545 BIPOLAR PLASMA VAPORIZATION AND NBI FOR LARGE NON-MUSCLE INVASIVE BLADDER TUMORS — RESULTS OF A PROSPECTIVE, RANDOMIZED, LONG TERM COMPARISON TO THE STANDARD APPROACH

TUR (p<0.05 for each). In multivariate analysis, the number of T1 chips on the first TUR (>1chips vs. 1chip; hazard ratio 15.8; p=0.016) and urine cytology between the first and the second TUR (positive vs. negative; hazard ratio 9.0; p=0.006) were the significant predictors for residual tumor on the second TUR. Of 15 patients with multiple T1 chips and positive urine cytology between the first and the second TUR, 13 (87%) had residual tumor on the second TUR, compared to 0% (0/15) in those with one T1 chip and negative urine cytology between the first and the second TUR. Conclusions: Second TUR may not be necessary for all T1 high-grade bladder urothelial carcinoma. Using the number of T1 chips on the first TUR and urine cytology between the first and the second TUR, we can skip second TUR for some patients and start intravesical BCG therapy early.

545

Bipolar plasma vaporization and NBI for large non-muscle invasive bladder tumors – Results of a prospective, randomized, long term comparison to the standard approach

Geavlete B., Multescu R., Stanescu F., Georgescu D., Jecu M., Geavlete P. 'Saint John' Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: This study aimed to evaluate the diagnostic accuracy and surgical efficacy of a new diagnostic and treatment approach consisting of narrow band imaging cystoscopy (NBIC) associated with bipolar plasma vaporization (BPV) by comparison to standard white light cystoscopy (WLC) and monopolar transurethral resection (TURBT) in cases of large bladder tumors. ReTUR and long-term recurrence rates were also assessed. Materials & Methods: A total of 210 patients with bladder tumors over 3 cm were included in the trial based on abdominal ultrasonography, computer tomography and flexible WLC. In one arm, 105 patients underwent WLC and NBIC, followed by BPV, while in the other 105 cases, only WLC and TURBT were performed. All NMIBC patients underwent standard Re-TUR 4 weeks after the initial procedure and follow-up urinary cytology and WLC at 3, 6, 9 and 12 months. Results: The preoperative parameters were similar in the two study groups. The CIS, pTa, pT1 and overall tumors’ detection rates in the NBIC-BPV arm were significantly improved for NBIC by comparison to WLC (95% versus 62.5%, 91% versus 78.1%, 95.7% versus 89.2% and 93.4% versus 80.6%, respectively). The rate of false positive results was 15.5% for NBIC versus 12.2% for WLC. The operation time, catheterization period and hospital stay were significantly shorter in the BPV arm. The obturator nerve stimulation, bladder wall perforation, mean hemoglobin drop, postoperative bleeding and blood transfusion rate were significantly reduced for BPV by comparison to monopolar TURBT. Perioperative parameters

BPV

TURBT

Operation time

19.1 min

31.3 min

Catheterization period

2.5 days

3.5 days

Hospital stay

3.5 days

4.5 days

Obturator nerve stimulation

3.6 %

19.1 %

7 times

56 times

Bladder wall perforation

0.9%

6.4%

Mean hemoglobin drop

0.2 g/dl

0.9 g/dl

Postoperative bleeding

0.9 %

5.5 %

Blood transfusion

0.9 %

4.5 %

The residual tumors’ rates at Re-TUR for overall, primary site and initial multiple tumors’ were significantly lower in the NBIC-BPV arm (8.4% versus 20.6%, 7.4% versus 18.5% and 8.5% versus 21.2%, respectively). The one year recurrence rate was significantly reduced in the NBIC-BPV group (18.9% versus 35.1%). Conclusions: NBIC significantly improved the diagnostic accuracy in NMIBC. BPV emphasized superior efficacy and reduced complication rate by comparison to TURBT. This combined new diagnostic and treatment approach provided a lower residual tumors’ rate at Re-TUR and a reduced recurrence rate during the one year follow-up.

546

Risk of transurethral resection of bladder cancer in octogenarians

status was established according to ECOG and Karnofsky ratings. Comorbidity was defined according to the scale of Charlson and anesthetic risk according to ASA classification. Postoperative complications were recorded during hospitalization and three months classified according to Clavien scale. We compared the risk of postoperative complications according to different classifications using the X2 test, and studied at the same time the possible association of each comorbidity individually with the risk of complications Results: A total of 111 patients with a new bladder cancer diagnosis was analyzed. The mean age was 85 years for the whole population. 74.8% were male. Patients characteristics were as follows: - ECOG ≥ 2: 28% (30 patients) - Karnofsky <80: 41.1% (44 patients). - Charlson> 2: 21.6% (24 patients) - ASA IV: 10.1% (11 patients)39 patients (35.8%) had postoperative complications of whom 7 (6.4%) had complications that led to serious consequences or lead to the death of the patient (Clavien’s grade 4-5 ) The risk of complications according to the preoperative classification was 3% in patients with better performance status and without comorbidities. In patients with poor general condition (Karnofsky < 80) and comorbidity (Charlson> 2) the risk for severe complications increased to 57.15 % (p 0.005) Conclusions: Morbidity of TURBT in octogenarians is significant. This should not be underestimated and must be weighed in making treatment decisions in these patients. Both baseline classifications such as comorbidity or anesthetic risk are useful predictors of an increased risk of postoperative complications, which can reach up to 57% in selected patients.

547

Puppo P., Introini C., Germinale F., Naselli A. National Institute for Cancer Research, Dept. of Urology, Genoa, Italy Introduction & Objectives: The main limit of the standard transurethral resection of bladder cancer is the fragmentation of the specimen. Tumor fragmentation may impair the pathological analysis. Infiltration of lamina propria or of muscular tissue may be not recognized as well as their extension may not be adequately assessed. Moreover disruption of the integrity of the tumor may be responsible of tumor seeding. The en bloc transurethral resection overcomes the problem of fragmentation. The technique has been previously described. Unfortunately only small lesions fit for the procedure as the specimen is retrieved through the resectoscope with the standard evacuator. We demonstrated in a consecutive series of patients that resection and extraction of the specimen in one piece is feasible by means of Collins loop, a resectoscope with a 5 mm working channel and a 5 mm laparoscopic forceps for lesions up to 4 cm. Materials & Methods: The bladder wall was incised around the lesion by mean of a Collins loop activated by bipolar cutting current starting from apparently sane mucosa surrounding the base and was then prolonged through the subepithelial connective tissue, muscolaris mucosae and muscolaris propria strata. During the procedure the bladder was filled at a medium capacity and the muscular fibers sectioned cautiously, inclining the loop, to avoid any serious perforation, from the periphery to the center of the lesion base. After the lesion was detached from the bladder a 5 mm laparoscopic forceps was inserted in the working channel and the tumor was grasped. Then the resectope was gently retrieved from bladder through the urethra. Each specimen was macroscopically orientated and examined to assess its greatest dimension. Circumferential lateral and base margins were macro and microscopically assessed. Results: 21 consecutive patients were submitted to the procedure in 2010. Median age was 65 years(44 – 79). 18 were males and 3 females. The neoplasm was newly diagnosed in 7 and recurrent in 14; it was single in 9 and multiple in 12. A total of 38 lesions were identified. 34, including 3 in proximity or surrounding the ureteral orifice, were treated by en bloc resection whereas 4 in the bladder neck of 3 male patients were resected with the traditional technique. The median dimension of the lesion extracted from the bladder was 2 cm, range 0.5 – 4.5 cm. 9 lesions were greater than 3 cm. No death or major surgical/medical complications were registered. Pathological examination revealed the presence of muscle tissue in 33/34 (97%) lesions. The circumferential lateral margins were positive in 4 lesions (12%) in a total of 2 patients (9.5%). Conclusions: Our technique of en bloc transurethral resection is feasible for most cases of bladder neoplasms. It is reproducible and may improve the quality of the endoscopic management of bladder cancer.

Diaz F.J.1, Hernández V.1, De La Peña E.1, Martin M.D.2, Blazquez C.1, Amaruch N.1, Llorente C.1 1 Hospital y Hospital Fundacion Alcorcón, Dept. of Urology, Madrid, Spain, 2Hospital Y Hospital Fundacion Alcorcón, Dept. of Preventive Medicine, Madrid, Spain Introduction & Objectives: As estimated by National agencies an increase of 19.2% for people older than years will take place in Spain over the next decade. This raise will more noticeable in octogenarians. As a consequence of the high prevalence of bladder cancer in our country it is of clinical interest to ascertain the surgical risk of those geriatric patients submitted to TURBT. The objective of this study is to evaluate specific surgical risk of TURBT in geriatric patients and to identify the best tool to predict potential complications. Materials & Methods: A retrospective study of all patients undergoing TURBT between 1999-2009, ≥ 80 years at diagnosis was done. The baseline performance

Feasibility of en bloc transurethral resection of bladder lesions up to 4.5 cm

Poster Session 46 BPH: BASIC RESEARCH Sunday, 20 March, 14.00-15.30, Hall E1

548

Elocalcitol improves effects by tolterodine in rats with partial urethral obstruction

Streng T.1, Andersson K.E.2, Hedlund P.3, Gratzke C.4, Baroni E.5, D’Ambrosio D.5, Benigni F.3 1 Turku University, Dept. of Pharmacology, Turku, Finland, 2Wake Forest University, Wake Forest Institute for Regenerative Medicine, Winston-Salem, United States

Eur Urol Suppl 2011;10(2):181