Page 6 - CUA2019 Abstracts - Reconstruction

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

field stimulation, while succinate relaxed carbachol-stimulated strips in 6. Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montréal Cognitive
C57Bl6 mice only. Nitric oxide and cGMP did not contribute to succinate Assessment, MoCA: A brief screening tool for mild cognitive impair-
activity, while a decrease in released ATP was demonstrated in urothelial ment. J Am Geriatr Soc 2005;53:695-9 https://doi.org/10.1111/
cell culture from C57Bl6 and KO mice in response to succinate. j.1532-5415.2005.53221.x
Conclusions: These results demonstrate that succinate is essential for blad- 7. Owen AM, McMillan KM, Laird AR, et al. N-back working memory
der physiology and that it contributes to the relaxation-contraction state of paradigm: A meta-analysis of normative functional neuroimaging
the detrusor through GPR91, through a decrease in urothelial ATP secretion. studies. Hum Brain Mapp 2005;25:46-59. https://doi.org/10.1002/
hbm.20131
MP-1.16
Is urinary urgency a source of diverted attention leading to gait changes MP-1.17
in older people with overactive bladder? Impact of surgeon’s experience in long-term outcome of sacral
William Gibson , Kathleen F. Hunter , Adrian S. Wagg 1 neuromodulation
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1 Division of Geriatric Medicine, Faculty of Medicine and Dentistry, Dean S. Elterman , Seyed Hossein Saadat , Valentine Shabataev 1
University of Alberta, Edmonton, AB, Canada; Faculty of Nursing, 1 Urology, University Health Network, Toronto, ON, Canada
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University of Alberta, Edmonton, AB, Canada Introduction: Management of overactive bladder symptoms, urinary reten-
This study was funded by the 2016 CUA-Astellas Research Grant Program tion (non-mechanical), and chronic pelvic/bladder pain can be refractory
Introduction: There is a strong but unexplained association between lower and require many treatment modalities. Sacral neuromodulation (SNM)
urinary tract symptoms, overactive bladder (OAB), and falls in older men and has shown to be very effective for these refractory symptoms. Although
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women. Incontinent, middle-aged women’s strong desire to void induces this treatment modality has been available for decades, to our knowledge,
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changes in gait. Diverted attention, the simultaneous execution of two there is no data on impact of surgeon experience on long-term outcomes.
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cognitively demanding tasks, leads to a decline in performance of both Methods: Failure of SNM was reviewed in patients who had received the
tasks. Diverted attention causes changes in gait in older adults. We hypothe- implant during the first year in practice of a single surgeon and compared
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sized that urinary urgency acts as a source of diverted attention in older adults to failure rates in those who received the implant after ≥18 months of
with OAB, and that this induces gait changes, which predispose to falls. the surgeons’ experience. The outcomes were categorized into: 1) initial
Methods: Participants were recruited from a specialist continence clinic results; 2) early results; and 3) long-term results. The study period was
and through local newsletters. Inclusion criteria were: age ≥65 years, a confined between December 2013 and December 2015 to allow for
clinical diagnosis of OAB, daytime frequency of eight and at least weekly three years’ followup. Failure was defined as <50% improvement despite
urgency incontinence. Exclusion criteria were: cognitive impairment, conservative management or revision of implant due to inefficacy or
defined as a Montréal Cognitive Assessment score of 25/30 or lower, bothersome symptoms.
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neurological disease, or inability to walk 30 meters unaided. Participants Results: A total 25 patients had received SNM implants during the first year
underwent 3D motion gait analysis while walking for 30 minutes under of the surgeon’s experience, while 31 implantations were done between
three conditions: undistracted and with an empty bladder; distracted by 18 and 24 months’ experience. The demographic data and storage symp-
performing the n-back test, a validated source of diverted attention; and toms, urinary retention, and pelvic pain were similar in the two groups
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when experiencing self-reported, ICS-defined urinary urgency, induced (p>0.05). Mean implantation time during the first and second years were
by drinking non-caffeinated fluids. Gait parameters (velocity, cadence, 55 minutes (25–142) and 36 minutes (24–60), respectively, with 34% of
and stride length) were recorded. These were then compared under surgeries in the first year lasting >60 minutes. Initial failure rates were
each of the three conditions using a repeated-measures ANOVA with higher during the first year (12% vs. 6.25%); however, this was not statisti-
Bonferroni correction. Statistical significance was set at p<0.05. cally significant (p=0.44; Fig. 1). Although log-rank (Mantel-Cox) test did
Results: Twenty-seven participants were recruited. The mean age was 75.3 not show significant outcome difference during 36 months of followup,
years (standard deviation 5.8); 22 (81%) were female. Gait parameters long-term outcomes (after 540 days of followup) were significantly bet-
are summarized in Fig. 1. ter in patients who had received the implants during the second year of
Conclusions: Urgency induced changes in gait, which were similar to surgeon’s experience (p=0.04) (Fig. 2).
those induced by distraction. These changes, specifically reduced gait Conclusions: Surgeons’ experience plays a significant role in the long-term
speed and shortened stride length, have been associated with increased outcome of SNM implantation.
falls risk in older adults. These results suggest that urgency may act as a This paper has figures, which may be viewed online at:
source of diverted attention in older adults with OAB. https://2019.cua.events/webapp/lecture/276
This paper has a figure, which may be viewed online at: References
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The authors gratefully acknowledge the Canadian Urological Association. Results of sacral neuromodulation therapy for urinary voiding dys-
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CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S85