Page 5 - CUA 2020_Trauma and Reconstruction

Moderated Posters 2: Trauma, Reconstruction, Pelvic Pain

4.8; 95% confidence interval [CI] 1.8–13.3; p=0.002), increasing stricture Results: Of the 828 patients undergoing urethroplasty over this period,
length (HR 1.2; 95% CI 1.1–1.4; p=0.002), and iatrogenic strictures (HR 387 patients completed IPSS scores pre- and postoperatively and of
3.2; 95% CI 1.1–9.1; p=0.03) were independently associated with stric- these 372 (96.1%) were stricture free on cystoscopy at six months.
ture recurrence, while comorbidity (p=0.06), prior endoscopic treatment Mean patient age was 49.5 years, mean stricture length was 4.3 cm, and
(p=0.41), prior urethroplasty (p=0.89), and other etiologies were not. 84.4% of patients failed prior endoscopic treatment. Stricture location
There was no significant difference between the cohorts with respect to was most commonly bulbar (60.2%), penile (19.6%), posterior (13.7%),
90-day complications (Clavien ≥2) (3.6% vs. 4.2%; p=0.74). and pan-urethral (6.5%). Techniques included buccal mucosa graft onlay
Conclusions: AAU is independently associated with stricture recurrence (50.5%), anastomotic (31.7%) or staged (12.4%) reconstruction. Mean
when compared to a pure DO technique. This may be related to urethral IPSS (19.0 vs. 5.4; p<0.0001) and median UQOL (5 vs. 1; p<0.0001)
ischemia. We recommend that AAU should be reserved for longer strictures were improved postoperatively. Despite being stricture-free on cystoscopy,
where DO is precluded due to areas of complete luminal obliteration. 13.7% of patients did not report improvement in IPSS (LUTS failure) and
10.2% did not report improvement in UQOL. On multivariate binary
MP-2.4 logistic regression, increasing patient age (odds ratio [OR] 1.04; 95%
confidence interval [CI] 1.01–1.06; p=0.006), lichen sclerosus (OR 7.6;
Improvement of storage-associated lower urinary tract symptoms 95% CI 1.1–51.0; p=0.04), and hypospadias strictures (OR 8.3; 95%
following urethroplasty: A prospective, single-cohort study CI 1.3–54.0; p=0.03) were associated with LUTS failure, while stricture
Dylan Hoare , Jordan Bekkema , Keith F. Rourke 1 location (p=0.46), length (p=0.07), previous urethroplasty (p=0.86), prior
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1 Division of Urology, University of Alberta, Edmonton, AB, Canada endoscopic treatment (p=0.50), type of urethroplasty (p=0.17), and other
Introduction: Storage symptoms tend to induce the greatest degree of urethroplasties did not. Increasing patient age was also the only factor
bother in patients with lower urinary tract symptoms (LUTS). When asso- associated with a lack of improvement in UQOL (OR 1.03; 95% CI
ciated with lower urinary tract obstruction, such as urethral stricture, it 1.01–1.06; p=0.02).
is unclear how these specific symptoms respond to surgery. This study Conclusions: While the majority of patients experience improvement in
aims to evaluate the prevalence and effect of urethroplasty on patient- lower urinary tract function after urethroplasty, 13.7% experience “LUTS
reported storage LUTS. failure” despite being stricture-free on cystoscopy, and 10.2% report no
Methods: This was a prospective, single-cohort, descriptive study evaluat- improvement in UQOL. Both occurrences are independently associated
ing patients undergoing urethroplasty for urethral stricture from 2012– with increasing patient age and may be related to concurrent benign
2019. Patients were administered the International Prostate Symptom prostatic hyperplasia or alternately detrusor dysfunction related to long-
Score (IPSS) preoperatively and six months post-urethroplasty. Outcome standing bladder outlet obstruction.
measures included the frequency, urgency, and nocturia domains of the
IPSS and a combined score of the aforementioned symptoms. Symptoms
were considered clinically significant if they were graded ≥3 for the MP-2.6
individual domains and >6 for the combined score. Significant change Two-year outcomes of a paclitaxel-coated balloon for treatment
was defined as a ≥2 points on the combined scale. Survey results were of male bulbar urethral stricture
compared using the Wilcoxon-signed rank test. Binary logistic regres- Sean Elliott , Ramón Virasoro , Jessica DeLong , Rafael Estrella , Merycarla
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sion was used to assess the association between clinical factors and Pichardo , Ramón Rodriguez Lay , Gustavo Espino , George Suarez ,
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non-responders. George Webster , Gerald Jordan , Mélanie Aube-Peterkin 8
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Results: A total of 387 patients completed IPSS surveys pre- and post- 1 Urology, University of Minnesota, Minneapolis, MN, United
operatively. Mean age was 50 years, with an average stricture length of States; Urology, Eastern Virginia Medical School, Norfolk, VA, United
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4.5 cm. Cystoscopic success at six months was 96%. Preoperatively, States; Urology, Baptist Hospital, Miami, FL, United States; Urology,
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urinary frequency (53%), urgency (49%), and nocturia (42%) were com- Hospital General de la Plaza de la Salud, Santo Domingo, Dominican
mon symptoms. Postoperatively, these rates decreased to 12%, 11%, and Republic; Urology, Royal Center, Panama City, Panama; Urology, Centro
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11%, respectively (p<0.0001). Likewise, overall storage symptom scores Especializado San Fernando, Panama City, Panama; Urology, Duke
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improved (median 8 vs. 2; p<0.0001) with 75.2% of patients reporting University Medical Center, Durham, NC, United States; Urology, McGill
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significant improvement in storage LUTS. On binary logistic regression, University Health Centre, Montreal, QC, Canada
no factor was associated with a lack of response (stricture recurrence, Introduction: We report two-year outcomes of ROBUST I, a multicenter,
age, stricture length, etc.). single-arm, open-label study on the safety and efficacy of a paclitaxel
Conclusions: Urethroplasty yields clinically and statistically significant drug-coated balloon (DCB) for treatment of urethral stricture.
improvements in storage LUTS in men with urethral strictures. Methods: Men with bulbar urethral strictures of 2 cm with 1–3 prior
endoscopic treatments were enrolled at four study sites in the Dominican
MP-2.5 Republic and Panama following ethics committee approvals. The DCB
was inflated under cystoscopic visualization and placement confirmed
Urinary symptom non-response (“LUTS failure”) after via fluoroscopy. International Prostate Symptom Score (IPSS) was docu-
urethroplasty: Incidence and associations mented at three, six, 12, and 24 months. Cystoscopy was documented
David W. Chapman , Jordan Bekkema , Keith F. Rourke 1 at six and 12 months. Primary efficacy endpoint was improvement in
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1 Urology, University of Alberta, Edmonton, AB, Canada IPSS and primary safety endpoint was serious complications through
Introduction: Urethroplasty is a highly effective treatment for recurrent three months. We also report updated results of our composite defini-
urethral stricture. However, some patients fail to experience significant tion of success: 1) no retreatment; 2) no recurrence on cystoscopy; and
improvement in lower urinary tract symptoms (LUTS) despite being 3) IPSS 11 at last followup. For the two-year outcomes data, men were
stricture-free. We aim to identify the incidence of “LUTS failure” after considered successful if they had a normal cystoscopy at 12 months
urethroplasty and examine associated factors. and IPSS remained 11 at two years. If IPSS was >11 at two years, men
Methods: Patients undergoing urethroplasty over a six-year period (January were considered a failure and cystoscopy was not repeated inside the
2012 to December 2018) were offered enrollment in a study examining study protocol.
urinary function after urethroplasty. Urinary function and urinary quality of Results: A total of 53 subjects were enrolled and all were successfully
life (UQOL) were assessed preoperatively and at six months postoperatively treated. Average subject age was 51 years (range 22–81). Average number
using the international prostate symptoms score (IPSS). “LUTS failure” was of prior treatments was 1.8 per subject (range 1–4). There were no serious
defined as less than three-point improvement in IPSS. Stricture recurrence or unexpected device related adverse events. Mean IPSS decreased from
was defined as the inability to pass a 16 Fr flexible cystoscope. Patients 25.2±4.5 (baseline) to 7.3±8.10 (p < 0.001) in 41 men with 24-month
with incomplete data were excluded. Descriptive statistics were used to data. Two-year success based on the composite definition was 30/45
summarize findings while multivariate binary logistic regression was used (67%) compared to 32/46 (70%) at one year. Failures in year 2 included
to determine the association between clinical factors and LUTS failure.
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S87