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2020 CUA ABSTRACTS
Podium Session 5: Training, Reconstruction
POD-5.1 Results: A total of 248 GURS members were invited to participate in the
Defining which outcomes are associated with patient satisfaction survey, with a response rate of 57.3% (n=142). The majority of participants
after urethroplasty perform >20 urethroplasties per year (n=108, 76.0%). Almost all respon-
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Jordan Bekkema , Keith F. Rourke 1 dents (97.9%, n=139) reported using intraoperative intravenous (IV) antibiotic
1 Division of Urology, University of Alberta, Edmonton, AB, Canada prophylaxis while a minority of surgeons use intraoperative pharmacologi-
Support: Dr. Rex Boake Studentship in Urology cal VTE prophylaxis (n=57, 40.1%). Most respondents routinely perform a
Introduction: Outcomes after urethroplasty can be assessed by multiple midline incision (n=124, 87.3%) while a small minority of surgeons prefer
measures, both surgeon-reported and patient-reported. We aimed to deter- a lambda incision (n=17, 12.0%). With respect to tissue transfer, most sur-
mine which clinical outcomes are associated with patient satisfaction after geons prefer buccal mucosa harvested from the cheek (n=138, 97.2%) in
urethroplasty. a rectangular shape (n=79, 55.6%) or, less commonly, oval shape (n=53,
Methods: From 2012–2018, 387 patients enrolled in this prospective, 37.3%). Respondents were more ambivalent on graft site closure, with a
single-center study. Patient-reported outcomes were assessed preopera- majority leaving the site open (n=76, 53.5%). Perineal drains are placed
tively and six months postoperatively. Voiding function was assessed with routinely by 25.3% of respondents (n=36) and of those left in situ, most are
the International Prostate Symptom Score (IPSS), erectile function with the removed within 48 hours (n=31, 86.1%). A majority of urethroplasty patients
International Index of Erectile Function (IIEF-5), and ejaculatory function are admitted to hospital for <24 hours (n=100, 70.4%). Only 21.3% (n=30)
with a hybrid of the brief sexual function inventory. While patient satisfac- of surgeons routinely prescribe bedrest for patients. In terms of postoperative
tion, penile curvature/appearance, genitourinary pain, post-void dribbling, antibiotic prophylaxis, a minority continue IV prophylaxis postoperatively
and standing voiding function were assessed using literature-derived three- (n=60, 42.3%), but most only do so for <24 hours (n=34, 56.7%). Oral
or five-point Likert scales. Urethroplasty success was defined as the easy antibiotic prophylaxis, however, is routinely administered by most urologists
passage of a 16 Fr flexible cystoscope. Descriptive statistics were used to (n=98, 69.0%), and most continue until the urinary catheter is removed
summarize findings, while multivariate binary logistic regression was used (n=70, 72.2%). Postoperatively, most patients are left with a urethral catheter
to determine the association between outcomes and patient satisfaction. for a period of 2–3 weeks (n=72, 58.5%) or 3–4 weeks (n=37, 30.1%). At the
Results: At six months’ followup, 96.1% of patients were stricture-free on time of catheter removal, most surgeons routinely perform urethral imaging
cystoscopy while 81.7% reported being satisfied. On multivariate analysis, with contrast (n=96, 67.6%). In terms of evaluating for stricture recurrence,
improvement in IPSS (odds ratio [OR] 1.1; 95% confidence interval [CI] a majority of urologists prefer some form of objective investigation (n=111,
1.1–1.2; p=0.04), de novo erectile dysfunction (OR 0.5; 95% CI 0.2–0.9; 78.2%), with uroflowmetry (n=91, 82.0%%) and post-void residual (n=88,
p=0.04), de novo penile curvature (OR 0.4, 95% CI 0.2–0.9; p=0.03), and 79.3%) being the most commonly reported methods, while cystoscopy was
improved standing voiding function (OR 1.3; 95% CI 1.1–1.5; p=0.004) also commonly performed (n=64, 57.7%). Although timing of these investiga-
were associated with patient satisfaction. Cystoscopic success (p=0.60), tions varied, most of them are routinely performed either 2–3 months (n=49,
change in pain score (p=0.14), post-void dribbling (p=0.69), change in 44.1%) or 4–6 months (n=38, 34.2%) postoperatively.
penile length (p=0.44), and ejaculatory dysfunction (p=0.51) were not. Conclusions: Though there appears to be majority consensus on most ure-
Conclusions: Improved voiding function, de novo penile curvature, de novo throplasty management decisions, significant heterogeneity remain in some
erectile dysfunction, and improved standing voiding function are associ- areas, including antibiotic use, VTE prophylaxis, donor site management,
ated with patient satisfaction and should be included in a patient-centered catheter management, and followup assessment. With a lack of evidence
approach to urethral stricture. While perhaps important to surgeons, cysto- in this space, decisions will continue to be made based on clinical experi-
scopic success is not associated with patient satisfaction. ence and best practice principles.
POD-5.2 POD-5.3
Perioperative management of urethroplasty patients: A survey of Triamcinolone acetonide injections for the treatment of recalcitrant
the Society of Genitourinary Reconstructive Surgeons post-radical prostatectomy vesicourethral anastomotic stenosis:
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R. Christopher Doiron , Keith F. Rourke 2 A large, modern-day series
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1 Department of Urology, Queen’s University, Kingston, ON, Sarah R. Ferrara , Humberto R. Vigil , Jennifer A. Locke , Sender Herschorn 1
Canada; Department of Surgery, Division of Urology, University of Alberta, 1 Urology, Sunnybrook Health Sciences Centre, University of Toronto,
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Edmonton, AB, Canada Toronto, ON, Canada
Introduction: Practice patterns in the field of reconstructive urology have Introduction: We sought to evaluate the success of bladder neck injections
been poorly described. We hypothesize significant heterogeneity exists of triamcinolone at the time of transurethral bladder neck incision (BNI)
within the field. We sought to survey fellowship-trained reconstructive for prevention of recurrent or recalcitrant post-radical prostatectomy (RP)
urologists with respect to perioperative practice preferences for patients vesicourethral anastomotic stenosis (VUAS)
undergoing urethroplasty. Methods: Patients with recurrent VUAS post-RP ± radiation were offered
Methods: An online survey examining perioperative management of urethro- triamcinolone injections at the time of BNI. VUAS was diagnosed after RP
plasty patients was administered to members of the Society of Genitourinary by symptoms, followed by cystoscopy or urethrography. The outpatient
Reconstructive Surgeons (GURS) between August and October, 2019. The procedures were done under general anesthesia. Cold knife incisions were
survey focused on anterior urethroplasty and inquired about preferences made at the 3, 9, and 12 o’clock bladder neck (BN) positions, followed
regarding tissue transfer, use of antibiotic and venous thromboembolism (VTE) by triamcinolone injections (4 mg/mL) into the 3 and 9 o’clock incision
prophylaxis, urinary catheter use, drain placement, and patient disposition. sites. Postoperative catheterization was 5–7 days. Treatment outcomes were
determined by clinical followup and cystoscopy.
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S41
© 2020 Canadian Urological Association