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

© The Canadian Journal of Urology TM : International Supplement, August 2020 An Effective Foley Catheter Training Protocol for all Intern Residents William J. Devan, MD , Brian Jumper, MD, Moritz Hansen, MD, Christina Gentile, MPH, Bethany Hundt, MA Maine Medical Center, South Portland, ME, USA Introduction: Bladder catheterization by means of foley catheter is a simple, effective medical intervention when utilized appropriately. Unfortunately, incorrect or improper usage is problematic. Catheter associated urinary tract infections (CAUTI) are a leading cause of nosocomial infections (> 30% of hospital acquired infections) and are associated with significant increases in patient morbidity and mortality as well as health care costs andhospitalreimbursement.CAUTIsareassociatedwithmultiplecatheterizationattempts and poor technique which both stem from inadequate education. Given these reasons, Maine Medical Center had prior policies limiting foley catheter placement to properly trained nurses with an exception for urology and ob-gyn providers. There is also a lack of overall knowledge regarding foley catheterization. The Canadian Journal of Urology reports that 70% of foley catheter consults to an academic urology service did not need an adjunct device (wire, cystoscope, etc). The authors argue this creates higher costs to the healthcare system for poor appropriation of resources. Finally, a report from 2004 paper show approximately 50% of representedmedical schools are not attaining theAssociation of American Medical College (AAMC) objective of rigorously teaching and evaluating technical procedures (including foley catheterization). Given these reasons, we developed a training program for foley catheterization for new intern residents. Materials &Methods: We obtained institution review board approval. We then created a training program that incorporated the following learning materials: instructional videos, educational infographic,referencepowerpointslides,multiplechoice test,andan in-person simulation using a pelvic model scored via a 10-point rubric. All educational materials were available on an online learning system. We trained all incoming interns who started on July 1 2019. The training was considered mandatory for all incoming interns. For the data collection component, we offered incoming residents an optional electronic survey prior to commencing their catheter training and again another optional paper survey immediately following the completion of their simulation component. Surveys contained a Likert scale confidence score and four question objective test that was scored from 0-100%. Results: There were a total of 65 interns that participated in the foley catheter training. These 65 represented eight intern programs. 53 interns (response rate 81.5%) completed the pre-training survey and 60 interns (response rate 92.3%) completed the post-training survey. 94.2% of incoming residents reported some form of foley catheter training during medical school, but of these, only 34.7% had undergone formal simulation. Prior to our training 51.1% of respondents were confident in their ability to place a foley catheter and their objective test score was 50%.After our intervention there was a significant difference in pre and post training confidence levels and objective test scores, 3 (2-3) vs. 4 (4-4.75) [Median (IQR)] p < 0.001 and 50% (50-75) vs. 100% (100-100) p < 0.001 respectively. Mann- Whitney U test p-values reported. Conclusions: Our data shows that interns are both lacking confidence and objective competence in placing foley catheters. We also demonstrate that our training protocol is a successful intervention by showing improvement in both metrics. P4 A Case Study Describing Successful Treatment of Recurrent Penile Abscesses using the Carrion Cast Lael Reinstatler, MD, MPH 1 , Martin Gross, MD 1 , Ricardo Munarriz, MD 2 1 Dartmouth HitchcockMedical Center, Lebanon, NH, USA; 2 Boston University, Boston, MA, USA Introduction: The Carrion cast was first published in 2015 as a technique for treating infected penile prostheses. Here we describe a case report applying this procedure to a persistent penile abscess with success. Materials & Methods: This is a case report. Results: A 67-year-old gentleman without significant past medical history presented to an ER with penile pain and swelling. Upon presentation he had clinical signs of infection with a temperature to 103F and WBC of 15. Urinalysis was positive only for trace blood. Due to a contrast allergy, non-contrast CT scan of the pelvis was orderedwhich showed left greater than right penile swelling without discrete abscess or collection. He was observed on IV antibiotics without significant improvement for 48 hours when gadolinium-MRI was obtained. This revealed bilateral 8x1.5cm corporal abscesses. Upon further questioning, the patient revealed that three weeks prior to this event he had performed masturba- tion to include placing an earthworm and barbecue skewer per his urethra. Of note, the worm was removed intact. Once this history was obtained and based on persistent signs of infection, he was taken to the OR for washout via penoscrotal approach. Purulent material was encountered, washed out with triple antibiotic solution (vancomycin/ zosyn/amphotericin), drains were placed and the incision was closed. His cultures grew streptococcus constellatus and he was transitioned to augmentin and discharged home several days later. He was seen in clinic in follow-up four weeks later where recurrent abscesses were suspected. Cystoscopy in the office was negative for fistula. He refused hospital admission given the Christmas Holiday but presented a day later for admission for IV antibiotics and repeat MRI which also ruled out a fistula and demonstrated recurrent bilateral abscesses. He was taken to the OR where the abscesses where washed out and calcium sulfate beads with vancomycin and tobramycin were instilled into both corporal spaces, as previously described by Dr. Carrion. Ultimately, he recovered from this second procedure, was discharged home, and has been seen in clinic with complete recovery and no further infectious issues. Conclusions: In addition to usage in the infected penile prosthesis context, the Carrion cast may be applied to penile abscesses unrelated to prostheses. P3 Nocturnal Urine Production is Central to the Pathogenesis of Nocturia in Patients with the Nocturnal Polyuria Syndrome Thomas F. Monaghan, MD Candidate 1 , Christina W. Agudelo, MD Candidate 1 , Syed N. Rahman, MD Candidate 1 , Kyle P. Michelson, MD 1 , Jason M. Lazar, MD 1 , Karel Everaert, MD, PhD 2 , Jeffrey P. Weiss, MD 1 , Donald L. Bliwise, PhD 3 1 SUNY Downstate Health Sciences University, Brooklyn, NY, USA; 2 Ghent University Hospital, Ghent, Belgium; 3 Emory University School of Medicine, Atlanta, GA, USA Introduction: Fundamentally, nocturia is driven by a mismatch between nocturnal urine production (NUP) and bladder capacity, and the degree of discordance between these two variables strongly correlates with nocturia severity (Avulova, et al, Scand J Urol, 2015). By definition, patients with nocturnal polyuria [NP] in the absence of identifiable contributory comorbidities (termed the Nocturnal Polyuria Syndrome [NPS]) incur excess NUP, but bladder capacity in these patients remains poorly characterized. This study compares voided volumes (as a proxy for functional bladder capacity) in nocturia patients with vs. without NPS. Materials & Methods: Retrospective analysis of voiding diaries showing ≥ 2 nocturnal void(s) frommen aged ≥ 18 years at an outpatient urology clinic. Patients with secondary causes of NP (diuretic use, sleep apnea, heart failure, edema, kidney disease, and diabetes insipidus) were excluded. Included patients were divided into 2 cohorts by NP status (NUP > 90 vs. ≤ 90 mL/h). The number of nocturnal voids (NV), 24-h maximum voided volume (MVV), and nocturnal MVV (NMVV) were compared between groups using the Wilcoxon Rank-sum test to determine significance. Results: Patients with (n = 49) vs. without (n = 60) NPS demonstrated greater NV (3 [2- 4] vs. 2 [2-3] voids, p = 0.030), MVV (375 [300-480] vs. 208 [173-300] mL, p < 0.001), and NMVV (300 [260-460] vs. 180 [125-240] mL, p < 0.001). Conclusions: Patients with vs. without NPS demonstrated more severe nocturia despite greater functional bladder capacity. Taken together, these results suggest that excess NUP (opposed to diminished bladder capacity) is the primary mechanism underlying the production-storage mismatch in NPS. Patients with nocturia owing to NPS may particularly benefit from behavioral/pharmacologic interventions targeting nocturnal urine volume. P2 Nocturnal-Only Voiding Diaries: ARational Alternative to 24-Hour Diaries for Patients with Nocturia? Thomas F. Monaghan, MD Candidate , Raymond Khargi, MD, Connelly D. Miller, MD Candidate,ChristinaW.Agudelo,MDCandidate,KyleP.Michelson,MD,SyedN.Rahman, MD Candidate, Matthew R. Epstein, MD, Jeffrey P. Weiss, MD SUNY Downstate Health Sciences University, Brooklyn, NY, USA Introduction: The major etiologies underlying nocturia can be divided into excess urine production (i.e., nocturnal [NP] and global polyuria [GP]) or small bladder capacity (SBC). An assessment of voiding diary data from the hours of sleep alone can, in of itself, support a diagnosis of NP, but the generalizability of nocturnal urinary data to the 24-h period (e.g., in the diagnosis of GP or SBC) remains unclear. This study determines the sensitivity and specificity of nocturnal urinary parameters in diagnosing nocturia owing to GP and SBC. Materials & Methods: Retrospective analysis of voiding diaries showing ≥ 1 nocturnal void(s) from men aged ≥ 18 years at an outpatient urology clinic. GP was defined as a 24-h urine volume > 3000 mL. SBC was defined as a 24-h Maximum Voided Volume (MVV) < 200 mL. Nocturnal urine production (NUP) > 125 mL/h (3000 mL divided by 24 hours) and Nocturnal MVV (NMVV) < 200 were employed as nocturnal proxies for GP and SBC, respectively. Results: A total of 483 entries from 288 patients were included. Fifty-eight diaries demonstrated a 24-h urine volume > 3000 mL, and 110 diaries reported NUP > 125 mL/h, such that NUP > 125 mL/h was 71% sensitive and 84% specific for GP. Eighty-nine diaries reported a 24-h MVV < 200 mL, and 139 entries demonstrated a NMVV < 200 mL, corresponding to a 100% sensitivity and 87% specificity for SBC. Conclusions: Beyond its intrinsic utility in diagnosing NP, nocturnal urinary data can predict diagnoses of GP and 24-h SBC with a fair degree of sensitivity and specificity. Nocturnal-only voiding diaries may represent a more patient-centered screening instrument in the initial evaluation of nocturia—particularly in the setting of patient nonadherence or when 24-h diaries are otherwise impractical. P1 Poster Session I 32