Johns Hopkins at AUA Annual Meeting
Explore the latest in research and clinical care case studies from the Brady Urology Institute faculty and trainees, as presented at the American Urological Association (AUA) Annual Meeting.
Visit our Clinical Connection page to access the latest news, research advancements and clinical resources from the Johns Hopkins Brady Urological Institute for urologists and other clinicians.
Johns Hopkins Medicine Faculty, Fellows, Residents and Staff at AUA 2026 Schedule
Friday, May 15, 2026
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Time: 7:00 AM to 9:00 AM
Location: 146C
Speaker:
Craig Cronin
Medical Student, Johns Hopkins University School of MedicineIP10: Surgical Technology & Simulation: Instrumentation & Technology I
Time: 9:30 AM to 11:30 AM
Location: 146C
Speaker:
Ahmed Ghazi, M.D.
Director of Surgical Simulation Training and the Division of Minimally Invasive and Robotic Surgery, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of Medicine006IC - Disasters in Endourology and How to Avoid Them
Time: 10:00 AM to 12:00 PM
Location: 151A
Speaker:
Arun Rai, M.D., MBA, MS
Director, Brady Urological Institute Quantitative Data Sciences
Assistant Professor of Urology, Johns Hopkins University School of MedicineWhat’s in it for Me? The IAUA from an Indian and Indian-American Perspective
Time: 10:40 AM to 10:50 AM
Location: 140A
Speaker:
Nirmish Singla, M.D.
Director of Translational Research in Genitourinary Oncology, Johns Hopkins Brady Urological Institute
Director of the Kidney Cancer Program, Johns Hopkins Brady Urological Institute
Associate Professor of Urology and Oncology, Johns Hopkins University School of MedicineTime: 11:14 AM to 11:22 AM
Location: 207A
Speaker:
Margaux Johnson, M.D.
Pediatric Urology Fellow, Johns Hopkins Brady Urological InstituteCrossfire: Prostate Cancer Nodes Only Recurrence - Is Surgery the Best Alternative?
Time: 11:55 AM to 12:15 PM
Location: Ballroom A
Speaker:
Misop Han, M.D.
Urologic Oncologist, Johns Hopkins Brady Urological Institute
David Hall McConnell Professor of Urology and Oncology, Johns Hopkins School of Medicine
Medical Director, Credentials Committee, Johns Hopkins Hospital
Director, Urology InformaticsTime: 1:00 PM to 3:00 PM
Location: 146B
Speaker:
Devin Dishong
Medical Student, Johns Hopkins University School of MedicineHF01-13: Fidelis Udeh: Expanding the Legacy of Black Urologists in the United States
Time: 1:00 PM to 1:30 PM
Location: 143B
Speaker:
Aurora Grutman
Student, Johns Hopkins University School of MedicineHF01-04: Forked Tongue Crusher of Stone: A Mystery of the Didusch Museum
Time: 1:00 PM to 1:30 PM
Location: 143B
Speaker:
Soum Lokeshwar, M.D.
Fellow, Johns Hopkins University School of MedicineHF01-01: The Scalpel and Spotlight: Harry W. Martin, The Urologist Who Treated Hollywood
Time: 1:00 PM to 1:30 PM
Location: 143B
Speaker:
William Azar, M.D., M.S.
Urology Resident, Johns Hopkins University School of MedicineTime: 1:00 PM to 3:00 PM
Location: 146A
Speaker:
Olivia Copelan, M.D.
Fellow, Johns Hopkins University School of MedicineTime: 1:30 PM to 1:55 PM
Location: S&T Hall, Booth #2161
Speaker:
Arun Rai, M.D., MBA, MS
Director, Brady Urological Institute Quantitative Data Sciences
Assistant Professor of Urology, Johns Hopkins University School of MedicineTime: 1:50 PM to 2:00 PM
Location: Hall B, The Square, Learning Lab
Speaker:
Lauren Shepard
Lab Manager, Johns Hopkins Brady Urological InstituteFocus on: Biomarkers, MRI and PSMA PET Imaging in Prostate Cancer
Time: 2:00 PM to 3:30 PM
Location: 150AB
Speaker:
Michael Carducci, M.D.
AEGON Professor in Prostate Cancer Research, Johns Hopkins University School of MedicineTime: 3:30 PM to 5:30 PM
Location: 146A
Speaker:
Tyler Garman, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 3:30 PM to 5:30 PM
Location: 145AB
Speaker:
Brendan Wallace, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 3:31 PM to 3:50 PM
Location: 202A
Speaker:
Arun Rai, M.D., MBA, MS
Director, Brady Urological Institute Quantitative Data Sciences
Assistant Professor of Urology, Johns Hopkins University School of MedicineTime: 3:49 PM to 3:56 PM
Location: 143B
Speaker:
Soum Lokeshwar, M.D.
Fellow, Johns Hopkins University School of MedicineYoung GURS 2024-2025 Reconstructive Literature Update
Time: 4:30 PM to 4:55 PM
Location: Marriott Marquis: Independence Ballroom Salon B
Speaker:
Andrew Cohen, M.D.
Division Director of Benign Urology and Director of Advanced Practice Providers, Johns Hopkins Brady Urological Institute
Director of the Kidney Cancer Program, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of Medicine
Saturday May 16, 2026
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Time: 9:30 AM to 11:30 AM
Location: S&T Hall, Booth #117, Robotics Theater
Speaker:
Mohamad Allaf, M.D.
Director of the Department of Urology and the Brady Urological Institute and Urologist-in-Chief of the Johns Hopkins Hospital
Professor of Urology and Oncology, Johns Hopkins School of MedicineIP33-17: HEALTH Randomized Trial – HIIT versus CME Effects on LUTS
Time: 9:30 AM to 11:30 AM
Location: 146B
Speaker:
Craig Cronin
Medical Student, Johns Hopkins University School of MedicineTime: 9:30 AM to 11:30 AM
Location: 147A
Speaker:
Aidan Weitzner
Student, Johns Hopkins University School of MedicineIP35-14: Diagnostic Utility of Pre-Cystectomy Bladder Magnetic Resonance Imaging
Time: 9:30 AM to 11:30 AM
Location: 147A
Speaker:
Taibo Li
Student, Johns Hopkins University School of MedicineTime: 9:30 AM to 11:30 AM
Location: 145AB
Speaker:
Sean Fletcher, M.D.
Urology Resident, Johns Hopkins Brady Urological InstituteTime: 9:30 AM to 11:30 AM
Location: 145AB
Speaker:
Zhuo Su, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 9:30 AM to 11:30 AM
Location: 147B
Speaker:
Zhuo Su, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 9:30 AM to 11:30 AM
Location: 145AB
Speaker:
Zhuo Su, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 9:30 AM to 9:40 AM
Location: 207B
Speaker:
Lauren Shepard
Lab Manager, Johns Hopkins Brady Urological InstituteIP32-08: A Bladder Matter: Redefining the Grading System for Pediatric Hemorrhagic Cystitis
Time: 9:30 AM to 11:30 AM
Location: 146A
Speaker:
Catherine Robey, M.D.
Pediatric Urology Fellow, Johns Hopkins Brady Urological InstituteTime: 9:40 AM to 9:50 AM
Location: 209B
Speaker:
Avinash Dhimal
Biomedical Engineer, Johns Hopkins Brady Urological InstituteTime: 10:00 AM to 11:00 AM
Location: Salon C
Speaker:
Marisa Clifton, M.D.
Vice President, Medical Affairs at Johns Hopkins Bayview Medical Center
Chief Medical Officer, The Johns Hopkins Hospital
Director, Women’s Health, Johns Hopkins Brady Urological Institute
Director, Urology Residency Program
Director, Urology Robotic EducationTime: 10:10 AM to 10:20 AM
Location: 209B
Speaker:
Ahmed Ghazi, M.D.
Director of Surgical Simulation Training and the Division of Minimally Invasive and Robotic Surgery, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of MedicineSemi-Live Surgical Showcase: Endourology
Time: 11:20 AM to 11:50 AM
Location: Hall D
Speaker:
Arun Rai, M.D., MBA, MS
Director, Brady Urological Institute Quantitative Data Sciences
Assistant Professor of Urology, Johns Hopkins University School of MedicineTime: 1:00 PM to 3:00 PM
Location: 145AB
Speaker:
Soum Lokeshwar, M.D.
Fellow, Johns Hopkins University School of MedicineTime: 1:00 PM to 3:00 PM
Location: 145AB
Speaker:
Soum Lokeshwar, M.D.
Fellow, Johns Hopkins University School of MedicineTime: 1:00 PM to 3:00 PM
Location: 146B
Speaker:
Alexander Tinana
Research Assistant, Johns Hopkins University School of MedicineTime: 3:30 PM to 5:30 PM
Location: 146A
Speaker:
Sean Fletcher, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 3:30 PM to 5:30 PM
Location: 146A
Speaker:
Taibo Li
Student, Johns Hopkins University School of MedicineTime: 4:00 PM to 6:00 PM
Location: 151A
Speaker:
Arthur Burnett, M.D.
Urologist, Johns Hopkins Brady Urological Institute
Professor of Urology, Johns Hopkins School of Medicine,Course Description: Over the past 10 years there have been numerous AUA/SMSNA Guidelines that have been published. In 2015, the first Peyronies’ Guidelines were released. In 2018 the AUA/SMSNA Testosterone and Erectile Dysfunction Guidelines were published. Finally, in 2021 and 2022 the AUA/SMSNA Priapism and Disorders of Ejaculation Guidelines were released. Many clinicians are still unaware of the new guideline recommendations on how to diagnose and treat these conditions. The purpose of this case-based course is to provide clinicians with the key important take away messages from each of the 5 sexual medicine guidelines. Each of the 5 guidelines will be led be either the Chair of the guideline or a committee member of their respective guideline. Each faculty will present 1-2 clinical cases and use each case to highlight key points from the guidelines. The goal of this instructional course is to make the course interactive and leave ample time for questions and answers after each of the case presentations. The learners from this course should be able to understand and implement the guideline recommendations, specifically on how to diagnose and treat men with hypogonadism, Peyronie’s disease, priapism, ejaculatory disorders and erectile dysfunction.
Learning Objective 1: Diagnose and manage patients with Peyronies’ s disease based on the 2015 AUA/SMSNA Peyronie’s Guidelines
Learning Objective 2: Diagnose and manage patients with erectile dysfunction based on the 2018 AUA/SMSNA Erectile Dysfunction Guidelines
Learning Objective 3: Diagnose and manage patients with hypogonadism based on the 2018 AUA/SMSNA Testosterone Guidelines
Learning Objective 4: To be familiar with how to diagnose and manage patients with priapism based on the 2021 AUA/SMSNA Priapism Guidelines
Learning Objective 5: To be familiar with how to diagnose and manage patients with premature and delayed ejaculation based on the 2022 AUA/SMSNA Disorders of Ejaculation GuidelinesTime: 3:30 PM to 5:30 PM
Location: 146B
Speaker:
Charlotte Wu, M.D.
Pediatric Urologist, Johns Hopkins Brady Urological Institute and Johns Hopkins Children’s Center
Assistant Professor of Urology in the Division of Pediatric Urology, Johns Hopkins School of MedicineTime: 3:30 PM to 5:30 PM
Location: 147B
Speaker:
Aurora Grutman
Student, Johns Hopkins University School of Medicine
Sunday, May 17, 2026
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Time: 8:15 AM to 8:45 AM
Location: Hall D
Speaker:
Brian Wildey, M.D.
Gynecologist and Obstetrician, Johns Hopkins Medicine
Assistant Professor, Johns Hopkins School of MedicinePerspectives of Running Clinical Trials as a Medical Oncologist in Academic Practice
Time: 8:28 AM to 8:41 AM
Location: Hall B, The Square, Learning Lab
Speaker:
Noah Hahn, M.D.
Deputy Director Johns Hopkins Greenberg Bladder Cancer Institute
Medical Oncologist, Johns Hopkins Brady Urological Institute
Professor of Oncology and Urology Johns Hopkins School of MedicineDescription:
This educational activity aims to explore the evolution and distinct stages of the complete multi-year process from idea to implementation to initial and late phase results of the leading, late breaking clinical trial across the field of urology.New Developments in Enucleation Technology
Time: 8:40 AM to 8:50 AM
Location: Independence Ballroom Salon B
Speaker:
Naren Nimmagadda, M.D,
Urologist, Johns Hopkins Brady Urological Institute
Assistant Professor of Urology, Johns Hopkins School of MedicinePlanning to Plenary: Audience Question and Answer Panel
Time: 8:48 AM to 8:58 AM
Location: Hall B, The Square, Learning Lab
Speaker:
Noah Hahn, M.D.
Deputy Director Johns Hopkins Greenberg Bladder Cancer Institute
Medical Oncologist, Johns Hopkins Brady Urological Institute
Professor of Oncology and Urology Johns Hopkins School of MedicineDescription:
This educational activity aims to explore the evolution and distinct stages of the complete multi-year process from idea to implementation to initial and late phase results of the leading, late breaking clinical trial across the field of urology.Time: 9:30 AM to 11:30 AM
Location: 146B
Speaker:
Soum Lokeshwar, M.D.
Fellow, Johns Hopkins University School of MedicineTime: 9:30 AM to 11:30 AM
Location: 147B
Speaker:
Ethan Lee
Research Assistant, Johns Hopkins Brady Urological InstituteTime: 9:30 AM to 11:30 AM
Location: 147A
Speaker:
Craig Cronin
Student, Johns Hopkins University School of MedicineTime: 9:30 AM to 11:30 AM
Location: 146C
Speaker:
Devin Dishong
Medical Student, Johns Hopkins University School of MedicineTime: 9:56 AM to 10:04 AM
Location: Hall B, The Square, Learning Lab
Speaker:
Max Kates, M.D.
Director, Division of Urologic Oncology, Johns Hopkins Brady Urological Institute
Co-Director, Greenberg Bladder Cancer Institute
R. Christian B. Evensen Professor and Associate Professor of Urology and Oncology, Hopkins School of MedicineTime: 10:36 AM to 10:44 AM
Location: Hall B, The Square, Learning Lab
Speaker:
Tyler Garman, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 11:22 AM to 11:30 AM
Location: 207A
Speaker:
Aidan Weitzner
Student, Johns Hopkins University School of MedicineIP62: Prostate Cancer: Markers I
Time: 1:00 PM to 3:00 PM
Location: 146A
Speaker:
Christian Pavlovich, M.D.
Urologic Oncologist, Johns Hopkins Brady Urological Institute
Director, Prostate Cancer - National Capital Region, Johns Hopkins Brady Urological Institute
Director, Prostate Cancer Active Surveillance Program, Johns Hopkins Brady Urological Institute
Co-Director, Prostate Cancer Multidisciplinary Clinics, Johns Hopkins Brady Urological Institute
Bernard L. Schwartz Distinguished Professor of Urologic Oncology, Johns Hopkins School of MedicineTime: 1:00 PM to 3:55 PM
Location: Hall D
Speaker:
Arthur Burnett, M.D.
Urologist, Johns Hopkins Brady Urological Institute
Professor of Urology, Johns Hopkins School of MedicineTime: 1:00 PM to 3:00 PM
Location: 146C
Speaker:
Erin Mayeux
Researcher, Johns Hopkins School of Medicine047IC - Contemporary Techniques in TURBT
Time: 1:30 PM to 3:30 PM
Location: 151A
Speaker:
Max Kates, M.D.
Director, Division of Urologic Oncology, Johns Hopkins Brady Urological Institute
Co-Director, Greenberg Bladder Cancer Institute
R. Christian B. Evensen Professor and Associate Professor of Urology and Oncology, Hopkins School of MedicineCourse Description: The most important aspect of bladder cancer management is the transurethral resection of the bladder tumor (TURBT). In this course, attendees will gain important skills in novel techniques for TURBT. This will include knowing when and how to perform restaging TURBTs, en bloc bladder tumor resections, resection of the ureteral orifice, and in-office ablation. The use of enhanced imaging techniques including blue light cystoscopy and narrow band imaging will be reviewed. Additionally, attendees will learn to minimize risk of complications during TURBT including obturator reflex, bladder perforation, excessive bleeding and TUR syndrome. At the conclusion of the course, attendees will return to their practices with new techniques to maximize benefit and minimize risk for their bladder cancer patients undergoing TURBT.
Learning Objective 1: Perform techniques during TURBT that minimize risk of operative complications, specifically obdurator reflex, bladder perforation, heavy bleeding.
Learning Objective 2: Utilize the AUA guidelines for muscle and non-muscle invasive bladder cancer in their practice in order to select appropriate patients for TURBT and ensure a high-quality resection.
Learning Objective 3: Perform en bloc bladder resections in appropriately selected cases of bladder cancer. Attendees will define the different modalities ( bipolar electrocautery vs laser) for performing en bloc resections and the rationale behind its use.
Learning Objective 4: Endoscopically manage bladder tumor involving the ureteral orifice. Specifically, attendees will be able to utilize advanced resection techniques of the ureteral orifice and understand when and when not to utilize ureteral stents.
Learning Objective 5: Perform in office ablation for recurrent low grade tumors, and understand the most appropriate patients to select for these procedures.
The Case for SP Extravesical Prostatectomy
Time: 2:10 PM to 2:15 PM
Location: Marriott Marquis: Independence Ballroom Salon B
Speaker:
Ahmed Ghazi, M.D.
Director of Surgical Simulation Training and the Division of Minimally Invasive and Robotic Surgery, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of MedicineTime: 2:20 PM to 2:28 PM
Location: Hall B, The Square, Learning Lab
Speaker:
Arvin George,M.D.
Director, Prostate Cancer Programs, Johns Hopkins Brady Urological Institute
Associate Professor (PAR) of Clinical Urology, Johns Hopkins School of MedicineTime: 3:30 PM to 5:30 PM
Location: 146A
Speaker:
Joseph Cheaib, M.D.
Resident (PGY-4), Johns Hopkins Brady Urological InstituteTime: 3:30 PM to 5:30 PM
Location: 146C
Speaker:
Heather DiCarlo,M.D.
Director, Pediatric Urology, Johns Hopkins Brady Urological Institute
Director, Pediatric Urology Research, Johns Hopkins Brady Urological Institute
Associate Professor of Clinical Urology, Johns Hopkins University School of MedicineTime: 3:30 PM to 5:30 PM
Location: 145AB
Speaker:
Tanisha Martheswaran
Medical Student, Johns Hopkins University School of MedicineTime: 4:00 PM to 6:00 PM
Location: 150AB
Speaker:
Brian Matlaga, M.D.
Executive Vice Chair, Johns Hopkins Brady Urological Institute
Professor of Urology, Johns Hopkins University School of Medicine
Director of the Stephens Center for Stone Disease, Johns Hopkins Brady Urological InstituteCourse Description: Attendees will refresh their knowledge of the AUA Surgical and Medical Stone Management Guidelines and also adapt these guidelines to new surgical techniques and complex medical/surgical case scenarios. We will also try and highlight new concepts in the upcoming AUA Guidelines on stone disease. The course will also include discussion of newer technologies (e.g., holmium versus vs. thulium laser, mini vs. standard percutaneous nephrolithotomy, ureteroscopy vs. shock wave lithotripsy, dusting vs. extraction, suction devices and techniques) and medications to incorporate into their practice for stone prevention. The course will incorporate the management of complications of surgical stone management. The course will be interactive with audience participation and time for Q&A interspersed throughout the format.
Learning Objective 1: Utilize holmium and thulium laser technologies in the management of stones and utilize laser settings to optimize dusting vs. fragmentation techniques, as well as laser pulse modulation to help in their treatment of stones.
Learning Objective 2: Identify complications that can occur during stone managementand apply techniques to mitigate the complication risks.
Learning Objective 3: Manage complex medical scenarios with kidney stonesincluding uric acid stones, infection stones and calcium phosphate stones.
Learning Objective 4: Manage stones in more complex clinical scenarios that are not specifically addressed in the current AUA Guidelines in addition to stones during pregnancy.
Learning Objective 5: Discuss new surgical techniques for the management of kidney stones including suction devices, next generation ureteral access sheaths, single-use scopes, and mini-PCNL.
Monday, May 18, 2026
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Time: 7:00 AM to 9:00 AM
Location: 146B
Speaker:
Brendan Wallace, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 8:40 AM to 8:50 AM
Location: 207B
Speaker:
Ahmed Ghazi, M.D.
Director of Surgical Simulation Training and the Division of Minimally Invasive and Robotic Surgery, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of MedicineTake Home Messages: Artificial Intelligence (RECORDING)
Time: 9:30 AM to 9:45 AM
Location: 140AB
Speaker:
Ahmed Ghazi, M.D.
Director of Surgical Simulation Training and the Division of Minimally Invasive and Robotic Surgery, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of MedicineTime: 9:30 AM to 11:30 AM
Location: 147A
Speaker:
Zhuo Su, M.D.
Resident, Johns Hopkins Brady Urological InstituteTime: 9:30 AM to 11:30 AM
Location: 147A
Speaker:
Alyssa Arbuiso
Medical Student, Johns Hopkins University School of MedicineTime: 10:00 AM to 12:00 PM
Location: 152A
Speakers:
Ahmed Ghazi, M.D.
Director of Surgical Simulation Training and the Division of Minimally Invasive and Robotic Surgery, Johns Hopkins Brady Urological Institute
Associate Professor of Urology, Johns Hopkins University School of MedicinePetronela Szima-Cotter, PA-C
PA, Johns Hopkins Brady Urological InstituteCourse Description: The initial SP adoption period represents a discovery phase, during which a restricted number of experienced surgeons have attempted to make the most of this new technology. This was particularly important in adaptation from the da Vinci Xi to the SP robot, as although the new features of the SP platform allow novel strategies, they have added complexity to procedures. .
Most urologists approaching Single Port surgery focus on technical aspects of the single port robot and neglect the modifications required in the surgical approach to adopt the novel platform. Urologists whom have successfully adopted SP surgery , advance through the learning curve of SP surgery by progressively adopting their approach and overcoming the technical challenges . In this course proposal, we aim to implement educational interventions to address skills for practicing urologists wishing to adopt Single Port robotic approach.In this course proposal, we aim to implement a video-based step by step educational strategies to address technical barriers for practicing urologists wishing to adopt Single Port robotic approach. We intend to achieve this by presenting unique perspective from 3 urologist who meticulously modified their conventional robotic approach to suit that of Single Port surgery eventually transforming their practice to Single Port robotics. Although the single-incision approach, offers potential benefits it also presents unique challenges for the surgical assistant in comparison to the multiport approach. In response, a Physician Assistant specializing in robotic bedside assistance was added to the faculty to address this gap.
This course serves to develop knowledge, skills and attitudes that most urologist are unfamiliar with but are rapidly becoming a part of patient care in today’s healthcare landscape. This course will be led by a group of directors and faculty who have a significant experience with the SP platform. Each Faculty will focus on a specific robotic procedure (Radical Prostatectomy, Partial Nephrectomy, Trans vesical prostate enucleation), each describing the evolution and modification to their approach, technical aspects, patient selection, and most importantly how to overcome complications. in addition, a PA specializing in robotic bed side assistance will guide the participants (Urologists and other APPs) on specifics to the single-port platform.
This course differs from other similar courses in that it will focus on how a surgeon can modify their procedure in a stepwise manner to safely adopt this novel technology without compromising patient care. All presentations will focus on video-based step by step instruction for the 3 surgical procedures, offering side by side comparisons of single port vs multiport for critical steps of the 3 procedures.
To optimize the participants understanding of the material several educational pedagogy will be utilized:
1- Audience participation and reflection through polls embedded into the faculty presentations
2- Presentations will focus on video based step by step instructions of cases (similar to semi-live surgeries)
3- Q&A sessions in between each presentation to encourage interactive discussions with the audienceLearning Objective 1: 1) Acquire the Knowledge required to safety adopt the single port robotic platform.
a. Understand the hardware/software differences between multiport and single port robotic platforms including the benefits and limitations of each technology.
b. Understand and explain the approaches, access , procedure modifications, post operative course unique to single port robotic surgery.Learning Objective 2: 2) Apply all the knowledge and approaches required to perform complex procedures (namely ; Extraperitoenal Radical Prostatectomy, Retroperitoneal partial nephrectomy and transvesical enucleation of the prostate) safety using the single port robotic platform .
a. Understand the unique access/docking methods and approaches for SP robot
b. Understand the various applications of the flexible SP camera
c. Understand the various applications of the SP instruments
d. Understand with various orientation of SP instruments and camera to complete a series of critical steps for the 3 procedures
e. Tips and trick to successfully and safely adopt the procedure
c. Understand how to avoid and manage complications that may arise from performing SP robotic surgeryLearning Objective 3: 3) Understand how to utilize the bed side assistant during these procedures including.
a. Port Placement: Accurately placing the ports under direct vision to ensure optimal space and prevent injury to vital structures.
b. Instrument Handling: Familiarity with laparoscopic instruments and their use in single-port surgery.
c. Traction and Retraction: Providing adequate traction and retraction to aid in tissue dissection.
d. Suction and Irrigation: Performing suctioning and irrigating to maintain a clear surgical field.
e. Safety Monitoring: Ensuring patient safety by monitoring the patient's position, robotic arms to prevent injury and particular issues related to insufflation.
Overall, the bedside assistant plays a vital role in single-port robotic surgery, contributing to the success of the procedure by providing essential support and ensuring patient safety within the constraints of the single-port approach.Time: 11:22 AM to 11:30 AM
Location: 206
Speakers:
Adrianna Amaral de Aragao
Research Fellow, Johns Hopkins University School of Medicine
Past Presentations
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Controversies in Urology: Erectile Dysfunction and Peyronie’s Diseases
Speaker: Arthur Burnett, M.D.
Artificial Intelligence Models in Urology
Speaker: Arun Rai, M.D., M.B.A.
Integration of Biomarkers, MRI and PSMA PET Imaging Into the Management of Prostate Cancer
Speaker: Steven Rowe, M.D., Ph.D.
019IC - AUA Guidelines Update: Surgical and Medical Management of Stones & Complex Cases
Speaker: Brian Matlaga, M.D.
020IC - Case-Based Approach - Understanding the AUA Sexual Medicine Guidelines
Speaker: Arthur Burnett, M.D.
MP03-17: SLICE 3-day Hands-on Masterclass: An effective approach to skill acquisition for practicing urologists adopting new approaches
Speaker: Lauren Shepard
MP02-03: Survival Outcomes after Surgical Treatment for Non-Clear Cell Renal Cell Carcinoma with Tumor Thrombus Extension: A Population-Based Analysis
Speaker: Joseph Cheaib, M.D., M.P.H.
IP02-14: Phase III, single-arm study - evaluate the efficacy and safety of intravesical paclitaxel-hyaluronic acid conjugate in patients with BCG-unresponsive Carcinoma in situ of the bladder +/- Ta-T1 papillary disease (Orion-BC study)
Speaker: Max Kates, M.D.
V03-06: Enhancing Surgical Skills in AEEP: A Simulation-Based Training Approach Utilizing Expert-Validated Hydrogel Models
Speaker: Avinash Dhimal
MP10-01: Can healthy habits slow cancer progression? Association between exercise, diet, and prostate cancer grade reclassification during active surveillance
Speaker: Michelle Higgins, M.D.
PD12-02: Results from the ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) Randomized Controlled Trial
Speaker: Michael Rezaee, M.D., and Michelle Higgins, M.D.
HF02-17: Charles Huggins' Road Not Taken at the Brady Urological Institute
Speaker: Aurora Grutman
PD11-11: Whole-exome sequencing reveals novel insights into genetic mechanisms underlying Peyronie's Disease
Speaker: Taibo Li
Immunogenomic Landscape of Prostate Cancer in African American Men
Speaker: Tamara Lotan, M.D.
Histotripsy: Non-Invasive Tumor Destruction and It’s Potential in Urologic Applications | Sponsored by: HistoSonics
Speaker: Arun Rai, M.D., M.B.A.
Donald S. Coffey Lectureship: Progress in Identifying Predictive Biomarkers for Bladder Cancer
Speaker: David McConkey, M.D.
Crossfire: Controversies in Urology: Surgical Treatment of the 100g Gland: RASP vs HOLEP
Speaker: Naren Nimmagadda, M.D.
IP09-33: Cannabis Use is Associated with New Diagnoses of LUTS in Pediatric Patients — A Large Claims Database Study
Speaker: Aurora Grutman
IP09-11: Impact of Intraoperative OnabotulinumtoxinA on Postoperative Recovery and Medication Use in Pediatric Bladder Reconstruction
Speaker: Jason Yang
IP11-24: Development of a high-fidelity simulation model for thulium laser enucleation of the prostate.
Speaker: Madison Brookfield
IP11-20: Pre-Clinical Visualization of Cavernous Nerves in Real-Time Using Fluorescence Guidance
Speaker: Anthony Song
IP10-15: Controlled Prevention Trial for Recurrent Priapism in Sickle Cell Anemia: Hydroxyurea plus Placebo vs. Hydroxyurea plus Tadalafil
Speaker: Arthur Burnett, M.D.
IP12-08: Molecular characterization of primary tumors and urinary tumor DNA in patients with concurrent bladder and upper tract urothelial carcinoma
Speaker: Maximilian Pallauf
V07-04: Technique for a Modified Florence Robot-Assisted Intracorporeal Neobladder (FloRIN) Creation
Speaker: Michelle Higgins, M.D.
PD16-01: Prostate Cancer Risk After Solid Organ Transplant: A Retrospective Claims-Based Matched Cohort Study
Speaker: Aurora Grutman
MP20: Reconstruction: Ureteral Reconstruction (including pyeloplasty) and Bladder Reconstruction (including trauma-related fistula)
Session Moderator: Charlotte Wu, M.D.
PD21-05: Validation of objective performance metrics in a simulation-based hydrogel training platform for Holmium Laser Enucleation of the Prostate (HoLEP)
Speaker: Lauren Shepard
Trial in Progress: PIVOT-006- A Phase 3, Randomized Study of Adjuvant Intravesical Cretostimogene Grenadenorepvec Versus Surveillance for the Treatment of Intermediate-Risk Non-Muscle Invasive Bladder Cancer
Speaker: Max Kates, M.D.
PD25-06: Malignant Ureteral Obstruction in Gynecologic Oncology: Location Matters
Speaker: Mark Alshak, M.D.
V13-07: Leveraging multiple approaches for patient specific simulation for the management of complex renal masses
Speaker: Nathan Schuler
IP20-11: Vaginoplasty in Female Bladder Exstrophy-Epispadias Complex: An In-Depth Analysis of Perioperative Technique, Outcomes, and Complications at a High-Volume Center of Excellence
Speaker: Logan Galansky, M.D.
IP20-34: Optimizing postoperative pain management in bladder exstrophy: the role of onabotulinumtoxinA
Speaker: Jason Yang
ARID II: Pivotal Study of Voro Urologic Scaffold for the Prophylactic Treatment of Post Prostatectomy Stress Urinary Incontinence
Speaker: Arvin George, M.D.
IP27-30: Comprehensive analysis of microRNA expression provides mechanistic insights into transcriptomic alteration in testicular germ cell tumors (TCGT)
Speaker: Taibo Li, M.D., Ph.D.
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MP16-14: A Phase II trial of intravesical Gemcitabine and Docetaxel (GEMDOCE) in the treatment of BCG-naïve non-muscle invasive urothelial carcinoma of the bladder
Authors: Sunil H. Patel, Andrew T. Gabrielson, Sin Chan, Deborah Schwartz, Connie Collins, Nirmish Singla, Bruce Trock, Trinity J. Bivalacqua, Noah Hahn, and Max R. Kates
Introduction: Combination intravesical Gemcitabine and Docetaxel (GemDoce) has demonstrated efficacy as a 2nd line therapy for patients with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). In the context of widespread BCG shortages, we performed a Phase 2 prospective trial to assess GemDoce for BCGnaïve NMIBC.
Methods: This study is a prospective single-arm open-label phase II trial for patients with BCG-naïve high risk NMIBC. Intravesical gemcitabine and docetaxel was given weekly for 6 weeks as induction followed by monthly maintenance therapy for 2 years among responders. The primary endpoint was 3-month complete response (CR), and key secondary endpoints included adverse events (AE) and 12-month CR.
Results: A total of 25 patients were enrolled between August 2020-August 2022 with median follow-up of 19.6 months. The pre-trial pathologic stages were: HGT1 with CIS (n=7), HGT1 without CIS (n=6), HGTa (n=9), and CIS alone (n=3) (Table 1). The 3-month and 12-month CR rate was 100% and 88%, respectively (Figure 1). Two patients with pre-trial HGT1 had HGT1 recurrences at 9 and 12 months. No patients progressed to T2 disease, underwent radical cystectomy, or had any radiographic evidence of progressive disease. Grade 1 AEs were common (23/25 patients) including hematuria, urinary frequency, urgency, and fatigue. Five patients (20%) experienced a Grade 3 AE including hematuria and UTI (Table 2).
Conclusions: In this single-arm phase II trial, GEMDOCE was well-tolerated with promising efficacy for patients with BCG-naïve HR NMIBC.
MP20-19: Bipolar Enucleation of the Prostate (BipolEP) versus Transurethral Resection of the Prostate: A Prospective Randomized Controlled Non-Inferiority Trial
Authors: Maximilian Pallauf, Christian Ramesmayer, Michael Abenhardt, Maximilian Horetzky, Hubert Grießner, Lukas Oberhammer, Martin Drerup, Thomas R. W. Herrmann, Lukas Lusuardi, and Thomas Kunit
Introduction: Endoscopic enucleation (EEP) is the preferred surgical technique for treating men with moderate-to-severe lower urinary tract symptoms (LUTS) and a large prostate (>80 mL) and an accepted alternative to transurethral resection (TURP) for mid-sized glands (30-80 mL). More recently, a treatmentspecific electrode was developed to facilitate EEP using bipolar current (BipolEP). This prospective randomized controlled trial tests the non-inferiority of BipolEP compared with TURP for prostates sized 50-140 mL.
Methods: We prospectively included men scheduled for surgical treatment of LUTS due to benign prostatic enlargement. We included men with an international prostate symptom score (IPSS) of ≥15, an IPSS quality-oflife score (IPSS-QoL) ≥ 3, and a peak flow rate (Qmax) of<15 ml/sec. or the inability to void following urinary retention. We randomized patients 1:1 for TURP vs. BipolEP and followed them for 12 months postoperatively. The key primary endpoint was the non-inferiority of BipolEP compared with TURP in the 12-month IPSS. According to the study protocol, the predefined non-inferiority range was 3, and the estimated sample size per treatment arm was 31. The key secondary endpoint was the superiority of BipolEP compared with TURP in resected prostate tissue per surgery-minute. We recorded complications to compare the safety of the procedures.
Results: We included 81
Authors: Logan Galansky, Andrew T. Gabrielson, Corey Able, and Chad Crigger
Introduction: Over the last decade, management of renal trauma has shifted to favor observation for highgrade renal trauma (HGRT) in hemodynamically stable children. We hypothesized that there has been a decrease in surgical intervention for pediatric HGRT compared to historical rates, but that HGRT continues to be managed with more aggressive intervention than low-grade renal trauma (LGRT).
Methods: A retrospective cohort study was conducted using the TriNetX database between 2012-2023. Patients<20 years old presenting with renal trauma were queried. We used AAST grading to categorize injuries as either LGRT (I-III) or HGRT (IV-V). We analyzed evaluation and management strategies after index trauma event, including initial and subsequent surveillance imaging modality, interventions within one week of trauma, and long-term sequela outcomes from 1 month to 5 years.
Results: A total of 1,997 renal trauma patients were identified (526 HGRT, 1,471 LGRT). Abdominal/retroperitoneal ultrasound and multi-phase CT were used at similar rates during the index trauma between groups, but those with HGRT were more likely to have additional imaging with abdominal/pelvic plain films. The most common management strategy in both groups was observation (95% vs. 84%, p<0.01), but those with HGRT were more likely to require transfusion (37% vs. 26%, p<0.01), embolization (6% vs. 3%, p<0.01), exploratory laparotomy (6% vs. 3%, p<0.01), and/or nephrectomy (4% vs. 0%, p<0.01). For surveillance, most patients were followed with renal ultrasound. There was no difference in rates of subsequent hypertension (11% vs. 10%, p=0.5), CKD (4% vs. 3%, p=0.2), need for renal replacement therapy (1% vs. 0.5%, p=0.4), depression (4% vs. 3%, p=0.9), or anxiety (9% vs. 8%, p=0.7).
Conclusions: Historically, pediatric HGRT management included surgical intervention in as high as 36% of patients. In this contemporary cohort, we observed much lower utilization of surgical interventions for HGRT, with observation as the most common current management strategy. Although LGRT was managed almost exclusively with observation, we observed similar rates of subsequent hypertension, CKD, and psychological sequela among patients with LGRT and HGRT, suggesting that even LGRT warrants continued follow-up and psychological support.
men, 41 TURP, and 40 BipolEP. At enrollment, the median prostate size was 79 mL (95%CI 60-95), the median PSA was 5.1 ng/ml (95%CI 2.6-8.2), the median IPSS was 21 (95%CI 16.5-24), and the median Qmax was 7.6 ml/sec. (95%CI 6-10.7); baseline characteristics did not differ between the treatment arms. 67 men (TURP 34, BipolEP 33) completed the 12-month follow-up. The median IPSS was 5 (95%CI 3-7) in the TURP arm and 5 (95%CI 3-9) in the BipolEP arm. BipolEP was tested to be non-inferior (intention-totreat and per-protocol analyses; p<0.05). BipolEP resected more prostate tissue per surgery-minute than TURP (median g/min. 0.5 95%CI 0.4-0.7 vs. 0.4 95%CI 0.3-0.6; p=0.04). At 12 months, we recorded at least one complication in 43% of the TURP arm and 61% of the BioplEP arm (p=0.1). 27% of TURP complications were major (Clavien Dindo ≥ IIIB), but only 1 (4.5%) in the BipolEP arm was (p=0.1).
Conclusions: We confirmed the non-inferiority of BipolEP compared with TURP for improving LUTS, and we proved the efficiency and safety of BipolEP. Longer follow-up is needed to assess whether the increased tissue removal results in a more sustained improvement of symptoms.
MP33-12: Industry Payments to Urologists in 2022: Descriptive Analysis of the Open Payments Program Database
Authors: Joseph Cheaib, Zhuo Su, Zeyad Hammadeh, Bruce J. Trock, and Misop Han
Introduction: Financial incentives may influence physician decision-making. The Open Payments Program (OPP) from the Centers for Medicare and Medicaid Services (CMS) now mandates medical device and pharmaceutical manufacturers to publicly report such incentives given to physicians. The OPP Payments fall under 3 main categories: general payments, research payments, and physician ownership/investment interest. This study aims to describe all open payments made to urologists in 2022.
Methods: All urologists in the US who received at least one payment in the OPP database in 2022 were included. Urologists were identified when the principal investigator reported their practicing specialty as urology. Descriptive analyses of payments by type, sex, and industry payer were performed.
Results: Open payments totaling $149,287,170 were made to 8,063 (62.2%) urologists in 2022. Research payments ($96,270,845) were the largest category, followed by general payments ($30,853,188) and then ownership ($22,163,137) (Table 1). The median payment to urologists in 2022 was $524, and the highest-paid urologist received a total of $8,354,885 (6% of all payments). Notably, top 10 urologists received 26% of all payments. Almost all urologists in this cohort (99%) received general payments; over 50% of these general payments were non-continuing medical education-related compensations. 38 urologists (0.47% of all urologists receiving payments) accepted payments of all 3 categories, receiving a total of $29 million (20% of all payments made to urologists). Boston Scientific and Urovant Sciences contributed the biggest number of individual payments, while Merck contributed the largest total amount ($32.6M) (Table 2).
Conclusions: Disproportionate amount of industry payments were made with 0.1% of urologists receiving 26% of the total payments in 2022. Research payments are the largest industry payment category to urologists. Further studies are warranted to better understand the nature of this industry-urologist relationship and its impact on physician decision making.
PD20-07: Oncologic Outcomes in Patients with Variant Histologies of Upper Tract Urothelial Cancer: Results from an International Multicenter Cohort
Authors: Maximilian Pallauf, Sean A. Fletcher, Michael Rezaee, Morgan Rouprêt, Stephen A. Boorjian, Aaron M. Potretzke, Hooman Djaladat, Alireza Ghoreifi, Francesco Soria, Andrea Mari, Riccardo Campi, Zine-Eddine Khene, Eiji Kikuchi, Michael Rink, Kazutoshi Fujita, David D’Andrea, Joost L. Boormans, Guillaume Ploussard, Alberto Breda, Firas Abdollah, Jay D. Raman, Shahrokh F. Shariat, Benjamin Pradere, and Nirmish Singla
Introduction: Histologic variants (VH) of urothelial carcinoma (UC) of the lower urinary tract are associated with worse oncologic outcomes than pure UC. However, outcomes for patients with VH in the upper urinary tract are poorly described, given their rarity. We sought to elucidate the oncologic outcomes for patients with upper tract urothelial carcinoma (UTUC) with VH.
Methods: We queried an international, multicenter cohort of non-metastatic UTUC patients treated with radical nephrouterectomy (RNU). We categorized patients into pure UC (no-VH) and VH. VH was subcategorized based on the distribution of subtypes into ‘squamous/glandular/trophoblastic’ (VH-S) and ‘other’ (VH-O), comprising all other VH. We compared clinicopathologic characteristics and oncologic outcomes, including recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS), among groups. We performed subanalyses matched by pathologic stage: organ-confined (OC: ≤pT2 and pN0-x) and non-organ-confined (NOC: ≥pT3 or pN1-2). Kaplan Meier methods and multivariable proportional hazards Cox regression with multivariate imputation by chained equations (MICE) for missing predictor covariates were performed to evaluate outcomes.
Results: We included 3,435 patients treated from 1985-2022 across 23 centers worldwide and identified 201 (6%) with VH. The median follow-up was 30 months (IQR 12-61). The most common VH subtype was VH-S (133/201, 66%). Neoadjuvant (12% vs. 5%, p<0.001) and adjuvant (27% vs. 13%, p<0.001) systemic therapy were more often administered in VH than in no-VH patients. Lymph node dissection was also more often performed in VH patients (54% vs. 39%, p<0.001). Patients with VH presented with more advanced pT (p<0.001) and pN (p<0.001) stage. In patients with OC disease, VH had worse RFS than no-VH (5-year RFS 58% vs. 80%, p=0.004), though CSS and OS were not significantly different. Stratified by VH subtype, VH-S exhibited similar oncologic outcomes as no-VH, but VH-O demonstrated worse stage-matched RFS (4-year RFS 39% vs. 83%, p<0.001 [OC] and 28% vs. 46%, p=0.01 [NOC]) and OS (5-year OS 45% vs. 75%, p=0.004 [OC]) compared to no-VH. VH-O independently predicted worse survival outcomes on multivariable Cox regression analyses.
Conclusions: UTUC patients with VH exhibit more aggressive disease at presentation compared to pure UC. Despite the increased use of systemic therapy, certain VH subtypes demonstrate worse oncologic outcomes compared to pure UC. Further study is warranted to elucidate the biology of different UTUC VH subtypes to optimize treatment approaches.
Source of Funding: This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS) a component of the National Institute of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH.Maximilian Pallauf gratefully acknowledges the support of the Paracelsus Medical University Research and Innovation Fund (2022-FIRE-004- Pallauf)
PD37-01: Measuring Seminiferous Tubules Diameter Using High-Frequency Ultrasound In Murine Models And Men With Non-Obstructive Azoospermia And Obstructive Azoospermia
Authors: Taylor P. Kohn, Nora Haney, Amin Herati, Max Kates, and Kenneth Pienta
Introduction: For men with non-obstructive azoospermia, no imaging exists to determine if sperm is present prior to testicular sperm extraction (TESE). The objective of this pilot study is to assess whether high-frequency ultrasound (HFUS), which can differentiate structures of less than 70 μm, is capable of distinguishing enlarged seminiferous tubules with spermatogenesis from sclerotic seminiferous tubules without spermatogenesis.
Methods: A 29 MHz HFUS (ExactVu micro-ultrasound system) was performed on 3 adult male SpragueDawley rats (controls), 3 three-week at pups (prepuberal), and 3 bulsulfan-treated (20 mg/kg) adult male rats. Ultrasound imaging was additionally performed in 3 fertile male controls, 3 men with microTESE-negative nonobstructive azoospermia, 3 men with TESE-positive obstructive azoospermia. Conventional ultrasound was also performed for a fertile man and man with NOA to compare resolution with HFUS. Each testicle was imaged in 3 cross-sectional frames with 30 seminiferous tubules measured in each frame using ImageJ.
Results: A total of 3,240 tubules were measured. HFUS could distinguish individual seminiferous tubules while no distinct structures were identifiable with conventional ultrasound (Figure 1). Control adult rats had significantly larger seminiferous tubules when compared to prepubertal rats (250±42 μm vs 139±26 um, p<0.0001, Figure 2). Busulfan-treated rats had wide range of tubule variability with some areas with larger tubules (220-350 μm) and patches with sclerotic tubules (100-170 μm). In humans, fertile men had significantly larger tubules when compared to men with microTESE-negative non-obstructive azoospermia (264±38 versus 163±32 μm, p<0.0001). Men with obstructive azoospermia had similar tubule size to men with proven fertility (241±53 versus 264±38 μm, p>0.05).
Conclusions: HFUS is able to differentiate tubule sizes in men with NOA and OA as well as regions of large tubules versus sclerotic tubules in rats treated with busulfan.
MP55-20: The effect of neonatal upper and lower urinary tract obstruction on the gastrointestinal microbiome in a murine animal model
Authors: Nora M. Haney, Kara Lombardo, Taylor P. Kohn, Charlotte Q. Wu, Max R. Kates, John P. Gearhart, and Trinity J. Bivalacqua
Introduction: The effect of congenital urinary obstruction on the gastrointestinal microbiome has not yet been characterized. The objective was to evaluate the effect of upper and lower urinary tract obstruction on the gastrointestinal microbiome in a neonatal animal model.
Methods: Male and female neonates were operated on day 3 of life. Control group (C) was sham operated. Partial left ureteral obstruction was performed in upper urinary tract obstruction group (U) via suture ligation over a wire. Partial urethral obstruction was created in lower urinary tract obstruction group (L) via modified clip applier technique. Kidney, bladder, and colonic fecal samples were obtained at the time of sacrifice. The intestinal microbiome was evaluated via 16S rRNA gene amplicon sequencing. Alpha and beta diversity, single taxa abundance, and unique indicator species analysis was performed using R Statistical Software 4.2.0 (p<0.05).
Results: At 21d post-operatively, body mass was lower in U compared to L (C: 62.8+/-3.4 g, U: 53.9 +/-3.2 g, L: 72.7+/-5.2 g, U v L p=0.003). Stool microbiome demonstrated elevated Firmicutes:Bacteroidota ratio in L compared to U (C: 3.0, U: 2.3, L: 3.4; U vs L p=0.014).Beta diversity clustered significantly between groups (C vs L p=0.016; C vs U, p=0.004; L vs U, p=0.012). Alpha diversity was not significant between groups (Observed p=0.065, Shannon p=0.799).Relative abundance demonstrated Lactobacillus B was significantly downregulated
in the U group compared to C (p=0.028) and L (p=0.033). All unique indicators of the U group came from the Lachnospirales order (Genus: Clostridium Q, p=0.013; 28-4, p=0.013; CAG81, p=0.017). One unique L indicator was an absence of a particular genus from the Firmicutes phylum (Genus: CAG302, p=0.014).Conclusions: This is the first study of its kind to evaluate the neonatal response of the gastrointestinal microbiome to upper and lower urinary tract obstruction. There were unique genera indicators and significant beta diversity clustering in U and L groups indicating that stool microbiome plays an important role in the downstream pathology of neonatal urinary tract obstruction.The Firmicutes:Bacteriodota composition, known to play a role in obesity, was associated with weight distribution, providing evidence of a direct effect of lower urinary tract obstruction on gut metabolism. In the future, such patterns in the intestinal microbiome may be used as a prognostic model to noninvasively detect children at high risk for end stage organ damage of the genitourinary system secondary to obstructive uropathy.
Source of Funding: This work was funded by the 2021 SWIU Elisabeth Pickett Research Award
MP50-05: A Scoping Review of Financial Toxicity and Bladder Exstrophy-Epispadias Complex: The Hidden Burdens of a Major Congenital Genitourinary Anomaly
Authors: Logan Galansky, Andrew T. Gabrielson, Tony Su, Victoria Maxon, Ahmad Haffar, Alex Hirsch, Heather Di Carlo, John P. Gearhart, and Chad Crigger
Introduction: Financial toxicity (FT) is the direct and indirect costs of healthcare on patients, which can lead to financial burden, psychosocial distress, diminished quality of life, and worse clinical outcomes. While FT has been widely examined in the oncology literature, it is still an emerging topic in pediatric urology. However, the impact of FT on the well-being of patients and caregivers is salient for those managing serious chronic conditions, such as bladder exstrophy-epispadias complex (BEEC). We aimed to provide the first review of FT and BEEC literature.
Methods: We conducted a scoping review of the literature addressing FT and BEEC using thematic search queries of the PubMed database built from unique keyword searches with MeSH terms and free text. Themes selected were quality of life, financial cost, caregiver burden, psychosocial and socioeconomic stress, and FT explicitly. All journal articles that were peer-reviewed and published in the English language were included. Given the relative paucity of BEEC literature, no restrictions were put on publication date. After abstracting the search results, two independent reviewers screened and extracted relevant articles to further evaluate for qualitative analysis.
Results: Our scoping review resulted in 296 articles related to our selected themes and BEEC. Of these articles, the quality of life theme query yielded the greatest number of overall search results (157 total), with the psychosocial and socioeconomic stress, cost, and caregiver burden queries producing 88, 38, and 13 results, respectively. The query for articles specifically analyzing FT and BEEC produced 0 results. After reviewing the selected abstracts, 45 total articles addressed the patient-level financial and psychosocial burdens of BEEC. Literature pertaining to the FT of BEEC on caregivers was particularly sparse with only 3 relevant articles included in our analysis.
Conclusions: While this scoping review revealed that studies evaluating cost and psychosocial factors related to BEEC exist, there were no articles addressing the concept of FT specifically for patients and caregivers in the BEEC community. This represents a clear gap in the literature that warrants future research to help improve support and outcomes for this patient population.
MP55-13: Contemporary Management and Outcomes of Pediatric Patients with Low-Grade vs. High-Grade Renal Trauma
Authors: Logan Galansky, Andrew T. Gabrielson, Corey Able, and Chad Crigger
Introduction: Over the last decade, management of renal trauma has shifted to favor observation for highgrade renal trauma (HGRT) in hemodynamically stable children. We hypothesized that there has been a decrease in surgical intervention for pediatric HGRT compared to historical rates, but that HGRT continues to be managed with more aggressive intervention than low-grade renal trauma (LGRT).
Methods: A retrospective cohort study was conducted using the TriNetX database between 2012-2023. Patients<20 years old presenting with renal trauma were queried. We used AAST grading to categorize injuries as either LGRT (I-III) or HGRT (IV-V). We analyzed evaluation and management strategies after index trauma event, including initial and subsequent surveillance imaging modality, interventions within one week of trauma, and long-term sequela outcomes from 1 month to 5 years.
Results: A total of 1,997 renal trauma patients were identified (526 HGRT, 1,471 LGRT). Abdominal/retroperitoneal ultrasound and multi-phase CT were used at similar rates during the index trauma between groups, but those with HGRT were more likely to have additional imaging with abdominal/pelvic plain films. The most common management strategy in both groups was observation (95% vs. 84%, p<0.01), but those with HGRT were more likely to require transfusion (37% vs. 26%, p<0.01), embolization (6% vs. 3%, p<0.01), exploratory laparotomy (6% vs. 3%, p<0.01), and/or nephrectomy (4% vs. 0%, p<0.01). For surveillance, most patients were followed with renal ultrasound. There was no difference in rates of subsequent hypertension (11% vs. 10%, p=0.5), CKD (4% vs. 3%, p=0.2), need for renal replacement therapy (1% vs. 0.5%, p=0.4), depression (4% vs. 3%, p=0.9), or anxiety (9% vs. 8%, p=0.7).
Conclusions: Historically, pediatric HGRT management included surgical intervention in as high as 36% of patients. In this contemporary cohort, we observed much lower utilization of surgical interventions for HGRT, with observation as the most common current management strategy. Although LGRT was managed almost exclusively with observation, we observed similar rates of subsequent hypertension, CKD, and psychological sequela among patients with LGRT and HGRT, suggesting that even LGRT warrants continued follow-up and psychological support.