ObjectiveDespite its ubiquity in the certification process among surgical specialties, there is little data regarding oral board delivery across various procedural fields. In this study we sought to determine the specifics of oral board exam administration across surgical disciplines with the goal of highlighting common practices, differences, and areas of innovation. This comparative analysis might further serve to identify unifying principles that undergird the oral board examination process across specialties.DesignA standardized questionnaire was developed that included domains of exam structure/administration, content development, exam prerequisites, information about examiners, scoring, pass/failure rates, and emerging technologies. Between December 2022 and February 2023 structured interviews were conducted to discuss specifics of various oral board exams. Interview answers were compared between various specialties to extrapolate themes and to highlight innovative or emerging techniques among individual boards.SettingInterviews were conducted virtually.ParticipantsExecutive members of 9 procedural medical boards including anesthesiology, neurosurgery, obstetrics, and gynecology, ophthalmology, orthopaedic surgery, otolaryngology—head and neck surgery, plastic surgery, general surgery, and urologyResultsCommon themes include assessment of pre-, intra- and postoperative care; all testing involved candidate examination by multiple examiners and psychometricians were used by all organizations. Important differences included virtual versus in person administration (3 out of 9), inclusion and discussion of candidates’ case logs as part of the exam (4 out of 9), formal assessment of professionalism (4 out of 9), and inclusion of an objective structured clinical examination (2 out of 9).ConclusionsWhile there are common themes and practices in the oral board delivery process between various surgical fields, and important differences continue to exist. Ongoing efforts to standardize exam administration and determine best practices are needed to ensure oral board exams continue to effectively establish that candidates meet the qualifications required for board certification.

OBJECTIVE To evaluate longitudinal trends in surgical case volume among junior urology residents. There is growing perception that urology residents are not prepared for independent practice, which may be linked to decreased exposure to major cases early in residency.METHODS Retrospective review of deidentified case logs from urology residency graduates from 12 academic medical centers in the United States from 2010 to 2017. The primary outcome was the change in major case volume for first-year urology (URO1) residents (after surgery internship), measured using negative binomial regression.RESULTS A total of 391,399 total cases were logged by 244 residency graduates. Residents performed a median of 509 major cases, 487 minor cases, and 503 endoscopic cases. From 2010 to 2017, the median number of major cases performed by URO1 residents decreased from 64 to 49 (annual incidence rate ratio 0.90, P < .001). This trend was limited to oncology cases, with no change in reconstructive or pediatric cases. The number of major cases decreased more for URO1 residents than for residents at other levels (P-values for interaction < .05). The median number of endoscopic cases performed by URO1 residents increased from 85 to 194 (annual incidence rate ratio 1.09, P < .001), which was also disproportionate to other levels of residency (P-values for interaction < .05).CONCLUSION There has been a shift in case distribution among URO1 residents, with progressively less exposure to major cases and an increased focus on endoscopic surgery. Further investigation is needed to determine if this trend has implications on the surgical proficiency of residency graduates. UROLOGY 179: 32-38, 2023. (c) 2023 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 Apr 2023MP48-07 NATIONAL TRENDS OF COMMON FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROCEDURES: 2016-2019 Connie Wang, Daniel Schoenfeld, Joseph Marte, and Gregory Joice Connie WangConnie Wang More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Joseph MarteJoseph Marte More articles by this author , and Gregory JoiceGregory Joice More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003294.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate national trends in settings and charges of common female pelvic medicine and reconstructive surgery (FPMRS) procedures. METHODS: Common FPMRS procedures were identified by Current Procedural Terminology and International Classification of Diseases (10th Revision) Procedure Coding System codes and classified into 3 categories: 1) stress urinary incontinence procedures (SUI-p) 2) pelvic organ prolapse procedures (POP-p) and 3) overactive bladder procedures (OAB-p). Data from inpatient (IP) and outpatient (OP) encounters for included procedures between 2016-2019 were extracted from the Nationwide Inpatient Sample and Nationwide Ambulatory Surgery Sample from the Healthcare Cost and Utilization Project. Stratified cluster sampling was used to create weighted, national estimates. Student t-tests and multivariable linear regression was performed to compare procedural factors. RESULTS: A total of 893,450 weighted procedures were analyzed, of which 9.3% were performed IP and 90.7% were performed OP. Over the study period, there was a 4.3% increase in total number of procedures, and the proportion performed OP increased from 88.1% to 92.5%. Between 2016-2019, there was a 10.6% and 10.5% increase in SUI-p and POP-p performed OP, respectively. Over the study period, proportion of SUI-p performed OP increased from 96.4% to 99.7%, and proportion of POP-p performed OP increased from 76.5% to 82.8%. 99.9% of OAB-p were performed OP. Charges for SUI-p performed IP were $16,705 higher than those performed OP (p=0.007) and charges for POP-p performed IP were $21,864 higher than those performed OP (p<0.0001). Predictors of SUI-p and POP-p being performed OP included private insurance, fewer co-morbidities, and receiving care at a rural facility or at a center in the Midwest or South. Additionally, SUI-p were more likely to be performed OP for patients < 52 years of age. POP-p were more likely to be performed IP than SUI-p (OR 20.8; 95% CI 20.2 - 21.5), while OAB-p were less likely to be performed IP than SUI-p (OR 0.01; 95% CI 0.01 – 0.02). CONCLUSIONS: An increasing majority of SUI and OAB procedures performed nationwide are performed in OP settings. These procedures performed OP carry less charge than those performed IP and are more likely for younger, healthier patients with private insurance. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e657 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connie Wang More articles by this author Daniel Schoenfeld More articles by this author Joseph Marte More articles by this author Gregory Joice More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction and ObjectivesThe standardization of fetal sonography has enabled early detection of genitourinary anomalies and referral for prenatal counseling with pediatric urologists. Prenatal urologic consultation can determine the need for antenatal and postnatal intervention, assuage parental anxiety, and establish continuity of care. The COVID-19 pandemic led to a significant increase in virtual visits (VVs). Our aim was to characterize a cohort of patients who underwent prenatal VVs with pediatric urologists and to assess adherence to prenatal recommendations for neonatal urologic care.Materials and MethodsData were collected through retrospective chart review of all patients receiving prenatal virtual consultation for genitourinary anomalies at our institution from July 1, 2020 to September 30, 2021. Data collected include maternal and gestational age at the time of prenatal imaging and VV, diagnosis of the fetus and neonate, and adherence to pediatric urological recommendations.ResultsDuring the study period, there were 70 prenatal VVs for 69 singleton and 1 twin gestation. 84 prenatal genitourinary diagnoses were made in these 71 cases. Of the 56/71 children known to have been born by the time of analysis, there are 63 postnatal genitourinary diagnoses. Postnatal diagnoses were consistent (38/56, 68%) or partially consistent (16/56, 29%) with prenatal diagnoses in 54/56 neonates (96%). There was 100% adherence to the postnatal imaging and antibiotic recommendations. One patient failed to attend the postnatal visit and one patient is due for repeat postnatal imaging to determine the necessity of follow-up.ConclusionsPrenatal VVs promoted effective counseling of genitourinary anomalies and were associated with impressive postnatal adherence to prenatal recommendations. This is, to our knowledge, the first study to assess the impact of prenatal virtual pediatric urological consultation on postnatal adherence to prenatal recommendations. Future study will benefit from survey of the patient VV experience and evaluation of the relative merits of virtual versus in-person prenatal visits in a prospective, randomized fashion.

You have accessJournal of UrologyEducation Research I (PD02)1 Sep 2021PD02-04 TOP-HEAVY TRAINING: TRENDS IN UROLOGY RESIDENT EXPOSURE TO MAJOR SURGERY Ezra Margolin, Daniel Schoenfeld, Suzanne Merrill, Jay Raman, R. Houston Thompson, Adam Reese, Dipen Parekh, John Lynch, Baruch Grob, Daniel Williams, Richard Lee, Stanley Zaslau, Thomas Guzzo, Patrick Shenot, and Gina Badalato Ezra MargolinEzra Margolin More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Suzanne MerrillSuzanne Merrill More articles by this author , Jay RamanJay Raman More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Adam ReeseAdam Reese More articles by this author , Dipen ParekhDipen Parekh More articles by this author , John LynchJohn Lynch More articles by this author , Baruch GrobBaruch Grob More articles by this author , Daniel WilliamsDaniel Williams More articles by this author , Richard LeeRichard Lee More articles by this author , Stanley ZaslauStanley Zaslau More articles by this author , Thomas GuzzoThomas Guzzo More articles by this author , Patrick ShenotPatrick Shenot More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001966.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The landscape of urologic training has shifted dramatically with the emergence of robotic surgery. Increased utilization of robotic surgery may alter the level of training at which residents are exposed to major urologic cases. We queried this through evaluation of volume trends in major cases among urology residents at different stages of training at a multi-institutional level. METHODS: Urology resident ACGME case logs from 12 institutions from 2011-2017 were obtained and de-identified. Trends in surgical case distribution were measured using linear regression for residents at each level of urologic training (URO1, URO2, URO3, and URO4). RESULTS: From a sample of 221 resident graduates, a total of 348,656 total cases were logged, of which 116,363 (33%) were major (robotic and open). Major case distribution included 60% oncology, 27% reconstructive and 13% pediatric. Robotic surgeries constituted 34% of all major cases, and the proportion of robotic cases increased by 1.4% per year (p<0.001 for slope). Major cases accounted for 17% of all cases done by URO1 residents, 21% for URO2, 39% for URO3, and 55% for URO4. From 2011 to 2017, the percentage of major cases among URO1 residents decreased from 26% to 13% (-1.8% per year, p<0.001 for slope). This trend primarily reflected a decrease in exposure to oncology cases (-1.8% per year, p<0.001). Among URO4 residents, the proportion of major cases increased from 52% to 60% (+0.9% per year, p=0.045). The proportions of major cases among URO2 and URO3 residents were not significantly changed. Although there was considerable inter-institutional variability in the percentage of major cases done by URO1 residents (ranging from 5% to 35%), the percentage decreased over time in 11 of the 12 institutions. CONCLUSIONS: Increased utilization of robotic surgery has coincided with a shift in exposure to major cases among urology residents at different stages of training, with less exposure to major cases among URO1 residents and more exposure among URO4 residents. This trend calls into question the preparedness of junior residents for senior-level training and the surgical proficiency of resident graduates. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e38-e38 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ezra Margolin More articles by this author Daniel Schoenfeld More articles by this author Suzanne Merrill More articles by this author Jay Raman More articles by this author R. Houston Thompson More articles by this author Adam Reese More articles by this author Dipen Parekh More articles by this author John Lynch More articles by this author Baruch Grob More articles by this author Daniel Williams More articles by this author Richard Lee More articles by this author Stanley Zaslau More articles by this author Thomas Guzzo More articles by this author Patrick Shenot More articles by this author Gina Badalato More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-03 EARLY MORBIDITY OF SUPRAPUBIC TUBE INSERTION: INCREASED COMORBIDITY PORTENDS INCREASED RISK Jane Kurtzman, Daniel Schoenfeld, Ruth Blum, Steven Brandes, and Doreen E. Chung Jane KurtzmanJane Kurtzman More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Ruth BlumRuth Blum More articles by this author , Steven BrandesSteven Brandes More articles by this author , and Doreen E. ChungDoreen E. Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Suprapubic tube insertion (SPT) is a commonly performed urologic procedure. However, few studies address its morbidity, and no studies address risk factors for complications. Our objective was to evaluate the impact of patient comorbidity on SPT-related perioperative and 90-day complications, emergency department (ED) visits, and hospital admission. METHODS: Retrospective review identified all adult patients who underwent SPT from 2014-2019 at a single institution. Age-adjusted Charlson Comorbidity Index score (CCI) was calculated in each patient. Logistic regression was used to explore the association between potential risk factors and the odds of perioperative (within 72 hours) and 90-day complications, ED visit and hospital admission. Kaplan Meir curves assessed complication free survival (CFS) and multivariable Cox regression was used to assess the impact of comorbidity. RESULTS: 222 SPTs, performed by 21 surgeons, were included. Median patient age: 66 years (IQR 50-77), BMI: 26 (IQR 23-30), and CCI: 4.0 (IQR 1-4). 31% resulted in ≥ 1 complication within 90-days (7% perioperative), 15% in ED visit and 8% in admission. Complications included: bowel injury (0.5%), vascular injury (0.5%), continuous bladder irrigation (5%), blood transfusion (4%), urinary tract infection (10%), sepsis (3%), tube malfunction (15%), wound infection (3%) or reoperation (4%). Increasing CCI score was associated with significantly increased odds of all four outcomes (all p <0.05), Table 1. Among patients with CCI < 4, perioperative CFS was 98% (95% CI: 92-99) and 90-day was 67% (95% CI: 53-77), compared to 88% (95% CI: 80-93) and 53% (95% CI: 43-63) for patients with CCI ≥ 4, Figure 1. On multivariable Cox regression, increasing CCI was significantly associated with an increased risk of SPT-related 90-day morbidity (HR 1.1; p=0.04), Table 1. CONCLUSIONS: Our finding that increased comorbidity portends increased risk of postoperative complication is critical for adequately counseling patients, particularly the sick and elderly, and families when considering SPT. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e11-e12 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Daniel Schoenfeld More articles by this author Ruth Blum More articles by this author Steven Brandes More articles by this author Doreen E. Chung More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy VI (MP63)1 Apr 2020MP63-02 A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING PAIN OUTCOMES OF OPIOID VS NON-OPIOID ANALGESIA IN PATIENTS UNDERGOING URETEROSCOPY OR PERCUTANEOUS NEPHROLITHOTOMY FOR URINARY STONE DISEASE Matthew S. DeMasi*, Amanda K. Mengotto, Pablo A. Cuartas, Daniel Schoenfeld, and Joshua M. Stern Matthew S. DeMasi*Matthew S. DeMasi* More articles by this author , Amanda K. MengottoAmanda K. Mengotto More articles by this author , Pablo A. CuartasPablo A. Cuartas More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , and Joshua M. SternJoshua M. Stern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000938.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The United States is currently experiencing an epidemic of overdose deaths involving prescription opioids. Opioids are commonly prescribed after urological surgeries, but are associated with high-risk adverse events. In this randomized clinical trial, we aim to determine whether NSAID based pain control is non-inferior to opioid therapy by analyzing pain outcomes after surgical treatment for urinary stone disease (USD). METHODS: Patients underwent ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for USD at our institution in the Bronx, NY. After excluding for renal disease, bleeding disorders, asthma, and peptic ulcer disease, patients were randomized into either Group A (ketorolac) or Group B (acetaminophen/oxycodone). Pain status was evaluated one week postoperatively using an 11-point ordinal rating scale with 5 specific questions regarding postoperative pain outcomes. Data were analyzed using a two-tailed t-test with a non-inferiority margin of maximal acceptable difference in mean scores of 1.3. RESULTS: In this interim analysis, 52 out of the planned 102 patients have completed the study: 28 in Group A (54%) and 24 in Group B (46%). Pain scores in Group A were non-inferior to Group B for each of the 5 assessed pain outcomes (See Table 1). For the overall worst pain intensity level, Group A reported significantly lower pain scores compared to Group B, with respective pain scores of 5.857 ± 3.546 (IQR 6) and 7.875 ± 3.125 (IQR 3.75). This corresponds to a difference in means of -2.018 ± 0.934 (p=0.036; [CI: -3.894 to -0.141]). 10.71% of patients in Group A returned to the ED within 30 days of surgery as compared to 16.67% of patients in Group B (p=0.54). CONCLUSIONS: Pain outcomes of NSAID based therapy were non-inferior to opioid analgesia after surgery for USD, and were shown to be significantly better for worst pain intensity levels. The trial is ongoing, but a large-scale randomized control trial is feasible and warranted to further assess the effectiveness of each medication and to potentially minimize opioid usage after surgery. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e954-e954 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew S. DeMasi* More articles by this author Amanda K. Mengotto More articles by this author Pablo A. Cuartas More articles by this author Daniel Schoenfeld More articles by this author Joshua M. Stern More articles by this author Expand All Advertisement PDF downloadLoading ...

To compare renal functional outcomes in patients with and without chronic kidney disease (CKD) to identify predictors of change in renal function after percutaneous nephrolithotomy (PCNL). We reviewed patients who underwent PCNL by a single surgeon over 3.5 years. Patients' pre- and post-operative Glomerular Filtration Rate (GFR) was calculated. Baseline GFR < 60 ml/min/1.73 m2 (stage ≥ 3 CKD) defined our CKD cohort. Patients' baseline renal function, comorbidities, stone parameters, and intra-operative variables were analyzed to determine the relationship with post-operative renal function after PCNL by multivariate analysis. 202 patients were analyzed. Mean follow-up time was 16 months. At baseline, 163 (80.7%) patients were free of CKD and 39 (19.3%) had CKD. Patients without CKD had an overall decrease in GFR from 105.6 to 103.3 ml/min/1.73 m2 (p = 0.494). 14/163 (8.6%) non-CKD patients experienced a significant decline in renal function after PCNL; 7/163 (4.3%) developed de novo CKD and 7 had a ≥ 30% decline in GFR. Patients with CKD had an overall increase in mean GFR post-operatively, from 47.3 to 54.0 ml/min/m2 (p = 0.067). Two in this cohort (5.1%) experienced a > 30% decline in renal function post-operatively. Age, gender, African American race, presence of comorbidities and pre-operative CKD were not significant predictors of renal function post-operatively on multivariate analysis. PCNL in this cohort appears GFR neutral in the setting of baseline CKD. CKD was not predictive of renal functional decline after PCNL. Given that stone disease carries a high recurrence rate and that CKD is associated with stone formers, further investigation into predictors of renal function change after PCNL is warranted.

To determine whether patients with ureteral stones received different standard of care in the emergency department (ED) according to various sociodemographic factors. We conducted a retrospective study of patients presenting to EDs in a large tertiary-care hospital in the Bronx, New York with a diagnosis of ureteral stones. Electronic chart review was used to assess each patient’s ED course and to gather socio-demographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage, and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, BMI category, socioeconomic status and insurance status were examined using multivariate logistic regression models. 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities: 40% Hispanic, 15% non-Hispanic Black, and 20% other/multiracial. Patients aged 55–64 years and those 65 or older were less likely to receive pain medication compared to patients < 35 years (OR = 0.48, 95% CI 0.27–0.86, p = 0.01 and OR = 0.46, 95% CI 0.21–1.00, p = 0.05, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR = 0.52, 95% CI 0.35–0.76, p = 0.001). Similarly, patients in the lowest quintile of SES received less imaging than patients in the highest SES group (OR = 0.50, 95% CI 0.27–0.90, p = 0.02). Finally, women were less likely to receive alpha blockade compared to men (OR = 0.68, 95% CI 0.49–0.92, p = 0.014). Multiple disparities exist among patients presenting to the emergency department for ureteral stones.

Urinary stone disease (USD) is a major health concern. There is a need for new treatment modalities. Recently, our group provided evidence for an association between the GMB composition and USD. The accessibility of the Gut Microbiome (GMB) makes it an attractive target for investigation and therefore, in these studies we have evaluated the extent to which the whole gut microbial community in fecal transplants can affect urinary stone risk parameters in an animal model. Fresh fecal pellets were collected from Zucker lean rats, homogenized in PBS (100 mg/mL), filtered through a 70 mu m strainer and then orally gavaged into C57BL/6NTac germ-free mice. Twenty-four hours urine collections and GMB analysis were performed over time for 1 month. Kidney and gut tissue were harvested from transplanted mice for western blot analysis of expression levels of the Slc26a6 transporter involved in oxalate balance. Urinary calcium decreased after fecal transplant by 55% (P < 0.001). Urinary oxalate levels were on average 24% lower than baseline levels (P < 0.001). Clostridiaceae family was negatively correlated with urinary oxalate at 4 weeks after transplant (r = -0.83, P < 0.01). There was a 0.6 unit average increase in urinary pH from a baseline of 5.85 (SE +/- 0.028) to 6.49 (SE +/- 0.04) (P < 0.001) after transplant. There was a concomitant 29% increase in gastrointestinal alkali absorption (P < 0.001) 4-weeks after fecal transplant. Slc26a6 expression increased by 90% in the cecum after transplant. Our results suggest that the gut microbiome may impact metabolism, alters urinary chemistry, and thereby may influence USD; the accessibility of the GMB can potentially be leveraged for therapeutic interventions.

Introduction: Multiple studies have concluded that ambulatory percutaneous nephrolithotomy (aPCNL) is safe. However, selection criteria remain vague and no investigators have assessed the practicality of using various post-procedural drainage strategies in the ambulatory setting. In this study we establish a set of inclusion and exclusion criteria for aPCNL, compare outcomes between aPCNL patients and those admitted following PCNL, and incorporate a variety of exit strategies including Double-J stent, ureteropelvic junction (UPJ) stent and totally tubeless techniques. Methods: We developed inclusion and exclusion criteria to determine patient eligibility for aPCNL. Between January 2014 and December 2016, 52 out of 145 patients met criteria for aPCNL and 47 of these patients were ultimately discharged on the same day. Forty-seven of the remaining 98 patients who were admitted following PCNL were randomly selected as a control group. Primary outcomes included stone-free status, emergency department (ED) visits and hospital readmissions within the 6-week post-operative period. Statistical analysis was performed using Student's t-tests, chi square tests, and Fischer's exact tests. Results: Both groups had similar age (P=0.91), sex (P=0.68), body mass index (P=0.91), and stone burden (P=0.12). Patients in the ambulatory group had a lower Charlson Comorbidity score (aPCNL CCS=0.11, inpatient PCNL CCS=0.62, P=0.002). Seventy three percent of ambulatory patients and 62% of standard PCNL patients had no residual stone burden 6 weeks following PCNL (P=0.33). The average residual stone fragment in our ambulatory and standard PCNL group was 3.5 and 3.2mm, respectively. Five patients (11%) from the aPCNL group and 4 (9%) from the standard PCNL group presented to the ED (P=0.76). One aPCNL (2%) and three standard PCNL (6%) patients were re-admitted to the hospital (P=0.62). Conclusions: In this study we establish specific inclusion and exclusion criteria for aPCNL. Using these criteria we then demonstrated the practicality of using various exit strategies to facilitate aPCNL. Future randomized control trials would be beneficial in confirming the safety and efficacy of aPCNL in select patients.

OBJECTIVES/SPECIFIC AIMS: Transgender individuals remain an underserved population with a unique set of healthcare needs. Given the recent increase in demand for gender affirmation surgery, there is a need to train urologists in the various aspects of surgical management of transgender patients. It is unclear how many urologic residency programs are participating in transgender care. In this study, we sought to determine the current status of urologic training programs in the delivery of transgender care and the sentiments regarding the current and future need to train urologists. METHODS/STUDY POPULATION: Between June and August 2017, a 22 item cross-sectional survey was emailed to all 138 program directors (PDs) as listed by the ACGME. Participation was voluntary and responses were anonymous. Statistical analysis was performed using SAS version 9.4. RESULTS/ANTICIPATED RESULTS: In total, 48 PDs completed the survey (36% of US PDs) and 1 declined to participate. All AUA regions had at least 25% representation, except the Western region (13%). In total, 42% of urology programs that responded participate in institutional transgender health programs; 76% of PDs believe there is a current or future need to train urology residents in the surgical care of transgender patients. PDs were significantly more likely to endorse a need for transgender training if their institution has a transgender health program (95% vs. 58%, p<0.005). Similarly, expressed interest in transgender care by trainees was associated with increased belief among PDs in the need for transgender training (95% vs. 58%, p<0.005). There was also an association between the presence of a transgender health program and trainee interest in transgender care (64% vs. 33%, p=0.04). Need for resident training in the following procedures was cited most often by PDs: complicated catheter placement (91%), orchiectomy (89%), urethral fistula repair (82%), penile/testicle prosthesis insertion (77%), phalloplasty (69%), vaginoplasty (66%), and metoidioplasty/urethral lengthening (54%). Despite the overall consensus that residents should be trained in transgender care, 83% of PDs responded that urologic transgender surgery should be trained in fellowship rather. DISCUSSION/SIGNIFICANCE OF IMPACT: There is an increased demand for surgeons competent in providing gender affirmation surgery. The majority of urology residency PDs believe in the need to train residents in the surgical care of transgender patients. A formalized curriculum for the urologic management of transgender patients should be instituted across residency programs to ensure adequate exposure and competency.

OBJECTIVES/SPECIFIC AIMS: The prevalence of kidney stone disease has increased significantly in the United States in the last 2 decades. While several studies have reported that disparities in access to and quality of medical care exist, there is a need for a more thorough investigation of factors that negatively impact patients seeking care specifically for kidney stone disease. We sought to examine whether kidney stone patients received different standard of care in the emergency department (ED) according to their race/ethnicity, gender, age, body mass index, socioeconomic status (SES), and insurance status. METHODS/STUDY POPULATION: We conducted a retrospective study of patients presenting to the ED at Montefiore Medical Center between January 1, 2014 and December 31, 2016. Patients with a diagnosis of nephrolithiasis were identified using ICD-9/10 codes and electronic chart review was used to assess each patient’s ED course as well as to gather sociodemographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, body mass index category, SES and insurance status were examined using multivariate logistic regression models. RESULTS/ANTICIPATED RESULTS: A total of 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities (40% Hispanic and 15% non-Hispanic African-American), whereas 21% were Caucasian and 24% declined to report race/ethnicity. Patients between the ages of 55–64 and those older than 65 were less likely to receive pain medication compared to younger patients aged <35 years (OR=0.48, 95% CI: 0.27–0.86 and OR=0.46, 95% CI: 0.21–1.00, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR=0.52, 95% CI: 0.35–0.76) including CT scan (OR=0.50, 95% CI: 0.35–0.72). Similarly, patients in the lowest quintile of SES received less imaging than patients in higher SES categories (OR=0.50; 95% CI: 0.27–0.90). Furthermore, African Americans (both genders) and women were less likely to be prescribed an alpha antagonist medication (e.g., tamsulosin) to facilitate stone passage compared with White patients (OR=0.61, 95% CI 0.36–1.03) and men (OR=0.68, 95% CI: 0.49–0.92), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: We found that multiple disparities exist among patients presenting to the ED for nephrolithiasis. A more thorough investigation into the causes of these disparities is warranted to limit their impact on patient care.

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology I1 Apr 2018PD03-02 EVIDENCE FOR A DISTINCT GUT MICROBIOME AMONG GENETIC HYPERCALCIURIC STONE-FORMING RATS Joshua Stern, Nancy Krieger, Daniel Schoenfeld, Sylvia Suadicani, Robert Burk, and David Bushinsky Joshua SternJoshua Stern More articles by this author , Nancy KriegerNancy Krieger More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Sylvia SuadicaniSylvia Suadicani More articles by this author , Robert BurkRobert Burk More articles by this author , and David BushinskyDavid Bushinsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.268AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the past 10 years, the gut microbiome (GMB) has been recognized as an important determinant of human health. Recent advances in sequencing of the human GMB have led to important breakthroughs that describe its relationship to diverse and important human health outcomes such as asthma, inflammatory bowel disease, and cardiovascular disease. However, the study of the gut microbiome in the field of benign urology is in its infancy. The Genetic Hypercalciuric Stone-forming (GHS) rat is an established model of kidney stone disease and has been selectively inbred for hypercalciuria, originally from standard Sprague Dawley (SD) rats. All GHS rats make stones by 18 weeks of age. The model has been extensively studied and phenotyped. However, no study has previously examined differences in the rats' microbiome. In this study we characterize the gut microbiome (GMB) from GHS rats compared to age and sex matched SD rats. METHODS 4 male GHS rats and 2 male SD rats were housed separately and fed similar diets of rat chow in the same animal room. Fresh fecal pellets were collected at one single time point, stored at -80 degrees celsius and sent to the Albert Einstein Department of Urology where the pellets were prepared for analysis by DNA extraction, amplification of the 16S rRNA V4 region using barcoded primers on an Illumina platform. QIIME was used for analysis. RESULTS 16s rRNA analysis between the 2 groups found significant differences. The alpha diversity of the GHS rats' GMB clustered well and was widely separated from SD. The GHS rats had a lower Shannon score diversity. Bacteroides genus was 39% more abundant in the GHS, similar to that found in our clinical study of stone formers. Roseburia genus, known to contain species that produce beneficial short chain fatty acids, was 70% more abundant in the SD group. Similarly Faecalibacterium genus, with known butyrate producers, was increased 35% in the SD rats. CONCLUSIONS We demonstrate that age, diet and sex matched GHS rats have a GMB that is distinct from its SD ancestors. Of particular interest is the decreased bacterial diversity seen in these rats. Bacteroides genera is significantly up-regulated in the GHS rats and similar to findings seen in human stone formers. Future studies to identify the role the GMB has in modulating USD risk are needed. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e71 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Joshua Stern More articles by this author Nancy Krieger More articles by this author Daniel Schoenfeld More articles by this author Sylvia Suadicani More articles by this author Robert Burk More articles by this author David Bushinsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology II1 Apr 2018MP24-03 FECAL TRANSPLANT MODULATES URINARY STONE RISK FACTORS IN AN ANIMAL MODEL Joshua Stern, Robert Burk, Daniel Schoenfeld, Kelvin Davies, John Asplin, and Sylvia Suadicani Joshua SternJoshua Stern More articles by this author , Robert BurkRobert Burk More articles by this author , Daniel SchoenfeldDaniel Schoenfeld More articles by this author , Kelvin DaviesKelvin Davies More articles by this author , John AsplinJohn Asplin More articles by this author , and Sylvia SuadicaniSylvia Suadicani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.756AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent advances in human Gut Microbiome (GMB) sequencing have led to innovative breakthroughs that describe its relationship to important human health outcomes. Most recently, ongoing clinical research has provided emerging evidence for an association between the GMB and urinary stone disease (USD) thereby leading us to investigate if GMB manipulation could similarly alter urinary stone risk parameters in an animal model. METHODS Fresh fecal pellets were collected from Zucker lean rats, homogenized in PBS (100 mg/mL) and filtered through a 70 micrometer strainer. Five C57BL/6NTac germ-free mice were then orally gavaged with 200 microliters of the filtrate immediately after its preparation. Two aged matched germ free mice were controls. 24 hour urine collection, analyzed by Litholink, and GMB analysis was performed for the five recipient mice at baseline and then again at weeks 1,2,3 and 4 post-transplant. At the end of 4 weeks, ileal, cecal and renal tissue was harvested from transplanted mice for western blot analysis to detect Slc26a3 (responsible for regulating intestinal oxalate absorption) and Slc26a6 (responsible for regulating intestinal oxalate secretion) transporters. RESULTS At 4 weeks post-transplant there was a 58% decrease in urinary calcium (p<0.001), an 18% decrease in urinary oxalate (p<0.01), a 0.7 unit pH increase (p<0.001), and 29% increase in GI alkali absorption (p<0.04) (Figure 1). There was also a 56% and 44% decrease in Slc26a3 protein expression in the cecum and ileum of the transplanted mice (p<0.01), respectively. Slc26a6 protein expression increased 162% in the cecum and decreased by 46% in the ileum of the transplanted compared to germ-free mice (p<0.01). Age matched control germ free mice showed none of these changes. CONCLUSIONS Introduction of a GMB via fecal transplant to a germ free mouse leads to dramatic changes in urinary calcium and oxalate. Moreover, changes in urinary chemistry seen after fecal transplant were accompanied by significantly altered expression of intestinal transporters responsible for calcium and oxalate homeostasis. These results demonstrate for the first time that the GMB can modulate urinary parameters that are important determinants for USD. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e290-e291 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Joshua Stern More articles by this author Robert Burk More articles by this author Daniel Schoenfeld More articles by this author Kelvin Davies More articles by this author John Asplin More articles by this author Sylvia Suadicani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...