- Email: [email protected]
S121 EVALUATION OF THE VASCULAR ANATOMY IN POTENTIAL LIVING KIDNEY DONORS WITH GADOLINIUM ENHANCED MAGNETIC RESONANCE ANGIOGRAPHY: COMPARISON WITH DIGITAL SUBTRACTION ANGIOGRAPHY AND INTRAOPERATIVE FINDINGS
examination, photographs, and penile USG, before and after therapy. All patients were treated with TEA of the combination of verapamil and dexamethasone. The treatment plan included a total of 20 sessions (at 3-day intervals for a period of 2 months), each with a duration of 20 min. At the end of the study, improvements in penile plaques, penile deviation, pain on erection, and erectile dysfunction were determined. Results: The findings in 41 of the 51 patients were eligible to present. Median patient age was 52 years. Median duration of disease at presentation was 8 months. Remarkable reduction in palpable plaques and in penile angulation was observed in 10 patients (24%) and 11 (26%) patients, respectively. There were significant decreases in median plaque volume from 72 mm(2) to 45 mm(2) (P < 0.001), and in median penile angulation from 25 degrees to 15 degrees (P < 0.001). Impaired sexual activity and pain on erection had completely resolved in 11 (55%) patients and in 16 (80%), respectively. Conclusions: The results of our study have shown that TEA of the combination of verapamil and dexamethasone is a more effective therapy for improving subjective symptoms rather than objective symptoms. Therefore, we think that this treatment can be individualized according to the clinical features of PD patients.
S120
Prevalence of erectile dysfunction in hyperthyroid patients: A cross-sectional study
Rezaeidanesh M., Shahnazari A., Rasouli M.R., Nikoobakht M.R. Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Introduction & Objectives: There are evidences that suggest erectile dysfunction (ED) is more frequent in patients with thyroid disorder. However, this association has not been fully supported by large studies. The aim of our study was to determine the prevalence of ED in hyperthyroid males. Material & Methods: In a cross-sectional study, hyperthyroid patients who had been presented to two endocrine clinics were evaluated regarding the presence of ED. Main Outcome Measures. Prevalence of ED which determined using the international index of erectile function (IIEF-5). Results: A total of 65 patients with documented hyperthyroidism with mean age of 44. 9 ± 17.3 years were included. The mean IIEF scores was 20.2 and respectively 4 (6.2%), 3 (4.6%), 9 (13.8%) and 9 (13.8%) cases had severe, moderate, mild to moderate and mild ED. Thus, prevalence of ED in hyperthyroid patients was 38.5%. There was no significant difference in prevalence of ED in various treatment groups (P = 0.2). Using a linear regression, there was no significant association between TSH level and ED (P = 0.437). However, there was a significant reverse association between the duration of hyperthyroidism and ED (0.44 constant decline in each month, P< 0.001). Conclusions: The present study revealed that prevalence of ED is considerable in hyperthyroid patients and there is relationship between duration of hyperthyroidism and ED. According to these facts, hyperthyroidism should be considered as one of the causes of ED.
Poster Session 7 BENIGN AND MALIGNANT RENAL DISEASES AND KIDNEY TRANSPLANTATION Friday, 1 October, 15.10-16.50, Poster Room 3
S121
Evaluation of the vascular anatomy in potential living kidney donors with gadolinium enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings
Asgari M.A.1, Dadkhah F.1, Ghadian A.R.1, Razzaghi M.R.2, Noorbala M.H.3, Amini E.1 1 Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran, 2Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran, 3Baqiyatallah Hospital, Baqiyatallah Medical Sciences University, Dept. of Urology, Tehran, Iran Introduction & Objectives: X-ray contrast arteriography has traditionally been used for preoperative evaluation in living kidney donors. Although Magnetic resonance angiography (MRA) offers a noninvasive alternative, has been considered to be less accurate. This study was performed to determine whether MRA in the preoperative investigation of living kidney donors provides sufficient information. Material & Methods: From December 2005 to December 2007, 173 potential live donors were evaluated in this study. Donors performed digital subtraction angiography (DSA) and those with one or more accessory arteries at least on one side recruited for further evaluation with three-dimensional gadolinium enhanced MRA. Results: A total of 30 donors constituted the study population. When compared with DSA as the reference method, MRA detected 20 of 36 renal accessory arteries
Eur Urol Suppl 2010;9(6):588
which indicates a sensitivity of 55.6%. The difference between MRA and DSA in identifying accessory renal arteries was significant (P-Value < 0.001). Considering intraoperative findings as the standard of reference, MRA depicted correctly 4 of 6 (66.7%) accessory arteries on the transplanted kidneys. Conclusions: MRA has the advantage of avoiding exposure to ionizing radiation and is noninvasive. These are important considerations in preoperative evaluation of a generally healthy donor population. However MRA provides suboptimal accuracy in detecting accessory arteries.
S122
The economics of transperitoneal versus retroperitoneal nephrectomies
Ahmad S., Akhter W., Zamora I., Peedikayil A., Gilliland E., Koye B. University Hospital North Tees, Dept. of Urology, Stockton On Tees, United Kingdom Introduction & Objectives: Laparoscopic retroperitoneal nephrectomies have revolutionized the post operative patient management with quicker recovery and early return to work. We present our series of RRN versus ORN from the north east of England which unfortunately is an underprivileged area with high unemployment rates and low per capita income compared to other parts of the country. Material & Methods: We prospectively recorded the data of all nephrectomies performed for malignancies (RCC & TCC) in our unit over a 24 month period. Over all, LRRN=29 (by surgeon A) versus TORN=34 (by surgeon B) were performed. Mean age of 64 (43-86 years) and a male to female ratio of 56:44 % was noted in either groups. All patients were given a questionere regarding there financial situation which they were asked to fill and bring back on there 1st post-op appointment i.e. after 6 weeks. Results: Operative results: Operating time Blood loss Transfusion Hospital stay Major Complications Positive margins
LRRN 130 (75-195) 150 (60-380) 2 (6.8%) 2 (1-7) days 3 (10.3%) 1 (3.4 %)
TORN 120 (70-165) 235 (80-600) 6 (17.6%) 5 (3-16) 6 (17.6%) 1 (2.9 %)
LRRN 11 (9-15) days 6 (20 %) 7 (24 %) 4 (14 %)
TORN 23 (16-36) days 7 (20%) 8 (23 %) 6 (18 %)
Questionere Results: Return to work Unemployed Self employed On state benefits
Conclusions: In the current economic downturn where the population is already under pressure financially, it is the urologists duty to contribute to the society with the aid of minimally invasive techniques to help improve the post-op physical as well as financial recovery of these patients. LRRN = Laparoscopic retroperitoneal radical nephrectomy ORN = Transperitoneal open radical nephrectomy.
S123
Temsirolimus in the treatment of metastatic renal cancer
Vojinov S., Levakov I., Jeremic D., Zivojinov S., Sekulic V., Marusic G. Clinical Center Vojvodina, Dept. of Urology, Novi Sad, Serbia and Montenegro Introduction & Objectives: Renal cell carcinoma aproximatly accounts 4% of all adult malignant diseases. In advanced stages, RCC is most resistant to therapy. The aim of this study is to show results of Temsirolimus (m-tor inhibitor,recommended as a first line treatment in high risk patients ) on metastatic renal cell carcinoma. Material & Methods: Our research has been performed at Department of UrologyClinical center of Vojvodina.We included 19 patient from May 2009 till now. Before patients were included we observed these parameters: laboratory analysis (blood count, biochemistry, proteins, electrolytes,) CT abdomen and lungs. On each control we performed: laboratory analysis, ECHO abdomen every 5th week, lung radiography every 10th week. Doses of 25mg per week was applied, mean follow up was 8.9 months. Results: Generally good tolerance was observed. Six patients were excluded (2 progression of lung metastasis, 2 worsening of general health status, 1 hypoglycemia, 1 abdominal pain, pneumonia, fever), 3 of them died. Survival rate was 81.25%. Overall survival in group of patients treated with Temsirolimus was 10.7 months. Conclusions: Survival rate in patients treated with Temsirolimus was 10.7 months, compared to patients treated with interferon – 7.3 months. Those results indicate that Temsirolimus is a potent m-tor inhibitor, with promising results in treatment of metastatic renal cell carcinoma.
S120
Prevalence of erectile dysfunction in hyperthyroid patients: A cross-sectional study
Rezaeidanesh M., Shahnazari A., Rasouli M.R., Nikoobakht M.R. Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran Introduction & Objectives: There are evidences that suggest erectile dysfunction (ED) is more frequent in patients with thyroid disorder. However, this association has not been fully supported by large studies. The aim of our study was to determine the prevalence of ED in hyperthyroid males. Material & Methods: In a cross-sectional study, hyperthyroid patients who had been presented to two endocrine clinics were evaluated regarding the presence of ED. Main Outcome Measures. Prevalence of ED which determined using the international index of erectile function (IIEF-5). Results: A total of 65 patients with documented hyperthyroidism with mean age of 44. 9 ± 17.3 years were included. The mean IIEF scores was 20.2 and respectively 4 (6.2%), 3 (4.6%), 9 (13.8%) and 9 (13.8%) cases had severe, moderate, mild to moderate and mild ED. Thus, prevalence of ED in hyperthyroid patients was 38.5%. There was no significant difference in prevalence of ED in various treatment groups (P = 0.2). Using a linear regression, there was no significant association between TSH level and ED (P = 0.437). However, there was a significant reverse association between the duration of hyperthyroidism and ED (0.44 constant decline in each month, P< 0.001). Conclusions: The present study revealed that prevalence of ED is considerable in hyperthyroid patients and there is relationship between duration of hyperthyroidism and ED. According to these facts, hyperthyroidism should be considered as one of the causes of ED.
Poster Session 7 BENIGN AND MALIGNANT RENAL DISEASES AND KIDNEY TRANSPLANTATION Friday, 1 October, 15.10-16.50, Poster Room 3
S121
Evaluation of the vascular anatomy in potential living kidney donors with gadolinium enhanced magnetic resonance angiography: comparison with digital subtraction angiography and intraoperative findings
Asgari M.A.1, Dadkhah F.1, Ghadian A.R.1, Razzaghi M.R.2, Noorbala M.H.3, Amini E.1 1 Shahid Modarress Hospital, Shahid Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran, 2Shohada-E-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Dept. of Urology, Tehran, Iran, 3Baqiyatallah Hospital, Baqiyatallah Medical Sciences University, Dept. of Urology, Tehran, Iran Introduction & Objectives: X-ray contrast arteriography has traditionally been used for preoperative evaluation in living kidney donors. Although Magnetic resonance angiography (MRA) offers a noninvasive alternative, has been considered to be less accurate. This study was performed to determine whether MRA in the preoperative investigation of living kidney donors provides sufficient information. Material & Methods: From December 2005 to December 2007, 173 potential live donors were evaluated in this study. Donors performed digital subtraction angiography (DSA) and those with one or more accessory arteries at least on one side recruited for further evaluation with three-dimensional gadolinium enhanced MRA. Results: A total of 30 donors constituted the study population. When compared with DSA as the reference method, MRA detected 20 of 36 renal accessory arteries
Eur Urol Suppl 2010;9(6):588
which indicates a sensitivity of 55.6%. The difference between MRA and DSA in identifying accessory renal arteries was significant (P-Value < 0.001). Considering intraoperative findings as the standard of reference, MRA depicted correctly 4 of 6 (66.7%) accessory arteries on the transplanted kidneys. Conclusions: MRA has the advantage of avoiding exposure to ionizing radiation and is noninvasive. These are important considerations in preoperative evaluation of a generally healthy donor population. However MRA provides suboptimal accuracy in detecting accessory arteries.
S122
The economics of transperitoneal versus retroperitoneal nephrectomies
Ahmad S., Akhter W., Zamora I., Peedikayil A., Gilliland E., Koye B. University Hospital North Tees, Dept. of Urology, Stockton On Tees, United Kingdom Introduction & Objectives: Laparoscopic retroperitoneal nephrectomies have revolutionized the post operative patient management with quicker recovery and early return to work. We present our series of RRN versus ORN from the north east of England which unfortunately is an underprivileged area with high unemployment rates and low per capita income compared to other parts of the country. Material & Methods: We prospectively recorded the data of all nephrectomies performed for malignancies (RCC & TCC) in our unit over a 24 month period. Over all, LRRN=29 (by surgeon A) versus TORN=34 (by surgeon B) were performed. Mean age of 64 (43-86 years) and a male to female ratio of 56:44 % was noted in either groups. All patients were given a questionere regarding there financial situation which they were asked to fill and bring back on there 1st post-op appointment i.e. after 6 weeks. Results: Operative results: Operating time Blood loss Transfusion Hospital stay Major Complications Positive margins
LRRN 130 (75-195) 150 (60-380) 2 (6.8%) 2 (1-7) days 3 (10.3%) 1 (3.4 %)
TORN 120 (70-165) 235 (80-600) 6 (17.6%) 5 (3-16) 6 (17.6%) 1 (2.9 %)
LRRN 11 (9-15) days 6 (20 %) 7 (24 %) 4 (14 %)
TORN 23 (16-36) days 7 (20%) 8 (23 %) 6 (18 %)
Questionere Results: Return to work Unemployed Self employed On state benefits
Conclusions: In the current economic downturn where the population is already under pressure financially, it is the urologists duty to contribute to the society with the aid of minimally invasive techniques to help improve the post-op physical as well as financial recovery of these patients. LRRN = Laparoscopic retroperitoneal radical nephrectomy ORN = Transperitoneal open radical nephrectomy.
S123
Temsirolimus in the treatment of metastatic renal cancer
Vojinov S., Levakov I., Jeremic D., Zivojinov S., Sekulic V., Marusic G. Clinical Center Vojvodina, Dept. of Urology, Novi Sad, Serbia and Montenegro Introduction & Objectives: Renal cell carcinoma aproximatly accounts 4% of all adult malignant diseases. In advanced stages, RCC is most resistant to therapy. The aim of this study is to show results of Temsirolimus (m-tor inhibitor,recommended as a first line treatment in high risk patients ) on metastatic renal cell carcinoma. Material & Methods: Our research has been performed at Department of UrologyClinical center of Vojvodina.We included 19 patient from May 2009 till now. Before patients were included we observed these parameters: laboratory analysis (blood count, biochemistry, proteins, electrolytes,) CT abdomen and lungs. On each control we performed: laboratory analysis, ECHO abdomen every 5th week, lung radiography every 10th week. Doses of 25mg per week was applied, mean follow up was 8.9 months. Results: Generally good tolerance was observed. Six patients were excluded (2 progression of lung metastasis, 2 worsening of general health status, 1 hypoglycemia, 1 abdominal pain, pneumonia, fever), 3 of them died. Survival rate was 81.25%. Overall survival in group of patients treated with Temsirolimus was 10.7 months. Conclusions: Survival rate in patients treated with Temsirolimus was 10.7 months, compared to patients treated with interferon – 7.3 months. Those results indicate that Temsirolimus is a potent m-tor inhibitor, with promising results in treatment of metastatic renal cell carcinoma.