Mohamed M. Elsaadany

Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: Perioperative outcomes of a contemporary series

Abstract Objective: To assess the perioperative morbidity of transvesical open prostatectomy (OP) and its predictors as a treatment for benign prostatic hyperplasia (BPH), and to update knowledge about the morbidity of OP using a standardised morbidity scale (Clavien), thus providing a platform for comparison with the newly developed techniques. Patients and methods: We retrospectively review men with BPH who were treated with transvesical OP between April 2002 and December 2012. Preoperative patients’ data were reviewed for relevant variables. Operative details, the postoperative course, and 30-day relevant data were assessed. The study cohort was stratified based on the resected prostate weight, with group 1 having a resected weight of ⩽120 g and group 2 >120 g. Results: The review identified 163 patients. The mean (SD, range) duration of catheterisation after OP was 7.9 (2.2, 5–20) days and the duration of hospitalisation after OP was 8.1 (1.8, 5–15) days; both were significantly longer in group 2. All patients were able to void spontaneously by the first follow-up visit. Of 163 OP procedures, there were 106 perioperative complications in 69 (42.3%). Low-grade complications (grade ⩽2) included 38 (45.2%) and 53 (67%) in groups 1 and 2, respectively (P = 0.8). High-grade complications (⩾3) included 3 (3.5%) and 12 (15.1%) in groups 1 and 2, respectively (P = 0.02). The blood transfusion rate was 24.5%, the perioperative mortality rate was 1.2% and the re-admission rate within the first 30 days after OP was 1.2%. High-grade complications were significantly associated with a greater resected prostate weight (odds ratio 1.08, 95% CI 1.001–1.17, P = 0.046). Conclusion: The OP procedure is associated with a significant perioperative morbidity that correlated significantly with the resected prostate weight, especially for high-grade complications.

Validation of the Arabic linguistic version of the Ureteral Stent Symptoms Questionnaire.

Abstract Objective: To validate the Arabic version of the Ureteral Stent Symptoms Questionnaire (USSQ). Patients and methods: The English version of the USSQ was translated into Arabic using a multi-step process by three urologists and two independent translators. The Arabic version was validated by asking 37 patients with temporary unilateral ureteric stents to complete the questionnaire at 2 weeks after stent insertion. The second group included 53 healthy individuals who agreed to complete the Arabic version of the questionnaire. The reliability of the Arabic version was evaluated for internal consistency using Cronbach’s α test. Domain structures were examined by interdomain (section) associations using Spearman’s correlation coefficient (r). The discrimination validity was evaluated by comparing the scores of patients with those of healthy individuals, using the Mann–Whitney test. Results: Internal consistency was high for the sexual index and intermediate for urinary, pain and general health indices. There were good correlations of urinary symptoms with body pain (r = 0.596) and general health (r = 0.690). There was also a good correlation between body pain and general health (r = 0.681). For discrimination validity, there were significant changes in all domain scores when comparing patients with ureteric stents and healthy individuals (P < 0.001). Conclusion: The Arabic version of the USSQ is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with ureteric stents.

A randomised controlled trial evaluating renal protective effects of selenium with vitamins A, C, E, verapamil, and losartan against extracorporeal shockwave lithotripsy‐induced renal injury

To evaluate the protective effects of selenium with vitamins A, C and E (selenium ACE, i.e. antioxidants), verapamil (calcium channel blocker), and losartan (angiotensin receptor blocker) against extracorporeal shockwave lithotripsy (ESWL)‐induced renal injury.

MP58-15 IMPACT OF TUMOR HISTOPATHOLOGIC TYPES ON PATTERN OF TUMOR RECURRENCE AFTER RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER (MIBC).

RESULTS: Out of 540 patients, 43 (7,9%) showed rare histotypes of bladder cancer. In 5 (11,6%) cases the uncommon histotypes was revealed by palliative TURBT . The remaining 38 patients were submitted to cystectomy for bladder tumors of considerable size (mean diameter 7,8 cm; range of 5-11 cm); 14 (36,8%) harbored a pT4 tumor. The rare histotypes were: squamous carcinoma 6 (13,9%), sarcomatoid 2 (4,8%), undifferentiated 5 (11,6%), neuroendocrine 3 (6,9%), mixed 27 (62,8%). TUR revealed an uncommon histotypes in 26 (68,4%) cases only. Moreover, in 5 (23.8%) patients an additional uncommon histology not detected by previous TUR, was demonstrated in cystectomy specimens. CONCLUSIONS: The prognostic role of uncommon histotypes in bladder cancer is well documented. Unrecognized rare histotypes might have important therapeutic implications since possibly less responsive to neoadjuvant chemotherapy. These patients could benefit from an immediate cystectomy avoiding neo-adjuvant chemotherapy. The inaccuracy of TUR in everyday clinical practice in detecting uncommon variants could be explained by an inadequate sampling of large tumors. The 00pre-cystectomy00 TUR is often performed only to confirm the infiltration. As a matter of fact, the pathologists might not receive an adequate amount of tissue. To standardize the TURBT strategy including sampling of different areas of bulky tumors could be of clinical value in patients undergoing neoadjuvant chemotherapy.

1076 A randomized controlled trial comparing alpha blocker (tamsulosin) and anticholinergic (solifenacin) in treatment of ureteral stent related symptoms

Purpose To compare the effectiveness of tamsulosin and solifenacin in relieving ureteral stents related symptoms.

Detrusor after contractions in men with lower urinary tract symptoms: Myth or reality?

Abstract Objectives: To study after contractions in men with lower urinary tract symptoms (LUTS) related to bladder outlet obstruction (BOO), in the absence of neuropathy, and to verify whether it is associated with the severity of symptoms or certain filling and voiding variables. Patients and methods: Of 380 patients with LUTS and who were assessed using urodynamic studies, we retrospectively analysed those who had after contractions (ACs). Bladder overactivity was diagnosed as any increase in the detrusor pressure of <2-s duration during the filling phase, and an AC was diagnosed as any increase in the detrusor pressure of ⩾2 s after the end of the voiding phase and complete cessation of flow. The presence of ACs was then assessed in relation to different components of the International Prostate Symptom Score (IPSS), using a two-tailed Levene’s test, and to filling and voiding cystometry variables, using Mann–Whitney-Wilcoxon Rank test. Results: In all, 373 of the 380 patients were included (seven had invalid voiding cystometry); ACs were detected in 51 (13.9%). There was no statistical significance for associations between AC and any of the variables assessed, including individual questions of the IPSS, detrusor overactivity, cystometric capacity, compliance, maximum urinary flow rate (Qmax), detrusor pressure at Qmax or the maximum detrusor voiding pressure. Conclusion: ACs detected on voiding cystometry of men with LUTS attributed to BOO do not seem to be related to symptoms, or filling and voiding variables.

Early detection of active Human Cytomegalovirus infection after living-donor liver transplantation

Human cytomegalovirus (HCMV) is a member of the beta herpes virinae. It is one of the most important virus in transplantation. It has direct and indirect impact on liver transplant recipient outcome. We aimed to diagnose early active HCMV infection in living donor liver transplant (LDLT) recipients. Also, to correlate the associated clinical and laboratory findings with HCMV infection. Here, we investigate 76 LDLT recipients for early detection of active HCMV infection in a period of 1-6 months after liver transplantation upon their suggested clinical data. These samples were collected in the period from 4/2013 to 12/ 2015 at Gastroenterology center, Mansoura University. They were 68 males and 8 females. HCMV infection diagnosed by ELISA (Ig M, Ig G) and real time PCR. Seventy-four patients were IgG seropositive recipient. Three patients (3.9%) were positive IgM. Ten samples from 76 patients (13.2%) were positive by real-time polymerase chain reaction (PCR). In this study, we concluded that, LDLT recipients are at high risk of HCMV infection (13.2%) and the most suitable method for HCMV detection was PCR.

MP54-07 PENTAFECTA AND TRIFECTA CRITERIA FOR REPORTING OUTCOMES OF RADICAL CYSTECTOMY FOR MUSCLE INVASAIVE UROTHELIAL BLADDER CANCER (MIBC)

used to identify patient and disease variables, including RARC volume, associated with overall and additional treatment-free survival. RESULTS: Of the 2,773 patients that underwent RARC, 975 (35%) died during follow-up. 948 RARC were performed at 00low volume centers00 (table 1). On multivariable analysis (table 2), age >80 years (HR 1.91, 95% CI 1.06-3.43, p1⁄40.03), stage (vs. <pT2, pT2 (HR 1.58 95% CI 1.19-2.11), pT3 (HR 3.33 95% CI 2.54-4.38), pT4 (HR 4.43 95% CI 3.21-6.10), all p<0.01), and length of stay (HR 1.01, 95% CI 1.001.01, p1⁄40.04) were associated with overall survival. RARC volume (>10) was independently associated with both overall (HR 0.74, 95% CI 0.59-0.93, p<0.01) and additional treatment free survival (HR 0.66 95% CI 0.49-0.88, p<0.01). CONCLUSIONS: Accounting for disease and hospital related variables, patients undergoing RARC at low volume centers had worse overall and additional treatment free survival. This suggests that adequate center volume may be important for conferring surgical quality and ultimately survival outcomes.

MP58-16 ONCOLOGIC OUTCOMES OF SQUAMOUS CELL CARCINOMA VERSUS UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AFTER RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER (MIBC)

RESULTS: Out of 540 patients, 43 (7,9%) showed rare histotypes of bladder cancer. In 5 (11,6%) cases the uncommon histotypes was revealed by palliative TURBT . The remaining 38 patients were submitted to cystectomy for bladder tumors of considerable size (mean diameter 7,8 cm; range of 5-11 cm); 14 (36,8%) harbored a pT4 tumor. The rare histotypes were: squamous carcinoma 6 (13,9%), sarcomatoid 2 (4,8%), undifferentiated 5 (11,6%), neuroendocrine 3 (6,9%), mixed 27 (62,8%). TUR revealed an uncommon histotypes in 26 (68,4%) cases only. Moreover, in 5 (23.8%) patients an additional uncommon histology not detected by previous TUR, was demonstrated in cystectomy specimens. CONCLUSIONS: The prognostic role of uncommon histotypes in bladder cancer is well documented. Unrecognized rare histotypes might have important therapeutic implications since possibly less responsive to neoadjuvant chemotherapy. These patients could benefit from an immediate cystectomy avoiding neo-adjuvant chemotherapy. The inaccuracy of TUR in everyday clinical practice in detecting uncommon variants could be explained by an inadequate sampling of large tumors. The 00pre-cystectomy00 TUR is often performed only to confirm the infiltration. As a matter of fact, the pathologists might not receive an adequate amount of tissue. To standardize the TURBT strategy including sampling of different areas of bulky tumors could be of clinical value in patients undergoing neoadjuvant chemotherapy.

Predicting the resected tissue weight from a digital rectal examination and total prostate specific antigen level before transurethral resection of the prostate

Abstract Objective: To determine the use of the prostate specific antigen (PSA) level and digital rectal examination (DRE) findings to estimate the resected tissue weight (RTW) before transurethral resection of the prostate (TURP). Patients and methods: We retrospectively analysed 983 patients who underwent TURP between December 2006 and December 2012. The primary outcome was the RTW required for clinical improvement, and was not associated with re-intervention. Age, PSA level, body mass index (BMI) and DRE findings were correlated and modelled with the RTW. The DRE result was defined as DREa (small vs. large) or DREb (small vs. moderate vs. large) according to the surgeon’s report. Equations to calculate RTW were developed and tested using receiver operating characteristic (ROC) curve analyses. Results: There were significant correlations between PSA level (r = 0.4, P < 0.001) and RTW, whilst BMI and age showed weak correlations. The median (range) RTW was 45 (7–60) vs. 15 (6–60) g for small vs. large prostates (DREa) (P < 0.001), respectively. Similarly, the median (range) RTW was 11 (6–59) vs. 26.2 (6–60) vs. 42 (7–60) g in small vs. moderate vs. large prostates (DREb) (P < 0.001), respectively. Using PSA level and DREb (model 3) there was a significantly better ability to estimate RTW than using PSA and DREa (model 2) or PSA alone (model 1) based on ROC curve analyses. The equation developed by model 3 (RTW = 1.2 + (1.13 × PSA) + (DREb × 9.5)) had a sensitivity and specificity of 82% and 71% for estimating a RTW of >30 g, and 84% and 63% for estimating a RTW of >40 g, respectively. Conclusions: The PSA level and DRE findings can be used to predict the RTW before TURP.