Page 2 - CUA 2020_Technology and Training_v2

2020 CUA Abstracts

Results: A total of 18 men underwent 25 procedures over a four-year POD-5.5
period. Mean age at diagnosis of VUAS was 64, and mean time to VUAS Experience and results of the first three years of implementing a
was 13.8 months after RP. Fourteen patients (77.8%) had undergone some competency-based didactic and simulation-focused boot camp
form of radiation treatment. The men had undergone 128 prior unsuc- for incoming urology residents
cessful VUAS treatments, with a mean of 7.1 failed treatments per patient. Yuding Wang , Jen Hoogenes , Hark Randhawa , Catherine Anne Lovatt ,
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Failed treatments included dilation, BNI, BN injection of mitomycin C, or Kevin Kim , Roderick Clark , Courtney Moore , Bobby Shayegan , Edward
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ALLIUM stent placement. The overall success rate after a mean of 16.2 D. Matsumoto 1
months from the time of triamcinolone injection was 83.3%. Six patients 1 Department of Surgery, Division of Urology, McMaster University,
went on to have successful incontinence surgery. Five patients (27.8%) Hamilton, ON, Canada; Department of Health Research Methods,
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had treatment complications (bleeding, urinary tract infection, pain, and Evidence and Impact, McMaster University, Hamilton, ON, Canada;
urinary extravasation). The three patients who did not respond to treat- 3 Department of Surgery, Division of Urology, Western University, London,
ment are stable and awaiting re-treatment with triamcinolone injection. ON, Canada
Conclusions: Triamcinolone bladder neck injections for post-RP VUAS Support: Centre for Minimal Access Surgery (CMAS), McMaster University
are a useful and safe treatment for recurrent or recalcitrant stenosis. and St. Joseph’s Healthcare Hamilton
Associated incontinence can subsequently be treated. Introduction: The launch of the CanMEDS Competence by Design (CBD)
initiative presents challenges for curricula design to ensure residents
POD-5.4 achieve proficiency as they progress through training. Surgical boot
Results of a surgical decision management protocol to treat camps have been used to improve the learning process by orienting and
incontinent pediatric neurogenic bladder patients: A 10-year, preparing new residents. We developed, implemented, and evaluated an
single-institution, retrospective series intensive didactic and simulation-focused boot camp for first-year urology
Karan Gandhi , Jacob Davidson , Zhan Tao (Peter) Wang , Sumit Dave 3 residents and report our experience and findings of its first three years.
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1 Schulich School of Medicine & Dentistry, Western University, London, Methods: Urology residents from two Canadian universities participated in
ON, Canada; Department of Surgery, Division of Pediatric Surgery , the two-day boot camp within the first three weeks of residency. The boot
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Western University, London, ON, Canada; Department of Surgery, camp includes 11 didactic lectures and six simulation sessions that allow
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Division of Urology and Pediatric Surgery, Western University, London, for instruction and deliberate practice with feedback. Pre-and post-boot
ON, Canada camp multiple choice questionnaires (MCQs) were administered. At the
Introduction: Incontinent neurogenic bladder (NB) patients are socially end of day two, a six-station objective structured clinical exam (OSCE)
ostracized and are additionally often at risk of upper tract renal damage. and feedback session were conducted. For initial validation, after year
Surgical management of NB incontinence requires assessment of the one, three PGY2 residents served as historical controls and completed
bladder and outlet as components responsible for incontinence. the MCQ and OSCE.
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Methods: This is a retrospective chart review of a prospective protocol Results: A total of 19 residents completed boot camp. The mean age
examining 22 incontinent NB patients who underwent one of two pro- was 26.4 years (±2.8) and 13 were male. Prior urology and simulation
cedures over a 10-year period between October 2009 and June 2019. experience was minimal. Participants markedly improved on the pre-
Augmentation cystoplasty (AC) with a Mitrofanoff procedure (MP) was and post-MCQs (year 1: 62% and 91%; year 2: 55% and 89%; year
performed for all NB patients who had a high detrusor leak point pressure 3: 58% and 86%, respectively), while historical controls scored 66%.
(DLPP) over 40 cm H O and showed significant bladder trabeculations Participants scored marginally higher than the controls on four of the six
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(AC+MP), while those with a low DLPP below 40 cm H O and a rela- OSCE stations. Total OSCE scores remained >88% over the three cohorts.
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tively smooth bladder underwent a bladder outlet procedure, including a All participants reported higher confidence levels and felt boot camp was
modified Young-Dees-Leadbetter procedure with a 360 rectus fascial sling an excellent preparation for residency.
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and bladder neck suspension procedure with concomitant AC and MP Conclusions: During its first three years, our urology boot camp has
(BOP+AC+MP). Postoperative success was defined as being completely demonstrated high feasibility and utility. Knowledge and technical skills
dry for a three-hour period without any incontinent appliance/pad or uptake were established via MCQ and OSCE results, with participants’
wet. Upper tract status and renal function was simultaneously assessed. scores near or above those of PGY2 controls. This boot camp will remain
Results: The mean age at the time of the procedure was 12.1 years (stan- in our CBD curriculum, and it can provide a framework for use by other
dard deviation=6 years), with 14 undergoing AC+MP and eight undergo- urology residency programs.
ing BOP+AC+ MP based on our preoperative criteria. Overall, 13 (59%)
patients were completely dry and nine (41%) patients still had some POD-5.6
ongoing leakage. Success rates for continence as defined was 71% in Organized basic laparoscopic urological skills (BLUS) course
the AC+MP group vs. 38% in the BOP+AC+MP group. The overall com- objectively improves trainee performance in a single session
plication rate was 45%, defined as those requiring surgical intervention David M. Mikhail , Aaron Tabibzadeh , Zachary Kozel , Arun Rai , Joseph
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following their index procedure. Sarcona , Patrick Samson , Christopher Hartman , Jessica Kreshover ,
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Conclusions: Surgical treatment of NB incontinence is fraught with a high Michael Schwartz , Louis Kavoussi , Domenico Veneziano , Lee Richstone 1
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complication rate and relatively poor outcomes, despite concomitant 1 Urology, Northwell Health, New York, NY, United States; Urology,
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AC. Bladder neck closure is possibly a reliable way to achieve socially Azienda Ospedaliera Bianchi-Melacrino-Morelli di Reggio Calabria,
acceptable continence in this population. Despite a three-procedure BOP, Calabria, Italy
success rates are still not acceptable after a concomitant AC. Introduction: Validated in 2012, the American Urological Association
Reference (AUA) Basic Laparoscopic Urological Skills (BLUS) curriculum has not
1. Amarenco G, Sheikh Ismael S, Chesnel C, et al. Diagnosis and been widely adopted. Simulation and objective evaluation of technical
clinical evaluation of neurogenic bladder. Eur J Phys Rehabil Med skills are essential to surgical training. We established the first standard-
2017;53:975-80. ized BLUS course for urology residents in North America. We aimed to
establish whether expert-taught BLUS curriculum can lead to objective
and measurable skills improvement in a single session.
Methods: Trainees self-reported laparoscopic experience and performed
baseline evaluations for five BLUS skills tasks: peg transfer, circle-cutting,
needle-guiding, lap-suturing, and vessel-clipping. They were evaluated
by two standardized metrics validated for BLUS tasks — the Performance
Improvement (Pi) score and Crowd-Sourced Assessment of Technical Skills
(CSATS). Pi is calculated based on time and error improvements. CSATS
S42 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)