Page 5 - CUA2019 Abstracts - BPH

2019 CUA Abstracts

Patients with ≥4 features were considered at high risk for MS. Data was This paper has a figure, which may be viewed online at:
analyzed using IBM SPSS software. Independent-samples t-test, Fisher’s https://2019.cua.events/webapp/lecture/191
or Chi-square tests were used as needed.
Results: In our cohort, of the 31 men who had ≥ 4 MS features, 58.1% UP-7.2
had mild LUTS and 54.8% had ED. In the 358 men with ≤ 3 MS features,
62.3% had mild LUTS and 49.4% had ED. Men at high risk for MS did not Modeling in vitro urinary tract infections caused by uropathogenic
experience more LUTS nor more ED than men who had less MS features Escherichia coli using tissue engineering 1
1
1
(p=0.7010, OR = 0.8382, 95% CI: 0.4120-1.697 and p=0.5805, OR = Élodie Dufresne , Stéphane Chabaud , Christophe Caneparo , Stéphane
1
0.8053, 95% CI: 0.3746-1.640). In our study, 194 (49.9%) men had ED J. Bolduc
1
ranging from mild to severe. 11.3% of men with ED were younger than Surgery, CHU de Québec-Université Laval Research Centre, Québec
40 years and 51.0% were between the ages of 40 to 60. Only 1.03% of City, QC, Canada
patients with ED reported the use of PDE5-inhibitor therapy. CUASF-Astellas Research Grant
Conclusions: In BPH treatment-naive men, the presence of four or more Introduction: Throughout a lifetime, 60% of women will have a urinary
1
MS features does not predict the presence of ED or LUTS. For middle- tract infection (UTI) and uropathogenic Escherichia coli (UPEC) will be
2
aged and aged men, clinicians should specifically question for ED and isolated in >85% of these cases. Among UTI-affected patients, 20–30%
2
treat accordingly. Only 1.03% of patients with ED reported the use of will be exposed to recurrences (rUTI). Indeed, some bacteria can invade
PDE5-inhibitor therapy. uroepithelial cells, providing protection through an F-actin network. It
References allows bacteria to divide while being protected from antibiotics and the
1. Alberti KG, Zimmet P, Shaw J, et al. The metabolic syndrome-a immune system. Bacteria can also invade deeper uroepithelial cell to
3
new worldwide definition. Lancet 2005;366:1059-62. https://doi. create a quiescent intracellular reservoir (QIR). Complications associ-
org/10.1016/S0140-6736(05)67402-8 ated with UTI lead to a greater social and economic cost. Antibiotics
2. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet are not constantly effective, as demonstrated by rUTI, and their use can
2005;365:1415-28. https://doi.org/10.1016/S0140-6736(05)66378-7 lead to significant complications, such as antibiotic resistance. Therefore,
3. Raheem OA, Su JJ, Wilson JR, et al. The association of erec- new strategies are required to prevent rUTI. Due to the low average rate
tile dysfunction and cardiovascular disease: A systematic criti- of successful translation of 2D cell culture and in vivo animal models
cal review. Am J Mens Health 2017;11:552-63. https://doi. to clinical trials, innovative models, such as those produced by tissue
org/10.1177/1557988316630305 engineering, are required.
Methods: A bilayer urological tissue is reconstructed using collagen gels
seeded with bladder mesenchymal cells. After 24 hours, urothelial cells
UP-7.1 are seeded on top of constructs. After a week of horizontal expansion
Holmium laser vaporesection of the prostate (HoLVRP): A step- in submerged condition, tissues are transferred in air/liquid interface for
by-step approach three weeks. The epithelium quality is evaluated and tissues are infected
Hazem Elmansy , Amr Hodhod , Ahmed Kotb , Owen Prowse , Walid with control BL21 E. coli or UPEC UTI-89, both expressing GFP. They
1
1
1
1
Shahrour 1 are infected for a six-hour period before being rinsed and incubated for
1 Urology, Northern Ontario School of Medicine, Thunder Bay, ON, three additional weeks with antibiotics.
Canada Results: After a six-hour infection and three weeks of incubation, we have
Introduction: Laser procedures are an innovative surgical treatment alter- detected the presence of IBC in our tissue only when uropathogenic UTI-
native to transurethral resection of the prostate secondary to prostatic 89 was used. IBC has not been detected with non-pathogenic BL21 E.
obstruction. Herein, we introduce the first known experience of pros- coli. QIR had not yet been detected after a three-week incubation period.
tate vaporesection using the side-firing holmium laser fiber. Conclusion: Our bladder mucosa tissue-engineered construct can rep-
Methods: Twenty patients underwent holmium laser vaporesection of licate UTI. The presence of IBC is still a rare occurrence. Therefore, we
the prostate (HoLVRP) from July to September2018. We used a 100 W will continue to optimize the infection parameters to increase it because
holmium: YAG laser (VersaPulse PowerSuite, Lumenis, Yokneam, Israel) QIR number depends on the number of IBC.
with a side-firing Xpeeda™ laser fiber. All patients were managed by a References
single surgeon (HE). Two posterior grooves were created at the 5 and 7 1. Al-Badr A, Al-Shaikh G. Recurrent urinary tract Infections manage-
o’clock positions up to the veromontanum, allowing vaporesection of ment in women: A review. Sultan Qaboos Univ Med J 2013;13:
the median lobe. The fiber was then rotated under the adenoma from 359-67. https://doi.org/10.12816/0003256
the 7 o’clock to 11 o’clock position, starting from the bladder neck to 2. Terlizzi ME, Gribaudo G, Maffei ME. UroPathogenic Escherichia
the verumontanum. The other lateral lobe was resected similarly. Patients’ coli (UPEC) infections: Virulence factors, bladder responses, anti-
demographics and preoperative data were collected, including transrec- biotic, and non-antibiotic antimicrobial strategies. Front Microbiol
tal ultrasound prostate sizing, and preoperative prostate-specific antigen 2017;8:1566. https://doi.org/10.3389/fmicb.2017.01566
(PSA) and International Prostate Symptom Score (IPSS). The laser energy 3. Flores-Mireles AL, Walker JN, Caparon M, et al. Urinary tract infec-
and operative times were recorded. Intra- and postoperative complica- tions: Epidemiology, mechanisms of infection, and treatment options.
tions were recorded, in addition to catheter time and hospital stay. A trial Nat Rev Microbiol 2015;13: 269-84. https://doi.org/10.1038/nrmi-
of void was done (TOV) after two hours. The short-term followup data cro3432
included IPSS and PVR at one-month postoperatively.
Results: Twenty patients with a median prostatic volume of 50 cc (37–63) MP-7.16
had HoLVRP. The median age at surgery was 66 years. Lower urinary tract
symptoms was the main presentation in 85% of patients, with median One-year safety and efficacy outcomes on a novel drug coated
post-void residual (PVR) of 168 mL (23–470) (Table 1). The median IPSS balloon (DCB) for urethral stricture disease – The ROBUST I Study
1
1
2
3
score was 22 (4–30). There were no intraoperative complications or blood Ramon Virasoro , Jessica DeLong , Rafael Estrella , Merycarla Pichardo ,
6
4
5
transfusions. All patients had a catheter removal at two hours postopera- Ramon Rodriguez Lay , Gustavo Espino , George Suarez , George
9
7
8
tively. Only three patients (15%) had failed TOV initially but succeeded Webster , Gerald Jordan , Sean Elliott
1
after 1–3 days. No patients had stress urinary incontinence. IPSS and Department of Urology, Eastern Virginia Medical School, Norfolk, VA,
2
PVR significantly improved at one month (p=0.006, 0.003, respectively). United States; Clinica Union Medica, Santiago de los Caballeros, Dominican
3
4
Conclusions: HoLVRP is a promising and safe technique in the manage- Republic; URUS, Santo Domingo, Dominican Republic; Cirujano Urology
5
ment of moderate-sized prostates. Further studies with longer followup Royal Center, Panama City, Panama; Centro Especializado San Fernando,
6
are warranted to evaluate this technique. Panama City, Panama; Jackson Memorial Hospital, Miami, FL, United
8
7
States; Duke University, Durham, NC, United States; Urology, Eastern
S134 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)