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C23 BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE VERSUS STANDARD TURP - "THE BETTER VHOICE" IN BPH ENDOSCOPIC TREATMENT?
Measurements: Age-matched comparison of the IPSS and various aspects of urinary incontinence between the RPE and the healthy control group. Results: A total of 363 patients with a mean follow-up after RPE of 7.6yrs (range: 5-14yrs) were included (n=363). Age-matched healthy men (n=363) served as controls. The mean IPSS of patients after RPE aged 61-70yrs (age refers to the year 2009) (n=172) was 5.0+4.4 (IPSS-Ql: 1.1+1.0) as compared to 5.5+4.9 (IPSSQl: 2.1+1.0) in the healthy age-matched cohort (n=269); the respective values for men aged 71-80yrs (RPE, n=191) were 6.0+4.9 (IPSS-Ql: 1.2+1.0) versus 7.5+5.7 (IPSS-Ql: 2.6+1.2) in the healthy cohort (n=106). Urinary incontinence defined as any involuntary loss during the past 4 weeks (Bristol female LUTS questionnaire) after RPE was reported in 41.9% (61-70yrs) and 37.7% (71-80yrs); the corresponding figures for healthy men were 7.5% and 15.1%. The retrospective nature of the study is the major limitation. Conclusions: This long-term comparative study demonstrates that patients after RPE have less LUTS, better LUTS related quality of life lower rates of urge urinary incontinence than unoperated, healthy men. These observations are most likely due to the long-standing absence of bladder outflow obstruction. Given the long-life expectancy after RPE this information might be helpful for patient counselling.
C22
Change of Quality of life due to urinary symptoms in geriatric ASA 0 patients with benign prostate hyperplasia(BPH) and chronic urinary retention after Transurethral Microwave Thermotherapy ( TUMT)
Mohamad Al-Ali B.E., Auprich M., Dieber G., Pummer K. Medical University Graz, Dept. of Urology, Graz, Austria Introduction & Objectives: A retrospective study to evaluate TUMT as a treatment option in geriatric high risk patients with BPH who have chronic urinary retention and an indwelling catheter. Material & Methods: 69 geriatric patients, 67 to 99 years of age ( mean 82 ) with BPH and urinary retention, and an indwelling catheter, were not healthy for general anesthesia (ASA 0) according to American Sociaty of Anesthesiology, with Anticoagulant, or Antiplatelet therapy, were treated with TUMT without stopping their anticoagulant, antiplatelet therapy. contraindications were median lobe, large protruding lobes into the bladder. All patients were treated with Prostalund Feedback Treatment. Ciprofloxin was prescribed after TUMT for 4 weeks, 1 month after treatment catheters were removed and residual urine volumes were measured by bladder sonography. Quality of life due to urinary symptoms was documented pre and post-operatively . Results: 45/69( 66%) of patients were able to void postoperatively with a mean residual urine of 70 ml. Treatment failure was noted in 24 /69 ( 34%) patients, mean PSA was( mean 3,0 ng/ml),mean treatment time was( 30 minutes), mean prostate volume was( 68 ml ).There was in one case a serious complication, namely a urethral stricture which needed to be operated, in this case the catheter could not be removed. Other complications were urinary tract infections (10%). We did not report a serious bleeding event despite continuation of therapy with Anticoagulants or Antiplatelets. Quality of life due to urinary symptoms changed from (5-6) unhappy and terrible to (1-2) pleased and mostly satisfied. Conclusions: Our study showed that TUMT is a valid Treatment modality for geriatric ASA 0 patients with BPH, with a success rate of about 70 %. Quality of life due to urinary symptoms changed from unhappy to mostly satisfied.
C23
Bipolar plasma vaporization of the prostate versus standard TURP – “The better vhoice” in BPH endoscopic treatment?
Geavlete B., Multescu R., Georgescu D., Jecu M., Dragutescu M., Moldoveanu C., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: In this study, we aimed to evaluate the efficiency, safety and short-term outcome of bipolar plasma vaporization of the prostate (BPVP) and to compare it to standard transurethral resection of the prostate (TURP). Material & Methods: A total of 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), Qmax < 10 ml/s, IPSS > 19 and prostate volume between 30 and 80 ml were enrolled in a prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months by International Prostate Symptom Score (IPSS), quality of life score (QOL), maximum flow rate (Qmax) and post-voiding residual urinary volume (RV). Results: Patients from both series emphasized similar preoperative parameters. BPVP and TURP were successfully performed in all cases (75 and 80, respectively). The operation time, catheterization period and hospital stay were significantly shorter for BPVP patients (35.1 versus 50.4 minutes, 23.8 versus 71.2 hours and 47.6 versus 93.1 hours, respectively). The 1, 3 and 6 months follow-up revealed statistically superior improvements for BPVP (IPSS – 4.4 versus 8.3 and Qmax – 22.7 versus 20.5 ml/s at 1 month; IPSS – 4.8 versus 8.6 and Qmax – 22.3 versus 20.0 ml/s at 3 months; IPSS – 5 versus 9.1 and Qmax – 21.8 versus 19.3 ml/s at 6 months). The prostate volume decrease at 6 months was similar for BPVP and TURP (70.1% versus 66.8%). Conclusions: BPVP represents a valuable endoscopic treatment alternative for
BPE patients, with superior efficacy, short-term results and complication rate by comparison to monopolar TURP.
C24
TURP for prostates over 80ml. How large is too large?
Persu C., Cauni V., Georgescu D., Arabagiu I., Nita G., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: TURP is considered the gold standard for mid-sized prostates. Our retrospective study aims to evaluate the results of TURP on a series of patients with prostate volumes over 80ml. Material & Methods: Between January 2005 and October 2009, in our department, a number of 1600 patients underwent endoscopic surgery for LUTS due to BPH. We selected 260 patients with prostates over 80 ml measured by suprapubic ultrasonography, in which TURP was performed. Data was compared to a series of 400 open prostatectomies from our department. Patients were comparable in terms of preoperative symptoms. Results: The largest prostate treated by TURP measured 150 ml, with a mean value of 95 ml. In 104 cases (40%), the prostate was removed in two interventions, in four weeks time. Other techniques used, operator dependent, included axial movement of the resectoscope during resection, suprapubic cystostomy during the intervention, etc. The mean operative time was 50 minutes for TURP and 65 minutes for open prostatectomy. The mean time of catheterization was 4.2 days in the TURP group and 9 days for open prostatectomy. The need of transfusion was 0.8% for TURP and 1.5% for the other group. Overall complication rate was comparable in the two groups (11.7% for TURP, 12.1% for open prostatectomy). Postoperative parameters improved in both groups with no significant difference. Conclusions: Even for large prostatic volumes, TURP offers similar results and fewer complications compared to open surgery. Although newer endoscopic technologies are now available and open prostatectomy offers good results, TURP is still the optimal choice for both small and large BPH.
C25
Influence of Transurethral Resection of the Prostate (TURP) on Prostate Cancer gene 3 (PCA3) score: Results from a six months prospective trial
Auprich M.1, Gutschi St.1, Luger F.1, Gallè G.1, Mannweiler S.2, Pürstner P.3, Augustin H.1, Pummer K.1 1 Medical University Graz, Dept. of Urology, Graz, Austria, 2Medical University Graz, Dept. of Pathology, Graz, Austria, 3Medical University Graz, Dept. of Gynecology and Obstetrics, Graz, Austria Introduction & Objectives: Transurethral resection of the prostate (TURP) currently represents the gold standard for invasive therapy of the obstructive benign prostate hypertrophy (BPH). In most cases PSA values considerably decrease after performing TURP, but patients with persisting high values of PSA are often suggested to be at risk of having prostate cancer (PC). Due to the fact that Prostate CAncer gene 3 (PCA3) is increasingly used as an additional diagnostic tool to indicate prostate biopsy, we prospectively studied changes of the PCA3 score after TURP. Material & Methods: Fifteen patients without catheter, who underwent TURP because of obstructive BPH, were included in this prospective study. Before TURP was done, digital rectal examination and measurement of PSA and free PSA levels were performed and the urinary PCA3 scores were determined according to the manufacturer’s instructions. The monopolar TURP was successfully carried out without any severe complications and all patients left our department relieved of obstructive symptoms. The clinical examination and baseline laboratory tests including the urinary PCA3 test were repeated 3 and 6 months after TURP. Results: Out of 15 patients three men showed a history of negative biopsies due to elevated PSA values and no patient was suspicious at DRE before TURP. Histological work-up of the resected tissue found no evidence of prostate cancer in all patients. Median PSA levels (ng/ml) measured before, 3 and 6 months after TURP decreased from 2.23 to 0.72 and 0.68 (a relative decline of 69.5%),whereas median percentage of free from total PSA (%) increased from 16.5 to 28.5 and 30 (82.8%). The median PCA3 score decreased from 21 to 15 and 16 (a relative decline of 23.8%), but increased until two and three fold higher values in 2 patients. All patients remained relieved of any obstructive symptoms. Conclusions: Our study demonstrates that PCA3 testing is principally feasible in patients after TURP. As the decrease of the PCA3 score over time is only modestly compared to PSA decline, our data suggests that the urinary PCA3 assay score is, as previously reported, less influenced by the prostate volume.
Eur Urol Suppl 2010;9(6):625
C22
Change of Quality of life due to urinary symptoms in geriatric ASA 0 patients with benign prostate hyperplasia(BPH) and chronic urinary retention after Transurethral Microwave Thermotherapy ( TUMT)
Mohamad Al-Ali B.E., Auprich M., Dieber G., Pummer K. Medical University Graz, Dept. of Urology, Graz, Austria Introduction & Objectives: A retrospective study to evaluate TUMT as a treatment option in geriatric high risk patients with BPH who have chronic urinary retention and an indwelling catheter. Material & Methods: 69 geriatric patients, 67 to 99 years of age ( mean 82 ) with BPH and urinary retention, and an indwelling catheter, were not healthy for general anesthesia (ASA 0) according to American Sociaty of Anesthesiology, with Anticoagulant, or Antiplatelet therapy, were treated with TUMT without stopping their anticoagulant, antiplatelet therapy. contraindications were median lobe, large protruding lobes into the bladder. All patients were treated with Prostalund Feedback Treatment. Ciprofloxin was prescribed after TUMT for 4 weeks, 1 month after treatment catheters were removed and residual urine volumes were measured by bladder sonography. Quality of life due to urinary symptoms was documented pre and post-operatively . Results: 45/69( 66%) of patients were able to void postoperatively with a mean residual urine of 70 ml. Treatment failure was noted in 24 /69 ( 34%) patients, mean PSA was( mean 3,0 ng/ml),mean treatment time was( 30 minutes), mean prostate volume was( 68 ml ).There was in one case a serious complication, namely a urethral stricture which needed to be operated, in this case the catheter could not be removed. Other complications were urinary tract infections (10%). We did not report a serious bleeding event despite continuation of therapy with Anticoagulants or Antiplatelets. Quality of life due to urinary symptoms changed from (5-6) unhappy and terrible to (1-2) pleased and mostly satisfied. Conclusions: Our study showed that TUMT is a valid Treatment modality for geriatric ASA 0 patients with BPH, with a success rate of about 70 %. Quality of life due to urinary symptoms changed from unhappy to mostly satisfied.
C23
Bipolar plasma vaporization of the prostate versus standard TURP – “The better vhoice” in BPH endoscopic treatment?
Geavlete B., Multescu R., Georgescu D., Jecu M., Dragutescu M., Moldoveanu C., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: In this study, we aimed to evaluate the efficiency, safety and short-term outcome of bipolar plasma vaporization of the prostate (BPVP) and to compare it to standard transurethral resection of the prostate (TURP). Material & Methods: A total of 155 patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH), Qmax < 10 ml/s, IPSS > 19 and prostate volume between 30 and 80 ml were enrolled in a prospective, randomized trial. All patients were evaluated preoperatively and at 1, 3 and 6 months by International Prostate Symptom Score (IPSS), quality of life score (QOL), maximum flow rate (Qmax) and post-voiding residual urinary volume (RV). Results: Patients from both series emphasized similar preoperative parameters. BPVP and TURP were successfully performed in all cases (75 and 80, respectively). The operation time, catheterization period and hospital stay were significantly shorter for BPVP patients (35.1 versus 50.4 minutes, 23.8 versus 71.2 hours and 47.6 versus 93.1 hours, respectively). The 1, 3 and 6 months follow-up revealed statistically superior improvements for BPVP (IPSS – 4.4 versus 8.3 and Qmax – 22.7 versus 20.5 ml/s at 1 month; IPSS – 4.8 versus 8.6 and Qmax – 22.3 versus 20.0 ml/s at 3 months; IPSS – 5 versus 9.1 and Qmax – 21.8 versus 19.3 ml/s at 6 months). The prostate volume decrease at 6 months was similar for BPVP and TURP (70.1% versus 66.8%). Conclusions: BPVP represents a valuable endoscopic treatment alternative for
BPE patients, with superior efficacy, short-term results and complication rate by comparison to monopolar TURP.
C24
TURP for prostates over 80ml. How large is too large?
Persu C., Cauni V., Georgescu D., Arabagiu I., Nita G., Geavlete P. Saint John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: TURP is considered the gold standard for mid-sized prostates. Our retrospective study aims to evaluate the results of TURP on a series of patients with prostate volumes over 80ml. Material & Methods: Between January 2005 and October 2009, in our department, a number of 1600 patients underwent endoscopic surgery for LUTS due to BPH. We selected 260 patients with prostates over 80 ml measured by suprapubic ultrasonography, in which TURP was performed. Data was compared to a series of 400 open prostatectomies from our department. Patients were comparable in terms of preoperative symptoms. Results: The largest prostate treated by TURP measured 150 ml, with a mean value of 95 ml. In 104 cases (40%), the prostate was removed in two interventions, in four weeks time. Other techniques used, operator dependent, included axial movement of the resectoscope during resection, suprapubic cystostomy during the intervention, etc. The mean operative time was 50 minutes for TURP and 65 minutes for open prostatectomy. The mean time of catheterization was 4.2 days in the TURP group and 9 days for open prostatectomy. The need of transfusion was 0.8% for TURP and 1.5% for the other group. Overall complication rate was comparable in the two groups (11.7% for TURP, 12.1% for open prostatectomy). Postoperative parameters improved in both groups with no significant difference. Conclusions: Even for large prostatic volumes, TURP offers similar results and fewer complications compared to open surgery. Although newer endoscopic technologies are now available and open prostatectomy offers good results, TURP is still the optimal choice for both small and large BPH.
C25
Influence of Transurethral Resection of the Prostate (TURP) on Prostate Cancer gene 3 (PCA3) score: Results from a six months prospective trial
Auprich M.1, Gutschi St.1, Luger F.1, Gallè G.1, Mannweiler S.2, Pürstner P.3, Augustin H.1, Pummer K.1 1 Medical University Graz, Dept. of Urology, Graz, Austria, 2Medical University Graz, Dept. of Pathology, Graz, Austria, 3Medical University Graz, Dept. of Gynecology and Obstetrics, Graz, Austria Introduction & Objectives: Transurethral resection of the prostate (TURP) currently represents the gold standard for invasive therapy of the obstructive benign prostate hypertrophy (BPH). In most cases PSA values considerably decrease after performing TURP, but patients with persisting high values of PSA are often suggested to be at risk of having prostate cancer (PC). Due to the fact that Prostate CAncer gene 3 (PCA3) is increasingly used as an additional diagnostic tool to indicate prostate biopsy, we prospectively studied changes of the PCA3 score after TURP. Material & Methods: Fifteen patients without catheter, who underwent TURP because of obstructive BPH, were included in this prospective study. Before TURP was done, digital rectal examination and measurement of PSA and free PSA levels were performed and the urinary PCA3 scores were determined according to the manufacturer’s instructions. The monopolar TURP was successfully carried out without any severe complications and all patients left our department relieved of obstructive symptoms. The clinical examination and baseline laboratory tests including the urinary PCA3 test were repeated 3 and 6 months after TURP. Results: Out of 15 patients three men showed a history of negative biopsies due to elevated PSA values and no patient was suspicious at DRE before TURP. Histological work-up of the resected tissue found no evidence of prostate cancer in all patients. Median PSA levels (ng/ml) measured before, 3 and 6 months after TURP decreased from 2.23 to 0.72 and 0.68 (a relative decline of 69.5%),whereas median percentage of free from total PSA (%) increased from 16.5 to 28.5 and 30 (82.8%). The median PCA3 score decreased from 21 to 15 and 16 (a relative decline of 23.8%), but increased until two and three fold higher values in 2 patients. All patients remained relieved of any obstructive symptoms. Conclusions: Our study demonstrates that PCA3 testing is principally feasible in patients after TURP. As the decrease of the PCA3 score over time is only modestly compared to PSA decline, our data suggests that the urinary PCA3 assay score is, as previously reported, less influenced by the prostate volume.
Eur Urol Suppl 2010;9(6):625