Standard Transurethral Resection Research Articles

Comparison of en-bloc resection of the bladder wall and tumor with standard transurethral bladder resection in treatment of non-muscle invasive bladder cancer

Comparison of en-bloc resection of the bladder wall and tumor with standard transurethral bladder resection in treatment of non-muscle invasive bladder cancer

Clinical outcomes of Holmium Laser Enucleation of the Prostate (HoLEP) in benign prostatic hyperplasia patients in Rajavithi Hospital

Objective: To evaluate the outcomes and safety of the surgical technique holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) for whom surgeryis indicated. Materials and Methods: The demographic characteristics, duration of surgery, blood transfusion rate, weight of tissue removed, catheterization time and complica- tions were recorded in 25 patients who underwent HoLEP surgery between January 2021 and May 2022 in Rajavithi Hospital. The International Prostate Symptom Score (IPSS), quality of life score (QoL), peak flow rate (Q-max), post-void residual urine volume (PVR), hematocrit (Hct) and prostate-specific antigen (PSA) levels were comparedbefore and after surgery. Results: The mean age of the patients was 71.28±7.54 years. There were statistically significant differences between mean preoperative and postoperative Hct (%) (40.5± 5.9 and 38.4±5.1), p = 0.001. Only 1 in 25 patients had 1 unit of blood transfusion. One month postoperatively the mean PSA had decreased from 4.55 to 1.2 ng/ml (p < 0.001); mean IPSS had improved from 21.0 to 7.0 (p < 0.001); mean QoL score had improved from 4.47 to 1.10 (p < 0.001); mean PVR had decreased from 98.0 to 39.7 ml (p = 0.002) and the mean Q-max had increased from 8.0 to 17.8 ml/sec (p = 0.015). The mean catheterization time was 2.40±0.57 days. There were no serious complications or incidence of TUR syndrome in this study. Conclusion: HoLEP is a safe alternative to the current gold standard transurethral resection of the prostate for BPH patients as there are fewer complications with similar functional outcomes

COmparing Urolift and Standard Transurethral resection of prostate Ahead of Radiotherapy in men with urinary symptoms secondary to prostate enlargement in Southwest London and North Cumbria (CO-STAR): a study protocol for a randomised feasibility study

IntroductionPatients undergoing prostate radiotherapy with an enlarged prostate can have short-term and long-term urinary complications. Currently, transurethral resection of the prostate (TURP) is the mainstay surgical intervention for men with...

Prostatic Arterial Embolization for Treatment of Lower Urinary Tract Symptoms Associated with Benign Prostatic Enlargement.

Prostatic artery embolization (PAE) is an emerging minimally invasive technique for lower urinary tract symptom reduction from benign prostatic hypertrophy (BPH). While the technique is becoming increasingly popular with patients and interventional radiologists, most urologists remain skeptical of the PAE's long-term efficacy and comparative success to the gold standard transurethral resection of the prostate. PAE has been found in multiple meta-analyses to perform similarly to the gold standard transurethral resection of the prostate (TURP) with regard to patient-driven measures like IPSS and IPSS-QoL, while also performing favorably in objective measurements including Qmax and PVR out to at least 12months post intervention. Furthermore, PAE has a demonstrated shorter hospital length of stay and fewer adverse events when compared to TURP. PAE provides patients with an alternative to transurethral options for the management of LUTS in the setting of bladder outlet obstruction. While long-term evidence demonstrating the durability of PAE is still forthcoming, the procedure has been demonstrated to be safe according to multiple meta-analyses. Patients deserve to be counseled on PAE as an alternative to surgery and made aware that while the overall treatment effect may not be as robust or durable, the procedure carries a favorable adverse event profile that is attractive to patients wishing to avoid a trans-urethral approach.

MP51-16 TRANSPERINEAL LASER ABLATION VERSUS TRANS-URETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC OBSTRUCTION: A RANDOMIZED CLINICAL TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP51-16 TRANSPERINEAL LASER ABLATION VERSUS TRANS-URETHRAL RESECTION OF PROSTATE FOR BENIGN PROSTATIC OBSTRUCTION: A RANDOMIZED CLINICAL TRIAL Riccardo Bertolo, Valerio Iacovelli, Chiara Cipriani, Marco Carilli, Matteo Vittori, Michele Antonucci, Francesco Maiorino, Marta Signoretti, Filomena Petta, and Pierluigi Bove Riccardo BertoloRiccardo Bertolo More articles by this author , Valerio IacovelliValerio Iacovelli More articles by this author , Chiara CiprianiChiara Cipriani More articles by this author , Marco CarilliMarco Carilli More articles by this author , Matteo VittoriMatteo Vittori More articles by this author , Michele AntonucciMichele Antonucci More articles by this author , Francesco MaiorinoFrancesco Maiorino More articles by this author , Marta SignorettiMarta Signoretti More articles by this author , Filomena PettaFilomena Petta More articles by this author , and Pierluigi BovePierluigi Bove More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transperineal interstitial laser ablation (TPLA) is among one of the latest ultra-minimally invasive technique to treat benign prostatic obstruction (BPO). No study investigated the actual rate of preservation of the ejaculatory function after TPLA, in comparison to the reference standard trans-urethral resection of prostate (TURP). We aimed to evaluate the reliability of TPLA in preserving the ejaculation compared to TURP. METHODS: In this single-center, prospective, randomized, open-label study, consecutive patients with indication to surgical treatment for BPO were enrolled between January 2020 and September 2021 (NCT04781049). Randomization defined two treatment arms: Group A: patients assigned to TPLA (experimental); Group B: patients assigned to TURP (standard). Primary endpoints included comparison of visual analogue scale (VAS), change in ejaculatory function (by EJ-MSHQ), and changes in sexual function (by IIEF-5) at 1 month after surgery. Secondary endpoints included ΔIPSS and ΔQoL, and Qmax improvement at 6 months. RESULTS: Fifty-one patients (26 TPLA versus 25 TURP) were analyzed. No differences were found in the perception of pain assessed by VAS. No differences in IIEF-5 score were found between groups. Distribution of ejaculatory function assessed by the EJ-MSHQ remained unmodified after TPLA (p=0.2) while a median 31% decrease in EJ-MSHQ score (IQR -67;-14%) was observed after TURP (p=0.01). Retrograde ejaculation was reported in one patient within the TPLA group (18 patients s/p TURP). A statistically significant difference between the treatment groups was found in terms of postoperative Qmax (15.2 (IQR 13.5–18.3) versus 26.0 (IQR 22.0–48.0) ml/s, TPLA versus TURP, p<0.001). Qmax was statistically significantly improved with respect to baseline after TPLA (%ΔQmax+42 (+24; +76), p<0.001). Both treatments significantly improved IPSS and QoL with respect to baseline, with TURP impacting more significantly (%ΔIPSS -35.9 (IQR -54.5; -1.3) versus -66.7 (-82.8; -46.7) and %ΔQoL -33.3 (-50; -8) versus -60.0 (IQR -80; -33), TPLA versus TURP, all p-values <0.03). CONCLUSIONS: TPLA allowed for maintaining ejaculation in 96% of the cases, confirming to be valid option in patients seeking for pairing the relief from BPO to the high probability of preserving ejaculatory function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e699 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Riccardo Bertolo More articles by this author Valerio Iacovelli More articles by this author Chiara Cipriani More articles by this author Marco Carilli More articles by this author Matteo Vittori More articles by this author Michele Antonucci More articles by this author Francesco Maiorino More articles by this author Marta Signoretti More articles by this author Filomena Petta More articles by this author Pierluigi Bove More articles by this author Expand All Advertisement PDF downloadLoading ...

Standard Transurethral Resection vs Transurethral Laser Surgery for Bladder Cancer: A Systematic Review and Meta-Analysis Comparing Clinical Outcomes and Complications.

Introduction: Transurethral resection of bladder tumor (TURBT) remains the gold standard method of diagnosing and treating nonmuscle invasive bladder cancer. Laser resection has been demonstrated as a safe and efficacious alternative; however, its mainstream use remains limited. The aim of this review is to comparatively evaluate clinical outcomes of TURBT and laser resection of bladder tumor (LRBT) for bladder cancer. Methods: A systematic review of the literature was performed for studies comparing TURBT and LRBT for bladder cancer. Outcome measurements were recurrence rates, complication rates, patient demographics, operative duration, and inpatient stay. Meta-analysis was performed using Review Manager 5. Results: Twenty studies on 2621 patients (n = 1364 for TURBT and n = 1257 for LRBT) met inclusion criteria. Demographics, including age and gender ratio and follow-up period, were similar in both groups. Recurrence rates were similar between TURBT and LRBT (29.1% vs 28.2%, p = 0.12). TURBT had a significantly greater obturator kick rate (11.5% vs 0.4%, p < 0.0001) and perforation rate (3.7% vs 0.009%, p = < 0.0001). In the six studies which reported on presence of detrusor muscle in the specimen, it was significantly greater in the LRBT group (96.6% vs 88.1%, p = 0.01). There was no significant difference in operative time between the two groups. TURBT was associated with a significantly longer catheter duration (mean difference [MD] 0.98 days shorter in LBRT group; 95% confidence interval [95% CI] -1.45 to -0.5, p = < 0.00001), and length of stay (MD 1.12 days shorter in LRBT group, 95% CI -1.7 to -0.54, p = 0.0001). Conclusions: LRBT for bladder cancer has the benefit of reduced catheter duration, length of stay, and perforation without impacting negatively on operation duration, recurrence rates, or specimen quality.

Outpatient Photodynamic Diagnosis–guided Laser Destruction of Bladder Tumors Is as Good as Conventional Inpatient Photodynamic Diagnosis–guided Transurethral Tumor Resection in Patients with Recurrent Intermediate-risk Low-grade Ta Bladder Tumors. A Prospective Randomized Noninferiority Clinical Trial

BackgroundTransurethral resection of recurrent low-grade intermediate-risk Ta bladder tumor (BT) in general anesthesia (GA) is burdensome to patients and health care system. Laser technologies enable treatment in office-based settings, reducing morbidity and costs. ObjectiveTo compare 4-mo recurrence-free survival after outpatient department (OPD) diode laser coagulation of BT in local anesthesia and gold standard transurethral resection of BT (TUR-BT) in GA in intermediate-risk Ta low-grade BT, and to evaluate treatment-related morbidity. Design, setting, and participantsA prospective randomized noninferiority trial with 4-mo follow-up, in the hospital setting, was conducted in Capital Region of Denmark from 2016 to 2020. Participants were patients with histologically verified Ta low-grade BT recurrence. A total of 206 patients were randomized; 176 finished treatment and follow-up as per protocol. InterventionLaser photocoagulation of bladder tumor (PC-BT) in OPD using a 980 nm diode laser compared with gold standard TUR-BT in GA, both performed with photodynamic diagnosis (PDD) guidance. Outcome measurements and statistical analysisFour-month recurrence-free survival was assessed; predefined inferiority criterion was set at 15%. The secondary outcomes were pain during PC-BT, postoperative morbidity, postoperative complications, and patient’s preference. Results and limitationsFour-month recurrence-free survival was 8% higher after PC-BT (95% confidence interval [CI]: –8% to 24%). The predefined noninferiority criterion was met. Pain score (1–10) during PC-BT was 2.4 (interquartile range 0.8–3.3). Postoperative lower urinary tract symptom score (0–100) was 13.9 points higher (95% CI: 6.9–21.0, p < 0.001) in the group with transurethral resection of the bladder. The frequency of minor complications was 8.1% higher after TUR-BT (95% CI: 1.0–14.6%, p = 0.026). Of the patients, 98% (95% CI: 92–100%) preferred PC-BT. ConclusionsPDD-guided PC-BT in OPD is as good as TUR-BT in GA to remove recurrent low-grade Ta BT. Postoperative quality of life is better after PC-BT and the frequency of minor complications was lower. Patient summaryThis study evaluates the efficacy of outpatient laser removal of low-grade noninvasive bladder tumor. Outpatient tumor removal with laser was as good as transurethral resection in general anesthesia and less burdensome to patients.

MP29-12 TRANSURETHRAL BIPOLAR ENUCLEATION (TUBE): IMPROVED OUTCOMES VERSUS STANDARD BIPOLAR TRANSURETHRAL PROSTATE RESECTION (TURIS) WITHOUT A SIGNIFICANT LEARNING CURVE MAY EASE ADOPTION OF ENUCLEATION TECHNIQUES INTO CLINICAL PRACTICE

You have accessJournal of UrologyCME1 May 2022MP29-12 TRANSURETHRAL BIPOLAR ENUCLEATION (TUBE): IMPROVED OUTCOMES VERSUS STANDARD BIPOLAR TRANSURETHRAL PROSTATE RESECTION (TURIS) WITHOUT A SIGNIFICANT LEARNING CURVE MAY EASE ADOPTION OF ENUCLEATION TECHNIQUES INTO CLINICAL PRACTICE Zachary Tully, Brian Barnes, Ryan Steinberg, and Bradley Erickson Zachary TullyZachary Tully More articles by this author , Brian BarnesBrian Barnes More articles by this author , Ryan SteinbergRyan Steinberg More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite ample evidence of safety and superiority, transurethral enucleation procedures, most commonly with the holmium laser (HOLEP), have not been widely adopted (<5% in US), likely due to a combination of a steep learning curve and technological barriers. Herein we present our experience with transurethral enucleation using the Olympus® bipolar electrode, a technology with wide availability, use, and surgeon familiarity. METHODS: We reviewed consecutive transurethral outlet procedures using bipolar energy for benign prostatic hyperplasia (BPH) from a single institution from 2010-20 and divided them into two cohorts: standard transurethral resection in saline (TURis; n = 383) and transurethral bipolar enucleation (TUBE; n = 208). All TUBE procedures were performed by a single surgeon. Perioperative characteristics between the two cohorts were compared with unpaired two-tailed t-tests and Chi-squared tests. A separate learning curve analysis was performed for the TUBE procedures that determined the impact that case number had on operative time and tissue resection. RESULTS: Comparisons are shown in the Table. The TUBE cohort was more likely to be catheter dependent pre-operatively and have a higher pre-op PSA. TURis operative time was 10 minutes less on average, but TUBE tissue resection weights were significantly greater. Hospital and catheter times were statistically similar. Post-operatively, TUBE led to a greater reduction in PSA, catheter dependence and BPH medication use. De novo incontinence and need for secondary outlet procedures were higher in TURis. De novo PDE-5 use was greater in TUBE. Cancer detection was greater after TURis. The variability in TUBE operative time (r2 = 0.0024) and resection weight (r2 = 0.007) was not related to surgery number/surgeon experience. CONCLUSIONS: Utilizing the same instrumentation and electrodes, the TUBE technique offers significant advantages to a standard TURis loop resection without an appreciable learning curve. Widespread instrument familiarity, as well as the ability to perform both resection and enucleation maneuvers in the same case, may increase the likelihood of adoption into clinical practice for those hesitant to learn HOLEP. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e473 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Tully More articles by this author Brian Barnes More articles by this author Ryan Steinberg More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Current evidence of ThuLEP for BPH: A review of literature.

Endoscopic enucleation of the prostate (EEP) techniques for the treatment of benign prostatic hyperplasia (BPH) have become increasingly popular among urologists over the past 23 years. Despite the energy source employed, the aim of all these procedures is to endoscopically remove the prostatic lobes by enucleating them from the prostate surgical capsule. The reasons for which EEP has gained popularity among urologists are the reduction in complications and hospital stay compared to endoscopic gold standard Transurethral Resection of the Prostate (TURP), but especially the possibility to treat large prostates, allowing to abandon open simple prostatectomy (OP) and to avoid the burden related to open surgery. Holmium laser enucleation of the prostate (HoLEP) sets the basic principles of all EEP techniques in 1998 and has become the treatment of reference for BPH. Since then, various lasers have been developed and applied to prostatic enucleation. The thulium laser has a slightly shorter wavelength compared to the holmium laser and a continuous wave output, which increase vaporization and reduce penetration depth. These features make it ideal for prostatic enucleation. A vapoenucleating technique called Thulium Laser Vapoenucleation of the Prostate was presented in 2009, followed by a blunt enucleating technique called Thulium Laser Enucleation of the Prostate in 2010. These techniques have become alternatives to HoLEP and TURP; however, the amount of literature and randomized controlled trials available are inferior compared to HoLEP. The aim of th describe, and discuss current evidence on thulium enucleating techniques.

Significance of 5-Aminolevulinic Acid-mediated Photodynamic Diagnosis Following Standard Transurethral Resection in Non-muscle Invasive Bladder Cancer.

Transurethral resection of bladder tumors (TURBT) guided by photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) has been shown to be superior to conventional white light (WL) cystoscopy with regard to diagnostic accuracy, for non-muscle invasive bladder cancer (NMIBC); however, PDD is usually performed prior to WL TURBT. The objective of this study was to investigate the diagnostic significance of 5-ALA-mediated PDD following TUR of NMIBC. In 83 NMIBC patients, all visible tumors were completely resected under the conventional WL guidance followed by additional resection if fluorescent lesions were observed under the blue light (BL) guidance, and random biopsy was further conducted. With the BL source, 39 (47.0%) patients were judged to have fluorescent lesions. Twenty (51.3%) of the 39 patients with positive findings by PDD were diagnosed with residual cancer by additional resection, while random biopsy detected cancers in 2 (4.5%) of the 44 patients with negative findings by PDD. Accordingly, the sensitivity, specificity, positive predictive value and negative predictive value in diagnosing residual cancer by our PDD system were 90.9, 68.9, 51.3 and 95.5%, respectively. Univariate analysis showed that the presence of residual cancers shown by WL TURBT was significantly associated with the preoperative findings of urinary cytology, tumor multiplicity, pathological T stage and tumor grade, of which only the preoperative finding on urinary cytology was shown to have an independent impact on the diagnosis of residual cancer. 5-ALA-mediated PDD following standard WL TURBT could improve the diagnostic accuracy in NMIBC patients, particularly those who are positive for preoperative urinary cytology.

Analyse des coûts de la photovaporisation prostatique au laser Greenlight versus résection transurétrale de la prostate : intérêt de la prise en charge ambulatoire

To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital. A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method. 871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays. In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care. 3.

The efficacy and safety of thulium laser resection of bladder tumor versus standard transurethral resection in patients with non muscle-invasive bladder cancer: a systematic review and meta-analysis

Purpose: This study was to analyze the efficacy and safety of thulium laser resection of bladder tumor (Tm-TURBT) versus TURBT for patients with non-muscle-invasive bladder cancer (NMIBC). Materials and Methods: Randomized controlled trial data were retrieved using the MEDLINE, Embase, Web of Science, and the Cochrane Library. We also searched Chinese databases including Chinese National Knowledge Infrastructure (CNKI), Wanfang data and VIP data. Results: A total of sixteen articles including 1662 participants were enrolled into our meta-analysis. We found no significant difference in terms of operation time, urethral stricture, 1-year recurrence rate, overall 1-year recurrence rate and overall 3-year recurrence rate between the two groups. Less intraoperative blood loss and a lower incidence of obturator nerve reflex (ONR), bladder perforation and bladder irritation were identified in Tm-TURBT group than in TURBT group in our analysis. The analysis also demonstrated faster postoperative recovery in terms of the catheterization, bladder irrigation and hospitalization time in Tm-TURBT group. The subgroup analysis was conducted based on different postoperative chemotherapy (epirubicin and non-epirubicin) concerning recurrence rate whereas no significant difference was noted. Conclusion: Tm-TURBT is an efficient and safe treatment for NMIBC and it could be an alternative choice for TURBT. Given that some limitations are clearly identified, more large-scale and well-designed RCTs are needed to confirm our findings.

Reduced bleeding with DRY CUT® transurethral resection of the prostate (TURP) compared to standard TURP

Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT® TURP.Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004–2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT® TURP during 2011–2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated.Results: The median bleeding was 300 ml (IQR = 100–645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30–268 ml) in the DRY CUT® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT® TURP (OR = 3.18, 95% CI = 1.72–5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient.Conclusions: The shift from standard TURP to DRY CUT® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital.

Improving the efficiency of bladder cancer diagnostic cystoscopy with 5-ALA hexyl ester

This article presents the results of a clinical study that examined the diagnostic efficacy of fluorescent diagnostics (FD) of non-muscularinvasive bladder cancer using a photosensitizer of FD of malignant neoplasms – 5-aminolevulinic acid hexyl ester (5-ALA HE) compared with standard cystoscopy. The study involved 110 patients. The study began with intravesical administration of 50 ml of 0.2% solution of 5-ALA HE, the exposure time was 1 hour, after which the drug was removed from the organ. During the next hour, the mucous membranes were examined in two cystoscopy modes, followed by a standard transurethral resection of all urothelium sites with suspicion for tumor lesion based on white light and visible red fluorescence, and a control blind biopsy from the visually unchanged and non-fluorescent mucous tissue in each patient. The results of the study indicate the high effectiveness of the developed FD methodology with 5-ALA HE in detecting non-muscularinvasive bladder cancer during intravesical administration of the drug, due to selective accumulation of hexasens-induced PPIX in the tumor tissue compared with healthy mucosa. Compared with the results of standard cystoscopy, fluorescence diagnostics significantly increased diagnostic sensitivity by 24.4% (from 75.1% to 99.5%), diagnostic accuracy – by 15.8% (from 82.4% to 98.2%) and a negative predictive value – by 33.2% (from 65.8% to 99%) (p≤0.05). Additionally, a total of 37 (33.6%) patients was found to have 63 foci of fluorescence with a diameter of 2.5 to 3.0 mm. 59 of these were morphologically confirmed to contain cancer cells.

Oncologic Outcomes of Post–Kidney Transplantation Superficial Urothelial Carcinoma

PurposeTo analyze the oncologic effect of post–kidney transplantation (KT) immunosuppressive status for end-stage renal disease (ESRD) patients with superficial urothelial carcinoma. MethodsFrom 2010 to 2015, there were 106 ESRD patients with superficial urinary bladder urothelial carcinoma (UB-UC) and 68 ESRD patients with superficial upper urinary tract urothelial carcinoma (UT-UC) in a single institution. Oncologic outcomes including bladder cancer recurrences and systemic disease recurrences within 5 years were compared between patients with and without KT. Superficial urothelial carcinoma was defined as Tis/Ta/T1 without nodal disease or distant metastasis. All the patients underwent standard transurethral resection of bladder tumor (TURBT) for superficial UB-UC and radical nephroureterectomy for superficial UT-UC. ResultsPatients with KT were younger according to our observation. Female predominance was noted in patients with UT-UC and post-KT UB-UC. Pathological stages were distributed similarly in UB-UC and UT-UC groups whether they underwent KT or not. More bladder cancer recurrences within 5 years were found in ESRD patients with KT after TURBT for superficial UB-UC compared with those without KT (77.7% vs 38%, P = .032). However, systemic disease recurrences were similar in the 2 groups (11% vs 1%, P = .163). For superficial UT-UC, there were no differences in bladder cancer recurrences and systemic disease recurrences in the 2 groups (25% vs 39%, P = .513 and 16% vs 3.5%, P = .141). ConclusionFor post-KT superficial urothelial carcinoma, radical surgery seems to result in better oncologic outcome. However, radical cystectomy is not a standard treatment choice for superficial bladder cancer. A higher incidence of bladder cancer recurrence after TURBT was found in ESRD patients with KT than those without KT.

Monopolar Transurethral Enucleo-Resection of the Prostate Versus Holmium Laser Enucleation of the Prostate: A Canadian Novel Experience.

To study the functional outcome of patients undergoing transurethral enucleation and resection of the prostate (TUERP) vs patients undergoing holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction. We retrospectively analyzed our prospectively collected database of two groups of patients. Twenty-four patients underwent TUERP (group 1), and 27 underwent HoLEP (group 2). Preoperative characteristics, intervention parameters, postoperative functional outcomes, uroflowmetry, and complications were collected. Mean prostate size in groups 1 and 2 were 87.2 and 93.5 cc, respectively. The mean duration of surgery was 110 minutes in group 1 and 136 minutes in group 2. In group 1, prostate-specific antigen (PSA) dropped from 4.4 to 1.2 ng/cc after 12 months. International Prostate Symptom Score (IPSS) was 3.75 at 12 months with a preoperative value of 20.9. With respect to maximum urinary flow rate (Qmax), it increased to 21.8 mL/s from a preoperative value of 6.4 mL/s. In group 2, the PSA dropped from 7.6 to 1.3 ng/cc. IPSS dropped from 22.3 to 3.8, Qmax increased from 7.7 to 22.5 mL/s. Hemoglobin, complications, and all studied parameters were not statistically significant between both groups. In this study, TUERP was safe and efficacious in benign prostatic hyperplasia patients with large glands. Modifications can be implemented on the standard transurethral resection of the prostate technique to treat patients with prostate sizes >70 cc.

Trans-Urethral Snare of Bladder Tumor (TUSnBT) with Stone Basket Retrieval: A Novel Time-Saving Technique in the Endoscopic Management of Papillary Bladder Lesions

Background: To assess if trans-urethral snare of bladder tumor (TUSnBT) with subsequent stone basket retrieval can be used as an effective, time-saving adjunct resection technique for papillary bladder lesions. Methods: Via standard cystoscopy, TUSnBT was performed using a standard endoscopic polypectomy snare with subsequent tumor extraction utilizing a standard stone retrieval basket, when lesions were more than 10 mm in diameter. Smaller lesions were removed with the polypectomy snare. Standard trans-urethral resection of bladder tumors (TURBT) of the tumor bed was performed post TUSnBT. Histological assessment was performed and assessed separately per session. Results: In total, 18 papillary lesions, measuring between 9 and 26 mm, were resected via TUSnBT. Operative TUSnBT time, ranged between 10 and 60 seconds duration per lesion. No significant postoperative morbidity was experienced by patients within this cohort. Histo-pathological assessment revealed adequate muscle representation in 83.3 % of TUSnBT grouped sessions assessed. Conclusion: TUSnBT with stone retrieval basket retrieval is a feasible method in selected papillary bladder lesions, and may be coupled with standard TURBT resection techniques. This method is less time consuming and would prove beneficial in select lesions. It may also be beneficial to assist with reducing the resection time or inadvertent bladder perforation encountered during the conventional TURBT.

Can tumor recurrence be reduced with plasma-kinetic vaporization of the area around the tumor in nonmuscle invasive bladder cancer?

PurposeTo investigate the effect on recurrence of vaporization of the tumor surroundings and suspicious areas with a plasma-kinetic (PK) system after transurethral resection (TUR) of nonmuscle invasive bladder cancer.Materials and MethodsThe study included 121 patients with a primary superficial bladder tumor who were randomized as those who underwent TUR with the PK system (Group 1, n=62) and those who underwent TUR with the monopolar system (Group 2, n=59). The vaporization procedure was performed by suppressing the cutting option of the PK system for a period, which would accumulate energy sufficient to make swelling-waves on the mucosa very close to the area of the loop to be vaporized.ResultsA total of 121 patients who met the study criteria were included for evaluation. Recurrence was determined in 21 patients in Group 1 (33.87%) and in 29 patients in Group 2 (49.15%) (p=0.088). Recurrence was close to the old resection site in 6 of 21 patients in Group 1, and in 13 patients in Group 2 (p=0.028); the difference was statistically significant. No statistically significant difference was determined between the two groups with respect to age, gender, number of tumor foci, rate or range of additional treatments applied, cigarette smoking rate, repeat TUR rate and rate of tumor en- countered in repeat TUR, T-stage, and tumor grade.ConclusionsThe effect of vaporization on recurrence by the PK system may seem similar to the effect of standard TUR, the recurrence- lowering effect surrounding nonmuscle invasive bladder cancers is better.

The Adjustable Transobturator Male System in Stress Urinary Incontinence After Transurethral Resection of the Prostate

To investigate the efficacy and safety of the Adjustable Transobturator Male System (ATOMS) in men with stress urinary incontinence after transurethral resection of the prostate (TURP). From a large international prospectively administrated ATOMS register, we identified 49 patients with an ATOMS device as a result of persistent stress urinary incontinence after TURP. For evaluation, the men were divided into standard transurethral resection of the prostate (sTURP) and palliative transurethral resection of the prostate (pTURP) in radiated patients. Baseline and follow-up measurements included continence parameters, urodynamics, quality-of-life surveys (Patient Global Impression-Improvement and International Consultation on Incontinence Questionnaire-Short Form), and pain ratings. The dry rate (0-1 security pad/<10 mL urine loss), the success rate (overall improvement), removals, complications, and treatment failures were recorded. A P value of <.05 was considered statistically significant. After a median of 34 and 22 months' follow-up and 2-3 adjustments, the sTURP and pTURP cohorts had 58% and 50% dry rates and 90% and 87% success rates. Hence, no improvement was seen in 10% and 13%. The removal rate was higher in pTURP (50% vs 10%, P = .0171) and infection was the most common side effect (50%) observed. Neither intraoperative nor Clavien-Dindo 4 and 5 adverse events were recorded. In sTURP and pTURP, the median daily pad count and the pad test improved significantly (all P <.001), and quality-of-life parameters shifted to a high satisfaction level (P <.001 and P = .001). Urodynamics remained unchanged and postoperative pain was not an issue. The ATOMS device shows promising treatment outcomes in patients after TURP and a similar efficacy as in postprostatectomy incontinence. There is no difference in continence outcome between sTURP and pTURP; however, a higher removal rate was found after pTURP, which may be important for patient counseling.

PD19-01 ACTIVE SURVEILLANCE FOR NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC): RESULT FROM BLADDER CANCER ITALIAN ACTIVE SURVEILLANCE (BIAS) PROJECT.

PD19-01 ACTIVE SURVEILLANCE FOR NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC): RESULT FROM BLADDER CANCER ITALIAN ACTIVE SURVEILLANCE (BIAS) PROJECT.