CUA KELOWNA: BPH & PROSTATITIS

In contrast to the large number of papers on prostate cancer, this year's CUA meeting in Kelowna had very few presentations on BPH and prostatitis. This perhaps reflects a decrease in the investigation of new technologies and a resurgence of interest in, and refinement of, traditional methods of prostate resection.

Interstitial Nd:YAG photocoagulation was explored by Leboeuf & associates at the University of Montreal in a small study of 43 patients who were treated and discharged the same day. Symptom scores and peak flow showed sustained improvement out to 24 months and there was an 18% diminution in prostate size. Catheters were left in place for 7 days however, and there was a 17% reintervention rate.

The ongoing multicentre results of the Targis transurethral thermal therapy were presented by Ramsey of the University of Manitoba in both podium and poster sessions. Urodynamic studies showed improvements in BOO, though flow rates were not as good as with TURP. Symptom score and quality of life improvements however, were similar to those achieved by TURP. Targis thermotherapy is as effective for large glands as for small glands and is felt to be a satisfactory treatment for those failing medical management but who wish to avoid surgery.

An intriguing poster by the group at UWO suggests that post TURP urethral strictures may be caused by capacitative currents along the resectoscope sheath, especially with faulty insulated loops and non-conductive gel. Some generators produced less capacitance and were associated with less risk for urethral burn. The take home message was to use generous amounts of gel, avoid poorly insulated loops, and there may be an advantage to using those generators producing less capacitance.

Krahn & Glezerson from Winnipeg presented their large series of Holmium Laser prostatectomy, and concluded that the majority of cases could be done in an ambulatory care setting, thus reducing hospital costs. Most patients took the catheter out themselves at home. Early complication rates were considered acceptable with a readmission rate of 7.1% and retreatment rate of 5%.

Two studies from Queen's University on Prostatitis were presented. One was a community based study using the NIH - Chronic Prostatitis symptom index, and it showed that almost 10% of the population had prostatitis-like symptoms.

The second paper presented a multicentre study on the effect of antibiotics on chronic prostatitis/chronic pelvic pain syndrome, and in particular whether culture, immune status or prostate fluid leucocyte count would predict the success or failure of antibiotic treatment. Surprisingly, none of these parameters was helpful in determining the response to therapy. All groups, regardless of the presence of documented bacterial infection, had improvement in their symptoms including pain.

The authors suggested that empiric antibiotic use may therefore be of some value but cautioned that further placebo controlled trials would be necessary.

Finally, Roger Kirby of St George's Hospital, London gave a fascinating and provocative talk on Men's Health, arguing for Urologists as advocates not merely of patients with genitourinary disease, but as counselors for the whole spectrum of diseases causing the gender gap in mortality. Men die on average almost six years earlier than women, and this is due to several factors involving risky behaviour such as AIDS, alcohol abuse, smoking, homicide, in addition to well recognized conditions such as heart disease and cancer.

Mr. Kirby proposed that as urologists we have unrivalled access to the male population, and that we should use that access to take our health care mandate beyond the narrow confine of urological disease into the broader realm of disease prevention in men.