Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 MP5-13 Post-Operative Opioid Prescribing Trends in Uro-Oncologic Surgery: A Single Institution Investigation J. Drevik 1,2 ; J. Ellis 1,2 ; R. Viterbo 1 ; R. Greenberg 1 ; M. Smaldone 1 ; D. Chen 1 ; R. Uzzo 1 ; A. Kutikov 1 ; J. Simhan 1,2 1 Fox Chase Cancer Center, Philadelphia, PA, USA; 2 Einstein Healthcare Network, Philadelphia, PA, USA Introduction: Opioid abuse continues to be a public health threat in the United States. Post-operative opioid prescribing has been identified as a major risk factor for developing long-term opioid abuse. We aim to characterize opioid prescribing following common urologic procedures and determine specialties providing refills for these patients. Materials & Methods: We reviewed cases performed between May 2017-April 2018 including endoscopic cases, and those involving kidney, ureter, bladder, and prostate cancer. Data were collected on patient demographics, comorbidities, peri- procedural details, and post-operative narcotic prescribed. A statewide narcotics registry was queried for postoperative opioid prescription data and refilling patterns. Logistic regression analyses were conducted to identify potential risk factors for obtaining post-operative opioid refills. Results: Our analysis included 666 cases performed at our institution. Cohort demographics and refilling patterns can be seen in tables 1 and 2. For endoscopic and kidney cases, non-urologic providers prescribed more total morphine equivalents (TME) than urologists. Patients undergoing prostate surgery received higher TME from urologists. On multivariate analysis, alcohol use (OR 3.3; 95% CI 1.3 – 8.2; p < 0.05), tobacco use (OR, 2.5; 95% CI 1.1-5.6; p < 0.05), and a previous opioid prescription (OR 2.6; 95% CI 1.7-4.1; p < 0.01) were associated with increased likelihood of obtaining a post-operative refill of opioid medication. Conclusions: Both urologists and non-urologists contribute to the overall post- operative burden of opioid refills for patients undergoing urologic surgery. More studies are needed to definitively assess patterns and risk factors for obtaining post-operative opioid refills to curb opioid use. HPG Axis Reset in Men with Hypergonadotrophic Hypogonadism Y. Bhanji; T. Kohn; J. Liu; A. Herati Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: Amongmenwith hypergonadotrophic, hypogonadal non-obstructive azoospermic (NOA), excess gonadotropin exposure carries the potential for desensitizing Leydig and Sertoli cells. The therapeutic dilemma with these men is the limited number of options to improve the intratesticular testosterone prior to sperm extraction operations, combinedwith the potential for a detrimental effect of gonadotropins on Sertoli and Leydig cells. We aim to explore and develop a novel protocol for hypothalamic-pituitary-gonadotropin (HPG) axis reset as a means to hormonally optimize hypergonadotrophic, hypogonadal men prior tomicrosurgical testicular sperm extraction (mTESE) surgery. Materials & Methods: From May 2012 to December 2019, a total of 43 men with hypergonadotrophic, hypogonadal NOAelecting mTESE underwent mTESE after either receiving HPG axis rest or standardmedical therapy. mTESE was performed by two academic infertility specialists. Menwho underwent HPG axis reset received intramuscular testosterone therapy weekly and hCG injections 3 times per week. Men in the control arm received selective estrogen receptor modulators, aromatase inhibitors or observation. Testicular biopsy was assessed for the presence of sperm in all patients after surgery. Baseline demographic, operative and postoperative data were collected by retrospective chart review. Comparative testing was utilized with significance set at α = 0.05. Results: The median age of the patients in the study was 36 years, with no significant difference between the groups (p=0.09). A total of 7 men received HPG axis reset prior tomTESEwhile 36men received standard of care. Menwho received HPG axis reset were significantly more likely to have sperm on testicular biopsy (86%) compared to men who received standard of care (44%) (6 vs. 16, P = 0.04). Conclusions: Our preliminary data suggests that sperm identification rates are improved by normalizing the LH and FSH levels prior to mTESE, including inmen who have previously undergone failed mTESE. MP5-12 Poster Session 5: Urologic Benign Diseases 2 38