Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Scientific Session III: BPH/RECON Does Achieving Your Own Access In Percutaneous Nephrolithotomy Decrease Pain and Opioid Use Among Patients? Mohammad H. Hout, MD , Maximilian Jentzsch, BS, MS, Frances Kazal, BS, Borivoj Golijanin, BS, Timothy K. O’rourke, Jr., MD, Nicole Thomasian, MD, Praveen Rajaguru, BS, Gyan Pareek, MD, David Sobel, MD Brown University, Providence, RI, USA Introduction: Percutaneous nephrolithotomy (PCNL) is a combination of two procedures that first requires the establishment of percutaneous renal access followed by endoscopic stone fragmentation. At many institutions, renal access is obtained by interventional radiologists (IR) prior to stone treatment by urologists, whereas other urologists obtain access at the time of PCNL. While efforts to reduce opioid use during and after PCNLare ongoing, narcotic medications are still standard of care postoperatively for many urologists. We sought to compare the differences in opioid use in patients whose access is established by urology vs. IR at our institution. Materials &Methods: Aretrospective analysis of 287 patients included from January 2016 - December 2020 undergoing PCNL at an academic institution was performed to compare those who had their nephrostomy access by IR vs. own urologist. IR access was performed in the radiology suite the same day under sedation, whereas urologist access was performed in the operating room at time of PCNL. Length of procedure was determined by times in the operating room alone. Opioidmedication dosing was converted to morphine equivalent daily dosing (MEDD) for comparison. An ANOVA analysis was conducted for inpatient opioid use and outpatient opioid prescriptions to determine differences. Results: 287 patients were included in the analysis. 250 patients underwent PCNL with IR access vs. 37 patients with own urologist access over the time interval. 76.8% of IR group received opioids postoperatively while inpatient vs. 56.8% of own access patients (P=0.03). The IR group received a median of 10 morphine milligram equivalents/day (MEDD) on floor vs. 7.5 MEDD for own access (P=0.194). Opioids were prescribed at discharge for 77.6% of IR vs. 56.8% for own access (p=0.012). MEDD of discharge opioids was 30 for both groups (p=0.226) but median quantity prescribed was 10 tablets for own access vs. 20 tablets for IR group (p=0.002). Length of procedure was 81 min for patients undergoing PCNL with urologist access vs. 47 min for IR obtained access (p< 0.001). Length of stay was 31.5hrs for own access vs. 46hrs IR group (p=0.228). Differences in moderate-severe complications (Clavien- Dindo 3+) were not statistically significant between the two groups (3% for own access vs. 11% for IR group (p=0.589). Conclusions: Achieving nephrostomy access by the urologist at time of PCNL decreases opioid use for patients includingMEDD dispensed as inpatients as well as outpatient opioid tablets prescribed, but at the cost of increased length of procedure. Further research is needed for opioid reduction strategies for patients undergoing either urologist or IR obtained access. The “Fragile” Urethra as a Predictor of Early Artificial Urinary Sphincter Erosion Khushabu Kasabwala, MD 1 , Rachel A. Mann, MD 2 , Jill C. Buckley, MD 3 , Benjamin N. Breyer, MD 4 , Bradley A. Erickson, MD 5 , Nejd F. Alsikafi, MD 6 , Thomas G. Smith, III, MD 7 , Sean P. Elliott, MD 2 1 Lahey Hospital and Medical Center, Burlington, MA, USA; 2 University of Minnesota, Minneapolis, MN, USA; 3 University of California, San Diego, La Jolla, CA, USA; 4 University of California, San Francisco, San Francisco, CA, USA; 5 University of Iowa, Iowa City, IA, USA; 6 Uropartners, Gurnee, IL, USA; 7 MD Anderson Cancer Center, Houston, TX, USA Introduction: Artificial urinary sphincter (AUS) cuff erosion occurs in 2-15% of patients. Some have described “fragile” urethras (previous pelvic radiation, failedAUS, or urethroplasty) to be at higher risk of erosion. Others have described risk factors such as androgen deprivation therapy (ADT), transcorporal placement, and 3.5 cm cuff. Most studies on AUS erosion have only included data on AUS cuffs placed at high volume university centers. Because university centers may have a higher concentration of high-riskmen, this could skew findings through a referral bias. We sought to study risk factors for erosion among a cohort of men who underwent AUS placement by either community-based or university surgeons in order to gain a more representative sample of men and see if previously described risk factors hold true. Materials & Methods: This was a multi-institutional retrospective review of all patients with AUS cuff erosions who underwent AUS explant from at 6 institutions. Cuff removals were all done by university physicians, but included men who were referred for removal after AUS placement by community surgeons. Univariate analyses included t-test and chi-square test. A Cox proportional-hazards model for time to erosion was performed with the predictors being the components of a fragile urethra controlling for other previously described risk factors. Kaplan-Meier survival curves and log-rank test compared “fragile” urethras with “not fragile” urethras. All statistical analysis was done using R version 3.5.2. Results: Of the 128 men included, 38% had undergone AUS placement by community-based surgeons. Median time to AUS explant was 15.5 months (interquartile range [IQR] 5.8 - 52.2). Eighty-one men (63%) had pelvic radiation, 49 (38%) ADT, 16 (12%) prior urethroplasty, 44 (34%) prior failed AUS, 39 (30%) transcorporal cuff, and 11 (9%) had a 3.5cm cuff. One hundred men (78%) had “fragile” urethras. Radiation (Odds ratio [OR] 1.60, 95% CI 1.05-2.44) and urethroplasty (OR 2.22, 95% CI 1.23-4.00) were independently associated with earlier time to erosion. The Kaplan-Meier estimates for AUS survival time by cohort show 1- and 5-year survival rates of 71.4% and 39.3%, respectively, for “not fragile” urethras and 47.0% and 14.0% for “fragile” urethras ( Figure 1 , p<0.0001). Conclusions: In a cohort of men whose AUS cuff eroded after placement by either community-based or university-based surgeons, previous findings about the “fragile” urethra held true. A“fragile” urethra remains a significant risk factor in cuff erosion; in fact, a large majority of the erosions occurred in men with fragile urethras. 22 21 12