Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts MP2-07 Mixing it Up: Are Patients With Mixed Urine Cultures at Higher Risk of Postoperative Sepsis After Ureteroscopy? P. Chialastri 1 ; T. Mueller 1,2 1 Rowan University & Jefferson University Hospitals, Department of Urology, Stratford, NJ, USA; 2 New Jersey Urology, Sewell, NJ, USA Introduction: Several studies have been performed to determine risk factors for sepsis after ureteroscopy. These include female gender, prolonged stent time > 1 month, and patients with sepsis at the time of initial stenting.Achieving a negative urine culture prior to ureteroscopy can sometimes be difficult. Often the specimen is reported as “probable contamination”, “mixed skin flora”, and “mixed gram positive and gram negative”. This study aims to determine if preoperative mixed urine cultures, have a higher rate of postoperative sepsis than negative cultures for uncomplicated outpatient ureteroscopy with laser lithotripsy. Materials & Methods: Retrospective multi-institutional chart review of all procedure codes including ureteroscopy with lithotripsy from April 2018 to December 2019. T-test was used to compare variables between mixed and negative urine cultures. Exclusion criteria included grossly positive urine culture, preoperative antibiotics, inpatients, and indwelling nephrostomy tube placement. Results: 143 patients were included in the study. Overall sepsis rate was 1.63% with a negative culture and 5%with a mixed which was not statistically significant. Statistically significantly longer indwelling stent time for septic patients (17 vs. 51 days).Stonesizewasnotsignificantlydifferentwith0.82cmfornon-septicvs.0.75cm for sepsis group. Composition was significantly different only in carbonate apatite between mixed and negative culture groups. Conclusions: There is no statistically significant difference in postoperative sepsis rates between preoperative mixed and negative urine cultures for ureteroscopy with laser lithotripsy. Increased indwelling stent time correlated with increased sepsis risk. There was a statistically significant difference in carbonate apatite in mixed urine cultures compared to negative cultures which is of unclear significance. MP2-06 Preventing and Identifying Ureteral Injury Through the Use of Prophylactic Ureteral Catheterization During Colorectal Surgery J. Li; J. Southern; B. Fulmer; A. Park Geisinger Health System, Danville, PA, USA Introduction: Iatrogenic ureteral injury is a rare complication of abdominal and pelvic surgery reportedly occurring in 0.5% - 10%of non-urologic cases. Prophylactic ureteral catheterization (PUC) has been suggested to increase intraoperative recognition of ureteral injury, but not their prevention. Here we present what is to our knowledge the largest published cohort of patients to receive PUC for colorectal surgery (CRS). Our primary outcome was to determine if PUC reduced the risk of ureteral injury. Secondary outcomes included whether or not PUC reduced the risk of an undetected intraoperative ureteral injury and determining which patients may benefit most from PUC. Materials & Methods: A retrospective review of 1,328 adult patients who underwent CRS between January 2007 and March 2019 within Geisinger Health System was performed. Patients were divided into those whom received PUC (n = 431) and those whom did not (n = 897). CRS cases were identified using the appropriate CPT codes. Primary and secondary outcomes were measured using multivariate statistical analyses controlled for age, sex, body mass index and indication for surgery as appropriate. Results: In the PUC group the rate of ureteral injury was 1/431 (0.2%) versus 16/897 (1.8%) in the non-PUC group (p = 0.02). In the PUC group the rate of intraoperative recognition of ureteral injury was 1/1 (100%) versus 13/16 (81%) in the non-PUC group. Conclusions: The data derived from this largest published cohort reveals that PUC prior to colorectal surgery significantly reduced the incidence of iatrogenic ureteral injury. Furthermore, this data shows that 19% of ureteral injuries in patients undergoing CRS without PUC were not recognized intraoperatively and suggests that PUC may reduce the risk of an undetected intraoperative ureteral injury in patients undergoing CRS. Characteristics found to be associated with ureteral injury included surgical indications of colon cancer or diverticulitis and patients undergoing sigmoidectomy or low anterior resection. Utility of Second Opinion Pathologic Review in the Surgical Treatment of Prostate Cancer: a Quality Improvement Analysis at aMajor Tertiary Care Center B. Chen 1 ; R. Talwar 1 ; L. Schwartz 1 ; R. Terlecki 2 ; T. Guzzo 1 ; R. Kovell 1 1 University of Pennsylvania, Philadelphia, PA, USA; 2 Wake Forest Baptist Health, Winston-Salem, NC, USA Introduction: Inter-institutional re-review of prostate needle biopsy (PNBx) material is required at our institution before surgery, but is resource-intensive and often cumbersome. In patients considering prostatectomy, these results may not translate to changes in clinical management. We aim to determine the utility of PNBx re-review. Materials & Methods: From 2017-2019, 388 prostate specimens from outside institutions were re-reviewed at our center. Clinicopathologic characteristics from initial and secondary review were analyzed. Major treatment change was determined by re-diagnosis of non-malignant tissue or change in candidacy for active surveillance (AS) versus definitive treatment. Thus, the following were considered treatment changes: downgrading to non-malignant tissue, or ISUP Grade Group (GG) any to GG1, and upgrading GG1 to GG2 or greater.Any change between GG2 to GG5 were not considered major, as surgery would proceed. Results: Overall, 10% (39/388) of patients had potential for major treatment changes based on secondary review. Initial pathologic GG (iGG), number of positive cores, and highest core percent were associated and predictive of with major treatment changes (Table 1). Upon both univariable and multivariable regression analysis, these were also predictive of treatment change (all p < 0.05). Table 2 demonstrates the change in pathologic grading by iGG; no patients with iGG > 2 had a clinically relevant change in management. Conclusions: Second reviewmay be helpful in patients with GG1 and few patients with GG2 prostate cancer, i.e. those considering AS, but may be unnecessary in iGG3+ patients planning to undergo prostatectomy. This may allow for redirection of hospital resources without compromising quality of care. MP2-05 21 Poster Session 2: Urologic Best Practices