OBJECTIVE:To assess selective median lobe holmium enucleation of the prostate (MHoLEP) durability at 1 year and beyond and identify factors associated with reoperation due to benign prostate hyperplasia treatment failure. METHODS:Patients of 2 urological surgeons at a single institution who underwent MHoLEP and standard HoLEP between April 2019 and May 2024 were retrospectively reviewed. Patients with less than 1 year of follow up were excluded from durability assessment. Kaplan-Meier estimates, nonparametric tests assessing unadjusted group differences, and multivariate logistic regression were used as indicated. RESULTS:One hundred twenty MHoLEP patients met durability inclusion criteria. Median follow up among durable patients was 31.7 months. Fifteen reoperations occurred resulting in 87.5% (CI: 81%-95%) MHoLEP durability for the cohort. One-year postoperative durability was 98% (CI: 95%-99.9%). No preoperative patient factors were identified that were associated with reoperations in both the unadjusted and covariate adjusted statistical analysis. Elevated postvoid residuals shortly post-MHoLEP correlated with future reoperation. CONCLUSION:MHoLEP has reduced adverse effects to standard HoLEP and robust 1-year durability. Unfortunately, longer-term durability is weaker and inferior to standard HoLEP and there does not appear to be any patient characteristics that can be used to guide patient selection. These factors highlight the need for shared decision making when considering MHoLEP over the traditional procedure. Further studies are required to support these findings and report longer-term durability with greater confidence.

INTRODUCTION: Endoscopic Enucleation of the Prostate (EEP) remains a size independent technique for the treatment of Benign Prostatic Hyperplasia (BPH) with many benefits. Adoption has lagged behind other interventions due to a purported steep learning curve and high cost of equipment. The Prostate Enucleation Collaborative (PEC) is a group of early career urologists which formed in 2024 to promote EEP education and research. Here we report the results of a survey of PEC members addressing common practice patterns and member experiences early in their learning curve to help aspiring non-EEP practitioners begin a successful EEP practice. METHODS: In August 2024, a survey, developed by the authors, of preoperative, perioperative, and postoperative management of EEP patients, as well as the challenges associated with implementation of an EEP program, was distributed to all members of PEC. RESULTS: 13 of 16 (81%) PEC members completed the survey; 9 (69.2%) performed EEP from the start of practice, while 4 (30.8%) adopted it later. Most initially see patients in person with validated symptom scores and imaging to confirm prostate size, but rarely urodynamics. Members recommended limiting the initial 50 cases to under 150 gm. Perioperatively, 69.2% hold anticoagulation if safe, and most use pulse-modulated holmium lasers. About half perform EEP as outpatient surgery, with 84.6% attempting a trial of void on postoperative day 1. Follow-up is commonly at 3 months (53.8%), and 92.3% check prostate-specific antigen (PSA) postoperatively. CONCLUSIONS: These findings provide preliminary, practical guidance for surgeons starting an EEP practice, highlighting strategies such as reviewing operative videos, engaging mentors for early case support and anticipating institutional barriers such as equipment acquisition and workflow integration that may affect program development. Although drawn from a small cohort, these insights offer useful direction for novice EEP surgeons during their initial learning curve.

Introduction: Percutaneous nephrolithotomy is a minimally invasive procedure indicated for the management of staghorn calculi or renal calculi >2.0 cm. Percutaneous renal access is a critical step in this procedure and can be performed by either urologists or interventional radiologists. The purpose of this study is to perform a meta-analysis to compare outcomes between urologist and interventional radiologist-mediated access.Methods: An electronic literature search was conducted to identify studies comparing urologist- and interventional radiologist-acquired access. Studies must have included both urologist- and intervention radiologist-acquired access data but were excluded if (1) not in English; (2) abstract without full text; (3) unable to determine who acquired access; and (4) only included either urologist or interventional radiologist data. Meta-analysis comparison was generated with the Review Manager 5.4 software.Results: After screening the abstracts and title, 55 relevant studies were identified. Nine articles were utilized in the meta-analysis. Urologist-acquired access was associated with a greater stone-free rate (risk ratio [RR] = 1.10; 95% confidence interval [CI], 1.01-1.20), a reduction in major complications (RR = 0.69; 95% CI, 0.53-0.92), and a shorter hospital stay (mean difference -0.40; 95% CI, -0.64 to -0.16) in comparison with radiologist-acquired access. Urologist-acquired access was associated with greater blood loss (mean difference 0.46; 95% CI, 0.32-0.60) when compared with interventional radiology-acquired access. No significant differences were found with regard to unusable access, multiple tracts, supracostal access, ancillary procedure requirement, operative time, minor complications, and transfusions.Conclusions: Urologist-acquired access may be associated with a higher stone-free rate and a reduction in major complications, whereas interventional radiologist-mediated access may be associated with a reduction in blood loss, despite similar transfusion rates.

You have accessJournal of UrologyCME1 Apr 2023MP10-06 RISK FACTORS FOR NEPHROLITHIASIS IN 24-HOUR URINE STUDIES OF PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) Michelle Chen, Alex Nourian, Johnathan Drevik, Eric Ghiraldi, and Justin Friedlander Michelle ChenMichelle Chen More articles by this author , Alex NourianAlex Nourian More articles by this author , Johnathan DrevikJohnathan Drevik More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , and Justin FriedlanderJustin Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been suggested to be an independent risk factor for renal stone disease by several studies. We aimed to identify abnormalities on 24-hour urine collection in this patient population. METHODS: 24-hour urine collections from a single tertiary care center were retrospectively reviewed from May 2014 to May 2021. Univariate analysis was performed using Chi-square test and unpaired T-test for categorical and continuous variables, respectively. A multivariable logistic regression was performed controlling for age, body mass index (BMI), diabetes mellitus (DM). RESULTS: 98 (24%) of 406 patients who met inclusion criteria were identified to have radiographic hepatic steatosis. There were no differences in baseline characteristics between groups including age, race, and gender. On univariate analysis, patients with NAFLD had decreased urinary pH (5.88 vs 6.06, p=0.02), elevated urinary oxalate (40 vs 36, p=0.04), calcium (219 vs 186, p=0.02) and sodium (185 vs 163, p=0.02) relative to those who did not have fatty infiltration of the liver on imaging. After controlling for DM and obesity as defined as BMI≥30, no 24-hour urine abnormalities were identified. CONCLUSIONS: After adjusting for confounding factors, patients with hepatic steatosis did not have identifiable abnormalities in their 24-hour urine studies. Increased risk of nephrolithiasis in patients with NAFLD is likely related to contributors of metabolic syndrome such as diabetes and obesity. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e116 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle Chen More articles by this author Alex Nourian More articles by this author Johnathan Drevik More articles by this author Eric Ghiraldi More articles by this author Justin Friedlander More articles by this author Expand All Advertisement PDF downloadLoading ...

), GLP-1 agonists users did not have a higher rate of UA stones compared to non-T2DM patients (18.2% vs 12.1%, p [ 0.54). There were no signi fi cant differences found with Metformin, sulfonylurea, DPP-4 inhibitors, SGLT-2 inhibitors, or insulin. CONCLUSIONS: T2DM is a known risk factor for nephrolithiasis, however, treatment with GLP-1 agonists may be litho-protective. The signi fi cant increase in urine citrate and reduction in UA stone formation suggests a lithoprotective effect of GLP-1 agonists independent of weight or diabetes control. Consideration should be made to recommend GLP-1 agonists to T2DM patients with nephrolithiasis.

OBJECTIVE:To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe. MATERIALS AND METHODS:We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate. Patients were asked to comment on whether they had retrograde ejaculation during their follow-up appointment. Urinary function was assessed using the American Urological Association Symptom Score and subjective evaluation of urinary incontinence. RESULTS:Median age of the cohort was 65 years (range: 44-91). Compared to preoperative, there was significant improvement in mean postoperative American Urological Association Symptom Score (22.5 vs 6.9, P < .001), mean postoperative quality of life scores (4 vs 1.2, P < .001), and mean postoperative post void residual volumes (244.1 vs 69.3 cc, P < .001). No patients reported stress urinary incontinence. Of the 55 patients who underwent selective enucleation of the median lobe, 40 were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged from pre-op, and 2 had new ejaculatory dysfunction. CONCLUSION:In this case series of selective laser enucleation of the median lobe, urinary function significantly improved in short-term follow-up with preservation of ejaculation in approximately 90% of men.

ObjectiveTo analyze the clinical presentation and outcomes for patients who presented with symptomatic urolithiasis during the initial months of the COVID-19 pandemic.MethodsWe retrospectively reviewed Emergency Department (ED) presentations from a Philadelphia healthcare system for symptomatic urolithiasis between March and June 2020 and compared these with presentations for the same time period from the year prior. Patient demographics, stone characteristics, management, and clinical outcomes were compared between the 2 years.ResultsOne hundred and thirty-nine patients presented during 2020 compared to 269 in 2019. There were fewer patients who presented during the initial COVID-19 pandemic surge who had obesity (37.41% vs 49.44%, P = .024), hyperlipidemia (18.71% vs 31.60, P = .006), and asthma (5.76% vs 16.73%, P = .002). Although overall stone characteristics did not differ between the 2 groups, a larger proportion of patients in 2020 presented with an obstructing stone (81.16% vs 64.1%, P = .001). Patients who presented during the COVID-19 pandemic did not have higher rates of infection, acute kidney injury, or complications. Rates of surgical modalities, emergent procedures, and discharges from the ED were similar between the 2 years.ConclusionThe COVID-19 pandemic initial surge resulted in fewer ED presentations for symptomatic urolithiasis; however, patients who did present were more likely to have obstructing stones, perhaps due to delaying presentation to avoid COVID-19 exposure in the ED. Despite higher rates of obstruction, clinical outcomes and morbidity were similar.

OBJECTIVE:To compare operative efficiency of Holmium laser enucleation of the prostate (HoLEP) using both the standard multi-incisional approach and en-bloc enucleation with early apical release during the initial learning curve.MATERIALS AND METHODS:We retrospectively reviewed the initial 95 consecutive men who underwent HoLEP between April 2019 and September 2020 by a single surgeon. We compared patient demographics, and pre-, intra-, and post-operative metrics between both groups. Differences between groups were evaluated with Mann-Whitney U and Kruskal-Wallis tests.RESULTS:Forty-nine patients underwent the standard HoLEP approach, and 46 patients underwent the en-bloc approach. Compared to a standard HoLEP, the en-bloc approach was associated with decreased operative time (131.11 minutes vs 153.59 minutes, P = .007) with similar weights of tissue removed. Operative efficiency, as measured by grams of prostate tissue removed per minute, was greater for the en-bloc approach (0.49 g/min vs 0.36 g/min, P = .005). There was no difference in length of stay (0.91 days vs 0.96 days, P = .383), laser efficiency (4.41 kJ/g vs 4.83 kJ/g, P = .200), or number of post-operative complications (10 vs 6, P = .236) between the groups.CONCLUSION:Utilization of the en-bloc technique during the initial learning curve allows for a faster, more efficient operation without any difference in functional outcomes or major complications compared to a standard HoLEP.

Introduction: Herein, we describe our initial experience performing waterjet ablation of the prostate without electrocautery. Materials and Methods: A retrospective review of patients undergoing Aquablation for benign prostatic hyperplasia between February and September 2019 was performed. A standardized perioperative protocol for optimizing hemostasis was implemented. The primary endpoint was to define bleeding complications perioperatively and up to 30 days postoperatively after Aquablation. Bleeding complications included hematuria requiring prolonged continuous bladder irrigation, drop in hemoglobin requiring transfusion, or take back to operating room for evacuation of bladder clots and bladder fulguration. Bivariable analysis using Fisher's exact test and unpaired t-tests were used to identify factors associated with bleeding complications. Results: Thirty-two patients underwent Aquablation over the study period. Average preoperative international prostate symptom score was 20 (range: 13-34) and Qmax was 7 mL/s (range: 0-11). Mean prostate volume was 65 cc (range: 30-200 cc). Average perioperative change in hemoglobin was 1.3 g/dL (range: -0.3 to 4.2 g/dL). Eight patients (25%) experienced bleeding complications. Three (9.4%) required blood transfusions. On Fisher's exact test, prostate volume (91 cc vs 55 cc; p = 0.0361) and preoperative prostate-specific antigen (6.6 vs 2.9; p = 0.0218) were associated with postoperative bleeding. Conclusions: Performing waterjet ablation of the prostate without the use of electrocautery after waterjet treatment to control bleeding resulted in significant bleeding complications (25% of our cohort) during our initial experience. A combination of traction and focal bladder neck electrocautery is the best strategy to minimize bleeding complications after Aquablation.

Objective: To investigate if peritumor and/or intratumor vasculature is associated with high-grade tumor histology for renal cell carcinoma.Methods: A retrospective review at a tertiary care facility was performed of patients who underwent radical nephrectomy or partial nephrectomy for a renal tumor between January 2015 and December 2020. Data of tumor characteristics were collected from final pathology reports. A single radiologist specializing in genitourinary imaging reviewed all preoperative cross-sectional imaging for peritumor vessels and intratumor vessels. Single and multivariable logistic regression was utilized to identify variables associated with high-grade tumor histology.Results: The average tumor size on final pathology report was 6.4 cm (range 3.0-17.0 cm). Ninety-two patients (56.1%) had either an enlarged peritumor vessel (n = 72), an intratumor vessel (n = 3), or both a peritumor vessel and an intratumor vessel (n = 17). Of the 92 patients with either a peritumor vessel or both a peritumor vessel and intratumor vessel, 60.9% of these patients had high Fuhrman grade histology on final pathology report (60.9% vs 39.1%, p < 0.001). Pathologic stage T1a tumors with an enlarged peritumor vessel on preoperative imaging were associated with high Fuhrman grade histology (58.3% vs 41.7%, p = 0.015). Across all stages, the presence of an enlarged peritumor vessel was significantly associated with high Fuhrman grade (odds ratio: 2.37, 95% confidence interval 1.17-4.9, p = 0.01).Conclusion: Findings suggest that vessels surrounding small renal tumors and large renal tumors is associated with high tumor grade (Fuhrman grade >3). Further research is needed to support the association of peritumor vessels with high tumor grade.

Aquablation has been well-studied in prostates sizes up to 150 mL. Recently, American Urological Association guidelines distinguish surgical interventions for men with large prostates (80 mL-150 mL) and now very large prostates (> 150 mL). Readers will gain an understanding of how to use Aquablation in the very large prostate size category.

You have accessJournal of UrologyCME1 May 2022MP58-11 COMPARISON OF PROSTATE CANCER DETECTION RATES BETWEEN TRANS-RECTAL MRI/US FUSION AND TRANS-PERINEAL COGNITIVE TARGETED PROSTATE BIOPSY APPROACHES Johnathan Drevik, Zafardjan Dalimov, Allen Rojhani, Phillip Abbosh, Steven Sterious, Joshua Cohn, Jay Simhan, Justin Friedlander, Eric Ghiraldi, Robert Uzzo, and Serge Ginzburg Johnathan DrevikJohnathan Drevik More articles by this author , Zafardjan DalimovZafardjan Dalimov More articles by this author , Allen RojhaniAllen Rojhani More articles by this author , Phillip AbboshPhillip Abbosh More articles by this author , Steven SteriousSteven Sterious More articles by this author , Joshua CohnJoshua Cohn More articles by this author , Jay SimhanJay Simhan More articles by this author , Justin FriedlanderJustin Friedlander More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Serge GinzburgSerge Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002641.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Many urology practices have access to MRI/US fusion technology for prostate targeting via transrectal (TR) approach. The adoption of transperineal (TP) prostate biopsy is increasing, but conversion to TP fusion technology can be financially prohibitive. Cognitive TP targeting is a cost-effective alternative but may be perceived as a barrier and assumed to result in lower cancer detection. We describe a single surgeon’s transition from TR MRI/US fusion to cognitive TP targeted biopsies. METHODS: A retrospective chat review of patients that underwent targeted prostate biopsy (either TP cognitive or TR MRI/US fusion) from 2015 - 2021 was performed. Patients with PSA > 20, concomitant procedures or metastatic disease were excluded. In patients with multiple biopsies only the first targeted biopsy was abstracted. Chi-Square and Mann-Whitney tests were utilized for univariable analysis of categorical and continuous variables, respectively. Multivariable logistic regression models were fit to evaluate variables associated with clinically significant prostate cancer on targeted biopsy. RESULTS: Of the 146 patients that underwent targeted prostate biopsy, 40% underwent TP cognitive approach. Clinicopathologic characteristics between the two groups differed in demographic distribution, prostate size, and MRI findings (Table 1). The detection of any prostate cancer (64% vs 39%, p=0.003) and clinically significant prostate cancer (csPCa) (48% vs 19%, p<0.001) were higher in the TP cognitive targeted group. On multivariable analysis, controlling for clinicopathologic characteristics, only PSA density above >0.15 ng/ml2 was associated with csPCa on targeted biopsy (Table 2). Targeted biopsy approach, TR fusion vs. TP cognitive targeted biopsy, was not associated with detection of csPCa. CONCLUSIONS: Clinically significant prostate cancer detection rate was not compromised when switching from transrectal MRI/US fusion to transperineal cognitive targeted biopsy technique. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e996 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johnathan Drevik More articles by this author Zafardjan Dalimov More articles by this author Allen Rojhani More articles by this author Phillip Abbosh More articles by this author Steven Sterious More articles by this author Joshua Cohn More articles by this author Jay Simhan More articles by this author Justin Friedlander More articles by this author Eric Ghiraldi More articles by this author Robert Uzzo More articles by this author Serge Ginzburg More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022PD45-08 SELECTIVE MEDIAN LOBE LASER ENUCLEATION OF THE PROSTATE: PRESERVING SEXUAL FUNCTION WITHOUT COMPROMISING URINARY OUTCOMES Benjamin Press, David Kim, Eric Ghiraldi, Michael Siev, and Daniel Kellner Benjamin PressBenjamin Press More articles by this author , David KimDavid Kim More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , Michael SievMichael Siev More articles by this author , and Daniel KellnerDaniel Kellner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is recommended for prostate glands of all sizes and is becoming a popular alternative to the transurethral resection of the prostate (TURP). Side effects of the procedure include stress incontinence, irritative lower urinary tract symptoms, and sexual function, most commonly retrograde ejaculation. We sought to evaluate perioperative outcomes related to sexual function and urinary function in patients who underwent selective laser enucleation of the prostate. METHODS: We conducted a retrospective review of the first 300 cases of HoLEP was performed from April 2019 – August 2021. Thirty-two patients within our cohort underwent selective enucleation of the median lobe of the prostate. Criteria for choosing to treat patients with selective enucleation were intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes. Patients were asked to comment on whether they had retrograde ejaculation during their follow up appointment. Urinary function was assessed using the American Urological Association Symptom Score (AUA-SS) and subjective evaluation of urinary incontinence. RESULTS: Mean age of our cohort was 65.9 years of age. Average peri-operative AUA-SS scores significantly improved (21.7 vs 6.8, p < 0.001). Average peri-operative quality of life scores significantly improved (4.1 vs 1.4, p < 0.001). Average peri-operative post void residual volumes were significantly improved (228.8 cc vs 45.7 cc, p = 0.001). No patients reported stress urinary incontinence. Of the 32 patients who underwent selective enucleation of the median lobe, 26 were sexually active. Of those men, 22 reported normal ejaculation, 2 men had retrograde ejaculation that was unchanged from pre-op. Data was missing for 2 men. CONCLUSIONS: In our case series of selective laser enucleation of the median lobe, urinary function significantly improved in short term follow-up with preservation of ejaculation in approximately 90% of men. A larger series is necessary with a longer follow up period to further investigate the durability of these findings. Further investigation is needed to define objective criteria to identify ideal candidates for selective median lobe enucleation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e785 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Press More articles by this author David Kim More articles by this author Eric Ghiraldi More articles by this author Michael Siev More articles by this author Daniel Kellner More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP29-10 AQUABLATION IN VERY LARGE PROSTATES (>150ML): TECHNIQUE AND MULTICENTER CASE SERIES Alexander Glaser, Brian Helfand, Ali Kasraeian, Steve Sterious, Pooja Talaty, Miguel Alcantara, Kaitlyn Alcantara, Andrew Higgins, Eric Ghiraldi, and Dean Elterman Alexander GlaserAlexander Glaser More articles by this author , Brian HelfandBrian Helfand More articles by this author , Ali KasraeianAli Kasraeian More articles by this author , Steve SteriousSteve Sterious More articles by this author , Pooja TalatyPooja Talaty More articles by this author , Miguel AlcantaraMiguel Alcantara More articles by this author , Kaitlyn AlcantaraKaitlyn Alcantara More articles by this author , Andrew HigginsAndrew Higgins More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , and Dean EltermanDean Elterman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation has been well-studied in men with prostate volume (PV) <150ml. AUA guidelines distinguish surgical interventions for men with large prostates (80-150ml) and very large prostates (>150ml). In this study, we describe the technique for Aquablation in men with PV>150mL and outcomes in a multicenter case series. METHODS: Additional procedural steps for men with PV>150mL are often needed based on the maximum ablation length (7cm) and depth (2.4cm) (Figure 1). After the first pass, the handpiece position should be adjusted by tipping the handpiece down to maximize depth (Figure 2). For long prostates (>7cm), the handpiece should then be leveled and re-positioned at the external sphincter, then a third pass completed (Figure 3). Focal bladder neck hemostasis is then performed as previously described. Data from was collected retrospectively for men with PV>150mL including international prostate symptom score (IPSS), peak urinary flow rate (Qmax), length of stay, and blood transfusion. RESULTS: Thirty-four men (age 69 ± 8) were treated at four institutions. The average PV was 209mL ± 56 (range 151-362mL). Symptoms improved from a baseline IPSS 19 ± 6 to 7 ± 5 after mean follow-up of 7 ± 9 months. Qmax also improved from 7 ± 4 mL/s to 19 ± 5 mL/s. There were no reports of transfusion, urinary incontinence, erectile dysfunction, or ejaculatory dysfunction, and most patients were discharged POD1. CONCLUSIONS: Most prostates greater than 150mL typically require repositioning of the handpiece for either depth or length. Preliminary data suggests Aquablation is effective and safe in prostates greater than 150mL. Source of Funding: Drs. Helfand, Kasraeian, Sterious, and Elterman have had or currently have a consulting agreement with PROCEPT BioRobotics. No funding was received this manuscript © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e472 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Glaser More articles by this author Brian Helfand More articles by this author Ali Kasraeian More articles by this author Steve Sterious More articles by this author Pooja Talaty More articles by this author Miguel Alcantara More articles by this author Kaitlyn Alcantara More articles by this author Andrew Higgins More articles by this author Eric Ghiraldi More articles by this author Dean Elterman More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-02 EVALUATING SPONTANEOUS STONE PASSAGE RATES DURING THE COVID-19 PANDEMIC Eric Ghiraldi, Stephanie Hanchuk, Matthew Buck, Hari Nair, Dinesh Singh, and Piruz Motamedinia Eric GhiraldiEric Ghiraldi , Stephanie HanchukStephanie Hanchuk , Matthew BuckMatthew Buck , Hari NairHari Nair , Dinesh SinghDinesh Singh , and Piruz MotamediniaPiruz Motamedinia View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic our institution limited elective surgery including management of kidney stones. Additionally, patients themselves were reluctant to pursue elective surgery. This presented us a unique opportunity to reassess the natural history of symptomatic nephrolithiasis given potentially prolonged periods of conservative management. METHODS: A retrospective review was performed of patients presenting to the emergency room (ER) with flank pain secondary to nephrolithiasis from March to April of 2020 (COVID peak period of elective surgery limitations), and a comparative cohort from March and April 2019. Assessed outcomes included definitive stone treatment at initial presentation to the ER, rate of spontaneous stone passage, and time to elective surgery from initial ER presentation. Chi-square or Mann-Whitney U tests were utilized for dependent binary variables and continuous variables, respectively. A Kaplan Meier analysis was used to demonstrate differences in time to elective surgery between the two eras. RESULTS: Baseline characteristics did not differ between groups (Table). Patients discharged from the ER were more often offered medical expulsive therapy (71.6% vs 55.0%, p=0.026) during the COVID era. The rate of surgical stone management or stent placement at initial presentation did not differ, however, discharged patients waited longer from initial ER presentation to elective surgery (55.3 vs 33.1 days, p=0.02). Spontaneous stone passage rates were similar between groups despite the delay, and similar stone location and stone size between eras. CONCLUSIONS: During the height of the COVID pandemic, ER patients with symptomatic stones had similar characteristics at presentation but were more often offered MET. Spontaneous stone passage during the pandemic was no different than in 2019, despite a significant difference in time to elective surgery from initial presentation to the ER with flank pain. Download PPT Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e317-e317 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Metrics Author Information Eric Ghiraldi More articles by this author Stephanie Hanchuk More articles by this author Matthew Buck More articles by this author Hari Nair More articles by this author Dinesh Singh More articles by this author Piruz Motamedinia More articles by this author Expand All Advertisement PDF downloadLoading ...