Urologic Research Research Articles

MP62-17 THE EVALUATION OF THREE VALIDATED COMORBIDITY INDICES TO PREDICT POSTOPERATIVE OUTCOMES AFTER INFLATABLE PENILE PROSTHESIS AND ARTIFICIAL URINARY SPHINCTER PLACEMENT: WHICH IS BEST?

You have accessJournal of UrologyCME1 Apr 2023MP62-17 THE EVALUATION OF THREE VALIDATED COMORBIDITY INDICES TO PREDICT POSTOPERATIVE OUTCOMES AFTER INFLATABLE PENILE PROSTHESIS AND ARTIFICIAL URINARY SPHINCTER PLACEMENT: WHICH IS BEST? Michael Tram, Nikolas Moring, Paul Feustel, Charles Welliver, and Brian Inouye Michael TramMichael Tram More articles by this author , Nikolas MoringNikolas Moring More articles by this author , Paul FeustelPaul Feustel More articles by this author , Charles WelliverCharles Welliver More articles by this author , and Brian InouyeBrian Inouye More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with increasing comorbidities are at risk of poor postoperative outcomes. Comorbidity indices have been developed to identify high-risk patients; the most common include the Charlson Comorbidity Index (CCI), Elixhauser/Van Walraven Index (VWI), and modified frailty index (mFI). This study compares the ability of these indices to predict adverse events after inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) placement. METHODS: Using the State Inpatient Database (SID) and State Ambulatory Surgery and Services Database (SASD) for Florida (FL) from 2010-2015 and for California (CA) from 2010-2011, we identified patients who underwent IPP or AUS placement. CCI, VWI, and mFI were calculated for each patient. We extracted 30-day ER services, 30-day inpatient readmissions, 90-day postoperative complications, and 90-day device complications. We constructed receiver operating characteristic curves and compared area under the curve (AUC) between the comorbidity indices. RESULTS: We identified 4242 IPP patients (3060 from FL and 1181 from CA) and 1190 AUS patients (705 from FL and 485 from CA). 4.4% of IPP patients and 7.6% of AUS patients had a device complication. All three comorbidity indices had poor performance in predicting postoperative outcomes. All AUCs and their 95% CIs were less than 0.70. The CCI was the weakest predictor of 30-day ER services (AUC=0.56, 95% CI [0.51-0.60] for IPP) while the VWI was weakest for 30-day readmissions (AUC=0.57, 95% CI [0.53-0.61] for IPP) (Figure 1). All indices had better performance for IPP patients compared to AUS patients (Figure 2). These findings were consistent when analyzing each state individually. CONCLUSIONS: All three commonly used comorbidity indices had poor predictive ability of adverse outcomes following IPP or AUS implantation. Our results support the need for further research and development of a urology-specific comorbidity index to better identify high-risk patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e868 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Tram More articles by this author Nikolas Moring More articles by this author Paul Feustel More articles by this author Charles Welliver More articles by this author Brian Inouye More articles by this author Expand All Advertisement PDF downloadLoading ...

MP12-04 THE EFFECT OF THE USPTSF PSA GUIDELINES ON PROSTATE CANCER DETECTION AND MORTALITY IN TWO UNDERSERVED CITIES IN NEW JERSEY

You have accessJournal of UrologyCME1 Apr 2023MP12-04 THE EFFECT OF THE USPTSF PSA GUIDELINES ON PROSTATE CANCER DETECTION AND MORTALITY IN TWO UNDERSERVED CITIES IN NEW JERSEY Thomas Hwang, David Ali, Gabriel Fernandez, Courtney Berg, Evan Kovac, Amjad Alwaal, and Robert Weiss Thomas HwangThomas Hwang More articles by this author , David AliDavid Ali More articles by this author , Gabriel FernandezGabriel Fernandez More articles by this author , Courtney BergCourtney Berg More articles by this author , Evan KovacEvan Kovac More articles by this author , Amjad AlwaalAmjad Alwaal More articles by this author , and Robert WeissRobert Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003227.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: NJ has one of the most ethically and racially diverse populations in the United States. There are nine million people in NJ – 56% White, 20% Hispanic, 13% African American (AA) and 9% Asian. Despite this diversity, the discriminatory practice of “redlining” which withheld services and investment from specific neighborhoods has resulted in significant segregation in several NJ cities. Two urban centers in NJ – Newark and Trenton are examples of this segregation. Newark has a population of 318,431 with 50.8% AA, 34.8% Hispanic, 11.1% White and 1.8% Asian. Trenton has a population 92,063 with 50.9% AA, 34% Hispanic, 13.8% White and 1.1% Asian. Both cities have significant poverty and are in the lowest 3% of the states annual per capita income. We investigated the effect of the change by the USPTSF PSA guidelines in 2012 on the detection and mortality of prostate cancer in these two underserved urban centers. METHODS: NJ State Cancer Registry was used to compare prostate cancer detection and mortality rates in from 2008- 2019. We specifically compared annual rates in Newark/ Essex County and Trenton/ Mercer County. The cohort of patients from 2008-2012 was compared to the cohort from 2013-2019 to determine if there was a change due to PSA screening RESULTS: The incidence of prostate cancer in Trenton was 1667 and Newark 3161 from 2008-2012. Age adjusted rate of prostate cancer was 166.2 whites and 303.7 AA in Trenton. The age adjusted rate of prostate cancer was 161.5 for whites and 221.5 for AA in Newark. The prostate cancer specific mortality was 21.1 for whites and 57.6 for AA in Trenton from 2008-2012. The prostate cancer specific mortality was 16.6 for whites and 48.3 for AA in Newark. CONCLUSIONS: Statewide rate of prostate cancer deaths in both white and AA has decreased in New Jersey since the initiation of the USPTSF guideline change in 2012. This decrease in mortality has been observed in both underserved Trenton and Newark. Better access to healthcare via Medicaid expansion and opportunities for earlier or more effective treatment may be areas that have improved outcomes and warrant further study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas Hwang More articles by this author David Ali More articles by this author Gabriel Fernandez More articles by this author Courtney Berg More articles by this author Evan Kovac More articles by this author Amjad Alwaal More articles by this author Robert Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

V07-04 A CASE OF COMPLICATED FOCAL LASER ABLATION OF PROSTATE CANCER MANAGED BY HOLMIUM LASER ENUCLEATION (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023V07-04 A CASE OF COMPLICATED FOCAL LASER ABLATION OF PROSTATE CANCER MANAGED BY HOLMIUM LASER ENUCLEATION (HOLEP) Mohamed Elsaqa and Marawan M. El Tayeb Mohamed ElsaqaMohamed Elsaqa More articles by this author and Marawan M. El TayebMarawan M. El Tayeb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a recent increasing interest in focal gland ablation for localized prostate cancer. The major advantage of focal therapy over whole gland treatment is reduction of urinary and sexual complications. However, there is still lack of high-quality evidence on long-term oncological outcome. METHODS: We present a case of 71 years old patient presented by hematuria and urine retention 3 weeks post-focal laser ablation of prostate cancer. The patient had enlarged prostate of 145 grams with large median lobe and Gleason score 4+3 prostate cancer. RESULTS: Cystoscopy revealed multiple areas of necrosis especially on the right lateral lobe and involving the ejaculatory ducts with possible extra-capsular necrosis extending to the seminal vesicles. HoLEP was deliberately performed as shown in the video. There were multiple areas of necrosis at the level of the capsule of the prostate that were formed by the focal laser ablation. At the end of the procedure, cystogram was done and methylene blue was injected inside the bladder with rectal exam to exclude connection between the prostatic urethra and the rectum. CONCLUSIONS: Multi-disciplinary approach is crucial for proper selection of the patients for focal therapy. Although data reports minimal complications with focal laser ablation of prostate cancer, significant urinary complications can be anticipated especially with large prostate volume. HoLEP is an effective option for management of urinary complications of focal therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e597 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elsaqa More articles by this author Marawan M. El Tayeb More articles by this author Expand All Advertisement PDF downloadLoading ...

MP80-10 MANAGEMENT OF BIOCHEMICAL RECURRENCE AFTER PROSTATECTOMY WITHIN THE MUSIC COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023MP80-10 MANAGEMENT OF BIOCHEMICAL RECURRENCE AFTER PROSTATECTOMY WITHIN THE MUSIC COLLABORATIVE David Gandham, Ji Qi, Stephanie Ferrante, Kevin Ginsburg, Brian Lane, Todd Morgan, Daniel Triner, Conrad Tobert, and Alice Semerjian David GandhamDavid Gandham 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 , Brian LaneBrian Lane More articles by this author , Todd MorganTodd Morgan More articles by this author , Daniel TrinerDaniel Triner More articles by this author , Conrad TobertConrad Tobert More articles by this author , and Alice SemerjianAlice Semerjian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although many men remain disease free following radical prostatectomy (RP), some men will develop biochemical recurrence (BCR). Treating (BCR) is challenging as various patient and cancer factors, balancing the oncological benefit, and potential morbidity of treatment must be considered. Herein, we evaluated the use of salvage therapy in men with BCR in diverse, real-world practices. METHODS: The MUSIC registry was queried for men undergoing RP between 3/2012 and 12/2021. Patients were included if they had an initial undetectable post-op PSA (<0.1) and then experienced BCR with PSA >=0.2. Time to salvage treatment after BCR and probability of undergoing treatment were estimated using the Kaplan-Meier method. Type of salvage therapy was summarized based on PSA value at time of treatment (0.1-0.19, 0.2-0.5, 0.51-1.0, and >1.0). Practice-level variation on time to salvage treatment was also assessed among those with at least ten patients. RESULTS: Of 17,755 patients who underwent RP in MUSIC, 2280 patients experienced BCR. Median time to BCR since RP was 9.0 months (IQR 1.7-23.8). Median length of follow up since BCR was 19.5 months (IQR 6.5-37.2). Probability of undergoing treatment sharply increased in the first 12 months following BCR, with 44% of patients getting treatment at 6 months, 52% at 12 months, and 61% at 24 months post-BCR (Figure 1). Among men receiving a salvage treatment, PSA before initiation of salvage therapy was 0.1-0.19 in 2.3% of patients, 0.2-0.5 in 58%, 0.51-1.0 in 15%, and >1.0 in 25%. Patients with higher PSA were more likely to receive systemic therapy (p<0.001). Significant practice-level variation was observed on time to salvage treatment after BCR, with the percent of patients undergoing treatment at 6 months ranging from 20% to 70% among 24 practices (p<0.001). CONCLUSIONS: The time from BCR and the PSA threshold used to trigger salvage treatment in men with BCR varies widely in MUSIC. This data may inform future quality improvement efforts aiming to decrease the variation in the PSA threshold used to initiate salvage therapy and the type of salvage therapy administered to men with BCR. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1155 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Gandham 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 Brian Lane More articles by this author Todd Morgan More articles by this author Daniel Triner More articles by this author Conrad Tobert More articles by this author Alice Semerjian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP31-18 TRENDS IN POSTOPERATIVE OUTCOMES AND COST FOR LIVE DONOR NEPHRECTOMIES ACROSS SURGICAL SPECIALTIES

You have accessJournal of UrologyCME1 Apr 2023MP31-18 TRENDS IN POSTOPERATIVE OUTCOMES AND COST FOR LIVE DONOR NEPHRECTOMIES ACROSS SURGICAL SPECIALTIES Ilon Weinstein, Camilo Arenas-Gallo, Stephen Rhodes, and Jonathan Shoag Ilon WeinsteinIlon Weinstein More articles by this author , Camilo Arenas-GalloCamilo Arenas-Gallo More articles by this author , Stephen RhodesStephen Rhodes More articles by this author , and Jonathan ShoagJonathan Shoag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Live donor nephrectomies (DN) were initially exclusively performed by urologists. Over time, general surgeons and transplant surgeons adopted DN into their scope of practice. Here, we investigate trends, postoperative complications, hospital length of stay, and cost across various surgical specialties performing DN. METHODS: Patients undergoing live DN from 2000-2020 were identified in the Premier Healthcare Database. Physician specialties were reported for each encounter, and patient and hospital characteristics for each specialty was compared. Multivariate logistic regression was used to assess association between physician specialty and postoperative complications and length of stay. Hospital charges and costs were log transformed and analyzed via linear mixed effects models. RESULTS: We identified 11,365 patients undergoing live DN by general surgery (n=3,922), urology (n=3,357), transplant surgery (n=3,123), and other (n=963). DN performed by urologists and transplant surgeons had similar odds ratios (OR) of complications compared to those performed by general surgery (0.91, p=0.4). The hospital length of stay for urology was similar to general surgery (incidence rate ratio (IRR) 1.03, p=0.12), and lower for transplant surgery (IRR 0.92, p<0.001). Urology had a slightly lower cost compared to general surgery ($11,666 vs $12,582) (Beta -0.08, p<0.001). CONCLUSIONS: Over the past two decades, general and transplant surgeons performed more DN with similar outcomes compared to urologists. From 2000-2020, there was an increase in annual numbers of DN performed by general and transplant surgeons and no significant differences in complications and length of stay between the surgical specialties. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e436 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ilon Weinstein More articles by this author Camilo Arenas-Gallo More articles by this author Stephen Rhodes More articles by this author Jonathan Shoag More articles by this author Expand All Advertisement PDF downloadLoading ...

MP14-19 ALTERATIONS OF INSULIN SIGNALING AND TUMOR BIOLOGY IN UROTHELIAL CARCINOMA OF DIABETIC AND NON-DIABETIC PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP14-19 ALTERATIONS OF INSULIN SIGNALING AND TUMOR BIOLOGY IN UROTHELIAL CARCINOMA OF DIABETIC AND NON-DIABETIC PATIENTS Simon Walz, Martin Heni, Carmen Wandel, Sven Walter, Marcus Scharpf, Arnulf Stenzl, Lisanne Exner, Jörg Hennenlotter, and Steffen Rausch Simon WalzSimon Walz More articles by this author , Martin HeniMartin Heni More articles by this author , Carmen WandelCarmen Wandel More articles by this author , Sven WalterSven Walter More articles by this author , Marcus ScharpfMarcus Scharpf More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , Lisanne ExnerLisanne Exner More articles by this author , Jörg HennenlotterJörg Hennenlotter More articles by this author , and Steffen RauschSteffen Rausch More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003234.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Differential insulin receptor (IR) expression and altered ratios of IR substrate (IRS) isoforms 1 and 2 in malignant tissues suggest a potential involvement of this cascade in urothelial cancer (UC) tumor biology and pathogenesis. Patients suffering from diabetes mellitus (DM) show an increased risk of developing UC and present with impaired prognosis. As the cellular link in pathogenesis is still unclear for UC and DM, we investigated IRß, IRS1, 2 and their ratio (%IRS1/2) in muscle-invasive UC compared to normal urothelial tissue and their influence on the pro-oncogenic PI3K-AKT-mTOR signaling pathway. METHODS: In 103 muscle-invasive UC patients (n=31 pT2, n=72 >pT2; n=25 G2, n=78 >G2; n=23 DM) after radical cystectomy, tumor tissue was constructed to a tissue microarray and protein expression levels of IRß and of IRS1, 2 were evaluated by immunohistochemistry and scored. Subsequently, expression results of these cascade proteins including their ratios were compared to expression levels of protein kinase B (AKT), each in the cytoplasm (CP) and nuclear (Nuc) compartment of UC and benign urothelium (n=42), respectively. RESULTS: All variables IRß, %IRS1/2-CP as well as -Nuc showed significantly lower expression levels in UC, with strongly decreased IRS1 expression (all p<0.02). UC tissue from patients with DM showed significantly lower IRS2-Nuc expressions (<0.03). Expression of IRß, IRS1,2-CP as well as -Nuc correlated with AKT in univariate analysis (all <0.0001). In multivariate analysis, IRß, IRS1-CP and IRS2-Nuc remained independently associated with AKT signaling. DM hereby modifies the relationship between IRS1-CP and AKT in UC: In patients suffering from DM, their linear association is less pronounced (m=0.01) as compared to UC patients without DM (m=0.003, interaction term p=0.039). CONCLUSIONS: The study shows significant alterations of insulin signaling in UC. The interactions of the IR cascade and protein kinase B appear individually associated with DM-associated metabolic alterations which may confer to distinct UC biology. Source of Funding: Funded by the Eberhard-Karls-University of Tuebingen and the University Hospital Tuebingen © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e190 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simon Walz More articles by this author Martin Heni More articles by this author Carmen Wandel More articles by this author Sven Walter More articles by this author Marcus Scharpf More articles by this author Arnulf Stenzl More articles by this author Lisanne Exner More articles by this author Jörg Hennenlotter More articles by this author Steffen Rausch More articles by this author Expand All Advertisement PDF downloadLoading ...

MP80-05 NEW PARADIGM IN ROBOTIC PROSTATECTOMY: PLANNED SAME DAY DISCHARGE IN ALL PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP80-05 NEW PARADIGM IN ROBOTIC PROSTATECTOMY: PLANNED SAME DAY DISCHARGE IN ALL PATIENTS Ronney Abaza, Bessel Salka, Benjamin Carey, Kyle Pettay, and Oscar Martinez Silva Ronney AbazaRonney Abaza More articles by this author , Bessel SalkaBessel Salka More articles by this author , Benjamin CareyBenjamin Carey More articles by this author , Kyle PettayKyle Pettay More articles by this author , and Oscar Martinez SilvaOscar Martinez Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2016 we began offering optional same-day discharge (SDD) to all robotic prostatectomy (RP) patients with increasing acceptance that accelerated during the COVID pandemic. Our resulting 98% SDD rate for RP after COVID facilitated initiation of an ambulatory surgery center (ASC) robotic urology program without overnight capability and planned SDD in all patients. We assessed our outcomes with planned outpatient RP in all patients in both the hospital and ASC settings. METHODS: We reviewed one year of consecutive RPs performed by a single surgeon at either a free-standing ASC or one of three hospitals between October 2021-October 2022. Pelvic lymphadenectomy was performed in all patients. Assignment to ASC versus hospital RP was based primarily on insurance eligibility. ASC policy for robotic or non-robotic procedures alike excluded history of severe cardiac disease, difficult airway, malignant hyperthermia, or BMI >45kg/m2 with no additional limitations applied to robotic surgery. All patients were instructed to expect same-day discharge (SDD) directly from the recovery room regardless of ASC or hospital location with overnight stay only for unexpected complications or side effects of anesthesia. RESULTS: Among 359 RP cases (162 ASC and 197 hospital), 356 (99%) were successfully discharged the same day as surgery with 3 overnight stays in the hospital group and none in the ASC group. Patients in the ASC group were younger (61.4yrs vs 67.1yrs, p<001) with no statistically-significant difference in BMI (29.2 kg/m2 vs 29.3 kg/m2, p=0.3), preoperative Gleason Score (p=0.1), operative time (131min vs 134min, p=0.2) or blood loss (87.5cc vs 84.8cc, p=0.71). Excluding the three overnight patients in the hospital group, the mean postoperative recovery room stay among SDD patients was shorter in the ASC group (1.7hrs vs 2.3hrs, p<0.0001). The 90-day readmission rate was 2.5% in both groups (4/162 and 5/197, p=0.93). No readmissions occurred within 24 hours of surgery and only one within the first week. CONCLUSIONS: Same day discharge as a routine following robotic prostatectomy is feasible and safe with readmission rates no higher than series with overnight stays. SDD may enable ASC RP when overnight stay capabilities are not available at an ASC with minimal risk of need for hospital transfer. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1153 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronney Abaza More articles by this author Bessel Salka More articles by this author Benjamin Carey More articles by this author Kyle Pettay More articles by this author Oscar Martinez Silva More articles by this author Expand All Advertisement PDF downloadLoading ...

Bladder Cancer: Invasive IV (MP56)

You have accessJournal of UrologyCME1 Apr 2023Bladder Cancer: Invasive IV (MP56) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

MP79-04 STEM-CELL, SHOCKWAVE, AND PLATELET RICH PLASMA THERAPY FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’s DISEASE: A SURVEY OF CLINICS ACROSS THE US

You have accessJournal of UrologyCME1 Apr 2023MP79-04 STEM-CELL, SHOCKWAVE, AND PLATELET RICH PLASMA THERAPY FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’s DISEASE: A SURVEY OF CLINICS ACROSS THE US Jordan Best, Jamie Thomas, Michael Sencaj, Armin Ghomeshi, Isaac Zucker, and Ranjith Ramasamy Jordan BestJordan Best More articles by this author , Jamie ThomasJamie Thomas More articles by this author , Michael SencajMichael Sencaj More articles by this author , Armin GhomeshiArmin Ghomeshi More articles by this author , Isaac ZuckerIsaac Zucker More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the significant increase in ED and PyD practices offering off-label restorative therapy, it is imperative to investigate if these practices are providing proper patient care, clear outcome expectations for patients, and necessary safety and side effect information to patients. Our objective was to identify clinics offering off-label therapies for erectile dysfunction (ED) and Peyronie’s disease (Pyd) including stem cell, platelet rich plasma, and shockwave therapy and to determine the transparency they provided to patients inquiring about these treatment modalities. METHODS: Clinics were identified in different regions in the US using a systematic search on online website directories and were approached by asking a series of standardized questions regarding cost of treatment, duration of therapy, medical staff involved, and patient outcome data. A total of 26 clinics were surveyed for stem cell therapy, 26 for PRP treatment, and 27 for shockwave therapy. RESULTS: Of the 79 clinics contacted, 93.7% provided some answers to the questions we asked, with a majority offering treatments for both ED and Pyd. Cost of treatment varied widely between clinics. The average cost per stem cell therapy injection was $5291, PRP per injection was $1336, and shockwave therapy per session was $413. Across all clinics surveyed, a physician was involved in only 67% of treatments. Over 75% of the clinics reported patient satisfaction following treatment. Durability of benefits to patients ranged from months to years according to the clinics’ reports. CONCLUSIONS: Our data not only demonstrates the widespread use of off-label therapies for ED and PyD across the US, but also elucidates the claims and information that is being provided to patients regarding the providers involved, outcomes and safety of these treatments. This study highlights the need for more oversight and standardization in novel regenerative therapies for ED and PyD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1142 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Best More articles by this author Jamie Thomas More articles by this author Michael Sencaj More articles by this author Armin Ghomeshi More articles by this author Isaac Zucker More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

PD17-11 MOLECULAR PROFILING REVEALS IMMUNOSUPPRESSIVE TUMOR IMMUNE MICROENVIRONMENT IN PRIMARY VERSUS PAIRED ASYNCHRONOUS METASTATIC CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023PD17-11 MOLECULAR PROFILING REVEALS IMMUNOSUPPRESSIVE TUMOR IMMUNE MICROENVIRONMENT IN PRIMARY VERSUS PAIRED ASYNCHRONOUS METASTATIC CLEAR CELL RENAL CELL CARCINOMA Brittney Cotta, Srinivas Nallandhighal, Daniel Triner, Nathan Graham, Rohit Mehra, Marcin Cieslik, Amy Kasputis, Todd Morgan, and Simpa Salami Brittney CottaBrittney Cotta More articles by this author , Srinivas NallandhighalSrinivas Nallandhighal More articles by this author , Daniel TrinerDaniel Triner More articles by this author , Nathan GrahamNathan Graham More articles by this author , Rohit MehraRohit Mehra More articles by this author , Marcin CieslikMarcin Cieslik More articles by this author , Amy KasputisAmy Kasputis More articles by this author , Todd MorganTodd Morgan More articles by this author , and Simpa SalamiSimpa Salami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003272.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clear cell renal cell carcinoma (ccRCC) is a highly immune infiltrated cancer, but how the tumor immune microenvironment (TIME) evolves during disease progression is unknown. Insights into heterogeneity within primary ccRCC raise questions about potential heterogeneity between primary and paired metastatic tumors. This information may improve understanding of immune evasion leading to metastatic disease and response to immunotherapy. In this study, we characterize and compare the TIME of primary ccRCC with paired asynchronous metastases. METHODS: Analysis of ccRCC patients who developed recurrence post radical nephrectomy and had both primary and metastatic tissue available. Whole-transcriptome sequencing was performed on formalin-fixed paraffin-embedded (FFPE) specimens using the illumina platform. Differential expression gene (DEG) analysis was performed using R package edgeR. Gene set enrichment analyses (GSEA) to identify hallmark pathway enrichment was performed using R package fgsea. TIME deconvolution was quantified using CIBEROSRT, an in silico flow cytometry tool. RESULTS: 42 tumor samples from 19 patients (19 primary tumors with 23 matched metastases) were analyzed. Metastasis sites included lung (n=6), bone (n=6), adrenal (n=4), liver (n=2), lymph node (n= 2), and soft tissue (n=3). Angiogenesis and epithelial to mesenchymal transition (EMT) were the most significantly enriched pathways in metastases compared to primary tumors (FDR < 5%). The primary tumors displayed a more immunosuppressive TIME than their matched metastases when comparing immune cell types. (Figure 1). The higher proportion of T regulatory cells (Tregs) in primary tumors was consistent compared against all metastasis tissue types. Metastasis samples displayed higher proportion of M2 macrophages (p=0.003), with the highest proportion in bone and soft tissue. Bone metastases also appeared to be more immunosuppressive in their TIME when compared to lung metastases, with greater Tregs and a lower immune content score. CONCLUSIONS: We demonstrate higher infiltration of immunosuppressive cells in the TIME of primary ccRCC compared with metastatic sites. Further studies are necessary to determine the prognostic and therapeutic significance of these findings. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e500 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittney Cotta More articles by this author Srinivas Nallandhighal More articles by this author Daniel Triner More articles by this author Nathan Graham More articles by this author Rohit Mehra More articles by this author Marcin Cieslik More articles by this author Amy Kasputis More articles by this author Todd Morgan More articles by this author Simpa Salami More articles by this author Expand All Advertisement PDF downloadLoading ...

MP56-11 IMPACT OF TYPES OF PREVIOUS ABDOMINAL SURGERY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP56-11 IMPACT OF TYPES OF PREVIOUS ABDOMINAL SURGERY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION Sij Hemal, Michael Eppler, Jorge Ballon, Gus Miranda, Ryan Davis, Aref Sayegh, Jie Cai, Inderbir Gill, Monish Aron, Mihir Desai, and Giovanni Cacciamani Sij HemalSij Hemal More articles by this author , Michael EpplerMichael Eppler More articles by this author , Jorge BallonJorge Ballon More articles by this author , Gus MirandaGus Miranda More articles by this author , Ryan DavisRyan Davis More articles by this author , Aref SayeghAref Sayegh More articles by this author , Jie CaiJie Cai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , and Giovanni CacciamaniGiovanni Cacciamani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with prior lower abdominal/pelvic surgery are likely to have significant post-surgical intra-abdominal adhesions that may distort the anatomy. Such a “hostile” abdomen has been considered a relative contraindication for subsequent complex robotic urologic surgery, such as robotic radical cystectomy with intracorporeal urinary diversion (RRC-ICUD). Herein, we evaluated outcomes of patients undergoing RRC-ICUD with a history of prior lower abdominal/pelvic surgery stratified by type of previous abdominal insult. METHODS: From 07/2010 to 12/2021, 445 consecutive patients underwent RRC-ICUD for bladder cancer. Patients with previous abdominal surgery (PAS) were divided into 4 cohorts by PAS type: within surgical Region of Interest (sROI); pelvic vs abdominal; major vs minor; and approach of PAS [minimally invasive (MIS) vs open]. Outcomes of interest were operative times (OTs), overall 30-day complication rate, readmission rate and genitourinary (GU) complications. Multivariate analyses assessed impact of the type of PAS on the outcomes of interest (p<0.05 significance level). RESULTS: Our cohort included a total of 445 patients: 266 with no PAS and 179 with PAS; 156 (89%) with PAS in sROI vs 19 (11%) with PAS not in sROI; 113 (64%) Major vs 63 (36%) Minor PAS; 82 (47%) with Pelvic PAS vs 93 (53%) with abdominal PAS; 22 (37%) with prior MIS vs 38 (63%) with open PAS. Oncologic outcomes: no significant differences between soft tissue positive margins amongst all 4 cohorts. Multivariate analysis: previous pelvic surgery and type of approach of PAS did not adversely impact perioperative outcomes (all p>0.05). PAS in sROI trended towards a higher overall GU complication rate (RR=3.8, p=0.08). Prior major PAS trended towards a higher 30-day complication rate (RR=1.9, p=0.06) and higher GU complication rate (RR=2.1, p=0.07). Across the models, BMI independently predicted longer OT (p=0.02)(Figure 1). CONCLUSIONS: In experienced hands, RRC-ICUD is feasible in a previously operated abdomen. However, patients with PAS in the sROI or major PAS should be counseled on a higher peri- and post-operative complication rate. Obese patients are likely to have prolonged operative times. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e778 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sij Hemal More articles by this author Michael Eppler More articles by this author Jorge Ballon More articles by this author Gus Miranda More articles by this author Ryan Davis More articles by this author Aref Sayegh More articles by this author Jie Cai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Giovanni Cacciamani More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-10 SELF-EXPANDING LARGE CALIBER URETERAL STENTS FOR TREATMENT OF IDIOPATHIC URETERAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP42-10 SELF-EXPANDING LARGE CALIBER URETERAL STENTS FOR TREATMENT OF IDIOPATHIC URETERAL STRICTURE Hyun Soo Lee, Sun Tae Ahn, Wonku Hwang, Seon Beom Jo, Jong Wook Kim, Mi Mi Oh, Hong Seok Park, and Du Geon Moon Hyun Soo LeeHyun Soo Lee More articles by this author , Sun Tae AhnSun Tae Ahn More articles by this author , Wonku HwangWonku Hwang More articles by this author , Seon Beom JoSeon Beom Jo More articles by this author , Jong Wook KimJong Wook Kim More articles by this author , Mi Mi OhMi Mi Oh More articles by this author , Hong Seok ParkHong Seok Park More articles by this author , and Du Geon MoonDu Geon Moon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment for the idiopathic ureteral stricture has not yet been established. Recently, efficacy of self-expanding large caliber stent (Allium, Allium LTD, Israel) for ureteral stricture related to surgery, radiation or malignancy was reported. This study aims to investigate the effect of Allium stent on idiopathic ureteral stricture. METHODS: From July 2018 and January 2022, 54 patients with 58 renal units were underwent ureteroscopic balloon dilation and placement of Allium stent. All the patients showed hydronephrosis before the stenotic lesion and pain. In all the patients, we used, 12 cm or 20cm length of self-expanding Allium ureteral stent and inserted retrogradely with intraoperative x-ray guidance after dilation of the stricture (Figure 1). The primary outcome was immediate improvement in pain and improvement in hydronephrosis through ultrasound examination at 1 month after the procedure. And the secondary outcome was stricture resolution rates following stent removal. RESULTS: Patients and ureteral stricture characteristics were summarized in Table 1. Of 54 patients, 20cm stent was inserted in 47 patients and 12cm stent was inserted in 7 patients. After median follow-up period of 16.5 months, 39.7 % (23/58) of stents were kept in situ. Median indwelling time was 10months (range 1-37) and stent migration was observed in 8 cases (13.8%). All the patients were immediately free of pain after the procedure, and through ultrasound examination, improvement of hydronephrosis was confirmed in 53 out of 58 renal units. Among the 42 renal units which stent removal was performed, 13 renal units (31.0%) recurred stricture. Logistic analysis showed that stricture length was a significant predicting factor for stent failure (HR 2.75, 95% CI 1.58, 4.79, p<0.01) CONCLUSIONS: Self-expanding allium ureteral stenting showed efficacy in relieving pain and improving hydronephrosis in idiopathic ureter stricture with minimal risk of complication. Overall success rate after stent removal was associated with preoperative stricture lengths. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e570 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hyun Soo Lee More articles by this author Sun Tae Ahn More articles by this author Wonku Hwang More articles by this author Seon Beom Jo More articles by this author Jong Wook Kim More articles by this author Mi Mi Oh More articles by this author Hong Seok Park More articles by this author Du Geon Moon More articles by this author Expand All Advertisement PDF downloadLoading ...

MP10-07 24-HOUR URINE CORRELATES TO INCREASING STONE BURDEN IN CYSTINURIC PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP10-07 24-HOUR URINE CORRELATES TO INCREASING STONE BURDEN IN CYSTINURIC PATIENTS Ukrit Rompsaithong, Heiko Yang, Wilson Sui, Rei Unno, David Bayne, Justin Ahn, Marshall Stoller, and Thomas Chi Ukrit RompsaithongUkrit Rompsaithong More articles by this author , Heiko YangHeiko Yang More articles by this author , Wilson SuiWilson Sui More articles by this author , Rei UnnoRei Unno More articles by this author , David BayneDavid Bayne More articles by this author , Justin AhnJustin Ahn More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stone growth and recurrence in cystinuric patients is a challenging issue to manage. Controlling 24-hour urine parameters may be the key to preventing kidney stone formation in this population. This study aimed to determine the association between 24-hour urine and stone burden in cystinuric patients. METHODS: We conducted a retrospective study on consecutive patients diagnosed with cystinuria from the Registry for Stones of the Kidney and Ureter (ReSKU) between 2017 and 2022. Patients were classified as having either stable or increased stone burden during clinic visits. An increasing stone burden was defined as an increasing stone number or growth ≥ 3 mm from prior imaging. 24-hour urine specimens were collected every 4-6 months. Clinical characteristics, stone-related symptoms and surgeries, and the average of the 24-hour urine parameters from all visits were compared between the two groups. We performed a longitudinal analysis using the generalized estimating equation to determine the marginal model for the 24-hour urine and increasing stone burden at each visit. The chi-square goodness-of-fit test was applied to evaluate the model. RESULTS: There were 20 patients in the increased stone burden and 24 in the stable group. The median initial stone burden in the increased and stable groups was 13 and 4.5 mm, respectively. Fifty symptomatic stone events were observed in the increased burden group and 16 for the stable group (p=0.014). There were 28 surgical events in the increased burden group and 5 in the stable group (p=0.007). We did not detect a significant difference in the average 24-hour cystine capacity between the two groups (p=0.053). However, in longitudinal analysis, the marginal model demonstrated that urine citrate ≤ 500 mg/d (OR 5.57, 95% CI 2.47–12.53) and a negative value of cystine capacity (OR 4.70, 95% CI 1.48–14.91) were significantly correlated with increasing stone burden at each visit (Table 1). CONCLUSIONS: In cystinuric patients, the 24-hour urine citrate and cystine capacity were highly associated with an increasing stone burden. In addition to general stone prevention advice, maintaining the values of these parameters within the normal range may be important to prevent the formation of kidney stones in this population. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e116 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ukrit Rompsaithong More articles by this author Heiko Yang More articles by this author Wilson Sui More articles by this author Rei Unno More articles by this author David Bayne More articles by this author Justin Ahn More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...

V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY

You have accessJournal of UrologyCME1 Apr 2023V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY Andrew Carey, Arighnno Das, Madison Wi, Fardod O'kelly, Shannon Cannon, Vinaya Bhatia, and Walid Farhat Andrew CareyAndrew Carey More articles by this author , Arighnno DasArighnno Das More articles by this author , Madison WiMadison Wi More articles by this author , Fardod O'kellyFardod O'kelly More articles by this author , Shannon CannonShannon Cannon More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients undergoing circumcisions with concomitant inguinal pathologies currently require both a penile and inguinal incision. We have previously described performing inguinal procedures through a penile incision. Herein we extend on this minimally invasive approach by performing a hydrocelectomy through a circumcision incision. METHODS: Once the preputial skin is excised, the penopubic junction is bluntly dissected. An S-shaped retractor is placed on the pubic bone and retracted towards the ipsilateral shoulder. With the pubic bone as a key landmark, the cord structures are carefully identified and the hydrocele sac is dissected off. The circumcision is then completed in the usual fashion. RESULTS: To date, we have offered this approach to all children undergoing circumcision and who also have undescended testis (UDT), hydroceles, or hernias. We have found that this approach is best for children who are under 5 years of age. Notably, this approach does not affect the appearance of the circumcision in any way. CONCLUSIONS: Children with inguinal pathologies, such as UDT, hernias or hydroceles, who are also undergoing circumcision or any penile procedure are currently offered this approach. A single penile incision for circumcision and correction of inguinal pathology is feasible, safe, and provides similar surgical outcomes with shorter overall operative time. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e341 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Carey More articles by this author Arighnno Das More articles by this author Madison Wi More articles by this author Fardod O'kelly More articles by this author Shannon Cannon More articles by this author Vinaya Bhatia More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

MP27-03 RNASEQ AND PATHWAY ANALYSIS OF RAT PENIS WITH CAVERNOUS NERVE INJURY AND SONIC HEDGEHOG TREATMENT BY PEPTIDE AMPHIPHILE

You have accessJournal of UrologyCME1 Apr 2023MP27-03 RNASEQ AND PATHWAY ANALYSIS OF RAT PENIS WITH CAVERNOUS NERVE INJURY AND SONIC HEDGEHOG TREATMENT BY PEPTIDE AMPHIPHILE Timothy Searl, Sarah Martin, Daniel Harrington, Samuel Stupp, Samuel Ohlander, Kevin Mcvary, and Carol Podlasek Timothy SearlTimothy Searl More articles by this author , Sarah MartinSarah Martin More articles by this author , Daniel HarringtonDaniel Harrington More articles by this author , Samuel StuppSamuel Stupp More articles by this author , Samuel OhlanderSamuel Ohlander More articles by this author , Kevin McvaryKevin Mcvary More articles by this author , and Carol PodlasekCarol Podlasek More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003255.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) treatments are minimally effective in prostatectomy and diabetic patients due to injury to the cavernous nerve (CN). CN injury causes loss of innervation, apoptosis of smooth muscle, fibrosis in the penis and ED. When developing novel therapies, the goal is to prevent the apoptotic response and penile remodeling, to preserve erectile function. Our previous studies found Sonic hedgehog (SHH) is a key mediator of penile remodeling. Our objective was to use RNA seq and pathway analysis, to identify changes in gene expression and signaling pathways that are altered in response to CN injury and the effect of SHH treatment by peptide amphiphile (PA), in a rat prostatectomy model of ED. METHODS: Corpora cavernosal (CC) tissue was obtained from Sprague Dawley rats (n=36) that underwent bilateral CN crush, CN crush plus SHH PA treatment of the penis, or sham surgery. Rats were sacrificed 1, 2 and 4 days after surgery. RNA was extracted using TRIzol, DNase treated, and purified by Qiagen mini kit. RNAseq analysis was performed, and directional pathway analysis was examined with Ingenuity. A 2-fold change with a q-value <0.05 was used as a threshold for differential expression. RESULTS: mRNA representing 523 genes had significant differential expression in CN crushed CC tissue relative to sham. Ingenuity analysis predicted increased necrosis, and decreased actin cytoskeleton, acute phase response signaling, cell movement, angiogenesis, and myeloid cell movement activity. With SHH PA treatment at the time of CN injury, these changes were reversed or significantly diminished. In addition, SHH PA impacted known mediators of ED by reducing apoptosis, and increasing cell survival, cell viability, muscle cell proliferation, VEGF, p38 MAPK, and PI3K/AKT pathways. CONCLUSIONS: RNAseq and pathway analysis identified changes in gene expression and pathway signaling associated with CN injury in a rat prostatectomy model. Pathway analysis predicted increases in processes associated with cell death and a loss of functions necessary for maintenance of CC architecture. Most CN injury associated changes were reversed or greatly diminished with SHH PA treatment of the penis at the time of injury. The results support the significant potential of SHH PA as a preventative treatment for ED in prostatectomy patients. Signaling pathways identified with CN injury provide many new avenues for intervention independently and in combination with SHH PA treatment. Source of Funding: DK101536 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e362 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Searl More articles by this author Sarah Martin More articles by this author Daniel Harrington More articles by this author Samuel Stupp More articles by this author Samuel Ohlander More articles by this author Kevin Mcvary More articles by this author Carol Podlasek More articles by this author Expand All Advertisement PDF downloadLoading ...

MP22-10 IMPACT OF SMOKING ON LONGITUDINAL HEALTH RELATED QUALITY OF LIFE MEASURES AMONG BLADDER CANCER SURVIVORS

You have accessJournal of UrologyCME1 Apr 2023MP22-10 IMPACT OF SMOKING ON LONGITUDINAL HEALTH RELATED QUALITY OF LIFE MEASURES AMONG BLADDER CANCER SURVIVORS Hannah Kay, Sarah Silver, Ram Basak, Kimberly Shoenbill, Deborah Usinger, Adam Goldstein, Angela Smith, Richard Matulewicz, Ronald C. Chen, and Marc Bjurlin Hannah KayHannah Kay More articles by this author , Sarah SilverSarah Silver More articles by this author , Ram BasakRam Basak More articles by this author , Kimberly ShoenbillKimberly Shoenbill More articles by this author , Deborah UsingerDeborah Usinger More articles by this author , Adam GoldsteinAdam Goldstein More articles by this author , Angela SmithAngela Smith More articles by this author , Richard MatulewiczRichard Matulewicz More articles by this author , Ronald C. ChenRonald C. Chen More articles by this author , and Marc BjurlinMarc Bjurlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003247.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cigarette smoking is the most common risk factor for the development of bladder cancer. However, there is a paucity of data characterizing the relationship between smoking status and longitudinal Health Related Quality of Life (HRQoL) outcomes in bladder cancer patients. We sought to examine the association between current smoking status and HRQoL measures among bladder cancer patients following their cancer diagnosis. METHODS: We performed a longitudinal, prospective study on a sample of patients aged ≥18 years diagnosed with bladder cancer in North Carolina from 2014-2015. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire core instrument (QLQ-C30) was administered at 3, 12, and 24 months after bladder cancer diagnosis. This questionnaire has been validated in diverse samples of cancer patients. The main exposure variable was current smoking status, assessed at 3, 12, and 24 months after bladder cancer diagnosis. We analyzed mean differences for each outcome between exposure groups with linear regression using Generalized Estimating Equations (GEE). RESULTS: A total of 167 bladder cancer patients completed at least one survey. Of those, 154 participated in later surveys. A total of 125 patients who did not smoke completed surveys at 3, 108 at 12, and 86 at 24 months. A total of 28 patients who smoked completed surveys at 3, 23 at 12, and 25 at 24 months. Bladder cancer patients who smoked had significantly worse HRQoL measures in the domains of physical function (mean difference (MD) = 6.78, p < .05), emotional function (MD = 6.06, p < .05), fatigue (MD = -7.68, p < .05), and financial difficulties (MD = -10.20, p < .05). When controlling for time, stage, demographic covariates, and treatment type, emotional function (MD = 6.00) and fatigue (MD = -6.98) remained significantly different (Table 1). CONCLUSIONS: Bladder cancer patients who smoke have significantly worse HRQoL scores in the domains of physical function, emotional function, and fatigue. These results underscore the need to treat smoking as an essential component of bladder cancer care. Future work should implement smoking interventions that are directed at patient goals with respect to their unique values regarding life quality. Source of Funding: UNC Lineberger Comprehensive Cancer Center University Cancer Research Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e300 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hannah Kay More articles by this author Sarah Silver More articles by this author Ram Basak More articles by this author Kimberly Shoenbill More articles by this author Deborah Usinger More articles by this author Adam Goldstein More articles by this author Angela Smith More articles by this author Richard Matulewicz More articles by this author Ronald C. Chen More articles by this author Marc Bjurlin More articles by this author Expand All Advertisement PDF downloadLoading ...

MP32-06 EARLY STENT REMOVAL AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP32-06 EARLY STENT REMOVAL AFTER RADICAL CYSTECTOMY Jessica Wenzel, Solange Bassale, Paul Jones, Eric Robinson, Sudhir Isharwal, Christopher Amling, Kamran Sajadi, and Jen Jane Liu Jessica WenzelJessica Wenzel More articles by this author , Solange BassaleSolange Bassale More articles by this author , Paul JonesPaul Jones More articles by this author , Eric RobinsonEric Robinson More articles by this author , Sudhir IsharwalSudhir Isharwal More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Kamran SajadiKamran Sajadi More articles by this author , and Jen Jane LiuJen Jane Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extended antibiotic prophylaxis after radical cystectomy (RC) reduces urinary tract infections (UTI) and urosepsis. Optimal duration of prophylaxis remains unknown as ureteral stents are associated with an increased risk of UTI. Similarly, the optimal duration and benefit of ureteral stents is unknown, with trends toward removing stents earlier or foregoing them altogether. Our protocol after RC previously consisted of ureteral stent duration of at least 14 days and 30 days of antibiotic prophylaxis postoperatively. To reduce stent duration and antibiotic exposure, we changed our protocol in 2020 to remove stents prior to discharge and stop antibiotic prophylaxis earlier (14d). We assessed rates of UTI and urine leak in our cohort of patients undergoing RC during this change. METHODS: We performed a retrospective chart review of all patients who underwent radical cystectomy for bladder cancer at our institution between 2016-2022(OHSU IRB approved). Patients were stratified into early or late stent removal ( <14 or >14 days post-operatively). The primary outcomes were incidence of UTI (defined as positive urine culture requiring antibiotic treatment) and urine leak, as measured by postoperative drain creatinine measurement greater than twice serum creatinine Statisical analysis was performed using Wilcoxon test and chi-square analysis. RESULTS: Of 221 patients with evaluable data, 33% of patients had early and 67% had late stent removal. Mean day of stent removal was 8.0 versus 19.9 in the early versus late group. Antibiotic exposure was lower in the early stent removal group (10 vs 21 days, p≤0.05). There was no difference in rate of postoperative UTI when comparing early versus late stent removal (10.8% vs 10.2%, p=0.9). Similarly, there was no difference in rate of urine leak when comparing early versus late stent removal (0% vs 1.3%, p=0.31). Readmission rates were similar for early versus late stent removal (7 vs 12%, p=0.3). CONCLUSIONS: Earlier stent removal and reduced duration of antibiotic prophylaxis after RC does not result in an increased rate of UTI or urine leak. Decreasing ureteral stent duration reduces postoperative antibiotic exposure without increasing adverse outcomes in patients undergoing RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e442 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Wenzel More articles by this author Solange Bassale More articles by this author Paul Jones More articles by this author Eric Robinson More articles by this author Sudhir Isharwal More articles by this author Christopher Amling More articles by this author Kamran Sajadi More articles by this author Jen Jane Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

PD14-06 QUALITY OF OVERACTIVE BLADDER VIDEOS ON SOCIAL MEDIA: WHAT IS THE PUBLIC LEARNING FROM TIKTOK?

You have accessJournal of UrologyCME1 Apr 2023PD14-06 QUALITY OF OVERACTIVE BLADDER VIDEOS ON SOCIAL MEDIA: WHAT IS THE PUBLIC LEARNING FROM TIKTOK? Arshia Sandozi, Kelli Aibel, Alexandra Tabakin, Sharon Choi, Wai Lee, and Justina Tam Arshia SandoziArshia Sandozi More articles by this author , Kelli AibelKelli Aibel More articles by this author , Alexandra TabakinAlexandra Tabakin More articles by this author , Sharon ChoiSharon Choi More articles by this author , Wai LeeWai Lee More articles by this author , and Justina TamJustina Tam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social media is an increasingly used health information resource; TikTok’s role in this space is not well-researched. In this study, we evaluated the presence of misinformation and quality of TikTok posts related to overactive bladder (OAB). METHODS: “Overactive bladder” and “OAB” were queried on TikTok. The first 100 results were identified, excluding videos that were private, unavailable, or not in English. Three independent reviewers scored videos using the Medical Quality Video Evaluation Tool (MQ-VET), a validated instrument for evaluating the quality of medical videos. The three MQ-VET scores were used to create a composite score ranging from 15-75. Reviewers also noted if any misinformation was present. RESULTS: The 95 videos included had a median of 1,727 views, 56 likes, four comments, and two shares. Median video length was 21 seconds. The median composite MQ-VET score was 29 (IQR 25.7-39). Videos longer than the median length had higher composite MQ-VET scores (39.7 vs 27.0 seconds, p<0.01). Misinformation was identified in 40% of all videos and in 74% of duplicated videos. The most common type of misinformation was mislabeling stress urinary incontinence as OAB. Seventeen videos had content that either replicated another user or consisted of a user’s reaction to the video. Composite MQ-VET scores did not differ between videos with and without misinformation , but there were significant differences in specific MQ-VET items (Table 1). Videos containing no misinformation scored higher in covering the basic concepts of OAB (item 7), explaining medical terms (item 9), and promoting new knowledge and skills (item 15) (p<0.05). Videos containing misinformation were shared more often. CONCLUSIONS: Information about OAB on TikTok is readily accessible, but the video posts contain substantial misinformation and are of poor quality. Longer videos were of higher quality than shorter videos. It is concerning that videos with misinformation are shared and duplicated more often, allowing incorrect information to be widely disseminated. Providers should be aware of the medical information and misinformation promoted on popular social media platforms such as TikTok when counseling patients with OAB. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e414 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arshia Sandozi More articles by this author Kelli Aibel More articles by this author Alexandra Tabakin More articles by this author Sharon Choi More articles by this author Wai Lee More articles by this author Justina Tam More articles by this author Expand All Advertisement PDF downloadLoading ...

MP16-17 PREVALENCE OF KIDNEY STONE DISEASE AMONG AMERICAN INDIAN ADULTS IN THE STRONG HEART FAMILY STUDY

You have accessJournal of UrologyCME1 Apr 2023MP16-17 PREVALENCE OF KIDNEY STONE DISEASE AMONG AMERICAN INDIAN ADULTS IN THE STRONG HEART FAMILY STUDY Joseph J. Crivelli, Amanda M. Fretts, Gerald McGwin, Dean G. Assimos, and Orlando M. Gutierrez Joseph J. CrivelliJoseph J. Crivelli More articles by this author , Amanda M. FrettsAmanda M. Fretts More articles by this author , Gerald McGwinGerald McGwin More articles by this author , Dean G. AssimosDean G. Assimos More articles by this author , and Orlando M. GutierrezOrlando M. Gutierrez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003236.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The epidemiology of kidney stone disease (KSD) has not been well described in American Indian communities. We studied the prevalence of KSD in the Strong Heart Family Study, a large prospective cohort of American Indian adults. METHODS: Strong Heart Family Study participants are members of American Indian tribes from Arizona, Oklahoma, and North/South Dakota. Self-reported history of KSD was available from the Phase VI visit (2014-2018). Differences in characteristics of participants with and without KSD were determined using chi-square tests for categorical variables and independent t tests for continuous variables. Modified Poisson regression with robust variance estimation was used to examine associations between participant characteristics and prevalent KSD. RESULTS: Among 2,069 participants from the Phase VI visit (mean age 51.6 years, 789 [38.1%] male), 133 (6.4%) had a self-reported history of KSD. No significant difference in KSD prevalence was observed by sex (5.8% for males vs. 6.8% for females, p=0.4). Prevalence ratio estimates derived through modified Poisson regression are shown in Table 1. Residence in Oklahoma or Arizona was associated with greater KSD prevalence, compared to North/South Dakota. Annual household income <$20,000 was also associated with greater KSD prevalence, compared to ≥$20,000. Several established risk factors for KSD in the U.S. (obesity, diabetes, and hypertension) were not significantly associated with prevalent KSD in this study. CONCLUSIONS: These findings suggest that there are meaningful socioeconomic risk factors for KSD in American Indian communities which require further investigation. Source of Funding: The Strong Heart Study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institute of Health, Department of Health and Human Services, under contract numbers 75N92019D00027, 75N92019D00028, 75N92019D00029, & 75N92019D00030. The study was previously supported by research grants: R01HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319 and by cooperative agreements: U01HL41642, U01HL41652, U01HL41654, U01HL65520, and U01HL65521. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Indian Health Service (IHS) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e209 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph J. Crivelli More articles by this author Amanda M. Fretts More articles by this author Gerald McGwin More articles by this author Dean G. Assimos More articles by this author Orlando M. Gutierrez More articles by this author Expand All Advertisement PDF downloadLoading ...

MP46-07 PROGNOSTIC VALUE OF PREOPERATIVE VASCULAR ENDOTHELIAL GROWTH FACTOR AND VASCULAR CELL ADHESION MOLECULE-1 IN BLADDER CARCINOMA TREATED WITH RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP46-07 PROGNOSTIC VALUE OF PREOPERATIVE VASCULAR ENDOTHELIAL GROWTH FACTOR AND VASCULAR CELL ADHESION MOLECULE-1 IN BLADDER CARCINOMA TREATED WITH RADICAL CYSTECTOMY Keiichiro Mori, Victor Schuettfort, Takafumi Yanagisawa, Satoshi Katayama, Ekaterina Laukhtina, Benjamin Pradere, Pawel Rajwa, Hadi Mostafaei, Takahiro Kimura, and Shahrokh Shariat Keiichiro MoriKeiichiro Mori More articles by this author , Victor SchuettfortVictor Schuettfort More articles by this author , Takafumi YanagisawaTakafumi Yanagisawa More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Hadi MostafaeiHadi Mostafaei More articles by this author , Takahiro KimuraTakahiro Kimura More articles by this author , and Shahrokh ShariatShahrokh Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Identification of preoperative biomarkers capturing each tumor's biological and clinical potential is crucial to improve risk stratification in patients with urothelial carcinoma of the bladder (UCB). Angiogenesis-related marker vascular endothelial growth factor (VEGF) and vascular cell adhesion molecule-1 (VCAM-1) have been shown to be elevated in UCB, but its predictive/prognostic role has not been determined. Thus, we aimed to investigate the predictive/prognostic value of these biomarkers in patients with UCB. METHODS: We enrolled 1,036 patients with clinically non-metastatic advanced UCB who underwent RC. The preoperative plasma levels of VEGF and VCAM-1 were measured. The correlation between plasma VEGF/VCAM-1 and pathological and survival outcomes was assessed. The clinical net benefit was evaluated using decision-curve analysis (DCA). RESULTS: Preoperative VCAM-1 was significantly elevated in patients with adverse pathological features. Higher VCAM-1 levels were independently associated with increased risk of lymph-node metastasis (LNM), ≥pT3 disease, and nonorgan-confined disease (NOCD; all p<0.001). Preoperative plasma VEGF/VCAM-1 were independently associated with recurrence-free, cancer specific, and overall survival (RFS/CSS/OS) in pre and postoperative multivariable models. Adding VCAM-1 to these models improved the discriminatory ability to predict all outcomes by a significant margin. On DCA, VCAM-1 addition to the reference models for LNM, NOCD, RFS, and CSS prediction resulted in relevant improvement. CONCLUSIONS: Elevated plasma VCAM-1 was associated with biologically and clinically aggressive UCB disease features. After validation, preoperative VCAM-1 may serve as biomarker to help identify patients likely to benefit from intensified/multimodal therapy. VCAM-1 also improved the discriminatory power of predictive/prognostic models and can be used to refine personalized clinical decision-making. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e633 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keiichiro Mori More articles by this author Victor Schuettfort More articles by this author Takafumi Yanagisawa More articles by this author Satoshi Katayama More articles by this author Ekaterina Laukhtina More articles by this author Benjamin Pradere More articles by this author Pawel Rajwa More articles by this author Hadi Mostafaei More articles by this author Takahiro Kimura More articles by this author Shahrokh Shariat More articles by this author Expand All Advertisement PDF downloadLoading ...