G. Velotti

Management of lower urinary tract symptoms associated with benign prostatic hyperplasia in elderly patients with a new diagnostic, therapeutic and care pathway.

Benign prostatic hyperplasia (BPH) resulting in lower urinary tract symptoms (LUTS) is a widespread disease that strongly interferes with the quality of life (QoL) of elderly males. It represents a real clinical and socio‐economic problem may be due to the lack of a diagnostic, therapeutic and care pathway (DTCP) tool for LUTS/BPH that considers elderly people population in its whole complexity. The aim of this study was to evaluate the clinical effectiveness of the proposed DTCP LUTS/BPH tool.

PD23-03 PROSPECTIVE RANDOMIZED STUDY COMPARING MONOPOLAR WITH BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE ON A LARGE COHORT OF PATIENTS WITH BENIGN PROSTATIC OBSTRUCTION: LONG TERM OUTCOMES

INTRODUCTION AND OBJECTIVES: Monopolar transurethral resection of the prostate (TURP) is the gold standard surgical treatment for bothersome moderate to severe lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction with enlarged prostates. The aim of the study is to compare monopolar vs. bipolar TURP focusing on operative and functional outcomes with a long term follow-up. METHODS: From January 2007 to July 2013 a total of 379 patients were randomized and prospectively scheduled to undergo bipolar (202) or monopolar (177) TURP. International prostate symptom score (IPSS), IPSS-Quality of life (QoL), post-void residual and maximum flow rate were assessed preoperatively and postoperatively at 3, 12, 24 and 36 months. Operative time, length of catheterization and length of hospitalization were all recorded. Rates of urethral strictures and bladder neck contractures were also reported. RESULTS: Perioperative results showed no statistical significance between the two groups in terms of catheterization days, postvoid residual, IPSS, IPSS-QoL score, blood transfusion and TUR syndrome. The operative time was proved to be statistically significant in the monopolar group while the hospitalization days was found statistically significant in the bipolar group. The 3, 12, 24 and 36 months follow up showed significant and equal improvements in LUTS related to BPO in the 2 treatment groups. CONCLUSIONS: Monopolar and bipolar TURP are safe and effective techniques for BPH. The 2 significant differences between them were operative time in favour of the monopolar group and hospitalization days in favour of the bipolar group. Bipolar TURP has the principle advantage in preventing TUR syndrome that was reported in 2 monopolar TURP patients.

MP85-14 PERISTEEN TRANSANAL IRRIGATION SYSTEM FOR THE TREATMENT OF NEUROPATHIC BOWEL DYSFUNCTION AND ABDOMINAL PAIN

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms, while common, are under reported in patients with multiple sclerosis. It is unclear what the impact of lower urinary tract symptoms due to MS is on the overall quality of life. We aim to define the incidence of lower urinary tract symptoms in patients with MS and their effect on neurologic quality of life. METHODS: We identified patients presenting to neurology clinic for routine follow up for multiple sclerosis. Each patient responded to validated questionnaires regarding urinary quality of life (MSQLI) and overall neurologic quality of life (NeuroQOL). Medical records were reviewed to assess for the presence of lower urinary tract symptoms. Overall neurologic quality of life was measured in the presence and absence of lower urinary tract symptoms and p-values were calculated using student0s t-test. Urinary quality of life score was correlated to overall neurologic quality of life score by calculating the Spearman0s rank correlation coefficient. RESULTS: 91 patients were included in the study. All 91 patients completed the validated questionnaires. 85 patients (93%) described the presence of at least one lower urinary tract symptom. The most common urinary tract symptoms were urgency (84%), frequency (69%), incontinence (54%), and retention (38%). 72 patients reported urologic symptoms negatively impacted urinary quality of life. Presence of lower urinary tract symptoms negatively impacted overall neurologic quality of life (Figure 1). Urinary quality of life was predictive of the overall neurologic quality of life (-0.24, p1⁄40.02). CONCLUSIONS: Lower urinary tract symptoms are very common in patients with multiple sclerosis. These symptoms greatly impact and importantly predict the overall neurologic quality of life in patients with multiple sclerosis.

M2 muscarinic receptors inhibit cell proliferation and migration in urothelial bladder cancer cells

The role of muscarinic receptors in several diseases including cancer has recently emerged. To evaluate the hypothesis that muscarinic acetylcholine receptors may play a role in bladder cancer as well as in other tumor types, we investigated their expression in bladder tumor specimens. All examined samples expressed the M1, M2 and M3 receptor subtypes. We also found that the level of M2 transcripts, but not those of M1 or M3, significantly increased with the tumor histologic grade. In view of these results, we proceeded to investigate whether the M2 agonist Arecaidine had any effect on in vitro cell growth and migration of T24 cells, a bladder tumor cell line expressing the muscarinic receptors, including the M2 subtype. We observed that Arecaidine significantly reduced T24 and 5637 cell proliferation and migration in a concentration dependent manner. The silencing of M2 receptor by siRNA in T24 and 5637 cell lines showed the inability of Arecaidine (100 mM) to inhibit cell proliferation after 48 hours, whereas the use of M1 and M3 antagonists in T24 appeared not to counteract the Arecaidine effect, suggesting that the inhibition of cell proliferation was directly dependent on M2 receptor activation. These data suggest that M2 muscarinic receptors may play a relevant role in bladder cancer and represent a new attractive therapeutic target.