Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Cost-Analysis of Mini-Percutaneous Nephrolithotomy (PCNL) and Standard Tract PCNLfor Stone BurdenGreater/Less Than 20mm in anAmbulatory Setting J. Chong 1 ; B. Magnan 2 ; M. Dunne 2 ; J. Davalos 1 1 Chesapeake Urology, Hanover, MD, USA; 2 University of Maryland School of Medicine, Baltimore, MD, USA Introduction: Mini-Percutaneous Nephrolithotomy (PCNL) (MIP, Karl Storz, Tuttlingen, Germany) has become a viable option for stones between 10-20 mm and has also demonstrated efficacy in stones > 20 mm. MIP has been touted to have significant cost savings in direct-items costs due to reusable dilator and sheath sets. The cost analysis of MIP in comparison to standard tract PCNL (sPCNL) has not previously been elucidated for various stone sizes. Materials &Methods: All PCNLprocedures (33 MIP and 61 sPCNL) performed at a single ambulatory surgery center fromApril 2019-September 2019 were reviewed. All MIP tracts were MIP-medium (16.5/17.5 French). sPCNL ranged from 24/28- 30/34 French. Patient and stone characteristics such as age, sex, BMI, skin-to-stone distance, Hounsfield Units (HU) and operative characteristics such as operating room (OR) time, fluoroscopy time, intracorporeal (IC) time and total treatment (TT) time were compared between groups. Cost in US Dollars (USD) were separated into two categories, < 20 mm and > 20 mm, based on the surgical CPT codes 50080 vs. 50081 and compared between the MIP and sPCNL groups. Results: Patients having MIP tended to be younger (50.4 vs. 59.1, p = 0.0045) and have lower overall stone burden (17.73 mm vs. 33.38 mm) compared to sPCNL procedures. There were no differences between groups in regard to operative time characteristics. The direct-items cost to patient was greater in sPCNL compared to MIP regardless of whether the stone treated was < 20 mm ($1805.20 vs. $1382.42, p = 0.0087) or > 20 mm ($1774.22 vs. $1293.31, p < 0.0001). Conclusions: The reusable MIP-medium single dilator and sheath combination has significant direct-items cost savings to the patient compared to patients having sPCNL. The cost savings remain even if stone burden is greater than 20 mm. Durable Efficacy of UroLIFT™ J. Orzel; N. Shaw; C. Pellegrino; G. Bandi MedStar Georgetown University Hospital Department of Urology, Washington, DC, USA Introduction: UroLIFT is a minimally invasive option for the management of BPH that can be performed in the office setting. We describe our single-surgeon experience with a standardized UroLIFT technique. We hypothesize UroLIFT will reduce or eliminate use of BPHmedications at least one year following procedure. Materials & Methods: We retrospectively reviewed data from an IRB-approved database of patients who underwent UroLIFT by a single surgeon from 2015-2019. Patients with a minimum of 12-month follow-up who had complete International Prostate Symptom Score (IPSS), Post Void Residual (PVR), and medication use data were included. Results: A total of 53 patients met all inclusion criteria. The average age was 65 years old, and the average gland size was 39.4 g (table 1). Average IPSS decreased significantly from 19.36 to 9.88 at 3 months and 12 at one year (table 2). Overall PVR was similar across all time points. Patients tolerated the procedure well with no adverse events captured (Grade II or higher), and only three patients required post- operative catheter for failed void trail. Medication use in all categories decreased with average per patient medication decreasing from 1.5 to 0.5 at 3 months with further decrease to 0.40 at 1 year. Conclusions: UroLIFT remains an effective treatment with minimal risk of complications. UroLIFT results in a significant reduction in IPSS and decreased need for medications. Interestingly, there was no change in average PVR and some rebound of IPSS at one year, but patients achieved excellent improvement in symptoms at one year following UroLIFT. MP2-11 MP2-10 23 Poster Session 2: Urologic Best Practices