Podium Presentation Abstracts 1

Podium Presentation Abstracts Andrology 1 Microsurgical epididymovasostomy outcomes for obstructive azoospermia J.W. GOOSSEN*,†, A.A. RAHEEM*, F. DE LUCA*, A.N. CHRISTOPHER* and D.J. RALPH* *University College Hospital, London, United Kingdom; †Greenslopes Private Hospital, Brisbane, Australia

Introduction: Azoospermia occurs in 1% of men and in 10–15% of the infertile male population. An obstructive aetiology is found in approximately 40% of azoospermic men. Of these, 30–67% have obstruction at the level of the epididymis. This study looks at the outcome of microsurgical epididymovasostomy in the management of obstructive azoospermia, specifically the patency and pregnancy rates after reconstruction. Patients and Methods: The outcome of the microsurgical epididymovasostomy procedures performed between 2000–2011 was retrospectively analysed. Azoospermic patients with normal testicular size, with or without epididymal dilatation, with a normal hormone profile (FSH, LH, and Testosterone), normal male reproductive genetic profile (XY), and a TRUS showing no evidence of ejaculatory duct obstruction, underwent scrotal exploration. An intraoperative vasogram was performed to exclude distal obstruction. Scrotal exploration was performed in 124 patients. The abscence of distal obstruction and the presence of sperm in the epididymal tubules was seen in 91 patients; these patients underwent microscopic epididymovasostomy. The mean patient age for this group was 42 years old (range 27–62). Microsurgical epididymovasostomy was performed using the standard technique in 73%, the intussusception technique in 26%, and a combination of both techniques in 1% of patients. A bilateral epididymovasostomy was performed in 36% of the 91 patients (n = 29). Results: Of the 91 reconstructed patients, 4 patients were lost to follow up during the initial assessment period. The patency rate in the remaining 87 patients was 54%

(n = 47). Of the patent group, 26 patients were followed up to assess pregnancy rates. For these patients, the natural pregnancy rate after 2 years was 27% (n = 7). With the addition of IVF using sperm from the ejaculate, the overall pregnancy rate was 38% (n = 10). The outcome was not significantly affected by the side of anastomosis, whether the reconstruction was unilateral or bilateral, the epididymal site of anastomosis (head vs. body vs. tail), or the microsurgical technique used (standard vs. 2 point intussusception). However, the presence of motile sperm in the epididymis positively affected postoperative patency. Of all aetiologies, the post-vasectomy reconstruction was associated with a higher patency rate. Pregnancy rate was significantly influenced by the age of the female partner; the age of the female was ≤35 in all couples that achieved pregnancy. Complications were recorded in 8% of patients with 5 haematomas and 2 infections. No testicular loss was recorded. Conclusions: In the absence of a female factor for infertility, microsurgical reconstruction should be offered to men with obstructive azoospermia. The outcome for the two different surgical techniques used appears similar. The presence of motile sperm in the epididymis positively influences patency rates. In this study, the age of the female partner (more or less than 35 years old) is the most important factor that influences the pregnancy rate.

© 2014 The Authors BJU International © 2014 BJU International | 113, Supplement 4, 1–50

2 The penile venous occlusion mechanism: evidence derived from the electrocautery effect to the sinusoids on defrosted human cadavers C.C. HUYNH*, G. HSU†, Y. HUANG‡, M. TSAI§ and S. HUANG¶ *Australian School of Advanced Medicine, Macquarie University Hospital, Sydney, Australia; †Microsurgical Potency Reconstruction and Research Center, Taipei Taiwan; ‡Department of Physiology, China Medical University, Taichung, Taiwan; § Department of Anatomy, China Medical University, Taichung, Taiwan; ¶National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan

Introduction: The venous occlusive mechanism is an important factor for maintaining penile rigidity during erections. This relationship between the penile erection-related veins and the tunica albuginea (TA) is not clearly understood. We aim to conduct an electrocautery study as an indirect means of measuring venous leakage. Materials and Methods: In 2010, seven adult human male defrosted cadavers with intact penises were used for this study. A median dorsal longitudinal incision was made from the retrocoronal sulcus to the pubic region to facilitate vascular access. Two #19 scalp needles were inserted and firmly fixed in place with 4-0 silk sutures at the 3 and 9 o’clock positions respectively. One needle was connected to an infusion pump and was used to inject 10% colloid into the corpora cavernosa, whereas the other needle was used to monitor the intracavernosal pressure (ICP). A 5 cm segment of the deep dorsal vein (DDV) was resected after opening Buck’s fascia, followed by a 2.5 × 0.5 cm2 block of dorsal corpus cavernosum some 0.5 cm proximal to retro-coronal sulcus while an emissary vein is included. A watertight milieu was re-established by 6-0 nylon closure of the corporotomy. A similar tissue block was obtained after electrocautery at 45–60 watts, was applied to the emissary branches of the proximal DDV stump while the ICP was kept at 0, 50, 90, 130 and 150 mmHg to each cadaver in series. Two further cadavers were treated in a similar fashion 1

2 Podium Presentation Abstracts

at 90 and 130 mmHg of ICP. Tissue specimens were sent for special stains and analysis. Results: The electrocautery effect penetrated categorically into the intracavernosal sinusoids in cadavers with ICP less than 70 mmHg. This effect was not seen on the deeper collagen bundles of the outer longitudinal layer of the TA in cadavers with ICP 130 and 150 mmHg. Conclusion: Extracorporeal electrocautery did not cause effects of the sinusoidal wall when an ICP is higher than 130 mmHg. In contrast it seemed to penetrate at ICP less than 70 mmHg. This implies that between 70 and 130 mmHg ICP pressure, the emissary veins do not conduct current and may have closed. 3 Buccal mucosal graft harvest for urethral reconstruction: long-term patient reported outcome of bothersome oral symptoms

poor wound healing, namely smoking and diabetes was also collected. Results: Of 126 patients that underwent urethroplasty with BUMG harvesting, 88 had donor-site closure. Of this subset 37 were interviewed. Of the 38 patients in the non-closure group, 19 were interviewed. Mean age was 45 years and 49 years respectively. No difference was found in mean pain scores between the groups (1.1 vs 1.3). The resumption of a normal diet favoured the closure group (0% vs 10.5%), with this group also reporting less perioral numbness (10.8% vs 21.1%). Non-closure resulted in a lower incidence of scar formation and biting (15.8% vs 27%) and favoured return to full mouth opening (15.8% vs 27%). Interestingly, a larger proportion of the closure group would permit future buccal harvest (92% vs 78.9%) and recommend BUMG urethroplasty as a result (97.3% vs 84.2%). Smoking did not increase the likelihood of graft harvest morbidity (37.5% vs 41.7%) but the presence of diabetes mellitus did (72.7% vs 35.5%).

J.S. GILL*, V. MODGIL*, P. VADUKUL*, I.P. WHARTON† and P.C.B. ANDERSON* *Russells Hall Hospital, Dudley, United Kingdom; †Sandwell Hospital, Birmingham, United Kingdom

Introduction: Buccal mucosal graft (BUMG) has proven itself to be the preferred graft material for urethral reconstruction due to its ease of harvest, its ability to take well and its resistance to lichen sclerosis. Historically both closure and non-closure of the buccinator fossa have been safe and effective options. However, there is little long term data on post operative oral symptoms following surgery. Furthermore, it would appear certain symptoms are more bothersome than others. Our study, performed at a leading regional centre for urethroplasty in the UK aimed to evaluate long term morbidity of BUMG in patients undergoing urethral reconstruction. Patients and Methods: All patients, on whom BUMG were harvested for urethroplasty were identified (June 07–Aug 09). Patients were interviewed 4 to 5 yrs post-procedure. BUMG morbidity was assessed using oral pain (5 point analogue score, 1 = none to 5 = severe) as a primary measure, with secondary measures of normalised diet, perioral numbness, tightness on mastication, and problems with scar biting. Data on factors specific to 2

Discharge Interview

number of urethroplasties in the UK and we set out to investigate, in the largest long term study if its kind, whether the symptoms patients experience early, persist. Patients and Methods: Patients who underwent urethroplasty (June 07–Aug 09) with the use of a buccal mucosal graft (BUMG) were interviewed both at time of discharge and 4 to 5 yrs post-procedure. Questionnaires assessing pain (5 point analogue score, 1 = none to 5 = severe), presence of perioral numbness, tightness during mastication and problematic scar biting were completed to assess the morbidity associated with the graft harvest. Results: Of the 126 patients that underwent urethroplasty with BUMG harvesting, 88 were interviewed at time of discharge with a mean age of 45 (range 17–74), whilst long term follow up was carried out in 56 patients with a mean age of 47 (range 22–74). Mean donor site healing was 6 weeks in duration. Differences in specific side-effects are:

Oral Pain (mean analogue score 1–5)

Perioral numbness (%)

Tightness during mastication (%)

Scar biting (%)

2.7 1.1

49 14

76 14

16 23

Conclusions: Our study reveals that return to a normal diet and prevention of perioral numbness are the most important donor site co morbidities when influencing a patients decision to undergo further BUMG harvesting for urethral reconstruction.

4 Does early symptomatology predict long-term buccal mucosal graft complications for urethral reconstruction? J.S. GILL*, V. MODGIL*, P. VADUKUL*, I.P. WHARTON† and P.C.B ANDERSON* *Russells Hall Hospital, Dudley, United Kingdom; †Sandwell Hospital, Birmingham, United Kingdom

Introduction: Buccal mucosa is the preferred graft material for urethral reconstruction. This is mainly due to the ease at which it is harvested. There is however, recognised donor site morbidity. Our institution carries out the largest

Conclusions: The results suggest that early oral symptomatology following BUMG harvest for urethral reconstruction is not an accurate predictor of long-term oral co-morbidity. In particular patients require careful counseling about developing scar biting in the longer term. 5 Counting sperms at home by microfluidic sperm chip – automatic fabrication and preliminary performance V.F.S. TSAI*,†, H. CHANG†, J. HSIEH†, A.M. WO‡ and B. ZHUANG§ *Department of Urology, Ten-Chen General Hospital, Taoyuan, Taiwan; †Department of Urology, National Taiwan University Hospital, Taipei, Taiwan; ‡Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan; § Chinese Academy of Science, Shenzhen, China

Introduction: Testing sperm quality at home has been indicated for male fertility

© 2014 The Authors BJU International © 2014 BJU International | 113, Supplement 4, 1–50

Podium Presentation Abstracts 3

screening and monitoring. Some commercial kits have been introduced in the market for years, such as Babystart , Fertell and SpermCheck . However, they are all based on immunological reactions and color change. We introduced and fabricated a novel at-home sperm analyzer MSC (Microfluidic Sperm Chip – based on microfluidic and impedance technologies) and compared the performance between conventional sperm analysis (CSA), MSC and Babystart kits. Patients and Methods: The testing MSC were fabricated for the first time by a totally automated process in this developing project. 42 semen specimens were checked by CSA, MSC and Babystart kits respectively. The MSC measured both total and motile sperm number by the same chip. The results by 3 methods were compared and correlated with each other. Results: There was good correlation in total sperm count between MSC and CSA (r = 0.47; p < 0.01), and in motile sperm between MSC and CSA (r = 0.54; p < 0.01). And the accuracy of Babystart for testing sperm count (over 20 million/ mL) was 0.74 compared to CSA. Conclusions: The automatically fabricated MSC fulfilled the need for at-home sperm counting. And the performance of MSC is comparable with Babystart kits for total sperm count and even better for motile sperm count.








Endourology/Stones 6 Is extra corporeal shockwave lithotripsy more effective when conducted under general anaesthetic compared with conscious sedation? A retrospective review C. GROBLER*, J. HAYES†, C. FRAMPTON‡ and S. ENGLISH§ *Nelson Hospital. Nelson. New Zealand; † Christchurch Polytechnic Institute of Technology, Christchurch, New Zealand; ‡ University of Otago, Christchurch, New Zealand; §Christchurch Hospital, Christchurch, New Zealand

Introduction: Extra corporeal shockwave lithotripsy (ESWL) is a non-invasive but painful treatment for urolithiasis. Within New Zealand one lithotripter provides the majority of lithotripsy treatments as it travels the length of the country. The local

urologist will decide the treatment pattern and, in conjunction with their anaesthetist, the type of anaesthesia given. This is usually conscious sedation or general anaesthetic. The objective of this study is to compare the efficacy of conscious sedation with that of general anaesthesia in the setting of ESWL. Patients and Methods: Data was collected from 5266 patients with a single primary nonstaghorn calculi who were treated with a Dornier S1 or Dornier S2 lithotripter between June 1995 and May 2011. Results: The overall success rate for ESWL in this review was 68%. Success was no remaining fragment greater than 4 mm. The success rate for treatment under general anaesthesia was 70.2%, compared with 65.6% for treatment under conscious sedation, (p < 0.001) 60.8% (n = 3411) of patients received general anaesthesia during ESWL. Of those with a stone larger than 10 mm 59.6% (n = 1140) received general anaesthesia. Patients with stones 17 at baseline were enrolled after informed consent. Patient demographics, change in IIEF-5 and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, and overall satisfaction score (on a 5-point scale) were recorded. This study utilises a treatment template consisting of 3000 shock waves (1000 shock waves each to proximal 1/3 penis, distal 1/3 penis and corporal bodies at perineum) twice weekly for 6 weeks period. Results: All patients have tried and failed oral phosphodiesterase type 5 inhibitors and the majority of patients have ED longer than 18 months (mean 21.8; 6 to 60 months). There was no reported adverse event. The majority of patients reported an improvement in IIEF-5 score by 5 points (70%) and EDITS Index score > 50% (65%). Most patients were satisfied (4 out of 5; 60%) and would recommend Li-ESWT to their friends (80%). Conclusion: Li-ESWT appears to improve erectile function and potential play an important role in penile rehabilitation in men with medical refractory ED.

17 Does the timing of intraoperative non-steroidal anti-inflammatory analgesia affect pain outcomes in ureteroscopy? A prospective, single-blinded, randomised controlled trial H. NICHOLSON, S. STRAHAN and M. WINES Sydney Adventist Hospital, Sydney, Australia

Introduction: Ureteroscopy (URS), rigid and flexible, is an intervention utilised for the management of ureteric and renal calculi. Ureteroscopy is generally performed as a day procedure, thus it is imperative to optimise post-operative analgesia to enable day of surgery discharge. Pain following URS is similar to that of renal colic, for which NSAIDs are gold-standard pharmacotherapy. In our institution, NSAID is routinely given as a per-rectal dose at the conclusion of the case. Our aim was to determine if early administration of NSAID prior to ureteroscopic instrumentation would improve pain outcomes when compared 8

with post-procedural administration of NSAID. Patients and Methods: We undertook a prospective, ethics approved, randomised controlled trial between March and September 2013 of all patients undergoing URS for management of renal calculi by a single surgeon at Sydney Adventist Hospital. Patients were allocated by computer-generated assignment to pre(post anaesthetic induction, prior to URS) and post- (URS complete, prior to anaesthetic cessation) procedural NSAID (Diclofenac, 100 mg PR). Patients were blinded, however the proceduralist was not blind to treatment allocation. Exclusion criteria included NSAID contraindications (chronic renal impairment, allergy, drug interactions), use of a ureteric access sheath or previous enrollment. Patients identified their pain levels on a 10 cm visual analogue scale (VAS) and a 4-point descriptive pain scale pre-, 1 and 4 hours post-operatively. The results were analysed using two-tailed Student’s t-test and Fisher’s Exact Test. Results: 36 patients were allocated to pre- (n = 16) and post- (n = 20) URS NSAID; all completed the survey. The groups were similar in terms of age (63, 63 yrs), intraoperative analgesia (10.25, 10.6 mg morphine) and length of URS (19, 23 mins) (means). The 10 Point VAS results of pre- (1.7, 1.5), 1 hr (0.9, 2.2) and 4 hr (0.9, 0.6) demonstrated lower pain scores at 1 hour in the pre-URS NSAID group, however this did not reach significance (p = 0.08). The 4 point pain scale similarly showed a significantly higher proportion of patients with no pain at 1 hour (p = 0.04), however this difference was not evident by 4 hours post-URS. In accordance, 1/16 (6%) patients in the pre-URS group required post operative opioid analgesia compared with 5/20 (25%) of the post-URS group. Conclusions: Our study shows a trend towards improved post-operative analgesia and lower post-operative opioid requirement with administration of NSAID analgesia prior to URS. Increased patient accrual may better delineate this trend.

18 How does T and N stage affect survival following cystectomy for transitional cell cancer of the bladder in a South Australian population? D. FOREMAN, S. PLAGAKIS, S. EDWARDS and M. O’CALLAGHAN Repatriation General Hospital, Daw Park, Australia

Introduction: Bladder cancer is often a lethal disease. Patients with high T stage or node positive (N+) disease are known to have poor survival. We set out to determine the 5-year survival of a cohort of patients who received a radical cystectomy for transitional cell cancer of the bladder in South Australia. We wish to analyse the effect pathological T (pT) or N staging has on survival of these patients, and document it for the first time within this population. Patients and Methods: Following ethics approval, all patients receiving cystectomy performed for transitional cell cancer of the bladder between 1 January 1978 and 30 October 2013 were identified from the Bladder Cancer Outcomes Database at the Repatriation General Hospital. There were a total of 107 patients included whose demographics, pathological T and N staging and survival outcomes were recorded. Cancer-specific and all-cause mortality were investigated against T and N staging using statistical software R. Multivariable Cox regression analysis was performed to test the effect of patients’ age, gender and ASA status on survival outcome. Results: The 5-year bladder cancer-specific survival was 75% for patients with ≤pT2 disease compared with 40% with ≥pT3 (p = 0.008). Similar survival was evident in all-cause mortality assessment. Node status also significantly affected bladder cancerspecific survival with 80% of N0 patients surviving at 5 years, compared with only 40% with N+ (p = 9e-06). The median overall survival time of N+ patients was 43.8 months. Female patients had a 2-fold higher risk of death from bladder cancer, compared to males. ≥pT3 disease was associated with a 3-fold higher risk of death. For each increase in ASA grade, a patient’s risk of survival decreased by 19%.

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Podium Presentation Abstracts 9

Survival time from diagnosis to bladder cancer specific death by N stage 100

Node Status N0 N+

% Surviving

80 60 40 20 0 0





Conclusions: This study demonstrated that a flexible ureteroscope can be utilised at a training hospital for approximately 40 cases prior to requiring repair or being substituted. With a repaired F-URS the rate of damage or repairs required can accelerate. This study is in keeping with other literature which have shown that breakage rates increase as ureteroscopes age and have incurred previous damage with refurbished/repaired endoscopes faring much worse. The cost of maintaining an older damaged ureteroscope should be carefully considered in comparison to the cost of a new ureteroscope.

Survival Time, Months

Conclusions: Patients with ≥pT3 or N+ status have a 5-year bladder cancer specific survival of 40%, which is approximately half compared to patients with ≤pT2 or N0. Female gender and higher ASA status were statistically significant predictors of poor outcomes, whilst age was not. This information will be used when counseling patients, particularly when considering the rationale for chemotherapy.

19 Durability of flexible ureterorenoscopes at a training hospital A. RANASINGHE, S. EHSMAN and R. MILLARD Prince of Wales Hospital, Sydney, Australia

Introduction: There is great variability in the literature regarding the durability of flexible ureterorenoscopes (F-URS), with variations dependent on the manufacturer, operator, method of sterilisation and many more. This study reviewed the usage and cost of maintenance of F-URS in a training hospital which provides a registrar-led service. Materials and Methods: A retrospective review was conducted of all cases performed using F-URS at Prince of Wales public hospital between November 2006 and September 2013. Data pertaining to the procedures were collected from laser logbooks and operation notes. Data was gathered for all repairs and replacements for F-URS over this time period from searching WebReqs r1.0 and individual companies.

Results: Two ACMI Uretero-Fiberscopes were used between November 2006 and September 2013. A total of 635 flexible ureteroscopy cases were performed which included diagnostic, basket extraction and laser lithotripsy. The registrar was the principal operator in the majority of cases (80%). There were 17 repairs made and 7 service replacements of F-URS. The total cost of repairs and replacements was AUD$151,014 in this time period. 47 cases were completed prior to the first repair of a F-URS. On average 25.125 cases were performed before one of the two F-URS was sent away for repair/replacements. The longest period saw 68 cases performed between May 2008 and 2009 before a F-URS was sent for repair. In the shortest period between repairs, 5 cases were completed prior to a replacement scope being sent for repair due to it being flooded with moisture. One F-URS was repaired 4 times from 2010 to 2012, at intervals of 7, 5 and 3 months, costing AUD$24,000, before a service replacement 9 months later costing a further AUD$8,652. A replacement F-URS was damaged within 3 months requiring another service replacement costing AUD$4916. The most common area of damage was to the insertion tube, image bundle and bending rubber. When total cost of repairs is spread over the total number of cases, there is a maintenance cost of approximately AUD$240 per case. On average each F-URS was used in approximately 40 cases prior to requiring repair/replacement.

© 2014 The Authors BJU International © 2014 BJU International | 113, Supplement 4, 1–50

20 Does baseline prevalence or targeted prophylaxis reduce infectious complications after prostate biopsy? A bias-adjusted meta-analysis M.J. ROBERTS*,†, D.A. WILLIAMSON‡,§,¶, P. HADWAY†, S.A.R. DOI**,††, D.L. PATERSON*,‡‡ and R.A. GARDINER*,† *Centre for Clinical Research, The University of Queensland, Brisbane, Australia; †Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia; ‡Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; § Department of Clinical Microbiology, Auckland District Health Board, New Zealand; ¶ Institute of Environmental Science and Research, Wellington, New Zealand; **School of Population Health, The University of Queensland, Brisbane, Queensland, Australia; †† Department of Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; ‡‡Infectious Diseases Unit, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia

Introduction: The relationship between antibiotic, specifically fluoroquinolone, resistance in rectal flora and infection following transrectal ultrasound guided prostate biopsy (TRUSPB) is unclear, but has caused recent, international concerns. When fluoroquinolones are used as antibiotic prophylaxis, pre-biopsy screening for fluoroquinolone resistant pathogens may facilitate tailored prophylaxis to reduce post-biopsy infections. We sought to characterize the relationship between the incidence of post-TRUSPB infection and the baseline prevalence of fluoroquinolone resistance in rectal flora, in addition to 9

10 Podium Presentation Abstracts

quantifying the efficacy of targeted prophylaxis. Patients and Methods: Electronic databases (MEDLINE, CENTRAL, EMBASE and CINAHL were searched for all potential, full text studies. Studies were assessed for methodological quality and comparable outcomes prior to metaanalysis (using quality- and random-effects models) in MetaXL 1.3. Unpaired t-test analysis was used to compare groups using GraphPad QuickCalcs. Abstracts were not included due to an inability to perform appropriate quality assessment. Results: 2541 patients from nine studies were included in the final meta-analysis. A higher prevalence of fluoroquinolone resistance was observed in rectal cultures obtained following fluoroquinolone-based prophylaxis (20.4%; 95% CI 18.0–22.8), compared with those obtained before antibiotics were used (12.8%; 95% CI 10.5–15.3; p < 0.001). Overall post-biopsy infection rates were higher in patients using empiric prophylaxis (3.3%; 95% CI 2.6–4.2) when compared with those using altered (targeted/protocol) regimes (0.3%; 95% CI 0–0.9; p < 0.001). Men with fluoroquinolone-resistance rectal cultures displayed higher infection rates (13.7%; 95% CI 7.9–20.2) than those with fluoroquinolone sensitive rectal cultures (1.4%; 95% CI 0.3–2.8; p < 0.001). For every fourteen men with fluoroquinoloneresistant rectal cultures, one additional infection was observed when compared with men with fluoroquinolone-susceptible rectal cultures. Conclusions: The presence of fluoroquinolone resistance in rectal flora is a significant predictor of post-TRUSPB infection when fluoroquinolone prophylaxis is used. Targeted or protocolbased prophylaxis regimes, based on rectal culturing prior to TRUSPB, may reduce morbidity and potentially provide economic benefits to health services. These results support a reassessment of current antimicrobial prophylaxis methods.


LUTS/BPH 21 Understanding rejection: qualitative assessment of onabotulinumtoxin A cessation in an outpatient setting L. BARLASS and S. ENGLISH Christchurch Hospital, Christchurch, New Zealand

Introduction: OnabotulinumtoxinA (ONA) is an effective intravesical treatment for overactive bladder. It has been used in the outpatient setting at Christchurch Hospital for 8 years, administered via flexible cystoscopy without analgesics or sedatives. Patients are recalled on a yearly basis for further treatment however some decline further administrations. In this qualitative study our primary aim was identify causative reasons for discontinuing use of ONA in patients who ceased administration after a single dose. Secondarily we aimed to assess patterns of usage and patient demographics. Patients and Methods: In a retrospective study patients receiving outpatient intravesical ONA for bladder overactivity, between January 2008 and June 2012 were followed for a period 1–5.5 years depending on the date of their initial assessment. Demographics, doses and baseline characteristics were recorded for each patient. Those who ceased ONA usage after one dose were interviewed over the phone and their case notes reviewed. The interview was composed of 8 questions developed using a deductive qualitative approach. Interview data was then analysed descriptively and qualitatively. Results: 171 patients received ONA. 84% female, 16% male. 79.3% received 100 units, 8.3% 200 units, 12.4% 300 units. 38.6% received only one administration, 31% only two. The remaining 30.4% received ≥three. Of those who received only a single dose, 35 were contactable for an interview. These phone interviews revealed four main themes for usage cessation. These were poor efficacy, intolerable discomfort during administration, requirement for catheterisation and the introduction of an equally effective, less invasive alternative. Over half of those interviewed described urinary tract infection or haematuria post procedure. 40% required catheterisation post procedure. 40% stated they would

consider a further ONA if it was likely to be effective despite discomfort during or post administration previously. All had trialed oral oxybutynin prior to ONA and over half were still taking some form of anticholinergic at the time of interview. 60% had undergone urodynamics prior to the botox administration. Many commented written information would have been valuable prior to first administration. Conclusions: OnabotulinumtoxinA is well tolerated by the majority of our patients and many seek multiple repeated administrations. In those who cease treatment a significant proportion find it either ineffective or its administration or subsequent complications intolerable.

22 Multicentre prospective crossover study of the prostatic urethral lift : analysis of LUTS improvement P. CHIN**,††, H. WOO‡‡, A. CANTWELL*, W. BOGACHE†, S. RICHARDSON‡, R. TUTRONE§, J. BARKIN¶ and J. FAGELSON** *Atlantic Urological Associates, Daytona Beach; †Caroline Urological Research Centre, Myrtle Beach; ‡Western Urological clinic, Salt Lake City; §Chesapeake Urology, Baltimore; ¶ University of Toronto; **Urology Associates of Denver, Denver; ††Figtree Private Hospital, Figtree; ‡‡Sydney Adventist Hospital Clinical School

Introduction: Crossover design allows for therapeutic effect of PUL to be compared to control for each individual subject. Patients and Methods: At 19 centers in North America and Australia, 53 subjects who were ≥50 years old with International Prostate Symptom Score (IPSS) ≥ 13, a peak flow rate (Qmax) ≤ 12 ml/s, and a prostate 30–80 cc underwent a sham procedure through a prospective, randomized, blinded study. These subjects elected after unblinding at 3 months to undergo crossover PUL. Sham procedure involved rigid cystoscopy with simulated active treatment sounds. PUL involved placing permanent UroLift implants into the lateral lobes of the prostate to enlarge the urethral lumen. LUTS, quality of life, Qmax, sexual function, and adverse events were assessed throughout the first post-operative year. Analysis of each IPSS parameter allowed for assessment of specific symptom responses to treatment.


© 2014 The Authors BJU International © 2014 BJU International | 113, Supplement 4, 1–50

Podium Presentation Abstracts 11

Results: The therapeutic effect of crossover PUL was 122% greater than sham at 3 months, p < 0.001 (Table 1). All IPSS parameters demonstrated significant improvement from baseline from 1 through 12 months (Figure 1, all p-Values < 0.02). Qmax increased stepwise after sham and then again after PUL (from 7.9 mL/s at baseline to 9.6 to 12.0 mL/s, respectively). There was no de novo, sustained ejaculatory or erectile dysfunction. Sexual function in the erectile, ejaculatory, and ejaculatory bother domains improved after PUL. Adverse events associated with the procedure were typically transient and mild to moderate. One subject (2%) required TURP in the first year. Conclusions: PUL significantly reduced overall LUTS and each individual symptom domain. Subjects often have low perioperative morbidity, quickly return to normal activity and experience rapid, durable symptom relief. PUL may be uniquely suited to treat LUTS while preserving sexual function.

23 The impact of very large prostate size >100 cc and urinary retention on the perioperative outcomes associated with performing 180W lithium triborate laser photoselective vaporisation of the prostate A. CHUNG, M. SU, K. WEST and H. WOO Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia

Introduction: Some of the most challenging cases in the surgical treatment of benign prostatic obstruction (BPO) are for men who have very large prostate sizes or are in urinary retention. This study evaluates the impact of these patient factors (very large prostate size and urinary retention) on the perioperative outcomes associated with performing 180W lithium triborate (LBO) laser photoselective vaporisation of the prostate (PVP). Patients and Methods: A prospectively collated database of all men who

underwent treatment with the 180W LBO PVP, from July 2010 to October 2013 inclusive, was analyzed. These men were classified into 4 groups according to the presence of patient factors; (A) very large prostate (defined as >100 cc) without urinary retention; (B) urinary retention without a very large prostate size; (C) very large prostate >100 cc and concurrent urinary retention; (D) neither a very large prostate nor urinary retention. Perioperative outcomes (operating time, laser time, energy utilization, duration of catheterisation, duration of hospital stay) and complications within 3 months were recorded. Statistical analyses were performed using Microsoft Excel 2011, and comparisons made using Student’s t Test with statistical significance defined at P < 0.05. Results: Of the study population (n = 224), 31 men were classified in group A (median age 69 y, median prostate size 125 cc), 30 men in group B (median age 68 y, prostate

Table 1. Baseline, follow-up, and change in each outcome measure after control sham therapy followed by crossover PUL in the same patient cohort Outcome Measure (paired sample size)

IPSS (53) QOL (52) BPHII (52) Qmax (39) MSHQ-EjD Function (36) MSHQ-EjD Bother (36) IIEF-5 (SHIM) (36)

Control Sham Period Mean ± Standard Deviation

Crossover PUL Period Mean ± Standard Deviation



3 Months



3 Months


25.2 ± 5.7 4.8 ± 1.1 7.2 ± 3.2 7.9 ± 2.4 11.3 ± 4.2 3.3 ± 1.7 16.2 ± 7.2

20.2 ± 8.3 3.9 ± 1.6 5.3 ± 3.2 10.3 ± 4.6 9.1 ± 3.8 2.4 ± 1.7 17 ± 7.2

−5.0 ± 7.5 −0.8 ± 1.4 −1.9 ± 3.4 2.4 ± 5.1 −2.1 ± 4.2 −0.8 ± 1.6 0.8 ± 4.3

23.4 ± 5.5 4.5 ± 1.2 6.2 ± 2.9 9.6 ± 4.3 8.9 ± 3.6 2.5 ± 1.7 16 ± 6.7

12.3 ± 7.9 2.2 ± 1.5 3 ± 2.9 12.0 ± 6.1 9.9 ± 3.7 2.1 ± 1.6 16.3 ± 8.2

−11.1 ± 7.2 −2.3 ± 1.7 −3.3 ± 2.9 2.4 ± 5.3 1.0 ± 2.9 −0.4 ± 1.3 0.3 ± 4.7

2 injections). Before BTXA, 16 of 18 patients were wet. 14 patients (78%) responded to BTXA. All patients with a history of RRP responded whereas 5 patients responded after TURP (p = 0.08). 11 patients remained wet and 7 were dry (4 in post RRP group and 3 in TURP group). Mean decrease in pad use was 1.57 in RRP group and 0.3 in TURP group (p = 0.07). The mean PGI-I score was 2.7 out of 7 (range 1–4) overall, 2.2 in the RRP group and 3.3 in the TURP group (p < 0.05). Conclusions: This study demonstrates that BTXA injections can be beneficial in patients with drug refractory NNOAB who have undergone previous prostate surgery. Whilst the majority of men had a symptomatic response to BTXA, men who had undergone RRP tended to have better improvement in symptoms than men who had undergone TURP.

26 HoLEP after previous TURP V. MEIYAPPAN and C. CHEMASLE Palmerston North Hospital, New Zealand

Introduction: Many patients who require HoLEP have had previous TURP. Our aim was to compare the outcomes of those who have HoLEP following previous TURP Vs no previous prostate surgery. Patients and Methods: Between February 2009 and September 2013 we performed 175 HoLEPs. The data was collected prospectively. Age, previous history of

© 2014 The Authors BJU International © 2014 BJU International | 113, Supplement 4, 1–50

Podium Presentation Abstracts 13

TURP and prostatic volume was recorded in all patients. They had their Qmax, post-void residual, hemoglobin level and PSA measured pre and postoperatively. We also measured the enucleation time/efficiency, morcellation time/efficiency, tissue weight and readmission rates. We identified 36 patients with a previous history of TURP. We compared them to the 139 patients with no previous prostate surgery. Statistical analysis included the Mann Whitney U test, Independent Samples t-test and Pearson’s Chi Square test. A P-value of

Abstracts of the Urological Society of Australia and New Zealand, 67th Annual Scientific Meeting, Brisbane, Australia, 16-19 March 2014.

Abstracts of the Urological Society of Australia and New Zealand, 67th Annual Scientific Meeting, Brisbane, Australia, 16-19 March 2014. - PDF Download Free
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