MP 05.10 Is bipolar transurethral resect

MODERATED POSTER SESSIONS

HoLEP, the identification of the extent of
the remaining attachment near the apex
and sphincter muscle and this dissection
between 10- to 2-o’clock position are
sometimes difficult, which may relate to
the relatively high occurrence of urinary
incontinence. Furthermore, intravesical
morcellation needs additional expensive
devices and may cause bladder injuries.
We present a combined procedure of
HoLEP and TURP (omega:wTURP).
Materials and Methods: Between Jan
2007 and April 2010, 45 patients with
lower urinary tract symptoms associated
with relatively large BPH underwent
wTURP. The patients had a mean age of
71.7 years (range 56-84) at the time of
surgery. The operation process includes:
Step 1- Make the inverted “U” incision just

proximal to the verumontanum by Holmium laser and find the surgical capsule
plane. Step 2- Dissect the lower part of
the whole gland between 2- and 10o’clock positions like “w”. Step 3- Resect
the whole gland like usual TURP.
Results: The mean prostate volume resected was 29 .2 (6-150g). The mean operation time was 112 minutes (20-262). At
the short-term follow-up (1 month), the
mean Qmax increased from 3.3 to 12.3
ml/sec (p⬍0.01) after wTURP while the
mean IPSS (international prostate symptom score) declined from 21.0 to 8.2
(p⬍0.01) and QOL (Quality of life) from
4.9 to 2.1 (p⬍0.01). Blood transfusion
was not needed. Severe complication
such as urinary incontinence and TUR
syndrome were not found.
Conclusions: This wTURP does not need
an expensive morcellator and intravesical
morcellation, complements the difficulty
with HoLEP and allows prostate glands of
virtually any size to be safely treated transurethrally.
MP-05.08

Holmium laser enucleation of the
prostate: non-mentor-aided learning
curve and its proper estimation
Oh S, Cho M, Bae J, Oh J, Paick J,
Jeong C
Seoul National University Hospital,
Seoul, South Korea
Introduction and Objective: Holmium
laser enucleation of prostate (HoLEP) is
known to have a steep learning curve,
which therefore limits its widespread use.
The purpose of this study was to analyze
the learning curve and early complications
following the HoLEP procedure.
Materials and Methods: Sixty-two consecutive patients who underwent HoLEP
from July 2008 to July 2009 by a single

surgeon (SJO) were enrolled. Perioperative clinical variables including enucleation time, morcellation time, enucleation
ratio (enucleation weight/transitional zone
volume), enucleation efficacy (enucleated

weight/enucleation time), enucleation ratio efficacy (enucleation ratio/enucleation
time), and early complication rate were
analyzed.
Results: Mean prostate volume was 59.0
ml (range 21-162) and preoperative International Prostate Symptom Score (IPSS)
was 19.5 (6-35). Mean enucleation time
and morcellation time were 55.1⫾32.2
(S.D.) min and 12.9⫾8.2 min, respectively. Median duration of postoperative
catheter indwelling was 1 (1-13) day and
hospital stay was 1 (1-14) day. There were
a total of 11 cases (17.7%) of surgery-related complications, and they were all
manageable. There was a significant increase between the initial 20, middle 20
and last 22 cases in terms of the enucleation efficacy (0.17⫾0.17 vs. 0.42⫾0.25
vs. 0.55⫾0.26, p⬍0.001), but not in the
enucleation ratio (0.44⫾0.28 vs.
0.57⫾0.22 vs. 0.60⫾0.19 p⫽0.07). Enucleation efficacy was linearly correlated
with the transitional zone volume (correlation coefficient, R⫽0.754, p⬍0.001). Increased enucleation efficacy mainly resulted from technical improvement during
the initial period and case selection of a
larger prostate during the later period.
Thus, enucleation ratio efficacy is believed

to be a more appropriate parameter in
evaluating the learning curve by eliminating the confounder of size (0.006 vs.
0.017 vs. 0.013, p⬍0.001).
Conclusions: Our results demonstrated
that the learning curve can be overcome
in about 25 cases. We believe that a more
appropriate parameter for estimating the
learning curve is enucleation ratio efficacy
rather than enucleation efficacy.
MP-05.09
Treatment of benign prostatic
hyperplasia with plasmakinetic
vaporization: six-year follow-up
Koca O, Keleþ M, Kaya C, Gu
¨ nes M,
Öztu
¨ rk M, Karaman M
Haydarpasa Numune Training and Research Hospital, Dept. of Urology, Istanbul, Turkey
Introduction and Objective: Benign
Prostatic Hyperplasia, parallel to the

changing demographic structure of community, is becoming a more common condition. Transurethral resection is still accepted as the most effective treatment
modality but different treatment modalities appear parallel to the new techno-

UROLOGY 76 (Supplement 3A), September 2010

logical development. In this study we
compared the long-term results of transurethral resection (TURP) and plasmakinetic vaporization (PKVP) (Gyrus Medical
Ltd., Bucks, UK).
Materials and Methods: Between the
years 2001 and 2003, 75 symptomatic patients referred to our clinic due to lower
urinary symptoms were randomized in to
two groups (TURP and PKVP). Thirty-six
patients who completed the 72 month
follow up period were included.
Results: Both groups were homogenous
in terms of age and preoperative parameters. In TURP group preoperative Qmax
value was 6 (2,3) ml/s, whereas during
the controls in 36th and 72th months this
value was 21,8 (3,4) and 20,1 (3,1) respectively. In PKVP group, these values were
measured as 6 (3,1), 14,4 (2,6) and

15,6 (2,8) respectively. When evaluated
according to IPSS values, in TURP group
these values were 22 (3,8), 5,7 (1,2) and
7,9 (2,6) respectively, while in PKVP
group these values were 21 (3,4),
7,6 (1,4) and 11 (2,4) respectively. In both
groups postoperative Qmax and IPSS values were significantly different from preoperative values. IPSS and Qmax values
measured in the 36th and 72th months
were significantly different in both
groups. In the PKVP group, 6 patients
were reoperated because of urinary outflow obstruction and 6 patients were
given alpha blockers. In the TURP group,
2 patients were reoperated and 1 patient
was given alpha blocker treatment
(p⬍0,05). In both groups one patient had
urethral stricture. ED developed in 5 patients in PKVP group and 3 patients in
TURP group and also retrograde ejaculation developed in 13 patients in PKVP
group and 8 patients in TURP group
(p⬎0,05).
Conclusions: When long term results

were considered, PKVP was found to be
less successful than standard TURP.
MP-05.10
Is bipolar transurethral resection in
saline (TURis) a good alternative for
laser?
Falahatkar S, Mokhtari G, Farzan A,
Afsharimoghaddam A, Enshaei A,
Kazemzadeh M, Allahkhah A
Urology Research Center, Guilan University of Medical Sciences, Rasht, Iran
Introduction and Objective: To assess
the efficacy and safety of bipolar transurethral resection or vaporization in saline.
Materials and Methods: During a twomonth period, November and December
2009, 24 men with BPH related lower uri-

S37

MODERATED POSTER SESSIONS

nary tract symptoms or bladder tumors

were enrolled in this study. Inclusion criteria for transurethral resection of prostate
(TURP) were benign prostatic hyperplasiainduced obstruction; prostatic volume
between 30 and 80 ml, IPSS⬎ 13 and inclusion criteria for transurethral resection
of bladder tumor (TURBT) was endoscopic evidence of intravesical lesions.
Nine TURBT, 1 TUVBT, 8 TURP and 6
TUVP were performed during the study.
All procedures were carried out with a
bipolar device in physiologic saline. We
evaluated age, tumor size, prostate volume, pre & post operative serum Na⫹ and
K⫹, pre & post operative serum BUN and
Cr, early postoperative urinary retention,
stimulation of obturator reflex, preoperative IPSS, resection time, Body Mass Index
(BMI), post-op catheterization time, hospital stay.
Results: None of the patients experienced a TUR syndrome. Mean age was 73
years. Mean tumor size was 6.6 cm. Mean
prostate volume was 46.6 cc. Early postoperative retention occurred in 3 patients
and one patient needed one unit blood
transfusion. Only 2 patients of 10 submitted to TUR-BT experienced stimulation of
obturator reflex. The mean preoperative
International Prostate Symptom Score

(IPSS) was 21. The mean operative time
was 51.8 minutes. The mean BMI was
23.8 kg/m2. The mean post-op catheterization time was about 5.2 days. The mean
hospital stay was 3 days. The mean pre &
post operative serum Na⫹ was 145.4 mEq/L
and 137.4 mEq/L, respectively. The mean
pre & post operative serum K⫹ was
4.2 mEq/L and 4 mEq/L, respectively. The
mean pre & post operative serum BUN
was 17.4mg/dl and 16.2 mg/dl, respectively.
The mean pre & post operative serum Cr
was 1.3 mg/dl and 1 mg/dl, respectively. The
mean valume of saline irrigation was 19
litters. We found no cases with post operative TUR syndrome or urethral stricture.
Conclusions: TURis seems to be effective
and safe especially in regard to the avoidance of TUR syndrome. Despite other studies, obturator reflex was stimulated in two
patients in our study. Because TURis system
is cheaper than laser, it can be good alternative for treatment of BPH and bladder tumor.

MP-05.11

Intraprostatic injection of botulinum
toxin type-A (Dysport) relieves
bladder outlet obstruction in men
Carl S, Lashcke S, Andreas J
City Hospital, Emmedingen, Germany

S38

Introduction: Injection of botulinum
toxin type A into the bladder and urethral
sphincter has been used to treat bladder
hyperactivity and sphincter dyssynergia.
In this pilot study we analyzed the effectiveness of botulinum toxin type A in the
treatment of patients with bladder outlet
obstruction (BOO)
Materials and Methods: Fifteen patients
diagnosed with BOO were treated with
cytoscopically controlled injections at 4
sites into the prostata with a total dose of
500 U Dysport2. All patients were evaluated by voiding diary and symptom questionnaire (IPSS), flow charts, residual

urine volume and an ultrasound of the
prostate at 6 weeks and three month after
therapy. Moreover PSA was measured
prior and three month after injection.
Results: Outcome improvement includes
decreases in prostate size, and residual
urine volume, and improvement in the
flow rate and prostate specific antigen: the
mean prostate volume, symptom score, and
quality of life index were significantly reduced by 32.3%, 77.9%, and 58.5% respectively. Maximal flow rate significantly increased by 81.0%. Moreover a significant
reduction of the mean miction frequency
(7x) and nocturia (1x) was seen.
Conclusions: The treatment of IC with
botulinum toxin type A is an effective,
minimally invasive and safe therapeutic
option with a substantial gain in the quality of life avoiding major surgery.
MP-05.12
Laser photovaporisation
prostatectomy (PVP) in high
hemorrhagic risk patients
Kharbouchi M, Colau A, Cariou G
Division of Urology, Ho
ˆ pital Diaconesses,
Paris, France
Introduction and Objective: The rising
rate of cardiovascular diseases requiring
anticoagulant or antiaggregant therapies
complicates the surgical approach of benign prostatic hyperplasia and especially
TURP. For such patients KTP laser brings
a new hope of cure without discontinuing
anticoagulants. The purpose is to assess
feasibility and safety of selective photovaporisation of the prostate in patients under
anticoagulants or antiaggregant therapy.
Materials and Methods: Of 147 patients
that underwent PVP for BPH symptoms
between January 2009 and April 2010; 31
had increased hemorrhagic risk due to
antivitamin K therapy or platelet antiaggregants (aspirin or clopidogrel). Their
mean age was 78. The mean prostate volume was 44 cc (20 to 80). Seven patients
(22%) were in retention. Five patients

were on fluindion, 18 on aspirin, one on
clopidogrel and 6 had a combination therapy: fluindion and aspirin (1) or clopidogrel and aspirin (5). One other patient
was on curative regimen of fondaparinux
for a recent pulmonary embolism. Of the
patients, 56% had coronary disease. The
others were treated for a peripheral vascular lesion. PVP was performed with a 120
W KTP side-firing laser HPS Green Light®.
Results: The mean operation time and energy were respectively: 38 min (15 to 70)
and 200000 Joules. Most of the patients
(90%) were catheter-free at day 1; 14% of
them had no catheter at all at the end of
the procedure. The median hospital post
operative stay was 2 days (1 to 6). One inpatient on aspirin experienced significant
bleeding needing transfusion at day 2. No
other readmission for hemorrhagic complications was registered. Two patients had a
transient urethral catheterization for post
operative retention. The mean post operative IPSS and residual urine volume were
respectively 5 and 45 ml.
Conclusions: PVP is a safe and efficient
procedure perfectly adapted to high hemorrhagic risk patients suffering from BPH
symptoms.
MP-05.13
National trends in the surgical
therapy of benign prostatic
hyperplasia in the United States
(2002-2008)
Elliott S1, Bland P1, Yu X2, Caldwell D1,
McBean M1
1
University of Minnesota, Minneapolis,
MN; 2Nova Southeastern University, Fort
Lauderdale, FL, USA
Introduction and Objective: We previously reported on the declining the rates
of transurethral resection of the prostate
(TURP) coincident with a dramatic increase in the utilization of thermotherapy
and laser therapy in the surgical treatment
of benign prostatic hyperplasia (BPH)
among the United States male Medicare
population (1999-2005) 65⫹ years of age.
We now report an update of these data
through 2008.
Materials and Methods: Using the 100%
Medicare carrier file (physician claims
data) for the years 2002-2008 we calculated counts and population-adjusted rates
of BPH surgery. Medicare covers nearly all
U.S. men over age 65 years. We calculated
rates of TURP, transurethral incision of
the prostate (TUIP), simple prostatectomy,
transurethral microwave therapy of the
prostate (TUMT), transurethral needle ablation of the prostate (TUNA), laser coagulation of the prostate (e.g. Nd:YAG inter-

UROLOGY 76 (Supplement 3A), September 2010