Page 1 - CUA2018 Abstracts - LUTS

2018 CUA AbstrACts

Poster Session 3: Male LUTS/Men’s Health

June 25, 2018; 0800–0930

MP–3.1 to TURP or aquablation. Six–month outcomes are reported for critical safety
Testosterone therapy prescribing patterns for 39 721 users in and efficacy endpoints.
British Columbia from 1997–2013 Results: After exclusion, 181 men were enrolled. Preoperative baseline
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Jennifer Locke , Ryan Flannigan , Mahyar Etminan , Hamid Tavakoli , Sean characteristics were comparable between groups. Mean operative time
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Skeldon , Ted Hoyda , Larry Goldenberg 1 was equivalent between the two groups, but mean resection time was
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1 Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; significantly lower in the aquablation group (4 vs. 27 minutes; p<0.01). At
2 Ophthalmology and Visual Sciences, University of British Columbia, six months, aquablation demonstrated non–inferiority to TURP, with com-
Vancouver, BC, Canada; Pharmaceutical Sciences, University of British parable International Prostate Symptom Score (IPSS) (5.9 vs. 6.8; p=0.1).
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Columbia, Vancouver, BC, Canada; Family Practice, University of Toronto, Maximum flow rate (Qmax) and post–void residual (PVR) improvements
Toronto, ON, Canada were also similar (p=NS). Subanalysis of men with 50–80 cc prostate vol-
Introduction: Testosterone therapy (TT) is Health Canada–approved for symp- ume, however, did demonstrate superiority with one–, three–, and six–
tomatic primary or secondary hypogonadism. We analyzed testosterone pre- month IPSS improvements favouring aquablation (p<0.05 for all). With
scribing patterns as related to actual serum testosterone (T) measurements. regards to procedure safetly, overall Clavien–Dindo complications were
Methods: With UBC Ethics approval, we linked a longitudinally collected greater for the TURP group (43% vs. 26%; p<0.01). For sexually active men,
British Columbia Ministry of Health diagnostic database (PopDataBC) to the anejaculation rates for TURP, aquablation with cautery, and aquablation
both pharmanet and laboratory databases. without cautery were 38%, 16%, and 7%, respectively.
Results: We identified 39 721 men prescribed any form of TT between 1997 Conclusions: In patients with LUTS due to BPH, surgical prostate resection
and 2013. There was a seven–fold increase in the number of annual pre- using a robotically guided/operated waterjet demonstrated non–inferior
scriptions written during the study period. Only 31.0% of first prescriptions symptom relief compared to TURP, but with a lower risk of sexual dys-
were linked to a serum T level drawn in the 365 preceding days and 66.9% function. A noteworthy superiority was also observed for LUTS improve-
of these serum T levels met the biochemical definition of hypogonadism ments in the larger prostates, suggesting superior tissue removal. This new
(serum T≤10.4 nmol/L). Of the treated men, only 18.9% had a serum T level semi–automated approach may diminish the need for substantial surgical
drawn in the year after the first prescription. Overall, the largest percent- experience to achieve optimal results.
age of prescriptions was written by general practitioners (GPs; 86.1%). In
terms of those for whom a pre–TT serum T was drawn, 83.1% were writ- MP–3.3
ten by GPs, 7.9% by urologists, and 4.6% by endocrinologists. Of those The use of assisted reproductive technology before male factor
who received a prescription without a serum T drawn, 87.4%, 5.2% and infertility evaluation
3.3% were written by GPs, urologists, and internal medicine, respectively. Madhur Nayan , Nahid Punjani , Ethan Grober , Kirk Lo , Keith Jarvi 1
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Overall, 26.0% had only one TT prescription filled and remained on treat- 1 Division of Urology, Departments of Surgery, University of Toronto,
ment for a mean duration of 46.74 days (standard deviation [SD] 37.22); Toronto, ON, Canada; Division of Urology, London Health Sciences
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41.0% received 10 or more prescriptions and remained on TT for a mean Centre, Western University, London, ON, Canada
duration of 1421.41 days (SD 1053.40). Introduction: Some centres are offering assisted reproductive technologies
Conclusions: During the study period, two–thirds of men received a TT (ART) (intra–uterine insemination [IUI] and in–vitro fertilization [IVF]), to
prescription without a serum T level being drawn. Less than half of men treat certain couples with male factor infertility without or before having the
prescribed TT remained on drug for more than 10 refills. We highlight the infertile men assessed by male infertility specialists. We sought to compare
need for improved physician education, both during and after medical the characteristics of couples having or not having prior ART use.
school, and for research into the compliance of therapy. Methods: We used our prospectively collected database to identify men
undergoing an initial evaluation for male infertility between 2008 and
MP–3.2 2017. We obtained data on patient demographics, the use of IUI and IVF,
The WATER study clinical results: A phase 3, blinded, randomized and semen analysis parameters. We used multivariable logistic regression
trial of aquablation vs. transurethral resection of the prostate with to identify characteristics associated with prior use of ART.
blinded outcome assessment for lower urinary tract symptoms Results: A total of 1545/8962 (17.2%) men reported the use of ARTs prior
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Kevin Zorn , Naeem Bhojani , Dean Elterman , Claus Roehrborn , Peter to evaluation in our clinic. Of these, 998 and 289 had tried IUI and IVF,
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Gilling 4 respectively, while 258 had tried both IUI and IVF. More than one attempt
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1 Urology, Université de Montréal, Montreal, QC, Canada; Urology, was reported in 470 (37.2%) and 154 (28.2%) of men with prior IUI and
University of Toronto, Toronto, ON, Canada; Urology, UT Southwestern IVF, respectively. Younger male age (adjusted odds ratio [aOR] 0.97 for each
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Medical Center, Dallas, TX, United States; Urology, Tauranga Hospital, Bay one–year increase; 95% confidence interval [CI] 0.95–0.99), older female
of Plenty District Health Board, Tauranga, New Zealand partner age (aOR 1.07 for each one–year increase; 95% CI 1.04–1.10),
Study Groups: WATER 1 Aquablation Study Group. and year of visit (aOR 1.05 for each one–year increase; 95% CI 1.01–1.09)
Introduction: Early reports of robotic aquablation surgery for lower urinary were significantly associated with prior use of IUI. Older female partner age
tract symptoms (LUTS due to benign prostatic hyperpalsia (BPH) suggest (aOR 1.07 for each one–year increase; 95% CI 1.02–1.12) was significantly
efficacy similar to that of transurethral resection of the prostate (TURP). We associated with prior use of IVF, but not male age or year of visit. None of
sought to compare the safety and efficacy of prostate ablation using aquabla- the semen analysis parameters, nor duration of infertility were associated
tion vs. TURP for 30–80 cc transrectal ultrasound (TRUS)–measured prostates. with prior IUI or IVF.
Methods: In this international, randomized, blinded, multicentre, phase 3 Conclusions: The prior use of ART is common among men presenting for an
trial, 275 men with moderate–to–severe LUTS related to BPH were assigned initial evaluation at a male infertility specialty clinic. Older female partner
CUAJ • June 2018 • Volume 12(6Suppl2) S79
© 2018 Canadian Urological Association