Ricardo R. Gonzalez

LONG-TERM RESULTS OF ARTIFICIAL URINARY SPHINCTERS IN CHILDREN ARE INDEPENDENT OF AGE AT IMPLANTATION

PURPOSEnThe long-term success and efficacy of the artificial urinary sphincter for the management of neurogenic incontinence have been well documented. We evaluated if long-term results were affected by patient age at the time of sphincter placement.nnnMATERIALS AND METHODSnA retrospective review of the medical records of patients who underwent artificial urinary sphincter placement and had minimum of 10 years of followup was conducted. All patients with an intact sphincter were interviewed to assess current results. Patients were stratified into groups 1 and 2 if the sphincter was implanted before or after age 11 years, respectively, and the results were compared statistically.nnnRESULTSnAn artificial urinary sphincter was placed in 45 children at Childrens Hospital of Michigan between October 1978 and August 1986, and medical records and followup were available for 32. Mean followup was 15.4 years. Of the 21 group 1 patients 12 (57%) have an intact sphincter after 26 revisions, and all are dry and 9 (75%) require intermittent catheterization. Of the 11 group 2 patients 7 (64%) have an intact sphincter, and 6 (86%) are dry, 3 (43%) perform intermittent catheterization and 6 required 8 revisions. There was no statistically significant difference in the number of artificial urinary sphincter removals, continence, revision rate, bladder augmentations, complications or upper tract changes.nnnCONCLUSIONSnThe artificial urinary sphincter is a successful and durable option for the surgical management of neurogenic incontinence. The long-term results appear independent of patient age at the time of sphincter placement.

MP02-09 EVALUATION OF SURGICAL OUTCOMES WITH PHOTOSELECTIVE GREENLIGHT XPS LASER VAPORIZATION OF THE PROSTATE IN HIGH MEDICAL RISK MEN WITH BENIGN PROSTATIC ENLARGEMENT: A MULTICENTER STUDY

underexplored. Herein, we describe outcomes of HoLEP in a select cohort of patients with significant LUTS, and known low risk PCa. METHODS: Data were collected retrospectively on patients undergoing HoLEP by a single surgeon. A select group of well informed patients with large symptomatic glands and low risk cancer were carefully counseled that HoLEP was an option to address the obstructive BPH, would unpredictably remove the cancer (all, part, or none), emphasizing they were not undergoing a cancer operation, and that HoLEP would be followed by continued surveillance. Preand postoperative clinical factors, and operative and hospital stay data were collected. RESULTS: In total, 7 men were included. All men had Gleason 3+3 cancer in at most 20% of at most 3 cores on biopsy. Other preop characteristics are described in Table 1. Mean tissue removed was 48.8g. No patients required transfusion or reoperation. Median length of hospital stay was 24.5 hours; median length of catheterization was 19 hours. On final pathology, 3 of 7 of patients had cancer in the specimen, all of which were Gleason 3+3. At f/u, all flow rates improved, PVR improved or remained low, and PSA significantly decreased in all patients (Table 1). No patient have developed stricture, bladder neck contracture, incontinence, or required reoperation. Median f/u time was 4 months (range 4-24 months). Notably, 2 patients had prostate MRI within 2 years of HoLEP, neither of which showed suspicion for PCa. CONCLUSIONS: We have offered HoLEP judiciously to select patients on surveillance for low risk PCa and significant symptomatic BPH, a complex and increasingly common scenario, with acceptable short term outcomes. Further investigations into long-term cancerspecific outcomes, as well as strategies for continued surveillance, will be crucial in order to further evaluate and refine this new approach.

2004 GREENLIGHT HPS-120W VS GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A GLOBAL, MULTI-CENTER, AND PROSPECTIVE COMPARATIVE ANALYSIS ACCORDING TO PROSTATE SIZE

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the surgical performance and impact of prostate volume (PV) of the new Greenlight XPS-180W laser system (AMS, Minnetonka, MI, USA) in comparison with the former generation HPS-120W system for the treatment of BPH by photo-selective vaporization of the prostate (PVP). METHODS: From July 2007 to March 2012, a total of 1809 patients underwent Greenlight PVP for the treatment of BPH performed at 7 international centers. 1187 cases were performed using HPS120W and 622 cases using XPS-180W laser system. Data were all collected prospectively. Comparative analysis was performed between XPS and HPS and according to PV 80 and 80 cc. RESULTS: The XPS compared to HPS, allowed significantly reduced laser and operative time with a mean lasing time of 29.6 min vs. 65.8 min and total operative time of 53 min vs. 80 min respectively (p 0.01 for both). The number of fiber used during procedures was significantly reduced with the XPS system 1.11 vs. 2.28 fiber (p 0.01) while total energy delivered was 250.2 vs. 267.7 kJ (p 0.043) respectively. Overall using XPS and HPS systems, the mean operative time (104.3 vs 55.6 min), mean laser time (86.5 vs 37.3 min) and mean energy usages (400 vs 197 kJ) were all significantly increased according to PV 80 cc vs 80cc. However, when stratified according to PV, XPS demonstrates significant advantages compared to HPS regardless of prostate size in all operative parameters (p 0.01) but energy; total energy delivery was equivalent between the two systems (p 0.05). CONCLUSIONS: The XPS-180W system exhibits reduced operative time and laser time with similar total energy delivery per given PV suggesting a significant increased efficiency compared to the HPS-120W system. Overall, both with XPS-180W and HPS-120W mean operative time, laser time and energy usage increased according to prostate size. This suggests evaluation of PV should be a mandatory assessment as part of pre-operative evaluation of Greenlight PVP because it has direct implications for the operating parameters. Source of Funding: None