Page 3 - CUA2018 Abstracts - LUTS

Poster session 3: Male LUts/Men’s Health

MP–3.7 enucleation started at 12 o’clock, which is extended anteroposteriorly
To TURP or not to TURP: How do urologists use non–traditional and downwardly toward the apical adenoma in the 6 o’clock position.
urodynamic results when treating male lower urinary tract The mucosal strip is easily visualized as the apical dissection is performed
symptoms? from top down. This eliminates the need to encircle the mucosal strip
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Patrick McGarry , Richard Baverstock , Kevin Carlson , Duane Hickling , reducing enucleation time. There were no reported intraoperative compli-
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Blayne Welk 1 cations (i.e., bladder mucosal injury, capsular perforation, ureteral orifice
1 Surgery, Western University, London, ON, Canada; Surgery, University injury) during morcellation.
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of Calgary, Calgary, AB, Canada; Surgery, University of Ottawa, Ottawa, Conclusions: We expect that this new technique may reduce the com-
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ON, Canada plexity, operating time, and learning curve for urologists performing the
Study Groups: Dr. McGarry was supported by a CUA Pfizer Incontinence HoLEP procedure.
Grant.
Introduction: High–pressure, low–flow urodynamics is a well–understood MP–3.9
finding with benign prostatic hyperplasia (BPH), however there is little Photoselective vaporization of the prostate: Evaluation of
research to suggest what to do with other urodynamic findings when a conflicts of interest and industrial sponsorship stratified by
transurethral resection of prostate (TURP) is being considered. outcome
Methods: We created four clinical scenarios. An online survey was dis- Marian Wettstein , Clinsy Pazhepurackel , Aline Neumann , Dixon
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tributed to members of the International Continence Society and the Woon , Jaime Omar Herrera Cáceres , Cédric Poyet , Tullio Sulser , Girish
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Society for Urodynamics and Female Pelvic Medicine, & Urogenital Kulkarni , Thomas Hermanns 1
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Reconstruction. 1 Department of Urology, University Hospital of Zurich, University of
Results: Forty urologists responded. Median age was 55–65 years, 67% Zurich, Zurich, Switzerland; Division of Urology, Department of Surgery,
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described their practice as academic, 39% of respondents estimated that Princess Margaret Hospital and University Health Network, University of
they did more than 50 TURPs per year, and 41% generally performed Toronto, Toronto, ON, Canada
urodynamics before TURP. Scenario 1: A man with an incidental residual Introduction: Photoselective vaporization of the prostate (PVP) is an
urine >1 L who could void a small volume of urine with a normal detru- accepted treatment modality for non–neurogenic lower urinary tract
sor pressure and medium urine flow. The majority (79%) would offer a symptoms secondary to prostate enlargement. Conflicts of interest (COIs)
TURP, however, the average chance urologists quote that his residual and industrial sponsorship (IS) might have an impact on the reporting of
volume would improve was only 58%. Scenario 2: A man with catheter– outcomes of studies assessing efficacy, safety, or cost parameters of PVP.
dependent retention and detrusor overactivity, but no voluntary voiding The aim of the current investigation was to evaluate COIs and IS stratified
contraction. The majority (76%) would offer a TURP, however, the average by study outcome of studies involving either one of the three PVP systems
chance quoted that he would void was only 48%. Scenario 3: A man with (80W, 120W or 180W).
catheter–dependent retention and an underactive detrusor (low–pressure, Methods: MEDLINE and EMBASE were systematically searched (January
low–flow voiding). The majority (86%) would offer him a TURP, however, 1990 to August 2017). Comparative studies (randomized controlled tri-
the average chance quoted that he would void was only 55%. Scenario als [RCTs] and non–randomized comparative studies [NRCSs]), in which
4: A man with only frequency and urgency, but high–pressure, low–flow PVP was one treatment modality were included in the final analysis.
voiding. The majority (88%) would offer him a TURP, however, the average Sponsorship assessment distinguished between IS and non–industrial
chance that his frequency and urgency would improve was only 63%, sponsoring. Two reviewers screened all abstracts and full–text articles
and the average postoperative risk of urgency incontinence was 28%. independently. Disagreement was resolved by reference to an indepen-
Hydronephrosis, a median lobe, or catheter intolerance made it more dent third reviewer. Favourability of outcome was evaluated on a binary
likely that the patient would be offered a TURP. scale by two independent board–certified urologists. Descriptive statistics
Conclusion: Even with urodynamic results that are not traditionally an were used for data analysis.
indication for a TURP, this operation is often recommended despite the Results: After full–text screening of 286 articles, 65 studies could be
modest results that are expected. included into the final analysis. The results of the COI and sponsorship
evaluation are presented in Table 1 (available at https://cua.guide/). The
MP–3.8 majority of the studies mentioned the absence/presence of potential COIs
Top–down technique holmium laser enucleation of the prostate (78%). In contrast, a sponsorship statement was only found in 29% of
(video presentation) the studies. The group of studies considering PVP equal/superior to the
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Hazem Elmansy , Ahmed Kotb , Owen Prowse , Walid Shahrour 1 control arm had a higher percentage of COIs (42% vs. 31%) and IS (8%
1 Urology, Northern Ontario School of Medicine, Thunder Bay, ON, vs. 3%) compared to the group of studies considering PVP inferior to the
Canada control procedure.
Introduction: Holmium laser enucleation of the prostate (HoLEP) is widely Conclusions: A majority of all RCTs and NRCSs on PVP mention the
regarded as a challenging procedure to perform. Its prolonged learning absence/presence of potential COIs. However, a sponsorship statement
curve, in comparison with transurethral resection of the prostate (TURP), was identifiable in only about one–third of all studies. COIs and IS were
has limited its acceptance in urological clinical practice. The top–down more frequent in studies reporting favourable outcomes of PVP.
enucleation technique aims to simplify the HoLEP procedure while simul-
taneously reducing operative time and shortening the learning curve. MP–3.10
Methods: Between October 2017 and December 2017, 20 patients with Classifying the health behaviours of Canadian men as basis for
benign prostatic hyperplasia (BPH) underwent HoLEP with the top–down making recommendations for targeted interventions
technique. All cases were operated upon by a single urologist (HE).We Ryan Flannigan 1,2,3 , John Oliffe , Donald McCreary , Nahid Punjani ,
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used a 100 W holmium:YAG laser (VersaPulse PowerSuite, Lumenis, Khushabu Kasabwala , Nick Black , Joe Rachert , Larry Goldenberg 2,3
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Yokneam, Israel) with a 550 mm laser fiber and a 28 Fr continuous flow 1 Urology, Weill Cornell Medicine, New York, NY, United States; Urologic
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resectoscope (Karl Storz, Germany). Enucleated tissue was morcellated Sciences, University of British Columbia, Vancouver, BC, Canada;
using a Karl Storz Morcellator. The surgical parameters, including enu- 3 Canadian Men’s Health Foundation, Vancouver, BC, Canada; Nursing,
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cleation time, morcellation time, and intraoperative complications,were University of British Columbia, Vancouver, BC, Canada; Psychology,
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evaluated. A video of the surgical technique, slides, and a voiceover Brock University, St. Catharines, ON, Canada; Urology, Western
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narration are included. University, London, ON, Canada; Intensions Consulting, Vancouver,
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Results: We demonstrate our version of this technique and present early BC, Canada
operative outcomes. One posterior groove is used allowing simultane- Study Groups: AUA Scholar Award, NY Section (RF); Canadian Men’s
ous enucleation of median lobe with attached lateral lobe. Top–down Health Foundation; Public Health Agency of Canada.
CUAJ • June 2018 • Volume 12(6Suppl2) S81