Page 2 - CUA2019 Abstracts - Reconstruction

Poster session 1: Urinary Incontinence, Lower Urinary tract reconstruction, renal transplantation

for descriptive purposes. Cox regression analysis was used to evaluate a 60-second, temperature-controlled radiofrequency (RF) protocol (RF60)
the association between surgeon experience and sling failure and binary compared to a 10-second, voltage-controlled RF protocol (RF10). We
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logistic regression to examine the effect on 90-day complications. evaluated the clinical outcomes of SBD according to the presence or
Results: Of 158 patients, continence was achieved in 82.3% (n=130) absence of baseline detrusor overactivity (DO).
with a mean followup of 42.9 months. Mean pad usage preoperatively Methods: This was a prospective observational institutional study of 46
was 2.8 pads per day with a mean change of 2.1±1.3 pads (p<0.0001). females with refractory OAB who underwent SBD from May 2015 to
Patient-reported satisfaction was 86.7% (n=137) and complications (any April 2017. The first 23 patients received RF10 whereas the last 23
Clavien grade) occurred in 12.0% (n=19) of patients. On univariate Cox received RF60. Patients were categorized according to treatment pro-
regression analysis, surgeon experience was not associated with sling tocol and DO status (DO- vs. DO+) on baseline urodynamics. Clinical
failure (p=0.55), while increasing age (p=0.01), CCI (p=0.02), and pre- outcomes assessed at 12 weeks and 12 months were the 24-hour pad
operative pad use (p<0.0001) were. (p=0.49). Likewise, on multivariate weight test (PWT), three-day voiding diary variables, and subjective
analysis, surgeon experience was not associated with sling failure (hazard improvement assessed via OAB-q, Treatment Benefit Scale, and subjec-
ratio [HR] 1.0; 95% confidence interval [CI] 0.9–1.1; p=0.92), while tive improvement rate.
increasing preoperative pad use was (H.R. 1.3; 95% CI 1.1–1.6; p=0.01). Results: In the RF10, only the DO- group reported significant reduc-
Additionally, surgeon experience did not influence the occurrence of tion in several outcomes at 12 weeks (voids/24-hour, urgency/three days
90-day complications after male slings (p=0.33). and Patient Perception of Intensity of Urgency Scale [PPIUS] grade 3/24
Conclusions: There does not appear to be a significant surgical learning hours), and at 12 months (voids/24 hours, nocturia, urgency and urgency
curve for placement of non-adjustable trans-obturator male slings, at least urinary incontinence (UUI) per three days). In the RF60, both DO- and
in surgeons with prior experience in urethral surgery. DO+ groups reported significant improvement at 12 weeks in the 24-hour
PWT, UUI/three days, urgency/three days, and PPIUS grades 0–2, 3, and
MP-1.4 4/24 hours, and at 12 months in urgency/three days and PPIUS grade
3/24 hours. When directly comparing DO- and DO+ outcomes, only
Association between stress incontinence surgery and pelvic the reduction of UUI/three days in the RF60 DO- group at 12 weeks
malignancy: A population-based cohort study was significantly different (-9.0 vs. -6.5; p=0.045; Table 1). Regardless of
Humberto Vigil , Christopher Wallis , Joseph R. LaBossiere , Sender the protocol, both groups were subjectively improved at each followup,
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Herschorn , Lesley Carr 1 except for the RF10 DO+ group at 12 weeks (Table 2).
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1 Division of Urology, Sunnybrook Health Sciences Centre, University of Conclusions: Regardless of baseline DO status, SBD for females
Toronto, Toronto, ON, Canada; Division of Urology, University of Alberta, with refractory OAB using the RF60 appears to provide more efficient
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Edmonton, AB, Canada results, both objectively and subjectively, than the RF10.
Introduction: Stress incontinence surgery was revolutionized by the This paper has figures, which may be viewed online at:
mid-urethral sling. However, concerns with respect to the implantation https://2019.cua.events/webapp/lecture/45
of pelvic mesh continue to exist. One such concern is a potential link References
between pelvic mesh and malignancy. We sought to evaluate the associa- 1. Birder L, Andersson KE. Urothelial signaling. Physiol Rev
tion between stress incontinence surgery (including transvaginal mesh) 2013;93:653-80. https://doi.org/10.1152/physrev.00030.2012
and carcinogenesis in a large, population-based cohort. 2. Tu LM, De Wachter S, Robert M, et al. Initial clinical experience
Methods: Using administrative data, we performed a retrospective cohort with selective bladder denervation for refractory overactive blad-
of all adult women who underwent stress incontinence surgery from 1994– der. Neurourol Urodyn 2019;38:644-52. https://doi.org/10.1002/
2016 in Ontario, Canada. The primary outcome of interest was the diagno- nau.23881
sis of pelvic cancer. The standardized incidence rate (SIR) was calculated
to evaluate for a potential increased risk of malignancy. Subgroup analyses
were performed for individual malignancies and urethral sling patients. MP-1.6
Results: A total of 120 999 women underwent a procedure for stress A randomized controlled trial of transcutaneous tibial nerve
incontinence in the form of urethropexy, combined abdominal/vaginal stimulation to treat overactive bladder and neurogenic bladder
sling, bulking agent, or urethral sling in Ontario during the study period. patients
Urethral sling accounted for 63% of procedures. Median followup was Blayne K. Welk , Mary McKibbon 2
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9.3 years (interquartile range [IQR] 5.4–14.4). Over a total of 1 221 668 1 Surgery, Western University, London, ON, Canada; St. Joseph’s Hospital,
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person-years of observation, 935 pelvic cancers were observed. Based on London, ON, Canada
an age-stratified sample of the general population, the expected number This study was funded by a CUA Astellas Grant and a SUFU
of cases was 1146 (SIR for any pelvic cancer 0.816, 95% confidence Neuromodulation Grant
interval [CI] 0.764–0.870). Similarly, among patients who underwent a Introduction: Percutaneous tibial nerve stimulation (using a needle) is an
urethral sling, the SIR was 0.831 (95% CI 0.758–0.909). established treatment for overactive bladder (OAB), but it is limited by
Conclusions: Stress incontinence surgery including the transvaginal high cost and provider burden. Transcutaneous tibial nerve stimulation
implantation of mesh was not associated with an increased risk of pelvic (TTNS) uses patch electrodes to deliver stimulation; previous study of this
malignancy in a large population-based cohort. has been limited by lack of blinding or a placebo group.
Methods: We conducted a randomized, double-blind, sham-controlled
MP-1.5 study. Patients were recruited into one of two groups: 1) adult women with
OAB; and 2) adults with neurogenic bladder symptoms. The intervention
Impact of detrusor overactivity on the efficacy of selective was unilateral stimulation of the posterior tibial nerve, 30 minutes three
bladder denervation for the treatment of female refractory times per week for 12 weeks at home. The sham group applied the elec-
overactive bladder trodes away from the tibial nerve. The primary outcome was the patient
Raphaëlle Brière , Patrick Richard , Matthieu Gratton , Stefan De perception of bladder condition (PPBC). Intention-to-treat analysis and
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Wachter , Le Mai Tu 2 ANCOVA models (with adjustment for baseline values) were used and
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1 Université Laval, Québec City, QC, Canada; Urology, Université de marginal means (MM) are reported; p<0.05 was considered significant.
Sherbrooke, Sherbrooke, QC, Canada; Urology, Université Laval, Québec Results: Twenty patients with OAB and 28 patients with neurogenic
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City, QC, Canada; Urology, University of Antwerp, Antwerp, Belgium bladder were recruited; 1/20 and 2/28 patients did not complete the
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Partial funding from Amphora Medical Inc. study. Most neurologic patients had multiple sclerosis (79%). Baseline
Introduction: Sub-trigonal afferent nerve signaling has been thought to characteristics in both groups were similar. There was a poor correlation
cause overactive bladder (OAB) symptoms. A recent publication reported between the patient’s actual and perceived assignment to sham/active
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the superior efficiency of selective bladder denervation (SBD) using treatment, suggesting adequate blinding. At completion, there was no
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S81