Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts MP5-02 Characteristics andOutcomes of Consultations for Urethral Catheter Placement M. Gray; K. Maciolek; E. Krebs; D. Rapp University of Virginia, Charlottesville, VA, USA Introduction: Assistance placing a urethral catheter or complications arising following catheter placement are common reasons for inpatient urologic consultation. There is limited published data to understand the incidence, characteristics, and outcomes of urethral catheter placements in the setting of urologic consultation. The present study represents a quality initiative to understand these characteristics in a tertiary care setting. Materials & Methods: We performed a retrospective review of prospectively collected data related to consults on adult patients for urethral catheter placement at a single tertiary care center. Clinical and patient characteristics were collected including catheter attempts prior to consultation, associated trauma, and the need for procedural or surgical intervention. Results: From January to December 2019, a total of 137 consults on 113 patients were performed. Themedian patient age was 67 years and 89%weremen. Urology placement of catheter was required in 122 (89%) consults, with the remaining consultations related to issues following catheter placement (e.g. hematuria). Of 137 consults, 112 (82%) had an attempted catheter placement prior to urologic consultation. In these cases, an average of 1.5 [0-5] catheters were attempted prior to consultation. Fifty-eight (42%) catheter placements were traumatic (presence of blood at meatus, known inflation of balloon in urethra, or false passage on cystoscopy). The development of hematuria and urinary tract infection was associated with 45 (33%) and 23 (17%) of consults. Twelve (9%), thirty-four (25%), and four (3%) consults required continuous bladder irrigation, cystoscopic- guided catheter placement, and suprapubic tube placement, respectively. Four (3%) consults required operative management of hematuria. Eighty-three (62%) consults were discharged with a catheter. Conclusions: Urologic consults related to urethral catheterization are common and often associatedwith significant relatedmorbidity. Further studies are needed to evaluate predictors and outcomes of traumatic urethral catheter placement and related cost. Zero Tolerance – Mitigating the Opioid Epidemic Among Minimally Invasive Urologic Patients L. Glick; D. Wong; T. Han; J.Y. Leong; M. Yi; J. Mark; M. Mann; E. Trabulsi; C. Lallas; T. Chandrasekar Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA Introduction: Opioids are routinely prescribed following minimally invasive surgery. Thus, reducing narcotics after MIS is a critical step towards mitigating the opioid epidemic. The goal of this study was to evaluate the impact of an “opt-in” non-narcotic post-operative pain regimen on post-operative narcotic utilization and patient-reported pain scores. Materials &Methods: An interventional trial was conducted at Thomas Jefferson University Hospital. Patients undergoing urologic MIS in June and July without a history of chronic opiate use were eligible. Patients in the pre-intervention (PrI) group received the established opiate-based pain protocol. Patients in the post- intervention (PoI) group received a new pain protocol prioritizing non-narcotic medications, an “opt-in” requirement for narcotic prescription, and patient education on pain expectations. Primary study measurements included amount of opioids received (in Morphine Equivalent Doses [MED]) and reported pain on Postoperative Day 1, discharge and follow-up. Results: Twenty-one patients participated in the PrI group; thirty in the PoI group. At discharge, 70% fewer patients were prescribed any opioids, and the amount prescribed was reduced by 95% (Table 1). Mean MED used following discharge also decreased by 76% (Table 1). Mean pain score at postoperative day 1, discharge and follow-up visit for PrI and PoI groups were 4.0, 3.6 and 1.5, and 4.5, 4.1 and 1.6, respectively. There was no significant difference in pain between groups. Subgroup analysis of the radical prostatectomy cohort showed similar reductions in MED and differences in pain. Conclusions: Standardized pain protocols with an “opt-in” requirement for prescription of opiates, emphasis on non-narcotic medications, and patient education, resulted in a significant decrease in opioid use. Simple frame-shifts in approach to pain management can yield significant gains in the fight against the opioid epidemic. MP5-04 Next Generation DNASequencingMay Detect Microorganisms More Promptly than Conventional Culture in Infected Urologic Prosthetics T. Hardacker; A. Das; P. Shenot; L. Gomella; P. Chung Thomas Jefferson University, Philadelphia, PA, USA Introduction: Next-generation DNA sequencing (NGS) is an emerging technol- ogy allowing evaluation of entire genomes and improved organism detection. Preliminary data suggest optimal NGS utilization may be in patients undergoing device removal for infection rather than malfunction. We hypothesize that NGS may provide a prompter evaluation of microorganisms compared to conventional culture in patients with device infection. Materials & Methods: A retrospective review of patients who underwent device removal for infection with or without device replacement from June 2018 to September 2019 was performed. Infected inflatable penile prosthesis (IPP) and artificial urinary sphincters (AUS) were swabbed on removal and sent for NGS (MicroGen Diagnostics, Lubbock, TX, USA) and quantitative PCR using extracted DNA. PCR functioned as a rapid screening test, identifying 25 common bacteria and eight resistance genes. NGS compared sequenced DNA against a database of 25,000 known microbes. Results: Nine patients underwent 10 device explants (6 IPP, 4 AUS) for infection. Infection was defined as urethral erosion (n = 6), gross infection (n = 3) or exposed tubing (n = 1). Rapid sequence PCR, NGS and conventional culture were congru- ent only in the 3 patients with gross infection (Pseudomonas, E. coli and Proteus mirabilis). NGS identified additional bacteria that were not previously seen on conventional culture for 4 other devices. Rapid sequence PCR was processed at an average of 2.5 hours. NGS resulted at a mean of 5.0 days compared to 6.9 days for conventional culture (p = 0.07). Conclusions: PCR and NGS detected microorganisms more promptly than conventional culture and may be most applicable in patients with gross device infection. Early targeted antimicrobial therapy may help to increase salvage rates and decrease patient morbidity. PCR and NGS may also play a key role in further characterizing device microbiome. Further evaluation of PCR and NGS in patients with device infection is warranted. MP5-01 Poster Session 5: Urologic Benign Diseases 2 35