R. Huet

Prospective evaluation of ambulatory laser vaporization of the prostate for benign prostatic hyperplasia

Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate in the surgical treatment of benign prostatic hyperplasia (BPH). Our objective was to prospectively evaluate the feasibility, safety, and efficacy of ambulatory photoselective vaporization of the prostate for benign prostatic hyperplasia.

MRI assessment of tissue effects after 180-W XPS greenlight laser vaporization of the prostate

Photoselective vaporization of the prostate (PVP) is an alternative to transurethral resection of the prostate (TURP) in the surgical management of Benign Prostate Obtruction (BPO), with a better hemostatic effect due to a coagulation depth of several millimeters. The objective of this study was to prospectively assess the tissue effects of PVP by Magnetic Resonance Imaging (MRI).

Does mechanical morcellation of large glands compromise incidental prostate cancer detection on specimen analysis? A pathological comparison with open simple prostatectomy

ObjectiveThis study sought to compare the incidental prostate cancer (iPCa) detection rate between pathological specimens from green laser enucleation of the prostate (GreenLEP) and open simple prostatectomy (OSP).Materials and methodsIn two institutions, the charts of all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and the data of all consecutive patients who underwent GreenLEP with tissue morcellation between July 2013 and January 2018 were also collected. Preoperative demographics and pathological findings were recorded. iPCa detection rate was retrospectively compared between the GreenLEP and OSP groups in a propensity score model, including all predetermined variables: Age, preoperative PSA level and prostate volume.ResultsOf 738 patients, 402 were included in the propensity-score matching analysis, and they were equally distributed among groups. The overall iPCa detection rates were similar in both groups (9.9% vs. 8.5%; p = 0.73), and there were no statistically significant differences in terms of tumour stage, Gleason score or the rate of clinically significant iPCa, although the number of cassettes analysed was significantly higher in the morcellation group than in the OSP group. No predictive factors for iPCa were identified.ConclusionsThe results of the present study suggest that the mechanical morcellation of large glands had no influence on iPCa detection. Compared with a specimen from standard OSP, a large morcellated tissue sample allows adequate pathological evaluation and does not alter a pathologist’s ability to detect iPCa.

PD27-04 ENDOSCOPIC ENUCLEATION OF THE PROSTATE USING 532NM GREEN LASER (GREENLEP) COMPARED TO HOLMIUM LASER SYSTEM (HOLEP): MULTICENTER EVALUATION OF THE LEARNING CURVE IN THE SURGICAL TREATMENT OF BENIGN PROSTATE OBSTRUCTION

INTRODUCTION AND OBJECTIVES: Temporary Implantable Nitinol Device (TIND MediTate ) is a new device for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). We already published the feasibility and safety of TIND implantation, herein we report the results of a one-arm, multi-center, international prospective study to assess the efficacy of second generation of MediTate i-TIND in subjects with BPH. METHODS: The i-TIND is comprised of three nitinol elongated struts and an anchoring leaflet and it is preloaded by crimping it into the delivery system. In expanded configuration, the struts of the i-TIND exert radial force that causes ischemic necrosis and subsequent incisions of bladder neck and prostatic urethra. i-TIND was implanted under light sedation, using a rigid 22F cystoscope. The device was removed 5 days later in an outpatient setting, with no need of anesthesia. Forty patients with LUTS were enrolled in this multi-center study from Oct 2014. Inclusion criteria were: IPSS score 1⁄4 10, peak urinary flow (Qmax) < 12 ml/sec and prostate volume < 75 cc. All patients discontinued medical therapy for BPH before the implantation. Demographics, perioperative, functional results and quality of life (QoL) were evaluated. For the purpose of this study we reported the results of 3 and 6 months follow-up. RESULTS: Patients’ age (mean+ SD) was 65.7 y (9.1) and BMI (mean+ SD) was 26.5 (4.1). Prostate volume (mean+ SD), IPSS score (median, range), QoL (median, range) and Qmax (mean+ SD), were 35.3 (+12.5) cc, 25(13-35), 4 (2-5), and 7.5 (2.87) ml/sec respectively. All the implantations and the removals of device were successfully concluded with no intraoperative complications. Three months after implantation IPSS score, QoL and Qmax were 7 (1-29), 1 (0-5) and 12.4ml/sec (4.9); after six months were 7 (0-29), 2 (0-4) and 14ml/sec (+6.01) respectively. No patients reported ejaculatory dysfunction during follow-up. Differences in terms of IPSS score, QoL andQmaxwhen comparing preoperative and 6 months postoperative results were statistically significant (p<0.05); specifically the mean change from baseline to month 6 in IPSS score was -15.33 and themean change ofQmaxwas 6.2ml/sec.During the follow up no patients required pharmacologic treatment or surgery for BPH. CONCLUSIONS: Second generation i-TIND implantation is a safe and effective minimally-invasive option for the treatment of BPH related LUTS at least at short term follow up. Further studies are required to assess durability of these results.

MP13-18 GREENLIGHT XPS PHOTOVAPORIZATION FOR LARGE PROSTATIC ADENOMAS (≥ 80 ML): A PROSPECTIVE MULTI-INSTITUTIONAL STUDY

Maxime Thoulouzan*, Romain Huet, Romain Mathieu, Karim Bensalah, Rennes, France; Jehanne Calves, Brest, France; Pierre Coeurdacier, Cesson-S evign e, France; Luc Corbel, Emmanuel Della Negra, SaintBrieuc, France; Alexandre Fourcade, Brest, France; Benoit Gires, Vivien Grafeille, Rennes, France; Marie-Aim ee Perrouin-Verbe, Sophie Serey-Eiffel, Antoine Valeri, Brest, France; Gr egory Verhoest, S ebastien Vincendeau, Rennes, France; Georges Fournier, Brest, France

La cystectomie partielle robotique pour cancer de l’ouraque

Objectifs.— L’adenocarcinome de vessie pour tumeur de l’ouraque est une pathologie rare dont le traitement est essentiellement chirurgical. En comparaison a la cystectomie totale, la cystectomie partielle permet de preserver l’organe et la fonction erectile, tout en reduisant les risques de complications. Dans cette video, nous decrivons la technique mini-invasive de cystectomie partielle par chirurgie robotique. Methodes.— Patient de 47 ans, consultant pour hematurie macroscopique terminale avec douleurs sus-pubiennes. La fibroscopie retrouve une masse tumorale d’allure necrotique au dome vesical. Le TDM montre une importante masse de la face anterieure de vessie, sans localisation secondaire. La resection de vessie met en evidence un adenocarcinome de l’ouraque, infiltrant le muscle et la graisse peri-vesicale. Une cystectomie partielle sera realisee a l’aide du Robot Da Vinci® Si. La chirurgie consistera dans un premier temps a realiser l’exerese du dome vesical emportant l’ouraque jusqu’a son insertion ombilicale, puis a realiser un curage ganglionnaire extensif emportant les ganglions ilio-obturateurs, iliaques externes et primitifs de maniere bilaterale. La vessie sera reconstruite en 2 plans. Resultats.— L’intervention aura dure 180min, sans incident per-operatoire. Le saignement etait de 150ml. Les suites postoperatoires ont ete simples avec une reprise du transit a j2. La cystographie realisee a j5 ne retrouvait aucune fuite de produit de contraste, avec une miction sans residu et une capacite vesicale de 250ml. L’analyse histologique retrouvait un adenocarcinome de l’ouraque infiltrant massivement la graisse peri-vesicale, classe pT3b N0 (0/22) M0, avec des marges negatives. Conclusion.— La cystectomie partielle robotique est une technique faisable et sure, presentant les avantages d’une chirurgie miniinvasive. La resection doit imperativement eviter toute marge positive. Un suivi a long terme et des series de plus grande importance doivent etre realises afin de determiner le role de la laparoscopie dans le traitement de cette maladie.

An explosive urinary tract infection

A 68-year-old man complained of urinary frequency and hypogastric discomfort. He was a smoker and had hypertension. Digital rectal examination showed a painful prostate but he had no fever. Urine analysis showed a pyuria and a bacteriuria of enterococcus species. The patient was treated with amoxicillin. 2 days after his admission, he suddenly developed acute right fl ank pain with hypotension. Blood tests showed a decrease in haemoglobin from 140 g/L on admission to 70 g/L. The CT showed that an abdominal aortic aneurysm was fi ssured in the retroperitoneum but with