PD45-01\u2003ASSOCIATION OF LOCAL ANAESTHETIC WOUNDS INFILTRATION AND ULTRASOUND TRANSVERSUS ABDOMINAL PLANE (US-TAP) BLOCK IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL PROSTATECTOMY: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL

INTRODUCTION AND OBJECTIVES: To determinate bene\ufb01ts of the association of local anaesthetic wounds in\ufb01ltration and US-TAPblock with ropivacaine on postoperative pain, early recovery and hospital stay in patients undergoing robot assisted radical prostatectomy (RARP). METHODS: The study is double-blinded randomized controlled trial. Our hypothesis was that the association of wound in\ufb01ltration and US-TAP block with Ropivacaine would decrease immediate postoperative pain and opioids use. Primary outcomes included postoperative pain and opioids demand during the hospital stay. Secondary outcomes were nausea/vomiting rate, stool passing time, use of pro-kinetics, length of hospital stay and 30-days readmission to the hospital for pain or other US-TAP-block related complications RESULTS: A total of 100 patients who underwent RARP were eligible for the analysis; 57 received the US-TAP block with 20 ml of 0.35% Ropivacaine (US-TAP-block group) and 43 did not receive USTAP block (no-US-TAP group). All the patients received the local wound anaesthetic in\ufb01ltration with 20 ml of 0.35% Ropivacaine. USTAP block group showed a decreased mean NRS (2.7vs1.8; p[0.04) and reduced use of opioid (8 vs 2; p[0.01) in the \ufb01rst 24 h. Moreover, we found a shorter mean LOS (4.7 vs 4.2; p[ 0.04) with a reduced use of pro-kinetics during the hospital stay (31 vs 12; p<0.001). No US-TAP-block related complications to were reported. CONCLUSIONS: Association of anaesthetic wound in\ufb01ltration and US-TAP block with Ropivacaine as part of a multimodal analgesic regimen can be safely offered to patients undergoing RARP and ePLND. It improves the immediate post-operative pain control, reducing opioids administration and is associated to a decreased use of pro-kinetics and shorter hospital stay

43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Role of the preoperative post void residual urine in males underwent turp for lower urinary tract symptoms

Introduction and aim of the study: The role of post void residual (PVR) urine in the evaluation of men with lower urinary tract symptoms (LUTS) is still controversial due to the missing standardization of PVR pathological thresholds. Therefore, the influence of PVR on the decision\u2010making of treatments for males with LUTS remains unclear. Aim of this study was to assess the role and the values of the preoperative PVR in males underwent transurethral resection of the prostate (TURP) for LUTS and the related outcomes after the procedure. Materials and methods: This is a prospective ongoing study started in January 2017 involving males with LUTS candidates for TURP. The medical and urological history was recorded in all the population. Both preoperative evaluation and the 1\u2010year follow\u2010up consisted in: peak flow (Qmax), PVR, PVR\u2010ratio as the ratio of PVR to bladder volume (BV: voided volume + PVR), and the International Prostate Symptoms Score Questionnaire (IPSS). Patients were also distributed in groups according to preoperative PVR thresholds: i) PVR 0\u201050ml; ii) PVR 51\u2010100ml; iii) PVR 101\u2010150ml; iiii) PVR 151\u2010200ml; iiiii) PVR>200ml. Statistical analysis was performed using T\u2010test, Wilcoxon test, one\u2010way ANOVA test, the Kruskal\u2010Wallis Test.Results: Data were complete in 52 patients, with a mean age of 68.9+8.5 years. A significant improvement in voided volume, Qmax, PVR, IPSS score was documented (Table 1). The majority of the males showed a PVR <100ml (59.6%), while the remaining 21/52 patients (40.4%) had a PVR >100ml. No significant difference was found in Qmax and IPSS score among the groups, in both preoperative and postoperative assessment (Table 2). In each group we found a significant improvement in Qmax and IPSS score after prostate resection. Interpretation of results: Only a minor part of the males showed a high preoperative PVR (>100ml), therefore PVR did not have a crucial role in the decision\u2010making. Quite the reverse, Qmax and symptoms score had the main influence. PVR was not correlated to preoperative and postoperative Qmax and IPSS. This finding suggests that PVR was a poor predictive factor for the decision\u2010making and outcomes in males candidates for TURP. Conclusions: In our cohort a high PVR was present only in a minority of patients candidates for TURP and did not significantly influence the outcomes of TURP. This study confirmed that PVR is still a controversial and poor reliable parameter in the evaluation of males with LUTS as well in the treatments\u2019 decision\u2010making

43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Nocturnal polyuria in males with LUTS: Prevalence and association with nocturia, IPSS and uroflowmetry

Introduction and aim of the study: Nocturnal Polyuria (NP) is a common finding in males with nocturia and/or lower urinary tract symptoms (LUTS) [1]. This condition needs a multidisciplinary management and should be assessed to avoid misleading diagnoses and following useless and/or unsatisfactory treatment. Aims of the study were to evaluate in males with LUTS: 1) the prevalence of NP; 2) the relation between NP, nocturia, and both International Prostate Symptom Score (IPSS) and uroflowmetry (UF). Materials and methods: From 9/2016 to 11/2017 we enrolled 461 consecutive pts with LUTS into a prospective double\u2010centre study. Data collected were: detailed medical history, UF, Post Void Residual urine volume (PVR), a self\u2010administered IPSS and a 3 days frequency volume charts (FVC), indicating \u201cbedtime\u201d and \u201cwaking time\u201d. Frequency, voided volume and Nocturnal Polyuria index (NPi) were assessed by 3 days\u2010FVC, and compared with IPSS data. NP was defined as a NPi >33%, and severe NP as NPi >50% [2], nocturia as at least 1 mean episode of nocturnal voiding at 3 daysFVC. Analyses were performed considering: total IPSS score; IPSS\u2010item #2 (frequency score); IPSS\u2010item #7 (nocturia score); IPSS\u2010item #8 (bother score); peak flow (Qmax) at the UF; PVR. A subanalysis according to patients age was also performed. For statistics the Kruskal\u2010Wallis test was used. Results: Both IPSS and 3\u2010days FVC were completed in 162 pts (mean age 70.95 \ub1 8.04 years). Prevalence of NP was 54,9% (89/162 pts), while severe NP rate was 9.88% (16/162 pts) with a mean NPi of 34.4% \ub111,2. Table 1 shows NP prevalence according to patients ages. TABLE 1 NP prevalence according to patients ages; median IPSS answers, peak flow and PVR, stratified according to NPi. IQR=interquartile range. *the Kruskal\u2010Wallis test.Frequency volume chart analysis showed nocturia in 110 pts (68%), of these 69% (76/110) referred NP. Nocturia was documented in 85% of the population with NP (76/89). Similar results can be found in literature [3]. In Table 1 are also listed median IPSS scores, Qmax, and PVR stratified according to NPi. Only median IPSS #7 and total IPSS showed significant difference.Interpretation of results: Our data showed a high NP prevalence (>50%) among males complaining LUTS. In only a minor part of the patients NP was severe (<10%). NP was diagnosed also in pts without nocturia. More than 2/3 patients reporting nocturia had nocturnal polyuria. Therefore, misleading this two pathological conditions could involve useless and/or unsatisfactory treatments. These data stress the necessity to a whole evaluation of males with nocturia and not a simple focus on nocturia per se. NP influenced outcomes of median IPSS domain 7 and total IPSS score but not findings of IPSS domain related to quality of life and frequency. UF data (Qmax and PVR) did not change according to NPi. Therefore, NP did not impact the micturition and the bladder emptying. Conclusions: NP was a common condition in males with LUTS and nocturia, however it was severe only in a minority. Nocturnal production of urine did not influence the voiding pattern, nor the bladder emptying. IPSS was a valid tool to diagnose nocturia, while only FVC could identify NP. Our data suggest that physicians should look for NP among males with LUTS and nocturia to manage these patients with the most appropriate treatments using both FVC and IPSS

43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Influence of emotional condition on uroflowmetry

Introduction and aim of the study: The emotional condition of patients before uroflowmetry (UF) may affect the micturition and consequently the results of the examination. Limited literature data are available on the correlation between anxiety levels and uroflowmetry1. Aim of this study was to assess the correlation between emotional condition of the patients at UF and whether anxiety/embarrassment may affect patient\u2019s micturition. Materials and methods: This is a prospective multicenter ongoing study started on July 2018. Patients were enrolled during an office uroflowmetry. Data recorded were: demographics (sex, age, educational level), urological history (therapy, surgical urological treatment), International Prostate Symptoms Score (IPSS) questionnaire in males, and ICIQ\u2010FLUTS questionnaire in females. General anxiety level of the patient was evaluated by the General Anxiety Disorder \u2010 7 (GAD \u2010 7) questionnaire2 considering the levels of severity as following: score <5 no anxiety, 5 to 9 mild anxiety, 10 to 14 moderate anxiety, 15 to 21 severe anxiety. Moreover, to better understand the anxiety level related to UF we applied questions #4 to 6 of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).3 Levels of severity were considered as follow: 3 to 6 no anxiety, 7 to 10 moderate anxiety, 11 to 15 severe anxiety. Specific linker\u2010type scales assessed the subjective micturition satisfaction/reproducibility and the discomfort. A dedicated nurse measured post\u2010void residual (PVR) urine by bladder\u2010scan immediately after the examination. Statistical analysis was performed using one\u2010way ANOVA test, and Mann\u2010Whitney test. Results: Patients enrolled in the study were 125 (mean age 65+13 years): 85 men (68%) and 40 women (32%). Voided volumes, Qmax, PVR, and discomforts did not correlate with higher level of anxiety. However, greater anxiety negatively influenced the subjectivesatisfaction and the UF reproducibility. Patients with higher anxiety levels showed greater symptomatology questionnaires (Table 1\u20102). A general high level of anxiety was assessed by GAD in 41,6% (52/125) of the cohort, while a high level of UF\u2010related anxiety was recorded by APAIS in 42,4% (53/125). Women reported GAD score >5 in the 87.5% (35/40), and APAIS score >6 in the 70% (28/40). GAD score >5 and APAIS modified score >6 were documented in males in 44,7% (38/85) and 29% (25/85) respectively. The relation between GAD \u2010 APAIS levels and satisfaction/reproducibility and discomforts of the patient are reported in Tables 3 to 4. A low satisfaction/reproducibility of the examination was reported by 31.2% of the patients (39/ 125): 38.5% males and 45% females. High discomforts were recorded in 51.2% (74/125) of the population: 56.5% men and 65% women. Interpretation of results: Most factors may influence UF outcomes, but the level of anxiety has been poorly investigated. In our study a high levels of general, and UF\u2010related anxiety was found in 4/10 patients. Surprisingly, we found a severe discrepancy of anxiety levels between genders. Women were mostly affected by high general and UF\u2010related high anxiety. Quite the reverse, in men an impaired emotional condition was documented in less than a half of the cases. Moreover, the higher levels of anxiety mainly influenced the subjective satisfaction/reproducibility of the UF. However, no significant differences were found among the objective outcomes (VV/Qmax/PVR). Patients with higher anxiety levels showed worst results at the symptomatology questionnaires. The emotional condition poorly influenced the UF discomforts.Conclusions: A relevant rate of patients showed high anxiety levels. This study demonstrated that UF, although is a simple and not invasive test, has an important impact on the emotional condition of the patients, mostly in women. This issue should be considered in the counseling of the patients. Anxiety influenced the subjectivity of the patients leading to the sensation of not having reproduced the normal urinary pattern. Therefore, a proper counseling may lower anxiety levels obtaining more physiological results at UF

Evaluation of post-void residual urine and functional outcomes in healty young volunteers

Introduction and aim of the study: Post\u2010void residual (PVR) urine is a debated part in the assessment of patients with lower urinary tract symptoms (LUTS) due to its not standardized threshold. Aim of this study was to measure PVR in young and healthy males and females. Materials and methods: This is an observational prospective multicenter ongoing study started on January 2018, involving volunteers both men and women with age 18 to 35 years. Medical history was recorded. Volunteers were asked to perform a uroflowmetry (UF) whit a normal micturition desire. A VAS scale was marked by each volunteer indicating the subjective evaluation of the voiding at UF compared to the habitual micturition at home. Peak\u2010flow (Qmax), voided volume and the curve of the UF were registered. PVR was measured immediately after the UF with a bladder scan. PVR\u2010ratio, as the ratio of PVR to bladder volume (BV: voided volume + PVR) was also calculated. Males filled the International Prostate Symptoms Score (IPPS) questionnaire, while women both W\u2010IPSS and ICIQ\u2010FLUTS. Population was also divided according with IPSS/WIPSS severity scores: (i) 0 to 7; (ii) 8 to 19; (iii) 20 to 39. UF data were also plotted on Liverpool nomograms. Statistical analysis was performed using T test and Mann\u2010Whitney test. Exclusion criteria were: urological and neurological diseases, surgery of the urinary tract or the pelvis or genitalia, pharmacological therapies, previous urethral catheterization, radiation therapy of the pelvis. Informed consent was obtained by all the volunteers. Results: A total amount of 114 volunteers were enrolled, 45.6% (n 52) males and 54.4% (n 62) females. Mean age was 26 years.o. (18\u201035). Table 1 reports data on Qmax, PVR, PVR \u2010ratio IPSS/WIPSS of the population. Mean ICIQ\u2010FLUTS score was 2.8 \ub1 3.9, and the median 2 (1\u20103). According to IPSS\u2010WIPSS scores 98.2% (n 110/112) of the volunteers reported a score <8, and 2 males (1.8%) referred an IPSS score between 8 and 19. VAS scale of the subjective evaluation of voiding was <6 in 5.3% (n 6/114) of the population. Table 2 reports outcomes according to Liverpool nomograms. A PVR of 0mL was found in 60.5% of the population (69/114), in 63% of the males (34/54) and in 56.4% of the females (35/62). A PVR>50 ml was found in 12.3% of the cohort (14/114): 7.7% of males (4/52%) and 16.1% (10/62). A PVR\u2010ratio >10% was found in 21% of the volunteers (24/114), in 17.3% in males (9/52) and 24.2% in females (15/62). Interpretation of results: In a young and healthy population with regular UF parameters only 60% had no PVR, while 1/10 volunteers showed a PVR >50ml, with a double rate in female volunteers. PVR \u2010ratio was found two times higher in females. The PVR\u2010ratio >10% was present in 1/5 volunteer, and more common in females.Although our population reported no lower urinary tract symptoms at the medical history, with normal symptom scores, surprisingly 17% of the volunteers showed an abnormal score at the Liverpool nomograms. Volunteers of this subgroup showed significantly lower Qmax without significant difference in PVR volumes. This data may indicate that PVR could be a poor reliable parameter of pathological bladder emptying. Conclusions: In a non\u2010negligible part of young and healthy population a PVR was documented. In females PVR wasamorefrequentfindingwithvolumestwotimeshigher. Liverpool nomograms evaluation recognized a significant part of the volunteers as pathological. This group had a significant lower Qmax, but no significant higher PVR. This data may confirm the controversial role of PVR in the evaluation of patients with voiding dysfunction

Impact of Combination of Local Anesthetic Wounds Infiltration and Ultrasound Transversus Abdominal Plane Block in Patients Undergoing Robot-Assisted Radical Prostatectomy: Perioperative Results of a Double-Blind Randomized Controlled Trial

Objective: To determinate benefits of the combination of local anesthetic wounds infiltration and ultrasound transversus abdominal plane (US-TAP) block with ropivacaine on postoperative pain, early recovery, and hospital stay in patients undergoing robot-assisted radical prostatectomy (RARP). Methods: The study is double-blinded randomized controlled trial. Our hypothesis was that the combination of wound infiltration and US-TAP block with ropivacaine would decrease immediate postoperative pain and opioids use. Primary outcomes included postoperative pain and opioids demand during the hospital stay. Secondary outcomes were nausea/vomiting rate, stool passing time, use of prokinetics, length of hospital stay (LOS), and 30-days readmission to the hospital for pain or other US-TAP block-related complications. Results: A total of 100 patients who underwent RARP were eligible for the analysis; 57 received the US-TAP block with 20 mL of 0.35% ropivacaine (US-TAP block group) and 43 did not receive US-TAP block (no-US-TAP group). All the patients received the local wound anesthetic infiltration with 20 mL of 0.35% ropivacaine. US-TAP block group showed a decreased mean Numerical Rating Scale (NRS) within 12 hours after surgery (1.6 vs 2.6; p = 0.02) and mean NRS (1.8 vs 2.7; p = 0.04) with lesser number of patients who used opioid (3.5% vs 18.6%; p = 0.01) during the first 24 hours. Moreover, we found a shorter mean LOS (4.27 vs 4.72, days; p = 0.04) with a lower requirement of prokinetics administration during the hospital stay (21% vs 72%; p < 0.001). No US-TAP block-related complications were reported. Conclusion: Combination of anesthetic wound infiltration and US-TAP block with ropivacaine as part of a multimodal analgesic regimen can be safely offered to patients undergoing RARP and extended pelvic lymph node dissection. It improves the immediate postoperative pain control, reducing opioids administration and is associated to a decreased use of prokinetics and shorter hospital stay

Rotterdam mobile phone app including MRI data for the prediction of prostate cancer: A multicenter external validation

Objectives: The Rotterdam Prostate Cancer Risk calculator (RPCRC) has been validated in the past years. Recently a new version including multiparametric magnetic resonance imaging (mpMRI) data has been released. The aim of our study was to analyze the performance of the mpMRI RPCRC app.Methods: A series of men undergoing prostate biopsies were enrolled in eleven Italian centers. Indications for prostate biopsy included: abnormal Prostate specific antigen levels (PSA&gt;4 ng/ml), abnormal DRE and abnormal mpMRI. Patients' characteristics were recorded. Prostate cancer (PCa) risk and high-grade PCa risk were assessed using the RPCRC app. The performance of the mpMRI RPCRC in the prediction of cancer and high-grade PCa was evaluated using receiver operator characteristics, calibration plots and decision curve analysis.Results: Overall, 580 patients were enrolled: 404/580 (70%) presented PCa and out of them 224/404 (55%) presented high-grade PCa. In the prediction of cancer, the RC presented good discrimination (AUC = 0.74), poor calibration (p = 0.01) and a clinical net benefit in the range of probabilities between 50 and 90% for the prediction of PCa (Fig. 1). In the prediction of high-grade PCa, the RC presented good discrimination (AUC = 0.79), good calibration (p = 0.48) and a clinical net benefit in the range of probabilities between 20 and 80% (Fig. 1).Conclusions: The Rotterdam prostate cancer risk App accurately predicts the risk of PCa and particularly high-grade cancer. The clinical net benefit is wide for high-grade cancer and therefore its implementation in clinical practice should be encouraged. Further studies should assess its definitive role in clinical practice. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved