Rodrigo Donalisio da Silva

Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy.

PURPOSE Statins are cholesterol lowering agents used to prevent cardiovascular disease. Evidence suggests a dichotomous effect of statins with cancer inhibiting and promoting properties. To our knowledge the effect of statins on the prognosis of muscle invasive urothelial carcinoma of the bladder remains uninvestigated to date. We tested the hypothesis that statin use impacts oncological outcomes in patients treated with radical cystectomy for urothelial carcinoma of the bladder. MATERIALS AND METHODS We retrospectively evaluated the records of 1,502 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant therapy at a total of 4 institutions. Cox regression models were used to determine the association of statins with disease recurrence and cancer specific mortality. RESULTS A total of 642 patients (42.7%) were on statins. At a median followup of 34 months 509 patients (33.9%) experienced disease recurrence and 402 (26.8%) had died of urothelial carcinoma of the bladder. Statin users were older (p = 0.003), had a higher body mass index (median 32 vs 28 kg/m(2), p <0.001) and were more likely to have positive soft tissue surgical margins (9% vs 4%, p <0.001). On univariable Cox regression analysis statins, female gender, advanced age, higher body mass index, smoking status, tumor stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis and adjuvant chemotherapy were associated with disease recurrence (p ≤ 0.05) and cancer specific mortality (p ≤ 0.02). On multivariable Cox regression analysis statin use was not associated with either outcome. CONCLUSIONS Statin users were at higher risk for disease recurrence and cancer specific mortality on univariable but not multivariable analysis. These data do not support modification of statin use in patients with high risk urothelial carcinoma of the bladder who will be treated with radical cystectomy.

Effect of statin use on outcomes of non-muscle-invasive bladder cancer

To assess the impact of statin use on outcomes of patients with non‐muscle‐invasive bladder cancer (NMIBC). To measure the effect of statin use on the efficacy of intravesical bacillus Calmette‐Guérin (BCG) therapy.

MP92-20 FEMALE GENITAL MUTILATION AT A SAFETY-NET HOSPITAL IN DENVER, CO

INTRODUCTION AND OBJECTIVES: Over 1 million CAUTIs occur annually among hospitalized U.S. patients receiving a Foley urinary catheter, accounting for over 13,000 deaths. CAUTI treatment requires antibiotics at a time when hospitals are expected to minimize avoidable antibiotic use. CAUTIs financially burden hospitals. The mean per-incident cost is estimated at

MP100-19 LAPAROSCOPIC VERSUS PERCUTANEOUS CRYOABLATION OF SMALL RENAL MASS: A META-ANALYSIS OF 1725 CASES

750-

Laparoscopic Single-Site Radical Nephrectomy

4,823. One facility in this study found its net cost, including longer length of stay, to be

PD53-03 COST ANALYSIS OF UTILIZATION OF DISPOSABLE FLEXIBLE URETEROSCOPES IN HIGH RISK FOR BREAKAGE CASES

11,419 per case. Most payers do not reimburse these costs. The ACA penalizes hospitals for high CAUTI rates. Data was collected from multiple sites to assess whether an intervention using a novel, non-toxic skin care system/formulation for Foley insertion and maintenance could reduce CAUTI rates. METHODS: Approximately 25 hospitals using the formulation were asked to provide insertion and maintenance details on use, plus preand post-implementation CAUTI rates reported to the National Healthcare Safety Network. The formulation was used in high-risk ICU, Neuro, C-V and trauma patient populations with fecal and urinary incontinence, in its foam and moisture-impregnated-cloth forms. Both forms are safe for the perineal area, do not cause antibiotic resistance, and are not associated with adverse events. Clinical protocol was to apply the formulation to the meatus and surrounding tissue to establish a zone of protection, then re-establish after each incidence of fecal incontinence as a maintenance intervention. RESULTS: Ten hospitals provided preand post-intervention data (average time pre-intervention 21.2 months; average time postintervention 20 months). Eight reported CAUTI rate reductions, ranging from 22.47% to 100% (with two sites reporting elimination of CAUTI). Two other hospitals noted compliance issues that affected their results and made their data unreliable. One of those two reported no change in CAUTI rates and the other reported a 30.31% increase. The mean preimplementation CAUTI rate for the eight compliant hospitals was 3.65/ 1,000 catheter days. The mean post-implementation CAUTI rate for those same hospitals was 1.72/1,000 catheter days. The mean change was a reduction in CAUTI rates of 52.88%. CONCLUSIONS: Eight of 10 reporting sites found use of the skin care formulation was associated with lower CAUTI rates. Further study of the formulation’s efficacy is warranted.

MP51-06 TELECONSULTATION SUPPORT PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA BEING DISCHARGED FROM SPECIALIZED CARE: A RANDOMIZED NONINFERIORITY STUDY

INTRODUCTION AND OBJECTIVES: Objective: To compare the surgical, oncological, and functional outcomes of laparoscopic and percutaneous cryoablation for the treatment of small renal masses. METHODS: A systematic review of the literature was performed through March 2016 using PubMed, Scopus, and Ovid databases. Article selection proceeded according to the search strategy based on PRISMA criteria. Only studies comparing laparoscopic and percutaneous kidney cryoablation were included in the meta-analysis. RESULTS: Eleven studies were selected for the analysis including 1725 cases: 804 (46.6%) percutaneous and 921 (53.4%) laparoscopic cryoablation. Included studies were all retrospective comparative ones. Percutaneous cryoablation was performed more frequently for posterior tumors (p<0.001), whereas laparoscopy was more common for endophytic lesions (p1⁄40.01). The length of follow-up was longer for laparoscopy (p<0.001). Percutaneous cryoablation was associated with a significantly shorter hospital stay (p<0.001). A lower likelihood of residual disease was recorded for laparoscopic (p1⁄40.003), whereas tumor recurrence rate favored percutaneous cryoablation (p1⁄40.02). The two procedures were similar for recurrence free survival (p1⁄4 0.08), and overall survival (p1⁄40.51). No significant difference was found in post-operative eGFR (p1⁄40.78). CONCLUSIONS: Laparoscopic and percutaneous kidney cryoablation offer similar favorable oncological outcomes with minimal impact on renal function. The percutaneous access can offer shorter hospital stay and faster recovery, which can be appealing in an era of cost restraint. Determining which approach to use in clinical practice will depend on the available technology and specific expertise at each center. Source of Funding: none

Prostate Cancer – Local Treatment after Radiorecurrence: Salvage Cryoablation

Laparoscopic surgery and less invasive techniques have changed surgery by decreasing incision size, leading to the concept of laparoendoscopic single-site surgery (LESS). LESS has the potential to improve laparoscopic outcomes when compared to some open procedures, decreasing morbidity, pain, and postsurgical cosmetic issues.