Page 6 - CUA2019 Abstracts - Miscellaneous/Other

2019 CUA AbstrACts

Podium Session 2: Mixed Non-oncology

June 30, 2019; 1150–1250

POD-2.1 Kingdom; Department of Urology, Infanta Leonor Hospital, Madrid, Spain;
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Opioid prescription to patients after low-acuity urological surgery 8 Astellas Pharma Global Development Inc., Northbrook, IL, United States;
is a risk factor for long-term opioid use 9 Astellas Pharma Europe Ltd., Chertsey, United Kingdom
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Jeffrey Campbell , Andrew McClure , Collin Clarke , Kelly Vogt , Introduction: The objective was to study the efficacy and safety of mirabe-
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Blayne Welk 1 gron (MIRA) vs. placebo (PL) for treating overactive bladder (OAB) symp-
1 Department of Surgery, Division of Urology, Western University, London, toms in men concurrently receiving tamsulosin (TAM) for lower urinary tract
ON, Canada; Institute for Clinical Evaluative Sciences, London, ON, symptoms (LUTS) due to underlying benign prostatic hyperplasia (BPH).
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Canada; Department of Anesthesia, Western University, London, ON, Methods: This 12-week, phase IV, randomized, double-blind, multicentre
Canada; Department of Surgery, Western University, London, ON, Canada (North America/Europe) study enrolled men (≥40 years) receiving TAM for
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Introduction: The opioid abuse epidemic is changing the way the medical ≥2 months. After a four-week TAM run-in period, patients were random-
community uses narcotics. Our objective was to determine if postoperative ized to either MIRA 25 mg or PL. At four weeks, all patients were titrated
opioid prescriptions after low-acuity urological surgeries leads to long-term to MIRA 50 mg or PL equivalent for eight more weeks. The primary end-
opioid use. point was change from baseline (BL) to week 12/end of treatment (EoT) in
Methods: We conducted a retrospective cohort study using administrative mean number of micturitions/24 hours. Changes in mean volume voided
data from the province of Ontario, Canada. We identified all adult men who (MVV)/micturition, urgency episodes/day, total urgency and frequency
underwent their first vasectomy, transurethral prostatectomy, urethrotomy, score (TUFS), and International Prostate Symptom Score (IPSS) total score
circumcision, spermatocelectomy, or hydrocelectomy from 2013–2016. were analyzed. Safety assessments were treatment-emergent adverse events
We excluded men with prior opioid use, confounding concurrent pro- (TEAEs) and changes in post-void residual (PVR) volume and maximum
cedures, a prolonged hospital stay, or cancer. Our primary exposure was urinary flow (Q max ).
whether patients filled a prescription for an opioid within five days of Results: Of 676 men, mean age was 64.9 years (380 [56.2%] were ≥65
their urological surgery. The primary outcome was evidence of at least two years). The adjusted mean change from BL to EoT in micturitions/24 hours
narcotic prescriptions filled 9–15 months after their urological surgery. To for TAM+MIRA was statistically superior to TAM+PL (Table 1). Statistically
ensure exposed and unexposed men were similar, 25 medical comorbidi- superior results were also obtained for TAM+MIRA in MVV/micturition,
ties and 16 markers for healthcare utilization potentially related to chronic urgency episodes/day, and TUFS (no significant difference in IPSS total
pain were measured. score). TEAE rates were higher with TAM+PL, although drug-related TEAE
Results: We identified 91 083 men, most of whom underwent vasectomy rates were higher with TAM+MIRA. Serious TEAE rates were similar in both
(78%). A total of 32 174 (35%) filled a prescription for an opioid after groups. One (0.3%) TAM+PL and six (1.7%) TAM+MIRA patients experi-
their procedure. The post-procedure opioid users and non-users did not enced urinary retention. Changes in mean PVR volume and Q max were not
differ in the majority of the medical comorbidities or markers of healthcare clinically meaningful.
utilization. The most common opioid prescribed was codeine (70%) and Conclusions: Among men receiving TAM for LUTS due to BPH, the addition
urologists were the primary prescribers (81%). Overall, 1447 (1.6%) of men of MIRA was superior to PL in mean number of micturitions/24 hours in
had evidence of long-term narcotic use; men who had filled a postopera- patients with OAB symptoms, the primary endpoint. Similar findings were
tive opioid prescription had both a significantly higher risk of long-term observed for MVV/micturition, urgency episodes/day, and TUFS. There were
narcotic use (adjusted odds ratio [aOR] 1.4; 95% confidence interval [CI] no unexpected safety concerns.
1.3–1.6) and the secondary outcome of overdose (OR 3.0; 95% CI 1.5–5.9). This paper has a figure, which may be viewed online at:
Conclusions: Physicians prescribing opioids after low-pain-intensity surgery https://2019.cua.events/webapp/lecture/273
is a significant risk factor for potential narcotic dependence; efforts should
be made to reduce postoperative narcotic use, especially for procedures POD-2.3
that should have minimal postoperative pain. Randomized, blinded, placebo-controlled trial of continuous
antibiotic prophylaxis for febrile urinary tract infection prevention
POD-2.2 in infants with prenatal hydronephrosis: The Alpha study
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Efficacy and safety of mirabegron vs. placebo add-on therapy in Luis H. Braga , Melissa McGrath , Steven Arora , Martha Fulford , Armando
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men with overactive bladder symptoms receiving tamsulosin for J. Lorenzo , Lucy Giglia , Farough Farrokhyar 5
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underlying benign prostatic hyperplasia (PLUS) 1 Surgery, McMaster University, Hamilton, ON, Canada; Pediatrics,
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Sender Herschorn , Steven Kaplan , Kevin McVary , David Staskin , McMaster University, Hamilton, ON, Canada; Infectious Diseases,
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Christopher Chapple , Steve Foley , Javier Cambronero Santos , Rita M. Medicine, McMaster University, Hamilton, ON, Canada; Urology, The
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Kristy , Nurul Choudhury , John Hairston , Carol Schermer 8 Hospital for Sick Children, Toronto, ON, Canada; Epidemiology and
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1 Department of Surgery/Urology, University of Toronto, Sunnybrook Health Biostatistics, McMaster University, Hamilton, ON, Canada
Sciences Centre, Toronto, ON, Canada; Department of Urology, Icahn Introduction: Continuous antibiotic prophylaxis (CAP) to prevent febrile
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School of Medicine at Mount Sinai, New York City, NY, United States; urinary tract infection (fUTI) in infants with prenatal hydronephrosis (PHN)
3 Department of Urology, Stritch School of Medicine, Loyola University remains controversial, contributing to a lack of consensus guidelines and
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Medical Center, Maywood, IL, United States; Department of Urology, diverse practice patterns. We aimed to determine whether CAP vs. placebo
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St Elizabeth’s Medical Center, Brighton, MA, United States; Department reduces fUTIs in prenatal HN patients within the first 18 months of life.
of Urology, Royal Hallamshire Hospital, Sheffield, United Kingdom; Methods: Infants 0–7 months old with PHN were recruited. Inclusion crite-
6 Department of Urology, Royal Berkshire Hospital, Reading, United ria included Society for Fetal Urology (SFU) grade III/IV with/without dilated
ureter (>7 mm) or urinary tract dilation (UTD) P2/P3, and voiding cystoure-
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S117
© 2019 Canadian Urological Association