Abstracts from the New England Section of the AUA 2020: A Virtual Experience

© The Canadian Journal of Urology TM : International Supplement, August 2020 Nocturia Independently Predicts Left Ventricular Hypertrophy and Left Atrial Enlargement among Patients with Cardiovascular Disease Thomas F. Monaghan, MD Candidate 1 , Pakinam Mekki, MD Candidate 1 , Christina W. Agudelo, MA 1 , Kyle P. Michelson, BA 1 , Fred Gong, BA 1 , Christopher D. George, BA 1 , Zhan D. Wu, BS 1 , Lily Lee, MPH 1 , Donald L. Bliwise, PhD 2 , Karel Everaert, MD, PhD 3 , Jeffrey P. Weiss, MD 1 1 SUNY Downstate Health Sciences University, Brooklyn, NY; 2 Emory University School of Medicine, Atlanta, GA; 3 Ghent University Hospital, Ghent, Belgium Introduction: Morbidly enlarged prostates > 400 g (MEP) due to benign prostatic hypertrophy(BPH)canresult insignificant lowerurinarytractsymptomsthatarerefractory to standard medical and surgical management. While the vast majority of large glands are amenable to either Holmium laser enucleation (HoLEP) or robotic simple prostatectomy (RSP), each of these procedures has drawbacks that limit effective management of MEPs. Namely, accessing the apex is difficult from the robotic approach; for HOLEP, base access and morcellation are challenging for glands of this size and perineal urethrostomy is often required.WesoughttodevelopasafeprocedurecombiningthestrengthsofHoLEPandRSP. Materials & Methods: Patients with MEP and bothersome LUTS underwent a combined HoLEPandRSPprocedurebetween2017-2019.Patientchartswereretrospectivelyreviewed. Results: Three patients were identified with a mean prostate volume of 498 g (range 400- 600 g) all of whom required self catheterization to empty their bladders preoperatively. Operative time ranged from 270-384 minutes. Mean drop in hematocrit was 8%. An average of 64% of the gland was removed (range 275-330 g).All patients were discharged 31 on postoperative day 2 with a mean time to catheter removal of 10 days. One patient required an intraoperative blood transfusion and was found to have high risk prostate cancer in the specimen requiring further treatment. All patients were able to void at the time of follow up (mean 8.5 months) with a mean PVR of 64 cc. None of the patients have developed a urethral stricture and all have excellent continence. Conclusions: Combined HoLEP and RSP is a safe procedure for MEP that may not be adequately treated by either procedure alone. By combining these approaches, the need for perineal urethrostomy and morcellation are obviated, endoscopic time is decreased, thereby potentially lowering the risk of urethral stricture formation, and apical dissection is substantially simplified. 32 ConservativeManagement of Radiation-inducedMale Urethral Strictures: CanUrethral Reconstruction be Safely Avoided? Alexander Rozanski, MD, Lawrence Zhang, BA , Steven Copacino, BA, Alex Vanni, MD Lahey Hospital and Medical Center, Burlington, MA Introduction: Nocturia is a well-recognized, but poorly characterized, manifestation of cardiovascular disease. Multiple studies have reported associations between hypertension and the presence and severity of nocturnal voiding. Hypertension is associated with multiple cardiac abnormalities which independently heighten the risk for adverse cardiovascular outcomes, including left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and prolonged QTc interval (p-QTc), However, the association between nocturia and these specific cardiac abnormalities is not well understood. This study aims to explore potential associations between nocturia and LVH, LAE, and p-QTc on electrocardiography (ECG). Materials & Methods: Retrospective analysis of self-reported nocturnal voiding frequencies from 153 patients evaluated at an inner-city academic cardiology practice. Patient-reported nocturnal voiding frequency was recorded in the medical record at the time of routine clinical encounter. A nocturia database was compiled with institutional review board approval via a waiver of informed consent for retrospective analysis. ECGs concurrent with the clinical encounter were abstracted and evaluated according to current American Heart Association guidelines by a reviewer blinded to nocturia status. ECGs were assessed for the presence of LVH (using the Cornell and Sokolow-Lyon criteria), LAE (product of the amplitude and duration of the terminal negative component of the P wave in lead V1 measuring ≥ 1 mm by 1 mm or a total duration of the P wave ≥ 120 ms in the inferior leads), and p-QTc (≥ 460 ms in women and ≥ 450 ms in men). Three different multiple logistic regression models were used to predict LVH, LAE, and p-QTc based on nocturia status: Model I adjusted for age; Model II adjusted for age, sex, and race; Model III adjusted for age, sex, race, body mass index (BMI), hypertension, diabetes mellitus, and diuretic utilization. Results : A total of 153 patients met the criteria for inclusion. The study sample was predominantly female (74%) and self-reported African-American race (90%), with a high prevalence of obesity (63%), hypertension (78%), diabetes mellitus (33%), and diuretic use (40%). Nocturia was present in 77% of study subjects, while LVH, LAE, and p-QTc were present in 44%, 41%, and 29% of study subjects, respectively. Nocturia predicted LVH according to Model I (OR 3.20, [1.18-8.69], p = 0.022), Model II (OR 3.17, [1.16-8.69], p = 0.025),andModelIII(OR2.99,[1.02-8.75],p=0.046).NocturiaalsopredictedLAEaccording to Model I (OR 4.72, [1.56-14.30], p = 0.006), Model II (OR 4.71, [1.54-14.37], p = 0.006), and ModelIII(OR4.24,[1.32-13.57],p=0.015).Nosignificantassociationswereobservedbetween nocturia and p-QTc according to Model I (OR 1.51, [0.56-4.10], p = 4.10), Model II (OR 1.39, [0.51-3.81], p = 0.517), or Model III (OR 1.19, [0.41-3.49], p = 0.747). Conclusions: LVH and LAE were both independently associated with nocturia in the outpatient cardiology setting. LVH is associated with reduced left ventricular compliance, whereas LAE reflects higher left ventricular preload, and both mechanisms likely predispose patients to sodiumandwater retention. Consistently, existing volume overload, particularly in conjunction with recumbency during sleep, would be expected to increase preload and cardiac output, lending to increased nocturnal urine production. Further investigation into nocturia as a marker of underlying cardiovascular disease is warranted. Combination Robotic Simple Prostatectomy and HoLEP for Morbidly Enlarged Prostates > 400g Alison Levy, MD , David Canes, MD, Jessica Mandeville, MD Lahey Hospital and Medical Center, Burlington, MA Introduction: Studies have established the effectiveness of Prostatic Urethral Lift (PUL) with relieving bladder outlet obstruction; however, predictors of success or failure with this new modality are not well documented. We sought to determine factors that may impact PUL outcomes. Materials & Methods: A retrospective review of prospectively maintained Benign Prostatic Hyperplasia (BPH) database for patients who underwent PUL at University of Vermont Medical Center between 2017-2020 was performed. Demographic data, procedure characteristics, International Prostate Symptom Score (IPSS), and Post Void Residuals (PVR) pre and post PUL were collected. Associations between the change in IPSS score (IPSS pre PUL - IPSS post PUL) were analyzed. Results: A total of 121 consecutive patients underwent PUL. Patients who did not have IPSS pre or post PUL (N = 13) or underwent median lobe Transurethral Resection of the Prostate (TURP) (N = 3) or Direct Vision Internal Urethrotomy (DVIU) (N = 1) in the same setting were excluded. One hundred and five patients were included. The median age was 71 years (interquartile [IQR] 63-77), with a median BMI of 28 (IQR 25-31). Most patients (76%) were on BPHmedications pre PUL. Of those, 54 (67.5%) were able to stop taking BPH medications post PUL. 9.5% of patients had previous BPH surgeries and 2.9% of patients required chronic Foley or clean intermittent catheterization (CIC) pre PUL. Median number of sutures placed at PULwas 4 (IQR 4-5). Median follow up time post PULwas 3.3 months (IQR2.4-14.5).IPSSdecreasedfromapre-operativemedianof19(IQR13-23)to11(IQR6-17), p < 0.001, while PVR decreased from 37 mL (IQR 10-116) to 35 mL (IQR 12-66), p = 0.046, respectively. In a multivariate regression analysis after adjusting for age, Body Mass Index, prostatevolume,BPHmedicationattimeofPULorpriorBPHsurgery,priorchroniccatheter or CIC, high median bar or lobe, number of sutures during PUL, median lobe transurethral incision, postoperative catheter due to retention, continued BPHmedications on follow up, and follow up time, we found that increasing age is associated with less change in IPSS (Coef. Mean = -0.3, 95% confidence interval -0.4 - -0.1, p = 0.010). Conclusions: Our results showed that even though PUL still has good effect in all ages, there was less change in IPSS in older patients. Although PUL is less invasive compared to other BPH surgical treatments, it may have less favorable outcomes specifically in patients older than 80 years. This may be due to bladder dysfunction from a more chronic obstructive process, and could potentially support earlier intervention for some patients. It may also sway surgeons toward performing TURP in older eligible patients. Regardless, we believe further study is needed to fully establish this relationship and to assess if the difference in efficacy is large enough to merit a change in clinical practice. 30 14 Scientific Session III: BPH/Recon