MP-19.17: Prediction of Therapeutic Shock Wave Lithotripsy Outcome of Renal and Upper Ureter Stone by Non-Enhanced Computed Tomography

MODERATED POSTER SESSIONS

side – PUJ segment – 5, upper ureter – 9, middle ureter – 3, lower ureter – 10; on the right side – PUJ segment – 3, upper ureter – 10, middle ureter – 2, lower ureter – 12. Results: In group A 19 (76%) patients had no complications and serum creatinine level dropped to normal after the first session ESWL. 6 patients needed ureteral catheterization or percutaneous nephrostomy because of rising serum creatinine. In group B no complications were observed in 21 (78%) patients and serum creatinine level returned back to normal. 6 patients needed auxiliary procedures. After normalization of serum creatinine patients underwent repeat sessions of ESWL if need. Conclusion: ESWL is effective method in immediate relief of obstruction in patients with oligo-anuria because of stone obstruction – in 75-80% urinary drainage was avoided and ESWL treatment was successfully carried out. MP-19.15 Extracorporeal Shock Wave Lithotripsy (ESWL) vs Percutaneous Nephrolithotomy (PNL) for Lower Pole Stones Larger than 10 mm: Own Experience Managadze G, Varshanidze L, Tevzadze K, Gabunia N, Managadze L National Center of Urology, Tbilisi, Georgia Introduction and Objective: Efficacy of ESWL and PNL was compared in treatment of lower caliceal ⬎10 mm stones. Materials and Methods: There were 132 patients with symptomatic lower caliceal stones larger than 10 mm who were treated in our institution from 2007 to 2008, 102 patients underwent ESWL and 30 – PNL. ESWL was performed with “Dornier Compact Delta”, while PNL was performed with “Storz – Calcuson”. Exclusion criterias were concomitant urinary stone(s) in other location, stones in calyceal diverticula, anatomical anomaly (horseshoe kidney, duplex system) or previous stone treatment. There were no significant differences in age and sex between the two groups (p ⫽ 0.932). Stone size was 10 – 27 mm for ESWL and PNL groups (p⬍0.001). Successful outcome was defined as radiological and sonografical stone-free state without symptoms 1 month after treatment. Hospital stay and complications rate were compared. Results: The overall stone-free rates after ESWL and PNL at 1 month were 46% and 92,3%, respectively. PNL was more effective in treating lower pole ⬎10 mm

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stones, even though the stone size was significantly larger than in ESWL group. Mean hospital stay for PCNL was 4,15 days, which was significantly longer than that for ESWL (1.21 days, p ⬍ 0.001). Complication rates were 25,5% (infection, clot retention, anemia) for PNL and 9,5% (pain, steinstrasse, hematoma) for ESWL. Treatment type does not contribute to complication rate (p ⫽ 0.146). Treatment type (p ⬍ 0.001), Gender (p ⫽ 0.03) and Age (p ⫽ 0.03) correlate with complication rate. One patient required blood transfusion for significant anemia after PCNL. Conclusion: PCNL is more effective in treating lower pole ⬎10 mm stones. Hospital stay in PCNL group was significantly longer, but high rate of successful outcome would translate into early discharge of patients and costs-effectiveness in the long run. MP-19.16 The Correlation between Urinary pH and Metabolic Syndrome in the Adult Korean Men Who Visited Health Promotion Center Yang W1, Song Y1, Kim J2 1 Dept of Urology, Soonchunhyang University College of Medicine, Seoul, South Korea; 2Dept of Urology, Gwangju Christian Hospital, Gwangju, South Korea Introduction and Objective: Low urinary pH (ⱕ5.5) was the most powerful risk factor of idiopathic uric acid stone and an acidic urine has been described as a renal manifestation of the metabolic syndrome. We evaluated the association between urinary pH and metabolic syndrome in the ostensively healthy adult Korean men. Materials and Methods: From 2004 to 2008, a total of 18,513 adult men who visited our health promotion center were enrolled in this study. The relation between urinary pH and various parameters associated with metabolic syndrome were evaluated. Results: The average age was 45.6 (1895), and 4,987 men (26.9%) were classified into metabolic syndrome. Mean urinary pH of metabolic syndrome group was 5.91, which was significantly lower than that of normal group (6.08). In univariate and multivariate analysis, body mass index (BMI), serum triglyceride, blood sugar were negatively correlated with urinary pH (p⬍0.05). In multivariate logistic regression analysis between low urinary pH (ⱕ5.5) and metabolic syndrome components, BMI (ⱖ25kg/m2), hypertriglyceridemia (ⱖ150mg/dl), high

fasting glucose (ⱖ110mg/dl) were the significant factors to predict low urinary pH below 5.5. Conclusions: This study revealed the metabolic syndrome was related with lower urinary pH in the ostensively healthy adult men. Further studies are needed to elucidate the exact mechanism responsible for the lower urine pH in individuals with the metabolic syndrome. MP-19.17 Prediction of Therapeutic Shock Wave Lithotripsy Outcome of Renal and Upper Ureter Stone by Non-Enhanced Computed Tomography Yu J, Sung L, Noh C, Chung J Inje University, Sanggye Paik Hospital, Seoul, South Korea Introduction and Objective: The outcome of Shock Wave Lithotripsy (SWL) depends on many factors including stone size, location, composition, fragility, etc. There have been many studies that Hounsfield Unit (HU) in non-enhanced computed tomography (NECT). NECT is useful parameter for prediction of therapeutic SWL. The aim of our study is to analyze the relationships between the characteristics of renal stones & upper ureter stone and SWL outcomes by NECT. Materials and Methods: Between March 2007 and March 2008, we evaluated 63 patients with solitary renal and upper ureteral calculi diagnosed by NECT undergoing SWL. The age, body mass index (BMI) of patients, size, location, HU density, and skin-to-stone distance (SSD) were assessed with the use of univariate and multivariate analysis. The HU density was evaluated by measuring three different areas of the stone on NECT. The SSD was calculated by averaging three distances from the skin to the stone on NECT. Failure of disintegration was defined as fragments bigger than 4 mm. We evaluated the ideal cut-off value of HU which could predict failure of SWL by using Receiver Operator Characteristic (ROC) curve. Results: Success of disintegration was observed in 48 patients (76.2%). The mean HU was 758.7⫾250.0 HU for success group versus 1232.1⫾472.4 HU for failure group. In ROC curve for predicting failure of therapeutic SWL, cut off value was ⬎794 HU (Area under the ROC curve: 0.812, 95% Confidence interval: 0.693-0.899, p⬍0.0001). On univariate analysis, HU and size were predictors for therapeutic SWL (p⬍0.0001, p⬍0.0001). By multivariate analysis, HU was a significant predictor as much as size (p⫽0.005441, p⫽0.006947).

UROLOGY 74 (Supplment 4A), October 2009

MODERATED POSTER SESSIONS

Conclusions: We therefore recommend that patients with a stone density ⬎ 794 HU should be considered for alternative therapy due to the high failure rates. This study shows that stone density of renal and upper ureteral calculi does predict the success of ESWL outcome.

Moderated Poster Session 20: Bladder Cancer 2 Thursday, November 5 10:45-12:15

CXCR4. On the contrary, CXCR4 was not detected in mouse and human normal bladder urothelium. Fluorescent T140 analogues could specifically label and illuminate bladder cancer cell lines on dish, human urothelial cancer cells in urine, and human bladder cancer specimens, although non-malignant cells and urothelium were not labeled. They could also label and visualize mouse superficial cancers, which were too small to recognize by phase contrast observation, on the urothelium. Conclusions: These results suggest that the fluorescent T140 analogue is a promising diagnostic tool to visualize small or flat high grade superficial bladder cancers in vivo.

MP-20.01 Fluorescent Imaging of Bladder Cancer Using T140 Analogue, A CXCR4 Antagonistic Peptide Nishizawa K1, Nishiyama H1, Ohishi S2, Saito R1, Watanabe J1, Fujii N2, Ogawa O1 1 Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; 2Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan

MP-20.02 Low Dose CT Virtual Cystoscopy: A Noninvasive Valuable Technology of Diagnosis to the Bladder Tumors Xie X1, Xu D1, Zhu XL2, Miao F2, Shen, ZJ1, Wu Y1 1 Department of Urology, Ruijin Hospital, Shanghai, China; 2Department of Radiology, Ruijin Hospital, Shanghai, China

Introduction and Objective: We aimed to develop a fluorescent molecular probe which can visualize small or flat high grade superficial bladder cancers in vivo and improve cancer detection. In the present study we developed fluorescent antagonists for chemokine receptor CXCR4 and evaluated them to visualize superficial bladder cancers in vivo. Materials and Methods: First, CXCR4 expression was analyzed in bladder cancer cell lines, mouse bladders with or without chemically induced cancer, and human bladder urotheliums with or without cancer by western blot and immunohistochemistory. Then we developed fluorescent TY14003 and TY14015 from T140, a highly sensitive antagonistic peptides for CXCR4. Non-specific fluorescent peptides for CXCR4 were also made as negative controls. A hundred nM of the fluorescent T140 analogue was applied to cancer cell lines on dish, human urine sedimentation from patients with (n⫽5) or without (n⫽3) bladder cancer, and human superficial bladder cancer specimens obtained by biopsy (n⫽5). It was also instilled into mouse bladders with (n⫽5) or without (n⫽5) cancers, which were harvested 10 minutes after instillation. The bladders cut in half were rinsed with PBS and observed by confocal fluorescent microscopy. Results: All the bladder cancer cell lines, mouse bladder cancers, and high grade superficial bladder cancers expressed

Introduction and Objective: To evaluate low dose CT virtual cystoscopy (CTVC) in the diagnosis and postsurgical follow-up of the bladder tumors. Materials and Methods: From January 2007 to March 2008, 68 cases (42 males, 26 females) of hematuria or post-TURBt were enrolled in the study. Volume scanning was estimated by spiral CT, 240mA in tube current of normal dose CT and 120mA in tube current of low dose CT. Virtual cystoscopy images were generated from volumetric data of low dose CT using “Fly Through” software. The bladders were observed from multidirections in the CTVC images. The positive rate, negative rate, Positive predictive value, negative predictive value of CTVE were calculated, the sensibility and specificity were compared with type-B ultrasonic by diagnosing gold-standard of conventional cystoscopy. Results: Among the 68 cases, 61 cases found the bladder tumors by low dose CTVC and conventional cystoscopy. The sensitivity of low dose CTVC was 100%, specificity was 71.43%, none false negativity and accuracy rating was 97.06%, Kappa⫽0.817. The sensitivity of type-B ultrasonic was 95.08%; specificity was 85.71%, false negativity was 4.29%, accuracy rating was 94.12%, Kappa⫽0.717. The average radiation dose of normal CT was 17.4 mSv, that of low dose CTVC was 6.9 mSv (P⬍0.05). Conclusions: Low dose CTVC has

UROLOGY 74 (Supplment 4A), October 2009

proved to be a noninvasive and valuable methods in the diagnosis of bladder tumors which can be served with type-B ultrasonic as supplement to cystoscopy. MP-20.03 Prognostic Significance of Epidermal Growth Factor Receptor (EGFR) and Survivin Expression in Bladder Cancer Tissue and Urine Cytology Sediment of Patients with Transitional Cell Carcinoma of the Urinary Bladder Kehinde EO1, Anim JT2, Kapila K2, Prasad A2, Jerin V1, Memon A3, John S1, Al-Juwaiser A2 1 Department of Surgery (Division of Urology), Kuwait University, Kuwait City, Kuwait; 2Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; 3Brighton and Sussex Medical School, Brighton, UK Introduction and Objective: To assess whether epidermal growth factor receptor (EGFR) and survivin immunostaining of tumour cells in urinary sediment and tissue of patients with bladder cancer has prognostic significance. Materials and Methods: Urine sediment obtained prior to cystoscopy in patients with transitional cell carcinoma (TCC) of the bladder cancer was processed for the presence or absence of EGFR and survivin immunostaining expression. Bladder cancer tissue resected at surgery was also immunostained for EGFR and survivin expression. EGFR and survivin immunostaining was considered positive when membrane staining was present in greater than 20% of tumour cells in one or more microscope slide fields (200 x surface area 0.59m2). The utility of EGFR and survivin expression in the diagnosis of TCC of the bladder was compared to urine cytology. Results: There were 178 patients studied. Of these, 43 had newly diagnosed bladder cancer while 58 had recurrent TCC and 77 had disease remission. Twenty-five patients with normal urothelium served as controls. The mean sensitivity of urine cytology, tissue survivin immunohistochemistry and tissue EGFR imunohistochemistry was 30.5%, 62% and 59% respectively. The corresponding mean specificity was 95%, 79% and 38% respectively. Tissue EGFR expression was positive in 47.8%, 92.9% and 100% of patients with grades 1, 2 and 3 bladder tumours. Tissue survivin expression was positive in 27.8%, 18.2% and 33.3% of patients with grades 1, 2 and 3 bladder tumours. EGFR expression on urine sediment was positive in 35.7%, 40% and 67.7% of patients with tissue grades 1, 2 and 3 bladder tu-

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