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532 laser for photoselective vaporization of prostate (PVP)
LB17
arts TREATMENT OF THE NON NEUROGENIC OVERACTIVE WITH BOTULINE TOXIN A DETRUSORINJECTIONS
BLADDER
LB18 HIGH POWER VAPORIZATION
Marchand W.‘, Merckx L.‘, Maes D.‘, Gillis J.‘, Everaert K.‘. De Ridder D.’
Mattioli
‘AZ St. Lucas Hospital. Urology, Ghent, Belgium, ‘Universtty Hospital. Urology, Ghent, Belgium, ‘Gasthuisberg University Hospital, Urology, Leuven, Belgium
Istituto
INTRODUCTION & OBJECTIVES: Almost half of the patients with non neurogenic overactive bladder symptoms are resistant to conservatwe treatment options. Different studies show a favourable effect of botulin toxin A detrusoriniections for treatment of the neurogenic overactive bladder. Therefore we started a multicentric pilot study with botulin detrusorinjections for patients with therapy resistant non-neurogenic overactive bladder. This is the first study, which evaluates the effect of botulin toxin A on objective parameters and quality of life scores for the treatment of non-neurogenic overactive bladder. MATERIAL & METHODS: Pre-treatment evaluation of all patients consisted of clinical examination, neuro-urologic evaluation, urineculture, urinecytology, cystoscopy, micturation diary, King’s College Health scores and urodynamic examination. The treatment was performed under general anaesthesia in day clinic setting. Patients were given 20 separate botulin toxin A injections (Dysport@) in the detrusor sparing the trigonum. In total 300 to 500 units Dysport@ were injected with a cystoscopic Williams needle (Cook@). During follow-up patients were evaluated with physical examination. micturation diary, King’s College Health Questionnaire at week 0,2, I2 and at 6 and 9 months. At week 12 a standard urodynamic examination was performed. RESULTS: 13 patients were treated in three separate urologic centers. Maximum follow-up is 6 months. None of the patients suffered from local or systemic complications due to the technique or toxin. There is an improvement of the incontinence impact score with 54%, the physical and social impact score with 54 respectively 55.5% after three months. Frequency decreases with 7.5 mictions a day and urgency diminishes with 7.4 as well. Almost all incontinent patients stay dry which results in only one or less pads a day for each patient. On urodynamic evaluation after 3 months we see a mean increase of the cystometric bladdercapacity with 82%: from 219 to 359 ml. Average volume at first desire to void increases from 109 to 168 ml. Mean post mictional residue does never exceed 26 ml CONCLUSIONS: Preliminary results of our pilot study are promising for patients with non neurogenic overactive bladder resistant to conservative treatments. There were no serious complications encountered with a dose of 500 units DysporG. There is an obvious improvement of all subjective parameters from King’s College Health Questionnaire. Objective parameters such as a three-day micturation diary, cystometric bladdercapacity and the volume at first desire to void improve significantly. Longer follow-up is necessary to evaluate the duration of effectiveness of’this treatment.
KTP/532 LASER OF PROSTATE (PVP)
FOR
PHOTOSELECTIVE
S.
Clinico S. Ambrogio,
Urology, Milan, Italy
INTRODUCTION & OBJECTIVES: Transurethral laser photoselective vaporisation of the prostate (PVP) with a high power KTPi532 laser has been demonstrated to be an effective and safe method for prostate ablation, and is thus a very promising alternative to conventional procedures. Since the KTP wavelength vaporizes rather than coagulate tissue, the technique offers significant advantages over transurethral resection of prostate (TURP), and the Holmiun procedure (HoLEP). KTP laser prostatectomy results in true disobstntction of the patient accompanied by immediate improvement in voiding symptomatology. MATERIAL & METHODS: The KTP laser was used in conjunction with a Laserscope ADD (Angled Delivery Device), engineered to rotate 360 degrees and to precisely focus laser energy (60-8OW), in order to minimize the risk of incomplete ablation of prostatic tissue. The duration of exposure ranged from 15 to 60 minutes. With the high power the pure ablation was employed effectively both on smaller glands (20 ml- I5 minutes of irradiation), and on larger glands (100 ml-60 minutes). A Foley catheter is then placed and removed 3-4 hours later. Patients are released catheter-free the following morning. RESULTS: A total of 25 patients underwent prostate vaporization using KTP laser. Patients ranged in age from 55 to 85. 5 patients presented urinary retention. 6 patients were on anticoagulant therapy. PSA t/f, transrectal ultrasound, biopsies if necessary, AUA-6 Symptom Score (AUA-SS), Q-max flow rate was performed. Our final results with high power KTP laser (mean AUA-SS from 20,O to 9,6; mean peak flow rate, from O-g.1 to l6,7 mbsec) are comparable to TURP-results. CONCLUSIONS: Key to the success of PVP is the capacity to completely vaporize tissue causing immediate reduction of prostatic tissue, immediate and consistent TURP-like results, with no tissue sloughing and delayed necrosis (only l-2 mm coagulation zone). PVP is fast and bloodless. As opposed to HoLEP no tissue morsellation is necessary for treatment of large glands.
LB19
LB20 EVALUATION OF SYNCHRONOUS TWIN PULSE TECHNIQUE FOR SHOCK WAVE LITHOTRIPSY: EARLY RESULTS OF THE FIRST PROSPECTIVE CLINICAL STUDY Sheir K.Z.‘, El-Diasty T.A.‘, Ismad A.M.’ ~Urology and Nephrology Center. Urology, Mansoura. Lgypt, Urology Center, Radiology, Mansoura, Egypt, ‘Urology and Nephrology Pathology, Mansoura. Egypt
and Nephrology Center, Clinical
INTRODUCTION & OBJECTIVES: Recently, the concept of synchronous twin pulse technique for shock wave therapy has been introduced and proved to be effective for in vitro stone fragmentation and safe when studied for in viva tissue effects in animals, using the hvinheads lithotriptor (THSWL). Herein, the early results of the first clinical study are presented.
WITHDRAWN
MATERIAL & METHODS: The study protocol was approved by the local ethics committee. Twenty urinary stone patients (I 2 males and 8 females) were enrolled to be treated with the twinheads lithotriuter after obtainine an informed consent. Entrv criteria were: adult patients over IX ye&s. radio-opaque &gle stone in the kidney br upper ureter that had not previously treated by any means. normal laboratory profile (as regards serum creatinine, liver functions, blood picture, bleeding and clotting time, and prothrombin concentration). Exclusion criteria included lower ureter stones, patients with urinary tract infection, obstructed urinary tract distal to the stones, or congenital abnormalities. All patients received one session and were evaluated by ultrasonography (US), urinary tract plam x-ray (UTP), and complete laboratory investigations (serum creatinine, BUN, blood picture, liver function tests, semm amylase, and LDH, and urine analysis) before and immediate after treatment, at 2 days, I4 days, and one month. Patients who were in need for retreatment at 14 days follow up had received a second session ofTHSWL and reevaluated after 7 and 14 days. RESULTS: The mean (SD) stone size (longest diameter) was 12.3 (2.6) mm (range 9 to 18 mm). Intravenous sedation was used in 12 patients. Mild hematuria was observed in 10 patients, on the day of treatment. Pain requiring outpatient attention was observed in 8 patients. No evidence of haematoma, parenchymal changes, upper urinary tract obstruction, or significant changes in the laboratory investigations were observed all over the follow-up period. At 14 days, six patients became free of stones. Residual stones 15 mm were observed in 8 patients, they became free of stones at one month follow up. Six patients had residual stone 6 to 9 mm, but with 50% reduction of the original stone size or more. Those patients with residual stones larger than 5 mm had received another THSWL session, and became free of stones within 14 days. Thus, the stone free rate was 100% within one month period.
CONCLUSIONS:
Synchronous twin pulse techmque is a promising novel concept of shock wave lithotripsy that is safe and effective m treatment of renal and upper ureter urolithiasis.
European
Urology Supplements 2 (2003) No. 1, pp. 220
arts TREATMENT OF THE NON NEUROGENIC OVERACTIVE WITH BOTULINE TOXIN A DETRUSORINJECTIONS
BLADDER
LB18 HIGH POWER VAPORIZATION
Marchand W.‘, Merckx L.‘, Maes D.‘, Gillis J.‘, Everaert K.‘. De Ridder D.’
Mattioli
‘AZ St. Lucas Hospital. Urology, Ghent, Belgium, ‘Universtty Hospital. Urology, Ghent, Belgium, ‘Gasthuisberg University Hospital, Urology, Leuven, Belgium
Istituto
INTRODUCTION & OBJECTIVES: Almost half of the patients with non neurogenic overactive bladder symptoms are resistant to conservatwe treatment options. Different studies show a favourable effect of botulin toxin A detrusoriniections for treatment of the neurogenic overactive bladder. Therefore we started a multicentric pilot study with botulin detrusorinjections for patients with therapy resistant non-neurogenic overactive bladder. This is the first study, which evaluates the effect of botulin toxin A on objective parameters and quality of life scores for the treatment of non-neurogenic overactive bladder. MATERIAL & METHODS: Pre-treatment evaluation of all patients consisted of clinical examination, neuro-urologic evaluation, urineculture, urinecytology, cystoscopy, micturation diary, King’s College Health scores and urodynamic examination. The treatment was performed under general anaesthesia in day clinic setting. Patients were given 20 separate botulin toxin A injections (Dysport@) in the detrusor sparing the trigonum. In total 300 to 500 units Dysport@ were injected with a cystoscopic Williams needle (Cook@). During follow-up patients were evaluated with physical examination. micturation diary, King’s College Health Questionnaire at week 0,2, I2 and at 6 and 9 months. At week 12 a standard urodynamic examination was performed. RESULTS: 13 patients were treated in three separate urologic centers. Maximum follow-up is 6 months. None of the patients suffered from local or systemic complications due to the technique or toxin. There is an improvement of the incontinence impact score with 54%, the physical and social impact score with 54 respectively 55.5% after three months. Frequency decreases with 7.5 mictions a day and urgency diminishes with 7.4 as well. Almost all incontinent patients stay dry which results in only one or less pads a day for each patient. On urodynamic evaluation after 3 months we see a mean increase of the cystometric bladdercapacity with 82%: from 219 to 359 ml. Average volume at first desire to void increases from 109 to 168 ml. Mean post mictional residue does never exceed 26 ml CONCLUSIONS: Preliminary results of our pilot study are promising for patients with non neurogenic overactive bladder resistant to conservative treatments. There were no serious complications encountered with a dose of 500 units DysporG. There is an obvious improvement of all subjective parameters from King’s College Health Questionnaire. Objective parameters such as a three-day micturation diary, cystometric bladdercapacity and the volume at first desire to void improve significantly. Longer follow-up is necessary to evaluate the duration of effectiveness of’this treatment.
KTP/532 LASER OF PROSTATE (PVP)
FOR
PHOTOSELECTIVE
S.
Clinico S. Ambrogio,
Urology, Milan, Italy
INTRODUCTION & OBJECTIVES: Transurethral laser photoselective vaporisation of the prostate (PVP) with a high power KTPi532 laser has been demonstrated to be an effective and safe method for prostate ablation, and is thus a very promising alternative to conventional procedures. Since the KTP wavelength vaporizes rather than coagulate tissue, the technique offers significant advantages over transurethral resection of prostate (TURP), and the Holmiun procedure (HoLEP). KTP laser prostatectomy results in true disobstntction of the patient accompanied by immediate improvement in voiding symptomatology. MATERIAL & METHODS: The KTP laser was used in conjunction with a Laserscope ADD (Angled Delivery Device), engineered to rotate 360 degrees and to precisely focus laser energy (60-8OW), in order to minimize the risk of incomplete ablation of prostatic tissue. The duration of exposure ranged from 15 to 60 minutes. With the high power the pure ablation was employed effectively both on smaller glands (20 ml- I5 minutes of irradiation), and on larger glands (100 ml-60 minutes). A Foley catheter is then placed and removed 3-4 hours later. Patients are released catheter-free the following morning. RESULTS: A total of 25 patients underwent prostate vaporization using KTP laser. Patients ranged in age from 55 to 85. 5 patients presented urinary retention. 6 patients were on anticoagulant therapy. PSA t/f, transrectal ultrasound, biopsies if necessary, AUA-6 Symptom Score (AUA-SS), Q-max flow rate was performed. Our final results with high power KTP laser (mean AUA-SS from 20,O to 9,6; mean peak flow rate, from O-g.1 to l6,7 mbsec) are comparable to TURP-results. CONCLUSIONS: Key to the success of PVP is the capacity to completely vaporize tissue causing immediate reduction of prostatic tissue, immediate and consistent TURP-like results, with no tissue sloughing and delayed necrosis (only l-2 mm coagulation zone). PVP is fast and bloodless. As opposed to HoLEP no tissue morsellation is necessary for treatment of large glands.
LB19
LB20 EVALUATION OF SYNCHRONOUS TWIN PULSE TECHNIQUE FOR SHOCK WAVE LITHOTRIPSY: EARLY RESULTS OF THE FIRST PROSPECTIVE CLINICAL STUDY Sheir K.Z.‘, El-Diasty T.A.‘, Ismad A.M.’ ~Urology and Nephrology Center. Urology, Mansoura. Lgypt, Urology Center, Radiology, Mansoura, Egypt, ‘Urology and Nephrology Pathology, Mansoura. Egypt
and Nephrology Center, Clinical
INTRODUCTION & OBJECTIVES: Recently, the concept of synchronous twin pulse technique for shock wave therapy has been introduced and proved to be effective for in vitro stone fragmentation and safe when studied for in viva tissue effects in animals, using the hvinheads lithotriptor (THSWL). Herein, the early results of the first clinical study are presented.
WITHDRAWN
MATERIAL & METHODS: The study protocol was approved by the local ethics committee. Twenty urinary stone patients (I 2 males and 8 females) were enrolled to be treated with the twinheads lithotriuter after obtainine an informed consent. Entrv criteria were: adult patients over IX ye&s. radio-opaque &gle stone in the kidney br upper ureter that had not previously treated by any means. normal laboratory profile (as regards serum creatinine, liver functions, blood picture, bleeding and clotting time, and prothrombin concentration). Exclusion criteria included lower ureter stones, patients with urinary tract infection, obstructed urinary tract distal to the stones, or congenital abnormalities. All patients received one session and were evaluated by ultrasonography (US), urinary tract plam x-ray (UTP), and complete laboratory investigations (serum creatinine, BUN, blood picture, liver function tests, semm amylase, and LDH, and urine analysis) before and immediate after treatment, at 2 days, I4 days, and one month. Patients who were in need for retreatment at 14 days follow up had received a second session ofTHSWL and reevaluated after 7 and 14 days. RESULTS: The mean (SD) stone size (longest diameter) was 12.3 (2.6) mm (range 9 to 18 mm). Intravenous sedation was used in 12 patients. Mild hematuria was observed in 10 patients, on the day of treatment. Pain requiring outpatient attention was observed in 8 patients. No evidence of haematoma, parenchymal changes, upper urinary tract obstruction, or significant changes in the laboratory investigations were observed all over the follow-up period. At 14 days, six patients became free of stones. Residual stones 15 mm were observed in 8 patients, they became free of stones at one month follow up. Six patients had residual stone 6 to 9 mm, but with 50% reduction of the original stone size or more. Those patients with residual stones larger than 5 mm had received another THSWL session, and became free of stones within 14 days. Thus, the stone free rate was 100% within one month period.
CONCLUSIONS:
Synchronous twin pulse techmque is a promising novel concept of shock wave lithotripsy that is safe and effective m treatment of renal and upper ureter urolithiasis.
European
Urology Supplements 2 (2003) No. 1, pp. 220