Page 1 - CUA 2020_Functional Urology

2020 CUA ABSTRACTS

Podium Session 3: Urinary Incontinence, Voiding Dysfunction

POD-3.1 Canada; Dalhousie University, Moncton, NB, Canada; Université de
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Are urodynamic studies necessary for AdVance sling placement Montréal, Montreal, QC, Canada; University of Calgary, Calgary, AB,
for post-prostatectomy stress urinary incontinence? Canada
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Jennifer A. Locke , Yu Zheng , Goran Rac , Nicholas Major , Jennifer Rolef , Introduction: The adjustable transobturator male system (ATOMS) is a tran-
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Lauren Rittenberg , Arthur Mourtzinos , Matthew Moynihan , O. Lenaine sobturator device with a non-circumferential adjustable hydraulic cushion
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Westney , Mike Metro , Sender Herschorn , Sarah R. Ferrara , Caitlin Lim , used to treat sphincteric incontinence after prostate cancer treatment. The
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Brittani Barrett-Harlow , Ross Rames , Lindsey Cox , Eric Rovner 2 aim of this multicenter study was to assess postoperative outcomes from
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1 Urology, Sunnybrook Health Sciences Centre, University of Toronto, the ATOMS device and to identify factors influencing failure to achieve
Toronto, ON, Canada; Urology, Medical University of South Carolina, continence.
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Charleston, SC, United States; Urology, Lahey Health, Burlington, MA, Methods: Men who underwent insertion of ATOMS for the treatment post-
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United States; Urology, MD Anderson, Houston, TX, United States; Urology, prostatectomy incontinence between September 2015 and August 2019
Temple Health, Philadelphia, PA, United States at nine Canadian centers were reviewed. The primary outcome was con-
Introduction: Urinary retention (UR) following AdVance sling placement tinence, defined as requiring ≤1 pad postoperatively for patients requiring
for post-prostatectomy stress urinary incontinence (SUI) is a known com- ≥2 pads preoperatively and 0 pads for those requiring one pad preopera-
plication. Urodynamic studies (UDS) are often performed prior to evaluate tively. Secondary outcomes included improvement (>50% change in pad
bladder function, however, its ability to predict post-operative urinary UR use), patient satisfaction, explantation, and 90-day complications. Other
is unknown. Therefore, our study sought to identify risk factors for UR fol- patient demographics included age, obesity (body mass index [BMI] ≥35),
lowing AdVance sling placement using preoperative UDS. comorbidities, concurrent radiotherapy, prior incontinence surgery, previ-
Methods: Following IRB approval, a retrospective review of medical records ous urethral stenosis, type of prostatectomy, and pads per day (ppd).
of patients from multiple institutions who underwent an AdVance sling Results: A total of 295 patients with a mean age of 69.9 years were ana-
for post-prostatectomy SUI from 2007–2019 was performed. Acute post- lyzed. Preoperatively, mean pad use was 4.2 ppd (1–12), 32.5% of patients
operative UR was defined as the complete inability to void or elevated reported severe incontinence (≥5 pads/day), 34.2% had concurrent radio-
post-void residual (PVR) leading to Foley catheter placement or intermittent therapy, and 20.0% had failed previous incontinence surgery. Initial post-
catheterization teaching. operative pad use was 1.4 ppd before cushion adjustment (p<0.0001) and
Results: A total of 389 patients were included in this study, 52 (13.4%) had 0.9 ppd following adjustments (p<0.0001). Most (71.2%, n=210) patients
acute UR. By the second postop visit, 75% had resolution of UR, and at underwent adjustment a mean of 2.1 (0–9) times for a mean total volume of
the last recorded postop visit, 1.5% had persistent UR (median followup 12.0 mL. Overall continence rate was 72.9% (n=215) at a mean followup
544 days). On UDS, average Pdet (27.3 cmH 0 vs. 27 cmH 0, p=0.95), of 19.7 months. The majority (89.2%, n=263) of patients experienced >50%
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maximum urinary flow rate (Qmax) (16 ml/s vs 16.2 ml/s, p=0.91) and improvement; 84.4% (n=249) of patients were satisfied with the results of
PVR (21.7 ml vs. 27.5 ml, p=0.64) were similar for patients with or without surgery. A total of 8.1% (n=24) required device explantation. On multivari-
UR following AdVance sling. Preoperative pad test (odds ratio [OR] 1.00; ate Cox regression analysis, concurrent radiotherapy (hazard ratio [HR]
confidence interval [Cl] 0.99–1.00; p=0.7), prior radiation (OR 2.22; Cl 2.5, p<0.0001), diabetes (HR 2.2, p=0.006) and increased pre-operative
0.65–7.71; p=0.20), bladder neck contracture (OR 2.52; Cl 0.75–0.842; pad usage (HR 1.1, p=0.03) were associated with failure to achieve con-
p=0.13), or diabetes (OR 0.87; Cl 0.37–2.05; p=0.74) were not significantly tinence, while patient age (p=0.51), obesity (p=0.08), prior urethral steno-
associated with risk of UR. Thirty-two patients (8.2%) had persistent stress sis (p=0.66), and prior incontinence surgery (p=0.17) were not. Radiation
urinary incontinence. Pdet, Qmax, and PVR from UDS were similar in therapy was also associated with device explantation (HR 3.1, p=0.007).
patients with persistent SUI compared to those whose incontinence resolved Conclusions: In the largest cohort study to date, ATOMS is a safe and
after AdVance sling placement. efficacious device for the treatment of a broad spectrum of patients with
Conclusions: The rate of acute postoperative UR after AdVance sling place- post-prostatectomy incontinence. Our study found a durable response on
ment for post-prostatectomy SUI was 13.4% but the long-term rate of UR continued followup, with high rates of continence, improvement, and
was quite low at 1.5%. Pdet, Qmax, and PVR obtained from UDS were not patient satisfaction. Patients with prior radiation, increased preoperative
predictive of UR or persistent SUI after AdVance sling placement. pad use, and diabetes are less likely to achieve continence.
POD-3.2 POD-3.3
Multicentered assessment of clinical outcomes and factors Evaluation of benefits and harms of surgical treatments for post-
associated with failure of the adjustable transobturator male radical prostatectomy urinary incontinence: Systematic review
system (ATOMS) and meta-analysis
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Elaine Redmond , Geneviève Nadeau , Le Mai Tu , R. Christopher Doiron , Roselyne Choiniere , Philippe D. Violette , Melanie Morin , Le Mai Tu ,
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Stephen S. Steele , Dean S. Elterman , Jennifer A. Locke , Sender Herschorn , Christine Reed , Philie Camille-Ariane , Benjamin Legault , Marie-Michele
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Conrad Maciejewski , Neil T. Dwyer , Lysanne Campeau , Kevin V. Carlson , Beaudry , Gordon H Guyatt , Patrick Richard 1
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Keith F. Rourke 1 1 Surgery, Division of Urology, University of Sherbrooke, Sherbrooke,
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1 University of Alberta, Edmonton, AB, Canada; Université Laval, QC, Canada; Health Research Methods Evidence and Impact, McMaster
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Quebec City, QC, Canada; University of Sherbrooke, Sherbrooke, University, Hamilton, ON, Canada; Surgery, Division of Urology, Western,
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QC, Canada; Queen’s University, Kingston, ON, Canada; University London, ON, Canada; Faculté de médecine et des sciences de la santé
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of Toronto, Toronto, ON, Canada; University of Ottawa, Ottawa, ON, FMSS École de réadaptation, University of Sherbrooke, Sherbrooke, QC,
Canada
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S33
© 2020 Canadian Urological Association