UP-1.78: The adjustable transobturator tape (TOT) for post-prostatectomy incontinence

UNMODERATED POSTER SESSIONS

of simultaneous implant of penile prosthesis and male sling: single anesthetic event, decrease overall recovery, minor risk of bacterial infection and contribution of inflatable penile implant for continence. Our experience shows that patients with mild to moderate SUI who are candidates for penile implant can be successfully treated in a single operative session. UP-1.76 Capio RP suturing device for vesicourethral anastomosis improves urinary continence and post-surgical strictures rates after radical retropubic prostatectomy Perugia G, Iori F, Di Viccaro D, Teodonio S, Chinazzi A, Borgoni G, De Luca F, Liberti M Dept. of Urology, University Sapienza, Rome, Italy Introduction and Objective: A well-performed vesico-urethral anastomosis should provide watertight closure with appropriate mucosal to mucosal coaptation, and a proper tension-free urethral realignment, in order to avoid early or late complications. There are still many questions on how to improve the functional results of an anastomosis. The Capio RP suturing device allows a perfect anastomosis with respect to the above-mentioned principles. The aim of the study is to evaluate urinary continence and post-surgical stenosis rates in patients having undergone radical prostatectomy and Capio RP assisted vesico-urethral anastomosis. Materials and Methods: There were 180 patients, age range from 50 to 73 years, who underwent radical retropubic prostatectomy and vesico-urethral anastomosis using the Capio RP, a suturing device with 45° curvature of the distal end, which can rotate 360° clockwise and counter-clockwise. After removal of the prostate and seminal vesicles, bladder neck was tailored, everting the mucosal to obtain a caliber compatible with urethral size for a better and safer anastomosis, by means of six “inside-outside” stitches. The Foley catheter was removed on postoperative day 7 during cystography, which showed a perfect anastomosis in all cases with small leakage in 4 patients. Urinary continence was evaluated on the basis of the daily count of pads used as reported by the patient. Results: One hundred and fifty-seven patients (87.2%) showed immediate complete urinary continence when the catheter was removed. Twenty-one patients (11.6%) had mild urinary dribbling (2 to 3 pads/day), which disappeared within 4 to

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6 weeks after surgery. One patient is completely incontinent and one has stress incontinence. Ten patients (5.5%) showed a stricture of the anastomosis occurring within 8 to 10 weeks from catheter removal and successfully treated with one endoscopic procedure. Conclusions: Complete urinary continence after radical prostatectomy depends mostly on a well-healed vesico-urethral anastomosis. The use of Capio RP made every anastomosis easy and safe, allowing the needle to rotate perfectly deep inside the urethral stump, through the mucosa, the smooth fibres of the urethra, and the peri-urethral muscular aponeurotic fibres, thus preserving, in most cases, an immediate complete urinary continence. Capio RP also allows a uniform depth of the sutures respecting proper urethral realignment, and reducing the incidence of strictures. UP-1.77 Postoperative status of bladder outflow and early cathter removal after radical retropubic prostatectomy Perugia G, Di Natale G, Chinazzi A, Di Viccaro D, Teodonio S, Bova G, Borgoni G, Liberti M Dept. of Urology, University Sapienza, Rome, Italy Introduction and Objective: Patients who underwent a radical prostatectomy are usually discharged with an indwelling catheter and return for catheter removal 2-3 weeks after surgery. Considering the improved techniques for vesico-urethral anastomosis, many Authors advocate to remove the catheter on postoperative day 7 or even earlier, if anastomosis is intraoperatively watertight, in order to achieve a catheter-free status at hospital discharge. The aim of the study is to determine the feasibility and the safety of routinely removing the urinary catheter 7 days after radical prostatectomy. Materials and Methods: One hundred and eighty patients underwent radical retropubic prostatectomy and vesico-urethral anastomosis using the Capio RP suturing device. Anastomosis was checked for water tightness after instillation of 250 mL of normal saline in the bladder. Patency of anastomosis was assessed 7 days later by cystography; patients who didn’t show extravasation had the catheter removed, and were discharged. If contrast extravasation was observed, the catheter was maintained and a second cystogram was obtained 5-7days later. Continence was evaluated with a daily count of pads; urinary flow was performed after catheter removal, and every month thereafter.

Results: Catheter was removed in all patients except 5 (2.7%). Fifteen patients (8.3%) developed acute urinary retention. Forty-eight patients (26.6%) showed obstruction on Qmax nomogram after catheter removal, but the number of patients with obstruction decreased to 22 (12.2%) at the urinary flow evaluation performed subsequently. Ten patients (5.5%) developed a significant anstomotic stricture, successfully treated with one single endoscopic cold-knife incision. Fifteen patients(8.3%)had previous prostatic surgery and 1 showed a stricture. One hundred and fifty-seven patients (87.2%) showed immediate complete continence; 21 patients(11.6%) showed dribbling(2-3 pads /day), which disappeared within 4-6 weeks. One patient is incontinent;1 patient has stress incontinence. Concerning the pathological findings, 168/180 patients were pT2 and 12/180 patients were pT3 and no significant correlation was found between bladder outflow status, continence and tumor stage or positive surgical margins. Conclusions: Early catheter removal after radical prostatectomy can be safely accomplished if anastomosis provides a watertight closure; nevertheless, some patients may have difficulty with urination or develop acute urinary retention, mostly due to edema of or to an increased tone of bladder neck smooth muscle, which occurred, in our experience, within 24-48hours from catheter removal. The study demonstrates how most patients will have no extravasation on cystogram performed on postoperative day 7 and removing the catheter at this time doesn’t increase the risk of complications or compromise overall urinary continence or anastomotic strictures rate. UP-1.78 The adjustable transobturator tape (TOT) for post-prostatectomy incontinence Yalcinkaya F, Sertcelik M, Yigitbasi O, Karabacak O, Bokurt H Diskapi Egitim Hospital, Ankara, Turkey Introduction: In this retrospective study, the objective is to evaluate the efficiency and safety of adjustable transobturator bulbo-urethral sling material (Argus, Promedon SA, Cordoba, Argentina) in male post prostatectomy incontinence (PPI) stress urinary incontinence. Materials and Methods: Between 2008 and 2009, 12 patients with PPI incontinence were treated with adjustable TOT. All cases had mild or moderate incontinence for at least one year despite conservative and medical therapies. None of the

UROLOGY 76 (Supplement 3A), September 2010

UNMODERATED POSTER SESSIONS

patients had radiotherapy, urethral stenosis or neurogenic bladder. Patients were evaluated pre- and post-operatively. Patients who did not use pads were accepted as cured. One or less pad was accepted as partial success. The stretch of the sling is adjusted (squeezed or loosened) depending on the continence of the patient after the sling surgery. Results: After the first intervention, 5 patients were cured (no pad) and 2 patients were improved. Re-adjusting procedure was performed on 5 patients (3 for incontinence, 2 for voiding difficulty). After second manipulation, 1 patient was cured while one was improved. In two cases, severity of incontinence was not affected. In one case, sling was removed because of severe discomfort and pain of the patient. At one year, total cure rate was 50 % (6 cases) and partial success rate was 25% (3 cases). Two patients were failed despite readjustment procedure. In one case, sling was removed. Pre-op and post-op mean Turkish ICIQ-SF score was 18.8 and 6.8 retrospectively. Postoperative perineal discomfort and dysuria, which responded to analgesics and lasted less than one month, was detected in half of the patients. Urethral erosion did not occur in any of the patients. Conclusion: Mild incontinence can be treated by conservative or medical therapies. For severe cases AUS is accepted as standard treatment procedure. But AUS has some limitations (cost, infection, revision etc.). The male sling was described recently and gained acceptance as an alternative surgical option. Although the early results were encouraging with the male sling procedure, there is still a need for larger series and long-term results. UP-1.79 The association between lower urinary tract symptoms and vascular risk factors in aging men: Hallym aging study Lee S1, Kim S1, Lee W1, Oh C1, Cho S1, Park C2, Lee S1, Kim H1, Choi N1 1 Dept. of Urology, School of Medicine, Hallym University, Chuncheon; 2Dept. of Urology, College of Medicine, Ulsan University, Ulsan, South Korea

Introduction and Objective: The aim of this study was to investigate the relationship between lower urinary tract symptoms (LUTS) and vascular risk factors (VRF) in a population-based cohort study, Hallym Aging Study (HAS). Materials and Methods: Of 1,520 participants in HAS, 280 men aged ⱖ50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluations of medical history and various life style factors and clinical measurements were included. VRF used in the present study included current tobacco use, hypertension, hyperlipidemia, and diabetes mellitus and were assessed by medical history and clinical measurement. LUTS was assessed by validated questionnaires, the International Prostate Symptom Score (IPSS) and the relationship between LUTS and VRF was investigated. Results: Of the 280 men, 260 (93%) had one or more VRF and 175 (62.5%) had moderate/severe LUTS (IPSS⬎7). There was significant correlation between the IPSS and the number of VRF (age adjusted r⫽0.277, p⬍0.05). The IPSS was similar in those with no (11.6⫾9.7) and one or two (11.5⫾8.5) VRF, but increased by 31% to 15.1⫾9.3 (p⬍0.05) in those with three or more VRF. The multivariate logistic regression analysis, controlling for age showed that men with three or more VRF were 3 times more likely to have moderate/severe LUTS than men without VRF (Table, p⬍0.05). Conclusions: Men with risk factors for vascular disease are more likely to have moderate/severe LUTS and these finding suggest that vascular risk factors play a role for the development of LUTS. UP-1.80 Robotic-assisted laparoscopic radical cystectomy (RARC) with extracorporeal urinary diversion and robotic-assisted laparoscopic partial cystectomy (RAPC) Jung S1, Seo Y1, Kim S1, Ha J1, Gil M2, Yoon S3, Chung J4, Kim S5 1 Dept. of Urology, College of Medicine, Dong-A University, Busan; 2Dept. of Urology, College of Medicine, Kangnam CHAGeneral Hospital, Pocheon Univer-

Table 1, UP-1.79

VRF

Age

No VRF 1-2 VRF ⱖ3

Moderate/severe LUTS Odds ratio (95% confidence interval) 1 1.57 (0.611-4.03) 3.22 (1.10-9.45) 1.10 (1.02-1.09)

UROLOGY 76 (Supplement 3A), September 2010

P value 0.349 0.033 0.002

sity, Seoul; 3Dept. of Diagnostic Radiology, College of Medicine, Dong-A University, Busan; 4Dept. of Urology, Paik University Hospital, College of Medicine, Inje University, Busan; 5Dept. of Physical Medicine & Rehabilitation, College of Medicine, Dong-A University, Busan, South Korea Introduction and Objective: The goals of managing bladder cancers are to control cancer, as well as to improve the quality of life including reducing pain and skin incision and also urinary diversions are essential parts of bladder cancer patients. The aims of this study are to present the clinical outcomes of bladder cancer patients who underwent robotassisted laparoscopic radical cystectomy (RARC) with extracorporeal ileal conduit and robot-assisted laparoscopic partial cystectomy(RAPC). Materials and Methods: For RARC surgical procedure, we undertook RACP and extracorporeal ileal conduit urinary diversion. First, using a six-port approach and the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), one surgeon carried out a complete pelvic lymphadenectomy and cystoprostatectomy using a technique developed specifically for robotic surgery. And then the specimen is entrapped in a bag and removed through a 5-6 cm suprapubic incision. Second, a different surgical team exteriorized the bowel through this incision and created an ileal conduit urinary diversion extracorporeally. For RACP surgical procedure, all surgical steps were undertaken with no difficulties. A urodynamic study was performed for evaluation of bladder functions post operatively. Results: For RARC surgical procedure, the patient age was 57.7 years. In our case, ileal conduit urinary diversion was performed extracorporeally. Mean operative time was 7.3 hours. Mean surgical blood loss was 310ml, which was significantly less than in our open cystectomy (450ml). On surgical pathology, TCC was confirmed and staging is PT1 &endash; T3b. In no case was there inadvertent entry into the bladder or positive surgical margins. The time to flatus was 3 days and time to bowel movement was 3 days. The patients were discharged home on postoperative days 7. For RACP surgical procedure, the patient age was 45 years. Mean operative time was 4.5 hours. Mean surgical blood loss was 70 ml. On surgical pathology, TCC and is pT2 was confirmed with no entry into the bladder or positive surgical margins. Urodynamic parameters were satisfied postoperatively. The vol-

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