Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MP5-05 MP5-08 Assessing Readability of Patient Education Materials on Bladder Cancer in the Urologic Patient Population L. Powell VCU School of Medicine, Richmond, VA, USA Introduction: Understanding of health-related materials, termed health literacy, affects decision makings and outcomes in the treatment of bladder cancer. The National Institutes of Health recommend writing education materials at a sixth- seventh grade reading level. 1 The goal of this study is to assess readability of bladder cancer materials available online. Materials &Methods: Materials on bladder cancer were collected from theAUA’s Urology Care Foundation and compared to top 10 websites ranked by search engine results. Resources were assessed for readability using validated readability assessment scales: Coleman-Liau Index, SMOG Readability Formula, Gunning Fog Index, and Flesch-Kincaid Grade Level. Results: The mean readability scores of resources on the AUA website include a Coleman-Liau Index of 9.37 (standard deviation [SD] 0.69, 9th grade), SMOG Readability of 7.57 (SD 0.49, 7th-8th grade), Gunning Fog Index of 8.875 (SD 1.09, 8th-9th grade), and Flesch-Kincaid of 8.05 (SD 0.71, 8th grade). The average readability of AUA by the four assessment tools was 8.46 (8th-9th grade reading level). For the top 10 websites, scores included a Coleman-Liau of 11.7 (SD 1.61, 11-12th grade), SMOG Readability of 10.16 (SD 1.71, 10th grade), Gunning Fox Index of 13.51 (SD 2.39, 13-14th grade), and Flesch-Kincaid of 11.81 (SD 2.11, 11-12th grade). The average readability of these websites by the four assessment tools was 11.795 (11-12th grade reading level). Conclusions: Most health information provided by the AUA on bladder cancer is written at a reading ability that aligns with most US adults, with top websites for search engine results exceeding the average reading level by several grade levels. By focusing on health literacy and improving patient understanding, urologists may contribute lowering barriers to health literacy, improving health care expenditure and perioperative complications. References 1 . Colaco M et al. “Readability Assessment of Online Urology Patient Education Materials. J Urol 2013;189(3):1048-1052. MP5-07 MP5-09 Use of sipIT Intervention to Reduce Common Perceived Barriers to Increasing Fluid Intake Among Adult Patients with Kidney Stones N. Streeper 1 ; D. Brunke-Reese 2 ; E. Thomaz 3 ; A. West 2 ; D. Conroy 2 1 Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA; 2 Penn State University, University Park, PA, USA; 3 The University of Texas at Austin, Austin, TX, USA Introduction: Compliance with increasing fluid intake to produce at least 2.5L of urine daily for stone prevention is commonly below 50%. We previously demonstrated that wrist-worn sensors can detect drinking behavior and provide automated lapse detection in fluid intake in the lab setting. From these studies we developed the sipIT intervention which is a context-sensitive behavior change system that incorporates a wrist-worn sensor (Fitbit Versa watch), connected water bottle (H20Pal) and self-monitoring through mobile apps. The purpose of this study was to determine the feasibility and acceptability of sipIT intervention in the clinical setting. In addition, the changes in perceived barriers to increasing fluid intake were evaluated. Materials &Methods: Patients with kidney stones were recruited to participate in a 3-month feasibility trial. Patients were given a Fitbit Versa watch with the sipIT app installed and an H20Pal connected water bottle. They completed a questionnaire to determine perceived barriers to increasing fluid intake at baseline, 1 and 3 months. Results: 31 patients with a history of kidney stones were enrolled to participate (58% female, age = 40.0 ± 14.3 years). Findings are based on n = 27 who completed the entire 3-month intervention. At the end of the intervention, patients reported that forgetting to drink and lack of thirst were less of a barrier to meeting fluid intake goals, 27% and 48% reduction respectively. Most participants perceived that the sipIT intervention helped them to achieve their fluid intake goals and would recommend it to other patients with a history of kidney stones (83%). Conclusions: The sipIT intervention may be used to detect drinking behavior and provide automated lapse detection in fluid intake in the clinical setting. The system was acceptable to patients and there was reduction in common perceived barriers to fluid intake. Combining digital tools with behavioral science may improve adherence to fluid intake recommendations. The Financial Burden of Applying to Urology Residency in 2020 A. Tabakin; A. Srivastava; C. Polotti; N. Gupta Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA Introduction: Applying to urology residency involves many costly components including research, away rotations, applications, and interviews. We aimed to calculate the contemporary cost for applying to urology residency. Materials & Methods: An electronic survey was emailed to all applicants who applied to Rutgers Robert Wood Johnson Medical School for a urology residency position for the 2019-2020American UrologicalAssociation (AUA) Match cycle after Match results were released. We collected information on applicant, application, and interview demographics as well as estimated educational debt and costs incurred applying to residency. Results: Of 245 applicants, 242 emails were sent and 3 bounced. 52 applicants responded (21.5%) representing all eight AUA sections, international schools, and schools without urology programs. The majority of respondents were male (60.4%), single (75.5%), and attended public medical school (52.8%). Most students (40.9%) used loans to pay for the interview trail, while the rest used family donations (30.7%), previous income (17%), and scholarships (8%). Students completed a median of 2 away rotations, applied to 80 programs, and attended 16 interviews. Total estimatedmedian cost per applicant for the 2019-2020 Match was $9,921 (IQR $6,524-13,628). This estimate included application fees [$1,739 (IQR $1,401-2,025)], away rotations [$2,750 (IQR $1,275-4,375)], interview trail travel [$2500 (IQR $1,625- 5,000)], interview trail lodging [$1,000 (IQR $712.50-2,225)], urology research [$50 (IQR $0-500)], interview attire [$300 (IQR $150-400)], and professional photos [$20 (IQR $0-50)]. Only one student attended a second look, spending $500. Applicants who attended public medical school were more likely to have a total cost above the average ($12,333.90 vs. 7.764.58; p = 0.037). Conclusions: The mean estimated cost of applying to urology residency for the 2019-2020Matchwas $9,921. Between 2013 and 2019, the number of applicants to the AUAMatch declined, while number of applications increased; taken together, these statistics may imply that applying to urology residency may be cost-prohibitive to some students. In-Hospital Predictors of Post-DischargeOpioidUse: Individualizing Prescribing After Radical Prostatectomy Based on the ORIOLES Initiative R. Becker; Z. Su; M. Huang; M. Biles; K. Harris; K. Koo; M. Han; M. Allaf; A. Herati; H. Patel Johns Hopkins Medical Institutions, Baltimore, MD, USA Introduction: Judicious opioid stewardship is imperative, and ideally matches each patient’s prescription to their medical necessity. However, minimal objective data exist to guide prescribers in fulfilling this mission. We evaluated in-hospital parameters as predictors of post-discharge opioid utilization in a large cohort of patients undergoing radical prostatectomy (RP), to provide objective evidence-based guidance for individualized prescribing. Materials & Methods: A prospective cohort of 443 patients who underwent open or robotic RP between 2017 and 2018 were followed in the IRB-approved Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) initiative. Baseline demographics, clinical variables, patient-reported pain scores (scale 0-10), and inpatient and post-discharge painmedication utilization were tabulated from electronic medical records and planned 30-day follow-up physician telephone calls.All opioidmedications were converted to oral morphine equivalents (OMEQ). Predictive factors for post-discharge opioid utilization were analyzed by univariate and multivariate linear regression. Results: Of 443 patients (102 open and 341 robotic RP), 374 (84%) were discharged on post-operative day 1. On univariable analysis, the factors most strongly associated with post-discharge opioid utilization included inpatient opioid utilization (overall, average per day, and in the 12 hours prior to discharge; Pearson’s correlation coefficients r = 0.34-0.38, p < 0.001), maximum patient-reported pain scores (24 hours, 12 hours, and final score prior to discharge; r = 0.26-0.32, p < 0.001), and history of prior opioid use. On multivariable analysis, inpatient opioid use (+0.7 post-discharge OMEQ per 1 inpatient OMEQ) and maximum pain score (+5.5 post-discharge OMEQ per 1 point) in the final 12 hours prior to discharge remained significantly correlatedwith post-discharge utilization.Afinal predictive model to guide post-discharge prescribing was constructed. Conclusions: Following RP, inpatient opioid use, patient-reported pain scores, and prior opioid use are strongly correlated with post-discharge opioid utilization. These data can help guide individualized opioid prescribing at hospital discharge to more reliably meet individual needs while minimizing risks of overprescribing. Poster Session 5: Urologic Benign Diseases 2 36