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

© The Canadian Journal of Urology TM : International Supplement, August 2020 From Focused Residency Training to Attending Practice: A Junior Attending’s Experience with Greenlight Laser Enucleation of the Prostate (GreenLEP) on Large Prostates (> 80 cc) Michael E. Rezaee, MD 1 , Christopher D. Ortengren, MD 1 , Alan Yaghoubian, MD 2 , Michael T. Grant, MD 1 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; 2 Massachusetts General Hospital, Boston, MA, USA Introduction: GreenLEP is a relatively new endoscopic technique for the treatment of symptomatic benign prostatic hyperplasia. The procedure consists of transurethral en-bloc excision of the transitional zone of the prostate gland using a combination of mechanical dissection with a rigid scope and the Greenlight laser. Advanced endoscopic enucleation proceduressuchasGreenLEPandHolmium laserenucleationoftheprostate(HoLEP)canbe viewed as minimally invasive alternatives to open or robotic assisted simple prostatectomy for the treatment of large glands (> 80 cc). Over the past two decades widespread adoption of HoLEP has been hampered by a significant learning curve and the procedure is disproportionallyutilizedbyurologistswithexposure infellowshiptrainingorwho learned the procedure after years of experience with transurethral resection. There is limited data suggesting GreenLEP may have a softer learning curve than HoLEP but little is known about patient and procedural outcomes associated with GreenLEP on large prostates (> 80 cc)afterstructuredmentorship inresidencytrainingandthetransitiontoattendingpractice. Materials & Methods: A retrospective cohort study of patients with prostates > 80 cc who underwent GreenLEP with a single attending surgeon after structured mentorship during residency training (6 months in chief year, 18 cases) was conducted at two academic institutions between November 2017 and January 2020. Paired t-test was used to assess differences in International Prostate Symptom Score (IPSS), Quality of Life (QOL) due to urinary symptoms, and post void residual (PVR) 1 month after GreenLEP. Multiple linear regression was used to identify predictors of operative time. Generalized estimating equations were used to estimate the post procedural odds of stress urinary incontinence (SUI) as a logistic function of time and covariates. Results: A total of 73 patients were included with an average age of 68.9 years and estimated prostate volume of 147.8 cc (79-365 cc, SD 53.5). Overall, patients who underwent GreenLEP experienced significant reductions in IPSS (22.4 vs. 6.4, p < 0.001), QOL (4.5 vs. 1.4, p < 0.001) and PVR (442.5 vs. 54.4 cc, p < 0.001) at 1 month. An increasing number of cases performed was associated with decreasing operative time (β -0.76, p < 0.001, Figure 1), while larger estimated prostate volume was positively associated with increasing operative time (β 0.56, p < 0.001). Post procedural SUI was 15.3% at 1 month, and declined to 4.3% and 1.4% at 3 and 6 months, respectively. Age was the only variable associated with transient SUI (p = .04). Conclusions: GreenLEP is a safe and effective surgical technique for prostates > 80 cc that can be successfully performed as a junior attending after structured mentorship during chief year. Significant improvements in IPPS, QOL, and PVR can be achieved 1 month after GreenLEP, while post procedural SUI is approximately 1.4% at 6 months. “I Only Want To See the Doctor” Comparison of Patient Satisfaction between Urology Physicians and Advanced Practice Providers Erin Santos, PA, MPH , Kelly Ernst, FNP, CUNP, Lisa Beaule, MD, Moritz Hansen, MD, Matthew Hayn, MD, Jesse Sammon, DO Maine Medical Partners Urology, South Portland, ME, USA Introduction: There is a projected national shortage of urologists in the coming decade. The American Urological Association supports the incorporation of advanced practice providers (APPs) into urologic practices. However, there has been limited research addressing the effect of increased utilization of APPs in the urologic setting and available research about patient satisfaction with APPs is mostly limited to primary care and non- surgical specialties. We are seeking to understand patient satisfaction with APPs in a urologic setting. The subspecialty nature of urologic practice leads us to believe that there may be measurable and meaningful differences in patient satisfaction. Materials & Methods: We performed a retrospective assessment of patient satisfaction surveys administered over a 3 month period at a single high-volume academic urology practice in Maine. Patients were queried shortly after an encounter with one of 8 APPs or 8 physicians. Seven survey questions, relating specifically to patient satisfaction, were abstracted for analysis. These were derived from the ConsumerAssessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). Responses to individual survey questions were assessed between provider category. The independent effect of provider type on patient satisfaction was assessedwithmultivariable analysis, controlling for available patient characteristics (age, race, gender, marital status). Results: We analyzed responses from 1018 patient encounters. Patients seeing APPs (vs. a physician) tended to be older (79.9% of APP patient encounters were with patients over age 60, while 76.5% of physician encounters were with patients over age 60), more likely female (25.7% vs. 17.5%), non-white (4.1% vs. 2.5%), and less likely to be married or with a partner (69.1% vs. 74.6%). On univariable analysis there were no significant differences between APPS and physicians in any of the 7 metrics measuring patient satisfaction. Following adjustment for covariates, there were still no differences in patient satisfaction as demonstrated in the Table. Conclusions: Despite the subspecialty nature of urologic practice, use of APPs is not associated with diminished patient satisfaction. While this finding suggests that patient satisfaction will not be reduced by increased utilization of APPs, more broadly, further research needs to clarify the most appropriate role for APPs within an outpatient urology practice. We plan further research to examine specific diagnoses and investigate the most appropriate role for outpatient urology APPs. Further, our study does not assess other clinically relevant patient outcomes, and more research needs to be done to examine the safety and efficacy of APP integration. Finally, it is important to examine our study’s findings in a more broadly representative population as our patient population does not reflect the national averages. Nonetheless, given the impending national shortage of urologic physicians, our findings support the notion that APPs can be integrated into urologic care without decreasing overall patient satisfaction. P9 P8 Poster Session I 34