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2020 CUA Abstracts
obstruction, of which six had laparoscopic pyeloplasty and 16 are being MP-5.13
followed. Twenty-four patients (22%) were diagnosed with non-obstruc- Hemopatch parenchymal closure technique and initial outcomes
tive hydronephrosis, with 88% (21/24) discharged to primary care. Of during robot-assisted partial nephrectomy
the remaining 61 patients, 15% (9/61) required intervention, 51% (31/61) Benjamin Beech , Ryan McLarty , Jan K. Rudzinski , Howard J. Evans 1
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are being followed, and 34% (21/61) were discharged from urology care. 1 Division of Urology, University of Alberta, Edmonton, AB, Canada
Conclusions: Based on these findings, we believe that a care pathway Introduction: The Hemopatch is a novel polyethylene glycol-coated (PEG-
for hydronephrosis patients can be developed for our triage team to help coated) collagen patch that acts as a topical hemostatic agent. It has been
expedite the referral process and prioritize patients based on clinical need. applied to a variety of surgical techniques. Here, we present our initial
References series using it for robot assisted laparoscopic partial nephrectomy (RAPN).
1. Greco Baldea, Kristin A. Renal, Upper Tract Obstruction. American Methods: We conducted a retrospective review of all patients undergoing
Urological Association. Oct. 2, 2018. Available at: https://univer- RAPN by a single surgeon at a tertiary Canadian medical center between
sity.auanet.org/modules/webapps/core/index.cfm#/corecontent/62. July and December 2018. We excluded patients if they did not have 90
Accessed April 23, 2020. days followup or a Hemopatch was not used on the renal parenchymal
2. Singh, IM, Strandhoy JW, Assimos DG. Pathophysiology of Urinary defect. We collected data pertaining to demographics, renal tumor com-
Tract Obstruction. In: Kavoussi L, Novick A, Partin A, Peters C, plexity (RENAL nephrometry score), and postoperative outcomes. This
eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier- included 90-day complications (Clavien-Dindo classification), 90-day
Saunders; 2012:1087-1108. https://doi.org/10.1016/B978-1-4160- arterial embolization, estimated blood loss (EBL), change in postopera-
6911-9.00040-2 tive hemoglobin, clamp method, and length of stay (LOS). Descriptive
statistics were used to examine our outcomes. We also describe in detail
MP-5.12 our “gloved sleeping bag” technique for Hemopatch deployment.
Evaluation of the new holmium laser Xpeeda TM side-firing fiber Results: Seventeen patients met inclusion criteria, of whom 12 were male.
vs. Greenlight XPS 180W vapo-enucleation of the prostate for Mean age was 63 years. Median size of renal mass was 2.85 cm in largest
benign prostatic obstruction: An early clinical experience dimension, and median RENAL score was 6. Hilar clamping was carried
Ahmed Ibrahim , Mélanie Aube-Peterkin , Hazem Elmansy , Serge Carrier 1 out in 12 (70.9%) cases, with an average warm ischemic time of 16.1
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1 Urology, McGill University, Montreal, QC, Canada; Urology, Thunder minutes. The remainder of cases were performed off-clamp. Median EBL
Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada was 238 mL and the mean change in hemoglobin on postoperative day
Introduction: Recently, holmium Lumenis Pulse™ 120W was introduced 1 compared to preoperatively was 21.2 g/L. Average LOS was 1.76 days.
and it stands apart from other available technologies as a combination No patient underwent angioembolization for bleeding within 90 days
of power and efficiency, which minimizes vaporization time. It delivers and there were no complications greater than Clavien-Dindo grade 2.
120W, which represent the highest holmium power on the market, with One patient developed a urinary tract infection and a second developed
better energy use through the new Xpeeda™ side-firing fiber. This tech- postoperative urinary retention.
nology seems to revolutionize use of the holmium power and delivering Conclusions: Hemopatch can be used safely and effectively in lieu of tra-
more energy directly to the tissue, due to its ability to be in contact with ditional two-layer renorraphy with acceptable outcomes. Larger prospec-
the tissue. Herein, we report our early clinical experience comparing both tive series are required to ascertain its true value and cost-effectiveness.
procedures in improving bothersome lower urinary tract symptoms (LUTS)
secondary to benign prostatic hyperplasia (BPH).
Methods: A prospective study comparing holmium laser Xpeeda side-
™
firing fiber of the Lumenis Pulse 120W to photoselective vapo-resection of
the prostate-XPS 180 W was conducted. International Prostate Symptom
Score (IPSS), flow rate, residual urine, prostate-specific antigen, and
prostate volume changes, as well as perioperative complications were
collected and compared.
Results: Overall, 26 and 30 patients were included in the holmium laser
Expeeda side-firing (group A) and photoselective vapo-resection (group
TM
B), respectively. There were no significant differences in terms of operative
time, hospital stay, and time to catheter removal between both groups
(p>0.05). There was a significant comparable improvement in IPSS and
post-void residual urine volume at one and four months. Re-intervention
was needed in one and two cases in groups A and B, respectively (p=0.1).
There were no significant difference between both groups in terms of
intraoperative complications (1 vs. 2, p>0.05).
Conclusions: Our early clinical experience suggests that the new holmium
laser Xpeeda side-firing fiber is safe, non-inferior, and effective in treat-
TM
ment of BPH when compared with Greenlight XPS. Long-term followup
and randomized clinical trials are definitely warranted to assess whether
this new technology is more effective and more cost-effective.
MP-5.13. Fig. 1. Preparation and deployment of Hemopatch into renal mass
defect. (A) The Hemopatch is rolled with the adhesive side facing inward and
placed into the cut fifth finger of a sterile glove. (B) The assistant deploys the
glove finger into the field; (C, D) and the surgeon can manipulate the Hemo-
patch onto the defect without contact with surrounding tissues.
S108 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)