HoLEP, the identification of the extent of the remaining attachment near the apex and sphincter muscle and this dissection between 10- to 2-o’clock position are sometimes difficult, which may relate to the relatively high occurrence of urinary incontinence. Furthermore, intravesical morcellation needs additional expensive devices and may cause bladder injuries. We present a combined procedure of HoLEP and TURP (omega:wTURP). Materials and Methods:Between Jan 2007 and April 2010, 45 patients with lower urinary tract symptoms associated with relatively large BPH underwent wTURP. The patients had a mean age of 71.7 years (range 56-84) at the time of surgery. The operation process includes: Step 1- Make the inverted “U” incision just proximal to the verumontanum by Hol-mium laser and find the surgical capsule plane. Step 2- Dissect the lower part of the whole gland between 2- and 10-o’clock positions like “w”. Step 3- Resect the whole gland like usual TURP. Results:The mean prostate volume re-sected was 29 .2 (6-150g). The mean op-eration time was 112 minutes (20-262). At the short-term follow-up (1 month), the mean Qmax increased from 3.3 to 12.3 ml/sec (p⬍0.01) after wTURP while the mean IPSS (international prostate symp-tom score) declined from 21.0 to 8.2 (p⬍0.01) and QOL (Quality of life) from 4.9 to 2.1 (p⬍0.01). Blood transfusion was not needed. Severe complication such as urinary incontinence and TUR syndrome were not found.
Conclusions:This wTURP does not need an expensive morcellator and intravesical morcellation, complements the difficulty with HoLEP and allows prostate glands of virtually any size to be safely treated trans-urethrally.
MP-05.08
Holmium laser enucleation of the prostate: non-mentor-aided learning curve and its proper estimation Oh S, Cho M, Bae J, Oh J, Paick J, Jeong C
Seoul National University Hospital, Seoul, South Korea
Introduction and Objective:Holmium laser enucleation of prostate (HoLEP) is known to have a steep learning curve, which therefore limits its widespread use. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure.
Materials and Methods:Sixty-two con-secutive patients who underwent HoLEP from July 2008 to July 2009 by a single
surgeon (SJO) were enrolled. Periopera-tive clinical variables including enucle-ation time, morcellenucle-ation time, enucleenucle-ation ratio (enucleation weight/transitional zone volume), enucleation efficacy (enucleated weight/enucleation time), enucleation ra-tio efficacy (enucleara-tion rara-tio/enucleara-tion time), and early complication rate were analyzed.
Results:Mean prostate volume was 59.0 ml (range 21-162) and preoperative Inter-national Prostate Symptom Score (IPSS) was 19.5 (6-35). Mean enucleation time and morcellation time were 55.1⫾32.2 (S.D.) min and 12.9⫾8.2 min, respec-tively. Median duration of postoperative catheter indwelling was 1 (1-13) day and hospital stay was 1 (1-14) day. There were a total of 11 cases (17.7%) of surgery-re-lated complications, and they were all manageable. There was a significant in-crease between the initial 20, middle 20 and last 22 cases in terms of the enucle-ation efficacy (0.17⫾0.17 vs. 0.42⫾0.25 vs. 0.55⫾0.26, p⬍0.001), but not in the enucleation ratio (0.44⫾0.28 vs. 0.57⫾0.22 vs. 0.60⫾0.19 p⫽0.07). Enu-cleation efficacy was linearly correlated with the transitional zone volume (correla-tion coefficient, R⫽0.754, p⬍0.001). In-creased enucleation efficacy mainly re-sulted from technical improvement during the initial period and case selection of a larger prostate during the later period. Thus, enucleation ratio efficacy is believed to be a more appropriate parameter in evaluating the learning curve by eliminat-ing the confounder of size (0.006 vs. 0.017 vs. 0.013, p⬍0.001).
Conclusions:Our results demonstrated that the learning curve can be overcome in about 25 cases. We believe that a more appropriate parameter for estimating the learning curve is enucleation ratio efficacy rather than enucleation efficacy.
MP-05.09
Treatment of benign prostatic hyperplasia with plasmakinetic vaporization: six-year follow-up Koca O, Keleþ M, Kaya C, Gu¨nes M, Öztu¨rk M,Karaman M
Haydarpasa Numune Training and Re-search Hospital, Dept. of Urology, Istan-bul, Turkey
Introduction and Objective:Benign Prostatic Hyperplasia, parallel to the changing demographic structure of com-munity, is becoming a more common con-dition. Transurethral resection is still ac-cepted as the most effective treatment modality but different treatment modali-ties appear parallel to the new
techno-logical development. In this study we compared the long-term results of trans-urethral resection (TURP) and plasmaki-netic vaporization (PKVP) (Gyrus Medical Ltd., Bucks, UK).
Materials and Methods:Between the years 2001 and 2003, 75 symptomatic pa-tients referred to our clinic due to lower urinary symptoms were randomized in to two groups (TURP and PKVP). Thirty-six patients who completed the 72 month follow up period were included. Results:Both groups were homogenous in terms of age and preoperative parame-ters. In TURP group preoperative Qmax value was 6 (2,3) ml/s, whereas during the controls in 36thand 72thmonths this
value was 21,8 (3,4) and 20,1 (3,1) respec-tively. In PKVP group, these values were measured as 6 (3,1), 14,4 (2,6) and 15,6 (2,8) respectively. When evaluated according to IPSS values, in TURP group these values were 22 (3,8), 5,7 (1,2) and 7,9 (2,6) respectively, while in PKVP group these values were 21 (3,4), 7,6 (1,4) and 11 (2,4) respectively. In both groups postoperative Qmax and IPSS val-ues were significantly different from pre-operative values. IPSS and Qmax values measured in the 36thand 72thmonths
were significantly different in both groups. In the PKVP group, 6 patients were reoperated because of urinary out-flow obstruction and 6 patients were given alpha blockers. In the TURP group, 2 patients were reoperated and 1 patient was given alpha blocker treatment (p⬍0,05). In both groups one patient had urethral stricture. ED developed in 5 pa-tients in PKVP group and 3 papa-tients in TURP group and also retrograde ejacula-tion developed in 13 patients in PKVP group and 8 patients in TURP group (p⬎0,05).
Conclusions:When long term results were considered, PKVP was found to be less successful than standard TURP.
MP-05.10
Is bipolar transurethral resection in saline (TURis) a good alternative for laser?
Falahatkar S, Mokhtari G, Farzan A, Afsharimoghaddam A, Enshaei A, Kazemzadeh M, Allahkhah A
Urology Research Center, Guilan Univer-sity of Medical Sciences, Rasht, Iran
Introduction and Objective:To assess the efficacy and safety of bipolar transure-thral resection or vaporization in saline. Materials and Methods:During a two-month period, November and December 2009, 24 men with BPH related lower
uri-MODERATED POSTER SESSIONS
nary tract symptoms or bladder tumors were enrolled in this study. Inclusion cri-teria for transurethral resection of prostate (TURP) were benign prostatic hyperplasia-induced obstruction; prostatic volume between 30 and 80 ml, IPSS⬎13 and in-clusion criteria for transurethral resection of bladder tumor (TURBT) was endo-scopic evidence of intravesical lesions. Nine TURBT, 1 TUVBT, 8 TURP and 6 TUVP were performed during the study. All procedures were carried out with a bipolar device in physiologic saline. We evaluated age, tumor size, prostate vol-ume, pre & post operative serum Na⫹and K⫹, pre & post operative serum BUN and Cr, early postoperative urinary retention, stimulation of obturator reflex, preopera-tive IPSS, resection time, Body Mass Index (BMI), post-op catheterization time, hospi-tal stay.
Results:None of the patients experi-enced a TUR syndrome. Mean age was 73 years. Mean tumor size was 6.6 cm. Mean prostate volume was 46.6cc
. Early postop-erative retention occurred in 3 patients and one patient needed one unit blood transfusion. Only 2 patients of 10 submit-ted to TUR-BT experienced stimulation of obturator reflex. The mean preoperative International Prostate Symptom Score (IPSS) was 21. The mean operative time was 51.8 minutes. The mean BMI was 23.8 kg/m2. The mean post-op
catheteriza-tion time was about 5.2 days. The mean hospital stay was 3 days. The mean pre & post operative serum Na⫹was 145.4mEq/L
and 137.4mEq/L
, respectively. The mean pre & post operative serum K⫹was 4.2mEq/L
and 4mEq/L
, respectively. The mean pre & post operative serum BUN was 17.4mg/dl
and 16.2mg/dl
, respectively. The mean pre & post operative serum Cr was 1.3mg/dland 1mg/dl, respectively. The
mean valume of saline irrigation was 19 litters. We found no cases with post oper-ative TUR syndrome or urethral stricture. Conclusions:TURis seems to be effective and safe especially in regard to the avoid-ance of TUR syndrome. Despite other stud-ies, obturator reflex was stimulated in two patients in our study. Because TURis system is cheaper than laser, it can be good alterna-tive for treatment of BPH and bladder tumor.
MP-05.11
Intraprostatic injection of botulinum toxin type-A (Dysport) relieves bladder outlet obstruction in men Carl S, Lashcke S, Andreas J
City Hospital, Emmedingen, Germany
Introduction:Injection of botulinum toxin type A into the bladder and urethral sphincter has been used to treat bladder hyperactivity and sphincter dyssynergia. In this pilot study we analyzed the effec-tiveness of botulinum toxin type A in the treatment of patients with bladder outlet obstruction (BOO)
Materials and Methods:Fifteen patients diagnosed with BOO were treated with cytoscopically controlled injections at 4 sites into the prostata with a total dose of 500 U Dysport2. All patients were
evalu-ated by voiding diary and symptom ques-tionnaire (IPSS), flow charts, residual urine volume and an ultrasound of the prostate at 6 weeks and three month after therapy. Moreover PSA was measured prior and three month after injection. Results:Outcome improvement includes decreases in prostate size, and residual urine volume, and improvement in the flow rate and prostate specific antigen: the mean prostate volume, symptom score, and quality of life index were significantly re-duced by 32.3%, 77.9%, and 58.5% respec-tively. Maximal flow rate significantly in-creased by 81.0%. Moreover a significant reduction of the mean miction frequency (7x) and nocturia (1x) was seen. Conclusions:The treatment of IC with botulinum toxin type A is an effective, minimally invasive and safe therapeutic option with a substantial gain in the qual-ity of life avoiding major surgery.
MP-05.12
Laser photovaporisation prostatectomy (PVP) in high hemorrhagic risk patients Kharbouchi M, Colau A,Cariou G Division of Urology, Hoˆpital Diaconesses, Paris, France
Introduction and Objective:The rising rate of cardiovascular diseases requiring anticoagulant or antiaggregant therapies complicates the surgical approach of be-nign prostatic hyperplasia and especially TURP. For such patients KTP laser brings a new hope of cure without discontinuing anticoagulants. The purpose is to assess feasibility and safety of selective photova-porisation of the prostate in patients under anticoagulants or antiaggregant therapy. Materials and Methods:Of 147 patients that underwent PVP for BPH symptoms between January 2009 and April 2010; 31 had increased hemorrhagic risk due to antivitamin K therapy or platelet antiag-gregants (aspirin or clopidogrel). Their mean age was 78. The mean prostate vol-ume was 44 cc (20 to 80). Seven patients (22%) were in retention. Five patients
were on fluindion, 18 on aspirin, one on clopidogrel and 6 had a combination ther-apy: fluindion and aspirin (1) or clopi-dogrel and aspirin (5). One other patient was on curative regimen of fondaparinux for a recent pulmonary embolism. Of the patients, 56% had coronary disease. The others were treated for a peripheral vascu-lar lesion. PVP was performed with a 120 W KTP side-firing laser HPS Green Light®. Results:The mean operation time and en-ergy were respectively: 38 min (15 to 70) and 200000 Joules. Most of the patients (90%) were catheter-free at day 1; 14% of them had no catheter at all at the end of the procedure. The median hospital post operative stay was 2 days (1 to 6). One in-patient on aspirin experienced significant bleeding needing transfusion at day 2. No other readmission for hemorrhagic compli-cations was registered. Two patients had a transient urethral catheterization for post operative retention. The mean post opera-tive IPSS and residual urine volume were respectively 5 and 45 ml.
Conclusions:PVP is a safe and efficient procedure perfectly adapted to high hemor-rhagic risk patients suffering from BPH symptoms.
MP-05.13
National trends in the surgical therapy of benign prostatic hyperplasia in the United States (2002-2008)
Elliott S1, Bland P1, Yu X2, Caldwell D1,
McBean M1
1University of Minnesota, Minneapolis,
MN;2Nova Southeastern University, Fort
Lauderdale, FL, USA
Introduction and Objective:We previ-ously reported on the declining the rates of transurethral resection of the prostate (TURP) coincident with a dramatic in-crease in the utilization of thermotherapy and laser therapy in the surgical treatment of benign prostatic hyperplasia (BPH) among the United States male Medicare population (1999-2005) 65⫹years of age. We now report an update of these data through 2008.
Materials and Methods:Using the 100% Medicare carrier file (physician claims data) for the years 2002-2008 we calcu-lated counts and population-adjusted rates of BPH surgery. Medicare covers nearly all U.S. men over age 65 years. We calculated rates of TURP, transurethral incision of the prostate (TUIP), simple prostatectomy, transurethral microwave therapy of the prostate (TUMT), transurethral needle ab-lation of the prostate (TUNA), laser coagu-lation of the prostate (e.g. Nd:YAG
