V-02.11: Photodynamic assisted detection and treatment of superficial bladder cancer using the...
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Purpose: We assessed the efficacy of laparoscopy in removal of difficult ureteral stones. Materials and Methods: We attempted laparoscopic removal of difficult ureteral stones in 16 patients (10 males and 6 females). We used transperitoneal ap- proach. 9 patients had proximal and 7 patients had middle or distal ureteral stones. Our criteria for selecting the pa- tient for laparoscopic treatment were large size ( 1cm) of stone or failing in treatment with SWL or intracorporeal lithotripsy. We used 3 (for proximal ure- teral stones) or 4 (for distal ureteral stones) trocars. Results: Transperitoneal laparoscopic ure- terolithotomy was successful in all of our 16 patients. Operative time ranged from 2.4 to 4.5 hours (mean 3.2 hours). Hospi- tal stay ranged from 3 to 14 days (mean 6.3 days). All patients were stone-free on post-operative KUB. Only in 3 patients complication (prolonged urinary leak) oc- curred and one of these needed open sur- gery for closing the ureteral incision. Fol- low-up IVP was performed in 10 patients and stone residue or ureteral obstruction was not found in anyone. Conclusion: Based on our experience, transpertioneal laparoscopic ureterolithot- omy is a safe practical alternative for open surgery in patients with large ureteral stones or when less invasive procedures fail to treat the stone. V-02.09 Potency- and continence preserving radical cystectomy with hemiprostatectomy Wolf M, Wunderlich H, Schubert J Friedrich-Schiller-University, Dept. of Urology, Jena, Germany Introduction: Radical cystectomy has been the gold standard for treatment of muscle invasive bladder cancer. However, this kind of therapy may have an impact on quality of life, including sexual-, uri- nary and social function. For this reason we performed prostate sparing surgery during radical cystectomy for invasive bladder cancer. Materials and Methods: Between De- cember 2003 and December 2005 34 pa- tients with a mean age of 63.2 years un- derwent radical cystectomy with hemiprostatectomy due to bladder cancer. Preoperative evaluation included a normal digital rectal examination, PSA lower than 4 ng/ml and an inconspicuous transrectal ultrasound. All patients underwent pros- tate biopsy preoperatively. Surgery con- sisted of radical cystectomy, hemiprostate- ctomy and resection of the prostate adenoma in the lower part of prostate as well as regional lymphadenectomy. The follow-up was 1-24 months. Results: Postoperative pathological stage was pTis in 2 patients, pTa in 1, pT1 in 5, pT2 in 20 and pT3 in 6 cases. Except of 7 patients no patient had a deterioration of sexual function. 30 pa- tients were fully continent during day- time and nighttime. The mean operation time was 225 minutes ( 42 minutes, ranged 167-370 minutes). Mean opera- tive blood loss was 499 ml ( 255 ml, ranged 100-1000ml). Conclusion: Radical cystectomy with prostate sparing surgery in patients with invasive bladder cancer allowed preserv- ing the external urethral sphincter and the neurovascular bundles. It is abso- lutely necessary that this procedure is restricted to highly selected patients, especially without concomitant prostate cancer. V-02.10 Laparoscopic radical cystoprostatectomy (LRC) Pen ˜a J, Prera A, Gonzalez J, Hannaoui N, Vicente E, Garcia D, Abad C, Prats J Servicio de Urologı ´a, Hospital de Sa- badell, Corporacio ´ Sanitaria Parc Tauli, Sabadell, Spain Introduction: Laparoscopic surgery is in clear expansion in our country given that it has been shown a decrease of the mor- bidity associated to open surgery with at least the same oncological results. LRC as is shown in the video is a feasible and reproducible proceeding. Methods: We show a video of a LRC as is done in our centre. Bilateral pelvic limph node dissection is simultaneously done. Specimen is removed on block (cystopros- tatectomy and lymphadenectomy). We present the case of 87-year-old male diag- nosed by TUR of a pT2 G III transitional cell carcinoma with CT scan and bone scan negative for metastasis. Patient com- plained of gross haematuria and severe dysuria. We indicated a LRC with a bilat- eral cutaneous ureterostomy as urine di- version. Results: Postoperative evolution was cor- rect and he was discharged at day 6 of surgery. Ileous last 24 hours. Blood lost was minimum and no transfusion was re- quired. Surgery took four and a half hours. Conclusion: LRC is a feasible proceeding to be done by teams with previous experi- ence in laparoscopic surgery. In our expe- rience, initial learning curve has been shorter than the laparoscopic prostatec- tomy one. The chance of a LRC in elderly patients must be kept in mind. V-02.11 Photodynamic assisted detection and treatment of superficial bladder cancer using the photosensitizer Hexvix® Thomas K, Ray E, Murphy D, Chatterton K, Khan S, O’Brien T Guy’s and St Thomas’ NHS Foundation Trust, London, UK Introduction: Photodynamic assisted transurethral resection (TUR) of bladder tumour may improve completeness of tu- mour resection. More precise mapping of bladder cancer could translate into better outcomes. This video describes the tech- nique of photodynamic diagnosis (PDD) using Hexvix® in our unit. Patients and Methods: There are cur- rently 4 ongoing studies using the intra- vesical photosensitizer Hexvix® in our unit; 1) a randomised trial of photody- namic assisted TUR versus standard white light TUR for primary superficial bladder cancer; 2) check cystoscopy post BCG; 3) positive urine cytology/no evidence of disease; 3) multi-focal tumour recurrence. Patients are consented for participation in the appropriate study. The photosensitizer Hexvix® is instilled into the bladder on the ward at least 90minutes before the procedure. The D-Light system (Storz) is used for the cystoscopy as it allows a switch between white and blue light. Ini- tially a “white” light cystoscopy is per- formed and a bladder map obtained. Us- ing the same equipment a “blue” light cystoscopy is performed and any areas of fluorescence photographed and biopsied. Results: The photosensitizer Hexvix® is well tolerated with no complications to date. Visualisation and colour contrast be- tween fluorescent tumour and non-fluores- cent urothelium are excellent. The tech- nique and interpretation of fluorescence have been easily acquired. The presence and histology of lesions detected under white and blue light is being compared. Conclusion: The technique of photody- namic diagnosis using Hexvix® can be easily established in clinical practice and shows promise in detecting and treating superficial bladder cancer but results are awaited. VIDEO SESSIONS 206 UROLOGY 68 (Supplement 5A), November 2006
Transcript of V-02.11: Photodynamic assisted detection and treatment of superficial bladder cancer using the...
Purpose: We assessed the efficacy oflaparoscopy in removal of difficult ureteralstones.Materials and Methods: We attemptedlaparoscopic removal of difficult ureteralstones in 16 patients (10 males and 6females). We used transperitoneal ap-proach. 9 patients had proximal and 7patients had middle or distal ureteralstones. Our criteria for selecting the pa-tient for laparoscopic treatment werelarge size (� 1cm) of stone or failing intreatment with SWL or intracorporeallithotripsy. We used 3 (for proximal ure-teral stones) or 4 (for distal ureteralstones) trocars.Results: Transperitoneal laparoscopic ure-terolithotomy was successful in all of our16 patients. Operative time ranged from2.4 to 4.5 hours (mean 3.2 hours). Hospi-tal stay ranged from 3 to 14 days (mean6.3 days). All patients were stone-free onpost-operative KUB. Only in 3 patientscomplication (prolonged urinary leak) oc-curred and one of these needed open sur-gery for closing the ureteral incision. Fol-low-up IVP was performed in 10 patientsand stone residue or ureteral obstructionwas not found in anyone.Conclusion: Based on our experience,transpertioneal laparoscopic ureterolithot-omy is a safe practical alternative for opensurgery in patients with large ureteralstones or when less invasive proceduresfail to treat the stone.
V-02.09Potency- and continence preservingradical cystectomy withhemiprostatectomyWolf M, Wunderlich H, Schubert JFriedrich-Schiller-University, Dept. ofUrology, Jena, Germany
Introduction: Radical cystectomy hasbeen the gold standard for treatment ofmuscle invasive bladder cancer. However,this kind of therapy may have an impacton quality of life, including sexual-, uri-nary and social function. For this reasonwe performed prostate sparing surgeryduring radical cystectomy for invasivebladder cancer.Materials and Methods: Between De-cember 2003 and December 2005 34 pa-tients with a mean age of 63.2 years un-derwent radical cystectomy withhemiprostatectomy due to bladder cancer.Preoperative evaluation included a normaldigital rectal examination, PSA lower than4 ng/ml and an inconspicuous transrectalultrasound. All patients underwent pros-tate biopsy preoperatively. Surgery con-
sisted of radical cystectomy, hemiprostate-ctomy and resection of the prostateadenoma in the lower part of prostate aswell as regional lymphadenectomy. Thefollow-up was 1-24 months.Results: Postoperative pathologicalstage was pTis in 2 patients, pTa in 1,pT1 in 5, pT2 in 20 and pT3 in 6 cases.Except of 7 patients no patient had adeterioration of sexual function. 30 pa-tients were fully continent during day-time and nighttime. The mean operationtime was 225 minutes (� 42 minutes,ranged 167-370 minutes). Mean opera-tive blood loss was 499 ml (� 255 ml,ranged 100-1000ml).Conclusion: Radical cystectomy withprostate sparing surgery in patients withinvasive bladder cancer allowed preserv-ing the external urethral sphincter andthe neurovascular bundles. It is abso-lutely necessary that this procedure isrestricted to highly selected patients,especially without concomitant prostatecancer.
V-02.10Laparoscopic radicalcystoprostatectomy (LRC)Pena J, Prera A, Gonzalez J, Hannaoui N,Vicente E, Garcia D, Abad C, Prats JServicio de Urologıa, Hospital de Sa-badell, Corporacio Sanitaria Parc Tauli,Sabadell, Spain
Introduction: Laparoscopic surgery is inclear expansion in our country given thatit has been shown a decrease of the mor-bidity associated to open surgery with atleast the same oncological results. LRC asis shown in the video is a feasible andreproducible proceeding.Methods: We show a video of a LRC as isdone in our centre. Bilateral pelvic limphnode dissection is simultaneously done.Specimen is removed on block (cystopros-tatectomy and lymphadenectomy). Wepresent the case of 87-year-old male diag-nosed by TUR of a pT2 G III transitionalcell carcinoma with CT scan and bonescan negative for metastasis. Patient com-plained of gross haematuria and severedysuria. We indicated a LRC with a bilat-eral cutaneous ureterostomy as urine di-version.Results: Postoperative evolution was cor-rect and he was discharged at day 6 ofsurgery. Ileous last 24 hours. Blood lostwas minimum and no transfusion was re-quired. Surgery took four and a halfhours.Conclusion: LRC is a feasible proceedingto be done by teams with previous experi-
ence in laparoscopic surgery. In our expe-rience, initial learning curve has beenshorter than the laparoscopic prostatec-tomy one. The chance of a LRC in elderlypatients must be kept in mind.
V-02.11Photodynamic assisted detection andtreatment of superficial bladdercancer using the photosensitizerHexvix®Thomas K, Ray E, Murphy D, ChattertonK, Khan S, O’Brien TGuy’s and St Thomas’ NHS FoundationTrust, London, UK
Introduction: Photodynamic assistedtransurethral resection (TUR) of bladdertumour may improve completeness of tu-mour resection. More precise mapping ofbladder cancer could translate into betteroutcomes. This video describes the tech-nique of photodynamic diagnosis (PDD)using Hexvix® in our unit.Patients and Methods: There are cur-rently 4 ongoing studies using the intra-vesical photosensitizer Hexvix® in ourunit; 1) a randomised trial of photody-namic assisted TUR versus standard whitelight TUR for primary superficial bladdercancer; 2) check cystoscopy post BCG; 3)positive urine cytology/no evidence ofdisease; 3) multi-focal tumour recurrence.Patients are consented for participation inthe appropriate study. The photosensitizerHexvix® is instilled into the bladder onthe ward at least 90minutes before theprocedure. The D-Light system (Storz) isused for the cystoscopy as it allows aswitch between white and blue light. Ini-tially a “white” light cystoscopy is per-formed and a bladder map obtained. Us-ing the same equipment a “blue” lightcystoscopy is performed and any areas offluorescence photographed and biopsied.Results: The photosensitizer Hexvix® iswell tolerated with no complications todate. Visualisation and colour contrast be-tween fluorescent tumour and non-fluores-cent urothelium are excellent. The tech-nique and interpretation of fluorescencehave been easily acquired. The presenceand histology of lesions detected underwhite and blue light is being compared.Conclusion: The technique of photody-namic diagnosis using Hexvix® can beeasily established in clinical practice andshows promise in detecting and treatingsuperficial bladder cancer but results areawaited.
VIDEO SESSIONS
206 UROLOGY 68 (Supplement 5A), November 2006
