EAU 2017: Efficacy of long acting sandostatin on reducing mucus production in patients with ileal neobladder

London, England (UroToday.com) Orthotopic neobladder diversion after radical cystectomy (RC) can be completed using many different techniques, but inherent to all those procedures involving the use of small bowel, mucus production is a significant problem post-operatively. High mucus production predisposes the patient to catheter obstruction, infection, pain, and even perforation/rupture of the urinary diversion. Most patients are instructed and taught how to self-irrigate their urinary catheters and drains to prevent obstruction. However, medications to help reduce the degree of mucus production could significantly improve post-RC patient burden.

Long-acting sandostatin (octreotide) is an octapeptide that mimics natural somatostatin. Both are used clinically in the management of GI fistulas to help reduce GI secretions and inhibiting motility.

This group in Iran translated this into the post-RC patient population. In this single institution, randomized, double-blind study, 65 eligible patients were randomized to octreotide or placebo. Group A, the sandostain group (n=32), received two doses of 20 mg intramuscular long acting sandostatin (LAS) four weeks before surgery and again on the day of surgery, while group B (n=33) received placebo. Primary outcome was the volume of mucus produced (the method of collection was not explained). Secondary outcome was the incidence of mucus plug requiring irrigation.

In terms of mucus production, at the end of the first week post-operatively, mucus production was 5.4±2.7ml versus 21.5±5.6ml in groups A and B, respectively (P<.001). At the end of the third week (after discharge), the amounts were relatively unchanged, still favoring the sandostatin arm. The average occurrence of neobladder irrigations due to mucus plug was 2.3±1.5 in group A and 9.5±4.3 in group B (P<.001) during the first week prior to discharge. This discrepancy increased to 2.5±1.5 versus 11.4±2.7 in groups A and B, respectively, (P<.001) after discharge from hospital.

Unfortunately, some key details such as exclusion criteria, method of urine mucus production calculation, urine culture and urine infection results were not provided.

Despite that, this is an innovative use of a common medication. Further study is warranted on a larger scale.

Presented by: Khorrami M.H. (not present, did not present poster)

Institution(s): Isfahan University of Medical Sciences, Dept. of Urology, Isfahan, Iran

Written by: Thenappan Chandrasekar , Clinical Fellow, University of Toronto
Twitter: @tchandra_uromd

at the #EAU17 -March 24-28, 2017- London, England