Igor Sorokin

Introducing the Twitter Impact Factor: An Objective Measure of Urology's Academic Impact on Twitter

BACKGROUND Social media use in academia and urology is rising. Specifically, individual journals now have Twitter accounts (Twitter Inc, San Francisco, CA, USA) and regularly tweet academic content. OBJECTIVE To present and evaluate the Twitter impact factor (TIF), a novel means of measuring a journals academic influence in the realm of social media. DESIGN, SETTING, AND PARTICIPANTS Journal Citation Reports (JCR; Thomson Reuters, New York, NY, USA) for 2014 was queried for urologic academic journals. English-language journals with active Twitter accounts since 2013 were included. The total number of followers, tweets, and retweets over a 2-yr period were collected. OUTCOME MEASURES AND STATISTICAL ANALYSIS Each journals TIF was calculated based on the number of retweets per original relevant tweet. Comparisons between the TIF and the journal impact factor (JIF) as well as the Klout score were made using the Pearson correlation. RESULTS AND LIMITATIONS Of 33 journals listed in the JCR for 2014, 7 (21%) had a Twitter presence as of 2013. The number of JCR-listed journals with a Twitter handle increased by 29% in 2014. There was an increase in the mean number of relevant tweets per journal during the study period and a 130% increase in the number of retweets over 1 yr. European Urology (1.80) and BJU International (1.46) had the highest TIFs. The journals with the highest number of Twitter followers were European Urology (5807) and the Journal of Urology (4402). The journals with the highest numbers of relevant tweets were European Urology (1159) and BJU International (1090). There was a positive but statistically insignificant association between the TIF and the JIF (r=0.64, p=0.12). There was a strongly positive linear correlation between the TIF and the Klout score (r=0.84, p=0.0086). CONCLUSIONS With the increasing use of social media by individuals and academic journals, the TIF can be a useful tool to measure the academic reach and impact of a journal on Twitter. PATIENT SUMMARY Social media is an increasing part of the way in which practitioners and academicians communicate. The TIF can be used to analyze the impact of journal Twitter feeds and their social media content.

Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary?

OBJECTIVE To compare the cost, efficacy, and safety of 3-arm versus 4-arm technique in robotic partial nephrectomy (RPN). Surgeons may either elect to utilize three vs four robotic instruments depending on preference. The purpose of this study is to compare the outcomes between the two techniques. METHODS RPNs from June 2016 to August 2017 were retrospectively reviewed. Tumor features, surgical parameters, and operative outcomes were evaluated. The number of arms used was determined. Statistical analysis was performed with the Students t test, chi-squared, and Mann-Whitney test. RESULTS A total of 61 consecutive 3-arm RPNs and 59 consecutive 4-arm RPNs were evaluated. Mean tumor diameter and median nephrometry score were 3.4 cm (± 1.1 SD) and 7 (6-8 IQR) for the 3-arm group and 3.3 cm (±1.2 SD) and 6 (5-8 IQR) for the 4-arm group, respectively (size: p = 0.7, nephrometry: p = 0.07). Hospital length of stay, operative time, estimated blood loss, complication rate, blood transfusion rate, and readmission rate all demonstrated no statistically significant difference between 3-arm and 4-arm groups (p >0.05). Mean ischemia time was shorter by 5.1 minutes in the 4-arm group (p = 0.02). Rate of margin positivity was higher in the 4-arm group (0% vs 10%, p = 0.03). CONCLUSION RPN can be safely and effectively completed with 3-robotic arms. While there was increased ischemia time, the difference was small and likely not of clinical significance. The routine addition of the fourth robotic arm in RPN is not necessary.

Medical therapy for nephrolithiasis: State of the art

The prevalence of nephrolithiasis is increasing worldwide. Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition. Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance. Insights into occupational exposures and antibiotic use may help uncover individual risk factors. Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.

PD10-08 LIGHT-REFLECTANCE SPECTROSCOPY TO DETECT POSITIVE SURGICAL MARGINS AT RADICAL PROSTATECTOMY: EXPLORATION OF NEW ALGORITHMS TO REFINE DETECTION RATE

was shown to bind to cells expressing PSMA demonstrating significant staining of prostatic adenocarcinoma. We performed the first in-human FDA-approved phase I 3+3 dose finding study of intravenously (IV) administered MDX1201 in intermediateto high-risk patients undergoing RARP and extended lymph node (LN) dissection. METHODS: Patients received a single intravenous infusion of MDX1201 four days prior to RARP to allow for safety evaluation. A 488 nanometer laser was attached to the da Vinci Si surgical robot camera at the time of RARP to allow for visualization of fluorescent dye marking presence of prostatic cancerous tissue. 5 mg dose was given to the first 3 patients, and then the dose was escalated to 15 mg provided safety considerations permit. Patients with prior prostate cancer treatment were excluded. RESULTS: MDX1201 was successfully administered to 5 patients, with no adverse events observed. Initial 5 mg dose failed to show visualization of fluorescent dye in first 3 patients. Of the 15 mg dose patients, patient #4 demonstrated fluorescence ex vivo within the sectioned prostate that correlated with pathological findings, while patient #5 demonstrated fluorescence in-vivo with mild prostatic fluorescence at the right apex, left apex, left mid, and also moderate fluorescence demonstrated at the right external iliac LNs. For patient #5, histopathologic examination confirmed tumor to the mid right lobe (dominant nodule), with a minor focus in anterior left lobe near the base. There was no LN metastasis in this patient (pT2cN0). In the five patients (median PSA 9.5, 80% intermediate-risk, 100% > pT2c), the median LN yield was 18 with no LN involvement in any patient. No positive margins were detected. CONCLUSIONS: We demonstrate the first in human study using an anti PSMA antibody demonstrating fluorescence in the prostate. Identification of prostatic tissue using a conjugated fluorescent marker with specificity against PSMA may help guide preservation of critical structures.

MP100-11 PERCUTANEOUS IRREVERSIBLE ELECTROPORATION OF RENAL TUMORS: OUTCOMES AFTER MEDIAN 2 YEAR FOLLOW-UP

investigate the cost of pre-procedure biopsy of renal masses vs immediate cryoablation with intraoperative biopsy for patients with small renal masses who are candidates for cryotherapy. METHODS: We retrospectively identified all patients who had laparoscopic cryoablation for a renal tumor by a single surgeon at an academic center between 2004 and 2013. Pathology results from intraoperative biopsies were collected. Cost analysis was performed for two treatment algorithms. Algorithms differed in the initial step in management: CT guided biopsy vs laparoscopic cryoablation with intraoperative biopsy. RESULTS: There were 96 patients in the study. Pathology results from intraoperative biopsies were: Cancer: 64 (66.7%), Indeterminate: 12 (12.5%), and Benign: 20 (20.8%). Cost of laparoscopic cryoablation and hospital stay is

MP52-04 THE DECLINE OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY: A SURVEY OF THE ENDOUROLOGICAL SOCIETY TO IDENTIFY SHORTCOMINGS AND GUIDANCE FOR FUTURE DIRECTIONS

10,600. Cost of a CT guided biopsy is

V4-06 THE DEVELOPMENT OF A WEB-BASED VIDEO PLATFORM FOR TEACHING THE ROBOTIC SIMPLE PROSTATECTOMY

5,400. Cost of 5 years of surveillance is

Cancer control of partial nephrectomy for high-risk localized renal cell carcinoma: population-based and single-institutional analysis

37,400. On average, the fiveyear cost to manage a patient initially with laparoscopic cryoablation is

PD45-02 NATURAL HISTORY OF RESIDUAL FRAGMENTS CONFIRMED BY COMPUTED TOMOGRAPHY AFTER URETEROSCOPY

40,200. This compares to

V04-02 ROBOT-ASSISTED LAPAROSCOPIC EXTRAVASCULAR STENT FOR NUTCRACKER SYNDROME

43,400 for CT guided biopsy as first management. In order for CT guided biopsy to be cost effective, 52% of small renal masses deemed appropriate for cryoablation would need to be benign. CONCLUSIONS: Immediate cryoablation is slightly more cost effective than getting a pre-operative CT guided biopsy for patients considering treatment of small renal masses with laparoscopic cryoablation. The cost difference is not enough to unilaterally drive clinical decisions but shared decision making should include cost. The overwhelming cost over five years is driven by cost of surveillance imaging.