North Central Section of the AUA, Inc. 93RD ANNUAL MEETING SEPTEMBER 11 - 14, 2019 Swissôtel Chicago | Chicago, Illinois
PROGRAM BOOK WELCOME
The Officers and Board of Directors welcome you to Chicago for the 93rd Annual Meeting of the North Central Section of the AUA, Inc. September 11 - 14, 2019 Swissôtel Chicago
David F. Jarrard, MD 2018 - 2019 NCS President Table of Contents
Schedule at a Glance...... 4 Hotel Directory...... 8 Promotional Partners...... 9 Exhibitors...... 10 Industry Satellite Symposium Events...... 11 CME Information...... 13 2018 - 2019 Board of Directors...... 16 2018 - 2019 Committee Listing...... 17 NCS Representatives to AUA Committees...... 20 Past Presidents and Annual Meeting Sites...... 21 Board of Directors and Committee Meetings...... 24 General Meeting Information...... 25 Evening Functions...... 26 Speaker Information...... 27 Scientific Program...... 28 Wednesday, September 11...... 28 Thursday, September 12...... 31 Friday, September 13...... 52 Saturday, September 14...... 75 Participant Index...... 88 Podiums...... 98 Posters...... 224 Annual Business Meeting Agenda...... 272 Membership Candidates and Transfers...... 273 Membership Summary Report...... 274 In Memoriam...... 275 Proposed Bylaws Changes...... 276 Bylaws...... 277 Award Recipients...... 290 AUA Officers...... 297 AUA Foundation Research Scholars...... 297
POLICY: Filming, Photography, Audio Recording, and Cell Phones No attendee/visitor at the NCS 93rd Annual Meeting may record, film, tape, photograph, interview, or use any other such media during any presentation, display, or exhibit without the express, advance approval of the NCS Executive Director. The policy applies to all NCS members, nonmembers, guests, and exhibitors, as well as members of the print, online, or broadcast media.
Table of Contents 3 WEDNESDAY, SEPTEMBER 11, 2019
7:00 a.m. - 5:00 p.m. Registration/Information Desk Hours: Monte Rosa Registration Desk
7:00 a.m. - 5:00 p.m. Speaker Ready Room Hours: Monte Rosa
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours: Matterhorn
7:30 a.m. - 9:00 a.m. Breakfast: Vevey Foyer
5:00 p.m. - 7:00 p.m. Welcome Reception in Exhibit Hall: Zurich Ballrooms D-G
8:00 a.m. Operating Theatre: Techniques, Tips and Tricks: Vevey Ballroom
9:30 a.m. NCS Faculty Lecture: Urolithiasis 2019: What the Practicing Urologist Needs to Know: Vevey Ballroom
10:00 a.m. State-of-the-Art Lecture: Late Effects Following Pediatric Bladder Operations for Congenital Conditions: Vevey Ballroom
10:30 a.m. ABU Update: Vevey Ballroom
10:40 a.m. Break: Vevey Foyer
11:00 a.m. Panel Discussion: Decision Making and Surgical Approach to Complex Renal Masses: Vevey Ballroom
12:00 p.m. Industry Sponsored Lunch Symposium: Zurich A
1:15 p.m. Health Policy and Practice Management: Vevey Ballroom
Table of Contents 4 THURSDAY, SEPTEMBER 12, 2019
6:00 a.m. - 5:30 p.m. Registration/Information Desk Hours: Monte Rosa Registration Desk
6:00 a.m. - 5:30 p.m. Speaker Ready Room Hours: Monte Rosa
6:00 a.m. - 7:30 a.m. Breakfast: Vevey Foyer
10:00 a.m. - 6:30 p.m. Exhibit Hall Hours: Zurich Ballrooms D-G
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours: Matterhorn
5:30 p.m. - 6:30 p.m. NCS Happy Hour: Zurich Ballrooms D-G
6:30 p.m. - 7:30 p.m. Young Urologists Mixer: Élevé Lakeview (42nd Floor)
6:30 a.m. Video Session I: Male and Couple 6:45 a.m. Montreux Infertility Podium Session: Adrenal/ Kidney/ Vevey Ballroom Ureter - Malignant/ Benign Poster Session: St. Gallen 3
7:30 a.m. Break: Vevey Foyer
8:00 a.m. President's Welcome: Vevey Ballroom
8:05 a.m. Pediatric Panel Discussion: Vevey Ballroom
8:50 a.m. State-of-the-Art Lecture: Volunteering in Urology: Vevey Ballroom
9:20 a.m. Prostate Cancer Panel Discussion: Vevey Ballroom
10:00 a.m. Endourology and Stone Disease Panel Discussion: Vevey Ballroom
10:40 a.m. Break - Visit Exhibits: Zurich Ballrooms D-G
11:10 a.m. State-of-the-Art Lecture: Difficult Issues in NMIBC: Guidelines and Beyond: Vevey Ballroom
12:00 p.m. Industry Sponsored Industry Sponsored Lunch Symposium: Zurich A Lunch Symposium: Zurich B
1:15 p.m. State-of-the-Art Lecture: How to Succeed in Medicine and Life: Vevey Ballroom
2:00 p.m. Endourology/ NCS Young Patient Safety Stone Disease Urologists Speed and Quality Podium Session: Mentoring Program: Improvements Vevey Ballroom St. Gallen 1-2 Podium Session: Montreux
3:00 p.m. State-of-the-Art Lecture: Prostate Cancer Active Surveillance: Establishing Boundaries, Defining Thresholds, and Future Directions: Vevey Ballroom
4:00 p.m. Break - Visit Exhibits: Zurich Ballrooms D-G
4:30 p.m. Penis/ Urethra/ Prostate Patient Safety Prostate Testis/ Scrotum - Malignant I and Quality Benign Poster Malignant/ Podium Improvements/ Session: Benign Podium Socioeconomics Session: Session: and Health Policy St. Gallen 3 Montreux Vevey Ballroom Poster Session: Zurich C
Table of Contents 5 FRIDAY, SEPTEMBER 13, 2019
6:00 a.m. - 5:30 p.m. Registration/Information Desk Hours: Monte Rosa Registration Desk
6:00 a.m. - 5:30 p.m. Speaker Ready Room Hours: Monte Rosa
6:00 a.m. - 8:30 a.m. Breakfast: Vevey Foyer / Zurich Ballrooms D-G
7:00 a.m. - 11:00 a.m. Exhibit Hall Hours: Zurich Ballrooms D-G
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours: Matterhorn
6:00 p.m. - 7:30 p.m. Closing Reception: Montreux/St. Gallen Foyer
6:30 a.m. Video Session II: Outcomes Research and Montreux Education Podium Session: Vevey Ballroom
7:30 a.m. Break - Visit Exhibits: Zurich Ballrooms D-G
8:00 a.m. NCS Faculty Lecture: The Evolving Role of Oncofertility: Vevey Ballroom
8:45 a.m. Infertility/ Sexual Dysfunction Panel Discussion: Vevey Ballroom
9:30 a.m. Break - Visit Exhibits: Zurich Ballrooms D-G
10:00 a.m. NCS Resident Bowl: Round 1: Vevey Ballroom
10:45 a.m. Women in Prostate 11:00 a.m. 11:00 a.m. Urology Malignant Session: Poster Pediatrics Laparoscopy/ St. Gallen 1-2 Session: Podium Robotics - St. Gallen 3 Session: Kidney/ Montreux Prostate/ Other Podium Session: Vevey Ballroom
12:00 p.m. Industry Sponsored Lunch Industry Sponsored Lunch Symposium: Zurich A Symposium: Zurich B
1:15 p.m. AUA Course of Choice Lecture: Winning the Battle Against Burnout: The Secrets to Resilience & the Work-Life Balance: Vevey Ballroom
2:00 p.m. AUA Update: Vevey Ballroom
2:10 p.m. Report from the NCS AUA Foundation Scholar: Vevey Ballroom
2:20 p.m. Award Presentation: John D. Silbar, Thirlby and Traveling Fellowship: Vevey Ballroom
2:25 p.m. Presidential Address: Why Have We Not Yet Cured Urologic Cancer?: Vevey Ballroom
3:00 p.m. Annual Business Meeting: Vevey Ballroom
3:45 p.m. Reconstruction Urology Panel Discussion: Vevey Ballroom
4:30 p.m. Urinary Prostate Endourology/ Male and Incontinence/ Malignant II Stone Disease Couple Neurourology Podium Poster Infertility Podium Session: Session: Poster Session: Vevey Ballroom St. Gallen 3 Session: Montreux Zurich C
Table of Contents 6 SATURDAY, SEPTEMBER 14, 2019
6:30 a.m. - 12:15 p.m. Registration/Information Desk Hours: Monte Rosa Registration Desk
6:30 a.m. - 12:15 p.m. Speaker Ready Room Hours: Monte Rosa
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours: Matterhorn
6:00 a.m. Industry Sponsored Breakfast Symposium: Zurich A
7:00 a.m. Adrenal/ Kidney/ Prostate Benign 7:30 a.m. Ureter - Malignant/ Podium Session: Benign Podium Montreux Trauma/ Transplant Session: Podium Session: Vevey Ballroom St. Gallen 1-2
8:00 a.m. Roundtable Discussion: Future of Urology: Vevey Ballroom
9:00 a.m. Bizarre and Interesting Cases Podium Session: Vevey Ballroom
9:45 a.m. Break: Vevey Foyer
10:00 a.m. Bladder Malignant Socioeconomics/ Health Policy Podium Session: Podium Session: St. Gallen 1-2 Vevey Ballroom
11:00 a.m. NCS Resident Bowl Finals: Vevey Ballroom
12:00 p.m. Best Poster, Best Video, and Bizarre & Interesting Case Award Presentations: Vevey Ballroom
12:05 p.m. Incoming NCS President Remarks: Vevey Ballroom
Table of Contents 7 Hotel Directory
General Session: Vevey Ballroom
Breakout Rooms: Montreux St. Gallen 1-2
Exhibit Hall: Zurich D-G
Industry Sponsored Symposium Events: Zurich A Zurich B
Poster Sessions: St. Gallen 3 Zurich C
Speaker Ready Room: Monte Rosa
Spouse/Guest Hospitality Suite: Matterhorn
Committee Meetings: Élevé Lakeview (42nd Floor) Lugano Room Arosa Room
Table of Contents 8 Promotional Partners
NCS recognizes and welcomes our 2019 Promotional Partners (as of 8/26/2019)
Platinum Partners Astellas Pharma and Pfizer Oncology AstraZeneca Genomic Health Janssen Biotech, Inc. Merck & Co., Inc. TOLMAR Pharmaceuticals
Silver Partners Astellas Pharma US, Inc. Lumenis, Inc. Myriad Genetics, Inc. University Compounding Pharmacy of Michigan
Thank You to Our 2019 Contributor Lumenis, Inc.
Table of Contents 9 Exhibitors
Thank You to Our 2019 Exhibitors (as of 8/26/2019)
AbbVie Lumenis, Inc. Allergan, Inc. MD Labs Alnylam Pharmaceuticals MDxHealth American Urological Association, Inc. Medispec, Ltd. Astellas Pharma and Pfizer Oncology Medtronic Astellas Pharma US, Inc. Merck & Co., Inc. AstraZeneca Myriad Genetics, Inc. Bayer HealthCare NeoTract Teleflex BK Medical NextMed, LLC Blue Earth Diagnostics, Inc OPKO Health, Inc Boston Scientific Corporation Pacific Edge Diagnostics USA Ltd. Coloplast Pathnostics Cook Medical Photocure Decipher Biosciences, Inc. PROCEPT BioRobotics Dendreon Pharmaceuticals LLC Prologics Healthcare, LLC EDAP TMS Pusen Medical Technology Co., LTD Endo Pharmaceuticals Retrophin Exosome Diagnostics, Inc. Richard Wolf Medical Instruments, Corp. ForTec Medical TOLMAR Pharmaceuticals Genomic Health United Medical Systems Guerbet, LLC University Compounding Pharmacy HealthTronics, Inc. University Compounding Pharmacy of Hitachi Healthcare Michigan Hybrid Medical UroGen Pharma Indiana University Health US Doctors Janssen Biotech, Inc. ZERO-The End of Prostate Cancer KARL STORZ
Table of Contents 10 Industry Satellite Symposium Events
WEDNESDAY, SEPTEMBER 11, 2019
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Sponsored by: Merck & Co., Inc. Location: Zurich A
“Treatment Approach for Certain Patients with Locally Advanced or Metastatic Urothelial Carcinoma” Nicklas R. Pfanzelter, MD NorthShore Medical Group
THURSDAY, SEPTEMBER 12, 2019
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Sponsored by Astellas Pharma and Pfizer Oncology Location: Zurich A
“Examining a Therapeutic Option for Castration-Resistant Prostate Cancer (CPRC)”
Richard Harris, MD President and CEO UroPartners, LLC
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Sponsored by: Genomic Health Location: Zurich B
“Biomarkers for Early- and Advanced-Stage Prostate Cancer” Andrew Stephenson, MD Rush University Medical Center
Table of Contents 11 FRIDAY, SEPTEMBER 13, 2019
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Sponsored by: Janssen Biotech, Inc. Location: Zurich A
“Treating Patients with Advanced Prostate Cancer: Metastatic and Non-Metastatic PC”
Jason Hafron, MD Michigan Institute of Urology, PC
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Sponsored by: TOLMAR Pharmaceuticals Location: Zurich B
“Androgen Targeted Therapy Across the Continuum of Prostate Cancer - A Review of Evolving Best Practices”
Jeffrey M. Frankel, MD Seattle Urology Research Center
SATURDAY, SEPTEMBER 14, 2019
6:00 a.m. - 7:00 a.m. Industry Sponsored Breakfast Symposium Sponsored by: AstraZeneca Location: Zurich A
“Multidisciplinary Team Workshop: A Case-Based Program on the Management of Urothelial Carcinoma” Randy Sweis, MD University of Chicago
Shaheen Alanee, MD, MPH, MBA, FACS Henry Ford Health System
Table of Contents 12 CME Information
Educational Needs
The Secretary of the North Central Section (Dr. Jeffrey Triest), consulted with other members of the Program Committee and the Executive Committee members, including the current NCS President Dr. David Jarrard, recent Past-President Dr. Gary Faerber, Chair of the NCS Education Committee, Dr. Bradley Schwartz, and AUA Secretary, Dr. John D. Denstedt regarding the needs we are attempting to fulfill through our annual scientific program. It was agreed by the above committee members, Section Officers and Director of the Office of Education of the AUA that there continues to be significant educational needs for our annual meeting and scientific program.
Urologic abnormalities can present with a myriad of clinical symptoms and signs. Accurate differential diagnosis and disease management, which meets current standards of care, requires ongoing review of the presentations of various urologic abnormalities as well as the appropriate use of safe and cost-effective imaging modalities and various pharmacologic, minimally invasive, and operative management options. In addition, advancements in medical science and progress in management of various urologic diseases require basic and clinical research. Presentation and discussion of such peer- reviewed and Abstract Reviewer-selected summaries and results of investigations provide “cutting edge” updates for practicing clinicians and essential feedback to researchers on the practical applications and translation of their investigations to clinical practice.
The American Urological Association provided many services and Health Policy support to practicing Urologists in the NCS region and the Past President, AUA Secretary, AUA Chairman of Education, NCS Board Representative, will provide an update on the activities of the AUA.
Educational Objectives
At the conclusion of the NCS 93rd Annual Meeting, attendees will be able to:
1. Apply Evidence Based Medicine (EBM) in urologic practice specifically incorporating AUA Guidelines into daily practice. 2. Explain the role of surgical management of renal/ureteral stone disease. 3. Explain the evolving role of active surveillance as a treatment strategy for patients with low risk Prostate cancer (LRPC) and the use of tools such as multiparametric MRI and genomic testing for prostate cancer risk stratification. 4. Explain the surgical and non-surgical management of small and complex renal masses. 5. Explain the evolving role of international volunteerism in urology and its impact on under-served low income international communities 6. Explain the factors associated with urologist burnout syndrome and strategies to prevent it. 7. Describe the role of urologists in the management of castrate resistant prostate cancer. 8. Analyze data pertaining to various pharmacologic and surgical treatments for voiding dysfunction and urinary incontinence. 9. Utilize evidence-based treatment algorithms to manage patients with challenging urolithiasis. 10. Integrate new and modified treatments for urinary bladder cancer, prostate cancer, erectile dysfunction, Peyronie’s disease, infertility, and use of testosterone. 11. Explain the management of superficial and invasive bladder cancer and the associated morbidity and mortality of different methods of treatment.
Table of Contents 13 12. Explain coding, physician payment reforms, and collaboratives between payers and providers. 13. Discuss management strategies for pediatric ureteropelvic junction obstruction, vesico-ureteral reflux disease, congential anomalies of the urinary tract and pediatric voiding dysfunction. 14. Discuss strategies to improve transition of care of the pediatric urology patient into an adult urology practice. 15. Discuss management strategies for evaluation and care of the infertile male. 16. Integrate new and modified treatments for the care of Peyronies disease, erectile dysfunction, priapism, and hypogonadism. 17. Discuss management strategies for the treatment of urethral stricture disease, lower urinary tract trauma, upper urinary tract trauma and transgender surgery.
Accreditation Information
Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Urological Association (AUA) and the North Central Section of the AUA. The American Urological Association (AUA) is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation: The American Urological Association designates this live activity for a maximum of 27.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Others Learners: The AUA is not accredited to offer credit to participants who are not MDs or DOs. However, the AUA will issue documentation of participation that states that the activity was certified for AMA PRA Category 1 Credit™.
Evidence Based Content: It is the policy of the AUA to ensure that the content contained in this CME activity is valid, fair, balanced, scientifically rigorous, and free of commercial bias.
AUA Disclosure Policy: All persons in a position to control the content of an educational activity (i.e., activity planners, presenters, authors) are required to disclose to the provider any relevant financial relationships with any commercial interest. The AUA must determine if the individual’s relationships may influence the educational content and resolve any conflicts of interest prior to the commencement of the educational activity. The intent of this disclosure is not to prevent individuals with relevant financial relationships from participating, but rather to provide learners information with which they can make their own judgments.
The disclosure report for this meeting may be found online by visiting: https://ncsaua.org/disclosures
Resolution of Identified Conflict of Interest: All disclosures will be reviewed by the program/course directors or editors for identification of conflicts of interest. Peer reviewers, working with the program directors and/or editors, will document the mechanism(s) for management and resolution of the conflict of interest and final approval of the activity will be documented prior to implementation. Any of the mechanisms below can/will be used to resolve conflict of interest: • Peer review for valid, evidence-based content of all materials associated with an educational activity by the course/program director, editor, and/or Education Conflict of Interest Review Work Group or its subgroup. • Limit content to evidence with no recommendations
Table of Contents 14 • Introduction of a debate format with an unbiased moderator (point- counterpoint) • Inclusion of moderated panel discussion • Publication of a parallel or rebuttal article for an article that is felt to be biased • Limit equipment representatives to providing logistics and operation support only in procedural demonstrations • Divestiture of the relationship by faculty
Off-label or Unapproved Use of Drugs or Devices: The audience is advised that this continuing medical education activity may contain reference(s) to off-label or unapproved uses of drugs or devices. Please consult the prescribing information for full disclosure of approved uses.
AUA Participant Information & Policies
Disclaimer: The opinions and recommendations expressed by faculty, authors and other experts whose input is included in this program are their own and do not necessarily represent the viewpoint of the AUA.
Consent to Use of Photographic Images: Attendance at or participation in AUA meetings and other activities constitutes an agreement by the registrant to AUA’s use and distribution (both now and in the future) of the attendee’s image or voice in photographs and electronic reproductions of such meetings and activities.
Audio, Video and Photographic Equipment: The use of audio, video and other photographic recording equipment by attendees is prohibited inside AUA meeting rooms.
Reproduction Permission: Reproduction of written materials developed for this AUA course is prohibited without the written permission from individual authors and the American Urological Association.
Special Assistance/Dietary Needs: The AUA complies with the Americans with Disabilities Act §12112(a). If any participant is in need of special assistance or has any dietary restrictions, please see the registration desk.
Table of Contents 15 2018 - 2019 Board of Directors
OFFICERS STATE REPRESENTATIVES
President Illinois David F. Jarrard, MD Joshua J. Meeks, MD, PhD
President-Elect Indiana Mark D. Stovsky, MD, MBA, FACS Charles R. Powell II, MD
Secretary Iowa Jeffrey A. Triest, MD Douglas W. Storm, MD
Secretary-Elect Michigan Elizabeth B. Takacs, MD Jeffrey C. Yeamans, MD
Treasurer Minnesota, North Dakota, South Matthew T. Gettman, MD Dakota Badrinath R. Konety, MD, MBA Immediate Past President Gary J. Faerber, MD Ohio Bodo E. Knudsen, MD, FRCSC Historian Thomas A. Gardner, MD, MBA Wisconsin David R. Paolone, MD
REPRESENTATIVE TO AUA BOARD OF DIRECTORS Chandru P. Sundaram, MD, FACS
HEALTH POLICY COUNCIL CHAIR James M. Dupree IV, MD, MPH
YOUNG UROLOGIST COMMITTEE
Young Urologist Committee Chair Kyle A. Richards, MD, FACS
Young Urologist Committee Vice Chair Adam O. Kadlec, MD
WOMEN IN UROLOGY COMMITTEE CHAIR Elizabeth B. Takacs, MD
HEADQUARTER OFFICE
Executive Director Wendy J. Weiser
Associate Director Samantha N. Panicola
Table of Contents 16 2018 - 2019 Committee Listing
Audit Committee James C. Ulchaker, MD, FACS (Committee Chair) Mark D. Dabagia, MD, FACS (Committee Member) Stephanie J. Kielb, MD (Committee Member)
Bylaws Committee Aaron J. Milbank, MD (Committee Chair) Patrick H. McKenna, MD, FAAP, FACS (Committee Member) Elizabeth B. Takacs, MD (Committee Member) Jeffrey A. Triest, MD (Committee Member)
Editorial and Awards Committee Aaron J. Milbank, MD (Committee Chair) Michael R. Abern, MD (Committee Member) Anne P. Cameron, MD, FPMRS (Committee Member) Gary J. Faerber, MD (Committee Member) Khurshid Ghani, MD, MBChB, MS, FRCS (Committee Member)
Education Committee Bradley F. Schwartz, DO, FACS (Committee Chair) Geoffrey N. Box, MD (Committee Member) Jeffrey A. Triest, MD (Secretary) Elizabeth B. Takacs, MD (Secretary-Elect) Bodo E. Knudsen, MD, FRCSC (Board of Directors Representative) Kyle A. Richards, MD, FACS (Young Urologist Committee Chair)
Finance Committee Matthew T. Gettman, MD (Committee Chair) David F. Jarrard, MD (President) Mark D. Stovsky, MD, MBA, FACS (President-Elect) Gary J. Faerber, MD (Immediate Past President) Jeffrey A. Triest, MD (Secretary) Elizabeth B. Takacs, MD (Secretary-Elect)
Health Policy Council James M. Dupree IV, MD, MPH (Committee Chair) Candace F. Granberg, MD (Vice Chair) Norm D. Smith, MD (Illinois) Thomas H. Tarter, MD, PhD (Illinois) Teresa D. Beam, MD, FACS (Indiana) Bradley G. Orris, MD (Indiana) James A. Brown, MD (Iowa) Bradley A. Erickson, MD, MS, FACS (Iowa) Earl R. Koenig, MD (Michigan) Leonard J. Zuckerman, MD (Michigan) Robert W. Geist, MD (Minnesota, North Dakota, South Dakota) Candace F. Granberg, MD (Minnesota, North Dakota, South Dakota) To Be Determined (Ohio) To Be Determined (Ohio) Timothy J. Kennedy, MD (Wisconsin) Daniel H. Williams IV, MD (Wisconsin)
Local Arrangements Committee Bradley A. Erickson, MD, MS, FACS (Local Arrangements Chair)
Table of Contents 17 Long Range Planning Committee Jeffrey A. Triest, MD (Committee Chair) David F. Jarrard, MD (President) Mark D. Stovsky, MD, MBA, FACS (President-Elect) Gary J. Faerber, MD (Immediate Past President) Elizabeth B. Takacs, MD (Secretary-Elect) Matthew T. Gettman, MD (Treasurer) Chandru P. Sundaram, MD, FACS (NCS Representative to AUA Board of Directors) Kyle A. Richards, MD, FACS (Young Urologist Committee Chair)
Membership Committee Gary J. Faerber, MD (Committee Chair) David F. Jarrard, MD (President) Mark D. Stovsky, MD, MBA, FACS (President-Elect) Jeffrey A. Triest, MD (Secretary) Elizabeth B. Takacs, MD (Secretary-Elect) Matthew T. Gettman, MD (Treasurer) James M. Dupree IV, MD, MPH (Health Policy Chair) Thomas A. Gardner, MD, MBA (Historian) Joshua J. Meeks, MD, PhD (Illinois) Charles R. Powell II, MD (Indiana) Douglas W. Storm, MD (Iowa) Jeffrey C. Yeamans, MD (Michigan) Badrinath R. Konety, MD, MBA (Minnesota, North Dakota, South Dakota) Bodo E. Knudsen, MD, FRCSC (Ohio) David R. Paolone, MD (Wisconsin) Chandru P. Sundaram, MD, FACS (Representative to AUA Board of Directors) Kyle A. Richards, MD, FACS (Young Urologist Committee Chair) Adam O. Kadlec, MD (Young Urologist Committee Vice Chair) Elizabeth B. Takacs, MD (Women in Urology Committee Chair)
Nominating Committee Gary J. Faerber, MD (Chair) Patrick H. McKenna, MD, FAAP, FACS (Vice Chair) Ranjiv Mathews, MD (Board of Directors Representative) Ronald S. Suh, MD (Indiana) Elizabeth B. Takacs, MD (Iowa) Jane M. Lewis, MD (Minnesota, North Dakota, South Dakota) Bodo E. Knudsen, MD, FRCSC (Ohio) E. Jason Abel, MD, FACS (Wisconsin)
Program Committee Jeffrey A. Triest, MD (Committee Chair) David F. Jarrard, MD (President) Mark D. Stovsky, MD, MBA, FACS (President-Elect) Gary J. Faerber, MD (Immediate Past President) Elizabeth B. Takacs, MD (Secretary-Elect) Bradley A. Erickson, MD, MS, FACS (Local Arrangements Chair) Bradley F. Schwartz, DO, FACS (Education Committee Chair)
Table of Contents 18 Women in Urology Committee Elizabeth B. Takacs, MD (Committee Chair) Anne P. Cameron, MD, FPMRS (Vice Chair) Larissa Bresler, MD, DABMA (Illinois Representative) Tamra E. Lewis, MD, FACS (Illinois Alternate Representative) Rosalia Misseri, MD (Indiana Representative) Shirley A. Harding, DO (Michigan Alternate Representative) Kristina D. Suson, MD (Michigan Representative) Nissrine A. Nakib, MD (Minnesota Representative) Hadley M. Wood, MD (Ohio Representative) Cheryl T. Lee, MD (Ohio Alternate Representative) Sarah E. McAchran, MD, FACS (Wisconsin Alternate Representative) Carley M. Davis, MD (Wisconsin Representative)
Young Urologists Committee Kyle A. Richards, MD, FACS (Committee Chair) Adam O. Kadlec, MD (Vice Chair) Aaron Benson, MD (Illinois Representative) Larissa Bresler, MD, DABMA (Illinois Representative) Clint Cary, MD, MPH (Indiana Representative) Benjamin G. Martin, MD (Indiana Representative) Kenneth G. Nepple, MD (Iowa Representative) To Be Determined (Iowa Representative) Steven M. Lucas, MD (Michigan Representative) Amarnath Rambhatla, MD (Michigan Representative) Michael S. Borofsky, MD (Minnesota Representative) Candace F. Granberg, MD (Minnesota Representative) Sri Sivalingam, MD, FRCSC (Ohio Representative) To Be Determined (Ohio Representative) Sara L. Best, MD (Wisconsin Representative) Nathan D. Grunewald, MD (Wisconsin Representative)
Table of Contents 19 NCS Representatives to the AUA Committees
NOTE: The NCS members below list only those serving on AUA Committees selected by the NCS, and does not include NCS members serving on AUA Committees selected by the AUA.
AUA Immediate Past President Robert C. Flanigan, MD, FACS
AUA Board of Directors Chandru P. Sundaram, MD, FACS (Representative) James C. Ulchaker, MD, FACS (Alternate Representative)
AUA Bylaws Committee Aaron J. Milbank, MD (Representative) Elizabeth B. Takacs, MD (Representative)
AUA Editorial Board Committee David C. Miller, MD, MPH (Representative) Bradley F. Schwartz, DO, FACS (Representative)
AUA Health Policy Council James M. Dupree IV, MD, MPH (Representative) Peter M. Knapp Jr., MD, FACS (Representative)
AUA History Committee Thomas A. Gardner, MD, MBA (Representative)
AUA Judicial & Ethics Council Gary J. Faerber, MD (Representative) Matthew T. Gettman, MD (Representative)
AUA Leadership Program Humphrey O. Atiemo, MD (Representative) Larissa Bresler, MD, DABMA (Representative) Audrey C. Rhee, MD (Representative)
AUA Practice Management Committee Teresa D. Beam, MD, FACS (Representative)
AUA Public Policy Council James M. Dupree IV, MD, MPH (Representative) Peter M. Knapp Jr., MD, FACS (Representative)
AUA Research Committee Daniel A. Shoskes, MD (Representative) John T. Wei, MD, MS (Representative)
AUA Resident's Committee Margaret Knoedler, MD (Representative)
AUA Section Secretaries/Membership Council Jeffrey A. Triest, MD (Representative)
AUA Young Urologist Committee Adam O. Kadlec, MD (Representative)
Table of Contents 20 Past Presidents and Annual Meeting Sites
1924 * G.J. Thomas, MD Iowa City, IA 1925 * N.G. Alcock, MD Detroit, MI 1926 * H.L. Morris, MD Cincinnati, OH 1927 * E.O. Smith, MD Madison, WI 1928 * J.L. Crenshaw, MD Columbus, OH 1929 * Harry Culver, MD Rochester, MN 1930 * Ira R. Sisk, MD Indianapolis, IN 1931 * H.M. Stang, MD St. Paul, MN 1932 * William N. Taylor, MD Detroit, MI 1933 * Vincent J. O'Connor, MD Chicago, IL 1934 * Frederic E.B. Foley, MD Cleveland, OH 1935 * Robert E. Cumming, MD Rocheater, MN 1936 * Parke Smith, MD Cincinnati, OH 1937 * Charles M. McKenna, MD Madison, WI 1938 * W.G. Sexton, MD Peoria, IL 1939 * Charles C. Higgins, MD Indianapolis, IN 1940 * Ernest Rupel, MD Milwaukee, WI 1941 * G.J. Thompson, MD Detroit, MI 1944 * H.W. Plaggemeyer, MD Chicago, IL 1946 * Walter M Kearns, MD Rochester, MN 1947 * William J. Baker, MD Cleveland, OH 1948 * Robert S. Breakey, MD Des Moines, IA 1949 * James C. Sargent, MD Grand Rapids, MI 1950 * Russell D. Herrold, MD Milwaukee, WI 1951 * William N Wishard Jr., MD Toledo, OH 1952 * Reed M Nesbit, MD Minneapolis, MN 1953 * William J. Engel, MD Cincinnati, OH 1954 * Rubin H. Flocks, MD Detroit, MI 1955 * William Joseph Butler, MD Chicago, IL 1956 * C.D. Creevy, MD Cleveland, OH 1957 * John L. Emmett, MD Mackinac Island, MI 1958 * C. Grafton Weller, MD Milwaukee, WI 1959 * N. Warren Bourne, MD Chicago, IL
Table of Contents 21 1960 * T. Brent Wayman, MD French Lick, IN 1961 * Edwin C. Graf, MD Cincinnati, OH 1962 * Charles J. Cooney, MD Detroit, MI 1963 * F. Harold Entz, MD Chicago, IL 1964 * Donald J. Jaffar, MD Columbus, OH 1965 * Ormond Culp, MD Minneapolis, MN 1966 * Frank B. Bicknell, MD Chicago, IL 1967 * Paul J. Schildt, MD Cleveland, OH 1968 * Baxter Allen Smith Jr., MD Rochester, MN 1969 * James W. Sargent, MD Milwaukee, WI 1970 * Myron H. Nourse, MD Cincinnati, OH 1971 * Jack N. Taylor, MD Detroit, MI 1972 * George J. Bulkley, MD Chicago, IL 1973 * Lester Persky, MD Acapulco, DF, Mexico 1974 * David A. Culp, MD Columbus, OH 1975 * David Presman, MD Phoenix, AZ 1976 * Harry E. Lichtwardt, MD Palm Beach, FL 1977 * Laurence F. Greene, MD Coronado, CA 1978 * Jack Lapides, MD Chicago, IL 1979 Charles F. McKiel Jr., MD Phoenix, AZ 1980 * David C. Utz, MD Hamilton, 1981 * William E. Forsythe, MD Indianapolis, IN 1982 Everette J. Duthoy, MD Marco Island, FL 1983 * John P. Donohue, MD Maui, HI 1984 * Edwin D. Kennedy, MD Cedar Rapids, IA 1985 * John D. Silbar, MD Palm Beach, FL 1986 Joseph C. Cerny, MD Rancho Mirage, CA 1987 Kenneth A. Kropp, MD Detroit, MI 1988 * Paul R. Hartig, MD Orlando, FL 1989 Charles W. Troup, MD Chicago, IL 1990 Lawrence S. Ross, MD Colorado Springs, CO 1991 Charles E. Hawtrey, MD Scottsdale, AZ 1992 Eugene T. McEnery, MD Dorado, PR 1993 Arthur J. Johnson, MD Milwaukee, WI 1994 Jack L. Summers, MD, PhD Boca Raton, FL
Table of Contents 22 1995 * Joseph W. Segura, MD Minneapolis, MN 1996 Earl H. Johnson, MD Tucson, AZ 1997 Ananias C. Diokno, MD Monterey, CA 1998 James E. Lingeman, MD Amelia Island, FL 1999 * Richard Dwayne Williams, MD Chicago, IL 2000 John Randolf Beahrs, MD, FACS Scottsdale, AZ 2001 Richard A. Memo, MD Chicago, IL 2002 Robert Bruce Bracken, MD Chicago, IL 2003 Elroy D. Kursh, MD Vancouver, BC, Canada 2004 Frank P. Begun, MD Miami Beach, FL 2005 Robert C. Flanigan, MD, FACS Chicago, IL 2006 David E. Patterson, MD Coronado, CA 2007 Dennis A. Pessis, MD Hollywood, FL 2008 Jay B. Hollander, MD Chicago, IL 2009 Stephen Y. Nakada, Scottsdale, AZ 2010 Steven W. Siegel, MD Chicago, IL 2011 Peter M. Knapp Jr., MD, FACS Rancho Mirage, CA 2012 Howard Neil Winfield, MD, FACS, Chicago, IL 2013 Chandru P. Sundaram, MD, FACS Naples, FL 2014 Christopher Scott Cooper, MD, FAAP, Chicago, IL 2015 Patrick H. McKenna, MD, FAAP, Amelia Island, FL 2016 Gary Michael Kirsh, MD Chicago, IL 2017 James C. Ulchaker, MD, FACS Scottsdale, AZ 2018 Gary Joseph Faerber, MD Chicago, IL 2019 David F. Jarrard, MD Chicago, IL
*Deceased
Table of Contents 23 Board of Directors and Committee Meetings
TUESDAY, SEPTEMBER 10, 2019
9:00 a.m. - 9:45 a.m. Executive Committee Meeting Location: Élevé Lakeview (42nd Floor)
9:45 a.m. - 10:30 a.m. Finance Committee Meeting Location: Élevé Lakeview (42nd Floor)
10:30 a.m. - 11:30 a.m. Long Range Planning Committee Meeting Location: Élevé Lakeview (42nd Floor)
11:30 a.m. - 12:00 p.m. Annual Meeting Committee Meeting Location: Élevé Lakeview (42nd Floor)
12:00 p.m. - 1:00 p.m. Board of Directors Luncheon Location: Élevé Riverview (42nd Floor)
1:00 p.m. - 5:00 p.m. Board of Directors Meeting Location: Élevé Lakeview (42nd Floor)
WEDNESDAY, SEPTEMBER 11, 2019
7:00 a.m. - 8:00 a.m. Nominating Committee Meeting (1) Location: Lugano Room
12:00 p.m. - 12:55 p.m. Health Policy Council Meeting Location: Arosa Room
12:00 p.m. - 1:15 p.m. Nominating Committee Meeting (2) Location: Lugano Room
THURSDAY, SEPTEMBER 12, 2019
12:00 p.m. - 1:15 p.m. Past Presidents Committee Meeting Location: Arosa Room
12:00 p.m. - 1:15 p.m. Young Urologists Committee Meeting Location: Lugano Room
6:00 p.m. - 7:00 p.m. Industry Roundtable Meeting Location: Arosa Room
FRIDAY, SEPTEMBER 13, 2019
12:00 p.m. - 1:15 p.m. Women in Urology Committee Meeting Location: Lugano Room
Table of Contents 24 General Meeting Information
Scientific Sessions: General Session Location: Vevey Ballroom Wednesday, September 11, 2019 8:00 a.m. - 5:00 p.m. Thursday, September 12, 2019 6:30 a.m. - 5:30 p.m. Friday, September 13, 2019 6:30 a.m. - 5:30 p.m. Saturday, September 14, 2019 7:00 a.m. - 12:15 p.m. *Concurrent session locations are indicated in the full scientific program.
Registration/Information Desk Hours Location: Monte Rosa Registration Desk Wednesday, September 11, 2019 7:00 a.m. - 5:00 p.m. Thursday, September 12, 2019 6:00 a.m. - 5:30 p.m. Friday, September 13, 2019 6:00 a.m. - 5:30 p.m. Saturday, September 14, 2019 6:30 a.m. - 12:15 p.m.
Exhibit Hall Hours Location: Zurich Ballrooms D-G Wednesday, September 11, 2019 Welcome Reception 5:00 p.m. - 7:00 p.m. Thursday, September 12, 2019 10:00 a.m. - 6:30 p.m. Friday, September 13, 2019 7:00 a.m. - 11:00 a.m.
Spouse Guest/Hospitality Suite Hours Location: Matterhorn Wednesday, September 11, 2019 7:30 a.m. - 11:00 a.m. Thursday, September 12, 2019 7:30 a.m. - 11:00 a.m. Friday, September 13, 2019 7:30 a.m. - 11:00 a.m. Saturday, September 14, 2019 7:30 a.m. - 11:00 a.m.
Speaker Ready Room Hours Location: Monte Rosa Wednesday, September 11, 2019 7:00 a.m. - 5:00 p.m. Thursday, September 12, 2019 6:00 a.m. - 5:30 p.m. Friday, September 13, 2019 6:00 a.m. - 5:30 p.m. Saturday, September 14, 2019 6:30 a.m. - 12:15 p.m.
Table of Contents 25 Evening Functions
One ticket to each evening function is included in attendee and spouse/guest registration. To purchase additional tickets, please visit the Registration/Information desk.
WELCOME RECEPTION Date: Wednesday, September 11, 2019 Time: 5:00 p.m. - 7:00 p.m. Location: Zurich Ballrooms D-G Attire: Casual Cost: One ticket is included in registration; additional tickets are $50 for adults and free for children under the age of 13. Description: Join us for a “Taste of Chicago” at the Welcome Reception. Attendees can sample a variety of craft beers, connect with fellow attendees and visit our industry sponsors and exhibitors while enjoying an array of appetizers.
NCS HAPPY HOUR Date: Thursday, September 12, 2019 Time: 5:30 p.m. - 6:30 p.m. Location: Zurich Ballrooms D-G Attire: Casual Cost: One ticket is included in registration; additional tickets are $30 for adults and free for children under the age of 13. Description: Join us for a reception in the Exhibit Hall! Attendees will get a chance to visit with our industry sponsors and exhibitors while enjoying light refreshments.
YOUNG UROLOGISTS MIXER Date: Thursday, September 12, 2019 Time: 6:30 p.m. - 7:30 p.m. Location: Élevé Lakeview (42nd Floor) Attire: Business Casual Cost: This is a free event open to residents and urologists who are within 10 years post-training. Description: This is a great way to network with other urologists and learn how to become more active in the Section.
CLOSING RECEPTION Date: Friday, September 13, 2019 Time: 6:00 p.m. - 7:30 p.m. Location: Montreux/St. Gallen Foyer Attire: Business Casual Cost: One ticket included in registration; additional tickets are $85.00. Description: The 2019 Closing Reception will be a night to remember. Attendees will enjoy cocktails and hors d’oeuvres while being surrounded by Chicago’s beautiful scenery.
Table of Contents 26 Speaker Information
The North Central Section thanks all the presenters for their outstanding commitment to the 93rd Annual Meeting.
Speaker Guidelines All presentations shall be loaded onto the computer in the Speaker Ready Room. An AV technician will be present during the Speaker Ready Room hours to load presentations and answer any question you may have. We strongly encourage you to turn in your presentations as early as possible. At a minimum, presentations must be turned in to the AV Technicians four hours prior to your presentation. Remember, all media must be IBM Compatible.
Poster Presentation Guidelines Please look for the board containing your poster number. NCS will provide pushpins. Posters must be removed immediately at the close of the session. NCS will not hold or be responsible for posters left behind.
Moderator Guidelines Please make every effort to ensure that the program runs on schedule by checking the speaker timer before each talk and each discussion. Also, encourage the speakers and discussants to adhere to the allotted time. Please be sure to inform the audience that all speakers have completed the AUA faculty disclosure process, a written report is included in the registration envelopes. Finally, remember to introduce presentations by the following: Title of Presentation, Speaker’s Name, and Speaker’s City. Please do not cite all of the authors’ names.
Speaker Ready Room Hours Location: Monte Rosa Wednesday, September 11, 2019 7:00 a.m. - 5:00 p.m. Thursday, September 12, 2019 6:00 a.m. - 5:30 p.m. Friday, September 13, 2019 6:00 a.m. - 5:30 p.m. Saturday, September 14, 2019 6:30 a.m. - 12:15 p.m.
Table of Contents 27 Scientific Program
All sessions will be located in Vevey Ballroom unless otherwise noted. Speakers and times are subject to change.
WEDNESDAY, SEPTEMBER 11, 2019
OVERVIEW
7:00 a.m. - 5:00 p.m. Registration/Information Desk Hours Location: Monte Rosa Registration Desk
7:00 a.m. - 5:00 p.m. Speaker Ready Room Hours Location: Monte Rosa
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours Location: Matterhorn
7:30 a.m. - 9:00 a.m. Breakfast Location: Vevey Foyer
5:00 p.m. - 7:00 p.m. Exhibit Hall Hours Location: Zurich Ballrooms D-G
5:00 p.m. - 7:00 p.m. Welcome Reception Location: Zurich Ballrooms D-G
GENERAL SESSION
8:00 a.m. - 9:30 a.m. Operating Theatre: Techniques, Tips and Tricks Moderator: Chandru P. Sundaram, MD, FACS Indianapolis, IN
8:00 a.m. - 8:30 a.m. Virgin and Post-Chemo Open RPLND Panelists: Clint Cary, MD, MPH Indianapolis, IN Timothy A. Masterson, MD Indianapolis, IN
8:30 a.m. - 9:00 a.m. Robotic Adrenalectomy Panelists: Arieh L. Shalhav, MD Chicago, IL Chandru P. Sundaram, MD, FACS Indianapolis, IN
9:00 a.m. - 9:30 a.m. Robotic Prostatectomy Panelists: Matthew T. Gettman, MD Rochester, MN David F. Jarrard, MD Madison, WI
9:30 a.m. - 10:00 a.m. NCS Faculty Lecture: Urolithiasis 2019: What the Practicing Urologist Needs to Know Speaker: Stephen Y. Nakada, MD, FACS, FRCS(Glasg.) Madison, WI
10:00 a.m. - 10:30 a.m. State-of-the-Art Lecture: Late Effects Following Pediatric Bladder Operations for Congenital Conditions Speaker: Hadley M. Wood, MD Cleveland, OH
Table of Contents 28 10:30 a.m. - 10:40 a.m. ABU Update Speaker: Stephen Y. Nakada, MD, FACS, FRCS(Glasg.) Madison, WI
10:40 a.m. - 11:00 a.m. Break Location: Vevey Foyer
11:00 a.m. - 12:00 p.m. Panel Discussion: Decision Making and Surgical Approach to Complex Renal Masses Moderator: Geoffrey N. Box, MD Columbus, OH Panelists: James A. Brown, MD Iowa City, IA Gopal N. Gupta, MD, FACS Maywood, IL Bradley C. Leibovich, MD, FACS Rochester, MN
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium* Location: Zurich A *Not CME Accredited
1:15 p.m. - 5:00 p.m. Health Policy and Practice Management Location: Vevey Ballroom
1:15 p.m. - 1:53 p.m. Washington Update Moderator: James M. Dupree IV, MD, MPH Ann Arbor, MI
1:15 p.m. - 1:30 p.m. AUA Public Policy Council Update Speaker: Christopher L. Coogan, MD Chicago, IL
1:30 p.m. - 1:45 p.m. 2019 RUC Update Speaker: Kyle A. Richards, MD, FACS Madison, WI
1:45 p.m. - 1:53 p.m. Discussion/ Q&A
1:53 p.m. - 2:15 p.m. New Frontiers in Legislative Advocacy Moderator: Christopher L. Coogan, MD Chicago, IL
1:53 p.m. - 2:08 p.m. The Importance of State-Level Advocacy: Organized Medicine's Response to Indiana State Senate Bill 394 Speaker: Bradley G. Orris, MD Greenwood, IN
2:08 p.m. - 2:15 p.m. Discussion/ Q&A
2:15 p.m. - 2:45 p.m. State-of-the-Art Lecture: Medical Malpractice: How to Protect Yourself From Being Sued Guest Speaker: Ben B. Rubinowitz, JD New York, NY
2:45 p.m. - 2:55 p.m. Discussion/ Q&A
2:55 p.m. - 3:10 p.m. Break
Table of Contents 29 3:10 p.m. - 4:10 p.m. Top Three Lessons I've Learned About Managing My Practice Moderator: Bradley A. Erickson, MD, MS, FACS Iowa City, IA
3:10 p.m. - 3:25 p.m. After My First Year in Practice Speaker: Alexander P. Glaser, MD Glenview, IL
3:25 p.m. - 3:40 p.m. After 5-6 Years in Practice Speaker: Emilie K. Johnson, MD, MPH Chicago, IL
3:40 p.m. - 3:55 p.m. After More Than 15 Years in Practice Speaker: Peter M. Knapp Jr., MD, FACS Carmel, IN
3:55 p.m. - 4:10 p.m. Discussion/ Q&A
4:10 p.m. - 4:55 p.m. New Frontiers in Practice Management Moderator: Candace F. Granberg, MD Rochester, MN
4:10 p.m. - 4:25 p.m. How I Use Telemedicine in My Practice: What Works and What Doesn't Work Speaker: Chad Ellimoottil, MD, MS Ann Arbor, MI
4:25 p.m. - 4:40 p.m. How I Use Social Media to Help Grow My Practice: What Works and What Doesn’t Work Speaker: Lawrence C. Jenkins, MD, MBA Columbus, OH
4:40 p.m. - 4:55 p.m. Discussion/ Q&A
4:55 p.m. - 5:00 p.m. NCS Health Policy Young Investigator Award Presentation Introducer: James M. Dupree IV, MD, MPH Ann Arbor, MI
#171 PAIN MANAGEMENT IN OUTPATIENT UROLOGIC PROCEDURES – A PROSPECTIVE RANDOMIZED TRIAL OF OXYCODONE VERSUS KETOROLAC Kirtishri Mishra, MD, Melody Chen, MD, Laura Bukavina, MD, Amr Mahran, MD, Jonathan Kiechle, MD, Michael Wang, BS, Christina Buzzy, PhD, Christopher Gonzalez, MD, Lee Ponsky, MD University Hospitals/Case Western Reserve University Presented By: Kirtishri Mishra, MD
5:00 p.m. - 7:00 p.m. Welcome Reception Location: Zurich Ballrooms D-G
Table of Contents 30 THURSDAY, SEPTEMBER 12, 2019
OVERVIEW
6:00 a.m. - 5:30 p.m. Registration/Information Desk Hours Location: Monte Rosa Registration Desk
6:00 a.m. - 5:30 p.m. Speaker Ready Room Hours Location: Monte Rosa
6:00 a.m. - 7:30 a.m. Breakfast Location: Vevey Foyer
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours Location: Matterhorn
10:00 a.m. - 6:30 p.m. Exhibit Hall Hours Location: Zurich Ballrooms D-G
5:30 p.m. - 6:30 p.m. NCS Happy Hour Location: Zurich Ballrooms D-G
6:30 p.m. - 7:30 p.m. Young Urologists Mixer Location: Élevé Lakeview (42nd Floor)
Concurrent Sessions Begin
Concurrent Session 1 of 3
6:30 a.m. - 7:30 a.m. Video Session I Location: Montreux Moderators: Mark D. Dabagia, MD, FACS Fort Wayne, IN Jeffrey A. Triest, MD Dearborn, MI
Video #1 WITHDRAWN
Video #2 PERC-TIC PCNL Tim Large, MD1, Chalres Nottingham, MD1, Amy Krambeck, MD2 1IU Health Hospial, 2India University School of Medicin Presented By: Tim Large, MD, MA
Video #3 MINIMALLY INVASIVE ENDOSCOPIC MANAGEMENT OF SYMPTOMATIC CALCIFIED DEFLUX Kristen Meier, Samantha Kraemer, Melissa Fischer, Zachary Liss Beaumont Health Presented By: Samantha Denae Kraemer, MD
Video #4 MOSES LASER ENUCLEATION OF THE PROSTATE: EARLY EXPERIENCE Mark Pickhardt, MD, Tim Large, MD, Amy Krambeck, MD IU Urology Presented By: Mark W. Pickhardt, MD
Table of Contents 31 Video #5 BLADDER NECK AUS PLACEMENT IN A YOUNG WOMAN WITH MYELOMENINGOCELE Molly DeWitt-Foy, MD, Hadley Wood, MD Cleveland Clinic Presented By: Hadley Merrideth Wood, MD
Video #6 REMOVAL AND REPLACEMENT OF IPP WITH BILATERAL DISTAL CORPOROPLASTY FOR MANAGEMENT OF SST DEFORMITY Aram Loeb, MD1, Laura Bukavina, MD MPH1, Kirt Mishra, MD1, Megan Cooper, DO2, Michael Wang, BS3, Rafael Carrion, MD2 1University Hospitals Cleveland Medical Center, 2University of Southern Florida, 3Case Western Reserve School of Medicine Presented By: Kirtishri Mishra, MD
Concurrent Session 2 of 3
6:30 a.m. - 7:30 a.m. Male and Couple Infertility Podium Session Location: Vevey Ballroom Moderators: Lawrence C. Jenkins, MD, MBA Columbus, OH Amarnath Rambhatla, MD Detroit, MI Discussant: Matthew J. Ziegelmann, MD Rochester, MN
6:30 a.m. #1 SUB-FERTILITY AND ITS PSYCHOLOGICAL IMPACT ON MEN Garrett Berger, MS, Pranav Dadhich, MD, Dietrich Peter, MD, Graham Machen, MD, Sandlow Jay, MD, PI, Abbey Kruper, PsyD Medical College of Wisconsin Presented By: Pranav Dadhich, MD
6:34 a.m. #2 Podium #2 USE OF RESTOREX PENILE TRACTION THERAPY TO MAINTAIN PENILE LENGTH POST PROSTATECTOMY Madeleine Manka, MD, Kevin Hebert, MD, Kevin Wymer, MD, David Yang, MD, Trost Landon, MD Mayo Clinic Presented By: Madeleine G. Manka, MD
6:38 a.m. #3 EARLY EXPERIENCE WITH LOW-DOSE ADDERALL FOR TREATMENT REFRACTORY DELAYED EJACULATION AND ANORGASMIA IN MEN Matthew Ziegelmann1,2, Tobias Kohler2, Matthew Houlihan2, Laurence Levine1 1Rush University Medical Center Department of Urology, 2Mayo Clinic Department of Urology Presented By: Matthew J. Ziegelmann, MD
6:42 a.m. #4 PENILE PROSTHESIS AFTER CYSTECTOMY: RARELY UTILIZED WITH ACCEPTABLE DEVICE SURVIVAL Brittany Adamic, MD1, William Boysen, MD1, Joshua Aizen, MD1, SangTae Park, MD2 1University of Chicago, 2Northshore HealthSystem Presented By: Brittany Adamic, MD
Table of Contents 32 6:46 a.m. #5 MODIFIED TECHNIQUE FOR VASECTOMY REVERSAL RESULTS IN SIGNIFICANTLY IMPROVED OUTCOMES Jamal Alamiri, MB, BCh, BAO, David Y Yang, MD, Madeleine Manka, MD, Joshua Savage, PA-C, Manaf Alom, MBBS, Kiran Sharma, PhD, Sevann Helo, MD, Tobias Kohler, MD MPH, Landon Trost, MD Mayo Clinic Department of Urology Presented By: Jamal Alamiri, MD
6:50 a.m. #6 MEN WHO HAVE NOT FATHERED CHILDREN AT TIME OF VASECTOMY ARE UNLIKELY TO SEEK FERTILITY RESTORATION Molly DeWitt-Foy, MD, Andrew Sun, MD, Sarah Vij, MD Cleveland Clinic Presented By: Scott Lundy, MD
6:54 a.m. #7 SUTURELESS PLAQUE INCISION WITH GRAFTING DURING IPP PLACEMENT IN PATIENTS WITH PEYRONIE'S DISEASE David Y Yang, MD1, Joshua Ring, MD2, Kevin J Hebert, MD1, Matthew J Ziegelmann, MD1, Georgios Hatzichristodoulou, MD, FEBU, FECSM3, Tobias S Kohler, MD, MPH1 1Mayo Clinic, Department of Urology, 2SIU Urology, 3Department of Urology and Pediatric Urology, Julius- Maximilians-University of Würzburg, Würzburg, Germany Presented By: David Y. Yang, MD
6:58 a.m. #8 POSTOPERATIVE EMERGENCY DEPARTMENT VISIT AFTER PENILE PROSTHESIS PLACEMENT PREDICTS HIGHER REVISION RATE Ryan Dornbier, MD1, Marc Nelson, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Eric Kirshenbaum, MD1, Gopal Gupta, MD1, Marshall Baker, MD2, Christopher Gonzalez, MD1, Ahmer Farooq, MD1, Kevin McVary, MD1 1Loyola University Medical Center, 2Loyola University Medical center Presented By: Ryan Austin Dornbier, MD
7:02 a.m. #9 PDE5 INHIBITOR TREATMENT PREFERENCES: A SYSTEMATIC REVIEW Gaurav Pahouja, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Martha Faraday, PhD2, Hossein Sadeghi-Nejad, MD3,4, Lawrence Hakim, MD5, Kevin T. McVary, MD1 1Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2AUA Guidelines Office, Lithincum, MD, 3Department of Urology, Hackensack University Medical Center, Hackensack, NJ, 4Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, 5Department of Urology, Cleveland Clinic Florida, Weston, FL Presented By: Gaurav Pahouja, MD
Table of Contents 33 7:06 a.m. #10 SHOULD CONTINUATION OF ANTITHROMBOTICS AT TIME OF INFLATABLE PEINLE PROSTHESIS SURGERY BE STANDARD OF CARE? Kevin Hebert, MD, David Yang, MD, Matthew Ziegelmann, MD, Jack Andrews, MD, Madeline Manka, MD, Kevin Wymer, MD, Matthew Houlihan, MD, Landon Trost, MD, Tobias Kohler, MD Mayo Clinic, Dept. Urology, Rochester, MN Presented By: Kevin Joseph Hebert, MD
7:10 a.m. #11 FREQUENCY OF FERTILITY PRESERVATION DISCUSSION IN CANCER PATIENTS VARIES BASED ON AGE Peter Dietrich, G. Luke Machen, Pranav Dadhich, Jonathan Doolittle, Kayvon Kiani, Daniel Roadman, Jay Sandlow Medical College of Wisconsin Presented By: Peter Dietrich, MD
7:14 a.m. #12 RISK FACTORS FOR NON-COMPLIANCE IN POST- VASECTOMY FOLLOWUP Johnathan Doolittle, MD, Peter Dietrich, MD, Pranav Dadhich, MD, Kayvon Kiani, Daniel Roadman, Sarah Brink, Graham Machen, MD, Jay Sandlow, MD MCW Presented By: Johnathan Doolittle, MD
7:18 a.m. - 7:30 a.m. Q&A
Concurrent Session 3 of 3
6:45 a.m. - 7:30 a.m. Adrenal/ Kidney/ Ureter - Malignant/ Benign Poster Session Location: St. Gallen 3 Moderators: Sapan N. Ambani, MD Ann Arbor, MI Aaron M. Potretzke, MD Rochester, MN
Poster #1 GENERATING PADUA NEPHROMETRY SCORES THROUGH KIDNEY AND TUMOR SEMANTIC SEGMENTATION IN COMPUTED TOMOGRAPHY Edward Walczak1, Keenan Moore1, Nicholas Heller2, Arveen Kalapara, MBBS3, Niranjan Sathianathen, MBBS3, Paul Blake1, Heather Kaluzniak4, Joel Rosenberg1, Zachary Rengel1, Nikolaos Papanikolopoulos, PhD2, Christopher Weight, MD3 1University of Minnesota Medical School, 2University of Minnesota, Department of Computer Sciences and Engineering, 3University of Minnesota Medical School, Department of Urology,4University of North Dakota Medical School Presented By: Edward Walczak, BS
Table of Contents 34 Poster #2 TIMING AND DISTRIBUTION OF METACHRONOUS CHROMOPHOBE RENAL CELL CARCINOMA METASTASES Maximilian Staebler, BSe1, Theodora Potretzke, MD2, Christine Lohse3, John Cheville, MD4, Bernard King, MD2, Matvey Tsivian, MD5, Bradley Leibovich, MD5, R Houston Thompson, MD5, Aaron Potretzke, MD5 1Mayo Clinic Alix School of Medicine, 2Mayo Clinic Department of Radiology, 3Mayo Clinic Department of Health Sciences Research, 4Mayo Clinic Department of Pathology, 5Mayo Clinic Department of Urology Presented By: Maximilian Helmut Staebler, BSe
Poster #3 TESTING THE EXTERNAL VALIDITY OF EORTC 30881 TRIAL COMPARING LYMPHADENECTOMY WITH RADICAL NEPHRECTOMY TO RADICAL NEPHRECTOMY ALONE FOR RENAL CELL CARCINOMA Alex Borchert, MD1, Sohrab Arora, MD1, Lee Baumgarten, MD1, Akshay Sood, MD1, Deepansh Dalela, MD1, Quoc-Dien Trinh, MD2,3, Craig Rogers, MD1, James Peabody, MD1, Mani Menon,MD1, Firas Abdollah, MD1 1Henry Ford Hospital, 2Brigham and Women's Hospital, 3Harvard University Presented By: Alex Borchert, MD
Poster #4 OUTCOMES OF MICROWAVE ABLATION FOR SMALL RENAL MASSES: A SINGLE CENTER EXPERIENCE Courtney Yong, MD1, Sarah Mott, MS2, Sandeep Laroia, MD3, Chad Tracy, MD1 1University of Iowa, Department of Urology, 2University of Iowa, Holden Comprehensive Cancer Center, 3University of Iowa, Department of Interventional Radiology Presented By: Courtney Yong, MD
Poster #5 IS TRIGONITIS A NEGLECTED, IMPRECISE, MISUNDERSTOOD OR FORGOTTEN DIAGNOSIS? Zhina Sadeghi1,2, Gregory MacLennan3, Stacy Childs4, Philippe Zimmern5 1University Hospitals Cleveland Medical Center, 2Case Western Reserve University, Department of Urology, Cleveland, OH, 3Division chief, Anatomic Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 4Director of urology, Rural partners in Medicine, Springs, CO, 5Urology Department, UT Southwestern Medical Center, Dallas, TX Presented By: Zhina Sadeghi, MD
Poster #6 MULTIPLEX POLYMERASE CHAIN REACTION TESTING COMPARED TO TRADITIONAL URINE CULTURE FOR DETECTION OF UROPATHOGENS IN FEMALE AND MALE PATIENTS WITH SYMPTOMATIC URINARY TRACT INFECTIONS Brett Watson, MD1, Elizabeth Olive2, Kirk Wojno, MD3, Howard Korman, MD3, Sabry Mansour, MD3, Syed Mohammad A. Jafri, MD3 1Beaumont Health, Dept of Urology, Royal Oak, MI, 2Oakland University William Beaumont School of Medicine, Rochester, MI, 3Comprehensive Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Table of Contents 35 Poster #7 DIFFERENCES IN PATHOGENIC ORGANISMS DETECTED BY POLYMERASE CHAIN REACTION BASED MOLECULAR TESTING AND TRADITIONAL URINE CULTURE FOR SYMPTOMATIC URINARY TRACT INFECTIONS Brett Watson, MD1, Md Saon2, Kirk Wojno, MD3, Howard Korman, MD3, Jeffrey O'Connor, MD3, Syed Mohammed A. Jafri, MD1 1Beaumont Health, Dept of Urology, Royal Oak, MI, 2Oakland University William Beaumont School of Medicine, Rochester, MI, 3Comprehensive Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Concurrent Sessions End
7:30 a.m. - 8:00 a.m. Break Location: Vevey Foyer
8:00 a.m. - 8:05 a.m. President's Welcome President: David F. Jarrard, MD Madison, WI
8:05 a.m. - 8:50 a.m. Pediatric Panel Discussion Moderator: Christopher S. Cooper, MD, FAAP, FACS Iowa City, IA Panelists: Jonathan Ellison, MD Milwaukee, WI John M. Park, MD Ann Arbor, MI Jonathan H. Ross, MD Cleveland, OH
8:50 a.m. - 9:20 a.m. State-of-the-Art Lecture: Volunteering in Urology Speaker: Charles R. Powell II, MD Indianapolis, IN
9:20 a.m. - 10:00 a.m. Prostate Cancer Panel Discussion Moderator: David F. Jarrard, MD Madison, WI Panelists: Gregory B. Auffenberg, MD, MS Chicago, IL Michael S. Cookson, MD, MMHC, FACS Oklahoma City, OK Eric A. Klein, MD Cleveland, OH Daniel W. Lin, MD Seattle, WA
10:00 a.m. - 10:40 a.m. Endourology and Stone Disease Panel Discussion Moderator: Amy E. Krambeck, MD Indianapolis, IN Panelists: Casey A. Dauw, MD Ann Arbor, MI Bodo E. Knudsen, MD, FRCSC Columbus, OH Thomas M. Turk, MD Maywood, IL
Table of Contents 36 10:40 a.m. - 11:10 a.m. Break - Visit Exhibits Location: Zurich Ballrooms D-G
11:10 a.m. - 12:00 p.m. State-of-the-Art Lecture: Difficult Issues in NMIBC: Guidelines and Beyond Guest Speaker: Michael S. Cookson, MD, MMHC, FACS Oklahoma City, OK
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium* Location: Zurich A *Not CME Accredited
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium* Location: Zurich B *Not CME Accredited
1:15 p.m. - 2:00 p.m. State-of-the-Art Lecture: How to Succeed in Medicine and Life* Speaker: Eric A. Klein, MD Cleveland, OH *Not CME Accredited
Concurrent Sessions Begin
Concurrent Session 1 of 3
2:00 p.m. - 3:00 p.m. Endourology/ Stone Disease Podium Session Location: Vevey Ballroom Moderators: Carley Davis, MD Milwaukee, WI Mark A. Wille, MD, FACS Chicago, IL Discussant: James E. Lingeman, MD Carmel, IN
2:00 p.m. #13 EXPLORING MECHANISMS OF PROTEIN INFLUENCE ON CALCIUM OXALATE KIDNEY STONE FORMATION Garrett Berger, PharmD1, Jessica Eisenhauer, BS2, Andrew Vallejos, BS3, Brian Hoffmann, PhD3, Jeffrey Wesson, MD, PhD2 1Medical College of Wisconsin, College of Medicine, Milwaukee, WI, 2Medical College of Wisconsin, Department of Medicine, Division of Nephrology, Milwaukee, WI, 3Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, WI Presented By: Garrett K. Berger, PharmD
2:04 p.m. #14 STONES FROM PATIENTS WITH METABOLIC SYNDROME EXHIBIT INCREASED BACTERIAL GROWTH COMPARED TO CONTROLS Ryan Dornbier, MD1, Petar Bajic, MD1, Michelle Van Kuiken, MD2, Marc Nelson, MD1, Alan Wolfe, PhD3, Larissa Bresler, MD1, Ahmer Farooq, DO1, Thomas Turk, MD1, Kristin Baldea, MD1 1Loyola University Medical Center, Maywood, IL, 2University of California Los Angeles, Los Angeles, CA, 3Loyola University Chicago, Department of Microbiology and Immunology Presented By: Ryan Austin Dornbier, MD
Table of Contents 37 2:08 p.m. #15 UNDERSTANDING URETERAL ACCESS SHEATH USE WITHIN A STATEWIDE COLLABORATIVE AND ITS EFFECTS ON SURGICAL OUTCOMES AND COMPLICATIONS Kristen Meier, MD1, Spencer Hiller, MD1, Casey Dauw, MD2, John Hollingsworth, MD2, Khurshid Ghani, MD2, Tae Kim2, Kavya Swarna2, Jaya Telang2, S. Mohammad Jafri, MD1, for the Michigan Urological Surgery Improvement, Collaborative2 1Beaumont Health, 2University of Michigan Presented By: Kristen Marie Meier, MD
2:12 p.m. #16 EFFECT OF STONE COMPOSITION ON SURGICAL STONE RECURRENCE: SINGLE CENTER LONGITUDINAL ANALYSIS Shuang Li, PhD1, Simone L. Vernez, MD1, Kristina L. Penniston, PhD1, R. Allan Jhagroo, MD2, Sara Best, MD1, Stephen Y. Nakada, MD1,3,4 1University of Wisconsin, School of Medicine Public Health, Department of Urology, 2University of Wisconsin, School of Medicine Public Health, Department of Medicine, 3Department of Medicine, 4Department of Radiology Presented By: Shuang Li, PhD
2:16 p.m. #17 REDUCTION IN POST-URETEROSCOPY OPIOID PRESCRIPTIONS IS NOT ASSOCIATED WITH HIGHER PAIN SCORES Morgan Schubbe, MD1, Kevin Flynn, MD1, Jacob Simmering, PhD2, Bradley Erickson, MD, MPH1, Chad Tracy, MD1 1University of Iowa Hospitals and Clinics Department of Urology, 2University of Iowa Hospitals and Clinics Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine Presented By: Morgan E. Schubbe, MD
2:20 p.m. #18 VOLUMETRIC MEASUREMENT IS UNNECESSARY FOR PREDICTING THE PASSAGE OF OBSTRUCTING URETERAL STONES Parth Patel, MD1, Alexander Kandabarow, MD1, Abrar Mian2, Spencer Hart, MD1, Gaurav Pahouja, MD1, Ryan Dornbier, MD1, Ahmer Faroo, DO1, Thomas Turk, MD1, Kristin Baldea, MD1 1LUMC, 2LUC Presented By: Parth Patel, MD
2:24 p.m. #19 AUGMENTING THE PREDICTIVE CRITERIA FOR SUCCESSFUL MEDICAL EXPULSIVE THERAPY Naveen Kachroo, MD, PhD1, Rajat Jain, MD2, Luay Alshara, MD1, Sherif Armanyous, MD1, Sara Maskal, BS3, Manoj Monga, MD1, Sriharan Sivalingam, MD1 1Cleveland Clinic, Cleveland, OH, 2University of Rochester, Rochester, NY, 3Case Western Reserve University School of Medicine, Cleveland, OH Presented By: Naveen Kachroo, MD, PhD
Table of Contents 38 2:28 p.m. #20 DOES “MYCHART” BENEFIT “MY” STONE SURGERY? – A LOOK AT THE IMPACT OF ELECTRONIC PATIENT PORTALS ON PATIENT EXPERIENCE Naveen Kachroo, MD PhD, Sriharan Sivalingam, MD Cleveland Clinic, Cleveland, OH Presented By: Naveen Kachroo, MD, PhD
2:32 p.m. #21 IMPACT OF AN ADVISED PAIN REGIMEN FOR URETERAL STONE PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT Robert Medairos1, Kaylee Luck2, Allison Apfel2, David Charles1, Amy Zosel3, John Ray3, Carley Davis1 1Medical College of Wisconsin, Department of Urology, 2Medical College of Wisconsin, 3Medical College of Wisconsin, Department of Emergency Medicine Presented By: Robert Anthony Medairos, MD
2:36 p.m. #22 UPPER POLE ACCESS FOR PRONE PERCUTANEOUS NEPHROLITHOTOMY: ADVANTAGE OR RISK? Ricardo Soares, Urologist1, Alec Zhu, Medical Student2, Vidit Talati, Medical Student2, Robert Nadler, Professor of Urology2 1Northwestern Medicine, 2Northwestern University - Feinberg Scho of Medicine Presented By: Ricardo Oliveira Soares, MD, FEBU
2:40 p.m. #23 CAN WE BE STONE FREE? VALIDATION OF A DYNAMIC DECISION ENGINE FOR PREDICITING STONE FREE RATE Whitney Halgrimson, Resident1, Susana Berrios, Student2, Matthew Del Pino, Student2, Simone Crivellaro, Visiting Associate Professor1 1UIC COM, Dept of Urology, 2UIC COM Presented By: Whitney Ryan Halgrimson, MD
2:44 p.m. #24 USE OF A COAGULUM DURING URETEROSCOPIC STONE REMOVAL ADDS NO ADDITIONAL CASE TIME OR COMPLICATIONS Crystal Valadon1, Charles Nottingham2, Tim Large2, Amy Krambeck2 1University of Louisville School of Medicine, 2Indiana University School of Medicine Presented By: Crystal Valadon
2:48 p.m. - 3:00 p.m. Q&A
Table of Contents 39 Concurrent Session 2 of 3
2:00 p.m. - 3:00 p.m. NCS Young Urologists Speed Mentoring Program* Location: St. Gallen 1-2 *Not CME Accredited
Concurrent Session 3 of 3
2:00 p.m. - 3:00 p.m. Patient Safety and Quality Improvements Podium Session Location: Montreux Moderator: Charles R. Powell II, MD Indianapolis, IN Discussant: Gary J. Faerber, MD Durham, NC
2:00 p.m. #25 IMPACT OF UROLOGIC SURGERY ON INCREASED RATES OF PERSISTENT OPIOID USE: A NATIONAL SAMPLE Joshua Aizen, MD, Sandra A. Ham, MS, Logan Galansky, BA, Brittany Adamic, MD, Craig Labbate, MD, Ciro Andolfi, MD, Sarah Faris, MD, Joel Wackerbarth, MD, John Richgels, MD University of Chicago Presented By: Joel J. Wackerbarth, MD
2:04 p.m. #26 NEW PERSISTENT OPIOID USE AFTER URETEROSCOPY FOR STONE TREATMENT Christopher Tam1, Casey Dauw1, Vidhya Gunaseelan1, Tae Kim1, David Leavitt2, Jeremy Raisky1, Phyllis Yan1, John Hollingsworth1, Michigan Urological Surgery Improvement Collab1 1University of Michigan, 2Henry Ford Hospital - Vattikuti Urology Institute Presented By: Christopher Tam, MD
2:08 p.m. #27 FEMALE SURGEONS AND SURGICAL TRAINEES TEND TO UNDER RATE TECHNICAL SKILLS ON SELF- ASSESSMENT Brady Miller, David Azari, Rebecca Gerber, Robert Radwin, Brian Le Presented By: Brady L. Miller, MD, MPH
2:12 p.m. #28 USING SURGEON HAND MOTIONS TO IDENTIFY SURGICAL MANEUVERS Brady Miller, David Azari, Rebecca Gerber, Robert Radwin, Brian Le Presented By: Brady L. Miller, MD, MPH
Table of Contents 40 2:16 p.m. #29 AN ASSESSMENT OF FACTORS ASSOCIATED WITH LACK OF EARLY SOCIAL CONTINENCE FOLLOWING RADICAL PROSTATECTOMY: ANALYSIS OF THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE (MUSIC) Alec Wilson, MD1, Michael Cher, MD2, Rodney Dunn, MS3, Khurshid Ghani, MD3, Tae Kim3, David Miller, MD3, James Montie, MD3, James Peabody, MD4, Ji Qi, MS3, M. Hugh Solomon, MD3, Alexander Tapper, MD1, Jaya Telang3, Bradley Rosenberg, MD5, Frank Burks, MD1, for the Michigan Urological Surgery Improvement, Collaborative3 1William Beaumont Hospital, 2Wayne State University, 3University of Michigan, 4Henry Ford Hospital - Vattikuti Urology Institute, 5Comprehensive Urology Presented By: Alec Wilson, MD
2:20 p.m. #30 THE BIOBURDEN IDENTIFIED ON REUSABLE SCOPES VERSUS SINGLE-USE SCOPE – SHOULD WE USE DISPOSABLE SCOPES IN HIGH-RISK PATIENTS Kirtishri Mishra, MD1, Laura Bukavina, MD MPH1, Vaishnavi Narayanamurthy, MS1, Mauricio Retuerto, PhD1, Irina Jaeger, MD1, Irma Lengu, MD2, Donald Bodner, MD3, Mahmoud Ghannoum, PhD1, Lee Ponsky, MD FACS1 1University Hospitals/Case Western Reserve University, 2Metro Health Medical Center/ Case Western Reserve University, 3Cleveland Veterans Affairs Medical Center/University Hospitals/Case Western Reserve University Presented By: Vaishnavi Narayanamurthy
2:24 p.m. #31 USING GEOGRAPHICALLY DETERMINED RESISTANCE PATTERNS TO GUIDE EMPIRIC THERAPY FOR UNCOMPLICATED URINARY TRACT INFECTIONS Jason Cohen, MD, Anthony Schaeffer, MD Northwestern University Feinberg School of Medicine Department of Urology Presented By: Jason E. Cohen, MD
2:28 p.m. #32 WHAT MAKES A GOOD SURGEON? AN EVALUATION OF MEDICAL TRAINEES’ PERCEIVED LEADERSHIP TRAINING AND SKILLS Tasha Posid, MA, PhD, Scott Holliday, MD The Ohio State University Wexner Medical Center Presented By: Tasha Posid, MA, PhD
2:32 p.m. #33 EPIDURAL ANESTHESIA INCREASES RATE OF COMPLICATIONS AND POST OPERATIVE STAY IN PATIENTS AFTER CYSTECTOMY: A NSQIP ANALYSIS Laura Bukavina, MD MPH1,2, Amr Mahran, MD MS1,2, Kirtishri Mishra, MD1,2, Brittany Adamic, MD3, Anjali Shekar, BS2, Vaishnavi Narayanamurthy, BS2, Carvell Nguyen, MD PhD4,2, Lee Ponsky, MD1,5 1University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 2Case Western Reserve University School of Medicine, Cleveland, Ohio, 3University of Chicago Medical Center, Chicago, Illinois, 4Metro Health Medical Center, Cleveland, Ohio, 5Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Laura Bukavina, MD, MPH
Table of Contents 41 2:36 p.m. #34 INCORRECT IMAGING FOR HEMATURIA WORKUP ACROSS SPECIALTIES IS LEADING TO POOR VALUE OF HEALTHCARE Brittany Adamic, MD1, Joshua Aizen, MD1, Craig Labbate, MD1, Alexander Cope2, SangTae Park, MD2 1University of Chicago, 2NorthShore University HealthSystem Presented By: Brittany Adamic, MD
2:40 p.m. #35 SELF-CENSORSHIP OF SOCIAL MEDIA CONTENT AMONG MEDICAL STUDENTS Joseph Mahon, MD1, Meredith Chan, MD2, Jacob Lucas, MD3, Jay Simhan, MD3, Martin Gross, MD4, Seun Akinola, MD5, Matthew Coward, MD6, Paul Feustel, PhD7, Henry Pohl, MD7, Barry Kogan, MD2, Charles Welliver, MD2 1Loyola University, 2Albany Medical Center, 3Einstein Health Network, 4Dartmouth Medical Center, 5Royan Hospital, 6University of North Carolina School of Medicine, 7Albany Medical College Presented By: Joseph Mahon, MD
2:44 p.m. #36 A REVIEW OF RESIDENT BURNOUT AND WELLNESS INTERVENTIONS: IS UROLOGY BEING LEFT OUT? Christopher Jaeger, MD, Tasha Posid, PhD Ohio State University Presented By: Christopher Jaeger, MD
2:48 p.m. - 3:00 p.m. Q&A
Concurrent Sessions End
3:00 p.m. - 4:00 p.m. State-of-the-Art Lecture: Prostate Cancer Active Surveillance: Establishing Boundaries, Defining Thresholds, and Future Directions Guest Speaker: Daniel W. Lin, MD Seattle, WA
4:00 p.m. - 4:30 p.m. Break - Visit Exhibits Location: Zurich Ballrooms D-G
Concurrent Sessions Begin
Concurrent Session 1 of 4
4:30 p.m. - 5:30 p.m. Penis/ Urethra/ Testis/ Scrotum - Malignant/ Benign Podium Session Location: Montreux Moderators: Frank N. Burks, MD Royal Oak, MI Ervin Kocjancic, MD Chicago, IL Discussant: Matthew J. Mellon, MD Indianapolis, IN
Table of Contents 42 4:30 p.m. #37 URETHRAL STRICTURE DISEASE IS NOT A FOCAL PROCESS Morgan Schubbe, MD1, Matthew Grimes, MD1, Katherine Cotter, MD2, Bradley Erickson, MD, MPH1 1University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, 2University of Massachusetts, Department of Urology, Worcester, MA Presented By: Morgan E. Schubbe, MD
4:34 p.m. #38 OPIOID AND NON-OPIOID BASED CARE PATHWAYS FOR RECONSTRUCTIVE MALE ANTERIOR URETHRAL SURGERY: EVIDENCE BASED APPROACH FOR OPIOID STEWARDSHIP Jason Joseph, MD1, Matthew Ziegelmann, MD1, Elizabeth Habermann, PhD, MPH2, Matthew Gettman, MD1, Boyd Viers, MD1 1Department of Urology, Mayo Clinic, Rochester, Minnesota, 2Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic,Rochester, Minnesota Presented By: Jason P. Joseph, MD
4:38 p.m. #39 MODIFIED-APPROACH FOR ‘MALE URETHRAL MINI- SLING’ WITH INFLATABLE PENILE PROSTHESIS FOR ERECTILE DYSFUNCTION AND CLIMACTURIA OR MILD STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECOMY: A TWO-CENTER EXPERIENCE Matthew J. Ziegelmann, MD1, M. Ryan Farrell, MD, MPH1, Joel H. Hillelsohn, MD2, Marissa A. Kent, MD2, Robert J. Valenzuela, MD2, Laurence A. Levine, MD1 1Rush University Medical Center, Division of Urology, Chicago, IL, 2Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY Presented By: M. Ryan Farrell, MD, MPH
4:42 p.m. #40 DEVELOPMENT AND APPLICATION OF A NOVEL AND EFFICIENT SKILLS ASSESSMENT TOOL: A PILOT INITIATIVE TO MEASURE VASECTOMY COMPETENCY ON A SMART PHONE Hal Kominsky, MD, Tasha Posid, MA, PhD, Lawrence Jenkins, MD, MBA The Ohio State University Wexner Medical Center Presented By: Hal Kominsky, MD
4:46 p.m. #41 URETHRAL STRICTURE DISEASE AMONG PATIENTS UNDERGOING COMPLEX BURIED PENIS REPAIR M. Francesca Monn, MD, MPH, Naveen Krishnan, MD, Matthew J. Mellon, MD Indiana Unversity School of Medicine, Department of Urology Presented By: Naveen Krishnan, MD
4:50 p.m. #42 DO RADIOGRAPHIC MARKERS IMPROVE DIAGNOSTIC UTILITY OF RETROGRADE URETHROGRAMS FOR URETHRAL STRICTURE DISEASE Brian Odom, MD, Frank Burks, MD Department of Urology, Beaumont Health System, Royal Oak, Michigan, USA Presented By: Brian D. Odom, MD
Table of Contents 43 4:54 p.m. #43 EFFECTIVENESS OF BILATERAL ORCHIECTOMY AS A MEANS OF REDUCING ANTI-ANDROGENS AND ESTROGEN REQUIREMENTS IN GENDER DYSPHORIA PATIENTS Ross G Everett, MD MPH, Kaylee C Luck, Jay I Sandlow, MD Medical College of Wisconsin Presented By: Ross G. Everett, MD, MPH
4:58 p.m. #44 PREVALENCE OF PREEXISTING MEDICAL CONDITIONS AND MICROORGANISMS IN PATIENTS WITH FOURNIER'S GANGRENE Clara Castillejo Becerra1, Christopher Jaeger2, Justin Rose2, Nicholas Beecroft1, Nayan Shah1, Lawrence Jenkins2, Nima Baradaran2 1The Ohio State University College of Medicine, Columbus, OH, 2The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH Presented By: Clara Castillejo Becerra
5:02 p.m. #45 NOVEL APPROACH TO FULL THICKNESS PENILE GRAFTING DURING BURIED PENIS REPAIR M Franesca Monn, MD, MPH, Naveen Krishnan, MD, Matthew J Mellon, MD Indiana University School of Medicine Department of Urology Presented By: Naveen Krishnan, MD
5:06 p.m. #46 PENOSCROTAL DECOMPRESSION AS A GLANS SPARING ALTERNATIVE TO SHUNT PROCEDURES FOR SURGICAL RELIEF OF REFRACTORY ISCHEMIC PRIAPISM Yooni Yi, MD1, Michael Davenport, MD1, Billy Cordon, MD2, Travis Pagliara, MD3, Jeffrey Gahan, MD1, Allen Morey, MD1 1UT Southwestern, 2Mount Sinai Medical Center Miami, 3Hennepin Health Care Presented By: Yooni Yi, MD
5:10 p.m. #47 PRESENTATION AND MANAGEMENT OF FOURNIER’S GANGRENE IN FEMALES Nicholas Beecroft1, Christopher Jaeger, MD2, Justin Rose2, Clara Castillejo Becerra1, Nayan Shah1, Lawrence Jenkins, MD2, Nima Baradaran, MD2 1The Ohio State University College of Medicine, 2The Ohio State University Department of Urology Presented By: Nicholas Beecroft
5:15 p.m. - 5:30 p.m. Q&A
Concurrent Session 2 of 4
4:30 p.m. - 5:30 p.m. Prostate Malignant I Podium Session Location: Vevey Ballroom Moderator: Nilesh Patil, MD Cincinnati, OH Discussant: Clinton D. Bahler, MD, MS Indianapolis, IN
Table of Contents 44 4:30 p.m. #48 UNDERSTANDING THE ROLE OF STATIN USE ON ADVANCED PROSTATE CANCER OUTCOMES: DOES THE STATIN TYPE, CUMULATIVE DOSE OR DURATION IMPACT SURVIVAL? Tariq A. Khemees, MD1, Jinn-ing Liou, M.S.2, E. Jason Abel, MD3, Tracy M. Downs, MD3, Tudor Borza, MD1, David F. Jarrard, MD3, Kyle A. Richards, MD1 1Department of Urology, University of Wisconsin and William S. Middleton Memorial Veterans Hospital, 2Department of Internal Medicine, University of Wisconsin, 3Department of Urology, University of Wisconsin Presented By: Tariq A. Khemees, MD
4:34 p.m. #49 REAL-WORLD IMPACT OF GENOMIC PROSTATE SCORE ASSAY ON USE AND PERSISTENCE OF ACTIVE SURVEILLANCE Benjamin H. Lowentritt, Michael Gong, Robert Abouassaly, Cynthia D Westermann, Gary M. Kirsh, Richard Sarle, John Bennett, Jay Newmark, Bethann S Hromatka, Michael J Kemeter, Eric A Klein Presented By: Eric A. Klein, MD
4:38 p.m. #50 18F-FLUCICLOVINE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) IN PATIENTS WITH SUSPECTED BIOCHEMICAL RECURRENCE OF PROSTATE CANCER: DETECTION OF BONE METASTASES AND IMPACT ON PATIENT MANAGEMENT PLANS Gerald Andriole, MD1, Michael Kipper, MD2, Paul Dato, MD2, Karen Linder, PhD3, Bela Denes, MD3 1Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA, 2Genesis Healthcare, San Diego, CA, USA, 3Blue Earth Diagnostics, Inc., Burlington, MA, USA Presented By: Gerald L. Andriole Jr., MD
4:42 p.m. #51 CRIBRIFORM OR INTRADUCTAL CARCINOMA ON PROSTATE BIOPSY: MARKERS OF NON-ORGAN CONFINED DISEASE Kyle Ericson, MD1, Shannon Wu2, Scott Lundy, MD, PhD1, Lewis Thomas, MD1, Andrew Stephenson, MD1, Eric Klein, MD1, Jesse McKenney, MD3 1Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH, 2Cleveland Clinic Lerner College of Medicine, 3Cleveland Clinic Foundation, Department of Anatomic Pathology, Cleveland, OH Presented By: Kyle J. Ericson, MD
4:46 p.m. #52 MRI FUSION BIOPSY TARGETED BIOPSIES ALONE WITHOUT SYSTEMATIC BIOPSY CAN MISS CLINICALLY SIGNIFICANT PROSTATE CANCERS Brijesh Patel, MD1, Eiftu Haile, BS1, John Ogunkeye, BS1, Pierece Massie, BS1, Celeste Ruiz, RN2, Justin Cohen, MD2, Christopher Coogan, MD1, Paul Yonover, MD2 1Rush University Medical Center, 2UroPartners Presented By: Brijesh Patel, MD
Table of Contents 45 4:50 p.m. #53 THE EFFECTS OF ANDROGEN DEPRIVATION THERAPY ON BRAIN VOLUME 3D PLANIMETRY Nishant Jain, BS1, Kimberly Woo, MD1, Laura Bukavina, MD MPH2, Kirtishri Mishra, MD2, Amr Mahran, MD MS2, Christopher Kondary, MD3, David Sheyn, MD2, Christina Buzzy PhD, PhD4, Lee Ponsky, MD2, Kristina Garrels, MD5, Carvell Nguyen, MD PhD5 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Metro Health Medical Center, Department of Radiology, Cleveland, Ohio, 4Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 5Metro Health Medical Center, Cleveland, Ohio/Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Kimberly Woo
4:54 p.m. #54 ≥50% REDUCTION IN PSA FOLLOWING 3 CYCLES OF TAXOTERE PREDICTS FAVORABLE RESPONSE FOLLOWING FULL TREATMENT WITH TAXOTERE Mohamad Ahmed, MBBCh., Jack Andrews, MD, Eugene Kwon, MD Mayo Clinic Presented By: Mohamed Ahmed
4:58 p.m. #55 EVALUATING THE IMPACT OF LEAD-TIME BIAS ON SURVIVAL BENEFIT OF EARLY SALVAGE RADIATION THERAPY IN PROSTATE CANCER: A POST- HOC ANALYSIS OF THE RTOG 9601 TRIAL Deepansh Dalela, Akshay Sood, Hoang Tang, Jacob Keeley, Craig Rogers, James Peabody, Mani Menon, Firas Abdollah VUI-CORE, Vattikuti Urology Institute, Henry Ford Health System Presented By: Deepansh Dalela
5:02 p.m. #56 PERFORMANCE OF PIRADS 3 LESIONS IN A LARGE MRI FUSION BIOPSY PROGRAM IN PREDICTING PROSTATE CANCER Brijesh Patel, MD1, John Ogunkeye, BS1, Eiftu Haile, BS1, Pierece Massie, BS1, Celeste Ruiz, RN1, Justin Cohen, MD2, Christopher Coogan, MD1, Paul Yonover, MD2 1RUMC, 2UroPartners Presented By: Brijesh Patel, MD
5:06 p.m. #57 CAN WE SPARE MEN 12-CORE BIOPSIES AT THE TIME OF MRI/TRUS FUSION PROSTATE BIOPSY? Spencer Hart, MD1, Thomson Tai2, Chirag Doshi, MD1, Cara Joyce, PHD3, Alex Gorbonos, MD1, Michael Woods1, Marcus Quek, MD1, Robert Flanigan, MD1, Gopal Gupta, MD1 1Loyola University Medical Center, 2Loyola University Stritch School of Medicine, 3Loyola University at Chicago Presented By: Thomson Tai, MD
Table of Contents 46 5:10 p.m. #58 RATES AND PATTERNS OF METASTASES IN PATIENTS WITH NODE-NEGATIVE PROSTATE CANCER AT RADICAL PROSTATECTOMY THAT EXPERIENCE PSA FAILURE: POST-HOC ANALYSIS OF RTOG 9601 TRIAL DATA Akshay Sood, MD, Jacob Keeley, M.S., Mani Menon, MD, Firas Abdollah, MD Henry Ford Health System Presented By: Akshay Sood, MD
5:14 p.m. #59 ISOPSA IS A SENSITIVE ASSAY FOR CRIBRIFORM AND INTRADUCTAL CARCINOMA Kyle Ericson, MD1, Shannon Wu2, Scott Lundy, MD, PhD1, Lewis Thomas, MD1, Jesse McKenney, MD3, Mark Stovsky, MD, MBA1, Eric Klein, MD1 1Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH, 2Cleveland Clinic Lerner College of Medicine, 3Cleveland Clinic Foundation, Department of Anatomic Pathology Presented By: Kyle J. Ericson, MD
5:18 p.m. - 5:30 p.m. Q&A
Concurrent Session 3 of 4
4:30 p.m. - 5:30 p.m. Patient Safety and Quality Improvements/ Socioeconomics and Health Policy Poster Session Location: Zurich C Moderators: Adam O. Kadlec, MD Milwaukee, WI R. Corey O'Connor, MD Milwaukee, WI
Poster #8 IMPLEMENTING AN ENHANCED RECOVERY PATHWAY IN CHILDREN UNDERGOING BLADDER AUGMENTATION Yvonne Y. Chan, MD1, Soojin Kim, MD1, Nicholas E. Burjek, MD2, Megan A. Brockel, MD3, Ilina Rosoklija1, Mehul V. Raval, MD4, Kyle O. Rove, MD5, Elizabeth B. Yerkes, MD1, David I. Chu, MD1 1Division of Pediatric Urology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 2Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 3Department of Anesthesiology, Children’s Hospital Colorado, Aurora, CO, 4Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 5Department of Pediatric Urology, Children’s Hospital Colorado, Aurora, CO Presented By: Yvonne Yuh-Ru Chan, MD
Poster #9 IMPROVING COMORBIDITY DOCUMENTATION FOR COMPLEX UROLOGY INPATIENTS JJ Zhang, MD, Molly DeWitt-Foy, MD, Kyle Ericson, MD, Scott Lundy, MD,PhD, Anup Shah, MD, Michelle Ponziano, MSN,RN, James Ulchaker, MD, Goldman Howard, MD Cleveland Clinic Foundation Presented By: JJ Haijing Zhang, MD
Table of Contents 47 Poster #10 PATIENT SELECTION AND OUTCOMES BETWEEN LOWER AND HIGHER VOLUME SURGEONS IN PERFORMANCE OF RADICAL PROSTATECTOMY: ANALYSIS OF THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE (MUSIC) Alexander Tapper, MD, Alec Wilson, MD, Steven Lucas, MD, Rodney Dunn, MS, Khurshid Ghani, MD, Tae Kim, David Miller, MD, James Montie, MD, James Peabody, MD, Ji Qi, MS, Hugh M. Solomon, MD, Jaya Telang, Frank Burks, for the Michigan Urologic Surgery Improvement, Collaborative Presented By: Alexander David Tapper, MD
Poster #11 AMERICAN UROLOGICAL ASSOCIATION QUALITY REGISTRY (AQUA) EARLY QUALITY REPORTING OF BPH SYMPTOM IMPROVEMENT Joseph Mahon, MD1, Ahmer Farooq, DO1, Parsons JK, MD2, Welliver Charles, MD3, Lerner Lori, MD4, Averch Timothy, MD5, Pichardo Daniel6, Kevin McVary, MD1 1Loyola University Medical Center, 2UC Sandiego, 3Albany Medical Center, 4VA Boston Healthcare System, 5Palmetto Health USC, 6American Urologic Association Presented By: Joseph Mahon, MD
Poster #12 SEVERE SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY (PCNL): COSTLY AND DEADLY Marc Nelson, MD, Alex Belshoff, MD, PhD, Marshall Baker, MD, Gopal Gupta, MD, Ahmer Farooq, MD, Kristin Baldea, MD Loyola University Medical Center Presented By: Marc Nelson, MD
Poster #13 URINE VS. URETERAL STENT CULTURES DURING URETERAL STENT REMOVAL Bijan Salari, MD, Muhamad Khalid, Samuel Ivan, Daniel Rospert, Obinna Ekwenna, MD, Firas Petros, MD, Puneet Sindhwani, MD Department of Urology, University of Toledo Presented By: Bijan William Salari, MD
Poster #14 TOUR DE CONSULT: HOW TO CHANGE THE CONSULT CULTURE – AN 11 YEAR EXPERIENCE AT A LARGE ACADEMIC MEDICAL CENTER Adam Cole, MD, Kathryn Marchetti, MD, Casey Dauw, MD, Julian Wan, MD University of Michigan Presented By: Adam I. Cole, MD
Poster #15 CROSS-CULTURAL COMPETENCY AND COMMUNICATION IN RESIDENCY TRAINING: WHERE DO WE STAND? Hemant Chaparala, MD1, Emefah Loccoh, BS1, Sabrina Amin2, Jessica Sciuva2, Tasha Posid, MA, PhD1, Kerestina Khalil2 1The Ohio State University Medical Center, 2The Ohio State University Presented By: Hemant Chaparala, MD
Table of Contents 48 Poster #16 NARCOTIC PRESCRIBING HABITS AMONG UROLOGY RESIDENTS IN URBAN AND SUBURBAN COMMUNITIES Joshua Palka, DO1, Sarah Martin, DO1, Zaid Farooq, DO1, Neal Krentz, BS2, Mazen Abdelhady, MD1 1Detroit Medical Center, 2Michigan State University Presented By: Sarah E. Martin, DO
Poster #17 GEOGRAPHIC ANALYSIS OF BROADBAND INTERNET ACCESS AND UROLOGIC CANCER MORTALITY IN THE UNITED STATES Paige Nichols1, Anne Corrigan2, Hiten Patel3, Frank Curriero2, Vidit Sharma1, Gettman Matthew1, Ziegelmann Matthew1, Pierorazio Phillip3, Michael Johnson3 1Mayo Clinic, 2Johns Hopkins Bloomberg School of Public Health, 3Johns Hopkins Brady Urological Institute Presented By: Paige Elizabeth Nichols, MD
Poster #18 IMPACT OF EXPOSURE TO TOXIC STRESS IN CHILDHOOD ON PHYSICIAN BURNOUT Lauren E. Corona, MD1, Nicholas J. Akselberg2, David C. Miller, MD1, Yongmei Qin, MD1, Brian R. Stork, MD3 1University of Michigan, Dept. of Urology, Ann Arbor, MI, 2University of Michigan, Ann Arbor, MI, 3University of Michigan, Dept. of Urology, Muskegon, MI Presented By: Lauren E. Corona, MD
Poster #19 PROSTATE CANCER IN CHICAGO: AN ANALYSIS OF DISPARITIES IN OUTCOMES USING NEIGHBORHOOD OF RESIDENCE John Ogunkeye, M-2, Chris Coogan, MD RUMC Presented By: John Ogunkeye
Poster #20 TIME TO AZOOSPERMIA: BALANCING HEALTH CARE EXPENDITURE ON REPEATED POST-VASECTOMY SEMENALYSIS AND PATIENT NON-COMPLIANCE. Woojin Han, Medical Student, Puneet Sindhwani, Chair, Department of Urology University of Toledo, Department of Urology Presented By: Woojin Han
Concurrent Session 4 of 4
4:30 p.m. - 5:30 p.m. Prostate Benign Poster Session Location: St. Gallen 3 Moderators: Michael S. Borofsky, MD Minneapolis, MN Irina Jaeger, MD Cleveland, OH
Table of Contents 49 Poster #21 PUBECTOMY WITH URINARY RECONSTRUCTION EFFECTIVELY IMPROVES QUALITY OF LIFE AND FUNCTION IN MEN WITH UROSYMPHYSEAL FISTULA AFTER PROSTATE CANCER THERAPY Jack Andrews, MD, Kevin Hebert, MD, Jason Joseph, MD, Boyd Viers, MD Mayo Clinic Presented By: Jack Andrews, MD
Poster #22 DULOXETINE FOR THE TREATMENT OF STRESS URINARY INCONTINENCE (SUI) AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Robert Medairos, MD, Nicholas Nordin, BS, David Charles, MD, Jacob Jipp, MD, Amy Guise, MD Medical College of Wisconsin Presented By: Robert Anthony Medairos, MD
Poster #23 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IN THE ELDERLY: AN AGE-CONTROLLED COMPARISON OF SURGICAL AND POSTOPERATIVE OUTCOMES Alex Borchert, MD, David Leavitt, MD Henry Ford Hospital Presented By: Alex Borchert, MD
Poster #24 CLINICAL OUTCOMES OF HOLMIUM LASER ENUCLEATION OF PROSTATE IN OCTOGENARIANS Timothy C. Boswell, MD, Malek Meskawi, MD, Marcelino E. Rivera, MD Department of Urology, Mayo Clinic, Rochester, MN Presented By: Timothy Charles Boswell, MD
Poster #25 CONTINUATION OF ANTIPLATELET AND/OR ANTICOAGULATION IN PATIENTS UNDERGOING REZUM PROSTATE ABLATION David Y Yang, MD, Tal D Cohen, MD, Ross A Avant, MD, Sevann Helo, MD, Tobias S Kohler, MD, MPH Mayo Clinic, Department of Urology Presented By: Tal D. Cohen
Poster #26 THE EFFECT OF PREOPERATIVE FINASTERIDE ON HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OPERATIVE METRICS Viraj Maniar, MD1, Maraika Robinson2, Amy Guise, MD3, Peter Dietrich, MD3, Robert Medairos, MD3 1Medical College of Wisconsin, Department of Urology, Milwaukee, WI, 2Medical College of Wisconsin, Milwaukee, WI, 3Medical College of Wisconsin, Department of Urology, Milwaukee, W Presented By: Viraj Maniar, MD
Poster #27 BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE AND URETHRAL STRICTURE: POSTOPERATIVE TRUTH VS HYPE: A RANDOMIZED CONTROL STUDY Hesham Helmy, Department of Urology Tanta university Presented By: Hesham Ahmed Helmy Sr., MD
Table of Contents 50 Poster #28 DECISION MAKING MARKOV MODEL TO BALANCE RISKS AND BENEFITS OF BENIGN PROSTATIC HYPERPLASIA TREATMENT Sofer Lauer, MD1, Crivellaro Simone, MD1, Zuberek Marcin, MD1, Paolo Serafini2 1University of Illinois at Chicago, Chicago, Illinois, 2Univserity of Udine, Italy Presented By: Laurel Sofer
Poster #29 THE EFFECT OF THE URINARY AND FECAL MICROBIOTA ON LOWER URINARY TRACT SYMPTOMS MEASURED BY THE INTERNATIONAL PROSTATE SYMPTOM SCORE Bradley Holland, MD1, Ahmed El-Zawahry, MD1, Danuta Dynda, MD1, Kevin McVary, MD1, Kristin Delfino, PhD1, Andrea Braudmeier-Fleming1, Shaheen Alanee, MD2 1Department of surgery, division of Urology, SIU School of medicine, 2VCORE – Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI Presented By: Bradley Holland, MD
Poster #30 TITLE: INITIAL EXPERIENCE WITH INTRAOPERATIVE FLUID WARMING DURING HOLMIUM LASER ENCULEATION OF THE PROSTATE (HOELP). Tim Large, MD, Charles Nottingham, MD, Amy Krambeck, MD Indiana University School of Medicine Presented By: Tim Large, MD, MA
Poster #31 SAFETY OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE IN THE OUTPATIENT SETTING Deepak Agarwal, MD, Kevin Hebert, MD, Marcelino Rivera, MD Mayo Clinic, Department of Urology, Rochester, MN Presented By: Deepak K. Agarwal, MD
Poster #32 REAL WORLD OUTCOMES OF PROSTATIC URETHRAL LIFT (PUL) FOLLOWING PROSTATE CANCER THERAPY Gregg Eure, MD1, Steven Gange, MD2, Peter Walter, MD3, Ansar Khan, MD4, Charles Chabert, MD5, Thomas Mueller, MD6, Paul Cozzi, MD7, Manish Patel, MD8, Sheldon Freedman, MD9,Peter Chin, MD10, Steven Ochs, MD11, Andrew Hirsh, MD12, Michael Trotter, MD13, Douglas Grier, MD14 1Urology of Virginia, Virginia Beach, VA, 2Summit Urology Group, Salt Lake City, UT, 3Western NY Urology Associates, Cheektowaga, NY, 4Urology Heath Center, Fremont, NE, 5The Prostate Clinic, Benowa, QSD, Australia, 6Delaware Valley Urology, Voorhees, NJ, 7Dr. Paul Cozzi, Hurstville, NSW, Australia, 8Urology MD Consultant, LLC, Elgin, SC, 9Sheldon Freedman, MD LTD, Las Vegas, NV, 10South Coast Urology, Wollongong, NSW, Australia, 11Urology One, Canton, OH, 12Jersey Urology Group, Somers, NJ, 13Midtown Urology Associates, Austin, TX, 14Sound Urological Associates, Edmonds, WA Presented By: Steven E. Ochs, MD
Table of Contents 51 Poster #33 SUPERFLUOUS HOSPITAL EXPENDITURE ASSOCIATED WITH UNINDICTED RENAL CYST SURVEILLANCE Michael Wang, BS1, Mitchell Ng, BS1, Laura Bukavina, MD MPH2, Amr Mahran, MD MS2, Kirtishri Mishra, MD2, Al Ray III, MD2, Christina Buzzy, PhD3, Kristina Garrels, MD4, Carvell Nguyen, MD PhD4 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 4Metro Health Medical Center, Cleveland, Ohio Presented By: Michael Wang, BS
Concurrent Sessions End
5:30 p.m. - 6:30 p.m. NCS Happy Hour Location: Zurich Ballrooms D-G
6:30 p.m. - 7:30 p.m. Young Urologists Mixer Location: Élevé Lakeview (42nd Floor) *This event is open to residents and urologists within 10 years of residency
FRIDAY, SEPTEMBER 13, 2019
OVERVIEW
6:00 a.m. - 5:30 p.m. Registration/Information Desk Hours Location: Monte Rosa Registration Desk
6:00 a.m. - 5:30 p.m. Speaker Ready Room Hours Location: Monte Rosa
6:00 a.m. - 8:30 a.m. Breakfast Location: Vevey Foyer / Zurich Ballrooms D-G
7:00 a.m. - 11:00 a.m. Exhibit Hall Hours Location: Zurich Ballrooms D-G
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours Location: Matterhorn
6:00 p.m. - 7:30 p.m. Closing Reception Location: Montreux/St. Gallen Foyer
Concurrent Sessions Begin
Concurrent Session 1 of 2
6:30 a.m. - 7:30 a.m. Video Session II Location: Montreux Moderators: Bryan D. Hinck, MD Edina, OH Michael Sourial, MD Columbus, OH
Table of Contents 52 Video #7 TRANS-RETRO ROBOTIC PARTIAL NEPHRECTOMY Paul Blake, Christopher Weight, MD, Niranjan Sathianathan, MD University of Minnesota Presented By: Paul Blake
Video #8 PROSTATIC ARTERY PRESERVATION: A NOVEL TECHNIQUE FOR ROBOTIC ASSISTED RADICAL PROSTATECTOMY Keegan Zuk, Halle Foss, Viraj Maniar, Andrew Radtke, Scott John, Kenneth Jacobsohn Medical College of Wisconsin, Department of Urology Presented By: Keegan Zuk, MD
Video #9 WE REPORT OUR TECHNIQUE OF TRANSURETHRAL LASER ENUCLEATION OF BLADDER TUMOR USING THE HOLMIUM LASER TECHNIQUE Jay Chavali, MD, Tim Large, MD Indiana University School of Medicine Presented By: Tim Large, MD, MA
Video #10 TECHNICAL CONSIDERATIONS OF SINGLE PORT URETERONEOCYSTOSTOMY UTILIZING DA VINCI SP PLATFORM Kevin Hebert, MD, Jason Joseph, MD, Matthew Gettman, MD, Matthew Tollefson, MD, Igor Frank, MD, Boyd Viers, MD Mayo Clinic Presented By: Kevin Joseph Hebert, MD
Video #11 ROBOTIC URETEROCALICOSTOMY Jonathan Schmidt1, Kevin Heinsimer2, Jay Sulek1, Chandru Sundaram1,3 1Indiana University School of Medicine, 2University of South Florida Urology, 3IU Health Department of Urology Presented By: Jonathan Schmidt
Video #12 ROBOT-ASSISTED LAPAROSCOPIC TRANSPLANT URETERAL REIMPLANTATION MITROFANOFF Rachel Shannon, Deborah Jacobson, MD, Elizabeth Yerkes, MD, Edward Gong, MD Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Rachel Lynn Shannon, BS
Concurrent Session 2 of 2
6:30 a.m. - 7:30 a.m. Outcomes Research and Education Podium Session Location: Vevey Ballroom Moderators: Kyle A. Richards, MD, FACS Madison, WI Elizabeth B. Takacs, MD Iowa City, IA Discussant: Matthew T. Gettman, MD Rochester, MN
Table of Contents 53 6:30 a.m. #60 GENDER DISPARITY IN CYSTECTOMY OUTCOMES: PROPENSITY SCORE ANALYSIS OF THE NSQIP DATABASE Laura Bukavina, MD MPH1, Kirtishri Mishra, MD2, Amr Mahran, MD MS1, Anjali Shekar, BS3, David Sheyn, MD4,5, Emily Slopnick, MD5, Adoniz Hijaz, MD5, Jason Jankowski, MD6, Lee Ponsky, MD4,6, Carvell Nguyen, MD PhD5,3 1University Hospitals Cleveland Medical Center/ Case Western Reserve Medical University, 2Case Western Reserve, 3Case Western Reserve University School of Medicine, 4University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 5Metro Health Medical Center, Cleveland, Ohio, 6Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Anjali Shekar
6:34 a.m. #61 ASSESSING THE QUALITY OF SYSTEMATIC REVIEWS IN UROLOGY (2016-18) USING AMSTAR-2 Leah Soderberg1, Maylynn Ding2, Jae Hung Jung3, Philipp Dahm4 1University of Minnesota Medical School, 2Michael G. DeGroote School of Medicine, McMaster University, 3Yonsai University Wonju College of Medicine, 4Minneapolis VA Healthcare System, Urology Section Presented By: Leah Soderberg
6:38 a.m. #62 IMPACT OF TIMING ON RADIATION THERAPY ADVERSE EVENTS FOLLOWING RADICAL PROSTATECTOMY, AN ANALYSIS OF THE RTOG 9601 COHORT Lee Baumgarten, MD1, Alex Borchert, MD1, Akshay Sood, MD1, Deepansh Dalela, MD1, Sohrab Arora, MD2, Jacob Keeley, MD2, Craig Rogers, MD1, James Peabody, MD1, Mani Menon, MD1, Firas Abdollah, MD2 1Henry ford hospital, 2Henry Ford Hospital Presented By: Lee C. Baumgarten, MD
6:42 a.m. #63 UROLOGY RESIDENTS’ EXPERIENCE AND ATTITUDE TOWARD SURGICAL SIMULATION: PRESENTING OUR SIX YEAR EXPERIENCE WITH A MULTI-INSTITUTIONAL, MULTI-MODALITY SIMULATION MODEL Shaan Setia, MD1, Carol Feng1, Alexander Chow, MD1, Santae Park, MD2, Stephanie Kielb, MD3, Thomas Turk, MD4, Diana Bowen, MD5, Mark Willie, MD, FACS6, Kristin Baldea, MD4, Arieh Shalhav, MD7, Ervin Kocjancic, MD8, Scott Eggener, MD7, Srinivas Vourganti, MD1, SarahAdelstein, MD1, Michael Abern, MD8, Christopher Coogan, MD1 1Rush University Medical Center, 2Northshore University Health System, 3Northwestern Feinberg School of Medicine, 4Loyola University Medical Center, 5Lurie Children's Hospital, 6Cook County Health and Hospital System, 7University of Chicago Medicine, 8University of Illinois Chicago Medical Center Presented By: Shaan Aariyan Setia, MD
Table of Contents 54 6:46 a.m. #64 EVALUATION OF A PILOT RESIDENT RESEARCH CURRICULUM FOR UROLOGY TRAINEES Tasha Posid, MA, PhD, Tatevik Broutian, MS, PhD, Justin Rose, BS, Cheryl Lee, MD The Ohio State University Wexner Medical Center Presented By: Tasha Posid, MA, PhD
6:50 a.m. #65 COMPARISON OF 30- AND 90-DAY COMPLICATION RATES FOLLOWING RADICAL CYSTECTOMY Jacob Knorr, Kyle Ericson, MD, Sylvia Botha, Thomas Lewis, MD, Byron Lee, MD PhD Cleveland Clinic, Glickman Urological Kidney Institute Presented By: Jacob M. Knorr, BS
6:54 a.m. #66 UROLOGY RESIDENTS’ EXPERIENCE WITH SIMULATION: INITIAL EVALUATION OF MRI FUSION BIOPSY WORKSHOP Shaan Setia, MD1, Carol Feng1, Srinivas Vourganti, MD1, Christopher Coogan, MD1, Michael Abern, MD2 1Rush University Medical Center, 2University of Illinois Chicago Presented By: Shaan Aariyan Setia, MD
6:58 a.m. #67 THE EFFECT OF SELECTIVE ANGIOEMBOLIZATION ON RENAL FUNCTION FOR POST-OPERATIVE BLEEDING AFTER PARTIAL NEPHRECTOMY: A MATCHED CASE-CONTROL STUDY Logan Galansky, BA, Joshua Aizen, MD, Ciro Andolfi, MD, Ragheed Saoud, MD, Osmanuddin Ahmed, MD, Arieh Shalhav, MD University of Chicago Presented By: Logan Galansky
7:02 a.m. #68 THE DEVELOPMENT OF AN AUTOMATED, SELF- SUSTAINING KIDNEY CANCER REGISTRY FROM ELECTRONIC HEALTH RECORDS Niranjan Sathianathen, MBBS (Hons)1,2, Vidhyalakshmi Ramesh, MCA3, Shawn Grove, BS1, Makinna Oestreich, BA4, Christopher Weight, MD1 1University of Minnesota, Dept. of Urology, Minneapolis, MN, 2University of Melbourne, Dept. of Surgery, Melbourne, Australia, 3University of Minnesota, Clinical and Translational Science Institute, Minneapolis, MN, 4University of Minnesota Medical School, Minneapolis, MN Presented By: Makinna Caitlin Oestreich, BA
7:06 a.m. #69 IS THERE A UROLOGIST IN THE HOUSE?: TRENDS IN THE MANAGEMENT OF CONSULTS BASED ON TIME, LOCATION, AND ORGANIZATION Anna Munaco, BS1, Kathryn Marchetti, MD2, Adam Cole, MD2, Yongmei Qin, MS2, Juan J Andino, MD2, Colton H Walker, MD2, Julian Wan, MD2 1University of Michigan Medical School, 2Michigan Medicine, Department of Urology Presented By: Anna Munaco, BSEng
Table of Contents 55 7:10 a.m. #70 IS THERE A BENEFIT TO ADDITIONAL NEUROAXIAL ANESTHESIA IN OPEN NEPHRECTOMY? A PROSPECTIVE NSQIP PROPENSITY SCORE ANALYSIS? Amr Mahran, MD MS1,2, Laura Bukavina, MD MPH2, Kirtishri Mishra, MD2, Danly Omil Lima, MD2, Bissan Abboud, BS2, Michael Wang, BS1, Christina Buzzy, PhD1, Jason Jankowski, MD3,2, Robert Abouassaly, MD MS4,5, Lee Ponsky, MD1,3, Irma Lengu, MD6,1 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 4Cleveland Clinic, Glickman Urology and Kidney Institute, Cleveland, Ohio, 5Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 6Metro Health Medical Center, Cleveland, Ohio Presented By: Danly O. Omil-Lima, MD
7:14 a.m. #71 UROLOGY RESIDENTS’ EXPERIENCE WITH SIMULATION: INITIAL EVALUATION OF MID-URETHRAL SLING WORKSHOP Shaan Setia, MD1, Carol Feng1, Diana Bowen, MD2, Sarah Adelstein, MD1, Christopher Coogan, MD1, Stephanie Kielb, MD2 1Rush University Medical Center, 2Northwestern University Feinberg School of Medicine Presented By: Shaan Aariyan Setia, MD
7:18 a.m. - 7:30 a.m. Q&A
Concurrent Sessions End
7:30 a.m. - 8:00 a.m. Break-Visit Exhibits Location: Zurich Ballrooms D-G
8:00 a.m. - 8:45 a.m. NCS Faculty Lecture: The Evolving Role of Oncofertility Speaker: James Wren, MD Chicago, IL
8:45 a.m. - 9:30 a.m. Infertility/ Sexual Dysfunction Panel Discussion Moderator: Robert E. Brannigan, MD Chicago, IL Panelists: David R. Paolone, MD Madison, WI Jay I. Sandlow, MD Milwaukee, WI Matthew J. Ziegelmann, MD Rochester, MN
9:30 a.m. - 10:00 a.m. Break-Visit Exhibits Location: Zurich Ballrooms D-G
Table of Contents 56 10:00 a.m. - 10:45 a.m. NCS Resident Bowl: Round 1 Moderator: Nick Tadros, MD, MCR Springfield, IL Judges: Adam O. Kadlec, MD Milwaukee, WI Jeffrey A. Triest, MD Dearborn, MI Jeffrey C. Yeamans, MD Royal Oak, MI
Concurrent Sessions Begin
Concurrent Session 1 of 4
10:45 a.m. - 12:00 p.m. Women in Urology Session* Location: St. Gallen 1-2 *Not CME Accredited
10:45 a.m. - 11:15 a.m. Stereotypes Speaker: Nissrine A. Nakib, MD Minneapolis, MN
11:15 a.m. - 11:45 a.m. Panel Discussion: Stereotypes in Life and Practice Moderator: Kristina D. Suson, MD Detroit, MI Panelists: Anne P. Cameron, MD, FPMRS Ann Arbor, MI Carley M. Davis, MD Milwaukee, WI Sarah E. McAchran, MD, FACS Madison, WI
11:45 a.m. - 12:00 p.m. Breakout Group Discussions
Concurrent Session 2 of 4
10:45 a.m. - 12:00 p.m. Prostate Malignant Poster Session Location: St. Gallen 3 Moderators: Thomas A. Gardner, MD, MBA Indianapolis, IN Richard C. Sarle, MD Dearborn, MI
Poster #34 CURRENT KNOWLEDGE AND OPINIONS OF MEDICAL TRAINEES REGARDING PSA SCREENING Tyler Sheetz, MD, Tasha Posid, MA, PhD OSUMC Presented By: Tyler James Sheetz, MD
Table of Contents 57 Poster #35 CLINICAL EXPERIENCE WITH GERMLINE MUTATION TESTING IN A COHORT OF PROSTATE CANCER PATIENTS TREATED AT ACADEMIC AND COMMUNITY CENTERS Sadhna Ramanthan1, Savitha Balaraman, MD2, Michael Levin, MD3, Benjamin Johnson, MD4, Jeff Fensterer5, Kirk Wojno, MD4, Howard Korman, MD2 1Albion College, 2Oakland University William Beaumont School of Medicine, 3Comprehensive Urology, 4Comprehensive Urology, 5Strand Diagnostics Presented By: Michael Levin, MD
Poster #36 SYSTEMIC TREATMENT FOR METASTATIC CASTRATION RESISTANT PROSTATE CANCER (M-CRPC): DOES SEQUENCE MATTER? Mohamed Ahmed, M.B., B.Ch.1, Jack Andrews, MD1, Rimki Haloi1, Robert Karnes, MD1, Eugene Kwon, MD1, Allan Bryce, MD2 1Mayo Clinic Urology, 2Mayo Clinic Arizona Medical Oncology Presented By: Mohamed Ahmed
Poster #37 ONSET AND MAINTENANCE OF TESTOSTERONE (T) SUPPRESSION IN FOUR PIVOTAL TRIALS OF SUBCUTANEOUSLY-ADMINISTERED LEUPROLIDE ACETATE (SC-LA) FORMULATED WITH BIODEGRADABLE POLYMER DELIVERY SYSTEM Vahan Kassabian, MD1, John McLane, PhD2, Deborah Boldt- Houle, PhD3, Stuart Atkinson, MB ChB3 1Advanced Urology, Atlanta, GA, 2Clinical Development, Tolmar, Inc., Fort Collins, CO, 3Medical Affairs, Tolmar Pharmaceuticals, Inc., Lincolnshire, IL Presented By: Vahan S. Kassabian, MD
Poster #38 LATE ADMINISTRATION OF LEUPROLIDE, IMPACT ON TESTOSTERONE (T) SUPPRESSION, AND FREQUENCY OF T AND PROSTATE-SPECIFIC ANTIGEN (PSA) TESTING IN PROSTATE CANCER (PCA) IN THE REAL- WORLD Judd Moul, MD1, Stuart Atkinson, MB ChB2, Deborah Boldt- Houle, PhD2, Vahan Kassabian, MD3 1Duke University, Durham, NC, USA, 2Medical Affairs, Tolmar Pharmaceuticals, Inc., Lincolnshire, IL, USA, 3Advanced Urology, Atlanta, GA, USA Presented By: Judd W. Moul, MD, FACS
Poster #39 FREE HAND TRANSRECTAL ULTRASOUND GUIDED SYSTEMATIC BIOPSIES VS TEMPLATE SYSTEMATIC BIOPSIES OBTAINED USING MRI -US FUSION MACHINES: AN ANALYSIS OF CANCER DETECTION RATES Connor Hoge1, Monzer Haj-Hamed1, Nilesh Patil1, James Donovan1, Krishnanath Gaitonde1, Sadhna Verma2, Abhinav Sidana1 1University of Cincinnati Department of Urology, 2University of Cincinnati Department of Radiology Presented By: Connor Hoge
Table of Contents 58 Poster #40 ASSESSMENT OF RACIAL DIFFERENCES IN THE UTILIZATION OF PROSTATE MULTIPARAMETRIC MRI FUSION BIOPSY IN PROSTATE CANCER EVALUATION Connor Hoge1, Monzer Haj-Hamed1, Nilesh Patil1, James Donovan1, Krishnanath Gaitonde1, Sadhna Verma2, Abhinav Sidana1 1University of Cincinnati Department of Urology, 2University of Cincinnati Department of Radiology Presented By: Connor Hoge
Poster #41 PRELIMINARY EVALAUATION OF ISOPSA VS. PIRADS SCORE FOR DETECTION OF HIGH GRADE PROSTATE CANCER Eric Klein, MD1, Arnon Cahit2, Aimee Kestranek2, Prassad Gawande2, Boris Zaslavsky2, Mark Stovsky1 1Cleveland Clinic, 2Cleveland Diagnostics Presented By: Eric A. Klein, MD
Poster #42 WHY IS SURGICAL CASTRATION UNDER-UTILIZED FOR METASTATIC PROSTATE CANCER? ANSWERS FROM PATIENTS RECEIVING ANDROGEN-DEPRIVATION THERAPY Morgan Schubbe, MD1, Conrad Tobert, MD1, Rohan Garje, MBBS2, Bradley Erickson, MD, MPH1, Paul Gellhaus, MD1 1University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, 2University of Iowa Hospitals and Clinics, Department of Internal Medicine, Division of Hematology, Oncology, and Blood Marrow Transplantation Presented By: Morgan E. Schubbe, MD
Poster #43 PREDICTING PATHOLOGIC T3 DISEASE PRIOR TO PROSTATECTOMY: THE UTILITY OF MULTIPARAMETRIC PROSTATIC MRI Isamu Tachibana, Adam Calaway, Ryan Speir, Yan Tong, Ronald Boris, Clint Cary, Michael Koch Indiana University Presented By: Isamu Tachibana, MD
Poster #44 CENTRAL LESION LOCATION UNDERLIES THE LEARNING CURVE ASSOCIATED WITH TARGETED MRI/ULTRASOUND FUSION PROSTATE BIOPSIES Aravind Viswanathan, MD, Natasza Posielski, MD, Shivashankar Damodaran, David Jarrard, MD University of Wisconsin Hospital Clinics Presented By: Aravind Viswanathan, MD
Poster #45 CORRELATION OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING VOLUME MEASUREMENTS TO PATHOLOGY AND IMPLICATIONS FOR FOCAL THERAPY Maria Uloko, MD, Christopher Warlick, MD, Greg Metzger, MD University of Minnesota Presented By: Maria Uloko, MD
Table of Contents 59 Poster #46 GENOMIC PROSTATE SCORE® TESTING REVEALS BROAD HETEROGENEITY OF RISK AMONG NCCN® FAVORABLE INTERMEDIATE RISK PATIENTS Richard Sarle1, David Albala2,3, Edward Uchio4, Michelle Turner5, Elizabeth Bagley5, Jay Newmark5 1Michigan Institute of Urology, Dearborn, MI, 2Department of Urology, Crouse Hospital, Syracuse, NY, 3Associated Medical Professionals of New York, Syracuse, NY, 4Department of Urology, University of California Irvine, Irvine, CA, 5Genomic Health, Inc., Redwood City, CA Presented By: Richard C. Sarle, MD
Concurrent Session 3 of 4
11:00 a.m. - 12:00 p.m. Pediatrics Podium Session Location: Montreux Moderators: Zachary Liss, MD St Clair Shores, MI Douglas W. Storm, MD Iowa City, IA Discussant: Elizabeth B. Roth, MD Milwaukee, WI
11:00 a.m. #72 CHALLENGING PROXIMAL HYPOSPADIAS REPAIRS: AN EVOLUTION OF TECHNIQUE FOR TWO STAGE REPAIRS Yvonne Y. Chan, MD, Anthony D'Oro, Elizabeth B. Yerkes, MD, Ilina Rosoklija, Bruce Lindgren, MD, Edward Gong, MD, Dennis B. Liu, MD, Emilie K. Johnson, MD, David I. Chu, MD, Earl Y. Cheng, MD Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL Presented By: Yvonne Yuh-Ru Chan, MD
11:04 a.m. #73 MEATAL MISMATCH: IMPLICATIONS OF HYPOSPADIAS MEATAL LOCATION DISCORDANCE Anthony D'Oro, BA, Ilina Rosoklija, MPH, Emilie Johnson, MD, MPH, Edward Gong, MD, Dennis Liu, MD, Max Maizels, MD, Derek Matoka, MD, Elizabeth Yerkes, MD, Earl Cheng, MD, David Chu, MD, MSCE Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Anthony D'Oro, BA
11:08 a.m. #74 TO STAGE OR NOT TO STAGE: SURGEON INTUITION AND EARLY COMPLICATIONS IN PROXIMAL HYPOSPADIAS REPAIR Anthony D'Oro, BA, Ilina Rosoklija, MPH, Bruce Lindgren, MD, Emilie Johnson, MD, MPH, Edward Gong, MD, Dennis Liu, MD, David Chu, MD, MSCE, Max Maizels, MD, Theresa Meyer, MS, RN, CPN, Earl Cheng, MD, Elizabeth Yerkes, MD Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Anthony D'Oro, BA
11:12 a.m. #75 THE OVER-PRESCRIPTION OF POSTOPERATIVE PAIN MEDICATION – HOW MUCH DO PEDIATRIC UROLOGISTS CONTRIBUTE? Zachary Rye, Christopher Cooper, Gina Lockwood, Bradley Erickson, Denise Juhr, Patrick TenEyck, Douglas Storm University of Iowa Hospitals and Clinics Presented By: Zachary Rye
Table of Contents 60 11:16 a.m. #76 HEMINEPHRECTOMY IS RARELY NEEDED FOR ECTOPIC URETERS/URETEROCELES Christopher Jaeger1, Daryl McLeod2,1, Seth Alpert2,1, Christina Ching2,1, Molly Fuchs2,1, Daniel Dajusta2,1, Venkata Jayanthi2,1 1Ohio State University, 2Nationwide Children's Hospital Presented By: Christopher Jaeger, MD
11:20 a.m. #77 HYDRONEPHROSIS FOLLOWING URETERAL REIMPLANTATION: WHEN IS IT CONCERNING? Ciro Andolfi, MD, Diboro Kanabolo, Veronica Rodriguez, MD, Joshua Aizen, MD, Brittany Adamic, MD, Craig Labbate, MD, Mohan Gundeti, MD University of Chicago Medicine Presented By: Ciro Andolfi, MD
11:24 a.m. #78 ENGAGING PARENTS IN THE DEVELOPMENT OF A HYPOSPADIAS DECISION AID PROTOTYPE Katherine Chan, MD, MPH1,2, Janet Panoch, MA1, Amr Salama, MD1, Elhaam Bandali, MS1, Brandon Cockrum, MFA3, Courtney Moore, BFA3, Sarah Wiehe, MD, MPH3 1Department of Urology, Indiana University School of Medicine, 2Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research, 3Department of Pediatrics, Section of Children's Health Services Research Presented By: Katherine Hubert Chan, MD, MPH
11:28 a.m. #79 EXPERIENCE WITH A NEW PARADIGM FOR ONE VISIT TO EXPEDITE NEWBORN CIRCUMCISION Max Maizels, Patrick Meade, Melanie Mitchell, Ilina Rosoklija Ann and Robert H. Lurie Children's Hospital of Chicago Presented By: Max Maizels, MD
11:32 a.m. #80 KNOWLEDGE GAPS AND INFORMATION- SEEKING BY PARENTS ABOUT HYPOSPADIAS Katherine Chan, MD, MPH1,2, Janet Panoch, MS1, Aaron Carroll, MD, MS2, Sarah Wiehe, MD, MPH3, Stephen Downs, MD, MS3, Mark Cain, MD1, Richard Frankel, PhD4 1Indiana University School of Medicine, Department of Urology, 2Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research, 3Department of Pediatrics: Children's Health Services Research Center, 4Indiana University School of Medicine and Cleveland Clinic Learner Institute, Cleveland, Ohio Presented By: Katherine Hubert Chan, MD, MPH
11:36 a.m. #81 A CASE SERIES OF RARE GENITOURINARY MANIFESTATIONS OF CROHN’S DISEASE Molly DeWitt-Foy, MD, Jacob Kurowski, MD, Audrey Rhee, MD Cleveland Clinic Presented By: JJ Haijing Zhang, MD
Table of Contents 61 11:40 a.m. #82 PEDIATRIC PYELOPLASTY 30-DAY OUTCOMES: COMPARISON OF OPEN VERSUS MINIMALLY INVASIVE PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION UTILIZING NSQIP DATABASE Kimberly Woo, BA1, Amr Mahran, MD MS2, Laura Bukavina, MD MPH2, Kirtishri Mishra, MD2, Megan Prunty, MD3, Lee Ponsky, MD3, Heather DiCarlo, MD4, Jonathan Ross, MD5, Lynn Woo, MD6 1Case Western Reserve School of Medicine, 2University Hospitals Cleveland Medical Center/ Case Western Reserve Medical University, 3University Hospitals Cleveland Medical Center/Case Western Reserve Medical University, 4Johns Hopkins School of Medicine/The James Buchanan Brady Urological Institute, Baltimore, Maryland, 5Rainbow Babies and Children's Hospital/Case Western Reserve University, 6MD Rainbow Babies and Children's Hospital/Case Western Reserve University Presented By: Kimberly Woo
11:44 a.m. #83 ANALYSIS OF POSTOPERATIVE OPIOID PRESCRIBING PATTERNS FOR PEDIATRIC UROLOGIC SURGERY PATIENTS Matthew Ziegelmann, Matthew Gettman, Paige Nichols, Daniel Ubl, Jason Joseph, Halena Gazelka, Bradley Leibovich, Patricio Gargollo, Elizabeth Habermann, Candace Granberg Mayo Clinic Presented By: Matthew J. Ziegelmann, MD
11:48 a.m. - 12:00 p.m. Q&A
Concurrent Session 4 of 4
11:00 a.m. - 12:00 p.m. Laparoscopy/ Robotics - Kidney/ Prostate/ Other Podium Session Location: Vevey Ballroom Moderators: Steven M. Lucas, MD Detroit, MI Chad R. Tracy, MD Iowa City, IA Discussant: Gopal N. Gupta, MD, FACS Maywood, IL
11:00 a.m. #84 TRANS-RETRO PARTIAL NEPHRECTOMY FOR POSTERIOR RENAL TUMORS: TECHNIQUE AND INITIAL EXPERIENCE Subodh Regmi, Fellow1, Paul Blake2, James K Anderson, Associate Professor1, Christopher Warlick, Associate Professor1, Christopher Weight, Associate Professor1 1University of Minnesota, Department of Urology, Minneapolis, MN, 2University of Medical School, Minneapolis, MN Presented By: Subodh Kumar Regmi
Table of Contents 62 11:04 a.m. #85 TENSILE FORCE EXERTED BY SUTURE DURING RENORRHAPY USING CURRENT TECHNIQUES Joseph Zanghi, DO1, James Siegert, DO1, Thai Nguyen MD, MD2 1Franciscan Health - Olympia Fields, 2Advanced Urology Associates Presented By: Joseph John Zanghi, DO
11:08 a.m. #86 ROBOTIC AND OPEN PARTIAL NEPHRECTOMY FOR INTERMEDIATE AND HIGH COMPLEXITY TUMORS: A MATCHED-PAIRS COMPARISON OF SURGICAL OUTCOMES AT A SINGLE INSTITUTION Zain A Abedali, M Francesca Monn, Brent E Cleveland, Jay Sulek, Clinton D Bahler, Ronald S Boris, Chandru P Sundaram Indiana University School of Medicine Department of Urology Presented By: Zain Abedali
11:12 a.m. #87 THE “STRAIGHTFORWARD” URETERAL REIMPLANTATION: IS THERE A ROBOTIC BENEFIT? Peyton Skupin1, Paholo Barboglio-Romo, MD2, Bahaa Malaeb, MD2, John Stoffel, MD2, Sapan Ambani, MD2 1University of Michigan Medical School, 2University of Michigan Department of Urology Presented By: Peyton Skupin
11:16 a.m. #88 PORCINE LAB AS A USEFUL AND POPULAR ADJUNCT FOR UROLOGIC SURGICAL TRAINING Daniel Szabo, MD, Tasha Posid, MA, PhD, Geoffrey Box, MD The Ohio State University Wexner Medical Center Presented By: Daniel Szabo, MD
11:20 a.m. #89 COMPLEX ROBOT-ASSISTED LAPAROSCOPIC URETERAL REIMPLANT: SAFETY AND OUTCOMES Bruce Lindgren, MD, Rachel Shannon, Ilina Rosoklija, MPH, Emilie Johnson, MD, Dennis Liu, MD, Edward Gong, MD Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Bruce Walter Lindgren, MD
11:24 a.m. #90 TECHNICAL APPROACH AND INITIAL EXPERIENCE FOR ROBOT-ASSISTED SINGLE PORT PROSTATECTOMY Ryan Dobbs, MD, Whitney Halgrimson, MD, Ikenna Madueke, MD, PhD, Hari Vigneswaran, MD, Simone Crivellaro, MD University of Illinois at Chicago, Dept. Urology, Chicago, IL Presented By: Ryan W. Dobbs, MD
11:28 a.m. #91 CHALLENGES IN USING VIDEO-BASED PEER REVIEW PROCESSES FOR ASSESSING SURGEON SKILL Zachary Prebay1, Rodney Dunn2, Ji Qi2, Firas Abdollah3, Wassim Bazzi4, Khurshid Ghani2, William Johnston4, Tae Kim2, Brian Lane5, Thomas Maatman6, Richard Sarle7, Eric Stockall8, Jaya Telang2, James Peabody3, for the Michigan Urological Surgery Improvement, Collaborative 1Medical College of Wisconsin, 2University of Michigan, 3Henry Ford Hospital - Vattikuti Urology Institute, 4Michigan Institute of Urology, 5Spectrum Health Medical Group, 6Michigan Urological Clinic, 7Sparrow Hospital, 8Capital Urological Associates Presented By: Zachary James Prebay
Table of Contents 63 11:32 a.m. #92 ROBOT ASSISSTED RADICAL PROSTATECTOMY IN PATIENTS WITH A HISTORY OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: THE INDIANA UNIVERSITY EXPERIENCE Zain A Abedali, Tim Large, Charles Nottingham, James E Lingeman, Matthew J Mellon, Ronald S Boris Indiana University School of Medicine Department of Urology Presented By: Zain Abedali
11:36 a.m. #93 IMPACT OF MEDIAN LOBES ON URINARY FUNCTION AFTER ROBOTIC RADICAL PROSTATECTOMY Oscar Martinez, MD, Ronney Abaza, MD Robotic Urologic Surgery OhioHealth Dublin Methodist Hospital, Dublin, OH Presented By: Ronney Abaza, MD, FACS
11:40 a.m. #94 HOW DOES THE SINGLE PORT PLATFORM STACK UP? EARLY EXPERIENCE WITH THE SINGLE PORT ROBOTIC- ASSISTED RADICAL PROSTATECTOMY VS ITS MULTI- PORT PREDECESSOR. Whitney Halgrimson, MD, Ryan Dobbs, MD, Gabriel van de Walle, Hari Vigneswaran, MD, Ikenna Madueke, MD, Simone Crivellaro, MD University of Illinois at Chicago Presented By: Whitney Ryan Halgrimson, MD
11:45 a.m. - 12:00 p.m. Q&A
Concurrent Sessions End
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Location: Zurich A *Not CME Accredited
12:00 p.m. - 1:15 p.m. Industry Sponsored Lunch Symposium Location: Zurich B *Not CME Accredited
1:15 p.m. - 2:00 p.m. AUA Course of Choice Lecture: Winning the Battle Against Burnout: The Secrets to Resilience & the Work- Life Balance AUA Course of Choice Guest Speaker: Paul Maroni, MD Aurora, CO
2:00 p.m. - 2:10 p.m. AUA Update AUA Past President: Robert C. Flanigan, MD, FACS Maywood, IL
2:10 p.m. - 2:20 p.m. Report from the NCS AUA Foundation Scholar Speaker: Bethany Baumann, PhD Chicago, IL
2:20 p.m. - 2:25 p.m. Award Presentation: John D. Silbar, Thirlby and Traveling Fellowship Presenter: Aaron J. Milbank, MD Woodbury, MN
Table of Contents 64 2:25 p.m. - 3:00 p.m. Presidential Address: Why Have We Not Yet Cured Urologic Cancer? President: David F. Jarrard, MD Madison, WI
3:00 p.m. - 3:45 p.m. Annual Business Meeting
3:45 p.m. - 4:30 p.m. Reconstruction Urology Panel Discussion Moderator: Bradley A. Erickson, MD, MS, FACS Iowa City, IA Panelists: Frank N. Burks, MD Royal Oak, MI Michael L. Guralnick, MD, FRCSC Milwaukee, WI Boyd R. Viers, MD Rochester, MN
Concurrent Sessions Begin
Concurrent Session 1 of 4
4:30 p.m. - 5:30 p.m. Urinary Incontinence/ Neurourology Podium Session Location: Montreux Moderators: Melissa C. Fischer, MD Bloomfield Twp, MI Brian J. Linder, MD, MS Rochester, MN Discussant: Larissa Bresler, MD, DABMA Maywood, IL
4:30 p.m. #95 STRONG CORRELATION BETWEEN STANDING COUGH TEST AND 24-HOUR PAD WEIGHTS IN THE EVALUATION OF MALE STRESS INCONTINENCE Yooni Yi, MD1,2, Christopher Graziano, MD3, Nabeel Shakir, MD1, Michael Davenport, MD1, Brian Christine, MD3, Allen Morey, MD1 1UT Southwestern Department of Urology, 2University of Michigan Department of Urology, 3Urology Center of Alabama - Birmingham Presented By: Yooni Yi, MD
4:34 p.m. #96 PREDICTIVE FACTORS FOR RECURRENT URINARY TRACT INFECTIONS IN PATIENTS WITH HISTORY OF SPINAL CORD INJURY Ross G Everett, MD MPH, David K Charles, MD, Halle E Foss, Michael A Avallone, MD, R. Corey O'Connor, MD, Michael L Guralnick, MD Medical College of Wisconsin Presented By: Ross G. Everett, MD, MPH
Table of Contents 65 4:38 p.m. #97 PREDICTORS OF UROLOGIC HOSPITALIZATION OR EMERGENCY ROOM VISITS IN SPINAL CORD INJURY PATIENTS ON CLEAN INTERMITTENT CATHETERIZATION Iryna Crescenze, MD1, Paholo Barboglio Romo, MD1, Sara Lenherr, MD, MS2, Jeremy Myers, MD2, Blayne Welk, MD, MSc3, Angela Presson, PhD, MS2, Diana O'Dell, MPH1, Sean Elliott, MD, MS4, John Stoffel, MD1 1University of Michigan, 2University of Utah, 3Western University, 4University of Minnesota Presented By: Iryna Crescenze, MD
4:42 p.m. #98 PUDENDAL NEUROMODULATION IS FEASIBLE AND EFFECTIVE AFTER PUDENDAL NERVE ENTRAPMENT SURGERY Kristen Meier, MD1, Patrick Vecellio2, Kim Killinger1,2, Judith Boura1,2, Kenneth Peters, MD1,2 1Beaumont Health, 2Oakland University William Beaumont School of Medicine Presented By: Kristen Marie Meier, MD
4:46 p.m. #99 WHAT IS THE ASSOCIATION OF NEUROGENIC BLADDER MANAGEMENT AND SEVERE BOWEL SYMPTOMS IN PATIENTS WITH SPINAL CORD INJURY? Paholo Barboglio Romo, MD, MPH1, Iryna M. Crescenze, MD2, Sara M. Lenherr, MD3, Jeremy B. Myers, MD3, Blayne Welk, MD4, Sean P. Elliott, MD, MS5, Diana O'Dell, MPH2, Angela Presson, PhD6, John T. Stoffel, MD2 1University of Mihigan, 2University of Michigan, 3University of Utah, 4Western University, London Ontario, 5University of Minnesota, 6Univerity of Utah Presented By: Paholo Barboglio, MD, MPH
4:50 p.m. #100 THE NO TOUCH TECHNIQUE FOR PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT: OUTCOMES AND HISTORICAL COMPARISON Matthew Ziegelmann, Brian Linder, Daniel Elliott Mayo Clinic Department of Urology Presented By: Matthew J. Ziegelmann, MD
4:54 p.m. #101 PERSISTENT SYMPTOMS AFTER SACRAL NEUROMODULATION: PATIENT TEST RESPONSES INDICATE DEFINITE NEUROPATHIES: AN EVIDENCE- BASED DISCUSSION Stanley Antolak, MD Center for Urologic and Pelvic Pain Presented By: Stanley John Antolak Jr., MD
4:58 p.m. #102 CENTRAL SENSITIZATION AND THE CHRONIC PELVIC PAIN SYNDROME: EVIDENCE FOUND DURING PATIENT EVALUATIONS. Stanley Antolak, MD Center for Urologic and Pelvic Pain Presented By: Stanley John Antolak Jr., MD
Table of Contents 66 5:02 p.m. #103 OUTCOMES IN PATIENTS WITH IDIOPATHIC OVERACTIVE BLADDER UNDERGOING AUGMENTATION CYSTOPLASTY IN THE ERA OF ONABOTULINUMTOXIN-A AND INTERSTIM Akshay Sood, MD, Phil Wong, MD, PhD, Humphrey Atiemo, MD Henry Ford Health System Presented By: Akshay Sood, MD
5:06 p.m. #104 EXAMINING BARRIERS TO FOLLOW UP TREATMENT WITH INTRADETRUSOR ONABOTULINUMTOXINA: THE ROLE OF PATIENT EDUCATION Kristin Ebert, MD1, Christopher Dall, MD, Ketul Shah, MD2, Matthew Harbrecht, MD, Fara Bellows, MD1 1The Ohio State University, 2OHIOHEALTH Presented By: Fara Bellows, MD
5:10 p.m. #105 INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME: LOOKING BEYOND THE BLADDER. EVALUATION OF WOMEN REFERRED FOR PERSISTENT PAIN AFTER PAST DIAGNOSIS AND TREATMENTS. Stanley Antolak, MD Center for Urologic and Pelvic Pain Presented By: Stanley John Antolak Jr., MD
5:15 p.m. - 5:30 p.m. Q&A
Concurrent Session 2 of 4
4:30 p.m. - 5:30 p.m. Prostate Malignant II Podium Session Location: Vevey Ballroom Moderators: Jason M. Hafron, MD Troy, MI Lee E. Ponsky, MD Cleveland, OH Discussant: Gregory B. Auffenberg, MD, MS Chicago, IL
4:30 p.m. #106 CLINICAL UTILITY OF CONFIRMMDX EPIGENETIC TESTING IN DIAGNOSIS OF PROSTATE CANCER Khashayar Arianpour, BS1, Brian Odom, MD2, Kirk Wonjo, MD3, Sugandh Shetty, MD3 1Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA, 2Department of Urology, Beaumont Health System, Royal Oak, Michigan, USA, 3Department Presented By: Brian D. Odom, MD
4:34 p.m. #107 NEGATIVE PREDICTIVE VALUE OF PRE-PROCEDURE MRI OF THE PROSTATE IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE Garrett Berger, PharmD, Robert Medairos, MD, Nicolas Nordin, BS, Peter Dietrich, MD, Scott Johnson, MD, Amy Guise, MD Medical College of Wisconsin, Department of Urology, Milwaukee, WI Presented By: Garrett K. Berger, PharmD
Table of Contents 67 4:38 p.m. #108 LONG-TERM OUTCOMES OF RADICAL PROSTATECTOMY IN MEN WITH A PREOPERATIVE PROSTATE-SPECIFIC ANTIGEN LEVEL 20-49 NG/ML AND >50 NG/ML Jack Andrews, MD, Laureano Rangel, MSc, Stephen Boorjian, MD, Bradley Leibovich, MD, Houston Thompson, MD, Robert Karnes, MD, Mathew Gettman, MD Mayo Clinic Presented By: Jack Andrews, MD
4:42 p.m. #109 FASCIAL ANASTOMOSIS SUSPENSION TECHNIQUE (FAST) DURING OPEN RETROPUBIC RADICAL PROSTATECTOMY: A NOVEL METHOD TO IMPROVE EARLY POSTOPERATIVE RECOVERY OF URINARY CONTINENCE Alessandra Ambu, Dr., Stefano Guercio, Dr., Mauro Mari, Dr., Marco Russo, Dr., Mariateresa Carchedi, Dr., Antonino Battaglia, Dr., Giulio Bonvissuto, Dr., Maurizio Bellina, Dr. Urology Division, Ospedale degli Infermi di Rivoli - ASL TO3 (Turin) Presented By: Alessandra Ambu
4:46 p.m. #110 TRENDS IN SURGICAL PATHOLOGY OF PROSTATE CANCER IN A LARGE COMMUNITY-BASED PRACTICE Paul Yonover1,2, Jason Huang2, David Greenwald2, Laurel Sofer2, Harpreet Wadhwa2, Daniel Dalton1, Justin Cohen1 1UroPartners LLC, Chicago, IL, 2Department of Urology, University of Illinois at Chicago, Chicago, IL Presented By: Jason Huang, MD
4:50 p.m. #111 EPIGENETIC METHYLATION DIFFERENCES ARE GREATER BETWEEN TUMOR-ASSOCIATED AND NON- TUMOR ASSOCIATED BENIGN PROSTATE TISSUES: THE FIELD DEFECT HYPOTHESIS Tariq A. Khemees, MD1, Bing Yang, PhD1, Adam Schultz, BS1, Glen Leverson, PhD2, Tyler Etheridge, MD1, Geoffrey Sonn, MD3, Cristina Magi-Galluzzi, MD4, Erick A Klein Erick A Klein, MD5, Michael Fumo, MD6, David F. Jarrard, MD7 1Department of Urology, University of Wisconsin, 2Department of Surgery, University of Wisconsin, 3Department of Urology, Stanford University, 4Department of Pathology, Cleveland Clinic, 5The Glickman Urological Kidney Institute/ Cleveland Clinic, 6Rockford Urologic, Rockford Illinois, 7Department of Urology/ University of Wisconsin and Carbone Cancer Center Presented By: Tariq A. Khemees, MD
4:54 p.m. #112 SURGICAL VERSUS MEDICAL CASTRATION FOR METASTATIC PROSTATE CANCER: EVALUATION OF OUTCOMES, UTILIZATION, AND FACTORS ASSOCIATED WITH TREATMENT TYPE IN A NATIONAL COHORT Adam Weiner, MD, Jason Cohen, MD, John Delancey, MD, MPH, Edward Schaeffer, MD, PhD, Gregory Auffenberg, MD Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL Presented By: Adam Benjamin Weiner, MD
Table of Contents 68 4:58 p.m. #113 EXTENDED LYMPH NODE DISSECTION IS ASSOCIATED WITH IMPROVED OVERALL SURVIVAL IN PATIENTS WITH VERY HIGH-RISK PROSTATE CANCER: A NATIONAL CANCER DATABASE ANALYSIS Akshay Sood, MD, Jacob Keeley, M.S., Mani Menon, MD, Firas Abdollah, MD Henry Ford Health System Presented By: Akshay Sood, MD
5:02 p.m. #114 PARADATA ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL FOR LONG-TERM PROSTATE CANCER SURVIVORS Alan Paniagua Cruz, BS1, Ted Skolarus, MD, MPH2,3, Dennis O'Reilly3, Tabitha Metreger, MA3, Sarah Hawley, PhD, MPH4,5 1University of Michigan Medical School, Ann Arbor, MI, 2Michigan Medicine, Department of Urology, Ann Arbor, MI, 3VA Ann Arbor Healthcare System, Ann Arbor, MI, 4University of Michigan School of Public Health, Annr Arbor, MI, 5Ann Arbor VA Center-Clinical Management Research, Ann Arbor, MI Presented By: Alan Paniagua Cruz, BS
5:06 p.m. #115 UTILIZING A DEEP-LEARNING NEURAL NETWORK TO AUTOMATE INTERPRETATION OF MAGNETIC RESONANCE IMAGING OF THE PROSTATE Michael Fenstermaker, MD1, Jeffrey Tosoian, MD1, Matthew Davenport, MD2, Simpa Salami, MD1, Arvin George, MBBS1, Rohit Mehra, MD3, Todd Morgan, MD1 1Department of Urology, University of Michigan, 2Department of Radiology, University of Michigan, 3Department of Pathology, University of Michigan Presented By: Michael Fenstermaker, MD
5:10 p.m. #116 TRANSITIONAL ZONE CANCERS DETECTED BY MRI AND URONAV BIOPSY Aidan Gaertner, intern1, Chris Gitter, intern1, Pete Sershon, MD2 1Minnesota Urology Foundation, 2Minnesota Urology Presented By: Chris Gitter
5:14 p.m. #117 WHOLE MOUNT HISTOPATHOLOGICAL CORRELATION WITH PROSTATE MRI IN GRADE I II PROSTATECTOMY PATIENTS Michael Wang, BS1, Nafiseh Janaki, MD2, Christina Buzzy, PhD3, Laura Bukavina, MD MPH3, Kirtishri Mishra, MD3, Amr Mahran, MD MS3,1, Gregory MacLennan, MD2, Lee Ponsky, MD3 1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA, 2Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA, 3Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA Presented By: Michael Wang, BS
5:18 p.m. - 5:30 p.m. Q&A
Table of Contents 69 Concurrent Session 3 of 4
4:30 p.m. - 5:30 p.m. Endourology/ Stone Disease Poster Session Location: St. Gallen 3 Moderators: Kristin G. Baldea, MD Maywood, IL Bodo E. Knudsen, MD, FRCSC Columbus, OH
Poster #47 EFFICIENCY OF HOLMIUM LASER LITHOTRIPSY USING A STONE STABILIZATION SUCTION DEVICE Matthew Lee, Presenting Author, Ali Aldoukhi, Timothy Hall, Khurshid Ghani, William Roberts, Senior Author University of Michigan Presented By: Matthew Lee, MD
Poster #48 COMPARISON OF AUTOMATED IRRIGATION SYSTEMS USING AN IN-VITRO URETEROSCOPY MODEL Donald Fedrigon, BS, Luay Alshara, MD, Manoj Monga, MD Cleveland Clinic Foundation- Glickman Urological Kidney Institute Presented By: Donald Charles Fedrigon III, BS
Poster #49 PREDICTING URETERAL STONE PASSAGE WITH THE RULE OF FOUR Alexander M. Kandabarow, MD, Parth M. Patel, MD, Spencer T. Hart, MD, Ryan A. Dornbier, MD, Gaurav Pahouja, MD, Thomas M.T. Turk, MD, Kristen G. Baldea, MD Loyola University Medical Center Presented By: Alexander M. Kandabarow, MD
Poster #50 INFLUENCE OF INFUNDIBULOPELVIC ANGLE (IPA) ON SUCCESS OF RETROGRADE FLEXIBLE URETEROSCOPY AND LASER LITHOTRIPSY FOR TREATMENT OF RENAL STONES Stephanie Dresner1, Viacheslav Iremashvili2, Sara Best1, Sean Hedican1, Stephen Nakada1 1University of Wisconsin, Dept. of Urology, Madison, WI, 2West Virginia University Health System, Bridgeport, WV Presented By: Stephanie Louise Dresner, MD
Poster #51 BARRIERS TO OBTAINING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) ACCESS Jennifer Saluk, MD1, Joshua Ebel, MD1, Justin Rose, BS1, Marilly Palettas, MPH2, Amy Lehman, MAS2, Bodo Knudsen, MD1 1Department of Urology, Ohio State University Medical Center, Columbus, OH, 2Center for Biostatistics, Ohio State University Medical Center, Columbus, OH Presented By: Jennifer Lynn Saluk, MD
Table of Contents 70 Poster #52 CHARACTERIZING INSTITUTIONAL TRENDS AND CLINICAL DECISION MAKING RELATED TO POSTOPERATIVE URETERAL STENTING FOLLOWING URETEROSCOPIC STONE MANAGEMENT Adam De Fazio, MD, JD, Sari Khaleel, MD, James Anderson, MD, Maria Ordonez, MD, Michael Borofsky, MD University of Minnesota, Department of Urology Presented By: Adam M. De Fazio, MD, JD
Poster #53 TRENDS IN OPIOID MEDICATION PRESCRIBING FOR ACUTE RENAL COLIC MANAGED IN THE EMERGENCY DEPARTMENT Hal Kominsky, MD, Justin Rose, Amy Lehman, MAS, Marilly Palettas, MPH, Michael Sourial, MD The Ohio State University Wexner Medical Center Presented By: Hal Kominsky, MD
Poster #54 PREDICTORS OF INCREASED NARCOTIC USE FOLLOWING URETEROSCOPY WITH URETERAL STENT PLACEMENT Spencer Hart, MD, Alex Kandabarow, MD, Parth Patel, MD, David Perlman, Jazzmyne Montgomery, Gracelene Wegrzyn, Ahmer Farooq, DO, Thomas Turk, MD, Kristin Baldea, MD Loyola University Medical Center Presented By: David Perlman
Poster #55 EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES REDUCES NARCOTIC REQUIREMENT RELATIVE TO MEDICAL EXPULSIVE THERAPY Crystal Valadon1, Charles Nottingham2, Tim Large2, Amy Krambeck2 1University of Louisville School of Medicine, 2Indiana University School of Medicine Presented By: Crystal Valadon
Table of Contents 71 Poster #56 GASTROINTESTINAL DISEASE REDUCES THE HEALTH- RELATED QUALITY OF LIFE OF PATIENTS WITH UROLITHIASIS: CROSS-SECTIONAL ANALYSIS FROM THE NORTH AMERICAN STONE QUALITY OF LIFE CONSORTIUM Kristina L. Penniston, PhD, FAND1, Jodi A. Antonelli, MD2, Necole M. Streeper, MD3, Sri Sivalingam, MD4, Davis P. Viprakasit, MD, FACS5, Timothy D. Averch, MD, FACS6, Jaime Landman, MD7, Thomas Chi, MD8, Ben H. Chew, MD, MSc, FRCSC9, Vincent G. Bird, MD10, Vernon M. Pais, MD11, Sero Andonian, MD, MSc, FRCSC, FACS12, Roger L. Sur, MD13, Noah E. Canvasser, MD14, Stephen Y. Nakada, MD, FACS, FRCS(Glasg.)1 1University of Wisconsin School of Medicine and Public Health, Dept. of Urology, Madison, WI, 2University of Texas Southwestern Medical Center, Dallas, TX, 3Pennsylvania State University College of Medicine, Hershey, PA, 4Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, 5University of North Carolina School of Medicine, Chapel Hill, NC, 6University of Pittsburgh Medical Center, Pittsburgh, PA, 7University of California Irvine School of Medicine, Orange, CA, 8University of California San Francisco School of Medicine, San Francisco, CA, 9University of British Columbia Department of Urologic Services, Vancouver, BC, 10University of Florida College of Medicine, Gainesville, FL, 11Dartmouth Hitchcock Medical Center, Lebanon, NH, 12McGill University Health Center, Montreal, QC, 13University of California San Diego, School of Medicine, San Diego, CA, 14University of California Davis School of Medicine, Sacramento, CA Presented By: Kristina L. Penniston, PhD, RDN, FAND
Poster #57 ANATOMIC AND CLINICAL IMPLICATIONS OF HETEROTOPIC OSSIFICATION IN RENAL PAPILLAE Charles Nottingham, MD1, Michael Borofsky, MD2, Sharon Bledsoe1, Tim Large, MD1, James Lingeman, MD1, James Williams, PhD1 1Indiana University School of Medicine, Indianapolis, IN, 2University of Minnesota Medical School, Minneapolis, MN Presented By: Charles U. Nottingham, MD MS
Concurrent Session 4 of 4
4:30 p.m. - 5:30 p.m. Male and Couple Infertility Poster Session Location: Zurich C Moderators: Ali A. Dabaja, MD Detroit, MI Samuel J. Ohlander, MD Chicago, IL
Table of Contents 72 Poster #58 EXAMINATION OF CENTRIOLE MARKER IN SPERMATOZOA SEPARATED BY DENSITY GRADIENT Mariam Asadullah1, Emily Fishman2, Ahmed Hussein3, Andrew Gerts2, Tariq Shah1, Puneet Sindhwani1, Tomer Avidor-Reiss2 1Department of Urology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 2Department of Biology, University of Toledo, Toledo, OH, 3Ohio State University, Columbus, OH Presented By: Mariam Asadullah
Poster #59 INTRAOPERATIVE USE OF BETADINE IRRIGATION IS ASSOCIATED WITH A 9-FOLD INCREASE OF PENILE PROSTHESSIS INFECTION Madeleine Manka, MD, Kevin Hebert, MD, David Yang, MD, Tobias Köhler, MD, Landon Trost, MD Mayo Clinic Presented By: Madeleine G. Manka, MD
Poster #60 PENILE PROSTHESIS PLACEMENT IN REGISTERED SEX OFFENDERS JJ Zhang, MD1, Molly DeWitt-Foy, MD1, Jane Jankowski, DPS2, Paul Ford, PhD2, Hadley Wood, MD1 1Glickman Urological Kidney Institute, Cleveland Clinic Foundation, 2Center for Bioethics, Cleveland Clinic Foundation Presented By: JJ Haijing Zhang, MD
Poster #61 DOES VAS DEFERENS LENGTH REMOVED AT TIME OF VASOVASOSTOMY AFFECT PREGNANCY OUTCOMES? Jeremy West, MD, Christopher Meier, MD, Denise Juhr, BS, Moshe Wald, MD University of Iowa, Department of Urology, Iowa City, IA Presented By: Jeremy M. West, MD
Poster #62 DISPARITIES BETWEEN EARLY AND LATE PENILE PROSTHESIS PLACEMENT FOLLOWING PROSTATECTOMY Ryan Dornbier, MD, Marc Nelson, MD, Petar Bajic, MD, Joseph Mahon, MD, Eric Kirshenbaum, MD, Ahmer Farooq, DO, Marshall Baker, MD, Gopal Gupta, MD, Christopher Gonzalez, MD, Kevin McVary, MD Loyola University Medical Center Presented By: Ryan Austin Dornbier, MD
Poster #63 INTRACAVERNOSAL VERSUS INTRAURETHRAL ALPROSTADIL: A SYSTEMATIC REVIEW Petar Bajic1, Joseph Mahon1, Hossein Sadeghi-Nejad2,3, Lawrence Hakim4, Kevin McVary1 1Loyola University Medical Center, Center for Male Health, Maywood, IL, 2Department of Urology, Hackensack University Medical Center, Hackensack, NJ, 3Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, 4Department of Urology, Cleveland Clinic Florida, Weston, FL Presented By: Petar Bajic, MD
Table of Contents 73 Poster #64 COMPARISION OF CENTRIOLE REMODELING DURING SPERMATOGENESIS IN HUMAN AND BOVINE TESTES Emily Fishman, PhD Candidate1, Zane Giffen, MD2, Bijan Salari, MD2, Katerina Turner, PhD Student1, Obi Ekwenna, MD2, Puneet Sindhwani, MD2, Tomer Avidor-Reiss, PhD1 1University of Toledo Department of Biological Sciences, 2University of Toledo Medical Center, Department of Urology Presented By: Zane C. Giffen, MD
Poster #65 CHARACTERISTICS OF MEN WHO ARE BOTHERED BY RAPID EJACULATION: RESULTS FROM CLINICAL INTAKE SURVEYS Ajay Gopalakrishna, Manof Alom, Yifan Meng, Raevti Bole, Tobias Kohler, Landon Trost Mayo Clinic Department of Urology Presented By: Ajay Gopalakrishna, MD, MHS
Poster #66 INCREASED PREPAREDNESS BEFORE RADICAL PROSTATECTOMY IS ASSOCIATED WITH BETTER PATIENT REPORTED POST-OPERATIVE SEXUAL OUTCOMES Abhinav Khanna, MD, Anna Faris, BA, Anna Zampini, MD, Daniel Hettel, MD, Hadley Wood, MD, Bradley Gill, MD, MS, Edmund Sabanegh, MD Cleveland Clinic Presented By: Bradley C. Gill, MD, MS
Poster #67 OSTEOCALCIN'S ROLE IN THE REGULATION OF TESTOSTERONE PRODUCTION AS OBSERVED IN RATS AND HUMANS. Jordan Krieger, MD1, Natasza Posielski, MD1, Arthur Burnett, MD2, Haolin Chen, PhD3, Barry Zirkin, PhD3, Brian Le, MD1 1University of Wisconsin, Department of Urology, Madison, WI, 2Johns Hopkins University, Department of Urology, Baltimore, MD, 3Johns Hopkins University, Department of Biochemistry and Molecular Biology, Baltimore, MD Presented By: Jordan Krieger, MD
Poster #68 OPTIMIZATION OF A HANDHELD WAND TO ACTIVATE A SHAPE MEMORY PENILE PROSTHESIS Brian Le, MD1, Kevin McVary, MD2, Rebecca Gerber, MD1, Alberto Colombo, PhD3 1University of Wisconsin School of Medicine Public Health, 2Loyola University Medical Center, 3Southern Illinois University Presented By: Rebecca Gerber, MD
Concurrent Sessions End
6:00 p.m. - 7:30 p.m. Closing Reception Location: Montreux/St. Gallen Foyer
Table of Contents 74 SATURDAY, SEPTEMBER 14, 2019
OVERVIEW
6:30 a.m. - 12:15 p.m. Registration/Information Desk Hours Location: Monte Rosa Registration Desk
6:30 a.m. - 12:15 p.m. Speaker Ready Room Hours Location: Monte Rosa
7:30 a.m. - 11:00 a.m. Spouse/Guest Hospitality Suite Hours Location: Matterhorn
6:00 a.m. – 7:00 a.m. Industry Sponsored Breakfast Symposium Location: Zurich A *Not CME Accredited
Concurrent Sessions Begin
Concurrent Session 1 of 3
7:00 a.m. - 8:00 a.m. Adrenal/ Kidney/ Ureter - Malignant/ Benign Podium Session Location: Vevey Ballroom Moderators: Marcus L. Quek, MD Maywood, IL Ahmad Shabsigh, MD, FACS Columbus, OH Discussant: Bradley C. Leibovich, MD, FACS Rochester, MN
7:00 a.m. #118 RISK FACTORS FOR RECURRENCE FOLLOWING ABLATION FOR CLINICAL T1 RENAL CELL CARCINOMA (RCC) Leo Dreyfuss, Shane Wells, MD, Natasza Posielski, MD, Sara Best, MD, Sean Hedian, MD, Timothy Ziemlewicz, MD, Meghan Lubner, MD, J. Louis Hinshaw, MD, Fred Lee, MD, Glenn Allen, David Jarrard, MD, Stephen Nakada, MD, FACS, FRCS, E. Jason Abel, MD, FACS University of Wisconsin School of Medicine and Public Health Presented By: Leo Dreyfuss, BS
7:04 a.m. #119 COMPUTER GENERATED TUMOR VOLUME AND SURFACE AREA AS PREDICTORS OF PATHOLOGICAL TUMOR GRADE AND STAGE IN RENAL CELL CARCINOMA Arveen Kalapara1, Nick Heller2, Niranjan Sathianathen1, Edward Walczak1, Paul Blake1, Joel Rosenberg1, Keenan Moore3, Heather Kaluzniak4, Zachary Rengel1, Makinna Oestreich1, Zach Edgerton1, Matthew Peterson1, Shaneabbas Raza4, Subodh Regmi1, Nikolaos Papanikolopoulos2, Christopher Weight1 1Department of Urology, University of Minnesota, 2Department of Computer Science Engineering, 3Carelton College, 4University of North Dakota Presented By: Arveen Kalapara, MBBS
Table of Contents 75 7:08 a.m. #120 TOPICAL TREATMENT FOR HIGH GRADE UPPER TRACT CYTOLOGY WITH NEGATIVE IMAGING (HGUTCNI) Andrew Vitale, MD MS1, Jeremy West, MD1, Brenton Sherwood, MD1, Kenneth Nepple, MD1, Sarah Mott, MS2, Michael O'Donnell, MD1 1University of Iowa Hospitals and Clinics, Department of Urology, 3 Roy J Carver, 200 Hawkins Drive, Iowa City, IA, 2University of Iowa Holden Comprehensive Cancer Center, 200 Hawkins Drive, Iowa City, IA Presented By: Andrew Michael Vitale, MD, MS
7:12 a.m. #121 DOES URETERAL STENT PLACEMENT FOR HYDRONEPHROSIS PRIOR TO RADICAL CYSTECTOMY FOR BLADDER CANCER INCREASE THE RISK OF UPPER TRACT RECURRENCE OR URETERAL COMPLICATIONS? Tanner Miest, MD, PhD, Vidit Sharma, MD, Praban Thapa, Matthew Tollefson, MD, Houston Thompson, MD, Stephen Boorjian, MD, Igor Frank, MD, Jeffrey Karnes, MD Department of Urology, Mayo Clinic Presented By: Tanner Miest, MD, PhD
7:16 a.m. #122 COMPUTER GENERATED VS. HUMAN GENERATED R.E.N.A.L. NEPHROMETRY SCORE TO PREDICT SURGICAL OUTCOMES IN RENAL CELL CARCINOMA Paul Blake1, Arveen Kalapara1, Niranjan Sathianathen1, Nick Heller2, Edward Walczak1, Joel Rosenberg1, Keenan Moore3, Heather Kaluzniak4, Zachary Rengel1, Makinna Oestreich1, Zach Edgerton1, Matthew Peterson1, Shaneabbas Raza4, Subodh Regmi1, NikolaosPapanikolopoulos2, Christopher Weight1 1Department of Urology, University of Minnesota, 2Department of Computer Science Engineering, University of Minnesota, 3Carelton College, 4University of North Dakota Presented By: Paul Blake
7:20 a.m. #123 ESTABLISHING A RENAL HEREDITARY SYNDROME CLINIC: A REVIEW OF IDENTIFICATION, TESTING AND SURVEILLANCE OUTCOMES Ryan Speir, MD, Courtney Schroeder, MS, Adam Calaway, MD, Gail Vance, MD, Ronald Boris, MD IU School of Medicine, Department of Urology Presented By: Ryan W. Speir, MD
7:24 a.m. #124 OPEN FIELD FLUORESCENCE IMAGING (SPY-PHI) IS A USEFUL TOOL TO ASSESS TISSUE INTEGRITY IN COMPLEX, OPEN, GENITOURINARY RECONSTRUCTIVE SURGERY Kevin Hebert, MD, Jason Joseph, MD, Jack Andrews, MD, Boyd Viers, MD Mayo Clinic, Department of Urology, Rochester, MN Presented By: Kevin Joseph Hebert, MD
Table of Contents 76 7:28 a.m. #125 A NOVEL METHOD FOR MEASURING SEVERITY OF URETEROPELVIC JUNCTION OBSTRUCTION THAT CORRELATES WITH ROBOTIC PYELOPLASTY FAILURE IN ADULTS Hal Kominsky, MD, Michael Souiral, MD, Justin Rose, Tatevik Broutian, PhD, Geoffrey Box, MD The Ohio State University Wexner Medical Center Presented By: Hal Kominsky, MD
7:32 a.m. #126 RARE RENAL MASS IN A PATIENT WITH A PRIOR PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA Edward Capoccia, resident, Eiftu Haile, Medical Student, Christopher Coogan, Attending Rush University Medical Center Presented By: Eiftu Haile
7:36 a.m. #127 MULTIPLEX POLYMERASE CHAIN REACTION BASED URINARY TRACT INFECTION ANALYSIS COMPARED TO TRADITIONAL URINE CULTURE IN IDENTIFYING SIGNIFICANT UROPATHOGENS IN SYMPTOMATIC PATIENTS Brett Watson, MD1, Andrew Korman2, Kirk Wojno, MD2, Howard Korman, MD2, David Wenzler, MD2, Syed Mohammed A. Jafri, MD1 1Beaumont Health, Dept of Urology, Royal Oak, MI, 2Comprehensive Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
7:40 a.m. #128 RISK FACTORS, DEMOGRAPHIC PROFILES AND MANAGEMENT OF UNCOMPLICATED RECURRENT UIRNARY TRACT INFECTIONS: A SINGLE INSTITUTION EXPERIENCE Amanda Ingram, MD, Aroh Pandit, BM, Justin Rose, BS, Tasha Posid, PhD, Fara Bellows, MD OSUWMC Presented By: Amanda R. Ingram, MD
7:44 a.m. #129 POSTERIOR DESCENT FOLLOWING ISOLATED CYSTOCELE REPAIR M. Francesca Monn, MD, Gabrielle Mcnary, MD, Ethan Ferguson, MD, Charles R. Powell, MD Indiana University Presented By: Ethan L. Ferguson, MD
7:48 a.m. - 8:00 a.m. Q&A
Concurrent Session 2 of 3
7:00 a.m. - 8:00 a.m. Prostate Benign Podium Session Location: Montreux Moderator: David Leavitt, MD Detroit, MI Discussant: James C. Ulchaker, MD, FACS Cleveland, OH
Table of Contents 77 7:00 a.m. #130 REZŪM WATER VAPOR THERMAL THERAPY FOR LOWER URINARY TRACT SYMPTOMS (LUTS) DUE TO BENIGN PROSTATIC HYPERPLASIA (BPH): DURABLE 4- YEAR RESULTS FROM RANDOMIZED CONTROLLED STUDY Kevin McVary, MD1, Claus Roehrborn, MD2 1Stritch School of Medicine, Loyola University Medical Center, 2University of Texas Southwestern Presented By: Kevin Thomas McVary, MD, FACS
7:04 a.m. #131 PREDICTORS OF TREATMENT FAILURE FOR TRANSURETHRAL CONVECTIVE RADIOFREQUENCY WATER VAPOR THERMAL THERAPY (REZUM) FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) Scott Hawken, MD MS, Juan Andino, MD MBA, Rohan Ved, Casey Dauw, MD, John Wei, MD, Chad Ellimoottil, MD, MS University of Michigan Department of Urology Presented By: Scott R. Hawken, MD, MS
7:08 a.m. #132 LONG-TERM REOPERATION RATES FOLLOWING SURGERY FOR BPH: VARIATION BASED ON SURGICAL MODALITY Abhinav Khanna, MD, Navin Sabharwal, BA, Khaled Fareed, MD, James Ulchaker, MD, Kyle Ericson, MD, Bradley Gill, MD, MS Cleveland Clinic Presented By: Bradley C. Gill, MD, MS
7:12 a.m. #133 MIRABEGRON IMPROVES SLEEP MEASURES, NOCTURIA, AND LOWER URINARY TRACT SYMPTOMS IN THOSE WITH URINARY SYMPTOMS ASSOCIATED WITH DISORDERED SLEEP Robert Petrossian1, Danuta Dynda1, Kristin Delfino1, Ahmed El-Zawahry2, Kevin McVary3 1Southern Illinois University, 2University of Toledo, 3Loyola University Medical Center Presented By: Robert Ara Petrossian, MD
7:16 a.m. #134 NATIONAL PRESCRIBING TRENDS IN BENIGN PROSTATIC HYPERPLASIA/LOWER URINARY TRACT SYMPTOMS (BPH/LUTS) Marc Nelson, MD1, Ryan Dornbier, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Brian Matlaga, MD2, Charles Welliver, MD3, Lydia Feinstein, PHD4, Ziya Kirkali, MD5, Tamara Bavendam, MD5, Julia Ward, PHD4, Chyng-Wen Fwu4, Ahmer Farooq, DO1, Kevin McVary, MD1 1Loyola University Medical Center, Maywood, IL, 2Johns Hopkins University, Baltimore, MD, 3Albany Medical College, Albany, NY, 4Social and Scientific Systems, Silver Spring, MD, 5National Institutes of Health, Bethesda, MD Presented By: Marc Nelson, MD
Table of Contents 78 7:20 a.m. #135 NATIONAL SURGICAL TRENDS IN BENIGN PROSTATIC HYPERPLASIA/LOWER URINARY TRACT SYMPTOMS (BPH/LUTS) Marc Nelson, MD1, Ryan Dornbier, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Brian Matlaga, MD2, Charles Welliver, MD3, Lydia Feinstein, PHD4, Ziya Kirkali, MD5, Tamara Bavendam, MD5, Julia Ward, PHD4, Chyng-Wen Fwu4, Ahmer Farooq, DO1, Kevin McVary, MD1 1Loyola University Medical Center, Maywood, IL, 2Johns Hopkins University, Baltimore, MD, 3Albany Medical College, Albany, NY, 4Social and Scientific Systems, Silver Spring, MD, 5National Institutes of Health, Bethesda, MD Presented By: Marc Nelson, MD
7:24 a.m. #136 PREOPERATIVE ANXIETY CORRELATES WITH LOWER URINARY TRACT SYMPTOMS IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE Charles Nottingham, MD, MS1, Crystal Valadon2, Tim Large, MD1, Amy Krambeck, MD1 1Indiana University School of Medicine, Department of Urology, 2University of Louisville, School of Medicine Presented By: Charles U. Nottingham, MD MS
7:28 a.m. #137 INITIAL EXPERIENCE WITH MOSES LASER ENUCLEATION OF THE PROSTATE (MOLEP) Tim Large, MD1, Charles Nottingham, MD1, Chanel Stephens2, Ashley Ross, RN2, Amy Krambeck, MD1 1Indiana University School of Medicine, 2Indiana University Methodist Hospital Presented By: Tim Large, MD, MA
7:32 a.m. #138 COMPARISON OF BPH MEDICATION PRESCRIBING AMONGST SEXAGENARIANS WITH MEDICARE AND PRIVATE INSURANCE Jazzmyne Montgomery1, Petar Bajic1, Marc Nelson1, Ryan Dornbier1, Joseph Mahon1, Lydia Feinstein2, Julia Ward2, Chyng-Wen Fwu2, Ziya Kirkali3, Brian Matlaga4, Charles Welliver5, Ahmer Farooq1, Kevin McVary1 1Loyola University Medical Center, Center for Male Health, Maywood, IL, 2Social and Scientific Systems, Silver Spring, MD, 3National Institutes of Health, Bethesda, MD, 4Johns Hopkins University, Baltimore, MD, 5Albany Medical College, Albany, NY Presented By: Jazzmyne Montgomery, MS
7:36 a.m. #139 PREDICTORS OF TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY COMPLICATIONS Raj Kumar1, Michael Abern2, Gerald Andriole3, Stephen Freedland4, Daniel Moreira2 1University of Illinois College of Medicine, 2University of Illinois, 3Washington University in St. Louis, 4Cedars-Sinai Medical Center Presented By: Raj Anirudh Kumar, BS
Table of Contents 79 7:40 a.m. #140 CLUSTER ANALYSIS REVEALS BOTH BLADDER OUTLET OBSTRUCTION AND DETRUSOR DYSFUNCTION DRIVE NEED FOR SURGICAL TREATMENT OF BPH/LUTS Andrew Schneider, PhD1, Matthew Grimes, MD1, Sijian Wang, PhD2, Wade Bushman, MD, PhD1 1University of Wisconsin, 2Rutgers University Presented By: Wade Bushman, MD, PhD
7:44 a.m. #141 INTERIMAGING ACCURACY OF CT, MRI, AND TRUS IN MEASURING PROSTATE VOLUME COMPARED TO THE ANATOMIC PROSTATIC WEIGHT Vaishnavi Narayanamurthy, MS, Kirtishri Mishra, MD, Amr Mahran, MD,MS, Laura Bukavina, MD, MPH, Lee Ponsky, MD, FACS, Anand Patel, MD, Donald Bodner, MD, Ehud Gnessin, MD University Hospitals/Case Western Reserve University Presented By: Vaishnavi Narayanamurthy
7:48 a.m. - 8:00 a.m. Q&A
Concurrent Session 3 of 3
7:30 a.m. - 8:00 a.m. Trauma/ Transplant Podium Session Location: St. Gallen 1-2 Moderator: Bahaa S. Malaeb, MD Ann Arbor, MI Discussant: Puneet Sindhwani, MD, MS Toledo, OH
7:30 a.m. #142 INDICATIONS AND OUTCOMES OF SIMULTANEOUS BILATERAL NATIVE NEPHRECTOMIES: OUR 10 YEAR PEDIATRIC EXPERIENCE Anja Zann, MD, Seth Alpert, MD, Rama Jayanthi, MD, Daryl McLeod, MD, Molly Fuchs, MD, Daniel Dajusta, MD, Christina Ching, MD Nationwide Children’s Hospital, Columbus, OH Presented By: Jennifer Lynn Saluk, MD
7:34 a.m. #143 RISK OF GENITOURINARY MALIGNANCY IN THE RENAL TRANSPLANT PATIENT Song Jiang, MD, PhD1, Scott Jackson, MS2, Collin Calvert, MPH3, Timothy Pruett, MD2, Christopher Warlick, MD, PhD1 1University of Minnesota, Department of Urology, 2University of Minnesota, Division of Transplantation, Department of Surgery, 3University of Minnesota School of Public Health Division of Epidemiology Community Health Presented By: Song Jiang, MD
7:38 a.m. #144 RISK OF UROLOGIC INJURY AFTER GROUND LEVEL FALL Lauren Folgosa Cooley, MD PhD, Emily Yura, MD, Jason Cohen, MD, Matthias Hofer, MD PhD Northwestern University Presented By: Lauren Folgosa Cooley, MD, PhD
Table of Contents 80 7:42 a.m. #145 PROCEDURES PERFORMED FOR LOWER URINARY TRACT DYSFUNCTION IN PATIENTS PRESENTING FOR RENAL TRANSPLANT EVALUATION Matthew Mazur, M.S., Sarah Perz, MD, Puneet Sindhwani, MD, Arvind Senthikumar, MS University of Toledo College of Medicine and Life Sciences Presented By: Matthew Mazur
7:46 a.m. #146 CONTEMPORARY DIAGNOSTIC EVALUATION OF TRAUMATIC PENILE INJURIES Matthew D. Houlihan, DO1, Mathew Q. Fakhoury, DO1, Florian A. Stroie, DO1, Tobias S. Kohler, MD2, Marc A. Bjurlin, DO3, Courtney M.P. Hollowell, MD1, Samuel Kingsley, MD, PhD4 1Cook County Health, Department of Surgery, Division of Urology, 2Mayo Clinic - Rochester, Department of Surgery, Division of Urology, 3University of North Carolina, Department of Surgery, Division of Urology, 4Advocate Illinois Masonic Hospital, Department of Surgery, Division of Trauma Acute Care Surgery Presented By: Matthew Houlihan, DO
7:50 a.m. - 8:00 a.m. Q&A
Concurrent Sessions End
8:00 a.m. - 9:00 a.m. Roundtable Discussion: Future of Urology Moderator: David F. Jarrard, MD Madison, WI Panelists: Douglas A. Husmann, MD Rochester, MN Ganesh Palapattu, MD, FACS Ann Arbor, MI Kyle A. Richards, MD, FACS Madison, WI Chandru P. Sundaram, MD, FACS Indianapolis, IN
9:00 a.m. - 9:45 a.m. Bizarre and Interesting Case Podium Session Moderators: Bryan D. Hinck, MD Edina, OH Jay B. Hollander, MD Royal Oak, MI
9:00 a.m. #147 POST-COITAL GROSS HEMATURIA: A UNIQUE PRESENTATION OF A RARE CASE OF BLADDER WALL ATERIO-VENOUS MALFORMATION Brijesh Patel, MD, Ryan Farrell, MD, MPH, Laurence Levine, MD RUMC Presented By: Brijesh Patel, MD
9:03 a.m. #148 PROSTAT -"EYE"- TIS: DISSEMINATED PSEUDOMONAS AERUGINOSA INFECTION FROM PROSTATIC ABSCESS PRESENTING WITH VISION LOSS Brett Watson, MD, Sugandh Shetty, MD Beaumont Health, Dept of Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Table of Contents 81 9:06 a.m. #149 HUMAN PENILE OSSIFICATION: A RARE CAUSE OF SEXUAL DYSFUNCTION Alex Belshoff, MD, PhD, Alessa Aragao, MD, Petar Bajic, MD, Maria Picken, MD, Christopher Gonzalez, MD Loyola University Medical Center Presented By: Alex Christopher Belshoff, MD
9:09 a.m. #150 A UNIQUE CASE OF METASTATIC UROTHELIAL SIGNET- RING CELL ADENOCARCINOMA OF THE BLADDER IN A PATIENT PREVIOUSLY DIAGNOSED WITH HIGH GRADE PAPILLARY UROTHELIAL CARCINOMA Ethan Vargo, DO1, Marwan Ali, MD1, Joshua Nething, MD2 1Cleveland Clinic Akron General, Akron OH, 2Summa Health System, Akron OH Presented By: Ethan H. Vargo, DO
9:12 a.m. #151 A UNIQUE CASE OF ESTROGEN-SECRETING LEYDIG CELL TUMOR John Ogunyeke, BS, Brijesh Patel, MD, Laurence Levine, MD, Christopher Coogan, MD RUMC Presented By: Brijesh Patel, MD
9:15 a.m. #152 THE CASE OF THE INCIDENTALLY FOUND DINOSAUR EGG TESTICLES Wesley Baas, MD, Samuel Grampsas, MD Southern Illinois University School of Medicine, Division of Urology Presented By: Wesley Baas, MD
9:18 a.m. #153 NEWLY DIAGNOSED PROSTATE CANCER PRESENTING AS ANTERIOR URETHRAL METASTASIS Yaejee Hong, MD University of Cincinnati Presented By: Yaejee Hong
9:21 a.m. #154 A CHYLOUS CONUNDRUM: THE CURIOUS CASE OF CRYPTOGENIC CLOUDY URINE Kristen Meier, MD, Neal Blatt, MD, PhD, Zachary Liss, MD Beaumont Health Presented By: Kristen Marie Meier, MD
9:24 a.m. #155 THE AIR DOWN THERE: A CASE OF SECONDARY PNEUMOSCROTUM Aravind Viswanathan, MD, Sarah McAchran, MD FACS University of Wisconsin, Madison Presented By: Aravind Viswanathan, MD
9:27 a.m. #156 A NOVEL ETIOLOGY OF URGE INCONTINENCE: IMPROPER URINARY DEVICE Madeleine Manka, MD, Brian Linder, MD Mayo Clinic Presented By: Madeleine G. Manka, MD
9:30 a.m. #157 MUCOSAL DYSPLASIA AND METAPLASIA AFTER CHILDHOOD GASTROCYSTOPLASTY Engy Habashy, MD, Abhinav Sidana, MD, Ayman Mahdy, MD, PhD University of Cincinnati Medical Center, Cincinnati, OH Presented By: Engy Habashy, MD
Table of Contents 82 9:33 a.m. #158 PRIMARY MESENCHYMAL NEOPLASM OF THE URETER CAUSING OBSTRUCTIVE HYDRONEPHROSIS IN A YOUNG MALE: A RARE PRESENTATION Rajiv Karani, BS, Yaejee Hong, MD, Abhinav Sidana, MD University of Cincinnati Presented By: Rajiv Karani
9:45 a.m. - 10:00 a.m. Break Location: Vevey Foyer
Concurrent Sessions Begin
Concurrent Session 1 of 2
10:00 a.m. - 11:00 a.m. Bladder Malignant Podium Session Location: Vevey Ballroom Moderator: Michael E. Woods, MD, FACS Maywood, IL Discussant: Kamal S. Pohar, MD Columbus, OH
10:00 a.m. #159 INCREASED URINARY VEGF-D LEVELS ARE ASSOCIATED WITH RESPONSE TO COMBINED INTRAVESICAL BCG AND ORAL SUNITINIB REGIMEN FOR TREATMENT OF HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) Colton H. Walker, MD1, Christopher M. Russell, MD1, Amir H. Lebastchi, MD2, Stephanie Daignault-Newton, MS1, Monica Liebert, PhD1, Khaled S. Hafez, MD1, Maha H. Hussain, MD3, Jeffrey S. Montgomery, MD1, David C. Miller, MD1, Brent K. Hollenbeck, MD1, Alon Z. Weizer, MD1, Samuel D. Kaffenberger, MD1 1Department of Urology, University of Michigan, 2Urologic Oncology Branch, National Cancer Institute, 3Robert H. Lurie Comprehensive Cancer Center, Northwestern University Presented By: Colton Harrison Walker, MD
10:04 a.m. #160 INTRAVESICAL HISTONE DEACETYLASE INHIBITORS IN COMBINATION WITH PROGRAM CELL DEATH 1 BLOCKADE INDUCES BLADDER TUMOR REGRESSION Spencer Hart, MD1, Brianna Burke2, Luordes Plaza-Rojas2, Gopal Gupta, MD1, Jose Guevara-Patino, MD, PHD2 1Loyola University Medical Center, 2Loyola University at Chicago Presented By: Spencer Hart, MD
10:08 a.m. #161 METASTASECTOMY FOR BLADDER CANCER: USE AND SURVIVAL OUTCOMES IN A NATIONAL COHORT Adam Weiner, MD, Minh Pham, MD, Dylan Isaacson, MD, MPH, Gregory Auffenberg, MD, MS Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL Presented By: Adam Benjamin Weiner, MD
Table of Contents 83 10:12 a.m. #162 IMPACT OF PRIOR ABDOMINOPELVIC RADIATION ON PATIENTS UNDERGOING CYSTECTOMY WITH URINARY DIVERSION Joshua Aizen, MD1, Brittany Adamic, MD1, Craig Labbate, MD1, Ciro Andolfi, MD1, Ryan Werntz, MD1, Norm Smith, MD2, Gary Steinberg, MD1, Joel Wackerbarth, MD1, John Richgels, MD1 1University of Chicago, 2NorthShore University HealthSystem Presented By: Joel J. Wackerbarth, MD
10:16 a.m. #163 SINGLE DOSE INTRAOPERATIVE ANTIBIOTIC PROPHYLAXIS DOES NOT AFFECT INFECTIOUS OUTCOMES AFTER RADICAL CYSTECTOMY Craig Labbate, MD, John Richgels, MD, Ryan Werntz, MD, Gary Steinberg, MD, Sarah Faris, MD University of Chicago Medicine Presented By: Craig Labbate, MD
10:20 a.m. #164 ANTIBIOTIC EXPOSURE PRIOR TO RADICAL CYSTECTOMY INCREASES RISK OF POSTOPERATIVE INFECTION Craig Labbate, MD1, John Richgels, MD1, Kristine Kuchta, MD2, Ryan Werntz, MD1, Norm Smith, MD2 1University of Chicago Medicine, 2Northshore University HealthSystem Presented By: Craig Labbate, MD
10:24 a.m. #165 LONG-TERM OUTCOMES AND SURVIVAL OF PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER AFTER RADICAL CYSTECTOMY AS COMPARED TO BLADDER- SPARING TRI-MODALITY THERAPY Logan Galansky, BA, Brittany Adamic, MD, Craig Labbate, MD, Joshua Aizen, MD, Ryan Werntz, MD, Gary Steinberg, MD University of Chicago Presented By: Logan Galansky
10:28 a.m. #166 PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION FOLLOWING RADICAL CYSTECTOMY: AN INSTITUTIONAL REVIEW. Maximilian Staebler, BSe1, Beija Villalpando, BS1, Robert Tarrell2, Matthew Tollefson, MD3 1Mayo Clinic Alix School of Medicine, Rochester, MN, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 3Department of Urology, Mayo Clinic, Rochester, MN Presented By: Maximilian Helmut Staebler, BSe
10:32 a.m. #167 IMPLICATIONS OF ALVIMOPAN USAGE ON RADICAL CYSTECTOMY PATIENTS: RETROSPECTIVE COHORT STUDY Peter Hanna, Research fellow, Arveen Kalapara, Research fellow, Subodh Regmi, Clinical fellow, Srajana Kalyana, Researcher, Joseph Zabell, Assistant Professor, Badrinath Konety, Professor, Darrel Randle, Assistant Professor, Joyce Wahr, Professor, Christopher Weight, Assistant Professor University of Minnesota Presented By: Peter Tawfik Hanna, Master degree
Table of Contents 84 10:36 a.m. #168 TRENDS IN UTILIZATION OF ROBOTIC AND OPEN APPROACH TO RADICAL CYSTECTOMY: A POPULATION-BASED STUDY, 2002-2014. Natasza Posielski, MD, Brady Miller, MD, E. Jason Abel, MD, Tudor Borza, MD, Glenn Allen, MD, Jessica Schumacher, David Jarrard, MD, Tracy Downs, MD, Kyle Richards, MD University of Wisconsin Presented By: Natasza Posielski, MD
10:40 a.m. - 11:00 a.m. Q&A
Concurrent Session 2 of 2
10:00 a.m. - 11:00 a.m. Socioeconomics/ Health Policy Podium Session Location: St. Gallen 1-2 Moderators: Philipp Dahm, MD, MHSc, FACS Minneapolis, MN Mark D. Stovsky, MD, MBA, FACS Cleveland, OH Discussant: Matthew T. Gettman, MD Rochester, MN
10:00 a.m. #169 BUSINESS AND PRACTICE READINESS IN EARLY CAREER UROLOGISTS—AN UNMET NEED. Larissa Bresler, MD, DABMA1, Michelle Semins, MD2, Humphrey Atiemo, MD3, Audrey Rhee, MD4, Richard Memo, MD5 1Loyola University Medical Center, 2University of Pittsburg, 3Henry Ford Hospital, 4Cleveland Clinic, 5North East Ohio Urology Associates Presented By: Larissa Bresler, MD, DABMA
10:04 a.m. #170 COST SAVINGS ANALYSIS OF INPATIENT ADVANCED PRACTICE PROVIDER Mitchell Ng, BS1, Michael Wang, BS1, Laura Bukavina, MD MPH2, Amr Mahran, MD MS2, Kirtishri Mishra, MD2, Michael Callegari, MD MBA2, Christina Buzzy, PhD3, Lee Ponsky, MD2,3 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Michael Joseph Jefferson Callegari, BS, MBA
10:08 a.m. #172 GENITOURINARY FOREIGN BODY: NATIONWIDE INCIDENCE, TREATMENTS, AND ECONOMIC BURDEN Marc Nelson, MD, Elizabeth Koehne, MD, Ryan Dornbier, MD, David Perlman, Emanuel Eguia, MD, Patrick Sweigert, MD, Marshall Baker, MD, Gopal Gupta, MD, Kristin Baldea, MD, Ahmer Farooq, DO Loyola University Medical Center Presented By: Elizabeth Leone Koehne, MD
Table of Contents 85 10:12 a.m. #173 EVOLUTION OF BPH HEALTHCARE COSTS: 2004-2013 Grace Wegrzyn1, Petar Bajic1, Marc Nelson1, Ryan Dornbier1, Joseph Mahon1, Lydia Feinstein2, Julia Ward2, Chyng-Wen Fwu2, Ziya Kirkali3, Tamara Bavendam3, Brian Matlaga4, Charles Welliver4, Ahmer Farooq1, Kevin McVary1 1Loyola University Medical Center, Center for Male Health, Maywood, IL, 2Social and Scientific Systems, Silver Spring, MD, 3National Institutes of Health, Bethesda, MD, 4Johns Hopkins University, Baltimore, MD Presented By: Gracelen Helene Wegrzyn, BS
10:16 a.m. #174 NATIONAL TRENDS IN USE OF TELEHEALTH BY UROLOGISTS FOR MEDICARE BENEFICIARIES, 2009- 2015. Juan Andino, MD,MBA1, Parth Modi, MD,MS1, Andrew Ryan, PhD,MA2, Brent Hollenbeck, MD1, Chad Ellimoottil, MD, MS1 1University of Michigan, Department of Urology, 2University of Michigan, School of Public Health Presented By: Juan Jose Andino, MD, MBA
10:20 a.m. #175 EVALUATING NATIONAL CARE PATTERNS FOR WOMEN WITH OVERACTIVE BLADDER: IDENTIFYING AREAS FOR IMPROVEMENT Brian Linder, MD, MS, John Gebhart, MD, MS, Daniel Elliott, MD, Holly Van Houten, BA, Lindsey Sangaralingham, MPH, Elizabeth Habermann, PhD Mayo Clinic Presented By: Brian J. Linder, MD, MS
10:24 a.m. #176 THE UROLOGY WORKFORCE SHORTAGE IN RURAL AMERICA: CHARACTERISTICS AND OPPORTUNITIES Daniel Sadowski, Raymond Fang, Amanda North, Christopher Gonzalez, Andrew Harris, William Meeks, Steven Schlossberg, Raj Pruthi, Patrick McKenna Presented By: Daniel James Sadowski, MD, MPhil
10:28 a.m. #177 EVALUATING THE COST-EFFECTIVENESS OF ROUTINE POSTOPERATIVE SERUM LABORATORY TESTING FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY Kevin Wymer, MD, Jason Joseph, MD, Malek Meskawi, MD, Elizabeth Habermann, PhD, Amy Glasgow, Igor Frank, MD, Matthew Tollefson, MD, Matthew Gettman, MD Mayo Clinic Presented By: Kevin Wymer, MD
10:32 a.m. #178 THE CURRENT STATE OF ACCESS AND HEALTHCARE UTILIZATION IN ADULTS WITH UROLOGIC CONGENITALISM: A NATIONAL SURVEY STUDY Nima Baradaran1, Kathryn Quanstrom2, Benjamin Breyer2, Hillary Copp2, Lindsay Hampson2 1Ohio State University, 2University of California San Francisco Presented By: Nima Baradaran
Table of Contents 86 10:36 a.m. #179 FACTORS AFFECTING PATIENT SELECTION OF UROLOGISTS Robert Medairos, MD, Garrett Berger, PharmD, Peter Regala, BA, Scott Johnson, MD Medical College of Wisconsin, Department of Urology, Milwaukee, WI Presented By: Garrett K. Berger, PharmD
10:40 a.m. #180 VARIABILITY IN CASH PRICES FOR ERECTILE DYSFUNCTION MEDICATIONS – ARE ALL PHARMACIES THE SAME? Kirtishri Mishra, MD, Laura Bukavina, MD, MPH, Amr Mahran, MD, MS, Aidan Bobrow, Christina Buzzy, PhD, Nishant Jain, BS, Ehud Gnessin, MD, Aram Loeb, MD, Lee Ponsky, MD University Hospitals/Case Western Reserve University Presented By: Nishant Jain
10:48 a.m. - 11:00 a.m. Q&A
Concurrent Sessions End
11:00 a.m. - 12:00 p.m. NCS Resident Bowl Finals Moderator: Nick Tadros, MD, MCR Springfield, IL Judges: Gary J. Faerber, MD Durham, NC David R. Paolone, MD Madison, WI Charles R. Powell II, MD Indianapolis, IN
12:00 p.m. - 12:05 p.m. Best Poster, Best Video, and Bizarre & Interesting Case Award Presentations Presenter: Jeffrey A. Triest, MD Dearborn, MI
12:05 p.m. - 12:15 p.m. Incoming NCS President Remarks President-Elect: Mark D. Stovsky, MD, MBA, FACS Cleveland, OH
Table of Contents 87 Participant Index
ABAZA, RONNEY AUFFENBERG, GREGORY 9/13/2019 11:36 a.m. AB #93 9/12/2019 9:20 a.m. 9/13/2019 4:30 p.m. ABEDALI, ZAIN 9/13/2019 11:08 a.m. AB #86 BAAS, WESLEY 9/13/2019 11:32 a.m. AB #92 9/14/2019 9:15 a.m. AB #152
ADAMIC, BRITTANY BAHLER, CLINTON 9/12/2019 6:42 a.m. AB #4 9/12/2019 4:30 p.m. 9/12/2019 2:36 p.m. AB #34 BAJIC, PETAR AGARWAL, DEEPAK 9/13/2019 4:30 p.m. Poster #63 9/12/2019 4:30 p.m. Poster #31 BALDEA, KRISTIN AHMED, MOHAMED 9/13/2019 4:30 p.m. 9/12/2019 4:54 p.m. AB #54 9/13/2019 10:45 a.m. Poster #36 BARBOGLIO, PAHOLO 9/13/2019 4:46 p.m. AB #99 ALAMIRI, JAMAL 9/12/2019 6:46 a.m. AB #5 BAUMANN, BETHANY 9/13/2019 2:10 p.m. AMBANI, SAPAN 9/12/2019 6:45 a.m. BAUMGARTEN, LEE 9/13/2019 6:38 a.m. AB #62 AMBU, ALESSANDRA 9/13/2019 4:42 p.m. AB #109 BEECROFT, NICHOLAS 9/12/2019 5:10 p.m. AB #47 ANDINO, JUAN 9/14/2019 10:16 a.m. AB #174 BELLOWS, FARA 9/13/2019 5:06 p.m. AB #104 ANDOLFI, CIRO 9/13/2019 11:20 a.m. AB #77 BELSHOFF, ALEX 9/14/2019 9:06 a.m. AB #149 ANDREWS, JACK 9/12/2019 4:30 p.m. Poster #21 BERGER, GARRETT 9/13/2019 4:38 p.m. AB #108 9/12/2019 2:00 p.m. AB #13 9/13/2019 4:34 p.m. AB #107 ANDRIOLE, GERALD 9/14/2019 10:36 a.m. AB #179 9/12/2019 4:38 p.m. AB #50 BLAKE, PAUL ANTOLAK, STANLEY 9/13/2019 6:30 a.m. Video #7 9/13/2019 4:54 p.m. AB #101 9/14/2019 7:16 a.m. AB #122 9/13/2019 4:58 p.m. AB #102 9/13/2019 5:10 p.m. AB #105 BORCHERT, ALEX 9/12/2019 6:45 a.m. Poster #3 ASADULLAH, MARIAM 9/12/2019 4:30 p.m. Poster #23 9/13/2019 4:30 p.m. Poster #58
Table of Contents 88 BOROFSKY, MICHAEL CHAPARALA, HEMANT 9/12/2019 4:30 p.m. 9/12/2019 4:30 p.m. Poster #15
BOSWELL, TIMOTHY COHEN, JASON 9/12/2019 4:30 p.m. Poster #24 9/12/2019 2:24 p.m. AB #31
BOX, GEOFFREY COHEN, TAL 9/11/2019 11:00 a.m. 9/12/2019 4:30 p.m. Poster #25
BRANNIGAN, ROBERT COLE, ADAM 9/13/2019 8:45 a.m. 9/12/2019 4:30 p.m. Poster #14
BRESLER, LARISSA COOGAN, CHRISTOPHER 9/13/2019 4:30 p.m. 9/11/2019 1:15 p.m. 9/14/2019 10:00 a.m. AB #169 9/11/2019 1:53 p.m.
BROWN, JAMES COOKSON, MICHAEL 9/11/2019 11:00 a.m. 9/12/2019 9:20 a.m. 9/12/2019 11:10 a.m. BUKAVINA, LAURA 9/12/2019 2:32 p.m. AB #33 COOLEY, LAUREN 9/12/2019 4:50 p.m. AB #53 9/14/2019 7:38 a.m. AB #144
BURKS, FRANK COOPER, CHRISTOPHER 9/12/2019 4:30 p.m. 9/12/2019 8:05 a.m. 9/13/2019 3:45 p.m. CORONA, LAUREN BUSHMAN, WADE 9/12/2019 4:30 p.m. Poster #18 9/14/2019 7:40 a.m. AB #140 CRESCENZE, IRYNA CALLEGARI, MICHAEL 9/13/2019 4:38 p.m. AB #97 9/14/2019 10:04 a.m. AB #170 DABAGIA, MARK CAMERON, ANNE 9/12/2019 6:30 a.m. 9/13/2019 11:15 a.m. DABAJA, ALI CARY, CLINT 9/13/2019 4:30 p.m. 9/11/2019 8:00 a.m. DADHICH, PRANAV CASTILLEJO BECERRA, CLARA 9/12/2019 6:30 a.m. AB #1 9/12/2019 4:58 p.m. AB #44 DAHM, PHILIPP CHAN, KATHERINE 9/14/2019 10:00 a.m. 9/13/2019 11:24 a.m. AB #78 9/13/2019 11:32 a.m. AB #80 DALELA, DEEPANSH 9/12/2019 4:58 p.m. AB #55 CHAN, YVONNE 9/12/2019 4:30 p.m. Poster #8 DAUW, CASEY 9/13/2019 11:00 a.m. AB #72 9/12/2019 10:00 a.m.
Table of Contents 89 DAVIS, CARLEY EVERETT, ROSS 9/12/2019 2:00 p.m. 9/12/2019 4:54 p.m. AB #43 9/13/2019 11:15 a.m. 9/13/2019 4:34 p.m. AB #96
DE FAZIO, ADAM FAERBER, GARY 9/13/2019 4:30 p.m. Poster #52 9/12/2019 2:00 p.m. 9/14/2019 11:00 a.m. DIETRICH, PETER 9/12/2019 7:10 a.m. AB #11 FARRELL, M. RYAN 9/12/2019 4:38 p.m. AB #39 DOBBS, RYAN 9/13/2019 11:24 a.m. AB #90 FEDRIGON, DONALD 9/13/2019 4:30 p.m. Poster #48 DOOLITTLE, JOHNATHAN 9/12/2019 7:14 a.m. AB #12 FENSTERMAKER, MICHAEL 9/13/2019 5:06 p.m. AB #115 DORNBIER, RYAN 9/12/2019 6:58 a.m. AB #8 FERGUSON, ETHAN 9/12/2019 2:04 p.m. AB #14 9/14/2019 7:44 a.m. AB #129 9/13/2019 4:30 p.m. Poster #62 FISCHER, MELISSA D'ORO, ANTHONY 9/13/2019 4:30 p.m. 9/13/2019 11:04 a.m. AB #73 9/13/2019 11:08 a.m. AB #74 FLANIGAN, ROBERT 9/13/2019 2:00 p.m. DRESNER, STEPHANIE 9/13/2019 4:30 p.m. Poster #50 GALANSKY, LOGAN 9/13/2019 6:58 a.m. AB #67 DREYFUSS, LEO 9/14/2019 10:24 a.m. AB #165 9/14/2019 7:00 a.m. AB #118 GARDNER, THOMAS DUPREE, JAMES 9/13/2019 10:45 a.m. 9/11/2019 1:15 p.m. 9/11/2019 4:55 p.m. GERBER, REBECCA 9/13/2019 4:30 p.m. Poster #68 ELLIMOOTTIL, CHANDY 9/11/2019 4:10 p.m. GETTMAN, MATTHEW 9/11/2019 9:00 a.m. ELLISON, JONATHAN 9/13/2019 6:30 a.m. 9/12/2019 8:05 a.m. 9/14/2019 10:00 a.m.
ERICKSON, BRADLEY GIFFEN, ZANE 9/11/2019 3:10 p.m. 9/13/2019 4:30 p.m. Poster #64 9/13/2019 3:45 p.m. GILL, BRADLEY ERICSON, KYLE 9/13/2019 4:30 p.m. Poster #66 9/12/2019 4:42 p.m. AB #51 9/14/2019 7:08 a.m. AB #132 9/12/2019 5:14 p.m. AB #59 GITTER, CHRIS 9/13/2019 5:10 p.m. AB #116
Table of Contents 90 GLASER, ALEXANDER HINCK, BRYAN 9/11/2019 3:10 p.m. 9/13/2019 6:30 a.m. 9/14/2019 9:00 a.m. GOPALAKRISHNA, AJAY 9/13/2019 4:30 p.m. Poster #65 HOGE, CONNOR 9/13/2019 10:45 a.m. Poster #39 GRANBERG, CANDACE 9/13/2019 10:45 a.m. Poster #40 9/11/2019 4:10 p.m. HOLLAND, BRADLEY GUPTA, GOPAL 9/12/2019 4:30 p.m. Poster #29 9/11/2019 11:00 a.m. 9/13/2019 11:00 a.m. HOLLANDER, JAY 9/14/2019 9:00 a.m. GURALNICK, MICHAEL 9/13/2019 3:45 p.m. HONG, YAEJEE 9/14/2019 9:18 a.m. AB #153 HABASHY, ENGY 9/14/2019 9:30 a.m. AB #157 HOULIHAN, MATTHEW 9/14/2019 7:46 a.m. AB #146 HAFRON, JASON 9/13/2019 4:30 p.m. HUANG, JASON 9/13/2019 4:46 p.m. AB #110 HAILE, EIFTU 9/14/2019 7:32 a.m. AB #126 HUSMANN, DOUGLAS 9/14/2019 8:00 a.m. HALGRIMSON, WHITNEY 9/12/2019 2:40 p.m. AB #23 INGRAM, AMANDA 9/13/2019 11:40 a.m. AB #94 9/14/2019 7:40 a.m. AB #128
HAN, WOOJIN JAEGER, CHRISTOPHER 9/12/2019 4:30 p.m. Poster #20 9/12/2019 2:44 p.m. AB #36 9/13/2019 11:16 a.m. AB #76 HANNA, PETER 9/14/2019 10:32 a.m. AB #167 JAEGER, IRINA 9/12/2019 4:30 p.m. HART, SPENCER 9/14/2019 10:04 a.m. AB #160 JAIN, NISHANT 9/14/2019 10:40 a.m. AB #180 HAWKEN, SCOTT 9/14/2019 7:04 a.m. AB #131 JARRARD, DAVID 9/11/2019 9:00 a.m. HEBERT, KEVIN 9/12/2019 8:00 a.m. 9/12/2019 7:06 a.m. AB #10 9/12/2019 9:20 a.m. 9/13/2019 6:30 a.m. Video #10 9/13/2019 2:25 p.m. 9/14/2019 7:24 a.m. AB #124 9/14/2019 8:00 a.m.
HELMY, HESHAM JENKINS, LAWRENCE 9/12/2019 4:30 p.m. Poster #27 9/11/2019 4:25 p.m. 9/12/2019 6:30 a.m.
Table of Contents 91 JIANG, SONG KOCJANCIC, ERVIN 9/14/2019 7:34 a.m. AB #143 9/12/2019 4:30 p.m.
JOHNSON, EMILIE KOEHNE, ELIZABETH 9/11/2019 3:25 p.m. 9/14/2019 10:08 a.m. AB #172
JOSEPH, JASON KOMINSKY, HAL 9/12/2019 4:34 p.m. AB #38 9/12/2019 4:42 p.m. AB #40 9/13/2019 4:30 p.m. Poster #53 KACHROO, NAVEEN 9/14/2019 7:28 a.m. AB #125 9/12/2019 2:24 p.m. AB #19 9/12/2019 2:28 p.m. AB #20 KRAEMER, SAMANTHA 9/12/2019 6:30 a.m. Video #3 KADLEC, ADAM 9/12/2019 4:30 p.m. KRAMBECK, AMY 9/13/2019 10:00 a.m. 9/12/2019 10:00 a.m.
KALAPARA, ARVEEN KRIEGER, JORDAN 9/14/2019 7:04 a.m. AB #119 9/13/2019 4:30 p.m. Poster #67
KANDABAROW, ALEXANDER KRISHNAN, NAVEEN 9/13/2019 4:30 p.m. Poster #49 9/12/2019 4:46 p.m. AB #41 9/12/2019 5:02 p.m. AB #45 KARANI, RAJIV 9/14/2019 9:33 a.m. AB #158 KUMAR, RAJ 9/14/2019 7:36 a.m. AB #139 KASSABIAN, VAHAN 9/13/2019 10:45 a.m. Poster #37 LABBATE, CRAIG 9/14/2019 10:16 a.m. AB #163 KHEMEES, TARIQ 9/14/2019 10:20 a.m. AB #164 9/12/2019 4:30 p.m. AB #48 9/13/2019 4:50 p.m. AB #111 LARGE, TIM 9/12/2019 6:30 a.m. Video #2 KLEIN, ERIC 9/12/2019 4:30 p.m. Poster #30 9/12/2019 9:20 a.m. 9/13/2019 6:30 a.m. Video #9 9/12/2019 1:15 p.m. 9/14/2019 7:28 a.m. AB #137 9/12/2019 4:34 p.m. AB #49 9/13/2019 10:45 a.m. Poster #41 LEAVITT, DAVID 9/14/2019 7:00 a.m. KNAPP, PETER 9/11/2019 3:40 p.m. LEE, MATTHEW 9/13/2019 4:30 p.m. Poster #47 KNORR, JACOB 9/13/2019 6:50 a.m. AB #65 LEIBOVICH, BRADLEY 9/11/2019 11:00 a.m. KNUDSEN, BODO 9/14/2019 7:00 a.m. 9/12/2019 10:00 a.m. 9/13/2019 4:30 p.m. LEVIN, MICHAEL 9/13/2019 10:45 a.m. Poster #35
Table of Contents 92 LI, SHUANG MASTERSON, TIMOTHY 9/12/2019 2:12 p.m. AB #16 9/11/2019 8:00 a.m.
LIN, DANIEL MAZUR, MATTHEW 9/12/2019 9:20 a.m. 9/14/2019 7:42 a.m. AB #145 9/12/2019 3:00 p.m. MCACHRAN, SARAH LINDER, BRIAN 9/13/2019 11:15 a.m. 9/13/2019 4:30 p.m. 9/14/2019 10:20 a.m. AB #175 MCVARY, KEVIN 9/14/2019 7:00 a.m. AB #130 LINDGREN, BRUCE 9/13/2019 11:20 a.m. AB #89 MEDAIROS, ROBERT 9/12/2019 2:32 p.m. AB #21 LINGEMAN, JAMES 9/12/2019 4:30 p.m. Poster #22 9/12/2019 2:00 p.m. MEIER, KRISTEN LISS, ZACHARY 9/12/2019 2:08 p.m. AB #15 9/13/2019 11:00 a.m. 9/13/2019 4:42 p.m. AB #98 9/14/2019 9:21 a.m. AB #154 LUCAS, STEVEN 9/13/2019 11:00 a.m. MELLON, MATTHEW 9/12/2019 4:30 p.m. LUNDY, SCOTT 9/12/2019 6:50 a.m. AB #6 MIEST, TANNER 9/14/2019 7:12 a.m. AB #121 MAHON, JOSEPH 9/12/2019 2:40 p.m. AB #35 MILBANK, AARON 9/12/2019 4:30 p.m. Poster #11 9/13/2019 2:20 p.m.
MAIZELS, MAX MILLER, BRADY 9/13/2019 11:28 a.m. AB #79 9/12/2019 2:08 p.m. AB #27 9/12/2019 2:12 p.m. AB #28 MALAEB, BAHAA 9/14/2019 7:30 a.m. MISHRA, KIRTISHRI 9/11/2019 4:55 p.m. AB #171 MANIAR, VIRAJ 9/12/2019 6:30 a.m. Video #6 9/12/2019 4:30 p.m. Poster #26 MONTGOMERY, JAZZMYNE MANKA, MADELEINE 9/14/2019 7:32 a.m. AB #138 9/12/2019 6:34 a.m. AB #2 9/13/2019 4:30 p.m. Poster #59 MOUL, JUDD 9/14/2019 9:27 a.m. AB #156 9/13/2019 10:45 a.m. Poster #38
MARONI, PAUL MUNACO, ANNA 9/13/2019 1:15 p.m. 9/13/2019 7:06 a.m. AB #69
MARTIN, SARAH NAKADA, STEPHEN 9/12/2019 4:30 p.m. Poster #16 9/11/2019 9:30 a.m. 9/11/2019 10:30 a.m.
Table of Contents 93 NAKIB, NISSRINE PANIAGUA CRUZ, ALAN 9/13/2019 10:45 a.m. 9/13/2019 5:02 p.m. AB #114
NARAYANAMURTHY, VAISHNAVI PAOLONE, DAVID 9/12/2019 2:20 p.m. AB #30 9/13/2019 8:45 a.m. 9/14/2019 7:44 a.m. AB #141 9/14/2019 11:00 a.m.
NELSON, MARC PARK, JOHN 9/12/2019 4:30 p.m. Poster #12 9/12/2019 8:05 a.m. 9/14/2019 7:16 a.m. AB #134 9/14/2019 7:20 a.m. AB #135 PATEL, BRIJESH 9/12/2019 4:46 p.m. AB #52 NICHOLS, PAIGE 9/12/2019 5:02 p.m. AB #56 9/12/2019 4:30 p.m. Poster #17 9/14/2019 9:00 a.m. AB #147 9/14/2019 9:12 a.m. AB #151 NOTTINGHAM, CHARLES 9/13/2019 4:30 p.m. Poster #57 PATEL, PARTH 9/14/2019 7:24 a.m. AB #136 9/12/2019 2:20 p.m. AB #18
OCHS, STEVEN PATIL, NILESH 9/12/2019 4:30 p.m. Poster #32 9/12/2019 4:30 p.m.
O'CONNOR, R. COREY PENNISTON, KRISTINA 9/12/2019 4:30 p.m. 9/13/2019 4:30 p.m. Poster #56
ODOM, BRIAN PERLMAN, DAVID 9/12/2019 4:50 p.m. AB #42 9/13/2019 4:30 p.m. Poster #54 9/13/2019 4:30 p.m. AB #106 PETROSSIAN, ROBERT OESTREICH, MAKINNA 9/14/2019 7:12 a.m. AB #133 9/13/2019 7:02 a.m. AB #68 PICKHARDT, MARK OGUNKEYE, JOHN 9/12/2019 6:30 a.m. Video #4 9/12/2019 4:30 p.m. Poster #19 POHAR, KAMAL OHLANDER, SAMUEL 9/14/2019 10:00 a.m. 9/13/2019 4:30 p.m. PONSKY, LEE OMIL-LIMA, DANLY 9/13/2019 4:30 p.m. 9/13/2019 7:10 a.m. AB #70 POSID, TASHA ORRIS, BRADLEY 9/12/2019 2:28 p.m. AB #32 9/11/2019 1:53 p.m. 9/13/2019 6:46 a.m. AB #64 9/13/2019 11:16 a.m. AB #88 PAHOUJA, GAURAV 9/12/2019 7:02 a.m. AB #9 POSIELSKI, NATASZA 9/14/2019 10:36 a.m. AB #168 PALAPATTU, GANESH 9/14/2019 8:00 a.m. POTRETZKE, AARON 9/12/2019 6:45 a.m.
Table of Contents 94 POWELL, CHARLES SANDLOW, JAY 9/12/2019 8:50 a.m. 9/13/2019 8:45 a.m. 9/12/2019 2:00 p.m. 9/14/2019 11:00 a.m. SARLE, RICHARD 9/13/2019 10:45 a.m. PREBAY, ZACHARY 9/13/2019 10:45 a.m. Poster #46 9/13/2019 11:28 a.m. AB #91 SCHMIDT, JONATHAN PRUNTY, MEGAN 9/13/2019 6:30 a.m. Video #11 9/13/2019 11:40 a.m. AB #82 SCHUBBE, MORGAN QUEK, MARCUS 9/12/2019 2:16 p.m. AB #17 9/14/2019 7:00 a.m. 9/12/2019 4:30 p.m. AB #37 9/13/2019 10:45 a.m. Poster #42 RAMBHATLA, AMARNATH 9/12/2019 6:30 a.m. SETIA, SHAAN 9/13/2019 6:42 a.m. AB #63 REGMI, SUBODH 9/13/2019 6:54 a.m. AB #66 9/13/2019 11:00 a.m. AB #84 9/13/2019 7:14 a.m. AB #71
RICHARDS, KYLE SHABSIGH, AHMAD 9/11/2019 1:30 p.m. 9/14/2019 7:00 a.m. 9/13/2019 6:30 a.m. 9/14/2019 8:00 a.m. SHALHAV, ARIEH 9/11/2019 8:30 a.m. ROSS, JONATHAN 9/12/2019 8:05 a.m. SHANNON, RACHEL 9/13/2019 6:30 a.m. Video #12 ROTH, ELIZABETH 9/13/2019 11:00 a.m. SHEETZ, TYLER 9/13/2019 10:45 a.m. Poster #34 RUBINOWITZ, BEN 9/11/2019 2:15 p.m. SHEKAR, ANJALI 9/13/2019 6:30 a.m. AB #60 RYE, ZACHARY 9/13/2019 11:12 a.m. AB #75 SINDHWANI, PUNEET 9/14/2019 7:30 a.m. SADEGHI, ZHINA 9/12/2019 6:45 a.m. Poster #5 SKUPIN, PEYTON 9/13/2019 11:12 a.m. AB #87 SADOWSKI, DANIEL 9/14/2019 10:24 a.m. AB #176 SOARES, RICARDO 9/12/2019 2:36 p.m. AB #22 SALARI, BIJAN 9/12/2019 4:30 p.m. Poster #13 SODERBERG, LEAH 9/13/2019 6:34 a.m. AB #61 SALUK, JENNIFER 9/13/2019 4:30 p.m. Poster #51 SOFER, LAUREL 9/14/2019 7:30 a.m. AB #142 9/12/2019 4:30 p.m. Poster #28
Table of Contents 95 SOOD, AKSHAY TRACY, CHAD 9/12/2019 5:10 p.m. AB #58 9/13/2019 11:00 a.m. 9/13/2019 4:58 p.m. AB #113 9/13/2019 5:02 p.m. AB #103 TRIEST, JEFFREY 9/12/2019 6:30 a.m. SOURIAL, MICHAEL 9/13/2019 10:00 a.m. 9/13/2019 6:30 a.m. 9/14/2019 12:00 p.m.
SPEIR, RYAN TURK, THOMAS 9/14/2019 7:20 a.m. AB #123 9/12/2019 10:00 a.m.
STAEBLER, MAXIMILIAN ULCHAKER, JAMES 9/12/2019 6:45 a.m. Poster #2 9/14/2019 7:00 a.m. 9/14/2019 10:28 a.m. AB #166 ULOKO, MARIA STORM, DOUGLAS 9/13/2019 10:45 a.m. Poster #45 9/13/2019 11:00 a.m. VALADON, CRYSTAL STOVSKY, MARK 9/12/2019 2:44 p.m. AB #24 9/14/2019 10:00 a.m. 9/13/2019 4:30 p.m. Poster #55 9/14/2019 12:05 p.m. VARGO, ETHAN SUNDARAM, CHANDRU 9/14/2019 9:09 a.m. AB #150 9/11/2019 8:00 a.m. 9/11/2019 8:30 a.m. VIERS, BOYD 9/14/2019 8:00 a.m. 9/13/2019 3:45 p.m.
SUSON, KRISTINA VISWANATHAN, ARAVIND 9/13/2019 11:15 a.m. 9/13/2019 10:45 a.m. Poster #44 9/14/2019 9:24 a.m. AB #155 TACHIBANA, ISAMU 9/13/2019 10:45 a.m. Poster #43 VITALE, ANDREW 9/14/2019 7:08 a.m. AB #120 TADROS, NICHOLAS 9/13/2019 10:00 a.m. WACKERBARTH, JOEL 9/14/2019 11:00 a.m. 9/12/2019 2:00 p.m. AB #25 9/14/2019 10:12 a.m. AB #162 TAI, THOMSON 9/12/2019 5:06 p.m. AB #57 WALCZAK, EDWARD 9/12/2019 6:45 a.m. Poster #1 TAKACS, ELIZABETH 9/13/2019 6:30 a.m. WALKER, COLTON 9/14/2019 10:00 a.m. AB #159 TAM, CHRISTOPHER 9/12/2019 2:04 p.m. AB #26 WANG, MICHAEL 9/12/2019 4:30 p.m. Poster #33 TAPPER, ALEXANDER 9/13/2019 5:14 p.m. AB #117 9/12/2019 4:30 p.m. Poster #10
Table of Contents 96 WATSON, BRETT ZHANG, JJ 9/12/2019 6:45 a.m. Poster #6 9/12/2019 4:30 p.m. Poster #9 9/12/2019 6:45 a.m. Poster #7 9/13/2019 11:36 a.m. AB #81 9/14/2019 7:36 a.m. AB #127 9/13/2019 4:30 p.m. Poster #60 9/14/2019 9:03 a.m. AB #148 ZIEGELMANN, MATTHEW WEGRZYN, GRACELEN 9/12/2019 6:30 a.m. 9/14/2019 10:12 a.m. AB #173 9/12/2019 6:38 a.m. AB #3 9/13/2019 8:45 a.m. WEINER, ADAM 9/13/2019 11:44 a.m. AB #83 9/13/2019 4:54 p.m. AB #112 9/13/2019 4:50 p.m. AB #100 9/14/2019 10:08 a.m. AB #161 ZUK, KEEGAN WEST, JEREMY 9/13/2019 6:30 a.m. Video #8 9/13/2019 4:30 p.m. Poster #61
WILLE, MARK 9/12/2019 2:00 p.m.
WILSON, ALEC 9/12/2019 2:16 p.m. AB #29
WOOD, HADLEY 9/11/2019 10:00 a.m. 9/12/2019 6:30 a.m. Video #5
WOODS, MICHAEL 9/14/2019 10:00 a.m.
WREN, JAMES 9/13/2019 8:00 a.m.
WYMER, KEVIN 9/14/2019 10:28 a.m. AB #177
YANG, DAVID 9/12/2019 6:54 a.m. AB #7
YEAMANS, JEFFREY 9/13/2019 10:00 a.m.
YI, YOONI 9/12/2019 5:06 p.m. AB #46 9/13/2019 4:30 p.m. AB #95
YONG, COURTNEY 9/12/2019 6:45 a.m. Poster #4
ZANGHI, JOSEPH 9/13/2019 11:04 a.m. AB #85
Table of Contents 97 Podiums
Podium #1 SUB-FERTILITY AND ITS PSYCHOLOGICAL IMPACT ON MEN Garrett Berger, MS, Pranav Dadhich, MD, Dietrich Peter, MD, Graham Machen, MD, Sandlow Jay, MD, PI, Abbey Kruper, PsyD Medical College of Wisconsin Presented By: Pranav Dadhich, MD
Introduction: Infertility affects an estimated 15% of couples attempting to conceive and male factor etiology is thought to play a part in 50% of cases. The psychologic impact of subfertility on individuals has not traditionally been addressed. This study aims to assess the potential psychological impact of sub-fertility on men presenting for an infertility evaluation. Methods: This single-center prospective study utilized a questionnaire containing both narrative questions and a Likert survey to probe the potential impact on mood, martial relations, sexual experience and ability to cope with subfertility. Data were analyzed using SPSSv24 Results: 164 men completed the questionnaire. Of those, 51.6% reported a negative effect on mood, 24.8% reported a negative effect on their relationship and 24.8% described a negative effect on their sexual experience. Approximately one third of men (34.6%) doubted their ability to manage the emotional impact of this pathology. Lastly, around one-fourth of men (25.7%) requested additional resources to aid in coping with these psychological impacts Conclusion: Sub-fertility has a significant impact on the emotional and psychological well-being of men who presented to our infertility clinic. While the medical management of infertility remains paramount, it is important to consider the emotional toll this pathology has on patients and possible need for further resources. Funding: N/A
Table of Contents 98 Podium #2 USE OF RESTOREX PENILE TRACTION THERAPY TO MAINTAIN PENILE LENGTH POST PROSTATECTOMY Madeleine Manka, MD, Kevin Hebert, MD, Kevin Wymer, MD, David Yang, MD, Trost Landon, MD Mayo Clinic Presented By: Madeleine G. Manka, MD
Introduction: Penile length loss occurs after prostatectomy in 15-68% of cases and reductions of >1 cm are common. Limited data exists on the impact of penile traction therapy (PTT) post-prostatectomy on preventing length loss. This series evaluates the efficacy of RestoreX PTT in men post-prostatectomy. Methods: A randomized, controlled trial (NCT03500419) is evaluating the impact of RestoreX PTT in 60 men post-prostatectomy. Men are randomized to one of three groups for 5 months: Group 1- no therapy; Group 2- treatment with Restorex for 30 minutes 5x/week; Group 3– treatment with RestoreX for 60 minutes 7x/week. Everyone then enters a 6-month open-label phase. Penile length and questionnaires are used to evaluate sexual function. Results: Thirty-one men (mean age 58.1) have enrolled, with 6-month data available on 8 (control=3, traction=5). Forty-five percent of men self-reported baseline erectile dysfunction (mean IIEF score of 22.2). Baseline penile length post-prostatectomy was 12.0 cm (SD 1.8; corona) and 14.7 cm (SD 3.2; tip). At 6-months, men receiving traction demonstrated a mean 2.3 cm length increase compared to 0.5 cm among controls (p=0.03). Reported satisfaction with traction using a 10-point Likert scale was 8.4 (10 highest). One hundred percent would recommend it to a friend and would have chosen PTT post-prostatectomy again. No de-novo penile curvature was reported. All adverse events with traction were mild and well tolerated (40% transient erythema/tenderness). Conclusion: PTT with RestoreX results in significant improvements in penile length post-prostatectomy, with high overall satisfaction and minimal adverse events. Additional data are needed to confirm findings. Funding: N/A
Podium #3 EARLY EXPERIENCE WITH LOW-DOSE ADDERALL FOR TREATMENT REFRACTORY DELAYED EJACULATION AND ANORGASMIA IN MEN Matthew Ziegelmann1,2, Tobias Kohler2, Matthew Houlihan2, Laurence Levine1 1Rush University Medical Center Department of Urology, 2Mayo Clinic Department of Urology Presented By: Matthew J. Ziegelmann, MD
Introduction: Available treatments for delayed ejaculation (DE) and anorgasmia are sub-optimal, leaving many patients to suffer. Adderall is a central nervous system stimulant that enhances cognitive performance and concentration. We hypothesized that harnessing the concentration-boosting effect of Adderall can be used to treat DE and anorgasmia. Methods: We evaluated men with DE or anorgasmia who were treated with low-dose Adderall (5-10 mg by mouth approximately 1-2 hours prior to anticipated sexual activity) from 2015-2018. Patients were screened with thorough medical and social histories. They were counselled on the off-label medication use and potential side effects. A retrospective review was performed to evaluate patient characteristics and subjective symptom improvements. Results: A total of 15 men were treated with Adderall including 6/15 (40%) for anorgasmia and 9/15 (60%) for DE. Median age was 58 years (range 20-76). 5/15 (33%) had stable anxiety or depression. All patients reported delayed/absent orgasm with penetrative intercourse, and 80% (n=12) reported difficulties with self-stimulation. Prior treatments included cabergoline (7/15), oxytocyin (2/15), sex therapy (5/15), PDE5- inhibitors (7/15), and penile vibration (4/15). Follow-up data was available in 13/15 patients, and median follow-up was 8-months. In total, 7/13 (54%) reported satisfactory
Table of Contents 99 improvement in DE including 2/5 with anorgasmia. Minimal side effects were seen in one patient who reported insomnia. Conclusion: Low dose Adderall resulted in symptom improvement in more than 50% of patients with DE or anorgasmia. However, further study including longer-term follow-up is necessary. Careful patient selection and counseling is mandatory given the potential for medication misuse. Funding: N/A
Podium #4 PENILE PROSTHESIS AFTER CYSTECTOMY: RARELY UTILIZED WITH ACCEPTABLE DEVICE SURVIVAL Brittany Adamic, MD1, William Boysen, MD1, Joshua Aizen, MD1, SangTae Park, MD2 1University of Chicago, 2Northshore HealthSystem Presented By: Brittany Adamic, MD
Introduction: Erectile dysfunction (ED) is common after radical cystectomy (RC), with rates as high as 80% however only 2% of these patients undergo penile prosthesis (PP) placement. We aimed to determine device outcomes and factors associated with PP after cystectomy. Methods: The SEER-Medicare Bladder cancer database was queried for men aged >65 who underwent RC between 2002-2013 and had no prior PP implanted. Patients with active disease after RC were excluded. Results: Of 4921 men treated with RC, 66 (1.34%) underwent subsequent PP insertion. Four (6.1%) malleable PP and 62 (93.9%) inflatable PP. The median time from cystectomy to PP placement was 10 months. Patients undergoing PP placement were younger, moslty resided in the West, had lower Charlson Comorbidity Index, and had a history of smoking. Diversion type was not independently associated with PP placement. The incidence of device infection was 3% at 30 days and 4.6% at 90 days. PP revision, removal, or replacement was need in 15.2% and 17.5% of patients at 1 and 3 years respectively. When compared to a propensity matched cohort of radical prostatectomy patients, device survival was worse in the post-cystectomy cohort, with survival rates of 84.8% vs 95.4% and 82.5% vs 93.8% at 1 and 3 years respectively (p=0.018). Conclusion: PP implantation after RC is rare (1.34%) despite device survival of 84.8% and 82.5% at 3 and 5 years respectively. Urologists should discuss ED more frequently in this population. Funding: N/A
Podium #5 MODIFIED TECHNIQUE FOR VASECTOMY REVERSAL RESULTS IN SIGNIFICANTLY IMPROVED OUTCOMES Jamal Alamiri, M.B., B.Ch., BAO, David Y Yang, MD, Madeleine Manka, MD, Joshua Savage, P.A.-C., Manaf Alom, M.B.B.S, Kiran Sharma, Ph.D, Sevann Helo, MD, Tobias Kohler, MD M.P.H, Landon Trost, MD Mayo Clinic Department of Urology Presented By: Jamal Alamiri, MD
Introduction: Vasectomy reversal (VR) technique varies without significant alterations from its original description. We report outcomes of a novel technique (NT) in our VR practice. Methods: A prospective registry of patients (143 men) undergoing VR was queried from 1/2014-10/ 2018. Since 1/2018, we modified our technique, utilizing 5-0 prolene sutures to secure the abdominal and testicular vasa in a side-to-side fashion. We compared outcomes of first-time reversal attempts prior to and following the NT utilizing Wilcoxon testing. Results: 126 men underwent VR (35 NT). Mean patient and partner ages were 42.0 and 32.8, respectively. Mean duration since vasectomy was 9.7 years. Comparing the traditional technique (TT) to NT, no differences were noted in clinicopathologic variables including patient/partner age, duration since vasectomy, number of
Table of Contents 100 vasovasostomy/epididymovasostomy anastomoses, or prior paternity. Compared to TT, men in the NT cohort had greater rates of >100,000 sperm (87% vs 58%,p<0.05), >1 million (87% vs 56%), and non-significantly elevated >0 (87% vs 67%,p=0.18), and >39 million (67% vs 46%,p=0.17). The NT was successful (defined as >5 million or confirmed spontaneous pregnancy) in 89% of cases vs 52% (p<0.01), despite a significantly shorter follow-up time in the NT group. When including only men with one or more vasovasostomy, success rates were more pronounced for all definitions. Conclusion: Based on a limited series, the use of a novel method of securing the vasal anastomosis during VR results in significantly greater outcomes. External validation is required to determine if outcomes can translate to other surgical practices. Funding: N/A
Podium #6 MEN WHO HAVE NOT FATHERED CHILDREN AT TIME OF VASECTOMY ARE UNLIKELY TO SEEK FERTILITY RESTORATION Molly DeWitt-Foy, MD, Andrew Sun, MD, Sarah Vij, MD Cleveland Clinic Presented By: Scott Lundy, MD
Introduction: After vasectomy 10% of men will go on to seek restoration of fertility. Some urologists will not perform vasectomies for patients who have not previously fathered children, assuming that these men are at higher risk for regret. In this study we aim to determine the utilization of fertility restoration among men who underwent vasectomy never having fathered a child. Methods: Retrospective chart review was performed of all patients undergoing vasectomy at one institution 14-years to identify men without prior paternity. Age at vasectomy was recorded. Chart review was performed to determine if patients had sought fertility restoration in our system. Patients who had not been seen within the last year were mailed a study information letter and then were called and asked if they had sought consultation for fertility restoration or used any cryopreserved sperm. Four attempts were made before patients were deemed unreachable. Results: Data was available for 1656 patients. Seventy-two men (4.35%) had not fathered children prior to vasectomy. The mean age at vasectomy for this population was 39.3 years (22-57 years). Seventeen patients were not reachable by phone and had not been seen in our system recently. Of the remaining 55 patients, zero patients had sought consultation for fertility restoration. Conclusion: At our institution no men who had not fathered children at the time of vasectomy sought consultation for reversal. This suggests that these men should not be counseled any differently than a patient who has fathered children, as they are unlikely to develop future regret. Funding: NA
Podium #7 SUTURELESS PLAQUE INCISION WITH GRAFTING DURING IPP PLACEMENT IN PATIENTS WITH PEYRONIE'S DISEASE David Y. Yang, MD1, Joshua Ring, MD2, Kevin J. Hebert, MD1, Matthew J. Ziegelmann, MD1, Georgios Hatzichristodoulou, MD, FEBU, FECSM3, Tobias S. Kohler, MD, MPH1 1Mayo Clinic, Department of Urology, 2SIU Urology, 3Department of Urology and Pediatric Urology, Julius-Maximilians-University of Würzburg, Würzburg, Germany Presented By: David Y. Yang, MD
Introduction: Plaque incision and grafting (PIG) is often necessary to correct residual curvature during IPP placement in Peyronie’s Disease (PD) patients. We present our multi-center experience using Tachosil® (Baxter Healthcare, Deerfield, IL, USA), a sutureless collagen fleece, during IPP placement in patients with severe PD. Methods: We retrospectively reviewed 45 IPP patients from 3 sites who underwent PIG with Tachosil®. Initially, a subcoronal incision is made. After IPP placement, the point of maximum curvature is marked. The neurovascular bundles are lifted, and an incision with
Table of Contents 101 cautery is made through the scar. The exposed device is covered with Tachosil, and the neurovascular bundles are re-approximated. The device is left 70% inflated for 3 weeks. The patient avoids sexual activity for 6 weeks. Results: Outcomes are reported in Table 1. Briefly, the average compound curvature was 70 degrees. The majority of cases had a dorsal component. Only two patients had a ventral curvature requiring urethral mobilization. All patients reported a functional erection at last follow up. Six patients noted residual curvature of less than 15 degrees. Post-operative complications requiring revision were minimal. Conclusion: Tachosil provides a sutureless graft material that is safe and effective for residual curve correction during IPP placement. Funding: N/A
Podium #8 POSTOPERATIVE EMERGENCY DEPARTMENT VISIT AFTER PENILE PROSTHESIS PLACEMENT PREDICTS HIGHER REVISION RATE Ryan Dornbier, MD1, Marc Nelson, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Eric Kirshenbaum, MD1, Gopal Gupta, MD1, Marshall Baker, MD2, Christopher Gonzalez, MD1, Ahmer Farooq, MD1, Kevin McVary, MD1 1Loyola University Medical Center, 2Loyola University Medical center Presented By: Ryan Austin Dornbier, MD
Introduction: Early revision is an undesired complication following penile prosthesis (PP). Though uncommon, reasons for revision include infection, mechanical failure and device erosion. We sought to determine the role of postoperative emergency department (ED) visit as a predictor of PP revision. Methods: Utilizing the Healthcare Cost Utilization Project State Inpatient, State Ambulatory Surgery and Services, and State Emergency Department Databases for Florida between 2009-2015, patients undergoing PP placement were identified by ICD-9 code. Patients were tracked for subsequent return to the ED within 90 days. Revision rates, defined by ICD-9 and CPT codes for PP revision, were compared between patients returning to the ED and those not requiring an ED visit using Chi-squared analysis. Results: 16,689 patients were identified undergoing PP placement. 1,627 patients (9.7%) returned to the ED within 90 days. Rate of revision for patients returning to the ED within 90 days was 19.3% compared to 11.8% for patients not requiring ED visit (p<0.001). The most common diagnosis upon return to the ED was urinary retention (8.6%) followed by unspecified disorder of the penis (3.0%), constipation (3.0%), post-
Table of Contents 102 operative pain (2.6%), and UTI (2.5%). The revision rates among patients presenting with urinary retention and UTI were 19.4% and 22.9%, respectively. Conclusion: Patients returning to the ED within 90 days of PP placement are at increased risk of requiring prosthesis revision. This subgroup of patients should be monitored closely for device infection, failure or erosion. Internal funding
Podium #9 PDE5 INHIBITOR TREATMENT PREFERENCES: A SYSTEMATIC REVIEW Gaurav Pahouja, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Martha Faraday, PhD2, Hossein Sadeghi-Nejad, MD3,4, Lawrence Hakim, MD5, Kevin T. McVary, MD1 1Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2AUA Guidelines Office, Lithincum, MD, 3Department of Urology, Hackensack University Medical Center, Hackensack, NJ, 4Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, 5Department of Urology, Cleveland Clinic Florida, Weston, FL Presented By: Gaurav Pahouja, MD
Introduction: Although the various PDE5 inhibitors (PDE5I’s) have similar efficacy, patient preferences may influence treatment choice and adherence. We performed a systematic review comparing patient preference for the most commonly prescribed PDE5I’s. Methods: We performed Pubmed, Embase, and Cochrane searches between 1/01/65- 7/20/16 to identify articles reporting on PDE5I treatment preferences for ED. Body of evidence was assigned a strength rating of A (high), B (moderate), or C (low). This review was performed as part of the 2018 AUA ED Guidelines. Results: A total of 11 studies examined PDE5I treatment preference. Nearly all studies were observational, evidence grade C. Studies comparing patient preference between two (tadalafil vs sildenafil) and three (tadalafil vs sildenafil vs vardenafil) PDE5I’s showed an overall preference towards tadalafil. 71-74% of patients preferred tadalafil over sildenafil in two-arm studies, and 52% preferred tadalafil vs 24-28% for sildenafil and 14- 20% for vardenafil in three-arm studies. Preferences were significantly associated with improved Psychological and Interpersonal Relationship Scales (PAIRS) time-concerns domain scores in multiple studies. Patients with mild-to-moderate ED preferred tadalafil by a 3-to-1 margin, while those with severe ED preferred it only 1.8-to-1. Of patients who switched from one PDE5i to another, those initially prescribed tadalafil were more likely to switch compared to those initially prescribed sildenafil or vardenafil. Conclusion: Tadalafil is generally favored by patients primarily due to longer duration of action. However, those initially treated with tadalafil were more likely to switch to a different PDE5i than those initially treated with sildenafil or vardenafil. Funding: This review was performed as part of the 2018 AUA Erectile Dysfunction Clinical Guidelines, with the support of the AUA Clinical Guidelines Office, Linthicum, MD.
Podium #10 SHOULD CONTINUATION OF ANTITHROMBOTICS AT TIME OF INFLATABLE PEINLE PROSTHESIS SURGERY BE STANDARD OF CARE? Kevin Hebert, MD, David Yang, MD, Matthew Ziegelmann, MD, Jack Andrews, MD, Madeline Manka, MD, Kevin Wymer, MD, Matthew Houlihan, MD, Landon Trost, MD, Tobias Kohler, MD Mayo Clinic, Dept. Urology, Rochester, MN Presented By: Kevin Joseph Hebert, MD
Introduction: Patients with erectile dysfunction frequently have cardiovascular risk factors requiring antithrombotics (anticoagulation/antiplatelets). Limited data are available on the perioperative morbidity associated with continuation of antithrombotics at time of IPP surgery.
Table of Contents 103 Methods: We retrospectively reviewed medical records of men undergoing IPP surgery at our institution. Statistical analysis was performed to evaluate differences in scrotal drain output, hematoma formation, and post-operative morbidity among patients who continued versus held antithrombotics. Results: 142 patients (mean 64.4 years) underwent IPP placement between July 2017 and December 2018. 85 patients (59%) reported baseline antithrombotic use. 49 of 85 patients (57%) continued antithrombotics through IPP surgery (aspirin 81mg, n=39; aspirin 325mg, n=4; clopidogrel, n=5; apixaban, n=4; warfarin, n=5; rivaroxaban, n=1; and combination therapy, n=9). On univariate analysis, no difference in median post- operative day zero drain output was identified between men who continued versus held antithrombotics through surgery, 82.5mL (38,126) vs 77.5mL (55,125) p=0.80, respectively. A statistically significant difference in self-resolving hematoma rates was seen in those continuing antithrombotics 4 of 49 (8%) versus those not on antithrombotics 1 of 93 (1%), p=0.04. 36 of 85 patients (42%) held antithrombotics with 3 of 36 (8%) experiencing a post-operative cardiovascular/cerebrovascular event. Conclusion: In a small operative series, continuing antithrombotics at the time of IPP surgery increased post-operative hematoma rates compared to those who held antithrombotics, however holding antithrombotics is not without risk. These data suggest judicious consideration of continuing antithrombotics at the time of IPP surgery and require further validation. Funding: N/A
Podium #11 FREQUENCY OF FERTILITY PRESERVATION DISCUSSION IN CANCER PATIENTS VARIES BASED ON AGE Peter Dietrich, G. Luke Machen, Pranav Dadhich, Jonathan Doolittle, Kayvon Kiani, Daniel Roadman, Jay Sandlow Medical College of Wisconsin Presented By: Peter Dietrich, MD
Introduction: The American Society of Clinical Oncology recommends all patients with a cancer diagnosis be counseled on fertility. Despite this, oncofertility is often omitted in pretreatment discussion and planning. This study seeks to evaluate the prevalence of cryopreservation discussions. Methods: A retrospective review was performed on 1442 male patients aged 18-60 years with a cancer diagnosis at a single institution. Patient’s charts were queried for “vasectomy”, “semen”, “sperm”, “fertility” and “preservation”. Data was collected for cryopreservation discussion, discussion before surgical or radiation treatment, discussion before chemotherapy, and if cryopreservation of sperm was performed. Results: A total of 1270 patients were included for analysis. Mean age was 49.5 years. 163 (12.83%) had documentation of counseling on cryopreservation. A logistic regression indicated a significant effect of age, race, organ system, primary treatment, and chemotherapy treatment on whether cryopreservation was discussed (chi2 <0.001, pseudo R2=0.25). Chemotherapy or radiation therapy as primary treatment (OR 4.37, 5.38 respectively, p=0.01) were significantly associated with counseling. Patients aged 30-39, 40-49, and 50-60 were significantly less likely to receive counseling when compared to patients aged 18-29 while controlling for other variables (OR 0.35, 0.12 and 0.05 respectively, p>0.001). Conclusion: Reproductive consequences are important to address when a patient receives a cancer diagnosis. Our study indicates that cryopreservation is vastly underdiscussed. Younger patients and those undergoing chemotherapy or radiotherapy alone as primary treatment were more likely to receive cryopreservation counseling. As assisted reproductive techniques have become more successful and readily available, it is important to counsel all patients. Funding: N/A
Table of Contents 104 Podium #12 RISK FACTORS FOR NON-COMPLIANCE IN POST-VASECTOMY FOLLOWUP Johnathan Doolittle, MD, Peter Dietrich, MD, Pranav Dadhich, MD, Kayvon Kiani, Daniel Roadman, Sarah Brink, Graham Machen, MD, Jay Sandlow, MD MCW Presented By: Johnathan Doolittle, MD
Introduction: Poor compliance with providing a post vasectomy semen analysis (PVSA) has previously been reported, with rates ranging from 34-46%, however reasons for poor compliance are not well described. We sought to further characterize this population by examining the pre-operative characteristics of patients of a large volume surgeon that were predictive of failure to provide a PVSA. Study Design: A retrospective chart review was performed from 2015 to 2018, which identified 1137 patients who underwent vasectomy. Patient characteristics analyzed included age, race, marital status, insurance type, and number of children. Results: 1,137 patients underwent vasectomy. The average age was 37.5 years. 27.5% of patients did not follow up for PVSA at any interval. Age was similar between groups (37.8 vs 37.3 years). However, race, marital status, and insurance did differ, as patients in the no PVSA cohort were more likely to be African American (8.3% vs 3.7%), single (15.3% vs 9.7%) and have Title 19/Medicaid (2.9% vs 1.2%) insurance coverage (all p values <0.05). On multivariate analysis, single relationship status was independently predictive of failing to present for PVSA (RR 1.86, p = 0.02). Age (RR 1.02, p = 0.08) and increasing number of children (RR 1.11, p =0.09) approached significance. Conclusion: A significant percentage of patients do not provide a PVSA confirming sterility, with single relationship status being most predictive of noncompliance when controlling for all other factors. Counseling these patients that they are not sterile until proven with a PVSA is paramount. Funding: N/A
Podium #13 EXPLORING MECHANISMS OF PROTEIN INFLUENCE ON CALCIUM OXALATE KIDNEY STONE FORMATION Garrett Berger, PharmD1, Jessica Eisenhauer, BS2, Andrew Vallejos, BS3, Brian Hoffmann, PhD3, Jeffrey Wesson, MD, PhD2 1Medical College of Wisconsin, College of Medicine, Milwaukee, WI, 2Medical College of Wisconsin, Department of Medicine, Division of Nephrology, Milwaukee, WI, 3Medical College of Wisconsin, Department of Biomedical Engineering, Milwaukee, WI Presented By: Garrett K. Berger, PharmD
Introduction: Calcium oxalate monohydrate (COM) is the primary constituent of most kidney stones, but urinary constituents of organic roots are likely critical to binding these inorganic crystals into stones. Recent data have shown that many proteins comprise this organic matrix, but the matrix was highly enriched in strongly anionic and strongly cationic proteins, suggesting a role for polyanion-polycation aggregation in stone formation. To test this hypothesis, protein aggregates were induced by adding a strongly cationic polymer (polyarginine, pR) to urine protein mixtures obtained from healthy adults to characterize protein distributions in polyanion-polycation aggregates. Methods: Purified proteins (PP) were obtainedfrom random urine samples from six healthy adultsby ultradiafiltration. Protein aggregation was induced byadding pR (0.5 µg pR/µg of PP) to PP solutions. The resulting protein aggregates were separated by centrifugation, yielding aggregate (pRB) and supernatant (pRS) fractions. Portions of each fraction and original PP samples were lyophilized and sent for mass spectrometry. Results: Mass spectrometry data revealed strong similarity between the most abundant COM matrix proteins and pRB proteins with respect to relative enrichment in or exclusion from aggregate phase/matrix but were strongly different then distributions from PP and pRS. Notable differences include enrichment of albumin and uromodulin in the pRB compared to exclusion from COM matrix and the absence of many intracellular or nuclear proteins prominent in COM matrix, but not observed in pRB or PP.
Table of Contents 105 Conclusion: The great similarity between COM matrix and pRB protein distributions suggests that protein aggregation may contribute to stone formation. Funding: NIDDK Research Education Program R25DK098104; VA Merit Review, CX- 001491-01A2
Podium #14 STONES FROM PATIENTS WITH METABOLIC SYNDROME EXHIBIT INCREASED BACTERIAL GROWTH COMPARED TO CONTROLS Ryan Dornbier, MD1, Petar Bajic, MD1, Michelle Van Kuiken, MD2, Marc Nelson, MD1, Alan Wolfe, PhD3, Larissa Bresler, MD1, Ahmer Farooq, DO1, Thomas Turk, MD1, Kristin Baldea, MD1 1Loyola University Medical Center, Maywood, IL, 2University of California Los Angeles, Los Angeles, CA, 3Loyola University Chicago, Department of Microbiology and Immunology Presented By: Ryan Austin Dornbier, MD
Introduction: Patients with metabolic syndrome (MetS) are at increased risk of urinary stones. Currently, association between urinary stones and MetS assumes a sterile urinary tract. With evidence that bacteria play a role in all stone compositions, we sought to characterize bacteria identified from urinary stones in patients with and without MetS. Methods: Adult patients with and without MetS, undergoing PCNL were enrolled. MetS was defined as those meeting 3 of 5 criteria (obesity, hypertension, elevated triglycerides, decreased HDL cholesterol, elevated fasting glucose). Patients received peri-operative antibiotics. Stones were sent for chemical analysis and an enhanced culture method called EQUC. Results: 39 patients with MetS and 10 controls were enrolled. Baseline demographics were similar, except those that pertain to MetS. The figure shows stone composition and bacterial growth by EQUC for both cohorts. Stone composition was not statistically different (top). 43.5% of MetS patients had growth on EQUC compared to 10% control patients (bottom, p=0.049). Bacterial isolates were members of the genera Staphylococcus, Proteus and Aerococcus. Conclusion: Stones extracted from patients with MetS are more likely to grow bacteria by EQUC. Bacteria were present in both infectious and non-infectious stone compositions. Greater abundance of urinary bacteria in MetS patients may make MetS patients more susceptible to stone formation. Internal Funding from Loyola University Chicago School of Medicine
Table of Contents 106 Podium #15 UNDERSTANDING URETERAL ACCESS SHEATH USE WITHIN A STATEWIDE COLLABORATIVE AND ITS EFFECTS ON SURGICAL OUTCOMES AND COMPLICATIONS Kristen Meier, MD1, Spencer Hiller, MD1, Casey Dauw, MD2, John Hollingsworth, MD2, Khurshid Ghani, MD2, Tae Kim2, Kavya Swarna2, Jaya Telang2, S. Mohammad Jafri, MD1, for the Michigan Urological Surgery Improvement, Collaborative2 1Beaumont Health, 2University of Michigan Presented By: Kristen Marie Meier, MD
Introduction: Ureteral access sheaths (UAS) represent a major advance in ureteroscopy (URS), but are not without potential risk. The MUSIC Reducing Operative Complications from Kidney Stones (ROCKS) initiative focuses on improving care by decreasing modifiable emergency department (ED) visits following URS. We investigated patterns and outcomes for UAS usage across Michigan utilizing data from the registry. Methods: We retrospectively analyzed patients undergoing URS from June 2016 to July 2018. Clinicopathologic features included UAS use, complications, readmissions, and ED visits. Results: Analysis included 5316 URS cases with UAS use in 1969 cases (37.7%). Of that, 47.3% of UAS were used for renal and 39.6% for ureteral stones. UAS use varied greatly across practices (Figure 1). There were no differences in intraoperative complications with UAS versus non (1.78% vs 1.51% p=0.447). After adjusting for risk factors, there was no difference in hospitalizations (OR 1.41, p=0.09) or stone-free rates (OR 0.79, p=0.089) between groups. ED visits were higher with UAS (10.16% vs 7.98%, p=0.007) even after adjusting for risk factors (OR 1.37, p=0.020). Conclusion: Though a difference in intraoperative complications was not found, higher rates of ED visits were noted with UAS use. Our findings demonstrate UAS use is not without risk and should be employed judiciously. Funding: Blue Cross Blue Shield of Michigan
Table of Contents 107 Podium #16 EFFECT OF STONE COMPOSITION ON SURGICAL STONE RECURRENCE: SINGLE CENTER LONGITUDINAL ANALYSIS Shuang Li, PhD1, Simone L. Vernez, MD1, Kristina L. Penniston, PhD1, R. Allan Jhagroo, MD2, Sara Best, MD1, Stephen Y. Nakada, MD1,3,4 1University of Wisconsin, School of Medicine Public Health, Department of Urology, 2University of Wisconsin, School of Medicine Public Health, Department of Medicine, 3Department of Medicine, 4Department of Radiology Presented By: Shuang Li, PhD
Introduction: The objective of this study was to explore the association between stone composition and surgical recurrence. Methods: Patients who underwent stone surgery at our institution (2009-2017) were followed for ≥1 year and had ≥1 stone composition analysis were identified. Stone composition (the analysis closest to surgery) was defined as the predominant component (>50%). Repeat surgery was defined as the second surgery on the same kidney unit. Results: Of patients included (n=944), 52% were men. Mean age was 59.0±15.0 y; mean BMI was 31.1±8.2. The time from surgery to stone analysis was 5.7±15.7 months. Patients had undergone ureteroscopy (75.1%), shock-wave lithotripsy (19.4%), and percutaneous lithotomy (5.5%). Over 4.9±2.4 y (median 4.8 y) of follow-up, 27.6% of patients required repeat surgery. Patients’ stone compositions were calcium oxalate (69.3%), calcium phosphate (14.2%), uric acid (9.1%), struvite (2.5%), and cystine (1.0%). Patients with no clear majority component (n=37) were excluded. Survival analysis showed that patients with predominantly calcium oxalate or uric acid stones had a lower risk of repeat surgery. Those with predominantly cystine, calcium phosphate, or struvite had a significantly higher risk of surgical recurrence compared with calcium oxalate (Graph). Conclusion: Patients with cystine, calcium phosphate, or struvite stones had more surgical recurrence compared to patients with calcium oxalate stones. Funding: N/A
Table of Contents 108 Podium #17 REDUCTION IN POST-URETEROSCOPY OPIOID PRESCRIPTIONS IS NOT ASSOCIATED WITH HIGHER PAIN SCORES Morgan Schubbe, MD1, Kevin Flynn, MD1, Jacob Simmering, PhD2, Bradley Erickson, MD, MPH1, Chad Tracy, MD1 1University of Iowa Hospitals and Clinics Department of Urology, 2University of Iowa Hospitals and Clinics Department of Internal Medicine, Division of Pulmonary, Critical Care, and Occupational Medicine Presented By: Morgan E. Schubbe, MD
Introduction: Following prior work that showed over-prescription of narcotics following ureteroscopy, we decreased post-operative narcotic prescription by 50%. Herein we investigate whether this change resulted in differences in post-ureteroscopy patient- reported pain and narcotic utilization. Methods: Patients undergoing ureteroscopy for nephrolithiasis were prospectively enrolled in a study evaluating post-operative pain twice daily through post-op day 14 using an automated text-messaging platform. Patients were discharged with oxycodone #15. The electronic medical record was reviewed for unexpected healthcare encounters (UHE) including phone calls, ER visits, and narcotic refill requests, within 30 days. Results were compared with prior cohort that received 30 pills. Results: Forty-four patients completed the study between October 2018 and January 2019. Mean daily pain scores (Figure), as well as severe pain (VAS ³4) were not statistically different. There was no difference between the 30 pill and 15 pill cohorts in time to pain resolution (6 days vs 4 days; p=0.10) or UHE (p=0.62). There were 13 UHE; 5 related to pain, including 4 ED visits and 1 phone call. There was 1 request for opioid refill. Overall, 94.4% of patients were satisfied with pain control. Conclusion: Reducing opioid prescriptions was not associated with an increase in post- ureteroscopy pain or UHE with high overall patient satisfaction. Funding: N/A
Table of Contents 109 Podium #18 VOLUMETRIC MEASUREMENT IS UNNECESSARY FOR PREDICTING THE PASSAGE OF OBSTRUCTING URETERAL STONES Parth Patel, MD1, Alexander Kandabarow, MD1, Abrar Mian2, Spencer Hart, MD1, Gaurav Pahouja, MD1, Ryan Dornbier, MD1, Ahmer Faroo, DO1, Thomas Turk, MD1, Kristin Baldea, MD1 1LUMC, 2LUC Presented By: Parth Patel, MD
Introduction: Patients with obstructing kidney stones are counseled on their expected prognosis based on linear computer topography (CT) measurements. Advances in imaging allow for volumetric assessments to more accurately predict stone size. The aim of this study was to investigate the clinical utility of volumetric measurements in predicting stone passage in patients with obstructing ureteral calculi. Methods: A retrospective review of emergency room visits between 2008 and 2009 was performed. Inclusion criteria were presence of a CT-confirmed obstructing ureteral calculus and subsequent discharge for trial of passage. Patient demographics and results of the spontaneous passage trial were recorded. Calculated stone parameters included location, two-dimensional linear measurements, and three-dimensional volume measurements (iPlan CMF). Univariate and multivariate analyses were performed to evaluate the association between the aforementioned stone parameters and stone passage. Results: A total of 70 patients were analyzed, 37 (53%) of whom passed their stones. On univariate analysis, patients who passed their stones had lower axial lengths (3.3mm ± 1.3 vs 5.1mm ± 1.7, p <0.01) and smaller volumes (0.03cm3 ± 0.02 vs 0.10cm3 ± 0.08, p <0.01). Multivariate analysis demonstrated that lower axial length was independently associated with stone passage (OR 0.46 [CI 0.29-0.71], p <0.01). Inclusion of stone volume measurements on multivariate analysis, however, provided no benefit for predicting stone passage rates (p = 0.35). Conclusion: Counseling patients with obstructing ureteral calculi based on axial stone length is likely sufficient, as volumetric measurements appear to provide no additional predictive benefit in anticipating their clinical course. Funding: N/A
Podium #19 AUGMENTING THE PREDICTIVE CRITERIA FOR SUCCESSFUL MEDICAL EXPULSIVE THERAPY Naveen Kachroo, MD, PhD1, Rajat Jain, MD2, Luay Alshara, MD1, Sherif Armanyous, MD1, Sara Maskal, BS3, Manoj Monga, MD1, Sriharan Sivalingam, MD1 1Cleveland Clinic, Cleveland, OH, 2University of Rochester, Rochester, NY, 3Case Western Reserve University School of Medicine, Cleveland, OH Presented By: Naveen Kachroo, MD, PhD
Introduction: Numerous clinical and radiological predictors of ureteral stone passage have been proposed. We aimed to identify the key CT based predictors of successful stone passage during medical expulsive therapy (MET). Methods: Patients with an acute unilateral ureteral stone presenting to the Emergency Room from February 2017 - February 2018, managed by MET, were prospectively followed at 1 month for stone passage confirmation. CT variables analyzed: Stone factors (location, size, volume, Hounsfield unit density (HUD)), ureteral HUD above and below the stone, maximal ureteral wall thickness (UWT) at the stone site, contralateral UWT and ureteral diameter above and below the stone. Binary logistic regression analysis was performed to identify stone passage predictors. Results: 49 patients met study inclusion criteria, 32 (65.3%) passed their stone. Only maximal UWT at the stone site was significantly associated with stone passage, with the odds of successful passage decreasing by 97.5% for each 1mm increase in UWT above 2mm (OR 0.0149, p=0.02) (Table 1). Youden’s criterion identified 2.3mm as the optimal UWT cut-off point, below which will accurately predict stone passage with an 87.5% sensitivity and 82.4% specificity.
Table of Contents 110 Conclusion: Maximal UWT at the stone site was the most significant predictor of successful MET in acute unilateral ureteral stones, with an optimal cut-off point of 2.3mm. Funding: N/A
Podium #20 DOES “MYCHART” BENEFIT “MY” STONE SURGERY? – A LOOK AT THE IMPACT OF ELECTRONIC PATIENT PORTALS ON PATIENT EXPERIENCE Naveen Kachroo, MD PhD, Sriharan Sivalingam, MD Cleveland Clinic, Cleveland, OH Presented By: Naveen Kachroo, MD, PhD
Introduction: Electronic patient portals can be beneficial by providing direct engagement and clarity to avoid unnecessary extra provider encounters. This study assessed whether portal usage among endourology patients affected telephone call frequency, unscheduled provider visits and ER presentations. Methods: Retrospective chart review of patients undergoing elective endourology procedures [Shockwave lithotripsy (SWL), Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL)] by a single surgeon at a tertiary Urology center from July 2017- July 2018. Patient demographics, operative details, patient portal (MyChart) registration, patient initiated MyChart messages, telephone encounters, unscheduled provider visits and ER presentations during a 1-month period before and after the procedure, were identified. Logistic regression analysis assessed relationships between MyChart use and study outcomes. Results: We identified 313 patients (200 MyChart users, 113 non-users) who underwent 374 procedures (SWL = 3, URS = 268, PCNL = 103). MyChart users were younger (56 vs 61, p=0.0011) and more likely to be married (69.5% vs 48.7%, p=0.0004). Mychart users made less provider telephone calls, prior to (1.1 vs 1.5, p=0.0037) and post procedure (0.9 vs 1.3, p=0.021) and had less ER visits (8 vs 19, p=0.0002). On multivariable analysis, MyChart non-users were 7.69 (95% CI 2.44-25) times more likely to have an unscheduled provider clinic visit (p=0.0004) and 1.79 (95% CI 1.001-3.125) times more likely to have an ER visit. Conclusion: Patients undergoing Endourology procedures who use MyChart make less telephone calls and are significantly less likely to make an unscheduled clinic/ER visit which will undoubtedly have a beneficial impact on their overall experience. Funding: N/A
Table of Contents 111 Podium #21 IMPACT OF AN ADVISED PAIN REGIMEN FOR URETERAL STONE PATIENTS DISCHARGED FROM THE EMERGENCY DEPARTMENT Robert Medairos1, Kaylee Luck2, Allison Apfel2, David Charles1, Amy Zosel3, John Ray3, Carley Davis1 1Medical College of Wisconsin, Department of Urology, 2Medical College of Wisconsin, 3Medical College of Wisconsin, Department of Emergency Medicine Presented By: Robert Anthony Medairos, MD
Introduction: Instructed pain regimens for symptomatic urolithiasis discharged from the Emergency Department (ED) are not well described. We aim to determine how often patients receive specific pain regimen instructions and the relation to unplanned healthcare resource utilization. Methods: A single-institution retrospective review of consecutive adults with ICD 9/10 codes for urolithiasis presenting to the ED from 6/1/2018 to 12/31/2018 was performed. A specific pain regimen was defined as instructions for acetaminophen or ibuprofen usage documented in the After-Visit Summary (AVS). Telephone calls and ED return visits for stone related symptoms within 30-days were evaluated using univariable and multivariable logistic regression analysis, controlling for possible confounders. Results: A total of 69 patients (42 ± 15 years; 51% male) were included. The average ureteral stone size was 3.5 ± 1.7 mm (31% proximal; 9% mid; 60% distal). Majority of patients were given an opioid prescription (76%). Patients received specific instructions for ibuprofen (76%), acetaminophen (45%), or none at all (17%). Patients advised with an ibuprofen regimen were less likely to call regarding pain related symptoms (multi- variable, p=0.002, B=0.133, R2=0.215), although no difference was observed for return rate to the ED (p=0.12). The rate of telephone calls and ED return visits did not differ with an advised acetaminophen or opioid prescription (p>0.05). Conclusion: A considerable number of patients presenting to the ED for symptomatic urolithiasis did not receive advised pain regimens. When advised ibuprofen, patients had a lower likelihood of calling for stone pain. Further studies evaluating standardized pain regimens may impact unplanned healthcare resource utilization. Funding: N/A
Podium #22 UPPER POLE ACCESS FOR PRONE PERCUTANEOUS NEPHROLITHOTOMY: ADVANTAGE OR RISK? Ricardo Soares, Urologist1, Alec Zhu, Medical Student2, Vidit Talati, Medical Student2, Robert Nadler, Professor of Urology2 1Northwestern Medicine, 2Northwestern University - Feinberg Scho of Medicine Presented By: Ricardo Oliveira Soares, MD, FEBU
Introduction: During percutaneous nephrolithotomy (PCNL), upper pole access is often avoided due to the concern for pleural injury. Our goal is to analyze outcomes of this access. Methods: We retrospectively collected data on patients undergoing PCNL at our institution. Patients were divided in 3 groups according to access: supracostal upper calyx (group 1), subcostal upper calyx (group 2) and non-upper calyx (group 3). Preoperative imaging was reviewed to assess stone burden, Hounsfield units (HU), location and Guy's Stone Score (GSS). Patients were considered stone-free if residual fragments were 3 mm or smaller on CT scan. Results: We analyzed 329 PCNL's (Left: 173; Right: 156). Stones had a median size of 32mm, 800 HU and GSS of 2. Groups 1, 2 and 3 had 121, 107 and 101 patients, respectively. The 90-day complication rate was 21.3%, (7.0% Clavien 3-4). Group 1 patients had higher BMI, stone size and GSS. In group 1, SFR was higher than group 3 (89.3% vs 79.2%, p=0.023) with less need for subsequent endoscopic procedures (6.6%), but with higher risk of grade 3-4 complications (15.7%, p=0.001). Within group 1, right PCNL carried higher risk of chest tube insertion (22.2% vs 3.4%, p=0.012). There was no significant difference in grade 3-4 complications between groups 2 and 3 (1.9% vs. 3.0%).
Table of Contents 112 Conclusion: Upper pole access is safe and effective, particularly if subcostal. Supracostal access is an effective option to achieve higher stone-free rates in complex stones, while carrying a risk of significant hydrothorax, particularly on the right side. Funding: N/A
Podium #23 CAN WE BE STONE FREE? VALIDATION OF A DYNAMIC DECISION ENGINE FOR PREDICITING STONE FREE RATE Whitney Halgrimson, Resident1, Susana Berrios, Student2, Matthew Del Pino, Student2, Simone Crivellaro, Visiting Associate Professor1 1UIC COM, Dept of Urology, 2UIC COM Presented By: Whitney Ryan Halgrimson, MD
Introduction: The choice of treatment for renal and ureteral stones between Ureteroscopy (URS) or Shock Wave Lithotripsy (SWL) is often based on surgeon preference, patient preference and stone characteristics. Unlike static generalized models, the Stone Decision Engine (Translational Analytics and Statistics, Tucson AZ) offers individualized stone free rate (SFR) predictions based on continuously updated data. We validated this predictive model using URS and SWL outcomes from our academic institution. Methods: We performed retrospective analyses of renal and ureteral stone cases treated with SWL or URS between September 2017 and August 2018. Stones greater than 20 mm, diverticular stones, or patients without follow-up were excluded. Stones were characterized by complexity and SFR were then predicted. The decision engine also offered a literature based SFR for comparison. Results: Fifty URS and 25 SWL procedures were performed during the time period. Patients were between 24 to 85 years age; 46/75 patients were female; BMI range was 13.5 to 46.5. True SFR for URS and SWL were 64% and 44%, respectively, compared to predicted rates of 71.8% and 75%. Area under the curve for the URS and SWL predictive models were 0.73 and 0.71. Conclusion: The Stone Decision Engine may be useful to patients and providers in predicting outcomes from URS and SWL. Funding: N/A
Table of Contents 113 Podium #24 USE OF A COAGULUM DURING URETEROSCOPIC STONE REMOVAL ADDS NO ADDITIONAL CASE TIME OR COMPLICATIONS Crystal Valadon1, Charles Nottingham2, Tim Large2, Amy Krambeck2 1University of Louisville School of Medicine, 2Indiana University School of Medicine Presented By: Crystal Valadon
Introduction: Ureteroscopic basketing of small stone fragments can be time-consuming and challenging, especially if the patient maintains a large overall burden of stone material. The purpose of this study was to evaluate if use of a blood coagulum provides any benefit or burden to ureteroscopic stone basket extraction. Methods: We enrolled adult patients undergoing ureteroscopic stone removal with laser lithotripsy for renal and ureteral stones under 20 mm in total size with IRB approval. Patients with a coagulative disorder or on anticoagulant medication were excluded. Following laser lithotripsy, a peripheral blood sample or “coagulum” administered through the ureteroscope into the areas of the kidney containing stone fragments. After five minutes of coagulation time, ureteroscopic stone basket extraction was initiated. We then matched these patients 1:1 to standard patients who had previously undergone ureteroscopic stone removal without coagulum by age, stone composition, and preoperative stone size. Results: We included 21 patients in each group, with all results summarized in table 1. A median of 9 milliliters of coagulum was used. We observed no difference in total operating room (99 vs 110 minutes; p=1.000), procedure time (84 vs 69 minutes; p=0.354), stone-free rate (91% vs 81%; p=0.663), or complication rate (0 vs 19%; p=0.107) between coagulum and matched standard patients. All complications were Clavien-Dindo grade II. Conclusion: Coagulum is a useful tool for ureteroscopic stone basket extraction that adds no additional procedural time or morbidity and does not alter the stone-free rate. Funding: N/A
Podium #25 IMPACT OF UROLOGIC SURGERY ON INCREASED RATES OF PERSISTENT OPIOID USE: A NATIONAL SAMPLE Joshua Aizen, MD, Sandra A. Ham, MS, Logan Galansky, BA, Brittany Adamic, MD, Craig Labbate, MD, Ciro Andolfi, MD, Sarah Faris, MD, Joel Wackerbarth, MD, John Richgels, MD University of Chicago Presented By: Joel J. Wackerbarth, MD
Introduction: Although perioperative opioid exposure is implicated in the emergent opioid epidemic, the impact of these prescriptions on long-term use following urologic surgery is unknown. We sought to determine rates of new persistent opioid use among a previously opioid-naïve surgical population. Methods: We identified adults aged 18 to 64 who underwent any urologic procedure in 2014-2015 using the Truven Health MarketScan database. Patients were excluded if they filled an opioid prescription in the 12 months preceding surgery. For patients who filled an opioid prescription in the immediate post-operative period, prevalence of persistent opioid use was calculated over 90-day intervals in the 12 months following surgery. We compared these rates to those of a 1:3 comorbidity-matched non-surgical sample. Results: In 2014-2015, 80,657 patients met the inclusion criteria. The cohort had a mean age of 44.4±10.7 years and was predominantly male (50,139 [62.2%]). Prevalence of persistent opioid use across the discrete time intervals ranged from 4.72-5.27%, 5.52- 6.54%, 8.20-8.80% and 3.46-3.80% for abdominal, endoscopic, percutaneous, and scrotal/penile/perineal/vaginal procedures, respectively. In the non-operative cohort, rates of new opioid use were significantly less, ranging from 3.26-3.59% (p <0.0001). Preoperative risk factors independently associated with persistent opioid use included tobacco use (OR 1.33; 95% CI 1.24-1.44), any mental health or pain-related diagnoses
Table of Contents 114 (≥3 diagnoses: OR 1.89; 95% CI 1.77-2.01), and total initial opioid prescription ≥300 morphine milligram equivalents (OR 1.35; 95% CI 1.26-1.45). Conclusion: A meaningful fraction of previously opioid-naïve patients receiving outpatient opioid analgesia following urologic procedures will go on to develop persistent opioid use. Funding: The University of Chicago Institute for Translational Medicine Core Subsidy Award
Podium #26 NEW PERSISTENT OPIOID USE AFTER URETEROSCOPY FOR STONE TREATMENT Christopher Tam1, Casey Dauw1, Vidhya Gunaseelan1, Tae Kim1, David Leavitt2, Jeremy Raisky1, Phyllis Yan1, John Hollingsworth1, Michigan Urological Surgery Improvement Collab1 1University of Michigan, 2Henry Ford Hospital - Vattikuti Urology Institute Presented By: Christopher Tam, MD
Introduction: Emerging data suggest that many opioid addictions surface after surgery. To examine this, we measured the incidence of persistent opioid use following ureteroscopy (URS) for stone treatment. Methods: Utilizing the Clinformatics DataMartTM Database, we identified adults who underwent outpatient URS for stone treatment between 1/1/2008 and 12/31/16 and filled an opioid prescription attributed to surgery. Our primary outcome was new persistent opioid use - defined as opioid-naive patients (those with no opioid prescriptions between 12 months and 31 days before surgery), who filled an opioid prescription attributed to surgery and then filled at least one additional opioid prescription 90 to 180 days after surgery. We then fit a multivariable logistic regression model to determine patient factors associated with new persistent opioid use. Results: 48,576 patients underwent outpatient URS for stone treatment. Of these, 53% were opioid-naive. Among opioid-naive patients, 1,671 (7%) developed new persistent opioid use. The figure shows the trajectory of mean daily opioid dose with patients stratified by perioperative opioid use. Patient factors associated new persistent opioid use included filling an opioid prescription within the 30 days before surgery (OR 1.26, 95% CI 1.12-1.41) and female gender (1.17; 1.06-1.30). Conclusion: Nearly 1 in 14 opioid-naive patients go on to persistent opioid use after URS for stone treatment. Funding: Blue Cross Blue Shield of Michigan.
Table of Contents 115 Podium #27 FEMALE SURGEONS AND SURGICAL TRAINEES TEND TO UNDER RATE TECHNICAL SKILLS ON SELF-ASSESSMENT Brady Miller, David Azari, Rebecca Gerber, Robert Radwin, Brian Le Presented By: Brady L. Miller, MD, MPH
Introduction: Simulation of surgical skills is increasingly common in modern residency training. Here, we identify gender differences in self-assessment of surgeons and trainees. Methods: Medical students, residents, attending and retired surgeons completed simple interrupted (SIS) and running subcuticular suturing (RSC) tasks. Assessment was self- rated using previously tested visual analog motion scales. Tasks were video recorded and rated by blinded expert surgeons using identical motion scales. Results: Female (n=17) and male (n=20) participants were equally distributed by level of training, p=0.76. Five expert surgeons evaluated 220 30-second video segments (mean 3.0 segments per task per participant). Self-assessment correlated well overall with expert rating for SIS, RSC tasks. Mean individual difference of self-assessment and expert assessment scores (SAS-ERS) differed by gender in the domains of motion economy (-1.1±1.6 female vs -0.2±1.6 male, p=0.08 for RSC) and fluidity of motion (-1.2±1.6 female vs -0.1±1.8 male, p=0.04 for SIS). SAS-ERS was similar in the domains of tissue handling and coordination. SAS-ERS did not differ significantly in any domains across levels of training. Expert ratings did not differ significantly by gender for any domain. Conclusion: Female surgeons and trainees under rate some technical skills on self- assessment, while male surgeon and trainee self-ratings were concordant with experts. Funding: Society of Academic Urologists
Podium #28 USING SURGEON HAND MOTIONS TO IDENTIFY SURGICAL MANEUVERS Brady Miller, David Azari, Rebecca Gerber, Robert Radwin, Brian Le Presented By: Brady L. Miller, MD, MPH
Introduction: Automatic computer vision recognition of surgical maneuvers could expedite video review and support objective assessment. Here, we explore how machine learning techniques predict simulated surgical maneuvers. Methods: Thirty-seven clinicians performing suturing benchtop simulations without sensors were video recorded. Three machine learning techniques (decision trees, random forests, and hidden markov models) classified surgical maneuvers every two seconds (60 frames). Twenty percent of video segments were randomly selected as a test set for random forest prediction, while thirty percent of participants from each experience group (medical students, junior residents, senior residents, attendings)
Table of Contents 116 comprised a testing set of twelve participants (ie, participant-controlled). This allowed for random selection and within-user population accuracy prediction estimates. Results: Random forest predictions correctly classified 74% of all video segments into suturing, tying, and transition states for a randomly selected test set. By comparison, decision tree analysis correctly classified 64% of video segments. Hidden markov model adjustments improved the random forest predictions to 79% for simple interrupted suturing on a subset of randomly selected participants. Conclusion: Random forest predictions aided by hidden markov modeling provided the best prediction of surgical maneuvers. Marker-less video motion tracking can predict surgical maneuvers with similar accuracy as robotic and sensor-aided platforms and may enable more efficient video review of surgical procedures. Funding: Society of Academic Urologists
Podium #29 AN ASSESSMENT OF FACTORS ASSOCIATED WITH LACK OF EARLY SOCIAL CO NTINENCE FOLLOWING RADICAL PROSTATECTOMY: ANALYSIS OF THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE (MUSI C) Alec Wilson, MD1, Michael Cher, MD2, Rodney Dunn, MS3, Khurshid Ghani, MD3, Tae Kim3, David Miller, MD3, James Montie, MD3, James Peabody, MD4, Ji Qi, MS3, M. Hugh Solomon, MD3, Alexander Tapper, MD1, Jaya Telang3, Bradley Rosenberg, MD5, Frank Burks, MD1, for the Michigan Urological Surgery Improvement, Collaborative3 1William Beaumont Hospital, 2Wayne State University, 3University of Michigan, 4Henry Ford Hospital - Vattikuti Urology Institute, 5Comprehensive Urology Presented By: Alec Wilson, MD
Introduction: Radical prostatectomy (RP) is a common treatment of localized prostate cancer (PCa). Next to oncologic control, maintenance of quality of life – especially urinary continence – remains a critical end point. The Michigan Urological Surgery Improvement Collaborative (MUSIC) aims to identify pre-operative characteristics that may predict lack of social continence (0-1 pad daily) 3 months post-RP. Methods: MUSIC, a physician lead quality improvement consortium, established a patient reported outcomes (PRO) program and collects validated survey responses before and 3, 6, 12, and 24 months post-RP. Retrospective review of the MUSIC registry identified a cohort of RP patients who completed PRO. Multivariable logistic regression was performed to identify characteristics associated with a lack of social continence at 3 months. Results: From April 2014-July 2018, 2704 RP patients completed PRO. On multivariable analysis, patients who were moderately or severely obese, diabetic, older, with worse baseline urinary incontinence, and those of low volume RP surgeons (<10 RP per year) were less likely to achieve social continence at 3 months post-RP (p<.05 each). Other
Table of Contents 117 factors including PSA, race, biopsy Gleason, clinical staging, and bilateral nerve sparing were not significantly associated with lack of early social continence. Conclusion: RP remains a common treatment modality for localized PCa. Identified preoperative characteristics associated with lower likelihood of social continence at 3 months post-RP will improve patient counseling regarding post-operative continence expectations. Further, these findings will help guide decision making for additional treatments in patients less likely to be socially continent 3 months post-RP. Funding: Blue Cross Blue Shield of Michigan
Podium #30 THE BIOBURDEN IDENTIFIED ON REUSABLE SCOPES VERSUS SINGLE-USE SCOPE – SHOULD WE USE DISPOSABLE SCOPES IN HIGH-RISK PATIENTS Kirtishri Mishra, MD1, Laura Bukavina, MD MPH1, Vaishnavi Narayanamurthy, MS1, Mauricio Retuerto, PhD1, Irina Jaeger, MD1, Irma Lengu, MD2, Donald Bodner, MD3, Mahmoud Ghannoum, PhD1, Lee Ponsky, MD FACS1 1University Hospitals/Case Western Reserve University, 2Metro Health Medical Center/ Case Western Reserve University, 3Cleveland Veterans Affairs Medical Center/University Hospitals/Case Western Reserve University Presented By: Vaishnavi Narayanamurthy
Introduction: The presence of residual biologic tissue, hemoglobin, and organic material on sterilized ureteroscopes has been previously characterized. Our study aims to evaluate the specific flora of the bioburden identified on sterilized ureteroscope. This flora will be compared to single-use scopes. Methods: A total of 6 reusable scopes from three different sites (two scopes each) were swabbed. In addition, two single-use scopes from a fourth site were swabbed. Following DNA extraction, amplification of the 16S and 5.8S rRNA genes were performed. The targeted bacterial and fungal amplicons were then sequenced using the Ion Torrent pipeline. Bioinformatics was performed for taxonomic identification. The number of copies of DNA amplicons was normalized to the negative. Descriptive statistics were performed. Results: In bacterial sequencing, 43 different species were identified. Table 1 demonstrates the major differences in the relative bacterial bioburden found on different scopes. Table 1 also highlights the most abundant species of fungus (Yarrowia lipolytica) found on the scopes. Conclusion: Current sterilization techniques leave a substantial amount of bioburden, specifically fungal, present on ureteroscopes that are not present to the same degree on a single use scope. While the clinical implications of the finding need to be explored, the use of a single use scope should be considered in high-risk patients. Internal funding from Department of Urology
Podium #31 USING GEOGRAPHICALLY DETERMINED RESISTANCE PATTERNS TO GUIDE EMPIRIC THERAPY FOR UNCOMPLICATED URINARY TRACT INFECTIONS Jason Cohen, MD, Anthony Schaeffer, MD Northwestern University Feinberg School of Medicine Department of Urology Presented By: Jason E. Cohen, MD
Introduction: Current guidelines recommend empirically treating and uncomplicated urinary tract infection (UTI) with nitrofurantoin or trimethoprim-sulfamethoxazole (TMPSMX) if local resistance does not exceed 20%, otherwise consider use of a fluoroquinolone. Local resistance patterns are often determined by aggregated hospital data, which most likely draws from too broad a population. Methods: Data on all women (age > 18) presenting to a Northwestern Medicine facility with a diagnosis of an uncomplicated UTI who submitted a urine culture from 2011 to 2017 was gathered. Univariate and multivariable regression models were used to determine risk ratios (RR) for predicting resistance to nitrofurantoin, TMPSMX and a fluoroquinolone, ciprofloxacin (CIP).
Table of Contents 118 Results: Of 20,759 patients with a diagnosis of an uncomplicated UTI, 4,575 (22.0%) had urine culture sensitivity results and an address with a Chicago ZIP code. On multivariable analysis, previous TMPSMX prescription (RR 1.20 [95% CI 1.01-1.42] p = 0.01), previous TMPSMX resistance (RR 2.71 [95% CI 2.17-3.37] p<0.001) and a ZIP code with higher than average TMPSMX resistance (RR 1.53 [95% CI 1.26-1.86] p<0.001) were associated with TMPSMX resistance on urine culture. Similar significant results were seen for nitrofurantoin and CIP. Conclusion: This data demonstrates the geographic dependence of antibiotic resistance in community acquired UTIs and how widespread data collection could focus empiric treatment. Funding: N/A
Podium #32 WHAT MAKES A GOOD SURGEON? AN EVALUATION OF MEDICAL TRAINEES’ PERCEIVED LEADERSHIP TRAINING AND SKILLS Tasha Posid, MA, PhD, Scott Holliday, MD The Ohio State University Wexner Medical Center Presented By: Tasha Posid, MA, PhD
Introduction: Good clinical leadership skills allow medical professionals to direct and support patient care and multi-disciplinary healthcare teams. Surgery is often referral- based and unpredictable in nature, requiring additional leadership skills beyond non- surgical medical training, yet almost no work has expressly measured leadership competence as a function of surgical vs. non-surgical specialty. Methods: An assessment measured residents’ and fellows’ leadership knowledge, skills, and experience. All questions fell along a 5-point Likert scale (e.g. unsatisfied to satisfied). Assessments were sent via RedCap to a university-wide listserv of medical trainees (N=879). Of 250 respondents (28.4%), 93 were from a surgical specialty and 157 were from non-surgical specialties. Results: Leadership Knowledge: All trainees rated their clinical knowledge (difficult patient conversations, common patient complaints) as above-average (ps<.001, ds>.05) and rated their non-clinical leadership skills (QI, managing conflict, teaching) as low (ps<.001, ds>.05). Leadership Skills: Although trainees generally rated their leadership skills as above-average (ps<.001, ds>1.07), surgical trainees felt less prepared to face challenges with team members (p=.021, d=0.33), but felt more skilled in acting as a role model for junior trainees (p=.045, d=.03). Leadership Training: Surgical trainees were less satisfied with their current leadership training and felt that they received less formal leadership training than their non-surgical peers (ps<.003, ds>0.4), despite needing more preparation for their career (p=.081, d=0.25).
Table of Contents 119 Conclusion: This study supports the need to address a critical gap in trainees’ professional development, as they prepare to transition from their role as a student to their role of leader, particularly for high-intensity surgical specialties. Funding: OSU Fisher Leadership Initiative Research Grant Program
Podium #33 EPIDURAL ANESTHESIA INCREASES RATE OF COMPLICATIONS AND POST OPERATIVE STAY IN PATIENTS AFTER CYSTECTOMY: A NSQIP ANALYSIS Laura Bukavina, MD MPH1,2, Amr Mahran, MD MS1,2, Kirtishri Mishra, MD1,2, Brittany Adamic, MD3, Anjali Shekar, BS2, Vaishnavi Narayanamurthy, BS2, Carvell Nguyen, MD PhD4,2, Lee Ponsky, MD1,5 1University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 2Case Western Reserve University School of Medicine, Cleveland, Ohio, 3University of Chicago Medical Center, Chicago, Illinois, 4Metro Health Medical Center, Cleveland, Ohio, 5Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Laura Bukavina, MD, MPH
Introduction: Our aim was to identify differences in intra- and post- operative complications, length of stay and readmission rates in cystectomy patients managed with different anesthesia modalities. Methods: Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone a cystectomy between 2014 and 2017. Patients were further subdivided based on additional anesthesia modality. Using stepwise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure related readmission, complications, and postoperative length of stay. Results: 6,229 patients met our inclusion and exclusion criteria. Univariate analysis demonstrated shortest operative time (153.28 ± 69.8) in the general+spinal anesthesia (GSA).Compared to GA alone after multivariable logistic regression, adjuvant epidural anesthesia showed increased odds of procedure related complications (aOR: 1.355, 95% CI: 1.184-1.55, p<0.001), and increased post-operative stay (aOR: 1.763, 95% CI: 1.192- 2.608, p= 0.005). Conclusion: Using 2014-2017 NSQIP database we were able to demonstrate increased rate of procedure related complications and prolonged post-operative stay, with no further differences in re-operation of readmission rate in patients in the combined general and epidural anesthesia group. Funding: n/a
Table of Contents 120 Podium #34 INCORRECT IMAGING FOR HEMATURIA WORKUP ACROSS SPECIALTIES IS LEADING TO POOR VALUE OF HEALTHCARE Brittany Adamic, MD1, Joshua Aizen, MD1, Craig Labbate, MD1, Alexander Cope2, SangTae Park, MD2 1University of Chicago, 2NorthShore University HealthSystem Presented By: Brittany Adamic, MD
Introduction: Value-based healthcare aims to decrease costs while increasing patients’ health outcomes and satisfaction. We aimed to identify the patterns of imaging ordered for hematuria working and its disparity with published AUA guidelines. Methods: We identified all Computerized Tomography Stone (CT-S), CT Urogram (CTU), CT Abdomen/Pelvis with contrast (CTAP w) and retroperitoneal ultrasound (RUS) performed for hematuria at our healthsystem during a 60-day period in 2018. Studies ordered for renal colic were excluded. The ordering physician’s specialty, patient age, sex, smoking status, renal function and need for additional imaging were recorded. Results: In the two-month study period, non-urologists ordered 201 (58%) of the 347 total radiographic studies for hematuria. Although 323 (93%) patients had a GFR >30, only 191 (59%) underwent CTU. Emergency physicians and nephrologists did not order a single CTU for the work up of hematuria, the former preferring CT-S and the latter preferring RUS. Twenty-nine (8.5%) patients underwent additional imaging for hematuria and 24 (82.8%) appropriately underwent CTU. Physician specialty, younger age, higher GFR and gross vs. microscopic hematuria were associated with correct CTU imaging (p<0.05) but smoking status was not associated with undergoing CTU (p=0.361). Conclusion: Among patients presenting with hematuria, over half undergo imaging tests ordered by non-urologists. Many undergo incorrect imaging despite normal renal function. Incorrect hematuria workup leads to increased costs, patient dissatisfaction, re- exposure to ionizing radiation therefore poor healthcare value. We believe more education across specialties is required to reduce these avoidable imaging errors. Funding: N/A
Podium #35 SELF-CENSORSHIP OF SOCIAL MEDIA CONTENT AMONG MEDICAL STUDENTS Joseph Mahon, MD1, Meredith Chan, MD2, Jacob Lucas, MD3, Jay Simhan, MD3, Martin Gross, MD4, Seun Akinola, MD5, Matthew Coward, MD6, Paul Feustel, PhD7, Henry Pohl, MD7, Barry Kogan, MD2, Charles Welliver, MD2 1Loyola University, 2Albany Medical Center, 3Einstein Health Network, 4Dartmouth Medical Center, 5Royan Hospital, 6University of North Carolina School of Medicine, 7Albany Medical College Presented By: Joseph Mahon, MD
Introduction: The public availability of social media content thought to be personal has led to scrutiny of many medical professionals, with some even losing their positions. The aim of the study was to evaluate the self-censorship of social media content by medical students and to assess the effects of age, training level and social media use education exhibit on these practices. Methods: Anonymous electronic surveys were distributed to first year and fourth year medical students at five universities, consisting of 13 multiple choice questions which assessed students’ current and past social media use, demographic information pertaining to social media use, application of self-censorship and assessment of social media use education. Results: 512 medical students completed the survey. 253 were first year medical students (3 responders did not indicate level). 289 (56.4%) respondents received previous social media use education. 69.6% of all respondents practiced self-censorship of currently used platforms; however, only 31.0% censored content on previously used. Fourth year students were more likely to self-censor current content (73.0% vs. 66.1%), though similar rates on previously used platforms (29.7% vs. 32.2%). Younger students exhibited a lower rate of self-censorship for current content compared to older
Table of Contents 121 students. Those receiving social media use education were more likely to practice self- censorship (74.1% vs. 65.2%). Conclusion: Younger students are less likely to censor their social media content than their older counterparts; though censorship of inactive accounts is poor among all respondents. Social media use education may aid students in protecting themselves. Funding: N/A
Podium #36 A REVIEW OF RESIDENT BURNOUT AND WELLNESS INTERVENTIONS: IS UROLOGY BEING LEFT OUT? Christopher Jaeger, MD, Tasha Posid, PhD Ohio State University Presented By: Christopher Jaeger, MD
Introduction: Burnout amongst residents continues to be an issue in the healthcare field given its many implications. Studies have investigated burnout in residency programs, as well as its impact on patient care, but fewer have evaluated the effectiveness of wellness interventions to alleviate this burnout. There is a need to assess the impact of such interventions on surgical subspecialties (e.g., Urology). Methods: Pubmed was searched for: “residency burnout wellness” and “residency mindfulness.” We abstracted data on study characteristics, specialties, interventions, survey tools, and outcomes. The initial queries yielded 453 results. Duplicates results were eliminated, and remaining articles were reviewed for relevance. 56 articles met our final inclusion criteria. Results: Articles were classified as (1) burnout inventories/reports on the existence of burnout (n=32) or wellness interventions (n=24). Only 23% (n=13) of articles focused on surgical subspecialties. No studies identified involved Urology. The following intervention themes were identified: meditation/mindfulness (n=5, 21%), work hour restrictions (n=6, 25%), exercise (n=2, 8%), counseling (n=1, 4%), formal curricula (n=5, 21%), emotional intelligence/empathy training (n=2, 8%), wellness “rounds” (n=1, 4%), implanting text- paging system (n=1, 4%), and narrative medicine (n=1, 4%). Conclusion: Although many studies report that burnout exists, only a few studies have assessed wellness interventions aimed at reducing burnout. Many specialties have been represented in the literature, but the majority do not involve surgical subspecialties. No wellness intervention to date has involved Urology residents, which represents an opportunity for medical educators within the field of Urology to improve upon this statistic. Funding: N/A
Podium #37 URETHRAL STRICTURE DISEASE IS NOT A FOCAL PROCESS Morgan Schubbe, MD1, Matthew Grimes, MD1, Katherine Cotter, MD2, Bradley Erickson, MD, MPH1 1University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, 2University of Massachusetts, Department of Urology, Worcester, MA Presented By: Morgan E. Schubbe, MD
Introduction: Recent work has identified a high prevalence of chronic inflammation in male urethral stricture disease (USD), and association between genital lichen sclerosus and systemic inflammation. USD may be a more dynamic and multifocal disease process. We sought to determine if histopathologic features found in stricture biopsy specimen extend into adjacent non-strictured segments of urethra. Methods: A prospective protocol was developed to obtain biopsies at time of anterior urethroplasty. A 2-mm punch biopsy was obtained from the strictured segment of urethra as well as non-strictured proximal and distal urethral segments. Pathology reports were reviewed for the presence or absence of histologic features associated with lichen sclerosus. Inflammation was labeled as acute, chronic, or both. Results: Eight patients underwent the protocol. Strictures averaged 2.4 ± 1.6 cm, etiologies were idiopathic (4), iatrogenic (3) and infectious (1); locations were mid-bulbar
Table of Contents 122 (7) and fossa (1). Stricture pathology showed chronic inflammation (75%), epidermal thickening/metaplasia (75%), and subepithelial fibrosis (87.5%). Epidermal metaplasia (86%), chronic inflammation (38%) and subepithelial fibrosis (38%) was found in “normal” tissue. Conclusion: The pathophysiology of USD is unknown in most patients. Chronic inflammation is commonly seen in strictured specimens, indicating active antigen presentation. This process may extend beyond the narrowed segments into “normal” urethra, the implications of which remain unclear. Funding: N/A
Podium #38 OPIOID AND NON-OPIOID BASED CARE PATHWAYS FOR RECONSTRUCTIVE MALE ANTERIOR URETHRAL SURGERY: EVIDENCE BASED APPROACH FOR OPIOID STEWARDSHIP Jason Joseph, MD1, Matthew Ziegelmann, MD1, Elizabeth Habermann, PhD, MPH2, Matthew Gettman, MD1, Boyd Viers, MD1 1Department of Urology, Mayo Clinic, Rochester, Minnesota, 2Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Surgical Outcomes Program, Mayo Clinic,Rochester, Minnesota Presented By: Jason P. Joseph, MD
Introduction: We sought to evaluate postoperative opioid requirements and efficacy of a standardized pain management pathway for men undergoing anterior urethroplasty. Methods: Between 8/2017 and 10/2018, we prospectively evaluated consecutive men undergoing outpatient urethroplasty. Standardized perioperative pain pathways were implemented (Figure 1). Postoperative opioid usage, amount of unused opioid, pain scores (Likert 0 best to 10 worst) were evaluated. Results: Data was obtained in 46 of 57 consecutive cases at a median 14 days postoperatively. Median age was 52 years (18-77) and 72-hour postoperative pain score was 3 (0-8). Median number of 5 mg oxycodone tablets used was 3.5 (0-42); 36 (78%) men used 5 tablets or less. Excess narcotic was prescribed to 38 (83%) men with a median 14 unused tablets (5-27) per patient. Postoperative narcotic usage did not differ by age, urethroplasty location, or use of buccal mucosa graft, but was greater among patients that reported preoperative narcotic usage (median 15 vs. 3 tabs; p=0.0008). Men without preoperative narcotic usage rarely required > 5 tablets relative to those using narcotics preoperatively (13% vs. 71%; p=0.003).
Table of Contents 123 Conclusion: In combination with the defined non-opioid care pathway, 5 tablets of 5 mg oxycodone provides appropriate pain control following anterior urethroplasty in patients without preoperative opioid use, while limiting overprescribing. Funding: N/A
Podium #39 MODIFIED-APPROACH FOR ‘MALE URETHRAL MINI-SLING’ WITH INFLATABLE PENILE PROSTHESIS FOR ERECTILE DYSFUNCTION AND CLIMACTURIA OR MILD STRESS URINARY INCONTINENCE AFTER RADICAL PROSTATECOMY: A TWO-CENTER EXPERIENCE Matthew J. Ziegelmann, MD1, M. Ryan Farrell, MD, MPH1, Joel H. Hillelsohn, MD2, Marissa A. Kent, MD2, Robert J. Valenzuela, MD2, Laurence A. Levine, MD1 1Rush University Medical Center, Division of Urology, Chicago, IL, 2Icahn School of Medicine at Mount Sinai Hospital, Department of Urology, New York, NY Presented By: M. Ryan Farrell, MD, MPH
Introduction: Erectile dysfunction (ED) and concurrent climacturia or mild stress urinary incontinence (SUI) is common after radical prostatectomy. Here, we describe our technique for “male urethral mini-sling” (MUMS) placement at the time of inflatable penile prosthesis (IPP) for this population and evaluate outcomes. Methods: We reviewed all men undergoing IPP and MUMS placement with a modified Virtue® (Coloplast Corp, Minneapolis, MN) sling mesh by two high-volume prosthetic urologists using the same modified technique (1/2016-10/2018). After proximal urethral exposure, the MUMS is sutured to the lateral corpora at the level of the bulbar urethra, proximal to and separate from the planned corporotomies. Excessive tension on the urethra is avoided. The IPP is then placed in standard fashion. Changes in patient- reported climacturia and pads per day (PPD) for SUI were assessed pre and post- operatively. Results: Thirty-six men underwent both IPP and MUMS placement. Mean age was 68 years. Etiology of ED and urinary symptoms was prostatectomy alone [30/36 (83%)] and prostatectomy plus radiation [6/36 (17%)]. Preoperative urinary symptoms included climacturia in 30/36 (83%) and SUI in 27/36 (75%). Mean (SD) follow-up was 5.9 (3.7) months. Climacturia resolved in 28/30 (93%) and SUI improved in 23/27 (85%). The mean (SD) number of PPD for patients with SUI decreased from 1.4 (1.1) preoperatively to 0.4 (0.6) postoperatively (p=.02). One patient required MMUS explant for urethral erosion after prolonged postoperative catheterization. Conclusion: IPP placement with modified MUMS is an effective treatment modality for ED with climacturia and/or mild SUI in an appropriately counseled patient. Funding: N/A
Table of Contents 124 Podium #40 DEVELOPMENT AND APPLICATION OF A NOVEL AND EFFICIENT SKILLS ASSESSMENT TOOL: A PILOT INITIATIVE TO MEASURE VASECTOMY COMPETENCY ON A SMART PHONE Hal Kominsky, MD, Tasha Posid, MA, PhD, Lawrence Jenkins, MD, MBA The Ohio State University Wexner Medical Center Presented By: Hal Kominsky, MD
Introduction: The current shift toward competency-based residency training has increased the need for evaluation of clinical skills in a method that is immediate, time efficient, and standardized. The objective of this study was to develop a novel skills assessment platform via use of a smart phone interface that measures procedural competency of Urology residents learning to perform a vasectomy. Methods: The assessment tool is a Qualtrics survey within a smart phone link that breaks down a vasectomy procedure into eight steps. Level of competency was measured on a scale of “1 – novice” to “5 – expert.” Nine residents from PGY-1 to PGY-5 were evaluated by one instructor. Data analyses compared individual trainees to each other, their performance (gains) over time, and competency against the program average. Results: There were 86 single-side cases recorded over a 6-month period. Data show similar skillfulness across Step 1 (puncturing+isolation of vas and hand positioning; p> 0.1), but marginally lower competency on Step 2 (opening of vassal sheath to expose/isolate vas; vs. cohort: p=.076, vs. residents: p=.082), significantly lower competency on Steps 3-6 (all ps<.04), suggesting greater attention should be paid to improving competency (i.e., targeted teaching) for cautery technique, fascial interposition, hemostasis, and positioning of stumps. Conclusion: We provide evidence that the use of a mobile-based skills assessment of clinical skills could be a valid assessment of competency for trainees. This tool is easily created and accessed, provides real-time feedback to teachers and learners, and can be used for either individual or group assessment. Funding: N/A
Podium #41 URETHRAL STRICTURE DISEASE AMONG PATIENTS UNDERGOING COMPLEX BURIED PENIS REPAIR M. Francesca Monn, MD, MPH, Naveen Krishnan, MD, Matthew J. Mellon, MD Indiana Unversity School of Medicine, Department of Urology Presented By: Naveen Krishnan, MD
Introduction: Severe buried penis secondary to obesity, hidradenitis suppurativa, or lymphedema can force men to have poor hygiene which is associated with lichen sclerosis. We sought to evaluate patients undergoing buried penis repair to determine the incidence of lichen sclerosis associated stricture disease. Methods: A retrospective cohort study was performed of men undergoing buried penis repair between 1/2013 and 4/2018. The primary endpoint was urethral stricture disease found at time of buried penis repair. Descriptive statistics were used to explore these patients. Results: Twenty-two patients were identified. Median (IQR) follow-up time was 5.5(3-8) months. Mean (SD) age and BMI were 45.0(13.9) and 39.7(10.1), respectively. Eight (36.4%) patients were noted to have lichen sclerosis with meatal stricture and required formal urethromeatoplasty. There was no evidence of proximal urethral stricture. Mean (SD) operative time was 210.5(59.4) minutes and median (IQR) length of stay was 2(1- 4). All catheters were removed on post-operative day one and no patients experienced urinary retention requiring replacement of the catheter. Five (22.7%) patients had post- operative wound infections requiring antibiotics, two of which required hospitalization for IV antibiotics. One patient required complete revision of his buried penis repair secondary to recurrent lymphedema. Three (13.6%) patients required minor cosmetic revisions. No patients required revision or subsequent intervention for urethral stricture disease.
Table of Contents 125 Conclusion: Thirty-six percent of patients undergoing buried penis repair required concurrent distal urethromeatoplasty for lichen sclerosis related meatal stricture. The index of suspicion for occult urethral stricture disease related to lichen sclerosis should be high in patients undergoing genital reconstruction for buried penis. Funding: na
Podium #42 DO RADIOGRAPHIC MARKERS IMPROVE DIAGNOSTIC UTILITY OF RETROGRADE URETHROGRAMS FOR URETHRAL STRICTURE DISEASE Brian Odom, MD, Frank Burks, MD Department of Urology, Beaumont Health System, Royal Oak, Michigan, USA Presented By: Brian D. Odom, MD
Introduction: Retrograde urethrograms (RUG) are routinely employed to assess the location and size of urethral strictures. RUGs are imperative for surgical planning and counseling of patients. The goal of this study is to determine if radiographic markers during RUGs improve the estimation of urethral stricture length when compared to length at the time of urethroplasty. Methods: A retrospective chart review was performed of male patients who underwent urethroplasty between 2011 and 2019 by a single reconstructive urologist in Southeast Michigan. We began using radiographic markers in early 2015 placed at the penoscrotal junction and base of scrotum. Patients were included who had documented RUG with estimated stricture length and intraoperative stricture length. Patient demographics, size, and location were collected. Descriptive and inferential statistics were performed. Results: 143 patients met inclusion criteria with a median age of 44 (IQR 31–59). Of 143 patients, 87 and 56 RUGS were performed with and without radiographic markers, respectively. Median intraoperative stricture length for all patients was 3 cm (IQR 2–4.9). Most common stricture location was bulbar (109) followed by panurethral (17), penile (11), and posterior urethra/membraneous (5). For all patients, RUG estimated, and intraoperative lengths were statistically different (p=0.007). A statistically significant difference between RUG estimated and intraoperative lengths were observed in the patients without radiographic markers (p = 0.013). When using radiographic markers, there was no significant difference between RUG estimated and intraoperative lengths (p=0.065). Conclusion: Our study suggests that radiographic markers can improve RUG interpretation of intraoperative stricture length. Funding: NA
Podium #43 EFFECTIVENESS OF BILATERAL ORCHIECTOMY AS A MEANS OF REDUCING ANTI-ANDROGENS AND ESTROGEN REQUIREMENTS IN GENDER DYSPHORIA PATIENTS Ross G Everett, MD MPH, Kaylee C Luck, Jay I Sandlow, MD Medical College of Wisconsin Presented By: Ross G. Everett, MD, MPH
Introduction: Androgen reducing medications are often given to suppress testosterone levels and reduce the dosage of exogenous estrogens in transwomen with gender dysphoria [GD]. Bilateral orchiectomy [BO] is utilized as an alternative means of castration to reduce the magnitude of hormone medication. However, few reports exist which report the actual changes in hormonal medication regimen that accompany BO. Methods: Retrospective chart review was used to identify patients with GD who underwent BO care at our institution between 2008-2018. Various parameters including medication regimen and hormone levels were compared before and after surgery. All data was analyzed in a standard statistical fashion. Results: Fourteen patients underwent BO as part of their treatment for GD. These patients met criteria for BO as established by The World Professional Association for Transgender Health (WPATH) guidelines. Median age at time of surgery was 44 years
Table of Contents 126 (IQR 36.5-53.3). Pre-operative and post-operative medication regimens were available for eight patients. Of these, seven (88%) were treated pre-operatively with spironolactone and two (25%) with finasteride. Post-operatively, six patients (86%) were noted to have cessation of spironolactone and one patient (50%) for finasteride. Three (38%) had reduced their exogenous estrogen supplementation. Median time of follow-up available after surgery was 16.5 (IQR 9.8-27.8) months. Conclusion: BO is an effective means of negating the need for ongoing androgen reducing medication for the majority of transgender female patients with 86% of patients stopping spironolactone post-operatively. Additionally, 38% reduced the amount of exogenous estrogen they used. Funding: N/A
Podium #44 PREVALENCE OF PREEXISTING MEDICAL CONDITIONS AND MICROORGANISMS IN PATIENTS WITH FOURNIER'S GANGRENE Clara Castillejo Becerra1, Christopher Jaeger2, Justin Rose2, Nicholas Beecroft1, Nayan Shah1, Lawrence Jenkins2, Nima Baradaran2 1The Ohio State University College of Medicine, Columbus, OH, 2The Ohio State University Wexner Medical Center, Department of Urology, Columbus, OH Presented By: Clara Castillejo Becerra
Introduction: Fournier’s gangrene (FG) is a life-threatening, necrotizing infection of the perineum and genitalia. In this study, we evaluate the prevalence of preexisting medical conditions and microorganisms in patients with FG. Methods: A retrospective chart review was conducted on patients treated for FG at OSUWMC between October 2011 and April 2018. Results: Among 157 identified patients, 122 (77.7%) were male and 35 (22.3%) female. The mean age of the patients was 54 (IQR: 45-61). The most common preexisting medical conditions were overweight with a BMI ≥25 (87.3%) and a median of 34.21 (IQR: 29.35-42.95), diabetes mellitus (67.5%), cardiac disease (38.2%), and alcoholism (5.1%). Wound culture was available in 142 (90.4%) of patients and the median number of microorganisms was 3 (IQR: 2-5) (Figure 1). The most frequently isolated microorganisms were Staphylococcus (45.9%), Streptococcus (35.7%), Bacteroides (22.9%), Escherichia coli (19.1%), Candida (19.1%), and Prevotella (19.1%). In monomicrobial cases, the most frequent microorganisms were Staphylococcus (44.4%) and Candida (16.7%). The mortality rate between polymicrobial and monomicrobial organisms (16.67% vs. 18.03%, P=1.0) was found to be similar. Conclusion: The most common comorbidities in patients presenting with FG were diabetes and obesity. The majority of wound cultures were found to be polymicrobial with gram positive organisms most frequently grown. Funding: N/A
Table of Contents 127 Podium #45 NOVEL APPROACH TO FULL THICKNESS PENILE GRAFTING DURING BURIED PENIS REPAIR M Franesca Monn, MD, MPH, Naveen Krishnan, MD, Matthew J Mellon, MD Indiana University School of Medicine Department of Urology Presented By: Naveen Krishnan, MD
Introduction: Many patients undergoing complex genital reconstruction for buried penis lose the majority of their penile skin and require grafting. Methods: Patients undergoing buried penis repair with full thickness graft (FTG) from January 2013 until April 2018 were identified. The pre-pubic skin is marked for panniculectomy and potential penile grafting. Stretched penile length (X axis) is ascertained and penile girth is also measured (Y axis) for marking out the penile graft tissue on the escutcheon (Figure 1A). All excess scrotal tissue is removed and the penis degloved. Scrotoplasty is performed using a split thickness graft if grafting is required. A panniculectomy/ escutcheonetomy was performed. We then re-created the penoscrotal and penopubic fixation as appropriate by dividing the penile suspensory ligament and placing a 2-0 PDS at 5 o’clock, 7 o’clock, and 12 o’clock for the new fixation. Finally, we performed the FTG by wrapping the transplanted skin dorsally to ventrally (Figure 1B) and reapproximating the penile raphe (Figure 1C, 1D). Results: Thirteen patients required FTG of the penis with median (IQR) follow-up of 6(4- 8) months. Of these thirteen, one required operative revision secondary to recurrent lymphedema. Two patients underwent minor cosmetic adjustments. Conclusion: Full thickness grafts for the penis are technically feasible and offer excellent cosmetic results for the patient. Funding: na
Table of Contents 128 Podium #46 PENOSCROTAL DECOMPRESSION AS A GLANS SPARING ALTERNATIVE TO SHUNT PROCEDURES FOR SURGICAL RELIEF OF REFRACTORY ISCHEMIC PRIAPISM Yooni Yi, MD1, Michael Davenport, MD1, Billy Cordon, MD2, Travis Pagliara, MD3, Jeffrey Gahan, MD1, Allen Morey, MD1 1UT Southwestern, 2Mount Sinai Medical Center Miami, 3Hennepin Health Care Presented By: Yooni Yi, MD
Introduction: Although widely practiced for definitive relief of refractory ischemic priapism (RIP), corporoglanular shunts are prone to failure in refractory cases with delayed presentation. We report our updated experience using a novel midshaft penile decompression procedure as a glans sparing alternative. Methods: We retrospectively reviewed clinical records for RIP patients treated with penoscrotal decompression (PSD) from 2014 – 2019. Patient clinical features were obtained, including duration and etiology of priapism, prior interventions, and clinical outcomes. Results: We analyzed 20 PSD procedures in 17 patients (mean age 36.6 years [12 – 58]). All patients failed irrigation and phenylephrine injection, seven patients had failed a distal corporoglanular shunt, and no patients had proximal shunts. The most common priapism etiologies in the cohort were intracavernosal injections (7) and other drugs (6). Despite an extended time to presentation (mean 64.9 hours), all 7 bilateral procedures resulted in prompt resolution of priapistic symptoms. Of 13 unilateral procedures, 11 were successful and 2 required subsequent bilateral PSD for recurrence. Fourteen patients had documented follow-up (average 162 days) and many reported preservation of potency status after PSD surgery (6 - normal erectile function, 1 - spontaneous erections). One with preoperative erectile dysfunction later underwent an inflatable penile prosthesis uneventfully 251 days following PSD. Conclusion: In this challenging RIP population, PSD appears to have a role both in lieu of corporoglanular shunt and as a salvage strategy for a failed corporoglanular shunt. PSD represents a simple, highly effective option for resolution of refractory ischemic priapism. Funding: N/A
Podium #47 PRESENTATION AND MANAGEMENT OF FOURNIER’S GANGRENE IN FEMALES Nicholas Beecroft1, Christopher Jaeger, MD2, Justin Rose2, Clara Castillejo Becerra1, Nayan Shah1, Lawrence Jenkins, MD2, Nima Baradaran, MD2 1The Ohio State University College of Medicine, 2The Ohio State University Department of Urology Presented By: Nicholas Beecroft
Introduction: Fournier’s gangrene (FG) is a rare and potentially life-threatening condition. The objective of this study is to report presentation and management of FG in female patients at a single tertiary care center. Methods: Patient records who were treated for FG from 2011- 2018 were retrospectively reviewed. Patient demographics, clinical presentation and treatment of FG was compared based on gender. Results: We identified 36 females from 157 patients treated for FG. Females had significantly higher median BMI. However other vitals signs upon presentation were comparable to men. Predominant microorganism in wound culture was not found to be significantly different although the vast majority of both genders had multi-organism growth (figure 1). Median number of debridements for both males and females was the same. Perineal involvement was less common in females, though not significantly different. Mortality rate during initial admission was similar in both groups. Conclusion: Females with FG have a wide range of presentation. Female patients have greater BMI however they have similar microbiologic characteristics and mortality rate. Funding: N/A
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Podium #48 UNDERSTANDING THE ROLE OF STATIN USE ON ADVANCED PROSTATE CANCER OUTCOMES: DOES THE STATIN TYPE, CUMULATIVE DOSE OR DURATION IMPACT SURVIVAL? Tariq A. Khemees, MD1, Jinn-ing Liou, M.S.2, E. Jason Abel, MD3, Tracy M. Downs, MD3, Tudor Borza, MD1, David F. Jarrard, MD3, Kyle A. Richards, MD1 1Department of Urology, University of Wisconsin and William S. Middleton Memorial Veterans Hospital, 2Department of Internal Medicine, University of Wisconsin, 3Department of Urology, University of Wisconsin Presented By: Tariq A. Khemees, MD
Introduction: We sought to investigate the impact of the statins type, dose and duration on oncologic outcomes in patients with advanced prostate cancer (PCa) who are treated with androgen deprivation therapy (ADT). Methods: We used the national VA database to identify men with PCa who are receiving ADT and were treated with statin medications for at least 6 months after PCa diagnosis between 2000 and 2008 with follow-up through May 2016. Patients were stratified based on type, cumulative dose, and total duration of statin used. Multivariable Cox proportional hazards analyses were performed to assess the association between those parameters and Pca specific survival (PCSS), overall survival (OS) and skeletal related events (SREs). Results: A total of 53,582 PCa patients were included in the study. On multivariable analyses controlling for multiple baseline characteristics, increased duration > 36 months (HR 0.60, 95% CI 0.57-0.63) and cumulative dose (HR 0.90, 95% CI 0.82-0.99) were associated with improved OS. Similar associations noted for PCSS. Increasing the cumulative dose to > 36 months was associated with reduce risk of SRE (HR 0.70, 95% CI 0.63-0.91). Use of hydrophilic statins was associated with improved OS (HR 0.58, 95% CI 0.54-0.62) and PCSS (HR 0.64, 95% CI 0.52-1.78). Conclusion: Our results suggest that there is a dose response relationship between the dose, duration and type of statin used in patients with advanced PCa who are treated with ADT. Patients who used higher dose of hydrophilic statins for longer period of time have improved oncological outcomes. Funding: Funded by Urology Care Foundation/ Research Scholar Program (T.K.), and Department of Defense grant via the Prostate Cancer Research Program #PC150221
Table of Contents 130 Podium #49 REAL-WORLD IMPACT OF GENOMIC PROSTATE SCORE ASSAY ON USE AND PERSISTENCE OF ACTIVE SURVEILLANCE Benjamin H. Lowentritt, Michael Gong, Robert Abouassaly, Cynthia D Westermann, Gary M. Kirsh, Richard Sarle, John Bennett, Jay Newmark, Bethann S Hromatka, Michael J Kemeter, Eric A Klein Presented By: Eric A. Klein, MD
Introduction: We assessed the effect of Oncotype DX Genomic Prostate Score® (GPSTM) assay on AS use and persistence in community and academic practices. Methods: We retrospectively audited charts of GPS-tested men with low- and intermediate-risk (LR, IR) prostate cancer in 12 centers from June 2013 - September 2017. Collection included decision to go on AS (primary endpoint; AS in chart or lack of treatment within six months of diagnosis). A second, prospective collection in five centers assessed persistence. Treatment-free interval was estimated with Kaplan-Meier, with log-rank test for effect of age and NCCN® on persistence. AS use and persistence were compared to historical controls. Results: 2,253 men underwent GPS testing; 561 (25%) had lower or higher risk than their clinical risk after GPS testing and 1,369 (61%) went on AS. Among the 1,567 LR, 1,098 (70%) went on AS; among the 686 IR, 271 (40%) went on AS. AS persistence was available for 695 men (table). Persistence was not significantly different between NCCN risk (p=0.166) or age groups (p=0.388). Conclusion: Real-world evaluation of GPS testing among LR and IR revealed higher numbers pursuing AS compared to historic controls. AS persistence in GPS-tested men was high across risk and age groups at three years and comparable with published studies (ProtecT). Funding: Genomic Health, Inc.
Podium #50 18F-FLUCICLOVINE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY (PET/CT) IN PATIENTS WITH SUSPECTED BIOCHEMICAL RECURRENCE OF PROSTATE CANCER: DETECTION OF BONE METASTASES AND IMPACT ON PATIENT MANAGEMENT PLANS Gerald Andriole, MD1, Michael Kipper, MD2, Paul Dato, MD2, Karen Linder, PhD3, Bela Denes, MD3 1Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA, 2Genesis Healthcare, San Diego, CA, USA, 3Blue Earth Diagnostics, Inc., Burlington, MA, USA Presented By: Gerald L. Andriole Jr., MD
Introduction: In patients with biochemical recurrence of prostate cancer, accurate localization of disease helps guide management. 18F-fluciclovine is a positron emission tomography (PET) tracer approved in the US and Europe for patients with rising PSA levels post-treatment. LOCATE (NCT02680041), a 15-center US prospective study, assessed the impact of 18F-fluciclovine PET/CT on management of such patients. Here we report on 18F-fluciclovine PET detection of bone metastases. Methods: Altogether 213 men (age ≥18 years; rising PSA after radical prostatectomy, radiotherapy, or both, and/or other curative-intent modalities; negative or equivocal conventional imaging in the 60 days pre-enrollment) underwent 18F-fluciclovine PET/CT. Before and after 18F-fluciclovine scans, treating physicians completed questionnaires to examine the scan’s impact on clinical management recommendations.
Table of Contents 131 Results: Overall, 18F-fluciclovine PET/CT was positive in 122 patients (57%), and changed management plans in 126 (59%). Of men with positive scans, 23 (19%) had 18F-fluciclovine-avid bone metastases. In these 23 patients, median (range) PSA concentration was 1.5 (0.2−70.4) ng/mL; pre-enrollment conventional bone imaging was negative in 21 patients, equivocal in 1, and not performed in 1. Based on 18F-fluciclovine PET/CT findings, recommended patient management changed for 15 of the 23 (65%): 9/15 (60%) were switched to a different treatment modality, while 6/15 (40%) had regimen modification of already-contemplated treatment. Conclusion: In men with biochemical recurrence of prostate cancer and negative or equivocal conventional imaging, 19% (23/122) of positive 18F-fluciclovine scans demonstrated 18F-fluciclovine-avid bone metastases. 18F-fluciclovine PET detection of bone metastases led to a change in management plans in nearly two-thirds (15/23, 65%) of cases. Funding: Blue Earth Diagnostics, Inc. sponsored the LOCATE study and supported the work of an independent medical editor, Robert J. Marlowe, editing this abstract.
Podium #51 CRIBRIFORM OR INTRADUCTAL CARCINOMA ON PROSTATE BIOPSY: MARKERS OF NON-ORGAN CONFINED DISEASE Kyle Ericson, MD1, Shannon Wu2, Scott Lundy, MD, PhD1, Lewis Thomas, MD1, Andrew Stephenson, MD1, Eric Klein, MD1, Jesse McKenney, MD3 1Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH, 2Cleveland Clinic Lerner College of Medicine, 3Cleveland Clinic Foundation, Department of Anatomic Pathology, Cleveland, OH Presented By: Kyle J. Ericson, MD
Introduction: Cribriform and intraductal carcinoma (CC and IDC) are aggressive subtypes of Gleason pattern 4 prostate cancer. The presence of either at prostatectomy is associated with worse pathologic and oncologic outcomes. Standard reporting of CC or IDC on biopsy and clinical implications of the information is evolving. Methods: We analyzed synoptic data from all biopsies performed or reviewed at the Cleveland Clinic between December 2017 and November 2018. Pathologic outcomes in men that underwent prostatectomy were compared based on the presence of CC or IDC (grouped as CC/IDC) on biopsy. The primary outcome was the presence of non-organ confined disease (≥pT3). Results: Of the 458 men that underwent prostatectomy, 41.6% had CC/IDC on biopsy. Patients with CC/IDC were older, had a higher PSA, and higher biopsy Grade Group. At prostatectomy, patients with CC/IDC on biopsy were more likely to be higher Grade Group, non-organ confined, and node positive. On multivariable analysis adjusting for age, PSA, and biopsy GGG, CC/IDC remained independently associated with ≥pT3 disease (table 1). Conclusion: The presence of CC or IDC on prostate biopsy is independently associated with non-organ confined disease. Men undergoing prostate biopsy should have their biopsies reviewed for the presence of CC and IDC and, if present, should not be enrolled in active surveillance. Funding: N/A
Table of Contents 132 Podium #52 MRI FUSION BIOPSY TARGETED BIOPSIES ALONE WITHOUT SYSTEMATIC BIOPSY CAN MISS CLINICALLY SIGNIFICANT PROSTATE CANCERS Brijesh Patel, MD1, Eiftu Haile, BS1, John Ogunkeye, BS1, Pierece Massie, BS1, Celeste Ruiz, RN2, Justin Cohen, MD2, Christopher Coogan, MD1, Paul Yonover, MD2 1Rush University Medical Center, 2UroPartners Presented By: Brijesh Patel, MD
Introduction: The diagnostic yield of MRI-guided targeted biopsies (TB) versus a 12 core trans-rectal US systematic biopsy (SB) continues to evolve. We used our UroPartners Cancer of the Prostate Registry (UroCap) to evaluate MRI fusion biopsy accuracy in a large practice setting. Methods: Between 01/2015 and 07/2018, 2188 patients with PIRADS 3, 4, or 5 lesions underwent SB and TB at a single center in a large, community-and-academic integrated setting. We examined patients with a positive SB and negative TB. Results: Of 2188 patients, prostate cancer (CaP) was diagnosed in 1126 (51.5%); overall, 252/1126 (22.4%) had a positive SB and negative TB. This 252 patient cohort had a total of 367 MRI lesions: 288 PIRADS 3 lesions, 69 PIRADS 4 lesions, and 10 PIRADS 5 lesions. Among these, clinically significant (Grade Groups 2-5) CaP was detected on SB alone in 57/288 (19.8%) PIRADS 3 lesions, 17/69 (24.6%) PIRADS 4 lesions, and 3/10 (30%) PIRADS 5 lesions. Conclusion: MRI-fusion targeted biopsies (TB) alone failed to detect CaP in at 22.4% of our patients. Targeted biopsies (TB) performed without systematic biopsy (SB) can miss clinically significant prostate cancer and both TB and SB should be performed together at time of MRI fusion biopsy. Funding: N/A
Podium #53 THE EFFECTS OF ANDROGEN DEPRIVATION THERAPY ON BRAIN VOLUME 3D PLANIMETRY Nishant Jain, BS1, Kimberly Woo, MD1, Laura Bukavina, MD MPH2, Kirtishri Mishra, MD2, Amr Mahran, MD MS2, Christopher Kondary, MD3, David Sheyn, MD2, Christina Buzzy PhD, PhD4, Lee Ponsky, MD2, Kristina Garrels, MD5, Carvell Nguyen, MD PhD5 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Metro Health Medical Center, Department of Radiology, Cleveland, Ohio, 4Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 5Metro Health Medical Center, Cleveland, Ohio/Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Kimberly Woo
Introduction: We aim to quantify the loss of cortical brain volume in patients on ADT. Methods: We retrospectively analyzed baseline and follow up CT head scans of 14 men prior to and after initiation of ADT. All CT imaging were reviewed using 3D planimetry software (3D Splicer ®, Version 4.0). Brain, ventricular surface area and volumes were assessed via segmentation protocol. Baseline socio-demographic variables, comorbidities, and risk factors were collected retrospectively. Results: A total of 14 patients were analyzed in the study. Mean age 74.36 yo (±13.76), with median ADT duration of 9.5 months (IQR 6.0, 16.25), with a median washout period of 11 months (IQR 6.5, 20.25) prior to follow up CT scan. Overall, 5 (35.7%) and 9 (64.3%) were started on either Leuprolide acetate plus Bicalutamide, vs Leuprolide
Table of Contents 133 acetate alone, respectively. Compared to baseline CT imaging, patients on ADT experienced statistically significant brain volume loss (-33.465 cm3 (95% CI -62.487, - 4.442), p=0.027)). Similarly, men on androgen deprivation experienced increase in ventricular volume (22.166 cm3 (95% CI -0.703, 45.035) p=0.056)). Conclusion: Our study found that men with prostate cancer experience significant cortical brain volume loss as well as ventricular volume expansion after initiation of androgen deprivation therapy. Funding: N/A
Podium #54 ≥50% REDUCTION IN PSA FOLLOWING 3 CYCLES OF TAXOTERE PREDICTS FAVORABLE RESPONSE FOLLOWING FULL TREATMENT WITH TAXOTERE Mohamad Ahmed, MBBCh., Jack Andrews, MD, Eugene Kwon, MD Mayo Clinic Presented By: Mohamed Ahmed
Introduction: Six to ten cycles of Taxotere typically comprises standard treatment for metastatic castrate resistant prostate cancer (m-CRP). A paucity of data exists predicting patients’ response to full course of Taxotere. We sought to investigate whether PSA reduction after 3 cycles was predictive of overall response. Methods: We retrospectively identified 77 m-CRP patients who received Taxotere. Patients receiving or having received second generation ADT or prior chemotherapy were excluded. The study cohort was divided into 2 groups, those with ≥50% reduction in PSA (53 patients) and those with <50% reduction in PSA (24 patients) after 3 cycles of Taxotere. Excellent response [JA1] was defined as a ³50% PSA reduction and complete or near-complete response on post-treatment (6-9 cycles) PET C-11-Choline scan. Results: Mean age at time of diagnosis of our population was 60.7 yrs, median Gleason score was 8, and median pre-chemo PSA was 6.4 ng/ml. On univariate and multivariate analysis, a ≥50% reduction in PSA predicted an excellent response in 85% of patients, while only 50% of patients with a <50% reduction of PSA had an excellent response (p=0.0012). [JA2] Conclusion: A ≥50% reduction in PSA after 3 cycles of Taxotere predicts favorable overall response after a full treatment course of Taxotere. We suggest that restaging patients with <50% reduction of PSA following 3 cycles of Taxotere may further delineate who will respond after a full course of treatment. Funding: N/A
Table of Contents 134 Podium #55 EVALUATING THE IMPACT OF LEAD-TIME BIAS ON SURVIVAL BENEFIT OF EARLY SALVAGE RADIATION THERAPY IN PROSTATE CANCER: A POST-HOC ANALYSIS OF THE RTOG 9601 TRIAL Deepansh Dalela, Akshay Sood, Hoang Tang, Jacob Keeley, Craig Rogers, James Peabody, Mani Menon, Firas Abdollah VUI-CORE, Vattikuti Urology Institute, Henry Ford Health System Presented By: Deepansh Dalela
Introduction: We evaluated the impact of lead-time bias on survival benefit of early salvage radiation therapy (i.e. sRT initiated at lower prostate specific antigen [PSA] level) for biochemically recurrent prostate cancer (PCa) post-radical prostatectomy (RP). Methods: Secondary data analysis of the Radiation Therapy Oncology Group (RTOG 9601) randomized controlled trial, abstracting raw data from the Project Data Sphere platform. Overall mortality was assessed based on pre-sRT PSA (<0.7 [n=405], 0.7-1.5 [n=237], and >1.5-4.0 ng/mL [n=118]) as reported in the original trial. To ascertain the role of lead-time bias, survival time zero was set to the time of (1) initiation of sRT, and (2) RP. Results: For men with pre-sRT PSA <0.7, 0.7-1.5, and >1.5-4 ng/mL, estimated 15-year overall mortality was significantly different when calculated from time since sRT but not when assessed from time since RP (Figure 1). On Cox proportional hazards multivariable analyses, pre-sRT PSA >1.5-4.0 ng/mL was significantly associated with overall mortality only when measured from time of initiation of sRT (HR 1.61, 95% CI 1.13-2.28; p=0.008), but not from time since RP (HR 1.24, 95% CI 0.87-1.76; p=0.2). Conclusion: Our findings suggest that survival benefit with early sRT instituted at lower PSA thresholds is mitigated when measured from time since surgery, highlighting the role of lead-time bias. Funding: n/a
Podium #56 PERFORMANCE OF PIRADS 3 LESIONS IN A LARGE MRI FUSION BIOPSY PROGRAM IN PREDICTING PROSTATE CANCER Brijesh Patel, MD1, John Ogunkeye, BS1, Eiftu Haile, BS1, Pierece Massie, BS1, Celeste Ruiz, RN1, Justin Cohen, MD2, Christopher Coogan, MD1, Paul Yonover, MD2 1RUMC, 2UroPartners Presented By: Brijesh Patel, MD
Introduction: We analyzed our UroPartners Cancer of the Prostate (UROCaP) Registry to better understand the significance of PIRADS 3 lesions as identified on mulitparametric MRI (mpMRI) of the prostate. Methods: From January 2015 to July 2018, 2188 patients underwent MRI fusion biopsy in a single center in a large community-and-academic integrated urology group. Per protocol, systematic 12 cores biopsies (SB) were performed concomitantly with targeted biopsies (TB). We report the subset of patients with PRIADS 3 lesions. Results: Of 2203 PIRADS 3 lesions undergoing biopsy, 1835 were benign (83.3%) and 368 harbored cancer (16.7%). Of those with cancer: 216 had Grade Group (GG) 1 (58.7%) and 152 (41.3%) had GG2-5. Additionally, of the 1835 benign lesions on TB, 467 (25.4%) patients harbored disease on SB (325 GG1 and 142 GG 2-5), giving an overall 21.2% (467/2203) cancer detection rate for patients with PIRADS 3 lesions (combined TB and SB). Conclusion: Among patients with PRIADS 3 lesions who underwent fusion biopsy, 21.2% of these patients harbored prostate cancer (combined TB and SB), 32.5% of these were clinically significant (GG2-5). Overall, 6.9% of PIRADS 3 lesions were clinically significant disease. Funding: N/a
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Podium #57 CAN WE SPARE MEN 12-CORE BIOPSIES AT THE TIME OF MRI/TRUS FUSION PROSTATE BIOPSY? Spencer Hart, MD1, Thomson Tai2, Chirag Doshi, MD1, Cara Joyce, PHD3, Alex Gorbonos, MD1, Michael Woods1, Marcus Quek, MD1, Robert Flanigan, MD1, Gopal Gupta, MD1 1Loyola University Medical Center, 2Loyola University Stritch School of Medicine, 3Loyola University at Chicago Presented By: Thomson Tai, MD
Introduction: Despite the use of multi-parametric MRI/US fusion biopsies, a concurrent standard 12-core template is commonly performed out of concern for under sampling. We aim to compare the concordance rates of standard 12-core biopsies, mpMRI/Ultrasound (US) fusion biopsy, and a combination approach with final post- prostatectomy pathology. Methods: A retrospective analysis of patients who underwent mpMRI/US fusion biopsy and concurrent 12-core biopsy followed by radical prostatectomy between 2014-2017 was performed. Highest Gleason score obtained from standard 12-core biopsy, MRI/US fusion biopsies, and combination was assessed. Concordance was defined as equivalence in highest Gleason score between biopsy specimens and final post- prostatectomy histopathologic analysis. Results: 151 men met criteria for analysis. The three biopsies strategies had similar rates of pathologic down staging, concordance rates, and pathologic upstaging. MRI/US fusion biopsies had superior concordance when compared to combination for Gleason 3+4 cancers (targets: 87.3% vs combination: 85.9%) and Gleason 4+4 cancers (targets: 55% vs combination: 45.2%). Conclusion: mpMRI/US fusion targeted biopsies alone have equivalent rates of concordance and pathologic upstaging when compared to combined targeted biopsy with concurrent 12-core template. It may be reasonable to spare men the morbidity of additional random 12-core biopsies without sacrificing oncologic outcomes. Funding: N/A
Table of Contents 136 Podium #58 RATES AND PATTERNS OF METASTASES IN PATIENTS WITH NODE-NEGATIVE PROSTATE CANCER AT RADICAL PROSTATECTOMY THAT EXPERIENCE PSA FAILURE: POST-HOC ANALYSIS OF RTOG 9601 TRIAL DATA Akshay Sood, MD, Jacob Keeley, M.S., Mani Menon, MD, Firas Abdollah, MD Henry Ford Health System Presented By: Akshay Sood, MD
Introduction: To evaluate rates and patterns of local and metastatic disease occurrence in patients with node-negative non-metastatic prostate cancer at radical prostatectomy (RP) that experience PSA elevation (recurrence or persistence) and undergo salvage radiation therapy (sRT). Methods: All available demographic, tumor-specific, treatment-specific, and local and metastatic disease occurrence data from 760 men who participated in the RTOG 9601 trial were extracted using the Project Data Sphere platform. Patients were stratified into PSA recurrence (post-RP PSA nadir <0.5 ng/ml) or PSA persistence (post-RP PSA nadir =>0.5 ng/ml) groups, based on cutoffs reported in the original trial. Inverse probability of treatment weighting (IPTW) analysis was utilized to minimize the baseline differences among the groups. Competing risk analysis tested the impact of PSA persistence versus recurrence on local and metastatic disease in IPTW-adjusted model. Results: Patients that experienced PSA persistence had higher Gleason grade disease (p=0.027), more advanced pathological stage (p=0.024), and higher PSA levels at the time of receipt of salvage therapy (p<0.001). The median follow-up was 12 yrs. In the IPTW-adjusted cohort, the 10-yr local recurrence rates were 3.2% versus 1.4% in patients with persistent versus recurrent PSA (Gray’s test p=0.0001). Similarly, 10-yr metastatic recurrence rates were 28.6% versus 10.1% in patients with persistent versus recurrent PSA (Gray’s test p<0.0001). Conclusion: Patients with PSA persistence are approximately 2.5 times more likely to experience local and metastatic disease, when compared to patients with PSA recurrence, despite local sRT with/without anti-androgen therapy. These data may facilitate patient counseling and shared treatment selection. Funding: N/A
Podium #59 ISOPSA IS A SENSITIVE ASSAY FOR CRIBRIFORM AND INTRADUCTAL CARCINOMA Kyle Ericson, MD1, Shannon Wu2, Scott Lundy, MD, PhD1, Lewis Thomas, MD1, Jesse McKenney, MD3, Mark Stovsky, MD, MBA1, Eric Klein, MD1 1Cleveland Clinic Foundation, Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH, 2Cleveland Clinic Lerner College of Medicine, 3Cleveland Clinic Foundation, Department of Anatomic Pathology Presented By: Kyle J. Ericson, MD
Introduction: IsoPSA, a serum assay that detects PSA isoforms associated with prostate cancer, improves upon the sensitivity and specificity of standard PSA. Here we report on the sensitivity of IsoPSA for detecting high risk cribriform and intraductal carcinoma (CC and IDC). Methods: We re-reviewed biopsies of men that underwent biopsy as part of a prospective IsoPSA validation cohort. Men were designated for biopsy by typical screening indications. All patients also underwent IsoPSA testing. The previously established cutoff of IsoPSA K ≥ 8 was used to determine whether men would have been biopsied if IsoPSA alone was used. Men with CC or IDC (grouped CC/IDC) were compared to men without CC/IDC. The primary outcome was the proportion of men that would not have been biopsied by IsoPSA indications alone Results: Of 100 men with prostate cancer, CC or IDC was present in 31 men. In the CC/IDC negative group, 14 (20.2%) would have been spared biopsy by IsoPSA criteria. In the CC/IDC positive group, all 31 men would have been biopsied; IsoPSA was 100% sensitive (figure 1; p = 0.004).
Table of Contents 137 Conclusion: In this cohort of men undergoing screening-indicated biopsy, IsoPSA would not have missed a single CC or IDC diagnosis. IsoPSA appears to be sensitive for high risk pattern 4 tumors. Funding for the prospective IsoPSA validation study was provided by Cleveland Diagnostics. The sponsor was involved in the original design of the IsoPSA validation study; however, the sponsor had no direct role in the analysis and design of this subgroup analysis.
Podium #60 GENDER DISPARITY IN CYSTECTOMY OUTCOMES: PROPENSITY SCORE ANALYSIS OF THE NSQIP DATABASE Laura Bukavina, MD MPH1, Kirtishri Mishra, MD2, Amr Mahran, MD MS1, Anjali Shekar, BS3, David Sheyn, MD4,5, Emily Slopnick, MD5, Adoniz Hijaz, MD5, Jason Jankowski, MD6, Lee Ponsky, MD4,6, Carvell Nguyen, MD PhD5,3 1University Hospitals Cleveland Medical Center/ Case Western Reserve Medical University, 2Case Western Reserve, 3Case Western Reserve University School of Medicine, 4University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 5Metro Health Medical Center, Cleveland, Ohio, 6Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Anjali Shekar
Introduction: The aim of this retrospective propensity score matched analysis was to evaluate the intra and post-operative differences between men and women undergoing radical cystectomy (RC) as well as evaluate reproductive organ preserving radical cystectomy (ROPRC) as compared to conventional RC. Methods: Utilizing 2011-2017 NSQIP database, men and women undergoing cystectomy were matched via propensity score matching (PSM). Similarly, PSM was utilized to adjust for baseline differences between the ROPRC and RC groups. Multivariable regression analysis was performed to evaluate for the risk of readmission, complications, and reoperation. Results: An evenly matched cohort of 1263 males and 1263 females who underwent radical cystectomy. The risk of readmission (aOR 1.228 (1.005-1.510), p=0.045), superficial surgical site infection (aOR 1.507 (1.095-2.086), p=0.012), and transfusion (aOR 2.031( 1.713-2.411), p<0.001) was increased in females.There were no observed differences in surgical outcomes, readmission, blood loss or risk of transfusion in ovarian preservation as compared to standard cystectomy among female patient groups. Conclusion: Using the ACS NSQIP database, we identified a more complicated postoperative recovery in female patients undergoing radical cystectomy as compared to
Table of Contents 138 males, including higher rates of transfusion, readmission and surgical site infections (SSI). We did not find any increased rate of complications in ovarian sparing approach as compared to radical cystectomy with oophorectomy. Funding: N/A
Podium #61 ASSESSING THE QUALITY OF SYSTEMATIC REVIEWS IN UROLOGY (2016-18) USING AMSTAR-2 Leah Soderberg1, Maylynn Ding2, Jae Hung Jung3, Philipp Dahm4 1University of Minnesota Medical School, 2Michael G. DeGroote School of Medicine, McMaster University, 3Yonsai University Wonju College of Medicine, 4Minneapolis VA Healthcare System, Urology Section Presented By: Leah Soderberg
Introduction: Assessment of Multiple Systematic Reviews (AMSTAR) is a validated instrument to assess systematic review (SR) methodological quality. It has recently been updated with more stringent expectations. AMSTAR-2 includes sixteen domains, seven of which are critical. This study investigates whether SRs published in urological literature meet these standards. Methods: We systematically searched PubMed® for SRs published in five major urology journals from 1/2016 to 12/2018 that address prevention/therapy. Two independent reviewers followed an a priori protocol to screen references and abstracted data using AMSTAR-2. Results: The literature search identified 553 studies, and 147 met inclusion criteria. The largest contributors were European Urology (53; 36.1%), Urology (38; 25.7%), and BJU International (25; 17.0%). Common topics were oncology (65; 44.2%), voiding dysfunction (32; 21.8%), and stones/endourology (15; 10.2%). The median number of studies included in SRs was 16.0 (IQR: 9, 31.0). Approximately one-third (53; 36.1%) of reviews had a registered protocol and one-third focused only on randomized trials (50; 34.0%). Nearly all SRs (142; 96.6%) searched two or more databases, but markedly fewer searched trial registries (46; 31.3%) or consulted experts (30; 20.4%). Most (120; 81.6%) screened references independently and in duplicate, but under half (67; 45.6%) reported the same for data abstraction. Few reviews (15; 9.2%) justified excluding individual studies. Conclusion: SR quality in urological literature is sub-optimal, undermining validity and value. It is important for authors, reviewers, and editors to better appreciate the underpinnings of methodologically sound, high quality SRs. Funding: Departmental
Table of Contents 139 Podium #62 IMPACT OF TIMING ON RADIATION THERAPY ADVERSE EVENTS FOLLOWING RADICAL PROSTATECTOMY, AN ANALYSIS OF THE RTOG 9601 COHORT Lee Baumgarten, MD, Alex Borchert, MD, Akshay Sood, MD, Deepansh Dalela, MD, Sohrab Arora, MD, Jacob Keeley, MD, Craig Rogers, MD, James Peabody, MD, Mani Menon, MD, Firas Abdollah, MD Henry Ford Hospital Presented By: Lee C. Baumgarten, MD
Introduction: The use of adjuvant radiotherapy (RT) after radical prostatectomy (RP) is limited due to concerns of worsening of functional outcomes with early RT. We sought to test the impact of timing between RP and RT on adverse events rate. Methods: The Radiation Therapy Oncology Group (RTOG) 9601 trial cohort consisted of 760 men with biochemical recurrence after RP, who received subsequent RT. Bowel adverse events; bladder adverse events (urinary frequency, dysuria, hematuria, and incontinence); and new erectile dysfunction were documented as acute (<90 days) or chronic, per trial protocol. Regression analysis tested the impact of timing on these adverse events, after adjusting for potential confounders. Results: The rate of acute bladder, acute bowel, late bladder, late bowel, and late impotence adverse events was, respectively, 49.3%, 60.9%, 61.2%, 48.8%, and 13.6%% in patients with a time period between RP and RT ≤2.1 years (the median) vs 47.5%, 63%, 59.1%,47%, and 14.5% in patients with >2.1 years (all p >0.5). At multivariable analysis, time from RP to RT was not an independent predictor of adverse events (all p>0.4). Conclusions: There was no impact of timing between RP and RT on adverse events related to RT. Thus, our analysis challenges whether early post-surgical RT compromises functional outcomes more than late RT. Funding: none
Table of Contents 140 Podium #63 UROLOGY RESIDENTS’ EXPERIENCE AND ATTITUDE TOWARD SURGICAL SIMULATION: PRESENTING OUR SIX YEAR EXPERIENCE WITH A MULTI- INSTITUTIONAL, MULTI-MODALITY SIMULATION MODEL Shaan Setia, MD1, Carol Feng1, Alexander Chow, MD1, Santae Park, MD2, Stephanie Kielb, MD3, Thomas Turk, MD4, Diana Bowen, MD5, Mark Willie, MD, FACS6, Kristin Baldea, MD4, Arieh Shalhav, MD7, Ervin Kocjancic, MD8, Scott Eggener, MD7, Srinivas Vourganti, MD1, SarahAdelstein, MD1, Michael Abern, MD8, Christopher Coogan, MD1 1Rush University Medical Center, 2Northshore University Health System, 3Northwestern Feinberg School of Medicine, 4Loyola University Medical Center, 5Lurie Children's Hospital, 6Cook County Health and Hospital System, 7University of Chicago Medicine, 8University of Illinois Chicago Medical Center Presented By: Shaan Aariyan Setia, MD
Introduction: Surgical simulation is increasingly used during residency programs to improve technical skills of surgical trainees. We present our six-year experience with a multi-institutional, multi-modality workshop model of urologic simulation for resident education. Methods: Residents from six Chicagoland area urology programs rotated through simulation stations in six consecutive sessions from 2014 to 2019. Simulation stations included GreenLight PVP, endoscopic stone extraction, laparoscopic peg transfer, 3−dimensional laparoscopy rope pass, transobturator sling placement, intravesical botox injection, high definition video system trainer (VITOM), vasectomy model, and Urolift implant. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a non-validated questionnaire evaluating the utility of the workshop. Results: 111 of 131 (85%) participants (PGY1-6) completed the exit questionnaire. Most common previous simulation experiences amongst residents included: robotic (75%), laparoscopy (67%), PVP (65%), and ureteroscopy (51%). Highest rated simulation stations included vasectomy (8.4), 3D laparoscopy (8.3), VITOM (8.25), and laparoscopy (8.1). Over the last six years, ratings of the simulation lab either remained stable or improved (scale of 0-10): ease of use (stable at 8.5), realness of simulation (stable at 7.5), time limit per station (improved 8 to 8.5), and overall course (improved 8.4 to 8.5). Faculty instruction and feedback was rated the highest on average (8.96/10). 110/112 participants (98%) found the simulators beneficial for surgical education. Conclusion: This multi-institutional, multi-modality surgical simulation workshop provides valuable simulation experience for residents. Vast majority of residents believe similar workshops should be required during residency training with most benefit to those early in their training. Funding: N/A
Podium #64 EVALUATION OF A PILOT RESIDENT RESEARCH CURRICULUM FOR UROLOGY TRAINEES Tasha Posid, MA, PhD, Tatevik Broutian, MS, PhD, Justin Rose, BS, Cheryl Lee, MD The Ohio State University Wexner Medical Center Presented By: Tasha Posid, MA, PhD
Introduction: Urology residents are required to participate in scholarly activity as part of ACGME requirements. Although research is an important component of resident training, limited resources and inherent barriers often hinder this. In response, other specialties have reported successful implementation of research training programs. Here, we evaluate a pilot research curriculum for urology residents and present initial findings. Methods: We developed a series of monthly workshops focused on improving resident knowledge of research fundaments relevant to the production of scholarly work, based on a pre-curriculum needs assessment. We calculated three dependent variables of interest: (1) Research Knowledge(difference score created from self- reported understanding of workshop content before and after each curriculum), (2) Curriculum Effectiveness(ratings of the curriculum via Likert scale), and (3) Content
Table of Contents 141 Knowledge(post-curriculum quiz). Analyses were conducted using single-sample and independent samples t-tests. Results: Residents (n=14) self-reported gains in research knowledge from pre- to post- curriculum (d-score vs. 0: t (13) =8.7, p<.001, Cohen’s d=4.8). Residents reported that the curriculum better helped them understand the research process (t(13)=8.7, p<.001, Cohen’s d=4.9) and strongly recommend the course to other programs (t(14)=10.0, p<.001, Cohen’s d=5.5). Junior residents (PGY1-3) reported greater perceived gains/benefits from the course vs. senior residents (PGY4-5; t (12) =2.2, p=.051, Cohen’s d=1.2). Average accuracy on the quiz component of the workshops was 75% and was significantly greater than chance (25%; t (13) =10.9, p<.001, Cohen’s d=6.1). Conclusion: This novel curriculum improves knowledge of the research process, particularly for junior trainees. This innovative urology curriculum has broad applications for medical education and training. Funding: N/A
Podium #65 COMPARISON OF 30- AND 90-DAY COMPLICATION RATES FOLLOWING RADICAL CYSTECTOMY Jacob Knorr, Kyle Ericson, MD, Sylvia Botha, Thomas Lewis, MD, Byron Lee, MD PhD Cleveland Clinic, Glickman Urological Kidney Institute Presented By: Jacob M. Knorr, BS
Introduction: Rates of morbidity and mortality are higher in radical cystectomy than any other urological procedure. Though many cystectomy outcomes studies only report complications at 30 days post-discharge, additional evaluation of complications at 90 days may more appropriately assess the natural course of complications following cystectomy. Methods: Complications were recorded for patients undergoing radical cystectomy at the Cleveland Clinic from August 2007 to August 2018. Major complications were defined as greater or equal to grade 3, as per Clavien-Dindo classification. McNemar’s test was used to compare rates of complication at 30 and 90 days. Results: In total, 984 patient records were assessed for complication post-cystectomy. The rate of major complication at 30 and 90 days was 16.6% (CI: 14.4%-19.0%) and 23.1% (CI: 20.5% - 25.8%), respectively. Rates of complication at 30 and 90 days were significantly different (p = <0.0001). Conclusion: Rates of complication at 30- and 90-days post-discharge are significantly different, suggesting that future studies should include assessment at these time points. Rates at 30 and 90 days also differed when comparing categories of complication. These findings suggest that studies excluding 90-day outcomes may also fail to identify a number of pertinent genitourinary complications that manifest later on in recovery. Funding: Supported by a grant from the Case Comprehensive Cancer Center
Table of Contents 142 Podium #66 UROLOGY RESIDENTS’ EXPERIENCE WITH SIMULATION: INITIAL EVALUATION OF MRI FUSION BIOPSY WORKSHOP Shaan Setia, MD1, Carol Feng1, Srinivas Vourganti, MD1, Christopher Coogan, MD1, Michael Abern, MD2 1Rush University Medical Center, 2University of Illinois Chicago Presented By: Shaan Aariyan Setia, MD
Introduction: Didactics with surgical simulation sessions can provide reinforcement of concepts and real-time feedback for residents. We present our initial experience with a multi-institutional workshop model of MRI fusion biopsy for resident education. Methods: Residents from six Chicagoland area urology programs participated in an MRI fusion biopsy workshop, which incorporated a 30-minute didactic session followed by hands-on simulation. The workshop was facilitated by fellowship-trained university faculty members and company representatives of MRI fusion technologies who provided teaching assistance and verbal feedback. Participants completed pre-and-post-test non- validated 4-item questionnaires graded on a Likert scale. Information on prior experience with TRUS and MRI fusion biopsies was also collected. Pre-and post-questionnaires were compared with paired t-tests for each survey domain (p<0.05 considered significant). Results: 33 residents (PGY 1-6, median PGY 3) participated in the workshop. 13 (40.6%) residents reported performing between 51-100 TRUS biopsies previously. 21 (65.6%) reported being familiar with PIRADS v2 interpretation of prostate MR imaging, however 17 (53.1%) had never previously performed MRI fusion biopsy. Analysis of pre- and post-test questionnaires showed increases in all four survey domains. Residents demonstrated increased familiarity with indications for fusion biopsy (mean difference = +0.59), preparation for fusion biopsy (mean difference = +1.16), methods of MRI to TRUS image registration (mean difference = +1.38), and advantages/disadvantages of perineal versus TRUS fusion biopsy (mean difference = +1.25). Conclusion: This workshop model which combines didactics followed by hands-on simulation training is an effective method for increasing the knowledge and familiarity with MRI fusion biopsy of trainees. Funding: N/A
Podium #67 THE EFFECT OF SELECTIVE ANGIOEMBOLIZATION ON RENAL FUNCTION FOR POST-OPERATIVE BLEEDING AFTER PARTIAL NEPHRECTOMY: A MATCHED CASE-CONTROL STUDY Logan Galansky, BA, Joshua Aizen, MD, Ciro Andolfi, MD, Ragheed Saoud, MD, Osmanuddin Ahmed, MD, Arieh Shalhav, MD University of Chicago Presented By: Logan Galansky
Introduction: Post-operative hemorrhage following partial nephrectomy occurs in 4-8% of patients. When clinically significant, this complication is commonly managed with selective angioembolization (SAE); however, some clinicians may opt for initial observation to avoid renal compromise. This study aims to determine the short- and long- term impact of SAE on renal function. Methods: We retrospectively reviewed our institutional database of patients who underwent partial nephrectomy from 2002-2018. Those who developed post-operative bleeding were identified. Patient factors, surgical characteristics, and short- and long- term renal function were compared to a 1:4 comorbidity-matched non-bleeding surgical cohort. Results: Overall, 18 patients underwent SAE for post-operative hemorrhage. Compared to 80 control patients, no significant differences existed in age, gender, race, pre- operative eGFR, or co-morbidities. Median post-operative follow-up time for intervention and control groups was 7.6 and 57.3 months, respectively. At post-operative day 1, 90, and at time of most recent follow-up, there were no significant differences in serum creatinine, eGFR, change in creatinine, or change in eGFR.
Table of Contents 143 Conclusion: No difference exists in short- or long-term renal function between bleeding and non-bleeding groups, suggesting that SAE does not significantly compromise renal function. The threshold for performing SAE after partial nephrectomy should be low, as it can lead to rapid clinical improvement with a nonexistent impact on renal function. Funding: N/A
Podium #68 THE DEVELOPMENT OF AN AUTOMATED, SELF-SUSTAINING KIDNEY CANCER REGISTRY FROM ELECTRONIC HEALTH RECORDS Niranjan Sathianathen, MBBS (Hons)1,2, Vidhyalakshmi Ramesh, MCA3, Shawn Grove, BS1, Makinna Oestreich, BA4, Christopher Weight, MD1 1University of Minnesota, Dept. of Urology, Minneapolis, MN, 2University of Melbourne, Dept. of Surgery, Melbourne, Australia, 3University of Minnesota, Clinical and Translational Science Institute, Minneapolis, MN, 4University of Minnesota Medical School, Minneapolis, MN Presented By: Makinna Caitlin Oestreich, BA
Introduction: An alluring possibility of electronic health records (EHRs) is the ease of collecting and analysing data to learn from patients in real time. We aimed to develop an automated nephrectomy registry for kidney cancer using structured data from EHRs and enriching the dataset with chart review. Methods: We identified patients using Common Procedural Terminology and International Classification of Diseases codes. We integrated data from EPIC, REDCap, CoPath, billing records, state death indexes, geo coding and natural language processing into a repository. Clinical Informatics experts built the registry on a protected health information-compliant environment using best practice procedures. Clinicians manually validated the data. The data are refreshed weekly to ensure it is up to date. Results: We created a cohort of 1,562 patients who underwent a nephrectomy between 2011 and 2018. We were able to collect complete data for primary demographic points and vital status. Similarly, we identified at least one comorbidity according to the Charlson Comorbidity Index in 1,245 (79.7%) of patients. Laboratory data extraction was also successful with 1,411 (90.3%) of patients returning a valid serum creatinine value prior to surgery. Pathology results were only obtainable for 1,035 (66.3%) of the cohort. The reliability of such a registry is limited by the coding of patients’ surgery and disease indication, as non-cancer cases (e.g. renal transplant) were included in the cohort. Conclusion: We have demonstrated the feasibility of creating an automated surgical database. This automated approach improves accessibility to high quality clinical data and facilitates quality improvement initiatives and clinical research. Funding: Climb 4 Kidney Cancer Foundation
Table of Contents 144 Podium #69 IS THERE A UROLOGIST IN THE HOUSE?: TRENDS IN THE MANAGEMENT OF CONSULTS BASED ON TIME, LOCATION, AND ORGANIZATION Anna Munaco, BS1, Kathryn Marchetti, MD2, Adam Cole, MD2, Yongmei Qin, MS2, Juan J Andino, MD2, Colton H Walker, MD2, Julian Wan, MD2 1University of Michigan Medical School, 2Michigan Medicine, Department of Urology Presented By: Anna Munaco, BSEng
Introduction: While consultation represents a significant workload for inpatient urology providers, it generates substantial financial returns. Despite the contribution to labor and earnings, consult patterns are poorly described in current literature. Methods: Between 2011 and 2018, urology consults at a single center were recorded. Consult time (day, night, overnight) and location (inpatient (IP), emergency room (ER), operating room (OR)) were documented. In July 2016, consult responsibilities were shifted from a nightly “on-call” resident to designated “in-house” resident. An autoregressive analysis was used to evaluate trends in percent billable consults by time, location, and status after adoption of an “in-house” resident. Results: In total, 12,840 consults were billable of 17,128 total consults seen. Cumulatively, 91% of IP, 72% of ER, and 88% of OR consults were billable. Adoption of an “in-house” consult resident was associated with an 12% increase in the percent of all billable consults (p = 0.003) (Figure 1). This change was driven by a significant increase in percent billable IP (13%, p = 0.0005) and ER daytime consults (16%, p = 0.0007). Conclusion: Adoption of an “in-house” consult resident was associated with an increased fraction of billable consults. Yet, nearly a quarter of ER consults were not reimbursed. Understanding consultation patterns offers insights into quality improvement measures. Funding: N/A
Table of Contents 145 Podium #70 IS THERE A BENEFIT TO ADDITIONAL NEUROAXIAL ANESTHESIA IN OPEN NEPHRECTOMY? A PROSPECTIVE NSQIP PROPENSITY SCORE ANALYSIS? Amr Mahran, MD MS1,2, Laura Bukavina, MD MPH2, Kirtishri Mishra, MD2, Danly Omil Lima, MD2, Bissan Abboud, BS2, Michael Wang, BS1, Christina Buzzy, PhD1, Jason Jankowski, MD3,2, Robert Abouassaly, MD MS4,5, Lee Ponsky, MD1,3, Irma Lengu, MD6,1 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 4Cleveland Clinic, Glickman Urology and Kidney Institute, Cleveland, Ohio, 5Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, 6Metro Health Medical Center, Cleveland, Ohio Presented By: Danly O. Omil-Lima, MD
Introduction: Neuroaxial (i.e spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and overall complications in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and post- operative complications, length of stay and readmission rates in nephrectomy patients managed with different anesthesia modalities. Methods: Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone a nephrectomy between 2014 and 2017. Patients were further subdivided based on additional anesthesia modality. Using stepwise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure related readmission, complications, and postoperative length of stay. Results: Out of 35,839 patients identified, 26,556 patients met our inclusion and exclusion criteria. Univariate analysis demonstrated shortest operative time (153.28 ± 69.8) in the general+spinal anesthesia (GSA), while general anesthesia alone (GA) group showed the longest operative time (172.70 ± 75.41, p< 0.001). Compared to GA alone, combined GSA showed lower odds of procedure related readmissions (aOR: 0.318, 95% CI: 0.098-0.752, p= 0.024), and lower odds of any complications (aOR: 0.457, 95% CI: 0.268-0.732, p= 0.002). Conclusion: Using 2014-2017 NSQIP database we were able to demonstrate reduced rate of procedure related readmission and complications in the combined general and spinal anesthesia group. Funding: n/a
Table of Contents 146 Podium #71 UROLOGY RESIDENTS’ EXPERIENCE WITH SIMULATION: INITIAL EVALUATION OF MID-URETHRAL SLING WORKSHOP Shaan Setia, MD1, Carol Feng1, Diana Bowen, MD2, Sarah Adelstein, MD1, Christopher Coogan, MD1, Stephanie Kielb, MD2 1Rush University Medical Center, 2Northwestern University Feinberg School of Medicine Presented By: Shaan Aariyan Setia, MD
Introduction: Didactics with surgical simulation sessions can provide reinforcement of concepts and real-time feedback for residents. We present our initial experience with a multi-institutional workshop model of mid-urethral sling placement for resident education. Methods: Residents from six Chicagoland urology programs participated in a mid- urethral sling workshop, incorporating a 20-minute didactic session followed by hands-on simulation. Simulation session included placement of trans-obturator and retropubic mid- urethral slings on pelvic models. This was facilitated by fellowship-trained university faculty members who provided teaching assistance and feedback. Faculty also documented ability of residents to perform the steps of sling placement independently. Participants completed a 14 item pre- and post-workshop nonvalidated exam to assess knowledge and familiarity with mid-urethral slings. Questions were grouped into 4 categories: sling characteristics, surgical technique, anatomy, and outcomes. Pre- and post- exams were compared with paired t-tests (p<0.05 considered significant). Results: 25 residents (PGY 1-6) participated in the workshop. Analysis of pre- and post- workshop exams showed significant score increases in 11 of 14 (79%) items. The percentage of total correct scores increased in all 4 question categories with greatest improvement in surgical anatomy knowledge (73% overall increase). Skills assessment showed that 13 out of 16 (81%) trainees completed at least 70% of the sling placement tasks independently. All participants (100%) viewed this teaching model as helpful and wanted incorporation into their training. Conclusion: This workshop model which combines didactics followed by hands-on simulation demonstrates increased knowledge of mid-urethral slings and documents high resident ability to perform sling placement independently. Funding: N/A
Podium #72 CHALLENGING PROXIMAL HYPOSPADIAS REPAIRS: AN EVOLUTION OF TECHNIQUE FOR TWO STAGE REPAIRS Yvonne Y. Chan, MD, Anthony D'Oro, Elizabeth B. Yerkes, MD, Ilina Rosoklija, Bruce Lindgren, MD, Edward Gong, MD, Dennis B. Liu, MD, Emilie K. Johnson, MD, David I. Chu, MD, Earl Y. Cheng, MD Ann and Robert H. Lurie Children's Hospital of Chicago, Division of Pediatric Urology, Chicago, IL Presented By: Yvonne Yuh-Ru Chan, MD
Introduction: Proximal hypospadias (PH) repair remains a challenge. Our approach to the first of a 2-stage PH repair has evolved from using Byars’ flaps (BF) to preputial inlay grafts (IG) in anatomically suitable cases and pedicled preputial flaps (PPF) in more complex repairs. We review our outcomes, hypothesizing that PPF has fewer complications than BF and complication rates would decrease with technique refinement. Methods: Retrospective review of boys who underwent primary, 2-stage PH repair from 2007-17 with >6 months follow up was conducted. Complications (fistula, complete/partial dehiscence, diverticulum, meatal stenosis, stricture) were evaluated. As we began to refine our technique and shift away from BF in 2012, comparisons between two cohort years (2007-12 and 2013-17) were made. Results: 74 patients were included. Overall complication rate was 47%. Fistulas (n=16, 22%), partial dehiscence (n=10, 13%), and stricture (n=5, 6.7%) were most common. Complications were significantly lower for PPF (33%) and IG (31%) compared to BF (83%) (PPF vs BF, p<0.01; IG vs BF, p<0.01). Comparing the earlier to later cohorts, overall complications decreased from 72% to 31% (p<0.01) (Table 1).
Table of Contents 147 Conclusion: Our complication rates reflect contemporary reports. PPF have fewer complications than traditional BF. Modification of our technique may have resulted in fewer complications in the short-term. Long-term follow-up is needed. Funding: N/A
Podium #73 MEATAL MISMATCH: IMPLICATIONS OF HYPOSPADIAS MEATAL LOCATION DISCORDANCE Anthony D'Oro, BA, Ilina Rosoklija, MPH, Emilie Johnson, MD, MPH, Edward Gong, MD, Dennis Liu, MD, Max Maizels, MD, Derek Matoka, MD, Elizabeth Yerkes, MD, Earl Cheng, MD, David Chu, MD, MSCE Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Anthony D'Oro, BA
Introduction: Hypospadias severity is often but not solely based on meatal location. However, preoperative meatus locations do not always match meatus locations after degloving and urethral cutback, affecting phenotyping systems like the Glans-Meatus- Shaft (GMS) score. We examined rates of meatal mismatch, hypothesizing that increased chordee predicts meatal mismatch. Methods: We performed a single-center, retrospective cohort study of patients who underwent primary hypospadias surgery from 03/2011-04/2018. Pre-operative meatus location (distal, midshaft, proximal shaft/penoscrotal, scrotal/perineal), degree of curvature, and penoscrotal anatomy were evaluated for their association with meatal upstaging (meatus moves proximally) and meatal downstaging (meatus moves distally) after degloving and urethral cutback. Results: Of 496 patients who met eligibility criteria, 63 (13%) patients’ meatal location upstaged and 19 (4%) patients’ meatal location downstaged (Table). Preoperative midshaft meatus locations changed most frequently, with 37% upstaged and 7% downstaged. Upstaging was significantly associated with preoperative testosterone and worsening chordee; downstaging was significantly associated with buried penis. Conclusion: Overall, 17% of our cohort had meatal mismatch following degloving. Over one third of patients whose meatus initially appeared midshaft (GMS: M3) upstaged their meatal locations after degloving (GMS: M4). Our results may help urologists counsel families about their child’s expected surgical course and highlight the need for clear phenotypic definitions when comparing outcomes across institutions. Funding: N/A
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Podium #74 TO STAGE OR NOT TO STAGE: SURGEON INTUITION AND EARLY COMPLICATIONS IN PROXIMAL HYPOSPADIAS REPAIR Anthony D'Oro, BA, Ilina Rosoklija, MPH, Bruce Lindgren, MD, Emilie Johnson, MD, MPH, Edward Gong, MD, Dennis Liu, MD, David Chu, MD, MSCE, Max Maizels, MD, Theresa Meyer, MS, RN, CPN, Earl Cheng, MD, Elizabeth Yerkes, MD Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Anthony D'Oro, BA
Introduction: There is limited data to indicate which patients may be suitable for a single stage as opposed to a planned multi-stage repair of proximal hypospadias (PH). This study aims to 1) identify patient characteristics which contributed to surgeons’ staging decision for PH repair, and 2) compare rates of short-term complications between single- and multi-staged repairs. Methods: A single-center, retrospective review of prospectively collected intra-operative data was conducted on patients who underwent primary PH repair from 07/2011- 12/2016. Patients without intra-operative measurements were excluded. Pre-operative physical characteristics, intra-operative penile measurements, and post-operative complications were compared between patients who underwent single-stage (Group 1) and planned multi-stage repair (Group 2). Results: 87 patients met inclusion criteria, including 35 patients in Group 1 and 52 patients in Group 2. Compared to Group 1, Group 2 had higher rates of bifid scrotum, penoscrotal transposition, chordee ≥60º, undescended testicles, meatus proximal to the penoscrotal junction, and flat glans (all p≤0.01). At a median follow-up of 19.7 months (IQR: 7.0-34.2), patients who underwent single-stage repair had a complication rate of 57%, compared to 33% for staged repair (p=0.03, Figure). Conclusion: Despite having more favorable characteristics as assessed both pre- and intra-operatively, patients who were selected for a single-stage repair had a complication rate above 50% at early follow-up. Funding: N/A
Table of Contents 149 Podium #75 THE OVER-PRESCRIPTION OF POSTOPERATIVE PAIN MEDICATION – HOW MUCH DO PEDIATRIC UROLOGISTS CONTRIBUTE? Zachary Rye, Christopher Cooper, Gina Lockwood, Bradley Erickson, Denise Juhr, Patrick TenEyck, Douglas Storm University of Iowa Hospitals and Clinics Presented By: Zachary Rye
Introduction: Over prescription of pain medications is a public crisis. We sought to better understand pediatric urology patients’ postoperative pain and pain requirements. Methods: Parents of a child undergoing a urologic operation receiving a prescription for oxycodone, acetaminophen and ibuprofen were eligible. Over a one-week period the parents received an evening text message with a link to a survey. The survey asked the parents to rate their child’s pain and record the number of doses of medication administered. This prospectively collected data was evaluated using generalized linear modeling. Results: 76 patients were enrolled with a mean age of 33.4 months (5-169 months). Surgical procedures included: circumcision (35%), communicating hydrocele repair (11%), hypospadias repair (22%), orchiopexy (29%) and ureteral reimplantation (3%). The average prescribed amount of each medication was: oxycodone - 13.2 doses, acetaminophen - 48.6 doses, and ibuprofen - 34.3 doses. Over seven days, the average pain score was 2.25 (4.19-0.92), significantly improving from postoperative day 1 (4.19) to day 7 (0.95) (p < 0.01). The average doses of any pain medication was 18.6 (0-51 doses) and improved from day #1 (7.3) to day #7 (1.2) (p < 0.01). On average, oxycodone was overprescribed by 10 doses and acetaminophen and ibuprofen by 41 doses and 26 doses, respectively. Orchiopexy (p=0.01), hydrocele repair (0.01) and hypospadias surgery (p<0.01) all predicted an increased pain medication requirement and higher pain score. Conclusion: Currently all post-operative pain medications are overprescribed. Work to create a model that predicts postoperative pain and medication requirements is underway. Funding: N/A
Podium #76 HEMINEPHRECTOMY IS RARELY NEEDED FOR ECTOPIC URETERS/URETEROCELES Christopher Jaeger1, Daryl McLeod2,1, Seth Alpert2,1, Christina Ching2,1, Molly Fuchs2,1, Daniel Dajusta2,1, Venkata Jayanthi2,1 1Ohio State University, 2Nationwide Children's Hospital Presented By: Christopher Jaeger, MD
Introduction: Heminephrectomy is a standard option for children with duplex anomalies. We have attempted to follow a reconstructive algorithm irrespective of upper pole function and, herein, we present our outcomes in this non-ablative approach. Methods: Patients with ectopic ureters/ureteroceles who underwent surgery between 2006 and 2018 were reviewed. Non-ablative procedures included ureterocele puncture, ureteroureterostomy (UU), and ureteral reimplantation. Ablative procedures included heminephrectomy and nephrectomy. Patients were separated by type of anomaly and outcomes were assessed. Children with ectopic ureters primarily underwent UU; ureteroceles with low grade reflux typically underwent primary UU; and all other ureteroceles underwent puncture prior to delayed UU. Ablative surgery was rarely considered. Results: 74 patients were identified with a total of 78 renal units. 38 patients (30F/8M, mean age – 24mo) had ectopic ureters (41 renal units). 40/41 units were initially managed with a non-ablative approach. 2 units that underwent UU required subsequent surgery, 1 unit managed with heminephrectomy. Mean follow-up was 36 months (2-116). 36 patients (25F/11M, mean age – 21mo) had ureteroceles (37 renal units). 36/37 units were initially managed with a non-ablative approach. 17/36 units were initially managed with puncture. Many underwent delayed reconstruction, but 1 unit underwent
Table of Contents 150 nephrectomy. 19/36 units were initially reconstructed. 2 units that underwent UU required subsequent surgery, 1 unit managed with nephrectomy. Mean follow-up was 27 months (2-94). 5/78 units came to ablative surgery. Conclusion: Heminpehrectomy is rarely necessary in the management of children with duplex anomalies. A primary reconstructive approach is safe. Funding: N/A
Podium #77 HYDRONEPHROSIS FOLLOWING URETERAL REIMPLANTATION: WHEN IS IT CONCERNING? Ciro Andolfi, MD, Diboro Kanabolo, Veronica Rodriguez, MD, Joshua Aizen, MD, Brittany Adamic, MD, Craig Labbate, MD, Mohan Gundeti, MD University of Chicago Medicine Presented By: Ciro Andolfi, MD
Introduction: Hydronephrosis (HN) without obstruction is a common finding in patients awaiting vesicoureteral reimplantation for high-grade vesicoureteral reflux (VUR). Though a common, postoperative HN (POHN) still raises concern for some surgeons who fear the presence of a silent obstruction. We aim to determine the natural progression of post- operative HN in children who have undergone open (OUR) or robot assisted (RALUR) ureteral reimplantation for VUR. METHODS: We reviewed records of patients who underwent OUR or RALUR between December 2007-17. Baseline characteristics, operative outcomes, and trends in post-operative HN were then compared between OUR and RALUR. RESULTS: 129 patients met inclusion criteria. 40.3% patients underwent OUR and 59.7% patients underwent RALUR. POHN was identified in 21 (40%) of OUR and 21 (27%) of RALUR patients. In POHN patients, 71% OUR and 62% RALUR had no pre-operative HN. 90.5% of POHN, had spontaneous improvement at 381 days. Mean time-to-resolution of POHN was 553 and 242 days for OUR and RALUR, respectively. Bilateral reimplantation was found to be an independent risk factor for both persistent HN and delayed recovery. Overall time-to-resolution of HN was significantly higher in this group compared to unilateral reimplantation (699 vs 216 days). CONCLUSIONS: HN following ureteral reimplantation is a common finding. POHN is frequently transient, benign, and resolves within one year. Patients with high-grade pre-operative bilateral VUR and HN requiring bilateral vesicoureteral reimplantation are at higher risk for developing more severe and prolonged POHN and should be closely monitored with imaging studies for resolution of their HN. Funding: N/A
Podium #78 ENGAGING PARENTS IN THE DEVELOPMENT OF A HYPOSPADIAS DECISION AID PROTOTYPE Katherine Chan, MD, MPH1,2, Janet Panoch, MA1, Amr Salama, MD1, Elhaam Bandali, MS1, Brandon Cockrum, MFA3, Courtney Moore, BFA3, Sarah Wiehe, MD, MPH3 1Department of Urology, Indiana University School of Medicine, 2Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research, 3Department of Pediatrics, Section of Children's Health Services Research Presented By: Katherine Hubert Chan, MD, MPH
Introduction: To engage researchers and parents of boys with hypospadias in the co- design of a decision aid (DA) prototype to help parents make decisions about hypospadias surgery. Methods: We conducted a workshop with researchers and parents of children with hypospadias, engaging them in a discussion of their decision-making about hypospadias surgery and recommendations for a DA prototype. Preferences regarding information sources and content and priorities regarding perioperative concerns, surgery goals and decision-making were explored. Examples of DA prototypes were created in small groups All activities were audio-recorded and professionally transcribed. The data was
Table of Contents 151 analyzed by six coders using a collaborative coding process to identify relationships between themes to inform the development of an affinity diagram (Figure 1). Results: Participants included 10 parents (6 mothers, 4 fathers; 8 Caucasian, 2 African American), ages 28-40, of hypospadias patients. DAs created by participants were user- friendly, interactive and available 24/7 (e.g. website) DA functions included educational content, an online forum and decision-making activities. Parents also included customizable content about hypospadias incidence and severity, a review of postoperative care and expert testimonials from parents. Conclusion: Parents of hypospadias patients desire a DA that is user-friendly, multi- purpose, customizable and available 24/7. Future directions include focus groups with providers/parents for further refinement of the DA prior to pilot-testing. Funding: K23 Career Development Award (1K23DK111987-01) from the National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases
Podium #79 EXPERIENCE WITH A NEW PARADIGM FOR ONE VISIT TO EXPEDITE NEWBORN CIRCUMCISION Max Maizels, Patrick Meade, Melanie Mitchell, Ilina Rosoklija Ann and Robert H. Lurie Children's Hospital of Chicago Presented By: Max Maizels, MD
Introduction: Newborn circumcision is typically done before postpartum discharge. However, circumcision is delayed if providers suspect abnormal penile anatomy. We believe this practice increases risk as circumcision is done in an older boy. We present our experience with a new paradigm to expedite both referral and circumcision at ″One Visit″. Methods: One Visit circumcision was provided to newborns referred due to scrotum web, small penis, chordee, or abnormal prepuce. Penis shaft, scrotum and glans were assessed by checklist for suitability to circumcise. Boys found suitable were circumcised under regional anesthesia using a Mogen clamp. Those found unsuitable were offered reconstruction. We tracked circumcision success, duration of the visit, complications, parent satisfaction, and circumcision requiring general anesthesia. Results: 833 boys presented for One Visit (1/2014 – 4/2018) and 657 (79%) were circumcised. 595/657 (91%) boys returned for follow up (avg. 1.2 weeks, range 1 - 6 weeks); 62/657 (9%) did not return. Circumcision success was achieved in 593/595 (99.7%); 2 boys required surgical repair. The duration of the One Visit (February - March 2018, n=48) averaged 111 ± 39 minutes. Hospital data showed 91% would recommend One Visit. No complications were noted, and none required general anesthesia for
Table of Contents 152 circumcision. We found 176 (21%) unsuited to circumcise due to buried penis (125), chordee (40), and hypospadias (11); 144 elected for surgical reconstruction, 32 did not. Conclusion: We found the One Visit paradigm is feasible to expedite newborn circumcision as we performed 595 circumcisions under a two-hour window, with a 99.7% success rate. Funding: N/A
Podium #80 KNOWLEDGE GAPS AND INFORMATION-SEEKING BY PARENTS ABOUT HYPOSPADIAS Katherine Chan, MD, MPH1,2, Janet Panoch, MS1, Aaron Carroll, MD, MS2, Sarah Wiehe, MD, MPH3, Stephen Downs, MD, MS3, Mark Cain, MD1, Richard Frankel, PhD4 1Indiana University School of Medicine, Department of Urology, 2Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research, 3Department of Pediatrics: Children's Health Services Research Center, 4Indiana University School of Medicine and Cleveland Clinic Learner Institute, Cleveland, Ohio Presented By: Katherine Hubert Chan, MD, MPH
Introduction: To develop a parent decision aid (DA) based on identifying knowledge gaps, information-seeking behaviors and informational needs of parents making decisions about hypospadias surgery for their sons. Methods: We conducted interviews with parents (≥ 18 yrs) of children with hypospadias, inquiring about knowledge gaps, information-seeking behaviors and informational needs. Data was analyzed using qualitative content analysis Results: Of the 43 eligible parents, 16 mothers and 1 father (39.5%) of 16 patients participated: 7 preoperative and 9 postoperative with distal (8) and proximal (8) meatal locations. Parents were ages 21-43: 15 Caucasians and 2 African Americans.We identified five categories of knowledge gaps relating to hypospadias surgery: epidemiology, timing/technique, perioperative experience, long-term cosmetic outcome and long-term risk of complications. Information sources included the internet, pediatrician and/or urologist and their social network. Most parents sought information online prior to their urology consultation from parent blogs/forums, medical school/hospital websites, journal articles and medical databases. They expressed concerns about the clarity/reliability of information and noted a lack of information on mild hypospadias cases and outcomes. They thought that video testimonials from other parents would help them relate to others in their social network and build confidence about the surgical process. Interactions with providers helped to clarify information they gathered online and build trust in the surgeon. Conclusion: The Internet is the primary source of information most parents to address knowledge gaps about hypospadias. Overall, parents felt that it was necessary to incorporate reliable information and parent testimonials in a DA. Funding: K23 Career Development Award (1K23DK111987-01) from the National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases
Podium #81 A CASE SERIES OF RARE GENITOURINARY MANIFESTATIONS OF CROHN’S DISEASE Molly DeWitt-Foy, MD, Jacob Kurowski, MD, Audrey Rhee, MD Cleveland Clinic Presented By: JJ Haijing Zhang, MD
Introduction: Genitourinary (GU) complications of Crohn's disease (CD) affect 4-35% of CD patients. Common manifestations include nephrolithiasis and fistula formation between bowel and GU organs. Here we present four boys with CD and uncommon urologic manifestations. Methods: Retrospective review was conducted of four patients with uncommon urologic manifestations of CD.
Table of Contents 153 Results: Patient 1 is an 11-year-old male with recurrent self-limited urinary frequency/urgency. During one episode he also complained of hematochezia, for which a colonoscopy was performed. Biopsy was diagnostic for CD, and the patient continued to experience lower urinary tract symptoms as harbingers of Crohn’s flares. Patient 2 is an 11-year-old male who presented with penoscrotal edema and rectal pain. Scrotal biopsy demonstrated non-necrotizing granulomatous dermatitis, suggestive of CD. This diagnosis was confirmed on colonoscopy, and all symptoms improved with infliximab therapy. Patient 3 is a 10-year-old male who presented with gross hematuria, diarrhea, and fever. CT showed only bladder wall thickening, urine culture was negative, stool culture grew campylobacter. Cystoscopy demonstrated bullous edema, biopsy showed acute and chronic inflammation. Later colonoscopy was diagnostic for CD. Patient 4 is an 18-year-old male with CD who presented with recurrent dysuria with negative culture and UA. Two years later cystoscopy demonstrated a 2cm urethra stricture, despite no history of GU trauma or instrumentation. He eventually underwent urethroplasty with resolution of symptoms. Conclusion: Here we present rare urologic manifestations of CD in a pediatric population. These rare genitourinary presentations of CD may represent a more virulent form that requires more aggressive medical management. Funding: N/A
Podium #82 PEDIATRIC PYELOPLASTY 30-DAY OUTCOMES: COMPARISON OF OPEN VERSUS MINIMALLY INVASIVE PYELOPLASTY FOR URETEROPELVIC JUNCTION OBSTRUCTION UTILIZING NSQIP DATABASE Kimberly Woo, BA1, Amr Mahran, MD MS2, Laura Bukavina, MD MPH2, Kirtishri Mishra, MD2, Megan Prunty, MD3, Lee Ponsky, MD3, Heather DiCarlo, MD4, Jonathan Ross, MD5, Lynn Woo, MD6 1Case Western Reserve School of Medicine, 2University Hospitals Cleveland Medical Center/ Case Western Reserve Medical University, 3University Hospitals Cleveland Medical Center/Case Western Reserve Medical University, 4Johns Hopkins School of Medicine/The James Buchanan Brady Urological Institute, Baltimore, Maryland, 5Rainbow Babies and Children's Hospital/Case Western Reserve University, 6MD Rainbow Babies and Children's Hospital/Case Western Reserve University Presented By: Kimberly Woo
Introduction: To evaluate the differences in outcomes between minimally invasive pyeloplasty (MIP) and open pyeloplasty (OP) for the surgical correction of ureteropelvic junction obstruction in children. Methods: Data was obtained from the pediatric National Surgical Quality Improvement Program (NSQIP) 2012-2017. We identified 1,280 patients who underwent MIP and 1,190 patients who underwent OP. Propensity score matching (PSM) was utilized to adjust for baseline differences. Univariate and multivariable regression were utilized to assess odds of complications and procedure related readmission. Results Patients who underwent OP had a significantly decreased operative time (192.42 vs. 142.00 min, p < 0.001). There was no significant difference in the rates of overall perioperative complications (3.7% (MIP) vs 2.4% (OP) p=0.397). On multivariable analysis, patients undergoing OP had a lower risk of procedure-related readmission (OR 0.404, 95% CI 0.157-0.951, p=0.046]. In a multivariable regression model, the risk of having any postoperative complication, regardless of surgical approach, decreased with increasing patient age [OR 0.945, 95% CI 0.893-0.996, p = 0.037]. Conclusion: MIP offers a minimally invasive alternative to OP in the pediatric population with similar rates of perioperative complications. However, our study shows decreased odds of procedure related readmission in OP, which may serve as a surrogate for postoperative complications in these patients. Funding: N/A
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Podium #83 ANALYSIS OF POSTOPERATIVE OPIOID PRESCRIBING PATTERNS FOR PEDIATRIC UROLOGIC SURGERY PATIENTS Matthew Ziegelmann, Matthew Gettman, Paige Nichols, Daniel Ubl, Jason Joseph, Halena Gazelka, Bradley Leibovich, Patricio Gargollo, Elizabeth Habermann, Candace Granberg Mayo Clinic Presented By: Matthew J. Ziegelmann, MD
Introduction: Opioid prescribing is relevant to pediatrics; wherein long-term effects of early exposure are unknown. Here, we sought to describe postoperative opioid prescribing practices in children undergoing urologic surgery. Methods: Prescribing data were evaluated for all patients ≤ 18 years-old undergoing one of 22 common pediatric urologic surgical procedures between 2016- 2017. Opioids were converted to oral morphine equivalents (OME), and patterns were compared across procedures. Results: 776 patients [165 females (21%) and 611 males (79%)] were identified. Median age was 3 years (IQR 0;8). 224 patients (29%) were prescribed opioids. Median OME/kg in those who were prescribed opioids was 2.2 (1.5;3.1). Variation within/amongst various procedures was observed.[Figure 1 – OME/kg stratified by procedure] Older children (ages 12-18) were significantly more likely to receive opioids (71%) compared with younger children (ages 3-11 years; 39%) and infants (ages 0-24 months, 8%; p<.001). Sub-group analysis of patients ≥ 11 years old (n=156), wherein weight-based dosing is less common, was performed. In these patients, median (IQR) prescribed OME was 85 (0;150), and 16/156 (10%) received > 200 OME. Conclusion: We identified variation in postoperative opioid prescribing for pediatric patients. Older children were more likely to receive a postoperative opioid prescription. While further study is needed, these findings suggest opportunities for standardization. Funding: N/A
Table of Contents 155 Podium #84 TRANS-RETRO PARTIAL NEPHRECTOMY FOR POSTERIOR RENAL TUMORS: TECHNIQUE AND INITIAL EXPERIENCE Subodh Regmi, Fellow1, Paul Blake2, James K Anderson, Associate Professor1, Christopher Warlick, Associate Professor1, Christopher Weight, Associate Professor1 1University of Minnesota, Department of Urology, Minneapolis, MN, 2University of Medical School, Minneapolis, MN Presented By: Subodh Kumar Regmi
Introduction: Posterior renal tumors could be ideally suited for retroperitoneal Robot Assisted Partial Nephrectomy (RAPN) but unfamiliarity and compromised working space limit widespread use. Poor visualization in trans-peritoneal approach drives most urologists to either open partial or laparoscopic nephrectomy. We describe the technique and initial experience of combining the two approaches into a hybrid Trans-retro approach for posterior renal tumors. Methods: On full flank position with operating table flexed, three 8 mm robotic and 12 mm airseal port are inserted after pneumoperitoneum. A fourth robotic port is placed, after initial trans-peritoneal dissection, close to tip of 12th rib. Scope is moved from arm 2 to arm 3 and arm 1 is used for medial kidney retraction. Hilar clamping, tumor resection and renorrhaphy are completed from this approach. Results: Nine patients with posterior renal tumors were operated between June 2018 and January 2019. Average age was 54.33yrs and the male to female ratio was 5:4. Mean tumor size was 3.35cm (range, 1.5-5cm) and mean R.E.N.A.L. score 7.22 (range, 4-10). Mean operative time and warm ischemia times were 217.33 and 25.95 minutes respectively. Mean estimated blood loss was 185ml with no transfusion requirements. Average hospital stay was 1.7 days and 3 patients had Clavien grade I complication. Conclusion: The trans-retro RAPN can be an alternative approach for those unfamiliar with a pure retroperitoneal RAPN for posterior renal tumors with acceptable postoperative outcomes and can obviate the need for an open partial or laparoscopic nephrectomy. Funding: N/A
Podium #85 TENSILE FORCE EXERTED BY SUTURE DURING RENORRHAPY USING CURRENT TECHNIQUES Joseph Zanghi, DO1, James Siegert, DO1, Thai Nguyen MD, MD2 1Franciscan Health - Olympia Fields, 2Advanced Urology Associates Presented By: Joseph John Zanghi, DO
Introduction: Partial nephrectomy has become the preferred treatment option for small renal masses. In particular, minimally invasive partial nephrectomy (MIPN) using laparoscopic or robotic approaches have shown decreased blood loss, shorter hospital stays, and faster return to normal activity compared to open surgery. However, MIPN still carries risk of postoperative complications including hemorrhage and urine leakage. Closure of the renal remnant, often called renorrhaphy, is a critical step to avoid these complications. Purpose: To provide quantitative data on suture properties during partial nephrectomy. Multiple suture techniques have been proposed for renal closure during robotic assisted partial nephrectomy. There is no consensus for preferred closure technique and this decision is at the discretion of the surgeon. Methods: Simulated partial nephrectomies were performed on porcine kidneys. Renorrhaphy was completed with barbed suture using a simple running, interrupted sliding-clip, or horizontal mattress technique. Suture tension was obtained prior to tissue failure with force sensors measuring in newtons (N). Results: The interrupted sliding-clip and horizontal mattress techniques performed similarly with median force values of 11.06N and 12.20N, respectively. The simple running technique performed with a median force of 3.62N. ANOVA proved statistical significance.
Table of Contents 156 Conclusion: Interrupted sliding-clip and horizontal mattress sutures exert similar forces prior to tissue failure during renorrhaphy. Simple running sutures failed at significantly lower forces. Therefore, when closing renal defects after partial nephrectomy, sliding clip and horizontal mattress should be utilized over simple running sutures. Funding: N/A
Podium #86 ROBOTIC AND OPEN PARTIAL NEPHRECTOMY FOR INTERMEDIATE AND HIGH COMPLEXITY TUMORS: A MATCHED-PAIRS COMPARISON OF SURGICAL OUTCOMES AT A SINGLE INSTITUTION Zain A Abedali, M Francesca Monn, Brent E Cleveland, Jay Sulek, Clinton D Bahler, Ronald S Boris, Chandru P Sundaram Indiana University School of Medicine Department of Urology Presented By: Zain Abedali
Introduction: Partial nephrectomy as standard of care for localized renal masses can be performed open (OPN) or with robotic assistance (RPN) with OPN often used for more complex masses. The objective is to compare peri-operative factors and renal function following OPN and RPN when controlling for tumor and patient complexity. Methods: Patients with intermediate (nephrometry score (NS) 7-9) or high (NS 10-12) complexity tumors who underwent partial nephrectomy were matched in a 2:1 ratio of RPN:OPN using NS, Charlson Comorbidity Index (CCI), and BMI (n=222). Patient characteristics, peri-operative values, renal function, and complication rates were analyzed and compared. Results: 74 OPN patients were matched to 148 RPN patients with no statistically significant difference in age, gender, BMI, CCI, NS or smoking status. Estimated blood loss, transfusion rate, and warm ischemia time were significantly higher in the OPN cohort. RPN patients had longer operative durations but shorter hospitalizations. GFR reduction after one month was not statistically significant between groups. Clavien III-V complications incidence was higher for OPN compared to RPN although not statistically significant. Conclusion: When matching for tumor and patient complexity, RPN patients had fewer high grade post-operative complications, less blood loss, and shorter hospitalizations. Robotic-assisted partial nephrectomy is a safe option for patients with intermediate and high complexity tumors. Funding: N/A
Table of Contents 157 Podium #87 THE “STRAIGHTFORWARD” URETERAL REIMPLANTATION: IS THERE A ROBOTIC BENEFIT? Peyton Skupin1, Paholo Barboglio-Romo, MD2, Bahaa Malaeb, MD2, John Stoffel, MD2, Sapan Ambani, MD2 1University of Michigan Medical School, 2University of Michigan Department of Urology Presented By: Peyton Skupin
Introduction: Many factors influence the ability to perform ureteral reconstruction robotically, which makes comparing the two approaches challenging. We sought to compare the outcomes of patients who underwent an open or robotic ureteroneocystostomy for ureteral obstruction. Methods: Retrospective review was performed on adult patients who underwent primary ureteroneocystostomy for obstruction from January 2012 to April 2018. Of 114 patients, 69 did not meet inclusion criteria based on surgery type. Intraoperative outcomes of estimated blood loss (EBL) and operative time, as well as postoperative outcomes of catheter and stent duration, length of hospital stay (LOS), inpatient nurse-controlled opioid use, patient-controlled analgesia (PCA) and outpatient opioid prescription, complications, readmission, radiologic and clinical stricture recurrence, and follow-up were compared. Results: Open ureteroneocystostomy was performed in 27 patients compared to 18 who underwent a robotic approach (Table). The open and robotic cohorts were not significantly different demographically. The robotic cohort had significantly lower EBL, LOS, prescribed morphine milliequivalents at discharge, and rate of PCA usage. Conclusion: Patients undergoing robotic primary ureteroneocystostomy for ureteral obstruction had lower post-operative pain requirements and a shorter length of stay. This approach does not convey a benefit in terms of stricture recurrence or postoperative complications. A robotic approach does provide a benefit in well-selected patients. Funding: None
Table of Contents 158 Podium #88 PORCINE LAB AS A USEFUL AND POPULAR ADJUNCT FOR UROLOGIC SURGICAL TRAINING Daniel Szabo, MD, Tasha Posid, MA, PhD, Geoffrey Box, MD The Ohio State University Wexner Medical Center Presented By: Daniel Szabo, MD
Introduction: “In vivo” animal labs mimic surgery in humans and can teach trainees key surgical skills before entering the operating room. This study evaluated the immediate impact of a porcine lab in teaching surgical skills to urologic trainees. Methods: Seventeen participants (residents: n=14, medical students: n=3) participated in a surgical lab using porcine models. Procedures covered were radical/partial nephrectomy (laparoscopic/robotic), emergent open conversion, and open ileal conduit creation. Following the lab, participants completed a survey assessing the curricular content and their subjective pre- and post-lab knowledge of the surgical skills taught. Results: Medical students and residents rated their knowledge as greater on all procedures taught (p<0.001 for each category, Figure 1). Junior residents (PGY 1-3) had significant knowledge gains in all skill categories (p<0.001 for each). Senior residents (PGY 4-5) showed improvements that were not statistically significant. Knowledge gains were highest for junior residents, followed by medical students, then senior residents: laparoscopic/robotic (p=0.006), open conversion (p=0.047), open surgery (p=0.03). Knowledge gains were highest for emergent open conversion. The curriculum was highly rated for improving surgical skills and preparing for work in the OR. All participants would highly recommend this curriculum to peers. Conclusion: Porcine models can be valuable and popular tools in advancing urologic surgical education, especially for junior trainees. Funding: N/A
Podium #89 COMPLEX ROBOT-ASSISTED LAPAROSCOPIC URETERAL REIMPLANT: SAFETY AND OUTCOMES Bruce Lindgren, MD, Rachel Shannon, Ilina Rosoklija, MPH, Emilie Johnson, MD, Dennis Liu, MD, Edward Gong, MD Ann Robert H. Lurie Children's Hospital of Chicago Presented By: Bruce Walter Lindgren, MD
Introduction: Current literature on robot-assisted laparoscopic ureteral reimplant (RALUR) contains a wide range of reported success rates, thus its role remains controversial. Success following open ureteral reimplant with tailoring has been reported at 74-90%. We have utilized RALUR for both straightforward and complex procedures in children. Given the limited literature, we aim to evaluate our institutional experience with complex RALUR.
Table of Contents 159 Methods: A retrospective review of RALUR 12/2011 - 6/2018 at a single institution was conducted. Cases were considered complex if RALUR was performed in conjunction with megaureter tapering or ipsilateral ureteroureterostomy (IUU), or if the patient had neurogenic bladder (NGB). Results: 40 complex RALUR were performed (34 with tapering, 4 with IUU, 2 in patients with NGB). Median patient age was 2 years (0.7–21), and median console time was 195 min (126 – 388). 2 patients were readmitted within 60 days, 1 for urinary retention and extravasation and 1 for febrile UTI. Post-operative US was available in 32/33 patients with pre-op obstruction, with sonographic improvement in 30/32 (94%). Of 22 patients with VUR, 17 underwent post-op VCUG, with resolution of VUR in 13/17 patients (76%). 5 patients (13%) required return to the OR for diagnostic (n=2), stent-related (n=1) or reoperative (n=2) procedures. Conclusion: Complex RALUR is safe and relief of obstruction can be expected. Resolution of VUR in complex RALUR is lower than with primary, uncomplicated VUR, but comparable to published success of open megaureter repair. Funding: N/A
Podium #90 TECHNICAL APPROACH AND INITIAL EXPERIENCE FOR ROBOT-ASSISTED SINGLE PORT PROSTATECTOMY Ryan Dobbs, MD, Whitney Halgrimson, MD, Ikenna Madueke, MD, PhD, Hari Vigneswaran, MD, Simone Crivellaro, MD University of Illinois at Chicago, Dept. Urology, Chicago, IL Presented By: Ryan W. Dobbs, MD
Introduction: Since the introduction of the da Vinci surgical platform (Intuitive Surgical, Sunnyvale, CA, USA), robotic technology has become the preferred approach for performing radical prostatectomy in the United States. The da Vinci SP system represents a new robotic model allowing for single port operations. We report a consecutive series of patients who underwent single port robot-assisted laparoscopic radical prostatectomy (SP-RALP) to assess the safety and feasibility of this approach. Methods: Ten consecutive patients with biopsy-confirmed prostate cancer underwent SP-RALP at our institution. Pre, peri, and postoperative data were prospectively collected regarding key outcomes including estimated blood loss, operative time, postoperative pain requirements, duration of hospital stay, and complications. Results: Patients were between 52 and 77 years of age with BMI between 24.4 and 36.7 kg/m2. Prostate volumes ranged from 26 to 136 cc with an average PSA 11.0 ng/mL (SD 10.6). Lymph node dissection was performed in 4 cases and nerve sparing performed in 5 cases. No intra-operative complications occurred, and no patients required conversion to open approach. Estimated total blood loss was 20 to 150 cc with median console time of 189 (IQR 171 – 207) minutes and median operative time of 234 minutes (IQR 216 – 247). No patients were readmitted or required re-intervention. Urethral catheters were removed a median 10 days (IQR 8-11) following surgery. Conclusion: SP-RALP appears to be a safe and feasible approach to performing robotic radical prostatectomy. Long term follow-up will be necessary to assess initial oncological and functional results. Funding: N/A
Table of Contents 160 Podium #91 CHALLENGES IN USING VIDEO-BASED PEER REVIEW PROCESSES FOR ASSESSING SURGEON SKILL Zachary Prebay1, Rodney Dunn2, Ji Qi2, Firas Abdollah3, Wassim Bazzi4, Khurshid Ghani2, William Johnston4, Tae Kim2, Brian Lane5, Thomas Maatman6, Richard Sarle7, Eric Stockall8, Jaya Telang2, James Peabody3, for the Michigan Urological Surgery Improvement, Collaborative 1Medical College of Wisconsin, 2University of Michigan, 3Henry Ford Hospital - Vattikuti Urology Institute, 4Michigan Institute of Urology, 5Spectrum Health Medical Group, 6Michigan Urological Clinic, 7Sparrow Hospital, 8Capital Urological Associates Presented By: Zachary James Prebay
Introduction: Michigan Urological Surgery Improvement Collaborative (MUSIC) surgeons participate in a video-based peer review program to improve surgical skill. MUSIC sought to better understand the relationship between surgical skill assessments and patient outcomes as a quality improvement initiative. Methods: MUSIC invited surgeons to submit complete Robot-Assisted Radical Prostatectomy (RARP) videos to undergo de-identification and editing into two parts of RARP: Bladder Neck dissection (BN) and Apical Dissection (AD). MUSIC recruited peer surgeons to review videos. Reviewers utilized the Global Evaluation and Assessment of Robotic Skills (GEARS; range 5-25), which assesses surgical skill in 5 domains (range 1- 5). Results: 50 urologists provided 522 reviews of 91 clips. At least 4 reviewers evaluated each clip. Mean BN scores ranged from 14 to 24 with no significant association with patient social continence (0-1 pads per day at 3 months, p=0.60). Additionally, 49 surgeons reviewed the same AD video to serve as a control. Control reviews were uniformly spread over nearly the full range (8-25) (Figure 1). Conclusion: Determining surgical skill has challenges. Evaluations composed a wide range of scores and had marked variation. Reviewer variation may be due to differences in experience, biases, or appreciations of technique. Future interventions aimed at reducing variation may allow for more accurate evaluations of skill. Funding from Blue Cross Blue Shield of Michigan
Table of Contents 161 Podium #92 ROBOT ASSISSTED RADICAL PROSTATECTOMY IN PATIENTS WITH A HISTORY OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: THE INDIANA UNIVERSITY EXPERIENCE Zain A Abedali, Tim Large, Charles Nottingham, James E Lingeman, Matthew J Mellon, Ronald S Boris Indiana University School of Medicine Department of Urology Presented By: Zain Abedali
Introduction: We sought to update our experience of oncologic and functional outcomes of robot-assisted radical prostatectomy (RARP) for prostate cancer in patients with history of holmium laser enucleation of the prostate (HoLEP). Methods: 28 patients with previous HoLEP who underwent RARP were matched 1:1 to RARP patients with no history of transurethral surgery. Demographic, operative, oncologic, continence, and erectile function outcomes were analyzed. Results: Median time between HoLEP and RARP was 31 months with a mean PSA doubling time of 4.28 ng/mL/yr. Operative times were significantly longer with higher bladder neck reconstruction rates and similarly low complication rates. Biochemical recurrence was relatively low (8%) in HoLEP group. Continence at last follow up was not statistically significant between groups, time to continence favored the non-HoLEP cohort. Erectile function recovery was generally poor in the post HoLEP cohort (12%) although bilateral nerve sparing was rarely performed (7%). Compared to our initial experience, there were significant improvements in time to continence (13.5 vs 34 weeks). No T2 post HoLEP RARP since 2010 has had a positive surgical margin. Conclusion: Post HoLEP prostatectomy remains feasible with similar perioperative and oncologic outcomes compared with matched cohorts. Functional recovery remains slowed yet may continue to improve with technical familiarity. Funding: N/A
Table of Contents 162 Podium #93 IMPACT OF MEDIAN LOBES ON URINARY FUNCTION AFTER ROBOTIC RADICAL PROSTATECTOMY Oscar Martinez, MD, Ronney Abaza, MD Robotic Urologic Surgery OhioHealth Dublin Methodist Hospital, Dublin, OH Presented By: Ronney Abaza, MD, FACS
Introduction: Enlarged median lobes (ML) can present a technical challenge and may affect the outcomes of robotic prostatectomy (RP). If known, the impact of potentially larger bladder necks on continence and chronic obstruction on postoperative urinary symptoms might aid patient counseling. We assessed the impact of intraoperatively identified median lobes (ML) on urinary function. Methods: We reviewed our prospective RP database between 2013-18. AUA symptoms scores (AUA-SS) were assessed preoperatively and at one, three, and six months. We compared patients with and without ML. Bladder-neck sparing was routine to avoid reconstruction. Results: Of 562 patients with complete data at all times, 163 (29%) had ML. There were no statistically significant differences in demographics, PSA, or clinical stage. Mean operative time was 153min with and 148min without ML (p<0.05). Only two in each group required bladder-neck reconstruction (1.2% versus 0.5%). There was no immediate or long-term difference in continence rates between groups. Baseline mean AUA-SS was higher in ML patients and showed more improvement postoperatively (-5.3 versus -3.47, <0.05) with greatest improvement in ML patients with severe preoperative symptoms (- 15.1) and no difference in AUA-SS between groups by 6mos. Conclusion: Patients with enlarged ML do not have an increased risk of incontinence but appear to benefit more in postoperative urinary function after RP. Funding: N/A
Table of Contents 163 Podium #94 HOW DOES THE SINGLE PORT PLATFORM STACK UP? EARLY EXPERIENCE WITH THE SINGLE PORT ROBOTIC-ASSISTED RADICAL PROSTATECTOMY VS ITS MULTI-PORT PREDECESSOR. Whitney Halgrimson, MD, Ryan Dobbs, MD, Gabriel van de Walle, Hari Vigneswaran, MD, Ikenna Madueke, MD, Simone Crivellaro, MD University of Illinois at Chicago Presented By: Whitney Ryan Halgrimson, MD
Introduction: The da Vinci Single Port (SP) platform (Intuitive Surgical, Sunnyvale CA) orchestrates four robotic arms through a single 3 cm incision with the potential to minimize patient morbidity. We compared the initial operative and patient experiences between the SP and legacy Multi-port (MP) platform to assess the potential benefit for patients undergoing robotic-assisted radical prostatectomy (RARP). Methods: We prospectively captured peri-operative and admission data from the initial 10 consecutive SP-RARP cases at our institution. Similar data were obtained retrospectively from 10 immediately preceding MP-RARP cases. All SP robotic components were performed entirely by a single experienced robotic surgeon, while both residents and this same surgeon performed the MP cases jointly. Variables were studied using Wilcoxon rank sum tests, with p < 0.05 indicating significance. Results: Ten MP-RARP cases were performed between August and November 2018, while 10 SP-RARP cases were performed between December 2018 and January 2019. Median estimated blood loss was 50 cc in SP cases compared to 125 cc in MP (P=0.014). Operative times were not significantly different. Cumulative opiate use was not significantly different. Conclusion: SP-RARP demonstrated non-inferiority to MP-RARP in several peri- operative and post-operative domains. Limitations include likely more extensive disease in the MP cohort and resident involvement in MP cases. Funding: N/A
Table of Contents 164 Podium #95 STRONG CORRELATION BETWEEN STANDING COUGH TEST AND 24-HOUR PAD WEIGHTS IN THE EVALUATION OF MALE STRESS INCONTINENCE Yooni Yi, MD1,2, Christopher Graziano, MD3, Nabeel Shakir, MD1, Michael Davenport, MD1, Brian Christine, MD3, Allen Morey, MD1 1UT Southwestern Department of Urology, 2University of Michigan Department of Urology, 3Urology Center of Alabama - Birmingham Presented By: Yooni Yi, MD
Introduction: The standing cough test (SCT) provides objective assessment of incontinence severity with strong correlation to patient-reported pads per day (PPD), improving male sling selectivity and outcomes. We sought to assess the correlation between the SCT and pad weights. Methods: A retrospective review of a single surgeon database of incontinence procedures was performed. The standing cough test was completed preoperatively utilizing the Male Stress Incontinence Grading Scale (MSIGS). All patients had PPD and 24-hour pad weights obtained. We determined the Spearman’s correlation between these variables. Results: There were 104 patients identified who underwent an AdVance Sling or Artificial Urinary Sphincter (AUS). In the sling group (65 patients), a majority (97%) of patients had an MSIGS of 0 – 2. In the AUS group (39 patients), the majority of patients (69%) had an MSIGS of 3 or 4. The Spearman’s coefficient between MSIGS and pad weight for the overall group was r=0.68 (p,0.0001) demonstrating a strong positive correlation. In contrast, PPD was not as strongly correlated with pad weight (r= 0.55, p,0.0001). As seen previously, MSIGS and PPD were correlated (r= 0.47, p<0.0001). In a multivariable model predicting pad weight, the effect of MSIGS was greater than PPD (b= 83 [54-111], p<0.0001 vs 45 [21 – 69], p = 0.0004). Conclusion: We show a strong correlation between MSIGS grading and pad weight, which has not been previously identified. The SCT is a promising reliable, non-invasive test for primary assessment prior to anti-incontinence procedures. Funding: N/A
Podium #96 PREDICTIVE FACTORS FOR RECURRENT URINARY TRACT INFECTIONS IN PATIENTS WITH HISTORY OF SPINAL CORD INJURY Ross G Everett, MD MPH, David K Charles, MD, Halle E Foss, Michael A Avallone, MD, R. Corey O'Connor, MD, Michael L Guralnick, MD Medical College of Wisconsin Presented By: Ross G. Everett, MD, MPH
Introduction: We sought to identify possible clinical and urodynamic risk factors for recurrent urinary tract infections [UTI] in spinal cord injury [SCI] patients who perform clean intermittent catheterization [CIC]. Methods: A retrospective chart review was performed on 103 SCI patients who perform CIC who had complete urodynamics and culture data available for analysis. Patients with recurrent UTIs [at least 3 per year] were compared to patients without recurrent UTIs [<3/yr] with respect to demographic/clinical and urodynamic variables. Multinomial logistic regression was used to determine factors associated with UTI. Results: Of 103 patients, 30 had recurrent UTIs whereas 83 did not. The only variables that were associated with recurrent UTIs were African American race (RR 4.09,0.014) and female sex (RR 7.64, p=0.011). Factors such as level of SCI and presence of nephrolithiasis as well as urodynamic variables such as bladder compliance/end fill detrusor pressure and presence of detrusor overactivity were not found to be significant predictors of UTI. Conclusion: African American race and female sex were the only variables associated with an increased likelihood of recurrent UTIs in SCI patients performing CIC. Urodynamic variables were not predictive. Funding: N/A
Table of Contents 165 Podium #97 PREDICTORS OF UROLOGIC HOSPITALIZATION OR EMERGENCY ROOM VISITS IN SPINAL CORD INJURY PATIENTS ON CLEAN INTERMITTENT CATHETERIZATION Iryna Crescenze, MD1, Paholo Barboglio Romo, MD1, Sara Lenherr, MD, MS2, Jeremy Myers, MD2, Blayne Welk, MD, MSc3, Angela Presson, PhD, MS2, Diana O'Dell, MPH1, Sean Elliott, MD, MS4, John Stoffel, MD1 1University of Michigan, 2University of Utah, 3Western University, 4University of Minnesota Presented By: Iryna Crescenze, MD
Introduction: SCI patients have a high rate of health care utilization. The aim of this study was to identify factors predicting urologic related hospitalizations or ER visits in SCI patients managed with CIC. Methods: Between 1/1/2016 to 6/30/2017, 1479 SCI patients ≥18 years old were enrolled through the Neurogenic Bladder Research Group multicenter, prospective, observational registry. This analysis included 753 patients on CIC followed over 1 year. Hand function was assessed using fine motor score (FMS) questionnaire. Results: The average age was 43.6+/-13.0 and time from injury was 13.2+/-10.6 years, 32.9% were female, 69.1% had injury at C4 17.6% vs. 7.1%, p=0.008), diminished hand function (46.7% vs. 27.9%, p <0.001), worse SF-12 physical scores (38.9+/-11.8 vs. 42.5+/-10.7, p=0.004), chronic pain (75.5% vs. 64.3%, p=0.029) and depended on caregiver for CIC (22.3% vs. 9.1%, p=0.001). On multivariable analysis accounting for age, gender, BMI, level of injury, and years from injury only impaired hand function (OR:0.04, 95%0.01-0.31, p=0.002) and SF-12 physical scores (OR:0.26, 95%CI0.07-0.95, p=0.043) predicted one year hospitalization or ER visit rate. Conclusion: SCI patients on CIC have a 14% rate of hospitalization or ER visits for urologic indication over one year. Physical limitation, and specifically diminished hand function, predicts a need for hospitalization or ER visit over time after adjusting for age, gender, and injury characteristics. Funding: Patient Centered Outcomes Research Institute Award – CER14092138
Podium #98 PUDENDAL NEUROMODULATION IS FEASIBLE AND EFFECTIVE AFTER PUDENDAL NERVE ENTRAPMENT SURGERY Kristen Meier, MD1, Patrick Vecellio2, Kim Killinger1,2, Judith Boura1,2, Kenneth Peters, MD1,2 1Beaumont Health, 2Oakland University William Beaumont School of Medicine Presented By: Kristen Marie Meier, MD
Introduction: Patients with intractable pain in the pudendal nerve distribution may benefit from pudendal neuromodulation; however, some may have previously undergone pudendal nerve entrapment surgery (PNES), potentially altering nerve anatomy and function. We examined pudendal neuromodulation outcomes in patients with prior PNES. Methods: Patients with a history of PNES and quadripolar, tined pudendal lead placement for urogenital pain were reviewed. Symptoms and outcomes were collected from existing medical records. Patients with pudendal neuromodulation and prior PNES were compared to patients with no prior PNES who had pudendal lead placement. Results: 15 patients with a history of 1, 2, or 3 prior PNES (n= 13, 1, and 1, respectively) were evaluated. Most (10; 67%) were female, with bilateral pain (9; 60%), and symptoms of 5 to 26 years. After trialing the lead, bladder symptoms and pain were improved in 8/12 and 9/14 patients, respectively, and 80% of patients (12/15) underwent permanent generator implantation. When prior PNES patients were compared to those with no prior PNES (n=43), gender (67% vs. 77% female; p=0.50), age (median 63 vs. 58 years; p=0.80), and median lead implant time (48 vs. 50 minutes; p=0.65) were similar; however, BMI differed (mean 24 vs. 29; p=0.008) and a lower proportion (12/15; 80% vs. 42/43; 98%; p=0.049) had generator implantation.
Table of Contents 166 Conclusion: Chronic pudendal neuromodulation can be a viable option even after prior PNES. Funding: Philanthropy (Ministrelli Program for Urology Research and Education- MPURE)
Podium #99 WHAT IS THE ASSOCIATION OF NEUROGENIC BLADDER MANAGEMENT AND SEVERE BOWEL SYMPTOMS IN PATIENTS WITH SPINAL CORD INJURY? Paholo Barboglio Romo, MD, MPH1, Iryna M. Crescenze, MD2, Sara M. Lenherr, MD3, Jeremy B. Myers, MD3, Blayne Welk, MD4, Sean P. Elliott, MD, MS5, Diana O'Dell, MPH2, Angela Presson, PhD6, John T. Stoffel, MD2 1University of Mihigan, 2University of Michigan, 3University of Utah, 4Western University, London Ontario, 5University of Minnesota, 6Univerity of Utah Presented By: Paholo Barboglio, MD, MPH
Introduction: The aim of this study was to investigate predictors for severe bowel symptoms in spinal cord injury (SCI) when assessing the type of neurogenic bladder management. Methods: The Neurogenic Bladder Research Group (NBRG) registry is a multicenter, prospective, observational study, which measures neurogenic bladder (NGB) related quality of life (QOL) after SCI. 1479 Adults with SCI were enrolled. Univariate analysis and Multivariable logistic regression were utilized. Bowel symptoms were assessed by Neurogenic Bowel Dysfunction score and patients scoring > 14 were categorized as having severe bowel symptoms. Bladder management was categorized as: voiding, clean intermittent catheterization (CIC), surgery (augmentation/diversion) or indwelling catheter. Results: There were 585 (40%) individuals with severe symptoms and 894 with non- severe. Bladder management (p<0.001), high (>T6) level of injury (p=0.005), incomplete injury (p=0.025) and autonomic dysreflexia (p=0.048) were associated with severe bowel symptoms. SF-12 (physical) questionnaire (p=0.037) was protective. All these were modeled into mixed binomial logistic regression analysis and only AD (p<0.001) and type of management were significantly associated with more severe symptoms. The odds risk (OR) for CIC was 0.74 (95%CI:0.56-0.97), surgery OR 0.52 (95%CI:0.38-0.71), Indwelling OR 0.39 (95%CI:0.29-0.52) when compared to voiding. Conclusion: Severe bowel symptoms are significantly associated to the management type of neurogenic bladder and the presence of AD. Urologist should assess both bladder and bowel symptoms when counseling on type of management for neurogenic bladder. Funding: Neurogenic Bladder Research Group
Podium #100 THE NO TOUCH TECHNIQUE FOR PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT: OUTCOMES AND HISTORICAL COMPARISON Matthew Ziegelmann, Brian Linder, Daniel Elliott Mayo Clinic Department of Urology Presented By: Matthew J. Ziegelmann, MD
Introduction: Infection remains a risk with artificial urinary sphincter (AUS) placement. We sought to describe our modified “No-Touch” (NT) technique for AUS placement and evaluate early device outcomes. Methods: We identified patients who underwent AUS placement at our institution from 1983 to 2018. A modified NT technique was implemented in 2014 wherein an Ioban® dressing is placed over the exposed abdominal and perineal skin. During the implantation, AUS components at no time touched the skin. Statistical analysis was performed to evaluate differences in patient demographics and identify the rate of postoperative device infection in patients who underwent NT, and compare this with patients who underwent our traditional technique.
Table of Contents 167 Results: 1,417 patients underwent primary AUS placement at our institution between 1983 and 2018, including 164 (11%) that underwent the NT technique. Mean (SD) age was 69 years (7.2). Those patients who underwent NT had higher rates of prior urethral sling (8% vs 3%; p<.001), radiation therapy (54% vs 30%; p<.0001) and androgen deprivation (30% versus 15%; p<.0001). In total, 28/1253 patients (2%) who underwent the traditional AUS implant technique experienced device infection, compared with 0/164 (0%) with the NT technique. 89% of infections occurred within the first 6-months after AUS placement. Due the small number of events, the difference in cumulative incidence at 12-months was not statistically significant (Grays test; p=.11). Conclusion: The modified No-Touch AUS placement represents an easy-to-implement modification with potential implications on device outcomes. This technique may be valuable to lower infection risks. Funding: N/A
Podium #101 PERSISTENT SYMPTOMS AFTER SACRAL NEUROMODULATION: PATIENT TEST RESPONSES INDICATE DEFINITE NEUROPATHIES: AN EVIDENCE-BASED DISCUSSION Stanley Antolak, MD Center for Urologic and Pelvic Pain Presented By: Stanley John Antolak Jr., MD
Introduction: 21 patients were referred because of persistent pain or bladder symptoms after sacral neuromodulation (SNM). Each underwent a uniform neurological examination for peripheral pelvic neuropathies followed by neurophysiologic testing. All patients had pudendal neuropathy and 11 had “additional” peripheral nerve pelvic pain generators. Methods: Consultation questioning includes: “is clothing painful?” Examination begins with a gentle cutaneous “pinch-roll” test for the thoracolumbar junction syndrome. Pressure at subcutaneous nerve pathways may identify tender nerves: abdominal cutaneous; iliohypogastric and ilioinguinal; T-12 posterior ramus and T-12 posterior cutaneous perforating; middle cluneal; and perineal branch of the posterior femoral cutaneous. Pudendal nerve evaluation uses pinprick sensation at each branch (n=6); pressure on the nerve during DRE; a warm thermal threshold detection test (WDT) and the pudendal nerve terminal motor latency test (PNTMLT). Results: All patients with failed SNM had pudendal neuropathy. Sensory examination identified pudendal neuropathy in 21 (100%). The WDT test was abnormal in 15 of 20 (75%). The PNTMLT was abnormal in 19 (90.5%). Responses indicating central sensitization were found in 16 (76.2%%). “Additional” neuropathic pelvic pain generators identified were: Thoracolumbar junction syndrome-6 (28.6%); Abdominal cutaneous neuropathies-2 (9.5%); Ilioinguinal/iliohypogastric neuropathies-7 (33.3%); T-12 posterior ramus-1 (4.5%); T-12 posterior cutaneous perforating branch-1 (4.5%); Middle cluneal nerves-5 (23.8%). Conclusion: Painful peripheral neuropathies with central sensitization are common in patients with persistent symptoms after sacral neuromodulation. Pudendal neuropathy is the most important neuropathy. Funding: Pudendal Neuralgia Foundation
Table of Contents 168 Podium #102 CENTRAL SENSITIZATION AND THE CHRONIC PELVIC PAIN SYNDROME: EVIDENCE FOUND DURING PATIENT EVALUATIONS. Stanley Antolak, MD Center for Urologic and Pelvic Pain Presented By: Stanley John Antolak Jr., MD
Introduction: The chronic pelvic pain syndrome (CPPS) has many clinical presentations. Patient complaints suggest possible peripheral neuropathic processes and central sensitization (CS). CS represents neuroplasticity induced by chronic pain triggers. Reduced thresholds to painful stimuli result in pain hypersensitivity (somatic and visceral). Allodynia is an easily recognized indicator of central sensitization. Signs and symptoms of CS also are unmasked during examination, testing and treatment. Methods: Indicators of CS are sought initially in the clinic’s standard questionnaire. This focuses on CPPS patient complaints with a possible neuritic basis, some of which also suggest CS. Uncommon questions are asked that can identify other CS indicators; i.e. do sexual thoughts precipitate pelvic pain? At examination a specific search is made for subcutaneous peripheral nerve pathways upon which pressure may stimulate pains at distal body sites or stimulate organ symptoms, e.g. urge to void, erection, nausea, etc. Skin is evaluated for sympathetic nerve changes. During neurophysiologic testing of the pudendal nerves any pains (hyperalgesia and/or hyperpathia), dysesthesias, after sensation or dislocation distant to the test site, are recorded. During perineural blockades similar complaints are also recorded. Temporal summation and spatial summation may be evident. Results: Among three different groups of CPPS patients, including both genders, we recorded a 76% to 94% occurrence of one or more indicators of central sensitization. Conclusion: Central sensitization is common among CPPS patients. That finding alerts caregivers to the necessity for systemic treatments for this destructive phenomenon. Intensive therapies should be instituted for underlying neuropathic stimulators of central sensitization. Funding: Pudendal Neuralgia Foundation
Podium #103 OUTCOMES IN PATIENTS WITH IDIOPATHIC OVERACTIVE BLADDER UNDERGOING AUGMENTATION CYSTOPLASTY IN THE ERA OF ONABOTULINUMTOXIN-A AND INTERSTIM Akshay Sood, MD, Phil Wong, MD, PhD, Humphrey Atiemo, MD Henry Ford Health System Presented By: Akshay Sood, MD
Introduction: Idiopathic overactive bladder (iOAB) refractory to conventional first-, second- and third-line therapies is a challenging condition to manage. In this study, we report on contemporary outcomes in patients with refractory iOAB undergoing augmentation cystoplasty. Methods: Medical charts of patients undergoing augmentation cystoplasty for iOAB during the years 2012-2018 were retrospectively reviewed (n=8). All patients were followed for at least 180 days; the median follow-up was 391 days (IQR: 348 to 494 days). Baseline characteristics including patient demographics, preoperative fluorourodynamic parameters, and first-, second- and third line iOAB treatments were recorded. Outcomes studied included perioperative outcomes and AUASS and M-ISI scores. Results: The median age of the cohort was 54.5 years. All patients were females. The median preoperative bladder compliance was 39.8 cm H2O and the median preoperative bladder capacity was 134.5 cc. All patients had tried-and-failed at least 2 drug regimens and tried-and-failed either treatment with Botox (37.5%) or InterStim (87.5%). The median operative time was 6 hours; the median blood loss was 150 cc. Postoperatively, 2 patients (25%) were voiding spontaneously while others were performing intermittent self-catheterization. There were significant improvements in patient’s AUASS and AUASS-QoL scores following surgery (p=0.032 for each); the M-ISI and M-ISI-bother
Table of Contents 169 scores also demonstrated similar trend, however, did not attain statistical significance (p=0.074 and p=0.057, respectively). Conclusion: In the current era of Onabotulinumtoxin-A and InterStim as third-line treatments for iOAB patients, augmentation cystoplasty should be considered a fourth- line treatment for the most refractory of patients and is associated with statistically improved symptoms scores. Funding: N/A
Podium #104 EXAMINING BARRIERS TO FOLLOW UP TREATMENT WITH INTRADETRUSOR ONABOTULINUMTOXINA: THE ROLE OF PATIENT EDUCATION KRISTIN EBERT, MD1, CHRISTOPHER DALL, MD, KETUL SHAH, MD2, MATTHEW HARBRECHT, MD, FARA BELLOWS, MD1 1The Ohio State University, 2OHIOHEALTH Presented By: Fara Bellows, MD
Introduction: Previous literature has reported poor patient compliance with repeat treatments with intradetrusor injection of onabotulinumtoxin A (Botox). We report on barriers to follow up for repeat Botox treatments. Methods: All patients who received bladder Botox at our institution from 2011-2018 were surveyed on their experience with their first treatment. We divided the cohort into patients who received one Botox treatment and patients who received multiple treatments. We then compared differences in knowledge that repeat procedures are necessary, as well as cost, travel time, periprocedural pain, adverse events, and clinical response. Results: 74 of 176 patients completed the survey; 53 underwent multiple treatments, and 21 received 1 treatment. Patients receiving multiple treatments were more likely to understand that repeat treatments were necessary (96%) than those undergoing one treatment (57%) (p<0.001). There were no significant differences in age, gender, ethnicity, English language status, household income, or history of a neurologic condition between patients who did and did not understand that repeat Botox treatments are needed. Differences between groups are shown in the table below. Conclusion: Patients who understand that repeat Botox treatments are necessary are more likely to return for additional treatments. The necessity of repeat treatments should be emphasized in periprocedural counseling to maximize patient compliance. Funding: N/A
Table of Contents 170 Podium #105 INTERSTITIAL CYSTITIS/PAINFUL BLADDER SYNDROME: LOOKING BEYOND THE BLADDER. EVALUATION OF WOMEN REFERRED FOR PERSISTENT PAIN AFTER PAST DIAGNOSIS AND TREATMENTS. Stanley Antolak, MD Center for Urologic and Pelvic Pain Presented By: Stanley John Antolak Jr., MD
Introduction: 34 women were referred to a clinic treating only chronic pelvic pain. Each had continuing pain and/or bladder symptoms after previous treatments for interstitial cystitis/painful bladder syndrome (IC/PBS). Symptom review, examination for painful pelvic neuropathies and neurophysiologic testing were completed. Methods: A questionnaire included neuritic complaints. Pudendal evaluation consisted of pinprick sensation of each branch (n=6); direct pressure on the nerve during vaginal or rectal examination; warm thermal threshold detection (WDT) and pudendal nerve terminal motor latency test (PNTMLT). Quantitative and qualitative test responses were recorded. Skin of the perineum and sacrococcygeal area was scrutinized for changes indicating sympathetic stimulation. Symptom scores were utilized: a female version of the National Institutes of Health Chronic Prostatitis Symptom Index (female anatomical terms) and the American Urological Association Symptom Index. Results: Thirty-three patients with IC/PBS had pudendal neuropathy (data unavailable n=1). Symptom scores indicated severe pelvic pain (fNIH-CPSI median 34) and moderately severe voiding complaints (AUSAI median 20.5). Sensory examination identified pudendal neuropathy in 31/32 (96.8%). WDT test was abnormal in 23 of 31 (74.1%). PNTMLT was abnormal in 25/31 (78.1%). Neurophysiologic response confirmed a definite diagnosis of pudendal neuropathy in 93.8%. Two women had only abnormal sensory findings. Responses indicating central sensitization were found in 32/33 (94.1%). “Additional” neuropathic pelvic pain generators were identified. Conclusion: This cohort of women with unsuccessful control of IC/PBS have pudendal neuropathy and concomitant central sensitization. Pudendal neuropathy is a definite neuropathy as defined by the International Association for the Study of Pain. Funding: Pudendal Neuralgia Foundation
Podium #106 CLINICAL UTILITY OF CONFIRMMDX EPIGENETIC TESTING IN DIAGNOSIS OF PROSTATE CANCER Khashayar Arianpour, BS1, Brian Odom, MD2, Kirk Wonjo, MD3, Sugandh Shetty, MD3 1Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA, 2Department of Urology, Beaumont Health System, Royal Oak, Michigan, USA, 3Department Presented By: Brian D. Odom, MD
Introduction: Prostate biopsy is the cornerstone of prostate cancer (PCa) diagnosis. Negative biopsy often leads to repeat biopsies due to rising prostate-specific antigen (PSA). ConfirmMDx (MDxHealth, Inc., Irvine, CA) is an epigenetic test that is able to quantify the methylation status of three PCa-associated genes in benign tissue surrounding cancer foci. This study aims to determine the negative predictive value of ConfirmMDx to reduce the need for repeat biopsies. Methods: A retrospective chart review was performed of patients treated at Comprehensive Urology (Royal Oak, MI) who underwent two or more biopsies in a 7- year period including ConfirmMDx testing on the first-time biopsy. Patient demographics, time between biopsies, pathologic and epigenetic data were collected. Sensitivity, specificity, positive predictive value and negative predictive values were obtained. Receiver operating characteristic (ROC) curves were used to assess diagnostic ability. Results: Between 2009 and 2016, 142 patients were included. Mean age 64.8. Average time elapsed between the first and repeat biopsies was 23.1 months (range 2.0 – 57.7). Results of repeat biopsies agreed with ConfirmMDx results in 50.0% of cases. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were 66%, 42%, 36% and 71%, respectively. Patient age and time elapsed between
Table of Contents 171 biopsies were poor predictors, as the area under curve for ROC curves were 0.52 and 0.53, respectively. Conclusion: Our reported NPV of 71% is lower than the industry-reported 90%. A significant 29% of ConfirmMDx negative patients had prostate cancer on second biopsy and should be followed closely using serial PSA. Funding: N/A
Podium #107 NEGATIVE PREDICTIVE VALUE OF PRE-PROCEDURE MRI OF THE PROSTATE IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE Garrett Berger, PharmD, Robert Medairos, MD, Nicolas Nordin, BS, Peter Dietrich, MD, Scott Johnson, MD, Amy Guise, MD Medical College of Wisconsin, Department of Urology, Milwaukee, WI Presented By: Garrett K. Berger, PharmD
Introduction: Incidental prostate cancer (PCa) detection following HoLEP has been reported at rates between 5-20%. Our study aims to assess the negative predictive value (NPV) of pre-procedure magnetic resonance imaging (MRI) in patients undergoing HoLEP. Methods: Single-institution retrospective review of patients undergoing HoLEP between 2013 and 2018. Men with previously known PCa history were excluded. Patients underwent standard PCa screening per AUA guidelines prior to HoLEP. Patients underwent MRI of the prostate for persistently elevated PSA or concerning PSA doubling time with a previous negative transrectal ultrasound (TRUS) biopsy. Three cohorts were analyzed: MRI, TRUS with biopsy, and no evaluation (NE). Cohorts were compared to HoLEP specimen pathological diagnosis. Results: Two-hundred-eleven men were included in this study. Fifteen (7.1%) men were in the MRI cohort, 62 (29.4%) in the TRUS cohort, and 134 (63.5%) in the NE cohort. Pre-procedure PSA was similar between the MRI and TRUS cohorts (9.4 vs. 6.3, p=.3), which were both significantly higher compared to the NE group (9.4 vs. 4.6, p=.03 and 6.3 vs. 4.6, p=.04, respectively). Thirty-three (15.6%) men were diagnosed with PCa on HoLEP pathology specimen. The NPV of men who underwent a pre-procedure MRI was 100% (15/15) which displayed superiority when compared to the NE group at (108/134, 79%, p=.04). There was no statistical difference when comparing the NPV to the TRUS group (54/62, 89%, p=0.2). Conclusion: Among patients undergoing PCa screening who plan to undergo elective HoLEP, a negative MRI can be a valuable tool to screen for PCa. Funding: N/A
Podium #108 LONG-TERM OUTCOMES OF RADICAL PROSTATECTOMY IN MEN WITH A PREOPERATIVE PROSTATE-SPECIFIC ANTIGEN LEVEL 20-49 NG/ML AND >50 NG/ML Jack Andrews, MD, Laureano Rangel, MSc, Stephen Boorjian, MD, Bradley Leibovich, MD, Houston Thompson, MD, Robert Karnes, MD, Mathew Gettman, MD Mayo Clinic Presented By: Jack Andrews, MD
Introduction: We update here, long-term outcomes in men treated with radical prostatectomy (RP) with preoperative serum prostate-specific antigen (PSA) between 20- 49 ng/mL and greater than 50 ng/mL. Methods: 1307 patients were identified at our institution who underwent RP with preoperative serum PSA greater than 20 ng/mL. The study cohort was divided into 2 groups, high PSA, 20 to 49 ng/mL (1051 patients), and very high PSA, ≥50 ng/mL (256 patients). Results: Biochemical recurrence 20-year rates in the groups of patients with a high PSA level and very high PSA were 59.6% and 63.2% (p=0.101). Systemic progression20 year rates with a high PSA level and very high PSA were 19.8% and 28.5% (p=0.007).
Table of Contents 172 Cancer-specific 20-year mortality rates with a high PSA level and very high PSA were 12.8% and 20.5% (p=0.001). Overall 20-year mortality rates with a high PSA level and very high PSA estimates were 62.2% and 71.2% (p=0.003). Conclusion: Although PSA greater than 20 ng/ml conveys higher risk disease, long-term cancer-specific survival remains excellent, supporting treatment with aggressive surgical management. Interestingly, while the data demonstrates similar rates of biochemical recurrence, both systemic progression and cancer-specific mortality was significantly higher in the very high PSA cohort. Funding: N/A
Podium #109 FASCIAL ANASTOMOSIS SUSPENSION TECHNIQUE (FAST) DURING OPEN RETROPUBIC RADICAL PROSTATECTOMY: A NOVEL METHOD TO IMPROVE EARLY POSTOPERATIVE RECOVERY OF URINARY CONTINENCE Alessandra Ambu, Dr., Stefano Guercio, Dr., Mauro Mari, Dr., Marco Russo, Dr., Mariateresa Carchedi, Dr., Antonino Battaglia, Dr., Giulio Bonvissuto, Dr., Maurizio Bellina, Dr. Urology Division, Ospedale degli Infermi di Rivoli - ASL TO3 (Turin) Presented By: Alessandra Ambu
Introduction: We show the results on early urinary continence recovery, with a novel technique for vesico-urethral anastomosis suspension, in order to avoid its downward dislocation. Methods: From May 2018 to November 2018, 40 consecutive patients with clinically localized prostate cancer were enrolled in a prospective randomized study and underwent to nerve-, bladder neck sparing open retropubic radical prostatectomy with a standard vesico-urethral anastomosis technique: group 1, or with a modified fascial anastomosis suspension technique (FAST): group 2. Standard anastomosis technique includes an interrupted suture with 6 stitches and a running suture on the posterior urethral plate. In the FAST procedure, 2 limbs of rectus muscle fascia on both sides of the linea alba are prepared with a distal attachment and the proximal extremity is sutured to the anastomosis. 20 patients (group 1) received a standard vesico-urethral anastomosis, while 20 patients (group 2) had a FAST procedure. Continence results were evaluated by number of pads per day and according to the International Consultation on Incontinence Questionnaire (ICIQ) score at 24 and 48 hours and at 4 weeks postoperatively. Continence was defined as the need of 0-1 pad per day.
Table of Contents 173 Results: Continence rate for group 1 and group 2 was 15% Vs. 40% at 24 hrs; 20% Vs. 50% at 48 hrs, and 30% Vs. 70% at 4 weeks respectively. No urinary obstructive complications were recorded in patients who received a FAST procedure. Conclusion: We observed earlier continence for patients who received a FAST, compared to patients who received a standard technique. Funding: N/A
Podium #110 TRENDS IN SURGICAL PATHOLOGY OF PROSTATE CANCER IN A LARGE COMMUNITY-BASED PRACTICE Paul Yonover1,2, Jason Huang2, David Greenwald2, Laurel Sofer2, Harpreet Wadhwa2, Daniel Dalton1, Justin Cohen1 1UroPartners LLC, Chicago, IL, 2Department of Urology, University of Illinois at Chicago, Chicago, IL Presented By: Jason Huang, MD
Introduction: Management of prostate cancer has evolved particularly in an effort to avoid over-treatment. We analyzed the UroPartners Cancer of the Prostate (UroCaP) Registry to better understand trends in surgical pathology over time in regards to grade and stage. Methods: From 2010 to 2018, 2903 patients with prostate cancer underwent radical prostatectomy (open or robotic assisted) by various surgeons in a large community and academic integrated urology group. The final pathology results were registered in the UroCaP database and analyzed. Results: Of 2903 patients undergoing radical prostatectomy, we observed a significant downward trend of Grade Group 1 (GG1) disease at final pathology, 35% of total cases in 2010 down to 11% in 2018. GG2 increased from 38% to 47% in 2018 and GG3-GG5 increased from 24% in 2010 to 42% in 2018. Likewise, significantly more pT3 disease was seen over the same period from 20% to 39%. Conclusion: We observed significantly less low-risk disease being managed by surgery in our large community-based urology practice surgical series over the last 9 years, which is likely multifactorial, including increasing adoption of active surveillance and changes in screening patterns in the general population. Funding: N/A
Table of Contents 174 Podium #111 EPIGENETIC METHYLATION DIFFERENCES ARE GREATER BETWEEN TUMOR- ASSOCIATED AND NON-TUMOR ASSOCIATED BENIGN PROSTATE TISSUES: THE FIELD DEFECT HYPOTHESIS Tariq A. Khemees, MD1, Bing Yang, PhD1, Adam Schultz, BS1, Glen Leverson, PhD2, Tyler Etheridge, MD1, Geoffrey Sonn, MD3, Cristina Magi-Galluzzi, MD4, Erick A Klein Erick A Klein, MD5, Michael Fumo, MD6, David F. Jarrard, MD7 1Department of Urology, University of Wisconsin, 2Department of Surgery, University of Wisconsin, 3Department of Urology, Stanford University, 4Department of Pathology, Cleveland Clinic, 5The Glickman Urological Kidney Institute/ Cleveland Clinic, 6Rockford Urologic, Rockford Illinois, 7Department of Urology/ University of Wisconsin and Carbone Cancer Center Presented By: Tariq A. Khemees, MD
Introduction: We sought to compare variations in DNA methylation at multiple loci in histologically normal biopsies from men with and without prostate cancer (PCa). Methods: Four centers contributed archived cancer-negative prostate biopsy tissue blocks from 129 patients. The non-tumor associated (NTA) controls were selected from patients who underwent ≥2 negative biopsies within 24 months. Tumor associated (TA) benign prostate biopsies were utilized from patients diagnosed with PCa who underwent prostatectomy to confirm final Gleason score of ≥7. After slides re-review, biopsy tissue was analyzed using pyrosequencing for DNA methylation encompassing CpG sites at CAV1, EVX1, FGF1, NCR2, PLA2G16 and SPAG4. Significant methylated probes for each sample were selected using cut-off of -log10(p) >10. Predictive accuracy for PCa detection was measured using ROC curves. The CpG site with highest AUC value from each gene was selected. The correlation of methylation for each CpG site in two biopsy samples was calculated for the entire cohort. Methylation differences across biopsies were further elucidated in a subset of patients who had four biopsy samples. Results: Patients diagnosed with GS ≥7 PCa (N=77) and the control group (N=52) demonstrated robust methylation differences comparing TA and NTA subjects within all gene regions (p<0.05). Five out of the six genes demonstrated increased correlation values for CpG site methylation for TA biopsies (p<0.05) compared biopsies from NTA samples. Conclusion: The methylation status of CAV1, EVX1, FGF1, NCR2, PLA2G16 and SPAG4 differ between TA and NTA normal prostate tissues marking field of epigenetic susceptibility associated with development of PCa. Funding: Funded by Urology Care Foundation/ Research Scholar Program (T.K.), and Department of Defense grant via the Prostate Cancer Research Program #PC150221
Podium #112 SURGICAL VERSUS MEDICAL CASTRATION FOR METASTATIC PROSTATE CANCER: EVALUATION OF OUTCOMES, UTILIZATION, AND FACTORS ASSOCIATED WITH TREATMENT TYPE IN A NATIONAL COHORT Adam Weiner, MD, Jason Cohen, MD, John Delancey, MD, MPH, Edward Schaeffer, MD, PhD, Gregory Auffenberg, MD Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL Presented By: Adam Benjamin Weiner, MD
Introduction: Surgical castration for newly diagnosed metastatic prostate cancer is used less frequently than medical castration, yet is lower in costs, requires less follow-up, and may be associated with fewer adverse effects. We assessed contemporary survival outcomes based on castration type and national rates of surgical castration. Methods: This retrospective cohort study sampled 21,580 men with newly diagnosed (de novo) metastatic prostate cancer from a national, hospital-based cancer registry in the United States (2004-2015). Multivariable Cox analysis evaluated the association between castration type and overall survival. Multivariable logistic regression assessed factors association with surgical castration use.
Table of Contents 175 Results: Overall, 5.7% of men received surgical castration: 8.5% in 2004 and 3.3% in 2015 (Per 1 year later: OR 0.88, 95% CI 0.87-0.90, p<0.001). After a median follow-up of 26 months, surgical castration was not associated with any change in survival (HR 1.04, 95% CI 0.97-1.11, p=0.3). Compared to Medicare, private insurance was associated with lower odds of surgery (OR 0.72, 95% CI 0.60-0.87, p<0.001) while Medicaid or no insurance was associated with increased odds (OR 1.57, 95% CI 1.24-1.97, <0.001 and OR 2.01, 95% CI 1.59-2.53, p<0.001, respectively). Regional median income >$63,000 was associated with decreased odds of surgical castration compared to <$38,000 (OR 0.60, 95% CI 0.47-0.77, p<0.001). Conclusion: In a national sample of contemporary patients, overall survival was not associated with castration type. Surgical castration is uncommon and given the potential benefits, it may represent an underused treatment. Funding: National Institutes of Health grant 5U01CA196390 and the Prostate Cancer Foundation (EMS).
Podium #113 EXTENDED LYMPH NODE DISSECTION IS ASSOCIATED WITH IMPROVED OVERALL SURVIVAL IN PATIENTS WITH VERY HIGH-RISK PROSTATE CANCER: A NATIONAL CANCER DATABASE ANALYSIS Akshay Sood, MD, Jacob Keeley, MS, Mani Menon, MD, Firas Abdollah, MD Henry Ford Health System Presented By: Akshay Sood, MD
Introduction: It is generally agreed that extended pelvic lymph node dissection (ePLND) provides valuable prognostic information and helps guide adjuvant therapy, however, its effect on survival has not been clearly elucidated. In this study, we sought to identify patients preoperatively that may derive a survival advantage from ePLND. Methods: Relying on the NCDB, we identified all patients with prostate adenocarcinoma undergoing radical prostatectomy between the years 2004-2015. After excluding patients with clinical nodal/metastatic disease (n=2,568), prior radiotherapy, chemotherapy and hormonal therapy (n=10,931) or missing data (166,696), a final sample of 406,409 patients was achieved. To analyze the impact ePLND (10+ LNs) versus none/limited PLND (0-9 LNs) on 10-yr overall survival, interaction between Godoy-nomogram predicted LNI (lymph node invasion) probability and ePLND/PLND was plotted using locally weighted methods controlling for age and comorbidities. Results: The lines for ePLND and none/limited PLND separated at Godoy-nomogram predicted LNI of 20%, indicating that patients with a predicted LNI risk >20% will benefit from ePLND (Figure 1). Cox-regression analysis demonstrated that patients undergoing ePLND (HR=1.22, 95% CI 1.19 to 1.26) had 8% incrementally lower hazard of 10-yr mortality as compared to patients undergoing none/limited PLND (HR=1.31, 95% CI 1.29 to 1.33) for every 10% increment in Godoy-nomogram predicted LNI risk (p<0.0001). Conclusion: Our study is the first to demonstrate that ePLND may have survival benefit in addition to prognostic value in prostate cancer patients at high-risk for LNI. Further, we identify these patients preoperatively which may facilitate patient counseling and reduce over and underutilization ePLND. Funding: N/A
Table of Contents 176 Podium #114 PARADATA ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL FOR LONG- TERM PROSTATE CANCER SURVIVORS Alan Paniagua Cruz, BS1, Ted Skolarus, MD, MPH2,3, Dennis O'Reilly3, Tabitha Metreger, MA3, Sarah Hawley, PhD, MPH4,5 1University of Michigan Medical School, Ann Arbor, MI, 2Michigan Medicine, Department of Urology, Ann Arbor, MI, 3VA Ann Arbor Healthcare System, Ann Arbor, MI, 4University of Michigan School of Public Health, Annr Arbor, MI, 5Ann Arbor VA Center-Clinical Management Research, Ann Arbor, MI Presented By: Alan Paniagua Cruz, BS
Introduction: Prostate cancer survivors carry a symptomatic burden resulting from treatment. We conducted and published a randomized controlled trial demonstrating that a symptom-tailored, self-management, ‘interactive voice response’ telephone intervention can be associated with quality of life improvements. Herein, we examine the paradata surrounding engagement with our novel intervention to understand generalizability. Methods: This trial enrolled 556 long-term prostate cancer survivors across four VA sites. The intervention arm underwent 4 automated telephone surveys to characterize symptom burden, engaged with audio content (e.g., testimonials), and received tailored self-management newsletters, while the control arm underwent usual care and received 1 non-tailored, self-management newsletter. We compared costs, content distribution and call length across age, race, and marital status. Results: On average, our cohort was 67 years old, 69.4% white, and 53.2% married. Overall, 6,478 calls were made during this study, 1,944 control and 4,523 intervention, with an average cost per participant of $0.65 and $1.40, respectively. The intervention group spent approximately 85 minutes engaging with the audio content, while controls spent 42 minutes. In both groups, we found no significant difference in engagement between white and black, or married and single patients. Older men in control (p=0.0061) and intervention (p=0.0221) groups spent longer time engaging compared with younger men. Among intervention participants, the majority focused on sexual health (41.8%), followed by urinary (27.6%), general (22.5%), and bowel (8.1%) self-management. Conclusion: This novel self-management tool was well-accepted by participating veterans. Low attrition and similar utilization rates across patient groups suggest unmet need and wide applicability. Funding: Department of Veterans Affairs (IIR 12-116)
Podium #115 UTILIZING A DEEP-LEARNING NEURAL NETWORK TO AUTOMATE INTERPRETATION OF MAGNETIC RESONANCE IMAGING OF THE PROSTATE Michael Fenstermaker, MD1, Jeffrey Tosoian, MD1, Matthew Davenport, MD2, Simpa Salami, MD1, Arvin George, MBBS1, Rohit Mehra, MD3, Todd Morgan, MD1 1Department of Urology, University of Michigan, 2Department of Radiology, University of Michigan, 3Department of Pathology, University of Michigan Presented By: Michael Fenstermaker, MD
Introduction: Prostate magnetic resonance imaging (MRI) is an important tool for detecting clinically significant prostate cancer. Yet, MRI has only moderate inter-rater agreement. Convolutional neural networks (CNNs) are a machine learning algorithm that are particularly adept at image analysis tasks. This study seeks to determine the ability of CNNs to identify MRIs suspicious for clinically significant prostate cancer. Methods: A total of 99 3-Tesla Prostate MRIs were obtained from The Cancer Imaging Archive. Diffusion-weighted (DWI) and T2-weighted (T2) sequences were included for analysis. Each MRI was interpreted by a radiologist. Suspicious (PIRADS ≥3) lesions then underwent targeted biopsy. MRIs were analyzed by a CNN (figure 1) optimized to predict the presence of Gleason Grade (GG)>1 disease on biopsy. After training on a set of 79 MRIs, a held-out test set of 20 MRIs was used to validate the predictive capability of the model.
Table of Contents 177 Results: On the test set of 20 MRIs, the CNN algorithm accurately predicted the presence or absence of GG>1 disease on biopsy for 18/20 (90%) MRIs. Sensitivity was 100% (0 false negatives), specificity 60% (2 false positives). Conclusion: CNNs appear to be sensitive for detecting clinically significant prostate cancer on MRI. Artificial intelligence algorithms have the potential to assist clinicians in evaluating prostate MRIs, though external validation is needed. Funding: n/a
Podium #116 TRANSITIONAL ZONE CANCERS DETECTED BY MRI AND URONAV BIOPSY Aidan Gaertner, intern1, Chris Gitter, intern1, Pete Sershon, MD2 1Minnesota Urology Foundation, 2Minnesota Urology Presented By: Chris Gitter
Introduction: To evaluate 375 patients with transitional zone only cancer found on a Uronav biopsy between January 2015 and December 2018 Methods: We retrospectively analyzed 1500 patients that underwent a UroNav biopsy over a 3-year period. The patients with a transitional and peripheral zone caner were analyzed. The PIRAD scores were evaluated and the percent cancer determined for each zone. Clinically significant cancer for each zone was also determined. Results: Of the 1500 patients with a PiRAD lesion, 25% were located in the transitional zone, 36% in the peripheral zone and 39% in both transitional and peripheral zone. Cancer was detected in 40% of transitional zone only lesions, 44% of peripheral zone only lesions and 38% combined zone lesion. Clinically significant cancer was noted in 26%, 27% and 20% respectively for the TZ, PZ and combined zones. PIRAD breakdown for transitional zone only cancers are as follows, PIRAD 3 (52% of patients): 24% cancer, 10% clinically significant PIRAD 4 (34% of patients): 43% cancer, 30% clinically significant PIRAD 5 (14% of patients): 75% cancer, 60% clinically significant Conclusion: The use of a Uronav biopsy has been instrumental in detecting clinically significant cancers in the transitional zone that otherwise would have been missed on a standard mapping biopsy. Funding: Grant provided by Minnesota Urology Foundation
Table of Contents 178 Podium #117 WHOLE MOUNT HISTOPATHOLOGICAL CORRELATION WITH PROSTATE MRI IN GRADE I II PROSTATECTOMY PATIENTS Michael Wang, BS1, Nafiseh Janaki, MD2, Christina Buzzy, PhD3, Laura Bukavina, MD MPH3, Kirtishri Mishra, MD3, Amr Mahran, MD MS3,1, Gregory MacLennan, MD2, Lee Ponsky, MD3 1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA, 2Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA, 3Division of Urologic Oncology, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA Presented By: Michael Wang, BS
Introduction: Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in detection and surveillance of prostate cancer. However, the co-localization of lower grade lesions between mpMRI and histopathologic specimen has not been well- established. We aim to determine the factors on final histopathological exam that correlate to tumor visibility for Grade I and II disease on mpMRI. Results: Of the 184 lesions identified on the whole mount histopathologic slides, 106 (57.6%), 62 (33.7%), 14 (7.6%), and 2 (1.1%) of the lesions had a GS of 3+3, 3+4, 4+3 and 4+4, respectively. On analysis, 27.3% (24/88) of GS 6 (< 1.5 cm in size), and 88.9% (16/18) of GS 6 (>1.5cm in size) were visualized (p<0.001). When assessing lesion proximity to the prostatic capsule, 46.1% (41/89) of lesions closer (≤ 0.05 cm), and 30.5% (29/95) of lesions further (> 0.05 cm) from the capsule were visualized. Conclusion: Lesion diameter, area, and capsule proximity correlated with MRI visibility. Funding: N/A
Podium #118 RISK FACTORS FOR RECURRENCE FOLLOWING ABLATION FOR CLINICAL T1 RENAL CELL CARCINOMA (RCC) Leo Dreyfuss, Shane Wells, MD, Natasza Posielski, MD, Sara Best, MD, Sean Hedian, MD, Timothy Ziemlewicz, MD, Meghan Lubner, MD, J. Louis Hinshaw, MD, Fred Lee, MD, Glenn Allen, David Jarrard, MD, Stephen Nakada, MD, FACS, FRCS, E. Jason Abel, MD, FACS University of Wisconsin School of Medicine and Public Health Presented By: Leo Dreyfuss, BS
Introduction: Tumor and patient characteristics associated with increased recurrence risk following RCC ablation are poorly described. The purpose of this study is to evaluate for risk factors associated with recurrence following percutaneous microwave (MWA) and cryoablation (CA) of RCC. Methods: Consecutive non-metastatic patients with biopsy proven RCC tumors ≤ 7cm treated with curative intent using percutaneous ablation from 2001-2017 were included.
Table of Contents 179 Univariate and multivariate cox analysis was used to identify factors associated with recurrence. Results: 294 patients with clinical T1 RCC were treated with ablation. Recurrence was identified in 32 patients (22 local, 10 distant) for overall 5-year RFS of 79.2%. Independent predictors of recurrence include cT stage (HR=3.11, p=0.001), nuclear grade (HR=3.42, p=0.02), and prior RCC history (HR=2.30, p=0.04). No difference in recurrence was identified based on: RCC subtype, MWA vs. CA, cystic vs. solid, bilateral tumors, multifocal tumors, gender, Nephrometry score. Patients were stratified into low (no risk factors) or high (≥1 risk factor) risk groups. 5- year RFS for 217 low-risk patients was 87.2%, and for 77 high-risk patients was 51.7% (figure). Conclusion: High nuclear grade (3 or 4), cT1b stage, and history of prior RCC are associated with higher recurrence risk following ablation for RCC ≤ 7cm. Individual patient risk should guide recommendations for post-ablation surveillance. Funding: N/A
Podium #119 COMPUTER GENERATED TUMOR VOLUME AND SURFACE AREA AS PREDICTORS OF PATHOLOGICAL TUMOR GRADE AND STAGE IN RENAL CELL CARCINOMA Arveen Kalapara1, Nick Heller2, Niranjan Sathianathen1, Edward Walczak1, Paul Blake1, Joel Rosenberg1, Keenan Moore3, Heather Kaluzniak4, Zachary Rengel1, Makinna Oestreich1, Zach Edgerton1, Matthew Peterson1, Shaneabbas Raza4, Subodh Regmi1, Nikolaos Papanikolopoulos2, Christopher Weight1 1Department of Urology, University of Minnesota, 2Department of Computer Science Engineering, 3Carelton College, 4University of North Dakota Presented By: Arveen Kalapara, MBBS
Introduction: Pre-operative decision making for renal cell carcinoma (RCC) has traditionally relied on tumor size as a predictor of pathological outcomes. We assessed the performance of computer generated (CG) tumor volume and surface area on CT in predicting presence of RCC, high grade (Fuhrman 3-4) and high stage (pT3-4) tumor, compared to manually generated (HG) tumor diameter alone. Methods: Retrospective review of 544 patients who underwent nephrectomy following CT imaging for suspected RCC between 2010 and 2018. After manually delineating tumors on CT, we developed an algorithm to calculate CG tumor volume and surface area. Tumor diameter was manually measured (HG) on CT by five medical professionals, independently. We used receiver operating characteristic curve analysis to quantify discriminative ability of each parameter.
Table of Contents 180 Results: CT imaging was available for 195 patients. 183 (94%) had malignant tumor and 60 (31%) had stage ≥ pT3. CG volume (AUC 0.68) and CG surface area (0.67) showed moderate discrimination for cancer, compared to HG diameter (0.71). CG volume (0.79) and CG surface area (0.79) were good predictors of high stage, along with HG diameter (0.82). CG volume (0.74) and CG surface area (0.73) were also good predictors of high grade, comparable with HG diameter (0.75). Conclusion: CG tumor volume and surface area offer good discrimination of high grade and high pathological stage RCC, at rates comparable with HG tumor diameter. Deep learning automatically segments tumor and kidney, calculating these parameters without human capital. These are promising findings which may improve with refinement of our algorithm. Funding: R01CA225435
Podium #120 TOPICAL TREATMENT FOR HIGH GRADE UPPER TRACT CYTOLOGY WITH NEGATIVE IMAGING (HGUTCNI) Andrew Vitale, MD MS1, Jeremy West, MD1, Brenton Sherwood, MD1, Kenneth Nepple, MD1, Sarah Mott, MS2, Michael O'Donnell, MD1 1University of Iowa Hospitals and Clinics, Department of Urology, 3 Roy J Carver, 200 Hawkins Drive, Iowa City, IA, 2University of Iowa Holden Comprehensive Cancer Center, 200 Hawkins Drive, Iowa City, IA Presented By: Andrew Michael Vitale, MD, MS
Introduction: Standard of care for high-grade upper tract urothelial carcinoma (UC) is complete nephroureterectomy (NU). However, no guidelines exist for managing localizing HGUTCNI. Topical therapy may be appropriate in such patients. Methods: Data was collected retrospectively on patients with HGUTCNI receiving upper tract (UT) BCG, sequential Gemcitabine/Docetaxel (Gem/Doce), or sequential Adriamycin/Gemcitabine alternating with Mitomycin/Docetaxel (Quad Chemo). Responders underwent one 3-week maintenance cycle for BCG and 6 once-monthly maintenance for chemo regimens. Gem/Doce was largely reserved for previous BCG unresponsive patients while Quad Chemo was used for Gem/Doce failures. After induction, patients were restaged with cytology, upper tract imaging and ureteroscopy. Results: Of 66 patients with HGUTCNI, 43 recurred with bladder cancer; 37 had UT recurrences and 13 underwent NU. 9 were not surgical candidates or refused NU, and 8 developed metastasis. At median 44-month follow-up, 22 died with 14 attributable to UC. Overall 1-year UT-Recurrence Free Survival (RFS) was 64% (67%, 91% and 33% for BCG, Gem/Doce, or Quad Chemo, respectively; see Figure). 24-month RFS for BCG was 61% with median time to recurrence >57 months. Conclusion: Topical treatment may provide durable RFS in patients with HGUTCNI, however, close follow up is necessary as progression and even metastasis is possible from both coexistent bladder cancer and UT disease. Funding: N/A
Podium #121 DOES URETERAL STENT PLACEMENT FOR HYDRONEPHROSIS PRIOR TO RADICAL CYSTECTOMY FOR BLADDER CANCER INCREASE THE RISK OF UPPER TRACT RECURRENCE OR URETERAL COMPLICATIONS? Tanner Miest, MD, PhD, Vidit Sharma, MD, Praban Thapa, Matthew Tollefson, MD, Houston Thompson, MD, Stephen Boorjian, MD, Igor Frank, MD, Jeffrey Karnes, MD Department of Urology, Mayo Clinic Presented By: Tanner Miest, MD, PhD
Introduction: Patients with hydronephrosis prior to radical cystectomy (RC) for urothelial carcinoma are variably treated with observation, ureteral stent, or nephrostomy tube. The impact of pre-operative ureteral stents on ipsilateral upper tract urothelial carcinoma (UTUC) recurrence after RC is understudied.
Table of Contents 181 Methods: Patients undergoing RC for urothelial carcinoma at our institution from 2000- 2015 were identified. Pre-operative hydronephrosis and pre-operative upper tract drainage were assessed. The risk of UTUC recurrence and relevant ureteral complications were assessed using Kaplan-Meier analyses and multivariable Cox proportional hazard modeling. Results: The cohort of 1049 RCs was stratified as: 1) no hydronephrosis (75%, N=787); 2) hydronephrosis without upper tract drainage (13%, N=132); 3) hydronephrosis with nephrostomy tube (3%, N=36); 4) hydronephrosis with ureteral stent (9%, N=94). Median follow up for survivors was 4.3 (IQR 1.2 – 8.4) years. The 5-year UTUC recurrence rate was 6.6%, 10.2%, 17%, 18.7% for groups 1-4, respectively (p=0.127). Multivariable Cox proportional hazard modeling found hydronephrosis without upper tract drainage (HR 1.31, 1.08-1.58, p=0.01) and hydronephrosis with nephrostomy tube (HR 1.49, 1.06-2.09, p=0.02) had higher UTUC recurrence rates than patients without hydronephrosis. Patients with hydronephrosis managed by ureteral stent had similar UTUC recurrence rates as those without hydronephrosis (HR 0.90, 0.72-1.12, p=0.33). The incidence of ureteroenteric anastomotic stricture did not differ significantly between groups 1-4 (8.5%, 9.2%, 8.3%, 10.6%, respectively, p=0.918). Conclusion: Pre-operative hydronephrosis is a risk factor for UTUC recurrence after RC; however, ureteral stent placement for upper tract drainage did not increase the risk of upper tract recurrence or ureteral complications. Funding: N/A
Podium #122 COMPUTER GENERATED VS. HUMAN GENERATED R.E.N.A.L. NEPHROMETRY SCORE TO PREDICT SURGICAL OUTCOMES IN RENAL CELL CARCINOMA Paul Blake1, Arveen Kalapara1, Niranjan Sathianathen1, Nick Heller2, Edward Walczak1, Joel Rosenberg1, Keenan Moore3, Heather Kaluzniak4, Zachary Rengel1, Makinna Oestreich1, Zach Edgerton1, Matthew Peterson1, Shaneabbas Raza4, Subodh Regmi1, NikolaosPapanikolopoulos2, Christopher Weight1 1Department of Urology, University of Minnesota, 2Department of Computer Science Engineering, University of Minnesota, 3Carelton College, 4University of North Dakota Presented By: Paul Blake
Introduction: RENAL nephrometry score is associated with pathological outcomes, complication rates and survival. Despite its success, widespread uptake has been limited by interobserver variability and time investment to generate scores. We developed an algorithm to produce a computer generated (CG) RENAL score, and compared this with human generated (HG) scores to predict RCC, high grade (Fuhrman 3-4), high stage (pT3-4) and tumor necrosis. Methods: Retrospective review of 544 patients undergoing nephrectomy following CT for suspected RCC from 2010-2018. After manually delineating tumors on CT using an internally made application, we developed an algorithm to automatically generate each RENAL score component. Each tumor was also manually, independently scored by one of five medical professionals. We used ROC curve analysis to quantify the discriminative ability of HG and CG RENAL scores. Results: CT imaging was available for 195 patients. 183 (94%) had malignant tumors. Interobserver agreement between CG and HG RENAL scores was significant, but slight (kappa=0.32, p<0.001). However, CG score had good discriminative ability for cancer (AUC 0.76), greater than HG (0.67). CG (0.59) and HG (0.62) scores were comparable for high grade, whilst HG score (0.80) outperformed CG (0.62) scores for high stage. HG (0.74) also outperformed CG (0.63) score for tumor necrosis. Conclusion: CG RENAL scores demonstrate significant agreement with HG RENAL scores and have similar ability to predict clinically important pathologic outcomes. These are promising results, and, with further refinement, automated RENAL scores may be more reliable, cheaper, faster and potentially supersede human RENAL scoring in predicting post-operative outcomes. Funding: R01CA225435
Table of Contents 182 Podium #123 ESTABLISHING A RENAL HEREDITARY SYNDROME CLINIC: A REVIEW OF IDENTIFICATION, TESTING AND SURVEILLANCE OUTCOMES Ryan Speir, MD, Courtney Schroeder, MS, Adam Calaway, MD, Gail Vance, MD, Ronald Boris, MD IU School of Medicine, Department of Urology Presented By: Ryan W. Speir, MD
Introduction: Patients with RCC may be linked to a hereditary predisposition. We established a referral center for patients with suspected hereditary renal syndromes. Our goals included facilitating genetic counseling, improving the efficiency of genetic testing, and increasing imaging compliance rates. Methods: The Renal Hereditary Syndrome Clinic (RHSC) was established in 2016 and included urologic oncology, medical genetics, and genetic counselling. A monthly multidisciplinary RHSC tumor board reviewed histories, imaging, genetic risk/testing, and management plans. We sought to establish rates of positive genetic testing and imaging compliance. Results: The RHSC saw 32 patients over 30 months. 17 patients were referred after renal tumor surgery. Tumor histology included clear cell (8), chromophobe (3), papillary type I (1), papillary type II (2), translocation RCC (1), renal epithelioid AML (1) and multifocal oncocytoma (1). 10 patients had a family history significant for malignancies. 11 underwent genetic testing with 2 positive results, both with +FH. Surveillance compliance in this cohort was 94%. 15 patients were nonsurgical, referred for a known genetic mutation (8), associated features of hereditary renal syndromes (5), family history of malignancy only (1), or a positive family history of genetic mutation(s) (1). Imaging compliance, when necessary, was 85%. Overall, 14 patients were diagnosed with a hereditary cancer predisposition syndrome. The most common diagnosis was HLRCC (57.1%). Conclusion: The RHSC found genetic mutations in >95% of non-surgical patients and 100% of the family members identified. While genetic mutations were found in 18% of surgical patients, the rate of imaging compliance at 94%. Funding: N/A
Podium #124 OPEN FIELD FLUORESCENCE IMAGING (SPY-PHI) IS A USEFUL TOOL TO ASSESS TISSUE INTEGRITY IN COMPLEX, OPEN, GENITOURINARY RECONSTRUCTIVE SURGERY Kevin Hebert, MD, Jason Joseph, MD, Jack Andrews, MD, Boyd Viers, MD Mayo Clinic, Department of Urology, Rochester, MN Presented By: Kevin Joseph Hebert, MD
Introduction: Genitourinary reconstruction is often required by patients at risk for poor tissue perfusion, such as prior radiotherapy. Maximizing tissue perfusion in an irradiated field is critical to optimizing reconstructive outcomes, yet methods for intraoperative assessment are limited, traditionally relying on direct surgeon visualization. SPY-PHI (Stryker, Kalamazoo, Michigan) is a portable handheld platform using near-infrared laser technology and indocyanine green to characterize tissue vascularity. We sought to compare subjective intraoperative surgeon assessment of tissue perfusion to objective perfusion using SPY-PHI technology. Methods: We utilized SPY-PHI in a cohort of 12 patients undergoing open, complex genitourinary reconstructive surgery for radiation induced complex urinary tract fistula disease between September 2017 and February 2019 at Mayo Clinic. The utility of SPY- PHI and its effect on intra-operative management were assessed. Results: Twelve patients (average age 69 years) underwent multi-modality reconstructive surgery secondary to radiation induced fistulous disease. Rate of discordance between subjective intraoperative surgeon assessment of tissue viability and that using SPY-PHI was 66% (n=8). Discordant assessment of distal ureteral viability was most common, seen in 7 of 9 patients (78%) and 10 of 18 ureters (55%), with mean difference in ureteral viability assessment being 3.3 cm (range 2-8cm).
Table of Contents 183 Conclusion: Near-infrared laser assessment using SPY-PHI is a useful adjunct for real- time intraoperative evaluation of tissue viability in complex genitourinary reconstructive surgery. More short and long-term data are necessary to evaluate the potential role of SPY-PHI technology in genitourinary reconstructive surgery. Funding: N/A
Podium #125 A NOVEL METHOD FOR MEASURING SEVERITY OF URETEROPELVIC JUNCTION OBSTRUCTION THAT CORRELATES WITH ROBOTIC PYELOPLASTY FAILURE IN ADULTS Hal Kominsky, MD, Michael Souiral, MD, Justin Rose, Tatevik Broutian, PhD, Geoffrey Box, MD The Ohio State University Wexner Medical Center Presented By: Hal Kominsky, MD
Introduction: How the degree of hydronephrosis influences success rates in the context of robotic pyeloplasty (RP) has not been well reported. The objective of our study was to determine whether preoperative degree of calyceal and renal pelvis dilation were associated with failure in RP. Methods: We conducted a retrospective review of patients undergoing RP for UPJO at our institution. Degree of calyceal and renal pelvis dilation were recorded as the largest anterior-posterior diameter measurement in the axial plane on CT scan. RP failure was defined as persistent pain at follow-up, evidence of obstruction on post-op imaging, or need for a secondary procedure. Results: We report on 95 patients (median age 40 years) with average follow-up of 20.0 months. Failure was noted in 14 (14.7%) patients: 14 (100%) had pain at follow-up visit and 10 (71.4%) required a secondary procedure. Of the 14 failures, 8 (57.1%) were primary repairs and 6 (42.9%) had at least one prior surgery for UPJO. Mean calyceal dilation was 31.8mm (±17.4) and 40.5mm (±18.6) and mean renal pelvis dilation was 44.2mm (±21.4) and 49.5mm (±20.2) for successful and failed pyeloplasty, respectively. Mean ratio of calyceal to renal pelvis dilation was 0.79 (±0.43) for successful pyeloplasty and 1.01 (±0.87) for failed pyeloplasty. No significant difference existed between groups for calyceal dilation (p=0.0914), renal pelvis dilation (p=0.3913), or ratio of calyceal to renal pelvis dilation (p=0.3743). Conclusion: Degree of calyceal and renal pelvis dilation were not associated with RP failure in the treatment of UPJO. Funding: N/A
Podium #126 RARE RENAL MASS IN A PATIENT WITH A PRIOR PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA Edward Capoccia, resident, Eiftu Haile, Medical Student, Christopher Coogan, Attending Rush University Medical Center Presented By: Eiftu Haile
Introduction: Pleomorphic hyalinizing angiectatic tumors (PHAT) of the kidney are exceedingly rare and may mimick malignant neoplasms of the kidney. Methods: Renal hilum PHAT presenting as a renal mass in a patient with a history of renal cell carcinoma (RCC) with prior partial nephrectomy in the ipsilateral kidney. Results: A 68 year old patient with a history of right sided RCC status post open partial nephrectomy with pathology showing clear cell RCC, grade 1 with negative margins, who presented with an incidentally found right renal hilum mass on surveillance imaging. CT scan with IV contrast showed a 1.8 x 2.8 cm enhancing renal hilum mass. Given the concern ofr metachronous RCC, a hand assisted laparoscopic radical nephrectomy was performed. The surgery was uncomplicated besides the expected perinephric adhesions from his prior partial nephrectomy. Pathology showed pleomorphic hyalinizing angiectatic tumor with the remaining renal parenchyma with no pathologic findings.
Table of Contents 184 Conclusion: PHAT are exceeding rare mesenchymal tumors typically presenting as a soft tissue massin the subcutaneous tissue of the lower extremity however it can present anywhere in the body. There are no documented metastases however wide local excision follwed by serial imaging is recommended given its characteristic locally aggressive behavior and high recurrence rate. This patient has done well after surgery and will be followed with serial imaging. Funding: N/A
Podium #127 MULTIPLEX POLYMERASE CHAIN REACTION BASED URINARY TRACT INFECTION ANALYSIS COMPARED TO TRADITIONAL URINE CULTURE IN IDENTIFYING SIGNIFICANT UROPATHOGENS IN SYMPTOMATIC PATIENTS Brett Watson, MD1, Andrew Korman2, Kirk Wojno, MD2, Howard Korman, MD2, David Wenzler, MD2, Syed Mohammed A. Jafri, MD1 1Beaumont Health, Dept of Urology, Royal Oak, MI, 2Comprehensive Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Introduction: Urine cultures (UC) have difficulty identifying polymicrobial infections and fastidious organisms. Polymerase chain reaction (PCR) based molecular testing can rapidly detect and quantify bacterial, viral, and fungal organisms. This study evaluated whether PCR is non-inferior to traditional UC at detecting organisms and polymicrobial infections in symptomatic patients Methods: Retrospective review of 582 consecutive patients with symptoms of lower UTI was conducted. All patients had traditional UC and PCR molecular testing run in parallel. Results: 582 patients (mean age 77; range 60-95) with clinical UTI had both UC and PCR molecular testing. PCR detected uropathogens in 56% while UC detected pathogens in 37%. Agreement between PCR and UC for positive UC was 91%, exceeding the non-inferiority threshold (p=0.017). Of the 365 patients with a negative UC, PCR identified pathogens in 130 (35.6%). PCR detected 88 polymicrobial infections compared to 13 on UC. Non-bacterial organisms were detected in 131/582 (22.5%), with yeast = 10 (1.7%) and virus = 121 (20.8%). Conclusion: Multiplex PCR is non-inferior to UC for detection of uropathogens in symptomatic patients, detecting around 50% additional positive infections, more polymicrobial infections, and viral genome in over 20% of patients. The accuracy and speed of PCR based testing over UC may significantly improve patient care. Funding: yes, Pathnostics
Table of Contents 185 Podium #128 RISK FACTORS, DEMOGRAPHIC PROFILES AND MANAGEMENT OF UNCOMPLICATED RECURRENT UIRNARY TRACT INFECTIONS: A SINGLE INSTITUTION EXPERIENCE Amanda Ingram, MD, Aroh Pandit, BM, Justin Rose, BS, Tasha Posid, PhD, Fara Bellows, MD OSUWMC Presented By: Amanda R. Ingram, MD
Introduction: Recurrent urinary tract infections (rUTI) are a common urologic complaint, with up to 8 million ambulatory visits for UTI recorded nationally in 2007. The objective of this study is to [describe the demographic profile of rUTI at our institution and] summarize practice patterns at a single tertiary health center. Methods: We conducted a retrospective record review of female patients presenting to the OSUWMC Department of Urology for diagnosis of uncomplicated rUTI/cystitis between October 2010 and September 2018. Results: There were 126 patients included in our final analyses. Of these cases, 80.8% were managed conservatively, 44.8% with probiotics, 44.0% with cranberry juice/extract, 28% with daily suppression. Certain treatment options differed by pre/post-menopausal status (treatment1, treatment2, treatment 6, treatment7; p<.04), as did use of Antibiotic1 (p=.046). Subsequent recurrence was seen in 38.9% of cases. For premenopausal women, age of presentation was associated with BMI and CCI score (ps<.03), and the number of past UTIs was associated with subsequent recurrence (p<.001). Risk factors for number of past UTIs were: ADD (p=.047), bipolar (p<.001), and constipation (p=.002; Model: R2=.561, p=.007). Conclusion: This single institution report sheds light on our patient demographics and practice patterns for the uncomplicated rUTI population at OSUWMC. Funding: N/A
Podium #129 POSTERIOR DESCENT FOLLOWING ISOLATED CYSTOCELE REPAIR M. Francesca Monn, MD, Gabrielle Mcnary, MD, Ethan Ferguson, MD, Charles R. Powell, MD Indiana University Presented By: Ethan L. Ferguson, MD
Introduction: The traditional teaching in pelvic organ prolapse repair requires concomitant anterior and posterior compartment repair in the setting of isolated compartment prolapse due to the presumption that fixing one compartment in isolation could lead to development of prolapse in the opposite compartment. Literature supporting this practice is sparse. We sought to evaluate the change in posterior compartment descent following isolated anterior prolapse repair. Methods: A retrospective cohort study was performed examining patients who underwent surgery for isolated anterior compartment prolapse between 7/2010 and 9/2017. All patients underwent anterior vaginal wall suspension (AVWS) with or without
Table of Contents 186 concurrent urethral sling. The primary outcomes were mean change in Bp, and development of posterior prolapse as defined by a Bp≥0. Results: 56 patients were identified for inclusion with mean (SD) age 57.6(13.5) and BMI 28.9(5.3). 30 (53.6%) underwent prior hysterectomy. 18(32.1%) underwent concomitant sling. Mean (SD) pre-operative Bp was -1.6 (0.95) and Ap was -2.1(0.59). Mean (SD) post-operative Bp was -1.7(1.1) and Ap was -2.1(1.0). Mean (SD) change in Bp was - 0.13 (1.1) (p>0.05). Three (5.4%) patients developed Bp≥0 whose pre-operative Bp was<0. Three patients began with Bp 0 and had Bp 0 after surgery but remained asymptomatic. Only one patient desired intervention for the posterior prolapse. Median (IQR) follow-up was 9.4(3.7-16.9) months. Conclusion: The majority of patients with isolated anterior prolapse can be managed with correction of only the anterior compartment without risk to the posterior compartment. Patients can be counseled of a 5% risk of posterior prolapse when AVWS is performed as the anterior repair. Funding: N/A
Podium #130 REZŪM WATER VAPOR THERMAL THERAPY FOR LOWER URINARY TRACT SYMPTOMS (LUTS) DUE TO BENIGN PROSTATIC HYPERPLASIA (BPH): DURABLE 4-YEAR RESULTS FROM RANDOMIZED CONTROLLED STUDY Kevin McVary, MD1, Claus Roehrborn, MD2 1Stritch School of Medicine, Loyola University Medical Center, 2University of Texas Southwestern Presented By: Kevin Thomas McVary, MD, FACS
Introduction: A randomized controlled trial of water vapor thermal therapy was conducted to treat moderate to severe LUTS/BPH and to determine minimal important differences in International Prostate Symptom Scores (IPSS) associated with perceptible changes in quality of life (QOL). Methods: Total 188 subjects in active arm: 135 men ≥50 years old, IPSS ≥13, maximum flow rate (Qmax) ≤15 ml/s and prostate volume 30 to 80 cm3 treated with Rezūm® System thermal therapy were followed 4 years; subset of 53 men, requalified for crossover from control to active treatment were followed 3 years. Results: IPSS, QOL, Qmax and BPH Impact Index improved ~50% and remained consistently durable throughout 4 years, p < .0001 (Figure); crossover subjects had similar sustained outcomes. At 4 years surgical retreatment rate was 4.4%, BPH medication resumption rate was 5.2%. Sexual function was preserved. IPSS and QOL scores strongly correlated; a mean IPSS change corresponding to a 1-point QOL improvement is ~ -5 points for IPSS 13-19, -8.2 for IPSS 20-26, -11.7 for severest LUTS of IPSS 27-35. Conclusion: Rezūm thermal therapy provides effective symptom relief and improved QOL with durability over 4 years, has limited impact on sexual function and is applicable to all prostate zones with procedures performed under local anesthesia in an office setting. Funding: Boston Scientific Corporation
Table of Contents 187 Podium #131 PREDICTORS OF TREATMENT FAILURE FOR TRANSURETHRAL CONVECTIVE RADIOFREQUENCY WATER VAPOR THERMAL THERAPY (REZUM) FOR TREATMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) Scott Hawken, MD MS, Juan Andino, MD MBA, Rohan Ved, Casey Dauw, MD, John Wei, MD, Chad Ellimoottil, MD, MS University of Michigan Department of Urology Presented By: Scott R. Hawken, MD, MS
Introduction: Rezum is a transurethral, minimally invasive treatment for men with lower urinary tract symptoms (LUTS) from BPH. There are few data regarding which men may be poor responders. Methods: All patients at our institution who underwent Rezum for LUTS from BPH were identified. Patient demographics, procedural details, routinely collected pre and post- treatment American Urological Association Symptom Index (AUASI) scores, medication use, and adverse events were retrospectively collected. “Treatment failure” was defined as a <3-point improvement in the AUASI from baseline to most recent follow-up. Outcomes and predictors of treatment failures were examined. Results: 60 patients underwent Rezum from 2016-2018. Three were lost to follow-up. Median follow-up was 55 days (IQR: 33-238). Pre- to post-treatment AUASIs had a mean decrease of 7.7 points (95% CI: 5.7-9.7, p<0.001, FIGURE). 12 men (21%) experienced treatment failure. Pre-procedural medication use for storage symptoms (anti-cholinergic and/or mirabegron) was associated with treatment failure, with 46% vs 14% taking these medications prior to Rezum experiencing failure (P=0.01). The number of prostatic injections, a surrogate for prostate size, was also associated with treatment failure, with a median of 6(IQR:4-7) injections for those with failure vs 4(IQR:4-5, p=0.02). Conclusion: Men with storage symptoms requiring medication use and those with larger prostates, requiring more intraprostatic injections, were less likely to have a perceptible benefit. Funding: N/A
Table of Contents 188 Podium #132 LONG-TERM REOPERATION RATES FOLLOWING SURGERY FOR BPH: VARIATION BASED ON SURGICAL MODALITY Abhinav Khanna, MD, Navin Sabharwal, BA, Khaled Fareed, MD, James Ulchaker, MD, Kyle Ericson, MD, Bradley Gill, MD, MS Cleveland Clinic Presented By: Bradley C. Gill, MD, MS
Introduction: This study compared re-operation rates of differing modalities of benign prostatic hypertrophy (BPH) surgeries. Methods: Retrospective review of the electronic medical record in a large health system identified patients undergoing first-time BPH surgery, including transurethral resection (TURP), laser vaporization (LVP), and simple prostatectomy (SP). The primary outcome was endoscopic reoperation at least 90 days after the index surgery. Results: A total 4,985 patients underwent BPH surgery between 2001-2016, including 2,304(46.2%) TURP; 2,549(51.1%) LVP; and 132(2.7%) SP. Median follow-up was 26.5[25%-75%: 7.1-59.0] months. There were 419(8.4%) subsequent endoscopic operations, occurring a median 19.5[7.7- 39.3] months after initial BPH surgery. Reoperation rates differed significantly across surgical modalities, with LVP (268/2549, 10.5%) being the highest, followed by TURP (148/2304, 6.4%), and SP (3/132, 2.3%) (p<0.0001) being the lowest. On Cox proportional hazards regression analysis, adjusted for baseline demographic and clinical characteristics, primary BPH surgical modality was independently associated with subsequent endoscopic surgery (p=0.007). Compared to LVP (referent), TURP (hazard ratio [HR] 0.78, 95% confidence interval 0.64-0.95) and SP (HR 0.28, 95%CI 0.09-0.87) were less likely to require secondary surgery (Figure 1). Conclusion: Modality of BPH surgery can impact the risk of undergoing subsequent endoscopic surgery, suggesting differing approaches provide varied long-term durability, as well as reoperation-related morbidity and healthcare resource utilization. Funding: N/A
Table of Contents 189 Podium #133 MIRABEGRON IMPROVES SLEEP MEASURES, NOCTURIA, AND LOWER URINARY TRACT SYMPTOMS IN THOSE WITH URINARY SYMPTOMS ASSOCIATED WITH DISORDERED SLEEP Robert Petrossian1, Danuta Dynda1, Kristin Delfino1, Ahmed El-Zawahry2, Kevin McVary3 1Southern Illinois University, 2University of Toledo, 3Loyola University Medical Center Presented By: Robert Ara Petrossian, MD
Introduction: The role of organized sleep in overall health and quality of life (QoL) is critical. Nocturia necessarily disrupts the normal sleep cycle and negatively impacts one’s health, work productivity, and QoL. We investigated, for the first time in an exploratory pilot, the effectiveness of mirabegron for improving sleep disturbance and nocturia. Methods: This was a prospective, open-label 12-week trial evaluating the efficacy of mirabegron in 34 men and women with disordered sleep and lower urinary tract symptoms (LUTS). Subjects received mirabegron 25 mg daily for 4 weeks, then increased to 50 mg. Subjects completed the Patient-Reported Outcome Measurement Information System Sleep Disturbance Short Form (PROMIS-SDSF), Jenkins Sleep Scale (JSS), International Prostate Symptom Score (IPSS), voiding diaries, and QoL questionnaires. Results: PROMIS-SDSF scores decreased from 26.5 points to 19.3, representing a categorical improvement from clinically "mild" to "none to slight" sleep disturbance (p<0.001). JSS scores also decreased from 14.1 to 8.3 (p<0.001). IPSS decreased from 21.0 to 12.4, denoting a categorical improvement from "severe" to "moderate" LUTS (p<0.001). Voiding diaries revealed 1.9 fewer voids per day (p<0.01) and 0.8 fewer nighttime voids (p<0.05). QoL improved from 0% in subjects who selected "mostly satisfied," "pleased," or "delighted" to 29.6% at follow-up. Conclusion: Mirabegron use produces rapid, durable, and clinically significant improvement in sleep disturbances and improves nocturia and LUTS in males and females with urinary symptoms associated with disordered sleep. Funding: Astellas Scientific and Medical Affairs
Podium #134 NATIONAL PRESCRIBING TRENDS IN BENIGN PROSTATIC HYPERPLASIA/LOWER URINARY TRACT SYMPTOMS (BPH/LUTS) Marc Nelson, MD1, Ryan Dornbier, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Brian Matlaga, MD2, Charles Welliver, MD3, Lydia Feinstein, PHD4, Ziya Kirkali, MD5, Tamara Bavendam, MD5, Julia Ward, PHD4, Chyng-Wen Fwu4, Ahmer Farooq, DO1, Kevin McVary, MD1 1Loyola University Medical Center, Maywood, IL, 2Johns Hopkins University, Baltimore, MD, 3Albany Medical College, Albany, NY, 4Social and Scientific Systems, Silver Spring, MD, 5National Institutes of Health, Bethesda, MD Presented By: Marc Nelson, MD
Introduction: BPH/LUTS is a chronic disease-causing significant morbidity and quality of life impairment amongst men. Medical therapy is the most common initial intervention. We assess trends in medical management of BPH/LUTS with private and Medicare insurance. Methods: As part of the Urologic Diseases in America (UDA) project, men with BPH aged 40-64 with private insurance (Optum© Clinformatics® Data Mart) or aged ≥65 with Medicare (CMS Medicare 5 Percent Sample) with full Part D insurance from 2004-2013 were identified using ICD-9-CM codes. The percentage of patients receiving BPH-related prescriptions was assessed on a yearly basis over the study period and broken down by 5-year age groups. Results: Use of medical BPH therapy increased throughout the study period. The figure demonstrates that the proportion of patients who filled prescriptions directly relates to age, with up to 67.1% of men aged 85+ filling prescriptions in 2013. Furthermore,
Table of Contents 190 medical management of BPH increased more for men with private insurance as compared to Medicare (14.0% vs 4.5%) over the study period. Conclusion: Over a 10-year period, BPH was increasingly managed with medical therapy. This increase was especially pronounced among younger men with private insurance. Funding: Urologic Diseases in America (UDA-NIDDK) The Urological Diseases in America project was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through a contract to Social Scientific Systems (HHSN276201500204U). Dr. Julia Ward and Dr. Lydia Feinstein are employed by Social Scientific Systems, and Dr. Brian Matlaga has a subcontract with the company.
Podium #135 NATIONAL SURGICAL TRENDS IN BENIGN PROSTATIC HYPERPLASIA/LOWER URINARY TRACT SYMPTOMS (BPH/LUTS) Marc Nelson, MD1, Ryan Dornbier, MD1, Petar Bajic, MD1, Joseph Mahon, MD1, Brian Matlaga, MD2, Charles Welliver, MD3, Lydia Feinstein, PHD4, Ziya Kirkali, MD5, Tamara Bavendam, MD5, Julia Ward, PHD4, Chyng-Wen Fwu4, Ahmer Farooq, DO1, Kevin McVary, MD1 1Loyola University Medical Center, Maywood, IL, 2Johns Hopkins University, Baltimore, MD, 3Albany Medical College, Albany, NY, 4Social and Scientific Systems, Silver Spring, MD, 5National Institutes of Health, Bethesda, MD Presented By: Marc Nelson, MD
Introduction: BPH/LUTS is a chronic disease-causing significant morbidity and quality of life impairment among older men. While medical therapy is commonly used, surgical management is often reserved for refractory disease. We assessed trends in the surgical management of BPH in men with Medicare and private insurance. Methods: As part of the Urologic Diseases in America (UDA) project, men aged ≥65 with BPH insured by Medicare (CMS Medicare 5% Sample) with full Part D coverage or aged 40-64 with private insurance (Optum© Clinformatics® Data Mart) from 2004-2013 were identified using ICD-9-CM codes. The percentage of patients who underwent surgery to treat BPH throughout the study period was examined. Results: Age group is related to rates of surgery for BPH (figure). Among the Medicare population, surgical procedures for BPH decreased in total and on a per-patient basis. BPH procedures decreased by 24.2%, with 4.5% of patients having surgery in 2004 compared to 2.8% in 2013. Among the privately insured patients, surgery for BPH was less common and mildly decreased during the study timeframe, from 2.1% in 2004 to 1.7% in 2013.
Table of Contents 191 Conclusion: Over a 10-year span, there was a dramatic reduction in rates of surgical therapy for BPH. Funding: The Urological Diseases in America project was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through a contract to Social Scientific Systems (HHSN276201500204U). Dr. Julia Ward and Dr. Lydia Feinstein are employed by Social Scientific Systems, and Dr. Brian Matlaga has a subcontract with the company.
Podium #136 PREOPERATIVE ANXIETY CORRELATES WITH LOWER URINARY TRACT SYMPTOMS IN PATIENTS UNDERGOING HOLMIUM LASER ENUCLEATION OF THE PROSTATE Charles Nottingham, MD, MS1, Crystal Valadon2, Tim Large, MD1, Amy Krambeck, MD1 1Indiana University School of Medicine, Department of Urology, 2University of Louisville, School of Medicine Presented By: Charles U. Nottingham, MD MS
Introduction: The purpose of this study was to evaluate if patient-reported anxiety correlates with pathologic characteristics in patients undergoing holmium laser enucleation of the prostate (HoLEP). Methods: Pathologic characteristics for patients undergoing HoLEP by a single surgeon at our institution are prospectively collected. We began collecting patient-reported anxiety scores (GAD-7) starting in November 2018. We retrospectively evaluated the relationship between preoperative GAD-7 score with preoperative age, BMI, urine flow metrics, and symptom scores for LUTS (AUA, BPHII, and MISI) and ED (SHIM and MSHQ-EJD). We then compared preoperative GAD-7 score to enucleated prostate weight, postoperative urine flow metrics, and postoperative symptom scores for LUTS and ED. Results: We included 55 patients for analysis. All analyzed variables are included in table 1. The GAD-7 score positively correlated with preoperative total AUA symptom score (B=0.018, p=0.043), MISI total score (B=0.389, p=0.001), and MISI bother (B=0.973, p=0.002). The GAD-7 score did not correlate with age, BMI, preoperative urine flow metrics, ED, or other LUTS symptom scores. Additionally, GAD-7 score showed no correlation with enucleated prostate weight, postoperative urine flow metrics, and postoperative LUTS and ED symptom scores. Conclusion: Higher preoperative anxiety correlated with more severe preoperative LUTS in patients requiring HoLEP. HoLEP appears to alter LUTS scores despite preoperative anxiety level. Funding: N/A
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Podium #137 INITIAL EXPERIENCE WITH MOSES LASER ENUCLEATION OF THE PROSTATE (MOLEP) Tim Large, MD1, Charles Nottingham, MD1, Chanel Stephens2, Ashley Ross, RN2, Amy Krambeck, MD1 1Indiana University School of Medicine, 2Indiana University Methodist Hospital Presented By: Tim Large, MD, MA
Introduction: The Lumenis Pulse 120H holmium laser with Moses technology has been used extensively in the treatment of nephrolithiasis. Moses technology modulates the pulsed laser energy to optomize tissue incision. Prior to Moses technology, standard laser fibers (slimline 550/1000 mm fiber by Boston Scientific) were used for HoLEP. The laser units have a cutting and coagulating laser peddle. Methods: This is prospectively collected data on 73 consecutive transurethral procedures for LUTS/BPH between July and October 2018 using the 120 H laser unit with MOSES technology. During the trial 3 different laser fibers were used including: slimline 550 (25), slimline 1000 (23) and the MOSES 550 (25) fiber. Basic demographics and intraoperative variables were collected and analyzed using t-test to compare means. Results: Prostate gland size did not differ significantly between the three groups (table 1). Significantly less time was spent achieving hemostasis with the Moses 550 fiber as compared to the other two fibers. Conclusion: Both the slimline 1000 and Moses 550 (with Moses mode enabled) fibers demonstrated shorter cut peddle and coagulation peddle times compared to slimline 550. Furthermore, laser time and total energy was also reduced for the 1000 and 550 moses fibers. A further cost analysis would provide additional information on the benefit of adopting the Moses platform for HoLEP. Funding: None
Table of Contents 193 Podium #138 COMPARISON OF BPH MEDICATION PRESCRIBING AMONGST SEXAGENARIANS WITH MEDICARE AND PRIVATE INSURANCE Jazzmyne Montgomery1, Petar Bajic1, Marc Nelson1, Ryan Dornbier1, Joseph Mahon1, Lydia Feinstein2, Julia Ward2, Chyng-Wen Fwu2, Ziya Kirkali3, Brian Matlaga4, Charles Welliver5, Ahmer Farooq1, Kevin McVary1 1Loyola University Medical Center, Center for Male Health, Maywood, IL, 2Social and Scientific Systems, Silver Spring, MD, 3National Institutes of Health, Bethesda, MD, 4Johns Hopkins University, Baltimore, MD, 5Albany Medical College, Albany, NY Presented By: Jazzmyne Montgomery, MS
Introduction: Prescribing of BPH medications increases with patient age. We characterized differences in BPH medication prescribing patterns for 60 to 69-year-olds with Medicare or private insurance. Methods: As part of the Urologic Diseases in America (UDA) project, two insurance claims databases were used: CMS 5% Sample (Medicare beneficiaries age ≥65) and Optum©Clinformatics® Data Mart (CDM, privately insured adults <65). Prescribing patterns for BPH (2006-2013) were stratified by medication and insurance types. Medicare data for 2012 was absent. Results: Prescribing of any BPH medication increased over time for both groups, with a greater rise in privately insured relative to Medicare (7.2% vs 2.5%, respectively). The largest difference between prescribing of a single medication was with α-blocker therapy (8.6% higher in the Medicare group on average). Anticholinergic use was steady amongst privately insured patients but declined in Medicare patients. 5αRI prescribing increased up to 2010, then decreased in both groups, with a less pronounced decline among Medicare patients. Tadalafil prescribing was more common in privately insured patients. Conclusion: Overall, there was a rise in BPH medication prescribing from 2006-2013. The decline in 5αRI prescribing correlates to the FDA “black box” warning on finasteride in 2011, and the decline in anticholinergic prescribing may relate to concerns over adverse effects or coverage issues. Funding: The Urological Diseases in America project was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through a contract to Social Scientific Systems (HHSN276201500204U). Dr. Julia Ward and Dr. Lydia Feinstein are employed by Social Scientific Systems, and Dr. Brian Matlaga has a subcontract with the company.
Table of Contents 194 Podium #139 PREDICTORS OF TRANSRECTAL ULTRASOUND-GUIDED PROSTATE BIOPSY COMPLICATIONS Raj Kumar1, Michael Abern2, Gerald Andriole3, Stephen Freedland4, Daniel Moreira2 1University of Illinois College of Medicine, 2University of Illinois, 3Washington University in St. Louis, 4Cedars-Sinai Medical Center Presented By: Raj Anirudh Kumar, BS
Introduction: Prostate biopsy-related complications have important health-related consequences. We analyzed the factors associated with complications following transrectal ultrasound-guided prostate needle biopsy. Methods: We analyzed data of 4,082 men 50-75 years-old undergoing prostate biopsy in the Reduction by Dutasteride of prostate cancer (PC) Events study. Complications included: hematuria, urinary tract infection (UTI), acute urinary retention (AUR), and hematospermia. Association of patient’s sociodemographics, family history of PC, rectal exam, prostate volume, prostate-specific antigen, international prostate symptom score, chronic prostatitis symptom index, peak flow, post-void residual (PVR), geographic region, diabetes mellitus (DM), hypertension, antiplatelet therapy (AT) and treatment arm with biopsy-related complications was assessed in uni- and multivariable analyses. Results: 218 (5.3%) men had prostate biopsy-related complications, including 149 (3.7%) hematurias, 31 (0.8%) UTIs, 19 (0.5%) AURs, and 86 (2.1%) hematospermias. In univariable analysis, any complication was associated with AT (OR=1.89, P<0.001), placebo arm (OR=1.39, P=0.020), and higher PVR (OR=1.01, P<0.001). Hematuria was associated with AT (OR=2.31, P<0.001), older age (OR=1.03, P=0.028), higher PVR (OR=1.01, P<0.001), and lower CPSI (OR=0.96, P=0.019). Hematospermia was associated with AT (OR=2.77, P<0.001), lower age (OR=0.96, P=0.032), higher PVR (OR=1.01, P=1.019), and placebo arm (OR=1.56, P=0.048). AUR was associated with DM (OR=5.01, P=0.001). Compared to North Americans, those in Europe (E) and other continents (O) had lower risk of complications (any complication: OR-E=0.516, P<0.001; OR-O=0.346, P<0.001; hematuria: OR-E=0.391, P<0.001; OR-O=0.306, P<0.001; hematospermia: ORE=0.195, P<0.001; ORO=0.089, P<0.001). Results were unchanged in multivariable analysis. Conclusion: Among men undergoing prostate biopsy, DM, AT and high PVR were associated with complications. Funding: N/A
Podium #140 CLUSTER ANALYSIS REVEALS BOTH BLADDER OUTLET OBSTRUCTION AND DETRUSOR DYSFUNCTION DRIVE NEED FOR SURGICAL TREATMENT OF BPH/LUTS Andrew Schneider, PhD1, Matthew Grimes, MD1, Sijian Wang, PhD2, Wade Bushman, MD, PhD1 1University of Wisconsin, 2Rutgers University Presented By: Wade Bushman, MD, PhD
Introduction: We performed a retrospective cluster analysis of objective patient characteristics including urodynamic variables and prostate volume of patients treated surgically for BPH/LUTS to identify meaningful subgroups within this cohort. Methods: We identified 94 men who underwent TURP or open simple prostatectomy for BPH/LUTS with complete preoperative urodynamic data. Hierarchical cluster analysis was performed on 11 variables: age, HTN, DM, BMI, prostate volume, volume at first uninhibited detrusor contraction, number of uninhibited contractions during filling, Bladder Outlet Obstruction Index (BOOI= PdetQmax – 2Qmax), Bladder Contractility index (BCI = PdetQmax + 5Qmax) and bladder power [Power= (PdetQmax)Qmax)]. Results: Cluster analysis identified two meaningful subgroups. Significant differences between the two groups included mean Prostate Volume (106 vs 55; p=0.014), BOOI (75 vs 50; p=0.002), BCI (127 vs 83; p<.0001) and Power (601 vs 233; p<.0001). Additional differences included mean opening pressure (86 vs 59; p=0.001); Max Flow (8.3 vs 4.9;
Table of Contents 195 p<.0001); Pdet Qmax (87 vs 58; p<.0001), average flow rate (4.3 vs 2.5; p=0.0002); Voided Volume (274 vs 163p=0.001) and Post Void Residual (106 vs 250; p=0.001). Conclusion: We identified two meaningful subgroups in patients undergoing surgery for BPH/LUTS. One group is distinguished by larger prostate volume, greater outlet resistance, greater bladder contractility and more effective voiding. The other is distinguished by smaller prostate volume, lesser outlet resistance, weaker bladder contractility and more impaired emptying. This suggests that outlet obstruction due to prostatic enlargement and decreased detrusor function both drive the need for surgical treatment of BPH/LUTS. Funding: I01 BX003454-01 (Bushman, PI) 04/01/16-03/31/20 VA Merit Award
Podium #141 INTERIMAGING ACCURACY OF CT, MRI, AND TRUS IN MEASURING PROSTATE VOLUME COMPARED TO THE ANATOMIC PROSTATIC WEIGHT Vaishnavi Narayanamurthy, MS, Kirtishri Mishra, MD, Amr Mahran, MD,MS, Laura Bukavina, MD, MPH, Lee Ponsky, MD, FACS, Anand Patel, MD, Donald Bodner, MD, Ehud Gnessin, MD University Hospitals/Case Western Reserve University Presented By: Vaishnavi Narayanamurthy
Introduction: To evaluate the accuracy of transrectal ultrasound (TRUS), computed tomography (CT), and magnetic resonance imaging (MRI) compared to the reference standard of the post-surgical anatomic prostatic weight (APW). Methods: A total of 349 patients from two institutions were included. CT and MRI dimensions, and TRUS reported prostate volumes (PV) were obtained. The prolate ellipsoid formula wasused to calculate prostate volumes. Cross-sectional measurements were evaluated and comparedto the reported post-surgical pathology measurements and calculated pathology volume (pathPV). Basic statistical analysis was performed using Pearson correlation, Bland-Altman analysis, and Passing-Bablok regression. Results: A total of 198 patients were included in the MRI group, 118 in the CT group, 295 in theTRUS group, and 51 in the all-inclusive common cohort. MRI PV demonstrated good toexcellent correlation with the APW (r = 0.79). CT PV demonstrated good correlation with APW (r = 0.78). TRUS PV showed a correlation with APW (r = 0.67). The correlations identified ineach individual group held true in the common cohort as well. Path PV showed excellentcorrelation with APW (r = 0.87), followed by MRI PV (r = 0.81), then CT PV (r = 0.73), andlastly TRUS PV (r = 0.71). Conclusion: MRI and CT are equally effective in assessing prostate volume, and can be readilyutilized to guide BPH management without repeating in-office TRUS. This is not only cost-effective, but also eliminates patient anxiety and discomfort. Funding: NA
Podium #142 INDICATIONS AND OUTCOMES OF SIMULTANEOUS BILATERAL NATIVE NEPHRECTOMIES: OUR 10 YEAR PEDIATRIC EXPERIENCE Anja Zann, MD, Seth Alpert, MD, Rama Jayanthi, MD, Daryl McLeod, MD, Molly Fuchs, MD, Daniel Dajusta, MD, Christina Ching, MD Nationwide Children’s Hospital, Columbus, OH Presented By: Jennifer Lynn Saluk, MD
Introduction: The role of native nephrectomy in pediatric patients who have undergone or are being considered for renal transplant is not well defined. We explored the indications and outcomes of our institution’s experience with bilateral native nephrectomies (BNN) over the last 10 years. Methods: We performed a retrospective chart review of pediatric patients with ESRD who underwent bilateral native nephrectomy from 2009-2019. We included patients regardless of dialysis status and transplant status. Demographic and clinical details were obtained.
Table of Contents 196 Results: We identified 8 patients that underwent BNN for indications associated with ESRD. The mean age of patients at the time of nephrectomy was 9.75 years. Indications included hypertensive crisis, nephrotic syndrome, Polycythemia Vera, and recurrent UTIs. Prior to nephrectomy 3 patients were on hemodialysis, 2 on peritoneal dialysis, and 3 were not on dialysis. Three were done robotically, and 5 via open flank incisions. The only complication was the development of intra-abdominal abscess requiring percutaneous drainage in the patient with UTIs. All patients had improvement of the inciting condition. One patient had previously been transplanted, and 5 patients went on to transplantation; 1 patient passed away prior to transplant from causes unrelated to surgery. One patient is still awaiting transplant. Conclusion: Bilateral native nephrectomy is a safe and effective way to manage difficult conditions associated with ESRD. This can be done open or using minimally invasive techniques. When managed in coordination with Nephrology colleagues, this can salvage an existing graft or prepare patients for successful transplant in the future. Funding: n/a
Podium #143 RISK OF GENITOURINARY MALIGNANCY IN THE RENAL TRANSPLANT PATIENT Song Jiang, MD, PhD1, Scott Jackson, MS2, Collin Calvert, MPH3, Timothy Pruett, MD2, Christopher Warlick, MD, PhD1 1University of Minnesota, Department of Urology, 2University of Minnesota, Division of Transplantation, Department of Surgery, 3University of Minnesota School of Public Health Division of Epidemiology Community Health Presented By: Song Jiang, MD
Introduction: The management of genitourinary cancer in transplant recipients is challenging and remains controversial. Currently there is no consensus regarding screening and management, with much of the clinical decision-making based on historical practices that fail to take into account recent progress in both genitourinary cancer diagnosis and management, as well as in immunosuppression protocols. Methods: The University of Minnesota Solid Organ Transplant database, curated based on UNOS data collected from 1984 - 2017, was queried for renal transplant recipients in whom development of subsequent urologic malignancies (prostate, bladder, renal, penile, and testicular cancer) was found. Results: In total, 4983 renal transplants were performed from 1984 to 2017 at the University of Minnesota. Among patients who underwent renal transplantation, genitourinary tumors were detected in 197 subjects (3.9%). The predominant genitourinary cancer was renal cell cancer, both of the native and of the transplanted kidney (n = 83), followed by prostate cancer (n = 59), and bladder cancer (n = 44). Cumulative incidence of all cancers of a genitourinary etiology are presented over an average follow up time of 10.8 years, with each of the respective GU malignancies demonstrating respective 20-year incidence rates from the time of transplant of less than 4%. Conclusion: This study presents analysis of the Minnesota experience with regard to the incidence of GU malignancy in the immunosuppressed transplant patient. We demonstrate that in this heavily screened and closely followed cohort of renal transplant recipients, genitourinary malignancies occur at a modestly higher incidence rate than the non-transplanted population. Funding: N/A
Table of Contents 197 Podium #144 RISK OF UROLOGIC INJURY AFTER GROUND LEVEL FALL Lauren Folgosa Cooley, MD PhD, Emily Yura, MD, Jason Cohen, MD, Matthias Hofer, MD PhD Northwestern University Presented By: Lauren Folgosa Cooley, MD, PhD
Introduction: Mechanism of injury guides the trauma workup. Ground level falls (GLF) are becoming increasingly common as our population ages, but prior studies have not analyzed associated urologic injuries. Our aim was to determine the incidence of and predictive factors for urologic injury following GLF. Methods: A retrospective cohort study comparing 13,718 adult (18-64 years) and 30,339 geriatric (≥ 65 years) patients for incidence of urologic injury following an involuntary, low-velocity GLF using the National Trauma Data Bank from 2014-2016. Urologic injury was determined by ICD-9-CM or ICD-10-CM codes for associated genitourinary organ. Results: While geriatrics were more likely to experience a GLF (p<0.0001), adults were significantly more likely to sustain a urologic injury following a GLF (3.8% vs. 2.2%, p < 0.0001). Regardless of age, males were more likely to sustain a urologic injury (p<0.0001). Renal injury was most prevalent overall, statistically more common in geriatrics (1.11% vs 0.84%, p < 0.0001), and associated with increased BMI and rib fracture (p=0.006). Following any urologic injury, geriatric patients were more likely admitted to ICU (22.4% vs 11.2%, p < 0.0001), but less likely to undergo operative intervention (2.1% vs 5.1%, p=0.0005). Conclusion: Historically, low-velocity GLF injury does not prompt urologic workup. However, we found a considerable fraction of GLF patients do sustain a urologic injury. Renal injuries were most common and significantly associated with male gender, age ≥ 65 years, rib fracture and increasing BMI, which should serve as clinical cues to trigger urologic workup in future GLF trauma patients. Funding: N/A
Podium #145 PROCEDURES PERFORMED FOR LOWER URINARY TRACT DYSFUNCTION IN PATIENTS PRESENTING FOR RENAL TRANSPLANT EVALUATION Matthew Mazur, M.S., Sarah Perz, MD, Puneet Sindhwani, MD, Arvind Senthikumar, MS University of Toledo College of Medicine and Life Sciences Presented By: Matthew Mazur
Introduction: We aimed to characterize the population of patients who presented to be evaluated for renal transplantation who had problems related to lower urinary tract dysfunction (LUTD) either before or after renal transplant, in order to better standardize urologic referral and optimize graft survival. Methods: 1560 patients were evaluated for renal transplant at our institution between 2001 and 2016. From this group, we included only patients that underwent procedures billed by urologists, related to lower urinary tract function. Results: 32 patients who had transplant as well as urologic procedures underwent a total of 68 non-transplant related urologic procedures (mean = 2.09 procedures per patient). The most common urologic diagnoses indicating procedural workup were urinary retention (24), benign prostatic hyperplasia (20), and recurrent urinary tract infection (20). The most common procedures performed were cystometrogram with or without pressure flow (26), post void residual measurement (19), and cystoscopy (20). Average age of patients who underwent urologic procedures was 58.7 years old, compared to 50.75 for those who did not (p<0.001). Patients with high output renal failure on initial evaluation were more likely to undergo more than one urologic procedure than those with normal or low urine output. Conclusion: We propose that pre-transplant urologic evaluation should be used selectively, when deemed necessary based on symptoms instead of universal screening for LUTD. Additionally, physicians should maintain a high index of suspicion for LUTD in renal patients with high output renal failure and those of older age. Funding: n/a
Table of Contents 198 Podium #146 CONTEMPORARY DIAGNOSTIC EVALUATION OF TRAUMATIC PENILE INJURIES Matthew D. Houlihan, DO1, Mathew Q. Fakhoury, DO1, Florian A. Stroie, DO1, Tobias S. Kohler, MD2, Marc A. Bjurlin, DO3, Courtney M.P. Hollowell, MD1, Samuel Kingsley, MD, PhD4 1Cook County Health, Department of Surgery, Division of Urology, 2Mayo Clinic - Rochester, Department of Surgery, Division of Urology, 3University of North Carolina, Department of Surgery, Division of Urology, 4Advocate Illinois Masonic Hospital, Department of Surgery, Division of Trauma Acute Care Surgery Presented By: Matthew Houlihan, DO
Introduction: The external nature of the male genitalia exposes it to increased risk of traumatic injury. Herein, we sought to evaluate the National Trauma Data Bank (NTDB) to assess the rate of penile injury in order to better understand the evaluation and management of this subset of injured patients. Methods: Traumatic cases from 2011 - 2014 were reviewed utilizing the American College of Surgeons National Trauma Data Bank (ACS-NTDB). Patient demographics, incident variables, associated injuries, hospital course, surgical intervention, rate of catheterization, imaging, and disposition were reviewed using the international Classification for Disease (10th edition) codes for penile injuries. Results: 2,257 cases of penile trauma were identified. 71% of victims were under 35 years of age, with 23% of victims 18 years of age and younger. Traumatic injuries included 52% penetrating (N=1196), 35% blunt (N=796), <1% burn (N=1), and 12% unknown. Of these traumatic penile injuries, 15% (N = 342) underwent urethral catheterization, with 13% (N=300) undergoing cystourethroscopy and 6% (N=148) undergoing retrograde urethrogram (RUG). 92% (N = 1095) of penetrating penile trauma and 95% (N=759) of blunt penile trauma did not undergo retrograde urethrogram. Conclusion: Penile trauma predominantly affects younger men with a sequelae having meaningful an impact on quality of life. The rarity of penile trauma presents clinical challenges and our review demonstrates the breadth of diagnostic evaluation and intervention. To our knowledge, this is largest retrospective review of the evaluation and management of penile trauma in the literature. Funding: N/A
Podium #147 POST-COITAL GROSS HEMATURIA: A UNIQUE PRESENTATION OF A RARE CASE OF BLADDER WALL ATERIO-VENOUS MALFORMATION Brijesh Patel, MD, Ryan Farrell, MD, MPH, Laurence Levine, MD RUMC Presented By: Brijesh Patel, MD
Introduction: Bladder arterio-venous malformations (B-AVMs) are exceedingly rare and typically present with severe, unprovoked gross hematuria (GH). Methods: B-AVM presenting as isolated post-coital GH. Results: 34-year-old male presented with a two-year history of painless, post-coital GH and clot retention necessitating 3 clot evacuations in the operating room at outside- hospital (OSH). GH occurred only after penetrative intercourse, and not masturbation. Random bladder/prostate biopsies from OSH showed chronic inflammation. In-office cystoscopy at our institution noted a raised 2cm lesion on the posterior bladder wall with central ulceration and necrosis but no active bleeding. Urine cytology was negative for high-grade urothelial cells. Urinalysis revealed blood but no evidence of infection. CT scan obtained during an episode of severe GH showed a prominent right superior vesical artery (R-SVA) with a bladder mucosal blush at its insertion (Figure 1A, B). Angiography demonstrated a hypertrophied R-SVA with early filling of venous branches suggestive of B-AVM (Figure 1C). The R-SVA was therefore selectively embolized (Figure 1D). Cystoscopy 2-months later showed resolution of the lesion. No further episodes of post- coital hematuria had occurred at 4-months post-embolization.
Table of Contents 199 Conclusion: B-AVMs are a rare, potentially life-threatening etiology of gross hematuria that require a high index of suspicion for diagnosis. Biopsy/resection should be deferred to avoid severe hemorrhage. Angio-embolization is an effective therapy. Funding: N/A
Podium #148 PROSTAT -"EYE"- TIS: DISSEMINATED PSEUDOMONAS AERUGINOSA INFECTION FROM PROSTATIC ABSCESS PRESENTING WITH VISION LOSS Brett Watson, MD, Sugandh Shetty, MD Beaumont Health, Dept of Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Introduction: Pseudomonas aeruginosa is not a common cause of acute prostatitis, accounting for just 3-7% of all infections. Prostatic abscess due to P. aeruginosa is a rare entity, described only 5 times in the literature. Patients who develop these infections typically are on immunosuppressant medications or have a history of diabetes mellitus. Case: A 69-year-old immunocompetent male presented with right eye pain and acute vision loss. He was found to have endophthalmitis complicated by corneal perforation and extrusion of intraocular contents, ultimately requiring enucleation of the eye. Urinalysis at the time of admission was suggestive of urinary tract infection. Further questioning revealed BPH with chronic urinary retention and a recent history of irritative voiding symptoms. Abdominal CT identified a prostatic abscess, which was drained transrectally. Culture of the prostatic aspirate grew P. aeruginosa, the same organism isolated in blood cultures and from the enucleated eye. Conclusion: We describe an exceedingly rare case of prostatic abscess caused by P. aeruginosa, which spread hematogenously and resulted in severe ophthalmologic infection and eye loss. This case highlights the potential for severe non-urologic sequelae of untreated genitourinary pathology such as BPH with chronic obstruction and prostatitis. Funding: N/A
Table of Contents 200 Podium #149 HUMAN PENILE OSSIFICATION: A RARE CAUSE OF SEXUAL DYSFUNCTION Alex Belshoff, MD, PhD, Alessa Aragao, MD, Petar Bajic, MD, Maria Picken, MD, Christopher Gonzalez, MD Loyola University Medical Center Presented By: Alex Christopher Belshoff, MD
Introduction: Human penile ossification is a rare urologic condition with fewer than 50 reported cases. We describe a unique case of Peyronie's disease associated with extensive corporal ossification that required partial excision and grafting. Methods: A 65-year-old man was referred for Peyronie’s disease with 90-degree dorsal curvature precluding normal sexual function. Examination showed a firm dorsal 2.5 cm by 1.5 cm plaque. Penile ultrasound demonstrated a sheetlike calcification of the dorsal tunica albuginea occupying most of the shaft. He was taken to the operating room for partial excision and grafting. Intraoperatively a large ossified corporal plaque was apparent and carefully excised. A bovine pericardial patch was used for closure of the corporal defect. Additionally, two tunica albuginea plication sutures were placed along the ventral shaft. Curvature was corrected to 10 degrees dorsally. Results: Pathologic examination illustrated lamellar bone surrounded by penile fibrous tissue as shown in the image. Minimal residual curvature was noted at two-month follow- up. He is currently sexually active with his partner and denies pain or residual curvature with intercourse. Conclusion: Penile ossification presents a unique challenge for the reconstructive surgeon. Referral to a reconstructive urologist with experience in the surgical treatment of Peyronie’s disease should be considered to optimize functional outcomes and patient satisfaction. Funding: N/A
Podium #150 A UNIQUE CASE OF METASTATIC UROTHELIAL SIGNET-RING CELL ADENOCARCINOMA OF THE BLADDER IN A PATIENT PREVIOUSLY DIAGNOSED WITH HIGH GRADE PAPILLARY UROTHELIAL CARCINOMA Ethan Vargo, DO1, Marwan Ali, MD1, Joshua Nething, MD2 1Cleveland Clinic Akron General, Akron OH, 2Summa Health System, Akron OH Presented By: Ethan H. Vargo, DO
Introduction: Primary signet ring cell adenocarcinoma of the bladder is a rare and aggressive malignancy. We report on a 56-year-old female nonsmoker who was initially diagnosed with high grade papillary urothelial carcinoma with invasion into lamina propria. Methods: The patient elected for surveillance with cystoscopy every three months and BCG intravesical treatments in accordance with standard SWOG regimen dosing guidelines.
Table of Contents 201 Nearly 2.5 years after initial diagnosis, having completed 6 of 8 scheduled rounds of BCG, a new bladder lesion was discovered near the location of the patient’s original tumor. Results: Biopsy results demonstrated primary signet ring cell adenocarcinoma of the bladder. This lesion stained positive for expression of CK7, focal CD20, and GATA-3 and was confirmed pathologically by staining to be urothelial in origin. Colonoscopy was negative for disease. The patient underwent robotic-assisted laparoscopic pelvic exenteration. Final pathology demonstrated primary urothelial signet ring cell adenocarcinoma with lymphovascular invasion and metastasis to colonic mucosa. Conclusion: To our knowledge, this is the first reported case of signet ring cell adenocarcinoma developing in a patient undergoing cystoscopic surveillance. Even with early and rapid diagnosis and treatment, final pathology was metastatic, further highlighting the aggressive nature of this tumor type. Funding: N/A
Podium #151 A UNIQUE CASE OF ESTROGEN-SECRETING LEYDIG CELL TUMOR John Ogunyeke, BS, Brijesh Patel, MD, Laurence Levine, MD, Christopher Coogan, MD RUMC Presented By: Brijesh Patel, MD
Introduction: Leydig cell tumors (LCTs) are rare neoplasms that account for <5% of all testicular cancers (T-Ca). Although usually asymptomatic, adolescents can present with precocious puberty while adults can present with gynecomastia, sexual dysfunction, and infertility. Methods: We report an atypical case of a benign LCT with azoospermia, hypogonadism and infertility. Results: A 26 year-old male presented with 12 months of unilateral testicular pain and suspected infertility. On exam, his BMI was 53, and his right testicle had a firm, palpable mass. A testicular ultrasound revealed a vascular heterogenous mass suspicious for T- Ca. Tumor markers were normal. A preoperative hormonal panel (table 1) demonstrated endocrine abnormalities, including hypogonadism, hyperprolactinemia, and elevated estrogen levels. Multiple semen analyses demonstrated azoospermia. After right radical- orchiectomy, pathological examination of the mass revealed a benign 3.6 cm LCT (pT1bNx) local to the testis without lympho-vascular invasion and negative surgical margins. A post-operative endocrine panel was consistent with an estrogen-secreting LCT, as estrogen and prolactin levels normalized, although luteinizing-hormone and testosterone levels still remained low. The patient has been lost to follow-up 6 months post-operatively. Conclusion: LCTs are commonly asymptomatic and hormonally inactive but can present with pain and androgen excess. Interestingly, our patient was hypogonadal. His LCT is suspected of secreting estrogen, causing hyperprolactinemia and infertility. Funding: N/a
Table of Contents 202 Podium #152 THE CASE OF THE INCIDENTALLY FOUND DINOSAUR EGG TESTICLES Wesley Baas, MD, Samuel Grampsas, MD Southern Illinois University School of Medicine, Division of Urology Presented By: Wesley Baas, MD
Introduction: The differential diagnosis for a patient with testicular enlargement includes congenital abnormalities, infection, or malignancy. We present a 33 year old male that presented to the hospital with nausea and vomiting, and was incidentally found to have testicles that were 97cc each. Methods: We present a case of a patient with marked testicular enlargement stemming from untreated congenital adrenal hyperplasia. Results: A 33 year old male presented to the hospital with complaints of nausea and vomiting. On physical exam he is found to have markedly enlarged testicles. Scrotal ultrasound revealed heterogeneous appearing testicles that were 97cc in size. Subsequent CT scan showed markedly enlarged adrenal glands, which lead to the diagnosis of 21-hydroxylase deficiency form of congenital adrenal hyperplasia (CAH). Conclusion: There are many etiologies for testicular enlargement which do not all involve malignancy. In this case an adult male was not receiving treatment for CAH which he had been diagnosed with as a child, and subsequently developed massively enlarged testicles. Funding: N/a
Podium #153 NEWLY DIAGNOSED PROSTATE CANCER PRESENTING AS ANTERIOR URETHRAL METASTASIS Yaejee Hong, MD University of Cincinnati Presented By: Yaejee Hong
Introduction: Metastatic lesions in anterior urethra are rare. We present a rare case of prostate cancer presenting as urethral metastases at diagnosis. Methods: Review of the electronic medical record for the selected case was performed. Results: A 77-year old male, with elevated prostatic specific antigen (PSA) of 11 ng/ml and previous negative prostate biopsy, presented with microscopic hematuria, urinary urgency and frequency. Exam revealed a small, anodular prostate. Urine cytology and computed tomography scan of abdomen and pelvis were negative for suspicious lesions. Subsequently, patient underwent cystoscopy and was found to have multiple smooth, nodular urethral lesions (Figure 1), which were biopsied. Final pathology for the urethral
Table of Contents 203 biopsy was prostatic carcinoma involving urothelial tissue. At follow up, metastatic work- up was negative for bone metastasis but there was evidence of pelvic lymphadenopathy. Patient was started on bicalutamide followed by anti-androgen therapy with leuprolide. Final clinical pathologic stage was T4, clinical N1. Conclusion: Anterior urethral metastases from prostate cancer are rare, with only about 11 reported cases so far and with unknown metastatic routes. This is the first report of prostate cancer presenting as non-contiguous anterior urethral metastasis at diagnosis with likely poor prognosis. Further follow-up will be needed to determine the disease progression of this rare presentation. Funding: N/A
Podium #154 A CHYLOUS CONUNDRUM: THE CURIOUS CASE OF CRYPTOGENIC CLOUDY URINE Kristen Meier, MD, Neal Blatt, MD, PhD, Zachary Liss, MD Beaumont Health Presented By: Kristen Marie Meier, MD
Introduction: Chyluria is a rare condition, particularly when not associated with filariasis. It represents lymphourinary reflux by fistulous connections from lymphatic obstruction, most commonly from parasitic disease particularly in tropical regions. Chyluria is sub- divided into parasitic and nonparasitic etiologies. Nonparasitic causes include trauma, neoplasms, diabetes, pernicious anemia, tuberculosis or congenital anomalies. Fistulas can occur at various genitourinary locations but are most commonly seen to the renal fornix. Case: A 13 yo male presented to his pediatrician with three-month history of new-onset painless and intermittent “milky” urine. Initially thought to have significant proteinuria, he was seen by nephrology and underwent a renal biopsy which was normal. Further analysis demonstrated significant lipiduria. MRI was thought initially to be unremarkable. He was then taken to the OR where retrograde pyelogram demonstrated a clear chylous fistula to the left kidney. Persistent post-operative renal colic necessitated temporary ureteral stent placement. While the chyluria has persisted, it has lessened in severity and frequency. He is tentatively scheduled for lymphangiogram with further treatment pending results. Conclusion: We describe a rare and interesting case of a non-parasitic, presumably idiopathic chylous fistula to the kidney in a pediatric patient. While the sight of the fistula is clear, the etiology and ideal treatment are uncertain. Funding: N/A
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Podium #155 THE AIR DOWN THERE: A CASE OF SECONDARY PNEUMOSCROTUM Aravind Viswanathan, MD, Sarah McAchran, MD FACS University of Wisconsin, Madison Presented By: Aravind Viswanathan, MD
Introduction: Pneumoscrotum, or subcutaneous emphysema of the scrotum, is a rare condition that may be either primary, or due to local scrotal pathology, or secondary and due to pathology elsewhere in the body. Methods: We present a case of secondary pneumoscrotum due to traumatic pneumothorax and discusses its clinical course, findings, and treatment. Results: A 59-year-old man was admitted to the emergency department 2 days after a fall with right sided chest pain and scrotal swelling. He was afebrile, hemodynamically stable, and oxygen saturation was 95% on room air. The scrotum was massively enlarged, obscuring the phallus, non-tender, and with non-palpable testes. There was crepitus. Urology was consulted regarding the enlarged scrotum and because of the lack of any prior surgical history or signs of infection, we requested a chest x-ray. This demonstrated right rib fractures with a small right pneumothorax, subcutaneous emphysema and pneumomediastinum. Subsequently a CT scan demonstrated extensive subcutaneous gas along the right chest extending into the abdomen and tracking into the right groin and scrotum. The patient was admitted to the hospital for one week and treatment involved chest tube placement. The pneumoscrotum was resolved by time of discharge. Conclusion: In secondary pneumoscrotum of thoracic origin, air travels along the layers of Scarpa’s and Camper’s fascia and down into Colles’ fascia at the base of the penis and Dartos fascia in the scrotum. Despite its impressive urologic presentation, treatment is focused on the primary etiology, with conservative management of the pneumoscrotum. Funding: N/A
Table of Contents 205 Podium #156 A NOVEL ETIOLOGY OF URGE INCONTINENCE: IMPROPER URINARY DEVICE Madeleine Manka, MD, Brian Linder, MD Mayo Clinic Presented By: Madeleine G. Manka, MD
Introduction: A 22-year-old otherwise healthy female presents with two weeks of dysuria, frequency, and urge incontinence beginning acutely after placement of an intrauterine device (IUD) for contraception. She denies any pelvic cramping or vaginal bleeding. She was treated for a urinary tract infection (UTI) without symptomatic improvement. Upon otherwise normal pelvic exam, IUD strings were not visualized. Therefore, a pelvic ultrasound was obtained demonstrating possible foreign body within the bladder. Methods: Cystoscopy was performed demonstrating the IUD intact with encrustation, free floating without attachment to or disruption of the urothelial lining (Figure 1). The bladder urothelium was diffusely erythematous. Results: Using grasping forceps, the IUD was removed by its strings in its entirety cystoscopically in the office. Conclusion: Multiple cases of intravesical IUDs have been reported in the literature, which have been attributed to device migration over the course of months. These patients present with chronic pain, recurrent UTIs and irritative voiding symptoms. We report acute presentation shortly after IUD placement and the feasibility of minimally invasive removal during office cystoscopy. Funding: N/A
Podium #157 MUCOSAL DYSPLASIA AND METAPLASIA AFTER CHILDHOOD GASTROCYSTOPLASTY Engy Habashy, MD, Abhinav Sidana, MD, Ayman Mahdy, MD, PhD University of Cincinnati Medical Center, Cincinnati, OH Presented By: Engy Habashy, MD
Introduction: Patients with augmented bladders using bowel segments for congenital bladder anomalies are at an increased risk for development of bladder cancer compared to the general population. Gastric augments have been implicated in as high as 14-15- fold risk increase. We describe a case of an incidental diagnosis of a bladder mass on a renal transplant pre-operative work-up. Case: 30-year-old male with history of end stage renal disease secondary to congenital posterior urethral valves status post remote gastrocystoplasty, appendiceal Mitrofanoff, and a failed renal transplant. He presented to our institution for a pre-transplant evaluation. Cystoscopy revealed large erythematous posterior wall mass. Biopsy of the mass revealed low grade dysplasia and intestinal mucosa metaplasia. Cross sectional imaging revealed irregular bladder wall thickening up to two centimeters and a mildly enlarged external iliac lymph node. Patient currently scheduled to undergo radical cystectomy with pelvic lymph node dissection.
Table of Contents 206 Conclusion: History of congenital neurogenic bladder, chronic inflammation, immunosuppression, and gastrointestinal bladder augmentation are independent risk factors for development of bladder cancer. High index of suspicion must be maintained when caring for patients with such risk factors. Funding: N/A
Podium #158 PRIMARY MESENCHYMAL NEOPLASM OF THE URETER CAUSING OBSTRUCTIVE HYDRONEPHROSIS IN A YOUNG MALE: A RARE PRESENTATION Rajiv Karani, BS, Yaejee Hong, MD, Abhinav Sidana, MD University of Cincinnati Presented By: Rajiv Karani
Introduction: Mesenchymal neoplasms arising in the ureter are uncommon. Typically, malignant ureteral tumors, mostly commonly urothelial carcinomas, occur in older adults. We present a rare care of primary mesenchymal neoplasm of the ureter in a young male. Methods: Retrospective chart review was performed. Results: A previously healthy 22-year-old male presented with left flank pain. Computed tomography (CT) with intravenous contrast showed an ill-defined hyperdensity in the left mid-ureter associated with hydronephrosis. Subsequently, patient underwent diagnostic cystourethroscopy and left ureteroscopy, which demonstrated a polyp-like mass occupying the entire lumen in the left mid-ureter (Figure 1). This entire mass was resected using the holmium laser in a piecemeal fashion. Postoperatively, patient recovered well. Final pathologic diagnosis was “unusual low-grade mesenchymal neoplasm undermining urothelium.” Interval CT obtained at 5-month follow-up re- demonstrated soft tissue lesion in the left mid-ureter, raising concern for persisting lesion. This patient will be closely followed with repeat left ureteroscopy followed by complete segmental excision of the affected ureter and ureteroureterostomy. Conclusion: Mesenchymal neoplasms of the ureter are rare. Prognosis of low-grade mesenchymal neoplasm in the ureter is not known. This case report outlines possible clinical presentation and features of mesenchymal neoplasm in the ureter and adds to the literature on such a rare entity. Funding: N/A
Table of Contents 207 Podium #159 INCREASED URINARY VEGF-D LEVELS ARE ASSOCIATED WITH RESPONSE TO COMBINED INTRAVESICAL BCG AND ORAL SUNITINIB REGIMEN FOR TREATMENT OF HIGH-RISK NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC) Colton H. Walker, MD1, Christopher M. Russell, MD1, Amir H. Lebastchi, MD2, Stephanie Daignault-Newton, MS1, Monica Liebert, PhD1, Khaled S. Hafez, MD1, Maha H. Hussain, MD3, Jeffrey S. Montgomery, MD1, David C. Miller, MD1, Brent K. Hollenbeck, MD1, Alon Z. Weizer, MD1, Samuel D. Kaffenberger, MD1 1Department of Urology, University of Michigan, 2Urologic Oncology Branch, National Cancer Institute, 3Robert H. Lurie Comprehensive Cancer Center, Northwestern University Presented By: Colton Harrison Walker, MD
Introduction: We conducted a phase II trial to evaluate combination therapy with Bacillus Calmette-Guerin (BCG) and Sunitinib for the prevention of recurrence and progression of high-risk NMIBC. We hypothesized that this regimen could increase the initial complete response (CR) to therapy via synergistic inhibition of the vascular endothelial growth factor (VEGF) pathway. We measured urine biomarker levels throughout treatment to identify trends that predict and/or explain response to therapy. Methods: Patients with high-grade clinical ≤T1N0M0 NMIBC who had not received BCG within 12 months of diagnosis were deemed eligible. Patients received a 6-week induction course of BCG followed by 28 days of Sunitinib. Urine samples were collected before and after both BCG and Sunitinib. Urine biomarker levels were measured using a multiplexed bead assay for VEGF-A, -C, and -D. Assays were performed in duplicate using a manufacturer-supplied 8-point standard curve along with a low- and high-quality control sample. Results: 36 patients met inclusion criteria, and 26/36 patients (72%, 95% CI[55,86]) exhibited 3-month CR. Responders exhibited higher VEGF-A levels after Sunitinib, but this effect was not statistically significant (p=0.85). VEGF-C levels exhibited high variability and were therefore unable to be analyzed. Responders exhibited lower VEGF- D levels until after Sunitinib at which point they developed a higher mean level and a greater change from study entry than non-responders. These changes were statistically significant (p=0.04). Conclusion: The increase in VEGF-D levels in responders supports the theory that VEGF plays an important role in the pathogenesis of NMIBC and thus warrants further investigation. Funding: Funded by Pfizer and supported by Grant Number P30DK020572 (MDRC) from the National Institute of Diabetes and Digestive and Kidney Diseases.
Podium #160 INTRAVESICAL HISTONE DEACETYLASE INHIBITORS IN COMBINATION WITH PROGRAM CELL DEATH 1 BLOCKADE INDUCES BLADDER TUMOR REGRESSION Spencer Hart, MD1, Brianna Burke2, Luordes Plaza-Rojas2, Gopal Gupta, MD1, Jose Guevara-Patino, MD, PHD2 1Loyola University Medical Center, 2Loyola University at Chicago Presented By: Spencer Hart, MD
Introduction: Bladder cancer is an immunologically active tumor capable of evading the host immune response. We hypothesize that deregulation of tumor gene expression may improve visibility of bladder cancer cells to the immune system and enhance anti-tumor response. In this study we explored the use of localized histone deacetylase inhibitors and systemic anti-PD-1 to induce tumor regression. Methods: Human and mouse bladder cancer cell lines were subjected to HDAC inhibition. Markers of genomic stress were assessed. An in vivo murine model was utilized to demonstrate anti-tumor activity of intravesical HDAC inhibitors in combination with systemic PD-1. Secondary tumor challenge was performed in previously treated mice to assess for long term tumor immunity. Results: In vitro exposure of human and mouse bladder cancer cell lines to non- cytotoxic doses of HDAC inhibitors results in development of cell stress response. In
Table of Contents 208 vivo, the combination of local HDAC inhibitor and systemic PD-1 blockade resulted in tumor regression and curative responses superior to monotherapies. This effect was durable and protective against a second tumor challenge. Post-treatment histopathologic analysis revealed maintenance of bladder integrity. Conclusion: In a preclinical model, the combination of intravesical HDAC inhibition and systemic adjuvant immunotherapy appears to be safe and effective in the treatment of bladder cancer. Funding: Unrestricted Gift from Volo Family Foundation
Podium #161 METASTASECTOMY FOR BLADDER CANCER: USE AND SURVIVAL OUTCOMES IN A NATIONAL COHORT Adam Weiner, MD, Minh Pham, MD, Dylan Isaacson, MD, MPH, Gregory Auffenberg, MD, MS Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL Presented By: Adam Benjamin Weiner, MD
Introduction: The role of metastasectomy for bladder cancer has been evaluated in small series with mixed conclusions. To better understand contemporary practice patterns and survival benefits, we evaluated metastasectomy utilization and outcomes in a national cohort. Methods: Within the National Cancer Data Base (2004-2015), we identified 12,087 patients diagnosed with de novo metastatic bladder cancer. We defined metastasectomy as part of the first course treatment with surgical excision of distant lymph nodes or distant sites. Cox multivariable regression evaluated the relationship between metastasectomy and overall survival amongst all patients and various sub-cohorts. Results: Metastasectomy was received by 7.1% of patients, 4.6% in 2004 and 7.0% in 2015. Median follow-up for survivors was 31 months. On multivariable analysis, metastasectomy was not associated with improved survival for the entire cohort (6.6 vs 5.5 months; HR 0.95, 95% CI 0.88-1.03, p=0.199; Table). In sub-cohort analyses, only patients with brain or lung metastases experienced improved survival following metastasectomy (HR 0.25, 95% CI 0.12-0.53, p<0.001 and HR 0.80, 95% CI 0.65-0.99, p=0.042, respectively). Conclusion: Metastasectomy for bladder cancer is uncommon and its use was not associated with improved survival, except in patients with brain or lung metastases. Metastasectomy, thus, may benefit certain sub-populations, but its widespread use is not warranted. Funding: n/a
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Podium #162 IMPACT OF PRIOR ABDOMINOPELVIC RADIATION ON PATIENTS UNDERGOING CYSTECTOMY WITH URINARY DIVERSION Joshua Aizen, MD1, Brittany Adamic, MD1, Craig Labbate, MD1, Ciro Andolfi, MD1, Ryan Werntz, MD1, Norm Smith, MD2, Gary Steinberg, MD1, Joel Wackerbarth, MD1, John Richgels, MD1 1University of Chicago, 2NorthShore University HealthSystem Presented By: Joel J. Wackerbarth, MD
Introduction: Cystectomy following radiation therapy (RT) is performed for many benign and malignant indications. Recognizing the added surgical complexity when operating in a radiated pelvis, we aimed to characterize surgical outcomes in patients undergoing cystectomy after prior abdominopelvic RT. Methods: We retrospectively reviewed records of patients who underwent cystectomy for any reason at our institution in 2013-2017. Patients who had previously been treated with abdominopelvic RT were identified. Operative outcomes, pathologic characteristics, and perioperative morbidity and mortality were compared between groups. Results: Of 464 patients who underwent simple or radical cystectomy, 72 (15.5%) had received previous abdominopelvic RT. Irradiated patients were older and more likely to have had prior radical prostatectomy (21% v 4%, p<0.01) and prior chemotherapy for non-urologic malignancies (16% v 0.7%, p<0.01). Patients with prior RT more often had benign final pathology (23% v 9.3%, p<0.01) and were less likely to have variant histology (19.4% v 38%, p<0.01). Notable variables that did not differ between groups included operative time, estimated blood loss, length of stay, and immediate and long- term complications, including need for reoperation, fistulae, bowel injury, and ureteral stricture. Recurrence-free survival (RFS) and overall survival (OS) were similar between groups (p=0.52 and p=0.40, respectively). Conclusion: Patients undergoing cystectomy following abdominopelvic RT had no differences in perioperative morbidity, RFS, or OS. Although cystectomy in this population is often more challenging, in the hands of an experienced surgeon prior RT should not be considered a deterrent to proceeding with cystectomy. Funding: N/A
Table of Contents 210 Podium #163 SINGLE DOSE INTRAOPERATIVE ANTIBIOTIC PROPHYLAXIS DOES NOT AFFECT INFECTIOUS OUTCOMES AFTER RADICAL CYSTECTOMY Craig Labbate, MD, John Richgels, MD, Ryan Werntz, MD, Gary Steinberg, MD, Sarah Faris, MD University of Chicago Medicine Presented By: Craig Labbate, MD
Introduction: Current best practice statements state that urologic surgery involving bowel should receive <= 24 hours of antibiotic prophylaxis. In January 2018, our center instituted a single intraoperative dose order-set for antibiotic prophylaxis during cystectomy with ileal conduit. We aimed to determine whether restricted duration affected perioperative outcomes. Materials/Methods – We performed a retrospective cohort analysis of patients undergoing radical cystectomy with ileal conduit diversion between 1/1/2016 and 9/30/2018. Patients were considered compliant with intraoperative dosing if there were no repeat antibiotic dosing within 24 hours after exiting the operating room. Results: Two hundred thirty-three patients underwent cystectomy with ileal conduit within the study period, of which 68 occurred after the introduction of the order-set. Adherence to the order-set was 54%. In total, 37 patients received only intraoperative antibiotics. Age, BMI, presence of diabetes, and smokers were not statistically different between cohorts. Use of antibiotics within the surgical admission was decreased in the single-dose group (24.3% v. 43.4%, p=0.03). In the single-dose cohort, there were 9 (24.3%) UTIs and 12 (32%) readmissions within 90 days compared to 37 (18.95%) UTIs 60 (30.6%) readmissions in the 24-hour antibiotic group (P=0.45 and P=0.826 respectively). Conclusion: In a single high-volume institution, restriction of perioperative antibiotic prophylaxis to intraoperative dosing did not lead to increased rates of documented urinary tract infection or readmission within 90 days. Extended antibiotic prophylaxis after wound closure may be unnecessary and lead to overuse of antibiotics. Funding: N/A
Podium #164 ANTIBIOTIC EXPOSURE PRIOR TO RADICAL CYSTECTOMY INCREASES RISK OF POSTOPERATIVE INFECTION Craig Labbate, MD1, John Richgels, MD1, Kristine Kuchta, MD2, Ryan Werntz, MD1, Norm Smith, MD2 1University of Chicago Medicine, 2Northshore University HealthSystem Presented By: Craig Labbate, MD
Introduction: In the evaluation of bladder cancer, patients may be exposed to unnecessary oral prophylactic antibiotics. Using a national sample, we aimed to determine exposure rates to outpatient antibiotics prior to radical cystectomy and their correlation with post-operative infections. Methods: We performed a retrospective cohort analysis of the SEER-Medicare database between 2008 and 2014 of patients who underwent radical cystectomy for bladder cancer with prescription claims information. Preoperative antibiotic prescriptions, infectious claims, readmissions, and deaths were tabulated within 30 days of operation. Results: Within the cohort (n=2248) 1149 (51.1%) patients were prescribed outpatient antibiotics before cystectomy. 545 (31.9%) of the prescriptions were for a fluoroquinolone. 487 (42.4%) patients received an oral antibiotic bowel prep. Only 193 (16.3%) patients were diagnosed with a preoperative infection. Those who received antibiotics before RC were more likely to be diagnosed postoperatively with any infection (56% vs 51% p<0.01), pneumonia (13% vs 9%, p<0.01), or UTI (36% vs 31% p<0.01) postoperatively. There was no difference in Clostridium difficileinfection or sepsis rates. Multivariate logistic regression controlling for other identified risk factors, including preoperative infection and comorbidity index confirmed that receiving a preoperative outpatient antibiotic is in an independent risk factor for postoperative infection (HR 1.19, p = 0.05) and readmission (HR 1.24, p=0.03).
Table of Contents 211 Conclusion: Antibiotic exposure prior to radical cystectomy is associated with increased risk of postoperative infection and readmission within 30 days. Judicious antibiotic use in the evaluation of bladder cancer should be considered to decrease morbidity associated with RC. Funding: N/A
Podium #165 LONG-TERM OUTCOMES AND SURVIVAL OF PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER AFTER RADICAL CYSTECTOMY AS COMPARED TO BLADDER-SPARING TRI-MODALITY THERAPY Logan Galansky, BA, Brittany Adamic, MD, Craig Labbate, MD, Joshua Aizen, MD, Ryan Werntz, MD, Gary Steinberg, MD University of Chicago Presented By: Logan Galansky
Introduction: Radical cystectomy (RC) with neoadjuvant chemotherapy is the standard of care for muscle-invasive bladder cancer (MIBC). However, some physicians may opt to treat appropriately selected patients with bladder-sparing tri-modality therapy (TMT), citing equivalent outcomes. This study aims to determine overall survival (OS) and relapse-free survival (RFS) in TMT eligible patients who undergo RC. Methods: We retrospectively reviewed patients who underwent RC at our institution from 2007-2017. Patients who were cT2-T4a with N0M0 disease, no hydronephrosis, and maximum TURBT were identified. OS and RFS were compared with a historic cohort of bladder salvage patients. Results: Of 139 RC patients, 20 patients (14.6%) had a recurrence and 29 (20.8%) were deceased with a median follow up of 32.1 months. When compared to the 366 historic TMT patients, RC patients had an OS advantage of 63% vs 53% at 5 years. Not surprisingly, lower T stage and no residual tumor at cystectomy were associated with improved OS (p=0.001) and RFS (p=0.001). Conclusion: Although TMT is an acceptable treatment option for individuals unable to undergo surgery, RC remains the standard of care with improved OS in these select patients. Therefore, in patients who are good surgical candidates, radical cystectomy should continue to be the treatment of choice. Funding: N/A
Table of Contents 212 Podium #166 PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION FOLLOWING RADICAL CYSTECTOMY: AN INSTITUTIONAL REVIEW. Maximilian Staebler, BSe1, Beija Villalpando, BS1, Robert Tarrell2, Matthew Tollefson, MD3 1Mayo Clinic Alix School of Medicine, Rochester, MN, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 3Department of Urology, Mayo Clinic, Rochester, MN Presented By: Maximilian Helmut Staebler, BSe
Introduction: This study explores the incidence and risk factors for Clostridium difficile infection (CDI) following radical cystectomy (RC). Methods: Our institutional registry yielded 2548 patients that underwent RC from 1995 to 2018. Forty-two patients (1.65%) developed C. difficile infection (CDI) noted as a positive test or reported through clinical follow-up. The medical record was examined to identify surgical procedures, patient characteristics, and use of perioperative antibiotics, antacids and bowel-preparations. Results: Thirty-four patients (eight lost to follow-up) were propensity-matched according to age, gender, surgical approach, tumor stage, and year of operation. Of this cohort, 47.1% developed CDI during their hospitalization, whereas 52.9% were diagnosed after discharge. Of the 52.9% diagnosed after discharge, 50% were diagnosed within one week. The average time from surgery to diagnosis was 19.7 days. Ninety-one percent of patients (66.7% in the matched group) had a history of tobacco use, 67.6% (52.9%) had a history of abdominal or pelvic surgery and 47.1% (41.2%) reported alcohol use. Perioperative antibiotic usage was documented in 82.4% (79.4%), antacid use in 47.1% (47.1%) and mechanical or antibiotic bowel prep in 64.7% (61.8%) of patients. Chi- squared analysis showed a significant difference only in-patient smoking history (p=0.0136). Conclusion: We found that CDI rate following cystectomy is low. Post-op CDI diagnosis is common after discharge, highlighting the importance of post-discharge follow-up. Our data support a previously documented association between tobacco-use and CDI, highlighting another dimension by which tobacco may contribute to post-operative complications. Funding: NA
Podium #167 IMPLICATIONS OF ALVIMOPAN USAGE ON RADICAL CYSTECTOMY PATIENTS: RETROSPECTIVE COHORT STUDY Peter Hanna, Research fellow, Arveen Kalapara, Research fellow, Subodh Regmi, Clinical fellow, Srajana Kalyana, Researcher, Joseph Zabell, Assistant Professor, Badrinath Konety, Professor, Darrel Randle, Assistant Professor, Joyce Wahr, Professor, Christopher Weight, Assistant Professor University of Minnesota Presented By: Peter Tawfik Hanna, Master degree
Introduction: Radical cystectomy for muscle invasive bladder cancer remains the gold standard treatment. However, it is frequently associated with delayed gastrointestinal recovery and longer hospital lengths of stay (LOS). Methods: 298 patients underwent radical cystectomy and urinary diversion (2010 through 2018). Introduction of Alvimopan to our enhanced recovery after surgery (ERAS) protocol was retrospectively evaluated. Effect of Alvimopan to time to return of bowel movements, tolerance to regular diet and decrease LOS is evaluated. Outcomes are summarized as mean (standard deviation or 95% CI) with stepwise linear regression analysis. Results: The mean age of patients is 67.56 years (SD=10.8) (79.1 % male and 20.1 % female). 147 patients (49.3 %) went through standard regimen and 151 patients (50.7 %) underwent ERAS protocol. 49 patients (16.4 %) received Alvimopan (group A) while 249 (83.6 %) didn’t (group B). The mean LOS for group A was 8.2 days (95% CI 7.0-9.4) while group B was 10.1 days (95% CI 9.4-10.8). The time to return of bowel movements
Table of Contents 213 was mean 4.24 (95 % CI 3.83-4.63) for group A vs 4.93 (95 % CI 4.67-5.18) for group B. Regarding tolerance to regular diet, the mean of group A was 5.69 (95 % CI 4.87-6.50) while it was 6.75 (95 % CI 6.21-7.29) for group B. Multiple linear regression analysis estimated that the use of Alvimopan was associated with a decreased LOS by 1.75 days (P= 0.039). Conclusion: Addition of Alvimopan for patients post radical cystectomy is useful in accelerating gastrointestinal recovery and decreasing LOS. Funding: N/A
Podium #168 TRENDS IN UTILIZATION OF ROBOTIC AND OPEN APPROACH TO RADICAL CYSTECTOMY: A POPULATION-BASED STUDY, 2002-2014. Natasza Posielski, MD, Brady Miller, MD, E. Jason Abel, MD, Tudor Borza, MD, Glenn Allen, MD, Jessica Schumacher, David Jarrard, MD, Tracy Downs, MD, Kyle Richards, MD University of Wisconsin Presented By: Natasza Posielski, MD
Introduction: Utilization of robotic cystectomy is increasing despite lack of evidence showing superior survival or morbidity. Our aim was to describe factors associated with robotic utilization for radical cystectomy and compare outcomes with an open approach. Methods: Patients who received radical cystectomy for bladder carcinoma were identified using Surveillance, Epidemiology, and End Results Medicare data. Factors associated with surgical approach were evaluated with multivariable logistic regression. Perioperative and survival outcomes were compared using propensity score models. Results: Cystectomies performed robotically rose from <1% in 2008 to 29.7% in 2014. Female gender, married status, and non-urban residence were associated with lower likelihood of robotic cystectomy (HR=0.78, p=0.04; HR=0.70, p=0.01; HR=0.63, <0.01). Higher pathological tumor stages were associated with lower rates of robotic cystectomy with HR 0.81, p=0.04 for T2 and HR=0.71, p<0.01 for ≥T3 disease. Neoadjuvant chemotherapy was associated with higher rates of robotic surgery (HR 1.35, p<0.01). Thirty-day readmission was similar between robotic and open surgery (29.9 vs 30.1%, p=0.93.) Length of stay was shorter for patients treated robotically 7 (IQR 6-10) vs 8 days (IQR 6-12), p<0.01. No significant differences were found in incidence of pulmonary embolus, myocardial infarction, cerebrovascular events or major complications. No differences were identified in five-year disease specific survival (HR 1.29, 95% CI 0.97- 1.70, p=0.08) or overall survival (HR 1.15, 95% CI 0.95-1.39, p=0.14). Conclusion: Non-clinical factors impacted probability of undergoing robotic cystectomy. Higher pathological stage was associated with lower rates of robotic approach. Peri- operative morbidity, readmission rates and survival were comparable to open cystectomy. Funding: N/a
Podium #169 BUSINESS AND PRACTICE READINESS IN EARLY CAREER UROLOGISTS—AN UNMET NEED Larissa Bresler, MD, DABMA1, Michelle Semins, MD2, Humphrey Atiemo, MD3, Audrey Rhee, MD4, Richard Memo, MD5 1Loyola University Medical Center, 2University of Pittsburg, 3Henry Ford Hospital, 4Cleveland Clinic, 5North East Ohio Urology Associates Presented By: Larissa Bresler, MD, DABMA
Introduction: Business education in residency defined as contract negotiation, investing, financial planning and information on practice types is currently lacking (1,2,3). It is unclear if early career urologists possess the business literacy needed to begin a practice. This study aimed to understand their perceived business knowledge base and readiness for practice, awareness of existing resources, and which vehicles of education are most preferred.
Table of Contents 214 Methods: A 12 question AUA survey was administered to all urology residents, fellows and recent graduates to assess the self-reported business preparedness for practice after residency and preferred educational format. Questions were administered regarding financial planning, familiarity of business models, ancillary income opportunities, coding and billing, contract negotiation, assessing financial net-worth, handling of management changes; awareness/utilization of AUA resources. Data were stratified by training year and practice type. AUA census results were also analyzed. Results: 230 responses received - 89 (38.7%) from practicing urologists, 141 (61.3%) from residents. (88.3%) were not comfortable with planning the business side of their practice and not aware of the AUA resources (71%) on the subject; few utilized the AUA resources for business development (16%). 8% of were extremely comfortable with contract negotiation, 70% were not comfortable with assessing their own financial value; >50% were interested in podcast, websites and Power Point; <50% were interested in ACGME education. Conclusion: This study demonstrates an unmet need for business education and resources amongst early career urologists. The development of an accessible curriculum and resources may play a vital role in the prevention of burnout (4). Funding: n/a
Podium #170 COST SAVINGS ANALYSIS OF INPATIENT ADVANCED PRACTICE PROVIDER Mitchell Ng, BS1, Michael Wang, BS1, Laura Bukavina, MD MPH2, Amr Mahran, MD MS2, Kirtishri Mishra, MD2, Michael Callegari, MD MBA2, Christina Buzzy, PhD3, Lee Ponsky, MD2,3 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Presented By: Michael Joseph Jefferson Callegari, BS, MBA
Introduction: Aim of our study was to evaluate direct cost savings of inpatient advanced practice provider by focusing on direct cost, length of stay, readmission rate and discharge planning. Methods: Data from a tertiary care referral center was collected between 2015Q1 to 2018Q2. Seven quarters prior to inpatient APP (2015Q1-2016Q3) were compared to 7 subsequent quarters after initiation of inpatient NP program (2016Q4-2018Q2). A total of 1190 major urological cases were performed during this time (178 cystectomies, 663 nephrectomies, 349 prostatectomies). Factors directly influenced by inpatient APP such as length of stay (LOS), discharge before 11am and total direct cost were analyzed. Results: Inclusion of APP as part of a health care delivery team showed an overall decreased LOS (p=0.042), with an increase in the number of discharges before 11 am (p < 0.001) (Table). While there was overall no significant change in the direct cost (p=0.89) combined for all three groups, total direct cost in the cystectomy group was significantly lower (p =0.048) (Figure). In additional, the median LOS for prostatectomy decreased significantly (p=0.015). Conclusion: Inclusion of advanced practice provider within inpatient setting has shown to consistently improve length of stay, and direct cost. Funding: N/A
Table of Contents 215 Podium #171 PAIN MANAGEMENT IN OUTPATIENT UROLOGIC PROCEDURES – A PROSPECTIVE RANDOMIZED TRIAL OF OXYCODONE VERSUS KETOROLAC Kirtishri Mishra, MD, Melody Chen, MD, Laura Bukavina, MD, Amr Mahran, MD, Jonathan Kiechle, MD, Michael Wang, BS, Christina Buzzy, PhD, Christopher Gonzalez, MD, Lee Ponsky, MD University Hospitals/Case Western Reserve University Presented By: Kirtishri Mishra, MD
Introduction: We evaluated whether ketorolac is equally as effective at pain control as oxycodone after routine outpatient urologic procedures. Secondarily, we evaluated whether patients disposed the leftover medications appropriately. We hypothesize that toradol is non-inferior to oxycodone, and that majority of patients do not dispose of their medications appropriately. Methods: Patients undergoing routine outpatient urologic procedures with a GFR >40 ml/min/1.73 m2, were randomized into the oxycodone (5mg tablet, 1-2 tablets every 4 hours for 5 days) or the ketorolac (10mg tablet, 1 tablet every 6 hours for to 5 days) arm. Patient demographics, Charlson Comorbidity score, operative procedure details, and complications were recorded. A phone survey was conducted one week after surgery to determine level of pain control. Results: A total of ninety-one patients were recruited. Table 1 shows the basic demographics. The oxycodone group used significantly more pills compared to ketorolac (7.4 vs 3.1; p = 0.005). In addition, the oxycodone group was significantly more likely to dispose their pills inappropriately. There was no difference in pain levels. Conclusion: Toradol is a non-inferior alternative to oxycodone for outpatient urologic procedures in properly selected patients. Only 9% of patients disposed of their medications appropriately. Patient and physician education is necessary to curtail the indiscriminate prescription, use, and disposal of opioids. Funding: NA
Table of Contents 216 Podium #172 GENITOURINARY FOREIGN BODY: NATIONWIDE INCIDENCE, TREATMENTS, AND ECONOMIC BURDEN Marc Nelson, MD, Elizabeth Koehne, MD, Ryan Dornbier, MD, David Perlman, Emanuel Eguia, MD, Patrick Sweigert, MD, Marshall Baker, MD, Gopal Gupta, MD, Kristin Baldea, MD, Ahmer Farooq, DO Loyola University Medical Center Presented By: Elizabeth Leone Koehne, MD
Introduction: Genitourinary (GU) foreign bodies have previously only been reported in single-center case reports or series. A population study was performed to characterize the incidence, treatments, and economic burden of the GU foreign body. Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample for years 2012-2014 and the Florida State Emergency Department Database and State Inpatient Database for years 2009-2015 were utilized. Patients were identified as having a diagnosis of GU foreign body by ICD-9 codes. Patients in Florida were tracked longitudinally to characterize recurrent visits. Results: Between 2012 and 2014, 1125 patients were admitted to United States hospitals with a primary diagnosis of genitourinary foreign body. Patients were mostly male (83.6%) and white (68.4%). Nearly 60% had a mental health disease diagnosis, and 11% had a substance abuse diagnosis. Procedures performed included removal of foreign body without incision (45.3%), cystoscopy (36.4%), cystotomy (16.4%), and transurethral clearance from bladder (16.0%). Mean cost per admission was $6835. Thirteen percent of admitted patients were discharged to court or law enforcement. Conclusion: This is the first population-level study characterizing genitourinary foreign bodies. Men with mental health disorders are at highest risk for the disorder, and a significant proportion of patients require surgical intervention for removal. Funding: N/A
Table of Contents 217 Podium #173 EVOLUTION OF BPH HEALTHCARE COSTS: 2004-2013 Grace Wegrzyn1, Petar Bajic1, Marc Nelson1, Ryan Dornbier1, Joseph Mahon1, Lydia Feinstein2, Julia Ward2, Chyng-Wen Fwu2, Ziya Kirkali3, Tamara Bavendam3, Brian Matlaga4, Charles Welliver4, Ahmer Farooq1, Kevin McVary1 1Loyola University Medical Center, Center for Male Health, Maywood, IL, 2Social and Scientific Systems, Silver Spring, MD, 3National Institutes of Health, Bethesda, MD, 4Johns Hopkins University, Baltimore, MD Presented By: Gracelen Helene Wegrzyn, BS
Introduction: Evolving BPH management has changed the distribution of healthcare spending. We characterized BPH-related Medicare and private insurance expenditures stratified by care-delivery location over a ten-year period. Methods: As part of the Urologic Diseases in America (UDA) project, two insurance claims databases were analyzed: CMS 5% Sample (Medicare beneficiaries age ≥65) and Optum© Clinformatics® Data Mart (CDM, privately insured adults age 40-64). BPH- related expenditures from 2004-2013 were stratified by three care-delivery locations: inpatient, hospital-based outpatient (HBO) and physician-office based outpatient (POBO). Results: Over ten years, inpatient BPH care accounted for a decreasing percentage of total dollars spent by Medicare (30% to 15%) and private insurance (37% to 15%). Relative outpatient costs rose, especially for private insurance (61% to 83%). Per-BPH- patient-per-year costs for HBO care rose and exceeded POBO costs from 2007 onward for private insurance, and from 2010 onward for Medicare (Figure). Conclusion: The distribution of healthcare expenditures for BPH management shifted across practice settings from 2004-2013, with increasing outpatient costs relative to inpatient costs. HBO expenses exceeded POBO and inpatient expenses for both Medicare and private insurance. This may be a result of the increased use of ambulatory surgical procedures for BPH. In-office minimally invasive surgical therapies will likely lead to higher POBO costs in the future. Funding: The Urological Diseases in America project was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through a contract to Social Scientific Systems (HHSN276201500204U). Dr. Julia Ward and Dr. Lydia Feinstein are employed by Social Scientific Systems, and Dr. Brian Matlaga has a subcontract with the company.
Table of Contents 218 Podium #174 NATIONAL TRENDS IN USE OF TELEHEALTH BY UROLOGISTS FOR MEDICARE BENEFICIARIES, 2009-2015. Juan Andino, MD,MBA1, Parth Modi, MD,MS1, Andrew Ryan, PhD,MA2, Brent Hollenbeck, MD1, Chad Ellimoottil, MD, MS1 1University of Michigan, Department of Urology, 2University of Michigan, School of Public Health Presented By: Juan Jose Andino, MD, MBA
Introduction: Health policymakers, administrators, clinicians, and patients are showing increasing interest in telehealth. The objective of this study was to understand national telehealth utilization by urologists. Methods: Using a national sample of fee-for-service Medicare claims, we identified evaluation and management (E&M) visits performed from 2009 through 2015 and the specialty of the clinician involved. We identified billable telehealth visits using current procedural terminology codes and modifiers. Finally, we calculated the overall proportion of E&M visits that utilized telehealth and the number of urologists using telehealth compared to other surgical subspecialists. Results: We identified 629,813,183 total evaluation and management visits performed by 1,217,170 clinicians from 2009 through 2015. Of these visits, 177,958 (28 per 100,000) were telehealth visits. Over the study period, there were few urologic telehealth visits ranging from 0.05 to 4.4 telehealth visits per 100,000 E&M visits per year. There were fewer urologic telehealth visits than medical and most other surgical telehealth visits (Figure 1). The proportion of urologists that performed at least one telehealth visit was 1.2 per 1,000 urologists. Conclusion: Telehealth use was exceedingly low in urology, but comparable to other surgical subspecialties. Future research should focus on ways to improve the utilization of telehealth for Medicare beneficiaries by urologists. Funding: n/a
Table of Contents 219 Podium #175 EVALUATING NATIONAL CARE PATTERNS FOR WOMEN WITH OVERACTIVE BLADDER: IDENTIFYING AREAS FOR IMPROVEMENT Brian Linder, MD, MS, John Gebhart, MD, MS, Daniel Elliott, MD, Holly Van Houten, BA, Lindsey Sangaralingham, MPH, Elizabeth Habermann, PhD Mayo Clinic Presented By: Brian J. Linder, MD, MS Introduction: To evaluate national patterns of care for women with overactive bladder (OAB) and identify potential areas for improvement. Methods: We performed an analysis using the OptumLabs® Data Warehouse, which contains de-identified administrative claims data from a large national U.S. health insurance plan. The study included women, over 18, with a new OAB diagnosis from 1/1/2007 to 6/30/17. We excluded those with an underlying neurologic etiology, interstitial cystitis/painful bladder syndrome, were pregnant, or did not have continuous enrollment for 12 months before and after OAB diagnosis. Trends in OAB management were assessed via Cochran-Armitage test. Time-to-discontinuation among medications was compared using t-test. Results: Of 1.4 million women in the database during the study timeframe, 60246 (4%) were included in the study. Median age was 61 years (IQR 50,73), and median follow-up was 2.6 years (IQR 1.6,4.2). Overall, 37% were treated with anticholinergics, 5% beta-3 agonists, 7% topical estrogen, 2% pelvic floor physical therapy, 26% saw a specialist, and 2% underwent third-line therapy. The median time to discontinuation was longer for beta-3 agonists versus anticholinergics (median 4.1 months [IQR 1,15] vs 3.6 months [IQR 1,10]; p <0.0001). Use of third-line therapies significantly increased over the study timeframe, from 1.1% to 2.2% (p<0.0001). Conclusion: Discontinuation rates of medications for OAB are high and a minority of patients was referred for specialty evaluation. While third-line therapy use is increasing, it is used in a small proportion of women with OAB. Given these patterns, there may be underutilization of specialist referral and other OAB therapies. Funding: N/A
Podium #176 THE UROLOGY WORKFORCE SHORTAGE IN RURAL AMERICA: CHARACTERISTICS AND OPPORTUNITIES Daniel Sadowski, Raymond Fang, Amanda North, Christopher Gonzalez, Andrew Harris, William Meeks, Steven Schlossberg, Raj Pruthi, Patrick McKenna Presented By: Daniel James Sadowski, MD, MPhil Introduction: Approximately three-fourths of rural counties have no urologist. There is also an increasing demand for urologic services as the population ages, and urology is a core specialty for community hospitals to offer comprehensive services. We aimed to describe the suspected shortage of urologists in rural areas. Methods: We used data from the AUA Annual Census and Urologist Population file to quantify and characterize the urology workforce in the U.S. for the years 2014-2017. Results: The rural urologists were more likely to be older (58.8 vs. 55.2 years), male (94.9% vs. 90.7%), in non-academic practices (95.9% vs. 72.2%), and employed by others (62.6% vs. 54.6%) compared to their urban counterparts. Over half of the rural urologists reported difficulty filling positions, compared to less than a third of urban urologists reporting that recruitment difficulty. Most of the difficulty in filling these rural vacancies was not having candidates available. The percentage of urologists in rural areas was relatively stable, with a slight increase of approximately 1% over the past 4 years (9.6% in 2014 to 10.7% in 2017). Around 10% of urologists were in rural areas compared to 19.3% of the US population there. Conclusion: These results document a demand for urologists in rural America. Increasing urologist recruitment to these communities may be achieved by establishing urology training programs in rural areas or targeting rural medical students for enrollment in urology residency. Other measures to improve access include outreach clinics in rural areas, telemedicine, and collaboration with physician extenders. Funding: N/A
Table of Contents 220 Podium #177 EVALUATING THE COST-EFFECTIVENESS OF ROUTINE POSTOPERATIVE SERUM LABORATORY TESTING FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY Kevin Wymer, MD, Jason Joseph, MD, Malek Meskawi, MD, Elizabeth Habermann, PhD, Amy Glasgow, Igor Frank, MD, Matthew Tollefson, MD, Matthew Gettman, MD Mayo Clinic Presented By: Kevin Wymer, MD
Introduction: Routine serum laboratory tests are common following prostatectomy (RRP), without evidence of benefit. Given the importance of value-based care, we evaluated the cost-effectiveness of laboratory testing following RRP. Methods: A decision analytic model was created to compare the cost-effectiveness of routine and clinically based Hgb and Cr following RRP. Outcomes were derived from our registry of 1,548 patients undergoing RRP between 2002 and 2016; 977 by a provider who routinely ordered postoperative Hgb and Cr and 571 patients by a provider who obtained postoperative Hgb and Cr based on clinical status. 97% (951) of patients in the routine laboratory group had a Hgb or Cr checked, compared to 13% (76) of the clinically based group. Outcomes included 30-day bleeding or readmission, blood transfusion, and hospital stay > 2 days. Costs, based on 2017 Medicare reimbursement, included only these complications and laboratory evaluation. Results: Overall postoperative complication and laboratory costs were $35 higher per patient among the routine laboratory group ($532) compared to the clinically based laboratory group ($497). There were no significant differences in outcomes between the two groups with both approaches resulting in 18.05 quality adjusted life years (QALYs). On univariate sensitivity analysis, routine postoperative Hgb and Cr became cost- effective only with higher rates of readmission (≥2.3%) or reoperation (≥1.5%) among the clinically based laboratory group. On probabilistic sensitivity analysis, the most cost- effective strategy was clinically based laboratories in 68% of simulations. Conclusion: Routine postoperative laboratory collection is not cost-effective. Rather, postoperative laboratory evaluation may be best reserved for patients with clinical indications. Funding: N/A
Podium #178 THE CURRENT STATE OF ACCESS AND HEALTHCARE UTILIZATION IN ADULTS WITH UROLOGIC CONGENITALISM: A NATIONAL SURVEY STUDY Nima Baradaran1, Kathryn Quanstrom2, Benjamin Breyer2, Hillary Copp2, Lindsay Hampson2 1Ohio State University, 2University of California San Francisco Presented By: Nima Baradaran
Introduction: Children born with congenital urologic anomalies are now living into adulthood. We studiedthe current state of urologic care for adults with urologic congenitalism in US. Methods: An anonymous online survey was distributed using Facebook® advertising to adults with urologic congenitalism. Results: 271 individuals (69.1% completion rate), 72.2% females with mean age of 39.3±12.8 years were included. Overall 92% had spina bifida, 2.9% had bladder/cloacal exstrophy. 81% of respondents reported having public insurance, 12% used their parents’ insurance, and 2.9% had no coverage. 33.2% lived >30 miles from their source of urologic care, 14.7% relied on public transportation and 33.6% relied on family/friends for rides to receive care. Regarding urologic history, 67% reported having undergone a mean of 3.1±1.6 urologic procedures, with 36% who had 5+ urologic surgeries. 12% currently receive care from a pediatric urologist (median age 27, range 18-63). 67 respondents (24%) do not see a urologist and overall 28.4% rely on their primary care provider for urologic care.
Table of Contents 221 Regarding healthcare utilization, 18.8% had not seen a physician for their urologic diagnosis in the past year, 27% reported ER visits for their urologic condition. 52% had more than one ER visit and 19.2% needed hospitalization in the past year related to their urologic diagnosis. Conclusion: There are significant discrepancies and potential gaps in urologic care among adults with urologic congenitalism. These results can assist guiding allocation of resources in order to minimize the barriers to care in this group of patients. Funding: N/A
Podium #179 FACTORS AFFECTING PATIENT SELECTION OF UROLOGISTS Robert Medairos, MD, Garrett Berger, PharmD, Peter Regala, BA, Scott Johnson, MD Medical College of Wisconsin, Department of Urology, Milwaukee, WI Presented By: Garrett K. Berger, PharmD
Introduction: As patient-centered healthcare continues to evolve, specialist physician selection is becoming more complex. Few studies exist that detail the factors influencing patient decisions when selecting a Urologist for care. Our study aims to describe the factors affecting patients’ selection of a Urologist, and the utilization of internet and social media. Methods: All new patients presenting to the Urology Clinics for evaluation were invited to complete an anonymous questionnaire at a single institution between April 2018 and October 2018. All patients received a cover sheet explaining the study and purpose. A 26-item questionnaire was used. In addition to demographics questions, a 5-point Likert scale, ranging from 1 (no importance) to 5 (most important) were used for the last 17 questions related to surveyed factors. Results: Two-hundred-thirty-eight patients responded. A total of 140 patients (59%) searched their medical condition prior to the appointment. Few patients utilized Facebook (7%) or Twitter (1%) to search their medical condition. Of the 17 surveyed Urologist selection factors, the three most important included hospital reputation (4.3 ± 1.0), in- network providers (4.0 ± 1.3), and ease of scheduling an appointment (3.9± 1.0). The three least important criteria included medical school attended (2.7± 1.3), Urologist with a social media website (1.9± 1.2), and advertisements (1.7± 1.3). Conclusion: This study suggests a significant proportion of patients likely search the internet regarding their medical condition prior to presenting to clinic. The most important factors when selecting a Urologist may be driven by a hospital’s reputation, in addition to scheduling convenience. Funding: N/A
Podium #180 VARIABILITY IN CASH PRICES FOR ERECTILE DYSFUNCTION MEDICATIONS – ARE ALL PHARMACIES THE SAME? Kirtishri Mishra, MD, Laura Bukavina, MD, MPH, Amr Mahran, MD, MS, Aidan Bobrow, Christina Buzzy, PhD, Nishant Jain, BS, Ehud Gnessin, MD, Aram Loeb, MD, Lee Ponsky, MD University Hospitals/Case Western Reserve University Presented By: Nishant Jain
Introduction: Variability in prices of medications is a well-known phenomenon. Erectile dysfunction (ED) medications are ideal to study price variations, as these medications are often not covered by insurances; therefore, the cost is the most direct reflection of price variability amongst pharmacies as they affect the patients. Herein, we aimed to evaluate the variability in cash prices for phosphodiesterase-5-inhibitors (PDEIs) at different types of pharmacies. Methods: Pre-specified doses of ED medications were identified. After exclusion, 323 pharmacies within a 25-mile radius were categorized as chain, independent, wholesale, or hospital-associated. Cash prices for medications were evaluated, along with
Table of Contents 222 demographic factors to determine if they had an impact on median drug pricing within each zip code. Results: Independent pharmacies provided the lowest cost for three out of four PDEIs. The median cost difference between independent pharmacies and chain pharmacies for Sildenafil was >900%, and >1100% for independent pharmacies versus hospital associated pharmacies (Figure 1). Demographic factors had no impact on the cost. Conclusion: The drastic differences in cash prices for the PDEIs provide an insight into the variability and cost-inflation for medications in the US, which hold true for other essential medications as well. We hope improved transparency will empower patients and encourage certain pharmacies to provide medications at more affordable prices. Funding: NA
Table of Contents 223 Posters
Poster #1 GENERATING PADUA NEPHROMETRY SCORES THROUGH KIDNEY AND TUMOR SEMANTIC SEGMENTATION IN COMPUTED TOMOGRAPHY Edward Walczak1, Keenan Moore1, Nicholas Heller2, Arveen Kalapara, MBBS3, Niranjan Sathianathen, MBBS3, Paul Blake1, Heather Kaluzniak4, Joel Rosenberg1, Zachary Rengel1, Nikolaos Papanikolopoulos, PhD2, Christopher Weight, MD3 1University of Minnesota Medical School, 2University of Minnesota, Department of Computer Sciences and Engineering, 3University of Minnesota Medical School, Department of Urology,4University of North Dakota Medical School Presented By: Edward Walczak, BS
Introduction: PADUA nephrometry scoring has proven useful for its association with high grade surgical complications and ischemia time in renal tumor patients undergoing partial nephrectomy. However, it has not been widely adopted due to high interobserver variability and high manual effort requirements. Towards mitigating these, we aimed to calculate computer-generated (CG) PADUA scores and compare them to human- generated (HG) ones. Methods: We collected preoperative contrast-enhanced CT scans of 190 patients who underwent nephrectomy at the University of Minnesota from 2011-2018. We delineated kidneys and tumors for each scan, and separately calculated HG PADUA scores. We produced CG PADUA scores through a computerized algorithm that derived each component through image semantic segmentation. For comparison, we divided patients into Groups 1:2:3 by PADUA scores (6-7):(8-9):(10-14) respectively. Results: Comparing HG and CG scores respectively (HG:CG), cancerous lesions were present in 88%:81% of Group 1, 90%:93% of Group 2, and 99%:97% of Group 3. High grade lesions were present in 35%:14% of Group 1, 23%:30% of Group 2, and 49%:45% of Group 3. High stage lesions were present in 5%:10% of Group 1, 17%:23% of Group 2, and 57%:45% of Group 3. Kappa=0.18 for inter-rater agreement between HG-groups and CG-groups. Conclusion: Grouping patients through computer-generated PADUA scores leads to distribution of characteristics in a manner similar to grouping patients through human- generated scores. Kappa of 0.18 indicates significant (if weak) association between groups formed from HG vs CG scoring. These results suggest automating PADUA scores is possible, removing barriers to its wider adoption. Funding: R01CA225435
Poster #2 TIMING AND DISTRIBUTION OF METACHRONOUS CHROMOPHOBE RENAL CELL CARCINOMA METASTASES Maximilian Staebler, BSe1, Theodora Potretzke, MD2, Christine Lohse3, John Cheville, MD4, Bernard King, MD2, Matvey Tsivian, MD5, Bradley Leibovich, MD5, R Houston Thompson, MD5, Aaron Potretzke, MD5 1Mayo Clinic Alix School of Medicine, 2Mayo Clinic Department of Radiology, 3Mayo Clinic Department of Health Sciences Research, 4Mayo Clinic Department of Pathology, 5Mayo Clinic Department of Urology Presented By: Maximilian Helmut Staebler, BSe
Introduction: Chromophobe renal cell carcinoma (chRCC) metastases occur less frequently than other histological subtypes and data on distribution of and time to metastases are scarce. We sought to report timing and distribution of metachronous metastatic chRCC in comparison to clear cell and papillary renal cell carcinoma (ccRCC and pRCC). Methods: Our institutional registry was queried to identify 1022 patients treated surgically for localized sporadic, unilateral ccRCC, pRCC and chRCC between 1970 and 2011 who were M0 at nephrectomy and developed distant metastases to 3 or fewer initial sites. Associations of histologic subtype with time to each distant metastatic site were
Table of Contents 224 evaluated using Cox models. Site-specific metastases-free survival rates were estimated using the Kaplan-Meier method. Results: Among the 1022 patients, 932, 57, and 33 were ccRCC, pRCC, and chRCC, respectively. The metastatic pattern is reported in Table 1. The most common metastatic sites for chRCC were lung, bone, and liver. Chromophobe histology was significantly associated with worse liver 2-year metastases-free survival compared with ccRCC and pRCC (82% vs. 91% vs. 89%, p<0.001). Conversely, the time to metastasis and 2-year metastases-free survival for non-regional lymph nodes was longer and higher for chRCC compared with ccRCC and pRCC (p=0.008). Conclusion: Distribution of distant metastasis from chRCC is distinct from other histologic subtypes of RCC. Site-specific 2-year metastases-free survival for chRCC is lower for and higher for non-regional lymph nodes when compared with ccRCC and pRCC. If validated, this information would aid in patient counseling for those with metastatic chRCC. Funding: N/A
Poster #3 TESTING THE EXTERNAL VALIDITY OF EORTC 30881 TRIAL COMPARING LYMPHADENECTOMY WITH RADICAL NEPHRECTOMY TO RADICAL NEPHRECTOMY ALONE FOR RENAL CELL CARCINOMA Alex Borchert, MD1, Sohrab Arora, MD1, Lee Baumgarten, MD1, Akshay Sood, MD1, Deepansh Dalela, MD1, Quoc-Dien Trinh, MD2,3, Craig Rogers, MD1, James Peabody, MD1, Mani Menon,MD1, Firas Abdollah, MD1 1Henry Ford Hospital, 2Brigham and Women's Hospital, 3Harvard University Presented By: Alex Borchert, MD
Introduction: Retrospective data has suggested that a subset of patients with renal cell carcinoma may benefit from lymphadenectomy at the time of nephrectomy. The only randomized trial investigating lymphadenectomy for renal cell carcinoma, EORTC 30881, reported that lymphadenectomy at the time of nephrectomy did not improve the overall survival. Our aim was to test the external validity of this trial in US patients. Methods: We identified 77,781 patients with renal-cell carcinoma, diagnosed between 2010-2015, within the National Cancer Database (NCDB), who met inclusion criteria of the EORTC 30881 trial. Descriptive characteristics were compared to the EORTC 30881 cohort using chi-squared test. Results: Median age was 61 vs 64 years (p=NA), and median tumor size was 5.75 cm vs. 4 cm (p=NA) in the EORTC 30881 vs NCDB cohorts. In the trial, a higher percentage of patients harbored cT3 tumors (29.1%, vs 13.3%, p<0.001), when compared to the NCDB cohort. Additionally, EORTC 30881 had significantly more women (39% vs 37%, p<0.001), and was more likely to have patients with right-sided tumors (54% vs 50.8%, p<0.001). Conclusion: EORTC 30881 trial patients were younger, had bigger tumors, and more cT3 stage disease, compared to the NCDB cohort. These patients are the ones who supposedly benefit the most from lymphadenectomy, based on retrospective data. As such, our findings seem to reinforce the findings of EORTC 30881. Implementing lymphadenectomy in clinical practice is thus unlikely to improve survival benefit. Funding: N/A
Table of Contents 225 Poster #4 OUTCOMES OF MICROWAVE ABLATION FOR SMALL RENAL MASSES: A SINGLE CENTER EXPERIENCE Courtney Yong, MD1, Sarah Mott, MS2, Sandeep Laroia, MD3, Chad Tracy, MD1 1University of Iowa, Department of Urology, 2University of Iowa, Holden Comprehensive Cancer Center, 3University of Iowa, Department of Interventional Radiology Presented By: Courtney Yong, MD
Introduction: Microwave ablation (MWA) is an emerging technology for treating renal masses. Methods: We retrospectively examined our experience with MWA between March 2015 and December 2018. We assessed technical success, changes in renal function, and complications. Rates of local recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method. Results: 38 patients underwent MWA during the study period (71% male). Mean age was 68.3±12.6 years. Mean BMI was 32.6±8.5. ASA score was ≥3 in 25 patients. 21% had undergone prior treatment for renal cell carcinoma (RCC). Mean tumor size was 2.6±0.7 cm and median modified RENAL nephrometry score was 7.5 (range 5-10). Postoperatively, there was a slight decline in GFR from preoperative levels (p=0.01, estimated -1.9 mL/min/1.73-m2/month) but not hemoglobin (p=0.07, estimated - 0.18/month) with no further decline in GFR (p=0.90) at last follow-up. There were four complications (10.5%): three Clavien grade 1 complications (hyperkalemia, delayed urine leak, perinephric fluid collection) and one Clavien grade 3 complication (intrarenal stricture). Tumor size decreased postoperatively (p<0.01, estimated -0.03 cm/month). Initial technical success was 95% (36/38). One-year RFS, CSS, and OS were 93% (figure), 100%, and 89% respectively. Conclusion: MWA is a safe and effective treatment for small renal masses with short- term outcomes similar to other ablative technologies. Funding: Watts Family Fellowship in Urology
Table of Contents 226 Poster #5 IS TRIGONITIS A NEGLECTED, IMPRECISE, MISUNDERSTOOD OR FORGOTTEN DIAGNOSIS? Zhina Sadeghi1,2, Gregory MacLennan3, Stacy Childs4, Philippe Zimmern5 1University Hospitals Cleveland Medical Center, 2Case Western Reserve University, Department of Urology, Cleveland, OH, 3Division chief, Anatomic Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, 4Director of urology, Rural partners in Medicine, Springs, CO, 5Urology Department, UT Southwestern Medical Center, Dallas, TX Presented By: Zhina Sadeghi, MD
Introduction: To consolidate our understanding of “trigonitis” and its relevance in current urologic practice, we reviewed the literature on this entity. Methods: A systematic review of MEDLINE, EMBASE and the Cochrane database (1905-present) was done for any English articles addressing the following terms: trigonitis, cystitis trigoni, cystitis cystica, squamous metaplasia, pseudomembranous trigonitis, vaginal metaplasia, infection or inflammation of the trigone, trigonitis in recurrent urinary tract infections (rUTI). Excluded were abstracts or articles not focused on trigonitis, or only repeating the findings from other original articles on trigonitis, and studies in children or men. Reported histologic findings on trigonitis, theories regarding its pathophysiology, and therapeutic strategies were reviewed. Results: From 57 relevant articles, only 27 focused on trigonitis. Cystoscopic evaluation of the trigone described inflammatory lesions of cystitis cystica, occasionally small stones or pus-filled lesions, an appearance which should be differentiated from white patches of squamous metaplasia. Embryological formation of the trigone, history of rUTIs, and hormonal effects on the trigone have been proposed as underlying pathophysiologic mechanisms. Numerous therapeutic strategies have been reported to treat symptomatic trigonitis, including antibiotic therapy, intravesical instillation of different agents, electro- fulguration, laser coagulation. But no treatment indication criteria has been well- established so far, and long-term data are lacking. Conclusion: Despite several reports describing histologic and endoscopic findings of trigonitis, its prevalence, pathophysiology, and treatment have remained poorly defined. Its relevance in the management of rUTIs should be further evaluated. Funding: N/A
Poster #6 MULTIPLEX POLYMERASE CHAIN REACTION TESTING COMPARED TO TRADITIONAL URINE CULTURE FOR DETECTION OF UROPATHOGENS IN FEMALE AND MALE PATIENTS WITH SYMPTOMATIC URINARY TRACT INFECTIONS Brett Watson, MD1, Elizabeth Olive2, Kirk Wojno, MD3, Howard Korman, MD3, Sabry Mansour, MD3, Syed Mohammad A. Jafri, MD3 1Beaumont Health, Dept of Urology, Royal Oak, MI, 2Oakland University William Beaumont School of Medicine, Rochester, MI, 3Comprehensive Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Introduction: Urine culture (UC) is regarded as the gold standard for detection and identification of causative organisms in urinary tract infections (UTI). Multiplex Polymerase Chain Reaction (PCR) molecular testing has been found to be useful in other infectious disease applications and can accurately identify urinary pathogens. We compare the frequency of uropathogens detected in males and females using UC and PCR. Methods: Retrospective review of 582 consecutive patients, 235 females (40%) and 347 males (60%), with lower UTI symptoms was conducted. Traditional UC and PCR molecular UTI analysis were run in parallel. Detection of specific pathogens in females and males according to PCR and UC were compared using Fisher’s exact tests. Results: PCR and UC results agreed in 74.1% of patients overall and were more likely to agree in males (77.5%) than females (68.9%). PCR detected five pathogens more
Table of Contents 227 commonly in females than males, while UC only detected one organism more commonly in females. Conclusion: PCR based molecular testing identifies several uropathogens more often than traditional UC, and this difference is more pronounced in female patients. PCR also reveals different bacterial profiles between the genders, which UC obscures. PCR may be a useful adjunct to traditional UC in the diagnosis of patients with symptomatic UTI, particularly in women. Funding: yes, Pathnostics
Poster #7 DIFFERENCES IN PATHOGENIC ORGANISMS DETECTED BY POLYMERASE CHAIN REACTION BASED MOLECULAR TESTING AND TRADITIONAL URINE CULTURE FOR SYMPTOMATIC URINARY TRACT INFECTIONS Brett Watson, MD1, Md Saon2, Kirk Wojno, MD3, Howard Korman, MD3, Jeffrey O'Connor, MD3, Syed Mohammed A. Jafri, MD1 1Beaumont Health, Dept of Urology, Royal Oak, MI, 2Oakland University William Beaumont School of Medicine, Rochester, MI, 3Comprehensive Urology, Royal Oak, MI Presented By: Brett J. Watson, MD
Introduction: Urine culture (UC) is regarded as the gold standard for identifying organisms causing urinary tract infections (UTI). Increasing evidence supports using Polymerase Chain Reaction (PCR) based molecular testing to detect urinary pathogens. This study aims to evaluate the differences in pathogens detected between PCR and UC in symptomatic patients. Methods: Retrospective review of 582 consecutive patients (≥ 60 years of age) with symptoms of lower UTI was conducted. All patients had UC and PCR testing run in parallel. Results: PCR detected 24 different bacteria while UC detected 21 different bacteria. Of PCR positive studies, E. coli (29%), Actinobaculum schaali (27%) and Viridans group Streptococci (27%) were commonly identified organisms. UC failed to detect Actinobaculum schaali (n=0), and Viridans group Streptococci was isolated only in 6% of culture positives. Of UC positive studies, E. coli (34%) and Enterococcus faecalis (21%) were the two most common species. PCR and UC had similar detection rates for E. coli, Enterococcus faecalis, and Klebsiella pneumoniae. There were 8 bacteria that were identified only by PCR, and 5 bacteria that were only detected by culture. Conclusion: PCR can detect a larger number of pathogenic bacteria at generally higher frequencies than UC. Several fastidious organisms on traditional UC were frequently identified using PCR. Funding: yes, Pathnostics
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Poster #8 IMPLEMENTING AN ENHANCED RECOVERY PATHWAY IN CHILDREN UNDERGOING BLADDER AUGMENTATION Yvonne Y. Chan, MD1, Soojin Kim, MD1, Nicholas E. Burjek, MD2, Megan A. Brockel, MD3, Ilina Rosoklija1, Mehul V. Raval, MD4, Kyle O. Rove, MD5, Elizabeth B. Yerkes, MD1, David I. Chu, MD1 1Division of Pediatric Urology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 2Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 3Department of Anesthesiology, Children’s Hospital Colorado, Aurora, CO, 4Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 5Department of Pediatric Urology, Children’s Hospital Colorado, Aurora, CO Presented By: Yvonne Yuh-Ru Chan, MD
Introduction: Implementation of an enhanced recovery pathway (ERP) is a safe and effective way to improve the recovery of children undergoing bladder reconstruction but has not been widely adopted in pediatric urology. We implemented an ERP as a quality improvement initiative for children undergoing bladder reconstruction at a single, free standing children’s hospital. Methods: We first met with pediatric practitioners with ERP experience to understand potential implementation barriers. We then held stakeholder meetings to engage anesthesiologists, nurses, case managers, and other ancillary staff in drafting our institution-specific pathway. We generated a standardized order set to improve pathway adherence. We are auditing and collecting data on adherence and patient outcomes (Figure 1). The pathway has been continuously refined with stakeholder feedback and audit results before and after implementation. Results: ERP was implemented in six patients undergoing bladder augmentation (median age 12 years, range 4-21). Median LOS was 5 days (range 4-12). A median of 13.5 (range 13-16) of 20 elements were implemented for each patient. Conclusion: Open communication and early stakeholder involvement were critical to implementation. Early pathway adherence is encouraging. Further follow-up is necessary to evaluate the impact on patient-centered and patient-reported outcomes. Audit results will continue to improve future adherence. Funding: N/A
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Poster #9 IMPROVING COMORBIDITY DOCUMENTATION FOR COMPLEX UROLOGY INPATIENTS JJ Zhang, MD, Molly DeWitt-Foy, MD, Kyle Ericson, MD, Scott Lundy, MD,PhD, Anup Shah, MD, Michelle Ponziano, MSN,RN, James Ulchaker, MD, Goldman Howard, MD Cleveland Clinic Foundation Presented By: JJ Haijing Zhang, MD
Introduction: Inpatient documentation often misrepresents patient complexity due to discrepancy between provider terminology and language deciphered by billing departments. Failure to clearly document comorbidities and complications results in poor interprovider communication and impacts diagnosis related grouping (DRG) assignment, reimbursement, and quality metrics. The Clinical Documentation Improvement (CDI) department addresses this situation by inspecting charts for discrepancies and sending time-consuming documentation inquiries to physicians. Reimbursement is ultimately determined by patient assignment into low (base), intermediate, and high-complexity DRG categories. We aimed to implement a user-friendly documentation tool to accurately capture patient complexity. Methods: Administrative billing data from a tertiary center was queried to obtain the top Major Comorbid Conditions (MCCs) within Urology. A simple smratphrase tool was created in EPIC electronic medical record to rapidly incorporate relevant MCCs. Educational sessions were enforced to promote high compliance for inpatient notes. DRG assignment rate, smartphrase compliance, and CDI inquiry rate was measured. Results: The top ten Urology MCCs were AKI/CKD/ESRD, Respiratory Failure, Sepsis, Malnutrition, Encephalopathy, Acute/Chronic CHF, Quadriplegia/Paraplegia, Pressure Ulcers, Anemia, and NSTEMI. Resident compliance over 4 months was 84.3%. High- complexity DRG capture rate improved for surgical admissions (13.2%-->16.3%, +3.1%). For queried diagnoses grouped into two DRG categories, intermediate/high complexity assignment increased (43.3%-->60.5%, +17.2%) from base DRG. Post-intervention CDI inquiries decreased by 27.6%. The estimated 4-month financial impact within queried diagnoses is +$589,569.00. Conclusion: Accurate documentation of comorbidities and complications requires consistency between language used by providers and administrative departments. Our preliminary 4-month data improved capture of patient complexity and reimbursement. Funding: N/A
Table of Contents 230 Poster #10 PATIENT SELECTION AND OUTCOMES BETWEEN LOWER AND HIGHER VOLUME SURGEONS IN PERFORMANCE OF RADICAL PROSTATECTOMY: ANALYSIS OF THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE (MUSIC) Alexander Tapper, MD, Alec Wilson, MD, Steven Lucas, MD, Rodney Dunn, MS, Khurshid Ghani, MD, Tae Kim, David Miller, MD, James Montie, MD, James Peabody, MD, Ji Qi, MS, Hugh M. Solomon, MD, Jaya Telang, Frank Burks, for the Michigan Urologic Surgery Improvement, Collaborative Presented By: Alexander David Tapper, MD
Introduction: Prostate cancer (PCa) is commonly treated by radical prostatectomy (RP). Surgical volume may impact patient selection and outcomes. By comparing surgical volume, we aim to discern variation in patient selection and surgeon technique to identify avenues to improve functional outcomes. Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement consortium of >250 Michigan urologists. The MUSIC patient reported outcomes (PRO) program began in April 2014 and uses a validated survey completed by RP patients pre- and 3, 6, 12, 24 months post-operatively. Lower volume surgeons performed <10 RPs annually; higher volume surgeons performed >10 RPs annually. Descriptive statistics examined patient selection and outcomes. Multivariable analysis compared surgical outcomes between surgeon groups. Results: Since commencement to July 2018, MUSIC PRO included 108 RP surgeons (48 low volume, 60 high volume) who performed 2704 RPs. Higher volume surgeons tended to operate on patients with lower PSA (p=0.036) and performed more bilateral nerve spare (p<.001). No significant differences seen regarding race, BMI, clinical staging, or Gleason score of RP patients. Controlling for patients factors, higher volume surgeons saw higher rates of social continence 3 months post-RP (66.7% v. 51.5% for low and high volume surgeons respectively, p=0.006). Conclusion: RP remains a common treatment for localized PCa, and functional outcomes remain a concern. The term lower volume prostatectomist encompasses a wide spectrum of Urologists with varying levels of experience and expertise. MUSIC PRO data presents opportunity to identify those with superior outcomes to aid in training of new practicing lower volume surgeons. Funding: Blue Cross Blue Shield of Michigan
Poster #11 AMERICAN UROLOGICAL ASSOCIATION QUALITY REGISTRY (AQUA) EARLY QUALITY REPORTING OF BPH SYMPTOM IMPROVEMENT Joseph Mahon, MD1, Ahmer Farooq, DO1, Parsons JK, MD2, Welliver Charles, MD3, Lerner Lori, MD4, Averch Timothy, MD5, Pichardo Daniel6, Kevin McVary, MD1 1Loyola University Medical Center, 2UC Sandiego, 3Albany Medical Center, 4VA Boston Healthcare System, 5Palmetto Health USC, 6American Urologic Association Presented By: Joseph Mahon, MD
Introduction: The AQUA Registry seeks to advance CMS quality reporting requirements among urological practices. We performed the first national assessment of BPH outcomes in AQUA. Methods: Data were received from the AQUA Registry. We examined all BPH patients with AUASS/ IPSS at the initial diagnosis of BPH and within one year thereafter to assess reporting of quality benchmark improvement of >20% of symptoms. We compared demographic characteristics of patients as well as several BPH treatments. Results: From 2014-2018, 1,130,772 newly diagnosed BPH patients were entered into the AQUA, 72,723 (6.4%) had a baseline IPSS >8, 6508 (9%) had recorded improvement of >20% in IPSS within one year of registration and 1077 underwent a recorded surgery. Mean age was 67.7yrs (67.3yrs men with improvement). Distributions of baseline IPSS and post-treatment IPSS demonstrated a shifting of the mean towards improvement. Of patients undergoing surgical techniques for BPH, TURP was most commonly reported (n=417). Only TURP, PVP, TUMT, and Prostatic Urethral Lift (PUL) had at >50 patients
Table of Contents 231 registered. Of reported men undergoing TURP, 31.4% (n=131 of 417) met >20% improvement in IPSS. Conclusion: The AQUA registry provides robust data for BPH practice patterns and outcomes. Early data suggest that the majority of patients are currently not meeting the AQUA quality benchmark of >20% improvement in LUTS within one year following diagnosis. Funding: AUA
Poster #12 SEVERE SEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY (PCNL): COSTLY AND DEADLY Marc Nelson, MD, Alex Belshoff, MD, PhD, Marshall Baker, MD, Gopal Gupta, MD, Ahmer Farooq, MD, Kristin Baldea, MD Loyola University Medical Center Presented By: Marc Nelson, MD
Introduction: Severe sepsis following PCNL is well-known for its association with poor outcomes and high cost. However, the scope of cost on a national scale and how it relates to severe sepsis has not been well described. We used a national database to further characterize the effects of severe sepsis following PCNL. Methods: The Healthcare Cost and Utilization Project National Inpatient Sample for years 2012-2014 was queried. ICD-9 codes were used to identify adults diagnosed with nephrolithiasis who underwent elective PCNL. Severe sepsis was defined using the Angus criteria. Costs of care were estimated by applying hospital specific cost to charge ratios and adjusting for inflation. Patient, hospital, and encounter hospital characteristics were extracted. Both univariate and multivariate analysis was performed. Results: 34,465 patients underwent inpatient PCNL from 2012-2014. 5.0% had severe sepsis during hospitalization. Patients with severe sepsis were more likely to be older (59.3 vs 54.5 years, p<0.005), female (58.9% vs. 55.3%, p<0.005), have Medicare insurance (55.2% vs. 33.8%, p<0.005), and have higher CCI (1.8 vs 0.69, p<0.005). On multivariate analysis, sepsis resulted in longer LOS (4.87 days, p<0.005), increased odds of mortality (6.67 OR, p<0.005), and increased costs ($12,384, p<0.005) Conclusion: Severe sepsis following PCNL is a significant source of increased costs, length of stay, and mortality. Prevention and early identification of severe sepsis is paramount. Funding: N/A
Poster #13 URINE VS. URETERAL STENT CULTURES DURING URETERAL STENT REMOVAL Bijan Salari, MD, Muhamad Khalid, Samuel Ivan, Daniel Rospert, Obinna Ekwenna, MD, Firas Petros, MD, Puneet Sindhwani, MD Department of Urology, University of Toledo Presented By: Bijan William Salari, MD
Introduction: Ureteral stents are associated with significant morbidity, including urinary tract infections (UTIs). Biofilms may play a role in linking stents with UTIs. The goal of this study was to identify whether urine and ureteral stent cultures correlate at the time of stent removal. Methods: We retrospectively reviewed N = 112 intraoperative urine and ureteral stent cultures at the time of stent removal. Inclusion criteria were adults (> 18 years old) who presented for ureteral stent removal. An intraoperative urine culture was obtained with the aid of a cystoscope, followed by removal of the ureteral stent with stent graspers and culture of the proximal tip. Results: Of 112 ureteral stents cultured, 51 (45%) were positive. Of positive stent cultures, 24 (47%) had negative intraoperative urine cultures. The most commonly isolated microorganisms on stents were Enterococcus faecalis and Staphylococcus epidermidis. All positive urine cultures (100%) had positive stent cultures with the same microorganism. 9 stents had yeast positive cultures, 4 (44%) of which had negative urine
Table of Contents 232 cultures. Candida glabrata was most commonly isolated. Mean ureteral stent indwelling time was 46 days vs. 62 days (p =0.053), for negative and positive stent cultures, respectively. Conclusion: In our study population stent cultures predicted positive intraoperative urine cultures 100% of the time, however 47% of positive stent cultures had negative intraoperative urine cultures. For this reason, we recommend culturing ureteral stents, which have been one of the few links to post-operative sepsis after ureteroscopy. Funding: N/A
Poster #14 TOUR DE CONSULT: HOW TO CHANGE THE CONSULT CULTURE – AN 11 YEAR EXPERIENCE AT A LARGE ACADEMIC MEDICAL CENTER Adam Cole, MD, Kathryn Marchetti, MD, Casey Dauw, MD, Julian Wan, MD University of Michigan Presented By: Adam I. Cole, MD
Introduction: An intradepartmental competition among the residents was created to encourage timely and accurate reporting of consults into an internal database. Rewards are given to the teams and individuals that see the most consults. We describe the unplanned clinical activity of urology residents at a high-volume academic medical center over an 11-year period. Methods: Demographic data regarding inpatient, OR and ER consults to the urology service was prospectively entered into an internal database. Consults from July 2007- June 2018 underwent review. Linear regression was used to evaluate trends in unplanned clinical activity and factors associated with whether a consult was billable. Results: During the study period, 24170 consults were recorded. The number of consults rose 5-fold during the study period (R²=0.9296, p<0.001). Consults were mostly seen in the ER (54.1%) and inpatient wards (41.1%). The percentage of billable adult consults increased over the study period (R²=0.7415, p=0.009). When accounting for patient volume, ED consults and inpatient consults also increased. Conclusion: The number of recorded urology consults and percentage of billable adult consults increased dramatically. We speculate these increases are due to improved compliance in reporting, greater resident willingness to see consults, increased consult utilization by other services. Together they represent an overall positive culture and attitude change towards consults. Funding: N/A
Table of Contents 233 Poster #15 CROSS-CULTURAL COMPETENCY AND COMMUNICATION IN RESIDENCY TRAINING: WHERE DO WE STAND? Hemant Chaparala, MD1, Emefah Loccoh, BS1, Sabrina Amin2, Jessica Sciuva2, Tasha Posid, MA, PhD1, Kerestina Khalil2 1The Ohio State University Medical Center, 2The Ohio State University Presented By: Hemant Chaparala, MD
Introduction: Despite a 2002 Institute of Medicine report describing the need to address health disparities, these disparities persist. Demonstration of cross-cultural competency is required of U.S. graduating resident physicians; however, curricula integrating medical education with training in cross-cultural competence is lacking. Methods: Pubmed was queried for the terms: resident cultural competency, resident cross-cultural communication, resident cross-cultural training, and resident cross-cultural competency training. The initial query produced 282 results. Results were cross- referenced and duplicate results were eliminated. The remaining articles were reviewed for (a) measurement of cross-cultural communication/competency or (b) interventions targeting cross-cultural communication/competence specific to residency training. The final number of articles was 76. Results: The 76 articles were classified as (1) intervention (n=28; N=1196 total participants, Median=26 participants; 6 did not report), (2) literature review/commentary (n=5), or (3) measurement (n=43). Surgery made up 21% of interventions (n=7) but was not amongst specialties assessed. We categorized the interventions: Content creation (e.g., modules, videos: n=3), community clinic experience (n=5), curriculum development/implementation (n=6), international experience (4), simulations (n=4), or workshops (n=5). 25% (n=7) interventions measured pre-post gains (mixed: learning, knowledge, satisfaction) and 61% (n=17) of interventions reported general satisfaction with the initiative (satisfaction >80%). Of note, sub-surgical specialties were neverincluded amongst retrospective measurements of cross-cultural competency or prospective interventions. Conclusion: The literature indicates that cross-cultural competency and communication is currently underrepresented in residency programs and understudied. To our knowledge, no research to date has focused specifically on sub-surgical specialty training, such as urology, as it relates to cross-cultural competency and communication. Funding: N/A
Poster #16 NARCOTIC PRESCRIBING HABITS AMONG UROLOGY RESIDENTS IN URBAN AND SUBURBAN COMMUNITIES Joshua Palka, DO1, Sarah Martin, DO1, Zaid Farooq, DO1, Neal Krentz, BS2, Mazen Abdelhady, MD1 1Detroit Medical Center, 2Michigan State University Presented By: Sarah E. Martin, DO
Introduction: There is a paucity of data assessing narcotic prescribing habits among urologists. Utilizing the Michigan MAPS system, we evaluated narcotic prescribing trends among urology residents and compared prescribing habits between suburban and urban hospitals. Our primary endpoint was to assess baseline narcotic prescribing patterns to suggest possible future interventions. Methods: All patients undergoing urologic surgery at two Detroit Medical Center hospitals between January and December 2017 were included. Procedure type, morphine milliequivalent (MME), and prescribing resident year were analyzed. The MAPS system was utilized to assess previously prescribed narcotics. Results: A total of 1,792 procedures were reviewed. Of these, 76.6% received narcotic prescriptions. Senior residents wrote more MME for minor endoscopic and minor open cases. There was no difference in MME given for major endoscopic and major open cases or whether a narcotic was given to a patient already on narcotic medication. Significantly more patients received narcotics post procedure at the suburban hospital than the urban hospital.
Table of Contents 234 Conclusion: Our study suggests that interventions should be aimed towards all resident levels of training. Further interventions will also be directed towards ensuring the use of the online MAPS system to reduce redundant narcotic prescriptions. These findings will help in developing post-graduate education programs to reduce narcotic prescriptions. Funding: N/A
Poster #17 GEOGRAPHIC ANALYSIS OF BROADBAND INTERNET ACCESS AND UROLOGIC CANCER MORTALITY IN THE UNITED STATES Paige Nichols1, Anne Corrigan2, Hiten Patel3, Frank Curriero2, Vidit Sharma1, Gettman Matthew1, Ziegelmann Matthew1, Pierorazio Phillip3, Michael Johnson3 1Mayo Clinic, 2Johns Hopkins Bloomberg School of Public Health, 3Johns Hopkins Brady Urological Institute Presented By: Paige Elizabeth Nichols, MD
Introduction: In recent years there has been an increased emphasis on integrating internet-based services into urologic care. However, the current relationship between internet access rates (IAR) and urologic outcomes is not well understood. We aim to establish how broadband internet access is associated with urologic cancer mortality rates (MR) for all US counties. Methods: Multivariable regressions were run to assess associations between 2014 county-level MR for bladder (BC), kidney (KC), prostate (PC), and testis cancer (TC) and county-level IAR. IAR are defined as percent of population with fixed residential broadband service at speeds of ≥25 Mbps downstream and 3 Mbps upstream. All multivariable models adjusted for access to urologists, rurality, income, education, and race. Results: TC, KC, and PC MR in 2014 increased by 1.54%, 1.42%, and 0.81% respectively for every 10% decrease in IAR (all p<0.01), while BC MR in 2014 decreased by 0.5% for every 10% decrease in IAR on univariable analysis (p<0.01). On multivariable analysis, every 10% decrease in IAR resulted in KC and TC MR increasing by 0.41% (p<0.01) and 0.38% (p=0.02) respectively. BC MR decreased by 0.30% (p<0.01). PC MR was not significantly associated with IAR on multivariate analysis (Table 1). Conclusion: Poor internet access is predictive of increased county-level KC and TC mortality and decreased BC mortality on a national scale. This supports the concept that internet access may be useful as a surrogate marker for KC and TC mortality, and studies investigating the underlying etiology of this association are warranted. Funding: AUA Data Grant
Table of Contents 235 Poster #18 IMPACT OF EXPOSURE TO TOXIC STRESS IN CHILDHOOD ON PHYSICIAN BURNOUT Lauren E. Corona, MD1, Nicholas J. Akselberg2, David C. Miller, MD1, Yongmei Qin, MD1, Brian R. Stork, MD3 1University of Michigan, Dept. of Urology, Ann Arbor, MI, 2University of Michigan, Ann Arbor, MI, 3University of Michigan, Dept. of Urology, Muskegon, MI Presented By: Lauren E. Corona, MD
Introduction: Adverse childhood experiences (ACEs) have been linked to mental and physical health problems in adulthood. Although broadly explored in patients, there is limited knowledge on their effect on physicians and burnout, where urologists rank among the top of all specialties. We sought to explore whether such a relationship exists in a statewide sample of community physicians and academic urologists. Methods: 269 physicians (226 community physicians and 43 academic urologists) in Michigan were administered the 10-item ACE questionnaire and 2-question Maslach Burnout Inventory. Emotional exhaustion and depersonalization were deemed significant if experienced more than once weekly, and burnout was defined as significant emotional exhaustion, depersonalization, or both. The prevalence of ACEs and burnout and the associations between the two were compared. Results: Survey response rate was 56%. The group consisted of 84% community physicians and 18% urologists. 44% reported at least one ACE. Overall, 14% had significant burnout, similar between urologists and non-urologists. Those who had experienced certain ACEs were more likely to report burnout (Fig 1). Conclusion: Physicians with ACEs were more likely to have burnout, suggesting that childhood exposure to toxic stress might be a risk factor, therefore. Knowledge of risk factors for burnout is crucial, and further exploration thereof could be an opportunity for intervention. Fig. 1. Funding: N/A
Table of Contents 236 Poster #19 PROSTATE CANCER IN CHICAGO: AN ANALYSIS OF DISPARITIES IN OUTCOMES USING NEIGHBORHOOD OF RESIDENCE John Ogunkeye, M-2, Chris Coogan, MD RUMC Presented By: John Ogunkeye
Introduction: Racial disparities related to Prostate Cancer (PCa) specific incidence and mortality in the United States are well-established. Although there have been significant improvements over the last 20 years, the disparity gap remains significant, as incidence and mortality for black men is 1.7 and 2.5 times higher respectively compared to white men nationally. In Chicago, a unique history of laws and policies have created a diverse metropolis largely segregated by race. Recent studies have demonstrated alarming disparities between these segregated Chicago communities in health-related areas. Additionally, the disparity gap in certain health outcomes has increased over the last several decades. The aim of this study is to investigate how trends in PCa-specific incidence and mortality vary between Chicago communities and to compare these trends to national outcomes. Methods: Nationwide data was sourced from the SEER program of the National Cancer Institute. Community data was acquired from the Illinois and Chicago Departments of Public health. Results: Chicago neighborhoods with majority black populations have an incidence 1.5- times higher than majority white communities. The disparity gap in mortality statistics are more significant, as black neighborhoods have PCa-specific mortality nearly 3.5 times higher than white neighborhoods. Moreover, while mortality rates have improved over the last two decades in majority white communities, the rates in black neighborhoods have moderately increased during the same time period. Conclusion: Although there has been national progress, a focused analysis reveals that in Chicago, significant disparities remain with regard to PCa-specific outcomes. Funding: RMC Alumni Association
Poster #20 TIME TO AZOOSPERMIA: BALANCING HEALTH CARE EXPENDITURE ON REPEATED POST-VASECTOMY SEMENALYSIS AND PATIENT NON-COMPLIANCE. Woojin Han, Medical Student, Puneet Sindhwani, Chair, Department of Urology University of Toledo, Department of Urology Presented By: Woojin Han
Introduction: Vasectomy is a popular permanent method of male contraception. However, sterility is not an immediate outcome. Current AUA guidelines recommend between 8–16 weeks after vasectomy for scheduling the first semenanalysis, but patient compliance is low. This review analyzes the optimal balance between compliance and time to azoospermia (TTA) to find evidence for shorter time intervals to semenanlysis. Methods: Databases (MEDLINE, EMBASE, POPLINE, and Cochrane Central Register of Controlled Trials (CENTRAL)) were searched for studies that contained the following results: rate of azoospermia and rare non-motile sperm (RNMS), compliance, recanalization, persistent RNMS, pregnancies, and incidence of repeat vasectomy, as these might indicate failure of the procedure. Results: A total of 28 studies were included in this review. The postvasectomy interval was 2–16 weeks Compliance ranged between 81%–62% for weeks 6–16. TTA was greater than 65% after 6 weeks. Six studies investigated lavage and its effect on TTA, only two of these studies showed reduction in TTA with lavage. Compliance and TTA curves crossed at 8 weeks, after which compliance dropped. Conclusion: Shortest TTA with the highest patient compliance is 8 weeks. This achieves ideal balance by potentially reduce spending on multiple semen analyses, without compromising patient compliance. Figure 1. Time to Azoospermia vs Compliance Rate Funding: N/A
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Poster #21 PUBECTOMY WITH URINARY RECONSTRUCTION EFFECTIVELY IMPROVES QUALITY OF LIFE AND FUNCTION IN MEN WITH UROSYMPHYSEAL FISTULA AFTER PROSTATE CANCER THERAPY Jack Andrews, MD, Kevin Hebert, MD, Jason Joseph, MD, Boyd Viers, MD Mayo Clinic Presented By: Jack Andrews, MD
Introduction: Urosymphaseal fistula (UF) is a rare but debilitating complication of prostate cancer (CaP) treatment. UF is often unrecognized or temporized with long-term indwelling catheters without symptomatic relief. The objective of this study is to describe the natural history, reconstructive solutions, and functional outcomes of those men undergoing pubectomy with urinary reconstruction for UF after CaP treatment. Methods: We identified 20 men with U, following CaP treatment, treated with pubectomy and urinary reconstruction between 2009 and 2018 at our institution. Results: All patients (N=20) had a history of pelvic radiation for CaP. Mean time from primary CaP treatment to diagnosis of UF was 11.3 years. The majority of men (19/20; 95%) presented with pubic pain during ambulation. History of posterior urethral stenosis or bladder neck contracture was common (16/20; 80%) with 50% having repetitive endoscopic treatments. Pubectomy was combined with varying extents of extirpative and reconstructive surgery including salvage prostatectomy (N=2), anterior exenteration (N=16), and combined anterior and posterior exenteration (N=2). Patient function significantly improved following reconstruction including mean pre to postoperative ECOG score (2.4 vs 0.4; p=0.035), pain improvement (19/20; 95%), and resolution of UF symptoms (18/20; 90%). Conclusion: UF often presents in a delayed fashion (10-15 years) following CaP therapy as pain with ambulation. Radiation and endoscopic manipulation are significant risk factors for UF. Conservative treatments are unlikely to provide symptom resolution, however pubectomy with urinary reconstruction safely achieves durable improvement of symptoms, pain, and functionality in the majority of men. Funding: N/A
Table of Contents 238 Poster #22 DULOXETINE FOR THE TREATMENT OF STRESS URINARY INCONTINENCE (SUI) AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Robert Medairos, MD, Nicholas Nordin, BS, David Charles, MD, Jacob Jipp, MD, Amy Guise, MD Medical College of Wisconsin Presented By: Robert Anthony Medairos, MD
Introduction: Duloxetine may improve SUI by increasing urethral sphincter contractility. We evaluated the outcomes of patients with mild to moderate SUI treated with Duloxetine after HoLEP. Methods: A retrospective review for men with bladder outlet obstruction undergoing HoLEP between 1/2014 to 6/2018 at a single institution was performed. All patients received training and instructions for Kegel exercises and pelvic floor therapy referrals for SUI prior to initiation of Duloxetine. Patients with persistent SUI defined as mild-to- moderate leakage with straining or physical activity, requiring 1 or more pads were started on a trial of 20 mg Duloxetine. Patients were re-evaluated within 3 months. Paired t-test analysis were used to evaluate for differences in reported pads per day. Results: A total of 217 patients underwent HoLEP, and 20 men were included for analysis. The average time to initiating Duloxetine treatment was 2.8 ± 2.5 months. Average follow-up time was 11.7 ± 9.1 months. Five patients discontinued the medication due to side effects, which included sleep disturbances (15%), fatigue (5%), rash (5%), and nervousness (5%). Of the remaining 15 patients on Duloxetine, SUI symptoms improved in 10 men (66%), where reported pads per day significantly decreased from 2.5 ± 1.4 pads pre-Duloxetine to 1.5 ± 2.0 pads post-Duloxetine (p=0.04, mean difference 0.9, 95% CI 0.1 – 1.8). At most recent follow-up, 66% of men were completely dry. Conclusion: Duloxetine significantly improved SUI after HoLEP in 66% of men. Duloxetine may benefit patients with SUI following HoLEP for patients with understanding of potential side effects. Funding: N/A
Poster #23 HOLMIUM LASER ENUCLEATION OF THE PROSTATE IN THE ELDERLY: AN AGE- CONTROLLED COMPARISON OF SURGICAL AND POSTOPERATIVE OUTCOMES Alex Borchert, MD, David Leavitt, MD Henry Ford Hospital Presented By: Alex Borchert, MD
Introduction: Holmium laser enucleation of the prostate (HoLEP) is a safe and effective treatment for benign prostatic hyperplasia (BPH). However, there is currently limited data evaluating the safety and outcomes of HoLEP in elderly patients. To better inform quality improvement of bladder outlet reduction procedures in elderly patients at our institution, we aimed to compare the outcomes of HoLEP in elderly patients with those of a younger cohort. Methods: We retrospectively analyzed our prospectively maintained institutional HoLEP database and included all patients who underwent HoLEP between December 2015 and October 2018. Study cohort was composed of patients of age greater than 80 years. Control cohort included patients ≤ 65 years old. Preoperative, operative, and postoperative parameters were recorded. Student’s t-test and chi-square test were utilized to compare continuous and categorical variables, respectively. Results: Forty-two patients were included in this study, 14 cases and 28 controls. ASA score was significantly higher amongst elderly patients (p=0.004). There was no significant difference between the groups in operative time, preoperative prostate volume, pathologic prostate volume, incidence of cancer detected, or estimated blood loss. Regarding postoperative parameters, there was no difference in length of hospital stay, complications, repeat procedures, emergency department visits, or readmissions.
Table of Contents 239 Conclusion: Following HoLEP at our institution, elderly patients had similar outcomes, rates of complications and subsequent health care encounters compared to a younger population. Though more data are needed, it appears with appropriate optimization, HoLEP may be a safe treatment option for elderly patients with symptomatic BPH. Funding: N/A
Poster #24 CLINICAL OUTCOMES OF HOLMIUM LASER ENUCLEATION OF PROSTATE IN OCTOGENARIANS Timothy C. Boswell, MD, Malek Meskawi, MD, Marcelino E. Rivera, MD Department of Urology, Mayo Clinic, Rochester, MN Presented By: Timothy Charles Boswell, MD
Introduction: Medical treatment of benign prostate hyperplasia (BPH) and increased life expectancy have resulted in more octogenarians presenting for BPH surgery. Thus, we aimed to review clinical outcomes and safety of Holmium laser enucleation of the prostate (HoLEP) in treating octogenarians with symptomatic BPH. Methods: We retrospectively reviewed all HoLEPs performed at our institution between 2009-2018 to identify patients > 80 years old. Baseline patient characteristics, operative factors, perioperative complications, and 3-month follow-up were tabulated. Achievement of Trifecta at 3 months after surgery was defined as mild AUASS (<8), no evidence of incontinence, and low residual volume (PVR<150 mL). Logistic regression models were fitted to identify predictors of Trifecta. Results: Of 1,342 HoLEPs performed during this time period, 157 (12%) patients were > 80 years old. Median age and prostate size were 82 years and 107 grams, respectively. 90 (57%) patients were catheter dependent preoperatively. Outpatient surgery with overnight stay was feasible in 74%. At 3 months, AUASS, Qmax, and PVR were significantly improved after surgery (all p<0.001). Clavien II, III and IV complications were recorded in 20, 1, and 2%, respectively. The rates of stress, mixed, and urge urinary incontinence at 3 months were 22, 4, and 8%. Trifecta outcome was achieved in 52% of patients at 3 months. In logistic regression analyses, only a urodynamic diagnosis of underactive/acontractile bladder was an independent predictor of worst Trifecta outcome (OR 2.7; p=0.02). Conclusion: HoLEP is safe and effective in treating octogenarians with symptomatic benign prostate hyperplasia. Funding: N/A
Poster #25 CONTINUATION OF ANTIPLATELET AND/OR ANTICOAGULATION IN PATIENTS UNDERGOING REZUM PROSTATE ABLATION David Y Yang, MD, Tal D Cohen, MD, Ross A Avant, MD, Sevann Helo, MD, Tobias S Kohler, MD, MPH Mayo Clinic, Department of Urology Presented By: Tal D. Cohen
Introduction: Rezūm is a minimally invasive technique to treat benign prostatic hyperplasia (BPH). Discontinuation of perioperative antiplatelet and/or anticoagulation (APAC) is preferred to avoid bleeding complications. We present our experience using Rezūm in patients continuing APAC in the perioperative setting. Methods: We retrospectively reviewed 144 patients that underwent Rezūm therapy by a single BPH surgeon since 7/2017. When deemed medically necessary, APAC was continued in the perioperative setting. Large glands (≥80 g) utilized stacked treatments and often received the max 15 Rezūm treatments per device. Post-procedure catheterization regimen included a minimum of 3 days and a maximum of 4 weeks in men with preoperative catheter dependence. Results: Thirty-seven patients were treated on APAC. Outcomes are reported in the Table. Briefly, the average prostate gland size was 71 grams. Significant improvements were seen in AUA symptom score, peak flow, and post void residual (p<0.05). Bleeding
Table of Contents 240 complications occurred in 3 (8.1%) patients. Two patients required catheter irrigation whereas a third patient required cystoscopic clot evacuation and blood transfusion. All 3 patients were on single antiplatelet therapy and no patients on anticoagulation had bleeding complications. Conclusion: In our experience, bleeding complications on APAC is rare. In patients with increased perioperative cardiovascular risk, continuing APAC in the perioperative Rezūm setting should be considered. Funding: N/A
Poster #26 THE EFFECT OF PREOPERATIVE FINASTERIDE ON HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) OPERATIVE METRICS Viraj Maniar, MD1, Maraika Robinson2, Amy Guise, MD3, Peter Dietrich, MD3, Robert Medairos, MD3 1Medical College of Wisconsin, Department of Urology, Milwaukee, WI, 2Medical College of Wisconsin, Milwaukee, WI, 3Medical College of Wisconsin, Department of Urology, Milwaukee, W Presented By: Viraj Maniar, MD
Introduction: Finasteride has long been used by urologists to treat patients with benign prostatic hyperplasia. Its impact on surgical intervention is unclear. We aimed to determine the effect of preoperative finasteride on operative metrics of HoLEP. Methods: A retrospective review of 198 patients who underwent a HoLEP by one surgeon from 2013 to 2018 was performed. Patients’ charts were reviewed for preoperative finasteride use (5 mg daily), and intraoperative variables of operative time, enucleation time, morcellation time, and pathologic specimen weight. MANOVA analysis was performed between the finasteride and non-finasteride groups examining operative time, enucleation, morcellation time, prostate specimen weight. Results: 67 patients used finasteride preoperatively compared to 131 who did not. Mean values for operative time, enucleation time, morcellation time, and pathologic specimen weight were calculated and can be seen in Table 1. Operative time, enucleation time, morcellation time, and pathologic specimen weight were significantly different between the two groups with a p=0.0082. Conclusion: The use of preoperative finasteride decreases operative time, enucleation time, morcellation time, and increased pathologic specimen weight obtained. Further studies are needed to determine the effect of preoperative finasteride use on intraoperative metrics as well as long term outcomes for HoLEP. Funding: N/A
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Poster #27 BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE AND URETHRAL STRICTURE: POSTOPERATIVE TRUTH VS HYPE: A RANDOMIZED CONTROL STUDY Hesham Helmy, Department of Urology Tanta University Presented By: Hesham Ahmed Helmy Sr., MD
Introduction: Bipolar transurethral resection of prostate (B-TURP) was introduced as an alternative procedure to minimize the surgical complications of monopolar TURP (M- TURP). However, there are concerns about increased incidence of stricture urethra (SU) post B-TURP. This study was designed to analyze the incidence of SU among patients undergoing M-TURP versus B-TURP. Methods: This is a randomized controlled, single blinded study; randomization was performed using a stratified permuted randomization algorithm (1:1 ratio) and only the patients were blinded. Both M-TURP and B-TURP were performed with a 26 Fr resectoscope; the electrosurgical generators were Karl Storz autocon II 400 and Olympus UES-40 surgMaster (TUR in saline [TURIS] method), respectively. Follow-up visits were scheduled at 3,6, and 12 months post-surgery and patients with lower urinary tract symptoms and a maximum urinary flow rate of <10 ml/sec on uroflowmetry underwent retrograde urethrography to assess for development of stricture urethra. Results: Twenty-six patients were randomized to each arm. One developed SU in the monopolar group, whereas there were two cases in the bipolar group (p=0.2). these two patients in B-TURP belonged to the refractory urinary retention subgroup; while the SU patient in M-TURP group belonged to the failed medical management subgroup (p=1.0). Conclusion: The incidence of SU following B-TURP using the TURIS system was comparable to conventional M-TURP. Moreover, the incidence of SU was same for both the techniques when sub-grouped according to the indication for surgery that is failed medical management versus refractory urinary retention. Funding: N/A
Poster #28 DECISION MAKING MARKOV MODEL TO BALANCE RISKS AND BENEFITS OF BENIGN PROSTATIC HYPERPLASIA TREATMENT Sofer Lauer, MD1, Crivellaro Simone, MD1, Zuberek Marcin, MD1, Paolo Serafini2 1University of Illinois at Chicago, Chicago, Illinois, 2Univserity of Udine, Italy Presented By: Laurel Sofer
Introduction: Treatments of BPH have improved outcomes but added risk of urinary incontinence (UI). We propose a tool to identify the most risk-effective treatment for BPH. Methods: Markov model was created based on a set of BPH health states. Utilities and calculated disutilities of each state were obtained from the literature. Transition probabilities were determined using mean changes in IPSS scores four surgical modalities from the literature and expert opinion. Risk analysis was performed using adverse event data. Average risk of UI versus given disutility thresholds was calculated using linear programming in a Markov decision model. Primary outcomes were percentage of post treatment patients with mild symptoms (IPSS 0-7).
Table of Contents 242 Results: Varying the maximum disutility, average risk of UI was determined and a risk- effectiveness curve was created, demonstrating the tradeoffs between % of patients leaving the model with mild symptoms (IPSS 0-7) and the rate of UI (Graph 1). With a breaking point of 89% of patients with mild symptoms, one can determine the most risk- effective procedure for each health state at a given % of patients having mild symptoms after treatment (Table 1). Conclusion: This model allows for the most risk-effective treatment of BPH. Limitations include reliance on data from available literature. Further studies are needed to validate the model. Funding: N/A
Poster #29 THE EFFECT OF THE URINARY AND FECAL MICROBIOTA ON LOWER URINARY TRACT SYMPTOMS MEASURED BY THE INTERNATIONAL PROSTATE SYMPTOM SCORE Bradley Holland, MD1, Ahmed El-Zawahry, MD1, Danuta Dynda, MD1, Kevin McVary, MD1, Kristin Delfino, PhD1, Andrea Braudmeier-Fleming1, Shaheen Alanee, MD2 1Department of surgery, division of Urology, SIU School of medicine, 2VCORE – Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI Presented By: Bradley Holland, MD
Introduction: Variations in the human microbiota may promote different benign disease conditions. Here we examine the association between urinary and fecal microbes and the different aspect of lower urinary tract symptoms (LUTS) in adult males. Methods: DNA extracted from urine and fecal samples from 30 adult males. International prostate symptom score (I-PSS) data was collected. Extracted DNA was amplified and sequenced using bacterial 16S rRNA gene high-throughput next-generation sequencing platform, and analyzed microbial profiles for taxonomy to examine the association between the different operational taxonomy units (OTUs) and LUTS represented by overall I-PSS score and its subcomponents (storage, nocturia, voiding, and bother). Results: 30 patients in our analysis (60 samples, one urine and one fecal per patient). 48 fecal OTUs showed significant association with one or more of the I-PSS components; 27 with nocturia, 19 with bother, 16 with storage symptoms, and 9 with voiding complaints. The strongest negative (protective) association was between Lachnospiraceae Blautia, a bacteria very active in the gut, and bother (correlation coefficient – 0.702, p-value 0.001). 10 urinary OTUs showed significant association with LUTS; 8 with nocturia, 1 with bother, 3 with storage, and 1 with void. One Bacteria that
Table of Contents 243 belongs to a family shown to be enriched in bladder cancer, Ruminococcaceae Gemmiger, was associated with increased voiding, storage, and nocturia scores. Conclusion: We found a plausible correlation between urinary and fecal microbiota and LUTS. Additional studies are needed to determine if these associations are applicable to the general population of LUTS patients. Funding: N/A
Poster #30 TITLE: INITIAL EXPERIENCE WITH INTRAOPERATIVE FLUID WARMING DURING HOLMIUM LASER ENCULEATION OF THE PROSTATE (HOELP). Tim Large, MD, Charles Nottingham, MD, Amy Krambeck, MD Indiana University School of Medicine Presented By: Tim Large, MD, MA
Introduction: Core body temperature is a tightly controlled process. Maintaining normothermia throughout surgical procedures and during the perioperative period is a critical as prior research has linked perioperative hypothermia to significant complications. We felt patients would have warmer core body temperatures after HoLEP using the FluidSmart system and reduce post anesthesia complications. Methods: This is prospective randomized trial comparing outcomes including intra and postoperative body temperature, hospital stay and complications after HoLEP using standard fluid irrigation and the FluidSmartTM system. Men with LUTS/BPH and 100gm prostate or larger based on TRUS, CT, or MRI scan were enrolled in the study. Single tail t-tests were used to compare outcomes. Results: 52 patients, 21 standard and 31 FluidSmartTM have undergone HoLEP (table 1). Core body temperature was higher after surgery in FluidSmartTM patients (36.4 vs 36.2 p=0.04). Complications were all clavian II or less (9.5%) with 1 patient in the FluidSmartTM identified as having a bladder perforation from over pressurizing the bladder. Additionally, 1 patient in each group had clot urinary retention that required readmission and foley catheter irrigation. Conclusion: The FluidSmart system does provide continuous warmed pressurized fluid safely. Patients who underwent a FluidSmartTM HoLEP had higher core body temperatures than standard HoLEP, however, the clinical significance is still under investigation. Funding: None
Table of Contents 244 Poster #31 SAFETY OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE IN THE OUTPATIENT SETTING Deepak Agarwal, MD, Kevin Hebert, MD, Marcelino Rivera, MD Mayo Clinic, Department of Urology, Rochester, MN Presented By: Deepak K. Agarwal, MD
Introduction: Limited data is available assessing holmium laser enucleation of prostate (HoLEP) performed in the outpatient setting. We performed a retrospective review of our outpatient HoLEP experience to assess feasibility of the approach. Methods: We retrospectively reviewed single surgeon data of men undergoing HoLEP in the outpatient setting between July 2017 and March 2018 at Mayo Clinic (Rochester, MN). Detailed preoperative, perioperative, and postoperative information was obtained. Statistical analysis was performed to evaluate for significant associations in men discharged the same day versus men admitted for overnight observation. Results: A total of 52 men (median age 69.1 years) underwent HoLEP with plan for same-day dismissal. Median prostate size was 58.5 cm3 (IQR 41-82.3), morcellated tissue volume 36.4 cm3, time on CBI 212 minutes (IQR 173-353), and total postoperative time prior to discharge 316 minutes (IQR 243-414). At 3-month follow-up, average improvement in flow rate was 12.4 ml/s and reduction in AUA symptom score was 13 points. No complications were noted however, four patients experienced postoperative retention requiring catheterization between 2-11 days. Only 5 (9.6%) patients required overnight admission for prolonged CBI. On univariate analysis, no statistically significant associations were noted between men discharged same day versus men admitted for overnight observation. There was a non-statistically significant association between CBI time compared to prostate size (p=0.067) Conclusion: Appropriately selected patients can undergo HoLEP in the outpatient setting. Further data is needed to assess maximum size that can be safely performed as an outpatient. Funding: N/A
Poster #32 REAL WORLD OUTCOMES OF PROSTATIC URETHRAL LIFT (PUL) FOLLOWING PROSTATE CANCER THERAPY Gregg Eure, MD1, Steven Gange, MD2, Peter Walter, MD3, Ansar Khan, MD4, Charles Chabert, MD5, Thomas Mueller, MD6, Paul Cozzi, MD7, Manish Patel, MD8, Sheldon Freedman, MD9,Peter Chin, MD10, Steven Ochs, MD11, Andrew Hirsh, MD12, Michael Trotter, MD13, Douglas Grier, MD14 1Urology of Virginia, Virginia Beach, VA, 2Summit Urology Group, Salt Lake City, UT, 3Western NY Urology Associates, Cheektowaga, NY, 4Urology Heath Center, Fremont, NE, 5The Prostate Clinic, Benowa, QSD, Australia, 6Delaware Valley Urology, Voorhees, NJ, 7Dr. Paul Cozzi, Hurstville, NSW, Australia, 8Urology MD Consultant, LLC, Elgin, SC, 9Sheldon Freedman, MD LTD, Las Vegas, NV, 10South Coast Urology, Wollongong, NSW, Australia, 11Urology One, Canton, OH, 12Jersey Urology Group, Somers, NJ, 13Midtown Urology Associates, Austin, TX, 14Sound Urological Associates, Edmonds, WA Presented By: Steven E. Ochs, MD
Introduction: Surgical treatment of BPH may not be recommended in prostate cancer (CaP) patients due to increased incidence of post-operative bleeding, incontinence and infection. This study summarizes outcomes of PUL following CaP therapy. Methods: Retrospective analysis of 1413 patients who received PUL was performed. 108 CaP subjects were identified, 73 who received: external radiation (n=28), brachytherapy (n=17), cryoablation (n=10) and androgen deprivation therapy +/- chemotherapy (n=18). IPSS, QoL and Qmax were evaluated at 1, 3, 6, 12, & 24 months post-procedure using paired t-tests and 95% confidence. Demographics and adverse event rates were compared to non-cancer subjects. Results: Baseline IPSS (18.6), QoL (4.1) and Qmax (11.4) for CaP subjects did not differ from the total study population, and mean duration from cancer diagnosis to PUL was 4.9 years [range 0.3-248mo]. Following PUL, mean IPSS for CaP subjects improved at all
Table of Contents 245 timepoints [range 4-13.3 (Figure 1)] and sub-analysis revealed symptom relief across therapy cohorts. CaP subjects did not experience any serious bleeding or significant increases in incontinence, urinary tract infection and urosepsis compared to subjects without cancer. Three patients underwent an additional surgical intervention an average of 277 days post-PUL. Conclusion: PUL provides symptom relief to CaP patients suffering from LUTS without increasing rates of specific adverse events of high concern. Funding: Neotract/Teleflex Inc.
Poster #33 SUPERFLUOUS HOSPITAL EXPENDITURE ASSOCIATED WITH UNINDICTED RENAL CYST SURVEILLANCE Michael Wang, BS1, Mitchell Ng, BS1, Laura Bukavina, MD MPH2, Amr Mahran, MD MS2, Kirtishri Mishra, MD2, Al Ray III, MD2, Christina Buzzy, PhD3, Kristina Garrels, MD4, Carvell Nguyen, MD PhD4 1Case Western Reserve University School of Medicine, Cleveland, Ohio, 2University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio, 3Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 4Metro Health Medical Center, Cleveland, Ohio Presented By: Michael Wang, BS
Introduction: Unindicated imaging for Bosniak I and II cysts occurs frequently despite their benign nature, incurring unnecessary costs to both the hospital, and to the patient. We aim to study the renal cyst surveillance patterns at our institution and the associated surplus cost of unindicated imaging. Methods: Patients with a renal cyst diagnosis between January 2017 and June 2018 were identified. Unindicated renal cyst follow-ups were defined by the Radiographic Society of North America (RSNA) and Canadian Urological Association (CUA). Total unnecessary expenditures from ultrasound (US), CT, and MRI were calculated using cost of services provided by the FairHealthConsumer. Results: A total of 1100 patients were identified, with random sample of 292 selected for analysis. 271 patients were diagnosed with Bosniak I and II renal cysts, 52 patients (19%) received unindicated imaging (60 US, 19 CT, and 5 MRI). Total superfluous cost of $964,711. Multivariable analysis showed higher unindicated imaging for Bosniak II renal cysts(OR: 3.2, 95% CI: 1.6- 6.3, p<0.001), and decreased surveillance imaging for African Americans (OR: 0.29, 95% CI: 0.13-0.59, p<0.001). Conclusion: Among patients diagnosed with Bosniak I and II renal cysts, unnecessary use of imaging in surveillance was associated with higher hospital costs. Funding: N/A
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Poster #34 CURRENT KNOWLEDGE AND OPINIONS OF MEDICAL TRAINEES REGARDING PSA SCREENING Tyler Sheetz, MD, Tasha Posid, MA, PhD OSUMC Presented By: Tyler James Sheetz, MD
Introduction: In 2019, PSA screening guidelines remain inconsistent, and controversy still exists about its clinical utility. In this study, we seek to assess knowledge and opinions of medical trainees and gain insight into their education on this topic. Methods: RedCap was used to survey 41 medical students and 22 residents from a single institution (N=63; Mage=26.7 years, 36 females). Variables measured included PSA clinical knowledge, awareness of the PSA controversy, and attitudes/confidence/viewpoints on use of PSA screening in clinical practice. Results: 60.6% of medical trainees reported little or no knowledge of PSA screening guidelines. Although residents reported greater knowledge of PSA guidelines than medical students (p=.004), actual knowledge of PSA screening did not differ between groups (p>.9). Trainees received education from other healthcare professionals (70.4%), didactics (66.7%), or internet (38.9%). Residents were more confident than medical students in discussing PSA screening with patients (p=.005). More than 75% of respondents wanted more information about PSA testing, with medical students particularly interested in diagnosis/detection (p=.062), treatment (p=.001), and survival (p=.029). Opinions towards adjunctive PSA testing were generally positive and appear in Figure 1. Conclusion: Better education about the current PSA screening guidelines for medical trainees is imperative, particularly given that shared decision-making is of great importance when counseling patients on cancer screening. Funding: N/A
Table of Contents 247 Poster #35 CLINICAL EXPERIENCE WITH GERMLINE MUTATION TESTING IN A COHORT OF PROSTATE CANCER PATIENTS TREATED AT ACADEMIC AND COMMUNITY CENTERS Sadhna Ramanthan1, Savitha Balaraman, MD2, Michael Levin, MD3, Benjamin Johnson, MD4, Jeff Fensterer5, Kirk Wojno, MD4, Howard Korman, MD2 1Albion College, 2Oakland University William Beaumont School of Medicine, 3Comprehensive Urology, 4Comprehensive Urology, 5Strand Diagnostics Presented By: Michael Levin, MD
Introduction: A significant subset of prostate cancer (PCa) patients harbor DNA damage repair (DDR) gene mutations associated with more aggressive disease, familial risk of hereditary cancers and potential benefit from newer therapies. Though guidelines recommend genetic testing (GT) for specific subgroups of PCa patients, limited access to GT and counseling services acts a barrier. We present our multi-disciplinary clinic experience with a streamlined process for germ line mutation testing. Methods: PCa patients at 32 academic and community practices were screened, based on family history and pathology. Patients were counseled by their physician and consent obtained for testing buccal swabs. GMT was done via Strand Diagnostics next generation sequencing. Results: 402 patients were tested for mutations in 7 DDR genes with no significant significance (SS) in median age of men with and without mutations (70.1 vs. 68.2 years, p=0.432). The overall mutation rate was 11.94%, with BRCA2, ATM and CHEK2 being the commonly mutated genes. Gleason 7 (3=4) tumors showed an unexpectedly high mutation rate (30.3%). Rate of Mutations in DNA Repair Genes Gene: # Patients (%) with Mutation (Total tested= 402) ATM: 10 (2.49%) BRCA1: 8 (1.99%) BRCA2: 13 (3.23%) CHEK2: 9 (2.24%) HOXB13: 3 (0.75%) PALB2: 2 (0.5%) RAD51D: 3 (0.75%) Conclusion: Our clinical experience with germline mutation testing was consistent with previously reported data and yielded interesting insights in certain subgroups of patients. The process was streamlined by implementing protocols to identify at risk patients, counselling and obtaining samples, resulting in increased compliance and expeditious testing. Funding: Strand Diagnostics
Poster #36 SYSTEMIC TREATMENT FOR METASTATIC CASTRATION RESISTANT PROSTATE CANCER (M-CRPC): DOES SEQUENCE MATTER? Mohamed Ahmed, MB, BCh1, Jack Andrews, MD1, Rimki Haloi1, Robert Karnes, MD1, Eugene Kwon, MD1, Allan Bryce, MD2 1Mayo Clinic Urology, 2Mayo Clinic Arizona Medical Oncology Presented By: Mohamed Ahmed
Introduction: Optimal sequencing of systemic therapy in the management of m-CRPC (i.e. chemotherapy or 2nd generation hormone therapy) remains poorly elucidated. In a retrospective study, we attempt to investigate two common treatment sequences. Methods: Retrospectively, we identified 96 patients with m-CRPC. 66 patients (Group-A) received full course docetaxel chemotherapy with no prior 2nd generation hormone therapy (2ndADT; i.e., Abiraterone or Enzalutamide). 30 patients (Group-B) received docetaxel after 2ndADT failed. Favorable outcomes were assessed after full course docetaxel treatment was given and defined as a ≥ 50% reduction in PSA from pre- Docetaxel values and/or achieving undetectable PSA <0.10.
Table of Contents 248 Results: Median age was 61.7, median Gleason score 9 and Pre-docetaxel PSA 6.4ng/ml for Group-A versus 14.5ng/ml for Group-B. Both Groups received median of 6 cycles Docetaxel treatment. Docetaxel treatment given in the absence of prior 2ndADT (Group-A) was associated with favorable outcomes in 84.9% subjects studied. Docetaxel treatment given after failure of 2ndADT (Group B) was associated with favorable outcomes in 33.3% of subjects. Comparison of outcomes group A versus B were statistically significant (p-value <0.0001). We also note significant differences in 5-year-survival between Group-A (69.4%) and Group-B (52.3%). (Log-Rank=0.0034) Conclusion: Our data indicates that sequence of systemic therapy may influence outcomes for subjects with m-CRPC. Although we recognize limitations in this retrospective study, we believe further investigations of sequencing such therapies for m- CRPC are clearly warranted. Funding: N/A
Poster #37 ONSET AND MAINTENANCE OF TESTOSTERONE (T) SUPPRESSION IN FOUR PIVOTAL TRIALS OF SUBCUTANEOUSLY-ADMINISTERED LEUPROLIDE ACETATE (SC-LA) FORMULATED WITH BIODEGRADABLE POLYMER DELIVERY SYSTEM Vahan Kassabian, MD1, John McLane, PhD2, Deborah Boldt-Houle, PhD3, Stuart Atkinson, MB ChB3 1Advanced Urology, Atlanta, GA, 2Clinical Development, Tolmar, Inc., Fort Collins, CO, 3Medical Affairs, Tolmar Pharmaceuticals, Inc., Lincolnshire, IL Presented By: Vahan S. Kassabian, MD
Introduction: Subcutaneously administered leuprolide acetate (SC-LA) formulated with a biodegradable polymer delivery system has demonstrated efficacy in suppressing T levels to achieve and maintain medical castration (T<50ng/dL) in advanced PCa patients. Sustaining T<20ng/dL may improve disease-specific survival. This study determines onset and maintenance of T≤50ng/dL with SC-LA. Methods: Eugonadal PCa patients received 7.5, 22.5, 30, or 45mg injections of SC-LA lasting 1, 3, 4, or 6 months, respectively, in 4 open-label, fixed-dose, pivotal trials. Onset and maintenance of T≤ target levels were calculated by extrapolating time when T first crossed target. Proportion of time below target was calculated as the total time T remained below target divided by time after target was first achieved to end of study. Results: Median onset of T≤50, ≤20, and ≤10ng/dL were 21, 28, and 35 days, respectively. The mean proportion of time T suppressed ≤50, 20, and 10ng/dL was 100%, 94-99%, and 66-85%, respectively (Table). Conclusion: SC-LA achieved effective onset of T≤50, ≤20, and ≤10ng/dL at 3, 4, and 5 weeks, respectively. SC-LA maintained consistently low T levels, with over 66% and 94% of the treatment period remaining ≤10 and 20ng/dL, respectively, and 100% of the treatment period remaining ≤50ng/dL. This T suppression may have implications for improved survival and extended time to disease progression. Funding: Tolmar, Inc.
Table of Contents 249 Poster #38 LATE ADMINISTRATION OF LEUPROLIDE, IMPACT ON TESTOSTERONE (T) SUPPRESSION, AND FREQUENCY OF T AND PROSTATE-SPECIFIC ANTIGEN (PSA) TESTING IN PROSTATE CANCER (PCA) IN THE REAL-WORLD Judd Moul, MD1, Stuart Atkinson, MB ChB2, Deborah Boldt-Houle, PhD2, Vahan Kassabian, MD3 1Duke University, Durham, NC, USA, 2Medical Affairs, Tolmar Pharmaceuticals, Inc., Lincolnshire, IL, USA, 3Advanced Urology, Atlanta, GA, USA Presented By: Judd W. Moul, MD, FACS
Introduction: Leuprolide is a frequently used drug for androgen deprivation therapy (ADT) in PCa. Maintaining T<20ng/dL with ADT is desirable and correlates with improved disease-specific survival in advanced PCa patients. However, T breakthroughs (levels rising above castrate level T<50ng/dL) may occur between administrations, especially when a dose is delayed. Late administration, inadequate T suppression, or disease progression to advanced PCa may also cause a rise in PSA levels. Current study evaluated timeliness of leuprolide administrations, rate of T breakthroughs, and frequency of T/PSA testing prior to dosing. Methods: Retrospective review of electronic medical records (1/1/07-6/30/16) of leuprolide administrations (n=78,358) evaluated the frequency of late administrations (defined as occurring on/after day 33, 98, 129, 195 for 1-, 3-, 4-, 6-month formulations, respectively), T tests >50ng/dL, and T/PSA test prior to dosing. Results: For all administrations, 26.7% were late: 14.5% ≤1 week, 3.2% 1-2 weeks, and 9% >2 weeks late. 28% of T values exceeded 50ng/dL when administrations were late vs. 4% when early or on-time. 83% of leuprolide administrations had a PSA test prior to administration; however, only 14% had a similarly timed T assessment. Conclusion: Across leuprolide administrations, more than a quarter of administrations were late. Late administrations were correlated with ineffective castration, yet T values were not routinely assessed. Considering the clinical benefits of suppressing T throughout ADT course, clinicians should administer treatments within approved dosing instructions, routinely monitor T levels, and consider prescribing treatments with proven efficacy through the dosing interval to maintain T at castrate levels. Funding: Tolmar Pharmaceuticals, Inc.
Poster #39 FREE HAND TRANSRECTAL ULTRASOUND GUIDED SYSTEMATIC BIOPSIES VS TEMPLATE SYSTEMATIC BIOPSIES OBTAINED USING MRI -US FUSION MACHINES: AN ANALYSIS OF CANCER DETECTION RATES Connor Hoge1, Monzer Haj-Hamed1, Nilesh Patil1, James Donovan1, Krishnanath Gaitonde1, Sadhna Verma2, Abhinav Sidana1 1University of Cincinnati Department of Urology, 2University of Cincinnati Department of Radiology Presented By: Connor Hoge
Introduction: There are some reports that the 12-core template systematic biopsies (SBx) obtained using software registration machines (e.g. Artemis) have higher cancer detection rates (CDRs) than that of the standard 12-core transrectal ultrasound (TRUS) guided biopsies. The goal of our study is to compare the CDRs of SBx in two independent patients’ cohorts who underwent TRUS systematic biopsy alone (Cohort A) or underwent SBx as a part of combined MRI-US fusion and SBx using MRI-US fusion machine (Cohort B). Methods: A retrospective review of all patients undergoing prostate biopsies over a 2- year period was performed. Statistical significance was considered at p < 0.05. Results: Four hundred and forty-nine men underwent SBx. The CS CDR of SBx in Cohort A & B were 92(43.2%) and 71(30.7%), respectively (p>0.05). In patients with no prior history of prostate biopsy, SBx CDR for CS disease was 183(85.9%) and 98(42.8%) in cohorts A & B, respectively. Multivariate logistic regression controlling for age, PSA, DRE, family history demonstrated comparable CS CDR by SBx in two cohorts even
Table of Contents 250 when stratified by prior biopsy history (all patients p=0.118, biopsy naive p=0.705, prior negative prostate biopsy p=0.453). Conclusion: Our study did not find a significant difference in the CS CDRs of SBx using registration software as compared to SBX using free hand TRUS. Unless the SBx is done at the time of MRI-US fusion biopsy, use of these machines for obtaining SBx only is unlikely to result in any increase of CS CDR. Funding: N/A
Poster #40 ASSESSMENT OF RACIAL DIFFERENCES IN THE UTILIZATION OF PROSTATE MULTIPARAMETRIC MRI FUSION BIOPSY IN PROSTATE CANCER EVALUATION Connor Hoge1, Monzer Haj-Hamed1, Nilesh Patil1, James Donovan1, Krishnanath Gaitonde1, Sadhna Verma2, Abhinav Sidana1 1University of Cincinnati Department of Urology, 2University of Cincinnati Department of Radiology Presented By: Connor Hoge
Introduction: Studies have demonstrated that the higher incidence and death rate of prostate cancer (PCa) in African American (AA) men can be attributed to genetics and modifiable risk factors, socioeconomic factors and health care disparities also contribute to worse outcomes. The goal of our study was to identify differences in utilization of MRI- ultrasound fusion biopsy (FBx) for PCa evaluation between AAs and White men presenting with suspicion for PCa. Methods: A retrospective review of patients undergoing either transrectal-US guided systematic biopsy (SBx) only or a combined FBx + SBx over a 2-year period was performed. Results: Four hundred and thirty-four (316 White, 118 AA) men were included in the study. AAs were less likely to undergo combined FBx+SBx than Whites (41.1% vs 64.4%; p < 0.0001). This trend was seen on analysis of biopsy naïve patients alone where AAs underwent SBx over combined FBx+SBx at a significantly higher rate (81.9% vs 58.3%; p < 0.0001). After controlling for age, PSA, DRE and family history, AAs were 2.4 times more likely to have a SBx over a combined FBx+SBx compared to their white controls (p < 0.0001). Among biopsy naïve patients, AAs were 2.6 times more likely to undergo SBx only (p= 0.004) after controlling for other factors. Conclusion: Although FBx is a superior modality for early detection of PCa, we found that AAs were less likely to undergo FBx when presenting with PCa suspicion. Further studies are needed to examine socioeconomic and insurance factors that could explain the above disparity. Funding: N/A
Poster #41 PRELIMINARY EVALAUATION OF ISOPSA VS. PIRADS SCORE FOR DETECTION OF HIGH GRADE PROSTATE CANCER Eric Klein, MD1, Arnon Cahit2, Aimee Kestranek2, Prassad Gawande2, Boris Zaslavsky2, Mark Stovsky1 1Cleveland Clinic, 2Cleveland Diagnostics Presented By: Eric A. Klein, MD
Introduction: We conducted a preliminary evaluation comparing clinical performance of PI-RADS score versus IsoPSA™, a novel structure-focused plasma-based test to assess potential discrimination of high-grade (Gleason≥7) from benign or low-grade (Gleason=6) patients. Methods: Plasma samples (N=89) were obtained from a single clinical site, collected within 30 days prior to prostate biopsy from patients with blood PSA between 2 and 41.1 ng/ml. IsoPSA and PI-RADS score were evaluated against either mpMRI-US fusion (N=69) or 12 core TRUS (when PI-RADS had zero score, N=20) biopsy results as gold standard, and ROC curve analysis was performed for both.
Table of Contents 251 Results: The prevalence of GS≥7 in this cohort was 30%. ROC analysis for IsoPSA resulted in AUC=0.83 vs. AUC=0.71 for PI-RADS score using the same biopsy method for both. For 20 patients with PI-RADS zero score that underwent TRUS biopsy, 3 had GS≥7, although the same patients were correctly predicted as having high-grade disease by IsoPSA. PI-RADS>3 correctly identified 22/27 (SN=81%) actionable cases while having 26/62 (SP=58%) false positives. Even PI-RADS>0 cutoff still missed 3/27 (SN=90%) high-grade cancers with 45/62 (SP=27%) false positives vs. IsoPSA at its usual cut-off K>8.5 resulting in 2/27 (SN=93%) false negatives and 34/62 (SP=45%) false positives. Conclusion: IsoPSA clinical performance improves with the quality of the gold standard (mpMRI-US fusion vs. TRUS). As a simple blood-based assay at significant cost differential advantage, IsoPSA also demonstrated superior clinical performance to PI- RADS score for selection of mpMRI-US fusion vs. TRUS biopsy. Funding: Cleveland Diagnostics
Poster #42 WHY IS SURGICAL CASTRATION UNDER-UTILIZED FOR METASTATIC PROSTATE CANCER? ANSWERS FROM PATIENTS RECEIVING ANDROGEN-DEPRIVATION THERAPY Morgan Schubbe, MD1, Conrad Tobert, MD1, Rohan Garje, MBBS2, Bradley Erickson, MD, MPH1, Paul Gellhaus, MD1 1University of Iowa Hospitals and Clinics, Department of Urology, Iowa City, IA, 2University of Iowa Hospitals and Clinics, Department of Internal Medicine, Division of Hematology, Oncology, and Blood Marrow Transplantation Presented By: Morgan E. Schubbe, MD
Introduction: Castration is required for metastatic prostate cancer treatment. This requires either orchiectomy or androgen-deprivation therapy (ADT). ADT is associated with worse adverse effects and higher costs after one year compared to orchiectomy. Despite this, some studies quote <1% rate of surgical castration. We sought to evaluate patient perceptions of ADT and orchiectomy. Methods: 142 patients receiving ADT for metastatic prostate cancer were identified by a pharmacy database. Patients were mailed a survey evaluating their bother with frequent clinic visits, fear of disease progression, treatment-related side effects and physical changes, and their recall of being offered surgical castration. They were also queried regarding their interest in orchiectomy. Results: Survey response rate was 40% (57/142). Among respondents, 16% worry about efficacy of therapy between injections. While 74% of patients receiving ADT are not bothered by the frequent clinic visits, more than half (63%) were not offered surgical castration as an alternative. 41% are interested in orchiectomy as an alternative (Figure 1). Conclusion: Patients with metastatic prostate cancer are interested in surgical castration more frequently than the treatment is offered. When planning surgical castration, reduced overall cost and fewer adverse effects associated with orchiectomy should be a part of the discussion. Funding: N/A
Table of Contents 252 Poster #43 PREDICTING PATHOLOGIC T3 DISEASE PRIOR TO PROSTATECTOMY: THE UTILITY OF MULTIPARAMETRIC PROSTATIC MRI Isamu Tachibana, Adam Calaway, Ryan Speir, Yan Tong, Ronald Boris, Clint Cary, Michael Koch Indiana University Presented By: Isamu Tachibana, MD
Introduction: We sought to assess the diagnostic accuracy of MRI for non-organ confined disease at the time of prostatectomy using radical prostatectomy specimens as the reference standard. Methods: A retrospective review of patients undergoing radical prostatectomy with a prostate MRI at Indiana University between July 2015 and March 2018 were analyzed. MRI findings and pathological specimens were compared to assess the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting extracapsular extension (ECE) and seminal vesicle invasion (SVI). Logistic regression models were fit to explore clinical variables that may increase the ability to predict pathological pT3 disease. ROC curves were plotted using this model (Figure). Results: 360 patients were identified who met inclusion criteria. Sensitivity, specificity, PPV and NPV of MRI in predicting ECE and SVI were 31.8, 85.1, 68.3 and 55.2% and 22, 98.3, 72.2, and 86.5%, respectively. The simple and multiple logistic regression models predicting ECE and SVI demonstrated that the inclusion of multiple clinical variables increased the ability to accurately predict ECE and SVI preoperatively compared to MRI results alone. Conclusion: Prostate MRI performs poorly in accurately determining pathological ECE and SVI. Combining pre-operative clinical factors with MRI results increases the ability to predict pathological T3 disease before prostatectomy. Funding: N/A
Table of Contents 253 Poster #44 CENTRAL LESION LOCATION UNDERLIES THE LEARNING CURVE ASSOCIATED WITH TARGETED MRI/ULTRASOUND FUSION PROSTATE BIOPSIES Aravind Viswanathan, MD, Natasza Posielski, MD, Shivashankar Damodaran, David Jarrard, MD University of Wisconsin Hospital Clinics Presented By: Aravind Viswanathan, MD
Introduction: Our objective was to evaluate factors that contribute to the learning curve for Multiparametric Magnetic Resonance Imaging Transrectal Ultrasound fusion prostate biopsy, which is an increasingly utilized technique for screening and surveillance of prostate cancer Methods: A prospectively maintained database of patients undergoing fusion prostate biopsy performed by a single surgeon was reviewed. The initial 106 patients who underwent fusion biopsy were analyzed as 2 cohorts (early vs. late, 53 patients each) and 4 cohorts (in consecutive quartiles of 26 patients each) to assess factors impacting detection rate of cancer. Results: Of the 106 patients who underwent mpMRI fusion biopsy, a total of 149 targetable lesions ≥ PIRADS 3 were identified. Cancer detection rates for transitional zone lesions were higher in the late cohort compared to the early cohort. 22% of TZ lesions in early cohort had detectable cancer compared to 60% in late cohort (p = 0.04). No differences in detection rates were seen for peripheral lesions. The odds ratio of detecting cancer in the late cohort compared to the early cohort was 1.91 (p = 0.05). When the same dataset was analyzed as 4 cohorts, the odds ratio for detecting cancer was 1.89 in the second (p = 0.21), 2.44 in the third (p = 0.07), and 2.84 in the fourth quartile (p = 0.03). Conclusion: There is a significant learning curve is associated with mpMRI/TRUS fusion biopsies. The increased cancer detection rates associated with increased experience are noted for lesions located in the TZ. Funding: N/A
Poster #45 CORRELATION OF MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING VOLUME MEASUREMENTS TO PATHOLOGY AND IMPLICATIONS FOR FOCAL THERAPY Maria Uloko, MD, Christopher Warlick, MD, Greg Metzger, MD University of Minnesota Presented By: Maria Uloko, MD
Introduction: Recently updated NCCN® Prostate Cancer Guidelines include a subclassification of Intermediate-Risk (IR), termed Favorable-Intermediate Risk (FIR), for whom active surveillance may be considered. FIR patients are distinguished from Low Risk (LR) patients by the presence of one of three IR features: presence of Gleason Score (GS) 3+4 disease, clinical stage T2b/c, or PSA 10-20ng/ml. This group is thus heterogeneous, and whether all IR features bear equivalently on patient risk is unclear. We looked at the probability of having adverse pathology as measured by the Oncotype DX Genomic Prostate Score® (GPSTM) test in a large cohort of FIR patients who submitted biopsies for commercial laboratory testing. Methods: Commercial reports for >4900 NCCN FIR patients tested with the GPS assay between 5/15/2017 and 5/28/2018 were reviewed for GPS result and post-test risk categorization. Methods for score generation and risk group definitions have been described elsewhere. Result: GPS result spanned the full range (0 to 100), with median score of 27. 17 and 16% of patients’ results placed them in High Risk (HR) and LR, respectively. GS 3+3 patients had 9% HR and 26% LR results; GS 3+4 subset had 20% HR and 13% LR. Conclusion: The wide range of GPS results in this FIR patient subset shows diversity of risk based on tumor biology. Notably, score distributions and resulting risk classification for patients with GS 3+3 and 3+4 disease differ. GPS testing identifies FIR patients
Table of Contents 254 whose risk more resembles that of low or high-risk patients, aiding treatment decisions in this heterogeneous group. Funding: N/A
Poster #46 GENOMIC PROSTATE SCORE® TESTING REVEALS BROAD HETEROGENEITY OF RISK AMONG NCCN® FAVORABLE INTERMEDIATE RISK PATIENTS Richard Sarle1, David Albala2,3, Edward Uchio4, Michelle Turner5, Elizabeth Bagley5, Jay Newmark5 1Michigan Institute of Urology, Dearborn, MI, 2Department of Urology, Crouse Hospital, Syracuse, NY, 3Associated Medical Professionals of New York, Syracuse, NY, 4Department of Urology, University of California Irvine, Irvine, CA, 5Genomic Health, Inc., Redwood City, CA Presented By: Richard C. Sarle, MD
Introduction: For successful focal therapy, tumor characteristics including accurate volume estimation of the index lesion must be measured accurately. Multi-parametric MRI (mpMRI) of the prostate aids in diagnosis and management of prostate cancer by identifying the location of clinically significant disease. We compare the radiologic index lesion volumes found on mpMRI in comparison to histologic pathology. Methods: We compared the accuracy of mpMRI to histology using a Voxel wise composite biomarker models created by co-registered mpMRI previously described by Metzger et al. Pathologic volumes of the index lesion (PVIL) were then compared to the radiologic volumes of the lesion (RVIL) using Pearson correlation and linear regression methods after adjusting for tumor shrinkage. Results: We analyzed 30 index lesions. The mean PVIL was 1.43 ml (SD 1.78) and the mean adjusted PVIL was 2.01 ml (SD 2.50), correcting for shrinkage. The mean RVIL 2.32 (SD 3.13). There was a positive correlation between histopathology tumor volume and magnetic resonance tumor volume (Pearson coefficient 0 0.77, p <0.0001). The mean difference between the adjusted PVIL and RVIL was – 0.31 ml (0.54). Conclusion: Voxel wise composite biomarker models shows an overestimation of tumor volume compared to histology. Future studies should be aimed at implementing this imaging technology for a larger cohort of patients. Funding: N/A
Table of Contents 255 Poster #47 EFFICIENCY OF HOLMIUM LASER LITHOTRIPSY USING A STONE STABILIZATION SUCTION DEVICE Matthew Lee, Presenting Author, Ali Aldoukhi, Timothy Hall, Khurshid Ghani, William Roberts, Senior Author University of Michigan Presented By: Matthew Lee, MD
Introduction: Retropulsion of stone fragments decreases the efficiency of holmium laser lithotripsy during ureteroscopy. The aim of this study was to assess the contribution to efficiency of suction when using this device during laser lithotripsy. Methods: Experiments were conducted with one spherical 5mm diameter Begostone (composition 15:5) contained within a prototype suction device. The Lumenis 120W Holmium laser was used with recommended laser settings of 0.3J x 50 Hz. Each operator performed two practice trials, followed by ten 2.5 min trials (five trials each, with and without suction, performed in alternating fashion). Student T-tests were used for comparison. Results: As shown in Figure 1b; the mean stone mass lost in trials with suction stabilization was 67.0± 11.1% vs. 65.3 ± 7.9% without suction (p=0.48). Mass lost was calculated by subtracting the weight of fragments after lithotripsy from the initial weight. The percentage of fragments: >2.0 mm was 16.6% vs 20.5%; 1.0-2.0 mm was 14.8% and 12.6%; with and without suction, respectively. Conclusion: Use of suction to stabilize stone fragments in conjunction with confinement did not result in a significant difference in stone disintegration during laser lithotripsy. The percentage of fragments >2 mm was greater in trials without suction, suggesting that suction stabilization did provide some benefit in terms of fragmenting stones into smaller pieces. Funding: N/A
Poster #48 COMPARISON OF AUTOMATED IRRIGATION SYSTEMS USING AN IN-VITRO URETEROSCOPY MODEL Donald Fedrigon, BS, Luay Alshara, MD, Manoj Monga, MD Cleveland Clinic Foundation- Glickman Urological Kidney Institute Presented By: Donald Charles Fedrigon III, BS
Introduction: Two automated irrigation systems, the Cogentix RocaFlow (CRF) and Thermedx FluidSmart (TFS) have been developed for use during endoscopic procedures such as ureteroscopy. The objective of this study was to directly compare these systems based on irrigating pressure accuracy, pressure-flow relationships, and fluid heating efficiency in order to help providers better utilize the temperature and pressure settings of each system.
Table of Contents 256 Methods: In-vitro ureteroscopy testing was performed with a short semirigid ureteroscope (6/7,5F, 31 cm Wolf 425612), a continuous digital pressure transducer (Meriam m1550), and digital thermometer (Omega DP25-TH). Pressure output, flow-rate, and temperature output were measured at incremental pressure settings within a range of 30-300 mmHg with multiple trials at each setting. Results: Both systems consistently provided pressure outputs above the desired setting, a difference of 15.7 ± 2.4 mmHg for the TFS compared to 5.2 ± 1.5 mmHg for the CRF (p<0.0001). In line with this finding, the TFS demonstrated a slightly higher flow rate (7 ± 2 mL/min) across all trials. Both systems reached a similar maximum temperature of 34.0 ⁰C, however, the TFS peaked after only 8 minutes and started to plateau as early as 4-5 minutes into the test while the CRF took over 18 minutes to peak. Conclusion: During our in-vitro testing, the CRF system was better pressure accuracy than the TFS system but with noticeably slower fluid heating capabilities. Despite their differences both systems provided steady irrigation at safe pressures within their expected operating parameters. Funding: N/A
Poster #49 PREDICTING URETERAL STONE PASSAGE WITH THE RULE OF FOUR Alexander M. Kandabarow, MD, Parth M. Patel, MD, Spencer T. Hart, MD, Ryan A. Dornbier, MD, Gaurav Pahouja, MD, Thomas M.T. Turk, MD, Kristen G. Baldea, MD Loyola University Medical Center Presented By: Alexander M. Kandabarow, MD
Introduction: Acute renal colic due to an obstructing ureteral stone is a common cause of emergency department (ED) visits. In this setting, clinicians are challenged with facilitating a patient's decision between a trial of spontaneous stone passage versus immediate surgical intervention. We offer our "Rule of Four" mnemonic as a tool that is easy to remember and deploy in the acute setting to predict stone passage. Methods: For 2007-2017, we retrospectively reviewed ED visits at a single institution with a diagnosis of ureteral stone disease confirmed with CT. We included patients discharged from the ED with plans for a trial of spontaneous passage. Patient factors, stone size and location, and the outcome of the trial were recorded. Multivariate logistic regression was used to determine factors associated with stone passage, and a nomogram to predict stone passage was devised and tested against the original data. Results: 474 ED visits were analyzed, 371 of which had complete medical records including follow up (mean 27 days [IQR 7-34]). Linear stone size (OR 0.54 [CI 0.44-0.65], p<0.01) and distal stone location (OR 6.3 [CI 3.8-10.5], p<0.01) were independently associated with stone passage. A "Rule of Four" nomogram was devised wherein non- distal stones ≥4mm and distal stones ≥8mm were predicted to fail a trial of passage. This nomogram predicted stone passage with 76% accuracy (sensitivity 78%, specificity 72%). Conclusion: Using the "Rule of Four" mnemonic, clinicians can counsel patients regarding their chances of a successful trial of stone passage with comparable accuracy to existing nomograms. Funding: n/a
Table of Contents 257 Poster #50 INFLUENCE OF INFUNDIBULOPELVIC ANGLE (IPA) ON SUCCESS OF RETROGRADE FLEXIBLE URETEROSCOPY AND LASER LITHOTRIPSY FOR TREATMENT OF RENAL STONES Stephanie Dresner1, Viacheslav Iremashvili2, Sara Best1, Sean Hedican1, Stephen Nakada1 1University of Wisconsin, Dept. of Urology, Madison, WI, 2West Virginia University Health System, Bridgeport, WV Presented By: Stephanie Louise Dresner, MD
Introduction: Influence of renal anatomy on outcomes of shock wave lithotripsy has been evaluated in the literature with emphasis on lower pole anatomy. Influence of renal anatomy has been less well evaluated in the setting of ureteroscopy and laser lithotripsy. This study analyzed influence of lower pole IPA on outcomes of ureteroscopy and laser lithotripsy with respect to stone-free rate and need for reoperation. Methods: We retrospectively analyzed 735 renal units undergoing retrograde flexible ureteroscopy with laser lithotripsy between January 2009 and December 2016. All cases were performed at a single institution. Success was defined as no stone fragments on follow-up imaging with KUB or US within 2 months of surgery. Failure was defined as stone present on follow-up imaging. Lower pole IPA was measured on intraoperative retrograde pyelogram as described by Elbahnasy et al. Univariate and multivariate analyses of factors contributing to stone-free rate were performed. Secondary outcomes included same-sided surgery within 6 months. Results: Of 735 cases evaluated, 243 cases had a retrograde pyelogram sufficient for IPA interpretation. 127 patients (52.3%) were stone free on follow up imaging, while 116 (47.7%) had residual stone. In multivariate analysis adjusting for stone size, stone-free status was statistically significantly associated with greater IPA (p<0.0001). IPA and stone size were both significantly influential on need for repeat surgery within 6 months (p<0.05). Conclusion: More acute IPA and larger preoperative stone size negatively affect stone- free rate and need for repeat surgery following retrograde flexible ureteroscopy with laser lithotripsy for treatment of renal stones. Funding: N/A
Poster #51 BARRIERS TO OBTAINING PERCUTANEOUS NEPHROLITHOTOMY (PCNL) ACCESS Jennifer Saluk, MD1, Joshua Ebel, MD1, Justin Rose, BS1, Marilly Palettas, MPH2, Amy Lehman, MAS2, Bodo Knudsen, MD1 1Department of Urology, Ohio State University Medical Center, Columbus, OH, 2Center for Biostatistics, Ohio State University Medical Center, Columbus, OH Presented By: Jennifer Lynn Saluk, MD
Introduction: Percutaneous nephrolithotomy (PCNL) remains the treatment of choice for kidney stones larger than two centimeters. Few studies have examined the reasons why some urologists obtain their own PCNL access while others prefer to have interventional radiology (IR) obtain access. The primary objective of this study was to investigate practice trends among newly practicing urologists, with regards to obtaining PCNL access, and what factors influence this decision. Methods: A survey was posted to the American Urological Association’s (AUA) Young Urologist Community online forum. Result: Among the 99 urologists who completed the survey, 92% currently performed PCNLs, 47% of which currently obtain their own access. Endourology fellowship-trained physicians were more likely to currently perform PCNLs (p=0.047) and currently obtain their own access (p=0.002), which did not hold true for all fellowship-trained physicians. Physicians who were more likely to obtain their own access also logged more cases during training where they obtained their own access (p<0.001), and currently have a larger annual PCNL case volume (p<0.001). The most common motivator for obtaining one’s own access was preference to control their own access point (95%), whereas the
Table of Contents 258 most common reasons for not currently obtaining one’s own access were convenience of IR (44%) and lack of comfort obtaining access (42%). Conclusion: Urologist-obtained PCNL access was associated with training experience and current annual PCNL case volume. Urologist reported factors that influenced the decision to obtain one’s own access include control of access, comfort level, and both physician and patient convenience. Funding: N/a
Poster #52 CHARACTERIZING INSTITUTIONAL TRENDS AND CLINICAL DECISION MAKING RELATED TO POSTOPERATIVE URETERAL STENTING FOLLOWING URETEROSCOPIC STONE MANAGEMENT Adam De Fazio, MD, JD, Sari Khaleel, MD, James Anderson, MD, Maria Ordonez, MD, Michael Borofsky, MD University of Minnesota, Department of Urology Presented By: Adam M. De Fazio, MD, JD
Introduction: While clinical practice reflects a strong preference for postoperative stent placement following uncomplicated ureteroscopy for urolithiasis, the benefits of such practice are uncertain. As part of a quality improvement effort aimed at reducing potentially unnecessary stenting, we sought to identify institutional practice patterns while investigating the underlying rationale for stent placement in uncomplicated cases. We further aimed to assess changes in practice following implementation of prompted intraoperative discussions regarding stent placement. Methods: We retrospectively evaluated stenting in 109 cases. Each case was classified as “complicated” or “uncomplicated” based on the 2016 AUA Guideline on the Surgical Management of Stones. We performed a similar prospective evaluation of 46 patients after instituting prompted intraoperative discussions regarding stent rationale. Results: 91.7% of patients in the retrospective cohort received stents with similar rates for complicated and uncomplicated cases (93.5% vs 90.5%, p=0.731). After intervention, there was a significant reduction in stent rates for uncomplicated cases (90.5% vs 70.4%, p=0.025). Access sheath use (26.3%) and recurrent urinary tract infection (21.1%) were the most common reasons for stenting in these uncomplicated cases. Conclusion: Prompted intraoperative consideration may decrease routine ureteral stent placement after uncomplicated ureteroscopy. Funding: N/A
Table of Contents 259 Poster #53 TRENDS IN OPIOID MEDICATION PRESCRIBING FOR ACUTE RENAL COLIC MANAGED IN THE EMERGENCY DEPARTMENT Hal Kominsky, MD, Justin Rose, Amy Lehman, MAS, Marilly Palettas, MPH, Michael Sourial, MD The Ohio State University Wexner Medical Center Presented By: Hal Kominsky, MD
Introduction: Kidney stone disease is a common reason for emergency department (ED) visits. With the ongoing opioid epidemic in the United States, it is unknown how the opioid prescribing patterns have changed over the years for acute renal colic. The objective of the study was to evaluate the longitudinal trends in opioid prescribing patterns for kidney stone patients acutely managed in the ED. Methods: Retrospective chart review of patients who presented to the ED between 2013 and 2018 with renal colic and were diagnosed with a kidney stone based on corresponding ICD codes. Patients who required admission or an emergent urologic intervention were excluded. Encounters during which opioids were prescribed in the ED and at discharge were stratified by year, race, location of ED (main campus vs hospital based in a community setting), and insurance status. Results: We reviewed 1958 ED encounters for 1636 unique patients. The proportion of patients receiving an opioid medication in the ED decreased from 81% in 2013 to 57% in 2018. Patients receiving opioids at discharge decreased from 77% to 59% over the same time period. This trend continued across race, ethnicity, insurance status, gender, and patients seen at our smaller community-based ER. Conclusion: The proportion of patients receiving narcotics for acute renal colic is decreasing over time, irrespective of a patient's race, insurance status, and location of ED. Concerted efforts should aim to reduce that proportion even more given the ongoing opioid epidemic. Funding: n/a
Poster #54 PREDICTORS OF INCREASED NARCOTIC USE FOLLOWING URETEROSCOPY WITH URETERAL STENT PLACEMENT Spencer Hart, MD, Alex Kandabarow, MD, Parth Patel, MD, David Perlman, Jazzmyne Montgomery, Gracelene Wegrzyn, Ahmer Farooq, DO, Thomas Turk, MD, Kristin Baldea, MD Loyola University Medical Center Presented By: David Perlman
Introduction: Ureteral stent placement after ureteroscopy is associated with significant discomfort. Patients exposed to excess narcotics in the postoperative period are at risk of long-term dependence. We aim to describe the population at risk for increased narcotic use following ureteroscopy with stent placement. Methods: A retrospective analysis of patients who underwent ureteroscopic lithotripsy and stent placement between 2014 and 2017. Demographic factors as well as a history of nephrolithiasis, prior stone procedures, neurologic conditions, presence of chronic pain requiring medical therapy, alpha blocker use, and anticholinergic use were assessed. Postoperative stent-related symptom-control regimens including NSAIDS, narcotics, anticholinergics, and alpha blockers were also analyzed. Patient calls regarding pain, Emergency Department visits, and the need for supplementary medications within 30 days were assessed. Multivariate logistic regression was performed. Results: 597 patients were included for analysis. Patients were more likely to be prescribed additional narcotics if they were younger (OR 0.97 [95% CI 0.95-0.99], p<0.01), female (OR 3.1 [95% CI 1.4-6.6], p<0.01), had non-obstructing stones (OR 0.26 [95% CI 0.12-0.58], p<0.01), were undergoing their first stone procedure (OR 0.47 [95% CI 0.23-0.96], p=0.04), or had a history of preoperative narcotic use (OR 3.6 [95% CI 1.7- 7.6], p<0.01).
Table of Contents 260 Conclusion: Young age, female gender, initial stone procedure, nonobstructing stones, and a history of preoperative narcotic use are associated with increased additional narcotic prescriptions following ureteroscopic lithotripsy with stent placement. Funding: N/A
Poster #55 EARLY SURGICAL INTERVENTION FOR SYMPTOMATIC RENAL AND URETERAL STONES REDUCES NARCOTIC REQUIREMENT RELATIVE TO MEDICAL EXPULSIVE THERAPY Crystal Valadon1, Charles Nottingham2, Tim Large2, Amy Krambeck2 1University of Louisville School of Medicine, 2Indiana University School of Medicine Presented By: Crystal Valadon
Introduction: Given the substantial burdens of the current opioid crisis, clinicians are tasked with reducing excessive narcotic analgesia. The purpose of this study was to evaluate if medical expulsive therapy or initial surgical intervention resulted in less narcotic analgesia utilization in patients with acute renal colic due to stone disease. Methods: We retrospectively evaluated patients at our institution who presented with acute renal colic due to a renal or ureteral stone. We excluded patients who required surgical intervention for acute kidney injury or infection. Patients are standardly offered medical expulsive therapy (MET) or surgical intervention with ureteral stenting or ureteroscopy (URS) at the time of diagnosis. Our standard practice following surgery is to provide no narcotics upon discharge except for pain refractory to non-narcotic analgesics. We compared rates of narcotic prescription over the entire treatment course for patients electing MET versus surgery at initial diagnosis. We secondarily analyzed rates surgical intervention among initial MET patients. Results: We included 143 patients for analysis, with 78 (55%) electing MET as initial treatment, 40 (28%) stent, and 25 (17%) URS. Ultimately, 46 (59%) MET patients underwent URS at a median time of 18 days (IQR 8-33 days) from diagnosis. A significantly higher proportion of MET patients required a narcotic prescription (59% vs 30% vs 32%, respectively; p=0.006) compared to patients electing initial stent or URS. Conclusion: Patients electing initial treatment with MET for renal colic due to stone disease were more likely to require a narcotic prescription than patients electing initial surgical intervention. Funding: N/A
Table of Contents 261 Poster #56 GASTROINTESTINAL DISEASE REDUCES THE HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH UROLITHIASIS: CROSS-SECTIONAL ANALYSIS FROM THE NORTH AMERICAN STONE QUALITY OF LIFE CONSORTIUM Kristina L. Penniston, PhD, FAND1, Jodi A. Antonelli, MD2, Necole M. Streeper, MD3, Sri Sivalingam, MD4, Davis P. Viprakasit, MD, FACS5, Timothy D. Averch, MD, FACS6, Jaime Landman, MD7, Thomas Chi, MD8, Ben H. Chew, MD, MSc, FRCSC9, Vincent G. Bird, MD10, Vernon M. Pais, MD11, Sero Andonian, MD, MSc, FRCSC, FACS12, Roger L. Sur, MD13, Noah E. Canvasser, MD14, Stephen Y. Nakada, MD, FACS, FRCS(Glasg.)1 1University of Wisconsin School of Medicine and Public Health, Dept. of Urology, Madison, WI, 2University of Texas Southwestern Medical Center, Dallas, TX, 3Pennsylvania State University College of Medicine, Hershey, PA, 4Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, 5University of North Carolina School of Medicine, Chapel Hill, NC, 6University of Pittsburgh Medical Center, Pittsburgh, PA, 7University of California Irvine School of Medicine, Orange, CA, 8University of California San Francisco School of Medicine, San Francisco, CA, 9University of British Columbia Department of Urologic Services, Vancouver, BC, 10University of Florida College of Medicine, Gainesville, FL, 11Dartmouth Hitchcock Medical Center, Lebanon, NH, 12McGill University Health Center, Montreal, QC, 13University of California San Diego, School of Medicine, San Diego, CA, 14University of California Davis School of Medicine, Sacramento, CA Presented By: Kristina L. Penniston, PhD, RDN, FAND
Introduction: We evaluated the hypothesis that gastrointestinal disease (GID) is associated with lower health-related quality of life (HRQOL) in patients with urolithiasis. Methods: This cross-sectional study included 2,655 patients from 14 urology sites in North America who completed the Wisconsin Stone Quality of Life questionnaire (WISQOL) and for whom the presence of GID (inflammatory bowel and irritable bowel disease, IBD and IBS; short bowel, SB; and gastric bypass, GB) was documented. Results: Patients were similar for characteristics (table). Patients with any GID had lower HRQOL than those with no GID (66.5 vs. 71.8 for total standardized WISQOL score; P=0.007). This difference was due largely to lower HRQOL of patients with SB and/or GB: the difference between scores of patients with and without SB and/or GB was much larger than that between patients with and without IBS and/or IBD. Items regarding social functioning and vitality were most bothersome to patients with SB and/or GB. Among only patients with stones at the time of WISQOL completion, patients with SB and/or GB had lower HRQOL than patients without SB or GB (difference in total score of 12.5; P=0.02). Conclusion: The presence of GID is associated with lower stone related HRQOL. Patients with SB and/or GB have worse HRQOL than those with IBS and/or IBD. Funding: N/A
Table of Contents 262 Poster #57 ANATOMIC AND CLINICAL IMPLICATIONS OF HETEROTOPIC OSSIFICATION IN RENAL PAPILLAE Charles Nottingham, MD1, Michael Borofsky, MD2, Sharon Bledsoe1, Tim Large, MD1, James Lingeman, MD1, James Williams, PhD1 1Indiana University School of Medicine, Indianapolis, IN, 2University of Minnesota Medical School, Minneapolis, MN Presented By: Charles U. Nottingham, MD MS
Introduction: First described by Phemister and Huggins in the 1920s, growth of bone in kidneys (heterotopic ossification) is rare but has unique clinical significance in patients with calculus disease. Methods: We prospectively collect data on a cohort of patients with kidney stone disease that includes stone analysis with micro-CT, metabolic studies, and renal biopsies. We included all patients found to have heterotopic ossification on micro-CT. Light microscopy on these stones was performed. Results: We identified six patients with heterotopic ossification by the presence of trabecular bone morphology on micro-CT. Four patients had predominantly calcium oxalate monohydrate, and two patients had brushite stones. Birefringent and polarized light microscopy revealed lamellar bone morphology and canaliculi, and von Kossa / MacNeal stained mineralized bony tissue and osteoid. Routine stone analysis revealed the presence of apatite within all six stone specimens. Two patients with calcium oxalate stones had hypercalciuria requiring a thiazide diuretic. Surgically, these stones were embedded within tissue making removal difficult, and one was resistant to holmium laser fragmentation. Conclusion: Heterotopic ossification within symptomatic renal stones occurs rarely and is associated with calcium-based stones. These stones are often very challenging to surgically treat with current endoscopic techniques, and routine stone analysis may incorrectly suggest a hydroxyapatite stone component that is actually bone. Funding: National Institutes of Health Grant P01 DK056788
Table of Contents 263 Poster #58 EXAMINATION OF CENTRIOLE MARKER IN SPERMATOZOA SEPARATED BY DENSITY GRADIENT Mariam Asadullah1, Emily Fishman2, Ahmed Hussein3, Andrew Gerts2, Tariq Shah1, Puneet Sindhwani1, Tomer Avidor-Reiss2 1Department of Urology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 2Department of Biology, University of Toledo, Toledo, OH, 3Ohio State University, Columbus, OH Presented By: Mariam Asadullah
Introduction: The sperm is the sole contributor of centrioles to the zygote; these centrioles are thought to be essential for fertility. Sperm centrioles are unique - male germ cells undergo “Centriole Remodeling,” which results in highly modified centrioles. The objective of this study was to detect a molecular marker that identifies abnormal sperm centrioles and to determine their relationship to infertility. Once such a marker is identified, it may be possible to diagnose sperm centriole abnormalities in infertile males. Methods: We compared normal and abnormal sperm from five infertile men. Semen were separated based on density, yielding a pellet of sperm that is denser than an interface of sperm. The less dense sperm in the interface is thought to be abnormal/immature. The interface and pellet sperm were stained with fluorescent antibodies against the centriole-specific protein POC1B. We used photon counting confocal microscopy to determine intensities in both centrioles and the axoneme. Results: We found that POC1B immunostaining was significantly enriched (P=0.008) in the axoneme of the sperm found in the interface (26±56) as compared to the pellet (12±22) in infertile males (n=5). Conclusion: In this study, we found that in infertile males, POC1B, which is normally restricted to the centrioles, is found unexpectedly in the axoneme when the sperm is less dense (abnormal / immature). POC1B could be the first centriole-specific marker that has differential staining between normal and abnormal sperm in a given sample, which is an important first step towards using a centriolar marker to determine sperm quality. Funding: University of Toledo
Poster #59 INTRAOPERATIVE USE OF BETADINE IRRIGATION IS ASSOCIATED WITH A 9- FOLD INCREASE OF PENILE PROSTHESSIS INFECTION Madeleine Manka, MD, Kevin Hebert, MD, David Yang, MD, Tobias Köhler, MD, Landon Trost, MD Mayo Clinic Presented By: Madeleine G. Manka, MD
Introduction: Infection remains a persistent complication of inflatable penile prosthesis (IPP) surgery. Despite popularity of Mulcahy’s washout protocol, betadine has known tissue toxicity. We evaluated IPP infection rate based on intraoperative irrigation utilized, Betadine (10%) versus Vancomycin/Gentamicin. Methods: We reviewed a prospective database of men undergoing primary, revision, and salvage IPPs. The primary outcome was IPP infection rate prior to and following the change of intra-operative irrigation. No other changes to operative or perioperative techniques occurred following the change in irrigation. Univariate and regression analyses were used to evaluate infection rate with use of Betadine versus Vancomycin/Gentamicin irrigation. Cofounders reviewed included patient demographics, comorbidities, type of surgery (primary, revision, salvage), prior penile surgery, and adjunctive techniques. Results: 217 patients (mean age 65 years) underwent IPP placement from January 2014 to April 2018, of whom 21 (9.7%) experienced an infection (primary=10 (7.1%), revision=11 (17.19%), salvage=0). Overall, 152 (70%) received irrigation with Betadine compared to 65 (30%) with Vancomycin/Gentamicin. Univariate analysis demonstrated significantly increased infection rates with Betadine irrigation (OR 4.64, p=0.006) and revision surgery (OR 2.68, p = 0.02). Significance was maintained (OR 9.3; p=0.025) after controlling for age, BMI, Charleson Comorbidity Index, smoking, diabetes, primary
Table of Contents 264 vs revision/salvage, prior penile surgery, use of ectopic reservoir, and adjunctive glanulopexy. Conclusion: Changing from intra-operative Betadine to Vancomycin/Gentamicin solution dramatically reduced infection rates among IPP placement in both primary and revision cases. Differences in infection rate may relate to the relative toxicity of Betadine or its non-sterile nature. Funding: N/A
Poster #60 PENILE PROSTHESIS PLACEMENT IN REGISTERED SEX OFFENDERS JJ Zhang, MD1, Molly DeWitt-Foy, MD1, Jane Jankowski, DPS2, Paul Ford, PhD2, Hadley Wood, MD1 1Glickman Urological Kidney Institute, Cleveland Clinic Foundation, 2Center for Bioethics, Cleveland Clinic Foundation Presented By: JJ Haijing Zhang, MD
Introduction: Treatment of erectile dysfunction (ED) impacts both patients and partners. However, no guidelines exist for eliciting a history of sexual misconduct in men seeking ED management. Prevalence of sexual violence in men presenting for penile prosthesis (PP)-placement remains unreported. The 2006 Sex Offender Registration and Notification Act (SORNA) established national registration/reporting standards, but de- registration policies remain under state jurisdiction with ~33% offenders unlisted on public registries. We aim to identify the prevalence of registered sex offenders in men who underwent PP-placement. Methods: IRB-approved retrospective review was conducted of patients who underwent PP-insertion at a high-volume institution from 1992-2018. Identifiers were cross- referenced with the National Sex Offender Public Website (www.NSOPW.gov) and de- identified following data retrieval. SORNA 2018 Implementation Report was reviewed for state compliance of registration/reporting standards. Institutional Bioethics Committee participated in study design and interpretation. Results: In total, 2209 patients underwent PP-insertion. One of 2209 patients (0.05%) was identified as an exact NSOPW match for child seduction conviction (Class D felony) before surgery. Two patients were identified as possible matches (≥3 matching characteristics). SORNA data reveals 17/50 states met 2018 registration/reporting standards. Conclusion: No standard exists for screening patients seeking PP-placement for history of sexual offenses. Our data suggest 0.05-0.1% of patients seeking PP-placement were registered sex offenders. We acknowledge that NSOPW is an incomplete database that allows sex offender de-registration in certain states, excludes unreported or non- convicted crimes, and reports low SORNA implementation in state jurisdictions. Further research and discussion of best practices on this topic is warranted. Funding: N/A
Poster #61 DOES VAS DEFERENS LENGTH REMOVED AT TIME OF VASOVASOSTOMY AFFECT PREGNANCY OUTCOMES? Jeremy West, MD, Christopher Meier, MD, Denise Juhr, BS, Moshe Wald, MD University of Iowa, Department of Urology, Iowa City, IA Presented By: Jeremy M. West, MD
Introduction: Approximately 3-6% of men will desire vasovasostomy (VV) for fertility purposes after undergoing vasectomy. Success rates defined as pregnancy after VV are reported as high as 76%. During VV, the prior ligated area is excised prior to performing anastomosis of the residual healthy vas deferens. We sought to investigate whether a correlation exists between vas deferens segment length removed at time of VV and overall pregnancy outcomes. Methods: Questionnaires were sent to all patients who underwent VV and vasoepididymostomy (VE) at our institution since 2004 to determine if conception
Table of Contents 265 occurred after the procedure. Linear and logistic regression models were performed to assess the correlations between mean length of obstructed vas deferens segments removed and post-operative outcomes including sperm concentration, pregnancy after VV, and overall pregnancy. Results: 170 surveys were sent to patients who underwent VV and VE from 2004-2018. A total of 35 patients were included for analysis. The mean length of obstructed vas deferens segment removed during vasovasostomy was 2.25 cm. Conception rates with and without the use of ART were 55.8% and 23.2% respectively. A longer vas deferens segment removed was significantly associated with an increase in 3 and 9-month sperm motility. Length of segment removed was not significantly associated with pregnancy achieved after surgery with or without ART. Conclusion: Longer vas deferens segments removed at time of VV was significantly associated with an increase in 3 and 9-month sperm motility. However, mean length removed at time of VV did not significantly correlate with conception after surgery. Funding: None
Poster #62 DISPARITIES BETWEEN EARLY AND LATE PENILE PROSTHESIS PLACEMENT FOLLOWING PROSTATECTOMY Ryan Dornbier, MD, Marc Nelson, MD, Petar Bajic, MD, Joseph Mahon, MD, Eric Kirshenbaum, MD, Ahmer Farooq, DO, Marshall Baker, MD, Gopal Gupta, MD, Christopher Gonzalez, MD, Kevin McVary, MD Loyola University Medical Center Presented By: Ryan Austin Dornbier, MD
Introduction: Erectile dysfunction after radical prostatectomy leads to decreased quality of life for patients and their partners. Penile prosthesis placement (PPP) is underutilized among post-prostatectomy patients. We sought to determine predictors of early versus late PPP after radical prostatectomy. Methods: Utilizing the Healthcare Cost Utilization Project inpatient and ambulatory surgery databases for Florida between 2009-2015, patients who underwent prostatectomy and subsequent PPP were identified using ICD-9 codes. Days to PPP were calculated and quartiles were determined. Patients were categorized by early prosthesis (first quartile) or late prosthesis (fourth quartile). Patient and encounter demographics and characteristics were compared between cohorts using Student’s T- test and Chi-square analysis. Results: 834 patients underwent PPP after prostatectomy (Table). PPP was <403 days in the first quartile and >966 days in the fourth quartile following prostatectomy. There were no differences between age, race, Charlson comorbidity index or surgical approach. Patients undergoing early PPP were more likely to be publicly insured (p<0.001) and live in lower income areas (p=0.043). Conclusion: Prolonged duration of ED following prostatectomy leads to decreased quality of life for prostate cancer survivors. In men undergoing PPP following prostatectomy, those with private insurance in higher income areas may experience treatment delays. Further counseling of these men may be necessary to ensure timely definitive therapy. Internal Funding
Table of Contents 266
Poster #63 INTRACAVERNOSAL VERSUS INTRAURETHRAL ALPROSTADIL: A SYSTEMATIC REVIEW Petar Bajic1, Joseph Mahon1, Hossein Sadeghi-Nejad2,3, Lawrence Hakim4, Kevin McVary1 1Loyola University Medical Center, Center for Male Health, Maywood, IL, 2Department of Urology, Hackensack University Medical Center, Hackensack, NJ, 3Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, 4Department of Urology, Cleveland Clinic Florida, Weston, FL Presented By: Petar Bajic, MD
Introduction: PDE5i marketing has led to decreased prescribing of intraurethral (IU) and intracavernosal (ICI) alprostadil. Despite the predominance of PDE5I use, IU and ICI remain viable treatment options. Because of decreased use, but continued relevance of IU/ICI, we performed a systematic review comparing safety and efficacy of these therapies including the most contemporary sources. Methods: We performed Pubmed, Embase, and Cochrane searches between 1/01/65- 7/20/16 to identify articles reporting on IU/ICI alprostadil for ED. Body of evidence was assigned a strength rating of A(high), B(moderate), or C(low). This review was performed as part of the 2018 AUA ED Guidelines. Results: 39 study arms reported on single agent ICI alprostadil in 5073 patients. 13 study arms reported on IU alprostadil in 1647 patients. Nearly all studies were observational, body of evidence level C. Follow-up in the ICI arms was longer (16 vs 2.9 mo), as was ED duration (52.1 vs 45.4 mo). ED etiology, comorbidities and withdrawal due to AEs were similar. Rates of in-office response and successful intercourse were higher with ICI (73.2% vs 59.3%, and 81.3% vs 64.3%, respectively). IU therapy was associated with higher rate of discontinuation due to lack of efficacy (22.2% vs 8.1%). ICI alprostadil showed higher rates of headache, flushing, bleeding, syncope, painful erection and priapism. Conclusion: IU and ICI alprostadil are safe and effective. ICI alprostadil is associated with higher in-office success and successful intercourse, and lower rates of discontinuation for lack of efficacy. However, fewer AEs make IU alprostadil a viable treatment option. Funding: This review was performed as part of the 2018 AUA Erectile Dysfunction Clinical Guidelines, with the support of the AUA Clinical Guidelines Office, Linthicum, MD.
Table of Contents 267 Poster #64 COMPARISION OF CENTRIOLE REMODELING DURING SPERMATOGENESIS IN HUMAN AND BOVINE TESTES Emily Fishman, PhD Candidate1, Zane Giffen, MD2, Bijan Salari, MD2, Katerina Turner, PhD Student1, Obi Ekwenna, MD2, Puneet Sindhwani, MD2, Tomer Avidor-Reiss, PhD1 1University of Toledo Department of Biological Sciences, 2University of Toledo Medical Center, Department of Urology Presented By: Zane C. Giffen, MD
Introduction: During fertilization, the egg provides most of the cytoplasmic contents of the embryo, but the sperm is responsible for delivering subcellular organelles known as the centrioles, regulated structures involved in cell-cell communication and cell division. The cells of the developing embryo need exactly two centrioles and, surprisingly, the ovum does not provide any. Recently, a second, "atypical" centriole was discovered in human spermatozoa, which functions in the zygote. The centrioles of murine sperm deviate dramatically from those of humans, and therefore are not a useful model for human centriole remodeling. We sought to determine if bovine sperm could be a more comparable model system. Methods: Human (ages 36 and 56) and bovine testes were embedded and sectioned. The samples were stained using antibodies against centriole remodeling proteins, CETN1 and POC5, and counterstained with the DNA stain Hoechst. Samples were imaged on a Leica SP8 Confocal Microscope and quantitatively compared. Results: The centrioles at each stage of spermatogenesis (spermatogonia, spermatocyte, round spermatid, and elongated spermatids) in human samples are similar to those of bovine testes. Conclusion: The discovery of the centriole remodeling process in bovine samples opens the door to the study of centriole changes during spermatogenesis. However, without direct comparison to humans, any findings are limited in their scope. This work confirms that the centrioles of developing sperm are similar between humans and bovines, which means any findings in the bovine can be cautiously applied to humans. This may ultimately help uncover novel molecular causes of idiopathic male-factor infertility. Funding: N/A
Poster #65 CHARACTERISTICS OF MEN WHO ARE BOTHERED BY RAPID EJACULATION: RESULTS FROM CLINICAL INTAKE SURVEYS Ajay Gopalakrishna, Manof Alom, Yifan Meng, Raevti Bole, Tobias Kohler, Landon Trost Mayo Clinic Department of Urology Presented By: Ajay Gopalakrishna, MD, MHS
Introduction: Premature ejaculation (PE) is a common condition that is variably defined based on ejaculatory latency times and associated bother. The objective of this study is to identify factors associated with a sense of bother with rapid ejaculation in a cohort of men presenting to a sexual dysfunction clinic, independent of a diagnosis of PE. Methods: A prospective database has been maintained at our institution on sequential patients seen in our clinic for sexual dysfunction. Patients complete an 89-item intake questionnaire querying various sexual dysfunctions. Regarding PE, patients are asked one of the questions recommended by an International Society of Sexual Medicine Panel, “do you feel bothered, annoyed, and/or frustrated by ejaculating too quickly?” A comparative analysis was performed between men responding “Yes” versus “No.” Results: A total of 1406 men completed the intake survey, of which 719 responded to the question on bother with rapid ejaculation. Overall, 43% of respondents reported bother with rapid ejaculation. These men were more likely to report higher overall bother with any sexual dysfunction (OR 1.54, p<0.0001), higher rates of problems with motivation (50% vs 39%, p<0.01), depression (33% vs 21%, p<0.01), difficulty concentrating (43% vs 33%, p<0.01), and negative impact on relationship (74% vs 51%, p<0.0001) and partner’s sexual satisfaction (27% vs 16%, p<0.001).
Table of Contents 268 Conclusion: Men who report bother with PE are more likely to desire treatment and feel that the symptoms are negatively impacting their motivation, mood, overall sexual relationship and satisfaction. Funding: N/A
Poster #66 INCREASED PREPAREDNESS BEFORE RADICAL PROSTATECTOMY IS ASSOCIATED WITH BETTER PATIENT REPORTED POST-OPERATIVE SEXUAL OUTCOMES Abhinav Khanna, MD, Anna Faris, BA, Anna Zampini, MD, Daniel Hettel, MD, Hadley Wood, MD, Bradley Gill, MD, MS, Edmund Sabanegh, MD Cleveland Clinic Presented By: Bradley C. Gill, MD, MS
Introduction: This study assessed the impact of pre-operative group education on preparedness for radical prostatectomy (RP) and post-operative sexual function outcomes. Methods: A pre-operative group education seminar by advanced practice providers experienced in post-RP care was offered to all men undergoing RP between 2015-2017. It covered the expected perioperative course, including erectile dysfunction and expectations for recovery. Patients were surveyed upon seminar conclusion and by telephone at 3W, 3M, 6M and 1Y post-operatively. Results: Of 210 participants, 147 had baseline erectile function with follow-up completed by 92(62.6%) at 3W, 69(46.9%) at 3M, 48(32.7%) at 6M, and 36(24.5%) at 1Y. Recovery of erections increased over time from 20.7% at 3W to 58.3% at 1Y (Figure 1). Erectile function being ″as expected″ or better decreased from 56.8% at 3W to 11.8% at 1Y. Greater pre-operative understanding that surgery may worsen erections was associated with post-operative erections being ″as expected″ or better (52.5% vs 0% at 3M, p=0.006), as was being ″prepared overall″ for surgery (45.2% vs 0% at 6M, p=0.003). At 3W 48.5% of men with no erections reported erections being″as expected″ where 0% did at 1Y (p<0.05). Conclusion: Despite erections recovering through 1-year post-prostatectomy, satisfaction with erections decreased over time, yet greater preparedness was associated with better patient-reported outcomes. Funding: N/A
Table of Contents 269 Poster #67 OSTEOCALCIN'S ROLE IN THE REGULATION OF TESTOSTERONE PRODUCTION AS OBSERVED IN RATS AND HUMANS. Jordan Krieger, MD1, Natasza Posielski, MD1, Arthur Burnett, MD2, Haolin Chen, PhD3, Barry Zirkin, PhD3, Brian Le, MD1 1University of Wisconsin, Department of Urology, Madison, WI, 2Johns Hopkins University, Department of Urology, Baltimore, MD, 3Johns Hopkins University, Department of Biochemistry and Molecular Biology, Baltimore, MD Presented By: Jordan Krieger, MD
Introduction: Osteocalcin (OC) regulates testosterone (T) production in mice. This relationship has not been studied in humans. We evaluated this relationship in a prospective cohort of men and analyzed the effect of T supplementation on OC levels in a rat model. Methods: Serum samples from hypogonadal men were assessed for total T, free T, sex hormone binding globulin (SHBG), bioavailable T, and OC. T and OC levels were measured in Brown-Norway rats. Translocator protein ligand (TSPO) and silastic testosterone implants were used to stimulate endogenous T production and increase exogenous T, respectively. Relationships between T and OC were evaluated. Results: Ninety-two men with average total T and OC of 381.7 +/- 195.7 and 49.2 +/- 18.4 were enrolled. Positive correlations were observed for total T and OC (R= 0.57, 95% CI 0.39-0.71) as well as free T and OC (R=0.47, 95% CI 0.27-0.63). OC levels were lower in hypogonadal men (Figure 1). This relationship was also observed in a group of 36 rats (R= 0.69, 95% CI 0.86-0.89). Rats receiving TSPO or T implants did not exhibit an increase in serum OC. Conclusion: OC correlated with total and free T in both rats and men. OC levels did not increase with higher endogenous testosterone production or administration of exogenous testosterone. Funding: N/A
Table of Contents 270 Poster #68 OPTIMIZATION OF A HANDHELD WAND TO ACTIVATE A SHAPE MEMORY PENILE PROSTHESIS Brian Le, MD1, Kevin McVary, MD2, Rebecca Gerber, MD1, Alberto Colombo, PhD3 1University of Wisconsin School of Medicine Public Health, 2Loyola University Medical Center, 3Southern Illinois University Presented By: Rebecca Gerber, MD
Introduction: We previously described a novel shape memory alloy penile prosthesis that could be activated using an external wand via magnetic induction, thus obviating the need for internal hydraulics. Herein, we characterize the parameters required to optimize the external wand for touchless activation of this novel prosthesis. Methods: Using an inductor with 1000Watt of maximum power, we measured the time of activation of the SMA prosthesis. We compared the time of activation of the existing design versus an alternate design with circumferential cross section. The time of activation and temperature were measured with the use of thermocouples on the prosthetic spine. Results: Using a SMA with a circular cross section, the activation temperature of 42C was reached within 2 seconds using a ring-shaped coil. Coupling between the prosthesis and the wand is dependent on distance, angle, coil geometry and relates ability to produce eddy currents in the prosthesis. Considering an ideal activation time around 30 seconds, a wand would be required to generate 10Watt of power, 150watts in case of a 2 second activation time. Conclusion: Our data showed that a perfectly circular section creates a loop of eddy currents that facilitate rapid activate of the prosthesis. Thus, battery use is feasible with use of closed loop geometry SMA prosthesis. Funding: Boston Scientific
Table of Contents 271 Annual Business Meeting Agenda
I. Call to Order: David F. Jarrard, MD
II. Approval of the Minutes of the 2018 Annual Business Meeting: Jeffrey A. Triest, MD
III. Secretary/ Board of Directors Report: Jeffrey A. Triest, MD
IV. Treasurer Report: Matthew T. Gettman, MD
V. Historian Report: Thomas A. Gardner, MD, MBA
VI. Committee Reports 1. Nominating Committee: Gary J. Faerber, MD a. Elections 2. Audit and Budget Committee: James C. Ulchaker, MD, FACS 3. 2019 Local Arrangements Committee: Bradley A. Erickson, MD, MS, FACS 4. Program Committee: Jeffrey A. Triest, MD 5. Editorial and Awards Committee: Aaron J. Milbank, MD 6. Health Policy Council: James M. Dupree IV, MD, MPH 7. Long Range Planning Committee: Jeffrey A. Triest, MD 8. Young Urologists Committee: Kyle A. Richards, MD, FACS 9. Bylaws Committee: Aaron J. Milbank, MD 10. Education Committee: Bradley F. Schwartz, DO, FACS
VII. Representative to the AUA Board of Directors: Chandru P. Sundaram, MD, FACS
VIII. Future Meetings: Jeffrey A. Triest, MD
IX. Membership Committee Report: Gary J. Faerber, MD 1. Election of New Members
X. New Business 1. Introduction of Incoming President
XI. Adjournment
Table of Contents 272 Membership Candidates and Transfers
CANDIDATES FOR MEMBERSHIP Active AMBANI, MD Sapan HADDAD, MD Joseph BARBOGLIO, MD, MPH Paholo JOHANS, MD Carrie BENSON, MD Jonas KOHUT, Jr., MD Robert BOROFSKY, MD Michael LISS, MD Zachary DAVILI, MD Zurab MURPHY, MD, MBA, MSCI Adam ELLIMOOTTIL, MD, MS Chandy NOLD, MD Stephen FARRAJ, MD Hamzeh PAGORIA, MD Dustin FISCHER, MD Melissa SACK, MD Bryan GANICK, MD Samantha STYN, MD Nicholas GRALNEK, MD Daniel Affiliate STARKEY Lana Associate ALTHAUS, MD Adam NISSEN, MD Melissa BERNEKING, MD Adam OGBOLU, MD Francis BRANCATO, MD Sam OLSEN, DO Jamie BROWN, MD Christopher PATE, MD Scott CHEVALIER, MD Nikita PATEL, DO Sundip KACHROO, MD, PhD Naveen PEARL, MD Jeffrey KASSON, BS Matthew PEARLMAN, MD Amy KHEMEES, MD Tariq PETROS, MD Firas KOTTWITZ, MD Michael SCHOMMER, MD Eric LANE, MD Giulia STORMONT, MD Ian LEVIN, MD Michael THRESS, MD Tyler LINDER, MD, MS Brian VIJ, MD Sarah LOMAS, MD, PharmD Derek WEATHERLY, MD David MIMA, MD Mahmoud ZHANG, MD Mimi TOTAL APPLICANTS 48 INTERNAL TRANSFERS To Active Membership ALLEN, MD Noah GUPTA, MD Shubham HARDING, DO, FACOS Shirley PATEL, MD Subodh NORRIS, MD Jeffrey SCHWARTZ, MD Bernard TADROS, MD, MCR Nicholas TELLE, MD William ANDERSON, MD, FACS Bradley To Associate Membership DUFFEY, DO Branden ISAC, MD Wahib To Senior Membership BARTON, MD Edward LUCAS, MD Mark BOUR, MD James MERING III, MD James CHENG, MD David PRICE, MD Michael DEPOLO Jr., DO Albert SELO, MD Richard ERCOLE, MD, FACS Cesar STUPPLER, MD Stephen GOLDMAN, MD Kenneth VAN EVERY, MD Marvin KOWALSKY, MD Steven WINFIELD, Jr., MD Raymond LEE, MD Joe TOMERA, MD Kevin TOTAL INTERNAL TRANSFERS 25
Table of Contents 273 Membership Summary Report
Active Active Member 969 Active Member - Transfer Internal 4 Active Member - Transfer into Section 5 Total Active Count: 1,017
Affiliate Affiliate Member 2 Total Affiliate Count: 2
Associate Associate Member 116 Total Associate Count: 116
Honorary Honorary 1 Total Honorary Count: 1
Senior Senior Member 546 Senior Member - Transfer Internal 15 Senior Member - Transfer into Section 1 Total Senior Count: 562
TOTAL MEMBERSHIP COUNT: 1,660
Table of Contents 274 In Memoriam
The North Central Section honors those members who have passed away this year. We will always be thankful for their commitment to the Section and miss them dearly.
Sosale M. Berkuchel, MD Brookville, OH
A. William Geordan, MD Parker, CO
Harry N. Kotsis, MD Grosse Pointe Farms, MI
Almon R. MacEwen, MD Onalaska, WI
John Alvin McFarlane, MD Sioux City, IA
Claude E. Merrin, MD Deerfield, IL
Kevin J. O'Connell, MD, FACS Sioux Falls, SD
Joseph R. Oldford, MD Commerce Twp, MI
Michael K. Ouwenga, MD Quincy, IL
Hosea Payne, MD Toledo, OH
Stafford W. Pile, MD Indianapolis, IN
Vincent J. Santare, MD Schererville, IN
Marcus I. Shelander, MD St. Paul, MN
Herbert Sohn, MD, JD Glenview, IL
Frederick Joseph Wiecher, MD Mansfield, OH
Table of Contents 275 Proposed Bylaws Change
ARTICLE IV COMMITTEES Section 9 – Bylaws Committee The Committee shall consist of three (3) Active or Senior Members and the Secretary. One member, other than the Secretary, shall be designated as Chair by the President. The term of office shall be three (3) years. Members shall be eligible for two (2) terms. The Chair of the Committee shall be a member of the Bylaws Committee of the AUA.
The Committee will adhere to the Section’s goal of complying with the Mission and Vision and Purposes of the AUA, as stated currently in Article I, Sections 1 and 2 of the AUA Bylaws, and propose Bylaws which are in accord, or not in conflict with, those of the AUA. The Chair will keep an accurate file of all correspondence to and from the members of the Committee and from the Secretary of proposed amendments by members of the Section. The Committee shall meet and review the Bylaws annually and recommend to the Board of Directors any changes that seem desirable. All proposed amendments to the Bylaws shall be submitted to the Board of Directors for approval. consideration prior to being published in the Newsletter sixty (60) days before the Annual Meeting.
ARTICLE VI AMENDMENTS These Bylaws may be amended by the two-thirds (2/3) vote of the members present and voting at the Annual Business Meeting. Proposed amendments must be submitted in writing to the Secretary and referred by the Secretary to the Bylaws Committee which shall consider all proposed amendments and present their recommendations to the Board of Directors. Any proposed amendment shall be printed with the Notice of the Annual Meeting at which the action is to be taken and shall be sent to the members at least thirty (30) days before such Annual Meeting. either by printed mail or electronic email.
ARTICLE VII RULES ON PARLIAMENTARY PROCEDURE The current edition of Robert’s Rule of Order, Newly Revised Sturgis Standard Code of Parliamentary Procedure, current edition, shall govern the proceedings of the Section, unless provided otherwise in the Articles of Incorporation or in these Bylaws.
Table of Contents 276 North Central Section of the AUA Bylaws (Amended 9/2018)
ARTICLE I MEMBERSHIP Section 1 – Boundaries An applicant for membership in the North Central Section of the American Urologic Association, Inc. (the “Section”) must be a resident of, or practice in, Illinois, Indiana, Iowa, Michigan, Minnesota, North Dakota, Ohio, South Dakota or Wisconsin. Individuals who initially join the Section and then at a future date relocate to another section of the American Urological Association, Inc. (“AUA”) may retain membership in the Section.
Section 2 – Member Categories The Section membership shall include: Active Members, Associate Members, Affiliate Members, Senior Members, Honorary Members, Corresponding Members and Candidate Members, Research Scientist Members, International Members, Allied Members, Advanced Practice Provider Members, International Members-in- Training, Resident/Fellow Members and Medical/Graduate Student Members.
Section 3 – Dues, Initiation Fees, and Assessments The fiscal year of the Section shall date from January first to December thirty-first. All members except for Senior and Honorary Members shall be assessed application fees and dues in an amount determined by the Board of Directors. Special assessments may be ordered by the Board of Directors but must be approved by a majority of the members present and voting at the Annual Business Meeting. Any member who after appropriate notification does not pay membership dues shall cease to receive Section publications and notices.
Section 4 – Voting Status and Rights Only Active and Senior Members of the Section who are members in good standing of the AUA and AUA Education and Research, Inc. (AUA E/R) shall be eligible to vote at the Annual Meeting. Active and Senior Members who are elected to Honorary Membership shall retain their voting status. Only voting members are eligible to hold office. All members shall be entitled to receive the latest available copy of the Articles of Incorporation, the Bylaws and the roster of membership of the Section.
Section 5 – Election/Approval of Membership All members shall be elected at the Annual Business Meeting and must be members of the AUA and AUA E/R or have made application for membership to the AUA and AUA E/R. New members shall receive a Certificate of Membership from the Secretary and the AUA will be notified of their Section membership.
Section 6 – Active Members Requirements for Active Members are as follows: 1) Possession of an unlimited license to practice medicine and surgery in the state, province or country of the applicant’s residence. 2) Membership in good standing in the American Urological Association, Inc. and practice within its geographical boundaries. 3) Possession of an MD or DO degree (or United States Medical Licensure equivalent), and completion of an ACGME accredited urology residency or equivalent by the Royal College of Surgeons (“RCS”) in Canada or the Quebec Board of Urology or the certifying Board of Urology in the country where practicing within the geographic boundaries of the AUA. 4) Limitation of practice to the specialty of Urology. 5) Certification by the American Board of Urology (“ABU”), the Royal College of Surgeons in Canada or the Quebec Board of Urology or the certifying Board of Urology in the country where practicing within the geographic boundaries of the AUA.
Table of Contents 277 6) Recommendation for membership by two (2) voting members of the Section, except if certified within the last 24 months as provided in item (5) above. 7) Letter of recommendation from the Chief of Urology, Medical Director, or Chair of the Credentials Committee at the hospital(s) where the applicant has privileges, except if certified within the last 24 months as provided in item (5) above.
Section 7 – Senior Members Members are eligible for Senior Membership in the Section if they have been Active Members for 20 years in either the Section or the AUA and are retired or are permanently disabled.
Section 8 – Associate Members Requirements for Associate Membership are as follows: a. Requirements are the same as Active Membership except for board certification. b. Candidate Members Eligible for Fast Track Associate Status. Associate Membership will be offered to all Candidate Members who have passed the qualifying examination (Part I) of the ABU. c. Non-Members Eligible for Associate Status. Associate Membership is available to non-member urologists who are practicing within the geographic boundaries of a chartered AUA Section, but are not certified by the ABU. If an Active Member fails to become recertified as required by the ABU (or other certifying board), the Section will transfer the individual to Associate Member status. If an Active Member becomes decertified by the ABU, or other certifying board, the member shall be automatically dropped for non-compliance with the Section Bylaws, pursuant to Expulsion and Reinstatement policies. d. Transfer to Active Membership. Associate Members who have passed the ABU certifying exam (Part II) will be transferred to Active Membership in the Section.
Section 9 – Affiliate Members Affiliate membership is available to Non-urologist MDs or Doctors of Osteopathy who are significantly contributing to the field of urology through clinical practice. They shall be nominated by two (2) Active or Senior Members who shall furnish the Section Board of Directors with the curricula vitae and other pertinent information.
Section 10 – Honorary Members Scientists who have achieved outstanding prominence in a field of medicine related to Urology, Past Presidents of the Section and other distinguished urologists are eligible for Honorary Membership. Candidates must be nominated by the Immediate Past President upon recommendation of at least three (3) Active or Senior Members. They must be approved by the Board of Directors and a majority of the members present and voting at the Annual Business Meeting. Honorary Members who have been Active, Associate, or Senior Members shall retain all of their previous rights and privileges but other Honorary Members do not have voting privileges nor eligibility to Section offices and committee assignments. All Honorary Members are exempt from initiation fees, annual dues, and special assessments.
Section 11 - Research Scientist Members Research Scientist Membership is available for independent investigators with PhDs or equivalent degrees, DVMs, non-practicing MDs and related professionals who have demonstrated achievements in the field of urology through research or who have made substantial contributions to urologic research in an administrative capacity.
Section 12 - International Members International Membership is available to urologists who practice in countries beyond the geographic boundaries of the AUA. The applicant shall be a member of the local or national urological organization in his country. If a national organization does not exist within the applicant’s country, a waiver of this requirement may be considered by the Executive Committee. The applicant’s practice must be limited entirely to the specialty of urology. The applicant must be a graduate of an acceptable medical school who has received a Doctor of
Table of Contents 278 Medicine or equivalent degree.
Section 13 - Allied Members Allied Membership is available to non-physician professionals, including nurses (e.g., RN, LPN, LVN), medical technicians, and medical assistants, specializing or concentrating in urology for at least one year.
Section 14 - Advanced Practice Provider Members Advanced Practice Provider Membership is available to physician assistants, nurse practitioners or advanced practice nurses specializing or concentrating in urology for at least one year.
Section 15 - International Residents-In-Training Members International Residents-in-Training Membership is established to extend AUA education and professional advantages to Urological Residents-in-Training who reside outside the geographic boundaries of the section. These members must be enrolled in a residency program approved by the European Board of Urology (EBU), Residency Review Committee for Urology or the appropriate credentialing body in a country other than the United States. Eligibility for this member status shall be for a period of ten (10) years from the member’s date of completion of medical school.
Section 16 - Resident/Fellow Members Resident/Fellow Membership extends section educational and professional advantages to urological residents or fellows and research postdoctoral fellows in training Resident/Fellow Members must be practicing and studying within the geographic boundaries of the section. Resident/Fellow membership is available to: 1) Residents enrolled in an ACGME-accredited or AOA-approved urology residency training program. 2) Post-doctoral research fellows with a MD, PhD or equivalent degree actively engaged in biomedical research under a qualified mentor. 3) Clinical Fellows enrolled in an accredited fellowship or post residency training program.
Section 16.1 ACGME Medical Doctors (MD) or Doctors of Osteopathy (DO) enrolled in a urology residency program approved by the Residency Review Committee and ACGME are eligible for Resident/Fellow Membership; and after completing training and passing part 1 of the ABU qualifying examination are eligible for Associate Member status (Fast Track), Section 8.1. Those who successfully pass all parts of the ABU certifying examination are eligible for Active Member status, Section 6.
Section 16.2 AOA Doctors of Osteopathy enrolled in an AOA-approved urology residency training program are eligible for Resident/Fellow Member status. DOs completing their urology training and passing the American Osteopathic Board of Surgery certifying examination are eligible for Associate Member status, Section 8.2.
Section 17 - Medical/Graduate Student Members Medical/Graduate Student Membership is established to provide education about urology as a surgical specialty and as a career. Medical/ Graduate Student Membership is available to: (1) Individuals enrolled full-time in a medical school for the purpose of obtaining a Medical Doctor degree, Doctors of Osteopathy degree, or equivalent degree, or (2) Individuals enrolled full-time in an accredited graduate school program for the purpose of obtaining a PhD or equivalent degree and actively engaged in research under a qualified mentor.
Section 18 – Application For Membership Application for membership in this Section must be made on forms approved by the Board of Directors and provided by the Secretary. Qualifications for membership in each of the indicated categories shall be as stated in this Article I.
Table of Contents 279 Section 19 – Publication of Names The names of applicants for Active membership which have been approved by the Section Board of Directors shall be available to the membership prior to the Annual Business Meeting.
Section 20 – Notification of Election Every newly elected member of the Section shall be officially notified of his or her election by the Secretary. The AUA shall also be notified of the new member’s election.
Section 21 – Transfer of Membership An Active, Senior, or Associate Member in good standing of the AUA and of another Section of the AUA who moves his or her residence or practice into the territory of the Section, and who meets all membership qualifications, is automatically eligible for membership in the Section upon presentation of credentials to the Board of Directors of the Section. These credentials shall include his or her previous section records and a letter from that section’s Secretary indicating the applicant’s membership status.
Section 22 – Resignation, Expulsion and Reinstatement a) Resignation. Any member who has complied with all the requirements of these Bylaws during the life of his or her membership may resign by written notification to the Secretary who shall officially acknowledge the receipt of the notice. The Secretary shall notify the Secretary of the AUA of such resignation. b) Expulsion. Any member expelled by, or refused membership in, the AUA or AUA E/R shall immediately have his or her Section membership terminated. In addition, a member may be expelled by the Board of Directors of the Section upon conviction of a serious crime, or upon revocation, suspension or surrender of his or her license to practice medicine for reasons of improper or unethical conduct, upon withdrawal of certification by the ABU, or on other grounds stated in these Bylaws. The expulsion of a Section member shall be promptly reported to the AUA Secretary, with a statement of reasons for such expulsion. c) Reinstatement. The reinstatement of suspended members to good standing in the Section shall be determined by the Board of Directors of the Section, which may recommend the reinstatement of expelled members who have been previously reinstated by the AUA; but this action must be ratified by a three- fourths vote of the members of the Section present and voting at a regular meeting.
Section 23 – Method of Election Applications for all categories of membership must reach the Secretary at least seven (7) days before the Annual Business Meeting. The names of the applicants for all categories of membership will be published in the Annual Business Meeting program book or circulated at the Annual Business Meeting. Each applicant for membership who has met the requirements contained in these Bylaws shall become a member if he or she receives a majority vote of the members present and voting at the Annual Business Meeting. The names of all new members elected in the past year shall be published in the program of the Annual Meeting. The Secretary shall furnish all new members a written notification of membership, a copy of the Bylaws, and a roster of membership of the Section. Active and Honorary Members shall be furnished a Certificate of Membership.
ARTICLE II OFFICERS Section 1 – Officers and Executive Committee The Officers shall be the President, the President-Elect, the Immediate Past President, the Secretary, the Secretary-Elect, the Treasurer, the Treasurer-Elect and the Historian. Each Officer shall serve without financial remuneration from the termination of the Annual Meeting at which he or she is elected until the termination of the Annual Meeting at which his or her successor has been chosen or until his or her successor has otherwise been chosen. No member shall serve more than one term in any office, provided a member can serve up to
Table of Contents 280 three one-year terms as Historian and a member can serve in more than one office, though not concurrently. Each Officer must be an Active or Senior Member in good standing, a resident of or practicing within the boundaries of the Section, elected by a majority vote at the Annual Business Meeting. The officers shall comprise “the Executive Committee”. The Executive Committee is empowered and may, on occasion, make policy and/or other decisions, but remain primarily advisory to the Board and Long Range Planning Committee to present issues to the Board for decisions on matters of the Section.
Section 2 – President The term of office shall be one (1) year. The President shall be the Chief Executive Officer of the Section and shall serve as Chair of the Board of Directors and at the Scientific and Business Sessions of the Section. The President shall appoint Active or Senior Members to vacancies on all standing committees and the Chairs of the committee, as provided in these Bylaws. The President shall appoint special committees authorized by the Board of Directors or membership. All committee appointments shall be made within sixty (60) days after the Annual Meeting and reported to the Secretary for inclusion in the next Newsletter. The President may call Special Meetings of the Board of Directors. The President shall direct the attention of the Board of Directors to all matters pertaining to the interpretation of the Bylaws and to all matters of discipline of members. The President shall be a member of the Program Committee for the Annual Meeting, a member of the Finance Committee and an ex-officio member of all Standing Committees. The President shall nominate a Section member in good standing to serve on the Editorial Board of the Journal of Urology when a vacancy occurs. The President shall appoint a Parliamentarian to all meetings of the Board of Directors and Business Sessions of the Section.
Section 3 – The President-Elect The term of office shall be one (1) year and the President-Elect shall automatically succeed the retiring President at the conclusion of the Annual Meeting at which the current President’s term of office expires. The President-Elect shall perform any duties assigned by the President and serve in his or her absence. The President-Elect shall appoint a Chair of the Local Arrangements Committee for the Annual Meeting at which he or she will preside, within sixty (60) days after assuming the office of President-Elect.
Section 4 – The Immediate past President The term of office shall be one (1) year or until his or her successor assumes the office.
Section 5 – The Secretary The term of office shall be three (3) years or until his or her successor assumes the office. The Secretary shall: (a) employ, with the approval of the Board of Directors, such secretarial assistance as is necessary under the direction of the Executive Director; (b) keep accurate records of all the activities of the Section; (c) give prompt attention to all correspondence; (d) train the Secretary-Elect during the Secretary’s last year in office; (e) keep an accurate list of (1) members, (2) applicants for membership, (3) applicants recommended for membership by the Board of Directors, (4) applicants rejected and dates of rejection, (5) members suspended or expelled and dates of suspension or expulsion, (6) members reinstated and the date of same, and (7) Active or Associate members transferred to Senior, Inactive, or Honorary membership; (f) provide application blanks and receive applications for all categories of membership and shall send them to the Board of Directors for consideration; (g) give written notification to all newly elected members and furnish them with a copy of the Bylaws, one (1) roster and a certificate of membership, in the case of Active and Honorary members; (h) publish and send Newsletters; (i) send notice of the time and place of the Annual Meeting by Newsletter to all members at least six (6) months prior to the meeting; (j) arrange for meetings of the Board of Directors and send notices of all regular and special meetings to all members of the Board of Directors at least fifteen (15) days prior to the meeting, (k) keep the minutes and all records of such meetings; (l) have charge of the arrangements for the Annual Meeting in cooperation with the Chair of the Local Arrangements Committee and in consultation with the President; (m) shall receive titles of abstracts and papers to be read at the Annual Meeting and present them to the Program Committee; (n) keep accurate minutes of the Annual Business Meeting and send one (1) copy to every member of the Board of Directors; (o) obtain the names of all committee
Table of Contents 281 members for the coming year from the President within sixty (60) days after the Annual Meeting and notify them in writing; (p) make an annual report of all his or her activities on behalf of the Section to the Board of Directors at the Annual Business Meeting and to members of the Section at the Annual Business Meeting; (q) report to the Chair of the Nominating Committee sixty (60) days before the Annual Meeting regarding vacancies which will occur in the offices of Representative and Alternative Representative to the Board of Directors of the AUA; (r) report to the Secretary of the AUA immediately after the Annual Meeting the names of those members elected as Representative and Alternative Representative to the Board of Directors of the AUA; (s) report immediately to the Secretary of the AUA the names of the members of the Section who have been elected for membership in the Section, and (t) take such other action as directed by the Board of Directors.
Section 6 – Secretary-Elect The Secretary-Elect shall be elected at the Annual Business Meeting one (1) year before the termination of the current Secretary's term of office. The term of office shall be one (1) year and the Secretary-Elect shall automatically become the new Secretary at the conclusion of the Annual Meeting at which the current Secretary's term expires. The Secretary-Elect shall become familiar with the duties of the Secretary during the Secretary's final year in office. The Secretary-Elect shall attend all meetings of the Board of Directors and the Finance Committee, and make site visits but shall not be eligible to vote.
Section 7 – Treasurer The term of office shall be three (3) years or until a successor assumes the office. The Treasurer shall: (a) keep an accurate record of all assets of the Section and keep them in the name of the Section; (b) be bonded for approximately the total amount of the assets of the Section, bond being held by the President; (c) disburse the monies of the Section only by the authority of the Board of Directors; (d) keep a journal, ledger, and alphabetical list of all members indicating the state of their accounts with the Section; (e) be responsible for the collection of all dues and assessments, both current and delinquent; (f) report delinquent members promptly to the Secretary and to the Board of Directors; (g) have an annual audit of the Section's financial status prepared by a certified public accountant and present a report of this audit to the Board of Directors and to the members of the Section at the Annual Business Meeting; (h) recommend to the Board of Directors the need for any special assessments; (i) be responsible for setting the budgets, subject to approval of the Board of Directors, for the Annual Meeting and working with the Local Arrangements Committee in monitoring expenses; (j) report annually to the Board of Directors on the assets held by the Section, the existence of which must be verified by the certified public accountant and the Audit and Budget Control Committee; (k) take such other action as directed by the Board of Directors, and (l) train the Treasurer-Elect during the Treasurer’s last year in office.
Section 8 – Treasurer-Elect The Treasurer-Elect shall be elected at the Annual Business Meeting one (1) year before the termination of the current Treasurer's term of office. The term of office shall be one (1) year and the Treasurer-Elect shall automatically become the new Treasurer at the conclusion of the Annual Meeting at which the current Treasurer's term of office expires. The Treasurer-Elect shall become familiar with the duties of the Treasurer during the Treasurer’s final year in office.
Section 9 – Historian The term of office shall be one (1) year and is renewable for two additional terms. The Historian shall: (a) prepare an accurate history of the Section; (b) keep records of the Section pertinent to its history; (c) present an annual report to the Board of Directors and to the Section at its Annual Business Meeting; (d) prepare for publication any historical issues relative to the Section and present it to the Board of Directors; e) prepare a necrology report and present it to the Board of Directors and members of the Section at the time of the Annual Business meeting. Present a brief eulogy of any member who has made outstanding contributions to Urology and a brief eulogy of any Section past president who has died in the preceding year at the Annual Business meeting or plenary session of the annual scientific meeting as determined by the Section Secretary. f) Present a encomium of Section past
Table of Contents 282 presidents, or any member who has made outstanding contributions to Urology, at the time of their retirement, to members of the Section during a time designated by the Secretary at the Annual Business meeting or during the plenary sessions of the annual scientific meeting. Funds required for the foregoing purposes shall be subject to the approval of the Board of Directors.
Section 10 – Executive Director The Executive Director shall be the Chief Administrative Officer of the Section and shall report directly to the Board of Directors of which he or she shall be an ex officio, non-voting member. The Executive Director need not be a physician nor a member of this Section. The Executive Director shall have the full and exclusive authority to hire and fire staff and to prescribe compensation within the framework of the approved budget. The Executive Director shall have the authority and ultimate responsibility to carry out all policies and programs of the Section within the framework of the budget and subject to the direction of the officers and the Board of Directors and the Section’s committees.
ARTICLE III BOARD OF DIRECTORS Section 1 – Members of Board The Board of Directors shall consist of the President, President-Elect, Immediate Past President, Secretary, Treasurer, Historian and one elected member from each of the following geographic units: (1) Illinois; (2) Indiana; (3) Iowa; (4) Michigan; (5) Minnesota, North Dakota, and South Dakota; (6) Ohio; and (7) Wisconsin. The Representatives to the Board of Directors of the AUA, the Secretary-Elect, the Treasurer-Elect, the Chair of the Women in Urology Committee, the Chair of the Health Policy Council, and the Chair and the Vice-Chair of the Young Leadership Committee shall be non-voting members of the Board of Directors.
Section 2 – Term The term of office of the geographic unit members shall be three (3) years and no retiring member of the Board of Directors shall be eligible for re-election to the Board as a representative of a geographic unit. Geographic unit members are required to practice in the state in which they are representing. If the representative moves outside of the state of representation during his or her term, a vacancy is automatically created and a replacement representative will be filled in accordance with these Bylaws.
Section 3 – Authority and Duties The Board of Directors shall constitute the governing Board of the Section and shall be responsible for the administration and management of the Section. The Board of Directors shall receive the reports of the standing and special committees of the Section and shall oversee all functions relating to financial management, member services, Annual Meeting, industry relations, ethics, and official publication. The Board of Directors shall employ the Executive Director whose duties, responsibilities and authority shall be as specified in Article II, Section 10 of these Bylaws. The Board of Directors shall report all actions to the membership at the Annual Business Meeting. The Board of Directors shall select the time and place of the Annual Meeting.
Section 4 – Meetings The Board shall hold a winter meeting and a meeting concurrently with the Annual Meeting of the Section and shall hold other interim meetings at such times and places as may be established by the President or any seven (7) voting members of the Board.
Section 5 – Notice Notice of each meeting of the Board of Directors shall be sent out by the Secretary to each member of the Board of Directors to be received at least fifteen (15) days before the date of the meeting. The matters to be discussed and voted upon at any duly called meeting of the Board of Directors shall not be limited to those set forth in the notice of such meeting.
Table of Contents 283 Section 6 – Quorum Seven (7) Directors shall constitute a quorum for transaction of business by the Board of Directors.
ARTICLE IV COMMITTEES Section 1 – Appointment Active and Senior Members only are eligible for appointment to Committees of the Section. All Committees are to be appointed by the new President within sixty (60) days following the Annual Meeting. The President shall have the power also to appoint special committees for a specific purpose subject to approval by the Board of Directors. All members must be given prompt written notification by the Secretary. A roster of all Section Committees shall be published in the first Newsletter following the Annual Meeting.
Section 2 – Nominating Committee a) The committee shall be composed of the two Immediate Past Presidents in attendance at the Annual Meeting, one member of the Board of Directors elected by the Board of Directors and four (4) or, if the Past-Past President is a non- voting member of the committee (as provided below), five (5), members selected by the geographic units other than the geographic units represented by the three (3) aforementioned other members of the Committee. The Chair shall be the most recent Past President on the committee and the Vice-Chair shall be the Past-Past President on the committee. In the event the two Immediate Past Presidents serving on the committee are from the same geographic unit, the Past-Past President shall be a non-voting member of the committee, and a total of five members shall be selected by the geographic units, as provided above, so that each geographic unit has representation on the committee. b) Each geographic unit not represented on the committee by the Past Presidents or the member of the Board of Directors shall choose one representative to serve on the committee who has demonstrated leadership or active participation in the Section and each geographic unit and the Board of Directors shall choose one alternate representative to serve in the event its representative cannot serve or attend meetings. Each such representative shall attend all meetings of the Committee, provided if the representative cannot attend, the alternate shall attend and serve in his or her stead. In the event that neither the delegate or alternate delegate from the geographical unit is able to attend the Nominating Committee meeting, the State Representative of the Section’s Board of Directors may serve on the Nominating Committee in their stead. c) It shall be the duty of this Committee to present to the members of the Section at the Annual Business Meeting a list of nominees for the following Section offices: 1) President-Elect 2) Secretary (every third year) 3) Treasurer (every third year) 4) Secretary-Elect (every third year) 5) Treasurer-Elect (every third year) 6) Historian (annually) 7) Two or more members of the Board of Directors d) The Nominating Committee shall also nominate members of the Section in good standing to serve as Representatives and Alternate Representatives on the AUA Board of Directors, the AUA Nominating Committee and other AUA committees for terms specified in the AUA Bylaws. e) Selection of AUA President-Elect: Selection of the AUA president will be accomplished by electronic balloting of the entire Membership. Membership will be contacted electronically to submit nominees for the AUA President-Elect in November prior to the annual meeting when it’s the section’s turn for rotation of the AUA President Elect. The potential nominees must provide a statement of intent that will be posted on the section’s website. The Chairman of the Nominating Committee, Secretary, and Executive Director will review the
Table of Contents 284 candidates and confirm eligibility for the position. Specifically, that the candidates meet the AUA requirements and have served on the Board of Directors or as an Officer of the North Central Section. Election Procedures: 1. Prior to the annual meeting where the position is open, all eligible voting members will be allowed to vote via a secure independent web based voting system. Only one vote per voting member will be counted and the Office of the Executive Director will verify only one vote per voting member. The deadline for voting will be January 31. 2. The election results will be verified by a committee consisting of the Secretary of the NCSAUA, Chairperson of the Nominating Committee and the Executive Director. 3. The winner must gather 50% of the vote plus one to be declared the victor 4. If there is no outright victor then the top two vote getters will face off in another electronic election, via a secure independent web based voting system to be completed by February 28th. Only one vote per voting member will be counted for the face-off election, and the Office of the Executive Director will verify only one vote per voting member. 5. The votes will be verified by the Secretary, Chairperson of the Nominating Committee, and the Executive Director. The victor will be notified at the Annual Business Meeting. f) The report of the Nominating Committee shall be presented at the Annual Business meeting, and a majority of votes shall be necessary to ratify that report. No nominations for Officers, Directors, or AUA Representatives shall be accepted from the floor of the Business Meeting. g) Should the report of the Nominating Committee be rejected, in whole or in part, by a majority of the membership voting at the Business Meeting, then the Committee shall promptly seek another acceptable candidate for each challenged position in accordance with the provisions of Article IV, Sections 2 (c) and (d) of these Bylaws. A subsequent candidate approved by the Nominating Committee shall be submitted through the mail, within 30 days thereafter, for approval by majority vote of all eligible Section members responding to that vote. h) The following shall be the Section representatives on AUA Committees: 1) Bylaws Committee. Chair of the Section Bylaws Committee. 2) Membership Committee. Secretary of the Section. 3) Health Policy Committee. Two members of the NCS Health Policy Committee. i) The representatives to the AUA AudioVisual Committee shall be appointed by the AUA President in consultation with the Section for a one-year term. j) While serving as a member of this Committee, no member shall be eligible for nomination to any elective office of the Section or the AUA nor for election as a representative to the AUA provided, however, incumbents in any office shall continue for their stated term of office.
Section 3 – Membership Committee The Committee shall consist of the Board of Directors. The Chair shall be the Immediate Past President. It shall consider applications for all categories of membership which have been filed with the Secretary. When necessary, it will make a thorough investigation of the ethical, moral and professional standards of an applicant. The Committee shall meet annually or as often as circumstances warrant.
Section 4 – Finance Committee The Finance Committee shall consist of the President, President-Elect, Immediate Past President, Secretary and Treasurer. The Secretary-Elect and Treasurer-Elect shall be non- voting members. The Treasurer shall be the Chair. The Finance Committee shall study and evaluate all financial affairs of the Section and make recommendations to the Board of Directors, set up a budget for the various activities and committees each year, and, on the basis of the projected budget, make recommendations to the Board of Directors regarding dues for the ensuing year. The Committee shall meet annually or as often as circumstances
Table of Contents 285 warrant.
Section 5 – Local Arrangements Committee The President-Elect shall appoint the Chair of the Local Arrangements Committee for the meeting at which the President-Elect will preside within sixty (60) days after his election as President-Elect. The Chair shall be from the State within the Section which is the host for such meeting. The Chair shall have the power to appoint all Local Chairs and Committee Members. The Treasurer of the Section shall serve as the Treasurer for the meeting and shall be responsible for all of the finances of the meeting. All expenditures must be authorized in advance by the Treasurer or the Chair in accordance with the budget for the Annual Meeting. The Committee shall prepare a budget for the Annual Meeting and present it to the Board of Directors for its approval. The Committee shall make all necessary arrangements for the Annual Meeting after consultation with the President and the Secretary and report such arrangements to the Board of Directors. The Committee shall prepare a program description for the Annual Meeting Program. Additional members of the Committee shall be the Secretary and the immediate past Chairmen of the Local Arrangements Committee.
Section 6 – Program Committee The Committee shall consist of the President, the President-Elect, the Chair of the Local Arrangements Committee, Chair of the Education Committee, a Resident Representative and the Secretary, who shall be Chair of the Committee, and the Secretary-Elect, if any. The Resident Representative will be appointed by the Long Range Planning Committee annually. The Committee shall arrange the scientific program for the Annual Meeting and select the abstracts best suited for the program. It shall be the prerogative of the Committee to invite any guest speakers from outside the Section whom the Committee determines would contribute to the program.
Section 7 – Audit Committee The Committee shall consist of three (3) Representatives of the Board, with 3-year staggered terms to ensure no more than one member rotates off the committee annually. The Chair will be the most senior member. The incoming members will serve one year in a training capacity before joining the committee as a voting member. Appointments are to be made by the President. The Audit Committee’s primary function is to assist the Board in the fulfilling its oversight responsibilities with respect to (1) the audit of the organization’s financial statement and records and (2) the system of internal controls that the organization has established. The Audit Committee shall interview and select the audit company upon request. The Audit Committee reports to the Board of Directors. The Chair of the Audit Committee presents the Audit Report to the Membership at the Business Meeting.
Section 8 – Editorial and Awards Committee The Committee shall consist of five (5) members and the term of office shall be five (5) years. One new member shall be appointed annually by the President and the most senior member shall be the Chair. No member of the Committee shall be eligible to receive an award granted by the Committee. The Committee may award one or more Traveling Fellowships annually, but if more than one award is to be made, approval by the Board of Directors is required. It shall make the Traveling Fellowship award to Residents or Urologists residing in the Section. Urologists who have been in practice more than five (5) years are not eligible for the award. The recipients need not be members of the Section. The Committee will judge and make awards for the named awards (Thirlby and Traveling Fellowship) and any special prizes accepted for competition by the Board of Directors. It shall instruct the Secretary to send a certificate or formal letter to each recipient stating that he or she has received this award from the Section. It shall request the recipients to give a report of their travel at the next Annual Meeting or submit a written report for publication in the Newsletter. It shall make other awards as directed by the Board of Directors.
Table of Contents 286 Section 9 – Bylaws Committee The Committee shall consist of three (3) Active or Senior Members and the Secretary. One member, other than the Secretary, shall be designated as Chair by the President. The term of office shall be three (3) years. Members shall be eligible for two (2) terms. The Chair of the Committee shall be a member of the Bylaws Committee of the AUA. The Committee will adhere to the Section’s goal of complying with the Mission and Vision and Purposes of the AUA, as stated currently in Article I, Sections 1 and 2 of the AUA Bylaws, and propose Bylaws which are in accord, or not in conflict with, those of the AUA. The Chair will keep an accurate file of all correspondence to and from the members of the Committee and from the Secretary of proposed amendments by members of the Section. The Committee shall meet and review the Bylaws annually and recommend to the Board of Directors any changes that seem desirable. All proposed amendments to the Bylaws shall be submitted to the Board of Directors for consideration prior to being published in the Newsletter sixty (60) days before the Annual Meeting.
Section 10 – Technical Exhibits Committee
Section 11 - Education Committee a) The Education Committee will evaluate educational opportunities, approaches and philosophies as they relate to the Section. Specifically, the Committee will address the content and approach of the Annual Meeting, ongoing educational issues of section members, and any concerns the members may have as they relate to urologic education within the Section. They will be advisory to the Board of Directors. b) This Committee will meet annually, at the Annual Meeting. c) The Committee will be comprised of a chair (selected by Board), one “at large” Board member (selected by the Board), the NCS Secretary, and the NCS Secretary-Elect, Chair of the Young Urologist Committee, a resident representative, two section members selected by the Committee Chair ( to serve at the discretion of the Committee Chair). The term of the chair will be 3 years, renewable once. At the discretion of the Chairman, one member of the committee will report to the Board of Directors at the Interim Board Meeting.
Section 12 – Health Policy Committee The Committee shall consist of two representatives from each state in the Section – and where feasible, one of those representatives should live or practice in the state capital or its vicinity. The Chair of the Committee shall be appointed by the Board for a term of two years, and may be reappointed for one additional two-year term. The Chair shall be expected to attend the annual and interim meetings of the Board. The AUA Health Policy Committee Representatives shall be members of the Health Policy Committee.
Section 13 – Young Urologists Committee The Committee shall consist of a Chair and Vice Chair, and two members less than 10 years out of residency, preferably one from private practice and one from academic practice, from the following geographic units: Illinois; Indiana; Iowa; Michigan; Minnesota, North Dakota, and South Dakota; Ohio; and Wisconsin with two year staggered terms to ensure no more than one member rotates off a geographic unit annually. Appointments to the geographic units are to be made by the President in consultation with the outgoing Young Urologists Committee member and/or the NCS Board of Directors representative of the outgoing geographic unit. The Committee itself appoints its own Chair and Vice Chair, each for a term of two years with the Vice chair ascending to the position of Chair at the end of the terms with the Young Urologist Committee approval. The Young Urologists Committee primary responsibility is to advise the Board of Directors on issues of particular concern to young urologists and addresses membership issues for young urologists. The Young Urologist Committee Chair and Vice Chair shall serve ex-officio, without vote, on the NCS Board of Directors for the duration of their terms. The Chair presents at Section Board of Directors’ meetings and is responsible for planning the young urologist segment on the annual meeting program when applicable. The Vice Chair of the Young Urologists Committee also serves as the NCS representative on the AUA Young Urologist Committee.
Table of Contents 287 Section 14 – Long-Range Planning Committee The Committee shall consist of the President, the President-Elect, the Treasurer, the immediate Past President, the Representative to the AUA, the Chair of the Young Leadership Committee, the Chair of the Education Committee, the Secretary-Elect and the Treasurer-Elect. The Secretary shall serve as the Chair of the Committee. It shall assess the Section's activities and membership needs and make recommendations to the Board of Directors regarding policy and programs.
Section 15 – Past Presidents Committee The Committee shall consist of the President, the President-Elect, and all of the previous Past Presidents of the NCS at the annual meeting. The President shall serve as the Chair of the Committee. It shall meet at the annual meeting and provide an update of the NCS programs. The committee should exchange historical information that may impact on current issues and offer suggestions to the Board for improvement to current program or new programming. The President who will be the Past President at the next interim meeting will report back to the Board.
Section 16 – Women in Urology Committee The Committee shall consist of a Chair and Vice Chair, and one member and one alternate from the following geographic units: Illinois, Indiana, Iowa, Michigan, Minnesota, North Dakota, South Dakota, Ohio, and Wisconsin with two year staggered terms to ensure no more than one member rotates off a geographic unit annually. Appointments to the geographic units are to be made by the Committee in consultation with the outgoing Women in Urology Committee member and/or the NCS Board of Directors representative of the outgoing geographic unit. The Committee itself appoints its own Chair and Vice Chair, each for a term of two years, renewable once, with the Vice chair ascending to the position of Chair at the end of the terms with the Women in Urology Committee approval. The Women in Urology Committee’s primary responsibility is to advise the Board of Directors on issues of particular concern to female urologists and addresses membership issues for female urologists. The Women in Urology Committee Chair shall serve ex- officio, without vote, on the NCS Board of Directors for the duration of her term. The Chair presents at the Section Board of Directors’ meetings and is responsible for planning the Women in Urology segment on the annual meeting program when applicable.
ARTICLE V MEETINGS The Annual and Special Meetings of the members shall be held at such time and place as designated by the President and the Board of Directors, subject to the provisions of these Bylaws. The President or five (5) members of the Board of Directors can call special meetings. Official notice of the Annual Meeting shall be included in a Newsletter which must reach the members at least six (6) months before the time of the meeting. Notice of Special meetings must be sent to the members at least twenty-one (21) days before such a meeting. The order of business at the Scientific Meeting shall be determined by the Secretary after consultation with the Program Committee. The members registered and eligible to vote who are present at the Annual Business Meeting and at any Special Meetings shall constitute a quorum for such meeting, and, unless otherwise specifically required by these Bylaws or applicable law, the vote of a majority of such members shall be required to approve any action at such meeting. The order of business at the Annual Meeting shall be set by the Board of Directors.
ARTICLE VI AMENDMENTS These Bylaws may be amended by the two-thirds (2/3) vote of the members present and voting at the Annual Business Meeting. Proposed amendments must be submitted in writing to the Secretary and referred by the Secretary to the Bylaws Committee which shall
Table of Contents 288 consider all proposed amendments and present their recommendations to the Board of Directors. Any proposed amendment shall be printed with the Notice of the Annual Meeting at which the action is to be taken and shall be sent to the members at least thirty (30) days before such Annual Meeting.
ARTICLE VII RULES ON PARLIAMENTARY PROCEDURE Sturgis Standard Code of Parliamentary Procedure, current edition, shall govern the proceedings of the Section, unless provided otherwise in the Articles of Incorporation or in these Bylaws.
ARTICLE VIII VACANCIES Should a vacancy occur in any elected position of the Section, more than sixty (60) days before a scheduled election, then the Executive Committee shall promptly nominate a replacement from among the membership or the existing Board of Directors, taking into account geographic considerations and relevant factors of experience and necessary qualifications for the vacant position. The vacancy shall be filled at a special meeting of the Section Board of Directors, requiring a vote of two-thirds of the entire Board, excluding the individuals whose names have been placed in nomination.
Table of Contents 289 Award Recipients
Traveling Fellowship Recipients 2018 Tyler Etheridge; Madison, WI 2017 Kevin Ginsburg, MD; Royal Oak, MI 2016 Matthias Hofer, MD, PhD; Chicago, IL 2015 Brian J. Linder, MD; Rochester, MN 2014 Brian J. Minnillo, MD; Cleveland, OH 2013 Florian R. Schroeck, MD, MS; Ann Arbor, MI 2012 Bruce Jacobs, MD, MPH; Ann Arbor, MI 2011 Sandip Prasad, MD, MPhil; Charleston, SC 2010 Cory M. Hugen, MD; Chicago, IL 2009 Michael C. Large, MD; Chicago, IL 2008 Tullika Garg, MD; New York, NY 2007 R. Houston Thompson, MD; Byron, MN 2007 Brian L. Gallagher, MD; West Des Moines, IA 2007 Brian R. Lane, MD; Grand Rapids, MI 2006 Brian L. Gallagher, MD; West Des Moines, IA 2006 R. Houston Thompson, MD; Byron, MN 2005 Ronney Abaza, MD; Columbus, OH 2005 Herkanwal S. Khaira, MD; San Francisco, CA 2004 Herkanwal S. Khaira, MD; San Francisco, CA 2004 David Allan Anderson, MD; Springfield, MO 2003 David C. Miller, MD, MPH; Ann Arbor, MI 2003 David S. Sharp, MD; Columbus, OH 2002 Richard C. Sarle, MD; Dearborn, MI 2001 Mihir M. Desai, MD; Highland Heights, OH 2001 Fernando J. Bianco Jr., MD; Coral Gables, FL 2000 Stephanie J. Kielb, MD; Chicago, IL 2000 Lee E. Ponsky, MD; Moreland Hls, OH 1999 Bijan Shekarriz, MD; Virginia Beach, VA 1998 Sanjay Ramakumar, MD; Tucson, AZ 1997 Steven G. Roberts, MD; Aptos, CA 1996 Jeffrey S. Palmer, MD, FACS, FAAP; Beachwood, OH 1995 Bradley P. Kropp, MD; Oklahoma City, OK 1994 Gregory D. Haselhuhn, MD; Toledo, OH 1993 Joel B. Nelson, MD; Pittsburgh, PA 1992 Earl Y. Cheng, MD; Chicago, IL 1991 Eric J. Dybal, MD; Elk Grove Village, IL 1990 Eugene D. Kwon, MD; Rochester, MN 1989 William A. See, MD; Milwaukee, WI 1988 Kevin T. McVary, MD; Chicago, IL 1987 Hugh A. Kennedy II, MD; Hartford, CT 1986 Julie R. Spencer, MD; Chicago, IL 1985 John E. Garnett, MD; Chicago, IL 1984 Raleigh G. Humphries, MD; Greensboro, NC 1983 Michael E. Kuglitsch, MD; Columbus, WI 1982 Max Maizels, MD; Chicago, IL 1982 Steven H. Selman, MD; Toledo, OH 1981 Philip T. Hoekstra, MD; Grand Rapids, MI 1980 Jeffrey P. Bolduan, MD; Goshen, IN 1979 William E. Kolbusz, MD; Oak Brook, IL 1978 C. Peter Fisher, MD; Ypsilanti, MI 1977 Randall G. Rowland, MD, PhD; Lexington, KY 1975 Reza S. Malek, MD; Rochester, MN 1975 John W. Timmons Jr., MD; Gainesville, FL 1974 Bageshwari P. Sirba, MD; Allen Park, MI 1974 Kalish R. Kedia, MD; Middleburg Heights, OH
Table of Contents 290 1973 Mark S. Soloway, MD; Miami, FL 1973 Martin I. Resnick, MD; Cleveland, OH 1972 Daniel S. Merrill, MD; Minneapolis, MN 1972 Mark S. Soloway, MD; Miami, FL 1971 Martin I. Resnick, MD; Cleveland, OH 1971 Nasser Javadpour, MD; Minneapolis, MN 1970 Kenneth A. Kropp, MD; Toledo, OH 1969 Carl V. Dreyer, MD; Toledo, OH 1968 Carl R. McKinley, MD; Minneapolis, MN 1967 John P. Donohue, MD; Melbourne Beach, FL 1966 Jack W. Jaffe, MD; Shaker Heights, OH 1965 Daniel B. Gute, MD; Wellesley, MA 1964 A. Colin Markland, MD; Charleston, SC 1963 Stanley R. Levine, MD; Highwood, IL 1962 Robert Adrain Rehm, MD; Hilliard, OH 1961 Charles A. Linke, MD; Rochester, NY 1960 Herbert Sohn, MD, JD; Chicago, IL
Thirlby Award Recipients 2018 Ronney Abaza, MD; Dublin, OH 2017 N/A 2016 Chirag N. Dave, MD; Royal Oak, MI 2015 Mahmood A. Hai, MD, FICS; Westland, MI 2014 Avinash Chennamsetty, MD; Birmingham, MI 2013 Joel Abbott, DO; Madison Hts, MI 2012 Richard A. Memo, MD; Yougstown, OH 2011 Christopher Knoedler, MD; Maplewood, MN 2011 Robert Gaertner, MD; Woodbury, MN 2010 Herbert W. Riemenschneider, MD; Columbus, OH 2009 Ronald S. Suh, MD; Brownsburg, IN 2008 Eduardo Kleer, MD; Ypsilanti, MI 2007 David S. Turk, MD; Medina, OH 2006 Serge P. Marinkovic, MD; Decature, IL 2006 Surendra M. Kumar, MD; Westland, MI 2005 Serge P. Marinkovic, MD; Decature, IL 2004 Serge P. Marinkovic, MD; Decature, IL 2003 Richard A. Memo, MD; Youngstown, OH 2001 Thomas J. Maatman, DO; Grand Rapids, MI 2000 Steven W. Siegel, MD; St. Paul, MN 1999 Thomas J. Maatman, DO; Grand Rapids, MI 1998 Michael G. Oefelein, MD, FACS; Tustin, CA 1997 Thomas J. Maatman, DO; Grand Rapids, MI 1996 Bruce E. Woodworth, MD; Knoxville, TN 1995 Arthur W. Devine Jr., MD; Cedar Rapids, IA 1994 Richard A. Memo, MD; Youngstown, OH 1993 Nader Sadoughi, MD; Dana Point, CA 1992 Thomas J. Maatman, DO; Grand Rapids, MI 1991 Jerrold J. Widran, MD; Palm Desert, CA 1990 Ahmad Hamidinia, MD; Cincinnati, OH 1989 Thomas J. Maatman, DO; Grand Rapids, MI 1988 Stephen W. Leslie, MD; Omaha, NE 1987 William C. Mobley, MD; Davenport, IA 1986 Jeffery Wacksman, MD; Bonita Springs, FL 1985 William S. Jasper Sr., MD; Meidna, OH 1984 Gerald W. Koos, MD; Duluth, MN 1983 Riad N. Farah, MD; Detroit, MI 1982 Carl R. McKinley, MD; Minneapolis, MN 1981 Jerrold J. Widran, MD; Palm Desert, CA
Table of Contents 291 1980 Paul R. Hartig, MD; Edina, MN 1979 William S. Jasper Sr., MD; Meidna, OH 1978 Jack L. Summers, MD; Sun City Center, FL 1977 James J. Meyer, MD; Chanhassen, MN 1976 Everette J. Duthoy, MD; Naples, FL 1975 Charles J. Cooney, MD; Fort Wayne, IN 1974 Stanley J. Antolak Jr., MD; Edina, MN 1972 Lorris M. Bowers, MD; Brimfield, IL 1970 Emile Maltry Jr., MD; Fargo, ND 1969 Joseph A. Santiago, MD; Milwaukee, WI 1968 Thomas C. Hall, MD; Traverse City, MI 1966 Sidney P. Hurwitz, MD; Milwaukee, WI 1965 Bruce E. Linderholm, MD; Minneapolis, MN 1964 Bernard J. Begley, MD; San Diego, CA 1963 Julian B. Galvin, MD; Pepper Pike, OH
John D. Silbar Award Recipients 2018 Akshay Sood, MD; Detroit, MI 2017 Adam Calaway, MD; Indianapolis, IN 2016 Laura A. Bertrand, MD; Iowa City, IA 2015 Matthew A. Uhlman, MD, MBA; Iowa City, IA 2014 Adam Kadlec, MD; Elmhurst, IL 2013 Clinton D. Bahler, MD; Indianapolis, IN 2012 Henry M. Rosevear, MD; Iowa City, IA 2011 Crystal Dover, MD; Madison, WI 2010 Christina B. Ching, MD; Cleveland, OH 2009 Brian L. Gallagher, MD; West Des Moines, IA 2008 David C. Arend, MD; Sioux Falls, SD 2007 Lynn L. Woo, MD; S. Euclid, OH 2007 Saleem S. Zafar, MD; Toledo, OH 2006 Curtis Crylen, MD; Greeley, CO 2005 Steven R. Mindrup, MD; Marion, IA 2004 John C. Thomas, MD; Nashville, TN 2003 Dimitri D. Kuznetsov, MD; Port Townsend, WA 2002 W. Patrick Springhart, MD; Shreveport, LA 2001 Melody A. Denson, MD; Austin, TX 2000 Courtney M.P. Hollowell, MD; Chicago, IL 1999 Steven Elliott Kahan, MD; Portsmouth, NH 1999 Steven E. Kahan, MD, JD; Portsmouth, NH 1998 Daniel S. Elliott, MD; Rochester, MN 1997 Sheila K. Gemar, MD; Willmar, MN 1996 Cheryl T. Lee, MD; Ann Arbor, MI 1995 Jerald A. Hochstetler, MD; Goshen, IN 1994 Mark J. Waples, MD; Milwaukee, WI
Bizarre and Interesting Case Award Recipients 2018 Maria Francesca Monn, MD, MPH; Indianapolis, IN 2018 Matthew J. Mellon, MD; Indianapolis, IN 2017 Michael F. Atwell; Peoria, IL 2016 Samer W. Kirmiz; Grand Rapids, MI 2016 Aron Liaw, MD; San Francisco, CA 2015 Benjamin Carpenter, MD; Indianapolis, IN 2014 Matthew R. Fulton, MD; Royal Oak, MI 2013 Megan Bing, MD; Iowa City, IA 2012 Anish Shah, MD; Cincinnati, OH 2011 David Wenzler, MD; Royal Oak, MI 2010 Zachary Q. Posey, MD; Ferndale, MI 2009 Anthony J. Polcari, MD; Chicago, IL
Table of Contents 292 2008 Christina B. Ching, MD; Cleveland, OH 2007 Randy M. Chudler, MD; Sterling Heights, MI 2006 Matthew M. Lux, MD; San Diego, CA 2006 Ryan C. Hedgepeth, MD; Minot, ND 2005 Mark Memo, DO; Youngstown, OH 2004 Peter C. Fisher, MD; Salt Lake City, UT 2003 Caleb P. Nelson, MD; Waban, MA 2002 Richard A. Santucci, MD; Northville, MI 2001 W. Patrick Springhart, MD; Shreveport, LA 2000 Puneet Sindhwani, MD, MB, BS, MS; Oklahoma City, OK
Basic Science Poster Award Recipients 2018 Parth Patel, MD; Maywood, IL 2018 Daniel Z. Sun, MD; Cleveland Heights, OH 2018 Brady L. Miller, MD, MPH; Madison, WI 2018 Megan Y. Devine, BS; Chicago, IL 2017 Daniel Smith, MD; Minneapolis, MN 2017 Brian Van Le, MD, MA; Madison, WI 2016 John Roger Bell, MD; Madison, WI 2016 Naveen Kachroo, MD, PhD; Detroit, MI 2016 Thomas Tieu, MD; Springfield, IL 2016 Paholo G. Barboglio Romo, MD, MPH; Ann Arbor, MI 2015 Khaled Shahrour, MD; Toledo, OH 2015 Jessica H. Hannick, MD; Chicago, IL 2015 Kristina L. Penniston, PhD, RD; Madison, WI 2015 Kenneth G, Nepple, MD; Iowa City, IA 2014 Grace B. Delos Santos, MD; Chicago, IL 2014 Kristin A. Greco, MD; Maywood, IL 2014 Ronney Abaza, MD, FACS; Dublin, OH 2014 Raman Unnikrishnan, MD; Cleveland, OH 2013 Kristin A. Greco, MD; Maywood, IL 2013 Ishai S. Ross, MD; Detroit, MI 2012 Devon Snow-Lisy, MD; Cleveland, OH 2012 Megan Schober, MD, PhD; Farmington Hills, MI 2012 Kristina L. Penniston, PhD, RD; Madison, WI 2011 Mitra De Cogain, MD; Rochester, MN 2011 Nathan A. Bockholt, MD; Coralville, IA 2011 Dae-Yun Kim, MD, PhD; Chicago, IL 2011 George R. Schade, MD; Ann Arbor, MI 2010 Eric A. Klein, MD; Cleveland, OH 2010 Robert E. Jackson, MD; Ypsilanti, MI 2010 Chad Reichard, BS; Chicago, IL 2010 Anthony J. Polcari, MD; Chicago, IL 2010 Kristina L. Penniston, PhD, RD; Madison, WI 2010 Srinivas Vourganti, MD; Cleveland, OH 2008 Helen Kuo, MD; Indianapolis, IN 2006 Brian L. Gallagher, MD; West Des Moines, IA 2005 W. Scott Webster, MD; Dallas, TX 2004 Ahmad H. Bani Hani, MD; Chadds Ford, PA 2003 David C. Miller, MD, MPH; Ann Arbor, MI 2002 Saleem S. Zafar, MD; Toledo, OH 2001 Louis S. Liou, MD, PhD; Cambridge, MA 2000 Jong M. Choe, MD; Mount Vernon, OH
Clinical Science Poster Award Recipients 2018 Antoin Douglawi, MD; Indianapolis, IN 2018 Benjamin M. Marsh, MD; Saint Paul, MN 2018 Ronald Stuart Boris, MD; Indianapolis, IN
Table of Contents 293 2018 Chirag Doshi, MD; Maywood, IL 2018 Belinda Li, MD; Maywood, IL 2017 Raevti Bole, MD, MA; Rochester, MD 2017 John Francis, MD; Cleveland, OH 2017 Victor Chen; Cleveland, OH 2017 Nikhil Gupta, MD; Columbus, OH 2017 Tariq A. Khemees, MD; Columbus, OH 2017 Matthew D. Grimes, MD; Madison, WI 2017 Mohamed Hendawi, MD; Columbus, OH 2016 Luke L. Wang, BS; Detroit, MI 2016 Michael S. Borofsky, MD; Minneapolis, MN 2016 Kevin B. Ginsburg, MD; Royal Oak, MI 2016 Andrew Todd, MD; Columbus, OH 2016 Eric Kirshenbaum, MD; Chicago, IL 2016 Matthew J. Ziegelmann, MD; Rochester, MN 2015 Robert A. Gaertner, MD; Woodbury, MN 2015 Julia Fiuk, MD; Springfield, IL 2015 Melissa A. St. Aubin, MD; Milwaukee, WI 2015 Derek J. Lomas, MD; Rochester, MN 2015 Ahmad M. El-Arabi, BS; Milwaukee, WI 2015 Samay Jain, MD; Toledo, OH 2014 Timothy Durso, BS; Maywood, IL 2014 Sarah P. Psutka, MD; Rochester, MN 2014 Brian A. VanderBrink, MD; Cincinnati, OH 2013 Thomas A. Gardner, MD; Indianapolis, IN 2013 Kenneth M. Peters, MD; Royal Oak, MI 2013 Florian R. Schroeck, MD, MS; Ann Arbor, MI 2013 Miriam Hadj-Moussa, MD; Ann Arbor, MI 2013 Daniel Miller, MD, MPH; Ann Arbor, MI 2013 Charles R. Powell II, MD; Indianapolis, IN 2012 Boyd R. Viers, MD; Rochester, MN 2012 Matthew Maurice, MD; Cleveland, OH 2012 Peter Stuhldreher, BS, MD; Cleveland, OH 2012 Joseph Zabell, MD; New Brighton, MN 2012 Conrad Tobert; Grand Rapids, MI 2011 Jason Hedges, MD, PhD; Portland, OR 2011 Simon Kim, MD, MPH; Rochester, MN 2011 Amit Patel, MD; Westmont, IL 2011 Sandip Prasad, MD, MPhil; Charleston, SC 2011 Frank J. Penna, MD; Birmingham, MI 2011 Christopher Mitchell, MD; Rochester, MN 2010 Jonathan Ellison, MD; Ann Arbor, MI 2010 Suzette E. Sutherland, MD; Plymouth, MN 2010 Clint K. Cary, MD; Indianapolis, IN 2010 K. Scott Coffield, MD; Temple, TX 2010 Eric Umbreit, MD; Rochester, MN 2010 Jeffery C. Wheat, MD; Ann Arbor, MI 2008 Joshua J. Meeks, MD, PhD; Chicago, IL 2008 Khanh Pham, MD; Milwaukee, WI 2008 Christopher J. Weight, MD; Rochester, MN 2008 Mark D. Stovsky, MD, MBA, FACS; Beachwood, OH 2006 Curtis Crylen, MD; Greeley, CO 2005 David S. Morris, MD; Hendersonville, TN 2004 James A. Kontak, MD; Cleveland, OH 2003 Peter Langenstroer, MD; Milwaukee, WI 2002 David A. Taub, MD, MBA; Toledo, OH 2001 Timothy L. Mulholland, MD; Mason City, IA 2000 Bradley C. Leibovich, MD; Rochester, MN
Table of Contents 294 College Bowl/Super Bowl 2018 Benjamin Marsh, MD; St. Paul, MN 2018 Andrew Nguyen, MD; Cleveland, OH 2018 Wesley Baas, MD; Springfield, IL 2018 Craig Labbate, MD; Chicago, IL 2018 Kristin Ebert; Columbus, OH 2017 Derek Lomas, MD, PharmD; Rochester, MN 2017 Min Jun, DO; Ferndale, MI 2017 Kevin Ginsburg, MD; Royal Oak, MI 2017 Abhinav Khanna, MD; Cleveland, OH 2016 Katherine J. Cotter, MD; Minneapolis, MN 2016 Joseph Ford, MD; Walled Lake, MI 2016 Daniel S. Murtagh, MD; Toledo, OH 2016 Joseph Rodriguez, MD; Chicago, IL 2015 Luke R. Frederick, MD; Springfield, IL 2015 Ian D. McLaren, MD; Ann Arbor, MI 2015 Hanhan Li, MD; Detroit, MI 2015 Luke Edwards, MD; Madison Heights, MI 2014 Adam C. Calaway, MD; Indianapolis, IN 2014 Adam S. Howe, MD; Columbus, OH 2014 Scott C. Johnson, MD; Milwaukee, WI 2014 Jessica R. Meyers, MD; Detroit, MI 2014 Joseph J. Pariser, MD; Chicago, IL 2013 Andrew C. Strine, MD; Indianapolis, IN 2013 Gregory McLennan, MD; Royal Oak, MI 2013 Casey A. Dauw, MD; Ann Arbor, MI 2013 Dhruti M. Patel, MD; Cleveland, OH 2013 Abhishek Patel, MD; Columbus, OH 2012 Casey Dauw, MD; Ann Arbor, MI 2012 Matthew Fulton, MD; Royal Oak, MI 2012 Matthew Johnson, MD, MS; Columbus, OH 2012 Devon Snow-Lisy, MD; Cleveland, OH 2011 Robert M. Kohut Jr., MD; Cleveland, OH 2011 M. Adam Childs, MD; Rochester, MN 2011 Aria Razmaria, MD; Chicago, IL 2011 Ken Haberman, MD; Minneapolis, MN 2011 Kiranpreet Khurana, MD; Cleveland, OH 2010 Kyle Kiriluk, MD; Chicago, IL 2010 Don T. Bui, MD; Troy, MI 2010 Ty T. Higuchi, MD, PhD; Rochester, MN 2010 Tarek Pacha, DO; Sterling Hts, MI 2010 Paul R. Tonkin, MD; Milwaukee, WI
Video Award 2018 Rachel Lynn Shannon, BS; Chicago, IL 2018 Elizabeth Leone Koehne, MD; Maywood, IL 2017 Edward Capoccia, MD; Chicago, IL 2016 David Y. Yang, MD; Rochester, MN 2015 Firas G. Petros, MD; Columbus, OH 2014 Elizabeth V. Dray, MD; Maywood, IL 2013 Thomas P. Frye, DO; Springfield, IL 2012 Robert M. Kohut Jr.; MD, Cleveland, OH 2011 Ken Haberman, MD; Minneapolis, MN 2010 Jesse Sammon, DO; Detroit, MI 2010 Christopher Mitchell; MD, Rochester, MN 2010 Ronney Abaza, MD; Columbus, OH
Table of Contents 295 NCS/AACU Health Policy Young Investigator Award 2018 Juan Andino; Ann Arbor, MI 2017 Andrew Sun, MD; Cleveland, OH 2016 Duncan R. Morhardt, MD, PhD; Ann Arbor, MI 2015 Lindsey A. Herrell, MD, MS; Ann Arbor, MI 2014 Chandy Ellimoottil, MD, MS; Chicago, IL
Table of Contents 296 AUA Officers
President John H. Lynch, MD, FACS
President-Elect Scott K. Swanson, MD, FACS
Immediate Past President Robert C. Flanigan, MD, FACS
Secretary John D. Denstedt, MD, FRCS(C), FACS
Treasurer David F. Green, MD, FACS
Chief Executive Officer Michael T. Sheppard, CPA, CAE
AUA FOUNDATION RESEARCH SCHOLARS
The AUA Foundation Research Scholars Program provides scholarships to young men and women who are interested in pursuing a career in urologic research. The Foundation also partners with other organizations to provide funding for research projects investigating specific urologic diseases. The AUA Foundation Website has information on all available scholarships and application procedures for the current application cycle.
Visit www.auanet.org/research/research-funding/aua-funding/research-scholar-awards for more information.
Table of Contents 297 Table of Contents 298 THANK YOU TO OUR 2019 PROMOTIONAL PARTNERS
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94th Annual Meeting October 14 - 17, 2020
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