Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 55 Is a Preoperative Type andScreenRequired inPatientsUndergoingCommon Urological Procedures? A Cost-Benefit Analysis Joshua R. Volin, B.S. 1 , Patrick Herndon, B.S. 1 , Aviv Spillinger, B.S. 1 , Patrick Karabon, M.S. 1 , James Blumline, B.S. 1 , Deanna Tran, B.S. 1 , Craig Fletcher, M.D. 2 , Jason Hafron, M.D. 2 1 Oakland UniversityWilliam Beaumont, Royal Oak, MI, USA; 2 Beaumont Hospital - Royal Oak, Royal Oak, MI, USA Introduction: Our objectivewas to evaluate the cost-effectiveness of obtaining preoperative type and screen (TS) for common urological procedures and to determine patient and hospital factors associated with receiving blood transfusions. Materials & Methods: Retrospective database analysis of the 2006-2015 Nationwide Inpatient Sample (NIS) was performed to identify patients undergoing a variety of urological procedures. A total of 4,113,144 cases were identified. Transfusion rates were then determined from NIS data, and multivariate regression analyses was used to identify factors associated with transfusions. A cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER) of obtaining preoperative TS to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500. Results: Transfusion rates of common urological procedure ranged from .91% to 33.14%. On multivariate modeling, all comorbidities with the exception of obesity were significantly associated with blood transfusion. Some examples included diabetes (OR, 1.26; 95% CI, 1.19-1.33), liver disease (OR, 1.20; 95% CI, 1.13-1.29), and metastatic cancer (OR, 2.69; 95% CI 2.54- 2.85) ( p < 0.01 for all). One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative TS. The ICER of preoperative TS for radical prostatectomy (transfusion rate = 3.88%) and penile implants (transfusion rate = 0.91%) were $1,607 and $7,709 per ERT prevented, respectively. Conclusions: Based on a large national database, institutions should consider a risk of transfusion greater than or equal to 4.12% to justify a preoperative TS. Aselective TS policy for high risk patients may reduce costs and unnecessary workload for laboratory staff. Scientific Session V: ED/Infertility 56 An Initiative to Reduce Door to Incision Time for Patients with Testicular Torsion Justin Nguyen, MD , Matthew Buck, BS, Alejandro Abello, MD, Marianne Casilla - Lennon, MD, Michael S. Leapman, MD, Adam B. Hittelman, MD, PhD, Jason Teitelbaum, MD, MBA, Beth L. Emerson, MD, MBA, Jaime Cavallo, MD, MPHS, Patrick A. Kenney, MD, Sarah M. Lambert, MD Yale University School of Medicine, New Haven, CT, USA Introduction: Time from symptom onset of testicular torsion to detorsion predicts likelihood of testicular salvage. We aimed to reduce time from door- to-incision to under 120 minutes at our institution. Materials & Methods : We developed a streamlined process to prioritize suspected torsion cases, coordinating a multidisciplinary team including urology, emergencymedicine, radiology, anesthesiology, perioperative services, and transport services. The Initial intervention involved rapid identification of suspected cases in the emergency room (ER), immediate parallel notification of urology and radiology for evaluation, case prioritization by perioperative services, and rapid assessment by anesthesiology. We subsequently implemented portable bedside ultrasound in the ER for all suspected torsion cases. We assessed the effects of the intervention with statistical X-mR process control charts and used Nelson rules to determine special cause. Results : From January 2019 to February 2021, we observed 33 torsion events requiring surgical intervention, 15 before and 18 after the intervention. Following improvement efforts, mean door-to-incision time decreased from 221 minutes to 123 minutes. After the intervention there was a significant decrease in door to incision time through a shift of 8 patients below the control limit. We further identified a significant reduction in patient-to-patient variation through a shift of 8 in the moving range below the control limit. Compared to cases prior to our intervention time from arrival to ultrasound remained unchanged from 60 minutes to 62 minutes, and time from arrival to urology evaluation decreased from 135 minutes to 62 minutes, ultrasound duration decreased from 43 minutes to 36 minutes, and time fromultrasound to incision decreased from 157 minutes to 76 minutes. Conclusions : Implementation of multidisciplinary improvement work reduced door to incision time for patients with suspected testicular time. These interventions provide a reproducible model to improve efficiency in treating patients with testicular torsion. Analyzing the Quality of YouTube Videos on Inflatable Penile Prosthesis Surgery Vivian Paredes-Bhushan, MD,MS 1 , Rutul D. Patel, MBS 2 , Michael E. Rezaee, MD,MPH 3 , Martin S. Gross, MD 3 1 Geisel School of Medicine at Dartmouth, Hanover, NH, USA; 2 NewYork Institute of Technology College of Osteopathic Medicine, OldWestbury, NY, USA; 3 Dartmouth- Hitchcock Medical Center, Lebanon, NH, USA Introduction: Video websites, predominantly YouTube.com, offer patients unfiltered and unregulated medical content. Patient commonly use these online medical resources to investigate intimate conditions. It remains unknown whether YouTube videos on penile prosthesis surgery are useful or informative for patients. We assessed the quality and reliability of YouTube videos pertaining to penile prosthesis surgery. Materials & Methods: We compiled penile prosthesis videos on YouTube using a combination of multiple pertinent keyword searches. Videos were screened by two reviewers. Videos that were irrelevant, not in English, or without audio and also without captioning were excluded. Video demographics and viewership information were collected and categorized by channel type. Videos were categorized by themes, which included useful, misleading, or patient views. Reliability was assessed using a modified 5-point DISCERN tool and videos were rated using 5-point Global Quality Scale (GQS). Video comprehensiveness was evaluated using a 5-point content score. Interobserver agreement was assessed using Cohen’s kappa score ( k ) and intraclass correlation coefficient. Results: Of the 165 videos that initiallymet inclusion criteria, 23 were hidden or deleted from YouTube at the time of analysis. The remaining 142 videos totaled 1.21 million views, with an average view count of 85,914. Of these, 57 (40.4%) were from universities, professional organizations, non-profits or physicians/physician groups. An additional 56 (39.7%) were medical advertisements from for-profit companies. 20 videos (14.2%) were from individual channels and 13 (9.2%) were stand-alone health information websites. The average reliability score was 3.56 (±0.0773), k= 0.489. The average GQSwas 3.22 (±0.0733), k =0.128. The average content score was 1.83 (±0.087), k =0.683. Intraclass correlation coefficient was calculated as for 0.537 for DISCERN and 0.662 for GQS, suggesting moderate reliability. 76 videos (53.9%) were identified as self-promotional. 20 videos (14.1%) were identified as patient testimonials. 123 videos (86.6%) were identified as “useful”, 2 videos (1.41%) “misleading” and, 17 videos (12%) as “patient views”. Conclusions: There is room for improvement in the quality and reliability of YouTube videos pertaining to penile prosthesis surgery. The analyzed YouTube videos also have low content comprehensiveness. Results were consistent across reviewers. Over half of penile prosthesis surgery videos on YouTube are clearly identified as self-promotional by reviewers. 54 28