Poster Session 8: Endourology, BPH (Part 2)

Introduction: Sarcopenia is the generalized loss of muscle mass and can be defined by axial skeletal muscle area on cross-sectional imaging.It has been correlated with patient outcomes across many fields, including urologic oncology, and is regarded as an objective measurement of frailty in geriatric patients.Sarcopenia has been linked to risk of nephrolithiasis; however, no studies to date have examined its utility in predicting perioperative risk in endourology.Accordingly, the objective of this study was to determine if sarcopenia can be used as a prognosticator of outcomes after percutaneous nephrolithotomy (PCNL) in a cohort of higher-risk elderly patients.Methods: Patients ≥70 years with cardiovascular disease who underwent PCNL from 2014-2019 at our institution were identified retrospectively.Patients without computed tomography (CT) imaging within one year of surgery were excluded.Sarcopenia was measured using skeletal muscle index (SMI).SMI was calculated by measuring total skeletal muscle (-29 to 150 Hounsfield Units) area at the mid-L3 vertebral body axial cut on CT, divided by height squared.Image analysis was performed using Aquarius iNtuition software.SMI <55 and <39 cm2/m2 was used to define sarcopenia for men and women, respectively.Results: The study cohort consisted of 80 patients, of which 56 (70%) met criteria for sarcopenia, with median SMI 45.1 and 39.6 cm2/m2 for males and females, respectively.There was no difference in mean age between the groups, however, the prevalence of sarcopenia was significantly higher among men compared to women (73.2% vs. 26.8%,p<.0001).There were no significant differences in transfusion rate (7.1% vs. 12.5%), ED readmissions (21.4% vs. 25%), or postoperative complications (28.6% vs. 37.5%) between sarcopenic and non-sarcopenic patients.Length of stay was similar between groups.Conclusions: This is a novel evaluation of sarcopenia as a predictor for outcomes after PCNL in higher-risk elderly patients.While sarcopenia was highly prevalent in our study cohort, it was not associated with increased perioperative complications and was not a predictor for inferior outcomes.Further studies focusing on a more general cohort are warranted and may have value in evaluating how sarcopenia can be used to guide surgical decision-making.