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

© The Canadian Journal of Urology TM : International Supplement, October 2021 Display Posters Concurrent Nephrolithiasis During Partial Nephrectomy: A Multi- Institution Retrospective Analysis of Post-Operative Complications A. Garcia 1 , D. Nemirovsky 1 , C. Klose 2 , T. Batter 3 , A. Smith 4 , M. Whalen 1,3 1 George Washington University School of Medicine and Health Sciences, Washington, DC, USA; 2 East Carolina University Brody School of Medicine, Greenville, NC, USA; 3 George Washington University Hospital, Washington, DC, USA; 4 Sibley Memorial Hospital, Washington, DC, USA Introduction and Objective: Partial nephrectomy (PN) for renal cell carcinoma (RCC) has become the standard of care for patients with tumors <7cm and individuals with imperative indications for nephron preservation. Synchronous renal calculus disease, a rare but important consideration given potential for ureteral obstruction and urine leak after PN, is not widely reported. In this study, we describe a multi-institution experience on calculus management and postoperative complications in patients with concurrent renal calculi at the time of surgery. Our objective was to provide a descriptive analysis on the impact of synchronous nephrolithiasis with regards to postoperative complications in patients undergoing PN for suspected RCC. Methods: A multi-institutional chart review and retrospective analysis of all patients who underwent PN from 2013-2020 was conducted from an IRB- approved database. Data on demographics, imaging, stone characteristics, and stone management were gathered. Statistical analysis included Fisher’s exact test to assess complication differences between patients treated and untreated for calculi before or during surgery. Results: 32/256 (13%) patients screened had concurrent renal calculi at the time of surgery.14/32 (44%) had ipsilateral, 9/32 (28%) had contralateral, and 9/32 (28%) had bilateral stones. 5/32 (16%) received stents at the time of surgery. 2/32 (6%) received concurrent pyolithotomy at the time of surgery. 4/32 (16%) had obstructing stones. Pertinent postoperative urinary system complications included hematoma (2), urine leak (1), urinary retention (1), IVC thrombosis (1), acute kidney injury (1), and flank pain (1). 1/7 (14%) with postoperative complications was treated prior to surgery. There was no significant difference in complications between patients treated or untreated for stones prior to surgery (7 treated, 25 untreated; p = 1) Conclusions: Our results indicate that untreated nephrolithiasis was not associated with greater complication rates compared to treated patients. Based on these findings, patients with asymptomatic stone disease may be able to delay stone disease treatment until after PN. More Stress or Relief? Patient Perceptions of Oncologic Follow-up After Surgery for Urologic Malignancies R. Owens 1 , T. Vu 1 , S. Strausser 1 , E. Schaefer 2 , S. Boltz 2 , M. Kaag 2 , J. Raman 2 , S. Merrill 2 1 Penn State College of Medicine, Hershey, PA, USA; 2 Penn State Hershey Medical Center, Hershey, PA, USA Introduction andObjective: In colorectal, cervical and breast cancers, follow- up can influence patient stress about disease recurrence. However, such experiences are less defined for urologic malignancies. Thus, we developed a cross-sectional prospective survey study to assess kidney (Kid), prostate (Pros), and bladder (Bld) cancer patient perceptions and expectations of oncologic follow-up following surgery. Methods: Eligible patients included those with pTanyNanyM0 Kid, Pros, and Bld cancer presenting > 60 days following primary surgery treatment. Adjuvant therapy or a documented recurrence were exclusion criteria. Validated questionnaires assessing attitudes towards follow-up and strategies to combat stress were administered to patients prior to revealing testing results. Persistence of Opioid Reduction Habits 1 Year After Implementation A. Quinn 1 , E. Mann 1 , J. Mark 1,2 , M. Mann 1,2 , E. Trabulsi 1,2 , C. Lallas 1,2 , L. Gomella 1,2 , T. Chandrasekar 1,2 1 Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA; 2 Thomas Jefferson University Hospital, Philadelphia, PA, USA Introduction andObjective: Changing prescribing habits amongst surgeons is an important mechanism of addressing the opioid epidemic. Urologists have made strides in reducing opioid prescribing in the postoperative setting, particularly in post-prostatectomy patients. While several prospective interventional studies have demonstrated reduction in opioid prescribing in the post-operative setting, there is limited evidence on whether these interventions have a durable impact beyond the initial time frame. Our study aims to assess the durability of such an institutional protocol one year after intervention. Methods: Thomas Jefferson University Hospital (TJUH), a large urban academic institution, implemented opioid reduction measures for patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) via a prospective 2-month protocol in July 2019. Patients who received a RALP prior to opioid reduction measures (1/1/2017 and 6/30/2019) and after these measures were implemented (7/1/2019 and 6/30/2020) were included. Opioid prescription and utilization patterns in the hospital setting and upon discharge were compared between the two cohorts. Results: 225 and 163 patients received a RALP prior to and following opioid reduction measures, respectively. There was no significant difference between demographics, NCCN risk groups, complication rates, and length of stay greater than 2 days. When comparing opiate use in the hospital setting, there was a significant sustained reduction in opiate receipt during hospital stay (65.0% before vs. 53.5% after, p = 0.002) and amount prescribed (42.3 morphine milligram equivalents (MME) before vs. 22.9 MME after, p < 0.001). When looking at opiate prescription patterns at discharge, there was a significant sustained reduction in opiate receipt at discharge (93.3% before vs. 42.9% after, p < 0.001) and amount prescribed (139.0 MME before vs. 51.9 MME after, p < 0.001). Conclusions: Simple opioid reductionmeasures in the post-operative setting, in the form of protocol shifts and EMR nudges, can yield durable changes in prescribing patterns beyond the initial study period. DP-03 DP-02 DP-01 Results: 337 patients were prospectively surveyed from 2018-2020: 127 (38%) Kid, 134 (40%) Pros, and 76 (23%) Bld. In follow-up, patients showed satisfaction with provided strategies to combat recurrence anxiety (Kid 86%, Pros 81%, Bld 85%). However, 16% of patients reported wanting, but not receiving, strategies for fear reduction. Most patients reported diagnostic tests were “Not at All” burdensome (Kid 86%, Pros 94%, Bld 82%) and disagree that fewer tests would alleviate anxiety (Kid 89%, Pros 91%, Bld 84%). The majority reported an increased sense of worry if there were no cancer follow- ups (Kid 84%, Pros 80%, Kid 81%), and preferred their specialist than family physician for follow-up (Kid 89%, Pros 91%, Bld 95%). When responses were stratified by recurrence risk, no significant differences existed for any cancer type. However, Pros patients did show a difference in fear of recurrence (“Not at All:” ≤T2 38%, ≥T3, 19%). Conclusions: Urology patients appear satisfied with their oncologic follow- up. Irrespective of cancer type, patients agree follow-up with urology providers are reassuring and diagnostic tests are not burdensome, whereas omission of visits would increase worry. Interestingly, up to 20% of patients desired additional strategies to combat fear, indicating opportunity for improvement. 46