Page 7 - CUA2019 Abstracts - Miscellaneous/Other

2019 CUA Abstracts

throgram (VCUG) to rule out Vesicoureteral reflux (VUR). Patients received POD-2.5
equivalent volumes of trimethoprim (TMP) or placebo (syrup)with a 1:1 Comprehensive prospective assessment of patient-reported
allocation ratio, using a computer-generated randomization sequence in outcomes after urethroplasty
random block sizes of four, six, and eight. Trial participants were blinded, Jordan Bekkema , Keith F. Rourke 1
1
except the pharmacist. The primary outcome was catheter specimen fUTIs 1 Division of Urology, University of Alberta, Edmonton, AB, Canada
adjudicated by a three-physician panel. The secondary outcome was Introduction: While urethroplasty is the most effective treatment for ure-
bacterial resistance patterns. Intention-to-treat (ITT) analysis to estimate thral stricture, the majority of outcomes are reported from a surgeon per-
fUTI-free rate was done using Kaplan-Meier curves. A subgroup analysis spective. Our objective is to comprehensively describe patient-reported
between ureteropelvic junction obstruction (UPJO)-like vs. non-refluxing outcomes after urethroplasty.
primary megaureter (NRPM) was conducted. Followup included monthly Methods: A total of 357 patients from 2011–2018 were enrolled in a pro-
phone calls and quarterly ultrasound for 12 months. Compliance was spective, single-centre study comprehensively assessing patient-reported
assessed through a medication logbook. outcomes after urethroplasty, including patient satisfaction, urinary
Results: We screened 1435 infants; 1137 did not meet inclusion criteria, function, quality of life, erectile function, ejaculatory function, penile
48 refused, and 150 were randomized (75 to placebo/75 to TMP) Four appearance/curvature, genitourinary pain, and post-void dribbling. Patient
patients withdrew, leaving 146 for analysis. Baseline characteristics were satisfaction was determined using a five-point Likert scale. Voiding func-
equally distributed between groups (Table 1). Overall fUTI rate was 6% tion was assessed with the International Prostate Symptom Score (IPSS).
(9/146), with eight events in the placebo group vs. one (TMP-resistant Erectile function was assessment with the International Index of Erectile
bacteria) in the intervention group (11% vs.1.4%; p=0.03). Eight fUTIs Function 5 (IIEF-5) with erectile dysfunction defined as a ≥5-point change.
occurred in uncircumcised males and one in a female. NRPM infants Ejaculatory function was scored using a hybrid of the brief Sexual Function
had a significantly higher fUTI rate vs. UPJO-like (14% vs.3; p=0.02). Inventory. The remaining measures were assessed using literature-derived
Median time to fUTI was three months (Figs. 1A, 1B). Multidrug resis- Likert scales. Descriptive statistics were used to summarize findings, while
tance was higher in placebo vs. intervention patients (42% vs. 22%; both parametric (paired t-test, Chi-square) and non-parametric (Wilcoxon)
p=non-significant). Overall number needed to treat (NNT) was 10 and tests were used to compare pre- and postoperative findings.
NNT for NRPM was four. Results: Of the 357 patients enrolled, mean age was 49.7 years with
Conclusions: Patients with SFUIII/IV-PHN receiving placebo were 10 a mean stricture length of 4.4 cm. Stricture location was most com-
times more likely to develop a fUTI than those on TMP. CAP should be monly bulbar (59.7%), followed by penile (19.9%) and posterior (13.7%).
offered to uncircumcised males and those with dilated ureters due to The most common stricture etiology was idiopathic (40.3%), iatrogenic
their higher risk of fUTI. (14.0%), trauma (13.2%), or lichen sclerosus (12.3%). Patients underwent
This paper has figures, which may be viewed online at: a variety of urethroplasty techniques, including buccal mucosa graft onlay
https://2019.cua.events/webapp/lecture/28 (42.6%), anastomotic (30.0%), or staged (11.2%). Most (92.0%) patients
were stricture-free on followup cystoscopy; 80.0% of patients reported
POD-2.4 being satisfied with surgery, while 7.3% of patients were unsatisfied.
Are renal bladder ultrasounds necessary for routine followups Voiding function was globally improved after urethroplasty, including uri-
of vesicoureteral reflux patients after continuous antibiotic nary quality of life (4.7 vs. 1.6; p<0.0001), IPSS (19.3 vs. 6.0; p<0.0001),
prophylaxis discontinuation? post-void dribbling (2.7 vs. 2.5; p=0.04), and sitting to void (2.4 vs.
Smruthi Ramesh , Melissa McGrath , Kornelia Palczek , Catherine 1.9; p<0.0001). Additionally, genitourinary pain scores improved post-
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1
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Lovatt , Luis H. Braga 1,2 operatively (2.2 vs. 1.6; p<0.0001). Overall, erectile function remained
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1 Surgery, McMaster Children’s Hospital, Hamilton, ON, Canada; Surgery, unchanged (17.7 vs. 17.2; p=0.46) but 12.0% of patients reported new-
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McMaster University, Hamilton, ON, Canada onset erectile dysfunction. The incidence of ejaculatory function remained
Introduction: Patients with vesicoureteral reflux (VUR) are routinely seen unchanged (p=0.13) but 7.1% of patients reported worsening of ejacula-
at followup visits with serial ultrasounds (US) after stopping continuous tory function postoperatively. The majority of patients reported minimal
antibiotic prophylaxis (CAP). Since there is little evidence to support this change in penile length or curvature but 6.7% and 3.1% of patients
practice, we sought to examine the impact of US findings on the clinical complained of bothersome loss of penile length or curvature, respectively.
management of VUR patients at followup visits. Conclusions: Urethroplasty globally improves voiding function and geni-
Methods: A prospectively collected VUR database from 2009–2018 was tourinary pain associated with urethral stricture. While sexual function
reviewed. We identified 218 patients who have stopped CAP. Variables is preserved for the majority of patients, a small proportion of patients
collected included age at CAP discontinuation, followup time, gender, cir- describe new-onset erectile dysfunction, as well as penile shortening or
cumcision status, Society for Fetal Urology (SFU) grades (low [I–II] vs. high curvature, and should be counselled accordingly.
[III–IV]), and febrile urinary tract infection (fUTI). Change in management
was defined as surgical intervention to treat symptomatic VUR or CAP. POD-2.6
Results: The median age at CAP discontinuation and median followup Implementing and evaluating the efficacy of an acute care
time were 20 months (interquartile range [IQR] 13–32) and 42 months urology model of care in a large community hospital
(IQR 28–61), respectively. Of 218 VUR patients, 105 (48%) were male and Abirami Kirubarajan , Roger J. Buckley , Shawn Khan , Rebecca Richard ,
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38 (36%) circumcised. There were 135 (62%) patients with unremarkable Veselina Stefanova , Nicole Golda 3
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serial US findings and 83 (38%) with hydronephrosis (HN). Patients with 1 MD Program, Faculty of Medicine, University of Toronto, Toronto,
normal vs. abnormal US findings experienced similar rates of change in ON, Canada; Institute of Health Policy Management and Evaluation,
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management (11% vs. 8%; p=0.7). In patients with normal US findings, University of Toronto, Toronto, ON, Canada; Urology, North York General
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those with fUTI were more likely to experience a change in management Hospital, Toronto, ON, Canada; Division of Urology, University of
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than those without (52% vs. 0%; p<0.01). Of patients with abnormal Toronto, Toronto, ON, Canada; Bachelor of Sciences Program, Western
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US findings, 58/83 (70%) had low-grade HN. In this group, change in University, London, ON, Canada
management was more likely to occur in patients with fUTI vs. those Introduction: An acute care urology (ACU) model was implemented at
without (50% vs. 2%; p<0.01). Classification of low vs. high HN did not a large Canadian community hospital to determine the impacts on safe
have a significant effect on change in management (9% vs. 8%; p=1.0). and timely care of patients with renal colic.
Conclusions: In 2/3 of VUR patients, US findings were unremarkable Methods: The model includes a dedicated ACU surgeon, a clinic for
and did not impact clinical management. The driving factor for change emergency department (ED) referrals, and additional daytime operating
in management was fUTI post-CAP discontinuation. Thus, asymptomatic room (OR) blocks for urgent cases. We conducted a chart review of
VUR patients may not require routine followups with renal US after stop- 579 patients presenting to the ED with renal colic. Data was collected
ping CAP. before (pre-intervention, September to November 2015) and after (post-
S118 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)