Page 12 - CUA 2020_Sexual Dysfunction and Transplant

2020 CUA ABSTRACTS

Moderated Poster Session 11: Urinary Incontinence, Voiding

Dysfunction, Sexual Dysfunction, Transplant

MP-11.2 Results: Eight patients with a neurogenic bladder underwent polyacrylamide
LIBERATE International: Evaluation of the safety and efficacy of hydrogel injections of their CCUD. Five patients had a concomitant bladder
the Viveve treatment for stress urinary incontinence augment while three had their native bladder. Five patients had a Monti
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Blayne K. Welk , Sean Peterson , Sender Herschorn 3 ileal tube and three patients had an appendix Mitrofanoff. The mean volume
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1 Western University, London, ON, Canada; Bluewater Clinical Research injected was 2 ml per treatment. At a median (range) followup of 30 (3–48)
Group, Sarnia, ON, Canada; University of Toronto, Toronto, ON, Canada months, one patient with a Mitrofanoff was completely dry after two sets
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Introduction: Energy-based vaginal treatments have been proposed as a of injections, three patients achieved partial success (>50% reduction in
non-invasive option to treat stress urinary incontinence (SUI), however, leakage; three Monti, one Mitrofanoff), and four patients failed the treatment
there is no high-quality evidence to support their efficacy. The primary (two Monti, one Mitrofanoff). Of the four patients who did not respond to
objective of this study was to evaluate the efficacy of the Viveve treatment, the injections, three underwent an open surgical revision of the channel,
SUI protocol (non-ablative, cryogen-cooled monopolar radiofrequency), in while the fourth patient is currently awaiting a second set of injections. The
improving mild-moderate SUI in premenopausal women as measured with only complication was a urinary tract infection for one patient.
the one-hour pad weight test (PWT). Conclusions: The use of Bulkamid injections for the treatment of urinary
Methods: This was a randomized, double blind, sham-controlled trial (RCT) incontinence after CCUD surgery cured or improved only half of our cohort,
of six months’ duration. Ninety-nine subjects at nine sites with mild-mod- but with a low complication rate. It should be considered a less invasive
erate SUI meeting the inclusion/exclusion criteria were randomized 2:1 alternative to avoid or delay major reconstructive surgery.
to either the active (90 J/cm RF and cryogen cooling) or sham (≤1 J/ cm2
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RF and cryogen cooling) group. Treatment involved delivering 220 intra- MP-11.4
vaginal pulses in two circumferential rings. At baseline and followup vis- Obesity, weight gain, and new comorbidities in patients with
its, subjects completed the one-hour PWT, additional objective endpoints, urinary incontinence following prostate cancer surgery
and patient-reported outcomes (PROs). Safety assessments were completed Elaine Redmond , R. Christopher Doiron , Keith F. Rourke 1
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throughout the study. 1 Department of Urology, University of Alberta, Edmonton, AB, Canada
Results: Patient baseline demographics were similar in both groups. At six Introduction: Approximately 3–5% of patients develop urinary inconti-
months post-treatment, the active and sham groups both had clinically nence following prostate cancer surgery. Post-prostatectomy incontinence
relevant, but not statistically different decreases in the one-hour PWT of (PPI) can have debilitating social consequences that may deter the patient
77% and 81%, respectively (p=0.403). The active group reported greater from engaging in physical activity and increase the risk of developing
improvements in all PROs over sham at six months, however, this did not comorbidities. The aim of this study was to examine the effect of PPI on
reach statistical significance (I-QOL, p=0.456; UDI-6, p=0.887; ICIQ-UI-SF, the development of weight gain and new comorbidities in patients with
p=0.817). No device-related safety issues were reported. PPI undergoing anti-incontinence surgery.
Conclusions: Blinded RCTs are essential to obtain high-quality data to Methods: Patients who underwent surgery for PPI at a single center from
evaluate energy-based treatments for SUI. This trial was one of the first to 2004–2018 were identified. A retrospective review was performed to docu-
report objective and subjective data in support of these treatments. The ment patient characteristics as noted at the time of prostate cancer treatment
active group reported clinically relevant changes in leakage volume and and compare these with parameters recorded at the time of anti-inconti-
SUI symptoms at six months post-treatment. Due to the magnitude of the nence surgery. Demographics included weight, body mass index (BMI),
sham response, further studies are needed to determine the effect of cryogen individual medical comorbidities, and Charlson comorbidity index (CCI).
cooling alone on vaginal tissue. Multivariate regression analysis was performed to identify factors which
might influence differences in health outcomes following prostatectomy.
MP-11.3 Results: A total of 229 patients were included in the study with a mean age
Efficacy and safety of polyacrylamide hydrogel (Bulkamid) of 68.8 years at the time of incontinence surgery. Median duration of incon-
injections for the treatment of leakage after continent urinary tinence was 3.5±4.6 years. There was no change in weight (91.1 vs. 91.8 kg;
diversion p=0.34), obesity (43.6% vs. 41.8%; p=1.0), or BMI (29.6 vs. 30.0; p=0.18)
Geneviève Nadeau , Michelle Bergeron , Stéphane J. Bolduc 1 between prostate cancer surgery and PPI surgery. There was a significant
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1 Urology, Laval University, Quebec, QC, Canada increase in CCI between prostate cancer surgery and PPI surgery (2.7±1.5
Introduction: Patients with a continent cutaneous urinary diversion (CCUD) vs. 4.1±1.9; p<0.0001). Almost half of patients (45.2%) developed a new
can develop leakage as a consequence of valve incompetence. Injection of comorbidity while awaiting incontinence surgery including an increase in the
bulking agents has been used as an alternative to open surgical revision. incidence of diabetes (21.9% vs. 12.7%; p<0.0001), hypertension (56.2% vs.
Case series on the use of various bulking agents (collagen, hyaluronic 36.7%; p<0.0001), coronary artery disease (14.6% vs. 8.9%; p=0.008), and
acid, polydimethylsiloxane) after CCUD have been published, but none arrhythmia (11.0% vs. 3.8%; p=0.008). On multivariate analysis, the duration
has described the use of polyacrylamide hydrogel (Bulkamid) injections. of incontinence (years) significantly predicted the likelihood of developing a
Since PDMS is no longer available in Canada, we have been using Bulkamid new comorbidity (odds ratio [OR] 1.2; 95% confidence interval [CI] 1.1–1.4;
as our bulking agent of choice for the last decade. Our objective was to p<0.01) while age (p=0.20) and severity of incontinence (p=1.0) did not.
assess the efficacy and safety of Bulkamid injections for the treatment of Conclusions: Patients with PPI may be at higher risk of developing new
incontinence in patients with CCUD. comorbidities while awaiting anti-incontinence surgery, which may be
Methods: We retrospectively analyzed the medical records of patients who related to the duration of incontinence. Strategies which expedite return
underwent polyacrylamide hydrogel injections for urinary incontinence of continence, such as early surgical intervention, may facilitate the resump-
after CCUD between 2010 and 2019 at our institution. tion of physical activity and minimize the risk of future comorbidity.
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S143
© 2020 Canadian Urological Association