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 Real-WorldHealthcare Resources Analysis Reveals UroLift PULhas Similar Surgical Retreatment Rates and Lower Post-Operative Complications vs. TURP and GreenLight Laser PVP Daniel Rukstalis, MD 1 , Steven Kaplan, MD 2 , Ronald Kaufman, MD 3 1 Prisma USC Division of Urology, Columbia, SC, USA; 2 Icahn School at Mount Sinai, New York, NY, USA; 3 Teleflex, LLC, New York, NY, USA Introduction: The surgical approach to resolving prostatic obstruction has evolved from being a TURP-only pathway to include innovative options that minimize toxicity with continued effectiveness. Real-world studies which compare outcomes for MISTs and traditional surgery for BPH and impacts on health care systems are sparse. Here, Medicare and commercial claims are analyzed for rates of surgical retreatment and post-operative complications experienced by patients who underwent a traditional surgery (TURP/ GreenLight Laser PVP) or MIST (Prostatic Urethral LIFT (PUL utilizing the UroLift System)/Rezum steam injection) for LUTS/BPH. Materials &Methods: Longitudinal patient-level data was acquired from a retrospective observational analysis of a representative sample of Medicare and commercial medical claims (obtained from IBM Watson). Men with a BPH diagnosis code who received an outpatient index procedure of TURP, GreenLight, UroLift PUL, or Rezum from January 2015-December 2019 were included. Surgical retreatment was defined as undergoing TURP, GreenLight, UroLift PUL, Rezum, or HoLEP secondary to the index procedure. Post- operative complications were defined as secondary procedures with a CPT or ICD10-PCS code. Rates for complications and surgical retreatment and were calculated through 1 and 4 years respectively via cumulative incidence curve. Results: The database includes the following patient distribution: 18,794 TURP patients, 9,894 Greenlight, 4,639 UroLift PUL and 780 Rezum patients. 9.5% of Rezum patients had a surgical retreatment over 4yrs, which was higher than retreatment after TURP (6.3%), GreenLight (7.0%), and UroLift PUL (6.8%) (logrank p=0.004) ( Figure 1 ). The lowest incidence of 1-year overall complications occurred after PUL (16%), and was highest after Rezum (23%). Rates of the following complications at 1-year were highest for the following procedures: catheterization - Rezum 7.3%, stone removal - TURP 4.5% and GreenLight 3.6%, and cystoscopy - UroLift PUL 4.1%. Other complications (e.g. bleeding control, stricture repair, fulguration) occurred at a frequency of ≤1%. Conclusions: The largest healthcare claims analysis for BPH procedures reveals that complications are lowest after UroLift PUL. Surgical retreatment occurs with similar frequency between UroLift PUL, TURP and GreenLight, and is highest after Rezum. Hypoalbuminemia is Associated with Increased 30-day Complications Following Rectourethral Fistula Repair: A NSQIP Study M. Ryan Farrell, MD, MPH , Alex J. Vanni, MD Lahey Hospital and Medical Center, Burlington, MA, USA Introduction: Surgical management of rectourethral fistula (RUF) is complex and can include bowel and urinary diversion, bowel resection, cystectomy, or urethral reconstruction. Hypoalbuminemia is a marker of poor nutrition and has been associated with increased complications in other major surgical procedures including cystectomy and colorectal surgery. Yet, the limited prevalence of RUF makes it a challenging entity to study. We sought to utilize a large national database to describe the population of men undergoing RUF repair and to evaluate the effect of hypoalbuminemia on postoperative complications. Materials &Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was queried for all male patients who underwent RUF repair from 2006-2018. Postoperative 30 day complications included wound infection, organ space surgical site infection, wound dehiscence, urinary tract infection, sepsis, venous thromboembolism, pneumonia, mortality, and return to operating room. Results: A total of 250 patients were identified. At the time of RUF repair, 17.2% underwent concurrent bowel diversion and 13.6% underwent bowel resection. Additional concurrent procedures included cystectomy (8.0%) and urethroplasty (14.8%). Amuscle, myocutaneous, or fasciocutaneous flap was used in 75.7% of those undergoing urethroplasty. Overall, median age was 66.0 years (IQR 59.0-72.0), BMI 26.6 kg/m2 (IQR 23.7-29.5), and 98.8% were functionally independent. Comorbidities included hypertension on medication (56.0%), smoking (22.0%), diabetes (6.8%), COPD (4.4%), and CHF (0.4%). Hypoalbuminemia (<3.5 g/dL) was present in 19.8%. Overall, 20.4% of patients experienced a complication within 30 days of surgery including wound infection (5.6%), sepsis (5.2%), organ space infection (4.4%), urinary tract infection (3.2%), and venous thromboembolism (3.2%). Hypoalbuminemia was associated with increased odds of an adverse event (OR 3.1, p=0.02). Median hospital length of stay was 5.0 days (IQR 3.0-8.0), and was significantly longer among patients undergoing cystectomy (8.0 days, IQR 6.0-13.0; p<0.01). Overall 30-day mortality was 2.0% and did not differ by concurrent procedures. Conclusions: Patients who underwent surgical repair of RUF were often functionally independent with limited major comorbidities. Hypoalbuminemia was associated with increased odds of an adverse postoperative event, thereby suggesting a role for nutritional optimization prior to RUF repair. 30 29 16