Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MP1-08 High Intensity Focused Ultrasound Treatment of Prostate Cancer: Early Assessment of a New Platform for Focal Ablation of Targeted Lesions B. Miles Houston Methodist Hospital, Houston, TX, USA Introduction: To report our initial experience and preliminary functional outcomes inmen undergoing primary focal treatment of prostate cancer with a newgeneration of high-intensity focused ultrasound system. Materials &Methods: Since March 2019, patients with localized PCa were treated with an updated HIFU technology (Focal One by Edap), participating in an IRB- approved prospective registry at two academic institutions. Complications, short- term functional outcomes, and effect on PSA levels were evaluated. Results: Forty-four patients, mean age of 70 (± 8), underwent focal PCa ablation. One patient had Gleason score (GS) of 3+3 (2%), 21 (48%) had GS 3+4, 14 (32%) GS 4+3, 5 (11%) GS 4+4, and 3 (7%) GS 4+5. MRI revealed a lesion abutting the capsule in ten patients (23%), and extracapsular extension in three (7%). Overall average ablation volume was 13 cm 3 (± 6), 38% of the whole prostate. Treatment volume of 40% or more was defined as hemi-ablation, performed in 20 patients (45%). Eight patients (18%) had nerve sparing. In 39 patients (89%) the Foley was removed after 6 days (± 2.4) withmicturition resumption. Three patients (6%) failed a voiding trial and were re-catheterized for an average of 8 (± 1.5) additional days. Acute urinary retention after a period of normal voiding, on average 22 days post-HIFU, occurred in 3 (6%) patients and resolved 24 days after re-catheterization. Complications included 5 patients with hematuria (11%), 2 urinary infections (5%), and 2 pelvic pain (5%). At an average 4-month follow up, PSA dropped 78%. No significant difference was found between pre- and post-operative IPSS scores .No significant difference between pre- and post-operative SHIM scores. Oncologic outcomes will be evaluated with MRI and biopsy between 6- and 12-month follow-up. Conclusions: Preliminary data suggest that PCa treatment with HIFU-Focal One may preserve patient’s quality of life with an acceptable complications. However, cancer control is yet to be determined. Sexual Health Disparities in Appalachian Urologic Oncology Patients A. Battin West Virginia University, Morgantown, WV, USA Introduction: Erectile dysfunction (ED) affects up to 30 million men in the United States, with the Appalachian population experiencing the highest national rates of contributing factors of ED. Urological malignancy (UM) and management can also affect these factors and directly impact sexual health. Further investigation is necessary to elucidate the extent of ED in patients with UM and the prevalence of comorbidities in Appalachia. Materials & Methods: An anonymous, voluntary survey with prior informed consented was administered to all male patients at a university based urology clinic. The survey included the Sexual Health Inventory for Men (SHIM), diagnosis of prostate, bladder, and/or kidney cancer, comorbid ED medical conditions, and demographic information. Analysis was performed between patients with or without UM diagnosis using JMP.14.1.0 software. Mann- Whitney U tests were used to compare means for continuous variables and chi-squared tests were used for categorical variable comparison. Results: A total of 762 patients completed the survey, with 214 (28.1%) patients reporting a history of UM. The mean SHIM scores for patients with history of UM and without UM is 15.478 +/- 7.823 and 17.598 +/- 7.574, respectively. The lower SHIM score for patients with UM is statistically significant (p < 0.05). Other than hypertension, no statistical significant difference was found in the reported comorbidities between those with and without history of UM. Of the patients with UM history, only 2.8% self-reported current use of some form of treatment for ED, with 64% self-reported being interested in learning about treatment options for ED. Conclusions: The study reveals that patients with diagnosis of UM suffer from ED significantly more than patients without diagnosis of UM. Seven of the eight comorbid conditions for ED screened were not found to be statistically significant, indicating similiar prevalence of comorbid conditions between the two populations. The study indicates a need for increased screening and management of ED in patients with diagnosis of UM. 16 Poster Session 1: Diagnostic Imaging and Risk Stratification in Cancer MP1-07 MP1-06 A Simple Povidone-Iodine Gel Prep for Transrectal Ultrasound Prostate Needle Biopsy G. Fialk The Urology Group, Reston, VA, USA Introduction: Previous studies have strongly supported the use of pre-transrectal ultrasound prostate needle biopsy (TRPNB) bowel prep of povidone-iodine (topical, enema or suppository) to reduce post TRPNB infections. This study uses a commercially available 10% povidone-iodine gel at the time of prostate biopsy as a lubricant and topical antiseptic. This study primarily assessed the incidence of post procedural infections including hospitalization for treatment of sepsis. Materials & Methods: A 6 year, 3 month review from January 1, 2014 through March 31, 2020 of consecutive TRPNB procedures performed by 2 urologists in a community office and ambulatory surgery center (ASC) setting. A total of 727 procedures were performed. For the office procedure, patient’s prep included a bisacodyl enema, oral quinolone antibiotic 2 hours before the procedure as well as a standard periprostatic nerve block (PPNB). ASC patients had the same oral and mechanical prep, total intravenous anesthesia and cefazolin 1 gm IV pre procedure and no PPNB. In the left lateral decubitus position, patients had a DRE prostate using the 10% povidone-iodine gel to reassess the prostate and “paint” the anterior rectal wall. This was followed by a generous application of the 10%povidone-iodine gel to the transducer prior to anal insertion. A standard TRPNB was performed in the usual fashion securing 12-14 cores as appropriate. Results: A total of 727 consecutive TRPNB procedures were reviewed, 518 performed in the office and 209 in theASC. One patient required hospital admission for treatment of sepsis for an incidence of 0.138%. Three other patients were treated for suspected urinary tract infection with antibiotics as outpatients (0.413%). Conclusions: By using an inexpensive, commercially available 10% povidone- iodine gel at the time of TRPNB we had one patient with sepsis requiring hospitalization out of 727 procedures for an incidence of 0.138%. Three other patients had outpatient antibiotic treatment for UTI (0.413%).