Page 1 - CUA2018 Abstracts - Reconstruction
P. 1
2018 CUA AbstrACts
Poster Session 6: Reconstruction/Trauma/Transplant
June 25, 2018; 0800–0930
MP–6.1 Methods: We performed a population–based, retrospective cohort study
Multicentre, comparative analysis of transecting and non– using adult men from Ontario, Canada. We identified patients who had
transecting anastomotic bulbar urethroplasty techniques undergone endoscopic treatment only (urethral dilation or VIU) or ure-
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David Chapman , Katherine Cotter , Niels Johnsen , Sunil Patel , Adam throplasty after one endoscopic treatment between January 1, 2003 and
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Kinnaird , Bradley Erickson , Jill Buckley , Bryan Voelzke , Keith Rourke 1 December 31, 2016 using administrative databases. Men had to have
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1 Urology, University of Alberta , Edmonton, AB, Canada; Urology, undergone two or more endoscopic treatments or urethroplasty after one
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University of Iowa, Iowa City, IA, United States; Urology, University of endoscopic procedure. We determined the total, one–year and five–year
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Washington, Seattle, WA, United States; Urology, University of California, average, per person healthcare costs in 2016 Canadian dollars using a
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San Diego, CA, United States methodology that calculates patient–level costing from healthcare usage.
Introduction: Transecting anastomotic urethroplasty has been the subject Results: In total, 11 893 men underwent at least two endoscopic procedures
of some controversy related to a possible adverse effect on sexual func- during the study period; 184 men had a urethroplasty after one endoscopic
tion. Non–transecting variations of anastomotic urethroplasty were created, procedure. The total cost for men who underwent at least two endoscopic
in part, to address this potential concern. The objective of this multicen- procedures was $59 855/person. The year one– and five–year average costs
tre study is to compare outcomes of transecting and non–transecting anas- were $16 067/person and $11 101/person, respectively. The total cost for
tomotic urethroplasty techniques. men who underwent urethroplasty after one endoscopic procedure was
Methods: A total of 352 patients with complete followup underwent anas- $45 062/person. The year one and year five average costs were $18 511/
tomotic bulbar urethroplasty from September 2003 to March 2017 per- person and $3394/person, respectively. Men who underwent a urethroplasty
formed by one of four reconstructive urologists. The primary (objective) had a total cost savings of $14 793/person.
outcome was success defined as urethral patency >16 Fr on routine fol- Conclusions: We found that performing urethroplasty after one failed endo-
lowup cystoscopy. Secondary outcome measures included 90–day compli- scopic procedure has an average cost savings of almost $15 000/person
cations (Clavien >2) and de novo sexual dysfunction assessed at six months. compared to pure endoscopic management.
Comparison between transecting and non–transecting cohorts were made References:
using Cox regression, t–test or Chi–square when appropriate. 1. Wessells H. Cost–effective approach to short bulbar urethral stric-
Results: Mean stricture length was 1.7±0.8 cm (0.5–5), with a mean age of tures supports single internal urethrotomy before urethroplasty. J Urol
44.6 years. The two groups did not differ by age (p=0.44) or stricture length 2009;181:954–5. https://doi.org/10.1016/j.juro.2009.02.042
(p=0.49). Overall, there was a 94.9% (n=334) success rate with a mean 2. Wright JL, Wessells H, Nathens AB, et al. What is the most cost–
followup of 64.2 months (6–170). Twenty–five patients (7.1%) experienced effective treatment for 1–2 cm bulbar urethral strictures: societal
a 90–day postoperative complication (Clavien >2) and 41 (11.6%) reported approach using decision analysis. Urology 2006;67:889–93. https://
an adverse change in sexual function. When comparing transecting (n=258) doi.org/10.1016/j.urology.2005.11.003
and non–transecting (n=94) techniques, there was no difference in success
(93.8% vs. 97.9%; p=0.18) and no difference in postoperative complica- MP–6.3
tions (8.1% vs. 4.3%; p=0.25). Patients undergoing transecting anastomotic Optimal preoperative staging of penile urethral stricture length:
urethroplasty were more likely to report an adverse change in sexual func- The critical role of pediatric cystoscopy
tion (14.3%; vs. 4.3%; p=0.008). Callum Lavoie , Keith Rourke 1
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Conclusions: Anastomotic urethroplasty remains a highly effective surgery 1 Division of Urology, University of Alberta, Edmonton, AB, Canada
with relatively minimal associated morbidity. Newer, non–transecting anas- Introduction: Accurate staging of penile urethral strictures can be challeng-
tomotic urethroplasty techniques compare quite favourably to transecting ing, particularly when the urethral meatus is involved. The aim of this study
techniques and likely reduce the risk of associated sexual dysfunction. is to examine the effect of a pediatric cystoscope when used in conjunction
with retrograde urethrography to accurately stage penile urethral stricture
MP–6.2 length prior to urethroplasty.
Comparing healthcare expenditures in the management of urethral Methods: We conducted a retrospective review of patients undergoing
stricture disease in Ontario surgery for penile urethral stricture (with involvement of the meatus) at a
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Alaina Garbens , Christopher Wallis , Rano Matta , Robert Nam , Ronald single centre from 2004–2016. Patients underwent retrograde urethrography
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Kodama , Sender Herschorn 1,2 preoperatively with or without the use of an 8 Fr semi–rigid pediatric cys-
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1 Urology, University of Toronto, Toronto, ON, Canada; Urology, Sunnybrook toscope. Outcome measures were discrepancy in stricture length between
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Health Sciences Centre, Toronto, ON, Canada and also length discrepancy ≥2 cm based on preoperative and intraoperative
Study Groups: University of Toronto Research Program in Functional measurements. Patient age, stricture etiology, prior endoscopic treatment,
Urology, CUA Resident Research Grant. prior urethroplasty, type of urethroplasty, complications, and success (easy
Introduction: Treatment options for urethral stricture disease (USD) in men of passage of a 16 Fr flexible cystoscope on followup) were recorded.
include endoscopic management and open surgical correction (urethro- Descriptive statistics were used to summarize findings and comparisons
plasty). Studies have found repeat endoscopic procedures to be costly, were made using t–tests, Chi–square, or Cox regression, where appropriate.
concluding that urethroplasty should be offered after one visual internal Results: Overall, 210 patients were included in the study with a mean
urethrotomy (VIU). Currently, no studies have looked at costs at the popu- age of 46 years; 90.5% (190) failed endoscopic treatments, while 38.6%
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lation level. We sought to determine the direct healthcare expenditures (81) also failed prior urethroplasty (Table 1; available at https://cua.guide/).
for men with USD following either endoscopic treatment only, or one The most common stricture etiologies were hypospadias (34.3%), lichen
endoscopic treatment with subsequent urethroplasty. sclerosus (30.0%), and iatrogenic (15.7%). Preoperative stricture length of
S96 CUAJ • June 2018 • Volume 12(6Suppl2)
© 2018 Canadian Urological Association