baseline (73% and 69%, respectively). This study provides real-world evidence on the decline in urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urological health services by demographics and procedure type.

PD50-12 THE NATIONAL IMPACT OF THE COVID-19 PANDEMIC ON US PROSTATE CANCER COMMUNITY CARE

You have accessJournal of UrologyProstate Cancer: Detection & Screening V (PD50)1 Sep 2021PD50-12 THE NATIONAL IMPACT OF THE COVID-19 PANDEMIC ON US PROSTATE CANCER COMMUNITY CARE Matthew Cooperberg, Paul Brendel, Daniel Lee, Rahul Doraiswami, Hariesh Rajasekar, Danil Makarov, William Meeks, Raymond Fang, Matthew Roe, and Jeremy Shelton Matthew CooperbergMatthew Cooperberg More articles by this author , Paul BrendelPaul Brendel More articles by this author , Daniel LeeDaniel Lee More articles by this author , Rahul DoraiswamiRahul Doraiswami More articles by this author , Hariesh RajasekarHariesh Rajasekar More articles by this author , Danil MakarovDanil Makarov More articles by this author , William MeeksWilliam Meeks More articles by this author , Raymond FangRaymond Fang More articles by this author , Matthew RoeMatthew Roe More articles by this author , and Jeremy SheltonJeremy Shelton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002072.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We used data from a specialty-wide, community-based urology registry to determine trends in outpatient prostate cancer (PCa) care during the COVID-19 pandemic. METHODS: 3,165 (∼ 25%) of US urology providers, representing 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry, which collects data via automated extraction from electronic health record systems. We analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. Risk stratification was based on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage, and we used a natural language processing algorithm to determine Gleason and T-stage from unstructured clinical notes. The primary outcome was mean weekly visit volume by PCa patients per practice (visits defined as all MD and mid-level visits, telehealth and face-to-face), and we compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019. RESULTS: There were 267,691 PCa patients in AQUA who received care between 2019 and 2020. From mid-March to early November, 2020 (week 10 – week 44) the magnitude of the decline and recovery varied by risk stratum, with the steepest drops for low-risk PCa (Table). For 2020, overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks (∼25). Visits declined to week 14 (18.19; a 31% drop from 2019), recovered to 2019 levels by week 23, and declined steadily to 11.89 (a 58% drop from 2019) as of week 44, the cut off of this analysis. CONCLUSIONS: Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November. This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely. Source of Funding: Verana Health © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e856-e856 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Cooperberg More articles by this author Paul Brendel More articles by this author Daniel Lee More articles by this author Rahul Doraiswami More articles by this author Hariesh Rajasekar More articles by this author Danil Makarov More articles by this author William Meeks More articles by this author Raymond Fang More articles by this author Matthew Roe More articles by this author Jeremy Shelton More articles by this author Expand All Advertisement PDF downloadLoading ...

PD60-12 IMPACT OF THE COVID-19 PANDEMIC ON UROLOGY CARE DELIVERY IN THE UNITED STATES

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making V (PD60)1 Sep 2021PD60-12 IMPACT OF THE COVID-19 PANDEMIC ON UROLOGY CARE DELIVERY IN THE UNITED STATES Daniel Lee, Jeremy Shelton, Paul Brendel, Rahul Doraiswami, Danil Makarov, William Meeks, Raymond Fang, Matthew Roe, and Matthew Cooperberg Daniel LeeDaniel Lee More articles by this author , Jeremy SheltonJeremy Shelton More articles by this author , Paul BrendelPaul Brendel More articles by this author , Rahul DoraiswamiRahul Doraiswami More articles by this author , Danil MakarovDanil Makarov More articles by this author , William MeeksWilliam Meeks More articles by this author , Raymond FangRaymond Fang More articles by this author , Matthew RoeMatthew Roe More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002097.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We determined the national impact over time of the COVID-19 pandemic on outpatient urology visits and procedural volume. METHODS: We examined temporal changes in urologic care delivery in the United States from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features using real-world data from the American Urological Association Quality (AQUA) Registry, which is a Qualified Clinical Data Registry. Data are collected via automated extraction from practices’ electronic health record systems. RESULTS: There were 2,750,001 unique patients represented in our study cohort, accounting for 8,953,832 total outpatient visits and 1,570,161 procedures; data represented 157 outpatient urologic practices and 3,165 providers across 48 US states and territories. We found large (>40%) declines in outpatient visits from March 2020 to April 2020 across all patient demographic groups and across states, regardless of timing of state stay-at-home orders. Visits recovered through May and early June, but began falling again by early July. Non-urgent outpatient visits decreased more across various non-urgent procedures (39–47%) than for procedures performed for urgent diagnoses (29–43%); surgical procedures for non-urgent conditions also decreased more (37–53%) than those for potentially urgent conditions (13–21%) (Table). African American and Hispanic patients had smaller decreases in outpatient visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (50%) while those on Medicaid had among the lowest percentage of recovery to baseline (84.4%). Practices in zip codes with lower median incomes, higher poverty levels, and lower urologist to population ratios had smaller decreases in outpatient visits. CONCLUSIONS: This study provides timely, real-world evidence on the magnitude of decline in the provision of specialty care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses. Source of Funding: Grant number K12HS026372 from the Agency for Healthcare Research and Quality and Verana Health © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1065-e1065 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Lee More articles by this author Jeremy Shelton More articles by this author Paul Brendel More articles by this author Rahul Doraiswami More articles by this author Danil Makarov More articles by this author William Meeks More articles by this author Raymond Fang More articles by this author Matthew Roe More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Robotic Freyer's prostatectomy: Operative technique and single-center experience.

Introduction:Transurethral resection of prostate replaced open surgery and remained the gold standard in surgical management of benign prostatic hyperplasia (BPH). Holmium laser enucleation and bipolar resection of prostate managed even larger glands. Open simple prostatectomy remains an option for large glands and concurrent pathologies. Minimally invasive laparoscopic simple prostatectomy lacks general acceptance. Surgeons have now started exploring the robotic platform due to its advantages. Herein, we present the technique and initial outcomes of robotic Freyer's prostatectomy (RFP).Materials and Methods:Thirteen transperitoneal RFPs were performed using the DaVinci Xi platform. We evaluated perioperative characteristics and functional outcomes.Results:Median patient age was 67.8 years and the mean prostate volume was 105.8 ml. The median International Prostate Symptom Score (IPSS) and American Urological Association quality of life (AUA-QoL) score was 19.6 and 5.3. There were no intraoperative complications or conversion to open surgery. The mean console time and estimated blood loss were 107.30 min and 92.5 ml, respectively. One patient required redo-surgery by robotic technique due to urine leak (Clavien-Dindo Grade 3b complication). Mean hospital stay and catheter duration were 4.9 days and 5.2 days, respectively. Change (preoperative vs. postoperative) in IPSS (19.6 vs. 4.67 points), maximum flow rate (6.8 vs. 15.1 ml/s), AUA-QoL score (5.3 vs. 2.2 points) and PVR (179.4 vs 7.1 ml) were significant (P < 0001).Conclusions:RFP is a safe and effective option for managing BPH, especially for large glands. It confers minimally invasive surgery benefits with good functional outcomes.

P0183 - Impact of the COVID-19 pandemic on urologic care delivery in the United States

Plain language summaryOutpatient visits and surgical procedures declined and recovered, and the magnitude of both varied by many factors, such as race, insurance type, location, urgency of diagnosis and procedure. The impact of delayed treatment and the differences in decline and recovery should inform approaches for the ongoing treatment of patients both during and post pandemic. Purpose We examined changes in urologic care delivery due to COVID-19 in the US based on patient, practice, and local/regional demographic and pandemic response features. Materials and methods We analyzed real-world data from the American Urological Association Quality (AQUA) Registry collected from electronic health record systems. Data represented 157 outpatient urologic practices and 3,165 providers across 48 US states and territories, including 3,297,721 unique patients, 12,488,831 total outpatient visits, and 2,194,456 procedures. The primary outcome measure was the number of outpatient visits and procedures performed (inpatient or outpatient) per practice per week, measured from January 2019 to February 2021. Results We found large (>50%) declines in outpatient visits from March 2020 to April 2020 across patient demographic groups and states, regardless of timing of state stay-at-home orders. Non-urgent outpatient visits decreased more across various non-urgent procedures (49-59%) than for procedures performed for potentially urgent diagnoses (38-52%); surgical procedures for non-urgent conditions also decreased more (43-79%) than those for potentially urgent conditions (43-53%). African American patients had similar decreases in outpatient visits compared with Asians and Caucasians, but also slower recoveries back to baseline. Medicare-insured patients had the steepest declines (55%) while those on Medicaid and Government insurance had the lowest percentage of recovery to baseline (73, and 69% respectively). Conclusions This study provides real-world evidence on the decline in urologic care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by demographics and procedure type.

The national impact of the COVID-19 pandemic on U.S. prostate cancer community care.

5061 Background: We used data from a specialty-wide, community-based urology registry to determine trends in outpatient prostate cancer (PCa) care during the COVID-19 pandemic. Methods: 3,165 (̃ 25%) of US urology providers, representing 48 states and territories, participate in the American Urological Association Quality (AQUA) Registry, which collects data via automated extraction from electronic health record systems. We analyzed trends in PCa care delivery from 156 practices contributing data in 2019 and 2020. Risk stratification was based on prostate-specific antigen (PSA) at diagnosis, biopsy Gleason, and clinical T-stage, and we used a natural language processing algorithm to determine Gleason and T-stage from unstructured clinical notes. The primary outcome was mean weekly visit volume by PCa patients per practice (visits defined as all MD and mid-level visits, telehealth and face-to-face), and we compared each week in 2020 through week 44 (November 1) to the corresponding week in 2019. Results: There were 267,691 PCa patients in AQUA who received care between 2019 and 2020. From mid-March to early November, 2020 (week 10 – week 44) the magnitude of the decline and recovery varied by risk stratum, with the steepest drops for low-risk PCa (Table). For 2020, overall mean visits per day (averaged weekly) were similar to 2019 for the first 9 weeks (̃25). Visits declined to week 14 (18.19; a 31% drop from 2019), recovered to 2019 levels by week 23, and declined steadily to 11.89 (a 58% drop from 2019) as of week 44, the cut off of this analysis. Conclusions: Access to care for men with PCa was sharply curtailed by the COVID-19 pandemic, and while the impact was less for men with high-risk disease compared to those with low-risk disease, visits even for high-risk individuals were down nearly one-third and continued to fall through November. This study provides real-world evidence on the magnitude of decline in PCa care across risk groups. The impact of this decline on cancer outcomes should be followed closely.[Table: see text]

The past, present, and future of urological quality improvement collaboratives.

Surgical quality improvement collaboratives (QIC) have been established across the nation in numerous specialties. These QICs have shown efficacy in improving the quality, safety and value of care delivered to patients with a wide range of medical conditions. In recent years, urological QICs have emerged, including regional collaboratives such as the Michigan Urological Surgical Improvement Collaborative (MUSIC) and Pennsylvania Urologic Regional Collaborative (PURC), as well as the national American Urological Association Quality Registry Program (AQUA). These urological collaboratives, developed with an initial focus on prostate cancer, have demonstrated an ability to accurately measure prostate cancer outcomes, compare these outcomes among providers and institutions, and enact change among both patients and providers to optimize outcomes for men with prostate cancer. Physician-led regional collaboratives may be uniquely positioned to respond quickly to the rapidly-evolving healthcare landscape and enact practice and provider-level changes when appropriate. This review describes the historical background, current structure and function, and potential future directions of these urologic QICs.

Changes in patient reported outcome measures after treatment for female urethral stricture.

There is a paucity of patient reported outcome measure (PROM) data for women with urethral strictures. To address this gap, we aim to evaluate change in PROM among women who underwent surgery for a stricture. American Urological Association Symptom Index (AUA-SI) and Urogenital Distress Inventory (UDI-6) data from a multi-institutional retrospective cohort study of women treated for urethral stricture was assessed. Fifty-seven women had either AUA-SS or UDI-6 and 26 had baseline and postoperative data for either. Most women underwent urethroplasty (77%) and the majority (73%) remained stricture free at median follow-up of 21 months (interquartile range [IQR] 7-37). The median baseline AUA-SI was 21 (IQR 12-28) and follow-up was 10 (IQR 5-24). After treatment, there was a median decrease of 12 (IQR -18 to -2) in AUA-SI (p = 0.003). The median AUA Quality of life (QOL) score at baseline and follow-up were 6 (IQR 4-6) and 3 (IQR 2-5), respectively. There was a median AUA-QOL improvement of 2 points (-5,0; p = 0.007) from a baseline 5 (unhappy) to 3 (mixed). Median UDI-6 scores were 50 (IQR 33-75) at baseline and 17 (IQR 0-39), at follow-up. After treatment, there was a median decrease of 19 (-31 to -11; p = 0.01). Women with urethral strictures have severe lower urinary tract symptoms which improved after surgery. This study substantiates the claims that recognizing and treating women with urethral stricture disease greatly improves lower urinary tract symptoms and QOL.