Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 14

2 7 T H CONGR SCAND ASSOC UROL
F Y L G I R I T 6 1
16 Plasma button electrode vaporization of the prostate
- short term outcome and complications
M H^jgaard’, L Fahrenkrug* 1, J Schou2
1Department of Urology, Herlev Hospital, Herlev, 2Urologisk Klinik,
Privathospitalet Hamlet, Soborg, Denmark
marhojOl ©heh. regionh.dk
Introduction: Transurethral resection of the prostate (TUR-P) in
saline can potentially reduce the risk of TUR-syndrome, increase
patient safety, shorten current path and reduce operating time.
The newest addition to the bipolar systems is a button electrode
for plasma vaporization (BEPV), allowing for vaporization of
the prostate. The aim of this study was to investigate safety and
short term outcome of patients operated for benign prostatic
hyperplasia with the BEPV.
Method: 94 patients at 2 urological centres underwent TUR-P
with the Olympus button electrode WA22557C in the TURis
system (UES-40 Surgmaster, Olympus, Hamburg, Germany)
in 2008. The operation decision was made by board certified
urologists (BCU) in accordance with current Danish guidelines.
The patients were operated by 5 BCUs. Maximum flow(Qmax),
residual urine(Vcs), prostate volume (Pvo|) and Danish Prostate
Symptom Score (DAN-PSS) were registered preoperatively.
Qmax, V,s , DAN-PSS and complications were registered 3
months postoperatively.
Results: 12 patients were operated using both BEPV and loop
electrode and were excluded from analysis, as were 3 patients
with prostate cancer, leaving 79 patients for analysis.
One patient required blood transfusions postoperatively, 1
patient had febrile urinary tract infection and 2 patients required
cystoscopic re-intervention to obtain hemostasis and clot
evacuation. No TUR syndromes were registered.
At 3 months 6 patients had, or had been scheduled for, surgery
for bladder neck strictures, 1 was re-operated for residual
adenoma and 1 patient complained of stress incontinence.
Table 1. Population characteristics
Age, mean 66 years (39-89)
Prostate volume, mean 53ml (16-168)
Operating time, mean 50 minutes (17-130)
Table 2. Symptom score and voiding parameter changes Pre-operatively 3 months follow up % change
Qmax mean 8.3 ml/s (2.0-17) 13.3 ml/s (3.7-32.6) + 60%*
Vres mean 126 ml (0-491) 61 ml (0-320) -52%*
DAN-PSS-score mean 32(1-61) 5.9(0-25) -82 %*
* p<0,01 Wilcoxon Signed Rank Test
Conclusions: The BEPV provides significant improvement
in voiding parameters and symptom score with few
postoperative bleedings and an acceptable amount of short term
complications.
Increases in Qmax were lower thanprevious studies on con ventional
TUR-P and photoselective vaporization of the prostate,
whilst improvements in symptom score were comparable.
Large scale, randomized studies are required to establish long
term outcome in aspects of voiding and safety in comparison
with other surgical modalities for BPH-treatment.
17 Development of UTI after TURP; Indwelling urinary
catheters as risk factors
M Cek1, P Tenke2, K Naber3, KV Pedersen4, TEB Johansen4 on behalf of the
GPIU*-investigators and the board of ESIU
'Urology Department, Taksim Teaching Hospital, Istanbul, Turkey
2Urologi/ Department, ]alm Terenc South-Pest Hospital, Budapest, Hungary,
3Karl-Bickleder-Str. 44c D-94315 Straubing, Germany, 4Urology Dept., Árhus
University Hospital, Árhus, Denmark
*Global Prevalence Study on Infedions in Urology
cekmd@doruk. net. tr
Aim of investigation: The role of indwelling urinary catheter
and preoperative administration of antibiotics in the develop-
ment of nosocomial urinary tract infections (NAUTI) in a subset
of patients undergoing TURP was studied.
Subjects and methods: 129 of the investigators registered for
GPIU (2006/7) completed an additional questionnaire for pa-
tients who underwent TURP. The presence and duration of a
catheter on admission, replacement within the last week, recent
prescription of antibiotics before TURP and development of a
NAUTI after TURP were addressed and analysed as possible
risk factors for the development of NAUTI after TURP.
Results and discussion: 599 patients with evaluable data were
included.17.3% of patients with indwelling catheters developed
UTI post-TURP compared to 6.7% of patients without catheter
(p=0,001). 13.2%who received antibiotics before and until TURP
developed UTI compared to 7.8% without antibiotics (p=0,001).
Patients without catheters on admission or had it for 7 days or
less, 7.9% developed NAUTI compared to 19.1% for those who
had catheters for more than a week (p=0.001).0f 91 patients
who had the catheter replaced within the week preoperatively
18.7% developed UTI compared to 36 out of 364 (9.9%) without
replacement (p=0.001).
Conclusions: Urinary catheters on admission, treatment with
antibiotics immediately before TURP and recent replacement
of urinary catheters are associated with the development of
NAUTI's in such patients.
18 Hypoxia-inducible factor-1 mRNA and protein levels
in renal cell carcinoma
A Lidgren, A Bergh, K Grankvist, G Lindh, B Ljungberg
Department ofSurgical and Perioperative Sciences, Umed University, Umed,
Sweden
borje. Iju ngberg@u rologi.umu.se
Aim: Angiogenesis plays a central role in tumor growth. The
hypoxia inducible factor (HIF-la) is a regulated subunit of HIF-
1, a key factor that carries fundamental features in angiogenesis
and tumour progression. Renal cell carcinoma (RCC) is rich
vascularised with a variable clinical outcome, having specific
genetic alterations in different RCC types. We investigated HIF-
1 4 LÆKNAblaðið 2009/95