Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 Resident Prize Essay Podium Session Adverse Pathologic Features for Small Renal Cell Carcinoma (≤ 4 cm) in the National Cancer Database L. Xia; R. Talwar; R. Chelluri; D. Lee; T. Guzzo Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Introduction: There is always the concern of aggressive pathology when patients are on active surveillance for small renal masses. Limited data exist on the characteristics of adverse pathologic features for small renal cell carcinomas (RCCs), especially at the national level. Materials & Methods: We identified patients with cT1aN0M0 RCCs (≤ 4 cm) diagnosed between 2010 and 2016 who underwent partial or radical nephrectomy in the National Cancer Database. We developed an adverse pathologic score (APS) and each of the following pathologic features was assigned as one point: lymphovascular invasion, perinephric fat/renal sinus invasion, vein involvement, sarcomatoid features, tumor necrosis, and Fuhrman grade 3-4. Outcomesmeasurements included APS ≥ 1 and overall survival (OS). Results: A total of 38,021 patients were included and 29.2% of them had APS ≥ 1. The distribution of APS is shown in Figure (A). Specifically, ≤ 2cm, 2-3cm, and 3-4cm tumors had an estimated 21.1%, 29.7%, and 36.6% likelihood of having APS ≥ 1, respectively. Distributions of APS by tumor size and sex are shown in Figure (B) and Figure (C). Multivariable logistic regression showed that compared with tumor size ≤ 2cm, 2-3cm (odds ratio [OR] = 1.54) and 3-4 cm (OR = 2.04) tumors had a higher likelihood of having APS ≥ 1. OS stratified by APS is shown in Figure (D) and Figure (E). Multivariable Cox regression showed that compared with APS = 0, higher APS was associated with worse OS (hazard ratio [HR] = 1.16, 1.46, and 2.22 for APS = 1, APS = 2, and APS ≥ 3, respectively). RPE-06 Lingual Versus Buccal Mucosal Graft for Substitution Urethroplasty: A Meta- Analysis of UrethroplastyOutcome and Patient-ReportedHarvest Site Outcomes A. Wang 1 ; M. Chua 1 ; K. McCammon 1 ; V. Talla 2 1 Eastern Virginia Medical School, Virginia Beach, VA, USA; 2 Old Dominion University, Norfolk, VA, USA Introduction: Lingual mucosal graft (LMG) and buccal mucosal graft (BMG) are both used as autologous tissue graft for substitution urethroplasty. We aim to compare urethroplasty outcomes and patient-reported harvest site morbidities between LMG and BMG through meta-analysis of comparative studies. Materials & Methods: A systematic literature search was performed in January 2019. Both non-randomized comparative studies and randomized controlled trials (RCT) were evaluated according to Cochrane Collaboration recommendations. The assessed data included urethroplasty outcomes, complications, and harvest site morbidities. Risk ratios (RR) with corresponding 95% confidence intervals (CI) were extrapolated. Effect estimates were pooled using the Mantel-Haenszel method with a random-effects model. Results: A total of 632 patients (LMG 323, BMG 309) from 12 comparative studies (4 RCTs and 8 non-randomized) were included for meta-analysis. Overall pooled effect estimates revealed no significant difference between the groups on reported urethroplasty outcomes and operative stricture-related complications. Effect estimates for patient-reported graft harvest site morbidities such as bleeding, pain/ discomfort and food intake did not show any differences between the groups at < 1-month, 1-3 months and up to 6-12 months follow-ups. However, LMG group reported a higher proportion of patients with difficulty speaking (RR 6.96) and tongue protrusion (RR 12.93) within 3-21 days post-op. Conclusions: The evidence suggests no overall significant difference between LMG and BMG in urethroplasty outcomes during up to 12-month follow-up. However, patients undergoing LMG urethroplasty have a higher chance of experiencing difficulty of speech and tongue protrusionwithin 1-month post-op. The BMG group has a higher likelihood of experiencing early harvest site swelling, mouth opening difficulty in 1-month post-op, and numbness up to 3-6 months. Establishment of Age Based Nomogram for Prostate Specific Antigen Vales in the Spinal Cord Injury Population N. Swavely 1,2 ; A. Sima 1 ; M. Ghatas 2 ; B. Grob 1,2 ; L. Goetz 2 ; A. Klausner 1,2 1 Virginia Commonwealth University, Richmond, VA, USA; 2 Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA Introduction: Men with SCI often experience frequent bladder/urethral manipulations which may affect PSA. Additionally, these individuals may have altered testosterone status, which can alter PSA. Therefore, current PSA screening guidelines may not be accurate in this population. The objective of this study was to establish normative values for PSA in the SCI population. Materials & Methods: All men with Spinal Cord Injury in the Veterans Health AdministrationwithPSAtestsperformedbetweentheyears1999to2017wereincluded, excluding patients with a prostate cancer diagnosis within 5 years. Data was obtained fromthenationalVAdatabasewithdeterminationofSCIbasedonICD9/ICD10codes reviewed by a specialist in physical medicine and rehabilitation with subspecialty training inSCI.Adedicatedbiostatisticianusedthedatatocreateandvalidateamodel to establish normative PSAvalues and develop a nomogram in the SCI population. Results: Atotal of 32,666 male veterans with SCI were included in the analysis with a total of 174,301 PSA values. PSA values for the 50th, 75th and 95th percentiles and stratified for age group were established, establishing the nomogram for PSA values in the SCI population. (Figure 1) Conclusions: Using a large, geographically diverse SCI population, a PSA nomogram can be created for the unique SCI population, which can help guide decision making. RPE-07 RPE-05 4 Conclusions: For small RCCs, still a significant number of patients have adverse pathologic features.Aggressive pathologic features are associatedwith greater size. Decision making regarding active surveillance, renal mass biopsy, versus surgical intervention for small renal mass should take tumor size andAPS into consideration.