Page 4 - CUA2018 Abstracts - Robotics

Poster session 8: robotics/Other Urology topics

References: MP–8.10
1. Mrkobrada M, Ying I, Mokrycke S, et al. CUA guidelines on antibiotic Duration of antibiotics in urinary stone–related urosepsis: An
prophylaxis for urologic procedures. Can Urol Assoc J 2015;9:13–22. analysis of patients in a tertiary care centre
https://doi.org/10.5489/cuaj.2382 Luke Witherspoon , Lizanne Beique , Janet Squires , Rosemary Zvonar ,
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2. Wolf JS, Bennett CJ, Dmochowski RR, et al. Best practice policy Neal Rowe , Matthew Roberts , Caroline Nott , Kathryn Suh , James
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statement on urologic surgery antimicrobial prophylaxis. J Urol Watterson 1
2008;179:1379–90. https://doi.org/10.1016/j.juro.2008.01.068 1 Urology, The Ottawa Hospital, Ottawa, ON, Canada; Pharmacy, The
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3. Carignan A, Roussy J–F, Lapointe V, et al. Increasing risk of infectious Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research
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complications after transrectal ultrasound–guided prostate biopsies: Institute, The Ottawa Hospital, Ottawa, ON, Canada; Infectious Disease,
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Time to reassess antimicrobial prophylaxis? Eur Urol 2012;62:453–9. The Ottawa Hospital, Ottawa, ON, Canada
https://doi.org/10.1016/j.eururo.2012.04.044 Introduction: The optimal duration of antibiotics for patients with an
obstructive infected urinary stone is not defined. We sought to compare
MP–8.9 the efficacy and safety of a short course of antibiotics (8–16 days) fol-
Fosfomycin compared to standard of care, fluoroquinolone, lowed by an antibiotic–free period (Group 1) vs. continuous antibiotics
prophylaxis for transrectal ultrasound–guided prostate biopsy: until definitive stone management (Group 2) in septic patients with an
A systematic review and meta–analysis obstructive urinary stone.
Morgan MacDonald , Christopher Wallis , Jaclyn Ferris , Robin Parker , Methods: We conducted a retrospective, observational cohort study of adult
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Stephen Williams , Padraic O’Malley 1 patients admitted with an obstructive infected urinary stone. Consecutive
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1 Urology, Dalhousie University, Halifax, NS, Canada; Internal Medicine, patients in each group were selected according to a reverse chronologi-
Dalhousie University, Halifax, NS, Canada; Surgery, University of Toronto, cal order of admission date starting January 2017. Endpoints included
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Toronto, ON, Canada; School of Information Management, Dalhousie recurrent infections and stone/stent–related complications, among others.
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University, Halifax, NS, Canada; Community Health and Epidemiology, Results: Out of 1770 visits based on ICD codes, 50 patients in Group
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Dalhousie University, Halifax, NS, Canada; Surgery, University of Texas 1 and 27 patients in Group 2 were identified. Patients in Group 2 had
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Medical Branch, Galveston, TX, United States significantly higher American Society of Anesthesiologists (ASA) score
Introduction: Transrectal ultrasound (TRUS)–guided biopsy remains the (p=0.039), bloodstream infections (p<0.001), infectious diseases consulta-
commonest way of diagnosing prostate cancer. Rates of TRUS biopsy– tions (p<0.001), and were more frequently admitted to the intensive care
related infectious complications have been on the rise secondary to fluo- unit (ICU) (p=0.020) compared to patients in Group 1. More recurrent
roquinolone (FLQ)–resistant bacterium. Using a meta–analysis approach, infections prior to stone removal were observed in Group 1 vs.Group 2
we sought to assess whether fosfomycin (FFM) represents a reasonable (14% vs. 4%, respectively; p=0.248) (Table 1; available at https://cua.
alternative to FLQ prophylaxis regimens. guide/). Subgroup analysis of patients admitted with a septic stone, but
Methods: Systematic review of Pubmed, Scopus, Embase, Web of not requiring ICU admission, revealed more recurrent infections prior to
Science, and clinicaltrials.gov up to December 25, 2017 was performed. stone removal in patients recieving short–course antibiotics as compared
Randomized controlled trials (RCTs) and observational studies (NRS) com- to continuous course antibiotics (13% vs. 5%, respectively; p=0.11).
paring FFM with FLQ for prophylaxis for TRUS biopsy were identified. Conclusions: Although statistical significance was not achieved and
Reviewers independently screened titles (JF, MM) and abstracted data the sample size was small, the difference in recurrent infection prior to
(MM, POM). Primary outcome was biopsy–related sepsis or febrile urinary stone removal between the two groups was unexpected. This suggests
infection. Secondary outcomes were any urinary tract infection (UTI) that continuing antibiotics until definitive stone management may be
and any complication. Meta–analysis performed using RevMan 5.3 with beneficial. Our data provide an impetus to conduct a larger trial to fur-
Mantel–Hanzel weighting and random effects models. RCTs and NRS ther explore the optimal duration of antibiotics and timing of surgery to
were pooled separately and between–group heterogeneity was assessed. optimize the management of obstructive infected stones.
Where there was no significant heterogeneity, these results were pooled.
Heterogeneity was quantified using I . Risk of bias assessed with Cochrane MP–8.11
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tool (RCT) and Newcastle–Ottawa Scale (NRS). Quantifying the ‘assistant effect’ in robotic–assisted radical
Results: We identified three RCTs (n=1383) and five NRS (n=42885). prostatectomy: Measures of technical performance
Prophylaxis with FFM was associated with decreased likelihood of the pri- Mitchell Goldenberg , Hossein Saadat , Antonio Finelli , Jason Lee , Teodor
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mary outcome of biopsy–related sepsis (combined result: odds ratio [OR] Grantcharov , Rajiv Singal , Michael Elfassy 1
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0.42; 95% confidence interval [CI] 0.19–0.91; p=0.03; I =68%). Despite 1 Division of Urology, University of Toronto, Toronto, ON, Canada;
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non–significant between group heterogeneity (p=0.23), the results of RCTs 2 Division of General Surgery, University of Toronto, Toronto, ON, Canada
(OR 0.81; 95% CI 0.35–1.90; p=0.63; I =0%) and NRS (OR 0.32; 95% Study Groups: Michael Garron Hospital Educational Scholarship and
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CI 0.09–1.11; p=0.07; I =82%) quantitatively differed. For the secondary Research Grant.
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outcome of any UTI, results favoured FFM (OR 0.30; 95% CI 0.15–0.62; Introduction: While robotic–assisted surgery provides several advantages
p=0.001; I =55%) with no hetergeneity between study designs (p=0.51). to the surgeon, it also requires the surgeon to be reliant on the bedside
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Conclusions: FFM is an alternative to FLQ prophylaxis for TRUS prostate assistant for various steps of the procedure. Despite this, our ability to
biopsy with potential for lower rates of sepsis and infectious complications. assess and understand the impact of the assistant on surgeon performance
References: remains limited. We used a modified rating tool to quantify the effect of
1. Lavallée LT, Breau RH, Fergusson D, et al. Trends in prostate biopsy in assistant skill on surgeon technical performance during robotic–assisted
Ontario, 1992–2014: A cohort study. CMAJ Open 2016;4:E698–705. radical prostatectomy (RARP).
https://doi.org/10.9778/cmajo.20160079 Methods: Prospective, intraoperative video from consecutive RARP cases
2. Nam RK, Saskin R, Lee Y, et al. Increasing hospital admission rates at a quaternary cancer referral centre was collected. The prostatic ped-
for urological complications after transrectal ultrasound–guided icle and neurovascular bundle step (PPNVB) was chosen for analysis.
prostate biopsy. J Urol 2013;189:S12–7. https://doi.org/10.1016/j. Trained expert analysts scored the surgeon performance using the Global
juro.2012.11.015 Evaluative Assessment of Robotic Skills (GEARS). Assistant performance
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was rated using a modified Objective Structured Assessment of Technical
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Skills (aOSATS), comprised of four of the seven OSATS domains.
Spearmans rho correlations were used to test the relationship between
assistant and surgeon technical performance.
CUAJ • June 2018 • Volume 12(6Suppl2) S111