Page 4 - CUA2018 Abstracts - Incontinence

Poster session 9: Incontinence

MP–9.10 Thirty–two patients (36%) have not required any additional surgery, 37 (42%)
The burden of overactive bladder in Canada: An examination of have had endoscopic procedures for bladder stones, 25 (12%) required
prevalence over time and healthcare resource use open surgery, including valve revision (13), BN procedure (4), ileal conduit
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Karissa Johnston , Katherine Gooch , Daniel Ng , Christina Qian , Alison (4), stomal hernia (2), and early perforation (2). Three patients died from
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Deighton , Anne Guttschow , Lysanne Campeau 3 unrelated causes and one from urothelial cancer after 15 years. Two women
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1 Broadstreet Health Economics & Outcomes Research, Vancouver, BC, had full–term pregnancies. No other significant morbidity has been seen.
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Canada; Medical Affairs, Americas, Astellas Pharmaceutical Global Conclusions: This procedure is a good option with long–term durability
Development, Northbrook, IL, United States; Lady Davis Institute for in patients who require a continent abdominal access to their bladders.
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Medical Research, McGill University, Montreal, QC, Canada Leaving urethral access and/or having a large catheterizing channel facili-
Introduction: The prevalence of overactive bladder (OAB) increases with tates endoscopic procedures if required.
age, and country–specific estimates of burden are dependent on demo-
graphic distributions. Estimates of the clinical and economic burden are MP–9.12
not available for Canada. The objective of this study was to characterize The bladder management experiences of spinal cord injury
the clinical and economic burden of OAB over time in Canada using patients: A systematic review of qualitative studies
provincial population–based administrative datasets. Patrick McGarry , Blayne Welk 1
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Methods: Using sample datasets from 2006–2015 from the Régie de 1 Surgery, Western University, London, ON, Canada
l’assurance maladie du Québec (RAMQ), outcomes were assessed among Study Groups: Dr. McGarry was supported by a CUA Pfizer Incontinence
a cohort aged ≥18, and a subset aged ≥65. The OAB cohort, which was Grant.
defined by two or more outpatient billing codes or prescription of an Introduction: Qualitative research is well–suited to identify a person’s
OAB–specific medication, was compared to an age– and sex–matched beliefs, principles, feelings, and motivations that explain behaviour. We
sample of the general population without OAB. We used a random sample systematically reviewed the qualitative literature on spinal cord injury
of outpatient and medication data for 125 000 individuals across all (SCI) and bladder management to better understand how SCI patients
cohorts, with denominator details included, allowing for population– choose a bladder management method.
level extrapolation. Prevalence was calculated based on the number of Methods: We searched EMBASE, CINAHL, and PsycINFO. Two review-
individuals meeting inclusion criteria for OAB, relative to the overall ers independently examined the papers to identify those that met our
population. Healthcare resource use and costs were identified from any inclusion criteria. This systematic review was prospectively registered
individual physician billing and pharmaceutical records among the OAB at PROSPERO, and a predetermined data extraction template was used.
and comparison cohorts during the period. Results: We identified 412 studies and included 11 studies (n=443
Results: Prevalence ranged from 0.39% in 2006 to 1.98% in 2015, and people). Of these studies, 6/11 included predominately SCI patients.
1.30% in 2006 to 5.15% in 2015 in the ≥18 and ≥65 OAB cohorts, Age range was 19–96 years, duration of catheter use was <1–40 years,
respectively. Healthcare resource use among the OAB cohort was notably and the majority were male (67%). Most studies used semi–structured
higher. In the first year, the patient had either one eligible prescription or focus groups to gather information. Several common themes emerged
the first of two eligible diagnoses (index year), the OAB cohort had more from these studies. Participants commonly described physical and social
outpatient visits than the comparison cohort (29 vs. 17; p<0.01), and a limitations associated with catheters. A negative impact on intimacy and
higher number of prescriptions filled (25 vs. 16; p<0.01). embarrassment/anxiety around public exposure of catheters was also
Conclusions: In Quebec, Canada, the prevalence of diagnosed OAB is commonly discussed. Participants described undergoing a process of
increasing over time and is associated with increased burden on health- normalization. This process is impacted by intermittent catheter barriers
care resources. (such as no appropriate public facilities, difficulties because of spasticity,
fear of inadvertent self–harm, increased time, and cost) and indwelling
MP–9.11 catheter benefits (reduced incontinence, simplifying life, and improved
Durability hemi–Kock continent stoma with cystoplasty in independence). The final stage of normalization was accepting both good
neurogenic bladder dysfunction days (when bladder management fades into the background) and bad days
Sender Herschorn 1 (when bladder management leads to stigma, shame, and complications).
1 Surgery, Urology, University of Toronto and Sunnybrook Health Sciences Conclusions: Directly addressing a SCI patient’s psychosocial issues related
Centre, Toronto, ON, Canada to bladder management may improve compliance rates with the safest
Introduction: The management of patients with neurogenic bladders who bladder management behaviours. Several factors are easily modifiable
require but cannot perform urethral clean intermittent catheterization (CIC) with medical treatment, education, and simple changes to catheter design.
is facilitated by surgical creation of a continent abdominal access. A cohort
of patients who underwent a continent cutaneous bladder stoma was ana- MP–9.13
lyzed to assess long–term durability and the need for revisional surgery. Mesenchymal stem cells inhibit hypoxia–induced inflammatory
Methods: A total of 88 patients, 66 women and 22 men (mean age 36.6 and fibrotic pathways in bladder smooth muscle cells
years, range 18–69), underwent the surgery, primarily for intractable urinary Bridget Wiafe , Peter Metcalfe , Adetola Adesida , Thomas Churchill 1
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incontinence. Diagnoses were spinal cord injury (44), spina bifida (23), MS 1 Surgery, University of Alberta, Edmonton, AB, Canada
(6), transverse myelitis (2), and other neurological causes (16). During the Introduction: Partial bladder outlet obstruction (pBOO) results in sig-
surgery, in addition to the intussuscepted ileal segment continent bladder nificant morbidity across childhood and in men with benign prostatic
stoma, 84 patients had a cystoplasty with adjacent ileum and four had hyperplasia (BPH). In children with severe disorders, such as spina bifida
sigmoid cystoplasty. To address urethral incompetence, in the women, 34 and posterior urethral valves, it can result in a lifetime risk of renal failure.
had bladder neck (BN) slings, 14 had slings with BN tapering, and nine Bladder deterioration is fundamentally driven by hypoxia, whereby the
had BN closure; in the men nine had BN slings with tapering and three constant contraction of bladder smooth muscles and elevation of intravesi-
had BN closure. Stomal and valve revision rate, surgical re–interventions, cal pressure results in the compression of capillaries and decreased blood
and overall success were analyzed based on prospectively collected data. flow to the bladder wall. We have characterized hypoxia’s role as a single
Success was defined as persistence with CIC and social continence. stressor and found that hypoxia is sufficient to induce an intense inflam-
Results: Mean followup was 8.6 years (range 0.33–27.2). All of the patients, matory and profibrotic switch in bladder smooth muscle cells (bSMCs).
except two quadriplegic females, carried out their own stomal IC. Bladder Current clinical management is cumbersome and carries significant risk
capacity increased significantly (203 cc to 433 cc), while pressure at capacity of morbidity. Mesenchymal stem cell (MSC) therapy is known to have a
decreased from 37 cm water to 9 cm water (p<0.0001). At last followup, huge potential in the treatment of hypoxic, inflammatory, and fibrotic
77 (87.5%) were managing with CIC ± pads. Eleven (12.5%) were failures conditions. We aimed to investigate if these hypoxia–signaling pathways
and of these, seven had indwelling catheters and four had ileal conduits.
S116 CUAJ • June 2018 • Volume 12(6Suppl2)