Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MP3-03 Does Targeted Education (TE) on The American Urological Association (AUA) Cryptorchidism Guidelines Have an Impact on The Referral Pattern in a Rural State? O. AL-Omar; T. Trump; D. Mcclelland; C. Morley West Virginia University (WVU), Morgantown, WV, USA Introduction: There are known discrepancies between the observed referral patterns/workupandthe2014AUAguidelinerecommendationsoncryptorchidism, which may be attributed to the lack of familiarity by the referring physicians with these guidelines. The purpose of this study is to assess the impact of Targeted Education (TE) on the AUA guidelines to referring providers in a rural state, in particular the time of referring/surgery and US imaging. Materials &Methods: TE started onDecember 2014 and refers to series of 8 lectures that were presented over a one-year period to pediatricians, family medicine practitioners, pediatric surgeons and general urologists at major tertiary centers, community hospitals and major private groups in the state. We retrospectively reviewed all patients who underwent surgical exploration for cryptorchidism between December 2012 and December 2016 at West Virginia University (WVU), which is the biggest health system and the only pediatric urology center in the state. Patients with cryptorchidism and complex urologic issues (VUR, hypospadias, etc.) were excluded. 268 patients met the inclusion criteria. Patients were divided into 2 groups, group 1 (100 pts.) represents the pre TE period (prior to December 2014) and group 2 (168 pts.) represents the post TE period (after December 2014). Results: 39% of patients underwent surgical exploration within the recommended period of 6-18 months of age (corrected for gestational age) in group 1 compared to 37% in group 2. No statistically significance was found between the two groups regarding age at the time of referral, age at the time of surgery, time between referral and surgical exploration, and scrotal Ultrasound imaging. Conclusions: In rural states, such as WV, Targeted Education did not change the adherence to the best practice on the management of cryptorchidism. This can be attributed to factors other than familiarity with guidelines by referring providers, like lack of access or others. VasectomyOutcomes in a Veteran Population at a Single Veterans AffairsMedical Center Over a 5 Year Time Period W. Visser 1 ; S. Krzastek 1,2 1 Virginia Commonwealth University, Richmond, VA, USA; 2 Hunter Holmes McGuire VAMC, Richmond, VA, USA Introduction: Over 500,000 vasectomies are performed yearlywith low failure rates (0.05%), but compliance with post-vasectomy semen analysis (PVSA) is poor. The 2012 AUA guideline outlines vasectomy technique and recommends that patients obtain a PVSA at 8-16 weeks. As part of a quality assurance assessment, we aimed to evaluate vasectomy outcomes at our institution. Materials &Methods: Aretrospective chart reviewwas performed of vasectomies conducted at the Hunter Holmes McGuire VAin Richmond, VA, between 2015 and 2020. Compliance with PVSA, time from surgery to first PVSA, and vasectomy failure rates were reviewed. Results: 201 vasectomies were performed. 40% of patients never underwent PVSA (n = 80), though 22.7% of these men (n = 18) were seen for a post-procedure visit. Mean time to first PVSA was 3 months (± 2 months, range 1-14 months). Of the 120 patients who underwent PVSA, sperm were seen in 33.3% (n = 40). PVSAwas performed prior to 8 weeks in 50% of cases with positive results (n = 20). 70% of patients with sperm seen on initial PVSA underwent repeat PVSA (n = 28), with 54% of these patients showing persistent sperm on repeat testing (n = 15). Conclusions: Patients showed poor compliance with PVSA, consistent with reported rates. Importantly, our results highlight challenges faced at our institution. Semen analyses performed at our institution are reported as sperm “seen” or “not seen,” making it impossible to diagnose true vasectomy failures. Additional work needs to be done to improve patient compliance with PVSA, provider compliance with AUA guidelines, and follow up with patients with a positive PVSA. MP3-01 26 Poster Session 3: Urologic Benign Diseases 1 MP3-02 Risky Business: Penile Prosthesis in the High Risk Population C. Goldman 1 ; J. Orzel 1 ; K. Venkatesan 2 1 MedStar Georgetown University Hospital Department of Urology, Washington, DC, USA; 2 MedStar Washington Hospital Center Department of Urology, Washington, DC, USA Introduction: Device infection is a devastating complication of penile prosthesis. Some, including diabetics and immunocompromised patients, may be at higher risk for infection. However, the data on this patient population is unclear and in places, contradictory. We review our experience in high-risk patients at a major urban tertiary-care center. Materials & Methods: We retrospectively reviewed patients undergoing penile prosthesis insertion at MedStar Washington Hospital Center. We recorded peri- operative HbA1c, mean and maximum blood glucose (BG), and patient outcomes including superficial and device infections. Results: From December 2012 to November 2019, 152 prostheses were implanted in 139 patients. 35 surgeries performed were revision surgeries using a mini-salvage washout technique. 61 patientswere diabetic, 6 solid organ transplant, 2HIV, 1 ESRD. Meanpatientagewas61years(33-76).Meanfollowupwas12.6months.Perioperative HbA1c, mean andmax BGvalueswere higher among diabetics (p < 0.01). No adverse events were significantly greater among diabetics or immunosuppressed patients, or associated with perioperative BG control (Tables 1 & 2). Re-do prosthesis insertions did not have significantly higher superficial (13.5% vs. 11.4% p = 0.74) or device infections (3.8% vs. 11.4% p = 0.099) compared to primary implantations. Conclusions: Our results suggest that diabetic and immunocompromised patients do not appear at higher risk for adverse outcomes in penile prosthesis implantation. Immediate perioperative hyperglycemia does not seem to portend a higher risk of complication.