Drs. Richard Baverstock and Kevin Carlson from the Section of Urology at the University of Calgary’s Cumming School of Medicine and vesia [Alberta Bladder Centre] have been awarded a two-year Movember Discovery Grant from Prostate Cancer Canada.
Funding from this two-year award will be used to study the effects of prostate cancer treatment on overactive bladder (OAB). Prostate cancer is the most commonly diagnosed cancer amongst Canadian men, and OAB is one of the more prevalent chronic conditions in the country. Yet, how treatment for prostate cancer effects symptoms of OAB is not well understood. This important study by Drs. Baverstock and Carlson will help healthcare providers better inform their patients about the risks associated with different treatment options for prostate cancer.
This study will be done in collaboration with the Prostate Cancer Centre in Calgary. The Prostate Cancer Centre will support this project by identifying potential participants for the study and disseminating the results to its network of men, families, and healthcare providers.
Dr. Baverstock is a Clinical Associate Professor with the University of Calgary’s Department of Surgery. He is recognized as a key opinion leader in OAB, incontinence and male reconstructive surgery in Canada. Dr. Carlson is a Clinical Associate Professor and Section Chief of Urology with the University of Calgary’s Department of Surgery. He is a recognized leader in pelvic floor reconstructive surgery, incontinence, OAB, and voiding dysfunction.
The study will be carried out at vesia [Alberta Bladder Centre], located within the Southern Alberta Institute of Urology at the Rockyview Hospital. Since being founded in 2011, vesia [Alberta Bladder Centre] has helped thousands of patients with neurological and idiopathic conditions affecting bladder and voiding function.
For more information regarding this study or the grant received, please contact the lead research assistant, Camille Charbonneau, at 403-943-8912.
New services offered at vesia – Pessary Fittings for patients with Stress Urinary Incontinence or Pelvic Organ Prolapse (only applicable for certain types). Referral from family doctor is necessary.
One year clinical fellowship with exposure to simple and complex presentations of incontinence, voiding dysfunction (neurogenic and non-neurogenic), pelvic organ prolapse, male stricture disease, female urologic conditions, and pelvic pain. Time will be spent in the clinic, urodynamics lab, cystoscopy suite and operating room. Technical skills will include performing and interpreting urodynamic studies (video and non-video), onabotulinum toxin A injection, implantation of prosthetics, pelvic organ prolapse repairs (vaginal and laparoscopic approaches, including hysterectomy), other vaginal surgery (fistula repair, diverticulum excision, removal of vaginal mesh), urethral reconstruction, numerous surgical approaches to incontinence, cystectomy including continent and incontinent urinary diversion. Sacral nerve stimulation may also be available to the interested candidate. Completion and publication of clinical research projects is expected and supported by dedicated research staff.
Dr. Debra Irwin and colleagues reported this month in BJU International, “the number of people experiencing lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI), and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) is expected to climb by approximately 20% worldwide, with Africa, South America, and Asia facing the steepest increases. The highest prevalence for all for all of these conditions, however, is expected to remain in Europe, followed by North America.” Reasons include an overall increase in population as well as in the aging population. The study authors state that there “is a clear and urgent need” for public programs and campaigns “to improve the awareness, prevention, diagnosis and management of these conditions.” This study further validates the efforts of Vesia to improve clinical care in this important field.
Dr. Richard Baverstock has developed a new set of guidelines to be used by the Trauma Service of the University of Calgary for the management of urethral injuries.
Vesia has been awarded a research grant from Allergan Canada for the development and evaluation of a shared registry of BOTOX™ injection into the bladder for refractory overactive bladder and neurogenic bladder. The study is expected to begin towards the end of 2011 and will take approximately one year to complete.
Dr. Baverstock, one of the directors of Vesia, was named a “Star Educator” by the PGY-1 residency program of Rockyview Hospital, recognising his countless hours and enthusiasm poured into teaching our future family doctors and specialists.
Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence
Efficacy of botulinum toxin A injection for neurogenic detrusor overactivity and urinary incontinence: a randomized, double-blind trial. This is the first-ever North American double-blind placebo-controlled trial of BOTOX® injection into the bladder for neurogenic bladder conditions.
Purpose: To determine the efficacy of the botulinum toxin type-A (onabotulinumtoxinA) in neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI) or multiple sclerosis (MS).
Materials and Methods: In a prospective, double-blind, multicenter study, 57 subjects aged 18–75 years with NDO, and urinary incontinence (UI; ≥1 occurrence/day) despite current antimuscarinic treatment, secondary to SCI or MS, were randomized to receive onabotulinumtoxinA 300U (n=28) or placebo (n=29) via cystoscopic injection at 30 intra-detrusor sites, sparing the trigone. Subjects were offered open-label onabotulinumtoxinA 300U at Week 36 and followed-up for a further six months; 25 subjects from the onabotulinumtoxinA group and 24 from the placebo group elected to receive open-label treatment (one in the onabotulinumtoxinA group discontinued prior to treatment). Primary efficacy parameter was daily UI frequency (on 3-day voiding diary) at Week 6. Secondary parameters included changes in urodynamics and quality of life (QOL) questionnaires (International Consultation on Incontinence Questionnaire and Urinary Incontinence QOL Scale) at Week 6. Diary and QOL evaluations were also performed after open-label treatment.
Results: Mean daily frequency of UI episodes was significantly lower with onabotulinumtoxinA versus placebo at Week 6 (1.31 vs 4.76, P<0.0001), and Weeks 24 and 36. Improvements in urodynamic and QOL parameters with onabotulinumtoxinA versus placebo were evident at Week 6 and persisted to Week 24–36. The most common adverse event in both groups was urinary tract infection.
Conclusions: In adults with antimuscarinic-refractory NDO and UI, onabotulinumtoxinA is well tolerated and provides clinically significant improvements for up to nine months.
Herschorn S, Gajewski J, Ethans K, Corcos J, Carlson K, Bailly G, Bard R, Valiquette L, Baverstock R, Carr L, Radomski S.
Journal of Urology 2011 Jun;185(6):2229-35.
A research study co-authored by Dr. Kevin Carlson MD, Dr. Richard Baverstock MD, and Dr. Trafford Crump PhD, was presented by Dr. Crump at the International Society for Shared Decision Making (ISDM) Annual Meeting in Maastricht, The Netherlands on June 19, 2011. The study examined the use of an internet-based medical information tool developed by Dr. Carlson by men newly diagnosed with prostate cancer.
Background: Patient education is a vital part of successful shared decision making between health care provider and patient. Conventional educational materials have included pamphlets or non-interactive videos, providing limited feedback to providers as to their use. Information technology (IT), however, offers opportunities for more interactive platforms and a richer understanding of the effectiveness of these tools. The purpose of this study is to better understand how patients interact with Patient Educational Technology (PET) aimed at informing them about their treatment options for prostate cancer.
Design and Methods: A PET library was developed for prostate cancer, including separate modules for different treatment options. The PET library content was developed by a committee of urologists using systematic reviews and updated with current evidence as necessary. Content generally includes a description of the intervention, its potential harms and benefits, and any ongoing care needed after the intervention. Data generated from patients’ use of PET feed into providers’ electronic medical record. The PET library was made freely available to the patient population of two urologists in Calgary, Canada between 2008 and 2011.
Results: Every patient (~300) was referred and given access to the PET library using a unique identifier. Over 50% of those logged in to the PET library and viewed at least one module for more than two minutes. The number of modules viewed by patients and the length of time (minutes) they were viewed were recorded. Data is currently being analysed as to the number of slides viewed within each module; the number of patients that returned to re-view a module; the span of time (days) that the PET library was accessed; and how these relate, if at all, to the ultimate treatment decision.
Conclusion: When referred, a number of patients diagnosed with prostate cancer engage with PETs on an ongoing basis between the time of diagnosis and time of treatment. Understanding how patients engage with these types of technologies is an important step in developing more useful PETs; tools that hold the potential to provide an effective and inexpensive means to improve shared decision making on a broad scale.
Assessing Morbidity Following Radical Prostatectomy. A Tertiary, Non-Teaching Urology Center’s Experience
Co-authored by Dr. Kevin Carlson, Dr. Ryan Flannigan and Dr. Bryan Donnelly, was presented at the Annual Meeting of the Canadian Urological Association (CUA) in Montreal, QB on June 21, 2011. This study evaluated complications of men undergoing radical prostatectomy for prostate cancer and the impact of a standardized post-operative care program.
Background: Insight into morbidity following radical prostatectomy may lend to improved future patient care. The objective of the current study was to determine the morbidity following radical prostatectomy in a tertiary, non-teaching urological centre.
Methods: Patients who underwent a radical prostatectomy (RP) in 2008 were retrospectively evaluated in this study. Post-operative morbidity for the entire cohort was assessed using the Modified Clavien Scale (MCS). Those patients readmitted to hospital or who visited an urban or rural emergency department (ED) within 90 days of surgery were further evaluated to determine reason for readmission.
Results: At our centre, 321 patients underwent RP in 2008 by 11 surgeons. 274 cases (85.4%) were done with an open retropubic technique, and 47 cases (14.6%) by laparoscopic technique (non-robotic). Seventy-seven patients overall (24.0%) visited an ED within 90 days, and 14 of these were readmitted to hospital, with an additional patient readmitted directly (total 15 readmissions, 4.7% overall). No patients died within the 90-day postoperative period. Results and readmission reasons are detailed in table 1 and 2. In 2009 we launched a pilot study wherein 115 RP patients received scheduled and on-demand follow-up care between May and November. 90-day readmission rates amongst this cohort dropped to 5% and 2.6% for ED visits and hospital readmission respectively.
Conclusions: This study uniquely reflects practice in a tertiary non-teaching centre. A significant number of patients presented back to hospital within 90 days following radical prostatectomy. Most of these patients (80.8%) were managed entirely through an outpatient ED, and many of these visits were for routine postoperative care. Only 18.2% (4.7% of the 321 prostatectomy patients) were readmitted to hospital. These data point to a need for enhanced postoperative support of patients to reduce costly and often unnecessary visits to acute care emergency departments. This conclusion is supported by our early experience.