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       Podium Session 5: Training, Reconstruction

       POD-5.1                                               Results: A total of 248 GURS members were invited to participate in the
       Defining which outcomes are associated with patient satisfaction   survey, with a response rate of 57.3% (n=142). The majority of participants
       after urethroplasty                                   perform >20 urethroplasties per year (n=108, 76.0%). Almost all respon-
       Jordan Bekkema , Keith F. Rourke 1                    dents (97.9%, n=139) reported using intraoperative intravenous (IV) antibiotic
       1 Division of Urology, University of Alberta, Edmonton, AB, Canada  prophylaxis while a minority of surgeons use intraoperative pharmacologi-
       Support: Dr. Rex Boake Studentship in Urology         cal VTE prophylaxis (n=57, 40.1%). Most respondents routinely perform a
       Introduction: Outcomes after urethroplasty can be assessed by multiple   midline incision (n=124, 87.3%) while a small minority of surgeons prefer
       measures, both surgeon-reported and patient-reported. We aimed to deter-  a lambda incision (n=17, 12.0%). With respect to tissue transfer, most sur-
       mine which clinical outcomes are associated with patient satisfaction after   geons prefer buccal mucosa harvested from the cheek (n=138, 97.2%) in
       urethroplasty.                                        a rectangular shape (n=79, 55.6%) or, less commonly, oval shape (n=53,
       Methods: From 2012–2018, 387 patients enrolled in this prospective,   37.3%). Respondents were more ambivalent on graft site closure, with a
       single-center study. Patient-reported outcomes were assessed preopera-  majority leaving the site open (n=76, 53.5%). Perineal drains are placed
       tively and six months postoperatively. Voiding function was assessed with   routinely by 25.3% of respondents (n=36) and of those left in situ, most are
       the International Prostate Symptom Score (IPSS), erectile function with the   removed within 48 hours (n=31, 86.1%). A majority of urethroplasty patients
       International Index of Erectile Function (IIEF-5), and ejaculatory function   are admitted to hospital for <24 hours (n=100, 70.4%). Only 21.3% (n=30)
       with a hybrid of the brief sexual function inventory. While patient satisfac-  of surgeons routinely prescribe bedrest for patients. In terms of postoperative
       tion, penile curvature/appearance, genitourinary pain, post-void dribbling,   antibiotic prophylaxis, a minority continue IV prophylaxis postoperatively
       and standing voiding function were assessed using literature-derived three-   (n=60, 42.3%), but most only do so for <24 hours (n=34, 56.7%). Oral
       or five-point Likert scales. Urethroplasty success was defined as the easy   antibiotic prophylaxis, however, is routinely administered by most urologists
       passage of a 16 Fr flexible cystoscope. Descriptive statistics were used to   (n=98, 69.0%), and most continue until the urinary catheter is removed
       summarize findings, while multivariate binary logistic regression was used   (n=70, 72.2%). Postoperatively, most patients are left with a urethral catheter
       to determine the association between outcomes and patient satisfaction.  for a period of 2–3 weeks (n=72, 58.5%) or 3–4 weeks (n=37, 30.1%). At the
       Results: At six months’ followup, 96.1% of patients were stricture-free on   time of catheter removal, most surgeons routinely perform urethral imaging
       cystoscopy while 81.7% reported being satisfied. On multivariate analysis,   with contrast (n=96, 67.6%). In terms of evaluating for stricture recurrence,
       improvement in IPSS (odds ratio [OR] 1.1; 95% confidence interval [CI]   a majority of urologists prefer some form of objective investigation (n=111,
       1.1–1.2; p=0.04), de novo erectile dysfunction (OR 0.5; 95% CI 0.2–0.9;   78.2%), with uroflowmetry (n=91, 82.0%%) and post-void residual (n=88,
       p=0.04), de novo penile curvature (OR 0.4, 95% CI 0.2–0.9; p=0.03), and   79.3%) being the most commonly reported methods, while cystoscopy was
       improved standing voiding function (OR 1.3; 95% CI 1.1–1.5; p=0.004)   also commonly performed (n=64, 57.7%). Although timing of these investiga-
       were associated with patient satisfaction. Cystoscopic success (p=0.60),   tions varied, most of them are routinely performed either 2–3 months (n=49,
       change in pain score (p=0.14), post-void dribbling (p=0.69), change in   44.1%) or 4–6 months (n=38, 34.2%) postoperatively.
       penile length (p=0.44), and ejaculatory dysfunction (p=0.51) were not.  Conclusions: Though there appears to be majority consensus on most ure-
       Conclusions: Improved voiding function, de novo penile curvature, de novo   throplasty management decisions, significant heterogeneity remain in some
       erectile dysfunction, and improved standing voiding function are associ-  areas, including antibiotic use, VTE prophylaxis, donor site management,
       ated with patient satisfaction and should be included in a patient-centered   catheter management, and followup assessment. With a lack of evidence
       approach to urethral stricture. While perhaps important to surgeons, cysto-  in this space, decisions will continue to be made based on clinical experi-
       scopic success is not associated with patient satisfaction.  ence and best practice principles.
       POD-5.2                                               POD-5.3
       Perioperative management of urethroplasty patients: A survey of   Triamcinolone acetonide injections for the treatment of recalcitrant
       the Society of Genitourinary Reconstructive Surgeons  post-radical prostatectomy vesicourethral anastomotic stenosis:
       R. Christopher Doiron , Keith F. Rourke 2             A large, modern-day series
       1 Department  of  Urology,  Queen’s  University,  Kingston,  ON,   Sarah R. Ferrara , Humberto R. Vigil , Jennifer A. Locke , Sender Herschorn 1
       Canada;  Department of Surgery, Division of Urology, University of Alberta,   1 Urology, Sunnybrook Health Sciences Centre, University of Toronto,
       Edmonton, AB, Canada                                  Toronto, ON, Canada
       Introduction: Practice patterns in the field of reconstructive urology have   Introduction: We sought to evaluate the success of bladder neck injections
       been poorly described. We hypothesize significant heterogeneity exists   of triamcinolone at the time of transurethral bladder neck incision (BNI)
       within the field. We sought to survey fellowship-trained reconstructive   for prevention of recurrent or recalcitrant post-radical prostatectomy (RP)
       urologists with respect to perioperative practice preferences for patients   vesicourethral anastomotic stenosis (VUAS)
       undergoing urethroplasty.                             Methods: Patients with recurrent VUAS post-RP ± radiation were offered
       Methods: An online survey examining perioperative management of urethro-  triamcinolone injections at the time of BNI. VUAS was diagnosed after RP
       plasty patients was administered to members of the Society of Genitourinary   by symptoms, followed by cystoscopy or urethrography. The outpatient
       Reconstructive Surgeons (GURS) between August and October, 2019. The   procedures were done under general anesthesia. Cold knife incisions were
       survey focused on anterior urethroplasty and inquired about preferences   made at the 3, 9, and 12 o’clock bladder neck (BN) positions, followed
       regarding tissue transfer, use of antibiotic and venous thromboembolism (VTE)   by triamcinolone injections (4 mg/mL) into the 3 and 9 o’clock incision
       prophylaxis, urinary catheter use, drain placement, and patient disposition.  sites. Postoperative catheterization was 5–7 days. Treatment outcomes were
                                                             determined by clinical followup and cystoscopy.
                                                CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)                 S41
                                                  © 2020 Canadian Urological Association
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