Page 1 - CUA2018 Abstracts - Miscellaneous/Other

2018 CUA AbstrACts

Podium Session 3: Miscellaneous

June 25, 2018; 1250–1350

POD–3.1 Introduction: Incontinence related to sphincter weakness is an important
A pilot randomized–controlled trial of the urodynamic efficacy potential complication of radical prostatectomy. The ATOMS (Adjustable
of mirabegron for patients with neurogenic lower urinary tract Trans–Obturator Male System) is self–anchoring transobturator device,
dysfunction which features a non–circumferential adjustable hydraulic cushion first
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Blayne Welk , Duane Hickling , Mary McKibbon , Sidney Radomski , Karen introduced to Canada in 2014. We aim to assess the efficacy and safety
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Ethans 3 profile of the ATOMS sling in a multicentred setting.
1 Surgery, Western University, London, ON, Canada; Surgery, University of Methods: We reviewed postoperative outcomes from eight Canadian cen-
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Toronto, Toronto, ON, Canada; Internal Medicine, University of Manitoba, tres in male patients undergoing treatment with ATOMS for post–prostatec-
Winnipeg, ON, Canada; Surgery, University of Ottawa, Ottawa, ON, tomy incontinence. The primary outcomes were mean pad change and con-
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Canada tinence defined as requiring ≤1 pad postoperatively for patients requiring
Study Groups: Astellas Investigator–Initiated Grant; peer–reviewed funding ≥2 pads preoperatively, and 0 pads for those requiring 1 pad preoperatively.
from the Rick Hansen Institute. Secondary outcomes included patient satisfaction, improvement (>50%
Introduction: Mirabegron is a beta– adrenoreceptor agonist used for over- change in pad use), and 90–day complications. Other patient demograph-
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active bladder (OAB). The objective of this study was to determine the ics, including age, obesity (body mass index [BMI]>35), comorbidities,
urodynamic (UDS) effectiveness of mirabegron in patients with neurogenic concurrent radiotherapy, previous incontinence surgery, previous urethral
lower urinary tract dysfunction. stenosis, and type of prostatectomy, were also examined. Improvement in
Methods: We conducted a randomized, double–blind, placebo–controlled continence (mean change and absolute change in pads/day) were calculated
study. Patients with spinal cord injury (SCI) or multiple sclerosis (MS) with with t–tests. Patient satisfaction, continence, and surgical complications
were recruited. Patients underwent investigations and UDS and were then were evaluated with descriptive statistics and Chi–square.
given mirabegron 25 mg (or placebo) for two weeks. Dose escalation to Results: A total of 160 patients with a mean age of 70.5 years were enrolled
mirabegron 50 mg (or placebo) then occurred and was maintained for eight with a mean followup of 9.5 months. Preoperatively mean pad use was 4.4
weeks, followed by repeat investigations and UDS. The primary outcome pads/day (1–10), 36.3% of patients reported severe incontinence (>5 pads/
measure was UDS bladder capacity. Secondary outcomes included other day), 31.3% had concurrent radiotherapy, and 16.3% had failed previous
UDS parameters, pad test, three–day diary, validated symptom scores, and incontinence surgery. Initial postoperative pad use was 1.5 pads/day (0–6)
quality of life measures. Intention to treat analysis and ANCOVA models before cushion adjustment (p<0.0001) and 0.9 pads/day (0–6) following
(with adjustment for baseline values) were used and marginal means (MM) adjustments (p<0.0001); 58.3% patients underwent adjustment with a
are reported; p–value <0.05 was considered significant. mean of 1.4 adjustments (0–7) for a total mean volume of 11.3 mL (0–31).
Results: A total of 16 (nine SCI and seven MS) patients were random- Overall continence rate was 80.0%, while 87.8% of patients experienced
ized to mirabegron and 16 (10 SCI and six MS) to placebo. At comple- >50% improvement and 86.3% of patients were satisfied with the results
tion, there was no significant difference in urodynamic bladder capacity of surgery. Although patients with concurrent radiotherapy did not differ
between mirabegron and placebo (MM 305 vs. 369 mL; p=0.20). There by preoperative pad usage (4.6 vs. 4.1; p=0.17), they were less likely to
was no significant difference in volume at first NDO (MM 183 vs. 133 mL; be continent (62.5% vs. 87.9%; p<0.0001), improved (77.1% vs. 92.6%;
p=0.10) and peak pressure of NDO (MM 69 vs. 82 cmH O; p=0.25). The p=0.01), and satisfied (69.8% vs. 93.2%; p<0.0001). Thirty–five patients
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effect size for these values was small (<0.20). NDO was documented in (22.3%) experienced 90–day complications (any Clavien grade), mostly
12/16 mirabegron and 13/16 placebo patients and persisted in 11/16 and Clavien I (17.8%), with 4.4% (n=7) of patients experiencing Clavien III
12/16, respectively (p=0.66). There was no significant difference in pad complications primarily related to the injection port.
weights or voiding diary. Mirabegron therapy did result in a significantly Conclusions: In the short–term, ATOMS is a safe and efficacious device
lower symptom burden (total Neurogenic Bladder Symptom Score MM 29 for the treatment of post–prostatectomy incontinence, even in the setting
vs. 34; p=0.047), however quality of life scores were similar. of severe incontinence. Patients with concurrent radiotherapy respond to
Conclusions: Among patients with SCI or MS, mirabegron may improve treatment, but are less likely to be continent, improved, or satisfied.
patient symptoms, however, there was no significant improvement in UDS
parameters, and observed trends were associated with only small effect sizes. POD–3.3
Do common urological procedures increase the risk of an infected
POD–3.2 joint prosthesis?
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The early Canadian experience with ATOMS for post–prostatectomy Nahid Punjani , Brent Lanting , Andrew McClure , Blayne Welk 1,3,4
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incontinence: A multicentre study 1 Division of Urology, Western University, London, ON, Canada; Division
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Trevor Haines , Geneviève Nadeau , Le Mai Tu , Julie Morisset , Christopher of Orthopedics, Western University, London, ON, Canada; Institute
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Doiron , Stephen Steele , Luc Valiquette , Dean Elterman , Conrad for Clinical Evaluative Sciences, Toronto, ON, Canada; Department of
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Maciejewski , Keith Rourke 1 Epidemiology and Biostatistics, Western University, London, ON, Canada
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1 Urology, University of Alberta, Edmonton, AB, Canada; Urology, Introduction: In order to reduce the risk of an infected total hip arthroplasty
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Université Laval, Quebec City, QC, Canada; Urology, Université de (THA) or total knee arthroplasty (TKA), urological guidelines suggest that
Sherbrooke, Sherbrooke, QC, Canada; Urology, Université de Montréal en antibiotic prophylaxis is necessary for certain urological procedures. Our
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Mauricie, Montreal, QC, Canada; Urology, Queen’s University, Kingston, objective was to determine if cystoscopy or transurethral resection of the
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ON, Canada; Urology, Université de Montréal, Montreal, QC, Canada; prostate (TURP) are associated with prosthetic joint infections.
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7 Urology, University of Toronto, Toronto, ON, Canada; Urology, University Methods: Using administrative data, we performed a retrospective, popula-
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of Ottawa, Ottawa, ON, Canada tion–based cohort study of patients >66 years old in Ontario undergoing
CUAJ • June 2018 • Volume 12(6Suppl2) S57
© 2018 Canadian Urological Association