Urologic Research Research Articles

PD01-12 DEEP LEARNING AUGMENTED DETECTION OF FLAT LESIONS ON WHITE LIGHT CYSTOSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD01-12 DEEP LEARNING AUGMENTED DETECTION OF FLAT LESIONS ON WHITE LIGHT CYSTOSCOPY Eugene Shkolyar, Xiao Jia, Okyaz Eminaga, Mark Laurie, Zixia Zhou, Tauhidul Islam, Lei Xing, and Joseph Liao Eugene ShkolyarEugene Shkolyar More articles by this author , Xiao JiaXiao Jia More articles by this author , Okyaz EminagaOkyaz Eminaga More articles by this author , Mark LaurieMark Laurie More articles by this author , Zixia ZhouZixia Zhou More articles by this author , Tauhidul IslamTauhidul Islam More articles by this author , Lei XingLei Xing More articles by this author , and Joseph LiaoJoseph Liao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003218.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While-light cystoscopy (WLC) has inadequate performance for detection of flat lesions such as carcinoma in situ. Blue-light cystoscopy (BLC) has improved flat-lesion detection, however adoption is modest due to equipment cost, drug instillation, and user experience. Here we develop a non-invasive, deep learning-based algorithm to augment WLC flat lesion detection by using blue-light informed transfer learning. METHODS: CystoFlatNet was developed based on CystoNet, a deep learning platform for WLC bladder cancer detection. CystoNet was enhanced to augment flat lesion detection in two stages. First, a WLC image was input into a BLC domain using domain adaption of CycleGAN. Second, a region of interest (ROI) detector was used to segment the regions within the transferred images occupied by a flat lesion. Transfer learning was applied to embed features learned from both WLC and BLC into the model weights. Algorithm outputs included an outline deployed in WLC and a “mock” BLC output. For algorithm development, images of WLC and BLC matches from 50 subjects with flat lesions were selected and annotated. A training set consisting of 40 subjects and a test set of 10 subjects were used. Training was performed on WLC and BLC images. WLC was the only input used for validation. Per-lesion sensitivity was determined and performance compared to CystoNet. RESULTS: CystoFlatNet detected flat lesions on WLC with a 90% per-lesion sensitivity (9/10). In comparison, the previously trained CystoNet had a 30% per-lesion sensitivity (3/10). Large accuracy gains were obtained in ROI overlap and visual guidance in the blue-light domain (Figure 1). CONCLUSIONS: We have developed a deep-learning algorithm that shows promise in WLC flat lesion detection. CystoFlatNet may aid in diagnostic decision-making and could serve as a non-invasive, accessible alternative to available adjunct technologies. Validation in a large prospective cohort is needed to further evaluate CystoFlatNet performance. Source of Funding: Department of Veterans Affairs Merit Review Award I01 BX005598, Urology Care Foundation Research Scholar Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e68 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Shkolyar More articles by this author Xiao Jia More articles by this author Okyaz Eminaga More articles by this author Mark Laurie More articles by this author Zixia Zhou More articles by this author Tauhidul Islam More articles by this author Lei Xing More articles by this author Joseph Liao More articles by this author Expand All Advertisement PDF downloadLoading ...

MP19-17 SPECIALTY-SPECIFIC TRENDS IN THE SURGICAL MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE POST VAGINAL MESH

You have accessJournal of UrologyCME1 Apr 2023MP19-17 SPECIALTY-SPECIFIC TRENDS IN THE SURGICAL MANAGEMENT OF APICAL PELVIC ORGAN PROLAPSE POST VAGINAL MESH Rahul Dutta, Gopal Badlani, and Catherine Matthews Rahul DuttaRahul Dutta More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Catherine MatthewsCatherine Matthews More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since transvaginal mesh (VM) for apical pelvic organ prolapse (APOP) repair was labeled “high-risk” in 2016 and subsequently banned in 2019 by the US Food and Drug Administration, remaining surgical treatment options include abdominal mesh-augmented sacrocolpopexy (AS) via laparoscopic (LAS) and open (OAS) approaches and vaginal native tissue apical suspension (VN). Our aim was to determine trends in APOP procedures post VM and whether differences existed between urologists and gynecologists. METHODS: Between 2011-2020, the National Surgical Quality Improvement Program (NSQIP) database was queried for AS, VM, and VN performed by both urologists and gynecologists. Trends in surgical approach were analyzed. RESULTS: 26,477 cases of APOP repair (32% AS, 6% VM, 62% VN) were included, 9% by urologists. Urologists operated on older (65 vs 61 years) patients with higher ASA score (32% vs 25% ASA III) with a higher prevalence of diabetes, chronic obstructive pulmonary disease, and bleeding disorders (p<0.05). Mean BMI was 28 and did not vary by specialty. Urologists performed significantly higher proportion of AS (65% vs 29%) and VM (8% vs 6%) relative to VN (27% vs 65%) than gynecologists (p<0.0001). VM utilization has decreased over time for both urologists (p=0.0242) and gynecologists (p=0.0001); a trend towards increasing AS (p=0.1646) in urologists and VN (p=0.0913) in gynecologists has concurrently occurred. Both specialties have increasingly favored LAS over OAS (p<0.0001). Operating room times did not vary for AS (p=0.1719) and were slightly higher for urologists in VM (111 vs 106 min, p=0.0432) and VN (118 vs 111 min, p<0.0001). Concurrent mid-urethral mesh sling placement occurred in 29% of cases overall; this has remained unchanged over time for urologists (p=0.8348) and decreased (p=0.0003) for gynecologists. CONCLUSIONS: Significant differences in the surgical approach to apical prolapse repair procedures and concomitant mid-urethral mesh slings exist between specialties. Urologists tend to operate on more medically complex and older patients with APOP and continue to demonstrate a strong preference for mesh-augmented repairs compared to transvaginal native tissue repairs. Minimally-invasive sacrocolpopexy is being more frequently performed by both specialties treating APOP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e272 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Dutta More articles by this author Gopal Badlani More articles by this author Catherine Matthews More articles by this author Expand All Advertisement PDF downloadLoading ...

PD25-04 APPLICATION OF A MULTIPLEX URINALYSIS TEST FOR PREDICTING TREATMENT RESPONSE IN PATIENTS WITH BCG UNRESPONSIVE BLADDER CANCER: A PILOT STUDY

You have accessJournal of UrologyCME1 Apr 2023PD25-04 APPLICATION OF A MULTIPLEX URINALYSIS TEST FOR PREDICTING TREATMENT RESPONSE IN PATIENTS WITH BCG UNRESPONSIVE BLADDER CANCER: A PILOT STUDY Hideki Furuya, Kaoru Murakami, Ian Pagano, Runpu Chen, Yijun Sun, Nari Kim, Edward Kadel, Cheryl Wong, Nicole Davarpanah, and Charles Rosser Hideki FuruyaHideki Furuya More articles by this author , Kaoru MurakamiKaoru Murakami More articles by this author , Ian PaganoIan Pagano More articles by this author , Runpu ChenRunpu Chen More articles by this author , Yijun SunYijun Sun More articles by this author , Nari KimNari Kim More articles by this author , Edward KadelEdward Kadel More articles by this author , Cheryl WongCheryl Wong More articles by this author , Nicole DavarpanahNicole Davarpanah More articles by this author , and Charles RosserCharles Rosser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003303.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently, we reported that OncuriaTM, a multiplex urinalysis test, could be predictive of BCG treatment response. Furthermore, high-grade BCG unresponsive bladder cancer have limited treatment options. Such patients are offered either radical cystectomy or systemic therapy. One of the systemic therapies include immune-oncology agents, e.g., PD-1 or PD-L1 inhibitors. In this study, we tested the performance of OncuriaTM in a BCG unresponsive cohort to determine if it could predict response to a PDL1 inhibitor. METHODS: OncuriaTM data was evaluated in voided urine samples obtained from a prospectively collected cohort of 18 subjects who have BCG-unresponsive NMIBC with treatment of atezolizumab monotherapy or atezolizumab BCG combination (provided by Genentech, NCT02792192). The urine samples were collected prior to treatment in both arms. The OncuriaTM test, which measures 10 cancer-associated biomarkers was performed in an independent clinical laboratory. Predictive models were previously developed using supervised learning and cross-validation analyses. Model performance was validated using ROC curves. RESULTS: Pre-treatment urinary concentrations of MMP9, VEGFA, CA9, SDC1, PAI1, APOE, A1AT, ANG and MMP10 were increased in patients who developed disease recurrence. A combinatorial predictive model of treatment outcome achieved sensitivity and specificity of >90%. CONCLUSIONS: Previous pilot study found that monitoring the urinary levels of a cancer-associated biomarker panel enabled the discrimination of patients who did not respond to intravesical BCG therapy. In this study, we noted the performance of OncuriaTM for the prediction of systemic PDL1 inhibitor treatment response. A limitation of this study includes its small sample size. With further study, the multiplex OncuriaTM test may be applicable for the clinical evaluation of bladder cancer patients who have not previously responded to intravesical BCG treatment and is considering systemic immune-oncology options. Source of Funding: NIH/NCI R21CA263230, NIH/NCI R01CA198887 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e730 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hideki Furuya More articles by this author Kaoru Murakami More articles by this author Ian Pagano More articles by this author Runpu Chen More articles by this author Yijun Sun More articles by this author Nari Kim More articles by this author Edward Kadel More articles by this author Cheryl Wong More articles by this author Nicole Davarpanah More articles by this author Charles Rosser More articles by this author Expand All Advertisement PDF downloadLoading ...

MP18-07 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON DELAYS TO SEEK CARE FOR CHILDREN WITH TESTICULAR TORSION

You have accessJournal of UrologyCME1 Apr 2023MP18-07 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON DELAYS TO SEEK CARE FOR CHILDREN WITH TESTICULAR TORSION Ashley Pittman, Monica Morales, Sri Chinta, Amy Pan, Liyun Zhang, and Jonathan S. Ellison Ashley PittmanAshley Pittman More articles by this author , Monica MoralesMonica Morales More articles by this author , Sri ChintaSri Chinta More articles by this author , Amy PanAmy Pan More articles by this author , Liyun ZhangLiyun Zhang More articles by this author , and Jonathan S. EllisonJonathan S. Ellison More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testicular torsion is a well-documented pediatric urological emergency that poses a time-sensitive risk to the testicle. Although management and treatment for suspected testicular torsion is standardized across most hospitals, delays may occur in time to presentation. Several social determinants of health (SDH) have been associated with higher orchiectomy rates for testicular torsion. However, factors associated with time to presentation are not well characterized. We investigated time from symptom onset to presentation patterns, hypothesizing an association between SDHs and prolonged time to presentation. METHODS: A retrospective chart review of children ≤17 years of age presenting with testicular torsionat a single tertiary pediatric center from 2013-2022 was performed. Children who were <1 month of age, no documented time of symptom onset, or did not receive surgery were excluded. Demographics, symptom onset, time course of care, and surgical outcomes were extracted from the electronic medical records. The primary outcome measure of the study was time from symptom onset to ED presentation. SDHs such as interpreter utilization, race, zip code, area deprivation index, and insurance status were compared and analyzed using univariate analyses. RESULTS: In total 253 children met inclusion criteria. The essential demographic variables include utilization of interpreter 22 (8.7%), public insurance 168 (66.4%), and Hispanic or Latino ethnicity 43 (17.0%). Racial make-up of the cohort was White 144 (56.9%), Black 79 (31.2%), Other 12 (4.7%), and Unknown 18 (7.1%). No difference was noted on univariate analysis of time to presentation between ethnicity, race, or interpreter usage. However, public insurance had a statistically significant greater time to presentation (Median 11.5 IQR 3.9-49.3 hrs vs 4.9, 2.7-26.2 hrs) (p=0.004) shown in Figure 1. A logistic regression analysis found ethnicity to have a higher association with adverse orchiectomy outcomes. CONCLUSIONS: Children with public insurance had significantly longer time intervals from reported symptom onset to presentation. Additionally, ethnicity was associated with higher orchiectomy rates. Further exploring barriers to seek care for testicular torsion serves as a foundation to reduce health disparities. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e225 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley Pittman More articles by this author Monica Morales More articles by this author Sri Chinta More articles by this author Amy Pan More articles by this author Liyun Zhang More articles by this author Jonathan S. Ellison More articles by this author Expand All Advertisement PDF downloadLoading ...

MP11-01 PRESCRIPTION PATTERNS OF SYSTEMIC THERAPY IN THE MANAGEMENT OF METASTATIC CASTRATION-SENSITIVE PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP11-01 PRESCRIPTION PATTERNS OF SYSTEMIC THERAPY IN THE MANAGEMENT OF METASTATIC CASTRATION-SENSITIVE PROSTATE CANCER Joseph Black, David Einstein, Xin Gao, Xiao Wei, Brendan Connell, Nick Kamkari, Boris Gershman, and Aria Olumi Joseph BlackJoseph Black More articles by this author , David EinsteinDavid Einstein More articles by this author , Xin GaoXin Gao More articles by this author , Xiao WeiXiao Wei More articles by this author , Brendan ConnellBrendan Connell More articles by this author , Nick KamkariNick Kamkari More articles by this author , Boris GershmanBoris Gershman More articles by this author , and Aria OlumiAria Olumi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003226.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastatic castration-sensitive prostate cancer (mCSPC) is an incurable disease. Although androgen deprivation therapy (ADT) remains the backbone treatment for patients with mCSPC, multiple randomized studies since 2015 have demonstrated that treatment intensification with the addition of taxanes and/or novel hormonal therapies (NHT) confers significantly improved overall survival. This adds complexity for providers with developing an individual therapeutic approach for patients with mCSPC. Provider prescription patterns for mCSPC are heterogenous, which may present barriers for patients in receiving newer interventions. To investigate this, we conducted a retrospective analysis on the prescription utilization patterns of clinicians initiating treatment for patients with mCSPC. METHODS: Pharmacy and claims data were queried from 2015-2022 to identify patients with prostate cancer (PCa). The dataset includes 18 million US cancer patients, including Medicaid, Medicare, Medicare Part D, and cash transactions. Patients with mCSPC were identified using at minimum two ICD9/10 diagnosis codes and/or medications on separate days. Drug classes analyzed include NHT, 1st-generation anti-androgens, chemotherapy, and LHRH monotherapy. Prescription rates of each class of drug were stratified by patient and provider baseline characteristics. RESULTS: NHT prescription has increased, while chemotherapy, first generation anti-androgens, and LHRH monotherapy have either remained unchanged or decreased since 2015. No variation in prescription patterns were observed between urban and rural settings. Medical oncologists were more likely to prescribe NHT than urologists (45% vs. 19%), whereas urologists were more likely to prescribe LHRH monotherapy (69% v 38%). CONCLUSIONS: Since 2015, NHT utilization and treatment intensification has nationally increased for mCSPC and prescription patterns do not vary between rural and urban settings. When compared to urologists, medical oncologists have more readily incorporated newer therapeutics for mCSPC and decreased the usage of LHRH monotherapy for patients with mCSPC. These data represent a potential area for growth for urologists in the treatment of mCSPC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e123 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Black More articles by this author David Einstein More articles by this author Xin Gao More articles by this author Xiao Wei More articles by this author Brendan Connell More articles by this author Nick Kamkari More articles by this author Boris Gershman More articles by this author Aria Olumi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-09 NOVEL ALGORITHM FOR INDWELLING URINARY CATHETER REMOVAL: A PILOT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP06-09 NOVEL ALGORITHM FOR INDWELLING URINARY CATHETER REMOVAL: A PILOT STUDY Emmett H Kennady, Kathleen Rea, Priyanka R Kumar, Dayna Monaghan, David E Rapp, Haerin Beller, and Emmett Kennady Emmett H KennadyEmmett H Kennady More articles by this author , Kathleen ReaKathleen Rea More articles by this author , Priyanka R KumarPriyanka R Kumar More articles by this author , Dayna MonaghanDayna Monaghan More articles by this author , David E RappDavid E Rapp More articles by this author , Haerin BellerHaerin Beller More articles by this author , and Emmett KennadyEmmett Kennady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Indwelling urinary catheter (IUC) complications including catheter-associated urinary tract infection (CAUTI) are a major source of patient morbidity associated with increased mortality and healthcare costs. Although urinary retention following IUC removal can lead to complications including CAUTI, no well-established algorithms exist for management following IUC removal. The objective of this study was to evaluate the impact of a comprehensive IUC removal algorithm. We hypothesized that a protocol driven approach to urinary retention would be superior to routine care. METHODS: A data-driven IUC removal algorithm was developed by a multidisciplinary team (Figure 1). This was made available via Epic order-set. All patients cared for in the neurosciences units in the first 3 months following implementation (April – July 2022) were evaluated. Patients were stratified by use of the algorithm. RESULTS: A total of 450 patients were evaluated during the study period. Following best of fit matching for length of stay, there were 189 patients in each cohort. There were largely no differences in baseline characteristics between algorithm and no algorithm groups, respectively (age 64 vs 64, p=0.455; BMI 28.58 vs 28.49; p=0.243). There were no CAUTIs in either group. Although the algorithm group had a significantly higher number of in-and-out catheterizations (430 vs 360; p=0.010) and bladder scans performed (826 vs 572; p=0.003), this led to a significant reduction in the proportion of patients discharged with indwelling catheters (4.3% vs 16.9%; p<0.001). There was no difference in the median time with IUC between groups (1.29 vs 1.09 days; p=0.435). There was only one consult for urinary retention in the algorithm group compared to five in the no-algorithm group (p=0.10). CONCLUSIONS: Implementation of a urinary retention algorithm following IUC removal is associated with a decrease in the number of patients discharged with an IUC. Furthermore, this algorithm may increase non-urologic clinicians’ independence in managing urinary retention. This novel algorithm was feasible and effective in a neuroscience patient population and these data warrant broader application. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e56 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emmett H Kennady More articles by this author Kathleen Rea More articles by this author Priyanka R Kumar More articles by this author Dayna Monaghan More articles by this author David E Rapp More articles by this author Haerin Beller More articles by this author Emmett Kennady More articles by this author Expand All Advertisement PDF downloadLoading ...

V06-11 RETROPERITONEAL SINGLE-PORT ROBOT-ASSISTED NEPHROURETERECTOMY WITH BLADDER CUFF EXCISION

You have accessJournal of UrologyCME1 Apr 2023V06-11 RETROPERITONEAL SINGLE-PORT ROBOT-ASSISTED NEPHROURETERECTOMY WITH BLADDER CUFF EXCISION Seokhwan Bang, Dongho Shin, Hyung Woo Moon, Hyuk Jin Cho, U-Syn Ha, Ji Youl Lee, and Sung-Hoo Hong Seokhwan BangSeokhwan Bang More articles by this author , Dongho ShinDongho Shin More articles by this author , Hyung Woo MoonHyung Woo Moon More articles by this author , Hyuk Jin ChoHyuk Jin Cho More articles by this author , U-Syn HaU-Syn Ha More articles by this author , Ji Youl LeeJi Youl Lee More articles by this author , and Sung-Hoo HongSung-Hoo Hong More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gold standard treatment of upper tract urothelial carcinoma is neprhoureterectomy with excision of the ipsilateral ureter orifice and a bladder cuff. However, due to various limitations of the current robot system, it has not been attempted as a retroperitoneal approach. We would like to introduce a new approach through this study. METHODS: We conducted this study on 10 patients from Sep. 2021 when Single port platform robot was introduced in our institution to Aug 2022 who needed nephroureterectomy for upper tract urothelial carcinoma. The patient was included when tumor was founded at the ureter or renal pelvis, and when a clear lesion was confirmed by ureteroscopy or urine cytology. CT scan was also taken to make sure there is no metastatic lesions. The operation was performed through the retroperitoneum in a lateral decubitus position, and only the direction of the robot arm was once changed during surgery. RESULTS: The average age of the patients was 68.70 years, and the mean BMI (body mass index) was 25.98 kg/m. The average tumor size was 2.39 cm and there were 7 cases on the right side and 3 cases on the left side. The average console time was 1 hour 53 minutes 48 seconds, and estimated blood loss was 120 ml. All 10 patients showed surgical margin negative on pathology and were discharged on the 4th day after surgery without complications. (Table 1) CONCLUSIONS: Retroperitoneal Single port robotic Nephroureterectomy with bladder cuff excision is a feasible procedure that could allow for Upper tract urothelial carcinoma. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e512 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seokhwan Bang More articles by this author Dongho Shin More articles by this author Hyung Woo Moon More articles by this author Hyuk Jin Cho More articles by this author U-Syn Ha More articles by this author Ji Youl Lee More articles by this author Sung-Hoo Hong More articles by this author Expand All Advertisement PDF downloadLoading ...

MP36-08 RISK FACTORS ASSOCIATED WITH COLLAGENASE CLOSTRIDIUM HISTOLYTICUM COMPLICATIONS AMONG MEN WITH PEYRONIE’S DISEASE

You have accessJournal of UrologyCME1 Apr 2023MP36-08 RISK FACTORS ASSOCIATED WITH COLLAGENASE CLOSTRIDIUM HISTOLYTICUM COMPLICATIONS AMONG MEN WITH PEYRONIE’S DISEASE Taher Naeem, Gal Saffati, Spoorthi Kamepalli, Sagar Patel, Basil Kaaki, Larry I. Lipshultz, and Mohit Khera Taher NaeemTaher Naeem More articles by this author , Gal SaffatiGal Saffati More articles by this author , Spoorthi KamepalliSpoorthi Kamepalli More articles by this author , Sagar PatelSagar Patel More articles by this author , Basil KaakiBasil Kaaki More articles by this author , Larry I. LipshultzLarry I. Lipshultz More articles by this author , and Mohit KheraMohit Khera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the United States, collagenase clostridium histolyticum (CCH) injections are widely used as a treatment for patients with Peyronie’s disease (PD). Although some studies have examined adverse events associated with CCH injections, none have studied their relationship to peri-procedural patient characteristics. The objective of this study is to evaluate peri-procedural risk factors associated with various known CCH complications for PD. METHODS: We performed an IRB-approved single-center retrospective study from 2009-2022 on patients with CCH injections for PD. Clinical and demographic information was extracted from patient medical records. Multivariate logistic regression modeling was used to identify statistically significant (p<0.05) associations between peri-procedural factors and injection complications. RESULTS: We identified 282 PD patients who received CCH injections. Of these patients, 33.3% (n=94) experienced bruising, 10.6% (n=30) experienced swelling, 24.8% (n=70) experienced pain, 7.4% (n=21) experienced a hematoma, and 2.1% (n=6) experienced a penile fracture (PF). We found that patients with erectile dysfunction (ED) were 3 times (Odds Ratio [OR]: 0.3, 95% Confidence Interval [CI]: 0.1-0.9) less likely to experience bruising following CCH injection as patients without ED. Additionally, patients on anticoagulants were 17 times (OR: 17, CI: 2.2-144) more likely to develop a hematoma following CCH treatment, although being on anticoagulants was not significantly associated with bruising as an adverse effect. CONCLUSIONS: We found that most CCH complications were low-grade in nature, with rare occurrences of more severe complications such as PF. We also found that having ED and being on anti-coagulants were associated with more significant complications following CCH treatment in patients with PD. These findings highlight the overall safety of CCH injections for treatment of PD and may inform clinical decisions for patients with certain risk factors. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e481 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Taher Naeem More articles by this author Gal Saffati More articles by this author Spoorthi Kamepalli More articles by this author Sagar Patel More articles by this author Basil Kaaki More articles by this author Larry I. Lipshultz More articles by this author Mohit Khera More articles by this author Expand All Advertisement PDF downloadLoading ...

MP43-02 COMBINATION OF MICROSCOPIC TESTICULAR SPERM EXTRACTION (MTESE) AND DENSITY GRADIENT PROCESSING TO OPTIMIZE SPERM RETRIEVAL AND PREGNANCY OUTCOMES IN MEN WITH NONOBSTRUCTIVE AZOOSPERMIA (NOA)

You have accessJournal of UrologyCME1 Apr 2023MP43-02 COMBINATION OF MICROSCOPIC TESTICULAR SPERM EXTRACTION (MTESE) AND DENSITY GRADIENT PROCESSING TO OPTIMIZE SPERM RETRIEVAL AND PREGNANCY OUTCOMES IN MEN WITH NONOBSTRUCTIVE AZOOSPERMIA (NOA) Nicholas Deebel, Banafsheh Nikmehr, Janmejay Hingu, Collette O'Connor, Rachel Ruble, Yueqiang Song, Ayse Vuruskan, Anuradha Devineni, Cihan Halicigil, Stuart Howards, Tamer Yalcinkaya, and Hooman Sadri-Ardekani Nicholas DeebelNicholas Deebel More articles by this author , Banafsheh NikmehrBanafsheh Nikmehr More articles by this author , Janmejay HinguJanmejay Hingu More articles by this author , Collette O'ConnorCollette O'Connor More articles by this author , Rachel RubleRachel Ruble More articles by this author , Yueqiang SongYueqiang Song More articles by this author , Ayse VuruskanAyse Vuruskan More articles by this author , Anuradha DevineniAnuradha Devineni More articles by this author , Cihan HalicigilCihan Halicigil More articles by this author , Stuart HowardsStuart Howards More articles by this author , Tamer YalcinkayaTamer Yalcinkaya More articles by this author , and Hooman Sadri-ArdekaniHooman Sadri-Ardekani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: mTESE with Intracytoplasmic sperm injection (ICSI) is the gold standard for treating infertile couples when NOA in the male is present. However, using conventional tissue processing techniques, many patients will remain negative for sperm on mTESE. Standard practice in assisted reproduction technology (ART) does not utilize the density gradient centrifugation process following mTESE. We hypothesize that gradient utilization can enrich sperm retrieval following mTESE. METHODS: Men with NOA underwent mTESE from 2019-2022 by a single surgeon. The biopsy specimens underwent mechanical dissection. Subsequent tissue processing and gradient wash were carried out through a gradient column including 90% and 50% gradient solution diluted in standard sperm wash medium. Upon verification of sperm, the post-gradient sperm and remaining un-dissociated tissue were cryopreserved separately. On the day of ICSI, the frozen gradient sperm were thawed to recover viable sperm. If needed, frozen tissue was thawed, subjected to mechanical dissociation, and a subsequent gradient to obtain enough viable sperm. Fertilization and embryo development were assessed morphologically with the Embryoscope and genetically with preimplantation genetic testing for aneuploidy (PGT-A). Following embryo transfer, biochemical (ß-HCG) and clinical (gestational sac) pregnancy were assessed. RESULTS: Overall, 24 male patients (36±1.5 years old) with NOA underwent mTESE for an average operating time of 110.6±6.9 minutes (range: 37-177). The primary sperm identification rate after mechanical dissociation of tissue was 37.5% (n=9). The use of the density gradient led to an overall sperm retrieval rate of 70.8% (n=17) (p<0.05) and secondary sperm retrieval rate (sperm identification in initially negative patients) of 53.3% (n=8). Retrieved sperm were cryopreserved to be used for ICSI. Thirteen couples (average female age and AMH 32.1±1.6 and 3.2±0.8 ng/ml respectively) underwent ICSI using extracted sperm. The overall fertilization, per-cycle pregnancy, and per-transfer pregnancy rates were 66%, 76%, and 100% respectively. Amongst these couples, 6 underwent PGT-A, and 70.0% of tested blastocysts were euploid. CONCLUSIONS: Utilization of mTESE with subsequent gradient technology may serve as a highly sensitive sperm detection and enrichment method for NOA patients in order to obtain superior ART outcomes. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e601 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Deebel More articles by this author Banafsheh Nikmehr More articles by this author Janmejay Hingu More articles by this author Collette O'Connor More articles by this author Rachel Ruble More articles by this author Yueqiang Song More articles by this author Ayse Vuruskan More articles by this author Anuradha Devineni More articles by this author Cihan Halicigil More articles by this author Stuart Howards More articles by this author Tamer Yalcinkaya More articles by this author Hooman Sadri-Ardekani More articles by this author Expand All Advertisement PDF downloadLoading ...

MP40-11 CONTRIBUTION OF GLEASON PATTERN 4 PROSTATE CANCER TISSUE TO PRE-OPERATIVE PSA VALUES IN INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM 4 860 RP SPECIMENS

You have accessJournal of UrologyCME1 Apr 2023MP40-11 CONTRIBUTION OF GLEASON PATTERN 4 PROSTATE CANCER TISSUE TO PRE-OPERATIVE PSA VALUES IN INTERMEDIATE RISK PROSTATE CANCER: RESULTS FROM 4 860 RP SPECIMENS Fabian Falkenbach, Lukas Hohenhorst, Zhe Tian, Mykyta Kachanov, Tobias Maurer, Sophie Knipper, Markus Graefen, and Lars Budäus Fabian FalkenbachFabian Falkenbach More articles by this author , Lukas HohenhorstLukas Hohenhorst More articles by this author , Zhe TianZhe Tian More articles by this author , Mykyta KachanovMykyta Kachanov More articles by this author , Tobias MaurerTobias Maurer More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Lars BudäusLars Budäus More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003278.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite advances in imaging and genetic testing, blood PSA remains the cornerstone of prostate cancer (PCa) diagnosis and risk stratification. Especially in the management of intermediate-risk PCa, the PSA value has strong implications for clinical decision-making. It is known, that within this group Gleason pattern (GP) 4 drives biological aggressiveness. Aim of our study was to assess the relationship between pre-operative blood PSA values and volume of GP 4 compared to GP 3 and benign tissue in Radical Prostatectomy (RP) specimens. METHODS: Overall, 4860 patients with localized pT2pN0cM0, intermediate risk PCa without tertiary GP were assessed. Individual GPs were quantified at the whole-mount section analysis of RP specimen. For analysis, patients with biochemical recurrence after RP and a pre-operative PSA >50 ng/ml were further excluded for avoiding contamination of the cohort by occult metastasis. Moreover, patients with prior / neoadjuvant treatment, a gland size <10 cc after TUR-P or gland size >150 cc (associated risk of chronic inflammation) were excluded. Multivariable linear regression analysis addressed the relationship between volume of tissue types and PSA values. RESULTS: Of 4860 patients, in 4390 (90%) a Gleason Score of 3+4 and in 470 (10%) a Gleason Score of 4+3 was present. Median age at RP was 63 years (IQR: 58-68 years), median PSA was 6.4ng/ml (IQR: 4.8-8.7ng/ml) and median prostate volume was 30cc (IQR: 23-40cc). PSA as well as PSA-Density were associated with the quantitative GP 4 fraction above 50% (p-value: <0.001). GP 4 tissue contributed to the pre-operative PSA by 0.37 ng/ml per cc, GP 3 and benign prostate tissue combined contributed by 0.062 ng/ml per cc (p-value: <0.001). There was no significant difference in PSA contribution between GP 3 and benign tissue. CONCLUSIONS: The highest contribution to PSA prior RP originates from GP 4 PCa tumor foci. PSA expression of GP 3 and benign tissue were not significantly different. This confirms the discussed potential indolent nature of GP 3 PCa. Within intermediate risk PCa, PSA is a strong surrogate parameter for the amount of GP 4 PCa tissue. Further confirmatory studies including e.g. imaging data are needed for excluding potential selection bias. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e549 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabian Falkenbach More articles by this author Lukas Hohenhorst More articles by this author Zhe Tian More articles by this author Mykyta Kachanov More articles by this author Tobias Maurer More articles by this author Sophie Knipper More articles by this author Markus Graefen More articles by this author Lars Budäus More articles by this author Expand All Advertisement PDF downloadLoading ...

MP65-02 UROSTOMAL HERNIAS: REPAIR TECHNIQUES AND RECURRENCE RATES AMONG PATIENTS WITH URINARY DIVERSION

You have accessJournal of UrologyCME1 Apr 2023MP65-02 UROSTOMAL HERNIAS: REPAIR TECHNIQUES AND RECURRENCE RATES AMONG PATIENTS WITH URINARY DIVERSION Anna Faris, Zachary Eisner, Krishnan Raghavendran, and John Stoffel Anna FarisAnna Faris More articles by this author , Zachary EisnerZachary Eisner More articles by this author , Krishnan RaghavendranKrishnan Raghavendran More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Following urinary diversion, a challenging complication is parastomal hernia formation, termed here as urostomal hernia. We examine patients who underwent urostomal hernia repair and describe their outcomes. METHODS: For individuals who underwent urostomal hernia repair, we collected retrospective demographic data, perioperative variables, surgical technique, and tracked hernia recurrence events. Kaplan Meier methods were used to estimate time from hernia repair to hernia recurrence. Cox proportional hazards modeling assessed risk factors for hernia recurrence. RESULTS: Thirty patients had a urostomal hernia repair between 2009 and 2022. Urinary diversion was initially performed for benign (37%) or malignant (63%) pathologies. Median age was 68.5 [IQR: 57.5,73.8], 57% male, and a median Charleston comorbidity index of 8 [IQR: 6,10]. Primary indications for urostomal hernia repair were bowel obstruction or incarceration (n=10, 33%), obstructive uropathy (n=6, 20%), pain (n=5, 16%), pouching difficulty (n=5, 16%), and recurrent urinary tract infections (n=4, 13%). Follow up period was a median of 2.5 [IQR: 1,5] years. Repair techniques included primary repair (n=15, 50%), stomal relocation without mesh (n=5, 17%), mesh placement without stomal relocation (n=7, 23%), and mesh with stomal relocation (n=3, 10%). Nearly a third (30%) had a concurrent procedure at the time of hernia repair (eg, nephrectomy, ureteral reimplant, ventral hernia, new ileal loop). Urostomal hernia recurrence rate was 67%, occurring at a median of 13 [IQR: 8,26] months from initial repair. Kaplan Meier analysis of time to urostomal hernia recurrence is depicted in Figure 1. Twelve (40%) individuals had a second urostomal hernia repair and three (10%) had a third repair. No associations found within the Cox proportional hazards model which was limited by sample size. At last follow up, the primary urostomal hernia complications that prompted hernia repair had resolved in 22 individuals (73%). CONCLUSIONS: Recurrence following urostomal hernia repair is common (67%) even in the hands of experienced urology and general surgery teams. For these complex patients, perhaps a more important metric of success is resolution of primary hernia complications following repair, which is 73% in this cohort. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e890 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Faris More articles by this author Zachary Eisner More articles by this author Krishnan Raghavendran More articles by this author John Stoffel More articles by this author Expand All Advertisement PDF downloadLoading ...

MP41-19 BILATERAL MULTIFOCAL RENAL ONCOCYTOMA: CLINICAL CHARACTERISTICS AND OUTCOMES OF MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP41-19 BILATERAL MULTIFOCAL RENAL ONCOCYTOMA: CLINICAL CHARACTERISTICS AND OUTCOMES OF MANAGEMENT Shiva Singh, Aditi Chaurasia, Nikhil Gopal, Noah Pinson, W. Marston Linehan, Ashkan Malayeri, and Mark Ball Shiva SinghShiva Singh More articles by this author , Aditi ChaurasiaAditi Chaurasia More articles by this author , Nikhil GopalNikhil Gopal More articles by this author , Noah PinsonNoah Pinson More articles by this author , W. Marston LinehanW. Marston Linehan More articles by this author , Ashkan MalayeriAshkan Malayeri More articles by this author , and Mark BallMark Ball More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003279.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal oncocytomas are benign neoplasms, accounting for 3-7% of renal tumors. A select number of patients can present with bilateral and/or multifocal oncocytomas and negative germline testing. There is limited data on the clinical course of this subset of patients and optimum treatment strategy remains unclear. This study seeks to evaluate the renal functional and oncological outcomes in patients with bilateral multifocal renal oncocytomas. METHODS: We retrospectively reviewed a cohort of 64 patients with histopathologically confirmed bilateral multifocal renal oncocytomas with negative genetic testing who underwent active surveillance, partial or radical nephrectomy at our institution. Demographics, oncologic outcomes, renal function change and tumor growth rate using 2-dimensional measurements on cross-sectional imaging were assessed. Renal function outcomes were assessed using serum creatinine levels within and between two groups (based on management strategy) with Wilcoxon signed ranked test and Mann-Whitney test respectively. RESULTS: A total of 64 patients (51 males, 13 females) with a median age of diagnosis of 64 years and mean follow-up of 5.7 years were studied. 19 patients underwent only active surveillance, and 45 patients underwent at least one surgical intervention during the study period. Median age of first procedure was 61.5 years. Interventions included 2 renal ablation, 52 partial, and 13 radical nephrectomies. The median growth rate was 0.21 cm/year (0.16-0.27 cm/year), with a new tumor diagnosed on imaging every five years. The median change in serum creatinine was 0.13 mg/dL on active surveillance and 0.12 mg/dL after surgery (p=0.6). No metastases were noted in this cohort throughout the study period. The median age of death was 82.4 years. CONCLUSIONS: Bilateral multifocal renal oncocytomas with negative genetic workup are benign tumors with an indolent course and are seen primarily in 6th decade of life. Considering a minimal difference in functional outcomes between active surveillance and surgical management, surgeons may consider the additional clinical characteristics of patients to design the individual management plan. Source of Funding: This research was supported, in part, by the Intramural Research Program of the National Institutes of Health Clinical Center. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e564 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shiva Singh More articles by this author Aditi Chaurasia More articles by this author Nikhil Gopal More articles by this author Noah Pinson More articles by this author W. Marston Linehan More articles by this author Ashkan Malayeri More articles by this author Mark Ball More articles by this author Expand All Advertisement PDF downloadLoading ...

MP37-06 VALIDATION OF THE LURN SI-10 QUESTIONNAIRE IN WOMEN UNDERGOING MIDURETHRAL SLING SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP37-06 VALIDATION OF THE LURN SI-10 QUESTIONNAIRE IN WOMEN UNDERGOING MIDURETHRAL SLING SURGERY Grace Lai, Joel Vetter, and H Henry Lai Grace LaiGrace Lai More articles by this author , Joel VetterJoel Vetter More articles by this author , and H Henry LaiH Henry Lai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The LURN SI-10 (10-item LURN Symptom Index) was developed by the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) to measure LUTS in men and women (Cella et al 2019). LURN SI-10 consists of ten items on LUTS, plus an additional question on global urinary bother. Two of the items focus on stress urinary incontinence with coughing/sneezing/laughing (SUI-1), and SUI with physical activities (SUI-2). Here we validate and evaluate the responsiveness of the LURN SI-10 questionnaire by comparing patients’ responses before and after midurethral sling surgery. METHODS: Adult women completed the LURN SI-10 and Urinary Distress Inventory (UDI-6) questionnaires before and after midurethral sling surgery (retropubic or trans-obturator TVT). Mean change in total LURN SI-10, SUI-1 and SUI-2 scores after surgery, paired t-tests, effect sizes (ES) of the change, and standardized response means (SRM) were tabulated. For ES and SRM, value of 0.5 to 0.7 is considered moderate responsiveness, 0.8 to 1.0 is considered good, and values >1.0 is considered excellent responsiveness to change. LURN SI-10 scores were compared to scores on the UDI-6. RESULTS: Total LURN SI-10, SUI-1 and SUI-2 scores on LURN SI-10 decreased by 59%, 85% and 90% respectively after midurethral sling surgeries (n=37, all p<0.001, paired t-tests, see Table 1). The effect sizes (ES) of the changes for SUI-1 and SUI-2 were 3.03 and 2.19 respectively, indicating excellent responsiveness to change to known effective treatments of SUI. The standardized response means (SRM) were 2.14 and 2.11 respectively, again indicating excellent responsiveness to change. The ES of SUI-1 was greater than the ES of UDI-6. The SRM of SUI-1 and SUI-2 were both greater than UDI-6. There were strong correlations between LURN SI-10 and UDI-6 before and after surgery (r=0.84 and 0.65 respectively, p both <0.01). CONCLUSIONS: The two stress urinary incontinence questions (SUI-1, SUI-2) on LURN SI-10 questionnaire were responsive to change to known effective treatments of SUI, and may be used to assess SUI symptom change or improvement after SUI treatments. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e515 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace Lai More articles by this author Joel Vetter More articles by this author H Henry Lai More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-15 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IS ASSOCIATED WITH COMPLICATIONS AND SEQUELAE EVEN IN THE HANDS OF AN EXPERIENCED SURGEON

You have accessJournal of UrologyCME1 Apr 2023MP13-15 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IS ASSOCIATED WITH COMPLICATIONS AND SEQUELAE EVEN IN THE HANDS OF AN EXPERIENCED SURGEON Francesco Montorsi, Paolo Capogrosso, Giuseppe Fallara, Eugenio Ventimiglia, Edoardo Pozzi, Federico Belladelli, Luigi Candela, Francesco Pellegrino, Federico Dehò, Andrea Salonia, and Alberto Briganti Francesco MontorsiFrancesco Montorsi More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Federico DehòFederico Dehò More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure. However, whether long surgical experience is able to improve peri- and post-operative outcomes is still unknown. We thus investigated results and complications after HoLEP performed by a highly experienced surgeon. METHODS: This is a single-institutional prospective study (NCT03583034) performed at a tertiary referral centre including 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single highly experienced surgeon (>1600 cases performed). Patients were assessed using validated questionnaires, PSA measurements and uroflowmetry at baseline and several follow-up dates. Intra- and postoperative complications were recorded and graded according to Clavien-Dindo (CD) classification. The Kaplan-Meier analysis estimated urinary continence (UC) (defined as no pad) and erectile function (EF) recovery rates. Logistic regression models assessed predictors of post-operative complications. RESULTS: Median (IQR) prostate volume (PV) was 87cc (60-115) with 146 (59.8%) patients having a PV>80 cc and 78 (32.1%) having an indwelling catheter at baseline. At 3-month follow-up, 219 (90.1%) patients had a peak flow rate >20 ml/s, and 182 (74.9%) had a null residual urine volume. Improvement in subjective symptoms as assessed with the IPSS was significant already at 1-month, and it was maintained until 12-month after surgery. UC recovery was slow with estimated rates of 68% (62-74%) at 1-month and 94% (91-97%) at 12-month post-HoLEP. Increased PV (HR 0.95; 95% CI: 0.91-0.99), incontinence at baseline (HR 0.45; 95% CI: 0.27-0.73) and a higher baseline IPSS (HR 0.97; 95% CI: 0.94-0.99) were predictors of worse UC recovery rates (all p<0.04). The EF recovery rates were 53% (46-61%) at 1-month and 85% (77-90%) at 12-month post-HoLEP. Post-operative complications were reported in 36 (14.8%) patients during hospital stay [CD-2: 14 (5.8%); CD-3: 1 (0.4%)], in 34 (14%) within one month post-discharge [CD-2: 17 (6.9%); CD-3: 1 (0.4%)] and in 10 (4.1%) at later follow-up [CD-2: 3 (1.2%); CD-3: 6 (2.4%)]. Severe complications (CD≥2) were more common in patients with indwelling catheter at baseline (OR: 5.05; p=0.006). CONCLUSIONS: A highly experienced surgeon is commonly referred complex cases of LUTS due to BPE. Although HoLEP remains an effective procedure, it is not devoid of complications and sequelae even in the hands of a surgeon with more than 1600 procedures completed. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e179 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Montorsi More articles by this author Paolo Capogrosso More articles by this author Giuseppe Fallara More articles by this author Eugenio Ventimiglia More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Luigi Candela More articles by this author Francesco Pellegrino More articles by this author Federico Dehò More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

MP44-20 MALE-CARRIERS OF GENE MUTATIONS ASSOCIATED WITH INCREASED RISK OF PROSTATE CANCER: RESULTS FROM A SINGLE INSTITUTION GENETIC COUNSELING CONSULTATION

You have accessJournal of UrologyCME1 Apr 2023MP44-20 MALE-CARRIERS OF GENE MUTATIONS ASSOCIATED WITH INCREASED RISK OF PROSTATE CANCER: RESULTS FROM A SINGLE INSTITUTION GENETIC COUNSELING CONSULTATION Estefania Linares-Espinós, Leticia Ruiz-Gimenez, Emilio Rios, Dario Sánchez-Cabrero, Elisa York Pineda, Asier Leibar, Jose María Alonso-Dorrego, and Luis Martínez-Piñeiro Estefania Linares-EspinósEstefania Linares-Espinós More articles by this author , Leticia Ruiz-GimenezLeticia Ruiz-Gimenez More articles by this author , Emilio RiosEmilio Rios More articles by this author , Dario Sánchez-CabreroDario Sánchez-Cabrero More articles by this author , Elisa York PinedaElisa York Pineda More articles by this author , Asier LeibarAsier Leibar More articles by this author , Jose María Alonso-DorregoJose María Alonso-Dorrego More articles by this author , and Luis Martínez-PiñeiroLuis Martínez-Piñeiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003290.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current international guidelines address genetic counseling for patients with Prostate Cancer (PCa) and family history and/or metastatic PCa (mPCa). We aimed to analyze results from males evaluated at our Family Cancer and Genetic Counseling Unit. METHODS: Between 07-2020 and 09-2022, 1472 patients were counseled for genetic testing, of whom 318 (21,6%) were men. Male patients referred by urologists had at least one criteria of: (a) mutation carrier family member, (b) mPCa, (c) PCa and family history of mPCa, (d) high risk PCa <60y and family history of PCa, and (e) PCa <60y and family history of breast or ovarian cancer at <50y.Identified mutations on tested males were recorded as pathogenic, variants of uncertain significance or negative. We analyzed patient and disease characteristics on pathogenic carriers. We reviewed management recommendations of male healthy carriers. RESULTS: Eighty-nine (28%) males had a pathogenic mutation on genetic testing. Fifthy-Five (17%) were related to PCa genetic counseling. We divided carriers into two groups: Group A (healthy carriers) and Group B (oncologic patients with identified pathogenic mutation). Group A (28/55; 51%) were tested due to known family mutation on close blood relatives. Family history was breast cancer in 24 (86%), PCa in 9 (32%), and HOBC in 6 (21%) HBOC. Median age was 41 (range 15-70), and pathogenic mutations were: 4 ATM, 7 BRCA1, 9 BRCA2, 1 MLH1, 2 MUTHY, 5 RAD51D and 1 TP53. Mean PSA was 1,02ng/dl (range 0,32-3,96). All group A patients had follow-up scheduled in Urology Genetic Counseling clinic and General Surgery Breast and Pancreas Cancer Unit. Healthy carriers had adapted PCa screening. Group B (27/55; 49%) patients had cancer: 16 (59%) had PCa, 7 (26%) Colorectal cancer and 4 (15%) other cancers. Median age was 52 (range 39-80). Family history of PCa was present in 13 (48%). Germline pathogenic mutations were found in 25 (93%): 4 ATM, 5 BRCA1, 4 BRCA2, 1 HOXB13, 2 MLH1, 1 MSH2, 1 MUTYH, 3 PALB2, 1 PMS2, 2 RAD51D and 2 TP53. Two patients (7%) had somatic pathogenic mutations. Out of the 16 patients with PCa, 37,5% had mPCa, 31,3% high risk PCa and 31,3% had intermediate risk PCa diagnosed at age <50y and >2 relatives with PCa. Somatic mutations were identified on mPCa. CONCLUSIONS: We found 28% of positive genetic testing in males.Patients with identified pathogenic variants should be recommended close follow-up as some are associated with aggressive PCa.The widespread use of genetic testing in other malignancies (i.e. Breast Cancer, HOBC), will increase healthy carriers. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e620 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Estefania Linares-Espinós More articles by this author Leticia Ruiz-Gimenez More articles by this author Emilio Rios More articles by this author Dario Sánchez-Cabrero More articles by this author Elisa York Pineda More articles by this author Asier Leibar More articles by this author Jose María Alonso-Dorrego More articles by this author Luis Martínez-Piñeiro More articles by this author Expand All Advertisement PDF downloadLoading ...

MP01-07 A NEXT-GENERATION SEQUENCING ANALYSIS OF THE SEMEN MICROBIOME IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA

You have accessJournal of UrologyCME1 Apr 2023MP01-07 A NEXT-GENERATION SEQUENCING ANALYSIS OF THE SEMEN MICROBIOME IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA Katherine Campbell, Farah Rahman, Camila Suarez, Aaron Miller, Emad Ibrahim, Scott D. Lundy, and Ranjith Ramasamy Katherine CampbellKatherine Campbell More articles by this author , Farah RahmanFarah Rahman More articles by this author , Camila SuarezCamila Suarez More articles by this author , Aaron MillerAaron Miller More articles by this author , Emad IbrahimEmad Ibrahim More articles by this author , Scott D. LundyScott D. Lundy More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003212.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Detection of a microbiome profile coupled with advanced genetic sequencing has opened a new research frontier. We hypothesized that the semen microbiome profile in men with non-obstructive azoospermia (NOA) would differ from that of fertile controls (FC). METHODS: NOA was diagnosed using semen analysis and clinical phenotype (small testis volume, FSH >10 IU/mL). FC were identified as men undergoing vasectomy after fathering at least one child. Semen samples were collected and underwent Next Generation Sequencing (NGS) including quantitative PCR and 16s rRNA V1/V2 region comprehensive sequencing using Illumina MiSeq technology. Data was processes and analyzed in dada2. Alpha diversity was analyzed via Margalef. Beta diversity was analyzed via Bray-Curtis difference. Differential abundance was evaluated with ANCOMBC procedure. RESULTS: After rarefaction analysis, 33 samples were included (18 NOA and 15 FC) determined samples had sufficient sequencing depth to capture microbiome diversity. Alpha diversity was lower in the NOA men but did not reach statistical significance. Beta diversity showed a difference between the NOA and fertile groups primarily driven by differences in ethnicity. At the phylum level, NOA patients demonstrated lower levels of Proteobacteria and Firmicutes and higher levels of Actinobacteriota compared to the FC group consistent with prior published work. At the genus level, the known uropathogens Ureaplasma (1.3% vs 0.16%) and Eschrichia/Shigella (2.26% vs 0.42%) were higher in the NOA group compared to fertile controls. Other notable differences were Raoultella (39-fold higher in Fertile – 2% vs 0.09%) and Sneathia (9.5-fold higher in Fertile – 1% vs. 0.1%). Differential abundance analysis largely confirmed these findings. CONCLUSIONS: Compared to fertile controls, men with NOA have a less diverse seminal microbiome enriched for known pathogens and several understudied organisms. This work supports the presence of a testicular microbiome, which may become dysbiotic with infertility and could be leveraged as a biomarker to guide treatment decision making in the future. Source of Funding: MicrogenDX © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e4 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Campbell More articles by this author Farah Rahman More articles by this author Camila Suarez More articles by this author Aaron Miller More articles by this author Emad Ibrahim More articles by this author Scott D. Lundy More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-20 PREDICTORS OF URINARY TRACT INFECTION POST-HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP51-20 PREDICTORS OF URINARY TRACT INFECTION POST-HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) Mohamed Elsaqa, Katherine Dowd, Amr Elmekresh, and Marawan M. El Tayeb Mohamed ElsaqaMohamed Elsaqa More articles by this author , Katherine DowdKatherine Dowd More articles by this author , Amr ElmekreshAmr Elmekresh 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.0000000000003299.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Irritative urinary symptoms and urinary tract infection (UTI) are among the most common complications following Holmium Laser Enucleation of Prostate (HoLEP). We aimed to study the incidence and risk factors for early irritative urinary symptoms and postoperative UTI post-HoLEP. METHODS: A maintained HoLEP database of over 5 years at our institution was reviewed. Patients' demographics, perioperative characteristics, post-operative irritative symptoms, and UTI rates (defined by irritative symptoms with positive urine culture) were analyzed. RESULTS: Total 473 patients with complete follow-up data were included. Tables 1 and 2 show the baseline and postoperative data of included patients respectively. Preoperative positive urine culture and urine retention were seen in 128 (27%) and 111 (23.4%) patients respectively. At 6-week follow-up, irritative urinary symptoms were reported by 153 (32.3%) patients, while urine culture was positive in only 64 (13.5%) patients. Multivariate analysis showed that high body mass index (BMI) (HR=2.02; CI=1.36-2.58, p=0.023), weak grip strength within preoperative frailty assessment (HR=1.36; CI=1.06-2.13, p=0.042), preoperative positive urine culture (HR=1.92; CI=1.3-3.38, p=0.025) and postoperative incontinence (HR=2.82; CI=1.8-5.67, p=0.002) were associated with statistically significant risk of positive urine within 1st 6 weeks post-HoLEP. CONCLUSIONS: Irritative urinary symptoms are common complaints post-HoLEP; however, it may be caused by inflammatory rather than infective process in significant percentage of patients. Irritative Symptoms can be associated with over-treatment with empirical antibiotics. Possible predictors of early UTI post-HoLEP are high BMI, preoperative positive urine culture, higher frailty scale, and postoperative urinary incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e701 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elsaqa More articles by this author Katherine Dowd More articles by this author Amr Elmekresh More articles by this author Marawan M. El Tayeb More articles by this author Expand All Advertisement PDF downloadLoading ...

Benign Prostatic Hyperplasia: Surgical Therapy &amp; New Technology IV (MP76)

You have accessJournal of UrologyCME1 Apr 2023Benign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (MP76) View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350AboutPDF 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 ...

PD46-04 A NOVEL URINE DNA PREDICTOR FOR NONINVASIVE EARLY DIAGNOSIS AND MONITORING MINIMAL RESIDUAL DISEASE OF UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023PD46-04 A NOVEL URINE DNA PREDICTOR FOR NONINVASIVE EARLY DIAGNOSIS AND MONITORING MINIMAL RESIDUAL DISEASE OF UPPER TRACT UROTHELIAL CARCINOMA Wei Zuo, Qi Tang, Wei Yu, Zhaoxia Guo, Huina Wang, Xuesong Li, Liqun Zhou, Zhisong He, and Beijing Wei ZuoWei Zuo More articles by this author , Qi TangQi Tang More articles by this author , Wei YuWei Yu More articles by this author , Zhaoxia GuoZhaoxia Guo More articles by this author , Huina WangHuina Wang More articles by this author , Xuesong LiXuesong Li More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , Zhisong HeZhisong He More articles by this author , and Beijing Beijing More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003359.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As for early detection and postoperative monitoring of upper tract urothelial carcinoma (UTUC), traditional detection methods were limited to invasiveness and insufficient sensitivity. It has been reported that urine tumor DNA was used to detect monitoring minimal residual disease (MRD) with better sensitivity.We tended to develop a novel noninvasive method to detect and monitor the disease. METHODS: To determine the performance of utLIFE-UC (a urine tumor DNA multidimensional bioinformatic predictor) which was established by low-coverage whole-genome sequencing and targeted deep sequencing in UTUC, an independent prospective validation cohort of 53 patients diagnosed with UTUC without metastasis were recruited. Morning urine samples were collected on the day of operation and 1 week after operation. A score of utLIFE-UC higher than 60 was defined as positive. RESULTS: utLIFE-UC of preoperative samples could discriminate UTUC with high sensitivity of 96.23% (51/53), both in different T stages (T1, 100.00% (27/27); ≥T2, 92.31% (24/26); p=0.236) and N stages (N0, 95.00% (38/40); ≥N1, 100.00% (13/13); p=1.000) (Figure 1). Moreover, the utLIFE-UC of preoperative samples also possessed greater sensitivity in the detection of UTUC than urine cytology (100.00%(13/13) vs 23.08%(3/13), p<0.0001), fluorescence in situ hybridization (FISH) (100.0%(16/16) vs 56.25%(9/16), p=0.007) and cystoscopy (100.0%(15/15) vs 60.00%(9/15), p=0.017). Notably, postoperative utLIFE-UC scores of minimal residual disease monitoring were significantly lower than those of preoperative samples (p<0.0001) (Figure 2). CONCLUSIONS: utLIFE-UC, a multidimensional bioinformatic predictor, tends to be a rapid and noninvasive approach with high sensitivity for early detection and perioperative MRD monitoring in UTUC. Source of Funding: This study was supported by no grants. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1171 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Zuo More articles by this author Qi Tang More articles by this author Wei Yu More articles by this author Zhaoxia Guo More articles by this author Huina Wang More articles by this author Xuesong Li More articles by this author Liqun Zhou More articles by this author Zhisong He More articles by this author Beijing More articles by this author Expand All Advertisement PDF downloadLoading ...

MP36-10 SAFETY AND FEASIBILITY OF PLATELET-RICH PLASMA INJECTIONS FOR PEYRONIE DISEASE: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CROSS-OVER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP36-10 SAFETY AND FEASIBILITY OF PLATELET-RICH PLASMA INJECTIONS FOR PEYRONIE DISEASE: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED CROSS-OVER STUDY Braian Ledesma, Manuel Molina, Kevin Chu, Thomas Masterson, Isaac Zucker, Emad Ibrahim, and Ranjith Ramasamy Braian LedesmaBraian Ledesma More articles by this author , Manuel MolinaManuel Molina More articles by this author , Kevin ChuKevin Chu More articles by this author , Thomas MastersonThomas Masterson More articles by this author , Isaac ZuckerIsaac Zucker More articles by this author , Emad IbrahimEmad Ibrahim More articles by this author , and Ranjith RamasamyRanjith Ramasamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003270.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The only FDA-approved medical therapy for Peyronie’s Disease involves use of intralesional collagenase injection. Platelet-derived therapies have acquired increased popularity in different areas in medicine due to their potential ability in tissue regeneration. In PD, autologous platelet rich plasma (PRP) may be an emerging viable treatment. Our hypothesis is that PRP can be safely used in PD, with minimal adverse events. Therefore, we are conducting a randomized, placebo controlled, cross over study to test it. METHODS: We analyzed data of a cohort of men from the ongoing trial treated with PRP vs placebo at our center from Apr-2021 to Oct-2022. Patients received two 0.5 ml injections of PRP obtained using an autologous platelet separator (Arthrex Angel, Arthrex Inc.) or placebo directly into the dominant plaque, separated by two weeks. Patients were examined immediately after the procedure and assessed with Visual Analogue Pain Scale, and at follow-up for complications. Patients are then followed three-months post-injections, at which point they cross over into the other treatment arm for two more injections. Patients undergo goniometer measurement, IIEF-15 and PDQ questionnaire assessment, prior to crossover. (NCT04512287) RESULTS: We report data from the 29 men who completed all injections. No minor or major adverse events such as penile bruising, swelling, edema, allergy, or penile fracture were reported. No patients experienced complications at follow-up. No worsening curvature was seen in men at later evaluations. CONCLUSIONS: From our data accumulated thus far in our ongoing randomized placebo-controlled trial with PRP for PD, PRP appears to be a safe and feasible treatment modality. Our study is the first one in the USA evaluating men with PRP for PD and we believe data from our study will be important for evaluating PRP as an additional medical treatment modality for PD. Source of Funding: This work was supported by NIH Grant R01 DK130991 and Clinician Scientist Development Grant from the ACS to RR, as well as SMSNA Research Grant to KC © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e483 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Braian Ledesma More articles by this author Manuel Molina More articles by this author Kevin Chu More articles by this author Thomas Masterson More articles by this author Isaac Zucker More articles by this author Emad Ibrahim More articles by this author Ranjith Ramasamy More articles by this author Expand All Advertisement PDF downloadLoading ...