You have accessJournal of UrologyCME1 Apr 2023PD05-08 ELEVATED FM/a BLOOD TEST IN PATIENTS WITH INTERSTITIAL CYSTITIS / BLADDER PAIN SYNDROME Claire Burton, Ashu Mohammad, Sean Berquist, and Amy Dobberfuhl Claire BurtonClaire Burton More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Sean BerquistSean Berquist More articles by this author , and Amy DobberfuhlAmy Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003229.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The FM/a test is a cytokine assay of in vitro stimulated peripheral blood mononuclear cells that has been previously validated for the diagnosis of fibromyalgia (FM). FM and Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS) share many common features, and cytokine abnormalities have been previously identified in both conditions. It has been hypothesized that the non-Hunner Lesion (HL) phenotype of IC/BPS may be more related to systemic pain syndromes and have overlap with FM. We hypothesized that patients with IC/BPS would also test positive on the FM/a test. METHODS: Men and women ≥18 years of age with a diagnosis of IC/BPS were included in the study. Patients were excluded if they were taking immunosuppressants or oral or inhaled steroids. All patients were prospectively enrolled and completed the blood test as well as the AUA-SS and the O’Leary-Sant Symptom and Problem Indices. Charts were reviewed for chronic overlapping pain conditions (COPCs) which include Irritable bowel syndrome, FM, chronic fatigue syndrome, migraine, and temporomandibular joint disorder as well as the prevalence of HL. RESULTS: A total of 15 patients enrolled in the study. 73% (11/15) of patients tested positive for FM/a with a score >50. Distribution of FM/a results is presented in Figure 1. One patient who tested negative reported being on Flonase and was excluded from further analysis. 13/14 had previously undergone cystoscopy for evaluation of HL. Demographic data is presented in Table 1. There was no difference in FM/a results among subjects with and without COPCs (70.8 vs 55.3, p=0.31) or HL vs Non-HL IC/BPS (65.2 vs 64.8, p=0.98). CONCLUSIONS: The FM/a test is highly positive in this small sample of patients with IC/BPS, the majority of whom do not carry a prior FM diagnosis. While the clinical utility of this test is uncertain, there may be potential to use this test to further phenotype patients with IC/BPS and/or clarify the diagnosis if in question. Further study of the sensitivity and specificity of the FM/a test in IC/BPS patients is warranted. Source of Funding: EpicGenetics paid for the laboratory fees and conducted the FM/a Test free of charge © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e151 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Burton More articles by this author Ashu Mohammad More articles by this author Sean Berquist More articles by this author Amy Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE To evaluate the effect of percutaneous tibial nerve stimulation (PTNS) in interstitial cystitis/ METHODS Retrospective chart review was completed for patients with at least 10 weekly treatments of PTNS from January 2010 to October 2021. PTNS success was defined as conversion to PTNS maintenance therapy following 12 weeks of PTNS induction therapy. Data were analyzed using RESULTS Over the 11-year study period, 27 out of 34 patients (mean age 52.9 +/- 16.8 years; 25 females, 9 males) completed 12 weeks of PTNS induction therapy, and 48.1% (13/27) successfully converted to PTNS maintenance therapy. Following 12 weeks of PTNS induction therapy, significant improvements were noted in the urgency severity scale (range 0-4: 2.9 +/- 1.2 before vs 1.1 +/- 1.1 after PTNS, P = .001) and nocturnal urinary frequency (number of voids: 3.3 +/- 1.9 before vs 2.2 +/- 1.6 after PTNS, P = .041); and nonsignificant improvements were noted in daytime void frequency (hours: 1.5 +/- 0.7 before vs 2.0 +/- 0.9 after PTNS, P = .090) and the pain domain of the interstitial cystitis symptoms index (question 4, range 0-4: 2.5 +/- 1.4 before vs 1.3 +/- 1.8 after PTNS, P = .082). CONCLUSION Our sample size is among the largest sample of PTNS in IC/BPS from a single center. While PTNS achieved nonsignificant improvements in pain and daytime void frequency, significant improvements were observed in urinary urgency and nocturia. PTNS appears to be a plausible option in the multimodal approach to managing IC/BPS. UROLOGY 182: 73-78, 2023. (c) 2023 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 May 2022PD08-12 EFFICACY OF PERCUTANEOUS TIBIAL NERVE STIMULATION (PTNS) FOR INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS) RELATED LOWER URINARY TRACT AND PELVIC SYMPTOMS Abdelrahman S. Abdalla, Sean W. Berquist, Chen Shenhar, Stefanie van Uem, Ashu Mohammad, and Amy D. Dobberfuhl Abdelrahman S. AbdallaAbdelrahman S. Abdalla More articles by this author , Sean W. BerquistSean W. Berquist More articles by this author , Chen ShenharChen Shenhar More articles by this author , Stefanie van UemStefanie van Uem More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002527.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our primary objective was to determine the efficacy of percutaneous tibial nerve stimulation (PTNS) in managing symptoms of patients with interstitial cystitis / bladder pain syndrome (IC/BPS). Secondary objective was to determine the magnitude of change in IC/BPS related lower urinary tract and pelvic symptoms (urinary frequency, urinary urgency, nocturia, pelvic pain). METHODS: Following IRB protocol approval, patient data were gathered using the STAnford Research data Repository (STARR) to identify patients with IC/BPS who underwent PTNS from January 2019 to October 2021. Direct chart review was performed to obtain any of the standardized outcome measures not contained in STARR. Lower urinary tract symptoms (LUTS) before starting PTNS therapy and after last PTNS visit, and percentage improvements in symptoms were quantified. Data are presented as mean ± standard deviation. RESULTS: A total of 14 patients (age 55.1 ± 19.6 yr, BMI 27.3 ± 6.1, medical comorbidities 6.4 ± 4.9) were analyzed according to the magnitude of response to PTNS (Table 1). LUTS before the initiation of therapy were recorded using the O’Leary Sant Symptom Index (frequency 3.4 ± 1.6, urgency 2.9 ± 1.5, nocturia 3.5 ± 1.2, pelvic pain 1.4 ± 1.4). Urgency improved the most with PTNS therapy (1.8 ± 1.5) with a mean percentage of improvement of 39%, followed by frequency (2.3 ± 1.9) with a mean improvement of 33.3%. Nocturia (2.3 ± 1.2) and pelvic pain (1.1 ± 1.6) were the symptoms least improved by PTNS, with a mean improvement of 32.4% and 21.1%, respectively. CONCLUSIONS: PTNS can be a promising option for managing IC/BPS in patients who fail to respond to other lines of therapy. Future research is needed to understand the physiologic mechanisms which underpin the bladder centric versus central sensitization phenotypes of IC/BPS and identify novel neuromodulation modalities. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e109 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Metrics Author Information Abdelrahman S. Abdalla More articles by this author Sean W. Berquist More articles by this author Chen Shenhar More articles by this author Stefanie van Uem More articles by this author Ashu Mohammad More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 May 2022PD38-01 FEASIBILITY, SAFETY AND EFFICACY RESULTS OF THE SUFU FOUNDATION OPEN LABEL CLINICAL TRIAL OF ULTRASOUND CONFIRMED TRANSVAGINAL BOTULINUM TOXIN A (BTA) FOR REFRACTORY OVERACTIVE BLADDER (OAB) Sean W. Berquist, Chen Shenhar, Stefanie van Uem, Ashu Mohammad, Abdelrahman S. Abdalla, Craig V. Comiter, Raveen Syan, Eboo Versi, and Amy D. Dobberfuhl Sean W. BerquistSean W. Berquist More articles by this author , Chen ShenharChen Shenhar More articles by this author , Stefanie van UemStefanie van Uem More articles by this author , Ashu MohammadAshu Mohammad More articles by this author , Abdelrahman S. AbdallaAbdelrahman S. Abdalla More articles by this author , Craig V. ComiterCraig V. Comiter More articles by this author , Raveen SyanRaveen Syan More articles by this author , Eboo VersiEboo Versi More articles by this author , and Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002596.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To address challenges associated with delivering botulinum toxin A (BTA) via traditional cystoscopy for refractory overactive bladder (OAB), the SUFU Foundation sponsored a pilot clinical trial to determine feasibility, safety and efficacy of transvaginal intradetrusor BTA. METHODS: Women with refractory OAB were prospectively enrolled (March 2019 to June 2021) and underwent transvaginal ultrasound to confirm anatomy of the trigone and bladder. Ultrasound was removed and transvaginal intradetrusor BTA injection (Botox® 100 units) was performed under direct visualization via half speculum. Repeat ultrasound was performed to confirm correct delivery of BTA. Prospective feasibility, safety and efficacy outcomes were recorded. Treatment benefit scale (TBS) and patient global impression of change (PGIC) were recorded at 6 and 12 weeks. After 12 weeks subjects were eligible for the continuity phase and repeat BTA injection at time of symptom recurrence (PGIC <50% improved) to determine inter-injection interval duration of effect. Covariates were recorded at each study visit: AUASS, OABq-SF SB & QOL, 3-day bladder diary. Data are presented as mean±SD, and analyzed in SAS by repeated measure ANOVA. RESULTS: Women (n=15, age 67±8 yr, BMI 27.5±5.2, medical comorbidities 4.5±2.6) underwent a total of 31 BTA injections, and were previously treated with 1.8±0.9 1st/2nd line, and 0.7±0.9 3rd line OAB treatments. Feasibility was demonstrated by all subjects completing BTA injection [procedure pain score 2.5±1.6 (0–10 scale)]. Ultrasound confirmed correct BTA delivery in all subjects. Safety was demonstrated by 0% immediate procedural complication, 0% rate of retention and 3% rate of UTI. Prior to 12 week follow-up, 2 subjects were lost, and 1 died of unrelated causes. 75% of subjects reported significant improvement at 6 weeks and 58% reported improvement at 12 weeks. There was significant improvement in AUASS, OAB-qSF SB & QOL total scores on ANOVA [F(1,11)=5.02, p=0.04; F(1,11)=7.14, p=0.02 & F(1,11)=8.4, p=0.01]. Mean void volume on diary significantly increased by 6 weeks [F(1,10)=6.2, p=0.03]. Eligible subjects were enrolled in the continuity phase and demonstrated an inter-injection interval of 18.9±9.6 weeks. CONCLUSIONS: Transvaginal BTA for refractory OAB appears to be a simple, feasible, safe, and efficacious procedure, with a mean inter-injection duration of effect greater than 18 weeks, when administered in an open label clinical trial. Source of Funding: SUFU Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e645 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean W. Berquist More articles by this author Chen Shenhar More articles by this author Stefanie van Uem More articles by this author Ashu Mohammad More articles by this author Abdelrahman S. Abdalla More articles by this author Craig V. Comiter More articles by this author Raveen Syan More articles by this author Eboo Versi More articles by this author Amy D. Dobberfuhl More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-19 TIME TO SPONTANEOUS RESOLUTION IN INFANT STONE DISEASE Sean Berquist, Gunjan Agrawal, Justine Dela Cruz, and Kathleen Kan Sean BerquistSean Berquist More articles by this author , Gunjan AgrawalGunjan Agrawal More articles by this author , Justine Dela CruzJustine Dela Cruz More articles by this author , and Kathleen KanKathleen Kan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urolithiasis is a rising concern in pediatric populations. Infant presentations are unique in their pathophysiology and may often present as incidental findings. We aim to characterize our population of infant stone formers at a single tertiary pediatric hospital in order to inform duration of follow-up and long-term management. METHODS: We utilized our electronic health record to identify patients with a first diagnosis of stone disease before the age of 12 months from 2014-2021. The final cohort (n=53) all had initial stones diagnosed by imaging at our institution with ≥1 subsequent radiology encounter. Patients with nephrocalcinosis and percutaneous tubes were excluded. History and presentation, radiographic findings, treatment/management and demographic variables were collected. Variables were analyzed using descriptive analysis, chi-square, Fisher test and Welch t-tests using R. Outcomes have been grouped into patients with complete resolution (Group 1) or with stones of equivocal or greater size (Group 2) on follow-up ultrasound. Results were considered significant if p < 0.05. RESULTS: The mean age of diagnosis of urolithiasis in 53 patients (male=37) was 3.25±2.52 months. The duration of follow up ranged from 1-72 months with a mean of 12.67±15.30 months. Most infants were asymptomatic at presentation (64.1%). Among the symptomatic infants, UTI (n=10, 18.8%) was the most common diagnosis followed by fever (n=4, 7%). There was no significant difference between the two groups in terms of gender, stone size, antenatal factors such as hydronephrosis and associated genitourinary abnormalities. Ultrasound at the time of diagnosis showed hydronephrosis (32.1%) and bilateral stones (37.7%) with only 1 patient having ureteral stones (1.9%). Mean time to spontaneous resolution was 6.48±5.46 months. The two groups had significant difference with regards to prematurity and history of furosemide intake (p<0.05). None of the 53 patients required medical treatment. 4 patients, all with a history of prematurity, underwent eventual surgical intervention. CONCLUSIONS: Infants with stones who have a history of prematurity or furosemide exposure may warrant closer follow-up as they are less likely to undergo spontaneous resolution of stone disease. This may be due to intrinsic physiologic and environmental factors related to initial stone formation itself. A meta-analysis may be required to further confirm the relationship between these factors and the rate of stone resolution in children. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e831-e831 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sean Berquist More articles by this author Gunjan Agrawal More articles by this author Justine Dela Cruz More articles by this author Kathleen Kan More articles by this author Expand All Advertisement Loading ...

475 Background: Upper tract urothelial cell carcinoma (UTUC) is an uncommon malignancy with disparate outcomes. We developed a novel morphometric scoring system for prediction of oncologic and survival outcomes before nephroureterectomy (NU). Methods: Retrospective, multicenter analysis of UTUC patients who underwent NU after negative metastatic workup. Preoperative CT-urography was used to evaluate scores, based on 3 factors (Tumor Size, Focality, Invasion of architecture) with a score of 1-3 based on degree of each factor (total score 3-9). Primary outcome was overall survival (OS). Secondary outcomes were recurrence and recurrence free survival (RFS). Multivariable (MVA) and Kaplan-Meier (KMA) analyses were utilized. Results: We analyzed 244 patients (mean age 70.9, mean follow up 29.5 months). 61% with SFI-UTUC score 3-6 and 39% were score 7-9. No difference in age, gender, comorbid conditions, surgical approach, or complications between groups. Score 7-9 had a higher rate of pN+ disease (24.2% vs. 8.1%, p=0.002) but similar nuclear grade. All-cause mortality was higher for score 7-9 (47.4% vs. 28.9%, p=0.004). On MVA for all-cause mortality, age (OR 1.1), recurrence (OR 4.4) and score 7-9 (OR 2.0) were significant (p<0.05). KMA for OS demonstrated 5 year OS of 57.0% for score 3-6 and 34.1% for score 7-9 (p<0.01). KMA for RFS was significant for renal UTUC location with 5 year RFS of 72.3% for score 3-6 and 54.2% for score 7-9, (p<0.01). Conclusions: A novel scoring system for UTUC preoperative imaging may predict OS for tumors in renal and ureteral locations, as well as RFS for renal locations. Renal location. [Table: see text]

642 Background: Incidental pathological upstaging to pT3a disease can occur after surgical treatment of clinical T1 and T2 Renal Cell Carcinoma (RCC), and upstaged pT3a disease is associated with worsened outcomes. Oncologic and survival outcomes within the pT3a category are heterogeneous. We investigated recurrence and survival outcomes in pT3a disease, and aimed to better categorize this cohort for improvement on current TMN staging. Methods: Multi-center retrospective analysis of patients with renal cell carcinoma (cT1-3aN0M0) from 1987-2016. After initial comparison of outcomes between pT1, pT2 and pT3a, patients were substratified within the pT3a category based on presenting clinical stage. Comparison was drawn between pT1, pT2 and the subdivided pT3a group (cT1 → pT3a, cT2 → pT3a, and cT3a → pT3a). Primary outcome was recurrence free survival (RFS). Secondary outcome was overall survival (OS). Kaplan−Meier (KM) analysis was utilized. Results: 2640 patients were analyzed (2125 cT1, 448 cT2, 67 cT3a, mean follow up 67.8 months). Rate of incidental T3a upstaging from cT1-2 was 14.7%. Compared to pT1-2 disease, patients with incidental pT3a upstaging had higher rate of recurrence (7.5% vs. 29.6%, p < 0.001) and all-cause mortality at last follow up (15.9% vs. 25.4%, p < 0.001). With regards to RFS, when pT3a was subdivided based on presenting clinical stage, significant differences in RFS emerged which aligned differently. Compared to 5 year RFS of pT1 (94.4%), cT1 → pT3a aligned with pT2 (76.6% and 81.2%, p = 0.346) while cT2 → pT3a aligned with cT3a → pT3a 47.4% and 44.0%, p = 0.815). With regards to OS, a similar alignment was noted for 5 year OS after subdivision, where pT1 was 89.9%, while cT1 → pT3a correlated with pT2 (79.8% and 83.1%, p = 0.640) and cT2 → pT3a correlated with cT3a → pT3a 67.0% and 64.2%; p = 0.893). Conclusions: Patients with cT1 → pT3a have outcomes more similar to pT2, than patients with cT2 → pT3a which align more closely to cT3a → pT3a. Future refinements of the TNM staging system for RCC should consider re-grouping cT1 → pT3a into the pT2 group. Further confirmation is requisite.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by core social impairments. ASD remains poorly understood because of the difficulty in studying disease biology directly in patients and the reliance on mouse models that lack clinically relevant, complex social cognition abilities. We use ethological observations in rhesus macaques to identify male monkeys with naturally occurring low sociality. These monkeys showed differences in specific neuropeptide and kinase signaling pathways compared to socially competent male monkeys. Using a discovery and replication design, we identified arginine vasopressin (AVP) in cerebrospinal fluid (CSF) as a key marker of group differences in monkey sociality; we replicated these findings in an independent monkey cohort. We also confirmed in an additional monkey cohort that AVP concentration in CSF is a stable trait-like measure. Next, we showed in a small pediatric cohort that CSF AVP concentrations were lower in male children with ASD compared to age-matched male children without ASD (but with other medical conditions). We demonstrated that CSF AVP concentration was sufficient to accurately distinguish ASD cases from medical controls. These data suggest that AVP and its signaling pathway warrant consideration in future research studies investigating new targets for diagnostics and drug development in ASD.

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2017MP67-07 PATHOLOGICAL DETERMINANTS OF ONCOLOGIC OUTCOMES IN STAGE II RENAL CELL CARCINOMA: AN INTERNATIONAL MULTICENTER ANALYSIS Zachary Hamilton, Daniel Han, Alp Tuna Beksac, Sean Berquist, Abd-elrahma Hassan, Charles Field, Aaron Bloch, Sumi Dey, Adam Bezinque, Samer Kirmiz, Fang Wan, James Proudfoot, Anthony Patterson, Bulent Akdogan, Haluk Ozen, Brian Lane, and Ithaar Derweesh Zachary HamiltonZachary Hamilton More articles by this author , Daniel HanDaniel Han More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Sean BerquistSean Berquist More articles by this author , Abd-elrahma HassanAbd-elrahma Hassan More articles by this author , Charles FieldCharles Field More articles by this author , Aaron BlochAaron Bloch More articles by this author , Sumi DeySumi Dey More articles by this author , Adam BezinqueAdam Bezinque More articles by this author , Samer KirmizSamer Kirmiz More articles by this author , Fang WanFang Wan More articles by this author , James ProudfootJames Proudfoot More articles by this author , Anthony PattersonAnthony Patterson More articles by this author , Bulent AkdoganBulent Akdogan More articles by this author , Haluk OzenHaluk Ozen More articles by this author , Brian LaneBrian Lane More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2043AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stage II Renal Cell Carcinoma (RCC) is characterized by varied oncological outcomes, as the risk of progression and recurrence can vary widely. We analyzed clinical and pathological risk factors associated with oncological outcomes in a multicenter, international cohort. METHODS Retrospective multicenter analysis of patients who underwent surgical excision of clinically localized stage 2 (T2) renal mass from 1987-2015. Patients with tumors amenable to nephron-sparing surgery, baseline chronic kidney disease, or bilateral renal masses were provided an option for partial nephrectomy (PN), otherwise radical nephrectomy (RN) was performed. Lymphadenectomy (LND) was performed when clinically indicated. Primary endpoint was Recurrence Free Survival (RFS). Secondary outcome was overall survival (OS). Kaplan-Meier (KM) log-rank test and multivariable analysis (MVA) for factors related to RFS and OS were performed. RESULTS 1328 patients were analyzed (mean age 59.2 years, median follow up 62.7 months, 66.4% male/33.6% female, 20% PN/80% RN). Overall recurrence rate was 22.3%. MVA for factors associated with recurrence was significant for RN (OR 4.68, p=0.010), positive margin (OR 34.19, p=0.012), tumor grade 3/4 (OR 2.35, p=0.001), and lymphovascular invasion (LVI, OR 2.03, p=0.018). MVA for tumor related factors associated with worsened OS was significant only for RN (OR 4.16, p=0.001). KM analysis revealed 5 year RFS of 78.7% for LVI negative and 49.9% for LVI positive patients (p<0.001), as well as a 5 year RFS of 81.8% for tumor grade 1/2 and 62.1% for tumor grade 3/4 (p<0.001, figure). CONCLUSIONS For Stage II RCC, LVI and tumor grade 3/4 are independently associated with increased risk of recurrence. Stage II RCC patients with these pathological findings represent a high risk subgroup that requires close follow up and has implications for clinical trial design. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e873-e874 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zachary Hamilton More articles by this author Daniel Han More articles by this author Alp Tuna Beksac More articles by this author Sean Berquist More articles by this author Abd-elrahma Hassan More articles by this author Charles Field More articles by this author Aaron Bloch More articles by this author Sumi Dey More articles by this author Adam Bezinque More articles by this author Samer Kirmiz More articles by this author Fang Wan More articles by this author James Proudfoot More articles by this author Anthony Patterson More articles by this author Bulent Akdogan More articles by this author Haluk Ozen More articles by this author Brian Lane More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

532 Background: Renal Cell Carcinoma (RCC) is a metabolically driven neoplasm. Inflammatory markers and morphometric measures have been suggested to be predictive for prognosis. We investigated the impact of a novel combination of preoperative tumor morphology (RENAL score) and a laboratory based inflammatory marker (DeRitis Ratio, AST/ALT) on survival outcomes in localized RCC. Methods: Single center, retrospective analysis of 264 patients with RCC (112 PN, 152 RN, mean follow-up 45 months) from 2003−2015. A priori, we assigned a positive marker score of “1” if RENAL >8 or DeRitis >1.5. Patients were stratified by increasing positive markers (“0”=RENAL ≤8 and DeRitis ≤1.5, “1”=RENAL >8 or DeRitis >1.5, “2”=RENAL >8 and DeRitis>1.5). Primary outcome was overall survival (OS). Cox models and Kaplan−Meier curves were utilized. Results: 264 patients, 61.7% male, mean age 64.5 ± 12.8 years, mean BMI 28.5 ± 5.6, mean AST/ALT 1.1 ± 0.4. With regards to tumor characteristics, mean clinical tumor size 4.7 ± 3.2cm and median RENAL score 9 (IQR 7−10). For clinical staging, 75.7% were cT1, 17.4% were cT2, and 6.9% were >cT2. 32.6% had 0 positive markers, 60.2% had 1 marker, and 7.2% had 2 markers. Kaplan−Meier analysis for “0”, “1”, and “2”demonstrated significantly worsened OS (log−rank p=0.03). On Cox model for OS, RENAL >8 (HR 2.13, p=0.01) or AST/ALT >1.5 (HR 2.25, p=0.028) were significantly associated with worsened survival, as was combined RENAL >8 and DeRitis > 1.5 (HR 5.1, p<0.001). Conclusions: Novel combination of a morphological score (RENAL) and an inflammatory marker (DeRitis ratio) was associated with worsened OS in localized RCC. Our findings point toward development and validation of a prognostic index to assist in risk stratification for localized RCC.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VII1 Apr 2017PD73-07 ANALYSIS OF RISK FACTORS ASSOCIATED WITH INFECTIONS COMPLICATIONS FOLLOWING PARTIAL NEPHRECTOMY Richmond Owusu, Michael Liss, Sean Berquist, Abd-elrahma Hassan, Charles Field, Aaron Bloch, Unwanaobong Nseyo, Fang Wan, Zachary Hamilton, and Ithaar Derweesh Richmond OwusuRichmond Owusu More articles by this author , Michael LissMichael Liss More articles by this author , Sean BerquistSean Berquist More articles by this author , Abd-elrahma HassanAbd-elrahma Hassan More articles by this author , Charles FieldCharles Field More articles by this author , Aaron BlochAaron Bloch More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Fang WanFang Wan More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is the standard for management for cT1a renal mass and is increasingly used for larger tumors. Compared to radical nephrectomy, however, it may carry a higher risk of procedure-specific complications, including perioperative infections. We determined to identify risk factors for infectious complications after PN METHODS Single-center retrospective analysis of patients who underwent PN from 7/2008-1/2015. Demographics, disease and operative characteristics (including surgical approach and length of antibiotic coverage), and occurrence and site of infectious complications were reviewed. Rate of infectious complications following PN at the 30 day and 90 day postoperative mark was calculated. Multivariable analyses (MVA) for risk factors associated with infectious complications during the first 30 and 90 days postoperatively were performed RESULTS 481 patients were analyzed (mean age 63.1 years, 61.3% male/38.7% Female). Median tumor size was 3.5 cm (IQR 1.9-4.7). Minimally invasive PN was performed in 63.1% (N=299) and open PN was performed in 36.9% (N=175). Urine leak occurred in 21 (4.4%). Infection in first 30 days postoperatively occurred in 29 patients (6%), while infection in first 90 days postoperatively occurred in 42 patients (8.7%). Infection sites during the first 30 day period were wound (N=9), urinary tract (N=8), respiratory (N=7), abscess/sepsis (N=4), and C. difficile (N=3). De novo infectious events >30 and < 90 days were wound (N=6), urinary tract (N=4), and abscess/sepsis (N=4). MVA for infectious complications in first 30 days revealed duration of antibiotic therapy >24 hours (OR 1.91, p=0.01) as being the only independent risk factor for development of infectious complication. MVA for infectious complications during first 90 days postoperatively revealed urine leak (OR 6.21, p<0.001) and increasing delta GFR (OR 1.02, p=0.006) as being independent risk factors CONCLUSIONS Postoperative infectious complications occurred in less than 10% of patients undergoing PN, with most occurring in the first 30 days. Overall wound and urinary tract infections were most common throughout, while abscess/sepsis increased over time, and respiratory and GI/C. difficile decreased over time. Perioperative antibiotics should be limited to <24 hours as part of strategies to reduce risk of infectious sequelae © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1369 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Richmond Owusu More articles by this author Michael Liss More articles by this author Sean Berquist More articles by this author Abd-elrahma Hassan More articles by this author Charles Field More articles by this author Aaron Bloch More articles by this author Unwanaobong Nseyo More articles by this author Fang Wan More articles by this author Zachary Hamilton More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

BACKGROUND:We compared quality outcomes between transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). METHODS:Two-center retrospective analysis of TRPN and RRPN from 10/2009 to 10/2015. Perioperative/renal function outcomes were analyzed. Primary endpoint was Pentafecta, a composite measure of quality [negative margin, no 30-day complication, ischemia time ≤25 min, return of glomerular filtration rate (eGFR) to >90% from baseline at last follow-up, and no chronic kidney disease upstaging]. Multivariable analysis (MVA) for factors associated with lack of optimal outcome was performed. RESULTS:404 patients (TRPN 263, RRPN 141) were analyzed. Comparing TRPN vs. RRPN, mean tumor size (3.1 vs. 2.9 cm, p = 0.122) and RENAL score (7.4 vs. 7.2, p = 0.503) were similar. Most TRPN were anterior (65.0%) and most RRPN posterior (65.3%, p < 0.001). Operative time (p = 0.001) was less for RRPN. No significant differences between TRPN vs. RRPN were noted for ischemia time (23.1 vs. 22.8 min, p = 0.313), blood loss (p = 0.772), positive margins (p = 0.590), complications (p = 0.537), length of stay (p = 0.296), ΔeGFR (p = 0.246), eGFR recovery to >90% (55.9 vs. 57.4%, p = 0.833), and lack of CKD upstaging (84.0 vs. 87.2%, p = 0.464). Pentafecta rates were not significantly different (TRPN 33.9 vs. RRPN 43.3%, p = 0.526). MVA revealed increasing RENAL score (OR 1.5, p < 0.001) and decreasing baseline eGFR (OR 2.4, p = 0.017) as predictive for lack of Pentafecta. CONCLUSIONS:TRPN and RRPN have similar quality outcomes, though RRPN may offer modest benefit for operative time and have utility in posterior tumors. Association of increasing RENAL score and decreased baseline eGFR with lack of Pentafecta suggests dominant role of non-modifiable factors.

BACKGROUND:The aim of this study was to compare outcomes of laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) radical nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses.METHODS:Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. Sixty-three patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway. Primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, estimated blood loss (EBL), complications, discharge pain score (visual analog pain, VAP), narcotic requirement (morphine equivalents, MSO4eq).RESULTS:130/133 MPL and 62/63 LESS were successfully performed. For MPL and LESS groups: mean tumor diameter (cm) for cT1b was 5.3 vs. 5.4 (P=0.689); and for cT2a was 8.2 vs. 8.3 (P=0.728); mean OR time (min) was 126.3 vs. 132.7 (P=0.314); mean EBL (mL) was 139.5 vs.127.8 (P=0.49). No significant differences in complications were noted (P=0.781). LESS was associated with significant reductions in LOS (2.14 vs. 2.45 days, P=0.043), discharge VAP (1.3 vs. 2.2, P<0.001), and narcotic use (5.9 vs. 10.7 MSO4eq, P<0.001).CONCLUSIONS:LESS is comparable to MPL-RN for cT1b and T2a renal tumors in terms of perioperative parameters and may confer benefit with respect to LOS and analgesic requirement.

PURPOSE:To describe the frequency and characteristics of developmental regression in a sample of 50 patients with Phelan McDermid Syndrome (PMS) and investigate the possibility of association between regression, epilepsy, and electroencephalogram (EEG) abnormalities and deletion size. METHODS:The Autism Diagnostic Interview-Revised (ADI-R) was used to evaluate regression in patients with a confirmed diagnosis of PMS. Information on seizure history and EEGs was obtained from medical record review. Deletion size was determined by DNA microarray. RESULTS:A history of regression at any age was present in 43% of all patients. Among those exhibiting regression, 67% had onset after the age of 30 months, affecting primarily motor and self-help skills. In 63% of all patients there was a history of seizures and a history of abnormal EEG was also present in 71%. No significant associations were found between regression and seizures or EEG abnormalities. Deletion size was significantly associated with EEG abnormalities, but not with regression or seizures. CONCLUSION:This study found a high rate of regression in PMS. In contrast to regression in autism, that often occurs earlier in development and affects language and social skills, we found regression in PMS most frequently has an onset in mid-childhood, affecting motor and self-help skills. We also found high rates of seizures and abnormal EEGs in patients with PMS. However, a history of abnormal EEG and seizures was not associated with an increased risk of regression. Larger deletion sizes were found to be significantly associated with a history of abnormal EEG.

BACKGROUND We evaluated the role of statins in patients who underwent surgery for renal cell carcinoma (RCC) and who had dyslipidemia, as use of statins has been suggested to improve outcomes in RCC. METHODS Two-center retrospective study of patients with dyslipidemia who underwent surgery for RCC from 7/1995 to 6/2005. Patients were managed by statins or ezetimibe, fibrate agents, or cholestyramine. Analysis was conducted between patients who received statin therapy versus those that did not. Primary outcome was progression-free survival (PFS). Secondary outcomes were cancer-specific (CSS) and overall survival (OS). Multivariable analysis was performed to identify risk factors associated with disease progression. RESULTS In this study 283 patients were analyzed (180 statin, 103 non-statin, median follow-up 68 months). There were no significant demographic differences. Median duration of antidyslipidemia therapy was similar (statin 31 months vs. non-statin 28 months, P=0.413). Tumor size (statin 5.4 cm vs. non-statin 5.6 cm, P=0.569), stage distribution (P=0.591), histology (P=0.801), and grade (P=0.807) were similar. Kaplan-Meier analysis demonstrated higher 5-yr PFS (91% vs. 70%, P<0.001), CSS (88% vs. 69%, P<0.001), and OS (71% vs. 67%, P=0.025) in statin vs. non-statin patients. Multivariable analysis for factors associated with disease progression found absence of statin therapy (OR 2.41, P<0.001), higher stage (OR 2.01-3.86 P<0.001), and higher grade tumors (OR 2.07, P=0.006) to be predictive. CONCLUSIONS In RCC patients with dyslipidemia, statin use was associated with improved survival outcomes, and was an independent predictor of PFS. Further investigations are requisite to determine utility of statins in RCC patients.

continuous and categorical variables, respectively.Outcomes of interest included estimated blood loss, warm ischemia time, estimated glomerular filtration rate at 6 months, length of stay, margin status, Fuhrman grade, tumor size, pathological histology, and symptoms index at presentation RESULTS: Among our cohort, 376 (62%) and 228 (38%) patients with were scheduled for RN and PN, respectively.Of the 228 patients originally scheduled for PN, 12% were converted to RN intraoperatively.A smaller proportion of patients scheduled to undergo PN had clear cell/conventional histology (77% vs 88%; p¼0.001) on pathology compared to patients scheduled for RN.Among patients with clear cell or papillary histology, a larger proportion of patients scheduled for PN had lower Fuhrman grade (24% vs 10.3% had FG 1 or 2; p<0.0001) on pathology than patients scheduled for RN.Of our 604 patients, 111 patients died, 33 from kidney disease.The median follow up time for survivors was 2.0 years from surgery.On multivariable analysis, scheduled PN was non-significantly associated with better OS (HR 0.62; 95% C.I. 0.37, 1.03; p ¼ 0.064), better CSS (HR 0.51; 95% C.I. 0.18, 1.49; p ¼ 0.2), and better RFS (HR 0.56; 95% C.I. 0.29, 1.07; p¼0.081).From the estimates of the hazard ratio, we suspect that the bias related to surgeons choosing PN or RN based on low or high risk disease is not appropriately adjusted for in our model CONCLUSIONS: We found no evidence to suggest that PN has poorer outcomes than RN in patients with pT3a tumors.The inherent benefits of PN on renal function preservation make this approach very attractive even in larger and complex tumors