Urological Outcomes Research Articles

Myelomeningocele repair in Latin America: a systematic review.

Myelomeningocele (MMC) carries high morbidity and mortality. The Management of Myelomeningocele Study (MOMS) showed improved outcomes after prenatal compared to postnatal repair. However, it is unclear how the MOMS trial affected practice and outcomes in the Latin American region. The objective of this study was to review the literature published by or including patients from the Latin American region and the reported management patterns of MMC. A systematic review of MMC repair was performed. Articles were included if the senior author or patient population was from a Latin American country or territory. Article characteristics such as senior author, title, year of publication, senior author department, and outcomes studied were extracted. Management of MMC repair was the primary outcome explored. A total of 71 studies satisfied all criteria for selection. Brazil (75%), Mexico (11%), Argentina (8%), Chile (7%), Costa Rica (1%), and Puerto Rico (1%) were represented countries or territories (some studies included patients from multiple countries). Neurosurgery (n = 23) was the most represented senior author department, followed by fetal medicine or fetal surgery (n = 15) and obstetrics (n = 14). Puerto Rico and Costa Rica described postnatal repair, while studies from Brazil, Chile, Argentina, and Mexico described prenatal repair. Brazil was the only country to prospectively study urological outcomes, reporting little to no improvement in urological outcomes with pre- versus postnatal repair. Prospective studies showed the safety and efficacy of endoscopic, microhysterotomy, and microneurosurgical approaches to in utero surgery. Six countries or territories in the Latin American region have published articles on MMC repair. All recent papers describe a prenatal approach. Prospective studies show a trend toward open fetal microhysterotomy and microneurosurgery in the region and a need for more research on long-term urological outcomes following in utero repair.

Urological outcomes in adult females born with anorectal malformation or Hirschsprung disease.

Women born with anorectal malformation (ARM) or Hirschsprung disease (HD) may have impaired urologic function resulting in sequelae in adulthood. This study assessed and compared self-reported urinary outcomes in adult females born with ARM or HD to a reference population. This was an IRB approved, cross-sectional study of female-born patients with ARM or HD, who completed surveys between November 2021 and August 2022. Female patients between the ages of 18 and 80years were included. Lower Urinary Tract Symptom Questionnaires were administered through REDCap and the responses were compared to a reference population using Chi-squared or Fisher's exact tests. Sixty-six born female patients answered the questionnaires, two of them identified as non-binary. The response rate was 76%. Median age was 31.6years. The majority were born with cloaca (56.3%), followed by other type of ARMs (28.1%), complex malformation (9.4%), and HD (6.3%). A history of bladder reconstruction was present for 26.6%. Catheterization through a channel or native urethra was present in 18.8%. Two had ureterostomies and were excluded from the analysis. Seven had chronic kidney disease or end-stage renal disease, three with a history of kidney transplantation. Patients with cloaca had significantly higher rates of urinary incontinence, urinary tract infection, and social problems due to impaired urological functioning, when compared to an age-matched reference population (Table3). This study emphasizes the need for a multi-disciplinary team that includes urology and nephrology following patients with ARM long term, especially within the subgroup of cloaca. III.

Uroflowmetry As a Long-Term Urological Outcome Assessment of Proximal Hypospadias Cases Repaired by Mansoura Modification of The Koyanagi Technique

Uroflowmetry As a Long-Term Urological Outcome Assessment of Proximal Hypospadias Cases Repaired by Mansoura Modification of The Koyanagi Technique

Associations Between Sodium-Glucose Co-transporter 2 Inhibitors and Urologic Diseases: Implications for Lower Urinary Tract Symptoms From a Multi-State Health System Analysis

To analyze the frequency of new urologic visits and urologic diagnoses in patients prescribed sodium-glucose co-transporter-2 inhibitors (SGLT-2is). Records from a multi-state health system between 2014 and 2022 were reviewed to identify patients referred for outpatient urology evaluation within 2 years of diabetes medication prescription. Patients were stratified by the prescription of SGLT-2is or another diabetes medication. Frequency of urology visits within 1-year, urologic diagnoses, and prescriptions to treat lower urinary tract symptoms (LUTS) were compared. Patients were stratified by whether they had achieved HbA1c goal (≥7% or <7%) following treatment as well as by sex. Multivariable logistic regression was performed to determine if SGLT-2 use independently predicted outcomes of interest. 163,827 patients met inclusion criteria. Use of SGLT-2is was associated with a higher frequency of early urologic referral, balanitis/balanoposthitis, overactive bladder, urinary frequency, urgency, and need for LUTS medications in males with HbA1c ≥7%. Females on SGLT-2is with HbA1c ≥7% also had higher rates of urinary incontinence. In those with HbA1c <7%, only balanitis/balanoposthitis and urinary incontinence were higher in the SGLT-2i cohorts for males and females, respectively. Multivariable analysis found SGLT-2i use as predictive of early urology referral, balanitis/balanoposthitis, urinary urgency, frequency, overactive bladder, and need for LUTS medications in males. Multivariable analysis of females demonstrated similar results. SGLT-2is may lead to worse urologic outcomes and increased utilization of urologic care relative to other diabetic medications. Future studies are necessary to identify which patients are at highest risk of adverse urologic outcomes.

Morphologic patterns observed in prostate biopsy cases with discrepant grade group and molecular risk classification.

Molecular-based risk classifier tests are increasingly being utilized by urologists and radiation oncologists to guide clinical decision making. The Decipher prostate biopsy test is a 22-gene RNA biomarker assay designed to predict likelihood of high-grade disease at radical prostatectomy and risk of metastasis and mortality. The test provides a risk category of low, intermediate, or high. We investigated histologic features of biopsies in which the Grade Group (GG) and Decipher risk category (molecular risk) were discrepant. Our institutional urologic outcomes database was searched for men who underwent prostate biopsies with subsequent Decipher testing from 2016 to 2020. We defined discrepant GG and molecular risk as either GG1-2 with high Decipher risk category or GG ≥ 3 with low Decipher risk category. The biopsy slide on which Decipher testing was performed was re-reviewed for GG and various histologic features, including % Gleason pattern 4, types of Gleason pattern 4 and 5, other "high risk" features (e.g., complex papillary, ductal carcinoma, intraductal carcinoma [IDC]), and other unusual and often "difficult to grade" patterns (e.g., atrophic carcinoma, mucin rupture, pseudohyperplastic carcinoma, collagenous fibroplasia, foamy gland carcinoma, carcinoma with basal cell marker expression, carcinoma with prominent vacuoles, and stromal reaction). Follow-up data was also obtained from the electronic medical record. Of 178 men who underwent prostate biopsies and had Decipher testing performed, 41 (23%) had discrepant GG and molecular risk. Slides were available for review for 33/41 (80%). Of these 33 patients, 23 (70%) had GG1-2 (GG1 n = 5, GG2 n = 18) with high Decipher risk, and 10 (30%) had GG ≥ 3 with low Decipher risk. Of the 5 GG1 cases, one case was considered GG2 on re-review; no other high risk features were identified but each case showed at least one of the following "difficult to grade" patterns: 3 atrophic carcinoma, 1 collagenous fibroplasia, 1 carcinoma with mucin rupture, and 1 carcinoma with basal cell marker expression. Of the 18 GG2 high Decipher risk cases, 2 showed GG3 on re-review, 5 showed large cribriform and/or other high risk features, and 10 showed a "difficult to grade" pattern. Of the 10 GG ≥ 3 low Decipher risk cases, 5 had known high risk features including 2 with large cribriform, 1 with IDC, and 1 with Gleason pattern 5. In GG1-2 high Decipher risk cases, difficult to grade patterns were frequently seen in the absence of other known high risk morphologic features; whether these constitute true high risk cases requires further study. In the GG ≥ 3 low Decipher risk cases, aggressive histologic patterns such as large cribriform and IDC were observed in half (50%) of cases; therefore, the molecular classifier may not capture all high risk histologic patterns.

32. Urologic Outcomes After Big Ben Method Phalloplasty

32. Urologic Outcomes After Big Ben Method Phalloplasty

Urological outcomes following pelvic exenteration for non-urological malignancies

BackgroundPelvic exenteration (PE) is a major surgical procedure used as a salvage therapy for patients with locally advanced or recurrent pelvic malignancies. Urinary reconstruction is a major part of PE and is often associated with high rates of post-operative complications. In the current study we evaluate the short and long-term urological outcomes following PE for Colo-Rectal (CR) and gyneco-oncological (GO) malignancies. MethodsStudy included 22 patients who underwent PE for recurrent or locally advanced CR and GO malignancies in our institution between the years 2010–2018. The endpoint was post-operative freedom from urological complications. ResultsOf 22 patients included, 13 (59 %) and 9 (41 %) underwent PE for CR and GO malignancies respectively. The mean age of the patients was 54 years. The median follow-up was 19 months. Seven (78 %) patients with GO malignancy and 11 (85 %) with CR malignancy underwent PE for local recurrence. Hydronephrosis prior to surgery existed in 8 (36.3 %) patients, of which, 5 patients required kidney drainage via nephrostomy tube. Two patients underwent posterior pelvic exenteration (PPE) with bladder preservation whereas the remaining 20 underwent cystectomy with urinary diversion by ileal conduit. Hydronephrosis post PE developed in 13 patients (59 %). eight (36 %) patients needed kidney drainage by nephrostomy tubes post PE, of these, 6 (75 %) had disease recurrence. The 2 years freedom from kidney drainage was 68 %, however the median time for kidney drainage was 0.5 months. The median overall survival was 12.5 months. ConclusionThe rate of urological complications following PE is relatively high and associated with disease recurrence.

Is Immobilization Technique Associated With Postoperative Pubic Rami Diastasis Following Bladder Exstrophy Closure?

Pelvic osteotomies relieve tension of the bladder and fascial closures during bladder exstrophy repair. Multiple techniques for postoperative immobilization of the pelvis and lower extremities have been described. The primary aim of this study was to assess differences in short and long-term changes in pubic rami diastasis when comparing Bryant traction to spica cast immobilization. Secondary aims included a comparison of length of stay, skin-related complications, and urologic outcomes. We performed a single-institutional retrospective review of bladder exstrophy patients younger than 18 months of age who underwent posterior pelvic osteotomy and bladder exstrophy closure from April 2005 to April 2020. Short-term and long-term pubic rami diastasis were defined as postoperative measurements ≤6 months and ≥12 months, respectively. Secondary outcomes included length of stay, pressure ulcer, skin rash/abrasion, urethrocutaneous fistula, and bladder or fascial dehiscence rates. Multivariable logistic regression assessed for an association between immobilization type and degree of diastasis while controlling for age at the time of diastasis measurement and sex. Fifteen patients underwent Bryant traction and 36 patients underwent spica cast immobilization. In both the short-term and long-term, there was a greater reduction in pubic diastasis in the spica cast group ( P = 0.002 and P = 0.05, respectively). After adjustments, there were higher odds of having a greater reduction in pubic rami diastasis in both the short-term (odds ratio: 2.71, 95% CI: 1.52-4.86, P = 0.001) and long-term (odds ratio: 2.41, 95% CI: 1.00-5.80, P = 0.05). Length of stay was significantly higher in Bryant's traction group (26 vs 19 d, P < 0.001). Rates of pressure ulcers were higher in the Bryant traction group (26.7% vs 0%, P = 0.005). Rates of skin rash/abrasions, urethrocutaneous fistula, and bladder/fascial dehiscence did not differ. Spica cast immobilization is a safe and effective immobilization method. Compared with Bryant traction, spica cast immobilization was associated with a greater reduction in postoperative pubic diastasis both short and long-term, along with a shorter length of hospitalization and reduced rate of pressure ulcers. Level III-therapeutic study.

Comparison of urological outcomes and quality of life after pelvic exenteration: partial vs radical cystectomy.

To compare perioperative morbidity, functional and quality-of-life (QoL) outcomes in patients with partial cystectomy vs radical cystectomy as part of pelvic exenteration. Retrospective analysis of a prospectively maintained database of pelvic exenteration patients (1998-2021) was conducted in a single centre. Study outcomes included postoperative complications, quality-of-life, functional and stoma-related outcomes. The 36-item Short-Form Health Survey Physical and Mental Health Components, Functional Assessment of Cancer Therapy-Colorectal questionnaires and Distress Thermometer were available pre- and postoperatively. QoL outcomes were compared at the various time points. Stoma embarrassment and care scores were compared between patients with a colostomy, urostomy, and both. Urological complications were similar between both groups, but patients with partial cystectomy experienced less wound-related complications. Overall, 34/81 (42%) partial cystectomy patients reported one or more long-term voiding complication (i.e., incontinence [17 patients], frequency [six], retention [three], high post-voiding residuals [10], permanent suprapubic catheter/indwelling catheter [14], recurrent urinary tract infection [nine], percutaneous nephrostomy [three], progression to urostomy [three]). The QoL improved following surgery in both the partial and radical cystectomy groups, differences between cohorts were not significant. Patients with two stomas reported higher embarrassment scores than patients with one stoma, although this did not result in more difficulties in stoma care. Partial cystectomy patients have fewer postoperative wound-related complications than radical cystectomy patients, but often experience long-term voiding issues. The QoL outcomes are similar for both cohorts, with significant improvement following surgery.

Urological Outcomes in Post-Pubertal Patients With Myelomeningocele: A Single-Center Retrospective Study

BackgroundRecent decades have seen changes in the urological treatment of myelomeningocele (MMC). We aimed to evaluate the urological outcomes in post-pubertal patients and to clarify associations with walking status, hydrocephalus, and sex. MethodsA retrospective study of 103 MMC patients at their final pediatric urological control. Urological procedures, the necessity for Clean Intermittent Catheterization (CIC) and anticholinergic medication, the state of continence, renal ultrasound findings, and serum creatinine values were assessed. ResultsThe median age of the patients was 18 years (IQR 16.7–19.6), with 51 (49.5%) being female. Renal function was preserved in all but of one, who presented with mild hydronephrosis. 38 patients walked without assistance, 46 used wheelchairs. Most patients (93%) utilized CIC, and 83% had interventions for overactive or poorly compliant bladder, including anticholinergic medication (47%), Botox treatments (35%), or bladder augmentation (36%). Nearly half (45%) had undergone bladder neck procedures. Continence status revealed 55% fully continent, 18% were rarely incontinent, and 26% were incontinent daily, with most episodes limited to droplet leakage. Incontinence was not associated with the ambulatory status, hydrocephalus, or sex (p = 0.08, >0.99, and 0.07 respectively). ConclusionsRenal function was effectively maintained with our treatment strategy; however, daily incontinence episodes occurred in one out of four patients, with an additional 18% experiencing occasional rare incontinence episodes. Incontinence, when present, was mostly mild. We found no association between patient characteristics, treatment approach, and continence. Emphasizing incontinence treatment becomes a mainstay in future studies. Level of EvidenceIV.

Disparities in indications and outcomes reporting for pediatric tethered cord surgery: The need for a standardized outcome assessment tool

PurposeTethered cord syndrome (TCS) is characterized by abnormal attachment of the spinal cord neural elements to surrounding tissues. The most common symptoms include pain, motor or sensory dysfunction, and urologic deficits. Although TCS is common in children, there is a significant heterogeneity in outcomes reporting. We systematically reviewed surgical indications and postoperative outcomes to assess the need for a grading/classification system.MethodsPubMed and EMBASE searches identified pediatric TCS literature published between 1950 and 2023. Studies reporting surgical interventions, ≥ 6-month follow-up, and ≥ 5 patients were included.ResultsFifty-five studies representing 3798 patients were included. The most commonly reported non-urologic symptoms were nonspecific lower-extremity motor disturbances (36.4% of studies), lower-extremity/back pain (32.7%), nonspecific lower-extremity sensory disturbances (29.1%), gait abnormalities (29.1%), and nonspecific bowel dysfunction/fecal incontinence (25.5%). Urologic symptoms were most commonly reported as nonspecific complaints (40.0%). After detethering surgery, retethering was the most widely reported non-urologic outcome (40.0%), followed by other nonspecific findings: motor deficits (32.7%), lower-extremity/back/perianal pain (18.2%), gait/ambulation function (18.2%), sensory deficits (12.7%), and bowel deficits/fecal incontinence (12.7%). Commonly reported urologic outcomes included nonspecific bladder/urinary deficits (27.3%), bladder capacity (20.0%), bladder compliance (18.2%), urinary incontinence/enuresis/neurogenic bladder (18.2%), and nonspecific urodynamics/urodynamics score change (16.4%).ConclusionTCS surgical literature is highly variable regarding surgical indications and reporting of postsurgical outcomes. The lack of common data elements and consistent quantitative measures inhibits higher-level analysis. The development and validation of a standardized outcomes measurement tool—ideally encompassing both patient-reported outcome and objective measures—would significantly benefit future TCS research and surgical management.

Prevalence of previously undiagnosed psychiatric symptom groupings in pediatric patients with bladder and bowel dysfunction

The incidence of concomitant psychiatric disorders in conjunction with bladder and bowel dysfunction (BBD) is thought to be higher than the general population. The identification of these disorders with validated tools followed by management may improve urological outcomes. The objective of this study was to determine the prevalence of undiagnosed psychiatric symptom groupings in children presenting with BBD. Consecutive patients 6-18yrs with a clinical diagnosis of BBD, a score ≥11 on the Vancouver Symptom Score (VSS) and no prior psychiatric diagnoses were recruited. Two validated questionnaires (Child Behavior Checklist for Ages 6-18 (CBCL) and Autism Spectrum Quotient 10 (AQ-10)) were used to screen for psychiatric comorbidities. Descriptive statistics for demographic variables were presented. Distribution of VSS for normal & abnormal categories (borderline/clinical) of CBCL scores were compared by Mann-Whitney U test. Spearman correlation coefficient was used to examine the relationship between VSS domain scores and CBCL. From Sept 2017-May 2022, 50 (17 male) of 110 eligible patients completed the study. Median VSS was 18 (11-33), indicating significant BBD. In 36 patients (72%), at least one of the CBCL subscales scored as borderline/clinical. Thirty-two patients (64%) scored in the abnormal range for Internalizing symptoms, 21 (42%) for Externalizing symptoms, and 31 (62%) for Total problem scores. Four patients of 48(8%) scored ≥6 on the AQ-10. The only significant correlation found between CBCL and VSS sub scores was with the Bowel Habit Domain of VSS and Internalizing CBCL T-scores (P=0.02). This study identified a high prevalence of previously undiagnosed psychiatric symptom groupings in patients presenting with BBD, with a higher prevalence of internalizing and externalizing symptoms and autism traits than reported in the general population. These findings should encourage urologists to use validated tools to screen for psychiatric comorbidities with referral for further assessment as appropriate. This may prevent unnecessary urological testing, save valuable health resources and potentially improve treatment outcomes of BBD in this population.

Effects of the beta-blocker carvedilol on arrhythmia and long-term clinical outcomes in benign prostate hypertrophy patients.

Benign prostatic hypertrophy (BPH) is associated with autonomic dysfunction and sympathetic nervous system mediated by the alpha receptor. However, limited data exist regarding the effects of the beta-blocker (BB) carvedilol on arrhythmia and urologic outcomes in BPH patients. Our database of patients diagnosed with BPH from 2015 to 2020 was used to obtain echocardiography and electrocardiogram data. Inclusion criteria were BPH patients taking BBs. International Prostate Symptom Score questionnaire were used to evaluate the urinary symptoms and quality of life. Among 448 patients with BPH (69.2 ± 10.9 years) taking BBs, 219 patients took carvedilol (48.9%) and 229 patients took a non-carvedilol BB (51.1%; bisoprolol, 184 patients, 80% or nebivolol, 45 patients, 20%). Difference in the baseline characteristics was not observed. During the median 36-month follow-up, a lower incidence of arrhythmic events (P = .029), total urologic events (P < .001), and less use of additive alpha-blocker was observed in the carvedilol group (P = .022). In multivariate analysis, less carvedilol use (P = .019), heart failure (P < .001), stroke (P < .001), and cardiomyopathy (P = .046) were independent risk factors for arrhythmic events. In addition, less carvedilol use (P = .009) and older age (P = .005) were independent risk factors for urologic events based on BB type at the median 36-month follow-up. The use of carvedilol was associated with less arrhythmic events in BPH patients with palpitation and decreased the incidence of urologic events in BPH compared with the use of non-carvedilol BBs in long-term follow-up.

Urological outcome with the use of salvage continent vesicostomy in pediatric reconstructive surgery. A single tertiary center experience

To report our experience and results in terms of complications, reoperation rate and urinary continence with the Salvage Continent Vesicostomy (SCV) technique in pediatric patients with history or need of enterocystoplasty and absent appendix. Retrospective review of all patients with a history of a continent catheterizable channel surgery performed in our institution between June 2016 and January 2022. Only patients with a SCV surgery with a minimum 6-month post operative follow up were included in this cohort and divided in group 1 (history of previous bladder augmentation) and group 2 (simultaneous bladder augmentation and SCV). Primary outcome of the study was to assess both continence and postoperative complication rates. Early complications were assessed using the Clavien-Dindo classification (I-V). Late complications were focused on the need of further subfascial revision. 84 patients with a history of a continent stoma creation surgery were identified. In 20 of them (12 males) a SCV was performed. The mean age at surgery was 10.38 (range 4.87-15.6) years and the median postoperative follow-up time was 32 (range 6-64) months. Eleven patients were included in Group 1, while 9 patients in Group 2. Early complications occurred in 4 patients (20%), two of them required a re-intervention (Clavien-Dindo IIIb). Stoma subfascial revision was further required in 2 patient (10%). Continence rate at last follow up was 95%. In our early experience, the salvage continent vesicostomy has proven to be a simple continent stoma technique with acceptable both continence and complication rates that can be used in selected patients with a history or need of bladder augmentation and absent appendix.

Long-term urological outcome of cloaca patients with multidisciplinary management.

Urological management of Cloacal Malformation (CM) focuses on preserving renal function and continence. Study aim was to analyze urinary and intestinal outcomes in CM patients, considering the length of common channel (CC) and presence of occult spinal dysraphism (OSD). Retrospective review of CM treated at our institution by a multidisciplinary team from 1999 to 2020. Patients with follow-up < 2.5years were excluded. Length of CC, renal function, urinary and bowel outcomes, presence of associated anomalies (especially OSD) were evaluated. Twenty patients were included, median age at follow-up: 8years (4-15). A long CC > 3cm was described in 11 (55%). Chronic kidney disease was found in 3 patients. Urinary continence was achieved in 8/20 patients, dryness (with intermittent catheterization) in 9/20. Fecal continence was obtained in 3/20, cleanliness in 14 (under bowel regimen). OSD was present in 10 patients (higher prevalence in long-CC, 73%). Among OSD, 1 patient reached fecal continence, 7 were clean; 2 achieved urinary continence, while 6 were dry. Length of CC and OSD may affect urinary and fecal continence. An early counseling can improve outcome at long-term follow-up. Multidisciplinary management with patient centralization in high grade institutions is recommended to achieve better results.

Comparison of Postoperative Outcomes of Trans-urethral Resection of the Prostate, Laser Vaporization, and Laser Enucleation: A Double Propensity Score Matched Analysis

To compare postoperative outcomes of three types of endourologic surgeries (TURP, laser vaporization (LVP) and laser enucleation (LEP)) for BPH treatment using the ACS-NSQIP database. The ACS-NSQIP database was queried for men who underwent TURP, PVP and LEP for treatment of BPH from 2011 till 2019. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed. Propensity score matching was then performed as a sensitivity analysis. 74,273 patients underwent endourologic surgeries for BPH, 65.4% had TURP, 28.6% PVP, and 5.9% LEP. Patients undergoing TURP were more likely to be older with higher ASA class, abnormal labs, and comorbidities (diabetic, congestive heart failure, and bleeding requiring transfusion) (p-value<0.001). After adjusting for covariates and propensity score matching, LVP demonstrated shorter hospital stays, shorter operative times, less reoperation rates, decreased DVT/PE risk, with however higher odds of urinary tract infection and sepsis as compared to TURP (p-value <0.028). Furthermore, LEP was found to have shorter hospital stays, longer operative times, and decreased odds of urinary tract infections and sepsis as compared to TURP (p-value <0.006). LVP and LEP showed better surgical outcomes and characteristics as compared to TURP. Further research is needed to account for longer duration of follow-up and patient-specific urologic outcomes, such as prostate size, urinary incontinence, erectile dysfunction, and retrograde ejaculation.

Real-World Evidence That a Novel Diagnostic Combining Molecular Testing With Pooled Antibiotic Susceptibility Testing is Associated With Reduced Infection Severity and Lower Cost Compared With Standard Urine Culture in Patients With Complicated or Persistently Recurrent Urinary Tract Infections

Purpose: Develop real-world evidence that rapid identification of uropathogens and susceptibilities improves urologic outcomes for patients with complicated or history of recurrent urinary tract infections (r/cUTIs). Standard urine culture (SUC) is slow, often missing polymicrobial infections and altered antibiotic resistance from their metabolic interactions. Materials and Methods: We compared 1-year UTI-related health care utilization and costs for UTIs diagnosed by outpatient multiplex polymerase chain reaction/pooled antibiotic susceptibility testing (mPCR/P-AST) vs SUC among Medicare beneficiaries with r/cUTIs, using claims from a deidentified random 5% sample of beneficiaries with an index UTI in 2018 followed by 12 months during which all outpatient UTI tests were either mPCR/P-AST or SUC. Outcomes were compared between 69 individuals diagnosed using mPCR/P-AST and 678 propensity-matched individuals using SUC. Regression models modeled cost differences with 95% confidence intervals (CIs). Results: Of 1,654,548 enrollees in 2018, 11.6%, 0.06%, and 9.6% had claims for UTI, mPCR/P-AST, and SUC, respectively. The matched mPCR/P-AST and SUC cohorts were statistically equivalent at baseline. The mPCR/P-AST cohort was nonsignificantly less likely than the SUC cohort to have a postindex UTI (65.2% vs 72.0%, P = .24). Cost per subsequent UTI was significantly lower for mPCR/P-AST ($767 vs $1,303, P = .0013). Average total 1-year UTI-related cost was $501.85 (95% CI: $79.87, $562.08 P = .004) lower per mPCR/P-AST member vs SUC ($629.55 vs $1131.39). Nonoutpatient treatment accounted for 22.5% of mPCR/P-AST vs 53.4% of SUC UTI-related costs. Conclusions: In patients with r/cUTI, rapid identification of pathogens and antibiotic susceptibilities using mPCR/P-AST is associated with lower UTI-related clinical care and utilization costs compared with SUC.

MP75-17 MATERNAL, NEONATAL AND PREGNANCY OUTCOMES IN UROLOGY: HOW DO WE MEASURE UP?

You have accessJournal of UrologyCME1 Apr 2023MP75-17 MATERNAL, NEONATAL AND PREGNANCY OUTCOMES IN UROLOGY: HOW DO WE MEASURE UP? Brittany Levy, Tess London-Bounds, Alexandra Kejner, Nikita Gupta, Adam Dugan, Will Cranford, and Amanda Saltzman Brittany LevyBrittany Levy More articles by this author , Tess London-BoundsTess London-Bounds More articles by this author , Alexandra KejnerAlexandra Kejner More articles by this author , Nikita GuptaNikita Gupta More articles by this author , Adam DuganAdam Dugan More articles by this author , Will CranfordWill Cranford More articles by this author , and Amanda SaltzmanAmanda Saltzman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003349.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Physicians and especially surgeons, are higher risk for pregnancy complications leading to poor pregnancy, neonatal and health outcomes. However, across surgical specialties, pregnancy and neonatal outcomes have not been delineated. The objective of this survey study was to evaluate maternal, neonatal and pregnancy outcomes compared to other surgical specialties. METHODS: A survey was distributed to practicing surgeons across specialties including general surgery, urology, otolaryngology, and associated subspecialties. Survey questions regarding demographics, career stage, pregnancy/delivery, neonatal complications, maternity leave, breast feeding goals, and barriers to meeting these goals were asked. Responses were analyzed comparing urology/urologic subspecialties to other surgical specialties. RESULTS: S:1162 births across surgical specialties were obtained, 159 of which were to urologic surgeons. Of these births, 454 were to trainees, while 694 children were birthed to attendings. Similarities across surgical subspecialties included gestational age at delivery (p=0.161). Those in urology/urology subspecialties were less likely to have pregnancy complications compared to other surgical specialties (31.4% vs 44.4%, p=0.003). Additionally, children born to urologists were more frequently healthy (87.8% vs 78.1%, p=0.031) without major or minor neonatal health issues (Figure 1). CONCLUSIONS: Overall, urologists have improved pregnancy and infant health outcomes compared to other surgical specialties. Further research is needed to identify specific etiologies to enable directed quality improvement measures for all child bearing surgeons. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1087 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittany Levy More articles by this author Tess London-Bounds More articles by this author Alexandra Kejner More articles by this author Nikita Gupta More articles by this author Adam Dugan More articles by this author Will Cranford More articles by this author Amanda Saltzman More articles by this author Expand All Advertisement PDF downloadLoading ...

PD34-09 THE ASSOCIATION BETWEEN ORGANOPHOSPHATE INSECTICIDES AND KIDNEY STONE FORMATION AMONG U.S. ADULTS

You have accessJournal of UrologyCME1 Apr 2023PD34-09 THE ASSOCIATION BETWEEN ORGANOPHOSPHATE INSECTICIDES AND KIDNEY STONE FORMATION AMONG U.S. ADULTS Frank Glover, Mohammad Hajiha, Michael Eisenberg, Federico Belladelli, Francesco Del Giudice, Nicolas Seranio, Wade Muncey, and Kenneth Ogan Frank GloverFrank Glover More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , Michael EisenbergMichael Eisenberg More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Nicolas SeranioNicolas Seranio More articles by this author , Wade MunceyWade Muncey More articles by this author , and Kenneth OganKenneth Ogan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney stones pose a significant disease burden within the U.S., where an estimated 10% of adults are affected. While several risk factors have been identified in the etiology of kidney stones (e.g., hydration status, diet, and genetic conditions) the pathogenesis remains to be fully elucidated. Recently, the contribution of environmental exposures in the pathogenesis of adverse urological outcomes has gained attention though data is limited. Organophosphate (OP) insecticides are widespread toxicants, and their use has been associated with endocrine disruption, metabolic dysregulation, and increased risk of chronic diseases. Currently, the association between kidney stone formation and OP exposure is unknown. The purpose of this study was to investigate the relationship between OP exposure and kidney stones. METHODS: Data for nationally representative U.S. cohort of 2373 individuals was leveraged from the National Health and Nutrition Examination (NHANES) Survey, annually conducted, population-based cross-sectional study. Trained individuals collected biological specimens via blood and urine draws, and sociodemographic data via in-person questionnaires. Urinary measurements of dialkyl phosphates (DAPs) were used as surrogates for OP exposure. Kidney stone history was evaluated based on questionnaire data, where individuals with kidney stones responded “yes” to either ever having kidney stones, or passed a kidney stone within the last year. Chi-square, ANOVA and multivariable, weighted logistic regression were used to analyze the relationship between DAP exposure, sociodemographic variables, and history of kidney stones. RESULTS: Stratification of total urinary DAPs by quartiles revealed a significant increased odds of kidneys stones in the fourth quartile compared to the first quartile (Q2 OR=1.65 95%CI [0.72,3.77], Q3 OR=2.72 95%CI [0.92,7.99], Q4 OR=3.08 95%CI [1.05,9.01]. CONCLUSIONS: Our study represents the first evaluation of OP exposure on risk of kidney stone formation, and these preliminary results suggest a potential role for OP exposure in the pathogenesis of kidney stone formation. Future studies are warranted to validate these findings, and to investigate potential mechanisms underlying these associations. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e923 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frank Glover More articles by this author Mohammad Hajiha More articles by this author Michael Eisenberg More articles by this author Federico Belladelli More articles by this author Francesco Del Giudice More articles by this author Nicolas Seranio More articles by this author Wade Muncey More articles by this author Kenneth Ogan More articles by this author Expand All Advertisement PDF downloadLoading ...

Fibrofatty filum terminale: long-term outcomes from a Singapore children's hospital.

The role of prophylactic detethering a fibrofatty filum terminale (FFT) remains equivocal. Furthermore, long-term studies focusing on urological outcomes are sparse. The aims of this study were to present an institutional experience on the perioperative and long-term outcomes of FFT surgery and to assess for factors that contribute to postoperative clean intermittent catheterization (CIC). This was a single-institution, retrospective study conducted over a 20-year period. Patients younger than 19 years of age who underwent surgery for FFT were included. Variables of interest included patient demographics, clinical presentation, radiological findings, postoperative complications, and long-term need for CIC. Outcomes were measured using the Necker functional score and modified Hoffer Functional Ambulation scale score at 3, 6, and 12 months postdischarge. A total of 164 surgeries were performed for FFT from 2000 to 2020. The median age at surgery was 1.1 years, and the mean follow-up duration was 8.3 years. There were 115 patients (70.1%) who underwent prophylactic-intent surgery and 49 patients (29.9%) who underwent therapeutic-intent surgery. The proportion of therapeutic-intent surgeries increased significantly with age percentiles (0-20th, 21.9%; 20th-40th, 9.1%; 40th-60th, 18.2%; 60th-80th, 36.4%; and 80th-100th, 63.6% [p < 0.001]). Thirty patients (18.3%) had an associated syndrome, the most common (n = 19, 11.6%) being VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities). Forty-eight patients (29.3%) had an associated malformation (anorectal anomaly = 37, urogenital anomaly = 16, and sacral anomaly = 3). Cutaneous manifestation was the most common presentation (n = 96, 58.5%), followed by lower-limb neurological deficits (n = 21, 12.8%). A low-lying conus was present in 36.0% of patients (n = 59), and 16.5% had an associated syrinx (n = 27). There were 26 patients (18.8%) with an abnormal preoperative urodynamic study. Three patients (1.8%) had postoperative complications that required repeat surgery. There were no cases of CSF leakage. One patient (0.6%) developed retethering requiring another surgery. Postoperative CIC was required in 11 patients (6.7%). Multivariable analyses showed that an abnormal preoperative urodynamic study (adjusted OR 5.5 [95% CI 1.27-23.9], p = 0.023) and having an intraspinal syrinx (adjusted OR 5.29 [95% CI 1.06-26.4], p = 0.042) were associated with the need for CIC. The authors' results demonstrate that detethering surgery for FFT is a relatively safe procedure and can be performed prophylactically. Nonetheless, the risks of postoperative CIC should be emphasized during the preoperative counseling process.