Page 1 - CUA2019 Abstracts - Reconstruction

2019 CUA AbstrACts

Poster Session 1: Urinary Incontinence, Lower Urinary Tract

Reconstruction, Renal Transplantation

June 30, 2019; 0730–0900

MP-1.1 cal disorders affecting voiding, and patients who displayed predominant
Is there an association between urinary incontinence and mortality urge incontinence on urodynamic studies (UDS). All patients were assessed
in community-dwelling elderly individuals? A retrospective cohort with UDS preoperatively. Incontinence was assessed by number of pad
study usage per day (PPD) prior to sling procedure, at 1–3 months postoperatively,
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Rano Matta , Amanda Hird , Refik Saskin , Sidney B. Radomski , Lesley and at the last documented followup. Severity of SUI was defined as mild
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Carr , Ronald T. Kodama , Robert K. Nam , Sender Herschorn 1,4 (1–2 PPD), moderate (3–5 PPD), and severe (≥6 PPD). Outcomes were
1 Division of Urology, University of Toronto, Toronto, ON, Canada; IC/ES, defined as cured (≤1 PPD), improved (≥50% PPD reduction), and failed
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Toronto, ON, Canada; Division of Urology, University Health Network, (<50% PPD reduction). A Cox proportional hazard regression model was
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Toronto, ON, Canada; Division of Urology, Sunnybrook Health Sciences used to identify possible prognostic variables for failure defined a priori,
Centre, Toronto, ON, Canada including age, prior radiation, sling type, body mass index (BMI), time from
Functional Urology Research Group, University of Toronto original procedure to sling insertion, and PPD.
Introduction: Urinary incontinence (UI) is a prevalent condition in com- Results: Between June 2010 and June 2018, a total of 23 AdVance and
munity-dwelling older adults. Frailty, as a state of vulnerability, an impor- 53 AdVance XP slings were implanted.Average age of the patients was
tant measure in this population, is associated with multiple adverse health 67.8±6.0 years with a BMI of 28.7±3.6. Median (range) followup time was
outcomes. Previous studies have demonstrated an association between UI 8.6 (1.3–81.1) and 13.7 (1.3– 42.9) months for the AdVance and AdVance
and increased mortality, independent of demographic and health status. XP, respectively. Cure rate was 95.7% and 92.5% at last followup for the
However, they have not accounted for the effect of frailty. We explored patients implanted with the AdVance and AdVance XP sling. Univariate
whether there was an association between UI and mortality, and if so, analysis showed no difference between the AdVance and AdVance XP in
whether adjustment for frailty diminishes the association. treatment failure rate and the only significant variable predictive of failure
Methods: We conducted a retrospective cohort study using a nationally rep- was age (hazard ratio [HR] 1.511; p=0.028); multivariate analysis signifi-
resentative sample of community-dwelling individuals ≥50 years surveyed cance toward age (HR 1.211; p=0.041) and a trend toward preoperative
in the 2003–2004 and 2005–2006 cohorts of the United States National pad useage (HR 2.742; p=0.057) as a predictor of failure to cure.
Health and Nutrition Examination Survey (NHANES). The primary outcome Conclusions: The AdVance and AdVance XP are both effective and safe
was overall survival reported on December 31, 2015. We used design- treatment options for male post-prostatectomy mild to severe SUI and
adjusted Cox proportional hazards regression models to estimate the hazard there appears to be no superiority of one over the other. Cure rates were
of mortality associated with UI. We adjusted our models for demographics similar at 95.7% and 92.4% for the AdVance and AdVance XP sling at our
and a validated 45-item frailty index, which incorporates an accumulation centre, slightly higher than reported in the literature. Increasing age was
of deficits in the domains of health and independence. a significant prognostic factor in predicting patients who would go on to
Results: We identified a sample of 2282 survey participants eligible for both ‘failed’ and ‘improved’ outcomes, but likely represents a relationship
analysis. Within this sample, 22% of individuals reported having UI at least with overall health and mobility rather than age alone. Preoperative pad
a few times a week. UI was independently associated with an increase in the usage also showed a trend towards predicting patients who may not go
frailty index by 6.1% (95% confidence interval [CI] 4.3–7.9%; p<0.0001). on to complete cure. Prior radiation, BMI, or preoperative urgency were
In survival analysis, adjusted for age, gender, race, household income, and not predictive of failure.
body mass index, and excluding the frailty index, individuals with UI expe-
rienced a higher risk of death (hazard ratio [HR] 1.40; 95% CI 1.11–1.76; MP-1.3
p=0.005). When adjusted for the frailty index, the association between Surgeon experience does not influence success or complications
UI and mortality was diminished (HR 1.09; 95% CI 0.87–1.36; p<0.44). of trans-obturator male slings
Conclusions: The reported association between UI and mortality can be Logan W. Zemp , Steven Tong , Nathan Hoy , Keith F. Rourke 1
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understood based on higher frailty in incontinent individuals. UI itself is 1 Division of Urology, University of Alberta, Edmonton, AB, Canada
not independently associated with mortality. Introduction: The effect of surgeon experience on trans-obturator male slings
is unclear. Our objective was to assess the effect of surgeon experience on
MP-1.2 non-adjustable trans-obturator sling failure and 90-day complications in men
AdVance/AdVance XP transobturator male slings: Single-centre undergoing treatment for post-prostatectomy incontinence (PPI).
experience for treatment of post-prostatectomy incontinence Methods: A retrospective, single-surgeon review of Advance/Advance XP
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Cameron Lam , Timothy O. Davies 1 trans-obturator male sling procedures for PPI was performed over a 10-year
1 Department of Surgery, Division of Urology, McMaster University, period (2007–2017). The treating surgeon had prior experience with urethral
Hamilton, ON, Canada surgery. Patients with known risk factors for sling failure were excluded from
Introduction: Male stress urinary incontinence (SUI) is a common occur- the study, including those with severe incontinence (>5 pads), radiation
rence after radical prostatectomy. Although the insertion of an artificial therapy, untreated detrusor overactivity, or neurogenic detrusor dysfunc-
urinary sphincter has been the standard of care, over the last 10 years, the tion. Clinical factors examined were patient age, Charlson comorbidity
transobturator male urethral sling has emerged as a minimally invasive index (CCI), diabetes, obesity (body mass index ≥35), type of prostatec-
option for management of SUI. tomy and number of preoperative pads. The outcome measures were sling
Methods: A retrospective review between June 2010 and June 2018 identi- failure (defined as 1 or less pads postoperatively if preoperative pads were
fied 76 patients who underwent insertion of a transobturator male urethral ≥2 or 0 pads if preoperative pad use was 1) and 90-day complications
sling at Hamilton Health Sciences by a single surgeon. Exclusion criteria (Clavien grade). Surgeon experience was coded as the total number of
included patients who had previous surgical management of SUI, neurologi- slings performed by the surgeon before each surgery and also by quartiles
S80 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association