Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts Moderated Poster Session 2: Stones/Infection/Pediatrics Implementation of a Pre-operative Testing Algorithm During the Initial COVID-19 Wave at a Rural Tertiary Care Center M. Mawhorter, P. Nguyen, M. Goldsmith, R. Owens, B. Baer, J. Raman Penn State Health - Milton S. Hershey Medical Center, Hershey, PA, USA Introduction andObjective: Infectionwith SARS-COV2 (COVID-19) presents known and unknown perioperative risks to the patient and operative staff. Pre-operative testing protocols have become widespread, yet little is known about the utility of this practice. We describe the impact of a testing protocol during the initial COVID-19 wave on the disposition of urologic surgeries in a rural academic hospital. Methods: Pre-operative COVID-19 testing was implemented in May 2020 and data from all procedures were collected over the initial 90 day period. These were stratified by surgical division and disposition was assessed for all positive and indeterminate results. Health system protocol for this period MP2-11 Surgical Correction of True Diphallia in a Newborn Male Z. Werner, A. Elbakry, C. Crigger, Y. Samadi, J. Ozolok, O. Al-Omar West Virginia University, Morgantown, WV, USA Introduction and Objective: Diphallia is an exceedingly rare congenital anomaly characterized by partial or complete duplication of the phallus, with causes yet to be fully discerned. Approximately 100 cases have been reported worldwide since its initial documentation in the 17th century. Our aim is to add to the existing literature on this rare disease with characterization of our case and subsequent surgical correction. Methods: The patient was born at 36 weeks 5 days and presented to our clinic at tendays of age. Karyotyping revealed 46 XYwith no additional chromosomal abnormalities. Physical examrevealedduplicatedphalluswith patentmeatuses bilaterally, penoscrotal transposition and a largemidline scrotal lipoma (Figure 1A). The patient underwent ultrasound imaging of the kidneys, bladder and genitalia, voiding cystourethrogram, and magnetic resonance imaging of the pelvis and genitalia pre-operatively (Figure 2A-2D). Results: He underwent extensive surgical correction with left phallic amputation, excision of scrotal lipoma, and bilateral scrotal flap creation to give the appearance of a single, circumcised phallus with bilateral descended testicles within a solitary scrotum (figure 1B). Post-operative evaluation at 3 months revealed excellent cosmesis. Conclusions: True complete diphallia is an especially rare and intimately disfiguring disease, however, with proper pre-operative planning and surgical technique, normal anatomic appearance may be attained. MP2-10 17 Provider Compliance and Clinical Outcomes Over Two Years Following Implementation of a Pre-biopsy Rectal Swab Protocol A. Seyer, J. Clark, J. Rosenblum, J. Knoedler, S. MacDonald, M. Kaag, S. Merrill, J. Raman Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA Introduction and Objective: Fluoroquinolone antibiotics are often used for infection prophylaxis prior to transrectal prostate needle biopsy (PNB). Fluoroquinolone-resistance of bacteria in the rectal vault may contribute to increasing rates of infection and hospitalization of patients. In 2018, we implemented pre-biopsy rectal swab testing for fluoroquinolone resistant (FQR) organisms in all patients undergoing transrectal PNB. Herein, we report on provider compliance and outcomes of this quality improvement intervention. Methods: Records of transrectal PNB procedures performed after rectal swab protocol implementation over 24 months from July 2018 – June 2020 were reviewed. We assessed for institutional compliance with swab utilization, incidence of FQR, and rates of post-biopsy infection. Logistic regression FQR, and post-biopsy infection. Results: Of 349 patients who underwent transrectal PNB, 309 (88.5%) had a FQR rectal swab performed. Algorithm compliance remained stable over the two year period (90% year 1; 87% year 2, p=0.50), despite decreased compliance observed in the four months following the COVID-19 pandemic (90% pre-COVID, 74% March-June 2020, p=0.01) (Figure). 34 patients had culture-proven quinolone resistance (11.0%). Antibiotic use within the previous 6 months (OR 5.23, p = 0.028) was associated with a positive swab, while healthcare worker status was associatedwith a negative swab (OR 0.19, p = 0.028). Seven of 349 (1.9%) of patients experienced post-PNB urinary tract infection or urosepsis. Infectious complications were associatedwith hospital admission in the previous six months (OR 19.67, p = 0.015). Conclusions: A protocol to perform rectal swab for evaluation of bacterial fluoroquinolone resistance prior to PNB was implemented over two years with approximately 90% compliance. In consideration of 11.0% resistance prevalence, this feasible, low-risk intervention is sustainable and can help improve antibiotic stewardship for patients undergoing PNB. MP2-12 required testing 3 to 5 days before elective surgery and immediately before urgent surgeries. Disposition assessed over a follow up period of 5 months. Results: Total of 31 positive results for 7579 (0.41%) pre-procedural tests, including 3 of 792 (0.38%) for urologic procedures. Following a positive test, 20 procedures (62.5%) were delayed an average of 49 days, 8 were not performed and 3 proceeded without delay. 3 of 3 urologic procedures were delayed a mean of 59 days. Cost per test ranged from $34-$54. Number needed to test for one positive result was 244 with a cost of $11,573 for each positive result. Conclusions: Institution of a universal pre-operative COVID-19 screening protocol in the early pandemic period identified clinically silent infection allowing for delay when appropriate. Cases were detected at a low frequency with a significant associated cost. This may be useful in triaging resources taking into account local conditions.