Page 5 - CUA2018 Abstracts - Incontinence

Poster session 9: Incontinence

can be mitigated using stem cells, as well as elucidate the molecular question asked how comfortable residents were with managing high SCI
mechanisms of interplay. patients; 42% responded they were comfortable, while the rest responded
Methods: bSMCs were cultured in 3% oxygen tension for 72 hours with that they were either neutral, uncomfortable, or very uncomfortable.
either the direct or indirect co–culture with bone marrow–derived MSCs. Conclusions: Most chief residents made similar surveillance decisions
High pore density transwells were used for indirect co–cultures. Total RNA for high SCI patients, however, they differed on the frequency of cystos-
was extracted for gene expression analysis and the Mesoscale multiplex copy and how comfortable they were managing this patient population.
assay was used for secreted cytokines and growth factor measurements. Comfortable or not, the decisions chief residents made regarding surveil-
Total collagen contents were determined using the Sirius Red collagen assay. lance were performed in the acute care setting and not in the outpatient
Results: Hypoxia increased expression of HIF3α, VEGF, TGFβ1, TNFα, setting. In the era of competency–based medical education, this informa-
IL–1β, IL–6, αSMA, and total collagen expression and decreased IL–10 tion can be used to highlight training opportunities and improvements
levels in bSMCs. Both direct and indirect MSCs co–cultures inhibited for this patient population .
>50% of hypoxia–induced TGFβ1 and IL–6 expression (p<0.005) in
a HIF–independent manner. Also, both MSCs co–culture techniques UP–9.2
induced >200% increase in IL–10 protein (p<0.005) and inhibited
hypoxia–induced αSMA, collagen I and III transcripts, as well as total Changes in patient–important outcomes among patients who
received sacral neuromodulation for fecal incontinence
collagen proteins (p<0.0001). Contrastingly, the hypoxia–induced IL–1β Dean Elterman , Shaun Shepherd 1,2
1
and TNFα were inhibited by only the direct co–cultures (p<0.05). 1
Conclusions: MSCs co–culture with bSMCs potently mitigates hypoxia– 2 Division of Urology, University Health Netwok, Toronto, ON, Canada;
induced inflammatory and profibrotic pathways. This work has elucidated Department of Health Research Methods, Evidence, and Impact,
the role of cell–cell contact and paracrine immunomodulatory mecha- McMaster University, Hamilton, ON, Canada
nisms of MSCs action and opened avenues for therapeutic intervention. Introduction: This study assessed pre–/post–changes in patient–important
outcomes in patients who underwent sacral neuromodulation (SNM) for
fecal incontinence (FI).
UP–9.1 Methods: FI can dramatically reduce the quality of life in patients who
Maintenance surveillance of high spinal cord lesion (T4/5) experience this condition. SNM is a standard therapeutic option for the
patients: A survey of chief urology residents management of FI syndromes. There is a gap in our knowledge on how
Avril Lusty , James Wilson 1 SNM affects patient quality of life among patients who experience FI. An
1
1 Department of Urology, Queen’s University , Kingston, ON, Canada administrative database managed by the principal investigator identified
Introduction: The urologist’s role in the management of patients with patients who underwent SNM for FI. The primary outcome was changed
spinal cord injury (SCI) is to prevent upper tract damage and, currently, in the Cleveland Clinic Incontinence Score (CCIS), FI Severity Index (FISI),
minimal data focuses on surveillance practices for this patient population. FI Quality of Life (FIQoL), Irritable Bowel Severity (IBS) Score, and Patient
The purpose of this study was to determine the preferred maintenance Assessment of Constipation–symptoms score (PACS– SYM) three months
surveillance practices of high SCI patients (T4/5) from the perspective of post–procedure. Mean values were assessed with 95% confidence inter-
chief urology residents. vals (CI). Statistical analysis was conducted with a two–sided paired t–test
Methods: A 14–question survey was administered at the QUEST chief with an alpha level of 0.05.
resident preparation examination in 2017. Topics included: imaging Results: Sixty–two patients (58 women and four men) received SNM
modality, laboratory testing, and procedures related to upper and lower for FI. The mean age is 57.9 (± 3.25) years. Mean difference values for
tract surveillance. Data was de–identified and participation was voluntary. outcomes were reported for the CCIS (–11 [± 3]), FIQoL (–30 [±10]), FISI
Results: All candidates completed a single questionnaire. Chief residents (–15 [±4]), IBS Score (–11 [±3]), and PAC–SYM (–8 [±3]). A two–sided
encountered high SCI patients in either diverse clinical settings, including paired t–test showed statistically significant p values for CCIS (p=0.00001),
rehabilitation centres, or single practitioner clinics, or solely as hospital FISI (p=0.00001), IBS (p=0.00001), and PAC–SYM (p=0.00001).
inpatients. Candidates had similar surveillance management algorithms for Conclusions: SNM is effective at improving patient quality of life by
stable patients with neurogenic voiding dysfunction of: yearly followup with reducing symptom severity and frequency. Further research is needed to
a serum creatinine and upper urinary tract ultrasound. The performance of assess demographic characteristics associated with improved quality of
surveillance cystoscopy in stable patients with neurogenic voiding dysfunc- life outcomes post–SNM among patients who experience FI.
tion and long–term, indwelling catheter had varied responses. The final

CUAJ • June 2018 • Volume 12(6Suppl2) S117