Dean Laganosky

Patient Acceptance of Teleurology via Telephone vs Face-to-Face Clinic Visits for Hematuria Consultation at a Veterans Affairs Medical Center

Introduction We evaluated the experience and preferences of patients undergoing hematuria consultation via teleurology compared to a conventional face‐to‐face clinic visit. Methods Patients evaluated for hematuria with teleurology or face‐to‐face clinic visit were surveyed regarding their experience and preferences. The survey consisted of 27 questions evaluating overall acceptance and satisfaction (8 questions), impact factors (17) and preference (2). Results A total of 450 patients participated in the survey at a 2‐to‐1 ratio (300 via teleurology, 150 via face‐to‐face visits). Overall, patient satisfaction level was higher with teleurology compared to face‐to‐face clinic visits (mean score 9.2 vs 8.4, p <0.0001). This finding was observed in all 8 domains (acceptance, efficiency, convenience, friendliness, quality of interview, communication and care, provider professionalism and privacy protection, all p <0.001). Transportation related issues were the most common underlying reason that influenced patient opinion, with at least 1 transportation factor being reported by 280 of 300 teleurology patients (93.3%) and 133 of 150 patients seen face‐to‐face (88.7%). Clinic operation and provider interaction factors similarly impacted patient satisfaction and preference. Time to access was significantly better for teleurology (12 days) compared to face‐to‐face clinics (72 days, p <0.001). Overall incidence of bladder cancer was 5.6% (25 of 450 patients), which was observed in 6.3% of the teleurology group (19 of 300) and 4.0% of the face‐to‐face group (6 of 150, p = 0.386). Conclusions Patients prefer teleurology to face‐to‐face clinic visits for the initial evaluation of hematuria. Teleurology positively impacts compliance and access by potentially eliminating common challenges facing patients, and by improving efficiency, convenience and flexibility.

Patient Acceptance of Teleurology via Telephone Versus Face-to-Face Clinic Visits for Hematuria in a Veterans Affairs Medical Center

Introduction We evaluated the experience and preferences of patients undergoing hematuria consultation via teleurology compared to a conventional face‐to‐face clinic visit. Methods Patients evaluated for hematuria with teleurology or face‐to‐face clinic visit were surveyed regarding their experience and preferences. The survey consisted of 27 questions evaluating overall acceptance and satisfaction (8 questions), impact factors (17) and preference (2). Results A total of 450 patients participated in the survey at a 2‐to‐1 ratio (300 via teleurology, 150 via face‐to‐face visits). Overall, patient satisfaction level was higher with teleurology compared to face‐to‐face clinic visits (mean score 9.2 vs 8.4, p <0.0001). This finding was observed in all 8 domains (acceptance, efficiency, convenience, friendliness, quality of interview, communication and care, provider professionalism and privacy protection, all p <0.001). Transportation related issues were the most common underlying reason that influenced patient opinion, with at least 1 transportation factor being reported by 280 of 300 teleurology patients (93.3%) and 133 of 150 patients seen face‐to‐face (88.7%). Clinic operation and provider interaction factors similarly impacted patient satisfaction and preference. Time to access was significantly better for teleurology (12 days) compared to face‐to‐face clinics (72 days, p <0.001). Overall incidence of bladder cancer was 5.6% (25 of 450 patients), which was observed in 6.3% of the teleurology group (19 of 300) and 4.0% of the face‐to‐face group (6 of 150, p = 0.386). Conclusions Patients prefer teleurology to face‐to‐face clinic visits for the initial evaluation of hematuria. Teleurology positively impacts compliance and access by potentially eliminating common challenges facing patients, and by improving efficiency, convenience and flexibility.

TEMPORARY REMOVAL: Patient Acceptance of Teleurology via Telephone Versus Face-to-Face Clinic Visits for Hematuria in a Veterans Affairs Medical Center

Introduction We evaluated the experience and preferences of patients undergoing hematuria consultation via teleurology compared to a conventional face‐to‐face clinic visit. Methods Patients evaluated for hematuria with teleurology or face‐to‐face clinic visit were surveyed regarding their experience and preferences. The survey consisted of 27 questions evaluating overall acceptance and satisfaction (8 questions), impact factors (17) and preference (2). Results A total of 450 patients participated in the survey at a 2‐to‐1 ratio (300 via teleurology, 150 via face‐to‐face visits). Overall, patient satisfaction level was higher with teleurology compared to face‐to‐face clinic visits (mean score 9.2 vs 8.4, p <0.0001). This finding was observed in all 8 domains (acceptance, efficiency, convenience, friendliness, quality of interview, communication and care, provider professionalism and privacy protection, all p <0.001). Transportation related issues were the most common underlying reason that influenced patient opinion, with at least 1 transportation factor being reported by 280 of 300 teleurology patients (93.3%) and 133 of 150 patients seen face‐to‐face (88.7%). Clinic operation and provider interaction factors similarly impacted patient satisfaction and preference. Time to access was significantly better for teleurology (12 days) compared to face‐to‐face clinics (72 days, p <0.001). Overall incidence of bladder cancer was 5.6% (25 of 450 patients), which was observed in 6.3% of the teleurology group (19 of 300) and 4.0% of the face‐to‐face group (6 of 150, p = 0.386). Conclusions Patients prefer teleurology to face‐to‐face clinic visits for the initial evaluation of hematuria. Teleurology positively impacts compliance and access by potentially eliminating common challenges facing patients, and by improving efficiency, convenience and flexibility.

MP100-16 LAPAROSCOPIC RENAL CRYOABLATION USING REAL-TIME INTRAOPERATIVE THERMAL MONITORING: 15 YEAR EXPERIENCE

effective, and non-invasive tissue ablation modality. Previous studies have shown that HIFU delivered laparoscopically can be used to ablate kidney tumors, potentially enabling a lower morbidity treatment with faster recovery time as compared to partial nephrectomy procedures. Challenges remain, however, including ensuring full tissue necrosis and consistent energy coupling to the target volume. The objective of this study was to evaluate whether a newly developed laparoscopic HIFU probe is able to address these challenges. METHODS: A laparoscopic porcine kidney model was used to investigate the safety and efficacy of the new 15mm HIFU probe. Under ultrasound guidance, kidneys of 12 pigs were targeted and ablated with HIFU, creating on average 2 ablation zones per kidney of varying sizes and locations in order to quantify the probe0s ability to deliver HIFU to any location on the kidney. Efficacy was evaluated via the analysis of ablation volume histology slides, real-time ultrasound images collected during HIFU delivery, and MRI and ultrasound contrast images. Safety was evaluated by surviving a subgroup of the animals (2w). Grosspathological data, sonication parameters, and workflow feedback was also collected during the study. RESULTS: Repeatable lesions could be created at a rate of 0.48cm/min and average energy densities of 584cal/cm. Histological evaluation indicated contiguous ablated volumes using these delivery parameters, extending from the transducer0s focal zone to the kidney surface, with a maximum treatment depth of 27mm. Ablated target volumes ranged from 5.1cm to 24.5cm. CONCLUSIONS: The results confirm the ability of the new probe to deliver HIFU in a consistent and reliable manner. Initial dose requirements for ablating tissue at various depths were also determined. Workflow feedback has resulted in additional system user interface improvements, with all of these results paving the way for a future clinical study.

MP32-19 COST ANALYSIS FOR INITIAL EVALUATION OF HEMATURIA: IMPACT OF TELE-UROLOGY CLINICS

RESULTS: 392 participants completed the survey from a broad geographic distribution from the upper Midwest (179 unique zip codes). Median age was 49 (Interquartile range 28-61), the female:male ratio was 3:2, 57% had completed a college or graduate degree and 85% were Caucasian vs. 15% ethnic minorities. When respondents were asked to compare/rank multiple surgeons, a large subset of respondents (n1⁄4136, 35%) drastically overestimated complication rates for some surgeons by 10 fold or more and were classified as misinterpreters. Misinterpreters were more likely to be willing to pay out of pocket expenses for a perceived 0better surgeon0 (odds ratio 3.4 95% CI 2.1-5.4), and were willing on average to pay

MP16-09 REEXAMINING THE ROLE OF EXTENDED LYMPHADENECTOMY FOR THE MANAGEMENT OF RENAL MALIGNANCY IN THE TARGETED THERAPY ERA

6101 for a 1 in 252 chance of lowering their risk of a postoperative complication. Misinterpreters were less likely to have graduated from college 45.6% vs. 62.5% who more accurately interpreted the data (p1⁄40.0013). CONCLUSIONS: Online surgeon rating websites that compare surgeons are often misinterpreted, particularly by those who did not graduate from college. Misinterpretation of the data may lead to patient harm by compelling patients to pay thousands of dollars of out-of-pocket expenses for an exceedingly low probability of benefit.

PD58-08 THE UTILITY OF STANDARDIZED WEEKLY INTRADEPARTMENTAL CONFERENCE IN DETECTING PREOPERATIVE ISSUES AND CONCERNS

INTRODUCTION AND OBJECTIVES: The potential benefit of extended lymphadenectomy (eLND) for advanced renal malignancy remains controversial. We aimed to assess contemporary survival outcomes associated with eLND performed for kidney cancer patients. METHODS: Using Surveillance, Epidemiology, End Results (SEER) data, we identified patients with non-metastatic renal cancer (2004-2013) treated with nephrectomy with 1+ lymph nodes removed. Our primary exposure was extended lymphadenectomy, defined by 10+ lymph nodes removed. Outcomes of interest included 5and 9-year cancer-specific (CSS) and overall survival (OS). Other covariates of interest included patient age, sex, race/ethnicity, marital status, year of diagnosis, tumor stage, tumor grade, nodal stage and tumor histology. Kaplan-Meier analyses and Cox proportional hazard models were generated to compare survival outcomes based on covariates and primary exposure of interest. Patients with missing tumor data were excluded from regression analyses. RESULTS: Among 66,013 kidney cancer patients treated with extirpative surgery, 7,523 (11.4%) had 1+ lymph nodes removed. The median lymph node count was 2 (IQR 1-6). Of this group, 1,031 (13.7%) patients had an eLND. Use of eLND was associated with advanced tumor stage and higher tumor grade (both p<0.001). Nine-year CSS and OS for eLND patients was 66.5% (vs 69.1% non-eLND, p1⁄40.01) and 58.5% (vs 56.3% non-eLND, p1⁄40.29), respectively. Among nodepositive patients, 5-year CSS and OS with eLND were 40.0% (vs 34.3% non-eLND, p1⁄40.55) and 33.1% (vs 28.4% non-eLND, p1⁄40.73), respectively. After adjusting for confounding factors, Cox proportional hazard models estimated a significant OS benefit associated with eLND (adjusted hazard ratio (HR) 0.86, 95% Confidence Interval (CI) 0.74 0.99, p1⁄40.04). Differences in CSS did not reach statistical significance overall (HR 0.88, 95% CI 0.74 1.03, p1⁄40.11), but a CSS advantage was seen among node-positive patients (HR 0.70, 95% CI 0.52 0.97, p1⁄40.03). CONCLUSIONS: Extended lymphadenectomy may provide a survival benefit among patients with advanced renal cell carcinoma.

PNFBA-12 LIQUID BIOPSY FOR RENAL CELL CARCINOMA

(OCTAVE-Anas) score was created by combining PRO urinary function score changes at 3-months post-RARP, percentage of patients having a urethral catheter duration >16 days, percentage of patients readmitted, and blinded peer-review Global Evaluative Assessment of Robotic Skill (GEARS) scores of videos of the anastomosis technique. Similarly, for nerve sparing (NS), OCTAVENS score was created based on differences in erectile function at 6months post-RARP, percentage of organ-confined patients with positive margin, and GEARS assessment of NS technique. All component measures were standardized to represent number of standard deviations better (positive values) or worse (negative values) than population averages, and the OCTAVE score was calculated as the sum of these standardized values. RESULTS: From 4/2014 through 4/2016, 20 surgeons from 14 different practices (2,774 total patients) sent video clips of their surgical techniques and had at least 50% of their patients participating in MUSIC PRO. OCTAVE-Anas scores ranged from -6.4 to 3.5, while OCTAVENS scores ranged from -3.7 to 3.5. Construct validity was demonstrated with moderate correlation between OCTAVE and the video assessment scores (Anas r1⁄40.59, NS r1⁄40.56, Figure 1). CONCLUSIONS: OCTAVE successfully incorporates multidimensional assessments to reliably determine better performing surgeons for the anastomosis and nerve-sparing aspects of RARP. This method may be used to identify surgeons to provide peer surgical skill quality improvement, with the aim to advance care for prostate cancer patients in the state of Michigan.