Page 15 - CUA 2020_Sexual Dysfunction and Transplant

2020 CUA Abstracts

time were 28.3 minutes (standard deviation [SD] 9.0) and 210 minutes MP-11.12
(SD 59.8), respectively. Only one patient required blood transfusion and The role of bariatric surgery on kidney transplantation: A
median estimated blood loss was 100 mL. Delayed graft function occurred systematic review and meta-analysis
in six cases and seven patients developed surgical complications. One Yung Lee , Lucshman Raveendran , Olivia Lovrics , Aristithes Doumouras ,
1
2
3
1
patient had renal vein thrombosis managed by thrombectomy. Urine leaks Martin A. Koyle , Monica Farcas , Yonah Krawkowsky , Dennis Hong 3
5
4
6
were identified in two patients and managed by nephrostomy and ureteric 1 Michael G. Degroote School of Medicine, McMaster University, Hamilton,
re-implantation, respectively. Overall, six allograft nephrectomies were ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON,
2
required for renal vein thrombosis (n=2), failed embolization of arterio- Canada; Department of Surgery, McMaster University, Hamilton, ON,
3
venous malformation (n=1), renal artery aneurysm (n=1), renal pedicle Canada; Division of Urology, The Hospital for Sick Children, Toronto,
4
torsion (n=1), and recurrent FSGS (n=1). Patients who had a previous ON, Canada; Division of Urology, St. Michael’s Hospital, Toronto, ON,
5
transplant, as well as those with ESRD due to obstruction or reflux were Canada; Department of Urology, University of Toronto, Toronto, ON,
6
significantly more likely to experience a surgical complication (30% vs. Canada
6%, p=0.043; 31% vs. 5%, p=0.016, respectively). However, there was Introduction: In patients with end-stage renal disease, kidney transplan-
no difference between cadaveric vs. living transplants (10% vs. 7%) or tation improves survival. However, due to safety and increased rates of
transplants performed overnight vs. daytime (14% vs. 5.6%, p=0.39). graft failure, severe obesity remains a relative contraindication for kidney
Mean anastomotic time (32.3 vs. 27.9 minutes) and age (14.0 vs. 11.8 transplantation. Kidney transplant recipients are also at a high risk for
years) were similar for patients who had surgical complications compared developing obesity. The aim of this systematic review and meta-analysis
to those who did not. is to investigate the role of bariatric surgery before and after kidney trans-
Conclusions: Perioperative outcomes post-pediatric renal transplantation plantation.
in our cohort are comparable to previously reported studies. Surgical Methods: Databases, including MEDLINE, EMBASE, CENTRAL, PubMed,
complications are infrequent but cause significant morbidity. We identify and Web of Science, were searched up to March 2019, and we included
previous renal transplantation and cause of ESRD as predictors for surgi- studies that performed bariatric surgery on patients with severe obesity
cal complications. before and after kidney transplantation. Outcomes for both groups
included change in body mass index (BMI) and rates of surgical mortal-
MP-11.11 ity and complications. For studies that performed bariatric surgery before
Patient-reported outcomes from renal transplant recipients: transplant, additional outcomes included the rate of patients listed for
Initial results from a single-center study and who subsequently received renal transplantation following bariatric
Keesha Khehra , Caelie Stewart , Angela Cho , Rohit Singla , Christopher surgery. Pooled estimates were calculated using the random effects meta-
1
1
2
3,4
Y. Nguan 2 analysis of proportions.
1 MD Undergraduate Program, Faculty of Medicine, University of British Results: Seventeen studies were eligible for the final review. Eight studies
Columbia, Vancouver, BC, Canada; Department of Urologic Sciences, investigated the role of bariatric surgery before kidney transplant (n=142).
2
University of British Columbia, Vancouver, BC, Canada; School of After bariatric surgery, the 30-day mortality rate was 0% and 84% of
3
Biomedical Engineering, University of British Columbia, Vancouver, BC, patients (95% confidence interval [CI] 64–98%) were successfully listed
Canada; MD/PhD Program, Faculty of Medicine, University of British for transplant, 70.0% (95% CI 37–95%) of whom underwent transplant.
4
Columbia, Vancouver, BC, Canada At total of 4.2% of patients experienced minor 30-day complications, and
Introduction: Patient-reported outcomes (PROs) are gaining popularity in major 30-day complications occurred in 3.5% of patients. Nine studies
various medical disciplines as a mechanism to improve accountability and investigated the role of bariatric surgery after kidney transplant (n=274).
overall quality of healthcare services. PROs can be effective tools for char- After bariatric surgery, the 30-day all-cause mortality rate was 0%, with
acterizing symptom burden and health-related quality of life. Many medi- one minor (1.54%) and one major (1.54%) 30-day complication having
cal guidelines for surgical procedures do not discuss specifics of recovery occurred.
or establish timelines of symptom presentation among patients. This work Conclusions: Bariatric surgery appears safe and effective in reducing
aims to establish a more accurate estimation of expected symptoms and weight to improve kidney transplant candidacy and outcomes in patients
report timelines for symptom recovery in renal transplant recipients. with severe obesity, as well as in patients following kidney transplantation.
Methods: Patients receiving a kidney transplant at Vancouver General
Hospital were recruited (n=51) to complete a postoperative recovery MP-11.13
survey at a gradually reduced frequency over a six-month period. Analysis Sexual Health Inventory for Men (SHIM) questionnaire as a
was performed to determine the number of patients that report experienc- screening method for erectile dysfunction in the general urology
ing each symptom and when the symptoms are reported to have resolved. clinic
Results: Postoperatively, common causes of concern among patients Amjad Alwaal , Mohannad Awad , Nathan Boggs , Jake Kuzbel , Brian
1
2
1
1
include graft rejection, sleep, pain, fluid overload, and bowel move- Snoad 1
ments. The initial results give insight into the symptoms experienced by 1 Urology, Marshall University, Huntington, WV, United States; Surgery,
2
recipients including: 90% (n=38) continue to report incision site pain for University of Vermont, Burlington, VT, United States
up to six weeks; 57% (n=24) will have urgency while urinating, lasting Introduction: Sexual Health Inventory for Men (SHIM) is a validated
up to eight weeks; and 86% (n=36) of recipients return to work within questionnaire that is widely used in urology clinics to evaluate and assess
six months. Forty-three percent (n=18) of patients report irritation when treatment efficacy for erectile dysfunction (ED). In this study, we evaluated
urinating, with this resolving within one week for 44% (n=18) of patients, the benefit of using SHIM questionnaire as a screening tool for ED in the
within two weeks for 61% (n=26), and within one month for 78% (n=33). general urology clinic.
The average time to return to regular bowel movements is 4±2 days and Methods: All new male urology patients who are 40 years of age or older
the average time of return to regular activity level is 27±13 days. visiting the general urology clinic for non-sexual issues received SHIM
Conclusions: Using PROs, new information can be obtained on expected questionnaire. Patients who wanted treatment for ED received a full ED
symptoms and recovery, which can improve management in a patient- evaluation and treatment.
centric manner, as well as inform supporting research. Longer-term analy- Results: A total of 379 patients received SHIM questionnaire. Forty-eight
sis is needed to evaluate the usability and applicability of the PRO tool patients (12.7%) refused to fill the questionnaire. We excluded all patients
in clinical practice. presenting for sexual health issues (67 patients, 17.7%). We included the
remaining 264 patients (69.6%). Mean age was 61.7 years (range 40–85).
Table 1 demonstrates patient characteristics. Chief complaint was not
predictive of the patient’s SHIM score or desire to have ED treatment.
S146 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)