Amr Emara

Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia Using the 180 Watt System: Multicenter Study of the Impact of Prostate Size on Safety and Outcomes

PURPOSE We evaluated photoselective vaporization of the prostate using the GreenLight™ XPS™ 180 W system for benign prostatic hyperplasia treatment in a large multi-institutional cohort at 2 years. We particularly examined safety, outcomes and the re-treatment rate in larger prostates, defined as a prostate volume of 80 cc or greater, to assess the potential of photoselective vaporization of the prostate as a size independent procedure. MATERIALS AND METHODS A total of 1,196 patients were treated at 6 international centers in Canada, the United States, France and England. All parameters were collected retrospectively, including complications, I-PSS, maximum urinary flow rate, post-void residual urine, prostate volume, prostate specific antigen and the endoscopic re-intervention rate. Subgroup stratified comparative analysis was performed according to preoperative prostate volume less than 80 vs 80 cc or greater on transrectal ultrasound. RESULTS Median prostate size was 50 cc in 387 patients and 108 cc in 741 in the prostate volume groups less than 80 and 80 cc or greater, respectively. The rate of conversion to transurethral prostate resection was significantly higher in the 80 cc or greater group than in the less than 80 cc group (8.4% vs 0.6%, p <0.01). I-PSS, quality of life score, maximum urinary flow rate and post-void residual urine were significantly improved compared to baseline at 6, 12 and 24 months of followup without significant differences between the prostate size groups. The re-treatment rate at 2 years reported in 5 of 411 patients was associated with the delivery of decreased energy density (2.1 vs 4.4 kJ/cc) in the group without re-treatment. CONCLUSIONS Photoselective vaporization of the prostate using the XPS 180 W system is safe and efficacious, providing durable improvement in functional outcomes at 2 years independent of prostate size when treated with sufficient energy.

Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate?

To assess the effect of energy density (kJ/mL) applied on adenoma during photoselective vaporization of the prostate (PVP) treatment for benign prostate hyperplasia (BPH) on functional outcomes, prostate‐specific antigen (PSA) reduction and complications.

MP59-01 IS RETRO THE WAY FORWARD? RETROPERITONEAL ROBOTIC-ASSISTED PARTIAL NEPHRECTOMY: SINGLE INSTITUTION EXPERIENCE.

INTRODUCTION AND OBJECTIVES: Survival expectancies is poor for bladder cancer (BCa) patients with disseminated disease. On the other hand, several reports showed that patients with survival in node positive patients treated with radical cystectomy (RC) is not invariably poor. However, at the time only scarce data exists about the efficacy of surgery in clinical node positive BCa patients with a limited disseminated disease. METHODS: We evaluated a total of 192 patients with BCa and concurrent node positive disease in the pelvis. All patients were treated with RC and pelvic lymph node dissection (PLND) without neoadjuvant chemotherapy between 2001 and 2013. Adjuvant chemotherapy was offered to patients on the bases of their characteristics and physicians preferences. We analyzed concordance between clinical and pathological findings. Moreover, Kaplan Meier analyses and Cox regression analyses were used to assess the impact of this features on recurrence, cancer specific survival (CSS) and overall survival (OS) after surgery. RESULTS: With a median follow up of 48 months, we recorded 5 year recurrence, CSS and OS of 46%, 44% and 38%, respectively. Overall, 99 patients (51.6%) where found without node metastases at RC, while 18 (9.4%), 58 (30.2%) and 17 (8.9%) patients were found pN1, pN2 and pN3, respectively. 5 year CSS survival rates were 54%, 42%, 32% and 18% for pN0, pN1, pN2 and pN3, respectively. Overall, 36 (18.8%) patients were treated with adjuvant chemotherapy. At univariable Cox regression analyses, the use of adjuvant chemotherapy was not associated with improved recurrence, CSS and OS after RC (all p>0.2). On the other hand, when only pN+ patients were considered, adjuvant chemotherapy was associated with improved OS (Hazard ratio [HR]: 0.42, confidence interval [CI]: 0.20-0.86, p1⁄40.02). CONCLUSIONS: We report excellent survival outcomes in clinical node positive patients treated with RC. The use of adjuvant chemotherapy after surgery was not associated with improvement in survival expectancies in cN+ patients, on the other hand, when only pN+ patients were considered adjuvant chemotherapy showed increased overall survival expectations. Our data needs to be further evaluated in high quality prospective study.

MP70-11 MEDIUM TERM OUTCOMES FOLLOWING FOCAL HIFU FOR THE TREATMENT OF LOCALISED PROSTATE CANCER: A SINGLE CENTRE EXPERIENCE.

HIFU; in eight patients (19,5%) the catheter was maintained until day 15. Nine men (21,9%) had self-resolving, mild to moderate, dysuria (median duration 7 days). Urinary tract infection was noted in 5 men (12,2%). Mean 6-months PSA was 2,4 ng/ml (0,2-9). Forthy patients (97,6%) had normal mpMRI findings 6-months after HIFU. One patient showed focal abnormal signal at mpMRI around the treated area: fusion biopsies confirmed the persistence of microfocal PCa with Gleason score 3+3 (treatment failure); in this patients a retreatment was performed. No major complication was observed. IPSS score showed no significant difference before and 6-months after HIFU. At 6 months, all patients were completely continent, and potency was maintained in 30 of 31 preoperatively potent patients. CONCLUSIONS: The integration between fusion biopsy and Focal One device allows to date the most accurate detection and treatment of index focus of PCa. This preliminary experience with 6-months follow-up time indicates that HIFU focal ablation of prostate cancer leads to 00Trifecta00 outcomes (cancer control, continence, sexual potency) in 91,5% of 41 men. The integration of new technologies enables the accurate and early diagnosis of recurrence after focal ablative treatment, leaving the possibility of a precise HIFU retreatment.

Emphysematous Pyelonephritis: a Review of a Rare Condition

Emphysematous pyelonephritis (EPN) is a rare condition which is potentially life threatening. It is characterised by gas formation within the collecting system, renal parenchyma and/or perirenal tissues. Diabetes is the single most common risk factor for the development of EPN. Other risk factors include urinary tract obstruction and immunocompromise. Escherichia Coli is the most common pathogen. EPN is characterised by fever, loin pain and systemic upset. Gold standard diagnosis and classification of EPN is made with contrast CT. Classification can be used as a prognostic indicator for mortality and to guide management. EPN may be managed conservatively or surgically. Patients managed conservatively are resuscitated and administered with intravenous antibiotics. Intravenous fluid, glucose control for diabetics and acid base balance are vital components for primary management. For those in whom conservative management is unsuccessful, a parenchymal drain may be considered to drain gas or a collection of pus. Patients with hydronephrosis will benefit from a nephrostomy or JJ stent insertion. Patients who have failed minimally invasive surgical intervention or who have a number of risk factors predisposing them to EPN should undergo either immediate or delayed nephrectomy. With treatment for EPN now moving away from nephrectomy towards less invasive interventions, mortality rates for EPN are improving but remaining high.

Persistent Urinary Tract Infections: Prevention and Management

Persistent urinary tract infections (UTIs) present a common and challenging problem for both primary care and urologists. They are either the result of bacterial reinfection or persistence, and the management varies depending on the underlying cause. Appropriate investigations are crucial in ruling out any underlying urinary tract abnormalities and identifying the causative organism. We review the underlying pathophysiology and up-to-date management strategies available to the practising urologist.