Current American Urological Association Research Articles

Evaluation of new treatments for benign prostatic obstruction: ICI‐RS 2023

AbstractAimsTo address how invasive therapies for benign prostatic obstruction (BPO) have been evaluated, what their effect is on BPO, if they can prevent progression to BPO and how new therapies need to be evaluated before implementation into clinical practice.MethodsThe think tank conducted a literature review and looked at the previous and current American Urological Association, European Association of Urology and the International Consultation on Urological Diseases guidelines to see what procedures have been used to treat BPO. They then assessed whether trials have been conducted before implementation of the procedures and whether they have been compared to a “gold” standard treatment. The use of urodynamics has also been addressed in the think tank in relation the clinical trials as well as terminology.ResultsGuidelines vary in the use of terminology when it comes to BPO with some continuing to use the term benign prostatic hyperplasia (BPH). There are several procedures for example, TUNA, which have become obsolete although continues to be mentioned in the guidelines until recently. Majority of procedures have been introduced without comparing to “gold” standard treatment and without any long‐term data. There continues to be many unknowns with regard to the success of some of the BPO procedures and why some of the adverse events develop.ConclusionThere needs to be more robust long‐term clinical trials conducted of new BPO therapies, with men who have both lower urinary tract symptoms and urinary retention, before introduction into clinical practice.

146. Review of Urine Culture Screening Practices Prior to Urologic Procedures

Abstract Background Screening for UTIs prior to urologic procedures is a well-established practice. However, screening for asymptomatic bacteriuria remains more controversial, especially for procedures considered to be low-risk for complications. The aim of this study was to characterize current screening practices at our facility. Methods This retrospective study reviewed outpatient urologic procedures performed between 10/01/2022 and 12/31/2022. Procedures were stratified by risk based on current American Urological Association guidance. Charts were reviewed for the following information: urinary symptoms, ucx results, antibiotic prescriptions, post-op complications. The primary outcome was the incidence of urinary (GU) infection or infection related hospitalization (IRH) within 30 days post-procedure. Secondary outcomes include ucx screening rates and risk of infection based on presence of urinary symptoms. Results: 210 procedures were reviewed. Risk of GU infection ranged from 8.2% to 12.9%, with the highest rates seen in intermediate- and high-risk procedures. Risk of IRH increased by increasing level of risk (Table 1). Pre-op ucx were ordered in 35% of procedures, however frequency of ordering varied based on level of risk, with intermediate-risk (96%) much more likely to have been screened and no screening was done prior to high-risk procedures (Table 2). Symptomatic patients were more likely to have a pre-op ucx (60.4% vs 28.2% if asymptomatic). Ucx positivity was 3-fold higher if patient was symptomatic. Rates of GU infection and IRH varied based on presence of symptoms and whether preop ucx was ordered. (Table 3)Table 1:Risk of GU infection or IRH by ucx ordering, stratified by risk*no data since no ucx were ordered in high-risk groupTable 2:Preoperative ucx ordering by risk stratificationTable 3:Ucx screening by symptom status Conclusion In this study sample, risk of infectious complications (especially IRH) increased with increasing level of procedural risk. However, screening trends were inconsistent limiting conclusions about the impact of ucx on the incidence of infectious complications prior to intermediate and high-risk procedures. The rate of ucx screening was higher when urinary symptoms were present, but clear trends did not appear. This study highlights the need for consistent screening practices, primarily based on risk of procedure. Larger numbers may help answer the question of whether or not screening should be based on presence of symptoms. Disclosures All Authors: No reported disclosures

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

MP57-11 RACIAL AND GENDER DIVERSITY ON AMERICAN UROLOGICAL ASSOCIATION (AUA) AND EUROPEAN UROLOGICAL ASSOCIATION (EAU) GUIDELINE PANELS

You have accessJournal of UrologyCME1 Apr 2023MP57-11 RACIAL AND GENDER DIVERSITY ON AMERICAN UROLOGICAL ASSOCIATION (AUA) AND EUROPEAN UROLOGICAL ASSOCIATION (EAU) GUIDELINE PANELS Matthew Holten, Zahrah Shakur, Shahnaz Sultan, Nissrine Nakib, Christopher Warlick, and Philipp Dahm Matthew HoltenMatthew Holten More articles by this author , Zahrah ShakurZahrah Shakur More articles by this author , Shahnaz SultanShahnaz Sultan More articles by this author , Nissrine NakibNissrine Nakib More articles by this author , Christopher WarlickChristopher Warlick More articles by this author , and Philipp DahmPhilipp Dahm More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003310.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Equity and acceptability are important domains when it comes to clinical guideline development, requiring broad stakeholder representation. We conducted this study to assess the panel composition on the two most important guideline developers in urology. METHODS: Based on a predefined protocol we identified all current AUA and EAU guideline documents from the organizations’ respective websites. Two members of the research team independently and in duplicate abstracted information on the guideline topic, number of panel members (voting and non-voting), support staff and consultants. We determined the panel members’ likely gender (woman, man, or non-binary) and racialization (white [not racialized] or non-white [racialized]) based on name, internet picture, pronouns used, bios available, and gender listed on their profile. Racialization data was further validated using the Ethnicity Estimator algorithm. RESULTS: We included 31 AUA and 20 EAU guidelines in this study. The median panel size was 19 (interquartile range [IQR]: 17; 21), including a median of 12 (IQR: 10; 14) voting and 7 (IQR: 4; 8) non-voting members. Panel composition of voting members was largely male (median: 83.3%; IQR: 72.7%; 92.9%) and white (median: 88.2%; IQR: 83.3%; 92.9%). About one in five guideline panels did not include a single female (11; 21.6%) or racialized individual (10; 19.6%). Overall, only 11 of 617 (1.8%) voting members were racialized women. When comparing oncology and non-oncology related guidelines, female (26.4% versus 25.8%; p=0.129) and non-white representation (21.9% versus 28.4%; p=0.129) was similar. For AUA and EAU guideline panels, female representation was similar (26.1% versus 25.8%; p=0.946) whereas racialized individuals were more frequent on AUA guidelines (29.3% versus 20.9%; p=0.048). CONCLUSIONS: As in other arenas of urology (such as the general workforce and academic leadership), female and racialized individuals are underrepresented on guideline panels of the two major professional organizations. More transparency in the panel member selection process and intentional efforts to promote gender parity and diversity are needed. Source of Funding: Departmental © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e788 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Holten More articles by this author Zahrah Shakur More articles by this author Shahnaz Sultan More articles by this author Nissrine Nakib More articles by this author Christopher Warlick More articles by this author Philipp Dahm More articles by this author Expand All Advertisement PDF downloadLoading ...

The Safety of Human Chorionic Gonadotropin Monotherapy Among Men With Previous Exogenous Testosterone Use.

Background and objectiveHuman chorionic gonadotropin (hCG) is homologous to luteinizing hormone (LH) and stimulates endogenous testosterone (T) production. Current American Urological Association (AUA) guidelines recommend hCG for T-deficient men who wish to preserve their fertility. However, there is no data available regarding the long-term efficacy and safety of hCG monotherapy in men with a history of exogenous T use. We hypothesized that transitioning to hCG would be a safe and effective option in this population.MethodologyWe performed a retrospective analysis involving 28 men with previous exogenous T use who were switched to hCG monotherapy and underwent follow-up lab work at least one month later. We evaluated changes in hormones [T, LH, follicle-stimulating hormone (FSH), and estradiol], hematocrit (HCT), glycated hemoglobin (HbA1c), and prostate-specific antigen (PSA).ResultsAmong the entire cohort, we found no significant change in mean hormone levels (including T), HbA1c, or PSA. There was a significant (p<0.05) decrease in HCT (45.27 ±4.06 to 44.16 ±3.48%, n=15). No thromboembolic events were reported. Additionally, among men who had their baseline labs completed outside their previous T therapy therapeutic time window prior to starting hCG monotherapy, there was a statistically significant increase in mean T levels (307.36 ±148.74 to 422.11 ±268.15 ng/dL, n=30 and 31, pre- and post-hCG, respectively) and a statistically significant decrease in mean PSA levels (0.91 ±0.35 to 0.69 ±0.23 ng/mL, n=5).ConclusionsThese results suggest that hCG is a safe and effective alternative to traditional T therapy for men with a history of exogenous T use and may lead to an advantageous decrease in HCT. hCG may serve as an alternative form of T therapy with a lower risk for secondary erythrocytosis, and further research is warranted to gain deeper insights into the topic.

Is Reddit a reliable source for information on erectile dysfunction treatment?

Patients may turn to social media websites, such as Reddit, for information on erectile dysfunction prior to seeking care from a physician. We sought to identify, characterize, and assess the quality of the erectile dysfunction treatments discussed on the highly influential Reddit website. We assessed 2634 comments from two subreddits, r/AskMen and r/ErectileDysfunction, for positive and negative statements regarding treatments for erectile dysfunction. A total of 45 unique treatments were discussed and consisted of changes in sexual behavior (30%), lifestyle changes (29%), medical interventions (23%), talking with a partner about ED (10%), and use of supplements (8%). Only 24.4% of all treatments discussed are in line with current American Urological Association guidelines. Only 43.8% of all positive statements made endorsed a guidelines-based treatment, indicating a high rate of self-proclaimed success with alternative therapies. Our results indicate that there is active discussion of erectile dysfunction treatment on Reddit with a wide range of therapies recommended, however, the majority of the recommendations are not supported by strong clinical evidence.

V12-12 PENOSCROTAL DECOMPRESSION OF REFRACTORY ISCHEMIC PRIAPISM: SURGICAL TECHNIQUE

You have accessJournal of UrologyCME1 May 2022V12-12 PENOSCROTAL DECOMPRESSION OF REFRACTORY ISCHEMIC PRIAPISM: SURGICAL TECHNIQUE Nicholas Ottaiano, Ganesh Sanekommu, Christopher Koller, Wayne Hellstrom, Allen Morey, and Omer Raheem Nicholas OttaianoNicholas Ottaiano More articles by this author , Ganesh SanekommuGanesh Sanekommu More articles by this author , Christopher KollerChristopher Koller More articles by this author , Wayne HellstromWayne Hellstrom More articles by this author , Allen MoreyAllen Morey More articles by this author , and Omer RaheemOmer Raheem More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours. Current American Urological Association (AUA) guidelines recommend proximal shunting following a failed distal shunt; however, proximal shunting is no longer common practice due to the technically challenging nature of the procedure. METHODS: A 43 year old African American male presented to our institutional hospital from an outside hospital for refractory ischemic priapism lasting longer than 72 hours. Corporal blood gas analysis confirmed priapism of ischemic nature, penile duplex ultrasound confirmed an absence of blood flow. The remaining lab work (CBC, urine toxicology, and Hb electrophoresis) was negative. Corporal decompression via a penoscrotal approach was then performed in hopes of preserving the patient's erectile function. RESULTS: Penoscrotal decompression proved to be an effective and safe way of managing refractory ischemic priapism. The technique showed to produce favorable results while maintaining adequate sexual function. Longer follow up periods and a larger patient size is needed for future evaluation. CONCLUSIONS: Corporal decompression via a penoscrotal incision has recently emerged as a viable alternative to proximal shunting with favorable outcomes in select patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e970 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Ottaiano More articles by this author Ganesh Sanekommu More articles by this author Christopher Koller More articles by this author Wayne Hellstrom More articles by this author Allen Morey More articles by this author Omer Raheem More articles by this author Expand All Advertisement PDF DownloadLoading ...

Wording of American Urological Association Guideline Recommendations Does Not Signal the Strength of Recommendation

To systematically analyze the wording of American Urological Association (AUA) clinical practice guidelines' recommendations. We systematically identified all AUA guideline documents that used the current AUA framework and extracted the individual recommendations, their statement type, and their corresponding evidence level (if applicable), and analyzed the recommendation wording separating out the modal verbs (eg, should, may, or must) as well as the main verbs (eg, recommend, treat, perform). We performed descriptive statistics using SPSS Version 27. We included 18 documents with 754 distinct recommendations; the median number of recommendations per guideline was 36 (interquartile range: 29; 48.5). Expert opinion was the most used statement type (193; 25.6%), followed by clinical principle (156; 20.7%). Four-hundred-four recommendations were either strong, moderate, or conditional: 135 (17.9%), 187 (24.8%) and 83 (11.0%), respectively. Most recommendation statements (701; 93.0%) used modal verbs to express a level of obligation. Overall, "should" was the most employed modal verb used (73.9%), followed by "may" (17.6%) and "must" (1.5%). Both "may" and "should" were used in conjunction with all five statement types, whereas "must" was limited to strong recommendations and clinical principles. The wording of AUA recommendation statements does not signal the strength of recommendation and the intended level of obligation, which may represent a barrier to guideline implementation. More consistent wording of recommendations by strength may improve guideline understanding, uptake, and adherence.

Male factor infertility: Initial workup and diagnosis in primary care.

To present a case-based discussion on the workup of male factor infertility and review currently available treatments. This discussion is based on the current Canadian Urological Association and American Urological Association guidelines, with reference to landmark papers as appropriate from 2010 onward. All articles were retrieved through PubMed. Approximately 15% of Canadian couples experience infertility, making it a commonly encountered condition in the primary care setting. Among couples suffering from infertility, male factors can be identified as the sole cause in 30% of cases and as a contributing issue in 20% of cases. Although many of the treatments described aim to improve a couple's chances of naturally conceiving a child via intercourse, many patients ultimately require medical or surgical intervention to achieve pregnancy. This can be a long, protracted course for patients, with important roles for primary care providers and fertility specialists alike. Male fertility assessment and treatment has historically been left in the hands of fertility specialists, creating a bottleneck for patients to receive fertility care. However, with increased understanding of the underlying causes of male factor infertility, the workup and initial management can occur in the primary care setting, helping to streamline care.

Physical Activity May Reduce Apolipoprotein E4-Associated Cognitive Decline in Parkinson Disease

<h3>Objective</h3> To present a case-based discussion on the workup of male factor infertility and review currently available treatments. <h3>Sources of information</h3> This discussion is based on the current Canadian Urological Association and American Urological Association guidelines, with reference to landmark papers as appropriate from 2010 onward. All articles were retrieved through PubMed. <h3>Main message</h3> Approximately 15% of Canadian couples experience infertility, making it a commonly encountered condition in the primary care setting. Among couples suffering from infertility, male factors can be identified as the sole cause in 30% of cases and as a contributing issue in 20% of cases. Although many of the treatments described aim to improve a couple’s chances of naturally conceiving a child via intercourse, many patients ultimately require medical or surgical intervention to achieve pregnancy. This can be a long, protracted course for patients, with important roles for primary care providers and fertility specialists alike. <h3>Conclusion</h3> Male fertility assessment and treatment has historically been left in the hands of fertility specialists, creating a bottleneck for patients to receive fertility care. However, with increased understanding of the underlying causes of male factor infertility, the workup and initial management can occur in the primary care setting, helping to streamline care.

MP24-09 SURVEILLANCE INTENSITY AND DETECTION OF RECURRENCE AND PROGRESSION IN INTERMEDIATE RISK NON MUSCLE INVASIVE BLADDER CANCER (NMIBC)

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP24)1 Apr 2020MP24-09 SURVEILLANCE INTENSITY AND DETECTION OF RECURRENCE AND PROGRESSION IN INTERMEDIATE RISK NON MUSCLE INVASIVE BLADDER CANCER (NMIBC) Abhishek Bhat*, Deukwoo Kwon, Nachiketh Soodana-Prakash, Indraneel Banerjee, Amit Bhattu, Venkatasai Atluri, Sanoj Punnen, Mark Gonzalgo, Dipen Parekh, and Chad Ritch Abhishek Bhat*Abhishek Bhat* More articles by this author , Deukwoo KwonDeukwoo Kwon More articles by this author , Nachiketh Soodana-PrakashNachiketh Soodana-Prakash More articles by this author , Indraneel BanerjeeIndraneel Banerjee More articles by this author , Amit BhattuAmit Bhattu More articles by this author , Venkatasai AtluriVenkatasai Atluri More articles by this author , Sanoj PunnenSanoj Punnen More articles by this author , Mark GonzalgoMark Gonzalgo More articles by this author , Dipen ParekhDipen Parekh More articles by this author , and Chad RitchChad Ritch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000857.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intermediate risk (IR) NMIBC is a heterogeneous entity with a variable risk of recurrence and progression. The current American Urological Association (AUA)/Society of Urologic Oncology (SUO) guideline for NMIBC recommends cystoscopy and urine cytology every 3-6 months for the first two years and cross-sectional imaging every 1 to 2 years. However, this recommendation is based on expert opinion and there is limited data to support a specific surveillance interval. We compare several surveillance strategies of varying intensity with respect to the detection of recurrence and progression in IR-NMIBC. METHODS: A retrospective review was performed using The University of Miami NMIBC database for IR-NMIBC (2004-2018). We developed three surveillance models based on annual CT urogram and varying frequency of cystoscopy and urine cytology: Model 1 – every 3 months, Model 2 – every 6 months and Model 3 – every 12 months. Using the IR-NMIBC cohort, we applied each model and determined the proportion of patients whose recurrence or progression would have been missed over a two-year period by each model. We used descriptive statistics to determine the proportion of recurrences and progression detected in each model and Chi-square test to compare the rate of missed recurrences and progression between groups. We also compared the potential time-delay in diagnosis (in months) between models. RESULTS: 130 patients with IR NMIBC cancer were included in the database. 94 (72.3%) patients in the study cohort were males while 36 (27.7%) were females. 110 (84.6%) patients had Stage Ta at diagnosis and 16 (12.3%) were Stage T1. 94 (74.3%) patients were diagnosed with high grade disease whereas 36 (27.7%) patients had low grade disease. There were a total of 81 (62.3%) recurrences and 10 (7.7%) episodes of progression during the follow up period. Over a two-year simulation period, the mean proportion of missed recurrences in Model 2 and Model 3 as compared to Model 1 was 52.2% and 87% respectively. Progression was missed in Model 2 and Model 3 in 50% and 79% respectively as compared to Model 1 (Figure 1). With respect to time-delay in detection of recurrence, there was a 1.8 months delay for model 1, 3.7 months for model 2 and 8 months for model 3 (Figure 2). Of those who progressed, there were no deaths from bladder cancer and none required radical cystectomy. CONCLUSIONS: As recommended by the AUA/SUO guidelines, a 3-6 month window for surveillance in IR-NMIBC is appropriate and minimizes the proportion of missed recurrences and episodes of progression. Furthermore, there is less time-delay in the detection of recurrence using this surveillance intensity. Fortunately, although there are significantly more missed recurrences and progression with a less intense surveillance regimen, it is unlikely to result in the need for radical treatment or death from bladder cancer. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e350-e351 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abhishek Bhat* More articles by this author Deukwoo Kwon More articles by this author Nachiketh Soodana-Prakash More articles by this author Indraneel Banerjee More articles by this author Amit Bhattu More articles by this author Venkatasai Atluri More articles by this author Sanoj Punnen More articles by this author Mark Gonzalgo More articles by this author Dipen Parekh More articles by this author Chad Ritch More articles by this author Expand All Advertisement PDF downloadLoading ...

Antibiotics are not necessary during routine cystoscopic stent removal: A randomized controlled trial at UC San Diego.

Introduction:Current American Urological Association (AUA) Best Practice Statement recommends antibiotic prophylaxis for cystoscopy with manipulation, including stent removal; although no Level 1b trials explicitly address prophylaxis for stent removal. We sought to determine the efficacy of prophylactic antibiotics to prevent infectious complications after stent removal.Materials and Methods:Following institutional review board approval, patients undergoing removal of ureteral stent placed during stone surgery were recruited from July 2016 to March 2019. Patients were recruited at the time of stent removal and randomized to treatment (single dose 500 mg oral ciprofloxacin) or control group (no antibiotics). Telephone contact was attempted within 14 days of stent removal to assess for urinary tract infection (UTI) symptoms, antibiotic prescriptions, or Emergency Department visits. Primary outcome was UTI within 1 month of stent removal – defined by irritative voiding symptoms, fever or abdominal pain associated with positive urine culture (Ucx) (>100k colony-forming units/mL).Results:Seventy-seven patients were enrolled, with 58 meeting final inclusion criteria for the analysis (33 treatment, 25 controls). No differences were seen with clinical and demographic variables, except a higher body mass index in the treatment group (P = 0.007). Positive Ucx rate before stone surgery (16.7% vs. 11.8%, P = 0.819) and at the time of stent removal (16.0% vs. 11.1%, P = 0.648) was not significantly different in treatment versus control groups, respectively. Primary outcome: No patients in either cohort developed symptomatic culture-diagnosed UTI within 1 month of stent removal. Of patients with documented phone follow-up (treatment n = 29, control n = 22), only one patient (control) reported any positive response on phone survey.Conclusions:We found a low infectious complication rate regardless of antibiotic prophylaxis use during cystoscopic stent removal. The necessity of antibiotics during routine cystoscopic stent removal warrants possible reevaluation of the AUA best practice statement.

Role of Telemedicine in Urology: Contemporary Practice Patterns and Future Directions.

As outlined in the white paper by the AUA (American Urological Association) Telemedicine Workgroup in 2016, telemedicine has the potential to revolutionize health care delivery and access to urological care. National trends pertaining to the contemporary use of telemedicine in the field of urology have yet to be elucidated. A web based survey consisting of 22 questions was developed by the AUA Leadership group in conjunction with the AUA Telemedicine Workgroup, and this questionnaire was sent electronically to 2,324 current AUA members. The questions focused on patterns in telemedicine use and barriers to implementation. A total of 243 responses were received and of these 47% reported an association with institutions that promote telemedicine in some aspect of health care delivery. Overall 26% of respondents reported personal involvement with telemedicine applications at some point in their career. However, only 14% claimed to be actively using telemedicine in their current work. The most commonly cited barrier to the implementation of telemedicine was an inability to effectively bill for services (72%). While telemedicine is a tool that holds great promise, with many respondents reporting infrastructure for telemedicine applications at their institutions, lack of reimbursement was cited as the major barrier to implementation. This issue regarding reimbursement is a central matter that will need to be standardized moving forward in order to promote widespread use.

Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses

BackgroundFungal infections of inflatable penile prostheses (IPPs) are inadequately understood in the literature. AimTo review a multi-institution database of IPP infections to examine for common patient and surgical factors related to IPP fungal infections. MethodsThis is a retrospective Institutional Review Board–approved analysis of 217 patients at 26 institutions who underwent salvage or device explant between 2001 and 2018. Patient data were compiled after an extensive record review. Outcomes26 patients (12%) with fungal infections were identified. Results23 of 26 patients (83%) with a fungal IPP infection were either diabetic or overweight. 15 patients had undergone primary IPP implantation, and the other 11 had previously undergone an average of 1.7 IPP-related surgeries (range 1–3; median 2). The average age at implantation was 63 years (range 31–92; median 63). 18 of the 26 patients with fungal infection had diabetes (69%), with a mean hemoglobin A1c (HbA1c) value of 8.4 (range 5.8–13.3; median 7.5). Twenty-two patients (85%) were overweight or obese. The mean body mass index for all patients was 30.1 kg/m2 (range 23.7–45 kg/m2; median 28.4 kg/m2), and that for diabetic patients was 30.8 kg/m2 (range 24.1–45 kg/m2, median 29.7 kg/m2). Ninety-one percent of implants were placed with intravenous antibiotics, consistent with current American Urological Association guidelines: an aminoglycoside plus first- or second-generation cephalosporin or vancomycin or ampicillin/sulbactam or piperacillin/tazobactam. 65% (17 of 26) of infected IPPs had only fungal growth in culture. No patient had concomitant immunosuppressive disease or recent antibiotic exposure before IPP implantation. Clinical ImplicationsMore than two-thirds of the fungal infections occurred in diabetic patients and 85% occurred in overweight or obese patients, suggesting that antifungal prophylaxis may be appropriate in these patients. Strengths & LimitationsThis is the largest series of fungal infections reported to date in the penile prosthesis literature. The overall number of such cases, however, remains small. ConclusionFungal infections represent 12% of all penile prosthesis infections in our series and were seen mostly in diabetic or overweight patients, who may benefit from antifungal prophylaxis.Gross MS, Reinstatler L, Henry GD, et al. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2019;16:1100–1105.

Quality improvement initiative to reduce variability and improve stewardship of antimicrobial prophylaxis for transrectal prostate needle biopsy.

To assess the impact of implementing the recommendations included in the 2014 American Urological Association (AUA) white paper on complications of transrectal prostate needle biopsy (PNB). In the outpatient setting of a single tertiary-care institution, prophylactic antibiotic use and rate of infectious complications were compared before and after implementation by nursing of a standardized algorithm to select antibiotic prophylaxis (derived from the recommendations of the AUA white paper). The 584 patients in cohort A (January 2011-January 2012) received antimicrobial prophylaxis at the discretion of the treating physician; 654 patients in cohort B (January 2014-January 2015) received standardized risk-adapted antibiotic prophylaxis. Data on antibiotics administered and infectious complications were analyzed. Fluoroquinolone was the most common prophylactic regimen in both cohorts. In cohort A, 73% of men received a single-drug regimen, although 19 different regimens were utilized with duration of 72h. In cohort B, 97% received 1 of 4 standardized single-drug antibiotic regimens for duration of 24h. Infectious complications occurred in 19 men (3.3%) in cohort A, and in 18 men (2.8%) in cohort B (difference -0.5%; one-sided 95% CI 1.1%). No clinically relevant increase in infectious complication rates was found after implementing this quality improvement initiative. Use of a standardized risk-adapted approach to select antibiotic prophylaxis for PNB by nursing staff reduced the duration of antimicrobial prophylaxis and number of antibiotic regimens used, without increasing the rate of infectious complications. Our findings validate the current AUA recommendations for antibiotic prophylaxis.

Total Surface Area Influences Stone Free Outcomes in Shock Wave Lithotripsy for Distal Ureteral Calculi.

Introduction: Current American Urological Association guidelines recommend ureteroscopy (URS) as primary management of distal ureteral stones and shock wave lithotripsy (SWL) as a secondary option. Utilization of SWL in the management of nephrolithiasis in North America has decreased. We hypothesized that SWL continues to be an effective option in the management of distal ureteral calculi and studied data from our center in patients who received SWL for distal ureteral stones. Methods: A retrospective review was performed of 104 patients treated initially with SWL for distal ureteral calculi between 2011 and 2018 at this institution. The success rate of SWL was assessed through radiologic imaging and if subsequent procedures were required to render patients stone free. Results: Operative note and chart review identified 104 patients who presented with distal ureteral stones and were treated with SWL as the initial form of management. Average patient age was 52.2 ± 15.3 years, average BMI was 27.4 ± 5.7, and average total axial stone surface area was 25.96 ± 14.32 mm2. Of these patients, 78.8% (n = 82) were stone free following one SWL and required no subsequent procedures. Of these patients, 87.5% (n = 91) were stone free following a second SWL, and 87.5% (n = 91) were stone free following a secondary URS. After the initial SWL, residual stones were identified in 21.2% of patients (n = 22). Four patients, 3.8%, required a salvage URS following a failed second SWL to achieve stone-free status. Conclusion: One SWL procedure offers a stone-free rate (SFR) of 78.8% and after two SWLs an 87.5% SFR. Only 12.5% of patients undergoing SWL at our center required URS to achieve a stone-free status. SWL is an effective modality in the treatment of distal ureteral stones.

MP39-16 SURVEY ON CURRENT PRACTICE IN ANTIBIOTIC PROPHYLAXIS PRIOR TO URETERAL STENT REMOVAL

INTRODUCTION AND OBJECTIVES:Urinary tract infections (UTI) are one of the most common complications after urologic surgery. Current American Urological Association (AUA) guidelines recommend antibi...

Current use of medical expulsive therapy among endourologists.

We aimed to characterize current practice patterns among endourologists on medical expulsive therapy (MET) for treatment of ureteral calculi. An online survey was administered to Endourological Society members. Respondents' MET usage, index case management, and awareness of recent guidelines and literature were compared based on international status, practice setting, interval since training, and endourological fellowship training. Of the 237 complete responses, 65% were international, 61% were academic, 66% had &gt;10 years in practice, and 71% were endourology fellowship-trained. MET was used by 88%, with no differences between international, academic, practice length, and fellowship-trained groups. MET was used more frequently for &lt;8 mm and distal stones and more U.S.-based respondents reported use for proximal/midureteral stones (68% vs 43%; p&lt;0.001). For the index patient, 70% preferred MET as the initial approach and respondents &lt;10 years from training were more likely to choose MET (82% vs. 64%; p=0.006). While 82% of respondents were aware of the SUSPEND trial, 70% reported that it had not altered their use of MET. Current American Urological Association (AUA) guideline awareness was 90%. Mean MET prescription length was 19.9±10.3 days, and was statistically significantly longer for respondents who were U.S.-based, academic and &lt;10 years from training. MET is the preferred approach for patients with ureteral calculi &lt;10 mm among endourologists despite conflicting data in the literature. While current AUA practice guidelines are followed by the majority of respondents, our survey suggests MET is being used more liberally than the guideline criteria, specifically in proximal and midureteral stones.

MP95-20 THE PERSISTENCE OF OPEN STONE SURGERY IN THE UNITED STATES IN THE 21ST CENTURY

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-20 THE PERSISTENCE OF OPEN STONE SURGERY IN THE UNITED STATES IN THE 21ST CENTURY Jessica Lange and Ryan Terlecki Jessica LangeJessica Lange More articles by this author and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3022AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the era of minimally-invasive surgery, endoscopic and percutaneous interventions for urinary tract stones have become a mainstay. As such, the need for open stone removing procedures has decreased. We sought to determine the contemporary incidence of open stone surgery among urologists in the United States. METHODS Case logs submitted for certification and recertification to the American Board of Urology from 2005-2015 were queried for Current Procedural Terminology codes relevant to open stone-related procedures (50060, 50065, 50070, 50075). Cases were then analyzed for the associated practice type, practice area population, geographic region, provider subspecialty, and certifying or recertifying status of the reporting urologist. RESULTS 334 cases of open stone surgery were identified with the majority (245/334; 73.4%) performed by urologists self-identified as generalists. The most common subspecialtists performing open stone surgery were endourologists (41/334; 12.3%). Most cases were done in the private practice setting (255/317; 80.4%) and in practice areas with populations exceeding 1,000,000 people (126/292; 43.2%). Open stone removal was more commonly reported by urologists applying for recertification (55%) than initial certification (45%). On average, 30 open stone cases were reported each year during the study period. Open stone removal was most commonly performed in the Western Section of the American Urological Association (AUA) (84/334; 25.1%) and least commonly performed in the Northeastern Section (5/334; 1.5%). A Chi-square analysis was performed comparing the number of open stone surgeries performed in each AUA section versus the number expected based on current AUA sectional membership data. The Western Section not only had the highest number of open stone cases reported, but it had a significantly higher number than expected as its urologists represent only 17% of the total AUA membership (p<0.01). The Northeastern section comprises 7% of the total AUA membership but only performed 1.5% of open stone cases which was significantly lower than anticipated (p<0.001). CONCLUSIONS Open stone surgery is still performed in the United States, typically by private practice general urologists. Open stone removal is more likely to be reported from the Western Section and in practice areas of the highest population density. This data may prove useful in determining the need and optimal location for future courses highlighting minimally-invasive stone removing strategies. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1293-e1294 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jessica Lange More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

News Media Analysis of the United States Preventive Services Task Force and American Urological Association Prostate Cancer Screening Guidelines

IntroductionRates of prostate specific antigen screening and prostate cancer diagnoses have declined following controversial changes to prostate cancer screening guidelines by the USPSTF (U.S. Preventive Services Task Force) in 2011 and 2012 advising against all prostate specific antigen screening. To understand whether uneven media coverage of the guidelines may have influenced shifts in clinical decision making, this study analyzes news reports about the USPSTF and AUA (American Urological Association) prostate cancer screening guidelines. MethodsTwo national databases were queried for news articles published within 30 days of the release of each guideline. Media analysis included consequences of screening, accuracy of guideline descriptions, discussion of primary evidence and neutrality of headlines. Thematic changes between the preliminary and final USPSTF guidelines were compared. ResultsOf the 45 news articles in the sample 24 were about the preliminary USPSTF guidelines, 17 about the final USPSTF guidelines and 4 about the revised AUA guidelines. More than 80% of the articles discussed adverse consequences of prostate specific antigen screening while a minority accurately summarized the recommendations or discussed limitations of the evidence. Significantly more articles about the final vs preliminary USPSTF guidelines had headlines opposing screening or suggested urologists’ financial gains from prostate specific antigen tests (p <0.05). Of the articles that mentioned the initial opposition of the AUA to the USPSTF, only 29% described the current AUA guidelines in any form. ConclusionsThe USPSTF guidelines were more extensively reported in the news than the AUA guidelines. Articles frequently emphasized the negative aspects of screening and did not discuss limitations of the evidence. These findings may have influenced patients’ decisions underlying declines in prostate specific antigen screening since 2011.