Yooni Yi

Factors Associated with Preventive Pharmacological Therapy Adherence among Patients with Kidney Stones

OBJECTIVE To determine adherence patterns for thiazide diuretics, alkali citrate therapy, and allopurinol, collectively referred to as preventive pharmacological therapy (PPT), among patients with kidney stones. METHODS Using medical claims data, we identified adults diagnosed with kidney stones between 2002 and 2006. Through National Drug Codes, we determined those with one or more prescription fills for a PPT agent. We measured adherence to PPT (as determined by the proportion of days covered formula) within the first 6 months of starting therapy and performed multivariate analysis to evaluate patient factors associated with PPT adherence. RESULTS Among 7980 adults with kidney stones who were prescribed PPT, less than one third (30.2%) were adherent to their regimen (indicated by proportion of days covered  ≥ 80%). Among those on monotherapy, rates of adherence differed by the type of PPT agent prescribed: 42.5% for thiazides, 40.0% for allopurinol, and 13.4% for citrate therapy. Factors that were independently associated with lower odds of PPT adherence included combination therapy receipt, female gender, less generous health insurance, and residence in the South or Northeast. In contrast, older patients and those with salaried employment had a higher probability of PPT adherence. CONCLUSION Adherence to PPT is low. These findings help providers identify patients where PPT adherence will be problematic. Moreover, they suggest possible targets for quality improvement efforts in the secondary prevention of kidney stones.

Diversity of patient profile, urethral stricture, and other disease manifestations in a cohort of adult men with lichen sclerosus

Purpose Lichen sclerosus (LS) in men is poorly understood. Though uncommon, it is often severe and leads to repeated surgical interventions and deterioration in quality of life. We highlight variability in disease presentation, diagnosis, and patient factors in male LS patients evaluated at a tertiary care center. Materials and Methods We retrospectively reviewed charts of male patients presenting to our reconstructive urology clinic with clinical or pathologic diagnosis of LS between 2004 and 2014. Relevant clinical and demographic information was abstracted and descriptive statistics calculated. Subgroup comparisons were made based on body mass index (BMI), urethral stricture, and pathologic confirmation of disease. Results We identified 94 patients with clinical diagnosis of LS. Seventy percent (70%) of patients in this cohort had BMI >30 kg/m2, and average age was 51.5 years. Lower BMI patients were more likely to suffer from urethral stricture disease compared to overweight counterparts (p=0.037). Patients presenting with stricture disease were more likely to be younger (p=0.003). Thirty percent (30%) of this cohort had a pathologic diagnosis of LS. Conclusions Urethral stricture is the most common presentation for men with LS. Many patients endure skin scarring and have numerous comorbidities. Patient profile is diverse, raising the concern that not all patients with clinical diagnosis of LS are suffering from identical disease processes. The rate of pathologic confirmation at a tertiary care institution is alarmingly low. Our findings support a role for increased focus on pathologic confirmation and further delineation of the subtype of disease based on location and clinical manifestations.

Comparative evaluation of physical characteristics of different inflatable penile prostheses

Abstract Objective: The aim of this study was to describe and evaluate existing inflatable penile prostheses (IPPs) in an independent laboratory setting. Materials and methods: New IPPs were obtained from two manufacturers: American Medical Systems (AMS) and Coloplast. The AMS 700™ LGX (18 cm), CX (18 cm) and CXR (14 cm), and the Coloplast Titan® Touch (18 cm) and Titan Narrow (14 cm) were investigated. Internal pressure, length and girth of the cylinders were measured at 2 ml increments. A urodynamic individual transducer connected to an analogue amplifier and recording system was used to measure pressure. Rigidity and axial loading of the different IPPs were evaluated with a compression system. Results: Regular-size prostheses were inflated to 22 ml and narrow prostheses to 16 ml. The Titan Touch had a girth of 17.8 mm at 22 ml compared to 15.6 mm for the AMS 700 LGX and 16.5 mm for CX. The AMS 700 LGX increased in length by 13 mm from baseline, a feature that was unique among all the tested prostheses. Rigidity curves as assessed by compression showed significant variability, with both Titan prostheses and the AMS CXR exhibiting similar patterns and requiring a higher load to reach 50% compression. The buckling experiment showed different patterns of deformity. Conclusions: The results suggest that these prostheses exhibit significant physical differences. The clinical impact of these differences is poorly elucidated. These variations in behavior of the prostheses could be considered by physicians and patients when objectively assessing the choice of prosthesis. These findings could aid in objective patient counseling.

Case ‒ Temporary chemical castration in the management of recurrent priapism

Stuttering priapism entails repeated, distinct episodes of persistent penile erection despite interval periods of detumescence. While individual episodes are acutely treated, overall management of the patient with recurrent priapism focuses on prevention of future incidents. According to American Urological Association (AUA) guidelines, systemic therapy may be used for prevention of priapism — including hormonal agents, baclofen, digoxin, and terbutaline. Other methods of management include selfinjection of sympathomimetic agents and surgical intervention with placement of a penile prosthesis. 1 This case report describes long-term use of hormonal therapy in the management of stuttering priapism in a young male.

PD25-12 EVALUATION OF INFLATABLE PENILE PROSTHESES: HOW THEY PERFORM IN THE LAB?

RESULTS: A total of 210 AMS IPP with Conceal reservoirs were included in this study. From this data set, there were four cases (1.9%) with reservoir-related mechanical failure or complication requiring revision surgeries. Of those four, two cases (0.95%) were mechanical failures resulting from the reservoir leaking. In both cases, the cause of leak was identified as an intrinsic point of weakness at the apex of the reservoir caused by inward folding of an unfilled segment. The inward folding of the reservoir was observed at volumes of 60 to 80 mL. In the remaining two cases (0.95%), the reservoir complication observed was refractory abdominal muscle pain related to ectopic location and intra-fascial placement. In both cases, revision surgery with reservoir repositioning resolved the pain. CONCLUSIONS: While ectopic placement of the Conceal reservoir is mechanically reliable, it must be filled in excess of 80 mL to prevent inward reservoir folding and resultant reservoir leakage. Additionally, with surgical consent, it is prudent for the patient to be counseled on the possibility of abdominal muscle pain when the reservoir is placed ectopically, though they should be informed that such pain is a rare side effect.

PD34-09 THE UTILITY OF UROFLOWMETRY PARAMETERS IN URETHROPLASTY SURVEILLANCE IS LIMITED

INTRODUCTION AND OBJECTIVES: Urethral stricture disease is common condition with significant quality of life and economic implications. While endoscopic treatment with incision or dilation is the most common treatment approach, guidelines increasingly recommend urethroplasty based on its high success rates. Whether real world, community practice outcomes mirror those of large volume single center institutional series is unknown. For these reasons, we conducted a population-based study of patients treated with urethroplasty and their outcomes. METHODS: We identified male patients who underwent urethroplasty between 2001 and June 2015 based on ICD-9 codes and administrative claims from a large, national US health insurer (ClinformaticsTM Data Mart Database, OptumInsight, Eden Prairie, MN). We assessed utilization of endoscopic treatments (urethrotomy and dilation) prior to and after urethroplasty. We defined urethroplasty failure by any subsequent urethral dilation, urethrotomy, or urethroplasty after initial urethroplasty. We examined factors associated with failure using multivariable logistic regression and Cox proportional hazards models. RESULTS: We identified 1345 patients treated with urethroplasty. Urethroplasty failure occurred in 344 (26%) of patients. Repeat urethroplasty was performed in 139 (40%) of failures (range 28). Increased number of endoscopic treatments prior to first urethroplasty was associated with urethroplasty failure. The mean ( SD) time to failure was 270 42 days. CONCLUSIONS: Our population-based study demonstrated significantly lower success rates for urethroplasty than previously published reports. Strategies to achieve better outcomes for patients with urethral stricture disease include increasing referrals to reconstructive urologic surgeons, and knowledge and technique transfer to community urologists interested in providing this service rather than repeated, low-value endoscopic treatment.