Enrique de la Peña

GreenLight HPS 120-W Laser Vaporization versus Transurethral Resection of the Prostate for the Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Randomized Clinical Trial with 2-year Follow-up

BACKGROUND High-level evidence to support the use of photoselective vaporization of the prostate (PVP) is limited. OBJECTIVE Assess the efficacy and safety of GreenLight HPS 120-W laser PVP compared with transurethral resection of the prostate (TURP). DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was performed with 50 patients having lower urinary tract symptoms due to benign prostatic hyperplasia in each treatment arm. INTERVENTION Random allocation to PVP or TURP. MEASUREMENTS International Prostate Symptom Score (IPSS), quality of life (QoL), and changes in maximum flow rate (Qmax) were the main end points. Patients were evaluated at a follow-up time of 2 yr. Five patients were lost to follow-up. A last observation carried forward analysis was done. RESULTS AND LIMITATIONS Both laser PVP and TURP resulted in the same IPPS reduction at 2 yr (-15.7 and -14.9, respectively; p=0.48) and in the same gain in Qmax (+14.5 ml/s and +13.1 ml/s, respectively; p=0.65). QoL was equivalent for both treatment modalities. These results were independent of prostate size, American Society of Anesthesiologists risk category, and prior indwelling catheter. No statistically significant differences were detected between arms in terms of complication rates. In the laser PVP group, three patients were readmitted to the hospital and two developed a urethral stricture. In the TURP group, two patients were readmitted, six developed a urethral stricture, and two developed bladder neck sclerosis. In-hospital stay and time to catheter removal were significantly shorter with PVP. Limitations are the potential lack of power to detect differences in the complications between groups and the lack of blindness due to the nature of the intervention. CONCLUSIONS GreenLight HPS 120-W laser PVP is as effective as TURP for symptom reduction and improvement of QoL. No differences were seen in the response of storage and voiding symptoms. Laser PVP and TURP have the same complication rate. Length of stay is shorter for laser PVP group.

Laser microperforated biodegradable microbial polyhydroxyalkanoate substrates for tissue repair strategies: an infrared microspectroscopy study

AbstractFlexible and biodegradable film substrates prepared by solvent casting from poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBHV) solutions in chloroform were microperforated by ultraviolet laser ablation and subsequently characterized using infrared (IR) microspectroscopy and imaging techniques and scanning electron microscopy (SEM). Both transmission synchrotron IR microspectroscopy and attenuated total reflectance microspectroscopy measurements demonstrate variations in the polymer at the ablated pore rims, including evidence for changes in chemical structure and crystallinity. SEM results on microperforated PHBHV substrates after cell culture demonstrated that the physical and chemical changes observed in the biomaterial did not hinder cell migration through the pores. FigureComposition showing visible and IR images of a microperforated PHBHV film, with IR spectra showing crystallinity differences between bulk film and pore rim, schematic of cell growth and propagation strategy and SEM image showing evidence of cell growth on the underside of the biodegradable substrate.

Long-term oncological outcomes of an active surveillance program in recurrent low grade Ta bladder cancer.

INTRODUCTION Over the last 2 decades, there has been a major increase in active surveillance (AS) as a therapeutic alternative in urological tumors regarded to be of low risk. Owing to the findings of significant clinical outcomes in our series, this report presents an update of our AS program in patients with recurrent non-muscle-invasive bladder tumor. The objective was to confirm the oncological long-term safety of this protocol and to determine possible variables associated with progression. MATERIALS AND METHODS Cohort of patients included in AS between 1999 and 2014. INCLUSION CRITERIA recurrent papillary tumors, previous pTa-pT1, G1-G2, shorter than 1cm, and fewer than 5 tumour sites. EXCLUSION CRITERIA prior G3, CIS (carcinoma in situ), or positive-result cytology. All patients underwent close monitoring with flexible cystoscopy every 3 to 4 months for the first 2 years. After this time, follow-ups were conducted every 6 months, alternating between cystoscopy and ultrasound. Urinary cytology test was performed at all visits. RESULTS In all, 252 AS periods in 186 patients were studied, with a median follow-up of 6 years. Out of all periods, 203 (80.6%) underwent active treatment. After remaining under observation, 86.4% had not progressed in stage, and 79.3% in grade. Of these patients, 4 experienced progression to T2; all of them were previously T1G2. CONCLUSIONS AS in a high-selectivity group of patients with recurrent non-muscle-invasive bladder tumor is feasible and oncologically safe in the long term. Patients with previous history of T1 should not be included in AS protocols even when very small recurrences are diagnosed.

MP58-17 CASE-LOAD IS NOT ASSOCIATED WITH SURGICAL OUTCOMES OF RADICAL CYSTECTOMY. A NATION-WIDE STUDY OF CURRENT PRACTICE

INTRODUCTION AND OBJECTIVES: Surgeonand hospitalcase volume are identified as factors related with outcomes of surgical procedures. Radical cystectomy (RC), due to its major impact on the patient, might substantially benefit from centralization if this assumption were true. We aim to test this hypothesis in Spain, a country in which no lower limit nor centralization for radical cystectomy exists. METHODS: We performed a retrospective cohort review of patients undergoing RC in Spain during 2011 and 2012, accessing data from inpatient discharge forms (CMBD) of every patient operated on of radical cystectomy. CMBD is a mandatory file that is submitted to the Ministry of Health and provides information on patient’s demographics as well as morbidity and cause of discharge including death. Hospitals were stratified into volume quartiles depending on their 2-year cumulative cystectomy volume (very lowvolume 58). Hospitals were also categorized according to their size in beds and teaching facilities. A comparison with data in the literature was made. RESULTS: We analyzed 5,594 RCs in 266 centers of Spain during 2011 and 2012 (2,701 RCs in 2011 and 2,893 RCs in 2012). Mean age was 66.5 9.8 years and 84.7% were males. Mean hospital stay was 20.7 16.6 days. Mortality rate at 30, 60 and 90 days was 2.8%, 4.7% and 5.9%, respectively. 90-day mortality rate for very-low, low, medium and high-volume centers was 5.9%, 5.9%, 7% and 5.1%, respectively (p1⁄40.2). Hospital size and teaching facilities were not associated with mortality. A statistically significant difference was noted in the complications and readmission rate. These results compare favorably with reported multicenter series in the literature with 90-day mortality rate ranging from 4.2 to 7.9%. CONCLUSIONS: Our data do not support an urgent need for regionalization of radical cystectomy in our country. However, initiatives to improve surgical outcomes of radical cystectomy within individual national setting should be explored.

Weight of the resected specimen after transurethral resection as a new predictive variable for recurrence of non-muscle-invasive bladder tumour: TUR SPECIMEN WEIGHT AS PREDICTOR FOR BLADDER CANCER RECURRENCE

Whats known on the subject? and What does the study add?