- Email: [email protected]
PD-02.03
PODIUM SESSIONS
1
Dept. of Urology; 2Dept. of Epidemiology, Jessenius Faculty of Medicine, Martin, Slovak Republic; 3Dept. of Pharmacology, Faculty of Medicine, Bratislava, Slovak Republic; 4Health Research Associates, Seattle, USA; 5Outpatient Clinic of Urology, Levice, Slovak Republic Introduction: To compare the effect of drugs on the need for surgical treatment of benign prostatic hyperplasia (BPH) among Slovakian men followed for 10 years. Methods: The Slovak Health Ministry registry was used to identify patients with BPH. All study patients were enrolled between 1995 and 2004. Inclusion criteria were moderate to severe obstructive lower urinary tract symptoms due to benign prostatic obstruction, decreased urinary flow rate below 15 ml/s, enlarged prostate on digital rectal examination. Patients with prostate or bladder cancer were excluded. Average period of BPH drug use was determined via a pilot study of randomly chosen patients evaluated in two independent outpatient clinics, results were estimated according to the Slovak registry. Surgical treatments consisted of transurethral resection/incision of the prostate (TURP) and suprapubic/retropubic prostatectomy. The primary endpoint was the change in BPH drug use and the secondary endpoint was the occurence of BPHrelated surgery. Overall follow-up was for ten years. Results: Six hundred thousand medical records were evaluated. Baseline characteristics were similar in the two treatment groups (BPH drug use vs. BPH-related surgery). Mean age was 65 years (range 50 – 80 yr.). The pilot study of 1538 patients confirmed average treatment period of 3.7 vs. 2.6 vs. 3.5 months in alpha-blockers vs. finasteride vs. plant extracts. According to the Slovak registry, most patients were initially treated with alpha-blockers (74.5 %) in the BPH drug use group and TURP ( 73.0 %) in the BPH-related surgery group. Age adjusted rates of BPH drug use between 1995 and 2004 increased by approximately 496.0 % (30.5 to 181.8/1,000 men). The alpha-blockers use significantly predominated over finasteride and plant extracts (p⬍0.05). Age adjusted rates of surgery for BPH between 1995 and 2004 declined by approximately 19.4% for TURP (3.1 to 2.5/1,000 men) and 53.3% for prostatectomy (1.5 to 0.7/1,000 men). The curves for the incidence of BPH-related surgery group and BPH drug use group diverged significantly over ten years of follow-up (p⬍0.05).
Conclusion: The study confirmed differences among patients with BPH-related surgery during ten years of follow up. The alpha-blockers use significantly reduced the need in elective indication for TURP. PD-02.03 A low vitamin D level is an independent risk factor for the development of benign prostatic hyperplasia Hammarsten J1, Damber J-E2, Johnell O3, ¨ 4, Ohlsson C5, Knutson T2, Ljunggren O Peeker R2, Smith U6, Waern W5, Mellstro ¨ m D5 1 ¨ lvsborg Hospital, Dept. of Southern A Surgery, Sweden; 2Sahlgrenska University Hospital, Dept. of Urology, Go ¨ teborg, Sweden; 3Malmo ¨ University Hospital, Dept. of Orthopedics, Malmo ¨ , Sweden; 4 Uppsala University Hospital, Dept. of Medicine, Uppsala, Sweden; 5Sahlgrenska University Hospital, Center for Bone Research at the Sahlgrenska Academy, Dept. of Internal Medicine, Go ¨ teborg, Sweden; 6The Lundberg Laboratory for Diabetes Research, Dept. of Internal Medicine, The Sahlgrenska Academy at Go ¨ teborg University, Go ¨ teborg, Sweden Introduction: The etiology of benign prostatic hyperplasia (BPH) is unknown. In the past, most interest has been focused on the steroid hormones as promoters of BPH. More recently, several reports have suggested that BPH is linked to the metabolic syndrome and its major endocrine aberration, hyperinsulinaemia. In a recent study, it was found that there was an inverse association between vitamin D concentrations on the one hand and insulin resistance and the prevalence of the metabolic syndrome on the other. If the hypothesis that BPH is a component of the metabolic syndrome is true, there should be an inverse association between vitamin D concentrations and BPH as measured by the prostate gland volume. Methods: A representative group of 184 men, 72-76 years of age, living in Go ¨teborg, Sweden, involved in the Mr Os study, were examined with respect to their prostate gland volume. The Mr Os study is an international study of male osteoporosis that deals with clinical, anthropometric, metabolic, endocrine and genetic factors. Serum Calcidiol (25-OH Vit3) was determined using RIA-technique. Results: Men previously diagnosed with prostate cancer or having had a prostate operation were excluded after which 164 men remained. The mean prostate gland volume was 46 ml (13-139 ml). Using univariate analysis, the prostate gland volume
UROLOGY 68 (Supplement 5A), November 2006
correlated inversely with Calcidiol (R⫽-0.28, P⫽0.0003), but not with the parathyroid hormone (PTH) (R⫽0.11, NS). Using a multivariate analysis, the prostate gland volume correlated inversely with Calcidiol (beta⫽ -0.287, P⫽0.0008) following adjustment for body composition, free testosterone, free oestrogen, fasting plasma insulin, age and PTH. The model explained 18.3% of the prostate gland volume variation. Conclusion: In the present study, a low vitamin D level was linked to an increased prostate gland volume, showing that a low vitamin D level is an independent risk factor for BPH. It has been reported recently that a low vitamin D level is linked to insulin resistance and the prevalence of the metabolic syndrome. Thus, a low vitamin D level could be linked to BPH via the metabolic syndrome and its major endocrine aberration, hyperinsulinaemia. The findings in the present study confirm that BPH is a component of the metabolic syndrome. PD-02.04 Myocardial injury during transurethral prostatectomy: identification, incidence, and risk factors Ibrahim H1, Brathwaite D1, Hussain Z1, Inman RD1, Hallworth MJ1, Jones PW2, Coppinger SWV1 1 Depts. of Urology and Clinical Chemistry, Royal Shrewsbury Hospital, Shrewsbury, UK; 2Dept. of Mathematics, Keele University, Keele, UK Introduction: Epidemiological studies have suggested that TURP carries a higher mortality than open prostatectomy, possibly due to myocardial injury. We performed a randomised controlled trial to evaluate the cardiac effects of TURP. Methods: 199 consecutive evaluable TURPs were included in the statistical analysis. Serum cardiac Troponin I was used as a marker of peroperative myocardial injury. Preoperative details, including age and medical history were recorded. Existing cardiac risk factors were recorded and scored using Detsky Score. Operative details, including duration of surgery, weight of resectate and histology were documented. Anaesthetic and postoperative details, including transfusion requirements, were also noted. The patient’s temperature was measured and the intra-operative irrigating fluid absorption was calculated using an on-table weighing technique. The haemoglobin concentration in the irrigant was measured using TUR microcuvettes and a HemoCue photometer and the intra-operative blood loss calculated. Statistical analysis was per-
5
1
Dept. of Urology; 2Dept. of Epidemiology, Jessenius Faculty of Medicine, Martin, Slovak Republic; 3Dept. of Pharmacology, Faculty of Medicine, Bratislava, Slovak Republic; 4Health Research Associates, Seattle, USA; 5Outpatient Clinic of Urology, Levice, Slovak Republic Introduction: To compare the effect of drugs on the need for surgical treatment of benign prostatic hyperplasia (BPH) among Slovakian men followed for 10 years. Methods: The Slovak Health Ministry registry was used to identify patients with BPH. All study patients were enrolled between 1995 and 2004. Inclusion criteria were moderate to severe obstructive lower urinary tract symptoms due to benign prostatic obstruction, decreased urinary flow rate below 15 ml/s, enlarged prostate on digital rectal examination. Patients with prostate or bladder cancer were excluded. Average period of BPH drug use was determined via a pilot study of randomly chosen patients evaluated in two independent outpatient clinics, results were estimated according to the Slovak registry. Surgical treatments consisted of transurethral resection/incision of the prostate (TURP) and suprapubic/retropubic prostatectomy. The primary endpoint was the change in BPH drug use and the secondary endpoint was the occurence of BPHrelated surgery. Overall follow-up was for ten years. Results: Six hundred thousand medical records were evaluated. Baseline characteristics were similar in the two treatment groups (BPH drug use vs. BPH-related surgery). Mean age was 65 years (range 50 – 80 yr.). The pilot study of 1538 patients confirmed average treatment period of 3.7 vs. 2.6 vs. 3.5 months in alpha-blockers vs. finasteride vs. plant extracts. According to the Slovak registry, most patients were initially treated with alpha-blockers (74.5 %) in the BPH drug use group and TURP ( 73.0 %) in the BPH-related surgery group. Age adjusted rates of BPH drug use between 1995 and 2004 increased by approximately 496.0 % (30.5 to 181.8/1,000 men). The alpha-blockers use significantly predominated over finasteride and plant extracts (p⬍0.05). Age adjusted rates of surgery for BPH between 1995 and 2004 declined by approximately 19.4% for TURP (3.1 to 2.5/1,000 men) and 53.3% for prostatectomy (1.5 to 0.7/1,000 men). The curves for the incidence of BPH-related surgery group and BPH drug use group diverged significantly over ten years of follow-up (p⬍0.05).
Conclusion: The study confirmed differences among patients with BPH-related surgery during ten years of follow up. The alpha-blockers use significantly reduced the need in elective indication for TURP. PD-02.03 A low vitamin D level is an independent risk factor for the development of benign prostatic hyperplasia Hammarsten J1, Damber J-E2, Johnell O3, ¨ 4, Ohlsson C5, Knutson T2, Ljunggren O Peeker R2, Smith U6, Waern W5, Mellstro ¨ m D5 1 ¨ lvsborg Hospital, Dept. of Southern A Surgery, Sweden; 2Sahlgrenska University Hospital, Dept. of Urology, Go ¨ teborg, Sweden; 3Malmo ¨ University Hospital, Dept. of Orthopedics, Malmo ¨ , Sweden; 4 Uppsala University Hospital, Dept. of Medicine, Uppsala, Sweden; 5Sahlgrenska University Hospital, Center for Bone Research at the Sahlgrenska Academy, Dept. of Internal Medicine, Go ¨ teborg, Sweden; 6The Lundberg Laboratory for Diabetes Research, Dept. of Internal Medicine, The Sahlgrenska Academy at Go ¨ teborg University, Go ¨ teborg, Sweden Introduction: The etiology of benign prostatic hyperplasia (BPH) is unknown. In the past, most interest has been focused on the steroid hormones as promoters of BPH. More recently, several reports have suggested that BPH is linked to the metabolic syndrome and its major endocrine aberration, hyperinsulinaemia. In a recent study, it was found that there was an inverse association between vitamin D concentrations on the one hand and insulin resistance and the prevalence of the metabolic syndrome on the other. If the hypothesis that BPH is a component of the metabolic syndrome is true, there should be an inverse association between vitamin D concentrations and BPH as measured by the prostate gland volume. Methods: A representative group of 184 men, 72-76 years of age, living in Go ¨teborg, Sweden, involved in the Mr Os study, were examined with respect to their prostate gland volume. The Mr Os study is an international study of male osteoporosis that deals with clinical, anthropometric, metabolic, endocrine and genetic factors. Serum Calcidiol (25-OH Vit3) was determined using RIA-technique. Results: Men previously diagnosed with prostate cancer or having had a prostate operation were excluded after which 164 men remained. The mean prostate gland volume was 46 ml (13-139 ml). Using univariate analysis, the prostate gland volume
UROLOGY 68 (Supplement 5A), November 2006
correlated inversely with Calcidiol (R⫽-0.28, P⫽0.0003), but not with the parathyroid hormone (PTH) (R⫽0.11, NS). Using a multivariate analysis, the prostate gland volume correlated inversely with Calcidiol (beta⫽ -0.287, P⫽0.0008) following adjustment for body composition, free testosterone, free oestrogen, fasting plasma insulin, age and PTH. The model explained 18.3% of the prostate gland volume variation. Conclusion: In the present study, a low vitamin D level was linked to an increased prostate gland volume, showing that a low vitamin D level is an independent risk factor for BPH. It has been reported recently that a low vitamin D level is linked to insulin resistance and the prevalence of the metabolic syndrome. Thus, a low vitamin D level could be linked to BPH via the metabolic syndrome and its major endocrine aberration, hyperinsulinaemia. The findings in the present study confirm that BPH is a component of the metabolic syndrome. PD-02.04 Myocardial injury during transurethral prostatectomy: identification, incidence, and risk factors Ibrahim H1, Brathwaite D1, Hussain Z1, Inman RD1, Hallworth MJ1, Jones PW2, Coppinger SWV1 1 Depts. of Urology and Clinical Chemistry, Royal Shrewsbury Hospital, Shrewsbury, UK; 2Dept. of Mathematics, Keele University, Keele, UK Introduction: Epidemiological studies have suggested that TURP carries a higher mortality than open prostatectomy, possibly due to myocardial injury. We performed a randomised controlled trial to evaluate the cardiac effects of TURP. Methods: 199 consecutive evaluable TURPs were included in the statistical analysis. Serum cardiac Troponin I was used as a marker of peroperative myocardial injury. Preoperative details, including age and medical history were recorded. Existing cardiac risk factors were recorded and scored using Detsky Score. Operative details, including duration of surgery, weight of resectate and histology were documented. Anaesthetic and postoperative details, including transfusion requirements, were also noted. The patient’s temperature was measured and the intra-operative irrigating fluid absorption was calculated using an on-table weighing technique. The haemoglobin concentration in the irrigant was measured using TUR microcuvettes and a HemoCue photometer and the intra-operative blood loss calculated. Statistical analysis was per-
5