Julie Jenks

Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence

Objectives: The objective of this study is to present the outcomes of men undergoing implantation of artificial urinary sphincter, after treatment for prostate cancer and also to determine the effect of radiotherapy on continence outcomes after artificial urinary sphincter (AUS) implantation. Material and Methods: A prospectively acquired database of all 184 patients having AUS insertion between 2002 and 2012 was reviewed, and demographic data, mode of prostate cancer treatment(s) before implantation, and outcome in terms of complete continence (pad free, leak free) were assessed. Statistical analysis was performed by Chi-squared and Fishers exact tests. Results: A total of 58 (32%) men had bulbar AUS for urodynamically proven stress urinary incontinence consequent to treatment for prostate cancer in this period. Median follow-up post-AUS activation was 19 months (1–119). Forty-eight (83%) men had primary AUS insertion. Twenty-one (36%) men had radiotherapy as part of or as their sole treatment. Success rates were significantly higher in nonirradiated men having primary sphincter (89%) than in irradiated men (56%). Success rates were worse for men having revision AUS (40%), especially in irradiated men (33%). Conclusion: Radiotherapy as a treatment for prostate cancer was associated with significantly lower complete continence rates following AUS implantation.

Predicting a successful outcome in sacral neuromodulation testing: Are urodynamic parameters prognostic?

To assess whether the urodynamic parameters of mean voided volume, peak detrusor overactivity (DO) pressure, bladder compliance, capacity, and volume at first detrusor overactivity during filling cystometry can predict a successful outcome at first stage tined lead placement (FSTLP).

PD27-09 DOES THE USE OF A DEDICATED OPERATING SPACE AND SURGICAL TEAM REDUCE INFECTION RATES FOR FIRST STAGE SACRAL NEUROMODULATION?

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is an effective treatment for medically refractory overactive bladder (OAB). The procedure is performed as a 2-stage technique with first stage tined placement (FSTLP) followed by second stage stimulator 4 weeks later. The most significant morbidity for the procedure is infection, reported in up to 12%. We assessed the infection rates in patients who were implanted within a dedicated SNM theatre environment and compared them to those in patients who underwent SNM on mixed operating lists. METHODS: We reviewed the complications in all patients having SNM surgery over a 12 month period within either a dedicated SNM operating theatre, with the same surgeon, advanced nurse practitioner, anaesthetist and radiological team, or on the mixed urological lists. In the mixed theatre lists SNM cases were performed amongst other urological cases by varying theatre teams. Infection rates (requiring lead or device explantation) were recorded, and results compared using Student T-tests. RESULTS: Between Sept 2013-2014, 118 consecutive patients had 2-stage implants performed by each of the two theatre processes (59 in each group). There was no difference in test conversion rates between theatres, but a significant difference in infection rate was observed (p<0.01)(Table 1). The single infection on the dedicated theatre team occurred when the advanced nurse practitioner was absent. CONCLUSIONS: In our centre a dedicated SNM theatre results in significant reduction in infection rates. We recommend grouping all SNM cases in dedicated theatre lists to reduce substantial patient morbidity and health care costs of implant infections.

PD11-12 PREDICTING A SUCCESSFUL OUTCOME WITH SACRAL NEUROMODULATION TESTING: ARE URODYNAMIC PARAMETERS DURING FILLING CYSTOMETRY PROGNOSTIC?

INTRODUCTION AND OBJECTIVES: Sacral neuromodulation (SNM) is an effective treatment modality for medically refractory overactive bladder (OAB). Standard selection criteria are based on frequency-volume charts, pad weight (objective) assessments, and patient reported (subjective) outcomes. Little is reported of the utility of urodynamic study in selecting patients for SNM therapy. We assessed whether the urodynamic parameters during filling cystometry correlated with successful outcome from first stage SNM testing. METHODS: All OAB patients were screened prior to first stage testing with urodynamics to confirm (idiopathic) detrusor overactivity (IDO). The mean voided volumes, peak amplitude of IDO contraction, compliance and end fill pressure was recorded. Primary outcomes were assessed using frequency-volume charts, pad testing and ICIQ/EQ5D questionnaires. Success was considered if patients achieved >50% improvement in urinary symptoms. Conversion to a permanent SNM implant was undertaken according to response. The predictive value of the four parameters was assessed using binary logistic regression analysis. RESULTS: 177 consecutive IDO patients had first stage SNM evaluation between 2010 and 2013. The mean voided volume for patients with successful response was 184 (147-223) mls and for those with failed response 171 (128-214) mls, peak DO pressure was 41.0 (29-52) cmH20 compared to 40 (28-52) cmH20, compliance pressure 12 (7-16) cmH20 compared to 49 (3-95) cmH20, and end fill pressure 25 (19-30) cmH20 compared to 24 (14-33) cmH20. Logistic regression analysis did not demonstrate any significant relationship between peak detrusor pressure and outcome (B 1⁄4 -0.005, 0.001, 0.026, 0.016 respectively) (Figure 1). Figure 1: Box plots representing the distribution of mean void volume, peak DO, compliance and end-fill pressures with first stage SNM testing. Box borders illustrate the upper, median and lower quartiles; whiskers depict the 99% interval. Extreme (star) and mild (circle) outliers are also shown. CONCLUSIONS: There was no correlation between any urodynamic parameter and successful SNM outcome. SNM is an option for all IDO patients, regardless of their dynamic bladder function on filling cystometry.