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588 CLINICOPATHOLOGIC FEATURES AND OUTCOMES OF A CHROMOPHOBE RENAL CELL CARCINOMA SERIES FROM A SINGLE INSTITUTION
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est among CC⫺RCC and smallest among AML (p⬍0.001). Homogeneous composition was more common among Pa⫺RCC and Ch⫺RCC (p⬍0.001). Overall 25 (15.3%) of tumors had washout ⬍0. Tumors with washout value ⬍0 were Pa⫺RCC 24/43 (56%), and Ch⫺RCC 1/6 (14%). No patients with CC-RR, OC, or AML had washout value ⬍0. Washout value ⬍0 had a specificity of 99.2% for Pa⫺RCC and 100% for non⫺CC⫺RCC. Washout value ⱖ0 had a sensitivity and NPV of 100% for CC⫺RCC, OC, and AML. Washout value ⱖ0 had a specificity of 35.2% and a PPV of 66.7% for CC-RCC. CONCLUSIONS: Washout value ⬍0 is highly specific for Pa⫺RCC and non⫺CC⫺RCC. Washout value ⱖ0 is highly sensitive for CC⫺RCC, OC, and AML. These findings may provide a further tool for clinical decision making and risk stratification. Additional prospective analysis is warranted. Source of Funding: None
588 CLINICOPATHOLOGIC FEATURES AND OUTCOMES OF A CHROMOPHOBE RENAL CELL CARCINOMA SERIES FROM A SINGLE INSTITUTION Alan Thong*, Tin Ngo, Elizabeth Weinzierl, John Leppert, Jesse McKenney, Benjamin Chung, Stanford, CA INTRODUCTION AND OBJECTIVES: Chromophobe RCC (cRCC) is a rare histological subtype of renal cell carcinoma (RCC) representing 3-5% of all RCCs. Cancer specific survival of cRCC appears to be favorable compared to that of conventional RCC. A novel pathologic grading system for cRCC has been proposed due to the controversial prognostic value of Fuhrman grade in cRCC (Paner et al, Am J Surg Pathol, 2010). Due to the rarity of cRCC, limited cohorts with this novel grading system have been reported in the literature. METHODS: An institutional kidney cancer database was retrospectively queried for those patients who had undergone radical or partial nephrectomy and had final pathology showing cRCC. Each case was then re-reviewed by a genitourinary pathologist to confirm the diagnosis and re-graded according to the novel chromophobe tumor grade (CTG). Preoperative symptoms, sex, age, date of surgery, medical co-morbidities, tumor size, stage, CTG, and sarcomatoid features were modeled against recurrence and cancer specific mortality using Fisher’s exact and Wilcoxon rank-sum tests. RESULTS: From 1989 to 2010, a total of 81 patients had pathology consistent with cRCC. Median age was 62.1 years (IQR 51.1-69.7). Average tumor size was 6.5 cm (IQR 3.2-8.4). Only one case had distant metastasis at diagnosis. 52 (64%) tumors were CTG 1, 27 (33%) were CTG 2, and 2 (2.5%) were CTG 3. Stage was T1a in 26 patients (32%), T1b in 21 (26%), T2 in 19 (23%), T3 in 14 (17%), and T4 in 1 (1.2%). One patient had N1 disease. Median length of follow-up was 32.5 months (IQR 12.9-68.7). Three patients (3.7%) had recurrence of disease and 2 (2.5%) of these patients died of their disease during this follow-up period. All three patients who had recurrence were ⱖ stage T3 and had either sarcomatoid features or nodal disease. Only two patients in this series had sarcomatoid features and both patients were deceased. CTG 3 encompasses sarcomatoid features and was associated with both mortality (p⬍0.0011) and recurrence (p⬍0.0021). Greater tumor size was also linearly associated with the risk of recurrence (p⬍0.0129). The remaining clinicopathologic features were not associated with adverse outcome. CONCLUSIONS: cRCC patients in this cohort demonstrated favorable prognosis. Recurrence and disease specific death were associated with sarcomatoid features. Longer clinical follow-up and larger multi-institutional cohorts are needed for adequate assessment of the utility of the novel CTG system. Source of Funding: None
Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012
Pediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis Moderated Poster Sunday, May 20, 2012
3:30 PM-5:30 PM
589 A PROSPECTIVE STUDY ON THE CONSISTENCY AND REPRODUCIBILITY OF UROFLOWMETRY STUDIES AND POST VOID RESIDUAL MEASUREMENTS AT A BLADDER VOLUME OF 50-100% ESTIMATED BLADDER CAPACITY IN CHILDREN Ma. Fluorence Flores*, David Bolong, Manila, Philippines INTRODUCTION AND OBJECTIVES: Uroflowmetry and post void residual studies are considered fundamental, noninvasive diagnostic tools in Pediatric Urology. Parameters are frequently used in the evaluation and reassessment of children with lower urinary tract dysfunction. Often the therapeutic decisions are based on a single or on a few determinations.Therefore, it is crucial to know whether these tests are reproducible to a clinically acceptable degree. Since current nomograms have been constructed from 1 to 2 voids per child, variability of flow parameters is unknown. This leads us to the question of “How many times should uroflowmetry and post void residual urine measurements be done to a single patient in order to get a reliable and consistent result?” In this study, we set the prevoid volume at 50 to 100% of the estimated bladder capacity of each child. OBJECTIVE: To assess the repeatability and consistency of uroflowmetry and post void residual urine (PVR) determination in children at a bladder volume of 50-100% of the estimated bladder capacity (EBC). METHODS: From April 2011- September 2011, twenty-five (25) children, ages 3-8 years, underwent uroflowmetry and post void urine measurements. Values were taken for 3 consecutive micturitions at a bladder volume of 50-100% of the estimated bladder capacity, as measured by transabdominal ultrasound. A total of 75 micturitions were studied. Uroflowmetry parameters and PVR were recorded and analyzed. RESULTS: There were no significant differences in the measurements across three trials for maximum flow rate (Qmax) and prevoid urine volume. There were significant differences in the measurements of PVR and uroflowmetry curves. PVR urine volumes were not related to prevoid urine volumes. Age, height and weight were related to the prevoid volumes. CONCLUSIONS: Uroflowmetry and post void residual tests will give informative and reliable values at a bladder volume of 50-100% estimated bladder capacity. In cases of any abnormal flow curve or pattern at this bladder capacity, a repeat examination is prudent; despite normal maximum flow rate (Qmax) and negligible post void residual urine. Source of Funding: Philippine Urological Association Inc. Research Grant
590 DESMOPRESSIN ORAL LYOPHYLISATE FORMULATION (MELT): AMELIORATING DESMOPRESSIN RESPONSE IN MONOSYMPTOMATIC NOCTURNAL ENURESIS? Ann De Guchtenaere, Joke Dehoorne, Ghent, Belgium; Ann Raes, Ghent, Belgium; Erik Van Laecke, Albert Groen, Johan Vande Walle, Piet Hoebeke*, Ghent, Belgium INTRODUCTION AND OBJECTIVES: Desmopressin is prescribed worldwide as a first-line treatment in MNE (Monosymptomatic Nocturnal Enuresis). Both desmopressin tablet and MELT oral lyophylisate formulations are frequently used, with desmopressin 200g tablet and desmopressin MELT oral lyophylisate 120g being considered
THE JOURNAL OF UROLOGY姞
est among CC⫺RCC and smallest among AML (p⬍0.001). Homogeneous composition was more common among Pa⫺RCC and Ch⫺RCC (p⬍0.001). Overall 25 (15.3%) of tumors had washout ⬍0. Tumors with washout value ⬍0 were Pa⫺RCC 24/43 (56%), and Ch⫺RCC 1/6 (14%). No patients with CC-RR, OC, or AML had washout value ⬍0. Washout value ⬍0 had a specificity of 99.2% for Pa⫺RCC and 100% for non⫺CC⫺RCC. Washout value ⱖ0 had a sensitivity and NPV of 100% for CC⫺RCC, OC, and AML. Washout value ⱖ0 had a specificity of 35.2% and a PPV of 66.7% for CC-RCC. CONCLUSIONS: Washout value ⬍0 is highly specific for Pa⫺RCC and non⫺CC⫺RCC. Washout value ⱖ0 is highly sensitive for CC⫺RCC, OC, and AML. These findings may provide a further tool for clinical decision making and risk stratification. Additional prospective analysis is warranted. Source of Funding: None
588 CLINICOPATHOLOGIC FEATURES AND OUTCOMES OF A CHROMOPHOBE RENAL CELL CARCINOMA SERIES FROM A SINGLE INSTITUTION Alan Thong*, Tin Ngo, Elizabeth Weinzierl, John Leppert, Jesse McKenney, Benjamin Chung, Stanford, CA INTRODUCTION AND OBJECTIVES: Chromophobe RCC (cRCC) is a rare histological subtype of renal cell carcinoma (RCC) representing 3-5% of all RCCs. Cancer specific survival of cRCC appears to be favorable compared to that of conventional RCC. A novel pathologic grading system for cRCC has been proposed due to the controversial prognostic value of Fuhrman grade in cRCC (Paner et al, Am J Surg Pathol, 2010). Due to the rarity of cRCC, limited cohorts with this novel grading system have been reported in the literature. METHODS: An institutional kidney cancer database was retrospectively queried for those patients who had undergone radical or partial nephrectomy and had final pathology showing cRCC. Each case was then re-reviewed by a genitourinary pathologist to confirm the diagnosis and re-graded according to the novel chromophobe tumor grade (CTG). Preoperative symptoms, sex, age, date of surgery, medical co-morbidities, tumor size, stage, CTG, and sarcomatoid features were modeled against recurrence and cancer specific mortality using Fisher’s exact and Wilcoxon rank-sum tests. RESULTS: From 1989 to 2010, a total of 81 patients had pathology consistent with cRCC. Median age was 62.1 years (IQR 51.1-69.7). Average tumor size was 6.5 cm (IQR 3.2-8.4). Only one case had distant metastasis at diagnosis. 52 (64%) tumors were CTG 1, 27 (33%) were CTG 2, and 2 (2.5%) were CTG 3. Stage was T1a in 26 patients (32%), T1b in 21 (26%), T2 in 19 (23%), T3 in 14 (17%), and T4 in 1 (1.2%). One patient had N1 disease. Median length of follow-up was 32.5 months (IQR 12.9-68.7). Three patients (3.7%) had recurrence of disease and 2 (2.5%) of these patients died of their disease during this follow-up period. All three patients who had recurrence were ⱖ stage T3 and had either sarcomatoid features or nodal disease. Only two patients in this series had sarcomatoid features and both patients were deceased. CTG 3 encompasses sarcomatoid features and was associated with both mortality (p⬍0.0011) and recurrence (p⬍0.0021). Greater tumor size was also linearly associated with the risk of recurrence (p⬍0.0129). The remaining clinicopathologic features were not associated with adverse outcome. CONCLUSIONS: cRCC patients in this cohort demonstrated favorable prognosis. Recurrence and disease specific death were associated with sarcomatoid features. Longer clinical follow-up and larger multi-institutional cohorts are needed for adequate assessment of the utility of the novel CTG system. Source of Funding: None
Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012
Pediatrics: Bladder Dysfunction - Myelodysplasia, Voiding Dysfnction, Enuresis Moderated Poster Sunday, May 20, 2012
3:30 PM-5:30 PM
589 A PROSPECTIVE STUDY ON THE CONSISTENCY AND REPRODUCIBILITY OF UROFLOWMETRY STUDIES AND POST VOID RESIDUAL MEASUREMENTS AT A BLADDER VOLUME OF 50-100% ESTIMATED BLADDER CAPACITY IN CHILDREN Ma. Fluorence Flores*, David Bolong, Manila, Philippines INTRODUCTION AND OBJECTIVES: Uroflowmetry and post void residual studies are considered fundamental, noninvasive diagnostic tools in Pediatric Urology. Parameters are frequently used in the evaluation and reassessment of children with lower urinary tract dysfunction. Often the therapeutic decisions are based on a single or on a few determinations.Therefore, it is crucial to know whether these tests are reproducible to a clinically acceptable degree. Since current nomograms have been constructed from 1 to 2 voids per child, variability of flow parameters is unknown. This leads us to the question of “How many times should uroflowmetry and post void residual urine measurements be done to a single patient in order to get a reliable and consistent result?” In this study, we set the prevoid volume at 50 to 100% of the estimated bladder capacity of each child. OBJECTIVE: To assess the repeatability and consistency of uroflowmetry and post void residual urine (PVR) determination in children at a bladder volume of 50-100% of the estimated bladder capacity (EBC). METHODS: From April 2011- September 2011, twenty-five (25) children, ages 3-8 years, underwent uroflowmetry and post void urine measurements. Values were taken for 3 consecutive micturitions at a bladder volume of 50-100% of the estimated bladder capacity, as measured by transabdominal ultrasound. A total of 75 micturitions were studied. Uroflowmetry parameters and PVR were recorded and analyzed. RESULTS: There were no significant differences in the measurements across three trials for maximum flow rate (Qmax) and prevoid urine volume. There were significant differences in the measurements of PVR and uroflowmetry curves. PVR urine volumes were not related to prevoid urine volumes. Age, height and weight were related to the prevoid volumes. CONCLUSIONS: Uroflowmetry and post void residual tests will give informative and reliable values at a bladder volume of 50-100% estimated bladder capacity. In cases of any abnormal flow curve or pattern at this bladder capacity, a repeat examination is prudent; despite normal maximum flow rate (Qmax) and negligible post void residual urine. Source of Funding: Philippine Urological Association Inc. Research Grant
590 DESMOPRESSIN ORAL LYOPHYLISATE FORMULATION (MELT): AMELIORATING DESMOPRESSIN RESPONSE IN MONOSYMPTOMATIC NOCTURNAL ENURESIS? Ann De Guchtenaere, Joke Dehoorne, Ghent, Belgium; Ann Raes, Ghent, Belgium; Erik Van Laecke, Albert Groen, Johan Vande Walle, Piet Hoebeke*, Ghent, Belgium INTRODUCTION AND OBJECTIVES: Desmopressin is prescribed worldwide as a first-line treatment in MNE (Monosymptomatic Nocturnal Enuresis). Both desmopressin tablet and MELT oral lyophylisate formulations are frequently used, with desmopressin 200g tablet and desmopressin MELT oral lyophylisate 120g being considered