Page 2 - CUA2019 Abstracts - BPH

Poster session 7: bPH, robotics, Infertility, sexual Dysfunction

in the Calgary zone from 2015–2017, with National Surgical Quality tions. Alpha-blocker medication is associated with an increased risk of
Improvement Program (NSQIP) data, the Discharge Abstract Database complications, and in the oldest patients, the risk increases the longer
(DAD), and the National Ambulatory Care Reporting System (NACRS). they are managed medically.
Primary outcomes were the 30-, 60-, and 90-day post-TURP ED revisit
rates and hospital readmission rates. Secondary outcomes were to identify MP-7.5
predictors of readmission to hospital.
Methods: We reviewed all NSQIP data for TURPs in the Calgary zone Are basic robotic surgical skills transferable from the simulator to
between 2015 and 2017. We validated this data using the DAD and the operating room? A randomized, double-blinded, prospective
NACRS databases in the same time frame. The 30-, 60-, and 90-day educational study 1 1 1
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hospital readmission rates and ED visit rates were collected and stratified Ahmad Almarzouq , Jason Hu , Anne Yin , Yasser Noureldin , Maurice
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based on age, Charlson comorbidity index (CCI), and surgical urgency. Anidjar , Franck Bladou , Simon Tanguay , Wassim Kassouf , Armen G.
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Results: NSQIP data from 2015–2017 was reviewed in 195 patients who Aprikian , Sero Andonian
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underwent TURP in the Calgary zone. The 30-day hospital readmission Urology Division, Department of Surgery, McGill University, Montréal,
rate was 8.2%. DAD and NACRS data from the same time period for 3059 QC, Canada
consecutive patients who underwent TURP was then analyzed. The 30-, Introduction: Several robotic simulators have been shown to improve
60-, and 90-day readmission rates were 7.4%, 9.5%, and 11.1%, respec- basic robotic skills, but there are no studies showing that basic robotic
tively. The 90-day readmission rate for elective vs. urgent/emergent TURPs skills could be transferred to the operating room (OR). The aim of this
was 10.7% vs. 26.4%, respectively. ED visit rates after TURP at 30-, 60-, study was to assess the transferability of basic robotic skills from the
and 90-days were 21.4%, 26%, and 28.6%, respectively. Multivariable daVinci Surgical Skills Simulator (dVSSS) to the OR.
logistic regressions analysis revealed age, urgency of surgery, and CCI to Methods: Fourteen robotic-naive urology residents were randomized to
be independent predictors of readmission. two groups: group A were required to practice three sessions on the
Conclusions: This study will be practice-changing for the Calgary zone, simulator, whereas group B was required to practice until reaching com-
with the most significant finding being that the urgent/emergent TURP petency as defined by the norm-referenced method with five experts. All
group has a significantly higher ED visit rate and hospital readmission experts and candidates performed nine exercises on the dVSSS and were
rate. We will also carefully consider TURP in the elderly or those with recorded. Both groups were progressed to perform bladder mobiliza-
comorbidities. tion and chief residents were also performed urethro-vesical anastomosis
(UVA) during robot-assisted radical prostatectomy (RARP). Recordings
were assessed blindly using GEARS by C-SATS. Wilcoxon rank-sum test
MP-7.4 was used to assess differences between groups. Spearman’s correlation
Complications after surgery for benign prostatic enlargement coefficient (rho) was used to assess relationships between dVSSS and
and medication use: A population-based cohort study in Ontario, GEARS scores.
Canada Results: There was no difference in total GEARS scores between the two
Rano Matta , Joseph R. LaBossiere , Christopher Wallis , Amanda Hird , groups. GEARS’ efficiency component score during “Energy and dissec-
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Girish S. Kulkarni , Ronald T. Kodama , Lesley Carr , Sidney B. tion” task on the dVSSS correlated with GEARS’ efficiency component
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Radomski , Sender Herschorn , Robert K. Nam 1,4 during bladder mobilization (rho= 0.62; p= 0.03). GEARS’ force sensitivity
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1 Division of Urology, University of Toronto, Toronto, ON, Canada; Division score during “Ring and rail” and “Dots and needles” tasks on the dVSSS
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of Urology, University of Alberta, Edmonton, AB, Canada; Division of correlated with GEARS’ force sensitivity score during bladder mobilization
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Urology, University Health Network, Toronto, ON, Canada; Division of (rho=0.58, p=0.047; rho=0.65, p=0.02, respectively). Total GEARS scores
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Urology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada for “Ring and rail” and “Suture sponge” tasks correlated with the total
Functional Urology Research Group, University of Toronto GEARS scores during UVA (rho=0.86; p=0.007) and (rho=0.90; p=0.002).
Introduction: Patients with benign prostatic enlargement (BPE) may eventu- Conclusions: There is correlation between objective blinded assessment
ally undergo surgery after conservative or medical management becomes of simulator performance and bladder mobilization and UVA during
ineffective. The relationship between the duration of non-surgical manage- RARP. Therefore, basic robotic skills could be transferred to the OR.
ment and the rates of complications from BPE surgery are unknown. Competency on the dVSSS was achieved with two sessions of nine
Methods: We conducted a retrospective, population-based cohort study exercises for most residents.
of men ≥66 years who underwent their first surgery for BPE from January
1, 2003 to December 31, 2014 in Ontario, Canada. The primary out- MP-7.6
come was 30-day overall complications. To test the association between
preoperative covariates and our outcomes, adjusted relative risks were WATER vs. WATER II: Potential volume independence of
computed using multivariable Poisson regression. Aquablation 1 2 3 4
Results: Over the study period, 52 162 men underwent BPE surgery, David-Dan Nguyen , Steven A. Kaplan , Dean S. Elterman , Alan I. So ,
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with the majority receiving a transurethral resection of the prostate Ryan F. Paterson , S. Larry Goldenberg , Kevin Zorn , Naeem Bhojani
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(TURP; n=45 463, 87%). The 30-day overall complication rate was 2 Faculty of Medicine, McGill University, Montréal, QC, Canada;
2828 events/10 000 procedures. The risk of complications increased by Department of Urology, Icahn School of Medicine at Mount Sinai,
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year of surgery (relative risk [RR] 1.02 per year; 95% confidence inter- Mount Sinai Health System, New York, NY, United States; Division
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val [CI] 1.02–1.03; p<0.0001), increasing age (RR 1.01 per year; 95% of Urology, University of Toronto, Toronto, ON, Canada; Department
CI 1.01–1.02; p<0.0001), and increasing comorbidity (RR 1.06; 95% of Urologic Sciences, University of British Columbia, Vancouver, BC,
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CI 1.04–1.07; p<0.0001). Receipt of an α-blocker prescription alone in Canada; Department of Urology, Université de Montréal Hospital Centre,
the previous year increased the risk of 30-day complications (RR 1.05; Montréal, QC, Canada
95% CI 1.00–1.09; p=0.033), while receipt of 5-alpha-reductase inhibi- Introduction: There is a need for novel surgical approaches when treat-
tor alone or in combination with an α-blocker did not have a significant ing large (>80 cc) prostates for lower urinary tract symptoms (LUTS) due
effect. Among the ≥80-year-old group, the effect of year of surgery was to benign prostatic hyperplasia (BPH). Aquablation (AquaBeam System,
highest (RR 1.03; 95% CI 1.02–1.04), which directly correlated with the PROCEPT BioRobotics, Inc., U.S.), an ultrasound-guided, robotically exe-
duration of medical management, increasing steadily from a mean of 4.3 cuted waterjet ablative procedure, could be this novel tool. We compare
years in 2007 to 6.4 years in 2014 (p<0.0001 for trend). Receipt of an the outcomes of Aquablation in 30–80 cc prostates with the outcomes
antithrombotic in the year prior to surgery also significantly increased the in 80–150cc prostates.
risk of overall complications (RR 1.27; 95% CI 1.22–1.32; p<0.0001). Methods: WATER is a prospective, double-blind, multicentre, interna-
Conclusions: Among elderly men receiving BPE surgery, increasing age tional clinical trial comparing the safety and efficacy of Aquablation and
and comorbidity are associated with a higher risk of 30-day complica- transurethral resection of the prostate (TURP) for LUTS/BPH in men with
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S131