Kathleen Lehman

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection.

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy (TRUS PNB) are increasing. Such infections are largely attributable to quinolone resistant microorganisms which colonize the rectal vault and are translocated into the bloodstream during the biopsy procedure. A povidone iodine rectal preparation (PIRP) at time of biopsy is a simple, reproducible method to reduce rectal microorganism colony counts and therefore resultant infections following TRUS PNB. All patients are administered three days of oral antibiotic therapy prior to biopsy. The PIRP technique involves initially positioning the patient in the standard manner for a TRUS PNB. Following digital rectal examination, 15 ml of a 10% solution of commercially available povidone iodine is mixed with 5 ml of 1% lidocaine jelly to create slurry. A 4 cmx4 cm sterile gauze is soaked in this slurry and then inserted into the rectal vault for 2 min after which it is removed. Thereafter, a disposable cotton gynecologic swab is used to paint both the perianal area and the rectal vault to a distance of 3 cm from the anus. The povidone iodine solution is then allowed to dry for 2-3 min prior to proceeding with standard transrectal ultrasonography and subsequent biopsy. This PIRP technique has been in practice at our institution since March of 2012 with an associated reduction of post-biopsy infections from 4.3% to 0.6% (p=0.02). The principal advantage of this prophylaxis regimen is its simplicity and reproducibility with use of an easily available, inexpensive agent to reduce infections. Furthermore, the technique avoids exposing patients to additional systemic antibiotics with potential further propagation of multi-drug resistant organisms. Usage of PIRP at TRUS PNB, however, is not applicable for patients with iodine or shellfish allergies.

MP96-06 TOPICAL RECTAL ANTISEPTIC AT TIME OF PROSTATE BIOPSY: HOW A RESIDENT PATIENT SAFETY PROJECT EVOLVED INTO INSTITUTIONAL PRACTICE

Purpose To report outcomes 5 years after a resident quality initiative incorporated topical rectal antiseptic into our ultrasound-guided prostate needle biopsy (TRUS PNB) protocol.

MP37-10 INCIDENCE AND RISK FACTORS FOR ADRENAL INSUFFICIENCY FOLLOWING UNILATERAL ADRENALECTOMY

INTRODUCTION AND OBJECTIVES: Although no definitive surgical guide line exist in Sub-clinical Cushing Syndrome: SCS, surgical resection is considered based on the presence of hyper tension (HT), diabetes mellitus (DM) and hyper lipidemia (HL). Cortisole(CS) level > 3mg/dL after use of 1mg dexamethasone(Dex) was the U.S. guideline of SCS, while >1.8mg/dL in Japanese guideline. In this analysis, we have studied the clinical benefit of surgically removal in SCS tumor, especially patients with gray zone(between US and Japanese guideline);1.8 CS<3.0mg/dL after Dex 1mg treatment. METHODS: Total of 112 patients diagnosed as SCS between 1997 and 2015 were included in this study. 94 patients underwent surgical adrenalectomy and 18 patients were none surgically observed. Clinical outcome such as HT, DM, HL and body mass index(BMI) were retrospectively analyzed. All the surgical adrenalectomies were performed by retroperitoneal laparoscopic adrenalectomy. RESULTS: Median age was 65 years. Median tumor diameters were 30 mm. Significant improvement in HT (P<.0001), HbA1c (P1⁄40.016) and BMI (P1⁄40.0018) were observed in overall surgically removed SCS patients. Significant improvements in HT (P1⁄40.034) and BMI (P1⁄40.042) were also observed in 1.8 CS<3.0mg/dL group after surgery. However, clinical improvement were more evident in 3.0mg/ dL group, such as HT (P1⁄40.0002), HbA1c (P1⁄40.028) and HDLC(P1⁄40.046), while no clinical improvement were observed in 1.8mg/dL groups. Although not reached statistical significance, surgical removal groups tends to show the reduction in prescribed drugs compare to none surgical groups(drugs related to DM 23 vs 10% p1⁄40.073, HT 37 vs 11% P1⁄40.078 and HL 43% vs 11% P1⁄40.282). CONCLUSIONS: The current data showed that surgically removal of SCS tumor mediated significant improvements in the clinical symptoms. Based on expected clinical benefit,the gray zone SCS patients; 1.8 CS<3.0mg/dL after Dex 1mg treatment may also be a optimal candidate for laparoscopic adrenalectomy. Source of Funding: None

PD52-06 CAPTURING RENAL CELL CARCINOMA RECURRENCES WHEN ASYMPTOMATIC IMPROVES PATIENT SURVIVAL

CONCLUSIONS: Based on the proposed model, it is possible to accurately estimate the risk of positive BS at kidney cancer staging using pre-operative characteristics. If BS is performed only when the risk of positive result is >5%, a negative BS is spared in 80% of the population and a positive BS is missed in 2% of the population only. When compared to decision-making based on symptoms only, which represents the strategy recommended by available guidelines, the proposed model resulted more objective, statistically more accurate and clinically associated with higher net benefit. These figures support an update of the available guidelines.