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

© The Canadian Journal of Urology TM : International Supplement, August 2020 WITHDRAWN P14 The Evolving Focus on Surgeon Pregnancy by the Medical Community Marianne Casilla-Lennon, MD , Stephanie Hanchuk, MD,Alyssa Grimshaw, M.S., Justin Nguyen, MD, Benjamin Press, MD, Sisi Zheng, BA, David Kim, BA, Jaime Cavallo, MD, MPHS Yale School of Medicine, New Haven, CT, USA Introduction: Women surgeons have co-managed pregnancy and surgical practice for as long as they have been surgeons. We sought to chronicle the evolution of the medical community’s focus on surgeon pregnancy by investigating thematic trends in the medical literature. Materials & Methods: A systematic literature search using keywords was performed in Web of Science, Embase, and Medline for publications regarding physician pregnancy. Data regarding surgeon pregnancy in training and in practice were abstracted from the literature search results. Results: Studies and narrative reviews regarding physician pregnancy began to populate the medical literature in the 1970s, paralleling a surge in medical school matriculation by women. Approximately fifteen years elapsed before the first studies of surgeon pregnancy emerged. The earliest studies focused on the effects of pregnancy on the field of specialty, practice type, and careers of women physicians. Multiple studies P15 reported that female physicians who bore children were significantly less likely to hold academic positions commensurate with their experience level or ability, to have full-time employment status, and to achieve the work productivity of male physicians or female physicians who did not bear children. Early studies also consistently reported that male medical faculty and trainees were significantly more likely to hold negative views of female trainee pregnancy, the medical work environment toward pregnant trainees, and family-medical career balance. The medical community began to shift its focus toward medical workforce planning in the 1990s by evaluating the existence and comparative features of maternity leave policies for physicians in practice and in training. Beginning around the turn of the millennium, multiple studies report an increase in the birthrate among women surgeons in training, coined the “surgical residency baby boom”. Studies in the newmillennium began to report on the occupational hazards of procedural careers on pregnancy, including radiation exposure, hazardous substance exposures, and long work hours. Higher frequencies of infertility, assisted reproductive technology utilization, spontaneous abortion, preeclampsia, fetal growth restriction, preterm labor, and labor induction have been reported in female surgeons compared to age-matched female peers. Conclusions: The medical community’s focus on surgeon pregnancy has evolved substantially froma prioritization of the effects of surgeon pregnancy on colleagues and the pregnant surgeon’s work productivity, to maternity leave policy advocacy, and ultimately to the occupational hazards of surgical practice on pregnancy. Ureteral Botulinum Toxin Attenuates Prostaglandin Expression in an Animal Model Kevin Krughoff, MD 1 , Scott Palisoul, BS 2 , Faith Anderson, BS 3 , Steven Tau, BS 3 , Alison Young, MS 3 , Jason Pettus, MD 2 , Karen Moodie, DVM 4 , Matthew Havrda, PhD 3 , David Chavez, MD 1 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; 2 Department of Pathology, Dartmouth-Hitchcock, Lebanon, NH, USA; 3 Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; 4 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA Introduction: Prostaglandin E (PGE) is associated with ureteral peristalsis and inflammation. Clostridium Botulinum toxin type A (BoNT-A) has been shown to impact several chemosensory mediators, however the impact on PGE is unknown. Our goal was to determine the effect of ureteral BoNT-A instillation on local PGE synthase expression in a novel animal model of ureteral inflammation. Materials & Methods: Cystotomy and unilateral ureteral BoNT-A instillation with ipsilateral distal ureteral ligation was performed on 3 New Zealand white rabbits (2.4-2.8 kg).Afourth rabbit underwent 4 cc saline instillation to serve as a negative control.Afifth rabbit underwent direct periureteral BoNT-Ainjection in addition to ureteral instillation to serve as a positive control. Rabbits were survived for 7 days. Ureteral tissue was fixed in formalin and paraffin embedded. Ureteral sections underwent antigen retrieval followed by incubation with PGE synthase antibody and DAB HRP secondary. RESULTS: All rabbits survived 7 days with one exception which was euthanized on post- operative day five following wound complications. PGE synthase was detected in ureteral tissue of all specimens. BoNT-A exposure was associated with a decrease in PGE synthase signalinadose-dependentfashion,withdirectinjectionshowingthegreatestdecreaseinsignal. Conclusions: The feasibility of an in-vivo study of ureteral BoNT-A instillation is demonstrated herein, with preliminary results showing attenuation of ureteral PGE synthase expression with BoNT-Aexposure. The ability of BoNT-Ato exert chemosensory and/or inflammatory modulating effects without direct injection is possible under conditions of inflammation. P13* Poster Session I 36 Figure 1: Left - Midline cystotomy with ureteral instillation followed by distal ligation. Right - Urethral catheterization and cystorrhaphy leak test. Figure 2: Native ureter stained for PGE synthase at 10X magnification. Figure 3: 40Xmagnification of ureter sections with distal ligation.A) No BONT-Aexposure. B) 20U BoNT-A ureteral instillation. C) 5U BoNT-A ureteral instillation and 30U direct injection into periureteral tissue and bladder. Figure 3: 40Xmagnification of ureter sections with distal ligation.A) No BONT-Aexposure. B) 20U BoNT-A ureteral instillation. C) 5U BoNT-A ureteral instillation and 30U direct injection into periureteral tissue and bladder. *Max K. Willscher Award Eligible