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

NE AUA 2020 Abstracts Scientific Session II: Stones I 11 Risk Factors for Sepsis Following PCNL William C. Daly, BS 1 , Erin Santos, PA-C 2 , Christopher Stockdale, MD 2 , Johann Ingimarsson, MD 2 1 MaineMedicalCenterResearchInstitute,Center forOutcomesResearchandEvaluation,Portland, ME; 2 Maine Medical Center Department of Urology, Portland, ME Introduction: Post-operative sepsis is a rare, potentially devastating, risk of percutaneous nephrolithotomy (PCNL). Knowledge of pre-operative risk factors may identify which patients will benefit most from new management strategies. Materials & Methods: Retrospective chart review was performed on 153 consecutive patients who underwent PCNL at Maine Medical Center between October 2016 and December 2018. Patient demographic factors, comorbidities, infection history, culture data, and stone factors were recorded. Post-operative sepsis was defined according to SIRS criteria for severe sepsis. Multivariate logistic regression was used to evaluate categorical variables as risk factors for sepsis. Fischer exact and student t tests were used to evaluate variables in patients with positive pre-op urine culture. Results: 14 of 153 patients developed post-operative sepsis. Septic patients did not differ from others with regards age, gender, BMI, stone laterality, diabetes mellitus or renal function. Infected stone as an indication for PCNL was an independent predictor of sepsis (OR 5.66; p = 0.015), as was large stone burden (a Seoul score >= 5 (OR 3.76; p = 0.046) or S.T.O.N.E score >= 9 (OR 5.52; p = 0.018)). Patients with limited mobility (upper or lower body) were much more likely to become septic (OR 21.4; p = 0.002). Any positive pre-op culture was independently associated with sepsis (OR 13.7; p = 0.002), as were gram negative bacteria as a group (OR 5.7; p = 0.025) and specifically the proteus species (OR 10.6; p = 0.023). Such association was not found for gram positive bacteria. Among 45 patients with positive pre-op cultures, female gender (RR 3.9; p = 0.047), infected stone as an indication (RR 3.1; p = 0.047), limited lower (RR 3.5; p = 0.022) and upper (RR 3.4; p = 0.027) body mobility were all associated with post-op sepsis. Negative culture was protective against sepsis (OR 0.073; p = 0.002).Among patients with negative pre-op cultures, 2/109 (1.8%) had post-op sepsis, both with large complex stones (Seoul and S.T.O.N.E scores >=9). Conclusions: Limited patient mobility and large stone burden are strong predictors of post PCNL sepsis. Positive pre-op urine culture, especially those with a gram-negative organism, also correlate with increased risk. Patients without these risk factors have low probability of sepsis, even before accounting for variation in intra-operative factors. Our results suggest a framework for risk-stratifying patients prior to surgery and the potential for more aggressive antimicrobial intervention in high risk patients, and less aggressive treatment in low risk patients. Risk Factors for Multiple Intravesical Recurrences of Non-muscle Invasive Bladder Cancer Andrew J. Charap, BS 1 , Jorge Daza, MD 1 , Linda Dey, MD 2 , Alberto Martini, MD 1 , John Pfail, BS 1 ,AshkanMortezavi, MD 2 , Gunnar Steineck, MD 2 , Lotta Renström-Koskela, MD 2 , Peter Wiklund, MD PhD 1 , John Sfakianos, MD 1 1 Icahn School of Medicine at Mount Sinai, NewYork, NY; 2 Karolinska Institute, Stockholm, Sweden Introduction: Currently available risk calculators such are useful in identifying patients withnon-muscle invasivebladdercancer(NMIBC)atriskforrecurrenceyetcannot identify patients who are at risk of multiple recurrence. Using an untreated cohort, we aimed to identify risk factors for multiple-recurrent disease in order to better risk stratify patients with NMIBC and aid clinical decision-making. Materials &Methods: Our cohort consisted of 535 patients diagnosedwith bladder cancer in StockholmCounty between the years 1995-96. We included patients with pathologic Ta or T1 disease who were confirmed to have at least one recurrence of their disease during median follow up of 12 years. Patients were excluded if they underwent cystectomy after first recurrence of disease. Patients who received curative chemotherapy, curative radiation, or an intravesical agent such as BCG or mitomycin were excluded to eliminate the confounding effects of these treatments on disease recurrence. Of this cohort, we identified 136 with NMIBC who experienced a recurrence during the course of the study and met criteria for inclusion. Results: The median age of the cohort at diagnosis was 72 years. 89 participants (65%) were male and 118 (88%) had pathologic Ta disease. 37 patients (27%) had high grade disease. Multiple recurrences were identified in 94 (69%) patients, versus 42 (31%) patients who experienced only a single recurrence. We found that patients with multiple-recurrent disease were more likely to experience their first recurrence within 6 months of their initial diagnosis (OR 2.49, 95% CI 1.07 - 5.79). Interestingly, many of the parameters included in the EROTC risk calculator were not significantly associated with multiple recurrence versus single recurrence, such as multifocal disease (OR 1.83, 95%CI .82 - 4.08), high-grade disease (OR 1.07, 95% CI .47 - 2.45), or T1 disease (OR .51, 95% CI .18 - 1.39), (Figure 1). Conclusions: In this study of an untreated cohort of patients we compared the clinical characteristics of patients withmulti- versus single-recurrent non-muscle invasive bladder cancer. We found that patients with multiple recurrences were more than two-and-a-half times as likely to have experienced a first recurrence within six months. This information is important for risk stratifying patients for intravesical treatment. 10 5