You have accessJournal of UrologyEducation Research I (MP17)1 May 2024MP17-13 ASSESSING THE USABILITY OF LIVE SURGICAL FEEDBACK FOR INTRAOPERATIVE TRAINING IMPROVEMENT J. Everett Knudsen, Runzhuo Ma, Elyssa Y. Wong, Lydia Lin, Eman Dadashian, Luis Medina, Marissa Maas, Randall Lee, Mitchell Goldenberg, Steven Cen, Xiuzhen Huang, and Andrew J. Hung J. Everett KnudsenJ. Everett Knudsen , Runzhuo MaRunzhuo Ma , Elyssa Y. WongElyssa Y. Wong , Lydia LinLydia Lin , Eman DadashianEman Dadashian , Luis MedinaLuis Medina , Marissa MaasMarissa Maas , Randall LeeRandall Lee , Mitchell GoldenbergMitchell Goldenberg , Steven CenSteven Cen , Xiuzhen HuangXiuzhen Huang , and Andrew J. HungAndrew J. Hung View All Author Informationhttps://doi.org/10.1097/01.JU.0001008628.15460.84.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical training requires trainees to receive continuous intraoperative feedback from attending surgeons, but it is unknown how feedback quality affects a trainee's ability to effectively change their behavior in the OR. This study aims to quantifiably assess feedback quality and determine its association with intraoperative behavioral outcomes. METHODS: Building on previous work where 3,711 feedback video clips from robotic urological cases were transcribed and categorized, we selected 157 clips where the trainer gave feedback, the trainee changed their behavior, and the trainer appraised the outcome as optimal (approval [N=81]) or suboptimal (disapproval [N=76]) (Figure 1A). We then developed a 5-point, 5-question Feedback-Specific System Usability Scale (FS-SUS) from the validated SUS (Figure 1B). Three groups of raters of different surgical experience levels (Figure 1B) were recruited to retrospectively apply FS-SUS to the feedback clips as if they were the trainee receiving intraoperative feedback. FS-SUS scores were calculated by standard methodology and compared between outcomes by hierarchical modeling. RESULTS: Through variance component analysis, we observed a>95% variance contribution in feedback usability scores from individual variation among trainers (Figure 1D). For all raters considered, the median FS-SUS was statistically significantly higher for the optimal outcome (median [IQR]: 75 [60-95]) as compared to the suboptimal outcome (70 [55-90], p<0.001). A similar pattern holds true when examining raters of different experience levels: expert (70 [60-80] vs. 65 [55-75], p=0.05), intermediate (70 [55-85] vs. 65 [50-80], p=0.027), and novice (90 (80-100) vs. 85 (52.5-100), p=0.002) (interaction p=0.39). CONCLUSIONS: As we have shown, there is a high degree of variability in feedback quality observed for all individual trainers. Additionally, higher quality feedback is perceptible by raters of varying experience levels, and higher quality feedback is associated with better trainee behavioral outcomes. This indicates a need to improve the quality of interoperative feedback delivered to surgical trainees at all training levels. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e296 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information J. Everett Knudsen More articles by this author Runzhuo Ma More articles by this author Elyssa Y. Wong More articles by this author Lydia Lin More articles by this author Eman Dadashian More articles by this author Luis Medina More articles by this author Marissa Maas More articles by this author Randall Lee More articles by this author Mitchell Goldenberg More articles by this author Steven Cen More articles by this author Xiuzhen Huang More articles by this author Andrew J. Hung More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-12 OUTCOMES OF MINIMALLY INVASIVE NEPHRECTOMY FOLLOWING IMMUNE-CHECKPOINT INHIBITOR THERAPY: DATA FROM A MULTICENTER STUDY Alireza Ghoreifi, Farshad Sheybaee Moghaddam, Stephan Bronimann, Thomas Gerald, Emma K. Helstrom, Ekam S. Deol, Sina Sobhani, Inderbir Gill, R. Houston Thompson, Robert Uzzo, Abhinav Khanna, Randall Lee, Vitaly Margulis, Nirmish Singla, and Hooman Djaladat Alireza GhoreifiAlireza Ghoreifi , Farshad Sheybaee MoghaddamFarshad Sheybaee Moghaddam , Stephan BronimannStephan Bronimann , Thomas GeraldThomas Gerald , Emma K. HelstromEmma K. Helstrom , Ekam S. DeolEkam S. Deol , Sina SobhaniSina Sobhani , Inderbir GillInderbir Gill , R. Houston ThompsonR. Houston Thompson , Robert UzzoRobert Uzzo , Abhinav KhannaAbhinav Khanna , Randall LeeRandall Lee , Vitaly MargulisVitaly Margulis , Nirmish SinglaNirmish Singla , and Hooman DjaladatHooman Djaladat View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is high-level evidence supporting the use of immune checkpoint inhibitors (ICIs) in advanced renal cell carcinoma (RCC); however, limited data is available regarding nephrectomy, especially through a minimally invasive (MIS) approach, in this setting. The aim of this study is to report the outcomes of MIS nephrectomy following ICI therapy. METHODS: Using our IRB-approved multicenter data registry, we included patients with advanced RCC who underwent nephrectomy following ICI therapy at five high-volume US academic centers between 2015 and 2023. Clinical features and perioperative outcomes of those who underwent MIS approach were reviewed. Multivariable logistic regression was performed to evaluate the factors influencing the choice between MIS and open approach. RESULTS: A total of 158 patients were included, of whom 76 and 82 underwent MIS and open nephrectomies, respectively. Baseline clinical features of patients are shown in Table 1. The MIS procedures included robotic (n=56) and laparoscopic (n=20). A total of 6 (8%) patients converted to open (4 robotic and 2 lap) due to pancreatic injury (n=1), vascular injury (n=1), and failure to progress (n=4). On multivariable analysis, patients with non-metastatic vs. metastatic RCC (HR 3.1, 95%CI 1.3–7.3, p=0.01), those with smaller tumor size (HR 1.2 for each cm, 95%CI 1.1–1.3, p=0.001) and no clinical evidence of inferior vena cava thrombus (HR 29, 95% CI 3.5–237.4, p=0.002) were more likely to undergo MIS compared to open approach. Perioperative outcomes of MIS nephrectomies are shown in Figure 1. The 90-day complication and readmission rates were 22% (Clavien≥3: 8%) and 9%, respectively. No 90-day mortality was reported. CONCLUSIONS: Minimally invasive approach appears safe in properly selected patients with advanced renal cell carcinoma who are candidates for nephrectomy following ICI therapy. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e437 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alireza Ghoreifi More articles by this author Farshad Sheybaee Moghaddam More articles by this author Stephan Bronimann More articles by this author Thomas Gerald More articles by this author Emma K. Helstrom More articles by this author Ekam S. Deol More articles by this author Sina Sobhani More articles by this author Inderbir Gill More articles by this author R. Houston Thompson More articles by this author Robert Uzzo More articles by this author Abhinav Khanna More articles by this author Randall Lee More articles by this author Vitaly Margulis More articles by this author Nirmish Singla More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...

Objective: Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. Patients and Methods: A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. Results: A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, p = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve vs 17% in the retreatment group, p = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] vs 2 [2-2] treatment-naïve, p = 0.037) and more additional procedures at follow-up (30% vs 8.3% treatment-naïve, p = 0.005). Conclusion: Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.

You have accessJournal of UrologyCME1 Apr 2023PD41-12 PERIOPERATIVE COMPLICATIONS AND OUTCOMES OF PATIENTS UNDERGOING AQUABLATION FOR BENIGN PROSTATIC HYPERPLASIA: A SINGLE TERTIARY REFERRAL CENTER EXPERIENCE IN 146 PATIENTS Alireza Ghoreifi, David Ortega Herrera, Michael Eppler, Randall Lee, Maria Lizana, Abhisek Venkat, Marissa Maas, Andre Abreu, Rene Sotelo, Mike Nguyen, Inderbir Gill, Leo Doumanian, Giovanni E. Cacciamani, and Mihir Desai Alireza GhoreifiAlireza Ghoreifi More articles by this author , David Ortega HerreraDavid Ortega Herrera More articles by this author , Michael EpplerMichael Eppler More articles by this author , Randall LeeRandall Lee More articles by this author , Maria LizanaMaria Lizana More articles by this author , Abhisek VenkatAbhisek Venkat More articles by this author , Marissa MaasMarissa Maas More articles by this author , Andre AbreuAndre Abreu More articles by this author , Rene SoteloRene Sotelo More articles by this author , Mike NguyenMike Nguyen More articles by this author , Inderbir GillInderbir Gill More articles by this author , Leo DoumanianLeo Doumanian More articles by this author , Giovanni E. CacciamaniGiovanni E. Cacciamani More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most published data with Aquablation, a recently introduced minimally-invasive technology for management of patients with benign prostatic hyperplasia (BPH), is from 2 large multicenter trials. The aim of this study is to report post-commercialization perioperative complications and outcomes of Aquablation from a single institution. METHODS: Using our IRB-approved database, we retrospectively reviewed the records of consecutive patients who underwent Aquablation for BPH in our institution between August 2020 and June 2022. Those with no available 90-day data were excluded. Primary and secondary outcomes were 90-day complications (graded by Clavien-Dindo classification) and 90-day readmission, respectively. Specific focus was placed on hemorrhagic complications. Univariate and multivariable logistic regression were performed to assess the factors affecting the 90-day complications. RESULTS: Among 146 patients who received Aquablation during the study timeframe, 133 patients with a median (IQR) age of 69 (64 – 73) years and median (IQR) prostate size of 85 (65 – 109) mL were included in the analysis. Baseline and clinical features of the patients are presented in Table 1. Median operative time was 64 minutes, and no intraoperative complication/blood transfusion was recorded. Median length of hospital stay and catheter time were 1 and 3 days, respectively. 90-day complications were recorded in 36 patients (27%) with a Clavien 3 in 11 patients (8%). A bleeding event was recorded in 5 patients (4%) of whom 4 required cystoscopic fulguration (Table 2). Average drop in postoperative hemoglobin was 1.5 gm/dL, yet no patient required peri-operative blood transfusions. The readmission rate was 4.5% (6/133). Two patients underwent re-treatment (transurethral resection of the prostate). On multivariable analysis, prostate size was not independently associated with 90-day complications (OR 1.02, 95% CI 0.99 – 1.03, p=0.07). CONCLUSIONS: Aquablation is safe with a 27% overall complication rate that is independent of patient or prostate factors. Bleeding rate with incorporation of selective cautery hemostasis has dropped compared to the Water and Water 2 trial data. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1063 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi More articles by this author David Ortega Herrera More articles by this author Michael Eppler More articles by this author Randall Lee More articles by this author Maria Lizana More articles by this author Abhisek Venkat More articles by this author Marissa Maas More articles by this author Andre Abreu More articles by this author Rene Sotelo More articles by this author Mike Nguyen More articles by this author Inderbir Gill More articles by this author Leo Doumanian More articles by this author Giovanni E. Cacciamani More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023MP76-07 THE IMPACT OF PREVIOUS BENIGN PROSTATIC HYPERTROPHY SURGERY ON WATER ABLATION THERAPY: A COMPARISON OF SAFETY AND EFFICACY Randall Lee, Giovanni Cacciamani, Alireza Ghoreifi, David Ortega Herrera, Michael Eppler, Abhisek Venkat, Marissa Maas, Lizana Maria, Leo Duomanian, Rene Sotelo, Andre Abreu, Mike Nguyen, Inderbir Gill, and Mihir Desai Randall LeeRandall Lee More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , David Ortega HerreraDavid Ortega Herrera More articles by this author , Michael EpplerMichael Eppler More articles by this author , Abhisek VenkatAbhisek Venkat More articles by this author , Marissa MaasMarissa Maas More articles by this author , Lizana MariaLizana Maria More articles by this author , Leo DuomanianLeo Duomanian More articles by this author , Rene SoteloRene Sotelo More articles by this author , Andre AbreuAndre Abreu More articles by this author , Mike NguyenMike Nguyen More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003350.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since its introduction in 2018, Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH) has expanded its indications, including prostate glands up to 150 cc. Patients who previously underwent BPH interventions with recurrence of LUTS often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and efficacy of Aquablation in patients with previous BPH surgical history. METHODS: A prospectively managed single institutional database of patients with BPH managed with Aquablation was queried from August 2020 to June 2022 for patients who failed previous BPH procedures. Comparison of perioperative outcomes (operative time (OT), estimated blood loss (EBL), hospital length of stay (LOS), catheter duration), complications, and functional outcomes (International Prostate Symptom Score (IPSS)) to patients without prior BPH surgery was performed using Chi-Square and Kruskal Wallis statistical analysis. RESULTS: A total of 146 patients with BPH presented for management with Aquablation. We identified 17 patients with a history of previous BPH procedures with median time since last intervention of 5.5 years. Patients who underwent previous BPH procedures had smaller prostate volumes (88.7 vs 69.7 cc, p=0.01). There was no difference in OT (63.8 vs 68 min, p=0.6), EBL (40.2 vs 38.8 cc, p=0.9), LOS (1.3 vs 1.05 days, p=0.2), or catheter duration (4 vs 4.1 days, p=0.3). We observed no difference in 90 day-post operative complications and no difference in pre or postoperative functional outcomes between cohorts. However, patients with and without previous intervention experienced greater percent and absolute improvements in IPSS scores (51.2% and 22.5% reduction, respectively). CONCLUSIONS: We demonstrate patients with previous BPH interventions remain excellent candidates for Aquablation, with no significant differences in perioperative, post operative, and functional outcomes compared to intervention naïve patients. The utilization of ultrasound for systematic planning for execution of efficient tissue resection, without the risk of injury, makes Aquablation an appropriate treatment following failed BPH procedures. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1093 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Randall Lee More articles by this author Giovanni Cacciamani More articles by this author Alireza Ghoreifi More articles by this author David Ortega Herrera More articles by this author Michael Eppler More articles by this author Abhisek Venkat More articles by this author Marissa Maas More articles by this author Lizana Maria More articles by this author Leo Duomanian More articles by this author Rene Sotelo More articles by this author Andre Abreu More articles by this author Mike Nguyen More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...