You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (MP51)1 May 2024MP51-20 CLINICOPATHOLOGIC RISK FACTORS AND SURVIVAL OUTCOMES FOR METASTATIC CHROMOPHOBE RENAL CELL CARCINOMA Danielle Wang, Shengxuan Wang, and Heinric Williams Danielle WangDanielle Wang , Shengxuan WangShengxuan Wang , and Heinric WilliamsHeinric Williams View All Author Informationhttps://doi.org/10.1097/01.JU.0001009492.49624.4b.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chromophobe renal cell carcinoma (chRCC) often carries a good prognosis unless it becomes metastatic. Using the American College of Surgeons National Cancer Database (NCDB), we evaluated the associated risk factors for metastatic chRCC and survival outcomes. METHODS: The NCDB was queried from 2004 to 2020 for all patients with chRCC. Clinicopathological factors of age, gender, ethnicity, synchronous metastatic status and sites, clinical/pathological stage, treatment type, co-morbidities, and follow-up were extracted. Numerical variables are summarized using median and interquartile range (IQR). Categorical variables are summarized using frequency and percentages. Univariate and multivariate logistic regressions were developed to identify the factors associated with metastases and overall survival. Survival was estimated using Kaplan-Meier method. Cox proportional-hazards regression model was used to identify factors associated with survival. Statistical analysis was conducted using SAS®. Results were considered statistically significant if p value was ≤0.05. RESULTS: Of 30,030 patients with chRCC, those with clinical T0 or Tx disease, unknown metastatic status, unknown tumor size, or those with missing data were excluded, resulting in a final population of 25,564 patients. The synchronous metastatic rate was 1.4% (n=376). Increased age (Odds ratio (OR) 1.03, 95% confidence interval (CI) 1.02-1.04, p<0.0001) and tumor size >10 cm (OR 11.98, 95% CI 1.67-86.19, p<0.0001) were independently associated with synchronous metastases on multivariate analyses. While the most common reported metastatic sites included bone (n=129), lung (n=103) and other (n=234), there was no difference in 5-year survival stratified by site (p=0.238). Factors associated with 5-year survival among metastatic patients included treatment (p<0.001) and clinical T stage (p<0.001). Among the treatment options evaluated, with no treatment as the referent, 5-year survival was best for partial nephrectomy (HR 0.303, 95% CI 0.14-0.68, p<0.001). The 5-year survival (95% CI) for those with chRCC metastases who underwent partial nephrectomy was 42.7% (16.1-67.2). CONCLUSIONS: While metastases are relatively rare in patients with chRCC, prognosis was poor irrespective of site of metastasis. Among those undergoing primary partial nephrectomy, total nephrectomy or no treatment, partial nephrectomy patients had the best 5-year survival. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e850 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Danielle Wang More articles by this author Shengxuan Wang More articles by this author Heinric Williams More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: Pain catastrophizing has been found to be correlated with worse outcomes following treatment for patients with CPP. Despite this association, there is scant evidence regarding catastrophication as a dynamic trait. We studied whether an improvement in pain catastrophizing during specialized pelvic floor physical therapy (PT) would portend better outcomes. METHODS: A retrospective chart review was performed among patients with CPP undergoing pelvic floor PT. Patients are given validated survey instruments three times over their treatment period, including the short-form Pain Catastrophizing Scale (PCS), Genitourinary Pain Index (GUPI), and Pelvic Floor Disability Index (PFDI-20). Patients were separated into catastrophication improvers (CI) and non-catastrophication improvers (NCI) based on their net change in PCS scores between weeks 0 and 6. Patients' changes on their GUPI and PFDI scores were compared utilizing unpaired two sample t-tests. RESULTS: CI patients (n[37, 74%) had a mean decrease in GUPI score of 5.16 compared to a mean decrease of only 0.46 points in the NCI group (n[13, 26%) after six weekly PT appointments (p [0.026). The CI group had improved scores for the urinary symptoms and quality of life subsections of the GUPI specifically (p<0.05). There was a nonsignificant difference in the mean PFDI score change between the two groups of 28.29 (p[0.143) with CI patients improving their PFDI score by 17.35 whereas the NCI group had a mean increase in PFDI score by 10.94. CONCLUSIONS: This is the first study to evaluate whether changes in pain catastrophication can affect outcomes in patients with CPP undergoing pelvic floor physical therapy. Preliminary data suggests patients who catastrophize less throughout treatment have improved pain symptoms, specifically in regard to urinary complaints and quality of life measures.

While percutaneous nephrolithotomy (PCNL) remains the treatment modality of choice for kidney stones larger than 2 cm, infectious complications are the most common, ranging from 5 to 32%. We present here a novel technique for potentially improving collecting system sterility during PCNL and our initial post-operative outcomes. Retrospective chart analysis of our irrigation protocol was collected from our first 56 patients between February to July 2019. Traditional prone PCNL was performed in standard fashion using fluoroscopic guidance. Using a ureteral catheter was placed cystoscopically, a renal pelvis urine culture was taken and subsequently 10mL of betadine solution was instilled into the collecting system. Gentamicin 80 mg/3L normal saline was utilized as irrigant fluid for the first 6L of irrigation. From this cohort, patients were 57% female and mean age was 60±14 years. About 23% of patients were diabetic and 55% were hypertensive. Seventy percent of patients stone burden >2cm and no patients had stone burden less than 1 cm. Fifteen patients had positive urine cultures treated preoperatively, while 4 patients had contaminated cultures. All patients were treated with our antibiotic irrigation and betadine protocol regardless of pre-operative cultures or antibiotics. Mean baseline creatinine was 0.95±0.41, with a mean change of 0.18 post-op day 1. Of the 15 (26%) of 56 patients with a SIRS response (2 of following 4 criteria: WBC<4 or >12; HR >90, hypothermia < 96.8F or hyperthermia >100.4F, RR>20), only 6 patients (11%) were febrile, and two patients had positive blood cultures (3%). There were no adverse reactions to the betadine or antibiotic irrigation. We present here our initial experience of a new technique for renal pelvis sterilization and its safety and feasibility using intrarenal instillation of betadine and antibiotic irrigation.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II (MP63)1 Sep 2021MP63-01 PAIN CATASTROPHIZING IS ASSOCIATED WITH WORSE PAIN OUTCOMES FOR SPECIALIZED PELVIC PT Shashank S. Pandya, Daniel Alaiev, Danielle Wang, Katelyn Kunkle, Lindsey Nyman, Jennifer Fariello-Moldwin, Stephanie Goldstein, and Robert M. Moldwin Shashank S. PandyaShashank S. Pandya More articles by this author , Daniel AlaievDaniel Alaiev More articles by this author , Danielle WangDanielle Wang More articles by this author , Katelyn KunkleKatelyn Kunkle More articles by this author , Lindsey NymanLindsey Nyman More articles by this author , Jennifer Fariello-MoldwinJennifer Fariello-Moldwin More articles by this author , Stephanie GoldsteinStephanie Goldstein More articles by this author , and Robert M. MoldwinRobert M. Moldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002103.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pain catastrophizing consists of exaggerated ruminating negative thoughts and emotions brought on by an actual, perceived, or an anticipated painful stimulus. Pain catastrophizing leads to less improvement over time. We sought to predict the relationship between pain catastrophizing and the outcomes of specialized pelvic floor physical therapy (PT). METHODS: Data was collected retrospectively between 2019-2020 from 39 patients (35 females and 4 males between the ages 18-72) diagnosed with UCPPS with pelvic floor myalgia who underwent 6 weeks of 1-2 sessions/week of specialized pelvic PT. All patients filled out the short version of the Pain Catastrophizing Scale (PCS; 0-24) and the Genitourinary Pain Index (GUPI; 0-45) before and after 6 six weeks of PT. Sets of Bayesian binomial regression models were generated to predict changes in pain scores using the full GUPI, GUPI Pain Subscale (0-23), Visual Analog Score (VAS; 0-10), and PCS split into terciles, quartiles, or maximum/minimum. A standard null model was fit as a benchmark against other models. PSIS-LOO cross-validation with pseudo-BMA weighting was used to select the best performing model. RESULTS: The best performing model predicted a significant clinical change in VAS after six weeks of PT for minimum/non-pain catastrophizers (NC; 0 PCS) and maximum/extreme pain catastrophizers (EC; 24 PCS). Table 1 shows the predictions for the change in VAS from baseline (ΔVAS=Week 6-initial VAS) after six weeks of PT. For example, at a baseline VAS of 6 and an initial PCS of 0 (NC), 97.1 % (posterior probability) of the time, the model predicts a median improvement of 3 points after with 95% (Bayesian credible interval) of the predictions falling between an improvement of 1 to 6 points. With the same baseline VAS of 6, if the initial PCS was 24 (EC), 97.1% of the time, the model predicts a median improvement of 0 with 95% of the predictions falling between an improvement of 2 points to a worsening of 3 points. CONCLUSIONS: NC’s were predicted to have improved VAS scores than EC’s after 6 weeks of PT. Unlike the Pain Subscale or GUPI, which are composite scores, VAS is better at predicting change over time (test-retest reliability). This has implications for future studies’ choice of instrument for tracking pain over time. A significant limitation of this model is the small sample size. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1101-e1101 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shashank S. Pandya More articles by this author Daniel Alaiev More articles by this author Danielle Wang More articles by this author Katelyn Kunkle More articles by this author Lindsey Nyman More articles by this author Jennifer Fariello-Moldwin More articles by this author Stephanie Goldstein More articles by this author Robert M. Moldwin More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To provide real-time assessment and feedback on the competency of urology residents' surgical skill via mobile applications and examine their feasibility and utility. MATERIALS AND METHODS Two mobile application-based systems (SIMPL and myTIPreport) were sequentially implemented for the case-by-case assessment of residents' performance of surgical skills at a single institution. Data was collected regarding residents' perception of their feedback pre- and post-implementation of the applications. Faculty were surveyed after their implementation to determine their feasibility and utility. RESULTS 297 individual evaluations were completed with SIMPL and 822 with myTIPreport over four and eleven months respectively. Post-implementation, residents showed significantly improved perceptions regarding the quantity and personalization of surgical skill feedback (P = .043 and .005 respectively). A majority (75%) of the faculty found the mobile applications feasible to use, an improvement compared to prior methods of resident evaluation, and would recommend continued use. CONCLUSION This study represents the first documented use of real-time surgical competency assessment in urology. The use of mobile applications to evaluate urology residents' surgical competency in clinical practice is both feasible and useful. Their use may allow for more individualized surgical skill teaching during training and for the verification of the surgical skills necessary to practice autonomously. (C) 2021 Elsevier Inc.

While percutaneous nephrolithotomy (PCNL) remains the treatment modality of choice for kidney stones larger than 2 cm, infectious complications are most common, ranging from 5% to 32%. We present here a novel technique for potentially improving collecting system sterility during PCNL and initial postoperative outcomes. Retrospective chart analysis data of our irrigation protocol were collected from our first 56 patients between February and July 2019. Traditional prone PCNL was performed in a standard manner using fluoroscopic guidance. Using a ureteral catheter that was placed cystoscopically, a renal pelvis urine culture was taken and subsequently 10 mL of betadine solution was instilled into the collecting system. Gentamicin in normal saline (80 mg/3 L) was utilized as the irrigant fluid for the first 6 L of irrigation. From this cohort, 57% patients were women and mean age was 60 ± 14 years. About 23% of patients were diabetic and 55% were hypertensive. Seventy percent of patients had stone burden >2 cm and no patients had stone burden <1 cm. Fifteen patients had positive urine cultures treated preoperatively, while four patients had contaminated cultures. All patients were treated with our antibiotic irrigation and betadine protocol regardless of preoperative cultures or antibiotics. Mean baseline creatinine level was 0.95 ± 0.41, with a mean change of 0.18 at postoperative day 1. Of the 15 (26%) of 56 patients with a systemic inflammatory response syndrome response (two of following four criteria: white blood cells <4 or >12; heart rate >90; hypothermia <96.8°F or hyperthermia >100.4°F; and respiratory rate >20), only six patients (11%) were febrile and two patients had positive blood cultures (3%). There were no adverse reactions to the betadine or antibiotic irrigation. We present here our initial experience of a new technique for renal pelvis sterilization and its safety and feasibility using intrarenal instillation of betadine and antibiotic irrigation. No Clinical Trial Registration number applicable.

INTRODUCTION AND OBJECTIVE: The goal of surgical residency is to create independently operating surgeons. The Accreditation Council for Graduate Medical Education (ACGME) has designated minimum case numbers that surgical resident must meet prior to graduation. While these case numbers are the benchmark for graduation as an independent surgeon, there is no data in the literature assessing if these numbers hold evidence for urology residents. To study this, we compared urology resident's autonomy during two common procedures to their number of cases logged for each procedure using a real-time smart phone application. METHODS: We utilized the myTIPreport mobile application from 12/18-11/19. Attending evaluations were logged post-operatively assessing the perceived autonomy of PGY 2's & 3's for transurethral bladder tumor resections (TURBT) and Ureteroscopies (URS). The Zwisch scale was used to assess the perceived autonomy. Independence was calculated as an autonomy score of Supervision Only or higher. Each myTIPreport evaluation was correlated with the number of cases logged for each individual procedure in the ACGME case logs at the time of evaluation and recorded. RESULTS: A total of 101 paired evaluations, 33 for TURBT and 68 for URS, from 5 residents were analyzed. For TURBT's, all residents received a rating of Supervision Only at least twice prior to the ACGME minimum required case number of 100 for Transurethral cases. For URS, all residents (4/4) with evaluations before the ACGME minimum required case number of 60 received a rating of Supervision Only at least once. CONCLUSIONS: For the procedures TURBT and URS, residents achieved surgical independence before the ACGME minimum case number. In the case of TURBT, residents were seen as independent much earlier than the designated ACGME case minimum, whereas for URS the minimum case number was an adequate benchmark for surgical independence. More data is needed to determine at what case number there is a progression in autonomy for each specific step of the case to best tailor resident specific educational needs.Source of Funding: None

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia (MP58)1 Apr 2020MP58-04 PAIN CATASTROPHIZING AFFECTS THE OUTCOMES OF PELVIC FLOOR PHYSICAL THERAPY Danielle Wang*, Stephanie Goldstein, Kate Kunkle, Jennifer Fariello, and Robert Moldwin Danielle Wang*Danielle Wang* More articles by this author , Stephanie GoldsteinStephanie Goldstein More articles by this author , Kate KunkleKate Kunkle More articles by this author , Jennifer FarielloJennifer Fariello More articles by this author , and Robert MoldwinRobert Moldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000927.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chronic pelvic pain and pelvic floor myalgia is still underrecognized and true incidence is unknown. Higher pain catastrophizing scores have been correlated to worse health outcomes. We studied the impact of pain catastrophizing behavior upon the effectiveness of specialized pelvic floor physical therapy (PT). METHODS: A retrospective chart review was conducted among patients receiving pelvic floor PT as part of their pelvic pain treatment. Patients are given validated survey instruments at initial evaluation, 6-week follow up, and 12-week follow up. These three instruments are the 6-item short form Pain Catastrophizing Scale (PCS), Genitourinary Pain Index (GUPI), and Pelvic Floor Disability Index (PFDI-20). Patients were separated into non-catastrophizing or catastrophizing cohort if their PCS scores were >20 at any time point. Patients' changes on their GUPI and PFDI scores were compared utilizing two sample t-test, mixed-effects ANOVA, and non-parametric test. RESULTS: Catastrophizing patients (n=9, 28%) had a mean of 5 comorbidities while non-catastrophizing patients (n=23, 72%) had a mean of 6.13 comorbidities. After 12 weekly PT sessions, 74% of non-catastrophizing patients saw improvement in their GUPI and PFDI scores while only 44% of catastrophizing patients saw improvements. Non-catastrophizing patients showed a mean decrease of 14.96% (GUPI) and 20.80% (PDFI) at 3 months. Conversely, catastrophizing patient showed a mean decrease of 4.44% (GUPI) and 4.21% (PFDI) (see a_image). Factors which were not predictive of PT outcomes include comorbidities, pain medications, gender, and past abdominal or genitourinary surgeries. CONCLUSIONS: This is the first study evaluating catastrophizing behavior and how it affects pelvic floor PT outcomes. The preliminary data suggests that pain catastrophizing negatively affects pelvic floor PT outcomes as assessed by GUPI and PFDI-20. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e872-e872 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Danielle Wang* More articles by this author Stephanie Goldstein More articles by this author Kate Kunkle More articles by this author Jennifer Fariello More articles by this author Robert Moldwin More articles by this author Expand All Advertisement PDF downloadLoading ...