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Posttraumatic posterior urethral stricture repair: long term results
09
353 POSTTRAUMATIC POSTERIOR LONG TERM RESULTS Wirtenberger
URETHRAL
Walter, Radmayr Christian.
Urology, University
of Innsbruck,
STRICTURE
REPAIR:
Bartach Georg
Innsbruck,
UROLOGICAL IMAGING Monday,February 25,13.45-15.15 hrs,RoomE
354
COMPARISON OF CONTRAST-ENHANCED COLOR DOPPLER TARGETED BIOPSY TO CONVENTIONAL SYSTEMATIC BIOPSY: IMPACT ON PROSTATE CANCER DETECTION
Andrea’,Volgger Hubert’, Halpern Ethan’. Steiner Hannes*, Pallwein Leo’, Schuster Antonius’, Moser Patriaia3. Rogatsch Hermann4, Frauscher Klauser
Ferdinand’,
Austria
INTRODUCTION & OBJECTIVES: In a retrospective study, we analysed the long term outcome of 188 patients who underwent open surgery for posterior urethral strictures in the last two and a half decades. MATERIALS & METHODS: In 147 patients the urethra was reconstructed with a one stage procedure, in 41 patients the lesions were corrected by two stage repairs, respectively. The one-stage procedures included direct end to end anastomosis in 38, bulboprostatic anastomosis in 99, and fasciocutaneous flap technique in IO patients, respectively. The two stage repairs in the remaining 41 patients consisted either of mesh grafts or of Johanson urethroplasties. Among all patients, 80 were available for long term results such as voiding and sexual history, uroflowmetry, retrograde urethrography, voiding cystourethrography, and cosmetic outcome.
Bartsch Georg’
‘Radiology. Radiology II, Innsbruck, Austria, *Urology, Innsbruck, Austria, ZRadiology. Division of Ultrasound, Philadelphia, United States of America, ‘Pathology, Innsbruck, Austria INTRODUCTION & OBJECTIVES: We conducted a prospective study to determine whether a limited biopsy approach with contrast-enhanced colour Doppler ultrasound (US) targeted biopsy of the prostate could detect cancers as well as gray-scale US guided rystematic biopsy with a larger number of biopsy cores. MATERIALS & METHODS: We examined 230 male screening volunteers (total PSAr 1.25 ngiml and free PSA
RESULTS: Of the 80 patients with a mean follow-up of 7 years examined, 54 had a maximum flow rate of more than 20 ml/set, I2 between 15-20 mlisec, and I4 of less than I5 mlisec. Recurrent strictures were found in 6 cases by means of voiding cystourethrography or retrograde urethrography. I2 patients reported erectile dysfunction. 9 of these due to severe pelvic trauma and 3 postoperatively. Deviation of the penile shaft was noted in 4 cases. Two patients were incontinent.
RESULTS: Cancer was detected in 691230 subjects (30%). Cancer was detected in 561230 subjects (24.4%) by contrast-enhanced targeted biopsy, and in 5 11230 patients (22.2%) with systematic biopsy. Cancer was detected with targeted biopsy alone in I7 subjects (7.4%), and with systematic biopsy alone in 13 subjects (5.6%). The overall cancer detection rate (by-patient) was not significantly different for targeted and systematic biopsy (p=O.S3). The detection rate of targeted biopsy cores (10.4% or I 18/l 139) was significantly better than that of systematic biopsy cores (5.3% or 1231230) (p
CONCLUSION: Our long term results clearly demonstrate that adequate primary care and the perineal approach combined with meticulous anastomosis technique or well vascularised pedicled penile skin grafts are essential for successful posttraumatic posterior urethral stricture repairs and sustain the long term outcome.
CONCLUSION: Contrast-enhanced colour Doppler targeted biopsy detected as many cancers as systematic biopsy with fewer than half the number of biopsy cores. Although an increase in cancer detection is obtained by combining targeted and systematic techniques in this screening population, contrastenhanced targeted biopsy alone is a reasonable approach to reduce the number of biopsy cores.
355 THE VALUE OF DYNAMIC CONTRAST ENHANCED POWER DOPPLER ULTRASOUND IN THE LOCALISATION OF PROSTATE CARCINOMA Goossen Tierk’, Sedelaar Wijkstra Hessel’
Michiel’, De la Rosette Jean’, Van Leenders Arno’,
‘Department of Urology, University Medical Centre Nijmegen. Nijmegen, The Netherlands, ‘Department of Pathology, University Medical Centre Nijmegen, Nijmegen. The Netherlands INTRODUCTION & OBJECTIVES: The development of Prostate Cancer (PCs) is associated with changes in perfusion. This abstract describes the localisation of PCs based on differences in perfusion. Perfusion is imaged using contrast-enhanced power Doppler ultrasound (CE-PDU) imaging. MATERIALS & METHODS: 29 patients with proven prostate malignancy, scheduled for radical prostatectomy. underwent an ultrasound examination prior to surgery. A bolus injection of contrast agent was administered intravenously. Transrectal CE-PDU was used to image the delivery of the contrast-enhanced blood to the prostate. The percentage of a selected area that showed enhancement was observed in time, resulting m a Time-Intensity Curve (TIC). From the TIC the Time to start (TtS), Time to peak (TtP), Peak value and the Rise time of the enhancement were calculated. Prior to evaluation. the patients were divided into 3 categories (I.11 & III) based on the TIC of the whole prostate. I and II showed clear enhancement. III showed no appreciable enhancement and was excluded (N=6). First circulation could clearly be distinguished in category I (N=I I). Three evaluation protocols divided the prostate into a number of areas: into 2 using the Left-Right (LR) and Dorsal-Ventral (DV) protocols and into 4 using the Quadrant-protocol (Q). The TICS were compared to identify the most affected area. The results were compared to the pathological findings. RESULTS: For the LR-protocol, the minimal TtP (minTtP) proved to be the most predictive parameter for selecting the major malignant area. 78% of the patients were diagnosed correctly (N=23). For category I only, this improved to 91% (N=l I). MinTtP detection within the DV-protocol resulted in 35% (N=23) accuracy. MinTtP within the Q-protocol resulted in an accuracy of 26% (N=23). When the two ventral areas were compared, in 77% (N=l3) the most affected ventral area could be identified. The most affected dorsal area could be identified with 73% (N=2?) accuracy. Comparing the left-ventral and left-dorsal areas resulted in 42% (N=l9) accuracy. Comparing the right areas resulted in 38% (N=l6) correct diagnose?. CONCLUSION: TICS obtained from CE-PDU exammations have a high predictive value for localising malignancies in either the right or the left lobe of the prostate. Comparison of the dorsal and ventral areas of the prostate is difficult. This is mo\t likely due to anatomical differences.
356 ENDORECTAL CANCER Comet-Battle Anton?
MRI
IN THE
EARLY
DIAGNOSIS
OF PROSTATE
Joseo’ Vilanova-Busquets . Carlea’, Saladie-Roig Josep’, Gelabert-Mas
‘Urology. Hospital Dr. J. Trueta, Girona, Spain, ‘Radiology, Centre Ressonancia Magnetica. Girona, Spain, zUrology, Hospital Germans Trias I Pujol, Badalona. Spain, 4Urology. Hospital Del Mar. Barcelona, Spain INTRODUCTION & OBJECTIVES: Patients with persistent abnormal prostate specific antigen (PSA) or digital rectal examination (DRE) often undergo several negative sextant biopsies. In the present study we evaluate the predictive value of a negative endorectal MRI (EMRI) to avoid subsequent sextant biopsies in these patients. MATERIALS & METHODS: 92 patients with elevated PSA (>4 ngiml) and/or abnormal DRE were included in the study. All patients underwent an endorectal MRI previous to transrectal ultrasound guided needle sextant biopsies. In case of negative biopsy, patient5 were subsequently followed and rebiopsied if indicated. We performed a total of 184 biopsies: 92 patients underwent I set of biopsies, 61 patients 2 biopsies, 27 patients 3 biopsies. 3 patients 4 biopsies and 1 patient 5 biopsies. 67 patients had a final negative biopsy and 25 had a final positive biopsy. Median PSA in this group of patients was IO.44 ngiml (I ,I3 ngiml-34 ngiml), and the median free/total PSA was 0.20. Uni and multivariate analysis and ROC curves were used to compare the accuracy of MRI, PSA, fPSA and DRE. The probability of positive biopsy with each technique and the association of these techniques were assessed, RESULTS: Median PSA was not statistically different in the group with negative biopsies (9.44 ngiml) and in the group with positive biopsies (1 I ,8 ngiml) (p=O,O64). EMRI had an elevated negative predictive value (91,076) and was the individual test with highest accuracy (77%), including PSA (62%). The association of EMRI-DREPSA had the highest accuracy (83%) but not significantly higher than EMRI-PSA (80%) or EMRl alone (77%). The probability of positive biopsy in patients with negative DRE and EMRI, and PSA values between 5-15 ngiml was 5.10% at first and second biopsies, but decreased progressively on subsequent biopsies (~8% at 3rd biopsy.
Urology
Supplements
1 (2002)
No. 1, pp. 91
353 POSTTRAUMATIC POSTERIOR LONG TERM RESULTS Wirtenberger
URETHRAL
Walter, Radmayr Christian.
Urology, University
of Innsbruck,
STRICTURE
REPAIR:
Bartach Georg
Innsbruck,
UROLOGICAL IMAGING Monday,February 25,13.45-15.15 hrs,RoomE
354
COMPARISON OF CONTRAST-ENHANCED COLOR DOPPLER TARGETED BIOPSY TO CONVENTIONAL SYSTEMATIC BIOPSY: IMPACT ON PROSTATE CANCER DETECTION
Andrea’,Volgger Hubert’, Halpern Ethan’. Steiner Hannes*, Pallwein Leo’, Schuster Antonius’, Moser Patriaia3. Rogatsch Hermann4, Frauscher Klauser
Ferdinand’,
Austria
INTRODUCTION & OBJECTIVES: In a retrospective study, we analysed the long term outcome of 188 patients who underwent open surgery for posterior urethral strictures in the last two and a half decades. MATERIALS & METHODS: In 147 patients the urethra was reconstructed with a one stage procedure, in 41 patients the lesions were corrected by two stage repairs, respectively. The one-stage procedures included direct end to end anastomosis in 38, bulboprostatic anastomosis in 99, and fasciocutaneous flap technique in IO patients, respectively. The two stage repairs in the remaining 41 patients consisted either of mesh grafts or of Johanson urethroplasties. Among all patients, 80 were available for long term results such as voiding and sexual history, uroflowmetry, retrograde urethrography, voiding cystourethrography, and cosmetic outcome.
Bartsch Georg’
‘Radiology. Radiology II, Innsbruck, Austria, *Urology, Innsbruck, Austria, ZRadiology. Division of Ultrasound, Philadelphia, United States of America, ‘Pathology, Innsbruck, Austria INTRODUCTION & OBJECTIVES: We conducted a prospective study to determine whether a limited biopsy approach with contrast-enhanced colour Doppler ultrasound (US) targeted biopsy of the prostate could detect cancers as well as gray-scale US guided rystematic biopsy with a larger number of biopsy cores. MATERIALS & METHODS: We examined 230 male screening volunteers (total PSAr 1.25 ngiml and free PSA
RESULTS: Of the 80 patients with a mean follow-up of 7 years examined, 54 had a maximum flow rate of more than 20 ml/set, I2 between 15-20 mlisec, and I4 of less than I5 mlisec. Recurrent strictures were found in 6 cases by means of voiding cystourethrography or retrograde urethrography. I2 patients reported erectile dysfunction. 9 of these due to severe pelvic trauma and 3 postoperatively. Deviation of the penile shaft was noted in 4 cases. Two patients were incontinent.
RESULTS: Cancer was detected in 691230 subjects (30%). Cancer was detected in 561230 subjects (24.4%) by contrast-enhanced targeted biopsy, and in 5 11230 patients (22.2%) with systematic biopsy. Cancer was detected with targeted biopsy alone in I7 subjects (7.4%), and with systematic biopsy alone in 13 subjects (5.6%). The overall cancer detection rate (by-patient) was not significantly different for targeted and systematic biopsy (p=O.S3). The detection rate of targeted biopsy cores (10.4% or I 18/l 139) was significantly better than that of systematic biopsy cores (5.3% or 1231230) (p
CONCLUSION: Our long term results clearly demonstrate that adequate primary care and the perineal approach combined with meticulous anastomosis technique or well vascularised pedicled penile skin grafts are essential for successful posttraumatic posterior urethral stricture repairs and sustain the long term outcome.
CONCLUSION: Contrast-enhanced colour Doppler targeted biopsy detected as many cancers as systematic biopsy with fewer than half the number of biopsy cores. Although an increase in cancer detection is obtained by combining targeted and systematic techniques in this screening population, contrastenhanced targeted biopsy alone is a reasonable approach to reduce the number of biopsy cores.
355 THE VALUE OF DYNAMIC CONTRAST ENHANCED POWER DOPPLER ULTRASOUND IN THE LOCALISATION OF PROSTATE CARCINOMA Goossen Tierk’, Sedelaar Wijkstra Hessel’
Michiel’, De la Rosette Jean’, Van Leenders Arno’,
‘Department of Urology, University Medical Centre Nijmegen. Nijmegen, The Netherlands, ‘Department of Pathology, University Medical Centre Nijmegen, Nijmegen. The Netherlands INTRODUCTION & OBJECTIVES: The development of Prostate Cancer (PCs) is associated with changes in perfusion. This abstract describes the localisation of PCs based on differences in perfusion. Perfusion is imaged using contrast-enhanced power Doppler ultrasound (CE-PDU) imaging. MATERIALS & METHODS: 29 patients with proven prostate malignancy, scheduled for radical prostatectomy. underwent an ultrasound examination prior to surgery. A bolus injection of contrast agent was administered intravenously. Transrectal CE-PDU was used to image the delivery of the contrast-enhanced blood to the prostate. The percentage of a selected area that showed enhancement was observed in time, resulting m a Time-Intensity Curve (TIC). From the TIC the Time to start (TtS), Time to peak (TtP), Peak value and the Rise time of the enhancement were calculated. Prior to evaluation. the patients were divided into 3 categories (I.11 & III) based on the TIC of the whole prostate. I and II showed clear enhancement. III showed no appreciable enhancement and was excluded (N=6). First circulation could clearly be distinguished in category I (N=I I). Three evaluation protocols divided the prostate into a number of areas: into 2 using the Left-Right (LR) and Dorsal-Ventral (DV) protocols and into 4 using the Quadrant-protocol (Q). The TICS were compared to identify the most affected area. The results were compared to the pathological findings. RESULTS: For the LR-protocol, the minimal TtP (minTtP) proved to be the most predictive parameter for selecting the major malignant area. 78% of the patients were diagnosed correctly (N=23). For category I only, this improved to 91% (N=l I). MinTtP detection within the DV-protocol resulted in 35% (N=23) accuracy. MinTtP within the Q-protocol resulted in an accuracy of 26% (N=23). When the two ventral areas were compared, in 77% (N=l3) the most affected ventral area could be identified. The most affected dorsal area could be identified with 73% (N=2?) accuracy. Comparing the left-ventral and left-dorsal areas resulted in 42% (N=l9) accuracy. Comparing the right areas resulted in 38% (N=l6) correct diagnose?. CONCLUSION: TICS obtained from CE-PDU exammations have a high predictive value for localising malignancies in either the right or the left lobe of the prostate. Comparison of the dorsal and ventral areas of the prostate is difficult. This is mo\t likely due to anatomical differences.
356 ENDORECTAL CANCER Comet-Battle Anton?
MRI
IN THE
EARLY
DIAGNOSIS
OF PROSTATE
Joseo’ Vilanova-Busquets . Carlea’, Saladie-Roig Josep’, Gelabert-Mas
‘Urology. Hospital Dr. J. Trueta, Girona, Spain, ‘Radiology, Centre Ressonancia Magnetica. Girona, Spain, zUrology, Hospital Germans Trias I Pujol, Badalona. Spain, 4Urology. Hospital Del Mar. Barcelona, Spain INTRODUCTION & OBJECTIVES: Patients with persistent abnormal prostate specific antigen (PSA) or digital rectal examination (DRE) often undergo several negative sextant biopsies. In the present study we evaluate the predictive value of a negative endorectal MRI (EMRI) to avoid subsequent sextant biopsies in these patients. MATERIALS & METHODS: 92 patients with elevated PSA (>4 ngiml) and/or abnormal DRE were included in the study. All patients underwent an endorectal MRI previous to transrectal ultrasound guided needle sextant biopsies. In case of negative biopsy, patient5 were subsequently followed and rebiopsied if indicated. We performed a total of 184 biopsies: 92 patients underwent I set of biopsies, 61 patients 2 biopsies, 27 patients 3 biopsies. 3 patients 4 biopsies and 1 patient 5 biopsies. 67 patients had a final negative biopsy and 25 had a final positive biopsy. Median PSA in this group of patients was IO.44 ngiml (I ,I3 ngiml-34 ngiml), and the median free/total PSA was 0.20. Uni and multivariate analysis and ROC curves were used to compare the accuracy of MRI, PSA, fPSA and DRE. The probability of positive biopsy with each technique and the association of these techniques were assessed, RESULTS: Median PSA was not statistically different in the group with negative biopsies (9.44 ngiml) and in the group with positive biopsies (1 I ,8 ngiml) (p=O,O64). EMRI had an elevated negative predictive value (91,076) and was the individual test with highest accuracy (77%), including PSA (62%). The association of EMRI-DREPSA had the highest accuracy (83%) but not significantly higher than EMRI-PSA (80%) or EMRl alone (77%). The probability of positive biopsy in patients with negative DRE and EMRI, and PSA values between 5-15 ngiml was 5.10% at first and second biopsies, but decreased progressively on subsequent biopsies (~8% at 3rd biopsy.
Urology
Supplements
1 (2002)
No. 1, pp. 91