UCSF Urology Clinicians Present Research Findings at SurgeWest 2025

Development of a novel RNA biomarker for prostate cancer detection using seminal fluid and mismatched opioid prescriptions following urologic surgery are among the topics being presented by UCSF clinicians and researchers at the Western Section of the American Urological Association’s SurgeWest 2025. The 101st SurgeWest meeting, taking place from Nov. 2-6, in Napa, California, is the largest regional gathering of urology professionals in the Western U.S.

This year’s program features innovative research and discussions by experts from the UCSF Department of Urology.

Leading UCSF presentations (all times Pacific):

Sunday, Nov. 2, from 10:15 a.m. to 11:45 a.m.

Walter Hsiang, MD, MBA, resident physician in the UCSF Department of Urology, presents “Mismatched Opioid Prescription to Patients After Urologic Surgery: A Retrospective Cohort Study” (#87) during the “Health Policy-Data Quality” session. This study evaluated the extent of mismatched opioid prescriptions (over-prescribing and under-prescribing) at the time of hospital discharge among patients undergoing inpatient urologic surgery and assessed the association between prescription mismatch and postoperative opioid refills. The study found that decreasing total dose of opioid alone is not sufficient to effectively decrease opioid refills. Hsiang reports that strategies which individualize discharge opioid dosing based on inpatient consumption may help reduce prescription mismatch, improve postoperative outcomes and enhance opioid stewardship.

Hsiang also presents “Use of Commercial Large Language Models to Expand Literacy Level Concordant Materials for Kidney Stone Patient Education” (#187) during the “Health Policy-Data Quality” session. In the United States, nearly 9 out of 10 patients have sub-proficient health literacy, which is associated with increased patient morbidity. In this study, Hsiang and his colleagues evaluated the accuracy and completeness of three commercial large language models (LLMs) in converting standard kidney stone education materials to the sixth-grade reading level as an initial assessment of these tools’ potential to expand access to health information for urologic patients with low literacy. Hsiang reports on LLM’s accuracy when converting kidney stone patient education materials into lower reading grade levels.

Lynn Leng, BS, medical student in the UC Berkeley–UCSF Joint Medical Program, presents “Rethinking Morbidity and Mortality Conferences: A Novel, Multi-Institutional Study of the M-PROVE Model” (#49) during the “Health Policy-Data Quality” session. Morbidity and mortality conferences (MMCs) serve as critical platforms to evaluate patient adverse events and promote continuous improvement in clinical practice and health systems.

In 2022, UCSF piloted the Morbidity and Mortality Process Redesign to Optimize Value and Education (M-PROVE) model as a standardized approach to improve educational value and increase opportunities for systems change in patient care in an inclusive, nonjudgmental manner. This study sought to implement the M-PROVE model at three additional academic urology institutions to evaluate its effectiveness and to identify any potential barriers. Leng reports on how the M-PROVE model can be implemented at other institutions and can effectively improve attendee attitudes and enhance the perceived value of MMCs across multiple domains.

Leng also presents “Social Predictors of No Shows at an Urban, Safety-Net Urology Clinic: A Mixed Effects Model Study” (#211) during the “Health Policy-Data Quality” session. Clinic non-attendance negatively affects patient outcomes and disrupts clinic workflow. This study aims to identify predictors of patient no-shows at an urban, safety-net urology clinic. Predictors of urologic clinic no-shows were a history of being unhoused, historical no-show rate, inactive patient portal and increased time from appointment scheduling, of which the latter two are intervenable. This study offers upstream solutions for improving attendance for a safety-net clinic and healthcare access for urologic patients.

Amy Showen, MD, MSc, resident physician in the UCSF Department of Urology, presents
“Characterizing 7-Day Hospital Revisits Following Outpatient Urologic Procedures: A Single-Institution Analysis Using Vizient Data” (#134) during the “Health Policy-Data Quality” session. The seven-day revisit rate is a metric gaining traction as a measure of healthcare quality and performance. Vizient, a leading healthcare performance improvement company, supports this metric’s adoption for internal benchmarking and national ranking. This study aims to characterize seven-day revisit rates after outpatient urologic procedures, identify procedure-related versus unrelated revisits, and compare revisit patterns between clinic-based and operating room (OR)-based procedures. Showen reports on the nature of seven-day hospital revisits and examines the opportunities for targeted interventions to reduce unnecessary emergency and inpatient utilization.

Marvin Carlisle, BA, UCSF medical student, presents “Development and Validation of a Generative Artificial Intelligence-Based Pipeline for Automated Clinical Data Extraction from Electronic Health Records: Technical Implementation Study” (#206) during the “Public Policy-Data Quality” session. Manual abstraction of unstructured clinical data for clinical research is time consuming and can be of variable quality. Large language models (LLMs) show promise in medical data extraction, yet integrating them into research workflows remains challenging and poorly described. The objective of this study was to develop and integrate an LLM-based system for automated data extraction from unstructured electronic health record (EHR) text reports within an established clinical outcomes database. Carlisle reports on the study’s successful integration of an LLM-based system for automated report extraction within an existing outcomes database and how this approach could significantly accelerate research timelines and expand feasible clinical studies for large-scale projects.

Monday, Nov. 3, from 2:15 p.m. to 3:30 p.m.

Kevin Shee, MD, PhD, resident physician in the UCSF Department of Urology, presents “Development of a novel RNA biomarker for prostate cancer detection using seminal fluid: results from a large multicenter clinical study” (#139) during the “Prostate Cancer 1” session. Prostate-specific antigen (PSA) testing remains the standard for prostate cancer (PCa) screening, but its limited specificity often leads to unnecessary biopsies and overdiagnosis. Given that the prostate contributes to approximately one-third of seminal fluid, this accessible biofluid represents a promising, noninvasive source for biomarker discovery. In this multicenter study, Shee and his colleagues developed a novel biomarker combining seminal fluid RNA expression with clinical data to detect clinically significant PCa (csPCa). Combining seminal fluid RNA with PSA and age improved csPCa detection.

Shee also presents “External validation of a pathology-based multimodal artificial intelligence biomarker for predicting prostate cancer outcomes after prostatectomy” (#132) during the “Prostate Cancer 1” session. Radical prostatectomy (RP) improves survival in localized prostate cancer (PCa), but 20%-40% of patients experience biochemical recurrence (BCR) within 10 years, with one-third progressing to metastasis. Predictive tools for stratifying post-RP risk remain limited. Shee and his colleagues previously developed and validated a digital pathology-based multimodal AI (MMAI) model (RP MMAI v1.1) using H&E images and clinical data to predict outcomes in BCR patients. In this study, Shee presents its first external validation in both BCR and non-BCR post-RP patients.

Tuesday, Nov. 4, from 9:00 a.m. to 10:30 a.m.

Behzad Abbasi, MD, research fellow in the UCSF Department of Urology, presents “Long-Term Reoperation Patterns After Surgical Correction of Male Urinary Incontinence” (#175) during the “Pelvic Floor Reconstruction and Voiding Dysfunction” session. This study evaluated long-term reoperation patterns in men undergoing artificial urinary sphincter (AUS) or male sling placement for stress urinary incontinence using population-level data. Specifically, the study aimed to quantify transitions to alternate treatment in each group, finding one in five sling patients ultimately undergo salvage AUS implantation and, over the long term, more than half of AUS patients require additional surgeries, representing twice the risk in sling patients.

Madeleine Ball, MD, resident physician in the UCSF Department of Urology, presents “OAB patient utilization of neuromodulation rates decrease as bladder botox rates increase; trends from the AUA AQUA registry” (#5) during “Pelvic Floor Reconstruction and Voiding Dysfunction” session. Overactive bladder (OAB) is a common condition affecting millions annually; treatments include behavioral, pharmacotherapy and minimally invasive therapies (MIT). While several MIT options exist – bladder botox (BB), tibial nerve stimulation (TNS), sacral neuromodulation (SNM) – overall utilization remains low. This study’s purpose was to evaluate treatment trends over time. Ball reports that overall utilization of MIT is low; less than 3% of diagnosed patients receive MIT over a 9-year period. While bladder botox has seen a steady uptick in utilization, SNM and percutaneous (P) TNS have declined, with the PTNS decline appearing to coincide with the COVID-19 pandemic. These findings highlight an opportunity to better understand patient and provider preferences and limitations when selecting MIT.

Tuesday, Nov. 4, from 11:15 a.m. to 12:30 p.m.

Walter Hsiang, MD, MBA, resident physician in the UCSF Department of Urology, presents
“Accessibility and costs of surgical fertility services in the United States using a secret shopper methodology” (#93) during the “Sexual Medicine and Infertility” session. When choosing male fertility services, many men face an opaque landscape of surgical options, insurance acceptance and cost. This study aimed to identify 1) the types of surgical fertility services such as vasectomy reversal (VR) and testicular sperm extraction (TESE), 2) the rates of insurance acceptance and 3) self-pay costs at all fertility centers across 22 states. Hsiang reports on the difficulty for men to access surgical fertility services and how the cost of surgical fertility services remains opaque, as many fertility centers refuse to provide a self-pay cost of a fertility procedure.

Thursday, Nov. 6, from 9:00 a.m. to 11:00 a.m.

Kevin Shee, MD, PhD, presents “Tumor Microenvironmental NRG1 Drives Resistance to PI3K Pathway Inhibition in Prostate Cancer” (#137) during the “Prostate Cancer 2” session. Despite the prevalence of phosphoinositide 3-kinase (PI3K) pathway alterations in prostate cancer (PCa), the clinical efficacy of PI3K-targeted therapies in combination with androgen deprivation therapy (ADT) has been limited. In this study, Shee and his colleagues designed a comprehensive secreted factor screen to determine novel TME-mediated resistance mechanisms to PI3K pathway inhibitors in PCa. NRG1 in the PCa TME activates HER3 signaling and promotes resistance to both AR and PI3K pathway inhibitors. Shee reports on how targeting HER3 in combination with PI3K inhibitors represents a promising therapeutic strategy to overcome NRG1-mediated resistance mechanisms in advanced prostate cancer.

Marvin Carlisle, BA, UCSF medical student, presents “Urinary Adverse Events Following Robotic versus Non-Robotic Radical Prostatectomy in Medicare Beneficiaries” (#161) during the “Prostate Cancer 2” session. Robot-assisted radical prostatectomy (RARP) is now the dominant surgical method for localized prostate cancer, yet comparisons of postoperative urinary adverse events (UAEs) to non-robotic approaches in the mature robotic era are limited. This study compares UAEs following RARP versus non-RARP using contemporary, population-based data. Carlisle reports on how RARP significantly reduced postoperative UAEs compared to non-RARP.

Thursday, Nov. 6, from 11:00 a.m. to 1:00 p.m.

Emily Hacker, MD, resident physician in the UCSF Department of Urology, presents
“An Unintended Perfect Puncture” (#50) during the “Round Table” program. This case involves a 40-year-old woman who presented to the ER on POD3 of abdominoplasty and liposuction of the flanks with hematuria, new urinary incontinence, acute kidney injury and flank pain. A ballistics-style analysis of the liposuction entrance site on her midline lower back and CT/renoscopy findings led the UCSF team to conclude her hematuria and subsequent clot retention were a result of two inadvertent renal punctures from deep passes of the liposuction cannula. Hacker presents this case of inadvertent penetrating renal trauma from liposuction, resulting in renal bleed and subsequent clot retention. While there have been reports of visceral injury, perforations of the bowel and liver, to date, there has been only one other case report of urologic injury (tear of the ureter at the ureteropelvic junction). To the researchers’ knowledge, this is the first case of renal parenchymal puncture as a consequence of liposuction.