Nirmish Singla

Diffuse Pontine Lesions in Children with Neurofibromatosis Type 1: Making a Case for Unidentified Bright Objects

Using an illustrative case of a presumed pontine unidentified bright object (UBO) with spontaneous lesion regression over 2 years, we review the importance of including UBOs in the differential diagnosis of children with confirmed or possible neurofibromatosis type 1 (NF1) who present with diffuse pontine enlargement and T2-weighted changes on MRI. Asymptomatic children with presumed NF1 and diffuse pontine lesions should not be treated with radiation and should not be biopsied. Prior reports of good prognosis associated with pontine glioma in patients with NF1 may have been unrecognized UBOs in some cases.

PD49-03 ADHERENCE TO GUIDELINES: SURGICAL STAGING OF INGUINAL LYMPH NODES IN HIGH-RISK CLINICALLY LOCALIZED PENILE CANCER AND SURVIVAL IMPLICATIONS

the adjusted OR was 3.48 for the moderate score (p1⁄40.02), and 17.01 for the high score (p<0.01), using the low score as a reference. The predictive accuracy of the ILCS for overall and major complications was 0.63 (0.56-0.70) and 0.73 (0.64-0.82), respectively. In the repetition cohort, the ILCS was significantly associated with major complications (OR1⁄417.33, p1⁄40.02) and showed a predictive accuracy of 0.79 (0.64-0.93). CONCLUSIONS: Using structured radiological measurements of the inguinal nodal basin, the ILCS provided accurate risk estimation of overall and major complications after ILND for penile cancer.

PD40-11 IMPACT OF PRIMARY CARE PHYSICIAN FACTORS ON ADHERENCE TO UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATION AGAINST PSA SCREENING

had greater core positivity, and a higher incidence of clinically significant disease. These results suggest that high risk patients in an inner city setting are also being negatively affected by the implementation of the task force recommendations. Further research is required to determine whether the practice pattern change occurred at the level of PSA screening or rather at patient selection for prostate biopsy. Such research will allow clinicians to provide more granular counseling with regards to PSA screening and prostate biopsies for high risk patients.

MP71-03 PROGNOSTIC VALUE OF PD-1 AND PD-L1 EXPRESSION IN PATIENTS WITH HIGH-GRADE UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT

addition, mutation spectrum in UTUC were also different depending on the anatomical location; Most of the RAS pathway mutations were found in renal pelvis (p1⁄40.0013) while KMT2Dmutations were observed more frequently in ureter (p<0.0001). In the analysis of normal epithelia, some epithelia and primary tumors harbored shared mutations as well as their private ones, indicating that clonal precancerous area expands in normal epithelia. By contrast, in other epithelia, we also found driver gene mutations that were not shared by primary tumors, suggesting the presence of a mutagenic field effect on urothelial multiple occurence. We also detected mutations in urine sediments identical to primary tumors with similar allele frequencies, suggesting that sequencing urine may be useful for disease monitoring. CONCLUSIONS: UTUC tumors are classified into 3 molecularly and clinically distinct subtypes based on the status of mutations in TP53/MDM2, FGFR3, and RAS pathway. Depending on their location, urothlial cancers have different genetic backgrounds, where a field effect and clonal expansion might contribute to multifocal occurrence of UTUC.

MP92-14 FACTORS ASSOCIATED WITH STAGE AT PRESENTATION AND SURVIVAL IN PENILE CANCER

INTRODUCTION AND OBJECTIVES: The number of Veterans in the US enrolled in the Veterans Health Administration increased by 52% from 2001 to 2014, leading to well-publicized access issues within the health care system. Wait times for routine cystoscopy were high at our VA. We sought a safe way to decrease this time by addressing cystoscopy appropriateness based on guideline compliance. METHODS: A chart review was performed on all men and women scheduled for cystoscopy that were over 3 months past their ideal cystoscopy date. Indications for the procedure, wait time and appropriateness of the scheduled appointment were scrutinized. For bladder cancer patients, the 2016 AUA guidelines on surveillance of non-muscle invasive bladder cancer were used. For all other cystoscopy indications, respective best-practice policy statements were utilized when possible. RESULTS: There were 152 patients in our system awaiting cystoscopy. Indication for cystoscopy was hematuria work-up in 62 (40.8%), bladder cancer surveillance in 64 (42.1%), neurogenic bladder surveillance in 9 (5.9%), and “other” evaluations (e.g. bladder neck contractures, BPH, AUS erosion, and previous atypical cytology) in 17 (11.2%). Median time between ideal cystoscopy date and scheduled cystoscopy date for new and return patients was 42 (IQR: 31, 61) and 39 (IQR: 31, 49) days, respectively. After review, cystoscopy was deemed inappropriate in 17 (11.1%) patients, the majority of which (n1⁄412; 70.5%) were for overly aggressive bladder cancer surveillance especially for low risk disease (Table 1). Other reasons included neurogenic bladder surveillance in 1 (5.9%) and “other” reasons in 4 (24.6%). CONCLUSIONS: By systematically reviewing our scheduled cystoscopy appointments, over 10% of our cystoscopies in a 3-month period were safely postponed or cancelled simply by compliance with the most up-to-date published guidelines. Review, and subsequent modification, of our practice patterns has simultaneously led to decreased wait times and improved evidence-based medicine.

MP72-20 DIFFERENTIAL HEMODYNAMIC AND ANTIHYPERTENSIVE CHANGES AFTER PARTIAL NEPHRECTOMY VERSUS RADICAL NEPHRECTOMY

Cedric Lebacle*, Le Kremlin-bicetre, France; Jean Christophe Bernhard, Bordeaux, France; Karim Bensalah, Rennes, France; Herve Baumert, Paris, France; Herve Lang, Didier Jacqmin, Brigitte Duclos, Strasbourg, France; Alain Ravaud, Bordeaux, France; Brigitte Laguerre, Rennes, France; Laurence Albiges, Villejuif, France; Armelle Arnoux, Le Kremlin-bicetre, France; Bernard Escudier, Villejuif, France; Jean Jacques Patard, Le Kremlin-bicetre, France

MP71-06 PROGNOSTIC SIGNIFICANCE OF EZH2 EXPRESSION IN UPPER TRACT UROTHELIAL CARCINOMA

Ahmet Aydin*, Ankara, Turkey; Nirmish Singla, Vandana Panwar, Ryan Hutchinson, Solomon Woldu, Dallas, TX; Christopher Wood, Jose Karam, Houston, TX; Alon Weizer, Ann Arbor, MI; Jay Raman, Hershey, PA; Mesut Remzi, Vienna, Austria; Nathalie Rioux-Leclercq, Rennes, France; Andrea Haitel, Vienna, Austria; Marco Roscigno, Bergamo, Italy; Christian Bolenz, Ulm, Germany; Karim Bensalah, Rennes, France; Arthur Sagalowsky, Dallas, TX; Shahrokh Shariat, Vienna, Austria; Yair Lotan, Aditya Bagrodia, Payal Kapur, Vitaly Margulis, Laura-Maria Krabbe, Dallas, TX

S&T-41 IS THERE A DIFFERENCE IN OUTCOME BETWEEN EARLY VERSUS DELAYED REMOVAL OF SUBURETHRAL MID-URETHRAL SLING?

Study design, materials and methods: A prospectively maintained, institutional review board approved, database of consecutive non-neurogenic women who underwent SSR for MUS complications and were followed for 6 months minimum was reviewed. Exclusion criteria included women with existing vaginal mesh in place, those who underwent concomitant vaginal mesh removal or concomitant surgery, or had 2 MUS removed. All MUS excisions were performed vaginally under general anaesthesia with the aim of removing as much MUS as possible. [1] Indications for SSR and outcomes at the last visit were classified based on patient self-reporting.

PD15-02 PRACTICE TIME OF PRIMARY CARE PHYSICIANS IS ASSOCIATED WITH CHANGE IN PSA ORDERING HABITS IN THE YEARS SURROUNDING THE UNITED STATES PREVENTATIVE SERVICES TASK FORCE RECOMMENDATION AGAINST PSA SCREENING

INTRODUCTION AND OBJECTIVES: The United States Preventative Services Task Force recommendation against PSA screening came in 2012, a time when many new primary care providers had been trained in the PSA screening era. We examined the differential effect of the recommendation on providers’ PSA screening and ordering habits by date of residency completion. METHODS: We reviewed all resulted PSA orders within a tertiary care academic institution from Jan 2010 to July 2015. Tests were excluded if they were performed by a non-primary care provider (urologist, oncologist or radiation oncologist), if the provider ordered fewer than four tests per year, had a practice break greater than 6 months within the period or if the provider was not employed at the institution for the entire period for any reason. Relative proportions of PSA orders per overall unique male ambulatory clinic volume were assessed for the periods of Jan 1, 2010 to Dec 31, 2011 (first period) and Jan 1, 2013 to July 31, 2015 (second period). Changes on a per-provider basis were assessed as a scatterplot and evaluated with linear regression and ANOVA. RESULTS: Overall unique male non-oncology care patients were 88558 for the first period and 140173 for the second period. 22 primary care providers met criteria. Average period between completion of residency and beginning of period (Jan 1, 2010) was 16 years (range 2-43 years). Average number of unique patients screened per provider in the first period was 138.0 (range 8-696) and 177.5 (range 16-701) in the second period. Providers less than 16 years from residency screened an average of 94.6 and 143.3 men in each period; providers over 16 years from residency screened 253.8 unique men in the first period and 268.7 in the second period (p 1⁄4 0.040 and 0.131 for difference each period). Proportion of all patients screened per overall unique male patient volume did not significantly differ between the two time periods (p 1⁄4 0.122, 95% CI for difference -0.00009 to 0.00067). Change in proportional screening of providers less than 16 years from residency was significantly different from that of providers greater than 16 years from residency (0.00001 vs -0.0009, p 1⁄4 0.023). Proportion of overall unique male patients screened versus time since residency demonstrated a significant negative trend (R2 1⁄4 0.308, p 1⁄4 0.007, slope of trendline -0.000005). CONCLUSIONS: Over the period of 2010 to July 2015 PSA screening per unique male patient did not change significantly for providers in continuous practice throughout the period. Time since residency completion was significantly associated with screening proportionally fewer men over the period. Source of Funding: None