North Central Section of the AUA, Inc. North Central Section of the AUA, Inc.

2019 Online Program Schedule

93rd Annual Meeting of the North Central Section of the AUA

September 11 - 14, 2019
Program Chair: Jeffrey Alan Triest, MD
All sessions will be located in Vevey Ballroom unless otherwise noted.
Speakers and times are subject to change.

DateTimeSession
OVERVIEW  
11
Wed
7:00 a.m.-5:00 p.m.
Registration/Information Desk Hours
Location: Monte Rosa Registration Desk
11
Wed
7:00 a.m.-5:00 p.m.
Speaker Ready Room Hours
Location: Monte Rosa
11
Wed
7:30 a.m.-11:00 a.m.
Spouse/Guest Hospitality Suite Hours
Location: Matterhorn
11
Wed
7:30 a.m.-9:00 a.m.
Breakfast
Location: Vevey Foyer
11
Wed
5:00 p.m.-7:00 p.m.
Exhibit Hall Hours
Location: Zurich D-G
11
Wed
5:00 p.m.-7:00 p.m.
Welcome Reception
Location: Zurich D-G
GENERAL SESSION  
11
Wed
8:00 a.m. - 9:30 a.m.
Operating Theatre: Techniques, Tips and Tricks
Location: Vevey Ballroom
Moderator:
Chandru P. Sundaram, MD, FACS
Indianapolis, IN
11
Wed
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
11
Wed
8:30 a.m. - 9:00 a.m.
Robotic Adrenalectomy
Panelists:
Arieh Leib Shalhav, MD
Chicago, IL


Chandru P. Sundaram, MD, FACS
Indianapolis, IN
11
Wed
9:00 a.m. - 9:30 a.m.
Robotic Prostatectomy
Panelists:
Matthew T. Gettman, MD
Rochester, MN


David F. Jarrard, MD
Madison, WI
11
Wed
9:30 a.m. - 10:00 a.m.
NCS Faculty Lecture: Urolithiasis 2019: What the Practicing Urologist Needs to Know
Location: Vevey Ballroom
Speaker:
Stephen Y. Nakada, MD,FACS,FRCS(Glasg.)
Madison, WI
11
Wed
10:00 a.m. - 10:30 a.m.
State-of-the-Art Lecture: Late Effects Following Pediatric Bladder Operations for Congenital Conditions
Location: Vevey Ballroom
Speaker:
Hadley Merrideth Wood, MD
Cleveland, OH
11
Wed
10:30 a.m. - 10:40 a.m.
ABU Update
Location: Vevey Ballroom
Speaker:
Stephen Y. Nakada, MD,FACS,FRCS(Glasg.)
Madison, WI
11
Wed
10:40 a.m. - 11:00 a.m.
Break
Location: Vevey Foyer
11
Wed
11:00 a.m. - 12:00 p.m.
Panel Discussion: Decision Making and Surgical Approach to Complex Renal Masses
Location: Vevey Ballroom
Moderator:
Geoffrey N. Box, MD
Columbus, OH
Panelists:
James Andrew Brown, MD
Iowa City, IA


Gopal Nand Gupta, MD
Maywood, IL


Bradley C. Leibovich, MD, FACS
Rochester, MN
11
Wed
12:00 p.m. - 1:15 p.m.
Industry Sponsored Lunch Symposium*
Location: Zurich A
11
Wed
1:15 p.m. - 5:00 p.m.
Health Policy and Practice Management
Location: Vevey Ballroom
11
Wed
1:15 p.m. - 1:53 p.m.
Washington Update
Location: Vevey Ballroom
Moderator:
James M. Dupree, IV, MD, MPH
Ann Arbor, MI
11
Wed
1:15 p.m. - 1:30 p.m.
AUA Public Policy Council Update
Location: Vevey Ballroom
Speaker:
Christopher L. Coogan, MD
Chicago, IL
11
Wed
1:30 p.m. - 1:45 p.m.
2019 RUC Update
Location: Vevey Ballroom
Speaker:
Kyle A. Richards, MD, FACS
Madison, WI
11
Wed
1:45 p.m. - 1:53 p.m.
Discussion/ Q&A
Location: Vevey Ballroom
11
Wed
1:53 p.m. - 2:15 p.m.
New Frontiers in Legislative Advocacy
Location: Vevey Ballroom
Moderator:
Christopher L. Coogan, MD
Chicago, IL
11
Wed
1:53 p.m. - 2:08 p.m.
The Importance of State-Level Advocacy: Organized Medicine's Response to Indiana State Senate Bill 394
Location: Vevey Ballroom
Speaker:
Bradley G. Orris, MD
Greenwood, IN
11
Wed
2:08 p.m. - 2:15 p.m.
Discussion/ Q&A
Location: Vevey Ballroom
11
Wed
2:15 p.m. - 2:45 p.m.
State-of-the-Art Lecture: Medical Malpractice: How to Protect Yourself From Being Sued
Location: Vevey Ballroom
Guest Speaker:
Ben B. Rubinowitz, JD
New York, NY
11
Wed
2:45 p.m. - 2:55 p.m.
Discussion/ Q&A
Location: Vevey Ballroom
11
Wed
2:55 p.m. - 3:10 p.m.
Break
Location: Vevey Ballroom
11
Wed
3:10 p.m. - 4:10 p.m.
Top Three Lessons I've Learned About Managing My Practice
Location: Vevey Ballroom
Moderator:
Bradley Allan Erickson, MD, MS, FACS
Iowa City, IA
11
Wed
3:10 p.m. - 3:25 p.m.
After My First Year in Practice
Location: Vevey Ballroom
Speaker:
Alexander P. Glaser, MD
Glenview, IL
11
Wed
3:25 p.m. - 3:40 p.m.
After 5-6 Years in Practice
Location: Vevey Ballroom
Speaker:
Emilie K. Johnson, MD, MPH
Chicago, IL
11
Wed
3:40 p.m. - 3:55 p.m.
After More Than 15 Years in Practice
Location: Vevey Ballroom
Speaker:
Peter M. Knapp, Jr., MD, FACS
Carmel, IN
11
Wed
3:55 p.m. - 4:10 p.m.
Discussion/ Q&A
Location: Vevey Ballroom
11
Wed
4:10 p.m. - 4:55 p.m.
New Frontiers in Practice Management
Location: Vevey Ballroom
Moderator:
Candace F. Granberg, MD
Rochester, MN
11
Wed
4:10 p.m. - 4:25 p.m.
How I Use Telemedicine in my Practice: What Works and What Doesn't Work
Location: Vevey Ballroom
Speaker:
Chandy Ellimoottil, MD, MS
Ann Arbor, MI
11
Wed
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
Location: Vevey Ballroom
Speaker:
Lawrence C. Jenkins, MD, MBA
Columbus, OH
11
Wed
4:40 p.m. - 4:55 p.m.
Discussion/ Q&A
Location: Vevey Ballroom
11
Wed
4:55 p.m. - 5:00 p.m.
NCS Health Policy Young Investigator Award Presentation
Location: Vevey Ballroom
Introducer:
James M. Dupree, IV, MD, MPH
Ann Arbor, MI
11
Wed
#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


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.



Conclusions:



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.



11
Wed
5:00 p.m. - 7:00 p.m.
Welcome Reception
Location: Zurich D-G
OVERVIEW  
12
Thu
6:00 a.m.-5:30 p.m.
Registration/Information Desk Hours
Location: Monte Rosa Registration Desk
12
Thu
6:00 a.m.-5:30 p.m.
Speaker Ready Room Hours
Location: Monte Rosa
12
Thu
6:00 a.m.-7:30 a.m.
Breakfast
Location: Vevey Foyer
12
Thu
7:30 a.m.-11:00 a.m.
Spouse/Guest Hospitality Suite Hours
Location: Matterhorn
12
Thu
10:00 a.m.-6:30 p.m.
Exhibit Hall Hours
Location: Zurich Ballrooms D-G
12
Thu
5:30 p.m.-6:30 p.m.
NCS Happy Hour
Location: Zurich Ballrooms D-G
12
Thu
6:30 p.m.-7:30 p.m.
Young Urologists Mixer
Location: Eleve
Concurrent Sessions Begin  
Concurrent Session 1 of 3  
12
Thu
6:30 a.m. - 7:30 a.m.
Video Session I
Location: Montreux
Moderators:
Mark D. Dabagia, MD, FACS
Fort Wayne, IN


Jeffrey Alan Triest, MD
Dearborn, MI
12
Thu
Video #1
WITHDRAWN
12
Thu
Video #2

PERC-TIC PCNL


Tim Large, MD1, Chalres Nottingham, MD1, Amy Krambeck, MD2
1IU Health Hospial, 2India University School of Medicin


12
Thu
Video #3

Minimally Invasive Endoscopic Management of Symptomatic Calcified Deflux


Kristen Meier, Samantha Kraemer, Melissa Fischer, Zachary Liss
Beaumont Health


12
Thu
Video #4

Moses Laser Enucleation of the Prostate: Early Experience


Mark Pickhardt, MD, Tim Large, MD, Amy Krambeck, MD
IU Urology


12
Thu
Video #5

Bladder Neck AUS Placement in a Young Woman with Myelomeningocele


Molly DeWitt-Foy, MD, Hadley Wood, MD
Cleveland Clinic


12
Thu
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


Concurrent Session 2 of 3  
12
Thu
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
12
Thu
6:30 a.m. #1

Sub-fertility and its Psychological Impact on Men


Garrett Berger, MS21, Pranav Dadhich, MD1, Dietrich Peter, MD2, Graham Machen, MD1, Sandlow Jay, MD, PI1, Abbey Kruper, PsyD1
1Medical College of Wisconsin, 2Medical College of Wisconsins


 



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.



 



Materials and 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.



 





 



 

12
Thu
6:34 a.m. #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


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).  



Conclusions: 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.

 

12
Thu
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


Introduction and Objectives: 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 improvement in DE including 2/5 with anorgasmia. Minimal side effects were seen in one patient who reported insomnia. 



Conclusions: 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.  

12
Thu
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


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).



Discussion



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.

12
Thu
6:46 a.m. #5

MODIFIED TECHNIQUE FOR  VASECTOMY REVERSAL RESULTS IN SIGNIFICANTLY IMPROVED OUTCOMES


Jamal Alamiri, M.B., B.Ch., BAO, David Y Yang, M.D., Madeleine Manka, M.D., Joshua Savage, P.A.-C., Manaf Alom, M.B.B.S, Kiran Sharma, Ph.D, Sevann Helo, M.D., Tobias Kohler, M.D. M.P.H, Landon Trost, M.D.
Mayo Clinic Department of Urology


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 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.

12
Thu
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


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.

12
Thu
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


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 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.



Conclusions: Tachosil provides a sutureless graft material that is safe and effective for residual curve correction during IPP placement.



12
Thu
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


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-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.

12
Thu
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


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.



 



Conclusions



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.

12
Thu
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


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.



 



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. 



 



Conclusions:  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. 

12
Thu
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


1. 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).



Conclusions: 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.

12
Thu
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


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, martial 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. 

12
Thu
7:18 a.m. - 7:30 a.m.
Q&A
Concurrent Session 3 of 3  
12
Thu
6:45 a.m. - 7:30 a.m.
Adrenal/ Kidney/ Ureter - Malignant/ Benign Poster Session
Location: St. Gallen 3
Moderators:
Sapan Nitin Ambani, MD
Ann Arbor, MI


Aaron Mark Potretzke, MD
Rochester, MN
12
Thu
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


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.



Conclusions



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.

12
Thu
Poster #2

TIMING AND DISTRIBUTION OF METACHRONOUS CHROMOPHOBE RENAL CELL CARCINOMA METASTASES


Maximilian Staebler, B.S.e1, Theodora Potretzke, M.D.2, Christine Lohse3, John Cheville, M.D.4, Bernard King, M.D.2, Matvey Tsivian, M.D.5, Bradley Leibovich, M.D.5, R Houston Thompson, M.D.5, Aaron Potretzke, M.D.5
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


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 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).  



Conclusions: 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.

12
Thu
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


INTRODUCTION AND OBJECTIVES: 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).



CONCLUSIONS: 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. 

12
Thu
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


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.



12
Thu
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


Objective: 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.

12
Thu
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


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 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.



12
Thu
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


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.



Concurrent Sessions End  
12
Thu
7:30 a.m. - 8:00 a.m.
Break
Location: Vevey Foyer
12
Thu
8:00 a.m. - 8:05 a.m.
President's Welcome
Location: Vevey Ballroom
President:
David F. Jarrard, MD
Madison, WI
12
Thu
8:05 a.m. - 8:50 a.m.
Pediatric Panel Discussion
Location: Vevey Ballroom
Moderator:
Christopher Scott Cooper, MD, FAAP, FACS
Iowa City, IA
Panelists:
Jonathan Ellison, MD
Milwaukee, WI


John M. Park, MD
Ann Arbor, MI


Jonathan Harry Ross, MD
Cleveland, OH
12
Thu
8:50 a.m. - 9:20 a.m.
State-of-the-Art Lecture: Volunteering in Urology
Location: Vevey Ballroom
Speaker:
Charles R. Powell, II, MD
Indianapolis, IN
12
Thu
9:20 a.m. - 10:00 a.m.
Prostate Cancer Panel Discussion
Location: Vevey Ballroom
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
12
Thu
10:00 a.m. - 10:40 a.m.
Endourology and Stone Disease Panel Discussion
Location: Vevey Ballroom
Moderator:
Amy Elizabeth Krambeck, MD
Indianapolis, IN
Panelists:
Casey A. Dauw, MD
Ann Arbor, MI


Bodo E. Knudsen, MD, FRCSC
Columbus, OH


Thomas M.T. Turk, MD
Maywood, IL
12
Thu
10:40 a.m. - 11:10 a.m.
Break - Visit Exhibits
Location: Zurich Ballrooms D-G
12
Thu
11:10 a.m. - 12:00 p.m.
State-of-the-Art Lecture: Difficult Issues in NMIBC: Guidelines and Beyond
Location: Vevey Ballroom
Guest Speaker:
Michael S. Cookson, MD, MMHC, FACS
Oklahoma City, OK
12
Thu
12:00 p.m. - 1:15 p.m.
Industry Sponsored Lunch Symposium*
Location: Zurich A
12
Thu
12:00 p.m. - 1:15 p.m.
Industry Sponsored Lunch Symposium*
Location: Zurich B
12
Thu
1:15 p.m. - 2:00 p.m.
State-of-the-Art Lecture: How to Succeed in Medicine and Life*
Location: Vevey Ballroom
Speaker:
Eric A. Klein, MD
Cleveland, OH
Concurrent Sessions Begin  
Concurrent Session 1 of 3  
12
Thu
2:00 p.m. - 3:00 p.m.
Endourology/ Stone Disease Podium Session
Location: Vevey Ballroom
Moderators:
Carley Marie Davis, MD
Milwaukee, WI


Mark A. Wille, MD
Chicago, IL
Discussant:
James E. Lingeman, MD
Carmel, IN
12
Thu
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


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. 



CONCLUSION The great similarity between COM matrix and pRB protein distributions suggests that protein aggregation may contribute to stone formation.

12
Thu
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


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.



12
Thu
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


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). 



CONCLUSIONS: 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.



 



12
Thu
2:12 p.m. #16

EFFECT OF STONE COMPOSITION ON SURGICAL STONE RECURRENCE: SINGLE CENTER LONGITUDINAL ANALYSIS


Shuang Li, Ph.D.1, Simone L. Vernez, M.D.1, Kristina L. Penniston, Ph.D.1, R. Allan Jhagroo, M.D.2, Sara Best, M.D.1, Stephen Y. Nakada, M.D.1,3,4
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


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).



Conclusions



Patients with cystine, calcium phosphate, or struvite stones had more surgical recurrence compared to patients with calcium oxalate stones.