Woo Jin Bang

Prostatic Urethral Angulation Associated With Urinary Flow Rate and Urinary Symptom Scores in Men With Lower Urinary Tract Symptoms

OBJECTIVE To evaluate the effect of the prostatic urethral angle (PUA) on the peak flow rate (Qmax) and urinary symptoms in the clinical setting. MATERIALS AND METHODS The records were obtained from a prospectively maintained database for first-visit men with lower urinary tract symptoms. Uroflowmetric measurements, postvoid residual urine volume, and International Prostate Symptom Score were assessed. The prostate-related parameters, including prostate volume, PUA, and intravesical prostatic protrusion, were measured using transrectal ultrasonography. Patients with comorbidities that can affect voiding function or in whom the PUA could not be measured were excluded. RESULTS A total of 316 patients were included. On multivariate linear regression analysis, the PUA (P = .002) was independently associated with the International Prostate Symptom Score. However, the International Prostate Symptom Score was not influenced by patient age, prostate volume, or intravesical prostatic protrusion. The mean PUA was significantly different according to symptom severity. The mean PUA was 42.2° ± 7.0°, 45.5° ± 9.1°, and 47.3° ± 8.6° in patients with mild, moderate, and severe symptoms, respectively (P = .004, analysis of variance). Although the PUA (P <.001) and patient age (P <.001) were independent predictors of Qmax, the prostate volume and intravesical prostatic protrusion did not affect the Qmax. The mean PUA was 52.2° ± 7.3° in patients with a Qmax <10 mL/s, 45.0° ± 7.9° in those with a Qmax ≥10 mL/s but <20 mL/s, and 39.8° ± 7.9° in those with a Qmax of ≥20 mL/s (P <.001, analysis of variance). CONCLUSION The results of our study has shown that the PUA is significantly associated with the Qmax and symptom scores in men with lower urinary tract symptoms. Our findings suggest that the PUA should be considered in the treatment of male patients with lower urinary tract symptoms.

Clinical implications of a feeling of incomplete emptying with little post-void residue in men with lower urinary tract symptoms

It remains unclear why patients suffer from a feeling of incomplete emptying despite no or little post‐void residual (PVR). Accordingly, we evaluated the clinical implications thereof in men with lower urinary tract symptoms (LUTS).

PD72-04 CANCER-SPECIFIC MORTALITY AMONG MEN WITH LOCALIZED PROSTATE CANCER TREATED WITH RADICAL PROSTATECTOMY VERSUS RADIOTHERAPY: A MULTI-CENTER STUDY USING PROPENSITY SCORE MATCHING AND COMPETING RISK REGRESSION ANALYSES

Nicola Fossati*, Milan, Italy; R. Jeffrey Karnes, Stephen Boorjian, Michele Colicchia, Rochester, NY; Alberto Bossi, Thomas Seisen, Villejuif, France; Cesare Cozzarini, Claudio Fiorino, Barbara Noris Chiorda, Giorgio Gandaglia, Milan, Italy; Thomas Wiegel, Ulm, Germany; Shahrokh F. Shariat, Gregor Goldner, Vienna, Austria; Steven Joniau, Antonino Battaglia, Karin Haustermans, Gert De Meerleer, Leuven, Belgium; Val erie Fonteyne, Piet Ost, Ghent, Belgium; Hein Van Poppel, Leuven, Belgium; Francesco Montorsi, Alberto Briganti, Milan, Italy

Cancer-specific mortality among Korean men with localized or locally advanced prostate cancer treated with radical prostatectomy versus radiotherapy: A multi-center study using propensity scoring and competing risk regression analyses

Purpose Studies comparing radical prostatectomy (RP) outcomes with those of radiotherapy with or without androgen deprivation therapy (RT±ADT) for prostate cancer (PCa) have yielded conflicting results. Therefore, we used propensity score-matched analysis and competing risk regression analysis to compare cancer-specific mortality (CSM) and other-cause mortality (OCM) between these two treatments. Materials and Methods The multi-center, Severance Urological Oncology Group registry was utilized to identify 3,028 patients with clinically localized or locally advanced PCa treated by RP (n=2,521) or RT±ADT (n=507) between 2000 and 2016. RT±ADT cases (n=339) were matched with an equal number of RP cases by propensity scoring based on age, preoperative prostate-specific antigen, clinical tumor stage, biopsy Gleason score, and Charlson Comorbidity Index (CCI). CSM and OCM were co-primary endpoints. Results Median follow-up was 65.0 months. Five-year overall survival rates for patients treated with RP and RT±ADT were 94.7% and 92.0%, respectively (p=0.105). Cumulative incidence estimates revealed comparable CSM rates following both treatments within all National Comprehensive Cancer Network risk groups. Gleason score ≥ 8 was associated with higher risk of CSM (p=0.009). OCM rates were comparable between both groups in the low- and intermediate-risk categories (p=0.354 and p=0.643, respectively). For high-risk patients, RT±ADT resulted in higher OCM rates than RP (p=0.011). Predictors of OCM were age ≥ 75 years (p=0.002) and CCI ≥ 2 (p < 0.001). Conclusion RP and RT±ADT provide comparable CSM outcomes in patients with localized or locally advanced PCa. The risk of OCM may be higher for older high-risk patients with significant comorbidities.

PD29-08 PREDICTIVE FACTORS FOR THE DEVELOPMENT OF RENAL INSUFFICIENCY FOLLOWING PARTIAL NEPHRECTOMY AND SUBSEQUENT RENAL FUNCTION RECOVERY

INTRODUCTION AND OBJECTIVES: To evaluate predictors of renal insufficiency and subsequent renal function recovery following partial nephrectomy (PN). METHODS: Data from 6 institutions on 393 patients who underwent PN for solid renal tumors between March 2001 and November 2013 were retrospectively reviewed. Clinicopathological features including age, sex, body mass index, histories of hypertension and diabetes mellitus, ASA score, tumor size, RENAL nephrometry score, operative time, clamp type, ischemic time, blood loss, and serum chemistry were assessed. Renal insufficiency was defined as a new onset eGFR <60 mL/min/1.73m after the operation on the second of two consecutive tests at least 3 months apart. Renal function recovery was defined as eGFR 60 ml/min/1.73m following renal insufficiency. Multivariate models were performed to evaluate predictors of renal insufficiency and subsequent renal function recovery. RESULTS: The median (IQR) age, tumor size, and follow-up period were 53 (45-63) years, 2.6 (1.9-3.8) cm, and 36 (12-48) months, respectively. Tumors were of low complexity in 48.9% of cases. Tumor complexity significantly correlated with ischemic time (p1⁄40.001); however, not with postoperative renal insufficiency. Clavien-Dindo complication GIII occurred in 10.5% patients and were mostly hemorrhagic. Renal insufficiency developed in 53 (13.5%) patients in which age 60 years (HR1⁄43.457, 95% CI 1.947-6.137; p<0.001) and preoperative Cr 1.1 mg/ml (HR1⁄43.533, 95% CI 2.047-6.100; p<0.001) were independent predictors. Among these patients, 20 (37.7%) patients exhibited renal function recovery within a median (IQR) period of 18 (12-36) months of which preoperative Cr <1.1 mg/ml revealed to be an independent predictor (HR1⁄45.937, 95% CI 1.454-24.24; p1⁄40.013). Retrospective nature of the study was a limitation. CONCLUSIONS: Age 60 years and preoperative Cr 1.1 mg/ ml were risk factors for renal insufficiency following PN; however, among patients exhibiting renal insufficiency, those with preoperative Cr <1.1 mg/ml may be expected for renal function recovery.