You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP32)1 Apr 2020MP32-15 INTEGRATION OF TELEMENTORING DURING THE ADOPTION PHASE OF A NOVEL ROBOTIC TECHNOLOGY: IS A VIRTUAL APPROACH VIRTUOUS? José Asmar, Muhieddine Labban, and Albert El Hajj* José AsmarJosé Asmar More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , and Albert El Hajj*Albert El Hajj* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000876.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Telemedicine is defined as the virtual conveyance of healthcare related information. Telementoring, a recently emerged proctoring tool, offers technical guidance in the learning phase and adoption of a new surgical technology. The aim of our study was to evaluate the feasibility of telementoring for Aquablation a novel robotic treatment modality for Benign Prostatic Obstruction (BPO) by comparing the outcomes of onsite versus telemetry proctoring. METHODS: The telemetry device of choice was Proximie; it is an innovative digital platform that uses live video stream with an augmented reality technology. In addition, it is general data protection regulation (GDPR) and Health Insurance Portability and Accountability Act (HIPAA) compliant. Our study retrospectively reviewed outcomes from our IRB approved prospective Aquablation database from March 2018 till October 2019. Procedures were guided by a proctor either onsite or remotely through telemetry. Baseline demographics, basic serum markers, and prostate size were compared amongst the two groups. In addition, perioperative factors were assessed. Mann-U Whitney Test was used for continuous variables whereas Chi squared was used for categorical ones. RESULTS: Our data included 57 patients who underwent a proctored based Aquablation of which 19 were telementor guided and 38 were onsite guided. The initial 10 procedures were done with the later approach. Subsequently, the approach was randomly assigned. There was no stastistical difference in age, comorbidities, prostate size, and baseline serum markers such as prostate specific antigen, haemoglobin, and creatinine amongst the two groups. In contrast, telementor guidance was associated with increased general anaesthesia use (78.9% vs. 18.4%) and haemostatic cauterization (84.2% vs. 44.7%), with a p-value < 0.0001 and 0.004 respectively. However, the main procedure outcomes: operative time, time to Foley catheter removal, haemoglobin drop, urinary retention, and adverse events were statistically insignificant - Table 1. CONCLUSIONS: Following an initial phase of onsite proctoring, telementoring can be safely used in the adoption phase of a new robotic technology. This approach allowed more flexibility in patient scheduling and reduced travel costs with similar outcomes. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e490-e490 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information José Asmar More articles by this author Muhieddine Labban More articles by this author Albert El Hajj* More articles by this author Expand All Advertisement PDF downloadLoading ...

Objectives: To assess the prognostic value of IgG4 reactivity in biopsy-proven cases of idiopathic membranous nephropathy (iMN) and to outline its potential in guiding therapy. Methods: A retrospective study of biopsy-proven iMN cases from January 1997 to August 2013 was undertaken. Patients were identified, and an extensive analysis of the clinical and histological parameters were performed. The primary endpoint was a worse renal outcome, which was defined as doubling of the serum creatinine baseline value. Results: The study included 52 patients, with mean age of 38.0 years. The median baseline creatinine was 112.7 ± 36.3 umol/l among those with positive staining for IgG4 and 67.4 ± 19.3 umol/l among those with negative staining for IgG4 (P=0.5). There was no significant difference in the 24 hr urine protein between IgG4 positive and IgG4 negative staining cases (P=0.375). The probability of doubling serum creatinine was similar among those with or without IgG4 deposition. Follow up of the patients revealed that 23.4% of those with positive IgG4 and 14% of those with negative IgG4 had deterioration of the renal function. The prevalence and severity of tubulo-interstitial inflammation was not statistically different between the two groups. Conclusion: There was no relationship between IgG4 positivity and the severity of clinical and/or histological parameters in patients with iMN. IgG4 reactivity had no impact on the long-term outcome of the patients. Further studies are needed to outline the potential use of targeted therapy against IgG4 auto-antibody in a certain category of patients with membranous nephropathy.