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PD24-10 EVALUATION OF THE LEARNING CURVE FOR THULIUM LASER TRANSURETHRAL VAPORESECTION OF THE PROSTATE (THUVARP)
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
e515
CONCLUSIONS: The study has shown that ThuVARP has a short learning curve not exceeding 12 cases for surgeons already experienced in performing TURPs. Results of the non-inferiority trial are awaited to see if outcomes are comparable to TURP, making it a feasible alternative with a short learning curve. Source of Funding: NIHR Health Technology Assessment
PD24-11 MULTICENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (PROSTATE VOLUME>100CC): LONG-TERM OUTCOMES OF 434 PATIENTS
Source of Funding: This work was partially sponsored by Fonds de la Recherche Sante du Quebec (FRSQ) Chercheur Boursier grant to Dr Sero Andonian and by a grant from the Urology Care Foundation Research Scholars Program and the Boston Scientific Corporation, The Endourological Society, and the Friends of Joe to Dr Yasser Noureldin and the CUASF-SIU International Scholarship grant to Dr Yasser Noureldin.
PD24-10 EVALUATION OF THE LEARNING CURVE FOR THULIUM LASER TRANSURETHRAL VAPORESECTION OF THE PROSTATE (THUVARP) Ala'a Sharaf*, jo worthington, Hashim Hashim, Bristol, United Kingdom INTRODUCTION AND OBJECTIVES: Transurethral resection of the prostate (TURP) has been the standard operation for voiding LUTS for 40 years with very few changes. It is generally a very successful operation but has well documented risks for the patient. Various laser techniques have become available but none have become widely used in the National Health Service (NHS) because of lengthy training required for surgeons or inferior performance on clinical outcomes. The thulium laser technique (ThuVARP) vaporises and resects the prostate using a surgical technique similar to TURP, facilitating a potentially shorter training period for surgeons. A systematic review of laser technology recently recommended ThuVARP as an acceptable alternative to TURP for the treatment of symptomatic benign prostatic obstruction (BPO). For patients undergoing BPO surgery, NICE clinical guidelines recommended offering TURP or holmium laser enucleation (HoLEP). However, HoLEP is only used in a few centres due to the steep learning curve. The Objective was to assess the surgical learning curve of ThuVARP, as part of a prospective, randomised, multicentre, controlled trial to determine the clinical and cost effectiveness of ThuVARP versus TURP in the NHS (UNBLOCS trial). METHODS: The UNBLOCS trial is funded by the NIHR HTA program. Consultant urologists were mentored to perform ThuVARP. All participating surgeons observed the chief investigator performing 1 to 2 cases. The lead surgeon then observed the principal investigators (PIs) performing 2 to 5 cases. The surgeons then performed cases without supervision. Competency was assessed with the Intercollegiate Surgical Curriculum Programme work-based assessments (ISCP-WBA) by an independent assessor and the PIs were signed off once the competency criteria were met. RESULTS: A total of 9 surgeons were involved form 6 different centres (3 district general hospitals and 3 tertiary referral centres). All of the surgeons have performed at least 150 TURPs. A mean of 2.1 cases were observed by each surgeon and a mean of 2.2 cases were performed by each surgeon under supervision. A mean of 7 cases were performed by the PIs before being signed off as competent.
Pierre-Alain Hueber*, Malek Meskawi, Roger Valdivieso, Tristan Martel, re, Tours, France; Mounsif Azizi, Montreal, Canada; Franck Bruye Vincent Misrai, Toulouse, France; Georges Fournier, Brest, France; Ravi Munver, Ganesh Sivarajan, New Jersey, NJ; Matthew Rutman, Alexis Te, Bilal Chughtai, New York, NY; Dean Elterman, Toronto, Canada; Kevin Zorn, Montreal, Canada INTRODUCTION AND OBJECTIVES: Prostate volume (PV) >100cc remains challenging for endoscopic BPH management. Although PVP using XPS-180 system is feasible for patients with large PV, long-term outcome data supporting its use is still lacking. The aim was to evaluate the outcomes and durability at 4 years in a large, multicenter experience. METHODS: This is a retrospective study of 434 men with preoperative TRUS PV>100cc that were treated in 8 centers in NorthAmerica (Canada, USA) and in Europe (France) with the GreenlightXPS laser using PVP for the treatment LUTS associated with BPH. To assess efficacy, IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and PSA were measured at 6, 12, 36 and 48 months. Durability was evaluated using re-treatment rate at 24, 36 and 48 months. RESULTS: Median prostate size and PSA were 121cc (IQR 108-150) and 6.3ng/mL. 42.3% of men had an indwelling catheter at the time of surgery. Median operative time and energy applied were 60min (IQR: 40-74) and 424kJ, with 2 fibers used in 40% of the cases. Median energy delivery was 3.4kJ/cc per case. Median length of stay was 24h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months (fig.1). Surgical BPH retreatment was 5.3% at 24 months which rose to 11.9% at 36 months. Interestingly, characteristics of re-treated men include energy delivery that was 2.4kJ (vs 3.4kJ) and PSA reduction at 12 months of 29% (vs46%). CONCLUSIONS: PVP treatment using Greenlight XPS-180W can potentially provide durable improvements with regards to functional outcomes including IPSS at 4 years. However retreatment rate rising after 3 years is a concern. This data highlights the need of utilizing a standardized technique with an operative endpoint of an enucleationlike-defect (down to the surgical capsule). Other than encouraging the use of transrectal imaging preoperatively, benchmark perioperative parameters of energy use (KJ/cc), 12-month PSA reduction and rising PSA during followup may serve as a surrogate markers for predicting durability.
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
e515
CONCLUSIONS: The study has shown that ThuVARP has a short learning curve not exceeding 12 cases for surgeons already experienced in performing TURPs. Results of the non-inferiority trial are awaited to see if outcomes are comparable to TURP, making it a feasible alternative with a short learning curve. Source of Funding: NIHR Health Technology Assessment
PD24-11 MULTICENTER INTERNATIONAL EXPERIENCE OF 180W LBO LASER PHOTO-VAPORIZATION IN MEN WITH LARGE PROSTATES (PROSTATE VOLUME>100CC): LONG-TERM OUTCOMES OF 434 PATIENTS
Source of Funding: This work was partially sponsored by Fonds de la Recherche Sante du Quebec (FRSQ) Chercheur Boursier grant to Dr Sero Andonian and by a grant from the Urology Care Foundation Research Scholars Program and the Boston Scientific Corporation, The Endourological Society, and the Friends of Joe to Dr Yasser Noureldin and the CUASF-SIU International Scholarship grant to Dr Yasser Noureldin.
PD24-10 EVALUATION OF THE LEARNING CURVE FOR THULIUM LASER TRANSURETHRAL VAPORESECTION OF THE PROSTATE (THUVARP) Ala'a Sharaf*, jo worthington, Hashim Hashim, Bristol, United Kingdom INTRODUCTION AND OBJECTIVES: Transurethral resection of the prostate (TURP) has been the standard operation for voiding LUTS for 40 years with very few changes. It is generally a very successful operation but has well documented risks for the patient. Various laser techniques have become available but none have become widely used in the National Health Service (NHS) because of lengthy training required for surgeons or inferior performance on clinical outcomes. The thulium laser technique (ThuVARP) vaporises and resects the prostate using a surgical technique similar to TURP, facilitating a potentially shorter training period for surgeons. A systematic review of laser technology recently recommended ThuVARP as an acceptable alternative to TURP for the treatment of symptomatic benign prostatic obstruction (BPO). For patients undergoing BPO surgery, NICE clinical guidelines recommended offering TURP or holmium laser enucleation (HoLEP). However, HoLEP is only used in a few centres due to the steep learning curve. The Objective was to assess the surgical learning curve of ThuVARP, as part of a prospective, randomised, multicentre, controlled trial to determine the clinical and cost effectiveness of ThuVARP versus TURP in the NHS (UNBLOCS trial). METHODS: The UNBLOCS trial is funded by the NIHR HTA program. Consultant urologists were mentored to perform ThuVARP. All participating surgeons observed the chief investigator performing 1 to 2 cases. The lead surgeon then observed the principal investigators (PIs) performing 2 to 5 cases. The surgeons then performed cases without supervision. Competency was assessed with the Intercollegiate Surgical Curriculum Programme work-based assessments (ISCP-WBA) by an independent assessor and the PIs were signed off once the competency criteria were met. RESULTS: A total of 9 surgeons were involved form 6 different centres (3 district general hospitals and 3 tertiary referral centres). All of the surgeons have performed at least 150 TURPs. A mean of 2.1 cases were observed by each surgeon and a mean of 2.2 cases were performed by each surgeon under supervision. A mean of 7 cases were performed by the PIs before being signed off as competent.
Pierre-Alain Hueber*, Malek Meskawi, Roger Valdivieso, Tristan Martel, re, Tours, France; Mounsif Azizi, Montreal, Canada; Franck Bruye Vincent Misrai, Toulouse, France; Georges Fournier, Brest, France; Ravi Munver, Ganesh Sivarajan, New Jersey, NJ; Matthew Rutman, Alexis Te, Bilal Chughtai, New York, NY; Dean Elterman, Toronto, Canada; Kevin Zorn, Montreal, Canada INTRODUCTION AND OBJECTIVES: Prostate volume (PV) >100cc remains challenging for endoscopic BPH management. Although PVP using XPS-180 system is feasible for patients with large PV, long-term outcome data supporting its use is still lacking. The aim was to evaluate the outcomes and durability at 4 years in a large, multicenter experience. METHODS: This is a retrospective study of 434 men with preoperative TRUS PV>100cc that were treated in 8 centers in NorthAmerica (Canada, USA) and in Europe (France) with the GreenlightXPS laser using PVP for the treatment LUTS associated with BPH. To assess efficacy, IPSS, Qmax, prostate volume (PV), postvoid residual (PVR) and PSA were measured at 6, 12, 36 and 48 months. Durability was evaluated using re-treatment rate at 24, 36 and 48 months. RESULTS: Median prostate size and PSA were 121cc (IQR 108-150) and 6.3ng/mL. 42.3% of men had an indwelling catheter at the time of surgery. Median operative time and energy applied were 60min (IQR: 40-74) and 424kJ, with 2 fibers used in 40% of the cases. Median energy delivery was 3.4kJ/cc per case. Median length of stay was 24h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months (fig.1). Surgical BPH retreatment was 5.3% at 24 months which rose to 11.9% at 36 months. Interestingly, characteristics of re-treated men include energy delivery that was 2.4kJ (vs 3.4kJ) and PSA reduction at 12 months of 29% (vs46%). CONCLUSIONS: PVP treatment using Greenlight XPS-180W can potentially provide durable improvements with regards to functional outcomes including IPSS at 4 years. However retreatment rate rising after 3 years is a concern. This data highlights the need of utilizing a standardized technique with an operative endpoint of an enucleationlike-defect (down to the surgical capsule). Other than encouraging the use of transrectal imaging preoperatively, benchmark perioperative parameters of energy use (KJ/cc), 12-month PSA reduction and rising PSA during followup may serve as a surrogate markers for predicting durability.