- Email: [email protected]
Botulinum toxin type A intravesical injections for intractable bladder overactivity
525 THE STANDARDISATION BLADDER
OF
ULTRASOUND
IMAGING
OF
THE
Radziszewski
Carter Simon’, Tubaro Andrea> ‘Urology, Charing Cross Hospital, L’Aquila University, L’Aquila, Italy
London,
United
Kingdom.
*Urology,
INTRODUCTION & OBJECTIVES: Ultrasound imaging of the bladder is commonly performed in most urology units since it was first introduced in 1967. The detrimental effect of the lack of standardisation in this field has probably been unrecognised. On behalf of the ICS committee on standardisation we have set up a subcommittee on standardisation of imaging and, after 3 years of work, we have produced a thorough analysis of peer-review literature and prepared a standardisation document on ultrasound imaging of the bladder. MATERIALS & METHODS: The Medline database was searched for references relative to standardisation of ultrasound imaging of the bladder and comparison of ultrasound bladder imaging with other imaging techniques. When no data were found available, recommendations were based on expert opinion. The following areas were covered: indications for static ultrasound imaging of the bladder in lower urinary tract dysfunction: preparation for static ultrasound imaging of the bladder in lower urinary tract dysfunction; recommendations for equipment used in bladder scanning; image collection, anatomical terms and orientation of images; standardisation issues in qualitative imaging of the bladder; measurement from static images of the bladder: bladder volume and bladder wall thickness and bladder mass; the measurement of the bladder neck position in women. RESULTS: Overall, 446 references were reviewed and 69 were considered to be of interest. The largest body of evidence was found as regards measurement of bladder volume and bladder neck position in women. The latter subject is the only area in which an attempt for standardisation had already been made. Review of available data resulted in a short list of major recommendations for each imaging issue. Areas of interest for future research were also defined. CONCLUSION: We hope that our effort will generate significant discussion as to the need for proper standardisation and training. Ultrasound imaging no longer pertains to radiology department only but is now part of the clinical daily practise of our speciality. 013
ADVANCED PROSTATE CANCER: HOFIMW THERAPY Tuesday,February 26,13.45-15.15 hcs, RoomE
CASTRATION AND OSTEOPORISRELATED 30-YEAR FOLLOW-UP Steineck Gunnarl,
526 BOTULINUM TOXIN TYPE A INTRAVESICAL INTRACTABLE BLADDER OVERACTIVITY
FRACTURES
Astrtim Kent?, Eriksson Elin’, Adolfsson
P.. Borkowski
Urology, Medical Academy
INJECTIONS
FOR
A. of Warsaw, Warszawa,
Poland
INTRODUCTION & OBJECTIVES: Botulinurn toxin type A (BTX) is a neurotoxin acting on presynaptic nerve terminals and causing chemical denervation of an appropriate muscle. BTX is known to produce improvement in both storage and voiding problems in patients with spinal cord in.jury. Therefore we decided to evaluate the response to BTX treatment in bladder overactivity in the patients with no underlying neurological cause of their disease. MATERJALS & METHODS: In our studies we included 12 patients (6 females, 6 males, mean age 60.8 years) with idiopathic bladder overactivity and urge incontinence. None of the patients demonstrated any neurological pathology. In case of bladder overactivity all patients demonstrated prior resistance to anticholinergic drugs or anticholinergic treatment was contraindicated. BTX (Dysport @, Boufour Ipsen International) was diluted in normal saline ex tempore to the final titration of 100 u/ml. The solution was injected through the cystoscope via 1% Cook endoscopic needle into IO-IS sites of the detrussor muscle, sparing the trigone. IO-20 u of BTX was used per injection site up to the total dose of 300 u. The procedure was performed under short intravenous anaesthesia. The post treatment evaluation included urodynamic evaluation and voiding diary performed one month after the treatment. RESULTS: All patients voided spontaneously after the procedure. No acute urinary retention occurred. Subjective improvement on the first post treatment day was considerable in terms of frequency, urgency and incontinence. One month after the treatment no patient demonstrated detrussor instability during urodynamic examination. A statistically significant reduction in the total number of micturitions (from 19.2 to 9.1 in the average) and a statistically significant increase in maximum cystometric capacity (from 321.2 ml to 408.3 ml in the average) was observed. All patients were continent. All patients voided efficiently without postvoid residual. They reported no dysuria. CONCLUSION: Our pilot study demonstrated that BTX might be a treatment of choice in refractory bladder overactivity. All patients at one month follow-up were cured from their symptoms (no instability, no urge incontinence). The exact mechanism of BTX action on bladder afferents and efferents remains to be elucidated.
527
528
IN A
IS THE EFFICACY OF HORMONAL THERAPY AFFECTED BY LYMPH NODE STATUS NEW DATA FROM THE BJCALUTAMIDE EPC PROGRAMME
Jan’
Iversen Peter’, Wirth Kevin’,
Manfred’. See William’, McLeod David”, Morris Thomas’, on behalf of the ‘Casodex Early Prostate Cancer Trialists’ Group
Carroll
‘Oncology and Pathology, Karolinska Institute, Clinical Epidemiology, Stockholm, Sweden, ZOncology and Pathology, Karolinska Institute, Clinical Institute, KARO, Cancerepidemiology, Stockholm, Sweden, 3Karolinska Stockholm, Sweden
‘Rigshospitalet, Copenhagen, Denmark. Germany, 3Medical College of Wisconsin, Reed Army Medical Centre, Washington Macclesfield, United Kingdom
INTRODUCTION & OBJECTIVES: Castration gives osteoporosis and may cause clinically important fractures. Due to the unique civic registration number for each citizen, information in several population-based registers can be matched in Sweden, allowing long-term follow-up.
INTRODUCTION & OBJECTIVES: Recent results from the large international trial programme on early prostate cancer (EPC) therapy showed that bicalutamide (‘Casodex‘) I50 mg in addition to standard care significantly reduces the risk of objective disease progression by 42% (p<
MATERIALS & METHODS: We identified (in the Swedish Cancer Registry) the 126 238 men with prostate cancer diagnosed in Sweden 1960-97, and analysed those 30 082 who were orchidectomised concerning occurrence of fractures (data from in-patient register 1964.97). Two control groups were used, prostate cancer patients without an orchidectomy and 631 190 population controls (matched for age and residency). The cause-of death register gave the date of death or emigration, allowing calculations of person-time at risk. RESULTS: The relative risk of hip fractures (assesed to be dependent on osteoporosis, collum femur and pertrochanteric) among those orchiectomised with 95% confidence interval) was 2.02 (1.90-2.14) compared with population controls and I S7 (1.48-I.67) compared with prostate cancer patients. In looking at fractures not believed to be related to osteoporosis (scull and face) the corresponding relative risks were 1.25 (0.94-I .68) and I .I7 (0.89-l S3). Unexpectedly, the increased relative risk for hip fractures was highest during the first year of follow-up (RR=2.48) and after five years the relative risk was close to unity. CONCLUSIONS: Castration results in clinically important osteoporosisrelated fractures. and the excess cases occur during the first five years after the procedure. European Urology Supplements
1 (2002) No. 1, pp.134
ZTechnical University of Dresden, Dresden, Milwaukee, United States of America, “Walter DC, United States of America. 5AstraZeneca,
MATERIAL & METHODS: XI I3 men with non-metastatic prostate cancer were enrolled m the programme of 3 randomlsed, double-blind, placebo-controlled trials. Randomised patients received bicalutamide 150 mg (n=4052) or placebo (1~4061) once daily, in addition to standard are (radical prostatectomy, radiotherapy or watchful waning). Objective disease progression was determined by bone scan, CT scan, MRI or ultrasound. Time to PSA doubling from baseline was assessed from PSA test?, performed every 12 weeks. RESULTS: At randomlsation,
150. 4806 and 3157 panenta had N+. NO and Nx disease. respectively. After a median follow-up of 3 years, bicalutamide treatment significantly reduced the risk of objective disease progression in patients with NO and Nx prostate cancer (by 41% [HR 0.59; 95% Cl 0.48, 0.731 and 40% [HR 0.60; 95% Cl 0.50, 0.721. respectively), with the most pronounced reduction in risk of objective progre\aion seen in Nt patients (by 71% [HR 0.29: 95% Cl 0.15.0.56]). vs standard care alone. As expected. bicalutamide significantly increased the time to PSA doubling (by 59%’ IHR 0.41: 95% Cl 0.38.0.45; p<
CONCLUSIONS:
Irrespectwe of patient lymph node status, badutamide IS0 mg reduces the risk of objective dibeaae progressmn and PSA doubling in patients wtth localized or locally advanced prostate cancer when used as immediate therapy alone or a\ adjuvant to therapy of curative intent. The risk reductions are most pronounced in N+ patients. The\e results support the findings of othera [Messing et al. N Engl J Med 1999; 341: 17X1-1788: Granfors et al. J Ural 199X; 159: 2030.20341 where a prolongation of time to objective progresston associated with early endocrine therapy in N+ patient\ tramlated into a significant survival benefit. The EPC programme is ongoing and survival data are awaited. ‘Casodex’ IS a trademark of the AstraZeneca group of cornpaGe\.
OF
ULTRASOUND
IMAGING
OF
THE
Radziszewski
Carter Simon’, Tubaro Andrea> ‘Urology, Charing Cross Hospital, L’Aquila University, L’Aquila, Italy
London,
United
Kingdom.
*Urology,
INTRODUCTION & OBJECTIVES: Ultrasound imaging of the bladder is commonly performed in most urology units since it was first introduced in 1967. The detrimental effect of the lack of standardisation in this field has probably been unrecognised. On behalf of the ICS committee on standardisation we have set up a subcommittee on standardisation of imaging and, after 3 years of work, we have produced a thorough analysis of peer-review literature and prepared a standardisation document on ultrasound imaging of the bladder. MATERIALS & METHODS: The Medline database was searched for references relative to standardisation of ultrasound imaging of the bladder and comparison of ultrasound bladder imaging with other imaging techniques. When no data were found available, recommendations were based on expert opinion. The following areas were covered: indications for static ultrasound imaging of the bladder in lower urinary tract dysfunction: preparation for static ultrasound imaging of the bladder in lower urinary tract dysfunction; recommendations for equipment used in bladder scanning; image collection, anatomical terms and orientation of images; standardisation issues in qualitative imaging of the bladder; measurement from static images of the bladder: bladder volume and bladder wall thickness and bladder mass; the measurement of the bladder neck position in women. RESULTS: Overall, 446 references were reviewed and 69 were considered to be of interest. The largest body of evidence was found as regards measurement of bladder volume and bladder neck position in women. The latter subject is the only area in which an attempt for standardisation had already been made. Review of available data resulted in a short list of major recommendations for each imaging issue. Areas of interest for future research were also defined. CONCLUSION: We hope that our effort will generate significant discussion as to the need for proper standardisation and training. Ultrasound imaging no longer pertains to radiology department only but is now part of the clinical daily practise of our speciality. 013
ADVANCED PROSTATE CANCER: HOFIMW THERAPY Tuesday,February 26,13.45-15.15 hcs, RoomE
CASTRATION AND OSTEOPORISRELATED 30-YEAR FOLLOW-UP Steineck Gunnarl,
526 BOTULINUM TOXIN TYPE A INTRAVESICAL INTRACTABLE BLADDER OVERACTIVITY
FRACTURES
Astrtim Kent?, Eriksson Elin’, Adolfsson
P.. Borkowski
Urology, Medical Academy
INJECTIONS
FOR
A. of Warsaw, Warszawa,
Poland
INTRODUCTION & OBJECTIVES: Botulinurn toxin type A (BTX) is a neurotoxin acting on presynaptic nerve terminals and causing chemical denervation of an appropriate muscle. BTX is known to produce improvement in both storage and voiding problems in patients with spinal cord in.jury. Therefore we decided to evaluate the response to BTX treatment in bladder overactivity in the patients with no underlying neurological cause of their disease. MATERJALS & METHODS: In our studies we included 12 patients (6 females, 6 males, mean age 60.8 years) with idiopathic bladder overactivity and urge incontinence. None of the patients demonstrated any neurological pathology. In case of bladder overactivity all patients demonstrated prior resistance to anticholinergic drugs or anticholinergic treatment was contraindicated. BTX (Dysport @, Boufour Ipsen International) was diluted in normal saline ex tempore to the final titration of 100 u/ml. The solution was injected through the cystoscope via 1% Cook endoscopic needle into IO-IS sites of the detrussor muscle, sparing the trigone. IO-20 u of BTX was used per injection site up to the total dose of 300 u. The procedure was performed under short intravenous anaesthesia. The post treatment evaluation included urodynamic evaluation and voiding diary performed one month after the treatment. RESULTS: All patients voided spontaneously after the procedure. No acute urinary retention occurred. Subjective improvement on the first post treatment day was considerable in terms of frequency, urgency and incontinence. One month after the treatment no patient demonstrated detrussor instability during urodynamic examination. A statistically significant reduction in the total number of micturitions (from 19.2 to 9.1 in the average) and a statistically significant increase in maximum cystometric capacity (from 321.2 ml to 408.3 ml in the average) was observed. All patients were continent. All patients voided efficiently without postvoid residual. They reported no dysuria. CONCLUSION: Our pilot study demonstrated that BTX might be a treatment of choice in refractory bladder overactivity. All patients at one month follow-up were cured from their symptoms (no instability, no urge incontinence). The exact mechanism of BTX action on bladder afferents and efferents remains to be elucidated.
527
528
IN A
IS THE EFFICACY OF HORMONAL THERAPY AFFECTED BY LYMPH NODE STATUS NEW DATA FROM THE BJCALUTAMIDE EPC PROGRAMME
Jan’
Iversen Peter’, Wirth Kevin’,
Manfred’. See William’, McLeod David”, Morris Thomas’, on behalf of the ‘Casodex Early Prostate Cancer Trialists’ Group
Carroll
‘Oncology and Pathology, Karolinska Institute, Clinical Epidemiology, Stockholm, Sweden, ZOncology and Pathology, Karolinska Institute, Clinical Institute, KARO, Cancerepidemiology, Stockholm, Sweden, 3Karolinska Stockholm, Sweden
‘Rigshospitalet, Copenhagen, Denmark. Germany, 3Medical College of Wisconsin, Reed Army Medical Centre, Washington Macclesfield, United Kingdom
INTRODUCTION & OBJECTIVES: Castration gives osteoporosis and may cause clinically important fractures. Due to the unique civic registration number for each citizen, information in several population-based registers can be matched in Sweden, allowing long-term follow-up.
INTRODUCTION & OBJECTIVES: Recent results from the large international trial programme on early prostate cancer (EPC) therapy showed that bicalutamide (‘Casodex‘) I50 mg in addition to standard care significantly reduces the risk of objective disease progression by 42% (p<
MATERIALS & METHODS: We identified (in the Swedish Cancer Registry) the 126 238 men with prostate cancer diagnosed in Sweden 1960-97, and analysed those 30 082 who were orchidectomised concerning occurrence of fractures (data from in-patient register 1964.97). Two control groups were used, prostate cancer patients without an orchidectomy and 631 190 population controls (matched for age and residency). The cause-of death register gave the date of death or emigration, allowing calculations of person-time at risk. RESULTS: The relative risk of hip fractures (assesed to be dependent on osteoporosis, collum femur and pertrochanteric) among those orchiectomised with 95% confidence interval) was 2.02 (1.90-2.14) compared with population controls and I S7 (1.48-I.67) compared with prostate cancer patients. In looking at fractures not believed to be related to osteoporosis (scull and face) the corresponding relative risks were 1.25 (0.94-I .68) and I .I7 (0.89-l S3). Unexpectedly, the increased relative risk for hip fractures was highest during the first year of follow-up (RR=2.48) and after five years the relative risk was close to unity. CONCLUSIONS: Castration results in clinically important osteoporosisrelated fractures. and the excess cases occur during the first five years after the procedure. European Urology Supplements
1 (2002) No. 1, pp.134
ZTechnical University of Dresden, Dresden, Milwaukee, United States of America, “Walter DC, United States of America. 5AstraZeneca,
MATERIAL & METHODS: XI I3 men with non-metastatic prostate cancer were enrolled m the programme of 3 randomlsed, double-blind, placebo-controlled trials. Randomised patients received bicalutamide 150 mg (n=4052) or placebo (1~4061) once daily, in addition to standard are (radical prostatectomy, radiotherapy or watchful waning). Objective disease progression was determined by bone scan, CT scan, MRI or ultrasound. Time to PSA doubling from baseline was assessed from PSA test?, performed every 12 weeks. RESULTS: At randomlsation,
150. 4806 and 3157 panenta had N+. NO and Nx disease. respectively. After a median follow-up of 3 years, bicalutamide treatment significantly reduced the risk of objective disease progression in patients with NO and Nx prostate cancer (by 41% [HR 0.59; 95% Cl 0.48, 0.731 and 40% [HR 0.60; 95% Cl 0.50, 0.721. respectively), with the most pronounced reduction in risk of objective progre\aion seen in Nt patients (by 71% [HR 0.29: 95% Cl 0.15.0.56]). vs standard care alone. As expected. bicalutamide significantly increased the time to PSA doubling (by 59%’ IHR 0.41: 95% Cl 0.38.0.45; p<
CONCLUSIONS:
Irrespectwe of patient lymph node status, badutamide IS0 mg reduces the risk of objective dibeaae progressmn and PSA doubling in patients wtth localized or locally advanced prostate cancer when used as immediate therapy alone or a\ adjuvant to therapy of curative intent. The risk reductions are most pronounced in N+ patients. The\e results support the findings of othera [Messing et al. N Engl J Med 1999; 341: 17X1-1788: Granfors et al. J Ural 199X; 159: 2030.20341 where a prolongation of time to objective progresston associated with early endocrine therapy in N+ patient\ tramlated into a significant survival benefit. The EPC programme is ongoing and survival data are awaited. ‘Casodex’ IS a trademark of the AstraZeneca group of cornpaGe\.