Page 5 - CUA2019 Abstracts - Reconstruction

2019 CUA Abstracts

2. Cannon RM, Jones CM, Hughes MG, et al. The impact of recipi- at risk for outcomes such as graft rejection and increases healthcare bur-
ent obesity on outcomes after renal transplantation. Ann Surg den. We investigated the incidence, trends in severity and treatment of
3
2013;257:978-84. https://doi.org/10.1097/SLA.0b013e318275a6cb ureteral strictures among kidney transplant recipients (KTR) in a large
3. Chang SH, Coates PTH, McDonald SP. Effects of body mass transplant centre.
index at transplant on outcomes of kidney transplantation. Methods: We conducted a single-centre, retrospective cohort study of
Transplantation 2007;84:981-7. https://doi.org/10.1097/01. KTR transplanted from January 1, 2005 to March 31, 2017 with a one-
tp.0000285290.77406.7b year followup period (n=1782). Non-kidney and simultaneous multior-
4. Lynch RJ, Ranney DN, Shijie C, et al. Obesity, surgical site infec- gan transplants were excluded. Trends in severity of, and treatments for,
tion, and outcome following renal transplantation. Ann Surgery ureteral strictures were examined. We used logistic regression models to
2009;250:1014-20. https://doi.org/10.1097/SLA.0b013e3181b4ee9a conduct a risk factor analysis of ureteral strictures.
5. Molnar MZ, Kovesdy CP, Mucsi I, et al. Higher recipient body mass Results: The incidence of ureteral strictures in the first year post-trans-
index is associated with post-transplant delayed kidney graft function. plant was 2.63 per 100 person-years (95% confidence interval [CI] 1.96,
Kidney Int 2011;80:218-24. https://doi.org/10.1038/ki.2011.114 5.53). Extended criteria donor (ECD) KTR had a significantly higher inci-
6. Yarlagadda SG, Coca SG, Formica Jr RN, et al. Association between dence than non-ECD KTR (p=0.0081). The mean number of days to reso-
delayed graft function and allograft and patient survival: A systematic lution was 32±6.9 days for simple events (strictures that resolved with
review and meta-analysis. Nephrol Dial Transplant 2008;24:1039- one intervention), and 133±22.7 days for complex events (required more
47. https://doi.org/10.1093/ndt/gfn667 than one intervention). Percutaneous nephrostomy was the most com-
mon initial treatment. In recent years, open surgery has become more
MP-1.13 frequent as an intervention. Lastly, some identified risk factors included
recipient history of peripheral vascular disease (odds ratio [OR] 2.40;
A randomized controlled trial of a modified cystoscopy technique 95% CI 1.05, 5.49; p= 0.038) and longer duration until stent removal in
to decrease patient’s pain and anxiety days (OR 1.002; 95% CI 1.001, 1.003; p=0.032).
Khalil Hetou , Ailsa Gan , Jonathan I. Izawa , Joseph Chin , Nicholas Conclusions: Factors associated with ureteral strictures include recipi-
1
1
1
1
E. Power 1 ent history of peripheral vascular disease and longer duration until stent
1 Urology, University of Western Ontario, London, ON, Canada removal. Targeting patients at risk may help reduce the incidence of
Introduction: Pain, anxiety, and embarrassment are documented feelings complex events and the need to resort to open surgery as a treatment.
in patients undergoing ambulatory cystoscopy. Peak-end theory suggests Future steps include studying relationships between ureteral strictures
that perception of any experience depends on the peak and end of that and clinical outcomes.
experience regardless of its duration. We explored using peak-end theory References
in improving pain perception in patients undergoing diagnostic cystos- 1. Krajewski W, Dembowski J, Kołodziej A, et al. Urological compli-
copy. We hypothesized that if we created a less unpleasant ending of cations after renal transplantation: A single-centre experience. Cent
the cystoscopy procedure, this will improve patients’ pain and anxiety Eur J Urol 2016;69:306-11.
perception after cystoscopy. 2. Berli JU, Montgomery JR, Segev DL, et al. Surgical management
Methods: We conducted a randomized clinical trial for patients undergo- of early and late ureteral complications after renal transplantation:
ing an ambulatory flexible diagnostic cystoscopy for the first time. Males to Techniques and outcomes. Clin Transplant 2014;29:26-33. https://
females, as well as arm-allocation ratios, were 1:1. Control arm received doi.org/10.1111/ctr.12478
a standard cystoscopy. In the intervention arm, the cystoscope was left in 3. Kumar S, Jeon JH, Hakim A, et al. Long-term graft and patient
the bladder for an additional two minutes without further manipulation survival after balloon dilation of ureteric stenosis after renal trans-
before scope removal. Pain and anxiety scores after cystoscopy were plant: A 23-year retrospective, matched-cohort study. Radiology
assessed using Visual Analogue Scale (VAS). 2016;281:301-10. https://doi.org/10.1148/radiol.2016151629
Results: We present the results of 54 patients out of 61 patients recruited
so far after exclusion of seven patients. Baseline characteristics were bal-
anced between the two arms. Mean VAS scores were lower in the inter- MP-1.15
vention arm but not statistically significant (17.2 mm vs. 12.0; p=0.30). The succinate receptor GPR91 mediates detrusor relaxation
VAS scores were also lower in the intervention arm in the female subgroup Abubakr Mossa , Monica Velasquez-Flores , Philippe Cammisotto ,
1
1
1
(8.1 vs. 9.6; p=0.73) and in the male subgroup (16.1 vs. 23.2; p=0.36). Lysanne Campeau 1,2
Post-cystoscopy anxiety scores were lower in the intervention arm (1.1 1 Lady David Institute, Jewish General Hospital, Montréal, QC, Canada;
vs. 2.3; p= 0.024). Anxiety scores were significantly lower only in the 2 Division of Urology, Department of Surgery, McGill University, Montréal,
male subgroup (0.96 vs. 3.4; p=0.013). In the female subgroup, interven- QC, Canada
tion arm showed lower scores but this was not statistically significant Introduction: The succinate receptor GPR91 is expressed by the bladder
(0.92 vs. 1.0; p=0.90). urothelium and detrusor layers. The acute and immediate effects of its
Conclusions: Our study represents the first assessment of peak-end the- activation on bladder function have yet to be described. Using a mouse
ory in the office-based urological setting. Making the end-phase of an model with specific deletion of the GPR91 receptor, we aimed to unravel
unpleasant procedure less unpleasant showed a potential improvement in the acute effect of succinate activation of its receptor GPR91 on bladder
post-cystoscopy pain and anxiety perception, especially in males. contraction/relaxation.
Methods: Conscious cystometry was carried out on SD rats, C57Bl6 and
MP-1.14 GPR91(-/-) mice. Contractile properties of bladder strips were assessed by
organ bath. Morphology and characterization of bladders were obtained
Ureteral strictures in kidney transplant recipients: Trends and by Masson’s trichrome and immunoblotting. Cell cultures were used to
severity measure nitric oxide secretion (colorimetric assay), ATP, and cGMP levels
Michelle Minkovich , Tierza Johnson , Wendi Qu , Olusegun Famure , (commercial kits).
1
1
1
1
Yanhong Li , S. Joseph Kim , Jason Lee 1,3 Results: GPR91(-/-) and C57Bl6 mice displayed similar body weight.
1
1,2
1 UHN Transplant Program, University Health Network, Toronto, ON, Bladder mass was higher and urothelium and lamina propria was thicker
Canada; Division of Nephrology, Department of Medicine, University in GPR91(-/-) mice. Conscious cystometry revealed that GPR91(-/-) mice
2
of Toronto, Toronto, ON, Canada; Division of Urology, Department of had a lower bladder capacity, lower micturition volume, and lower inter-
3
Medicine, University of Toronto, Toronto, ON, Canada contraction interval. When intravesical instillation of succinate (10 mM)
Introduction: Ureteral complication post-kidney transplant can be a sig- was performed, bladder capacity increased in C57Bl6 mice only. In organ
nificant morbidity, often requiring invasive re-operations to repair leaks bath, bladder strips from C57Bl6 and GPR91(-/-) mice presented similar
and strictures and potentially impacting graft function. This puts patients contractions elicited by potassium chloride, carbachol, and electrical
1,2
S84 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)