Page 3 - CUA2019 Abstracts - Reconstruction

2019 CUA Abstracts

significant difference in the PPBC between active or sham groups in the (175 g, 13x7x3 cm LxWxH) were used to test the device. Kidneys were
OAB group (MM 4.4 vs. MM 4.6; p=0.60) or neurogenic bladder cohort placed at 24 ºC; surface and core temperatures were monitored using
(MM 4.0 vs. MM 4.2; p=0.63). Similarly, there were no significant dif- implanted thermocouples. Device usability was tested by anastomosing
ferences in secondary patient-reported outcomes: the MM of the OAB-sf porcine kidney vessels to GORE-TEX vascular grafts with the cooling
®
score for the OAB cohort was 47.5 (active) vs. 48.8 (placebo), (p=0.83) jacket in place in a simulated ex-vivo operative field.
and the MM of the NBSS score for the neurogenic bladder groups was Results: Our cooling jacket costs less than $3.00 to produce and is
32.9 (active) vs. 35.5 (placebo) (p=0.35). There were no differences in moldable to any size kidney. The device resulted in mean surface and
24-hour pad weights. core temperatures at 60 minutes of (mean ± standard deviation [SD])
Conclusions: TTNS does not appear to be efficacious among people with 5.8±0.6 ºC and 5.4±0.5 ºC, respectively, significantly less than those of the
OAB or neurogenic bladder dysfunction. control, 16.6±1.4 ºC and 16.6±1.2 ºC (p<0.00001 in both), respectively
(Fig. 1). Moreover, our device mitigated surface temperature increases
MP-1.7 (2.4±1.3 ºC vs. 12.9±0.9 ºC) and core temperature increases (2.8±1.7 ºC
vs. 14.1±1.5 ºC) at 60 minutes (p<0.00001). Ex-vivo anastomosic test-
The relationship between overactive bladder and obstructive ing was not inhibited or delayed by our device during testing by expert
sleep apnea in a Canadian community-based population transplant surgeons (Fig. 2).
Samer Shamout , Sarah Bouhadoun , Abubakr Mossa , Peter Chan , Conclusions: WIT is associated with many adverse outcomes. We devel-
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Lysanne Campeau 1 oped a novel inexpensive, and easy-to-use aluminum cooling jacket that
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1 Urology, McGill University, Montréal, QC, Canada; Urology, McGill mitigated temperature increase, and maintained renal temperatures below
University Health Centre, Montréal, QC, Canada metabolically active levels, without impeding anastomoses.
Introduction: Obstructive sleep apnea syndrome (OSAS) is associated This paper has figures, which may be viewed online at:
with hypoxia, cardiovascular complications, and metabolic syndrome, https://2019.cua.events/webapp/lecture/52
all of which have been linked to overactive bladder syndrome (OAB) References
and erectile dysfunction (ED). We aimed to identify the prevalence of 1. Russell JC, Chambers MM. Comparative temperature dependence of
OAB symptoms among patients with OSAS and to describe the relation- (Na+ + K+)-ATPase. Physiol Chem Phys 1976;8:237-51.
ship between OSAS, OAB, and ED in a community-based population of 2. Szostek M, Kosieradzki M, Chmura A, et al. Does “second warm isch-
Canadian men. emia time” play a role in kidney allograft function? Transplant Proc
Methods: This is a cross-sectional study of 988 male participants of the 1999;31:1037-8. https://doi.org/10.1016/S0041-1345(98)01892-2
Men’s Health Day organized by McGill University (Montréal, Canada) 3. Ward JP. Determination of the optimum temperature for regional renal
(2013–2015). Participants underwent clinical evaluation, urine analy- hypothermia during temporary renal ischemia. Br J Urol 1975;47:17-
sis, and blood sampling, and completed validated questionnaires of sexual 24. https://doi.org/10.1111/j.1464-410X.1975.tb03913.x
health inventory (Sexual Health Inventory for Men [SHIM] and ADAM) 4. Kuipers TG, Hellegering J, El Moumni M, et al. Kidney temperature
and lower urinary tract symptoms (OAB-V8 and International Prostate course during living organ procurement and transplantation. Transpl
Symptoms Score [IPSS]). Berlin questionnaire was used to classify partici- Int 2017;30:162-9. https://doi.org/10.1111/tri.12892
pants into high and low risk of OSAS. Patients with persistent symptoms
in any two of three domains were considered at high risk for OSAS.
Results: A total of 988 men with a mean age of 55 (±12.8) years showed a MP-1.9
prevalence of 22.8% for OSAS, 36% for OAB, 50% for ED (mild to severe), Safety of ureterolysis in the management of retroperitoneal
and 60% for androgen deficiency. The high-risk OSAS group demonstrated fibrosis
significantly higher body mass index, blood pressure, triglycerides, and James Ross , Neal E. Rowe 1
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OAB-V8 score, while their testosterone level was significantly lower than 1 Department of Surgery, Division of Urology, University of Ottawa,
the low-risk group. The incidence of diabetes mellitus, hypogonadism, and Ottawa, ON, Canada
severe lower urinary tract symptoms (IPSS) were also higher among the Introduction: Retroperitoneal fibrosis (RPF) is rare and can progress to
high-risk group. The OAB-V8 score positively correlated with age (r=0.234), extrinsic ureteric obstruction. Surgical management with ureterolysis is
IPSS score (r=0.721), and Berlin score (r=0.111). SHIM score inversely typically reserved for patients failing medical treatment; however, cur-
correlated with OAB score (r=-0.263), IPSS (r=-0.259), and age (r=-0.418). rent literature on complications is limited to small, single-centred series.
Conclusions: Higher risk of OSAS appears to be associated with metabolic In this study, we aim to use a large, multicentred database to assess the
syndrome, OAB, and lower testosterone level. Severity of ED correlated short-term surgical outcomes of ureterolysis for patients with RPF.
with severity of symptoms of OAB syndrome but showed no association Methods: Using the American College of Surgeons National Quality
with OSAS. Improvement Program (NSQIP) database, a retrospective review was
This paper has a figure, which may be viewed online at: conducted on patients who underwent ureterolysis for RPF between
https://2019.cua.events/webapp/lecture/47 January 1, 2006 and December 31, 2016. Only patients who under-
went ureterolysis as a principle operative procedure by a urologist were
MP-1.8 included. Complications within 30 days of surgery were captured in the
data set and organized based on the Clavien-Dindo classification system.
Novel cooling device for kidney transplant surgery The frequency of secondary urological procedures at the time of initial
Ali Dergham , Luke Witherspoon , Thomas A. Skinner 2 ureterolysis (ureteroureterostomy, ureteroneocystostomy, and ureteroneo-
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1 School of Medicine, Faculty of Health Sciences, Queen’s University, cystostomy with psoas hitch/bladder flap) was identified.
Kingston, ON, Canada; Division of Urology, Department of Surgery, Results: One hundred patients (51 male, 49 female) were included in the
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The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada cohort, with a mean age of 57 years (interquartile range [IQR] 43, 66). Of
Introduction: In renal transplantation, warm ischemia time (WIT) describes these patients, four underwent a secondary urological procedure at the
the period of ischemia beginning with removal of the organ from ice and time of ureoterolysis: one ureteroureterostomy, two ureteoneocystostomy,
concluding at reperfusion. Metabolic activity in cooled kidneys is minimal and one ureteroneocystostomy with psoas hitch/bladder flap. The overall
at 5 ºC and resumes above 15 ºC, a temperature reached after only 15 complication rate was 12%, of which almost all were Clavien grade I or
minutes of WIT. We set out to develop a novel, inexpensive device to II (wound or urinary infection). Only one patient required a return to the
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maintain allograft temperatures ≤5 ºC, thereby limiting ischemic damage operating room (Grade III) and there were no high-grade complications
during transplantation. (Grade IV or V).
Methods: 3/16” aluminum tubing was organized in a serpentine pattern Conclusions: This is the largest study of perioperative complications from
to create a malleable, form-fitting cooling jacket. Coolant comprised 4 ureterolysis in the setting of RPF. The overall complication rate was low
ºC saline solution flowing at 240 mL/min. Adult porcine kidneys (n=4)
S82 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)