Page 3 - CUA2018 Abstracts - Incontinence

Poster session 9: Incontinence

with a mean followup of 42.7 months. Mean pad usage preoperatively was MP–9.9
2.8 pads per day with a mean change of 2.1±1.3 pads. Patient satisfaction Where are they now? Long–term adherence to intravesical
was 86.7% (n=137) and complications (any Clavien grade) occurred in onabotulinumtoxinA
17.1% (n=27) of patients. On univariate Cox regression analysis, increas- Braden Millan , Luc Wittig , Kevin Carlson , Trafford Crump , Richard
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ing age (p=0.02), CCI (p=0.02), and preoperative pad use (p<0.0001) were Baverstock 2
associated with failure to achieve continence, whereas obesity (p=0.95), 1 Department of Medicine, Cumming School of Medicine, University of
diabetes (p=0.49), and type of prostatectomy (p=0.88) were not. On mul- Calgary, Calgary, AB, Canada; Department of Surgery, vesia [Alberta
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tivariate analysis, increasing preoperative pad usage remained associated Bladder Centre], University of Calgary, Calgary, AB, Canada; Department
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with failure to achieve continence (hazard ratio [HR] 1.3; 95% confidence of Surgery, Cumming School of Medicine, University of Calgary, Calgary,
interval [CI] 1.1–16; p=0.008), while patient age (p=0.29) and CCI (p=0.10) AB, Canada
did not. Patients wearing more than three pads per day were more likely Introduction: OnabotulinumtoxinA (BoNT–A) is approved for the treat-
to experience failure (35.5% vs. 13.4%; p=0.007). ment of refractory idiopathic overactive bladder (iOAB) and neurogenic
Conclusions: Increasing preoperative pad usage is independently associ- detrusor overactivity (NDO). The purpose of this study was to investigate
ated with an increased risk of failure after non–adjustable sling for PPI long–term adherence to BoNT–A therapy and reasons for discontinuation.
in otherwise well–selected patients. In particular, over 1/3 of patients Methods: We performed a retrospective cohort analysis of all patients
using more than three pads per day failed to achieve continence and who received either a first injection or any repeat injection of BoNT–A in
may be better managed by other means, such as an adjustable sling or 2013 and followed them until 2017 or booked for injection in 2018. Data
an artificial urinary sphincter. regarding the indication for and dose of BoNT–A, need for clean intermit-
tent catheterization (CIC), as well as any patient–reported outcomes was
MP–9.8 collected. 1,2 Parametric t–tests were used to determine statistical differ-
The effect transcorporal cuff placement on artificial urinary ences between cohorts. For all tests, a p–value <0.05 was considered
sphincter outcomes in patients with a “fragile urethra” statistically significant.
Steven Tong , Logan Zemp , Nathan Hoy , Keith Rourke 1 Results: Our cohort was comprised of 274 patients, 197 (71.9%) female,
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1 Urology, University of Alberta, Edmonton, AB, Canada and mean age was 58.7 years (range 22–94). The indication for BoNT–A
Introduction: The artificial urinary sphincter (AUS) is the gold standard was: NDO in 151 (55.1%), iOAB in 106 (38.7%), and 17 (6.23%) had
for treatment of post–prostatectomy incontinence. However, patients another indication, such as painful bladder syndrome/interstitial cystitis
with a “fragile urethra” (prior radiation, AUS, or urethroplasty) are at (PBS/IC). Of the 274 patients who received BoNT–A in 2013, 189 (67.9%)
increased risk of AUS failure. Our objective is to assess overall outcomes received an injection in 2017 or are booked for repeat injection in 2018.
and transcorporal cuff outcomes in patients undergoing AUS with a “frag- Adherence was higher in patients with NDO in comparison to patients
ile urethra.” with iOAB (72.8% vs. 63.2%; p=0.053), and the lowest in patients with
Methods: We reviewed postoperative outcomes of patients with a fragile PBS/IC (52.9%). In our cohort, 105 patients (38.7%) received their first
urethra (defined as a history of radiation, previous failed AUS, or previous BoNT–A injection in 2013, and 48 (44.8%) completed both a before
urethroplasty) undergoing treatment with an artificial urinary sphincter for and after patient perception of bladder condition (PPBC) survey, while
post–prostatectomy incontinence from 2004–2017. The primary outcome 20 (19.0%) completed an eight–item overactive bladder questionnaire
was the need for AUS revision. Secondary outcomes included change in (OAB V8). There was a significant reduction in the mean PPBC score
pad use, patient satisfaction, continence (defined as requiring ≤1 pad), following BoNT–A (4.32 vs. 3.23; p<0.01), as well as the OAB V8 score
improvement (≥50% change in pad use), and erosion rates. Other patient (25.7 vs. 21.0; p<0.05). For the 139 (50.7%) patients who were previously
demographics included age, diabetes, obesity (body mass index [BMI] voiding spontaneously, 41 (29.5%) patients initiated CIC: 27 (65.9%) had
>35), Charlson Comorbidity Index, salvage/adjuvant radiotherapy, previ- iOAB, nine (22.0%) had NDO and six (14.6%) had PBS/IC. For NDO,
ous AUS, previous urethroplasty, and type of prostatectomy. Mean pad the most common reason for discontinuation was undocumented for 17
change was compared with t–tests. Patient satisfaction, continence, and (41.5%) patients, while 12 (30.8%) iOAB patients changed their prefer-
improvement rates were evaluated with Chi–square, while revision and ence. BoNT–A was discontinued due to a lack of efficacy for five patients
erosion rates were compared using the log–rank test. (12.2%) with NDO and five patients (12.8%) with iOAB.
Results: A total of 76 sphincters were placed in fragile urethras, with Conclusions: The results indicate that BoNT–A adherence is good, but
a mean age of 71.6 years and a mean followup of 37.9 months. Mean higher in NDO than iOAB, and overall, two–thirds of patients continue
preoperative pad use was 6.4 pads/day (2–12), 72.4% of patients reported therapy a minimum of five years following initiation. The most common
severe incontinence (>5 pads/day), 42.1% had salvage/adjuvant radio- reason for discontinuation was a change of management for NDO vs. a
therapy, 56.6% had failed prior AUS, and 19.7% had prior urethroplasty. change in patient preference in iOAB.
Postoperative pad use was 0.9 (0–5) (p<0.0001) for a mean pad change of References:
5.5 pads per day. Overall improvement rate was 93.4%, 71.1% reported 1. Coyne KS, Matza LS, Kopp Z, et al. The validation of the patient per-
continence, and 73.6% of patients were satisfied with the results of sur- ception of bladder condition (PPBC): A single–item global measure
gery. The revision rate was 31.6% and cuff erosion rate was 14.5%. A for patients with overactive bladder. Eur Urol 2006;49:1079–86.
total of 31.6% of cases underwent transcorporal cuff placement (n=24) https://doi.org/10.1016/j.eururo.2006.01.007
and those patients had lower revision rates (20.8% vs. 36.5%; p=0.05), 2. Peterson AC, Sehgal A, Crump RT, et al. Evaluating the 8–item
greater change in pad use (6.5 vs.5.0; p=0.02), and a trend toward lower overactive bladder questionnaire (OAB–v8) using item response
erosion rates (8.3% vs. 17.3%; p=0.09). There were non–significant dif- theory. Neurourol Urodyn 2017. Epub ahead of print. https://doi.
ferences in continence (66.7% vs. 73.1%; p=0.57), improvement (100% org/10.1002/nau.23420
vs. 90.4%; p=0.17), and satisfaction (82.6% vs. 69.4%; p=0.26).
Conclusions: The AUS is a viable treatment option for post–prostatectomy
incontinence even in patients with a fragile urethra. Use of a transcorporal
cuff may be associated with lower revision rates, greater reduction in pad
usage, and lower urethral erosion rates.

CUAJ • June 2018 • Volume 12(6Suppl2) S115