Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 Perioperative Trends andRisk Factors for Long TermOpioidUseAfter Endoscopic Stone Surgery S. Christianson 1 ; E. Ghiraldi 1 ;A.Nourian 1 ; J. Jacob 2 ;Y.Son 3 ; J. Simhan 1 ; J. Friedlander 1 1 Einstein Healthcare Network, Philadelphia, PA, USA; 2 Touro College of Osteopathic Medicine, NewYork, NY, USA; 3 Philadelphia College of OsteopathicMedicine, Philadelphia, PA, USA Introduction: We examined opioid prescribing patterns following surgical management of nephrolithiasis. Our goal was to identify risk factors for long- term opioid use, defined as ongoing use 6 months after endoscopic stone surgery. Materials & Methods: We performed a single-center retrospective review of patients undergoing ureteroscopy (URS) or Percutaneous nephrolithotomy (PCNL) from 2014-2018. Perioperative opioid prescribing trends were assessed with the Pennsylvania Prescription Drug Monitoring Program (PA-PDMP). The number of prescriptions, tablets and total morphine equivalents (TME) were quantified. Patients were excluded if using opioids within three months prior to surgery. Results: PDMPdata was available for 273 opioid naive patients. The absolute risk of long-termopioid use was 7.9% (9/113) and 2.5% (4/160) for URS and PCNLgroups, respectivelywhiletherelativeriskwas3.19(95%CI1.05-10.9).Sub-analysisperformed on the URS group to identify factors associated with long-term use (Table 1). TME at discharge (mean 147.44 vs. 274.66, p = 0.003), at 0-3 months (mean 106.9 vs. 341.66 p = 0.003), and the number of narcotic refills between 0-3 months (mean 0.53 vs. 1.22 p = 0.003) were all significant risk factors for long-term opioid use. On multivariate adjusted analysis, TME prescribed at discharge was an independent predictor for long-term opioid use. Table 2 lists characteristics of patients that developed long term opioid use after ureteroscopy. Conclusions: Patients undergoing URS had a higher absolute risk of opioid use at 6 months after surgery compared to patients undergoing PCNL. Limiting TME and number of prescriptions in first 3 months after URS may help reduce the risk of ongoing opioid use after ureteroscopy. Dornier HM3 Has a Higher Stone Free Rate and Lower Follow up Procedure Rate than the Storz Modulith SLX-F2 J. Farhi; M. Sultan; M. Tuong; C. Yeaman; C. Ballantyne; N. Schenkman University of Virginia, Charlottesville, VA, USA Introduction: The relative efficacy and complication rates between the first generation and latest generation lithotripters are unknown. We sought to examine the differences in stone free rate and complications between the Dornier HM3 and the Storz Modulith SLX-F2. We hypothesized that the Dornier HM3 had an superior stone free rate. Materials & Methods: We performed a retrospective cohort analysis of nephrolithiasis patients at a single academic institution treated with the Dornier HM3 and the Modulith SLX-F2 from July 2016 to August 2019. Patients over the age of 18 with first time treatment for the stone episode were included. Patients with staghorn calculi were excluded. Results: 61 patients were treated with the Modulith SLX-F2. 79 patients were treated with the Dornier HM3.Age, sex, BMI, and stone size showed no significant differences between the cohorts (Table 1). The Dornier HM3 had a statistically significant higher stone free rate of 73.4%, than the Modulith SLX-F2, which had a stone free rate of 49.2%. Stone free rate was defined as less than 2 mm residual targeted calculi on follow up imaging within 3 months of the procedure. Patients treated with the Dornier HM3 had a statistically significant lower follow up procedure rate than the Modulith SLX-F2 (Table 2). Conclusions: The Dornier HM3 is more effective in treating nephrolithiasis than the Modulith SLX-F2. The Dornier HM3 had a statistically significant higher stone free rate and a statistically significant lower follow up procedure rate. The newer generation lithotripters may sacrifice treatment efficacy for portability and economics. PDB-09 PDB-08 12 Podium Session B