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MP13-10 THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP): LONG-TERM RESULTS DURING 6-YEAR FOLLOW-UP OF 500 PROCEDURES
THE JOURNAL OF UROLOGYâ
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and postoperative prostate volume (18.3 vs 20.4 ml, p¼0.460). Although there were no significant differences in the laser activation time and energy usage, Vapoenucleation efficiency (total vapoenucleation volume / vapoenucleation time) was significantly better in the 5ARI group (0.88 vs 0.57 g/min p ¼ 0.028). There were differences between the groups in total operativing time (55.8 vs 69.2 min, p¼0.039) and vapoenucleation time (39.8 vs 55.5 min, p¼0.041). There was a tendency of lower hemoblobin decrease in 5ARI group, however, this results was not statistically significant. There were also no significant differences in improvement of IPSS, QoL and urodynamic findings between the two groups. CONCLUSIONS: Our data suggest that the preoperative use of 5ARI does not compromise the efficiency of Thulium laser vapoenucleation. There is no reason to discontinue of 5ARI before Thulium laser vapoenucleation. Source of Funding: None
MP13-10 THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP): LONG-TERM RESULTS DURING 6-YEAR FOLLOW-UP OF 500 PROCEDURES Christopher Netsch*, Daniela Jakobler, Thorsten Bach, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: A retrospective analysis of long-term outcomes of ThuVEP with regard to micturition improvement and complication rates in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS: We retrospectively analyzed 500 consecutive patients with LUTS secondary to BPO undergoing ThuVEP combined with mechanical morcellation from January 2007 until January 2010 at a single-centre. Patients were assessed by maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), and quality of life (QoL) 12-, 36-, and 72-months after ThuVEP. RESULTS: Median (interquartile range (IQR)) follow-up was 37 (17e60) months. Median age (IQR) at surgery was 71 (65.25-76) yrs. Median American Society of Anesthesiologists score was two. Median (IQR) preoperative PVR, Qmax, IPSS, and QoL were 120 (70e200) ml, 8 (4.83-12.28) ml/s, 21 (17e27) and 5 (4e5), respectively. Postoperatively, all variables showed significant improvement until the last follow-up at 72-months. Median postoperative PVR, Qmax, IPSS, and QoL were 23 ml, 18.2 ml/s, 4.5, and 1 at 12-months (p<0.001), 35.85 ml, 16.9 ml/s, 5, and 1 at 36-months (p<0.001), and 53.25 ml, 14.1 ml/s, 2 and 1 at 72-months (p<0.015), respectively. Bladder-neck contractures and urethral strictures developed in 1.8% (n¼9) and 1.6% (n¼8) of the patients, respectively. Three patients (0.6%) were re-treated during follow-up for recurrent prostatic tissue. Urinary tract infections, episodes of epididymitis and acute urinary retention occurred in twenty-one (4.2%), three (0.6%), and six (1.2%) patients during the 72-month follow-up period, respectively. CONCLUSIONS: ThuVEP is a durable procedure for the treatment of symptomatic BPO with regard to micturition improvement. The reintervention and complication rate of the ThuVEP procedure at long-term follow-up was low. Source of Funding: None
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
MP13-11 THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) FOR PROSTATES LARGER THAN 80ML: LONG-TERM DURABILITY OF THE PROCEDURE Christopher Netsch*, Daniela Jakobler, Thorsten Bach, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: A retrospective study of 90 consecutive patients to assess the long-term durability of ThuVEP in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) and prostate volumes of 80 cc or greater. METHODS: 90 patients with prostates larger than 80 cc underwent ThuVEP between July 2008 and January 2010 at our institution. Patient demographics, short-term and long-term follow-up was evaluated. Maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), and quality of life (QoL) was assessed at follow-up. Patient data were expressed as median (interquartile range (IQR)). RESULTS: Age at surgery was 71 (66e75.25) yrs. American Society of Anesthesiologists score was 2 (2e3). Thirty-seven (41.1%) of the patients were in urinary retention at time of surgery. Prostate volume was 100 (88e122) cc. Operative time was 95 (70e120) minutes and the enucleation time 53.5 (35.25-80) minutes, whilst resected tissue weighted 66 (52e86) gm. Median catheter time was 2 days. Two (2.2%) patients required a second-look operation in the immediate postoperative course (clot retention due to bleeding n¼1, residual tissue at the apex of the prostate n¼1). Two patients (2.2%) had blood transfusions postoperatively. Recatheterization was necessary in two patients (2.2%) within 1 week after surgery. Median (IQR) follow-up was 36.5 (16e60) mos. Median preoperative PVR, Qmax, IPSS, and QoL were 265 ml, 5.95 ml/s, 24 and 5, respectively. Postoperatively, all variables showed significant improvement starting at discharge and remained improved until last follow-up at 60-month follow-up (p<0.001). Postoperative median PVR was 15.75, 27, and 30 ml, median Qmax was 20.15, 18.9, and 19.3 ml/s, median IPSS was 4, 4, and 3, and median QoL was 1, 1 and 1 at 12-month, 36-month, and 60-month follow-up, respectively. Bladder-neck contractures and urethral strictures each developed in 1.1% and 1.1% of the patients, respectively. One patient (1.1%) was re-treated during follow-up for recurrent prostatic tissue. CONCLUSIONS: ThuVEP appears to be a durable modern alternative to open prostatectomy for patients with symptomatic BPO. The incidence of complications with ThuVEP during long-term follow-up was low. Source of Funding: None
MP13-12 AGE-STRATIFIED OUTCOMES OF THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) Christopher Netsch*, Daniela Jakobler, Thorsten Bach, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: To assess age-stratified outcomes after ThuVEP in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS: We retrospectively analyzed and compared the morbidity, the perioperative outcomes and functional outcomes of 451 patients aged 60e69, 70e79, and older than 80 years treated by ThuVEP between January 2008 and January 2010 at our institution. Complications were assessed according to the modified Clavien classification system during the first 30 days. Patients were reassessed by maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), and quality of life (QoL) 12-months after ThuVEP. RESULTS: A total of 451 patients underwent ThuVEP, of whom 167 patients were aged 60e69 yrs., 224 were aged 70e79 yrs., and 60 were aged older than 80 yrs. The median preoperative prostate size
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and postoperative prostate volume (18.3 vs 20.4 ml, p¼0.460). Although there were no significant differences in the laser activation time and energy usage, Vapoenucleation efficiency (total vapoenucleation volume / vapoenucleation time) was significantly better in the 5ARI group (0.88 vs 0.57 g/min p ¼ 0.028). There were differences between the groups in total operativing time (55.8 vs 69.2 min, p¼0.039) and vapoenucleation time (39.8 vs 55.5 min, p¼0.041). There was a tendency of lower hemoblobin decrease in 5ARI group, however, this results was not statistically significant. There were also no significant differences in improvement of IPSS, QoL and urodynamic findings between the two groups. CONCLUSIONS: Our data suggest that the preoperative use of 5ARI does not compromise the efficiency of Thulium laser vapoenucleation. There is no reason to discontinue of 5ARI before Thulium laser vapoenucleation. Source of Funding: None
MP13-10 THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP): LONG-TERM RESULTS DURING 6-YEAR FOLLOW-UP OF 500 PROCEDURES Christopher Netsch*, Daniela Jakobler, Thorsten Bach, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: A retrospective analysis of long-term outcomes of ThuVEP with regard to micturition improvement and complication rates in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS: We retrospectively analyzed 500 consecutive patients with LUTS secondary to BPO undergoing ThuVEP combined with mechanical morcellation from January 2007 until January 2010 at a single-centre. Patients were assessed by maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), and quality of life (QoL) 12-, 36-, and 72-months after ThuVEP. RESULTS: Median (interquartile range (IQR)) follow-up was 37 (17e60) months. Median age (IQR) at surgery was 71 (65.25-76) yrs. Median American Society of Anesthesiologists score was two. Median (IQR) preoperative PVR, Qmax, IPSS, and QoL were 120 (70e200) ml, 8 (4.83-12.28) ml/s, 21 (17e27) and 5 (4e5), respectively. Postoperatively, all variables showed significant improvement until the last follow-up at 72-months. Median postoperative PVR, Qmax, IPSS, and QoL were 23 ml, 18.2 ml/s, 4.5, and 1 at 12-months (p<0.001), 35.85 ml, 16.9 ml/s, 5, and 1 at 36-months (p<0.001), and 53.25 ml, 14.1 ml/s, 2 and 1 at 72-months (p<0.015), respectively. Bladder-neck contractures and urethral strictures developed in 1.8% (n¼9) and 1.6% (n¼8) of the patients, respectively. Three patients (0.6%) were re-treated during follow-up for recurrent prostatic tissue. Urinary tract infections, episodes of epididymitis and acute urinary retention occurred in twenty-one (4.2%), three (0.6%), and six (1.2%) patients during the 72-month follow-up period, respectively. CONCLUSIONS: ThuVEP is a durable procedure for the treatment of symptomatic BPO with regard to micturition improvement. The reintervention and complication rate of the ThuVEP procedure at long-term follow-up was low. Source of Funding: None
Vol. 193, No. 4S, Supplement, Friday, May 15, 2015
MP13-11 THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) FOR PROSTATES LARGER THAN 80ML: LONG-TERM DURABILITY OF THE PROCEDURE Christopher Netsch*, Daniela Jakobler, Thorsten Bach, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: A retrospective study of 90 consecutive patients to assess the long-term durability of ThuVEP in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) and prostate volumes of 80 cc or greater. METHODS: 90 patients with prostates larger than 80 cc underwent ThuVEP between July 2008 and January 2010 at our institution. Patient demographics, short-term and long-term follow-up was evaluated. Maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), and quality of life (QoL) was assessed at follow-up. Patient data were expressed as median (interquartile range (IQR)). RESULTS: Age at surgery was 71 (66e75.25) yrs. American Society of Anesthesiologists score was 2 (2e3). Thirty-seven (41.1%) of the patients were in urinary retention at time of surgery. Prostate volume was 100 (88e122) cc. Operative time was 95 (70e120) minutes and the enucleation time 53.5 (35.25-80) minutes, whilst resected tissue weighted 66 (52e86) gm. Median catheter time was 2 days. Two (2.2%) patients required a second-look operation in the immediate postoperative course (clot retention due to bleeding n¼1, residual tissue at the apex of the prostate n¼1). Two patients (2.2%) had blood transfusions postoperatively. Recatheterization was necessary in two patients (2.2%) within 1 week after surgery. Median (IQR) follow-up was 36.5 (16e60) mos. Median preoperative PVR, Qmax, IPSS, and QoL were 265 ml, 5.95 ml/s, 24 and 5, respectively. Postoperatively, all variables showed significant improvement starting at discharge and remained improved until last follow-up at 60-month follow-up (p<0.001). Postoperative median PVR was 15.75, 27, and 30 ml, median Qmax was 20.15, 18.9, and 19.3 ml/s, median IPSS was 4, 4, and 3, and median QoL was 1, 1 and 1 at 12-month, 36-month, and 60-month follow-up, respectively. Bladder-neck contractures and urethral strictures each developed in 1.1% and 1.1% of the patients, respectively. One patient (1.1%) was re-treated during follow-up for recurrent prostatic tissue. CONCLUSIONS: ThuVEP appears to be a durable modern alternative to open prostatectomy for patients with symptomatic BPO. The incidence of complications with ThuVEP during long-term follow-up was low. Source of Funding: None
MP13-12 AGE-STRATIFIED OUTCOMES OF THULIUM VAPOENUCLEATION OF THE PROSTATE (THUVEP) Christopher Netsch*, Daniela Jakobler, Thorsten Bach, Andreas J. Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: To assess age-stratified outcomes after ThuVEP in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS: We retrospectively analyzed and compared the morbidity, the perioperative outcomes and functional outcomes of 451 patients aged 60e69, 70e79, and older than 80 years treated by ThuVEP between January 2008 and January 2010 at our institution. Complications were assessed according to the modified Clavien classification system during the first 30 days. Patients were reassessed by maximum urinary flow rate (Qmax), post-void residual urine (PVR), international prostate symptom score (IPSS), and quality of life (QoL) 12-months after ThuVEP. RESULTS: A total of 451 patients underwent ThuVEP, of whom 167 patients were aged 60e69 yrs., 224 were aged 70e79 yrs., and 60 were aged older than 80 yrs. The median preoperative prostate size