Michigan Urological Surgery Improvement Collaborative Research Articles

PD21-02 ASSESSING THE GENERALIZABILITY OF RANDOMIZED EVIDENCE BY COMPARING RESULTS FROM A CLINICAL TRIAL AND ESTABLISHED QUALITY IMPROVEMENT COLLABORATIVE: RESULTS FROM G-MINOR AND MUSIC

You have accessJournal of UrologyCME1 Apr 2023PD21-02 ASSESSING THE GENERALIZABILITY OF RANDOMIZED EVIDENCE BY COMPARING RESULTS FROM A CLINICAL TRIAL AND ESTABLISHED QUALITY IMPROVEMENT COLLABORATIVE: RESULTS FROM G-MINOR AND MUSIC Udit Singhal, Ralph Jiang, Daniel E. Spratt, Matthew Schipper, Simpa S. Salami, Stephanie Daignault-Newton, Rodney Dunn, Thomas J. Maatman, Brian R. Lane, Frank N. Burks, Paul Rodriguez, Eduardo Kleer, Richard Sarle, Felix Y. Feng, Michael L. Cher, Robert T. Dess, and Todd M. Morgan Udit SinghalUdit Singhal More articles by this author , Ralph JiangRalph Jiang More articles by this author , Daniel E. SprattDaniel E. Spratt More articles by this author , Matthew SchipperMatthew Schipper More articles by this author , Simpa S. SalamiSimpa S. Salami More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Rodney DunnRodney Dunn More articles by this author , Thomas J. MaatmanThomas J. Maatman More articles by this author , Brian R. LaneBrian R. Lane More articles by this author , Frank N. BurksFrank N. Burks More articles by this author , Paul RodriguezPaul Rodriguez More articles by this author , Eduardo KleerEduardo Kleer More articles by this author , Richard SarleRichard Sarle More articles by this author , Felix Y. FengFelix Y. Feng More articles by this author , Michael L. CherMichael L. Cher More articles by this author , Robert T. DessRobert T. Dess More articles by this author , and Todd M. MorganTodd M. Morgan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003287.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although randomized controlled trials (RCTs) represent the gold standard for clinical research, results from RCTs are often substantially less dramatic when implemented in practice. Previous studies have evaluated the congruence of observational studies with RCTs and shown conflicting results. However, minimal to no data exist comparing RCT populations with their non-RCT contemporaries. We aimed to assess the generalizability of RCT evidence by comparing results from an RCT with those from a prospectively collected, geographically equivalent, quality improvement collaborative. METHODS: The G-MINOR RCT randomized 356 men with localized prostate cancer at high-risk of recurrence after prostatectomy to clinical risk stratification with or without Decipher testing to assess its utility in clinical decision-making. Enrollment of patients occurred across 12 practices within the Michigan Urological Surgery Improvement Collaborative (MUSIC). Matching between MUSIC and G-MINOR was performed using 3:1 nearest neighbor matching on propensity scores. Differences between the matched populations were assessed via Kaplan-Meier estimates and multivariable Cox regression, with a primary endpoint of failure-free survival (FFS), which was defined as any biochemical recurrence or receipt of salvage treatment. Secondary endpoints were adjuvant treatment-free survival and cumulative incidence of salvage treatment. RESULTS: After matching, a total of 1352 men were included in the analysis (338 G-MINOR, 1014 MUSIC), with no differences in age, race, comorbidity, PSA, grade group, clinical T-stage, margin status, presence of extra-prostatic extension, or Decipher risk between the groups. Despite matching, FFS was greater at 48 months follow-up in the G-MINOR group compared to MUSIC (20.1% vs 19.9%, p=0.041). Men in MUSIC received significantly more adjuvant therapy (20.1% vs 9.2%, p<0.0001), but salvage treatment rates were similar between the groups (G-MINOR 11.2% vs MUSIC 8.6%, p=0.62). CONCLUSIONS: Despite similar geographic, practice-level, and disease-related characteristics, men enrolled in a RCT were less likely to have failure after initial treatment compared to matched patients in the same communities not enrolled in the RCT. These results suggest possible unmeasured differences between these populations or unmeasured benefits of trial participation that may result in improved outcomes for RCT participants. Source of Funding: U.S. is supported by an AUA/UCF Research Scholar Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e590 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Udit Singhal More articles by this author Ralph Jiang More articles by this author Daniel E. Spratt More articles by this author Matthew Schipper More articles by this author Simpa S. Salami More articles by this author Stephanie Daignault-Newton More articles by this author Rodney Dunn More articles by this author Thomas J. Maatman More articles by this author Brian R. Lane More articles by this author Frank N. Burks More articles by this author Paul Rodriguez More articles by this author Eduardo Kleer More articles by this author Richard Sarle More articles by this author Felix Y. Feng More articles by this author Michael L. Cher More articles by this author Robert T. Dess More articles by this author Todd M. Morgan More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-01 NEGATIVE PREDICTIVE VALUE OF PROSTATE MRI IN REAL WORLD PRACTICE: RESULTS FROM A STATEWIDE SURGICAL COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023PD38-01 NEGATIVE PREDICTIVE VALUE OF PROSTATE MRI IN REAL WORLD PRACTICE: RESULTS FROM A STATEWIDE SURGICAL COLLABORATIVE Alex Zhu, Arnav Srivastava, John Michael DiBianco, Ji Qi, Apoorv Dhir, Mahir Maruf, Stephanie Ferrante, Anna Johnson, Alice Semerjian, Matthew S. Davenport, Leena Mammen, Ali Dabaja, Brian Lane, Kevin Ginsburg, Karla Witzke, Arvin K. George, and For the Michigan Urological Surgery Improvement Collaborative Alex ZhuAlex Zhu More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , John Michael DiBiancoJohn Michael DiBianco More articles by this author , Ji QiJi Qi More articles by this author , Apoorv DhirApoorv Dhir More articles by this author , Mahir MarufMahir Maruf More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Matthew S. DavenportMatthew S. Davenport More articles by this author , Leena MammenLeena Mammen More articles by this author , Ali DabajaAli Dabaja More articles by this author , Brian LaneBrian Lane More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Karla WitzkeKarla Witzke More articles by this author , Arvin K. GeorgeArvin K. George More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The negative predictive value (NPV) for multi-parametric prostate magnetic resonance imaging (mpMRI) in the detection of clinically significant prostate cancer (csPCa) approaches 90%. Consequently, mpMRI has been proposed as a stratification and staging tool to detect csPCA while limiting unnecessary biopsies. However, wide variation exists in the application and interpretation of mpMRI. It remains to be seen if the high NPV published from expert centers remains reproducible and generalizable. We aimed to determine the real-world NPV of mpMRI across diverse practices in the Michigan Urological Surgery Improvement Collaborative (MUSIC). METHODS: The MUSIC clinical registry was used to determine the NPV for mpMRI in the detection of csPCa, defined as Grade Group (GG)≥2 PCa. We identified patients between 7/2016–7/2022 with negative mpMRI, defined as an absence of PI-RADS 3-5 lesions, who underwent biopsy within 1 year. Patients were classified into 2 groups: (1) biopsy naïve and (2) active surveillance (AS). NPV of MRI was summarized overall and for each subgroup. Multivariable logistic regression identified factors associated with csPCa. RESULTS: 857 patients who underwent 871 biopsies within 1 year of negative mpMRI were identified across 26 practices. 439 biopsies were performed in the biopsy naïve setting, and 432 while on AS. Median age was 65 years (IQR 60-69) and median PSA was 5.6 ng/dl (IQR 4.1-8.1). The NPV of prostate MRI for ≥GG2 PCa in biopsy-naïve patients, those undergoing AS, and the entire cohort was 80%, 75%, and 77%, respectively. On multivariable analysis, PSA density ≥0.1 was associated with higher risk of having csPCa diagnosis after negative MRI (OR 5.1 [95% CI 3.22-8.01], p<0.001). CONCLUSIONS: Across diverse urologic practices, the NPV of prostate MRI is 77%, lower than previously reported. Real-world data suggests that approximately 25% of men may miss a diagnosis of csPCA, most commonly GG2, if they do not undergo biopsy with a negative MRI. This likely represents limitations with current mpMRI implementation, and an opportunity to more accurately identify which patients should undergo biopsy, despite negative mpMRI findings. PSA density ≥0.1 should be utilized as a stratification tool for pursuing prostate biopsy after a negative mpMRI. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e993 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Zhu More articles by this author Arnav Srivastava More articles by this author John Michael DiBianco More articles by this author Ji Qi More articles by this author Apoorv Dhir More articles by this author Mahir Maruf More articles by this author Stephanie Ferrante More articles by this author Anna Johnson More articles by this author Alice Semerjian More articles by this author Matthew S. Davenport More articles by this author Leena Mammen More articles by this author Ali Dabaja More articles by this author Brian Lane More articles by this author Kevin Ginsburg More articles by this author Karla Witzke More articles by this author Arvin K. George More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

PD07-01 PRACTICE-LEVEL VARIATION IN OPIOID-FREE DISCHARGE FOLLOWING SURGERY FOR T1 RENAL MASSES: A MUSIC-KIDNEY ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD07-01 PRACTICE-LEVEL VARIATION IN OPIOID-FREE DISCHARGE FOLLOWING SURGERY FOR T1 RENAL MASSES: A MUSIC-KIDNEY ANALYSIS Samantha Wilder, Ji Qi, Mahin Mirza, Adam Gadzinski, Thomas Maatman, Brian Lane, Craig Rogers, and for the Michigan Urological Surgery Improvement Collaborative Samantha WilderSamantha Wilder More articles by this author , Ji QiJi Qi More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Adam GadzinskiAdam Gadzinski More articles by this author , Thomas MaatmanThomas Maatman More articles by this author , Brian LaneBrian Lane More articles by this author , Craig RogersCraig Rogers More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The prescription of opioids following surgery has played a role in the current opioid epidemic, both by increasing the risk of persistent opioid use and through diversion of unused pills into the community. We evaluated practice-level variation in opioid prescribing following surgery for cT1 renal masses (T1RM) and examined the relationships between opioid-free discharge and postoperative emergency department (ED) visits and readmissions. METHODS: We retrospectively examined all T1RM patients with data regarding prescription of postoperative opioids within the MUSIC-KIDNEY registry from April 2021 to August 2022. Patients were stratified into those who received opioids at discharge and those who had opioid-free discharge, and associations with patient, tumor, and surgical factors were evaluated. Practice-level variation was assessed. Rates of postoperative ED visits and readmissions within 30 days were compared between cohorts. RESULTS: Of 248 patients who underwent surgery for T1RM across 11 practices in MUSIC-KIDNEY, 24.2% underwent opioid-free discharge. Practice level variation in rates of opioid-free discharge ranged from 0% to 72.7% (Figure 1). For patients prescribed opioids, the median number of pills was 12 (IQR 8-12). Patients prescribed opioids at discharge had a higher median BMI than those with opioid-free discharge (31.7 vs 28.7, p=0.003). Other patient comorbidities, tumor factors, surgical approach (minimally invasive vs. open), and surgery type (partial vs. radical nephrectomy) did not differ between cohorts (p>0.05). The opioid-free group had at least comparable rates of 30 day ED visits (0% vs. 3.2%) and readmission (1.7% vs. 5.3%), although this did not reach statistical significance (P>0.05). CONCLUSIONS: MUSIC-KIDNEY data suggests that opioid-free discharge is not associated with increased rates of postoperative ED visits or readmissions. There exists wide practice-level variation in the prescription of opioids following surgery for T1RM in the state of Michigan. Further investigation into additional factors driving this variation is warranted. There is potential to learn from practices that are safely limiting the number of pills entering the community, and future QI initiatives may focus on this metric. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e161 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha Wilder More articles by this author Ji Qi More articles by this author Mahin Mirza More articles by this author Adam Gadzinski More articles by this author Thomas Maatman More articles by this author Brian Lane More articles by this author Craig Rogers More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP55-10 LOWER RATES OF CLINICALLY-SIGNIFICANT PROSTATE CANCER ARE PRESENT IN PI-RADS 4 AND 5 LESIONS IN THE TRANSITIONAL ZONE THAN PERIPHERAL ZONE

You have accessJournal of UrologyCME1 Apr 2023MP55-10 LOWER RATES OF CLINICALLY-SIGNIFICANT PROSTATE CANCER ARE PRESENT IN PI-RADS 4 AND 5 LESIONS IN THE TRANSITIONAL ZONE THAN PERIPHERAL ZONE Jessica Shannon, Sabrina L. Noyes, Andrew Moriarity, Grand Rapids, Mi, Ji Qi, Bruce Lyu, Brian R Lane, and For the Michigan Urological Surgery Improvement Collaborative Jessica ShannonJessica Shannon More articles by this author , Sabrina L. NoyesSabrina L. Noyes More articles by this author , Andrew MoriarityAndrew Moriarity More articles by this author , Grand RapidsGrand Rapids More articles by this author , Mi Mi More articles by this author , Ji QiJi Qi More articles by this author , Bruce LyuBruce Lyu More articles by this author , Brian R LaneBrian R Lane More articles by this author , and For the Michigan Urological Surgery Improvement CollaborativeFor the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is limited data comparing prostate cancer (PC) detection rates in lesions identified within the peripheral zone (PZ) and transitional zone (TZ) on prostate MRI (pMRI). We compared the diagnostic performance of PIRADSv2 for detecting clinically significant (CS) PC in the PZ and TZ. METHODS: Data were queried from the Michigan Urological Surgery Improvement Collaborative (MUSIC) and Spectrum Health EMR to identify patients undergoing MRI assessed using PIRADS v2 by Advanced Radiology Services physicians between June 2016 and September 2022. All patients identified as having one or more PIRADS 4 or 5 lesions were included if they underwent targeted biopsy within 12 months of the MRI. The primary outcome was CSPC defined as GG2 or greater in biopsy of the targeted lesion. RESULTS: A total of 322 lesions in 224 patients were identified, with mean age 67 years, mean PSA 7.1 ng/ml, and mean prostate volume 63.4 cm3. Overall detection of PC was 75.2%, CSPC was 47.2%, and predominant pattern 4-5 (GG3-GG5) was 47.2%. 131 lesions were in the TZ and 191 in the PZ. CSPC was detected in 41.2% of TZ lesions and 51.3% of PZ lesions (p=0.075). CSPC detection was significantly higher for PI-RADS 4 lesions in the PZ compared to TZ (44.7% vs. 29.4%, p=0.034) and trended towards significance in PI-RADS 5 lesions (70.0% vs. 54.0%, p=0.0823). For GG3-GG5 PC, there was also a significant difference seen with PI-RADS 4 (8.8% vs. 20.6%, p=0.033) and a trend with PI-RADS 5 lesions (12.7% vs. 24.0%, p=0.117). CONCLUSIONS: Overall detection of PC was consistent with prior literature for PI-RADS 4 and 5 lesions. Lesions in the TZ were more likely to be benign or low-grade PC. This is important information for clinicians managing patients with TZ lesions and may suggest re-consideration of the precise features leading to PI-RADS assignments in the TZ in subsequent revisions. Source of Funding: The corresponding author would like to thank the Betz Family Endowment for Cancer Research for their continued support. Funding was provided in part by the Spectrum Health Foundation. Funding was provided in part by the Value Partnerships program at Blue Cross Blue Shield of Michigan. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e767 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Shannon More articles by this author Sabrina L. Noyes More articles by this author Andrew Moriarity More articles by this author Grand Rapids More articles by this author Mi More articles by this author Ji Qi More articles by this author Bruce Lyu More articles by this author Brian R Lane More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

PD38-05 IS ROUTINE ANTIBIOTIC PROPHYLAXIS REQUIRED FOR TRANSPERINEAL PROSTATE BIOPSY?

You have accessJournal of UrologyCME1 Apr 2023PD38-05 IS ROUTINE ANTIBIOTIC PROPHYLAXIS REQUIRED FOR TRANSPERINEAL PROSTATE BIOPSY? Apoorv Dhir, Alexander Zhu, Ji Qi, Stephanie Ferrante, Kevin Ginsburg, Alice Semerjian, Craig Rogers, Amit Patel, Brian Stork, Arvin George, and For the Michigan Urological Surgery Improvement Collaborative Apoorv DhirApoorv Dhir More articles by this author , Alexander ZhuAlexander Zhu More articles by this author , Ji QiJi Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Craig RogersCraig Rogers More articles by this author , Amit PatelAmit Patel More articles by this author , Brian StorkBrian Stork More articles by this author , Arvin GeorgeArvin George More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003336.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal prostate biopsy (TPBx) has successfully reduced the risk of infectious complications compared to the transrectal approach. Contemporary guidelines continue to recommend antibiotic prophylaxis due to potential rectal/skin flora contamination or entry into the urinary tract; however, this inherently risks escalating antimicrobial resistance. We sought to evaluate the current practice patterns of antibiotic prophylaxis (ATB) for TPBx and the associated rates of infectious complications. METHODS: Men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) prostate cancer registry who underwent non-fusion (systematic) TPBx between 2017 and 2022 were analyzed. Patient demographics, disease characteristics, and peri-procedural outcomes were assessed. The primary outcome was infectious complications after TPBx. Infections were defined as fever, sepsis, and/or UTI. RESULTS: We identified 2212 men who underwent non-fusion (systematic) TPBx in the study period, 669 (30%) of whom did not receive ATB for TPBx (Table 1). The yearly percentage of patients with no ATB rose from 0.81% in 2017 to 65.6% in 2022 (Figure 1). Between patients with ATB and no ATB, there were no statistically significant difference in rates of infection (0.65% vs 0.45%, p=0.77) or infectious hospitalizations (0.32% vs 0.45%, p=0.70). CONCLUSIONS: Use of antibiotic prophylaxis for TPBx has decreased over time in the state of Michigan. Antibiotic prophylaxis was not associated with rates of infection and infectious hospitalizations after transperineal fusion biopsy. Source of Funding: funding from Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e994 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Apoorv Dhir More articles by this author Alexander Zhu More articles by this author Ji Qi More articles by this author Stephanie Ferrante More articles by this author Kevin Ginsburg More articles by this author Alice Semerjian More articles by this author Craig Rogers More articles by this author Amit Patel More articles by this author Brian Stork More articles by this author Arvin George More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-01 STONE LOCATION AND STENTING INFLUENCE PATIENT-REPORTED PAIN AND QUALITY OF LIFE AFTER URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023MP19-01 STONE LOCATION AND STENTING INFLUENCE PATIENT-REPORTED PAIN AND QUALITY OF LIFE AFTER URETEROSCOPY Russell E. N. Becker, Stephanie Daignault-Newton, Andrew M. Higgins, Mahin Mirza, Bronson Conrado, Golena Fernandez Moncaleano, Mahmoud Hijazi, Karla Witzke, Jeremy Konheim, Richard Sarle, Kandis Rivers, William W. Roberts, Khurshid R. Ghani, Casey A. Dauw, and for the Michigan Urological Surgery Improvement Collaborative Russell E. N. BeckerRussell E. N. Becker More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Mahmoud HijaziMahmoud Hijazi More articles by this author , Karla WitzkeKarla Witzke More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , Richard SarleRichard Sarle More articles by this author , Kandis RiversKandis Rivers More articles by this author , William W. RobertsWilliam W. Roberts More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies of ureteroscopy outcomes have historically centered on efficacy (stone-free rates) and safety (complications). However, the patient’s own subjective experience, including pain and health-related quality of life (HRQOL), are gaining recognition as additional important factors. Empirical data on these are severely lacking. We have previously reported that ureteral stent placement after ureteroscopy increases unplanned healthcare encounters. However, less is known about the impact of stent placement on HRQOL. METHODS: The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) group launched a patient-reported outcomes (PRO) program in 2021 which includes assessments of pain (PROMIS Pain Intensity and Pain Interference), lower urinary tract symptoms (LURN), and treatment satisfaction (ICIQ). This automated system distributes electronic questionnaires preoperatively and at 7-10 days and 4-6 weeks postoperatively. We compared postoperative day 7-10 (POD7) PROs for stented versus not stented patients based on stone location (renal versus ureteral) with linear regression models adjusting for preoperative score, age, gender, pre-stenting, and stone size. RESULTS: Clinical and PRO data were collected on 338 patients (64% ureteral, 36% renal stones). Overall 251 (74.3%) had a stent placed at the time of surgery. Stented patients had larger stones in both the ureteral (8 vs 6mm, p<0.001) and renal (10 vs 7mm, p<0.001) subgroups. Stent omission in patients with ureteral stones resulted in improved PROMIS Pain Interference (52.7 vs 57.4, p<0.01), PROMIS Pain Intensity (48.9 vs 53.6, p<0.01), LURN urinary symptoms (6.3 vs 10.3, p<0.001), and ICIQ treatment satisfaction (21.1 vs 18.5, p<0.01) at POD7 (Figure 1). For patients with renal stones, stent omission resulted in improved PROMIS Pain Interference (55.8 vs 61.1, p=0.02) and LURN urinary symptoms (6.9 vs 10.7, p<0.001), without significant differences in PROMIS Pain Intensity (52.9 vs 56.6, p=0.1) or ICIQ treatment satisfaction (20.0 vs 17.6, p=0.07). CONCLUSIONS: Stent omission at the time of ureteroscopy was associated with significantly better PROs at POD7 for patients with both ureteral and renal stones. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e264 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russell E. N. Becker More articles by this author Stephanie Daignault-Newton More articles by this author Andrew M. Higgins More articles by this author Mahin Mirza More articles by this author Bronson Conrado More articles by this author Golena Fernandez Moncaleano More articles by this author Mahmoud Hijazi More articles by this author Karla Witzke More articles by this author Jeremy Konheim More articles by this author Richard Sarle More articles by this author Kandis Rivers More articles by this author William W. Roberts More articles by this author Khurshid R. Ghani More articles by this author Casey A. Dauw More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP38-15 DISCONTINUATION OF ACTIVE SURVEILLANCE WITHOUT RISK RECLASSIFICATION PRIOR TO TREATMENT

You have accessJournal of UrologyCME1 Apr 2023MP38-15 DISCONTINUATION OF ACTIVE SURVEILLANCE WITHOUT RISK RECLASSIFICATION PRIOR TO TREATMENT Mark Pressprich, Cullen Hudson, Ji Qi, Stephanie Ferrante, Khurshid Ghani, Brian Lane, Richard Sarle, Jason Hafron, Michael Cher, Alice Semerjian, Arvin George, Kevin Ginsburg, and For the Michigan Urological Surgery Improvement Collaborative Mark PressprichMark Pressprich More articles by this author , Cullen HudsonCullen Hudson More articles by this author , Ji QiJi Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Brian LaneBrian Lane More articles by this author , Richard SarleRichard Sarle More articles by this author , Jason HafronJason Hafron More articles by this author , Michael CherMichael Cher More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Arvin GeorgeArvin George More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Guideline organizations support the use of active surveillance (AS) for all men with low risk (LR) and select men with favorable intermediate risk (FIR) prostate cancer (PC). Although encouraging AS as the initial approach for favorable-risk PC is an important first step in reducing overtreatment, this strategy is incomplete as it ignores another source of overtreatment: delayed treatment of men on AS who have not had risk reclassification. We evaluated the proportion of men that transitioned from AS to treatment without risk reclassification. METHODS: We reviewed the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry for men diagnosed with NCCN LRPC and FIRPC that underwent treatment after a period of AS to identify the proportion of men that did not have risk reclassification prior to treatment. Reclassification was defined as meeting any criteria for NCCN FIRPC for men initially diagnosed with LRPC and any criteria for NCCN unfavorable intermediate risk PC for men initially diagnosed with FIRPC. RESULTS: From 2013 to 2021, 2118 men in MUSIC underwent treatment after initial AS, of which 741 (35%) did not have risk reclassification prior to treatment. A higher proportion of men with FIRPC underwent treatment without risk reclassification compared with LRPC (50% vs. 29%, p<0.001). The proportion of men with LRPC undergoing delayed treatment decreasing from 60% in 2013 to 23% in 2021 (Figure 1). Alternatively, the proportion of men with FIRPC treated without risk reclassification has remained stable. CONCLUSIONS: The overall percent of patients leaving AS for treatment without risk reclassification has declined in MUSIC, likely due to an increasing acceptance and comfort with AS for favorable-risk PC. The proportion of men with FIRPC undergoing treatment without risk reclassification has remained relatively stable, which may be explained by the clinical uncertainty regarding a treatment threshold for these men on AS. While there remains uncertainty regarding when patients with FIRPC on AS should be treated, there are QI opportunities to reduce overtreatment in men with LRPC on AS, a group for which the urologic community has coalesced around the use of AS as the preferred approach. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e530 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Pressprich More articles by this author Cullen Hudson More articles by this author Ji Qi More articles by this author Stephanie Ferrante More articles by this author Khurshid Ghani More articles by this author Brian Lane More articles by this author Richard Sarle More articles by this author Jason Hafron More articles by this author Michael Cher More articles by this author Alice Semerjian More articles by this author Arvin George More articles by this author Kevin Ginsburg More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

PD28-08 URETEROSCOPY DUSTING VERSUS FRAGMENTATION/BASKETING FOR TREATING RENAL STONES: REAL WORLD UTILIZATION AND OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023PD28-08 URETEROSCOPY DUSTING VERSUS FRAGMENTATION/BASKETING FOR TREATING RENAL STONES: REAL WORLD UTILIZATION AND OUTCOMES Alex Zhu, Russell E.N. Becker, Andrew M. Higgins, Monica S. Van Til, Stephanie Daignault-Newton, Sung Yong Cho, Richard C. Sarle, Eric R. Stockall, Rabia Martin, Bronson Conrado, Golena Fernandez Moncaleano, Casey A. Dauw, Khurshid R. Ghani, and FOR the Michigan Urological Surgery Improvement Collaborative Alex ZhuAlex Zhu More articles by this author , Russell E.N. BeckerRussell E.N. Becker More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Monica S. Van TilMonica S. Van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Richard C. SarleRichard C. Sarle More articles by this author , Eric R. StockallEric R. Stockall More articles by this author , Rabia MartinRabia Martin More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and FOR the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003313.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Dusting technique for ureteroscopy (URS) laser lithotripsy has become popular, but there remains a knowledge gap about how often it is performed compared to fragmentation with basketing. Prior studies of dusting vs. fragmentation/basketing are from expert single centers and may not reflect real-world practice. We assessed practice patterns and outcomes of the two techniques in Michigan. METHODS: Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all single-stage cases of URS laser lithotripsy performed for renal stones between 2016-2022. Data was collected by independent abstractors at each practice using standardized definitions. Stone-free rate (SFR) was defined as zero fragments on imaging reports (ultrasound, x-ray, CT scan) within 60 days. We assessed practice and urologist-level utilization of dusting vs. fragmentation/basketing. We compared characteristics of patients. Using multivariable regression we assessed the association of each technique with 30-day postoperative emergency department (ED) visits accounting for patient, stone, and surgical characteristics. RESULTS: Among 4,772 ureteroscopy procedures for renal stones performed by 230 surgeons across 34 practices, 2,838 (59%) were performed with a dusting technique. Significant variation in use of dusting was observed across practices (3-99%, p<0.001) and urologists (0-100%, p<0.001) (Figure 1). Utilization was greatest in larger practices. Dusting was used more frequently for larger stones (median [IQR]: 9mm [7-13] vs 8mm [6-11], p<0.001) and stones in multiple locations (30% vs. 20%, p<0.001). Ureteral access sheaths (55% vs 72%, p<0.001) and post-operative stents (79% vs 86%, p<0.001) were used less frequently with dusting. Post-operative imaging was performed in 48% of patients; SFR was lower with dusting (41% vs 57%, p<0.001). Dusting was associated with higher ED visits on multivariable analysis (OR 1.4, 95% CI 1.1-1.8, p=0.006). CONCLUSIONS: Six of ten patients with renal stones undergoing URS are treated with a dusting technique in Michigan. Our data suggests dusting is more frequently used in larger practices which could be related to access of high-power lasers. Real-world practice indicates dusting is associated with more post-operative ED visits. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e821 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Zhu More articles by this author Russell E.N. Becker More articles by this author Andrew M. Higgins More articles by this author Monica S. Van Til More articles by this author Stephanie Daignault-Newton More articles by this author Sung Yong Cho More articles by this author Richard C. Sarle More articles by this author Eric R. Stockall More articles by this author Rabia Martin More articles by this author Bronson Conrado More articles by this author Golena Fernandez Moncaleano More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author FOR the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP44-09 CAN MRI REPLACE REPEAT BIOPSY IN MEN WITH MULTIFOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA OR ATYPICAL SMALL ACINAR PROLIFERATION?

You have accessJournal of UrologyCME1 Apr 2023MP44-09 CAN MRI REPLACE REPEAT BIOPSY IN MEN WITH MULTIFOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA OR ATYPICAL SMALL ACINAR PROLIFERATION? Michael Sessine, Codrut Radoiu, Ji Qi, Frank Burks, Arvin George, Brian Lane, Kenneth Lim, Ali Dabaja, Michael Cher, Alice Semerjian, Kevin Ginsburg, and For the Michigan Urological Surgery Improvement Collaborative Michael SessineMichael Sessine More articles by this author , Codrut RadoiuCodrut Radoiu More articles by this author , Ji QiJi Qi More articles by this author , Frank BurksFrank Burks More articles by this author , Arvin GeorgeArvin George More articles by this author , Brian LaneBrian Lane More articles by this author , Kenneth LimKenneth Lim More articles by this author , Ali DabajaAli Dabaja More articles by this author , Michael CherMichael Cher More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and For the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High-grade prostatic intraepithelial neoplasia (HGPIN) and atypical small acinar proliferation (ASAP) are associated with an increased risk of clinically significant prostate cancer (CaP) on subsequent prostate biopsy. We investigated the association of multiparametric MRI (mpMRI) findings in men with a previous diagnosis of HGPIN or ASAP with findings on repeat biopsy. METHODS: We retrospectively reviewed patients with multifocal HGPIN or ASAP undergoing a repeat biopsy in the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry. We compared the proportion of men with a benign biopsy, GG1, and ≥GG2 CaP on repeat biopsy within 24 months of the initial biopsy with HGPIN/ASAP. Men were placed into three groups: 1) without a mpMRI, 2) with a mpMRI demonstrating a PIRADS 1-3 lesion, 4) and PIRADS 4-5 lesion. Men with a mpMRI performed before or after the initial biopsy that demonstrated HGPIN/ASAP were analyzed separately. RESULTS: There were 219 men in the MUSIC registry with a diagnosis of HGPIN or ASAP on their initial biopsy that underwent a repeat biopsy, of which 86 had a mpMRI before (n=12) or after (n=74) the initial biopsy. Among men with a mpMRI after the initial biopsy (Figure 1), we noted that a lower proportion of men with PIRADS 1-3 lesions had GG1 (15%) or ≥GG2 (3.0%) CaP and a higher proportion had benign biopsies (82%) compared with men without a mpMRI (19%, 12%, and 70%, respectively, p=0.237). Men with a PIRADS 4-5 lesion after the initial biopsy had a higher proportion of ≥GG2 (56%) and GG1 (17%) CaP and a lower proportion of benign biopsies (27%) on repeat biopsy compared with men without a mpMRI (19%, 12%, and 70%, respectively, p<0.001). Among patients with a mpMRI prior to the initial biopsy, 0/12 patients were diagnosed with ≥GG2 CaP on repeat biopsy. CONCLUSIONS: Men with PIRADS 1-3 lesions on MRI after a diagnosis of HGPIN/ASAP had a low risk of clinically significant CaP on repeat biopsy while men with PIRADS 4-5 lesions were less likely to have benign biopsies and more likely to have clinically significant CaP compared with men without an MRI prior to repeat biopsy. MRI is a valuable tool to triage which men with HGPIN or ASAP on initial biopsy should undergo or avoid repeat biopsy without missing clinically significant CaP. Source of Funding: Blue Cross Blue Shield of Michigan, Rogel Cancer Center © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e614 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Sessine More articles by this author Codrut Radoiu More articles by this author Ji Qi More articles by this author Frank Burks More articles by this author Arvin George More articles by this author Brian Lane More articles by this author Kenneth Lim More articles by this author Ali Dabaja More articles by this author Michael Cher More articles by this author Alice Semerjian More articles by this author Kevin Ginsburg More articles by this author For the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-10 DUELING ACTIVE SURVEILLANCE: DOES UTILIZATION OF ACTIVE SURVEILLANCE FOR LOW RISK PROSTATE CANCER CORRESPOND WITH UTILIZATION OF ACTIVE SURVEILLANCE FOR SMALL RENAL MASSES?

You have accessJournal of UrologyCME1 Apr 2023MP64-10 DUELING ACTIVE SURVEILLANCE: DOES UTILIZATION OF ACTIVE SURVEILLANCE FOR LOW RISK PROSTATE CANCER CORRESPOND WITH UTILIZATION OF ACTIVE SURVEILLANCE FOR SMALL RENAL MASSES? Michael Wang, Sophie Wittenberg, Michael Cher, JI Qi, Stephanie Ferrante, Mahin Mirza, Anna Johnson, Alice Semerjian, Arvin George, Craig Rogers, Samantha Wilder, Richard Sarle, Khurshid Ghani, Brian Lane, Kevin Ginsburg, and For The Michigan Urological Surgery IMPROVEMENT Collaborative Michael WangMichael Wang More articles by this author , Sophie WittenbergSophie Wittenberg More articles by this author , Michael CherMichael Cher More articles by this author , JI QiJI Qi More articles by this author , Stephanie FerranteStephanie Ferrante More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Anna JohnsonAnna Johnson More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Arvin GeorgeArvin George More articles by this author , Craig RogersCraig Rogers More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Richard SarleRichard Sarle More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Brian LaneBrian Lane More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) is the recommended management strategy for men with low-risk prostate cancer (CaP). Similarly, AS has been shown to be safe for patients with renal masses <4 cm (cT1aRM). Here, we assessed surgeon-level practice patterns for the use of AS in patients with GG1 CaP and cT1aRM. We hypothesized that the proportion of a urologist’s patients with CaP managed with AS will correlate with the use of AS for their patients with cT1aRM. METHODS: We reviewed practice patterns of surgeons in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Urologists were included if they managed at least 10 GG1 CaP and 10 cT1aRM patients between 2017 and 2021. Using the Chi-squared test, we compared the proportions of cT1aRM patients managed with AS among surgeons in the lowest and highest quartile of AS use for those with GG1 CaP. We fit separate multivariable mixed-effects logistic regression models to obtain risk-adjusted proportions of a urologist’s patients with GG1 CaP and cT1aRM managed with AS. Correlation between a surgeon’s risk-adjusted use of AS for the two groups was assessed with Pearson’s correlation coefficient. RESULTS: 27 urologists met the inclusion criteria. 82% of men with GG1 CaP were managed on AS compared with 49% of men with cT1aRM. Among the surgeons in the lowest quartile of AS use for CaP (<71% of men with GG1 CaP managed on AS), 33% of men with cT1aRMs were managed with AS compared to 49% of men with cT1aRMs managed by the surgeons in the highest quartile of CaP AS use (>89% of men with GG1 CaP managed with AS, p<0.001, Figure 1). There was a modest positive correlation between the proportion of a surgeon’s men with GG1 prostate cancer and cT1aRM managed with AS (correlation coefficient: 0.47, p=0.014). CONCLUSIONS: There is marked variability in the use of AS for patients with GG1 CaP and cT1aRMs by surgeons. Those that are low utilizers of AS for men with GG1 CaP used less AS for patients with cT1aRM compared with surgeons that are high utilizers of AS for GG1 CaP. Thus, urologists who use AS for GG1 CaP are more likely to use AS for patients cT1aRM, while those that are more likely to operatively manage one low risk malignancy are likely to also operate on a second low risk malignancy. Source of Funding: funding from Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e884 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Wang More articles by this author Sophie Wittenberg More articles by this author Michael Cher More articles by this author JI Qi More articles by this author Stephanie Ferrante More articles by this author Mahin Mirza More articles by this author Anna Johnson More articles by this author Alice Semerjian More articles by this author Arvin George More articles by this author Craig Rogers More articles by this author Samantha Wilder More articles by this author Richard Sarle More articles by this author Khurshid Ghani More articles by this author Brian Lane More articles by this author Kevin Ginsburg More articles by this author For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE Sami E. Majdalany, Monica van Til, Stephanie Daignault-Newton, David Leavitt, Khurshid Ghani, Casey Dauw, Naveen Kachroo, and Michigan Urological Surgery Improvement Collaborative Sami E. MajdalanySami E. Majdalany More articles by this author , Monica van TilMonica van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , David LeavittDavid Leavitt More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Casey DauwCasey Dauw More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Shockwave lithotripsy (SWL) is a commonly performed stone procedure in the US. AUA guidelines do not recommend routine stent placement for SWL patients. We evaluated statewide practice patterns and predictors for stent placement at the time of SWL and whether stent placement affected stone free rates (SFR) and 30-day complication rates. METHODS: Adult patients undergoing SWL between 2016-2022 were identified using the MUSIC Reducing Operative Complications from Kidney Stones prospectively collected registry. We determined stent usage prior and during SWL across practices and collected demographic, clinical, stone and procedural factors. Outcomes included peri-operative management, complications and SFR. Multivariable logistic regression was used to identify predictors of stent placement at time of SWL. RESULTS: Among 13,063 cases identified from 35 practices (222 urologists), wide practice variation in stent placement patterns were noted ranging from 0-17% (Figure 1). Overall, 2.3% cases were stented at the time of SWL and 15.5% had a prior stent. Stent on a string was performed in 26 cases (9%) by 11 urologists (54% by 1 provider). Stented SWL patients (prior/time of SWL) were more likely to be older, have a higher Charlson comorbidity index, solitary kidney, 1st upper tract stone, ureteral stone, larger stone, hydronephrosis and positive urinalysis/urine culture (all p<0.01). Stented patients were more likely to have peri-op and post-op antibiotics and anticholinergics (p<0.001). Predictors of stent placement at time of SWL included ureteral stones (OR1.6, 95%CI 1.1-2.3, p=0.01), larger stones (OR1.2, 95%CI 1.216-1.23, p<0.001), African-American race (OR1.8, 95%CI 1.03-3.0, p=0.039) and hydronephrosis (OR1.8, 95%CI 1.3-2.6, p<0.001). There were no differences in emergency department (ED) visits between stented and unstented patients (5.3% vs 3.9%, p=0.21) or 60-day SFR (34% vs 40%, p=0.10). Stented patients had significantly higher infectious complications (3% vs 0.6%, p<0.001). CONCLUSIONS: Variation exists amongst urologists regarding stent usage with SWL, influenced by specific patient and stone factors as well as provider preference. Although ED visits and SFR did not differ, stented patients had a significantly increased post operative infection rate. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e756 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sami E. Majdalany More articles by this author Monica van Til More articles by this author Stephanie Daignault-Newton More articles by this author David Leavitt More articles by this author Khurshid Ghani More articles by this author Casey Dauw More articles by this author Naveen Kachroo More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

PD40-03 PRACTICE AND SURGEON-LEVEL VARIATION IN THE SURGICAL MANAGEMENT OF T1A RENAL MASSES: RESULTS FROM A STATEWIDE COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023PD40-03 PRACTICE AND SURGEON-LEVEL VARIATION IN THE SURGICAL MANAGEMENT OF T1A RENAL MASSES: RESULTS FROM A STATEWIDE COLLABORATIVE Samantha Wilder, Mahmoud Hijazi, Ananya Vittal, Ji Qi, Mahin Mirza, Mohammad Jafri, Brian Lane, Craig Rogers, and for the Michigan Urological Surgery Improvement Collaborative Samantha WilderSamantha Wilder More articles by this author , Mahmoud HijaziMahmoud Hijazi More articles by this author , Ananya VittalAnanya Vittal More articles by this author , Ji QiJi Qi More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Brian LaneBrian Lane More articles by this author , Craig RogersCraig Rogers More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend prioritizing partial nephrectomy (PN) over radical nephrectomy (RN) in the management of cT1a renal masses (T1aRM). We examined variation in PN use for surgically treated T1aRM and identified factors associated with PN use in the MUSIC-KIDNEY collaborative. METHODS: All patients in the MUSIC-KIDNEY registry undergoing surgery for T1aRM between 5/2017 and 5/2022 were included. Practice- and surgeon-level variation in use of PN (vs RN) were evaluated among those who treated at least 5 patients surgically. Multivariable mixed-effects logistic regression model was performed to identify factors associated with PN use. Rates of prolonged hospitalization (>3 days for minimally invasive, >5 days for open), 30-day emergency department (ED) visits, and 30-day readmissions were compared between patients undergoing PN and RN, using Chi-squared test or Fisher’s exact test. RESULTS: 1014 surgically treated T1aRM patients from 14 practices and 68 surgeons were included. Among these, 843 (83%) underwent PN and 171 (17%) underwent RN. Rates of utilization of PN ranged from 50-93% across practices and 38-100% across surgeons (Figure 1). Low patient comorbidity, preoperative GFR>60, and low nephrometry score (RENL 4-6) were associated with increased use of PN (p<0.05). Postoperative ED visit rates were low for both RN and PN (3.5% vs 2.6%) and did not differ significantly (p>0.05). RN was associated with higher rates of prolonged hospitalization (19% vs 7.7%, p<0.05) and readmission (5.9% vs 2.9%, p<0.05). CONCLUSIONS: Over 80% of surgically treated T1aRM underwent PN in MUSIC-KIDNEY with variation across practices and surgeons. Association of high preoperative GFR with PN may be related to the high rates of surveillance (>50%) for T1aRM in MUSIC-KIDNEY for masses that may have otherwise undergone PN. Higher rates of prolonged hospitalization and readmission for RN may be related to higher baseline comorbidity. Quality improvement initiatives within MUSIC-KIDNEY include a PN video library and live peer-to-peer review sessions with the goal of increasing surgeon comfort and skill in PN. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1052 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha Wilder More articles by this author Mahmoud Hijazi More articles by this author Ananya Vittal More articles by this author Ji Qi More articles by this author Mahin Mirza More articles by this author Mohammad Jafri More articles by this author Brian Lane More articles by this author Craig Rogers More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP41-06 ASSESSING UTILIZATION OF RENAL MASS BIOPSY IN THE MANAGEMENT OF T1A VS. T1B RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023MP41-06 ASSESSING UTILIZATION OF RENAL MASS BIOPSY IN THE MANAGEMENT OF T1A VS. T1B RENAL MASSES Dennis Boynton, Sabrina Noyes, Mahin Mirza, Brian Seifman, Edward Schervish, Mohit Butaney, Ji Qi, Craig Rogers, Brian R. Lane, and for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI Dennis BoyntonDennis Boynton More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Brian SeifmanBrian Seifman More articles by this author , Edward SchervishEdward Schervish More articles by this author , Mohit ButaneyMohit Butaney More articles by this author , Ji QiJi Qi More articles by this author , Craig RogersCraig Rogers More articles by this author , Brian R. LaneBrian R. Lane More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The appropriate and optimal use of renal mass biopsy (RMB) lacks standardization and varies from physician to physician. Our objective is to explore the impact that RMB has on active surveillance (AS), nephron-sparing intervention (NSI), and radical nephrectomy (RN) rates for cT1 renal masses (cT1RM). METHODS: Data regarding 3,466 patients with a newly diagnosed cT1RM and managed with AS, NSI (partial nephrectomy, tumor ablation, and stereotactic body radiation), or RN was collected retrospectively by MUSIC-KIDNEY registrars. Patient, tumor, RMB, and management data were extracted from the registry. RESULTS: Of 3,466 patients, 626 (18%) underwent RMB, including 17% with T1a and 20% with T1b tumors. There were no significant differences in age, race, sex, GFR >or ≤60, or T1a vs. T1b in the cohorts with or without RMB. Management differed somewhat between the cohorts with vs. without RMB; AS was elected by 41% vs. 50%, NSI by 45% vs. 35%, and RN by 14% vs. 15% (p<0.001, Fig. 1). In patients with T1a masses with or without RMB, AS was elected by 44% vs. 58%, NSI by 48% vs. 36%, and RN by 7.8% vs. 6.0% (p<0.001). In contrast, management in T1b patients with or without RMB, AS was elected by 33% vs. 23%, NSI by 37% vs. 33%, and RN by 30% vs. 44% (p=0.0027, Fig. 2). CONCLUSIONS: While academic discussion of RMB tends to focus more on patients with T1a renal masses, RMB appears to impact treatment choice for T1b more than for T1a masses. Utilization of RMB in patients with T1b renal masses resulted in increased rates of NSI and AS; for every 8 RMB in this group of patients, 1 kidney will be saved from RN. More patients with T1a masses underwent intervention after RMB than those not having RMB. Perhaps providing a cancer diagnosis to patients who were initially considering AS for their ‘renal mass’ pressured them to pursue unnecessary intervention. Source of Funding: The corresponding author would like to thank the Betz Family Endowment for Cancer Research for their continued support. Funding was provided in part by the Spectrum Health Foundation. Funding was provided in part by the Value Partnerships program at Blue Cross Blue Shield of Michigan. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e556 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dennis Boynton More articles by this author Sabrina Noyes More articles by this author Mahin Mirza More articles by this author Brian Seifman More articles by this author Edward Schervish More articles by this author Mohit Butaney More articles by this author Ji Qi More articles by this author Craig Rogers More articles by this author Brian R. Lane More articles by this author for the Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI More articles by this author Expand All Advertisement PDF downloadLoading ...

PD45-11 DOES THE USE OF A URETERAL ACCESS SHEATH REDUCE INFECTION-RELATED HOSPITALIZATION? REAL-WORLD DATA FROM A SURGICAL COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023PD45-11 DOES THE USE OF A URETERAL ACCESS SHEATH REDUCE INFECTION-RELATED HOSPITALIZATION? REAL-WORLD DATA FROM A SURGICAL COLLABORATIVE Russelle. N. Becker, Andrew M. Higgins, Golena Fernandez Moncaleano, Sung Yong Cho, Mohammad Jafri, Jessica Phelps, Jeremy Konheim, Bronson Conrado, Monica S. Van Til, Stephanie Daignault-Newton, Casey A. Dauw, Khurshid R. Ghani, and For The Michigan Urological Surgery IMPROVEMENT Collaborative Russelle. N. BeckerRusselle. N. Becker More articles by this author , Andrew M. HigginsAndrew M. Higgins More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , Sung Yong ChoSung Yong Cho More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Jessica PhelpsJessica Phelps More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Monica S. Van TilMonica S. Van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elevated intrarenal pressure during ureteroscopy (URS) may result in pyelovenous backflow, which is hypothesized to increase the risk of sepsis. When treating renal stones, the ureteral access sheath (UAS) is considered a pressure mitigation strategy, yet evidence on whether a UAS reduces infectious complications is unclear. Prior studies are limited by small cohorts, heterogenous inclusion criteria, ambiguous endpoints, or lack adequate risk adjustment. We examined UAS use when treating renal stones and its association with infection-related hospitalization in a statewide registry. METHODS: Using the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry, we identified all patients undergoing single-stage unilateral URS for renal stones, with or without the use of a UAS. We assessed variation in UAS in practices with>10 cases. We evaluated demographic differences between cases with or without UAS. A multivariable logistic regression model was constructed to examine the impact of UAS use and other patient, stone, and surgical factors on 30-day infection-related hospitalization. RESULTS: Among 6,142 patients undergoing URS by 233 urologists across 34 practices, 152 (2.5%) had an infection-related hospitalization within 30 days. Patients with UAS had significantly larger stones, more positive preoperative urine culture, and higher comorbidity. Overall 59% of cases utilized UAS, with significant variation between practices (4.1% to 99.5%, p<0.0001; Figure). Infection-related hospitalization rates were no different for cases with (2.6%) vs. without (2.3%) UAS use (p=0.5). On multivariable analysis, infection-related hospitalizations did not differ by UAS (OR 0.8; 95% CI 0.6 - 1.2; p=0.4), but were associated with higher Charlson Comorbidity Index (CCI 1 vs. 0, OR 1.9; 95% CI 1.2 - 2.9; CCI 2+ vs. 0, OR 2.3; 95% CI 1.4 - 3.6; p<0.001), history of recurrent UTI (OR 2.4; 95% CI 1.4 - 4.0; p<0.01), larger stones (OR per 5mm 1.1; 95% CI 1.0 - 1.3; p=0.04), and positive preoperative urine culture (OR 1.8; 95% CI 1.2 - 2.7; p<0.01). CONCLUSIONS: Utilization of UAS when treating renal stones varies widely across practices within Michigan. UAS did not reduce infection-related hospitalization following URS for renal stones. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1167 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russelle. N. Becker More articles by this author Andrew M. Higgins More articles by this author Golena Fernandez Moncaleano More articles by this author Sung Yong Cho More articles by this author Mohammad Jafri More articles by this author Jessica Phelps More articles by this author Jeremy Konheim More articles by this author Bronson Conrado More articles by this author Monica S. Van Til More articles by this author Stephanie Daignault-Newton More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP64-09 THREE-YEAR FOLLOW-UP FOR SURVEILLANCE OF T1 RENAL MASSES: A MUSIC-KIDNEY ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP64-09 THREE-YEAR FOLLOW-UP FOR SURVEILLANCE OF T1 RENAL MASSES: A MUSIC-KIDNEY ANALYSIS Samantha Wilder, JI Qi, Mahin Mirza, Sabrina Noyes, Mohammad Jafri, Brian Seifman, Alice Semerjian, Craig Rogers, Brian Lane, and For The Michigan Urological Surgery IMPROVEMENT Collaborative Samantha WilderSamantha Wilder More articles by this author , JI QiJI Qi More articles by this author , Mahin MirzaMahin Mirza More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Brian SeifmanBrian Seifman More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Craig RogersCraig Rogers More articles by this author , Brian LaneBrian Lane More articles by this author , and For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003322.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Questions remain regarding the durability of surveillance as a management option for cT1 renal masses (T1RM). MUSIC-KIDNEY prospectively collects data regarding patients with newly diagnosed T1RM that are evaluated in any of 21 Michigan urologic practices. We evaluated imaging study performance and delayed intervention for patients who were initially placed on surveillance prior to 2020. METHODS: Between 5/2017 and 12/2019, patients in the MUSIC-KIDNEY registry who were initially managed without definitive treatment within 90 days of initial evaluation for T1RM were included. Follow-up imaging studies and treatment data were summarized. Treatment-free survival was calculated using the Kaplan-Meier method. RESULTS: A total of 443 patients were managed without definitive treatment within 90 days, including 347 (78%) with solid, 49 (11%) with complex cystic (Bosniak III-IV), and 47 (11%) with indeterminate T1RM. Median length of follow up since initial urology encounter was 26 months (IQR 13-34). Median age was 69 (IQR 59-77). Median tumor size was 2.2cm (IQR 1.5-3.2). After initiating surveillance, 36 patients have died (1 from prostate cancer, 1 from kidney cancer, 30 from other causes, 4 from unknown causes). Among patients with at least 1 year of clinical follow-up (n=339), 202 (60%) received at least one follow up imaging study during the 1st year. 59 (17%) underwent treatment during the 1st year, including radical nephrectomy (RN) (n=17), partial nephrectomy (PN) (n=32), tumor ablation (TA) (n=8), and stereotactic body radiation therapy (SBRT) (n=2). Among patients with at least 2 years of follow up (n=233), 113 (48%) received at least one follow up imaging study per year. During these 2 years, 66 (28%) were treated, including 19 RN, 34 PN, 8 TA, and 5 SBRT. Three-year treatment-free survival for all T1RM was 67% (95% CI 61%-72%) (Figure). CONCLUSIONS: MUSIC data demonstrate that surveillance is a durable option for management of T1RM, with over 65% of patients initially managed without intervention remaining treatment-free at 3 years. Future investigations will include examining predictors of delayed intervention and outcomes of delayed vs. primary intervention. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e884 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha Wilder More articles by this author JI Qi More articles by this author Mahin Mirza More articles by this author Sabrina Noyes More articles by this author Mohammad Jafri More articles by this author Brian Seifman More articles by this author Alice Semerjian More articles by this author Craig Rogers More articles by this author Brian Lane More articles by this author For The Michigan Urological Surgery IMPROVEMENT Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-01 THE EFFECT OF OPIATES ON PATIENT REPORTED OUTCOMES AFTER URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023MP48-01 THE EFFECT OF OPIATES ON PATIENT REPORTED OUTCOMES AFTER URETEROSCOPY Andrew Higgins, Russell Becker, Stephanie Daignault-Newton, Golena Fernandez Moncaleano, John Ludlow, Hector Pimentel, Brian Seifman, David Wenzler, Bronson Conrado, Karla Witzke, and Khurshid Ghani Casey Dauw Andrew HigginsAndrew Higgins More articles by this author , Russell BeckerRussell Becker More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Golena Fernandez MoncaleanoGolena Fernandez Moncaleano More articles by this author , John LudlowJohn Ludlow More articles by this author , Hector PimentelHector Pimentel More articles by this author , Brian SeifmanBrian Seifman More articles by this author , David WenzlerDavid Wenzler More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Karla WitzkeKarla Witzke More articles by this author , and Khurshid Ghani Casey DauwKhurshid Ghani Casey Dauw More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The outcomes of kidney stone surgery have long been focused on stone-free rates and safety, yet patient reported outcomes (PRO) are often lacking. In 2018 the Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) group initiated a pain optimization pathway using an opioid-free multi-modal pain regimen. This has resulted in a decline in opioid prescription rates after ureteroscopy (86 to 19%). We used a comprehensive PRO system to understand the initiative’s impact on patients’ experiences of treatment pain and satisfaction. METHODS: MUSIC ROCKS instituted its patient-reported outcomes (PRO) program in 2020 which included an assessment of patient pain (PROMIS Pain Intensity short form and Pain Interference short form) and overall treatment satisfaction (ICIQ-S). This system is automated and distributes questionnaires preoperatively and at 7-10 days and 4-6 weeks following ureteroscopy (URS). We compared patients who were prescribed opiates after URS to those who were not. After adjusting for observed demographic differences (age, gender, pre-stent status, stone location/size, and preoperative pain), we evaluated PRO pain intensity and interference with linear mixed models. A clinically meaningful difference in PROMIS scores is 2.5-3.5 points. Treatment satisfaction scores were compared with Wilcoxon rank tests. RESULTS: A total of 292 patients completed all questionnaires (258 non-opioid and 34 opioid). There was no significant difference between non-opioid and opioid cohorts with regards to age (60 vs 59 years), gender (50 vs 53% male), pre-stenting status (76 vs 65%), stone location (64 vs 59% ureteral), and stone size (8.0 vs 7.2 mm). After adjustment, there was no significant difference in preoperative pain intensity scores between the groups at pre-URS (p=0.06), 7-10 days postop (p=0.87), and 4-6 weeks postop (p=0.99, Figure). Pain interference followed a similar pattern, with no significant differences observed at any timepoint. There was no difference in satisfaction scores, as measured both 7-10 days (p=0.46) and 4-6 weeks (p=0.47) after URS. CONCLUSIONS: Rates of opiate prescription have declined after URS in Michigan. Using a novel PRO system, we confirmed that utilization of opioid-free pathways has not resulted in increased pain nor decreased patient satisfaction. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e654 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Higgins More articles by this author Russell Becker More articles by this author Stephanie Daignault-Newton More articles by this author Golena Fernandez Moncaleano More articles by this author John Ludlow More articles by this author Hector Pimentel More articles by this author Brian Seifman More articles by this author David Wenzler More articles by this author Bronson Conrado More articles by this author Karla Witzke More articles by this author Khurshid Ghani Casey Dauw More articles by this author Expand All Advertisement PDF downloadLoading ...

Determining the impact of genomic classifier testing on patient-reported quality of life after prostatectomy: Results from the G-MINOR randomized trial.

345 Background: Decipher is a tissue-based genomic classifier (GC) developed and validated in the post-radical prostatectomy (RP) setting to help guide adjuvant treatment decisions for prostate cancer (PCa). We conducted the first prospective, randomized trial assessing the impact of GC testing on adjuvant therapy use. Here, we determine the impact of GC testing on patient reported (PRO) quality of life outcomes (QoL) in men at high-risk of post-RP recurrence. Methods: The G-MINOR trial is a prospective, unblinded, randomized trial which enrolled 356 patients from 12 centers in the Michigan Urological Surgery Improvement Collaborative (MUSIC). Patients were enrolled between Aug 2016-July 2018. Eligible patients had undergone RP within 9 months of enrollment, had pT3-4 disease and/or positive surgical margins, and a post-RP PSA &lt;0.1ng/mL. Patients were assigned to either the GC or usual-care (UC) group using cluster-crossover block randomization assignments. Evaluable patients (338) were followed for at least 18 months. PROs were obtained using the Expanded Prostate Cancer Index Composite (EPIC-26) survey at baseline (before RP), 3, 6, 12, and 24 months after RP. Results: A total of 226/338 evaluable men (67%) had PRO data for this analysis (116 UC arm/110 GC arm). Median age was 65 years. Of the 226 men included in the PRO analysis, a total of 23 (9 UC arm/14 GC arm) had adjuvant treatment (p = 0.22). At 12 months follow-up, those in the GC arm had no significant change in adjusted mean difference in domain score from baseline compared to those in the UC arm for urinary irritative (UIR) function (1.0, 95% CI [-2.9– 4.9], p=0.6), urinary incontinence (UI) (0.8, 95% CI [-5.1– 6.7], p=0.8), or sexual function (SF) (0.5, 95% CI [-6.9– 7.9], p=0.9). This remained true at 24 months for all three domains [UIR; (2.3, 95% CI [-2.1– 6.6], p=0.3)], [UI; (-0.3, 95% CI [-7.3– 6.7], p=0.9)], [SF; (1.5, 95% CI [-6.8– 9.7], p=0.7)]. Conclusions: In the first ever randomized trial testing the clinical utility of a GC test in localized PCa, longitudinal patient reported QOL outcomes were not significantly different between men who underwent risk stratification with or without Decipher. Clinical trial information: NCT02783950 .

Stent Omission in Pre-stented Patients Undergoing Ureteroscopy Decreases Unplanned Health Care Utilization.

Despite AUA guidelines providing criteria for ureteral stent omission after ureteroscopy for nephrolithiasis, stenting rates in practice remain high. Because pre-stenting may be associated with improved patient outcomes, we assessed the impact of stent omission vs placement in pre-stented and non-pre-stented patients undergoing ureteroscopy on postoperative health care utilization in Michigan. Using the MUSIC (Michigan Urological Surgery Improvement Collaborative) registry (2016-2019), we identified pre-stented and non-pre-stented patients with low comorbidity undergoing single-stage ureteroscopy for ≤1.5 cm stones with no intraoperative complications. We assessed variation in stent omission for practices/urologists with ≥5 cases. Using multivariable logistic regression, we evaluated whether stent placement in pre-stented patients was associated with emergency department visits and hospitalizations within 30 days of ureteroscopy. We identified 6,266 ureteroscopies from 33 practices and 209 urologists, of which 2,244 (35.8%) were pre-stented. Pre-stented cases had higher rates of stent omission vs non-pre-stented cases (47.3% vs 26.3%). Among the 17 urology practices with ≥5 cases, stent omission rates in pre-stented patients varied widely (0%-77.8%). Among the 156 urologists with ≥5 cases, stent omission rates in pre-stented patients varied substantially (0%-100%); 34/152 (22.4%) never performed stent omission. Adjusting for risk factors, stent placement in pre-stented patients was associated with increased emergency department visits (OR 2.24, 95% CI:1.42-3.55) and hospitalizations (OR 2.19, 95% CI:1.12-4.26). Pre-stented patients undergoing stent omission after ureteroscopy have lower unplanned health care utilization. Stent omission is underutilized in these patients, making them an ideal group for quality improvement efforts to avoid routine stent placement after ureteroscopy.

Development of a Surgical Decision Aid for Patients with Nephrolithiasis: Shockwave Lithotripsy vs Ureteroscopy.

Introduction and Objective: Shared decision making is recommended to guide medical/surgical treatment strategies. We aimed at developing a surgical decision aid (SDA) facilitating decision making between ureteroscopy (URS) or shockwave lithotripsy (SWL) in patients with symptomatic nephrolithiasis. Methods: The SDA scope was identified through discussions with patients and urologists in the Michigan Urological Surgery Improvement Collaborative (MUSIC). A steering committee of patient advocates, MUSIC coordinating center, content experts, biostatisticians, and urologists was formed. Content domains were assessed through best available evidence and content experts. For content validation we anonymously surveyed 35 MUSIC urologists. Content validity ratios (CVR), numeric value indicating degree of expert validity, were calculated. Face validation interviews were conducted with patient advocates. Results: The SDA prototype using descriptive plain language and pictorial information was designed for nephrolithiasis patients, candidates for SWL or URS. It first provides patients procedural education whereas the second section informs urologists of patient goals. Six content domains were chosen: anesthesia type, effectiveness, number of procedures, risk, pain, and recovery. Overall, 91.4% and 85.7% of MUSIC urologists indicated that each section accomplished their goals, respectively. Anesthesia received an unacceptable CVR. High levels of face validation overall were reported with unacceptable scoring for anesthesia and recovery. Conclusions: We developed an SDA facilitating treatment choice between SWL and URS with promising content and face validity. Agreement and contradiction between anesthesia type and recovery validation results indicate the importance of shared decision making and the need for a validated SDA. Future work should focus on the SDAs value and opportunities for refinement in practice.

The Use and Short-term Outcomes of Active Surveillance in Men With National Comprehensive Cancer Network Favorable Intermediate-risk Prostate Cancer: The Initial Michigan Urological Surgery Improvement Collaborative Experience.

National Comprehensive Cancer Network favorable intermediate-risk prostate cancer is a heterogeneous disease with varied oncologic and survival outcomes. We describe the Michigan Urological Surgery Improvement Collaborative's experience with the use of active surveillance and the short-term oncologic outcomes for men with favorable intermediate-risk prostate cancer.Materials and Methods:We reviewed the Michigan Urological Surgery Improvement Collaborative registry for men diagnosed with favorable intermediate-risk prostate cancer from 2012-2020. The proportion of men with favorable intermediate-risk prostate cancer managed with active surveillance was calculated by year of diagnosis. For men selecting active surveillance, the Kaplan-Meier method was used to estimate treatment-free survival. To assess for the oncologic safety of active surveillance, we compared the proportion of patients with adverse pathology and biochemical recurrence-free survival between men undergoing delayed radical prostatectomy after a period of active surveillance with men undergoing immediate radical prostatectomy. Of the 4,275 men with favorable intermediate-risk prostate cancer, 1,321 (31%) were managed with active surveillance, increasing from 13% in 2012 to 45% in 2020. The 5-year treatment-free probability for men with favorable intermediate-risk prostate cancer on active surveillance was 73% for Gleason Grade Group 1 and 57% for Grade Group 2 disease. More men undergoing a delayed radical prostatectomy had adverse pathology (46%) compared with immediate radical prostatectomy (32%, P < .001), yet short-term biochemical recurrence was similar between groups (log-rank test, P = .131). The use of active surveillance for men with favorable intermediate-risk prostate cancer has increased markedly. Over half of men with favorable intermediate-risk prostate cancer on active surveillance remained free of treatment 5 years after diagnosis. Most men on active surveillance will not lose their window of cure and have similar short-term oncologic outcomes as men undergoing up-front treatment. Active surveillance is an oncologically safe option for appropriately selected men with favorable intermediate-risk prostate cancer.