Page 8 - CUA2019 Abstracts - Reconstruction

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

2 received two treatments six weeks apart. Followup visits occurred at UP-1.7
10 days and at one, four, six, and 12 months post-treatment. Subjects Management of neurogenic lower urinary tract dysfunction and
were asked to perform a one-hour pad weight test (PWT) and complete impact on disability in spinal cord injury patients in Canada
a voiding diary and validated SUI questionnaires. This study received Samer Shamout , Nawar Touma , Lysanne Campeau 1
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Health Canada ITA clearance and approval from the Health Research 1 Urology, McGill University, Montréal, QC, Canada
Ethics Board of Alberta. BMI ranges were provided by the Center for Acknowledgement: The Rick Hansen SCI Registry (RHSCIR)
Disease Control (CDC); normal was defined as 18.5–24.9, overweight Introduction: Management of neurogenic lower urinary tract dysfunction
as 25.0–29.9, and obese as over 30. (NLUTD) following spinal cord injury (SCI) is a crucial component of
Results: Results from 12-month data indicate improvements in SUI symp- the rehabilitation program with an immediate impact on quality of life.
toms for subjects, as determined by the one-hour PWT and SUI question- Therefore, we aimed to identify the impact of NLUTD and related man-
naires. The percentage of women with a >50% reduction in pad weight agement strategy on disability and quality of life in the SCI population
was 62%, 50%, and 25% for normal weight, overweight, and obese from a Canadian societal perspective.
women, respectively. Women in the normal BMI range observed the Methods: This is a retrospective, multicentre study analyzing the database
greatest percent reduction from baseline, over 71%. registry of 198 adult patients with traumatic SCI who received urological
Conclusions: The outcome measures indicate an improvement in SUI care at Rick Hansen Institute participating facilities in Montréal, Canada
symptoms for all BMI ranges based on the one-hour PWT and several SUI from April 2010 to July 2017. Participants underwent clinical evalua-
subjective patient-reported outcomes. The benefit of the CMRF vaginal tion, including demographic and injury profile based on the American
treatment for SUI suggests its potential use as a non-surgical approach Spinal Injury Association Impairment Scale (ASIA). Patients provided urine
to treat SUI. analysis and completed validated questionnaires of General Self-Efficacy
Scale (GSE) and pain inventory. Functional state of patients was evalu-
UP-1.6 ated by using the Spinal Cord Independence Measure (SCIM). Patients
Reconstruction by tissue engineering and subcutaneous also described their bladder management method over the long-term.
implantation into mice of an endothelialized human-derived Results: A total of 155 men and 43 women with a mean age of 53 (±18.5)
3D vaginal mucosa years were included in the study. The etiology of lesion was traumatic falls
Weronika Jakubowska , Christophe Caneparo , Stéphane Chabaud , in 98 (50%) patients and transport-related injury in 43 (22%) patients. The
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Geneviève Bernard , Stéphane J. Bolduc 1 mean period following injury at assessment was 3 (±8.3) years. Most of
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1 Surgery, CHU de Québec-Université Laval Research Centre, Québec these SCls were incomplete motor by the ASIA classification; 64 (40%)
City, QC, Canada. fit the classification for AIS D, 43 (27%) for AIS A, 29 (18%) for AIS C, 25
Merck Sharpe & Dohme Corp.-Université Laval Foundation (15%) for AIS B, and one (0.6%) for AIS E. The prevalence of urinary tract
Introduction: Reconstruction of autologous vagina mucosa (VM) by tissue infection (UTI) was 42%. The method of bladder management at followup
engineering (TE) would open the door to new surgical options for vaginal was normal voiding in 73 (49%) cases, intermittent self-catheterization
reconstruction for patients suffering from congenital anomalies, trauma, (ISC) in 52 (35%), catheterization by attendant in four (3%), indwelling
or post-radiotherapy consequences. A major challenge in TE is the rapid urethral catheterization in 12 (8%), and suprapubic catheterization in
revascularization of reconstructed tissues. Graft survival, and therefore seven (5%) cases. Patients with UTI had significantly less total SCIM
success rate, highly depends on it. In this study, we aim to reconstruct score and subscales scores (p<0.001). Analysis of bladder management
a microvascular network (MVN) within a tissue-engineered VM, free of method in relation to quality of life parameters revealed ISC and normal
exogenous material, using the self-assembly technique. voiding groups had significantly higher SCIM and GSE scores compared
Methods: Vaginal stromal and epithelial cells were isolated from healthy to other groups (Table 1).
donors’ biopsies. The stromal cells were co-seeded with human umbilical Conclusions: The most common bladder management methods were
cord vein endothelial cells (HUVEC) and cultured for four weeks until normal voiding and ISC. Bladder management strategy and urinary tract
the formation of a tissue-like scaffold, and mechanical properties of the infection had substantial impact on long-term ability of SCI patients to
constructs were measured. Then, epithelial cells were seeded on top of the perform basic activities independently. The use of ISC can provide optimal
scaffold and cultured for an additional week before being raised at the air/ management and is associated with better long-term quality of life and
liquid interface for a final three-week maturation period. Differentiation lower disability in selected SCI patients.
of the vaginal epithelium was assessed by immunofluorescences (IF) and This paper has a figure, which may be viewed online at:
periodic acid Schiff staining. The presence of a MVN was verified by https://2019.cua.events/webapp/lecture/64
IF. After quality-check, VM were subcutaneously implanted on the back
of nude mice as open pockets containing an agarose stent. Mice were
sacrificed after three weeks and VM harvested and analyzed using the
same techniques as before implantation.
Results: VM showed markers of adequate maturation and a dense MVN
was present. The VM survived to the implantation period and signs of
reperfusion of the graft MVN to the host were present, as evidenced
by mice red blood cells in the human MVN. Some contraction of the
implanted VM has been noted.
Conclusions: Our VM is a promising alternative to techniques currently
used. HUVEC will be replaced by vaginal-specific human microvascular
endothelial cells and contraction should be limited by the use of a silicon
stent instead of biodegradable agarose.

CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S87