POS-03.111: Continence rates and stricture formation following radical prostatectomy

UNMODERATED POSTER SESSIONS

longer follow-up period is needed to confirm the results. POS-03.110 Complete apical dissection at radical prostatectomy Kiyotaka K, Ichikawa H Tochigi Cancer Center, Utsunomiya, Japan Objectives: The apical dissection is the most important part of radical prostatectomy for complete removal of tumor and not only for limiting blood loss. We present the new way to achieve complete dissection of the apex of the prostate. Materials & Methods: Following incision of the endopelvic fascia, we completely dissect the levator muscle fuse to the apex by ligasure. We resect the puboprostatic ligaments as distal as possible. Then, we can do blunt dissection between the urethra and the surrounding muscle arising from the levator ani muscle. After resection of this muscle, we can easily find out the space between the urethra and the NVB as fold. Right angle clamp is placed in this fold. This place is the landmark of precise junction of the urethra and the apex of the prostate. When we cut at distal side of this line, we never incise into the apex of the prostate. Results: Positive surgical margin rate decreased in comparison with the former method (4% vs. 8%). The urinary incontinence rate did not increase. Conclusions: We think this method is the best way to achieve complete apical dissection. POS-03.111 Continence rates and stricture formation following radical prostatectomy Bhatt J, Little B, Begg H, McPhee S, Cameron L, Bell A, Crombie E, Al Saffar N, Hollins G The Ayr Hospital, NHS Ayrshire and Arran, Ayr, Scotland, UK Objectives: To examine long-term continence rates and stricture formation following radical prostatectomy in a single institution retrospective cohort study. Materials & Methods: A retrospective case review was performed on all radical prostatectomy patients undergoing surgery at a single institution between 1996 and 2006. For patients with at least 5 years follow up, the degree of post-operative incontinence was graded, as was the uptake rate of artificial urinary sphincter surgery, and the duration of physiotherapy review until maximal functional continence. For the entire cohort a post-opera-

tive stricture rate was calculated based on flow rate and flexible cystoscopy findings. Results: Radical prostatectomy was performed in 150 patients over a ten year period. The stricture rate was 15% overall. Forty-five patients had greater than 5 years follow up. Of this group, 42% had no urinary leakage at any time after discharge from physiotherapy, 47% had to use incontinence pads at night and 11% required sheath catheters. Of the latter group, 40% required artificial urinary sphincter placement. Incontinence rates in the highest age quartile (66-71 years) were higher at 64% compared to 45% for those in the lowest quartile (48-53 years). Those requiring sheath drainage was also higher at 18% vs 9%. The mean duration of physiotherapy review was 9 months (Range 0 to 19 months). Dry patients were discharged at a mean of 6 months. Patients using pads at night were discharged at a mean of 11 months. For patients with incontinence requiring sheath drainage, the mean review time was 12 months (8 – 19 months). Unsurprisingly, patients with any incontinence required longer physiotherapy input than patients who were completely dry (p⫽0.001). Conclusions: Severe urinary incontinence requiring permanent sheath drainage occurs in 11% of patients undergoing radical prostatectmy. Further improvement after 12 months is unlikely, and patients with intractable symptoms should be considered for artificial sphincter placement at this stage. Newer treatment modalities such as duloxetine are also being evaluated in this unit, and is discussed further. Abstract Withdrawn POS-03.113 Initial Canadian experience of hypofractionated accelerated radiotherapy for low risk localized prostate cancer (pHART 3) Holden L1, Loblaw A1, Cheung P1, Morton G1, Basran P1, Tirona R1, Cardoso M1, Pang G1, Gardner S2 Departments of Radiation Oncology, 1 University of Toronto, 2Department of Clinical Trials and Epidemiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Background: Approximately 7000 patients were diagnosed with low risk prostate cancer in Canada last year but the annual incidence could increase by 33-100% in the next decade. This increase would likely be due to the aging population and lower thresholds for prostate biopsy. The vast majority of men with low risk disease will

UROLOGY 70 (Supplment 3A), September 2007

choose radical treatment and tend to prefer treatments with high control rates and minimal disruption to their lives. There are now data from several randomized studies showing that higher total doses of radiotherapy improve biochemical disease free survival and that the alpha/beta ratio of the prostate is low (1.3 in a recent meta-analysis). These hypofractionated external radiation treatments have the advantage of maintaining high bioequivalent tumor doses while decreasing treatment visits and reducing side effects. This study explores the use of this dose fractionation and evaluates the primary endpoint of acute toxicity. Methods: A phase 1/2 study is currently underway whereby patients with T1-2, Gleason⬍6, PSA⬍10 ng/ml receive 35 Gy in 5 fractions, once weekly for 5 consecutive weeks. Gold seed feducial markers, daily image guidance and a 4 mm CTVPTV margin are used. Results: As of March 2007, 23 patients have been accrued, of which 21 have completed treatment with 16 having completed 3 months of follow-up. Of the 16, the median PSA pre-treatment was 6.0 ng/ml. Treatment was very well tolerated with no grade 3 fatigue/GI/GU symptoms observed. One patient (6%) was started on an alpha blocker for hesitancy, 3 (19%) had the onset of moderate fatigue and 4 (25%) developed moderate flatulence during treatment all of which have resolved post-treatment. Dose-volume histogram objectives and daily imaging were achievable in all 23 patients. At first follow-up, the median PSA was 3.2 ng/ml and 44% had a PSA ⬍ 3.0 ng/ml. An impact analysis revealed a net cost savings of $600 per course of treatment compared to our current standard protocol for low risk patients (76Gy/38 fractions). Conclusions: This novel technique appears feasible, costs less than standard fractionation regimens and is well tolerated. Further study and follow-up will be needed to document late toxicity and efficacy. POS-03.114 Factors affecting the need for endoscopic intervention for debris or stricture after HIFU for prostate cancer Dudderidge T1, Zacharakis E1, Calleary J1, Allen C2, IIling E2, Emberton E1, Ahmed H 1 Institute of Urology, Division of Surgical and Interventional Sciences, University College London; 2Department of Radiology, University College London Hospitals NHS Foundation Trust Introduction: Complications from HIFU mainly relate to passage of necrotic debris and stricture formation. We present a pro-

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