Page 1 - CUA2019 Abstracts - BPH

2019 CUA AbstrACts

Poster Session 7: BPH, Robotics, Infertility, Sexual Dysfunction

July 1, 2019; 0730–0900

MP-7.1 setting, as a day care surgery (DCS). To our knowledge, only two smaller
One-year outcomes of the top-down holmium laser enucleation contemporary studies have reported on the feasibility and safety of this
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of prostate (HoLEP) method. Herein, we review our experience with regards to the safety
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Fabiola Oquendo , Amr Hodhod , Cale Leeson , Ahmed Kotb , Owen and efficacy of patients undergoing outpatient mTURP.
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Prowse , Walid Shahrour , Hazem Elmansy 1 Methods: The records of patients treated at our institution between January
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1 Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada 2016 and March 2018 who had undergone mTURP for BPH were reviewed.
Introduction: Holmium laser enucleation of prostate (HoLEP) has similar Patients’ demographics, complications and outcomes were recorded.
outcomes but fewer morbidities than open prostatectomy for large prostates. Results: Of the 362 mTURP procedures, 187 (52%) were DCS and 175
However, the major drawback for its wide application is the relatively were POH. Patients in the POH group were slightly older than the DCS
long steep learning curve required to efficiently master the technique. In group (73 vs. 70 years; p=0.002). There were no significant differences
2017, the “top-down” technique was introduced to shorten the operative between the two groups for American Society of Anesthesiologists (ASA)
time and lessen the procedure number required to master the technique. score, body mass index (BMI), surgery performed under acetylsalicylic acid
In this study, we present the one-year results of the top-down technique (13% in each group), and mean reduced prostate weight (17.4 vs, 18.9 g).
performed at our institution. Mean resection time of 48 minutes in the DCS group and 52 minutes in
Methods: We retrospectively reviewed the charts of prospectively collected the POH group were comparable (p=0.06). In each group, 22% of patients
patients who underwent top-down HoLEP from 2017–2018. All cases were consulted in the emergency room within the first 30 postoperative days,
operated upon by a single urologist (HE). We used a 100 W holmium:YAG with similar rates of hematuria (11.3%), acute retention (9.6%), or urinary
laser (VersaPulse PowerSuite, Lumenis, Yokneam, Israel) with a 550 μm tract infection (9.4%). Readmission rate was 4.4% overall (eight patients
laser fiber and a 2 8Fr continuous flow resectoscope (Karl Storz, Germany). in each group). Blood transfusion was required for six patients in the DCS
Enucleated tissue was morcellated using a Karl Storz DrillCut Morcellator. group and one in the POH group (p=0.06). Re-operation (clot evacuation
We collected the enucleation time, morcellation time, and intraoperative and fulguration) within 30 days occurred for eight cases in the POH group.
and postoperative complications. All patients had postoperative followups No death occurred. Long-term complication rate was similar.
at one, three, six, and 12 months. The evaluation included the International Conclusions: In our study, comparable 30-day complication rates were
Prostate Symptom Score (IPSS), quality of life assessment (QoL), maximum observed between both groups, suggesting that mTURP is suitable for an
flow rate (Qmax), and post-void residual (PVR). outpatient setting in carefully selected patients.
Results: Sixty consecutive patients were recruited. Patients characteristics References
and preoperative data are demonstrated in Table 1. The median prostatic vol- 1. Wein AJ, et al. Campbell-Walsh urology. 11e ed. 2016, Philadelphia,
ume, resected prostatic weight, and resected prostatic tissue percentage Pennsylvania: Elsevier.
were 124 cc (70– 266), 90 g (44–242), and 76% (46–97%), respectively. 2. Anderson BB, Pariser JJ, Helfand BT. Comparison of patients undergo-
The median enucleation and morcellation times were 80 (25–200) and ing PVP vs. TURP for LUTS/BPH. Curr Urol Rep 2015;16:55. https://
14.5 (4–58) minutes, respectively. A single patient had a simple bladder doi.org/10.1007/s11934-015-0525-7
mucosal injury and another developed clot retention. Within the first three 3. Thangasamy IA, Chalasani V, Bachmann A, et al. Photoselective
months of followup, four patients (6.6%) had stress urinary incontinence vaporisation of the prostate using 80 W and 120 W laser vs. trans-
(SUI), and urge incontinence (UI) was present in eight patients (13.3%). At urethral resection of the prostate for benign prostatic hyperplasia:
the last followup, one patient (1.7%) manifested by persistent SUI and three A systematic review with meta-analysis from 2002-2012. Eur Urol
patients (5%) had UI. One patient had a meatal stenosis. The IPSS, QoL, 2012;62:315-23. https://doi.org/10.1016/j.eururo.2012.04.051
and PVR were significantly improved during the entire followup (p<0.001, 4. Khan A. Day care monopolar transurethral resection of prostate: Is
<0.001, 0.005, respectively) (Table 2). it feasible? Urol Ann 2014;6:334-9. https://doi.org/10.4103/0974-
Conclusions: Our one-year results of the top-down technique are satisfac- 7796.140998
tory and comparable to those of the classic HoLEP. However, the top-down 5. Bright E, Stocker M, Koupparis A, et al. Day-case monopolar and
technique may reduce the complexity and operating time of HoLEP. bipolar transurethral resection of the prostate. J Clin Urol 2014;8:63-7.
This paper has figures, which may be viewed online at: https://doi.org/10.1177/2051415814548475
https://2019.cua.events/webapp/lecture/174
MP-7.3
MP-7.2 Urgent and elderly transurethral resection of the prostate patients
Feasibility and safety of monopolar transurethral resection of the suffer alarming readmission rates: Calgary NSQIP data confirmed
prostate in the outpatient setting by Alberta provincial data
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Marie-Pier St-Laurent , Samuel Tremblay , Geneviève Nadeau 1 Hilary L. Brotherhood , Trafford Crump , Asher Khan , Kevin Carlson ,
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1 Department of Urology, University Hospital of Québec – Université Laval, Richard J. Baverstock 2
Québec City, QC, Canada 1 Reconstructive and Functional Urology, University of Calgary, Calgary,
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Introduction: Transurethral resection of the prostate using monopolar AB, Canada; Department of Urology, University of Calgary, Calgary, AB,
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current (mTURP) is still the gold standard treatment of benign prostatic Canada; Department of Urology, University of Calgary, Calgary, AB, Canada
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hyperplasia (BPH). Newer technologies have been advocated to reduce Introduction: Hospital readmission after surgery is a topic of interest and is
complications and length of hospital stay. Traditionally, mTURP is a key metric for healthcare quality. Transurethral resection or laser vaporiza-
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performed in an inpatient setting (postoperative hospitalization [POH]). tion of the prostate (TURP) may have complications, leading to return to
At our centre, many patients have undergone mTURP in an outpatient the emergency department (ED) and readmission. We identified all TURPs
S130 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association