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C72 BIPOLAR PLASMA ENUCLEATION IN LARGE BPH CASES – BETTER THAN OPEN PROSTATECTOMY?
symptoms, 19.1% had severe symptoms, 46% had a PSA >1.5 ng/mL, and 76% had a prostate volume ≥30 cc by DRE. Overall, 38.2% of the men diagnosed with BPH were at risk of BPH progression (PSA >1.5 ng/mL and prostate volume ≥30 cc). Characteristic IPSS (categorical)
PSA, ng/mL PSA (categorical) Prostate size (DRE performed by GP) Prostate size, cc (abdominal ultrasound performed by a urologist) Age
Mild symptoms (0–7) Moderate symptoms (8–19) Severe symptoms (20–35) Mean (SD) ≤1.5 ng/mL >1.5 ng/mL Small (<30 cc) Medium (30–60 cc) Large (>60 cc)
BPH patients (n=440) 88 (20.0%) 268 (60.9%) 84 (19.1%) 2.14 (2.41) 236 (53.6%) 204 (46.4%) 106 (24.1%) 303 (68.9%) 31 (7.1%)
Mean (SD)
41.8 (18.6)
Mean (SD)
62.0 (8.0)
Conclusions: BPH accounts for the majority of men who spontaneously attend a GP clinic with LUTS. A substantial proportion of such men will have risk factors for BPH progression, an important consideration when deciding on the most appropriate medical therapy.
C72
Bipolar plasma enucleation in large BPH cases – Better than open prostatectomy?
Geavlete B., Multescu R., Georgescu D., Stanescu F., Moldoveanu C., Jecu M., Iacoboaie C., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial evaluated the viability of the bipolar plasma enucleation of the prostate (BPEP) versus open transvesical prostatectomy (OP) in cases of large prostates. A prospective, randomized, medium term comparison was accomplished concerning the surgical efficacy, perioperative morbidity and follow-up parameters. Material & Methods: A total of 130 BPH patients with prostate volume over 80 ml, Qmax below 10 ml/s and IPSS >19 were randomized in the 2 study arms. All cases were evaluated at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, QoL and post-voiding residual urinary volume (PVR). The prostate volume and PSA level were measured every 6 months. Results: Similar operating times were determined for BPEP and OP (89.8 versus 87.6 minutes). The mean hemoglobin drop (2.0 versus 3.3 g/dl), postoperative hematuria (3.1% versus 15.4%) and blood transfusion (1.5% versus 10.8%) rates were significantly improved for BPEP, while early acute urinary retention occurred in the OP series alone (6.1% of cases). The mean catheterization period (35.4 versus 98.3 hours) and hospital stay (2.4 versus 5.2 days) were significantly lower in the BPEP group. During all check-ups, no statistically significant difference was determined concerning the IPSS, Qmax, QoL and PVR. At 6 and 12 months, similar values were established for PSA and prostate volume, with equivalent prostate volume decrease (88.3-88.9% versus 87.3-87.7%). Conclusions: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good efficiency, significantly reduced complications, faster postoperative recovery, similar prostatic tissue removal capabilities and satisfactory follow-up results.
C73
Bipolar plasma vaporization versus monopolar and bipolar resection – Which is “the better choice” in cases of average size BPH?
Geavlete B., Moldoveanu C., Stanescu F., Jecu M., Multescu R., Georgescu D., Iacoboaie C., Geavlete P.A. St John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial assessed the bipolar plasma vaporization of the prostate (BPVP), the bipolar transurethral resection in saline (TURis) and the monopolar transurethral resection of the prostate (TURP) in cases of average size BPH. A prospective, long term, randomized comparison was performed regarding the surgical efficacy, complication rate and follow-up results. Material & Methods: A total of 510 BPH patients with prostate volume between 30 and 80 ml, Qmax below 10 ml/s and IPSS over 19 were equally randomized in the 3 series. All cases were evaluated at 6-month intervals by IPSS, Qmax, QoL and PVR, prostate volume and PSA level. Results: The mean operation time (39.7 versus 52.1 and 55.6 minutes), catheterization period (23.5 versus 46.3 and 72.8 hours) and hospital stay (1.9 versus 3.1 and 4.2 days) were significantly shorter for BPVP patients. The mean
hemoglobin drop (0.5 versus 1.2 and 1.6 g/dl), intraoperative bleeding (1.8% versus 8.2% and 13.5%) and capsular perforation (1.2% versus 7.1% and 9.4%) rates were significantly reduced in the BPVP series. The rate of early irritative symptoms was statistically similar in the 3 study arms. During the long term followup, BPVP patients emphasized significantly superior parameters concerning IPSS and Qmax, while QoL and PVR were similar in the 3 series. The PSA level and postoperative prostate volume emphasized a similar evolution. Conclusions: BPVP displayed superior surgical efficacy, similar BPH tissue removal capabilities, reduced perioperative morbidity, faster postoperative recovery and improved symptom scores and voiding characteristics when compared to TURis and TURP.
C74
Continuous plasma vaporization – A new step forward in BPH endoscopic treatment
Geavlete B., Moldoveanu C., Stanescu F., Jecu M., Geavlete P.A. St John Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The study evaluated the impact of a new energy source over the efficiency of the bipolar plasma vaporization (BPV) approach in average size BPH cases. A comparison between the previous generation UES-40 bipolar generator and the newly introduced ESG-400 power source was achieved. Material & Methods: An initial series of 10 medium size BPH cases (30-80 ml) with severe lower urinary tract symptoms underwent BPV using the new technical setting. This group was retrospectively compared to an equal number of patients with similar preoperative features in which the plasma vaporization was performed utilizing the previously developed generator. Results: The UES-40 based BPV implied necessarily imposed pauses in the tissue vaporization process every 20-30 seconds in order to avoid overheating the system. The ESG-400 generator provided continuous plasma activation, unrestricted by any time limitation. Consequently, the mean operation time was significantly reduced in cases benefitting from this approach (32.3 versus 40.2 minutes), thus emphasizing a 19.6% difference in surgical length between the two technical setups. Otherwise, no significant complications were encountered in either of the two groups, while the mean hemoglobin drop (0.4 versus 0.5 g/dl), catheterization period (23.8 versus 23.1 hours) and hospital stay (2.1 versus 1.9 days) were also similar. Conclusions: The new technical improvement of the plasma vaporization procedure was able to reduce the BPV surgical time by an average proportion of 20%. The advantages of satisfactory safety and efficiency as well as short postoperative recovery were maintained, while the previously compulsory interruptions were eliminated.
C75
Higher dose of antimuscarinic for the treatment of neurogenic detrusor overactivity
Persu C., Mirciulescu V., Nita G., Paraianu B., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: Neurogenic detrusor overactivity (NDO) is a bothersome condition, with increased incidence and a long list of subsequent complications. While antimuscarinics remain the first line therapy, there are many cases where the efficacy of treatment is sub-optimal, prompting for an alternative. We present our data from a prospective, open-label clinical trial with 20 mg of solifenacin a day. Material & Methods: All the patients started with a dose of 10mg solifenacin a day. After one month, the patients who were not satisfied with the efficacy of the treatment were given the choice to opt for a double dose of the drug, while others remained stable on the initial dose, for the next two months. Patients’ evaluation included 3 days bladder diary, urinalysis, ultrasonography and filing cystometry, done at the inclusion and at the final visit. All adverse effects and observations of the patients were recorded during the study. We compared data from the bladder diary and cystometry between the two arms, at the end of the three months treatment, using the t-test analysis. Results: A total number of 49 patients completed the study (32 males, 17 females), with various neurological conditions: spinal cord injury (SCI) – 19 cases, multiple sclerosis (11), Parkinson’s disease (PD) – 5 cases and stroke – 14 cases. After one month, 22 patients switched to the 20 mg dose. Final data shows statistically significant improvements in voided volume, number of micturitions, Pdet max and reflex volume. There was a decrease in the number of incontinence episodes and an increase in post void residual volume (PVR), both without statistical significance (see table for actual data). Patients reported improvements as early as 7 days after shifting to the 20 mg dose. There was an obvious increase in the rate and intensity of common adverse reactions (dry mouth, constipation, dizziness, etc). By the end of the trial, no patient discontinued the treatment and no serious adverse events occurred. Conclusions: A 20 mg dose of solifenacin is a good conservative treatment option for NDO. The storage and voiding parameters are improved, and the rate of adverse reactions, although higher, is fully balanced by the benefits and still reasonable for the patient.
Eur Urol Suppl 2012;11(4):99
PSA, ng/mL PSA (categorical) Prostate size (DRE performed by GP) Prostate size, cc (abdominal ultrasound performed by a urologist) Age
Mild symptoms (0–7) Moderate symptoms (8–19) Severe symptoms (20–35) Mean (SD) ≤1.5 ng/mL >1.5 ng/mL Small (<30 cc) Medium (30–60 cc) Large (>60 cc)
BPH patients (n=440) 88 (20.0%) 268 (60.9%) 84 (19.1%) 2.14 (2.41) 236 (53.6%) 204 (46.4%) 106 (24.1%) 303 (68.9%) 31 (7.1%)
Mean (SD)
41.8 (18.6)
Mean (SD)
62.0 (8.0)
Conclusions: BPH accounts for the majority of men who spontaneously attend a GP clinic with LUTS. A substantial proportion of such men will have risk factors for BPH progression, an important consideration when deciding on the most appropriate medical therapy.
C72
Bipolar plasma enucleation in large BPH cases – Better than open prostatectomy?
Geavlete B., Multescu R., Georgescu D., Stanescu F., Moldoveanu C., Jecu M., Iacoboaie C., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial evaluated the viability of the bipolar plasma enucleation of the prostate (BPEP) versus open transvesical prostatectomy (OP) in cases of large prostates. A prospective, randomized, medium term comparison was accomplished concerning the surgical efficacy, perioperative morbidity and follow-up parameters. Material & Methods: A total of 130 BPH patients with prostate volume over 80 ml, Qmax below 10 ml/s and IPSS >19 were randomized in the 2 study arms. All cases were evaluated at 1, 3, 6 and 12 months after surgery by IPSS, Qmax, QoL and post-voiding residual urinary volume (PVR). The prostate volume and PSA level were measured every 6 months. Results: Similar operating times were determined for BPEP and OP (89.8 versus 87.6 minutes). The mean hemoglobin drop (2.0 versus 3.3 g/dl), postoperative hematuria (3.1% versus 15.4%) and blood transfusion (1.5% versus 10.8%) rates were significantly improved for BPEP, while early acute urinary retention occurred in the OP series alone (6.1% of cases). The mean catheterization period (35.4 versus 98.3 hours) and hospital stay (2.4 versus 5.2 days) were significantly lower in the BPEP group. During all check-ups, no statistically significant difference was determined concerning the IPSS, Qmax, QoL and PVR. At 6 and 12 months, similar values were established for PSA and prostate volume, with equivalent prostate volume decrease (88.3-88.9% versus 87.3-87.7%). Conclusions: BPEP represents a promising endoscopic approach in large BPH cases, characterized by good efficiency, significantly reduced complications, faster postoperative recovery, similar prostatic tissue removal capabilities and satisfactory follow-up results.
C73
Bipolar plasma vaporization versus monopolar and bipolar resection – Which is “the better choice” in cases of average size BPH?
Geavlete B., Moldoveanu C., Stanescu F., Jecu M., Multescu R., Georgescu D., Iacoboaie C., Geavlete P.A. St John Emergency Clinical Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The trial assessed the bipolar plasma vaporization of the prostate (BPVP), the bipolar transurethral resection in saline (TURis) and the monopolar transurethral resection of the prostate (TURP) in cases of average size BPH. A prospective, long term, randomized comparison was performed regarding the surgical efficacy, complication rate and follow-up results. Material & Methods: A total of 510 BPH patients with prostate volume between 30 and 80 ml, Qmax below 10 ml/s and IPSS over 19 were equally randomized in the 3 series. All cases were evaluated at 6-month intervals by IPSS, Qmax, QoL and PVR, prostate volume and PSA level. Results: The mean operation time (39.7 versus 52.1 and 55.6 minutes), catheterization period (23.5 versus 46.3 and 72.8 hours) and hospital stay (1.9 versus 3.1 and 4.2 days) were significantly shorter for BPVP patients. The mean
hemoglobin drop (0.5 versus 1.2 and 1.6 g/dl), intraoperative bleeding (1.8% versus 8.2% and 13.5%) and capsular perforation (1.2% versus 7.1% and 9.4%) rates were significantly reduced in the BPVP series. The rate of early irritative symptoms was statistically similar in the 3 study arms. During the long term followup, BPVP patients emphasized significantly superior parameters concerning IPSS and Qmax, while QoL and PVR were similar in the 3 series. The PSA level and postoperative prostate volume emphasized a similar evolution. Conclusions: BPVP displayed superior surgical efficacy, similar BPH tissue removal capabilities, reduced perioperative morbidity, faster postoperative recovery and improved symptom scores and voiding characteristics when compared to TURis and TURP.
C74
Continuous plasma vaporization – A new step forward in BPH endoscopic treatment
Geavlete B., Moldoveanu C., Stanescu F., Jecu M., Geavlete P.A. St John Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: The study evaluated the impact of a new energy source over the efficiency of the bipolar plasma vaporization (BPV) approach in average size BPH cases. A comparison between the previous generation UES-40 bipolar generator and the newly introduced ESG-400 power source was achieved. Material & Methods: An initial series of 10 medium size BPH cases (30-80 ml) with severe lower urinary tract symptoms underwent BPV using the new technical setting. This group was retrospectively compared to an equal number of patients with similar preoperative features in which the plasma vaporization was performed utilizing the previously developed generator. Results: The UES-40 based BPV implied necessarily imposed pauses in the tissue vaporization process every 20-30 seconds in order to avoid overheating the system. The ESG-400 generator provided continuous plasma activation, unrestricted by any time limitation. Consequently, the mean operation time was significantly reduced in cases benefitting from this approach (32.3 versus 40.2 minutes), thus emphasizing a 19.6% difference in surgical length between the two technical setups. Otherwise, no significant complications were encountered in either of the two groups, while the mean hemoglobin drop (0.4 versus 0.5 g/dl), catheterization period (23.8 versus 23.1 hours) and hospital stay (2.1 versus 1.9 days) were also similar. Conclusions: The new technical improvement of the plasma vaporization procedure was able to reduce the BPV surgical time by an average proportion of 20%. The advantages of satisfactory safety and efficiency as well as short postoperative recovery were maintained, while the previously compulsory interruptions were eliminated.
C75
Higher dose of antimuscarinic for the treatment of neurogenic detrusor overactivity
Persu C., Mirciulescu V., Nita G., Paraianu B., Geavlete P.A. St John Clinical Emergency Hospital, Dept. of Urology, Bucharest, Romania Introduction & Objectives: Neurogenic detrusor overactivity (NDO) is a bothersome condition, with increased incidence and a long list of subsequent complications. While antimuscarinics remain the first line therapy, there are many cases where the efficacy of treatment is sub-optimal, prompting for an alternative. We present our data from a prospective, open-label clinical trial with 20 mg of solifenacin a day. Material & Methods: All the patients started with a dose of 10mg solifenacin a day. After one month, the patients who were not satisfied with the efficacy of the treatment were given the choice to opt for a double dose of the drug, while others remained stable on the initial dose, for the next two months. Patients’ evaluation included 3 days bladder diary, urinalysis, ultrasonography and filing cystometry, done at the inclusion and at the final visit. All adverse effects and observations of the patients were recorded during the study. We compared data from the bladder diary and cystometry between the two arms, at the end of the three months treatment, using the t-test analysis. Results: A total number of 49 patients completed the study (32 males, 17 females), with various neurological conditions: spinal cord injury (SCI) – 19 cases, multiple sclerosis (11), Parkinson’s disease (PD) – 5 cases and stroke – 14 cases. After one month, 22 patients switched to the 20 mg dose. Final data shows statistically significant improvements in voided volume, number of micturitions, Pdet max and reflex volume. There was a decrease in the number of incontinence episodes and an increase in post void residual volume (PVR), both without statistical significance (see table for actual data). Patients reported improvements as early as 7 days after shifting to the 20 mg dose. There was an obvious increase in the rate and intensity of common adverse reactions (dry mouth, constipation, dizziness, etc). By the end of the trial, no patient discontinued the treatment and no serious adverse events occurred. Conclusions: A 20 mg dose of solifenacin is a good conservative treatment option for NDO. The storage and voiding parameters are improved, and the rate of adverse reactions, although higher, is fully balanced by the benefits and still reasonable for the patient.
Eur Urol Suppl 2012;11(4):99