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MP-05.08: Laparoscopic adrenalectomy for suspected metastasis of the adrenal glands: our experience
MODERATED POSTER SESSIONS
1.25%), c) Two renal and inferior polar artery (4 cases, 1.67%). There were cases where the origin was not the same on both sides. B] Veins: The renal vessel system has obtained great interest recently because of vascular surgery and transplantations. Generally we knew that the variation of veins is greater than the respective arteries. 1) The left renal vein – in our study group- is a single vein. Of course, it is probable to bifurcated forming a loop around the abdominal aorta (7 cases, 2.92%). In the total of our cases the left renal vein received vein return from a suprarenal vein and from the internal spermatic vein. The junction of the above referred veins with the left renal one was done in an almost perpendicular way and this has a clinical significance, particularly in the second case. The existence of a second inferior vena cava (persistent inferior vena cava) leading to the left renal vein (4 cases, 1.67%) and the retro aortal route of the renal vein (5 cases, 2.08%) were remarkable cases. 2) The right renal vein does not show many differences referring its route. In 71 cases (29.58%) it was found to be double. Also, in 32 cases (13.33%) had 3 right renal veins. We did not observe any other veins leading to the right renal vein. Conclusion: Our conclusion is that the right renal vein is multiple to a significant amount. Abstract Withdrawn MP-05.08 Laparoscopic adrenalectomy for suspected metastasis of the adrenal glands: our experience Castillo O1,2, Vitagliano G1, Kerkebe M1, Dı´az M1, Sa´nchez-Salas R1, Foneron A1 1 Section of Endourology and Laparoscopic Urology, Department of Urology, Clı´nica Santa Maria; 2Department of Urology, School of Medicine, Universidad de Chile, Santiago, Chile Introduction: We present our experience in laparoscopic adrenalectomy for isolated adrenal metastasis. Methods: A total of 34 adrenalectomies were performed in 32 patients for incidental adrenal masses discovered at the time of primary tumor diagnosis or during follow-up. Primary tumors were: 13 lung carcinoma, 9 renal cell carcinoma, 2 colorectal carcinoma, 2 bladder carcinoma and 1 ovarian carcinoma, breast cancer, gastric cancer and melanoma respectively. Two patients had no history of a primary tumor. Mean patient age was 59 years
64
(range 26 - 75). Male to female ratio was 1.9:1. Results: Mean operative time was 87 minutes (range 40 - 240). Average blood loss was 89 ml (range 0 - 1000). There was no need for conversion to open surgery. Mean hospital stay was 3 days (range 1 5). There was 1 intraoperative diaphragmatic lesion repaired laparoscopically and 1 patient had a pancreatic fistula which was managed by percutaneous drainage. Mean tumor size was 4.3 cm (range 1.5 9). Microscopic analysis showed 22 malign lesions (64.7%) and 12 cases of benign pathology (35.3%). Mean survival time was 26 months (range 4 – 64) for the 22 patients with malign lesions. In 2 patients (9.1%) surgical margins were positive. Conclusions: Laparoscopic adrenalectomy for small isolated metastases is feasible. However, due high risk of positive margins this procedure should only be done by expert laparoscopist. We haven’t found correlation between mass size and malignancy. Nevertheless, we believe that longer follow-up is mandatory before definitive conclusions are drawn.
Results: Overall the prevalence of prostatic involvement was 83%, this includes prostate adenocarcinoma, PIN 3 and TCC invasion. Prostate adenocarcinoma was identified in 47% of specimens (n⫽14). 10% were considered clinically insignificant, that is less than 1% tissue involved and Gleason score less than 7. The mean Gleason score was 6. 71% (n⫽10) of tumours arose from the apex. 14% (n⫽2) showed extra prostatic extension. Overall PIN 3 was found in 43% of specimens (n⫽13) and isolated PIN 3 was found in 27% (n⫽8). TCC invasion was identified in 13% of cases (n⫽4). Of the patients who were identified to have incidental prostate adenocarcinoma at the time of surgery, none have developed biochemical recurrence of their disease during follow up. Conclusions: The prevalence of prostate lesions found at the time of radical cystectomy is among the highest rates published. In addition the majority of prostate cancers were seen to arise from the apex of the gland. This would necessitate very careful selection of patients for prostate or partial prostate sparing cystectomy.
MP-05.09 Prevalence of incidental prostate cancer in radical cystectomy specimens Sweeney C, Hendry DS Gartnavel General Hospital, Glasgow, UK
Abstract Withdrawn
Objective: Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer. Coexistence of prostatic TCC and incidental prostate adenocarcinoma has traditionally required en bloc resection of the prostate at the time of radical cystectomy. Recently however, with improved survival rates, interest has surrounded total or partial prostate sparing cystectomy in well selected patients, with a view to improved quality of life. Studies have reported high rates of continence and retained erectile function following prostate sparing surgery. We aimed to determine the prevalence of prostatic malignancy among men undergoing radical cystectomy. Patients & Methods: Between 2004 and 2006 at this hospital, 40 patients have undergone radical cystectomy for muscle invasive bladder cancer. All procedures were performed by the same surgeon. 30 patients were male, mean age 68.7 (range 55 to 80). The pathology reports of these patients were reviewed. Two different pathologists had reported all the specimens.
MP-05.10 Antegrade versus retrograde stenting in laparoscopic pyeloplasty: a two centre analysis Arumainayagam N1, Minervini A2, Davenport K1, Kumar V1, Masieri L2, Serni S2, Carini M2, Timoney AG1, Keeley F1 1 Bristol Urological Institute, Southmead Hospital, Bristol, UK; 2Department of Urology, Careggi Hospital, University of Florence, Florence, Italy Objective: To compare operative times between retrograde and antegrade ureteric stenting as part of laparoscopic pyeloplasty. Patients & Methods: Laparoscopic pyeloplasty procedures from January 2002 to January 2007 were identified through a prospective database. Procedures on 126 patients were carried out using the same transperitoneal technique apart from the method of stenting, which was performed in either a retrograde manner before laparoscopy or an antegrade manner during the laparoscopic portion of the procedure. Results: A total of 45 patients underwent antegrade stenting, 50 had retrograde stenting, 20 patients already had a stent in place, and 8 patients had a retrograde pyelogram followed by antegrade stenting. Operative time in antegrade stented patients was significantly faster than the ret-
UROLOGY 70 (Supplment 3A), September 2007
1.25%), c) Two renal and inferior polar artery (4 cases, 1.67%). There were cases where the origin was not the same on both sides. B] Veins: The renal vessel system has obtained great interest recently because of vascular surgery and transplantations. Generally we knew that the variation of veins is greater than the respective arteries. 1) The left renal vein – in our study group- is a single vein. Of course, it is probable to bifurcated forming a loop around the abdominal aorta (7 cases, 2.92%). In the total of our cases the left renal vein received vein return from a suprarenal vein and from the internal spermatic vein. The junction of the above referred veins with the left renal one was done in an almost perpendicular way and this has a clinical significance, particularly in the second case. The existence of a second inferior vena cava (persistent inferior vena cava) leading to the left renal vein (4 cases, 1.67%) and the retro aortal route of the renal vein (5 cases, 2.08%) were remarkable cases. 2) The right renal vein does not show many differences referring its route. In 71 cases (29.58%) it was found to be double. Also, in 32 cases (13.33%) had 3 right renal veins. We did not observe any other veins leading to the right renal vein. Conclusion: Our conclusion is that the right renal vein is multiple to a significant amount. Abstract Withdrawn MP-05.08 Laparoscopic adrenalectomy for suspected metastasis of the adrenal glands: our experience Castillo O1,2, Vitagliano G1, Kerkebe M1, Dı´az M1, Sa´nchez-Salas R1, Foneron A1 1 Section of Endourology and Laparoscopic Urology, Department of Urology, Clı´nica Santa Maria; 2Department of Urology, School of Medicine, Universidad de Chile, Santiago, Chile Introduction: We present our experience in laparoscopic adrenalectomy for isolated adrenal metastasis. Methods: A total of 34 adrenalectomies were performed in 32 patients for incidental adrenal masses discovered at the time of primary tumor diagnosis or during follow-up. Primary tumors were: 13 lung carcinoma, 9 renal cell carcinoma, 2 colorectal carcinoma, 2 bladder carcinoma and 1 ovarian carcinoma, breast cancer, gastric cancer and melanoma respectively. Two patients had no history of a primary tumor. Mean patient age was 59 years
64
(range 26 - 75). Male to female ratio was 1.9:1. Results: Mean operative time was 87 minutes (range 40 - 240). Average blood loss was 89 ml (range 0 - 1000). There was no need for conversion to open surgery. Mean hospital stay was 3 days (range 1 5). There was 1 intraoperative diaphragmatic lesion repaired laparoscopically and 1 patient had a pancreatic fistula which was managed by percutaneous drainage. Mean tumor size was 4.3 cm (range 1.5 9). Microscopic analysis showed 22 malign lesions (64.7%) and 12 cases of benign pathology (35.3%). Mean survival time was 26 months (range 4 – 64) for the 22 patients with malign lesions. In 2 patients (9.1%) surgical margins were positive. Conclusions: Laparoscopic adrenalectomy for small isolated metastases is feasible. However, due high risk of positive margins this procedure should only be done by expert laparoscopist. We haven’t found correlation between mass size and malignancy. Nevertheless, we believe that longer follow-up is mandatory before definitive conclusions are drawn.
Results: Overall the prevalence of prostatic involvement was 83%, this includes prostate adenocarcinoma, PIN 3 and TCC invasion. Prostate adenocarcinoma was identified in 47% of specimens (n⫽14). 10% were considered clinically insignificant, that is less than 1% tissue involved and Gleason score less than 7. The mean Gleason score was 6. 71% (n⫽10) of tumours arose from the apex. 14% (n⫽2) showed extra prostatic extension. Overall PIN 3 was found in 43% of specimens (n⫽13) and isolated PIN 3 was found in 27% (n⫽8). TCC invasion was identified in 13% of cases (n⫽4). Of the patients who were identified to have incidental prostate adenocarcinoma at the time of surgery, none have developed biochemical recurrence of their disease during follow up. Conclusions: The prevalence of prostate lesions found at the time of radical cystectomy is among the highest rates published. In addition the majority of prostate cancers were seen to arise from the apex of the gland. This would necessitate very careful selection of patients for prostate or partial prostate sparing cystectomy.
MP-05.09 Prevalence of incidental prostate cancer in radical cystectomy specimens Sweeney C, Hendry DS Gartnavel General Hospital, Glasgow, UK
Abstract Withdrawn
Objective: Radical cystectomy is the gold standard treatment for muscle invasive bladder cancer. Coexistence of prostatic TCC and incidental prostate adenocarcinoma has traditionally required en bloc resection of the prostate at the time of radical cystectomy. Recently however, with improved survival rates, interest has surrounded total or partial prostate sparing cystectomy in well selected patients, with a view to improved quality of life. Studies have reported high rates of continence and retained erectile function following prostate sparing surgery. We aimed to determine the prevalence of prostatic malignancy among men undergoing radical cystectomy. Patients & Methods: Between 2004 and 2006 at this hospital, 40 patients have undergone radical cystectomy for muscle invasive bladder cancer. All procedures were performed by the same surgeon. 30 patients were male, mean age 68.7 (range 55 to 80). The pathology reports of these patients were reviewed. Two different pathologists had reported all the specimens.
MP-05.10 Antegrade versus retrograde stenting in laparoscopic pyeloplasty: a two centre analysis Arumainayagam N1, Minervini A2, Davenport K1, Kumar V1, Masieri L2, Serni S2, Carini M2, Timoney AG1, Keeley F1 1 Bristol Urological Institute, Southmead Hospital, Bristol, UK; 2Department of Urology, Careggi Hospital, University of Florence, Florence, Italy Objective: To compare operative times between retrograde and antegrade ureteric stenting as part of laparoscopic pyeloplasty. Patients & Methods: Laparoscopic pyeloplasty procedures from January 2002 to January 2007 were identified through a prospective database. Procedures on 126 patients were carried out using the same transperitoneal technique apart from the method of stenting, which was performed in either a retrograde manner before laparoscopy or an antegrade manner during the laparoscopic portion of the procedure. Results: A total of 45 patients underwent antegrade stenting, 50 had retrograde stenting, 20 patients already had a stent in place, and 8 patients had a retrograde pyelogram followed by antegrade stenting. Operative time in antegrade stented patients was significantly faster than the ret-
UROLOGY 70 (Supplment 3A), September 2007