1425 URINARY TRACT INFECTION IN PATIENTS WITH AN ORTHOTOPIC NEOBLADDER

Vol. 189, No. 4S, Supplement, Monday, May 6, 2013

THE JOURNAL OF UROLOGY姞

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CONCLUSIONS: In this long-term study, patients with an Ipouch experienced a lower rate of recurrent UTIs and tended to be at lower risk of vitamin B12 supplementation. These findings may be attributable to the reduced length of ileum used for the formation of the pouch. The heterogeneity of findings suggests that questionnaires, as the QLQ-C30 and -BLM30 are not valid enough to adequately address QoL aspects in patients with ileal neobladders. These data hint at the necessity to develop neobladder-specific questionnaires to adequately address QoL issues in different ileal neobladders. Source of Funding: None

1425 URINARY TRACT INFECTION IN PATIENTS WITH AN ORTHOTOPIC NEOBLADDER Roy Mano*, Hanan Goldberg, Yariv Stabholz, Jack Baniel, Daniel Kedar, Ofer Yossepowitch, Petach Tikva, Israel

Source of Funding: None

1424 QUALITY OF LIFE ANALYSIS IN PATIENTS FOLLOWING RADICAL CYSTECTOMY AND ORTHOTOPIC URINARY DIVERSION: A SINGLE-INSTITUTION COMPARISON OF STUDER- AND I-POUCH NEOBLADDER Johannes Mischinger*, Mohamed F. Abdelhafez, Tilman Todenhöfer, Arnulf Stenzl, Georgios Gakis, Tuebingen, Germany INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate health-related QoL differences in patients with different ileal neobladder substitutes of 40cm (I-Pouch) and 60cm (StuderPouch, S-Pouch) length. METHODS: Of a total of 171 ileal neobladder procedures (I-pouch: 91 pat., S-pouch: 80 patients) performed in a tertiary academic center between 2002 and 2011 we evaluated QoL aspects in 61 patients (51 men, 12 women) who underwent radical cystectomy for bladder cancer. Thirty-three patients (26 men, 7 women) underwent an I-pouch and 28 (19 men, 9 women) an S-pouch procedure. The following questionnaires were used: the EORTC QLQ-C30, QLQBLM30 and the GIQLI (evaluating changes bowel habits). Additionally, we assessed the rate of vitamin B12 supplementation, bicarbonate substitution and recurrent urinary tract infections. Median follow-up was 66 months (IQR: 41-104; total range: 9-161. RESULTS: Median age at surgery was 68 (IQR: 43-84) in the I-Pouch and 66 years (IQR: 39-74) in the S-Pouch group (p⫽0.47). Patients with an I-pouch reported similar QLQ-C30 overall health status (median: 6, IQR: 4-6) compared to patients with an S-pouch (median: 5; IQR: 4-6; p⫽0.24). Patients with I-Pouch reported better QLQ-C30 QoL status (median: 6, IQR: 5-6) compared to patients with an S-Pouch (median 5, IQR: 4-6; p ⫽ 0.037). Patients with an S-pouch reported better QLQ-BLM30 general health status (median 19, IQR: 11-26) compared to patients with an I-pouch (median: 29, IQR: 26-34; p⬍0.001). The median GIQLI score was 0.5 in patients with an I-pouch (IQR: 0-3) and 2 (IQR: 0.75-5) in patients with an S-pouch (p⫽0.11). Median number of recurrent UTIs was 0 (IQR: 0-2) in patients with an I-Pouch and 1 (IQR: 0-4) in patients with an S-pouch (p⫽0.036). Patients with an S-pouch tended to be on vitamin B12 substitution compared to I-pouch patients (p⫽0.07). No significant difference was noted with regard to the rate of bicarbonate substitution between both groups (p⫽0.57).

INTRODUCTION AND OBJECTIVES: Radical cystectomy with orthotopic neobladder (ONB) urinary diversion is a morbid procedure with a high complication rate. Bacterial infections are the most common early complications, encountered in 24% of patients. We aimed to investigate the incidence, clinical characteristics and predictors of urinary tract infections (UTI) in patients with ONB. METHODS: We reviewed the medical records of 79 patients treated with radical cystectomy and ONB urinary diversion between 2004 - 2012. Data pertaining to bacteriuria and clinical UTI after hospital discharge were retrieved. The study endpoints were the incidence and clinical characteristics of bacteriuria, febrile UTI requiring hospital admission and urosepsis. Cumulative incidence of clinical events was assessed with the Kaplan-Meier method. RESULTS: The study cohort included 69 males and 10 females at a mean age of 59 ⫾ 8 years. The ONB was constructed with small intestine in 45 (57%) patients, and included a segment of large intestine in 34 (43%). Clean intermittent catheterization was required in 21 (27%) patients early after surgery, most of which resolved over time. Estimated rates of bacteriuria, febrile UTI and urosepsis during follow-up are depicted in figure 1. Bacteriuria was diagnosed in as much as 80% of the patients. Symptomatic urinary tract infection occurred in 36% of the patients during the first 3 month after surgery, but only in 10% and 8% of the patients 3-6 and 6-12 months after surgery, respectively. Common pathogens were Pseudomonas Aeruginosa (22%), E. Coli (22%) and Klebsiella Pneumonia (20%). Overall, 71% of the pathogens were susceptible to Amikacin. On multivariate analysis, age, Charlson comorbidity index, intermittent catheterization, bowel segment used for reconstruction and perioperative chemotherapy treatment did not impact the rates of bacteriuria or clinical UTI. CONCLUSIONS: Urinary tract infection after radical cystectomy with ONB is a common complication, occurring usually within the first 3 month after surgery. Pseudomonas aeruginosa is the most commonly involved pathogen. Empirical antibiotic treatment with Amikacin is advised in these cases.

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Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013

CONCLUSIONS: The pre-operative laboratory parameters ESR, Hb and possibly Leu, may improve prognostication in patients undergoing RC. Future studies are needed to confirm the findings of this study.

Source of Funding: None

Bladder Cancer: Invasive (I)

Source of Funding: None

Moderated Poster Session 52 Tuesday, May 7, 2013

8:00 AM-10:00 AM

1426 THE PROGNOSTIC VALUE OF PRE-OPERATIVE LABORATORY PARAMETERS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR BLADDER CANCER Harman Maxim Bruins*, Tom Arends, Mijke Pelkman, Antoine G. van der Heijden, Alfred J Witjes, Nijmegen, Netherlands INTRODUCTION AND OBJECTIVES: Several clinical, histopathologic and molecular markers have been explored to improve prognostication in patients undergoing radical cystectomy (RC) for bladder cancer. The prognostic value of pre-operative laboratory parameters, however, have insufficiently been explored albeit routinely obtained. In this study, we evaluated the prognostic value of multiple laboratory parameters prior to RC. METHODS: Patients who underwent RC with intent-to-cure for bladder cancer between 1998 and 2011 without neo-adjuvant or adjuvant chemo- or radiotherapy were included. The following laboratory parameters were determined pre-operatively: Erythrocyte Sedimentation Rate (ESR; elevated ⬎20 mm/hour), C-Reactive Protein (CRP; elevated ⬎10 mg/L), leukocytes (Leu; elevated ⬎11.0x109 / L), thrombocytes (Thr; elevated ⬎400 x109 / L), hemoglobin (Hb; anemia ⬍8.0 mmol/L in males or ⬍7.3 mmol/L in females) and lactate dehydrogenase (LDH; elevated ⬎450 U/L). Endpoints were 90-day mortality rate (90dM), recurrence-free survival (RFS) and overall survival (OS). Median follow-up time was 4.9 years. Univariate and multivariate analysis for OS and RFS were performed. RESULTS: A total of 320 patients were included. Elevated levels of ESR, CRP, LDH, Leu and Thr were present in 28.7%, 23.4%, 15.3%, 10.6% and 6.9% of patients, respectively. Nearly one-third of patients (30.3%) had anemia prior to RC. The 90dM was 6.3% (N⫽20) and only elevated Thr (p ⫽ 0.02) was univariately associated with increased 90dM. Table 1 shows the OS and RFS rates stratified by laboratory parameter. On univariate analysis, elevated ESR, CRP, Thr, Leu and low Hb were associated with both decreased OS and RFS. Adjusting for age, gender, ASA score, tumor stage and lymph node status, only elevated ESR (HR 1.71; p ⫽ 0.03) remained independently associated with decreased RFS, although elevated Leu level (HR 1.88; p ⫽ 0.05) was borderline significant. With respect to OS, only low Hb (HR 1.70; p ⫽ 0.013) was independently associated with decreased OS.

1427 IMPACT OF STATIN USE ON ONCOLOGICAL OUTCOMES OF PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER TREATED WITH RADICAL CYSTECTOMY Rodrigo Donalisio-da-Silva*, São Paulo, Brazil; Evanguelos Xylinas, Paris, France; Luis Kluth, Hamburg, Germany; Joseph Crivelli, New York, NY; Daher Chade, Giuliano Guglielmetti, São Paulo, Brazil; Yair Lotan, Dallas, TX; Pierre karakiewicz, Maxine Sun, Montreal, Canada; Armin Pycha, Bolzano, Italy; Francesco Montorsi, Milano, Italy; Marc Zerbib, Paris, France; Douglas Scherr, Shahrokh Shariat, New York, NY INTRODUCTION AND OBJECTIVES: Statins, among the most commonly prescribed drugs worldwide, are cholesterol-lowering agents used to manage and prevent cardiovascular and coronary heart diseases. Statins have been shown to act through cholesterol-dependent and -independent mechanisms and are able to affect several tissue functions and modulate specific signal transduction pathways that could account for statin pleiotropic effects. Evidence suggest a dichotomous effect of statins with both cancer-inhibiting or -promoting effects. To date, the effect of statin use on bladder cancer prognosis in muscle-invasive urothelial carcinoma of the bladder (UCB) remains uninvestigated. We tested the hypothesis that statin use impacts oncologic outcomes of patients treated with radical cystectomy (RC) for UCB. METHODS: We retrospectively collected data of 1502 patients treated at four institutions with RC and pelvic lymphadenectomy without neoadjuvant therapy. Univariable and multivariable cox regression models addressed the association of statin use with disease recurrence and cancer specific mortality after RC. RESULTS: A total of 642 (42.7%) patients used statin. Within a median follow-up of 34 months, 509 (33.9%) patients experienced disease recurrence and 402 patients (26.8%) died of UCB. Patients who used statin were slightly older (p⫽0.003), had a higher BMI. (median 32 vs 28, p⬍0.001), were more likely to have non-organ confined UCB (44% vs 40%) and positive soft tissue surgical margins (9 vs 4%, p⬍0.001). In univariable Cox regression analyses, statin use, female gender, advanced age, higher BMI, smoking status, pT stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis, and adjuvant chemotherapy were all associated with both disease recurrence (p-valuesⱕ0.05) and cancerspecific mortality (p-valuesⱕ0.02). In multivariable Cox regression analyses that adjusted for the effects of standard clinic-pathologic