Page 1 - CUA2018 Abstracts - Robotics

2018 CUA AbstrACts

Poster Session 8: Robotics/Other Urology Topics

June 26, 2018; 0800–0930

MP–8.1 Methods: Prospective data of 578 RARPs performed by one surgeon (KCZ)
Impact of the Rocco stitch on return to urinary continence at an academic centre were reviewed. NP was planned preoperatively using
following robot–assisted radical prostatectomy: Results of a an institution–adopted protocol. Age, body mass index (BMI), prostate–
prospective, longitudinal, randomized controlled trial specific antigen (PSA), cStage, prostate size, number of lifetime biopsies,
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Jen Hoogenes , Derek Bos , Lisa Patterson , Yuding (Ding) Wang , post–biopsy sepsis, Gleason score, Sexual Health Inventory for Men (SHIM)
Christopher Wu , Forough Farrokhyar , Bobby Shayegan 1 score, and time from biopsy to surgery were compared to change in NP.
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1 Department of Surgery, Division of Urology, McMaster University, Surgical techniques were NP (interfascial resection) or nerve resection (NR)
Hamilton, ON, Canada (extrafascial resection). Significant/near–significant predictors on univariate
Study Groups: The Masonic Foundation of Ontario. regression underwent multivariate analysis.
Introduction: Urinary incontinence post–radical prostatectomy is a well– Results: A total of 271(46.9%) cases underwent some intraoperative change
recognized complication. Twelve–month continence rates typically range in NP from preoperative plan; 234 were to any unplanned NR, with 98 to
from 85–95%, yet few patients are continent in the early postoperative bilateral NR. Age, prostate size, Gleason score, cStage, SHIM score, and
period. Posterior reconstruction of the Denonvilliers’ musculofascial plate, post–biopsy sepsis were significant univariate predictors of additional NR.
also referred to as the “Rocco stitch” technique, may improve early return On multivariate analysis,Gleason ≥7 and older age were significant predic-
to continence. We evaluated short– and long–term return to urinary con- tors of unplanned NR. Older age and post–biopsy sepsis were significantly
tinence post–robot–assisted radical prostatectomy (RARP) by comparing associated with more unplanned bilateral NR. There were no predictors
the Rocco stitch (intervention) vs. conventional urethrovesical anastomosis of unexpected NP.
(UVA) (control). Conclusions: Our study provides a first insight into factors leading to change
Methods: Consecutive patients undergoing RARP were prospectively in NP surgical planning in RARP, directly affecting functional outcomes.
recruited in clinic and randomly allocated to either the intervention or Older age, Gleason ≥7, and post–biopsy sepsis were significant predic-
control group and blinded to allocation status. All cases were performed tors of more unplanned NR, which should guide counselling of risks and
by a single high–volume surgeon at a tertiary healthcare centre. Outcomes functional outcomes. Finally, number of lifetime biopsies had no effect on
were assessed using the EPIC–26 form at baseline and two–, three–, four–, NP, suggesting that more biopsies in actively surveilled patients may not
six–, eight–, and 12–month followup. Pad use and continence scores were lead to more unplanned NR.
compared using the Chi–square and Mann–Whitney U tests. An ordinal Reference:
generalized estimating equation model assessed the treatment effect of the 1. Zorn K, Gofrit O, Steinberg G, et al. Planned nerve preservation to
Rocco stitch on urinary continence over time. reduce positive surgical margins during robot–assisted laparoscopic
Results: A total of 139 patients were included in the analysis (Rocco n=73; radical prostatectomy. J Endourol 2008;22:1303–9. https://doi.
control n=66). Mean age was 63.2±8 years. No differences were found org/10.1089/end.2008.0009
between groups for preoperative clinical and functional variables. Using
a continence definition of ≤1 pad(s)/day, no significant differences were MP–8.3
found between groups at any of the followup time points (Table 1; avail- Randomized control trial evaluating the utility of verapamil in
able at https://cua.guide/). Frequency of urine leak, quantity of pad use, perfusate solution during pulsatile perfusion in renal transplants
subjective urinary control, and overall bother improved significantly in all Roderick Clark , Shawna Boyle , Seyed Acquil , Alp Sener , Patrick Luke 1
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patients during the study period (p<0.001). The 12–month continence rate 1 Urology, Western University, London, ON, Canada; Urology, University
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for the Rocco group was 93.0% vs. 85.7% for the control group (p=0.258). of Nebraska Medical Center, Omaha, NE, United States
Conclusions: The use of the Rocco stitch showed no statistical significance Introduction: Contemporary kidney transplantation has seen dramatic
in shortening time to urinary continence post–RARP when compared to improvements in acute rejection rates, but improving graft function/survival
conventional UVA. Larger, multicentre studies are required to support continues to be a challenge. The objective of our study was to evaluate
these findings. whether the addition of verapamil into cold pulsatile perfusion solution
can improve overall graft function or survival in renal transplant recipients.
MP–8.2 Methods: Between October 2008 and September 2010, 30 patients receiv-
Risk factors for deviation of planned nerve preservation during ing matched pair deceased donor organs were randomized to have vera-
robotic radical prostatectomy pamil infused into the perfusate during pulsatile perfusion of their kidneys.
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Stefano Polesello , Félix Couture , Côme Tholomier , Assaad El–Hakim , One kidney of the donor pair received 5 mg of verapamil, whereas the
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Pierre Karakiewicz , Kevin Zorn 1 second kidney did not receive supplementation. Surgeons and physicians
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1 Department of Urology, University of Montreal Hospital Centre, Montreal, were blinded to the randomization.
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QC, Canada; Section of Urology, Department of Surgery, McGill University, Results: The study group contained 10 women and participants had an
Montreal, QC, Canada median body mass index of 27.6 and median age of 57 years. In terms
Introduction: Robot–assisted radical prostatectomy (RARP) enhances surgi- of the transplanted organs, 24 were from donors after neurological death,
cal precision of nerve preservation (NP) in localized prostate cancer treat- 20 were from standard criteria donors, and median cold ischemia time was
ment. Studies have shown the effect on surgical margins and functional 1002 minutes. There were no significant differences between our recipients’
outcomes of protocol use for NP planning. Despite protocol use, many demographic characteristics as a consequence of the matching process.
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planned NP techniques change intraoperatively. Currently, no published There were no differences in groups for cold ischemia time or initial urine
work evaluates preoperatively planned and executed NP in RARP or risk output. We found significant improvements in the estimated glomerular
factors for deviation. Our study aims to identify risk factors of intraoperative filtration rate (eGFR) at one year for individuals who received verapamil
change in NP technique. (0.84, 95%; p=0.04) but no difference in eGFR at two–year (0.84; p=0.12)
S108 CUAJ • June 2018 • Volume 12(6Suppl2)
© 2018 Canadian Urological Association