Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MP1-14 Litigation Patterns in Oncologic Nephrectomies A. Herbert 1 ; M.A. Hadavand 1 ; D. Ambinder 1 ; M.M. Siddiqui 2 1 University of Maryland School of Medicine, Baltimore, MD, USA; 2 University of Maryland Medical Center, Baltimore, MD, USA Introduction: The litigious environment encompassing the medical-legal domain is an increasing concern for surgical fields, with urology being no exception. The objective of our study was to systematically review, evaluate, and summarize the factors associated with oncologic nephrectomy litigation to determine factors contributing to verdicts or settlements. Materials &Methods: Publicly available verdict reports were retrieved using the Westlaw® legal database (Reuters). Cases were identified using the search term “nephrectomy” with dates ranging from January 1, 1990 to July 01, 2019. Each case was evaluated by two independent reviewers for defendant specialty, alleged breach in treatment, resulting complications, verdict outcomes, and indemnity payment. Complications were determined to be preoperative, perioperative and postoperative. Data was analyzed using SPSS software to produce the descriptive statistics. Results: After accounting for duplicates and irrelevant cases, a total of 101 cases were analyzedwith over three-fourths being radical nephrectomies (78%). Themost common claim was preoperative negligence (48%); however, negligence in peri- operative care received the highest average monetary payment of $5,493,151 (Table 1). 41% of cases were perioperative with the majority being attributed to vascular injury (46%). The type of perioperative negligence claims and its’ average payment were found to be statistically significant (p = 0.042). Overall, 57% of plaintiff claims were denied, while 28% were awarded. Conclusions: Nephrectomies can leave urologists vulnerable to litigation risks associated with negligence involving patient care. Our data show that while the highest number of cases were due to preoperative negligence, perioperative negligence accounts for the highest settlement awards. Providers should be aware of factors contributing to oncologic nephrectomy malpractice to minimize surgical complications and improve patient outcomes. Clinical Characteristics and Germline Genetic Testing Outcomes in a Recently Recommended Prostate Cancer Population M. Gay; S. Kukkala; M. Williams Eastern Virginia Medical School, Virginia Beach, VA, USA Introduction: Emerging research suggests that men with prostate cancer (PCa) have germline mutation rates of 15% regardless of stage and 12% with metastatic PCa. Genetic mutations bestow variable risk for prostate cancer aggressiveness and targeted therapy may be used in patients identified to have pathogenic variants (PVs) in certain genes. Updated NCCN guidelines recommend germline genetic testing (GT) in men with high or very high risk, regional and metastatic PCa. This study evaluates GT results and clinical characteristics identified in this population. Materials & Methods: A retrospective chart review was conducted for patients who had a diagnosis of high or very high risk, regional and metastatic PCa who received multi-gene GT. Clinical characteristics and germline GT were analyzed. Results: Between January 1, 2019 and March 1, 2020, 42 men with prostate cancer had evaluable genetic testing results. Overall, 3 pathological variants were identified in 3 men (7.1%). PVs were distributed among BRCA2 (n = 1, 2.3%) and HOXB13 (n = 2, 4.8%). Menwith PVs showed no difference in grade group andwere distributed across multiple NCCN risk groups. Family history of prostate cancer was not statistically associated with genetic test results (PV: 67%, no PV: 39.0% p = 0.55). 13 variants of uncertain significance (VUS) were identified in 12 patients (31.0%). VUS were distributed among MSH6 (n = 3, 7.1%), MSHS2 (n = 2, 4.7%), PSMS2 (n = 2, 4.7%), ATM (n = 2, 4.7%), BRCA1 (n = 1, 2.4%), BRCA2 (n = 1 , 2.4%), CHEK2 (n = 1, 2.4%), and EPCAM (n = 1 , 2.4%). Conclusions: Utilization of GT in this community setting identified a prevalence of PVs in BRCA2 and HOXB13 comparable to previous research. Further research is needed to determine howVUS affect prostate cancer aggressiveness. Inclusion of GT in clinical management of these patients may help identify PV and potentially lead to targeted therapy. MP1-13 18 Poster Session 1: Diagnostic Imaging and Risk Stratification in Cancer