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Program Schedule

South Central Section of the AUA, Inc.
99th Annual Meeting

October 7 - 10, 2020
Hilton Austin
Austin, TX

99th Annual Meeting of the South Central Section of the AUA

October 07 - 10, 2020
Program Chair: Michael S. Cookson, MD, MMHC, FACS
All Sessions will be located in Salon FG unless otherwise noted.

DateTimeSession
OVERVIEW  
07
Wed
7:30 a.m.-10:30 a.m.
Spouse/Guest Hospitality Suite Hours
Location: Meeting Room 602
07
Wed
7:30 a.m.-5:00 p.m.
Registration/Information Desk Hours
Location: Grand Ballroom Foyer
07
Wed
8:00 a.m.-11:00 a.m.
Board of Directors Meeting
Location: Meeting Room 415AB
07
Wed
11:00 a.m.-5:00 p.m.
Speaker Ready Room Hours
Location: Meeting Room 618
07
Wed
6:00 p.m.-8:00 p.m.
Welcome Reception in Exhibit Hall
Location: Salon HJK
GENERAL SESSION  
07
Wed
11:00 a.m. - 12:00 p.m.
Industry Sponsored Lunch Symposium
Location: Meeting Room 400/402
07
Wed
12:00 p.m. - 12:05 p.m.
Presidential Welcome
President:
James M. Cummings, MD, FACS
Columbia, MO
07
Wed
12:05 p.m. - 12:10 p.m.
Program Chair Welcome
Program Chair:
Michael S. Cookson, MD, MMHC, FACS
Oklahoma City, OK
07
Wed
12:10 p.m. - 12:20 p.m.
Fellows Essay Competition
Moderator:
Nicholas Cost, MD
Denver, CO
07
Wed
12:10 p.m. #1

COMPARING CONFIRMATORY BIOPSY OUTCOMES BETWEEN MRI-TARGETED BIOPSY AND STANDARD SYSTEMATIC BIOPSY AMONG MEN BEING ENROLLED IN PROSTATE CANCER ACTIVE SURVEILLANCE


Daniel Shapiro, MD1, John Ward, MD FACS1, Amy Lim, MD PhD1, Graciela Nogueras-Gonzalez, MPH2, Brian Chapin, MD1, John Davis, MD FACS1, Justin Gregg, MD1
1University of Texas MD Anderson Cancer Center, Dept. of Urology, Houston, TX, 2University of Texas MD Anderson Cancer Center, Dept. of Biostatistics, Houston, TX


Introduction



The ASIST randomized trial previously demonstrated that the addition of prostate MRI-targeted biopsies to systematic biopsy did not improve detection rates of clinically significant prostate cancer among men undergoing confirmatory biopsy for prostate cancer; however, enrolling centers had limited MRI-biopsy experience. [1]  We aimed to evaluate the ability of MRI-targeted biopsy combined with systematic biopsy (MRI-biopsy) to reduce negative biopsies and detect clinically significant prostate cancer compared to transrectal ultrasound guided systematic biopsy (SB) alone in the confirmatory biopsy setting using matched cohorts at a center with significant MRI-biopsy experience.



Methods



Patients were identified who had a previously positive SB followed by a confirmatory biopsy at a single institution between 2006-2019.  Patients were divided into two cohorts based on confirmatory biopsy technique, either a SB alone or MRI-biopsy (which included MRI-targeted and systematic biopsies).  Cohorts were then matched on age, PSA, number of positive cores on initial biopsy and initial biopsy Gleason grade group (GG).  Conditional logistic regression was performed to identify associations with confirmatory biopsy upgrading.



Results:



After matching, 514 patients were identified (257 per cohort).  PSA, prostate volume, and PSA density prior to initial biopsy in addition to total number of initial biopsy positive cores and GG were similar between the matched cohorts (p>0.05 for all).  After confirmatory biopsy, 118/257 (45.9%) within the MRI-biopsy cohort were upgraded compared to 46/257 (17.9%) within the SB cohort (p<0.001) (Figure 1).  The rate of negative confirmatory biopsy was 32/257 (12.5%) compared to 97/257 (37.7%) among the MRI-biopsy and SB cohorts, respectively (p<0.001).  Confirmatory MRI-biopsy was independently associated with greater odds of confirmatory biopsy upgrade from GG1 to ≥GG2 compared to SB alone (OR 5.02, 95% CI 2.68-9.41; p<0.001).



Conclusion:



The addition of MRI-targeted biopsies to systematic biopsy in the confirmatory biopsy setting among men with previously detected prostate cancer resulted in fewer negative confirmatory biopsies and detection of more clinically significant prostate cancer compared to systematic biopsy alone. 



1. Klotz L, Loblaw A, Sugar L, et al. Active Surveillance Magnetic Resonance Imaging Study (ASIST): Results of a Randomized Multicenter Prospective Trial. Eur Urol. 2019;75: 300-309.





Figure 1. Confirmatory biopsy outcomes by confirmatory biopsy technique. 

07
Wed
12:20 p.m. - 1:00 p.m.
Resident Essay Finalist Podium Session
Moderator:
Nicholas Cost, MD
Denver, CO
07
Wed
12:20 p.m. #2

ARTIFICIAL URINARY SPHINCTER CUFF EROSION “HEAT MAP” SHOWS SIMILAR ANATOMIC CHARACTERISTICS FOR TRANSCORPORAL AND STANDARD APPROACH


Maia VanDyke, Nicolas Ortiz, Avery Wolfe, Adam Baumgarten, Ellen Ward, Steven Hudak, Allen Morey
Department of Urology, UT Southwestern Medical Center


Introduction/Background: Cuff erosion is one of the most serious complications of artificial urinary sphincter (AUS) surgery, typically mandating surgical removal of the device. The transcorporal (TC) approach for cuff placement avoids dissection on the thinnest dorsal aspect of the urethra and also incorporates the underlying tunica albuginea of the paired corporal bodies into the cuff which is thought to have a bolstering effect. We aim to evaluate TC placement as a protective strategy in patients at risk for urethral cuff erosion. We studied the characteristics of TC versus standard (ST) placement AUS cuff erosions in order to compare their anatomical patterns.



 



Methods/Materials: We retrospectively reviewed men who presented with AUS erosion treated by a single surgeon between 2007 and 2019 at a tertiary medical center. TC indications included complications of prior anti-incontinence procedures and prior urethral reconstruction.  Location of AUS cuff erosion defects were assessed by cystoscopy prior to device explantation; findings were stratified by AUS cuff placement technique (TC vs ST).



 



Results:  Out of 723 AUS cases in 611 patients, we identified 54 (7.5%) cuff erosions.  Erosion developed in 15/82 (18.3%) cases of TC AUS and 39/641 (6.1%) cases of ST AUS (p<0.05). AUS cuff erosions occurred predominantly ventrally in both groups (66.7% for TC and 79.5% for ST AUS, p=0.4) followed by lateral urethral location (33.3% TC and 15.4% ST, p=0.2). Dorsal erosions were rare in both groups (20% TC and 5.1% ST, p=0.1). History of AUS and previous erosion were associated with TC AUS erosion. History of radiotherapy, prior urethroplasty, hypogonadism, and urethral cuff size were similar between groups.



 



Conclusions: AUS cuff erosions appear to occur ventrally and laterally in most patients regardless of cuff placement technique. Dorsal erosions were the least common in both groups, casting doubt on the protective effect of the TC cuff strategy.



07
Wed
12:27 p.m. #3

OPEN VERSUS ROBOTIC-ASSISTED SIMPLE PROSTATECTOMY: A NATIONAL DATABASE COMPARISON OF COST, COMPLICATIONS, AND LENGTH OF STAY


Raj Bhanvadia, M.D., Caleb Ashbrook, B.A., Ryan Mauck, M.D., Jeffery Gahan, M.D., Yair Lotan, M.D., Vitaly Margulis, M.D., Claus Roehrborn, M.D., Solomon Woldu, M.D.
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA


Introduction: For men with benign prostatic hyperplasia and large adenomas, open simple prostatectomy (OSP) has been a mainstay of surgical management. While OSP has played a key role in treatment, robotic-assisted approaches have increased in popularity. We compared cost of hospitalization, complications, and length of stay (LOS) between OSP and robotic-assisted simple prostatectomy (RASP) using a large population database.



 



Methods: The Nationwide Inpatient Sample (NIS) was queried for cases of OSP and RASP from 2013 to 2016. Cases involving radical prostatectomy or diagnosis of prostatic malignancy were excluded. Statistical analysis was performed using Stata®, version 13.0 (College Station, TX).  Total hospitalization cost, perioperative complications, LOS, and non-routine discharge were compared between OSP and RASP. A multivariate linear regression model was generated to compare total hospitalization cost by surgical approach.



 



Results: From 2013- 2016, we identified 2,133 and 704 cases of OSP and RASP, respectively. Patients undergoing RASP were younger, (p<0.01), more likely to be white (non-minority), have less comorbidities, (p<0.01), more likely to have private insurance (p<0.01), and be treated at  teaching hospitals (p<0.01). Reported rates of perioperative complications were higher for OSP, with greater overall complications (16% vs 7%, p<0.01), higher rates of genitourinary complications (10% vs 3%, p<0.01), ileus (5% vs 3%, p=0.01), and blood transfusions (16% vs 4%, p<0.01). OSP was associated with higher rates of non-routine discharge to nursing facility (23% vs 11%, p<0.01).  Compared to RASP, OSP was associated with double the LOS [median, (IQR) = 4 (3-6) days vs 2 days (1–3) days, p<0.01]. Despite longer LOS and greater perioperative complications, total cost was less for OSP [median, (IQR) = $10,854 ($7,965-$15,675) vs $13,466 ($10,572-$17,721), p<0.01]. Adjusting for LOS, patient and hospital characteristics, a robotic approach to simple prostatectomy was associated with greater cost ($6,132, p<0.01), suggesting that upfront surgical costs may not be completely offset by lower rates of complications, shorter LOS and discharge to home.



 



Conclusion: RASP appears to be associated with significantly lower perioperative complication rates, shorter LOS, and higher likelihood of discharge to home rather than nursing facility.  Despite these advantages, hospital cost remained higher for RASP, likely related to greater upfront operative costs. Our study is limited in several ways – it is based on administrative data, does not include post-discharge complications and resultant costs, and there is significant variability in individual hospital costs – in particular with regards to robotic cost amortization.

07
Wed
12:34 p.m. #4

RISK TABLES PREDICT CLINICALLY SIGNIFICANT PROSTATE CANCER ON MRI FUSION BIOPSY


David Cochran, MD, Connor Davey, BS, Michael Cookson, MD, Kelly Stratton, MD, Daniel Parker, MD
OUHSC Department of Urology


Introduction



Men at risk for prostate cancer are routinely recommended prostate biopsy with MRI fusion guided targeted biopsies.  We have previously shown that PSA density (PSAd) is predictive of clinically significant prostate cancer on fusion biopsy.  Multiparametric MRI has been shown to be a useful tool to detect clinically significant prostate cancer across all prostate biopsy indications.   However, it is challenging to conveniently provide patients with risk predictions based on MRI results and PSAd.  In this study we examined patients undergoing MRI fusion biopsy to create risk tables predicting prostate cancer diagnosis and presence of clinically significant prostate cancer.   



Methods



We retrospectively reviewed a prospective prostate cancer database to identify patients undergoing fusion biopsy.  All patients underwent 3T mpMRI read by a certified GU radiologist using PIRADS V2. Fusion technology then guided targeted and systematic biopsies.  PIRADS, PSA density based on MRI prostate volume, adjusted PSA (PSA doubled if on 5-alpha reductase), and biopsy results were then evaluated across our patient population of 902 patients.  We formatted our results into clinically useful predictive tables based on PIRADS score.   



Results



Of the 902 patients, 379 (42%) were found to have a PIRADS 3-5 lesion.  Prostate cancer was found in 491 (54%) patients. Of these, 321(36%) had clinically significant disease.  Based on increasing PSAd and PIRADS score, the risk of clinically significant cancer increased. 





Conclusions



This study found that increasing PSA density and higher PIRADS score corelates with a higher likelihood of a clinically significant prostate cancer. By grouping patients into PIRADS score and their corresponding PSA density, we created a useful tool for predicting clinically significant prostate cancer.  

07
Wed
12:41 p.m. #5

Digital Flexible Ureteroscope Breakage Profile at a Tertiary Care Center: An Opportunity for Improvement and Cost Reduction


Raphael Carrera, MD, Daniel Igel, MD, David Duchene, MD, Donald Neff, MD, Kerri Thurmon, MD, Wilson Molina, MD
Kansas University Medical Center, Department of Urology, Kansas City, KS


Introduction and Objectives: Digital flexible ureteroscopy is the most common treatment for renal and ureteral calculi in the United States. With the introduction of disposable flexible ureteroscopes, concerns have been raised regarding the lifespan of digital ureteroscopes in terms of not only durability but also overall cost of running a flexible ureteroscopy program (including up-front, repair and sterilization process costs). In order to reduce costs by increasing the number of procedures per scope before maintenance is required, it is essential to understand the breakage pattern of digital ureteroscopes. The aim of this study is to provide a description of the damage patterns associated with digital flexible ureteroscopes in a tertiary care center and identify potential solutions that could be introduced to prevent each type of scope damage.



Materials and Methods: A retrospective analysis of data from all flexible digital ureteroscopes (Storz FLEX-XC) damaged at the University of Kansas Medical Center over one-year period was performed. We identified the location and type of damage for each scope and correlated that data with potential damage mechanisms.



Results: A total of seventeen types of damage were reported in 77 devices sent for repair over one-year period. The distal portion of the ureteroscopes was the primary site of breakage. Articulating angle cover cuts were the most common type of damage found, accounting for 47 (61%) broken ureteroscopes, followed by working channel puncture leak in 21 (27%), loss of deflection in 12 (16%), distal working channel scratches in 11 (14%), vertebrae leakage in 10 (12%), laser damage to the distal part of the working channel in 8 (10%), and overbending the proximal shaft in 7 (8%) cases. Breakage events were associated with poor handling of the scope at the back table, transportation and cleaning, as well as during surgery itself (Table 1).Conclusions: Digital ureteroscopes are expensive and fragile devices that require correct surgical technique and appropriate handling by OR staff during the cleaning process before sterilization. Efforts should be made to ensure that staff, residents and the OR team are properly trained prior to working with this equipment.

07
Wed
12:48 p.m. #6

EFFECT OF PRIOR RADIATION ON DIFFERENTIATION, STAGE, AND HISTOLOGY OF BLADDER CANCER: AN ANALYSIS OF THE SEER DATABASE


Syed Alam, MD1, Lynn Chollet-Hinton, PhD, MSPH2, Jeffrey Thompson, PhD2, Jeffrey Holzbeierlein, MD1
1University of Kansas, Department of Urology, Kansas City, KS, 2University of Kansas, Department of Biostatistics, Kansas City, KS


Introduction/Background: The receipt of radiation therapy is a known risk factor for the development of bladder cancer. Clinically significant differences in radiation-related bladder cancer are not well-defined. Previous studies have explored this primarily in the setting of radiation for prostate cancer. This large-scale retrospective review seeks to evaluate bladder cancers developed in any patient with prior radiation affecting the bladder. 



 



Methods/Materials: The 1973-2011 Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients diagnosed with bladder cancer as a second malignancy. Patients having undergone radiation prior to the development of bladder cancer were selected for comparative analysis. Patients for whom the bladder would likely be outside the radiated field were excluded. Demographic data including age, sex, and race were abstracted. Individual bladder cancers were evaluated based on differentiation, stage, and histology. Unconditional logistic regression (for binary outcomes) and multinomial logistic regression (for non-binary outcomes) were used to generate odds ratios (ORs) and 95% confidence intervals (CIs). All models were adjusted for age, race, sex, and year of diagnosis.



 



Results: A total of 25,836 patients were identified for analysis, of which 10,258 (39.7%) received radiation for their primary malignancy.  Updated TNM staging was available for 6,623 (25.6%) patients. Average age at bladder cancer diagnosis was 75.4 years, and the mean duration between initial cancer diagnosis and bladder cancer diagnosis was 6.10 years. Patients having received prior radiation were less likely to be diagnosed with moderately- or poorly-differentiated bladder tumors (OR 0.89, CI 0.82-0.97; OR 0.79, CI 0.73-0.85). These patients were also less likely to be diagnosed with T2 (OR 0.82, CI 0.72-0.93), T3 (OR 0.69, CI 0.57-0.82), T4 (OR 0.70, CI 0.53-0.92), or node-positive disease (OR 0.60, CI 0.39-0.92). Prior radiation was associated with an increased risk of squamous cell carcinomas (OR 1.38, CI 1.08-1.76) and rare variant histology (OR 1.39, CI 1.03-1.88), while risk of adenocarcinomas was decreased (OR 0.78, CI 0.62-0.99). Of the radiation modalities, implants were associated with an increased risk of poorly-differentiated bladder cancer (OR 1.21, CI 1.02-1.43). All cause likelihood of death was significantly increased in patients having received prior radiation (OR 1.09, CI 1.02-1.16).



 



Conclusions: Bladder cancers diagnosed following radiation therapy are less likely to be poorly-differentiated or of higher stage. Radiation exposure may influence the likelihood of developing non-urothelial bladder tumors. More data are needed to evaluate the natural progression of radiation-related bladder tumors and their response to surgical or medical intervention.

07
Wed
12:55 p.m. #7

POPULATION LEVEL TRENDS IN THE SURGICAL TREATMENT OF PEYRONIE'S DISEASE: OVERUTILIZATION OF PENILE PROSTHESES AND UNDERUTILIZATION OF PLAQUE EXCISION/INCISION WITH GRAFTING?


Ali Antar, MD1, Debduth Pijush, MPH, Steven Brandes, MD2, Shyam Sukumar, MD1
1Scott Department of Urology, Baylor College of Medicine, 2Columbia University Department of Urology


Introduction and Objectives



Numerous surgical options exist for the treatment of Peyronie’s disease (PD). The majority of prior reports on the surgical management of PD are from high volume centers or single surgeon series. There is a paucity of population-based data on the surgical management of PD.



 



Methods



The Statewide Planning and Research Cooperative System database-a large statewide (New York) database that captures comprehensive all-payer data on patients across all outpatient and inpatient settings- was reviewed to identify patients with PD undergoing surgery from 2003-2015. Descriptive statistics and multinomial regression modeling was used.



 



Results



1733 patients underwent surgical treatment for PD. Median age was 60 years and 52% of patients were Caucasian. The most commonly performed procedures were penile prosthesis (PP) alone or as a combination procedure (CP; defined as a PP with concurrent modeling, tunical plication-TP- or plaque incision/excision with grafting-PEG). 



Of all patients without ED, 21% received PP (alone or as CP, see Figure 1). Over the course of the study period, relative rates of TP were stable, but there was a significant increase in the use of CP (p=0.009) and a decrease in the use of PEG (p=0.006).



Hospital and surgeon volume are predictors of receipt of penile prosthesis. Patients presenting to low volume providers at high volume hospitals are the most likely to receive a penile prosthesis (OR: 1.17, P=0.001) for Peyronie’s disease. 



 



Conclusions



Penile prosthesis is by far the most commonly performed primary procedure for PD in this statewide analysis. One in 5 patients with Peyronie’s disease without ED received a penile prosthesis and this trend appears to be increasing. This trend of overuse of Penile prostheses in patients without ED, appears to be at the expense of PEG. 



 



07
Wed
1:00 p.m. - 1:30 p.m.
Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: an AUA/SUFU Guideline(2019)
Guest Speaker:
Ekene A. Enemchukwu, MD, MPH
Stanford, CA
07
Wed
1:30 p.m. - 2:15 p.m.
Controversies in Men's Health: A Case Based Approach
Moderator:
Mohit Khera, MD, MBA, MPH
Houston, TX
Panelists:
Ty T. Higuchi, MD, PhD
Aurora, CO


Parviz K. Kavoussi, MD, FACS
Austin, TX


Saneal Rajanahally, MD
Houston, TX
07
Wed
2:15 p.m. - 2:30 p.m.
Break
Location: Grand Ballroom Foyer
07
Wed
2:30 p.m. - 3:15 p.m.
Difficult Cases of Male Stress Incontinence: Surgical Considerations
Moderator:
Brian J. Flynn, MD
Aurora, CO
Panelists:
Joshua Alan Broghammer, MD, FACS
Kansas City, KS


Ekene A. Enemchukwu, MD, MPH
Stanford, CA


Gennady Slobodov, MD
Oklahoma City, OK


O. Lenaine Westney, MD
Houston, TX
07
Wed
3:15 p.m. - 4:00 p.m.
Urologic Trauma Update: Observation vs. Operative Intervention
Moderator:
Edward Charles Osterberg, III, MD
Austin, TX
Panelists:
Cooper R. Benson, MD
New Orleans, LA


Ehab Eltahawy, MD, MRCS
Little Rock, AR


Maxx Gallegos, MD
Albuquerque, NM


To Be Determined
Concurrent Sessions Begin  
Concurrent Session 1 of 3  
07
Wed
4:00 p.m. - 5:00 p.m.
General & Education Poster Session
Location: Meeting Room 615 AB
Moderators:
Frances M. Alba, MD
Albuquerque, NM


Ajay K. Nangia, MBBS, FACS
Kansas City, KS
07
Wed
Poster #1

ASSESSING THE MISUSE OF URINE CYTOLOGY IN MICROHEMATURIA EVALUATIONS


S. Clint McFerren, MD, Madeleine Palmer, BS, Addison Himmelberger, BA, Julie Riley, MD, FACS
Division of Urology, University of New Mexico Health Sciences Center


Objectives: According to the updated 2012 AUA microhematuria guideline, the ordering of urine cytologies is not recommended. The objective of this study is to assess provider adherence with this guideline, focusing on the inappropriate use of urine cytologies.



Methods: A retrospective chart review was performed of all patients with an ICD diagnosis code of hematuria, ranging from 01/2006 to 12/2015. 535 patients with microhematuria were identified. Data was collected including basic patient demographics, whether a urine cytology was ordered at their initial evaluation, the result of the cytology, and the ordering provider (urologist vs. non-urologist). An analysis was then performed to identify any significant discrepancies and Chi square tests were used to determine statistical significance, with a p value of less than 0.05.



Results: Of the total 535 patients with microhematuria, 326 (60.9%) had a urine cytology ordered while 209 (39.1%) did not. Of the 326 urine cytologies that were ordered, only 4 (1.2%) returned positive or suspicious for urothelial carcinoma. Additionally, there were 57 (17.5%) that returned atypical while 265 (81.3%) were completely negative. Providers were almost twice as likely to order a urine cytology prior to the guideline change in 2012 (219/272 or 80.6% vs. 107/263 or 40.8%, p < 0.00001). Providers were not more likely to order a urine cytology in those with a history of tobacco use (151/246 or 61.4% vs. 175/289 or 60.6%, p = 0.85). Female patients with microhematuria were more likely to have a cytology ordered when compared to males (173/263 or 65.8% vs. 153/270 or 56.7%, p = 0.03). Roughly 68.7% (224/326) of the inappropriate cytologies during this time period were ordered by a urologist while 31.3% (102/326) were ordered by a non-urologist. The percentage of inappropriate cytologies that was ordered by urologists did not change after the implementation of the 2012 guideline (154/222 or 69.8% vs. 70/104 or 67.3%). Over the course of 10 years, the total cost of unnecessary urine cytologies exceeded $35,000.



Conclusions: The updated microhematuria guideline in 2012 has significantly reduced the inappropriate ordering of urine cytologies, but there remains a significant proportion (40%) of urologists and non-urologists alike who obtain a urine cytology as a part of their microhematuria evaluation. This results in difficulty interpreting results and determining next steps, while placing an unwarranted cost on the patient and health care system as a whole.

07
Wed
Poster #2

CAN EXCESS NOCTURNAL URINE VOLUME PREDICT EXCESS 24-HOUR URINE VOLUME?


Thomas Monaghan1, Syed Rahman1, Connelly Miller1, Donald Bliwise2, Christina Agudelo1, Kyle Michelson1, Corey Weinstein1, Jason Lazar1, Karel Everaert3, Joseph Verbalis4, Jeffrey Weiss1
1SUNY Downstate Health Sciences University, 2Emory University School of Medicine, 3Ghent University Hospital, 4Georgetown University Medical Center


Introduction: Nocturia in the setting of excess nocturnal urine volume (NUV) may be attributable to nocturnal polyuria (NP) or 24-h polyuria (i.e., “global polyuria” [GP]). NP and GP are not mutually exclusive, but are each associated with a unique differential diagnosis, and thus warrant distinct diagnostic and therapeutic interventions (Cornu et al, Eur Urol 2012;62:877). Analysis of voiding diary data from the hours of sleep can, in of itself, support a diagnosis of NP, but its generalizability to the 24-hour period (i.e., in diagnosing GP) has not been established. However, by rate, the common criteria for GP (a) 40 mL/kg/24-h [117 mL/kg/h in a 70-kg individual] or b) 3000 mL/24-h [125 mL/h]) are more stringent than those for NP (a) NUV >90 mL/h or b) Nocturnal Polyuria index [NPi; nocturnal volume/24-h volume] >0.33 [no minimum rate]). It remains unclear whether NUV may reliably delineate between NP patients with and without comorbid GP.



Methods: Analysis of voiding diaries showing ≥1 nocturnal void(s) from men aged ≥18 years at an outpatient urology clinic. Four separate analyses were performed using all combinations of the 2 NP and 2 GP criteria listed above. For each analysis, patients were included if they met the criteria for NP (n=122 for NUV >90 mL/h; n=154 for NPi >0.33), and then stratified by presence or absence of GP (i.e., NP+GP [cases] vs. isolated NP [reference group]).



Results: Median NUV was greater among patients with NP+GP for all criteria combinations analyzed (Figure 1). Sensitivities of ≥ 80%/90%/100% for NP+GP were observed at 1275/1230/1085 mL for {NPi >0.33 + 24-h volume >3000 mL}; 1075/1035/1035 mL for {NPi >0.33 + 24-h volume >40 mg/kg}; 900/745/630 mL for {NUP >90 mL/h + 24-h volume >3000 mL}; and 1074/1035/990 mL for {NUP >90 mL/h + 24-h volume >40 mg/kg}.



Conclusions: An inordinate NUV among men with NP is fairly sensitive for comorbid GP, such that nocturnal-only urinary data may, in fact, provide valuable insight regarding both major etiologies of polyuria (i.e., NP as well as GP). This finding supports the rational use of nocturnal-only voiding diaries as a less-cumbersome (and thus more patient-centered) alternative to the 24-hour voiding diary in the initial evaluation of nocturia owing to polyuria.



07
Wed
Poster #3

EXPECT THE UNEXPECTED. PERIOPERATIVE MORBIDITY OF GENDER AFFIRMING SURGERY


Nathan Green, MD1, Mahmoud Khalil, MD1, Cooper Benson, Md2, Mahip Acharya3, Nalin Payakachat3, Bruno Machado1, Rodney Davis1
1Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 2Department of Urology, Tulane University, New Orleans, Louisiana, 3Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas


Introduction



Gender affirming surgery (GAS) is recognized as an integral component to the management of gender dysphoria in transgender (TG) patients. There has been significant growth and interest in the medical and surgical care for TG patients among urology community. We sought to characterize the demographics, the types of procedures performed for the purpose of gender affirmation and short term postoperative complications utilizing a national dataset.



Methods



A retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database from 2010-2016 was utilized to identify adult (age >18) patients undergoing GAS with a post-operative diagnosis of gender dysphoria (GD). Procedures were categorized into masculinizing surgery (MS) or feminizing surgery (FS). Statistical Analysis was performed using SAS 9.4.



Results



We identified a total of 381 patients with the post-operative diagnosis of GD, with 94 undergoing FS and 287 undergoing MS. The majority of patients were 25-34 years old, 35% in the FS and 40% in the MS groups. Between 2010 and 2015 there was a significant increase in the total numbers of all FS (0 procedures to 39 procedures) and MS (6 procedures to 132 procedures). The most common MS were mastectomy (48.4%) and hysterectomy (41.5%) procedures, only 5.2% of cases coded as “intersex; female to male surgery.” Among the FS group, the most common procedures were for breast reconstruction (37.2%), and orchiectomy (28.7%), and only 19.2% were coded as “intersex surgery, male to female.” There was only one penectomy and 7 vaginoplasty procedures performed during this period. When including all patients, there were only 4 reoperations within 30 days and 1 readmission in the FS group and 7 reoperations and 9 readmissions in the MS group. Overall, 55% underwent reoperation for drainage of a hematoma/seroma. Overall, the rate of 30-day complications were low with a rate of 2% in the FS group and 3.5% in the MS group. Reported complication were wound related infection and urinary tract infection.



Conclusions



The complication rates of genital GAS demonstrated in the literature are not well captured in the NSQIP database. However, the overall complication rates herein mirror that of claim based studies during the same period. This database clearly underestimates the real world experience of GAS, especially genital part. As TG surgical care continues to grow, there is clearly a need for more accurate and comprehensive reporting of surgical outcomes.

07
Wed
Poster #4

THE IMPACT OF A DEPARTMENT CLINICAL RESEARCH DIVISION AND FORMAL RESEARCH CURRICULUM IN RESIDENCY


Alexandra Dahlgren, Katie Glavin, Mirza Moben
Department of Surgery, Division of Urology, University of Kansas Medical Center


Introduction: Research during residency training can be challenging.  Having support and structure to participate and initiate meaningful and impactful research is very difficult.  Our objective was to examine the impact of the creation of a clinical research division, dedicated research rotation, and the implementation of a formal research curriculum on resident research, publications, presentations, and enrollment in clinical trials.



Methods: Data was collected from three years (2014, 2015, 2016) prior to the implementation of the research curriculum in residency and the creation of a clinical research division for the department as well as three years after (2017, 2018, 2019). The clinical research division was created in 2017 and the concurrent research curriculum and dedicated research rotation for residents was implemented. The number of publications with a resident as an author as well as the total impact factor for all publications were tallied. The number of presentations given by residents were totaled and categorized based on conference. The total number of patients enrolled in clinical trials were calculated as well.  Results were based on curriculum vitae, each journal’s self-reported impact factor, and eResearch portal registration. Number of trials were also calculated and then classified based on resident initiation and prospective design.



Results:  There were an average of 9.7 publications per year prior and 9 publications per year after implementation.   The impact factors of all resident publications was 1.9 prior and 2.8 after implementation.  There were an average of 19 presentations per year prior and 17.3 presentations per year after implementation.  Prior to implementation there was only one resident initiated prospective trial and after implementation there were seven resident initiated prospective trials. Prior to implementation only 58 patients were enrolled in prospective clinical trials and after implementation 1861 patients were enrolled in prospective trials.



Conclusions: The overall number of presentations and publications did not change significantly, however there was a significant increase in the total impact and the impact per article after the implementation.  The number of resident initiated prospective trials and patients enrolled in trials is dramatically higher since implementation of a curriculum and creation of a research division highlighting the importance of structure and support for meaningful and impactful resident research.  

07
Wed
Poster #5

COMPARISON OF TRENDELENBURG FRICTION PADS– COEFFICIENT OF FRICTION, WATER RETENTION, TENSILE STRENGTH AND ELASTIC MODULUS


Thomas Lowrey, MD1, Braden Miller, BS1, Marc Moore, Ph.D2, Sanjay Patel, MD1
1University of Oklahoma Health Sciences Center Department of Urology, 2University of Oklahoma Stephenson School of Biomedical Engineering


Introduction: Optimal patient positioning and safe padding during surgical procedures is critical to provide surgeons the best access while minimizing perioperative risk to patients. Manufactures have continued to engineer new products to improve patient safety, and providers have developed new techniques to limit patient sliding, but there are few published studies evaluating the efficacy of various padding materials in association with these factors. The purpose of this study is to compare material characteristics (coefficient of friction, water retention, tensile strength and elastic modulus) of various Trendelenburg pads utilized in urologic surgery.



Methods: Five Trendelenburg pads (Xodus, Soule New, Soule Old, Soule Extra Thick, Soule Convoluted) were evaluated. For each tested parameter, 4 samples of each pad were utilized, with results averaged and standard deviations calculated. To determine coefficient of friction (u), a uniaxial tensile testing rig with a 100 N static load cell capable of force resolution ≥ 0.0125 N was employed.  A 200 g metal block was pulled across each pad at a rate of 50 mm/min.  For water retention (g H20/ g dry material), dry sample weights were attained and specimens were then submerged in water. Samples were dried for 10 minutes (to allow surface water drainage) and reweighed. To calculate tensile strength and elastic modulus (kPa), full thickness samples were stretched with a load rate of 50 mm/min utilizing the uniaxial testing rig.



Results: The Soule New had a 38% lower coefficient of friction (1.43 ± 0.04) relative to Xodus (2.29 ± 0.26) and 45% lower coefficient compared to Soule Old (1.83 ± 0.07) (Table 1) . Soule New was more absorbent than Xodus, with water retention values of 19.99 ± 0.65 g H20/ g dry material and 11.37 ± 1.42 g H20/ g dry material, respectively. Soule New had a much greater ultimate tensile strength than Xodus (134.44 ± 1.51 kPa  vs. 10.77 ± 2.27 kPa) as well as 5 times greater elastic modulus (38.99 ± 0.48 vs. 7.79 ± 0.63).



Conclusions: Calculation of coefficient of friction, water retention, ultimate tensile strength and elastic modulus was feasible with consistent results using the techniques described above.  This data will be utilized to conduct further prospective clinical studies regarding the efficacy of different padding materials and its impact on patient safety and outcomes. 

07
Wed
Poster #6

Cost analysis of enhanced recovery after surgery for robotic radical and partial nephrectomy


JuliAnne Rathbun, MD, Kate Lowrey, BS, Naveen Pokala, MD, Katie Murray, DO
University of Missouri


Introduction/Background



Enhanced recovery after surgery (ERAS) protocols in urology are now widely accepted for radical cystectomy, with demonstrated clinical benefits, including decreased opioid use, quicker return of bowel function, and shorter length of stay (LOS). Applying ERAS to other urological procedures such as radical nephrectomy (RN) has been questioned due to naturally short length of stay and generally unaffected bowel function; however, the aim of this study is to evaluate the financial impact of our institution’s Team InteGrated Enhanced Recovery (TIGER) protocol for robotic radical nephrectomy. Primary outcomes were hospitals costs and length of stay. Secondary outcomes were readmissions and unanticipated revisits (inpatient, observation, or emergency). 



Methods



After IRB approval, our institution implemented the TIGER protocol for robotic radical and partial nephrectomy in January 2018. We compared cost analysis for TIGER protocol patients with standard care patients from January 2018 through December 2019. SPSS was used for statistical analysis and p<0.05 was considered significant.



Results



178 patients underwent robotic radical or partial nephrectomy (PN) during the study period by two surgeons, with 4 patients undergoing concurrent inferior vena cava thrombectomy. 158 patients received standard care and 20 underwent TIGER protocol. Standard RN median contribution margin was $3,151 with LOS 3.24 days vs TIGER RN with $3,285 with LOS 1.92 days. Standard PN median contribution margin was $2,374 with LOS 2.68 days vs TIGER PN with $4,225 with LOS 2.25 days. Overall median contribution margin was $2,635 with LOS 3.06 days for standard vs $3,616 with LOS 2.05 days for TIGER (LOS, p=0.003). TIGER protocol patients have had no unplanned readmissions or revisits compared to 4.4% readmissions and 7.6% revisits of standard care patients. 



Conclusion



Enhanced recovery protocol may make a significant impact on length of stay, which in turn may affect median contribution margin. Direct cost is negligibly different between standard of care and TIGER protocol; however, decreased length of stay even for relatively short index admissions may allow for higher contribution margins. Our institution will continue to implement TIGER protocol. 

07
Wed
Poster #7

#UROINSERVICEPREP: A PILOT PROTOCOL OF TWITTER AS A COLLABORATIVE LEARNING TOOL FOR UROLOGY RESIDENT EDUCATION

 


Shreeya Popat, MD1, Angeline Johny, MD1, Christopher Tallman, MD2, Mohit Khera, MD1
1Baylor College of Medicine, 2Houston Methodist Hospital


INTRODUCTION/OBJECTIVE:



With the changing dynamic of graduate medical education and a technologically-adept generation of aspiring phyicians, it is imperative to embrace new tools for education.  Twitter has proven a valuable adjunct in medical education, with a volume of literature demonstrating its accessibility and ability to promote collaborative discussions in internal medicine and general surgery residency programs (1).  We sought to explore the educational potential of Twitter in urology resident education.



METHODS:



We conducted a collaborative study group online on Twitter in the months preceding the annual urology In Service Exam.  Open-ended case-based discussion questions were designed to cover a variety of fundamental urologic concepts: renal masses, adrenal masses, hypogonadism, Peyronie’s disease, infertility, medical and surgical management of nephrolithiasis, male lower urinary tract symptoms, female incontinence, neurogenic bladder, neonatal hydronephrosis, recurrent UTIs, elevated PSA, bladder cancer, upper tract urothelial cancer, urethral stricture, testicular cancer, penile cancer, and genitourinary trauma.



Urology trainees and faculty were invited to respond using the hashtag “#UroInServicePrep.”  They were encouraged to cite literature and evidence-based guidelines in posts and continue to promote discussion with follow-up questions.



RESULTS:



Over one month, eighteen discussion questions were posted on Twitter, at a frequency of 4-5 times per week. Twenty-five faculty and trainees participated internationally (Figure 1).  There were over 250 associated tweets.   Participants described the exercise as “awesome” and “excellent.”  They reported “great benefit [from] these discussions” and that it “helped…structure study time.”



CONCLUSIONS:



Urologic education is entering a dynamic period of exponential growth.  Through this pilot protocol, we demonstrated the feasibility of Twitter as a tool for collaborative education among urology residents.  We found that Twitter can potentially serve as a resource that allows residents to not only review key urologic concepts but learn from global experts in real time. Future steps include surveying participants to assess the value and subjective perceptions of the exercise and interest in continuing it in the future.



1. Lamb, Laura C., Monica M. DiFiori, Vijay Jayaraman, Brian D. Shames, James M. Feeney. “Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination.” Journal of Surgical Education. 2017 Nov –Dec; 74(6): 986-991. doi: 10.1016/j.jsurg.2017.05.010.



07
Wed
Poster #8

CURRENT ATTITUDES OF GURS VERSUS NON-GURS SURGEONS TOWARD ROBOTIC RECONSTRUCTIVE UROLOGY


Bryn Launer1, David Koslov2, Kirk Redger2, Humberto Villarreal2, Ty Higuchi2, Brian J Flynn2
1University of Colorado School of Medicine, 2Department of Urology, University of Colorado Hospital


INTRODUCTION/BACKGROUND:



The robotic platform has become integral to urologic oncology and is now expanding into reconstructive urology. Despite this, most GURS (Genitourinary Reconstructive) surgeons have not adopted robotics into their practice. In this study, we sought to compare current robotic practice patterns amongst GURS and non-GURS trained surgeons for reconstructive cases and assess opinions on the future role of robotics in reconstructive urology.



 



METHODS/MATERIALS:



REDCap was used to circulate our survey to collect data from both GURS and non-GURS trained urologists via email, social media, and at professional conferences. Survey topics included demographics, urologic training, current practice patterns, robotic experiences, and attitudes regarding robotic surgery.



 



RESULTS:



A total of 108 surveys were completed. The majority of respondents had been in practice for less than 10 years (59%), currently practiced in an academic setting (57%) and completed a fellowship 54% (n=58) including GURS 14% (n=15), oncology 12% (n=13), minimally invasive surgery 10% (n=11), FPMRS 7% (n=8) and other 10% (n=11). Thirty-one percent of respondents performed at least 10 robotic reconstructive cases per year, 33% < 10, and 36% performing 0. Respondents most commonly performed robotic pyeloplasty (55%), ureteral reconstruction (54%), and bladder reconstruction (40%). Amongst responders, only 22% indicated that most robotic reconstructive cases (ureteral or bladder) at their institution were performed by a GURS surgeon, while 78% said most were done by non-GURS surgeons. Most responders viewed robotic outcomes as equal to or better than open approach for reconstructive cases (92%, n=101). Despite this, non-robotic surgeons were still less likely to discuss a robotic approach than robotic surgeons. Overall, 70% thought any surgeon with advanced robotic training are most qualified to perform robotic reconstructive cases, while 51% expected GURS trained surgeons to be perform more of these in the future. Of those involved in GURS fellowship training, 59% supported GURS fellowship committee adding robotic ureteral/bladder reconstruction to the fellow’s case log.



 



CONCLUSIONS:



A large portion of robotic urologic reconstructive cases are performed by non-GURS surgeons. Overall, most see benefit of the robotic platform to upper urinary tract reconstruction and expect GURS surgeons to perform more of these in the future. Academics tended to favor integrating robotics into GURS fellowship case logs.

07
Wed
Poster #9

THE POSITIVE EFFECT OF MONETARY INCENTIVE ON UROLOGY RESIDENT RESEARCH


Ryan Larsen1, Cole Bowdino1, Bryant Van Leeuwen, M.D., PGY21,2, Chad LaGrange, M.D., Program Chair1,2, Christopher Deibert, M.D., M.P.H., Program Director1,2
1University of Nebraska Medical Center, 2Division of Urologic Surgery


Abstract:



Background: Urology residents help generate research at academic medical centers. Their reward for this can be measured in personal achievement, acceptance into fellowship, or fulfilling graduation requirements. This is a retrospective study that examined the effect of a financial incentive given to urology residents for participation in research projects that led to publications.



Objective: The objective of this study was to evaluate whether the incentive changed research patterns among residents over a 12-year period.



Methods: Beginning in July 2016, any resident work that led to a PubMed citation was awarded $1,000.  A review of the PubMed database and the regional meeting of the South Central Section of AUA (SCS/AUA) presentation itineraries were used to quantify and qualify the participation in research by these residents before and after introduction of the financial incentive.



Results: Scholarly activity from all thirty possible residents was evaluated. The monetary incentive resulted in increased production post-incentive (6.33) vs. pre-incentive (2.44) in average total authorship participation published to PubMed per year (p=0.0125). The average number of PubMed primary authorships per year for the entire residency program increased from 0 in July 2007-June 2008 to 0.7 in July 2018-June 2019, displaying upward trajectory. Average primary authorship of research produced per year presented at SCS/AUA and published to PubMed increased post-incentive (9.00) vs. pre-incentive (4.89) (p=0.0479). More review articles and less basic science research were published after the incentive. 



Conclusion: Offering financial incentives to urology residents increased publications and meaningful participation in research.

07
Wed
Poster #10

An overview of Men’s Health Clinics offering Testosterone Therapy in a Midwest State. 


Jinfeng Jiang, BA1, Jordan Stegman, MD2, Christopher Deibert, MD, MPH2
1University of Nebraska Medical Center, College of Medicine, Omaha, NE, 2University of Nebraska Medical Center, Division of Urologic Surgery, Omaha, NE


Introduction/ Background – Since 2001, there has been a 300% increase in the use of Testosterone therapy. However, there remains limited published data on the demographics of facilities and providers that advertise this service. This study aims to look at such demographics of advertised Men’s health clinics in Nebraska. 



Methods/ Materials – An internet search was conducted with the phrases “Nebraska Male health clinics, Nebraska Low T/testosterone, Nebraska Hormone Replacement Therapy”. All clinics that were found offering Testosterone therapy with Men’s health in their mission statement were included. Data was gathered using 6 questions, with answers obtained from the public website or by calling the office.  



Results – 19 different facilities were found that self-identified as Men’s Health clinics. 5/19 facilities were nationally corporate owned, 13/19 were individually owned, and 1 was an academic university. All offered Testosterone Therapy. Of the 19 facilities, 10/19 branded themselves primarily as Men’s Health Clinics. 6/10 out of those offered testosterone therapy, Plasma infusion, and Penile Shockwave Therapy. Those that offered services other than Men’s health were marketed as Medical Spas and Aesthetic centers, offering hormone replacement therapy, aesthetics, and anti-aging treatments. 10/19 Clinics had no MD listed and visits would be with a mid-level provider (NP or PA). Only 1/19 provided prices online, others required consultation before prices would be given. Of the 19 facilities, only 6 accept insurance and the rest are cash-pay clinics only.  



Conclusions – Of the Nebraska clinics that self-identify as men’s health clinics, many are individually owned clinics with a focus on hormone replacement or aesthetics. Of those clinics, many were run entirely by mid-levels or with a supervising MD overseeing mid-levels. Less than 1/3rd of facilities accept insurance and there is a lack of price transparency. 

07
Wed
Poster #11

BURNOUT IN VA UROLOGISTS


Jeffrey Marks, MD1, Brett Wiesen, BS1, Granville Lloyd, MD2
1University of Colorado, Division of Urology, Aurora, CO, 2VA ECHCS Department of Surgery


Introduction: Physician burnout is linked to decreased job performance, increased medical errors and depression. Prior studies have suggested Urologists may experience a high rate of burnout with the 2016 AUA Census finding a prevalence of 38.8% among respondents. We sought to assess burnout and associated risks among the unique population of VA Urologists.



Methods: An IRB approved survey was emailed to members of the VA National mail group members containing the Maslach Burnout Inventory as well as demographic and practice variables. Burnout was defined as scoring high on the scales of emotional exhaustion (score 27 or greater) and depersonalization (score 10 or greater) consistent with previously validated studies. Data was analyzed using a two sample T-test.



Results: 54 physician responses were received of the 369 members of the mail group (14.6%). Overall, 31.5% of VA Urologists met the criteria for burnout, with 27% scoring high for emotional exhaustion and 16% scoring high for depersonalization. VA urologists were less likely to experience burnout than the respondents to the 2016 AUA census, although this was not statistically significant. Burnout was more common in females and younger physicians (<55 years of age) (p<0.05).  Those experiencing burnout had no significant difference in total hours worked per week, total hours worked per week at the VA, and total hours spent using the VA electronic medical record (EMR). 72% of respondents would recommend a VA position to a new graduate. 



Conclusions: These results suggest that the prevalence of burnout is similar to other urologists. Females and younger VA urologists were more likely to experience burnout than their peers. Burnout prevalence did not correlate with time spent working or using the EMR, contrary to previous studies. However, 72% of VA urologists would recommend a VA position to a new graduate. Targeting preventable causes for burnout within this cohort is imperative to ensure continued excellent urologic care of the veteran and a diverse workforce. 



07
Wed
Poster #12

DIFFERING PERCEPTIONS OF OPERATIVE EDUCATION AMONG UROLOGY FACULTY AND TRAINEES


Shreeya Popat, MD, Wesley Mayer, MD, Jennifer Taylor, MD
Baylor College of Medicine


INTRODUCTION AND OBJECTIVE:



Graduate medical education is constrained by many factors, including duty hour restrictions, demands for efficiency, and an ever-growing volume of clinical content. The operating room is a high-stakes setting where these constraints are magnified, which results in difficulty standardizing surgical technical education. We sought to understand perceptions of operative education among attending and resident physicians in our program.





METHODS:



A survey assessing the frequency and value of peri-operative educational discussions was distributed electronically to attending and resident physicians. The survey included open-ended and 5-point Likert scale (1=lowest, 5=highest) questions. Responses between the faculty and trainee cohorts were compared.



RESULTS:



The survey was completed by 23 attending (92%) and 14 resident (88%) physicians. Residents rated collaborative establishment of educational goals as relatively more important than attendings (4.4 vs. 3.7, p=0.01). The frequency at which educational goals were discussed prior to surgical cases was reported significantly lower by residents than attendings (p = 0.007). Both faculty and trainees found it challenging to set specific technical goals before cases. When asked why, residents stated concerns about appearing “pushy” or “offending/upsetting” their superiors. Faculty described lack of continuity in teacher-student relationships, resulting in uncertainty about trainees’ progress. Both faculty and trainees described post-operative feedback as very important for education. Attendings reported giving both immediate post-operative feedback and periodic summative feedback significantly more often than residents reported receiving it (p<0.001). Attendings also described more time per case devoted to feedback than residents (mean 4.5 vs. 1.8 minutes, p<0.001). Faculty reported providing feedback that was significantly more specific than trainees reported receiving (p<0.001). Finally, residents described soliciting feedback as significantly more challenging than attendings rated giving feedback (p<0.001).



CONCLUSIONS:



Both resident and attending physicians find it challenging to establish collaborative technical educational goals. In addition, there are significant differences between their perceptions of the frequency and specificity of post-operative feedback. These differences can lead to learner and educator frustration and negatively impact learning. Future work will address these disparities in order to improve and innovate surgical training with a structured feedback model.

07
Wed
Poster #13

ASSESSMENT OF BURNOUT AMONG UROLOGY RESIDENTS WITHIN SOUTH CENTRAL SECTION OF AMERICAN UROLOGICAL ASSOCIATION


Parth Joshi, BS1, David Cheung, BS1, Facundo Davaro-Comas, MD2, Hector Osei, MD3, Matthew Smeds, MD4, Sameer Siddiqui, MD2
1Saint Louis University School of Medicine, St. Louis, MO, 2Division of Urology, Department of Surgery, Saint Louis University, St. Louis, MO, 3Cardinal Glennon Children's Hospital, St. Louis, MO, 4Division of Vascular and Endovascular Surgery, Department of Surgery, Saint Louis University, St. Louis, MO


Introduction: Burnout, a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment is prevalent among physicians at all levels of training.



Methods: We distributed an anonymous electronic survey using Research Electronic Data Capture (REDCap©) system to urology residents within the South-Central Section (SCS) of the American Urological Association (AUA). Validated scales of burnout (Oldenburg burnout inventory (OLBI)), stress (perceived stress scale (PSS)), depression (patient health questionnaire (PHQ-4)), social support (social support scale (SSS)), unhealthy alcohol use, and self-efficacy (New General Self-Efficacy Scale (SES)) were used. Participants were grouped into quartiles based on OLBI score and logistical regression (LR) was performed.



Results: 244 surveys were delivered and 57 responses were received (23.3% response rate). 40 trainees (16.3%) completed the survey in its entirety. Average OLBI was 23.24 (1.64) in lowest quartile and 47.45 (1.51) in highest quartile with a 27.5% and 72.5% rate of burnout, respectively (p<0.001). Female trainees in the lower three quartiles were less likely to abuse alcohol (p=0.046). Using LR, univariate analysis showed trainees scoring in the highest quartile were more likely to be younger (OR 1.8, p=0.039) compared to the lower three quartiles. Multivariate analysis confirmed this, OR of 3.28 (1.15-9.4, p=0.027). Gender, number of residents per year, presence of physician extenders, weekends off, number of 80-hour work week violations, PHQ-4, PSS, SSS, SES were not significantly different between groups.



Conclusion: Younger urology trainees are at increased risk of burnout. Other individual and program related variables did not correlate with likelihood of burnout.

07
Wed
Poster #14

More Urologists: Examining the Urology Match from 2006-2020 


Jinfeng Jiang, Medical Student1, Christopher Deibert, Assistant Professor2
1University of Nebraska Medical Center, College of Medicine, Omaha, NE, 2University of Nebraska Medical Center, Division of Urologic Surgery, Omaha, NE
Jay

Introduction/ Background – The urology match remains highly competitive, but there is limited analysis of how the characteristics of the Urology match have changed over the past decade. This study aims to examine the National Urology Match and changes from 2006-2020. 



Methods/ Materials – Match Statistics through 2006-2020 were obtained from American Urological Association website and combined by year. Match data were analyzed for trends of application numbers, available positions, interview invites, and match rates by year from 2006-2020. 



Results – 5,475 applicants submitted rank lists to the AUA match from 2006 to 2020. Applications steadily rose over the years with a slight decrease in 2018-2019, but the 2020 match saw the highest number of applicants at 441. Available positions have increased 50% (235 to 354) during the same time period. Of the 5,916 applicants, 4,428 successfully matched (72%). Match rates hovered between 60.9% to 79.1% until 2019, which peaked at a record 85% of all applicant's matched. There was a slight dip in 2020 back to 80%. In the same time period, programs applied to per applicant rose on average 2 per year (39.5 to 74). Interviews attended by applicants has steadily risen from 9.9 in 2006 to 13 in 2019.  



Conclusions – The Urology match has remained competitive over the study timeframe with an average match rate of 72%. The 2019 match rate was 85%, the highest ever in the past 2 decades. To ensure a spot, applicants are applying to a greater number of programs and attending more interviews.  This is likely due to a factor of increased spots available and a recent surge in applicants. As we face a projected shortage of Urologists in the future, increasing training opportunities for qualified applicants should continue as the demand for urologists grows.   

Concurrent Session 2 of 3  
07
Wed
4:00 p.m. - 5:00 p.m.
Endourology/Laparoscopy & Calculus Disease Poster Session
Location: Meeting Room 616 AB
Moderators:
Lindsay Lombardo, DO
Saint Louis, MO


Julie M. Riley, MD, FACS
Albuquerque, NM
07
Wed
Poster #15

URINARY CULTURE MICROBE IDENTITY AND ANTIBIOTIC RESISTANCE TRENDS


Geoffrey Rosen, MD, Katie Murray, DO
University of Missouri, Columbia, MO


Introduction/Background:



Urinary tract antibiotic treatment and prophylaxis guidelines abound. We use a retrospective examination of culture data from a large clinical database to examine patterns of microbial isolate identity and antibiotic resistance. We examine the role of guideline recommended antimicrobial prophylaxis in selection for antimicrobial resistance.



 



Methods/Materials:



We queried the HealthFacts database for positive urine cultures. This database includes 192 million cultures from 750 facilities. We examined trends in microbe and antibiotic resistance for the years 2000 – 2018. We used linear regression and Pearson’s chi-squared test. We also examined antibiotic resistance in the first 30 days after transurethral procedures and how it relates to the perioperative antibiotic given. Where appropriate, we corrected for multiple testing using the false discovery rate.



 



Results:



Of 3 million positive urine cultures, Escherichia coli (54%) was most commonly isolated, followed by Klebsiella pneumoniae (8.3%), Enterococcus faecalis (6.2%), Proteus mirabilis (5.4%), and Pseudomonas aeruginosa (3.5%). E coli prevalence increased yearly by 0.8% (R-squared for year=0.91, P < 0.0005). 25% of isolates were resistant to fluoroquinolones (FQ), 25% to first or second generation cephalosporins (CEPH) and 23% to sulfamethoxazole-trimethoprim (SMX-TMP). There were statistically significant but not clinically meaningful year-over-year changes in resistance rates (Figure 1). After transurethral procedures, the proportion of positive cultures resistant to the perioperative antibiotic was 45% for FQ, 37% for CEPH, and 30% for SMX-TMP (P=0.02). Pairwise analysis demonstrated the only significant difference was between proportion resistant to FQ and to SMX-TMP (P=0.02). 



 



Conclusions:



E coli was isolated from the majority of positive urine cultures, with an increasing trend over time, while other common uropathogens were stable. Despite guideline changes in antibiotic administration, the proportional resistance to commonly prescribed agents remained stable throughout the study period. Those treated with FQ with positive cultures in the first 30 post-operative days were significantly more likely to demonstrate resistance to the administered antibiotic than were those administered SMX-TMP. Overall, clinical urinary isolate characteristics were essentially stable in the years 2000 to 2018, and we begin to investigate the role of perioperative prophylaxis in antibiotic resistance.