Alyssa Greiman

Quality of life related to urinary continence in adult spina bifida patients.

Introduction To analyze the correlations of bladder management technique, ambulatory status and urologic reconstruction on quality of life (QOL) as affected by urinary symptoms in adult spina bifida (SB) patients. Material and methods Sixty–six adult SB patients completed the RAND 36–Item Health Survey (mSF–36) and Incontinence Quality of Life (I–QOL). Demographic information, history of urinary reconstruction, and bladder management techniques were reviewed and analyzed with respect to survey scores. Results Mean age of patients was 32.3 (SD ±7.2) years and 44 patients (66.7%) were female. Forty–five patients (68.2%) were mainly ambulatory, 21 (31.8%) use a wheelchair and 10 (15.2%) had urologic reconstruction, while 56 (83.3%) did not. Twelve patients (18.2%) void, 42 (63.6%) perform clean intermittent catheterization (CIC), 4 (6.1%) use an indwelling catheter, 3 (4.5%) have an ileal conduit (IC) and 5 (7.6%) mainly use diapers. Mean mSF–36 General Health score was 56.5 (SD ±22.9) and mean I–QOL Sum score was 50.9 (SD ±21.7), where lower scores reflect lower QOL. mSF–36 and I–QOL scores did not significantly correlate with bladder management technique, ambulatory status or urologic reconstruction. A correlation was noted between I–QOL scales and most mSF–36 scales (all p <0.02). Conclusions In our cohort study of adult SB patients, bladder management technique and urologic reconstruction did not correlate with urinary (I–QOL) or general health (mSF–36) domains, although I–QOL and mSF–36 scores correlated closely, suggesting urinary continence is significantly related to general QOL. However, we are unable to identify a single factor that improves either urinary or general QOL.

A snapshot of the adult spina bifida patient – high incidence of urologic procedures

Introduction To describe the urologic outcomes of contemporary adult spina bifida patients managed in a multidisciplinary clinic. Material and methods A retrospective chart review of patients seen in our adult spina bifida clinic from January 2004 to November 2011 was performed to identify urologic management, urologic surgeries, and co-morbidities. Results 225 patients were identified (57.8% female, 42.2% male). Current median age was 30 years (IQR 27, 36) with a median age at first visit of 25 years (IQR 22, 30). The majority (70.7%) utilized clean intermittent catheterization, and 111 patients (49.3%) were prescribed anticholinergic medications. 65.8% had urodynamics performed at least once, and 56% obtained appropriate upper tract imaging at least every other year while under our care. 101 patients (44.9%) underwent at least one urologic surgical procedure during their lifetime, with a total of 191 procedures being performed, of which stone procedures (n = 51, 26.7%) were the most common. Other common procedures included continence procedures (n = 35, 18.3%) and augmentation cystoplasty (n = 29, 15.2%). Only 3.6% had a documented diagnosis of chronic kidney disease and 0.9% with end-stage renal disease. Conclusions Most adult spina bifida patient continue on anticholinergic medications and clean intermittent catheterization. A large percentage of patients required urologic procedures in adulthood. Patients should be encouraged to utilize conservative and effective bladder management strategies to reduce their risk of renal compromise.

Revisions of Mid Urethral Slings Can be Accomplished in the Office

PURPOSE Mid urethral slings occasionally require revision for obstructive voiding symptoms or vaginal extrusion. Our approach has been to offer revision in office or resection done under local anesthesia when the patient is agreeable and deemed an appropriate candidate. The results and complications of these procedures are presented. MATERIALS AND METHODS We retrospectively reviewed the charts of patients from January 2003 to October 2010 to determine the subset with mid urethral sling insertion who subsequently underwent revision in the office or operating room, as identified through the Northwestern Medical Enterprise Data Warehouse. The CPT code for female sling insertion (57288) or revision/removal (57287) was used. RESULTS A total of 41 revisions were performed in 28 of the 118 patients (23.7%) who underwent synthetic sling insertion. Reasons for adjustment were an intravesical sling (1 operating room case), extruded vaginal mesh (7 operating room and 19 office) and obstructive voiding symptoms (7 operating room and 7 office). Obstructive voiding symptoms in 6 of 7 operating room and 6 of 7 office patients improved immediately after sling release. There were no complications in either group but 3 office patients required repeat revision in the operating room due to inability to tolerate the procedure in 2 and to nonrelief of symptoms in 1. A total of 13 operating room adjustments were made according to surgeon preference while 2 patients elected the operating room, although adjustment in office was offered. CONCLUSIONS Sling adjustment due to vaginal mesh extrusion or obstructive voiding symptoms can be successfully performed in the office with good result. When greater adjustment is needed, the operating room may be preferable. Surgeons should make these decisions based on their comfort level and patient preference.

Viral Diversity in Asthma

Asthma exacerbations are precipitated primarily by respiratory virus infection and frequently require immediate medical intervention. Studies of childhood and adult asthma have implicated a wide variety of respiratory viruses in exacerbations. By focusing on both RNA and DNA respiratory viruses and some newly identified viruses, this review illustrates the diversity and highlights some of the uncertainties that exist in our understanding of virus-related asthma exacerbations.

Northwestern University Pilot Urology Residency Curriculum: Impact of Flexible Training and Residency Electives on Educational Outcomes

PURPOSE We report on our first 4 years of experience with a pilot urology residency curriculum. This novel program was approved by the Urology Residency Review Committee and involves a flexible educational program for residents, incorporating elective time (4 months each in postgraduate years 2 and 4 of training) into the residency rotation schedule. MATERIALS AND METHODS We performed a prospective assessment of the urology residency program overall, the electives chosen by the residents, and the impact on resident operative logs and in-service scores compared to residents completing residency before the implementation of the elective curriculum. Overall faculty and resident evaluation of the residency program and elective curriculum was collected, and categorized as positive, negative or neutral. RESULTS When comparing the first 3 years of the pilot program to the 5 years before implementation of the program, the average final graduated resident case total increased by 232 (2,390 vs 2,158). Resident in-service scores (postgraduate years 3 to 5) trended higher since the elective program was instituted with a 5% increase in percentile scores compared to their peers (75% vs 72%). Subjective evaluations of the new residency program by residents and faculty were overwhelmingly positive. CONCLUSIONS The pilot urology residency curriculum including elective time had a positive impact on the program based on resident and faculty feedback without a deleterious effect on urology index case logs or in-service scores.

MP63-10 DO URODYNAMICS PREDICT URINARY RETENTION AFTER SLING PLACEMENT IN THE COMPLEX PATIENT: VALUE OF REPRODUCING SYMPTOMS OF URODYNAMICS

experienced UUI resolution in the successes, and 10 (17.2%) in the failures (P .001). Among successes, a significant interaction (p<.001) was detected between the baseline and postoperative urodynamic parameters, including Qmax, corrected Qmax, postvoid residual (PVR), voiding volume, voiding efficiency(VE), and bladder outlet obstruction index (BOOI). Significantly increased PdetQmax was also observed after surgery (P .015). A significant interaction (P .034) is detected from the baseline to 6 months between successes and failures for BOOI. CONCLUSIONS: Suburethral sling has a durable long-term effect in our study. There is a trend suggesting that the decreased Qmax, corrected Qmax and VE are associated with surgical success, while increased Pdet. Qmax, BOOI, and PVR are also associated with success. Slight obstruction makes efficacious sling surgery. The increased outlet resistance is essential for achieving dryness.

MP79-07 INDICATIONS FOR NOVEL INTERPOSITION MYOCUTANEOUS FLAP FOR THE REPAIR OF RECTO-URINARY FISTULA

drainage of lesions is ineffective in curing the root cause of the problem, and persistence or worsening is the rule over time. Complete surgical resection followed by local flap or skin graft closure is possible, curative and most often successful, at the cost of a unsurprisingly high number of self limited wound complications. Urologists should endeavor to fix instead of merely manage this difficult problem.

MP76-17 PATTERNS OF CARE FOR THE EVALUATION OF HEMATURIA AMONG INSURED NON-ELDERLY PATIENTS

INTRODUCTION AND OBJECTIVES: Fifty percent of patients with hematuria will have demonstrable causes. Full evaluation includes cystoscopy, urine cytology, and imaging. We determined patterns of care for hematuria evaluation in the insured population. METHODS: Utilizing a national administrative database of privately insured patients (Truven Health Analytics MarketScan Research Database), we performed a cross-sectional analysis of men and women aged 40-65 years with newly diagnosed gross or microscopic hematuria in the calendar year 2013. Patients with pre-existing genitourinary diagnoses in the previous 12 months were excluded. The primary outcome was hematuria evaluation as assessed by the use of cystoscopy, urine cytology, and/or imaging for 6 months after a hematuria diagnosis identified by claims coding. RESULTS: We identified 22,514 and 69,310 patients with gross and microscopic hematuria, respectively; 44% of patients were male and 56% were female. Patients with gross and microscopic hematuria had complete evaluation in 6.3% and 5.2% and had no evaluation in 37.2% and 47.9% of cases, respectively (p<0.001 for all). For patients with gross and microscopic hematuria, 46.1% and 29.0% underwent cystoscopy, respectively (p<0.001). Performance of imaging and cytology are described in Table 1. CONCLUSIONS: Among men and women with initial presentation of gross or microscopic hematuria, less than 6% of patients receive a complete evaluation with imaging, urine cytology and cystoscopic examination while over 48% have no evaluation. Practice patterns between gross and microscopic hematuria did not differ significantly, raising quality of care concerns that physicians treat these two conditions similarly despite significant differences in the natural history and the risk of urologic malignancies of these entities. Future studies should address causes for the discrepancies observed in the evaluation of hematuria.

MP40-16 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA: A SELECTIVE APPROACH

CONCLUSIONS: Use of third line therapy for OAB has been reported to be less than 5%. This rate is higher at our institution, likely due to access to multiple FPMRS providers. The authors also use a care pathway that emphasizes early patient education on available options should they fail first and second line treatments. Even in a tertiary referral center it is likely that third line therapy is not being offered to many patients who would benefit from it. Our data demonstrate an opportunity for urologists to improve the quality of care and treatment success rates for OAB patients.