1. CHALLENGING CASES URINARY RETENTION Charles Chabert

2. Introduction  Recommendation not to perform PVP on urinary retention in initial series  Submucosal varicosies- problematic bleeding  Older patient group, impaired detrusor contractility Charles Chabert

3. International GL Users 305 patients treated at 8 centres Mean F/U 4.2 months 63 in retention 120W HPS H Woo et al EU Supplement 7(2007) 378-383 Charles Chabert

4. Woo et al No retention (n=242)In retention (n=63) Age68.172 Prostate Vol (ml)59.768.2 IPSS21.929.1 Qmax (ml/sec)8.1NR PVR (ml)156719 Charles Chabert H Woo et al EU Supplement 7(2007) 378-383

5. Clinical Outcome Base lineFollow-up IPSS29.7 (n=18)7.8 (n=52) Qmax (ml/sec)Nr16.0 (n=48) PVR719 (n=49)43.3 (n=54) Prostate Vol68.2 9N=57)36.8 (N=57) Charles Chabert H Woo et al EU Supplement 7(2007) 378-383

6. Summary Patients in retention (p<0.01) anticoagulants and large prostates were significantly older than those in the opposing cohort Safe & effective Limited follow-up H Woo et al EU Supplement 7(2007) 378-383 Charles Chabert

7. Ruszat et al Eur Urol 2006 80W KTP n=183In retention (n=70)No retention (n=113) Prostate Vol (cc)60.8 (20-130)53.2 (10-180) Length of Stay (days)5.5 (3-15)5.3 (3-16) Length of IDC1.7 (1-7)1.8 (1-10) Charles Chabert Ruszat et al Eur Urol 2006;50:1040-9

8. Outcomes In retention (n=70)No retention (n=113) Re catheterisation12.9% (9 patients)10.6% (12 patients) IDC at discharge10% (7 patients)8.8% (10 patients) IDC free at 1 monthAll patients Ruszat et al Eur Urol 2006;50:1040-9 Charles Chabert

9. At 24 months (n=16) IPSS Baseline (% improvement)15.5 – 4.4 (71.6%) IPSS QoL (% improvement)3.5-0.9 (74.3%) Ruszat et al Eur Urol 2006 Ruszat et al Eur Urol 2006;50:1040-9 Charles Chabert

10. Complications Reoperation2.9% (2 patients) BN contracture0% Urethral stricture5.7% (5 patients) UTI4.3% Mild-moderate dysuria4.3% Transient Haematuria1.4% Charles Chabert Ruszat et al Eur Urol 2006;50:1040-9

11. PVP (80W) in men with urinary retention PatientsN=100 Residual Volumes > 1000ml48 Age years70.1 (51-88) Operative time (mins)57.5 (14-150) Cathetrisation time (hours)23.1 (3-72) Rajbabu et al J Endourol Aug 2006;20(suppl. 2): A242 abstract Charles Chabert

12. Complications Postoperative Haemorrhage2 Ureteric injury1 3 month F/UNo long term IDC Urethral Stricture1 Rajbabu et al J Endourol Aug 2006;20(suppl. 2): A242 abstract Charles Chabert

13. Summary  Safe and effecctive  Technically more challenging  Not recommended in initial series Charles Chabert