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Highlights from the Irish Society of Urology Annual Meeting 2018

 

Dr Kent T. Perry Jr. delivers a lecture on minimally invasive kidney surgery

The Irish Society of Urology annual meeting has a strong tradition of attracting world class guest speakers, and this year was no different. We were joined by Dr Kent T. Perry Jr. (Co-Director of the Minimally Invasive Surgery Program & Associated Professor at Northwestern University Chicago), Professor Hendrik Van Poppel (Adj. Secretary General of EAU for Education), Mr Jeremy Ockrim (Honorary Lecturer and Consultant Urologist at University College London), Mr Kieran O’Flynn (Immediate BAUS past president and Consultant Urologist at Salford Royal Foundation), and Dr Matthias Hofer (Assistant Professor at Dept. Urology, Northwestern University Chicago). The excellent programme of guest speakers started on Friday afternoon with Dr Matthias Hofer’s talk on urethral reconstruction-a ‘no frills’ overview of a complex topic which surely inspired several trainees in the room to consider a career in Reconstructive Urology.

The historic Strokestown House, Co. Roscommon

The Saturday formal dinner was held in the historic Strokestown House in Roscommon-the former home of the Packenham Mahon family, built on the site of a 16th Century castle, which was home to the O’Conor-Roe Gaelic Chieftains. It is now the site of the National Famine Museum. We were treated to a fascinating tour of the house on arrival, before enjoying a wonderful dinner, and some fantastic harp-playing. The presidential chain was conferred to the incoming president, Mr Paul Sweeney of The Mercy University Hospital in Cork, and the society are already looking ahead to exciting things during his tenure as president.

 

About the authors:

Dr Clare O’Connell is a first year Urology SpR in the Department of Urology & Transplant in Beaumont Hospital, Dublin (@oconnellclare).

 

 

 

Dr Sorcha O’Meara is a second year Urology SHO in the Department of Urology in The Mater Misericordiae University Hospital, Dublin (@sorchaOm).

 

 

 

Video: Aquablation – image-guided robot-assisted waterjet ablation of the prostate

Aquablation – image-guided robot-assisted waterjet ablation of the prostate: initial clinical experiences

Peter Gilling, Rana Reuther, Arman Kahokehr and Mark Fraundorfer

 

Department of Urology, Tauranga Hospital, Tauranga, New Zealand

 

Objective

To assess the safety and feasibility of aquablation in a first-in-man study. Aquablation is a novel minimally invasive water ablation therapy combining image guidance and robotics (aquabeam®) for the targeted and heat-free removal of prostatic tissue in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Patients and Methods

A prospective, non-randomised, single-centre trial in men aged 50–80 years with moderate-to-severe LUTS was conducted. Under real-time image-based ultrasonic guidance, aquabeam technology enables surgical planning and mapping, and leads to a controlled heat-free resection of the prostate using a high-velocity saline stream. Patients were evaluated at 1, 3, and 6 months after aquablation.

Results

In all, 15 patients were treated with aquablation under general anaesthesia. The mean (range) age was 73 (59–86) years and prostate size was 54 (27–85) mL. A substantial median lobe was present in six of the 15 patients. The mean International Prostate Symptom Score (IPSS) was 23 and the maximum urinary flow rate (Qmax) was 8.4 mL/s at baseline. The mean procedural time was 48 min with a mean aquablation treatment time of 8 min. All procedures were technically successful with no serious or unexpected adverse events (AEs). All but one patient had removal of catheter on day 1, and most of the patients were discharged on the first postoperative day. No patient required a blood transfusion, and postoperative sodium changes were negligible. There were no serious 30-day AEs. One patient underwent a second aquablation treatment within 90 days of the first procedure. The mean IPSS score statistically improved from 23.1 at baseline to 8.6 at 6 months (P < 0.001) and the Qmax increased from 8.6 mL/s at baseline to 18.6 mL/s at the 6-month follow-up (P < 0.001). At 6 months, the mean detrusor pressure at Qmax decreased to 45 cmH20 from 66 cmH20 at baseline (P < 0.05), and the mean prostate size was reduced to 36 mL, a 31% reduction in size vs baseline (P < 0.001). No cases of urinary incontinence or erectile dysfunction were reported.

Conclusions

These preliminary results from this initial study show aquablation of the prostate is technically feasible with a safety profile comparable to other BPH technologies. The combination of surgical mapping by the operating surgeon and the high-velocity saline provides a promising technique delivering a conformal, quantifiable, and standardised heat-free ablation of the prostate. Advantages of this technique include reduction in resection time compared with other endoscopic methods, as well as the potential to preserve sexual function.

 

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