Page 3 - CUA2018 Abstracts - Robotics

Poster session 8: robotics/Other Urology topics

MP–8.6 symptoms was 5±4.5 years. The NIH–CPSI scores are depicted in Table
Incorporating measures of patient safety into technical skill 1 (available at https://cua.guide/). One month after completing ESWT,
assessments in robotic–assisted radical prostatectomy 100% of patients reported an improvement in all the NIH–CPSI domains,
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Mitchell Goldenberg , Hossein Saadat , Alaina Garbens , Jason Lee , with a mean improvement in total score of 9.7±6.3 points, in pain score
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Antonio Finelli , Teodor Grantcharov 2 of 5.3±3.9 points, in urinary symptom score of 0.9±2.2 points, and in
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1 Division of Urology, University of Toronto, Toronto, ON, Canada; quality of life score of 3.5±2.7. However, six months after completing
2 Division of General Surgery, University of Toronto, Toronto, ON, Canada ESWT, 79.4% of patients reported an improvement in all the NIH–CPSI
Introduction: The expansion of robotic surgery in urology has necessitated domains, with a mean improvement in total score of 8±8.1 points, in pain
the creation of assessment tools to evaluate trainee and surgeon technical score of 3.8±4.9 points, in urinary symptom score of 0.8±2.6 points, and
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performance. It remains unknown whether these assessments have any in quality of life score of 3.5±3.1. None of the patients developed any
relationship with intraoperative adverse events (iAEs). We examine the treatment–related complications.
correlative properties of global rating scales (GRS) and iAEs in a cohort Conclusions: ESWT is a safe and effective treatment modality for patients
of robotic–assisted radical prostatectomy (RARP) patients. with CPPS, with long–term improvement in symptoms.
Methods: Intraoperative video from prospective, RARP cases at a single, References:
quaternary referral cancer centre was collected sequentially. Expert video 1. Schaeffer AJ. Epidemiology and evaluation of chronic pelvic pain
analysts blindly rated intracorporeal video, using the Global Evaluative syndrome in men. Int J Antimicrob Agents 2008;31: S108–11. https://
Assessment of Robotic Skills (GEARS), the Prostatectomy Assessment of doi.org/10.1016/j.ijantimicag.2007.08.027
Competency Evaluation (PACE), and the Generic Error Rating Tool (GERT). 2. Walz J, Perrotte P, Hutterer G, et al. Impact of chronic prostati-
The GERT is a validated tool that allows for detailed, objective quanti- tis–like symptoms on the quality of life in a large group of men.
fication and categorization of iAEs, including surgeon technical errors. Br J Urol Int 2007;100: 1307–11. https://doi.org/10.1111/j.1464–
Spearmans rho correlations tested the association between performance 410X.2007.07250.x
and safety measures. 3. Zimmermann R, Cumpanas A, Milea F, et al. Extracorporeal shock-
Results: A total of 38 RARP cases had complete assessment data for wave therapy for the treatment of chronic pelvic pain syndrome in
inclusion in the analysis. Overall GEARS score moderately correlated males: A randomized, double–blind, placebo–controlled study. Eur
with overall PACE score (0.513; p=0.002) and had a weak but significant Urol 2009;56: 418–24. https://doi.org/10.1016/j.eururo.2009.03.043
correlation with iAEs (–0.374; p=0.029) (Fig. 1; available at https://cua.
guide/). Overall PACE score correlated with total surgeon technical error MP–8.8
(–0.357; p=0.028) and total mechanical injury (–0.462; p=0.004). There Antibioprophylaxis for transrectal ultrasound–guided needle
were significant inverse correlations between GEARS scores and iAEs prostate biopsy: Is prevention of post–procedural urinary sepsis
during the bladder drop (–0.341; p=0.039) and seminal vesicles (–0.502; improved with the novel combination of ciprofloxacin and
p=0.002) steps, and GEARS scores and technical errors during the semi- fosfomycin?
nal vesicles (–0.457; p=0.004), apical dissection (–0.310; p=0.050), and Alexandre Morin , Marco Bergevin , Nathalie Rivest , Steven Lapointe 3
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urethrovesical anastomosis (–0.453; p=0.005) steps. 1 Faculté de Médecine, Université de Sherbrooke, Sherbrooke, QC,
Conclusions: This is the first study to describe associations between iAEs Canada; Service de Microbiologie, Cité–de–la–Santé, Laval, QC, Canada;
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and measures of surgeon technical performance in RARP. Future work 3 Service d’Urologie , Cité–de–la–Santé, Laval, QC, Canada
in this space includes testing the predictive ability of these metrics on Study Groups: Mathieu Bettez, Jean Cossette, Benoit Guertin, Bechir
clinical and oncological outcomes. Hage, Samer Hanna, Marie–Paule Jammal, Jean Simard.
Reference: Introduction: Prostate biopsy is performed to diagnose prostate cancer.
1. Hung AJ, Jayaratna IS, Teruya K, et al. Comparative assessment Quinolones are recommended as first–line antibioprophylaxis (ATBPx) for
of three standardized robotic surgery training methods. BJU Int transrectal ultrasound–guided prostate needle biopsy (PNB). Recently,
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2013;112:864–71. https://doi.org/10.1111/bju.12045 some authors have shown an increase in post–PNB infections associated
with emergent quinolone resistance in E. coli, urging re–evaluation of
MP–8.7 ATBPx. 3
Extracorporeal shockwave therapy for chronic pelvic pain in Methods: Our objective was to compare the rate of post–PNB urosepsis
men: A long–term treatment option associated with two regimens of ATBPx: oral ciprofloxacin (CIP) alone
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Kareim Khalafalla , Ahmed Majzoub , Haitham Elbardisi , Sami Alsaid , (Group 1) vs. oral CIP and fosfomycin (FOS) (Group 2). We performed
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Ardalan Ghafouri , Raidh A. Talib Alzubaidi , Khalid Al–Rumaihi , a retrospective, pre–post intervention, quasi–experimental study on
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Mohamed Arafa 1,2 patients who underwent PNB from January 2012 to December 2015.
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1 Urology, Hamad Medical Corporation, Doha, Qatar; Andrology, Cairo ATBPx was changed from CIP to CIP/FOS in December 2013. Patients
University, Cairo, Egypt who consulted at the emergency for urosepsis within one month post–
Introduction: Chronic pelvic pain syndrome (CPPS) is a frequent urological PNB were identified. Sepsis rates were analyzed using log–binomial
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diagnosis that can affect the patient’s quality of life. Extracorporeal shock- regression considering the propensity scores weights of 14 known risk
wave therapy (ESWT) is recently recognized as a treatment option for men factors for post PNB infection.
with CPPS. This study is aimed at evaluating the long–term efficacy of Results: We reviewed charts of 2157 patients, including 1015 in Group 1
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ESWT for the treatment of men with CPPS. and 1142 in Group 2. The incidence of urosepsis in the CIP alone group was
Methods: This prospective, self–controlled study included 34 patients 1.2% (12/1015) and fell to 0.2% (2/1142) in the CIP/FOS group. Our analy-
who were diagnosed with CPPS at the outpatient department of a tertiary sis indicates that CIP/FOS significantly decreased the risk of sepsis compared
medical centre between June 2016 and July 2017. Patients were referred to CIP alone (aRR=0.17; p=0.021). The pathogen was E. coli in 12/14 cases
for ESWT and received four sessions one week apart by a protocoal of and seven strains were CIP–resistant. Seven cases also had E. coli bactere-
3000 impulses, 0.25 mJ/m and 3Hz frequency using Duolith SD1 Ultra mia, with 5/7 blood cultures CIP resistant. Eleven of 12 E. coli were from
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Device (Storz Medical company, Tuttlingen, Switzerland). In addition to Group 1 patients, including all blood culture and resistant isolates. One
demographic and clinical data, patients’ symptoms were assessed using case of B. fragilis septicemia was identified in the CIP/FOS group. No cases
the National Institute for Health–Chronic Prostatitis Symptom Index (NIH– of C. difficile diarrhea were identified at three months post–PNB.
CPSI) questionnaire on the initial visit, and three and six months after Conclusions: The adoption of CIP/FOS as ATBPx in PNB significantly
completing their ESWT treatment. Complications were also recorded. lowered our rates of post–procedural sepsis. Conveniently, this regimen is
Results: The patients’ mean age was 39±7.6 years. Both diabetes mellitus oral and obviates the need for rectal swab screening. Further prospective
and hypertension were reported by five patients. The mean duration of studies should be performed to confirm our findings.
S110 CUAJ • June 2018 • Volume 12(6Suppl2)