Ted Lee

Twitter response to the United States Preventive Services Task Force recommendations against screening with prostate-specific antigen.

To examine public and media response to the draft (October 2011) and finalised (May 2012) recommendations of the United States Preventive Services Task Force (USPSTF) against prostate‐specific antigen (PSA) testing via Twitter, a popular social network with over 200 million active users.

Uterine sparing robotic-assisted laparoscopic sacrohysteropexy for pelvic organ prolapse: safety and feasibility.

BACKGROUND AND PURPOSE The aim of this study was to describe the surgical technique and report the safety and feasibility of robotic-assisted laparoscopic sacrohysteropexy, a uterine sparing procedure to correct pelvic organ prolapse (POP). Hysterectomy at the time of POP surgery has yet to be proven to improve the durability of repair. Nevertheless, the leading indication for hysterectomy in postmenopausal women is POP. PATIENTS AND METHODS We reviewed the medical records of a consecutive case series of uterine sparing prolapse repair procedures from 2005 to 2011. Fifteen women were identified. Procedures utilized a type I polypropylene mesh securing the posterior uterocervical junction to the sacral promontory. This was later modified to utilize a Y-shaped strip that was inserted through the broad ligaments to include the anterior uterocervical junction. RESULTS Objective success was defined as Baden Walker grade 0 uterine prolapse and subjective success was defined as no complaint of vaginal bulge or pressure. The mean age of women was 51.8 years (28-64 years). No intraoperative complications were noted. The mean operating time was 159.4 minutes (130-201 minutes) and mean estimated blood loss was 35 mL (0-100 mL). The mean length of stay was 1.6 days (1-4 days) and mean length of follow-up was 10.8 months. Uterine prolapse improved in all 15 patients. Objective success was 93% (14/15) and subjective success was 80% (12/15). CONCLUSION Robotic-assisted laparoscopic sacrohysteropexy was found to be a safe and feasible surgical treatment option for POP patients who desire uterine preservation.

Impact of Clinical Guidelines on Voiding Cystourethrogram Use and Vesicoureteral Reflux Incidence

Purpose To prevent over diagnosis and overtreatment of vesicoureteral reflux the 2007 NICE (National Institute for Health and Care Excellence) and 2011 AAP (American Academy of Pediatrics) guidelines recommended against routine voiding cystourethrograms in children presenting with first febrile urinary tract infections. The impact of these guidelines on clinical practice is unknown. Materials and Methods Using an administrative claims database (Clinformatics™ Data Mart) children who underwent voiding cystourethrogram studies or had a diagnosis of vesicoureteral reflux between 2001 and 2015 were identified. The cohort was divided into children age 0 to 2 and 3 to 10 years. Single and multiple group interrupted time series analyses (difference‐in‐difference) were performed with the guidelines as intervention points. The incidence of vesicoureteral reflux was compared across each period. Results Of the 51,649 children who underwent voiding cystourethrograms 19,422 (38%) were diagnosed with vesicoureteral reflux. In children 0 to 2 years old voiding cystourethrogram use did not decrease after the 2007 NICE guidelines were announced (−0.37, 95% CI −1.50 to 0.77, p = 0.52) but did decrease significantly after the 2011 AAP guidelines were announced (−2.00, 95% CI −3.35 to −0.65, p = 0.004). Among children 3 to 10 years old voiding cystourethrogram use decreased during the entire study period. There was a decrease in the incidence of vesicoureteral reflux in both groups that mirrored patterns of voiding cystourethrogram use. Conclusions The 2011 AAP guidelines led to a concurrent decrease in voiding cystourethrogram use and incidence of vesicoureteral reflux among children 0 to 2 years old. Further studies are needed to assess the risks and benefits of reducing the diagnosis of vesicoureteral reflux in young children.

Long-term Satisfaction After Open Radical Prostatectomy

OBJECTIVE To determine the association between baseline factors, post-treatment factors, and long-term satisfaction after radical prostatectomy (RP). METHODS Between January 2000 and March 2009, 1425 men who underwent RP by a single surgeon were enrolled in an institutional review board-approved, prospective, longitudinal outcomes study. Baseline characteristics and post-treatment functional and oncologic outcomes were captured through 2013. Patient survey responses from 875 (61.4%) of these men were used to evaluate satisfaction with treatment outcome and treatment decision. RESULTS Overall, 88.2% and 91.0% men were satisfied to very satisfied with treatment outcome and treatment decision, respectively. Baseline sexual function was associated with satisfaction with both treatment outcome (adjusted odds ratio [aOR] = 1.40; 95% confidence interval [CI], 1.01-1.93) and treatment decision (aOR = 1.47; 95% CI, 1.08-2.01). Among post-treatment factors, higher University of California, Los Angeles Prostate Cancer Sexual Function (aOR = 2.95; 95% CI, 2.06-4.22), University of California, Los Angeles Prostate Cancer Urinary Function (aOR = 2.38; 95% CI, 1.66-3.40), and lower urinary tract symptom scores (aOR = 1.91; 95% CI, 1.19-3.06) were predictors of satisfaction with outcome. Bother due to incontinence and sexual dysfunction, and perception of cure were independent predictors of both satisfaction with treatment outcome and treatment decision. CONCLUSION Nearly 90% of men are satisfied with both their treatment outcome and treatment decision after open RP. Improving long-term satisfaction after RP requires efforts to provide realistic expectations and improve functional outcomes.

MP61-07 NATIONAL TRENDS IN VCUG UTILIZATION AFTER THE RELEASE OF THE 2011 AAP GUIDELINES

Source of Funding: Data is this study were collected by the Chronic Kidney Disease in children prospective cohort study (CKiD) with clinical coordinating centers (Principal Investigators) at Children’s Mercy Hospital and the University of Missouri Kansas City (Bradley Warady, MD) and Children’s Hospital of Philadelphia (Susan Furth, MD, Ph.D.), Central Biochemistry Laboratory (George Schwartz, MD) at the University of Rochester Medical Center, and data coordinating center (Alvaro MuO1oz, Ph.D). at the Johns Hopkins Bloomberg School of Public Health. The CKiD is funded by the National Institute of Diabetes and Digestive Kidney Diseases, with additional funding from the National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01-DK-66143, U01-DK-66174, U01-DK-082194, U01-DK-66116).

MP45-13 INTERMEDIATE AND LONG-TERM PREDICTORS OF SATISFACTION FOLLOWING OPEN RADICAL RETROPUBIC PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: The Phoenix definition for PSA failure following RT is the accepted way of defining biochemical failure but its accuracy has never been examined with long-term followup. We sought to compare this definition to the ASTRO and AUA definitions in prostate cancer (PC) patients treated with definitive RT METHODS: 1669 men with T1-3 PC were treated with brachytherapy alone or in conjunction with hormone therapy (HT) or external beam radiation (EBRT) and followed a minimum of 5 years (mean 10, range 5-20). The median PSA was 6.9 ng/ml (mean 9.7, range 0.3-300). There were 1128 (67.5%) low (NCCN), 369 (22.1%) intermediate and 172 (10.4%) with high risk disease. HT was given to 898 (53.8%, median 6 months). 568 (34%) had supplemental EBRT. Radiation doses were converted to the biologic effective dose (a/b1⁄42) and analyzed as 3 groups: 200 Gy2 (n1⁄4778). PSA failure definitions were the AUA (increase PSA to above 0.2 ng/ml), ASTRO (3 consecutive increases above a nadir) and Phoenix (nadir followed by rise of 2 ng/ml). Survival estimates were determined by Kaplan Meier method with significant differences determined by log rank and Cox proportions hazard rates. RESULTS: The 5, 10 and 15 year bFFF, the 10 year bFFF by NCCN and dose group for the three failure definitions are shown in the table (p 0.2 compared 5.5% of the ASTRO patients. The last PSA for non-failures was >0.21 in 16.4%, 7% and 3.1% of the patients in the 3 dose groups, respectively (p 200 Gy2) these differences are negligible with all 3 definitions demonstrating a 10 year bFFF rate of 90%. Biochemical FFF should be estimated using the AUA PSA failure definition unless the highest doses are delivered.

How to Best Predict Success of the Transobturator Male Sling

Although the male sling is a popular and effective option to treat stress urinary incontinence, the reported success rates are highly variable. Detailed knowledge of the factors affecting male sling outcome can improve clinical efficacy and provide realistic expectations for patients. The objective of this article is to review the current literature that identifies factors associated with surgical outcome, with the goal of optimizing pre-operative selection criteria. Since most practitioners prefer the transobturator approach, the retrourethral transobturator sling (i.e., AdVance™ sling) is the focus of this review.