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UP-03.191 Clinical Experience of Interstitial Cystitis Treated with Hydrodistension
UNMODERATED POSTER SESSIONS
events, onset age and, dose per body weight were investigated, no significant differences were noted in either the tolterodine or solifenacin treatment group. Decreased concentration occurred after dose elevation in 4 of the 5 tolterodinetreated patients and all 5 solifenacintreated patients, 28 days after dose elevation in 2 of the 5 solifenacin-treated patients, and 2-8 days after administration or dose elevation in 4 and 3 tolterodineand solifenacin-treated patients, respectively. This adverse event spontaneously disappeared without dose reduction or discontinuation in 1 and 2 of the tolterodine- and solifenacin-treated patients, respectively. Conclusion: Both tolterodine and solifenacin caused a neurological symptom, decreased mental concentration, at a high rate. Attention should be paid to neurological adverse effects on the administration of muscarinic antagonists.
UP-03.191 Clinical Experience of Interstitial Cystitis Treated with Hydrodistension Yamamoto Y, Takahashi M, Tsuda M, Takemura M, Nakatsuji H, Izaki H, Fukumori T, Kanayama H Dept. of Urology, The University of Tokushima, Tokushima, Japan Introduction and Objective: To examine clinical features of the patients with interstitial cystitis (IC) undergoing hydrodistension at Tokushima University Hospital. Materials and Methods: We retrospectively evaluated 31 hydrodistension (four times is one, three times is three, twice is two, one time is 14) of 19 (5 male and 14 female) IC patients between December 2004 and March 2011. Hydrodistension was carried out under the epidural / lumbar anesthesia, and subsequently Transurethral coagulation of Hunner’s Ulcer was performed in patients with ulcer. Results: The median age of the 19 patients at the first hydrodistension was 65.5 years (range 20-77). Of them, 84.2% reported urinary frequency, 84.2% bladder or lower abdominal pain related to bladder filling, and 10.5% voiding difficulty. Glomerulation was found in 21 cases (70%) and 6 had Hunner’s ulcers. The median of bladder capacity at hydrodistension was 500ml (range 270-860). The complication was bladder rupture, and occurred in two cases when instilled saline volume was 850ml or more. Therapeutic efficacy at one month after hydrodistension was shown in 30/31 cases
S408
(96.7%). Oral suplatast tosilate (22 cases, 71%), tricyclic antidepressant (7cases, 22.6%), behavior therapy (2 cases, 6.5%) were adjunctive therapies. The symptom relapsed in six cases, and the next hydrodistension was performed in 8.2 months on the average. Conclusions: Hydrodistension was effective for IC patients, as previously reported. But recurrence rate was high, thus it is necessary to examine the t adjunctive therapies. There is a risk for rupture when bladder capacity at hydrodistention is 850ml or more.
UP-03.192 Tibial Nerve Stimulation in Women with Non-Neurogenic Lower Urinary Tract Dysfunction Aydur E1, Seckin B2, Yildirim I1, Irkilata H1 1 Depts. of Urology, Gulhane Military Medical Academy, Ankara, 2Dept. of Urology, Selcuklu Medical Faculty, Selcuk University, Konya, Turkey Introduction and Objective: Non-neurogenic lower urinary tract dysfunction is a common urological problem. Electrical stimulation is a treatment approach for management of voiding dysfunction. In this prospective study, we evaluated efficacy and safety of percutaneous peripheric nerve stimulation (PPNS) for treatment of women with non-neurogenic bladder overactivity (BO) or chronic urinary retention (CUR). Material and Methods: Study population included 79 female patients with the symptoms of voiding dysfunction. 68 patient were diagnosed as BO and 11 were diagnosed as idiopathic CUR. In the BO group, 28 women underwent PPNS, while other 40 patients received oral oxybutynin was composed as control group. In the CUR group, who also underwent PPNS, no control group was composed due to lack of a comparable treatment option. Success was defined as the patient request for continued chronic treatment for maintenance. Results: Overall success rate of PPNS was 51.3% in all patients with either BO or CUR, while only mild side effects were observed. In BO patient group, no patient discontinued the therapy during PPNS treatment period. Of the 28 patients, 15 (53.6%) requested continuation of therapy because of the improvements in their symptoms. In the remaining 13 patients (46.4%), treatment was unsuccessful since they did not choose maintenance therapy. During oral oxybutynin treatment, 4 pa-
tients (10%) discontinued the treatment due to its side effects and 33 patients (82.5%) requested continuation of therapy because they had significant improvement of symptoms while 3 patients (7.5%) did not. When compared the findings obtained in both treatment group, side effect/complication related both treatments and response to therapies were statistically significant (p⬍0.001 and p⫽0.002, respectively). In the CUR group undergoing PPNS, only one patient (9%) discontinued the therapy. PPNS in 5 women (45.5%) was considered successful because they requested continuation of therapy, while in other 5 patients (45.5%) was unsuccessful since they did not select maintenance therapy. Conclusions: PPNS is less efficient than oral oxybutynin but is a safer alternative in the treatment of bladder overactivity and is also a safer treatment option that should be considered before performing more invasive therapies for chronic urinary retention.
UP-03.193 Surgical Treatment of Stress Urinary Incontinence With the ATOMS® System: One-Year Single Centre Experience Martenstein C, Krause J, Hermann B, Hamza A Dept. of Urology, St. Georg Hospital, Leipzig, Germany Introduction and Objective: For the treatment of male stress urinary incontinence (SUI), adjustable slings are gaining confidence to omit secondary surgical procedures for readjustment. We report operative and functional outcomes of patients with a new adjustable transobturator male sling. Materials and Methods: Ten patients received the ATOMS® system between April 2010 –April 2011. Reasons for incontinence were radical prostatectomy in 7. One patient each had prior retropubic adenomectomy, TUR-P and radiotherapy. A radiopaque silicone cushion is held in a suburethral position by two transobturator mesh-arms. A titan-port for adjustments is implanted suprapubically connected to the silicone cushion. Adjustments were performed until continence was maintained. The evaluation included preoperative vs. postoperative 24h pad use, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), urinary flow and clinical status. Results: At final follow-up cured, improved and failed patients were 6, 2 and 2
UROLOGY 78 (Supplement 3A), September 2011
events, onset age and, dose per body weight were investigated, no significant differences were noted in either the tolterodine or solifenacin treatment group. Decreased concentration occurred after dose elevation in 4 of the 5 tolterodinetreated patients and all 5 solifenacintreated patients, 28 days after dose elevation in 2 of the 5 solifenacin-treated patients, and 2-8 days after administration or dose elevation in 4 and 3 tolterodineand solifenacin-treated patients, respectively. This adverse event spontaneously disappeared without dose reduction or discontinuation in 1 and 2 of the tolterodine- and solifenacin-treated patients, respectively. Conclusion: Both tolterodine and solifenacin caused a neurological symptom, decreased mental concentration, at a high rate. Attention should be paid to neurological adverse effects on the administration of muscarinic antagonists.
UP-03.191 Clinical Experience of Interstitial Cystitis Treated with Hydrodistension Yamamoto Y, Takahashi M, Tsuda M, Takemura M, Nakatsuji H, Izaki H, Fukumori T, Kanayama H Dept. of Urology, The University of Tokushima, Tokushima, Japan Introduction and Objective: To examine clinical features of the patients with interstitial cystitis (IC) undergoing hydrodistension at Tokushima University Hospital. Materials and Methods: We retrospectively evaluated 31 hydrodistension (four times is one, three times is three, twice is two, one time is 14) of 19 (5 male and 14 female) IC patients between December 2004 and March 2011. Hydrodistension was carried out under the epidural / lumbar anesthesia, and subsequently Transurethral coagulation of Hunner’s Ulcer was performed in patients with ulcer. Results: The median age of the 19 patients at the first hydrodistension was 65.5 years (range 20-77). Of them, 84.2% reported urinary frequency, 84.2% bladder or lower abdominal pain related to bladder filling, and 10.5% voiding difficulty. Glomerulation was found in 21 cases (70%) and 6 had Hunner’s ulcers. The median of bladder capacity at hydrodistension was 500ml (range 270-860). The complication was bladder rupture, and occurred in two cases when instilled saline volume was 850ml or more. Therapeutic efficacy at one month after hydrodistension was shown in 30/31 cases
S408
(96.7%). Oral suplatast tosilate (22 cases, 71%), tricyclic antidepressant (7cases, 22.6%), behavior therapy (2 cases, 6.5%) were adjunctive therapies. The symptom relapsed in six cases, and the next hydrodistension was performed in 8.2 months on the average. Conclusions: Hydrodistension was effective for IC patients, as previously reported. But recurrence rate was high, thus it is necessary to examine the t adjunctive therapies. There is a risk for rupture when bladder capacity at hydrodistention is 850ml or more.
UP-03.192 Tibial Nerve Stimulation in Women with Non-Neurogenic Lower Urinary Tract Dysfunction Aydur E1, Seckin B2, Yildirim I1, Irkilata H1 1 Depts. of Urology, Gulhane Military Medical Academy, Ankara, 2Dept. of Urology, Selcuklu Medical Faculty, Selcuk University, Konya, Turkey Introduction and Objective: Non-neurogenic lower urinary tract dysfunction is a common urological problem. Electrical stimulation is a treatment approach for management of voiding dysfunction. In this prospective study, we evaluated efficacy and safety of percutaneous peripheric nerve stimulation (PPNS) for treatment of women with non-neurogenic bladder overactivity (BO) or chronic urinary retention (CUR). Material and Methods: Study population included 79 female patients with the symptoms of voiding dysfunction. 68 patient were diagnosed as BO and 11 were diagnosed as idiopathic CUR. In the BO group, 28 women underwent PPNS, while other 40 patients received oral oxybutynin was composed as control group. In the CUR group, who also underwent PPNS, no control group was composed due to lack of a comparable treatment option. Success was defined as the patient request for continued chronic treatment for maintenance. Results: Overall success rate of PPNS was 51.3% in all patients with either BO or CUR, while only mild side effects were observed. In BO patient group, no patient discontinued the therapy during PPNS treatment period. Of the 28 patients, 15 (53.6%) requested continuation of therapy because of the improvements in their symptoms. In the remaining 13 patients (46.4%), treatment was unsuccessful since they did not choose maintenance therapy. During oral oxybutynin treatment, 4 pa-
tients (10%) discontinued the treatment due to its side effects and 33 patients (82.5%) requested continuation of therapy because they had significant improvement of symptoms while 3 patients (7.5%) did not. When compared the findings obtained in both treatment group, side effect/complication related both treatments and response to therapies were statistically significant (p⬍0.001 and p⫽0.002, respectively). In the CUR group undergoing PPNS, only one patient (9%) discontinued the therapy. PPNS in 5 women (45.5%) was considered successful because they requested continuation of therapy, while in other 5 patients (45.5%) was unsuccessful since they did not select maintenance therapy. Conclusions: PPNS is less efficient than oral oxybutynin but is a safer alternative in the treatment of bladder overactivity and is also a safer treatment option that should be considered before performing more invasive therapies for chronic urinary retention.
UP-03.193 Surgical Treatment of Stress Urinary Incontinence With the ATOMS® System: One-Year Single Centre Experience Martenstein C, Krause J, Hermann B, Hamza A Dept. of Urology, St. Georg Hospital, Leipzig, Germany Introduction and Objective: For the treatment of male stress urinary incontinence (SUI), adjustable slings are gaining confidence to omit secondary surgical procedures for readjustment. We report operative and functional outcomes of patients with a new adjustable transobturator male sling. Materials and Methods: Ten patients received the ATOMS® system between April 2010 –April 2011. Reasons for incontinence were radical prostatectomy in 7. One patient each had prior retropubic adenomectomy, TUR-P and radiotherapy. A radiopaque silicone cushion is held in a suburethral position by two transobturator mesh-arms. A titan-port for adjustments is implanted suprapubically connected to the silicone cushion. Adjustments were performed until continence was maintained. The evaluation included preoperative vs. postoperative 24h pad use, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), urinary flow and clinical status. Results: At final follow-up cured, improved and failed patients were 6, 2 and 2
UROLOGY 78 (Supplement 3A), September 2011