Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MP2-09 Factors Associated with Urinary Tract Infection and Urosepsis after Renal Transplant: A Single Center Experience M. Waguespack 1 ; M. Rice 1 ; R. Malik 2 ; W. Xie 2 ; T. Al-Qaoud 3 1 University of Maryland School of Medicine, Baltimore, MD, USA; 2 University of Maryland Medical Center, Baltimore, MD, USA; 3 University of Wisconsin, Madison, WI, USA Introduction: In renal transplant patients, urinary tract infection (UTI) and urosepsis are common complications that cause significant morbidity andmortality. While antibiotic prophylaxis and immunosuppression adjustment have reduced the incidence of UTI after renal transplant, the complication rate remains high. Our objective is to evaluate factors associatedwith UTI and urosepsis in renal transplant patients to identify patients at risk. Materials &Methods: Aretrospective chart reviewwas conducted examining 651 consecutive patients undergoing renal transplant between 2016 and 2019 at a tertiary care academic center. Patient demographics, medical history, surgical history, type and time on dialysis, urinary status collected. Primary outcomes were the occurrence of UTI and of urosepsis that required hospitalization post-transplant. Variables were compared using Pearson’s chi-squared test and the duration of dialysis was evaluated using a two-sample t-test in Stata. Results: Of the 651 patients undergoing renal transplant, 84 (13%) developed a UTI within 1 year of transplant. Compared to patients who did not have a UTI, those who developed a UTI post-transplant were more likely to have Diabetes Mellitus (Type 1 or 2) (56% vs. 44%, p = 0.033) and anuria (< 100 mL of urine/day, 37% vs. 26%, p = 0.039) prior to their transplant. A similar trend was seen in patients who had to be hospitalized for urosepsis. They tended to be anuric (38% vs. 27%, p = 0.065) and were on dialysis longer (1599 vs. 1244 days, p = 0.0555) than patients who did not have to be hospitalized for urosepsis (Table 1). Conclusions: UTI and urosepsis develop after renal transplantation in a small subset of patients. These factors may help identify patients that may require adjustment in their immunosuppression regimen and antibiotic prophylaxis. Outcomes of Adjunct Bipolar Cautery During Holmium Laser Enucleation of the Prostate (HoLEP) N. Shaw 1 ; H. Lee 2 ; J. Orzel 2 ; G. Bandi 1 1 Georgetown Department of Urology, Washington, DC, USA; 2 Georgetown University School of Medicine, Washington, DC, USA Introduction: Holmium laser enucleation of the prostate (HoLEP) remains an excellent surgical option for BPH management. In our experience, hemostasis prior to morcellation is a crucial step for efficient and safe completion, particularly for challenging cases. We sought to examine our experience with bipolar cautery following enucleation on operative and peri-operative outcomes. Materials &Methods: We retrospectively reviewed an IRB-approved database of patients who underwent HoLEP by a single surgeon from 2015-2019. 213 patients were identified. The first 50 cases were excluded to account for learning curve. Patients with complete operative and peri-operative outcomes were included for analysis and grouped into those that did and did not receive intra-operative bipolar cautery. Primary outcomes were operative times, complications (including patient phone calls), and patient report symptoms. Results: Atotal of 61 patients met inclusion criteria. Nineteen patients had bipolar used prior to morcellation and 42 did not. The average age and percentage of tissue resected were comparable between the two groups (table 1). The group where bipolar was used had a larger average gland size (141 g vs. 105 g) and longer operative times. Patients in both groups had similar improvements in IPSS and complications. The bipolar group had lower rates of post-op phone calls, fewer catheter days, and shorter length of stay. Conclusions: Bipolar cautery led to significant improvement in intra-operative and post-operative outcome measures. There was a significant reduction in overall operative and laser time when adjusted for size. Additionally, these patients were more likely to leave the hospital on the first post-operative day without the catheter, and less likely to have post-operative concerns at home. Bipolar cautery in select HoLEP patients can save time and add clinical benefit. MP2-08 Poster Session 2: Urologic Best Practices 22 Table 1: Factors Associated with UTI and Urosepsis after Renal Transplant Total n=651 No Postoperative UTI n=567 Occurrence of Postoperative UTI n=84 p- value NoPostoperative Urosepsis Hospitalization n=599 Occurrence of Postoperative Urosepsis Hospitalization n=52 p-value n (%) n (%) n (%) n (%) n (%) PastMedicalHistory DiabetesMellitus (DM) 294 (45) 247 (44) 47 (56) 0.033 267 (45) 27 (52) 0.307 DMwith end-organ complications 112 (17) 98 (17) 14 (17) 0.919 104 (17) 8 (15) 0.895 BenignProstatic Hyperplasia 30 (5) 23 (4) 7 (8) 0.081 27 (5) 3 (6) 0.677 ProstateCancer 27 (4) 21 (4) 6 (7) 0.14 23 (4) 4 (8) 0.181 ObstructiveSleep Apnea 69 (11) 61 (11) 8 (10) 0.732 66 (11) 3 (6) 0.238 KidneyStones 58 (9) 53 (9) 5 (6) 0.308 57 (10) 1 (2) 0.065 RecurrentUTI 81 (12) 68 (12) 13 (15) 0.367 72 (12) 9 (17) 0.268 PastSurgicalHistory Hysterectomy 55 (8) 47 (8) 8 (10) 0.704 51 (9) 4 (8) 0.838 SpinalSurgery 31 (5) 25 (4) 6 (7) 0.272 28 (5) 3 (6) 0.722 ProstateSurgery 19 (3) 15 (3) 4 (5) 0.282 17 (3) 2 (4) 0.679 OtherUrologic Surgery 99 (15) 81 (14) 18 (21) 0.089 88 (15) 11 (210 0.213 PriorRenal Transplant 68 (10) 62 (11) 6(7) 0.289 63 (11) 5 (10) 0.838 ESRD-SpecificFactors Oliguria 352 (54 302 (53) 50(60) 0.283 319 (53) 33 (63) 0.157 Anuria 179 (28) 148 (26) 31 (37) 0.039 159 (27) 20 (38) 0.065 Duration ofDialysis NoDialysis 96 (15) 88 (16) 8 (10) 0.374 91 (15) 5 (10) 0.72 Dialysis<1 year 100 (15) 89 (16) 11 (13) 92 (15) 8 (15) Dialysis 1-5 years 268 (41) 228 (40) 40 (48) 246 (41) 22 (42) Dialysis>5 years 187 (29) 162 (29) 25 (30) 170 (28) 17 (33) Type andTime onDialysis History ofPeritoneal Dialysis 110 (17) 92 (16) 18 (21) 0.235 97 (16) 13 (25) 0.104 History of Hemodialysis 456 (70) 395 (70) 61 (72) 0.581 420 (70) 36 (69) 0.894 Never onDialysis 96 (15) 88 (16) 8 (10) 0.148 91 (15) 5 (10) 0.277 MeanDuration Dialysis (days) 1330 1257 1384 0.4112 1243 1612 0.0555