Page 7 - CUA2019 Abstracts - Reconstruction

2019 CUA Abstracts

UP-1.1 and increased in prevalence over time (p=0.009), while both flap and
Outcomes of urethroplasty for radiation-induced urethral staged techniques decreased over time (p=0.008, p=0.004, respectively).
stenoses The remaining techniques did not vary over time. Finally, the overall suc-
1
1
Runhan Ren , Logan W. Zemp , Keith F. Rourke cess rate was 90% (n=1106). This appeared to improve significantly with
1
1 Urology, University of Alberta, Edmonton, AB, Canada time (n=248, 87% [T1], n=359, 90% [T2], n=499, 93% [T3]; p=0.001].
Introduction: Bulbomembranous urethral stenosis is a challenging and Conclusions: The surgical treatment of urethral stricture has evolved over
under-reported complication of radiotherapy, particularly for prostate can- the last 15 years with an increase in patient age, increase in radiation and
cer. Our objective is to report outcomes of urethroplasty for these patients. iatrogenic strictures, decrease in stricture length, and a reduction in the
Methods: A retrospective review of 81 patients undergoing urethroplasty number of endoscopic procedures performed prior to referral. Increased
for refractory radiation-induced bulbomembranous stenoses from January use of single-stage urethroplasty using buccal mucosa was observed,
2004 to March 2018 was done at the University of Alberta. Primary which may have contributed to an increase in urethroplasty success over
outcome was urethral patency greater than 16 Fr on routine followup the same time period.
cystoscopy. Secondary outcomes were 90-day complications, de novo
erectile dysfunction, and incontinence assessed at six months. UP-1.3
Results: Forty and 41 patients had posterior urethral stenosis due to Necessity for routine crossmatch for blood transfusion at the
brachytherapy and external beam radiation, respectively. Mean stenosis time of renal transplantation: A quality improvement project
length was 2.8 cm, mean time from radiation to urethroplasty was 6.8 Douglas C. Cheung , Luke F. Reynolds , Melin Peng , Michael Ordon 1
1
1
1
years, and mean number of prior failed endoscopic procedures was 3.6. 1 Urology, University of Toronto, Toronto, ON, Canada
A total of 34.6% (28) of patients had an indwelling suprapubic catheter Introduction: Routine crossmatch of packed red blood cells (pRBCs) is
preoperatively and 53.1% (43) had preoperative erectile dysfunction; completed preoperatively at many transplantation centres in Canada.
71.6% (58) underwent anastomotic urethroplasty, with the remainder However, rates of blood transfusion vary and the timing of transfusion
undergoing substitution urethroplasty (23). Overall, there was an 87.7% during the hospital stay is unclear. Furthermore, judicious and medically
(71) urethral patency rate, with a mean followup of 51.3 (6–173) months. appropriate resource adjudication remains a concern. Our objective was
Ninety-day postoperative complication (Clavien ≥2) occurred in 17.3% of to determine the incidence of perioperative pRBC transfusion and predic-
patients; 17.3% and 22.2% reported adverse changes in erectile function tors of transfusion in patients undergoing renal transplantation.
and incontinence, respectively. On Cox regression analysis, substitution Methods: A retrospective review of all patients undergoing renal transplan-
compared to anastomotic urethroplasty had a higher rate of recurrent tation at our institution from January 2013 to May 2016 was performed.
stenosis (14.3% vs. 4.3%; p=0.003), with no difference in secondary out- Demographic, biochemical, and clinical parameters, including the inci-
comes. Patients with prior prostate surgery (p=0.002) and infrapubectomy dence of perioperative transfusion, were determined. Perioperative transfu-
(p=0.03) were more likely to experience adverse changes in continence. sion, defined as an intraoperative transfusion or transfusion within two days
Conclusions: Urethroplasty for radiation-induced bulbomembranous of surgery, was the primary outcome. Multivariable logistic regression was
stenosis yields satisfying patency rates but with some risk of de novo performed to assess for predictors of perioperative transfusion.
incontinence and erectile dysfunction. Anastomotic urethroplasty appears Results: We identified 428 patients during the study period (average age
more successful and should be used when possible. 55 years, 60% male, 72% deceased donor, and 43% blood thinner use).
Twenty (4.7%) patients required an intraoperative transfusion with a mean
UP-1.2 of 3.1 pRBCs per transfusion. Forty (9.3%) patients required transfusion
The evolution of urethral stricture and urethroplasty over 15 perioperatively with a mean of 2.8 pRBCs per transfusion, with the most
years: A single-centre, single-surgeon 1319 urethroplasty analysis common reason for transfusion being a gradual Hb decline over two days
1
R. Christopher Doiron , Keith F. Rourke 1 (51%). On multivariable regression analysis, lower preoperative Hb (per
1 Division of Urology, Department of Surgery, University of Alberta, g/L unit increase odds ratio [OR] 0.92; 0.88–0.95; p<0.01) and female
Edmonton, AB, Canada gender (OR 2.76; 1.20–6.73; p=0.02) were associated with periopera-
Introduction: The management of urethral strictures has evolved dramati- tive transfusion.
cally over the last 15 years. We aimed to analyze trends in patient presen- Conclusions: In our retrospective review, intraoperative and periopera-
tation and reconstructive practice in all patients undergoing urethroplasty tive transfusion rates were low, suggesting routine cross-match may not
at a single centre over 15 years. be necessary. Given that only 9.3% of patients required perioperative
Methods: Patients undergoing urethroplasty by single surgeon (KFR) from transfusion within two days, 90.7% of cross-matched blood went unused
August 2003 to May 2018 were included in the analysis. Patient demo- in our cohort. Preoperative Hb and female gender were associated with
graphics, clinical presentation, and surgical procedure and outcomes data increased transfusion.
were collected in a prospectively maintained database. A retrospective
analysis categorized patients into three, five-year cohorts based on date UP-1.5
of surgery, and trends over time were analyzed. Effect of cryogen-cooled monopolar radiofrequency treatment
Results: A total of 1319 urethroplasties were completed over the study for stress urinary incontinence in women: A subanalysis based
period. During the first five years (T1), 299 urethroplasties were per- on body mass index
formed, while 431 and 589 were performed in T2 and T3, respectively. Bruce B. Allan , Kathryn Husarek
2
1
Mean overall patient age was 46.8 years and this increased significantly 1 Allan Centre, Calgary, AB, Canada; Medical Affairs, Viveve, Englewood,
2
over time (p<0.001). Most patients presented with an idiopathic cause of CO, United States
their stricture (n=516, 39%) and this did not change over time. Trauma was Introduction: Stress urinary incontinence (SUI) is the most common type
the second most common etiology overall (n=262, 20%), but decreased of urinary incontinence. Millions of women are affected, with prevalence
significantly over time (p<0.001). Radiation-induced strictures signifi- increasing with body mass index (BMI). While a variety of treatment
cantly increased over time (n=9, 3% ([T1], n=22, 5% [T2], n=51, 9% options exist, treatment efficacy varies depending on severity of incon-
([T3]; p=0.001), as did iatrogenic strictures. Mean stricture length was 4.4 tinence and the impact on quality of life. This gap in treatment options
cm and this decreased over time (4.7 cm [T1], 4.8 cm [T2], 4.0 cm [T3]; for SUI presents an opportunity to meet an unmet need in healthcare
p<0.001). Most patients presented with a previously failed endoscopic for women. This abstract represents a subanalysis of the data based on
treatment alone (n=861, 65%), while 249 patients (19%) had additionally BMI from a clinical feasibility study aimed to investigate the safety and
undergone a prior open reconstruction. Overall, patients had a mean of efficacy of a non-surgical cryogen-cooled monopolar radiofrequency
3.2 prior endoscopic procedures; this decreased over time (3.4 [T1]), 3.9 (CMRF) treatment for SUI.
[T2], and 2.5 [T3]; p<0.001). Overall, single-stage urethroplasty with buc- Methods: Thirty-five subjects were enrolled and treated. Subjects were
cal mucosa was the most common technique performed (n=656, 50%) randomized into two groups: group 1 received one treatment and group
S86 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)