Abstracts from the Mid-Atlantic Section of the AUA 2020
© The Canadian Journal of Urology TM : International Supplement, October 2020 MP2-02 Pulling the Foley: Can the Prostatic Urethral Lift be used in Men with Catheter Dependent Urinary Retention? K. Thalody; G. McMahon; S. Panuganti; K. Vattikonda; T. Mueller Rowan University, Stratford, NJ, USA Introduction: The purpose of our study was to evaluate the efficacy of Prostatic Urethral Lift (PUL) as a surgical treatment option in men with catheter dependent urinary retention (UR). Specifically, we analyzed International Prostatic Symptom Scores (IPPS), Quality of Life (QOL) scores, post void residual (PVR) measurements, and success defined by catheter free rates. Materials & Methods: This was a retrospective chart review of 30 patients with catheter dependent UR who underwent in office PUL between 2016-2019 by one single surgeon. Of note, men were not excluded if they had prior prostatic surgical intervention. IPSS, QOL, and PVRs were recorded pre-operatively and at subsequent post-operative office visits. Catheter free rates were observed. A paired-sample T-test was used to compare pre-and post-treatment values. Results: Descriptive statistics included: the average prostate volume was 52.7g, the mean number of implants used for each PUL was 5.8, and the average time from procedure to catheter removal was 2.9 days. The catheter free rate significantly improved following intervention. 25 (83.3%) men remained catheter free at a mean follow up time of 7.1 6.5 months. 5 out of 30 (16.7%) men required a catheter to be replaced at a mean follow up time of 2.8 3.9 months. IPSS, QOL, and PVR values improved from 14.8 to 5.8, 3.0 to 1.2, and 744.1 to 332.3, respectively.All three values demonstrated statistical significance. Conclusions: Our study demonstrates significant improvement in catheter free rate, IPSS, QOL, and PVR suggesting PUL is an effective treatment option. Further research is necessary to identify the durability of PUL in men with UR. MP2-03 Early Recovery and Patient Experience After Minimally Invasive Surgical Treatment (MIST) With Prostatic Urethral Lift or Steam Injection R. Tutrone 1 ; W. Schiff 2 1 Chesapeake Urology Research Associates, Towson, MD, USA; 2 Urology Associates of Central California, Fresno, CA, USA Introduction: As an alternative to medical therapy and invasive surgery, MISTs should offer not only effective and durable symptom relief, but also rapid recovery with low morbidity. Here we elucidate the early patient experience following mechanical disobstruction with UroLift prostatic urethral lift (PUL) or tissue ablation with steam injection (Rezum). Materials &Methods: 38 non-urinary retention subjects (from2 US sites) completed a patient experience questionnairewithin 2months after treatment with PUL(n = 22) or Rezum (n = 16). Questions focused on recovery, satisfaction, postoperative catheterization, daily interference, BPH medication and symptom response. Outcomes were compared between arms. Results: Subjects completed the questionnaire a mean 32 d post-treatment (Table 1) and were 69 ± 8.6 y.o. with prostates 56 ± 30.0 g. No differences in age or prostate volume were found between groups. After treatment, absolute IPSS and QoL scores were significantly better for PUL(IPSS 8.9 ± 5.1) compared to Rezum (IPSS 15.6 ± 9.2; p = 0.002). 87% of Rezum subjects were catheterized following treatment (vs. 57% for PUL) for a mean duration of 6.0d ± 3.3 Rezum vs. 2.2d ± 2.3 PUL (p =< 0.001). Rates of BPHmedication use following treatment was significantly higher for Rezum subjects (87% vs. 34% PUL). 97% of PUL subjects (vs. 70% for Rezum) were satisfied with their treatment. 42% of Rezum subjects (vs. 8% for PUL) reported interference with entertainment-related activities and 40% (vs. 12% for PUL) reported interference with community-related activities. Conclusions: Preliminary data suggests PULprovides a superior patient experience with higher patient satisfaction compared to steam injection. Post-Operative Recovery After Opioid-Free Ureteroscopy for Nephrolithiasis: Assessing Pain Intensity and Interference R. Talwar;A. Shah; C. Sperling; R. Dobbs; G. Lin; H. Stambiako; G. Tasian; J. Ziemba University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA Introduction: Recovery following ureteroscopy is not well described, particularly when opioid-free, making patient counseling a challenge. Pain is the most common post-operative complaint. Therefore, we prospectively assessed patient-reported post-operative pain in patients undergoing opioid-free ureteroscopy. Materials &Methods: Adults undergoing ureteroscopy for renal/ureteral stones were eligible for inclusion (11/2018-1/2020). Exclusion criteria included vulnerable populations, inability to speak English or to receive email. All received a standing non-opioid postoperative pain regimen. Patients prospectively completed PROMIS- Pain Intensity and Interference instruments pre-op on POD 0 and via email on POD 1, 7 and 14. Scores are reported as T-scores (normalized to US pop., mean = 50) with a change of 5 (0.5 SD) considered clinically significant. Regression modeling was performed to assess demographic and operative characteristics. Results: 126 patients enrolled at POD 0 (POD 1 = 74, POD 7 = 61, POD 14 = 47). Compared to US means, intensity and interference were clinically and statistically significantlydifferentatallpost-optimecomparisons(Wilcoxonranktest;allp<0.001) exceptintensityatPOD7andinterferenceatPOD14.Forbothintensityandinterference, therewasasignificantdifferenceateachtimecomparison(repeatedmeasuresANOVA; allp<0.05)(Figure1).Onunadjustedregressionanalysis,increasingagewaspredictive of lower intensity(CI:-0.31–-0.04;p=0.012)and interference(CI:-0.36–-0.06;p=0.01) at POD1; post-op stent was predictive of higher intensity (CI: 0.68—10.81; p=0.03) and interference (CI: 0.61—12.96; p=0.03) at POD 7. On multivariable regression, only age remained significant at POD 1 (CI: -0.46 – -0.01; p = 0.03). Conclusions: Pain intensity and interference are elevated immediately, but intensity returns to normal after POD 1, while interference is persistently elevated until POD 14. Age and ureteral stent influence both pain intensity and interference. MP2-01 20 Poster Session 2: Urologic Best Practices
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