Urologic Research Research Articles

MP40-05 ELEVATED ISOPSA IS ASSOCIATED WITH BOTH CRIBRIFORM AND INTRADUCTAL CARCINOMA MORPHOLOGIC FEATURES AT THE TIME OF PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP40-05 ELEVATED ISOPSA IS ASSOCIATED WITH BOTH CRIBRIFORM AND INTRADUCTAL CARCINOMA MORPHOLOGIC FEATURES AT THE TIME OF PROSTATE BIOPSY Zaeem Lone, Tarik Benidir, Nour Abdallah, Andrew Wood, Jane Nguyen, Robert Abouassaly, Samuel Haywood, Zeyad Schwen, Eric Klein, and Christopher Weight Zaeem LoneZaeem Lone More articles by this author , Tarik BenidirTarik Benidir More articles by this author , Nour AbdallahNour Abdallah More articles by this author , Andrew WoodAndrew Wood More articles by this author , Jane NguyenJane Nguyen More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Samuel HaywoodSamuel Haywood More articles by this author , Zeyad SchwenZeyad Schwen More articles by this author , Eric KleinEric Klein More articles by this author , and Christopher WeightChristopher Weight More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: IsoPSA is a structure-based assay that has been prospectively validated to outperform total PSA and percentage free PSA in detecting clinically significant prostate cancer (csCaP) defined as Grade Group (GG) > 2. If IsoPSA is to be utilized as a biopsy triage method, it should not miss cancers with unfavorable histologic features such as cribriform (CF) or intraductal carcinoma (IDC). Therefore, we sought to investigate the ability of IsoPSA to identify patients with these unfavorable morphologic features. METHODS: This was a retrospective review of patients who underwent PSA, IsoPSA, and prostate biopsy from 2017-2022. All biopsies were read by dedicated genitourinary pathologists and included CF/IDC status. Our primary outcome was the sensitivity of an elevated IsoPSA ratio (defined as IsoPSA >6) in detecting either CF or IDC at biopsy. We also compared the discriminatory power of total PSA to IsoPSA by receiving operating characteristic curves. RESULTS: Nine-hundred and sixty one men underwent biopsy, 54.4% (523/961) were diagnosed with CaP among which 60% had csCaP. In our CaP cohort, 32.7% (174/523) had positive CF/IDC at biopsy. IsoPSA >6 had a 94.2% sensitivity and 16.6% specificity for identifying men with these unfavorable morphologic features. The PPV was 20% and the NPV was 94%. Patients with CF/IDC had higher median IsoPSA than those that did not (10.3 vs. 8.2, p<0.001). The area under the curve for IsoPSA was 0.67 compared to 0.62 for total PSA (Figure 1, p<0.001). CONCLUSIONS: IsoPSA is highly sensitive for not only csCaP but also unfavorable histologic features including CF/IDC status. This association may not only help inform the need for biopsy but also refine treatment selection when considering active surveillance, focal therapy or whole gland treatments. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e546 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zaeem Lone More articles by this author Tarik Benidir More articles by this author Nour Abdallah More articles by this author Andrew Wood More articles by this author Jane Nguyen More articles by this author Robert Abouassaly More articles by this author Samuel Haywood More articles by this author Zeyad Schwen More articles by this author Eric Klein More articles by this author Christopher Weight More articles by this author Expand All Advertisement PDF downloadLoading ...

MP08-07 IS PELVIC LYMPH NODE DISSECTION NECESSARY IN NMIBC PATIENTS UNDERGOING RC?

You have accessJournal of UrologyCME1 Apr 2023MP08-07 IS PELVIC LYMPH NODE DISSECTION NECESSARY IN NMIBC PATIENTS UNDERGOING RC? Qiang Lv, Xiao Yang, Qiang Cao, and Juntao Zhuang Qiang LvQiang Lv More articles by this author , Xiao YangXiao Yang More articles by this author , Qiang CaoQiang Cao More articles by this author , and Juntao ZhuangJuntao Zhuang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) combined with pelvic lymph node dissection (PLND) is the principle for muscle invasive bladder cancer (MIBC), but it is unclear whether PLND is necessary for high-risk non-muscle invasive bladder cancer (NMIBC). METHODS: From January 2021, patients diagnosed as high-risk NMIBC without swollen lymph nodes (or lymph nodes ≤8mm) on MRI/CT were prospectively enrolled, and randomly received RC+PLND or RC alone (NCT: 05123625). Perioperative clinical data, 90-day complications, and medical expenses, et al were recorded. The endpoint was progression-free survival (PFS) and overall survival (OS). All statistical analyses were performed in SPSS26.0 and R software (version 3.6.3). RESULTS: As of September 19, 2022, a total of 63 patients were enrolled, with 40 patients received ileal conduit, 5 patients received orthotopic neobladder, and 18 received ureteral cutaneous diversion. Among all patients, 26 cases were in RC+PLND group, with the age of 65.5 (IQR: 57.25-72.75) years. Laparoscopic surgery was performed in 15 cases, robotic-assisted in 10 cases, and open surgery in 1 case due to excessive bleeding. Pathological stage was Ta/ Tis: 6 cases and T1: 20 cases. None positive lymph node was found. There were 37 cases in RC only group, with the age of 66 (IQR: 59-73) years. Laparoscopic surgery was performed in 7 cases, and robotic-assisted in 30 cases. Pathological stage was Ta/Tis: 6 cases and T1: 31 cases. The operation time of RC group was significantly shorter than that of RC+PLND group (241±63 min vs. 335±83 min, p < 0.001), and the intraoperative blood loss was significantly lower than that of RC+PLND group (p=0.026). The average daily postoperative drainage volume of patients in RC group was significantly less than that in RC+PLND group (p=0.002), and the time from postoperative to discharge was shorter (8.0±2.4 vs. 11.2±6.3 days, p=0.019). Within 90 days after operation, the incidence of Clavien-Dindo grade II-III complications in RC group were lower than that in RC+PLND group (2.7% vs 19.2%, p=0.073). At the median follow-up of 9.5 (IQR: 6.9-12.8) months, there was no significant difference in PFS and OS between the two groups (Figure 1). CONCLUSIONS: For high-risk NMIBC patients, combined PLND has no survival benefit but increases the incidence of complications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e95 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Qiang Lv More articles by this author Xiao Yang More articles by this author Qiang Cao More articles by this author Juntao Zhuang More articles by this author Expand All Advertisement PDF downloadLoading ...

MP07-10 BEFORE AND AFTER THE BAN: NATIONAL INCIDENCES OF TRANSVAGINAL MESH PLACEMENT AND REMOVAL FOR PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-10 BEFORE AND AFTER THE BAN: NATIONAL INCIDENCES OF TRANSVAGINAL MESH PLACEMENT AND REMOVAL FOR PELVIC ORGAN PROLAPSE Elie Kaplan-Marans, Mariela Martinez, Arshia Sandozi, Jeffrey Lee, Dhaval Jivanji, Karis Buford, and Allison Polland Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Mariela MartinezMariela Martinez More articles by this author , Arshia SandoziArshia Sandozi More articles by this author , Jeffrey LeeJeffrey Lee More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Karis BufordKaris Buford More articles by this author , and Allison PollandAllison Polland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In April 2019, the Food and Drug Administration (FDA) banned manufacturers from selling and distributing mesh for transvaginal repair of pelvic organ prolapse (POP). We assessed national incidences of transvaginal mesh placement and revision or removal for POP before and after the ban. METHODS: The Medicare Physician and Other Practitioners database was queried for all transvaginal mesh placements and revisions or removals for POP between 2013 and 2020 using CPT codes 57267 and 57295, respectively. Linear regression was performed with statistical significance set to 95% confidence intervals. RESULTS: A total of 51,234 mesh placements and 15,854 mesh revisions or removals were identified. As shown in the Figure 1, there was a significant and gradual downward trend in utilization of both procedures during the study period, without precipitous changes after the ban (mesh placement, R2=0.97, p<0.001; mesh revisions or removals, R2=0.97, p<0.001). From 2013 to 2020, mesh placement decreased from 10,397 to 2,813 cases (370%) and mesh revision or removal decreased from 2,975 to 1,091 cases (270%). Despite the FDA ban, transvaginal mesh placement for POP was still performed in 2020 (2,813 cases). CONCLUSIONS: There was not a precipitous decline in the use of transvaginal mesh for prolapse after the 2019 ban. Utilization has instead gradually decreased since the original FDA notification in 2011. Physicians may now be using the remaining stock of transvaginal mesh or other types of mesh that are off-label for prolapse repair. It is important to discuss the risks and benefits of using transvaginal mesh as well as the FDA notification and ban with patients prior to prolapse surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e88 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elie Kaplan-Marans More articles by this author Mariela Martinez More articles by this author Arshia Sandozi More articles by this author Jeffrey Lee More articles by this author Dhaval Jivanji More articles by this author Karis Buford More articles by this author Allison Polland More articles by this author Expand All Advertisement PDF downloadLoading ...

MP04-08 COMPREHENSIVE ANALYSIS OF COPY NUMBER VARIATION AND SENSITIVITY TO TARGETED THERAPY IN RENAL CELL CARCINOMA USING IN-HOUSE CANCER GENE PANEL TESTING

You have accessJournal of UrologyCME1 Apr 2023MP04-08 COMPREHENSIVE ANALYSIS OF COPY NUMBER VARIATION AND SENSITIVITY TO TARGETED THERAPY IN RENAL CELL CARCINOMA USING IN-HOUSE CANCER GENE PANEL TESTING Akihito Takeuchi, Mayu Takeda, Eiji Sugihara, Yoshinari Muto, Sachio Nohara, Shigeki Tanishima, Kenji Zennami, Kiyoshi Takahara, Tetsuya Tsukamoto, Ryoichi Shiroki, Hideyuki Saya, and Makoto Sumitomo Akihito TakeuchiAkihito Takeuchi More articles by this author , Mayu TakedaMayu Takeda More articles by this author , Eiji SugiharaEiji Sugihara More articles by this author , Yoshinari MutoYoshinari Muto More articles by this author , Sachio NoharaSachio Nohara More articles by this author , Shigeki TanishimaShigeki Tanishima More articles by this author , Kenji ZennamiKenji Zennami More articles by this author , Kiyoshi TakaharaKiyoshi Takahara More articles by this author , Tetsuya TsukamotoTetsuya Tsukamoto More articles by this author , Ryoichi ShirokiRyoichi Shiroki More articles by this author , Hideyuki SayaHideyuki Saya More articles by this author , and Makoto SumitomoMakoto Sumitomo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003215.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) are the main drugs used to treat metastatic renal cell carcinoma (mRCC), but there are no effective biomarkers to determine their use. In this study, we aimed to identify factors that correlate with staging of RCC and drug sensitivity to mRCC based on the results of an in-house cancer gene panel test at Fujita Health University. METHODS: 133 patients with RCC (70 non-metastatic RCC and 63 mRCC). DNA was analyzed for mutations in 143 cancer genes using the PleSSision Rapid cancer gene panel test. NextSeq2000 was used as the next-generation sequencer. From the curated reports obtained, factors including each gene mutation information and the correlation between copy number (CN) variation (CNV) cluster analysis information, clinicopathological information, and therapeutic response to ICI or TKI was examined. In this study, the therapeutic response was evaluated with RECIST1.1 and complete response and partial response were determined as objective response (OR). The endpoint was progression-free survival 2 (PFS2) defined as the interval between first-line treatment and the second relapse. RESULTS: Mutational analysis showed no difference in the pattern of genetic variation with or without metastasis. CNV analyses showed a marked trend toward a decrease in CN on homologous recombination repair genes in a part of mRCCs. Cluster analysis of CNV information for each gene in response to TKI treatment in mRCC revealed multiple regions of decreased or increased CN. The main regions of increased CN were shown to be those formed by CN gain of oncogenes on chromosomes 7 and 12. Detailed analysis of this hot spot showed that when the cutoff value of sum of CN for KRAS, ERBB3, CDK4, and MDM2 for chromosome 12 set to 9, 8 (72.7%) of 11 patients with CN 9 or higher were in OR group, while 4 (7.7%) of 52 patients with CN less than 9 were in OR group, showing a significant difference between the two groups (P < 0.001). Similarly, when the cutoff value of sum of CN for EGFR, MET, and BRAF for chromosome 7 set to 8, 5 (83.3%) of 6 patients with CN 8 or higher were in OR group, while 7 (12.3%) of 57 patients with CN < 8 were in OR group, showing a significant difference between the two groups (p<0.001). On the other hand, genetic markers predicting susceptibility to ICI could not be identified. Kaplan-Meier analysis showed that the group of patients with higher CN values for either chromosome 7 or 12 had better PFS2 after TKI treatment than the group of patients with lower CN values for either chromosome 7 or 12 (p<0.001). CONCLUSIONS: Our results from in-house cancer gene panel tests successfully showed an association between RCC progression and cancer-related gene alterations. Furthermore, the results showed the possibility of predicting TKI treatment sensitivity in mRCC by focusing on CN gain of oncogenes in specific chromosomal regions. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e36 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akihito Takeuchi More articles by this author Mayu Takeda More articles by this author Eiji Sugihara More articles by this author Yoshinari Muto More articles by this author Sachio Nohara More articles by this author Shigeki Tanishima More articles by this author Kenji Zennami More articles by this author Kiyoshi Takahara More articles by this author Tetsuya Tsukamoto More articles by this author Ryoichi Shiroki More articles by this author Hideyuki Saya More articles by this author Makoto Sumitomo More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostate Cancer: Basic Research &amp; Pathophysiology II (PD04)

You have accessJournal of UrologyCME1 Apr 2023Prostate Cancer: Basic Research & Pathophysiology II (PD04) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003228AboutPDF 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 ...

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

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

V05-09 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR NEW OR RECURRENT TUMOR IN PATIENT WITH PRIOR PARTIAL NEPHRECTOMY OR TUMOR ABLATION

You have accessJournal of UrologyCME1 Apr 2023V05-09 ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR NEW OR RECURRENT TUMOR IN PATIENT WITH PRIOR PARTIAL NEPHRECTOMY OR TUMOR ABLATION Sumit Saini, Timothy O'Rourke, Parth Thakker, and Ashok Hemal Sumit SainiSumit Saini More articles by this author , Timothy O'RourkeTimothy O'Rourke More articles by this author , Parth ThakkerParth Thakker More articles by this author , and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Salvage robot-assisted partial nephrectomy (sRAPN) for new or recurrent renal tumor is a technically challenging procedure secondary to varying degree of peri & paranephric fibrosis and intrarenal changes in parenchymal architecture. Here in, we demonstrate surgical technique in such complex cases. METHODS: Between January 2013 and July 2022, we queried our prospectively maintained institutional database. We identified 20 renal lesions in 18 patients who underwent robot-assisted salvage partial nephrectomy for local recurrences after prior partial nephrectomy or tumor ablation. Meticulous dissection through the adhesions while ensuring a rim of normal renal parenchyma is the key to achieve negative surgical margins in these challenging cases. Intraoperative ultrasound and indocyanine green-near infrared fluorescence imaging (ICG-NIRF) also play an indispensable role in these cases. RESULTS: Majority of our patients either had prior cryoablation or prior partial nephrectomy (Table 1). A second/new renal lesion was noted in 2 patients in the same kidney following initial cryoablation which were also excised simultaneously. Median time to recurrence from primary procedure was 2 years (1-7) and mean age at salvage surgery was 65±10.2 years. Mean operative time was 161.4 minutes (66-348) and mean warm ischemia time was 23.3±4.6 minutes. All the surgical margins were negative and none of the patients developed any major complications post-operatively. At median follow up of 15 months (3-62), all patients are alive and none of the patients developed any recurrence. CONCLUSIONS: sRAPN for new or recurrent renal tumor in patients with prior partial nephrectomy or tumor ablation is technically feasible with excellent peri-operative and oncological outcomes. However, it requires prudent cross-sectional imaging to understand spatial anatomy and technical tools such as intraoperative ultrasound/near infrared fluorescence imaging with ICG. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e426 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sumit Saini More articles by this author Timothy O'Rourke More articles by this author Parth Thakker More articles by this author Ashok Hemal More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL

You have accessJournal of UrologyCME1 Apr 2023MP18-13 IS INDOCYANINE GREEN SUPERIOR TO SURGEON’S SUBJECTIVE ASSESSMENT WHEN CREATING A CATHETERIZABLE CHANNEL? DEVELOPMENT OF A STANDARDIZED PROTOCOL Amanda Raines, Jennifer Ahn, Nicolas Fernandez, Mark Cain, Byron Joyner, Kathleen Kieran, Margarett Shnorhavorian, and Paul Merguerian Amanda RainesAmanda Raines More articles by this author , Jennifer AhnJennifer Ahn More articles by this author , Nicolas FernandezNicolas Fernandez More articles by this author , Mark CainMark Cain More articles by this author , Byron JoynerByron Joyner More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Margarett ShnorhavorianMargarett Shnorhavorian More articles by this author , and Paul MerguerianPaul Merguerian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While we know blood supply to catheterizable channels is important to their long term success, there is currently no objective means to assess perfusion. Indocyanine green has a well established use in the evaluation of bowel perfusion, however, use has not been reported in catheterizable channels. Our aims were to develop a standardized protocol for using ICG in the creation of catheterizable channels and establish perfusion patterns of the channels. METHODS: A standardized protocol for the use of ICG in catheterizable channel creation was developed in an adaptive process in this single institution pilot study. Stryker’s SPY PHI system and SPY-QP quantification system were used. SPY-QP allowed for quantification of ICG uptake in the channel relative to healthy bowel. The standardized protocol is described in figure 1. RESULTS: ICG was used in the creation of 3 new appendicovesicostomies and 1 channel revision. Overall, perfusion to the channel decreased with increasing mobilization, but degree of decrease varied between patients. The median ICG uptake went from 85.5% immediately after stapling the appendix to 63.5% when examining the subfascial channel after maturing and 27% at the stoma. In the one revision, ICG clearly delineated an area of poor perfusion in the distal channel after complete mobilization of the channel off the skin and fascial attachments. CONCLUSIONS: The standardized protocol for use in catheterizable channels was successfully implemented. In the channel revision, ICG clearly delineated the area of distal hypoperfusion after channel takedown. ICG can provide surgeons with an objective assessment of channel perfusion rather than relying on subjective assessment alone. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e228 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Raines More articles by this author Jennifer Ahn More articles by this author Nicolas Fernandez More articles by this author Mark Cain More articles by this author Byron Joyner More articles by this author Kathleen Kieran More articles by this author Margarett Shnorhavorian More articles by this author Paul Merguerian More articles by this author Expand All Advertisement PDF downloadLoading ...

MP30-12 HIGHER TESTOSTERONE SERUM LEVELS ARE ASSOCIATED WITH A HIGHER CHILDBIRTH IN PATIENTS TREATED FOR TESTICULAR CANCER

You have accessJournal of UrologyCME1 Apr 2023MP30-12 HIGHER TESTOSTERONE SERUM LEVELS ARE ASSOCIATED WITH A HIGHER CHILDBIRTH IN PATIENTS TREATED FOR TESTICULAR CANCER Cosimo De Nunzio, Riccardo Lombardo, Antonio Nacchia, Giorgio Guarnotta, Aldo Brassetti, Gabriele Tuderti, Antonio Luigi Pastore, Yazan Al Sahli, Giuseppe Simone, Antonio Carbone, and Andrea Tubaro Cosimo De NunzioCosimo De Nunzio More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Antonio NacchiaAntonio Nacchia More articles by this author , Giorgio GuarnottaGiorgio Guarnotta More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan Al SahliYazan Al Sahli More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Antonio CarboneAntonio Carbone More articles by this author , and Andrea TubaroAndrea Tubaro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aim of our study was to assess fertility of patients treated with orchifunicolectomy for testicular cancer. METHODS: A retrospective analysis of patients undergoing orchifunicolectomy for testicular cancer was conducted in three centers from 2000 to 2019. Demographic, clinical and histological characteristics of the patients were recorded. Adjuvant treatments were recorded. Number of pregnancies, number of children, cryopreservation, in vitro fertilization were recorded as well as post-operative testosterone serum level. Risk factors for pregnancy were evaluated. Univariate and multivariate analysis were performed to evaluate factors influencing pregnancy rates. RESULTS: Overall 271 patients were enrolled with a median age of 31 (25/35) years and a median BMI of 25 (23/28 Kg/m2). Overall 187 of 271 (69%) presented a seminoma, 61 of 271 (22%) presented advanced stage (≥pT2), 4 of 271 (1%) presented metastasis, 13 of 271 (5%) underwent lymphadenectomy. 112 of 271 (41%) underwent adjuvant chemotherapy and 35 of 271 (13%) underwent adjuvant radiotherapy. 71 of 271 (26%) patients had at least one child, 165 of 271 (60%) performed cryopreservation, 9 of 271 (3%) performed fertilization in vitro and out of them 8 of 9 (89%) had at least one child. Patients with at least one child presented higher levels of testosterone and performed more often in vitro fertilization (Table). On multivariate analysis testosterone levels (OR=1,94; 95% CI: 1,35-2,80, p=0,001) were associated with a higher probability of having a child after testicular cancer surgery. Table 1. Patients characteristics according to Child status CONCLUSIONS: In our experience, patients undergoing testicular cancer surgery have 25% probability of having a child. Higher testosterone levels increase the probability of having a child in patients treated for testicular cancer. Source of Funding: No one © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e395 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cosimo De Nunzio More articles by this author Riccardo Lombardo More articles by this author Antonio Nacchia More articles by this author Giorgio Guarnotta More articles by this author Aldo Brassetti More articles by this author Gabriele Tuderti More articles by this author Antonio Luigi Pastore More articles by this author Yazan Al Sahli More articles by this author Giuseppe Simone More articles by this author Antonio Carbone More articles by this author Andrea Tubaro More articles by this author Expand All Advertisement PDF downloadLoading ...

MP40-16 MICROULTRASOUND IN THE DETECTION OF THE INDEX LESION IN PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP40-16 MICROULTRASOUND IN THE DETECTION OF THE INDEX LESION IN PROSTATE CANCER Adriana Marcela Pedraza Bermeo, Raghav Gupta, Michael A. Gorin, Mani Menon, and Ashutosh Tewari Adriana Marcela Pedraza BermeoAdriana Marcela Pedraza Bermeo More articles by this author , Raghav GuptaRaghav Gupta More articles by this author , Michael A. GorinMichael A. Gorin More articles by this author , Mani MenonMani Menon More articles by this author , and Ashutosh TewariAshutosh Tewari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The natural history of PCa is driven by an index lesion (IL), which is often either the largest in size and/or highest in grade. By analyzing genome-wide single nucleotide polymorphisms and copy number variations, researchers have been able to show that the vast majority of metastatic prostate cancers have monoclonal origins. Therefore, the identification of IL plays a key role in treatment decision-making.Microultrasound (MUS) provides a resolution of up to 70 microns. Evidence seems to suggest comparable performance to mpMRI in the identification of clinically significant prostate cancer. The goal of our study is to evaluate the accuracy of a transrectal MUS for the detection of the IL in prostate cancer compared to mpMRI. METHODS: Two hundred and eighty-one patients who underwent robot-assisted radical prostatectomy (RARP) from June 2021 to May 2022 were included. All received mpMRI and MUS within three months prior to RARP. MUS was performed by experienced urologists blinded to mpMRI and biopsy results. The IL in the radical prostatectomy specimen was defined as the lesion with extraprostatic extension, the highest Gleason Score (GS), or the largest tumor volume if the GS was the same. A correlation between imaging and final pathology findings was performed. A descriptive statistical analysis is presented. RESULTS: The patients’ prostates were analyzed in 12 regions (anterior/posterior, right/left, apex/mid/base). A total of 3,372 regions were identified. Of these, 731 were involved by the IL. Compared to final pathology, MUS demonstrated a sensitivity, specificity, PPV, and NPV of 66%, 96%, 81%, and 92%, respectively, while mpMRI showed a sensitivity, specificity, PPV, and NPV of 66%, 97%, 87%, and 91%, respectively, for the detection of the IL. Most of the lesions missed by MUS were located in the anterior zone (62%). CONCLUSIONS: MUS has comparable diagnostic performance to mpMRI in identifying prostate cancer index lesion. MUS is less expensive, provides a real-time anatomic evaluation, and has no lag in the acquisition process. Prospective randomized trials are needed to verify our results. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e551 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adriana Marcela Pedraza Bermeo More articles by this author Raghav Gupta More articles by this author Michael A. Gorin More articles by this author Mani Menon More articles by this author Ashutosh Tewari More articles by this author Expand All Advertisement PDF downloadLoading ...

MP54-17 FERTILITY PRESERVATION RATES AMONG TRANSGENDER GIRLS IN A MULTIDISCIPLINARY TRANSGENDER PROGRAM

You have accessJournal of UrologyCME1 Apr 2023MP54-17 FERTILITY PRESERVATION RATES AMONG TRANSGENDER GIRLS IN A MULTIDISCIPLINARY TRANSGENDER PROGRAM Nir Tomer, Eva Baldisserotto, Alexandra Siegal, Benjamin Eilender, Erin Miller, Mabel Yau, Matthew Oransky, Joshua Safer, and Neha Malhotra Nir TomerNir Tomer More articles by this author , Eva BaldisserottoEva Baldisserotto More articles by this author , Alexandra SiegalAlexandra Siegal More articles by this author , Benjamin EilenderBenjamin Eilender More articles by this author , Erin MillerErin Miller More articles by this author , Mabel YauMabel Yau More articles by this author , Matthew OranskyMatthew Oransky More articles by this author , Joshua SaferJoshua Safer More articles by this author , and Neha MalhotraNeha Malhotra More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Fertility preservation (FP) should be an important step in health care prior to initiating gender affirming hormonal therapy (GAHT) or puberty blockade in transgender and gender diverse (TGD) people. However, FP is often not integrated into comprehensive gender affirming care. Prior studies show low rates of FP in transgender youth. The aim of this study was to understand how the integration of a pediatric urology team into our Center for Transgender Medicine and Surgery program would impact the overall number of transgender girls who pursue fertility preservation. METHODS: To assess the success of fertility preservation, we performed a retrospective review of a database of all TGD patients who were 18 years or younger with testes, and sought GAHT. Patients were evaluated and followed in our Center for Transgender Medicine and Surgery from 4/2022 through 10/2022. Demographics, age, hormonal treatment, Tanner stages, and FP use were recorded from the medical record. Successful sperm banking was defined as freezing >1 vial of sperm. RESULTS: Twenty seven patients ranging from ages 10-17 years old were referred to pediatric urology for FP. Of patients referred to the clinic, 20 (74.1%) were interested in pursuing/are in the process of sperm banking. Of the patients who didn’t pursue FP, 1 (3.7%) of the patients were prepubertal (Tanner I), 4 (14.8 %) patients declined to attempt FP because they wanted to avoid masturbation, and 2 (7.4%) patients declined referral altogether. Twelve patients began the process of FP with sperm banking - ten of whom successfully froze sperm within WHO reference ranges of semen parameters and 2 children were azoospermic. Upon review, these 2 patients with azoospermia were found to already have started hormonal suppression. CONCLUSIONS: Our data suggest that a large percentage of patients may be interested in fertility preservation. The integration of a pediatric urology team can help to increase access to this service. Importantly, that the children who already started pubertal suppression were azoospermic highlights the importance of the integration of pediatric urology and FP into the health care process prior to pubertal suppression therapy. In our program, counseling on GAHT and puberty blockers’ impact on fertility is introduced early and pediatric urology consultation is offered concurrently or even prior to endocrinology consultation. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e760 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nir Tomer More articles by this author Eva Baldisserotto More articles by this author Alexandra Siegal More articles by this author Benjamin Eilender More articles by this author Erin Miller More articles by this author Mabel Yau More articles by this author Matthew Oransky More articles by this author Joshua Safer More articles by this author Neha Malhotra More articles by this author Expand All Advertisement PDF downloadLoading ...

MP69-16 INPATIENT OUTCOMES OF RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER, WITH TRENDS IN UTILIZATION AND IMPACT OF ROBOTIC SURGERY: A NATIONAL INPATIENT SAMPLE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP69-16 INPATIENT OUTCOMES OF RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CANCER, WITH TRENDS IN UTILIZATION AND IMPACT OF ROBOTIC SURGERY: A NATIONAL INPATIENT SAMPLE ANALYSIS Sohrab Arora, Samantha Wilder, Matthew Davis, Nicholas Corsi, Ivan Rakic, Chase Morrison, Rafe Affas, Akshay Sood, Riccardo Autorino, Craig Rogers, and Firas Abdollah Sohrab AroraSohrab Arora More articles by this author , Samantha WilderSamantha Wilder More articles by this author , Matthew DavisMatthew Davis More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Ivan RakicIvan Rakic More articles by this author , Chase MorrisonChase Morrison More articles by this author , Rafe AffasRafe Affas More articles by this author , Akshay SoodAkshay Sood More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our primary aim was to evaluate the inpatient morbidity, mortality, and cost of radical nephroureterectomy (NU) for upper tract urothelial cancer (UTUC). We also aimed to evaluate the trends in utilization of robotic surgery for this procedure, and to assess the difference between robotic NU and open NU in terms of the above outcomes from within the National Inpatient Sample (NIS). METHODS: We focused on 9581 records of adult patients with nonmetastatic UTUC undergoing radical NU from 2003-14, representing an estimated 47204 NUs performed in the US during this period. Data after 2014 was excluded due to International Classification of Diseases (ICD) coding change in 2015. ICD-9 code for robotics was introduced in 2008, so data before 2008 was not used when comparing surgical approaches. ICD-9 codes were used to define complications. Complex-survey procedures were used to study descriptive characteristics, and outcomes of patients undergoing NU. Cost of admission was inflation-adjusted to 2014 US dollars. Table: Descriptive statistics and outcomes of radical NU for upper tract urothelial carcinoma in 47204 records from the NIS from 2008-2014, stratified by surgical approach. RESULTS: Overall, the median age of the patients was 72 (IQR 63-79) years. 22974 (49%) patients had a Charlson comorbidity index of 3 or more. 33693 (71%) patients had Medicare/Medicaid insurance. 14692 (31%) patients had complications, with 6814 (14%) having major complications. Significant trend towards use of robotic approach was seen during the study period. Overall, 4635 NUs were performed robotically: accounting for 33% of NUs in 2014. Table 1 shows the outcomes after stratification by approach. Robotic surgery was associated with significantly lower rate of any complications 962 (21%) vs 7675 (33%) for open; p<0.001. This was also true for in hospital mortality (0.3% vs 1.2%; p 0.02), and major complications (10% vs 19%; p<0.001). CONCLUSIONS: Nephroureterectomy is associated with a high inpatient morbidity and mortality. There is increasing utilization of robotic approach in the US. Robotic surgery is associated with lower morbidity and in hospital mortality in these patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e970 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sohrab Arora More articles by this author Samantha Wilder More articles by this author Matthew Davis More articles by this author Nicholas Corsi More articles by this author Ivan Rakic More articles by this author Chase Morrison More articles by this author Rafe Affas More articles by this author Akshay Sood More articles by this author Riccardo Autorino More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-01 THE DILEMMA OF THE ADOLESCENT VARICOCELE: A QUALITATIVE EXPLORATION OF THE PATIENT AND FAMILY PERSPECTIVE

You have accessJournal of UrologyCME1 Apr 2023MP18-01 THE DILEMMA OF THE ADOLESCENT VARICOCELE: A QUALITATIVE EXPLORATION OF THE PATIENT AND FAMILY PERSPECTIVE Grace E. Sollender, Eduardo Piqueiras, Jennifer S. Singer, and Sriram V. Eleswarapu Grace E. SollenderGrace E. Sollender More articles by this author , Eduardo PiqueirasEduardo Piqueiras More articles by this author , Jennifer S. SingerJennifer S. Singer More articles by this author , and Sriram V. EleswarapuSriram V. Eleswarapu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The experiences of adolescents and families contending with varicocele diagnosis and treatment decision-making remain largely unknown. The objective of this ongoing qualitative study is to explore first-person attitudes and concerns among adolescents and their parents regarding varicocele diagnosis and subsequent management using a qualitative approach to elicit core themes affecting decision-making. METHODS: Using an IRB-approved exploratory qualitative design, semi-structured interviews were conducted separately with adolescents diagnosed with varicoceles and their parents from 8/2022-11/2022. Purposive sampling identified eligible patients between the ages of 10-19 diagnosed with a varicocele and seen in the urology clinic who elected conservative management or surgical varicocelectomy. Seven adolescents and 12 parents were interviewed. A standardized interview script was employed to cover the following topics: potential long-term impacts of varicoceles on fertility and sexual function; varicocele-specific knowledge; family experiences with diagnosis; factors involved in decision-making; level of parent involvement; and attitudes toward semen analysis testing. RESULTS: Semi-structured interviews revealed that care preferences, treatment-related decisional conflict, and educational resources are critical yet underutilized aspects of adolescent varicocele diagnosis and treatment. Qualitative analysis indicated: 1) fertility concerns for patients and parents are poorly addressed; 2) family discomfort with semen analysis requires sensitive, direct communication; 3) a high degree of uncertainty impacts follow up; 4) scrotal aesthetics and impact on perceived masculinity are an important consideration for patients and parents; and 5) families have limited knowledge of the condition and potential short- and long-term impacts (Table 1). CONCLUSIONS: This study describes previously unexamined patient and family experiences that may improve care and decision-making interventions regarding adolescent varicoceles. The perspectives gleaned can be used to guide family-centered education and informed decision-making. Source of Funding: H H Lee Research Program © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e222 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace E. Sollender More articles by this author Eduardo Piqueiras More articles by this author Jennifer S. Singer More articles by this author Sriram V. Eleswarapu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP35-12 ASSESSMENT OF DUST QUALITY WHILE ABLATING WITH THULIUM FIBER LASER, AN IN VITRO STUDY

You have accessJournal of UrologyCME1 Apr 2023MP35-12 ASSESSMENT OF DUST QUALITY WHILE ABLATING WITH THULIUM FIBER LASER, AN IN VITRO STUDY Francois Soto Palou, Robert Medairos, Junqin Chen, Jodi Antonelli, Michael Lipkin, Glenn Preminger, and Pei Zhong Francois Soto PalouFrancois Soto Palou More articles by this author , Robert MedairosRobert Medairos More articles by this author , Junqin ChenJunqin Chen More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , Michael LipkinMichael Lipkin More articles by this author , Glenn PremingerGlenn Preminger More articles by this author , and Pei ZhongPei Zhong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous benchtop studies have shown that optimal stone ablation with the thulium fiber laser (TFL) is achieved with short pulse and maximum peak power. Furthermore, in vitro TFL studies have also demonstrated that at equivalent power, the combination of higher energy and lower frequency offers the most efficient dusting settings. Holmium based benchtop studies have shown that low pulse energy produces small fragments while high pulse energy produces larger fragments.1 No such studies have been performed with the TFL platform, and thus with this study we aim to assess the quality and size of fragments produced at different pulse energies. METHODS: All tests were conducted using an IPG Photonics TLR-50W TFL system and a 200 μm fiber on “soft” (5:2) Begostone 6 mm×6 mm (H×D) phantoms. We tested six different pulse energies (0.05 J, 0.1 J, 0.2 J, 0.4 J, 0.5 J, and 1 J) at varying frequencies to produce either 10 W or 20 W of power. Our previous benchtop studies have shown that short pulse provides superior ablation, so all pulse profiles were adjusted to maximum peak power and short pulse. The laser fiber was advanced beyond the distal end of a flexible ureteroscope (Dornier AXISTM, 3.6 F working channel) and the stone phantoms were treated in a test tube filled with water and immersed in a water bath at room temperature (Figure 1). Continuous dusting was performed for 1 minute with the 10 W settings, and 30 seconds with the 20 W settings. Each pulse energy was tested three times with three different stone phantoms. Resultant fragments were sieved, dried for 24 hours and examined under the microscope. RESULTS: At all tested pulse energies, no stone phantoms were broken into large fragments. All stone materials were pulverized into small dust. When examined under the microscope, individual dust particles were smaller than 20 μm for all the tested settings (Figure 1). Exact measurements were not obtained and deemed not clinically relevant. CONCLUSIONS: Unlike Holmium lithotripsy where higher pulse energy results in larger fragments, in Thulium lithotripsy higher pulse energy did not result in increased fragment size. Reference: 1. Sea J, Jonat LM, Chew BH, Qiu J, Wang B, Hoopman J, Milner T, Teichman JM. Optimal power settings for Holmium:YAG lithotripsy. J Urol. 2012 Mar;187(3):914-9. doi: 10.1016/j.juro.2011.10.147. Epub 2012 Jan 20. PMID: 22264464. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e474 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francois Soto Palou More articles by this author Robert Medairos More articles by this author Junqin Chen More articles by this author Jodi Antonelli More articles by this author Michael Lipkin More articles by this author Glenn Preminger More articles by this author Pei Zhong More articles by this author Expand All Advertisement PDF downloadLoading ...

Stone Disease: Surgical Therapy (including ESWL) IV (PD45)

You have accessJournal of UrologyCME1 Apr 2023Stone Disease: Surgical Therapy (including ESWL) IV (PD45) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003358AboutPDF 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 ...

MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL

You have accessJournal of UrologyCME1 Apr 2023MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL Chia-Min Liu and Chan Jung Liu Chia-Min LiuChia-Min Liu More articles by this author and Chan Jung LiuChan Jung Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the standard treatment for large renal stone. Despite the advanced techniques, postoperative fever and bleeding remain the two major complications but still without effective predictor. Mayo adhesive probability (MAP) score is an image-based renal morphometry scoring system that is used to predict the potential risks and complications of partial nephrectomy but was never evaluated for the association with post-PCNL complications. We aim to explore the predictive value of MAP score on postoperative fever and estimated total blood loss (ETBL) in patients underwent miniaturized PCNL (mPCNL). METHODS: This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores was determined on the basis of pre-operative computed tomography and was calculated algorithmically by posterior renal fat thickness and the extent of perinephric fat stranding. We used Bourke and Smith formula to calculate intraoperative ETBL. Logistic regression analysis was used to determine independent risk factors associated with fever and ETBL. The predictive values of preoperative urine culture combining MAP score for postoperative fever was determined by receiver operating characteristic (ROC) curve analysis. RESULTS: Among 159 study subjects, over half of the patients presented with MAP score ≥ 3 (n=90, 56.6%). Men, elderly, chronic kidney disease, and diabetes mellitus were associated with a higher MAP score. The patients with higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate logistic regression, preoperative positive urine culture (OR 2.44, p=0.01) and a higher MAP score (OR 2.13, p=0.026) were both significantly associated with postoperative fever. ROC curves analysis combining these two factors on predicting postoperative fever showed AUC 0.73 (0.652–0.810) (Figure 1). The posterior perinephric fat thickness was significantly associated with ETBL (β=7.36, p=0.04). CONCLUSIONS: The MAP score was associated with postoperative fever in patients undergoing mPCNL, while posterior perinephric fat demonstrated borderline association with estimated perioperative blood loss volume. The combination of preoperative urine culture and the MAP score can significantly predict the probability of fever in patients receiving mPCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chia-Min Liu More articles by this author Chan Jung Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

MP53-14 RENAL FUNCTION BY EGFR CALCULATORS IN PRUNE BELLY SYNDROME AND POSTERIOR URETHRAL VALVES

You have accessJournal of UrologyCME1 Apr 2023MP53-14 RENAL FUNCTION BY EGFR CALCULATORS IN PRUNE BELLY SYNDROME AND POSTERIOR URETHRAL VALVES Alexandra Carolan, Shane Batie, Samuel Gold, Shaheer Ali, Daniel Wong, Nida Karra, Nathalia Amado, Jyothsna Gattineni, Bruce Schlomer, Yvonne Chan, and Linda Baker Alexandra CarolanAlexandra Carolan More articles by this author , Shane BatieShane Batie More articles by this author , Samuel GoldSamuel Gold More articles by this author , Shaheer AliShaheer Ali More articles by this author , Daniel WongDaniel Wong More articles by this author , Nida KarraNida Karra More articles by this author , Nathalia AmadoNathalia Amado More articles by this author , Jyothsna GattineniJyothsna Gattineni More articles by this author , Bruce SchlomerBruce Schlomer More articles by this author , Yvonne ChanYvonne Chan More articles by this author , and Linda BakerLinda Baker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003301.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In prune belly syndrome (PBS), prior comparison of estimated glomerular filtration rate (eGFR) with calculators using creatinine (Cr) and/or Cystatin C (Cys) showed lower mean eGFR with Cys-based calculators than with the “Bedside Schwartz” Cr-based calculator (eGFRcr) in Chronic Kidney Disease (CKD) 1 and 2. As abdominal skeletal muscle paucity in PBS could reduce serum Cr, we hypothesized the differences in mean eGFRcr and eGFR by Cys-based calculators (denoted as Δ) will be greater in PBS compared to posterior urethral valves (PUV), with intact musculature. METHODS: A 2014-2021 retrospective ICD-10 search identified PBS and PUV patients with labs and height without neuromuscular disorders or renal replacement. eGFRcr, eGFRcys and creatinine-cystatin C-based GFR (eGFR-CKiD) were calculated. CKD stages were assigned by eGFRcr. Δ eGFRcr, eGFRcys, and eGFR-CKiD between PBS and PUV were compared with t-test. Those with normal Cr and/or Cys but who had CKD by eGFR calculators were identified. The proportion of changes in CKD staging by each calculator was compared with chi-square or Fishers exact test. RESULTS: 95 PUV and 26 PBS patients were analyzed (Figure 1). Δ eGFRCr and eGFR with Cys-based calculators by CKD stage or by all CKD stages combined were not different between PBS and PUV. By all CKD stages combined, Δ eGFRcr and eGFRcys was 18 and 13 mL/min/1.73 m2 in PBS and PUV, respectively (p=0.22) and Δ eGFRcr and eGFR-CKiD was 8 and 5 ml/min/1.73 m2 in PBS and PUV, respectively (p=0.71). Among patients with normal Cr and/or Cys, at least 25% had CKD2-3 by eGFR calculation. Changes in CKD stage by Cys-based calculators compared to eGFRcr were not significantly different between PBS and PUV (p>0.3). Upstaging was most frequent in PBS and PUV CKD1 and 2. CONCLUSIONS: Differences between eGFRcr and eGFR by Cys-based calculators in PBS and PUV patients were not significant, suggesting paucity of abdominal musculature in PBS may not account for the lower eGFRs observed using Cys-based calculators. In 25% of patients, normal Cr and/or Cys actually had CKD2-3, highlighting importance of eGFR calculation. Cys-based calculators upstaged, especially in CKD1 and 2. Cys-based eGFRs calculators should be considered for early identification of CKD in patients with congenital urologic abnormalities prone to renal dysfunction. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e717 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Carolan More articles by this author Shane Batie More articles by this author Samuel Gold More articles by this author Shaheer Ali More articles by this author Daniel Wong More articles by this author Nida Karra More articles by this author Nathalia Amado More articles by this author Jyothsna Gattineni More articles by this author Bruce Schlomer More articles by this author Yvonne Chan More articles by this author Linda Baker More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-20 PROGNOSTIC FACTORS FOR RECURRENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: REAL-WORLD DATA FROM JAPANESE SINGLE HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP47-20 PROGNOSTIC FACTORS FOR RECURRENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: REAL-WORLD DATA FROM JAPANESE SINGLE HIGH-VOLUME CENTER Shun Watanabe, Toshio Takagi, Hiroki Ishihara, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, Tsunenori Kondo, and Hideki Ishida Shun WatanabeShun Watanabe More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , and Hideki IshidaHideki Ishida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy has been accepted as a standard treatment option for small renal cell carcinoma. For careful follow-up after surgery, identifying prognostic factors for recurrence is important. However, few studies have investigated the recurrence of renal cell carcinoma after partial nephrectomy, focusing on robotic surgery. Therefore, we investigated post-operative recurrence-free survival and predictive factors that affect tumor recurrence after robot-assisted partial nephrectomy. METHODS: In total, 1039 patients who underwent robot-assisted laparoscopic partial nephrectomy for clinical T1 renal cell carcinoma at a single institution between January 2013 and December 2020 were retrospectively evaluated. RESULTS: The median age was 59 years and the median tumor size was 30 mm. With a median follow-up of 37 months (Interquartile range 24-53 months), 38 patients (3.7%), including 6 with local recurrence, 5 recurrence in the operated kidney, and 27 with other organs or lymph-nude, experienced recurrence. The 3-year recurrence-free survival was 97%. Multivariate analyses revealed high grade tumor (hazard ratio: 2.71, p=0.0047), upstaging to pathological T3a (hazard ratio: 3.47, p=0.0248) and lymphovascular invasion (hazard ratio: 4.03, p=0.0002) were independent prognostic factors for worse recurrence-free survival (Table). CONCLUSIONS: In conclusions, patients after robot-assisted laparoscopic partial nephrectomy with high grade tumor, upstaging to pathological T3a and lymphovascular invasion had a risk of worse recurrence-free survival. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e652 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shun Watanabe More articles by this author Toshio Takagi More articles by this author Hiroki Ishihara More articles by this author Hironori Fukuda More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Hideki Ishida More articles by this author Expand All Advertisement PDF downloadLoading ...

MP28-18 ADJUVANT IMMUNOTHERAPY IN RENAL CELL CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

You have accessJournal of UrologyCME1 Apr 2023MP28-18 ADJUVANT IMMUNOTHERAPY IN RENAL CELL CARCINOMA: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS Emily Huang, Carlos Riveros, Sanjana Ranganathan, Zachary Klaassen, Rini Brian, Christopher Wallis, and Raj Satkunasivam Emily HuangEmily Huang More articles by this author , Carlos RiverosCarlos Riveros More articles by this author , Sanjana RanganathanSanjana Ranganathan More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Rini BrianRini Brian More articles by this author , Christopher WallisChristopher Wallis More articles by this author , and Raj SatkunasivamRaj Satkunasivam More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite surgical resection, many patients with high-risk renal cell carcinoma (RCC) experience recurrence. Following approvals in metastatic RCC, there has been interest in using immune checkpoint inhibition (ICI) in the adjuvant setting. The objective of this study is to synthesize available data regarding the disease-free survival (DFS) benefit of adjuvant ICIs for patients with RCC and evaluate the overall safety profile of ICIs in this setting. METHODS: PubMed, Embase, and relevant conference proceedings were searched from inception up to September 18, 2022. Phase III randomized controlled trials (RCTs) comparing adjuvant ICI versus placebo/observation were included. Study screening and selection, along with data extraction was performed in duplicate according to a predefined registered protocol. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and the Cochrane Collaboration’s tool for assessing risk of bias were used. All outcomes were analyzed using random-effects meta-analysis owing to interstudy heterogeneity. Sensitivity and subgroup analyses were performed to identify potential sources of heterogeneity. The primary outcome of interest was DFS. Variables for subgroup analyses were PD-L1 expression, sarcomatoid features, nephrectomy type, and disease-risk category. Secondary outcomes included grade ≥3 adverse events (AEs), immune-related AEs, and treatment discontinuation due to AEs. RESULTS: Among the four included studies, one demonstrated a significant DFS benefit. There was considerable clinical and statistical heterogeneity (I2=64%) due to differences in inclusion criteria and interventions. While pooled results across the four studies did not demonstrate a significant benefit in DFS overall (HR 0.85, 95% CI 0.69-1.04), there was significant benefit among patients with positive PD-L1 expression (HR 0.72, 95% CI 0.55-0.94) or sarcomatoid features (HR 0.59, 95% CI 0.38-0.91). CONCLUSIONS: The evidence base to date regarding ICI as adjuvant therapy in RCC is mixed – conclusions are limited by considerable heterogeneity between studies. However, pooled analyses suggest that patients with positive PD-L1 expression or sarcomatoid features are most likely to benefit from adjuvant immunotherapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e378 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Huang More articles by this author Carlos Riveros More articles by this author Sanjana Ranganathan More articles by this author Zachary Klaassen More articles by this author Rini Brian More articles by this author Christopher Wallis More articles by this author Raj Satkunasivam More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-16 HOW DO TIKTOK USERS PRESENT THIRD LINE OAB THERAPIES TO THE PUBLIC?

You have accessJournal of UrologyCME1 Apr 2023MP74-16 HOW DO TIKTOK USERS PRESENT THIRD LINE OAB THERAPIES TO THE PUBLIC? Alexandra Tabakin, Sharon Choi, Arshia Sandozi, Kelli Aibel, Michael Weintraub, Harvey Winkler, Dara Shalom, Justina Tam, and Wai Lee Alexandra TabakinAlexandra Tabakin More articles by this author , Sharon ChoiSharon Choi More articles by this author , Arshia SandoziArshia Sandozi More articles by this author , Kelli AibelKelli Aibel More articles by this author , Michael WeintraubMichael Weintraub More articles by this author , Harvey WinklerHarvey Winkler More articles by this author , Dara ShalomDara Shalom More articles by this author , Justina TamJustina Tam More articles by this author , and Wai LeeWai Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: TikTok is a social media outlet with over 1 billion monthly users, but the quality and accuracy of its health-related videos is less known. In this cross-sectional study, we assessed the quality of TikTok videos on overactive bladder (OAB) 3rd line therapies. METHODS: We abstracted the top 50 TikTok videos for each of these keywords: "axonics", "sacral neuromodulation","interstim", "PTNS", "posterior tibial nerve stimulation", and "bladder botox". Videos were included if they contained information about the therapy and excluded if they were non-English, did not contain information about the therapy, or were unavailable for viewing at time of scoring. Demographic information was compiled. Videos were scored for quality by 3 independent reviewers using the Medical Quality Video Evaluation Tool (MQ-VET), a validated tool for assessing medical videos. A composite score, ranging 15-75, was tallied from the mean scores. Two authors, both urologists, determined if videos had misinformation (MI). RESULTS: Of 300 videos screened, 119 videos met inclusion criteria. 21% were made by medical professionals (MPs). MP videos had more shares (5 vs 1, p<0.01) but were similar in length, views, likes, and comments. Although MP videos had significantly higher MQ-VET scores (43 vs 27, p<0.01), there was no difference in rate of MI between MP and non-MP videos. Videos with more shares (>1) correlated with higher MQ-VET score (34 vs 26, p<0.01), but the same pattern was not seen for higher likes, comments, or views. 18.4% of videos contained MI, which were 3 times longer (50.5 vs 15 sec, p<0.01) and had higher MQ-VET scores (34.5 vs 27, p=0.03) than those without MI (Table 1). Common themes of MI were related to therapy indication or mechanism of action and patient limitations after therapy. CONCLUSIONS: Most TikTok videos on OAB 3rd line therapies are poor quality and made by the public. About one-fifth of all TikTok videos on OAB 3rd line therapies contain MI. We found that videos with MI tend to be longer and, paradoxically, of higher quality than those without MI. While more frequently shared videos tend to be higher quality, that is not true for videos with more views, likes, and comments. MPs should be aware of MI permeating TikTok given its large audience. MPs on TikTok have credibility with the public and should ensure they are not posting, and inadvertently promoting, MI. Source of Funding: - © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1076 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Tabakin More articles by this author Sharon Choi More articles by this author Arshia Sandozi More articles by this author Kelli Aibel More articles by this author Michael Weintraub More articles by this author Harvey Winkler More articles by this author Dara Shalom More articles by this author Justina Tam More articles by this author Wai Lee More articles by this author Expand All Advertisement PDF downloadLoading ...