Page 4 - CUA2018 Abstracts - Reconstruction

Poster session 6: reconstruction/trauma/transplant

Methods: A retrospective review of patients <20 kg who underwent kidney stenting may not impact rate of UTIs. In addition, we found that UVS often
transplant in our institution from 2000–2015 was performed. Patients present in a delayed fashion, so early routine transplant ultrasonography
at increased risk of thrombosis (previous thrombosis, thrombophilia, at 8–10 weeks postoperative may not be beneficial.
nephrotic syndrome) and bleeding (therapeutic doses of heparin, diag-
nosis of coagulopathy) were excluded. Parameters collected included: UP–6.2
age, weight, sex, dialysis type, donor type, heparin infusions/doses, hemo-
globin (Hb) levels, post–transplant pRBC transfusions, surgical re–explo- Better defining the optimal management of penile urethral
ration, and thrombotic events. Bleeding complications were defined as: strictures: A retrospective comparison of single–stage vs. two–
drop in Hb >20 mg/L, post–transplant pRBC transfusions, and surgical stage urethroplasty 1 1 1
1
re–exploration. Nathan Hoy , David Chapman , Keith Rourke , Alvaro Saavedra
1
Results: A total of 56 patients were identified (HP n=46; NHP n=10). Division of Urology, University of Alberta, Edmonton, AB, Canada
Baseline demographics were similar between HP & NHP (Table 1; avail- Introduction: The purpose of our study is to compare single–stage and
able at https://cua.guide/). HP group was more likely to have drop in two–stage urethroplasty techniques in the treatment of penile urethral
Hb >20 g/L (67.4% vs. 30.0%; p=0.038). There was no statistical differ- strictures.
ence in frequency of transfusions, surgical re–exploration, or thrombotic Methods: We performed a retrospective review of penile urethroplas-
events, but those who had drop in Hb >20 g/L were more likely to ties performed at a single centre between 2003 and 2017, including all
also require pRBC transfusions (Table 2; available at https://cua.guide/). patients who underwent repair of a penile urethral stricture. The primary
Subgroup analysis of the HP group showed that those who had bleeding outcome was urethral patency, defined as the ability to easily pass a 16
complications had similar Hb levels as those who did not at baseline and Fr flexible cystoscope at six and 18 months of followup, and develop-
post–transplant (Table 3; available at https://cua.guide/). ment of complications.
Conclusions: HP may be effective at preventing thrombotic complications Results: In total, 101 single–stage procedures (48 buccal mucosal graft
in kidney transplant recipients weighing <20 kg. However, HP increases [BMG] and 53 penile fasciocutaneous flap [PFF]) and 53 two–stage pro-
the likelihood of >20 g/L drop in Hb, which may increase the rates of cedures were performed. There was no difference in mean stricture length
transfusions. between groups (p=0.25). Cox regression analysis did not find stricture
References: etiology (p=0.76), length (0.29), age (p=0.24), obesity (p=0.07), prior
1. Kranz B, Vester U, Nadalin S, et al. Outcome after kidney trans- reconstruction (p=0.36), or urethroplasty technique (p=0.35) to be associ-
plantation in children with thrombotic risk factors. Pediatr ated with failure. Kaplan–Meier plots and log rank testing did not dem-
Transplant 2006;10:788–93. https://doi.org/10.1111/j.1399– onstrate a difference in success rates between surgical techniques (91%
3046.2005.00483.x PFF vs. 83% BMG vs. 87% two–stage). Overall, 36% (56/154) of patients
2. Murashima M, Konkle B, Bloom RD, et al. A single–centre expe- experienced a complication (51% PFF vs. 25% BMG vs. 32% two–stage).
rience of pre–emptive anticoagulation for patients with risk fac- Binary logistic regression analysis found urethroplasty technique to be the
tors for allograft thrombosis in renal transplantation. Clin Nephrol only factor associated with development of complication (p=0.02). The
2010;74:351–7. https://doi.org/10.5414/CNP74351 odds ratio for complications relative to BMG was 3.1 (95% confidence
interval [CI] 1.33–7.30; p=0.009) for PFF and 1.4 (95% CI 0.59–3.4;
p=0.43) for two–stage urethroplasty.
UP–6.1 Conclusions: There appears to be little difference in success for penile
Urological complications following renal transplantation: Who urethroplasty between single–stage BMG, PFF, and two–stage urethroplas-
and why? ties. Complication rates were higher with single–stage PFF and two–stage
Jethro Kwong , Tadeusz Kroczak , John Honey , Robert Stewart , Kenneth repairs. The paradigm shift to a single–stage BMG, when appropriate,
2
2
1
2
Pace , Michael Ordon , Jason Lee 2 appears to be founded on the basis of less operations for the patient,
2
2
1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada; relative to a two–stage repair, and a lower complication profile, relative
2 Division of Urology, Department of Surgery, University of Toronto, to single–stage PFF, without compromising success rates.
Toronto, ON, Canada
Introduction: Urological complications after renal transplantation, such UP–6.3
as ureterovesical strictures (UVS) and urinary tract infections (UTI), can
compromise graft survival and impact patient morbidity. Our objective Characterization and outcomes of hypospadias–associated
was to retrospectively review renal transplants performed at our cen- urethral strictures in adults: Proposal of a treatment classification
tre to determine the incidence of UVS and UTI, as well as to examine system 1 1
patient and surgical factors possibly related to the development of these 1 Alvaro Saavedra , Keith Rourke
complications. Division of Urology, University of Alberta, Edmonton, AB, Canada
Methods: All renal transplants performed at our centre between June 2011 Introduction: Urethral stricture is one of the most frequent complications
1–5
and September 2013 were retrospectively reviewed. The primary outcome after hypospadias repair (HR), but remains poorly described. The aim
was the diagnosis of UVS or UTI within one year postoperative. UVS was of this study is to better characterize hypospadias–associated urethral
defined as clinically significant hydronephrosis due to stricture disease strictures (HAUS) and postoperative outcomes (PO).
necessitating intervention. UTI was defined as positive urine culture in Methods: We included 84 patients who underwent urethroplasty (UP) for
the presence of lower urinary tract symptoms. Patient and surgical factors HAUS from 2003–2016 at our centre. All patients underwent preopera-
were assessed to see if they were predictors of the primary outcomes. tive cystoscopy and urethrogram, as well as at six and 18–24 months PO.
Results: A total of 288 patients were eligible for inclusion in our retrospec- They were divided into four groups based on their stricture characteristic:
tive review. UTIs occurred in 9.9% of patients, with E. coli being the most Group 1: Previous HR with stricture involving the entire repair; Group 2:
common organism (55.2%). The majority of UTIs (58.6%) occurred with “Junctional stricture” with acceptable HR and stricture at the junction of
the stent in situ, however, there was no correlation between stent dura- the neourethra and native urethra; Group 3: Isolated stricture outside the
tion and development of a UTI. UTIs were weakly associated with older repaired urethra; and Group 4: Urethral stricture in non–treated hypo-
age (r=0.126; p=0.04), and female gender (r=0.135; p=0.03). UVS were spadias. Patients were characterized with regard to age, stricture length,
seen in only three patients (1.0%), with mean time of presentation 16.7 location, concurrent pathology/complications, previous repairs, and type
weeks postoperative. UVS were weakly associated with a history of prior of UP, as well as PO outcomes and complications. Univariate and survival
kidney transplantation (r=0.200; p<0.01) and DGF (r=0.233; p<0.001). multivariate analysis were performed.
Conclusion: This study demonstrates that while UTIs are somewhat com- Results: Median patient age was 36 years and mean stricture length 5.0
mon post–renal transplant (~10%), UVS are relatively rare (~1%). Our cm (Table 1; available at https://cua.guide/). Patients were categorized in
study suggests older women are more prone to UTIs, but duration of four groups based on stricture length, location and number of previous
CUAJ • June 2018 • Volume 12(6Suppl2) S99