457 PREDICTORS OF RETREATMENT IN PATIENTS UNDERGOING HIGH ENERGY TRANSURETHRAL MICROWAVE THERMOTHERAPY: MULTICENTER EUROPEAN POOLED ANALYSIS AT 9 YEARS

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Predictors of retreatment in patients undergoing high energy transurethral microwave thermotherapy: Multicenter European pooled analysis at 9 years

Waldert M.1, Seitz C.1, Harik M.1, Margreiter M.1, Alavi S.1, Dobronski P.2, Ravery V.3, Nowak M.1, Kaisary A.4, Marberger M.1, Djavan B.1 Medical University of Vienna, Department of Urology, Vienna, Austria, 2University of Warsaw, Department of Urology, Warsaw, Poland, 3Hôpital Bichat Claude Bernard, Department of Urology, Paris, France, 4University of London, Department of Urology, London, United Kingdom 1

Introduction & Objectives: (1) A Multicenter European evaluation of the long term ef­fi­cacy, safety and retreatment rates of tar­geted high energy transurethral mi­cro­wave thermotherapy (TUMT) in patients with lower urinary tract symptoms due to Bladder outlet obstruction (BOO). (2) To identify predictors of retreatment in patients undergoing TUMT at 9 years follow up. Material & Methods: 614 pa­tients undergoing high energy TUMT between 1996 and 2004 were available and evaluated with a follow up of 2-8 years (mean 5.1 + 2 years). Pa­tient eval­u­a­ tion in­cluded de­ter­mi­na­tion of In­ter­na­tional Pros­tate Symp­tom Score (IPSS), obstructive (OSS) and irritative (ISS) symptom score, peak flow rate (Qmax), and qual­ity of life (QOL) score, total and transition zone (TZ) prostate volume, serum PSA, %free PSA prior to TUMT and at pe­ri­odic intervals up to 6 years and a urodynamical investigation pre- TUMT and 3 years there after a multivariate analysis identified predictors of retreatment. Results: 78.4%, 75.8% and 64.7%, and 63.5%, 84.3% and 84,7% of pa­tients dem­on­strated a 50% or greater im­prove­ment in IPSS, Qmax and QOL score, re­spec­tively by 2 and 3 years, com­pared with 51.2%, 66.5%, 63.3%, and 43,4%, 57.6% and 49.5% re­spec­tively, by 6 and 9 years. At 3 years follow up, urodynamical results were available in 188 patients. In these, Pdet max, Pdet max at maximal flow and Schaefer score decreased by 42.3 cm H20, 29.5 cm H20 and 1.7 points, respectively. At 3 years, the ac­tu­ar­ial rate of retreatment was 20.5% (95% CI, 18.4-25.0 %). At 9 years, the ac­tu­ar­ial rate of retreatment was 35.4% (95% CI, 25.0-36.5 %). Higher retreatment rates correlated with TZ volumes > 50cc or < 20 cc, PSA < 2 ng/mL, the presence of an endovesical lobe > 0.5 cm and a pretreatment IPSS > 20. In a multivariate lo­gis­tic re­gres­sion model that took ac­count of dif­fer­ences in various pre­treat­ment clinical and biochemical parameters, pre-TUMT PSA, TZ volume and OSS (in declining order) did correlate with a sig­nif­i­cantly higher prob­a­bil­ity of symptom and QOL improvement (odds ra­tio = 4.3). Conclusions: In patients with LUTS due to BOO, TUMT provides a suitable option for improvement of their condition. Overall, 78.4% and 43.4% of TUMT treated patients will observe a 50% or greater im­prove­ment in IPSS at 6 and 8 years, respectively, suggesting a significant decrease over time. Retreatment will be required in 35.4% at 9 years. Higher retreatment rates correlated with TZ volumes > 50cc or < 20 cc, PSA < 1.8 ng/mL, the presence of an endovesical lobe > 0.5 cm and an initial IPSS > 20.



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Prospective randomized study confronting monopolar versus bipolar TURP. 6 months follow up outcome Bertolotto F., Naselli A., Vigliercio G., Raggio M., Puppo P. National Institute for Cancer Research, Urology, Genoa, Italy Introduction & Objectives: TURP represents the gold standard for managing BPH with decreasing complication rates. Bipolar technology is an alternative device developed to further minimize the risks of this technically difficult procedure. Material & Methods: Candidates to surgery for obstructive symptoms entered the study, gave written consent and were randomized to monopolar or bipolar TURP (MTURP, BTURP respectively). Inclusion criteria were prostate estimated volume of less than 100 mL, Qmax of 15 ml/s or less, IPSS symptom score of 13 or greater, PSA 4 ng/mL or less. Pts were grouped by gland volume: A group <= 30 mL, B group >30 and <50 mL, C group >50 cc. Pts were evaluated after six months from surgery. Primary outcomes were the Qmax and IPSS score. Secondary outcomes were urethral stricture or bladder neck contraction incidence. 100 pts were consecutively enrolled from 3 urology departments from April to October 2005. Pts were so randomized: Group A: 32 pts; 20 MTURP 12 BTURP Group B: 44 pts; 16 MTURP 28 BTURP Group C: 24 pts: 16 MTURP 8 BTURP Results: Median age was 71 years, range 56-85. Median prostate volume was 43, range 20 to 90 mL. Median surgery time A: 20 MTURP - 45’; 12 BTURP - 43’ B: 16 MTURP - 68’; 28 BTURP -59’ C: 16 MTURP - 71’; 8 BTURP -70’ Primary outcomes After a follow up of 6 months, all pts had a Qmax of 14 mL/s and a IPSS of 5 or less, except 1 pt of group C with a urethral stricture. Secondary outcomes No urethral stricture or bladder neck contraction were signalled in group A or B. One urethral bulbar stricture was diagnosed and treated with internal urethrotomy in a pt who underwent BTURP in group C Conclusions: This study indicates that BTURP is a safe and efficacious treatment for BPH at 6 months. The main advantage respect to MTURP is that there is no risk of TUR syndrome.

O11 UROGENITAL RECONSTRUCTION 2 Thursday, 22 March, 14.00-15.30, Room 3

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Vaporesection of the prostate. Preliminary results with a one year follow-up using a Thulium: Yag 70 Watt 2 micron continuous wave laser (RevoLix)

Proliferation of seeded cells on different collagenscaffolds and commercially available small intestinal submucosa

Bach T.1, Herrmann T.2, Ganzer R.3, Gross A.1

Roelofs L.1, Nuininga J.1, Van Kuppevelt T.2, Feitz W.1

Asklepios Hospital Barmbek, Urology, Hamburg, Germany, 2Medical College of Hannover, Urology, Hanover, Germany, 3University Hospital Regensburg, Urology, Regensburg, Germany 1

Introduction & Objectives: Although transurethral resection of the prostate remains the gold standard, multiple laser systems (e.g. Holmium, KTP) for the treatment of benign prostatic hyperplasia are introduced. Current laser systems have limitations due to their laser physics. The RevoLix laser combines the advantages of the Holmium:YAG laser with the comfort of a continuous wave laser beam. This study reports the preliminary results of vaporesection of the prostate, using the 2 micron continuous wave (cw) laser. Material & Methods: 54 consecutive patients were treated with the 70 Watt RevoLix laser for BPH. The mean age was 61 years (56-82 years). Mean prostate volume was 30.3 ccm (12 – 38 ccm). A 365 micron PercuFib bare ended fibre was used in combination with a 26 French continuous flow laser resectoscope. Measured outcomes were resection time, decrease in hemoglobin and transfusion rate. Furthermore catheter-time, improvement in urinary flow rate, post-voidingresidual urine (PVR), AUA-SS and QoL score were recorded. Results: Average resection time was 52 minutes. After crossing the learning curve, a tissue ablation of approximately 1.5 g/min is possible. Transfusions were not necessary in any patient. Catheter time was 1,7 days (1 to 3 days). Q-max significantly improved from 4.2 to 20.1 ml in average. PVR decreased from 86 to 12 ml. AUA-SS and QoL-Score improved from 19.8 to 6.9 and 4 to 1 respectively. No patient required re-hospitalisation. Conclusions: This preliminary results indicate that RevoLix 2 micron cw vaporesection of the prostate is a safe and efficient procedure. One year followup data showed a significant improvement in voiding symptoms and patients quality of life. Longer follow-up is needed, to compare the long term results with transurethral resection of the prostate.

Van

Moerkerk

H.2,

Daamen

W.2,

Oosterwijk

E.1,

Radboud University Nijmegen Medical Centre, Department of Urology, Nijmegen, The Netherlands, 2Radboud University Nijmegen Medical Centre, Department of Biochemistry, Nijmegen, The Netherlands 1

Introduction & Objectives: Different scaffolds have been used for bladder wall regeneration. In search for better materials we have developed collagen scaffolds and compared the invitro viability and proliferation of seeded urothelial and smooth muscle cells on 3 different collagen scaffolds and the commercially available small intestinal submucosa (SIS®). Material & Methods: Collagen scaffolds were created from cross-linked bovine collagen type I: 1) a porous scaffold with large pore size; 2) a dual-layer scaffold, combining a thin film-layer, with small pores, with a porous layer; 3) a porous scaffold with one closed side. Urothelial cells (SCaBER celline) and smooth muscle cells (PM151T celline) were seeded separately on these scaffolds and on the SIS® scaffold, and cultured under standard conditions. After 3, 7, 14 and 21 days cell viability and proliferation was analysed with the WST-1 assay. Statistical analysis was performed using the univariate ANOVA test. Additionally, (immuno-) histological examination of the scaffolds by H&E, cytokeratins AE1/ AE3 and E-cadherin (urothelial cells), and α-smooth muscle actin (smooth muscle cells) was performed. Results: Progressive growth of urothelial and smooth muscle cells was observed on all scaffolds. Collagen scaffolds showed better proliferation and viability of cells in comparison to SIS® (p<0.001). No statistically significant differences were seen between the different collagen scaffolds. Histology and immunohistochemistry demonstrated the formation of continuous multi layered urothelial and single layered smooth muscle cells on top of all scaffolds. Minimal penetration of cells into the scaffolds occurred as of the 14 days timepoint, exclusively in the collagen scaffolds. Furthermore, histology showed cell-nuclei in the seeded and unseeded SIS® scaffold, indicating porcine DNA was still residing, as earlier reported 1. The collagen scaffolds were completely clear of cellular remnants. Conclusions: Based on in-vitro cell proliferation, collagen scaffolds are better devices for cell growth than the SIS® scaffold. Furthermore, the collagen scaffolds are better defined and not contaminated with cellular remnants. 1 Feil et al. Investigations of urothelial cells seeded on commercially available small intestinal submucosa. European Urology 2006; June 16

Eur Urol Suppl 2007;6(2):137