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MP-01.17: New approach in treatment of pelvic chronic pain syndrome (CPPS)
MODERATED POSTER SESSIONS
with the aid of an electrical current via the bladder into the affected tissue. Results: Pollakiuria as well as nocturia and urgency were significantly reduced The same was noted for pain. The rating for the quality of life showed a significant improvement. The bladder capacity increased from a mean of 55,6 (⫾10,5) ml (base value) to a mean of 80,3 (⫾8,5) ml (final value) in Group 1; from a mean of 120,3 (⫾11,2) ml (base value) to a mean of 238,5 (⫾10,5) ml (final value) in Group 2 and from a mean of 215 (⫾7,5) ml(base value) to a mean of 320,3 (⫾10,5) ml (final value) in Group 3. Conclusion: EMDA provides a quicker effect and is well tolerated. We feel that affection on submucosal bladder layer in patients with BPS/IC is an important part of the treatment. Combination with local ulcer ablation and hydrodistention will lead to better results. We feel that patients with predominant pain symptoms and preserved bladder capacity show better results. MP-01.16 The etiology of acute epididymitis Kim K, Jung H, Cho J, Cho S, Lee Y Department of Urology, Hallym University Medical College, Seoul, Korea Objectives: Acute epididymitis is one of the most common etiologies of acute scrotum and especially has clinical significance in children. However, it has only been known that its etiology in children is different in organisms to that in adult. So, we investigated prospectively some organisms supposed to be concerned to the etiology of acute epididymitis through the clinical features and additional laboratory data in children and adults. Materials & Methods: A total of 44 patients with acute epididymitis were enrolled in this study and divided into 2 groups, (1) children group; 21 patients 6 to 14 years (mean age 9.68⫾2.42) and (2) adult group; 23 patients 15 to 78 years (mean age 37⫾17.83). Scrotal Doppler ultrasonogram, microbiological tests of urine for bacteriuria, throat culture for mumps virus, urethral swab for Chlamydia trachomatis, and serologic tests for Chlamydia trachomatis, adenovirus were performed on admission. Results: All 44 patients had scrotal pain and tenderness as well as scrotal swelling except one child. There were epididymal swelling and increased blood flow on all scrotal ultrasonograms except one child without scrotal swelling. Only two patients (9.5%) in children and 6 patients (26.1%) in adults had mild fever over
37.5°C on admission. 2 patients (9.5%) in children and 7 patients (30.4%) in adult had leukocytosis (WBC⬎10⫻103/ml). Pyuria (WBC⬎5/HPF) were found in none of children and 10 patients (43.4%) of adult (p value 0.001). There were positive urine culture in 3 patients of children and one patient of adult. There were chlamydia trachomatis positive in none of children and 10 patients (43.4%) of adult (p value 0.022). Increased adenovirus titers were found only in 9 adult patients (40.9%). Mumps virus tests were all negative in urine and throat of patients. Conclusions: There was no difference in clinical features and sonographical findings of the scrotum between children and adult groups. In adults, there were significantly more pyuria and Chlamydia positive in comparison with children, which suspect the possibility of sexually tansmitted epididymitis. In children, however, bacteriuria, adeno-virus and mumps virus have the least possibility as an etiologic organisms of acute epididymitis. So, in adults, administration of some drugs for sexually transmitted disease has a rationale but in children any antibiotics is not indicated for acute epididymitis.
MP-01.17 New approach in treatment of pelvic chronic pain syndrome (CPPS) Tornero J, Lo ´ pez P, Lo ´ pez-Cubillana P, Go ´ mez G, Pe´rez M Department of Urology, Universitary Hospital Virgen de la Arrixaca, Murcia, Spain Objectives: To evaluate the feasibility, safety and efficacy of intravesical instillation of a new therapeutic tool in patients suffering from chronic pelvic pain syndrome (CPPS). Methods: Between September 2005 and July 2006 we recruited 14 patients (mean age 49, range 26 to 68) who had been diagnosed with CPPS, according to the Nationale Institute of Health criteria, and refractory to previous treatments. All patients had undergone previously evaluation consisting of urine culture, ultrasound, cistoscopy, cytology and urodina´mic study. The intravesical solution consisted of estheroids, local anaesthetic, antibiotic and saline solution. Instilation was administrated following our own protocol (3 times weekly for 1 month and 1 monthly of maintenance 6 months).All patients were asked to mark on a visual analogue scale the intensity of pain; voiding frequency and subjective improvement (with patient global im-
UROLOGY 70 (Supplment 3A), September 2007
provement impression PGI-I) were also evaluated. Results: Pain at baseline with bladder filling and voiding was 6’5 and 6’2 respectively (mean global pain 6’4); at 1 month and 6 months mean filling and voiding pain was 4’5 and 4’1 respectively (mean global pain 4’8 at one month and 3’0 at six months). 75% of the patients showed improvement in the reduction of pain. Voiding frequency at baseline was 22’5 daily. At one and six months, voiding frequency was 16’2 and 13’5 respectively (improvement of 29’4%). According to the PGI-I test 30% of patients were much better, 30% moderate improvement, 10% slight improvement and 30% with no changes at 1 month. At 6 months, 15% of patients were much better, 40% moderated improvement, 15% slight improvement and 30% with no changes. None of the patients felt worse than before treatment. Conclusions: Therapeutic results of our intravesical solution traduces in an improvement of pain and voiding frequency reduction with no side-effects. Patients benefit of this improvement in the PGI-I test that reflects an improvement in quality of life. We consider this treatment a second-line approach for CPPS in which gold standard management is still a challenge. MP-01.18 Extracellular beta-nadⴙ increases intracellular free calcium in human detrusor muscle cells and induces relaxation of human detrusor detrusor muscle Bouchelouche K1, Nordling J2, Bouchelouche P1 1 Smooth Muscle Research Center, Koege Hospital, University of Copenhagen; 2Department of Urology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark Introduction: Recent studies have demonstrated that beta-NAD⫹ is a novel nucleotide released from nerve terminals in human detrusor muscle upon stimulation, that it acts on the human P2Y11 purinergic receptors and behaves as a novel proinflammatory cytokine recruiting inflammatory cells. Furthermore, beta-NAD⫹ is the natural substrate of CD38 which catalyzes the conversion of beta-NAD⫹ to cADPR. Beta–NAD⫹ is normally localized inside cells. However, increased concentrations of extracellular beta–NAD⫹ may occur either as a result of local tissue injury, e.g., during inflammation, or released from nerve terminals. During inflamma-
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with the aid of an electrical current via the bladder into the affected tissue. Results: Pollakiuria as well as nocturia and urgency were significantly reduced The same was noted for pain. The rating for the quality of life showed a significant improvement. The bladder capacity increased from a mean of 55,6 (⫾10,5) ml (base value) to a mean of 80,3 (⫾8,5) ml (final value) in Group 1; from a mean of 120,3 (⫾11,2) ml (base value) to a mean of 238,5 (⫾10,5) ml (final value) in Group 2 and from a mean of 215 (⫾7,5) ml(base value) to a mean of 320,3 (⫾10,5) ml (final value) in Group 3. Conclusion: EMDA provides a quicker effect and is well tolerated. We feel that affection on submucosal bladder layer in patients with BPS/IC is an important part of the treatment. Combination with local ulcer ablation and hydrodistention will lead to better results. We feel that patients with predominant pain symptoms and preserved bladder capacity show better results. MP-01.16 The etiology of acute epididymitis Kim K, Jung H, Cho J, Cho S, Lee Y Department of Urology, Hallym University Medical College, Seoul, Korea Objectives: Acute epididymitis is one of the most common etiologies of acute scrotum and especially has clinical significance in children. However, it has only been known that its etiology in children is different in organisms to that in adult. So, we investigated prospectively some organisms supposed to be concerned to the etiology of acute epididymitis through the clinical features and additional laboratory data in children and adults. Materials & Methods: A total of 44 patients with acute epididymitis were enrolled in this study and divided into 2 groups, (1) children group; 21 patients 6 to 14 years (mean age 9.68⫾2.42) and (2) adult group; 23 patients 15 to 78 years (mean age 37⫾17.83). Scrotal Doppler ultrasonogram, microbiological tests of urine for bacteriuria, throat culture for mumps virus, urethral swab for Chlamydia trachomatis, and serologic tests for Chlamydia trachomatis, adenovirus were performed on admission. Results: All 44 patients had scrotal pain and tenderness as well as scrotal swelling except one child. There were epididymal swelling and increased blood flow on all scrotal ultrasonograms except one child without scrotal swelling. Only two patients (9.5%) in children and 6 patients (26.1%) in adults had mild fever over
37.5°C on admission. 2 patients (9.5%) in children and 7 patients (30.4%) in adult had leukocytosis (WBC⬎10⫻103/ml). Pyuria (WBC⬎5/HPF) were found in none of children and 10 patients (43.4%) of adult (p value 0.001). There were positive urine culture in 3 patients of children and one patient of adult. There were chlamydia trachomatis positive in none of children and 10 patients (43.4%) of adult (p value 0.022). Increased adenovirus titers were found only in 9 adult patients (40.9%). Mumps virus tests were all negative in urine and throat of patients. Conclusions: There was no difference in clinical features and sonographical findings of the scrotum between children and adult groups. In adults, there were significantly more pyuria and Chlamydia positive in comparison with children, which suspect the possibility of sexually tansmitted epididymitis. In children, however, bacteriuria, adeno-virus and mumps virus have the least possibility as an etiologic organisms of acute epididymitis. So, in adults, administration of some drugs for sexually transmitted disease has a rationale but in children any antibiotics is not indicated for acute epididymitis.
MP-01.17 New approach in treatment of pelvic chronic pain syndrome (CPPS) Tornero J, Lo ´ pez P, Lo ´ pez-Cubillana P, Go ´ mez G, Pe´rez M Department of Urology, Universitary Hospital Virgen de la Arrixaca, Murcia, Spain Objectives: To evaluate the feasibility, safety and efficacy of intravesical instillation of a new therapeutic tool in patients suffering from chronic pelvic pain syndrome (CPPS). Methods: Between September 2005 and July 2006 we recruited 14 patients (mean age 49, range 26 to 68) who had been diagnosed with CPPS, according to the Nationale Institute of Health criteria, and refractory to previous treatments. All patients had undergone previously evaluation consisting of urine culture, ultrasound, cistoscopy, cytology and urodina´mic study. The intravesical solution consisted of estheroids, local anaesthetic, antibiotic and saline solution. Instilation was administrated following our own protocol (3 times weekly for 1 month and 1 monthly of maintenance 6 months).All patients were asked to mark on a visual analogue scale the intensity of pain; voiding frequency and subjective improvement (with patient global im-
UROLOGY 70 (Supplment 3A), September 2007
provement impression PGI-I) were also evaluated. Results: Pain at baseline with bladder filling and voiding was 6’5 and 6’2 respectively (mean global pain 6’4); at 1 month and 6 months mean filling and voiding pain was 4’5 and 4’1 respectively (mean global pain 4’8 at one month and 3’0 at six months). 75% of the patients showed improvement in the reduction of pain. Voiding frequency at baseline was 22’5 daily. At one and six months, voiding frequency was 16’2 and 13’5 respectively (improvement of 29’4%). According to the PGI-I test 30% of patients were much better, 30% moderate improvement, 10% slight improvement and 30% with no changes at 1 month. At 6 months, 15% of patients were much better, 40% moderated improvement, 15% slight improvement and 30% with no changes. None of the patients felt worse than before treatment. Conclusions: Therapeutic results of our intravesical solution traduces in an improvement of pain and voiding frequency reduction with no side-effects. Patients benefit of this improvement in the PGI-I test that reflects an improvement in quality of life. We consider this treatment a second-line approach for CPPS in which gold standard management is still a challenge. MP-01.18 Extracellular beta-nadⴙ increases intracellular free calcium in human detrusor muscle cells and induces relaxation of human detrusor detrusor muscle Bouchelouche K1, Nordling J2, Bouchelouche P1 1 Smooth Muscle Research Center, Koege Hospital, University of Copenhagen; 2Department of Urology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark Introduction: Recent studies have demonstrated that beta-NAD⫹ is a novel nucleotide released from nerve terminals in human detrusor muscle upon stimulation, that it acts on the human P2Y11 purinergic receptors and behaves as a novel proinflammatory cytokine recruiting inflammatory cells. Furthermore, beta-NAD⫹ is the natural substrate of CD38 which catalyzes the conversion of beta-NAD⫹ to cADPR. Beta–NAD⫹ is normally localized inside cells. However, increased concentrations of extracellular beta–NAD⫹ may occur either as a result of local tissue injury, e.g., during inflammation, or released from nerve terminals. During inflamma-
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