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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
                     1
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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
                                                                        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
                                                                                          2
        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
                                1
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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)
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