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 5: Surgical Technology/Imaging The Delayed and Diminished Nephrogram on Computed Tomography: Measurement and Association with Impaired Renal Function M. Loecher 1 , M. Strother 2 , E. Cho 1 , D. Strauss 1 , E. Handruf 2 , J. Yu 2 , J. Anaokar 2 , A. Kutikov 2 1 Temple University Health System, Philadelphia, PA, USA; 2 Fox Chase Cancer Center, Philadelphia, PA, USA Introduction and Objective: Unilateral delayed/diminished nephrogram contrast-enhanced computed tomography (CT) is qualitatively known to be associated with ureteral obstruction. We sought to quantitatively describe these phenomena usingmethods applied in clinical practice and to determine whether they might be independently associated with loss of renal function. Methods: We retrospectively reviewed images from 76 patients from 1/2010 to 1/2021 who had a contrast-enhanced CT scan within 30 days of technetium-99m mercaptoacetyltriglycine diuretic renal scintigraphy (DRS) which showed one kidney to have normal (T1/2 <10 min on DRS) and the other to have abnormal (T1/2 >10 min) drainage on DRS. The Hounsfield units (HU) of the renal cortex and medulla were measured separately using circular regions of interest. Renal cortical volume was estimated using simple linear measurements which have been previously described and found to be highly correlated with renal function. Differential renal attenuation (DRA) was measured as absolute differences in HU between the subject and normal kidney. Delayed nephrogram was defined using the difference in corticomedullary differentiation (DCMD) between units. Results: Cortical DRA > 15, medullary DRA > 20, and DCMD >20 showed specificity of 100%, 100%, and 97% respectively for abnormal drainage on DRS. 30-50% of patients with prolonged drainage on DRS had no appreciable delayed or diminished nephrogram. Kidneys with delayed or diminished nephrograms functioned less well per unit of renal volume (p = <0.001 for all measures of delay/diminishment). Conclusions: Delayed and diminished nephrograms specific but not sensitive for renal obstruction on MAG3. These signs are independently associated with poorer renal functioning, suggesting that they may identify a subset of patients who are experiencing ongoing high collecting system pressure and are at increased risk of further renal functional loss. MP5-12 Telehealth in Urology 1-year into the Pandemic: Sustained Change or a Flash in the Dark A. Alzubaidi 1,2 , E. Eidelman 1,2 , S. Ramedani 1,2 , V. Walter 2 , J. Raman 1,2 , J. Littlejohn 1,2 1 Penn State Health Medical Center, Hershey, PA, USA; 2 Penn State College of Medicine, Hershey, PA, USA Introduction and Objective: Telemedicine (TM) was historically underutilized within surgical specialties in part to limited billability and subsequent reimbursement. During the COVID-19 pandemic, in-person exposure risk alongside evolving reimbursement models incentivized adoption of TM. We review TM experience 1-year into the pandemic within a large rural health system to determine: 1) adoption and sustained use across surgical domains; 2) use within Urologic subspecialties; and 3) variances by provider type (MD vs. APP) Methods: Data on TM versus in-person visits to surgical specialties were prospectively collected from March 2020 to February 2021. Comparison across (1) surgical specialties (Urologic, Plastics, Neurosurgery, Colorectal, Minimally Invasive Surgery, ENT, and Ophthalmology); (2) urologic subspecialties (Oncology, Pediatrics, General, Endourology, and FPMRS); and (3) urologic provider type was performed using the chi-square test. Results: Overall 23679 health visits across surgical services were recorded. Of these, 19381 (82%) were on-site visits and 4298 (18%) were TM. Greatest TM use occurred during the first 3months of the pandemic averaging 49.2%versus 15.7% within the past 3 months. Urology demonstrated the second greatest use of TM (23%) although rates over the past 6 months have averaged (13.7%, range 8.5% - 27%). Variations were noted in subspecialties of Urology, with the highest in Endourology (38%) compared to general urology (14%). APP utilization of TMwas higher compared to physicians (28% vs. 21%, p<0.001). Conclusions: Telemedicine was used in ~20% of visits during the first year of this pandemic although utilization has dropped over the past 6 months to under 14%. Amongst surgical specialties, Urology, specifically Endourology, was a higher utilizer of TM. Understanding barriers to TM deployment including technology platform, patient preference, and geography may increase utilization. MP5-11 38