Non-urologic Surgery Research Articles

P-1655. Impact of an Educational Leaflet on Urinary Tract Infections, Asymptomatic Bacteriuria, and Antibiotics for Adults ≥65 years

Abstract Background Adults ≥65yrs are at high risk of harm from antibiotic overuse due to misdiagnosis of asymptomatic bacteriuria (ASB) as urinary tract infection (UTI). Alongside strategies to improve clinician prescribing, patients should be educated on ASB and empowered to discuss harms and benefits of antibiotic treatment. Previously, we used a user-centered design process to develop a patient-focused educational leaflet on UTI, ASB, and antibiotic use (Figure 1). Here, we tested whether the leaflet improved patients’ knowledge about ASB and willingness to avoid unnecessary antibiotics.Figure 1.A three-page antibiotic education designed with patients, caregivers, and clinicians. Methods In an online survey experiment of US adults ≥65yrs, respondents read a scenario of themselves as an asymptomatic patient with a positive urine test during prescreening for non-urologic surgery. Respondents were randomized to one of four experimental conditions which varied educational leaflet provision and the surgeons’ treatment recommendation (Figure 2). Outcome measures included whether respondents thought they (as the patient described in the case) had a UTI, how comfortable they would be not taking antibiotics, and their knowledge about UTIs, ASB, and antibiotics Results Figure 2 shows characteristics of the 504 study respondents [completion=89%]. Compared to those not provided the educational leaflet, respondents shown the educational leaflet were less likely to believe they had UTI (p< .001), were more comfortable not taking antibiotics (p< .001), and answered more knowledge questions correctly (p< .001) (Figures 3&4). Conversely, respondents who were told the surgeon recommends antibiotics were more likely to believe they had UTI (p< .001) and less comfortable with not taking antibiotics (p=.013) but did not differ in their knowledge (p=.096). Conclusion A patient-centered educational leaflet, designed with patients, caregivers, and clinicians, was effective in aligning antibiotic treatment preferences with clinical guidelines and improving knowledge about UTI, ASB, and antibiotics. Findings offer important preliminary evidence on the potential for patient/caregiver-focused education to help prepare patients/caregivers to engage in treatment decisions and contribute to reducing antibiotic overuse and its associated harms. Disclosures All Authors: No reported disclosures

A Retrospective Analysis of Urethroplasty and Medical Malpractice

ObjectivesTo review malpractice suits stemming from urethroplasty intervention, which is the standard of care for patients suffering from urethral strictures. MethodsThis retrospective study analyzed the LexisNexis and Westlaw databases between 1980 and 2024. Each database was queried with “urethroplasty” which yielded 48 cases and 20 jury verdicts/settlements in the LexisNexis database and 46 cases and 14 jury verdicts in the Westlaw database. Selected cases were reviewed variables including chief allegation, litigation location, plaintiff demand, plaintiff award, and verdict. Exclusion criteria included but were not limited to lawsuits regarding non-urologic surgery necessitating urethroplasty and litigation based on traumatic injury necessitating urethroplasty. ResultsAfter manual review of 128 cases in the LexisNexis and Westlaw databases, 12 met inclusion criteria. 5 (42%) cases sued for deformation of the genitalia after urethroplasty, 2 (17%) sued for failure of informed consent, 2 (17%) sued for erectile dysfunction, 1 (8%) sued for a post-operative venous thrombosis, 1 (8%) sued for post-operative infection, and 1 (8%) sued for failure to treat. 6 (50%) cases resulted in plaintiff awards; 3 of these were settled before a final verdict. Plaintiff awards varied from $72,500 - $810,000. Of the twelve cases, 2 (17%) occurred in California and 2 (17%) occurred in Illinois; the remaining locations were isolated. ConclusionsThe most common cause of litigation following urethroplasty was centered on the perceived deformation of the genitalia after urethroplasty, which underscores the significance of urologists setting realistic expectations for patients with thorough pre-operative counseling.

Urinary retention after non-urological surgeries: Management patterns and predictors of prognosis

Objective:Urinary retention after non-urological surgery is a common morbidity, yet its​ etiology and treatment approaches are still a matter of debate. The primary aims of this study are to evaluate the management of urinary retention after non-urological surgeries, determine the predictors of prognosis, and report follow-up data. Methods:Patients who were referred to the urology clinic at a single center due to postoperative urinary retention between December 2014 and November 2021 were included. Demographical, clinical, and surgical parameters were recorded. In all patients, a urethral catheter was kept in-situ for at least 5 days after urinary retention. In case of persistent urinary retention after catheter removal, clean intermittent catheterization (CIC) was recommended. Results of the patients who spontaneously regained micturition after conservative treatment and those with persistent urinary retention were compared. Results:Among 95 patients, the median age was 65 (24–90) years. In 75 patients (78.9%), spontaneous micturition returned with conservative management (Group 1). Twenty patients (21.1%) required CIC due to persistent urinary retention (Group 2). The percentages of males in Group 1 and 2 were 81.3% and 50% respectively (p<0.05). The ratio of non-supine positioning in Group 1 and Group 2 were, 10.6% (8/75) and 35% (7/20), respectively (p=0.02). Female gender and non-supine operative position remained significant predictors of persistent urinary retention after conservative treatment with odds ratios of 3.5 and 3.6, respectively (Confidence intervals, 1.2–10 and 1–12.1, p= 0.02 and 0.04, respectively). During a median follow-up duration of 36 (2–86) months, only 5 patients (20%) stopped doing CIC and voided spontaneously. The median CIC duration of these 5 patients was 6 (1–9) months. Conclusion:The majority of the patients who developed urinary retention after non-urological surgeries regained spontaneous micturition with conservative management. Female gender and non-supine operative positioning were independent risk factors for persistent urinary retention. In patients with persistent urinary retention, spontaneous micturition could be expected to return in approximately 6 months.

Comparison between Tramadol and Butorphanol for Treating Postoperative Catheter-Related Bladder Discomfort: A Randomized Controlled Trial.

Background Intraoperative catheterization often leads to postoperative catheter-related bladder discomfort (CRBD) during the restoration period. This study aimed to assess the curative effect of butorphanol as a K receptor agonist in the treatment of postoperative CRBD. Patients and Approaches. Sixty patients with CRBD who underwent elective nonurological surgery at the postanesthesia care unit were randomly and evenly assigned to two groups. The control group was slowly injected with tramadol 1.5 mg/kg using a Murphy dropper, whereas the experimental group was intravenously injected with butorphanol 0.02 mg/kg. Severity, pain score, and sedation score of CRBD were evaluated at 0 min, 5 min, 15 min, 30 min, 1 h, and 6 h later. Results The severity score of CRBD and visual analog scale pain score were lower in the butorphanol group than in the control group, whereas the sedation score was higher in the butorphanol group than in the control group. Conclusion Butorphanol relieves on postoperative urination discomfort and pain compared with tramadol.

Tips and tricks in achieving zero peri-operative opioid used in onco-urologic surgery

To review non-opioid based protocols in urologic oncologic surgery and describe our institutional methods of eliminating peri-operative opioids. A thorough literature review was performed using PUBMED to identify articles pertaining to reducing or eliminating narcotic use in genitourinary cancer surgery. Studies were analyzed pertaining to protocols utilized in genitourinary cancer surgery, major abdominal and/or pelvic non-urologic surgery. Reducing or eliminating peri-operative narcotics should begin with an institutionalized protocol made in conjunction with the anesthesia department. Pre-operative regimens should consist of appropriate counseling, gabapentin, and acetaminophen with or without a non-steroidal anti-inflammatory medications. Prior to incision, a regional block or local anesthetic should be delivered. Anesthesiologists may develop opioid-free protocols for achieving and maintaining general anesthesia. Post-operatively, patients should be on a scheduled regimen of ketorolac, gabapentin, and acetaminophen. Eliminating peri-operative narcotic use is feasible for major genitourinary oncologic surgery. Patients not only have improved peri-operative outcomes but also are at significantly reduced risk of developing long-term opioid use. Through the implementation of a non-opioid protocol, urologists are able to best serve their patients while positively contributing to reducing the opioid epidemic.

Reducing Opioid Use After Endourologic Procedures.

Surgeons have played a significant role in the current opioid epidemic through overprescribing practices in the postoperative setting. However, contemporary efforts have helped to decrease opioid excess, particularly in the field of urology. Minimally invasive surgery offers a unique avenue to address overuse of narcotics in the postoperative period given its emphasis on enhanced recovery. Historically, the majority of the literature characterizing postoperative opioid use and its reduction has focused on non-urological surgery. However, recent studies have shown that patients undergoing urologic procedures are prescribed opioids in a similar manner as patients in other surgical specialties. Reduction strategies have been implemented through the use of regional anesthesia, enhanced recovery after surgery pathways, and the development of procedure-specific opioid prescription recommendations. Patients undergoing urologic surgery experience the same risk of opioid misuse and abuse as patients undergoing other types of surgery. However, the wide use of minimally invasive urological surgeries including robotic surgery offers a unique opportunity to reduce postoperative opioid use through multimodal and interdisciplinary protocols and standardizing guidelines.

Urinary Retention Following Non-urologic Surgery

To evaluate the literature assessing postoperative urinary retention (POUR) after non-urologic surgeries, including risk factors, as well as short- and long-term consequences. POUR is multifactorial; however, several risk factors, such as male sex, advanced age, and preexisting lower urinary tract symptoms are well established. Procedures that do not involve damage to the urinary or nervous system are rarely associated with long-term consequences, as opposed to colorectal surgery in which long-term voiding dysfunction may be experienced. Improved surgical technique may improve results in these cases. Various preventive methods have been studied. While medical prevention has been efficacious in some cases, physical, noninvasive interventions failed to show a benefit. While general risk factors for POUR are known, the literature assessing these factors varies widely and, in many cases, with conflicting results. With the expansion of ambulatory surgery, it is expected that the POUR will become more frequent. Prospective, well-designed studies are needed to guide the management in these cases.

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

Effect of low-flow sevoflurane anesthesia on early postoperative renal function

Objective To evaluate the effect of low-flow sevoflurane anesthesia on the early postoperative renal function in patients. Methods Sixty patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, scheduled for elective non-urological surgery with general anesthesia, with an expected surgical duration>4 h, were divided into 2 groups (n=30 each) using a random number table method: middle-flow anesthesia group (groupⅠ) and low-flow anesthesia group (group Ⅱ). Anesthesia was induced with IV midazolam, sufentanil, propofol and cisatracurium besylate.Mechanical ventilation was performed after tracheal intubation.Pure oxygen served as carrier, the fresh gas flow of oxygen was set at 4-5 L/min, sevoflurane was inhaled for 10-15 min, and then fresh gas flow was decreased to 2 L/min(groupⅠ) and 0.5 L/min (group Ⅱ). End-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.The end-tidal concentration of sevoflurane was set at 2.0%-2.4%, remifentanil and cisatracurium besylate were infused intravenously, and sufentanill or propofol was injected intermittently to maintain anesthesia.Bispectral index value was maintained at 40-60 during operation.Before anesthesia induction (T0), at 1, 2, 3 and 4 h after anesthesia induction (T1-4), immediately after operation (T5) and at 24 h after operation (T6), peripheral venous blood samples were collected for determination of serum fluoride ion concentrations.Peripheral venous blood samples and urine specimens were collected at T0, T5, T6, 48 h after operation (T7) and 72 h after operation (T8) for determination of creatinine (Cr), blood urea nitrogen (BUN) and cystatin C (Cys C) and serum and urine β2-microglobulin (β2-MG) concentrations. Results Compared with the baseline at T0, serum fluoride ion concentrations were significantly increased at T1-6 in two groups, the serum Cys C concentration was increased at T5, and serum and urine β2-MG concentrations were increased at T5 and T6 in groupⅠ, serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5 and T6, and the serum Cys C concentration was increased at T5-T7 in groupⅡ (P<0.05). Compared with groupⅠ, serum fluoride concentrations were significantly increased at T1-6, serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5, and serum Cys C concentrations at T5-T7 and urine β2-MG concentrations at T5 and T6 were increased in groupⅡ (P<0.05). Conclusion Low-flow sevoflurane anesthesia produces no marked effect on early postoperative renal function in patients. Key words: Anesthetics, inhalation; Kidney function tests; Fresh gas flow

Bladder and ureteral injuries during benign hysterectomy: an observational cohort analysis in New York State.

Hysterectomy (Hys) is the most common non-urologic surgery associated with iatrogenic genitourinary (GU) injury. We present the largest known population-based evaluation of GU injury related to benign Hys. The New York Statewide Planning and Research Cooperative System (SPARCS) was queried by ICD-9 and CPT codes. SPARCS for women from 1995 to 2014, who underwent laparoscopic or robotic Hys (minimally invasive surgery = MIS), abdominal Hys (AH), and vaginal Hys (VH) for benign diagnoses. Bladder and ureteral repairs were captured based on the procedure codes. Codes for ureteroneocystotomy (UNC) were compared to any other ureteral repairs, to elucidate injury patterns. Statistical analysis was conducted using Chi squared test, ANOVA, Mann-Whitney test and Poisson Regression and multivariable analysis were performed. 516,340 women underwent Hys for a benign etiology. 69% were AH, 25% VH, and 6% were MIS. 7490 patients (1.45%) had a concomitant GU injury. Compared to VH, MIS and AH were associated with greater odds of bladder and ureteral injury (p < 0.001). MIS and AH, compared to VH, were associated with reduced odds of UNC compared to complex reconstruction (OR 0.27, p < 0.001 and OR 0.12, p < 0.00, respectively). The injured cohort had higher total mean charges ($29,889 vs $15,808) and length of hospitalization (6.32 vs 3.56days) (p < 0.001). Bladder and ureteral injuries during hysterectomy are uncommon in contemporary practice and are lower than historical rates. GU injury increases hospitalization cost. VH is associated with the lowest rate of GU injury, and thus appears to be a valuable approach, when feasible.

Intraoperative administration of dexmedetomidine reduced the postoperative catheter-related bladder discomfort and pain in patients undergoing lumbar microdiscectomy.

We aimed to evaluate the effect of the intraoperative dexmedetomidine (DEX) on the incidence and severity of catheter-related bladder discomfort (CRBD) after non-urologic surgery. The secondary aim was to find the correlation between the levels of CRBD and postoperative pain sensation. Adult male patients undergoing lumbar microdiscectomy were enrolled. Patients were randomized into two groups. After propofol administration, group D (n=35) received DEX at a loading dose of 1μg/kg over 10min, followed by a continuous infusion of 0.3-0.5μg/kg/h until the end of surgery. In group C (n=35), an identical volume of 0.9% saline was infused in the same manner. Induction and maintenance of anesthesia were standardized. The incidence and severity of CRBD, postoperative pain, and adverse effects were assessed at 1, 3, and 6h after surgery. The incidence of CRBD was significantly lower in group D than in group C at 1h (34.3 vs. 62.9%, P=0.017), 3h (25.7 vs. 60%, P=0.004), and 6h (17.1 vs. 54.3%. P=0.001) postoperatively. The severity of CRBD at 1, 3, and 6h postoperatively was less in group D than in group C. Postoperative pain score was significantly lower in group D than in group C at 3 and 6h postoperatively. Adverse events were comparable between two groups. There was a significant correlation between the severity of CRBD and postoperative pain score. Intraoperative administration of DEX is a safe and effective practice for the prevention of CRBD after lumbar microdiscectomy and can reduce postoperative pain.

National Cohort Study of Preoperative Bacteriuria, Surgical Prophylaxis, and Postoperative Outcomes

BackgroundDespite recommendations against screening urine for bacteriuria prior to non-urological surgery, it is still a common practice. If the urine culture (Ucx) is positive, clinicians often feel compelled to give targeted therapy or expand the peri-operative prophylaxis (PPX) regimen to cover the urinary organism. Large multicenter studies are lacking. We aimed to evaluate rates and results of preoperative urine screening and postoperative outcomes among a national cohort of surgical patients.MethodsAll patients who underwent cardiac, orthopedic implant, or vascular surgery within the national VA health care system during the period from 10/1/08–9/30/13 and had the PPX regimen manually validated were included. Rates of positive Ucx and wound cultures during the 90-day post-operative period were compared between patients with and without pre-operative bacteriuria. Among patients with a positive pre-op urine culture the association between activity of surgical PPX and positive post-op cultures was evaluated.Results N = 78,810 surgeries were evaluated (21,889 cardiac, 46,565 orthopedic implant, 10,356 vascular). A pre-op Ucx was performed in 26% (Fig); of these, 6.6% were positive and 852 (63%) received PPX active against the uropathogen. Positive pre-op Ucx was associated with higher rates of positive post-op Ucx and wound cultures (Fig). Among patients who received active PPX, post-op Ucx was positive in 46% compared with 39% who received inactive PPX. The rate of post-op wound cultures was not different between patients who received active (25%) vs. inactive (24%) PPX. The pre-op and post-op organisms were the same in 117/221 (52.9%) Ucx and 17/104 (16.3%) wound cultures, respectively. PPX activity did not affect the match rate.ConclusionThis is the largest, multicenter study demonstrating no difference in post-op urine and wound cultures in patients receiving active vs. inactive surgical PPX for pre-op bacteriuria. Prevalence of bacteriuria was similar to other surgical populations. Limitations include predominantly male population and need for further characterization of pre-op antibiotic therapy and UTI and SSI outcomes.Disclosures All authors: No reported disclosures.

Prediction of infection caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: development of a clinical decision-making nomogram

Objective: This study aimed to assess the population at risk of infection by extended-spectrum beta-lactamase (ESBL)-producing organisms, using clinical criteria.Materials and methods: All urine cultures positive for Enterobacteriaceae in a Spanish hospital department from January 2010 to 2014 were reviewed. All isolates with ESBL-positive strains were collected, and isolates received during the first week of each month with ESBL-negative strains from symptomatic patients hospitalized or admitted to the emergency room. Multivariate analysis of the factors involved was undertaken and a nomogram developed to predict the probability of infection by ESBL-producing microorganisms.Results: The study included 1524 patients with urinary tract infection (UTI): 416 ESBL-positive and 1108 ESBL-negative. In univariate analysis, risk factors were: male gender (p = 0.036), age (p < 0.0001), nursing home (p < 0.0001), previous antimicrobial therapy (p < 0.0001) or hospitalization (p < 0.0001), diabetes (p < 0.0001), chronic renal insufficiency (p < 0.0001), severe underlying disease (p < 0.0001), neoplasia (p = 0.0005), urological (p < 0.0001) and non-urological invasive procedure (p = 0.0003), recurrent UTI (p < 0.0001), urological (p < 0.0001) or abdominal surgery (p < 0.0001) and permanent urethral catheter (p < 0.0001). In multivariate analysis, the data set was split into a development cohort of 1067 patients and a validation cohort of 457 cases. A nomogram was developed to predict the probability of infection by ESBL-producing bacteria, which included seven variables: age (p < 0.0001), gender (p = 0.004), nursing home (p < 0.0001), previous antimicrobial therapy (p = 0.04) or hospitalization (p < 0.0001), recurrent UTI (p < 0.0001) and non-urological invasive procedure (p = 0.005). The discriminative accuracy was 0.79 (95% confidence interval 0.77–0.83).Conclusions: A nomogram was developed that predicts the risk of infection by ESBL-producing Enterobacteriaceae with reasonable accuracy. It could improve clinical decision making and enable more efficient empirical treatment.

Postoperative Urinary Retention is an Independent Predictor of Short-Term and Long-Term Future Bladder Outlet Procedure in Men

Postoperative urinary retention is a common complication across surgical specialties. To our knowledge no literature to date has examined postoperative urinary retention as a predictor of long-term receipt of surgery for bladder outlet obstruction. We retrospectively reviewed the records of inpatients who underwent nonurological surgery in California between 2008 and 2010. Postoperative urinary retention during the index admission was identified, as was receipt of a bladder outlet procedure (transurethral prostate resection, prostate photoselective vaporization or suprapubic prostatectomy) at a subsequent encounter. Patients were matched using propensity scoring of demographics, comorbidities and surgery type. Adjusted Kaplan-Meier analysis was performed to determine the cumulative incidence of subsequent bladder outlet procedures by patient group, including group 1-age 60 years or greater and postoperative urinary retention, group 2-age 60 years or greater and no postoperative urinary retention, group 3-age less than 60 years and postoperative urinary retention, and group 4-age less than 60 years and no postoperative urinary retention. Of 769,141 eligible male patients postoperative urinary retention developed in 8,051 (1.1%). Following hospital discharge 1,855 patients (0.24%) underwent a bladder outlet procedure. Those treated with a bladder outlet procedure were significantly more likely to have experienced postoperative urinary retention during the index admission (6.3% vs 1.0%, p <0.001). On matched analysis the bladder outlet procedure rate at 3 years was 7.1%, 2.2%, 0.8% and 0.0% in groups 1, 2, 3 and 4, respectively. In men 60 years old or older postoperative urinary retention identified those with an increased incidence of bladder outlet procedures within 3 years. Men younger than 60 years had a low rate of subsequent bladder outlet procedures regardless of a postoperative urinary retention diagnosis.

Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery.

Despite the various treatment and prevention options for catheter-related bladder discomfort (CRBD), many uncertainties persist in clinical practice. To systematically review the literature on the management of CRBD in patients who underwent surgery. Eligible, randomized controlled trials were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent reviewers using Cochrane Collaboration's tools. A total of 1441 patients from 14 articles published between 2005 and 2014 were included. Data heterogeneity precluded meta-analysis; therefore, data were synthesized narratively. Compared with nonurological surgery, CRBD is frequent and occurred immediately after urological surgery, especially after transurethral resection of the bladder tumor (TURBT). Data from included studies suggested that muscarinic antagonists, anesthetics, antiepileptics, and analgesics were associated with significant improvement in symptoms and reducing the incidence of CRBD, compared with placebo. Anticholinergic agents and antiepileptics (gabapentin and pregabalin) administered 1 hour before surgery reduced the incidence and severity of CRBD in the immediate postoperative period. Tramadol and ketamine are centrally acting opioid analgesics with antimuscarinic actions, which effectively prevent CRBD when administered intravenously. Paracetamol administered was also effective for the management of CRBD. Additionally, we perceived that TURBT is the surgical procedure that is the most refractory to treatment. Muscarinic antagonists, anesthetics, antiepileptics, and paracetamol appear to achieve the greatest improvement in the clinical symptoms and a significant reduction in the incidence of CRBD compared with placebo. Although these studies observed a high incidence of intervention-related side effects, in general, patients tolerated these treatments well.

This Month In: Anesthesiology

This Month In: Anesthesiology

MP36-10 PRE-OPERATIVE URINE AQUAPORIN-1 CONCENTRATIONS INCREASE WITH TUMOR SIZE IN PATIENTS WITH RENAL CELL CARCINOMA.

You have accessJournal of UrologyKidney Cancer: Evalution/Staging III1 Apr 2014MP36-10 PRE-OPERATIVE URINE AQUAPORIN-1 CONCENTRATIONS INCREASE WITH TUMOR SIZE IN PATIENTS WITH RENAL CELL CARCINOMA. Jonathan Mobley, Jeremiah Morrissey, R. Sherburne Figenshau, Sam Bhayani, Joel Vetter, Joseph Song, and Evan Kharasch Jonathan MobleyJonathan Mobley More articles by this author , Jeremiah MorrisseyJeremiah Morrissey More articles by this author , R. Sherburne FigenshauR. Sherburne Figenshau More articles by this author , Sam BhayaniSam Bhayani More articles by this author , Joel VetterJoel Vetter More articles by this author , Joseph SongJoseph Song More articles by this author , and Evan KharaschEvan Kharasch More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1074AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aquaporin-1 (AQP1) protein expression has been documented in renal cell carcinoma (RCC). We compare pre-operative urine concentrations of AQP1 in patients with clear cell and papillary RCC with control patients undergoing non-urological surgery. We evaluate the effects of tumor size, stage, and grade on urine AQP1 concentrations. METHODS Pre-operative urine samples were obtained from 61 patients undergoing partial or radical nephrectomy for clear cell or papillary RCC and 43 controls matched by age, sex, smoking history, estimated glomerular filtration rate, and weight. Urine AQP1 concentrations were measured using Western blot procedures normalized to the urine creatinine excretion. Evaluations of urine AQP1 based on tumor size, pathological stage, and nuclear grade was performed. RESULTS The median AQP1 levels for the RCC and control group was 53 and 1.5 relative absorbance units per milligram creatinine (Mann-Whitney U, P<0.001). AQP1 levels were positively correlated with tumor size (Spearman Coefficient 0.78, P<0.001). There was an increase in AQP1 levels between pT1a to pT1b and pT1b to pT2, but not from pT2 to pT3 (Mann-Whitney U, P=0.003, P=0.030, and P=0.127, respectively). There was no significant difference found in AQP1 levels based on grade. CONCLUSIONS Urine AQP1 is elevated in patients with clear cell and papillary RCC when compared to controls. These levels increase with tumor size, but do not reflect tumor grade. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e382 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jonathan Mobley More articles by this author Jeremiah Morrissey More articles by this author R. Sherburne Figenshau More articles by this author Sam Bhayani More articles by this author Joel Vetter More articles by this author Joseph Song More articles by this author Evan Kharasch More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

434 NOVEL RENAL CELL CARCINOMA BIOMARKER IDENTIFICATION FROM URINARY EXOSOMES

You have accessJournal of UrologyKidney Cancer: Basic Research III1 Apr 2012434 NOVEL RENAL CELL CARCINOMA BIOMARKER IDENTIFICATION FROM URINARY EXOSOMES Todd M. Morgan, Kevin L. Schey, David L. Hachey, Salisha Hill, and Peter E. Clark Todd M. MorganTodd M. Morgan Nashville, TN More articles by this author , Kevin L. ScheyKevin L. Schey Nashville, TN More articles by this author , David L. HacheyDavid L. Hachey Nashville, TN More articles by this author , Salisha HillSalisha Hill Nashville, TN More articles by this author , and Peter E. ClarkPeter E. Clark Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Proteomic technologies have shown great promise in the identification of biomarkers, however these efforts in renal cell carcinoma (RCC) have been hampered by technical limitations. We have developed a novel approach utilizing lipid microvesicles, termed exosomes, to circumvent many of the obstacles to urinary biomarker identification. We sought to test whether shotgun proteomics of urinary exosomes can be utilized to identify candidate biomarkers of RCC. METHODS Urine was obtained from 8 patients with clear cell RCC prior to nephrectomy and from 12 patients without malignancy undergoing non-urologic surgery. Exosomes were isolated by ultracentrifugation and proteins were analyzed by multidimensional protein identification technology (MudPIT). Differentially expressed peptides were identified by quasi-likelihood Poisson regression modeling using a false discovery rate <0.05. As an exploratory and validation measure, angiotensin converting enzyme (ACE) immunohistochemistry (IHC) was performed on a tissue microarray containing 139 matched RCC and normal cores. RESULTS An average of ∼1,500 proteins were identified in each of the 22 patient samples. There were 14 differentially expressed proteins identified with a p<0.05 between RCC and control samples, as well as 2 additional proteins that approached statistical significance. Six were upregulated in RCC and 10 were downregulated compared to controls. In order to validate our approach, we focused our attention on those that have been previously proposed as cancer biomarkers (Table). Since ACE has been associated with RCC in a prior study, we tested this by IHC. Consistent with the results by MudPIT, we found no expression in 69/70 RCC cores and high expression in 69/69 matched normal cores. Table. Notable differentially expressed proteins in RCC vs. control patients. Protein Gene Description Ratio (RCC:Control) p A8K1D9 PTPN11/SHP2 Protein tyrosine phosphatase, non-receptor type 11 0.15 0.008 B2RD06 ENPP3 Ectonucleotide pyrophosphatase/phosphodiesterase family member 3 0.064 0.029 HIP1R DNASE2 Deoxyribonuclease II 3.50 0.038 Q96CZ9 HIP1R Huntingtin-interacting protein 1-related protein 0.001 0.038 B2R9V9 CDH11 Cadherin 11 type 2, OB-cadherin 10.00 0.045 B2RMS9 DYRK2 Dual-specificity tyrosine-(Y)-phosphorylation regulated kinase 2 0.057 0.048 B2RMS9 ITIH4 Inter-alpha (Globulin) inhibitor H4 2.20 0.048 B7Z544 GLS Inter-alpha-trypsin inhibitor heavy chain H4 2.23 0.048 ACE ACE Angiotensin-converting enzyme 0.23 0.073 CONCLUSIONS Rich in cell-specific protein signatures, exosomes are upregulated in several cancers and provide a unique source for urinary biomarkers. We utilized a novel proteomic approach to evaluate urinary exosomes and identified a number of putative biomarkers, suggesting this novel approach may be an effective approach to biomarker discovery in RCC. Further work is ongoing to evaluate the urinary expression of these candidate markers in patients with RCC. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e178 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Todd M. Morgan Nashville, TN More articles by this author Kevin L. Schey Nashville, TN More articles by this author David L. Hachey Nashville, TN More articles by this author Salisha Hill Nashville, TN More articles by this author Peter E. Clark Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Predictors of Successful Trial without Catheter for Postoperative Urinary Retention Following Non-Urological Surgery

PurposeTo investigate the success rate of trial without catheter (TWOC) for postoperative urinary retention (POUR) after non-urological surgery and to determine predictors of successful TWOC.MethodsA total of 104 patients who underwent non-urological surgery and were referred to the department of urology for POUR were included in this retrospective study. All eligible patients underwent indwelling catheterization as an initial treatment and then TWOC was performed 3 to 7 days later. POUR was defined as micturition difficulty with greater than 400 mL of postvoid residual (PVR) urine volume measured by catheterization after non-urological surgery. Successful TWOC was defined as voiding with less than 100 mL of PVR urine volume. Predictive factors were identified by multivariate regression analysis. All definitions corresponded to recommendations of the International Continence Society.ResultsThe mean age of the patients was 65.2 (range, 23 to 92) years. There were 45 male and 59 female patients. Intraoperative indwelling catheterization was performed in 69 (66.3%) patients. Mean duration of indwelling catheterization for POUR was 5.0 (range, 3.0 to 7.0) days and 83 (79.8%) patients received medication with an alpha-blocker. A successful TWOC was observed in 70 (67.4%) patients. The mean age of the patients with failure of TWOC was significantly higher than that of the patients with successful TWOC. The percentages of female patients, spinal surgery, and prone position during surgery in patients with unsuccessful TWOC were higher than in those with successful TWOC. In the multivariate logistic regression analysis, age and location of surgery (spine vs. non-spine) were the independent predictors of successful TWOC for POUR.ConclusionsOur data suggest that older age and spinal surgery may be important risk factors for failure of TWOC for POUR after non-urological surgery. Thus, adequate prevention measures may be necessary for POUR after non-urological surgery, especially in patients with these risk factors.