Mary Kate Keeter

Male adolescent fertility preservation

Until the 1960s, few adolescents and young adults (AYAs) survived their initial cancer diagnoses. Now, ∼12,400 AYA patients are diagnosed with cancer each year, and almost 80% will now achieve a long-term cure. This dramatic improvement in survival is primarily due to multimodal treatments and combined chemotherapeutic regimens. Unfortunately, the increase in survival is often accompanied by treatment-related toxicities due to chemotherapy, radiation therapy, and surgical procedures. Despite guidelines published by the American Society of Clinical Oncology and numerous other professional organizations, high percentages of male AYA oncology patients are not properly counseled regarding their fertility preservation options before cancer treatment. Although administering fertility preservation care to adolescent males can be challenging in many ways, numerous studies show that this care can be delivered with high degrees of success and high levels of patient and parent satisfaction. The key to this success at many institutions has been the implementation of formalized integrated fertility preservation programs with infrastructure geared toward the delivery of comprehensive expedited care.

Scrotal Ultrasound for Pain: Low Frequency of Absolute Surgical Indications

OBJECTIVE To examine the results of scrotal ultrasounds (US) conducted for scrotal or testicular pain and review the pathologic findings of orchiectomies done for lesions that were suspicious for malignancy on US. MATERIALS AND METHODS We retrospectively reviewed the indications and findings of all scrotal US completed at our institution from 2002 to 2014. If a patient underwent an orchiectomy for an intratesticular lesion that was concerning for malignancy on US, the pathology report was also reviewed. RESULTS There were 18,593 scrotal US performed, with 7,668 (41.2%) conducted for scrotal pain. Of the US performed for pain, 80.4% revealed benign or normal findings, and only 2.2% demonstrated a finding that is an absolute indication for surgery (intratesticular lesion suspicious for malignancy 0.8%, abscess 0.7%, torsion 0.6%, infiltrative process such as lymphoma 0.1%). For those patients undergoing an orchiectomy, 75% had malignancy on pathologic analysis. CONCLUSION The majority of the 7668 US performed to evaluate scrotal or testicular pain reveal normal or benign findings. A low percentage demonstrates a finding that necessitates urgent or emergent surgery.

Discrepancies in staging, treatment, and delays to treatment may explain disparities in bladder cancer outcomes: An update from the National Cancer Data Base (2004-2013)

INTRODUCTION We sought to characterize national disparities in the diagnosis of advanced stage bladder cancer. Among patients with advanced disease, we explored disparities in overall survival, treatment, and time to treatment. METHODS AND MATERIALS We queried the National Cancer Data Base for patients diagnosed with bladder urothelial carcinoma. We used multivariable logistic regression to assess the association between covariates and diagnosis of advanced disease (AJCC stage III-IV). We used Kaplan-Meier, log-rank, and Cox proportional analyses to evaluate disparities in overall survival for patients with advanced disease. Receipt of treatment and delays to treatment were compared between subgroups. RESULTS Among our cohort of 328,560 patients, 7.6% were diagnosed with advanced disease. Female sex, black race, Hispanic ethnicity, and living in a region of lower income and education were all associated with increased odds of advanced disease. Female sex (HR = 1.16; 95% CI: 1.12-1.20; P<0.001), black race (HR = 1.10; 95% CI: 1.04-1.18; P = 0.002), and lower regional income levels (fourth quartile compared to first: HR = 1.08; 95% CI: 1.02-1.16; P = 0.016) portended worse overall survival. Chemotherapy (HR = 0.55, 95% CI: 0.53-0.57; P<0.001) and radical cystectomy (HR = 0.61; 95% CI: 0.59-0.64, P<0.001) improved survival. Females, black patients, and patients from regions of lower income and education were less likely to receive treatment and less likely to receive treatment within 12 weeks of diagnosis. CONCLUSION There are several disparities in the diagnosis and treatment of advanced bladder cancer. Overall survival for certain groups may benefit from earlier diagnosis and improved timely access to potentially life prolonging treatment.

Barriers and facilitators toward HIV testing and health perceptions among African-American men who have sex with women at a South Side Chicago community health center: A pilot study

In the United States, African-Americans’ (AAs) HIV infection rates are higher than any other racial group, and AA men who have sex with women (MSW) are a significant proportion of new cases. There is little research into AA MSW HIV/AIDS knowledge, barriers, and facilitators of HIV testing in Chicago. We enrolled a convenience sample of AA MSW from a community health clinic who completed self-administered surveys assessing HIV knowledge and testing-related barriers and facilitators. The survey was a combination of questions from several validated instruments, and additional questions were written based on key informant interviews with social scientists to tailor the questionnaire for AA men living on the South Side of Chicago. We recruited 20 AA MSW (mean age 47.4 years). Sixty-five percent had incomes <

Gender-based differences in discriminatory questions asked of urology applicants during residency interviews

10,000/year, 30% were insured, and 50% had post-secondary education. Despite low socioeconomic status, their HIV literacy was relatively high. The identified major barriers to testing were low perceived HIV risk, concerns over privacy, and external stigma at testing sites. Future efforts should focus on educating AA MSW on actual risk for HIV and address issues of privacy and stigma at testing sites.

Self-reported Black race predicts significant prostate cancer independent of clinical setting and clinical and socioeconomic risk factors

Introduction: Interviews are essential to the residency application process. Questions regarding marital status, childbearing, ethnicity and religion violate employment law if asked by the interviewer. In this study we determined rates of discriminatory questions asked during urology residency interviews and assessed for differences by applicant gender. Methods: A 22-question anonymous survey was distributed to 340 urology residency applicants. Questions were asked in a 2-part, stepwise fashion. If candidates replied “no” to whether they introduced a restricted topic, they were subsequently asked how often interviewers introduced the topic. Results: Overall 35% of respondents believed they were asked an inappropriate question. However, for the 7 restricted topics assessed in this survey 54.5% of respondents reported being asked at least 1 unprompted illegal question. Of note, 85% of female respondents vs 44.9% of male respondents reported being asked about 1 of the restricted topics from the survey (p <0.0001). Women were statistically more likely to be asked about age (33.3% vs 12.4%, p=0.0064), parental status (59.1% vs 31.1%, p=0.0172) and intent for children (41.9% vs 12.5%, p=0.0003). Men were more frequently asked about their opinions and rankings of other residency programs (51.6% vs 18.8%, p=0.0296). Conclusions: An alarming percentage of urology applicants are asked interview questions that violate employment law. Female applicants are disproportionately questioned about age, parental status and intent for children. Education of interviewers regarding legally restricted questions is warranted.

A pragmatic randomized comparative effectiveness trial of transitional care for a socioeconomically diverse population: Design, rationale and baseline characteristics

INTRODUCTION AND OBJECTIVE Studies have linked Black race to prostate cancer (CaP) risk but most fail to account for established risk factors such as 5-ARI use, prostate volume, socioeconomic status, and hospital setting. We assess whether Black race remains associated with CaP and Gleason ≥3 + 4 CaP, after adjusting for clinical setting and socioeconomic and clinical factors at prostate biopsy, with a focus on men aged 40-54 years, who may be excluded from current screening guidelines. METHODS We recruited 564 men age 40-79 undergoing initial prostate biopsy for abnormal PSA or digital rectal examination (DRE) from three publicly funded and two private hospitals from 2009-2014. Univariate and multivariate analyses examined the associations between hospital type, race, West African Ancestry (WAA), clinical, and sociodemographic risk factors with CaP diagnosis and Gleason ≥3 + 4 CaP. Given changes in CaP screening recommendations, we also assess the multivariate analyses for men aged 40-54. RESULTS Black and White men had similar age, BMI, and prostate volume. Black men had higher PSA (8.10 ng/mL vs. 5.63 ng/mL) and PSA density (0.22 ng/mL/cm3 vs. 0.15 ng/mL/cm3, all p < 0.001). Blacks had higher frequency of CaP (63.1% vs. 41.5%, p<0.001) and Gleason ≥3+4 CaP relative to Whites in both public (27.7% vs 11.6%, p<0.001) and private (48.4% vs 21.6%, p = 0.002) settings. In models adjusted for age, first degree family history, prostate volume, 5-ARI use, hospital type, income, marital and educational status, Black race was independently associated with overall CaP diagnosis (OR = 2.13, p = 0.002). There was a significant multiplicative interaction with Black race and abnormal DRE for Gleason ≥3 + 4 CaP (OR = 2.93, p = 0.01). WAA was not predictive of overall or significant CaP among Black men. Black race (OR = 5.66, p = 0.02) and family history (OR = 4.98, p = 0.01) were independently positively associated with overall CaP diagnosis for men aged 40 to 54. CONCLUSIONS Black race is independently associated with CaP and Gleason ≥3+4 CaP after accounting for clinical and socioeconomic risk factors including clinical setting and WAA, and has a higher odds ratio of CaP diagnosis in younger men. Further investigation into optimizing screening in Black men aged 40 to 54 is warranted.

MP95-11 EVALUATION, MANAGEMENT, AND OUTCOMES OF PREGNANT PATIENTS WITH CLINICALLY SYMPTOMATIC NEPHROLITHIASIS AT A LARGE WOMEN'S HOSPITAL

Transitional care programs have been widely used to reduce readmissions and improve the quality and safety of the handoff process between hospital and outpatient providers. Very little is known about effective transitional care interventions among patients who are uninsured or with Medicaid. This paper describes the design and baseline characteristics of a pragmatic randomized comparative effectiveness trial of transitional care. Northwestern Medical Group- Transitional Care (NMG-TC) care model was developed to address the needs of patients with multiple medical problems that required lifestyle changes and were amenable to office-based management. We present the design, evaluation methods and baseline characteristics of NMG-TC trial patients. Baseline demographic characteristics indicate that our patient population is predominantly male, Medicaid insured and non-white. This study will evaluate two methods for implementing an effective transitional care model in a medically complex and socioeconomically diverse population.

MP35-13 VASECTOMY AND THE GENDER GAP: SHIFTING DEMOGRAPHICS OF THE UROLOGIC WORKFORCE

those who had been pregnant had over twice the odds of having had kidney stones (OR 2.44, 95% CI 1.50-3.98). An increased likelihood of nephrolithiasis among those with history of pregnancy persisted on multivariable logistic regression adjusting for age, ethnicity, obesity, history of diabetes, gout, hormone use, water intake and high sodium diet (OR 2.13, 95% CI 1.31-3.45). Finally, the adjusted prevalence of nephrolithiasis increased significantly with increasing number of pregnancies, from 5.2% in those with 0 reported pregnancies to 12.4% in those with 3 or more pregnancies (p1⁄40.001). CONCLUSIONS: Nephrolithiasis is strongly associated with prior pregnancies. Among women of reproductive age, the odds of stones are greater than doubled in those who had been pregnant compared with those never pregnant. Nephrolithiasis prevalence also increases with increasing number of pregnancies. Future investigation and identification of modifiable risk factors among pregnant patients may allow reduction in burden of stone disease in women.

MP35-12 SURGICAL TREATMENT OF MALE FACTOR INFERTILITY: DOES INSURANCE COVERAGE MATTER?

multiple comparison analysis, sperm concentration (p1⁄40.042) and progressive motility (p1⁄40.03) were significantly lower in heavy smokers; similarly, DFI values were significantly higher in Group 3 patients than in no smokers (p1⁄40.025). At multivariable analyses, FSH (OR 1.1, p1⁄40.02) and being heavy smokers (OR 4.1, p1⁄40.006) were independent predictors for pathologic DFI score after accounting for age, BMI and CCI. Similarly, being heavy smokers achieved independent predictor status for pathologic sperm count (OR 2.7, p1⁄40.047) and pathologic total progressive motility (OR 6.3, p1⁄40.002), after accounting for the same variables. CONCLUSIONS: The routine assessment of DFI is getting increasing clinical relevance. Heavy cigarette smoking emerged as the most detrimental factor impacting on the DFI rate, along with an impaired sperm concentration and progressive motility.