Page 9 - CUA2019 Abstracts - Miscellaneous/Other

2019 CUA AbstrACts

Poster Session 8: Community Urology and Management

July 1, 2019; 0730–0900

MP-8.1 Prior to this, transgender patients in Ontario were forced to seek surgical
Efficacy and safety of pharmacological prophylaxis for venous care in Québec, the United States, Europe, or Asia.
thromboembolism in patients undergoing non-cardiac surgery: A Methods: The TRS program currently consists of two urologists, three plastic
network meta-analysis surgeons, a gynecologist, a dedicated nurse practitioner (NP), and admin-
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Maura Marcucci , Itziar Etxeandia , Arnav Agarwal , Shyla Gupta , Federico istrative support at WCH. Surgeons have augmented their training through
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Germini , Stephen Yang , Matthew Ventresca , Shaowen Tang , Kari A.O. mentorship with experts in the United States and attendance of surgical
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Tikkinen , Gordon H. Guyatt , Philippe D. Violette 1,5 workshops and conferences. Referrals are centralized through the NP, who
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1 Health Research Methods Evidence and Impact, McMaster University, triages them to appropriate surgeons. Referral volumes and surgical book-
Hamilton, ON, Canada; Medicine, University of Toronto, Toronto, ings were categorized and analyzed.
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ON, Canada; Epidemiology, School of Public Health, Nanjing Medical Results: The first six months of the TRS program saw 79 referrals for
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University, Nanjing, People’s Republic of China; Urology and Public lower and 66 for upper surgery. Lower surgery consultations were for
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Health, University of Helsinki, Helsinki, Finland; Surgery, Division of orchiectomy +/- scrotectomy (n=17), vaginoplasty complications (n=21),
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Urology, Division of Urology, London, ON, Canada phalloplasty support or complications (n=15), vaginoplasty (n=19), and
American Society of Hematology (ASH), MacGRADE Centre, McMaster hysterectomy (n=7). Lower surgery cases included penile implant revision
University (n=3), urethral or vaginal stricture repair (n=4), and orchiectomy +/- scro-
Introduction: Low-dose low molecular weight heparin (LMWH) and direct tectomy (n=7). Upper surgery consultations were for breast augmentation
oral anticoagulants (DOAC) may be reasonable alternatives for postopera- (n=14) and chest masculinization (n=52). Four chest masculinization and
tive thromboprophylaxis in urology. We, therefore, performed a systematic one breast augmentation procedures were performed and 24 patients
review and network meta-analysis (NMA) of randomized controlled trials are awaiting surgery.
(RCTs) of these agents. Conclusions: The TRS program serves as a model for the development of
Methods: We searched Medline, Embase, and Central Cochrane library up a government-supported, publically funded program to offer transgender
to August 2018 to identify RCTs evaluating LMWH or DOAC in head-to- patients surgical care. The first six months of the program have demonstrated
head comparisons or compared with placebo or no treatment in patients a need for local surgical expertise in managing surgical complications,
undergoing non-cardiac surgery. Outcomes included symptomatic pulmo- which is now being met. The TRS program demonstrates the importance
nary embolism (PE), symptomatic venous thromboembolism (VTE), and of collaboration between government, hospital administration, and clini-
major bleeding. We used the Cochrane Collaboration risk of bias tool, and cal staff in the establishment of publicly funded surgical options for the
GRADE assessments of quality are pending. trans community.
Results: We included 72 RCTs (62 792 patients) of which 56 involved ortho-
pedic surgery, nine general, four thoracic, two gynecologic, and one urologic MP-8.3
surgery, typically comparing LMWH to DOAC (32%) or placebo (36%). Studies Exploring the patterns of practice and satisfaction among female
reported 99 (0.24%) symptomatic PEs in 40 791 patients, 191 (0.66%) symp- urologists in Canada
tomatic VTEs in 29 085 patients, and 345 (0.86%) major bleedings in 39 Amanda Hird , Marie-Pier St-Laurent , Geneviève Nadeau , Lesley Carr ,
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921 patients. The majority of studies were generally low risk of bias (Fig. 1). Monica Farcas 3
Compared to LMWH, DOACs may reduce symptomatic VTE (odds ratio [OR] 1 Urology, Sunnybrook Health Sciences Centre, University of Toronto,
0.49; 0.30–0.80; p=0.005) without increase in major bleeding (OR 1.13; 0.81– Toronto, ON, Canada; Urology, University Hospital of Québec, Université
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1.57; p=0.469). LMWH did not reduce symptomatic VTE (OR 0.54; 0.20,1.45; Laval, Québec City, QC, Canada; Urology, St. Michael’s Hospital, Toronto,
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p=0.219) but did increase major bleeding (OR 1.79; 1.00, 3.23; p=0.049). Both ON, Canada
DOACs and LMWH increased major bleeding relative to placebo (Table 1). Introduction: Our aim was to explore the satisfaction, personal and profes-
Conclusions: DOACs may be more effective than LMWH at reducing symp- sional challenges, and practice barriers among female leaders in urology
tomatic VTE. Difference in efficacy between LMWH and DOAC in reducing in Canada.
symptomatic PE could not be demonstrated likely due to low event rates. Methods: A literature review was completed. Trends with respect to career
Our NMA emphasizes the need for an RCT to directly evaluate the efficacy and personal satisfaction were identified, including academic advance-
of pharmacological thromboprophylaxis in urological surgery. ment, mentorship, professional challenges, workplace discrimination, per-
This paper has figures, which may be viewed online at: sonal/family satisfaction, as well as remuneration, among others. These key
https://2019.cua.events/webapp/lecture/194 themes were formatted into 44 questions and distributed electronically as
a survey to 67 female urology staff across Canada.
MP-8.2 Results: Fifty-nine (88%) women responded to our survey. Most had been
New beginnings: Canada’s first publically funded transition-related in practice <5 years (43%) and 90% completed a fellowship. The most
surgery program common fellowship training programs included female urology (20%),
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Yonah I. Krakowsky , Alexandra (Alexi) L. Millman , Emery Potter , Ethan neurourology (16%), and pediatrics (12%). Most (96%) of women were
D. Grober 1,2 very satisfied or somewhat satisfied with their career. Seeing more time-
1 Urology, University of Toronto, Toronto, ON, Canada; Urology, Women’s consuming patients and financial constraints within the healthcare system
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College Hospital, Toronto, ON, Canada were the greatest sources of dissatisfaction. Sixty percent of respondents
Introduction: In 2018, Ontario’s Ministry of Health, with support from the reported that they received significant mentorship during their training and
University of Toronto and Women’s College Hospital (WCH), opened the 43% felt that it was difficult to find a mentor. Fifty-seven percent experi-
first publicly funded transition-related surgery (TRS) program in Canada. enced gender discrimination during their career, most commonly from a
S136 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association