Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts PDB-07 Prevalence and Characterization of Pelvic Pain in a General Urology Clinic Population J. Zillioux 1 ; C. Yeaman 1 ; K. Boatman 1 ; S. Krzastek 2 ; D. Rapp 1 1 University of Virginia, Charlottesville, VA, USA; 2 Virginia Commonwealth University, Richmond, VA, USA Introduction: Available data estimates pelvic pain prevalence in women to range between 6-26%. Notably, basic data elucidating pain characteristics, including quality and location, are not well reported. Such study is fundamental to a better understanding of the multifactorial nature of pelvic pain and to optimize related therapies. We assessed the prevalence and character of pelvic pain in a general urology population presenting for evaluation of unrelated non-painful complaints. Materials &Methods: This is an IRB-approved prospective, cross-sectional survey- based study of female patients presenting to a urology clinic over a 10-month period (7/2018-5/2019). Patients completed a 32-item survey with questions pertaining to pelvic pain, focusing on pain location, quality, frequency, and severity. Detailed anatomic figures were included to aid in localization.Analysis was performedwith R programming language (3.6.1). Results: A total of 181 women completed the survey, with a mean age of 56 years. 75 (41%) women reported pelvic pain. Patients described a significant variety of pain locations and qualities (Figures 1). The most common sites of pain were lower back (73%) and bladder (72%), while “dull/aching” was the most common pain quality. Notably, a majority (84%) of patients reported multiple pain locations. Median pain severity was 7 [IQR 4, 8] on a 10-point scale. Over half (52%) also reported dyspareunia. A majority (57%) of patients reported feeling “unhappy” or “terrible” as a result of pain. 83% of patients reported that pelvic pain inhibited normal activities. Conclusions: A significant percentage of women presenting to a general urology clinic experience pelvic pain. There was notable variety in patient-reported pain location and quality. Further study is needed to further understand patterns of pain characteristics and their relationshipwith underlying etiologies of pelvic pain. Pediatric Epididymitis – Antibiotic Prescribing Patterns in the Outpatient Setting C. Cheung 1 ; S. Gowtham 1 ; J. Sumfest 1 1 Geisinger Medical Center, Danville, PA, USA Introduction: Only a minority of pediatric patients with acute epididymitis or epididymo-orchitis have a bacterial etiology proven with a positive urine culture (approximately 4-10%) 1,2 . Boys with normal urinalysis or negative urine culture can be safely managed with supportive care only1. For children 2-14 years of age with acute epididymitis, theAmericanAcademy of Family Physicians recommends antibiotic treatment based on urinalysis or urine culture results. Similarly, the American Academy of Pediatrics recommends urine testing prior to initiating antibiotics in pediatric patients with epididymitis. The present study aims to investigate the evaluation and treatment pattern of pediatric patients diagnosed with epididymo-orchitis in the outpatient setting at a single academic institution. Materials & Methods: We conducted a retrospective chart review of patients under the age of 18 who were diagnosedwith epididymitis, orchitis, or epididymo- orchitis between 1996 and 2017 in the outpatient setting at a single institution. IRB approval was obtained. Results: 672 patients under the age of 18with the diagnosis of epididymitis, orchitis, or epididymo-orchitis were identified. 403 patients (60%) received antibiotics. Of the patients who received antibiotics, 303 (75%) did not have a urinalysis or urine culture performed at the time of diagnosis, and 16 (4%) had a positive urine culture or abnormal urinalysis. 269 (40%) patients did not receive antibiotics, 44 of them had a urinalysis or urine culture performed and all were negative for infection. Conclusions: Contrary to national guidelines, most pediatric patients diagnosed with epididymo-orchitis were prescribed antibiotics inappropriately despite negative urinalysis and urine cultures. 75% of patients who received antibiotics did so without having a prior urinalysis or urine culture. Future directions to the study will include efforts to decrease inappropriate antimicrobial use for pediatric epididymitis in our institution. PDB-05 11 Podium Session B PDB-06 Extended Manual Modeling: an Updated Method for Safely and Effectively Managing Curvature During Penile Prosthesis Implantation J. Lucas 1 ; M. Gross 2 ; R. Barlotta 1 ; A. Sudhakar 1 ; J. Simhan 1 1 Einstein Healthcare Network, Philadelphia, PA, USA; 2 Darmouth-Hitchcock Medical Center, Lebanon, NH, USA Introduction: Manual modeling is an effective strategy at reducing penile curvature in patients with erectile dysfunction (ED) and Peyronie’s Disease (PD) who undergo inflatable penile prosthesis (IPP) insertion. Due to a lack of contemporary data and a historic 4% rate of urethral perforation, many have opted towards other surgical options for treating concomitant ED and PD. Comparison was made of outcomes in patients undergoing a variant of the original technique (‘extended manual modeling,’ EMM) to patients with no ancillary straightening (NAS) procedure. Materials &Methods: All IPP cases from 2 high-volume implanters fromNov 2015 through Aug 2019 were reviewed. Patients with > 30 of residual curvature after cylinder placement who underwent EMM were compared to a matched cohort of NAS patients. Concomitant grafting and/or plication cases were excluded. EMM was performed by forcibly bending the erect penis in the direction opposite of the point of maximal curvature for 90-second intervals for as many cycles as necessary to achieve < 30 curvature. Results: 40 (50.0%) patients underwent EMM while 40 (50.0%) were in the NAS group. The median pre-modeling curvature in the EMM group was 45.0 (IQR 36.3- 60.0) while post-modeling curvature improved to 10.0 (IQR 5.0-15.0; p < 0.001). There was no difference between cohorts with respect to operative time (82.7 vs. 84.7 min, p = 0.77) or surgical approach (95.0% vs. 87.5%penoscrotal, p = 0.43). Both groups had similar cylinder length and reservoir volume, but the EMM cohort had a smaller mean rear-tip extender (1.3 cm vs. 1.8 cm; p = 0.02). No patient in either cohort experienced an intraoperative or postoperative complication at a mean follow-up of 6.0 (IQR 3.3-13.4) months. Conclusions: Although many prosthetic urologists forego manual modeling in cases of severe penile curvature, our series shows it to be both safe and effective. EMM may preclude the need for more complex surgical procedures