Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Scientific Session II: Stones I PSADensity is Complementary to ProstateMRI PI-RADS Scoring System for Stratifying Clinically Significant Prostatic Malignancies J. Frisbie, A. Van Besien, A. Lee, L. Xu, S. Wang, A. Choksi, M. Afzal, M. Naslund, A. Wnorowski, M. Siddiqui University of Maryland School of Medicine, Baltimore, MD, USA Introduction: While PSAhas traditionally been used for prostate cancer(PCa) risk stratification, prostateMRI hasmore recently allowed improved diagnosis of clinically significant PCa(CSPC). However, it is not well described if these two tests are complementary to each other. The objective of this study was to determine if prostate MRI and PSA can provide complementary insights into PCa risk-stratification. Materials &Methods: Biopsy results were reviewed from 327 patients who underwent MR/US fusion targeted prostate biopsy. Each biopsy sample from the lesions was given a Gleason grade (GG) and pathologic outcomes were stratified by various parameters, including PI-RADS v2 score. CSPC was defined as Gleason score ≥7. Logistic regression was used to determine OR with 95%CI. Results: A total of 709 lesions were analyzed. We found PSAdensity (PSAD) and PIRADS-score provided complementary predictive value for diagnosis of CSPC (AUC PSAD: 0.67, PIRADS: 0.72, combined: 0.78, p<0.001). When using a PSAD cut-off of ≥0.15 ng/ml/cc, 24% of all PIRADS-4 and 47% of all PIRADS-5 lesions were found to have CSPC, compared to 11% of PIRADS-4 and 35% of PIRADS-5 lesions with PSAD<0.15 (figure 1). When controlling for PIRADS-score, age, and race, multivariate analysis showed that PSAD was independently associated with CSPC using the cutoff of ≥0.15 ng/ml/ cc (OR 2.24, 95%CI 1.41-3.54, p<0.001). This finding was also supported when performing multivariate analysis controlling for PIRADs, age and race using PSAD as a continuous variable (OR 1.03 per 0.01 PSAD increase, 95% CI 1.02-105, p<0.001). Conclusions: PSAD appears to be a useful marker that can stratify the risk of CSPC in a complementary manner to prostate MRI. Further studies are warranted to help determine optimal PSAD cut-offs by PI-RADS scores to optimize CSPC predictions. Sagacity of Same Day Discharge: Incidence and Timing of Postoperative Adverse Events Following Minimally Invasive Urologic Surgery A. Castro Bigalli, K. Ginsburg, R. Viterbo, R. Greenberg, R. Uzzo, D. Chen, M. Smaldone, A. Kutikov, A. Correa Fox Chase Cancer Center, Philadelphia, PA, USA Introduction: Among efforts to judiciously utilize resources and contain cost, is a push to reduce postoperative length of stay, resulting in several groups promoting same day discharge (SDDC) for patients undergoing minimally invasive prostatectomy (MIP) and minimally invasive partial nephrectomy (MIpN). We aimed to 1) describe the incidence and timing of adverse events and 2) compare the incidence of these outcomes for patients undergoing SDDC and non-SDDC following MIP and MIpN. Materials &Methods: We review theAmerican College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients undergoingMIP andMIpN from 2015 to 2019. The primary outcomes were to describe the incidence of adverse events, readmission, reoperation, and death and the timing of these outcomes after surgery. We compared the incidence of outcomes of interest between patients undergoing same day discharge (SDDC) vs. non-SDDC using the chi-squared test. Results: Atotal of 64,975 patients underwent MIP (46,869) andMIpN (18,106), of which 650 (1%) had a SDDC. We noted 4,593 complications in 3,560 (5.5%) patients. Compared with non-SDDC patients, SDDC patients had similar incidence of any complication (5.2% vs. 5.4%, p=0.830), reoperation (0.9% vs. 1.3%, p=0.372), readmission (3.5% vs. 4.4%, p=0.268), or death (0.16% vs. 0.13%, p=0.836). With regards to timing of adverse events, 984/1057 (93%) blood transfusions, 59/129 (46%) myocardial infarctions, 40/86 (47%) cardiac arrests, 91/397 (23%) reoperations, 219/2857 (8%) readmissions, and 14/87 (16%) deaths occurred within 2 days of the index surgery. Conclusions: The perioperative period for patients undergoing MIP and MIpN remains a critical period in which serious adverse events do occur. Same day discharge may be a viable option for select patients, but a period of observation to ensure patients safety should remain the standard of care for most individuals undergoing MIP and MIpN. 14 13 8