Page 4 - CUA2019 Abstracts - Reconstruction

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

and most complications were low-grade. As such, ureterolysis likely rep- cess defined as urethral patency >16 Fr on routine followup cystoscopy.
resents a safe treatment option for ureteric obstruction secondary to RPF. Secondary outcome measures included 90-day complications, de novo
erectile dysfunction, incontinence, and persistence of lower urinary tract
MP-1.10 symptoms (LUTS).
Results: Thirty-six patients underwent urethroplasty caused by either trans-
Urethral stricture is frequently a morbid condition: Identifying urethral resection of the prostate (69.4%) or Greenlight photovaporization
patients at increased risk for complications due to urethral of the prostate (30.6%). Mean stricture length was 2.7 cm and mean
stricture patient age was 71.9 years. Most (94.4%) patients had failed prior endo-
Christopher King , Keith F. Rourke 1 scopic treatment a mean of 3.3 times. Overall success rate was 91.7% at a
1
1 Division of Urology, University of Alberta, Edmonton, AB, Canada mean followup of 53.2 months. A total of 5.6% of patients experienced de
Introduction: While urethral stricture can diminish a patient’s quality of novo erectile dysfunction and 0% had an adverse change in continence;
life, some patients will also experience complications directly related to 21.2% of stricture-free patients complained of persisting LUTS without
urethral stricture. The objective of this study is to determine the frequency evidence of lower urinary tract obstruction after urethroplasty.
of complications related to urethral stricture and identify clinical factors Conclusions: Urethroplasty for proximal bulbar urethral strictures after
associated with them. transurethral resection for BPH yields satisfying patency rates with minimal
Methods: A total of 1851 patients with urethral stricture presenting to a impact on erectile function and continence. However, patients endorse
single urologist from 2005–2016 were retrospectively reviewed. Clinical persistent LUTS without evidence of lower urinary tract obstruction likely
variables examined were complications directly related to urethral stricture owing to underlying detrusor dysfunction.
at the time of presentation, presenting signs/symptoms, type of complica-
tions, patient age, stricture length, location, and etiology. Complications
considered significant were acute urinary retention or difficult catheteriza- MP-1.12
tion requiring emergent urological intervention or renal failure, urosepsis, Use of subcutaneous low-suction drains for the prevention of
or urethral abscess directly related to urethral stricture. Patients without wound-related complications in obese renal transplant recipients
complete data were excluded from the study. The occurrence of complica- Thomas A. Skinner , Nikhile Mookerji , Luke Witherspoon , Annie-
1
1,2
1,2
tions was compared in relation to patient age, symptoms, stricture length, Claude Blouin , Nicholas Paterson , Brian D. Blew , John E. Mahoney ,
1,2
1,2
1,2
3
location, and etiology using binary logistic regression. Jeffrey Warren
1,2
Results: Of 1023 patients meeting inclusion criteria, mean patient age 1 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada;
was 48.0 years and mean stricture length was 5.0cm (1–18). Stricture 2 Department of Surgery, Division of Urology, The Ottawa Hospital,
etiology was most commonly idiopathic (46.3%), iatrogenic (15.0%), or Ottawa, ON, Canada; Department of Surgery, Division of Urology,
3
due to lichen sclerosus (14.9%). The most common stricture location was Université Laval, Québec City, QC, Canada
bulbar (65.6%), followed by penile (18.6%), multisegment (10.6%), and Introduction: Postoperative wound complications in the kidney transplant
posterior (5.4%). Less than half (40.6%, 415) of patients had at least one population are common and include infection, hematoma, lymphocele,
complication directly related to urethral stricture, including acute urinary dehiscence, and hernia. These complications are especially prevalent in
retention (32.6%), difficult catheterization (16.0%), urethral abscess/uro- patients with elevated body mass index (BMI) and contribute to longer
sepsis (5.0%), and renal failure (3.1%); 7.0% of patients experienced com- hospital stays, higher readmission rates, and return trips to the emergency
plications deemed to be life-threatening. On multivariate analysis, stricture department. Any intervention that may reduce the risk of wound com-
1-6
length (in cm) (odds ratio [OR1.1; 95% confidence interval [CI] 1.1–1.2; plications is worth exploring and some surgeons at our centre have begun
p=0.01), lack of reported lower urinary tract symptoms (LUTS) (OR 3.8; using extra-fascial, low-suction (Jackson-Pratt) drains in patients with ele-
95% CI 1.9–7.3; p<0.0001), posterior stenosis (OR 3.0; 95% CI 1.3–6.8; vated BMI as a prophylactic strategy. We set out to determine whether the
p=0.01), and traumatic strictures (OR 1.6; 95% CI 1.1–2.4; p=0.02) were placement of these drains at the time of kidney transplantation is protective
associated with complications related to urethral stricture. On multivariate against wound-related complications in the postoperative period.
analysis, stricture etiology, particularly trauma (OR 2.2; 95% CI 1.1–4.6; Methods: A retrospective chart review of all patients who underwent
p=0.03) and hypospadias (OR 2.5; 95% CI 1.1–6.5; p=0.05) were associ- renal transplantation at The Ottawa Hospital between January 1, 2016
ated with an increased risk of life-threatening complications. and January 20, 2018 was conducted. Patient demographics, type and
Conclusions: Urethral stricture is frequently a morbid condition. Patients severity of complications, and drain use were recorded. Univariate and
with longer strictures, posterior stenoses, absence of preceding LUTS, and multiple logistic regression analyses were performed to determine the
traumatic strictures are at highest risk for complications related to urethral relationship between drain use and wound complications.
stricture. Patients with these high-risk characteristics should perhaps be Results: A total of 295 patients were identified in the study, with an aver-
strongly encouraged to pursue definitive treatment. age age of 55 years (Table 1). Ninety-seven (33%) patients were obese
or morbidly obese (BMI>30). Drains were used in 24 (39%) non-obese
MP-1.11 patients and 38 (61%) obese or morbidly obese patients. Wound compli-
cations were found in 33 (51%) obese patients, 13 (39%) of whom had
Reconstruction of proximal bulbar strictures caused by drains. Univariate analysis identified drain use as a protective factor for
transurethral procedures for benign prostatic hyperplasia wound complications (odds ratio [OR] 0.41; 95% confidence interval [CI]
Callum Lavoie , Keith F. Rourke , R. Christopher Doiron 1 0.236, 0.708). Multiple regression analysis indicated no significant effect
1
1
Division of Urology, University of Alberta, Edmonton, AB, Canada of drain use on wound complication rate, however, BMI and delayed graft
1
Introduction: Proximal bulbar urethral strictures are a well-known compli- function were independent risk factors for the development of wound
cation of transurethral treatments for benign prostatic hyperplasia (BPH). complications (OR 1.09 and 2.99, respectively; p<0.05) (Fig. 1).
Urethroplasty outcomes in this specific population are important given the Conclusions: Through a robust retrospective chart review, we failed to
close proximity of these strictures to the membranous urethra in patients demonstrate a convincing benefit to using superficial incisional drains in
with a compromised bladder neck. Our objective is to examine outcomes overweight and obese renal transplant recipients.
of urethroplasty for proximal bulbar strictures caused by transurethral This paper has figures, which may be viewed online at:
procedures for BPH. https://2019.cua.events/webapp/lecture/48
Methods: A retrospective review of patients undergoing urethroplasty for References
proximal bulbar urethral strictures caused by transurethral procedures 1. Shabanzadeh DM, Sørensen LT. Laparoscopic surgery compared
from January 2004 to March 2018 was performed. Patient age, demo- with open surgery decreases surgical site infection in obese patients:
graphics, stricture length, etiology, prior treatment, surgical technique, A systematic review and meta-analysis. Ann Surg 2012;256:934-45.
90-day complications, and semi-quantitative assessment of erectile func- https://doi.org/10.1097/SLA.0b013e318269a46b
tion and incontinence were recorded. The primary outcome was suc-
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S83