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MP-21.15 (Podium): The protective effect of erythropoietin on seminiferous tubules damage in rat testicular torsion model
MODERATED POSTER SESSIONS
2006. Age distribution: 14-68 years. Etiology: Trauma 20/73(27.39%), Balanitis Xerotica Obliterans 2/73(2.73%), Iatrogenic 26/73(35.61%), Infection 3/73(4.10%), Idiopathic 22/73(30.13%). Site: Penobulbar–25/73, Bulbar-38/73, Membranous8/73 and Full length-2/73. Suprapubic catheter was inserted preoperatively: 21/73 patients. Preputial / distal penile skin was used in all patients. Buccal mucosa was not used in any patient. Hospitalization was for 4-5 days. Catheter was removed after 21 days. All patients had their first endoscopic checkup after 3 months. Subsequently, they were followed up by uroflometry. Routine imaging of urethra for follow up was not carried out. Results: 63/73 (86.30%) patients had satisfactory outcome not requiring any further treatment. 8/73 (10.95%) patients developed anastomotic stricture, 3/8 optical internal urethrotomy, 5/8 dilatation alone, 2/73 (2.75%) external meatal stenosis. None had urinary fistula and required repeated urethroplasty. Follow up ranged from 3 months to 8 years. Conclusions: Dorsal onlay urethroplasty using preputial/distal penile skin is a satisfactory procedure. Preputial/distal penile skin is devoid of hair and fat and hence, is an ideal graft material. Even in circumcised patients, distal penile skin can be harvested. Long-term follow up is required in judging results of patients with stricture urethra. MP-21.15 (Podium) The protective effect of erythropoietin on seminiferous tubules damage in rat testicular torsion model Purnomo BB, Setiadi A Department of Urology Saiful Anwar General Hospital, Malang, Indonesia Introduction: Testicular torsion is an acute spermatic cord twist that need emergency detorsion. Delayed management will lead to infarct or testicular damage, infertility, and risk of testicular lost due to ischemic hypoxia, inflammation, and apoptosis. Previous studies show the benefit of erythropoietin as a tissue protective agent by improves blood circulation, stimulates angiogenesis, altered inflammation and apoptosis process. The aim of this study is prove that erythropoietin has testoprotective effect in testicular torsion. Material & Methods: Fifteen (10-12 week, 150-200 grams) male Sprague-Dawley rats were divided into three equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar
operation but the right testis was rotated 720° clockwise, maintained by fixing the testis to the scrotum for 60 minutes, followed by rerotated (retorsion) and saline infused during the procedure. Group 3 underwent similar torsion and retorsion but r-Hu EPO 5000 IU/KgBW was infused during the procedure. All the testes were harvested from rats 48 hours after surgery and evaluated histologically, assessing seminiferous tubule diameter, tubule seminiferous density, loss of germ cell layers, and disarray of germ cell layers. Immunohistochemistry examination to assess apoptotic mechanism. Result: There was a significant difference in the indicators of histological damage between groups 1 and groups 2 and 3. The damage was significantly less in group 3 than in group 2. Apoptosis is less detected in group 1 than in group 2 and group 3, and was significantly less in group 3 than in groups 2. Conclusion: These results suggest that erythropoietin has protective effect on seminiferous tubule damage after testicular torsion, and preventing apoptosis process of germinal cells. MP-21.16 (Podium) Primary laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testis tumor: long term results Castillo O1,2, Campero JM3, SanchezSalas R1, Secin F4, Vitagliano G1, Diaz M1, Aranguibe JC1, Foneron A1 1 Section of Endourology and Laparoscopic Urology, Clı´nica Santa Marı´a, Santiago, Chile; 2Facultad de Medicina, Universidad de Chile, Santiago, Chile; 3 Department of Urology. Clı´nica Las Condes, Santiago, Chile; 4CEMIC, Buenos Aires, Argentina Introduction: There is controversy regarding the efficacy of the laparoscopic retroperitoneal lymph-node dissection (LRPLND) as an alternative to the open approach for the management of nonseminomatous germ cell testicular tumors (NSGCT). Our objective was to assess retrospectively the cancer control and morbidity of primary L-RPLND in patients with clinical Stage I NSGCT. Methods: We reviewed 172 patients with clinical Stage I NSGCT undergoing primary L-RPLND between 1993 and 2007. A modified template dissection was performed. Patients with retroperitoneal metastases were offered adjuvant chemotherapy. Clinical and pathologic data have been recorded. Kaplan Meier curves were generated estimating time to recurrence.
UROLOGY 70 (Supplment 3A), September 2007
Results: Eighty-two (48%) patients had any embryonal component in the primary tumor and 35 (20%) had lymphovascular invasion in the orchiectomy specimen. The median (IQR) age, operative time, length of hospital stay, blood loss and number of lymph nodes retrieved was 28 years (24,33), 135 mins. (120, 180), 48 hs. (24, 48), 50 cc. (20, 100) and 14 (10,18). Lymph nodes were negative in 132 (77%) patients. Followup was available in 80 of these 132 patients. Of these, 7 patients had recurrence, one of them 33 months after L-RPLND. Median follow-up for pts. without recurrence was 14 mo (IQR: 4,35). The cumulative 3-year recurrence free rate for this group was 82% (95%CI: 64, 91). Retroperitoneum was the site of 5 recurrences (1 associated with mediastinum) and three in the lungs. 32 patients had lymph nodes with metastatic testicular cancer. Follow-up was available in 15 of these 32 patients. Fourteen underwent adjuvant chemotherapy and 2 patients had recurrence at 3 and 64 months. Both recurred in the retroperitoneum, with one also recurring in the port sites (3 month). 17 (10%) of 172 patients had peri/operative complications including vascular and non vascualar injuries. 4 patients required conversion to open surgery. Two patients needed blood transfusion. Retrograde ejaculation was registered in 3 patients. No perioperative deaths occurred. Conclusions: Laparoscopic RPLND can only be performed by highly specialized surgeons. Its oncologic safety needs to be prospectively evaluated in randomized trials. MP-21.17 (Podium) Paratesticular masses: the Mayo Clinic experience Tsao AK, Karnes RJ, Sebo TJ, Nehra A Departments of Urology and Anatomic Pathology, Mayo Clinic, Rochester, MN Introduction & Objectives: The majority of masses found within the scrotal sac are usually within the testes and neoplastic. However, a subset of these tumors arise from paratesticular tissues and are extratesticular. Paratesticular tumors, although infrequent, are associated with a high incidence of malignancy. Methods: A retrospective analysis of clinical characteristics and surgical outcomes of 29 patients from 1954-2006 was performed. Data abstracted included age, diagnosis, date of surgery, pathologic features, recurrence, and follow-up time. Results: Twenty nine men underwent radical orchiectomy for a diagnosed paratesticular mass. The mean age was 52 years (14-86
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2006. Age distribution: 14-68 years. Etiology: Trauma 20/73(27.39%), Balanitis Xerotica Obliterans 2/73(2.73%), Iatrogenic 26/73(35.61%), Infection 3/73(4.10%), Idiopathic 22/73(30.13%). Site: Penobulbar–25/73, Bulbar-38/73, Membranous8/73 and Full length-2/73. Suprapubic catheter was inserted preoperatively: 21/73 patients. Preputial / distal penile skin was used in all patients. Buccal mucosa was not used in any patient. Hospitalization was for 4-5 days. Catheter was removed after 21 days. All patients had their first endoscopic checkup after 3 months. Subsequently, they were followed up by uroflometry. Routine imaging of urethra for follow up was not carried out. Results: 63/73 (86.30%) patients had satisfactory outcome not requiring any further treatment. 8/73 (10.95%) patients developed anastomotic stricture, 3/8 optical internal urethrotomy, 5/8 dilatation alone, 2/73 (2.75%) external meatal stenosis. None had urinary fistula and required repeated urethroplasty. Follow up ranged from 3 months to 8 years. Conclusions: Dorsal onlay urethroplasty using preputial/distal penile skin is a satisfactory procedure. Preputial/distal penile skin is devoid of hair and fat and hence, is an ideal graft material. Even in circumcised patients, distal penile skin can be harvested. Long-term follow up is required in judging results of patients with stricture urethra. MP-21.15 (Podium) The protective effect of erythropoietin on seminiferous tubules damage in rat testicular torsion model Purnomo BB, Setiadi A Department of Urology Saiful Anwar General Hospital, Malang, Indonesia Introduction: Testicular torsion is an acute spermatic cord twist that need emergency detorsion. Delayed management will lead to infarct or testicular damage, infertility, and risk of testicular lost due to ischemic hypoxia, inflammation, and apoptosis. Previous studies show the benefit of erythropoietin as a tissue protective agent by improves blood circulation, stimulates angiogenesis, altered inflammation and apoptosis process. The aim of this study is prove that erythropoietin has testoprotective effect in testicular torsion. Material & Methods: Fifteen (10-12 week, 150-200 grams) male Sprague-Dawley rats were divided into three equal groups. Group 1 underwent a sham operation of the right testis under general anaesthesia. Group 2 underwent a similar
operation but the right testis was rotated 720° clockwise, maintained by fixing the testis to the scrotum for 60 minutes, followed by rerotated (retorsion) and saline infused during the procedure. Group 3 underwent similar torsion and retorsion but r-Hu EPO 5000 IU/KgBW was infused during the procedure. All the testes were harvested from rats 48 hours after surgery and evaluated histologically, assessing seminiferous tubule diameter, tubule seminiferous density, loss of germ cell layers, and disarray of germ cell layers. Immunohistochemistry examination to assess apoptotic mechanism. Result: There was a significant difference in the indicators of histological damage between groups 1 and groups 2 and 3. The damage was significantly less in group 3 than in group 2. Apoptosis is less detected in group 1 than in group 2 and group 3, and was significantly less in group 3 than in groups 2. Conclusion: These results suggest that erythropoietin has protective effect on seminiferous tubule damage after testicular torsion, and preventing apoptosis process of germinal cells. MP-21.16 (Podium) Primary laparoscopic retroperitoneal lymph-node dissection for clinical stage I nonseminomatous germ-cell testis tumor: long term results Castillo O1,2, Campero JM3, SanchezSalas R1, Secin F4, Vitagliano G1, Diaz M1, Aranguibe JC1, Foneron A1 1 Section of Endourology and Laparoscopic Urology, Clı´nica Santa Marı´a, Santiago, Chile; 2Facultad de Medicina, Universidad de Chile, Santiago, Chile; 3 Department of Urology. Clı´nica Las Condes, Santiago, Chile; 4CEMIC, Buenos Aires, Argentina Introduction: There is controversy regarding the efficacy of the laparoscopic retroperitoneal lymph-node dissection (LRPLND) as an alternative to the open approach for the management of nonseminomatous germ cell testicular tumors (NSGCT). Our objective was to assess retrospectively the cancer control and morbidity of primary L-RPLND in patients with clinical Stage I NSGCT. Methods: We reviewed 172 patients with clinical Stage I NSGCT undergoing primary L-RPLND between 1993 and 2007. A modified template dissection was performed. Patients with retroperitoneal metastases were offered adjuvant chemotherapy. Clinical and pathologic data have been recorded. Kaplan Meier curves were generated estimating time to recurrence.
UROLOGY 70 (Supplment 3A), September 2007
Results: Eighty-two (48%) patients had any embryonal component in the primary tumor and 35 (20%) had lymphovascular invasion in the orchiectomy specimen. The median (IQR) age, operative time, length of hospital stay, blood loss and number of lymph nodes retrieved was 28 years (24,33), 135 mins. (120, 180), 48 hs. (24, 48), 50 cc. (20, 100) and 14 (10,18). Lymph nodes were negative in 132 (77%) patients. Followup was available in 80 of these 132 patients. Of these, 7 patients had recurrence, one of them 33 months after L-RPLND. Median follow-up for pts. without recurrence was 14 mo (IQR: 4,35). The cumulative 3-year recurrence free rate for this group was 82% (95%CI: 64, 91). Retroperitoneum was the site of 5 recurrences (1 associated with mediastinum) and three in the lungs. 32 patients had lymph nodes with metastatic testicular cancer. Follow-up was available in 15 of these 32 patients. Fourteen underwent adjuvant chemotherapy and 2 patients had recurrence at 3 and 64 months. Both recurred in the retroperitoneum, with one also recurring in the port sites (3 month). 17 (10%) of 172 patients had peri/operative complications including vascular and non vascualar injuries. 4 patients required conversion to open surgery. Two patients needed blood transfusion. Retrograde ejaculation was registered in 3 patients. No perioperative deaths occurred. Conclusions: Laparoscopic RPLND can only be performed by highly specialized surgeons. Its oncologic safety needs to be prospectively evaluated in randomized trials. MP-21.17 (Podium) Paratesticular masses: the Mayo Clinic experience Tsao AK, Karnes RJ, Sebo TJ, Nehra A Departments of Urology and Anatomic Pathology, Mayo Clinic, Rochester, MN Introduction & Objectives: The majority of masses found within the scrotal sac are usually within the testes and neoplastic. However, a subset of these tumors arise from paratesticular tissues and are extratesticular. Paratesticular tumors, although infrequent, are associated with a high incidence of malignancy. Methods: A retrospective analysis of clinical characteristics and surgical outcomes of 29 patients from 1954-2006 was performed. Data abstracted included age, diagnosis, date of surgery, pathologic features, recurrence, and follow-up time. Results: Twenty nine men underwent radical orchiectomy for a diagnosed paratesticular mass. The mean age was 52 years (14-86
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