- Email: [email protected]
V3-02 FREEHAND TRANSPERINEAL PROSTATE BIOPSY UNDER LOCAL ANESTHESIA
THE JOURNAL OF UROLOGYâ
e466
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
CONCLUSIONS: Long-term treatment with silodosin and propiverine significantly improved not only subjective symptoms but also storage function and bladder outlet obstruction in the BPE patients with OAB. The CT more effectively improved the subjective symptoms, QOL, and storage function than a1-blocker MT in the long term.
Source of Funding: Hanmi Pharm, Korea
Male Voiding/Sexual Dysfunction/BPH/ Incontinence/ Infection/Infertility Video Saturday, May 7, 2016
Source of Funding: none
PD22-12 EFFICACY OF DOSE ESCALATION OF TAMSULOSIN FOR THE TREATMENT IN SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA OF LOWER URINARY TRACT SYMPTOMS: A RANDOMISED, DOUBLE-BLIND, PHASE 3 TRIAL IN KOREAN MEN. Kyu Shik Kim, Guri, Korea, Republic of; Jae Heon Kim, Seung Hwan Lee, U-Syn Ha, Deok Hyun Han, In Ho Chang, Jae Hyun Bae, Jun Hyun Han, Tag Keun Yoo, Se Woong Kim, Jae Il Chung, Seoul, Korea, Republic of; Tae Hyo Kim, Busan, Korea, Republic of; Cheol Young Oh*, Seoul, Korea, Republic of; Jae Hoon Chung, Sok-cho, Korea, Republic of; Seung Wook Lee, Guri, Korea, Republic of; Jina Jung, Yong-Il Kim, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: To verify the efficacy and safety of the tamsulosin 0.4mg compared with tamsulosin 0.2mg and placebo in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). METHODS: A total of 523 patients from multi-centers participated. All study subjects entered double blind, randomized, phase 3 trial. Eligible patients were randomly assigned to the tamsulosin 0.4 mg group, the 0.2 mg group, or the placebo group. International Prostate Symptom Score (IPSS), maximum ?ow rate (Qmax), post void residual urine (PVR), blood pressure, heart rate, and adverse events were compared between the three groups at 4 weeks, 8weeks and 12 weeks. RESULTS: A total of 471 patients were enrolled and analyzed. There were no differences in baseline characteristics between the three groups. After 12 weeks of medication, the IPSS was improved in the 0.2mg and 0.4mg group. And 0.4mg group had better improvement than 0.2mg group (-9.57 (0.39) vs. -5.63 (0.38), p<0.0001). Secondarytotal IPSS in patients with severe symptom (IPSS>20), 0.4mg group had most changes in IPSS (-11.27(0.55), p<0.0001). Qmax, PVR were improved in 0.4mg and 0.2mg groups. However, they were not statistically different. No patients experienced any serious adverse effects to tamsulosin in these three groups. CONCLUSIONS: Tamsulosin 0.4 mg and 0.2mg appears to be superior treatment compare to placebo and tamsulosin 0.4mg is more effective than 0.2mg in Total IPSS. Tamsulosin0.4 mg has favorable efficacy and tolerabilityin patients with symptomatic BPH in korean men.
1:00 PM-3:00 PM
V3-01 INFLATABLE PENILE PROSTHESIS INSERTION WITH SYNCHRONOUS PENILE PLICATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’S DISEASE Paul H. Chung*, Ryan J. Flemons, Allen F. Morey, Dallas, TX
INTRODUCTION AND OBJECTIVES: Twenty to thirty percent of patients with Peyronie’s disease have erectile dysfunction refractory to medical therapy. We present clinical outcomes of inflatable penile prosthesis (IPP) placement with synchronous penile plication for the simultaneous correction of Peyronie’s disease and erectile dysfunction. METHODS: Patients receiving IPP placement with synchronous penile plication were reviewed. After induction of an artificial erection through saline intracorporal injection, plication was performed through a penoscrotal incision retracted distally along the penile shaft as needed for correction. IPP placement was then conducted through the same incision. RESULTS: 27 patients with dorsal, lateral, or biplanar curvature with a mean age of 63 years underwent IPP with synchronous penile plication from 2010 to 2015. Mean pre-op curvature was 37 degrees corrected to <5 degrees after plication. A mean of 4 sutures (range 3-6) were used for PP with each suture providing a mean correction of 8 degrees. No patient suffered post-operative complications and all patients were discharged home on post-operative day one. Upon follow up, three patients reported residual curvature; however, no patient reported continued pain or required release of plication sutures. CONCLUSIONS: IPP placement with synchronous penile plication is a reliable option for correction of erectile dysfunction and Peyronie’s disease. Source of Funding: None
V3-02 FREEHAND TRANSPERINEAL PROSTATE BIOPSY UNDER LOCAL ANESTHESIA John Michael DiBianco, Washington, DC; Matthew Allaway*, Cumberland, MD INTRODUCTION AND OBJECTIVES: 500,000 trans-rectal prostate biopsies are performed annually in the U.S. Infection is the most common reason for hospitalization after a TRPB with increasing
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
incidence of resistant bacteria. Transperineal prostate biopsy (TPB) is a method that has been shown to drastically decrease infectious complications by avoiding the rectum altogether. However, it has been understood that due to pain, TPB must be done under general anesthesia, thus increasing cost and procedural time. The previous described freehand transperineal prostate biopsy (FHTPB) technique, only utilizes 2 puncture sites through which all prostate biopsies are taken. Thus the objective of the current study was to investigate patient pain during FHTPB under local anesthesia only. METHODS: Retrospective review of all prospectively performed FHTPBs under local anesthesia between January 1, 2012 and October 30, 2015 was performed. Primary outcome measurements were patient reported pain utilizing both numerical and visual analog scale at multiple time points throughout the procedure. RESULTS: 33 patients with an average age, BMI, positive family history, prostate volume and PSA of 74.64 9.43 years, 28.21 4.26 15%, 50.34 32.0mL and 9.796.50ng/dL respectively, underwent FHTPB under local anesthesia. The procedure was well tolerated by all patients with probe insertion and local anesthetic injection as the highest pain rating median of 3 (3-4) and 4 (3-5) respectively, and a post-procedural pain rating of 2 (1-2). Additionally, patients described bladder discomfort when obtaining cores form the anterior horn. The mean procedural time was 9.19 3.54mins with a mean of 12.94 3.38cores taken per biopsy. CONCLUSIONS: Freehand transperineal prostate biopsy under local anesthesia only is feasible, safe and tolerated by patients. Source of Funding: None
V3-03 MALE STRESS INCONTINENCE GRADING SCALE FOR EVALUATION OF MEN WITH POST-PROSTATECTOMY INCONTINENCE: A PILOT STUDY Allen Morey, Nirmish Singla*, Paul Chung, Alexandra Klein, Timothy Tausch, Jordan Siegel, Isamu Tachibana, Jeremy Scott, Maude Carmel, Dallas, TX INTRODUCTION AND OBJECTIVES: We developed an objective clinical grading scale to characterize post-prostatectomy incontinence (PPI) and evaluated its use as a tool to facilitate male antiincontinence procedure selection. METHODS: Over the past year, we prospectively implemented a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI patients based on incontinence severity. Patients included were those referred for PPI who had no prior anti-incontinence surgery. During the initial outpatient consultation, each patient was prospectively assigned an incontinence grade score of 0 through 4 based on the consensus of 2 examiners performing a standing cough test (SCT). All patients refrained from voiding for at least 60 minutes prior to the SCT. Men with mild SUI (MSIGS grades 0-2) were offered AdVance sling surgery while those with heavier SUI (MSIGS grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to patient-reported pads-per-day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed. RESULTS: Of 62 consecutive new PPI patients, 20 were graded as mild based on SCT [five (8%) grade 0, 10 (16%) grade 1, five (8%) grade 2] while 42 were graded as moderate-severe [10 (16%) grade 3, 32 (52%) grade 4]. MSIGS grade demonstrated a strong correlation with preoperative PPD (r¼0.74, Figure 1). Among the 53 patients who underwent surgical intervention for PPI, 14 with mild SUI were treated with AdVanceâ male urethral sling (MSIGS grade 0, 1, or 2) while 39 more severe cases received AUS (MSIGS grade 3 or 4). Patient-reported improvement was high overall (median 95%) and similar for sling and AUS patients (95% and 96.5% respectively, p¼0.596). The median time from radical prostatectomy to anti-incontinence surgery was 5.4 years (range 1-20).
e467
CONCLUSIONS: The Male Stress Incontinence Grading Scale provides a rapid, simple, non-invasive, objective assessment of PPI severity which strongly correlates with patient-reported pads-per-day and appears to facilitate anti-incontinence surgical procedure selection.
Source of Funding: none
V3-04 SUBCORONAL APPROACH TO INFLATABLE PENILE PROSTHESIS PLACEMENT WITH A MODIFIED NO TOUCH TECHNIQUE Alexander C. Small*, Aaron C. Weinberg, Matthew J. Pagano, New York, NY; Christopher M. Deibert, Omaha, NE; Robert J. Valenzuela, New York, NY INTRODUCTION AND OBJECTIVES: Surgical treatments for erectile dysfunction can be performed from a variety of approaches. Inflatable penile prosthesis (IPP) design and implantation techniques through penoscrotal and infrapubic incisions have evolved over recent years. Here we present our surgical experience and outcomes with a single subcoronal incision for IPP placement with a modified no touch technique. This approach allows for access to the entire corporal shaft for prosthesis placement and simultaneous additional male reconstructive procedures. METHODS: The index patient is 60 year old male, status-post radical prostatectomy with 2 years of erectile dysfunction refractory to medical therapy. Work up consisted of history and physical. The patient underwent placement of an IPP through our subcoronal approach with a modified no touch technique. The penis was degloved to the level of the penoscrotal junction, and the cremaster muscle was everted and secured to the drapes to allow scrotal and penile skin exclusion from the operative field. The implant is placed through ventral corporotomy incisions similar to standard penoscrotal approach. RESULTS: The procedure was unevenful and was performed entirely in the ambulatory setting, without the use of a foley catheter or a Jackson Pratt drain. There were no complications during this surgery and the patient was satisfied with his functional and cosmetic results. To date, 228 subcoronal IPP placements have been performed at our institution. CONCLUSIONS: Subcoronal IPP placement with modified no touch technique is an appealing approach and shows promising early outcomes. Urologists can safely and easily perform multiple procedures simultaneously with IPP placement through this incision, including circumcision, glanulopexy, Peyronie’s disease correction, length preservation and urethral reconstruction. The subcoronal approach allows for access to the entire corporal shaft providing excellent visibility and allows exclusion of surrounding skin through a modified no touch technique. Source of Funding: None
e466
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
CONCLUSIONS: Long-term treatment with silodosin and propiverine significantly improved not only subjective symptoms but also storage function and bladder outlet obstruction in the BPE patients with OAB. The CT more effectively improved the subjective symptoms, QOL, and storage function than a1-blocker MT in the long term.
Source of Funding: Hanmi Pharm, Korea
Male Voiding/Sexual Dysfunction/BPH/ Incontinence/ Infection/Infertility Video Saturday, May 7, 2016
Source of Funding: none
PD22-12 EFFICACY OF DOSE ESCALATION OF TAMSULOSIN FOR THE TREATMENT IN SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA OF LOWER URINARY TRACT SYMPTOMS: A RANDOMISED, DOUBLE-BLIND, PHASE 3 TRIAL IN KOREAN MEN. Kyu Shik Kim, Guri, Korea, Republic of; Jae Heon Kim, Seung Hwan Lee, U-Syn Ha, Deok Hyun Han, In Ho Chang, Jae Hyun Bae, Jun Hyun Han, Tag Keun Yoo, Se Woong Kim, Jae Il Chung, Seoul, Korea, Republic of; Tae Hyo Kim, Busan, Korea, Republic of; Cheol Young Oh*, Seoul, Korea, Republic of; Jae Hoon Chung, Sok-cho, Korea, Republic of; Seung Wook Lee, Guri, Korea, Republic of; Jina Jung, Yong-Il Kim, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: To verify the efficacy and safety of the tamsulosin 0.4mg compared with tamsulosin 0.2mg and placebo in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). METHODS: A total of 523 patients from multi-centers participated. All study subjects entered double blind, randomized, phase 3 trial. Eligible patients were randomly assigned to the tamsulosin 0.4 mg group, the 0.2 mg group, or the placebo group. International Prostate Symptom Score (IPSS), maximum ?ow rate (Qmax), post void residual urine (PVR), blood pressure, heart rate, and adverse events were compared between the three groups at 4 weeks, 8weeks and 12 weeks. RESULTS: A total of 471 patients were enrolled and analyzed. There were no differences in baseline characteristics between the three groups. After 12 weeks of medication, the IPSS was improved in the 0.2mg and 0.4mg group. And 0.4mg group had better improvement than 0.2mg group (-9.57 (0.39) vs. -5.63 (0.38), p<0.0001). Secondarytotal IPSS in patients with severe symptom (IPSS>20), 0.4mg group had most changes in IPSS (-11.27(0.55), p<0.0001). Qmax, PVR were improved in 0.4mg and 0.2mg groups. However, they were not statistically different. No patients experienced any serious adverse effects to tamsulosin in these three groups. CONCLUSIONS: Tamsulosin 0.4 mg and 0.2mg appears to be superior treatment compare to placebo and tamsulosin 0.4mg is more effective than 0.2mg in Total IPSS. Tamsulosin0.4 mg has favorable efficacy and tolerabilityin patients with symptomatic BPH in korean men.
1:00 PM-3:00 PM
V3-01 INFLATABLE PENILE PROSTHESIS INSERTION WITH SYNCHRONOUS PENILE PLICATION FOR THE TREATMENT OF ERECTILE DYSFUNCTION AND PEYRONIE’S DISEASE Paul H. Chung*, Ryan J. Flemons, Allen F. Morey, Dallas, TX
INTRODUCTION AND OBJECTIVES: Twenty to thirty percent of patients with Peyronie’s disease have erectile dysfunction refractory to medical therapy. We present clinical outcomes of inflatable penile prosthesis (IPP) placement with synchronous penile plication for the simultaneous correction of Peyronie’s disease and erectile dysfunction. METHODS: Patients receiving IPP placement with synchronous penile plication were reviewed. After induction of an artificial erection through saline intracorporal injection, plication was performed through a penoscrotal incision retracted distally along the penile shaft as needed for correction. IPP placement was then conducted through the same incision. RESULTS: 27 patients with dorsal, lateral, or biplanar curvature with a mean age of 63 years underwent IPP with synchronous penile plication from 2010 to 2015. Mean pre-op curvature was 37 degrees corrected to <5 degrees after plication. A mean of 4 sutures (range 3-6) were used for PP with each suture providing a mean correction of 8 degrees. No patient suffered post-operative complications and all patients were discharged home on post-operative day one. Upon follow up, three patients reported residual curvature; however, no patient reported continued pain or required release of plication sutures. CONCLUSIONS: IPP placement with synchronous penile plication is a reliable option for correction of erectile dysfunction and Peyronie’s disease. Source of Funding: None
V3-02 FREEHAND TRANSPERINEAL PROSTATE BIOPSY UNDER LOCAL ANESTHESIA John Michael DiBianco, Washington, DC; Matthew Allaway*, Cumberland, MD INTRODUCTION AND OBJECTIVES: 500,000 trans-rectal prostate biopsies are performed annually in the U.S. Infection is the most common reason for hospitalization after a TRPB with increasing
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
incidence of resistant bacteria. Transperineal prostate biopsy (TPB) is a method that has been shown to drastically decrease infectious complications by avoiding the rectum altogether. However, it has been understood that due to pain, TPB must be done under general anesthesia, thus increasing cost and procedural time. The previous described freehand transperineal prostate biopsy (FHTPB) technique, only utilizes 2 puncture sites through which all prostate biopsies are taken. Thus the objective of the current study was to investigate patient pain during FHTPB under local anesthesia only. METHODS: Retrospective review of all prospectively performed FHTPBs under local anesthesia between January 1, 2012 and October 30, 2015 was performed. Primary outcome measurements were patient reported pain utilizing both numerical and visual analog scale at multiple time points throughout the procedure. RESULTS: 33 patients with an average age, BMI, positive family history, prostate volume and PSA of 74.64 9.43 years, 28.21 4.26 15%, 50.34 32.0mL and 9.796.50ng/dL respectively, underwent FHTPB under local anesthesia. The procedure was well tolerated by all patients with probe insertion and local anesthetic injection as the highest pain rating median of 3 (3-4) and 4 (3-5) respectively, and a post-procedural pain rating of 2 (1-2). Additionally, patients described bladder discomfort when obtaining cores form the anterior horn. The mean procedural time was 9.19 3.54mins with a mean of 12.94 3.38cores taken per biopsy. CONCLUSIONS: Freehand transperineal prostate biopsy under local anesthesia only is feasible, safe and tolerated by patients. Source of Funding: None
V3-03 MALE STRESS INCONTINENCE GRADING SCALE FOR EVALUATION OF MEN WITH POST-PROSTATECTOMY INCONTINENCE: A PILOT STUDY Allen Morey, Nirmish Singla*, Paul Chung, Alexandra Klein, Timothy Tausch, Jordan Siegel, Isamu Tachibana, Jeremy Scott, Maude Carmel, Dallas, TX INTRODUCTION AND OBJECTIVES: We developed an objective clinical grading scale to characterize post-prostatectomy incontinence (PPI) and evaluated its use as a tool to facilitate male antiincontinence procedure selection. METHODS: Over the past year, we prospectively implemented a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI patients based on incontinence severity. Patients included were those referred for PPI who had no prior anti-incontinence surgery. During the initial outpatient consultation, each patient was prospectively assigned an incontinence grade score of 0 through 4 based on the consensus of 2 examiners performing a standing cough test (SCT). All patients refrained from voiding for at least 60 minutes prior to the SCT. Men with mild SUI (MSIGS grades 0-2) were offered AdVance sling surgery while those with heavier SUI (MSIGS grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to patient-reported pads-per-day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed. RESULTS: Of 62 consecutive new PPI patients, 20 were graded as mild based on SCT [five (8%) grade 0, 10 (16%) grade 1, five (8%) grade 2] while 42 were graded as moderate-severe [10 (16%) grade 3, 32 (52%) grade 4]. MSIGS grade demonstrated a strong correlation with preoperative PPD (r¼0.74, Figure 1). Among the 53 patients who underwent surgical intervention for PPI, 14 with mild SUI were treated with AdVanceâ male urethral sling (MSIGS grade 0, 1, or 2) while 39 more severe cases received AUS (MSIGS grade 3 or 4). Patient-reported improvement was high overall (median 95%) and similar for sling and AUS patients (95% and 96.5% respectively, p¼0.596). The median time from radical prostatectomy to anti-incontinence surgery was 5.4 years (range 1-20).
e467
CONCLUSIONS: The Male Stress Incontinence Grading Scale provides a rapid, simple, non-invasive, objective assessment of PPI severity which strongly correlates with patient-reported pads-per-day and appears to facilitate anti-incontinence surgical procedure selection.
Source of Funding: none
V3-04 SUBCORONAL APPROACH TO INFLATABLE PENILE PROSTHESIS PLACEMENT WITH A MODIFIED NO TOUCH TECHNIQUE Alexander C. Small*, Aaron C. Weinberg, Matthew J. Pagano, New York, NY; Christopher M. Deibert, Omaha, NE; Robert J. Valenzuela, New York, NY INTRODUCTION AND OBJECTIVES: Surgical treatments for erectile dysfunction can be performed from a variety of approaches. Inflatable penile prosthesis (IPP) design and implantation techniques through penoscrotal and infrapubic incisions have evolved over recent years. Here we present our surgical experience and outcomes with a single subcoronal incision for IPP placement with a modified no touch technique. This approach allows for access to the entire corporal shaft for prosthesis placement and simultaneous additional male reconstructive procedures. METHODS: The index patient is 60 year old male, status-post radical prostatectomy with 2 years of erectile dysfunction refractory to medical therapy. Work up consisted of history and physical. The patient underwent placement of an IPP through our subcoronal approach with a modified no touch technique. The penis was degloved to the level of the penoscrotal junction, and the cremaster muscle was everted and secured to the drapes to allow scrotal and penile skin exclusion from the operative field. The implant is placed through ventral corporotomy incisions similar to standard penoscrotal approach. RESULTS: The procedure was unevenful and was performed entirely in the ambulatory setting, without the use of a foley catheter or a Jackson Pratt drain. There were no complications during this surgery and the patient was satisfied with his functional and cosmetic results. To date, 228 subcoronal IPP placements have been performed at our institution. CONCLUSIONS: Subcoronal IPP placement with modified no touch technique is an appealing approach and shows promising early outcomes. Urologists can safely and easily perform multiple procedures simultaneously with IPP placement through this incision, including circumcision, glanulopexy, Peyronie’s disease correction, length preservation and urethral reconstruction. The subcoronal approach allows for access to the entire corporal shaft providing excellent visibility and allows exclusion of surrounding skin through a modified no touch technique. Source of Funding: None