Neil Barber

Photoselective vaporization of the prostate with the potassium‐titanyl‐phosphate laser in men with prostates of >100 mL

To assess the efficacy of photoselective vaporization of the prostate (PVP) in men with prostates of >100 mL and causing bladder outlet obstruction (BOO), using the high‐power 80 W potassium‐titanyl‐phosphate laser (GreenLight PV®, Laserscope, San Jose, CA, USA), which offers rapid tissue ablation with minimal bleeding.

Determination of optimal drug dose and light dose index to achieve minimally invasive focal ablation of localised prostate cancer using WST11-vascular-targeted photodynamic (VTP) therapy

To determine the optimal drug and light dose for prostate ablation using WST11 (TOOKAD® Soluble) for vascular‐targeted photodynamic (VTP) therapy in men with low‐risk prostate cancer.

High-power KTP laser prostatectomy: the new challenge to transurethral resection of the prostate.

Purpose of review The quest for a successful surgical modality that can be used in the day-case setting, with minimal risk of complications and without the need for postoperative catheter drainage, may finally be fulfilled in the form of the new-generation, high-power potassium titanyl phosphate (KTP) lasers. In this review we will trace the development of KTP laser technology and its use by urologists over the years and describe why its physical properties make it so different from the lasers of the past. Recent findings The most high powered (80 W) incarnation has a relatively short history, particularly in terms of peer-reviewed publications. We will, however, outline the data so far and demonstrate what an exciting tool this represents for the urologist not only in terms of qualitative and quantitative improvements in lower urinary tract symptoms, but also in offering a day case, and in some instances catheterless, procedure with the prospect of a significantly lower impact on sexual function compared with standard surgical options. Summary Despite the lack of long-term data it is certainly possible that high-power KTP lasers represent a very significant challenge to the ‘gold standard’ status of transurethral resection of the prostate. Furthermore, the ability to use this technology to safely and effectively treat very large prostates represents an opportunity to assign the associated morbidity of the open prostatectomy to the annals of history.

Lycopene inhibits DNA synthesis in primary prostate epithelial cells in vitro and its administration is associated with a reduced prostate-specific antigen velocity in a phase II clinical study

Interest in lycopene has focused primarily on its use in the chemoprevention of prostate cancer (CaP); there are few clinical trials involving men with established disease. In addition, most data examining its mechanism of action have been obtained from experiments using immortal cell lines. We report the inhibitory effect(s) of lycopene in primary prostate epithelial cell (PEC) cultures, and the results of a pilot phase II clinical study investigating whole-tomato lycopene supplementation on the behavior of established CaP, demonstrating a significant and maintained effect on prostate-specific antigen velocity over 1 year. These data reinforce the justification for a large, randomized, placebo-controlled study.

Prostate tissue and leukocyte levels of n-3 polyunsaturated fatty acids in men with benign prostate hyperplasia or prostate cancer.

To compare the levels of n‐3 polyunsaturated fatty acids (PUFAs) in leukocytes and prostate tissue in men with prostate cancer or benign prostatic hyperplasia (BPH), as dietary intake of n‐3 PUFAs has been linked to the risk of prostate cancer; the prostate‐specific antigen (PSA) level was also compared to prostate tissue levels of n‐3 PUFAs.

How do we investigate haematuria and what role has finasteride

Nerve-sparing radical prostatectomy (NSRP) is a common procedure which has been associated with very satisfactory rates of subsequent urinary continence, while the preservation of erectile function after surgery is clearly a major challenge for most urologists [1]. Several factors are considered to be of major importance in preserving erectile function after NSRP. Patients being considered for NSRP should be potent beforehand; this is very important as patients who report some degree of erectile dysfunction (ED) or who use phosphodiesterase type 5 inhibitors (PDE5-I) before the procedure are more likely to develop severe ED afterward [2]. The use of validated questionnaires such as the International Index of Erectile Function (IIEF) may facilitate the diagnosis of ED during the initial assessment of the patient. The age of the patient at the time of surgery is also important, as the best potency rates are obtained in younger patients and it seems reasonable to consider patients aged £ 65 years as candidates for a nerve-sparing procedure. Comorbid conditions also seem to affect the recovery of spontaneous erections after surgery, as they may affect the baseline penile haemodynamics, i.e. a concomitant diagnosis of diabetes mellitus, hypertension, ischaemic heart disease, hypercholesterolaemia or a history of cigarette smoking identified when the patient is assessed before surgery should be considered as potentially negative predictive factors for the recovery of potency after surgery [3].

Evaluation of ideal irrigation fluid in 'Greenlight' photoselective vapourization of the prostate.

Although many anecdotal opinions are available that water gives a better visual quality, no studies have analysed the differences in the visual quality of the operative field with the use of either saline or sterile water. As part of a prospective audit we wished to assess the effect of differing irrigant fluids on intraoperative visibility during Greenlight photoselective vapourization of prostate (PVP). Twenty-nine consecutive patients with prostates less than 100 cm3 who underwent PVP were studied. The irrigation fluid used was randomly connected on a bag-by-bag basis, with the surgeon blinded to the bags contents. Towards the end of each bag the surgeon gave a score to the quality of vision. All surgeons were familiarized with the vision scoring system in advance. The scores were analysed in two ways. The mean scores for water and saline were compared. In addition, a mean score for each fluid in each patient where both fluids were used (n=24) was separately calculated and the means for each fluid compared. One hundred and twenty-four bags of fluid in 29 operative cases were analysed. The mean overall vision scores were 3.94% for saline and 4.01% for water (P=0.62). The paired data were analysed using the Students t-test and there was no statistically significant difference (P=0.34). We showed no significant difference in visual quality between water and saline during PVP. Although fluid absorption is almost unknown with PVP, there seems to be no justification for using water irrigation if saline is available, particularly with a theoretical risk of absorption.

Retroperitoneal dismembered pyeloplasty: Initial experiences

Aim: To review the results of our first 40 cases of retroperitoneal dismembered pyeloplasty and to compare them with series of open and other minimally invasive treatments of pelviureteric junction (PUJ) obstruction. Also to compare our first 20 cases with the second 20 cases to see if there was an improvement in results with experience.

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.

PD5-10 TRANSURETHRAL RESECTION OF THE PROSTATE (GL-XPS OR TURP) DOES NOT RESULT IN SIGNIFICANT IMPAIRMENT OF ERECTILE FUNCTION

James Andrew Thomas*, Bridgend, Wales, United Kingdom; Andrea Tubaro, Rome, Italy; Neil Barber, Frimley, Camberley Surrey, United Kingdom; Frank d’ Ancona, Nijmegen, Netherlands; Gordon Muir, London, United Kingdom; Ulrich Witzsch, Frankfurt, Germany; Marc-Oliver Grimm, Jena, Germany; Joan Benejam, Manacor, Spain; Jens-Uwe Stolzenburg, Leipzig, Germany; Antony Riddick, Edinburgh, Scotland, United Kingdom; Sascha Pahernik, Heidelberg, Germany; Johannes Roelink, Almelo/Hengelo, Netherlands; Filip Ameye, Gent, Belgium; Christian Saussine, Strasbourg, France; Frank Bruyere, Tours, France; Wolfgang Loidl, Linz, Austria; Tim Larner, Brighton, United Kingdom; Nirjan Gogoi, Wakefield, United Kingdom; Richard Hindley, Hampshire, United Kingdom; Rolf Muschter, Rotenburg, Germany; Andrew Thorpe, Newcastle upon Tyne, United Kingdom; Nitin Shrotri, Kent, United Kingdom; Stuart Graham, London, United Kingdom; Moritz Hamann, Kiel, Germany; Kurt Miller, Berlin, Germany; Martin Schostak, Magdeburg, Germany; Carlos Capitan, Madrid, Spain; Helmut Knispel, Berlin, Germany; Alexander Bachmann, Basel, Switzerland