- Email: [email protected]
608 RECURRENT URINARY TRACT INFECTIONS IN ADULTS: IS THIS AN INDICATION FOR MICTURATING CYSTOURETHROGRAPHY?
Vol. 183, No. 4, Supplement, Monday, May 31, 2010
had not been studied, so we examined expression and localization of two cell-surface receptors involved in APC signaling, thrombomodulin (TM) and endothelial protein C receptor (ECPR) in the mouse urothelium during cyclophosphamide (CYP) cystitis. METHODS: Male C57 BL/6 mice (25 g) were treated with CYP (300 mg/kg; i.p.) and bladders were removed and processed, 4 hr, 1 day and 2 days (n⫽6/group) after treatment. Intact mice (n⫽6) were used as controls. TM and EPCR were localized within tissues using standard paraffin immunoperoxidase techniques and confocal microscopy. Bladder homogenates were processed for expression of TM and EPCR by RT-PCR. Data are presented as Mean⫹SEM and analyzed using ANOVA followed by Dunnet’s multiple comparisons. RESULTS: Intact urothelium showed slight, focal immunostaining for TM with significant increases observed at 1 and 2 day after CYP. EPCR immunostaining was slight to moderate in intact urothelium, localized basal and full-thickness and significantly increased 4 hr, 1 day and 2 day after CYP treatment. Confocal microscopy showed CYP treatment elicited increased cell-surface immunostaining of both TM and EPCR. No immunostaining was seen on the luminal cell surface of treated mice although other regions of luminal cells were clearly immunostained. Increased gene expression of TM was seen at 4 hr (8.4 fold) and 1 day (2.8) returning to normal at 2 days. Upregulation of EPCR was observed at 4 hr (43.4 fold) and 1 day (10.5 fold) returning to normal at 2 days. CONCLUSIONS: The major new finding of this study is upregulation of TM and EPCR, cell-surface receptors involved in APC signaling. Localization to urothelial cell-surface indicates a possible role for APC in mediating bladder inflammation. Lack of luminal staining indicates either lack of expression on the luminal surface, or alternatively, receptor turnover from APC binding. The functional role of APC in bladder inflammation is being investigated. Source of Funding: VA Merit Award Program (PLV; KLMS); NIDDK DK075059 (PLV); The Bay Pines Foundation
607 FEMTOSECOND LASER BASED HIGH RESOLUTION OPTICAL COHERENCE TOMOGRAPHY FOR DETECTION OF CYSTITIS CYSTICA IN HUMAN BLADDER - A FEASIBILITY STUDY Joachim Grosse*, Murnau, Germany; Joerg Bornemann, Felix Spo¨ler, Amjad Naami, Ruth Knuchel-Clarke, Gerhard Jakse, Axel Heidenreich, Aachen, Germany INTRODUCTION AND OBJECTIVES: The feasibility of high resolution optical coherence tomography (HR-OCT) as a non-invasive imaging technique was shown in many cases in the past. With image resolutions down to 1 m and imaging depths in the range of 1-3 mm this method has now the potential to classify and distinguish the layers in healthy and morphological altered bladder tissue. The objective of our study is to show the feasibility to detect cystitis cystica in the way of virtual histology. METHODS: An OCT system comprising a Ti:Sapphire femtosecond laser to support a resolution of 3 m axial x 7 m lateral was employed to image 48 fresh human bladder tissue specimens from cystectomies. The OCT tomograms were evaluated double blinded and finally referenced to histological sections using standard HE staining. RESULTS: In greyscaled OCT tomograms cystitis cystica appears as a cavernous dark structure surrounded by more scattering brighter tissue. In 10 histological sections of 48 specimens cystitis cystica could be detected by light microscopy (Tab.1). 9 of these 10 specimens were correctly identified by OCT tomograms before (90 %), one sample was categorized as nonexisting urothelium.
THE JOURNAL OF UROLOGY姞
e239
CONCLUSIONS: HR-OCT is a promising modality for the evaluation of bladder microstructures with the possibility to differentiate cystits cystica from normal and cancerous tissue. This might be helpful for the selection of endoscopic bladder biopsies
Source of Funding: DFG supported, grant no. Kn 263/10-1, Ja 482/5-1, Ku 540/47-2
608 RECURRENT URINARY TRACT INFECTIONS IN ADULTS: IS THIS AN INDICATION FOR MICTURATING CYSTOURETHROGRAPHY? Renate Pichler, Eberhard Steiner, Michael Mitterberger, Friedrich Aigner, Andrea Kerschbaumer, Peter Rehder*, Innsbruck, Austria INTRODUCTION AND OBJECTIVES: To determine the role and the positive and negative predictive values (PPV and NPV) of performing a micturating cystourethrography (MCUG) in adults that suffer from recurrent urinary tract infections (UTI’s), i.e. more than 3 proven positive-urine- culture- taken- by- catheter UTI’s per year. METHODS: Between January 2002 and December 2008 a total of 284 patients (273 (96.1%) female, 11 (3.9%) male) with recurrent UTI’s were examined with a MCUG. Predisposing factors were recorded. The patients were divided into 2 groups (68 with and 216 without risk factors for UTI’s) and correlated with the pathologies found in the MCUG. RESULTS: The average age of patients was 36 years. Pathologies were found in 49 (17.3%) patients: vesicoureteral reflux (VUR) (35%), bladder prolapse (26%), bladder diverticula and trabeculation (26%), proximal urethral dilatation (13%) (dysfunctional voiding (8%), urethral diverticula (2%) and urethral stricture (3%)). Risk factors were found in 68 (23.9 %) patients. The presence of risk factors correlated significantly with the occurrence of pathological MCUG findings (42.6% with vs 9.3% without risk factors). Kidney transplant patients (p⬍0.01), patients with recurrent UTI’s during childhood (p⬍0,01) and patients with urogenital anomalies (p⬍0.05) showed a higher incidence of VUR. Patients with recurrent UTI’s during childhood showed a higher tendency towards dysfunctional voiding (p⬍0.01) and patients with stress urinary incontinence to bladder prolapse (p⬍0.01). Age above 50 years was a predictive factor of abnormality at micurating cystourethrography (p⬍0.01). An intrauterine device and ureteropelvic junction stenosis showed no correlation. The PPV in respect to risk factors for recurrent UTI’s was 43 %, the NPV 91 %, the sensitivity 59%, the specifity 84%. CONCLUSIONS: A MCUG is helpful in the examination of patients that suffer from recurrent UTI’s that also have predisposing risk factors identified during patient history. The MCUG seems of no additional value when recurrent UTI’s occur in adults that have no predisposing factors, an age below 50 years and are otherwise healthy. Source of Funding: None
had not been studied, so we examined expression and localization of two cell-surface receptors involved in APC signaling, thrombomodulin (TM) and endothelial protein C receptor (ECPR) in the mouse urothelium during cyclophosphamide (CYP) cystitis. METHODS: Male C57 BL/6 mice (25 g) were treated with CYP (300 mg/kg; i.p.) and bladders were removed and processed, 4 hr, 1 day and 2 days (n⫽6/group) after treatment. Intact mice (n⫽6) were used as controls. TM and EPCR were localized within tissues using standard paraffin immunoperoxidase techniques and confocal microscopy. Bladder homogenates were processed for expression of TM and EPCR by RT-PCR. Data are presented as Mean⫹SEM and analyzed using ANOVA followed by Dunnet’s multiple comparisons. RESULTS: Intact urothelium showed slight, focal immunostaining for TM with significant increases observed at 1 and 2 day after CYP. EPCR immunostaining was slight to moderate in intact urothelium, localized basal and full-thickness and significantly increased 4 hr, 1 day and 2 day after CYP treatment. Confocal microscopy showed CYP treatment elicited increased cell-surface immunostaining of both TM and EPCR. No immunostaining was seen on the luminal cell surface of treated mice although other regions of luminal cells were clearly immunostained. Increased gene expression of TM was seen at 4 hr (8.4 fold) and 1 day (2.8) returning to normal at 2 days. Upregulation of EPCR was observed at 4 hr (43.4 fold) and 1 day (10.5 fold) returning to normal at 2 days. CONCLUSIONS: The major new finding of this study is upregulation of TM and EPCR, cell-surface receptors involved in APC signaling. Localization to urothelial cell-surface indicates a possible role for APC in mediating bladder inflammation. Lack of luminal staining indicates either lack of expression on the luminal surface, or alternatively, receptor turnover from APC binding. The functional role of APC in bladder inflammation is being investigated. Source of Funding: VA Merit Award Program (PLV; KLMS); NIDDK DK075059 (PLV); The Bay Pines Foundation
607 FEMTOSECOND LASER BASED HIGH RESOLUTION OPTICAL COHERENCE TOMOGRAPHY FOR DETECTION OF CYSTITIS CYSTICA IN HUMAN BLADDER - A FEASIBILITY STUDY Joachim Grosse*, Murnau, Germany; Joerg Bornemann, Felix Spo¨ler, Amjad Naami, Ruth Knuchel-Clarke, Gerhard Jakse, Axel Heidenreich, Aachen, Germany INTRODUCTION AND OBJECTIVES: The feasibility of high resolution optical coherence tomography (HR-OCT) as a non-invasive imaging technique was shown in many cases in the past. With image resolutions down to 1 m and imaging depths in the range of 1-3 mm this method has now the potential to classify and distinguish the layers in healthy and morphological altered bladder tissue. The objective of our study is to show the feasibility to detect cystitis cystica in the way of virtual histology. METHODS: An OCT system comprising a Ti:Sapphire femtosecond laser to support a resolution of 3 m axial x 7 m lateral was employed to image 48 fresh human bladder tissue specimens from cystectomies. The OCT tomograms were evaluated double blinded and finally referenced to histological sections using standard HE staining. RESULTS: In greyscaled OCT tomograms cystitis cystica appears as a cavernous dark structure surrounded by more scattering brighter tissue. In 10 histological sections of 48 specimens cystitis cystica could be detected by light microscopy (Tab.1). 9 of these 10 specimens were correctly identified by OCT tomograms before (90 %), one sample was categorized as nonexisting urothelium.
THE JOURNAL OF UROLOGY姞
e239
CONCLUSIONS: HR-OCT is a promising modality for the evaluation of bladder microstructures with the possibility to differentiate cystits cystica from normal and cancerous tissue. This might be helpful for the selection of endoscopic bladder biopsies
Source of Funding: DFG supported, grant no. Kn 263/10-1, Ja 482/5-1, Ku 540/47-2
608 RECURRENT URINARY TRACT INFECTIONS IN ADULTS: IS THIS AN INDICATION FOR MICTURATING CYSTOURETHROGRAPHY? Renate Pichler, Eberhard Steiner, Michael Mitterberger, Friedrich Aigner, Andrea Kerschbaumer, Peter Rehder*, Innsbruck, Austria INTRODUCTION AND OBJECTIVES: To determine the role and the positive and negative predictive values (PPV and NPV) of performing a micturating cystourethrography (MCUG) in adults that suffer from recurrent urinary tract infections (UTI’s), i.e. more than 3 proven positive-urine- culture- taken- by- catheter UTI’s per year. METHODS: Between January 2002 and December 2008 a total of 284 patients (273 (96.1%) female, 11 (3.9%) male) with recurrent UTI’s were examined with a MCUG. Predisposing factors were recorded. The patients were divided into 2 groups (68 with and 216 without risk factors for UTI’s) and correlated with the pathologies found in the MCUG. RESULTS: The average age of patients was 36 years. Pathologies were found in 49 (17.3%) patients: vesicoureteral reflux (VUR) (35%), bladder prolapse (26%), bladder diverticula and trabeculation (26%), proximal urethral dilatation (13%) (dysfunctional voiding (8%), urethral diverticula (2%) and urethral stricture (3%)). Risk factors were found in 68 (23.9 %) patients. The presence of risk factors correlated significantly with the occurrence of pathological MCUG findings (42.6% with vs 9.3% without risk factors). Kidney transplant patients (p⬍0.01), patients with recurrent UTI’s during childhood (p⬍0,01) and patients with urogenital anomalies (p⬍0.05) showed a higher incidence of VUR. Patients with recurrent UTI’s during childhood showed a higher tendency towards dysfunctional voiding (p⬍0.01) and patients with stress urinary incontinence to bladder prolapse (p⬍0.01). Age above 50 years was a predictive factor of abnormality at micurating cystourethrography (p⬍0.01). An intrauterine device and ureteropelvic junction stenosis showed no correlation. The PPV in respect to risk factors for recurrent UTI’s was 43 %, the NPV 91 %, the sensitivity 59%, the specifity 84%. CONCLUSIONS: A MCUG is helpful in the examination of patients that suffer from recurrent UTI’s that also have predisposing risk factors identified during patient history. The MCUG seems of no additional value when recurrent UTI’s occur in adults that have no predisposing factors, an age below 50 years and are otherwise healthy. Source of Funding: None