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2026 EMBOLIZATION OF BENIGN PROSTATIC HYPERPLASIA IN SYMPTOMATIC PATIENTS. SHORT AND MEDIUM TERM RESULTS
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
ages 50-87. The patients were randomized into two groups. All operations were performed under spinal anesthesia (3 mL bupivacaine 5 mg/ mL (Marcaine Spinal plain) installed at the L2–L3 or L3–L4 interspaces). After operation when anesthesia disappeared and patients started feeling pain 30 cc of prilocain of 1% were injected into irrigation solutions of 0,9% serum physiologic and let the irrigation fluid flow in regular manner to clarify hematuria within the indwelling catheter. RESULTS: There was no statistical difference between two groups in operative parameters. All the patients in the prilocain group satisfied with prilocain analgesic effect except for two patients (8%). These patients were administered additional analgesics to stop pain. Mean number of irrigation solutions was 7,04 ⫾1,02 for each patient and mean catheter withdrawal and postoperative hospital stay was 2,8⫾0,8 days. No prilocain induced adverse effect was seen. For patients of control group, all the patients, but two, were administered analgesics intravenously or intramuscularly when postoperative pain feeling started. Mean number of irrigation solutions was 7,16⫾1,18 and catheter withdrawal and hospital stay were 3,3⫾0,9 days. Mean VAS values were 0.35⫾0.12 in prilocain group and 5.10 ⫾ 3.26 in control group (p⬍0.001). CONCLUSIONS: Use of continuous bladder irrigation with diluted prilocain solution consistently reduced need for parenteral analgesics, both as rescue and total dose. Prilocain could be given in a proportion of 1/3000 concentration in irrigation solutions of serum physiologic, safely for relieving post operative pain in patients undergone TUR-P for BPH. Source of Funding: None
2025 LONG TERM OUTCOME OF 43 PATIENTS WITH PARKINSON’S DISEASE AND BENIGN PROSTATIC OBSTRUCTION UNDERGOING A TRANSURETHRAL RESECTION OF THE PROSTATE Andreas Neisius*, Mainz, Germany; Yvonne Neisius, Worms, Germany; Jens Woellner, Zurich, Switzerland; Joachim W. Thueroff, Christian Hampel, Mainz, Germany INTRODUCTION AND OBJECTIVES: According to the current literature patients with Parkinson’s disease and Benign Prostatic Obstruction or Hypocontractility of the detrusor have an increased risk of a postoperative urinary incontinence after transurethral resection of the Prostate (TUR- P). The biggest population which has been published so far did not exceed 23 cases. We analysed the outcome after TURP in patients with a neurological proven Parkinson’s disease. METHODS: From 10/1987 until 08/2011 a total amount of 43 patients with proven Parkinson’s disease underwent a TUR-P because of benign prostatic obstruction or detrusor hypocontractility and were retrospectively analysed. Patients with multiple system atrophy or any other systemic neurological disorders were excluded. RESULTS: The median patient age at intervention was 75 years. Benign Prostate Syndrom (BPS)- patients without indwelling catheter or urgency incontinence (n⫽19) benefit most from TUR- P. The de novo- Stress incontinence rate was 2/19 (11%). 14 of 43 patients had a preoperative indwelling catheter, of whom 6 (43%) required an indwelling Foley catheter also after TUR- P. In 8 of these 14 patients (57%) voiding without PVR was possible postoperatively. In 2 patients (14%) a de novo stress urinary incontinence occurred. From another 10 patients with preoperative urgency incontinence 7 regained continence (70%), 2 were significantly less incontinent (20%) and only 1 (10%) remained as incontinent as before TUR-P. In 4 of 43 cases (9.3 %) a de novo urinary incontinence was ascertained three months after TUR-P. At a median follow up of 11 years transurethral resection in patients with a Parkinson’s disease were successful in 30 of 43 (70%) cases. CONCLUSIONS: Based on our results patients with Parkinson’s disease and benign prostatic obstruction or detrusor hypocontractility do benefit in up to 70% from a TUR-P. These patients have an
THE JOURNAL OF UROLOGY姞
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increased risk of postoperative urinary incontinence (9.3%). According to the current literature the rate for postoperative de novo incontinence after TUR- P in patients without neurogenic risk factors ranges from 2.1 to 3.3 %. A preoperatively performed urodynamic test should be recommended to discriminate between bladder outlet obstruction and detrusor hypocontractility. In conclusion Parkinson’s disease should not be esteemed as a mandatory contraindication for a TUR-P. Source of Funding: None
2026 EMBOLIZATION OF BENIGN PROSTATIC HYPERPLASIA IN SYMPTOMATIC PATIENTS. SHORT AND MEDIUM TERM RESULTS Luis Campos Pinheiro*, Lisboan, Portugal; Joao Pisco, Tiago Bilhim, Hugo Rio Tinto, Vitor Vaz Santos, Joao O’Neill, Lisbon, Portugal INTRODUCTION AND OBJECTIVES: To evaluate whether prostatic arterial embolization (PAE) is a safe and effective procedure, at short and medium term follow-up, without sexual dysfunction, in patients with symptomatic benign prostatic hyperplasia (BPH). METHODS: Ninety-two patients, aged 52 - 82 years (mean 69.5 years) with symptomatic BPH, after failure of medical treatment for at least 6 months, were selected for PAE. Sixteen patients were in urinary retention with bladder catheters. Four patients had a partial prostatectomy 10, 14, 18, and 6 years before. The baseline data were IPSS (22); QoL (3.8); IIEF (16.6); PSA (7.8); Qmax (6.1); prostate volume by transrectal ultrasound (77.8cc), and by magnetic resonance (79.6), and PVR - post-void residual volume (126.9cc). These parameters were evaluated before, 1, 3, 6, 12 and every 6 months after PAE: PAE was performed under local anaesthesia, by single femoral approach with a C2F5 or a RUC catheter and a microcatheter. Non spherical 200 m were used in the first 14 patients and 100 m polyvinyl alcohol (PVA) particles were used in the remaining patients. Eighty-seven patients were discharged 2 - 8 hours after the procedure and five 18 hours later, the next morning. RESULTS: PAE was technically successful in 89 of the 92 patients (96.7%). In 8 patients, only one side prostatic artery were embolized (9.0%) and in the remaining patients, prostatic arteries of both sides were embolized (91%). In 4 patients with unilateral embolization the procedure was performed in the other side 3 weeks later and they improved. Only 9 patients referred light to moderate pain, and there was one major complication, a bladder ischemia. The control follow-up was performed at 1 and 3 months in all patients, at 6 months in 45 patients, at 12 months in 18 patients and at 18 months in 15 patients. There was a mean follow up of 7.1 months (range 1 - 18 months). The vesical catheter was removed from the patients with urinary retention between 5 and 14 days after the PAE. At 3 months the symptoms improved significantly in 73 patients (82%). Sixteen of them were considered failures due to slight improvement in 15 (18%) or no improvement in one patient (0.1%). None of the patients with slight improvement needed the prostatic drugs that they were taken before the procedure. From the 15 patients controlled at 18 months there was improvement in 12 (80%) and recurrences in 3 (20%). CONCLUSIONS: PAE is a safe and effective procedure, without sexual dysfunction, in patients with symptomatic BPH, with good short and medium term results. Source of Funding: None
ages 50-87. The patients were randomized into two groups. All operations were performed under spinal anesthesia (3 mL bupivacaine 5 mg/ mL (Marcaine Spinal plain) installed at the L2–L3 or L3–L4 interspaces). After operation when anesthesia disappeared and patients started feeling pain 30 cc of prilocain of 1% were injected into irrigation solutions of 0,9% serum physiologic and let the irrigation fluid flow in regular manner to clarify hematuria within the indwelling catheter. RESULTS: There was no statistical difference between two groups in operative parameters. All the patients in the prilocain group satisfied with prilocain analgesic effect except for two patients (8%). These patients were administered additional analgesics to stop pain. Mean number of irrigation solutions was 7,04 ⫾1,02 for each patient and mean catheter withdrawal and postoperative hospital stay was 2,8⫾0,8 days. No prilocain induced adverse effect was seen. For patients of control group, all the patients, but two, were administered analgesics intravenously or intramuscularly when postoperative pain feeling started. Mean number of irrigation solutions was 7,16⫾1,18 and catheter withdrawal and hospital stay were 3,3⫾0,9 days. Mean VAS values were 0.35⫾0.12 in prilocain group and 5.10 ⫾ 3.26 in control group (p⬍0.001). CONCLUSIONS: Use of continuous bladder irrigation with diluted prilocain solution consistently reduced need for parenteral analgesics, both as rescue and total dose. Prilocain could be given in a proportion of 1/3000 concentration in irrigation solutions of serum physiologic, safely for relieving post operative pain in patients undergone TUR-P for BPH. Source of Funding: None
2025 LONG TERM OUTCOME OF 43 PATIENTS WITH PARKINSON’S DISEASE AND BENIGN PROSTATIC OBSTRUCTION UNDERGOING A TRANSURETHRAL RESECTION OF THE PROSTATE Andreas Neisius*, Mainz, Germany; Yvonne Neisius, Worms, Germany; Jens Woellner, Zurich, Switzerland; Joachim W. Thueroff, Christian Hampel, Mainz, Germany INTRODUCTION AND OBJECTIVES: According to the current literature patients with Parkinson’s disease and Benign Prostatic Obstruction or Hypocontractility of the detrusor have an increased risk of a postoperative urinary incontinence after transurethral resection of the Prostate (TUR- P). The biggest population which has been published so far did not exceed 23 cases. We analysed the outcome after TURP in patients with a neurological proven Parkinson’s disease. METHODS: From 10/1987 until 08/2011 a total amount of 43 patients with proven Parkinson’s disease underwent a TUR-P because of benign prostatic obstruction or detrusor hypocontractility and were retrospectively analysed. Patients with multiple system atrophy or any other systemic neurological disorders were excluded. RESULTS: The median patient age at intervention was 75 years. Benign Prostate Syndrom (BPS)- patients without indwelling catheter or urgency incontinence (n⫽19) benefit most from TUR- P. The de novo- Stress incontinence rate was 2/19 (11%). 14 of 43 patients had a preoperative indwelling catheter, of whom 6 (43%) required an indwelling Foley catheter also after TUR- P. In 8 of these 14 patients (57%) voiding without PVR was possible postoperatively. In 2 patients (14%) a de novo stress urinary incontinence occurred. From another 10 patients with preoperative urgency incontinence 7 regained continence (70%), 2 were significantly less incontinent (20%) and only 1 (10%) remained as incontinent as before TUR-P. In 4 of 43 cases (9.3 %) a de novo urinary incontinence was ascertained three months after TUR-P. At a median follow up of 11 years transurethral resection in patients with a Parkinson’s disease were successful in 30 of 43 (70%) cases. CONCLUSIONS: Based on our results patients with Parkinson’s disease and benign prostatic obstruction or detrusor hypocontractility do benefit in up to 70% from a TUR-P. These patients have an
THE JOURNAL OF UROLOGY姞
e817
increased risk of postoperative urinary incontinence (9.3%). According to the current literature the rate for postoperative de novo incontinence after TUR- P in patients without neurogenic risk factors ranges from 2.1 to 3.3 %. A preoperatively performed urodynamic test should be recommended to discriminate between bladder outlet obstruction and detrusor hypocontractility. In conclusion Parkinson’s disease should not be esteemed as a mandatory contraindication for a TUR-P. Source of Funding: None
2026 EMBOLIZATION OF BENIGN PROSTATIC HYPERPLASIA IN SYMPTOMATIC PATIENTS. SHORT AND MEDIUM TERM RESULTS Luis Campos Pinheiro*, Lisboan, Portugal; Joao Pisco, Tiago Bilhim, Hugo Rio Tinto, Vitor Vaz Santos, Joao O’Neill, Lisbon, Portugal INTRODUCTION AND OBJECTIVES: To evaluate whether prostatic arterial embolization (PAE) is a safe and effective procedure, at short and medium term follow-up, without sexual dysfunction, in patients with symptomatic benign prostatic hyperplasia (BPH). METHODS: Ninety-two patients, aged 52 - 82 years (mean 69.5 years) with symptomatic BPH, after failure of medical treatment for at least 6 months, were selected for PAE. Sixteen patients were in urinary retention with bladder catheters. Four patients had a partial prostatectomy 10, 14, 18, and 6 years before. The baseline data were IPSS (22); QoL (3.8); IIEF (16.6); PSA (7.8); Qmax (6.1); prostate volume by transrectal ultrasound (77.8cc), and by magnetic resonance (79.6), and PVR - post-void residual volume (126.9cc). These parameters were evaluated before, 1, 3, 6, 12 and every 6 months after PAE: PAE was performed under local anaesthesia, by single femoral approach with a C2F5 or a RUC catheter and a microcatheter. Non spherical 200 m were used in the first 14 patients and 100 m polyvinyl alcohol (PVA) particles were used in the remaining patients. Eighty-seven patients were discharged 2 - 8 hours after the procedure and five 18 hours later, the next morning. RESULTS: PAE was technically successful in 89 of the 92 patients (96.7%). In 8 patients, only one side prostatic artery were embolized (9.0%) and in the remaining patients, prostatic arteries of both sides were embolized (91%). In 4 patients with unilateral embolization the procedure was performed in the other side 3 weeks later and they improved. Only 9 patients referred light to moderate pain, and there was one major complication, a bladder ischemia. The control follow-up was performed at 1 and 3 months in all patients, at 6 months in 45 patients, at 12 months in 18 patients and at 18 months in 15 patients. There was a mean follow up of 7.1 months (range 1 - 18 months). The vesical catheter was removed from the patients with urinary retention between 5 and 14 days after the PAE. At 3 months the symptoms improved significantly in 73 patients (82%). Sixteen of them were considered failures due to slight improvement in 15 (18%) or no improvement in one patient (0.1%). None of the patients with slight improvement needed the prostatic drugs that they were taken before the procedure. From the 15 patients controlled at 18 months there was improvement in 12 (80%) and recurrences in 3 (20%). CONCLUSIONS: PAE is a safe and effective procedure, without sexual dysfunction, in patients with symptomatic BPH, with good short and medium term results. Source of Funding: None