Page 11 - AUQ2022Abstracts

Session IV

Analyzing outcomes of the adjustable transobturator male Conclusions : L’approche rétropéritonéale offre une alternative équiva-
system for post-prostatectomy incontinence and its relationship lente à l’approche transpéritonéale pour les masses postérieures avec
with overactive bladders and radiotherapy with the help of une durée de séjour hospitalier et de pertes sanguines moindres que
urodynamics l’approche transpéritonéale.
Samuel Farag , Joanie Pelletier , Salima Ismail , Le Mai Tu 1
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1 CHUS Fleurimont- Université de Sherbrooke, Sherbrooke, QC, Canada Transperineal prostate biopsy: Review of technique and
Introduction: Adjustable transobturator male system (ATOMS) has been preliminary pathological results at our institution
a treatment option for post-prostatectomy incontinence (PPI) in Canada Elie Antebi , Christian Diab , Emilie Baillargeon , Daniel Jonathan
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since 2014. It has recently gained popularity, touting advantages such as Lewinshtein , Mahmoud Nachabé , Tal Benzvi , Philippe Arjane 1
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surgical simplicity and postoperative adjustability. We report our single 1 Hôpital Charles Lemoyne, Longueuil, QC, Canada
center’s device effectiveness and security. We also explore effects of Introduction: Prostate cancer is the most common cancer in men.
prior radiotherapy and of overactive bladder (OAB) on these outcomes. Diagnosis is usually made with an image-guided biopsy of the prostate.
Methods: A retrospective study was done on 91 patients who had The most common technique is a transrectal (TR) ultrasound-guided
ATOMSinstalled between February 2016 and March 2021 at our center. biopsy. Complications from this procedure include rectal bleeding and

Preoperative incontinence severity was defined as <2 pads per day (PPD), risk of bacterial prostatitis and sepsis. A more recent technique has
2–4 PPD, and >4 PPD with regards to 24-h pad-count or/and <200g, emerged using the transperineal (TP) route, which has the advantage
200–400g and >400g regarding 24-h pad-test (24h-PT) to classify mild, of not puncturing the rectum to get biopsies. This alleviates the risks of
moderate, and severe, respectively. Dryness was defined as requiring 0 rectal bleeding, prostatitis, and urosepsis. Our objective was to evaluate
or 1 PPD postoperatively. Patients considered “improved” or “very much the efficacy of the TP biopsy technique in terms of cancer detection and
improved” were defined as having a PPD diminution of ≥ 50% or ≥ 75%, positive cores.
respectively. Significant patient satisfaction was defined by “Much better,” Methods: We report data on our first 50 patients who underwent TP
and “Very much better” PGI-I results. prostate biopsy. TP biopsy was performed under local anesthesia in an
Results: Sixty-five patients were included among 91 (26 excluded due office setting. Twelve-core biopsies were taken using an automatic biopsy
to followup <12 months). Mean patient age was 71 years and mean device and were evaluated by the same pathology department. Some
followup was 29.9 months (SE 1.8 [12–67]). Median preoperative PPD samples were sent for a second opinion at the McGill pathology depart-
and 24h-PT were 4 (IQR 6–3 [1–10]) and 358 g (IQR 607–256 [34– ment to be examined by a uropathologist. Patients received one dose
1592]) respectively. Median PPD at final followup was 1 (IQR 2–0 [0–5], of cephalosporin antibiotic one hour before the procedure. We then
p<0.001). Fifty-six (86.2%) patients noted overall improvement, with 43 tabulated pathology data and positive core results.
(76.7%) being “very much improved” and 42 (75.0%) being “dry.” Most Results: Fifty patients were included in the analysis. All patients under-
(87.7%, n=57) patients were satisfied. Fifty-nine (90.7%) patients required went TP biopsy. The median age was 66 years and median prostate-
adjustment postoperatively, with a mean of 2.4 adjustments (SE 0.2498) specific antigen (PSA) was 7.2 ng/ml. Sixty-five percent of the biopsies
and a mean total instilled volume of 14.8 mL (SE 0.7641, range 6–31). were positive for adenocarcinoma of the prostate. We had an average
Eight (12.3%) patients experienced complications of any Clavien-Dindo of 4.29 positive cores in patients in whom cancer was detected. Eight
grade, of which four were grade III (one migration [1.5%], three leakages patients had a PI-RADS 4 or more lesion on multiparametric prostate
[4.6%]). Patients having received prior radiotherapy (n=22, 33.8%) had magnetic resonance imaging before biopsy, of which seven patients had
lower improvement (73% vs. 93%, p=0.03) and “dry” (45.5% vs. 74.4%, adenocarcinoma detected. We had two cases of urinary retention in the
p=0.02) rates but required more adjustments (MED 3.5 vs. 2, p=0.01) first 48 hours. There were no cases of prostatitis or urinary sepsis or infec-
and total instilled volume (MED 18.3 mL vs. 13 mL, p=0.01). No other tion. Thirty-one percent of patients experienced hematuria.
statistically significant difference was found in this subgroup or in that Conclusions: Our results corroborate literature findings of cancer detec-
of patients with OAB. tion and complications for the TP prostate biopsy technique. This tech-
Conclusions: This study vouches ATOMS as safe and effective for PPI. nique is associated with less rectal bleeding and urosepsis in our cohort.
Also, radiotherapy seems to impact its effectiveness, whereas OABs do not.
Prevalence of QTc prolongation in prostate cancer patients
Comparaison entre la néphrectomie partielle robotique undergoing brachytherapy
transpéritonéale et rétropéritonéale : notre expérience initiale Daniel Taussky , Simon Saad , Carole Lambert , Maroie Barkati ,
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dans le CIUSSS de l’Est-de-l’île-de-Montréal Charles Darianne , Mikhael Laskine , Guila Delouya 1,2
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Massine Fellouah , Thierry Lebeau , Julien Letendre , Nawar Hanna 1 1 Department of Radiation Oncology, University of Montreal Health
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1 Département d’Urologie, CIUSSS de l’Est-de-l’île-de-Montréal, Université Center, Montreal, QC, Canada; CRCHUM-Centre de Recherche du
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de Montréal, Montreal, QC, Canada Centre Hospitalier, de l’Université de Montréal, Montreal, QC, Canada;
Introduction : La néphrectomie partielle laparoscopique est le traitement 3 Department of Urology, University of Montreal Health Center, Montreal,
chirurgical de choix pour les petites masses rénales. Cette chirurgie peut QC, Canada; Department of Urology, Hôpital Européen Georges-
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se faire soit par approche transpéritonéale ou rétropéritonéale. L’objectif Pompidou, Paris University, Paris, France; Department of Medicine,
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de l’étude est de comparer les résultats peropératoires et postopératoires Université de Montréal, Montreal, QC, Canada
de l’approche robot-assistée rétropéritonéale et transpéritonéale. Introduction: QTc has been associated with a higher risk of Torsade
Méthodes : Une analyse rétrospective de tous les cas de néphrectomies de Pointes, sudden cardiac arrest, and general cardiac mortality. We
partielles robotique a été réalisée entre janvier 2019 et septembre 2021. examined the prevalence of prolonged QTc in prostate cancer patients
Les résultats peropératoires et postopératoires suivant ont été compilés : undergoing brachytherapy, in patients with aggressive cancers, and in
la durée opératoire, les pertes sanguines, le temps de clampage, la durée patients who underwent prostatectomy.
d’hospitalisation ainsi que les taux de complications. Les résultats ont été Methods: We randomly selected 1094 patients receiving low-dose or
comparés entre l’approche transpéritonéale et rétropéritonéale. high-dose rate brachytherapy between August 2010 and February 2022.
Résultats : Sur les 74 cas, 17 (23%) étaient par approche rétropéritonéale All patients had a preoperative ECG and QTc was automatically cal-
et 57 (77%) par approche transpéritonéale. La taille moyenne des masses culated with the Bazett formula. Patients with left or complete bundle
rénales était de 2,6 cm. Les résultats peropératoires incluant le durée branch block, ventricular extrasystoles, atrial fibrillation, pacemaker, or
opératoire (149 min vs. 157 min), et le temps de clampage (23min vs. QRS ≥120 ms were excluded. As primary outcome, a QTc ≥450 ms was
24min) étaient similaires entre les deux approches. Les pertes sanguines considered abnormal. Chi-squared or Fisher’s exact test were used to
étaient plus élevées pour l’approche transpéritonéale (165cc vs. 86cc). compare groups. Correlations between QTc and clinical values were
Pour ce qui est des résultats postopératoires, la durée d’hospitalisation evaluated with Pearson correlation coefficient and binary multivariable
était plus courte pour l’approche rétropéritonéale (1,8j vs. 2,6j). regression analysis.
CUAJ • Décembre 2022 • volume 16, numéro 12S3 S211