Page 28 - CUA Absracts 2022_Fulldraft

2022 CUA Abstracts

MP-1.9 improvement (90%), complication rate (<25%), and adjunct treatment
A systematic review of decision aids for patients with lower percentage (35%) as compared to the entire OAB cohort. The neurogenic
urinary tract dysfunction bladder subgroup (n=7) also experienced high satisfaction, both at less
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Carolyn MacLeod , Blayne Welk , Zachary Chuang , Zoe MacNeily , Chris and beyond 12 months (100% and 86%, respectively), improvement in
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Elliott , Jeremy Myers 3 symptoms (100%), no complications, and 29% use of adjunct treatments.
1 Division of Urology, Western University, London, ON, Canada; Urology, Conclusions: SNM in men with neurogenic and idiopathic OAB is a useful
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Stanford University, Stanford, CA, United States; Urology, University of and safe procedure. Most patients experience long-term satisfaction and
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Utah, Salt Lake City, UT, United States improvements continue for years after the surgery. Finally, the compli-
Introduction: Lower urinary tract symptoms (LUTS) often have a signifi- cation rate in this study is less than the average found in the literature.
cant impact on a patient’s quality of life. Patient decision aids (PDAs)
can be used to increase patients’ knowledge of their health condition MP-1.11
and help guide treatment decisions. Our objective was to systematically Intravesical botulinum toxin: Practice patterns and barriers to
review PDAs designed for adult patients with LUTS. delivery from a survey of Canadian urologists
Methods: MEDLINE, Embase, and CINAHL were searched from inception James Ross , Rhea Coriaty , Conrad Maciejewski , Duane R. Hickling ,
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through to June 2021. This review followed PRISMA guidelines and was Humberto Vigil 1
registered with PROSPERO (#220534). After designing comprehensive 1 Division of Urology, Department of Surgery, University of Ottawa,
search strategies, two reviewers independently screened abstracts to iden- Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa,
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tify those that met inclusion criteria. Studies reporting on the develop- ON, Canada
ment or evaluation of PDAs for LUTS were included. PDAs were exam- Introduction: Intravesical botulinum toxin is a safe and effective treatment
ined based on the International Patient Decision Aid Standards (IPDAS) for refractory overactive or neurogenic bladder. The objectives of this study
and evaluation studies were compared in accordance with Standards were to conduct a survey of intravesical botulinum toxin administration
for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE). practices in Canada, to compare practices based on level of training, and
Results: Overall, 2096 abstracts were reviewed and 33 full-text articles to identify barriers to delivery.
were analyzed, resulting in 17 papers meeting inclusion criteria. PDA Methods: A voluntary online survey was sent to all Canadian urologists.
topics included prostatic hyperplasia (12), stress incontinence (2), over- Respondents who provide intravesical botulinum toxin were questioned
active bladder (2), and urethral strictures (1). Types of PDAs included an on training, surgical volume, workup, technique, and followup practi-
interactive multimedia program, a decision support booklet, a mobile ces. Those with formal training in functional/reconstructive urology were
application, and several web-based decision aids. No PDA met all IPDAS compared to those without. Potential barriers to treatment delivery were
criteria. The main outcomes support the idea that PDAs increase patients’ identified.
knowledge of their health condition, decrease decisional conflict, and Results: The overall response rate was 26% (148/570). Most providers
improve patient satisfaction with their treatment choice. Adherence to (59%) perform 1–10 treatments/month. Preoperatively, 51% perform
SUNDAE ranged from 46–100%. cystoscopy and 43% perform urodynamics. A majority (66%) give rou-
Conclusions: This systematic review revealed there is limited data pub- tine antimicrobial prophylaxis; however, regimen and duration varied.
lished on PDAs to help patients guide management of their LUTS outside Most (79%) perform some treatments under local anesthetic and 52%
of the patient with prostatic hyperplasia. Given the increasing number instill lidocaine solution for analgesia. There was a wide variation in
of options available for patients with LUTS and the evidence supporting technique with regards to the number of injections administered (range
the use of PDAs, further development of high-quality PDAs would be <10 to >20), volume administered per injection (range 0.5 mL to 2 mL),
beneficial. location of injections (bladder body vs. trigone vs. both), and depth of
injection. Postoperative followup ranged from three days to three months.
MP-1.10 Respondents with fellowship training in functional/reconstructive urology
Sacral neuromodulation outcomes in male patients with performed more treatments per month and administered fewer injections
overactive bladder (neurogenic and non-neurogenic) per treatment. Common barriers to delivery included lack of experience/
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Samuel Otis-Chapados , Fatemah Hussain , Emad Alwashmi , Dean training among non-providers (45%), lack of resources (34%), and lack
Elterman 1 of medication funding (32%).
1 Division of Urology, Department of Surgery, University Health Network, Conclusions: Despite intravesical botulinum toxin being a widely
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University of Toronto, Toronto, ON, Canada; Department of Surgery, accepted treatment, significant variability in practices and several bar-
Qassim University, Qassim, Saudi Arabia riers to delivery exist in Canada. Further study is required to optimize
Introduction: Sacral neuromodulation (SNM) is an effective, guideline- treatment access and quality.
supported, third-line treatment for overactive bladder (OAB). While the
prevalence of OAB is similar between males and females, no studies MP-1.12
assess the outcomes of SNM in male patients alone. In this retrospective Urologist-perceived barriers and perspectives on the underuse of
study, we followed 53 male patients with neurogenic and idiopathic sacral neuromodulation for overactive bladder in Canada
OAB to assess efficacy, personal satisfaction, complications, and need Peter J. Gariscsak , Gary Gray , Stephen Steele , Dean Elterman , R.
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for other treatments. Christopher Doiron 3
Methods: Between 2014 and 2021, 53 male patients underwent SNM 1 School of Medicine, Queen’s University, Kingston, ON, Canada;
for neurogenic (n=7) and idiopathic (n=46) OAB. All patients were fol- 2 Department of Surgery, University of Alberta, Edmonton, ON, Canada;
lowed from 1–7 years after the SNM. Thorough chart review assessed 3 Department of Urology, Queen’s University, Kingston, ON, Canada;
patient satisfaction, symptom improvement, complications, and the need 4 Department of Surgery, University of Toronto, Toronto, ON, Canada
for other treatments. Introduction: An estimated 18% of Canadians have overactive bladder
Results: Most patients had medical therapy (79%) and/or intravesical (OAB), with approximately 24% of those reporting difficulty adhering to
Botox injection (28%) prior. After SNM, only five patients (9%) had pharmacotherapy. Although the proportion of medically refractory OAB
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insufficient symptom relief (<50% symptom improvement). Male patients is substantial, the availability of choice in patients’ treatment is limited. To
reported high satisfaction within a year (91%), more than a year (81%), date, there has been no investigation into barriers facing sacral neuromo-
and significant improvement overall (94%). Most patients did not have any dulation (SNM) as a treatment for OAB in Canada.
complications after surgery (77%) except for device pain (12%), insuffi- Methods: Current Canadian Urological Association members were invited
cient efficacy (6%), and infection (5%). Most patients did not need other to participate in an anonymous survey. Data collected included open-
treatment after SNM (60%). Our analysis of the wet OAB subgroup (n=20) ended and Likert scale responses addressing barriers to referral for SNM.
indicated the same early and long-term satisfaction (85%, 80%), overall
S26 CUAJ • June 2022 • Volume 16, Issue 6(Suppl1)