Page 1 - CUA2018 Abstracts - Incontinence

2018 CUA AbstrACts

Poster Session 9: Incontinence

June 26, 2018; 0800–0930

MP–9.1 Methods: This was a retrospective study of all patients who underwent
Metabolomic analysis of candidate urinary markers of overactive test–phase (peripheral nerve evaluation [PNE] and/or first–stage procedure)
bladder syndrome in an aging female population: Pilot prospective and then SNM by a single surgeon from 1994–2017. The primary out-
study come was to assess long–term outcomes of SNM using the global response
1,2
1
Abubakr Mossa , Samer Shamout , Philippe Cammisotto , Lysanne assessment scale. This included percent improvement in pain, as well as
1
Campeau 1,2 storage and voiding lower urinary tract symptoms. Secondary outcomes
2
1 Lady Davis Institute, McGill University, Montreal, QC, Canada; Urology included number of revisions, reason for revision, complications, and rate
Department, Jewish General Hospital, Montreal, QC, Canada of device removal.
Study Groups: Metabolomics Core Facility, Goodman Cancer Research Results: A total of 435 patients were included, with 374 (85%) female and
Centre, Montreal–Qc, Quebec Network for Research on Aging – 61 (15%) male patients. All patients underwent test phase and 236/435
Incontinence Thematic Group. (54%) patients eventually received a SNM implant. Mean age at time of
Introduction: Overactive bladder syndrome (OAB) is strongly associated with implant was 48 years. Mean followup time was 5.7 years (1 month–20
aging and metabolic syndrome. However, the exact links remain to be clari- years). Seventy–two of 36 (30%) devices were removed due to device fail-
fied. Urinary metabolome is a useful tool to diagnose metabolic alterations ure, complication, and/or no improvement in symptoms; 169/236 (71%)
that can impact bladder physiology. We aim to identify specific metabolic patients underwent at least one followup surgical revision and 81/236
markers of OAB using urine metabolomics of an aging female population. (34%) patients underwent more than one revision. The mean percentage
Methods: Forty female patients (20 OAB patients and 20 healthy subjects) improvement in symptoms on the last followup (mean 6.4 years) for patients
between the age of 50 and 80 years old underwent clinical evaluation with successful SNM was 69%.
and lower urinary tract symptoms assessment with Overactive Bladder Conclusions: Traditionally, patients with OAB, VD, and IC who failed con-
Symptom Score (OABSS), International Consultation on Incontinence–Short servative measures were left only with highly invasive options, such as
Form (ICIQ–SF), and Incontinence Impact Questionnaire (IIQ–7), a three– augmentation cystoplasty and urinary diversions. In this chart review, we
day voiding diary, and blood sampling. Early morning midstream urine find that SNM is an effective option prior to major surgical interventions.
samples were collected for culture and metabolomics analysis. The uri- There is a high revision rate, but overall, SNM is a minimally invasive
nary metabolome was analyzed by gas chromatography–mass spectrometry. procedure with a good safety profile and excellent long–term outcomes.
ANCOVA was performed to control for the effect of age. References:
Results: Patients in the OAB group had a significant higher mean age, 1. Marcelissen T, Leong RK, de Bie RA, et al. Long–term results of
reflecting a higher prevalence in the elderly (56.3 years ± 5.2 control sacral neuromodulation with the tined lead procedure. J Urol
vs. 68.9 ± 11.4 OAB; p<0.001). Serum analysis showed a higher insulin 2010;184:1997–2000. https://doi.org/10.1016/j.juro.2010.06.142
resistance index (HOMA–IR) and serum urea in the OAB patients when 2. Al–zahrani AA, Elzayat EA, Gajewski JB. Long–term outcome and
controlled for age (Table 1; available at https://cua.guide/). Urine metabo- surgical interventions after sacral neuromodulation implant for
lomic analysis showed higher levels of urinary mitochondrial dysfunction lower urinary tract symptoms: 14–year experience at 1 centre. J Urol
(itaconic, malic and fumaric acids), oxidative stress (L–pyroglutamic and 2011;185:981–6. https://doi.org/10.1016/j.juro.2010.10.054
a–hydroxyglutaric acids), and ketosis (β–hydroxybutyric and hydroxyiso- 3. Van Voskuilen AC, Oerlemans DJAJ, Weil EHJ, et al. Long–term results
butyric acids) intermediates in OAB patients, with values correlating sig- of neuromodulation by sacral nerve stimulation for lower urinary tract
nificantly with OAB symptoms (Table 2; available at https://cua.guide/). symptoms: A retrospective single–centre study. Eur Urol 2006;49:366–
Multiple linear regression model showed that age, blood glucose, and urine 72. https://doi.org/10.1016/j.eururo.2005.11.009
metabolites (malic, fumaric, and hydroxyisobutyric) are predictor factors
of OAB severity assessed by questionnaire scores. MP–9.3
Conclusions: OAB patients showed increased insulin resistance and higher Effects of baseline body mass index and overactive bladder
urinary metabolic stress intermediates that correlated significantly with the duration on onabotulinumtoxinA efficacy and safety in patients
severity of OAB symptoms. This study proposes new metabolites to serve as with overactive bladder
biomarkers of OAB and explains its link to metabolic syndrome. Sender Herschorn , Tomasz Rechberger , Jennifer Miles–Thomas , Douglass
3
2
1
Hale , Linda Cardozo , Amelia Orejudos , Anand Patel , Christopher
4
5
7
6
MP–9.2 Chermansky 8
Long–term outcomes of sacral neuromodulation: A 23–year 1 Division of Urology, University of Toronto, Toronto, ON, Canada;
experience 2 Department of Gynecology, Medical University Lublin, Lublin, Poland;
4
1
Shreyas Gandhi , Sulaiman Almutairi , Abdullah Ali , Ashley Cox , Jerzy 3 Urology of Virginia, Virginia Beach, VA, United States; Urogynecology
1
1
1
5
Gajewski 1 Associates, Indianapolis, IN, United States; King’s College Hospital, London,
7
6
1 Department of Urology, Dalhousie University, Halifax, NS, Canada United Kingdom; Allergan plc, Irvine, CA, United States; Allergan plc,
8
Introduction: Sacral neuromodulation (SNM) has been found effective for Marlow, United Kingdom; Female Urology and Neurourology, University
the treatment of overactive bladder (OAB), urgency urinary incontinence, of Pittsburgh Medical Center, Pittsburgh, PA, United States
interstitial cystitis (IC), and voiding dysfunction (VD). Several studies show Study Groups: Funding: Allergan plc.
the safety and efficacy of SNM at short– and medium– term followup. 1–3 In Introduction: We evaluated the effects of baseline overactive bladder (OAB)
this study, we review the long–term outcomes and complications of SNM duration and body mass index (BMI) on onabotulinumtoxinA (onabotA)
treatment for any indication. efficacy and safety in a large population of OAB patients with urinary
incontinence (UI).
CUAJ • June 2018 • Volume 12(6Suppl2) S113
© 2018 Canadian Urological Association