Shahab Bozorgmehri

Association of Sleep Disordered Breathing with Erectile Dysfunction in Community Dwelling Older Men.

Purpose: We investigated the association between sleep disordered breathing and erectile dysfunction in older men. Materials and Methods: We performed a cross‐sectional analysis of community dwelling men age 67 years or older enrolled in the Osteoporotic Fractures in Men Sleep Study. Participants underwent overnight polysomnography (2003 to 2005) and completed sexual health questionnaires (2005 to 2006). We defined sleep disordered breathing using the apnea‐hypopnea index or nocturnal hypoxemia. Erectile dysfunction was defined using the MMAS (Massachusetts Male Aging Study) scale and, in sexually active men, the International Index of Erectile Function. We used logistic regression to examine the association between sleep disordered breathing and erectile dysfunction. Results: Mean participant age was 76±5 years. Of the 2,676 men completing the MMAS, 70% had moderate to complete erectile dysfunction. Among 1,099 sexually active men completing the IIEF‐5 (5‐item International Index of Erectile Function), 26% had moderate to severe erectile dysfunction. A higher apnea‐hypopnea index was associated with greater odds of MMAS defined moderate to complete erectile dysfunction after adjusting for age and study site (OR 1.39, 95% CI 1.00–1.92 for severe sleep disordered breathing vs none, p trend=0.008), but not after further adjustment for body mass index, socioeconomic status and comorbidities (OR 1.05, 95% CI 0.75–1.49, p trend=0.452). Greater nocturnal hypoxemia was associated with increased odds of MMAS defined moderate to complete erectile dysfunction (unadjusted OR 1.36, 95% Cl 1.04–1.80 vs none) but this was attenuated after adjustment for age and study site (OR 1.24, 95% CI 0.92–1.66). Sleep disordered breathing was not associated with erectile dysfunction by 5‐item International Index of Erectile Function. Conclusions: In this cross‐sectional analysis in older men sleep disordered breathing was associated with higher odds of erectile dysfunction in unadjusted analyses that was largely explained by higher body mass index and increased comorbidity among men with sleep disordered breathing. Prospective studies accounting for obesity and multimorbidity would further clarify the association of sleep disordered breathing and erectile dysfunction.

Patient Perceptions of Chaperones During Intimate Exams and Procedures in Urology Clinic

Introduction: We surveyed patients on their expectations and preferences regarding chaperones during intimate examinations and procedures in urology clinic. Methods: Patients identified in the outpatient urology clinic were queried for demographics, expectations and preferences regarding chaperones through a 16-item survey. Results: We collected data from 200 patients (52.5% male, 47.5% female), average age 60.5 years (SD ± 15.5). Most patients were Caucasian (84.5%), completed some college (65.5%) and were married (52.0%). Most had a prior genitourinary procedure (men 74.7%, women 62.4%), during which 21.5% of men vs 60.7% of women had chaperones present. Most patients did not care if they had a chaperone (men 53.3%, women 54.7%). Only 11.5% of patients preferred a chaperone. Of that minority there was a higher percentage of women who preferred a chaperone compared to men (men 3.8%, women 20%). The majority of patients did not care about the gender of the chaperone but cited comfort level with the provider (men 50.0%, women 54.9%) and invasiveness of procedure or examination (men 36.4%, women 35.4%) as most important. The majority of patients (men 84.8%, women 88.4%) felt that they should have the right to refuse a chaperone. Conclusions: A minority of patients preferred to have a chaperone during an intimate examination or procedure in urology clinic. Patients prioritized comfort level with the provider, which trumped gender of provider, invasiveness of examination and identity of the chaperone. The use of chaperones during intimate examinations and procedures is routine at many institutions. In an era of patient centered care it is crucial to understand patient preferences and expectations.

Career Expectations and Preferences of Urology Residency Applicants

OBJECTIVE To survey the characteristics, career goals, and practice preferences of current urology applicants. METHODS An anonymous survey was emailed to applicants pursuing a residency position at the University of Florida for the 2017-2018 academic year Urology Match. The survey included questions on demographics, motivating factors to pursue urology, plans for fellowship training, and anticipated and desired practice patterns. RESULTS A total of 151 of 295 applicants completed the survey, mean age 26.9± SD 2.3. Males had a higher interest in academics/research, cancer, mens health, and minimally invasive surgery technology. Females had a higher interest in public health, surgery, and mixture of surgical and medical management. A total of 64.1% planned on completing a fellowship. Males had a higher interest in urologic oncology and endourology. Females had a higher interest in female pelvic medicine and reconstructive surgery, andrology and sexual medicine, and pediatric urology. A total of 76.9% anticipated having an academic affiliation, 68.9% working in an urban setting, and 98% working full-time, with no difference based on gender. For desired quality of life after residency, maximum number of hours considered acceptable was 51-60 (36.4%) and 61-70 (35.1%). Regarding an acceptable call schedule, most considered 2-4 nights per month reasonable. Most felt an acceptable starting salary was

Distinct renal outcomes for transcatheter aortic valve replacement and surgical repair

250,000-

Evaluating Region of Interest Measurement Strategies to Characterize Upper Urinary Tract Stones on Computerized Tomography

400,000 and

Age, Body Mass Index, and Gender Predict 24-Hour Urine Parameters in Recurrent Idiopathic Calcium Oxalate Stone Formers.

200,001-

1976 EVALUATION OF REGION OF INTEREST (ROI) STRATEGIES FOR CHARACTERIZATION OF UPPER URINARY TRACT STONES DETECTED ON COMPUTERIZED TOMOGRAPHY

350,000 for private practice and academic urology, respectively. CONCLUSION Current urology applicants desire to work in academics, urban settings, and pursue subspecialty fellowship training. What they consider acceptable work hours, call schedule, and financial compensation appear compatible with the current practice of urology.

A Pilot Study of Immunosuppression Resumption Following BK Viremia Resolution

To the editor, Aortic stenosis is one of the most common cardiac degenerative valvular diseases with an estimated prevalence of 1.3% in patients aged between 65 and 74 years and 2.8–4.6% in those aged 75 or more [1, 2]. Transcatheter aortic valve replacement (TAVR) has emerged as a viable option for the treatment of patients with aortic stenosis who are not suitable candidates for surgical aortic valve replacement (SAVR). Acute kidney injury (AKI) is considered an established postoperative complication that is associated with a significant increase in the risk of mortality [3]. We sought to explore the available evidence on the risk of AKI after TAVR as compared with SAVR. We searched the articles cited in PubMed database from years 2000 to 2017 using key words “aortic stenosis” and “transcatheter aortic valve replacement”, and those evaluating the role of TAVR in management of aortic stenosis were reviewed. Randomized controlled trials (RCT) that contained data on comparative impact of TAVR and SAVR on renal function were selected [4–7]. Relevant data including baseline renal function, definition of AKI, and incidence of AKI were extracted and compared (Table 1). Using Altman formula, the relative risk (RR) of AKI, its standard error, and 95% confidence intervals (CI) were extracted and compared for each study. A total of 113 citations were reviewed and after exclusion of duplicate studies, 4 RCTs with 3310 participants (1640 TAVR and 1584 SAVR) were included. The weighted mean age was 81.6 years and 55.2% were men. There existed substantial variation across studies in the degree of baseline renal function and the definition of AKI. Two studies defined AKI as the need for renal replacement therapy [4, 5], one as an increase in serum creatinine greater than 50% of the baseline [6], and the other as KDIGO stage 2–3 [7]. The incidence of AKI was reported between 2.9–5.8% and 0–13.5% for TAVR and SAVR, respectively. Three main studies (including 98% of the included patients) reported lower incidence of AKI with TAVR compared to SAVR. Two studies [6, 7] reached statistical significance (RR 0.43, 95% CI 0.27–0.69, and RR 0.41, 95% CI 0.22–0.74, respectively) and one [5] did not (RR 0.96, 95% CI 0.53–1.74). The RR of AKI could not be calculated from the smallest study [4] that included 70 patients because there were no cases of AKI in the SAVR group. The limited number of RCTs that have compared TAVR and SAVR used diverse definitions for post-procedural renal complications. Currently available evidence suggests that the two options for treatment of aortic stenosis might portend distinct impact on renal function; TAVR is associated with lower RR of AKI compared to SAVR. Future prospective studies with pre-defined renal endpoints are needed to confirm these findings and evaluate the impact of baseline renal function on the incidence of post-procedural renal complications. Author contributions All the authors had access to the data and contributed to writing of the manuscript.

MP36-06 USING AORTA-LESION-ATTENUATION-DIFFERENCE (ALAD) ON PREOPERATIVE CONTRAST-ENHANCED CT SCAN TO DIFFERENTIATE BETWEEN MALIGNANT AND BENIGN RENAL TUMORS

Purpose: Computerized tomography imaging is regularly used to assess stone HU values as a surrogate for stone composition and fragility. Techniques for measuring HU values are unstandardized, leading to high variability. We investigated several region of interest measurement strategies to quantify this variability. Materials and Methods: Patients from an institutional database who underwent preoperative computerized tomography, surgical stone extraction and stone composition analysis were identified. HU measurements were made of each patient stone using transverse/coronal slices in the abdominal/bone windows with 4 region of interest techniques, including 1) the maximum diameter region of interest, 2) the maximum diameter region of interest at all stone inclusive slices, 3) 2 equal‐sized, nonoverlapping circular regions of interest and 4) 3 to 5 smaller nonoverlapping regions of interest randomly placed on the stone. Stones that were 80% or greater pure by composition were separately analyzed. Results: A total of 172 patients were included in study. Mean ± SD stone size was 19.3 ± 15.6 mm. On subtype analysis 51 stones were calcium oxalate monohydrate, 9 were calcium oxalate dihydrate, 7 were calcium phosphate hydroxyapatite/brushite and 16 were uric acid. Mean HU values in the abdominal window for all stones identified by region of interest techniques 1 to 4 were 457 ± 253, 351 ± 210, 581 ± 363 and 587 ± 329, respectively. The distribution of means significantly differed across region of interest techniques, planes and windows when considering all stones together (p <0.0001), stones with greater than 80% calcium oxalate dihydrate (p = 0.0113) and greater than 80% calcium oxalate monohydrate (p <0.0001), and uric acid stones (p <0.0001). Conclusions: HU values obtained to assess stone density vary depending on window, plane and region of interest technique. We recommend that clinicians select a single region of interest measurement technique and use it consistently to minimize interinstitutional variability.

PD13-09 ACUTE KIDNEY INJURY AFTER UROLOGIC SURGERIES

INTRODUCTION AND OBJECTIVE Despite guidelines, routine 24-hour urine testing is completed in <10% of high-risk, recurrent stone formers. Using surrogates for metabolic testing, such as key patient characteristics, could obviate the cost and burden of this test while providing information needed for proper stone prevention counseling. METHODS We performed a retrospective study of 392 consecutive patients from 2007 to 2014 with ≥2 lifetime stone episodes, >70% calcium oxalate by mineral analysis, and ≥1 24-hour urine collection. We compared mean 24-hour urine values by age in decades. We used logistic regression and receiver operating characteristic (ROC) curve analysis to assess the predictive ability of age, gender, body mass index (BMI), and comorbidities to detect abnormal 24-hour urine parameters. RESULTS The mean age of the cohort was 51 ± 16 years. Older age was associated with greater urinary oxalate (p-trend <0.001), lower urinary uric acid (UA) (p-trend = 0.007), and lower urinary pH (p-trend <0.001). A nonlinear association was noted between age and urinary calcium or citrate (calcium peaked at 40-49 years, p = 0.03; citrate nadired at 18-29 years, p = 0.001). ROC analysis of age, gender, and BMI to predict 24-hour urine abnormalities performed the best for hyperuricosuria (area under the curve [AUC] 0.816), hyperoxaluria (AUC 0.737), and hypocitraturia (AUC 0.740). Including diabetes mellitus or hypertension did not improve AUC significantly. CONCLUSIONS In our recurrent calcium oxalate cohort, age significantly impacted urinary calcium, oxalate, citrate, and pH. Along with gender and BMI, age can be used to predict key 24-hour urine stone risk results. These data lay the foundation for a risk prediction tool, which could be a surrogate for 24-hour urine results in recurrent stone formers, who are unwilling or unable to complete metabolic testing. Further validation of these findings is needed in other stone populations.