718 Alternative autoaugmentation techniques in sheep model

716 MIB-I, CELL

BAX AND CARCINOMA

Kallio .I.‘. Hirvikoski Martikainen P.3

BCL-2

EXPRESSION

P.‘, Helin H.‘, Luukkaala

AND

PROGNOSIS

IN RENAL

T.4, Tammela T.‘, Kellokumpu-Lehtinen

P40

PAEDIATRIC UROLOGY Saturday, 27 March, 13.30-15.00,

717

Hall I/ Blue level

AGE AND LEAN BODY WEIGHT RELATED GROWTH CURVES INFANT KIDNEYS USING REAL TIME-THREEDIMENSIONAL ULTRASOUND

OF

Radmavr

J.l

P.5,

C.‘, Lunacek

A.‘;

Schwentner

C.‘, Deibl

M.2, Bartsch

G.3; Oswald

‘Tampere University Hospital, Department of Urology, Tampere; Finland, LOulu University Hospital, Department ofpathology, Oulu, Finland, 3Tampere University Hospital, Department of Pathology, Tampere, Finland, 4Tampere University Hospital, Research Unit, Tampere, Finland, 5Tampere University Hospital, Department of Oncology, Tampere, Finland

‘University of Innsbruck, 2University of Innsbruck, of Innsbruck, Department

INTRODUCTION & OBJECTIVES: The Ki-67 is a traditional proliferation marker. Bcl-2 gene has inhibitory effect on apotosis, while Bax acts to promote cell death. Results of studies of the relationship between bcl-2 proteins and RCC characteristics and survival have been disparate. In our study we explored Ki-67(MIB-I), Bcl-2 and Bax levels and their assoaations with survival in hunours of clinical RCC patients.

INTRODUCTION & OBJECTIVES: Kidney volume and growth are important parameters evaluating and monitoring urologic and renal diseases in infancy and childhood. Until now normal values of kidney size and growth have been based upon two dimensional measurements combined with arithmetic formulas for the ellipsoid. Real-time three-dimensional (RT3D) ultrasound is a relatively new imaging modality using special ultrasound and software allowing threedimensional imaging in real time mode determining the kidney volume with a short time exposure. The objective of this study is to create nomograms of kidney volumes for routine diagnostics in children that could serve as a standard for infant renal growth assessment reducing the need of invasive tests.

MATERIAL & METHODS: Our shady population consisted of 138 consecutive patients who underwent radical nephrectomy for RCC. Clinical stage was assigned using the TNM Classification of Malignant Tumours (UICC 1997). All turnours were classified according to Heidelberg classification and graded according to the Fuhrman system. For the immunostaining of Ki-67(MIB-l), Bax and B&2 routine commercial kits were used. Findmgs were analyzed semi quantitatively: stainings were quantitated by intensity (O-3) and percentage of area1 (or cellular percentage with Ki-67) expression (O-100%) and with multiplying getting a staining score (o-300). Cox regression analysis was used for testing associations with survival. RESULTS: In univariate analysis according to survival statistically significant differences were reached by Bax (positive vs. negative; HR 3.04; 95%CI 1.27.7.23), Bcl-2 (positive vs. negative; HR 0.43: 95%CI 0.23-0.X1), MIB-I (contmuous; HR 1.03; 95%CI l.OOI-1.064), nuclear grade by Fuhrman (grade 4 vs. grades I plus 2; HR 8.15; 95%CI 3.13-21.20) and stage (4 vs.1; HR 60.04; 95%CI 13.99-257.68). Only stage (HR 47.96; 95%CI 10.85-212.03) and Fuhrman classification (HR 4.32; 95%CI 1.60-11.65) reach statistical significance in Cox regression lnultivariate analysis. When Bax and Bcl-2 values were handled as continuous parameters or divided in two classes at median the findings were similar. In cross-tabulation negative Bax values associated with low Fuhrman grades 1 and 2 and negative Bcl-2 values with high Fuhrman grades 3 and 4 (Fisher’s exact test) explaining their dropouts as independent prognostic factors in multivariate analysis. Bax and Bcl-2 -values had no specific associations with stage. MIB-I was not associated with Bax (t-test) or Bcl-2 (Welch’s test). MIB-1 values were associated with Fuhrman (p=O.O25) but not with stage (ANOVA). CONCLUSIONS: According to om results Bax -indexes are positively and Bcl-2-indexes negatively correlated with poor prognosis in RCC. However. in multivariate analysis they do not reach the status of independent prognostic factor. When Bax is considered to act as accelerator and Bcl-2 as inhibitor of apoptosis, this will led to careful conclusion of high apoptotic activity associating to poor prognosis in RCC.

Department of Paediatric Urology, Institute of Biostatistics, Innsbruck, of Urology, Innsbruck, Austria

Innsbruck, Austria, Austria, YJniversity

MATERIAL & METHODS: RT3D ultrasound volumetry of 620 kidneys in 3 10 children ranging from newborns to 10 years with a homogeneous age distribution and without any evidence ofurological or renal disease wascarried out. The RT3D ultrasound was determined with a Voluson 730 (Kretztechnik, GE) system. Polynomial regression analysis was applied for prediction and estimation of growth variables of kidney volumes as a function of either age, body mass index (BMI) or lean body weight (LBW). RESULTS: Kidney volume correlated significantly with age (boys: r2 = 0.682 left kidney, r2 = 0.651 - right kidney; girls: r2 = 0.600 left kidney, r2 = 0.578 right kidney) and LBW (r2 0.732 - left kidney and r2 0.724 - right kidney). Stepwise multiple regression analysis incorporating the independent variables of age, height, weight, sex, BMI and LBW indicated that age and LBW were the strongest predictors of kidney volumes in children. CONCLUSIONS: This study shows that RT3D ultrasound is particularly qualified evaluating kidney volume in infancy. Three-dimensional kidney volumetry is suitable for monitoring renal growth reflecting kidney function which is crucial in the diagnosis and conservative management of renal and genitourinary tract pathologies in children. Furthermore this volumetric sonography is feasible in screening programs assessing congenital urogenital diseases.

718 ALTERNATIVE MODEL

AUTOAUGMENTATION

Burgu B.‘, Keskin S.‘, Ozgencil

TECHNIQUES

IN

SHEEP

719 IMMUNOHISTOCHEMICAL MUSCARINIC RECEPTORS EXSTROPHY

INVESTIGATION IN PATIENTS

OF

THE WITH

M2

AND M3 BLADDER

E.2, Orhan D.3, Senel 0.2, Tekgiil S.’

‘Hacettepe University - Faculty of Medicine, Department of Urology, Ankara, Turkey, 2Anlcarauniversity - Faculty of Veterinary Medicine, Department of Surgery, Ankara, Turkey, 3Hacettepe University - Faculty of Medicine, Department of Surgery, Ankara, Turkey 1NTRODUCTION & OBJECTIVES: Autoaugmentation is considered to be less successful compared to other augmentation techniques, as fibrosis on the bladder wall makes it difficult to maintain the bladder capacity and compliance that had been achxved during the operation. Modified autoaugmentation techniques using an intravesical balloon in sheep model were investigated. Long term success and degree of fibrow on histopathology with different techniques were evaluated. MATERIAL & METHODS: Three different techniques of autoaugmentation covered with omenturn were applied to equally reduced bladders of 12 sheep. Bladder capacities and compliances were noted before and after the reduction. In group I; after the catheterization of ureteral orifices, ten standard longitudinal one cm. long incisions including the mucosa were applied to the bladders of five sheep. A silicon balloon was placed and inflated intravesically to maintain the incisions stay open. Bladders were wrapped with omental flaps. 4 sheep in Group II and 3 in Group III underwent classical autoaugmentation in a standard fashion. Silicon balloon was placed inside the bladder in Croup II and covered with omental flaps, where as no balloon was used for the sheep in group III. Balloons were extracted ten days after the surgery. 3 months later, all animals except one in group I were sacrificed to investigate the histopathology of the bladder after measurement of the bladder capacities and compliance. One animal in group I was sacrificed in 30 days to i?vestigate the early findings.

Makedonsky Children’s

I., Lisogubov Hospital,

V., Usenko

Department

V.

of Paediatric

Urology,

Dnepropetrovsk,

Ukraine

INTRODUCTION & OBJECTIVES: The anatomical, histological and biochemical properties of the exstrophied bladder are poorly understood. In normal urinary bladder detrusor smooth muscle is endowed principally with M2 and M3 muscarinic receptors with the former predominating in number. Muscarinic receptors are also located on the epithelial lining of the bladder. No data known about localization and quantity of M2 and M3 muscarinic receptors in exstrophied bladders. The aim of this work was immunohistochemically detect localization and distribution of M2 and M3 muscarinic receptors in normal bladder and bladder exstrophy patients. MATERIAL & METHODS: Tissue samples were obtained during primary closure from the bladder wall of 8 children with bladder exstrophy, and in a period 1 and 2 years post primary operation. Control biopsies from 6 healthy bladders of an age-compatible group were subjected to the same examination. Indirect immunocytochemistry for muscarinic receptors M2 and M3 was performed on 5-micron paraffin sections. Computing image analysis was used for quantification of distribution and concentration of antigens.

RESULTS: Incisions in early sacrificed animal healed well even after 30 days. The gained bladder capacity was not significant in Group III (144 ml before surgery versus 15 1 ml after surgery). The increase of bladder capacities in Group II and I were significant. Mean bladder capacities before and after the surgery were 151ml and 180 ml in Group I and 157.5 ml and 182.5 ml in Group II respectively. Bladder comphance at leak point capacity in Group III (mean 9.4 ml/cm H20) was significantly lower than Group I (mean 22 ml/cm H20) and II (mean 25.5 ml/cm H20). Mucosea in all groups were intact and viable. In all of the groups but especially in group III sub-epithelial inflammation and fibrosis were observed and quantified as increased compared to other groups.

RESULTS: We found MAchR-M2 and MAchR-M3 in smooth muscles of the detrusor (SMD) and vessels (SMV), epithelium in normal bladders. Exstrophy bladders of the newborn patients had decreased (47 fold) level of MAchR-M2 (P
CONCLUSIONS: Classical autoaugmentation covered omental flap in sheep model does not result with a reliable increase in bladder capacity and compliance. This is due to heavy fibrosis on the bladder wall. Bladder wall enlargement made by incisions induces less fibrosis as vascularisation of the bladder wall is much less impaired. An inflated balloon insertion with any of the two techniques results with a satisfying increase in bladder capacity and compliance.

CONCLUSIONS: Our studies suggest that exstrophied bladders present pathological changes in distribution and quantity of MAch-M2 and MAch - M3 receptors. Primary bladder closure leads to changes of muscarinic receptor presentation even in incontinent bladders. Normalization of muscarinic receptor presentation appears at the age of 2 years.

European

Urology

Supplements

3 (2004)

No. 2, pp. 182