OBJECTIVE:To assess the impact of Distressed Communities Index (DCI) on treatment disparities and disease-related quality of life (QoL) in a nationwide sample of patients with nephrolithiasis. METHODS:We performed a nationwide online cross-sectional survey of adult registrants of ResearchMatch with nephrolithiasis. Patients from distressed communities (DCI ≥75) were compared to patients from not distressed communities. Stone burden, prevention recommendations, stone-related QoL (WISQOL), and patient-reported barriers to prevention were compared. Multivariable linear regression was used to evaluate the association between DCI and WISQOL scores, adjusting for demographics, emergency care, and income. RESULTS:Of the 938 respondents in this cohort, 126 (13.4%) were from distressed communities (DCI ≥75). Individuals from distressed communities had significantly lower WISQOL scores (median WISQOL 83 [IQR 55.7-92] vs 87.5 [IQR 68.8-94.6]; P = .005), were more likely to miss ≥5 workdays due to nephrolithiasis (17.5% vs 8.4%; P = .003) and report barriers to making stone-prevention dietary changes (44.4% vs 29.2%; P<.001), primarily due to cost. On multivariable analysis, after controlling for demographics and emergency care utilization, DCI remained inversely correlated with WISQOL; however, upon the addition of income, this association was attenuated. CONCLUSION:In this nationwide study, patients from distressed areas faced additional barriers to stone prevention and lower stone-related QoL, though this relationship was primarily driven by income. These findings suggest that community-level socioeconomic distress associated with disparities among patients with stones and may help urologists tailor more equitable and supportive care strategies.

You have accessJournal of UrologyDiversity, Equity & Inclusion: Increasing Representation in Urology (MP54)1 May 2024MP54-10 FEMALE UROLOGIC SURGERY GRADUATES FACE HIGHER RATES OF BURNOUT DESPITE HIGH RATES OF JOB RETENTION Jackson Cabo, Kate Dwyer, Sam S. Chang, and Kristen Scarpato Jackson CaboJackson Cabo , Kate DwyerKate Dwyer , Sam S. ChangSam S. Chang , and Kristen ScarpatoKristen Scarpato View All Author Informationhttps://doi.org/10.1097/01.JU.0001008944.36895.9d.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A historically male field, urology continues to have gender-based disparities in income and academic advancement. In this multi-institutional study, we sought to characterize graduates' differential experiences in career advisement, job selection, job retention, and burnout. METHODS: We performed a computer-based survey distributed to residency graduates from 14 U.S. programs. The survey included questions about training program and employment characteristics. Outcomes included job retention in one's first job after training and factors involved in job selection (Ranked 1-7). Burnout was measured using the validated two-item Maslach Burnout Inventory (MBI) which includes an emotional exhaustion and depersonalization domain. RESULTS: A total of 180 responses were obtained with 41 (23%) being female and 137 (77%) male. The majority of male (N=99, 70%) and female (N=32, 78%) respondents remained in their initial post-training position (p=0.50) to a median of 6 and 4 years post-training, respectively. A greater proportion of women (N=26, 63%) compared to men (N=56, 41%: p=0.01) scored high in the MBI emotional exhaustion domain. Impressions of formal and informal career advising during residency were similar between groups and most respondents reported their faculty reached out to prospective employers (Table 1). Location was the most prioritized factor in job selection in men and was third-ranked in women (Table 2), while compensation structure was more highly rated in men (Median Rank 4, IQR 3-5) compared to women (Median Rank 5, IQR 4-6; p=0.004). CONCLUSIONS: Despite having similar early-career job retention to males and viewing their career advising experience favorably, female urologists reported higher rates of burnout, highlighting that job retention itself is an insufficient metric to characterize early career quality of life. As programs seek to optimize support for female alumni, advising and recruiting should be tailored to target not only employment longevity but also individual-specific goals for quality of life. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e879 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jackson Cabo More articles by this author Kate Dwyer More articles by this author Sam S. Chang More articles by this author Kristen Scarpato More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND:Sexual satisfaction is an important component of global quality life for many adult men. Substantial gaps exist in our appreciation of how age mediates sexual satisfaction in the context of functional sexual measures. We sought to evaluate modifiable factors associated with overall sexual satisfaction and health-related quality of life (HRQoL) in a large, age-stratified community-based sample of adult men. METHODS:A sample of adult males registered with the online research service ResearchMatch completed a 75-item online questionnaire in this cross-sectional study. Queries included demographics, general health data, and validated sexual health measures including International Index of Erectile Function-5 (IIEF-5) and Premature Ejaculation Diagnostic Tool (PEDT). Multivariable regression was performed to assess associations with self-reported sexual satisfaction (defined by "moderately satisfied" or "very satisfied" on the 5-level Likert scale) and overall HRQoL (as measured by the EQ-5D-visual analog scale (VAS) stratified by age. RESULTS:One thousand thirty-three men completed the survey and were stratified by age cohorts. IIEF-5 and PEDT scores were higher in younger cohorts. On multivariable regression analysis, higher IIEF-5, lower PEDT, better overall health-related quality of life, and the presence of a sexual partner within the last month were associated with an increased likelihood of overall sexual satisfaction. When stratified by age cohort, higher IIEF-5 scores were consistently positively associated with sexual satisfaction (Odds Ratio (OR) 1.18, 95% CI 1.15-1.22, P < 0.001), as well as independently associated with improved overall HRQoL by EQ-5D-VAS (β = 0.71, Standard Error (SE) = 0.08, P < 0.001). CONCLUSIONS:The erectile function was independently associated with sexual satisfaction and quality of life across all age strata and predictive of both sexual satisfaction and global HRQoL. Low overall rates of sexual satisfaction across cohorts highlight the critical importance of evaluation and treatment of sexual health, regardless of age.

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes II (MP57)1 May 2024MP57-17 MYUROLOGY HEALTH: IMPLEMENTATION OF A NOVEL EPISODE BASED PAYMENT MODEL FOR NEPHROLITHIASIS Kate Dwyer, Ruchika Talwar, Jackson Cabo, Brittany L. Cunningham, Chelsea Parris, C. J. Stimson, Sabrina J. Poon, and Ryan S. Hsi Kate DwyerKate Dwyer , Ruchika TalwarRuchika Talwar , Jackson CaboJackson Cabo , Brittany L. CunninghamBrittany L. Cunningham , Chelsea ParrisChelsea Parris , C. J. StimsonC. J. Stimson , Sabrina J. PoonSabrina J. Poon , and Ryan S. HsiRyan S. Hsi View All Author Informationhttps://doi.org/10.1097/01.JU.0001009420.83948.eb.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Value-based payment (VBP) implementation has been a priority in healthcare, but applications in urology have been limited. Herein, we describe a single academic institution's experience with a direct-to-employer bundled program, "MyUrology Health," covering all nephrolithiasis care for a single prospective price with zero patient-facing costs, including repeat procedures and emergency visits, irrespective of volume of services utilized. METHODS: Eligible patients from two self-insured employers were enrolled prospectively from 1/2023-9/2023 under one of four tiers (Figure 1). For those managed non-surgically, EOC ended 100 days after enrollment. For those managed surgically, EOC ended 6 months after first procedure. Clinic and emergency visits, imaging/laboratory testing related to nephrolithiasis and dietician consultation were included in the EOC. We analyzed short-term clinical and quality outcomes. RESULTS: In total, 60 patients were enrolled (Table 1): 97% had a health system sponsored health plan. Less than 5% of patients had a high-deductible plan. 73% were enrolled at the time of a symptomatic stone episode; most opted for the trial of passage (40%) or single endoscopic tier (48%). Over half (60%) received surgery within a mean of 30 days from EOC start. Of those who required intervention, 7 had urgent procedures prior to the initiation of the EOC. Postoperatively, 34/36 patients had imaging ordered, with 30 completing it (83%). 31 patients completed a 24-hour urine analysis and 7 saw a dietician. Ten emergency visits fell within the EOC. CONCLUSIONS: Under MyUrologyHealth, the first-ever VBP for nephrolithiasis, 95% had zero out-of-pocket expenses for their EOC. This included comprehensive services including surgery if indicated, provider visits, and stone prevention care. Future analyses will provide insight into the overall cost and quality implications of this novel VBP model. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e944 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kate Dwyer More articles by this author Ruchika Talwar More articles by this author Jackson Cabo More articles by this author Brittany L. Cunningham More articles by this author Chelsea Parris More articles by this author C. J. Stimson More articles by this author Sabrina J. Poon More articles by this author Ryan S. Hsi More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: New opioid dependency after urologic surgery is a serious adverse outcome that is well-described in the literature. Patients with stone disease often require multiple procedures because of recurrence of disease and hence are at greater risk for repeat opioid exposures. Despite this, opioid prescribing after urologic surgery remains highly variable and in an emergency setting, opioids are still used commonly in management of acute renal colic. Methods: Two literature searches were performed using PubMed. First, we searched available literature concerning opioid-sparing pathways in acute renal colic. Second, we searched available literature for opioid-sparing pathways in ureteroscopy and percutaneous nephrolithotomy (PCNL). Abstracts were reviewed for inclusion in our narrative review. Results: In the setting of acute renal colic, multiple randomized control trials have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) attain greater reduction in pain scores, decreased need for rescue medications, and decreased vomiting events in comparison with opioids. NSAIDs also form a core component in management of postureteroscopy pain and have been demonstrated in randomized trials to have equivalent to improved pain control outcomes compared with opioids. Multiple opioid-free pathways have been described for postureteroscopy analgesia with need for rescue narcotics falling under 20% in most studies, including in patients with ureteral stents. Enhanced Recovery After Surgery protocols after percutaneous nephrolithotomy are less well described but have yielded a reduction in postoperative opioid requirements. Conclusions: In select patients, both acute renal colic and after kidney stone surgery, adequate pain management can usually be obtained with minimal or no opioid medication. NSAIDs form the core of most described opioid-sparing pathways for both ureteroscopy and PCNL, with the contribution of other components to postoperative pain outcomes limited because of lack of head-to-head comparisons. However, medications aimed specifically at targeting stent-related discomfort form a key component of most multimodal postsurgical pain management pathways. Further investigation is needed to develop pathways in patients unable to tolerate NSAIDs.

You have accessJournal of UrologyCME1 Apr 2023MP68-03 USING A COMPUTER VISION-MEDIATED ANALYSIS TO DISTINGUISH SURGEON EXPERIENCE DURING ENDOSCOPIC STONE SURGERY Jackson Cabo, Daiwei Lu, Zach Stoebner, Ipek Oguz, and Nick Kavoussi Jackson CaboJackson Cabo , Daiwei LuDaiwei Lu , Zach StoebnerZach Stoebner , Ipek OguzIpek Oguz , and Nick KavoussiNick Kavoussi View All Author Informationhttps://doi.org/10.1097/JU.0000000000003331.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The assessment of surgical competency is essential for clinical training and safety. Currently, there are no validated, objective, real-time tools for evaluating expertise during endoscopic surgery. We sought to apply validated, automated kidney stone segmentation software to distinguish expert and trainee surgeons during flexible ureteroscopy (fURS). METHODS: Forty-six separate videos of fURS were prospectively recorded. Surgeons were categorized as 'expert' (n=2, fellowship trained endourologist, case volume of >100 fURS per year) or trainee (n=2, resident, <100 fURS per year), performing two defined tasks: stone localization, and holmium laser ablation (dusting). Surgeons were randomly assigned to one of these tasks per case. Stone localization was standardized as evaluation of the entire collecting system. For the localization task, we analyzed first 5 seconds of video after stone identification. For the laser ablation task, we analyzed the first 20 seconds of stone ablation. All videos were visually validated for quality and frames extracted at 30fps. Frames were analyzed by previously validated automated stone segmentation models. We performed a pixel-based analysis, evaluating percent occupancy of stone for each frame and compared differences between trainees and experts for each task. RESULTS: Of 46 videos (N=14299 frames), 28 were evaluated for the localization task (14 trainee, 14 expert) and 18 for the laser ablation task (9 novice, 9 expert). The percentage of frames without stones identified was higher in trainees compared to experts for both localization (25% vs. 5%, p<0.01) and laser ablation (16% vs. 8%, p<0.01), indicating more frequent loss of stone visualization by trainees. Stones occupied more of each frame for trainees compared to experts for both localization (18% vs. 11% , p<0.01) and laser ablation (20% vs. 16%, p<0.01), suggesting closer stone visualization during stone treatment by trainees (Fig. 1). There was greater variation in frame-to-frame stone occupancy for trainees compared to experts during stone localization (2.9% vs 1.5%, p<0.01). CONCLUSIONS: Objective and automated computer vision-mediated analysis can distinguish surgical experience between experts and trainee surgeons performing fURS for kidney stones. Source of Funding: Endourologic Society Grant Funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e953 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jackson Cabo More articles by this author Daiwei Lu More articles by this author Zach Stoebner More articles by this author Ipek Oguz More articles by this author Nick Kavoussi More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX Evan Watkins, Abimbola Ayangbesan, George Koch, Rohan Bhalla, Jackson Cabo, Helen Gambrah, Theresa Zwaschka, and Niels Johnsen Evan WatkinsEvan Watkins More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Helen GambrahHelen Gambrah More articles by this author , Theresa ZwaschkaTheresa Zwaschka More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Living in socioeconomically disadvantaged neighborhoods affects health behaviors and outcomes. How neighborhood disadvantage impacts care of benign urologic disease has not been previously studied. In this pilot study, we sought to evaluate how patient-level social risk determinants impact care of urethral stricture patients. METHODS: Patients treated with urethroplasty between 9/4/2019 and 12/29/2021 were analyzed. Those with a history of urethroplasty and under the age of 18 were excluded. To evaluate neighborhood disadvantage, we used the area deprivation index (ADI), a 17-component index composed of education, employment, housing-quality, and poverty measures utilizing data from the American Community Survey. Patient addresses were geocoded and assigned a national ADI rank, with scores normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. For this analysis, patients were grouped into ADI quartiles. Multiple endoscopic procedures was defined as >2 procedures prior to urethroplasty. Impact of ADI on treatment and processes of care was analyzed utilizing univariate and multivariate models. RESULTS: 104 patients were included, with a median age 54.5 (IQR 38, 66) and ADI of 63.5 (IQR 38.8, 79.3). When separated into quartiles, 15.4%, 21.2%, 31.7% and 31.7% were in the first, second, third and fourth ADI quartiles, respectively, with higher quartiles representing increased levels of deprivation. There were no significant differences in race or insurance status by ADI quartile. Patients in the highest ADI quartile underwent significantly more endoscopic procedures prior to urethroplasty than those in the lowest, at 0 (0, 1) versus 2 (1, 4) (p=0.01). On multivariate analysis adjusting for age and insurance status, ADI quartile was associated with an increased likelihood of undergoing multiple endoscopic procedures, with OR 4.97 (95% CI 1.22-26.14) and OR 5.05 (95% CI 1.23 – 26.53) for third and fourth quartiles, respectively. A one-point increase in ADI was associated with a 2% increased risk of repeat endoscopic procedures prior to urethroplasty (OR 1.02 [95% CI 1.01 – 1.04]). CONCLUSIONS: This is the first analysis evaluating how a patient’s physical neighborhood can mediate processes of care for urethral stricture disease. We found that increased neighborhood deprivation, regardless of race or insurance status, can lead to increased endoscopic treatments and delays to urethroplasty. Utilization of this methodology can help further identify disparities in care and highlight the impact of social determinants on urologic care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e911 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evan Watkins More articles by this author Abimbola Ayangbesan More articles by this author George Koch More articles by this author Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Helen Gambrah More articles by this author Theresa Zwaschka More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP79-05 IDENTIFYING RISK FACTORS FOR NON-PRESCRIPTION PDE-5 INHIBITOR USE IN ADULT MEN Jackson Cabo, George Koch, Rohan Bhalla, and Niels Johnsen Jackson CaboJackson Cabo More articles by this author , George KochGeorge Koch More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: PDE-5 inhibitors (PDE-5i) are the mainstay of medical management for erectile dysfunction but do carry risk. Increased availability of these medicines from sources outside of a physician’s office may present risks to patients due to incomplete counseling or medication reconciliation and may also expose individuals to counterfeit medication. We sought to characterize associations of demographics, sexual function, and sexual orientation with PDE-5i obtained from non-prescription means. METHODS: Adult males were recruited through a national registry of volunteers (ResearchMatch) to participate in an online survey. We assessed PDE-5 inhibitor use and the medications’ source of within the last year. Demographic, sexual partner, and validated scores for erectile function (IIEF-5) and ejaculatory function (PEDT) were obtained. Logistic regression analyses were performed to identify associations with obtaining non-prescription PDE-5 inhibitors. RESULTS: Of the 1033 men who completed the survey, 348 reported using PDE-5i in the past year (Table 1) with 88 (25.1%) obtaining PDE-5i from a non-prescription source. Men obtaining non-prescription PDE-5i tended to be younger (median age 51.5 vs. 62, p<0.001) than those obtaining it with a standard prescription. Sexual function characteristics by IIEF and PEDT scores were similar between groups. Men who have sex with men (MSM) were nearly twice as likely to have obtained PDE-5i from a non-prescription source (37.3 vs. 22.5%, p=0.018). Married men were less likely than single men to purchase PDE-5i from a non-prescription source (22.3 vs. 35.9%, p=0.017). On multivariable analysis, only older age was associated with decreased odds of obtaining PDE-5i from an online or non-prescription source (OR 0.97, 0.95-0.98, p<0.001). CONCLUSIONS: In this large, community-based study of adult men, we found that a quarter of PDE-5i users had obtained medication without seeing a physician. We found that younger men and men who have sex with men (though not significant on multivariable analysis) were more likely to obtain these medicines from alternative sources. While these medicines are typically well tolerated, medication obtained from unreliable sources is more likely to be counterfeit and may place individuals at higher risk for adverse events. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1142 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jackson Cabo More articles by this author George Koch More articles by this author Rohan Bhalla More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To characterize stone-related financial burden among adults with nephrolithiasis through vali-dated questionnaires for financial toxicity. METHODS We performed a cross-sectional survey of adults with history of nephrolithiasis at an outpa-tient clinic. The survey contained a measure of stone-related financial toxicity (COST score), and assessed demographics, stone event history, and burden of overall, ancillary, pre-ventative, and insurance costs. A COST score <= 21 was classified as high financial toxicity. Multivariable logistic regression was used to evaluate associations with demographic variables and stone event history. RESULTS One hundred patients completed the survey (median age 57, IQR, 48-64). The median COST score was 30 (IQR, 23-37), and 19% reported high financial toxicity. Insurance sta-tus, household income, stone surgeries during lifetime and within the last 3 years were asso-ciated with financial toxicity on univariable analysis (P <.05). Burden of costs was significantly higher in all categories within the high financial toxicity cohort (each P <.05). On multivariable logistic regression, only income >$75,000 remained significant within the second model (OR: 0.22, 95% CI, 0.05-0.77, P = .02), however, this relationship did not persist on the final model. When asked whether providers should be mindful of their finan-cial situation prior to making treatment recommendations, 39% responded "quite a bit" or "very much." CONCLUSION One in 5 patients seeking care for nephrolithiasis meet criteria for high financial toxicity. Finan-cial toxicity was associated with household income, insurance, education, and frequency of stone events. Thirty-nine percent reported that their provider should be mindful of their financial situa-tion when making recommendations. UROLOGY 174: 52-57, 2023. (c) 2023 Elsevier Inc.

INTRODUCTION AND OBJECTIVE: Expectant management for blunt renal trauma has primarily taken place in ICU settings. Recent reports have questioned this practice, as most patients do not require surgery or angioembolization for low-grade renal injuries. American Association for the Surgery of Trauma renal injury grade (AAST) III injuries are sometimes categorized with AAST IV and V injuries, as “High Grade Renal Trauma.” Unlike AAST IV and V injuries, however, AAST III injuries rarely require surgical or procedural intervention and thus may be candidates for early discharge. We hypothesized that patients with blunt AAST III injuries discharged within 48 hours of admission do not have increased rates of readmission due to renal complications compared to patients observed for more than 48 hours. METHODS: Renal trauma patients from 2005 through 2020 were identified from our institutional trauma registry. Patients with AAST III blunt renal injuries were included. Patients who died within 48 hours of admission were excluded. Univariable analysis was used to identify variables associated with discharge within 48 hours. Reasons for readmission were tabulated and compared between patients who were and were not discharged within 48 hours of admission. RESULTS: Of the 1751 renal trauma patients, 377 (21.5%) presented with a blunt AAST III renal injury and survived beyond 48 hours from admission. Sixty-five of 377 (17.2%) AAST III injuries were discharged within 48 hours of admission and 312 of 377 (82.8%) were admitted for more than 48 hours. On univariate analysis, arrival condition (responsive vs. unresponsive, p <0.001), hypotension on arrival (p[0.02), Injury Severity Score (ISS, p <0.001) and presence of a splenic injury (p[0.04) were associated with length of stay longer then 48-hours. No patients required a urologic procedure. While 35 patients (9.2%) required a readmission for non-urologic reasons, 3 in the early discharge group and 32 in the group admitted for more than 48 hours, no patients required readmission for renal or urologic reasons. CONCLUSIONS: Intermediate-grade blunt renal traumas have a low risk of complication and intervention, and thus a low rate of readmission, with non-renal injuries often driving a patient's length of stay and risk for readmission. Select patients with isolated AAST III injuries or AAST III injuries with less severe concomitant injuries may be appropriate for early discharge.

INTRODUCTION AND OBJECTIVE: Little is known regarding the financial burden of patients with kidney stone disease. We sought to characterize stone-related financial toxicity in among U.S. adults with kidney stones through validated questionnaires for financial toxicity and disease-specific health-related quality of life. METHODS: We performed a cross-sectional survey of adults with kidney stone disease from the general population ascertained through a national registry of volunteers (ResearchMatch). A 75-item computer-based survey was administered to query stone event history and stone-related costs, the Wisconsin Stone related Quality of Life (WISQOL), and an 11-item measure of stone-related financial toxicity (COST score). Patients in the highest quartile COST score group were categorized as having high financial burden, and the lower 3 quartiles were categorized as having low financial burden. Multivariable logistic regression was performed to evaluate predictors of high financial burden. RESULTS: There were 262 responses were obtained, with median age 53 (IQR 41-63) years and 60% female (Table 1). Patients with high financial burden ($50; IQR 0-600) spent more out of pocket (OOP) than patients with low financial burden ($0; IQR 0-50; P<0.001) in past year on stone treatment, had more stone-related encounters (2 vs. 0; P<0.001) and were more likely to borrow money from family/ friends to pay for treatment (13% vs. 1%; P<0.001). Patients with high financial burden were more likely to have a stone-related event or procedure in the last year (69% vs. 42%; P<0.001) and were more likely to defer recommended treatment due to anticipated cost (21% vs. 3%; P<0.001). Financial toxicity by COST score correlated with poorer stone related quality of life across WISQOL social, vitality, and disease impact domains (Table 1). Multivariable logistic regression (Table 1B) showed independent associations between high financial toxicity and poorer stone-related QOL in disease (P<0.001) and vitality (P[0.02) WISQOL domains. CONCLUSIONS: In this national survey of adults with kidney stone disease, we found that financial toxicity as estimated by COST score was associated with disease-specific out of pocket costs, more frequent clinical encounters, deferral of recommended treatment, and poorer health-related quality of life. Source of Funding: VUMC VICTR

OBJECTIVE To characterize stone-related financial toxicity among US adults with kidney stones through validated questionnaires for financial toxicity and disease-specific health-related quality of life. MATERIALS AND METHODS We performed a cross-sectional survey of adults with kidney stone disease from the general population ascertained through a national registry of volunteers (ResearchMatch). A computer-based survey queried stone event history and related costs for medical care, disease-specific quality of life (WISQOL), and an 11-item measure of stone-related financial toxicity (COST-11 score). Multi variable logistic regression was performed to evaluate predictors of financial toxicity, defined as having a COST-11 score & LE;20.RESULTS Of 942 responses, median COST-11 score was 29 (IQR 21-38), and 24.7% (N = 233) met criteria for disease-specific financial toxicity. Stone-formers with financial toxicity spent more out of pocket on stone-treatment in the previous year than patients with lower financial burden (P <.001) and were more likely to defer or delay recommended treatment due to anticipated cost (27% vs 3%; P <.001). Stone-specific financial toxicity was associated with poorer disease-specific health-related quality of life across all WISQOL domains (each P <.001). Multivariable logistic regression showed that female gender (OR 1.81; 95% CI 1.24-2.67), Medicaid compared to private insurance (OR 3.91; 95% CI 2.34-6.94), and stone passage in the previous year (OR 2.00; 95% CI 1.41-2.86) were independently associated with financial toxicity.CONCLUSION Approximately 1 in 4 individuals with kidney stone disease report disease-specific financial toxicity. These data suggest the financial burden of the condition may influence decision-making and associates with poorer disease-specific quality of life. UROLOGY 171: 57-63, 2023. & COPY; 2022 Elsevier Inc.

You have accessJournal of UrologyCME1 May 2022MP52-07 IMPACT OF FRAILTY ON ADVERSE COMPLICATIONS FOLLOWING ARTIFICIAL URINARY SPHINCTER IMPLANTATION Rohan Bhalla, Jackson Cabo, Tanya Marvi, Abimbola Ayangbesan, George Koch, Stephen Hill, Douglas Milam, Melissa Kaufman, and Niels Johnsen Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Tanya MarviTanya Marvi More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Stephen HillStephen Hill More articles by this author , Douglas MilamDouglas Milam More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002627.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Frailty is a well-established predictor of postoperative outcomes. We aimed to investigate the association between the modified Frailty Index (mFI) and postoperative complications after artificial urinary sphincter (AUS) surgery. METHODS: Men who underwent AUS surgery at a single institution (1/1/13 – 7/31/2020) were identified and electronic medical records were reviewed. The mFI is a validated measure of predicting patient morbidity and mortality that consists of 11 patient co-morbidities. Each variable is given 1 point with composite scores ranging from 0 (no frailty) to 11 (highest degree of frailty). Operative and non-operative complications were categorized as: mechanical failure, cuff erosion, infection, intractable pain, urinary retention, or other. Multivariable logistic regression was used to identify an association between mFI and postoperative complications. RESULTS: 203 AUS patients met inclusion criteria. The median age was 69.8 years (IQR 65.1-75.0) with 33% (n=67) of patients having a history of radiation and 29.1% (n=59) of patients with a history of diabetes mellitus. The median time from surgery to data collection was 73.4 months (IQR 54.4-89.2). The median cuff size was 4.5cm (IQR 4-5). The complication rate was 26.6% with 18.7% of men requiring a surgical intervention (mechanical failure: n=11, cuff erosion: n=16, infection: n=7, other n=4). The median mFI was 2 (IQR 1-4) for patients with a complication and 2 (IQR 1-3) for those with no complication (Table 1). Multivariable analysis demonstrated no association between mFI and overall complication (OR 1.04, 95% CI 0.83-1.29; p=0.75) or surgical complication (OR 1.04, 95% CI 0.81-1.34; p=0.75). Prior radiation and time since surgery were significantly associated with postoperative complications (Table 2). CONCLUSIONS: The mFI was not associated with an increased risk of AUS complications. However, a prior history of radiation and extended time from surgery were independently associated with complications and the need for surgical intervention. Source of Funding: N/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e888 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Tanya Marvi More articles by this author Abimbola Ayangbesan More articles by this author George Koch More articles by this author Stephen Hill More articles by this author Douglas Milam More articles by this author Melissa Kaufman More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF DownloadLoading ...

You have accessJournal of UrologyCME1 May 2022MP22-14 A MIXED METHODS APPROACH TO EXPLORING PATIENT MOTIVATIONS FOR DELAYING DEFINITIVE TREATMENT OF URETHRAL STRICTURE DISEASE Abimbola Ayangbesan, George Koch, Helen Gambrah, Rohan Bhalla, Jackson Cabo, Stephen Hill, and Niels Johnsen Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Helen GambrahHelen Gambrah More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Stephen HillStephen Hill More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethroplasty (UPL) for urethral stricture disease (USD) has high success and satisfaction rates, yet many patients trial endoscopic management with either dilation or urethrotomy. Access to care, surgeon expertise and counseling, and patient health literacy all play a role in the decision to defer UPL. Mixed methods research using both qualitative and quantitative data may allow for a more comprehensive understanding of patient's motivations to defer UPL. We hypothesize that decreased access to care and the logistical ease of endoscopic procedures will be associated with delayed UPL. METHODS: Retrospective review of our institutional UPL database was performed. Patients were categorized based on whether or not they had undergone at least two endoscopic procedures prior to UPL. Demographic data were collected, including median household income (MHI). Multivariable logistic regression using an a priori model was used to determine the odds of undergoing ≥2 prior endoscopic procedures. Telephone interviews were conducted with patients who had undergone ≥2 procedures in order to better understand their experiences and to identify motivations for delaying UPL. RESULTS: One hundred and five patients who underwent UPL from September 2019 to July 2021 were included in the study. Of these, 50 (47.6%) had previously undergone ≥2 endoscopic procedures (IQR 3-5), with 6 patients undergoing ≥10 procedures. On multivariable analysis, age at UPL (OR 1.03 [95% CI 1.01-1.06] p=0.02) and referral from non-teaching facility (OR 2.90 [95% CI 1.07-7.83] p=0.04) were predictors of delayed definitive treatment. Conversely, MHI >$100,000 was protective (OR 0.07 [95% CI 0.01-0.72] p=0.03). When interviewed, 83% of patients expressed a desire to have undergone UPL sooner and 61% were unaware of the lower success rates for repeated endoscopic treatments. Reasons for delaying UPL included not wanting to be admitted overnight due to being sole provider for family members, scheduling conflicts/times constraints, and fear of a more involved recovery. CONCLUSIONS: Predictors of delayed definitive treatment included age and referral from non-teaching facility, while higher MHI was protective. Most patients who underwent multiple endoscopic procedures prior to UPL expressed a desire to have pursued definitive management sooner. Patients in the delayed group cited logistical issues with a more involved procedure, as well as fear of longer recovery. These results illustrate the need for improved patient counseling and access to care for urethral stricture patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e376 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Abimbola Ayangbesan More articles by this author George Koch More articles by this author Helen Gambrah More articles by this author Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Stephen Hill More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction The TWIST score is a 5-component physical examination score used to aid in diagnosis of testicular torsion (TT) and could lessen need for radiologic testing in certain clinical scenarios. Objective TWIST use was not previously widespread at our institution. The primary objective of this quality improvement study was to achieve 100% compliance in TWIST utilization among urology and ED residents and to assess for score concordance between ED and urology assessments. Secondary goals were correlation of TWIST components with need for orchiectomy. Methods ED staff were educated about the TWIST score and asked to complete assessment for patients presenting with acute scrotal pain. Simultaneously, an electronic medical record-based dot phrase was introduced for urology trainees to complete an independent TWIST evaluation. Spearman correlation was performed to assess association between ED and Urology TWIST scores. Multivariable logistic regression was performed to assess association of TWIST score components and need for orchiectomy. Results 103 patients presented to the ED from 3/2018-11/2020 with a complaint of acute scrotal pain; 47 were diagnosed with torsion. As compared to our retrospective cohort, the documentation rate of complete TWIST score components on exam rose from 9% to 98% (P < 0.001) on ED evaluation and 16%-66% on urology evaluation (P < 0.001). Rates of repeat ultrasound for patient's transferred between facilities was similar (58% vs. 63%; p = 0.66) as was median time to OR (160 min vs. 145 min; p = 0.5). Using TWIST cutoff of >5 yielded a specificity of 94.5% for diagnosis of torsion, with corresponding strong correlation between ED and urology scores (rho = 0.71). A firm testicle was noted on urology evaluation in 100% of orchiectomy patients (vs. 61% of salvage patients) with persistent association after controlling for duration of symptoms (OR 28.1; P = 0.016). Discussion Through two-pronged quality improvement efforts, we significantly improved utilization of the TWIST score by ED and urology staff for workup of patients with acute testicular pain. We confirmed the high sensitivity and specificity of the TWIST score and demonstrated inter-rater reliability between ED and urology assessments. On prospective analysis, testicular firmness on exam was predictive of need for orchiectomy. Conclusion The TWIST score is an accurate diagnostic tool for both ED and urology providers in workup of children with acute scrotal pain, with a normal score essentially ruling out the condition. Future work should aim at minimizing unnecessary testing in patients demonstrated to be at high risk for torsion. [GRAPHICS] .

OBJECTIVE To characterize training and practice factors that influence early career stability and satisfaction in urology residency and fellowship graduates. METHODS A computer-based survey was distributed to residency and fellowship graduates from a single, large US training program from 1992 to 2015. Queries encompassed training program specifics, posttraining practice characteristics, and a validated burnout assessment. RESULTS Of 108 surveyed individuals there were 77 (71.3%) respondents. Fifty-one (67.1%) remained in their first position after residency. While 52 (67.5%) urologists reported that the program did not formally assist in finding their first post-residency position, no respondent reported difficulty securing a position. Proximity to family was a major factor in selecting a post-residency position in 40 (51.9%) of respondents. Twenty-nine (37.7%) participants joined practices with at least one other graduate of the same urology training program on staff and 24 remain in this position (82%). CONCLUSION Urology graduates from a large US training program did not have difficulty finding employment after training and most remain in their first post-training position. While proximity to family was a strong consideration for graduates, the perceived importance of first-position characteristics varied widely. 37.7% of our cohort took initial positions at a practice already employing a graduate from the same training program with >80% staying in this position. Surveying a broader range of programs may help future graduates and training programs better tailor their mentorship curricula and alumni networks to trainee goals. (C) 2022 Elsevier Inc.

You have accessJournal of UrologyCME1 May 2022PD29-01 SELECTIVE ANGIOEMBOLIZATION IS ASSOCIATED WITH NEED FOR HEMODIALYSIS AFTER HIGH-GRADE RENAL TRAUMA Stephen Hill, George Koch, Jackson Cabo, Rohan Bhalla, Abimbola Ayangbesan, Helen Gambrah, and Niels Johnsen Stephen HillStephen Hill More articles by this author , George KochGeorge Koch More articles by this author , Jackson CaboJackson Cabo More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , Helen GambrahHelen Gambrah More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current AUA Urotrauma guidelines recommend immediate intervention for hemodynamically unstable renal trauma patients. While selective angioembolization is often favored over surgery as it offers the potential advantage of a nephron sparing approach, the impact on overall renal function and need for hemodialysis is not well established. We hypothesized that selective angioembolization for high-grade renal injuries does not increase the need for hemodialysis during the index admission. METHODS: 611 patients with high-grade renal trauma, defined as American Association for the Surgery of Trauma Grade (AAST) III-V injuries, from 2005 through 2020 were identified from our institutional trauma registry. Of these patients, we identified all patients who had renal failure that required hemodialysis (HD) during their index admission. Univariate and multivariate analyses were performed to identify associations of arrival condition (responsive vs not), hypotension on arrival, ASST grade, age, injury severity score (ISS), presence of bilateral renal injury, urinary extravasation, perinephric fluid collection, or selective renal embolization with the need of HD. RESULTS: Four hundred and eight patients had AAST III injuries, 150 had AAST IV and 53 had AAST V. Nineteen (3.1%) of the 611 patients had renal failure requiring HD during their trauma admission. Of those 19 patients, 4 (21.1%) underwent an angioembolization. There were 17 embolized in the non-HD group. Variables associated with need for HD were arrival condition (p=0.005), hypotension on admission (p=0.035), AAST injury grade (p=0.0007), age (p=0.004), ISS (p=0.0001) and angioembolization (p=<0.0001). On multivariate analysis adjusting for ISS and arrival hypotension undergoing angioembolization resulted in an increased odds of requiring HD (OR 10.0, 95% CI 2.36-36.0). CONCLUSIONS: The current practice in high-grade renal trauma favors selective embolization as first line therapy for renal hemorrhage in unstable patients. Our data suggests that when adjusted for overall injury severity and hypotension, selective embolization is associated with need for HD during the index admission. Further research is required to understand the impact of angioembolization on renal functional outcomes long-term. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e504 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Hill More articles by this author George Koch More articles by this author Jackson Cabo More articles by this author Rohan Bhalla More articles by this author Abimbola Ayangbesan More articles by this author Helen Gambrah More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...