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MP02-15 PSA-CHANGES AND MICTURITION IMPROVEMENT 5-YEARS AFTER THULIUM VAPOENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC OBSTRUCTION
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THE JOURNAL OF UROLOGYâ
METHODS: Our study included 141 patients who underwent HoLEP. Enrolled patients were divided into two groups according to the presence of UI. Independent t test was used to compare between two groups. Logistic regression was performed to analyze a correlation between de novo UI and other factors such as age, prostate volume, retrieved tissue weight, operative time, and the first post-void residual (PVR) urine volume immediately after removing postoperative urethral catheter. Urethral catheter was removed after bladder instillation with a 200 ml normal saline via urethral catheter, and PVR urine volume was estimated immediately after the first postoperative self-voiding. All definitions of UI corresponded to recommendations of the International Continence Society. RESULTS: After HoLEP, 44 patients (31.2%) had de novo UI, most of which resolved within 1-6 months; 34 had stress UI, 6 had urgency UI, and 4 had mixed UI. Age and PVR urine volume were significantly higher in UI group than non-UI group (75.09 6.82 vs 72.01 8.04 years; P ¼ 0.029, 81.88 67.13 vs 30.15 23.56 ml, P < 0.001). In a logistic linear regression analysis, only PVR urine volume was an independent predictor of de novo UI after HoLEP. The most optimal cut-off value of PVR urine volume for predicting de novo UI was defined as 39.5 ml in the receiver operating characteristics curve analysis (sensitivity, 75.0%; specificity, 74.2%; AUC, 0.815; P < 0.001). CONCLUSIONS: About one-third of patients might undergo de novo UI following HoLEP, and most of them might have been resolved within 1-6 months. High PVR urine volume after removal of postoperative urethral catheter is associated with de novo UI after HoLEP, and could be used as a practical tool to predict postoperative de novo UI. Source of Funding: none
MP02-15 PSA-CHANGES AND MICTURITION IMPROVEMENT 5-YEARS AFTER THULIUM VAPOENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC OBSTRUCTION Christopher Netsch*, Benedikt Becker, Ann Kathrin Orywal, Hamburg, Germany; Thomas Herrmann, Hannover, Germany; Andreas Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: To assess the long-term results of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of symptomatic benign prostatic obstruction (BPO) retrospectively. METHODS: 500 patients with symptomatic BPO were treated with ThuVEP and consecutive mechanical morcellation between January 2007 and January 2010 at our institution. Patients were reassessed 1 and 5 years after ThuVEP with International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), PSA, and prostate volume measured by transrectal ultrasound. To assess treatment effects, patients were divided into two groups according to the prostate volume: group A (<60ml) and group B (>60ml). Patient data is presented as median (interquartile range). RESULTS: 131 patients completed the 5-year follow-up and were included in the final analysis. IPSS, QoL, Qmax, and PVR improved significantly and continued to do so during 5-year follow-up (p0.001). At 1-year follow-up, the median prostate volume (50 ml vs. 13 ml, p<0.001) decreased significantly with a median prostate volume reduction of 80.8% (64.3-88%). Median PSA was significantly reduced at 1-year (0.83 ml/l) and 5-year (0.72 mg/l) follow-up as
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
compared to median preoperative PSA (3.39 mg/l) (p0.001). The median PSA-reduction was 77.1% (51.5-89.3%) at 5-year follow-up and significantly different between group A (70.2% (42.7-87.3)%) and group B (83.5% (70.2-91.5%)) (p0.006). IPSS was significantly lower at 5-year follow-up in group B compared to group A (2.5 vs. 6, p<0.001), while Qmax, QoL, PVR showed no differences at 5-year follow-up between the groups. Bladder-neck contractures (n¼4) and urethral strictures (n¼4) developed 3.1% of the patients each. Three patients (2.3%) were re-treated during follow-up for recurrent prostatic tissue. CONCLUSIONS: ThuVEP is a durable procedure for the treatment of symptomatic BPO with regard to micturition improvement and prostate volume reduction. The reintervention rate of the ThuVEP procedure at long-term follow-up was low. Source of Funding: None.
MP02-16 EFFECTS OF 5?-REDUCTASE INHIBITION ON BENIGN PROSTATIC HYPERPLASIA TREATED BY PHOTOSELECTIVE VAPORIZATION PROSTATECTOMY WITH THE 180 WATT GREENLIGHT XPS LASER SYSTEM: RESULTS FROM THE GOLIATH POPULATION Aldo Brassetti*, Flavia Proietti, Riccardo Lombardo, Cosimo De Nunzio, Andrea Tubaro, Rome, Italy INTRODUCTION AND OBJECTIVES: Objective of the study was to investigate whether the effectiveness of GreenLight XPS (GLXPS) laser Photoselective Vaporization Prostatectomy is different in patients with or without chronic 5-Alpha-Reductase Inhibitors (5ARI) therapy. METHODS: We retrospectively evaluated prospectively collected 12 months data from the multicenter GOLIATH study regarding the 136 patients with benign prostatic hyperplasia (BPH) treated by PVP with the GL-XPS Laser System. A total of 36 patients were on chronic 5ARI therapy while 100 were not. The two groups were compared with respect to lasing density defined as kilojoules of energy applied per gram of prostate volume, prostate volume and Prostate Specific Antigen (PSA) reduction from baseline, symptom score change from baseline and uroflowmetry parameters improvement. RESULTS: The two groups were largely similar at baseline. Mean prostate volume was 51.7 and 47.5 g in the group taking 5ARI and the group not, respectively. Lasing time and energy used were also greater in that group (50.522.4 min vs 42.420.4 min; 269.2138.9 kJ vs 219.2124 kJ). Energy delivered per prostate volume was greater in the group taking 5ARIs but the difference was not statistically significant (5.53.1 kJ/g vs 4.82.3 kJ/g, p ¼ 0.185). No statistically significant differences were observed postoperatively in the two groups regarding prostate volume reduction, PSA decrease, improvement in symptom score and uroflowmetry parameters (Table 1). CONCLUSIONS: Twelve-month efficacy outcomes and lasing efficiency were not statistically significantly different between the group taking 5ARI and the group not taking pharmaceuticals. 5ARI do not reduce the ability to treat patients with the GreenLight XPS laser system.
THE JOURNAL OF UROLOGYâ
METHODS: Our study included 141 patients who underwent HoLEP. Enrolled patients were divided into two groups according to the presence of UI. Independent t test was used to compare between two groups. Logistic regression was performed to analyze a correlation between de novo UI and other factors such as age, prostate volume, retrieved tissue weight, operative time, and the first post-void residual (PVR) urine volume immediately after removing postoperative urethral catheter. Urethral catheter was removed after bladder instillation with a 200 ml normal saline via urethral catheter, and PVR urine volume was estimated immediately after the first postoperative self-voiding. All definitions of UI corresponded to recommendations of the International Continence Society. RESULTS: After HoLEP, 44 patients (31.2%) had de novo UI, most of which resolved within 1-6 months; 34 had stress UI, 6 had urgency UI, and 4 had mixed UI. Age and PVR urine volume were significantly higher in UI group than non-UI group (75.09 6.82 vs 72.01 8.04 years; P ¼ 0.029, 81.88 67.13 vs 30.15 23.56 ml, P < 0.001). In a logistic linear regression analysis, only PVR urine volume was an independent predictor of de novo UI after HoLEP. The most optimal cut-off value of PVR urine volume for predicting de novo UI was defined as 39.5 ml in the receiver operating characteristics curve analysis (sensitivity, 75.0%; specificity, 74.2%; AUC, 0.815; P < 0.001). CONCLUSIONS: About one-third of patients might undergo de novo UI following HoLEP, and most of them might have been resolved within 1-6 months. High PVR urine volume after removal of postoperative urethral catheter is associated with de novo UI after HoLEP, and could be used as a practical tool to predict postoperative de novo UI. Source of Funding: none
MP02-15 PSA-CHANGES AND MICTURITION IMPROVEMENT 5-YEARS AFTER THULIUM VAPOENUCLEATION OF THE PROSTATE FOR SYMPTOMATIC BENIGN PROSTATIC OBSTRUCTION Christopher Netsch*, Benedikt Becker, Ann Kathrin Orywal, Hamburg, Germany; Thomas Herrmann, Hannover, Germany; Andreas Gross, Hamburg, Germany INTRODUCTION AND OBJECTIVES: To assess the long-term results of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of symptomatic benign prostatic obstruction (BPO) retrospectively. METHODS: 500 patients with symptomatic BPO were treated with ThuVEP and consecutive mechanical morcellation between January 2007 and January 2010 at our institution. Patients were reassessed 1 and 5 years after ThuVEP with International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR), PSA, and prostate volume measured by transrectal ultrasound. To assess treatment effects, patients were divided into two groups according to the prostate volume: group A (<60ml) and group B (>60ml). Patient data is presented as median (interquartile range). RESULTS: 131 patients completed the 5-year follow-up and were included in the final analysis. IPSS, QoL, Qmax, and PVR improved significantly and continued to do so during 5-year follow-up (p0.001). At 1-year follow-up, the median prostate volume (50 ml vs. 13 ml, p<0.001) decreased significantly with a median prostate volume reduction of 80.8% (64.3-88%). Median PSA was significantly reduced at 1-year (0.83 ml/l) and 5-year (0.72 mg/l) follow-up as
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
compared to median preoperative PSA (3.39 mg/l) (p0.001). The median PSA-reduction was 77.1% (51.5-89.3%) at 5-year follow-up and significantly different between group A (70.2% (42.7-87.3)%) and group B (83.5% (70.2-91.5%)) (p0.006). IPSS was significantly lower at 5-year follow-up in group B compared to group A (2.5 vs. 6, p<0.001), while Qmax, QoL, PVR showed no differences at 5-year follow-up between the groups. Bladder-neck contractures (n¼4) and urethral strictures (n¼4) developed 3.1% of the patients each. Three patients (2.3%) were re-treated during follow-up for recurrent prostatic tissue. CONCLUSIONS: ThuVEP is a durable procedure for the treatment of symptomatic BPO with regard to micturition improvement and prostate volume reduction. The reintervention rate of the ThuVEP procedure at long-term follow-up was low. Source of Funding: None.
MP02-16 EFFECTS OF 5?-REDUCTASE INHIBITION ON BENIGN PROSTATIC HYPERPLASIA TREATED BY PHOTOSELECTIVE VAPORIZATION PROSTATECTOMY WITH THE 180 WATT GREENLIGHT XPS LASER SYSTEM: RESULTS FROM THE GOLIATH POPULATION Aldo Brassetti*, Flavia Proietti, Riccardo Lombardo, Cosimo De Nunzio, Andrea Tubaro, Rome, Italy INTRODUCTION AND OBJECTIVES: Objective of the study was to investigate whether the effectiveness of GreenLight XPS (GLXPS) laser Photoselective Vaporization Prostatectomy is different in patients with or without chronic 5-Alpha-Reductase Inhibitors (5ARI) therapy. METHODS: We retrospectively evaluated prospectively collected 12 months data from the multicenter GOLIATH study regarding the 136 patients with benign prostatic hyperplasia (BPH) treated by PVP with the GL-XPS Laser System. A total of 36 patients were on chronic 5ARI therapy while 100 were not. The two groups were compared with respect to lasing density defined as kilojoules of energy applied per gram of prostate volume, prostate volume and Prostate Specific Antigen (PSA) reduction from baseline, symptom score change from baseline and uroflowmetry parameters improvement. RESULTS: The two groups were largely similar at baseline. Mean prostate volume was 51.7 and 47.5 g in the group taking 5ARI and the group not, respectively. Lasing time and energy used were also greater in that group (50.522.4 min vs 42.420.4 min; 269.2138.9 kJ vs 219.2124 kJ). Energy delivered per prostate volume was greater in the group taking 5ARIs but the difference was not statistically significant (5.53.1 kJ/g vs 4.82.3 kJ/g, p ¼ 0.185). No statistically significant differences were observed postoperatively in the two groups regarding prostate volume reduction, PSA decrease, improvement in symptom score and uroflowmetry parameters (Table 1). CONCLUSIONS: Twelve-month efficacy outcomes and lasing efficiency were not statistically significantly different between the group taking 5ARI and the group not taking pharmaceuticals. 5ARI do not reduce the ability to treat patients with the GreenLight XPS laser system.