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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)
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