Abstracts from the New England Section of the AUA 2020: A Virtual Experience

NE AUA 2020 Abstracts Sodium Bicarbonate to Augment Lidocaine’s Intravesical Activity: A Randomized, Crossover Study Michael E. Goltzman, MD 1 , Brendan Gontarz, MD 1 , Suzanne Roman, LPN 2 , Gerard Pregenzer, MD 2 1 UConn Health, Farmington, CT; 2 Saint Francis Hospital, Trinity Health of New England, Hartford, CT Introduction: There are multiple indications for intravesical botulinum toxin-A(BTX-A) injections. Local anesthetic has been used to improve discomfort experienced during intradetrusor injections.Alkalization of local anesthetic has improved its efficacy in other areas of the human body. We sought to study its effects in the naturally acidic environment of the bladder. The purpose of the study was to determine if there is a difference in pain perception during intradetrusor BTX-A injection when utilizing alkalinized lidocaine versus lidocaine alone. Materials & Methods: This study was an IRB-approved, prospective, randomized controlled trial with a crossover design conducted by a single urologist in the office setting. Patients with indications for intravesical BTX-A injections and possessing the cognitive ability to report subjective pain scores were eligible. On the first procedure, patients were randomized to either the control or intervention group. Controls received 50 mL of 2% lidocaine alone, whereas the intervention group received a mix of 50 mL of 2% lidocaine with 5 mL of 8.4% sodium bicarbonate. On the second visit, 4-6 months later, participants would be switched to their opposite group to act as their own controls. On the third visit all patients received the intervention (Figure 1). Subjective pain, regarded as the primary outcome, was measured prior to the procedure, at time of first injection and throughout the procedure. Pain levels were assessed by identical pain questionnaires, including a qualitative measure of pain as per a visual analog pain scale (VAS). Demographic information was collected prior to intervention including age, sex, race, and prior analgesic use. Results: Twenty-six of the 33 patients (13 men, 20 women; mean age: 59.5 years) received 2 procedures and 16 received a 3rd procedure . Of the 68 procedures, 26 were in the control arm and 42 intervention. Subjective pain score at first injection was significantly lower in the intervention arm (2.31 vs. 3.81; p = 0.028). Pain throughout the procedure was lower in the intervention arm although not significant (2.08 vs. 2.75; p = 0.258). There were no adverse events noted during the study. Conclusions: In our cohort, those who received the sodium bicarbonate experienced less pain at first injection compared to those subject to lidocaine alone.Although subjective pain scores vary between patients, acting as their own controls limits this bias. With no adverse events and no significant alterations to the office-based procedure, we found sodium bicarbonate is an effective and cost-conscious augmentation to lidocaine instillation for intradetrusor BTX-A therapy. Buffering of lidocaine has a greater likelihood of achieving successful anesthesia which may promote further treatment adherence. 70 Single Surgeon Outcomes with Artificial Urinary Sphincter (AUS) implants in High- Risk Patient Population Wesley H. Chou, BA , Ajay K. Singla, MD Massachusetts General Hospital, Boston, MA Introduction: Artificial urinary sphincter (AUS) implant is the gold standard treatment for stress urinary incontinence following management of prostate cancer, with post- prostatectomy incontinence (PPI) being the most common indication. Complications include device infection, urethral erosion, urethral atrophy, and device malfunction. Although certain factors have been linked to higher rates of complication and revision, prior literature has focused more on heterogeneous patient series versus higher-risk patients specifically. Thus, we sought to describe our experience with AUS in a high-risk patient population with regards to complication rates. Materials & Methods: A retrospective chart review of patients who received AUS procedures over 2.5 years in a single surgeon’s practice at a tertiary care center was performed. Inclusion criteria for high-risk patients included any of the following: prior anti-incontinence procedure, prior radiation treatment, history of bladder neck contracture and/or urethral stricture, urethral erosion and/or infection, and/or history of penile implant (prior or concomitant). Patients receiving a “virgin”AUS without meeting above criteria were excluded. Results: A total of 53 AUS procedures in 43 male patients were initially identified. Of these, 41 AUS procedures in 31 patients met ≥ 1 inclusion criterion while 12 patients with primary implant and no other risk factors were excluded. Regarding inclusion criteria, 68.3% of cases (28/41) had ≥ 1 prior anti-incontinence procedure; 61.0% (25/41) had prior radiation treatment; 41.5% (17/41) had a history of bladder neck contracture and/or urethral stricture; 63.4% (26/41) met ≥ 2 inclusion criteria. Mean age was 71.0 ± 7.6 years, with the oldest patient being 90 years old at procedure time; mean BMI was 28.8 ± 3.3, with 39.0% (16/41) having BMI in the obese range; 65.9% (31/41) had current or former smokers; 7.3% (3/41) carried a diagnosis of coronary artery disease; 14.6% (6/41) carried a diagnosis of diabetes mellitus. Regarding case type, 56.1% (23/41) were insertions, 24.4% (10/41) were revisions, 12.2% (5/41)wereremovalandreplacements,and7.3%(3/41)wereremovals; thenumberofAUS re-operations undergone by patients is summarized in Table 1. Mean operating time was 118.2 ± 32.5 min, and salvage procedure using dermal grafts were used in 17.1% (7/41). Mean length of post-procedure follow-up was 345 ± 252 days. Urethral atrophy was the most common complication in 22.0% (9/41), with a mean onset time of 400.6 ± 227 days. There were 4.9% of cases (2/41) with device infection/urethral erosion and 2.4% of cases (1/41) with device failure. Where listed, chart review showed that 45.5% of cases (15/33) were described as using one or fewer pads per day in postoperative follow-up. Conclusions: Complication rates are comparable to those of prior literature, showing the feasibility of salvaging AUS in a highly complex patient cohort with a greater risk of complication and recurrent incontinence. Further follow-up of this cohort is warranted to better characterize complication rate and quality of life outcomes. 69 Scientific Session VII: Female/Neuro 31