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

MA-AUA 2021 Abstracts Moderated Poster Session 6: Trauma/Sexual Dysfunction AComparison of Hospital Charges Between Secondary Robotic Pyeloplasty and Chronic Ureteral Stenting for Management of Recurrent Ureteropelvic Junction Obstruction M. Lee 1 , Z. Lee 1 , I. Hollin 2 , D. Eun 1 1 Temple University Hospital, Philadelphia, PA, USA; 2 Temple University, Philadelphia, PA, USA Introduction and Objective: We compared hospital charges for patients undergoing secondary robotic pyeloplasty (SRP) versus chronic ureteral stenting (CUS) formanagement of recurrent ureteropelvic junction obstruction (UPJO) after prior failed pyeloplasty. Methods: We constructed a decision tree to demonstrate two options for UPJO management (Figure 1). We performed probability-weighted calculations based on success rates to determine total hospital charges for CUS and SRP. CUS was assumed to have a 100% success rate. Success rate for SRP was determined using data from our Collaborative of Reconstructive Robotic Ureteral Surgery database. Hospital charges were determined using the PennsylvaniaHealthCare Cost Containment Council databasewhich contains data from centers across 5 counties in Pennsylvania. Total hospital charges to payers were calculated using room/board, ancillary, drug, equipment, specialty, and miscellaneous charges. We determined how many ureteral stent exchanges would be required for CUS to result in higher hospital charges compared to SRP. Results: Success rate for SRP is 90%. Mean hospital charges for an SRP and a single ureteral stent exchange are $40,871.40 and $5,894.10, respectively. Total probability-weighted charges for both options were determined in terms of the number of stent exchanges. Total charge for CUS was $5,894.10×Number of Stent Exchanges. Total charge for SRP was calculated by adding the probability-weighted charge of a successful SRP (0.9×$40,871.40) to the probability-weighted charge of a failed SRP (0.1x[$40,871.40+$5,894.10×Num ber of Stent Exchanges]). Hospital charges for CUS were higher than hospital charges for SRP after 8 ureteral stent exchanges. Conclusions: After 8 stent exchanges, CUS may result in higher hospital charges to payers versus SRP for management of recurrent UPJO after prior failed pyeloplasty. These data may factor into a patient’s decision-making process for management of recurrent UPJO. MP6-06 Patterns of Surgical Management of Male Stress Urinary Incontinence: Data from the AUA Quality (AQUA) Registry H. Dani 1 , W. Meeks 2 , C. Weiss 2 , R. Fang 2 , A. Cohen 1 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2 American Urological Association Education & Research, Linthicum, MD, USA Introduction and Objective: Effective surgical treatment options for male stress urinary incontinence (SUI) are underutilized. Urethral bulking appears less efficacious, and cure is rare according to the recent AUA guidelines. We aim to describe contemporary patterns in SUI treatment utilizing the AQUA registry. Methods: We identified men with SUI using diagnosis and procedure codes in the AQUA registry. Characteristics of the patient, surgeon, and practice were included in a multivariate analysis of predictors of management type. Results: From 2014 to 2019, we identified 119,994 men with SUI and a total of 10,791 SUI procedures. Artificial urinary sphincter (AUS) was most common, followed by urethral sling and urethral bulking. Utilization of sling is increasing (p=0.02), while there was no change in AUS or bulking over time. The initial procedure chosen was bulking in 562 (13%) of men, sling in 1,638 (37%), andAUS in 2,241 (50%). Median follow-up after the first procedure was 277 days. Of men undergoing initial bulking, 237 men (42%) required a secondary procedure; 159 (67%) of this group had repeat bulking. Of men undergoing initial sling orAUS, 223 (14%) and 609 (27%), respectively, required a secondary procedure. Table 1 summarizes patient characteristics. On multivariate analysis, significant predictors of undergoing an open surgical procedure include history of radical prostatectomy, urethroplasty, or academic practice setting. Factors associated with increased odds of urethral bulking include a history of bladder cancer, hypogonadism, increased age of surgeon, or female gender of surgeon. Conclusions: Utilization of urethral bulking remains stable albeit at lower rates than that of sling or AUS. Quality improvement initiatives can target the populations that are currently more likely to undergo bulking and may find more success with alternatives. MP6-05 41