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2020 CUA Abstracts
UP-2.9. Table 2. Baseline characteristics and mortality with a diagnosis of prostate cancer were included. Patient demographics,
presentation of disease, treatments received, and outcomes were assessed.
outcomes from Fournier’s gangrene Results: The median patient age at time of referral was 91 (interquar-
Variable Alive Death p tile range [IQR] 3); 95.5% of patients presented with urinary symptoms
n=33 (%) n= 7 (%) (n=42) and 47.7% were diagnosed on the basis of an elevated prostate-
Age 56.2±12.2 54±12.6 0.667 specific antigen (PSA) (n=21). Skeletal-related events occurred in 29.5%
of patients (n=13), with spinal cord compression occurring in 4.5% of
Sex patients (n=2). Surprisingly, only 20.5% of patients received a referral to
Female 5 (15.2) 1 (14.3) palliative care (n=9). A total of 79.5% of patients underwent at least one
Male 28 (84.8) 6 (85.7) 1.000 urological intervention (n=35). Cystoscopy and catheter insertion were
Location the most common interventions at 72.7% and 75.0%, respectively. Most
(70.5%) patients received androgen deprivation therapy as the primary
Rural 16 (48.5) 2 (28.6) form of treatment (n=31). The median age at death was 95 (IQR 3). Death
Urban 17 (51.5) 5 (71.4) 0.427 from any cause was seen in 47.4% of patients (n=19), and death due to
Colostomy prostate cancer was observed in only 18.2% of patients (n=8).
Conclusions: This study highlights that nonagenarian patients with prostate
No 28 (84.8) 7 (100) cancer frequently present with urinary complaints and are diagnosed based
Yes 5 (15.2) 0 0.565 on PSA. The majority of this cohort underwent an operative intervention.
Scrotal debridement Many of these patients may live with urological complaints for many years
after referral. Awareness of prostate cancer outcomes in this patient popula-
No 21 (63.6) 7 (100) tion is important due to the increasing number of nonagenarians.
Yes 12 (36.4) 0 0.081 References
Charlson score 4.4 (1.7–6.9) 5.4 (3.2–17.3) 0.233 1. Decady Y, Greenberg L; Statistics Canada, issuing body, publisher.
(2014). Ninety years of change in life expectancy (Health at a
LOS 58 (49.5–64.5) 52 (49–66) 0.521 glance). Ottawa, Ontario: Statistics Canada.
Mean ± SD, median (IQR 25–75). 2. World Bank. (July 8, 2018). World development indicators: Canadian
life expectancy. Available at: https://data.worldbank.org/indicator/
Methods: The Manitoba intensive care unit (ICU) prospective registry SP.DYN.LE00.MA.IN?locations=CA. Accessed April 21, 2020.
began in 1999. We identified patients admitted to the ICU with a diagnosis
of FG from February 1999 to October 2019. Patient age, gender, Charlson UP-2.11
comorbidity index (CCI), presence of colostomy and scrotal debridement, Incisional hernia at specimen extraction site for robot-assisted
length of stay (LOS), and mortality outcomes were obtained. Only patients laparoscopic radical prostatectomy: A single-surgeon operator series
with a record of their residence were analyzed and categorized as being Brennan Timm , Peter Liodakis 1,2
1,2
rural or urban. Categorical variables were presented as absolute values 1 Urology, Austin Health, Heidelberg, Australia; North Eastern Urology,
2
and frequencies and analyzed with the Fisher’s exact test. Continuous vari- Heidelberg, Australia
ables were presented as means and standard deviations (±SD) or medians Introduction: Robot-assisted laparoscopic radical prostatectomy (RALP)
and interquartile ranges (25–75) and analyzed with the Mann-Whitney U continues to gain traction as a patient-driven means of managing prostate
test or Student’s t-test. A p<0.05 was considered statistically significant. cancer via a minimally invasive approach, with excellent cosmetic out-
Statistical analysis was performed with SPSS software (version 24). comes, shorter convalescence, and equivalent functional and oncological
Results: A total of 87 patients were diagnosed and admitted to the ICU outcomes compared to open surgery. However, there is growing evidence
1
with FG. Location was obtained for 40 patients, with 18 (45%) and 22 that RALP is significantly associated with incisional hernia (IH) at speci-
(55%) residing in rural and urban regions, respectively. There was no men extraction site compared to open surgery. This retrospective study
2,3
difference in baseline characteristics between the rural and urban groups aims to review local rates of these complications where all contemporary
with respect to age, gender, CCI, need for colostomy, scrotal debride- hernia-sparing techniques are applied in the Australian population.
ment, LOS, or mortality (Table 1). When evaluating mortality outcomes, Methods: We reviewed a single-surgeon series of 186 RALP patients
there was no difference in baseline characteristics nor region of residency between August 2012 and August 2018, where 1–7 years of followup
(Table 2). was observed. The study endpoint was IH rates at the supraumbilical
Conclusions: Location of residence (urban or rural) was not predictive of specimen extraction site used by the surgeon.
death from FG in Manitoba. In addition, baseline characteristics, such Results: IH rate at extraction site was 8.6%, with an incidental IH rate of
as age, gender, CCI, surgical interventions, or LOS, were also not found 1.1% at a lateral port site (not associated with specimen removal). Average
to be associated with mortality. age at operation was 60.9 years old and hernias were diagnosed at a
mean of 11.8 and a median of 12 months. Common demographics in the
UP-2.10 population suffering IH were previous abdominal surgery, adhesiolysis,
Urological outcomes following diagnosis of prostate cancer in history of smoking (current or quit), and obesity.
nonagenarians Conclusions: Supraumbilical extraction-site hernias continue to possibly
Joshua White , Jenna Coles , Ross Mason , Karthik Tennankore , Ashley be an under-reported complication of RALP, which may impact quality of
2
3
1
1
R. Cox 1 life and prompt further surgical correction. Further large-scale, prospec-
1 Department of Urology, Dalhousie University, Halifax, NS, tive research is required.
Canada; Postgraduate Medical Education, Dalhousie University Medical References
2
School, Halifax, NS, Canada; Department of Nephrology, Dalhousie 1. Parsons JK, Bennett JL. Outcomes of retropubic, laparoscopic, and
3
University, Halifax, NS, Canada robotic-assisted prostatectomy. Urology 2008;72:412-6. https://doi.
Introduction: Nonagenarians are one of the fastest-growing population org/10.1016/j.urology.2007.11.026
groups in Canada. They represent a challenging patient population that 2. Chennamsetty A, Hafron J, Edwards L, et al. Predictors of inci-
1,2
has previously not been evaluated in terms of prostate cancer treatment sional hernia after robotic-assisted radical prostatectomy. Adv Urol
and outcomes. We sought to review the treatment selection and outcomes 2015;2015:7. https://doi.org/10.1155/2015/457305
of our nonagenarian population diagnosed with prostate cancer. 3. Seveso M, Melegari S, Bozzini G, et al. Does site of specimen
Methods: A retrospective chart review of nonagenarians was conducted extraction affect incisional hernia rate after robot-assisted laparo-
at a single academic institute. We reviewed patients who were at least 90 scopic radical prostatectomy? Int J Surg 2017;47:96-100. https://doi.
years of age at the time of referral to 11 urologists from 2007–2018. Men org/10.1016/j.ijsu.2017.09.065
S62 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)