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Bladder Pain Syndrome Patients
UNMODERATED POSTER SESSIONS
in recurrence, progression to invasive disease and cancer specific survival according to the characteristics of the tumours related to the treatment received. Material and Methods: This is a retrospective analysis of 1039 patients with primary and recurrent stage T1G3 NMIBC (mean age 66.5⫹/⫺9.8 years, range 21-88; male/female ratio 9:1) with complete TUR with multiple bladder biopsies and muscle in the specimen. All of them were treated conservatively as follows: 1) no BCG, 2) Re-TUR only, 3) BCG Connaught 27 mgrs induction course, 4) BCG Connaught 81 mgrs induction course, 5) BCG Connaught 81 mgrs induction course ⫹ maintenance. There were no differences regarding age, sex, and multifocality distribution. Patients with CIS and recurrent tumours were more frequently treated with BCG (p⬍0.001). Recurrence, progression and disease specific mortality were related to gender, age, association to CIS, tumour size, multifocality, primary/recurrent tumour and early recurrence were evaluated. Time to event was estimated by Kaplan Meier curves and log-rank test. Results: With a median followup of 62 ⫹/⫺ 39 months there were significantly less recurrences in BCG treated patients with maintenance, compared to other treatments (p ⬍ 0.001). If we consider within the BCG group, there was a significant difference in primary or solitary or tumours less than 3cm or with CIS treated with BCG plus maintenance versus full dose or 1/3 dose. There were no differences in recurrent or multiple lesions or tumours more than 3cm. Progression rate was also lower in BCG treated patients that other treatments (p⫽0.003). There was an advantage for full dose compared to 1/3 dose in primary, solitary/multiple tumours and tumour more than 3cm (p⫽0.013). However, in patients with CIS there were no significant differences in progression between different doses of BCG. Early recurrence before 4-6 months was a significant prognostic factor of progression (p⫽ 0.007). Conclusions: BCG full dose plus maintenance treatment is the best treatment to decrease recurrence in T1G3 NMIBC. Differences are more evident in primary or solitary or tumours less than 3cm or in patients with CIS. Regarding progression to invasive disease, BCG full dose with or without maintenance is better than 1/3 dose and only TUR or Re-TUR. Early recurrence before 4-6 months is a negative prognostic factor for progression. Early recurrence and progression are the risk factors of disease mortality.
UP-01.068 Intravesical Non-alkalinized Lidocaine Instillation for Interstitial Cystitis/ Bladder Pain Syndrome Patients Aoyagi T, Sakamoto N, Takeuchi H, Tachibana M Dept. of Urology, Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan Introduction and Objectives: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Materials and Methods: Five female patients (40-71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68 year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0-7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient’s requirements and symptoms. The treatment’s effect was evaluated comparing O’Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O’Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis cystoscopic findings disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder filling pain decreased from 7 to 3 as a visual analog scale score. None of these patients showed side effects concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis / bladder pain syndrome patients was an easy, safe and effective treatment.
UP-01.069 Does Transobturator Tape Procedure Affect Walking? A Prospective Study with 3D Computerized Gait Analysis
UROLOGY 78 (Supplement 3A), September 2011
Seckin B1, Aydur E2, Balaban B3, Coguplugil A2, Möhür H3, Dayanc M2 1 Dept. of Urology,Selcuklu Medical Faculty, Selcuk University, Konya; 2Dept. of Urology, Gulhane Military Medical Academy, Ankara; 3Dept. of Physical Therapy and Rehabilitation, GMMA, Ankara, Turkey Introduction and Objective: Transobturator tape procedure is performed by the blind needle passage through the obturator foramen. This blind manner of needle passage may cause injury to the fascias, muscles and nerves in the obturator fossa. Therefore, the procedure may affect these patients’ walking. However, no study has been performed yet to explore this condition. Materials and Methods: This prospective study included 7 women (mean age: 48.5 range 34-60) who underwent outside-in transobturator tape (TVT-O) procedure by the same surgeon, using a commercial sling material for stress urinary incontinence. All subjects underwent 3D computerized gait analysis pre- and 3 weeks postoperatively to determine a possible effect of the surgery on walking. The kinematic parameters related to the surgery (maximum hip adduction and abduction, anterior pelvis tilt, maximum hip extension and flexion, pelvic rotation) [2] were analyzed and compared by an experienced specialist on physical therapy and rehabilitation. The only exclusion criterion was the presence of any neurological disorder. Results: The comparisons of the kinematic parameters investigated did not show any statistically significant difference. This study was limited in sample sizes and by the lack of electromyographic study. Conclusions: Our prospective study demonstrated that TVT-O, by performing with a blind needle passage, does not cause any gait disturbances and thus it is a safe procedure in terms of walking, by the findings obtained with 3D computerized gait analysis.
UP-01.070 Assessment of Structural Changes and Complications in Obturator Fossa Due To Outside-In Transobturator Tape Procedure Using MRI Aydur E1, Seckin B2, Akgun V3, Coguplugil A1, Dayanc M1 1 Dept. of Urology, Gulhane Military Medical Academy, Ankara; 2Dept. of Urology,Selcuklu Medical Faculty, Selcuk University, Konya; 3Dept. of Radiology,
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in recurrence, progression to invasive disease and cancer specific survival according to the characteristics of the tumours related to the treatment received. Material and Methods: This is a retrospective analysis of 1039 patients with primary and recurrent stage T1G3 NMIBC (mean age 66.5⫹/⫺9.8 years, range 21-88; male/female ratio 9:1) with complete TUR with multiple bladder biopsies and muscle in the specimen. All of them were treated conservatively as follows: 1) no BCG, 2) Re-TUR only, 3) BCG Connaught 27 mgrs induction course, 4) BCG Connaught 81 mgrs induction course, 5) BCG Connaught 81 mgrs induction course ⫹ maintenance. There were no differences regarding age, sex, and multifocality distribution. Patients with CIS and recurrent tumours were more frequently treated with BCG (p⬍0.001). Recurrence, progression and disease specific mortality were related to gender, age, association to CIS, tumour size, multifocality, primary/recurrent tumour and early recurrence were evaluated. Time to event was estimated by Kaplan Meier curves and log-rank test. Results: With a median followup of 62 ⫹/⫺ 39 months there were significantly less recurrences in BCG treated patients with maintenance, compared to other treatments (p ⬍ 0.001). If we consider within the BCG group, there was a significant difference in primary or solitary or tumours less than 3cm or with CIS treated with BCG plus maintenance versus full dose or 1/3 dose. There were no differences in recurrent or multiple lesions or tumours more than 3cm. Progression rate was also lower in BCG treated patients that other treatments (p⫽0.003). There was an advantage for full dose compared to 1/3 dose in primary, solitary/multiple tumours and tumour more than 3cm (p⫽0.013). However, in patients with CIS there were no significant differences in progression between different doses of BCG. Early recurrence before 4-6 months was a significant prognostic factor of progression (p⫽ 0.007). Conclusions: BCG full dose plus maintenance treatment is the best treatment to decrease recurrence in T1G3 NMIBC. Differences are more evident in primary or solitary or tumours less than 3cm or in patients with CIS. Regarding progression to invasive disease, BCG full dose with or without maintenance is better than 1/3 dose and only TUR or Re-TUR. Early recurrence before 4-6 months is a negative prognostic factor for progression. Early recurrence and progression are the risk factors of disease mortality.
UP-01.068 Intravesical Non-alkalinized Lidocaine Instillation for Interstitial Cystitis/ Bladder Pain Syndrome Patients Aoyagi T, Sakamoto N, Takeuchi H, Tachibana M Dept. of Urology, Tokyo Medical University, Ibaraki Medical Center, Ibaraki, Japan Introduction and Objectives: The effectiveness of daily or weekly instillation of non-alkalinized lidocaine for patients suffering interstitial cystitis and/or bladder pain syndrome was evaluated retrospectively. Materials and Methods: Five female patients (40-71 years old) diagnosed as interstitial cystitis by cystoscopic findings and a 68 year-old bladder pain syndrome patient were enrolled. All patients, having interstitial cystitis, had undergone hydrodistention therapy previously and had not improved their symptoms by empirical therapies. Daily or weekly (upon their severity of symptoms) intravesical instillation of 20 ml of 4% non-alkalinized (pH 6.0-7.0) lidocaine solution was performed for several times, and patients were asked to keep them in the bladder as long as two hours each time. Previous medications such as anti-cholinergic drugs and analgesics were continued according to patient’s requirements and symptoms. The treatment’s effect was evaluated comparing O’Leary-Sant Symptom Index for interstitial cystitis patients and visual analog pain scale before and after the series of therapies. Results: Instillation was made 6 to 16 times. Patients with interstitial cystitis improved their symptoms from O’Leary-Sant Symptom Index 17.5 to 10, Problem Index from 14.8 to 6 in an average. Crouching pain disappeared in all these patients after the instillation therapy. Severe interstitial cystitis cystoscopic findings disappeared completely in one patient after the therapy. One patient having bladder pain syndrome reduced her analgesics use, and bladder filling pain decreased from 7 to 3 as a visual analog scale score. None of these patients showed side effects concerning lidocaine toxicity. Conclusions: Intravesical non-alkalinized lidocaine instillation therapy for interstitial cystitis / bladder pain syndrome patients was an easy, safe and effective treatment.
UP-01.069 Does Transobturator Tape Procedure Affect Walking? A Prospective Study with 3D Computerized Gait Analysis
UROLOGY 78 (Supplement 3A), September 2011
Seckin B1, Aydur E2, Balaban B3, Coguplugil A2, Möhür H3, Dayanc M2 1 Dept. of Urology,Selcuklu Medical Faculty, Selcuk University, Konya; 2Dept. of Urology, Gulhane Military Medical Academy, Ankara; 3Dept. of Physical Therapy and Rehabilitation, GMMA, Ankara, Turkey Introduction and Objective: Transobturator tape procedure is performed by the blind needle passage through the obturator foramen. This blind manner of needle passage may cause injury to the fascias, muscles and nerves in the obturator fossa. Therefore, the procedure may affect these patients’ walking. However, no study has been performed yet to explore this condition. Materials and Methods: This prospective study included 7 women (mean age: 48.5 range 34-60) who underwent outside-in transobturator tape (TVT-O) procedure by the same surgeon, using a commercial sling material for stress urinary incontinence. All subjects underwent 3D computerized gait analysis pre- and 3 weeks postoperatively to determine a possible effect of the surgery on walking. The kinematic parameters related to the surgery (maximum hip adduction and abduction, anterior pelvis tilt, maximum hip extension and flexion, pelvic rotation) [2] were analyzed and compared by an experienced specialist on physical therapy and rehabilitation. The only exclusion criterion was the presence of any neurological disorder. Results: The comparisons of the kinematic parameters investigated did not show any statistically significant difference. This study was limited in sample sizes and by the lack of electromyographic study. Conclusions: Our prospective study demonstrated that TVT-O, by performing with a blind needle passage, does not cause any gait disturbances and thus it is a safe procedure in terms of walking, by the findings obtained with 3D computerized gait analysis.
UP-01.070 Assessment of Structural Changes and Complications in Obturator Fossa Due To Outside-In Transobturator Tape Procedure Using MRI Aydur E1, Seckin B2, Akgun V3, Coguplugil A1, Dayanc M1 1 Dept. of Urology, Gulhane Military Medical Academy, Ankara; 2Dept. of Urology,Selcuklu Medical Faculty, Selcuk University, Konya; 3Dept. of Radiology,
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