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C179 EARLY URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY: A COMPARISON OF RADICAL
problem and need a chirurgical treatment. The aim os study is to presente our experiences with treatment of morbus peyronie by wide cut of lamina from tunica albuginea penis and supplement using transplant from vena saphena. In all cases lamina was localized in updominal part of the penis and create curvature penis and unable sexual act. Material & Methods: Treatment was started by exact mate of lamina and taking fragment of vana saphena, that was twice longer than lamina making curvature penis. Transplant of vena cut by two parts. All of this cut longways and sew up by side with single stitch. On this way make flat autologicus which saw in a defect in tunica albuginea. Results: In all three cases healing was correct, cosmetic and sexual effect was good, time of observation 2,5 years.
C76
The bi-intestinal neobladder – a functional multifactorial analysis of longterm results of an original orthotopic reconstruction of lower urinary tract after radical cystoprostatectomy
Antoniewicz A.A., Zapala L., Poletajew S., Skrzypczyk M., Borowka A. The Medical Centre of Postgraduate Education, Dept. of Urology, Warsaw, Poland Introduction & Objectives: Bi-intestinal neobladder formed from short segments of small and large intestine (of 12-15cm each) is an alternative to standard methods of orthotopic reconstruction after cystoprostatectomy. The long-term functional analysis of neobladder concerning i.a. collection of urine and voiding with the aspects of continence and quality of life needs a special interest. The aim of the study was to define the long term results assessed in a multifactorial analysis by objective analysis of urinary tract functioning with the clinical and pathophysiological findings and subjective assessment of patient’s quality of life. Material & Methods: Between 1996-2009 in 64 male pts (av. age 64 yrs) an orthotopic bi-intestinal neobladder was constructed. 27 pts were assessed in details 5 yrs after the surgery. General patient’s condition, complications of the surgery, function of the neobladder, urinary continence, function of upper urinary tract with the metabolic balance were evaluated with medical examination, US of urinary tract, cystoscopy, urodynamics, blood tests, urine analysis, continence assessment, visual micturition assessment, functional assessment of digestive tract, quality of life questionnaires and sexual examination. Results: The majority of pts (74%) in long-term observation were in good general condition, while 7 pts (26%) had specific abnormalities to urological condition (abdominal hernia - 3 pts, urethral stricture – 3, inguinal hernia - 2, UTI – 1). US showed: no abnormality – 12 pts, dilatation of upper urinary tract - 11, hydronephrosis – 4. In 5 pts (19%) defecation rate was 2x/24h, the rest (81%) defecates normally. Cystoscopy revealed no abnormalities in 24 pts, a mucous was visible and ureteral orifices were clearly recognizable in the majority of pts, while in 3 pts slight urethral stricture at anastomosis was noticed. The mean maximum functional capacity of the neobladder was 366 ml. Urodynamic results at 5 or more yrs showed unchanged characteristics of micturition pattern, post-void residual and neobladder pressure remained low (pves=12 mmH20, Rv=38ml). 24 pts (89%) showed excellent or good continence status during the daytime and 18 (67%) were completely dry at night. Only 1 patient required AUS implantation due to SUI. Renal function and metabolic status were comparable before and 5 yrs after the surgery. None of the patients developed metabolic acidosis and needed the administration of bicarbonates. Conclusions: The data presented above provide evidence that bi-intestinal neobladder is a valuable alternative for commonly performed neobladders formed from small intestine and demonstrates good functioning in a long-term follow-up.
C77
Long-term complications of the memokath stent
Nita G.D., Moldoveanu C., Mirciulescu V., Arabagiu I., Persu C., Geavlete B., Multescu R., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: Memokath 044 and 051 are thermo–expandable titanium–nickel stents developed for long-term urethral and ureteral stenting. The aim of this study was to evaluate and assess the long-term complications of using the thermo-expandable, nickel-titanium alloy stent (Memokath™ 051and 044, Engineers & Doctors A/S, Hornbaek, Denmark) for managing ureteric and urethral strictures. Material & Methods: Over a 3-year period, in the Saint John Emergency Clinical Hospital Department of Urology, 27 Memokath stents were inserted (mean age 58 years, range 35–85): Memokath 051 ureteral stents in 17 patients (Group I) and Memokath 044 urethral stents in 11 patients (Group II). In group I, extrinsic ureteral obstruction was secondary to pelvic or abdominal malignancy. In group II, all patients were diagnosed with urethral strictures and a history of multiple interventions (at least 4) and recurrences. Patients were followed for a mean period of 9 months (range 3 to 24). Results: No complications or side-effects occurred for 11 ureteral stents (Group
Eur Urol Suppl 2010;9(6):638
I); 6 stents were removed or repositioned after a mean period of 10 months (range 4 to 18). One of these became encrusted and consequently was removed. The other 5 stents migrated and repositioning or replacement was necessary. In Group II, the stent had to be removed or replaced in 5 out of 11 patients due to extensive mucosal proliferation causing obstruction to the lumen of the stent (2 cases), stent encrustation (2 cases) and migration (1 case). In 6 patients, the stents continued to function satisfactorily. Conclusions: The Memokath stent appears to have a useful role in managing malignant ureteral strictures or recurrent urethral strictures, but it must be closely monitored. Insertion and removal are easy in most patients. However, migration and obstruction may occur and careful follow-up is necessary.
C78
Lower abdominal gibson access is attractive for less renal surgery
Klinger H.C., Margreiter M., Weibl P., Marberger M. Medical University Vienna, Dept. of Urology, Vienna, Austria Introduction & Objectives: Umbilical access is commonly utilised for renal LESS. Aim of this prospective study was to determine feasibility, morbidity and postoperative pain by lower abdominal (ALESS) as compared to umbilical (ULESS) access and standard laparoscopy (SLAP). Material & Methods: Between 9/2009 and 4/2010 we evaluated 12 ALESS, 10 ULESS (cyst marsupalisation, radical nephrectomy, nephroureterctomy, renal cryotherapy). 15 consecutive SLAP served as control group. All techniques were evaluated for intraoperativ results and complications. Postoperative morbidity was assessed by quantifying pain medication and by daily evaluation of Visual Analogue Scale (VAS). Results: All groups were similar in respect to patient’s characteristics. Mean incision length was 5.3 (4-9) cm. No difference was seen in postoperative mobilisation and discharge. No significant complications occurred in either group. In 5 patients (3 ULESS, 2 ALESS) an additional 5mm port was inserted due to lack of triangulation. In 3 patients conversion to standard laparoscopy was performed, in 2 ALESS due to massive obesity. Average VAS score on the 1st and 5th postoperative day was 3.5 ± 1.5 vs. 4.9 ± 1.0 vs. 3.6 ± 1.9 and 1.9 ± 1.2 vs. 2.4 ± 0.9 vs. 2.0 ± 0.9. Mean analgesic consumption within the first postoperative week was 160 vs. 240 vs. 160 mg of Parecoxib respectively. Conclusions: ALESS is feasible, seems associated with less pain as compared to ULESS and gives an excellent access to the renal pedicle when needed. ALESS is most helpful in renal cryosurgery, but less suitable when excessive obesity is present.
C179
Early urinary continence after radical prostatectomy: A comparison of radical perineal, retropubic and endoscopicpreperitoneal prostatectomy
Klitsch M.C., Bliem F., Böhm R., Holup P., Bauer W., Lamche M., Schramek P. Barmherzige Brüder Hospital Vienna, Dept. of Urology and Andrology, Vienna, Austria Introduction & Objectives: Within the last decades, the functional outcome of radical prostatectomy (rPE) has considerably improved due to surgical enhancements, nevertheless postoperative urinary incontinence (UI) remains a major drawback. To show our results on early continence after rPE with reference to 3 different, but well established operation techniques, i.e. perineal (RPP), retropubic (RRP) and endoscopic-preperitoneal (REP) approach, performed in a single centre. Material & Methods: Between October 2001 and November 2009 rPE was performed with a perineal, a retropubic and an endoscopic-preperitoneal approach in 250 cases respectively. Pre- and postoperatively 4 and 16 weeks after rPE early continence was assessed by validated urine symptom inventory and an additional quality-of-life questionnaires. Results: Early continence was defined as no incontinence or the use of 1 security liner after 4 or 16 weeks postoperatively. The overall early continence rate after 4 weeks in the RPP was 38.8%, 50.4% in the RRP and 39.2% in the REP group, and after 16 weeks 72.8%, 60.8% and 63.6% respectively. Conclusions: In our cohort the RRP approach seems to have a slightly better continence rate after 4 weeks compared to RPP and REP group. Then after 16 weeks continence rates are almost the same in the 3 groups. These early continence rates, compared with recently published data prove that due to surgical expertise it is justifiably to perform 3 different operation techniques in a single centre.
C76
The bi-intestinal neobladder – a functional multifactorial analysis of longterm results of an original orthotopic reconstruction of lower urinary tract after radical cystoprostatectomy
Antoniewicz A.A., Zapala L., Poletajew S., Skrzypczyk M., Borowka A. The Medical Centre of Postgraduate Education, Dept. of Urology, Warsaw, Poland Introduction & Objectives: Bi-intestinal neobladder formed from short segments of small and large intestine (of 12-15cm each) is an alternative to standard methods of orthotopic reconstruction after cystoprostatectomy. The long-term functional analysis of neobladder concerning i.a. collection of urine and voiding with the aspects of continence and quality of life needs a special interest. The aim of the study was to define the long term results assessed in a multifactorial analysis by objective analysis of urinary tract functioning with the clinical and pathophysiological findings and subjective assessment of patient’s quality of life. Material & Methods: Between 1996-2009 in 64 male pts (av. age 64 yrs) an orthotopic bi-intestinal neobladder was constructed. 27 pts were assessed in details 5 yrs after the surgery. General patient’s condition, complications of the surgery, function of the neobladder, urinary continence, function of upper urinary tract with the metabolic balance were evaluated with medical examination, US of urinary tract, cystoscopy, urodynamics, blood tests, urine analysis, continence assessment, visual micturition assessment, functional assessment of digestive tract, quality of life questionnaires and sexual examination. Results: The majority of pts (74%) in long-term observation were in good general condition, while 7 pts (26%) had specific abnormalities to urological condition (abdominal hernia - 3 pts, urethral stricture – 3, inguinal hernia - 2, UTI – 1). US showed: no abnormality – 12 pts, dilatation of upper urinary tract - 11, hydronephrosis – 4. In 5 pts (19%) defecation rate was 2x/24h, the rest (81%) defecates normally. Cystoscopy revealed no abnormalities in 24 pts, a mucous was visible and ureteral orifices were clearly recognizable in the majority of pts, while in 3 pts slight urethral stricture at anastomosis was noticed. The mean maximum functional capacity of the neobladder was 366 ml. Urodynamic results at 5 or more yrs showed unchanged characteristics of micturition pattern, post-void residual and neobladder pressure remained low (pves=12 mmH20, Rv=38ml). 24 pts (89%) showed excellent or good continence status during the daytime and 18 (67%) were completely dry at night. Only 1 patient required AUS implantation due to SUI. Renal function and metabolic status were comparable before and 5 yrs after the surgery. None of the patients developed metabolic acidosis and needed the administration of bicarbonates. Conclusions: The data presented above provide evidence that bi-intestinal neobladder is a valuable alternative for commonly performed neobladders formed from small intestine and demonstrates good functioning in a long-term follow-up.
C77
Long-term complications of the memokath stent
Nita G.D., Moldoveanu C., Mirciulescu V., Arabagiu I., Persu C., Geavlete B., Multescu R., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: Memokath 044 and 051 are thermo–expandable titanium–nickel stents developed for long-term urethral and ureteral stenting. The aim of this study was to evaluate and assess the long-term complications of using the thermo-expandable, nickel-titanium alloy stent (Memokath™ 051and 044, Engineers & Doctors A/S, Hornbaek, Denmark) for managing ureteric and urethral strictures. Material & Methods: Over a 3-year period, in the Saint John Emergency Clinical Hospital Department of Urology, 27 Memokath stents were inserted (mean age 58 years, range 35–85): Memokath 051 ureteral stents in 17 patients (Group I) and Memokath 044 urethral stents in 11 patients (Group II). In group I, extrinsic ureteral obstruction was secondary to pelvic or abdominal malignancy. In group II, all patients were diagnosed with urethral strictures and a history of multiple interventions (at least 4) and recurrences. Patients were followed for a mean period of 9 months (range 3 to 24). Results: No complications or side-effects occurred for 11 ureteral stents (Group
Eur Urol Suppl 2010;9(6):638
I); 6 stents were removed or repositioned after a mean period of 10 months (range 4 to 18). One of these became encrusted and consequently was removed. The other 5 stents migrated and repositioning or replacement was necessary. In Group II, the stent had to be removed or replaced in 5 out of 11 patients due to extensive mucosal proliferation causing obstruction to the lumen of the stent (2 cases), stent encrustation (2 cases) and migration (1 case). In 6 patients, the stents continued to function satisfactorily. Conclusions: The Memokath stent appears to have a useful role in managing malignant ureteral strictures or recurrent urethral strictures, but it must be closely monitored. Insertion and removal are easy in most patients. However, migration and obstruction may occur and careful follow-up is necessary.
C78
Lower abdominal gibson access is attractive for less renal surgery
Klinger H.C., Margreiter M., Weibl P., Marberger M. Medical University Vienna, Dept. of Urology, Vienna, Austria Introduction & Objectives: Umbilical access is commonly utilised for renal LESS. Aim of this prospective study was to determine feasibility, morbidity and postoperative pain by lower abdominal (ALESS) as compared to umbilical (ULESS) access and standard laparoscopy (SLAP). Material & Methods: Between 9/2009 and 4/2010 we evaluated 12 ALESS, 10 ULESS (cyst marsupalisation, radical nephrectomy, nephroureterctomy, renal cryotherapy). 15 consecutive SLAP served as control group. All techniques were evaluated for intraoperativ results and complications. Postoperative morbidity was assessed by quantifying pain medication and by daily evaluation of Visual Analogue Scale (VAS). Results: All groups were similar in respect to patient’s characteristics. Mean incision length was 5.3 (4-9) cm. No difference was seen in postoperative mobilisation and discharge. No significant complications occurred in either group. In 5 patients (3 ULESS, 2 ALESS) an additional 5mm port was inserted due to lack of triangulation. In 3 patients conversion to standard laparoscopy was performed, in 2 ALESS due to massive obesity. Average VAS score on the 1st and 5th postoperative day was 3.5 ± 1.5 vs. 4.9 ± 1.0 vs. 3.6 ± 1.9 and 1.9 ± 1.2 vs. 2.4 ± 0.9 vs. 2.0 ± 0.9. Mean analgesic consumption within the first postoperative week was 160 vs. 240 vs. 160 mg of Parecoxib respectively. Conclusions: ALESS is feasible, seems associated with less pain as compared to ULESS and gives an excellent access to the renal pedicle when needed. ALESS is most helpful in renal cryosurgery, but less suitable when excessive obesity is present.
C179
Early urinary continence after radical prostatectomy: A comparison of radical perineal, retropubic and endoscopicpreperitoneal prostatectomy
Klitsch M.C., Bliem F., Böhm R., Holup P., Bauer W., Lamche M., Schramek P. Barmherzige Brüder Hospital Vienna, Dept. of Urology and Andrology, Vienna, Austria Introduction & Objectives: Within the last decades, the functional outcome of radical prostatectomy (rPE) has considerably improved due to surgical enhancements, nevertheless postoperative urinary incontinence (UI) remains a major drawback. To show our results on early continence after rPE with reference to 3 different, but well established operation techniques, i.e. perineal (RPP), retropubic (RRP) and endoscopic-preperitoneal (REP) approach, performed in a single centre. Material & Methods: Between October 2001 and November 2009 rPE was performed with a perineal, a retropubic and an endoscopic-preperitoneal approach in 250 cases respectively. Pre- and postoperatively 4 and 16 weeks after rPE early continence was assessed by validated urine symptom inventory and an additional quality-of-life questionnaires. Results: Early continence was defined as no incontinence or the use of 1 security liner after 4 or 16 weeks postoperatively. The overall early continence rate after 4 weeks in the RPP was 38.8%, 50.4% in the RRP and 39.2% in the REP group, and after 16 weeks 72.8%, 60.8% and 63.6% respectively. Conclusions: In our cohort the RRP approach seems to have a slightly better continence rate after 4 weeks compared to RPP and REP group. Then after 16 weeks continence rates are almost the same in the 3 groups. These early continence rates, compared with recently published data prove that due to surgical expertise it is justifiably to perform 3 different operation techniques in a single centre.