- Email: [email protected]
UP-02.042 Therapeutic Efficacy of Bipolar Radio Frequency Thermal Treatment for Patients with Benign Prostate Hyperplasia
UNMODERATED POSTER SESSIONS
the bladder wall for the treatment of IC, which was improved in symptoms of urinary storage but not in pain.
UP-02.041 Initial Treatment of Incident Benign Prostatic Hyperplasia Cases in the United States, 2006 McBean A, Bland P, O’Connor H, Caldwell D, Elliott S University of Minnesota School of Public Health, Minneapolis, USA Introduction and Objective: We have previously used U.S. Medicare Program claims data to describe evolving trends over the past decade in the surgical treatment of BPH/LUTS. In January 2006, the Medicare Program began coverage for elderly beneficiaries who chose to enroll in the Medicare Prescription Drug Program (Medicare Part D). Using these new drug data, we now describe the initial treatment choices made for incident cases of BPH/LUTS diagnosed in 2006. Materials and Methods: The data source was the 5% random sample of Medicare enrollment and traditional claims-based data files for 2005-2008, and the Part D data files for 2006- 2008. Men 66⫹ years of age were identified as having BPH in 2006 if they had diagnoses consistent with BPH/LUTS in 2006 but not in 2005. Cases were then followed through the end of 2008 to determine the first treatment selected. Results: There were 26,471 of the 34,479 incident cases (76.7%) that received no medication or surgical treatment during the study period. The most common initial treatment was an alpha blocker alone, 12.7%. An additional 1.2% of incident cases received an alpha blocker plus a 5-alpha reductase inhibitor (5-ARI) simultaneously as the first treatment. A 5-ARI alone was initially used in 3.1% of the patients. 6.2% underwent surgery as their initial treatment (3.4% MIST; 2.8% TURP). Compared with men 66-74 years of age, men 75-84 years of age were 16% more likely to initially receive surgical treatment, and men 85⫹ years of age were 74% more likely to initially receive medications (p ⬍ 0.001 for both). White men were almost 50% more likely to be initially treated with surgery than men of other race groups. Conclusions: The majority of elderly men did not receive BPH/LUTS treatment during our period of observation. Given the treatment options available for BPH, it is not surprising that the choice of initial
S274
treatment varies by age and race. Reasons for these differences are to be explored.
UP-02.042 Therapeutic Efficacy of Bipolar Radio Frequency Thermal Treatment for Patients with Benign Prostate Hyperplasia Noh J1, Yoo D2, Oh B3, Kim J4, Park Y4 1 Gwangju Christian Hospital, Gwangju, South Korea; 2Chonnam University Medical School, Gwangju, South Korea; 3 Gwangju Veterans Hospital, Gwangju, South Korea; 4Naju Urologic Clinic, Gwangju, South Korea Introduction: In regarding of cost, ease of use and efficacy, bipolar radio frequency thermal therapy (Tempro system from Direx-Initia) for patients with benign prostate hyperplasia (BPH), especially dissatisfied with conventional medication and unwilling to surgery, shows effective improvement in the voiding symptom and the quality of life. We compared the clinical symptom and treatment result in order to evaluate the therapeutic efficacy. Materials and Methods: A prospective study of 63 patients diagnosed as BPH who presented with a serum prostate specific antigen (s-PSA) level lower than 4ng/ml between october 2009 and september 2010 was performed. We used the Tempro system with a treatment protocol of 55 degree Celsius for 50 minutes, medium heating rate. Patients with BPH performed the uroflowmetry and the international prostate symptom score (IPSS) before and after treatment. Results: In the patients with BPH, the average s-PSA level was 1.1⫾0.8ng/ml and the prostate volume was 35.5⫾8.7gm, and the mean maximal flow rate (Qmax) was 11.9⫾4.3ml/s before treatment and it was 13.9⫾5.9ml/s after treatment (p⬍.05). Also, the IPSS was significantly decreased from 19.6⫾5.7 to 13.6⫾6.1, and the effect on the quality of life from 3.3⫾0.9 to 2.3⫾0.9 (p⬍.001). Conclusions: Tempro system for patients with BPH can provide significant improvement in uroflowmetry, IPSS and the effect on the quality of life. It will be alternative treatment option for patients with BPH dissatisfied with conventional medication and unwilling to surgery but large, randomized controlled trials are needed to confirm the efficacy of these data.
UP-02.043 Pubic Symphysitis Following
Transurethral Resection of the Prostate: A Rare Complication Ziesel C1, Frees S1, Schröder A1, Stein R1, Thüroff J1, Gillitzer R2 1 Urologische Klinik und Poliklinik der Unversitätsmedizin Mainz, Mainz, Germany, 2Urologische Klinik, Klinikum Darmstadt, Darmstadt, Germany Introduction and Objectives: Pubic symphysitis (PS) after urological operations or interventions is uncommon and reported only in few case studies. This is a single institution experience of nine patients with PS out of 3,513 transurethral resection of the prostate (TUR-P). Materials and Methods: In thirteen years (1997 until 2009) 10,221 transurethral endoscopic operations were performed in our department. There were 3,513 patients (34%) who underwent TUR-P reviewed, of which 9 patients (0.2562%) developed a pubic symphysitis. Results: The average age of these 9 patients was 71 ⫾ 6 years and the average body-mass-index was 26 ⫾ 7 kg/sqm. Except for mild hypertension in 5 cases and diabetes mellitus in 2 cases no other medical diseases were preexistent, especially no immunological deficits. All patients had obstructive voiding, 5 with acute urinary retention. The mean residual urine volume was 242 ⫾ 172ml prior to operation. The mean PSA was 1.7 ⫾ 1.3 ng/ml. Urine culture was positive in 2 cases. All 9 TUR-P were complete resections done by experienced surgeons in monopolar technique. Mean resection weight was 38 ⫾ 20 gr. One patient had intraoperative perforation of the prostatic capsule. Histopathological examination revealed chronic prostatitis in 7 cases. After 1.3 ⫾ 1.1 months, patients developed pain in the pubic region and walking difficulties. After 1.9 ⫾ 1.6 months, all patients underwent MRI which suggested pubic symphysitis and additional soft tissue involvement in 8 cases. In 6 patients, a perisymphyseal liquid collection was described. 2 patients developed a fistula which required excision. Symptomatic treatment comprised walking aids (9/9), fistula excision (2/9), non steroidal anti inflammatory drugs (5/9), suprapubic catheter urinary diversion (5/9), transurethral catheter urinary diversion (3/9) and combinations of the above. Antibiotic therapy was administered orally and intravenously. Final outcome was complete resolution of symptoms in all patients after 6.3 ⫾ 1.4 months. None of the patients had retained voiding difficulties after TUR-P or developed urinary incontinence. Conclusions: Pubic symphysitis remains a rare complication after TUR-P. We could
UROLOGY 78 (Supplement 3A), September 2011
the bladder wall for the treatment of IC, which was improved in symptoms of urinary storage but not in pain.
UP-02.041 Initial Treatment of Incident Benign Prostatic Hyperplasia Cases in the United States, 2006 McBean A, Bland P, O’Connor H, Caldwell D, Elliott S University of Minnesota School of Public Health, Minneapolis, USA Introduction and Objective: We have previously used U.S. Medicare Program claims data to describe evolving trends over the past decade in the surgical treatment of BPH/LUTS. In January 2006, the Medicare Program began coverage for elderly beneficiaries who chose to enroll in the Medicare Prescription Drug Program (Medicare Part D). Using these new drug data, we now describe the initial treatment choices made for incident cases of BPH/LUTS diagnosed in 2006. Materials and Methods: The data source was the 5% random sample of Medicare enrollment and traditional claims-based data files for 2005-2008, and the Part D data files for 2006- 2008. Men 66⫹ years of age were identified as having BPH in 2006 if they had diagnoses consistent with BPH/LUTS in 2006 but not in 2005. Cases were then followed through the end of 2008 to determine the first treatment selected. Results: There were 26,471 of the 34,479 incident cases (76.7%) that received no medication or surgical treatment during the study period. The most common initial treatment was an alpha blocker alone, 12.7%. An additional 1.2% of incident cases received an alpha blocker plus a 5-alpha reductase inhibitor (5-ARI) simultaneously as the first treatment. A 5-ARI alone was initially used in 3.1% of the patients. 6.2% underwent surgery as their initial treatment (3.4% MIST; 2.8% TURP). Compared with men 66-74 years of age, men 75-84 years of age were 16% more likely to initially receive surgical treatment, and men 85⫹ years of age were 74% more likely to initially receive medications (p ⬍ 0.001 for both). White men were almost 50% more likely to be initially treated with surgery than men of other race groups. Conclusions: The majority of elderly men did not receive BPH/LUTS treatment during our period of observation. Given the treatment options available for BPH, it is not surprising that the choice of initial
S274
treatment varies by age and race. Reasons for these differences are to be explored.
UP-02.042 Therapeutic Efficacy of Bipolar Radio Frequency Thermal Treatment for Patients with Benign Prostate Hyperplasia Noh J1, Yoo D2, Oh B3, Kim J4, Park Y4 1 Gwangju Christian Hospital, Gwangju, South Korea; 2Chonnam University Medical School, Gwangju, South Korea; 3 Gwangju Veterans Hospital, Gwangju, South Korea; 4Naju Urologic Clinic, Gwangju, South Korea Introduction: In regarding of cost, ease of use and efficacy, bipolar radio frequency thermal therapy (Tempro system from Direx-Initia) for patients with benign prostate hyperplasia (BPH), especially dissatisfied with conventional medication and unwilling to surgery, shows effective improvement in the voiding symptom and the quality of life. We compared the clinical symptom and treatment result in order to evaluate the therapeutic efficacy. Materials and Methods: A prospective study of 63 patients diagnosed as BPH who presented with a serum prostate specific antigen (s-PSA) level lower than 4ng/ml between october 2009 and september 2010 was performed. We used the Tempro system with a treatment protocol of 55 degree Celsius for 50 minutes, medium heating rate. Patients with BPH performed the uroflowmetry and the international prostate symptom score (IPSS) before and after treatment. Results: In the patients with BPH, the average s-PSA level was 1.1⫾0.8ng/ml and the prostate volume was 35.5⫾8.7gm, and the mean maximal flow rate (Qmax) was 11.9⫾4.3ml/s before treatment and it was 13.9⫾5.9ml/s after treatment (p⬍.05). Also, the IPSS was significantly decreased from 19.6⫾5.7 to 13.6⫾6.1, and the effect on the quality of life from 3.3⫾0.9 to 2.3⫾0.9 (p⬍.001). Conclusions: Tempro system for patients with BPH can provide significant improvement in uroflowmetry, IPSS and the effect on the quality of life. It will be alternative treatment option for patients with BPH dissatisfied with conventional medication and unwilling to surgery but large, randomized controlled trials are needed to confirm the efficacy of these data.
UP-02.043 Pubic Symphysitis Following
Transurethral Resection of the Prostate: A Rare Complication Ziesel C1, Frees S1, Schröder A1, Stein R1, Thüroff J1, Gillitzer R2 1 Urologische Klinik und Poliklinik der Unversitätsmedizin Mainz, Mainz, Germany, 2Urologische Klinik, Klinikum Darmstadt, Darmstadt, Germany Introduction and Objectives: Pubic symphysitis (PS) after urological operations or interventions is uncommon and reported only in few case studies. This is a single institution experience of nine patients with PS out of 3,513 transurethral resection of the prostate (TUR-P). Materials and Methods: In thirteen years (1997 until 2009) 10,221 transurethral endoscopic operations were performed in our department. There were 3,513 patients (34%) who underwent TUR-P reviewed, of which 9 patients (0.2562%) developed a pubic symphysitis. Results: The average age of these 9 patients was 71 ⫾ 6 years and the average body-mass-index was 26 ⫾ 7 kg/sqm. Except for mild hypertension in 5 cases and diabetes mellitus in 2 cases no other medical diseases were preexistent, especially no immunological deficits. All patients had obstructive voiding, 5 with acute urinary retention. The mean residual urine volume was 242 ⫾ 172ml prior to operation. The mean PSA was 1.7 ⫾ 1.3 ng/ml. Urine culture was positive in 2 cases. All 9 TUR-P were complete resections done by experienced surgeons in monopolar technique. Mean resection weight was 38 ⫾ 20 gr. One patient had intraoperative perforation of the prostatic capsule. Histopathological examination revealed chronic prostatitis in 7 cases. After 1.3 ⫾ 1.1 months, patients developed pain in the pubic region and walking difficulties. After 1.9 ⫾ 1.6 months, all patients underwent MRI which suggested pubic symphysitis and additional soft tissue involvement in 8 cases. In 6 patients, a perisymphyseal liquid collection was described. 2 patients developed a fistula which required excision. Symptomatic treatment comprised walking aids (9/9), fistula excision (2/9), non steroidal anti inflammatory drugs (5/9), suprapubic catheter urinary diversion (5/9), transurethral catheter urinary diversion (3/9) and combinations of the above. Antibiotic therapy was administered orally and intravenously. Final outcome was complete resolution of symptoms in all patients after 6.3 ⫾ 1.4 months. None of the patients had retained voiding difficulties after TUR-P or developed urinary incontinence. Conclusions: Pubic symphysitis remains a rare complication after TUR-P. We could
UROLOGY 78 (Supplement 3A), September 2011