Page 7 - CUA 2020_Endourology

Unmoderated Posters 1: Prostate Cancer, Endourology, BPH

seven (21%) of those patients having undergone previous concurrent ing the intravenous use of TXA vs. routine care were identified. Reviewers
TURP while 27 (79%) had not. The average time to stone recurrence for independently screened titles (SW, MM) and extracted data (SW, MM).
patients with a previous TURP was 92.9 months and 103.1 months for Primary outcomes were requirement of blood transfusion and estimated
the non-TURP group. In the non-TURP group, seven of the 27 patients blood loss. Secondary outcomes included rates of sepsis, stone-free rate,
underwent repeat cystolitholapaxy alone, with three patients ultimately time in hospital and procedure time. Risk of bias (RoB) was assessed with
developing recurrent stones. Cochrane RoB 2 tool (RCT).
Conclusions: Time to stone recurrence following cystolitholapaxy was Results: We identified five RCTs, with most studies demonstrating some
similar between patients who underwent concurrent TURP and those RoB and some studies demonstrating high RoB. All studies demonstrated a
that did not; however, the rate of recurrence was greater amount patients decreased blood transfusion rate in the TXA group, however, only two of
without a previous TURP. the five studies showed statistical significance. No statistically significant
difference was found in estimated blood loss between patients receiving
UP-1.5 TXA and those who did not (mean difference -0.74 [units]; 95% confi-
dence interval [CI] -1.56, 0.08; z=1.76; p=0.08). Patient receiving TXA
Prospective study evaluating ureteroscopy under conscious had slightly lower operative times than those not receiving TXA (mean
sedation difference -12.46 min; 95% CI -14.08, -10.83; z=14.99; p <0.001). No
Amanda Eng , M. Eric Saltel , Premal Patel 1 statistically significant difference was found in hospital length of stay
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1 Urology, University of Manitoba, Winnipeg, MB, Canada between patients receiving TXA and those not (mean difference -1.09
Introduction: Flexible ureteroscopy (fURS) to treat renal or ureteric stones days; 95% CI -2.68, 0.51; z =0.33, p=0.18). There was not enough data
is typically performed in the operating room with spinal or general anes- extracted to comment on stone-free rate.
thesia. However, as endoscopic technology has improved and with limited Conclusions: The studies currently available examining the routine use
operating room resources, the ability to perform fURS under conscious of TXA during PCNL are of poor quality and insufficient to comment on
sedation may expedite patient care and reduce healthcare costs. We the utility. There may be a trend to decreased rates of blood transfusions
sought to prospectively evaluate our experience of fURS under conscious and decreased operative time with the routine use of TXA during PCNL.
sedation at a tertiary care center as a proof of principle. Reference
Methods: Beginning November 2019, we prospectively collected data on 1. Fenner A. Surgery: Tranexamic acid reduces bleeding during per-
patients undergoing fURS with the use of intravenous sedation (fentanyl cutaneous nephrolithotomy. Nature reviews. Urology 2013;10:2.
and midazolam) administered by nursing staff. Surgical variables include https://doi.org/10.1038/nrurol.2012.224
previous ureteric stenting or other stone procedures; whether or not an
access sheath, dilator, laser, or basket was used; and if a ureteric stent
was placed post-stone extraction. Stone-free rates are determined by the UP-1.8
surgeon’s ability to remove the stones and on examination of the ureter, Urinary and sexual function outcomes at 12 months post-radical
as well as on followup imaging. prostatectomy: Robotic-assisted vs. laparoscopic approach
Results: From November to December 2019, a total of 11 patients under- Courtney Moore , Jen Hoogenes , Jaskirat Saini , Adel Moalwi , Bobby
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went fURS for stone management under conscious sedation. Preliminary Shayegan , Edward D. Matsumoto 1
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results demonstrate successful stone-free rate in 82% (9/11). Two were 1 Department of Surgery, Division of Urology, McMaster University,
unsuccessful, as the ureter was too tight and a ureteric stent was inserted Hamilton, ON, Canada
for definitive stone management at a later time, and in one case a stone Introduction: The objective of this study was to examine urinary and
had already passed on its own. The average analgesics used are 2.5 mg sexual function in prostate cancer (PC) patients at the 12-month mark
of midazolam and 90 μg of fentanyl. No procedure was discontinued following robotic-assisted (RARP) or laparoscopic (LRP) prostatectomy
due to patient intolerability. to identify any significant differences between groups. All cases were
Conclusions: Our preliminary prospective results demonstrate the feasibil- conducted by a single surgeon with expertise using both approaches
ity of performing fURS for the treatment of renal/ureteric calculi under (>1000 LRPs and >500 RARPs).
conscious sedation. Based on our current collected data, ureteroscopy Methods: Eligible patients underwent RARP or LRP at a single center
can be performed using short-acting anesthetics in a safe and efficient way and were followed in clinic for at least 12 months. Patients completed
with good tolerability and stone-free rates. Over the next few months, we the validated UCLA PC Index and the five-item International Index of
hope to increase our study size and analyze other variables. Erectile Function (IIEF-5) at the 12-month mark. Clinical characteristics
and scores were evaluated between groups, with an additional focus on
UP-1.7 three domains: sexual bother, urinary bother, and daily pad usage.
Results: A total of 90 patients were eligible (RARP n=45; LRP n=45)
The routine use of tranexamic acid during percutaneous and had a mean age of 62.2 (±6.7); 55.6% of RARP and 40.0% of LRP
nephrolithotomy: A systematic review patients underwent bilateral nerve-sparing (NS) and an equal percent-
Morgan MacDonald , Stewart Whalen , Robyn Parker , Ross Mason , age of patients in both groups (64.4%) received postoperative erectile
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Andrea G. Lantz Powers 1 dysfunction (ED) treatment. RARP patients had higher (more favorable)
1 Department of Urology, Dalhousie University, Halifax, NS, Canada; W.K. IIEF-5 scores (p<0.05) and used fewer pads (p<0.05). LRP patients reported
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Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, higher levels of sexual bother on the UCLA PC Index (p<0.05). Patients
Canada with bilateral NS in both groups had significantly higher scores on the
Introduction: Percutaneous nephrolithotomy (PCNL) is the gold standard IIEF-5 (p=0.042). There were no differences between groups for age, pre-
procedure for management of large nephrolithiasis. Bleeding and infec- and postoperative prostate-specific antigen, overall UCLA PC Index score,
tion are the most concerning and common complications associated or the urinary bother domain.
with PCNL. Transfusion rates post-PCNL vary by center but have been Conclusions: RARP patients had significantly higher IIEF-5 scores, lower
estimated to be 2–12%. Tranexamic acid (TXA) is an antifibrinolytic agent levels of sexual bother, used fewer pads, and had a higher rate of bilateral
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that has been used safely in many other surgical specialties. We sought NS than LRP patients. The high rate of ED treatment and bilateral NS in
to determine whether the routine administration of TXA during PCNL all patients may relate to higher IIEF-5 scores, despite surgical approach.
reduces blood loss, transfusion rates, and operative time, or increases Continued followup past the 12-month mark, along with a larger sample
stone-free clearance. size, will allow for a greater understanding of urinary and sexual function
Methods: Systematic review of PubMed, Scopus, Embase, CENTRAL, and in this patient population.
clinicaltrials.gov up to June 20, 2019 was performed with assistance of a
professional librarian (RP). Randomized controlled trials (RCTs) compar-
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S45