Page 2 - CUA2018 Abstracts - LUTS

Poster session 3: Male LUts/Men’s Health

age was associated with prior ART, however, semen analysis parameters or Results: A total of 82 patients were included in the study (41 per arm).
duration of infertility were not. These results help us understand why cou- Both groups were comparable in terms of age, preoperative prostate size
ples are being treated with ARTs prior to a male infertility investigation. (114 vs. 112 mL; p>0.05), enucleation time (95.3 vs. 91.7 minutes; p>
0.05), and morcellation time (21.6 vs. 18.3 minutes; p>0.05). However,
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MP–3.4 the DrillCut morcellator was associated with significantly lower morcel-
lation efficiency when compared with the VersaCut (3.8% vs. 4.9% g/
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Cost–utility analysis of upfront pharmacotherapy compared to min; p=0.03). There was no significant difference between morcellators
an upfront surgical intervention for patients with moderate–to– in terms of complication rates (7.3 vs. 2.4%; p=0.1). There was one case
severe benign prostatic hyperplasia of small bladder perforation requiring abdominal exploration with the
Aysegul Erman , Lisa Masucci , Murray Krahn 1,2,3 , Dean Elterman 1,2,3 VersaCut™ morcellator. The cost of disposable instruments were higher
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1 Toronto Health Economics and Technology Assessment Collaborative with the new DrillCut morcellator when compared with the VersaCut
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(THETA), University of Toronto, Toronto, ON, Canada; Leslie Dan Faculty ($247.5 vs.$160.9; p<0.01).
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of Pharmacy, University of Toronto, Toronto, ON, Canada; Department Conclusions: The new Karl Storz DrillCut morcellator was associated
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of Urology, University Health Network , Toronto, ON, Canada with significantly lower morcellation efficiency and higher cost of dispos-
Introduction: The purpose of our study was to evaluate the cost–util- ables when compared with Lumenis VersaCut morcellator.
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ity of upfront pharmacotherapy (i.e., alpha–blockers, 5–alpha reductase
inhibitors, or combination) followed by delayed surgical intervention (i.e.,
either transurethral resection of the prostate [TURP], or photoselective MP–3.6
vapourization of the prostate [PVP] using Greenlight laser [GL]) compared Robotic simple prostatectomy for large–volume adenomas after
to surgery as initial treatment. prior benign prostatic hyperplasia surgery
Methods: The target population was men with a mean age of 65 years with Pierre–Alain Hueber , Peter Mekhail , Matthew Winter , Akbar Ashrafi ,
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moderate–to–severe symptoms with no contraindications for benign pros- Nieroshan Rajarubendra , Andre Berger , Monish Aaron , Inderbir Gill ,
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tatic hyperplasia (BPH) surgery. A microsimulation model was developed Mihir Desai 1
to project the costs and quality–adjusted life years (QALYs) of the target 1 Urology, University of Southern California, Los Angeles, CA, United
population. Costs of pharmacotherapy was obtained from the Ontario States
Drug Benefit Formulary. Costs of BPH surgeries were collected retro- Introduction: Surgical treatment options for symptomatic bladder outlet
spectively. All other parameters were obtained from the literature. The obstruction associated with benign prostatic hyperplasia (BPH) in patients
cost–utility analysis was performed from a public payer perspective using with large adenoma (>100 cc) are open simple prostatectomy (OSP) and
a life–time time horizon, a discount rate of 1.5%, and a cost–effective- holmium enucleation of the prostate (HoLEP). Robotic simple prostatec-
ness threshold of $50 000 per QALY gained. Probabilistic analysis was tomy (RSP) has recently evolved as a minimally invasive alternative to OSP
performed to estimate parameter uncertainty. with improved perioperative morbidity. There is limited data reporting its
Results: Compared to the upfront pharmacotherapy options, upfront surgi- use in patients that have had previous BPH surgery.
cal interventions were, on average, more costly and more effective. All Methods: We retrospectively reviewed records of 132 patients that under-
options involving upfront pharmacotherapy followed by delayed TURP went RSP for symptomatic BPH from May 2011 to September 2017 at
were dominated. Upfront TURP was the most costly and most effective our institution and identified patients that had a previous BPH surgery.
option, followed by upfront GL–PVP. On average, upfront TURP cost Perioperative outcomes, including transfusion, complications, length of
$1015 more and resulted in a marginal gain of 0.03 QALYs compared catheterization, and hospitalization, were examined. Functional out-
to upfront GL–PVP. This translated to an incremental cost per QALY comes, including International Prostate Symptom Score (IPSS), peak uri-
gained of $29 066. Probabilistic analysis indicated that upfront BPH nary flow (Qmax), and post–void residual (PVR), were analyzed with a
surgery would be the optimal choice for cost–effectiveness thresholds over median followup of six months.
$18 000 per QALY. Results: A total of 28 patients that underwent RSP had previous BPH
Conclusions: In general, upfront BPH surgery is cost–effective compared surgical therapy: transurethral resection of the prostate (TURP) (n=12),
to pharmacotherapy. Given the lower costs, relative effectiveness, and transurethral microwave therapy (TUMT) (n=10), Greenlight photoselec-
better safety, GL–PVP may be considered as an upfront intervention for tive vaporization of the prostate (PVP) (n=4), HolEP (n=1), and open retro-
certain patients with moderate–to–severe BPH. pubic prostatectomy (n=1). Despite these previous interventions, the mean
preoperative prostate volume was 143.6 cc and 57% of patients were
MP–3.5 in urinary retention at baseline (Table 1; available at https://cua.guide/).
Mean operative time and estimated blood loss (EBL) were 242 minutes and
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Karl Storz DrillCut vs. Lumenis VersaCut prostate tissue 149 ml, respectively. No intraoperative complication or need for transfu-
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morcellators after holmium laser enucleation: A prospective, sion was observed. Mean hospital stay was four days and mean catether
randomized controlled trial duration was seven days. Hematuria requiring cystoscopic fulguration
Ahmed Ibrahim , Mostafa Elhilali , Sero Andonian , Serge Carrier 1 (Clavien 3a) was the solitary complication. Postoperative functional out-
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1 Department of Urology, McGill University Health Centre, Montreal, QC, comes with a followup of six months, including IPSS, Qmax, and PVR,
Canada were all significantly improved (p<0.5 for all) compared to baselines
Introduction: The DrillCut morcellator has been recently introduced by (Fig. 1; available at https://cua.guide/).
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Karl Storz with unique features designed to optimize the critical step Conclusions: RSP can be a safe and efficient surgical option for patients
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of the holmium laser enucleation of the prostate (HoLEP). To date, the with recurrence of symptomatic BPH for prostate size >100 cc after pre-
comparative efficacy of the new Karl Storz DrillCut device remains vious BPH surgery.
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undetermined. Therefore, the objective of the present study was to com-
pare safety, efficacy and cost–effectiveness outcomes between the new
Karl Storz DrillCut and Lumenis VersaCut prostate tissue morcellation
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devices after HoLEP.
Methods: After obtaining ethics approval, consecutive patients undergoing
HoLEP for symptomatic benign prostatic hyperplasia were randomized to
have their enucleated prostates morcellated by either Karl Storz DrillCut
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or Lumenis VersaCut morcellators. All procedures were performed by
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two experienced urologists. Patients’ demographics and perioperative data
were recorded. Both morcellators were compared for their safety, efficacy,
and cost–effectiveness outcomes.
S80 CUAJ • June 2018 • Volume 12(6Suppl2)