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567 Holmium laser enucleation of the prostate (HOLEP) versus open prostatectomy for prostates >70 GR: Short term follow-up
565 TRANSURETHRAL IS IT A DURABLE Phillips
J., Rosario
NEEDLE OPTION?
ABLATION
OF THE
D., Hazel1 J., Chapple
C.
Hospital,
of Urology,
PROSTATE
(TUNA)
566 -
IMPACT OF HOLMIUM LASER ENUCLEATION (HOLEP) VERSUS TRANS-URETHRAL RESECTION (TURP) OF THE PROSTATE ON SEXUAL FUNCTION: RESULTS OF A PROSPECTIVE MULTICENTRIC RANDOMIZED TRIAL Briganti A.‘, Naspro Rigatti P.‘, Montorsi
R.‘, Vavassori F.’
INTRODUCTION & OBJECTIVES: Transurethral needle ablation (TUNATM) of the prostate is a minimally invasive technique for the treatment of symptomatic benign prostatic obstruction @PO). Whilst safe and providing significant symptomatic improvement in the short-term, there is little published evidence on its long-term benefit. The aim of this study was to re-evaluate the outcome seven years after TUNATM in a cohort of men with documented BP0 at the outset.
‘Scientific ‘Cliniche
H. San Raffaele, Department of Urology, Department of Urology, Bergamo, Italy
MATERIAL & METHODS: Seventy-one men who had previously undergone TUNATM more than seven years previously were re-evaluated using clinical outcome, IPSS symptom score, uroflowmetry, and residual urine estimation. The median follow-up period was 102 months (range 92 105 months). Treatment failure was defined as those patients who required further intervention to control lower urinary tract symptoms.
MATERIAL & METHODS: Between January and December 2002 100 patients (mean age &SD: 64.617.3 yrs; range 49-79) affected by BPH have been enrolled in this study. 52 out of 100 patients (mean age &SD: 65.14*7.1 yrs) underwent HoLEP (Group 1) and 48 (mean age *SD: 64.517.4 yrs) underwent TURP (Group 2), p=O.9. Baseline assessment, follow-up at 3 and 6 months based on sexual and medical history; physical examination, total serum PSA, trans-rectal ultrasound, uroflowmetry and International Index of Erectile Function (IIEF) were performed. Statistical analysis has been performed by means of the Student’s t test and ChiSquare Test. Data are shown as mean *SD.
Royal
Hallamshire
Department
Sheffield,
United
Kingdom
RESULTS: Of the original 71 patients, 10 (14%) died from unrelated causes during the follow-up period. 35 patients (49%) have undergone further surgery, which included TURP (n=32), BNI (n=2), or thermo-ablation (n=l). The median time to symptom recurrence for this group was 12 months. Of those remaining, 14 patients continue to be satisfied with their symptoms (QLA score O-2), of which 7 are concomitantly on alpha-receptor antagonists, 24 men had received either alpha-blockade only or no further intervention after 7 years, of whom 15 (62.5%) returned for full re-assessment. All of these were obstructed on uroflowmetry, regardless of their symptom status. CONCLUSIONS: Whilst TUNATM provides early symptomatic relief in the majority, it does not appear to provide durable long-term symptomatic improvement, and should not be recommended as a standard treatment option for symptomatic BPO.
Institute Gavazzeni,
I.*, Suardi N.‘,
Salonia A.‘,
Mazzoccoli
B.r,
Milan,
Italy,
INTRODUCTION & OBJECTIVES: This study was aimed at investigating clinical sexual function outcome in patients affected by Benign Prostatic Hyperplasia (BPH) undergoing either Holmium laser enucleation (HoLEP) or trans.urethral resection (TURP) of the prostate.
RESULTS: None of the 100 patients affected by BPH presented any preoperatively anatomic alteration of the penis assessed at the physical examination, IIEF Erectile Function Domain (Group 1 vs. Group 2). Baseline: 21.4i3.1 vs. 22.3h3.6 (p=O.5); Three months follow-up: 23.5h3.6 vs. 23.4i3.5 (p=O.67); Six months follow-up: 23.8h3.9 vs. 24.113.7 (p=0.55).IIEF Orgasmic Function Domain (Group 1 vs. Group 2). Baseline: 8.5 h2.1 vs. 8.751.9 (p=O.5); Three months follow-up: 6.511.2 vs. 5.911.1 (p=O.67); Six months follow-up: 6.5*1.3 vs. 6.311.1 (p=O.71). The statistical analysis shows a signiticative difference concerning IIEF Orgasmic Function Domain between pre and post-operative data both in TURP (p
567 HOLMIUM LASER ENUCLEATION VERSUS OPEN PROSTATECTOMY TERM FOLLOW-UP
OF THE PROSTATE (HOLEP) FOR PROSTATES >70 GR: SHORT
Naspro R., Mazzoccoli B., Suardi N., Salonia A., Deho’ F., D1 Glrolamo V.. Colombo R., Guazzoni G., Rigattl P., Montorsi F. University
Vita-Salute, Scientific Institute H. San Raffaele, Department of Urology, Milan. Italy
INTRODUCTION & OBJECTIVES: To compare intra and peri-operative outcomes and follow-up after holmium laser enucleation (HoLEP) or standard open prostatectomy for the treatment of benign prostatic hyperplasia (BPH) of prostates >70 gr. IMATERIAL & METHODS: From March to August 2003, 40 consecutive patients with symptomatic BPH and a prostatic weight >70gr were prospectively random&d to be treated surgically either with HoLEP (group 1, n=20) or standard open prostatectomy (group 2: n=20). Patients of both groups were pre-operatively assessed by scoring of subjectwe symptoms with International Prostate Symptom Score (I-PSS) and Quality of life (QoL) questionnaires, physical exam including digital rectal examination, total serum PSA level, kidney-bladder and tram-rectal prostatic ultrasonography. Total time in the operative room, tune of morcellation, total grams oftissue removed, pre-operative and post-operative serum haemoglobin levels, time of catheterization, of hospital stay and histologic diagnosis were also assessed. Patients were evaluated at 1 and 3 month follow-up with the same tests. RESULTS: The mean pre-operative trans.rectal ultrasound volume of the prostates was (meaniSE) 108.15*30.5 grand 116.7*24.02 gr (p=O.33) and volume of the adenoma was (meaniSE) 75.8-1-34.5 grand X2.5+4.5 gr (p-0.41), in the HoLEP and open prostatectamy groups respectively. Pre-operative total PSA values (meaniSE) were 5.X13.01 ngidl and 6.9+2.89 ngidl (p=O.29), in the HoLEP and open prostatectomy groups respectively. Time of the operation was overall longer in the HoLEP group (62.9118.3 mins vs. 53.5+11.5 mins, p=O.O6), whilst catheter removal (1.5+1.07 days and 4.110.5 days) and hospital stay (2711.07 days vs. 5.4+1.05 days, p
European
Urology
Supplements
3 (2004)
No. 2, pp.
144
568 PROSPECTIVE STUDY OF FLUID ABSORPTION USING ETHANOL TAGGED IRRIGANT FLUID ESTIMATION Bapat S.‘, Umranikar ‘Maharashtra 2Maharashtra India
IN TURP & SERUM
& HOLEP SODIUM
S. ‘, Satav V.‘, Bapat A.‘, Joshi A.2, Ranade G2
Medical Medical
Foundation, Foundatmn,
Joshi Hospital, Department Joshi Hospital, Department
of Urology, Pune, India, of Anaesthesiology, Pune,
INTRODUCTION & OBJECTIVES: To detect and compare occurrence and volume of fluid absorbed during Holmium enucleation of prostate (HoLEP) and conventional TURP using ethanol (l%w/v) tagged fluid and Serum Sodium (S. Na.) concentration. MATERIAL & METHODS: This prospective study comprised of 50 patients of symptomatic BPH of which 26 underwent TURP and 24 HoLEP. It was conducted after Ethics Committee approval and informed consent. All patients were investigated as per the institutional protocol. Patients were matched for age and other parameters. Irrigation fluid was sterile water, tagged with ethanol (l%w/v). Procedure was performed under spinal (10) or epldural (40). Irma-operative vitals and expired breath ethanol using alcohol breathalyser were monitored at IO-minute intervals. Sr. Na. estimations were done pre and postoperatively. Volume resected and total resection time was noted. Results were analysed statistically using standard nomograms. Majority of patients (45150) were operated by a single operator. RESULTS: 1 Patient data Average gland resected Resection time
In millilitres.
1 HoLEP
TlJRP
13.8 gms
19.7 gms
I 40 minutes
I 43 minutes
300
280
1
900 -980
CONCLUSIONS: Fluid absorption was detected in 32150 patients (HoLEP - 10124 and TURP - 22126). Of the 18 patients with no absorption, 14 underwent HoLEP. Volume of absorbed fluid in HoLEP was very small. This study conclusively proved that HoLEP is associated with mild to negligible fluid absorption and low risk of TUR syndrome. Quantification of fluid absorption was very easy and more accurate with alcohol breathalyser.
J., Rosario
NEEDLE OPTION?
ABLATION
OF THE
D., Hazel1 J., Chapple
C.
Hospital,
of Urology,
PROSTATE
(TUNA)
566 -
IMPACT OF HOLMIUM LASER ENUCLEATION (HOLEP) VERSUS TRANS-URETHRAL RESECTION (TURP) OF THE PROSTATE ON SEXUAL FUNCTION: RESULTS OF A PROSPECTIVE MULTICENTRIC RANDOMIZED TRIAL Briganti A.‘, Naspro Rigatti P.‘, Montorsi
R.‘, Vavassori F.’
INTRODUCTION & OBJECTIVES: Transurethral needle ablation (TUNATM) of the prostate is a minimally invasive technique for the treatment of symptomatic benign prostatic obstruction @PO). Whilst safe and providing significant symptomatic improvement in the short-term, there is little published evidence on its long-term benefit. The aim of this study was to re-evaluate the outcome seven years after TUNATM in a cohort of men with documented BP0 at the outset.
‘Scientific ‘Cliniche
H. San Raffaele, Department of Urology, Department of Urology, Bergamo, Italy
MATERIAL & METHODS: Seventy-one men who had previously undergone TUNATM more than seven years previously were re-evaluated using clinical outcome, IPSS symptom score, uroflowmetry, and residual urine estimation. The median follow-up period was 102 months (range 92 105 months). Treatment failure was defined as those patients who required further intervention to control lower urinary tract symptoms.
MATERIAL & METHODS: Between January and December 2002 100 patients (mean age &SD: 64.617.3 yrs; range 49-79) affected by BPH have been enrolled in this study. 52 out of 100 patients (mean age &SD: 65.14*7.1 yrs) underwent HoLEP (Group 1) and 48 (mean age *SD: 64.517.4 yrs) underwent TURP (Group 2), p=O.9. Baseline assessment, follow-up at 3 and 6 months based on sexual and medical history; physical examination, total serum PSA, trans-rectal ultrasound, uroflowmetry and International Index of Erectile Function (IIEF) were performed. Statistical analysis has been performed by means of the Student’s t test and ChiSquare Test. Data are shown as mean *SD.
Royal
Hallamshire
Department
Sheffield,
United
Kingdom
RESULTS: Of the original 71 patients, 10 (14%) died from unrelated causes during the follow-up period. 35 patients (49%) have undergone further surgery, which included TURP (n=32), BNI (n=2), or thermo-ablation (n=l). The median time to symptom recurrence for this group was 12 months. Of those remaining, 14 patients continue to be satisfied with their symptoms (QLA score O-2), of which 7 are concomitantly on alpha-receptor antagonists, 24 men had received either alpha-blockade only or no further intervention after 7 years, of whom 15 (62.5%) returned for full re-assessment. All of these were obstructed on uroflowmetry, regardless of their symptom status. CONCLUSIONS: Whilst TUNATM provides early symptomatic relief in the majority, it does not appear to provide durable long-term symptomatic improvement, and should not be recommended as a standard treatment option for symptomatic BPO.
Institute Gavazzeni,
I.*, Suardi N.‘,
Salonia A.‘,
Mazzoccoli
B.r,
Milan,
Italy,
INTRODUCTION & OBJECTIVES: This study was aimed at investigating clinical sexual function outcome in patients affected by Benign Prostatic Hyperplasia (BPH) undergoing either Holmium laser enucleation (HoLEP) or trans.urethral resection (TURP) of the prostate.
RESULTS: None of the 100 patients affected by BPH presented any preoperatively anatomic alteration of the penis assessed at the physical examination, IIEF Erectile Function Domain (Group 1 vs. Group 2). Baseline: 21.4i3.1 vs. 22.3h3.6 (p=O.5); Three months follow-up: 23.5h3.6 vs. 23.4i3.5 (p=O.67); Six months follow-up: 23.8h3.9 vs. 24.113.7 (p=0.55).IIEF Orgasmic Function Domain (Group 1 vs. Group 2). Baseline: 8.5 h2.1 vs. 8.751.9 (p=O.5); Three months follow-up: 6.511.2 vs. 5.911.1 (p=O.67); Six months follow-up: 6.5*1.3 vs. 6.311.1 (p=O.71). The statistical analysis shows a signiticative difference concerning IIEF Orgasmic Function Domain between pre and post-operative data both in TURP (p
567 HOLMIUM LASER ENUCLEATION VERSUS OPEN PROSTATECTOMY TERM FOLLOW-UP
OF THE PROSTATE (HOLEP) FOR PROSTATES >70 GR: SHORT
Naspro R., Mazzoccoli B., Suardi N., Salonia A., Deho’ F., D1 Glrolamo V.. Colombo R., Guazzoni G., Rigattl P., Montorsi F. University
Vita-Salute, Scientific Institute H. San Raffaele, Department of Urology, Milan. Italy
INTRODUCTION & OBJECTIVES: To compare intra and peri-operative outcomes and follow-up after holmium laser enucleation (HoLEP) or standard open prostatectomy for the treatment of benign prostatic hyperplasia (BPH) of prostates >70 gr. IMATERIAL & METHODS: From March to August 2003, 40 consecutive patients with symptomatic BPH and a prostatic weight >70gr were prospectively random&d to be treated surgically either with HoLEP (group 1, n=20) or standard open prostatectomy (group 2: n=20). Patients of both groups were pre-operatively assessed by scoring of subjectwe symptoms with International Prostate Symptom Score (I-PSS) and Quality of life (QoL) questionnaires, physical exam including digital rectal examination, total serum PSA level, kidney-bladder and tram-rectal prostatic ultrasonography. Total time in the operative room, tune of morcellation, total grams oftissue removed, pre-operative and post-operative serum haemoglobin levels, time of catheterization, of hospital stay and histologic diagnosis were also assessed. Patients were evaluated at 1 and 3 month follow-up with the same tests. RESULTS: The mean pre-operative trans.rectal ultrasound volume of the prostates was (meaniSE) 108.15*30.5 grand 116.7*24.02 gr (p=O.33) and volume of the adenoma was (meaniSE) 75.8-1-34.5 grand X2.5+4.5 gr (p-0.41), in the HoLEP and open prostatectamy groups respectively. Pre-operative total PSA values (meaniSE) were 5.X13.01 ngidl and 6.9+2.89 ngidl (p=O.29), in the HoLEP and open prostatectomy groups respectively. Time of the operation was overall longer in the HoLEP group (62.9118.3 mins vs. 53.5+11.5 mins, p=O.O6), whilst catheter removal (1.5+1.07 days and 4.110.5 days) and hospital stay (2711.07 days vs. 5.4+1.05 days, p
European
Urology
Supplements
3 (2004)
No. 2, pp.
144
568 PROSPECTIVE STUDY OF FLUID ABSORPTION USING ETHANOL TAGGED IRRIGANT FLUID ESTIMATION Bapat S.‘, Umranikar ‘Maharashtra 2Maharashtra India
IN TURP & SERUM
& HOLEP SODIUM
S. ‘, Satav V.‘, Bapat A.‘, Joshi A.2, Ranade G2
Medical Medical
Foundation, Foundatmn,
Joshi Hospital, Department Joshi Hospital, Department
of Urology, Pune, India, of Anaesthesiology, Pune,
INTRODUCTION & OBJECTIVES: To detect and compare occurrence and volume of fluid absorbed during Holmium enucleation of prostate (HoLEP) and conventional TURP using ethanol (l%w/v) tagged fluid and Serum Sodium (S. Na.) concentration. MATERIAL & METHODS: This prospective study comprised of 50 patients of symptomatic BPH of which 26 underwent TURP and 24 HoLEP. It was conducted after Ethics Committee approval and informed consent. All patients were investigated as per the institutional protocol. Patients were matched for age and other parameters. Irrigation fluid was sterile water, tagged with ethanol (l%w/v). Procedure was performed under spinal (10) or epldural (40). Irma-operative vitals and expired breath ethanol using alcohol breathalyser were monitored at IO-minute intervals. Sr. Na. estimations were done pre and postoperatively. Volume resected and total resection time was noted. Results were analysed statistically using standard nomograms. Majority of patients (45150) were operated by a single operator. RESULTS: 1 Patient data Average gland resected Resection time
In millilitres.
1 HoLEP
TlJRP
13.8 gms
19.7 gms
I 40 minutes
I 43 minutes
300
280
1
900 -980
CONCLUSIONS: Fluid absorption was detected in 32150 patients (HoLEP - 10124 and TURP - 22126). Of the 18 patients with no absorption, 14 underwent HoLEP. Volume of absorbed fluid in HoLEP was very small. This study conclusively proved that HoLEP is associated with mild to negligible fluid absorption and low risk of TUR syndrome. Quantification of fluid absorption was very easy and more accurate with alcohol breathalyser.