Microplastics (MPs) are environmental contaminants with sizes of the order of less than 5 mm that can enter the human body through inhalation and ingestion. Studies have shown that MPs can pose a threat to human health, and thus evaluation of the presence and potential adverse effects of MPs in tissues is critical. Typical MP studies include enzymatic or chemical tissue digestion that can lead to the loss of some MPs. Moreover, digestion does not allow mapping the location of the contaminant within the tissue architecture. This study aimed to develop a method to evaluate the presence of MPs in histological (thin) sections of tissues without digestion using optical photothermal infrared (O-PTIR) microspectroscopy at sub-micron (500 nm) spatial resolution. Tissue phantoms containing specific amounts and types of MPs and biological tissues were evaluated using polarized light microscopy (PLM) and O-PTIR, and several data analysis approaches were employed to detect MPs in non-digested samples. MPs of sizes from 3 to 85 µm were detected and characterized in tissue phantoms. Furthermore, we detected MPs related to the breakdown products of nylon and cellulose particles in thin sections of biological tissues and discussed obstacles related to the use of database spectra for comparison with O-PTIR spectra, demonstrating the potential of this novel approach and the associated challenges.

PURPOSE:Current prognostic assessment of men with biochemical recurrence (BCR) after radical prostatectomy (RP) relies on data from the pre-2000s era when androgen deprivation therapy (ADT) was delayed until metastasis. Most men now initiate ADT at low PSA values before metastases, especially for high-risk disease in which expanded ADT improves metastasis-free survival. We defined rates of cancer progression and mortality in men treated with early ADT for post-RP BCR. MATERIALS AND METHODS:We conducted an observational study of 1108 men with nonmetastatic prostate cancer receiving ADT for BCR after RP from 1988 to 2019 from the Veterans Affairs SEARCH database. Fine and Gray competing risk models quantified risk of metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM) across key predictors. RESULTS:The median follow-up after ADT among men who did not die of prostate cancer was 5.8 years (IQR 3.0-9.9). The median PSA at ADT was 1.3 ng/mL (IQR 0.4-4.9). Across all men, risks of metastasis, CRPC, and PCSM at 15 years after ADT were 28%, 27%, and 19%, respectively. In multivariable models, higher pre-ADT PSA, shorter pre-ADT PSA doubling time, higher pathologic grade group, and seminal vesicle invasion were associated with higher risk of metastasis, CRPC, and PCSM. We created predictive nomograms and tables estimating 3-, 5-, 10-, and 15-year risks of metastasis, CRPC, and PCSM by PSA at ADT, PSA doubling time at ADT, pathologic grade group, and seminal vesicle invasion. Risks of PCSM at 15 years after ADT initiation ranged from 2% to 60% across subgroups. CONCLUSIONS:These contemporary prognostic estimates are more applicable to men receiving early ADT for post-RP BCR and can help identify high-risk patients who are candidates for intensified hormonal therapy.

Life expectancy (LE) is essential for triage between aggressive and conservative management for all prostate cancer risk subtypes. We sought to investigate differences in how Black and Hispanic men interpret LE in treatment decision-making. We used targeted crowdsourcing to sample a cohort reflecting sociodemographics of a US prostate cancer population. Subjects completed a conjoint analysis exercise where they iteratively chose between aggressive treatment versus conservative management across levels of 4 tradeoffs—tumor risk (lives saved by aggressive treatment at 5/10/20 year); erectile dysfunction; urinary incontinence; and irritative urinary symptoms—while considering their LE as calculated by the Prostate Cancer Comorbidity Index. Multinomial conditional logistic regression compared odds of choosing aggressive vs. conservative treatment across LEs ranging from 0 to 20 years overall and across racial/ethnic subgroups. Of 2046 men, 435 (22%) were Black and 230 (11%) were Hispanic. Across all men, the odds of aggressive treatment choice increased by 17% for every 5 years of additional LE (OR = 1.17, 95%CI = 1.12–1.22, p < 0.001). Men were significantly more likely to choose aggressive treatment at LE > 13 y and non-aggressive treatment at LE ≤ 10 y. Among Black men, LE was not associated with treatment choice, as they consistently preferred aggressive treatment across all LE categories. Among Hispanic men, increased LE was associated with a higher likelihood of choosing aggressive treatment, with significant preference for aggressive treatment observed only when LE > 10 years. These patterns remained consistent when further stratified by tumor risk. LE had no impact on treatment decisions in Black men, in contrast to other races and ethnicities. Future research is needed to identify reasons for this phenomenon and to inform culturally relevant approaches to communicating competing mortality risks.

Background: Guidelines for prostate cancer treatment in men with limited life expectancy are based on expert opinion. Patient preferences for when to defer treatment based on longevity are unknown. We sought to define life expectancy thresholds at which men are more likely to choose conservative management in the context of varying risks of cancer death and treatment-related side effects. Materials and methods: We crowdsourced a conjoint analysis exercise to 2,046 men sociodemographically matched to a US prostate cancer population. Subjects were given a longevity estimate based on their age and comorbidity. They then chose between treatment and conservative management across scenarios with varying risks of cancer death at 5, 10, and 15 years, erectile dysfunction, urinary incontinence, and irritative urinary symptoms. Multivariable multinomial logistic regression identified the life expectancy threshold when men were more likely to choose conservative management over treatment. Results: Across all men, there was a significant interaction between longevity and treatment choice (P < 0.001), with probability of treatment decreasing 15% for every 5-year decrease in life expectancy (OR0.85, 95% CI0.82-0.89). Across all tumor risk subtypes, men were significantly more likely to choose conservative management at life expectancy<10 years(OR<1, P < 0.05). For low-, favorable-intermediate-, unfavorable-intermediate-, and high-risk cancers, men were more likely to choose conservative management at life expectancy thresholds of <= 15, <= 10, <= 9, and <= 7 years, respectively (P < 0.05). Conclusions: Preferences for when to consider conservative management of prostate cancer based on longevity align with current guidelines recommendations, except for low-risk disease, for which men are likely to consider conservative management at even higher life expectancy thresholds.. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

You have accessJournal of UrologyInfertility: Basic Research & Pathophysiology (PD53)1 May 2024PD53-01 ARE MICROPLASTICS PRESENT IN HUMAN TESTICLE TISSUE? ANALYSIS USING INFRARED SPECTROSCOPY John M. Masterson, Azita HassanMazandarani, William Querido, Andrzej Steplewski, Yi Zhang, Carissa Huynh, Andrzej Fertala, Nancy Pleshko, and Maurice M. Garcia John M. MastersonJohn M. Masterson , Azita HassanMazandaraniAzita HassanMazandarani , William QueridoWilliam Querido , Andrzej SteplewskiAndrzej Steplewski , Yi ZhangYi Zhang , Carissa HuynhCarissa Huynh , Andrzej FertalaAndrzej Fertala , Nancy PleshkoNancy Pleshko , and Maurice M. GarciaMaurice M. Garcia View All Author Informationhttps://doi.org/10.1097/01.JU.0001009456.01770.91.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Environmental microplastics are a consequence of plastic pollution and represent a growing public health concern. Microplastic particles, have been found in human tissues of varying organ systems and have almost uniformly been identified via infrared or Raman spectroscopy. However, little is known about the ability of microplastic particles to infiltrate the male reproductive system. We analyzed male testicle tissue to identify microplastics using standard Fourier-transform infrared (FTIR) spectroscopy followed by high-resolution optical photothermal infrared (O-PTIR) spectroscopy of sectioned tissue. METHODS: Fresh tissue from orchiectomy specimen was paraffin-embedded, sectioned into 5-micron slices, and mounted on low-e microscope slides. Polarizing microscopy was performed using the Nikon Eclipse LV 100N POL light microscope and Perkin Elmer Spotlight 400 imaging spectrometer to identify foreign particles within the tissue. The FTIR spectra of the identified particles were obtained with a resolution of 6.25 µm. These spectra were then compared to entries in a standard Perkin Elmer database. Additionally, spectral data at a spatial resolution of 500 nm were acquired from the same particle using O-PTIR spectroscopy. RESULTS: The comparison of the FTIR spectra with the Perkin Elmer database revealed that the analyzed particle exhibited spectral characteristics matching Azlon (search score 0.67), polyamide resin (search score 0.67), nylon (search score 0.65), and ecteola-modified cellulose (search score 0.65). Refined analyses using O-PTIR demonstrated variations in the spectra from different particle regions, and absorbance peaks were present at 1062, 1166, 1540, and 1650 cm-1 (Figure 1). We propose that broad absorbance centered at∼1062 cm-1 likely indicates modification of the nylon structure, possibly by oxidation. CONCLUSIONS: This is the first report to demonstrate that microplastic materials are indeed able to infiltrate testicular tissue. The clinical consequences of tissue infiltration by microplastics are currently unknown, including whether this phenomenon results in as-yet undescribed clinical harms or benefits. The clinical consequence of this phenomenon remains an area of active research. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1138 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information John M. Masterson More articles by this author Azita HassanMazandarani More articles by this author William Querido More articles by this author Andrzej Steplewski More articles by this author Yi Zhang More articles by this author Carissa Huynh More articles by this author Andrzej Fertala More articles by this author Nancy Pleshko More articles by this author Maurice M. Garcia More articles by this author Expand All Advertisement PDF downloadLoading ...

Background. Physician treatment preference may influence how risks are communicated in prostate cancer consultations. We identified persuasive language used when describing cancer prognosis, life expectancy, and side effects in relation to a physician's recommendation for aggressive (surgery/radiation) or nonaggressive (active surveillance/watchful waiting) treatment. Methods. A qualitative analysis was performed on transcribed treatment consultations of 40 men with low- and intermediate-risk prostate cancer across 10 multidisciplinary providers. Quotes pertaining to cancer prognosis, life expectancy, and side effects were randomized. Coders predicted physician treatment recommendations from isolated blinded quotes. Testing characteristics of consensus predictions against the physician's treatment recommendation were reported. Coders then identified persuasive strategies favoring aggressive/nonaggressive treatment for each quote. Frequencies of persuasive strategies favoring aggressive/nonaggressive treatment were reported. Logistic regression quantified associations between persuasive strategies and physician treatment recommendations. Results. A total of 496 quotes about cancer prognosis (n = 127), life expectancy (n = 51), and side effects (n = 318) were identified. The accuracy of predicting treatment recommendation based on individual quotes containing persuasive language (n = 256/496, 52%) was 91%. When favoring aggressive treatment, persuasive language downplayed side effect risks and amplified cancer risk (recurrence, progression, or mortality). Significant predictors (P < 0.05) of aggressive treatment recommendation included favorable side effect interpretation, downplaying side effects, and long time horizon for cancer risk due to longevity. When favoring nonaggressive treatment, persuasive language amplified side effect risks and downplayed cancer risk. Significant predictors of nonaggressive treatment recommendation included unfavorable side effect interpretation, favorable interpretation of cancer risk, and short time horizon for cancer risk due to longevity. Conclusions. Physicians use persuasive language favoring their preferred treatment, regardless of whether their recommendation is appropriate. Implications. Clinicians should quantify risk so patients can judge potential harm without solely relying on persuasive language.

OBJECTIVE:To improve our previous simulation-based training module by using sustainable material to mold an anatomically accurate terrain and reproducing major vascular injuries encountered during robot-assisted nephrectomy. METHODS:The simulator was built with a pump, gauge, and valve linked via silicone tubing. Artificial blood was made from cornstarch, water, and red dye, and pumped through 3D-Med artificial vessels with the dimensions of an average renal artery. Silicone was used to emulate the pliability of organic tissue and mold an anatomically accurate terrain. Eight urologic residents participated in the pilot simulation. We employed validated assessment tools including Non-Technical Skills for Surgeons and Objective Structured Assessment of Technical Skills forms to guide debrief sessions moderated by an expert physician after individual performance evaluations. RESULTS:The apparatus demonstrated high reproducibility across all simulation scenarios, enhancing resident problem-solving skills. Residents' pre-simulation surveys revealed significant concern regarding their acute hemorrhage management. Residents' post-simulation survey demonstrated average realism scores increased from 4.375 to 4.75. Residents also felt the simulator enhanced learning, offering valuable practice and knowledge applicable to their surgical specialty. CONCLUSION:The management of acute hemorrhage during robot-assisted surgery remains a space for additional surgical education and training. Our simulation successfully provided a reliable, reproducible training for residents to practice their technical and non-technical skills in managing acute hemorrhage.

Background Trainee autonomy has eroded over time as surgery has become more subspecialized and as attending oversight has increased, causing many trainees to seek additional fellowship training beyond resi-dency. Less clear is whether there are cases that attendings view as "fellowship-level" or "privileged" cases in which resident-level trainees should not have high levels of autonomy due to complexity or high-stakes outcomes. Objective We sought to better understand current attitudes and practices with regards to trainee autonomy in hypospadias repair as it represents a high complexity procedure within pediatric urology. Study design We administered a RedCap survey to the SPU mem-bership, asking respondents to describe the level of autonomy afforded to trainees in various types of hypospadias repair (distal, midshaft, proximal, perineal) as measured by the Zwisch scale. The Zwisch scale describes the role of the attending in the attending-trainee relationship in a low-to-high trainee autonomy fashion: show and tell; active help; passive help; supervision only. Results 177 of 761 (23%) unique recipients completed our survey and 174 of 177 (98%) of respondents felt that trainees should not perform hypospadias repair independently in practice without addi-tional fellowship training. Among pediatric urolo-gists who train residents, trainee autonomy as measured by the Zwisch scale decreased as the type of hypospadias repair moved from distal to proximal. Discussion There was near unanimous agreement among re-spondents that urology trainees should not perform hypospadias repair in practice without additional pediatric urology fellowship training, and that current practice affords little trainee autonomy in hypospadias repair at the resident level. These findings introduce a new wrinkle into the issue of trainee autonomy: cases in which trainees perhaps should not have autonomy. Concurrently, the concern with such findings is that this intentional lack of autonomy may extend to other urologic procedures that one would expect trainees to be able to perform independently. Conclusion Urology trainees are not expected to be able to perform hypospadias in practice without additional training. This raises the question that there may be other such procedures in urology, and if so, should we as instructors, be forthcoming about the limita-tions of urology residency training to set appropriate trainee expectations?

You have accessJournal of UrologyCME1 Apr 2023MP67-09 RELATIONSHIP BETWEEN SKIN CANCER AND AGGRESSIVE PROSTATE CANCER: RESULTS FROM THE SEARCH DATABASE John m. Masterson, Jaruda Ithisuphalap, Durham NC, Emilie J. Fowler, Christopher L. Amling, William J. Aronson, Matthew R. Cooperberg, Lourdes Guerrios-Rivera, San Juan, Puerto Rico, Christopher J. Kane, Zachary Klaassen, Martha K. Terris, and Stephen J. Freedland John m. MastersonJohn m. Masterson More articles by this author , Jaruda IthisuphalapJaruda Ithisuphalap More articles by this author , Durham NCDurham NC More articles by this author , Emilie J. FowlerEmilie J. Fowler More articles by this author , Christopher L. AmlingChristopher L. Amling More articles by this author , William J. AronsonWilliam J. Aronson More articles by this author , Matthew R. CooperbergMatthew R. Cooperberg More articles by this author , Lourdes Guerrios-RiveraLourdes Guerrios-Rivera More articles by this author , San JuanSan Juan More articles by this author , Puerto RicoPuerto Rico More articles by this author , Christopher J. KaneChristopher J. Kane More articles by this author , Zachary KlaassenZachary Klaassen More articles by this author , Martha K. TerrisMartha K. Terris More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Skin cancer and prostate cancer (PC) are the two most cancers in men. Some data suggest sun exposure and Vitamin D levels inversely correlate with PC. We tested the association between pre-surgery skin cancer presence and outcomes after radical prostatectomy (RP) for PC in a large multi-center cohort. METHODS: We retrospectively reviewed data from men treated by RP from 1988-2020 at 9 VA hospitals. We excluded Black (n=2,743), other (n=299), and missing (n=69) race as skin cancers in these groups was very low. Men were segregated as melanoma, non-melanoma, and no skin cancer. Baseline features across groups were compared. Cox models were used to test the association between skin cancer groups and biochemical recurrence (BCR), metastasis, and castration resistant PC (CRPC). For PC specific mortality (PCSM), competing risk models were used to account for death from other causes. RESULTS: 6,817 men met inclusion: 557 had skin cancer (497 non-melanoma; 60 melanoma). Men with skin cancer were older (median 67 vs 65 yrs), had surgery more recently (median 2011-2 vs. 2006), were slightly less likely to have cT2, and more likely to have grade group 3-5 than men without skin cancer (all p<0.05). On univariable analyses, non-melanoma was unrelated to BCR, metastasis, and CRPC (HRs 0.98-1.05; all p>0.1) (Table 1). Melanoma was linked with numerically fewer poor outcomes (HR 0.46-0.75 and not calculable for PCSM due to no events), though none of these associations were significant. On multivariable analyses, the null associations between non-melanoma and outcomes remained, though all HRs were <1 (0.79-0.94). For melanoma, all HRs remained in the direction of lower risk (HRs 0.16-0.73), though results were not significant (Table 1). CONCLUSIONS: Our results suggest presence of non-melanoma skin cancer is unrelated to PC outcomes after RP, though a very modest association cannot be ruled out. While the numeric direction of reduced aggressiveness (all HRs <1) is in line with our hypothesis that Vitamin D levels associated with sun exposure may reduce PC aggressiveness, the lack of significance suggests any effects, if real, are modest at best. Alternatively, the more strongly, but still null, inverse associations with melanoma warrants further study given our sample only included 60 men with melanoma. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e946 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John m. Masterson More articles by this author Jaruda Ithisuphalap More articles by this author Durham NC More articles by this author Emilie J. Fowler More articles by this author Christopher L. Amling More articles by this author William J. Aronson More articles by this author Matthew R. Cooperberg More articles by this author Lourdes Guerrios-Rivera More articles by this author San Juan More articles by this author Puerto Rico More articles by this author Christopher J. Kane More articles by this author Zachary Klaassen More articles by this author Martha K. Terris More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF downloadLoading ...

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic altered many aspects of the urology residency application process, including a shift to virtual interviews and limits on both in-person interactions and away-rotations. We sought to determine how these changes affected match outcomes. METHOD(S): Publicly available match statistics from the American Urological Association (AUA) were analyzed in combination with self-reported applicant data from the Urology Residency Applicant Google Spreadsheet and a list of matched urology residents and their medical schools, verified on social media and residency program websites. Data from pandemic match years of 2021 and 2022 were compared to the four years prior. RESULT(S): Match data from the AUA indicates that the number of applicants per residency spot, number of applications submitted per applicant, and percentage of matched female applicants have been increasing since 2019. The overall match rate during the pandemic was significantly lower than the 4 years prior (70% vs 79%, p<0.0001) and has been decreasing since 2019. According to self-reported match data, during the pandemic applicants received fewer interviews per application submitted (24% vs 31%, p<0.0001) and accepted interview offers at a higher rate (84% vs 68%, p<0.001). The percentage of matched applicants with a residency program at their home institution has been decreasing since 2017. These students were just as likely to match to their home program during the pandemic as in the years prior (p=0.17). CONCLUSION(S): The changes to the match process due to COVID-19 pandemic did not cause fundamental changes in match outcomes but rather accelerated many pre-existing trends, most notably increased competition. (Figure Presented).

Background:Reconstructive urologists often place both a urethral and suprapubic catheter intraoperatively to prevent extravasation of undrained urine across anastomosis sutures. As no consensus exists on which catheter drains the bladder more completely, many surgeons leave one catheter to gravity drainage and cap the other postoperatively. We sought to identify differences in catheter urine outflow during dual bladder drainage with suprapubic and urethral catheters in postoperative urology patients. Methods:Urine output (UOP) from transgender men who underwent Stage II Phalloplasty with urethral lengthening was retrospectively reviewed. Both 16 French urethral and suprapubic catheters were placed to gravity drainage postoperatively. Urine output from each catheter was recorded separately, twice daily. Mixed model regression modeling tested for differences in urine output by time of day (day/night) and activity status (Bedrest: Postop Day 0-2, Ambulatory: Postop Day 3+). Results:The aggregate number of 12-hour shift urine output observations was 250 (125 for urethral and 125 for suprapubic catheters) across 14 inpatients. Suprapubic catheters had a mean 410 ml higher output than urethral catheters per 12-hour shift (p=0.002; 95% CI: 185, 636 ml). During daytime, Suprapubic catheters demonstrated higher UOP than urethral catheters per 12-hour shift (Estimated Difference: 464 ml; p=0.002; 95% CI: 211, 718 ml). During nighttime, a similar phenomenon was observed (Estimated Difference: 356 ml; p=0.009; 95% CI: 104, 606 ml). When comparing mean UOP from each catheter during the Bedrest Phase, suprapubic catheters averaged an estimated 295 ml higher UOP compared to urethral catheters per 12-hour shift with a trend toward statistical significance (p=0.052; 95% CI -3, 594 ml). During the Ambulatory Phase, mean suprapubic catheter UOP was an estimated 472 ml higher than urethral catheters per 12-hour shift (p=0.009; 95% CI 142, 802 ml). Conclusions:Simultaneous bladder drainage with urethral and suprapubic catheters shows greater drainage from the suprapubic catheter (35% vs 65%). When using two catheters, both can be placed to gravity to maximize bladder drainage as the suprapubic catheter can drain residual urine not adequately drained by the urethral catheter.

Abstract Objective This study aims to describe our technique and review our experience with synchronous robotic bilateral nephrectomy for large kidneys in ADPKD with the da Vinci XI and da Vinci Single Port platforms (Intuitive Surgical, Sunnyvale, CA). Materials and Methods We performed a retrospective review of all robotic bilateral nephrectomy cases from January 2020 to present at a high‐volume robotic single centre. Demographic data and perioperative details including preoperative CT scans, indication for nephrectomy and renal function were collected. We also collected post‐op course data and final specimen data details. Results Fourteen cases were included. Patient demographics, indications for surgery and specimen data are outlined in Table 1. The largest kidney removed has a measurement of 32 cm in the largest dimension on preoperative imaging. Median operating time from incision to closure was 299 min (IQR 260, 339). Median estimated blood loss was 75 cc (IQR 50, 187.5). Two patients were transfused intraoperatively. Median pre‐ and post‐operative Hgb was 11.0 and 9.6, respectively. Median length of stay was 3 days (IQR 2, 3.5). There were no intraoperative complications and no open conversions. Post‐operative complications included one incisional hematoma and one superficial wound infection. One patient was admitted to the surgical ICU post operatively for ventilatory support. Two patients were readmitted within 30 days of surgery. Conclusion The robotic approach to bilateral native nephrectomy for ADPKD should be considered when native nephrectomies are indicated. The operative times and outcomes are favourable compared with prior series, and this technique works even for very large kidneys.

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. There is a dearth of studies evaluating long term erectile function after episodes or treatment for priapism. Objective We evaluated the functional outcomes of a larger, multi-institutional population of men with priapism due to recreational use of ICIs. Methods Men who presented with ischemic priapism due to recreational use of ICIs to Cedars-Sinai Medical Center (Los Angeles, CA), University of California at San Francisco (San Francisco, CA), and Jackson Memorial Hospital (Miami, FL) from January 2010 to December 2018 were contacted via telephone. All participants completed the five-item international index of erectile function (IIEF-5). Results A total of 19 men aged 24 – 59 (mean 47.9) were recruited from the 3 sites. Mean follow up was 77.2 months (+/− 27.6). 17 men (89%) were white; the one man was Asian (5.5%) and one man was Hispanic (5.5%). Seven men (37%) had been diagnosed with ED prior to their priapism episode however none of the men had a prescription for ICIs. Four men (21%) required no intervention at all, eleven men (58%) required phenylephrine irrigation alone, four men (21%) required distal shunting. No men required proximal shunting. None of the men had no ED, 31.6% had mild ED, 36.8% had mild-moderate ED, 26.3% had moderate ED, and 5.3% had severe ED. Mean IIEF-5 for the population was 13.4 (+/− 3.9). Strengths of our study included the large population size give the relative rarity of this condition as well as the geographic diversity of our population. Limitations include our low overall recruitment rate and lack of objective measures of erectile function prior to priapism. Conclusions Men who suffer ischemic priapism secondary to recreational use of ICIs appear to retain some erectile function following their priapism episode. Nevertheless, 100% report some level of ED. This is likely due a combination of adequate erectile function at baseline and expeditious treatment of priapism in a minimally invasive manner. Disclosure No

COVID-19 has disproportionately affected socially vulnerable communities characterized by lower income, lower education attainment, and higher proportions of minority populations, among other factors (1-4). Disparities in COVID-19 incidence and the impact of vaccination on incidence disparities by community income were assessed among 81 communities in Los Angeles, California. Median community vaccination coverage and COVID-19 incidence were calculated across household income strata using a generalized linear mixed effects model with Poisson distribution during three COVID-19 surge periods: two before vaccine availability (July 2020 and January 2021) and the third after vaccines became widely available in April 2021 (September 2021). Adjusted incidence rate ratios (aIRRs) during the peak month of each surge were compared across communities grouped by median household income percentile. The aIRR between communities in the lowest and highest median income deciles was 6.6 (95% CI = 2.8-15.3) in July 2020 and 4.3 (95% CI = 1.8-9.9) in January 2021. However, during the September 2021 surge that occurred after vaccines became widely availabile, model estimates did not identify an incidence disparity between the highest- and lowest-income communities (aIRR = 0.80; 95% CI = 0.35-1.86). During this surge, vaccination coverage was lowest (59.4%) in lowest-income communities and highest (71.5%) in highest-income communities (p<0.001). However, a significant interaction between income and vaccination on COVID-19 incidence (p<0.001) indicated that the largest effect of vaccination on disease incidence occured in the lowest-income communities. A 20% increase in community vaccination was estimated to have resulted in an additional 8.1% reduction in COVID-19 incidence in the lowest-income communities compared with that in the highest-income communities. These findings highlight the importance of improving access to vaccination and reducing vaccine hesitancy in underserved communities in reducing disparities in COVID-19 incidence.

Interstitial cystitis/bladder pain syndrome is a poorly understood yet prevalent condition accounting for a significant proportion of urology office visits. Identification of reliable biomarkers for disease remains an important yet challenging area of research given the heterogeneity of disease presentation and pathophysiology. A review of the literature by the authors revealed a handful of original investigations that revealed promising biomarkers within various physiologic processes or organ systems including immunity, inflammation, neural pathways, urothelial integrity, and anesthetic bladder capacity. Although no perfect biomarker has yet been identified for IC/BPS, research in this area has greatly expanded our understanding of disease.

You have accessJournal of UrologyCME1 Apr 2023MP38-01 PATIENT-LEVEL VALIDATION OF LIFE EXPECTANCY CUTOFFS FOR TRIAGE OF AGGRESSIVE TREATMENT BY TUMOR RISK USING TARGETED CROWDSOURCING John M. Masterson, Michael Luu, Rebecca Gale, Brennan Spiegel, Stephen J. Freedland, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Michael LuuMichael Luu More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Life expectancy (LE) thresholds for triage of treatment vs conservative management (CM) in prostate cancer (PC) guidelines are based on expert opinion. However, patient opinion of when to defer treatment based on LE is lacking. We crowdsourced a conjoint analysis to define at which LE men are more likely to choose against treatment. METHODS: We used targeted crowdsourcing to query 2,046 men sociodemographically reflecting a US PC population based on SEER. We asked subjects to complete a conjoint analysis exercise in which they chose between treatment versus CM considering 4 tradeoffs: tumor risk, risk of erectile dysfunction, risk of urinary incontinence, risk of irritative urinary symptoms. Subjects were asked to consider LE throughout, which was calculated using the validated Prostate Cancer Comorbidity Index. Multinomial logistic regression defined the LE at which men were more likely to choose no treatment overall and in subgroups of tumor risk. RESULTS: We found an interaction between LE and treatment, indicating the odds of treatment vs CM choice is dependent on LE (p<0.001). The predicted probability of treatment decreased 15% with every 5 years of decreasing LE (OR 0.85, 95% CI .82-.89, p <0.001). Across all tumor risk levels, men were more likely to choose CM at a LE threshold <10 years (OR<1, p<0.05) (Figure 1). For low-, favorable intermediate-, unfavorable intermediate-, and high-risk cancers, men were more likely to choose CM at LE thresholds of <15, <10, <9, and <7 years, respectively. NCCN guidelines recommend CM overall at LE thresholds of £10 and <5–10 years for favorable and unfavorable intermediate-risk disease, and <5 years for high-risk disease (Figure 2). CONCLUSIONS: Patient preferences for LE cutoffs for when to consider CM align well with current guidelines recommendations, except for low-risk disease, for which patients are likely to consider conservative management even at LE <15 years, rather than <10. Guidelines should take patient preferences into account when recommending thresholds for CM. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e523 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Luu More articles by this author Rebecca Gale More articles by this author Brennan Spiegel More articles by this author Stephen J. Freedland More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction: The purpose of this study was to determine which characteristics of urology residency programs are most highly valued by medical students and residents, and how these change during training. Materials and methods: We distributed a survey to urology residents and medical students interested in urology via program director email and social media. The survey collected demographic data, future career plans, and asked respondents to rank the relative importance of six categories of residency program characteristics and specific characteristics within each category. Results: Among the six categories of residency characteristics, resident experience was ranked most important by both medical students and residents, followed by geography and clinical experience which were tied. Medical students ranked clinic experience and formal mentorship with greater importance while residents placed higher value on the active role of clinical faculty and help from advanced practice providers. Trainees planning for an academic career ranked research experiences and resident diversity as more important than those entering private practice. Conclusions: Residents and medical students mostly agreed on the relative importance of residency program characteristics. The differences observed suggest that as trainees gain experience they place greater importance on informal relationships with faculty and value characteristics that enhance surgical training such as support from advanced practice providers and less time in clinic. These findings may guide programs on what information to include on their websites and presentations.

You have accessJournal of UrologyCME1 Apr 2023MP19-11 RACIAL AND ETHNIC DISPARITIES IN VALUATION OF LIFE EXPECTANCY IN PROSTATE CANCER TREATMENT DECISION MAKING John M. Masterson, Michael Luu, Rebecca Gale, Brennan Spiegel, Stephen J. Freedland, and Timothy J. Daskivich John M. MastersonJohn M. Masterson More articles by this author , Michael LuuMichael Luu More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the indolent nature of prostate cancer (PC), life expectancy (LE) is essential in triage between aggressive local therapy and conservative management for all tumor risk subtypes. Black men are more likely to be overtreated for low-risk PC. We sought to investigate racial or ethnic disparities in how Black and Hispanic men value LE in PC treatment decision making. METHODS: We used targeted crowdsourcing to query a group of men reflecting sociodemographics of a typical US PC population. Subjects completed a conjoint analysis exercise in which they iteratively chose between aggressive treatment vs conservative management across varying levels of 4 tradeoffs: tumor risk; risk of erectile dysfunction; risk of incontinence; and risk of irritative urinary symptoms. Subjects were asked to consider their LE when making decisions, which was calculated using the Prostate Cancer Comorbidity Index. Multinomial conditional logistic regression compared the odds of choosing aggressive vs conservative treatment across LEs ranging from 0 to 20 years by racial and ethnic subgroups. We calculated the interaction between LE and race/ethnicity in predicting treatment choice overall and across levels of tumor risk. RESULTS: Of 2,046 men, 435 (22%) were Black and 230 (11%) were Hispanic. Across all men, the odds of aggressive treatment choice increased by 17% for every 5 years of additional LE (OR 1.17, 95%CI 1.12-1.22), with men more likely to choose aggressive treatment at LE of >13 years and non-aggressive treatment at LE of £10 years. However, among Black men, LE was not associated with treatment choice (OR 0.97, 95%CI 0.90–1.05) (Figure 1A). Black men were more likely to choose aggressive treatment overall, regardless of LE or tumor risk. Among Hispanic men, LE was associated with treatment choice, akin to the non-Hispanic population (OR 1.14, 95%CI 1.02–1.27) (Figure 1B). While Hispanic men were more likely to choose aggressive treatment overall, their choices differed by both LE and tumor risk. Healthy literacy was equivalent by race/ ethnicity. CONCLUSIONS: Black men did not take LE into account when making treatment decisions, in stark contrast to other races and ethnicities. Culturally sensitive approaches to communication of competing risks of mortality may be needed to improve decision making in these men. Source of Funding: © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e269 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Luu More articles by this author Rebecca Gale More articles by this author Brennan Spiegel More articles by this author Stephen J. Freedland More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

Background While both the number (+LN) and density (LND) of metastatic lymph nodes on radical prostatectomy lymphadenectomy predict mortality in prostate cancer, the independent impact of each on overall mortality (OM) is unknown. Methods We sampled men who underwent radical prostatectomy and lymphadenectomy between 2004 and 2013 from the National Cancer Database. Multivariable Cox proportional hazards analysis with restricted cubic spline was used to assess the non-linear association of +LN count and LND with OM. Results Of 229,547 men in our sample, 3% ( n = 7507) had +LNs, of which 89% had 1-3 +LN and 11% had ≥4 +LN. In multivariable Cox analysis across all patients, OM increased with each additional +LN up to four (HR 1.14, 95%CI 1.06–1.23 per node), with no increase beyond 4 +LN. LND was an independent predictor of OM (HR 1.09, 95%CI 1.06–1.12 per 10% increase). However, after excluding patients with inadequate nodal sampling (<5 LN examined), the variation in OM explained by LND was negligible for patients with ≤3 +LN. In men with 1, 2, and 3 +LN, there was a 0.28%, 0.02%, and 0.50% increase in OM for each 10% increase in LND, compared with 1.9% and 1.6% for men with 4 or 5+ LNs. Conclusions While +LN count and LND independently predict OM, the impact of LND is negligible in men with ≤3 +LN, who comprise the vast majority of men with +LN. Pathological nodal staging should primarily rely on LN count rather than LND.