Page 2 - CUA2018 Abstracts - Miscellaneous/Other

Podium session 3: Miscellaneous

a first time THA/TKA between April 1, 2003 and March 31, 2013. Our Conclusions: Analyses demonstrate men with large prostates (50–80 mL)
exposures were patients who had cystoscopy or TURP within two years of undergoing aquablation show significantly better efficacy and safety
a THA/TKA. Our primary outcome was prosthetic joint infection requiring results as compared to those undergoing TURP.
hospital admission. Cox proportional hazards models were used and we
adjusted for numerous covariates. POD–3.5
Results: A total of 113 061 patients met inclusion criteria (44 495 THA
and 68 566 TKA). Median age was 74 years, and 40% were male. A total Canadian urology workforce study — the graduating cohort of
of 8426 (7.5%) of patients had cystoscopy within two years of THA/TKA. 2014–16 1,2 2,3 2,4 2,11
In multivariate analysis, there was no significant association between Omar Nazif , Hassan Razvi , Curtis Nickel , Keith Rourke 2,5 ,
2,6
2,7
2,10
cystoscopy and joint infection (hazard ratio [HR] 1.05; 95% confidence Christopher French , Frank Papanikolaou , John Kell , Lorne Aaron ,
2,9
1,2
2,8
2,4
interval [CI] 0.85–1.30; p=0.66). The HR was still non–significant when 1 Robert Siemens , Dianne Heritz , William Tinmouth , Peter Anderson
considering only patients who underwent cystoscopy without antibiotic Department of Urologic Sciences, University of British Columbia, Surrey,
2
prophylaxis. A total of 1095 (2.5%) patients had a TURP within two years BC, Canada; Health Policy Committee, Canadian Urological Association,
3
of THA/TKA. In multivariate analysis TURP was a significant risk factor Montreal, QC, Canada; Urology, University of Western Ontario,
4
for peri–prosthetic joint infection (HR 3.42; 95% CI 1.29–9.10; p=0.01). London, ON, Canada; Urology, Queen’s University, Kingston, ON,
6
5
Conclusions: Contemporary cystoscopy is a very non–invasive proce- Canada; Urology, McGill University, Montreal, QC, Canada; Urology,
7
dure and does not appear to be associated with a significant risk of a University of Toronto, East York, ON, Canada; Urology, University of
8
subsequent peri–prosthetic joint infection. This is contrasted with TURP, Toronto, Mississauga, ON, Canada; Urology, McMaster University,
9
which is a more invasive procedure and does appear to be associated St. Catharines, ON, Canada; Urology, Dalhousie University, Halifax,
10
with an increased risk of peri–prosthetic joint infections. This has implica- NS, Canada; Urology, Memorial University, St. John’s, NL, Canada;
11
tions for the rationale use of antibiotic prophylaxis and should be taken Urology, University of Alberta, Edmonton, AB, Canada
into account when updating societal antibiotic prophylaxis guidelines. Introduction: In Canada, there is a perception that recent urology gradu-
ates are having difficulty finding employment and that Canadian urol-
ogy residency programs are training too many residents. The Canadian
POD–3.4 Urological Association Health Policy Committee (CAU HPC) set out to
The WATER study clinical results: A subgroup analysis of quantitatively assess recent Canadian urology graduates regarding their
larger prostates from the phase 3, blinded, randomized trial of training and employment opportunities in Canada.
aquablation vs. transurethral resection of the prostate Methods: The CUA HPC formulated an anonymous, self–report, and mul-
Paul Anderson 1 tifaceted 88–question survey to study the graduating cohort of 2014–16
1 Urology, Royal Melbourne Hospital, Melbourne, Australia in the following areas: demographics, competency, fellowship training,
Study Groups: WATER study investigators. employment, job resources, work week, income, and job satisfaction.
Introduction: Prostate resection for patients with lower urinary tract symp- Questions were open–ended, binary, and five–point Likert scale. A web–
toms (LUTS) remains the gold standard for surgical treatment of benign based survey was created and piloted through the HPC. Descriptive sta-
prostatic hyperplasia (BPH). The length of resection time and the risk of tistics were used to analyze the data.
complications during a transurethral resection of the prostate (TURP) are a Results:
direct correlation with the size of the prostate. We aimed to compare the • Demographics: 98% of grads are between the ages of
safety and efficacy of prostate ablation using aquablation (A) vs. TURP (T) 30–39. Respondents were from almost every province in Canada,
in prostates between 50 and 80 mL in volume and analyze as a subgroup with 18% from the U.S.
from the WATER study. • Fellowships: 85% of respondents are planning to, actively doing, or
Methods: In this randomized, blinded, multicentre, phase 3 trial, men with have completed a fellowship; 93% believe the likelihood of finding
moderate–to–severe LUTS related to BPH were assigned to TURP using a job is better with fellowship training.
either standard electrosurgery or robotically–assisted waterjet ablation in a • Employment: A permanent staff position with hospital privileges
1:2 ratio. A pre–planned subgroup analysis based on prostate volume (<50 was offered to 28% in residency. The majority (57%) are gainfully
vs. ≥50 mL) used the trial’s co–primary safety and efficacy endpoint. The employed as a staff urologist. Of those gainfully employed, 29% are
primary safety endpoint was the occurrence of Clavien–Dindo Grade 1 in the limited capacity of locum–tenens.
(persistent ejaculatory dysfunction, erectile dysfunction, or urinary incon- • Income: Of those with a permanent job, 63% report a gross income
tinence) or Grade 2 or higher operative complications at three months. between $300–500K per year.
The primary efficacy endpoint was the reduction in International Prostate • Satisfaction: 70% report satisfaction as a urologist. Only 40% would
Symptom Score (IPSS) score at six months. encourage a medical student to apply to urology.
Results: There were 184 patients enrolled in the study. The mean baseline • Residency enrollment: 86% support contraction of residency posi-
IPSS score (T: 22.2 vs. A: 22.9; p=0.43), demographic profile, and mean tions across Canada.
prostate volume (T: 52 mL vs. A: 54 mL; p=0.31) were similar in both arms. Conclusions: Despite more challenging job prospects, the majority of
Mean operative time was equivalent between the two groups (T: 35.5 vs. Canadian–trained urology graduates are satisfied in their role as a urolo-
A:32.8 minutes; p=0.28), but mean resection time was significantly lower gist. The cohort supports a contraction of residency positions. Further
in the aquablation group (28 vs. 4 minutes; p<0.0001). The primary safety longitudinal study is warranted to determine if the perception of an over-
endpoint (Clavien–Dindo Grade 1 persistent or Grade 2 or higher event abundance of urologists is matched by actuality.
in the first three months) occurred in 19% of aquablation subjects and
43% of TURP subjects (p<0.01), demonstrating superiority of aquabla- POD–3.6
tion vs. TURP in men with 50–80 mL prostates. There were 99 patients
with a prostate volume greater than 50 mL (T:35 vs. A:64). For men with Twenty–two–year population–level trends in the surgical
larger prostates, changes in IPSS were greater after aquablation compared management of female stress urinary incontinence in Ontario,
to TURP (by approximately four points; p=0.0056). In an exploratory Canada 1,2,4 1,4 1,4 2,3,4
analysis, IPSS changes were larger with aquablation compared to TURP Joseph LaBossiere , Christopher Wallis , Lesley Carr , Refik Saskin ,
1,4
1,2,4
(by 3.7 points; p=0.0118) in men with baseline maximum flow rates Robert Nam , Sender Herschorn
1
(Qmax) <9 mL/sec. For men with both larger (>50 mL) baseline prostate Division of Urology, Department of Surgery, University of Toronto,
2
volume and lower (<9 mL/sec) flow rates, the improvement in IPSS scores Toronto, ON, Canada; Institute of Health Policy, Management &
3
was seven points larger in aquablationcompared to TURP (p<0.0001). For Evaluation, University of Toronto, Toronto, ON, Canada; Institute of
men with prostate size <50 mL and maximum flow rate >9 mL/sec, the Clinical Evaluative Sciences, Sunnybrook Research Institute, University of
4
change with TURP was 4.3 points larger after TURP (p=0.0963). Toronto, Toronto, ON, Canada; University of Toronto Functional Urology
S58 CUAJ • June 2018 • Volume 12(6Suppl2)