Page 2 - CUA2018 Abstracts - Reconstruction

Poster session 6: reconstruction/trauma/transplant

the entire cohort was 5.5 cm (±3.1) and intraoperative stricture length MP–6.5
was 6.0 cm (±3.1) (p<0.0001). Overall, 10.5% of patients were found Buccal vs. lingual mucosa as ventral onlay grafts in substitution
to have a discrepancy of ≥2 cm when compared to preoperative staging urethroplasty for bulbar urethral strictures
(Table 2; available at https://cua.guide/). Of the 210 patients, 100 (47.6%) Ehab Elkady , Mohamed Teleb , Tamer Dawod , Waleed Shabana ,
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underwent preoperative staging with pediatric cystoscopy. Patients under- Nashaat Salama 1
going preoperative assessment with pediatric cystoscopy had a smaller 1 Urology Department, Zagazig University, Zagazig, Egypt
mean discrepancy in stricture length (0.1 vs. 0.9 cm; p<0.0001) and were Introduction: We aimed to compare the outcome of buccal and lingual
less likely to have a discrepancy of ≥2 cm (1.0% vs. 19.1%; p<0.0001) mucosae applied as ventral onlay grafts in substitution urethroplasty (SU)
(Table 3; available at https://cua.guide/). Patient age (p=0.31), previous for bulbar urethral strictures >2 cm.
endoscopic treatment (p=0.24), prior urethroplasty (p=0.64), and stricture Methods: A prospective, randomized study was conducted on 64 patients
etiology (p=0.76) were not associated with stricture length discrepancy with bulbar urethral strictures >2 cm over four years. Our patients were
(Table 4; available at https://cua.guide/). Use of pediatric cystoscopy was randomized into two groups of 32 patients each: Group A, in whom
not associated with stricture recurrence (p=0.74) or postoperative com- buccal mucosa graft (BMG) SU was performed; and Group B, which
plications (p=0.58). Ancillary urethral pathology was detected in 7.6% included those managed by lingual mucosa graft (LMG) SU. Operative
(16/210) of patients. time, post–procedure outcomes, and perioperative complications were
Conclusions: Preoperative use of semi–rigid pediatric cystoscopy more recorded and statistically analyzed in followup periods that ranged from
accurately stages penile urethral stricture length prior to operative inter- 12–48 months. Reconstruction was considered successful if there was
vention. A pediatric cystoscope should be an instrument found in every normal voiding (subjective and objective) without the need for any endo-
reconstructive urologist’s surgical armamentarium. scopic or surgical intervention.
Results: Operative time (mean ± standard deviation [SD]) and success
MP–6.4 rate were 150±31 minutes and 93.75 % in the BMG group, and 155±29
Bulbospongiosus muscle–sparing urethroplasty vs. standard minutes and 90.62% in the LMG group, with no statistically significant
urethroplasty: A comparative study difference. Postoperative urinary extravasation was noted in four (12.5%)
Ehab Elkady , Waleed Shabana , Mohamed Teleb , Tamer Dawod 1 three (9%) patients in Groups A and B, respectively. All these cases were
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1 Urology Department, Zagazig University, Zagazig, Egypt managed by catheter re–insertion for an additional two weeks. Both donor
Introduction: We aimed to compare the outcome of muscle– and nerve– site and urethroplasty–related perioperative complications were compa-
sparing bulbar urethroplasty with the standard bulbar urethroplasty as rable between the two groups.
regard ejaculatory dysfunction and post–void dribbling. Conclusions: Both buccal and lingual mucosae can be applied success-
Methods: This prospective randomized study included 50 patients with fully as ventral onlay grafts in substitution urethroplasty to manage urethral
bulbar urethral stricture who underwent urethroplasty over a period of five strictures >2 cm.
years. All patients were operated by ventral onlay buccal mucosal graft
(BMG) urethroplasty. Patients were randomly divided into two groups. MP–6.6
Group 1 (n=25) was operated by the standard bulbar urethroplasty. Multichannel urodynamic assessment in men with post–
Group 2 (n=25) was operated by bulbar urethroplasty with preservation prostatectomy urinary incontinence: A cost–utility analysis
of the bulbospongiosus muscle and nerve. Followup for postoperative Rano Matta , Joseph LaBossiere , Alaina Garbens , Ronald Kodama ,
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complications, as well as ejaculatory dysfunction and post–void urine Robert Nam , David Naimark , Sender Herschorn 1
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dribbling, was performed at one, six, and 12 months, and annually there- 1 Division of Urology, University of Toronto, Toronto, ON, Canada;
after. Urethrography was done at one month, while uroflowmetry was 2 Institute of Health Policy, Management and Evaluation, University of
performed at six and 12 months. Urethrography was indicated if maximum Toronto, Toronto, ON, Canada; Division of Nephrology, University of
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flow rate (Qmax) was <14 ml/sec. Success was defined as normal voiding Toronto, Toronto, ON, Canada
without using any auxiliary procedures. Study Groups: University of Toronto Research Program in Functional
Results: Success rate was 88% and 92% in Groups 1 and 2, respectively. Urology.
There was no statistically significant difference between the two groups as Introduction: Men with persistent post–prostatectomy incontinence (PPUI)
regard mean (± standard deviation [SD]) age, body mass index, followup receive standard investigation (SI) consisting of history, physical examina-
period, and stricture length. Urethral sacculation was not detected in any tion, and cystoscopy. In complex cases, they receive urodynamic (UDS)
patient in either group. One patient from Group 1 was complicated by assessment, although this is not standard. Some experts argue that UDS
urinary extravasation after catheter removal and required re–catheter- should be performed routinely, although there is a paucity of evidence to
ization for another one week. Two patients (one in each group) were support this. Therefore, our objective was to compare the quality–adjusted
complicated by postoperative wound infection managed by antibiotics. life expectancy (QALE) and the relative cost–utility of treatment decisions
Post–void dribbling was the complaint of nine patients in Group 1 and based on SI vs. SI+UDS in men with PPUI.
one patient in Group 2, while semen sequestration was present in 10 and Methods: We constructed a Markov model employing a two–dimensional
two patients in Groups 1 and 2, respectively. Statistical significant differ- Monte Carlo simulation using a lifetime horizon to compare the use of
ences were observed between the two groups with regard to post–void preoperative SI+UDS and SI. We assumed that UDS always identifies the
dribbling and ejaculatory dysfunction (p<0.05). correct diagnosis. We validated our model using previous retrospective
Conclusions: Bulbar urethroplasty with bulbospongiosus muscle– and studies. Transition probabilities and health state utilities were derived from
nerve–sparing seems to be a safe and effective alternative for the standard a literature search of MEDLINE and expert consensus. Direct healthcare
bulbar urethroplasty. costs were derived from health administrative data. Using the simula-
tion results, we conducted a cost–utility analysis comparing the two
approaches.
Results: Men receiving SI+UDS assessment were incontinent for 12.4
months less than those assessed with SI alone, experienced less medica-
tion failure, and had an incremental cost–utility ratio (ICUR) of $1110
per quality adjusted life year (QALY). SI+UDS was cost–effective with a
willingness–to–pay (WTP) threshold set at $50 000 per QALY gained. The
model was sensitive to patient age at treatment, with SI+UDS becoming
the dominant strategy after a threshold age of 70. In probabilistic sen-
sitivity analysis, the model was robust to parameter uncertainty across
CUAJ • June 2018 • Volume 12(6Suppl2) S97