Page 7 - CUA 2020_Technology and Training_v2

Moderated Posters 5: Technical Advances in Urology, Improving Patient Relations

stratified by normal or abnormal MRI result. Questionnaires exploring MP-5.10
patient experience and knowledge acquisition were administered before Early therapeutic intervention of hyperbaric oxygen improves
and after their clinical encounter. In addition, there was a study coordina- radiation-induced hemorrhagic cystitis and proctitis
tor observing each clinical encounter to see how physicians and patients Hayato Takeda , Go Kimura , Shuhei Nozaki , Mikio Shibasaki , Yuya
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interacted with the TRRs and PACERRs. Hasegawa , Naoto Hodotsuka , Ryo Amakawa , Shigehito Minaguchi ,
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Results: Twenty-seven patients with a median age of 64.5 years were Hikaru Mikami , Masato Yanagi , Jun Akatsuka , Yuki Endo , Tatsuro
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included. Men were either on active surveillance (n=14), had prior nega- Hayashi , Yukihiro Kondo 1
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tive biopsy (n=9), or were biopsy-naive (n=4). MRI was abnormal in 1 Urology, Nippon Medical School, Tokyo, Japan
15 men (55%). Following the clinical encounter, more patients in the Introduction: Severe radiation-induced side effects can diminish quality
PACERR arm reported improved ability to express themselves (93% vs. of life (QOL) and cause life-threatening conditions. Hyperbaric oxygen
57%, p=0.03) and understand the doctor’s explanation of the report (86% therapy (HBOT) is an effective treatment not responding to conventional
vs. 50%, p=0.04). Adding the PACERR to the clinical encounter did not management. This study analyzed the clinical factors that affect the effi-
increase the median visit length (5 vs. 6 minutes). More abnormal items cacy of HBOT.
were correctly identified by men in the PACERR arm compared to men Material: Prostate cancer patients who were treated with external beam
in the TRR arm (100% vs. 62%, p=0.001). radiation therapy (EBRT), produced Radiation Therapy Oncology Group
Conclusions: Using the PACERR in clinical practice empowers patients and the European Organization for Research and Treatment of Cancer
to express themselves and comprehend their results. Patients report bet- (RTOG/EORTC) grade 3 hemorrhagic cystitis and proctitis, and received
ter interaction with their medical professionals. Further work should be HBOT were identified. Therapeutic effects were evaluated after at least six
directed toward improving the generalizability of PACERRs to other dis- months of followup using RTOG/EORTC late radiation morbidity scoring
ease sites and automation from traditional reports. schema. Time from radiation to onset of side effect and HBOT, as well as
Reference number of HBOT sessions were statistically analyzed by the chi-squared
1. Barry MJ, Edgman-Levitan S. Shared decision-making — the pin- test. Complete resolution was defined as disappearance of macroscopic
nacle of patient-centered care. New Engl J Med 2012;366:780-1. hematuria and hemorrhagic stool, and partial resolution as lower RTOG/
https://doi.org/10.1056/NEJMp1109283 EORTC score.
Results: Between 2005 and 2016, out of 389 patients with sufficient
MP-5.9 data, 57 patients complained of hemorrhagic stool or hematuria. Twenty
Systematic review on timing of perioperative pharmacological patients (12 proctitis and eight cystitis) with grade 3 side effects, mean
thromboprophylaxis initiation and its effect on venous age 78 years, received an average of 36 (range 1–224) HBOT. Complete
thromboembolism and bleeding outcomes and partial resolution rates were 50.0% and 25.0%, respectively. Four
Kristen McAlpine , Rodney H. Breau , Marc Carrier , Dean Fergusson , patients (20.0%) had no improvement and further surgical treatment was
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Ilias Cagiannos , Christopher G. Morash , Luke T. Lavallée 1,2 carried out in three patients (15.0%). One patient (5.0%) had a mild
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1 Division of Urology, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa earache but continued therapy. When treated within one month from
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Hospital Research Institute, Ottawa, ON, Canada; Department of onset of side effect, 54.5% completely cured and 18.2% showed partial
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Medicine, The Ottawa Hospital, Ottawa, ON, Canada resolution (p=0.092), whereas 33.3% were partially cured with treatment
Introduction: Venous thromboembolism (VTE) and bleeding are important delivery after a month. Side effects that occurred within 24 months after
complications of urological surgery. Thromboprophylaxis guidelines for radiation showed 50% resolution (p=0.208), and 22.2% resolved after 20
urologists are conflicting on timing of the initial dose of perioperative HBO sessions (p=0.547) did not affect clinical outcomes.
thromboprophylaxis and are largely based on non-urological literature. Conclusions: Treatment effectiveness was correlated with the time from
We sought to systematically assess the literature on the effect of the tim- onset of side effect to start of HBOT and associated with efficient clinical
ing of the initial dose of perioperative thromboprophylaxis on VTE and improvement. Early primary use of HBOT can successfully and safely treat
bleeding outcomes. severe radiation-induced cystitis and proctitis.
Methods: EMBASE, MEDLINE, and CENTRAL databases were search on
July 10, 2019 for randomized controlled trials (RCT) that evaluated VTE MP-5.11
and/or bleeding outcomes between groups receiving the initial dose of Establishing a care pathway for hydronephrosis
thromboprophylaxis at different times perioperatively. Trials were limited Betty Wang , Nathan Hoy , Shubhadip (Shubha) K. De , Trevor D.
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to those that used the same medication between groups to ensure compa- Schuler , Timothy A. Wollin 1
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rability. Prespecified subgroup analyses of abdominopelvic surgery (e.g., 1 Department of Urology, University of Alberta, Edmonton, AB, Canada
urological) and orthopedic surgery RCTs were planned. Introduction: The diagnostic evaluation for hydronephrosis is not uniform
Results: The initial search resulted in 3067 entries. After manual review, for every patient. Depending on the severity, acuity, and renal function,
21 RCTs including 16 962 randomized patients met full inclusion the urgency of the referral and evaluation will vary. This becomes chal-
criteria. Nine RCTs assessed abdominopelvic surgery, nine assessed lenging for triage staff, as there is no established care pathway. We aimed
orthopedic surgery, and three assessed other surgeries (e.g., thoracic). to establish a pathway for the triage of hydronephrosis patients.
Only three RCTs showed a statistically significant difference between Methods: For this quality improvement project, we conducted a retrospec-
study groups in VTE (one RCT) or bleeding outcomes (two RCTs). These tive chart review of all new adult hydronephrosis referrals to the Kipnes
RCTs showed increased bleeding and decreased VTE rates with earlier Urology Centre from July 2018 to September 2019. Data was abstracted
initiation of thromboprophylaxis. Bleeding outcomes were reported with from our electronic medical record and entered into a RedCap database.
high variability with only three RCTs using established definitions for The following key parameters were recorded: patient demographics, type
major and minor bleeding. Most studies were underpowered to detect of referral, location and severity of hydronephrosis, investigations prior to
a difference between study groups. Variability in the timing and medica- referral, and additional investigations requested by urology. Final diagno-
tions between studies did not allow for a meta-analysis of outcomes. sis and disposition were also included.
Conclusions: This systematic review confirms limited high-quality evi- Results: A total of 111 charts were reviewed. Mean age at referral was
dence is available on the optimal timing of the initial dose of perioperative 55 years. Mild, moderate, and severe hydronephrosis was reported in
thromboprophylaxis to prevent VTEs and bleeding. RCTs in urological 38%, 32%, and 30%, respectively. Investigations prior to referral con-
patients are necessary to guide best practice. sisted of renal ultrasound (85%), contrast computed tomography (37%),
NCCT (12%), and diuretic renal scan (13%). After chart review and/or
urology consultation, additional investigations included diuretic renal in
60%, retrograde pyelography in 10%, and no additional imaging in 23%.
Twenty-six patients (23%) were diagnosed with ureteropelvic junction
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S107