UP-03.122 Prostate Myths: What Is the Prostate Awareness in the General Male Population in Turkey?

UP-03.122 Prostate Myths: What Is the Prostate Awareness in the General Male Population in Turkey?

UNMODERATED POSTER SESSIONS UP-03.119, Table 1. 1st 25 2nd 25 3rd 25 4th 25 5th 25 Console time (mins) median 210 210 165 155 154 Blood loss (mL) ...

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UNMODERATED POSTER SESSIONS

UP-03.119, Table 1.

1st 25 2nd 25 3rd 25 4th 25 5th 25

Console time (mins) median 210 210 165 155 154

Blood loss (mL) median 350 300 325 400 400

UP-03.120 Regional Medical Collaboration Guidelines for Lower Urinary Tract Symptoms (LUTS) Kondo F1, Miyanaga N2 1 Kensei General Hospital, Ibaraki, 2Mito Saiseikai General Hospital, Mito, Japan Introduction and Objectives: The number of patients who visit healthcare providers with a chief complaint of LUTS including frequent urination, urinary incontinence and difficulty in urination is increasing due partly to the effects of TV commercials on the topics of pollakisuria and urinary incontinence. However, in our area (Sakuragawa-Chikusei area, Ibaraki, Japan) which has a population of about 154,000, there are only two fulltime urologists, the author and a general practitioner. Consequently, the treatment currently provided to patients with LUTS is inadequate. Given this situation, we created regional medical collaboration guidelines for LUTS two years ago and started education activities to increase understanding and awareness of LUTS among the doctors in the regional medical association. Material and Methods: At the lecture and study meetings held by the medical association, we attempted to explain and increase understanding of consultation, treatments, precautions and lifestyle guidance focusing on these guidelines. Nonurologists can apply the guidelines to patients suffering from frequent urination, difficulty in urination and urinary incontinence. Results: Both doctors from the regional medical association and pharmacists participated in the lectures and meetings, and we were able to increase knowledge and awareness of LUTS among non-urologists. As a result, the number of consultations for LUTS increased and regional medical collaboration was enhanced. Conclusions: We created regional medical collaboration guidelines for LUTS and attempted to explain and increase understanding of these symptoms. We believe this was useful for non-urologist general

LOS (days) median 4 3 2 2 2

Positive Margin Rate T2 T3 11% 24% 14% 32% 15% 24% 13% 24% 12% 28%

practitioners and made a worthwhile contribution to regional medical collaboration in the field of LUTS.

UP-03.121 Complications of Continent Catheterizable Channels: A 25-Year Experience Catalan G, Gómez R, Marchetti P, Vidal A, Castillo O Hospital del Trabajador, Santiago, Chile Introduction and Objective: Catheterizable ileovesicostomies are an excellent alternative for continent diversion with bladder preservation. However, the catheterizable channel may present significant complications. We report here the incidence and evolution of these complications in our 25-year experience. Material and Methods: Retrospective review of ileovesicostomies was performed between November 1986 and January 2011. In our early experience, the channel was based on the intussuscepted ileocecal valve over a mesh, as originally described in the Koch Pouch. Due to a high morbidity rate, we later adopted the tapered distal ileum channel as described in the Indiana Pouch. A few individual cases were resolved using the Mitrofanoff principle with either the appendix or an ileum (Monti) tube. Results: There were 66 ileovesicostomies, 54 male and 12 female, mean age 41 years (20-68). Mean follow-up was 98 months (2-293). We observed channel complications in 27 patients (41%): twelve at the valve level leading to incontinence, six at the conduit (4 fistulas and 2 tortuosity) and nine at the stoma (all keloid strictures) (Table). Twenty-one patients (77%) needed surgical correction of the complication.There was a progressive reduction of complications over time, from 67% in the first 15 cases to 7% in the last 15 cases (p⬍0.0001). On late follow up, 92% of patients are dry on uncomplicated self-catheterism. Conclusion: The channel for self-catheterism is a frequent site for complications in continent ileovesicostomy. In our

UROLOGY 78 (Supplement 3A), September 2011

experience, these complications were related to the surgical technique (intususcepted versus tapered ileum) and to the cumulated experience of our team. Despite a high complication and reoperation rate, the goals of this surgery were achieved in the vast majority of patients.

UP-03.122 Prostate Myths: What Is the Prostate Awareness in the General Male Population in Turkey? Kulaksizoglu H, Kilic O, Gul M, Kucur M, Goktas S Dept. of Urology, Selcuk University Selcuklu Medical Faculty, Konya, Turkey Introduction and Objective: The aim of the study was to evaluate the prostate awareness in the general male population and find out about the common misinformation about prostate diseases. Materials and Method: A cross sectional population sampling was performed in the general population for men between the ages of 18-70 with a survey conducted by medical students. The survey consisted of 15 questions addressing different aspects of the prostate diseases and common misinformation in the general population. All participants were stratified according to decades of age, degree of education, occupation and whether the person himself or a close relative has visited a urologist for prostate diseases. All questionnaires were anonymous and patients were informed about the confidentiality of the results. Results: A total of 1004 men between the ages of 18-70 were included in the study (mean age 38.0 ⫾12.9 years). Of the participants, 20.2% were primary school graduates, 8.6% secondary school, 25.5% high school, 39.8% university, 5.8% doctorate or higher education. There was 31.5% who had seen a urologist or had attended an interview with a close relative about a prostatic disease in a urologist’s office. Of the participants, 56.2% reported ‘prostate’ as a disease and only 16.5% as an organ. There were 50.2% who believed all men had ‘prostate’, 5.4% said sexual activity would cause it, and 13% thought sexual activity would prevent prostate disease. 24.9% of the participants reported that rectal exam would affect sexual activity. There were 63.5% of the participants who believed that urinating when squatting would prevent prostate hyperplasia. Prostate cancer transmission to sexual partner was marked as true by 5% of the men. As many as 41.3% of the participants believed that early prostate surgery for

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BPH would prevent prostate cancer, and 13% of the men reported that sexual activity ceases with prostate surgery and retrograde ejaculation or anejaculation is equal to the end of sexual activity in men. Conclusion: The survey clearly showed that prostate awareness is still very unsatisfactory in the Turkish male population and we urologists need to inform the general population more. The knowledge is still lacking through all education levels.

UP-03.123 What is the Best Technique for Primary Closure of the Bladder Neck in Continent Ileovesicostomy? Marchetti P, Gomez R, Catalan G, Vidal A, Castillo O Hospital del Trabajador, Santiago, Chile Introduction and Objective: Closure of the bladder neck is a key step when constructing a continent ileovesicostomy. A variety of surgical techniques have been used with this purpose, including both perineal or retropubic, extra or transvesical approaches. However, since the contraction of the detrusor muscle produces opening of the bladder neck, this closure is not easy and frequently may present leaking failure. We present our experience with this specific surgical problem. Material and Methods: Retrospective review of all ileovesicostomies performed from November 1986 to January 2011 in our institution. Our technique for ileovesicostomy includes the use of the ileocecal segment, detubularizing the ascending colon for bladder augmentation and tapering the distal ileum as a continent catheterizable channel with umbilical stoma. Primary closure of the bladder neck was obtained using extra or transvesical open techniques. In our early experience a variety of techniques were attempted, with a high failure rate. We then adopted the transvesical technique described by Reid et. al. (1), in which a transvesical resection of the prostatic urethra is performed and the defect is closed with 3 overlapping purse-string sutures of 3-0 polyglycolic acid. Results: There were 49 ileovesicostomies, 41 male and 8 female. Mean age was 38 years (20-68) and mean follow up was 118 months (2-293). Leaking failure of the primary closure of the bladder neck was observed in 11 cases (22%) (Table): Conclusions: Although not statistically significant in our experience, the transvesical technique described by Reid and coworkers allowed us to markedly reduce

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UP-03.123, Table 1. Technique Reid Other

n 40 9

Failure 7 4

% 17 44 P⫽0.09

the incidence of leaking failure and currently it is our procedure of choice.

Transurethral resection of the membranous urethra is a new, simple and effective alternative, suitable in males for either primary closure or as a rescue option of a leaking failure after an open procedure.

UP-03.124 Bladder Neck Closure for Continent Ileovesicostomy by Transurethral Resection of the Membranous Urethra Catalan G, Gómez R, Marchetti P, Vidal A Hospital Del Trabajador, Santiago, Chile

UP-03.125 Is YouTube the Future of Patient Information? An Analysis of a Common Urological Surgical Procedure Posted on a Global Video Sharing Website Makanjuola J, Rao A Dept. of Urology, King’s College Hospital, London, UK

Introduction and Objective: Closure of the bladder neck is a key step when constructing a continent ileovesicostomy. A variety of open surgical techniques have been used with this purpose, including both perineal or retropubic approaches. We present here a minimally invasive alternative using a transurethral resection of the membranous urethra. Material and Methods: Retrospective review of all ileovesicostomies performed in males from November 1986 to January 2011 in our institution. Our technique for ileovesicostomy includes the use of the ileocecal segment, detubularizing the ascending colon for bladder augmentation and tapering the distal ileum as a continent catheterizable channel with umbilical stoma. Closure of the bladder neck was obtained using extra or transvesical open techniques. Recently, an extensive transurethral resection of the membranous urethra and external sphincter has been used in males. With this procedure, an injury is created at this level, which heals by second intention leading to urethral sealing. Results: There were 41 ileovesicostomies in male patients, 8 of whom needed a second closure after failure of the primary procedure. Of these 49 closure procedures, 43 were done by open surgical techniques (Group 1); in the other 6, a transurethral resection of the membranous urethra was performed (Group 2). Mean age was 39 years (20-68) and mean follow up was 118 months (2-293). Leaking failure was observed in 9/49 cases in Group 1 (18%) versus 0/6 in Group 2. Two cases in Group 2 had bleeding complications: one required postoperative endoscopic hemostasis and the other presented mild bloody urethral discharge due to a urethral granuloma, which was fulgurated. There were no late complications. Conclusions: Bladder neck closure for continent ileovesicostomy is challenging.

Introduction and Objectives: Patients are able to search the Internet for information regarding urological procedures. YouTube is the number one global videosharing website on which users can upload, share, and view videos. There is no regulation or peer review of urological videos posted on YouTube. Prospective patients are able to view videos of operations, without any medical explanation. We analysed Robotic Laparoscopic Prostatectomy videos showing robotic surgery on YouTube to determine 1) length of videos 2) the video authors 3) whether there was a declaration of patient consent and 4) who posted comments on the videos. Materials and Methods: A key word search of ‘Robotic’ ‘Laparoscopic’ ‘Prostatectomy’ on YouTube was performed. Our inclusion criteria were videos that displayed robotic surgery for a duration of ⬎ 5 minutes ⬍ 15 minutes. Two physician viewers watched each video and recorded the title of the video posted, the author, video length, number of views, number of comments, number of other videos posted and country of video origin. Videos excluded were 1) those promoting hospitals or surgeons 2) videos created by patient groups 3) academic lectures. Results: A total of 533 urological videos were returned following the keyword search. There were 42 videos remaining once the exclusion criterion was applied. The videos averaged 8515 views (11196078) and 748 seconds duration. There was on average one comment on the videos posted (0-29), with all comments coming from non-clinical viewers and 5% from previous patients of this procedure. Of the videos posted 65% were from the USA, 7% Canada, 10% Europe, 4% South America, 2% Australasia with 9% of the videos posted from an unknown location.

UROLOGY 78 (Supplement 3A), September 2011