Abstracts from the Mid-Atlantic Section of the AUA 2020

© The Canadian Journal of Urology TM : International Supplement, October 2020 Urologist-Level Utilization Patterns of Cytoreductive Surgery for Metastatic Renal Cell Carcinoma J. Cheaib; J. Wainger; H. Patel; M. Huang; M. Metcalf; M. Biles; R. Becker; J. Canner; M. Johnson; M. Allaf; P. Pierorazio Johns Hopkins Medicine, Baltimore, MD, USA Introduction: Cytoreductive surgery (CS) has been integral in the multimodal management of patients withmetastatic renal cell carcinoma (mRCC) in the tyrosine kinase inhibitor (TKI) era. Its role has recently been questioned with the release of data fromprospective trials.Accordingly, reporting current urologist-level patterns of utilization of CS would be important to evaluate the impact of such findings on future CS implementation. Materials &Methods: We performed a population-based study of mRCC patients from 2004-2013 using the linked Surveillance, Epidemiology, and End Results- Medicare database. Patients were assigned to a primary urologist using Medicare physician specialty codes. Multivariable mixed-effects logistic regression was used to evaluate the association between use of CS and select patient characteristics; predicted probability of using CS was then obtained for each urologist. Results: A total of 4226 patients with 1964 primary urologists were identified. On average, each urologist saw 3 (range: 1-35) patients. Overall, 1370 (32%) patients underwent CS (radical nephrectomy (N = 1285, 94%), partial nephrectomy (N = 55, 4%), thermal ablation (N = 30, 2%)) for mRCC. Table 1 shows patient characteristics and predictors of CS. At the individual urologist level, the estimated probability of using CS varied from 26.9% to 38.7% (mean: 32.2%) (Figure 1). 1077 (55%) urologists never offered CS. Conclusions: Significant variation exists in utilization of CS for mRCC in the TKI era, with 27-39% of patients undergoing CS and 55% of urologists never offering CS. These data serve as a benchmark to measure ongoing changes in the contemporary era, with randomized trials demonstrating little benefit to CS in patients with poor-risk mRCC. Testicular Ultrasound as a Prognostic Factor for Improvement in Semen Parameters After Varicocelectomy V. Pena; T. Kohn; R.Alam; J. Liu; Y. Bhanji;A. Gabrielson; M. Rabinowitz;A. Herati Johns Hopkins University School of Medicine, Baltimore, MD, USA Introduction: It is difficult to identify the sub-groups of infertile men who will benefit most from varicocelectomy. We theorize that advanced processing of ultrasound images can predict testicular sperm density as posterior acoustic enhancement could result in increased echogenity and heterogeneity as ultrasound waves pass through larger seminiferous tubules. The objective of our study was to evaluate testicular ultrasound heterogeneity as a predictor for improved semen parameters after varicocelectomy. Materials & Methods: Infertile men undergoing varicocelectomy were included if they had pre-operative testicular ultrasound plus pre- and post-operative semen analysis.Azoospermic men were excluded. Greyscale testicular ultrasound images were assessed with pixel intensity histogram. The standard deviation (SD) of the histogram was theorized to measure of heterogeneity and thus representative of testicular sperm density. The difference in histogram SDs between the testicle with the more significant varicocele and the testicle with less significant varicocele was taken to control for variable gain on separate ultrasound examinations (Figure 1). Linear regressionwas performed to assess the correlation between the pre-operative difference in the testicular histogram SD and the change in total motile sperm count (TMSC) following varicocelectomy. Results: Twenty-two men were included. Median preoperative TMSC was 22.1 million sperm (IQR: 9.0-44.5). Fifteen men experienced an increase in TMSC after varicocelectomy: median increase 16.1 million sperm (IQR: 2.9-24.0). The remaining seven men experienced a decline in TMSC: median decrease 27.6 million sperm (IQR: 19.9-29.6). A greater pre-operative difference in the testicular histogram SD between the two testicles was associated with a greater improvement in TMSC following varicocelectomy (p < 0.05, R2 = 0.21). Conclusions: This novel method to evaluate testicular heterogeneity may help predict which men will experience an improvement in semen parameters after varicocelectomy. PDA-08 PDA-07 8 Podium Session A