Henry Okafor

Polymorphism in the SCN9A Voltage-Gated Sodium Channel Gene Associated With Interstitial Cystitis/Bladder Pain Syndrome

OBJECTIVE To determine whether an association exists between interstitial cystitis/bladder pain syndrome (IC/BPS) and a nonsynonymous single nucleotide polymorphism in the SCN9A voltage-gated sodium channel gene previously associated with other chronic pain syndromes. MATERIALS AND METHODS Germline deoxyribonucleic acid was sampled from archived bladder biopsy specimens from patients with a documented diagnosis of IC/BPS. Deoxyribonucleic acid from hysterectomy specimens was obtained as a control population. The genotype of single nucleotide polymorphism rs6746030 was determined by deoxyribonucleic acid sequencing after polymerase chain reaction amplification. Contingency analysis of genotypes was performed using Pearsons chi-square test and Fishers exact test. RESULTS Polymerase chain reaction product was obtained from 26 of 31 control specimens and from 53 of 57 IC/BPS biopsy specimens. Of the 26 control subjects, 3 (11.5%) were genotype AG and 23 were GG. In contrast, AA or AG genotypes were present in 21 of 53 (39.6%) patients with IC/BPS, a statistically significant difference compared with the controls (Pearsons chi-square, P=.036). Similarly, the A allele was at a greater frequency in the IC/BPS group using Fishers exact test (P=.009). CONCLUSION These data strongly suggest that pain perception in at least a subset of patients with IC/BPS is influenced by this polymorphism in the SCN9A voltage-gated sodium channel.

Impact of Short-Stay Urethroplasty on Health-Related Quality of Life and Patient’s Perception of Timing of Discharge

Objective. To evaluate health-related quality of life in patients after a short-stay or outpatient urethroplasty. Methods. Over a 2-year period a validated health-related quality-of-life questionnaire, EuroQol (EQ-5D), was administered to all patients after urethroplasty. Postoperatively patients were offered to be sent home immediately or to stay overnight. Within 24 hours after discharge they were assessed for mobility, self-care, usual activities, pain or discomfort, and anxiety and depression. An additional question assessing timing of discharge was added to the survey. Clinical and operative characteristics were examined. Results. Forty-eight patients after anterior urethroplasty completed the survey. Mean age and mean stricture length were 51.6 years (21–78) and 60 mm (5–200 mm), respectively. Most etiologies were idiopathic (50% n = 24), trauma (19%, n = 9), and iatrogenic (19%, n = 9). Forty-one patients (85%) stayed overnight, while 7 patients (15%) chose to be discharged the same day. Overall, ninety-six percent were discharged within 23 hours of surgery. In the short-stay and the outpatient cohorts, 90% and 86%, respectively, felt they were discharged on time. No patient reported a severe problem with postoperative pain or mobility. Conclusions. The majority of patients discharged soon after their procedure felt that discharge timing was appropriate and their health-related quality of life was only minimally affected.

MP63-19 THE VALUE OF URODYNAMICS PRIOR TO SACRAL NEUROMODULATION IN MEN

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is an effective therapy for non-obstructive urinary retention, refractory urgency/frequency and urgency incontinence, however it may be underutilized in men. There is a dearth of literature on SNM in men, as most male lower urinary tract symptoms (LUTS) research focuses on medical therapy and bladder outlet procedures, offering little guidance about SNM in men. To what extent UDS can yield diagnostic clarity in male LUTS and its role in predicting SNM success in men is unknown. Herein, we analyze how UDS findings relate to SNS utilization in men. METHODS: A retrospective review of men undergoing SNM procedures from 2011-2015 at our institution was performed. Demographics, comorbidities, prior urologic treatments, SNM indication, and SNM utilization were assessed. Patients were stratified according to UDS 12 months before SNM (+UDS) vs. no UDS testing (-UDS). Descriptive statistics characterized the groups, T-test or chi-square tests were used where appropriate, and logistic regression was used to identify clinical and UDS parameters related to SNM outcomes. RESULTS: 56 men underwent SNM therapy and 28 had UDS within the prior year. UDS+ and UDSmen were similar in age and co-morbid conditions. On average, +UDS men had a greater BMI (30.4+6.5 v 27.3+4.6, p 0.045). Rates of prior transurethral prostate procedures were not significantly different (17.9% v 25%) between the groups. Most (N1⁄453) men underwent staged implant, though 3 (+UDS N1⁄42, -UDS N1⁄41) had peripheral nerve evaluation (PNE). All PNE trials were successful, while rates of Stage 1 success (80.8% v 63.0%, p 0.22) and Stage 2 completion (95.2% v 94.1%, p 1.00) did not differ between +UDS or -UDS men. Device revision (21.4% vs. 25%, p 0.75) and explant (17.9% v 14.5%, p 1.00) rates also did not differ by +UDS or -UDS. No stress urinary incontinence (N1⁄40) was noted on UDS in any patient, but detrusor overactivity was present in 50% (N1⁄414) with urgency urinary incontinence in 25% (N1⁄47). UDS findings of obstruction (N1⁄41), poor compliance (N1⁄41), and hypocontracility (N1⁄41) were rare. Rates of Stage 1 success, Stage 2 completion, device revision, and device explant did not differ in the presence or absence of UDS-proven pathology CONCLUSIONS: Sacral nerve stimulation is a feasible treatment for men with refractory lower urinary tract symptoms. Neither the performance of urodynamics nor the presence of urodynamically-proven pathology was associated with greater likelihood of progression to stage 2, device revision or explant. Our findings suggest that SNM may be safely and effectively utilized in men without preoperative urodynamics.

PD54-02 REMOVAL OF SACRAL NERVE STIMULATION DEVICES FOR MAGNETIC RESONANCE IMAGING: WHAT HAPPENS NEXT

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNS) is an effective therapy; however, these devices are not approved to undergo magnetic resonance imaging (MRI) of sites other than the brain. Therefore, when non-brain MRIs are required, devices are often removed prior to imaging. We assessed the frequency of device removal for MRI and the subsequent clinical course of these patients. METHODS: A retrospective review of all SNS procedures in the urology department at a tertiary care center from 2010-2015 was performed and explants identified. Cases explanted for MRI were analyzed to collect demographics, clinical characteristics, and postremoval management. Descriptive statistics were calculated and presented as mean(standard deviation) or median[interquartile range] as appropriate. RESULTS: A total of 90 patients underwent SNS device removal, with 21(23%) occurring for MRI, of which all devices were implanted in 2012 or before. At explant, patients were 95%(N1⁄420) female, 66[52-72] years of age, and had a 29.6[23.8-34.6] kg/m2 body mass index. Suboptimal symptom control from SNS was noted in 7(33%) patients prior to explantation and 4 patients in the cohort (19%) had Multiple Sclerosis. Of those explanted, 24% required MRI for neurologic and 57% for orthopedic concerns. The remaining MRI indications included abdominal masses (10%), genitourinary disease (5%), surveillance for prior spinal cord malignancy (5%), and cardiac disease (5%). Only 16 (76%) patients explanted ultimately underwent MRI, a median of 13[3-16] days after device removal. MRI results actively impacted clinical management in half of the imaged patients, with no pharmacologic interventions, but instead surgical evaluation (5), physical therapy/rehabilitation (1), an outpatient procedure (1), and a headache diary (1) being recommended. Only 10%(N1⁄42) of explanted patients underwent device replacement, while 7 patients resumed medical therapy, 3 utilized intermittent self-catheterization or an indwelling catheter, 2 patients pursued Botulinum toxin, 1 sought care with a local urologist, and 1 underwent cystectomy and ileal conduit urinary diversion. Of the remainder, 1 is deceased and 4 were lost to follow-up. CONCLUSIONS: In patients receiving SNS therapy, device removal for MRI is a rare event, most commonly due to orthopedic and neurologic pathologies. About half of the MRIs performed impacted clinical management. As SNS replacement was rare in this cohort, research is needed on the safety of various MRI types with SNS devices in vivo.

PD36-05 RATE AND RISK FACTORS FOR SACRAL NERVE STIMULATOR LEAD BREAKAGE AT THE TIME OF LEAD REVISION OR EXPLANTATION

Por: Pizarro-Berdichevsky, J (Pizarro-Berdichevsky, Javier)[ 1,2,3 ] ; Clifton, MM (Clifton, Marisa M.)[ 1 ] ;Dielubanza, EJ (Dielubanza, Elodi J.)[ 1 ] ; Gill, BC (Gill, Bradley C.)[ 1 ] ; Okafor, HT (Okafor, Henry T.)[ 1 ]; Faris, AE (Faris, Anna E.)[ 1 ] ; Rackley, RR (Rackley, Raymond R.)[ 1 ] ; Moore, CK (Moore, Courtenay K.)[ 1 ] ; Vasavada, SP (Vasavada, Sandip P.)[ 1 ] ; Goldman, HB (Goldman, Howard B.)[ 1 ] ...Más

Percutaneous Bladder Catheterization (Suprapubic Bladder Catheterization)

A suprapubic catheter (SPC) is a safe way to drain the urinary bladder when the urethra is inaccessible or needs to be avoided. There are several well-established methods of placing a SPC; a percutaneous approach is the minimally invasive way to establish bladder drainage in urgent and nonurgent settings. Several kits are now commercially available providing a straightforward means to place an SPC with some basic training.