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

© The Canadian Journal of Urology TM : International Supplement, October 2021 Moderated Poster Session 3: BPH/Urodynamics Morbidity of Bladder Outlet Obstruction Treatment Following Radiotherapy for Prostate Cancer M. Tedeschi 1 , L. Keenan 1 , G. Eure 1,2 , K. McCammon 1,2 1 Eastern Virginia Medical School, Norfolk, VA, USA; 2 Urology of Virginia, Virginia Beach, VA, USA Introduction and Objective: There is no consensus on the best treatment for bladder outlet obstruction (BOO) in patients after radiation therapy. In this study we look at the morbidity of prostatic urethral lifts (PULs), laser photovaporization of the prostate (PVP), transurethral resection of the prostate (TURP), and transurethral incision of the prostate (TUIP) in the treatment of BOO in patients who have undergone radiotherapy for prostate cancer. Methods: In this retrospective study, patients with a history of radiotherapy for prostate cancer who required a BOO procedure between October 2011 and September 2020 were investigated. Forms of radiation included external beam radiation (EBRT), brachytherapy (BT), EBRT + BT, and proton therapy (PT). Results: Eighty-nine patients with a history of radiation underwent treatment for BOO between October 2011 and September 2020. Twenty-five, 28, 32, and 4 patients underwent PULs, PVP, TURP, and TUIP, respectively. The average time from radiotherapy to a BOO procedure was 6.9 years. Of the patients who underwent EBRT, BT, ERBT + BT, and PT, 48%, 47%, 62%, and 46%, respectively, needed additional procedures for BOO after their initial procedure. Of the patients who underwent PULs, PVP, TURP, and TUIP, 32%, 68%, 44%, and 75% of patients, respectively, required additional procedures. Incontinence was the most common adverse event in patients undergoing PULs, PVP, and TURP. (40%, 54%, and 28% of patients, respectively). Of the radiation treatments, EBRT + BT had the highest rate of incontinence at 69%. Conclusions: Patients undergoing PULs required less subsequent procedures compared to patients undergoing TURP, PVP, or TUIP. PVP should be avoided as it had high rates of stricture formation, incontinence, and need for additional procedures. Regardless of the surgical approach, patients with BOO and a history of radiation need to be counseled on adverse side effects and the high likelihood of multiple additional procedures. MP3-01 MP3-02 Evaluating Patient Priorities in Benign Prostatic Hyperplasia Treatment Using Conjoint Analysis P. Huffman, E. Yin, A. Cohen The Brady Urological Institute at Johns Hopkins Medicine, Baltimore, MD, USA Introduction and Objective: Discordance between patient and urologist priorities for the treatment of benign prostatic hyperplasia (BPH) hinders patient-centered care. Physician assumptions regarding patient preferences lead to dissatisfied patients; a poor outcome in any quality of life surgery. American UrologicAssociation guidelines urge urologists to consider patient preferences when recommending a BPH treatment. Hence, the objective of this study is to quantify BPH patient preferences to promote guidelines- compliant, patient-centered care. Methods: In this cross-sectional, online survey study using researchmatch. org, participants were required to decide between theoretical BPH treatments in a balanced, choice-based conjoint analysis. The treatments had varying levels of four attributes: efficacy, recovery difficulty, risk of complications (Clavien-Dindo 2+), and risk of de novo ejaculatory dysfunction. Demographic information and International Prostate Symptom Score (IPSS) were collected and analyzed using comparative statistics. Each attribute was analyzed using a conditional logit model, and attribute importance (range in utility between attribute-levels) was calculated (Figure 1). Results: Out of 1235 recruited participants, 812 (66%) completed the study. Median IPSS and age was 6 (IQR 3-12) and 56 (IQR 38-67), respectively. Complication risk was the most important attribute (0.767), followed by efficacy (0.498), recovery difficulty (0.480), and risk of ejaculatory dysfunction (0.392). In a subgroup analysis of age quartiles (Figure 2), participants age <38 and >67 held efficacy (31%) and complication risk (47%) to the highest relative importance, respectively. Conclusions: Males valued BPH treatments that minimize complication risks, while ejaculatory dysfunction was least impactful. Variation in results between age subgroups emphasizes the need for individualized care to maximize patient satisfaction. Moses Technology Improves Efficiency of Laser Lithotripsy for Patients Undergoing Mini-PCNL M. Dunne 1 , M. Drescher 2 , J. Davalos 1 1 Chesapeake Urology and University of Maryland, Hanover, MD, USA; 2 University of Maryland, Baltimore, Baltimore, MD, USA IntroductionandObjective: Theutilizationof Lumenis Pulse™120HMOSES™ holmium laser is associated with improved operative times for treatment of urolithiasis through retrograde ureteroscopy. In this study, we compare the utilization ofMOSES Technologywith an industry standardholmiumlaser fiber during mini access percutaneous nephrolithotomy (MPCNL) Methods: This is a retrospective case series of MPCNL, defined as PCNL with access diameter from 11-20F. All were performed at a single ambulatory surgical center between 2017 and 2020. Lithotripsy was performed using either MOSES or an industry standard holmium laser fiber. Patient and laser records were analyzed to evaluate laser performance with a primary endpoint of treatment efficiency score. Univariate statistics were performed using two tailed t-test and chi-squared test for continuous and categorical independent variables, respectively. Efficiency scores were calculated as the quotient of stone volume by laser utilization time. Results: 140 patients met inclusion criteria. 79 patients underwent lithotripsy with a standard laser fiber and 62 patients with MOSES. There were no significant differences in patient age or comorbidity. Most stones were lower pole, renal pelvis or proximal ureter for both cohorts. Mean stone volume was 20.5mmfor patientswho receivedMOSES and 18.5mmfor patients treatedwith a standard fiber. The predicted post-procedure stone free rate was 95% for all patients. Procedures with MOSES resulted in significantly reduced operative times (85.9 min vs. 98.1 min, p = 0.03) and reduced intracorporeal treatment times (38.82minvs. 44min, p= 0.05).MOSESdemonstrated improved treatment efficiency (2.4 vs. 1.8, p = 0.03) compared to the standard fiber. There was no significant difference in predicted post-procedure stone-free rate. Conclusions: MOSES Technology demonstrates reduced operative times and intracorporeal operative time during MPCNL. In our series, MOSES Technology outperformed an industry standard holmium laser fiber in treatment efficiency with no significant differences in clinical outcomes. MP2-13 18