MODERATED POSTER SESSIONS Moderated Poster Session 9 BPO/LUTS Tuesday, October 18 13:15-14:45 MP-09.01 Hydrodynamic Aspects of Intravesical Protrusion of the Prostate in Patients with Voiding Dysfunction Sakuyama G1, Ishii T1, Yamanishi T2, Igarashi T1 1 Dept. of Medical System Engineering, Faculty of Engineering, Chiba University, Chiba, Japan; 2Dept. of Urology, Dokkyo Medical University School of Medicine, Mibu Machi, Japan Introduction and Objective: Intravesical protrusion of the prostate is known as potent predictor of voiding dysfunction (Int J Urol 13: 1509, 2006; J Urol 178(2): 573, 2007). On the other hand, previous report indicated that urine flows along the wall of the bladder (Acta Urol Jpn 38: 531, 1992). The present study examined the hydraulic energy loss through passage of urine stream through the bladder outlet using hydrodynamic model of lower urinary tract with intravesical protrusion of the prostate. Material and Methods: Three models for flat, slightly and severely deformed bladder outlet by protruded prostate were prepared. CAD software (SolidWorks, SolidWorks Japan Inc., Tokyo) was used to depict the three-dimensional models of the bladder and prostatic urethra, tracing the MRI image of the patients with BPH. The software was used to test the hydrodynamic simulation on the models. The hydraulic energy is calculated using the following formula: E⫽p/wg⫹(Q/A)2/ 2g. (E: hydraulic energy, p: pressure, w: density of water, g: gravity, Q: flow rate, A: cross area of flow). Results: The urine flow is clearly disrupted by protrusion of the prostate in the bladder outlet (figure 1 B). The hydraulic energy of the urine flow was reduced through passing the bladder outlet in the slightly protruded model, and is deteriorated before reaching to the bladder outlet in the severely protruded model (figure 2). Conclusions: The study indicated importance of shape of the bladder outlet for voiding dysfunction. Hydrodynamic model would be useful to understand the mechanism of voiding dysfunction. S94 MP-09.01, Figure 1. MP-09.01, Figure 2. MP-09.02 Role of Resistive Index as Prognostic Indicator in Treatment of BPH Singh H, Kumar A Dept. of Surgery, C. S. M. Medical University, Lucknow, India Objectives: Currently pressure-flow study is considered as reference standard for diagnosing bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH). However it is invasive, costly and associated with urinary tract infections. In BOO due to BPH, intra-prostatic pressure rises. These pressure changes cause changes in prostatic blood flow that can be studied by colour doppler sonography by calculating Resistive Index (RI). This study was done to evaluate the RI in cases of BPH presenting with moderate to se- vere symptoms and change in its value after treatment. Material and Methods: The study was conducted on 30 newly diagnosed men with BOO who had not received any treatment. Parameters noted were IPSS score, uroflowmetry, measurement of post-void residual urine and serum PSA. Transrectal doppler ultrasonography was done to look for prostate size and RI. Men with prostate cancer, prostatitis, raised PSA, diabetes, coronary artery disease and peripheral vascular disease were excluded. Based on the findings the patients underwent either medical therapy (alphablocker with dutasteride) (Group 1) or were subjected to transurethral resection of prostate (Group 2). The RI was calculated again at 6-weeks and 6-months after treatment. Pearson’s coefficient of correlation was used for statistical analysis. UROLOGY 78 (Supplement 3A), September 2011 MODERATED POSTER SESSIONS Results: The mean age was 58.2 years (range 50 – 65). There were 22 and 8 patients in Groups 1 and 2 respectively. The mean pre-treatment IPSS of Groups 1 and 2 were 23.09⫾6.07 and 23.50⫾9.98 and prostate volumes were 48.90⫾12.42 ml and 37.75⫾9.5 ml respectively. Post-therapy the IPSS became 19.9⫾6.1 at 6-weeks and 14.18⫾5.8 at 6-months in Group 1 and 7.0⫾1.15 at 6-weeks and to 4.5⫾1.0 at 6-months in Group 2. In Group 1, RI reduced from 0.75⫾0.05 to 0.69⫾0.03 at 6-weeks and to 0.62⫾0.04 at 6-months. In Group 2, the RI reduced from 0.72⫾ 0.06 to 0.59⫾ 0.09 at 6-weeks and to.57⫾0.09 at 6-months. Conclusion: Resistive index was significantly high in cases of BPH with moderate to severe symptoms that significantly reduced after treatment. Resistive index may become a non-invasive index for measuring BOO and can also serve as a prognostic marker. The main drawback of the study is small number of cases. MP-09.03 Operative Impacts on Lower Urinary Tract Symptom of Patients With BPH and Prostatitis: Comparison of Post Transurethral Resection State Noh C, Yu J, Sung L, Chung J Inje University, Sanggye Paik Hospital, Seoul, South Korea Introduction and Objective: Combination of benign prostatic hyperplasia (BPH) with prostatitis aggravates clinical symptoms of BPH and complicates its treatment. Persistent lower urinary tract symptoms (LUTS) are highly resistant to conventional medical management. Recent studies have shown that BPH with prostatitis contributed to poor improvement of LUTS after transurethral resection of prostate (TURP). We tried to find out the operative impacts on LUTS of patients with BPH according to the presence of prostatitis. Materials and Methods: Between 2005 and 2010, 116 patients who had treated by TURP were investigated. International prostate symptom score (IPSS) was checked before and after TURP within 1yr. Patients with prostate cancer were excluded. Group A was defined as patients with BPH without prostatitis, and group B was patients with prostatitis. The presence of prostatitis was determined by pathologic confirmation after TURP. Results: Pathologically group A had 58 patients, and group B had 58 patients. Preoperative IPSS was higher in group B (group A: 20.14⫾5.61 vs. group B: 22.95⫾5.65, P⫽0.001), Especially preoperative irritative symptom score was notably high. (group A: 6.63⫾3.57 vs. group B: 9.29⫾4.06, P⫽0.015) There were no statistical differences in average postoperative IPSS. (group A vs. group B: 14.63⫾6.57 vs. 14.12⫾4.91, P⫽0.634) However, the differences of pre and postoperative IPSS were 5.51 in group A and 8.83 in group B. (P⬍0.001). Conclusions: When the prostate hyperplasia was combined to inflammation, LUTS was more aggravated than the patient with BPH without prostatitis. And the efficacy of TURP in patients with prostatitis is better than patients without prostatitis. MP-09.04 The Long-Term Benefits of Combined Therapy of Chronic Non-bacterial Prostatitis Bardan R, Cristina B, Botoca M, Cumpanas A, Secasan C, Bucuras V Dept. of Urology, Clinical Emergency Hospital, Timisoara, Romania Introduction and Objective: While most studies of chronic prostatitis therapy concentrate on immediate effects, our objective was to evaluate the impact of a combined therapy regimen at three months after its discontinuation. Material and Methods: During the time interval 01 January 2009 – 30 June 2010 we have evaluated a number of 92 male patients, aged between 30 and 50 years, which presented to our outpatient Department for low urinary tract symptoms. We have applied the diagnosis criteria for prostatitis and 68 patients were diagnosed with type III chronic non-bacterial prostatitis. They have signed the informed consent and started combined therapy, using ciprofloxacin (500 mg p.o. bid), nimesulid (200 mg p.o. bid), and alfuzosin (10 mg extended-release formulation, p.o., od), for six weeks. Clinical evaluation was performed at baseline, at therapy end, and at three months after therapy discontinuation, including (along total serum PSA dosing and digital rectal examination) the measurement of peak urinary flow rates (Qmax), post-void residual volume (PVRV), and the NIH-CPSI and SHIM questionnaires. Results: At three months after therapy discontinuation, compared with therapy end, patients still had a significant average increase of the Qmax (⫹2.88 ml/s vs. ⫹3.53 ml/s) and decrease of PVRV (⫺15,7 ml vs. ⫺19,2 ml). Regarding the NIH-CPSI score, the pain component (questions 1 – UROLOGY 78 (Supplement 3A), September 2011 4) was reduced in average with 4.68 points at therapy end; after three months, this reduction was of only 1.96 points in average. The urinary symptoms component (questions 5, 6) was reduced in average with 2.48 points at therapy end and the beneficial effect still persisted after 3 months, with 2.23 point of average reduction. The same trend was observed for the quality of life component (questions 7 – 9): it was improved with 3.51 points in average after therapy and with 2.87 points after 3 months. Finally, the SHIM score improvement of 3.15 points in average at therapy end was maintained after 3 months, with a 2.92 points average improvement, compared with baseline. Conclusions: Combined therapy of chronic non-bacterial prostatitis has proven beneficial effects, even at 3 months after discontinuation. MP-09.05 Treatment with Once Daily Tadalafil: Improvement in Symptoms of Benign Prostate Hyperplasia and Related Quality of Life for Men with or Without Erectile Dysfunction Drasa K1, Tartari F2, Dredha H2, Dani E1, Katroshi R3 1 Central Polyclinic,Tirana, Albania; 2 Mother Teresa Hospital, Tirana, Albania; 3Hospital, Durres, Durres, Albania Introduction and Objective: Once daily Tadalafil is currently approved only for treatment of erectile dysfunction (ED), including as needed and once daily dosing options. Here we tested whether baseline ED history influenced the effects of tadalafil on benign prostatic hyperplasia (BPH), low urinary tract symptoms (LUTS). Materials and Methods: Men (n⫽154) with LUTS secondary to BPH were enrolled in this randomized double blind controlled study in a 12 week treatment to placebo or various doses of tadalafil. They were associated with statistically and clinically significant improvements compared to placebo in total International Prostate Symptoms Scores (IPSS) and IPSS quality of life (QoL) score at all doses and in BPH impact index (BII) at 2.5, 5,10 and 20 mg. Subgroup analyses were performed using an ANCOVA model with effects for baseline, treatment, ED history indicator and ED history/by treatment/ interaction to analyze baseline to endpoint changes in IPPSS, BII and IPSS QoL (question 8). Results: There were 71.4 % (n 110 ) of men who reported history of ED. Tadalafil S95 MODERATED POSTER SESSIONS was associated with similar improvements in total IPSS and BII scores with or without ED history. Comparing men with vs without ED history, tadalafil had similar improvements in both IPSS and BII as identified by non-significant subgroup and interaction p-values for IPSS (subgroup interaction p-values for IPSS (subgroup/ interaction p-values/0,353/0.646) and BII (0.761/0.855). Tadalafil also improved IPSS QoL scores compared to placebo (No ED history, placebo: 0.7; tadalafil 2.5, 5, 10, 20 mg: ⫺0.7, ⫺0.9, ⫺0.8, ⫺0.8), (ED history, placebo: 0.6; tadalafil 2.5, 5, 10, 20 mg: ⫺0.9, ⫺0.9, ⫺1.0, ⫺1.1). Like IPSS and BI I, improvements in QoL were not significantly influenced by ED history (0.09 /0.793). In men with ED history, changes in IIEF scores were significantly correlated to changes in IPSS, BII and IPPS QoL, all p⬍ 0.001. Conclusion: The results of this study indicate that tadalafil treatments demonstrated consistent improvements in IPSS and BII in men with BPH /LUTS, regardless of their baseline ED history. Tadalafil was also associated with significant improvements in patients’ reported QoL in both subgroups. In men with ED, improvements in BPH / LUTS were correlated to improvements in erectile function as well. MP-09.06 Role of Combined Use of Ketoconazole and Tamsulosin in the Management of Acute Urinary Retention Due to Benign Prostatic Obstruction Elbendary M, El-Gamal O, Gaber M, Taha M Tanta University Hospital, Tanta, Egypt Introduction and Objective: Ketoconazole is an imidazole derivative that has been shown to block testosterone synthesis and can lower testosterone concentration to castrate levels within 48 hours. We investigated the effect of addition of ketoconazole to tamsulosin in cases of acute urinary retention (AUR) due to benign prostatic obstruction. Materials and Methods: The patients who presented with AUR for the first time due to benign prostatic obstruction (BPO) were included in this study. Patients with hepatic or renal impairments were excluded. After urethral catheterization, the selected patients were randomized into 2 groups. The first group (23 patients) received tamsulosin 0.4 mg/day while the second one (22 patients) was given tamsulosin plus ketoconazole 200 mg three S96 times daily. The urethral catheter was kept in place and drugs were maintained for 7 days. Patients were put on trial without catheter (TWOC) and those who voided were evaluated with peak flow rate (PFR) and post-void residual urine volume (PVRV) assessment with abdominal ultrasound. Results: The mean age of the patients was 64.2 ⫾ 6.3 and 66.4 ⫾5.1 years and the mean prostate size was 65.7 ⫾ 12.5 and 68.5 ⫾ 11.7 cc for the first and the second groups respectively with no significant difference between both groups. The received medications were well tolerated by all patients with no reported significant side effects. The first and the second groups had successful TWOC in 43.5% (10/23) and 77.3% (17/22) respectively (p⫽0.03). Among those who had a successful TWOC, the peak flow rate was 7.3 ⫾ 1.4 versus 8.9 ⫾ 1.2ml/s (p⫽ 0.02) and the post-void residual urine volume was 135.6 ⫾ 24.7 versus 114.2 ⫾ 15.8 ml (p⫽ 0.03) in the tamsulosin and the combined treatment groups respectively. Conclusion: Ketoconazole can increase the success rate of trial without catheter in patients with benign prostatic obstruction. MP-09.07 New Direction in the Treatment of Benign Prostate Hyperplasia Using Adenoprosin: Biologically Active Entomological Medicine Ghicavii V1, Tanase A1, Ceban E1, Dumbraveanu I1, Ciuhrii V2 1 Dept. of Urology, State Medical University, Chisinau, Moldova; 2Newtone Trading, Bucharest, Romania Introduction and Objective: Currently the absolutely new forms of drugs are developed such as biologically active substances with antiradical and antioxidant properties obtained from insects’ biomass. This is a new approach for the development of medicine for BPH treatment. The active substance from Lymantria dispar larvae has high stability and specific antioxidant activity, inhibiting the oxidation of low density lipoproteins and reducing the NO radicals. Material and Methods: During 5 years (2005-2010), 127 patients with BPH were investigated and observed. Eighty-five of them (I group: IPSS 16.8 3.98; QOL 3.68 1.10; DRE; TRUS 52.32 6.7 cm3 prevalently of glandular tissue; QMAX 9.2 2.63 ml/s; PSA 4 –10 ng/ml; PVR 53.7 22.4 ml) were treated conservatively with suppositories Adenoprosin (250 mg daily) during 5 months. The outcomes were compared with placebo group of 42 patients (II group: IPSS 18.2 3.7; QOL 3.2 1.0; DRE; TRUS 51.0 3.8 cm3 prevalently of glandular tissue; PSA 4 – 10 ng/ml; QMAX10.5 3.4 ml/s; PVR 46.5 26.5 ml). Results: BPH symptoms were already changed during the treatment. The final treatment results in the first group were: IPSS 11.2 2.24; QOL 2.4 0.3; TRUS 49.8 6.8 cm3; QMAX 13.8 2.8 ml/s; PVR 41.5 18.5 ml; and for the placebo group were: IPSS 16.8 3.2; QOL 3.1 1.2; TRUS 52.2 4.2 cm3; QMAX9.2 3.8; PVR 48.8 20.6 ml. The average prostate volume did not deviated essentially from the initial stage in both groups. In the first group it was decreased only in 4.8% of patients (from 52.32 ⫾ 6.7 cm3 to 49.8 ⫾ 6.8 cm3). In the placebo-group the average volume of prostate was increased in 2.3% patients (from 51.0 ⫾ 3.8 cm3 up to 52.2 ⫾ 4.2 cm3). IPSS index decreased in 33% patients (from 16.8 3.98 to 11.2 ⫾ 2.24) after 5 months of treatment in patients with Adenoprosin, and in 7.6% patients from placebo group (from 18.2 ⫾ 3.7 to 16.8 ⫾ 3.2). We observed the improving of the life quality index by 3.4% (from 3.68 up to 2.4) in patients treated with Adenoprosin and 3.2% (from 3.2 up to 3.1) in the patients from placebo group. At the 5th month of treatment the urinary flow speed was increased by 4.6 ml/s (in 33.3% patients) from baseline in the first group and decreased by 1.3 ml/s (12.2% patients) in placebo group. The residual urine volume was reduced on by 12.2 ml (in 22.7% patients) in the first group and increased by 2.3 ml (4.7%) in placebo group. PSA serum levels did not change during treatment. Conclusions: 1- Adenoprosin may induce sclerosis changes and volume reduction especially in BPH with glandular tissue. 2 Adenoprosin exerts a rapid and essential improvement of the general symptoms and urodynamic parameters in the first 3-4 weeks of treatment.- We consider that prostate volume reduction occurs due to both reducing of the paraprostatic edema and venous retention in prostate tissue, and influence on vascular phase of capillaries permeability in inflammation. MP-09.08 Serum Prostate Specific Antigen Level Predicts the Effectiveness of Silodosin in Patients with Benign Prostate Hyperplasia Nakajima F1, Murai T2, Yanada S2, Yuri Y2, Ohya K2, Kishimoto Y2, Matsuzaki J2, Fukasawa R2, Kawakami S2, UROLOGY 78 (Supplement 3A), September 2011 MODERATED POSTER SESSIONS Torii T2, Mizuo T2 1 Keiyu Hospital, Yokohama, Kanagawa, Japan; 2Yokohama LUTS Study Group, Yokohama, Kanagawa, Japan Introduction and Objective: Silodosin is a highly selective alpha-1A antagonist that is widely used in the treatment of benign prostatic hyperplasia (BPH). We investigated the factors that influence the efficacy of silodosin. Materials and Methods: One hundred and thirty-two Japanese patients with clinical BPH were entered into this study from October 2008 to July 2010. The dose of silodosin was 8 mg/day. Serum prostate specific antigen (PSA), international prostate symptom score (IPSS), overactive bladder symptom score (OABSS), and maximum flow rate (Qmax) were recorded before and after 12 weeks on silodosin. Results: IPSS decreased from 16.6 ⫾ 6.2 (mean ⫾ SD) to 10.9 ⫾ 6.2 (P⬍0.001), Qmax increased from 10.73⫾ 5.46 to 12.29 ⫾ 6.09 mL/sec (P⫽0.051) and overactive bladder rate decreased from 59.2% to 29.4%. Next, the background factors in patients who showed improvement in Qmax (group A: 8.69 ⫾ 4.07 to 13.89 ⫾ 5.97 [mL/sec]) and those who did not (group B: 12.85 ⫾ 6.26 to 9.85 ⫾ 4.53 [mL/sec]) were studied. Before treatment, age, period of illness, IPSS and prostate volume (PV) did not differ between the two groups; however, PSA was lower in group A (2.35 ⫾ 1.72 versus 4.98 ⫾ 6.04 )(P⫽0.0133). There was a positive correlation between PSA and PV (r⫽0.239, P⫽0.0217) in all the patients; however, PV did not differ between groups A and B. Moreover, PSA density (PSAd: PSA / PV [ng/mL/cc]) in group A (0.071 ⫾ 0.050) was significantly lower than that in group B (0.145 ⫾ 0.189) (P⫽0.0222). PSAd and PV did not show correlation (r⫽0.138, P⫽0.189). The reasons PSA and PSAd were significantly lower in group A were not clarified. Nevertheless, the results showed that PSA production may be negatively correlated with the sensitivity to silodosin and may suggest that higher PSA and PSAd indicate a larger volume of glandular tissue and less capacity of smooth muscle to relax under treatment with silodosin. Conclusions: BPH patients with lower PSA and PSAd showed a better response to silodosin treatment, suggesting that these factors may predict the effectiveness of alpha-1 antagonists and contribute to the selection of treatment. MP-09.09, Table 1. Baseline characteristics of study patients. Characteristics Alfuzosin group Udenafil group Combination group (nⴝ20) (nⴝ21) (nⴝ21) Mean age (years) 62.0⫾7.3 61.0⫾5.9 59.8⫾6.3 Mean prostate volume (ml) 32.3⫾7.9 30.4⫾7.0 30.4⫾7.0 Mean IPSS* 18.3⫾4.2 16.2⫾6.1 18.0⫾6.4 Mean IPSS-QOL** 3.9⫾0.5 3.3⫾1.5 3.3⫾0.8 Mean IIEF*** 14.9⫾4.7 12.8⫾3.5 61.0⫾5.9 Mean Qmax (ml/sec) 9.5⫾1.9 9.7⫾5.4 9.9⫾4.0 Mean post-void residual 35.3⫾21.0 38.0⫾23.0 32.5⫾21 urine volume (ml) * International prostate symptom score, ** International prostate symptom score-quality of life, *** International index of erectile function MP-09.09 Efficacy and Safety of Combination of Alfuzosin and Low Dose Udenafil Once Daily versus Monotherapy in Patients with Comorbid Lower Urinary Tract Symptoms and Erectile Dysfunction: Randomized Prospective Open-label Study Cho D3, Seo J1, Kim J1, Seo H1, Lee J1, Lee W1, Kim J2, Kim G3 1 Top Urology Linic, Daegu, South Korea; 2 Daegu Fatima Hospital, Daegu, South Korea; 3CHA University, Gumi CHA Hospital, Gyeongsangbukdo, South Korea Introduction and Objective: The purpose of this study was to assess the efficacy and safety of the alfuzosin 10mg once daily (OD), the PDE-5 inhibitor udenafil 50mg OD, and the combination of both on lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) with erectile dysfunction (ED). Materials and Methods: A randomized, open-label, three-arm study was conducted from September 2009 to February 2010. Patients aged 50-76 year were randomized to receive alfuzosin (n⫽20), udenafil (n⫽21), or the combination of both (n⫽21) for 12 weeks. International prostate symptoms score (IPSS), IPSS quality of life (IPSSQOL), maximum flow rate (Qmax), postvoid residual volume (PVR), transrectal ultrasonography (TRUS) and erectile function domain of the international index of erectile function (IIEF) were evaluated at baseline, 6 and 12 weeks. Complications were also evaluated. Results: Baseline characteristics of patients were shown at table 1. There was no statistical difference of baseline parameters in three groups. After 12 weeks, changes in IPSS from baseline was significantly improved in Alfuzosin and combination groups ( Alfuzosin: ⫺17.4%, combination: ⫺26.7%, p⬍0.05, udenafil: ⫺1.8%, p⬎0.05). Qmax and PVR were significant UROLOGY 78 (Supplement 3A), September 2011 improved in Alfuzosin (Qmax and PVR with percentage changes of 13.6%, ⫺27.9%, respectively, p⬍0.05) and combination groups (Qmax and PVR: 22.3%, ⫺26.4%, p⬍0.05). Improvement of IIEF was significant with udenafil and combination treatments (combination: 52.1%, udenafil: 34.9%, p⬍0.05, alfuzosin: 8.0%, p⬎0.05). Especially, IPSS, Qmax and IIEF were significant improved in combination treatment compared with alfuzosin or udenafil only (p⬍0.05). All three treatments were well tolerated. Conclusions: The combination treatment of alfuzosin and low dose udanafil once daily is more effective than monotherapy in patients with comorbid ED and LUTS suggestive of BPH, And combination treatment is also safe. MP-09.10 Rapid Increases in Healthcare Utilization and Cost Due to Benign Prostatic Hyperplasia in South Korean Males: Retrospective Population-Based Analysis Choi W1, Song S2, Jeong H3, Son H3, Kang J4, Hong S5, Lee H6, Kim S7, Park B8, Lee H9 1 Dept. of Urology, Yanggu Health Center, Yanggu, South Korea; 2Dept. of Urology, Seoul National University Hospital, Seoul, South Korea; 3Dept. of Urology, Seoul National University Boramae Hospital, Seoul, South Korea; 4Dept. of Urology, Eulji University Hospital, Seoul, South Korea; 5Dept. of Urology, Seoul National University Bundang Hospital, Seoul, South Korea; 6Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 7Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea; 8Dept. of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea; S97 MODERATED POSTER SESSIONS MP-09.10, Table 1. - Hospital visits and duration of treatment by age groups and by years 2004 2005 2006 2007 2008 Hospital visits Inpatient outpatient inpatient outpatient inpatient outpatient inpatient outpatient inpatient outpatient Sub total 20s 72 1,960 43 1,662 26 1,767 52 856 36 684 7,158 30s 924 19,474 1,099 20,207 1,299 20,311 1,247 17,225 760 16,837 99,383 40s 5,649 110,862 7,502 118,759 7,366 141,098 6,336 150,749 7,037 160,455 715,813 50s 21,263 341,120 24,517 382,598 29,495 464,709 29,654 504,770 26,379 553,075 2,377,580 60s 56,007 639,286 68,017 701,119 74,345 818,942 76,642 921,221 78,455 1,043,364 4,477,398 70s 44,946 444,778 52,426 510,746 68,036 616,242 82,399 716,297 83,302 833,513 3,452,685 ⬎80s 15,582 124,806 16,101 142,189 23,133 166,459 28,483 189,011 32,525 220,689 958,978 Sub total 144,443 1,682,286 169,705 1,877,280 203,700 2,229,528 224,813 2,500,129 228,494 2,828,617 12,088,995 Total 1,826,729 2,046,985 2,433,228 2,724,942 3,057,111 Duration of 2004 2005 2006 2007 2008 Sub total Treatment inpatient outpatient inpatient outpatient inpatient outpatient inpatient outpatient inpatient outpatient 20s 111 2,414 123 1,925 86 1,855 86 927 57 844 8,428 30s 1,426 24,316 1,574 24,736 1,871 24,090 2,013 20,486 1,695 20,564 122,771 40s 7,761 136,217 10,142 143,254 10,533 175,727 9,925 189,279 11,550 206,786 901,174 50s 32,435 713,919 36,367 829,935 45,680 956,906 45,912 990,598 46,198 1,017,950 4,715,900 60s 92,490 1,017,676 105,926 1,256,252 119,984 1,624,750 126,144 2,047,781 134,570 2,597,312 9,122,976 70s 75,740 1,148,624 85,228 1,286,461 109,966 1,488,953 128,577 1,636,818 136,303 1,907,998 8,004,668 ⬎80s 26,885 183,415 26,936 220,867 35,950 278,786 41,908 343,601 47,988 428,972 1,675,308 Sub total 236,848 3,226,672 266,296 3,763,430 324,070 4,551,067 354,565 5,229,490 378,361 6,220,426 24,551,225 Total 3,463,520 4,029,726 4,875,137 5,584,055 6,598,787 9 Dept. of Urology, Kyung Hee University School of Medicine, Seoul, South Korea Introduction and Objective: Korea is rapidly becoming an aged society and it seems certain that benign prostatic hyperplasia (BPH) will emerge as a topic of primary concern for health care service authorities. We investigated the amount of healthcare utilization due to BPH and to find any seasonal or regional variation in the amount and cost of health care utilization. Materials and Methods: The Health Insurance Review and Assessment service (HIRA) database, which contains reimbursement records from all medical facilities in South Korea, was used in this study. Patients aged 20 or older diagnosed from 2004 to 2008 with BPH [ICD-10 diagnostic code: N40] as the primary diagnosis were included. Age and year-specific amount of hospital visits (HVs), durations of treatment (DT), the total and per capita insurance payments (TAIPs and PCIPs) and their seasonal variations were evaluated. Results: A total of 12,088,995 HVs were studied. Total HVs increased 1.7 times and DTs almost doubled in 2008 as compared with 2004. HVs, DTs, and TAIPs showed linearly increasing patterns by year. Time series analysis showed that HVs increased in winter and demonstrated a seasonal pattern. Poisson regression analysis showed that annual variations in HVs, DTs, TAIPs, and PCIPs differed by age. In patients older than 40, HV significantly S98 increased every year compared with the previous year, and in patients in their 60s and 80s, DTs were markedly higher than in other age groups. The rate of increase in PCIP was steeper for patients of ⱖ50 than for patients of ⬍50 years. Conclusions: Healthcare utilization due to BPH is increasing rapidly in South Korea and this increase is remarkable in the elderly. Seasonal variations in HVs demon- strated that health care utilization of BPH patients increased during the winter. MP-09.11 Prevalence of Benign Prostatic Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) in Ghanaians Yeboah E2, Hsing A5, Chokkalingham A1, Biritwum R2, Tettey Y2, Jadallah S3, MP-09.10, Figures A, B and C. Quarterly amount of; A. Hospital visits per month, B. Duration of treatment per month, C. Total amount of insurance payment per month show seasonality UROLOGY 78 (Supplement 3A), September 2011 MODERATED POSTER SESSIONS Platz E3, Chu L4, Niwa S7, Thompson I6 1 School of Public Health of California, Berkeley, USA; 2University of Ghana Medical School, Accra, Ghana; 3Brady Urological Institute, Baltimore, USA; 4 John Hopkins University, Baltimore, USA; 5Division of Cancer Epidemiology and Genetics NCI, Bethesda, USA; 6 University of Texas Health Science Center, San Antonio, USA; 7Westat Inc, Rockville, USA Introduction and Objectives: BPH is the commonest cause of urinary retention, LUTS and haematuria in Ghanaian men. Due to difficulties in defining LUTS and BPH in population-based studies their impact on many populations is unclear. Materials and Methods: We examined the prevalence of BPH on DRE and LUTS in probability sample of 950 Ghanaian men aged 50 –74 in Accra who had no prostate cancer. We elicited LUTS based on International prostate symptom score (IPSS) and severe LUTS. For subjects undergoing Transrectal ultrasound (TRUS) guided biopsy of the prostate we estimated prostate volume. In the analysis we used several definitions to derive age-standardized prevalence of estimates of BPH and LUTS such as prostate size on DRE, PSA ⱖ1.5ng/ml (estimate prostate vol. ⱖ30 mls) and IPSS. Statistical analysis was used randomly selected cases. Management of symptomatic BPH; These were along the lines approved by IRB and were dependent on IPSS score. Quality of life (QOL), Peak flow Rate (PFR) and Post void residual urine (PVR). Those with IPSS 0 – 7 were managed by watchful waiting. Those with IPSS 8 – 19 were managed by alpha adrenergic blockers ⫾ 5 alpha reductase inhibitors. Operations were performed for those with refractory retention of urine, recurrent infection, excessive bleeding, calculi, diverticula and uraemia from obstructive uropathy. The operations performed were transurethral incision of prostate (TUIP) or resection of bladder neck. Simple prostatectomy by Transurethral resection of prostate (TURP) for glands ⬍50G or open simple transvesical or retropubic prostatectomy for prostates ⬎50G. Results: There were a total of 1038 men studied. We excluded 88 men (73 with prostate cancer and 15 with occult prostate cancer). The prevalence of DRE detected BPH was 62.3%. Using self-reported IPSS the overall prevalence of moderate to severe urinary symptoms was only 19% and the prevalence of PSA ⱖ1.5ng/ml (an estimate of prostate volume ⱖ 30cc) was 36.7%. The prevalence of DRE – BPH with IPSS ⱖ 8 indicative of symptomatic prostate enlargement was 13.3%. Conclusions: The prevalence of DRE – detected BPH of 62.3% in Ghanaians is higher than previously reported in other populations while the prevalence of IPSS ⱖ 8 of 19.9% was comparable to those of previous populations but lower than those reported separately for African Americans. The study confirms that BPH and LUTS are major health problems in Ghanaian men aged 50 years and above. MP-09.12 Prostatic Urethral Angulation Can Predict Urinary Flow Rate and Urinary Symptom Score in Men With Lower Urinary Tract Symptom Ham W1, Park S2, Lee S2, Kim T3, Cho W3, Kim D4, Sung Y5, Yu H1, Cho K1 1 Dept. of Urology, Yonsei University, College of Medicine, Seoul, South Korea; 2 Dept. of Urology, Hanyang University, College of Medicine, Seoul, South Korea; 3 Dept. of Urology, Dong-A University, College of Medicine, Busan, South Korea; 4 Dept. of Urology, Bonseng Hospital, Busan, South Korea; 5Dept. of Urology, Marrynol Hospital, Busan, South Korea Introduction and Objective: Recently, prostatic urethral angulation (PUA) has been theoretically proposed as a new influencing factor on lower urinary tract symptoms (LUTS). We evaluated the association between PUA and peak flow rate (Qmax) and urinary symptoms in the clinic setting. Materials and Methods: The records of first-visit men with LUTS between Apr 2010 and Sep 2010 were reviewed. Uroflowmetry, post-void residual, International Prostatic Symptom Score (IPSS), serum prostate specific antigen levels, and urinalysis were checked. Prostate-related parameters including volume, PUA, and intravesical prostatic protrusion (IPP) were prospectively measured by transrectal ultrasonography. Patients with comorbidities which may affect voiding function were excluded. Results: A total of 156 patients were included and their mean age was 62.2⫾11.0 years. Mean total prostate volume (TPV), transitional zone volume (TZV), and transitional zone index (TZI) were 28.7⫾9.8 ml, 11.3⫾6.6ml, and 0.37⫾0.11, respectively. Mean PUA and IPP were 45.7⫾9.2° (11.9-66.3) and 2⫾3mm (0-16). Mean IPSS score and Qmax were 14.6⫾7.1 and 14.9⫾7.3mL/s. On multiple linear regression models, PUA (p ⬍ 0.001) and TZI (p ⫽ 0.021) were independently associ- UROLOGY 78 (Supplement 3A), September 2011 ated with IPSS score. However, IPSS score was not influenced by TPV, TZV and IPP. Mean PUA according to symptom severity was significantly different: Mean PUA was 41.0⫾7.7° in patients with mild symptoms, 45.8⫾9.4° in those with moderate symptoms, and 49.0⫾8.3° in those with severe symptoms (p ⫽ 0.002). Meanwhile, PUA (p ⬍ 0.001), TZI (p ⫽ 0.015), and TZV (p ⫽ 0.024) were independent predictors of Qmax, but which was not affected by TPV and IPP. Mean PUA was 50.8⫾7.4° in patients with Qmax⬍10mL/s, 46.3⫾8.2° in those with Qmax ⬎ 10mL/s and ⬍ 20mL/s, and 38.2⫾8.5° in those with Qmax ⬎ 20mL/s (p ⬍ 0.001). Conclusions: Among prostate-related parameters, PUA is the most potent predictor of peak flow rate and symptom scores in men with LUTS. Our finding suggests that PUA should be considered in the management of male LUTS patients. MP-09.13 Contribution of Common Medications to Lower Urinary Tract Symptoms Among Community Dwelling Men Wuerstle M1, Van Den Eeden S2, Poon K3, Quinn V3, Hollingsworth J4, Loo R5, Jacobsen S3 1 Dept. of Urology, Kaiser Permanente Southern California, Los Angeles Medical Center, Los Angeles, USA; 2Division of Research, Kaiser Permanente Northern California, Oakland, USA; 3Dept. of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA; 4Department of Urologic Surgery, University of Michigan, Ann Arbor, USA; 5Dept. of Urology, Kaiser Permanente Southern California, Bellflower Medical Center, Downey, USA Introduction and Objective: The causes of male lower urinary tract symptoms (LUTS) are likely multifactorial and may include concomitant medication use. Motivated by this, we performed a cross-sectional study examining the association between commonly prescribed medications and LUTS. Materials and Methods: Through the California Men’s Health Study (CMHS), we identified men between 45 and 69 years of age, who were members of the Kaiser Permanente Northern and Southern California Health plans. Of 84,170 participants, 63,579 met inclusion criteria. The use of specific medications (i.e., antidepressants, antihistamines, bronchodilators, anticholinergics, sympathomimetics, and diurectics) was determined through phar- S99 MODERATED POSTER SESSIONS macy records. We assessed LUTS through responses to the American Urological Association Symptom Index. We modeled the association between a LUTS and medication use, adjusting for age, race/ethnicity, region, and prostate size. With this information, we determined the proportion of a man’s LUTS that could be attributable to his medication use. Results: With the exception of sympathomimetics, all examined medications were associated with a higher odds of LUTS (e.g., for antihistamines, odds ratio [OR], 1.17; 95% confidence interval [CI] 1.12 – 1.23). After adjustment, bronchodilators and antidepressants had the strongest association (OR⫽1.22; 95% CI, 1.15-1.29 and OR, 1.39; 95% CI, 1.32-1.47, respectively). The adjusted OR for any study medication use and LUTS was 1.29 (95%CI, 1.25-1.34). When stratified by the report of an enlarged prostate, the associations were strongest among those participants without an enlarged prostate. Based on these associations, the fractions that could be attributed to bronchodilators, diuretics and antidepressants were 2.2%, 2.9% and 3.7%, respectively. The use of any study drug could account for 10% of LUTS. Conclusions: A significant proportion of LUTS may be attributable to the use of many common medications in communitydwelling men, especially those not having been told they had an enlarged prostate. This underscores the importance of evaluating current medication use in clinical evaluations as well as in research studies of LUTS. MP-09.14 Comparison Between 70w-120w-150w in the Vaporesection of BPH With Thulium Laser Mattioli S, Picinotti A, Sabatino M The Laser Urology Centre, Arezzo, Italy Introduction and Objective: The Thulium Laser is a urological surgical Laser used in the treatment of BPH. Several studies showed that Thulium Laser is a safe, effective and bloodless procedure at 70W that 120 W. The aim of our study is to report our experience in the treatment of BPH with Thulium Laser 150 W comparing it to the results of 120W and 70W. Material and Method: From May 2004 to January 2010, we treated a total of 530 patients (age ranged: 41 – 85 yrs) with BPH using Thulium Laser. There were 310 pts with 70W (Group 1), 120 pts with 120W (Group 2), 105 pts with 150W (Group 3). Prostatic volume range: 30 – S100 110 gr. Vaporesection, in continuous wave, is a protocol used to vaporize tissue and resect the prostate. The Thulium Laser was used in conjunction with a frontal and side fibre. At the end of procedure a new Wolf Morcellator was employed for treat large pieces. The catheter was removed 48 hours later. Discharge after 72 hour. Results: Mean operative time: 65 min with Group1; 50 min with Group2; 50 min with Group3. No major complications were reported. At a follow-up of 6 mts, comparing the pre and post operative parameters (AUA-SS, Mean QMax, PVR), in all three groups, we had a total resolution of obstruction. The patients refered discomfort: 7/310 (2.25%) pts in Group1; 0 pts in Group 2; 6/105 (5.71%) pts in Group 3. Bladder neck sclerosis developped in 5/310 (1,61%) pts in Group 1; 1/120 (0.83%) pts in Group 2 and 3/105 (2,85%) pts in Group 3. A statistical difference is between the percentage of discomfort between the Group 3 and Group 1-2 and the percentage of bladder neck sclerosis between Group 3 and 2, no difference in the utilized number of fibers. Conclusion: The use of Thulium Laser for Vaporesection of the prostate is safe and efficacy also to high power as 120 W and 150W in particular in the treatment of large prostates without prolonged operative time. Nevertheless, our results suggested that there are not advantages in the use of 150W if we considered the higher risk of discomfort syndrome and bladder neck sclerosis. MP-09.15 Photoselective Vaporization of Prostate vs TURP: A Prospective, Randomized Study with 1 Year Follow-Up Mohanty N, Vasudeva P, Kumar A, Arora R V.M.Medical College & Safdarjang Hospital, New Delhi, India Introduction and Objective: To evaluate the efficacy and safety of KTP-PVP (Potassium titanyl phosphate- photoselective vaporization of prostate) when compared to TURP for management of LUTS due to BPE. Materials and Methods: In a prospective, randomized study conducted between February 2009 and August 2009, consecutive patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE) who satisfied the inclusion/exclusion criteria were planned for surgery according to the International BPH guidelines of the American Urology Association were randomized to one of two Groups. Group A: Underwent PVP using the 80W KTP laser. Group B: Underwent standard TURP. Primary outcome measures for group analysis included subjective (IPSS, QOL, IIEF5) and objective (Prostate volume, PVRU and Q max) parameters at 1, 3, 6 and 12 months. Secondary outcome measures analyzed included various perioperative parameters and complications, if any. Data was analyzed using SPSS version 12.0. and P values ⬍0.05 were considered statistically significant. Results: Of 128 patients randomized, 117 were available for analysis. Follow-up data at 1, 3, 6 and 12 months was available for 60, 60, 58, 52 and 57, 55, 50, 50 patients in group A and B , respectively. Baseline characteristics did not differ significantly between the two groups. Both groups showed significant improvement in the IPSS score, QOL score, prostate volume, Q max and PVRU at each of the follow-up visits with no significant differences noted between the 2 groups except for QOL score at 1 month which was significantly better in group B. The need, amount and duration of postoperative irrigation, perioperative haemoglobin drop and duration of postoperative catheterization were all significantly lesser in group A as compared to group B. Clot retention and blood transfusion rates were significantly higher in Group B than Group A while dysuria was higher in Group A than Group B. Conclusion: KTP-PVP is an equally efficacious alternative to TURP in the management of LUTS due to BPE with durable results at 1 year follow-up. It has the added benefits of significantly lesser perioperative blood loss and transfusion requirements along with a shorter catheterization time. MP-09.16 Does a Patient With Parkinson’s Disease and Benign Prostatic Obstruction or Hypocontractility of the Detrusor Benefit From a Transurethral Resection of the Prostate Neisius A1, Neisius Y2, Wöllner J3, Thüroff J1, Hampel C1 1 Dept. of Urology, Johannes Gutenberg University, Mainz, Germany; 2Dept. of Paediatrics, Hospital Worms, Worms, Germany; 3Dept. of Neuro-Urology, Spinal Cord Injury Center, Balgrist, University Zurich, Zurich, Switzerland UROLOGY 78 (Supplement 3A), September 2011 MODERATED POSTER SESSIONS Introduction and Objective: In common opinion and according to the current literature, patients with Parkinson’s disease and Benign Prostatic Obstruction or Hypocontractility of the detrusor have an increased risk of a postoperative urinary incontinence. The number of patients in studies published so far does not exceed the maximum 23 cases. Therefore, we analyzed the outcome after transurethral resection of the prostate in patients with a neurological proven Parkinson’s disease. Materials and Methods: All in all a total amount of 41 patients with proven Parkinson’s disease, who underwent transurethral resection of the prostate because of benign prostatic obstruction or detrusor hypocontractility, were retrospectively analyzed. Patients with multiple system atrophy or any other systemic neurological disorders were excluded. Results: The median patient age at intervention was 75 years. Twelve of 41 patients had a preoperative indwelling catheter, in 8 (67%) of the 12 patients voiding was possible postoperatively but in 2 (17%) of these 8 patients a de novo stress urinary incontinence occurred. Four (33%) required an indwelling Foley catheter afterwards. From another 10 patients with preoperative urge incontinence 7 (70%) recovered continence, 2 (20%) were significantly less incontinent and only 1 (10%) remained as incontinent as before the intervention. In 4 of 41 cases (10%) a de novo (Stress) urinary incontinence was ascertained three months after transurethral resection of the prostate. At a median follow up of three years transurethral resection in patients with a Parkinson’s disease were successful in 30 of 41 (73%) cases. Conclusions: Patients with a Parkinson’s disease and benign prostatic obstruction or hypocontractility of the detrusor do benefit in up to 73% and the risk of a postoperative de novo urinary incontinence seams quite low. In conclusion, Parkinson’s disease should not be mandatory esteemed as a contraindication for a transurethral resection of the prostate. Nevertheless a preoperatively performed urodynamic investigation is obligatory to prove bladder outlet obstruction or detrusor hypocontractility. MP-09.17 Medication Adherence and Strategies for Improvement of Tamsulosin in the Elderly Benign Prostatic Hyperplasia Patients Oh-Oka H Dept. of Urology, Kobe Medical Center, Kobe, Japan Introduction and Objective: I examine the medication adherence of elderly benign prostatic hyperplasia (BPH) patients (75 years or older) and strategies for improvement of adherence. Materials and Methods: There were 200 patients over 75 years old who regularly visit my department for treatment of BPH, and take tamsulosin (tam.) under stable micturition for more than three years (IPSS; 8-12, median;10, IPSS-QOL; 0-3, median; 2). From January 2010, I confirmed medication adherence at patient revisit of hospital after having obtained a written informed consent from relatives (in 99.0% a spouse), where I prescribe tam. for 8 weeks after examination (we do not notify patients themselves regarding medication adherence). And I have randomly assigned 50 to the next four groups; A) usual medical examination, testing and prescribe tam., B) I ask outside Parliament drugstore pharmacists for more detailed explanation and guidance including importance of medication adherence (more than 4 times for 8 weeks), C) Explanation and education regarding importance of adherence to relatives from physicians, staffs and ask for promoting medication when patients do not take medicine at home, and D) Chief doctor contacts the home on the telephone after dinner about micturition once within 1-2 weeks. I compared medication adherence between above-mentioned four groups. In addition, 92.5% of patients (185/200) took 2-10 other oral medicine (median; 4.0). Results: The original medication adherence was 81.0% (162/200). After the subsequent classification to four groups, group A; 80.0% (40/50), group B; 84.0% (42/50), group C; 78.0% (39/50), and revealed significant improvement with group D; 98.0% (49/50) (Between group A and D, p⫽0.004). Background factors do not show a significant difference between each group. Conclusion: The maintenance of the adherence at the treatment of various diseases for elderly people is important, and medication adherence in Japan is not good. The oral medicine tends to increase in morning, which is one of the major causes to decrease medication adherence including observance of medication time. My data suggest that the construction of a good relationship of mutual trust between the patients and the attending physician influences medication adherence, and aggressive communications from physicians are also important. UROLOGY 78 (Supplement 3A), September 2011 MP-09.18 Diode Laser Vaporization of the Prostate in comparison with Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: Preliminary Results of a Randomized Clinical Trial Razaghi M, Mokhtarpour H, Mazloomfard M Laser Application in Medical Sciences Research Center, Tehran, Iran Introduction: Transurethral resection of the prostate (TURP) is still the standard treatment of benign prostatic hypertrophy (BPH) but the surgical lasers recently introduced seem to offer the patient a very low perioperative complication rate, a short learning curve, and reduced operating time. A recently introduced high-powered diode laser (980nm) offers a simultaneous absorption in water and hemoglobin but is lacking clinical experience. In this clinical trial study, the feasibility, and postoperative outcome of vaporization of prostate by means of a diode laser were investigated and compared with TURP as a gold standard treatment. Material and Methods: From January 2007 to January 2009, 100 patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia were included in this study. Using computergenerated simple random tables in a 1:1 ratio, patients were assigned to two fifty-patient groups according to the method of surgical treatment: TURP and high-powered diode laser (980nm). All patients underwent physical examination and evaluation of symptoms according to the International Prostate Symptoms Score (IPSS). Blood tests included blood cell count, serum chemistry, serum prostate-specific antigen (PSA), and urine analysis. Additionally, post-void residual urine volume (PVR) and the peak urinary flow rate (Qmax) were measured. Prostate size were assessed by transrectal ultra-sound (TRUS). Demographic characteristics, the duration of the operation, the changes in hemoglobin and serum sodium, the complications, the hospitalization period and the duration of indwelling catheter were compared between the two aforesaid groups. Functional results in terms of improvement of IPSS, Qmax, and PVR urine were assessed at 1, 6, and 12 months. Result: The mean ⫾ SD age of the patients was 68.2⫾7.8 years (TURP) and 68.5⫾8.8 years (Diode), with a mean S101 MODERATED POSTER SESSIONS preoperative prostate volume of 59.6⫾14.1 and 61.1⫾16.1 mL, respectively. In TURP and Diode groups, the operation time was 54.9⫾15.3 vs. 60.6⫾22.6 minutes (p⫽0.14); Foley catheterization time, 50.8⫾22.5 vs. 20.1⫾4.6 minutes (p⫽0.0001); and postoperative hospital stay was 4.2⫾0.8 vs. 1.8⫾0.4 (p⫽0.0001) respectively. The mean ⫾ SD energy delivery with the diode laser was 145.8⫾19.9 kJ. Among patients of TURP, capsule perforation was observed in 5 patients (10%), 6 S102 (12%) required blood transfusion and 2 (4%) developed TUR syndrome during surgery; whereas none of these complications were observed in the Diode group. One patient in the TURP group required redo-TURP, while two patients of the Diode group required redo-TURP. Outcome in regards to increase in Qmax, decrease in IPSS, and decrease in PVR show a dramatically improvement in the three parameters compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up (1, 6 and 12 months post-operatively). Conclusion: The gold standard treatment in patient suffering lower urinary tract symptoms due to BPH is TURP. According to our study high-powered diode laser (980nm) offers a safe and feasible procedure in the management of patients with symptomatic BPH with lower complication rate. However, time of operation and need for future treatment increase in this technique. UROLOGY 78 (Supplement 3A), September 2011
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