UP-1: Unmoderated Poster Session 1

Transcription

UNMODERATED POSTER SESSIONS
UP-1: Unmoderated
Poster Session 1
Thursday, October 14
UP-1.01
Impact of lower urinary tract
symptoms on sexual function in
patients with symptomatic prostatic
disorders
Ali M, Rashwan H
Urology Dept., Faculty of Medicine, Suez
Canal University, Ismailia, Egypt
Introduction: Sexual dysfunctions (SDs)
and LUTS due to benign or malignant
prostatic disorders have an important correlation especially in aging men. Both of
them have a significant bothersome impact on quality of life.
Materials and Methods: Three hundred
patients over 45 years old with LUTS due
to symptomatic prostatic disorders attending urology outpatient clinic were subjected to assessment of lower urinary tract
symptoms (LUTS) and sexual functions
using the International Prostate symptom
score (IPSS), International Index of Erectile Function (IIEF) and The International
Continence Society (ICSsex) male sex
questionnaire. Patients with abnormal
digital rectal examination and/or PSA ⬎
4ng/ml were subjected to TRUS and prostate biopsies.
Results: The prevalence of overall SDs in
patients with LUTS due to benign or
malignant prostatic disorders was 71%.
Prevalence of erectile dysfunction (ED),
ejaculatory dysfunctions (EjD), orgasmic
dysfunction and diminished sexual desire
were 60%, 40%, 30% and 28% respectively. Increasing severity of LUTS was
associated with an increasing prevalence
of sexual dysfunctions among patients.
Conclusion: SDs are highly prevalent in
patients with LUTS due to either benign
or malignant prostatic disorders
UP-1.02
Urinary incontinence in patients with
symptomatic benign prostatic
enlargement: features and impact on
sexual dysfunction
Ismail I, Ali M, Metawea M, Bakr M,
Rashwan H
Urology Dept., Faculty of Medicine, Suez
Canal University, Ismailia, Egypt
Introduction and Objectives: To determine prevalence and types of urinary incontinence in patients with symptomatic
benign prostatic enlargement (BPE) and to
evaluate impact of incontinence on sexual
functions in those patients.
Materials and Methods: Descriptive analytic cross-sectional study including 140
patients with symptomatic (BPE) was conducted. Evaluation of lower urinary tract
symptoms (LUTS) was done by fulfillment
of International Prostatic Symptom Score
(IPSS). Urinary incontinence was assessed
by using international continence society
male incontinence symptom questionnaire
(ICSmale IS). Features and severity of SDs
were assessed by International Index of
Erectile Function (IIEF) and The International Continence Society (ICSsex) male
sex questionnaire.
Results: Prevalence of incontinence in
our patients was 58.6% (82 patients). The
most commonly existing types of incontinence in these patients were urge incontinence 92.7% (76 patients); post voiding
dribbling 75.6% (62 patients). There was
61 (74%) out of 82 patients who had
mixed types of incontinence. Quality-oflife question score was strongly correlated
with the presence of urinary incontinence. Comparing (ICSmale IS) total score
in patients with and without different
types of SDs, we found a highly significant statistically difference (p⬍ 0.004)
between total incontinence score in presence or absence of any type of SDs, including: erectile, ejaculatory, orgasmic
and desire dysfunctions.
Conclusion: Majority of patients with
symptomatic BPE had one or more type of
urinary incontinence. Bother of symptomatic BPE is strongly correlated with the
presence of urinary incontinence. Urinary
incontinence is strongly correlated with
presence of all types of SDs in these
patients.
UP-1.03
Lower urinary tract symptoms and
sexual dysfunction in women:
correlation of symptoms with
urodynamic parameters
Bal K, Aydinoglu E, Bolukbasi A,
Sengul F, Ozcift B, Sezer A
Ataturk Research and Training Hospital,
Izmir, Turkey
Objectives: Lower urinary tract symptoms (LUTS) and urinary incontinence in
the female population have negative impact on female sexual function. In this
study we investigated the prevalence of
female sexual dysfunction (FSD) in
women suffering from LUTS and incontinence. We also evaluated the association
of FSD with the severity of LUTS and urodynamic parameters.
UROLOGY 76 (Supplement 3A), September 2010
Materials and Methods: All subjects had
regular heterosexual relationship for the
past 6 months. In the patient group there
were 39 women suffering from urge,
stress or mixed type urinary incontinence.
Patients’ urinary symptoms were evaluated with IPSS and ICI-Q (International
Consultation on Incontinence Questionnaire). Uroflowmetry and filling cystometry was performed in the patient group.
Sexual functions are evaluated by FSFI
(Female Sexual Function Index). The control group (n⫽32) is selected from
women who do not have any sign or
symptoms of LUTS, therefore control
group was evaluated by only FSFI. The
relationship between FSFI, IPSS, ICI-Q and
urodynamic parameters is evaluated
within the patient group.
Results: Mean age of the patient and control group were 37.9⫹8.2 (18-49) and
33.9⫹7.7(21-48) respectively. In the patient group, 31 patients (79.5%) had FSD
(FSFI score ⬍27), while only 5 women
(15.6%) had FSD in the control group
(p⫽0,000). Mean total FSFI score of patient group was significantly lower than
the control group (21.4 vs 29.6). Also
the 6 domain scores of the FSFI were significantly lower in the patient group
(p⫽0.000). Total FSFI score was negatively correlated with quality of life item
of both ICI-Q and IPSS (p⫽0.01). No
other correlation was demonstrated between FSFI and other items of IPSS and
ICI-Q. There was also no relationship between urodynamic parameters and FSFI
domain scores.
Conclusions: The prevalence of FSD is
increased in women with urinary incontinence. These women have significantly
lower FSFI scores when compared with
normal controls. We found no association
between FSI and IPSS, ICI-Q and urodynamic parameters. The only factor determining the severity of FSD was disturbed
quality of life due to urinary incontinence.
UP-1.04
Interest of uroflowmetry in prostatic
hyperplasia
Benhatchi N, Nouredine O
Centre d’Urologie Oran, Oran, Algeria
Introduction and Objective: Urodynamic explorations experienced considerable development these past years. Uroflowmetry became a necessary exam in
the taking care of prostatic diseases. The
purpose of our job is to assess the effectiveness of the surgical treatment of the
prostatic hyperplasia.
Materials and Methods: There were 87
patients with mean age 67 years with
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prostatic hyperplasia who were operated
at our centre: 99% by endoscopic resection and a single patient by high way. All
patients were subjected to uroflowmetry
before and after the surgery.
Results: Of the patients, 84% saw their
uroflowmetry improving to J7 against 16%
with a stable uroflowmetry. After a
month, 81 of 87 patients introduced the
upper uroflowmetry in 15 ml/s.
Conclusions: Uroflowmetry nowadays is
obvious in the initial balance sheet of the
prostate. It remains the most objective
exam to control the effectiveness of prostatic hyperplasia treatments.
UP-1.05
Clinical significance of detrusor after
contraction
Cho S, Yi J, Park J, Jeong M, Oh S
Seoul National University Hospital,
Seoul, South Korea
Introduction and Objective: The aim of
this study is to understand the real significance and clinical implication of detrusor
aftercontraction (DAC) in the patients
with neurogenic and non-neurogenic voiding dysfunction.
Materials and Methods: A retrospective
analysis was performed in 2,309 adult patients with neurogenic or non-neurogenic
voiding dysfunction. All the clinical and
urodynamic data was collected in a prospective setting for lower urinary tract
symptoms and past medical history. To
find out whether DAC was an artifact or
not, investigators compelled patients to
cough when DAC occurred, because no
change of detrusor pressure (Pdet) can
confirm that DAC is a true contraction.
Patients with DAC were subcategorized
according to several factors: PVR (⬍ 50
vs ⱖ 50 ml), the presence of dyssynergia
in electromyography (yes vs no), the
amount of Pdet change (⬍ 20 vs ⱖ20
cmH2O), and multiplicity (single vs multiple DAC).
Results: DAC was found in 188 patients
(132 males and 56 females). Males with
DAC had a higher occurrence rate of trabeculation and bladder outlet obstruction
or benign prostatic hyperplasia (BPH).
Females had a higher occurrence rate of
female LUTS and multiple sclerosis. Males
and females with DAC had a higher incidence rate of frequency, postvoid residual
urine (PVR), nocturia, slow stream, and
urgency. Subgroup analysis showed that a
presence of dyssynergia in males with
DAC was correlated with the increased
occurrence of trabeculation and diverticulum. A BPH patient with a small PVR
would have a higher probability of a
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strong DAC. DAC which occurred in a
male with a small PVR and a female with
a large PVR had a significant relationship
with the presence of overactive bladder.
A female with a small PVR had a potential
risk of stress urinary incontinence. A patient with dyssynergia had a significant
correlation between the presence of DAC
and neurogenic diseases of hydrocephalus, herniated disc and spinal surgery. A
male of multiple DACs and a female of a
single DAC would have a higher risk of
overactive bladder.
Conclusions: DAC were correlated with
neurogenic and non-neurogenic conditions. The identification of DAC should
be followed by screening for underlying
conditions.
UP-1.06
Urinary diversion continence: pocket
Casablanca
Khelil M, El Neil H, Elgachbour S,
Ksiri K, Elmaataoui A, Abouteib R,
Joual A, Rabii R, Meziane F
Ibn Rochd University Hospital, Casablanca, Morocco
Introduction: Urinary diversion continence is a good and interesting alternative
compared to trans cutaneous ureterostomy ileal Bricker type when the urine
must be diverted to the skin. Several techniques have been described but none has
been able to prove its superiority.
Materials and Methods: We report a
new case of urinary continence a vale according to the method of Meziane (pocket
Casablanca) first described in 1993 and
improved in 1996 and amended in 2009.
This is a patient of 30 years, with a
vesico-vaginal-complex made repeatedly;
complicated by vesico-rectal fistula for
which she received a colostomy as a first
step and then recovery continuity has
been achieved. Our patient consulted for
a permanent urinary incontinence. The
valve under consideration showed a complete destruction of the urethra with a
very narrow vagina. The IVU has objectified a reduced bladder capacity without
individualization tank bladder during urination and pictures with a moderate expansion of the upper urinary tract. The
surgical technique was to use two ileal
graft détubulé the first of 45cm for the
neo bladder and the second of 3 cm for
the system Motti. This allowed the piece
of clothing in the bladder-tank with antireflux effectively protecting the upper
tract drains or both ureters in a groove
anti reflux. Continence is ensured by a
robust hydraulic bivalve connected to a
stoma mucosal lining touching the skin by
the segment of 3 cm.
Results: The evolution is marked by the
maintenance of renal function. On the
radiological, there is a stabilization of the
top unit with a reservoir of good capacity
and the absence of reflux after falling a
year. The flexibility and permeability of
our pack have a self-survey easy four to
six times a day with no post-voiding residue demonstrated in ultrasound.
Conclusions: The physical and urodynamic of this derivation makes a solid
mounting protect renal function with a
continent reservoir perfectly easy to drain.
UP-1.07
Bladder pheochromocytoma
conservative treatment: endoscopic
surgery coupled with open surgery
University Hospital Ibn Rochd, Casablanca, Morocco
Introduction and Objective: The pheochromocytoma is a neuroendocrine tumor
of ectodermal origin. It is situated at the
level of residues of the neural crest, usually in the adrenal glands, bladder exceptional level, posing the problem of surgical resection while maintaining a
sufficient pool.
Materials and Methods: We report the
case of a 39 year-old patient followed for
severe hypertension resistant to medical
treatment. As part of the workup of hypertension and its impact, an assessment
was made.
Results: The rates of metanepherine and
normetanephrine plasma were high. Ultrasound and abdominal CT scan found a
mass of tissue is irregularly shaped enhancing significantly after injection of contrast medium, measuring 53 * 50 * 60 mm
at the expense of the left lateral wall and
floor of the bladder. This mass is the seat
of small calcifications. Preoperative cystoscopy objectified repression of the left lateral wall without visible mass budding
endo-bladder. The intervention consisted
of a partial cystectomy conducted by subcutaneous peritoneal having been to a
mono bloc excision of the mass and the
bladder wall opposite. The postoperative
course was uneventful. The pathologic
study has found a pheochromocytoma
without signs of malignancy; the biological and radiological checks each month
are normal.
Conclusions: The pheochromocytomas
are rare. Their diagnosis should be considered in the clinical and biological pheo-
chromocytoma with absence of adrenal
tumor. The endoscopic evaluation after
preoperative radiological assessment allows the choice of mode of removal as is
the case with our patient. This allowed us
to keep the urinary reservoir.
UP-1.08
Lower urinary tract symptoms in
patients with familial amyloidotic
polyneuropathy
Farinha R, Oliveira e Silva T,
Campos Pinheiro L, Barroso E, Mendes R
Curry Cabral Hospital, Lisbon, Portugual
Introduction and Objective: Familial
amyloidotic polyneuropathy (Portuguese
Type) is an autosomal dominantly inherited neuropathic amyloidosis, caused by a
mutant transthyretin (TTR). The initial
symptoms are related to peripheral neuropathy and various autonomic disturbances. Our objective was to evaluate the
lower urinary tract dysfunction in this disease and its impact in satisfaction with
life, before and after hepatic transplant.
Materials and Methods: We evaluated
66 patients with familial amyloidotic polyneuropathy, through application of a
questionnaire comprising symptoms of
lower urinary tract dysfunction and a Satisfaction With Life Scale (SWLS).
Results: In this group, 27% reported incomplete emptying of the bladder, 29%
urinary incontinence, 14% dysuria, 23%
frequency, 18% urinary tract infections,
64% erectile dysfunction and 61% decreased sperm volume. This is a disease
that as a major impact in satisfaction with
life. In SWLS we found scores lower than
24 in 48% of cases before transplant and
in 32% of cases after transplant.
Conclusions: Familial amyloidotic polyneuropathy produces a variety of lower
urinary tract symptoms and has a major
impact on satisfaction with life. The hepatic transplant was associated with
slightly better scores in SWLS.
UP-1.09
Impact of benign prostatic
hyperplasia (BPH) on medically
treated patients’ quality of life
Fourcade R1, Lacoin F2, Slama A3,
Gaudin A3, Le Fur C3, Michel E4,
Sitbon A4, Cotté F3
1
Centre Hospitalier d’Auxerre, Auxerre;
2
Cabinet Medical, Albens; 3Laboratoire
Glaxo-Smith-Kline, Marly Le Roy; 4Cegedim Strategic Data, Boulogne, France
Introduction and Objective: BPH Patients’ Quality of Life (QoL) may be substantially altered despite appropriate medi-
Table 1, UP-1.09
BPH
IPSS score (N⫽718)
Severity
Mild
Moderate
Severe
p-Val.
Unadjusted EQ-5D
[0–1]
0.87 (0.13)
0.78 (0.19)
0.71 (0.21)
⬍0.001
Unadjusted VAS
[0–100]
73.8 (14.0)
64.0 (15.8)
61.1 (19.0)
⬍0.001
0.79 (0.77–0.80)
0.75 (0.73–0.77)
0.73 (0.24)
67.7 (66.5–69.0)
62.5 (61.0–63.9)
NA
0.72 (0.25)
68.3 (16.5)
Other chronic diseases
COPD (Rutten-van Mölken
et al. 2006)
Type II diabetes (Vexiau
et al. 2008)
Osteoporosis (Rajzbaum
et al. 2009)
Moderate
Severe
With hypoglycemia
occurrences
With fracture history
*Lower scores indicate lower QoL
cal management. The study’s aim was to
assess relationship between BPH severity
and general QoL and to balance its magnitude to that of other chronic diseases.
Materials and Methods: A cross-sectional observational study was conducted
among French general practitioners in
2009-2010 exploring Quality of life in
men over the age of 50 treated medically
for BPH. The EuroQoL validated questionnaire five-dimension (EQ-5D), was used
ranging from 0 (death) to 1 (perfect
health) and General QoL was further assessed with a Visual Analogue Scale (EQVAS; 0 –100). BPH severity was evaluated
using the IPSS score and its categories:
mild (0 –7), moderate (8-19) and severe
(20-35). Variables associated with EQ-5D
score were selected by univariate analysis
to be included in linear regression models
for adjustment.
Results: Questionnaires from a total of
718 men with BPH were analyzed. Their
mean EQ-5D and EQ-VAS scores were
0.81 (⫾0.18) and 67.6 (⫾16.1), respectively. Both scores were significantly different between IPSS categories (p⬍0.001)
(table). After adjustment for age, education and comorbidities, association between IPSS and EQ-5D scores remained
significant (p⬍0.001). Taking men with
mild symptoms as a reference, the adjusted losses of QoL were ⫺0.09 (95%CI:
⫺0.12 to ⫺0.07) and ⫺0.14 (95%CI:
⫺0.19 to ⫺0.10) for patients with moderate and severe symptoms, respectively.
These QoL levels are compared to other
heavy comorbidities explored with similar
questionnaires (table).
Conclusion: QoL measured by EQ-5D
and EQ-VAS scores severely decreased as
BPH symptom severity increased. BPH
moderate-to-severe symptoms have an
equivalent impact on QoL to other severe
chronic conditions.
UP-1.10
Urinary incontinence in obese people:
urodynamics studies
Gentile BC, Giulianelli R, Brunori S,
Albanesi L, Pisanti F
Villa Tiberia, Rome, Tialy
Introduction and Objectives: The purpose of this study was to describe urodynamic characteristics of obese women
with urinary incontinence. We investigated whether BMI is associated with
lower urinary tract symptoms in women.
Methods: Body mass index was defined
as normal (less than 25 kg/m (2)), overweight (25 to less than 30 kg/m(2)) and
obese (30 kg/m(2) or greater). Urinary
incontinence severity was measured with
minctional diary, number of daily pads, a
cough stress test and Valsalva leak point
pressure from urodynamic testing. The
quality of life was measured with incontinence Impact Questionnaire. This study
analyzed 130 female patients who were
referred to the Urological Unit from 2003
to 2007, with urinary disturbances. Patients were divided into four BMI class (I,
II, III, IV). Each class was analyzed as a
function of the following variables: grade
and type of urogenital prolapsed, grade
and type of urinary incontinence, number
of daily pads and, during urodynamics,
urine leakage, hypovalid stream feeling of
incomplete bladder emptying.
Results: We observed higher weight category was associated with incontinence
episode frequency (p ⬍0.0001), Valsalva
leak point pressure (p ⫽ 0.003) and Incontinence Impact Questionnaire score
(p ⫽ 0.0004). The incidence rose as the
BMI increased. In BMI class I 68.8% referred to urinary leakage while coughing
or under physical effort. In Class II BMI
77.3% referred urinary incontinence. In
BMI class III, 95.0% referred urinary in-
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continence and all patients in BMI class IV
were incontinent.
Conclusions: Obese women with stress
urinary incontinence report more incontinence episodes and worse quality of life,
and depression status. BMI had a stronger
association with Pabd than with Pves, suggesting a possible mechanism for the association between obesity and urinary incontinence. These results suggest that
weight reduction of body weight can improve urinary incontinence severity and
its effects on quality of life in obese
women.
UP-1.11
Is TURP possible without
postoperative irrigation?
Ghoundale O, Bazine K, Assebbane M,
Kasmaoui E, Alami M, Lezrek M
Military Hospital Moulay Ismail, Meknes,
Morocco
Introduction and Objective: Is the postoperative bleeding a normal consequence
of transurethral resection of the prostate?
We present our experience with the paraprostatic injection of adrenaline prior to
the transurethral resection of the prostate.
Moreover, extensive coagulation at the
end of the procedure is performed, in
order to have an almost perfect hemostasis and possibly without postoperative
irrigation.
Materials and Methods: from March
2008 to February 2009, 33 consecutive
patients were operated by one surgeon,
recruited without selection through his
consulting room. The patients had a mean
age of 59 years, and presented with benign hyperplasia of the prostate unresponsive to medical treatment, with or without
urinary retention. The average prostate
size was 40 to 150g. Operative technique:
Under spinal anesthesia and lithotomy
position, an injection of 10 ml of 2 % lidocaine adrenaline solution is performed, in
each para-prostatic space via a supra-pubic route. Then a monopolar transurethral
resection of the prostate is performed
with a slow progression of the cutting
loop, throughout the entire procedure. At
the end of the resection, the entire surface of resection was systematically coagulated with a barrel-shaped coagulating
electrode. Patients were hydrated intravenously, with the help of intra venous 20
mg of furosemide, if needed, in order to
have a good diuresis immediately when
the 3 way catheter is inserted. If the urine
is clear or pink, irrigation is not installed.
Results: The average time of the procedure was 70 min. The intraoperative
bleeding was minimal, and no complica-
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tions were noted. Postoperative Irrigation
was performed only in 4 patients. For the
other 29 patients, no irrigation was
needed in the theater room or after. No
patient presented late hemorrhage or clotting. The mean hemoglobin loss was 1,25
g/dl. The catheter was removed after a
mean 56 hours. The patients were reviewed
at one month and no complications were
reported, especially hemorrhagic complications that we were concerned about
after extensive coagulation.
Conclusion: Postoperative bleeding is
not a normal result or fate after TURP.
Hemostasis almost perfect is possible.
Most of the times, a single postoperative
drainage, without irrigation, can be
enough. We think that the injection of
adrenaline in para-prostatic space seems
to provide a better homeostasis and a secure TURP. But only a comparative study,
with or without adrenaline, can tell.
UP-1.12
Anastomotic stricture after radical
prostatectomy: risk factors
Capoun O1, Hanus T1, Babjuk M2,
Pavlik I1, Dvoracek J1, Novak K1
Dept. Of Urology, 1General Faculty Hospital; 2Faculty Hospital Motol, Prague,
Czech Republic
Introduction and Objective: Identification of parameters associated with increased risk of vesicouretral anastomosis
stricture formation after radical prostatectomy (RP).
Materials and Methods: A total of 651
patients underwent RP from January 2000
to December 2008. Patients with missing
data at follow-up were excluded from the
analysis (n⫽42). In addition to standard
parameters, specimen weight, margin status, operating time, intraoperative blood
loss, technique of bladder neck reconstruction, time to catheter removal, surgical complications and postoperative radiotherapy were registered. The freedom
from anastomotic stricture formation was
calculated using the Kaplan-Meier method,
multivariate analysis was performed by
using the stepwise regression method.
Results: Mean age was 62 years (40-79),
mean level of prostate specific antigen
was 10.25 ng/ml (0.59-50.00 ng/ml). As
locally advanced were identified in
26.76% of specimen, median weight was
49g (17-203g). Median operating time was
135 minutes (44-540), mean blood loss
1395ml and median time of catheterization was 14 days (6-42). A surgical complication occurred in 68 (11.17%) cases.
Adjuvant or salvage radiotherapy was indicated in 80 (13.14%) patients. A total of
103 (16.91%) men underwent endoscopic
procedure due to anastomotic stricture
formation, 27 (4.43%) patients repeatedly.
Perioperative blood loss (p⫽0.034), time
to catheter removal (p⫽0.001), surgical
complication (p⬍0.0001) and postoperative radiotherapy (p⫽0.0091) were found
to be statistically significant in prediction
of anastomotic stricture formation.
Conclusions: Neither any of preoperative
and histological parameters nor surgical
technique increased risk of vesicourethral
anastomosis stricture after RP. Patients at
greatest risk for the subsequent endoscopic procedure were those with perioperative blood loss greater than 1700ml,
surgical complication and postoperative
radiotherapy.
UP-1.13
The efficacy and safety of combined
therapy with tamsulosin and
tolterodine for female patients with a
maximal flow rate less than 12ml/sec
Kim S, Hwang E, Im C, Oh K, Jung S,
Kang T, Kwon D, Park K, Ryu S
Dept. of Urology, Chonnam National
University Medical School, Gwangju,
South Korea
Introduction and Objective: There has
been little research on the efficacy and
safety of combined therapy with ␣-blocker
and anticholinergics in female patients
with low maximal flow rate (Qmax) suspecting functional BOO. We assessed the
effect of tamsulosin HCl (0.2 mg) with or
without tolterodine extended release (2
mg) on female patients with Qmax less
than 12 ml/s who are suspected of suffering functional BOO.
Materials and Methods: From January
2007 to December 2008, 250 patients
with a Qmax less than 12 ml/sec were
selected for this for this prospective observational study. The patients were
treated with tamsulosin alone (0.2 mg/
day) (group I, n⫽106) or tamsulosin combined with tolterodine (2 mg/day) (group
II, n⫽75). The effectiveness of these medications was assessed at baseline and after
12 weeks of treatment on the basis of the
International Prostate Symptom Score
(IPSS), the Qmax and the postvoid residual urine volume.
Results: The total IPSS, the voiding symptom score, the Qmax and the residual
urine volume were significantly improved
from baseline after 12 weeks of treatment
(p⬍0.05) in both groups, whereas the
storage symptom score significantly improved only in group II (p⬍0.05). After
12 weeks of treatment, there were no significant differences in subjective symptom
score and objective uroflowmetric parameters between two groups, except for
storage symptoms (group I; 4.3⫾1.6 vs
group II; 3.8⫾0.9) and postvoid residual
urine (group I; 31.8⫾22.4 vs group II;
56.1⫾29.7) which were not considered
meaningful value to induce harmful effect
in a clinical setting. There was no acute
urinary retention in either group.
Conclusions: Combination therapy with
tamsulosin and tolterodine significantly
improved the subjective symptoms and
uroflowmetric measures of female patients
with a maximal flow rate of less than 12
ml/s. Combination therapy may be an effective, safe treatment approach for female patients who are suspected of suffering from functional BOO and storage
symptoms.
UP-1.14
The effect of chronic prostatic
inflammation and prostatic calculi on
benign prostatic hyperplasia
Kim H1, Cho Y2, Kim J2, Lee D2, Han C2,
Lee Y2, Kim S2, Cho S2
1
St. Paul’s Hospital, The Catholic University of Korea; 2The Catholic University of
Korea, Seoul, South Korea
Introduction and Objective: This study
aims to examine and compare the correlation between chronic prostatic inflammation and prostatic calculi and the clinical
variables of BPH.
Materials and Methods: This study was
based on 225 patients who had gone
through the transurethral resection of
prostate from March 2004 to July 2009.
Of the 225 patients, 181 patients were
pathologically diagnosed as having a BPH
with prostatitis and 44 patients had the
only BPH (group G0). Chronic inflammation was graded as I (group G1: scattered
inflammatory cell infiltrated within the
stroma without lymphoid nodules), II
(group G2: nonconfluent lymphoid nodules) or III (group G3: large inflammatory
areas with confluence of infiltrate). The
prostatic calculi which was found in the
transrectal ultrasonography was classified
into type A (a discrete small reflection),
type B (a large mass of multireflection),
type M (type A and type B coexist) and
type N (the calculi was not found) by
type. The relationship with each group
was analyzed and also, PSA, volume of
prostate, maximum urinary flow rate, residual urine volume, and IPSS were compared in each group.
Results: There was not a connection with
the grades of inflammation and each type
of stone. The grades of inflammation and
the volume of prostate were each that
G0⫽36.0⫾11.4, G1⫽44.4⫾18.1, G2⫽
51.1⫾27.7, G3⫽ 51.7⫾20.7ml, it displayed the aspect that the more inflammation is serious, the volume becomes
larger, and the difference between G2,
G3 and G0 among those was significant
(p⬍0.01, p⬍0.001). The storage symptom of IPSS was that G0⫽6.85⫾3.5,
G1⫽8.26⫾3.6, G2⫽9.84⫾4.0,
G3⫽10.10⫾4.1, the sum of IPSS was
that G0⫽19.41⫾7.3, G1⫽21.83⫾6.1,
G2⫽23.63⫾7.2, G3⫽24.00⫾6.3; therefore
the more serious the inflammation is, the
more those increased (p⫽0.002, p⫽0.03).
There was not a significant difference between each clinical variable by the calculi
types.
Conclusions: Prostatic calculi were not
related to the chronic inflammation and
the clinical variables of BPH. The historical chronic inflammation which appeared
in the BPH was intimately associated with
volume of the prostate and the storage
symptom, so it is presumed not only to be
related with the progression of the BPH,
but also will be one of the causes of
lower urinary tract symptoms.
UP-1.15
The effect of intraprostatic chronic
inflammation on benign prostate
hyperplasia treatment
Kim B1, Chang H1, Kim C1, Park CH1,
Park J2
1
Dept. of Urology, Keimyung University
School of Medicine, Daegu; 2Dept. of
Urology, College of Medicine, Daegu
Catholic University, Daegu, South Korea
Introduction and Objective: Asymptomatic chronic inflammation of the prostate
is a common finding in benign prostatic
hyperplasia (BPH). We investigated how
the chronic inflammation affects medical
treatment for BPH.
Materials and Methods: One pathologist
reviewed the chronic inflammation of 82
BPH patients who underwent transrectal
ultrasonography (TRUS)-guided needle
biopsy. The extent of chronic inflammation was classified into 4 grades, categorized into two groups: the low-grade
group and the high-grade group. We compared total, voiding, and storage International Prostate Symptom Score (IPSS) and
quality of life (QoL) between the groups
at baseline and 1, 3, 6, and 12 months
after medical treatment for BPH.
Results: There were no significant differences in total IPSS or QoL between the
groups during the follow-up period. The
low-grade group showed continuous improvement of storage symptoms until 12
months; however, the high-grade group
showed improvement until 3 months.
Maximal improvements of QoL were observed at 6 months in the high-grade
group and at 3 months in the low-grade
group. There was no episode of surgery
in the low-grade group, but four patients
in the high-grade group (9.1%) underwent
surgical treatment due to acute urinary retention or insufficient therapeutic response.
Conclusions: Although there was no statistical significance, improvements in IPSS
were higher and lasted longer in the lowgrade group. We might suggest medical
treatment for intraprostatic chronic inflammation in BPH patients.
UP-1.16
Long-term effect of loxoprofen
sodium on nocturia in patients with
benign prostatic hyperplasia
Chang H1, Kim B1, Park C1, Kim C1,
Park J2
1
Dept. of Urology, Keimyung University
School of Medicine, Daegu; 2Dept. of
Urology, College of Medicine, Daegu
Catholic University, Daegu, South Korea
Introduction and Objective: Recently,
there have been several reports about the
short-term efficacy of Loxoprofen sodium
(loxoprofen), a non-selective cyclooxygenase inhibitor. We evaluated the long-term
effect of loxoprofen on nocturia in patients with benign prostatic hyperplasia
(BPH).
Materials and Methods: Between January 2006 and December 2008, forty BPH
patients with 2 or more episodes of nocturia received alpha-blocker, 5-alpha reductase inhibitors and loxoprofen 60 mg
at night prior to sleep for 12 months
(Group I). During the same period, thirtyeight BPH patients with 2 or more episodes of nocturia only received alphablocker, 5-alpha reductase inhibitors; they
were selected to control group (Group
II). After 3, 6, 12 months treatment
course, patients were re-evaluated by
number of nocturia.
Results: There was no significant difference of baseline number of nocturia in
group I and II (3.5⫾0.8, 3.3⫾0.8,
p⫽0.278). After 3 months of treatment,
the number of nocturia in group I and II
decreased significantly compare with baseline (1.9⫾0.7, 2.1⫾0.7, p⬍0.05). But degree of decreased nocturia in group I and
II show a significant difference (⫺1.5⫾0.9,
⫺1.1⫾0.9, p⫽0.034). After 6, 12 months,
number of nocturia in group I and II decreased significantly compared with baseline (p⬍0.05), but degree of decreased
nocturia in both group did not show a
difference (p⬎0.05). After 6 months’ treat-
S57
ment in group I, treatment-emergent adverse events, including gastric discomfort
(5 patients, 12.5%), leg edema (3 patients,
7.5%), decreased urine volume (1 patients,
2.5%), occurred in 9 of the 40 (22.5%)
patients. But, in group II, treatment-emergent adverse events, including gastric discomfort (2 patients, 5.2%), leg edema (1
patient, 2.6%) occurred in 3 of the 38
(7.8%) patients.
Conclusions: Loxoprofen can be effective treatment for patients with nocturia
secondary to BPH in short-term period.
Long-term use of loxoprofen does not
recommanded because of side effect of
loxoprofen, so we suggest that use of
loxoprofen within 3 months might be
safe.
UP-1.17
Is there a best method for
measurement of Q tip angle?
Lee C1, Yun J2, Kim D1, Jeon Y1, Lee N1
1
Soonchunhyang University, Cheonan
Hospital, Cheonan; 2Soonchunhyang
University, Gumi Hospital, Gumi, South
Korea
Introduction and Objective: We evaluated the effect of the patient’s position
and bladder filling status on outcome of Q
tip angle assessing urethral hypermobility.
Materials and Methods: All patients underwent Q tip angle and POP-Q staging
measurement. Q tip angle was measured
at supine position and 30 degree angle
reclining position at empty status and
then repeated Q tip angle measurement at
filling status, usually 150-200mL. It was
placed at the urethrovesical junction. We
defined urethral hypermobility using the
definition of urethral angle with straining
or coughing minus urethral angle at rest
greater than 30 degrees. Hypermobility
concordance rate was calculated as the
ratio of hypermobility at straining and
coughing to hypermobility at straining or
coughing.
Results: All of 17 female patients (mean
age 54 ⫾ 13 years, 27-89) who complained of a stress urinary incontinence
were assessed Q tip angle. The POP-Q
stages of all patients were stage 1 or less.
In emptying status, the rate of urethral
hypermobility was 41.2% (7/17) at supine
and 64.7% (11/17) at 30 degree angle reclining position. In filling status, the rate
of urethral hypermobility was 58.9% (10/
17) at supine position and 64.7% (11/17)
at 30 degree angle reclining position. The
positive rate is significantly higher at reclining position than supine position
(64.7% (22/34) vs. 50.0% (17/34),
p⫽0.059). The positive rate is higher at
S58
filling status than emptying status (61.8%
(21/34) vs. 52.9% (18/34)). But the difference is not significant (p⫽0.317). Hypermobility concordance rate was 30.0% (3/
10) at supine and emptying, 69.2% (9/13)
at reclining and emptying, 69.2% (9/13) at
supine and filling, 83.3% (10/12) reclining
and filling status.
Conclusions: The outcome of Q tip angle measurement and the rate of urethral
hypermobility were changed in relation to
patient’s position and filling status. Reclining position shows increased Q tip angle
measurement and positive urethral hypermobility. Hypermobility concordance rate
is most high at reclining and filling status.
So we can assume that Q tip angle measurement at reclining and filling status
might be a most practical method.
UP-1.18
Sacral neuromodulation: utility if
reprogramming during the initial
test phase
Marchand C, Ripert T, Messaoudi R,
Azemar M, Staerman F, Ménard J
Dept. of Urology-Andrology, Robert Debré
Academic Hospital, Reims, France
Introduction and Objective: To assess
the utility of sacral nerve stimulation’s
reprogramming during the initial test
phase (stage 1) in refractory urinary urgency/frequency (UF), urge incontinence
and idiopathic urinary retention (UR).
During stage 1, stimulation’s parameters
are adjusted to provide the best improvement in voiding dysfunction. We evaluated stage 1 results with various frequencies different to the 10-14Hz usually used.
Materials and Methods: We prospectively evaluated 29 consecutive patients
(23 women, 6 men) (mean age 59.8⫾13.4
years) implanted by a single surgeon between June 2008 and April 2010. Etiologies were 26 UF (idiopathic (21), radiation
cystitis (2), interstitial cystitis (2), spinal
epidural metastasis (1)) and 3 UR. Preoperative assessment included clinical examination, voiding diaries, urodynamics,
cystoscopy and kidney ultra-sound. During
stage 1, the device was systematically programmed at 5Hz, 15Hz, 40Hz and a TestOff, with lead level and amplitude modifications. Effectiveness was based on
voiding diaries and the permanent implantation was decided if improvement ⬎50%.
Mean follow-up was 7.9⫾6.1 months.
Results: The overall implantation rate was
68.9% (73% for UF and 33.3% for UR).
Mean test period was 25.3⫾8.4 days.
Among the UF permanent implanted patients, daily and nocturnal voids decreased
respectively by 36.6% and 72.4%, voiding
volume increased by 31.8%, number of
leakage episodes decreased by 74%, and
pads per day decreased by 84.4%. Of the
20 permanent implanted patients, stage 1
was successful for 19 (95%) at 15Hz, 9
(45%) at 5Hz, 14 (70%) at 40Hz; Test-Off
was always positive. Optimal frequency
was 15Hz, 5Hz, 40Hz for respectively 15,
3 and 2 patients. One patient was only
improved with 40Hz and was permanently implanted at this frequency with
stable results at 6 months. During stage 1,
complications occurred in 3 patients
(acute urinary retention [1], regional pain
[1], infection requiring electrode removal
[1]). None of the 20 permanent neuromodulators needed revision surgery.
Conclusion: In 10-14Hz non responders
during initial test phase, 5Hz and 40Hz
should also be tested. In our experience,
modifying frequencies during this phase
improves neuromodulation outcomes in a
quarter of patients but needs high physician availability.
UP-1.19
The role of urodynamics in the
management of children’s
vesicoureteric reflux
Orsolya M1, Kiss E2, Boja R1
University of Medicine TG. Mures, 1Clinic
of Urology; 2Clinic of Pediatric Nephrology, Targu Mures, Romania
Introduction and Objective: Vesicoureteric reflux (VUR) is a frequently encountered anomaly of childhood, a problematic issue in paediatric urology. The
aim of this retrospective study is to
present the role of urodynamics.
Materials and Methods: Between 2005
and 2009, 230 (14,37%) out of a total of
1600 flowmetries in our unit were performed in cases of children aged 3-16
years, presenting VUR. In these cases, we
studied the curve pattern, value of Qmax
(the values considered were age and gender related, after Abrams), duration of
micturition, hesitancy, time to Qmax and
amount of voided volume.
Results: To be able to evaluate the result
a minimal volume of 150 ml was required.
All the flowmetries (230-100%) were performed in physiologic conditions, after
the beginning of the antibiotherapy, to
have a good bladder capacity. In the case
of a good curve, without artefacts, we
didn’t continue the testing; otherwise,
from two consecutive curves we considered the one without artefacts. Our findings showed reduced bladder capacity in
65 cases (28.26%); in majority of the patients, 145 (63.04%), bladder capacity was
normal, while in 20 cases (8.69%), all
girls, the bladder capacity was important
(above 500 ml) but without residual
urine. Regarding the values, there were
differences caused by age, but we found
real high values of Qmax (⬎30 ml/sec.) in
30 girls (13.04%). In 40 (21.30%) cases
the values were low (below 10 ml/sec) in
spite of a bladder capacity ⬎150 ml. The
shape of the curves of our results revealed
normal shape in 155 cases (67.39%), interrupted curves in 34 cases (14,78%), irregular curves in 30 cases (13.04%) and in
the remaining 11 cases (4.78%), the
curves were obstructed. Children with
irregular and interrupted curve patterns
presented a low grade reflux (gr.I- 45, gr.
II-19). In these cases (total of 64 patients,
27.82%), we treated first the voiding dysfunctions (behavioral therapy, bladder
training or pharmacotherapy-alpha 1
blockers, anticholinergics as it required).
Invasive treatment was applied if the bladder outlet obstruction was certified and
the reflux proved to be a secondary one
(hymen hypertrofy, meatus stenosis, posterior urethra valve). An invasive VUR
treatment (endoscopic or surgical one)
was never performed without having a
normal urodynamic status.
Conclusions: Urodynamics are very useful in differentiation between primary and
secondary reflux due to bladder outlet
obstruction. The aspect of the curve
seems to be of great importance in defining the correct management of the reflux.
Invasive treatment indication of VUR requires normal urodynamic status. Appropriate management of voiding dysfunction
can lead to the resolution of the reflux.
plasia who had been receiving 0.2 mg of
tamsulosin and had an IPSS ⱖ8 and consented to this study. The mean age was
69.7 years, the mean prostate volume was
36.7 ml, and the average tamsulosin (0.2
mg) treatment period was 17.9 months.
We evaluated the IPSS-QOL score, urinary
flow parameters, and residual urine volume before and 4 weeks after increasing
the dose of tamsulosin to 0.4mg. Comparison within the same group was achieved
using the Wilcoxon test.
Results: The mean IPSS changed from
14.8 ⫾ 5.2 to 11.9 ⫾ 7.3, and the QOL
score from 3.8 ⫾ 1.1 to 3.1 ⫾ 1.3. As
storage symptoms of the IPSS, urgency
decreased from 1.4 ⫾ 1.4 to 1.1 ⫾ 1.3,
and daytime urinary frequency from 2.9 ⫾
1.6 to 2.0 ⫾ 1.7. Furthermore, maximum
urinary flow rate and residual urine volume were significantly changed after the
event in 22 patients, to whom voiding
volume more than 100ml. Among the 31
cases, one patient newly complained of
chest pain and one patient had vertigo.
Conclusions: The possibility was suggested that increasing the dose of tamsulosin is worthy of consideration before
switching to other drugs.
UP-1.20
Effect of increasing the dose of
tamsulosin to 0.4 mg on dysuria
associated with benign prostatic
hyperplasia
Okamura T, Hirose Y, Ando R, Nakane A,
Akita H
J.A. Aichi Anjo Kosei Hospital, Anjo,
Japan
Introduction and Objective: Men with
large prostate and high prostate specific
antigen are at high risk for disease progression in patients with benign prostatic
hyperplasia. We determined risk factors of
urinary tract infection in patients with
benign prostatic hyperplasia.
Materials and Methods: Between Jan.
2005 and Dec. 2008, 354 consecutive
men visited our urologic clinic due to
lower urinary tract symptoms. In a retrospective study, we analyzed certain criteria in 184 men without symptoms of
acute urinary tract infection, including
urinalysis, urine culture, prostate specific
antigen, symptom assessment by International Prostate Symptom Score, peak urine
flow rate, post-voided residual urine volume using transabdominal ultrasonography, and prostate volume using transrectal
ultrasonography.
Results: Of the patients, 75% (138/184)
presented with pyuria; 10.9% (20/184) of
the patients presented with a positive
Introduction and Objective: While tamsulosin is most commonly administered at
a dose of 0.4 mg in the West, 0.2 mg is
more often applied in Japan, Korea, and
elsewhere in Asia, to take into account
body size. However, this may influence
efficacy and therefore the present study of
the effect of increasing the dose of tamsulosin from 0.2 mg to 0.4 mg in Japanese
patients who had dysuria associated with
benign prostatic hyperplasia was conducted.
Materials and Methods: We investigated
31 patients with benign prostatic hyper-
UP-1.21
Large prostate volume is a risk factor
of pyuria in patients with benign
prostatic hyperplasia/lower urinary
tract symptoms
Park S, Lee J, Kang I, Han D, Seo I,
Jeong H, Rim J
Wonkwang University Medical School
and Hospital, Iksan, South Korea
urine culture. Patients presenting with
pyuria had significantly larger prostate
volume than patients without pyuria
(56ml vs. 42ml, p⫽0.008). Patients with a
positive urine culture had significantly
larger voiding volume than patients with a
negative urine culture (207.8 vs. 159.6 ml,
p⫽0.015), but post-voided residual urine
volume was not statistically difference
between two groups (72.8ml vs. 48.8ml,
p⫽0.085). International Prostate Symptom
Score, peak urine flow rate, prostate volume was not statistically difference according to pyuria and positive urine culture (p⬎0.05).
Conclusions: Large prostate is a risk factor of pyuria and large voiding volume is a
risk factor of a positive urine culture in
patients with benign prostate hyperplasia/
lower urinary tract symptoms.
UP-1.22
Differential diagnosis of lower
urinary tract symptoms in elderly
men: a 7-year retrospective analysis of
symptoms and urodynamics
Park J1, Kim D1, Cho W2, Kim C3,
Chung H4
1
Daegu Catholic University Medical Center, Daegu; 2Dong-A University Hospital,
Busan; 3Kaemyung University Dongsan
Hospital, Daegu; 4Youngnam University
Hospital, Daegu, South Korea
Introduction and Objective: The cause
and pathogenesis of lower urinary tract
symptoms (LUTS) in elderly men is unclear. We analyzed the clinical and urodynamic findings in elderly men with LUTS
to search for accurate diagnosis and effective treatments.
Materials and Methods: We performed a
retrospective chart review of 154 male
patients older than 65 years old with
LUTS who underwent urodynamic studies
between January 2002 and December
2008. The patients were divided into irritative and obstructive symptom groups
according to their chief complaints. The
urodynamic findings between two groups
were compared. The prevalence of detrusor dysfunction (either detrusor underactivity; DU or detrusor overactivity; DO)
according to various clinical factors (age,
history of urinary retention, presence of
an indwelling urethral catheter, neurologic disease, or diabetes) was estimated.
Results: The mean age of men was
70.8⫾4.5 years. On urodynamics, detrusor
dysfunction was detected in 116 of 154
patients (75.4%) (DO: 46.1%, DU: 50.6%,
DO⫹DU: 21.4%). 67(43.5%) showed BOO.
Twenty-four (15.6%) patients showed
DU⫹BOO and 18(11.7%) showed
S59
DO⫹BOO, respectively. Irritative symptom group showed more DO comparing
obstructive symptom group (p⬍0.01).
The prevalence of DU was significantly
greater in the presence of history of acute
urinary retention and an indwelling urethral catheter (p⬍0.05).
Conclusions: Our data has showed high
percentage of detrusor dysfunction, especially DU, in elderly men with LUTS. This
result re-confirms that urodynamic study
would play a role in establishing a correct
diagnosis and treatment plan in elderly
patients with LUTS.
UP-1.23
Evaluation of lower urinary tract
symptoms in men with type II
decompression sickness
Patris E1, Patris V2, Efthimiou I1,
Kalaitzis C1, Giannopoulos S1,
Giannakopoulos S1, Touloupidis S1
1
Dept. of Urology, University Hospital of
Thrace, Alexandroupolis; 2Medical Hyperbaric Center, General Hospital of Kalymnos, Kalymnos, Greece
Introduction and Objective: Type II
decompression sickness (DCS) is characterized, among other manifestations, by
nervous system involvement. Aim of the
study was to assess lower urinary tract
symptoms (LUTS) in these patients.
Materials and Methods: We studied 9
sponge divers (mean age 53.22⫾17.8
years) with Type II DCS 2-46 years ago
(range 16.9⫾18.6). Maximum diving
depth was 37-65m (range: 51,1⫾10.2 m).
Diving mode was with compressed atmospheric air supplied from the surface
through a long umbilical. Bottom time
was four hours, twice a day. All the cases
had delayed hyperbaric treatment. Assessment was with the I-PSSE questionnaire
and urodynamic studies using Dantec UD
5500 equipment.
Results: All the patients had neurologic
deficits. Four and five patients had paraparesis and paraplegia respectively. One patient was on chronic indwelling catheter
and two were on intermittent self-catheterization. The I-PSS score was recorded
in the rest 6 patients and was 14-25
(20.9⫾3.5). Filling symptoms were most
marked than emptying ones but without
statistic significance.The Quality of Life
score was 2-4, with 4 in 9 feeling disappointed due to urinary bladder problems.Urodynamic study was carried out in
four patients. Neurogenic detrusor overactivity was diagnosed in three cases and in
one case detrusor-sphincter dyssynergia.
S60
Conclusion: LUTS and neurogenic bladder dysfunction are frequent problems in
Type II DCS due to different modes of
nervous system involvement. Early recompression and urodynamic control after the
phase of spinal shock assist in the assessment of bladder dysfunction and should
be a fundamental part of management of
such cases.
UP-1.24
Relationship between clinical
outcome of photoselective
vaporization prostatectomy and
pressure flow study
Seo Y1, Kisik S1, Jeongmoon H1,
Cheolsoo Y2
1
Veterans Hospital; 2Hanseo Hospital,
Busan, South Korea
Introduction and Objective: To determine a formula for predicting the outcome of photoselective vaporization prostatectomy using pressure flow study (PFS)
and compare the predictive value of the
maximum flow rate (Qmax) and ultrasound determination of residual urine
volume.
Materials and Methods: The clinical
records of 105 men with lower urinary
tract symptoms who underwent a photoselective vaporization prostatectomy(PVP) between September 2007 and
September 2009 were retrospectively
analysed. Preoperative urodynamic studies were performed with undelling 8 Fr
suprapubic catheter. The results of the
pressure-flow study (PFS) were divided
into two groups: obstructed and unobstructed, using an ICS nomogram, pQ
slope or the minimal urethral opening
pressure. Other preoperative studies
were done like uroflowmetry for Qmax,
sonographic measurement of post void
residual urine volume and prostate volume. The results of PFSs were not considered to decide operation. The success
was defined as Qmax above 15 ml/s or a
50% reduction in IPSS.
Results: Eighty-one cases (77.1%) were
obstructed and 24 (22.9%) were unobstructed. The success rates of the PVP for
the obstructed and unobstructed were
88.9% and 54.2 (over all success rates
80.9%) respectively. The success rate of
obstructed group was significently higher.
The sensitivity and specificity of the PFS
were 84.7 and 51.0%, respectively. Obstructed patients‘ significiently lower IPSS
and postvoid residual urine volume at the
same point compared with unobstructed
patients. We constructed receiver operating characteristics (ROC) curves using
various threshold values for Qmax, residual urine and prostate volume. We selected a cut-off value for Qmax 10 or less
ml/s residual urine volume less than 50ml
and prostate volume of 30 gm. or greater
for predictor of success. The sensitivity of
the maximal flow rate (⬍ or ⫽10ml/sec)
was 81.7%, and the specificity of the prostate volume (⬎ or ⫽30gm) was 47.3%.
Conclusions: Preoperative urodynamic
study is not a mandatory preoperative
technique for patient undergoing PVP.
However, it can decrease the PVP failure rate by patient selection and preand postoperative counseling. Other
non-invasive parameters like Qmax, residual urine, prostate volume can be
preoperatively useful for men planning
PVP, as long as they are applied compositely carefully.
UP-1.25
Urodynamic alterations of patients
with varying degrees of cystocele
Lee J1, Shin D1, Lee W1, Bang S2, Lee J3,
Park B4, Park C1, Park S2
1
Pusan National University Hospital,
Busan; 2Pusan National University
Yangsan Hospital, Yangsan; 3Busan St.
Mary’s Hospital, Busan; 4Wallace Memorial Baptist Hospital, Busan, South Korea
was aimed at evaluating and comparing
the bladder function of patients with varying degrees of cystocele according to urodynamic study.
Materials and Methods: Sixty-five
women with cystocele who underwent
urodynamic study between August 2002
and February 2008 were included in this
study. To assess whether result was influenced by the grade of cystocele, the patients were classified into four groups according to pelvic organ prolapse
quantification (POPQ) of the International
Continence Society (ICS). The patients
were evaluated with history taking, a
physical examination and urodynamic
Table 1, UP-1.25. Patient characteristics
Grade I (nⴝ7)
Grade II (nⴝ33)
Age (years)
59.7⫾3.2
58.0⫾9.1
BMI (kg/m2)
23.1⫾5.4
22.9⫾7.3
Delivery (No.)
3.4⫾1.0
2.8⫾0.9
Grade III (nⴝ18)
62.0⫾9.4
23.2⫾5.5
3.2⫾1.3
Grade IV (nⴝ7)
61.6⫾8.2
23.4⫾6.2
3.7⫾0.8
Table 2, UP-1.25. Uroflowmetry and cystometric parameters
Grade I
Grade II
Bladder capacity (ml)
448.7⫾125.1
418.9⫾149.0
Max Pdet (cmH2O)
33.7⫾20.6
37.7⫾21.0
Qmax (ml/s)
25.1⫾15.9
21.0⫾9.5
PVR (ml)
18.6⫾23.6
35.4⫾26.1
Grade III
448.4⫾202.7
32.4⫾14.5
20.6⫾11.4
43.7⫾34.7
Grade IV
410.1⫾55.8
42.7⫾7.6
18.8⫾7.3
58.6⫾25.4
Table 3, UP-1.25. Comparisons of data according to urodynamic findings
p-value
Bladder capacity (ml)
Max Pdet (cmH2O)
Qmax (ml/s)
PVR (ml)
G I vs G II G I vs G III G I vs G IV G II vs G III G II vs G IV G III vs G IV
0.319
0.809
0.249
0.636
0.735
0.856
0.454
0.952
0.179
0.629
0.233
0.154
0.643
0.716
0.442
0.595
0.545
0.880
0.033
0.033
0.010
0.482
0.032
0.224
study. By urodynamic study, we measured
bladder capacity, maximum detrusor pressure (Max Pdet), maximum flow rate
(Qmax), postvoiding residual volume
(PVR). Statistical analysis was conducted
using Mann-Whitney U test and the p values ⬍ 0.05 were considered significant.
Results: See Tables 1-3.
Conclusions: There are no significant
differences in cystocele severity with respect to bladder capacity, Max Pdet and
Qmax. However, PVR tend to increase
significantly with an increase in cystocele
severity.
UP-1.26
The role of alpha 1(A) Adrenoceptor
antagonist tamsulosin for the treatment
of patients with lower urinary tract
symptoms in women: the effect of
nocturia and sleep quality
Ryu SB, Kim S, Hwang E, Im C, Oh K,
Jung S, Kang T, Kwon D, Park K
Dept. of Urology, Chonnam National
University Medical School, Gwangju,
South Korea
Introduction and Objective: Nocturia is
considered to be the main cause of disturbance of sleep maintenance and the quality of life. We assessed the effectiveness
of administering alpha 1(A)-adrenoceptor
antagonist tamsulosin for the female patients with lower urinary tract symptoms
with nocturia on quality of sleep.
2008 to December 2008, 350 patients
with lower urinary tract symptoms (maximal flow rate ⱕ15ml/s, IPSSⱖ8, predominant voiding symptoms) were prospectively selected for this study. Study was
conducted among respondents with nocturia (void/nightⱖ1) (n⫽296), with participants completing a questionnaire on Medical Outcomes Study (MOS) sleep scale.
The effectiveness of tamsulosin was as-
sessed by analyzing the International Proatatic Symptom Score (IPSS), the bother
score, the Qmax, and postvoid residual
urine. The data for these parameters were
acquired at baseline and after 4 weeks of
treatment.
Results: The patient population had a mean
age of 58.3 years. In the patients, the mean
number of voids per night was 2.66⫾1.3,
the IPSS total/bother score were 15.2⫾8.9
and 3.4⫾1.2, respectively. The clinical parameters, including the IPSS, the bother
score, the Qmax and the residual urine
showed significantly improved from the
baseline. The change of nocturnal frequency was 1.12. For the sleep quality, the
sleep problem index was significantly decreased. Among the MOS sleep scale, the
subcaterogies of sleep disturbance, somnolence and sleep adequacy were significantly
changed (p⬍0.05).
Conclusions: Alpha 1(A)-adrenoceptor
antagonist, tamsulosin, significantly improved sleep quality and nocturia as well
as voiding symptoms in women with low
maximal flow rate, which was confirmed
by measuring the clinical parameters and
sleep-related questionnaire.
UP-1.27
TRUS assisted transurethral incision
of ejaculatory ducts (TUIED): a novel
technique
Veeramoni M, Mishra S, Kurien A,
Ganpule A, Sabnis R, Desai M
Muljibhai Patel Urological Hospital,
Nadiad, India
Introduction and Objective: Ejaculatory
duct obstruction (EJDO) has been traditionally managed with transurethral resection of
ejaculatory ducts (TURED). However, wide
resection can lead to reflux of urine with
epididymitis. We demonstrate a novel technique: transrectal ultrasound [TRUS] assisted
transurethral incision of ejaculatory duct
(TUIED) that avoids these problems.
Materials and Methods: Patients included
for this procedure (TUIED) were those with
azoospermia (n⫽8), severe oligospermia
with ejaculatory duct obstruction (n⫽2) and
5 patients with hematospermia. TRUS was
done using high resolution 7.5 MHz biplanar probe in the left lateral position. All
patients were subjected to seminal vesical
aspiration which was subjected to microscopic evaluation followed by seminal vesiculography using methylene blue mixed
with contrast under USG guidance and
fluoro monitoring. After confirming the obstruction, the patient was given general anesthesia and placed in the dorsal lithotomy
position for the definitive procedure. Incision was made with 3 Fr Hook electrode
over the ejaculatory ducts till the obstruction was relieved as evident by free flow of
methylene blue. Foley catheter was kept for
24 hours. Semen analysis was repeated at 3
months.
Results: All 5 patients with hematospermia
had complete remission of symptoms. In
the infertility group, at 3 months the mean
sperm count increased from 2.5 (range
0-20) million/ml to 21.5 (range 1-40) million/ml. Semen volume increased from a
mean of 0.8ml to 2.5ml. At 1 year, 33% patients achieved conception. No patient had
retrograde ejaculation or incontinence.
Conclusion: TRUS-assisted TUIED is a
viable option for EJDO, and is minimally
invasive and carries low morbidity.
UP-1.28
Additive tolterodine for elderly male
LUTS in Taiwan
Kuo H, Chung S, Wu W
Buddhist Tzu Chi General, Taipei,
Taiwan
Introduction and Objectives: To determine the efficacy and safety of toterodine
extended release (ER) treatment for 1 year
in older men with benign prostatic hyperplasia (BPH) and storage symptoms
treated with alpha-blockers and/or 5-alpha-reductase inhibitors (5ARI).
Materials and Methods: Men aged over
70 years with BPH/ bladder outlet obstruction (BOO) and clinical storage symptoms were randomly treated with or without tolterodine ER in combination with
alpha-blockers and/or 5ARI for 12 months.
Among them, 50 patients (group 1) received additive tolterodine extended release (ER) 4mg q.d., and another 87 patients (group 2) did not. All patients had a
baseline and 12th month post-treatment
evaluation, which comprised of uroflowmetry, post-void residual (PVR) volume,
S61
International Prostate Symptom Score
(IPSS), and quality of life index (QoL-I),
transrectal ultrasound of the prostate and
serum prostate specific antigen.
Results: Of 153 enrolled patients, 137
with a mean age of 74.9 years completed
the study. Treatment benefit demonstrated
in both groups included deceased total,
voiding and storage IPSS scores, increased
peak urinary flow rate and deceased
QoL-I. Inter-group difference was only
observed on the storage domain of IPSS
score (p⫽0.012). The mean PVR after
treatment did not significantly differ between two groups. Two patients of group
1 and three of group 2 developed acute
urinary retention. Among group 1, six patients discontinued tolterodine ER for intolerable dry mouth; among group 2,
three patients reported dizziness.
Conclusions: This longer comparative
study indicated that additive treatment with
tolterodine ER in older men with BPH/BOO
and significant storage symptoms is a beneficial and safe therapeutic option.
UP-1.29
GreenLight HPS laser photoselective
vaporisation prostatectomy in a
district General Hospital
Alnajjar H, Bondad J, Magrill D,
Gordon S, Le Roux P
Epsom & St Helier University Hospitals
NHS Trust, London, UK
Introduction and Objective: In March
2008 we introduced GreenLight photoselective vaporisation prostatectomy (PVP)
as an option for patients with benign
prostatic hyperplasia requiring surgery,
including large prostates and patients in
urinary retention. As part of our clinical
governance all patients undergoing PVP
are entered into a prospective audit measuring both validated Patient Outcome
Measurements (POMs) and objective data.
Materials and Methods: All patients
electing to undergo PVP were included
(122 to date). Pre- and post-operative
IPSS, AUA – QoL score, maximum flow
rate (Qmax) and post-void residual volume (PVR) were recorded. Peri-operative
data collection included lasing time, energy delivered, duration of catheterisation
and inpatient stay.
Results: The mean age was 71 (44-89).
Mean pre-operative Qmax was 9.0 ml/sec
(1.8-29.6), PVR 268mls (0-2000), AUA QoL
4.4 and IPSS 23. Mean applied energy was
139,000J with mean lasing time 25 minutes. Mean length of stay was 1.4 days.
Eighty-one percent of patients were discharged catheter free on the first post
operative day. Of the 19 patients admitted
S62
with a catheter, 11 were discharged catheter-free. The mean post-operative Qmax
was 16.0 ml/sec, PVR 99.0 mls, AUA QoL
1.5 and a mean IPSS of 7.3. The mean improvement in IPSS was 15. There were no
major complications. Twenty of 122 patients complained of transient irritative
LUTS or had microbiologically proven
UTIs.
Conclusions: We found PVP with the
GreenLight HPS a safe and effective treatment for BPH, with a short hospital stay,
good short-term functional results and
patient recorded outcomes, and a low
incidence of peri-operative complications.
UP-1.30
Comparison of clinical outcome
between benign prostatic hyperplasia
patients with and without extension of
the prostate into urinary bladder after
transurethral resection of prostate
Chen S
Taipei City Hospital Renai Branch, National Yang-Ming University, Taipei,
Taiwan
Introduction and Objective: The influence of enlargement of prostate with extension into urinary bladder (UB) on clinical outcome for patients with benign
prostatic hyperplasia (BPH) after transurethral resection of prostate (TURP) remains
unclear. In order to compare the clinical
outcome between BPH patients with and
without extension of prostate into UB after TURP, we made a prospective study.
Materials and Methods: Between April
2004 and May 2009, 82 men (mean age
68.5 years, range 52-83) with symptomatic
BPH were included for evaluation. The
American Urological Association (AUA)
symptom score, maximal flow rate
(Qmax) and mean flow rate (Qave) were
done before and 12 weeks after TURP.
The 82 patients were divided into two
groups: group A (40 patients without extension of prostate into UB) and group B
(42 patients with extension of prostate
into UB). The total prostate volume and
the volume of prostate with extension
into UB (PVUB) were measured by transrectal ultrasonography (TRUS). The clinical
outcome was evaluated by the difference
(⌬) in AUA symptom score, Qmax and
Qave before and 12 weeks after surgery.
Results: There was a close correlation
between the estimated prostate weight
and the actual weight of the TURP specimen (r ⫽ 0.83 and 0.81 in group A, and
r ⫽ 0.75 and 0.62 in group B for adenoma
and total prostate, respectively), and the
correlation was higher in patients of
group A than those of group B. The
⌬AUA, ⌬Qmax and ⌬␮Qave were 11.7 ⫾
4.9, 9.2 ⫾ 4.5 ml/sec, and 6.4 ⫾ 2.9 ml/
sec in group A, and 9.1 ⫾ 3.2, 7.0 ⫾ 3.1
ml/sec, and 4.0 ⫾ 1.6 ml/sec in group B,
respectively. The improvement after TURP
was more significant in patients of group
A than those of group B. Furthermore,
there was a significant negative correlation between PVUB and ⌬AUA, ⌬Qmax
and ⌬␮Qave (r ⫽ ⫺0.72, ⫺0.81, and
⫺0.71, respectively, p⬍0.05).
Conclusions: TRUS is a useful tool for
estimating prostate weight before TURP.
Patients without extension of prostate
into UB had better clinical outcome than
those with extension of prostate into UB
after TURP. Besides, patients with lower
PVUB had better surgical outcome than
those with higher PVUB.
UP-1.31
Factors that Contribute to improve
Qmax after transurethral resection of
the prostate
Cho IR1, Lee AG1, Cho SY1, Chung JY2
Dept. of Urology, 1Inje University Ilsanpaik Hospital, Koyang; 2Inje University
Sanggyepaik Hospital, Koyang, South
Korea
Introduction and Objective: We investigated which factors contribute to improve
the maximum flow rate (Qmax) after releasing bladder outlet obstruction (BOO)
by transurethral resection of prostate
(TURP) in clinically diagnosed benign
prostatic hyperplasia (BPH) patients who
have both BOO and lower urinary tract
symptom (LUTS).
Materials and Methods: Among 301 patients who had a transurethral resection of
prostate because of LUTS, we carried out
the investigation with 58 patients who
were excluded from the group of patients
diagnosed with urethral stricture, neurogenic bladder or prostate cancer. We investigated retrospectively in detail about
the patients such as age, preoperative
prostate volume, postoperative prostate
volume, resection volume, resection ratio,
preoperative prostate specific antigen
(PSA), preoperative Qmax and residual
urine volume, International Prostate Symptom Score (IPSS). After the operation, we
divided them in two group based on
Qmax 15ml/s and analyzed which factors
have statistically significant difference between two groups.
Results: As the analysis with comparing
the factors before and after the operation
based on Qmax 15ml/s, there was a significant difference statistically in the total
score of IPSS (p⫽0.02) and the total score
of the item that reflect storage symptom
(p⫽0.019). But there was no significant
difference in any other factors.
Conclusion: The relation that Qmax has
with the storage symptom score when
BOO is eliminated with TURP, shows that
the items of storage score of IPSS before
operation can be the factors that can estimate the bladder dysfunction before the
operation. Therefore, it should be evaluated about the function of the bladder by
urodynamic study in cases that we are
planning to TURP for patients with high
storage score before the operation.
UP-1.32
Predictors of successful cessation of
alpha-blockers in patients with
benign prostatic hyperplasia/lower
urinary tract symptoms: a pilot study
Cho K1, Lee S2, Park S3, Kim D4, Yoo T2
Depts. of Urology, 1Yonsei University College of Medicine, Urological Science Institute, Wonju; 2Eulji University School of
Medicine, Daejeon; 3Hanyang University
College of Medicine, Seoul; 4Kwandong
University College of Medicine, Goyang,
South Korea
Introduction and Objective: There is a
lack of prospective data on voiding symptoms of benign prostatic hyperplasia/
lower urinary tract symptom (BPH/LUTS)
patients after cessation of alpha-blockers.
We aimed to analyze parameters influencing successful cessation of alpha-blockers
in those with BPH/LUTS.
first-visit BPH/LUTS patients with mild to
moderate symptoms were enrolled in this
prospective study. Patients were evaluated
with digital rectal examination, International Prostate Symptoms Score (IPSS),
prostate specific antigen, uroflowmetry,
post-void residual urine measurement, and
prostate volume using transrectal ultrasonography. After a 12 week-period of
alpha-blocker medication, cessation of
alpha-blocker was tried in patients with
IPSS improvement of 2 or greater, Qmax
over 12 mL/sec, and PVR of less than 50
mL. After 4, 8, and 12 weeks after medication cessation patients were surveyed
upon re-treatment. Patients were advised
to re-start medication during each visit
according to PVR over 50 mL or patient’s
willingness.
Results: Sixty-nine patients (71.1 %) completed a 12 week-period of ␣-blockers
treatment. Among them, 28 (41%) were
able to discontinue medication. A follow-up period of 12 weeks after alphablocker discontinuation was possible in
23 patients. Among 23 patients, 10 (43%)
needed re-administration (unsuccessful
cessation group). The other 13 (57%) patients remained in satisfactory voiding
symptoms without medication (successful
cessation group). The IPSS of the successful cessation group at first visit, the end of
treatment, 4, 8, and 12 weeks after cessation was 9.9, 6.5, 8.2, 8.5, and 9.2, respectively. The Qmax of each corresponding period was 10.3, 13.9, 14.2, 14.1, and
13.3 mL/sec, respectively. Parameters including prostate volume, IPPS before cessation, and Qmax at the first visit showed
statistically significant differences between
the two groups (p⬍0.05).
Conclusions: BPH/LUTS patients with
relatively small prostate volumes and favorable Qmax before treatment would be
able to continuously cease medication
after symptom improvement. A large and
long-term follow-up study is needed to
confirm our findings.
UP-1.33
Could elevated prostate-specific
antigen be a useful marker for
bladder outlet obstruction?
Choi S, Chung J
Dept. of Urology, Kosin University College of Medicine, Busan, South Korea
Introduction and Objectives: Deciding
on strategy for patients with elevated
prostate-specific antigen (PSA) levels, unsuspicious digital rectal examination and
TRUS, and multiple negative extended
prostate biopsies is dilemma for urologists. We investigated the changes of PSA
level and voiding parameters after TURP
in these patients with urodynamic proven
bladder outlet obstruction (BOO).
Material and Methods: We retrospectively included 50 patients (Jan. 2003 Jun. 2009) aged 56-85 years, with LUTS,
elevated PSA (⭌4ng/ml), and no signs of
prostate cancer (PCa) after (multiple) negative extended prostate biopsies who underwent TURP after they were diagnosed
by urodynamics with BOO. We evaluated
the clinical benefit of TURP by assessing
its effect on PSA, IPSS, peak flow rate
(Qmax) and histologic examination of the
resected tissue, and evaluated the correlation of elevated PSA with BOO parameters
(ICS & Schäfer nomograms).
Results: After TURP, histologic analysis of
the resected specimen revealed that 4
(8.0%) patients had PCa. The remaining
46 (92.0%) patients were diagnosed with
BOO due to BPH. In this group the mean
PSA level decreased from 12.5 ng/ml (4.242.2) before TURP to 3.2 ng/ml (1.2-5.2)
in the 3rd month, and 1.9 ng/ml (0.4-5.1)
in the first year after TURP. The mean
IPSS decreased from 17.6 (7-20) before
TURP and 6.1 (0-14) in the first year after
TURP. The mean Qmax increased 7.4ml/s
(5-12) before TURP and 22.7ml/s (13-29)
in the first year after TURP. Elevated PSA
showed significant correlation with urodynamic BOO parameters (ICS & Schäfer
nomograms, p⫽0.0001 & p⫽0.005, respectively, in ANOVA test).
Conclusions: The patients with elevated
PSA without evidence of PCa showed significant correlation with BOO, and may
benefit from TURP.
UP-1.34
Changes in lower urinary tract
symptoms after cryosurgical ablation
for prostate cancer
Choi S, Chung J
Dept. of Urology, Kosin University College of Medicine, Busan, South Korea
Introduction and Objectives: The primary objective of this study was to evaluate the impact of cryosurgery on lower
urinary tract symptoms (LUTS) in patients
with clinically localized prostate cancer.
Material and Methods: Between November 2006 and January 2010, 47 men with
clinically localized prostate cancer underwent cryosurgery (including 6 cases of
nerve sparing procedures). A brachytherapy template, 17 gauge cryoneedles and
the SeedNet Gold system (Galil Medical,
Westbury, NY, USA) were used for cryosurgery. The International Prostate Symptom Score (IPSS) and the IPSS quality of
life (QoL) score, and uroflowmetry were
administered both prior to and 3 months
after cryosurgery.
Results: The overall mean maximal flow
rate, postvoid residual volume, mean total
IPSS and IPSS QoL improved over time
after cryosurgery. The mean maximal flow
rate changed from 11.4⫾5.2mL/s to
22.1⫾9.9mL/s (p⬍0.05) after cryosurgery.
The residual urine volume changed from
33.1⫾9.6mL to 8.3ml⫾5.0mL (p⬍0.05)
after cryosurgery. Total IPSS also changed
from 19.2⫾2.7 to 10.8⫾3.4 (p⬍0.05) after cryosurgery. IPSS QoL score changed
from 3.6⫾0.5 to 2.2⫾0.7 (p⬍0.05) after
cryosurgery.
Conclusions: Cryosurgery showed to
improve uroflowmetric parameters, including maximal flow rate, postvoid residual urine, and IPSS (including IPSS QoL
score) in cases of LUTS as well as definite
treatment for prostate cancer.
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UP-1.35
An analysis of the factors of bladder
irritation symptoms after
transurethral resection of the prostate
(TURP)
Chung H, Song J, Kim S, Kim K, Jung J
Yonsei University Wonju College of Medicine, Wonju City, South Korea
Introduction and Objective: Approximately 30 percent of patients with benign
prostatic hyperplasia (BPH) require medication or supplementary treatment for
symptoms of continuous bladder irritation
after transurethral prostatic resection.
Hence the purpose of this study was to
identify any factors related to onset of
symptoms and to predict patient selection
and post operative results.
Materials and Methods: Of all patients
who underwent TURP from January 2006
to June 2008, 160 patients who received
long-term follow up were selected. IPSS
were assessed 12 months after surgery in
all patients and were divided into two
groups: One group consisting of patients
with bladder irritation symptoms of less
than 7 (total 15) and another group with
greater than 8 (irritative symptom group).
Pre-operative microscopic urine analysis,
urodynamic study, pre-operative and postoperative IPSS, flow rate and differences
in prostate shape on transrectal prostatic
ultrasonography(TRUS) were analyzed in
both groups.
Results: Of the total 160 patients, 93 patients were classified as the non-irritative
group and 67 as the irritative group. No
significant difference was seen between
the two groups in age, initial symptoms,
prostate size, and amount of prostate removed. Pre-operative IPSS was significantly higher in the irritative group
(24.96⫾7.7) compared to the non-irritative group (21.26⫾7.1). In particular, the
bladder irritation symptom exhibited a
statistically significant different between
the two groups (8.69⫾3.6 vs 10.55⫾3.4).
Also, retrourethral hyperplasia of the prostate observed on TRUS was more frequently seen in the irratative group. Symptoms of urinary frequency, incontinence
and urgency were significantly greater in
the irritative group. While no significant
difference of pre-operative quality of life
was seen between the two groups, postoperative quality of life was significantly
impaired in the irritative group (1.95⫾1.2
vs 3.49⫾1.6).
Conclusions: The shape of the prostate
and the preoperative irritation score correlated significantly with the postoperative severity of bladder irritative symptoms. Therefore, physicians should be
S64
cautious when performing TURP in patients with retrourethral hyperplasia
of the prostate and severe irritative
symptoms.
UP-1.36
Definitive assessment of early postoperative symptoms after laser
photovaporization of the prostate
(PVP): validation of a dedicated
questionnaire
Cornu J, Terrasa J, Tligui M, Sèbe P,
Peyrat L, Ciofu C, Traxer O, Cussenot O,
Haab F, Lukacs B
Tenon Hospital, Paris, France
Introduction and Objective: Reported
rate of early post-operative low urinary
tract symptoms (LUTS) after laser prostatectomy vary between 2.4% and 10%.
However, these symptoms are always estimated through post-operative international prostate symptom score (IPSS),
which is not dedicated to this issue, introducing flaws in published data. Early LUTS
and bother after laser prostatectomy may
therefore be underestimated, leading to a
default of quality of care in the first postoperative month. To accurately assess
bothersome symptoms after PVP, we created and prospectively evaluated a dedicated “one-month questionnaire”.
Materials and Methods: Fifty-seven patients aged of 69⫾8 years (49-88) underwent PVP with the 120W-GreenLight KTP
laser for LUTS/BPH resistant to medical
management or acute urinary retention.
Mean pre-operative IPS-S was 21.8⫾7 (635), and mean prostate volume was
64⫾28 mL (18-160). Fifteen patients were
receiving oral anticoagulation therapy at
the time of surgery. Each patient filled a
one-month questionnaire grading the following symptoms: pain while voiding,
blood in urine, urgencies, involuntary loss
of urine, subjective urinary flow strength.
Intra and perioperative complications
were prospectively collected.
Results: Mean hospital stay was 2.2 days
⫾0.5 (2-4) and 52/57 patients were catheterized for 24 hours. Subjective urine flow
strength was improved in 90% of cases
and objective maximum flow rate increased after surgery from 8.9⫾4.4 (2-23)
to 19⫾7 (5-34), p⬍ 0.0001. A one-month
questionnaire was available for all patients. Results show that patients complained about bothersome/intense pain
during voiding (45%), haematuria with
clots (20%), bothersome urgency/OAB
symptoms (63%), involuntary loss of urine
(27%). Only 9 out of 57 patients had no
bothersome LUTS according to this
1-month questionnaire. One patient pre-
sented acute urinary retention and one
patient was surgically managed at day 2
for post-operative hemorrhage.
Conclusions: Our work shows short
term-results in line with previous evaluations of PVP in terms of short-term efficacy, intraoperative complication and hospital stay, but with a high incidence of
post-operative LUTS at 1-month dedicated
evaluation. This study shows that immediate troublesome LUTS following PVP are
largely blinded by usual evaluations. Such
a dedicated questionnaire should be helpful to inform patients, and diagnose and
treat these bothersome symptoms to
improve the benefits of laser prostate
therapy.
UP-1.37
Prospective evaluation of
transurethral needle ablation (TUNA)
procedure in an ambulatory setting
Cornu J1, Desgranchamp F2,
De la taille A3, Lukacs B1
1
Tenon Hospital; 2Saint Louis Hospital;
3
Henry Mondor Hospital, Paris, France
the results of transurethral needle ablation
(TUNA) performed in an ambulatory setting in men with lower urinary tract
symptoms (LUTS)/benign prostatic hyperplasia (BPH).
Materials and Methods: Fifty-two patients were enrolled in this prospective,
multi-centre open-label study, and were
treated by TUNA (ProstivaTM device) on
an outpatient basis. Median age was 66,4
years (45-85), and median prostate volume
was 40cc (18-82). Short-term success was
defined by two outcome measures: ability
to leave the hospital on the evening of
the intervention, and absence of rehospitalization due to complications during the
first month after the intervention. Other
endpoints were focused on efficacy (patient satisfaction one month after the intervention, changes in IPSS score, IPSS
QoL score, Qmax and PVR from baseline)
and tolerance (Danish prostate symptom
score, IIEF questionnaire, complications).
Results: The procedure was successful in
44 out of 49 patients. Global patient satisfaction was very high. More than 80% of
patients were (very) satisfied one month
after the intervention, and 87.8% of patients were prepared to undergo the procedure again if needed, independently of
their rehospitalization rate, type of anesthesia and pain/bother experienced during the procedure. All assessed efficacy
and complications parameters (IPSS, IIEF,
Dan-PSS, maximum flow rate) had improved one month after the procedure.
IPSS was improved for both subscores
(voiding and storage symptoms). Sexual
and ejaculatory function was not affected
(or had slightly improved) in the majority
of patients (notably, no cases of retrograde ejaculation was reported). Only five
out of 49 patients had to be rehospitalized
within one month after the intervention
(for acute urinary retention and/or hematuria, and one case of decompensation
inguinal hernia).
Conclusions: Our short-term data show
efficacy results in line with those already
published. Therefore, TUNA can be successfully performed in an ambulatory setting under local and/or general anesthetics with a high level of patient satisfaction
and a low short-term morbidity. Thus, the
procedure is a suitable alternative for
those patients who cannot/do not want to
take medical therapy nor undergo invasive
surgical procedures.
those obtained preoperatively. Complications included hematuria lasting 1 and 3
months (4.2%), transient incontinence
(4.2%), transient dysuria (10.6%), frequency (21.2%), urgency (12.7%) and retrograde ejaculation (51%).
Conclusions: These results demonstrate
that PVP is safe and efficacious for the
treatment of symptomatic BPH. Long follow-up will further validate this new modality as the standard for surgical treatment of BPH.
UP-1.38
Short-term results on efficacy and
safety of high power (80W) KTP
(Potassium-Titanyl-Phosphate) laser
vaporization of the prostate
Kim Y1, Lee J2
1
Jeju National University Medical School,
Jeju; 2Jeju Sunshine Urologic Clinic Center, Jeju, South Korea
Introduction and Objective: We investigated the effect of the intraprostatic urethral length on lower urinary tract symptoms (LUTS) and urinary flow rate in men
without benign prostatic enlargement.
Materials and Methods: Between August
2009 and March 2010, 1235 men with
LUTS aged ⱖ45 years were enrolled. The
patients completed the International Prostate Symptom Score (IPSS), uroflowmetry,
and transrectal ultrasound (TRUS). Voiding symptom score was defined as the
sum of scores for questions 1, 3, 5, and 6
of the IPSS. Bladder storage symptom
score was defined as the sum of scores
for questions 2, 4, and 7 of the IPSS. Intraprostatic urethral length (IUL) was determined by the sum of urethral length from
bladder neck to the verumontanum and
from verumontarum to the apex on the
mid-sagital plane of TRUS. IUL-to-prostate
volume (IULP) ratio was defined as IUL
divided by prostate volume. The relationship between IPSS and IULP ratio was
evaluated. The relationship between urinary flow rate and IULP ratio was also
evaluated.
Results: According to the IPSS, 101 patients with prostate volume less than 25
cm3 were divided into two groups (Group
1: IPSS ⬍8, n⫽42; Group 2: IPSS ⱖ8,
n⫽59). There was no age difference between Group 1 (64.7⫾9.6 years; range,
46-80) and Group 2 (64.7⫾7.5 years;
range, 49-80, p⫽0.964). There was also
no prostate volume difference between
Group 1 (22.1⫾2.1 cm3; range, 15.5-24.9)
and Group 2 (22.1⫾2.3 cm3; range, 14.824.9, p⫽0.986). IULP ratio was significantly longer in Group 2 (0.184⫾0.027)
than Group 1 (0.166⫾0.024, p⫽0.004).
Introduction and Objectives: Transurethral resection of the prostate (TURP) is
the gold standard treatment for symptomatic benign prostate hyperplasia, but significant complications are associated with
this procedure. The aim of this study was
to compare the standard TURP with the
high power (80W) potassium-titanyl-phosphate laser (KTP/532; Greenlights PVTM
laser system; Laserscope, San Jose, USA)
to elucidate the efficacy and safety of laser
treatment.
Materials and Methods: Forty-seven consecutive men with symptomatic BPH underwent PVP with an 80W KTP laser. All
underwent preoperative and postoperative evaluation, including assessments of
international prostate symptom score
(IPSS), quality of life (QOL), peak urinary
flow rate (Qmax), post-void residual volume (PVR), prostate specific antigen
(PSA), and ultrasound prostate volume
(PV). Secondary outcome parameters included surgical time, anesthesia, and
length of catheterization. Follow-up assessment occurred at 3 and 12 months.
Results: Mean age was 68⫾1.1 years.
Mean operative time was 58⫾15.4 minutes. Mean catheterization times were
12.3⫾1.6 hours. All efficacy parameters
were significantly improved compared to
UP-1.39
Long intraprostatic urethral length as
a cause of lower urinary tract
symptoms in patients with prostate
volume less than 25 cm3
Lee S, Park D, Jeon H, Choi D, Gong I
Dept. of Urology, CHA Bundang Medical
Center, CHA University, Seongnam-Si,
South Korea
The correlation between IPSS and IULP
ratio, and between urinary flow rate and
IULP ratio were evaluated including both
Group 1 and 2. IULP ratio positively correlated with voiding symptom score
(r⫽0.229, p⫽0.021), bladder storage
symptom score (r⫽0.158, p⫽0.114), and
total IPSS score (r⫽0.220, p⫽0.027). IULP
ratio negatively correlated with urinary
flow rate (r⫽-0.245, p⫽0.014).
Conclusions: IULP ratio was significantly
longer in LUTS patients with prostate volume less than 25 cm3. IULP ratio positively correlated with IPSS and negatively
correlated with urinary flow rate. The
long IUL for prostate volume could be an
important factor of LUTS in patients without benign prostatic enlargement.
UP-1.40
Short-term results of bladder
hydrodistention for interstitial cystitis
in young adult men
Min S1, Kim S1, Lee S1, Jo M2
Depts. of Urology, 1National Police Hospital, Seoul; 2Korea Cancer Center Hospital, Seoul, South Korea
Introduction and Objective: Interstitial
cystitis (IC) is prevalent in middle-aged
women, characterized by frequency, urgency, nocturia, suprapubic pain and dysuria. We estimated the clinical aspects
and short-term results of hydrodistention
for young male IC patients.
chart review was conducted of 10 patients who had been treated for interstitial
cystitis between March 2002 and March
2009. They were diagnosed with exclusive criteria from National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) group. All of them were normal
in urine analysis, prostatic secretion and
transrectal ultrasonography (TRUS), and
were not improved with anti muscarinic
agents. We performed urodynamic study
(UDS), potassium chloride sensitivity test
(PST) and cystoscopy with hydrodistention under spinal anesthesia.
Results: Symptom durations were less
than 5 years in 4 (40%) patients, between
5-10 years in 3 (30%) and more than 10
years in 3 (30%). PST was positive in 7
(70%) patients. On cystoscopy, glomerulations were noted in all patients and two
(20%) had the Hunner’s ulcer. On bladder
mucosal biopsy, there were mast cells in
3 (30%) specimens. All patients had enlarged both the volume of first voiding
sensation and the maximal capacity of
bladder with statistical significance and
improved symptoms at 1 month after
hydrodistention.
S65
Conclusions: Symptoms of young male
IC patients were not different with general IC symptoms. Even though the results
show short-term effects, simple bladder
hydrodistention would be the effective
treatment modality for them.
UP-1.41
The role of trial without catheter in
the initial management of acute
urinary retention due to benign
prostatic hyperplasia
Cumpanas A1, Botoca M1, Minciu R1,
Fahes M1, Pojoga O2, Daminescu L1,
Bucuras V1, Miclea F1
1
Dept. of Urology, University Hospital,
Victor Babes University of Medicine and
Pharmacy, Timisoara; 2Municipal Clinic
Hospital, Timisoara, Romania
Introduction and Objective: Currently,
there is no consensus on the management
of the first episode of acute urinary retention (AUR) by BPH neither in terms of
duration of catheterization nor regarding
the optimal medical management after
catheterization. The aim of our study was
to evaluate the results of trial without
catheter (TWOC) for the first episode of
AUR by BPH.
Materials and Methods: We prospectively included in the study 80 patients
with AUR by BPH which received alpha
blocker treatment during the catheterization, assessing the following aspects: demographic data, history of BPH, prostatic
size at ultrasound, the drained urinary volume, the length of catheterization and the
success rate at the first attempt.
Results: The results of our study reveals a
success rate of 68.75% (55 cases), being
higher for those with precipitated AUR
than those with spontaneous AUR. The
success rate is higher for precipitated
AUR (20/27patients-74%) than for spontaneous AUR (35/53 cases- 66%), for prostate sizes smaller than 40 cmc (20/24 cases- 83%) than for patients with prostate
larger than 40 cmc (35/56 cases- 62.5%).
At 1 year follow-up, the success rate (defined as the absence of the AUR during
the period) decreased to 40.9 % (18 out
of the 44 patients remained in the study).
For patients with BPH larger than 40 cmc
which successful passed the TWOC, who
were subsequently treated by combined
treatment with tamsulosin⫹dutasteride,
the incidence of secondary AUR within
1-year of treatment was significantly lower
than those treated with alpha blockers.
Conclusions: TWOC can be considered
for patients experiencing the first episode
of AUR due to BPH, with excellent results
S66
in cases of precipitated AUR and prostate
sizes less than 40 cmc.
UP-1.42
The prevalence of benign prostate
hyperplasia in a rural community of
South Korea
Moon H1, Kwon J1, Park S1, Kim Y1,
Park H1, Choi H1, Kim S2, Choi B2,
Lee T1
1
Dept. of Urology; 2Dept. of Preventive
Medicine, Hanyang University, Seoul,
South Korea
Introduction and Objectives: It is considered that the prevalence of benign
prostate hyperplasia (BPH) in Asian men
is lower than that of Caucasian. In Korea,
prevalence of BPH has been increasing
recently. We studied prevalence of BPH
and correlation factors in middle-aged
men inhabitants in rural community of
South Korea.
Materials and Methods: We examined
305 men aged over 40 years old who
dwell in a rural Korean community. A
trained examiner carried out International
Prostrate Symptom Score (IPSS) questionnaire. A urologist performed digital rectal
examination (DRE) and transrectal ultrasonography (TRUS). Prostate specific antigen (PSA) was sampled from all participants. BPH was defined in cases of
IPSS⬎8 and prostate volume exceeding 25
grams on TRUS. We excluded participants
who had palpable nodule on DRE or PSA
higher than 2.5ng/ml. The final study population was comprised of 238 men.
Results: The average prostate volume was
30.9⫾9.91 grams and average PSA value
was 1.08⫾0.56 ng/ml. The overall prevalence of BPH was 17.6% (42/238). The
prevalence of BPH according to the age
was 3.7% (1/27) in men in 40s, 9.0% (6/
67) in 50s, 22.4% (17/76) in 60s, 26.5%
(18/68) over 70s, respectively (p⬍0.05).
IPSS was strongly correlated with quality
of life (age adjusted spearman r⫽0.561,
p⬍0.001). However, PSA and prostate
volume showed no correlation(r⫽-0.015,
p⫽0.8131; r⫽-0.039, p⫽5512). IPSS
showed weak correlation with
PSA(r⫽0.261, p⫽0.0992), but did not
have statistical significance.
Conclusion: The prevalence of BPH and
IPSS severity increased with each age
group in this study. The prevalence of
BPH in rural community of South Korea
was lower than previously reported prevalence in South Korean urban community.
Westernized lifestyle of urban community
may have accounted for these results.
UP-1.43
Penetration depth is key: the optimal
treatment of BPH (Benign Prostatic
Hyperplasia) using multi-disciplinary
laser DIOLAS LFD 3000 for the
photoselective vaporization of the
prostate
Neymeyer J1, Abdul-Wahab Al-Ansari W1,
Abdel-Aziz F2, Gunnemann A3, Beer M1
1
Dept. of Urology & Urogynecology,
Franziskus-Hospital-Berlin; Germany,
Berlin; 2Dept. of Urology, Al-Qasimi-Hospital, Dubai, Sharjah, UAE; 3 Dept. of
Urology, Klinikum-Lippe-Detmold, Detmold, Germany
Introduction and Objective: A topic
that received much attention in recent
months and years regarding the laser treatment of Benign Prostatic Hyperplasia
(BPH) was the issue of penetration depth
into soft tissue. In fact, one has to distinguish between two types of penetration
depths: the area that is effectively vaporized by laser energy, and the region below that is usually referred to as the coagulation zone, or zone of thermal damage.
Understanding the logic behind this discussion begins with the outcome. Patients
treated by laser energy often suffer from
inflammation, swelling and further postoperative problems related to the zone of
thermal damage. Necrosis and remaining
problems for the patient in the mid and
long run have been the symptoms seen.
Our aim for this clinical trial was to understand better the physics and reasons
for such problems, and compare available
laser systems for finding an optimal treatment of BPH.
Materials and Methods: This comparative clinical study included a total of 58
patients (n⫽32 with DIOLAS LFD 3000;
n⫽26 with GreenLight PV) who suffered
from BPH, where 52 patients took bloodthinning drugs. Various important indicators of the pre-, intra- and postoperative
settings were evaluated during and after
treatment for comparison with the 80 W
GreenLight PV laser system. Consequently, all patients were evaluated regarding IPSS, QoL, PSA, maximal flow rate
(Qmax) and post-voiding residual volume
(Vres). Strong attention was given to the
penetration depth to be understood as the
zone of thermal damage below the tissue
vaporized. For analyzing the conditions
after treatment, various TURP resections
were taken from both groups of patients
immediately after the laser procedure. Furthermore, modern ultrasound technology
(B&K) was used before, immediately after,
and in various follow-up sessions, to examine the tissue conditions.
Results: While complying with all typical
advantages of the laser treatment of BPH,
the group of patients treated with LFD
3000 showed less typical complications
during the first week after treatment such
as residual urine, inflammations and pain
than the group of PVP patients. Further
positive aspects of the DIOLAS LFD 3000
are installation requirements (no high voltage, no external water supply), conditions
during treatment (vaporization efficacy,
free sight, coagulation effect, etc.) and
general comfort for the surgeon (no optical filters needed, handling). More importantly, preliminary results confirm that
there seems to be a clear correlation between the zone of thermal damage and
important factors of the patient outcome.
In particular, we have seen effects on the
likeliness of inflammation, swelling and
necrosis that occurred much less using
the LFD Therapy with its coagulation
zone depth of about 1 mm.
Conclusions: The DIOLAS laser using the
newly developed LFD 3000 mode for
reaching a minimum penetration depth at
excellent coagulation has shown significant improvements in comparison to established systems such as the 80 W PVP.
The outcome of the treatments has shown
convincing results that are supported by
mid- and long-term indicators. To conclude, it can be said that the DIOLAS LFD
3000 has proven effective in daily clinical
use and implies better handling at lower
costs. The minimal zone of thermal damage using the LFD Therapy seems to
have a direct impact on patient outcome,
as we have seen much less post-operative complications as known from other
devices.
UP-1.44
Laser vaporization for the treatment
of BPH: prospective study with an
eighteen-month follow-up
Nouri A, N’Guebou F, Makhoul B,
Bassard S, Fourcade R
Service d’Urologie Centre Hospitalier
d’Auxerre, Auxerre, France
Introduction and Objective: Selective
photo vaporization with the 80-Watts KTP
laser for the treatment of BPH is gaining
Table 1, UP-1.44
J-1
IPSS
20.3
QoL
4.3
Q Max
7.5
IIEF
10.5
M1
9.5
2.1
19
11
M3
7
1.8
20.1
10.3
interest in many countries. Short-term outcomes appear promising. However, longterm data are scarce. We report our experience with 18-month follow-up.
Materials and Methods: This is a monocentric prospective study including patients
treated with the 80 W KTP laser from February 2006 to February 2009. Indications for
Laser treatment were identical to those for
TURP e.g. bothering symptoms with middlesized prostate volume. IPSS, uroflow and
complications were monitored at baseline,
1, 3, 6, 9, 12, and 18 Months.
Results: Ninety-three consecutive patients
have been included with a mean age of
71 (range 50-90 years– old). Mean preoperative prostate volume was 55 ml (20130) and mean PSA was 5.24 (0.4-21.4).
Prostate biopsies were done if patient was
at suspicion for cancer and prone to have
a treatment change in case of positive biopsy. Forty-five patients had coagulation
disorders, 26 with anti platelet treatment,
17 with coumadin analogues and 2 with
idiopathic thrombopenia. No treatment
was stopped peri-operatively. Mean operative time was 42⫾ 15 minutes for a mean
application of 188 kJ (80-270 kJ). Two
patients had their operation converted
into TURP. A 20 F Foley catheter was inserted and only two patients needed
post-op irrigation. No transfusion was required. Functional results are summarized
in the table.
Antegrade ejaculation was observed in
48% of the patients who had an active
sexual life. Two patients were re-operated
for insufficient “lasing” at the beginning of
our experience and two other required a
bladder neck incision for bladder neck
fibrosis.
Conclusion: Photovaporization with
the 80-Watts KTP laser appears as a safe
alternative to TURP, with comparable
functional results. Its hemostatic properties allow treating anti-coagulated patients without modifying their treatment, which is a great advantage in this
aged and sometimes fragile population.
Mid-term results are encouraging. Provided they are durable, laser vaporization could become a standard for the
treatment of BPH
M6
5
1.5
22
11.4
M9
5
1
23.6
9
M12
4.3
1.3
23
8.4
M18
4.1
0.7
23.1
N/A
UP-1.45
Efficacy of TURP for the treatment of
BPH in patients with diabetes mellitus
Papadopoulos G, Karyotis I, Volanis D,
Ploumidis A, Garaganis G, Serafetinides E,
Delakas D
Dept. Of Urology, Asklipieio General Hospital, Voula, Athens, Greece
Introduction and Objective: Diabetes
mellitus (DM) has been associated with
lower urinary tract pathologies, mainly
decreased bladder contractility and
chronic retention. The combination of
diabetic cystopathy and bladder outlet
obstruction aggravates bladder dysfunction. In the current study we present the
outcome of transurethral prostate resection (TURP) in patients with postvoid residual (PVR) urine volume ⱖ 300ml in
diabetic and non-diabetic individuals.
Materials and Methods: During the period 2006-2010, 19 patients with DM (group
A, mean age: 69 years) were diagnosed with
chronic retention [mean PVR: 621 (3702700)ml]. Group B comprised 23 patients
(mean age: 71 years) with chronic retention
[mean PVR: 588 (387-3200)ml] without DM
(p⬎0.05). Eight patients from group A
(42%) and 9 (39%) from group B were also
found to have bilateral pelvicalyceal dilatation and impaired renal function (p⬎0.05).
Both groups underwent a TURP and were
followed with PVR measurement, uroflowmetry, ultrasound and serum creatinine investigations.
Results: Resected prostatic issue was 28
and 32g, in groups A and B, respectively
(p⬎0.05). Patients with post-operative
PVR ⬍ 150ml were considered to have
successful outcome. Fifteen patients from
group A (79%) and 18 from group B
(78.3%) met the above criterion (p⬎0.05)
with a Qmax ⱖ 12ml/sec. Mean follow-up
was 25 (4-43) months.
Conclusions: In our study, diabetes mellitus was not found to be a prognostic factor
of poor outcome in patients with chronic
retention who underwent TURP. Thus, such
a pathology should not, in advance, suggest
a contra-indication to surgery.
UP-1.46
Results of retropubic prostatectomy
and transurethral resection of prostate:
comparison of results and investigation
of cause of different results
Park SW1, Jung SG1, Kim TN2, Shin DG2,
Lee SD1, Lee JZ2, Chung MK1
1
Pusan National University Yangsan
Hospital, Yangsan; 2Pusan National University Hospital, Yangsan, South Korea
Introduction and Objectives: To retrospectively compare the results of a retropu-
S67
bic prostatectomy to that of a transurethral
resection of the prostate (TURP) and investigated the causes of the different results.
Materials and Methods: Fifteen patients
were retrospectively included in each
group, who were operated on by one experienced urologist. The direct outcomes,
such as max flow rate (Qmax), prostate and
transitional zone (TZ) volumes, proximal
prostatic urethral width, and transrectal ultrasonography (TRUS) and urethroscopic
findings, and intermediate outcomes, such
as International Prostate Symptom Score
(IPSS) and Quality of Life (QOL), were measured both before and after the operation.
The adenoma resection rates (resected volume/preoperative TZ volume) were compared and its value investigated.
Results: In the retropubic prostatectomy
group, the IPSS and QOL decreased from
24.5⫾4.9 and 4.3⫾1.0 to 4.8⫾3.3 and
1.2⫾0.9, respectively, and the Qmax increased from 6.3⫾2.6 to 23.1⫾6.6ml/sec. In
the TURP group, the IPSS and QOL decreased from 23.5⫾6.0 and 3.9⫾1.3 to
12.0⫾9.0 and 1.6⫾1.4, respectively, and the
Qmax increased from 8.2⫾ 3.6 to
16.6⫾7.7ml/sec. The adenoma resection
rate and proximal prostatic urethra width
were 0.98 (mean, max⫽1.63, min⫽0.30)
and 8.5⫾3.7mm, respectively, in the retropubic prostatectomy group, compared with
0.61 (mean, max⫽1.41, min⫽0.35),
4.3⫾1.9mm in the TURP group. In the retropubic prostatectomy group, the proximal
prostatic urethra was wider and more symmetrical and its surface more even (p▫0.05).
Conclusions: A retropubic prostatectomy
achieved a better result than the TURP
because the proximal prostatic urethra
was more symmetrical and its surface
more even.
scope and the bipolar loop used to control any bleeding. After this, a stitch was
taken on the prostatic lobes and bladder
neck mucosa was incised circumferentially from above and the base of the
prostate enucleated using a combination
of sharp and blunt dissection. Prostate
was delivered through the bladder incision and primary closure of the bladder
was done. Hemostasis was achieved by
electrocautery from above or below as
required.
Results: Case 1: 79 yr-old male; with ultrasound size of prostate 66g and retention of urine. The initial setup of the surgery took some time as the two surgical
teams got used to working together. Total
time taken was 120 min. There was some
blood loss as there was some delay in retrieving the gland from the bladder. Case
2: 81 yr-old male; with ultrasound size of
prostate 85g and retention of urine. The
two teams worked together very smoothly
this time. The total time was 50 min.
There was minimal blood loss. The first
patient needed a blood transfusion (1
unit) as there was some blood loss while
the gland was being removed. The second
patient had minimal blood loss and the
surgical time was considerably reduced.
The ease of enucleation in both patients
was remarkable. Hemostasis could be
achieved from either. There were no electrolyte abnormalities. Both patients were
fully ambulatory in 1 day.
Conclusions: This procedure seems to
combine the benefits of both procedures
and reduces the time of surgery compared
to either procedure. It is definitely a feasible procedure and appears to have advantages over any one of the procedures.
UP-1.47
A novel technique combining bipolar
and LESS Enucleation for BPH
Rao P1, Desai M2, Chen B3, Sotelo R4,
Liu CX3
1
Mamata Hospital, Mumbai, India; 2USC,
Los Angeles, CA, USA; 3Zhujian Hospital,
Guangzhou, China, 4Instituto Medico La
Floresta, Caracas, Venezuela
UP-1.48
Management of acute urinary
retention associated with benign
prostatic hyperplasia in real life
practice in Thailand
Ratana-Olarn K1, Reten - World Thailand
Study2
1
Dept. of Surgery, Ramathibodi Hospital,
Mahidol University, Bangkok; 2Bangkok,
Thailand
Introduction and Objectives: We combined the techniques of transvesical and
transurethral enucleation of the prostate
to maximize the benefits of the two procedures. We present our experience of
the first two cases.
Materials and Methods: In both cases,
the Triport was first inserted into the
bladder under cystoscopic control. The
apical enucleation was then done transurethrally using the beak of the resecto-
S68
Objectives: To evaluate current practice
of acute urinary retention (AUR) associated with benign prostatic hyperplasia
(BPH) in Thailand.
Thai men with AUR associated with BPH
were enrolled by 23 urologists from 17 hospitals in a prospective cross sectional survey
evaluating real life management of AUR.
The patients’ demography, history of BPH,
type of catheterization and management
following catheterization were collected.
Results: Among 304 patients, 78 (25.7%)
had precipitated AUR and 226 (74.3%) had
spontaneous AUR. Benign prostatic hyperplasia was revealed by AUR in 94 patients
(30.9%). Overall, 89 patients (29.3%) were
hospitalized for AUR (precipitated 23.1%,
spontaneous 31.4%). Urethral catheter was
inserted in most patients (98.7%). After
catheterization, 237 (78.0%) underwent trial
without catheter (TWOC). In all, 229
(75.3%) received an alpha-1 blocker. Trial
without catheter was successful in 65% of
cases, whatever the type of AUR (precipitated 69.7%, spontaneous 63.2%, P ⫽ 0.34).
The success rate of TWOC with an alpha-1
blocker was significantly higher than TWOC
alone (67.8% VS 50.0%, P ⫽ 0.038). In case
of first TWOC success, most patients continued medical treatment (precipitated 95.7%,
spontaneous 96.3%, P ⫽ 0.852). In the case
of first TWOC failure, 25 of 83 patients
(30.1%) tried a second TWOC with a success rate of 41.7%. In the case of second
TWOC success, all cases continued the
medicine, while re-catheterization followed
by elective surgery was mostly performed in
second TWOC failure.
Conclusions: Trial without catheter has
become a common practice for BPH with
AUR in Thai patients. Alpha-1 blocker
prior to TWOC is widely used with increasing chance of successful TWOC.
UP-1.49
Management of chronic retention:
overcoming a dilemma
Sabnis R, Mishra S, Bhattu A, Mutthu V,
Desai M
MPUH, Nadiad, India
Introduction and Objective: Old patients with chronic urinary retention
(CUR), showing hypocontractile / acontractile detrussor after adequate bladder
decompression for 4-6 weeks, pose a management dilemma of whether to do outlet
correction surgery (TURP). Our objective
was to determine any alternative diagnostic modality that would prognosticate
which category of the above-mentioned
population would benefit from TURP.
Material and Methods: Forty-three patients presented to the hospital with CUR in
1 year. Twenty patients with UDS proven
hypocontractile/acontractile detrusor after 6
weeks of bladder decompression were included in the study. All patients underwent
TRUS with measurement of PCAR (presumed area circle ratio). PCAR ⬍0.76
(group 1), 0.76 - 0.85 (group 2) and ⬎0.85
(group 3) was defined as no, mild and
marked bladder outlet obstruction (BOO).
Immediate postoperative improvement was
defined as: Good – voiding well with insignificant PVR, Mild – voiding with significant
PVR. Outcome was successful if they voided
well with nil PVR at 6 months. Follow-up
ranged from 6 months to 18 months.
Results: The average age of the patients
was 63.5 (range 50-75). On TRUS, average
total gland size; transition gland size and
PCAR was 34⫾18.1, 19.9⫾13.8 and 0.80
⫾0.7, respectively. PCAR ranged between
0.6 and 0.92. Of 20, 4 pts did not void (2
each in gr1&2), 16 voided with q max,
and residual urine of 17.5⫾7.4, and 65.2
⫾65.4, respectively. Of these, improvement was marked in 8 (all group 3) &
mild in 8 (4 in each group 1 &2). Overall
success at 6 months was in 14 patients (2
in group 1, 4 in group 2 and 8 in group 3).
Conclusion: PCAR is a sensitive index for
prognosticating postoperative success after
TURP in chronic retention. In this study
100%, 66% and 33% patients with PCAR
⬎0.85, 0.76-0.85 and ⬍0.76 demonstrated
benefit with outlet correction surgery.
UP-1.50
Tadalafil monotherapy is as
efficacious as tamsulosin in patients
with LUTS secondary to BPH: results
of first head-on comparative,
prospective, randomized study to
evaluate the efficacy of tadalafil and
tamsulosin, in patients with LUTS
secondary to BPH
Sabnis R, Jaoin V, Mishra S, Kurian A,
Veeramoni M, Desai M
MPUH, Nadiad, India
Introduction and Objectives: LUTS and
erectile dysfunction often coexist in men,
particularly with advancing age. The recent
evidence that PDE-5 inhibitors generate improvement in ED as well as LUTS, suggest
that they might be of particular value in
patients with both these conditions, as single agents. To date, there are no large studies designed that directly compare alphablockers with PDE-5 inhibitor in LUTS. The
question of whether PDE-5 inhibitors are as
efficacious as alpha-blockers in LUTS currently cannot be answered by these studies.
The present study was conceptualized with
the aim to directly compare the efficacy of
a PDE-5 inhibitor (tadalafil) and an alphablocker (tamsulosin), in relieving LUTS in
patients with BPH, and to evaluate efficacy,
and safety, of tadalafil in patients with LUTS
secondary to benign prostatic hyperplasia
and compare it with tamsulosin.
Materials and Methods: Adult OPD patients over the age of 45 years having LUTS
secondary to BPH requiring medical management, having fulfilled the Inclusion/ex-
clusion criteria were enrolled in the study
to receive randomly (by chit system),
tadalafil (10 mg once daily) or tamsulosin
(0.4 mg once daily) with 35 patients in each
group. Two-tailed Student’s t test has been
used to test the mean change, between the
two groups, for each of the efficacy variables (IPSS, IIEF, peak flow rates, post-void
residual urine and quality of life) over
3-month period.
Results: Tadalafil, given in the dose of 10
mg/day is as efficacious as tamsulosin (0.4
mg/day) in improving IPPS and QOL, increasing the peak urinary flow rates, and
reducing the post-void residual urine in patients with LUTS secondary to BPH. In addition, tadalafil improves the erectile function
of these patients significantly, which tamsulosin clearly fails to do so.
Conclusion: In men with LUTS with concomitant ED, a PDE-5 inhibitor ALONE
could perceivably be used as first-line
treatment and decrease the dose or delay
the need for alpha-blockers.
faction by self-judgment. Adverse events
were monitored throughout the study.
Results: A total of 68 patients (26.8%)
had residual bothersome irritating symptoms and were treated with the combination of tamsulosin and tolterodine. After 3
months 58 patients (85.5%) reported treatment benefit and wanted to remain on
combination treatment. Of the 10 patients
that did not want to continue the combination treatment none reported urinary
retention; 3 patients (4.4%) discontinued
because of side effects (dry mouth and
dizziness) and 7 patients (10.1%) because
of perceived lack of treatment benefit
(persistence of symptoms).
Conclusions: Tolterodine plus tamsulosin
was well tolerated. The results suggest that
treatment with tolterodine 1 mg bid plus
tamsulosin 0.4 mg qd for 3 months provides
benefit for men with moderate to severe
lower urinary tract symptoms and residual
urgency and frequency after monotherapy
with alpha-receptor antagonists.
UP-1.51
Tolterodine and tamsulosin for
treatment of men with benign
prostatic hyperplasia and lower
urinary tract symptoms
Stanca V, Maxim R, El Aidi Y, Prundus P,
Coman I
Dept. of Urology, Municipal Hospital
Cluj-Napoca, Cluj-Napoca, Romania
UP-1.52
Lower urinary tract symptoms in men
with prostate cancer: correlation with
cancer control
Stander J, Van der Walt C, Heyns C
Stellenbosch University and Tygerberg
Hospital, Tygerberg, South Africa
Introduction and Objective: Men with
benign prostatic hyperplasia and lower
urinary tract symptoms (LUTS) may not
respond to monotherapy with alpha-receptor antagonists. The cause of this may
be the detrusor overactivity induced by
the bladder outlet obstruction. The purpose of this study is to evaluate the medication adherence, patient satisfaction and
safety and tolerability of tolterodine plus
tamsulosin in men with residual LUTS after tamsulosin monotherapy.
men 50 years old or older were treated in
our service with tamsulosin 0.4 mg qd for
benign prostatic hyperplasia with LUTS between June 2009 and March 2010. The patients had post-void residual urine of less
than 100 ml, prostatic specific antigen of
less than 4 ng/ml and an International Prostate Symptom Score of 8 or greater. The
patients were evaluated for residual symptoms after 1 month of treatment. Patients
with residual urgency and frequency were
treated with 1 mg tolterodine bid in association to tamsulosin for 3 months. We registered the adherence after three months
(proportion of patients wanting to remain
on combination treatment) and patient satis-
Introduction and Objective: To evaluate
the relationship between lower urinary
tract symptoms (LUTS) and disease control in men with adenocarcinoma of the
prostate (ACP).
Materials and Methods: Men with ACP
followed up at out institution between January 2007 and April 2009 were evaluated
using the international prostate symptom
score (IPSS), uroflowmetry and transrectal
ultrasound (TRUS). The only exclusion criterion was previous radical prostatectomy.
Disease status was defined by serum prostate specific antigen (PSA) at evaluation relative to pre-treatment PSA: Remission ⫽ PSA
reduction ⱖ50%, Progression ⫽ PSA increase ⬎50%, Stable disease ⫽ the rest. Statistical analysis was performed with Student’s t, Mann-Whitney, Fisher’s exact and
Spearman’s correlation tests as appropriate
(all values mean and range).
Results: The study group (n⫽198) had
mean age 67.4 years (range 46-91), clinical stage T1-2 in 48%, T3-4 in 51%. Initial
treatment was androgen deprivation
(74.7%), watchful waiting (19.7%) or radiotherapy (5.6%). At evaluation 56.1%
were in remission, 14.6% had progression
and 29.3% had stable disease. Overall, the
IPSS was ⱖ12 in 43%, peak urinary flow
(Qmax) was ⱕ12 ml/sec in 69%, and
S69
Table 1, UP-1.52
Number
Treatment
Androgen deprivation
Watchful waiting
Radiotherapy
Time since diagnosis (years)
Uroflowmetery
IPSS ⬎12/35
Qmax (ml/sec)
Qmax ⬍12 ml/sec
Qave (ml/sec)
Prostate volume (cc)
Remission
111
Progression
29
88.9%
9.3%
1.8%
2.8 (0.1-15.4)
62.1%
20.7%
17.2%
5.8 (0.5-17.0)
⬍0.0001
55.2%
8.3 (3-20)
88.9%
4.9 (1.7-10.7)
24 (4-56)
NS
0.0052
0.0107
0.0397
NS
38.5%
11.2 (1.4-32)
61.5%
6.2 (0.9-22)
31.5 (5-204)
voided volume was ⬍150 ml in 49.5%.
The groups with remission versus progression are compared in Table 1.
Conclusions: Compared to the group
with ACP in remission, the group with
ACP progression had a greater proportion
managed with radiotherapy or watchful
waiting, with IPSS ⬎12/35, and significantly lower peak and average urine flow
rates, although the prostate volume was
not significantly greater. This indicates
that LUTS in men with ACP and disease
progression are determined by factors
other than prostate size alone.
UP-1.53
The introduction of a prostate
holmium laser service to a district
general hospital (DGH)
Vyas L, Kastner C, Beard R
Worthing Hospital, Worthing, England
Table 1, UP-1.53
Variable (mean)
Characteristics
Age (years)
Prostate volume (ml)
Indications
LUTS
AUR
CUR
unknown
HoLEP
HoLA/RP
Extracted tissue volume (g)
Service related outcomes
Hospital stay (d)
Successful TWOC
All
postOP
2 weeks
3-months FU
n
Discharge
Better but FU
Same or worse
Reported complications
S70
P value
Introduction and Objective: Holmium
Laser Enucleation (HoLEP) is increasingly
regarded as new gold standard for BOO
surgery. The learning curve can be mastered by modular teaching. The use of
HoL ablation and resection, (HoLA/RP)
produces similar outcomes to TURP.
We present experience and impact of the
introduction of HoLaser to our DGH.
Materials and Methods: A multidisciplinary HoLaser pathway was developed.
This included protocols for trials without
catheter (TWOC) and for nurse-lead follow-up clinics. One experienced surgeon
and two beginners were involved in
HoLaser. Data on consecutive HoLaser
cases was collected prospectively over 6
months (N⫽70). We retrospectively collected data on TURP cases (N⫽30) of the
same time period.
Results: Patients’ characteristics represent
HoLaser (Nⴝ70)
TURP (Nⴝ30)
72
64.7
40
6
14
10
28
42
18.8
74
1.6
98%
75%
13%
51
70%
19%
11%
4
2.9
85%
18
61%
4
an average retirement area population.
Twenty-eight HoLEP and 42 HoLA/RP
were performed. The mean extracted tissue volume was 18.8g with a maximum of
81g. We noticed a sharp decrease in hospital stay with 1.6d for HoLaser and 2.9d
for TURP and a TWOC success rate of
98% and 85% respectively. At 3 month’s
follow-up, 70% vs. 61% were discharged.
Conclusions: Disciplined planning and
team approach allow safe introduction of
a HoLaser prostate service to a DGH with
maintenance of disease related outcomes
and early achievement of service related
HoLaser benefits.
UP-1.54
The alteration of autonomic nervous
system activity in women with urge
urinary incontinence
Choi J1, Kim J2, Kim H2, Yeo J3, Seo Y1,
Kim Y1, Lee J4
1
Ajou University School of Medicine, Suwon; 2Catholic University School of Medicine, Seoul; 3Inje University School of
Medicine, Busan; 4Korea University
School of Medicine, Seoul, South Korea
Introduction and Objective: Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) have different
mechanisms of action. We believe that
changes in autonomic nervous system
(ANS) activity may be contributory to
UUI, because the lower urinary tract is
regulated through the sympathetic and
parasympathetic nervous systems. Heart
rate variability (HRV) is a tool by which
autonomic nervous function can be measured. We measured and compared parameters of HRV between women with
SUI and UUI.
female patients who suffered from urinary
incontinence were evaluated with 3-day
voiding diary, urodynamic study (UDS)
and routine laboratory examination. None
of them had diabetes, cardiovascular problem or other diseases which can affect
ANS. Also 120 female volunteers were
included as control group. Forty-seven
women were diagnosed as pure and 29
women as UUI according to their voiding
diary. We measured their HRV in the resting state and compared it between SUI,
UUI and control groups.
Results: There was no difference of HRV
indexes between SUI and control group.
In comparison of HRV indexes between
UUI and SUI or control group, LF and HF
in UUI group were lower than SUI and
control groups, LF/HF ratio was higher in
UUI group than SUI and control group.
Conclusions: Analysis of HRV indexes
Table 1, UP-1.54
Control group (N⫽120)
SUI group (N⫽47)
UUI group (N⫽27)
p Value
Age (year-old)
45.2⫾6.9
47.2⫾13.1
52.5⫾12.2
*;0.070, ⫹;0.093
2
LF (msec )
243.2⫾18.2
228.4⫾51.0
98.7⫾18.4
*;0.000, ⫹;0.020
2
HF(msec )
270.5⫾30.7
200.7⫾61.2
79.2⫾21.9
*;0.000, ⫹;0.067
LF/HF ratio
1.6⫾0.2
1.8⫾0.2
3.3⫾0.7
*;0.020, ⫹;0.032
*; p value between Control group and UUI group
⫹; p value between SUI group and UUI group
shows that there is a significant difference
of ANS activity between UUI group and
SUI or control group. The increase of
LF/HF in UUI group might be interpreted
as imbalance of ANS function and increased systemic sympathetic activity.
UP-1.56
Effectiveness of botulinum toxin Type
A in the management of neurogenic
lower urinary tract dysfunction
Catalan G, Gómez R, Marchetti P,
Vidal A
Hospital Del Trabajador, Santiago, Chile
UP-1.55
Comparison of urodynamics between
ischemic and hemorrhagic stroke
patients: can we suggest the category
of urinary dysfunction in patients
with cerebrovascular accident
according to type of stroke?
Choi S, Yoo K, Lee H
Dept. of Urology, School of Medicine,
Kyung Hee University, Seoul, South
Korea
Introduction and Objectives: To report
our experience with the use of botulinum
toxin type A (BTA) in the management of
neurogenic lower urinary tract dysfunction.
Materials and Methods: Retrospective
review of patients receiving BTA treatment between January 2005 and December 2009. In Group A, detrusor injection
of BTA (200 or 300 units) was used to
control urinary incontinence due to overactive bladder refractory to anticholinergics in spinal cord or traumatic brain
injured patients; BTA dose was injected
endoscopically in 30 fractions following a
radial pattern, avoiding the trigone. Disappearance of incontinence was considered
a complete response (CR); ⬎50% reduction of incontinence was considered a
partial response (PR) and no change or
⬍50% reduction of incontinence was a
failure (F). In Group B, BTA (30 to 200
units) was used to control striated urethral sphincter spasticity interfering with
intermittent catheterism in spinal cord
patients; BTA dose was injected endoscopically in quadrants. Disappearance of
sphincter spasticity allowing easy catheter
passage was considered a success.
Results: See Table 1.
We observed only one minor complication: superficial urethral tear managed
this study is to compare the urodynamic
parameters in ischemic and hemorrhagic
stroke patients with bladder dysfunction.
Materials and Methods: We retrospectively reviewed medical records such as
computed tomography (CT) or magnetic
resonance imaging (MRI) and urodynamic
study and identified 84 cases among 150
stroke patients underwent urodynamic
test due to lower urinary tract symptoms
(LUTS) from June 2003 to May 2008. Exclusion criteria are diabetes mellitus (DM)
cystopathy, previous pelvic surgery, spinal
cord injury, benign prostate hyperplasia
(BPH), and other neurologic etiology
Results: Among analyzed variables of urodynamic study, total bladder capacity,
postvoid residual urine volume and bladder compliance have a significant value
between ischemic and hemorrhagic stroke
group (P ⫽ 0.004, P ⫽ 0.017, P ⫽ 0.007).
Ischemic group had detrusor overactivity
(DO) (70.7%), detrusor underactivity (DU)
(29.3%), and hemorrhagic group have DO
(34.6%), DU (65.4%). (P ⫽ 0.003).
Conclusions: Evaluation of the stroke
type may be helpful in the determination
of the type of urinary dysfunction and in
deciding the appropriate bladder management. The urodynamic study, however,
is essential to manage LUTS in stroke
patients.
with transient Foley diversion. There were
no drug side effects.
Conclusions: Botulinum toxin type A is a
minimally invasive and safe alternative for
temporary control of lower urinary tract
neurogenic dysfunction. We found this
drug highly efficient (⬎90% CR ⫹ PR) to
control urinary incontinence associated
with hyperactive neurogenic bladder; two
hundred units were as effective as 300
units for this purpose. Our very limited
experience in striated sphincter spasticity
treatment suggests that 200 units should
be used, but a larger experience is needed
to draw stronger conclusions.
UP-1.57
Effect of Clean Intermittent
Catheterization on PSA Levels of
Spinal Cord Injured Patients
Torricelli F, Lucon M, Gomes C,
Vicentini F, Srougi M, Bruschini H
University of São Paulo School of Medicine, São Paulo, Brazil
Introduction and Objectives: PSA is an
organ (prostate)-specific marker, and its
level can be elevated in various situations
as well as following urologic manipulations. The effect of clean intermittent
catheterization (CIC) on serum PSA levels
is unclear. The aim of this study is to evaluate serum PSA levels of patients with
spinal cord injury (SCI) submitted or not
to CIC in comparison to those of the general population.
Materials and Methods: We retrospectively studied 140 men with SCI admitted
in our service from January 2005 to May
2009. Thirty-four SCI patients had PSA
levels available due to age and absence of
infections, comprising 21 under CIC and
13 managed without CIC. Patients under
CIC performed it 4 to 6 times per day for
a mean time of 72.4 months (range 30 to
192). The most common etiology of SCI
was fall (33%), followed by car/motorcycle crashes (15%). Control group was
composed by 670 healthy men referred to
our service as a screening for kidney do-
Table 1, UP-1.56
Group A (16 patients):
No patients
200 units
6
300 units
10
Group B (2 patients):
Case 1
Case 2
No procedures
13
12
No procedures
2
2
30 units
failure
—
CR
10 (77%)
9 (75%)
PR
2 (15%)
2 (16%)
F
1 (8%)
1 (8%)
100 units
failure
⬍4 mo. success
Mean duration
of response
7.7 (4-15 mo.)
7.7 (4-18 mo.)
200 units
—
⬎6 mo. success
S71
Table 1, UP-1.57. Mean age and PSA level in SCI patients and controls
Mean age (years)
SCI patients
54
Controls
57
SCI patients with CIC
60
p-value
0.66
SCI patients without CIC
50
Controls with similar age
47
p-value
0.332
nation or prostate evaluation. We used
t-student test and variance analysis
(ANOVA) for age and PSA comparison
between the groups.
Results: Overall, patients with SCI and
controls had similar mean age (54 vs. 57
years-old, p ⫽ 0.11) and mean PSA level
(1.81 vs. 1.95 ng/ml, p ⫽ 0.66). Patients
without CIC had similar mean age (60 vs.
57 years-old, p ⫽ 0.11) and similar PSA
values when compared to controls (1.72
vs 1.95 ng/ml, p ⫽ 0.89). Patients under
CIC were compared to controls with similar age (50 vs. 47 years, p⫽0.332) and
their PSA levels were significantly greater
(1.86 vs. 0.79 ng/ml, p ⫽ 0.026). Table 1.
Conclusions: Clean intermittent catheterization increases almost to double the PSA
levels in SCI patients. However, those SCI
patients managed without CIC had PSA
levels similar to the control group.
UP-1.58
Efficacy of clean intermittent
catheterization (CIC) for urinary
incontinence in children with
neurogenic bladder dysfunction
secondary to myelodysplasia
Obara K, Mizusawa T, Isahaya E,
Suzuki K, Hara N, Takahashi K
Division of Urology, Graduate School of
Medical and Dental Sciences, Niigata
University, Niigata, Japan
the efficacy of clean intermittent catheterization (CIC) for urinary incontinence in
myelodysplastic children.
Materials and Methods: The cohort
comprised 38 children (19 boys and 19
girls, aged between 10 months and 16
years) with neurogenic bladder secondary
to myelodysplasia. The Group A included
16 children who had dilated upper urinary tract or vesicoureteral reflux when
CIC was introduced. The remaining 22
children with normal upper urinary tract
were enrolled in Group B. In the present
study, we defined socially acceptable continence as having completely dry or slight
stress incontinence that patients can manage with several small pads.
S72
Mean PSA (ng/ml)
1.81
1.95
1.72
0.89
1.86
0.79
0.26
Results: Of the 16 group A patients, nine
obtained socially acceptable continence
by conservative management. Of the 22
group B patients, eleven reported socially
acceptable continence by conservative
management. Vesical compliance was significantly higher in cases who reported
socially acceptable continence than in
those with incontinence persistent regarding all participants (10⫾7.2 versus
6.8⫾6.2 ml/cmH2O, P⫽0.0347) and
Group A (9.1⫾6.7 versus 3.7⫾1.4 ml/
cmH2O, P⫽0.0350). Leak point pressure
was significantly higher in patients who
obtained socially acceptable continence
than in those having persistent incontinence regarding all participants (50⫾17.2
versus 25⫾6.6 ml/cmH2O, P⫽0.0003),
Group A (51⫾21.4 versus 26⫾7.2 ml/
cmH2O, P⫽0.0348) and also, Group B
(49⫾12.8 versus 23.7⫾6.3 ml/cmH2O,
P⫽0.0043).
Conclusions: In our series, socially acceptable continence was obtained in only
20 patients (52%) by conservative management. The present study suggests that the
limitation of conservative treatment seems
to be apparent when they have urethral
closure deficiency and/or intractable poor
vesical compliance.
UP-1.59
Urological features of quadriplegia:
six years of experience
Persu C, Cauni V, Geavlete P
Saint John Emergency Clinical Hospital,
Bucharest, Romania
Introduction: The quadriplegic patient,
due to the complexity of his pathology,
requires a particular approach by the physician. The aim of our study is to synthesize the urological features of quadriplegia
based on our experience.
Material and Methods: Between January
2004 and January 2010, in our department, 34 patients (26 males, 8 females)
with quadriplegia after traumatic spinal
cord injury were admitted. The age of the
patients was between 19 and 36 years
old. The investigation protocol included:
careful history tacking, clinical examina-
tion, neurological evaluation, bladder diary, abdominal ultrasound, urinalysis and
urodynamic evaluation. In selected cases
we performed cystoscopy and IVP.
Results: All patients had voiding troubles.
The voiding sensation was present in all
patients, although it was usually signaled
by the overactivity of the autonomic nervous system – heavy sweating, hypertension, slow pulse – being very specific and
having good sensitivity. Hypogastric percussion is the most common way of initiating voiding (70%). Twenty-two patients
reported incontinence episodes. Urinalysis
showed infection in all cases, requiring
antibiotherapy. Bladder stones were found
in 10 patients. The results of the urodynamic tests showed detrusor-sphincter
dyssynergia in all cases. Maximum bladder
capacity was 205ml; the lowest was 70ml,
with a medium value of about 140ml. Detrusor overactivity was found in all patients, with a maximum Pdet of over
300cm water. Maximum urinary flow had
a mean value of 12ml/sec.
Conclusions: Urodynamic tests are mandatory for patients with quadriplegia. Urological features of quadriplegia are not
determined by the level of the lesion, by
age or by the sex of the patient, nor by
the time elapsed from the moment of the
trauma. Intermittent catheterization is still
rare among these patients.
UP-1.60
Preliminary report of the first
experience of sacral neuromodulation
in Iranian patients with voiding
dysfunction
Sharifiaghdas F, Soltani MH
Shahid Beheshti University of Medical
Sciences, Tehran, Iran
Introduction and Objective: We report
our preliminary experience of electrical
stimulation of sacral nerve root for treatment of patients with voiding dysfunction.
Materials and Methods: Among ninetythree suitable candidates, 15 patients (9
female and 2 male) with voiding dysfunction refractory to medical therapy including oral and injectable agents accepted to
undergo sacral neuromodulation test
phase. Preoperative assessments were
urine analysis, ultrasonography with post
void residual measurement, urodynamic
study and cystoscopy and 24 hour voiding
diary during three days before operation.
All procedures were performed by using
electrical stimulator inserted adjacent to
S3 root under fluoroscopic guidance and
sedative anesthesia. Postoperative evaluation consisted of 24 hour voiding diary.
Positive response was defined as more
than 50% improvement in voiding diary
chart.
Results: The main reason of the majority
of cases who refused SNM therapy was
cost of device in 68 patients, and fear of
intervention in nerve roots in 10. Mean
age of patients was 42.5 (18 -76) years
old. Main symptoms in our patients were
unobstructive retention in 8, refractory
urgency and urge/incontinence symptoms
in 3 and stress/urge incontinency in 4
cases. Three patients had previous history
of hysterectomy and one case had undergone repair of disc herniation. Eight cases
did clean intermittent catheterization
(CIC) preoperatively. Mean operative time
was 35 minutes and hospital stay in all
patients was one day. Positive response
was noted in ten patients, two cases revealed no improvement and electrical
wire was displaced the day after operation
in three other cases. No significant complications were observed.
Conclusion: This is the first experience
reported from our country. Even though
the number of patients enrolled in this
study was not significant, experience of
SNM was concomitant with noticeable
results and negligible side effects in patients with voiding dysfunction. The major
reason in our group of patients who rejected trial of therapy was cost of device,
and fear of intervention in nerve roots
which prompts serious attention.
UP-1.61
Prostatic inflammation and prostate
cancer: is there evidence for a link?
Engelhardt P1, Brustmann H2,
Seklehner S1, Riedl C1
1
Dept. of Urology and Andrology, Landesklinikum Thermenregion, Baden, Austria;
2
Dept. of Pathology, Landesklinikum
Thermenregion, Mödling, Austria
Introduction and Objectives: Recent
reports support the hypothesis that longstanding chronic inflammation of the prostate gland is a risk factor for the development of prostate cancer. In a controlled
prospective trial we investigated the extent and association of chronic prostatic
inflammation in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa).
Material and Methods: From 1/2009 to
12/2009 patients who underwent transurethral resection of the prostate (BPH
group, n⫽83) or radical prostatectomy
(PCa– group, n⫽57) were randomised in a
prospective trial. The presence of chronic
inflammation of the prostate was verified
by histological examination and its extent
was evaluated according to the grading
system by Irani et al. Additional immunohistochemical investigations were performed for interleukin-2-receptors (IL2)
and interleukin-6-receptors (IL6). Histological and immunhistochemical findings
were correlated with patient age, prostate
volume, PSA levels, cholesterol, lipids,
IPSS Score and body mass index in patients with BPH vs. PCa.
Results: A significant difference between
patient groups was found in age (63.4 vs.
69.1 years), volume of the prostate gland
(34.9 vs. 51.0 ml) and lipids levels (163
vs. 132 mg/dl) in PCa versus BPH patients. All other parameters showed no
significant difference.
Chronic prostatic inflammation was verified in 10.53% (6/57 patients) of the PCa
group versus 61.45% (51/83 pat.) of the
BPH group (p⫽0.0001). The extent of
chronic prostatic inflammation was significantly higher in BPH patients. We could
not find any further correlation between
chronic prostatic inflammation and Gleason score of PCa patients, IPSS Score in
BPH or PCa patients, prostate volume,
cholesterol, lipids or BMI.
Conclusion: About 60% of our BPH patient group treated with TUR-P showed
chronic prostatic inflammation. In contrast, prostatic inflammation was detected
in only 10% of PCa patients. No further
correlation of histological prostatic inflammation to BPH or PCa was found.
UP-1.62
Pelvic drain can be avoided after
transvesical prostatectomy for
prostate benign hyperplasia
Ghoundale O, Touiti D
Avicenne Military Hospital, Marrakech,
Morocco
Introduction and Objective: Open surgery still keeps its place in the management of benign prostate hyperplasia
(BPH). We present our preliminary experience of open transvesical prostatectomy
with a drain-free.
Materials and Methods: We assessed
prospectively 100 consecutive prostatectomies for BPH, performed by retropubic
approach between June 2007 and July
2009. Adenoma enucleation was performed via sagittal incision of the bladder.
In the first 50 patients (group 1), aspirative Redon drain were placed below peritoneum. In the following 50 (group 2),
after positive watertight test, no drain was
placed.
Results: The two groups were matched
for age and prostate size. Average hospitalization was one day greater in group 1.
Overall rate of complications were identical in the two groups (10%).
Conclusions: Drain-free simple retropubic prostatectomy for BPH is not associated with more complications than the
classic procedure with a drain in the pelvis; it actually allows quite the reverse: a
gain in hospital stay.
UP-1.63
Use of hyperbaric oxygen therapy for
hemorrhagic cystitis secondary to
pelvic radiotherapy
Parra C2, Gómez R1, Felmer A1,
Castillo O3, Rubio G3
1
Hospital del Trabajador; 2Universidad
Catolica de Chile; 3Clinica Indisa, Santiago, Chile
Introduction: Hemorrhagic cystitis (HC)
after pelvic radiotherapy occurs in 2-8% of
patients. A variety of treatments have
been described, most of them with uncertain results. We assessed the efficacy of
hyperbaric oxygen therapy (HBOT) in HC
cases.
analysis of patients with HC after pelvic
radiotherapy receiving HBOT between
January 2002 and January 2010. Indications for pelvic radiation, elapsed time
between radiotherapy and HC, between
HC and HBOT, other treatments for HC
and HBOT-related complications were recorded. HBOT was performed in a multiplace hyperbaric chamber with 90 minutes of 100% oxygen breathing at 2.2 atm.
We defined complete response (CR) as
definitive stop of gross hematuria and
partial response (PR) as persistence of
minor occasional self-limited episodes of
gross hematuria. Telephone follow up was
updated at the time of submission in all
cases.
Results: Twenty-five patients were treated
(21 male, 4 female), mean age 66.7 years
(range 42 - 80). Twenty men were irradiated for prostate cancer (17 post radical
prostatectomy and 3 as monotherapy) and
one for bladder cancer. Three women had
cervix cancer and one endometrial cancer. All patients were initially managed by
bladder clot removal/endoscopic cauterization under anesthesia plus saline irrigation. One case received alum irrigation. In
all cases HBOT was considered only after
other measures failed. Mean follow up
was 21.2 months (range 3-66). Mean time
between radiotherapy and HC was 31
months (range 1-106) and between the
onset of HC and HBOT was 4.7 months
(range 1-12). Median number of HBOT
was 40 sessions (range 15-44). We observed CR in 64% (16 patients) and PR in
S73
32% (8 patients). One patient was considered a failure (4%), because intra-HBOT
treatment with KTP laser was needed.
Success was not related to the elapsed
time between the onset of HC and beginning of HBOT. Two cases presented mild
middle-ear pressure equalization problems.
Conclusions: HBOT is highly effective in
HC after pelvic radiotherapy. A combined
CR plus PR of 96% makes this option a
first line alternative in these difficult
cases.
UP-1.64
Impact of dutasteride on serum
testosterone and body mass index in
men with benign prostatic
hyperplasia
Hong S, Oh J, Jeong C, Jeong S, Byun S,
Lee S
Dept. of Urology, Seoul National University Bundang Hospital, Seongnam-Si,
South Korea
Introduction and Objective: Previously,
serum testosterone level has been shown
to be increased with finasteride treatment
in men with benign prostatic hyperplasia
(BPH). Meanwhile, it is widely known that
testosterone level is inversely correlated
with body mass index (BMI) in men.
Therefore, it can be hypothesized that
5␣-reductase inhibitor treatment may well
result in the reduction of BMI as well in
men with BPH. Thus, we investigated impact of dutasteride on serum testosterone
level and BMI in men who received medical therapy for BPH.
patients with BPH were randomized to
three treatment groups: tamsulosin 0.2
mg/day (alpha-blocker group), dutasteride
0.5 mg/day (dutasteride group), or tamsulosin 0.2 mg plus dutasteride 0.5 mg/day
(combination group) for the duration of 1
year. For all subjects, BMI and serum testosterone levels were checked at baseline
and after 1-year treatment.
Results: Among the evaluable 107 subjects, dutasteride group (n ⫽ 33) and
combination group (n ⫽ 37) showed significantly higher increases in serum testosterone level (16.3% and 15%, respectively)
compared with alpha-blocker group (n ⫽
37) (0.3%) following 1-year treatment
(both p ⬍ 0.001). When analyzed by baseline serum testosterone tertile, such increases in serum testosterone level among
dutasteride group and combination group
were greatest in the lowest tertile. Regarding BMI, dutasteride group and combination group demonstrated mean decreases
of 0.17 kg/m2 and 0.20 kg/m2, respectively, at 1 year whereas alpha blocker
S74
group showed mean increase of 0.04 kg/
m2. Meanwhile, such decreases in BMI for
dutasteride group and combination group
were statistically significant only in the
lowest baseline serum testosterone tertile
(p ⫽ 0.048 and p ⫽ 0.010, respectively).
Conclusions: Dutasteride treatment in
men with BPH led to significant increase
in serum testosterone level and also significant decrease in BMI among those with
relatively lower baseline serum testosterone level. Although observed decreases in
BMI were relatively small, further investigation would be needed to elucidate exact underlying mechanism and clinical
significances of such change in BMI following dutasteride treatment in men
with BPH.
UP-1.65
Effect of silodosin on ejaculation
function and qol in patients with
lower urinary tract syndrome (LUTS)
Iwamoto T1, Hasegawa T2, Minagawa N3,
Nukui F4, Kinoshita Y5, Satomi Y6,
Furuhata A7, Kawabe K8
1
Center for Infertility and IVF, International University of Health and Welfare
Hospital, Nasushiobara; 2Ofuna Chuo
Hospital, Kamakura; 3Minagawa Urology Clinic, Yokohama; 4Tsurumi Clinic,
Yokohama; 5Kinoshita Clinic, Yokohama; 6Satomi Renal Urology Clinic, Yokosuka; 7Furuhata Urology Clinic, Yokosuka; 8Tokyo Teishin Hospital, Tokyo,
Japan
Introduction and Objectives: Silodosin
is a novel selective ␣1A-adrenoceptor antagonist launched in Japan only. Although
silodosin showed significant improvement
in LUTS, it showed relatively high incidence rate of ejaculation disturbance as
an adverse event. The purpose of this
study is to evaluate the efficacy and the
influence of silodosin on QOL.
Materials and Methods: Enrolled male
patients (ⱖ50yr.) had an opportunity of
sexual intercourse and international prostate symptom score (IPSS) ⱖ8 and QOL
index ⱖ4. The patients were prescribed
silodosin 4mg twice daily for 8-12 weeks.
Before and at the end of study, following
parameters were measured: IPSS, QOL
index, King’s Health Questionnaire
(KHQ), and questionnaire for ejaculation.
Results: IPSS and QOL score improved
significantly (n⫽38). Change of the status
of patients on ejaculatory function after
silodosin treatment (n⫽27): 1) Anorgasmia and anejaculation: increased from 3%
to 20%. 2) Orgasm (⫹) but anejaculation:
increased from 7% to 50%. 3) Orgasm (⫹)
but decrease in ejaculate volume: de-
creased from 50% to 23%. Changes on
satisfaction associated with ejaculation: 1)
Satisfactory or almost satisfactory: decreased from 53 to 21%. 2) Depressed feel
for ejaculation (lack of satisfaction): increased from 6% to 35%. To sum up these
results, silodosin was demonstrated to induce significant disturbance in the ejaculation function and dissatisfaction with ejaculation. The domain scores of KHQ
related to role limitations, physical limitations, and social limitations significantly
improved after administration of silodosin.
Evaluation of drug after completion of
administration (n⫽40): Request for continued silodosin administration; 40%, Request
for change of drug; 40%, others;20%. The
improvement of LUTS or that of daily life
was the reason in 94% of those who requested continued treatment with silodosin.
Conclusions: This study is very unique in
that it investigated the influence of ejaculation disturbance induced by silodosin on
the QOL of LUTS patients who have opportunity of having sexual intercourse. As
a conclusion to this study, it is assumed as
a national trait that the Japanese males
place more importance on the improvement of various symptoms related to LUTS
rather than on their sexual life.
UP-1.66
Correlation between serum
parathyroid hormone and prostate
size in patients with benign prostatic
hyperplasia
Kim W, Kim Y, Yun S, Lee S, Kim W
Dept. of Urology, Chungbuk National
University College of Medicine, Cheongju,
South Korea
Objective: Calcium and Parathyroid hormone (PTH) are related with the development and progression of prostate cancer.
In addition, the hypothesis that serum
calcium and PTH stimulate prostate
growth in men without clinical prostate
cancer has previously been shown. We
evaluated the relationship between prostate size, prostate-specific antigen (PSA),
serum calcium and PTH.
Materials and Methods: We evaluated
285 BPH patients with possible retrospective chart review between December
1999 and February 2010. We excluded
patients with high PSA (⬎10 ng/mL). We
examined the laboratory test with serum
of these patients.
Results: Mean age, prostate size, and PSA
were 69.3 ⫾ 7.5 years, 43.0 ⫾ 24.9 g, and
3.0 ⫾ 2.3 ng/mL, respectively. Mean serum calcium, serum vitamin D, and serum
PTH was 9.3 ⫾ 1.9 mg/dl, 18.2 ⫾ 8.3 ng/
ml, and 24.8 ⫾ 16.8 pg/ml, respectively.
Age, PSA, PTH were significantly positively correlated with prostate size
(r⫽0.176, p⫽0.003). Adjusted for Age and
PSA, PTH was correlated with prostate
size (r⫽0.148, p⫽0.019).
Conclusions: Serum PTH is significantly
positively correlated with prostate size.
This finding supports the association between serum PTH and prostate growth.
UP-1.67
Diagnostic value of functional bladder
capacity, urine osmolality and
daytime storage symptoms for
severity of nocturnal enuresis
Kim T, Kim J
SoonChunHyang University, Bucheon
Hospital, Bucheon, South Korea
Introduction and Objective: The objective of this study was to investigate the
correlation between bladder capacity,
urine osmolality, daytime storage symptoms and severity of nocturnal enuresis.
Materials and Methods: We assessed a
total of 101 children with nocturnal enuresis (mean age 7.7⫾2.3 years). The severity of enuresis were divided into 3
groups: (1) 1-6 episodes per week (46
cases, 45.5%); (2) 1 episode every day (29
cases 28.7%); and (3) multiple episodes
every day (26 cases 25.8%). Baseline parameters were obtained from bladder diary for 2 days, first morning urine osmolality, the questionnaire for presence of
frequency, urgency and daytime incontinence. We regarded reduced functional
bladder capacity (FBC) as the under 65%
of expected bladder capacity (EBC), and
normal urine osmolality value as more
than 850mOsm/kg.
Results: The severity of enuresis was increased with younger age (p⫽0.037), and
reduced functional bladder capacity
(p⫽0.017). No difference of urine osmolality was found among all groups. Patients with multiple enuresis episodes per
day had daytime storage symptoms of frequency (p⫽0.008) and incontinence
(p⫽0.028) more frequently.
Conclusions: Our findings show that the
reduced functional bladder capacity and
age influenced the severity of nocturnal
enuresis. About half of the patients with
multiple enuresis episodes per day were
included in non-monosymptomatic nocturnal enuresis.
UP-1.68
Results of patients’ questionnaires
after photoselective vaporisation of
the prostate: single institution survey
Klecka J, Hora M, Behounek P, Eret V,
Stransky P, Urge T
Dept. of Urology, Faculty Teaching Hospital, Plzen, Czech Republic
Introduction and Objective: The objective was to evaluate the results of surveys
by patients after photoselective vaporization of the prostate, who underwent this
mini-invasive procedure over the period
2007-2008 with 80W KTP Greenlight
laser.
Methods and Materials: Current treatment of patients with benign prostate hyperplasia is moving towards mini-invasive
methodologies that minimize blood loss,
postoperative complications, and provide
patients with a faster return to normal
life. On this topic, many articles were
published, which evaluates the methodology, individually or by comparing them
with each other. There is, however, little
data, given to patients so that they evaluate their status after surgery and evaluate
the contribution of a new methodology
for themselves. Therefore, we have sent a
questionnaire to 250 patients who underwent photoselective vaporization of the
prostate at dept. of urology at University
Hospital in Pilsen in period 2007-2008
with the 80W KTP Greenlight laser machine. The questionnaire contained 15
questions. A total of 101 returned questionnaires were evaluated.
Results: For answers to fundamental
questions regarding postoperative pain,
67% of patients responded that it was
completely without pain, 10% of patients
had slight pain, 19% moderate pain, no
patient had severe pain and 5% of patients
had severe pain. Immediately after surgery, 33% of patients felt that their post-
Table 1, UP-1.67
Age (years)
Gender (M:F) (cases)
FBC/EBC (%)
Urine osmolality (mOsm/kg)
Frequency
Urgency
Daytime incontinence
Group 1 (nⴝ46)
8.3⫾2.3
32 : 14
79.1⫾32.4
859.7⫾208.5
10 (21.7%)
29 (63.0%)
7 (17.4%)
Group 2 (nⴝ29)
7.5⫾2.4
19 : 10
70.2⫾31.3
895.2⫾202.9
7 (24.7%)
12 (41.4%)
5 (17.2%)
Group 3 (nⴝ26)
7.1⫾2.3
21 : 5
57.8⫾21.3
852.9⫾244.3
14 (53.8%)
15 (57.7%)
11 (42.3%)
P value
0.037
N.S
0.017
N.S
0.008
N.S
0.028
operative status is complicated; 67% of
patients experienced no complications.
Duration of hospitalization, in patients
perceived that 1 day after surgery 57% of
patients left for home; 2 day after surgery
it was 33% longer and 10% of patients
were hospitalized. Questions directed to
the period of reconvalescence: the average time the ability to perform normal
activities on average was 5 days. The average duration of incapacity for work in
normal job was 9 days and time to return
to full capacity was 14 days. Assessing the
improving of urination after surgery, 57%
of patients had much improved urine
flow, 33% reported that their stream of
urine is better and 10% of patients felt
that there was no improvement of micturition. On a very important issue regarding the quality of life after surgery, 33% of
patients perceived that there was a significant improvement, 52% of patients had a
better quality of life, 10% had the same
duality of life, and 5% had a deterioration
in their quality of life.
Conclusions: For a comprehensive
evaluation of methodology, the processing of objective data is not only important, but also reflection, obtained from
patients who completes a comprehensive look at the methodology. In our
monitoring a total of 90% of patients
interviewed, after photoselective vaporization of prostate, there was improvement of urine flow and 85% of patients
had improved quality of life. The results
are encouraging. This work was supported by grant of Ministry of Health
MSM 0021620819.
UP-1.69
Cystocele plication risk (CPR) trial:
a pilot study
Miranda V1,2, Drutz H1, Alarab M1,
Murphy K1, Lovatsis D1
1
Mount Sinai Hospital, Toronto; 2University of Toronto, Toronto, ON, Canada
Introduction and Objectives: The objectives are: (1) To determine the feasibility of
a single centre, randomized, masked, controlled trial to investigate if avoiding cystocele plication decreases the need of catheterization beyond post-operative day
number two; (2) To determine the risk of
ureteric obstruction during the cystocele
repair.
Materials and Methods: There was a
randomized controlled trial of women undergoing transvaginal repair of midline
cystocele, with or without concomitant
correction of prolapse in other vaginal
compartment, but without correction of
stress urinary incontinence. Patients were
S75
randomly assigned to either plicating sutures or no plicating sutures at the time of
the surgical step of bladder plication, during cystocele repair.
Results: Women were recruited at one
hospital in Toronto from February 17,
2009 to April 12, 2010. Of the 26 women
who were approached and were eligible
for the study, 22 (85%) were recruited
and 3 (15%) refused to participate. Our
recruitment rate was on average 1.5 patients per month (below our target). Of
the 3 refusals, 2 (67%) did not want to be
randomized, and 1 (33%) had other personal reason for refusing to enter the trial.
Of the 22 patients who were randomized,
20 (91%) would participate in the study
again. The physicians involved in the
study felt comfortable with the randomization process and the new surgical technique. Neither cases of post-operative
voiding dysfunction that required catheterization beyond post-operative day two,
nor cases of ureteric obstruction were
identified in our cohort of patients.
Conclusions: A multicentre randomized
controlled trial is required to determine the
benefits and risks of avoiding plicating sutures during the cystocele repair. An instrument to identify recurrence of prolapse
should be considered in a large study.
UP-1.70
Impact of preoperative urinary
dysfunction on functional outcomes
following open radical prostatectomy
Yamamoto S, Yonese J, Urakami S,
Kitsukawa S, Numao N, Kubo Y,
Sukegawa G, Yasuda Y, Fukui I
Cancer Institute Hospital, Japanese Foundation For Cancer Research, Tokyo, Japan
the rate of improvement of postoperative
urinary function in patients with preoperative urinary dysfunction treated with
open radical prostatectomy (RP).
Materials and Methods: Between July
2006 and March 2009, a total of 274 Japanese patients diagnosed with clinically
non-metastatic prostate cancer underwent
RP at our hospital. Postoperative urinary
function was evaluated using the Japanese
version of the self-reported Expanded
Prostate Cancer Index Composite (EPIC)
at baseline, 3, 6 and 12 months after RP.
Patients were divided into two groups by
preoperative International Prostate Symptom Score (IPSS); Group 1 (less than 8
points) and Group 2 (8 points or greater).
Group 1 and Group 2 were composed of
145 and 129 men, respectively.
Results: Group 1 patients were significantly younger (p ⫽ 0.026) and had larger
S76
prostate volume (p ⬍ 0.001) than Group
2 patients. Estimated blood loss during
RP (p ⫽ 0.869), body mass index (p ⫽
0.835), PSA (p ⫽ 0.483) and rate of nervesparing RP (p ⫽ 0.467) did not differ significantly between the groups. Mean quality of life (QOL) scores for urinary
function (UF), urinary bother (UB), urinary incontinence (UIN) and urinary irritative-obstructive symptoms (UIR) at all
time points including baseline in Group 1
were significantly higher than those in
Group 2. The postoperative percent return to baseline of UB and UIR at 3, 6 and
12 months after RP in Group 2 was significantly greater than that in Group 1. UB
and UIR scores at 6 months after RP improved beyond those at baseline in
Group 2.
Conclusions: In patients with urinary
dysfunction treated with RP, urinary irritative/ obstructive and urinary bother symptoms had improved beyond preoperative
levels at 6 months after RP. It is important
for urologists to inform patients that the
rate of urinary function improvement differs depending on the presence or absence of preoperative urinary dysfunction.
value of 8, 9 ng/ml. The mean duration of
urinary catheterization was 14, 5 days after laparoscopy, 10, 8 days after classic
surgery and 9 days after the robotic approach. The evaluation of the functional
results indicates that urinary continence
was preserved in 63% of the cases of laparoscopic prostatectomy, 78% of the classic
surgery patients and 81, 8% of the patients treated by robotic procedure. Uretrovesical stricture of the anastomosis developed in 8 of the patients who
benefited from laparoscopic intervention
and in 4 of the cases of classic prostatectomy. This study is limited by the short
follow-up of a small number of patients
treated by robotic surgery.
Conclusions: The first steps of the operating team consisted of radical laparoscopic prostatectomy, which explains the
favorable oncological and functional results compared to classical or robotic approach (the robotic approach was first
performed in November 2009). The difficulties of laparoscopic uretrovesical anastomosis compared to classic and robotic
procedure explain the reduced continence in the laparoscopic approach.
UP-1.71
Urinary continence after open,
laparoscopic and robotic
prostatectomy: a single center
experience
El Aidi Y, Crisan N, Feciche B, Stanca D,
Lapusan C, Manea C, Prundus P,
Neiculescu C, Ona V, Coman I
Romanian Association of Urology, ClujNapoca, Romania
UP-1.72
Antegrade approach provides higher
and earlier continence rates and
better health-related quality of life on
urination following radical
prostatectomy
Fujisaki A1, Shiga Y1,2, Kurobe M1,
Iwabuchi T1, Minagawa S1, Sugimura T1,
Endo F1, Yashi M1, Hattori K1,
Muraishi O1
1
St.Luke’s International Hospital, ChuoKu, Tokyo; 2Meirikai Chuo General Hospital, Tokyo, Japan
Introduction and Objectives: Oncological and functional results after radical
prostatectomy depend both on the surgeon’s experience and on the elected surgical procedure. This study aims to evaluate urinary continence after 119 (108)
radical prostatectomies (classic, laparoscopic and robotic) performed at the Robotic Surgery Center of the Clinic County
Hospital, Cluj-Napoca.
Materials and Methods: Between March
2005 and March 2010 we evaluated 108
patients with prostate cancer. Radical
prostatectomy was performed in all of
them as it follows: open radical prostatectomy was performed in 50 cases, laparoscopic approach was elected for 58 of the
patients and robotic prostatectomy was
performed in 11 cases. Urinary continence
was evaluated after the radical surgery.
Results and Limitations: The age of patients was from 50 to 70 years, with a
mean age of 63 years. The PSA value was
between 1, 7 and 33 ng/ml, with a mean
Introduction: Urinary incontinence following prostatectomy is a common problem because it reduces a patient’s quality
of life. At our hospital, we perform the
antegrade radical prostatectomy (antegrade RRP) in all cases.
patients underwent antegrade RRP between April 2008 and July 2009 in our
hospital. Their average age was 67.7 years
(range, 50 to 78). Parameters measured
including uroflowmetry (UFM), QoL questionnaire (IPSS, Expanded Prostate Cancer
Index Composite; EPIC) related to urination following RRP were investigated at
baseline, 3, 6, 9, and 12 months after the
operation. Continence was defined as the
time when a patient no longer needed
a pad.
Results: The rates of patients being pad
free at 3 and 12 months after the surgery
were 95% and 98%, respectively. Mean
postoperative urinary incontinence rate
(calculated as (Incontinence volume / Total urine volume) x 100) was 0.42%, and
complete urinary continence was
achieved in 43.8% of patients on the day
after removal of the urethral catheter. The
QoL questionnaires and UFM will also be
discussed in the session.
Conclusions: Antegrade RRP provided
good continence rates; therefore, it may
enhance QoL.
UP-1.73
Primary results of Argus readjustable
male sling after 15 cases
Karaolides T, Kalogeropoulos T,
Koutsiaris E, Konandreas A,
Arvanitakis T
Saint Savvas Hospital, Athens, Greece
the efficacy and safety of Argus male sling
in the treatment of post-radical prostatectomy stress urinary incontinence.
Materials and Methods: Between March
2009 and March 2010 the Argus male
sling was implanted in 15 patients with
stress urinary incontinence after radical
prostatectomy (n⫽13) and brachytherapy
and TURP (n⫽2). Mean age was 68.3
years (55-81). All patients underwent a
complete preoperative assessment that
included physical examination, patient
history, stress urinary incontinence and
quality of life evaluation using validated
questionnaires (ICIQ-SF and IQOL) and
urodynamic control.
Results: Mean follow-up period was 6.9
months (1-12) during which 3 slings were
re-adjusted (1, 4, 6 months after implantation). Finally, 9 patients (60%) are dry, 4
patients (23%) present significant improvement as they mention urine loss
only in severe stress (coughing) and two
slings had to be removed. The mean pad
usage decreased from 2.9 at baseline to
0.4 per day, the mean ICIQ-SF score decreased from 15.9 (12-21) to 4.3 (1-12)
and the IQOL score increased from 47.2%
(19.3%-68.2%) to 76.3% (53.2-94.4%). Bladder perforation is a possible complication
during the implantation procedure
whereas post-operatively infection, perineal discomfort and temporary urinary
retention can occur. Most of the complications were managed successfully.
Conclusions: Argus male sling is a safe
and effective surgical option in the treatment of male patients with stress urinary
incontinence. The implantation procedure
is simple and reproducible with a small
learning curve. Argus has the important
advantage of being re-adjustable.
UP-1.74
Evaluation and classification of
sphincter lesions due to radical
prostatectomy (RP)
Karig R1,2, Bagner J1,2, Gerullis H1,2,
Eimer C1,2, Quast S1,2, Otto T1,2
1
Dept. of Urology, Lukaskrankenhaus,
Neuss, Germany; 2Institute for Tissue
Engineering and Regenerative Medicine
ITERM, Neuss, Germany
Introduction and Objective: Grade III
urinary stress incontinence (USI) as consequence of the damage of the external urethral sphincter is a rare (5%) but typical
complication after RP. From October 2005
until September 2008, 162 patients from
32 different German hospitals were seen
at our institution for grade III USI.
Materials and Methods: Apart from
medical history and clinical examination,
diagnostic tools were as follows: Protocol
of micturition, PAD Test, Urodynamics,
Urethrocystoscopy.
Results: Median age of the patients was
68.3 years. Incontinence persisted for
44.8 months (range: 12-180). Medical care
concerning USI contained the use of diapers and urinary condoms. Sufficient micturition volume could be reached in horizontal position only. Urodynamics
revealed reduced bladder capacity and
residual-free voiding. Of the patients, 66 %
(n⫽107) had undergone retropubic RP,
30% (n⫽49) laparoscopic or robot-assisted
RP und 4 % (n⫽6) perineal RP. Urethrocystoscopically, morphologic lesions of
the external urethral sphincter could be
seen in all patients (n⫽162). The evaluation of the lesions can be classified as follows: In 46 % of the cases (n⫽74) the
sphincter was damaged by anastomosis
sutures. Transsection/incision of the
sphincter could be observed in 65%
(n⫽105). 87 % (n⫽141) of the lesions can
be found in the lower, 13 % (n⫽21) in
the upper circumference of the sphincter.
A concomitant therapy-requiring stricture
associated with the sphincter (anastomosis stricture (n⫽73), bladder neck (n⫽76),
penile urethral stricture (n⫽42)) was detected in all patients (n⫽162). Two or
more synchronic stricture localisations
were seen in 46% (n⫽75) of the patients.
Conclusions: Etiology of postoperative
urinary stress incontinence is complex
and combines sphincter damage and stricture formation. Of sphincter lesions, 87%
are located in immediate vicinity of the
dorsal anastomosis sutures. The high rate
of sphincter penetrations by sutures is
remarkable. The high prevalence of stricture formation can be explained as consequence of the anastomosis technique. On
the other hand it may be resulting from
urinoma formation after catheter removal.
Of penile urethral strictures, 26% are
suggestive of catheter problems. The disproportionally high percentage of laparoscopically treated patients with incontinence during our recruiting period
indicates difficulties concerning the learning curve for laparoscopic techniques.
UP-1.75
Results of simultaneous implantation
of inflatable penile prosthesis and
bone anchored bulbourethral sling
after radical prostatectomy
Oliveira R, Resende A, Guimaraes M,
Tomada N, Vendeira P, Dinis P, Cruz F
Dept. of Urology, Hospital de São João,
Porto, Portugal
Introduction and Objective: Erectile
dysfunction (ED) and stress urinary incontinence (SUI) are major complications after radical prostatectomy. For mild to
moderate SUI, refractory to conservative
management, bone anchored bulbourethral slings are now being considered as a
first treatment option. As these patients
may also need an inflatable penile prosthesis for correction of ED, some concerns exists about the possibility of combining the two procedures. We describe
our experience with the placement of the
two devices in the same operative session.
Materials and Methods: Nine patients
(54-65 years old) with refractory ED and
mild to moderate SUI after radical prostatectomy were submitted, between 2005
and 2009, to simultaneous implantation of
a penile inflatable prosthesis and bone
anchored bulbourethral sling. The sling
was implanted through a small perineal
incision and the penile prosthesis through
a penoscrotal one. The procedures were
performed under spinal anesthesia. All
patients were discharged on the second
day following the surgery. Clinical outcome was determined with medical history and physical examination, urodynamics and cystourethroscopy. Satisfaction
was evaluated with simplified verbal
questionnaires.
Results: After a mean follow-up of 2 years
(1-4 years), all nine patients were continent and sexually active. All were satisfied
with the penile implant. There were no
cases of infection, new onset of urgency,
or difficulty using the penile prosthesis.
After surgery, two patients reported persistent scrotal numbness. Another two
had prolonged urinary residual volume,
resolved spontaneously with transient
catheterization.
Conclusions: There are some advantages
S77
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.
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
S78
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.
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
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
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)
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-
S79
ume of residual urine was estimated below 50 ml.
Conclusion: Our initial experience with
robot-assisted laparoscopic radical cystectomy (RARC) with extracorporeal ileal
conduit urinary diversion and robot-assisted laparoscopic partial cystectomy
(RAPC) appears to be favorable with acceptable operative, pathological and shortterm clinical outcomes. The volume of
residual urine estimated below 50 ml was
an excellent result.
UP-2: Unmoderated
Poster Session 2
Friday, October 15
UP-2.01
Endoscopic removal of spontaneously
migrated IUD to the bladder
Jorge Pereira B, Retroz E, Brandõ Á,
Coelho H, Borges R, Leaõ R, Grenha V,
Sobral F
Centro Hospitalar de Coimbra, Coimbra,
Portugual
Introduction and Objective: Intrauterine
devices (IUDs) have been used as contraceptives for more than 30 years. Uterine
perforation by IUDs is uncommon, and its
spontaneous intravesical migration with formation of secondary lithiasic aggregates, a
very rare complication. Authors intend to
present a case report with video.
Materials and Methods: Clinical and imaging evaluation and endoscopic treatment of a female patient with filling symptoms who presented migrated IUD to the
bladder.
Results: ACAMC, 41 years old female,
previously healthy, underwent placement
of an IUD 3 years before. A transvaginal
ultrasound performed 1 year and 6
months later showed IUD out of their intrauterine position, prompting suspicion
of exteriorization. Laparoscopic Fallopian
tubal ligation has been proposed. During
the procedure were identified pelvic
wires compatible with IUD migration,
confirmed by abdominal MRI (“in contact
with an intestinal loop”). Before being
referred to our Dept., she initiated LUTS
(filling symptoms). Urethrocystoscopy revealed partially intravesical IUD coated on
its distal end by a lithiasic aggregate. She
underwent a transurethral removal of IUD
with forceps in a rotary motion. There
was good apposition of the edges of the
small hole at the location where the IUD
transposed the detrusor. Bladder washing
was carried out to remove lithiasic debris.
S80
Excellent postoperative course and the
patient discharged 24 hours after the
procedure.
Conclusions: IUD migration is a rare
cause of bladder lithiasis secondary to foreign body. Patients suffering from IUD
should make regular follow-up radiological
examinations (abdominal plain x-ray, pelvic or transvaginal ultrasound). The possibility of uterine perforation should be
placed in patients that don’t report spontaneous exteriorization. Endoscopic removal was a safe and effective treatment
despite the close contact with an intestinal loop.
UP-2.02
The Effect of Tamsulosin in Female
Patients with Lower Urinary Tract
Symptoms and Predictive Factors for
Therapeutic Outcome: Multicenter,
Prospective Study
Lee SH1, Kim SY1, Lee WK1, Oh CY1,
Kim H1, Choi NG1, Lee SW2, Kim JH2,
Chung HC3, Park CM4
1
Department of Urology, School of Medicine, Hallym University, Chuncheon,
South Korea; 2Department of Urology,
Kangwon National University College of
Medicine, Chuncheon, South Korea; 3Department of Urology, Yonsei University,
Wonju College of Medicine, Wonju, South
Korea; 4Department of Urology, College
of Medicine, Ulsan University, Ulsan,
South Korea
Introduction and Objective: We performed a multicenter, prospective study
to evaluate the effect and outcome predictors of tamsulosin in female patients with
LUTS.
Methods: The total 82 female patients
with LUTS, irrespective of Qmax, from 4
medical centers were included. Initial
evaluations included International Prostate
Symptom Score (IPSS) for subjective assessment of LUTS, measurements of Qmax,
postvoid residual urine volume (PVR),
micturition frequency in daytime and
night, mean voided volume from uroflowmetry (UFR) and voiding diary for objective assessment and IPSS-quality of life
(QOL), Urogenital Distress Inventory
(UDI-6) for QOL assessment and measurements of blood pressure, pulse rate for
assessment of adverse events. All patients
were treated with tamsulosin at a dose
0.2mg/day and after 2 and 4 weeks of
treatment, we re-evaluated the patients
and analyzed the differences of these parameters.
Results: The mean age of the patients
was 53.4⫾9.8 years old and among the 82
patients, 50 (61%) had moderate LUTS, 32
(39%) had severe LUTS and 60 (73.2%)
had Qmax of ⬍15ml/sec, 22 (26.8%) had
Qmax of ⱖ15ml/sec. Total IPSS, voiding
and storage symptom scores were significantly decreased after 2,4 weeks of treatment and voiding symptom score was
more decreased than storage symptom
score (35.5% vs 25.3%, p⬍0.05). There
were significant improvements in Qmax,
PVR, frequency in daytime and night,
mean voided volume, IPSS-QOL and UDI-6
scores. When the improvement of LUTS
after treatment was defined as decrease in
IPSS more than 20% after 4 weeks of treatment, 58 (70.7%) were improved and in
multivariate analysis to determine the predictive factors influencing the improvement, voiding symptom score of IPSS before treatment was significantly associated
with the improvement of LUTS, whereas
age, Qmax, PVR and storage symptom
score were not. There was significant decrease in systolic blood pressure after 4
weeks of treatment; however, it did not
cause associated adverse events.
Conclusions: In female patients with
LUTS, tamsulosin was effective and well
tolerated for improving subjective, objective voiding symptoms and QOL, irrespective of Qmax. Therefore, tamsulosin may
be an initial treatment option in female
patients with LUTS, especially in patients
with severe voiding symptom of LUTS.
UP-2.03
Improvement of lower urinary tract
dysfunction after trocar-guided
transvaginal mesh repair of pelvic
organ prolapse in elderly women
Lee SJ, Park DC
St. Vincent’s Hospital, Catholic University
of Korea, Suwon, South Korea
Introduction and Objective: Lower urinary tract dysfunction occurs frequently
in elderly women with pelvic organ prolapse and urinary incontinence. Our purpose was to compare lower urinary tract
symptoms in women with uterovaginal
prolapse before and after trocar-guided
transvaginal mesh repair.
Materials and Methods: Thirty-two sexually active women, mean age 61 (52-68)
years, with stage ⬎or⫽3 prolapse according to the pelvic organ prolapse quantification (POP-Q) system underwent vaginal
total hysterectomy with trocar-guided
transvaginal mesh repair (Prolift) surgery.
All patients were evaluated by pelvic examination and urodynamics. The women
completed the Pelvic Floor Distress Inventory at baseline and again 6 months after
surgery. Postoperative changes in symptoms of urinary urgency, frequency, and
urge urinary incontinence were assessed.
If a mid-urethral sling for stress urinary
incontinence was required, tension-free
vaginal tape-obturator (TVT-O) was undertaken at the end of surgery.
Results: A TVT-O for stress urinary incontinence was performed in 75% of the patients. Recurrent prolapse did not occur
in follow-up patients. Detrusor overactivity was documented in 15.6% of patients.
Surgery resulted in a significant reduction
of urgency and frequency symptoms 6
months after surgery. Overall, a clinically
and statistically significant improvement in
the irritative subscale of the Pelvic Floor
Distress Inventory was observed at 6
months (26.3%, P ⬍ 0.001) after surgery.
There were no significant changes in uroflowmetry parameters.
Conclusions: Trocar-guided transvaginal
mesh repair surgery for stage 3 or 4 pelvic organ prolapse significantly reduces
lower urinary tract symptoms in elderly
women as did improvement of anatomical
prolapse at 6 months after surgery.
UP-2.04
Transvaginal repair of genital
prolapse with prolift system:
morbidity and anatomic outcomes
after 5 years of use: a multicentric
study
Ripert T1, Ménard J1, Messaoudi R1,
Azemar M1, Samarcq B2,
Nicolacopoulos Y2, Bednarzyck L3,
Staerman F1
1
Dept. of Urology-Andrology. Robert
Debrè Academic Hospital, Reims, France;
2
Dept. of Urology, Manchester General
Hospital, Charleville, France; 3Dept. of
Obstetrics and Gynecology, Manchester
General Hospital, Charleville, France
Introduction and Objectives: The Gynecare Prolift™ mesh system for treatment
of genital prolapse was introduced in
2005. We reported our outcomes using
this new vaginal approach in pelvic
reconstruction.
retrospective chart review of all patients
who underwent a Prolift™ procedure in 2
centres. We recorded all intra-operative
incidents, post-operative complications,
anatomical and functional outcomes. All
patients underwent a recent pelvic examination. Failure was defined as recurrent
prolapse (stageⱖ2) or any symptomatic
prolapse. We reported the rate of de novo
prolapse of an initially unaffected and
non-treated vaginal compartment and assessed the post-operative sexuality.
Results: Over a 5-year period, 70 consecutive patients were included with a mean
follow-up of 26.3 months (1-55). Mean
age was 63.8⫾11.2 years (40-83) and median parity was 3 (1-8). Twenty seven patients had a stage 3 (38.6%) and 4 patients, a stage 4 (5.7%). Prolift™ surgery
was performed for prolapse recurrence in
27.1% (n⫽19). Total mesh was used in 20
patients (28.6%), an isolated anterior mesh
in 31 patients (44.3) and an isolated posterior mesh in 19 patients (27.1%). Concomitant surgical procedures were performed in 25 patients (35.7%). We
reported 3 intra-operative bladder injuries
(4.3%). None transfusion and bleeding
greater than 250mL were reported. Postoperative complications occured in 25.7%
(n⫽18) including defecation difficulties
(7), urinary tract infections (2), urinary
retentions (2), infections (3), chronic pain
syndroms (2) and mesh exposures (2).
One mesh exposure was successfully managed with mesh resection under anesthesia; the second required ablation after secondary retraction at 45 months. Overall,
88.8% (16/18) of the complications were
managed medically. We reported a failure
rate of 7.1% (n⫽5) occuring after a mean
of 16.4⫾11.2 months (6-35). Four patients
presented a de novo prolapse (5.7%).
Thirty six patients had pre-operative sexual activity (51.4%). The de novo dyspareunia rate was 25% (n⫽9; insertion
(5), deep penetration (1), throughout intercourse (3)). Four patients reported a
decline of their sexual activity after surgery (11%).
Conclusions: The Prolift™ system seems
to be associated with few severe complications and achieved good mid-term anatomic outcomes. A long term follow-up is
necessary to confirm the effectiveness of
the procedure.
UP-2.05
Female urethral diverticulum and the
result of surgical repair
Sharifiaghdas F, Mortazavi N,
Ghaderian N
Shahid Labbafinejad Hospital, Urology
Nephrology Research Center, Shahid
Beheshti University of Medical Sciences,
Tehran, Iran
Introduction and Objective: To report a
case series of female urethral diverticulum
and the result of surgical repair.
Method and Materials: The inpatient
medical record of all female patients with
urethral diverticulum who underwent surgical repair during 9 years (2001-2010)
were studied. Data including age, the interval between symptom onset and clinical diagnosis, pregnancy rate and delivery,
previous pelvic surgeries, lab tests (CBC,
serum biochemistry, U/A,U/C), imaging
results including ultrasound, voiding cystourethrography, MRI, and cystourethroscopy was recorded.
Results: Fifteen patients with a mean age
of 49 (range 39-71) years were evaluated.
Mean interval between the onset of symptoms and clinical diagnosis was 10.2 (9
months to 18 yrs) years. Eleven were multipar. Recurrent or persistant urinary tract
infection was documented in all. Six and
nine patients suffered from stress urinary
incontinence and dyspareunia. Diverticular stone was documented in 2. Eight patients had previous history of multiple
times cystoscopy and urethral dilation
(mean 3.5 times). Cystoscopy was diagnostic in 3 patients, VCUG in 4, and MRI
in all 8 cases. All patients underwent diverticulectomy and urethral repair. Surgical access was vaginal access without
graft or flap interposition in eight patients; seven underwent combined abdominal – vaginal repair with rectus fascial
graft and martius flap. One case of surgical failure was re-operated through combined access. Mean post– op follow up
time was 33 (range 9-61) months.
Conclusion: Female urethral diverticulum
is rare. The interval between symptom onset and clinical diagnosis is often very long,
though the surgical success rate is high.
UP-2.06
Vesicovaginal fistulas: the surgical
management in our center
Golmayo Muñoz-Delgado E,
Sanchis Bonet A, Olivares J,
Rodriguez Cruz I, Sanchez Chapado M
Hospital Universitario Principe De Asturias, Madrid, Spain
Introduction and Objectives: Globally,
the most frequent cause of vesicovaginal
fistulas (VVF) is the obstetric procedure,
while in our society, the fistulas are
mostly associated with gynecologic procedures, most frequently with the hysterectomy. The objective is to investigate the
causes of VVF and review the surgical
management of these patients in our center.
review of 26 patients with the diagnosis
of an urinary fistula, 23 VVF and 3 ureterovaginal (UVF), which have been
treated with a surgical procedure in our
center during the last 16 years.
Results: Of the fistulas, 65.4% were produced during an hysterectomy. The radical hysterectomy associated to a gynecologic cancer was the most frequent cause.
In 8 cases, the simple hysterectomy was
due to a benign condition (adenomyosis).
S81
Of the fistulas 15.4% had an obstetric
cause. The radiation treatment induced a
fistula in 11.5% of the patients. The failure
of conservative management with catheterization treatment confirmed with imaging studies (cistourography or intravenous
urogram and cystoscopy) lead us to the
surgical treatment in 26 patients. The
most common location of the fistula was
supratigonal. The abdominal approach,
using the bivalve or the transvesical technique with or without the use of flaps,
was the most frequently used in our center. Only in one case the fistula was
treated with a vaginal approach as a primary repair which failed, using a peritoneal flap in an abdominal approach as a
second treatment. Five of our patients
(19,2%) required a ureteral implantation
due to a concomitant ureteral lesion. With
a median follow-up of 24 months, 95% of
our patients were dry.
Conclusions: The abdominal approach
for the repair of the VVF with or without
use of flaps has demonstrated to be a successful approach in our center.
UP-2.07
Disorders in urinary bladder
micturition after rectal operations
Addali M, Zugor V, Witt J, Porres D
St. Antonius Hospital, Gronau, Germany
Introduction and Objective: Functional
disorders of micturition after rectal resection were investigated on an in-house patient collective. Because the neuro-anatomy
of the small pelvis is very complex, the aim
of this study was to evaluate the incidence
and form of disorders in micturition.
patients were operated on for a rectal carcinoma during the period 2000 to 2004.
Patients with a recurrent tumor and patients who died during the study were
excluded (140 patients). All patients were
retrospectively questioned on the preoperative and postoperative bladder function using a standard questionnaire.
Results: The patient collective consisted
of 167 males and 111 females with an average age of 63 years and a mean follow-up time of 2.6 years. Age (⬍65 years
versus ⬎65 years) was found not to play a
significant role with respect to micturition
(p⬎0.05). Of the patients, 20 already had
a pollakisuria before the operation, and 63
patients after the operation. Also 9 patients already had a nycturia before the
operation, and 55 after the operation. An
imperative urgency to urinate was experienced by 9 patients before and 47 after
the operation. Stress incontinence grade I
was present in 21 patients before the op-
S82
eration, grade II in 4 patients and grade III
in 1 patient. Of the patients 43 complained of stress incontinence grade I after the operation, 20 patients of a grade II
and 15 of a grade III. The postoperative
quality of life was assessed as very limited
by 57 patients and moderately limited
by 85.
Conclusions: Functional disorders of
micturition after rectal resection in rectal
cancer patients are commonly occurring
complications which have received relatively little attention in the literature considering the clinical significance. Only few
affected patients have received a urological treatment. Further studies are necessary, also experimental in nature, to understand the neuro-anatomy of the small
pelvis in order to avoid intra-operative
neurolesions as far as possible.
UP-2.08
TVT vs. TOT: a comparison of
continence results, complications
and quality of life after a median
follow-up of 48 months
Addali M, Zugor V, Witt J, Porres D
St. Antonius Hospital, Gronau, Germany
Introduction and Objective: To compare the tension-free vaginal tape (TVT)
and obturator tape (TOT) procedures in
terms of continence results, complications and quality of life after a median
follow-up of 48 months.
Materials and Methods: Two hundred
and eight female patients suffering from
urodynamically proven urinary incontinence underwent TVT or TOT. The clinicopathologic parameters of the patients
included age, body mass index, type of
incontinence, onset of incontinence, previous pelvic surgery, parity, menopausal
statement, perioperative and postoperative complications and outcome in terms
of continence and quality of life.
Results: TVT was performed on 48.6% of
patients and TOT on 51.4%. The median
age was 63.4 and median follow-up period
was 48 months. Prior to surgery, stress
urinary incontinence (SUI) was diagnosed
in 75.7% of patients and mixed incontinence (SUI and urge incontinence) with a
predominant SUI in 24.3%. An objective
cure rate in patients who underwent TOT
was observed in 77.7% of cases and in
those who underwent TVT in 81%. The
quality of life improved in 80% of cases.
There was no significant difference between the procedures in terms of continence results and quality of life. The rate
of the complications was significantly
higher with the TVT procedure when
compared to that of the TOT procedure.
Conclusions: Although there were no
significant differences between the two
types of procedures in terms of continence results and quality of life, the TOT
procedure demonstrates significantly better results in terms of the rate of complications, making it, if indicated, our first
choice.
UP-2.09
Consideration on surgical results and
quality of life in the surgical repair of
anterior vaginal prolapse
Brancato T1, Nupieri P1, d’Ascenzo R1,
Orsolini G1, Paulis G1, Valducci G2,
Alvaro R3
1
Dept. of Urology, Regina Apostolorum
Hospital, Rome; 2Gynecology, Cristo Re
Hospital, Rome; 3Nursing Sciences, Tor
Vergata University, Rome, Italy
Introduction and Objective: In the last
decade, there has been an increase in the
use of graft materials in vaginal prolapse
surgery. Common approach of cystocele
repair is the use of anterior wall mesh
placed via a transobturator route. Despite
good surgical results scant evidences has
been reported on the evaluation of quality-of-life (QOL) in those patients. The aim
of this study is to evaluate the midterm
results of surgical intervention and the
impact on patients’ QOL before and after
transvaginal surgery.
to 2009, 21 patients (median age: 62.7
years) with ⬎/⫽ stage II anterior wall prolapse defined using International Continence Society guidelines, underwent bladder neck suspension with anterior/
posterior colporrhaphy with an anterior
wall soft-polypropylene mesh (Perigee
system, AMS Inc.) placed via a transobturatory approach. Concomitant procedures in other compartment were also
completed as indicated. Mean follow-up
was 7,5 months (range 3-18 months).
Twelve patients (57%) had urinary incontinence and were treated with TOT at the
same time. Cystography and urodynamic
study was performed in all patients. Quality of life questionnaires were administered at baseline and at first three months
follow-up. All patients completed a FSFI
questionnaire.
Results: At midterm six months followup, we observe a 100% objective cure
rate. None of the patients has mesh exposure or required other reparative surgery
for cystocele. There were no incidences
of chronic pain, infection, or abscess, and
no patient required complete mesh removal for infection, pain, or extrusion. In
women with normal sexual activity we
observe a 10% of improvement of FSFI
scores in the domains desire, arousal, lubrication, overall satisfaction. When
present, orgasm remained unchanged.
Conclusions: The Perigee System, via the
transobturator route is a safe and effective
procedure to repair cystocele with a low
rate of complications as well as improving
the QOL.
UP-2.10
Midterm results of continence,
complications and quality of life after
TOT procedure
Brancato T1, Nupieri P1, D’Ascenzo R1,
Orsolini G1, Paulis G1, Valducci G2,
Alvaro R3
1
Dept. Urology, Regina Apostolorum Hospital, Rome; 2Gynecology, Cristo Re Hospital, Rome; 3Nursing Sciences, Tor Vergata University, Rome, Italy
Introduction and Objective: Mid-urethral slings are currently considered the
treatment of choice for stress urinary incontinence (SUI) because simpler than
previous anti-incontinence surgeries and
the feasibility under local anesthesia. Success rate of the procedure has reached
90% in world reports.
Materials and Methods: Fifty female patients suffering from urodynamically
proven urinary stress incontinence underwent TOT between January 2006 and December 2009. The clinico pathologic parameters of the patients included age,
body mass index, type of incontinence,
onset of incontinence, previous pelvic
surgery, parity, menopausal statement,
perioperative and postoperative complications and outcome in terms of continence. Quality of life (QoL) was measured
by administrating the Incontinence (IQoL) questionnaire before, at three and
12 months after the procedure.
Results: Prior to surgery, stress urinary
incontinence (SUI) was diagnosed in
75.7% of patients and mixed urinary incontinence (MUI) with a predominant SUI
in 24.3%. Previous gynaecological surgery
was present in 62% of patients. The median onset of incontinence was 43 months
(18-63). The median age was 64,3 and
median follow-up period was 19,2 months
(range 4-43 months). An objective cure
rate in patients who underwent TOT was
observed in 77.7% of cases. The quality of
life improved in 80% of cases. A “de
novo” urgency occurred in 5,2% of patients. Mean operative time was shorter
(20 min⫹/⫺6). No bladder injury occurred. Three months after surgery, the
average I-QoL score was found to have
improved to 53,2⫹/⫺10,3 points and
there were no significant differences between stress and mixed urinary incontinence in terms of cure and satisfaction
(p⬎0.03).
Conclusions: Although there were no
significant differences between the two
types of procedures in terms of continence results and quality of life, the TOT
procedure demonstrates significantly better results in terms of the rate of complications, making it, if indicated, our first
choice.
UP-2.11
A comparative analysis of MiniArc™
™
and Monarc™
™ sub-urethral slings for
female stress urinary incontinence
Brown A, Khafagy R, Kabir S, Kimuli M,
Urwin G
York Hospital, Beverley, United Kingdom
Introduction and Objective: Women
with SUI prior to July 2007 underwent
the Monarc™ transobturator procedure.
Following the introduction of the MiniArc™ single incision sub-urethral sling
procedures after this date, we undertook
a comparative analysis of the two methods.
casenote analyses of the last sixty
Monarc™ and the first sixty MiniArc™
performed. Demographics, previous pelvic
and bladder neck surgery and the effect
on preceding symptoms analyzed, together with time-specific outcomes and
further intervention.
Results: In total, 60 Monarc™ sling procedures and 55 MiniArc™ procedures
were analyzed. Outcome criteria included
continence or subjective improvement
following procedure.
The Monarc™ sling produced an overall
improvement for 51 patients (88%, 95%
CI - 8%). Forty-nine patients were dry by 3
months (82%, 95% CI – 9%) and two patients (3%) reported and overall improvement but still experiencing leakage. Seven
patients (12%) did not experience and
overall improvement and required further
intervention. The MiniArc™ sling produced an overall improvement in 46 cases
(88%, 95% CI – 8.68%). Thirty-seven patients (71%, 95% CI – 12%) were dry by 3
months and 8 patients (15%) reported an
overall improvement but still experiencing
leakage. There were six (11%) required
further investigation or treatment. Statistically there is no significant difference between the two groups for improvement
(Chi squared 0.007 with 1 df, 2 tailed p⫽
0.93). There is also no significant difference in being dry at 3 months (Chi
squared 1.67 with 1df, 2 tailed p⫽0.20).
Conclusions: The MiniArc™ is a well
tolerated procedure and results are comparable with the prior Monarc™ treatment.
UP-2.12
Laparoscopic sacrocolpopexy: initial
experience in 10 cases
Castillo O1,2,3, Foneron A1, Gómez R1,
Vidal-Mora I1,3, Rubio G1,3, Campos R1
1
Dept. of Urology, Clinica Indisa, Santiago; 2Faculty of Medicine, Universidad
Andrés Bello, Santiago; 3Faculty of Medicine, Universidad de Chile, Santiago,
Chile
Introduction and Objective: The loss of
normal paracolpos and parametria support
(Delancey level 1) is associated with uterine prolapse, vaginal vault prolapse (VVP)
and enterocele. Abdominal Sacrocolpopexy is the gold standard for VVP
showing lower rates of recurrence and
less dyspareunia than vaginal sacrocolpopexy. Our aim is to present our experience in laparoscopic sacrocolpopexy assessing its feasibility and reproducibility.
prospective analysis of laparoscopic sacrocolpopexy operated between April 2004
and May 2009. For each case we reviewed
the surgical history and the presence of
urinary incontinence, surgical technique
and associated surgery, operative time,
length of hospital stay and perioperative
complications.
Results: During this period 10 laparoscopic sacrocolpopexy were performed.
Average age was 50.6 years. Four patients
had a history of prior hysterectomy and
one patient had a history of surgery for
VVP. Six patients were managed with a
mesh to the vaginal vault and 4 with an
anteroposterior mesh. In 4 patients we
also performed a subtotal hysterectomy
and in 1 patient a total hysterectomy. Five
patients had a history of urinary incontinence. Four of them were managed with
a transobturator tape (TOT) and 1 with a
transvaginal tape (TVT). Average operative
time was 103,7 minutes (45-130) and
mean length of hospital stay was 2.7
days (2-3). All patients evolved without
complications.
Conclusions: Laparoscopic sacrocolpopexy is a feasible technique that can
safely achieve the concepts of open
sacrocolpopexy.
S83
UP-2.13
Characteristics of lower urinary tract
symptoms and efficacy of treatment
with desmopressin in female
patients
Cho HJ, Kim SJ, Yun BI, Hong SH,
Lee JY, Kim SW, Hwang TK
The Catholic University of Korea, Seoul,
South Korea
Introduction and Objective: Nocturia is
one of the important lower urinary tract
symptoms to cause a decline in quality of
life and about 15% of females experience
more than 2 voids per night. However,
there are few studies about nocturia in
females. Therefore we studied, retrospectively, the cause of nocturia, the efficacy
of desmopressin and the relation with
other lower urinary tract symptoms in
female patient.
Materials and Methods: Seventy-two
female patients who were bothered by
voiding one or more times nightly concomitant with other LUTS and treated
with desmopressin 0.2 mg were included
in this study. The baseline evaluation included a careful history taking, physical
examination, international prostate symptom score (IPSS) and consecutive voiding
diaries for 3 days. Voiding diary data was
used to derive nocturnal polyuria index
(NPi) and nocturnal bladder capacity index (NBCi). Nocturnal polyuria was defined as a nighttime urine volume of more
than 35% of the total daily urine volume
and reduced nocturnal bladder capacity
was defined as NBCi greater than 0. After
treatment with desmopressin, a reduction
by more than half in the number of nocturnal voids compared with baseline was
regarded as effective.
Results: The mean patient age was 66.8
(40-88). The mean nocturnal voids were
3.6⫾1.0 per night. Nocturnal poyuria and
reduced nocturnal bladder capacity were
observed in 20/72(27.8%) and 4/72(5.6%),
respectively. Forty-eight patients (66.7%)
showed both nocturnal polyuria and reduced nocturnal bladder capacity. Mean
IPSS total score, mean IPSS voiding subscore, mean IPSS storage sub-score and
QoL score were 18.9⫾9.7, 9.3⫾7.1,
10.1⫾4.4 and 4.2⫾1.5, respectively.
Twenty-four patients were treated with
antimuscarinics and 4 patients took alpha
blockers. Twenty-one patients showed a
significant decrease in the mean nocturnal
voids from 3.6⫾1.0 to 1.4⫾1.2 after treatment (p⬍0.05). There were no remarkable differences in the baseline IPSS score
and LUTS regardless of the improvements
of nocturia after therapy with desmopres-
S84
sin. The patients did not respond to the
desmopressin and showed significantly
increased NBCi (0.9⫾0.5) compared to
the patients who showed improvement
(0.5⫾0.4) (p⬍0.05). However, 62.5% (45/
72) patients with response to desmopressin also showed decreased NBCi.
Conclusions: The important cause of
nocturia in female patients is considered
as not only nocturnal poyuria but also
reduced nocturnal bladder capacity. Moreover, reduced nocturnal bladder capacity
was noted in more than 50% in the patients as a treatment effect. Therefore desmopressin may have an effect on reduced
nocturnal bladder capacity as well as nocturnal polyuria in female patients with
nocturia.
UP-2.14
The effects of the REMEEX system®
for treatment of re-do urinary
incontinence and intrinsic sphincteric
deficiency
Jung H1, Song P1, Kim J1, Oh T2, Park J3
1
YeungNam University, Daegu;
2
SungKyunkwan University, Masan Samsung Hospital, Masan; 3Dept. of Urology,
College of Medicine, Daegu Catholic University, Daegu, South Korea
was conducted to evaluate the effectiveness of the REMEEX system® (EXternal
MEchanical REgulation, Neomedic International, Terrassa (Barcelona), Spain)
for treatment of re-do urinary incontinence and intrinsic sphincteric
deficiency.
Materials and Methods: From August
2006 to January 2009, a total of 43 patients underwent the REMEEX system威.
Patients were categorized into failed urinary incontinence (Group A, 16 patients)
and intrinsic sphincteric deficiency
(Group B, 27 patients). Of the 43 patients,
16 had previous incontinence surgical interventions, 9 had other pelvic surgeries,
and 10 either had spine surgery, diabetes
mellitus, cerebrovascular accident, Parkinson’s disease, spine fracture, herniated
lumbar disc, mood disorder or so on. The
success rate of patients after surgery was
assessed by cure and satisfaction rate followed up postoperatively at 1, 6, and 12
months. Clinical, urodynamic, peri- and
post-operative data with respect to success rates were analyzed.
Results: The mean age of patients was
61.7 years (range 44-81) and the mean
follow-up period was 20.1 months (range
12-34). Total cure rates with the REMEEX
system威 (Group A/Group B) were 100.0%/
96.3% at 1 month and 100.0%/76.2% at
12-month follow-up. Satisfaction rates
were 100.0%/88.8% at 1 month and
83.4%/71.5% at 12-month follow-up in
group A and B. Neither bladder puncture
(37.2%) nor surgical wound infection
(7.0%) statistically influenced the cure and
satisfaction rate of the REMEEX system威
in either group (P⫽0.681, P⫽0.451, respectively) by Fisher’s exact test.
Conclusions: The REMEEX system威 may
be an effective procedure regardless of
previous incontinence surgical interventions and intrinsic sphincteric deficiency.
The absence of adverse events associated
with the REMEEX system威 until 12-month
follow-up and high subjective and objective 12-month postoperative success rates
make the REMEEX system威 a recommendable surgical treatment for re-do urinary
incontinence and intrinsic sphincteric
deficiency.
UP-2.15
The effect of stage II or less cystocele
on voiding pattern after midurethral
sling
Kim H1, Paick S1, Lho Y1, Park H1,
Park W2, Jo M3
1
Konkuk University, School of Medicine,
Seoul; 2Inha University College of Medicine, Incheon; 3Korea Cancer Center Hospital, Seoul, South Korea
Introduction and Objective: The presence of cystocele is known to be negative
effect after sling surgery. We investigate
the effect of stage II or less cystocele on
voiding pattern after sling surgery in stress
incontinence patients.
Materials and Methods: From March
2008 to November 2010, we reviewed
medical records of 164 patients who underwent mid urethral sling and did not
undergo cystocele repair concomitantly.
Urodynamic study was done to all patients. According ICS cystocele grade, we
classified patients into 0, I and II grade.
No cystocele group was defined as patients who had cystocele of 0 and cystocele group was defined as grade I or II.
We compared the preoperative and postoperative IPSS score, quality of life (QoL)
scare, peak uroflow (Q max), post void
residual (PVR) and success rate of sling
surgery between two groups.
Results: Among the 164 patients, 137
were in no cystocele group and 27 in cystocele group. The mean patient age, preoperative Q max, PVR, IPSS score and
QoL score were similar in the two groups.
In urodynamic study, MUCP and VLPP
value were no different between two
groups. After 3 month of sling surgery, Q
max, PVR, IPSS score and QoL score were
not statistically different between two
groups. The success rate of sling surgery
was 90% and 92% respectively and did not
statistically different.
Conclusions: Sling surgery without cystocele repair did not affect voiding pattern
or sling success rate to patients who have
stress incontinence and cystocele grade I
or II compared to patients who have no
cystocele. Our study suggests that cystocele repair is not mandatory with sling
surgery for patient who have cystocele
grade I or II.
Conclusions: Obese SUI patients had
worse SUI symptom grade, urgency and
urge incontinence symptoms than nonobese patients. However, surgical correction using TOT operation could restore
the symptoms and voiding parameters as
effectively as with non-obese patients.
UP-2.16
The influence of obesity on patients
with female stress urinary
incontinence
Kim Y1, Kim W1, Tchey D1, Yun S1,
Lee S1, Kim W1, Jo S2
Dept. of Urology, 1Chungbuk National
University College of Medicine, Cheongju;
2
Cheongju Saint Mary’s Hospital, Cheongju, South Korea
UP-2.17
Postoperative voiding difficulty after
midurethral sling surgery in female
stress urinary incontinence: when
does it get better?
Lee D1, Kim J2, Kim Y3, Choi J4, Kim H5,
Lee T6, Park W6
Depts. of Urology, 1Incheon St. Mary’s
Hospital, The Catholic University of Korea, Incheon; 2Bucheon St. Mary’s Hospital, The Catholic University of Korea,
Bucheon; 3Bucheon Soonchunhyang Hospital, Soonchunhyang University,
Bucheon; 4Ajou University, Suwon; 5St.
Paul’s Hospital, The Catholic University
of Korea, Seoul; 6Inha University Hospital, Incheon, South Korea
Objective: The purpose of our study was
to evaluate the influence of obesity on the
clinical characteristics, quality of life
(QoL) and outcomes in the stress urinary
incontinence patients who underwent the
transobturator tape (TOT) surgery.
Materials and Methods: The items of
preoperative evaluations consisted of history taking, physical examination, cystometrography, 3 day frequency-volume
chart, King’s health questionnaire (KHQ)
and symptom perception scale questionnaires. Patients with any neurologic diseases that affect the voiding pattern were
excluded. From 2007 to 2009, 107 patients with TOT operation were enrolled.
The patients were divided into non-obese
(BMI⬍25) and obese group (BMIⱖ25).
Results: The non-obese group was 55
(51.4%) patients and obese group was 52
(48.6%). The median age was 49.0 (30.873.5) years in non-obese group and 52.7
(35.5-73.5) in obese group (p⬎0.05). The
obese group showed the higher SUI symptom grade, urethral hypermobility, urgency and urge incontinence scale than
the non-obese group (each p⬍0.05). Each
domain of KHQ and item of 3-day frequency-volume chart did not show the
differences between two groups (each
p⬎0.05). After the operation, the symptom scales and parameters in the 3-day
frequency-volume chart of the obese
group were similar to those of the nonobese group (each p⬎0.05). The objective
success, recurrence and complication
rates in 1 year were similar in the two
groups (each p⬎0.05).
was designed to clarify the time when the
voiding difficulty caused by midurethral
sling procedure was disappeared spontaneously by prospective observation of the
patients’ natural courses with regard to
obstructive symptom after sling procedure.
Materials and Methods: We observed
patients’ voiding difficulties that occurred
immediately after transobturator sling surgery for female stress urinary incontinence from October 2006 to August 2007.
Those patients who have complained of
voiding difficulties were asked about the
time when those symptoms were disappeared spontaneously at weekly interval.
Voiding difficulty was defined as postoperative subjective symptom of decreased
urine flow compared to that before surgery. Patients who underwent urethral
dilatation, tape release or administration
of alpha blocker due to large postvoid
residual urine were excluded in this
study.
Results: Sixteen (12.7%) out of 126 patients had complained of voiding difficulties immediately after surgery. However, 2
patients who were managed by urethral
dilatation or tape release because of larger
amount of postvoid residual urine (⬎400
ml) were excluded. The mean age of 14
patients were 44.7 years old and 5 had
low valsalva leak point pressure (⬍60
cmH2O); 1 had low peak urine flow (⬍20
ml/sec). Concomitant surgeries were hysterectomy in 3, perineorrhaphy in 3 and 3
patients were mixed incontinence. All had
no residual urine at the time of discharge
from hospital. Voiding difficulties were
disappeared spontaneously; 5 in the second, 3 in the third, 1 in the fourth, 2 in
the fifth, 1 in the sixth, 1 in the eighth
week. However, the remaining 1 had
complained of persisted voiding difficulty
since 4 months after surgery. Voiding difficulties disappeared within 6 weeks in 12
(85.7%) out of 14 patients.
Conclusions: Most of the postoperative
voiding difficulties immediately after sling
surgery disappeared spontaneously within
6 weeks. Therefore, we need to make
those patients who showed voiding difficulties after sling surgery feel relieved.
UP-2.18
Evaluation of a modified novel vaginal
flap operation in stress urinary
incontinence (SUI) using dynamic
MRI
Fayed A, Abdelkarim A, Mahfouz W,
Elsalmy S
Genitourinary Surgery, Alexandria University, Alexandria, Egypt
Introduction and Objective: Stress urinary
incontinence is a common problem among
women in all age groups. Numerous risk
factors have been identified as age, parity,
menopause and hysterectomy. Dynamic
MRI has been used to evaluate success after
surgical treatment of incontinence. The objective of this study was objective evaluation of tension-free vaginal flap (TVF) operation in SUI using Dynamic MRI and
understanding the possible mechanisms of
continence offered by this operation.
Materials and Methods: Twenty female
patients were included in this prospective
study from September 2006 to February
2008. All patients underwent thorough
history taking, physical examination, urodynamics and dynamic MRI. The operation was done with creation of a trapezoid vaginal flap based on the midurethra.
The endopelvic fascia was opened on
both sides through the retropubic spaces.
Four corners prolene sutures were taken
in the flap. The sutures were drawn to
the suprapubic region through two separate stab incisions situated 2 cm lateral to
the midline using a Stamey needle. The
sutures of each side were ligated to each
other without tension, 1 cm superficial to
the rectus sheath. Dynamic MRI was done
in the supine position one week preoperatively and six months postoperatively. Images were obtained in the mid-sagittal
plane both at rest and during straining.
Images were evaluated for anatomical
stress urinary incontinence alterations,
such as the increased distance between
the pubococcygeal line and the bladder
S85
base and the posterior urethrovesical angle and the urethral inclination angle. Another 2 new measurements were used in
our study; the distance between the
symphsis pubis and the posterior bladder
neck, and the distance between the symphysis pubis and the anterior bladder
neck, both were measured during straining.
Results: Compared to the preoperative
data, the bladder base was raised significantly to an average of 0.65cm
(P⬍0.0001), posterior urethrovesical angle
was decreased significantly to a mean of
130.3°(P⬍0.0001), angle of urethral inclination was decreased significantly to a
mean of 13.6°(P⬍0.0001). There was no
significant decrease in the distance between the symphysis pubis & the anterior
bladder neck postoperatively (P⬍0.119).
The distance between the symphysis pubis and the posterior bladder neck was
significantly decreased postoperatively
during stress ranging between 0.6 cm and
2 cm with a mean of 1.275 cm (P⬍0.004).
Conclusion: TVF has a high success rate
of 92% in treatment of SUI with a relative
low complication rate. It is effective in
urethral hypermobility and mild forms of
ISD. Tension-free vaginal flap (TVF) can
restore female stress urinary continence
through elevation of the bladder in a
more retropubic position as well as compression of the posterior urethral wall towards the anterior urethral wall (coaptation). Dynamic MRI has an important
value as an academic tool that help understand the pathophysiology of stress urinary incontinence and can prove or disprove the different proposed theories of
the etiology of stress urinary incontinence.
UP-2.19
Adjustable devices in the treatment of
stress incontinence
Middela S1, Hejj R2, Chow W2, Barnes D2
1
Manchester Royal Infirmary; 2North
Manchester General Hospital, Manchester, UK
Introduction and Objective: Artificial
urinary sphincter insertion has been the
gold standard for stress incontinence (SUI)
in post prostatectomy male and complicated / recurrent female patients. Adjustable slings and balloons offer minimally
invasive alternatives helping to achieve
the balance between leakage and urinary
retention. We describe our single institutional experience with adjustable slings
(REMEEX system®) and balloons (Pro-ACT
system®) in 17 patients.
Materials and Methods: Seventeen patients were offered surgical intervention
by a single surgeon for mild to moderate
S86
SUI (Grade I – II). Symptomatic failures
after one year of conservative management were offered surgical treatment. All
the patients underwent evaluation by
means of flow rate (FR), post void scans
(PVS), urodynamic tests and flexible cystoscopy preoperatively. Immediate postoperative FR and PVS were performed
before discharge. Flexible cystoscopy was
carried out before and after readjusting
the slings. Successful treatment was defined by zero usage of pads and partial
success by usage of a single pad during
activity.
Results: Fourteen male and three female
patients with an average age of 65 years
had surgical intervention for SUI. The indications being post prostatectomy (Radical
– 10, TURP – 1), post prostatic radiotherapy (2), neurological (spina bifida – 1)
and mixed incontinence in 3 females (previous surgical failures). Twelve patients
had Remeex adjustable slings while 5 patients had Proact balloon devices inserted.
The average follow-up was 2 years (range
1-4 years). Average adjustments of 1.8 per
patient were undertaken. Nine patients
were completely dry (53%), two patients
(12%) needed pads only during vigorous
activity. Six patients (35.3%) did not experience any benefit. Complications were in
the non-benefit group included infection
resulting in removal (1), migration (1), mechanical failure (1), urinary retention (1)
and new onset overactive bladder. There
were no intraoperative complications.
Conclusions: Adjustable devices are a
reasonable alternative method of improving the continence in this group of patients. A significant improvement is
seen in 65% of patients in the midterm
period.
UP-2.20
Sacrospinous ligament fixation for
vaginal vault prolapse with a reusable
suturing device (RSD-Ney) in 5 minutes
Neymeyer J1, Abou-Dakn M2,
Abdul-Wahab Al-Ansari W1, Greiner E1,
Kassin S1, Beer M1
1
Dept. of Urology & Urogynecology,
Franziskus-Hospital-Berlin; 2 Dept. of Gynecology & Obsterics, St. Joseph-HospitalBerlin, Berlin, Germany
Introduction and Objective: To reduce
operation time and intra- and postoperative complications, we developed a new
reusable suturing device (RSD-Ney) and
looked for follow-up results in women
with sacrospinous ligament fixation.
Materials and Methods: Between
01/2009 and 03/2010, 58 women (mean
age 76.3 years, range 46 to 93 years) underwent vaginal unilateral sacrospinous
ligament fixation with the RSD. All patients had had prior hysterectomy. In 32
patients, sacrospinous ligament fixation
was combined with the following procedures: 26 enterocele repairs, 29 anterior colporrhaphies and 9 posterior
colporrhaphies.
Results: All 58 patients were analyzed
especially for operative handling by using
the RSD and intra- and postoperative complications. The time of secure finding and
suturing the sacrospinous ligament with
the RSD was 3 (2-5) min. The total mean
operation time was 25 (15-36) min. Main
complication registered were urinary tract
infection (n ⫽ 8), temporary irritation of
the sciatic nerve (n ⫽ 2) and blood loss
less than 200 ml (n ⫽ 4). All occurred in
the postoperative phase. We did not find
any temporary partial ureteral obstruction.
Figure 1, UP-2.20
Figure 2, UP-2.20
Recurrent cystoceles, rectoceles, enteroceles were found in 2 cases. These patients complete recurrence of vaginal
vault prolapse successfully underwent
with a vaginal titanium coated mesh interposition. The mean duration of follow-up
was 9 (4-13) months.
Conclusions: Sacrospinous ligament fixation with the reusable suturing device is
an effective and safe procedure with a
low recurrence and complication rate.
The procedure has the advantage of fast
and secure suturing the sacrospinlous ligament, facilitating other vaginal repairs
needed during the same operation, preserving vaginal function and shortening
the time necessary for anesthesia and
surgery.
UP-2.21
Preliminary report of the readjustable
sling procedures for treatment of
stress urinary incontinence with
intrinsic sphincter deficiency in
Korean females
Noh JH1, Jeong HJ2
1
Kwangu Christian Hospital, Gwangju;
2
Wonkwang University School of Medicine, Iksan, South Korea
Introduction and Objective: The
Remeex (Mechanical External Regulation)
sling as a bladder neck sling that allows
adjustment of the sling tension in the
postoperative period. We evaluated the
early outcomes of the procedure in patients in which the success rate of tension
free slings is less, like intrinsic sphincter
deficiency (ISD).
Materials and Methods: We included
seventeen women with urodynamically
proven stress urinary incontinence (SUI)
that underwent the Remeex procedure
were followed for at least 12 months. The
patients were considered to have ISD on
basis of a Valsalva leak point pressure
(VLPP) ⬍60 cmH20 or maximum urethral
closure pressure (MUCP) ⬍20 cmH20. We
analyzed parameters including history taking, urodynamic study (UDS) and postoperative clinical outcomes. Patients’ success
and satisfaction rates were evaluated after
procedure. Also we asked about lower
urinary tract symptoms (LUTSs) with using a questionnaire and the efficacy of
LUTSs was assessed with the Visual Analog Scale(VAS) on pre- and 12 months
post operation.
Results: The mean age was 55.66⫾9.58
years. Four (23.5%) patients had mixed
incontinence. Five patients (29.4%) had
previous surgery for SUI. At a mean follow-up of 13.3 months (12-16), fourteen
patients (82.3%) were cured and three
patients (17.6%) were improved. Four patients (23.5%) answered very satisfied and
thirteen patients (76.4%) answered satisfied by satisfaction questionnaire. Also,
LUTSs was improved except voiding pain
(p⬍0.05).
Conclusions: This procedure provides a
high cure and satisfaction rate. Our results
demonstrate that Remeex procedure is
suitable for women SUI with ISD.
UP-2.22
Initial experience of cystocele and
stress incontinence repair with prolift
system and concomitant tension-free
vaginal tape (TVT)
Paick S, Kim H, Park H, Lho Y
Konkuk University Hospital, Seoul, South
Korea
Introduction and Objective: The objective of this study is to report our initial
experience about the feasibility, effectiveness, and safety of transobturator tensionfree vaginal mesh (Prolift™) and concomitant tension-free vaginal tape (TVT) as a
treatment of female anterior vaginal wall
prolapse associated with stress urinary
incontinence (SUI).
Materials and Methods: We reviewed
the charts of patients who underwent
Prolift™ and TVT between April 2009
and March 2010. All patients had a physical examination and staging of cystocele. According to the International
Continence Society (ICS) system 2, 5, 3
women had stage grade II, III, and IV
respectively. All the patients underwent
pelvic examination 1, 3, 6 month and 1
year after operation and anatomical and
functional outcomes were recorded. An
anatomic cure after intervention was
defined as stage 0 and an improvement
was defined as stage I. Anatomic failures
were defined as stage II or higher on
the last physical examination.
Results: The mean follow-up was 7.1
(1-11) months. Overall success rate of
cystocele repair was 90%. The anatomical cure rate of cystocele was 50%. The
cystocele repair improved 4 patients,
but failed in 1. SUI was cured in all patients. No significant complications including bladder or vessel injury and
mesh related erosion occurred. The
postoperative complication was transient voiding difficulty (2 cases).
Conclusions: These preliminary results
suggest that Prolift™ and TVT offer a safe
and effective treatment for female anterior
vaginal wall prolapse and SUI. However, a
long-term follow-up is necessary in order
to support the good result maintenance.
UP-2.23
Voiding pattern after ‘U-method’
TVT-Secur: is it obstructive?
Richard P1, Gagnon L-O2, Tu LM1
1
Sherbrooke University Hospital Center,
Sherbrooke, QC; 2McGill University
Health Center, Montreal, QC, Canada
Introduction and Objective: Stress urinary incontinence (SUI) is a common
problem affecting women of all ages. The
last generation of midurethral slings, the
tension-free vaginal tape system (TVTSecurTM, Gynecare, Ethicon, NJ, USA)
was introduced in 2005 in an attempt to
lower the complication rates. There are
S87
two surgical techniques currently used,
either the ‘hammock’ or the ‘U-method’
technique. With the latter, the sling is
tightened as to create a ‘pillowing effect’
on the urethra until obtaining a negative
stress test. Short-term current results of
this surgical option seem promising; however, no study ever reported on the voiding
function after its implantation. This is a retrospective, clinical study in which the main
objective is to evaluate if this method creates an obstructive pattern on pressureflow study 12 months after the surgery.
Materials and Methods: The population
consisted of 33 women operated between
October 2007 and April 2009. The implantation of the TVT-Secur™ system was
done under local anesthesia by a single
surgeon, using the ‘U-Method’ technique.
Patients were evaluated before and 12
months after the surgery with regard to
different urodynamic findings including
uroflowmetry (UFM), postvoiding residual
volume (PVR), filling cystometry (CMG),
pressure-flow studies and valsalva leak
point pressures (VLPP).
Results: The 12-month urodynamic evaluation was completed by 31 of the 33
patients (93.9%). The mean (⫾ standard
deviation [SD]) age of the population
was 63 (⫾ 9) years old, 21.2 % (7/33)
complained of genuine SUI while 18.2 %
(6/33) of them previously underwent an
anti-incontinence surgery. At 12 months
post-op, median satisfaction rate was
98.5% (range 0-100), the overall subjective improvement rate (defined as an
improvement of more than 50% of
symptoms) was 93.8% (30/32) while
71.9% (23/32) reported being cured (defined as no leakage at all). The objective
cure rate (defined as no leakage at all
during the VLPP study) was 60% (18/30)
while 36.7% (11/30) of the subjects
were objectively improved (defined as
leakage which occurred at a higher volume or higher bladder pressure than the
preoperative VLPP study). UFM and PVR
were not affected by the surgery. The
pressure-flow studies weren’t obstructed
in all evaluated subjects (29/29).
Conclusion: Midurethral TVT-SecurTM
slings represent an appropriate option for
patients suffering from SUI. They are not
associated with any significant bladder
obstruction nor long-term urinary retention while having very similar cure rate as
the other midurethral slings. To our knowledge, this is the first study comparing preoperative and postoperative urodynamic
findings in patients with ‘U-method’ TVTSecurTM midurethral sling.
S88
UP-2.24
TOT surgery experience with
Unitape-T-Plus mesh
Salazar A1, Miranda A1, Montiglio C1,
Vicherat C1, Sandoval J1, Badilla S1,
Schwarze E1, Sarrat G2
1
Chilean Airforce Hospital, Santiago;
2
Andrès Bello University, Santiago, Chile
UP-2.25
Early urinary catheter removal after
TOT Procedure: evaluation of
immediate postoperative voiding
Salazar A, Miranda A, Montiglio C,
Acuña A, Orellana N, Vicherat C, Badilla S
Chilean Air Force Hospital, Santiago, Chile
Introduction and Objective: Since the
introduction of tension free vaginal tape
(TVT) surgery for treating Stress Urinary
Incontinence (SUI), this method has become a popular surgical technique that is
relatively standard and comparable. Later,
the transobturator tape (TOT) surgery was
introduced and this has shown comparable
results, but reduces some risks, particularly
bladder injuries and low urinary tract obstruction. Currently, various tapes/slings,
which are similar, are available in the market. We have gained experience in working
with several of these implants, and today
we are using the Unitape T Plus® mesh
(Promedon®, Argentina). Our objective is
to present TOT long-term surgical results
using the Unitape T Plus® mesh (Promedon®, Argentina).
review of records of patients who underwent surgery in which the TOT inside-out
technique has been used with Unitape T
Plus at our hospital, recording therapeutic
results and complications.
Results: From April 2007 to November
2009, we have operated on 51 patients using Unitape T Plus. The mean follow-up was
16 months (with a range of 6 to 35
months). The average age was 55 years (38
to 81). The average body mass index was
26.8, which indicates overweight. Twenty
patients (39%) had a history of gynecological or prior incontinence surgeries. In 27
patients (53%), the diagnosis was Stress Urinary Incontinence (SUI), and in 24 patients
(47%) it was Mix Urinary Incontinence
(MUI). In 47 patients (98%), we carried out
a urodynamic study. Of the 51 patients, in 1
(2%) patient SUI remains the same and in 3
(5.9%) patients, it has improved and patients only leak urine under great stress. Of
the 24 MUI patients, UUI disappeared in 19
(79.2%) patients. Two patients (3.9%) suffering pure SUI showed de novo urgency and
prolonged inguinal pain. No other complications were observed.
Conclusions: Our TOT surgery experience using Unitape T Plus has shown excellent results for resolving SUI. The implant includes a set of disposable needles
to help its placement, being a recommendable minimally invasive technique
for solving SUI with a low complication
rate for trained surgeons.
Introduction and Objective: Transobturator tape (TOT) has been validated as
treatment for stress urinary incontinence
(SUI) since its introduction in 2001. TOT
technique has published objective cure
ranged from 84% to 98% and it is associated with fewer obstructive voiding complication than TVT. The interval before
removal of the urinary catheter in TOT
surgery depends on surgeon preference.
Our aim was to evaluate the feasibility of
early catheter removal after TOT.
Methods: This is a prospective study. Between July 2007 and January 2010, we
identified, from our outpatient clinics,
female patients with SUI confirmed by
urodynamic studies. TOT surgeries were
performed under general anesthesia by a
single surgeon with standard in-out technique (using Unitape T plus kit or A & B
kit). No tension test was done to adjust
tape in its suburethral position. A 20Fr
Foley catheter was used during the surgery and removed before patient left the
operating room.
Results: Forty-one consecutive patients
were included in the present study. All of
them had SUI confirmed by urodynamic
studies. Mean age was 57.6 years old
(range 38 to 81). Fourteen patients (34%)
had history of gynecological or prior incontinence surgeries. We completed 41
TOT surgeries without complications;
mean operating time was 20 minutes
(range 15–35 min). There were no bladder perforations after the TOT procedure.
Mean follow-up was 16.6 months (range
4-32) with an objective SUI cure of 100%,
and there were no mesh extrusion. After
the catheter was removed all patients were
able to void. Mean time to void was 194
minutes (range 90 – 420). Average voiding
volume was 299 ml (range 80 to 500 ml).
Conclusions: Our study shows that TOT
is a safe procedure with outcomes according to published clinical series. According
to our outcomes, early urinary catheter
removal after TOT procedure does not
increase the risk of urinary retention and
facilitate hospital discharge. We conclude
that systematic early removal of the catheter is safe and comfortable for the patient
and was not associated with a higher obstructive complication rate.
UP-2.26
Short-term results of mini-sling TVT
secure and rectus facial sling surgery
in the treatment of female stress
urinary incontinence
Sharifiaghdas F, Mirzaei M
Shahid Labbafinejad Medical Center,
Urology and Nephrology Research Center
(UNRC), Shahid Beheshti Medical University, (SBMU), Tehran, Iran
Introduction and Objective: To report
the short term results of both TVTs compared to rectus facial sling as a standard
surgery in the treatment of type II stress
urinary incontinence in female patients.
Materials and Methods: Thirty-six patients underwent TVTs (Group I) versus
thirty-nine for rectus facial sling (Group
II). Evaluation was performed by 2-hour
pad weight test, cystoscopy and cough
stress test urodynamic study, incontinence
quality of life instrument (I Qol), urogenital distress inventory score (UDI-s) and
incontinence impact questioner (IIQ).
Clinicopathologic parameters included
age, weight, type of incontinence, previous pelvic surgery, parity, menopausal
state, operative time, perioperative and
post operative complications and surgical
outcome.
Results: Mean age was 53 years for
Group I, and 56.5 for Group II. Mean follow up time was 12 and 13.5 months for
groups I and II. Mean operative time was
15 and 70 minutes for groups I and II. An
objective cure rate was observed in
91.66% and 94.87% in groups I and II.
The I-Qol score, UDI-S, IIQ improved in
88.88% and 84.61% of groups I and II.
There was no intra or postoperative major
complications in each group.
Conclusions: This short term follow up
reveals that both TVT-S and rectus facial
sling procedures have high success rate in
the treatment of female stress urinary incontinence with no statistically significant
difference between groups. The only statistically difference was operative time.
UP-2.27
The effect of postoperative physical
activity on the outcomes of
transobturator tape procedure
Lee J1, Shin D1, Bang S2, Lee J3, Park B4,
Park C1, Lee W1
1
Pusan National University Hospital,
Busan; 2Pusan National University
Yangsan Hospital, Yangsan; 3Busan St.
Mary’s Hospital, Busan; 4Wallace Memorial Baptist Hospital, Busan, South Korea
Table 1, UP-2.27. Patient characteristics
Age (years)
Duration of incontinence (years)
Follow-up (months)
Grade of incontinence
I (%)
II (%)
III (%)
plication of patients with transobturator
tape (TOT) operation according to physical activity after surgery.
Materials and Methods: Forty-five
women with stress urinary incontinence
who underwent TOT procedure between
September 2007 and February 2008 were
included in this study. To assess whether
outcome was influenced by the physical
activity after surgery, the patients were
divided into two groups: Active group
(n⫽19) was defined as no restriction of
activities or immediate return to all activities and Inactive group (n⫽26) scheduled
return to special activities. Preoperatively,
the patients were evaluated with history
taking, a physical examination, a one-hour
pad test, uroflowmetry and urodynamic
study. The procedure was carried out using a previously established method under
local anesthesia. The post-operative symptoms and patient satisfaction were assessed by questionnaire.
Results: There was no significant difference between the 2 groups in terms of
the success rate: cure (56.3% vs. 61.5%,
p⫽0.757), improved (37.5% vs. 38.5%,
p⫽1.000), and same as preoperation
(6.2% vs. 0%, p⫽0.381) for Active and
Inactive group, respectively. In addition,
the patient satisfaction rate was not different significantly between 2 groups. The
intraoperative complications were not
found.
Conclusions: Regardless of physical activity after surgery, TOT procedure
showed high success rate and satisfaction
for treating female stress urinary incontinence. We consider the TOT procedure
Active (nⴝ19)
52.9⫾8.2
6.8⫾5.7
14.5⫾1.6
Inactive (nⴝ26)
53.6⫾9.0
5.4⫾6.4
14.7⫾1.5
0 (0)
16 (84.2)
3 (15.8)
0 (0)
24 (92.3)
2 (7.7)
to be an effective treatment for stress
urinary incontinence, with no restriction
of activities or immediate return to all
activities.
UP-2.28
Comparison of TOA and TOT for
treating female stress urinary
incontinence: short-term outcomes
Song K1,2, Sul C1,2, Na Y1,2, Lim J1,2,
Chang Y1,2
1
Chungnam National University Hospital; 2Konyang University Hospital,
Daejon, South Korea
Introduction and Objective: Suburethral
tapes have been widely adopted to treat
stress urinary incontinence (SUI). Transobturator adjustable tape (TOA) sling operation is a newly developed procedure and
allows for the adjustment of tension after
surgical intervention thus permitting correction of postoperative incontinence or
obstruction, but there has been limited
literature produced. The aim of this study
was to compare the efficacy and safety of
TOA with transobturator tape (TOT) for
the treatment of SUI. And we reviewed
our experience and assessed urinary functional outcomes in the TOA versus the
TOT by one urologist.
Materials and Methods: Between June
2008 and June 2009, 40 women with SUI
who underwent the TOA procedure and
63 women who underwent the TOT procedure were followed for at least 3
months postoperatively and analyzed. The
preoperative evaluation included history
taking, physical examination, voiding di-
Table 2, UP-2.27. Success and satisfaction rate
No. of patients (%)
Outcome
Success
Satisfaction
was aimed at evaluating and comparing
the clinical efficacy, satisfaction and com-
Cure
Improved
Same as preoperation
Very satisfied
Satisfied
Unsatisfied
Very unsatisfied
Active (nⴝ16)
9 (56.3)
6 (37.5)
1 (6.2)
8 (50.0)
7 (43.8)
0 (0)
1 (6.2)
Inactive (nⴝ26)
16 (61.5)
10 (38.5)
0 (0)
12 (46.2)
12 (46.2)
2 (7.6)
0 (0)
S89
ary, stress and 1-hour pad tests, and a
comprehensive urodynamic examination.
Postoperative evaluation included stress
test, 1-hour pad test, and uroflowmetry
with post-void residuals at the 1-week, 3
months postoperative follow-up visit.
Results: The overall cure rate showed
that TOA group was 90.0% and TOT
group was 85.7% using cough stress test
and 1-hour pad test. The rate of satisfaction was the higher in the TOA group
compared with the TOT group (95 versus
85.6%). Four patients in the TOA group
(10%) needed reduced tension due to urinary obstruction (flow rate⬍ 10 ml/sec
and/or residual urine⬎50cc). The tension
of the mesh was tightened in 1 patient
(2.5%) due to a certain degree of continuing incontinence. Vaginal wall injury occurred in 3 patients in the TOT group
(4.8%) and urethral perforation occurred
in 1 patient in the TOA group (2.5%). The
residual urine volume was significantly
lower in the TOA group compared with
the TOT group (7.8ml versus 43ml,
p⫽0.000).
Conclusions: TOA allowed postoperative
readjustment of the suburethral sling pressure for a number of days after surgical
intervention, which resulted of good
short-term treatment outcomes. These
data suggest that better subjective and
objective results and residual urine volume can be obtained than those achieved
with the traditional non-adjustable mesh,
and without significant postoperative
complications.
UP-2.29
Prevalence of stress urinary
incontinence in Romania
Surcel C, Mirvald C, Chibelean C,
Avram D, Gingu C, Iordache A, Savu C,
Harza M, Manu M, Sinescu I
Fundeni Clinical Institute of Uronephrology and Renal Transplantation, Bucharest, Romania
Objectives: The study included the following objectives: prevalence of urinary
incontinence among female population
from Romania, aged 40 years old and
over; determining how often urine leakage happens, the leaking amount and the
moment of leaking; the disorder interference in everyday life. The main parameter
evaluated was the stress urinary incontinence and its prevalence.
Materials and Methods: The study was
conducted during 3-22 August 2009, using
the ICI-Q questionnaire. The interviews
were conducted face to face, in respondents’ home, “pen and paper”. Although
the questionnaire was conducted with a
S90
witness, the responses were concluded.
The sampling technique was based on a
probabilistic sample. The stratification was
done on region and locality size and
based on a random distribution of sampling areas and random household selection. Inside the household, the respondents were selected according to the rule
of “first birthday”. The interviews were
conducted with women from urban and
rural area, aged 40 years old and over.
According to the included sample size of
874 respondents, the maximum sampling
error is ⫹/⫺ 3.3 % considering a confidence level of 95%.
Results: After applying the questionnaire
in the field, there were obtained 874 interviews with women aged 40 years old
and over. Of the respondents, 60% are
aged between 40 and 60 years old; 51% of
the respondents are 8-10 classes graduates; 79% of the respondents do not suffer
from urinary incontinence. Out of those
who leak urine (21% of all respondents),
half of them stated that this happens
about once a week or less often at mild
efforts (cough, walking, laughing, etc).
There are 22.4% of them who leak urine
several times a day. Out of those who suffer from stress urinary incontinence, 98%
consider that this disorder interfere with
their everyday life and gave an average
mark of 6.2 on a scale from 1 to 10,
where 10 means “a great deal of interference with everyday life”.
Conclusion: Stress urinary incontinence
is a matter of public health which affects
the quality of life of the female population
at different ages, especially women between 40-60 years. In our country, the
prevalence of stress urinary incontinence
was 11.5%.
UP-2.30
TVT and vaginal prolapse: a long-term
follow-up
Topuzovic C, Tulic C
Clinical Center of Serbia, Clinic of Urology, Belgrade, Serbia
prospectively the incidence of vaginal prolapse after TVT as primary operation for
SUI and determine the need for prolapserepair surgery in these patients.
Materials and Methods: Forty-five female with clinically and urodynamic
proven SUI underwent TVT. All of patients had cystocele grade I-II without the
presence of rectocele. The clinical examinations were done preoperatively and repeated 5-years postoperatively.
Results: Five years after TVT the objective cure rate of SUI was 90%, the cure
rate of cystocele was 62% and de novo
rectocele was found in 36% patients. Five
years postoperatively the vaginal examination revealed a significant progression of
(de novo) rectoceles but TVT significantly
cured cystoceles. There were no differences in any of bowel function before and
after surgery. Therefore, the presence of
rectocele was asymptomatic.
Conclusions: TVT is an effective procedure for the correction of SUI and concomitant mild to moderate cystocele.
Rectocele developed following TVT were
mild and asymptomatic and demanded no
corrective surgery.
UP-2.31
Is there a place for nonsurgical
management of female stress
incontinence?
Topuzovic C, Pejcic T
Clinical Center of Serbia, Clinic of Urology, Belgrade, Serbia
efficiency and place of nonsurgical therapy in women with stress incontinence in
today’s circumstances of minimally invasive stress surgery with very successful
outcome.
Materials and Methods: We prospectively studied 82 females with symptomatology of pure stress (40 pts) and mixed
incontinence (42 pts). Mean age of patients was 57 years, range 39-78 years. All
patients had clinically and urodynamicallyproven genuine stress incontinence. The
patients underwent combined nonsurgical
therapy. Nonsurgical treatment included:
bladder training, Kegel’s pelvic floor exercises, functional electrical stimulation of
pelvic floor (acute maximal and continual)
and drug therapy (anticholinergics and
oestrogens). Treatment response was evaluated objectively by one-hour pad weighing test at least 5 years after therapy. Cure
was considered urine loss lower than 2g
and improvement was a urine loss lower
by 50% than on pad test before treatment.
Results: Five years after nonsurgical therapy, cure rates were observed in 14%
patients with stress and in 28% patients
with mixed incontinence and improvement was detected in 30% patients with
stress and 46% patients with mixed
incontinence.
Conclusions: Our study illustrated the
lower success rates found in treatment of
pure female stress incontinence by nonsurgical therapy and significant effect of
nonsurgical therapy in mixed incontinence. Nonsurgical therapy was effective
in reducing urge incontinence and can be
beneficial in the treatment of mixed
incontinence.
UP-2.32
Sacrocolpopexy for pelvic floor
reconstruction in pelvic organ
prolapse causing female stress
urinary incontinence: first results of a
minimally invasive laparoscopic
approach
Zimmermann R, Jeschke S, Janetschek G
Dept. of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria
Introduction and Objective: Repair of
female stress urinary incontinence (SUI)
can be a complex surgical task. Periurethral sling procedures reconstruct only
the anterior compartment. Pelvic organ
prolapse (POP) involves frequently the
entire pelvic floor. Reconstruction of mid
and posterior compartment can effectively
be achieved by sacrocolpopexy which is
in our dept. performed exclusively by
laparoscopic approach (LSP). This study is
to evaluate our first patient series.
Materials and Methods: Starting in
12/02 45 patients suffering from higher
grade (⬎I°) and/or POP have been operated by LSP after extensive urodynamic
evaluation. Complete follow up (FU) is
available of 25 patients. By a 4-trocar access a mesh is inserted each between
bladder/anterior face of vagina and posterior vaginal face/anterior face of rectum.
The anterior mesh is fixed near the trigonum to anterior vaginal wall, the posterior
to pelvic floor and sacro-uterine ligament.
Both meshes are fixed to the promontory
by non-absorbable sutures, retroperitoneum is closed again. The anterior mesh
is directed through tubar mesenterium
above cardinal ligament. Simultaneous hysterectomy was avoided as possible.
Results: Patients’ age was 57 (range 4081), 14 have had former abdominal surgery, 4 out of them sling procedure.
There was no conversion/transfusion or
major side effects intra-/postoperatively.
Mean OR time was 150 min., blood loss
was 50ml. Due to previous operations
insertion of posterior mesh was once impossible and once further difficult but feasible. Lesions of anterior vaginal wall
(n⫽4) and bladder wall (n ⫽ 1) could be
sufficiently closed intraoperatively. A lesion of the distal ureter (n⫽1) was
drained by a tube for 6 weeks. All meshes
have been tolerated well. POP could be
corrected in all patients (n⫽25). Residual
urine (n ⫽ 2) was each treated successfully under clinical aspects. SUI could be
treated by single LSP in 9 pat. Persisting
SUI (n ⫽16) was finally cured by sling
(n⫽12) and myoblast injection (n⫽4).
Conclusions: POP as deficiency of mid/
posterior compartment can be anatomically restored by minimally invasive laparoscopic procedure. Being not an
incontinence operation per se LPS is a
fundamental element for anatomical reconstruction of pelvic floor. This is frequently necessary in stress incontinent
women apart of the potentially necessary
repair of anterior compartment which is
routinely done later. LSP and – if necessary - slings lead finally to restored pelvic
floor anatomy of all compartments and to
definite cure of stress incontinence.
UP-2.33
Estimation of female urethral
elasticity and flexibility from
cystourethroscopic image
Horiuchi K1, Ishii T1, Naya Y2,
Nakada T3, Yamanishi T4, Igarashi T1
1
Division of Artificial Systems of Science,
Graduate School of Engineering, Chiba
University, Chiba; 2Dept. of Urology,
Teikyo University Chiba Medical Center,
Chiba; 3Dept. of Urology, Yotsukaido Tokushukai Hospital, Chiba; 4Dept. of Urology, Dokkyo Medical University, Dokkyo,
Japan
Introduction and Objective: Elasticity
and flexibility of the female urethra plays
an important role for continence mechanism and voiding function, and some attempts have been made to estimate it.
Since Cystourethroscopy is performed
with irrigation, urethral elasticity and flexibility could be estimated by analyzing
deformation of the urethral wall under
intermittent irrigation in the cystourethroscopic image. We produced a method of
detecting female urethral deformation and
tested its feasibility.
Materials and Methods: During the last
four months, cystourethroscopic video
image was recorded in two female patients with bladder neck contracture and
detrusor-sphincter dysynergia scheduled
for transurethral incision of bladder neck.
Urethra was observed using rigid cystourethroscope fixed in the distal part of the
urethra under intermittent irrigation of
isotonic water with water pressure set at
80cmH2O. The video image was captured
to Windows based PC and was assessed
using algorithm designed to track concerned area of the urethral wall in every
frame and to depict a graph that corresponds to the deformation of the urethral
wall. The amount of the deformation was
obtained with template matching process,
which accuracy was enhanced by using
green colored image as template and
matched image. To detect the amount of
the deformation in the whole area of the
urethra that the cystourethroscopy can
cover, templates were set on lines radially
from the center of the urethral axis, and
were compared according to irrigation
status and around the incision.
Results: The shift of the urethral wall by
the water pressure can be detected in every direction of the urethra before and
after incision. The results show that the
method delineates the effect of bladder
neck incision on the urethral deformation.
Thus recovery of flexibility of the urethral
wall by incision of the bladder neck was
estimated semi-quantitatively and was evident in the proximal urethra.
Conclusions: Estimation of elasticity and
flexibility of the urethra is possible and is
rational in clinical practice. Further study
is necessary to ascertain its validity as a
diagnostic tool for female urethral function.
UP-2.34
Impact on quality of life of botulinum
toxin-a in non-neurogenic detrusor
overactivity refractory to
anticholinergics
Bayoud Y, Ménard J, Staerman F
Dept. of Urology and Andrology, Robert
Debré Academic Hospital, Reims, France
Objective: A Botulinum toxin-A showed
an efficacy in the treatment of non-neurogenic detrusor overactivity refractory to
anticholinergics. We evaluated its efficacy
and its impact on quality of life in nonneurogenic detrusor overactivity refractory to anticholinergics.
Materials and Methods: In a prospective
study of 14 patients suffering non-neurogenic detrusor overactivity refractory to
anticholinergics, the baseline evaluation
included a clinical assessment, a 3-day
voiding diary, a urodynamic assessment
and 3 questionnaires: MHU, Ditrovie and
Contilife ( french validated questionnaire).
A dose of 300 U of botox or 900 U of
Dysport was administered at 30 sites in
the bladder. All patients were followed-up
at day 30, day 90, day 180 and day 365.
Results: A mean of a daily leakage episodes was 3.58⫾4.7 at baseline, 0.6⫾1 at
day 180 (p⫽0.02) and 1.22⫾2.5 at day
365(p⫽0.01). A mean of daytime frequency was 9.9⫾4 before injection,
7.2⫾2.9 at day 180(p⫽0.03) and
7.55⫾2.8 at day 365(p⫽0.03). A nocturia
was enhanced from a daily mean
3.14⫾1.8 at baseline to 1.8⫾1.5 at day
365(p⫽0.01). A mean of daytime urgency
was initially 4.6⫾3.8, 1.22⫾2.4 at day
90(p⫽0.05) and 1.91⫾2.7 at day
S91
365(p⫽0.12). A mean of daily number of
pads was 3.8⫾2.4 at baseline, 1.1⫾1.6 at
day 180(p⫽0.008), and 1.3⫾1.9 at day
365(p⫽0.008). There was no significant
change in 24-h urinary volume. A mean
score of Contilfe was 70⫾22 initially and
54.6⫾20.6 after a year (p⫽0.02). Ditrovie
mean score was 26.3⫾10 at baseline and
19.9⫾8.6 at day 365(p⫽0.03).The MHU
mean score was 7.62⫾2.4 at the beginning of study, 3.54⫾3.4 at day
180(p⫽0.02) and 4.83⫾3.5 at day
365(p⫽0.1).
Conclusion: Our study showed a significant objective and subjective improvement up to 12 months after botulinum
toxin-A injection, with steady results. This
treatment might be an efficient option in
the treatment of non-neurogenic detrusor
overactivity refractory to anticholinergics.
UP-2.35
Total urgency score (TUS) as a
measure of frequency and urgency
in SUNRISE
Cardozo L1, Mikulas J2, Amarenco G3,
Drogendijk T4, Compion G5
1
King’s College Hospital, London, UK;
2
Faculty Hospital, Zilina, Slovakia; 3Hopital Rothschild APHP, Paris, France; 4Astellas Pharma Europe B.V., Leiderdorp,
The Netherlands; 5Astellas Pharma Europe Ltd, Staines, UK
Introduction and Objective: In the
SUNRISE study, solifenacin 5/10 mg significantly reduced urgency episodes and extent of urgency bother by day 3 of treatment using conventional scoring systems.
We report change in frequency and urgency using TUS, calculated as the mean
of the summed urgency intensity ratings
at void per 24 h (PPIUS grade 0 – 4; 0 ⫽
no urgency, 4 ⫽ urge incontinence). For
each diary day, all recorded PPIUS grades
at each void are summed to a daily total.
A mean is calculated by totalling these
daily sums and dividing by the number of
diary days.
Materials and Methods: The 16-week,
phase IIIb study enrolled patients aged
ⱖ18 years with OAB symptoms persisting
for ⱖ3 months and ⱖ3 episodes of urgency with or without incontinence assessed using a 3-day diary. The primary
endpoint was change from baseline to
end of treatment (EOT) in urgency episodes with or without urgency incontinence per 24 h (grade 3⫹4 urgency episodes, PPIUS scale).
Results: Solifenacin (5/10 mg) achieved a
greater reduction in urgency episodes
than placebo using PPIUS 3⫹4 urgency
episodes and TUS (Table). Both efficacy
measures correlated with patients’ Perception of Bladder Condition (PBC) at EOT
(Spearman rank correlation: 0.41 for
PPIUS 3⫹4 and 0.47 for TUS; p⬍0.0001
for both). Mean number of micturitions
per 24 h fell from 11.3 at baseline to 9.3
at EOT with solifenacin, and from 11.1 at
baseline to 9.9 at EOT for placebo.
Conclusions: Solifenacin (5/10 mg) was
more effective at reducing urgency episodes than placebo using PPIUS 3⫹4 urgency episodes and TUS. TUS appears to
be useful for assessing improvements in
major OAB symptoms (frequency and urgency) in clinical trials.
UP-2.36
Effectiveness and tolerability of a
combined medication of two different
anticholinergics for patients with
symptoms of overactive bladder
Lee SE1, Jeong SJ1, Yi J, Park H2, Oh JJ1,
Jeong CW1, Jeong H3, Yoon CY1,
Hong SK1, Byun SS1
Depts. of Urology, 1Seoul National University Bundang Hospital, Seoul; 2Kangwon National University Hospital, Chunchon; 3Seoul Metropolitan Boramae
Medical Center, Seoul, South Korea
Introduction and Objective: In most
patients with symptoms of overactive
bladder, a single anticholinergic medication is usually sufficient for the control of
their urinary symptoms. However, in small
portions of patients, its efficacy may be
limited. The aim of this study was to assess the efficacy and tolerability of a com-
Table 1, UP-2.35
PPIUS 3ⴙ4
Mean baseline score
Mean score at EOT
Mean change from baseline
Median % change from baseline
p vs placebo
S92
Solifenacin
5/10 mg
(nⴝ503)
5.1
2.5
⫺2.6
⫺70%
⬍0.0001
Placebo
(nⴝ216)
5.5
3.7
⫺1.8
⫺50%
—
Total urgency score
Solifenacin
5/10 mg
(nⴝ503)
26.7
17.8
⫺9.0
⫺34%
⬍0.0001
Placebo
(nⴝ216)
27.8
21.3
⫺6.4
⫺26%
—
bined medication of two different anticholinergics for the treatment of symptoms of
overactive bladder in the patients who did
not respond to a single anticholinergic
medication.
Materials and Methods: We reviewed
the medical records of 23 patients who
received a combined medication of two
different anticholinergics for ⬎ 8 weeks.
In all patients, previous single anticholinergic medication had been not effective
or sufficient, even though without significant adverse effects resulting in discontinuation of medication. Overactive bladder
was 18 patients and neurogenic bladder
was 5 patients. Mean duration of a single
medication was 3.2 months (2-7). Treatment efficacy was measured by the
changes of IPSS-storage score, voiding
score, QoL, number of voiding/day, and
maximal voided volume after combined
medication. In addition, patients were
interviewed regarding treatment benefit.
Uroflowmetry and post-void residual volume were also evaluated.
Results: Mean age was 63.4 years (24-79)
and 74% of patients were women. Mean
duration of combined medication was 9.0
months (2-18). A composition of combination was as follows: tolterodine ⫹ propiverine in 13 patients, tolterodine ⫹ solifenacin in 7, tolterodine ⫹ trospium in 1,
tolterodine ⫹ oxybutynin in 1, propiverine ⫹ solifenacin in 1. In 21 patients without CIC, IPSS-storage score, voiding score,
and QoL score decreased by 2.9
(p⬍0.001), 2.0 (p⬍0.013), and 1.0
(p⫽0.001), respectively and the number
of voiding/day decreased significantly
(p⬍0.001) after combined medication.
Maximal voided volume did not change
significantly. Fourteen (66.7%) patients
reported to have benefit from combined
medication. In 2 patients with CIC, the
number of CIC decreased by 1 and 2 respectively, and mean CIC volume increased by 80 and 70 ml respectively.
Qmax and post-void residual volume did
not change significantly. Five (21.7%) patients discontinued a combined medication due to less effectiveness (n⫽2),
gastro-intestinal symptom or dry mouth
(n⫽3).
Conclusions: A combined medication of
two different anticholinergics was effective with regard to IPSS symptom score
and voiding diary in the patients who did
not respond to a single agent medication.
In addition, two-thirds of patients reported to have treatment benefit. A combined medication was tolerated in most
patients. Previously, the combined medication of two different anticholinergics
was found to be effective and tolerable in
the treatment of adults with neurogenic
bladder and children with refractory overactive bladder in whom single anticholinergic treatment failed. The present study
reports for the first time the effectiveness
and tolerability of dual anticholinergic
medication in the non-neurogenic adults
with symptoms of overactive bladder.
UP-2.37
Impact of prostate volume on the
efficacy of solifenacin succinate
monotherapy in men with lower
urinary tract symptoms and
overactive bladder symptoms
Kitayama S1, Takazawa R1, Tsujii T1,
Yoshikawa T2
Depts. of Urology, 1Tokyo Metropolitan
Ohtsuka Hospital; 2Tokyo Metropolitan
Health and Medical Treatment Corporation, Toshima Hospital, Tokyo, Japan
Introduction and Objective: Alpha
1-blockers represent the first-line drug
treatment of male patients with lower urinary tract symptoms (LUTS), and anticholinergics are often given with alpha
1-blockers because of concerns for developing acute urinary retention. In some
patients, however, alpha 1-blockers are
ineffective, and in other patients, alpha
1-blockers cannot be continued due to
adverse effects. In this open label prospective study, we evaluated the efficacy
and safety of solifenacin succinate monotherapy (SOL) in male LUTS patients with
overactive bladder (OAB) symptoms, and
the influence of prostate volume.
men with International Prostate Symptom
Score (IPSS) ⬎ or ⫽ 8, Overactive Bladder
Symptom Score (OABSS; developed and
validated by the Japan Urological Association) ⬎ or ⫽ 3 and urgency (at least one
episode/week) received SOL (5 mg daily)
for 12 weeks. Patients with postvoid residual urine (PVR) ⬎ 100 ml or maximum
urinary flow rate (Qmax) ⬍ 5 ml/s were
excluded. Patients who had been previously treated by alpha 1-blockers had a
washed-out period of at least 2 weeks.
IPSS, OABSS, QOL index, PVR and Qmax
were assessed at baseline, 4 weeks and 12
weeks after the treatment. Patients were
stratified into two groups using the median prostate volume as a cut-off.
Results: All 38 patients (prostate volume
range 11.2 – 62.0, median 24.5 ml) completed the 12 weeks of SOL. Mean 24hour micturition frequency decreased
from 10.9 to 9.3. Significant improvement
in mean IPSS (from 15.5 to 9.5), mean
OABSS (from 8.1 to 5.2) and mean QOL
index (from 4.7 to 3.2) were observed.
The treatment did not worsen Qmax. No
urinary retention was observed. Changes
in IPSS, OABSS, QOL index, Qmax and
PVR did not differ significantly between
the two prostate volume groups.
Conclusions: SOL in mild to moderate
BPH patients with LUTS and OAB symptoms may be a reasonable therapeutic option as an initial therapy or after failed
treatment with alpha 1-blockers.
UP-2.38
Rate and predictive factors of the
anticholinergic add-on therapy in
men with residual overactive bladder
symptom after 4 weeks of ␣-blocker
monotherapy
Lee SE3, Park WH5, Lee KS1, Lee HN1,
Lee YS2, Choi HY1, Choo MS4
1
Samsung Medical Center, Sungkyunkwan University School of Medicine,
Seoul; 2Masan Samsung Hospital,
Sungkyunkwan University School of
Medicine, Masan; 3Seoul National University Bundang Hospital, Seongnam;
4
Asan Medical Center, University of Ulsan College of Medicine, Seoul; 5Incheon
Inha University Hospital, Incheon, South
Korea
was aimed to investigate the proportion
of patients and predictive factor for the
solifenacin add-on treatment in men with
persistent OAB symptoms after tamsulosin
monotherapy for 4 weeks.
Materials and Methods: This was phase
IV, prospective, open-label, observational,
multicenter study. Primary objective was
to explore the rate of add-on therapy with
solifenacin in men with OAB symptoms
after 4 weeks of tamsulosin monotherapy.
Secondary objective was to explore the
predictive factors of determining the solifenacin add-on therapy. Men aged ⱖ 45yr
with IPSSⱖ12 and OAB symptoms(OAB
screener V8ⱖ8, frequencyⱖ8 times/24hr,
urgencyⱖ2 episodes/24hr) were treated
with tamsulosin 0.2mg daily for 4 weeks.
The patients with persistent OAB symptoms after tamsulosin monotherapy(OAB
screener V8ⱖ8, frequencyⱖ8 times/24hr,
urgencyⱖ1 episode/24hr) and with answering about tamsulosin treatment satisfaction as “Dissatisfied” or “A little satisfied” were received solifenacin 5mg daily.
Subjects completed IPSS, Quality of
life(QoL) index, OAB screener V8, International Consultation of Incontinence Questionnaire(ICIQ)-Male LUTS, patient’s perception of bladder condition(PPBC) and
3-day bladder diaries at baseline and
week 4.
Results: Of total 303 patients, 261 patients completed 4 weeks of tamsulosin
treatment. The patients who added solifenacin were 181(69.4%, 95% CI 0.6930.749). The predictive factors of the solifenacin add-on therapy were duration of
LUTS, IPSS(total, storage, item 4 score),
number of micturitions for 24 hours, nocturnal micturitions, urgency episodes, urgency severity score in bladder diary, and
OAB V8 score by the univariate analysis.
When the multivariate analyses were performed, LUTS durations (OR⫽1.008, 95%
CI 1.000-1.016), serum PSA (OR⫽1.706,
95% CI 1.180-2.468), prostate size
(OR⫽0.973, 95% CI 0.948-0.998) could be
the predictive factors of solifenacin
add-on therap y(p⬍0.05). IPSS (total, storage, voiding, item 4), QoL score, number
of micturitions per 24 hr, nocturnal micturitions, daytime micturitions and urgency episodes, the scores of OAB V8,
ICIQ (voiding, incontinence), PPBC were
improved after tamsulosin monotherapy
(p⬍0.05).
Conclusion: Even though the clinically
valuable predictive factor with significant
odds ratio could not be obtained, patients
with longer and more severe symptoms
may be notified the possibility of anticholinergic add-on.
UP-2.39
Symptom change after discontinuation
of successful anticholinergic treatment
in patients with overactive bladder
symptoms: prospective, randomized,
multicenter trial
Choo MS4, Lee HM2, Lee KS1, Choi HY1,
Lee SE2, Park WH3
Depts. of Urology, 1Samsung Medical
Center, Sungkyunkwan University School
of Medicine, Seoul; 2Seoul National University Bundang Hospital, Seongnam;
3
Inha University College of Medicine,
Incheon; 4Asan Medical Center, University of Ulsan College of Medicine, Seoul,
South Korea
Introduction and Objective: To evaluate the change in OAB symptoms after
successful anticholinergic treatment and
to explore the predictive factors for
re-treatment.
Materials and Methods: Women with
OAB symptoms (urgency episode ⱖ
2/24hrs and micturition frequency ⱖ
8/24hrs) were screened. After 1-month
treatment with Tolterodine SR 4mg, patients who showed successful treatment
outcome were enrolled and randomly allocated to one of three groups; 1) no additional treatment (group A), 2) 2-month
S93
Table 1, UP-2.39. Change in overactive bladder symptoms
Completion of
Baseline
treatment
Voiding diary
Urgency episode/24hrs
8.0 ⫾ 5.6
2.2 ⫾ 3.1*
Micturition frequency/24hrs 11.7 ⫾ 4.6
8.3 ⫾ 2.2*
Urgency severity/voiding
2.9 ⫾ 0.7
2.1 ⫾ 0.6*
OAB questionnaire
Bother score
47.9 ⫾ 20.5 20.9 ⫾ 17.4*
HRQL score
62.0 ⫾ 22.6 82.8 ⫾ 17.2*
PPBC
4.6 ⫾ 0.9
2.8 ⫾ 0.9*
PPU
1.7 ⫾ 0.5
2.3 ⫾ 0.6*
1-month posttreatment visit
3-month posttreatment visit
4.0 ⫾ 4.6*
9.0 ⫾ 3.0*
2.4 ⫾ 0.9*
4.4 ⫾ 4.5*
9.1 ⫾ 2.9
2.5 ⫾ 0.9
29.0 ⫾ 22.7*
75.8 ⫾ 21.5*
3.3 ⫾ 1.3*
2.1 ⫾ 0.6*
31.3 ⫾ 23.5
75.4 ⫾ 21.6
3.2 ⫾ 1.3
2.1 ⫾ 0.6
Result: There was a significant association
between fall and overactive bladder (odds
Ratio, OR⫽1.80, 95% confidence interval,
95% CI 1.05 to 3.11). However, there was
no association between fracture and overactive bladder (OR⫽1.06, 95% CI 0.60 to
1.88).
Conclusion: Urgency or urge incontinence symptom was associated with falls
among OAB patients. Early diagnosis and
proper treatment can prevent falls and
it can improve quality of life in OAB
patients.
*p ⬍ 0.05 compared with each preceding visit
additional treatment (group B), 3)
5-month additional treatment (group C).
After completion of the 1, 3, 6-month
treatment, patients discontinued the medication and followed-up at 1 and 3 months.
Criteria for the successful treatment and
discontinuation were 1) decrease in micturition frequency ⱖ 2/24hrs, 2) decrease
in urgency episode ⱖ 50%, 3) patients’
answer of “benefit” to the patient perception of treatment benefit (PPTB) questionnaire, and 4) patients’ consent to discontinue the treatment. Subjects were
assayed by a 3-day bladder diary, OAB
questionnaire (OAB-q), patient’s perception of bladder condition (PPBC), patients’
perception of urgency (PPU), PPTB and
patient’s need of re-treatment.
Results: Of a total of 542 patients who
took the study medication, 168 were randomized (A; 57, B; 60, C; 51) and 108
were analyzed (A; 40, B; 40, C; 28). Their
mean age was 56.2 years, a mean micturition frequency was 11.7/24hrs, and a
mean urgency episode was 8.0/24hrs. The
mean urgency episode was decreased by
5.8 times/24hrs after treatment. After
completion of successful treatment, the
urgency episode was increased by 1.8
times at 1 month post-treatment visit and
0.4 times at 3-month post-treatment visit
compared with each preceding visits. The
changes in the voiding diary and questionnaires were summarized in the table.
Overall, 64.8% needed re-treatment (A;
60%, B; 60%, C; 79%, p⫽0.208) and 66.7%
relapsed (A; 57.5%, B; 62.5%, C; 67.9%,
p⫽0.685). HRQL of OAB-q (OR; 0.952,
95% CI 0.901-1.007, p⫽0.035) was the
only predictive factor for retreatment.
Conclusions: This may help to enhance
communication between the patient
and physician on the durability of the effectiveness of the anticholinergic treatment and to increase persistence of the
medication.
S94
UP-2.40
Influence of overactive bladder on
falls: study on females aged 40 and
older in urban and rural communities
Moon H1, Kim J1, Park S1, Kim Y1,
Park H1, Choi H1, Kim S2, Choi B2,
Lee T1
1
Dept. of Urology; 2Dept. of Preventive
Medicine, Hanyang University, Seoul,
South Korea
Introduction and Objectives: Unpredictable urgency or urge incontinence affects
quality of life. Patients who suffer from
overactive bladder (OAB) dash to the toilet to prevent incontinence frequently and
their behavior would increase risk of falls
and fractures. This study was done to investigate the influence of overactive bladder on falls in females aged over 40 who
dwell in urban and rural communities.
Materials and Methods: We conducted a
poll with King’s health questionnaire
(KHQ) and questionnaire regarding fall on
female aged over 40 years old from Guri
city, a medium-sized urban city and rural
Yangpyung county. Definition of fall was
whether the respondents experienced a
fall in the last year and definition of fracture was whether the respondents experienced a fracture from a fall in her life
time. Total number of respondents
reached 535 females and among these, 4
who did not complete the questionnaire
were excluded. Statistical analysis was
performed by chi-square test and t-test.
Multivariate logistic regression model was
adopted in order to examine the effects of
OAB on fall. Age, area, marital status, education, self reported doctor’s diagnosis of
disease (diabetes, hypertension, cerebrovascular disease, osteoporosis, osteoarthritis and urinary incontinence) were documented as covariates. 2-tailed test at the
level of ␣-error⫽0.05 was performed for
every statistical analyses. SAS 9.1(SAS Institute Cary, NC) was used for statistical
tool.
UP-2.41
A comprehensive patient support
programme improves persistence
with solifenacin in overactive bladder
(OAB)
Siddiqui E1, Wood D2, Compion G1
1
Astellas Pharma Ltd, Staines, UK, 2University College London Hospitals, London, UK
Introduction and Objective: Persistence
with antimuscarinics is often suboptimal.
Analysis of UK prescription data for antimuscarinic agents in OAB patients previously showed that persistence with solifenacin was higher than with tolterodine,
oxybutynin, trospium and darifenacin.
Nevertheless, only about a third of patients remained on solifenacin after 12
months. In the UK, a Patient Support
Programme (PSP) is available to solifenacin-treated patients, for a duration of 12
weeks. We investigated if enrolment in
the PSP improved persistence with
solifenacin.
Materials and Methods: OAB patients
who were prescribed solifenacin were
offered the opportunity to enrol in the
PSP, after which they received various
support items, e.g. helpful hints leaflet,
educational DVD, progress monitor, alert
card, dedicated website and care line, reminder e-mails/texts and similar reminder
items; they also received telephone calls
from a PSP nurse at weeks 3, 7 and 11.
To evaluate persistence, a questionnaire
survey was used to obtain feedback from
50 different patients each month for 12
months, with their prior consent, i.e. the
first group of 50 had enrolled 12 months
ago, the second group had enrolled 11
months ago, etc. Data from patients who
enrolled in the PSP within 4 weeks of
starting solifenacin were used in the current analysis.
Results: Overall, 445/600 patients enrolled in the PSP within the first 4 weeks
of being prescribed solifenacin. For this
subgroup, cumulative persistence data
were available from 319 patients who had
enrolled in the PSP 3 months prior to the
questionnaire, 218 at 6 months, 110 at 9
months, and 36 at 12 months. Persistence
with solifenacin was 83%, 80%, 76% and
78% at 3, 6, 9 and 12 months after PSP
enrolment, respectively.
Conclusions: Enrolment of OAB patients
into a 12-week PSP gave a high level of
persistence with solifenacin at the end of
the PSP. Persistence remained high in the
following 9 months in this sample group
(ⱖ76% of patients were still taking solifenacin at 3-12 months after PSP enrolment). This represents an improvement
for patients taking solifenacin and other
antimuscarinic treatments.
UP-2.42
Phasic or terminal detrusor
overactivity in women: age,
urodynamic findings and sphincter
behavior relationships
Valentini F1, Marti B2, Robain G1,
Nelson P,1 Osaghae S3
1
ER6-Université Pierre et Marie Curie
(Paris 06); 2Hôpital Saint Antoine, Paris,
France; 3Pilgrim Hospital, Boston, UK
Introduction and Objective: Detrusor
overactivity (DO) is a frequent urodynamic diagnosis in women with urge syndrome. According with the ICS recommendations, it is usual to distinguish
phasic (P) (wave(s) with or without leakage) from terminal (T) DO (single contraction resulting in leakage and micturition)
[1]. Our purpose was to search for correlation between P or T DO and age, urodynamic findings or sphincter behavior.
Materials and Methods: DO was the
urodynamic diagnosis for 172 women (77
had a history of neurological disease)
among 493 successive female patients.
Four sub-groups: pre- (18-44y), peri- (4554y), post-menopause (55-74y) and oldest
old (ⱖ75y). Cystometries: triple lumen
catheter 7F, filling rate of 50 mL/min in
seated position. Urethral sensor positioned at the level of the maximum urethral closure pressure for sphincter behavior analysis; a displacement during filling
led to exclusion. DO or sphincter response needed a variation of 5 cmH2O in
pressure (detrusor or urethra). Recordings
were reviewed independently by three
investigators.
Results: Occurrence of P and T DO was
similar in the whole population: 90
(52.3%) P and 82 (47.4%) T. Incidence of
age on P DO was weak while it was significant on T DO (table) (p ⫽ .0005). The
percentage of P DO remained constant
(12%) in each age-group while that of T
DO increased with age, from 5% to 45%.
Occurrence of P or T DO was not associated with a history of neurological disease. Uninhibited contraction occurred at
a smaller bladder volume in the P group:
149⫾95 vs 221⫾113 mL (p⬍.0001).
Steady sphincter was predominant for T
DO: 46.9% vs 38.0%. It increased significantly in the ⱖ 75y sub-group (P: 53.0%
vs 34-29-38%; T: 64% vs 44-38-37%).
Conclusions: Steady sphincter during
uninhibited detrusor contraction for both
P and T DO, and occurrence of T DO appear as specific of aging. In elderly, occurrence of steady sphincter may be associated with loss of sensory nerve function
in the urethra, and occurrence of T DO
could be related to the change in muscarinic receptors subtypes and the increase
in non-neuronal acetylcholine release from
urothelium with aging. 1- NAU 2002; 21:
167-178.
UP-2.43
Nervous control of lower urinary tract
(LUT) during detrusor overactivity
(DO): an approach using modeled
analysis of filling cystometries and
pressure-flow studies
Valentini F1, Nelson P1, Osaghae S2
1
ER6-Université Pierre et Marie Curie
(Paris 06), Paris, France; 2Pilgrim Hospital, Boston, UK
Introduction and Objective: DO is a
frequent urodynamic diagnosis in patients
with urge syndrome. DO is characterized
by non inhibited detrusor contractions
(NIDCs). The precise mechanism underlying DO remains discussed but evaluation
of the detrusor excitation during NIDC
and subsequent voiding could allow determining some ways of research. In the
VBN model [1], the detrusor contraction
depends on the excitation of the efferent
neurons, quantified by their firing rate F
or by F/Fmax [0-1]. Without DO, F/Fmax⫽0
during continence and in the range 0-1
during voiding, our objective was to apply
the model to cystometries in order to analyze the efferent excitation.
Materials and Methods: Cystometries
(filling rate 50 mL/min, catheter size 6 or
7F) of 13 men (suspected of benign prostatic enlargement) and 11 women (incontinence or frequency) with phasic (5M7W) or terminal (8M-4W) DO were
analyzed. The VBN model [1] was applied
to the recordings to deduce F/Fmax from
the recorded pressures. Due to the calcium turnover, the detrusor pressure is a
sigmoid function of an “intermediate excitation” E proportional to the free Ca2⫹
concentration and given by dE/dt ⫽(F/
Fmax - E)/T with T⫽6s.
Results: Phasic DO: In men and women,
each NIDC resulted from an efferent excitation of constant amplitude F/Fmax and of
7-10s duration (then F/Fmax returned to
0). F/Fmax was ⫽1 during all NIDCs and
voiding for 4/12 patients. F/Fmax was in
the range 0.3-0.8 during NIDCs for the
other 8 patients, but was ⫽1 for 6 of
them during voiding. When F/Fmax⬍1
(2/8 patients) the value was the same during NIDCs and voiding. Terminal DO: During NIDC: for all women F/Fmax⫽1, for
men F/Fmax⫽1 in 4/8 patients. For the
other 4 men, there was a 2 steps mechanism with F/Fmax initially in the range 0.20.5 and then ⫽1 without intermediate
decrease.
Conclusions: Several authors ascribe DO
to abnormal afferent signalling. That first
study of the efferent signal suggests that the
afferent signal would trigger a normal contraction of the detrusor. In phasic DO, an
inhibitory reflex stops the contraction after
a 5s delay while that reflex is inadequate in
terminal DO. 1- NAU 2000; 19:153-176
UP-2.44
An electronic tool to support the
selection of patients with overactive
bladder syndrome for sacral
neuromodulation
Van Kerrebroeck P1, Chartier-Kastler E2,
Castro-Diaz D3, De Ridder D4, Elneil S5,
Kaufmann A6, Kessler T7, Spinelli M8,
Wachter J9, Stoevelaar H10
1
Dept. of Urology, University Hospital
Maastricht, Maastricht, The Netherlands;
2
Dept. of Urology, Pitié-Salpêtrière Hospital, Paris, France; 3Dept. of Urology, University of La Laguna, Santa Cruz de
Tenerife, Spain; 4Dept. of Urology, University Hospital KU Leuven, Leuven, Belgium; 5Dept. Uro-neurology, National
Hospital for Neurology and Neurosurgery, London, United Kingdom; 6Kontinenz-Zentrum Maria Hilf, Centre for
Continence and Neurourology, Mönchengladbach, Germany; 7Dept. of Urology,
University of Bern, Bern, Switzerland;
8
Dept. of Urology, Alberto Zanollo Center Niguarda Hospital, Milan, Italy;
9
Donauspital, Dept. of Urology, Vienna,
Austria; 10Ismar Healthcare, Centre For
Decision Analysis and Support, Lier,
Belgium
Introduction and Objective: Sacral neuromodulation (SNM) is an established
treatment for patients with idiopathic
overactive bladder (i-OAB) syndrome, insufficiently responding to conservative
treatment. However, identifying the appropriate candidates for a test procedure
may be challenging to non-specialised
S95
physicians. We developed an electronic
tool to support the appropriate selection
of patients with i-OAB for the consideration of SNM.
Materials and Methods: Using the
RAND/UCLA Appropriateness Method, a
panel of 9 European experts identified 49
clinical conditions relevant to the selection for SNM testing (type of symptoms,
previous treatments, concomitant urinary
tract and pelvic disorders, physical and
mental co-morbidities). Panellists individually scored the appropriateness of SNM
testing for all conditions, distinguishing
between inappropriate (absolute contraindication), appropriate (not limiting SNM
consideration), and conditionally appropriate (dependent on the nature of the condition). Panellists were also asked to document the considerations behind their
choices. During a plenary meeting, adaptations were made to the conditions and
related definitions, and the revised conditions (n⫽48) were rerated. The final results were embedded in an electronic decision tool that allows the user to select a
patient profile and to see the related
panel recommendation including the considerations behind.
Results: Agreement (at least 7/9 panellists
having the same score) increased from
49% to 92% between the two rounds. Five
conditions (10%) were deemed to be an
absolute contra-indication for SNM testing
(anatomical low bladder compliance, current urinary tract infection, urinary tumours, pregnancy, progressive neurological disease). Twenty-three conditions
(48%) were considered not limiting SNM
testing, provided that these are well-controlled (e.g. diabetes mellitus, cardiovascular disease). For the remaining 20
conditions (42%), the outcome was conditionally appropriate, i.e. dependent on
their specific nature.
Conclusions: The panel method proved to
be valuable in determining the criteria for
SNM consideration in patients with symptoms of idiopathic OAB. The electronic tool
may be useful to support patient management and to promote best practice.
UP-2.45
Orthotopic enterocystoplasty for
bladder substitution: 120 cases
Benlamssouhi F, Elbaghouli M, Joual A,
Rabii R, Fekak H, Aboutaib R, Dakir M,
Debagh A, Bennani S, Meziane F
Service d’Urologie, CHU Ibn Rochd, Casablanca, Morocco
Introduction and Objective: Orthotopic
enterocystoplasty represents one elegant
replacement technique since it permits us
S96
to obtain a functional neobladder, continent with micturition by natural ways.
Materials and Methods: We report our
study through a retrospective serial concerning 120 cases of bladder replacement
enterocystoplasty, in the Dept. of urology
of CHU Ibn Rochd of Casablanca during a
10 year period (January 1998 - January
2008).
Results: Surgical technique is that described by Studer with modifications to
the configuration which will be in double
U and ileoureteral reimplantation using
Wallace technique. From functional result,
the diurnal continence was acquired immediately at 95% of the patients, whereas
the nocturnal continence was observed at
85%. We did not detect any metabolic
disorder at all patients of our serial. Perioperative mortality was reported among 4
patients.
Conclusions: The urologic complications
were observed with variable degrees, 6
cases of urinary fistula. No case of ureteroileal stenosis, lithiasis or reflux was announced in our series. We conclude that
our enterocystoplaty technique is functional with low rate of complication and
safe for renal function.
UP-2.46
Why Studer orthotopic bladder?
observation of 110 patients
Shishkov D, Mateev D, Angelov V,
Starev R, Sarachev A
Dept. of Urology, Plovdiv, Bulgaria
Introduction and Objective: To introduce our ten-year experience with 110
patients who underwent radical cystectomy with subsequent Studer orthotopic
bladder from ileum.
Materials and Methods: After radical
cystectomy concerning bladder cancer,
we have made Studer orthotopic bladders
for 110 patients. To avoid some already
familiar complications, we allowed ourselves to perform some small modifications with some of the cases (with 47 of
the patients), that were namely the implantation of the ureter to the aductor for
the strengthening of the pelvic floor.
Results: Most of the operated patients are
continent with capacity of the substitute
bladder from 400 ml to 700 ml. For the
observed period of ten years, 15 of the
patients required therapeutic correction
of metabolic disorders. During a period of
9 to 50 months after the operation, 21 of
the operated patients died from relapses
in the pelvis. With the rest of the patients
we had good results.
Conclusion: Studer orthotopic bladder is
a good alternative for patients who have
undergone radical cystectomy. The strict
adherence to indications of orthotopic
replacement, the right selection of patients, and active postoperative observation leads to very good results.
UP-2.47
Quality of life after orthotopic urinary
diversion
Vojinov S, Jeremic D, Levakov I,
Sekulic V, Djozic J, Marusic G
Dept. of Urology, Novi Sad, Serbia
Introduction and Objectives: Quality of
life (QoL) has been evaluated in patients
after radical cystectomy due to invasive
urinary bladder carcinoma with different
orthotopic urinary diversion.
Materials and Methods: The study included 163 patients who had been operated at Clinic of Urology, Novi Sad. Questionnaire was answered by 151 of them
(all were polled 12 months after operation, or later). Ratio of male to female patients was 3.73:1. Youngest one was 43
and the oldest 78 years of age (average
63.53). The most frequent derivation was
‘vesica ileale’ Padovana (VIP) – 64.70%;
neovesica orthotopica Hautmann –
25,49%; neovesica orthotopica Studer –
9,80%. Psycho-physical, emotional, social
and economic consequences of malignant
diseases treatment were investigated by
EORTC QLQ-30, standard questionnaire.
Results: Patients answered in 31.3% of
cases that they had spent most of the day
in bed. Only six patients (3.97%) stated
that they experienced very limited work
abilities and everyday activities. There
were 132 patients who found that personal hygiene was easy to keep, no difference between various types of continent
urinary diversion has been observed. Ability to stay out of the house environment
has been scored with 5.03 of maximum 7
points. Better possibilities for sex life has
also been found (score 1.43 of maximum
7 points), with no difference depending
on the type of continent urinary diversions. When asked if they had been worried during the past week, all groups gave
approximately the same answer.
Conclusion: The results of QoL assessment are significantly affected by the follow-up time (time after operation until
polling varied), age, patient’s personality,
ability to solve problem, and grade of education. No significant difference between
vesica ileale Padovanna, Hautmann and
Studer derivation has been found. As psychological and social factors in operative
techniques choosing has been very important, we hold the opinion that patients
should be informed about the possible
advantages and disadvantages of certain
types of derivation.
UP-2.48
Long-term tolerability and efficacy of
pentosan polysulphate sodium in the
treatment of patients with bladder
pain syndrome (BPS)
Al-Zahrani A, Gajewski J
Dept.of Urology, Dalhousie University,
Halifax, NS, Canada
the patient’s compliance and long-term
efficacy and tolerability of Pentosan Polysulphate Sodium (PPS) in the treatment of
patients with Bladder Pain Syndrome
(BPS).
Materials and Methods: This is a single
institution, retrospective study. The study
period was from 1994 to 2008. We have
included all patients with bladder pain
symptoms and either frequency, urgency
or nocturia in the absence of urinary tract
infection and any other pathology. All patients had glomerulation with cystoscopic
hydrodistention under general anaesthesia.
Patients with prior PPS intake were excluded. The primary end point of this
study is the overall improvement on the
global response assessment scale (GPA).
Results: There were 271 patients eligible
for the study. Most of the patients were
female (90%), and the mean age at presentation was 45.5 years (SD ⫾ 13.9). The
average duration of symptoms was 28.5
months (SD ⫾ 25.4). With a mean follow
up of 22 month (SD⫾ 28), 147 patients
(54.2%) reported more than 50% improvements in there bothered symptoms using
the GRA. There was mild improvement in
an additional 55 patients (20.2 %). Ninetythree patients (34.3%) decided to stop
taking the medication for various reasons.
The most common reason to stop the
medication was poor response in 45 patients (16.6%). Others include side effects
in 30 patients (11.1%), resolution of the
BPS symptoms in 11 patients (4.1%) and
financial reason in 6 patients (2.2%). The
side effects include stomach upset in 23
patients (8.5%), headache in 6 patients
(2.2%), hair loss in 3 patients (1.1%), hypersensitivity in 3 patients (1.1%), and
increase in liver enzymes in 2 patients
(0.7%). Patients with history of severe
nocturia or who had DO during the UD
were predictor of poor outcome of the
PPS with p values of 0.01 and 0.037 respectively. For patients with more severe
disease in cystoscopic evaluation, they
had a better outcome (p⫽0.013).
Conclusions: The PPS is an effective oral
therapy to control the symptoms of the
BPS with good long-term efficacy and tolerability. More than 65% of patients continued to take the medication with a median follow up of 22 months.
UP-2.49
Prospective study on prostate biopsy
in patients with high serum PSA in
consideration of prostatic
inflammation
Cho I1, Choi Y1, Cho S1, Chung J2
Depts. of Urology, Inje University 1Ilsanpaik Hospital; 2Sanggyepaik Hospital,
Koyang, South Korea
Introduction and Objectives: We have
studied about the PSA variation, the frequency of prostate biopsy and the prostate cancer detection rate during the diagnosis and the medical treatment
considering the prostatitis.
Materials and Methods: The investigation is conducted based on 413 patients
with over 4ng/ml, under 10ng/ml PSA
level for 5 years. Patients with positive in
EPS or VB3 were treated with quinolone
antibiotics during two months, and in
case the PSA level was increased after 2
months, we carried out the prostate
biopsy.
Results: Among the entire number of sub-
PSA elevation
n=413
n=215
(52%)
EPS or VB3 or pyospermia (-)
n=198
(48%)
Antibiotics treatment
TRUS, PBx.
EPS(+) or VB3 (+) or pyospermia(+)
PSA normalizes
n=53
(12%)
Still PSA elevates
n=162
(39%)
CaP BPH
n=41, n=149
(9%), (36%)
Chr. Prostatitis treatment
TRUS, PBx
Treat accordingly
CaP
n=7
(1%)
Atypical hyperplasia
n=9
(2%)
Chr’Prostatitis
n=146
(35%)
Treat accordingly
Close surveilance for CaP
Treat accordingly
Atypical hyperplasia
n=8
(1%)
Close surveilance for
CaP
Figure 1, UP-2.49
S97
Figure 1, UP-2.50. GAGs in IC/PBS patients and controls in bladder biopsies
jects, the prostate cancer detection rate
was 11.6%, while among the patients
tested negative in EPS or VB3 the prostate
cancer detection rate was 20.7% and
among positive group was 3.2% (see
Figure).
Conclusions: In case the PSA level is increasing, if we make a diagnosis to exclude firstly the prostatitis and serial diagnostic procedure, it reduces unnecessary
prostatic biopsy and helps to establish
more specific treatment algorithm.
UP-2.50
Glycosaminoglycans in bladder
biopsies and in urine as possible
markers for intestitial cystitis/painful
bladder syndrome
Lucon M1, Dreyfuss J2, Silva A2, Leite K1,
Nader H2, Srougi M1, Bruschini H1
1
Divison of Urology, University of São
Paulo; 2Division of Biochemistry Federal
University of São Paulo, São Paulo,
Brazil
Introduction and Objective: Interstitial
cystitis/painful bladder syndrome (IC/PBS)
is a chronic condition characterized by
bladder or pelvic pain and voiding symptoms with no single definitive diagnostic
test. Thus IC/PBS is considered after exclusion of other pathological situations.
Since urothelial glycosaminoglycans
(GAG) layer is referred as a bladder protective factor involved in this syndrome,
we evaluated their metabolism in an attempt to identify changes possibly related
to patients with IC/PBS.
Materials and Methods: Urine and tissue
biopsies of four patients with IC/PBS according to NIDDK criteria were compared
to four controls. Patients with IC/PBS
were only under pain medication and not
using any other therapy for the last six
months. Women with urinary stress incontinence served as control group. After informed consent, urine and random bladder biopsies were collected during
cystoscopy as part of surgery for incontinence and during cystoscopy/hydrodistension for IC/PBS patients. The expression
of sulfated GAGs was investigated in tissue samples. Hyaluronic acid and sulfated
glycosaminoglycans levels were evaluated
in the urine of patients and controls. The
methods of analysis were previously described (1,2). Histopathological analysis of
the bladder tissue using hematoxylin eosin
staining was also performed. Urothelial
Figure 2, UP-2.50. Urinary GAGs in IC/PBS patients and controls
S98
alterations were graded as present or absent. Lamina propria alterations were
graded as severe moderate or mild.
Results: The histopathological analysis of
IC/PBS patients showed half of them with
urothelial erosion/ulcers compared to
none of the controls. Minimal or mild alterations in lamina propria were seen similarly in both groups. Among the different
sulfated GAGs, dermatan sulfate was the
most prevalent in bladder tissue of both
patients and controls. There was a clear
tendency to increase the expression of
chondroitin and heparan sulfate in bladder tissue of patients when compared to
controls. On the other hand, the sulfated
GAGs in urine showed undetectable dermatan sulfate levels in both groups, and
again a clear tendency to increase the levels of chondroitin and heparan sulfates in
urine of patients when compared to the
control group. Urinary levels of hyaluronic
acid were similar in IC/PBS patients and
in controls.
Conclusions: Results indicate a tendency
to increased values of chondroitin and
heparan sulfates in bladder samples of
IC/PBS patients. Similarly, a clear tendency to increase urinary levels of chondroitin sulfate was observed in IC/PBS
patients. Larger number of patients will
possibly give power to these findings and
chondroitin sulfate can potentially represent a promising marker to better identify
this syndrome.
UP-2.51
Comparison of Maki’s technique and
sonication in the diagnosis of
microbial ureteral stent colonization:
a randomized prospective study
Bonkat G1, Bachmann A1, Rieken M1,
Rentsch C1, Wyler S1, Gasser T1,
Widmer A2
1
Dept. of Urology; 2Division of Infectious
Diseases and Hospital Epidemiology,
University Hospital, Basel, Switzerland
Introduction and Objective: Ureteral
stent related urinary tract infection remains one of the leading risk factors associated with ureteral stent placement. Although the diagnosis of ureteral stent
related infection is ideally made before
device removal, a definite diagnosis involves a culture from the stent. The reference method is the semiquantitative technique described by Maki et al. in 1977.
However, no comparative prospective
studies have been performed to compare
this method with quantitative techniques
and no gold standard exists. We report
the initial results of a prospective, randomised clinical trial comparing Maki’s
technique (MT) with sonication in the
diagnosis of ureteral stent colonization.
ureteral stents from 82 patients were included in the study. Stents were removed
under aseptic conditions and divided into
four parts: The proximal (I) and distal
loop (IV) and 5 cm of the adjacent proximal (II) and distal (III) section. Each part
was separately placed in a sterile tube and
processed by the microbiology laboratory
within 6 hours. The two proximal and
distal specimens were randomly assigned
for microbial investigation by using Maki’s
technique or sonication. Maki’s technique
was performed by rolling specimens on
the surface of a sheep-blood agar plate.
Sonication was conducted in an ultrasound bath to dislodge adherent bacteria.
The resulting sonicate-fluid was plated and
incubated at 35 to 37°C in 5 to 7% carbon
dioxide aerobically for 2 days. Microorganisms were enumerated and classified by
routine microbiologic techniques.
Results: Sonicate-fluid culture resulted in
significant higher detection rate of microbial stent colonization (32%) as compared
to Maki’s technique (22%, n⫽20/91,
p⬍0.001). Sonicate fluid culture encountered a total of 55 (MT 22) microorganisms; i.e., on average 1.9 (MT 1.1) microorganisms per significant colonized stent.
Singular microbial growth was observed
by sonicate-fluid culture in 48% (MT 90%)
and mixed growth in 52 % (MT 10%). The
most commonly isolated microorganisms
from sonicate-fluid culture were Enterococcus spp. (25%), Candida spp. (15%)
and Escherichia coli (13%). Maki‘s technique missed primarily Enterococcus spp.,
Candida spp. and Coagulase-negative
staphylococci spp.
Conclusions: Culture of samples obtained by sonication of ureteral stents is
more sensitive than Maki’s technique for
the diagnosis of ureteral stent colonization. The frequency of ureteral stent colonization and the nature of responsible
pathogens should be investigated in depth
since such data may guide pharmaceutical
treatment of stent related lower urinary
tract symptoms as well as develop appropriate coatings to delay stent colonization.
UP-2.52
The relationship between microbial
ureteral stent colonisation and male
lower urinary tract symptoms
Bonkat G1, Bachmann A1, Rieken M1,
Rentsch C1, Wyler S1, Gasser T1,
Widmer A2
1
Dept. of Urology; 2Division of Infectious
Diseases and Hospital Epidemiology,
University Hospital, Basel, Switzerland
Introduction and Objectives: Ureteral
stent related symptoms are assumed to be
provoked by mechanical irritation of the
urothelium. The clinical impact of microbial device colonisation has not been evaluated yet. The aim of the present study
was to investigate the relationship between microbial ureteral stent colonisation (MUSC) and device associated symptoms in male with a focus on the
development of storage lower urinary
tract symptoms (S-LUTS).
Materials and Methods: Two hundred
and seventy-one ureteral stents of 197
consecutive male patients were prospectively evaluated. Conventional urine culture (CUC) was obtained prior to device
removal. Dipstick analysis was performed
to indicate leukocyturia. Ureteral stents
were sonicated to dislodge adherent microorganisms. A standardized questionnaire was applied to all patients. Data
were recorded to categorize the study
population in three subgroups (asymptomatic, mechanical disorders, S-LUTS).
Results: Forty-one percent of cases were
asymptomatic while 22% showed MD and
37% S-LUTS. Dipstick analysis detected
significant leucocyturia in 40% of asymptomatic patients, in 50% of patients with
MD and in 67% of patients with S-LUTS.
Sonicate-fluid culture detected MUSC in
16% of asymptomatic patients, 17% of patients with MD and 30% of patients with
S-LUTS, respectively. S-LUTS were significant correlated with MUSC (p⬍0.05).
Conventional urine cultures remained negative in 66 % of the patients affected.
Conclusions: In male patients S-LUTS
and MUSC are significantly correlated.
Since conventional urine cultures were
negative in two-thirds of the patients affected, this association remains frequently
undetected. Further research on the
pathophysiology of S-LUTS in correlation
with MUSC might reveal peripheral mechanisms which are involved. Identification
of these pathways could be helpful to prevent the development of stent related
symptoms as well as to improve pharmaceutical treatment.
UP-2.53
Correlation between post-void
residual urine volume and urinary
tract infection in asymptomatic men
visited for prostate examination
Cho YH, Kim HW
The Catholic University of Korea, Seoul,
South Korea
Introduction and Objective: The large
post-void residual urine (PVR) could be
related to various complications, especially urinary tract infections (UTIs). Although, numerous cut-off value of PVR
related to UTIs have been proposed, there
is still debate on that. We investigated the
correlation between PVR and UTIs.
2008 to December 2008, retrospective
analysis was performed on 351 asymptomatic male patients who visited our clinic
for prostate examination. The results of
levels of prostate specific antigen (PSA),
peak urine flow rate, PVR, voided urine
volume, IPSS (International Prostatic
Symptom Score) and urine culture results
were obtained. PVR was measured by portable bladder scanner. A positive result of
urine culture was defined as growth of
more than 100,000 bacteria per ml. We
investigated the association between urine
culture results and PVR, and estimated
cut-off value of PVR predicting bacteriuria
using ROC analysis.
Results: The mean age of patients was
63.3 and overall 8.83% of the patients (31
patients) showed positive results in urine
culture. Mean PVR volume was significantly higher in the group with positive
urine culture (105.55 mL vs 41.83 mL,
p⬍0.001), but we couldn’t validate cut-off
value of PVR for predicting UTIs.
Conclusions: Significant bacteriuria was
found in 8.83% of the asymptomatic male
patients. Although a positive relationship
between PVR and the risk of UTI was
found, we couldn’t validate cut-off value
of PVR for predicting UTIs.
UP-2.54
What volume of post-void residual
urine causes urinary tract infection?
Jung TS, Song JH, Cho KH, Song MH,
Kim DS, Lee CH, Jeon YS, Lee NK
Dept. of Urology, Soonchunhyang University Cheonan Hospital, Cheonan,
South Korea
S99
Introduction and Objective: It is usually
believed that large post void residual
urine volume may cause urinary tract infection (UTI). However, it is not known
how much volume of post void residual
predisposes patients to higher risk of UTI.
In this prospective study we determined
cut off value of post void residual volume
that makes adults at risk of bacteriuria.
patients who visited our institute without
symptoms of UTI were enrolled to this
study from January 2009 to August 2009.
The post void residual urine (PVR) was
measured by two methods. One is bladder
scanning by BladderScan™ (VERATHON,
Washington, USA) ultrasonographically
right after voiding. And the other is bladder catheterization right after voiding.
Urine samples from each patient were
sent to laboratory for culture and the results were analyzed comparatively with
PVR.
Result: Mean age of patients was 61.9
years old. The mean PVR was 36.09 cc in
age of forties, 80.58 cc in fifties, 69.58 cc
in sixties and 104.28 cc in seventies and
older. It shows PVR was increased with
aging. The 43 (28%) patients presented
positive urine culture and their mean PVR
was 137.90 cc. And the 112 (72%) patients presented negative and their mean
PVR was 51.78 cc. At 65 cc of PVR, it
showed highest sensitivity (86.0%) and
specificity (69.6%). And in that PVR positive predicting rate of urine culture was
52% and negative was 92%.
Conclusion: This study shows that patients who have more than 65cc of PVR
have increased risk of UTI even though
he/she have no urinary symptoms. Those
patients need close medical surveillance
because there may be necessary drug
medication or surgery to improve the
bladder emptying.
UP-2.55
Ciprofloxacin in the treatment of
urinary tract infections in general
practice
University Hospital Ibn Rochd, Casablanca, Morocco
this paper is assess epidemiological profile, clinical therapy and changing of UTI
in medicine City.
Materials and Methods: This is a prospective, multicenter study extending
between May and December 2009 with
a recent Population of 12,944 patients,
S100
including 9 504 with urinary tract
infections.
Results: All patients were adult men or
women with symptoms of urinary infection or not and who had received treatment with ciprofloxacin. The average age
of patients was 44 years ranging from
14-95 years. There is a female with 59% in
the whole study population, and 65% in
the subgroup cystitis. In our series cystitis
was largely dominant with more than 3⁄4
of diagnoses, followed by pyelonephritis
and prostatitis. In patients who have practiced a urinalysis, the organisms isolated
were largely dominated by E-coli, followed by staphylococcus, and other GNB.
In terms of symptoms, there is the predominance of micturition burns in over
80% of cases, followed by urinary frequency, pain and suprapubic. The existence of a predisposing factor was reported in 85% of cases, these include
constipation, sex, diabetes, BPH, urolithiasis or menopause. The effectiveness of
treatment with ciprofloxacin was satisfactory or very satisfactory in 95% of patients, whether or not they had a urine
culture, suggesting that the efficacy rate
of urinary tract infections in this study by
ciprofloxacin was the same as the diagnosis has been on the balance sheet or not
bacteriologically. During monitoring visits,
the tolerance of ciprofloxacin was satisfactory or very satisfactory in 96% of cases.
Conclusion: Through this study we
wanted to verify the epidemiological profile and clinical therapy of urinary tract
infections in our context.
UP-2.56
Urogenital tuberculosis (about 116
cases)
Elmaataoui A, Ksiri K, Abouteib R,
University Hospital IBN Rochd, Casablanca, Morocco
Introduction and Objective: Tuberculosis (TBK) urogenital is still common in our
climate. It is the fifth most common after
pulmonary tuberculous localizations, ganglion, musculoskeletal and digestive systems. The purpose of our work was to
analyze the diagnostic and therapeutic
aspects of this disease in order to establish an early diagnosis and therapy clear.
Materials and Methods: Our study focused on 116 cases of TUG collected in 6
years (1999-2005) at Dept. of Urology CHU
Ibn Rushd. The average age of our patients
was 36 years [16-74] with a male predominance (63%). The time to diagnosis is often
delayed by an average 1 to 2 years. The tell-
tale sign, cystitis, remains the most common
(73%); other signs, hematuria, back pain,
genital signs and signs nephrology (HT, IR),
are not uncommon. Vaccination with BCG
does not exclude the diagnosis.
Results: Clinical examination was more
eloquent in men than in women when
there is a genital outbreak. All our patients were started on antibiotic treatment: 2 SRHZ/7RH. The TUG is a serious
condition. Resection or reconstruction
and/or treatment endourology are often
necessary to relieve the obstruction and
improve the quality of life of patients. The
fact remains that the best treatment is
prevention.
Conclusions: The prevention of urogenital
tuberculosis is based on the BCG vaccination, improved sanitary conditions of life
and the fight against poverty and illiteracy.
UP-2.57
Antimicrobial effect of lactobacillus in
a rat model of escherichia coli lower
urinary tract infection: a preliminary
study
Han C, Kim H, Cho Y
College of Medicine, The Catholic University of Korea, Seoul, South Korea
Introduction and Objective: Urinary
tract infection (UTI) is one of the most
common infectious diseases. There are
reports that loss or destruction of normal
urinary flora such as Lactobacillus increases UTI, and in more recent reports,
human urinary epithelial cells have been
found to competitively block uropathogen
conjugation. We investigated the blocking
effect of the Lactobacillus rhamnosus in
a rat model of UTI caused by Escherichia
coli.
Materials and Methods: Thirty-two adult
female Sprague-Dawley rats weighing 250
to 350 g (Samtako BioKorea, Osan, South
Korea) were randomly divided into 4
groups (Group I, control group; Group II,
Lactobacillus group; Group III, E. coli
group; Group IV, E. coli and Lactobacillus
group). After 3 weeks, the urine and bladder were cultured for microbiological
study and the bladder was examined histopathologically.
Results: Microbiological culture of urine
demonstrated no significant differences in
the four groups, but there were significantly
fewer bacteria in group IV than in group III
(p▫0.05). The bacterial growth of the bladder tissue showed the same result. Histological exam of the bladder of group IV
showed decreased infiltration of leukocytes
and less submucosal edema than in group III.
Conclusions: We were able to confirm
the blocking effect of L. rhamnosus on
E. coli growth. More studies are needed
to further identify the therapeutic effect
of Lactobacillus and to determine the optimal lactobacilli species, dose, and method
of administration.
UP-2.58
Schistosomiasis: unusual cause of
LUTS in Europe
Leão R, Azinhais P, Pereira B, Borges R,
Grenha V, Coelho H, Retroz E, Sobral F
Dept. of Urology, Centro Hospitalar de
Coimbra, Coimbra, Portugal
Introduction and Objective: Schistosomiasis is a parasitary disease of the hot
climates. S.haematobium is the main agent
of urinary schistosomiasis. Although rare
in Europe it is described in some immigrants from Africa.
Materials and Methods: Clinical case of
a 24-year-old black man, who went to ER
complaining of right lumbar pain. Urinary
tract ultrassonography revealed bilateral
urethero-hydronefrosis. X-Ray revealed
linear pelvic calcifications. Intermittent
hematuria and LUTS from 15 years old
until present day. Complementary studies
came to disclose a diagnosis of a chronic
urinary tract schistosomiasis.
Results: The diagnosis of schistosomiasis
was carried out by cystoscopy and biopsies with evidence of calcified eggs of
schistosoma in the harvested sample. The
patient was presented to the ER with
complications from the disease, bilateral
uretero-hydronephrosis with terminal
stricture of both ureters and bladder contracted (small capacity), causing the lower
urinary tract symptoms. He was proposed
to undergo augmentation cystoplasty (ileocystoplasty) and ileal uretero-neocystostomy.
Conclusions: lthough schistosomiasis is
rare in Europe, it should always be considered in individuals from endemic areas.
Urinary complaints in potentially infected
individuals must presuppose the diagnosis. The correct diagnosis is thus based on
a scrupulous and meticulous clinical story
and by a high index of suspicion.
UP-2.59
Large retroperitoneal abscess
complicating neurogenic lower
urinary tract dysfunction
Patris E, Efthimiou I, Kalaitzis C,
Zachariadis C, Giannopoulos S,
Giannakopoulos S, Tsakaldimis G,
Touloupidis S
Dept. of Urology, University Hospital of
Thrace, Alexandroupolis, Greece
Introduction and Objective: Although
UTIs are among the most common uro-
logic complications of neurogenic lower
urinary tract dysfunction (NLUTD), retroperitoneal abscesses are rare clinical manifestations. Herein we present our experience in diagnosis and management of
such cases.
Materials and Methods: We studied retrospectively 6 patients (4 females and two
males) with a mean age 62 years (range
51-80) presented in our hospital in the
last 7 years. Three cases had a previous
history of spinal cord injury (SCI) and and
the rest of them had a history of multiple
sclerosis (MS). Range of duration of neurologic disease was 5-35 years. No patient
had ever had any kind of urodynamic
study before.
Results: Mean duration of symptoms, before the definite diagnosis, was 15 days
(range 12-35 days) and all had a history of
recurrent UTIs. The diagnosis was confirmed with ultrasonography and computed tomography. The patients were
treated, except of broad spectrum of intravenous antibiotics, with an interventional management. The collections were
drained with an percutaneous tube,
guided under imaging control. In one case
the drain remained for five months before
the definite removal. In addition one patient required emergency nephrectomy
due to progression to sepsis (16.6%).
Conclusion: Retroperitoneal abscess formation is a late complication in NLUTD
and mainly presents in patients with long
lasting disease. Minimal treatment with
percutaneous drainage offers excellent
results as a first line treatment.
UP-2.60
Clinical significance of postoperative
bacteriouria after transurethral
surgery: results of a prospective
multicenter study
El Basri A1, Petrolekas A2, Cariou G2,
Cortesse A2, Colau A2, Bruyère F3
1
Service d’Urologie, Errikos Dynan Hospital, Athens, Greece; 2Service d’Urologie,
Hôpital des Diaconesses, Paris, France;
3
Service d’Urologie, Hopital de Tours,
Tours, France
Introduction and Objective: The objective of this study is to evaluate the need
of a postoperative urinanalysis. We
present the results of a multicenter prospective study on the prevalence and the
clinical outcome of asymptomatic postoperative bacteriuria after transurethral
operation.
Materials and Methods: Between January 2008 and September 2009, 508 patients underwent TURP and TURB in 2
centers and have been followed prospec-
tively. Routine urinalysis was performed
preoperatively, postoperatively (mid
stream sample of the 2nd urination after
catheter removal) and at 1 month postoperatively. Any urinanalysis with cfu⬎10*3
and ⱕ2 uropathogens was considered
positive. Only patients symptomatic in
postoperative period were treated. Sex,
age, preoperative catheterization, diabetes, positive preoperative urinanalysis, duration of the surgery and associated intervention were evaluated as risk factors for
a positive postoperative urinanalysis. The
prevalence of a positive urinanalysis at 1
month and of infectious complications
during the follow up was recorded and
postoperative bacteriouria was examined
as a risk factor. SPSS 14.0 was used for
the statistical analysis.
Results: TURP was performed in 236 patients, TURB in 265 and 7 had both.
There were 445 men and 63 women. After excluding those with positive preoperative urinanalysis and missing values, 452
were entered in the analysis. Mean age
was 71,9 years. Mean follow up was 4,2
months. Mean catheterisation postoperatively was 2,23 days. Twenty-six (5,7%)
patients had a positive postoperative urine
culture, were asymptomatic and not
treated. Age of the patient was the only
risk factor for postoperative bacteriouria
(p⫽0,003). Thirty-two patients had a positive urinanalysis at 1 month and twentysix presented an infectious complication
during follow up. A positive postoperative
urinanalysis was not a risk factor neither
for a positive urinanalysis at 1 month nor
for an infectious complication during follow up(p⫽0,11 and 0,67 respectively).
Conclusions: Postoperative asymptomatic bacteriouria is not a risk factor for
infectious complications postoperatively.
Therefore, routine postoperative urinanalysis should be advocated only in symptomatic patients.
UP-2.61
Possibility of antibiotic usage
according to their activity spectrum
and price for uncomplicated urinary
tract infections on the primary level
of healthcare in the region
Rainauli Z, Rainauli S, Rainauli N
Iakob Gogebashvili Telavi State University Educational Clinic, Telavi, Georgia
Introduction and Objective: Antibiotics
belong to the number of the most frequently used preparations in the practice
of urology. Their accurate selection defines the result of treatment. To formulate
practical recommendations for antibiotic
therapy for urinary tract infections under
S101
the conditions of non-regulative pharmaceutical market and limited economic environment, taking into consideration the
activity spectrum of antibiotics, their
price and regional peculiarities for the
doctors of primary healthcare.
Materials and Methods: Special literature concerning the experience of antibiotic usage in the uncomplicated urinary
tract infections; Information about the
diversity of antibiotics in pharmaceutical
trade section in Telavi region according to
their quality, name and price.
Results: Taking into consideration the
antibiotics, existing in the pharmaceutical
net of the region, several recommendations were made regarding the usage of
antibiotics by the doctors of the region on
the basis of the corresponding literature
in this field.
Conclusions:
1) Usage of broad spectrum antibiotics is
groundless for uncomplicated urinary
tract infections.
2) Short-term antibiotic therapy (max. 3
days) is advisable by “single shot” method
for uncomplicated urinary tract infections. Recommended preparations are
cotrimoxazol, quinolones and per oral
cephalosporins.
3) Common dose of the preparation(s) in
usage should be defined in the process of
antibiotic therapy
4) For the prophylaxis of re-infections cotrimoxazol or cephalexin is recommended
for chronic infections of urinary tract
5) The synergism of already-used preparations should be taken into consideration
during combined antibiotic therapy.
UP-2.62
Intravesical instillation of hyaluronic
acid in the treatment of recurrent
urinary tract infection in women
Sharifiaghdas F, Hamzehi Esfahani N
Shahid Labbafinejad Hospital, Urology
Nephrology Research Center, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
the impact of intravesical instillation of
hyaluronic acid as a protective layer of
urothelium in the treatment or improvement of recurrent urinary tract infections
in female patients.
Materials and Methods: Thirty women
with a history of recurrent urinary tract
infection were included. Inclusion criteria
were: at least 3 documented positive
urine cultures during the last year. Patients underwent full clinical and paraclinic evaluation which consisted of: ultrasonography, voiding cystourethrography,
S102
rigid cystourethroscopy, urodynamic study
and in selected cases intravenous urography. Exclusion criteria were: abnormalities of external genitalia, neurogenic bladder dysfunction, intrauterine device, and
high post-voiding residue.
All patients received hyaluronate (40 mg
in 50 ml phosphate-buffered saline), once
weekly for one month, then once every
other week for the second month, followed by 5 more monthly instillations for
five months.
Results: Mean age was 71 years (Age
range of 25-75). Mean follow-up time is 11
months (after complete therapy). Sixteen
patients (53%) had negative urine cultures
during the seven months treatment phase
and were recurrence free at the end of
follow up ( at least six months at the time
of report ). In non-responders, the median
time to recurrence during hyaluronate
therapy, was 30 days. Ecoli was the main
bacteria before and after HA therapy.
Conclusion: This preliminary study reveals that bladder instillation of hyaluronate is effective in the treatment of recurrent urinary tract infection in half of
female patients, at short term follow-up,
although more long-term studies with expanding patients number is needed.
UP-2.63
The role of neonatal circumcision in
prevention of urinary infection: a
large prospective study with long
term follow-up using Plastibell
Simforoosh N, Tabibi A, Khalili SA,
Soltani MH, Afjehi A, Aalami F, Bodoohi H
Shahid Labbafinejad Medical Center,
Urology and Nephrology Research Center
(UNRC), Shahid Beheshti Medical University, (SBMU), Tehran, Iran
has been performed to evaluate the preventive effect of neonatal circumcision on
urinary tract infection (UTI) and the incidence of complications following neonatal
circumcision by using plastibell.
Materials and Methods: Our prospective
study has been carried out since 2004.
During this period, 3000 neonatal circumcisions were done. All of the cases were
examined in order to find any complications one week later and occurrence of
meatal stenosis was followed up to 15
months of age. In this group, urine analysis and culture was successfully obtained
four times on 2000 circumcised infants at
1.5, 3, 9 and 15 months. The control
group consisted of 3000 uncircumcised
infants that in 1000 cases accomplished
urine analysis and culture at the same
designated intervals.
Results: Definite positive urine culture
was observed in none of circumcised
cases and in 20 (2%) uncircumcised cases
after obtaining suprapubic bladder aspiration sample. The latter 20 infants were
circumcised and follow-up cultures were
negative in 17 cases. The overall complication rate in circumcised group was
1.6%. The difference in frequency of UTI
between two groups is statistically significant (P⬍ 0.0001).
Conclusion: Neonatal circumcision with
infrequent complications is routinely recommended as a preventive health measure for the neonates.
UP-2.64
Perioperative morbidity and mortality
in Fournier’s gangrene
Surcel C, Mirvald C, Chibelean C,
Gingu C, Cerempei V, Avram D, Dudu C,
Zogas V, Sinescu I
Fundeni Clinical Institute of Uronephrology and Renal Transplantation, Bucharest, Romania
Introduction and Objective: Fournier’s
gangrene is a potentially lethal disorder
with an abrupt onset of the necrotizing
infection of soft-tissue in the external genital area with rapid dissemination along
fascial planes resulting pathological lesions as: cellulites, fasciitis, myositis. This
paper describes the experience of Fundeni Clinical Institute in the last decade
representing 42 cases of Fournier gangrene with various etiologies.
Material and Method: All patients are
hospitalized in intensive care unit and
rapid evaluation starts with routine blood
and urine analysis (full blood count, urea
and electrolytes, liver function tests, coagulation profile, glucose level, C-reactive
protein, uroculture). Blood and tissues
cultures were also taken. Consent for debridement and organ excision is obtained
and an aggressive surgical treatment is
immediately approached. No matter the
infection source, preoperative minimal
cystostomy was performed in all cases.
The results were evaluated by KaplanMeier model as far as survival rate is concerned and by Cox model for multivariate
analysis.
Results: All patients were male, mean age
being 57 years with range between 2 and
84. Twenty-six patients displayed genitourinary source (14 with suppurative orchiepididymitis and scrotal fistulae, 6 patients
with neglected urethral strictures and
periurethral abscess formation after misplaced Foley catheters, 3 patient with UTI
and urethral lesions after instrumentation
and urethral bleeding and 2 patients with
Cowper glands infection); 4 patients with
anorectal origin-ischiorectal fossa phlegmon and 6 patients with skin sources (3
cases after self-insertion of metal balls or
lipstick in the foreskin or the penile shaft
and 3 patients with neglected cutaneous
lesions after penoscrotal edema remission.
Risk factors were as follows: 14 patients
had Diabetes mellitus (type 1, 4 cases,
type 2, 24 cases), 10 liver cirrhosis, 2 patients bone marrow aplasia, chronic alcohol addiction 12 cases, cardiac failure 8
patients, chronic renal failure in 4 cases,
leukemia-4 patients and 2 patients with
HIV/AIDS infection. The median hospitalization period was 23 days, ranging between 2 and 48. Eight patients needed a
second surgical intervention due to extension of initial lesions; 6 of them had hepatic cirrhosis and 2 patient chronic kidney failure. The overall survival rate was
78.26 %, the worst prognosis in our study
being associated with hepatic cirrhosis
(p⬍0.03). Ten patients displayed myonecrosis lesions: 4 died and 6 of them underwent a second intervention.
Conclusion: Acute orchiepididymitis is
an uncommon cause of Fournier gangrene
but suppurative infection neglected with
scrotal skin fistula may be an important
etiology. An early recognition of this lesions and proper treatment are essential
in avoiding complications. The worst
prognosis is associated with myonecrosis
lesions and hepatic cirrhosis in our statistic evaluation.
UP-2.65
Life saving D-J stenting in lower
urinary tract infection: really a daring
step or not?
Umer M
Haris Medical Complex, Gujranwala,
Pakistan
Introduction and Objective: If one kidney is already poorly functioning or nonfunctioning then the second contra lateral
is also become risky for life if its function
deteriorates because of obstruction due to
infection (pus), stones, clots, debris and
strictures.
Materials and Methods: In my studies a
total of 10 patients presented with life
threatening emergencies like: 1) pain and
haematuria; 2) oligurea; 3) Anurea; 4) Renal failure. In all these patients, life saving
D-J stenting was done endoscopically with
great success.
Results: All patients reported a high quality of life post operatively with preservation of upper and lower urinary tract
function.
Conclusion: The result of my study have
shown that if timely intervention of lower
urinary tract is done, high quality of life
with great success rate and preservation
of life and renal function can be assured.
UP-2.66
AUA recommended preparations
(antibiotic prophylaxis and cleansing
enema) are important to prevent
febrile complications in transrectal
ultrasonography guided prostate
biopsy
Yu J, Sung L, Chung J, Noh C
Inje University, Sanggye Paik Hospital,
Seoul, South Korea
Introduction and Objective: Transrectal
ultrasonography (TRUS) guided prostate
biopsy is a safe technique, but it is not
complication-free. Post-biopsy infection
(acute prostatitis or sepsis) could be a
serious complication of the procedure.
Recent studies showed that patients with
urethral catheter, diabetes mellitus or
those planned to undergo biopsy from
more sites than the standard, should be
closely monitored after biopsy because of
higher febrile complication rate. We evaluated the risk factors for febrile complications after TRUS guided prostate biopsy in
one center.
Materials and Methods: Between January 2005 and May 2009, 484 patients who
underwent TRUS guided prostate biopsy
were assessed retrospectively. AUA recommended preparations (antibiotic prophylaxis and cleansing enema) were given
to most patients. Some patients didn’t get
recommended preparations. The relationships between febrile complications and
age, serum total PSA level, prostate volume, number of cores, number of repeated biopsies, presence of urethral
catheter and diabetes mellitus, and unprepared prostate biopsy were assessed. Unprepared prostate biopsy was defined if
the patients didn’t get AUA recommended
preparations.
Results: Of the 484 patients, 20 (4.13%)
developed febrile complications, consisting of acute prostattitis (17 patients,
3.51%), sepsis (3 patients, 0.62%) within a
week after biopsy. And 7 patients were
hospitalized for intravenous antibiotics.
Non-febrile complications were urinary
retension (3 patients, 0.62%) and persistent hematuria (1 patients, 0.21%). On
univariate and multivariate analysis, unprepared prostate biopsy was the only parameter for complications (OR(95% C.I.),
6.559(1.980-21.731), p⫽0.002,
5.888(1.706-20.323), p⫽0.005).
Conclusions: AUA recommended preparations (antibiotic prophylaxis and cleans-
ing enema) would be necessary to prevent febrile complications, even though
the complication rate is low.
UP-2.67
Anastomotic stricture after radical
prostatectomy (about 7 cases)
Maarouf J, Ghorbel J, Gammoudi Z,
Dridi M, Khiari R, Ghozzi S, Khouni H,
Ben Rais N
Tunis Military Hospital, Tunis, Tunisia
Introduction and Objective: The objective of this study is to evaluate the risk
factors of anastomotic stricture in patients
with prostate cancer treated by retropubic
prostatectomy in order to prevent and to
propose a therapeutic approach.
analysis of 50 consecutive retropubic radical prostatectomies performed between
January 1999 and January 2008. Univariate
and multivariate analysis of main risk factors were performed.
Results: We have noticed seven cases of
anastomotic stricture after total prostatectomy with a middle delay of apparition of
3.9 months. The main significant risk factor on univariate and multivariate analysis
is urinary extravasation (p ⫽ .0001).
Conclusion: The anastomotic stricture
remains one of the dreaded complications
of prostatectomy. A good knowledge of
risk factors, such as urinary extravasation,
is fundamental in preventing them because it is only while decreasing its morbidity that we will really make radical
prostatectomy the treatment of choice for
localized cancer of the prostate.
UP-2.68
Low power holmium laser
urethrotomy can be safely performed
under local anesthesia in urethral
stricture patients following
transurethral resection of the prostate
Cho K1, Lee S2, Park S3, Kim D4, Lee D5,
Yoo T2
Depts. of Urology, 1Yonsei University College of Medicine, Urological Science Institute, Seoul; 2Eulji University School of
Medicine, Daejeon; 3Hanyang University
College of Medicine, Seoul; 4Kwandong
University College of Medicine, Goyang;
5
Ewha Woman’s University, School of
Medicine, Dept. of Uology, Seoul, South
Korea
Introduction and Objective: Endoscopic
internal urethrotomy has been effectively
used for urethral strictures; however, general or regional anesthesia is usually required. We performed urethrotomies under local anesthesia using low power
S103
holmium laser and evaluated the safety
and efficacy.
Materials and Methods: Twenty-four
male patients with symptomatic urethral
strictures were treated with holmium laser urethrotomy under local anesthesia.
All strictures occurred after transurethral
resection of the prostate. We used a semirigid ureteroscope with an outer diameter
of 8Fr at the tip. Before the urethrotomy,
patients received 2% intraurethral lidocaine gel instillation. After 10 minutes, the
stricture was incised under vision at the
12 o’clock location. Laser energy was set
at 1.0 J with a frequency of 0.8 Hz. Urethral catheter was not placed postoperatively. A 10 cm visual analogue pain scale
was used to assess intraoperative pain.
Success was defined as peak urinary flow
rate of 15ml/sec, or greater, at 4 weeks
after surgery.
Results: Preoperative average peak urinary flow rate was 6.93⫾2.21 ml/sec.
Postoperative average peak urinary flow
rate was increased to 15.96⫾3.51 ml/sec.
Visual analogue pain scale score was
2.07⫾2.3. The total success rate was
75.0% (18/24). The success rate of short
segmental urethral stricture of ⬍2cm was
84.6% (11/13). No major intraopreative
complication was noted.
Conclusions: Low power holmium laser
urethrotomy under local anesthesia appears to be a safe and effective technique
for short segment urethral strictures.
UP-2.69
York Mason approach: a good
technique for the management of
urethrorectal fistulas
Statoua M, El Khader K, El Ghanmi J,
El Karmouni T, Tazi K, El Koutani A,
Ibn Attya A, Al Hachimi A
Urology B Dept., Avicenne Hospital,
Rabat, Morocco
Introduction and Objective: To review
our experience with York Mason technique for the management of urethrorectal fistulas.
and 2008, 5 patients with urethra-rectal
fistula were operated by the same surgeon
(Hachimi Mohammed) using York Mason
technique (transanosphincteric approach).
All patients were evaluated before and
after the operation by clinical and radiological examination.
Results: The mean follow up was 5 years
(ranging from 2 to 10 years). The mean
operating time was 120 minutes; no post
operative complications were observed
and all patients were cured.
Conclusions: The York Mason approach
S104
is an effective procedure for the treatment
of urethro-rectal fistulas.
UP-2.70
Incidence of fossa navicularis
strictures in retropubic radical
prostatectomy
Giulianelli R, Pisanti F, Gentile B,
Brunori S, Mavilla L, Albanesi L, Attisani F,
Shestani T, Vincenti G
Villa Tiberia Clinic, Rome, Italy
Introduction and Objective: Fossa navicularis strictures following retropubic
radical prostatectomy are reported infrequently. No works in Literature analyze
the caliber of the catheter as a risk factor.
The aim of this study is to determine the
incidence of fossa navicularis strictures
depending on the catheter’s caliber.
Materials and Methods: A cohort of 405
patients underwent RRP from January
2004 to December 2008; out of this number, in 274 patients, we used a 20F catheter, and in 131, a 22F catheter. Mean catheterization time was 8 days (range 6 –
11). Fossa strictures were diagnosed based
on acute onset of obstructive voiding
symptoms and bougie calibration. Parameters were evaluated using Fisher’s exact
test and Student’s t test for means.
Results: We observed 10/405 fossa navicularis strictures: the 20F catheter group
(n⫽ 274) developed 1 fossa strictures,
whereas the 22F catheter group (n⫽131)
developed 9 fossa strictures (p⬍0,02).
The fossa stricture rate in the 20F group
was 0,36% versus 6,9% in the 22F group.
The 10 patients underwent uretrotomy
but 4 of them had a recurrence in 90 days
(22F group), and one again 3 months after
the second-look endoscopic treatment.
The two groups had no differences regarding demographic features (age, BMI),
cardiovascular diseases, clinical evaluation
(IPSS, pre-surgical PSA) and perioperative
data (operative time, estimated blood loss,
cautery use or prostate size).
Conclusions: In our experience the use
of a 20F catheter appears to reduce the
incidence of fossa navicularis strictures as
compared to 22F. With larger urethral
catheter size increase, over 20-fold, there
is risk of local urethral ischemia, local
traumas and inflammation.
UP-2.71
Substitution urethroplasty
Sharma D
Woodlands Hospital, Georgetown, Guyana
Introduction and Objective: Repair of the
long posterior urethral stricture that results
from severe posterior urethral injury poses
formidable challenges to the operating surgeon. Substitution urethroplasty using either
a scrotal skin flap or a free buccal mucosal
graft offers the surgeon the freedom to manage this difficult problem. The operation
proceeds in two stages.
Materials and Methods: We introduced a
sutureless scrotal skin flap technique suitable for the very infected case, for example:
watering can perineum or the elderly patient or the patient with limiting co-morbidities. The great challenge for buccal mucosal
free flap insertion has been working within
the confined anatomical space of the bladder neck, posterior urethral region, bone
anteriorly, rectum posteriorly and the urethral sphincteric mechanism somewhere in
between.
A very few special instruments are required and they can be made or adapted
in the hospital workshop.
1. Standard Turner-Warwick needles
2. Modified Turner-Warwick needles –
Lal Beharry
3. Bladder neck director/retractor
Results: The skin tube neo-urethra functions for approximately 20 years. Some
100 patients have had scrotal skin flap
substitution. Six patients have had buccal
mucosal flap substitution. All six are free
of catheters, are continent and able to
rejoin their friends and society.
Conclusions: Substitution urethroplasty
has a place in the urological armamentarium. It can be performed by good, welltrained non-specialist surgeons. It is less
risky than more demanding anastomotic
procedures. Substitution urethroplasty is
most useful for long strictures, especially
strictures complicated by infection.
UP-2.72
Urethroplasty in multiple stages using
buccal mucosa grafts
Vander Eeckt K, Joniau S
Dept. of Urology, University Hospitals,
Leuven, Belgium
Introduction and Objective: There are
few reports about urethral surgery in multiple stages. We aimed to compare the restricture rates and erectile function changes
after urethroplasty in multiple stages.
patients who underwent urethral surgery
at our institution between 2003 and 2009.
Of those patients, 23 had a urethroplasty
in multiple stages with a buccal mucosa
graft. Different pre- and postoperative parameters were collected: cause of stricture, pre- and postoperative maximum
flow rate (Qmax), pathology report, postoperative complications, preoperative remembered IIEF-5 score (r-IIEF-5) and pro-
spectively collected IIEF-5 (p-IIEF-5) and
IPSS scores at last follow-up. Any urethral
instrumentation after surgery was considered a treatment failure. One-way ANOVA,
Chi-square and Kaplan-Meier with log-rank
test were used for statistical analysis.
Results: Thirteen patients (56,5% ) had an
idiopathic stricture, 9 patients presented
with hypospadias cripple (39,1%) and one
had a perineostomy stenosis (4,3%). Of all
idiopathic strictures, eight patients (8/13)
had proven lichen sclerosis et atroficans on
pathology report. Eleven patients had a
meatal stricture, nine a distal stricture after
multiple hypospadias repair, one a stricture
of a perineostomy and one a bulbar stricture. Fourteen patients (60,9%) had a two
stage procedure; two patients (8,7%) did
not want a second repair, and 7 patients
(30,4%) had a procedure in three stages (4
patients had a reconstruction on the glans,
one needed a second buccal mucosa graft
because of graft failure and 2 a fistula repair). The mean pre- and postoperative
Qmax were 7 and 15,4ml/s respectively.
The mean follow-up was 28,4 months (SD
⫹/⫺ 17,8). Complication rate was 43,5% (2
patient had a UWI and 8 patients wound
problems). The overall 3 year failure-free
rate were respectively 85,5%. Of the 4 patients who had a recurrence, three were
treated with urethral dilatation and/or urethrotomy and one received a perineostomy.
There mean IPSS at last follow-up was 9 (SD
⫹/⫺ 7,6). Six patients had new onset postmicturation dribbling. There was a significant difference between r-IIEF-5 (mean 21,2
(SD ⫹/⫺5.1)) and p-IIEF-5 (mean 14,13(SD
⫹/⫺8,3)) (p⫽0,001).
Conclusions: Even though multiple stage
urethroplasty is complex surgery because
of a history of lichen sclerosus et atroficans or hypospadias cripple, we present a
very acceptable 3 year failure-free rate
survival of 85,5%. However, patients need
to be well counseled regarding the complexity of this surgery as there is a high
incidence of complications with some
patients needing more than two stages.
Furthermore, erectile function decline is
evident after this surgery and patients
should be well informed about this.
UP-2.73
End-to-end repair or augmented
anastomosis for single-stage bulbar
urethroplasty in short urethral
strictures?
Vander Eeckt K, Joniau S
Dept. of Urology, University Hospitals,
Leuven, Belgium
Introduction and Objectives: It is common practice to use an end-to-end (ETE)
urethroplasty in short (ⱕ2cm) urethral
strictures. Sometimes, an augmented anastomosis with roof strip buccal mucosa
graft is needed peroperatively when ETE
is not feasible.
However, the restricture rates and functional outcomes of those 2 techniques
have never been compared directly. We
aimed to compare the restricture rates
after single-stage ETE versus the augmented buccal mucosa graft (BMG) repair
for bulbar urethral stricture disease.
Materials and Methods: Sixty-two patients underwent a single stage bulbar urethroplasty for small strictures at our institution between 2003 and 2009: 42
patients had an ETE and 20 had an augmented anastomosis using a BMG graft
(BMG-AA) repair. Different clinical parameters were collected: pre- and postoperative maximum flow rate (Qmax), previous
urethral manipulations, stricture length,
postoperative complications and prospectively collected IPSS scores at last followup. Any urethral instrumentation after surgery was considered a treatment failure.
Results: The mean stricture length was
1.34 cm in ETE versus 2.08 cm in the augmented BMG repair (p⬍0.001). The mean
pre- and postoperative Qmax of ETE versus
the augmented BMG urethroplasty were 8.1
vs. 8.42 ml/s (p⫽0.8) and 20.4 vs. 19.4 ml/s
(p⫽0.8) respectively. The mean follow-up
was 18,5 months (SD ⫹/⫺ 9,24) and this
was identical for the two groups (p⫽0.83).
Complication rate was 9.7%, with no significant difference between groups (p⫽0.85).
The estimated failure-free rate of the ETE
and the BMG repair were 79.9% and 92.3%
respectively (p⫽0.3). IPSS at last follow-up
was in favor of the ETE (5.4 vs 8.5,
p⫽0.011). 31.6% of the patients had new
onset postmicturition dribbling with no significant difference between the 2 groups
(p⫽0.47).
Conclusions: In bulbar urethral strictures, the failure-free rates and complication rates after end-to-end or augmented
BMG repair were comparable. These results have important implications for clinical practice, as when there is any doubt
during surgery about the feasibility of performing an end-to-end urethroplasty, the
threshold to take a BMG graft for an augmented anastomosis repair must be low.
Introduction and Objective: Male urethral carcinoma is an extremely rare malignancy and comprises less than 1% of all
malignancies. Once invasive cancer is detected, radical surgery is indicated, although the prognosis usually is poor. Literature search found the association of
stricture urethra to urethral carcinoma
ranges from 16%-80%. One of the common practices of urethral stricture management is self calibration and multiple
endoscopic interventions. Age old hypothesis of chronic irritation to tissue leads to
dysplasia and malignancy. Objective is to
study the association between stricture
urethra / multiple urethral instrumentation and male urethral carcinoma
review of patients treated for urethral carcinoma in our institute from 1990 to
2009. The patients were analyzed in terms
of age, presence of stricture urethra, duration of disease, urethral instrumentation,
mode of presentation, radiological findings of urethral carcinoma, stage of the
disease and surgery performed.
Results: Fourteen patients were treated,
11 (80%) patients had stricture urethra,
with the mean age of 57 years and the
mean duration of stricture urethra was 62
months. All with stricture urethra had a
history of multiple urethral instrumentations with the range of 2-4 attempts of
endoscopic management and 10 were on
self-calibration for the period ranging from
24-40 months. Most common presentation
was obstructive symptoms and periurethral mass in 5 and 4 patients respectively. Ten of the eleven (90%) patient
had squamous cell carcinoma and most
common site was bulbomembranous junction 8/11 (72.72%). Nine out of 11 required total penectomy; one patient had
undergone preputial tubularised urethroplasty, and another two had total penectomy with cysto prostatectomy.
Conclusion: Urethral carcinoma is
strongly associated with stricture urethra.
Patients had multiple surgical interventions for stricture urethra should be kept
on regular follow up with high index of
suspicion to detect the carcinoma earlier
and needs prospective studies to know
the histological changes of urethral mucosa in patients on self-calibration.
UP-2.74
Male urethral carcinoma: does
stricture urethra / multiple
instrumentation predispose it?
Veeramoni M, Mishra S, Kurien A,
Ganpule A, Sabnis R, Desai M
Muljibhai Patel Urological Hospital,
Nadiad, India
UP-2.75
Outcome of daycase optical
urethrotomy
Venugopal S, Schoeman D, Farrier A,
Das S, Powell C, Pettersson B
Countess of Chester NHS Foundation
Trust, Chester, UK
S105
Introduction and Objective: Surprisingly, there is currently no consensus
about the length of stay or the duration
of catheterisation following optical urethrotomy, though urethral stricture is a
common urological problem encountered in all the urological units and has
a high rate of recurrence and morbidity.
Even within the same unit the practice
is quite varied, with trial without catheter offered anywhere between 1 day to
a week or in some instances up to six
weeks.
We set out to assess the outcomes of day
case optical urethrotomy and analyze the
results of early trial without catheter offered less than 48 hours irrespective of
the site or length of stricture.
consecutive patients who underwent optical urethrotomy for primary urethral stricture in the day unit over the past 3 years
who were analyzed. Patients with recurrent
strictures were excluded from the study.
Patients were brought back for a trial without
catheter within 48 hours of the procedure.
Results: The results suggest that this is a
well-tolerated procedure and successful
early trial without catheter could be
achieved with a recurrence rate of 27.2%.
All the patients who had recurrence as
evidenced by flow rate and flexible cystoscopy were then offered a repeat urethrotomy and self dilation. The mean follow-up
was 16.7 months and median of 15.5
months.
Conclusions: Our analysis indicates that
optical urethrotomy can be carried out as
a day case procedure and early removal of
catheter within 48 hours is associated
with a lower recurrence rate than quoted
in the literature. This would help to re-
S106
duce the hospital stay as well as catheter
related morbidity. A proper randomized
control trial is required, taking into account factors such as the length and position of stricture to compare the outcomes
against current standards.
UP-2.76
A comparative study on the clinical
effects of silodosin and naftopidil in
patients with lower urinary tract
symptoms associated with benign
prostatic hyperplasia
Shirakawa T1, Haraguchi T1,
Matsumoto M1, Morishita S2,
Minayoshi K3, Miyazaki J4, Yamada Y5,
Tanaka K1, Takenaka A1, Fujisawa M1
1
Department of Urology, Kobe University
Graduate School of Medicine; 2Department of Urology, Kobe Century Memorial Hospital; 3Department of Urology,
Shakaihoken Kobe Central Hospital; 4Department of Urology, Kobe Ekisaikai
Hospital; 5Department of Urology, Hyogo
Prefectural Amagasaki Hospital, Kobe,
Japan
Introduction and Objective: Silodosin is
a novel alpha-adrenoceptor antagonist
highly selective to subtype alpha1A, and
has been used in clinical in Japan from
2006 and in U.S.A from 2008, for the
treatment of LUTS (lower urinary tract
symptoms) with BPH (Benign Prostatic
Hyperplasia). In the present study, we
attempt to evaluate a clinical effects of
silodosin compared with naftopidil in patients with LUTS associated with BPH.
Methods: A randomized, open-label controlled study is being conducted at multicentres in Japan. Men aged ⬎50 years
with an International Prostate Symptom
Score (IPSS) of ⬎7, a quality-of-life (QoL)
score of ⬎2, a maximum urinary flow rate
(Qmax) of ⬍15ml/s, a prostate volume of
⬎20ml are eligible for this study. The patients had never received alpha-blocker
before the enrollment, or were receiving
tamuslosin 0.2mg at the enrollment. The
patients were randomized to receive silodosin 4mg twice daily or naftopidil 50mg
once daily for 8 weeks. At this point, 96
patients had been enrolled into 4 groups;
the patients freshly received silodosin (29
patients) or naftopidil (26 patients), or
changed from tamuslosin to silodosin (21
patients) or naftopidil (20 patients). IPSS,
QoL, Qmax are used as efficacy criteria.
Statistical significance was determined by
Student’s t test (p⬍0.05).
Results: In the alpha-blocker naı̈ve patients at four and eight weeks, both of
silodosin and naftopidil significantly improved IPSS and QoL. In the patients who
changed from tamsulosin, both silodosin
and naftopidil significantly improved IPSS
at four and eight week; the significant
improvement of QoL was observed at four
and eight week by silodosin and at eight
week by naftopidil. In addition, silodosin
showed significant improvement of total
IPSS compared with naftopidil in the alpha-blocker naı̈ve patients at four and
eight week. Furthermore, in the patients
with prostate volume more than 50ml,
silodosin improved IPSS score in seven
out of nine patients, whereas naftopidil
improved IPSS score none in of the eight
patients. The Qmax was not significantly
changed in any of the treatment groups.
Conclusions: This ongoing study showed
the clinical usefulness of silodosin in the
treatment of LUTS with BPH. Additional
patients will be enrolled to this study until the presentation.
UROLOGY 74 (Supplment 4A), November 2009

UP-1: Unmoderated Poster Session 1

Transcription

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