Page 6 - CUA 2020_Trauma and Reconstruction
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2020 CUA Abstracts
two men with a new increase in IPSS >11; censors in year 2 included mon presenting symptom was continuous incontinence in 19 patients
one man lost to followup. No man was retreated in year 2. (46.3%). Nineteen patients had a fascial sling placed at the time of surgery
Conclusions: Two-year data indicate that in men with short bulbar urethral (47.5%). Concomitant sling placement was associated with a statistically
stricture refractory to standard endoscopic management, the paclitaxel significant decrease in postoperative SUI (10.5% vs. 38.1%; p=0.0481)
DCB is safe and produces a durable improvement in IPSS. and no significant difference in postoperative complication rates (26.3%
vs. 23.8%; p=0.855). Two patients had Clavien-Dindo grade I complica-
MP-2.7 tions (5%) and two patients had grade III complications (5%). Four patients
had long-term complications (10%), including urinary retention, chronic
Lower urinary tract reconstruction after radiation therapy for pain, and urethral stricture. Two patients had UVF recurrence (5%). Mean
pelvic cancer followup after surgery was 3.44 years (0.11–17.04).
Sender Herschorn , Geneviève Nadeau 2 Conclusions: Although UVF is rare, it should be suspected in patients with
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1 Urology, University of Toronto, Toronto, ON, Canada; Urology, CHU de continuous incontinence following a surgical procedure, and patients
Québec – Université Laval, Quebec City, QC, Canada should be counselled on the risk of UVF associated with SUI proce-
Support: University of Toronto Functional Urology Research dures. Most UVF surgical repairs are successful, with or without simul-
Introduction: Pelvic radiation therapy (RT) for malignancies may compro- taneous fascial sling placement.
mise the lower urinary tract (LUT). Reconstruction can be quite challenging,
especially when combined with surgical extirpation. As an alternative to
cystectomy, enterocystoplasty with or without ureteral re-implantation or MP-2.9
continent stoma creation brings the potential benefit of preserving the LUT. Management of female vesicovaginal fistula Canadian tertiary
Methods: The records of patients treated between 1994 and 2019 center experience
who underwent LUT reconstruction after pelvic RT were reviewed. Samer Shamout , Richard J. Baverstock , Kevin V. Carlson 1
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Complications and functional results were recorded. 1 Department of Surgery, Division of Urology, University of Calgary,
Results: Thirty-one patients (15 women,16 men) who had received RT for Calgary, AB, Canada
advanced or recurrent pelvic cancer were identified. Ten patients under- Introduction: Surgical repairs of vesicovaginal fistula (VVF) are most com-
went reconstruction as part of primary tumor excision after chemo-rads monly performed vaginally, abdominally, or laparoscopically. Treatment
(group 1) and 21 had surgery due to radiation complications (group 2). approach from either abdominal or vaginal is often dictated by complex-
Mean age at surgery was 58.4 years (range 33–76). All patients under- ity of the fistula and surgeons’ preference. The study aims to present the
went enterocystoplasty and 19 (61%) of these had simultaneous ureteral outcomes of all patients referred with vesico-vaginal fistulae to a tertiary
re-implants either into an intestinal limb (12) or into the bladder (7). center, and to investigate the patient, fistula, and surgical factors relevant
Re-implants were done for obstruction due to cancer or post-RT. Eight to success.
patients had continent abdominal stomas performed with the augmenta- Methods: This is a retrospective study analyzing the database registry
tion due to devastated urethras. After a mean of 49 months (range 2–170), of 63 consecutive patients who underwent vesicovaginal fistula repair
the re-operation rate was 30% and was similar in both groups. Nine between 2005 and 2019. Participants underwent clinical evaluation,
patients had re-operations; stoma problems (4), bladder stones (3), and including demographic, fistula profile, and surgical approach (vaginal
vesicovaginal fistula (1). One anastomotic leak was treated with diversion. or abdominal). Operative data, postoperative outcome, and followup
Two developed ureteral anastomotic strictures that responded to tempo- were recorded. Two surgical groups were compared, including abdominal
rary stents. No renal deterioration was seen. Seventeen of 24 non-stoma and vaginal repair.
patients void spontaneously, two do intermittent catheterization (IC), and Results: A total of 63 women with a mean age of 47.7 (±10.7) years
two have Foley catheters. All eight stoma patients do IC. Urinary inconti- and mean body mass index of 28.8 kg/m (±7.27) were included in the
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nence was noted in five patients. Twenty-eight of 31 patients considered study. The etiology of fistula was secondary to malignancies in six (9.5%)
their reconstruction successful. patients and gynecological/obstetric procedure related in 57 (90.4%)
Conclusions: Prior pelvic RT is not a contraindication to enterocysto- patients. Thirteen (20.6%) patients had prior repair and 50 (79.3%) were
plasty with or without ureteral reimplantation or continent abdominal naive. The mean period from onset of leakage to time of repair was 44.47
stoma. Satisfactory functional outcomes and acceptable morbidity can (±85.1) days. Forty-two patients had transvaginal repair, whereas 21 VVF
be achieved. had abdominal repair. The two groups did not show a significant differ-
ence in demographics (Table 1). Transvaginal approach had a significant
MP-2.8 shorter operative time, less intraoperative blood loss, and reduced post-
operative hospital stay (p<0.005). Transabdominal repair was associated
Urethrovaginal fistula repair with or without concurrent fascial with increased complications after surgery (p<0.05). Length of operative
sling placement time and estimated blood loss were positively and significantly correlated
Sarah R. Ferrara , Jennifer A. Locke , Sender Herschorn 1 with age (r=0.392; p=0.005 and r=0.394, p=0.002, respectively) and
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1 Urology, Sunnybrook Health Sciences Centre, University of Toronto, time to surgery (r=0.0386; p=0.01 and r=0.416; p=0.002, respectively).
Toronto, ON, Canada The success rates of transvaginal and abdominal techniques were 97.6%
Introduction: Urethrovaginal fistula (UVF), a rare diagnosis in the devel- and 85.7% respectively.
oped world, is most often due to iatrogenic causes. We reviewed our Conclusions: Transvaginal repair of VVF is a technically feasible approach
29-year experience on the management and outcomes of UVF repair, with a high success rate and low morbidity. Despite varied etiology and
with or without concomitant fascial sling placement. different surgical approach, age, and time of VVF repair are significant
Methods: All patients diagnosed with UVF at our center from 1988–2017 determinants of operative complexity.
were included in this study through a prospectively kept database. Chi-
square or Fisher’s exact test were used to compare postoperative stress
urinary incontinence (SUI) rates and complication rates between patients
with or without fascial sling placement at the time of UVF repair.
Results: We identified 41 cases of UVF, 40 of whom underwent surgi-
cal repair. Mean age at diagnosis was 47.8 (21–81). All patients had
undergone pelvic surgery; 20 patients (48.8%) having had SUI sur-
gery. Etiology of UVF was secondary to SUI surgery in 16 patients (39%)
and urethral diverticulum repair in eight patients (19.5%). The most com-
S88 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)