1566

PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) IN MEN WITH PREOPERATIVE CATHETERIZATION DUE TO CHRONIC URINARY RETENTION

Alexander Bachmann*, Robin Ruszat, Hans-Helge Seifert, Roberto Casella, Steven Wyler, Tullio Sulser, Basel, Switzerland

INTRODUCTION AND OBJECTIVE: PVP is a high-power (80W) potassium-titanyl-phosphate (KTP) laser prostatectomy that has been established as a viable therapy for men with symptomatic BPH. The purpose of this study was to compare the outcome of patients with preoperative catheterization (CTHR) due to chronic urinary retention and without preoperative catheterization (nCTHR) undergoing PVP.

METHODS: Over a period of 12 month 98 men with BPH underwent 80W KTP laser vaparization. Due to chronic urinary retention 42 men were preoperatively catheterized. All men underwent preoperative and postoperative (3, 6 and 12 month) evaluation including International Prostate symptom score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax), and post-void residual volume (RV).

RESULTS: Mean age of both groups were comparable, 72.4±11 years (CTHR) and 68.9±8.2 years (nCTHR), respectively. Average preoperative PSA and prostate volume (ultrasound) was higher in CTHR as in nCTHR, 5.2±4.2 ng/ml vs. 2.9±2.6 ng/ml and 54.9±31.3 cc. vs. 46.6±22.1 cc, respectively. Mean outcome parameters of both groups are described in Table 1. Qmax, RV, IPSS and QoL improved in both groups to a statistically significant extent and maintained throughout the follow-up. Neither intraoperative, nor postoperative transfusions were required in both groups. Mean catheterisation time was 1.8±1.1 days in CTHR and 1.7±1.1 days in nCTHR. The rate of postoperative urinary retention was 19.0% (n=8) in CTHR and 10.7% (n=6) in nCTHR. Minor complications including transient dysuria, urge-incontinence, and urinary tract infection were comparable in both groups.

CONCLUSIONS: Our results demonstrate that PVP is a viable treatment option for patients with preoperative catheterization due to chronic urinary retention. Most of the patients can be exempted from catheter just after surgery.

Session Info: Moderated Poster - Wednesday, May 25, 2005, 10:00 AM - 12:00 PM

1569

GREEN LIGHT PVP: SAFETY AND EFFICAY IN LARGE PROSTATES >100CM3

Srinath K Chandrasekera*, Neil J Barber, Kilian Walsh, Peter M Thompson, Gordon H Muir, London, United Kingdom

INTRODUCTION AND OBJECTIVE: The new generation high-power 80W KTP laser (Greenlight PVP, Laserscope Ca) has already shown promise in achieving rapid vaporisation of prostate adenoma with complete absence of fluid absorption during surgery. We report our experience in treating patients with large prostate glands.

METHODS: 29 patients with a mean prostate volume of 142.9ml(range100-240ml) have been treated up to date.11/29 were following urinary retention. Of these 4 patients were deemed unsuitable for open prostatectomy/TURP due to co morbidity. Four patients were on wafarin requiring conversion to shorter acting anticoagulation. Sterile water was used as irrigant. All but 4 patients had a 2 way catheter at the end of the procedure. One patient needed a mini resection (TURP) (2.5g) at the end of procedure to remove an apical flap. Another had a repeat procedure 3 days post operatively, as part of a planned 2 staged procedure. None had evidence of TUR syndrome.

RESULTS: Mean hospital stay was 14.7 hours (range5-72), 26/29 patients being operated as day cases. Improvements were noted at 6 months in terms of mean IPPS score 18.2 to 8, quality of life score 4.6 to 2.1, and maximum flow rate12.5 to 17.5 ml/sec. Mean reduction in prostate volume was 53%(35-67%) on TRUS. One patient with previously known DVT died at 13 weeks due to pulmonary embolism.

CONCLUSIONS: The high-power 80w KTP laser is a promising modality in the treatment large prostate adenomas with minimal morbidity. This technique makes open prostatectomy potentially obsolete and also offers new hope for selected patients deemed unsuitable for surgery.

Session Info: Moderated Poster - Wednesday, May 25, 2005, 10:00 AM - 12:00 PM

1703

TRANSITION ZONE HYPOTHESIS IN BENIGN PROSTATIC HYPERPLASIA

Leonard S Marks*, Los Angeles, CA; Eric Wolford, Timothy G Wilson, Raleigh, NC; Claus G Roehrborn, Dallas, TX

INTRODUCTION AND OBJECTIVE: The transition zone (TZ) is considered the most relevant prostate zone in benign prostatic hyperplasia (BPH) due to its proximity to the urethra. However, the importance of TZ volumetrics has not been adequately examined in datasets of sufficient size. We examined data from Phase III dutasteride (DUT) trials, which provide the largest existing TZ dataset in men with symptomatic BPH, to evaluate the importance of TZ volume (TZV) in assessing disease severity or response to treatment.

METHODS: 2802 men aged =50 y.o. were randomized into 2 multicenter, 2-year double-blind trials assessing the efficacy and safety of DUT in the treatment of BPH. Eligible patients had AUA-SI scores =12, prostate volume (PV) =30 cc by TRUS, Qmax =15 mL/sec, and serum PSA between 1.5 and 10 ng/mL. Treatments included DUT 0.5 mg/day or placebo (PBO). PV and TZV were measured in accordance with a standardized video at baseline, and months 6, 12, and 24. Peripheral zone volume (PZV) was calculated by subtracting TZV from PV. Transition zone index (TZI) was calculated by dividing TZV by PV.

RESULTS: Data were available for 2766 men. Mean baseline (cc) PV=55±23, TZV=27 ±17, PZV=28±13 and TZI=0.47±0.16. No significant differences were noted between groups at baseline. At 24 months, treatment differences were observed for PV, TZV, and PZV. DUT reduced each measure similarly, while PBO had no effect. TZI remained relatively constant (0.48 for DUT and 0.49 for PBO) out to 24 months. No baseline correlation with symptoms was found for PV, TZV, or PZV. However, TZV was significantly related to changes in symptoms at 24 months in the DUT group (p<0.001) but not in the PBO group.

CONCLUSIONS: In men with symptomatic BPH and enlarged prostates treated with DUT for two years, the TZV remains at ~50% of the total PV. In contrast to what has been previously hypothesized, dutasteride reduces androgenic stimulation to the TZV and PZV equally, furthering a potential basis for chemopreventive use.

Session Info: Podium - Wednesday, May 25, 2005, 3:30 PM - 5:30 PM

1704

ABILITY OF THE TRANSITION ZONE INDEX TO PREDICT CHANGES IN SYMPTOMS AND MAXIMUM FLOW RATE IN MEN WITH BPH TREATED WITH PLACEBO VERSUS DUTASTERIDE

Leonard S Marks*, Los Angeles, CA; Eric Wolford, Timothy G Wilson, Raleigh, NC; Claus G Roehrborn, Dallas, TX

INTRODUCTION AND OBJECTIVE: The importance of the transition zone in the development of BPH is well documented. However, the predictive value of this specific zone relative to overall prostate volume in men with BPH is less well defined. The current analysis investigates the relationship of the transition zone index (TZI) with AUA-SI scores and Qmax in the dutasteride (DUT) Phase III clinical trials.

METHODS: 2802 men aged =50 were randomized into one of 2 multicenter, 2-year double-blind trials assessing the efficacy and safety of DUT in the treatment of BPH. Eligible patients had AUA-SI scores =12, prostate volume (PV) =30 cc by TRUS, Qmax =15 mL/sec, and serum PSA between 1.5 and 10 ng/mL. Treatments included DUT 0.5 mg/day or placebo (PBO). PV and transition zone volume (TZV) were measured at baseline, and months 6, 12, and 24. TZI was calculated by dividing TZV by PV. Data presented represent changes from baseline at 24 months.

RESULTS: Data were available for 2766 men. Mean baseline values and mean changes from baseline are presented in the table stratified in tertiles of TZI. No significant relationships were noted between TZI and AUA-SI or Qmax at baseline. Within each TZI tertile, significant treatment differences were found for AUA-SI (p<0.002) and for Qmax (p<0.008). Significantly larger AUA-SI improvements were associated with increasing TZI for DUT (p<0.002) whereas smaller Qmax improvements were associated with increasing TZI for PBO (p<0.002). The net benefit of DUT was greatest in the highest TZI tertile.

CONCLUSIONS: Greater TZI predicts a smaller placebo response in terms of symptoms and flow rate, but a greater improvement with DUT, thus creating an increasing net drug benefit.

Session Info: Podium - Wednesday, May 25, 2005, 3:30 PM - 5:30 PM

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