Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts MP3-11 Should Men Presenting With Depression be Screened for Low Testosterone? M. Gray 1 ; J.Y. Congleton 1 ; J. Smith 2 ; R. Smith 1 1 University of Virginia- Department of Urology, Charlottesville, VA, USA; 2 University of Virginia- Department of Psychiatry, Charlottesville, VA, USA Introduction: The non-specific symptoms of low testosterone are largely indistinguishable from those of mood disorders treated in outpatient psychiatric settings. Current hypogonadism guidelines recommend assessing for decreased energy and lack of sexual interest; however, routine screening for low testosterone is not performed in psychiatric clinics. Many of the treatments for mood disorders can lower testosterone and cause sexual dysfunction. We sought to determine the prevalence of hypogonadism in men presenting for depressive symptoms to a tertiary-care outpatient psychiatry clinic. Materials &Methods: Adult men with a chief complaint of depressive symptoms were screened at an outpatient psychiatric clinic for study enrollment. Study participants completed the Patient Health Questionnaire-9 (PHQ-9) andAndrogen Deficiency in the Aging Male (ADAM) questionnaire in addition to a baseline medical history. Serum free and total testosterone levels were obtained. Descriptive statistics were calculated. Results: Twenty-two men were enrolled with a mean age of 44.2 +/- 17.3 years. The majority had moderately severe depression with a median PHQ-9 score of 17 (n = 21). Ninety-one percent were at risk for hypogonadismwith a medianADAM score of 7 (n = 11). Of the 16 men who completed laboratory testing, only 1 patient met criteria for hypogonadism (T < 300 ng/dL). The mean total testosterone was 488 ng/dL(range 86-832 ng/dL) andmean free testosterone was 91.7 ng/dL(range 15.7-203.9 ng/dL). No patient was started on testosterone therapy. Conclusions: Ninety-one percent of men presenting with depressive symptoms met criteria for hypogonadism based on ADAM questionnaire testing; however, only one patient had a serum testosterone < 300 ng/dL. This study reinforces current hypogonadism guidelines which recommend against using the ADAM questionnaire for screening. While underpowered, the prevalence of 6.25% in this study is noteworthy, as nearly 6 million men in the United States suffer from depression every year. Further study is warranted. AQualitative Study of the Transgender Patient Experience in the Urology Setting P. Chung 1 ; S. Spigner 2 ; V. Swaminathan 1 ; S. Teplitsky 1 ; R. Frasso 2 1 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; 2 Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA Introduction: Transgender patients face significant barriers to care which include fear of stigma, misgendering and not being understood. Urologists may be apprehensive to provide care to this patient population due to a lack of familiarity with their specific health needs. The aim of this study is to describe perspectives and experiences of transgender women (TGW) related to urology care-seeking. Materials &Methods: This HIPAA-compliant study was IRB approved. Through semi-structured interviews, researchers explored the perspectives and experiences of TGW seeking and obtaining urological care. Open-ended questions were designed to elicit responses rather than quantifiable data. Two research assistants independently coded all de-identified transcripts.Analysis of intercoder reliability confirmed near perfect agreement (k = 0.94). Codes pertaining to patient experiences of TGW were assessed and described in this study. Results: Interviews were conducted with 25 TGW. Participants reported an array of factors that informed and inhibited care-seeking, factors that framed individual urologic care experiences and their overall impression of the healthcare system’s ability to effectively and respectfully serve TGW. Specifically, participants reported that prior negative healthcare experiences dissuaded them from seeking care, this included feeling discriminated against and having a lack of trust in providers. Participants reported feeling a need and responsibility to “educate” providers on both their medical needs and psychosocial experiences. Participants were also unclear about what symptoms merited urological care and how best to identify “trans-friendly” urologists, including finding providers who are culturally competent and have appropriate medical knowledge. Other barriers to appropriate urological care included costs of care, fear of discrimination, misgendering and challenges related to gender and name discrepancies in medical and insurance records. Conclusions: Transgender patients are at an increased risk for care avoidance. TGW shared important insights into the urological care experience. Their perspectives highlight important opportunities to improve services and to inform training for urologists and their staff. MP3-12 Poster Session 3: Urologic Benign Diseases 1 Urologic Surgery During COVID-19: An Examination of Triage Guidance Documents B. Shinder; H. Patel; J. Sterling; A. Tabakin; I. Kim; T. Jang; E. Singer Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood JohnsonMedical School, New Brunswick, NJ, USA Introduction: The COVID-19 pandemic placed urologic surgeons in an unprecedented situation. Providers and healthcare systems were forced to rapidly create triage schemas in order to preserve resources and reduce potential viral transmission while continuing to care for patients. We reviewed US and international triage proposals from professional societies, peer-reviewed publications, and publicly available institutional guidelines to identify common themes and critical differences. Materials & Methods: A critical analysis of all proposals available as of 4/1/2020 was performed. Recommendations were dichotomized into oncology and non- oncology operations and implementation factors were examined. Results: Prior to the COVID-19 outbreak, no guidelines existed on urologic surgery triage. Eight proposals were reviewed, with considerable heterogeneity observed in their reporting of priority levels and recommendations. Specific urologic oncology cases were examined in six of these proposals. Only radical surgery for muscle- invasive urothelial carcinoma and ≥ cT3 kidney cancer was considered highest priority across all resources in which they were examined. High-risk prostate cancer was high priority in two guidelines and intermediate priority, or able to be delayed, in four. Testis cancer was commented on in four proposals, while only two evaluated adrenal and penile carcinomas. Two resources accounted for length of time patients had the disease and one offered alternate therapies to consider. Non- oncologic conditions were examined in four proposals. Obstructed kidneys in the setting of infection and testicular torsion were listed as emergent cases throughout. Conclusions: To date, there are varying levels of agreement on the optimal triaging of urologic cases. As the need to preserve resources grows, prioritizing only high priority surgical cases is paramount. In the oncologic setting, evidence-based approaches should be employed to decide which cases can be delayed without compromising survival outcomes. While these decisions will often be made on a case-by-case basis, further consensus guidelines are needed for the future. MP3-10 29