946 URETEROSIGMOIDOSTOMY IN BLADDER EXSTROPHY - HIGH RISK FOR SECONDARY MALIGNANCIES IN A BENIGN DISEASE

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Diagonal tubularization of Monti ileum/sigmoid fragment for the construction of continent urinary stoma Skobejko-Wlodarska L.

Introduction & Objectives: Evaluating the usefulness of own method of continent urinary stoma construction and its use in patients with problems or inability to learn CIC via urethra. Material & Methods: Construction of continent urinary stoma was performed in 92 patients with neuropathic bladder, which was due to congenital malformation of Central Nervous System and spinal trauma. In order to construct the continent stoma, different materials such as appendix, ileum or sigmoid segments and ureter were used. In 26 out of 92 patients qualified for continent urinary stoma construction, own method of continent stoma creation was applied. In 21 of them appendix was used to construct continent appendicocaecostomy and in other 5 patients the approach to appendix was impossible due to adhesions after insertion of ventriculo peritoneal shunt or high position of caecum. Results: Patients’ follow-up ranged from 1 year to over 4 years. The complications were observed in 5 patients, in whom own method of continent urinary stoma construction was applied and included: 1 stomal stenosis within the skin, 2 stomal incontinence and 2 stomal angulation. Conclusions: The described method is one of the simplest ways to construct the continent urinary stoma, especially in a situation when the appendix cannot be used to create the stoma. The method is helpful in obese patients or in patients with bone deformities because it enables to create longer tunnel of continent stoma in case of long distance between bladder and place of stoma.



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Retroperitoneal Neuroblastoma - Single Institution Experience with 90 cases Stein R., Schröder A., Wiemer I., Trabold G., Thüroff J. Johannes Gutenberg University of Mainz, Department of Urology, Mainz, Germany

Introduction & Objectives: Nowadays many neuroblastomas are detected incidentally by ultrasound in early stages and young patient age. Primary surgery with complete resection of the tumor, chemotherapy and/or radiontherapy are treatment options. However, the approach in baby’s with neuroblastoma is controversial, a surveillance strategy is propagated by some groups. In this retrospective study, we evaluated age and stage of disease at diagnosis, therapy and outcome of patients treated at our institutions since 1970, with a minimal follow-up of 3 years. Material & Methods: Until 2002, 90 patients with retroperitoneal neuroblastomas were treated at our institutions. The cases were reviewed for stage of disease, therapy and outcome. The patients were divided into two groups according to age: A (<1 year), B (>1year). Results: At the time of diagnosis 40/90 patients were < 1 year of age (A), (21 < 3 months). 50 patients were > 1 year of age (B) (1-18 years). In 12 patients (30%) of group A, and in 5/50 patients (10%) in group B, an asymptomatic tumor was incidentally detected by ultrasound. The remaining patients had symptoms like abdominal pain, palpable mass, and others. Group A 4 4 17

Group B 3 2 10

Tab. 1: One patient in each group could not be classified adequately. Therapy Resection alone Resection + chemo Resection + radio-chemo Chemo alone Radiochemo alone

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Ureterosigmoidostomy in Bladder Exstrophy - High Risk for Secondary Malignancies in a Benign Disease Schröder A., Stein R., Thüroff J.W. Johannes Gutenberg - University, Department of Urology, Mainz, Germany

Children’s Memorial Health Institute, Paediatric Urology, Warsaw, Poland

Tumor stage at diagnosis: Stage I Stage II Stage III



Group A 13 11 5 8 3

Group B 4 14 12 10 10

Tab. 2: In 5/40 patients in group A, chemotherapy was started immediately because of life threatening symptoms due to huge tumor size. Group A: 30/40 patients (75%) had no evidence of disease after therapy, in 5/40 patients (12.5%) tumor recurrence was successfully treated by chemotherapy. 2/40 children (5%) in group A died of disease, 2 have residual tumor and 1 is lost to follow-up. Group B: 15/50 patients (30%) have no evidence of disease after therapy, 33/50 patients (66%) died, 8 of which more than 2 years after diagnosis and 2 patients (4%) have residual tumor. Conclusions: In patients with neuroblastoma, early detection by ultrasound at a younger age and lower stage of disease compared to detection by clinical symptoms, improves the prognosis. For babies the prognosis is good, even in advanced stages requiring aggressive therapy. Due to the large size of most high stage tumors, expectant management seems to be not justified. Patients older than 1 year with a stage III-IV disease have a poor prognosis despite aggressive treatment.

Introduction & Objectives: Ureterosigmoidostomy was used until 1991 at our institution for urinary diversion in patients with bladder exstrophy and incontinent epispadias. Today, closure of suitable bladder plates or urinary diversion by a recto-sigmoid-pouch are our treatment options. However, patients who received a ureterosigoidostomy 15 to 38 years ago are still under surveillance. We annually reevaluate their current status and their risk for secondary malignancies. Material & Methods: From 1968 - 1991, ureterosigmoidostomy was performed in 42 patients with bladder extrophy with a mean age at surgery of 5 years (range 0.5 – 22 years). In 31 patients, primary urinary diversion was performed and, in 11 patients as a secondary procedure after failed primary treatment. Five patients were lost to follow-up. Results: Over a mean follow-up of 26 years (range 12 – 38 years), 6 out of 37 patients died, 2 from sigmoid cancer (5%), which occurred 24 and 31 years after surgery. The other 4 patients died from causes unrelated to the procedure. Four patients (11%) developed adenomas of the sigmoid colon after a mean of 16 years (range 14 – 26 years), which were removed endoscopically in 3, and surgically excised in one. Two more patients developed a sigmoid carcinoma 30 and 38 years after surgery, respectively. Both patients underwent conversion, one patient received a rectosigmoid-pouch, the other an ileal conduit. Stenosis of the ureteral implantation occurred in 9/37 patients (24%). In 4 patients, stenosis occurred within the first 6 postoperative months, in the remainder 5 within the first 4 years. Conversion into a different urinary diversion was performed in 10 patients. Three were performed because of ureteral stenosis, 2 because of incontinence, one because of recurrent pyelonephritis, 3 due to sigmoid cancer, and one due to development of an adenoma of the sigmoid colon. 4 received a colon conduit, 2 an ileocecal continent cutaneous diversion, 2 an ileal conduit, and 2 a rectosigmoid pouch. Conclusions: Complications of the upper urinary tract occurred within the early years after surgery. Conversion was performed in 10/37 of the patients for ureteral stenosis (4), incontinence (2), pyeloneprhitis (1), and tumor development (3). The risk of secondary tumor development appears to be as high as 19%, in 11% the tumor was malignant. Annual life-long follow-up endoscopy is crucial in order to detect benign tumors before malignancy develops.

P54 SEXUAL DYSFUNCTION: MALE AND FEMALE 2 Friday, 23 March, 14.00-15.30, Room 15B

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Sexual aspirations and unmet needs of men and women worldwide: initial findings of the Global Better Sex Study Mulhall J.P.1, King R.2, Glina S.3, Hvidsten K.4

Weill Medical College of Cornell University, Department of Urology, New York, United States of America, 2Sydney Centre for Sex and Relationship Therapy, Middle Cove, Australia, 3Instituto H. Ellis, São Paulo, Brazil, 4Pfizer, Inc, São Paulo, New York, United States of America 1

Introduction & Objectives: The Global Better Sex Study (GBSS) was an epidemiologic survey that explored the sexual aspirations and unmet needs of >12,500 men and women in 27 countries throughout the world. Material & Methods: The GBSS was conducted in 2005 in the Americas (Brazil, Canada, Mexico, US), Asia (Hong Kong, Indonesia, Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand), Oceania (Australia), Europe (France, Germany, Italy, Spain, Switzerland, Turkey, UK), the Middle East (Israel, Kuwait, Lebanon, UAE), and Africa (Egypt, Morocco, South Africa) by phone, door-todoor, and street intercept interview. Respondents must have had sexual intercourse at least once in the past 12 months; female respondents were required to have had heterosexual intercourse. Demographic data were weighted by populations to ensure that samples were representative of countries. Results: Of the 12,563 respondents (6291 men, 6272 women), approximately half were ≤40 years, 41% were 40-59 years, and 11% were ≥60 years; 91% of men and 94% of women were married, living with a partner, or in a relationship. All aspects of sex (ie, attraction to partner, foreplay, intercourse, ability to achieve orgasm) were important to most respondents (≥88%). Almost all men (91%) and women (90%) indicated that a man’s confidence in his sexual ability and giving their partner pleasure (97% of men and 94% of women) is critical to having a good love relationship. However, only 51% of men who have not taken a prescription medication for erectile dysfunction (ED) in the past 4 weeks (n=5761) reported being able to always get and maintain an erection good enough for sex. Only 43% of men and 42% of women included in the survey were very satisfied with their sex life. 30% of men and 17% of women were highly or very highly interested in improving their sexual experience. Getting and maintaining a hard erection was considered very important for a good sexual experience by approximately two thirds of men and one half of women. Satisfaction with erection hardness was associated with satisfaction with sex life, love/romance, and overall health among responders who have had sex within the past 4 weeks. 74% of men who have not taken a prescription ED medication within the past 4 weeks would do so if they thought they had ED, and 64% of women would support such a decision. More than 75% of men who had taken an ED medication indicated that such treatment improved the hardness, reliability, and duration of their erections, and their ability to satisfy their partners. Conclusions: Sex is very important to men and women worldwide; however, a substantial proportion of men and women are not fully satisfied with their sex lives. The GBSS shows the desire and willingness among men and women to improve their sex lives.

Eur Urol Suppl 2007;6(2):259